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Storage
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Warnings Precautions
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Possible Side Effects
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is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme.
Lisinopril is used to treat high blood pressure (hypertension), congestive heart failure, and to improve survival after a heart attack.
Lisinopril may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking lisinopril?
Do not use this medication if you are allergic to lisinopril or to any other ACE inhibitor, such as benazopril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik).
Before using lisinopril, tell your doctor if you are allergic to any drugs, or if you have:
kidney disease (or if you are on dialysis);
liver disease;
heart disease or congestive heart failure;
diabetes; or
a connective tissue disease such as Marfan syndrome, Sjogren’s syndrome, lupus, scleroderma, or rheumatoid arthritis.
If you have any of these conditions, you may not be able to use lisinopril, or you may need a dosage adjustment or special tests during treatment.
FDA pregnancy category D. Do not use this medication without telling your doctor if you are pregnant or planning a pregnancy. Lisinopril could cause birth defects in the baby if you take the medication during pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment. It is not known whether lisinopril 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 lisinopril?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
Your doctor may occasionally change your dose to make sure you get the best results from this medication.
Take each dose with a full glass of water.Lisinopril can be taken with or without food.
Vomiting, diarrhea, or heavy sweating can cause you to become dehydrated. This can lead to very low blood pressure, electrolyte disorders, or kidney failure while you are taking lisinopril. Drink plenty of water each day while you are taking this medication.
To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.
If you need to have any type of surgery, tell the surgeon ahead of time that you are taking lisinopril. You may need to stop using the medicine for a short time.
If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.
Store lisinopril at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take 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. Symptoms of a lisinopril overdose may include feeling extremely dizzy or light-headed, or fainting.
Lisinopril side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
feeling light-headed, fainting;
urinating more or less than usual, or not at all;
fever, chills, body aches, flu symptoms;
tired feeling, muscle weakness, and pounding or uneven heartbeats;
chest pain; or
swelling, rapid weight gain.
Less serious side effects may be more likely to occur, such as:
cough;
dizziness, drowsiness, headache;
nausea, vomiting, diarrhea, upset stomach; or
mild skin itching or rash.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect lisinopril?
Before taking lisinopril, tell your doctor if you are taking any of the following drugs:
lithium (Lithobid, Eskalith);
a potassium supplement such as K-Dur, Klor-Con;
salt substitutes that contain potassium;
insulin or diabetes medication you take by mouth;
aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Voltaren), etodolac (Lodine), indomethacin (Indocin), ketoprofen (Orudis), naproxen (Aleve, Naprosyn), and others; or
a diuretic (water pill).
If you are using any of these drugs, you may not be able to use lisinopril or you may need dosage adjustments or special tests during treatment.
There may be other drugs not listed that can affect lisinopril. 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.
is an antiarrhythmic agent. Disopyramide can help the heart to return to and maintain a normal heart rhythm. Disopyramide helps to slow rapid heartbeats (tachycardia). Generic disopyramide capsules are available.
What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:
• abnormal levels of potassium in the blood
• bladder obstruction
• diabetes
• glaucoma
• heart disease or problems other than rhythm and heart rate problems
• kidney disease
• liver disease
• myasthenia gravis
• prostate trouble
• an unusual or allergic reaction to disopyramide, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding
How should I take this medicine?
Take disopyramide capsules or extended-release capsules by mouth. Follow the directions on the prescription label. Swallow the capsules with a drink of water; do not suck or chew the extended-release capsules. Take your doses at regular intervals. Do not take your medicine more often than directed.
What if I miss a dose?
If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Leave an interval of at least 4 hours between doses of regular capsules and 6 to 8 hours between doses of extended-release capsules. Do not take double or extra doses.
What drug(s) may interact with disopyramide?
