Thursday, 29 September 2016

Emizof




Emizof may be available in the countries listed below.


Ingredient matches for Emizof



Ondansetron

Ondansetron hydrochloride (a derivative of Ondansetron) is reported as an ingredient of Emizof in the following countries:


  • Ireland

International Drug Name Search

Meclofenamate





Dosage Form: capsule

Meclofenamate Description


Meclofenamate sodium is N-(2,6-dichloro-m-tolyl) anthranilic acid, sodium salt, monohydrate. It is an anti-inflammatory drug for oral administration. Meclofenamate sodium capsules contain 50 mg or 100 mg meclofenamic acid as the sodium salt and the following inactive ingredients: colloidal silicon dioxide, FD&C Blue #1, gelatin, magnesium stearate, microcrystalline cellulose, pregelatinized starch, FD&C Red #3, sodium lauryl sulfate, titanium dioxide and D&C Yellow #10.


The structural formula of Meclofenamate sodium is:


Molecular Formula: C14H10Cl2NNaO2•H2O



It is a white to creamy white, odorless to almost odorless, crystalline powder with melting point 287° to 291°C, molecular weight 336.15, and it is freely soluble in water.



Meclofenamate - Clinical Pharmacology



Pharmacodynamics


Meclofenamate sodium is a non-steroidal agent which has demonstrated anti-inflammatory, analgesic, and antipyretic activity in laboratory animals. The mode of action, like that of other non-steroidal anti-inflammatory agents, is not known. Therapeutic action does not result from pituitary-adrenal stimulation. In animal studies, Meclofenamate sodium was found to inhibit prostaglandin synthesis and to compete for binding at the prostaglandin receptor site. In vitro, Meclofenamate sodium was found to be an inhibitor of human leukocyte 5-lipoxygenase activity. These properties may be responsible for the anti-inflammatory action of Meclofenamate sodium. There is no evidence that Meclofenamate sodium alters the course of the underlying disease.


In several human isotope studies, Meclofenamate sodium, at a dosage of 300 mg/day, produced a fecal blood loss of 1 to 2 mL per day, and 2 to 3 mL per day at 400 mg/day. Aspirin, at a dosage of 3.6 g/day, caused a fecal blood loss of 6 mL per day.


In a multiple dose, one week study in normal human volunteers, Meclofenamate sodium had little or no effect on collagen-induced platelet aggregation, platelet count, or bleeding time. In comparison, aspirin suppressed collagen-induced platelet aggregation and increased bleeding time. The concomitant administration of antacids (aluminum and magnesium hydroxides) does not interfere with absorption of Meclofenamate sodium.



Pharmacokinetics


Meclofenamate sodium is rapidly absorbed in man following single and multiple oral doses with peak plasma concentrations occurring in 0.5 to 2 hours. Based on a comparison to a suspension of meclofenamic acid, Meclofenamate sodium is completely bioavailable.


The plasma concentrations of meclofenamic acid decline monoexponentially following oral administration. In a study in 10 healthy subjects following a single oral dose the apparent elimination half-life ranged from 0.8 to 5.3 hours. After the administration of Meclofenamate sodium for 14 days every 8 hours, the apparent elimination half-life ranged from 0.8 to 2.1 hours with no evidence of accumulation of meclofenamic acid in plasma (see Table).

































TABLE SUMMARY OF Meclofenamate SODIUM PHARMACOKINETIC PARAMETERS
Mean (Range) Parameter Values (n=10)
 Meclofenamic Acid 100 mg*Metabolite I

*

Administered every 8 hours for 14 days


3-Hydroxymethyl metabolite of meclofenamic acid with 20% activity of Meclofenamate sodium in vitro


Peak plasma concentration

§

Time to peak plasma concentration


Trough plasma concentration

#

Oral clearance

Þ

Oral distribution volume

ß

Elimination half-life

à

Estimated from mean data

Cmax mcg/mL4.8 (1.8 to 7.2)1.0 (0.5 to 1.5)
tmax hr§0.9 (0.5 to 1.5)2.4 (0.5 to 4.0)
Cmin mcg/mL0.2 (0.5 to 1.5)0.4 (0.2 to 1.1)
Cl/F mL/min#206.0 (126 to 342)---
Vd/F litersÞ23.3 (9.1 to 43.2)---
t1/2 hrß1.3 (0.8 to 2.1)15.3à
% of Dose in Urine Unconjugated0.0 ---0.5 (0 to 1.2)
Total2.7 (0 to 4.5)21.6 (7.5 to 32.6)

Meclofenamic acid is extensively metabolized to an active metabolite (Metabolite I; 3-hydroxymethyl metabolite of meclofenamic acid) and at least six other less well characterized minor metabolites. Only this Metabolite I has been shown in vitro to inhibit cyclooxygenase activity with approximately one fifth the activity of Meclofenamate sodium. Metabolite I (3-hydroxymethyl metabolite of meclofenamic acid) with a mean half-life of approximately 15 hours did accumulate following multiple dosing. After the administration of 100 mg Meclofenamate sodium for 14 days every 8 hours, Metabolite I reached a peak plasma concentration of only 1 mcg/mL. By contrast, the peak concentration was 4.8 mcg/mL for the parent compound on both days 1 and 14. Therefore, the accumulation of Metabolite I is probably not clinically significant.


Approximately 70% of the administered dose is excreted by the kidneys with 8% to 35% excreted as predominantly conjugated species of meclofenamic acid and Metabolite I (see Table). Other metabolites, whose excretion rates are unknown, account for the remaining 35% to 62% of the dose excreted in the urine. The remainder of the administered dose (approximately 30%) is eliminated in the feces (apparently through biliary excretion). There is insufficient experience to know if Meclofenamate sodium or its metabolites accumulate in patients with compromised renal or hepatic function. Therefore, Meclofenamate sodium should be used with caution in these patients (see PRECAUTIONS). Trace amounts of Meclofenamate sodium are excreted in human breast milk.


Meclofenamic acid is greater than 99% bound to plasma proteins over a wide drug concentration range.


Unlike most NSAIDs, which when administered with food have a decrease in rate but not in extent of absorption, meclofenamic acid is decreased in both. It has been reported that following the administration of Meclofenamate sodium capsules one-half hour after a meal, the average extent of bioavailability decreased by 26%, the average peak concentration (Cmax) decreased fourfold and the time to Cmax was delayed by 3 hours.



Clinical Studies


Controlled clinical trials comparing Meclofenamate sodium with aspirin demonstrated comparable efficacy in rheumatoid arthritis.


The Meclofenamate sodium treated patients had fewer reactions involving the special senses, specifically tinnitus, but more gastrointestinal reactions, specifically diarrhea.


The incidence of patients who discontinued therapy due to adverse reactions was similar for both the Meclofenamate sodium and aspirin-treated groups.


The improvement with Meclofenamate sodium reported by patients and the reduction of the disease activity as evaluated by both physicians and patients with rheumatoid arthritis are associated with a significant reduction in number of tender joints, severity of tenderness, and duration of morning stiffness.


