SEO PLR Content Directory Georgia

Tuesday, 13 March 2012

Glucagon Emergency Kit

Generic Name: glucagon (Injection route)

GLOO-ka-gon

Commonly used brand name(s)

In the U.S.

Glucagen

Glucagen Diagnostic Kit

Glucagon

Glucagon Diagnostic Kit

Glucagon Emergency Kit

Available Dosage Forms:

Powder for Solution

Therapeutic Class: Glucose Regulation, Antihypoglycemic

Uses For Glucagon Emergency Kit

Glucagon belongs to the group of medicines called hormones. It is an emergency medicine used to treat severe hypoglycemia (low blood sugar) in patients with diabetes who have passed out or cannot take some form of sugar by mouth.

Glucagon is also used during x-ray tests of the stomach and bowels to improve test results by relaxing the muscles of the stomach and bowels. This also makes the testing more comfortable for the patient.

Glucagon also may be used for other conditions as determined by your doctor.

Glucagon is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, glucagon is used in certain patients with the following medical conditions or undergoing certain medical procedures:

Overdose of beta-adrenergic blocking medicines

Overdose of calcium channel blocking medicines

Removing food or an object stuck in the esophagus

Hysterosalpingography (x-ray examination of the uterus and fallopian tubes)

Before Using Glucagon Emergency Kit

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

Allergies

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

Pediatric

This medicine has been tested in children and, in effective doses, has not been shown to cause different side effects or problems than it does in adults.

Geriatric

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

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acenocoumarol

Anisindione

Dicumarol

Phenindione

Phenprocoumon

Warfarin

Interactions with Food/Tobacco/Alcohol

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

Proper Use of glucagon

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

Glucagon is an emergency medicine and must be used only as directed by your doctor. Make sure that you and a member of your family or a friend understand exactly when and how to use this medicine before it is needed .

Glucagon is packaged in a kit with a vial of powder containing the medicine and a syringe filled with liquid to mix with the medicine. Directions for mixing and injecting the medicine are in the package. Read the directions carefully and ask your health care professional for additional explanation, if necessary.

Glucagon should not be mixed after the expiration date printed on the kit and on one vial. Check the date regularly and replace the medicine before it expires. The printed expiration date does not apply after mixing, when any unused portion must be discarded.

Dosing

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

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

As an emergency treatment for hypoglycemia:
- Adults and children weighing 20 kilograms (kg) (44 pounds) or more: 1 milligram (mg). The dose may be repeated after fifteen minutes if necessary.
- Children weighing up to 20 kg (44 pounds): 0.5 mg or 20 to 30 micrograms (mcg) per kg (9.1 to 13.6 mcg per pound) of body weight. The dose may be repeated after fifteen minutes if necessary.

Storage

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

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Glucagon Emergency Kit

Patients with diabetes should be aware of the symptoms of hypoglycemia (low blood sugar). These symptoms may develop in a very short time and may result from:

using too much insulin (“insulin reaction”) or as a side effect from oral antidiabetic medicines.

delaying or missing a scheduled snack or meal.

sickness (especially with vomiting or diarrhea).

exercising more than usual.

Unless corrected, hypoglycemia will lead to unconsciousness, convulsions (seizures), and possibly death. Early symptoms of hypoglycemia include: anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.

Symptoms of hypoglycemia can differ from person to person. It is important that you learn your own signs of low blood sugar so that you can treat it quickly. It is a good idea also to check your blood sugar to confirm that it is low.

You should know what to do if symptoms of low blood sugar occur. Eating or drinking something containing sugar when symptoms of low blood sugar first appear will usually prevent them from getting worse, and will probably make the use of glucagon unnecessary. Good sources of sugar include glucose tablets or gel, corn syrup, honey, sugar cubes or table sugar (dissolved in water), fruit juice, or nondiet soft drinks. If a meal is not scheduled soon (1 hour or less), you should also eat a light snack, such as crackers and cheese or half a sandwich or drink a glass of milk to keep your blood sugar from going down again. You should not eat hard candy or mints because the sugar will not get into your blood stream quickly enough. You also should not eat foods high in fat such as chocolate because the fat slows down the sugar entering the blood stream. After 10 to 20 minutes, check your blood sugar again to make sure it is not still too low.

Tell someone to take you to your doctor or to a hospital right away if the symptoms do not improve after eating or drinking a sweet food. Do not try to drive yourself.

If severe symptoms such as convulsions (seizures) or unconsciousness occur, the patient with diabetes should not be given anything to eat or drink. There is a chance that he or she could choke from not swallowing correctly. Glucagon should be administered and the patient's doctor should be called at once.

If it becomes necessary to inject glucagon, a family member or friend should know the following:

After the injection, turn the patient on his or her left side. Glucagon may cause some patients to vomit and this position will reduce the possibility of choking.

The patient should become conscious in less than 15 minutes after glucagon is injected, but if not, a second dose may be given. Get the patient to a doctor or to hospital emergency care as soon as possible because being unconscious too long can be harmful.

When the patient is conscious and can swallow, give him or her some form of sugar. Glucagon is not effective for much longer than 1½ hours and is used only until the patient is able to swallow. Fruit juice, corn syrup, honey, and sugar cubes or table sugar (dissolved in water) all work quickly. Then, if a snack or meal is not scheduled for an hour or more, the patient should also eat some crackers and cheese or half a sandwich, or drink a glass of milk. This will prevent hypoglycemia from occurring again before the next meal or snack.

