Manganese

Dosage Form: injection, solution
Manganese

0.1 mg/mL

Manganese Chloride

Injection, USP

FOR I.V. USE ONLY AFTER DILUTION

Plastic Vial

Rx only

Manganese Description

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) is a sterile, nonpyrogenic solution intended for use as an additive to intravenous solutions for total parenteral nutrition (TPN). Each mL of solution contains 0.36 mg Manganese chloride, tetrahydrate and 9 mg sodium chloride. The solution contains no bacteriostat, antimicrobial agent or added buffer. The pH is 2.0 (1.5 to 2.5); product may contain hydrochloric acid and sodium hydroxide for pH adjustment. The osmolarity is 0.313 mOsmol/mL (calc.).

Manganese Chloride, USP is chemically designated Manganese chloride, tetrahydrate (MnCl2 • 4H2O), a deliquescent, crystalline compound soluble in water.

Sodium Chloride, USP is chemically designated NaCl, a white, crystalline compound freely soluble in water.

The semi-rigid vial is fabricated from a specially formulated polyolefin. It is a copolymer of ethylene and propylene. The safety of the plastic has been confirmed by tests in animals according to USP biological standards for plastic containers. The small amount of water vapor that can pass through the plastic container wall will not significantly alter the drug concentration.

Manganese - Clinical Pharmacology

Manganese is an essential nutrient which serves as an activator for enzymes such as polysaccharide polymerase, liver arginase, cholinesterase and pyruvate carboxylase. Providing Manganese during TPN helps prevent development of deficiency symptoms such as nausea and vomiting, weight loss, dermatitis and changes in growth and color of hair.

Under conditions of minimal intake, 20 mcg Manganese/day is retained. Manganese is bound to a specific transport protein, transmanganin, a beta-l-globulin. Manganese is widely distributed but concentrates in the mitochondria rich tissues such as brain, kidney, pancreas, and liver. Assays for Manganese in whole blood result in concentrations ranging from 6 to 12 mcg/Manganese/liter.

Excretion of Manganese occurs mainly through the bile, but in the event of obstruction, ancillary excretion routes include pancreatic juice, or return into the lumen of the duodenum, jejunum, or ileum. Urinary excretion of Manganese is negligible.

Indications and Usage for Manganese

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) is indicated for use as a supplement to intravenous solutions given for total parenteral nutrition (TPN).

Administration helps to maintain Manganese serum levels and to prevent depletion of endogenous stores and subsequent deficiency symptoms.

Contraindications

None known.

Warnings

Direct intramuscular or intravenous injection of Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) is contraindicated as the acidic pH of the solution (pH 2.0) may cause considerable tissue irritation.

Liver and/or biliary tract dysfunction may require omission or reduction of copper and Manganese doses because these elements are primarily eliminated in the bile.

WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.

Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.

Precautions

General

Do not use unless solution is clear and seal is intact.

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) should only be used in conjunction with a pharmacy directed admixture program using aseptic technique in a laminar flow environment; it should be used promptly and in a single operation without any repeated penetrations. Solution contains no preservatives; discard unused portion immediately after admixture procedure is completed.

Laboratory Tests

Serum Manganese levels can be measured periodically at the discretion of the investigator. Because of the low serum concentration normally present, samples will usually be analyzed by a reference laboratory.

Carcinogenesis, Mutagenesis, and Impairment of Fertility

Long-term animal studies to evaluate the carcinogenic potential of Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) have not been performed, nor have studies been done to assess mutagenesis or impairment of fertility.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) additive is administered to a nursing woman.

Pediatric Use

(See DOSAGE AND ADMINISTRATION section.) Safety and effectiveness in pediatric patients have not been established.

Pregnancy Category C.

Animal reproduction studies have not been conducted with Manganese chloride. It is also not known whether Manganese chloride can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Manganese chloride should be given to a pregnant woman only if clearly indicated.

Geriatric Use

An evaluation of current literature revealed no clinical experience identifying differences in response between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Adverse Reactions

None known.

Drug Abuse and Dependence

None known.

Overdosage

Manganese toxicity in TPN patients has not been reported.

Manganese Dosage and Administration

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) contains 0.1 mg Manganese/mL and is administered intravenously only after dilution. The additive should be administered in a volume of fluid not less than 100 mL. For the adult receiving TPN, the suggested additive dosage for Manganese is 0.15 to 0.8 mg/day (1.5 to 8 mL/day). For pediatric patients, a dosage of 2 to 10 mcg Manganese/kg/day (0.02 to 0.1 mL/kg/day) is recommended.

Periodic monitoring of Manganese plasma levels is suggested as a guideline for subsequent administration.

Parenteral products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. (See PRECAUTIONS.)

How is Manganese Supplied

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) is supplied in 10 mL Plastic Vials (NDC No. 0409-4091-01).

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

Revised: November, 2009

Printed in USA                           EN - 2320

Hospira, Inc., Lake Forest, IL 60045 USA

RL-0104

 

Manganese  Manganese chloride  injection, solution

Product Information Product Type HUMAN PRESCRIPTION DRUG NDC Product Code (Source) 0409-4091 Route of Administration INTRAVENOUS DEA Schedule

Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength Manganese CHLORIDE (Manganese) Manganese 0.1 mg  in 1 mL

Inactive Ingredients Ingredient Name Strength SODIUM CHLORIDE   HYDROCHLORIC ACID   SODIUM HYDROXIDE

Product Characteristics Color      Score      Shape Size Flavor Imprint Code Contains

Packaging # NDC Package Description Multilevel Packaging 1 0409-4091-01 25 VIAL In 1 TRAY contains a VIAL 1 10 mL In 1 VIAL This package is contained within the TRAY (0409-4091-01)

Marketing Information
Marketing Category	Application Number or Monograph Citation	Marketing Start Date	Marketing End Date
NDA	NDA018962	08/04/2010

Labeler - Hospira, Inc. (141588017)

Revised: 08/2011Hospira, Inc.

More Manganese resources

• Manganese Drug Interactions
• Manganese Support Group
• 0 Reviews · Be the first to review/rate this drug

maprotiline

Generic Name: maprotiline (ma PROE ti leen)

Brand Names: Ludiomil

What is maprotiline?

