Natural Fiber Therapy

Generic Name: psyllium (SIL ee um)

Brand Names: Fiberall, Hydrocil, Konsyl, Konsyl Orange Sugar-free, Konsyl-D, Konsyl-Orange, Laxmar, Laxmar Orange, Laxmar Sugar Free, Metamucil, Metamucil Berry Burst Smooth Texture Sugar Free, Metamucil Orange Coarse Milled Original Texture, Metamucil Orange Smooth Texture, Metamucil Orange Smooth Texture Sugar Free, Metamucil Original Texture Regular, Metamucil Pink Lemonade Smooth Texture Sugar-Free, Metamucil Unflavored Coarse Milled Original Texture, Metamucil Unflavored Smooth Texture Sugar Free, Natural Fiber Therapy, Perdiem Fiber Powder, Reguloid

What is Natural Fiber Therapy (psyllium)?

Psyllium is a bulk-forming fiber laxative. Psyllium works by absorbing liquid in the intestines and swelling to create a softer, bulky stool that is easier to pass.

Psyllium is used to treat occasional constipation or bowel irregularity. Psyllium may also be used to treat diarrhea and may help lower cholesterol when used together with a diet low in cholesterol and saturated fat.

Psyllium may also be used for purposes not listed in this product guide.

What is the most important information I should know about Natural Fiber Therapy (psyllium)?

Laxatives may be habit-forming if they are used too often or for too long. This can lead to damage of intestinal nerves or muscle tissues. Do not take psyllium for longer than directed on the label or prescribed by your doctor. You should not take this product if you are allergic to psyllium, or if you have trouble swallowing, a sudden change in bowel habits that lasts longer than 2 weeks, severe nausea, vomiting, or stomach pain, or if you have ever had a skin rash while taking psyllium.

Also talk with your doctor before using psyllium if you have a colostomy or ileostomy, rectal bleeding, or a blockage in your intestines.

Stop using psyllium and call your doctor at once if you have choking or trouble swallowing, severe stomach pain or cramping, nausea or vomiting, constipation that lasts longer than 7 days, rectal bleeding, or itchy skin rash. Do not take psyllium for longer than 7 days in a row unless your doctor has told you to.

What should I discuss with my healthcare provider before taking Natural Fiber Therapy (psyllium)?

Laxatives may be habit-forming if they are used too often or for too long. This can lead to damage of intestinal nerves or muscle tissues. Do not take psyllium for longer than directed on the label or prescribed by your doctor. You should not take this product if you are allergic to psyllium, or if you have:

• 
  

  trouble swallowing;

  
  


• 
  

  a sudden change in bowel habits that lasts longer than 2 weeks;

  
  


• 
  

  severe nausea, vomiting, or stomach pain; or

  
  


• 
  

  if you have ever had a skin rash while taking psyllium.

  
  

Ask a doctor or pharmacist if it is safe for you to take this medicine if you have:

• 
  

  a colostomy or ileostomy;

  
  


• 
  

  rectal bleeding; or

  
  


• 
  

  a blockage in your intestines.

  
  

Psyllium products may contain sugar, sodium, or artificial sweeteners. This may be of concern to you if you have diabetes, high blood pressure, or phenylketonuria (PKU). Check the product label if you have any of these conditions.

Psyllium is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether psyllium passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Natural Fiber Therapy (psyllium)?

Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Take psyllium with a full glass (at least 8 ounces) of water or another liquid. Taking psyllium without enough liquid may cause it to swell in your throat and cause choking. Drinking plenty of fluids each day while you are taking psyllium will also help improve bowel regularity.

The psyllium wafer must be chewed before you swallow it.

Do not swallow psyllium powder dry. It must be mixed with liquid. Place the psyllium powder into an empty glass and add at least 8 ounces of water or other liquid such as fruit juice. Stir this mixture and drink all of it right away.

If the powder and liquid mixture is too thick, add more liquid. After drinking the entire mixture, add a little more liquid to the same glass, swirl gently and drink right away to make sure you get the entire dose of psyllium.

Psyllium may be only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

It may take up to 3 days of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 2 or 3 days of treatment.

Do not take psyllium for longer than 7 days in a row unless your doctor has told you to. Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Since psyllium is used as needed, it does not have a daily dosing schedule. Call your doctor promptly if your symptoms do not improve after using psyllium.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, and stomach pain. Using a laxative too often or for too long may cause severe medical problems involving your intestines.

What should I avoid while taking Natural Fiber Therapy (psyllium)?

Avoid taking other oral (by mouth) medications within 2 hours before or after you take psyllium. Bulk-forming laxatives can make it harder for your body to absorb other medications, possibly making them less effective.

Avoid breathing in the dust from psyllium powder when mixing. Inhaling psyllium dust may cause an allergic reaction.

If you take psyllium as part of a cholesterol-lowering treatment plan, avoid eating foods that are high in fat or cholesterol. Your treatment will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

Natural Fiber Therapy (psyllium) side effects

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

• 
  

  choking or trouble swallowing;

  
  


• 
  

  severe stomach pain, cramping, nausea or vomiting;

  
  


• 
  

  constipation that lasts longer than 7 days;

  
  


• 
  

  rectal bleeding; or

  
  


• 
  

  itchy skin rash.

  
  

Less serious side effects may include:

• 
  

  bloating; or

  
  


• 
  

  minor change in your bowel habits.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Natural Fiber Therapy (psyllium)?

Tell your doctor about all other medications you use, especially:

• 
  

  a blood thinner such as warfarin (Coumadin, Jantoven); or

  
  


• 
  

  demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

  
  

This list is not complete and other drugs may interact with psyllium. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Natural Fiber Therapy resources

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

• Konsyl Powder MedFacts Consumer Leaflet (Wolters Kluwer)


• Metamucil MedFacts Consumer Leaflet (Wolters Kluwer)

Compare Natural Fiber Therapy with other medications

• Constipation
• Dietary Fiber Supplementation
• Irritable Bowel Syndrome

Where can I get more information?

• Your pharmacist can provide more information about psyllium.

