Moxapen may be available in the countries listed below.
Amoxicillin trihydrate (a derivative of Amoxicillin) is reported as an ingredient of Moxapen in the following countries:
International Drug Name Search
Piroxicam A may be available in the countries listed below.
Piroxicam is reported as an ingredient of Piroxicam A in the following countries:
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Glucobene may be available in the countries listed below.
Glibenclamide is reported as an ingredient of Glucobene in the following countries:
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Regulax may be available in the countries listed below.
Sodium Picosulfate is reported as an ingredient of Regulax in the following countries:
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Lac Stop may be available in the countries listed below.
Cabergoline is reported as an ingredient of Lac Stop in the following countries:
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Lospre may be available in the countries listed below.
Losartan potassium salt (a derivative of Losartan) is reported as an ingredient of Lospre in the following countries:
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Licomet may be available in the countries listed below.
Cimetidine is reported as an ingredient of Licomet in the following countries:
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Amoxicillin acis may be available in the countries listed below.
Amoxicillin trihydrate (a derivative of Amoxicillin) is reported as an ingredient of Amoxicillin acis in the following countries:
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Ronalgin may be available in the countries listed below.
Metamizole is reported as an ingredient of Ronalgin in the following countries:
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Wosulin Biphasic 50/50 may be available in the countries listed below.
Insulin Injection, Biphasic Isophane human (a derivative of Insulin Injection, Biphasic Isophane) is reported as an ingredient of Wosulin Biphasic 50/50 in the following countries:
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Lotan may be available in the countries listed below.
Hydrochlorothiazide is reported as an ingredient of Lotan in the following countries:
Losartan potassium salt (a derivative of Losartan) is reported as an ingredient of Lotan in the following countries:
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Cloranfenicol Fabra may be available in the countries listed below.
Chloramphenicol succinate (a derivative of Chloramphenicol) is reported as an ingredient of Cloranfenicol Fabra in the following countries:
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Lisipril may be available in the countries listed below.
Lisinopril is reported as an ingredient of Lisipril in the following countries:
Lisinopril dihydrate (a derivative of Lisinopril) is reported as an ingredient of Lisipril in the following countries:
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Tanezox may be available in the countries listed below.
Azithromycin dihydrate (a derivative of Azithromycin) is reported as an ingredient of Tanezox in the following countries:
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Fervex may be available in the countries listed below.
Diclofenac sodium salt (a derivative of Diclofenac) is reported as an ingredient of Fervex in the following countries:
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Acébutolol ratiopharm may be available in the countries listed below.
Acebutolol hydrochloride (a derivative of Acebutolol) is reported as an ingredient of Acébutolol ratiopharm in the following countries:
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Pan-Terramicina may be available in the countries listed below.
In some countries, this medicine may only be approved for veterinary use.
Oxytetracycline hydrochloride (a derivative of Oxytetracycline) is reported as an ingredient of Pan-Terramicina in the following countries:
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Carrashimease may be available in the countries listed below.
Tilactase is reported as an ingredient of Carrashimease in the following countries:
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Controlling inner eye pressure in patients with open-angle glaucoma. It may also be used for other conditions as determined by your doctor.
Dipivefrin is a sympathomimetic. It works by decreasing fluid formation inside the eyeball and increasing fluid drainage from the eyeball, which helps lower pressure inside the eye.
Contact your doctor or health care provider right away if any of these apply to you.
Some medical conditions may interact with Dipivefrin. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
Some MEDICINES MAY INTERACT with Dipivefrin. Tell your health care provider if you are taking any other medicines, especially any of the following:
This may not be a complete list of all interactions that may occur. Ask your health care provider if Dipivefrin 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.
Use Dipivefrin as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Ask your health care provider any questions you may have about how to use Dipivefrin.
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:
Blurred vision; burning; eye redness; headache; itching; sensitivity to light; stinging.
Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); decrease in vision; eye pain; fast heartbeat; irregular heartbeat; swelling of the eye or eyelids.
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: Dipivefrin side effects (in more detail)
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.
Store Dipivefrin at room temperature, between 59 and 77 degrees F (15 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Dipivefrin out of the reach of children and away from pets.
This information is a summary only. It does not contain all information about Dipivefrin. 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.
Glucofor may be available in the countries listed below.
Metformin hydrochloride (a derivative of Metformin) is reported as an ingredient of Glucofor in the following countries:
International Drug Name Search
Trihexifenidilo may be available in the countries listed below.
Trihexyphenidyl hydrochloride (a derivative of Trihexyphenidyl) is reported as an ingredient of Trihexifenidilo in the following countries:
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Leios may be available in the countries listed below.