Maprotiline is an antidepressant. Maprotiline affects chemicals in the brain that may become unbalanced and cause depression.

Maprotiline is used to treat major depressive disorder, depressive neurosis, and manic-depression illness.

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

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

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Do not use maprotiline if you have a seizure disorder, or if you have used an MAO inhibitor within the past 14 days. Serious, life-threatening side effects can occur if you take maprotiline before the MAO inhibitor has cleared from your body.

Before taking maprotiline, tell your doctor if you have liver or kidney disease, seizures, heart disease, a thyroid disorder, if you receive electroshock therapy, or if you have a history of heart attack, stroke, drug abuse, or suicidal thoughts.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

It may take up to 3 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 3 weeks of treatment. Avoid drinking alcohol. It can increase some of the side effects of maprotiline. Maprotiline 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.

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

You should not take this medication if you are allergic to maprotiline, or if you have a seizure disorder.

You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Do not use maprotiline if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take maprotiline before the MAO inhibitor has cleared from your body.

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

• liver or kidney disease;


• 
  

  if you are receiving electroshock therapy;

  
  


• 
  

  seizures or epilepsy;

  
  


• 
  

  a thyroid disorder;

  
  


• 
  

  heart disease, heart rhythm disorder;

  
  


• 
  

  a history of heart attack or stroke; or

  
  


• 
  

  a history of drug abuse or suicidal thoughts.

  
  

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

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. Maprotiline can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more sensitive to the side effects of this medication.

How should I take maprotiline?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Take the regular tablet form of maprotiline with water.

Maprotiline is usually taken once a day at bedtime. Follow your doctor's instructions.

It may take up to 3 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 3 weeks of treatment. Store maprotiline at room temperature, away from moisture and heat.

See also: Maprotiline dosage (in more detail)

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include extreme drowsiness, fast heart rate, confusion, vomiting, blue lips or fingernails, and seizure (convulsions).

What should I avoid while taking maprotiline?

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by maprotiline. Tell your doctor if you need to use any of these other medicines while you are taking maprotiline. Avoid drinking alcohol. It can increase some of the side effects of maprotiline. Maprotiline 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.

Maprotiline side effects

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have any of these serious side effects:

• 
  

  seizure (convulsions);

  
  


• 
  

  fast or pounding heart rate;

  
  


• 
  

  confusion, hallucinations;

  
  


• 
  

  unusual thoughts or behavior; or

  
  


• 
  

  feeling like you might pass out.

  
  

Less serious side effects include:

• 
  

  drowsiness, dizziness;

  
  


• 
  

  loss of balance or coordination;

  
  


• 
  

  numbness or tingling;

  
  


• 
  

  blurred vision;

  
  


• 
  

  ringing in your ears;

  
  


• 
  

  nausea, stomach pain;

  
  


• 
  

  constipation;

  
  


• 
  

  dry mouth; or

  
  


• 
  

  thirst.

  
  

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Maprotiline Dosing Information

Usual Adult Dose for Depression:

For outpatients with mild to moderate depression:
Initial Dose: 75 mg orally as a single or divided daily dose.

For severely depressed hospitalized patients:
Initial Dose: 100 mg to 150 mg orally as a single or divided daily dose.
Maintenance Dose: May be reduced to 75 to 150 mg orally as a single or divided daily dose, with subsequent adjustment depending on therapeutic response.

Usual Geriatric Dose for Depression:

For outpatients with mild to moderate depression:
Initial Dose: 25 mg per day orally
Maintenance Dose: 50 to 75 mg as a single or divided daily dose is usually satisfactory for patients over 60 years of age.

What other drugs will affect maprotiline?

The following drugs can interact with maprotiline. Tell your doctor if you are using any of these:

• 
  

  guanethidine (Ismelin);

  
  


• 
  

  medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), mesoridazine (Serentil), or thioridazine (Mellaril);

  
  


• 
  

  a sedative such as Valium;

  
  


• 
  

  cimetidine (Tagamet); or

  
  


• 
  

  phenytoin (Dilantin).

  
  

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

More maprotiline resources

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

• maprotiline Advanced Consumer (Micromedex) - Includes Dosage Information


• Maprotiline Prescribing Information (FDA)


• Maprotiline MedFacts Consumer Leaflet (Wolters Kluwer)


• Ludiomil Prescribing Information (FDA)


• Maprotiline Hydrochloride Monograph (AHFS DI)

Compare maprotiline with other medications

• Depression
• Panic Disorder

Where can I get more information?

• Your pharmacist can provide more information about maprotiline.

See also: maprotiline side effects (in more detail)

metformin

met-FOR-min hye-droe-KLOR-ide

Oral route(Tablet;Tablet, Extended Release;Solution)

Fortamet(R), Glucophage(R), Glucophage XR(R), Riomet(R): Lactic acidosis is a rare, but serious, metabolic complication that can occur due to metformin accumulation during treatment with metformin hydrochloride; when it occurs, it is fatal in approximately 50% of cases. Lactic acidosis may also occur in association with pathophysiologic conditions, including diabetes mellitus, characterized by significant tissue hypoperfusion and hypoxemia. The risk of lactic acidosis increases with renal impairment, increased age, congestive heart failure, and hepatic insufficiency. Treatment with metformin should not be initiated in patients 80 years old or older, unless measurement of creatinine clearance demonstrates that renal function is normal. Therapy should temporarily be discontinued prior to any intravascular radiocontrast study or surgical procedure. Excessive alcohol use should be avoided, because alcohol potentiates the effects of metformin on lactate metabolism. Discontinue therapy immediately and institute supportive measures promptly for suspected lactic acidosis .

Oral route(Tablet, Extended Release)

Glumetza(R): Lactic acidosis is a rare, but serious, complication that can occur due to metformin accumulation. The risk of lactic acidosis increases with renal or hepatic impairment, acute congestive heart failure, sepsis, dehydration, and excess alcohol intake. Onset may be subtle and include nonspecific symptoms such as malaise, myalgia, respiratory distress, somnolence, and abdominal distress; laboratory abnormalities include low pH, increased anion gap and elevated blood lactate. If lactic acidosis is suspected, Glumetza(R) should be discontinued and the patient immediately hospitalized .

Commonly used brand name(s)

In the U.S.

