Adderall (AMPHETAMINE WITH DEXTROAMPHETAMINE-ORAL TABLET)

GENERIC NAME: DEXTROAMPHETAMINE/AMPHETAMINE- ORAL (am-FET-a-meen/DEX-troe-am-FET-a-meen)

BRAND NAME(S): Adderall

WARNING: Misuse or abuse of amphetamine may cause serious (possibly fatal) heart and blood pressure problems. Amphetamine-type medications can be habit-forming. Use only as directed. If you use this drug for a long time, you may become dependent on it and may have withdrawal symptoms after stopping the drug. Consult your doctor or pharmacist for more details. (See also How to Use section).
USES: This combination medication is used to treat attention deficit hyperactivity disorder (ADHD) as part of a total treatment plan, including psychological, social, and other treatments. It may help to increase the ability to pay attention, concentrate, stay focused, and stop fidgeting.This product is a combination of stimulants (amphetamine and dextroamphetamine). It is thought to work by restoring the balance of certain natural substances (neurotransmitters) in the brain.This drug may also be used to treat a certain sleeping disorder (narcolepsy) to help you stay awake during the day. It should not be used to treat tiredness or to hold off sleep in people who do not have a sleep disorder.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking amphetamine/dextroamphetamine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually 1 to 3 times a day. The first dose is usually taken when you wake up in the morning. If more doses are prescribed, take them as directed by your doctor, usually 4-6 hours apart. Taking this medication late in the day may cause trouble sleeping (insomnia).The dosage is based on your medical condition and response to treatment. Your doctor may adjust your dose to find the dose that is best for you. Follow your doctor's instructions carefully.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.During treatment, your doctor may occasionally recommend stopping the medication for a short time to see whether there are any changes in your behavior and whether the medication is still needed.This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (including severe tiredness, sleep problems, mental/mood changes such as depression) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.Along with its benefits, this medication may rarely cause abnormal drug-seeking behavior (addiction). This risk may be increased if you have abused alcohol or drugs in the past. Take this medication exactly as prescribed to lessen the risk of addiction. Do not increase your dose or use this drug more often or for longer than prescribed. Properly stop this medication when so directed.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Tell your doctor if your condition does not improve or if it worsens.

SIDE EFFECTS: Loss of appetite, weight loss, dry mouth, stomach upset/pain, nausea/vomiting, dizziness, headache, diarrhea, fever, nervousness, and trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor of any high results.Tell your doctor right away if you have any serious side effects, including: numbness/pain/skin color change/sensitivity to temperature in the fingers or toes, mental/mood/behavior changes (such as agitation, aggression, mood swings, depression, abnormal thoughts), uncontrolled movements, continuous chewing movements/teeth grinding, outbursts of words/sounds, change in sexual ability/desire, frequent/prolonged erections (in males).Get medical help right away if you have any very serious side effects, including: shortness of breath, chest/jaw/left arm pain, fainting, severe headache, fast/pounding/irregular heartbeat, seizures, swelling of the ankles/feet, extreme tiredness, blurred vision, weakness on one side of the body, slurred speech, confusion.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to sympathomimetic drugs (such as epinephrine, pseudoephedrine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (such as Raynaud's disease), certain mental/mood conditions (such as severe agitation, psychosis), personal/family history of mental/mood disorders (such as bipolar disorder, depression, psychotic disorder, suicidal thoughts), heart problems (including irregular heartbeat/rhythm, coronary artery disease, heart failure, cardiomyopathy, problems with the heart structure such as valve problems), family history of heart problems (such as sudden death/irregular heartbeat/rhythm), history of stroke, high blood pressure, overactive thyroid (hyperthyroidism), a certain eye problem (glaucoma), seizures, personal or family history of regular use/abuse of drugs/alcohol, personal or family history of uncontrolled muscle movements (such as Tourette's syndrome), kidney disease, liver disease.This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be more sensitive to the side effects of this drug, especially weight loss. This medication may slow down a child's growth. The doctor may recommend temporarily stopping the medication from time to time to reduce this risk. Monitor your child's weight and height. Consult your doctor or pharmacist for more details.Older adults may be more sensitive to the side effects of this drug, especially chest pain, trouble sleeping, or weight loss.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Infants born to mothers who are dependent on this medication may be born too soon (premature) and have low birth weight. They may also have withdrawal symptoms. Tell your doctor immediately if you notice possible mood changes, agitation, or unusual tiredness in your newborn.This medication passes into breast milk and may have undesirable effects on a nursing infant. Therefore, breast-feeding is not recommended while using this drug. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.Check the labels on all your medicines (such as cough-and-cold products, diet aids) because they may contain ingredients that could increase your heart rate or blood pressure. Ask your pharmacist about using these products safely.Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas), eating large amounts of chocolate, or taking over-the-counter products that contain caffeine. Caffeine can increase the side effects of this medication.Dextroamphetamine is very similar to lisdexamfetamine. Do not use medications containing lisdexamfetamine while using dextroamphetamine.This medication may interfere with certain medical/laboratory tests (including blood and urine steroid levels, brain scan for Parkinson's disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe mental/mood changes, seizures, severe/persistent headache, severe restlessness, fast breathing.
NOTES: Do not share this medication with others. It is against the law.Laboratory and/or medical tests (such as blood pressure, heart rate, growth monitoring in children) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember in the morning hours. If it is late in the afternoon or near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Adderall (amphetamine and dextroamphetamine)

What is amphetamine and dextroamphetamine, and how does it work (mechanism of action)?

Adderall contains amphetamine salts (amphetamine and dextroamphetamine) and is used for treating attention-deficit hyperactivity disorder (ADHD) and narcolepsy. Amphetamines stimulate the brain by increasing the level of neurotransmitters, dopamine and norepinephrine, in the brain. (Neurotransmitters are chemicals produced by nerves that are released and attach to other nearby nerves as a means of communication among nerves.) The exact mechanism of action in ADHD is unknown. Adderall XR is an extended release form of Adderall. Adderall was approved by the FDA in 1996.

What brand names are available for amphetamine and dextroamphetamine?

Adderall, Adderall XR

Is amphetamine and dextroamphetamine available as a generic drug?

GENERIC AVAILABLE: Yes (Adderall), No (Adderall XR)

Do I need a prescription for amphetamine and dextroamphetamine?

Yes

What are the side effects of amphetamine and dextroamphetamine?

Side effects of amphetamines include excessive stimulation of the nervous system leading to:

• nervousness,
• restlessness,
• excitability,
• dizziness,
• headache,
• insomnia,
• fear,
• anxiety,
• tremor,
• hallucinations, and
• convulsions (seizures).

