What Is Diclofenac

What is diclofenac?
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). This medicine works by

reducing substances in the body that cause pain and inflammation.
Diclofenac is used to treat mild to moderate pain, or signs and symptoms

of osteoarthritis or rheumatoid arthritis. The Cataflam brand of this medicine is also used
to treat menstrual cramps.
Diclofenac oral powder (Cambia) is used to treat a migraine headache attack. Cambia will
only treat a headache that has already begun. It will not prevent headaches or reduce the
number of attacks.
Important information
You should not use diclofenac if you have a history of allergic reaction to aspirin or NSAIDs
(non-steroidal anti-inflammatory drugs).
Diclofenac may increase your risk of fatal heart attack or stroke, especially if you use it long
term or have heart disease. Do not use this medicine just before or after heart bypass
surgery (coronary artery bypass graft, or CABG).
Slideshow: Drug Treatment for Rheumatoid Arthritis - What Are Your Options?
Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These
conditions can occur without warning while you are taking this medicine.
Before taking this medicine

Do not use Cambia to treat a cluster headache.
To make sure diclofenac is safe for you, tell your doctor if you have:
 heart disease, high blood pressure, or history of heart attack, stroke, or blood clot;
 a history of stomach ulcers or bleeding;
 liver or kidney disease;
 asthma;
 polyps in your nose;
 a bleeding or blood clotting disorder; or
 if you smoke.
FDA pregnancy category D. Tell your doctor if you are pregnant or plan to become pregnant
during treatment.Taking diclofenac during the last 3 months of pregnancy may harm the
unborn baby. Do not take diclofenac during pregnancy unless your doctor has told you to.
See also: Pregnancy and breastfeeding warnings (in more detail)
It is not known whether diclofenac passes into breast milk or if it could harm a nursing baby.
You should not breast-feed while using this medicine.
Do not give this medicine to a child younger than 18 years old without medical advice.
How should I take diclofenac?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller
amounts or for longer than recommended.
Different brands of diclofenac contain different amounts of this medicine, and may have
different uses. If you switch brands, your dose needs may change. Follow your doctor's
instructions about how much medicine to take. Ask your pharmacist if you have any
questions about the brand of diclofenac you receive at the pharmacy.
Do not crush, chew, or break an extended-release tablet or delayed-release tablet.

Swallow it whole.
Dissolve Cambia in 1 to 2 ounces of water. Do not use any other type of liquid. Stir this
mixture and drink all of it right away. Cambia works best if you take it on an empty stomach.
Call your doctor if your headache does not completely go away after taking Cambia. Do not
take a second dose of Cambia without your doctor's advice.
If you use diclofenac long-term, you may need frequent medical tests at your doctor's office.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for
your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking diclofenac?

Ask a doctor or pharmacist before using any cold, allergy, or pain medication. Many
medicines available over the counter contain aspirin or other medicines similar to diclofenac.
Taking certain products together can cause you to get too much of this type of medication.
Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.
Avoid drinking alcohol. It may increase your risk of stomach bleeding.
Diclofenac side effects

Get emergency medical help if you have any of these signs of an allergic reaction to
diclofenac: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using diclofenac and call your doctor at once if you have:
 severe nausea;
 sudden or severe stomach pain, bloody or tarry stools, coughing up blood or vomit that
looks like coffee grounds;
 flu symptoms, pale skin, unusual tiredness;
 swelling, rapid weight gain;
 worsening asthma (wheezing, chest tightness, trouble breathing);
 heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder,
nausea, sweating;
 signs of a stroke--sudden numbness or weakness (especially on one side of the body),
sudden severe headache, slurred speech, problems with vision or balance;
 liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark
urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
 signs of a kidney problem--little or no urinating, painful or difficult urination, swelling in your
feet or ankles; or
 severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your
eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face
or upper body) and causes blistering and peeling.
Older adults may be more likely to have serious stomach problems while taking medicine that
contains an NSAID.
Common diclofenac side effects may include:
 heartburn, indigestion, gas, stomach pain, nausea, vomiting;

 diarrhea, constipation;
 headache, dizziness, drowsiness;
 itching, increased sweating;
 increased blood pressure; or
 swelling, pain in your arms or legs.
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.
See also: Side effects (in more detail)
Diclofenac dosing information

Usual Adult Dose for Osteoarthritis:
Diclofenac: 50 mg orally 2 to 3 times a day or 75 mg orally twice a day. Doses greater than
150 mg/day are not recommended for osteoarthritis.
Extended-release: 100 mg orally once a day.
Usual Adult Dose for Ankylosing Spondylitis:
Diclofenac Sodium: 25 mg orally 4 times a day. An additional 25 mg dose may be

administered at bedtime, if necessary.
Usual Adult Dose for Dysmenorrhea:
Diclofenac Potassium: 50 mg orally 3 times a day. In some patients an initial dose of 100 mg
of diclofenac potassium, followed by 50 mg doses, will provide better relief. After the first day,
the total daily dose should generally not exceed 150 mg.
Diclofenac Potassium liquid filled capsules (Zipsor) are only approved by the FDA for mild to
moderate acute pain. The dosage for this product is 25 mg orally 4 times a day.
For mild to moderate acute pain in adults:

Diclofenac marketed as Zorvolex :
Zorvolex is not interchangeable with other formulations. Other formulations contain a salt of
diclofenac (i.e., diclofenac potassium or sodium), while Zorvolex contains the free acid.
Recommended dose: 18 or 35 mg orally 3 times a day
-Taking Zorvolex with food may cause a reduction in effectiveness compared to taking on an
empty stomach.
Usual Adult Dose for Pain:
Diclofenac Potassium: 50 mg orally 3 times a day. In some patients an initial dose of 100 mg
of diclofenac potassium, followed by 50 mg doses, will provide better relief. After the first day,
the total daily dose should generally not exceed 150 mg.
Zipsor is only approved by the FDA for mild to moderate acute pain. The dosage for this
product is 25 mg orally 4 times a day.
For mild to moderate acute pain in adults:

Diclofenac marketed as Zorvolex :
Zorvolex is not interchangeable with other formulations. Other formulations contain a salt of
diclofenac (i.e., diclofenac potassium or sodium), while Zorvolex contains the free acid.
Recommended dose: 18 or 35 mg orally 3 times a day
-Taking Zorvolex with food may cause a reduction in effectiveness compared to taking on an
empty stomach.
Usual Adult Dose for Rheumatoid Arthritis:
Diclofenac: 50 mg orally 3 to 4 times a day or 75 mg orally twice a day
Extended-release: 100 mg orally once a day
Doses greater than 225 mg/day are not recommended for rheumatoid arthritis.
Usual Adult Dose for Migraine:
For acute treatment of migraine without aura:
Cambia: Mix one packet (50 mg) with 1 to 2 ounces (30 to 60 mL) water in a cup and drink
immediately.
Usual Pediatric Dose for Pain:
Children: 2 to 3 mg/kg/day orally in divided doses 2 to 4 times daily

Maximum dose: 200 mg daily.
What other drugs will affect diclofenac?

Ask your doctor before using diclofenac if you take an antidepressant such as citalopram,
escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or
vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed
easily.
Tell your doctor about all medicines you use, and those you start or stop using during your
treatment with diclofenac, especially:
 a blood thinner such as warfarin (Coumadin, Jantoven); or

 steroid medicine (prednisone, dexamethasone, methylprednisolone, and others).
This list is not complete. Other drugs may interact with diclofenac, including prescription and
over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are
listed in this medication guide.
Next → Side Effects

Ibuprofen
Pronunciation
Generic Name: ibuprofen (EYE bue PROE fen)

Brand Names: Advil, Advil Childrens, Advil Junior Strength, Advil Pediatric, Genpril, IBU,
Midol IB, Midol Maximum Strength Cramp Formula, Motrin Childrens, Motrin IB, Motrin Infant
Drops, Motrin Migraine Pain
What is ibuprofen?
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones
that cause inflammation and pain in the body.
Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions
such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury.
Ibuprofen is used in adults and children who are at least 6 months old.
Ibuprofen may increase your risk of fatal heart attack or stroke, especially if you use it long
Slideshow: All Eyes On Ibuprofen: What You Need To Know
Ibuprofen may also cause stomach or intestinal bleeding, which can be fatal. These
conditions can occur without warning while you are using this medicine.
Do not take more than your recommended dose. An ibuprofen overdose can damage your
stomach or intestines. Use only the smallest amount of medication needed to get relief
from your pain, swelling, or fever.

You should not use this medicine if you are allergic to ibuprofen, aspirin or other NSAIDs.
Ibuprofen may increase your risk of fatal heart attack or stroke, especially if you use it long
Ibuprofen may also cause stomach or intestinal bleeding, which can be fatal. These
conditions can occur without warning while you are using ibuprofen.
Ask a doctor or pharmacist if it is safe for you to take this medicine if you have:
 a history of heart attack, stroke, or blood clot;

 heart disease, congestive heart failure, high blood pressure;
 a history of stomach ulcers or bleeding;
 asthma;
 polyps in your nose;
 systemic lupus erythematosus (SLE);
 a bleeding or blood clotting disorder; or
 if you smoke.
Taking ibuprofen during the last 3 months of pregnancy may harm the unborn
baby. Tell your doctor if you are pregnant or plan to become pregnant while using ibuprofen.
It is not known whether ibuprofen passes into breast milk or if it could harm a nursing baby.
Tell your doctor if you are breast-feeding a baby.
Do not give ibuprofen to a child younger than 2 years old without the advice of a
doctor.
How should I take ibuprofen?

Use ibuprofen exactly as directed on the label, or as prescribed by your doctor. Do not use in
larger or smaller amounts or for longer than recommended.
Do not take more than your recommended dose. An ibuprofen overdose can damage your
stomach or intestines. The maximum dosage for adults is 800 milligrams per dose or 3200
mg per day (4 maximum doses). Use only the smallest amount of ibuprofen needed to get
relief from your pain, swelling, or fever.
A child's dose of ibuprofen is based on the age and weight of the child. Carefully follow the
dosing instructions provided with children's ibuprofen for the age and weight of your child.
Ask a doctor or pharmacist if you have questions.
Take ibuprofen with food or milk to lessen stomach upset.
Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid
medicine with the dosing syringe provided, or with a special dose-measuring spoon or
medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
The chewable tablet must be chewed before you swallow it.
If you take ibuprofen for a long period of time, your doctor may want to check you on a
regular basis to make sure this medicine is not causing harmful effects.
Store at room temperature away from moisture and heat. Do not allow the liquid medicine to
freeze.