• Fortamet


• Glucophage


• Glucophage XR


• Glumetza


• Riomet

Available Dosage Forms:

• Tablet


• Tablet, Extended Release


• Solution

Therapeutic Class: Hypoglycemic

Chemical Class: Metformin

Uses For metformin

Metformin is used to treat high blood sugar levels that are caused by a type of diabetes mellitus or sugar diabetes called type 2 diabetes. With this type of diabetes, insulin produced by the pancreas is not able to get sugar into the cells of the body where it can work properly. Using metformin alone, with a type of oral antidiabetic medicine called a sulfonylurea, or with insulin, will help to lower blood sugar when it is too high and help restore the way you use food to make energy.

Many people can control type 2 diabetes with diet and exercise. Following a specially planned diet and exercise will always be important when you have diabetes, even when you are taking medicines. To work properly, the amount of metformin you take must be balanced against the amount and type of food you eat and the amount of exercise you do. If you change your diet or exercise, you will want to test your blood sugar to find out if it is too low. Your doctor will teach you what to do if this happens.

Metformin does not help patients does not help patients who have insulin-dependent or type 1 diabetes because they cannot produce insulin from their pancreas gland. Their blood glucose is best controlled by insulin injections.

metformin is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, metformin is used in certain patients with the following medical conditions:

• Polycystic ovary syndrome.

Before Using metformin

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

Allergies

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

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of metformin oral solution and tablets in children 10 to 16 years of age. However, safety and efficacy of metformin extended-release tablets in the pediatric population have not been established.

Geriatric

Although appropriate studies on the relationship of age to the effects of metformin have not been performed in the geriatric population, geriatric-specific problems are not expected to limit the usefulness of metformin in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution in patients receiving metformin. metformin is not recommended in patients 80 years of age and older who have kidney problems.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

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

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

• Acetrizoic Acid


• Diatrizoate


• Ethiodized Oil


• Iobenzamic Acid


• Iobitridol


• Iocarmic Acid


• Iocetamic Acid


• Iodamide


• Iodipamide


• Iodixanol


• Iodohippuric Acid


• Iodopyracet


• Iodoxamic Acid


• Ioglicic Acid


• Ioglycamic Acid


• Iohexol


• Iomeprol


• Iopamidol


• Iopanoic Acid


• Iopentol


• Iophendylate


• Iopromide


• Iopronic Acid


• Ioseric Acid


• Iosimide


• Iotasul


• Iothalamate


• Iotrolan


• Iotroxic Acid


• Ioversol


• Ioxaglate


• Ioxitalamic Acid


• Ipodate


• Metrizamide


• Metrizoic Acid


• Tyropanoate Sodium

Using metformin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acetazolamide


• Alatrofloxacin


• Balofloxacin


• Cimetidine


• Ciprofloxacin


• Clinafloxacin


• Dichlorphenamide


• Dofetilide


• Enoxacin


• Fleroxacin


• Flumequine


• Gatifloxacin


• Gemifloxacin


• Grepafloxacin


• Levofloxacin


• Lomefloxacin


• Moxifloxacin


• Norfloxacin


• Ofloxacin


• Pefloxacin


• Prulifloxacin


• Rufloxacin


• Sparfloxacin


• Temafloxacin


• Topiramate


• Tosufloxacin


• Trovafloxacin Mesylate


• Zonisamide

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

• Acebutolol


• Alprenolol


• Atenolol


• Betaxolol


• Bevantolol


• Bisoprolol


• Bitter Melon


• Bucindolol


• Carteolol


• Carvedilol


• Celiprolol


• Cephalexin


• Clorgyline


• Dilevalol


• Enalaprilat


• Enalapril Maleate


• Esmolol


• Fenugreek


• Glucomannan


• Guar Gum


• Iproniazid


• Isocarboxazid


• Labetalol


• Levobunolol


• Mepindolol


• Metipranolol


• Metoprolol


• Moclobemide


• Nadolol


• Nebivolol


• Nialamide


• Oxprenolol


• Pargyline


• Penbutolol


• Phenelzine


• Pindolol


• Procarbazine


• Propranolol


• Psyllium


• Rifampin


• Selegiline


• Sotalol


• Talinolol


• Tertatolol


• Timolol


• Toloxatone


• Tranylcypromine


• Trospium

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of metformin. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol, excessive use or


• Underactive adrenal glands or


• Underactive pituitary gland or


• Undernourished condition or


• Weakened physical condition or


• Any other condition that causes low blood sugar—Patients with these conditions may be more likely to develop low blood sugar while taking metformin.

• Anemia (low levels of red blood cells) or


• Vitamin B12 deficiency—Use with caution. May make these conditions worse.

• Congestive heart failure, acute or unstable or


• Dehydration or


• Heart attack, acute or


• Hypoxemia (decreased oxygen in the blood) or


• Kidney disease or


• Liver disease or


• Sepsis (blood poisoning) or


• Shock (low blood pressure, blood circulation is poor)—A rare condition called lactic acidosis can occur. Talk with your doctor if you have concerns about this.

• Diabetic ketoacidosis (ketones in the blood) or


• Kidney disease, severe or


• Metabolic acidosis (extra acids in the blood) or


• Type 1 diabetes—Should not be used in patients with these conditions.

• Fever or


• Infection or


• Surgery or


• Trauma—These conditions may cause temporary problems with blood sugar control and your doctor may want to treat you with insulin.

Proper Use of metformin

metformin usually comes with a patient information insert. Read the information carefully and make sure you understand it before taking metformin. If you have any questions, ask your doctor.

Carefully follow the special meal plan your doctor gave you. This is a very important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed.

Metformin should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment.

Swallow the extended-release tablet whole with a full glass of water. Do not crush, break, or chew it.

While taking the extended-release tablet, part of the tablet may pass into your stool after your body has absorbed the medicine. This is normal and nothing to worry about.

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

Use only the brand of metformin that your doctor prescribed. Different brands may not work the same way.

You may notice improvement in your blood glucose control in 1 to 2 weeks, but the full effect of blood glucose control may take up to 2 to 3 months. Ask your doctor if you have any questions about this.