The patient or caregiver should continue to monitor the patient's blood sugar. For about 3 to 4 hours after the patient regains consciousness, the blood sugar should be checked every hour.

If nausea and vomiting prevent the patient from swallowing some form of sugar for an hour after glucagon is given, medical help should be obtained.

Keep your doctor informed of any hypoglycemic episodes or use of glucagon even if the symptoms are successfully controlled and there seem to be no continuing problems. Complete information is necessary for the doctor to provide the best possible treatment of any condition.

Replace your supply of glucagon as soon as possible, in case another hypoglycemic episode occurs.

You should wear a medical identification (I.D.) bracelet or chain at all times. In addition, you should carry an I.D. card that lists your medical condition and medicines.

Glucagon Emergency Kit Side Effects

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

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

Less common

Dizziness

lightheadedness

trouble in breathing

Symptoms of overdose

Diarrhea

irregular heartbeat

loss of appetite

muscle cramps or pain

nausea (continuing)

vomiting (continuing)

weakness of arms, legs, and trunk (severe)

Check with your doctor as soon as possible if any of the following side effects occur:

Less common

Skin rash

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

Less common or rare

Fast heartbeat

nausea

vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Glucagon Emergency side effects (in more detail)

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

More Glucagon Emergency Kit resources

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

Compare Glucagon Emergency Kit with other medications

Diagnosis and Investigation
Hypoglycemia

Monday, 12 March 2012

Vivotif Berna Vaccine Delayed-Release Capsules

Pronunciation: TIE-foyd
Generic Name: Typhoid Vaccine Live
Brand Name: Vivotif Berna Vaccine

Vivotif Berna Vaccine Delayed-Release Capsules are used for:

Preventing typhoid fever in persons 6 years old 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).

Vivotif Berna Vaccine Delayed-Release Capsules are a vaccine. It works by stimulating the body to produce antibodies against typhoid fever.

Do NOT use Vivotif Berna Vaccine Delayed-Release Capsules if:

you are allergic to any ingredient in Vivotif Berna Vaccine Delayed-Release Capsules

you have a current infection, cancer, fever, persistent vomiting or diarrhea, other stomach illness, or HIV or another condition that weakens the immune system

you are taking a sulfonamide (eg, sulfamethoxazole), another antibiotic (eg, penicillin), or a medicine that weakens the immune system (eg, cyclosporine, certain cancer medicines)

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

Before using Vivotif Berna Vaccine Delayed-Release Capsules:

Some medical conditions may interact with Vivotif Berna Vaccine Delayed-Release Capsules. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

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

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

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

if you have an infection or fever, chronic diarrhea, an illness affecting the stomach or intestines, undiagnosed rectal hemorrhage, or persistent vomiting, or you are receiving chemotherapy or radiation therapy

Some MEDICINES MAY INTERACT with Vivotif Berna Vaccine Delayed-Release Capsules. Tell your health care provider if you are taking any other medicines, especially any of the following:

Antibiotics (eg, penicillin), corticosteroids (eg, prednisone), immunosuppressants (eg, certain cancer medicines, cyclosporine), or sulfonamides (eg, sulfamethoxazole) because they may decrease Vivotif Berna Vaccine Delayed-Release Capsules's effectiveness

Proguanil because it may decrease Vivotif Berna Vaccine Delayed-Release Capsules's effectiveness. You should not take proguanil for at least 10 days after your last dose of Vivotif Berna Vaccine Delayed-Release Capsules. Discuss any questions with your doctor

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

How to use Vivotif Berna Vaccine Delayed-Release Capsules:

Use Vivotif Berna Vaccine Delayed-Release Capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Vivotif Berna Vaccine Delayed-Release Capsules with a cold or lukewarm drink 1 hour before or 2 hours after a meal.

Swallow Vivotif Berna Vaccine Delayed-Release Capsules whole. Do not break, crush, or chew before swallowing.

Do not take cracked or broken capsules.

Do not drink alcohol within 2 hours of taking Vivotif Berna Vaccine Delayed-Release Capsules.

Do not forget to skip a day between capsules. Take a capsule EVERY OTHER DAY as directed by your doctor.

For Vivotif Berna Vaccine Delayed-Release Capsules to be effective, you must complete all 4 doses at least 1 week before exposure to typhoid fever.

If you miss a dose of Vivotif Berna Vaccine Delayed-Release Capsules, take it as soon as possible. If you do not remember until the next day, take the dose as soon as possible and reschedule your doses from that day.

Ask your health care provider any questions you may have about how to use Vivotif Berna Vaccine Delayed-Release Capsules.

Important safety information:

Notify your doctor if you experience diarrhea, vomiting, or flu-like symptoms after taking Vivotif Berna Vaccine Delayed-Release Capsules.

This vaccine helps prevent typhoid fever, but does not provide 100% protection. It is important to also avoid infected people, food, and water.

It is recommended that you receive another 4 doses of Vivotif Berna Vaccine Delayed-Release Capsules every 5 years if you continue to be exposed to typhoid fever.

Vivotif Berna Vaccine Delayed-Release Capsules are not recommended for use in CHILDREN younger than 6 years of age; 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 Vivotif Berna Vaccine Delayed-Release Capsules during pregnancy. It is not known if Vivotif Berna Vaccine Delayed-Release Capsules are found in breast milk. If you are or will be breast-feeding while you use Vivotif Berna Vaccine Delayed-Release Capsules, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Vivotif Berna Vaccine Delayed-Release Capsules:

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

Diarrhea; fever; headache; muscle pain; nausea; stomach cramps or pain; vomiting.