The improvement reported by patients and as evaluated by physicians in patients treated with Meclofenamate sodium for osteoarthritis is associated with a significant reduction in night pain, pain on walking, degree of starting pain, and pain on passive motion. The function of knee joints also improved significantly.


Meclofenamate sodium has been used in combination with gold salts or corticosteroids in patients with rheumatoid arthritis. Studies have demonstrated that Meclofenamate sodium contributes to the improvement of patients' conditions while maintained on gold salts or corticosteroids. Data are inadequate to demonstrate that Meclofenamate sodium in combination with salicylates produces greater improvement than that achieved with Meclofenamate sodium alone.


In controlled clinical trials of patients with mild to moderate pain, Meclofenamate sodium 50 mg provided significant pain relief. In these studies of episiotomy and dental pain, Meclofenamate sodium 100 mg demonstrated additional benefit in some patients. The onset of analgesic effect was generally within one hour and the duration of action was 4 to 6 hours.


In controlled clinical trials of patients with dysmenorrhea, Meclofenamate sodium 100 mg t.i.d. provided significant reduction in the symptoms associated with dysmenorrhea.


In randomized double-blind crossover trials of Meclofenamate sodium 100 mg t.i.d. versus placebo in women with heavy menstrual blood loss (MBL), Meclofenamate sodium treatment was usually associated with a reduction in menstrual flow.


The graph below is a scatter plot of menstrual flow from the average of two menstrual periods on Meclofenamate sodium treatments (vertical axis) versus two menstrual periods on placebo (horizontal axis) for 55 women. Of note, although the amount of reduction in MBL was variable, some degree of reduction occurred in 90% of women in this study.



The points on the graph represent the mean MBL for each subject when treated for two periods with placebo and two periods with Meclofenamate sodium. To ease in interpretation, the following examples may be helpful. Point A represents a woman who had MBL of 459 mL while on placebo, and 405 mL on Meclofenamate sodium. Point B represents a woman who had MBL of 472 mL while on placebo, and 64 mL when treated with Meclofenamate sodium.


In association with this reduction in menstrual blood loss, the duration of menses was decreased by one day; tampon/pad usage was decreased by an average of two per day on the two days of heaviest flow; and symptoms of dysmenorrhea were significantly reduced.



Indications and Usage for Meclofenamate


Meclofenamate sodium is indicated for the relief of mild to moderate pain.


Meclofenamate sodium is also indicated for the treatment of primary dysmenorrhea and for the treatment of idiopathic heavy menstrual blood loss (see CLINICAL PHARMACOLOGY and PRECAUTIONS).


Meclofenamate sodium is also indicated for relief of the signs and symptoms of acute and chronic rheumatoid arthritis and osteoarthritis. As with all non-steroidal anti-inflammatory drugs, selection of Meclofenamate sodium requires a careful assessment of the benefit/risk ratio (see WARNINGS, PRECAUTIONS and ADVERSE REACTIONS).


Meclofenamate sodium is not recommended in children because adequate studies to demonstrate safety and efficacy have not been carried out.



Contraindications


Meclofenamate sodium should not be used in patients who have previously exhibited hypersensitivity to it.


Because the potential exists for cross-sensitivity to aspirin or other non-steroidal anti-inflammatory drugs, Meclofenamate sodium should not be given to patients in whom these drugs induce symptoms of bronchospasm, allergic rhinitis, or urticaria.



Warnings



Risk of GI Ulceration, Bleeding and Perforation with NSAID Therapy


Serious gastrointestinal toxicity, such as bleeding, ulceration, and perforation, can occur at any time, with or without warning symptoms, in patients treated chronically with NSAID therapy. Although minor upper gastrointestinal problems, such as dyspepsia, are common, usually developing early in therapy, physicians should remain alert for ulceration and bleeding in patients treated chronically with NSAIDs even in the absence of previous GI tract symptoms. In patients observed in clinical trials of several months to two years duration, symptomatic upper GI ulcers, gross bleeding or perforation appear to occur in approximately 1% of patients treated for 3 to 6 months, and in about 2% to 4% of patients treated for one year. Physicians should inform patients about the signs and/or symptoms of serious GI toxicity and what steps to take if they occur.


Studies to date have not identified any subset of patients not at risk of developing peptic ulceration and bleeding. Except for a prior history of serious GI events and other risk factors known to be associated with peptic ulcer disease, such as alcoholism, smoking, etc., no risk factors (e.g., age, sex) have been associated with increased risk. Elderly or debilitated patients seem to tolerate ulceration or bleeding less well than other individuals, and most spontaneous reports of fatal GI events are in this population. Studies to date are inconclusive concerning the relative risk of various NSAIDs in causing such reactions. High doses of any NSAID probably carry a greater risk of these reactions, although controlled clinical trials showing this do not exist in most cases. In considering the use of relatively large doses (within the recommended dosage range), sufficient benefit should be anticipated to offset the potential increased risk of GI toxicity.



Precautions



General


Patients receiving non-steroidal anti-inflammatory agents, such as Meclofenamate sodium, should be evaluated periodically to insure that the drug is still necessary and well tolerated (see other PRECAUTIONS, WARNINGS, and ADVERSE REACTIONS).


Diarrhea, gastrointestinal irritation and abdominal pain may be associated with Meclofenamate sodium therapy. Dosage reduction or temporarily stopping the drug have generally controlled these symptoms (see ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION).


Decreases in hemoglobin and/or hematocrit levels have occurred in approximately 1 of 6 patients, but rarely required discontinuation of Meclofenamate sodium therapy. The clinical data revealed no evidence of increased chronic blood loss, bone marrow suppression, or hemolysis to account for the decreases in hemoglobin or hematocrit levels. Patients who are receiving long-term Meclofenamate sodium therapy should have hemoglobin and hematocrit values determined if anemia is suspected on clinical grounds.


If a patient develops visual symptoms (see ADVERSE REACTIONS) during Meclofenamate sodium therapy, the drug should be discontinued and the patient should have a complete ophthalmologic examination.


When Meclofenamate sodium is used in combination with steroid therapy, any reduction in steroid dosage should be gradual to avoid the possible complications of sudden steroid withdrawal.



Elderly


Adverse effects are seen more commonly in the elderly; therefore, a lower starting dose and careful follow-up are advised.



Evaluation of Patients with Heavy Menstrual Blood Loss


Prior to prescribing Meclofenamate sodium for heavy blood flow and primary dysmenorrhea, a thorough risk/benefit assessment should be made that takes into account the results described in the CLINICAL PHARMACOLOGY section. It is recommended that Meclofenamate sodium treatment not be prescribed for heavy menstrual flow without establishing its idiopathic nature. Spotting or bleeding between cycles should be evaluated fully and not treated with Meclofenamate sodium. Worsening of menstrual blood loss or excessive blood loss failing to respond to Meclofenamate sodium should also be evaluated by an appropriate work-up and not treated with Meclofenamate sodium.