Dosing

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

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

• For type 2 diabetes:
  
  • For oral dosage form (extended-release tablets):
    
    • Adults—
      
      • Metformin alone (Fortamet®): At first, 1000 milligrams (mg) once a day taken with the evening meal. Your doctor may increase your dose if needed until your blood sugar is controlled. However, the dose is usually not more than 2500 mg per day.
      
      
      • Metformin alone (Glucophage® XR): At first, 500 mg once daily with the evening meal. Your doctor may increase your dose if needed until your blood sugar is controlled. However, the dose is usually not more than 2000 mg per day.
      
      
      • Metformin alone (Glumetza®): At first, 500 mg once a day taken with the evening meal. Then, your doctor may increase your dose if needed until your blood sugar is controlled. However, the dose is usually not more than 2000 mg per day.
      
      
      • Metformin with a sulfonylurea: Your doctor will determine the dose of each medicine.
      
      
      • Metformin with insulin: At first, 500 mg once a day. Then, your doctor may increase your dose by 500 mg every week if needed until your blood sugar is controlled. However, the dose is usually not more than 2500 mg per day.
      
      
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  
  • For oral dosage form (solution):
    
    • Adults—
      
      • Metformin alone: At first, 5 milliliters (mL) two times a day, or 8.5 mL once a day with meals. Your doctor may increase your dose if needed until your blood sugar is controlled. However, the dose is usually not more than 25.5 mL per day.
      
      
      • Metformin with a sulfonylurea: Your doctor will determine the dose of each medicine.
      
      
      • Metformin with insulin: At first, 5 mL once a day. Your doctor may increase your dose if needed until your blood sugar is controlled. However, the dose is usually not more than 25 mL per day.
      
      
    
    
    • Children 10 to 16 years of age—At first, 5 mL two times a day with meals. Your doctor may increase your dose if needed until your blood sugar is controlled. However, the dose is usually not more than 20 mL per day.
    
    
    • Children younger than 10 years of age—Use and dose must be determined by your doctor.
    
    
  
  
  • For oral dosage form (tablets):
    
    • Adults—
      
      • Metformin alone: At first, 500 milligrams (mg) two times a day taken with the morning and evening meals, or 850 mg a day taken with the morning meal. Your doctor may increase your dose if needed until your blood sugar is controlled. Later, your doctor may want you to take 500 or 850 mg two to three times a day with meals. However, the dose is usually not more than 2550 mg per day.
      
      
      • Metformin with a sulfonylurea: Your doctor will determine the dose of each medicine.
      
      
      • Metformin with insulin: At first, 500 mg a day. Your doctor may increase your dose by 500 mg every week if needed until your blood sugar is controlled. However, the dose is usually not more than 2500 mg per day.
      
      
    
    
    • Children 10 to 16 years of age—At first, 500 mg two times a day taken with the morning and evening meals. Your doctor may increase your dose if needed until your blood sugar is controlled. However, the dose is usually not more than 2000 mg per day.
    
    
    • Children younger than 10 years of age—Use and dose must be determined by your doctor.
    
    
  
  

Missed Dose

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

Storage

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

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using metformin

It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take metformin. Blood and urine tests may be needed to check for unwanted effects.

metformin may interact with the dye used for an X-ray or CT scan. Your doctor should advise you to stop taking it before you have any medical exams or diagnostic tests that might cause less urine output than usual. You may be advised to start taking the medicine again 48 hours after the exams or tests if your kidney function is tested and found to be normal.

Make sure any doctor or dentist who treats you knows that you are using metformin. You may need to stop using metformin several days before having surgery or medical tests.

It is very important to carefully follow any instructions from your health care team about:

• Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.


• Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.


• Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur with lifestyle changes, such as changes in exercise or diet. Counseling on birth control and pregnancy may be needed because of the problems that can occur in pregnancy for patients with diabetes.


• Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.


• In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.

Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure. Symptoms of lactic acidosis include abdominal or stomach discomfort, decreased appetite; diarrhea; fast or shallow breathing; a general feeling of discomfort; severe muscle pain or cramping; and unusual sleepiness, tiredness, or weakness.

If symptoms of lactic acidosis occur, you should get immediate emergency medical help.

Metformin can cause low blood sugar (hypoglycemia). However, this can also occur if you delay or miss a meal or snack, drink alcohol, exercise more than usual, cannot eat because of nausea or vomiting, take certain medicines, or take metformin with another type of diabetes medicine. The symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so that you can treat it quickly.

Symptoms of hypoglycemia (low blood sugar) include anxiety; behavior change similar to being drunk; blurred vision; cold sweats; confusion; cool, pale skin; difficulty with thinking; drowsiness; excessive hunger; fast heartbeat; headache (continuing); nausea; nervousness; nightmares; restless sleep; shakiness; slurred speech; or unusual tiredness or weakness.

If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes; or drink fruit juice, non-diet soft drink, or sugar dissolved in water. Also, check your blood for low blood sugar. Glucagon is used in emergency situations when severe symptoms such as seizures (convulsions) or unconsciousness occur. Have a glucagon kit available, along with a syringe or needle, and know how to use it. The members of your household also should know how to use it.

High blood sugar (hyperglycemia) is another problem related to uncontrolled diabetes. Symptoms of mild high blood sugar appear more slowly than those of low blood sugar. These may include blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased urination (frequency and volume); ketones in the urine; loss of appetite; sleepiness; stomachache, nausea or vomiting; tiredness; troubled breathing (rapid and deep); unconsciousness; or unusual thirst.

High blood sugar may occur if you do not exercise as much as usual, have a fever or infection, do not take enough or skip a dose of your diabetes medicine, or overeat or do not follow your meal plan.