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

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

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: Vivotif Berna 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 Vivotif Berna Vaccine Delayed-Release Capsules:

Store Vivotif Berna Vaccine Delayed-Release Capsules in the refrigerator, between 36 and 46 degrees F (2 and 8 degrees C), at all times. Do not freeze. Keep Vivotif Berna Vaccine Delayed-Release Capsules out of the reach of children and away from pets.

General information:

If you have any questions about Vivotif Berna Vaccine Delayed-Release Capsules, please talk with your doctor, pharmacist, or other health care provider.

Vivotif Berna Vaccine Delayed-Release Capsules 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 Vivotif Berna Vaccine Delayed-Release Capsules. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

More Vivotif Berna Vaccine resources

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

Compare Vivotif Berna Vaccine with other medications

Typhoid Prophylaxis

Thursday, 8 March 2012

Humulin L

Generic Name: insulin zinc (IN suh lin ZINK)

Brand Names: Humulin L, Iletin Lente, Insulin Lente Pork, Novolin L

What is Humulin L (insulin zinc)?

Insulin is a hormone naturally produced by the pancreas. Insulin enables the body to use the sugar in food as a source of energy. When the body does not produce enough insulin, or when the insulin produced by the body is not effective enough, the condition is called diabetes mellitus. This condition allows sugar levels in the blood to become very high. Diabetics must use man-made insulin or insulin that comes from pigs (which is very similar to human insulin) to lower these high blood sugar levels.

Insulin zinc is used is used in the treatment of diabetes mellitus.

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

What is the most important information I should know about Humulin L (insulin zinc)?

Know the signs and symptoms of low blood sugar (hypoglycemia), which include shaking; nausea; headache; drowsiness; weakness; dizziness; fast heartbeat; sweating; pale, cool skin; anxiety; and difficulty concentrating. Carry a piece of candy or glucose tablets with you to treat episodes of low blood sugar.

Follow any diet and exercise plan that you have developed with your doctor or nurse. Changes in what you eat or how much you exercise can change the amount of insulin that you need to control your blood sugar levels.

Ask your doctor or nurse what to do if you are sick with a cold, flu, or fever. These illnesses may change your insulin requirements.

Do not change the brand of insulin zinc or syringe that you are using without first talking to your doctor or pharmacist. Some brands of insulin and syringes are interchangeable, while others are not. Your doctor and/or pharmacist know which brands can be substituted for one another.

What should I discuss with my healthcare provider before using Humulin L (insulin zinc)?

Do not use insulin zinc if you are allergic to insulin or if you have intolerance to a certain insulin zinc product.

Before using insulin, tell your doctor if you have any other medical conditions or if you take other prescription or over-the-counter medications, including vitamins, minerals, and herbal supplements.

Before using insulin zinc, tell your doctor if you have kidney or liver disease. You may require a dosage adjustment or special monitoring during treatment.

Most insulins can be used during pregnancy and breast-feeding. They are not expected to be harmful to an unborn baby. It is very important to control blood sugar levels during pregnancy and breast-feeding and insulin is often chosen as the treatment. Some types of insulin may be better than others for use during pregnancy and breast-feeding. Talk to your doctor about the use of insulin during pregnancy and breast-feeding.

How should I use Humulin L (insulin zinc)?

Use insulin zinc exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, nurse, or pharmacist to explain them to you.

If insulin zinc has been stored in the refrigerator, it can be warmed to room temperature before use. Also, roll it slightly between your hands to be sure that it is mixed. Never shake an insulin zinc suspension vigorously.

If you are mixing different types of insulins in the same syringe, follow your doctor's directions and always draw up the different insulins in the same order (usually the clear insulin first). This may help prevent a dosage error. Do not mix different insulins in the same syringe unless specifically directed to do so by your doctor. Some types of insulins should not be mixed.

Do not use any insulin that is discolored, looks thick, has particles in it, or looks different from previous bottles, cartridges, or pens of insulin zinc.

Change injection sites as directed by your doctor. Usually, you should not inject within 1 inch of the same site within 1 month.

Never reuse a needle or syringe. Dispose of all needles and syringes in an appropriate, puncture-resistant disposal container.

Do not change the insulin strength (e.g., U-100) or insulin type (e.g., zinc, regular, lispro, etc.) unless your doctor recommends a change for you.

Do not change the brand of insulin zinc or syringe that you are using without first talking to your doctor or pharmacist. Some brands of insulin zinc and syringes are interchangeable, while others are not. Your doctor and/or pharmacist know which brands can be substituted for one another.

Ask your doctor or nurse what to do if you are sick with a cold, flu, or fever. These illnesses may change your insulin requirements.

Your healthcare provider may recommend regular monitoring of blood sugar levels with blood or urine tests.

Wear some type of medical identification bracelet, necklace, or other alert tag to inform others that you have diabetes and that you require insulin in the case of an emergency.

Proper foot care, eye care, dental care, and overall proper health care are important for people with diabetes. Visit your doctor, dentist, eye doctor, and other heath care practitioners as recommended by your doctor.

Store unopened vials of insulin zinc the refrigerator between 36 and 46 degrees Fahrenheit (2 and 8 degrees Celsius), in the original carton. Do not store insulin zinc in the freezer and do not allow it to freeze. Do not use insulin zinc if it has been frozen. Throw away any expired insulin zinc. Vials of insulin zinc can be kept unrefrigerated for up to 28 days, but should not be exposed to excessive heat or sunlight.