Blood pressure and heart rate may increase, and patients may experience palpitations of the heart.
Other important side effects include:

• Sudden death,
• stroke,
• heart attack,
• depression,
• manic episodes,
• aggressive behavior or hostility,
• psychosis,
• growth suppression (long-term use),
• dependence, and
• withdrawal symptoms

Priapism defined as painful and nonpainful penile erection lasting more than 4 hours, have been reported in pediatric and adult patients treated with stimulants. The erection usually resolves when the drug is stopped. Prompt medical attention is required in the event of suspected priapism.

What is the dosage for amphetamine and dextroamphetamine?

Adderall usually is taken once or twice a day. Doses should be separated by at least 4-6 hours. The recommended dose is 2.5 to 60 mg daily depending on the patient's age and the condition being treated. Adderall XR is taken once daily. The recommended dose is 5-40 mg daily administered in the morning. The entire contents of the Adderall XR capsules may be sprinkled into applesauce and consumed immediately. Amphetamines should be administered during waking hours and late evening doses should be avoided in order to avoid insomnia.

Which drugs or supplements interact with amphetamine and dextroamphetamine?

Amphetamines should not be taken with monoamine oxidase (MAO) inhibitor drugs including phenelzine (Nardil), tranylcypromine (Parnate), and Zyvox; use of amphetamine within 14 days of using MAO inhibitor drugs should be avoided. Patients receiving antihypertensive medications may experience loss of blood pressure control with amphetamine. Antacids may increase absorption of amphetamine salts and increase their effectiveness and side effects.

Is amphetamine and dextroamphetamine safe to take if I'm pregnant or breastfeeding?

Amphetamines should not be used during pregnancy. Infants who are born to mothers dependent on amphetamines exhibit symptoms of withdrawal and have an increased risk of low birth weight.
Mothers taking amphetamines should refrain from nursing their infants because these drugs are excreted in human milk and can have undesirable effects on the child.

What else should I know about amphetamine and dextroamphetamine?

What preparations of amphetamine and dextroamphetamine are available?

Adderall tablets: 5, 7.5, 10, 12.5, 15, 20, and 30 mg. Adderall XR capsules: 5, 10, 15, 20, 25, and 30 mg.

How should I keep amphetamine and dextroamphetamine stored?

Tablets should be stored at room temperature, between 15 C and 30 C (59 F and 86 F).

Summary

Amphetamine and dextroamphetamine (Adderall, Adderall XR) is a drug prescribed for the treatment of ADHD (attention-deficit hyperactivity disorder) and narcolepsy. Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.

Adapin (doxepin)

What is doxepin, and how does it work (mechanism of action)?

Doxepin belongs to a class of drugs called tricyclic antidepressants (TCAs) that are used primarily to treat depression and anxiety. Other examples of TCAs include amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), and several others. Depression is an all-pervasive sense of sadness and gloom. In some patients with depression, an imbalance in levels of neurotransmitters in the brain may be the cause of the depression. Neurotransmitters are chemicals that nerves use to communicate with each other. Neurotransmitters affected by doxepin include serotonin, norepinephrine, acetylcholine, and histamine. Doxepin may elevate mood by raising the levels of serotonin and norepinephrine. It also blocks the activity of acetylcholine and histamine. The FDA approved doxepin in March 1974.

What brand names are available for doxepin?

Silenor

Is doxepin available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for doxepin?

Yes

What are the side effects of doxepin?

The most common side effect of doxepin is drowsiness. Drowsiness improves as therapy continues. Other side effects associated with doxepin include:

• blurred vision,
• urinary retention (difficulty urinating),
• dry mouth,
• constipation,
• weight gain or loss,
• low blood pressure when rising from a sitting position (orthostatic hypotension),
• rash,
• hives,
• rapid or irregular heart rates,
• seizures, and
• hepatitis.

Doxepin also can cause elevated pressure in the eyes of some patients withglaucoma. Doxepin may dilate pupils which may trigger an angle closure attack in a patient with angle closure glaucoma.
If antidepressants, including doxepin, are discontinued abruptly, symptoms may include:

• dizziness,
• headache,
• nausea, and
• changes in mood.

Such symptoms of withdrawal may occur even when a few doses of antidepressant are missed. Therefore, it is recommended that the dose of antidepressant be reduced gradually when therapy is discontinued.
Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of any antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thinking or behavior, and unusual changes in behavior.

What is the dosage for doxepin?

The usual dose of doxepin for depression or anxiety is 25 to 300 mg daily administered at bedtime or in two or three divided doses. Doses greater than 300 mg daily are not more effective. Optimal improvement in depressive symptoms is seen after 2-3 weeks; anti-anxiety effects occur much sooner. Insomnia is treated with 3 to 6 mg daily taken 30 minutes before sleeping. Avoid taking doxepin with high fat meals because high fat meals increase the absorption of doxepin.

Which drugs or supplements interact with doxepin?

Tricyclic antidepressants , including doxepin, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants (for example, isocarboxazid [Marplan], phenelzine [Nardil], tranylcypromine [Parnate], selegiline [Eldepryl], and procarbazine [Matulane]) or other drugs that inhibit monoamine oxidase such as linezolid [Zyvox] and intravenous methylene blue. Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. Doxepin should not be administered for at least 14 days after stopping.
Drug that affect heart rhythm such as amiodarone (Cordarone), bepridil (Vascor), and disopyramide (Norpace) should not be combined with doxepin since it also affects heart rhythm.
Cimetidine (Tagamet) increases the breakdown of doxepin by the liver and can increase doxepin blood levels, possibly causing side effects from doxepin.

Is doxepin safe to take if I'm pregnant or breastfeeding?

There are no adequate studies of doxepin use in pregnant women.
It is not known if doxepin is secreted in breast milk. There is one report of apnea (cessation of breathing) and drowsiness occurring in a nursing infant whose mother was taking doxepin.

What else should I know about doxepin?

What preparations of doxepin are available?

Capsules: 10, 25, 50, 75, 100, 150 mg; Liquid: 10 mg/ml

How should I keep doxepin stored?

Doxepin should be stored below 30 C (86 F) in a tight, light resistant container.

Summary

Doxepin doxepin (Sinequan and Adapin are discontinued brands in the US; Silenor) is an antidepressant that belongs to the drug class called tricyclic antidepressants. Doxepin is prescribed for depression, anxiety, bipolar disorder, or depression due to alcoholism or brain damage. Side effects and drug interactions should be reviewed prior to taking this medication.