See also: Natural Fiber Therapy side effects (in more detail)

Nebcin injection

Generic Name: tobramycin (injection) (toe bra MYE sin)

Brand Names: Nebcin

What is Nebcin (tobramycin (injection))?

Tobramycin is in a group of antibiotics called aminoglycosides (ah-meen-oh-GLY-ko-sides). Tobramycin fights infections that are caused by bacteria.

Tobramycin injection is used to treat bacterial infections of the skin, heart, stomach, brain and spinal cord, respiratory system, and urinary tract. It is also used in the treatment of cystic fibrosis. Tobramycin injection is sometimes used together with other antibiotics.

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

What is the most important information I should know about Nebcin (tobramycin (injection))?

Do not use this medication without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

There may be other drugs that can affect tobramycin injection. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Contact your doctor promptly if you have any hearing loss or ringing in your ears, even if these side effects occur long after you have stopped using tobramycin injection.

Other serious side effects include urinating less than usual or not at all, muscle stiffness or uncontrolled twitching, and wheezing, chest tightness, or trouble breathing.

Use this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Tobramycin injection will not treat a viral infection such as the common cold or flu. Tobramycin injection can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my health care provider before using Nebcin (tobramycin (injection))?

Do not use this medication if you are allergic to tobramycin or other aminoglycosides such as amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), neomycin (Mycifradin, Neo-Fradin, Neo-Tab), netilmicin (Netromycin), or streptomycin.

Before using this medication, tell your doctor if you are allergic to any drugs, or if you have:

• 
  

  kidney disease;

  
  


• 
  

  a muscle disorder such as myasthenia gravis;

  
  


• 
  

  Parkinson's disease;

  
  


• 
  

  asthma; or

  
  


• 
  

  a metabolic disorder such as high or low levels of potassium, calcium, or magnesium in your blood.

  
  

If you have any of these conditions, you may need a dose adjustment or special tests to safely use tobramycin.

FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use tobramycin injection without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Tobramycin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more likely to have side effects from this medication.

How should I use Nebcin (tobramycin (injection))?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Tobramycin is given as an injection through a needle placed into a vein or as a shot given into a muscle. Your doctor, nurse, or other healthcare provider will give you this injection. You may be shown how to inject your medicine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Use each disposable needle only one time. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Drink 6 to 8 full glasses of water each day while you are using tobramycin injection. You may become easily dehydrated while using this medication. Use this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Tobramycin injection will not treat a viral infection such as the common cold or flu.

To be sure this medication is not causing harmful effects, your doctor will need to check your progress on a regular basis. Your hearing and kidney function may also need to be tested. Do not miss any scheduled appointments.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using tobramycin injection. You may need to stop using the medicine for a short time.

Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include dizziness, ringing in your ears, and urinating more or less than usual, or not at all.

What should I avoid while using Nebcin (tobramycin (injection))?

Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are using tobramycin.

Tobramycin injection can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Nebcin (tobramycin (injection)) side effects

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

• 
  

  hearing loss or ringing in your ears (even after you have stopped using tobramycin injection);

  
  


• 
  

  urinating less than usual or not at all;

  
  


• 
  

  muscle stiffness or uncontrolled twitching;

  
  


• 
  

  wheezing, chest tightness, trouble breathing;

  
  


• 
  

  confusion, seizure (convulsions); or

  
  


• 
  

  fever, sore throat, and headache with a severe blistering, peeling, and red skin rash.

  
  

Less serious side effects may include:

• 
  

  muscle weakness; or

  
  


• 
  

  numbness or tingly feeling.

  
  

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Nebcin (tobramycin (injection))?

Before using tobramycin injection, tell your doctor if you are using any of the following drugs:

• 
  

  pentamidine (Nebupent, Pentam);

  
  


• 
  

  tacrolimus (Prograf);

  
  


• 
  

  amphotericin B (Fungizone, AmBisome, Amphotec, Abelcet);

  
  


• 
  

  a diuretic (water pill);

  
  


• 
  

  antibiotics such as capreomycin (Capastat), rifampin (Rifadin, Rimactane, Rifater), vancomycin (Vancocin, Vancoled);

  
  


• 
  

  antiviral medicines such as acyclovir (Zovirax), adefovir (Hepsera), cidofovir (Vistide), or foscarnet (Foscavir); or

  
  


• 
  

  cancer medicine such as aldesleukin (Proleukin), carmustine (BiCNU, Gliadel), cisplatin (Platinol), ifosfamide (Ifex), oxaliplatin (Eloxatin), plicamycin (Mithracin), streptozocin (Zanosar), or tretinoin (Vesanoid).

  
  

This list is not complete and there may be other drugs that can interact with tobramycin injection. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

More Nebcin resources

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

Compare Nebcin with other medications

• Bacteremia
• Bacterial Infection
• Bone infection
• Burns, External
• Cystic Fibrosis
• Endocarditis
• Febrile Neutropenia
• Intraabdominal Infection
• Kidney Infections
• Meningitis
• Peritonitis
• Pneumonia
• Rabbit Fever
• Sepsis
• Shunt Infection
• Skin Infection

Where can I get more information?

• Your pharmacist can provide more information about tobramycin injection.

See also: Nebcin side effects (in more detail)

nebivolol

ne-BIV-oh-lol

Commonly used brand name(s)

In the U.S.

• Bystolic

Available Dosage Forms:

• Tablet

Therapeutic Class: Antihypertensive

Pharmacologic Class: Beta-Adrenergic Blocker, Cardioselective

Uses For nebivolol

Nebivolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Nebivolol is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

nebivolol is available only with your doctor's prescription.

Before Using nebivolol

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 nebivolol, the following should be considered:

Allergies

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

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of nebivolol in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of nebivolol in the elderly.

Pregnancy

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

Breast Feeding

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

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking nebivolol, 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 nebivolol 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.