Hepatic Reactions


As with other non-steroidal anti-inflammatory drugs, borderline elevations of one or more liver tests may occur in some patients. These abnormalities may progress, may remain essentially unchanged, or may be transient with continued therapy. The SGPT (ALT) test is probably the most sensitive indicator of liver dysfunction. Meaningful (three times the upper limit of normal) elevations of SGPT or SGOT (AST) occurred in controlled clinical trials in less than 1% of patients. A patient with symptoms and/or signs suggesting liver dysfunction, or in whom an abnormal liver test has occurred, should be evaluated for evidence of the development of more severe hepatic reaction while on therapy with Meclofenamate sodium. Severe hepatic reactions, including jaundice and cases of fatal hepatitis, have been reported with other non-steroidal anti-inflammatory drugs. Although such reactions are rare, if abnormal liver tests persist or worsen, if clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (e.g.; eosinophilia, rash), Meclofenamate sodium should be discontinued.



Renal Effects


As with other non-steroidal anti-inflammatory drugs, long-term administration of Meclofenamate sodium to animals has resulted in renal papillary necrosis and other abnormal renal pathology. In humans, there have been reports of acute interstitial nephritis with hematuria, proteinuria, and occasionally nephrotic syndrome.


A second form of renal toxicity has been seen in patients with prerenal conditions leading to a reduction in renal blood flow or blood volume, where the renal prostaglandins have a supportive role in the maintenance of renal perfusion. In these patients administration of an NSAID may cause a dose dependent reduction in prostaglandin formation and may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics, and the elderly. Discontinuation of NSAID therapy is typically followed by recovery to the pretreatment state.


Since Meclofenamate sodium metabolites are eliminated primarily by the kidneys, patients with significantly impaired renal function should be closely monitored; a lower daily dosage should be employed to avoid excessive drug accumulation.



Information for Patients


Patients should be advised that nausea, vomiting, diarrhea, and abdominal pain have been associated with the use of Meclofenamate sodium. The patient should be made aware of a possible drug connection and accordingly should consider discontinuing the drug and contacting his or her physician if any of these conditions are severe.


Women who are taking Meclofenamate sodium for heavy menstrual flow should be advised to consult their doctor if they have spotting or bleeding between cycles or worsening of their menstrual blood flow. These symptoms may be signs of the development of a more serious condition that is not appropriately treated with Meclofenamate sodium.


Meclofenamate sodium may be taken with meals or milk to control gastrointestinal complaints. Concomitant administration of an antacid (specifically, aluminum and magnesium hydroxides) does not interfere with the absorption of the drug.


Meclofenamate sodium, like other drugs of its class, is not free of side effects. The side effects of these drugs can cause discomfort, and rarely, there are more serious side effects, such as gastrointestinal bleeding, which may result in hospitalization and even fatal outcomes.


NSAIDs (non-steroidal anti-inflammatory drugs) are often essential agents in the management of arthritis and have a major role in the treatment of pain, but they also may be commonly employed for conditions which are less serious.


Physicians may wish to discuss with their patients the potential risks (see WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS) and likely benefits of NSAID treatment, particularly when the drugs are used for less serious conditions where treatment without NSAIDs may represent an acceptable alternative to both the patient and physician.



Laboratory Tests


Patients receiving long-term Meclofenamate sodium therapy should have hemoglobin and hematocrit values determined if signs or symptoms of anemia occur.


Low white blood cell counts were rarely observed in clinical trials. These low counts were transient and usually returned to normal while the patient continued on Meclofenamate sodium therapy. Persistent leukopenia, granulocytopenia, or thrombocytopenia warrant further clinical evaluation and may require discontinuation of the drug.


When abnormal blood chemistry values are obtained, follow-up studies are indicated.


Elevations of serum transaminase levels and of alkaline phosphatase levels occurred in approximately 4% of patients. An occasional patient had elevations of serum creatinine or BUN levels.


Because serious GI tract ulceration and bleeding can occur without warning symptoms, physicians should follow chronically treated patients for the signs and symptoms of ulceration and bleeding and should inform them of the importance of this follow-up (see WARNINGS: Risk of GI Ulceration, Bleeding and Perforation with NSAID Therapy).



Drug Interactions


1. Warfarin

Meclofenamate sodium enhances the effect of warfarin. Therefore, when Meclofenamate sodium is given to a patient receiving warfarin, the dosage of warfarin should be reduced to prevent excessive prolongation of the prothrombin time.


2. Aspirin

Concurrent administration of aspirin may lower Meclofenamate sodium plasma levels, possibly by competing for protein binding sites. The urinary excretion of Meclofenamate sodium is unaffected by aspirin, indicating no change in Meclofenamate sodium absorption. Meclofenamate sodium does not affect serum salicylate levels. Greater fecal blood loss results from concomitant administration of both drugs than from either drug alone.


3. Propoxyphene

The concurrent administration of propoxyphene hydrochloride does not affect the bioavailability of Meclofenamate sodium.


4. Antacids

Concomitant administration of aluminum and magnesium hydroxides does not interfere with absorption of Meclofenamate sodium.



Carcinogenesis


An 18 month study in rats revealed no evidence of carcinogenicity.



Pregnancy


Meclofenamate sodium, like aspirin and other non-steroidal anti-inflammatory drugs, causes fetotoxicity, minor skeletal malformations, e.g., supernumerary ribs, and delayed ossification in rodent reproduction trials, but no major teratogenicity. Similarly, it prolongs gestation and interferes with parturition and with normal development of young before weaning. Meclofenamate sodium is not recommended for use during pregnancy, particularly in the 1st and 3rd trimesters based on these animal findings. There are, however, no adequate and well controlled studies in pregnant women.



Nursing Mothers


Trace amounts of meclofenamic acid are excreted in human milk. Because of the possible adverse effects of prostaglandin-inhibiting drugs on neonates, Meclofenamate sodium is not recommended for nursing women.



Pediatric Use


Safety and effectiveness in children below the age of 14 have not been established.



Adverse Reactions



Incidence Greater Than 1%


The following adverse reactions were observed in clinical trials and included observations from more than 2,700 patients, 594 of whom were treated for one year and 248 for at least two years.


Gastrointestinal: The most frequently reported adverse reactions associated with Meclofenamate sodium involve the gastrointestinal system. In controlled studies of up to six months duration, these disturbances occurred in the following decreasing order of frequency with the approximate incidences in parentheses: diarrhea (10% to 33%), nausea with or without vomiting (11%), other gastrointestinal disorders (10%), and abdominal pain1. In long-term uncontrolled studies of up to four years duration, one third of the patients had at least one episode of diarrhea some time during Meclofenamate sodium therapy.


In approximately 4% of the patients in controlled studies, diarrhea was severe enough to require discontinuation of Meclofenamate sodium. The occurrence of diarrhea is dose related, generally subsides with dose reduction, and clears with termination of therapy. The incidence of diarrhea in patients with osteoarthritis is generally lower than that reported in patients with rheumatoid arthritis.


Other reactions less frequently reported were pyrosis1, flatulence1, anorexia, constipation, stomatitis, and peptic ulcer. The majority of the patients with peptic ulcer had either a history of ulcer disease or were receiving concomitant anti-inflammatory drugs, including corticosteroids which are known to produce peptic ulceration.


Cardiovascular: edema


Dermatologic: rash1, urticaria, pruritus


Central Nervous System: headache1, dizziness1


Special Senses: tinnitus



1


Incidence between 3% and 9%. Those reactions occurring in 1% to 3% of patients are not marked with an asterisk.