ADAPALENE-TOPICAL

GENERIC NAME: ADAPALENE - TOPICAL (a-DAP-a-leen)

BRAND NAME(S): Differin

USES: This medication is used to treat acne. It may decrease the number and severity of acne pimples and promote quick healing of pimples that do develop. Adapalene belongs to a class of medications called retinoids. It works by affecting the growth of cells and decreasing swelling and inflammation.

HOW TO USE: Wash your hands before applying this medication. Gently clean the affected skin with a mild or soapless cleanser and pat dry. Use your fingertips to apply a small amount of medication in a thin layer, usually once daily at bedtime, or as directed by your doctor. A gauze pad or cotton swab can be used to apply the solution.Use this medication on the skin only. Do not apply to the inner lip area or inside the nose/mouth. Do not apply to cut, scraped, sunburned, or eczema-affected skin.Avoid getting this medication in your eyes. If this medication gets into your eyes, flush with large amounts of water. Call your doctor if eye irritation develops. Wash your hands after using the medication to avoid accidentally getting it in your eyes.During the first few weeks of using adapalene, your acne might appear worse because the medication is working on pimples forming inside the skin. It may take up to 8-12 weeks to notice results from this medication.Use it regularly in order to get the most benefit from it. To help you remember, use it at the same time each day. Do not use a larger amount or use it more frequently than recommended. Your skin will not improve any faster, and it will increase the risk of developing redness, peeling and pain.This medication is available in different strengths and forms (e.g., gel, cream, solution). The best type of medication for you to use will depend on the condition of your skin and your response to therapy. Inform your doctor if your condition persists or worsens.

SIDE EFFECTS: A brief sensation of warmth or stinging may occur immediately after applying the medication. Skin redness, dryness, itching, scaling, mild burning, or worsening of acne may occur during the first 2-4 weeks of using the medication. These effects usually decrease with continued use. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Your doctor may want you to decrease how often you use adapalene, change the strength, or have you stop using it.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these unlikely but serious side effects occur: very red/irritated skin, an intense burning sensation, eye redness and watering (conjunctivitis), eyelid swelling, skin discoloration.A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before using adapalene, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: eczema.This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths, and sunlamps. Weather extremes such as wind or cold may also be irritating to the skin. Use a sunscreen daily and wear protective clothing when outdoors. Wait until your skin has completely recovered from a sunburn before using adapalene.Avoid electrolysis, waxing and chemical depilatories for hair removal on the treated areas while using this product.If you have recently used products containing sulfur, resorcinol or salicylic acid, use adapalene with caution. Wait until the effects of such products on the skin have decreased before using adapalene.This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: See also Precautions section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: products containing alpha hydroxy acids, products containing glycolic acid, hair perming solutions, alcohol/lime/menthol-containing products (such as astringents, toners, shaving lotions), medicated or abrasive soaps and cleansers, products containing sulfur, resorcinol or salicylic acid, soaps and cosmetics with a strong drying effect, other drugs that may increase your sensitivity to sunlight (e.g., fluoroquinolones such as ciprofloxacin, tetracyclines, thiazide water pills such as hydrochlorothiazide, sulfa drugs such as sulfamethoxazole, phenothiazines such as chlorpromazine).

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. This medication may be harmful if swallowed.


NOTES: Do not share this medication with others.Cosmetics may be used, but clean skin thoroughly before applying the medication.Some cosmetics and soaps may worsen your acne. Moisturizers may be safe to use. When buying cosmetics, moisturizers or other skin care products, check the label for "non-comedogenic" or "non-acnegenic." These products are unlikely to worsen your acne. Ask your doctor or pharmacist which products are safe to use. Remember, acne is not caused by dirt. Cleaning your skin too often or too vigorously can irritate your skin and worsen acne.

MISSED DOSE: If you forget to use this medication, use it as soon as you remember if you remember the same day. If you don't remember until morning, wait until your next dose is scheduled.


STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Different forms of this medication may have different storage requirements. Read the package labeling or ask your pharmacist for the storage requirements for the product you are using. Gel preparations are flammable. Do not expose to heat or fire sources. Do not smoke during use. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Adapalene vs. Benzoyl Peroxide

Adapalene vs. Benzoyl Peroxide

• Adapalene and benzoyl peroxide are topical agents used for the treatment of acne vulgaris (pimples).
• A brand name for adapalene is Differin. Brand names for benzoyl peroxide include Proactiv, Neutrogena On-The-Spot Acne Treatment, Clearasil, and Clearskin.
• A difference is adapalene is only available with a prescription, while benzoyl peroxide is available over-the-counter (OTC) and in generic form.
• Side effects of adapalene and benzoyl peroxide that are similar include skin irritation, redness, dryness, itching, flares of acne, and increased sun sensitivity
• Most of the side effects of adapalene and benzoyl peroxide lessen with continued use. If side effects become bothersome, decreasing the frequency with which adapalene or benzoyl peroxide is applied may reduce these side effects.
• A difference is the frequency of application of the medications. Adapalene is applied in a thin layer of gel to the affected areas once daily at bedtime. Benzoyl peroxide products may be applied to the skin up to three times daily, as needed.
• Combining adapalene or benzoyl peroxide with other topical acne treatments can lead to excessive dryness and irritation of the skin.

What are adapalene and benzoyl peroxide?

Adapalene is a gel used for the treatment of acne vulgaris (pimples). The exact mechanism of action is not known. Scientists believe that when adapalene is applied to the skin, it affects the growth of skin cells and thereby reduces the formation of pimples.
Benzoyl peroxide is a topical medication used for treating acne (pimples). It kills the bacteria associated with acne (Propionibacterium acnes) and promotes the growth of new skin cells. It also dries the skin. Increased cell growth leads to replacement of the pimple-containing skin with new skin.

What are the side effects of adapalene and benzoyl peroxide?

Adapalene

The most common side effects of adapalene are:

• irritation,
• redness,
• dryness, and
• itching
• flares of acne.

Most of these side effects lessen with continued use; however, if they are bothersome, decreasing the frequency with which adapalene is applied may reduce these side effects.
Adapalene may increase the sensitivity of the skin to sun and lead to sunburn. Excessive sun exposure should be avoided, and sunscreens should be used over the treated areas if exposure to the sun cannot be avoided. Adapalene should not be applied to sunburned skin, cuts, eyes, nose, or lips.

Benzoyl peroxide

Common side effects include:

• Contact dermatitis
• Erythema
• Peeling
• Skin dryness

Possible serious side effects include:

• Hypersensitivity reaction
• Increased sun sensitivity

What is the dosage for adapalene vs. benzoyl peroxide?