• Albuterol


• Amiodarone


• Arformoterol


• Bambuterol


• Bitolterol


• Broxaterol


• Clenbuterol


• Clonidine


• Colterol


• Diltiazem


• Dronedarone


• Fenoldopam


• Fenoterol


• Formoterol


• Hexoprenaline


• Indacaterol


• Isoetharine


• Levalbuterol


• Metaproterenol


• Pirbuterol


• Procaterol


• Reproterol


• Rimiterol


• Ritodrine


• Salmeterol


• Terbutaline


• Tretoquinol


• Tulobuterol


• Verapamil

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

• Acarbose


• Aceclofenac


• Acemetacin


• Acetohexamide


• Alclofenac


• Alfuzosin


• Amlodipine


• Apazone


• Arbutamine


• Benfluorex


• Benoxaprofen


• Bromfenac


• Bufexamac


• Bunazosin


• Carprofen


• Chlorpropamide


• Cimetidine


• Clometacin


• Clonixin


• Dexketoprofen


• Diclofenac


• Diflunisal


• Digoxin


• Dipyrone


• Doxazosin


• Droxicam


• Etodolac


• Etofenamate


• Felbinac


• Felodipine


• Fenbufen


• Fenoprofen


• Fentiazac


• Floctafenine


• Flufenamic Acid


• Fluoxetine


• Flurbiprofen


• Gliclazide


• Glimepiride


• Glipizide


• Gliquidone


• Glyburide


• Guar Gum


• Ibuprofen


• Indomethacin


• Indoprofen


• Insulin


• Insulin Aspart, Recombinant


• Insulin Glulisine


• Insulin Lispro, Recombinant


• Isoxicam


• Ketoprofen


• Ketorolac


• Lacidipine


• Lercanidipine


• Lornoxicam


• Manidipine


• Meclofenamate


• Mefenamic Acid


• Meloxicam


• Metformin


• Mibefradil


• Miglitol


• Moxisylyte


• Nabumetone


• Naproxen


• Nicardipine


• Nifedipine


• Niflumic Acid


• Nilvadipine


• Nimesulide


• Nimodipine


• Nisoldipine


• Nitrendipine


• Oxaprozin


• Oxyphenbutazone


• Phenoxybenzamine


• Phentolamine


• Phenylbutazone


• Pirazolac


• Piroxicam


• Pirprofen


• Pranidipine


• Prazosin


• Propyphenazone


• Proquazone


• Repaglinide


• Sildenafil


• St John's Wort


• Sulindac


• Suprofen


• Tamsulosin


• Tenidap


• Tenoxicam


• Terazosin


• Tiaprofenic Acid


• Tolazamide


• Tolbutamide


• Tolmetin


• Trimazosin


• Troglitazone


• Urapidil


• Zomepirac

Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

The presence of other medical problems may affect the use of nebivolol. Make sure you tell your doctor if you have any other medical problems, especially:

• Angina (severe chest pain)—May provoke chest pain if stopped too quickly.

• Peripheral vascular disease (clogged blood vessels)—Use with caution. May make this condition worse.

• Bradycardia (slow heartbeat), severe or


• Cardiogenic shock (shock caused by heart attack) or


• Heart block or


• Heart failure or


• Liver disease, severe or


• Lung disease (e.g., bronchitis, emphysema) or


• Sick-sinus syndrome (heart rhythm problem), without a pacemaker—Should not be used in patients with these conditions.

• Diabetes or


• Hyperthyroidism (overactive thyroid) or


• Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.

• Kidney disease, severe or


• Liver disease, moderate—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

• Pheochromocytoma (adrenal gland tumor)—Use an alpha-blocker medicine before taking nebivolol.

Proper Use of nebivolol

In addition to the use of nebivolol, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that nebivolol will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

You may take nebivolol with or without food.

Dosing

The dose of nebivolol 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 nebivolol. 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.

• For oral dosage form (tablets):
  
  • For high blood pressure:
    
    • Adults—At first, 5 milligrams (mg) once a day. Your doctor may increase your dose if needed.
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  

Missed Dose

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

Storage

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

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

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

Precautions While Using nebivolol

It is very important that your doctor check your progress at regular visits to make sure nebivolol is working properly and to check for unwanted effects.

Do not interrupt or stop using nebivolol without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

nebivolol may cause changes in your blood sugar levels. Also, nebivolol may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using nebivolol. You may need to stop using nebivolol several days before having surgery.

Before you have any medical tests, tell the medical doctor in charge that you are taking nebivolol. The results of some tests may be affected by nebivolol.

nebivolol may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking nebivolol.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

nebivolol Side Effects

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

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

Less common

• Bloating or swelling of the face, arms, hands, lower legs, or feet


• chest pain or discomfort


• difficult or labored breathing


• lightheadedness, dizziness, or fainting


• rapid weight gain


• shortness of breath


• slow or irregular heartbeat


• tightness in the chest


• tingling of the hands or feet


• unusual tiredness or weakness


• unusual weight gain or loss


• wheezing

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

Symptoms of overdose

• Absence of or decrease in body movement


• anxiety


• blue lips, fingernails, or skin


• blurred vision


• chills


• cold sweats


• coma


• confusion


• cool, pale skin


• cough


• decreased urine output


• depression


• dilated neck veins


• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position


• dry mouth


• extreme fatigue


• fast heartbeat


• headache


• increased hunger


• increased sweating


• increased thirst


• irregular, fast or slow, or shallow breathing


• loss of appetite


• mood changes


• muscle pain or cramps


• nausea or vomiting


• nervousness


• nightmares


• noisy breathing


• numbness in the hands, feet, or lips


• seizures


• shakiness


• slurred speech


• troubled breathing


• vomiting


• weight gain

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:

More common

• Mild headache

Less common

• Diarrhea


• rash


• sleeplessness


• trouble sleeping


• unable to sleep

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: nebivolol 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.

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More nebivolol resources

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

• Nebivolol Professional Patient Advice (Wolters Kluwer)


• Nebivolol MedFacts Consumer Leaflet (Wolters Kluwer)


• Bystolic Prescribing Information (FDA)


• Bystolic Monograph (AHFS DI)


• Bystolic Consumer Overview

Compare nebivolol with other medications

• High Blood Pressure
• Mitral Valve Prolapse

NegGram

Pronunciation: nal-i-DIX-ik AS-id
Generic Name: Nalidixic Acid
Brand Name: NegGram

NegGram is used for:

Treating urinary tract infections caused by certain bacteria.