• arsenic trioxide
• astemizole
• bepridil
• beta-blockers, often used for high blood pressure or heart problems
• bosentan
• certain antibiotics (such as clarithromycin, erythromycin, gatifloxacin, grepafloxacin, levofloxacin, moxifloxacin, sparfloxacin)
• cisapride
• cyclobenzaprine
• ginger
• hawthorn
• lidocaine
• medicines for colds or breathing difficulties (including asthma)
• medicines for mental depression such as tricyclic antidepressants
• medicines for anxiety, mental problems or psychotic disturbances
• medicines for movement abnormalities as in Parkinson’s disease, or for gastrointestinal problems
• medicines for seizures such as phenytoin, phenobarbital, carbamazepine
• medicines to control heart rhythm (examples: amiodarone, digoxin, dofetilide, sotalol, procainamide, quinidine)
• mexiletine
• pimozide
• potassium salts
• probucol
• rifampin
• ritonavir
• sevelamer
• terfenadine
• warfarin
Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.
What side effects may I notice from taking disopyramide?
Side effects that you should report to your prescriber or health care professional as soon as possible:
• change in the amount of urine passed, or difficulty passing urine
• chest pain, palpitations
• confusion
• cool, pale skin
• difficulty breathing
• fever, chills, or sore throat
• headache
• lightheadedness or fainting spells
• muscle weakness
• skin rash, itching
• swelling of feet or legs
• unusual weakness or tiredness
• unusual weight increase
• unusual hunger
• yellowing of the skin or eyes
Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• dizziness, drowsiness
• blurred vision, dry eyes
• dry mouth and throat
• constipation, or less likely, diarrhea
• nausea, vomiting
• sexual difficulties
• stomach pain or bloating
is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).
Propranolol is used to treat tremors, angina (chest pain), hypertension (high blood pressure), heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack, and to reduce the severity and frequency of migraine headaches.
Propranolol may also be used for purposes other than those listed in this medication guide.
How should I take InnoPran XL (Propranolol)?
Take propranolol exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor.
Take this medication with a full glass of water.
Take propranolol at the same time every day.
Do not crush, chew, break, or open an extended-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.
To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
Do not skip doses or stop taking propranolol without first talking to your doctor. Stopping suddenly may make your condition worse.
To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. It is important that you not miss any scheduled visits to your doctor.
If you need to have any type of surgery, tell the surgeon that you are using propranolol. You may need to briefly stop using propranolol before having surgery.
Propranolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
Hypertension often has no symptoms, so you may not even feel that you have high blood pressure. Continue using this medicine as directed, even if you feel well. You may need to use blood pressure medication for the rest of your life.
What are the possible side effects of InnoPran XL (Propranolol)?
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:
slow or uneven heartbeats
feeling light-headed, fainting
feeling short of breath, even with mild exertion
swelling of your ankles or feet
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)
depression; or
cold feeling in your hands and feet
Other less serious side effects are more likely to occur, such as:
decreased sex drive, impotence, or difficulty having an orgasm
sleep problems (insomnia)
tired feeling; or
anxiety, nervousness
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs affect InnoPran XL (Propranolol)?
Before taking propranolol, tell your doctor if you are using:
allergy treatments (or if you are undergoing allergy skin-testing)
clonidine (Catapres)
guanabenz (Wytensin)
an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam)
a diabetes medication such as insulin, glyburide (Diabeta, Micronase, Glynase), glipizide (Glucotrol), chlorpropamide (Diabinese), or metformin (Glucophage)
a heart medication such as nifedipine (Procardia, Adalat), reserpine (Serpasil), verapamil (Calan, Verelan, Isoptin), diltiazem (Cartia, Cardizem)
medicine for asthma or other breathing disorders, such as albuterol (Ventolin, Proventil), bitolterol (Tornalate), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire, Brethine, Bricanyl), and theophylline (Theo-Dur, Theolair); or
cold medicines, stimulant medicines, or diet pills
If you are using any of these drugs, you may not be able to take propranolol, or you may need dosage adjustments or special tests during treatment.
There may be other drugs not listed that can affect propranolol. 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.
What happens if I overdose on InnoPran XL (Propranolol)?