Incidence Less Than 1%—Probably Causally Related


The following adverse reactions were reported less frequently than 1% during controlled clinical trials and through voluntary reports since marketing. The probability of a causal relationship exists between the drug and these adverse reactions.


Gastrointestinal: bleeding and/or perforation with or without obvious ulcer formation, colitis, cholestatic jaundice


Renal: renal failure


Hematologic: neutropenia, thrombocytopenic purpura, leukopenia, agranulocytosis, hemolytic anemia, eosinophilia, decrease in hemoglobin and/or hematocrit


Dermatologic: erythema multiforme, Stevens-Johnson Syndrome, exfoliative dermatitis


Hepatic: alteration of liver function tests


Allergic: lupus and serum sickness-like symptoms



Incidence Less Than 1%—Causal Relationship Unknown


Other reactions have been reported but under conditions where a causal relationship could not be established. However, in these rarely reported events, that possibility cannot be excluded. Therefore, these observations are listed to alert physicians.


Cardiovascular: palpitations


Central Nervous System: malaise, fatigue, paresthesia, insomnia, depression


Special Senses: blurred vision, taste disturbances, decreased visual acuity, temporary loss of vision, reversible loss of color vision, retinal changes including macular fibrosis, macular and perimacular edema, conjunctivitis, iritis


Renal: nocturia


Gastrointestinal: paralytic ileus


Dermatologic: erythema nodosum, hair loss



Overdosage


The following is based on the little information available concerning overdosage with Meclofenamate sodium and related compounds. After a massive overdose, CNS stimulation may be manifested by irrational behavior, marked agitation and generalized seizures. Following this phase, renal toxicity (falling urine output, rising creatinine, abnormal urinary cellular elements) may be noted with possible oliguria or anuria and azotemia. A 24 year-old male was anuric for approximately one week after ingesting an overdose of 6 to 7 grams of Meclofenamate sodium. Spontaneous diuresis and recovery subsequently occurred.


Management consists of emptying the stomach by emesis or lavage and instilling an ample dose of activated charcoal into the stomach. There is some evidence that charcoal will actively absorb Meclofenamate sodium, but dialysis or hemoperfusion may be less effective because of plasma protein binding. The seizures should be controlled by an appropriate anticonvulsant regimen. Attention should be directed throughout, by careful monitoring, to the preservation of vital functions and fluid-electrolyte balance. Dialysis may be required to correct serious azotemia or electrolyte imbalance.



Meclofenamate Dosage and Administration



Usual Dosage


For Mild to Moderate Pain

The recommended dose is 50 mg every 4 to 6 hours. Doses of 100 mg may be needed in some patients for optimal pain relief (see CLINICAL PHARMACOLOGY). However, the daily dose should not exceed 400 mg (see ADVERSE REACTIONS).


For excessive menstrual blood loss and primary dysmenorrheal

The recommended dose of Meclofenamate sodium is 100 mg three times a day, for up to six days, starting at the onset of menstrual flow.


For rheumatoid arthritis and osteoarthritis (including acute exacerbations of chronic disease)

The dosage is 200 to 400 mg per day, administered in three or four equal doses.


Therapy should be initiated at the lower dosage, then increased as necessary to improve clinical response. The dosage should be individually adjusted for each patient, depending on the severity of the symptoms and the clinical response. The daily dosage should not exceed 400 mg per day. The smallest dosage of Meclofenamate sodium that yields clinical control should be employed.


Although improvement may be seen in some patients in a few days, two to three weeks of treatment may be required to obtain the optimum therapeutic benefit.


After a satisfactory response has been achieved, the dosage should be adjusted as required. A lower dosage may suffice for long-term administration.


If gastrointestinal complaints occur (see WARNINGS and PRECAUTIONS), Meclofenamate sodium may be administered with meals or with milk (see CLINICAL PHARMACOLOGY for a description of food effects). If intolerance occurs, the dosage may need to be reduced. Therapy should be terminated if any severe adverse reactions occur.



How is Meclofenamate Supplied


Meclofenamate Sodium Capsules, USP are available containing either 50 mg or 100 mg of meclofenamic acid as the sodium salt.


The 50 mg capsule is a hard-shell gelatin capsule with a coral opaque cap and a coral opaque body axially printed with MYLAN over 2150 in black ink on both the cap and body. The capsule is filled with an off-white powder blend. They are available as follows:


       NDC 0378-2150-01


       bottles of 100 capsules


The 100 mg capsule is a hard-shell gelatin capsule with a coral opaque cap and a white opaque body axially printed with MYLAN over 3000 in black ink on both the cap and body. The capsule is filled with an off-white powder blend. They are available as follows:


       NDC 0378-3000-01


       bottles of 100 capsules


       NDC 0378-3000-05


       bottles of 500 capsules


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


Protect from light and moisture.


Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.


Mylan Pharmaceuticals Inc.


Morgantown, WV 26505


REVISED MAY 2006


MCFT:R10



 


PRINCIPAL DISPLAY PANEL - 50 mg


NDC 0378-2150-01


Meclofenamate

SODIUM

CAPSULES, USP

50 mg*


100 CAPSULES (Rx only)


*Each capsule contains

Meclofenamate sodium

monohydrate equivalent

to 50 mg of

meclofenamic acid.


Dispense in a tight, light-resistant

container as defined in the USP

using a child-resistant closure.


Keep container tightly closed.


Keep this and all medication out

of the reach of children.


Store at 20° to 25°C (68° to 77°F).

[See USP for Controlled Room

Temperature.]


Protect from light and moisture.


Usual Adult Dosage: 200 to

400 mg per day; administered in

three or four equal doses. See

package outsert for full prescribing

information.


Mylan Pharmaceuticals Inc.

Morgantown, WV 26505


RM2150A5




 


PRINCIPAL DISPLAY PANEL - 100 mg


NDC 0378-3000-01


Meclofenamate

SODIUM

CAPSULES, USP

100 mg*


100 CAPSULES (Rx only)


*Each capsule contains

Meclofenamate sodium

monohydrate equivalent

to 100 mg of

meclofenamic acid.


Dispense in a tight, light-resistant

container as defined in the USP

using a child-resistant closure.


Keep container tightly closed.


Keep this and all medication out

of the reach of children.


Store at 20° to 25°C (68° to 77°F).

[See USP for Controlled Room

Temperature.]


Protect from light and moisture.


Usual Adult Dosage: 200 to

400 mg per day; administered in

three or four equal doses. See

package outsert for full prescribing

information.


Mylan Pharmaceuticals Inc.