Ethinylestradiol is reported as an ingredient of Leios in the following countries:
Levonorgestrel is reported as an ingredient of Leios in the following countries:
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Renatriol may be available in the countries listed below.
Calcitriol is reported as an ingredient of Renatriol in the following countries:
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Generic Name: flurbiprofen ophthalmic (FLUR bi PROE fen)
Brand Names: Ocufen
Flurbiprofen is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Flurbiprofen works by reducing hormones that cause inflammation and pain in the body.
Flurbiprofen ophthalmic may also be used for purposes not listed in this medication guide.
Before you receive flurbiprofen ophthalmic, tell your doctor if you are allergic to any medications, or if you have a bleeding or blood-clotting disorder or take a blood thinner such as warfarin (Coumadin).
Do not use other eye medications during treatment with flurbiprofen ophthalmic unless your doctor tells you to.
To make sure you can safely use flurbiprofen ophthalmic, tell your doctor if you have a bleeding or blood-clotting disorder.
Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
Flurbiprofen ophthalmic is usually given every 30 minutes beginning 2 hours before your surgery. If you receive this medication at the surgery center, the eye drops will be given by a healthcare professional.
If you have been given the medication to start using your drops at home on the day of your surgery, follow the instructions below.
To apply the eye drops:
Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Hold the dropper above the eye with the tip down. Look up and away from the dropper as you squeeze out a drop, then close your eye.
Gently press your finger to the inside corner of the eye (near your nose) for about 1 minute to keep the liquid from draining into your tear duct.
Use the eye drops only in the eye you are having surgery on.
Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.
If you use this medication at home, try not to miss any doses.
Call your doctor if you miss a dose of this medication. The timing of your doses in relation to your surgery is very important for the medication to be effective.
Do not use other eye medications during treatment with flurbiprofen ophthalmic unless your doctor tells you to.
eye pain or redness;
vision changes; or
severe burning, stinging, or itching of your eyes.
Less serious side effects may include mild burning, stinging, or itching of your eyes.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Tell your doctor about all other medications you use, especially a blood thinner such as warfarin (Coumadin).
This list is not complete and other drugs may interact with flurbiprofen ophthalmic. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
See also: Ocufen side effects (in more detail)
Hydrocortisone Na Succin. may be available in the countries listed below.
Hydrocortisone 21-(sodium succinate) (a derivative of Hydrocortisone) is reported as an ingredient of Hydrocortisone Na Succin. in the following countries:
International Drug Name Search
Lexaprofen may be available in the countries listed below.
Ibuprofen is reported as an ingredient of Lexaprofen in the following countries:
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Fosfomycin Trometamol may be available in the countries listed below.
Fosfomycin Trometamol (BANM) is known as Fosfomycin in the US.
International Drug Name Search
Glossary
| BANM | British Approved Name (Modified) |
Tetracyclin Nizhpharm may be available in the countries listed below.
Tetracycline hydrochloride (a derivative of Tetracycline) is reported as an ingredient of Tetracyclin Nizhpharm in the following countries:
International Drug Name Search
Cokenzen may be available in the countries listed below.
Candesartan cilexetil (a derivative of Candesartan) is reported as an ingredient of Cokenzen in the following countries:
Hydrochlorothiazide is reported as an ingredient of Cokenzen in the following countries:
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Generic Name: etoposide (Intravenous route)
e-TOE-poe-side
Severe myelosuppression with resulting infection or bleeding may occur with etoposide .
Severe myelosuppression with resulting infection or bleeding may occur with etoposide phosphate .
In the U.S.
In Canada
Available Dosage Forms:
Therapeutic Class: Antineoplastic Agent
Pharmacologic Class: Mitotic Inhibitor
Etoposide injection (also known as VP-16) is used in combination with other cancer medicines to treat cancer of the testicles and small cell lung cancer. It is also sometimes used to treat some other kinds of cancer in both males and females.
Etoposide belongs to the group of medicines known as antineoplastic agents. The exact way that etoposide acts against cancer is not known. However, it seems to interfere with the growth of the cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by etoposide, other effects will also occur. Some of these may be serious and must be reported to your doctor. Other effects, like hair loss, may not be serious but may cause concern. Some effects may not occur until months or years after the medicine is used.
Before you begin treatment with etoposide, you and your doctor should talk about the benefits of this medicine as well as the risks of using it.
This medicine is to be administered only by or under the immediate supervision of your doctor.
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, etoposide is used in certain patients with the following medical conditions:
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:
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.
Appropriate studies have not been performed on the relationship of age to the effects of etoposide injection in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of etoposide injection in the elderly. However, elderly patients are more likely to have unwanted side effects (e.g., infection, nausea and vomiting, hair loss), and have age-related kidney, liver, or heart problems, which may require caution in elderly patients receiving etoposide injection.
| Pregnancy Category | Explanation | |
|---|---|---|
| All Trimesters | D | Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk. |
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.