NegGram is an antibacterial. It works by killing sensitive bacteria in the urinary tract by stopping the production of essential proteins needed by the bacteria to survive.

Do NOT use NegGram if:

• you are allergic to any ingredient in NegGram


• you have the blood disease porphyria or a history of convulsions


• you are undergoing cancer chemotherapy with the medicine melphalan or related medicines, or you are taking an antiarrhythmic for abnormal heartbeat (eg, quinidine, procainamide, amiodarone, sotalol)

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

Before using NegGram:

Some medical conditions may interact with NegGram. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

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


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


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


• if you have Alzheimer disease, a central nervous system disease, hardening of the arteries in your brain, increased pressure in your brain, liver problems, sensitivity to the sun, severe kidney problems, or a family history of heartbeat problems

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

• Anticoagulants (eg, warfarin), antiarrhythmics (eg, quinidine, procainamide, amiodarone, sotalol), certain medicines that affect heartbeat (eg, cisapride, erythromycin, amitriptyline), cyclosporine, melphalan, or theophylline because the risk of their side effects may be increased by NegGram


• Probenecid because the effectiveness of NegGram may be decreased and the risk of its side effects may be increased by NegGram

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

How to use NegGram:

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

• Take NegGram with or without food. If stomach upset occurs, take with food to reduce stomach irritation.


• Do not take products containing magnesium (eg, quinapril, didanosine, vitamins), aluminum, calcium, sucralfate, iron, or zinc preparations within 2 to 3 hours of taking NegGram. These products bind with the medicine preventing its absorption.


• Drink a full glass of water with each dose. Drink several additional glasses of water daily unless otherwise directed by your doctor. Do not drink products with caffeine while taking NegGram.


• To clear up your infection completely, take NegGram for the full course of treatment. Keep taking it even if you feel better in a few days.


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

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

Important safety information:

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


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


• Mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea (pseudomembranous colitis) may rarely occur. This may develop while you use the antibiotic or within several months after you stop using it. Contact your doctor right away if stomach pain or cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea without first checking with your doctor.


• NegGram only works against bacteria; it does not treat viral infections (eg, the common cold).


• Be sure to use NegGram for the full course of treatment. If you do not, the medicine may not clear up your infection completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future.


• Long-term or repeated use of NegGram may cause a second infection. Tell your doctor if signs of a second infection occur. Your medicine may need to be changed to treat this.


• Diabetes patients - NegGram may cause the results of some tests for urine glucose to be wrong. Ask your doctor before you change your diet or the dose of your diabetes medicine.


• Lab tests, including liver function, kidney function, and complete blood cell counts, may be performed while you use NegGram. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.


• NegGram should not be used in CHILDREN younger than 18 years old. NegGram is not recommended for use in CHILDREN younger than 3 months old or younger than 9 years old with diarrhea or a gastrointestinal infection.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using NegGram while you are pregnant. It is not known if NegGram is found in breast milk. Do not breast-feed while taking NegGram.

Possible side effects of NegGram:

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

Diarrhea; dizziness; drowsiness; feeling of a whirling motion; headache; nausea; rash; stomach pain or discomfort; vomiting.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred or decreased vision; burning or tingling sensation; changes in color vision; convulsions; decrease in ability to sense pain, temperature, or body position; double vision; itching; numbness; pain; pain, redness, or swelling of a tendon; seeing halos around lights; weakness.

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: NegGram side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include seizures; unusual sluggishness.

Proper storage of NegGram:

Store NegGram at room temperature, below 77 degrees F (25 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep NegGram out of the reach of children and away from pets.

General information:

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


• NegGram is to be used only by the patient for whom it is prescribed. Do not share it with other people.


• If your symptoms do not improve or if they become worse, check with your doctor.


• Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about NegGram. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More NegGram resources

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

• NegGram Prescribing Information (FDA)


• Neggram Advanced Consumer (Micromedex) - Includes Dosage Information

Compare NegGram with other medications

• Bladder Infection
• Prevention of Bladder infection

Necon 7/7/7

Generic Name: ethinyl estradiol and norethindrone (ETH in il ess tra DYE ole and nor ETH in drone)

Brand Names: Aranelle, Balziva, Brevicon, Briellyn, Cyclafem 1/35, Cyclafem 7/7/7, Estrostep Fe, Femcon FE, Generess Fe, Gildess FE 1.5/0.03, Gildess FE 1/0.2, Junel 1.5/30, Junel 1/20, Junel Fe 1.5/30, Junel Fe 1/20, Leena, Lo Loestrin Fe, Loestrin 21 1.5/30, Loestrin 21 1/20, Loestrin 24 Fe, Loestrin Fe 1.5/30, Loestrin Fe 1/20, Microgestin 1.5/30, Microgestin 1/20, Microgestin FE 1.5/30, Microgestin FE 1/20, Modicon, Necon 0.5/35, Necon 1/35, Necon 10/11, Necon 7/7/7, Norinyl 1+35, Nortrel 0.5/35, Nortrel 1/35, Nortrel 7/7/7, Ortho-Novum 1/35, Ortho-Novum 7/7/7, Ovcon 35, Ovcon 35 Fe, Ovcon 50, Tilia Fe, Tri-Legest Fe, Tri-Norinyl, Zenchent Fe, Zeosa

What is Necon 7/7/7 (ethinyl estradiol and norethindrone)?

Ethinyl estradiol and norethindrone contains a combination of female hormones that prevent ovulation (the release of an egg from an ovary). This medication also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ethinyl estradiol and norethindrone are used as contraception to prevent pregnancy. It is also used to treat severe acne.

Ethinyl estradiol and norethindrone may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Necon 7/7/7 (ethinyl estradiol and norethindrone)?

Do not use birth control pills if you are pregnant or if you have recently had a baby. Do not use this medication if you have any of the following conditions: a history of stroke or blood clot, circulation problems, a hormone-related cancer such as breast or uterine cancer, abnormal vaginal bleeding, liver disease or liver cancer, or a history of jaundice caused by birth control pills.