Seek emergency medical attention if you think you have used too much of this medicine.
Symptoms of an propranolol overdose may include uneven heartbeats, shortness of breath, bluish-colored fingernails, dizziness, weakness, fainting, or seizure (convulsions).
What happens if I miss a dose of InnoPran XL (Propranolol)?
For regular (short-acting) propranolol: Take the missed dose as soon as you remember. If your next dose is less than 4 hours away, skip the missed dose and take the medicine at the next regularly scheduled time.
For extended-release propranolol (Inderal LA, InnoPran XL and others): Take the missed dose as soon as you remember. If your next dose is less than 8 hours away, skip the missed dose and take the medicine at the next regularly scheduled time.
Do not take extra medicine to make up the missed dose.
What is the most important information I should know about InnoPran XL (Propranolol)?
Do not stop taking propranolol without first talking to your doctor. Stopping suddenly may make your condition worse.
If you need to have any type of surgery, you may need to temporarily stop using propranolol. Be sure the surgeon knows ahead of time that you are using propranolol.
Propranolol 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, which could increase drowsiness and dizziness while you are taking propranolol.
Propranolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
Hypertension often has no symptoms, so you may not even feel that you have high blood pressure. Continue using this medicine as directed, even if you feel well. You may need to use blood pressure medication for the rest of your life.
Where can I get more information regarding InnoPran XL (Propranolol)?
Your pharmacist has additional information about propranolol written for health professionals that you may read.
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Saw Palmetto
Verapamil-based medications can be prescribed for several heart and blood pressure problems. The fast-acting brands (Calan and Isoptin) are taken for angina (chest pain due to clogged cardiac arteries), as well as irregular heartbeat and high blood pressure. The longer-acting brands (Calan SR, Isoptin SR, Verelan, and Verelan PM) are typically used only for high blood pressure. Covera-HS is prescribed for both high blood pressure and angina.
Verapamil is a type of medication called a calcium channel blocker. It eases the heart’s workload by slowing down the passage of nerve impulses through it, and hence the contractions of the heart muscle. This improves blood flow through the heart and throughout the body, reduces blood pressure, corrects irregular heartbeat, and helps prevent angina pain.
Some doctors also prescribe verapamil to prevent migraine headache and asthma and to treat manic depression and panic attacks.
Most important fact about Calan
If you have high blood pressure, you must take verapamil regularly for it to be effective. Since blood pressure declines gradually, it may be several weeks before you get the full benefit of verapamil; and you must continue taking it even if you are feeling well. Verapamil does not cure high blood pressure; it merely keeps it under control.
How should you take Calan?
Calan, Isoptin, and Verelan can be taken with or without food. Calan SR and Isoptin SR should be taken with food.
Covera-HS, Calan SR, Isoptin SR, Verelan and Verelan PM must be swallowed whole and should not be crushed, broken, or chewed.
You may open Verelan capsules and sprinkle the pellets on a spoonful of cool applesauce. Swallow all of the mixture immediately, and then drink a glass of cool water.
Take this medication exactly as prescribed, even if you are feeling well. Try not to miss any doses. If the drug is not taken regularly, your condition can get worse.
Check with your doctor before you stop taking this drug; a slow reduction in the dose may be required.
If you miss a dose…
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.
Storage instructions…
Store at room temperature away from heat, light, and moisture
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking verapamil.
Side effects may include:
Congestive heart failure, constipation, dizziness, fatigue, fluid retention, headache, low blood pressure, nausea, rash, shortness of breath, slow heartbeat, upper respiratory infection
Why should Calan not be prescribed?
If you have low blood pressure or certain types of heart disease or heartbeat irregularities, you should not take verapamil. Make sure the doctor is aware of any cardiac problems you may have.
If you are sensitive to or have ever had an allergic reaction to Calan or any other brands of verapamil, or other calcium channel blockers, do not take this medication.