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 receiving 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 is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
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.
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. 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 may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
This section provides information on the proper use of a number of products that contain etoposide. It may not be specific to Dom-Etoposide. Please read with care.
A nurse or other trained health professional will give you this medicine in a hospital or cancer treatment center. This medicine is given through a needle placed in one of your veins. The medicine must be injected slowly, so your IV tube will need to stay in place for 30 to 60 minutes.
Etoposide is sometimes given together with certain other medicines. If you are using a combination of medicines, make sure that you take each one at the proper time and do not mix them. If you are taking some of these medicines by mouth, ask your doctor to help you plan a way to remember to take your medicines at the right times.
Etoposide often causes nausea, vomiting, and loss of appetite, which may be severe. However, it is very important that you continue to receive the medicine, even if you begin to feel ill. Ask your doctor for ways to lessen these effects.
It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
Etoposide can temporarily lower the number of white blood cells in your blood, increasing the chance of your getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:
This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor or nurse right away if you have chills; fever; lightheadedness, dizziness, or fainting; fast, pounding heartbeat; swelling of the face, tongue, and throat; or trouble with breathing after you receive the medicine.
Injection site reactions may occur while you are receiving this medicine. Tell your doctor right away if you notice swelling, pain, or redness at the injection site.
This medicine may cause leukemia (cancer of the blood or bone marrow) in rare cases. Talk with your doctor about any concerns you have about this.
Talk with your doctor before getting flu shots or other vaccines while you are receiving this medicine because there are certain vaccines that you should not receive.
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 or nurse immediately if any of the following side effects occur:
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:
This medicine often causes a temporary loss of hair. After treatment with etoposide has ended, normal hair growth should return.
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: Dom-Etoposide 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.
Picalm may be available in the countries listed below.
Piketoprofen hydrochloride (a derivative of Piketoprofen) is reported as an ingredient of Picalm in the following countries:
International Drug Name Search
Lomudal may be available in the countries listed below.
Cromoglicic Acid disodium salt (a derivative of Cromoglicic Acid) is reported as an ingredient of Lomudal in the following countries:
International Drug Name Search
In some countries, this medicine may only be approved for veterinary use.
Ph. Eur.
Antidiabetic agent
Insulin with rapid action (normal)
Neutral, sterile solution of bovine, porcine or human insulin
International Drug Name Search
Glossary
| BAN | British Approved Name |
| DCF | Dénomination Commune Française |
| IS | Inofficial Synonym |
| JAN | Japanese Accepted Name |
| OS | Official Synonym |
| PH | Pharmacopoeia Name |
| Ph. Eur. | European Pharmacopoeia |
| USAN | United States Adopted Name |
Trimidura may be available in the countries listed below.
Trimipramine maleate (a derivative of Trimipramine) is reported as an ingredient of Trimidura in the following countries:
International Drug Name Search
dye-piv-EF-rin
In the U.S.
Available Dosage Forms:
Therapeutic Class: Antiglaucoma
Pharmacologic Class: Adrenergic
Chemical Class: Alkylarylamine
Dipivefrin is used to treat certain types of glaucoma.
dipivefrin is available only with your doctor's prescription.
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 dipivefrin, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to dipivefrin 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.
Studies on dipivefrin have been done only in adult patients, and there is no specific information comparing use of dipivefrin in children with use in other age groups.
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 dipivefrin in the elderly with use in other age groups, dipivefrin is not expected to cause different side effects or problems in older people than it does in younger adults.
| 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. |
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.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
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.
The presence of other medical problems may affect the use of dipivefrin. Make sure you tell your doctor if you have any other medical problems, especially:
Use dipivefrin only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of too much medicine being absorbed into the body and the chance of side effects.
To use:
The dose of dipivefrin 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 dipivefrin. 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.
If you miss a dose of dipivefrin, apply 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.
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.
Your doctor should check your eye pressure at regular visits.
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 as soon as possible if any of the following side effects occur:
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:
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: dipivefrin Ophthalmic 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.
Laxyl may be available in the countries listed below.
Bromazepam is reported as an ingredient of Laxyl in the following countries:
International Drug Name Search
Cefomycin may be available in the countries listed below.
Cefoperazone sodium salt (a derivative of Cefoperazone) is reported as an ingredient of Cefomycin in the following countries:
International Drug Name Search
Lanzul may be available in the countries listed below.
Lansoprazole is reported as an ingredient of Lanzul in the following countries:
International Drug Name Search
Licoklin may be available in the countries listed below.
Tetracycline hydrochloride (a derivative of Tetracycline) is reported as an ingredient of Licoklin in the following countries:
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Licuagen may be available in the countries listed below.