Since ibuprofen is used when needed, you may not be on a dosing schedule. If you are on a
schedule, use the missed dose as soon as you remember. Skip the missed dose if it is
almost time for your next scheduled dose. Do not use extra medicine to make up the missed
dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose
symptoms may include nausea, vomiting, stomach pain, drowsiness, black or bloody stools,
coughing up blood, shallow breathing, fainting, or coma.
What should I avoid while taking ibuprofen?

Avoid drinking alcohol. It may increase your risk of stomach bleeding.
Avoid taking ibuprofen if you are taking aspirin to prevent stroke or heart attack. Ibuprofen
can make aspirin less effective in protecting your heart and blood vessels. If you must use
both medications, take the ibuprofen at least 8 hours before or 30 minutes after you take the
aspirin (non-enteric coated form).
Ask a doctor or pharmacist before using any cold, allergy, or pain medicine. Many medicines
available over the counter contain aspirin or other medicines similar to ibuprofen. Taking
certain products together can cause you to get too much of this type of medication. Check
the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.
Ibuprofen side effects

Get emergency medical help if you have signs of an allergic reaction to ibuprofen: hives;
difficulty breathing; swelling of your face, lips, tongue, or throat.
Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred
speech, or problems with vision or balance.
Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or
tarry stools, or coughing up blood or vomit that looks like coffee grounds.
Stop taking ibuprofen and seek medical attention or call your doctor at once if you have:
 swelling or rapid weight gain;

 little or no urinating;
 nausea, upper stomach pain, itching, 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;
 bruising, severe tingling, numbness, pain, muscle weakness; or
 severe headache, neck stiffness, chills, increased sensitivity to light, and/or seizure
(convulsions).
Common ibuprofen side effects may include:
 upset stomach, mild heartburn, nausea, vomiting;

 bloating, gas, diarrhea, constipation;
 dizziness, headache, nervousness;
 mild itching or rash; or
 ringing in your ears.
Ibuprofen dosing information

Usual Adult Dose for Dysmenorrhea:
200 to 400 mg orally every 4 to 6 hours as needed.
Usual Adult Dose for Osteoarthritis:
Initial dose: 400 to 800 mg orally every 6 to 8 hours.

Maintenance dose: May be increased to a maximum daily dose of 3200 mg based on patient
response and tolerance.
Usual Adult Dose for Rheumatoid Arthritis:
Initial dose: 400 to 800 mg orally every 6 to 8 hours.

Maintenance dose: May be increased to a maximum daily dose of 3200 mg based on patient
response and tolerance.
Usual Adult Dose for Headache:
Study (n=34) - Prevention of Electroconvulsive therapy (ECT)-induced headache:

600 mg orally 90 minutes prior to the initial ECT session
Usual Adult Dose for Pain:
Oral: Mild to moderate pain:

200 to 400 mg orally every 4 to 6 hours as needed. Doses greater than 400 mg have not
been proven to provide greater efficacy.
IV: (Patients should be well hydrated before IV ibuprofen administration):
Pain: 400 to 800 mg intravenously over 30 minutes every 6 hours as needed.
Usual Adult Dose for Fever:
Oral:
200 to 400 mg orally every 4 to 6 hours as needed.
IV: (Patients should be well hydrated before IV ibuprofen administration):

Fever: Initial: 400 mg intravenously over 30 minutes
Maintenance: 400 mg every 4 to 6 hours or 100 to 200 mg every 4 hours as needed.
Usual Pediatric Dose for Fever:
Greater than 6 months to 12 years:

5 mg/kg/dose for temperature less than 102.5 degrees F (39.2 degrees C) orally every 6 to 8
hours as needed.
10 mg/kg/dose for temperature greater than or equal to 102.5 degrees F (39.2 degrees C)
orally every 6 to 8 hours as needed.
The recommended maximum daily dose is 40 mg/kg.
OTC pediatric labeling (analgesic, antipyretic): 6 months to 11 years: 7.5 mg/kg/dose every 6
to 8 hours; Maximum daily dose: 30 mg/kg
Infants and Children: 4 to 10 mg/kg orally every 6 to 8 hours as needed.

The recommended maximum daily dose is 40 mg/kg.
OTC pediatric labeling (analgesic, antipyretic): 6 months to 11 years: 7.5 mg/kg/dose every 6
to 8 hours; Maximum daily dose: 30 mg/kg
Usual Pediatric Dose for Rheumatoid Arthritis:
6 months to 12 years:
Usual: 30 to 40 mg/kg/day in 3 to 4 divided doses; start at lower end of dosing range and
titrate; patients with milder disease may be treated with 20 mg/kg/day; doses greater than 40
mg/kg/day may increase risk of serious adverse effects; doses greater than 50 mg/kg/day
have not been studied and are not recommended.
Maximum dose: 2.4 g/day
Usual Pediatric Dose for Cystic Fibrosis:

Oral: Chronic (greater than 4 years) twice daily dosing adjusted to maintain serum
concentration of 50 to 100 mcg/mL has been associated with slowing of disease progression
in pediatric patients with mild lung disease.
Usual Pediatric Dose for Patent Ductus Arteriosus:
Ibuprofen lysine:
Gestational age 32 weeks or less, birth weight: 500 to 1500 g:
Initial dose: 10 mg/kg, followed by two doses of 5 mg/kg after 24 and 48 hours
Note: Use birth weight to calculate all doses. Hold second or third doses if urinary output is
less than 0.6 mL/kg/hour; may give when laboratory studies indicate renal function is back to
normal. A second course of treatment, alternative pharmacologic therapy, or surgery may be
needed if the ductus arteriosus fails to close or reopens following the initial course of therapy.
What other drugs will affect ibuprofen?

Ask your doctor before using ibuprofen if you take an antidepressant such as citalopram,
escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or
vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed
easily.
Ask a doctor or pharmacist if it is safe for you to use this medicine if you are also using any of
the following drugs:
 lithium;
 methotrexate;
 a diuretic or "water pill";
 other NSAIDs--aspirin, naproxen (Aleve, Naprosyn, Treximet), celecoxib (Celebrex),
diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze),
indomethacin (Indocin), meloxicam (Mobic), and others; or
 heart or blood pressure medicine--benazepril (Lotensin), enalapril (Vasotec), lisinopril
(Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), and others.
This list is not complete. Other drugs may interact with ibuprofen, including prescription and
over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are
listed in this medication guide.

Paracetamol
Pronunciation
Generic Name: paracetamol (oral/rectal) (par RA cet a MOL)

Alternate Name: acetaminophen (a SEET a MIN oh fen)
What is paracetamol?
Paracetamol (acetaminophen) is a pain reliever and a fever reducer. The exact mechanism
of action of is not known.
Paracetamol is used to treat many conditions such as headache, muscle aches, arthritis,
backache, toothaches, colds, and fevers. It relieves pain in mild arthritis but has no effect on
the underlying inflammation and swelling of the joint.
Paracetamol may also be used for other purposes not listed in this medication guide.
There are many brands and forms of paracetamol available and not all brands are listed on
this leaflet.
Do not use more of this medication than is recommended. An overdose of paracetamol can
cause serious harm. The maximum amount of paracetamol for adults is 1 gram (1000 mg)
per dose and 4 grams (4000 mg) per day. Taking more paracetamol could cause damage to
your liver. If you drink more than three alcoholic beverages per day, talk to your doctor before
taking paracetamol and never use more than 2 grams (2000 mg) per day.
Slideshow: Fighting the Fight: Fibromylagia Explained
Do not use this medication without first talking to your doctor if you drink more than three
alcoholic beverages per day or if you have had alcoholic liver disease (cirrhosis). You may
not be able to use paracetamol.
Before using paracetamol, tell your doctor if you have liver disease or a history of alcoholism.
Do not use any other over-the-counter cough, cold, allergy, or pain medication without first
asking your doctor or pharmacist. Paracetamol is contained in many combination medicines.
If you use certain products together you may accidentally use too much paracetamol. Read
the label of any other medicine you are using to see if it contains paracetamol,
acetaminophen or APAP. Avoid drinking alcohol while taking this medication. Alcohol may
increase your risk of liver damage while taking paracetamol.
Do not use this medication if you are allergic to acetaminophen or paracetamol.
Ask a doctor or pharmacist if it is safe for you to take paracetamol if you have:
 liver disease; or
 a history of alcoholism;
It is not known whether paracetamol will harm an unborn baby. Before using paracetamol, tell
your doctor if you are pregnant. This medication can pass into breast milk and may harm a
nursing baby. Do not use paracetamol without telling your doctor if you are breast-feeding a
baby.
How should I use paracetamol?

Use paracetamol exactly as directed on the label, or as prescribed by your doctor.
Do not use more of this medication than is recommended. An overdose of paracetamol can
cause serious harm. The maximum amount for adults is 1 gram (1000 mg) per dose and 4
grams (4000 mg) per day. Using more paracetamol could cause damage to your liver. If you
drink more than three alcoholic beverages per day, talk to your doctor before taking
paracetamol and never use more than 2 grams (2000 mg) per day. If you are treating a child,
use a pediatric form of paracetamol . Carefully follow the dosing directions on the medicine
label. Do not give the medication to a child younger than 2 years old without the advice of a
doctor.
Measure the liquid form of paracetamol with a special dose-measuring spoon or cup, not a
regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for
one. You may need to shake the liquid before each use. Follow the directions on the
medicine label.
The paracetamol chewable tablet must be chewed thoroughly before you swallow it.
Make sure your hands are dry when handling the paracetamol disintegrating tablet. Place the
tablet on your tongue. It will begin to dissolve right away. Do not swallow the tablet whole.
Allow it to dissolve in your mouth without chewing.
To use the paracetamol effervescent granules, dissolve one packet of the granules in at least
4 ounces of water. Stir this mixture and drink all of it right away. To make sure you get the
entire dose, add a little more water to the same glass, swirl gently and drink right away.
Do not take a paracetamol rectal suppository by mouth. It is for use only in your rectum.
Wash your hands before and after inserting the suppository.
Try to empty your bowel and bladder just before using the paracetamol suppository. Remove
the outer wrapper from the suppository before inserting it. Avoid handling the suppository too
long or it will melt in your hands.
For best results from the suppository, lie down and insert the suppository pointed tip first into
the rectum. Hold in the suppository for a few minutes. It will melt quickly once inserted and
you should feel little or no discomfort while holding it in. Avoid using the bathroom just after
inserting the suppository.
Stop using paracetamol and call your doctor if:
 you still have a fever after 3 days of use;

 you still have pain after 7 days of use (or 5 days if treating a child);
 you have a skin rash, ongoing headache, or any redness or swelling; or
 if your symptoms get worse, or if you have any new symptoms.
Urine glucose tests may produce false results while you are taking paracetamol . Talk to your
doctor if you are diabetic and you notice changes in your glucose levels during treatment.
Store paracetamol at room temperature away from heat and moisture. The rectal
suppositories can be stored at room temperature or in the refrigerator.