You may need to use back-up birth control, such as condoms or a spermicide, when you first start using this medication. Follow your doctor's instructions.

Taking hormones can increase your risk of blood clots, stroke, or heart attack, especially if you smoke and are older than 35.

Some drugs can make birth control pills less effective, which may result in pregnancy. 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.

What should I discuss with my healthcare provider before taking Necon 7/7/7 (ethinyl estradiol and norethindrone)?

This medication can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant, or if you miss two menstrual periods in a row. If you have recently had a baby, wait at least 4 weeks before taking birth control pills (6 weeks if you are breast-feeding). You should not take birth control pills if you have:

• 
  

  coronary artery disease, a severe or uncontrolled heart valve disorder, untreated or uncontrolled high blood pressure;

  
  


• 
  

  a history of a stroke, blood clot, or circulation problems;

  
  


• 
  

  a hormone-related cancer such as breast or uterine cancer;

  
  


• 
  

  unusual vaginal bleeding that has not been checked by a doctor;

  
  


• 
  

  liver disease or liver cancer;

  
  


• 
  

  severe migraine headaches; or

  
  


• 
  

  a history of jaundice caused by pregnancy or birth control pills.

  
  

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

• 
  

  high blood pressure or a history of heart disease;

  
  


• 
  

  high cholesterol, gallbladder disease, or diabetes;

  
  


• 
  

  migraine headaches or a history of depression; or

  
  


• 
  

  a history of breast cancer or an abnormal mammogram.

  
  

The hormones in birth control pills can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. Do not use if you are breast-feeding a baby.

How should I take Necon 7/7/7 (ethinyl estradiol and norethindrone)?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Take your first pill on the first day of your period or on the first Sunday after your period begins (follow your doctor's instructions).

You may need to use back-up birth control, such as condoms or a spermicide, when you first start using this medication. Follow your doctor's instructions.

The 28-day birth control pack contains seven "reminder" pills to keep you on your regular cycle. Your period will usually begin while you are using these reminder pills.

You may have breakthrough bleeding, especially during the first 3 months. Tell your doctor if this bleeding continues or is very heavy.

Take one pill every day, no more than 24 hours apart. When the pills run out, start a new pack the following day. You may get pregnant if you do not use this medication regularly. Get your prescription refilled before you run out of pills completely.

The chewable tablet may be chewed or swallowed whole. If chewed, drink a full glass of water just after you swallow the pill.

If you need surgery or medical tests or if you will be on bed rest, you may need to stop using this medication for a short time. Any doctor or surgeon who treats you should know that you are using birth control pills.

Your doctor will need to check your progress on a regular basis. Do not miss any scheduled appointments.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Missing a pill increases your risk of becoming pregnant. If you miss one "active" pill, take two pills on the day that you remember. Then take one pill per day for the rest of the pack.

If you miss two "active" pills in a row in week one or two, take two pills per day for two days in a row. Then take one pill per day for the rest of the pack. Use back-up birth control for at least 7 days following the missed pills.

If you miss two "active" pills in a row in week three, or if you miss three pills in a row during any of the first 3 weeks, throw out the rest of the pack and start a new one the same day if you are a Day 1 starter. If you are a Sunday starter, keep taking a pill every day until Sunday. On Sunday, throw out the rest of the pack and start a new one that day.

If you miss two or more pills, you may not have a period during the month. If you miss a period for two months in a row, call your doctor because you might be pregnant.

If you miss any reminder pills, throw them away and keep taking one pill per day until the pack is empty. You do not need back-up birth control if you miss a reminder pill.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, and vaginal bleeding.

What should I avoid while taking Necon 7/7/7 (ethinyl estradiol and norethindrone)?

Do not smoke while using birth control pills, especially if you are older than 35. Smoking can increase your risk of blood clots, stroke, or heart attack caused by birth control pills.

Birth control pills will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

Necon 7/7/7 (ethinyl estradiol and norethindrone) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

• 
  

  sudden numbness or weakness, especially on one side of the body;

  
  


• 
  

  sudden severe headache, confusion, problems with vision, speech, or balance;

  
  


• 
  

  sudden cough, wheezing, rapid breathing, coughing up blood;

  
  


• 
  

  pain, swelling, warmth, or redness in one or both legs;

  
  


• 
  

  chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

  
  


• 
  

  a change in the pattern or severity of migraine headaches;

  
  


• 
  

  pain in your upper stomach, jaundice (yellowing of the skin or eyes);

  
  


• 
  

  a lump in your breast;

  
  


• 
  

  swelling in your hands, ankles, or feet; or

  
  


• 
  

  symptoms of depression (sleep problems, weakness, mood changes).

  
  

Less serious side effects may include:

• 
  

  mild nausea or vomiting, appetite or weight changes;

  
  


• 
  

  breast swelling or tenderness;

  
  


• 
  

  headache, nervousness, dizziness;

  
  


• 
  

  problems with contact lenses;

  
  


• 
  

  freckles or darkening of facial skin, loss of scalp hair; or

  
  


• 
  

  vaginal itching or discharge.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Necon 7/7/7 (ethinyl estradiol and norethindrone)?

Some drugs can make ethinyl estradiol and norethindrone less effective, which may result in pregnancy. Before using ethinyl estradiol and norethindrone, tell your doctor if you are using any of the following drugs:

• 
  

  acetaminophen (Tylenol) or ascorbic acid (vitamin C);

  
  


• 
  

  bosentan (Tracleer);

  
  


• 
  

  prednisolone (Orapred);

  
  


• 
  

  St. John's wort;

  
  


• 
  

  theophylline (Elixophyllin, Theo-24, Uniphyl);

  
  


• 
  

  an antibiotic;

  
  


• 
  

  HIV or AIDS medications;

  
  


• 
  

  phenobarbital (Solfoton) and other barbiturates; or

  
  


• 
  

  seizure medication.