Cilostazol is reported as an ingredient of Licuagen in the following countries:
International Drug Name Search
Class: Amphetamines
VA Class: CN801
CAS Number: 51-63-8
Brands: Adderall, Dexedrine, DextroStat
Amphetamines have a high potential for abuse.101 102 103
Administration of amphetamines for prolonged periods of time may lead to drug dependence.101 102 103 b
Particular attention should be paid to the possibility of individuals obtaining amphetamines for nontherapeutic use or distribution to others, and the drugs should be prescribed or dispensed sparingly.101 102 103
The possibility that family members may abuse the patient’s medication should be considered.e
Possible sudden death and serious cardiovascular events, particularly in individuals who abuse amphetamines.101 102 103 h (See Sudden Death and Serious Cardiovascular Events under Cautions.)
Dextrorotatory isomer of amphetamine; noncatechol, sympathomimetic amine with CNS-stimulating activity.102 b
Used as an adjunct to psychological, educational, social, and other remedial measures in the treatment of attention deficit hyperactivity disorder (ADHD) (hyperkinetic disorder, hyperkinetic syndrome of childhood, minimal brain dysfunction).101 102 103 b e
Can be used for ADHD in pediatric (children, adolescents) as well as adult patients.d e
Almost all studies comparing behavioral therapy versus stimulants alone have shown a much stronger therapeutic effect from stimulants than from behavioral therapy, and stimulants (e.g., amphetamines, methylphenidate) remain the drugs of choice for the management of ADHD.d e
Drug therapy is not indicated in all patients with ADHD, and such therapy should be considered only after a complete evaluation including medical history has been performed.b e
Use should depend on age, adequate diagnosis (based on medical, special psychological, educational, and social resources), and the clinician’s assessment of the severity and duration of symptoms and should not depend solely on one or more behavioral characteristics.103 b e
Not recommended for ADHD symptoms associated with acute stress reactions.b
Used as a stimulant to reduce daytime sleepiness in the management of narcolepsy.101 102 b
Amphetamines remain the mainstay of treatment for narcolepsy based on a long record of clinical experience.f
Tolerance to the clinical effects may develop with long-term therapy, particularly at high dosages.f
Has been used as an adjunct to caloric restriction and behavioral modification in the short-term treatment of exogenous obesity†.d However, because of the limited efficacy (short-lived) and risk of abuse, such use no longer is included in the FDA-approved labeling101 102 103 and is discouraged.d
The anorexigenic effect appears to be temporary, seldom lasting more than a few weeks, and tolerance may occur.d
Obesity usually is a chronic disease, and short-term or intermittent therapy with anorexigenic drugs is unlikely to maintain a long-term benefit.
When used as an anorexigenic, the dose is given 30–60 minutes before meals.d
Administer initial dose on awakening;101 102 b when administered in divided doses, additional doses are given at intervals of 4–6 hours.101 102 b Because of potential for insomnia, avoid administering in the late evening.101 102 b
Administer initial dose on awakening.b Because of potential for insomnia, avoid administering in the late evening.102
Administer on awakening.103 Because of potential for insomnia, avoid administering in the afternoon.103
Administer capsules with or without food;103 capsules may be swallowed intact or the entire contents of a capsule(s) may be sprinkled on a small amount of applesauce immediately prior to administration.103 Do not subdivide the capsule contents.103 Do not chew or crush the pellets contained in the capsules and do not store the sprinkle/food mixture for later use.103
Dosages of dextroamphetamine sulfate alone and of total amphetamine base equivalence are the same.101 103 e f
Dextroamphetamine sulfate extended-release capsules or fixed-combination extended-release capsules containing various salts of dextroamphetamine and amphetamine can be substituted for their respective conventional short-acting preparations if less-frequent daily dosing is desirable.102 103 b
Dosage of fixed-combination preparations containing various salts of dextroamphetamine and amphetamine is expressed as total amphetamine base equivalence.101 103 b
Adjust dosage according to individual response and tolerance; the smallest dose required to produce the desired response should always be used.101 102 103 b
When possible, therapy should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued treatment.101 102 103 b
Dosage titration usually requires 2–4 weeks.e
Dosing in pediatric patients may begin with once-daily administration in the early morning, adding a noon dose if the effect does not last throughout the school day.e Increasing the morning dose may extend its duration.e A third dose may be added at around 4 p.m. if necessary.e
Children 3–5 years of age: Initially, 2.5 mg daily; the daily dosage is increased in 2.5-mg increments at weekly intervals until the optimum response is attained.101 102 b e
Children ≥6 years of age: Initially, 5 mg once or twice daily; the daily dosage is increased in 5-mg increments at weekly intervals until the optimum response is attained.101 102 b e Total daily dosage rarely should exceed 40 mg.101 102 b e
Total daily dosage of dextroamphetamine sulfate is the same for extended-release capsules (Dexedrine Spansules) and conventional tablets (Dexedrine).102
Although extended-release capsules usually are administered once daily,102 some patients may benefit from dividing the dosage into 2 doses daily.