Morgantown, WV 26505


RM3000A6










Meclofenamate SODIUM 
Meclofenamate sodium  capsule










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)0378-2150
Route of AdministrationORALDEA Schedule    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
Meclofenamate SODIUM (MECLOFENAMIC ACID)Meclofenamate SODIUM50 mg
























Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE 
FD&C BLUE NO. 1 
GELATIN 
MAGNESIUM STEARATE 
CELLULOSE, MICROCRYSTALLINE 
STARCH, CORN 
FD&C RED NO. 3 
SODIUM LAURYL SULFATE 
TITANIUM DIOXIDE 
D&C YELLOW NO. 10 


















Product Characteristics
ColorPINK (coral opaque)Scoreno score
ShapeCAPSULESize14mm
FlavorImprint CodeMYLAN;2150
Contains      










Packaging
#NDCPackage DescriptionMultilevel Packaging
10378-2150-01100 CAPSULE In 1 BOTTLE, UNIT-DOSENone










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANDAANDA07108105/20/2011







Meclofenamate SODIUM 
Meclofenamate sodium  capsule










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)0378-3000
Route of AdministrationORALDEA Schedule    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
Meclofenamate SODIUM (MECLOFENAMIC ACID)Meclofenamate SODIUM100 mg
























Inactive Ingredients
Ingredient NameStrength
SILICON DIOXIDE 
FD&C BLUE NO. 1 
GELATIN 
MAGNESIUM STEARATE 
CELLULOSE, MICROCRYSTALLINE 
STARCH, CORN 
FD&C RED NO. 3 
SODIUM LAURYL SULFATE 
TITANIUM DIOXIDE 
D&C YELLOW NO. 10 


















Product Characteristics
ColorPINK (coral opaque) , WHITE (white opaque)Scoreno score
ShapeCAPSULESize15mm
FlavorImprint CodeMYLAN;3000
Contains      














Packaging
#NDCPackage DescriptionMultilevel Packaging
10378-3000-01100 CAPSULE In 1 BOTTLENone
20378-3000-05500 CAPSULE In 1 BOTTLENone










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANDAANDA07108105/20/2011


Labeler - Mylan Pharmaceuticals Inc. (059295980)
Revised: 01/2010Mylan Pharmaceuticals Inc.

More Meclofenamate resources


  • Meclofenamate Side Effects (in more detail)
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  • Drug Images
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  • Meclofenamate Support Group
  • 0 Reviews for Meclofenamate - Add your own review/rating


  • Meclofenamate MedFacts Consumer Leaflet (Wolters Kluwer)

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  • Meclofenamate Sodium Monograph (AHFS DI)



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    • Canada

    International Drug Name Search

    Delvosteron




    Delvosteron may be available in the countries listed below.


    In some countries, this medicine may only be approved for veterinary use.

    Ingredient matches for Delvosteron



    Proligestone

    Proligestone is reported as an ingredient of Delvosteron in the following countries:


    • Austria

    • Belgium

    • France

    • Germany

    • Ireland

    • Luxembourg

    • Netherlands

    • New Zealand

    • Poland

    • South Africa

    • Switzerland

    • United Kingdom

    International Drug Name Search

    Wednesday, 28 September 2016

    Ticlopidine Qualimed




    Ticlopidine Qualimed may be available in the countries listed below.


    Ingredient matches for Ticlopidine Qualimed



    Ticlopidine

    Ticlopidine hydrochloride (a derivative of Ticlopidine) is reported as an ingredient of Ticlopidine Qualimed in the following countries:


    • France

    International Drug Name Search

    metaproterenol


    met-a-proe-TER-e-nol


    Commonly used brand name(s)

    In the U.S.


    • Alupent

    In Canada


    • Alti-Orciprenaline

    Available Dosage Forms:


    • Syrup

    • Tablet

    Therapeutic Class: Bronchodilator


    Pharmacologic Class: Beta-2 Adrenergic Agonist


    Uses For metaproterenol


    Metaproterenol is used to treat asthma and bronchospasm in patients with bronchitis, emphysema, and other lung diseases.


    Metaproterenol belongs to the family of medicines known as adrenergic bronchodilators. Adrenergic bronchodilators are medicines that open up the bronchial tubes (air passages) in the lungs. They relieve cough, wheezing, shortness of breath, and troubled breathing by increasing the flow of air through the bronchial tubes.


    metaproterenol is available only with your doctor's prescription.


    Before Using metaproterenol


    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 metaproterenol, the following should be considered:


    Allergies


    Tell your doctor if you have ever had any unusual or allergic reaction to metaproterenol 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 metaproterenol oral solution and tablets in children younger than 6 years of age. Safety and efficacy have not been established.


    Geriatric


    No information is available on the relationship of age to the effects of metaproterenol in geriatric patients.


    Pregnancy








    Pregnancy CategoryExplanation
    All TrimestersCAnimal 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 metaproterenol, 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 metaproterenol 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.


    • Acebutolol

    • Alprenolol

    • Arotinolol

    • Atenolol

    • Befunolol

    • Betaxolol

    • Bevantolol

    • Bisoprolol

    • Bopindolol

    • Bucindolol

    • Bupranolol

    • Carteolol

    • Carvedilol

    • Celiprolol

    • Dilevalol

    • Esmolol

    • Labetalol

    • Landiolol

    • Levobetaxolol

    • Levobunolol

    • Mepindolol

    • Metipranolol

    • Metoprolol

    • Nadolol

    • Nebivolol

    • Nipradilol

    • Oxprenolol

    • Penbutolol

    • Pindolol

    • Propranolol

    • Sotalol

    • Talinolol

    • Tertatolol

    • Timolol

    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 metaproterenol. Make sure you tell your doctor if you have any other medical problems, especially:


    • Diabetes or

    • Heart or blood vessel disease or

    • Hypertension (high blood pressure) or

    • Hyperthyroidism (overactive thyroid) or

    • Seizures—Use with caution. May make these conditions worse.

    • Heart rhythm problems (e.g., arrhythmia) or

    • Tachycardia (fast or rapid heartbeat)—Should not be used in patients with these conditions.

    Proper Use of metaproterenol


    Use metaproterenol only as directed by your doctor. Do not use more of it and do not use it more often than your doctor ordered. Also, do not stop using metaproterenol or any asthma medicine without telling your doctor. To do so may increase the chance for breathing problems.


    Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.


    Dosing


    The dose of metaproterenol 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 metaproterenol. 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 asthma and bronchospasm:
      • For oral dosage form (solution):
        • Adults—Two teaspoonfuls (10 milliliters [mL]) three or four times a day. Your doctor may adjust your dose as needed.

        • Children older than 9 years of age or weighing more than 60 pounds (lbs)—Two teaspoonfuls (10 mL) three or four times a day. Your doctor may adjust your dose as needed.

        • Children 6 to 9 years of age or weighing less than 60 lbs—One teaspoonful (5 mL) three or four times a day. Your doctor may adjust your dose as needed.

        • Children younger than 6 years of age—Use and dose must be determined by your child's doctor.


      • For oral dosage form (tablets):
        • Adults—20 milligrams (mg) three or four times a day. Your doctor may adjust your dose as needed.

        • Children older than 9 years of age or weighing more than 60 pounds (lbs)—20 mg three or four times a day. Your doctor may adjust your dose as needed.

        • Children 6 to 9 years of age or weighing less than 60 lbs—10 mg three or four times a day. Your doctor may adjust your dose as needed.

        • Children younger than 6 years of age—Use is not recommended.



    Missed Dose


    If you miss a dose of metaproterenol, 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 metaproterenol


    It is very important that your doctor check your progress or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to check for any unwanted effects.