Once punctured, the insulin vial in use, whether stored in the refrigerator or at room temperature, must be used within 28 days. Throw away any unused insulin 28 days after the vial is first punctured.

What happens if I miss a dose?

Follow your doctor's directions if you miss a dose of insulin. To prevent missed doses, be sure to always have enough insulin on hand, especially if you are going on vacation.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.

Symptoms of an insulin overdose reflect very low blood sugar levels and include headache, irregular heartbeat, increased heart rate or pulse, sweating, tremor, nausea, increased hunger, and anxiety.

What should I avoid while using Humulin L (insulin zinc)?

Do not use alcohol without first talking to your doctor. It lowers blood sugar, and you may experience dangerously low blood sugar levels.

Follow any diet and exercise plan that you have developed with your doctor or nurse. Changes in what you eat or how much you exercise can change the amount of insulin you need to control your blood sugar levels.

Humulin L (insulin zinc) side effects

Rarely, people have allergic reactions to insulin. Seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives).

The side effects of insulin therapy result mostly from blood sugar levels that are either too high or too low. You should be familiar with the symptoms of both high and low blood sugar levels and know how to treat both conditions. Also, be sure your family and close friends know how to help you in an emergency.

Low blood sugar may occur when too much insulin is used; when meals are missed or delayed; if you exercise more than usual; during illness, especially with vomiting or diarrhea; if you take other medications; after drinking alcohol; and in other situations.

Hypoglycemia, or low blood sugar, has the following symptoms: shaking; nausea; headache; drowsiness; weakness; dizziness; fast heartbeat; sweating; pale, cool skin; anxiety; and difficulty concentrating.

Keep sugary candy, fruit juice, or glucose tablets on hand to treat episodes of low blood sugar.

Increased blood sugar may occur if not enough insulin is used, if you eat significantly more food then usual, if you exercise less than usual, if you take other medications, if you have a fever or other illness, and in other situations.

Hyperglycemia, or high blood sugar, has the following symptoms: increased thirst, increased hunger, and increased urination.

Monitor your blood sugar levels and ask your doctor how to adjust your insulin doses if your blood sugar levels are too high.

Side effects may also occur at the site of injection. If the area becomes thickened, hard, or pitted, talk to your doctor before injecting at that site again.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Humulin L (insulin zinc)?

Many drugs can interact with insulin or affect blood sugar levels. Do not take any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, without first talking to your doctor or pharmacist during treatment with insulin.

More Humulin L resources

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

Humulin L Prescribing Information (FDA)

Compare Humulin L with other medications

Diabetes, Type 1
Diabetes, Type 2
Gestational Diabetes

Where can I get more information?

Your pharmacist has additional information about insulin zinc written for health professionals that you may read.

What does my medication look like?

Insulin zinc is available under the brand names Humulin L, Novolin L, Iletin II Lente, and Insulin Lente Pork. The insulin should be a clear, colorless or evenly colored liquid after it is gently rolled or shaken. Do not use it if it appears to be thick, looks sticky, has particles in it, or looks different from previous bottles of insulin that you have had. Always use the same brand unless your doctor approves a change. Ask your pharmacist, nurse, or doctor any questions you have about this medication.

Humulin L-10 mL vials

Novolin L-10 mL vials

Iletin II Lente-10 mL vials

Insulin Lente Pork-10 mL vials

See also: Humulin L side effects (in more detail)

Sunday, 4 March 2012

Sabril

Generic Name: vigabatrin (Oral route)

vye-GA-ba-trin

Oral route(Tablet;Solution)

Vigabatrin causes permanent vision loss which may occur at any time during therapy and the risk increases with total dose and duration of use. Periodic vision testing is required for patients receiving vigabatrin therapy. Vigabatrin should not be used concomitantly with other drugs associated with adverse ophthalmic effects or in patients at high risk for other types of irreversible vision damage. Vigabatrin is only available through a special restricted distribution program .

Commonly used brand name(s)

In the U.S.

Sabril

Available Dosage Forms:

Tablet

Powder for Solution

Powder

Therapeutic Class: Anticonvulsant

Pharmacologic Class: Gamma Aminobutyric Acid Transaminase Inhibitor

Chemical Class: Gamma Aminobutyric Acid (class)

Uses For Sabril

Vigabatrin is used alone or together with other medicines to control certain types of seizures (convulsions) in the treatment of epilepsy. This medicine is used in patients with seizures who have already been treated with other medicines that did not work well.

Vigabatrin is an anticonvulsant. It increases the amount of the chemical called gamma amino butyric acid (GABA) in the brain. It is thought that epileptic seizures are the result of low levels of GABA. By increasing the amount of GABA, vigabatrin reduces the likelihood of an epileptic seizure.

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

Before Using Sabril

Allergies

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of vigabatrin oral solution to treat infantile spasms in children and infants 1 month to 2 years of age.

Appropriate studies have not been performed on the relationship of age to the effects of vigabatrin tablets in children and teenagers younger than 16 years of age with complex partial seizures. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of valproate sodium injection in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require an adjustment in the dose for patients receiving vigabatrin.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Interactions with Medicines

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Carbamazepine

Ketorolac

Naproxen

Fosphenytoin

Ginkgo

Phenytoin

Interactions with Food/Tobacco/Alcohol

Proper Use of Sabril

Take this medicine exactly 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. To do so may increase the chance of side effects.