Adapalene

Wash and dry the affected areas. Apply a thin layer of gel to the affected areas once daily at bedtime. Avoid the eyes, lips and nose. There may be a worsening of acne during the first few weeks of therapy because adapalene promotes the growth of pimples that have begun to form but are not yet visible. Therefore, treatment should not be stopped if acne appears to be worsening. Beneficial effects should be seen by 8 to 12 weeks.

Benzoyl peroxide

• The affected area should be thoroughly washed.
• Benzoyl peroxide cream, lotion, or gel should then be applied sparingly once, twice, or three times daily as needed.
• Topical cleansers should be used to wash the affected areas once or twice daily.
• The frequency of use should be decreased if excessive dryness or irritation occurs.

What drugs interact with adapalene and benzoyl peroxide?

Excessive skin irritation may occur if adapalene is used with other acne medications.
Combining benzoyl peroxide with other topical acne treatments such as dapsone (Aczone) can lead to excessive dryness and irritation of the skin.

Are adapalene and benzoyl peroxide safe to use while pregnant or breastfeeding?

Only very small amounts of adapalene are absorbed through skin and into the body. However, there are no adequate studies in pregnant women. It is not known whether adapalene is excreted in breast milk.
Benzoyl peroxide has not been tested in pregnant or nursing women.

Summary

Adapalene and benzoyl peroxide are topical agents used for the treatment of acne vulgaris (pimples). Adapalene is only available with a prescription, while benzoyl peroxide is available over-the-counter (OTC) and in generic form. Side effects of adapalene and benzoyl peroxide that are similar include:

• skin irritation,
• redness,
• dryness,
• itching,
• flares of acne, and
• increased sun sensitivity

Adapalene

What is adapalene, and how does it work (mechanism of action)?

Adapalene is a gel used for the treatment of acne vulgaris (pimples). The exact mechanism of action is not known. Scientists believe that when adapalene is applied to the skin, it affects the growth of skin cells and thereby reduces the formation of pimples.

What brand names are available for adapalene?

Differin

Is adapalene available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for adapalene?

Yes

What are the side effects of adapalene?

The most common side effects of adapalene are:

• irritation,
• redness,
• dryness, and
• itching
• flares of acne.

Most of these side effects lessen with continued use; however, if they are bothersome, decreasing the frequency with which adapalene is applied may reduce these side effects.
Adapalene may increase the sensitivity of the skin to sun and lead to sunburn. Excessive sun exposure should be avoided, and sunscreens should be used over the treated areas if exposure to the sun cannot be avoided. Adapalene should not be applied to sunburned skin, cuts, eyes, nose, or lips.

What is the dosage for adapalene?

Wash and dry the affected areas. Apply a thin layer of gel to the affected areas once daily at bedtime. Avoid the eyes, lips and nose. There may be a worsening of acne during the first few weeks of therapy because adapalene promotes the growth of pimples that have begun to form but are not yet visible. Therefore, treatment should not be stopped if acne appears to be worsening. Beneficial effects should be seen by 8 to 12 weeks.

Which drugs or supplements interact with adapalene?

Excessive skin irritation may occur if adapalene is used with other acne medications.

Is adapalene safe to take if I'm pregnant or breastfeeding?

Only very small amounts of adapalene are absorbed through skin and into the body. However, there are no adequate studies in pregnant women.
It is not known whether adapalene is excreted in breast milk.

What else should I know about adapalene?

What preparations of adapalene are available?

Gel, 0.1%

How should I keep adapalene stored?

Store at room temperature, 20 C - 25 C (68 F - 77 F)

Summary

Adapalene (Differin) is a gel prescribed for the treatment of acne (pimples). Side effects (sun sensitivity, for example), drug interactions, pregnancy safety information, and dosing should be reviewed prior to taking any medication.

ADALIMUMAB-INJECTION

GENERIC NAME: ADALIMUMAB - INJECTION (A-da-LIM-ue-mab)

BRAND NAME(S): Humira

WARNING: This medication can decrease your immune system's ability to fight infections. Though unlikely, this drug may increase your risk of developing serious (possibly fatal) infections (such as fungal infections, bacterial infections including tuberculosis). This risk is higher if you are also taking other drugs to suppress the immune system such as cyclosporine. Tell your doctor your medical history, especially of past/recent/current infections. You should also tell your doctor if you have lived or traveled in areas where certain fungal infections (such as coccidioidomycosis, histoplasmosis) are common or if you have been near someone with tuberculosis. Areas where these types of fungal infections are commonly found include the Ohio and Mississippi River valleys and the southwestern United States. See Side Effects section for symptoms of infection, and seek immediate medical attention if symptoms occur.
Before starting this drug and during treatment, you should take a tuberculosis (TB) skin test to check for a type of tuberculosis that may not be causing any symptoms (latent TB). If you are diagnosed with TB, you must first be treated for it before you start adalimumab to prevent a serious TB infection.
Though it is very unlikely to happen, there is a risk (especially in children/teens/young adults) of developing cancer (such as lymphoma, skin) due to this medication or due to your medical condition. Discuss the risks and benefits of treatment with your doctor. Tell your doctor immediately if you develop symptoms such as unusual lumps/growths, swollen or painful abdomen, unexplained weight loss, persistent fever or night sweats.

