Ampicillin is an antibiotic in the penicillin group of drugs. It fights bacteria in your body.

Ampicillin is used to treat many different types of infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella infection.

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

What is the most important information I should know about Ampicillin?

Do not use this medication if you are allergic to ampicillin or to any other penicillin antibiotic, such as amoxicillin (Amoxil), carbenicillin (Geocillin), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill), penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids), and others.

Before using ampicillin, tell your doctor if you are allergic to cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others, or if you have asthma, kidney disease, a bleeding or blood clotting disorder, mononucleosis (also called “mono”), or a history of any type of allergy.

Ampicillin can make birth control pills less effective, which may result in pregnancy. Before taking ampicillin, tell your doctor if you use birth control pills. Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Ampicillin will not treat a viral infection such as the common cold or flu. Do not give this medication to another person, even if they have the same symptoms you do.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

What should I discuss with my healthcare provider before taking Ampicillin?

Do not use this medication if you are allergic to ampicillin or to any other penicillin antibiotic, such as:

• amoxicillin (Amoxil, Amoxicot, Biomox, Dispermox, Trimox);
• carbenicillin (Geocillin);
• dicloxacillin (Dycill, Dynapen);
• oxacillin (Bactocill); or
• penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids, and others).

Before using ampicillin, tell your doctor if you are allergic to any drugs (especially cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others), or if you have:

• asthma;
• kidney disease;
• a bleeding or blood clotting disorder;
• mononucleosis (also called “mono”);
• a history of diarrhea caused by taking antibiotics; or
• a history of any type of allergy.

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

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Ampicillin can make birth control pills less effective, which may result in pregnancy. Before taking ampicillin, tell your doctor if you use birth control pills. Ampicillin 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.

How should I take Ampicillin?

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.

Take the medicine with a full glass of water. Ampicillin should be taken on an empty stomach, at least 1 hour before or 2 hours after eating a meal.

To be sure this medication is helping your condition, your blood will need to be tested 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 are being treated for gonorrhea, your doctor may also have you tested for syphilis, another sexually transmitted disease.

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Ampicillin will not treat a viral infection such as the common cold or flu. Do not give ampicillin to another person, even if they have the same symptoms you do.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using ampicillin.

Store ampicillin 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.

Overdose symptoms may include confusion, behavior changes, a severe skin rash, urinating less than usual, or seizure (black-out or convulsions).

Ampicillin side effects

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

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
• diarrhea that is watery or bloody;
• fever, chills, body aches, flu symptoms;
• easy bruising or bleeding, unusual weakness;
• urinating less than usual or not at all;
• agitation, confusion, unusual thoughts or behavior; or
• seizure (black-out or convulsions).

Less serious side effects may include

• nausea, vomiting, stomach pain;
• vaginal itching or discharge;
• headache;
• swollen, black, or “hairy” tongue; or
• thrush (white patches or inside your mouth or throat).

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

Ampicillin Dosing Information

Usual Adult Dose for Bacterial Endocarditis Prophylaxis:

Low to moderate risk: 2 g IV or IM 30 minutes before procedure.

High risk: Ampicillin 2 g plus gentamicin 1.5 mg/kg IV or IM 30 minutes before procedure. Follow with ampicillin 1 g IV or IM, or amoxicillin 1 g orally, 6 hours after initial dose.

Usual Adult Dose for Bronchitis:

Bacterial exacerbations of chronic bronchitis:
250 to 500 mg orally every 6 hours for 5 to 10 days, depending on the nature and severity of the infection.

Usual Adult Dose for Endocarditis:

Enterococcal:
Ampicillin 2 g IV every 4 hours plus gentamicin 1 mg/kg IV every 8 hours for 4 to 6 weeks.

Usual Adult Dose for Gastroenteritis:

250 to 500 mg orally every 6 hours.

Usual Adult Dose for Intraabdominal Infection:

1 to 2 g IV every 4 to 6 hours in combination with other antibiotics, depending on the nature and severity of the infection.

Duration: 10-14 days.

Usual Adult Dose for Leptospirosis:

Moderate to severe: 0.5 to 1 g intravenously every 6 hours.
Mild: 500 to 750 mg orally every 6 hours.