If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.

metformin is only part of a complete program for controlling diabetes. It is important that you always eat a healthy diet, watch your weight, and get regular exercise.

metformin Side Effects

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

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

More common

• Abdominal or stomach discomfort


• cough or hoarseness


• decreased appetite


• diarrhea


• fast or shallow breathing


• fever or chills


• general feeling of discomfort


• lower back or side pain


• muscle pain or cramping


• painful or difficult urination


• sleepiness

Less common

• Anxiety


• blurred vision


• chest discomfort


• cold sweats


• coma


• confusion


• cool, pale skin


• depression


• difficult or labored breathing


• dizziness


• fast, irregular, pounding, or racing heartbeat or pulse


• feeling of warmth


• headache


• increased hunger


• increased sweating


• nausea


• nervousness


• nightmares


• redness of the face, neck, arms, and occasionally, upper chest


• seizures


• shakiness


• shortness of breath


• slurred speech


• tightness in the chest


• unusual tiredness or weakness


• wheezing

Rare

• Behavior change similar to being drunk


• difficulty with concentrating


• drowsiness


• lack or loss of strength


• restless sleep


• unusual sleepiness

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

More common

• Acid or sour stomach


• belching


• bloated


• excess air or gas in the stomach or intestines


• full feeling


• heartburn


• indigestion


• loss of appetite


• metallic taste in the mouth


• passing of gas


• stomachache


• stomach upset or pain


• vomiting


• weight loss

Less common

• Abnormal stools


• bad, unusual, or unpleasant (after) taste


• change in taste


• difficulty with moving


• discoloration of the fingernails or toenails


• flu-like symptoms


• joint pain


• rash


• runny nose


• sneezing


• stuffy nose


• swollen joints

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: metformin side effects (in more detail)

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

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

More metformin resources

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

• Fortamet Prescribing Information (FDA)


• Glucophage Prescribing Information (FDA)


• Glucophage Consumer Overview


• Glucophage XR Extended-Release Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Glucophage XR Prescribing Information (FDA)


• Glumetza Prescribing Information (FDA)


• Metformin MedFacts Consumer Leaflet (Wolters Kluwer)


• Metformin Prescribing Information (FDA)


• Metformin Hydrochloride Monograph (AHFS DI)


• Riomet Prescribing Information (FDA)


• Riomet Consumer Overview


• Riomet Solution MedFacts Consumer Leaflet (Wolters Kluwer)

Compare metformin with other medications

• Diabetes, Type 2
• Female Infertility
• Insulin Resistance Syndrome
• Polycystic Ovary Syndrome

meningococcal vaccine, diphtheria conjugate Intramuscular

me-NINJ-oh-kok-kal VAX-een, dif-THEER-ee-a KON-joo-gate

Available Dosage Forms:

• Powder for Suspension


• Suspension

Therapeutic Class: Vaccine

Uses For meningococcal vaccine, diphtheria conjugate

Meningococcal diphtheria conjugate vaccine is an active immunizing agent used to prevent infection by certain groups of meningococcal bacteria. The vaccine works by causing your body to produce its own protection (antibodies) against the disease.

The following information applies only to the meningococcal vaccine used for meningococcal bacteria Groups A, C, Y, and W-135. These groups cause nearly all of the meningococcal meningitis cases in the U.S. The vaccine will not protect against infection caused by other meningococcal bacteria groups, such as Group B.

Meningococcal infection can cause life-threatening illnesses, such as meningococcal meningitis, which affects the brain, and meningococcemia, which affects the blood. Some persons with meningococcal meningitis and/or meningococcemia also may die. The rate of these diseases peak in adolescence and early adulthood and are more likely to occur in persons with certain diseases or conditions that make them more susceptible to a meningococcal infection or more likely to develop serious problems from a meningococcal infection.

Immunization against meningococcal disease is recommended for persons 9 months to 55 years of age who are at risk of getting the disease because:

• They have certain diseases or conditions that make them more susceptible to a meningococcal infection or more likely to develop serious problems from a meningococcal infection.


• They are living in, working in, or visiting an area where there is a strong possibility of contracting meningococcal disease. .

This vaccine is to be administered only by or under the supervision of your doctor.

Before Using meningococcal vaccine, diphtheria conjugate

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

Allergies

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

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of meningococcal diphtheria conjugate vaccine in infants younger than 9 months of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies have not been performed on the relationship of age to the effects of meningococcal diphtheria conjugate vaccine in adults older than 55 years of age. Safety and efficacy have not been established.

Interactions with Medicines

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

Receiving this vaccine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Measles Virus Vaccine, Live

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this vaccine. Make sure you tell your doctor if you have any other medical problems, especially:

• Guillain-Barré syndrome (nerve disease that causes paralysis), history of—Should not be used in patients with this condition.

• Hemophilia (blood disorder with tendency to bleed uncontrollably) or


• Illness, recent or critical or


• Other bleeding problems—May make these conditions worse.

• Immunodeficiency disorder or


• Weak immune system—This vaccine may not work well in patients with these conditions.

Proper Use of meningococcal vaccine, diphtheria conjugate

A nurse or other trained health professional will give you or your child this vaccine. This vaccine is given as a shot into one of your or your child’s muscles.

This vaccine is usually given only once. You will not need a booster dose, unless your doctor tells you otherwise.

Vaccine information statements are given to the patient, parent, or guardian before receiving this vaccine. Read the information carefully. Ask your doctor if you have any questions.

Precautions While Using meningococcal vaccine, diphtheria conjugate

It is very important that your doctor check you or your child at regular visits to make sure this vaccine is working properly and to check for unwanted effects.

The stopper of the vial contains dry natural latex rubber. Make sure your doctor knows if you or your child have had an allergic reaction to latex rubber.

Check with your doctor right away if you have a cough, difficulty with swallowing, dizziness, fast heartbeat, hives, itching, puffiness or swelling of the eyelids or around the eyes, face, lips or tongue, shortness of breath, skin rash, tightness in the chest, unusual tiredness or weakness, and/or wheezing. These could be symptoms of an allergic reaction to the vaccine.

Contact your doctor immediately if you or your child have sudden weakness or are not able to move your arms or legs. This could be a sign of a serious condition called Guillain-Barré syndrome (GBS).

Make sure your doctor knows if you or your child are receiving medicine or a procedure that may weaken the immune system, such as steroids, cancer medicines, or radiation.

It is important that your doctor should know about all other vaccines you or your child have recently received, including a flu shot.

It is important to tell your doctor if you become pregnant. Your doctor may want you to join a pregnancy registry for patients receiving this vaccine.