Children 3–5 years of age: Dosage must be initiated and titrated with conventional tablets in this age group.102 Can substitute with once-daily dosing only when the total daily dose is divisible by 5 mg.102
Children ≥6 years of age: Initially, 5 or 10 mg once daily; the daily dosage is increased in 5-mg increments at weekly intervals until the optimum response is attained.102 b Total daily dosage rarely should exceed 40 mg.102 b
Children 6–12 years of age: Initially, 10 mg once daily; daily dosage may be increased in 5- or 10-mg increments at weekly intervals to a maximum dosage of 30 mg daily.103 b Alternatively, initiate with 5 mg once daily when lower initial dosage is appropriate.103 b
Adolescents 13–17 years of age: Initially, 10 mg once daily.103 Increase to 20 mg once daily after 1 week if symptoms not adequately controlled.103 No evidence that dosages >20 mg daily provide any additional benefit.103
When switching from fixed-combination conventional tablets (Adderall) to fixed-combination extended-release capsules (Adderall XR), the total daily dosage may remain the same but may be given once daily.103 b
When intolerable adverse effects occur (e.g., insomnia, anorexia), dosage should be reduced.101 102 b
Children 6–12 years of age: Initially, 5 mg daily; daily dosage is increased in 5-mg increments at weekly intervals until the optimum response is attained.101 102 b
Children ≥12 years of age: Initially, 10 mg daily; daily dosage is increased in 10-mg increments at weekly intervals until the optimum response is attained.101 102 b
Maintenance: Usually, 5–60 mg daily, depending on patient age and response, given in divided doses.101 102 b
Total daily dosage of dextroamphetamine sulfate is the same for extended-release capsules (Dexedrine Spansules) and conventional tablets (Dexedrine).102
Although extended-release capsules usually are administered once daily,102 some patients may benefit from dividing the dosage into 2 doses daily.
Children 6–12 years of age: Initially, 5 mg once daily; daily dosage is increased in 5-mg increments at weekly intervals until the optimum response is attained.102 b
Children ≥12 years of age: Initially, 10 mg once daily; daily dosage is increased in 10-mg increments at weekly intervals until the optimum response is attained.102 b
Maintenance: Usually, 5–60 mg once daily, depending on patient age and response, given in divided doses.102 b
Dosage titration usually requires 2–4 weeks.e
Initially, 5 mg once or twice daily; the daily dosage is increased in 5- to 10-mg increments at weekly intervals until the optimum response is attained.101 102 b e Total daily dosage rarely should exceed 40 mg.101 102 b e
Total daily dosage of dextroamphetamine sulfate is the same for extended-release capsules (Dexedrine Spansules) and conventional tablets (Dexedrine).102
Although extended-release capsules usually are administered once daily,102 some patients may benefit from dividing the dosage into 2 doses daily.
Initially, 5 or 10 mg once daily; the daily dosage is increased in 5-mg increments at weekly intervals until the optimum response is attained.102 b e Total daily dosage rarely should exceed 40 mg.102 b e
20 mg once daily as initial therapy or when switching from other drugs.103 No evidence that dosages >20 mg daily provide any additional benefit.103
When switching from fixed-combination conventional tablets (Adderall) to fixed-combination extended-release capsules (Adderall XR), the total daily dosage may remain the same but may be given once daily.103 b
When intolerable adverse effects occur (e.g., insomnia, anorexia), dosage should be reduced.101 102 b
Initially, 10 mg daily; daily dosage is increased in 10-mg increments at weekly intervals until the optimum response is attained.101 102 b
Maintenance: Usually, 5–60 mg daily, depending on response, given in divided doses.101 102 b
Excessive dosage can cause pediatric patients to become overfocused on the medication or to appear dull or overly restricted. Rarely, psychotic reactions, mood disturbances, or hallucinations can occur.