Special warnings about Calan
Verapamil can reduce or eliminate angina pain caused by exertion or exercise. Be sure to discuss with your doctor how much exertion is safe for you.
Verapamil may cause your blood pressure to become too low. If you experience dizziness or light-headedness, notify your doctor.
Congestive heart failure and fluid in the lungs have occurred in people taking verapamil together with other heart drugs known as beta blockers. Make sure your doctor is aware of all medications you are taking.
If you have a heart condition, liver disease, kidney disease, myasthenia gravis, or Duchenne’s dystrophy (the most common type of muscular dystrophy), make certain your doctor knows about it. Verapamil should be used with caution.
If you are taking Covera-HS and you have a narrowing in your stomach or intestines, be sure your doctor was aware of it when the drug was prescribed.
The outer shell of Covera-HS does not dissolve; do not worry if you see it in your stool.
Recommended dosage for Calan
FOR CALAN AND ISOPTIN
Dosages of this medication must be adjusted to meet individual needs. In general, dosages of this medication should not exceed 480 milligrams per day. Your doctor will closely monitor your response to this drug, usually within 8 hours of the first dose.
Safety and effectiveness of this drug in children have not been established.
Angina
The usual initial dose is 80 to 120 milligrams, 3 times a day. Lower doses of 40 milligrams 3 times a day may be used by people who have a stronger response to this medication, such as the elderly or those with decreased liver function. The dosage may be increased by your doctor either daily or weekly until the desired response is seen.
Irregular Heartbeat
The usual dose in people who are also on digitalis ranges from 240 to 320 milligrams per day divided into 3 or 4 doses.
In those not on digitalis, doses range from a total of 240 to 480 milligrams per day divided into 3 or 4 doses.
Maximum effects of this drug should be seen in the first 48 hours of use.
High Blood Pressure
Effects of this drug on blood pressure should be seen within the first week of use. Any adjustment of this medication to a higher dose will be based on its effectiveness as determined by your doctor.
The usual dose of this drug, when used alone for high blood pressure, is 80 milligrams, 3 times per day. Total daily doses of 360 milligrams and 480 milligrams may be used. Smaller doses of 40 milligrams 3 times per day may be taken by smaller individuals and the elderly.
FOR CALAN SR, ISOPTIN SR, AND VERELAN
Dosages for high blood pressure should be adjusted to meet each individual’s needs.
Adults
The usual starting dose of Calan SR and Isoptin SR is 180 milligrams taken in the morning. For Verelan, it is 240 milligrams. A lower starting dose of 120 milligrams may be taken if the person is smaller. Your doctor will monitor your response to this drug and may adjust it each week. In addition, your doctor may increase the dose and add evening doses to the morning dose, based on the effectiveness of the drug.
You should see results from the drug within a week.
Children
The safety and effectiveness of this drug in children under age 18 have not been established.
Older Adults
Your doctor may start you at a lower dose of 120 milligrams and then adjust it according to your response.
FOR COVERA-HS AND VERELAN PM
Adults
For use only at bedtime, these delayed-action forms of verapamil are timed to deliver their peak benefits in the morning, when blood pressure tends to spike. The usual starting dose is 180 milligrams of Covera-HS or 200 milligrams of Verelan PM. Your doctor may raise the dose gradually if you need more.
Children
Safety and effectiveness in children under age 18 have not been established.
Older Adults
If you have poor kidneys, the dosage may need to be lowered.
Overdosage
Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.
An overdose of Calan can cause fluid buildup in the lungs, kidney problems, seizures, dangerously low blood pressure, and life-threatening heart problems such as a slow or irregular heartbeat.