Usual Adult Dose for Meningitis:

IV:
200 mg/kg/day (up to 12 g/day) IV in equally divided doses every 4 hours, in combination with other parenteral antibiotics.

Intrathecal or intraventricular:
10 to 50 mg/day in addition to IV antibiotics.

Usual Adult Dose for Peritonitis:

CAPD-associated peritonitis: 250 to 500 mg orally twice daily and/or 100 to 125 mg/L exchange intraperitoneally, with or without other antibiotics depending on the nature and severity of the infection.

Secondary: 1 to 2 g IV every 4 to 6 hours in combination with other antibiotics, depending on the nature and severity of the infection.

Duration: 10 to 14 days.

Usual Adult Dose for Pneumonia:

Beta-lactamase negative, penicillin-susceptible: 1 to 2 g IV every 4 to 6 hours, in combination with other antibiotic(s) depending on the nature and severity of the infection.

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease:

As an alternative to penicillin G: 2 g IV as a loading dose, followed by 1 g every 4 hours until delivery.

Usual Adult Dose for Pyelonephritis:

500 mg to 2 g IV or IM every 4 to 6 hours with or without other antibiotics, depending on the nature and severity of the infection.
Duration: 2 to 3 weeks.

Usual Adult Dose for Septicemia:

1 to 2 g IV every 3 to 4 hours, in combination with other antibiotics.

Usual Adult Dose for Shigellosis:

500 mg orally every 6 hours for 5 days

Usual Adult Dose for Skin or Soft Tissue Infection:

250 to 500 mg orally every 6 hours or 1 to 2 g IV every 4 to 6 hours, depending on the nature and severity of the infection.

Usual Adult Dose for Surgical Prophylaxis:

Liver transplant: Ampicillin 1 g plus cefotaxime 1 g IV at induction, then every 6 hours for 48 hours after closure.

Usual Adult Dose for Typhoid Fever:

Severe, fully susceptible: 25 mg/kg IV or IM every 6 hours for 10 to 14 days.
Carrier state: 1.5 g orally or IV with probenecid 500 mg every 6 hours for 6 weeks.
Fluoroquinolones or amoxicillin are considered the drugs of choice.

Usual Adult Dose for Otitis Media:

500 mg orally or 1 to 2 g IV or IM every 6 hours, depending on the nature and severity of the infection.

Usual Adult Dose for Pharyngitis:

500 mg orally or 1 to 2 g IV or IM every 6 hours, depending on the nature and severity of the infection.

Usual Adult Dose for Sinusitis:

500 mg orally or 1 to 2 g IV or IM every 6 hours, depending on the nature and severity of the infection.

Usual Adult Dose for Upper Respiratory Tract Infection:

500 mg orally or 1 to 2 g IV or IM every 6 hours, depending on the nature and severity of the infection.

Usual Adult Dose for Urinary Tract Infection:

Mild, uncomplicated: 250 to 500 mg orally every 6 hours
Severe, complicated: 500 mg to 2 g IV every 4 to 6 hours with or without other antibiotics, depending on the nature and severity of the infection.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

Low to moderate risk: 50 mg/kg IV or IM 30 minutes before procedure.

High risk: 50 mg/kg plus gentamicin 1.5 mg/kg, both intramuscularly or IV 30 minutes before procedure. Follow with ampicillin 25 mg/kg IV or IM, or amoxicillin 25 mg/kg orally, 6 hours after initial dose.

Usual Pediatric Dose for Meningitis:

Neonates:
< 7 days, birthweight < 2000 g: 50 mg/kg IV every 12 hours.
< 7 days, birthweight > 2000 g: 50 mg/kg IV every 8 hours.
> 7 days, birthweight < 1200 g: 50 mg/kg IV every 12 hours.
> 7 days, birthweight 1200 to 2000 g: 50 mg/kg IV every 8 hours.
> 7 days, birthweight > 2000 g: 50 mg/kg IV every 6 hours.

Infants and children:
50 to 100 mg/kg IV every 6 hours. Maximum dose 12 g/day.

Ampicillin should be given in combination with another antibiotic, depending on the nature of the infection.

Usual Pediatric Dose for Skin or Soft Tissue Infection:

IV: 6.25 to 12.5 mg/kg every 6 hours (maximum 12 g/day).

Oral: 6.25 to 12.5 mg/kg every 6 hours (maximum 2 to 3 g/day).