It is very important that you understand the requirements of the SHARE program, and become familiar with Sabril® Medication Guide. Ask your doctor or pharmacist before starting treatment with vigabatrin.

You may take this medicine with or without food.

To use the oral solution:

Open the packet and empty the contents into an empty cup.

Dissolve it with 10 milliliters (mL) of cold or room temperature water.

Measure the dose with an oral syringe that comes with the package.

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

Dosing

For oral dosage form (solution):
- For infantile spasms:
  - Children and infants 1 month to 2 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 50 milligrams (mg) per kilogram (kg) of body weight per day, given in smaller doses two times a day. Your doctor may adjust the dose as needed up to a maximum dose of 150 mg per kg of body weight per day.
  - Infants up to 1 month—Use and dose must be determined by your doctor.

For oral dosage form (tablets):
- For seizures:
  - Adults—At first, 500 milligrams (mg) two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 3000 mg a day.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

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

Storage

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

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

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

Precautions While Using Sabril

It is very important that your doctor check your or your child's progress at regular visits to allow for changes in the dose and to check for any unwanted effects.

It is important to tell your doctor if you become pregnant. Your doctor may want you to join a pregnancy registry for patients taking a seizure medicine.

This medicine may increase your risk of permanent vision loss. Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. It is very important that your ophthalmologist (eye doctor) check your child's or your eyes approximately every 3 months for any visual problems.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests (e.g., magnetic resonance imaging or MRI).

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor right away.

This medicine may cause some people to become drowsy, sleepy, or weak than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are drowsy or not alert.

Check with your doctor right away if you or your child are having burning, numbness, tingling, or painful sensations in the arms, hands, legs, or feet. These could be symptoms of a condition called peripheral neuropathy.

Tell your doctor if you or your child have increased weight or swelling in the hands, ankles, or feet while taking this medicine.

Do not suddenly stop taking this medicine without checking first with your doctor. Your doctor may want to gradually reduce the amount you are using before stopping it completely. Stopping this medicine suddenly may cause seizures.

Sabril Side Effects

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

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

More common

Blue-yellow color blindness

blurred vision

decreased vision or other vision changes

eye pain

increase in seizures

loss of memory

problems with memory

Less common or rare

Uncontrolled rolling eye movements

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

Symptoms of overdose

Mood or mental changes

More common

Abdominal or stomach pain

abnormal coordination

agitation

anxiety

burning, tingling, or prickly sensations

clumsiness

confusion

constipation

diarrhea

dizziness

double vision or seeing double

drowsiness

increased movement

joint pain

mental depression

restlessness

shakiness

sleepiness or unusual drowsiness

trembling

tremor

trouble sitting still

unsteadiness

Less common

Aggression

headache

increased saliva

muscle weakness

nausea

poor concentration

sleeplessness

speech disorder

thinking abnormal

trouble sleeping

unable to sleep

vomiting

weight gain

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Sabril side effects (in more detail)

More Sabril resources

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

Sabril Prescribing Information (FDA)

Sabril MedFacts Consumer Leaflet (Wolters Kluwer)

Sabril Consumer Overview

Vigabatrin Professional Patient Advice (Wolters Kluwer)

Compare Sabril with other medications

Epilepsy
Seizure Prevention
Seizures

Thursday, 1 March 2012

Phena-Plus

Pronunciation: KLOR-fen-IR-a-meen/FEN-il-EF-rin/pir-IL-a-meen
Generic Name: Chlorpheniramine/Phenylephrine/Pyrilamine
Brand Name: Phena-Plus

Phena-Plus is used for:

Relieving symptoms of sinus congestion, pressure, runny nose, and sneezing due to colds, upper respiratory infections, and allergies. It may also be used for other conditions as determined by your doctor.

Phena-Plus is 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, which relieves congestion and pressure.

Do NOT use Phena-Plus if:

you are allergic to any ingredient in Phena-Plus

you have severe high blood pressure, severe heart blood vessel disease, rapid heartbeat, or severe heart problems

you are unable to urinate or are having an asthma attack

you take droxidopa, sodium oxybate (GHB), or if you have taken furazolidone or a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days

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

Before using Phena-Plus:

Some medical conditions may interact with Phena-Plus. 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 history of adrenal gland problems (eg, adrenal gland tumor); heart problems (eg, cor pulmonale; fast, slow, or irregular heartbeat; heart disease); high blood pressure; diabetes; blood vessel problems; stroke; glaucoma or increased pressure in the eye; seizures; or thyroid problems

if you have a history of asthma or other breathing problems, chronic cough, lung problems (eg, chronic bronchitis, emphysema), chronic obstructive pulmonary disease (COPD), or sleep apnea

if you have a blockage of your bladder, stomach, or bowels; ulcers; trouble sleeping; trouble urinating; an enlarged prostate or other prostate problems

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

Digoxin or droxidopa because the risk of irregular heartbeat or heart attack may be increased

Beta-blockers (eg, propranolol), catechol-O-methyltransferase (COMT) inhibitors (eg, tolcapone), furazolidone, indomethacin, linezolid, MAOIs (eg, phenelzine), sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Phena-Plus's side effects

Bromocriptine or hydantoins (eg, phenytoin) because the risk of their side effects may be increased by Phena-Plus

Guanadrel, guanethidine, mecamylamine, methyldopa, or reserpine because their effectiveness may be decreased by Phena-Plus

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

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

Take Phena-Plus by mouth with or without food.