Dosage rarely should exceed a total daily dosage of 40 mg.101 b e Individual doses rarely should exceed 10 mg each in children <25 kg.e
Dosage rarely should exceed a total daily dosage of 40 mg.102 b e Individual doses rarely should exceed 10 mg each in children <25 kg.e
Children 6–12 years of age: Dosages >30 mg daily have not been studied systematically.103 b
Adolescents 13–17 years of age: Dosages up to 40 mg daily in individuals weighing ≤75 kg or 60 mg daily in those weighing >75 kg have been used in clinical studies; however, no evidence that dosages >20 mg daily provide any additional benefit.103
Long-term use (>3 weeks in children or >4 weeks in adolescents) has not been studied systematically.103 If used for long-term therapy, periodically reevaluate the usefulness of the drug.103
Dosages up to 0.9 mg/kg daily but rarely exceeding 40 mg daily.101 102 b e Such higher doses may be more likely in adults than in school-aged children because of increased dosing frequency to cover a longer work day.e
Tolerance is more likely with relatively high dosages.e
Dosages up to 0.9 mg/kg daily but rarely exceeding 40 mg daily.102 b e Such higher doses may be more likely in adults than in school-aged children because of increased dosing frequency to cover a longer work day.e
Tolerance is more likely with relatively high dosages.e
Dosages up to 60 mg daily have been evaluated in clinical studies; however, no evidence that dosages >20 mg daily provide any additional benefit.103
Long-term use (>4 weeks) has not been studied systematically.103 If used for long-term therapy, periodically reevaluate the usefulness of the drug.103
No specific hepatic dosage recommendations.101 102 103
No specific renal dosage recommendations.101 102 103
No specific geriatric dosage recommendations.101 103
Contraindicated in patients with hypersensitivity or idiosyncrasy to the sympathomimetic amines,101 102 103 d symptomatic cardiovascular disease,101 102 103 d hyperthyroidism,101 102 103 d moderate to severe hypertension,101 102 103 d glaucoma,101 102 103 d e or advanced arteriosclerosis;101 102 103 d within 14 days of MAO inhibitor therapy;101 102 103 d e and in agitated patients.101 102 103 d
Although amphetamines generally should not be used in patients with a history of drug abuse,101 102 103 d e some experts state that this is not an absolute contraindication, provided the patient can be monitored more carefully than would otherwise be indicated.e
Sudden unexplained death, stroke, and MI reported in adults with ADHD receiving usual dosages of stimulants; sudden death also reported in children and adolescents with structural cardiac abnormalities or other serious cardiac conditions receiving usual dosages of the drugs.102 103 h
Epidemiologic data suggest a possible association between use of stimulants and sudden unexplained death in healthy children and adolescents.i j k FDA unable to conclude that these data affect evaluation of overall risk and benefit of stimulants used to treat ADHD in children and adolescents.i FDA is conducting an ongoing safety review of amphetamines and other stimulants to evaluate possible link between use of these agents and sudden death in children.i j k Pediatric patients with ADHD and their parents should avoid discontinuing the child’s use of such stimulants before consulting a clinician.i
Thoroughly review medical history (including evaluation for family history of sudden death or ventricular arrhythmia) and perform physical examination in all children, adolescents, and adults being considered for stimulant therapy; if initial findings suggest presence of cardiac disease, perform further cardiac evaluation (e.g., ECG, echocardiogram).102 103
In general, avoid use of CNS stimulants in patients with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, CAD, or other serious cardiac conditions.102 103 (See Contraindications under Cautions.)
Patients who develop exertional chest pain, unexplained syncope, or other manifestations suggestive of cardiac disease during stimulant therapy should undergo prompt cardiac evaluation.102 103
Possible modest increases in average BP (i.e., by about 2–4 mm Hg) and heart rate (i.e., by about 3–6 bpm); larger increases may occur.102 103 Modest increases not expected to have short-term sequelae; however, monitor all patients for larger changes in BP and heart rate.102 103
Caution advised in patients with underlying medical conditions that might be affected by increases in BP or heart rate (e.g., hypertension, heart failure, recent MI, ventricular arrhythmia).102 103
May exacerbate symptoms of behavior disturbance and thought disorder in patients with preexisting psychotic disorder.102 103
Psychotic symptoms (e.g., hallucinations, delusional thinking) may occur with usual dosages in children and adolescents without prior history of psychotic illness.102 103 If psychotic symptoms occur, consider causal relationship to stimulants, and discontinue therapy as appropriate.102 103
May precipitate mixed or manic episodes in ADHD patients with comorbid bipolar disorder; use with caution in these patients.102 103 Prior to initiating therapy, carefully screen patients with ADHD and comorbid depressive symptoms to identify risk for bipolar disorder; screening should include a detailed psychiatric history (e.g., family history of suicide, bipolar disorder, or depression).102 103
Manic symptoms may occur with usual dosages in children and adolescents without prior history of mania.102 103 If manic symptoms occur, consider causal relationship to stimulants, and discontinue therapy as appropriate.102 103
Aggressive behavior and hostility (frequently observed in children and adolescents with ADHD) reported in patients receiving drug therapy for ADHD.102 103 No systematic evidence that stimulants cause these adverse effects; however, monitor patients beginning treatment for ADHD for onset or worsening of aggressive behavior or hostility.102 103
Long-term (i.e., >14 months) administration expected to cause at least a temporary suppression of normal weight and/or height patterns in some children and adolescents.102 103 Dose-related weight loss reported in adolescents during first 4 weeks of therapy with fixed-combination extended-release capsules.103
Manufacturers recommend monitoring growth during treatment; patients not growing or gaining weight as expected may require temporary discontinuance of treatment.101 102 103 However, AAP states that studies of stimulants in children found little or no decrease in expected height, with any decrease in growth early in treatment being compensated for later on.