  
  

This list is not complete and other drugs may interact with birth control pills. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Necon 7/7/7 resources

• Necon 7/7/7 Side Effects (in more detail)
• Necon 7/7/7 Use in Pregnancy & Breastfeeding
• Drug Images
• Necon 7/7/7 Drug Interactions
• Necon 7/7/7 Support Group
• 2 Reviews for Necon 7/7/7 - Add your own review/rating

• Aranelle Prescribing Information (FDA)


• Balziva Prescribing Information (FDA)


• Brevicon Prescribing Information (FDA)


• Briellyn Prescribing Information (FDA)


• Cyclafem 1/35 Prescribing Information (FDA)


• Cyclafem 7/7/7 Prescribing Information (FDA)


• Estrostep Fe Prescribing Information (FDA)


• Femcon FE Prescribing Information (FDA)


• Femcon Fe Chewable Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Femhrt Consumer Overview


• Femhrt Prescribing Information (FDA)


• Femhrt MedFacts Consumer Leaflet (Wolters Kluwer)


• Jevantique Prescribing Information (FDA)


• Jinteli Prescribing Information (FDA)


• Leena Prescribing Information (FDA)


• Lo Loestrin Fe MedFacts Consumer Leaflet (Wolters Kluwer)


• Lo Loestrin Fe Consumer Overview


• Lo Loestrin Fe Advanced Consumer (Micromedex) - Includes Dosage Information


• Lo Loestrin Fe Prescribing Information (FDA)


• Loestrin 24 FE Prescribing Information (FDA)


• Loestrin 24 Fe Consumer Overview


• Loestrin Fe 1/20 MedFacts Consumer Leaflet (Wolters Kluwer)


• Ovcon 35 MedFacts Consumer Leaflet (Wolters Kluwer)


• Tilia FE Prescribing Information (FDA)


• Tri-Norinyl Prescribing Information (FDA)


• Zenchent FE Prescribing Information (FDA)


• Zeosa Prescribing Information (FDA)

Compare Necon 7/7/7 with other medications

• Abnormal Uterine Bleeding
• Acne
• Birth Control
• Endometriosis
• Gonadotropin Inhibition
• Menstrual Disorders
• Polycystic Ovary Syndrome
• Postmenopausal Symptoms
• Prevention of Osteoporosis

Where can I get more information?

• Your pharmacist can provide more information about ethinyl estradiol and norethindrone.

See also: Necon 7/7/7 side effects (in more detail)

Nelarabine

Class: Antineoplastic Agents
VA Class: AN300
Chemical Name: 2-Amino-9-β-D-arabinofuranosyl-6-methoxy-9H-purine
Molecular Formula: C₁₁H₁₅N₅O₅
CAS Number: 121032-29-9
Brands: Arranon

• Neurotoxicity


• 
  

  Severe, possibly irreversible, neurologic events (e.g., somnolence, confusion, seizures, peripheral neuropathy).^{1 2 3 5} Craniospinal demyelination and ascending peripheral neuropathy (similar in presentation to Guillain-Barré syndrome) reported.¹ (See Neurotoxicity under Cautions.)

  
  


• 
  

  Closely monitor for adverse neurologic effects; discontinue therapy for neurologic events of NCI Common Toxicity Criteria grade ≥2.¹

  
  

• Experience of Supervising Clinician


• 
  

  For IV use only; administer only under the supervision of qualified clinicians experienced in the use of cancer chemotherapeutic agents.^a

  
  

Introduction

Antimetabolite antineoplastic agent.^{1 2 5}

Uses for Nelarabine

Acute Lymphocytic Leukemia (ALL)

Treatment of acute T-cell lymphocytic (lymphoblastic) leukemia (ALL) and T-cell lymphoblastic lymphoma in patients whose disease is refractory to or has relapsed after ≥2 prior chemotherapy regimens (designated an orphan drug by FDA for these conditions).^{1 2 4 6}

Nelarabine Dosage and Administration

General

• 
  

  Consult specialized references for procedures for proper handling and disposal of antineoplastics.¹

  
  


• 
  

  Appropriate measures (e.g., administration of IV fluids, allopurinol, and alkalinization of urine) should be taken to prevent hyperuricemia of tumor lysis syndrome.¹ (See Tumor Lysis Syndrome under Cautions.)

  
  

Administration

IV Administration

Administer by IV infusion.¹

Nelarabine injection should not be diluted prior to administration.¹

Withdraw appropriate dose from the required number of vials and transfer into empty PVC infusion bags or glass containers prior to administration.¹

Rate of Administration

Adults: Administer by IV infusion over 2 hours.¹

Pediatric patients: Administer by IV infusion over 1 hour.¹

Dosage

Pediatric Patients

Acute Lymphocytic Leukemia

Relapsed or Refractory T-cell ALL or T-cell Lymphoblastic Lymphoma

IV

650 mg/m² daily for 5 consecutive days; repeat every 21 days.^{1 2}

Optimal duration of treatment not established.¹ In clinical studies, treatment was continued until evidence of disease progression, unacceptable toxicity, bone marrow transplantation, or lack of clinical benefit was observed.¹

Adults

Acute Lymphocytic Leukemia

Relapsed or Refractory T-cell ALL or T-cell Lymphoblastic Lymphoma

IV

1500 mg/m² on days 1, 3, and 5; repeat every 21 days.^{1 2}

Optimal duration of treatment not established.¹ In clinical studies, treatment was continued until evidence of disease progression, unacceptable toxicity, bone marrow transplantation, or lack of clinical benefit was observed.¹

Special Populations

Hepatic Impairment

No specific dosage recommendations at this time.¹

Renal Impairment

No dosage adjustment required in patients with mild renal impairment (Cl_cr ≥50 mL/minute); not studied in patients with moderate to severe renal impairment.¹

Geriatric Patients

No specific dosage recommendations at this time.¹

Cautions for Nelarabine

Contraindications

• 
  

  Known hypersensitivity to nelarabine or any ingredient in the formulation.¹

  
  

Warnings/Precautions

Warnings

Adequate Patient Monitoring and Evaluation

Administer only under the supervision of qualified clinicians experienced in the use of cancer chemotherapy agents.¹