If you miss a dose of Phena-Plus and you are taking 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 Phena-Plus.

Important safety information:

Phena-Plus may cause dizziness, drowsiness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Phena-Plus with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

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

Do not take diet or appetite control medicines while you are taking Phena-Plus without checking with your doctor.

Before you start any new medicine, check the label to see if it has a decongestant or antihistamine in it too. If it does or if you are not sure, check with your doctor or pharmacist.

Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.

If your symptoms do not get better within 5 to 7 days or if they get worse, check with your doctor.

Phena-Plus may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Phena-Plus. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.

Phena-Plus may interfere with skin allergy tests. If you are scheduled for a skin test, talk to your doctor. You may need to stop taking Phena-Plus for a few days before the tests.

Tell your doctor or dentist that you take Phena-Plus before you receive any medical or dental care, emergency care, or surgery.

Use Phena-Plus with caution in the ELDERLY; they may be more sensitive to its effects, especially confusion, dizziness, drowsiness, dry mouth, excitability, low blood pressure, and trouble urinating.

Caution is advised when using Phena-Plus in CHILDREN; they may be more sensitive to its effects, especially excitability.

PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Phena-Plus while you are pregnant. Phena-Plus may be found in breast milk. Do not breast-feed while taking Phena-Plus.

Possible side effects of Phena-Plus:

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:

Constipation; diarrhea; dizziness; drowsiness; dry mouth, nose, or throat; excitability; headache; loss of appetite; nausea; nervousness or anxiety; trouble sleeping; upset stomach; vomiting; weakness.

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); blurred vision or other vision changes; confusion; difficulty urinating or inability to urinate; fast or irregular heartbeat; fever, chills, or persistent sore throat; hallucinations; mood or mental changes; persistent trouble sleeping; restlessness; seizures; severe dizziness, drowsiness, lightheadedness, or headache; tremor.

See also: Phena-Plus 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 blurred vision; confusion; hallucinations; ringing in the ears; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; unusually fast, slow, or irregular breathing; unusually fast, slow, or irregular heartbeat; vomiting.

Proper storage of Phena-Plus:

Store Phena-Plus at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Phena-Plus out of the reach of children and away from pets.

General information:

If you have any questions about Phena-Plus, please talk with your doctor, pharmacist, or other health care provider.

Phena-Plus 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 Phena-Plus. 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

More Phena-Plus resources

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

Phena-Plus Concise Consumer Information (Cerner Multum)

Poly Hist PD Prescribing Information (FDA)

Compare Phena-Plus with other medications

Cold Symptoms
Hay Fever

Tuesday, 28 February 2012

Neomycin Sulfate eent

Class: Antibacterials
ATC Class: S01AA03
VA Class: OT101
CAS Number: 1405-10-3
Brands: Coly-Mycin S, Cortisporin, Maxitrol, Neosporin, Pediotic, Poly-Pred

Introduction

Antibacterial; aminoglycoside antibiotic produced by Streptomyces fradiae.^a ^b ^c ^d ^e ^f ^k ^l

Uses for Neomycin Sulfate

Bacterial Ophthalmic Infections

Used in fixed combination with other anti-infectives (e.g., polymyxin B with bacitracin or gramicidin) for treatment of superficial infections of the eye caused by susceptible bacteria.^b ^f

Used in fixed combination with corticosteroids and other anti-infectives when such combination therapy is indicated.^a ^d ^h ⁱ ^j

Bacterial Otic Infections

Used in fixed combination with other anti-infectives and corticosteroids for treatment of otitis externa caused by susceptible bacteria.^c ^e ^g ^k

Neomycin Sulfate Dosage and Administration

Administration

Ophthalmic Administration

In fixed combination with other anti-infectives or corticosteroids, apply topically to the eye as an ophthalmic ointment, solution, or suspension.^a ^b ^d ^h

Not for injection; do not inject subconjunctivally or directly into the anterior chamber of the eye.^a ^b ^d ^h ⁱ ^j

Avoid contamination of preparation container.^a ^b ^d ^h

Shake suspension well prior to each use.^a ^h

To treat eyelids, instill into the eye, then close the eye and rub the excess onto the lids and lid margins.^h

Otic Administration

In fixed combination with other anti-infectives and corticosteroids, instill into the external ear as an otic solution or suspension.^c ^e ^g

Otic preparations are not for use in the eye.^c ^e ^g ^k

Clean and dry ear canal prior to administration.^c ^e ^g ^k Lie with the affected ear upward, then instill the otic preparation into the ear canal; maintain this position for 5 minutes.^c ^e ^g ^k Repeat procedure if necessary for the opposite ear.^c ^e ^g ^k

Shake suspension well prior to each use.^e ^g ^k

Use the dropper provided by the manufacturer for otic solutions or suspensions.^k

Avoid contamination of preparation container.^g

Dosage

Available as neomycin sulfate; dosage expressed in terms of the salt.^a ^b ^c ^d ^e ^f ^g ^k ^l

Pediatric Patients

Bacterial Otic Infections

Neomycin and Colistin Sulfates and Hydrocortisone Acetate

Otic Suspension

Children: 4 drops into affected ear(s) 3 or 4 times daily for up to 10 days.^k

Alternatively, insert a cotton wick saturated with the suspension into the ear canal; keep the wick moist by adding additional drug every 4 hours.^k Replace the wick at least once every 24 hours.^k