Usual Pediatric Dose for Upper Respiratory Tract Infection:

IV: 6.25 to 12.5 mg/kg every 6 hours (maximum 12 g/day).

Oral: 6.25 to 12.5 mg/kg every 6 hours (maximum 2 to 3 g/day).

Usual Pediatric Dose for Surgical Prophylaxis:

Liver transplant: Ampicillin 50 mg/kg plus cefotaxime 50 mg/kg at induction and every 6 hours for 48 hours after closure.

Usual Pediatric Dose for not applicable:

< 7 days, birthweight < 2000 g: 25 to 50 mg/kg IV or IM every 12 hours.
< 7 days, birthweight > 2000 g: 25 to 50 mg/kg IV or IM every 8 hours.
> 7 days, birthweight< 1200 g: 25 to 50 mg/kg IV or IM every 12 hours.
> 7 days, birthweight 1200 to 2000 g: 25 to 50 mg/kg IV or IM every 8 hours.
> 7 days, birthweight > 2000 g: 25 to 50 mg/kg IV or IM every 6 hours.

>1 month:
Mild to moderate infections:
Parenteral: 25 to 50 mg/kg IV or IM every 6 hours (maximum 12 g/day).
Oral: 12.5 to 25 mg/kg every 6 hours (maximum 2 to 4 g/day).

Severe infections: 50 to 100 mg/kg IV every 6 hours (maximum 12 g/day).

What other drugs will affect Ampicillin?

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

• allopurinol (Zyloprim);
• methotrexate (Rheumatrex, Trexall);
• probenecid (Benemid);
• a sulfa drug (such as Bactrim or Septra); or
• a tetracycline antibiotic such as demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

This list is not complete and there may be other drugs that can interact with ampicillin. 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.

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Treating severe acne. It may also be used for other conditions as determined by your doctor.

Cleocin T Gel is a topical lincomycin antibiotic. It works by killing sensitive bacteria that cause acne and reducing the amount of free fatty acids that irritate the skin surface.

Do NOT use Cleocin T Gel if:

• you are allergic to any ingredient in Cleocin T Gel or to lincomycin
• you have Crohn disease, antibiotic-associated colitis, or ulcerative colitis

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

Before using Cleocin T Gel:

Some medical conditions may interact with Cleocin T Gel. 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 gastrointestinal (bowel) disease or diarrhea

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

• Nondepolarizing muscle relaxants (eg, vecuronium) or succinylcholine because their actions and the risk of their side effects may be increased by Cleocin T Gel
• Erythromycin because it may decrease Cleocin T Gel’s effectiveness

This may not be a complete list of all interactions that may occur. Ask your health care provider if Cleocin T Gel 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 Cleocin T Gel:

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

• Cleocin T Gel is for topical use on the skin only.
• Clean and dry the affected area. Cover the affected and surrounding area with a thin film of medicine.
• Cleocin T Gel works best if it is used at the same time each day.
• Continue to use Cleocin T Gel even if your condition improves. Do not miss any doses.
• If you miss a dose of Cleocin T Gel, use 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 use 2 doses at once.

Ask your health care provider any questions you may have about how to use Cleocin T Gel.

Important safety information:

• Cleocin T Gel may cause harm if it is swallowed. If you may have taken it by mouth, contact your poison control center or emergency room right away.
• Several weeks may pass before you see improvement in your acne. Continue using Cleocin T Gel for the full time recommended by your doctor.
• Be sure to use Cleocin T Gel for the full course of treatment. If you do not, the medicine may not clear up your infection completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future.
• Do not get Cleocin T Gel in your eyes or on the inside of your nose or mouth. If you accidentally get the medicine in your eye, immediately flush with a large amount of cool tap water.
• If severe diarrhea, stomach pain or cramping, or bloody stools develop during treatment or within several months after treatment with Cleocin T Gel, check with your doctor or pharmacist right away. Do not treat it without first checking with your doctor.
• Talk with your doctor before you use any other medicines or cleansers on your skin.
• Cleocin T Gel should not be used in CHILDREN younger than 12 years old; safety and effectiveness in these children have not been confirmed.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Cleocin T Gel while you are pregnant. It is not known if Cleocin T Gel is found in breast milk. Do not breast-feed while taking Cleocin T Gel.