Possible lowering of seizure threshold in patients with history of seizures, in those with prior EEG abnormalities but no history of seizures, and, very rarely, in those without history of seizures and with no prior evidence of EEG abnormalities.102 103 If seizures occur, discontinue therapy.102 103
Visual disturbances (difficulty with accommodation, blurred vision) reported with stimulants.102 103
Some commercially available preparations of dextroamphetamine (e.g., DextroStat, Dexedrine tablets) contain the dye tartrazine (FD&C yellow No. 5), which may cause allergic reactions including bronchial asthma in susceptible individuals.102 b Incidence of tartrazine sensitivity is low, but it frequently occurs in patients who are sensitive to aspirin.b
Least amount of amphetamine feasible should be prescribed or dispensed at one time in order to minimize possible overdosage.101 102 103
Amphetamines reported to exacerbate motor and phonic tics and Tourette’s syndrome.101 102 103 However, a history of tics or their development during therapy is not an absolute contraindication to continued use.e Several controlled studies have not found stimulants to worsen or precipitate tics or Tourette’s syndrome.e Nevertheless, evaluate for presence of tics and Tourette’s syndrome in children and their families prior to initiating stimulant therapy.102 103 d
Category C.101 102 103 f
Risk of prematurity, low birth weight, and withdrawal symptoms (e.g., dysphoria, lassitude, agitation) in infants born to dependent women.101 102 103 f
Distributed into milk.101 103 f Discontinue nursing or the drug.101 103
Not recommended for ADHD in children <3 years of age.101 102 103 e
Aggressive behavior, hostility, and psychotic (e.g., hallucinations, delusional thinking) or manic symptoms reported in children and adolescents receiving stimulants for management of ADHD.102 103 (See Warnings under Cautions.)
Sudden death reported in children and adolescents with structural cardiac abnormalities or other serious cardiac conditions receiving usual dosages of stimulants.102 103 Epidemiologic data also suggest a possible association between use of stimulants and sudden death in healthy children and adolescents.i j k (See Sudden Death and Serious Cardiovascular Events under Cautions.)
Long-term administration expected to cause at least a temporary suppression of normal weight and/or height patterns in some children and adolescents.102 103 (See Growth Suppression under Cautions.)
Possible inhibition of drug elimination, resulting in prolonged exposure.103
Possible inhibition of drug elimination, resulting in prolonged exposure.103
Most commonly abdominal pain (stomachache), loss of appetite, insomnia.103
Also, palpitations,101 102 103 tachycardia,101 102 103 elevation of BP,101 102 103 overstimulation,101 102 103 restlessness,101 102 103 dizziness,101 102 103 euphoria,101 102 103 dyskinesia,101 102 103 dysphoria,101 102 103 tremor,101 102 103 headache,101 102 103 dryness of mouth,101 102 103 taste aberration,101 103 diarrhea,101 102 103 constipation,101 102 103 abdominal bloating,101 103 impotence,101 102 103 changes in libido.101 102 103
Isolated reports of cardiomyopathy associated with chronic amphetamine use.101 102 103
Anorexia and weight loss may occur as undesirable effects when amphetamines are used for other than the anorectic effect.101 102 103
Inhibits MAO.103
Amphetamine or metabolites modestly inhibit CYP2D6, 1A2, and 3A4 in vitro.103 In vivo effects on metabolism of drugs metabolized by CYP isoenzymes not known.103
Drug or Test | Interaction | Comments |
|---|---|---|
Acidifying agents, GI (ascorbic acid, glutamic acid hydrochloride, reserpine) | Decreases absorption, serum concentrations, and efficacy of amphetamines101 102 103 | |
Acidifying agents, urinary (ammonium chloride, sodium acid phosphate) | Increases urinary excretion and decreases serum concentrations and efficacy of amphetamines101 102 103 | |
Adrenergic blockers | Potential inhibition of adrenergic blockade101 102 103 | |
Alkalinizing agents, GI (antacids, sodium bicarbonate) | Increases absorption and serum concentrations and potentiates the effects of amphetamines101 102 103 | Avoid concomitant use103 |
Alkalinizing agents, urinary (acetazolamide and some thiazides) | Decreases urinary excretion and increases serum concentrations and potentiates the effects of amphetamines101 102 103 | |
Antidepressants, tricyclic (desipramine, protriptyline) | Enhanced activity of tricyclic antidepressants; desipramine or protriptyline cause striking and sustained increases in the concentration of dextroamphetamine in the brain; cardiovascular effects can be potentiated101 102 103 | |