USES: This medication is used to reduce pain and swelling due to certain types of arthritis (e.g., rheumatoid, psoriatic, and ankylosing spondylitis). This medication is also used to treat psoriasis (plaque-type). It works by blocking a protein (tumor necrosis factor or TNF) found in the body's immune system that causes joint swelling and damage.Early treatment of rheumatoid arthritis with more aggressive therapy, including this type of medication (TNF blockers), helps to reduce further joint damage and preserve joint function.This medication is also used to treat certain bowel conditions (Crohn's disease, ulcerative colitis). It is used in cases that are moderate to severe and/or keep coming back.
HOW TO USE: Read the Patient Information Leaflet and the Medication Guide provided by your pharmacist before you start using adalimumab and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Use this medication exactly as prescribed. This drug is given under the skin (subcutaneously or SC) every other week, or weekly in some cases, or as directed by your doctor. Learn all preparation and usage instructions in the product package. Do not shake.Rotate injection sites. New injections should be given at least 1 inch (2.5 centimeter) from an old site. Do not inject into any areas of the skin that are sore, bruised, red or hard.Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid.Learn how to store and discard needles and medical supplies safely. Never reuse syringes or needles. Consult your pharmacist.
SIDE EFFECTS: See also Warning section.Redness, itching, pain, or swelling at the injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fast/irregular/pounding heartbeat, stomach pain, blood in the stools, mental/mood changes, severe headache, easy bruising or bleeding, dark urine, yellowing eyes and skin, leg pain or swelling, numbness or tingling of the arms/hands/legs/feet, unsteadiness, unexplained muscle weakness, difficulty with speaking/chewing/swallowing/facial movements, vision changes, extreme fatigue, joint pain, butterfly-shaped rash on the nose and cheeks.Get medical help right away if you have any very serious side effects, including: seizures, chest pain.Tell your doctor right away if you develop signs of infection while using this drug, such as: fever, chills, night sweats, persistent sore throat, trouble breathing, painful or frequent urination, persistent cough, unusual vaginal discharge, white patches in the mouth (oral thrush).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: See also Warning section.Before using adalimumab, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients (such as natural rubber/latex), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: current/past/recurrent infections (such as hepatitis B, TB infection, histoplasmosis), decreased bone marrow function, seizures, certain brain/spinal cord/nerve disorders (demyelinating disorders such as multiple sclerosis, Guillain-Barre syndrome), history of cancer (e.g., lymphoma), a certain type of heart disease (heart failure), lupus.Adalimumab can make you more likely to get infections or may worsen any current infections. Therefore, wash your hands well to prevent the spread of infection. Avoid contact with people who have infections that may spread to others (such as chickenpox, measles, flu). Consult your doctor if you have been exposed to an infection or for more details.Do not have immunizations/vaccinations without the consent of your doctor. Avoid contact with people who have recently received live vaccines (such as flu vaccine inhaled through the nose).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be at greater risk for infections while using this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk in small amounts. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: abatacept, live vaccines, other TNF-blockers (such as etanercept, infliximab), certain arthritis drugs (such as leflunomide, anakinra, tofacitinib), drugs that suppress the immune system (e.g., cyclosporine).

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., CBC, liver function) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, contact your doctor or pharmacist to establish a new dosing schedule.


STORAGE: Store in the refrigerator away from light and moisture. Do not freeze. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

Adalimumab Humira

What is adalimumab (Humira), and what is it used for?

Rheumatoid Arthritis

Humira is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis. Humira can be used alone or in combination with methotrexate or other disease-modifying anti-rheumatic drugs (DMARDs).

Psoriatic Arthritis

Humira is indicated for reducing signs and symptoms of active arthritis, inhibiting the progression of structural damage, and improving physical function in patients with psoriatic arthritis. Humira can be used alone or in combination with DMARDs.

Ankylosing Spondylitis

Humira is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.

Crohn’s Disease

Humira is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active Crohn’s disease who have had an inadequate response to conventional therapy. Humira is indicated for reducing signs and symptoms and inducing clinical remission in these patients if they have also lost response to or are intolerant to infliximab.

Plaque Psoriasis

Humira is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. Humira should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician.

What are the side effects of adalimumab (Humira)?

Serious side effects, which sometimes lead to death, have happened in patients taking Humira, including:

• Serious infections.

Your doctor will examine you for TB and perform a test to see if you have TB. If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with Humira and during treatment with Humira. Even if your TB test is negative your doctor should carefully monitor you for TB infections while you are taking Humira. Patients who had a negative TB skin test before receiving Humira have developed active TB. Tell your doctor if you have any of the following symptoms while taking or after taking Humira:

• cough that does not go away
• low grade fever
• weight loss
• loss of body fat and muscle (wasting)
• Certain types of Cancer.
• There have been cases of certain kinds of cancer, in patients taking Humira or other TNF blockers.
• Some patients receiving Humira have developed types of cancer called non-melanoma skin cancer (basal cell cancer and squamous cell cancer of the skin), which are generally not life-threatening if treated. Tell your doctor if you have a bump or open sore that doesn't heal.
• Patients with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma.
• Allergic reactions. Signs of a serious allergic reaction include a skin rash, a swollen face, or trouble breathing.

Hepatitis B virus reactivation in patients who carry the virus in their blood. In some cases patients have died as a result of hepatitis B virus being reactivated. Your doctor should monitor you carefully during treatment with Humira if you carry the hepatitis B virus in your blood. Tell your doctor if you have any of the following symptoms:

• feel unwell
• poor appetite
• tiredness (fatigue)
• fever, skin rash, or joint pain
• Nervous system problems. Signs and symptoms of a nervous system problem include: numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
• Blood problems. Your body may not make enough of the blood cells that help fight infections or help to stop bleeding. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
• New heart failure or worsening of heart failure you already have. Symptoms include shortness of breath or swelling of your ankles or feet or sudden weight gain.
• Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or a rash on your cheeks or arms that gets worse in the sun. Symptoms may go away when you stop Humira.

Call your doctor or get medical care right away if you develop any of the above symptoms. Your treatment with Humira may be stopped.
Common side effects with Humira include:

• Injection site reactions such as redness, rash, swelling, itching, or bruising. These symptoms usually will go away within a few days. If you have pain, redness or swelling around the injection site that doesn’t go away within a few days or gets worse, call your doctor right away.
• Upper respiratory infections (including sinus infections)
• Headaches
• Rash
• Nausea

These are not all the possible side effects with Humira. Tell your doctor if you have any side effect that bothers you or that does not go away. Ask your doctor or pharmacist for more information.

What is the dosage for adalimumab (Humira)?

Humira is administered by subcutaneous injection.

Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis

The recommended dose of Humira for adult patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis is 40 mg administered every other week. Methotrexate, glucocorticoids, salicylates, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics or other DMARDs may be continued during treatment with Humira. In rheumatoid arthritis, some patients not taking concomitant methotrexate may derive additional benefit from increasing the dosing frequency of Humira to 40 mg every week.

Crohn’s Disease

The recommended Humira dose regimen for adult patients with Crohn’s disease is 160 mg initially at Day 1 (given as four 40 mg injections in one day or as two 40 mg injections per day for two consecutive days), followed by 80 mg two weeks later (Day 15). Two weeks later (Day 29) begin a maintenance dose of 40 mg every other week. Aminosalicylates, corticosteroids, and/or immunomodulatory agents (e.g., 6mercaptopurine and azathioprine) may be continued during treatment with Humira. The use of Humira in Crohn’s disease beyond one year has not been evaluated in controlled clinical studies.

Plaque Psoriasis

The recommended dose of Humira for adult patients with plaque psoriasis is an initial dose of 80 mg, followed by 40 mg given every other week starting one week after the initial dose. The use of Humira in moderate to severe chronic plaque psoriasis beyond one year has not been evaluated in controlled clinical studies.