This vaccine will not prevent diphtheria, and will not treat symptoms of meningococcal infection if you already have the disease.

meningococcal vaccine, diphtheria conjugate Side Effects

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

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

Rare

• Cough


• difficulty with swallowing


• dizziness


• fast heartbeat


• hives


• itching


• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue


• shortness of breath


• skin rash


• tightness in the chest


• unusual tiredness or weakness


• wheezing

Incidence not known

• Inability to move the arms and legs


• fainting


• sudden and progressing muscle weakness


• sudden and severe back pain


• sudden numbness and weakness in the arms and legs


• weakness of the muscles in your face

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

More common

• Chills


• diarrhea


• difficulty with moving


• fever


• general feeling of discomfort or illness


• hard lump at the injection site


• headache


• irritability


• loss of appetite


• muscle pain or stiffness


• pain in the joints


• pain, redness, or swelling at the injection site


• sleepiness


• weight loss

Less common

• Vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: meningococcal vaccine, diphtheria conjugate Intramuscular side effects (in more detail)

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

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

More meningococcal vaccine, diphtheria conjugate Intramuscular resources

• Meningococcal vaccine, diphtheria conjugate Intramuscular Side Effects (in more detail)
• Meningococcal vaccine, diphtheria conjugate Intramuscular Use in Pregnancy & Breastfeeding
• Meningococcal vaccine, diphtheria conjugate Intramuscular Drug Interactions
• Meningococcal vaccine, diphtheria conjugate Intramuscular Support Group
• 0 Reviews for Meningococcal vaccine, diphtheria conjugate Intramuscular - Add your own review/rating

Compare meningococcal vaccine, diphtheria conjugate Intramuscular with other medications

• Meningococcal Meningitis Prophylaxis

mebendazole

me-BEN-da-zole

Commonly used brand name(s)

In the U.S.

• Vermox

Available Dosage Forms:

• Suspension


• Tablet, Chewable

Therapeutic Class: Anthelmintic

Chemical Class: Benzimidazole

Uses For mebendazole

Mebendazole belongs to the family of medicines called anthelmintics. Anthelmintics are medicines used in the treatment of worm infections.

Mebendazole is used to treat:

• Common roundworms (ascariasis);


• Hookworm infections (uncinariasis);


• Pinworms (enterobiasis; oxyuriasis);


• Whipworms (trichuriasis); and


• More than one worm infection at a time.

mebendazole may also be used for other worm infections as determined by your doctor.

Mebendazole works by keeping the worm from absorbing sugar (glucose). This gradually causes loss of energy and death of the worm.

Mebendazole is available only with your doctor's prescription.

Before Using mebendazole

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

Allergies

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

Pediatric

mebendazole has been tested in a limited number of children 2 years of age or older and, in effective doses, has not been shown to cause different side effects or problems in children than it does in adults.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of mebendazole in the elderly with use in other age groups.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of mebendazole. Make sure you tell your doctor if you have any other medical problems, especially:

• Crohn's disease or


• Liver disease or


• Ulcerative colitis—Patients with these diseases may have an increased chance of side effects from mebendazole

Proper Use of mebendazole

Mebendazole usually comes with patient directions. Read them carefully before using mebendazole.

No special preparations or other steps (for example, special diets, fasting, other medicines, laxatives, or enemas) are necessary before, during, or immediately after taking mebendazole.

Mebendazole tablets may be chewed, swallowed whole, or crushed and mixed with food.

For patients taking mebendazole for hookworms, roundworms, or whipworms:

• To help clear up your infection completely, take mebendazole exactly as directed by your doctor for the full time of treatment. In some patients a second course of mebendazole may be required to clear up the infection completely. Do not miss any doses.

For patients taking mebendazole for pinworms:

• To help clear up your infection completely, take mebendazole exactly as directed by your doctor. A second course of mebendazole is usually required to clear up the infection completely.


• Pinworms may be easily passed from one person to another, especially in a household. Therefore, all household members may have to be treated at the same time. This helps to prevent infection or reinfection of other household members. Also, all household members may have to be treated again in 2 to 3 weeks to clear up the infection completely.

For patients taking mebendazole for infections in which high doses are needed:

• Mebendazole is best taken with meals, especially fatty ones (for example, meals that include whole milk or ice cream). This helps to clear up the infection by helping your body absorb the medicine better. However, if you are on a low-fat diet, check with your doctor.

Dosing

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

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

• For oral dosage form (chewable tablets):
  
  • For common roundworms, hookworms, and whipworms:
    
    • Adults and children 2 years of age and over—100 milligrams (mg) two times a day, morning and evening, for three days. Treatment may need to be repeated in two to three weeks.
    
    
    • Children up to 2 years of age—Use and dose must be determined by your doctor.
    
    
  
  
  • For pinworms:
    
    • Adults and children 2 years of age and over—100 mg once a day for one day. Treatment may need to be repeated in two to three weeks.
    
    
    • Children up to 2 years of age—Use and dose must be determined by your doctor.
    
    
  
  
  • For more than one worm infection at a time:
    
    • Adults and children 2 years of age and over—100 mg two times a day, morning and evening, for three days.
    
    
    • Children up to 2 years of age—Use and dose must be determined by your doctor.
    
    
  
  

Missed Dose

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

Storage

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

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using mebendazole

It is important that your doctor check your progress at regular visits, especially in infections in which high doses are needed. This is to make sure that the infection is cleared up completely and to allow your doctor to check for any unwanted effects.

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

For patients taking mebendazole for pinworms:

• In some patients, pinworms may return after treatment with mebendazole. Washing (not shaking) all bedding and nightclothes (pajamas) after treatment may help to prevent this.


• Some doctors may also recommend other measures to help keep your infection from returning. If you have any questions about this, check with your doctor.