    Check with your doctor at once if you or your child continue to have breathing problems after using a dose of metaproterenol or if your condition gets worse.


    Do not change your dose or stop using metaproterenol without asking your doctor first.


    Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.


    metaproterenol Side Effects


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


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


    More common
    • Fast, pounding, or irregular heartbeat or pulse

    Less common
    • Shakiness in the legs, arms, hands, or feet

    • trembling or shaking of the hands or feet

    • worsening of asthma

    Rare
    • Blurred vision

    • chest pain

    • chills

    • cough

    • diarrhea

    • dizziness

    • fainting

    • fever

    • general feeling of discomfort or illness

    • headache

    • increased sweating

    • joint pain

    • loss of appetite

    • muscle aches and pains

    • nausea

    • nervousness

    • pounding in the ears

    • puffiness of the face and fingers

    • runny nose

    • shivering

    • slow or fast heartbeat

    • sore throat

    • sweating

    • swelling

    • trouble sleeping

    • unusual tiredness or weakness

    • vomiting

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


    Symptoms of overdose
    • Arm, back, or jaw pain

    • chest discomfort

    • chest tightness or heaviness

    • confusion

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

    • dry mouth

    • general feeling of discomfort or illness

    • shortness of breath

    • sleeplessness

    • unable to sleep

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


    Less common
    • Abdominal or stomach pain

    Rare
    • Bad, unusual, or unpleasant (after) taste

    • change in appetite

    • drowsiness

    • dry mouth or throat

    • itching skin

    • pain

    • raised red swellings on the skin, lips, tongue, or in the throat

    • tightening of the muscles

    • weakness

    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: metaproterenol side effects (in more detail)



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


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


    More metaproterenol resources


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


    • metaproterenol Concise Consumer Information (Cerner Multum)

    • Metaproterenol MedFacts Consumer Leaflet (Wolters Kluwer)

    • Alupent Monograph (AHFS DI)

    • Alupent Prescribing Information (FDA)

    • Metaproterenol Prescribing Information (FDA)



    Compare metaproterenol with other medications


    • Asthma, acute
    • Asthma, Maintenance
    • COPD, Acute
    • COPD, Maintenance

    Tuesday, 27 September 2016

    Migranal


    Generic Name: dihydroergotamine (Nasal route)

    dye-hye-droe-er-GOT-a-meen

    Nasal route(Solution)

    Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of dihydroergotamine with potent CYP3A4 inhibitors including protease inhibitors and macrolide antibiotics. Because CYP3A4 inhibition elevates the serum levels of dihydroergotamine, the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased. Hence, concomitant use of these medications is contraindicated .



    Commonly used brand name(s)

    In the U.S.


    • Migranal

    Available Dosage Forms:


    • Spray

    Therapeutic Class: Antimigraine


    Chemical Class: Ergot Alkaloid


    Uses For Migranal


    Dihydroergotamine belongs to the group of medicines called ergot alkaloids. It is a nasal solution used to help relieve migraine headaches. Nasal dihydroergotamine is not an ordinary pain reliever. It will not relieve any kind of pain other than throbbing headaches.


    Nasal dihydroergotamine may cause blood vessels in the body to constrict (become narrower). This action can lead to serious effects that are caused by a decrease in the flow of blood (blood circulation) to many parts of the body. Be sure that you discuss with your doctor the risks of using this medicine as well as the good it can do.


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


    Before Using Migranal


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


    Allergies


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


    Pediatric


    There is no specific information comparing use of nasal dihydroergotamine in children with use in other age groups.


    Geriatric


    There is no specific information comparing use of nasal dihydroergotamine in older adults with use in other age groups.


    Pregnancy








    Pregnancy CategoryExplanation
    All TrimestersXStudies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

    Breast Feeding


    Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.


    Interactions with Medicines


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


    Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.


    • Almotriptan

    • Amprenavir

    • Atazanavir

    • Azithromycin

    • Boceprevir

    • Clarithromycin

    • Cocaine

    • Darunavir

    • Delavirdine

    • Dirithromycin

    • Efavirenz

    • Epinephrine

    • Erythromycin

    • Fosamprenavir

    • Frovatriptan

    • Indinavir

    • Itraconazole

    • Josamycin

    • Ketoconazole

    • Lidocaine

    • Lopinavir

    • Mepartricin

    • Midodrine

    • Miokamycin

    • Naratriptan

    • Nefazodone

    • Nelfinavir

    • Norepinephrine

    • Phenylpropanolamine

    • Posaconazole

    • Propylhexedrine

    • Pseudoephedrine

    • Ritonavir

    • Rizatriptan

    • Rokitamycin

    • Roxithromycin

    • Saquinavir

    • Saralasin

    • Spiramycin

    • Sumatriptan

    • Telaprevir

    • Tipranavir

    • Troleandomycin

    • Voriconazole

    • Zolmitriptan

    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.


    • Crizotinib

    • Dexfenfluramine

    • Eletriptan

    • Fluconazole

    • Fluvoxamine

    • Imatinib

    • Ranolazine

    • Sibutramine

    • Telithromycin

    • Vemurafenib

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


    • Nitroglycerin

    • Propranolol

    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. 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 is usually not recommended, 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.


    • Grapefruit Juice

    Other Medical Problems


    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:


    • Heart or blood vessel disease or

    • Hypertension (high blood pressure) or

    • Kidney disease or

    • Liver disease or

    • Infection—The chance of serious side effects caused by nasal dihydroergotmine may be increased. Heart or blood vessel disease and high blood pressure sometimes do not cause any symptoms, so some people do not know that they have these problems. Before deciding whether you should use nasal dihydroergotamine, your doctor may need to do some tests to make sure that you do not have any of these conditions.

    Proper Use of Migranal


    It is important to use this medicine properly. Make sure that you read the patient directions carefully before using this medicine.


    Do not use nasal dihydroergotamine for a headache that is different from your usual migraine. Instead, check with your doctor.


    To relieve your migraine as soon as possible, use nasal dihydroergotamine as soon as the headache begins. Even if you get warning signals of a coming migraine (an aura), you should wait until the headache pain starts before using nasal dihydroergotamine.


    Lying down in a quiet, dark room for a while after you use this medicine may help relieve your migraine.


    If you feel much better after a dose of nasal dihydroergotamine, but your headache comes back or gets worse after a while, you may use more nasal dihydroergotamine. However, use this medicine only as directed by your doctor. Do not use more of it, and do not use it more often, than directed.


    Your doctor may direct you to take another medicine to help prevent headaches. It is important that you follow your doctor's directions, even if your headaches continue to occur. Headache-preventing medicines may take several weeks to start working. Even after they do start working, your headaches should occur less often, and they should be less severe, and easier to relieve. This can reduce the amount of nasal dihydroergotamine or other pain medicines that you need. If you do not notice any improvement after several weeks of headache-preventing treatment, check with your doctor.


    Dosing


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


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


    • For nasal dosage form (nasal solution):
      • For migraine headaches:
        • Adults—One spray (0.5 mg) in each nostril. After 15 minutes, another spray (0.5 mg) in each nostril should be used.

        • Children—Use and dose must be determined by your doctor.