General Considerations for Administration

Humira is intended for use under the guidance and supervision of a physician. A patient may self-inject Humira if a physician determines that it is appropriate, and with medical follow-up, as necessary, after proper training in subcutaneous injection technique.
The solution in the Humira Pen or prefilled syringe should be carefully inspected visually for particulate matter and discoloration prior to subcutaneous administration. If particulates and discolorations are noted, the product should not be used. Humira does not contain preservatives; therefore, unused portions of drug remaining from the syringe should be discarded. NOTE: The needle cover of the syringe contains dry rubber (latex), which should not be handled by persons sensitive to this substance.
Patients using the Humira Pen or prefilled syringe should be instructed to inject the full amount in the syringe (0.8 mL), which provides 40 mg of Humira.
Injection sites should be rotated and injections should never be given into areas where the skin is tender, bruised, red or hard.

Dosage Forms and Strength

Pen

A single-use pen (Humira Pen), containing a 1 mL prefilled glass syringe with a fixed 27 gauge ½ inch needle, providing 40 mg (0.8 mL) of Humira.

Prefilled Syringe

A single-use, 1 mL prefilled glass syringe with a fixed 27 gauge ½ inch needle, providing 40 mg (0.8 mL) of Humira.

What drugs interact with adalimumab (Humira)?

Anakinra

Concurrent administration of anakinra (an interleukin-1 antagonist) and another TNF-blocking agent has been associated with an increased risk of serious infections, an increased risk of neutropenia and no additional benefit compared to these medicinal products alone. Therefore, the combination of anakinra with other TNF-blocking agents, including Humira, may also result in similar toxicities.

Live Vaccines

Live vaccines should not be given concurrently with Humira.

Methotrexate

Humira has been studied in rheumatoid arthritis patients taking concomitant methotrexate. Although methotrexate reduced the apparent adalimumab clearance, the data do not suggest the need for dose adjustment of either Humira or methotrexate.

Is adalimumab (Humira) safe to take if I'm pregnant or breastfeeding?

Pregnancy

Pregnancy Category B - An embryo-fetal perinatal developmental toxicity study has been performed in cynomolgus monkeys at dosages up to 100 mg/kg (266 times human AUC when given 40 mg subcutaneously with methotrexate every week or 373 times human AUC when given 40 mg subcutaneously without methotrexate) and has revealed no evidence of harm to the fetuses due to adalimumab. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction and developmental studies are not always predictive of human response, Humira should be used during pregnancy only if clearly needed.
Pregnancy Registry: To monitor outcomes of pregnant women exposed to Humira, a pregnancy registry has been established. Physicians are encouraged to register patients by calling 1-877-311-8972.

Nursing Mothers

It is not known whether adalimumab is excreted in human milk or absorbed systemically after ingestion. Because many drugs and immunoglobulins are excreted in human milk, and because of the potential for serious adverse reactions in nursing infants from Humira, 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.

What else should I know about adalimumab (Humira)?

Humira (adalimumab) is a recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF). Humira was created using phage display technology resulting in an antibody with human derived heavy and light chain variable regions and human IgG1:k constant regions. Adalimumab is produced by recombinant DNA technology in a mammalian cell expression system and is purified by a process that includes specific viral inactivation and removal steps. It consists of 1330 amino acids and has a molecular weight of approximately 148 kilodaltons.
Humira is supplied as a sterile, preservative-free solution of adalimumab for subcutaneous administration. The drug product is supplied as either a single-use, prefilled pen (Humira Pen) or as a single-use, 1 mL prefilled glass syringe. Enclosed within the pen is a single-use, 1 mL prefilled glass syringe. The solution of Humira is clear and colorless, with a pH of about 5.2. Each syringe delivers 0.8 mL (40 mg) of drug product. Each 0.8 mL of Humira contains 40 mg adalimumab, 4.93 mg sodium chloride, 0.69 mg monobasic sodium phosphate dihydrate, 1.22 mg dibasic sodium phosphate dihydrate, 0.24 mg sodium citrate,
1.04 mg citric acid monohydrate, 9.6 mg mannitol, 0.8 mg polysorbate 80, and Water for Injection, USP. Sodium hydroxide added as necessary to adjust pH.

How does adalimumab (Humira) work?

Humira (adalimumab) is a recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF). Humira was created using phage display technology resulting in an antibody with human derived heavy and light chain variable regions and human IgG1:k constant regions. Adalimumab is produced by recombinant DNA technology in a mammalian cell expression system and is purified by a process that includes specific viral inactivation and removal steps. It consists of 1330 amino acids and has a molecular weight of approximately 148 kilodaltons.
Humira is supplied as a sterile, preservative-free solution of adalimumab for subcutaneous administration. The drug product is supplied as either a single-use, prefilled pen (Humira Pen) or as a single-use, 1 mL prefilled glass syringe. Enclosed within the pen is a single-use, 1 mL prefilled glass syringe. The solution of Humira is clear and colorless, with a pH of about 5.2. Each syringe delivers 0.8 mL (40 mg) of drug product. Each 0.8 mL of Humira contains 40 mg adalimumab, 4.93 mg sodium chloride, 0.69 mg monobasic sodium phosphate dihydrate, 1.22 mg dibasic sodium phosphate dihydrate, 0.24 mg sodium citrate,
1.04 mg citric acid monohydrate, 9.6 mg mannitol, 0.8 mg polysorbate 80, and Water for Injection, USP. Sodium hydroxide added as necessary to adjust pH.

Summary

Humira is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis and other inflammatory conditions like psoriasis and Crohn's. Humira can be used alone or in combination with methotrexate or other disease-modifying anti-rheumatic drugs (DMARDs).

Adalimumab

What is adalimumab, and how does it work (mechanism of action)?

Adalimumab is an injectable protein(antibody) that blocks the inflammatory effects of tumor necrosis factor alpha (TNF alpha) in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and Crohn 's disease of the intestine. Inflammation is the body's reaction to injury and is a necessary process for the repair of injury. TNF is a protein that the body produces when there is inflammation. TNF promotes inflammation and the signs of inflammation, which, in the case of arthritis, include fever as well as pain, tenderness, and swelling of joints. In the case of Crohn's disease, the signs of inflammation include fever, abdominal pain, and diarrhea. The unchecked inflammation of rheumatoid arthritis eventually leads to destruction of the joints. The inflammation in Crohn's disease can lead to strictures (narrowing) of the intestine or intestinal perforation. Adalimumab is a synthetic (man-made) antibody that binds to TNF in the body and thereby blocks the effects of TNF. As a result, inflammation and its consequences in the joints and intestine are reduced. In arthritis, the progressive destruction of the joints is slowed or prevented. Adalimumab is a disease modifying anti-rheumatic drugs (DMARD) because it slows or prevents destruction of joints. Adalimumab was approved by the FDA in December 2002.