Possible side effects of Cleocin T Gel:

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:

Dryness; itching; oiliness or oily skin.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood or mucus in stools; bloody or severe diarrhea; stomach cramps or pain; swelling, redness, burning, or peeling of your skin.

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. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Cleocin T Gel may be harmful if swallowed.

Proper storage of Cleocin T Gel:

Store Cleocin T Gel at room temperature, between 68 and 77 degrees F (20 and 25 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Protect from freezing. Keep Cleocin T Gel out of the reach of children and away from pets.

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Aciclovir Capsules is used for treating chickenpox (varicella) or shingles (herpes zoster) and treating or suppressing genital herpes infections. It may also be used for other conditions as determined by your doctor.

How Taken

Use Aciclovir as directed by your doctor.

• Take Aciclovir by mouth with or without food.
• Drinking extra fluids while you are taking Aciclovir is recommended.
• Start therapy with Aciclovir at the earliest sign or symptom of shingles or genital herpes (pain, burning, blisters).
• If treating an acute outbreak, continue using Aciclovir for the full course of treatment even if you feel better in a few days.
• For suppressive therapy, Aciclovir works best if it is taken at the same times each day.

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

Drug Class and Mechanism

Aciclovir is an antiviral. It works by stopping viral replication. However, Aciclovir does not eliminate the virus, is not a cure, and does not prevent transmission to others.

Missed Dose

If you miss a dose of Aciclovir and are using it regularly, 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.

Storage

Store Aciclovir between 68 and 77 degrees F (20 and 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 Aciclovir out of the reach of children and away from pets.

Warnings/Precautions

Do not use Aciclovir if:

• you are allergic to any ingredient in Aciclovir;
• 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 kidney problems or a weakened immune system.

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

Some medical conditions may interact with Aciclovir Capsules. 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 kidney problems or a weakened immune system

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

• Medicines that may harm the kidney (eg, aminoglycoside antibiotics [eg, gentamicin], amphotericin B, cyclosporine, nonsteroidal anti-inflammatory drugs [NSAIDs] [eg, ibuprofen], tacrolimus, vancomycin) because the risk of kidney side effects may be increased. Ask your doctor if you are unsure if any of your medicines might harm the kidney

Possible Side Effects

Check with your doctor if any of these most common side effects persist or become bothersome:

• diarrhea; general body discomfort; headache; nausea/vomiting.

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

• severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); aggressive behavior; blood in the urine; confusion; decreased consciousness; decreased urination; hallucinations; lower back pain; mental or mood changes; red, swollen, blistered, or peeling skin; seizures; unusual bruising or bleeding.

More Information

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

Aciclovir Capsules 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.

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Glimepiride and pioglitazone is a combination of two oral diabetes medicines that help control blood sugar levels.

Glimepiride and pioglitazone is for people with type 2 diabetes who do not use daily insulin injections. Glimepiride and pioglitazone is sometimes given with other diabetes medications when greater blood sugar control is needed.

This medication is not for treating type 1 diabetes.

Glimepiride and pioglitazone may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Duetact (Glimepiride / Pioglitazone)?

You should not use this medication if you are allergic to glimepiride or pioglitazone, if you have severe heart failure, or if you are in a state of diabetic ketoacidosis.

Before taking glimepiride and pioglitazone, tell your doctor if you have congestive heart failure or heart disease, a history of heart attack or stroke, liver disease, or kidney disease.

Taking certain oral diabetes medications may increase your risk of serious heart problems. However, not treating your diabetes can damage your heart and other organs. Talk to your doctor about the risks and benefits of treating your diabetes with glimepiride and pioglitazone. Know the signs of low blood sugar (hypoglycemia) and how to recognize them, including hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma (severe hypoglycemia can be fatal). Always keep a source of sugar available in case you have symptoms of low blood sugar.

What should I discuss with my health care provider before taking Duetact (Glimepiride / Pioglitazone)?

You should not use this medication if you are allergic to glimepiride (Amaryl, Avandaryl) or pioglitazone (Actos), or if you have:

• severe heart failure; or
• if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before you take glimepiride and pioglitazone, tell your doctor if you have:

• congestive heart failure or heart disease;
• a history of heart attack or stroke; or
• liver or kidney disease.