    Storage


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


    Keep out of the reach of children.


    Do not keep outdated medicine or medicine no longer needed.


    Precautions While Using Migranal


    Drinking alcoholic beverages can make headaches worse or cause new headaches to occur. People who suffer from severe headaches should probably avoid alcoholic beverages, especially during a headache.


    Some people feel drowsy or dizzy during or after a migraine attack, or after taking nasal dihydroergotamine to relieve a migraine headache. As long as you are feeling drowsy or dizzy, do not drive, use machines or do anything else that could be dangerous if you are dizzy or are not alert.


    Migranal 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 as soon as possible if any of the following side effects occur:


    Less common or rare
    • Chest pain

    • cough, fever, sneezing, or sore throat

    • feeling of heaviness in chest

    • irregular heartbeat

    • itching of the skin

    • numbness and tingling of face, fingers, or toes

    • pain in arms, legs, or lower back

    • pain in back, chest or left arm

    • pale bluish-colored or cold hands or feet

    • shortness of breath or troubled breathing

    • weak or absent pulses in legs

    Symptoms of overdose
    • Confusion

    • convulsions (seizures)

    • delirium

    • dizziness

    • headaches

    • nausea and/or vomiting

    • numbness, tingling, and/or pain in the legs or arms

    • shortness of breath

    • stomach pain

    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
    • Burning or tingling sensation, dryness, soreness, or pain in the nose

    • change in sense of taste

    • diarrhea

    • dizziness

    • dry mouth

    • fatigue

    • headache

    • increased sweating

    • nausea and or vomiting

    • muscle stiffness

    • runny and or stuffy nose

    • sudden sweatings and feelings of warmth

    • sensation of burning, warmth, or heat

    • sore throat

    • sleepiness

    • unexplained nose bleeds

    • unusual tiredness or weakness

    Less common
    • Anxiety

    • blurred vision

    • cold clammy skin

    • confusion

    • congestion in chest

    • cough

    • decreased appetite

    • depression

    • difficulty swallowing

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

    • ear pain

    • eye pain

    • fever

    • heartburn

    • increased watering of eyes

    • increased watering of the mouth

    • increased yawning

    • muscle weakness

    • nervousness

    • pinpoint red spots on skin

    • pounding heartbeat

    • red or irritated eyes

    • ringing or buzzing in ears

    • skin rash

    • stomach pain

    • sudden fainting

    • swelling of face, fingers, feet, or lower legs

    • trembling or shaking of hands or feet

    • trouble in sleeping

    • unusual feeling of well being

    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: Migranal side effects (in more detail)



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


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


    More Migranal resources


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


    • Migranal Prescribing Information (FDA)

    • Migranal Spray MedFacts Consumer Leaflet (Wolters Kluwer)

    • Migranal Concise Consumer Information (Cerner Multum)

    • D.H.E. 45 Prescribing Information (FDA)

    • D.H.E. 45 injection Concise Consumer Information (Cerner Multum)

    • D.H.E. 45 MedFacts Consumer Leaflet (Wolters Kluwer)

    • Dihydroergotamine Mesylate Monograph (AHFS DI)



    Compare Migranal with other medications


    • Cluster Headaches
    • Migraine

    Monday, 26 September 2016

    Mangimin


    Generic Name: manganese supplement (Oral route, Parenteral route)


    Commonly used brand name(s)

    In the U.S.


    • Mangimin

    Available Dosage Forms:


    • Tablet

    • Capsule

    Uses For Mangimin


    Manganese supplements are used to prevent or treat manganese deficiency.


    The body needs manganese for normal growth and health. For patients who are unable to get enough manganese in their regular diet or who have a need for more manganese, manganese supplements may be necessary. Manganese helps your body break down fats, carbohydrates, and proteins. It does so as part of several enzymes.


    Manganese deficiency has not been reported in humans. Lack of manganese in animals has been found to cause improper formation of bone and cartilage, may decrease the body's ability to use sugar properly, and may cause growth problems.


    Injectable manganese supplements are given by or under the supervision of a health care professional.


    Importance of Diet


    For good health, it is important that you eat a balanced and varied diet. Follow carefully any diet program your health care professional may recommend. For your specific dietary vitamin and/or mineral needs, ask your health care professional for a list of appropriate foods. If you think that you are not getting enough vitamins and/or minerals in your diet, you may choose to take a dietary supplement.


    Manganese is found in whole grains, cereal products, lettuce, dry beans, and peas.


    The daily amount of manganese needed is defined in several different ways.


    • For U.S.—

    • Recommended Dietary Allowances (RDAs) are the amount of vitamins and minerals needed to provide for adequate nutrition in most healthy persons. RDAs for a given nutrient may vary depending on a person's age, sex, and physical condition (e.g., pregnancy).

    • Daily Values (DVs) are used on food and dietary supplement labels to indicate the percent of the recommended daily amount of each nutrient that a serving provides. DV replaces the previous designation of United States Recommended Daily Allowances (USRDAs).

    • For Canada—

    • Recommended Nutrient Intakes (RNIs) are used to determine the amounts of vitamins, minerals, and protein needed to provide adequate nutrition and lessen the risk of chronic disease.

    Because a lack of manganese is rare, there is no RDA or RNI for it. The following daily intakes are thought to be plenty for most individuals:


    • Infants and children—
      • Birth to 3 years of age: 0.3 to 1.5 milligrams (mg).

      • 4 to 6 years of age: 1.5 to 2 mg.

      • 7 to 10 years of age: 2 to 3 mg.


    • Adolescents and adults—2 to 5 mg.

    Before Using Mangimin


    If you are taking a dietary supplement without a prescription, carefully read and follow any precautions on the label. For these supplements, the following should be considered:


    Allergies


    Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group 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


    Problems in children have not been reported with intake of normal daily recommended amounts.


    Geriatric


    Problems in older adults have not been reported with intake of normal daily recommended amounts.


    Pregnancy


    It is especially important that you are receiving enough vitamins and minerals when you become pregnant and that you continue to receive the right amount of vitamins and minerals throughout your pregnancy. The healthy growth and development of the fetus depend on a steady supply of nutrients from the mother. However, taking large amounts of a dietary supplement in pregnancy may be harmful to the mother and/or fetus and should be avoided.


    Breast Feeding


    It is important that you receive the right amounts of vitamins and minerals so that your baby will also get the vitamins and minerals needed to grow properly. However, taking large amounts of a dietary supplement while breast-feeding may be harmful to the mother and/or baby and should be avoided.


    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. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.


    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 dietary supplements in this class. Make sure you tell your doctor if you have any other medical problems, especially:


    • Biliary disease or

    • Liver disease—Taking manganese supplements may cause high blood levels of manganese, and dosage of manganese may have to be changed.

    Proper Use of Mangimin


    Dosing


    The dose medicines in this class 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 these medicines. 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 (as part of a multivitamin/mineral supplement):
      • To prevent deficiency, the amount taken by mouth is based on normal daily recommended intakes:
        • Adults and teenagers—2 to 5 milligrams (mg) per day.

        • Children 7 to 10 years of age—2 to 3 mg per day.

        • Children 4 to 6 years of age—1.5 to 2 mg per day.