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

Seek emergency medical attention if you think you have used too much of this medicine.
The first signs of an paracetamol overdose include loss of appetite, nausea, vomiting,
stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in
your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes.
What should I avoid?

Do not use any other over-the-counter cough, cold, allergy, or pain medication without first
asking your doctor or pharmacist. Paracetamol is contained in many combination medicines.
If you use certain products together you may accidentally use too much paracetamol . Read
the label of any other medicine you are using to see if it contains paracetamol,
acetaminophen or APAP. Avoid drinking alcohol while taking this medication. Alcohol may
increase your risk of liver damage while taking paracetamol .
Paracetamol side effects

paracetamol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop
using this medication and call your doctor at once if you have a serious side effect such as:
 low fever with nausea, stomach pain, and loss of appetite;

 dark urine, clay-colored stools; or
 Jaundice (yellowing of the skin or eyes).
This is not a complete list of paracetamol 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.
Paracetamol dosing information

Usual Adult Paracetamol Dose for Fever:
General Dosing Guidelines: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours
orally or rectally.
Paracetamol 500mg tablets: Two 500 mg tablets orally every 4 to 6 hours
Usual Adult Paracetamol Dose for Pain:
General Dosing Guidelines: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours
orally or rectally.
Paracetamol 500mg tablets: Two 500 mg tablets orally every 4 to 6 hours
Usual Pediatric Dose for Fever:
Oral or Rectal:
<=1 month: 10 to 15 mg/kg/dose every 6 to 8 hours as needed.
>1 month to 12 years: 10 to 15 mg/kg/dose every 4 to 6 hours as needed (Maximum: 5

doses in 24 hours)
Fever: 4 months to 9 years: Initial Dose: 30 mg/kg (Reported by one study (n=121) to be
more effective in reducing fever than a 15 mg/kg maintenance dose with no difference
regarding clinical tolerance.)
>=12 years: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours.

Oral or Rectal:
<=1 month: 10 to 15 mg/kg/dose every 6 to 8 hours as needed.
>1 month to 12 years: 10 to 15 mg/kg/dose every 4 to 6 hours as needed (Maximum: 5

doses in 24 hours)
Fever: 4 months to 9 years: Initial Dose: 30 mg/kg (Reported by one study (n=121) to be
more effective in reducing fever than a 15 mg/kg maintenance dose with no difference
regarding clinical tolerance.)
>=12 years: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours.
What other drugs will affect paracetamol?

There may be other drugs that can interact with paracetamol. Tell your doctor about all your
prescription and over-the-counter medications, vitamins, minerals, herbal products, and
drugs prescribed by other doctors. Do not start a new medication without telling your doctor.
Tramadol - Drug Information

Generic Name : Tramadol | Pronunciation : tra' ma dole
JE4
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Latest prescription information about Tramadol. Learn how to pronounce the drug's name, its indications, dosage,
how to take, when to take, when not to take, side effects, special precautions, its storage instructions and warnings if
any when taken during pregnancy. Also listed are the International and Indian trade name(s) of the drug and its price
list.
ICD Code : Y45.3 | Therapeutic Classification : Analgesics
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Trade Name(s):
India :
Antram - Plus | Standol | Medol SR | Troma -50 | Painadol SR (50 mg) | Tramataur SR | Urgendol X
L | Novadol | Trugesic | Tramol Plus | Ultram Inj (50 mg) | Paine | Trim | Dolriz | Veeradol | Simol | Tram | Movon -
PT | Tramagesic | Opidol SR | T - Dol | Cosdol | Potamp Plus | Dolfre DT | Painadol | Trofel | Mandol
DT | Ultram | Opigesic | Eltram 50 DT
More...
International :
Rybix ODT, Ryzolt, Ultram, Ultram ER
India- Acema Inj, Adamon Cap, Adamon Inj, Adamon Suscap, Admadol Cap, Admadol Inj Amp, Amtadol Inj,
Anatram Inj, Anatram Tab, Arodol Inj, Arrestadol Inj, Atdol Inj, Avdol Inj, Axedol Vial, Bestodol Inj, Bestodol Tab,
Bludol Inj Amp, Bolodol Inj, Bramadol Inj, Cadol Amp, Cemadol Cr-Cap, Cemadol Inj, Cg-Mac Cap, Contramal
Cap, Contramal Dispertab, Contramal Inj, Contramal Sr-Tab, Cormadol Inj, Cradol Inj, Damadol Inj, Damol Inj,
Damol Sr-Tab, Decotram Cap, Decotram Inj, Didol Amp, Dol Inj, Doleira Inj, Dolex Inj, Dolodol Amp, Dolomed-T
Vial, Dolotram Cap, Dolotram Inj, Dolriz Amp, Dols Amp, Dolstar Inj, Doltel Inj, Domadol Cap, Domadol Vial, E-
Dol Amp, Eltram Amp, Formador Amp, Fs Amp, Gemodol Amp, Haledol Inj, Idol Inj, Ivydol Sr-Tab, Kamadol
Amp, Kevtram Tab, Lagesic Inj, Leedol Amp, Madol Inj, Madol-Sr Tab, Medol Inj, Medol Sr-Tab, Medol Tab,
Meridol Amp, Midol Amp, Neutram Cap, Neutram Inj, Nictram Amp, Nictram-Dt Dispertab, Nobligan Inj, Nobligan
Sr-Tab, Nobligan Tab, Novadol Inj, Opiate Inj, Opiate-P Tab, Opi-Ot Inj Amp, Orchidol Amp, Orchidol Tab, Oshdol
Tab, Ospidol Inj, Ospidol Tab, Painadol Inj, Painadol Sr-Tab, Painex Inj, Paxmax Film-Coated Tab, Paxmax Inj,
Pentazen Inj Amp, Postadol Inj, Radol Inj, Ramadol Inj, Ramadol-Sr Tab, Ramax Cap, Ramax Inj, Ramcet Inj Amp,
Relidol Amp, Relidol Cap, Rimol Amp, Sayodol Amp, Sayodol-Dt Tab, Sedate Inj, Servodol Inj, Siatram Inj,
Sigmadol Inj, Simol Amp, Soztram Tab, Stemadol Inj, Strom-Sr Tab, Supridol Cap, Supridol Inj, Tacil Inj Inj, Takol-
Cr Tab, Tamody Inj, Tandam Tab, Taxidol Tab, Tol Amp, Traceta Inj Inj, Tradol Cap, Tradol Inj, Traiz Inj, Trak
Amp, Trama Dispertab, Tramabit Amp, Tramabit Cap, Tramacip Cap, Tramacip Inj, Tramadex Amp, Tramadex Cap,
Tramaflam Inj, Tramaflam Tab, Tramagesic Inj, Tramalex Amp, Tramalex Cap, Tramasol Cap, Tramatas Cap,
Tramatas Inj, Tramataur Cap, Tramataur Inj, Tramataur Tab, Tramazac Amp, Tramazac Cap, Tramazac Od Tab,
Tramazac Od-Tab, Tramazac Tab, Tramazac-Tc Sr-Tab, Tramazol Inj, Trambax Tab, Tramdop Inj, Tramed Amp,
Tramed Sr-Tab, Tramest Inj, Tramex Inj, Tramex Tab, Tramoflex Amp, Tramol Amp, Tramot Cap, Tramot Inj,
Tranat Inj, Trandol Inj, Transic Amp, Transic Cap, Trany Inj, Tranzat Amp, Trapain Amp, Trasic Cap, Trasic Inj,
Trasic Sr-Tab, Trazac Tab, Trd-Contin Cr-Tab, Trd-Md Dispertab, Treat Amp, Treat Tab, Trectadol Amp, Tremtec
Inj, Trest Amp, Trim Tab, Trofel Amp, Trofel Tab, Troma Cap, Troma Inj, Trum Inj, Trump Inj, Trump Tab, Trydol-
100 Amp, Tryme Amp, Typhon Amp, Ultracon Amp, Ultram Inj, Unidol Amp, Unidol Cap, Unidol-Dp Dispertab,
Unidol-Sr Tab, Urgendol Cap, Urgendol Inj, Urgendol Melt-Tab, Urgendol Sr-Tab, Urgendol Xl-Tab, Vardol Amp,
Verdol Vial, Victadol Tab, Vintram Cap, Xidol Inj, Zotadol Amp, Zytram Amp
Why it is prescribed (Indications) :
This medication is an opioid analgesic, prescribed for moderate to severe pain in adults. It works by changing the
way the body senses pain.
When it is not to be taken (Contraindications):

Contraindicated in patients with suicidal thoughts, acute alcoholism, head injuries, raised intracranial pressure, severe
kidney impairment, hypersensitivity and during breastfeeding.
Pregnancy Category :ABCDX
Category C :
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled
studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Dosage & When it is to be taken :
PO- The recommended dose is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain. The
maximum dose is 400 mg/day.
IV/IM- Moderate to severe pain- The recommended dose is 50-100 mg 4-6 hourly.
How it should be taken :
It comes as a tablet, capsule to take by mouth with or without food. It also comes as a solution for injection to be
administered by a healthcare provider into the vein or large muscle.
Warnings and Precautions :

Caution should be exercised in patients with history of epilepsy, brain or spine infection, head injury, brain tumor,
stroke, obstructive bowel disease, muscle weakness, respiratory depression, prostate enlargement, liver or kidney
disease, elderly, children and during pregnancy.
It may cause dizziness or drowsiness, do not drive a car or operate machinery while taking this medication.
Patients may develop with an increased risk of epilepsy while taking this medication; if it so consult with your
doctor.
Side Effects :
Most Common- Dizziness/vertigo, nausea, constipation, headache, drowsiness, vomiting, itching, CNS stimulation,
weakness, sweating, indigestion, dry mouth and diarrhea.
Body as a Whole- Uneasiness.
Heart- Dilatation of blood vessels.
Central Nervous System- Anxiety, confusion, coordination disturbance, elevated mood, nervousness and sleep
disorder.
Gastrointestinal- Abdominal pain, loss of appetite and flatulence.
Musculoskeletal- Increased muscle tone.
Skin- Rash.
Eye- Visual disturbances.
Genitourinary- Menopausal symptoms, urinary frequency and urinary retention.
Other Precautions :
Avoid alcohol consumption.
Avoid excess dosage.
Read more: Tramadol (Rybix ODT) Drug Information - Indications, Dosage, Side Effects and Precautions |
Medindia http://www.medindia.net/doctors/drug_information/tramadol.htm#ixzz3mG4gtixe
Cetirizine
Pronunciation
Generic Name: cetirizine (se TIR a zeen)

Brand Names: Zyrtec
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What is cetirizine?
Cetirizine is an antihistamine that reduces the natural chemical histamine in the body.
Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. It is
used to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose.
Cetirizine is also used to treat itching and swelling caused by hives.

