Flurbiprofen is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Flurbiprofen works by reducing hormones that cause inflammation and pain in the body.

Flurbiprofen is used to treat pain or inflammation caused by arthritis.

Flurbiprofen may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Ansaid (flurbiprofen)?

This medicine can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. Do not use this medicine just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

Seek emergency medical help if you have symptoms of heart or circulation problems, such as chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

This medicine can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking flurbiprofen. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. This includes black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

What should I discuss with my healthcare provider before taking Ansaid (flurbiprofen)?

Taking an NSAID can increase your risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer you use an NSAID. Do not use this medicine just before or after having heart bypass surgery (also called coronary artery bypass graft, or CABG).

NSAIDs can also increase your risk of serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and gastrointestinal effects can occur without warning at any time while you are taking an NSAID. Older adults may have an even greater risk of these serious gastrointestinal side effects.

Do not use this medication if you are allergic to flurbiprofen, or if you have:

• severe kidney disease; or
• a history of allergic reaction to aspirin or other NSAIDs.

Before taking flurbiprofen, tell your doctor if you are allergic to any drugs, or if you have:

• a history of heart attack, stroke, or blood clot;
• heart disease, congestive heart failure, high blood pressure;
• liver or kidney disease;
• asthma;
• polyps in your nose; or
• if you smoke.

If you have any of these conditions, you may not be able to use flurbiprofen, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking flurbiprofen during the last 3 months of pregnancy may result in birth defects. Do not take flurbiprofen during pregnancy unless your doctor has told you to. Flurbiprofen can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medicine to a child without the advice of a doctor.

How should I take Ansaid (flurbiprofen)?

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.

The maximum amount of flurbiprofen for adults is 400 milligrams (mg) per day. Know the amount of flurbiprofen in the specific product you are taking.

If you take flurbiprofen for a long period of time, your doctor may want to check you on a regular basis to make sure this medication is not causing harmful effects. Do not miss any scheduled visits to your doctor.

Store flurbiprofen at room temperature, away from moisture, heat, and light.

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 your 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 flurbiprofen overdose may include nausea, vomiting, stomach pain, dizziness, drowsiness, black or bloody stools, coughing up blood, urinating less than usual or not at all, shallow breathing, fainting, or coma.

Ansaid (flurbiprofen) side effects

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

• chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;
• black, bloody, or tarry stools, coughing up blood or vomit that looks like coffee grounds;
• urinating less than usual or not at all;
• pain, burning, or bleeding when you urinate;
• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or
• bruising, severe tingling, numbness, pain, muscle weakness.

Keep taking flurbiprofen and talk to your doctor if you have any of these less serious side effects:

• upset stomach, mild heartburn or stomach pain, diarrhea, constipation; bloating, gas;
• dizziness, headache, nervousness;
• skin itching or rash;
• dry mouth;
• increased sweating, runny nose;
• blurred vision; or
• ringing in your ears.

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 Ansaid (flurbiprofen)?

Before taking flurbiprofen, tell your doctor if you are taking any of the following drugs:

• a blood thinner such as warfarin (Coumadin;
• a diuretic (water pill) such as furosemide (Lasix);
• cyclosporine (Gengraf, Neoral, Sandimmune);
• lithium (Eskalith, Lithobid);
• methotrexate (Rheumatrex, Trexall);
• steroids (prednisone and others);
• aspirin or NSAIDs (non-steroidal anti-inflammatory drugs) such as diclofenac (Voltaren), etodolac (Lodine), fenoprofen (Nalfon), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others;
• an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik); or
• a beta-blocker such as atenolol (Tenormin), carteolol (Cartrol), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), timolol (Blocadren), and others.

If you are using any of these drugs, you may not be able to use flurbiprofen or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect flurbiprofen. 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.

Ansaid

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Generic name: Bupropion hydrochloride
Other brand names: Wellbutrin SR, Wellbutrin XL

Wellbutrin is prescribed to help relieve major depression. Symptoms include a severely depressed mood (for 2 weeks or more) and loss of interest or pleasure in usual activities accompanied by sleep and appetite disturbances, agitation or lack of energy, feelings of guilt or worthlessness, decreased sex drive, inability to concentrate, and sometimes, suicidal thoughts or behavior.

Wellbutrin is thought to work by altering levels of the brain chemicals norepinephrine and dopamine. It is not chemically related to other antidepressants such as tricyclics (Elavil), MAO inhibitors (Nardil, Parnate), or serotonin re-uptake inhibitors (Paxil and Prozac).