        • Children birth to 3 years of age—0.3 to 1.5 mg per day.


      • To treat deficiency:
        • Adults, teenagers, and children—Treatment dose is determined by prescriber for each individual based on severity of deficiency.



    Missed Dose


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


    If you miss taking manganese supplements for one or more days there is no cause for concern, since it takes some time for your body to become seriously low in manganese. However, if your health care professional has recommended that you take manganese, try to remember to take it as directed every day.


    Storage


    Keep out of the reach of children.


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


    Do not keep outdated medicine or medicine no longer needed.


    Mangimin Side Effects


    No side effects or toxic effects have been reported for manganese. However, check with your health care professional if you notice any unusual effects while you are taking it.



    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.

    Meloxicam Suspension



    Pronunciation: mel-OX-i-kam
    Generic Name: Meloxicam
    Brand Name: Mobic

    Meloxicam Suspension is a nonsteroidal anti-inflammatory drug (NSAID). It may cause an increased risk of serious and sometimes fatal heart and blood vessel problems (eg, heart attack, stroke). The risk may be greater if you already have heart problems or if you take Meloxicam Suspension for a long time. Do not use Meloxicam Suspension right before or after bypass heart surgery.


    Meloxicam Suspension may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Elderly patients may be at greater risk. This may occur without warning signs.





    Meloxicam Suspension is used for:

    Treating rheumatoid arthritis, osteoarthritis, and juvenile arthritis. It may also be used for other conditions as determined by your doctor.


    Meloxicam Suspension is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms.


    Do NOT use Meloxicam Suspension if:


    • you are allergic to any ingredient in Meloxicam Suspension

    • you have had a severe allergic reaction (eg, severe rash, hives, trouble breathing, growths in the nose, dizziness) to aspirin or a nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, celecoxib)

    • you have recently had or will be having bypass heart surgery

    • you have a peptic ulcer

    • you are in the last 3 months of pregnancy

    • you take sodium polystyrene sulfonate

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



    Before using Meloxicam Suspension:


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


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

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

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

    • if you have a history of kidney or liver disease, diabetes, stomach or bowel problems (eg, bleeding, perforation, ulcers), or H. pylori infection

    • if you have a history of swelling or fluid buildup, asthma, growths in the nose (nasal polyps), or mouth inflammation

    • if you have high blood pressure, blood disorders, bleeding or clotting problems, heart problems (eg, heart failure), or blood vessel disease, or if you are at risk for any of these diseases

    • if you have poor health, dehydration or low fluid volume, or low blood sodium levels, you drink alcohol or smoke, or you have a history of alcohol abuse

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


    • Anticoagulants (eg, warfarin), antiplatelet medicines (eg, clopidogrel), aspirin, bisphosphonates (eg, alendronate), corticosteroids (eg, prednisone), dabigatran, desirudin, heparin, rivaroxaban, or serotonin reuptake inhibitors (eg, fluoxetine) because the risk of stomach bleeding may be increased

    • Sodium polystyrene sulfonate because a serious and possibly fatal bowel problem (intestinal necrosis) may occur

    • Probenecid because it may increase the risk of Meloxicam Suspension's side effects

    • Cholestyramine because it may decrease Meloxicam Suspension's effectiveness

    • Cyclosporine, lithium, methotrexate, quinolones (eg, ciprofloxacin), or sulfonylureas (eg, glipizide) because the risk of their side effects may be increased by Meloxicam Suspension

    • Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), angiotensin receptor blockers (eg, losartan), or diuretics (eg, furosemide, hydrochlorothiazide) because their effectiveness may be decreased by Meloxicam Suspension and the risk of kidney problems may be increased

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


    How to use Meloxicam Suspension:


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


    • Meloxicam Suspension comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Meloxicam Suspension refilled.

    • Take Meloxicam Suspension by mouth. It may be taken with food if it upsets your stomach. Taking it with food may not lower the risk of stomach or bowel problems (eg, bleeding, ulcers).

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

    • Shake gently before each use.

    • Take Meloxicam Suspension with a full glass of water (8 oz/240 mL) as directed by your doctor.

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

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



    Important safety information:


    • Meloxicam Suspension may cause dizziness. This effect may be worse if you take it with alcohol or certain medicines. Use Meloxicam Suspension with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

    • Serious stomach ulcers or bleeding can occur with the use of Meloxicam Suspension. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking Meloxicam Suspension with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.

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

    • Meloxicam Suspension has an NSAID in it. Before you start any new medicine, check the label to see if it has an NSAID (eg, ibuprofen) in it too. If it does or if you are not sure, check with your doctor or pharmacist.

    • Do not take aspirin while you are using Meloxicam Suspension unless your doctor tells you to.

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

    • Use Meloxicam Suspension with caution in the ELDERLY; they may be more sensitive to its effects, especially stomach bleeding and kidney problems.

    • Caution is advised when using Meloxicam Suspension in CHILDREN; they may be more sensitive to its effects, especially diarrhea, fever, headache, stomach pain, and vomiting.

    • Meloxicam Suspension should be used with extreme caution in CHILDREN younger than 2 years old; safety and effectiveness in these children have not been determined.

    • PREGNANCY and BREAST-FEEDING: Meloxicam Suspension may cause harm to the fetus. Do not use it during the last 3 months of pregnancy. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Meloxicam Suspension while you are pregnant. It is not known if Meloxicam Suspension is found in breast milk. Do not breast-feed while taking Meloxicam Suspension.


    Possible side effects of Meloxicam Suspension:


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



    Constipation; diarrhea; dizziness; gas; headache; heartburn; mild stomach pain; nausea; stomach upset; trouble sleeping; vomiting.



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

    Severe allergic reactions (rash; hives; itching; trouble breathing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue; unusual hoarseness); bloody or black, tarry stools; change in the amount of urine produced; chest pain; confusion; dark urine; difficult or painful urination; fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; loss of appetite; mental or mood changes (eg, depression); numbness of an arm or leg; one-sided weakness; pale stools; red, swollen, blistered, or peeling skin; ringing in the ears; seizures; severe or persistent headache or dizziness; severe or persistent stomach pain or nausea; severe vomiting; shortness of breath; sudden or unexplained weight gain; swelling of hands, legs, or feet; unusual bruising or bleeding; unusual joint or muscle pain; unusual tiredness or weakness; vision or speech changes; vomit that looks like coffee grounds; yellowing of the skin or eyes.



    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: Meloxicam 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 chest pain; decreased urination; loss of consciousness; seizures; severe dizziness, headache, or drowsiness; severe nausea, vomiting, or stomach pain; slow or troubled breathing; sluggishness; symptoms of liver problems (eg, dark urine, loss of appetite, pale stools, severe stomach pain, yellowing of the skin or eyes); symptoms of stomach or bowel bleeding (eg, bloody or black, tarry stools; vomit that looks like coffee grounds).


    Proper storage of Meloxicam Suspension:

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


    General information:


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

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

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

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

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



    Issue Date: February 1, 2012

    Database Edition 12.1.1.002

    Copyright © 2012 Wolters Kluwer Health, Inc.

    More Meloxicam resources


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


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