Cetirizine may also be used for other purposes not listed in this medication guide.
Cetirizine 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. It can increase some of
the side effects of cetirizine. Tell your doctor if you regularly use other medicines that make you
sleepy (such as other cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers,
and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by cetirizine.
Call your doctor if your symptoms do not improve, if they get worse, or if you also have a fever.

You should not use this medication if you are allergic to cetirizine.
Before taking cetirizine, tell your doctor about all of your medical conditions.
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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. Cetirizine can pass into
breast milk and may harm a nursing baby. Do not use cetirizine without telling your doctor if you are
breast-feeding a baby.
Older adults may need to take a lower than normal dose. Follow your doctor's instructions.
How should I take cetirizine?

Take cetirizine exactly as directed on the label, or as prescribed by your doctor. Do not use it
in larger amounts or for longer than recommended.
You may take cetirizine with or without food.
The chewable tablet must be chewed before you swallow it.
Measure liquid medicine with a special dose-measuring spoon or cup, not a regular table
spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
Call your doctor if your symptoms do not improve, if they get worse, or if you also have a fever. Store
cetirizine at room temperature away from moisture and heat.

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait
until then to take the medicine and skip the missed dose. Do not take extra medicine to make
up the missed dose.

Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include feeling restless or nervous, and then feeling drowsy.
What should I avoid?

Tell your doctor if you regularly use other medicines that make you sleepy (such as other cold or
allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures,
depression, or anxiety). They can add to sleepiness caused by cetirizine. Cetirizine 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. It can increase some of the side effects of
cetirizine.
Cetirizine side effects

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

 weakness, tremors (uncontrolled shaking), or sleep problems (insomnia);
 severe restless feeling, hyperactivity;
 confusion;
 problems with vision; or
 urinating less than usual or not at all.
Less serious side effects may include:
 dizziness, drowsiness;
 tired feeling;
 dry mouth;
 sore throat, cough;
 nausea, constipation; or
 headache.
This is not a complete list of side effects and others may occur. Tell your doctor about any
unusual or bothersome side effect.

What other drugs will affect cetirizine?
There may be other drugs that can interact with cetirizine. Tell your doctor about all your
prescription and over-the-counter medications, vitamins, minerals, herbal products, and
drugs prescribed by other doctors. Do not start a new medication without telling your doctor.
Promethazine
Pronunciation
Generic Name: promethazine (oral) (pro METH a zeen)

Brand Names: Phenergan
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What is promethazine?
Promethazine is in a group of drugs called phenothiazines (FEEN-oh-THYE-a-zeens). It
works by changing the actions of chemicals in your brain. Promethazine also acts as an
antihistamine. It blocks the effects of the naturally occurring chemical histamine in your body.
Promethazine is used to treat allergy symptoms such as itching, runny nose, sneezing, itchy
or watery eyes, hives, and itchy skin rashes. It also prevents motion sickness, and treats
nausea and vomiting or pain after surgery. It is also used as a sedative or sleep aid.
Promethazine is not for use in treating symptoms of asthma, pneumonia, or other lower
respiratory tract infections.
Stop using promethazine and call your doctor at once if you have twitching or uncontrollable
movements of your eyes, lips, tongue, face, arms, or legs. These could be early signs of
dangerous side effects. Promethazine should not be given to a child younger than 2 years
old. Promethazine can cause severe breathing problems or death in a child in very young
children. Carefully follow your doctor's instructions when giving this medicine to a child of any
age.
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Promethazine 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 can increase some of the side effects of promethazine. There are many other
medicines that can interact with promethazine. 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. Keep a list with you of all the medicines you use and show this list to any doctor or
other healthcare provider who treats you.

Promethazine should not be given to a child younger than 2 years old. Promethazine can
cause severe breathing problems or death in very young children. Carefully follow your
doctor's instructions when giving this medicine to a child of any age.
You should not take this medicine if you are allergic to promethazine or to similar medicines
such as chlorpromazine, fluphenazine, mesoridazine, perphenazine, prochlorperazine,
thioridazine, or trifluperazine.
To make sure promethazine is safe for you, tell your doctor if you have:
 asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing
disorder;
 a sulfite allergy;
 a history of seizures;
 a weak immune system (bone marrow depression);
 glaucoma;
 enlarged prostate or problems with urination;
 stomach ulcer or obstruction;
 heart disease or high blood pressure;
 liver disease;
 adrenal gland tumor (pheochromocytoma);
 low levels of calcium in your blood (hypocalcemia); or
 if you have ever had a serious side effect while using promethazine or any other
phenothiazine.
FDA pregnancy category C. It is not known whether promethazine will harm an unborn baby.
Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.
See also: Pregnancy and breastfeeding warnings (in more detail)
It is not known whether promethazine passes into breast milk or if it could harm a nursing
baby. You should not breast-feed while using this medicine.
How should I take promethazine?

Take promethazine exactly as prescribed by your doctor. Follow all directions on your
prescription label. Your doctor may occasionally change your dose to make sure you get the
best results. Do not take this medicine in larger or smaller amounts or for longer than
recommended.
Promethazine is often taken at bedtime or before meals. For motion sickness, promethazine
is usually started within 1 hour before traveling. When used for surgery, promethazine is
usually taken the night before the surgery.
How often you take this medicine and the timing of your dose will depend on the condition
being treated.
Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring
spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for
one.
If a child is using this medicine, tell your doctor if the child has any changes in weight.
Promethazine doses are based on weight in children, and any changes may affect your
child's dose.
Call your doctor if your symptoms do not improve, or if they get worse while using
promethazine.
This medicine can cause unusual results with certain medical tests. Tell any doctor who
treats you that you are using promethazine.
Store at room temperature away from moisture, heat, and light.


Overdose symptoms may include overactive reflexes, loss of coordination, severe

drowsiness or weakness, fainting, dilated pupils, weak or shallow breathing, or seizure
(convulsions).
What should I avoid while taking promethazine?

This medicine may impair your thinking or reactions. Be careful if you drive or do anything
that requires you to be alert. Avoid getting up too fast from a sitting or lying position, or you
may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Drinking alcohol can increase certain side effects of promethazine.
Avoid exposure to sunlight or tanning beds. Promethazine can make you sunburn more
easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are
outdoors.
Promethazine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives;
difficult breathing; swelling of your face, lips, tongue, or throat.
Stop using promethazine and call your doctor at once if you have:
 severe drowsiness, weak or shallow breathing;

 a light-headed feeling, like you might pass out;
 confusion, agitation, hallucinations, nightmares;
 seizure (convulsions);
 fast or slow heartbeats;
 jaundice (yellowing of the skin or eyes);
 uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue
movement, blinking or eye movement);
 easy bruising or bleeding (nosebleeds, bleeding gums);
 sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, red or swollen
gums, trouble swallowing; or
 severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion,
fast or uneven heartbeats, tremors, feeling like you might pass out.
Side effects such as confusion and severe drowsiness may be more likely in older adults.
Common promethazine side effects may include:
 drowsiness, dizziness;
 ringing in your ears;
 double vision;
 feeling nervous;
 dry mouth; or
 tired feeling, sleep problems (insomnia).
Promethazine dosing information

Usual Adult Dose of Promethazine for Anaphylaxis:
Parenteral: 25 mg IV or IM once, followed by close observation for response. This dose may
be repeated within 2 hours if needed. Oral therapy should be started as soon as feasible if
continued medication is required.
Oral: 25 mg orally once. This dose may be repeated every 4 hours as needed.
Rectal: 25 mg administered rectally once. This dose may be repeated every 4 hours as
needed.
Usual Adult Dose for Allergic Reaction:
Oral or rectal: 12.5 mg before meals and 25 mg at bedtime, if necessary. Alternatively, a

single 25 mg dose given at bedtime or 6.25 mg to 12.5 mg three times daily.
IM or IV: 25 mg, may repeat in 2 hours if necessary.
Usual Adult Dose of Promethazine for Allergic Rhinitis:
Parenteral: 25 mg IV or IM, followed by close observation for response. This dose may be
repeated within 2 hours if needed. Oral therapy should be started as soon as feasible if
Oral: 25 mg at bedtime. Alternatively, 12.5 mg may be administered before the evening meal
and again at bedtime for antihistamine effects.
Rectal: 25 mg at bedtime. Alternatively, 12.5 mg may be administered before the evening

meal and again at bedtime for antihistamine effects.
The safety of promethazine for long-term treatment of allergic rhinitis has not been
established.
Usual Adult Dose for Light Sedation:
Parenteral: 25 mg IV or IM once, followed by close observation for response. An additional

dose, up to 50 mg, may be administered to achieve the desired clinical effect.
Oral: 25 mg once. An additional dose, up to 50 mg, may be administered to achieve the

desired clinical effect.
Rectal: 25 mg once. An additional dose, up to 50 mg, may be administered to achieve the