What brand names are available for adalimumab?

Humira

Is adalimumab available as a generic drug?

GENERIC AVAILABLE: No

Do I need a prescription for adalimumab?

Yes

What are the side effects of adalimumab?

The most common side effects are:

• headache,
• rash,
• nausea and
• stomach upset.

Adalimumab may cause swelling, redness, pain and itching at the site of injection. Adalimumab suppresses the immune system and is therefore associated with minor infections of the urinary tract, respiratory tract, and sinuses. Like other drugs that block TNF, use of adalimumab also has been associated with serious infections such as tuberculosis, sepsis (bacteria in the blood) and fungal infections. Individuals with active infections should not be treated with adalimumab. Adalimumab also may worsen the symptoms of diseases of the nervous system. In studies some patients who used adalimumab or other TNF blocking drugs developed cancer. Since patients with rheumatoid arthritis have a higher rate of cancers than the general population, the connection between cancer and use of adalimumab is unclear.
Other side effects of adalimumab include:

• hypersensitivity reactions (including anaphylaxis) and
• reduced levels in the blood of platelets and red cells (aplastic anemia).

Adalimumab may increase the risk of reactivating hepatitis B virus in chronic carriers of the virus.

What is the dosage for adalimumab?

Adalimumab is injected under the skin. The recommended dose for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis is 40 mg every other week, but some patients may need weekly administration.
Crohn's disease is treated with 160 mg initially, followed by 80 mg two weeks later, then 40 mg every 2 weeks.
Juvenile idiopathic arthritis is treated with 20 or 40 mg every other week and plaque psoriasis is treated with 80 mg followed by 40 mg every other week.

Is adalimumab safe to take if I'm pregnant or breastfeeding?

Adalimumab has not been adequately studied in pregnant women.
Use of adalimumab by nursing mothers has not been adequately evaluated.

What else should I know about adalimumab?

What preparations of adalimumab are available?

Prefilled glass syringe: 20 mg/0.4 ml and 40 mg/0.8 ml; Prefilled pen: 40 mg/0.8 ml.

How should I keep adalimumab stored?

Adalimumab should be refrigerated at 2-8 C (36-46 F).

Summary

Adalimumab (Humira) is a drug prescribed for reducing the symptoms and signs of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, juvenile idiopathic arthritis, and Crohn's disease. Side effects, drug interactions, and pregnancy safety information should be reviewed prior to taking this medication. 

Adalat CC (NIFEDIPINE SUSTAINED ACTION-ORAL)

GENERIC NAME: NIFEDIPINE SUSTAINED-ACTION - ORAL (nye-FED-i-peen)

BRAND NAME(S): Adalat CC

USES: This medication is used alone or in combination with other drugs to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Nifedipine belongs to a class of medications known as calcium channel blockers. It works by relaxing blood vessels so blood can flow more easily.OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.This medication may also be used for certain types of chest pain (angina). It may help to increase your ability to exercise and decrease the frequency of angina attacks. This medication must be taken regularly to be effective. It should not be used to treat attacks of chest pain when they occur. Use other medications (e.g., sublingual nitroglycerin) to relieve attacks of chest pain as directed by your doctor. Consult your doctor or pharmacist for details.This medication may also be used to treat certain blood circulation disorders (Raynaud's syndrome).

HOW TO USE: Take this medication by mouth on an empty stomach, usually once daily or as directed by your doctor. Do not crush or chew this medication. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.Your doctor may gradually increase your dose. Follow your doctor's instructions carefully. Dosage is based on your medical condition and response to treatment.Avoid eating grapefruit or drinking grapefruit juice while being treated with this medication unless your doctor instructs you otherwise. Grapefruit juice can increase the amount of certain medications in your bloodstream. Consult your doctor or pharmacist for more details.Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.Do not suddenly stop taking this medication without consulting your doctor. Your condition may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.Tell your doctor if your condition worsens (e.g., increase in your routine blood pressure readings).

SIDE EFFECTS: Headache, dizziness, nausea, flushing, constipation, leg/muscle cramps, or sexual problems may occur. To reduce dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these unlikely but serious side effects occur: swelling of the ankles/feet, shortness of breath, unusual weakness/tiredness.Tell your doctor immediately if any of these rare but very serious side effects occur: fast/slow/irregular heartbeat, fainting, mental/mood changes, swollen/tender gums, vision changes.Although this medication is effective in preventing chest pain (angina), some people who already have severe heart disease may rarely develop worsening chest pain or a heart attack after starting this medication or increasing the dose. Get medical help right away if you experience: worsening chest pain, symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating).A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to other calcium channel blockers (e.g., felodipine, amlodipine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (e.g., congestive heart failure, aortic stenosis), liver problems, kidney problems, a certain metabolic disorder (porphyria).Before having surgery, tell your doctor or dentist that you are taking this medication.This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Nifedipine passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.


DRUG INTERACTIONS: See also How to Use section.Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: alpha blockers (e.g., doxazosin), beta blockers (e.g., propranolol, metoprolol), calcium or magnesium sulfate received through a vein, digoxin, fentanyl, melatonin, quinidine, certain drugs that may weaken the immune system (e.g., sirolimus, tacrolimus), drugs affecting liver enzymes that remove nifedipine from your body (e.g., cimetidine, nefazodone, quinupristin/dalfopristin, St. John's wort, azole antifungals such as itraconazole, macrolide antibiotics such as erythromycin, rifamycins such as rifampin, anti-seizure medicines such as carbamazepine/phenytoin).Check the labels on all your medicines (e.g., cough-and-cold products, diet aids, nonsteroidal anti-inflammatory drugs-NSAIDs for pain/fever reduction) because they may contain ingredients that could increase your blood pressure or heart rate (e.g., pseudoephedrine, phenylephrine, chlorpheniramine, diphenhydramine, clemastine, ibuprofen, naproxen). Ask your pharmacist about using those products safely.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting, fast/slow/irregular heartbeat.

NOTES: Do not share this medication with others.Lifestyle changes such as stress reduction programs, exercise, and dietary changes may increase the effectiveness of this medicine. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.Laboratory and/or medical tests (e.g., liver or kidney function tests, EKG) may be performed from time to time to monitor your progress or check for side effects. Consult your doctor for more details.Have your blood pressure checked regularly while taking this medication. Learn how to monitor your own blood pressure at home, and share the results with your doctor.There are different tablet strengths of this medication available. Some tablet strengths may not be used in place of others. Do not change tablet strengths or use a different number of tablets for your dose without consulting your doctor or pharmacist.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.