Neurotoxicity

Potentially irreversible and dose-limiting neurotoxicity, usually manifested by somnolence, confusion, seizures, and peripheral neuropathy (ranging from numbness to motor weakness and paralysis).^{1 2 3 5} Coma, status epilepticus, craniospinal demyelination, and ascending peripheral neuropathy (similar in presentation to Guillain-Barré syndrome) reported.¹

Increased risk of neurotoxicity in patients who have received prior or concomitant intrathecal chemotherapy or prior craniospinal irradiation; discontinue therapy in patients experiencing neurologic events of NCI Common Toxicity Criteria grade ≥2.¹

Fetal/Neonatal Morbidity and Mortality

May cause fetal harm; teratogenicity demonstrated in animals.¹ Avoid pregnancy during therapy; if used during pregnancy or patient becomes pregnant, apprise of potential fetal hazard.¹

General Precautions

Hematologic Effects

Leukopenia, thrombocytopenia, anemia, and neutropenia reported.¹ Perform CBC, including platelet count, regularly while patient is receiving the drug.¹

Tumor Lysis Syndrome

May occur as a result of nelarabine therapy; consider measures (e.g., hydration, urinary alkalinization, allopurinol) to prevent hyperuricemia in patients at risk for tumor lysis syndrome.¹

Immunization

Avoid administration of live virus vaccines during therapy.¹

Specific Populations

Pregnancy

Category D.¹ (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Lactation

Not known whether nelarabine or ara-G is distributed into milk; discontinue nursing because of potential risk to nursing infants.¹

Pediatric Use

Safety and efficacy established in patients 2.5–21 years of age.¹

Geriatric Use

Possible inreased incidence of neurologic effects compared with younger adults.¹ (See Neurotoxicity under Cautions.)

Hepatic Impairment

Not studied in patients with hepatic impairment; possible increased risk of adverse reactions in patients with severe hepatic impairment (serum bilirubin >3 mg/dL).¹

Renal Impairment

Possible increased risk of adverse reactions in patients with severe renal impairment (Cl_cr <30 mL/minute).¹

Common Adverse Effects

In adults: Myelosuppresion,^{1 2} somnolence,^{1 2} dizziness,¹ peripheral neurologic disorders,¹ hypoesthesia,^{1 2} headache,^{1 2} paresthesia,¹ fatigue,¹ pyrexia,¹ asthenia,¹ edema,¹ pain,¹ myalgia,¹ nausea,¹ diarrhea,¹ vomiting,¹ constipation,¹ cough,¹ dyspnea,¹ pleural effusion,¹ petechiae.¹

In pediatric patients: Myelosuppression,^{1 2} headache,^{1 2} peripheral neurologic disorders,¹ elevated serum transaminase concentrations,¹ hyperbilirubinemia,¹ hypokalemia,¹ hypoalbuminemia,¹ vomiting.¹

Interactions for Nelarabine

Does not appear to inhibit CYP isoenzymes, including 1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, or 3A4 in vitro.¹

Specific Drugs

Drug	Interaction	Comments
Adenosine deaminase inhibitors (i.e., pentostatin)	Possible decrease in nelarabine efficacy and/or change in adverse effect profile for either druga	Concomitant use not recommendeda
Fludarabine	Pharmacokinetics of nelarabine not altered1

Nelarabine Pharmacokinetics

Distribution

Extent

Extensively distributed throughout the body.¹

Not known whether nelarabine crosses the placenta or is distributed into milk.^a

Plasma Protein Binding

<25%.^a

Elimination

Metabolism

Metabolized to ara-G, principally via O-demethylation by adenosine deaminase; ara-G undergoes further hydrolysis to guanine.^a

Elimination Route

Nelarabine and ara-G are partially eliminated by the kidneys.^a

Half-life

Nelarabine: 0.5 hour.^a

Ara-G: 3 hours.^a

Special Populations

In pediatric patients, clearance of nelarabine is increased by 30%; ara-G clearance is comparable to that in adults.^a

Renal impairment may reduce clearance.^a

In white patients, clearance and volume of distribution of nelarabine increased by 10%; clearance and volume of distribution of ara-G decreased by 15–20% when compared with black patients.^a

Stability

Storage

Parenteral

Solution

25°C (may be exposed to 15–30°C).^a

Stable in PVC bags and glass containers at ≤30°C for up to 8 hours.^a

ActionsActions

• 
  

  Prodrug of the deoxyguanosine analog ara-G, which is subsequently converted to the active 5′-triphosphate, ara-GTP.^{1 2 5}

  
  


• 
  

  Ara-GTP accumulates in leukemic blasts and incorporates into DNA, inducing fragmentation and apoptosis.^{1 2 5}

  
  

Advice to Patients

• 
  

  Risk of neurotoxicity; importance of informing clinician immediately if any changes in mental status, signs and symptoms of peripheral neuropathy (e.g., tingling or numbness in extremities, unsteadiness while walking, difficulty with fine motor coordination, increased tripping, weakness when rising from a low chair or climbing stairs), or seizures occur.^a

  
  


• 
  

  Risk of sleepiness; avoid driving or operating machinery.¹

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as concomitant illnesses.¹

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed; necessity for clinicians to advise women to avoid pregnancy during therapy; advise pregnant women of risk to the fetus.^{1 a}

  
  


• 
  

  Importance of informing patients of other important precautionary information. (See Cautions.)

  
  

Preparations

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

Nelarabine

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	Injection, for IV use	5 mg/mL (250 mg)	Arranon	GlaxoSmithKline

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions May 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. GlaxoSmithKline. Arranon (nelarabine) injection prescribing information. Research Triangle Park, NC; 2005 Oct.

2. Anon. Nelarabine (Arranon) for T-cell acute lymphoblastic leukemia. Med Lett Drugs Ther. 2006; 48:14-5.

3. Berg SL, Blaney SM, Devidas M et al. Phase II study of nelarabine (compound 506U78) in children and young adults with refractory T-cell malignancies: a report from the Children’s Oncology Group. J Clin Oncol. 2005; 23:3376-82. [PubMed 15908649]

4. Childhood acute lymphoblastic leukemia. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2006 Feb 17.

5. Kisor DF. Nelarabine: a nucleoside analog with efficacy in T-cell and other leukemias. Ann Pharmacother. 2005; 39:1056-63. [PubMed 15870141]

6. Food and Drug Administration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414). Rockville, MD; 2006 Mar 21. From FDA website (). Accessed 2006 Apr 3.