desired clinical effect.
Usual Adult Dose of Promethazine for Motion Sickness:
Oral or rectal: 25 mg 30 to 60 minutes before departure, then every 12 hours as needed.
Usual Adult Dose for Nausea/Vomiting:
Oral, rectal, IM or IV: 12.5 to 25 mg every 4 to 6 hours as needed.
Usual Adult Dose of Promethazine for Opiate Adjunct:
Oral, rectal, IM or IV: 25 to 50 mg every 4 hours as needed to augment the effects of

concomitantly administered opioids.
Usual Adult Dose for Urticaria:
Parenteral: 25 mg IV or IM, followed by close observation for response. This dose may be
repeated within 2 hours if needed. Oral therapy should be started as soon as feasible if
Oral: 25 mg at bedtime. Alternatively, 12.5 mg may be administered before the evening meal
and again at bedtime for antihistamine effects.
Rectal: 25 mg at bedtime. Alternatively, 12.5 mg may be administered before the evening

meal and again at bedtime for antihistamine effects.
Usual Adult Dose for Sedation:
Oral, rectal, IM or IV: 25 to 50 mg/dose.
Usual Adult Dose for Vertigo:
Acute Vertigo:
Initial: 25 mg IM, IV, orally, or by suppository.
Maintenance: 12.5 to 50 mg every 4 to 8 hours.
Maximum daily dose should not exceed 75 mg.
Usual Pediatric Dose for Allergic Reaction:
Greater than or equal to 2 years: oral or rectal: 0.1 mg/kg/dose every 6 hours during the day
and 0.5 mg/kg/dose at bedtime as needed.
Usual Pediatric Dose for Motion Sickness:
Greater than or equal to 2 years: Oral or rectal: 0.5 mg/kg (not to exceed 25 mg) 30 minutes
to 1 hour before departure, then every 12 hours as needed.
Usual Pediatric Dose for Nausea/Vomiting:
Greater than or equal to 2 years: oral, rectal, IM or IV: 0.25 to 1 mg/kg/dose (not to exceed
25 mg) 4 to 6 times a day as needed.
Usual Pediatric Dose for Sedation:
Greater than or equal to 2 years: Sedation: oral, IM, IV, or rectal: 0.5 to 1 mg/kg/dose (not to
exceed 25 mg) every 6 hours as needed.
Greater than or equal to 2 years: Preoperative analgesia/hypnotic adjunct: IM, IV: 1.1 mg/kg
once in combination with an analgesic or hypnotic (at reduced dosage) and with an atropine-
like agent (at appropriate dosage). Note: Promethazine dosage should not exceed half of
suggested adult dosage.
What other drugs will affect promethazine?

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers,
and medicine for seizures, depression or anxiety can interact with promethazine and cause
medical problems or increase side effects. Tell your doctor if you regularly use any of these
medicines.
Also tell your doctor if you are using any of the following medicines:
 lithium (Eskalith, Lithobid);

 atropine (Atreza, Sal-Tropine), belladonna (Donnatal, and others), benztropine (Cogentin),
dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-
Scop);
 blood pressure medication such as guanadrel (Hylorel), guanethidine (Ismelin),
propranolol (Inderal), and others;
 a blood thinner such as warfarin (Coumadin);
 bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);
 bladder or urinary medications such as oxybutynin (Ditropan, Oxytrol), solifenacin
(Vesicare), and others;
 an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine
(Nardil), or selegiline (Eldepryl, Emsam); or
 medicines to treat Parkinson's disease, restless leg syndrome, or pituitary gland tumor
(prolactinoma); or
 medicine to treat stomach ulcer or irritable bowel syndrome, such as dicyclomine (Bentyl),
glycopyrrolate (Robinul), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others),
mepenzolate (Cantil), or propantheline (Pro-Banthine).
This list is not complete and there are many other medicines that can interact with
promethazine. Tell your doctor about all your prescription and over-the-counter medications,
vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a
new medication without telling your doctor. Keep a list with you of all the medicines you use
and show this list to any doctor or other healthcare provider who treats you.
Albendazole
Pronunciation
Generic Name: albendazole (al-BEN-da-zole)

Brand Name: Albenza
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Albendazole is used for:

Treating certain tapeworm infections.
Albendazole is an anthelmintic. It works by killing sensitive parasites.
Do NOT use albendazole if:

 you are allergic to any ingredient in albendazole or to benzimidazoles (eg, rabeprazole)
Contact your doctor or health care provider right away if any of these apply to you.
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Before using albendazole:

Some medical conditions may interact with albendazole. 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 liver problems, eye problems (eg, retinal lesions), bone marrow problems, low white
blood cell counts, or low platelet counts
Some MEDICINES MAY INTERACT with albendazole. Tell your health care provider if you
are taking any other medicines, especially any of the following:
 Cimetidine, dexamethasone, or praziquantel because they may increase the risk of albendazole's
side effects
 Theophylline because the risk of its side effects may be increased by albendazole
This may not be a complete list of all interactions that may occur. Ask your health care
provider if albendazole 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 albendazole:

Use albendazole as directed by your doctor. Check the label on the medicine for exact
dosing instructions.
 Take albendazole by mouth with food.
 If you have trouble swallowing the tablet whole, it may be crushed or chewed with a little water.
 If you miss a dose of albendazole, 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. If more than one dose is missed, contact your doctor or pharmacist.
Ask your health care provider any questions you may have about how to use albendazole.
Important safety information:

 Albendazole may cause dizziness. This effect may be worse if you take it with alcohol or certain
medicines. Use albendazole with caution. Do not drive or perform other possibly unsafe tasks until
you know how you react to it.
 Albendazole may rarely lower the ability of your body to fight infection. Avoid contact with people
who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat,
rash, or chills.
 If you are a woman who may become pregnant, you should have a negative pregnancy test before
you start taking albendazole. You must use an effective form of birth control while you take
albendazole and for at least 1 month after you stop taking it. Talk with your doctor if you have
questions about effective birth control.
 Lab tests, including complete blood cell counts and liver function, may be performed while you use
albendazole. These tests may be used to monitor your condition or check for side effects. Be sure
to keep all doctor and lab appointments.
 Albendazole should be used with extreme caution in CHILDREN younger than 1 year old; safety
and effectiveness in these children have not been confirmed.
 PREGNANCY and BREAST-FEEDING: Do not use albendazole if you are pregnant. It may cause
harm to the fetus. Avoid becoming pregnant while you are taking it and for at least 1 month after
you stop taking it. If you think you may be pregnant, contact your doctor right away. It is not known
if this medicine is found in breast milk. If you are or will be breast-feeding while you use
albendazole, check with your doctor. Discuss any possible risks to your baby.
Possible side effects of albendazole:

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:
Headache; nausea; stomach pain; 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); dark urine; decreased urination; fever, chills, or
sore throat; red, swollen, peeling, or blistered skin; seizures; severe or persistent dizziness or
headache; unusual bruising or bleeding; unusual tiredness or weakness; vision changes;
yellowing of the eyes or 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. To report side effects to the appropriate agency, please read the Guide to
Reporting Problems to FDA.
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.
Proper storage of albendazole:
Store albendazole 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. Keep albendazole out of the reach of children and away from pets.
General information:
 If you have any questions about albendazole, please talk with your doctor, pharmacist, or other
health care provider.
 Albendazole 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 should not be used to decide whether or not to take albendazole or any
other medicine. Only your health care provider has the knowledge and training to decide
which medicines are right for you. This information does not endorse any medicine as safe,
effective, or approved for treating any patient or health condition. This is only a brief
summary of general information about albendazole. It does NOT include all information about
the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks
that may apply to albendazole. This information is not specific medical advice and does not
replace information you receive from your health care provider. You must talk with your
healthcare provider for complete information about the risks and benefits of using
albendazole.
Amoxicillin
Pronunciation
Generic Name: amoxicillin (am OX i sil in)

Brand Names: Amoxil, Moxatag, Trimox, Wymox, Amoxil Pediatric Drops, Biomox,
Amoxicot, Moxilin, Dispermox
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What is amoxicillin?
Amoxicillin is a penicillin antibiotic that fights bacteria.
Amoxicillin is used to treat many different types of infectioncaused by bacteria, such as

tonsillitis, bronchitis, pneumonia, gonorrhea, and infections of the ear, nose, throat, skin, or
urinary tract.
Amoxicillin is also sometimes used together with another antibiotic called clarithromycin
(Biaxin) to treat stomach ulcers caused by Helicobacter pylori infection. This combination is
sometimes used with a stomach acid reducer called lansoprazole (Prevacid).
There are many brands and forms of amoxicillin available and not all brands are listed
on this leaflet.
Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic,
such as ampicillin (Omnipen, Principen), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill),
penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids), and
others.
Before using amoxicillin, tell your doctor if you are allergic to cephalosporins such as
Omnicef, Cefzil, Ceftin, Keflex, and others. Also tell your doctor if you have asthma, liver or
kidney disease, a bleeding or blood clotting disorder, mononucleosis (also called "mono"), or
any type of allergy.
Slideshow: View Frightful (But Dead Serious) Drug Side Effects
Amoxicillin can make birth control pills less effective. Ask your doctor about using a non-
hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent
pregnancy while taking this medicine. Take this medication for the full prescribed length of
time. Your symptoms may improve before the infection is completely cleared. Amoxicillin will
not treat a viral infection such as the common cold or flu. Do not share this medication with
another person, even if they have the same symptoms you have.
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have
diarrhea that is watery or bloody, stop taking amoxicillin and call your doctor. Do not use anti-
diarrhea medicine unless your doctor tells you to.

You should not use amoxicillin if you are allergic to any penicillin antibiotic, such as
ampicillin, dicloxacillin, oxacillin, penicillin, or ticarcillin.
To make sure amoxicillin is safe for you, tell your doctor if you have:
 asthma;
 mononucleosis (also called "mono");
 a history of diarrhea caused by taking antibiotics; or
 food or drug allergies (especially to a cephalosporin antibiotic such as Omnicef, Cefzil,
Ceftin, Keflex, and others).
If you are being treated for gonorrhea, your doctor may also have you tested for syphilis,
another sexually transmitted disease.
Amoxicillin is not expected to harm an unborn baby. Tell your doctor if you are pregnant or
plan to become pregnant during treatment.
Amoxicillin can make birth control pills less effective. Ask your doctor about using non
hormonal birth control (condom, diaphragm with spermicide) to prevent pregnancy while
taking this medicine.
Amoxicillin can pass into breast milk and may harm a nursing baby. Tell your doctor if you
are breast-feeding a baby.
The amoxicillin chewable tablet may contain phenylalanine. Talk to your doctor before using
the chewable tablets if you have phenylketonuria (PKU).
How should I take amoxicillin?