STORAGE: Store at room temperature below 86 degrees F (30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

Adalat CC (nifedipine)

What is nifedipine?

Nifedipine belongs to a class of medications called calcium channel blockers (CCBs) that are used to treat angina (heart pain), high blood pressure, and abnormal heart rhythms.

Is nifedipine available as a generic drug?

Yes

Do I need a prescription for nifedipine?

Yes

Why is nifedipine prescribed to patients?

Nifedipine is used for the treatment and prevention of angina resulting from either an increased workload on the heart (as with exercise) or spasm of the coronary arteries. It is used in the treatment of high blood pressure, to treat abnormally fast heart rhythms such as atrial fibrillation, and in the prevention of episodes of rapid heart rhythm originating from the atria of the heart.
It also is used to dilate blood vessels that go into spasm such as those causing Raynaud's phenomenon, a painful condition of the hands caused by spasm of the arteries supplying blood to the hands.
Non-FDA approved uses include:

• anal fissures (applied to the fissures),
• prevention of migraine headaches in adults,
• ureteral stones (as secondary therapy) and
• wound healing (applied to the skin).

  What are the side effects of nifedipine?

  
  Side effects of nifedipine are generally mild, and reversible. Most side effects are expected consequences of the dilation of the arteries. The most common side effects include:
  

  • Headache
  • Dizziness
  • Flushing
  • Edema (swelling) of the lower extremities

  Less common side effects include:
  

  • Nausea
  • Constipation

  Uncommon side effects include:
  

  • Muscle cramps
  • Wheezing
  • Over growth of gums
  • Erectile dysfunction
  • Excessive reduction in blood pressure
  
  

  What is the dosage for nifedipine?

  
  

  • The usual dose for nifedipine capsules for treating angina is 10 to 20 mg three times daily. Up to 20 to 30 mg every 6-8 hours daily may be required. The dose should not exceed 180 mg daily. For extended release tablets, the usual dose is 30 or 60 mg once daily. The maximum dose is 120 mg daily.
  • Hypertension is treated with 30-60 mg daily using extended release tablets. The maximum dose is 90 mg/day (Adalat CC) or 120 mg/day (Procardia XL).
  • Nifedipine can be taken with or without food.
  • The tablets and capsules should be swallowed whole and not bitten or cut in half.

    Which drugs or supplements interact with nifedipine?

    
    In rare instances, congestive heart failure has been associated with nifedipine, usually in patients already on a beta blocker, for example, propranolol (Inderal), metoprolol (Lopressor), etc. Excessive lowering of blood pressure (hypotension) during initiation of nifedipine treatment can occur, especially in patients already taking another blood pressure lowering drug.
    Generally, nifedipine is avoided in children.
    Nifedipine decreases the elimination of digoxin (Lanoxin) by the kidneys which can increase digoxin blood levels in the blood and give rise to digoxin toxicity. It is important, therefore, to monitor blood levels of digoxin in order to avoid toxicity.
    Nifedipine interferes with the breakdown of tacrolimus (Prograf) by the liver, which in turn causes elevated blood levels of tacrolimus and may increase the risk of toxicity from tacrolimus.
    Nifedipine reduces the blood levels of quinidine (Quinaglute, Quinidex, Quinora) which may reduce the effectiveness of quinidine. Conversely, blood levels of nifedipine are increased by quinidine and may lead to side effects from nifedipine.
    Cimetidine (Tagamet) interferes with breakdown by the liver of nifedipine and increases nifedipine blood levels. Therefore, cautious dosing is necessary when both medications are administered concurrently.
    Nifedipine should not be taken with grapefruit juice since grapefruit juice (one glass, approximately 200 ml) inhibits the breakdown of nifedipine by the liver and increases the levels of nifedipine in the blood.
    
    

    Is nifedipine safe to use during pregnancy or while breastfeeding?

    
    There are no adequate studies of nifedipine in pregnant women, and in general, it is avoided during pregnancy.
    Nifedipine is excreted in human breast milk. Generally, nifedipine is avoided in females who are nursing.
    

    What else should I know about nifedipine?

    
    

    What preparations of nifedipine are available?

    Capsules: 10 and 20 mg. Tablets: 30, 60, and 90 mg
    

    How should I keep nifedipine stored?

    Tablets should be stored at room temperature 15 C to 25 C (59 F to 77 F). They should be protected from light, moisture, and humidity.
    

    How does nifedipine work?

    Other drugs in the same class as nifedipine include:
    

    • amlodipine (Norvasc),
    • diltiazem (Cardizem LA, Tiazac),
    • felodipine (Plendil),
    • isradipine (Dynacirc),
    • nicardipine (Cardene),
    • nimodipine (Nimotop), and
    • verapamil (Covera-HS, Veralan PM, Calan).

    Like other CCBs, nifedipine works by blocking the flow of calcium into the muscle cells surrounding the arteries that supply blood to the heart (coronary arteries) as well as other arteries of the body. Since the inflow of calcium is what causes the muscle cells to contract, blocking the entry of calcium relaxes the muscles and dilates (widens) the arteries. By dilating coronary arteries, nifedipine increases the flow of blood to the heart. This treats and prevents angina which occurs when the flow of blood to the heart is not adequate to supply the heart with enough oxygen necessary to pump blood. Relaxing the muscles surrounding other arteries of the body lowers blood pressure and thereby reduces the pressure against which the heart must pump blood and function. This reduces the demand of the heart for oxygen--another mechanism by which CCBs treat and prevent angina. In addition, nifedipine slows conduction of the electrical current that travels through the heart that causes the muscle of the heart to contract. This effect can be used to correct abnormally rapid heartbeats.
    

    When was nifedipine approved by the FDA?

    The FDA approved nifedipine in December 1981.
    

    Summary

    Nifedipine (Adalat, Procardia, Afeditab, Nifediac) is in the drug class of calcium channel blockers (CCBs). Nifedipine (Adalat, Procardia, Afeditab, Nifediac) is prescribed for the treatment of angina, high blood pressure, and abnormal heart rhythms such as atrial fibrillation. Off label uses of nifedipine (Adalat, Procardia, Afeditab, Nifediac) Raynaud's phenomenon, anal fissures, and prevention of migraine headaches. Side effects, warnings and precautions, drug interactions, and safety during pregnancy information should be reviewed prior to taking this medication.