After treatment for an overdose, you should remain under observation in the hospital for at least 48 hours, especially if you have taken the sustained-release form of the drug.
bisulfate is an anti-platelet drug, which prevents platelets from clumping together as a part of a blood clot. It’s chemical structure and in the way of interaction is identical to ticlopidine (Ticlid). In contrast to ticlopidine, clopidogrel bisulfate does not cause serious reductions of white cells in the blood and that is why there is no need to test blood on the level of them during treatment. Patients with a recent history of stroke or heart attack and patients with peripheral vascular disease* have an increased risk of heart attacks and strokes (which usually are caused by blood clots). (*Peripheral vascular disease is the same as atherosclerotic arterial disease or “hardening” of the arteries in which the arteries become narrowed. The symptoms such as claudication or pain in the legs upon walking are usual). Treating by Clopidogrel bisulfate promotes the reduction of the risk of heart attacks and strokes in such patients. The approval of Clopidogrel bisulfate by the FDA was in 1997.
Storage:
Tablets should be kept at room temperature, 15-30°C (59-86°F).
Prescribed for:
Clopidogrel is ordered to prevent strokes and heart attacks in persons who are at high risk. One large study showed that clopidogrel bisulfate was more effective than aspirin in reducing heart attacks. As for side effects clopidogrel bisulfate was similar to aspirin for frequency; however, stomach and intestinal bleeding probably were observed rarely with clopidogrel bisulfate than with aspirin.
Dosing:
Clopidogrel bisulfate usually is taken once daily with or without food.
Drug Interactions:
Treating by clopidogrel together with such drugs as nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen (Motrin; Advil; Nuprin), naproxen (Naprosyn, Aleve), diclofenac (Voltaren), etodolac (Lodine), nabumetone (Relafen), fenoprofen (Nalfon), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis; Oruvail), oxaprozin (), piroxicam (Feldene), sulindac (Clinoril), tolmetin (Tolectin), and mefenamic acid (Ponstel) may growth the danger of stomach and intestinal bleeding. If the concentration of clopidogrel in the blood is high, it prevents the activity of the enzyme which metabolizes (eliminates) warfarin (Coumadin), a “blood thinner”. This could be a cause of an increase in levels of warfarin and growth the risk of bleeding because of over-thinning of the blood. There is no information if interaction in humans between warfarin and clopidogrel is dangerouse or not. Nonetheless, because of warfarin’s quality to increase the risk of bleeding, blood tests to measure the degree when blood can’t coagulate well or becomes thin (prothrombin time; INR) may be ordered to evaluate the degree of blood-thinning in case when both warfarin and clopidogrel are used during the treatment. The same enzyme also answers for the metabolism of phenytoin (Dilantin), tamoxifen (Nolvadex), tolbutamide (Orinase), torsemide (Demadex), and fluvastatin (Lescol). Though it’s unlikely that important interactions between clopidogrel and these drugs can occur, it is better to monitor interactions carefully.
Pregnancy:
There are no information if clopidogrel in harmful for pregnant women. Therefore, if the doctor determines it is needed, it can be used in pregnancy.
Nursing Mothers:
On the basis of studies in rats it was found out that clopidogrel appears in breast milk; however, it is no information whether it also appears in human breast milk. So when prescribing clopidogrel to nursing mothers the doctor should compare the potential benefits to possible risks.
Side Effects:
The tolerability of clopidogrel and aspirin is alike. Diarrhea, rash, or itching takes place in nearly 1 in 20 persons treating by clopidogrel. Abdominal pain also occurs in about 1 in 20 persons, but it is rarely than with aspirin. Ticlopidine (Ticlid) is an antiplatelet medicine quite similar to clopidogrel. It’s influence leads to a severe reduction in white blood cell count in between 0.8% and 1% of persons. As for clopidogrel the danger of appearence of this side effect with clopidogrel is much less than with ticlopidine but twice that of aspirin and averages about 0.04%. The condition of thrombotic thrombocytopenic purpura (TTP) rarely occurs when treating by clopidogrel. It happens in one out of every 250,000 people. When in such condition the blood clots form throughout the body. Blood platelets, which take part in clotting, are consumed, and it can result to bleeding because of absence of normally blood clotting. To observe the situation, ticlodipine (Ticlid), the related drug, become the reason for TTP 17-50 times more frequently than clopidogrel.
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