Take amoxicillin exactly as prescribed by your doctor. Follow all directions on your
prescription label. Do not take this medicine in larger or smaller amounts or for longer than
recommended.
Take this medicine at the same time each day.
The Moxatag brand of amoxicillin should be taken with food, or within 1 hour after eating a
meal.
Some forms of amoxicillin may be taken with or without food. Check your medicine label to
see if you should take your medicine with food or not.
You may need to shake the liquid medicine well just before you measure a dose. Follow the
directions on your medicine label.
Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring
spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for
one. You may place the liquid directly on the tongue, or you may mix it with water, milk, baby
formula, fruit juice, or ginger ale. Drink all of the mixture right away. Do not save any for later
use.
The chewable tablet should be chewed before you swallow it.
Do not crush, chew, or break an extended-release tablet. Swallow it whole.
While using amoxicillin, you may need frequent blood tests. Your kidney and liver function
may also need to be checked.
If you are taking amoxicillin with clarithromycin and/or lansoprazole to treat stomach ulcer,
use all of your medications as directed. Read the medication guide or patient instructions
provided with each medication. Do not change your doses or medication schedule without
your doctor's advice.
Use this medicine for the full prescribed length of time. Your symptoms may improve before
the infection is completely cleared. Skipping doses may also increase your risk of further
infection that is resistant to antibiotics. Amoxicillin will not treat a viral infection such as the flu
or a common cold.
Do not share this medicine with another person, even if they have the same symptoms you
have.
This medicine can cause unusual results with certain medical tests. Tell any doctor who
treats you that you are using amoxicillin.
Store at room temperature away from moisture, heat, and light.
You may store liquid amoxicillin in a refrigerator but do not allow it to freeze. Throw away any
liquid medicine that is not used within 14 days after it was mixed at the pharmacy.


Overdose symptoms may include confusion, behavior changes, a severe skin rash, urinating
less than usual, or seizure (black-out or convulsions).
What should I avoid while taking amoxicillin?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have
diarrhea that is watery or bloody, stop using amoxicillin and call your doctor. Do not use anti-
diarrhea medicine unless your doctor tells you to.
Amoxicillin side effects

amoxicillin: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
 diarrhea that is watery or bloody;

 fever, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu
symptoms, cough, trouble breathing;
 swollen glands, rash or itching, joint pain, or general ill feeling;
 pale or yellowed skin, yellowing of the eyes, dark colored urine, fever, confusion or
weakness;
 severe tingling, numbness, pain, muscle weakness;
 easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint
spots under your skin; or
 severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your
eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face
or upper body) and causes blistering and peeling.
Common amoxicillin side effects may include:
 stomach pain, nausea, vomiting, diarrhea;

 vaginal itching or discharge;
 headache; or
 swollen, black, or "hairy" tongue.
What other drugs will affect amoxicillin?

Other drugs may interact with amoxicillin, including prescription and over-the-counter
medicines, vitamins, and herbal products. Tell each of your health care providers about all
medicines you use now and any medicine you start or stop using.
Ampicillin
Pronunciation
Generic Name: ampicillin (AM-pi-SIL-in)

Brand Name: Principen
 Overview
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Ampicillin is used for:

Treating infections caused by certain types of bacteria.
Ampicillin is a penicillin antibiotic. It works by killing sensitive bacteria by interfering with

formation of the bacteria's cell wall while it is growing. This weakens the cell wall and it
ruptures, resulting in the death of the bacteria.
Do NOT use ampicillin if:

 you are allergic to any ingredient in ampicillin or to any other penicillin antibiotic (eg, amoxicillin)
 you are taking a tetracycline antibiotic (eg, doxycycline)
 you have mononucleosis ("mono")
 you have recently received or will be receiving live oral typhoid vaccine
Contact your doctor or health care provider right away if any of these apply to you.
Slideshow: When Harmless Bacteria Turn Bad: Group B Strep
Before using ampicillin:

Some medical conditions may interact with ampicillin. 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 stomach infection or diarrhea
 if you have had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to
a cephalosporin antibiotic (eg, cephalexin) or other beta-lactam antibiotic (eg, imipenem)
Some MEDICINES MAY INTERACT with ampicillin. Tell your health care provider if you are
taking any other medicines, especially any of the following:
 Tetracyclines (eg, doxycycline) because they may decrease ampicillin's effectiveness
 Probenecid because it may increase the risk of ampicillin's side effects
 Allopurinol because the risk of skin rash may be increased
 Anticoagulants (heparin, warfarin) or methotrexate because the risk of their side effects may be
increased by ampicillin
 Aminoglycosides (eg, gentamicin), birth control pills, or live oral typhoid vaccine because their
effectiveness may be decreased by ampicillin
This may not be a complete list of all interactions that may occur. Ask your health care
provider if ampicillin 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 ampicillin:

Use ampicillin as directed by your doctor. Check the label on the medicine for exact dosing
instructions.
 Take ampicillin by mouth at least one-half hour before or 2 hours after eating.
 Take ampicillin with a full glass of water (8 oz/240 mL).
 Take ampicillin on a regular schedule to get the most benefit from it. Taking ampicillin at the same
time each day will help you remember to take it.
 To clear up your infection completely, use ampicillin for the full course of treatment. Keep using it
even if you feel better in a few days.
 If you miss a dose of ampicillin, 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 ampicillin.
Important safety information:

 Ampicillin only works against bacteria; it does not treat viral infections (eg, the common cold).
 Be sure to use ampicillin for the full course of treatment. If you do not, the medicine may not clear
up your infection completely. The bacteria could also become less sensitive to this or other
medicines. This could make the infection harder to treat in the future.
 Long-term or repeated use of ampicillin may cause a second infection. Tell your doctor if signs of a
second infection occur. Your medicine may need to be changed to treat this.
 If vomiting or diarrhea occurs, you will need to take care not to become dehydrated. Contact your
doctor for instructions.
 Mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea
(pseudomembranous colitis) may rarely occur. This may develop while you use the antibiotic or
within several months after you stop using it. Contact your doctor right away if stomach pain or
cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea without first checking with
your doctor.
 Hormonal birth control (eg, birth control pills) may not work as well while you are using ampicillin.
To prevent pregnancy, use an extra form of birth control (eg, condoms).
 Diabetes patients - Ampicillin may cause the results of some tests for urine glucose to be wrong.
Ask your doctor before you change your diet or the dose of your diabetes medicine.
 Lab tests, including white blood cell counts and kidney function tests, may be performed while you
use ampicillin. These tests may be used to monitor your condition or check for side effects. Be
sure to keep all doctor and lab appointments.
 Use ampicillin with extreme caution in CHILDREN younger than 10 years old who have diarrhea or
an infection of the stomach or bowel.
 PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will
need to discuss the benefits and risks of using ampicillin while you are pregnant. Ampicillin is
found in breast milk. If you are or will be breast-feeding while you use ampicillin, check with your
doctor. Discuss any possible risks to your baby.
Possible side effects of ampicillin:

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:
Inflammation and redness of the tongue; irritation of mouth or throat; mild diarrhea; nausea;
second infection; 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); bloody stools; severe diarrhea; stomach
pain/cramps; vaginal irritation or discharge .
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.
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
diarrhea; nausea; seizures; vomiting.
Proper storage of ampicillin:
Store ampicillin at room temperature, between 59 and 86 degrees F (15 and 30 degrees C),
in a tightly closed container. Store away from heat, moisture, and light. Keep ampicillin out of
the reach of children and away from pets.
General information:
 If you have any questions about ampicillin, please talk with your doctor, pharmacist, or other health
care provider.
 Ampicillin 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 should not be used to decide whether or not to take ampicillin or any other
medicine. Only your health care provider has the knowledge and training to decide which
medicines are right for you. This information does not endorse any medicine as safe,
effective, or approved for treating any patient or health condition. This is only a brief
summary of general information about ampicillin. It does NOT include all information about
the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks
that may apply to ampicillin. This information is not specific medical advice and does not
replace information you receive from your health care provider. You must talk with your
healthcare provider for complete information about the risks and benefits of using ampicillin.
Issue Date: June 3, 2015
Database Edition 15.2.1.003
Copyright © 2015 Clinical Drug Information, LLC

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other
medicine. Only your health care provider has the knowledge and training to decide which medicines are
right for you. This information does not endorse any medicine as safe, effective, or approved for treating
any patient or health condition. This is only a brief summary of general information about this medicine. It
does NOT include all information about the possible uses, directions, warnings, precautions, interactions,
adverse effects, or risks that may apply to this medicine. This information is not specific medical advice
and does not replace information you receive from your health care provider. You must talk with your
healthcare provider for complete information about the risks and benefits of using this medicine.
Usual Adult Dose for Bacterial Infection

The manufacturer recommends:
Parenteral:
-Infections of the respiratory tract and soft tissues: 250 to 500 mg IM or IV every 6 hours
-Infections of the gastrointestinal and genitourinary tracts (including Neisseria gonorrhoeae
infections in females): 500 mg IM or IV every 6 hours
-Urethritis in males due to N gonorrhoeae: 500 mg IM or IV every 8 to 12 hours for 2 doses
-Bacterial meningitis: 150 to 200 mg/kg/day in equally divided doses every 3 to 4 hours; may
start with IV drip therapy and continue with IM injections
-Septicemia: 150 to 200 mg/kg/day; start with IV administration for at least 3 days and
continue with IM route every 3 to 4 hours
Oral:
-Genitourinary or gastrointestinal tract infections (other than gonorrhea): 500 mg orally every
6 hours
-Gonorrhea: 3.5 g orally as a single dose (plus probenecid 1 g)
-Respiratory tract infections: 250 mg orally every 6 hours
Approved indications:
-Parenteral: Respiratory tract Infections, bacterial meningitis, septicemia, endocarditis,
urinary tract infections, gastrointestinal infections
-Oral: Genitourinary tract infections (including gonorrhea), respiratory tract infections,
gastrointestinal tract infections, and meningitis
Some experts recommend:

Parenteral: 1 to 2 g IM or IV every 4 to 6 hours or 50 to 250 mg/kg/day IM or IV in divided
doses
Maximum dose: 12 g/day
Oral: 250 to 500 mg orally every 6 hours

Usual Adult Dose for Endocarditis
The manufacturer gives no specific dosing instructions.
-Parenteral: Endocarditis due to susceptible gram-positive organisms including
Streptococcus species, penicillin G-susceptible staphylococci, and enterococci
American Heart Association (AHA) recommendations for patients with normal renal
function:
Native valve or prosthetic valve infections due to susceptible enterococci: Ampicillin 2 g IV
every 4 hours plus gentamicin or streptomycin (if gentamicin resistant)
Duration of therapy:
-Native valve: 4 weeks (symptoms for less than 3 months) or 6 weeks (symptoms for at least
3 months)
-Prosthetic valve: At least 6 weeks
Native valve or prosthetic valve infections due to Enterococcus faecalis strains resistant to
penicillin, aminoglycoside, and vancomycin: Ampicillin 2 g IV every 4 hours plus imipenem-
cilastatin or ceftriaxone
Duration of therapy: At least 8 weeks
Infections due to susceptible strains of Escherichia coli or Proteus mirabilis: Ampicillin 2 g IV

every 4 hours plus an aminoglycoside (usually gentamicin)
Usual Adult Dose for Bacterial Endocarditis Prophylaxis

(Not approved by FDA)
AHA recommendations: 2 g IM or IV as a single dose 30 to 60 minutes before procedure
Comments:
-Recommended for patients unable to take oral medication.
-Antibiotic prophylaxis may be used for dental procedures (involving manipulation of gingival
tissues or periapical region of teeth or perforation of oral mucosa), respiratory tract
procedures, or procedures on infected skin, skin structures, or musculoskeletal tissue only for
patients with the highest risk of infective endocarditis.
Usual Adult Dose for Meningitis

The manufacturer recommends: 150 to 200 mg/kg/day IV in equally divided doses every 3 to
4 hours
Comments:
-Therapy may be started with IV administration and continued with IM injections.
-Parenteral: Bacterial meningitis due to E coli, group B streptococci, and other gram-negative
bacteria (Listeria monocytogenes, N meningitidis)
-Oral: Meningitis due to N meningitidis

IV: 200 mg/kg/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 Septicemia

The manufacturer recommends: 150 to 200 mg/kg/day
Comments:
-Start with IV administration for at least 3 days and continue with the IM route every 3 to 4
hours
-Parenteral: Septicemia due to susceptible gram-positive organisms including Streptococcus
species, penicillin G-susceptible staphylococci, and enterococci; gram-negative sepsis due to
E coli, P mirabilis, and Salmonella species
Some experts recommend: 1 to 2 g IV every 3 to 4 hours, in combination with other

antibiotics
Usual Adult Dose for Gastroenteritis

The manufacturer recommends: 500 mg orally or IM or IV every 6 hours
Comments:
-Severe, chronic, or stubborn infections may require larger doses.
-Parenteral: Gastrointestinal infections due to Salmonella species (including S typhi) and
Shigella species
-Oral: Gastrointestinal tract infections due to Shigella, Salmonella species (including S typhi),
E coli, P mirabilis, and enterococci
Some experts recommend: 250 to 500 mg orally every 6 hours
Usual Adult Dose for Intraabdominal Infection

Comments:
-Parenteral: Gastrointestinal infections due to Salmonella species (including S typhi) and
Shigella species
-Oral: Gastrointestinal tract infections due to Shigella, Salmonella species (including S typhi),
E coli, P mirabilis, and enterococci
Some experts recommend: 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 of therapy: 10 to 14 days
Usual Adult Dose for Skin or Soft Tissue Infection

The manufacturer recommends: 250 to 500 mg IM or IV every 6 hours
Some experts recommend: 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 Pharyngitis

Parenteral: 250 to 500 mg IM or IV every 6 hours
Oral: 250 mg orally every 6 hours
Parenteral: Respiratory tract infections due to Streptococcus pneumoniae, Staphylococcus
aureus, Haemophilus influenzae, and Group A beta-hemolytic streptococci
Oral: Respiratory tract infections due to nonpenicillinase-producing H influenzae and
staphylococci, and streptococci (including S pneumoniae)
Some experts recommend: 500 mg orally or 1 to 2 g IM or IV every 6 hours, depending on

the nature and severity of the infection
Usual Adult Dose for Sinusitis


Usual Adult Dose for Upper Respiratory Tract Infection


Usual Adult Dose for Pneumonia

Parenteral: Respiratory tract infections due to S pneumoniae, S aureus, H influenzae, and
Group A beta-hemolytic streptococci

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 Bronchitis

Parenteral: Respiratory tract infections due to S pneumoniae, S aureus, H influenzae, and
Group A beta-hemolytic streptococci

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 Urinary Tract Infection

Comments:
-Parenteral: Urinary tract infections due to sensitive strains of E coli and P mirabilis
-Oral: Genitourinary tract infections due to E coli, P mirabilis, enterococci, Shigella,
Salmonella species (including S typhi)

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 Adult Dose for Pyelonephritis

Comments:
Some experts recommend: 500 mg to 2 g IM or IV every 4 to 6 hours with or without other

antibiotics, depending on the nature and severity of the infection
Duration of therapy: 2 to 3 weeks
Usual Adult Dose for Shigellosis

Comments:
Approved indications: Gastrointestinal tract infections due to Shigella species
Some experts recommend: 500 mg orally every 6 hours for 5 days
Usual Adult Dose for Typhoid Fever

Comments:
Approved indications: Gastrointestinal tract infections due to Salmonella species (including S

typhi)

Severe, fully susceptible: 25 mg/kg IM or IV 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
Comments:
-Fluoroquinolones or amoxicillin are considered the drugs of choice.
Usual Adult Dose for Prevention of Perinatal Group B

Streptococcal Disease
Centers for Disease Control and Prevention (CDC) recommendations: 2 g IV initial dose,
then 1 g IV every 4 hours until delivery
Comments:
-Ampicillin is recommended as an alternative to penicillin G.
Usual Adult Dose for Surgical Prophylaxis

Liver transplant: Ampicillin 1 g IV plus cefotaxime 1 g IV at induction of anesthesia, then

every 6 hours during procedure and for 48 hours after final surgical closure
Usual Adult Dose for Leptospirosis

Mild: 500 to 750 mg orally every 6 hours
Moderate to severe: 0.5 to 1 g IV every 6 hours
Usual Adult Dose for Peritonitis


CAPD-associated peritonitis: 250 to 500 mg orally twice a day 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
Duration of therapy: 10 to 14 days
Usual Adult Dose for Otitis Media


Usual Pediatric Dose for Bacterial Infection

American Academy of Pediatrics (AAP) General Dosing Recommendations for
Susceptible Infections:
Neonates:
7 days or less, 2000 g or less: 50 mg/kg IM or IV every 12 hours
7 days or less, greater than 2000 g: 50 mg/kg IM or IV every 8 hours
8 to 28 days, 2000 g or less: 50 mg/kg IM or IV every 8 hours
8 to 28 days, greater than 2000 g: 50 mg/kg IM or IV every 6 hours
1 month or older:
Mild to moderate infections:
Parenteral: 25 to 37.5 mg/kg IM or IV every 6 hours
Oral: 12.5 to 25 mg/kg orally every 6 hours
Severe infections: 50 to 100 mg/kg IM or IV every 6 hours

The Manufacturer Recommends:

Parenteral:
-Infections of the respiratory tract and soft tissues:
Less than 40 kg: 25 to 50 mg/kg/day IM or IV in equally divided doses every 6 to 8 hours
40 kg or more: 250 to 500 mg IM or IV every 6 hours
-Infections of the gastrointestinal and genitourinary tracts (including N gonorrhoeae

infections in females):
Less than 40 kg: 50 mg/kg/day IM or IV in equally divided doses every 6 to 8 hours
40 kg or more: 500 mg IM or IV every 6 hours
-Bacterial meningitis:
Children: 150 to 200 mg/kg/day in equally divided doses every 3 to 4 hours; may start with IV
drip therapy and continue with IM injections
-Septicemia:
Children: 150 to 200 mg/kg/day; start with IV administration for at least 3 days and continue
with IM route every 3 to 4 hours
Oral:
-Genitourinary or gastrointestinal tract infections:
20 kg or less: 25 mg/kg orally every 6 hours
Greater than 20 kg: 500 mg orally every 6 hours
-Respiratory tract infections:

20 kg or less: 50 mg/kg/day orally in equally divided doses every 6 to 8 hours
Comments:
-Pediatric doses should not exceed recommended adult doses.
-Parenteral: Respiratory tract Infections, bacterial meningitis, septicemia, endocarditis,
urinary tract infections, gastrointestinal infections
-Oral: Genitourinary tract infections (including gonorrhea), respiratory tract infections,
gastrointestinal tract infections, and meningitis
Usual Pediatric Dose for Bacteremia

AAP Recommendations:
Group B streptococcal bacteremia (presumed or proven):
Neonates:
7 days or younger, 2000 g or less: 100 mg/kg IM or IV every 12 hours
7 days or younger, greater than 2000 g: 50 mg/kg IM or IV every 8 hours or 100 mg/kg IM or
IV every 12 hours
Duration of therapy: At least 10 days for treatment of bacteremia without defined focus

Children: 150 to 200 mg/kg/day
Comments:
hours
Usual Pediatric Dose for Septicemia

Group B streptococcal bacteremia (presumed or proven):
Neonates:
7 days or younger, 2000 g or less: 100 mg/kg IM or IV every 12 hours
7 days or younger, greater than 2000 g: 50 mg/kg IM or IV every 8 hours or 100 mg/kg IM or
IV every 12 hours
Duration of therapy: At least 10 days for treatment of bacteremia without defined focus

Children: 150 to 200 mg/kg/day
Comments:
hours
Usual Pediatric Dose for Meningitis