Most important fact about Wellbutrin

Wellbutrin is associated with an increased risk of seizures. This risk is greater at higher doses (approximately 4 in 1,000 patients at dosages of 300 to 450 milligrams a day). Certain factors increase the risk of seizure, including:

A history of head trauma or previous seizure
Central nervous system tumor
Severe liver disease such as cirrhosis
A history of eating disorders, including anorexia and bulimia
Excessive use of alcohol, or abrupt withdrawal from alcohol or sedatives
Taking medications that lower the seizure threshold (see “Possible food and drug interactions when taking this medication”)

To minimize the risk of seizures, dose increases should be done gradually, and the total daily dose of Wellbutrin should not exceed 450 milligrams. Additionally, the doctor should be aware of all your medical conditions, and you should not take any other medications (both prescription and over-the-counter) unless the doctor approves.

How should you take Wellbutrin?

Take Wellbutrin exactly as prescribed by your doctor. The usual dosing regimen is 3 equal doses spaced evenly throughout the day. Allow at least 6 hours between doses. Your doctor will probably start you at a low dosage and gradually increase it; this helps minimize side effects.

If Wellbutrin works for you, your doctor will probably have you continue taking it for at least several months.

–If you miss a dose…

Take it as soon as you remember. If it is within 4 hours of 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. Protect from 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 Wellbutrin.

• Side effects of Wellbutrin may include:
  Agitation, constipation, dizziness, dry mouth, excessive sweating, headache, nausea, vomiting, skin rash, sleep disturbances, tremor

• Side effects of Wellbutrin SR may include:
  Agitation, constipation, dizziness, dry mouth, insomnia, nausea, rash, sweating, weight loss

• Side effects of Wellbutrin XL may include:
  Abdominal pain, agitation, anxiety, constipation, diarrhea, dizziness, dry mouth, heart palpitations, increased urination, insomnia, muscle soreness, nausea, rash, ringing in the ears, sore throat, sweating

You should take Wellbutrin SR, the sustained-release form, in 2 doses, at least 8 hours apart. Wellbutrin XL extended-release tablets should be taken once a day in the morning. Swallow Wellbutrin SR and Wellbutrin XL tablets whole; do not chew, divide, or crush them.

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, notify your doctor immediately. Wellbutrin should be taken during pregnancy only if clearly needed.

Wellbutrin does pass into breast milk and may cause serious reactions in a nursing baby; therefore, if you are a new mother, you may need to discontinue breastfeeding while you are taking this medication.

Recommended dosage

No single dose of Wellbutrin should exceed 150 milligrams.

ADULTS

Wellbutrin

At the beginning, your dose will probably be 200 milligrams per day, taken as 100 milligrams 2 times a day. After at least 3 days at this dose, your doctor may increase the dosage to 300 milligrams per day, taken as 100 milligrams 3 times a day, with at least 6 hours between doses. This is the usual adult dose. The maximum recommended dosage is 450 milligrams per day taken in doses of no more than 150 milligrams each.

Wellbutrin SR

The usual starting dose is 150 milligrams in the morning. After 3 days, if you do well, your doctor will have you take another 150 milligrams at least 8 hours after the first dose. It may be 4 weeks before you feel the benefit and you will take the drug for several months. The maximum recommended dose is 400 milligrams a day, taken in doses of 200 milligrams each.

If you have severe cirrhosis of the liver, your dosage should be no more than 75 milligrams once a day. With less serious liver and kidney problems, the dosage will be reduced as needed.

Wellbutrin XL

The usual starting dose is 150 milligrams taken once a day in the morning. If this dose is well tolerated after a minimum of 3 days, the doctor may increase the dose to 300 milligrams, also taken once a day in the morning. If no improvement is seen after several weeks of treatment, the doctor may increase the dose to a maximum of 450 milligrams once a day.

If you have severe liver damage, use this drug with extreme caution. Your dose should not exceed 150 milligrams every other day. People with mild to moderate liver damage or kidney impairment will be prescribed a lower dose as well.

CHILDREN

The safety and effectiveness in children under 18 years old have not been established.

Overdosage

There have been rare reports of death after an overdose of Wellbutrin. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Wellbutrin overdose may include:
  Hallucinations, heart failure, loss of consciousness, rapid heartbeat, seizures

• Symptoms of Wellbutrin SR overdose may include:
  Blurred vision, confusion, jitteriness, lethargy, light-headedness, nausea, seizures, vomiting

• An overdose that involves other drugs in combination with Wellbutrin may also cause these symptoms:
  Breathing difficulties coma fever rigid muscles stupor

Wellbutrin SR

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Naproxen is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen works by reducing hormones that cause inflammation and pain in the body.

Naproxen is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout, or menstrual cramps.

Naproxen may also be used for purposes other than those listed in this medication guide.

How should I take Naprosyn (Naproxen)?

Take this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts, or use it for longer than recommended.