For patients taking mebendazole for hookworms or whipworms :

• In hookworm and whipworm infections anemia may occur. Therefore, your doctor may want you to take iron supplements to help clear up the anemia. If so, it is important to take iron every day while you are being treated for hookworms or whipworms; do not miss any doses. Your doctor may also want you to keep taking iron supplements for up to 6 months after you stop taking mebendazole. If you have any questions about this, check with your doctor.

mebendazole Side Effects

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

Check with your doctor as soon as possible if any of the following side effects occur:

Rare

• Fever


• skin rash or itching


• sore throat and fever


• unusual tiredness and weakness

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

Less common

• Abdominal or stomach pain or upset


• diarrhea


• nausea or vomiting

Rare

• Dizziness


• hair loss


• headache

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: mebendazole side effects (in more detail)

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

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

More mebendazole resources

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

• Mebendazole Prescribing Information (FDA)


• Mebendazole Professional Patient Advice (Wolters Kluwer)


• Mebendazole Monograph (AHFS DI)


• Mebendazole MedFacts Consumer Leaflet (Wolters Kluwer)


• Vermox Consumer Overview

Compare mebendazole with other medications

• Angiostrongylosis
• Ascariasis
• Capillariasis
• Dracunculiasis
• Echinococcus
• Filariasis, Elephantiasis
• Hookworm Infection, Necator or Ancylostoma
• Hydatid Disease
• Pinworm Infection, Enterobius vermicularis
• Trichinosis
• Trichostrongylosis
• Visceral Larva Migrans, Toxicariasis
• Whipworm Infection

M-END DMX Liquid

Pronunciation: SOO-doe-e-FED-rin/DEX-brome-fen-IR-a-meen/DEX-troe-meth-OR-fan
Generic Name: Pseudoephedrine/Dexbrompheniramine/Dextromethorphan
Brand Name: M-END DMX

M-END DMX Liquid is used for:

Relieving sinus congestion, runny nose, sneezing, itchy nose or throat, itchy or watery eyes, and cough due to colds, upper respiratory infections, or allergies. It may also be used for other conditions as determined by your doctor.

M-END DMX Liquid is a nasal decongestant, antihistamine, and cough suppressant combination. The nasal decongestant works by constricting blood vessels and reducing swelling in the nasal passages. The antihistamine works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing. The cough suppressant works in the brain to help decrease the cough reflex to reduce a dry cough.

Do NOT use M-END DMX Liquid if:

• you are allergic to any ingredient in M-END DMX Liquid


• you have severe or uncontrolled high blood pressure, severe heart blood vessel disease, fast heartbeat, or severe heart problems


• you are unable to urinate or are having an asthma attack


• you are taking abiraterone, droxidopa, or sodium oxybate (GHB), or you have taken furazolidone or a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days

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

Before using M-END DMX Liquid:

Some medical conditions may interact with M-END DMX Liquid. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

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


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


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


• if you have a history of adrenal gland problems (eg, adrenal gland tumor), heart problems (eg, fast, slow, or irregular heartbeat; heart disease), high or low blood pressure, low blood volume, diabetes, blood vessel problems, a stroke, glaucoma or increased pressure in the eye, thyroid problems, or trouble sleeping


• if you have a history of asthma, chronic obstructive pulmonary disease (COPD), or other lung or breathing problems (eg, chronic bronchitis, emphysema, sleep apnea); chronic cough; or if your cough occurs with large amounts of mucus


• if you have a history of stomach or bowel ulcers; a blockage of your stomach, bladder, or bowel; kidney problems; trouble urinating; or an enlarged prostate or other prostate problems


• if you take medicine for high blood pressure

MEDICINES MAY INTERACT with M-END DMX Liquid. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Digoxin or droxidopa because the risk of irregular heartbeat or heart attack may be increased


• Abiraterone, beta-blockers (eg, propranolol), catechol-O-methyltransferase (COMT) inhibitors (eg, tolcapone), furazolidone, indomethacin, linezolid, MAOIs (eg, phenelzine), selective serotonin reuptake inhibitors (SSRIs) (eg, citalopram, fluoxetine), sodium oxybate (GHB), tricyclic antidepressants (eg, amitriptyline), or urinary alkalinizers (eg, sodium bicarbonate) because they may increase the risk of M-END DMX Liquids side effects


• Bromocriptine or hydantoins (eg, phenytoin) because their side effects may be increased by M-END DMX Liquid


• Guanadrel, guanethidine, mecamylamine, methyldopa, or reserpine because their effectiveness may be decreased by M-END DMX Liquid

This may not be a complete list of all interactions that may occur. Ask your health care provider if M-END DMX Liquid 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 M-END DMX Liquid:

Use M-END DMX Liquid as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• M-END DMX Liquid may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation.


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


• If you miss a dose of M-END DMX Liquid and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use M-END DMX Liquid.

Important safety information:

• M-END DMX Liquid may cause dizziness, drowsiness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use M-END DMX Liquid with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not drink alcohol while you are using M-END DMX Liquid.


• Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are taking M-END DMX Liquid; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


• Do not take diet or appetite control medicines while you are taking M-END DMX Liquid without checking with your doctor.


• M-END DMX Liquid has a decongestant, antihistamine, or cough suppressant in it. Before you start any new medicine, check the label to see if it has a decongestant, antihistamine, or cough suppressant in it too. If it does or if you are not sure, check with your doctor or pharmacist.


• Do not use M-END DMX Liquid for a cough with a lot of mucus. Do not use it for a long-term cough (eg, caused by asthma, emphysema, or smoking). However, you may use it for these conditions if your doctor tells you to.


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


• If new symptoms occur, or if cough or nasal congestion persists for more than 1 week, gets worse or returns, or occurs along with a fever, rash, or persistent headache, check with your doctor. A persistent cough may be a sign of a serious condition.


• M-END DMX Liquid may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to M-END DMX Liquid. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.


• M-END DMX Liquid may interfere with skin allergy tests. If you are scheduled for a skin test, talk to your doctor. You may need to stop taking M-END DMX Liquid for a few days before the tests.


• Tell your doctor or dentist that you take M-END DMX Liquid before you receive any medical or dental care, emergency care, or surgery.


• Use M-END DMX Liquid with caution in the ELDERLY; they may be more sensitive to its effects, especially confusion, drowsiness, dizziness, dry mouth, nervousness, sleeplessness, and trouble urinating.


• Caution is advised when using M-END DMX Liquid in CHILDREN; they may be more sensitive to its effects, especially excitability.


• M-END DMX Liquid should not be used in CHILDREN younger than 6 years old without first checking with the child's doctor; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant while taking M-END DMX Liquid, contact your doctor. You will need to discuss the benefits and risks of using M-END DMX Liquid while you are pregnant. It is not known if M-END DMX Liquid is found in breast milk. Do not breast-feed while taking M-END DMX Liquid.

Possible side effects of M-END DMX Liquid:

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:

Anxiety; constipation; diarrhea; dizziness; drowsiness; dry mouth, nose, or throat; excitability; headache; loss of appetite; nausea; trouble sleeping; upset stomach; vomiting; weakness.