Neomycin and Polymyxin B Sulfates and Hydrocortisone

Otic Solution or Suspension

Children ≥2 years of age: 3 drops into the affected ear(s) 3 or 4 times daily for up to 10 days.^c ^e ^g

Alternatively, insert a cotton wick saturated with the otic preparation into the canal; keep the wick moist by adding additional drug every 4 hours.^c ^e ^g Replace the wick at least once every 24 hours.^c ^e ^g

Adults

Bacterial Ophthalmic Infections

Neomycin and Polymyxin B Sulfates and Bacitracin Zinc

Ophthalmic Ointment

Apply to the affected eye(s) every 3 or 4 hours for 7–10 days, depending on the severity of the infection.^l

Neomycin and Polymyxin B Sulfates, Bacitracin Zinc, and Hydrocortisone Acetate

Ophthalmic Ointment

Apply to the affected eye(s) every 3 or 4 hours, depending on the severity of the infection.^d

Neomycin and Polymyxin B Sulfates and Dexamethasone

Ophthalmic Ointment

Apply a 1.25-cm ribbon into the conjunctival sac of the affected eye(s) up to 3 or 4 times daily.ⁱ

Ophthalmic Suspension

Mild infections: 1 or 2 drop(s) into the conjunctival sac of the affected eye(s) up to 4–6 times daily.^j

Severe infections: 1 or 2 drops into the conjunctival sac of the affected eye(s) hourly.^j Reduce dosing frequency as infection improves.^j

Neomycin and Polymyxin B Sulfates and Gramicidin

Ophthalmic Solution

1 or 2 drops into the affected eye(s) every 4 hours for 7–10 days.^b

Severe infections: Up to 2 drops into the affected eye(s) every hour.^b

Neomycin and Polymyxin B Sulfates and Hydrocortisone

Ophthalmic Suspension

1 or 2 drops into the affected eye(s) every 3 or 4 hours, or more frequently if necessary.^a

Neomycin and Polymyxin B Sulfates and Prednisolone Acetate

Ophthalmic Suspension

1 or 2 drops into the affected eye(s) every 3 or 4 hours, or more frequently, as required.^h For acute infections, may administer every 30 minutes.^h Reduce dosing frequency as infection improves.^h

To treat eyelids: 1 or 2 drops into the affected eye(s) every 3 to 4 hours.^h (See Administration under Dosage and Administration.)

Bacterial Otic Infections

Neomycin and Colistin Sulfates and Hydrocortisone Acetate

Otic Suspension

5 drops into affected ear(s) 3 or 4 times daily for up to 10 days.^k

Alternatively, insert a cotton wick saturated with the suspension into the ear canal; keep the wick moist by adding additional drug every 4 hours.^k Replace the wick at least once every 24 hours.^k

Neomycin and Polymyxin B Sulfates and Hydrocortisone

Otic Solution or Suspension

4 drops into the affected ear(s) 3 or 4 times daily for up to 10 days.^c ^e ^g

Prescribing Limits

Pediatric Patients

Bacterial Otic Infections

Neomycin and Colistin Sulfates and Hydrocortisone Acetate

Otic Suspension

Maximum 10 days of therapy.^k

Neomycin and Polymyxin B Sulfates and Hydrocortisone

Otic Solution and Suspension

Children ≥2 years of age: Maximum 10 consecutive days of therapy.^c ^e ^g

Adults

Bacterial Otic Infections

Neomycin and Colistin Sulfates and Hydrocortisone Acetate

Otic Suspension

Maximum 10 days of therapy.^k

Neomycin and Polymyxin B Sulfates and Hydrocortisone

Otic Solution and Suspension

Maximum 10 consecutive days of therapy.^c ^e ^g

Special Populations

No special population dosage recommendations at this time.^a ^b ^c ^d ^e ^g ^h ⁱ ^j ^k ^l

Cautions for Neomycin Sulfate

Contraindications

Known hypersensitivity to neomycin or any ingredient in the formulation.^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l

Warnings/Precautions

Warnings

Ototoxicity

With otic administration, neomycin can induce permanent sensorineural hearing loss due to cochlear damage; risk is greater with prolonged use.^c ^e ^g

Do not use otic preparations in patients with perforated tympanic membranes.^c ^e ^g

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity reactions possible;^a ^b ^c ^d ^e ^g ^h ⁱ ^j anaphylaxis reported rarely.^a ^b ^d ^h If hypersensitivity reaction occurs, discontinue the drug.^a ^b ^c ^d ^e ^g ^h

Ophthalmic preparations: Neomycin sensitivity may manifest as pruritus, erythema, and edema of the conjunctiva and eyelid or as failure to heal.^a ^b ^d ^h

Otic preparations: Neomycin sensitivity may manifest as erythema, swelling, dry scaling, and pruritus or as failure to heal.^c ^e

Cross-allergenicity occurs among the aminoglycosides; patients who experience neomycin sensitivity also may be sensitive to kanamycin, paromomycin, streptomycin, and possibly gentamicin.^a ^b ^c ^d ^f ^g ^h

Sulfite Sensitivity

Some formulations contain sulfites, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.¹¹¹ ¹¹² ¹¹³ ¹¹⁴ ¹¹⁵ ¹¹⁶ ¹¹⁷ ¹¹⁸ ^c ^f

General Precautions

Superinfection

Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi.^b ^c ^g ^h If superinfection occurs, discontinue the drug and institute appropriate therapy.^b ^g ^h