7. GlaxoSmith Kline, Research Triangle Park, NC: Personal communication

a. GlaxoSmithKline. Arranon (nelarabine) injection prescribing information. Research Triangle Park, NC; 2006 July.

More Nelarabine resources

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

• Nelarabine MedFacts Consumer Leaflet (Wolters Kluwer)


• Nelarabine Professional Patient Advice (Wolters Kluwer)


• nelarabine Intravenous Advanced Consumer (Micromedex) - Includes Dosage Information


• Arranon Prescribing Information (FDA)


• Arranon Consumer Overview

Compare Nelarabine with other medications

• Acute Lymphoblastic Leukemia
• Lymphoma

Nembutal Sodium

Generic Name: pentobarbital (PEN toe BAR bi tal)

Brand Names: Nembutal Sodium

What is Nembutal Sodium (pentobarbital)?

Pentobarbital is in a group of drugs called barbiturates (bar-BIT-chur-ates). Pentobarbital slows the activity of your brain and nervous system.

Pentobarbital is used short-term to treat insomnia. Pentobarbital is also used as an emergency treatment for seizures, and to cause you to fall asleep for surgery.

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

What is the most important information I should know about Nembutal Sodium (pentobarbital)?

You should not use this medication if you are allergic to pentobarbital, or if you have porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

Before using pentobarbital, tell your doctor if you have liver or kidney disease, chronic pain, severe or uncontrolled asthma or COPD, a history of mental illness or suicide attempt, or a history of addiction to drugs or alcohol.

Pentobarbital may be habit-forming and should be used only by the person it was prescribed for. Pentobarbital should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Pentobarbital can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. Alcohol can also add to sleepiness caused by pentobarbital. Pentobarbital can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while using pentobarbital.

What should I discuss with my healthcare provider before using Nembutal Sodium (pentobarbital)?

You should not use this medication if you are allergic to pentobarbital, or if you have porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication:

• liver disease;


• kidney disease;


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  chronic pain;

  
  


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  severe or uncontrolled asthma or COPD (chronic obstructive pulmonary disorder);

  
  


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  a history of depression, mental illness, or suicide attempt; or

  
  


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  a history of drug or alcohol addiction.

  
  

Pentobarbital may be habit-forming and should be used only by the person it was prescribed for. Pentobarbital should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. FDA pregnancy category D. Do not use pentobarbital without telling your doctor if you are pregnant. It could harm the unborn baby. Pentobarbital may cause addiction or withdrawal symptoms in a newborn if the mother uses the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Pentobarbital can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while using pentobarbital. Pentobarbital can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more likely to have side effects from this medication.

How should I take Nembutal Sodium (pentobarbital)?

Pentobarbital is given as an injection into a muscle or vein. Your doctor, nurse, or other healthcare provider will give you this injection. You may be shown how to inject your medicine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of needles, IV tubing, and other items used in giving the medicine.

When injected into a vein, pentobarbital must be given slowly.

Use each disposable needle only one time. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Do not stop using pentobarbital suddenly after using it long-term, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when you stop using pentobarbital.

To be sure this medication is not causing harmful effects, your blood may need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any follow-up visits to your doctor.

If you store pentobarbital at home, keep it at room temperature away from moisture and heat.

Keep track of how much of this medicine has been used. Pentobarbital is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

Since pentobarbital is often used only when needed, you may not be on a dosing schedule. If you are using the medication regularly, use the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of pentobarbital can be fatal.

Overdose symptoms may include pinpoint or dilated pupils, weak or limp feeling, urinating less than usual or not at all, fast heart rate, slow heart rate, weak pulse, fainting, slow breathing (breathing may stop).

What should I avoid while taking Nembutal Sodium (pentobarbital)?

Pentobarbital can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. Alcohol can add to sleepiness caused by pentobarbital, which could be dangerous.

Nembutal Sodium (pentobarbital) side effects

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

• 
  

  confusion, hallucinations;

  
  


• 
  

  weak or shallow breathing;

  
  


• 
  

  slow heart rate, weak pulse; or

  
  


• 
  

  feeling like you might pass out.

  
  

Less serious side effects may include:

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  problems with memory or concentration;

  
  


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  excitement, irritability, or aggression (especially in children or older adults);

  
  


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  loss of balance or coordination;

  
  


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  nightmares;

  
  


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  nausea, vomiting, constipation;

  
  


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  headache; or

  
  


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  "hangover" effect (drowsiness the day after a dose).

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Nembutal Sodium (pentobarbital)?

Before using pentobarbital, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can cause add to sleepiness caused by pentobarbital, which could be dangerous.

Tell your doctor about all other medications you use, especially:

• 
  

  a blood thinner such as warfarin (Coumadin);

  
  


• 
  

  doxycycline (Adoxa, Doryx, Mondox, Oracea, Vibramycin, and others);

  
  


• 
  

  other seizure medications such as divalproex (Depakote), phenytoin (Dilantin), or valproic acid (Depakene);

  
  


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  an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate);

  
  


• 
  

  griseofulvin (Grisactin, Fulvicin PG, Grifulvin V);

  
  


• 
  

  birth control pills or hormone replacement estrogens; or

  
  


• 
  

  steroids such as prednisone (Orasone, Deltasone), prednisolone (Prelone, Delta Cortef), methylprednisolone (Medrol), and others.

  
  

This is not a complete list and there may be other drugs that can interact with pentobarbital. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

More Nembutal Sodium resources

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

• Nembutal Prescribing Information (FDA)


• Nembutal Monograph (AHFS DI)

Compare Nembutal Sodium with other medications

• Insomnia
• Sedation
• Status Epilepticus

Where can I get more information?

• Your pharmacist can provide more information about pentobarbital.

See also: Nembutal Sodium side effects (in more detail)