Taking certain oral diabetes medication may increase your risk of serious heart problems. However, not treating your diabetes can damage your heart and other organs. Talk to your doctor about the risks and benefits of treating your diabetes with glimepiride and pioglitazone. Some women using glimepiride and pioglitazone have started having menstrual periods, even after not having a period for a long time due to a medical condition. You may be able to get pregnant if your periods restart. Talk with your doctor about the need for birth control. FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Similar diabetes medications have caused severe hypoglycemia in newborn babies whose mothers had used the medication near the time of delivery. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether this medication 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 Duetact (Glimepiride / Pioglitazone)?

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 glimepiride and pioglitazone with your first meal of the day.

Glimepiride and pioglitazone is only part of a complete program of treatment that also includes diet, exercise, and weight control. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your liver function may also need to be tested, and you may need regular eye exams. Do not miss any scheduled visits to your doctor.

Your medication needs may change if you become sick or injured, if you have a serious infection, or if you have any type of surgery. Your doctor may want you to stop taking glimepiride and pioglitazone for a short time if any of these situations affect you.

Take care not to let your blood sugar get too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress.

Know the signs of low blood sugar (hypoglycemia) and how to recognize them:

• hunger, headache, confusion, irritability;
• drowsiness, weakness, dizziness, tremors;
• sweating, fast heartbeat;
• seizure (convulsions); or
• fainting, coma (severe hypoglycemia can be fatal).

Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

If your blood sugar gets too high (hyperglycemia), you may feel very thirsty or hungry. You may also urinate more than usual. Call your doctor right away if you have any symptoms of hyperglycemia. Store glimepiride and pioglitazone at room temperature, protected from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take the medicine with food). 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. A glimepiride overdose can cause life-threatening hypoglycemia.

Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions).

Duetact (Glimepiride / Pioglitazone) side effects

Stop using glimepiride and pioglitazone and 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:

• swelling in your feet, rapid weight gain, feeling short of breath (even with mild exertion);
• pale skin, easy bruising or bleeding;
• pain or burning when you urinate; or
• dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
• nausea, vomiting, weakness, loss of appetite, feeling restless or irritable, confusion, hallucinations, muscle pain or weakness, and/or seizure.

Less serious side effects may include:

• sneezing, stuffy nose, cough, sore throat, or other cold symptoms;
• gradual weight gain;
• mild nausea, diarrhea;
• headache, dizziness, blurred vision;
• tooth problems; or
• mild itching or skin rash.

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

What other drugs will affect Duetact (Glimepiride / Pioglitazone)?

Before taking glimepiride and pioglitazone, tell your doctor if you are taking:

• delavirdine (Rescriptor);
• gemfibrozil (Lopid);
• nicardipine (Cardene) or nifedipine (Adalat, Procardia); or
• rifampin (Rifadin, Rimactane, Rifater); or
• fluconazole (Diflucan), ketoconazole (Nizoral).

Using certain medicines can make it harder for you to tell when you have low blood sugar. Tell your doctor if you use any of the following:

• albuterol (Proventil, Ventolin);
• clonidine (Catapres);
• reserpine;
• guanethidine (Ismelin); or
• beta-blockers such as atenolol (Tenormin), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others.

You may be more likely to have hyperglycemia (high blood sugar) if you are taking glimepiride and pioglitazone with other drugs that raise blood sugar. Drugs that can raise blood sugar include:

• isoniazid;
• diuretics (water pills);
• steroids (prednisone and others);
• phenothiazines (Compazine and others);
• thyroid medicine (Synthroid and others);
• birth control pills and other hormones;
• seizure medicines (Dilantin and others); and
• diet pills or medicines to treat asthma, colds or allergies.

You may be more likely to have hypoglycemia (low blood sugar) if you are taking glimepiride and pioglitazone with other drugs that lower blood sugar. Drugs that can lower blood sugar include:

• probenecid (Benemid);
• some nonsteroidal anti-inflammatory drugs (NSAIDs);
• aspirin or other salicylates (including Pepto-Bismol);
• sulfa drugs (Bactrim, Gantanol, Septra, and others); and
• a monoamine oxidase inhibitor (MAOI).

This list is not complete and there may be other drugs that can interact with glimepiride and pioglitazone. 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.

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