Use of Fixed Combinations

Concomitant topical corticosteroids may mask clinical signs of bacterial, fungal, or viral infections; prevent recognition of ineffectiveness of the antibiotic; or suppress hypersensitivity reactions to ingredients in the formulation.^d ^h ⁱ ^j ^m

When neomycin is used in fixed combination with other agents (corticosteroid, other anti-infectives), consider the cautions, precautions, and contraindications associated with the concomitant agent(s).^a ^b ^c ^d ^h ⁱ ^j

Specific Populations

Pregnancy

Category C.^a ^b ^c ^d ^g ^h ⁱ ^j

Lactation

For preparations containing neomycin in fixed combination with other anti-infectives: Caution advised.^b ^l

For ophthalmic preparations containing neomycin in fixed combination with hydrocortisone: Manufacturers recommend discontinuing nursing or the drug.^a ^d

For ophthalmic preparations containing neomycin in fixed combination with dexamethasone or prednisolone: Caution when used in nursing women.^h ⁱ ^j

For otic preparations containing neomycin in fixed combination with corticosteroids: Caution advised.^c ^e ^g ^k

Pediatric Use

Ophthalmic preparations: Safety and efficacy not established.^a ^b ^d ^h ⁱ ^j

Otic preparations in fixed combination with polymyxin B sulfate and hydrocortisone: Safety and efficacy not established in children <2 years of age.^c ^e ^g

Geriatric Use

Ophthalmic preparations: No overall differences in safety or efficacy relative to younger patients.^a ^h ⁱ

Otic preparations: Insufficient clinical trial experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults; other clinical experience has not identified differences in response.^c ^e ^g

Common Adverse Effects

Ophthalmic administration: Pruritus, swelling, conjunctival erythema.^a ^b

Otic administration: Local irritation.^c ^g

Neomycin Sulfate Pharmacokinetics

Absorption

Bioavailability

Absorbed into the aqueous humor following topical instillation onto the eye in rabbits; absorption is greatest when cornea is abraded.^f

Absorbed through the ear in dogs, absorption greatest when tympanic membrane is perforated.^f

Distribution

Extent

Not known whether topical neomycin is distributed into human milk.^b ^l

Stability

Storage

Ophthalmic

Ointment

Neomycin and polymyxin B sulfates and bacitracin zinc: Tightly closed containers at 15–25°C.^l

Neomycin and polymyxin B sulfates and bacitracin zinc with hydrocortisone acetate: 15–25°C.^d

Neomycin and polymyxin B sulfates and dexamethasone: 2–25°C.ⁱ

Solution

Neomycin and polymyxin B sulfates and gramicidin: Tightly closed containers at 15–25°C; protect from light.^b

Suspension

Neomycin and polymyxin B sulfates and dexamethasone: 8–27°C.^j

Neomycin and polymyxin B sulfates and hydrocortisone: 20–25°C.^a

Neomycin and polymyxin B sulfates and prednisolone acetate: Tightly closed containers at 15–25°C.^h Store in upright position; protect from freezing.^h

Otic

Solution

Neomycin and polymyxin B sulfates and hydrocortisone: 15–25°C.^c

Suspension

Neomycin and colistin sulfates and hydrocortisone acetate: 20–25°C.^k

Neomycin and polymyxin B sulfates and hydrocortisone: 15–25°C.^e ^g

Actions and SpectrumActions

Usually bactericidal.^f

Appears to inhibit protein synthesis^b ^k ^l in susceptible bacteria by irreversibly binding to 30S ribosomal subunits.^f

Spectrum of activity includes many aerobic gram-negative bacteria and some aerobic gram-positive bacteria.^a ^b ^c ^d ^f

Inactive against fungi, viruses, and most anaerobic bacteria.^f

Gram-positive aerobes: Active against Staphylococcus aureus and S. epidermidis.^f Most streptococci are resistant.^f

Gram-negative aerobes: Active against Enterobacter, Escherichia coli, Haemophilus influenzae, Klebsiella, Neisseria, Moraxella lacunata, and Proteus.^f Inactive against Serratia marcescens and Pseudomonas aeruginosa.^f

Advice to Patients

Importance of discontinuing therapy and consulting clinician if condition worsens or does not improve or if signs of sensitivity occur (redness, swelling, itching).^a ^b ^c ^d ^g ^h ^k

Advise patients to immediately consult clinician regarding continued use of ophthalmic preparations if another eye condition (e.g., trauma, infection) occurs.^f

Importance of not touching tip of container to the eye, eyelid, fingers, or any other surface to avoid contamination.^a ^b ^c ^d ^g ^h Advise patient to keep container tightly closed when not in use.^a ^b ^h

Importance of not wearing contact lenses in the presence of signs and symptoms of an eye infection.^h ⁱ When an ophthalmic preparation that contains benzalkonium chloride is used, importance of removing soft contact lenses prior to administering a dose and for at least 15 minutes after administration.^f

Importance of patients informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.^a ^b ^c ^d ^g

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^a ^b ^c ^d ^g

Importance of informing patients of other important precautionary information.^a ^b ^c ^d ^g (See Cautions.)

Preparations

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

Colistin and Neomycin Sulfates and Hydrocortisone Acetate
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Otic	Suspension	Colistin Sulfate 0.3% (of colistin), Neomycin Sulfate 0.33% (of neomycin), and Hydrocortisone Acetate 1%	Coly-Mycin S Otic with Neomycin and Hydrocortisone (with thimerosal and thonzonium bromide)	JHP
			Cortisporin-TC (with thimerosal and thonzonium bromide)	JHP