EC-Naprosyn is a slower-acting form of naproxen and this brand should be used only for treating arthritis or ankylosing spondylitis. Follow your doctor’s instructions.

Do not crush, chew, or break an extended-release or enteric-coated tablet. Swallow the pill whole. The extended-release pill is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating.

Shake the oral suspension (liquid) well just before you measure a dose. 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.

If you take naproxen for a long period of time, your doctor may want to check you on a regular basis to make sure this medication is not causing harmful effects. Do not miss any scheduled visits to your doctor.

Store naproxen at room temperature away from moisture and heat.

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Prednisone, a steroid drug, is used to reduce inflammation and alleviate symptoms in a variety of disorders, including rheumatoid arthritis and severe cases of asthma. It may be given to treat primary or secondary adrenal cortex insufficiency (lack of sufficient adrenal hormone in the body). It is used in treating all of the following:

Abnormal adrenal gland development
Allergic conditions (severe)
Blood disorders
Certain cancers (along with other drugs)
Diseases of the connective tissue including systemic lupus erythematosus
Eye diseases of various kinds
Flare-ups of multiple sclerosis
Fluid retention due to “nephrotic syndrome” (a condition in which damage to the kidneys causes protein to be lost in the urine)
Lung diseases, including tuberculosis
Meningitis (inflamed membranes around the brain)
Prevention of organ rejection
Rheumatoid arthritis and related disorders
Severe flare-ups of ulcerative colitis or enteritis (inflammation of the intestines)
Skin diseases
Thyroid gland inflammation
Trichinosis (with complications)

Most important fact about Prednisone

Prednisone lowers your resistance to infections and can make them harder to treat. Prednisone may also mask some of the signs of an infection, making it difficult for your doctor to diagnose the actual problem.

How should you take Prednisone?

Take prednisone exactly as prescribed. Dosages are kept to an absolute minimum.

If you need long-term prednisone treatment, your doctor may prescribe alternate-day therapy, in which you take the medication only every other morning. The “resting day” gives your adrenal glands a chance to produce some hormone naturally so they will not lose the ability.

If you have been taking prednisone for a period of time, you will probably need an increased dosage of the medication before, during, and after any stressful situation. Always consult your doctor if you are anticipating stress and think you may need a temporary dosage increase.

When stopping prednisone treatment, tapering off is better than quitting abruptly. Your doctor will probably have you decrease the dosage very gradually over a period of days or weeks.

You should take prednisone with food to avoid stomach upset.

If you are on alternate-day therapy or have been prescribed a single daily dose, take prednisone in the morning with breakfast (about 8 a.m.). If you have been prescribed several doses per day, take them at evenly spaced intervals around the clock.

Patients on long-term Prednisone therapy should wear or carry identification.

–If you miss a dose…

If you take your dose once a day, take it as soon as you remember. If you don’t remember until the next day, skip the one you missed.

If you take several doses a day, take the forgotten dose as soon as you remember and then go back to your regular schedule. If you don’t remember until your next dose, double the dose you take.

If you take your dose every other day, and you remember it the same morning, take it as soon as you remember, then go back to your regular schedule. If you don’t remember until the afternoon, do not take a dose until the following morning, then skip a day.

–Storage instructions…

Store at room temperature.

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 prednisone.

Prednisone may cause euphoria, insomnia, mood changes, personality changes, psychotic behavior, or severe depression. It may worsen any existing emotional instability.

At a high dosage, prednisone may cause fluid retention and high blood pressure. If this happens, you may need a low-salt diet and a potassium supplement.

With prolonged prednisone treatment, eye problems may develop (e.g., a viral or fungal eye infection, cataracts, or glaucoma).

If you take prednisone over the long term, the buildup of adrenal hormones in your body may cause a condition called Cushing’s syndrome, marked by weight gain, a “moon-faced” appearance, thin, fragile skin, muscle weakness, brittle bones, and purplish stripe marks on the skin. Women are more vulnerable to this problem than men. Alternate-day therapy may help prevent its development.

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, inform your doctor immediately. Prednisone should be taken during pregnancy or while breastfeeding only if clearly needed and only if the benefit outweighs the potential risks to the child.

Recommended dosage

Dosage is determined by the condition being treated and your response to the drug. Typical starting doses can range from 5 milligrams to 60 milligrams a day. Once you respond to the drug, your doctor will lower the dose gradually to the minimum effective amount. For treatment of acute attacks of multiple sclerosis, doses of as much as 200 milligrams per day may be given for a week, followed by 80 mg every other day for a month.

Overdosage

Long-term high doses of prednisone may produce Cushing’s syndrome (see “Side Effects” section). Although no specific information is available regarding short-term overdosage, any medication taken in excess can have serious consequences. If you suspect an overdose of prednisone, seek medical attention immediately.

Prednisone

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