Antihistamines | May counteract the sedative effects of antihistamines101 102 103 | |
Antihypertensives | May antagonize the hypotensive effects of antihypertensives101 102 103 | |
Chlorpromazine | Inhibits the central stimulant effects of amphetamines by blocking dopamine and norepinephrine receptors101 102 103 | Can be used to treat amphetamine poisoning101 102 d |
Ethosuximide | Intestinal absorption may be delayed by amphetamines101 102 103 | |
Haloperidol | Inhibits the central stimulant effects of amphetamines by blocking dopamine receptors101 102 103 | |
Lithium carbonate | May inhibit the anorectic and stimulatory effects of amphetamine101 102 103 | |
MAO inhibitors | Slow the metabolism of amphetamines, increasing their effect on the release of norepinephrine and other monoamines leading to headaches and other signs of hypertensive crisis101 102 103 Toxic neurologic effects, hypertensive crisis, and malignant hyperpyrexia can occur, sometimes with fatal results101 102 103 | Amphetamines contraindicated in patients currently or recently (within 14 days) receiving MAO inhibitor101 102 103 |
Meperidine | Amphetamines potentiate the analgesic effect of meperidine101 102 103 | |
Methenamine | Acidifying agents used with methenamine increase urinary excretion and decrease efficacy of amphetamines101 102 103 | |
Norepinephrine | Amphetamines enhance the adrenergic effects of norepinephrine101 102 103 | |
Phenobarbital | Amphetamines may delay absorption of phenobarbital; concomitant use may produce a synergistic anticonvulsant action101 102 103 | |
Phenytoin | Amphetamines may delay absorption of phenytoin; concomitant use may produce a synergistic anticonvulsant action101 102 103 | |
Propoxyphene | In propoxyphene overdosage, amphetamine CNS stimulation is potentiated and fatal convulsions can occur101 102 103 | |
Sympathomimetic agents | Enhanced activity of sympathomimetic agents102 103 | |
Test, plasma corticosteroids | Can elevate plasma corticosteroid concentrations; this increase is greatest in the evening101 102 103 | |
Test, urinary steroids | May interfere with urinary steroid determinations101 102 103 | |
Veratrum alkaloids | Amphetamines inhibit the hypotensive effect of veratrum101 102 103 |
Similar for dextroamphetamine sulfate extended-release capsules versus immediate-release tablets.102
Plasma concentration-time profiles for fixed combinations containing various salts of dextroamphetamine and amphetamine are similar for single 20-mg extended-release dose versus two 10-mg immediate-release doses given 4 hours apart.103
Peak plasma concentration and AUC of amphetamines decrease with increasing body weight in individuals receiving fixed-combination extended-release capsules (Adderall XR).103
Therapeutic effects persist for 4–24 hours.PDH
Food does not affect the rate or extent of absorption of dextroamphetamine sulfate from the extended-release capsules (e.g., Dexedrine Spansules).102
Food does not affect the extent of absorption of the fixed-combination extended-release preparation (Adderall XR), but prolongs Tmax by 2.5 hours (for d-amphetamine) and 2.1 hours (for l-amphetamine).103 Opening the capsule and sprinkling the contents on applesauce results in comparable absorption to the intact capsule taken in the fasted state.103
Tmax, immediate-release dextroamphetamine sulfate: About 3 hours.101 102
Tmax, extended-release dextroamphetamine sulfate: About 8 hours.102
Tmax, immediate-release fixed combinations containing various salts of dextroamphetamine and amphetamine: About 3 hours.103
Tmax, extended-release fixed combinations containing various salts of dextroamphetamine and amphetamine: About 7 hours.103
Therapeutic plasma concentrations are 5–10 mcg/dL.PDH
Distributed widely throughout body, with high levels in the brain.PDH
Apparently crosses the placenta since withdrawal manifestations have occurred in neonates.101 102 103 f
Distributed into milk in concentrations 3–7 times maternal blood concentrations.f
Volume of distribution increases with increasing body weight in individuals receiving fixed-combination extended-release capsules.103
Metabolized to several active metabolites.103
Enzymes involved in metabolism not clearly defined; however, CYP2D6 is involved with formation of at least one metabolite.103 Because CYP2D6 is genetically polymorphic, potential variability in metabolism among patients exists.