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); difficulty urinating or inability to urinate; fast or irregular heartbeat; fever, chills, or persistent sore throat; hallucinations; loss of coordination; mental or mood changes (eg, depression, nervousness); seizures; severe or persistent dizziness, drowsiness, light-headedness, or headache; severe dryness of mouth, nose, and throat; severe or persistent trouble sleeping; shortness of breath; tremor; unusual bruising or bleeding; unusual tiredness or weakness; vision problems (eg, double vision, severe or persistent blurred vision).

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: M-END DMX side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include blurred vision; confusion; flushing; hallucinations; mental or mood changes; muscle spasms; seizures; severe dizziness, light-headedness, or headache; severe drowsiness; trouble breathing; unusually fast, slow, or irregular heartbeat; vomiting.

Proper storage of M-END DMX Liquid:

Store M-END DMX Liquid at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep M-END DMX Liquid out of the reach of children and away from pets.

General information:

• If you have any questions about M-END DMX Liquid, please talk with your doctor, pharmacist, or other health care provider.


• M-END DMX Liquid is to be used only by the patient for whom it is prescribed. Do not share it with other people.


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More M-END DMX resources

• M-END DMX Side Effects (in more detail)
• M-END DMX Use in Pregnancy & Breastfeeding
• M-END DMX Drug Interactions
• 0 Reviews for M-END DMX - Add your own review/rating

Compare M-END DMX with other medications

• Cough and Nasal Congestion

magnesium amino acids chelate

Generic Name: magnesium amino acids chelate (mag NEE zee um a MEEN oh AS ids KEE late)

Brand Names: Chelated Magnesium, MG Plus Protein

What is magnesium amino acids chelate?

Magnesium is a naturally occurring mineral. Magnesium is important for many systems in the body especially the muscles and nerves.

Magnesium amino acids chelate is used as a supplement to maintain adequate magnesium in the body.

Magnesium amino acids chelate may also be used for purposes not listed in this medication guide.

What is the most important information I should know about magnesium amino acids chelate?

Before taking magnesium amino acids chelate, tell your doctor about all of your medical conditions, allergies, and any other medicines you use.

Tell your doctor if you are pregnant or breast-feeding. It is not known whether magnesium chloride could harm an unborn baby, or if it passes into breast milk and could harm a nursing baby. Your dose needs may be different while you are pregnant or breast-feeding.

Tell your doctor about all other medications you use, especially antibiotics, diuretics, or medication for osteoporosis or Paget's disease.

Tell your doctor if you have signs that your magnesium blood levels are too low, such as confusion, uneven heart rate, jerking muscle movements, and muscle weakness or limp feeling.

What should I discuss with my healthcare provider before taking magnesium amino acids chelate?

You should not use magnesium amino acids chelate if you are allergic to it, or if you have kidney disease.

To make sure you can safely take magnesium amino acids chelate, tell your doctor if you have any of these other conditions:

• 
  

  diabetes;

  
  


• 
  

  Crohn's disease, ulcerative colitis;

  
  


• 
  

  if you are malnourished; or

  
  


• 
  

  if you drink large amounts of alcohol.

  
  

FDA pregnancy category C. It is not known whether magnesium amino acids chelate will harm an unborn baby. Your dose needs may be different during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether magnesium amino acids chelate passes into breast milk or if it could harm a nursing baby. Your dose needs may be different while you are nursing. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take magnesium amino acids chelate?

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

Take this medication with a full glass of water.

Use magnesium amino acids chelate regularly to get the most benefit. Take the medicine at the same time each day.

To be sure this medication is helping your condition and not causing harmful effects, your blood may need to be tested on a regular basis. Your kidney function may also need to be tested. Do not miss any follow-up visits to your doctor.

Tell your doctor if you have signs that your magnesium blood levels are too low, such as confusion, uneven heart rate, jerking muscle movements, and muscle weakness or limp feeling.

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.

Overdose symptoms may include numbness or tingly feeling in your face, limp muscles, slow heartbeat, weak or shallow breathing, vomiting, or fainting.

What should I avoid while taking magnesium amino acids chelate?

Avoid using antacids or laxatives without your doctor's advice. Use only the specific type of antacid your doctor recommends. These medications may contain minerals and if you take certain products together you may get too much magnesium.

If you are taking a tetracycline antibiotic, avoid taking it within 2 hours before or 3 hours after you take magnesium amino acids chelate. Tetracycline antibiotics include doxycycline (Adoxa, Alodox, Avidoxy, Oraxyl, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn), or tetracycline (Ala-Tet, Brodspec, Panmycin, Sumycin, Tetracap).

Magnesium amino acids chelate side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; severe dizziness, difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have severe or ongoing diarrhea.

• 
  

  depression, feeling tired or irritable;

  
  


• 
  

  muscle cramps;

  
  


• 
  

  severe or ongoing diarrhea.

  
  

Less serious side effects may include:

• 
  

  mild diarrhea;

  
  


• 
  

  nausea, stomach pain; or

  
  


• 
  

  upset stomach.

  
  

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

What other drugs will affect magnesium amino acids chelate?

Tell your doctor about all other medicines you use, especially:

• 
  

  digoxin (Lanoxin, Lanoxicaps);

  
  


• 
  

  a diuretic (water pill);

  
  


• 
  

  an antibiotic such as ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), or penicillamine (Cuprimine, Depen); or

  
  


• 
  

  medicines for osteoporosis or Paget's disease, such as alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), pamidronate (Aredia), risedronate (Actonel), tiludronate (Skelid), or zoledronic acid (Reclast, Zometa).

  
  

This list is not complete and other drugs may interact with magnesium amino acids chelate. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More magnesium amino acids chelate resources

• Magnesium amino acids chelate Drug Interactions
• Magnesium amino acids chelate Support Group
• 0 Reviews for Magnesium amino acids chelate - Add your own review/rating

Compare magnesium amino acids chelate with other medications

• Hypomagnesemia

Where can I get more information?

• Consult with a licensed healthcare professional before using any herbal/health supplement. Whether you are treated by a medical doctor or a practitioner trained in the use of natural medicines/supplements, make sure all your healthcare providers know about all of your medical conditions and treatments.