Neonates:
Group B streptococcal meningitis:
7 days or younger: 50 to 100 mg/kg IV every 8 hours; some experts recommend 75 mg/kg IV
every 6 hours
Older than 7 days: 50 to 75 mg/kg IV every 6 hours
Duration of therapy: At least 14 days (if uncomplicated)
Infants, children, adolescents: 50 to 100 mg/kg IV every 6 hours


Children: 150 to 200 mg/kg/day IV in equally divided doses every 3 to 4 hours
Comments:
-Therapy may be started with IV administration and continued with IM injections.
-Parenteral: Bacterial meningitis due to E coli, group B streptococci, and other gram-negative
bacteria (L monocytogenes, N meningitidis)
-Oral: Meningitis due to N meningitidis
Usual Pediatric Dose for Endocarditis

The manufacturer gives no specific dosing instructions.
-Parenteral: Endocarditis due to susceptible gram-positive organisms including
Streptococcus species, penicillin G-susceptible staphylococci, and enterococci
AHA Recommendations for Patients with Normal Renal Function (dosage should not
exceed adult dose):
Native valve or prosthetic valve infections due to susceptible enterococci: Ampicillin 300
mg/kg/day IV in equally divided doses every 4 to 6 hours plus gentamicin or streptomycin (if
gentamicin resistant)
Duration of therapy:
-Native valve: 4 weeks (symptoms for less than 3 months) or 6 weeks (symptoms for at least
3 months)
-Prosthetic valve: At least 6 weeks
Native valve or prosthetic valve infections due to E faecalis strains resistant to penicillin,
aminoglycoside, and vancomycin: Ampicillin 300 mg/kg/day IV in equally divided doses every
4 to 6 hours plus imipenem-cilastatin or ceftriaxone
Duration of therapy: At least 8 weeks
Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

AHA Recommendations:
Children: 50 mg/kg IM or IV as a single dose 30 to 60 minutes before procedure
Comments:
-Recommended for patients unable to take oral medication.
-Antibiotic prophylaxis may be used for dental procedures (involving manipulation of gingival
tissues or periapical region of teeth or perforation of oral mucosa), respiratory tract
procedures, or procedures on infected skin, skin structures, or musculoskeletal tissue only for
patients with the highest risk of infective endocarditis.
Usual Pediatric Dose for Upper Respiratory Tract Infection

AAP General Dosing Recommendations for Susceptible Infections:
Neonates:
1 month or older:


Parenteral:
Oral:
Comments:
-Parenteral: Respiratory tract infections due to S pneumoniae, S aureus (penicillinase and
nonpenicillinase-producing), H influenzae, and group A beta-hemolytic streptococci
-Oral: Respiratory tract infections due to nonpenicillinase-producing H influenzae and
Usual Pediatric Dose for Pneumonia

Neonates:
1 month or older:

Infectious Diseases Society of America (IDSA) and Pediatric Infectious Diseases

Society (PIDS) Recommendations:
Community-acquired pneumonia:
Older than 3 months:
Empiric therapy, S pneumoniae (MICs for penicillin 2 mcg/mL or greater), or H influenzae
(beta-lactamase negative) in fully immunized patients: 37.5 to 50 mg/kg IV every 6 hours
Group A Streptococcus: 50 mg/kg IV every 6 hours
S pneumoniae resistant to penicillin (MICs 4 mcg/mL or greater): 75 to 100 mg/kg IV every 6
hours; recommended as alternate therapy

Parenteral:
Oral:
Comments:
-Parenteral: Respiratory tract infections due to S pneumoniae, S aureus (penicillinase and
nonpenicillinase-producing), H influenzae, and group A beta-hemolytic streptococci
-Oral: Respiratory tract infections due to nonpenicillinase-producing H influenzae and
Usual Pediatric Dose for Skin or Soft Tissue Infection

Neonates:
1 month or older:


Parenteral:
Comments:
Usual Pediatric Dose for Urinary Tract Infection

Neonates:
1 month or older:

Parenteral:
Less than 40 kg: 50 mg/kg/day IM or IV in equally divided doses every 6 to 8 hours
40 kg or more: 500 mg IM or IV every 6 hours
Oral:
20 kg or less: 25 mg/kg orally every 6 hours
Comments:
Usual Pediatric Dose for Surgical Prophylaxis


Liver transplant:
1 month or older: Ampicillin 50 mg/kg IV plus cefotaxime 50 mg/kg IV at induction of
anesthesia and every 6 hours for 48 hours after final surgical closure
Renal Dose Adjustments

Dose adjustment(s) may be required; however, no specific guidelines have been suggested
by the manufacturer.

Adults:
CrCl 10 to 50 mL/min: Usual dose every 6 to 12 hours
CrCl less than 10 mL/min: Usual dose every 12 to 24 hours
Liver Dose Adjustments

No adjustment required.
Dose Adjustments
The manufacturer states that larger doses may be required for severe or chronic infections;
this applies to all patients, irrespective of age and weight.
Precautions
Consult WARNINGS section for dosing related precautions.
Dialysis
Conventional hemodialysis removes 40% of ampicillin. Doses should either be given after
dialysis sessions or a supplemental dose should be given on dialysis days.
Other Comments
Administration advice:
-All infections should be treated for at least 48 to 72 hours after the patient becomes
asymptomatic or proof of bacterial eradication has been obtained.
-Treatment for at least 10 days is recommended for any infection due to group A beta-
hemolytic streptococci to help prevent acute rheumatic fever or acute glomerulonephritis.
-Stubborn infections may require several weeks of therapy.
-Parenteral ampicillin should be used for moderately severe and severe infections and for
patients unable to take the oral forms; may switch to oral ampicillin as soon as appropriate.
-Absorption is best when oral ampicillin is taken 1 hour before or 2 hours after meals.
-Oral ampicillin should not be used for initial treatment of severe or life-threatening infections.
Storage requirements:
-Parenteral: The manufacturer's product information should be consulted.
-Oral: The reconstituted oral suspension should be stored in a refrigerator; any unused
portion should be discarded after 14 days.
Reconstitution/preparation techniques: The manufacturer's product information should be

consulted.
General:
-Bacteriologic studies are recommended to determine the causative organisms and their
susceptibility to ampicillin; therapy may be started before the results of susceptibility testing.
-Smaller doses than those recommended should not be used.
-Prolonged intensive therapy is needed for complications of gonorrheal urethritis (such as
prostatitis and epididymitis).
Monitoring:
-Gastrointestinal: Frequent bacteriologic and clinical appraisal with chronic gastrointestinal
infections (needed during therapy and may be needed for several months afterwards).
-General: Bacteriologic studies/susceptibility testing; organ system function assessment,
including renal, hepatic, and hematopoietic (during prolonged therapy and with high dose
regimens); darkfield examinations in gonorrhea patients with suspected primary syphilis
lesion (prior to therapy); serological tests for syphilis in all gonorrhea patients where
concomitant syphilis is suspected (at diagnosis and monthly for at least 4 months).
-Genitourinary: Frequent bacteriologic and clinical appraisal with chronic urinary infections
(needed during therapy and may be needed for several months afterwards); Follow-up
cultures from original infection site(s) (7 to 14 days after gonorrhea therapy); culture test-of-
cure from endocervical and anal canals in women (after gonorrhea therapy).
-Hematologic: Organ system function assessment, including hematopoietic (during prolonged
therapy and with high dose regimens).
-Hepatic: Organ system function assessment, including hepatic (during prolonged therapy
and with high dose regimens).
-Renal: Organ system function assessment, including renal (during prolonged therapy and
with high dose regimens).
Next → Interactions

What Is Diclofenac

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What Is Diclofenac

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What is diclofenac?

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). This medicine works by

Diclofenac is used to treat mild to moderate pain, or signs and symptoms

Before taking this medicine

See also: Pregnancy and breastfeeding warnings (in more detail)

How should I take diclofenac?

Do not crush, chew, or break an extended-release tablet or delayed-release tablet.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

What happens if I overdose?

What should I avoid while taking diclofenac?

Avoid drinking alcohol. It may increase your risk of stomach bleeding.

Diclofenac side effects

Common diclofenac side effects may include:

 heartburn, indigestion, gas, stomach pain, nausea, vomiting;

Diclofenac dosing information

Extended-release: 100 mg orally once a day.

Usual Adult Dose for Ankylosing Spondylitis:

Diclofenac Sodium: 25 mg orally 4 times a day. An additional 25 mg dose may be

Usual Adult Dose for Dysmenorrhea:

For mild to moderate acute pain in adults:

Usual Adult Dose for Pain:

For mild to moderate acute pain in adults:

Usual Adult Dose for Rheumatoid Arthritis:

Diclofenac: 50 mg orally 3 to 4 times a day or 75 mg orally twice a day

Extended-release: 100 mg orally once a day

Usual Adult Dose for Migraine:

For acute treatment of migraine without aura:

Usual Pediatric Dose for Pain:

Children: 2 to 3 mg/kg/day orally in divided doses 2 to 4 times daily

What other drugs will affect diclofenac?

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

Next → Side Effects

Generic Name: ibuprofen (EYE bue PROE fen)

Slideshow: All Eyes On Ibuprofen: What You Need To Know

Before taking this medicine

 a history of heart attack, stroke, or blood clot;

How should I take ibuprofen?

Take ibuprofen with food or milk to lessen stomach upset.

The chewable tablet must be chewed before you swallow it.

What happens if I miss a dose?

What happens if I overdose?

What should I avoid while taking ibuprofen?

Ibuprofen side effects

 swelling or rapid weight gain;

 upset stomach, mild heartburn, nausea, vomiting;

See also: Side effects (in more detail)

Ibuprofen dosing information

200 to 400 mg orally every 4 to 6 hours as needed.

Usual Adult Dose for Osteoarthritis:

Initial dose: 400 to 800 mg orally every 6 to 8 hours.

Usual Adult Dose for Rheumatoid Arthritis:

Initial dose: 400 to 800 mg orally every 6 to 8 hours.

Usual Adult Dose for Headache:

Study (n=34) - Prevention of Electroconvulsive therapy (ECT)-induced headache:

Usual Adult Dose for Pain:

Oral: Mild to moderate pain:

Usual Adult Dose for Fever:

IV: (Patients should be well hydrated before IV ibuprofen administration):

Usual Pediatric Dose for Fever:

Greater than 6 months to 12 years:

The recommended maximum daily dose is 40 mg/kg.

Usual Pediatric Dose for Pain: