chondroitin

Generic Name: chondroitin (KON droy tin)

Brand names: OptiFlex-C

What is chondroitin?

The use of chondroitin in cultural and traditional settings may differ from concepts accepted by current Western medicine. When considering the use of herbal/health supplements, consultation with a primary health care professional is advisable. Additionally, consultation with a practitioner trained in the uses of herbal/health supplements may be beneficial, and coordination of treatment among all health care providers involved may be advantageous.

Chondroitin is also known as chondroitin sulfate, chondroitin sulfuric acid, and chonsurid.

Chondroitin has been used for the alleviation of the symptoms of arthritis.

It has been reported that chondroitin may be involved in the production of cartilage that is important for healthy joints.

Chondroitin has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of chondroitin may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Chondroitin may also have uses other than those listed in this product guide.

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

Chondroitin has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of chondroitin may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Who should not take chondroitin?

Before taking chondroitin, talk to your doctor, pharmacist, or health care professional if you have any other medical conditions, allergies, or if you take other medicines or other herbal/health supplements. Chondroitin may not be recommended in some situations.

Do not take chondroitin without first talking to your doctor if you are pregnant or could become pregnant. Do not take chondroitin without first talking to your doctor if you are breast-feeding a baby. There is no information available regarding the use of chondroitin by children. Do not give any herbal/health supplement to a child without first talking to the child's doctor.

How should I take chondroitin?

The use of chondroitin in cultural and traditional settings may differ from concepts accepted by current Western medicine. When considering the use of herbal/health supplements, consultation with a primary health care professional is advisable. Additionally, consultation with a practitioner trained in the uses of herbal/health supplements may be beneficial, and coordination of treatment among all health care providers involved may be advantageous.

If you choose to take chondroitin, use it as directed on the package or as directed by your doctor, pharmacist, or other health care provider.

Chondroitin is often combined with glucosamine in the treatment of the symptoms of arthritis.

Different formulations of chondroitin are available to be used internally (orally).

Do not use different formulations (e.g., tablets and powder) of chondroitin at the same time, unless specifically directed to do so by a health care professional. Using different formulations together increases the risk of an overdose of chondroitin.

Although chondroitin may be readily available for use, it is important to consult with your doctor regarding traditional treatments for arthritis, to maintain proper body weight, and to continue with an exercise regimen as directed.

Store chondroitin as directed on the package. In general, chondroitin should be protected from light and moisture and stored in a sealed container.

What happens if I miss a dose?

Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra chondroitin 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 chondroitin?

Follow your healthcare provider's instructions about any restrictions on food, beverages, or activity.

Chondroitin side effects

Although uncommon, allergic reactions to chondroitin have been reported. Stop taking chondroitin and seek emergency medical attention if you experience symptoms of a serious allergic reaction including difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives.

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 chondroitin?

Interactions between chondroitin and other prescription or over-the-counter medicines or herbal/health supplements have not been reported. Talk to your doctor, pharmacist, or health care professional before taking chondroitin if you are taking any other medicines or supplements.

More chondroitin resources

• Chondroitin Drug Interactions
• Chondroitin Support Group
• 0 Reviews for Chondroitin - Add your own review/rating

• Chondroitin Natural MedFacts for Professionals (Wolters Kluwer)


• Chondroitin Natural MedFacts for Consumers (Wolters Kluwer)

Compare chondroitin with other medications

• Osteoarthritis
• Rheumatoid Arthritis

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.

choline magnesium trisalicylate

Generic Name: choline magnesium trisalicylate (KOE leen mag NEE see um TRYE sa LIS i late)

Brand Names: Choline Magnesium Trisalicylate, Tricosal, Trilisate

What is Choline Magnesium Trisalicylate (choline magnesium trisalicylate)?

Choline magnesium trisalicylate is a non-steroidal anti-inflammatory drug (NSAID) that contains a combination of choline salicylate and magnesium salicylate.

Choline magnesium trisalicylate is used to reduce pain and inflammation caused by conditions such as arthritis. This medication is also used to treat fever in adults.

Choline magnesium trisalicylate may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Choline Magnesium Trisalicylate (choline magnesium trisalicylate)?

This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term. Do not use just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning, especially in older adults.

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. This medication should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Salicylates can cause a serious and sometimes fatal condition called Reye's syndrome in children.

What should I discuss with my healthcare provider before taking Choline Magnesium Trisalicylate (choline magnesium trisalicylate)?

This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term. Do not use choline magnesium trisalicylate just before or after heart bypass surgery (coronary artery bypass graft, or CABG). You should not use this medication if you are allergic to aspirin or to an NSAID, or if you have recently used cidofovir (Vistide), ketorolac (Toradol), or nasal flu vaccine (FluMist).

To make sure you can safely take this medicine, tell your doctor if you have any of these other conditions:

• 
  

  heart disease, high blood pressure, congestive heart failure, or a history of stroke or heart attack;

  
  


• 
  

  a stomach ulcer or intestinal bleeding;

  
  


• 
  

  a bleeding or blood clotting disorder;

  
  


• 
  

  diabetes;

  
  


• 
  

  anemia (a lack of red blood cells);

  
  


• 
  

  liver or kidney disease;

  
  


• 
  

  an enzyme deficiency called glucose-6-phosphate dehydrogenase deficiency (G6PD);

  
  


• 
  

  asthma, nasal polyps; or

  
  


• 
  

  swelling or fluid retention, or if you are dehydrated.

  
  

FDA pregnancy category C. Salicylates and NSAIDs may be harmful to an unborn baby if the mother takes the medication during the last 3 months of pregnancy. Tell your doctor if you are pregnant or plan to become pregnant. Choline magnesium trisalicylate can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Salicylates can cause a serious and sometimes fatal condition called Reye's syndrome in children.

How should I take Choline Magnesium Trisalicylate (choline magnesium trisalicylate)?

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

Take choline magnesium trisalicylate with food, milk, or an antacid if it upsets your stomach. You may need to take the medicine at bedtime, at least 30 minutes before you lie down.

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. You may mix the liquid with a small amount of fruit juice to make the medicine taste better. Stir the mixture well and drink all of it right away.

It may take up to 3 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 2 weeks of treatment.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using choline magnesium trisalicylate.

If you need surgery, tell the surgeon ahead of time that you are using choline magnesium trisalicylate. You may need to stop using the medicine for a short time. 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 ringing in your ears, severe dizziness or drowsiness, confusion, or seizure (convulsions).

What should I avoid while taking Choline Magnesium Trisalicylate (choline magnesium trisalicylate)?

If you also take an antibiotic, avoid taking it within 2 hours before or after you take choline magnesium trisalicylate. This medication can make it harder for your body to absorb certain antibiotics.

If you are also taking low-dose aspirin to prevent heart attack or stroke, do not stop taking it or change your dose without your doctor's advice. Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

Ask a doctor or pharmacist before using any cold, allergy, or pain medicine. Many medicines available over the counter contain salicylates or NSAIDs. Taking certain products together can cause you to get too much of a certain drug. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, naproxen, or a salicylate. Drinking alcohol may increase your risk of stomach bleeding. Smoking can also increase your risk of stomach bleeding.

Choline Magnesium Trisalicylate (choline magnesium trisalicylate) 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 choline magnesium trisalicylate and call your doctor at once if you have a serious side effect such as:

• 
  

  chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;

  
  


• 
  

  sudden numbness or weakness, especially on one side of the body;

  
  


• 
  

  bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  
  


• 
  

  blood in your urine, urinating more or less than usual;

  
  


• 
  

  hearing problems, ringing in your ears;

  
  


• 
  

  severe stomach pain, ongoing nausea or vomiting, jaundice (yellowing of the skin or eyes);

  
  


• 
  

  easy bruising or bleeding, unusual weakness; or

  
  


• 
  

  fast or pounding heartbeats, feeling like you might pass out.

  
  

Less serious side effects may include:

• 
  

  heartburn, upset stomach, diarrhea, constipation;

  
  


• 
  

  dizziness, drowsiness, lack of energy; or

  
  


• 
  

  headache.

  
  

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 Choline Magnesium Trisalicylate (choline magnesium trisalicylate)?

Ask your doctor before taking an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor). Taking any of these drugs with an NSAID may cause you to bruise or bleed easily.

Many drugs can interact with choline magnesium trisalicylate. Below is just a partial list. Tell your doctor if you are using:

• 
  

  cyclosporine (Gengraf, Neoral, Sandimmune);

  
  


• 
  

  lithium (Eskalith, LithoBid);

  
  


• 
  

  methotrexate (Rheumatrex, Trexall);

  
  


• 
  

  a blood thinner such as warfarin (Coumadin), or medication used to prevent blood clots, such as clopidogrel (Plavix);

  
  


• 
  

  diabetes medication you take by mouth;

  
  


• 
  

  a diuretic (water pill);

  
  


• 
  

  heart or blood pressure medication;

  
  


• 
  

  medicine to treat or prevent osteoporosis;

  
  


• 
  

  seizure medication such as phenytoin (Dilantin), phenobarbital (Solfoton), or valproic acid (Depakene);

  
  


• 
  

  medicines that contain sodium bicarbonate, sodium citrate, or potassium citrate; or

  
  


• 
  

  steroid medicine (prednisone and others).

  
  

This list is not complete and there are many other drugs that can interact with choline magnesium trisalicylate. 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. Keep a list of all your medicines and show it to any healthcare provider who treats you.

More Choline Magnesium Trisalicylate resources

• Choline Magnesium Trisalicylate Use in Pregnancy & Breastfeeding
• Drug Images
• Choline Magnesium Trisalicylate Drug Interactions
• 0 Reviews for Choline Magnesium Trisalicylate - Add your own review/rating

Compare Choline Magnesium Trisalicylate with other medications

• Osteoarthritis
• Pain

Where can I get more information?

• Your pharmacist can provide more information about choline magnesium trisalicylate.

Cialis

Generic Name: Tadalafil
Class: Phosphodiesterase Inhibitors
VA Class: GU900
Chemical Name: (6R,12aR) - 6 - (1,3 - benzodioxol - 5 - yl) - 2,3,6,7,12,12a - hexahydro - 2 - methylpyrazino[1′,2′:1,6]pyrido[3,4 - b]indole - 1,4 - dione
Molecular Formula: C₂₂H₁₉N₃O₄
CAS Number: 171596-29-5

Special Alerts:

[Posted 10/18/2007] FDA informed healthcare professionals of reports of sudden decreases or loss of hearing following the use of PDE5 inhibitors sildenafil (Viagra), tadalafil (Levitra), vardenafil (Cialis) for the treatment of erectile dysfunction, and sildenafil (Revatio) for the treatment of pulmonary arterial hypertension. In some cases, the sudden hearing loss was accompanied by tinnitus and dizziness. Medical follow-up on these reports was often limited which makes it difficult to determine if the loss of hearing was related to the use of one of the drugs, an underlying medical condition or other risk factors for hearing loss, a combination of these factors or other factors. The PRECAUTIONS and ADVERSE REACTIONS sections of the approved product labeling for sildenafil (Viagra), tadalafil, and vardenafil were revised. FDA is working with the manufacturer to revise the labeling for sildenafil (Revatio). For more information visit the FDA website at: , , and .

Introduction

Vasodilating agent; a selective phosphodiesterase (PDE) type 5 inhibitor.¹

Uses for Cialis

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Erectile Dysfunction

To facilitate attainment of a sexually functional erection in males with erectile dysfunction (ED, impotence).¹

Cialis Dosage and Administration

General

• 
  

  Dosage must be individualized carefully according to the patient’s tolerance and erectile response.¹

  
  


• 
  

  Sexual stimulation is required for response to therapy.^{1 2}

  
  

Administration

Oral Administration

Administer orally, no more than once daily, without regard to meals.^{1 2}

Some patients achieve an erection sufficient for successful intercourse within 30 minutes after tadalafil administration;^{1 2 3 7 8} ability to have sexual activity has been improved for up to 36 hours.^{1 2 4 7 9 13} Timing of administration relative to anticipated sexual activity is less important than with relatively short-acting drugs for erectile dysfunction.^{3 9}

Dosage

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Adults

Erectile Dysfunction

Oral

Initially, 10 mg.¹ Depending on effectiveness and tolerance, increase dosage to a maximum of 20 mg or decrease to 5 mg.¹

Prescribing Limits

Adults

Erectile Dysfunction

Oral

Maximum 20 mg daily.¹

Special Populations

Hepatic Impairment

In patients with mild to moderate hepatic impairment (Child-Pugh class A or B), maximum dosage is 10 mg once daily.¹ Use not recommended in patients with severe hepatic impairment (Child-Pugh class C).¹

Renal Impairment

If Cl_cr is 31–50 mL/minute, reduce initial dosage to 5 mg once daily; maximum dosage is 10 mg administered no more frequently than once every 48 hours.¹ If Cl_cr is <30 mL/minute), including patients undergoing hemodialysis, maximum dosage is 5 mg administered no more frequently than once daily.¹

Geriatric Patients

No dosage adjustments necessary based solely on age.¹

Cautions for Cialis

Contraindications

• 
  

  Known hypersensitivity to tadalafil or any ingredient in the formulation.¹

  
  


• 
  

  Concomitant use of any form of organic nitrates (e.g., nitrates, nitrites, or nitric oxide donors).^{1 2 10} (See Specific Drugs and Food under Interactions.)

  
  


• 
  

  Should not be used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status.^{1 2}

  
  

Warnings/Precautions

Warnings

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Cardiovascular Effects

Serious, potentially fatal cardiovascular events reported.¹

Use not recommended in patients with a recent MI (within 90 days) or stroke (within 6 months); uncontrolled arrhythmias, hypotension (<90/50 mm Hg systolic/diastolic BP) or uncontrolled hypertension (170/110 mm Hg systolic/diastolic BP); heart failure (>NYHA class II) in the previous 6 months; or those with unstable angina or angina occurring during sexual intercourse.¹

Possible hypotension, particularly in patients with left-ventricular outflow obstruction (e.g., aortic stenosis, idiopathic hypertrophic subaortic stenosis) and in patients with severely impaired autonomic control of blood pressure.¹

Potentiation of hypotensive effect with organic nitrates may result in life-threatening hypotension and/or hemodynamic compromise; manufacturers state that concomitant use with vardenafil is contraindicated.¹ (See Specific Drugs and Food under Interactions.)

Consider whether patients with underlying cardiovascular disease could be adversely affected by tadalafil’s vasodilatory activity, especially in combination with sexual activity.¹

Ocular Effects

Visual disturbances (e.g., blurred vision, changes in color vision, conjunctivitis, eye pain, increased lacrimation, periorbital edema, nonarteritic anterior ischemic optic neuropathy, visual field defect, retinal vein occlusion) reported rarely.^{1 2 13}

Use not recommended in patients with hereditary degenerative retinal disorders, including retinitis pigmentosa.¹

Priapism

Possible prolonged erections (>4 hours) and priapism (painful erection >6 hours).^{1 2}

May result in penile tissue damage and permanent loss of potency if priapism is not treated immediately.¹ Use with caution in patients with conditions that may predispose to priapism (e.g., sickle cell anemia, multiple myeloma, leukemia).¹

General Precautions

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Patient Assessment

Thorough medical history and physical examination is recommended to diagnose erectile dysfunction, determine potential underlying causes, and identify appropriate treatment options.^{1 14 15 16 17 18 19 20 21 22}

GU Precautions

Use with caution in patients with anatomical deformation of the penis (e.g., angulation, cavernosal fibrosis, Peyronie’s disease).¹

Concomitant Therapies for Erectile Dysfunction

Safety and efficacy not established for use in combination with other treatments for erectile dysfunction; combined therapy is not recommended.¹

Concomitant Administration with α-Adrenergic Blocking Agents

Potentiation of hypotensive effect in patients receiving concomitant therapy with α-adrenergic blocking agents, due to vasodilatory action.¹

Stabilize hemodynamic parameters in patients receiving an α-adrenergic blocking agent prior to initiating a PDE type 5 inhibitor at the lowest possible dosage.¹ In patients receiving a PDE type 5 inhibitor, initiate concomitant therapy with an α-adrenergic blocking agent at the lowest dosage.¹ Incremental increases in the dosage of the α-adrenergic blocking agent during concomitant therapy may be associated with a further lowering of BP.¹ Safety of concomitant therapy also may be affected by intravascular volume depletion and use of additional anti-hypertensive agents.¹ (See Specific Drugs and Foods under Interactions.)

Concomitant Administration with Potent CYP3A4 Inhibitors

Increased plasma tadalafil concentrations with concomitant administration; dosage reduction of tadalafil recommended.¹ (See Specific Drugs and Food under Interactions.)

Specific Populations

Pregnancy

Category B.¹ Not labeled for use in women.¹

Lactation

Not labeled for use in women; use not recommended in nursing women.¹

Pediatric Use

Safety and efficacy not established in patients <18 years of age.¹

Geriatric Use

Safety and efficacy in those ≥65 years of age is similar to that in younger men.^{1 8} Possibility exists of greater sensitivity to the drug in some geriatric individuals.¹ (See Geriatric Patients under Dosage and Administration.)

Hepatic Impairment

Use not recommended in patients with severe hepatic impairment (Child-Pugh C).¹ Dosage adjustment for moderate hepatic impairment. (See Hepatic Impairment under Dosage and Administration.)

Renal Impairment

Clearance decreased in patients with mild (Cl_cr 51–80 mL/minute) to severe renal insufficiency (end-stage renal disease on hemodialysis), and may result in increased adverse effects (e.g., back pain).¹ No dosage adjustments are necessary in those with mild renal impairment.¹ Dosage adjustments based on degree of renal impairment. (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Headache,^{1 4 6 7 8 9 10} dyspepsia,^{1 4 6 7 8 9 10} back pain,^{1 4 6 7 8} myalgia,^{1 4 6 7 8 9} nasal congestion,^{1 4 7 8} flushing (facial and other areas).^{1 4 6 7 8 9 10}

Interactions for Cialis

Metabolized principally by CYP3A4.¹ Does not appear to induce or inhibit the clearance of other drugs metabolized by CYP isoforms 1A2, 3A4, 2C9, 2C19, 2D6, or 2E1.¹

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors of CYP3A4: Potential pharmacokinetic interaction (increased plasma tadalafil concentrations).^{1 33}

Inducers of CYP3A4: Potential pharmacokinetic interaction (decreased plasma tadalafil concentrations).¹

Specific Drugs and Foods

Drug or Food	Interaction	Comments
α-Adrenergic blocking agents	Possible symptomatic hypotension 1	In those who are stable on an α-adrenergic blockers, initiate tadalafil at lowest recommended dosage1 In those currently receiving tadalafil, initiate α-adrenergic blocker at the lowest dosage1 (See Hypotensive Effects with α-Adrenergic Blocking Agents under Cautions)
Alcohol	Possible additive hypotensive effects with heavy alcohol ingestion (e.g., ≥180 mL of 80 proof vodka) 1	Do not use alcohol excessively (e.g., ≥5 glasses of wine or shots of whiskey) 2
Amlodipine	Possible additive hypotensive effects1
Antacids	Possible delayed absorption of tadalafil 1
Antifungal agents, azole	Possible increased AUC and peak plasma concentrations of tadalafil1	Maximum tadalafil dosage 10 mg given once every 72 hours1
Angiotensin II receptor antagonists	Potential additive hypotensive effects1
Antiretroviral agents, HIV protease inhibitors	Increased tadalafil concentrations and increased risk of tadalafil-associated adverse effects (e.g., hypotension, visual changes, prolonged erection)1 33 a b	Lopinavir in fixed combination with ritonavir: Do not exceed a single tadalafil dose of 10 mg in 72 hours1 33 Atazanavir, fosamprenavir, amprenavir, nelfinavir, saquinavir, ritonavir, indinavir: Use an initial tadalafil dosage of 5 mg and do not exceed a single dose of 10 mg in 72 hours).1 33 Use with caution; monitor closely for adverse effects33 a
Antiretroviral agents, nonnucleoside reverse transcriptase inhibitors	Possible increased tadalafil concentrations and increased risk of tadalafil-associated adverse effects (e.g., hypotension, visual changes, prolonged erection)33	Delavirdine: Use initial tadalafil dosage of 5 mg; do not exceed a single dose of 10 mg in 72 hours33
Aspirin	No increase in bleeding time reported1
Bendroflumethiazide	Possible additive hypotensive effects1
Carbamazepine	Potential decreased AUC of tadalafil 1	No dosage adjustment recommended1
Enalapril	Possible additive hypotensive effects1
Erythromycin	Potential increased AUC of tadalafil 1
Grapefruit juice	Potential increased AUC of tadalafil 1
Inhaled nitrites (e.g., amyl or butyl nitrite)	Potentiation of hypotensive effect34	Concomitant use is contraindicated1 2 4 5 8 10 (see Cautions)
Lovastatin	Pharmacokinetic interaction unlikely1
Metoprolol	Possible additive hypotensive effects1
Midazolam	Pharmacokinetic interaction unlikely1
Nitrates and nitrites (e.g., nitroglycerin, isosorbide dinitrate)	Potentiation of hypotensive effect1	Concomitant use is contraindicated1 4 5 8 10 (see Cautions) If necessary for a life-threatening condition, allow ≥48 hours to elapse between tadalafil administration and nitrate use;1 10 administer under close supervision with appropriate hemodynamic monitoring1
Nitric Oxide Donors	Increased hypotensive effect1	Concomitant use contraindicated1 4 5 8 10 (See Cautions)
Nizatidine	Pharmacokinetic interaction unlikely1
Phenobarbital	Potential decreased AUC of tadalafil 1	No dosage adjustment recommended1
Phenytoin	Potential decreased AUC of tadalafil 1	No dosage adjustment recommended1
Rifampin	Possible decreased AUC and peak plasma concentrations of tadalafil1	No dosage adjustment recommended1
Theophylline	Pharmacokinetic interaction unlikely1 Slight increase in heart rate (3 bpm) with concomitant therapy1
Warfarin	Pharmacokinetic interaction unlikely1

Cialis Pharmacokinetics

Absorption

Bioavailability

Rapidly absorbed following oral administration; peak plasma concentrations usually attained within 0.5–6 hours.¹

Onset

Following a single oral dose, effects were obtained within 30 minutes.^{1 2}

Duration

Improved erection up to 36 hours.^{1 2 4 7 9 13}

Food

Food does not appear to affect absorption.¹

Distribution

Extent

Distributed into tissues.¹

Plasma Protein Binding

Approximately 94%.¹

Elimination

Metabolism

Metabolized in the liver, principally by CYP3A4, to inactive metabolites.¹

Elimination Route

Excreted principally as metabolites in the feces (61%) and urine (36%).¹ Not appreciably removed by hemodialysis.¹

Half-life

17.5 hours.¹

Special Populations

Clearance reduced in patients ≥65 years of age compared with younger adults.¹

In patients with mild (Cl_cr 51-80 mL/minute) or moderate (Cl_cr 31-50 mL/minute) renal impairment, clearance was reduced, resulting in a twofold increase in AUC compared to healthy adults.¹ In patients with end-stage renal disease or in those on hemodialysis, clearance was reduced, resulting in a twofold to fourfold increase in AUC compared to healthy adults.¹

In patients with diabetes mellitus, AUC and peak plasma concentrations are decreased compared with healthy individuals.¹

Stability

Storage

Oral

Tablets

25°C (may be exposed to 15–30°C).¹

ActionsActions

• 
  

  Selective inhibitor of phosphodiesterases (PDEs), with the greatest selectivity for PDE type 5, the principal isoenzyme involved in the metabolism of cGMP to GMP in the corpora cavernosa of the penis.^{1 3 4 8}

  
  


• 
  

  Enhances the effect of nitric oxide by inhibiting PDE type 5-mediated hydrolysis of cGMP, resulting in vascular relaxation.^{1 3}

  
  


• 
  

  Potentiates accumulation of cGMP only when cGMP production in the penis is increased by sexual arousal.^{1 2} No effect on erectile function in the absence of sexual stimulation.^{1 2}

  
  


• 
  

  Modest peripheral vasodilation at usual dosages.^{1 4 5}

  
  


• 
  

  Less affinity than sildenafil or vardenafil for PDE type 6 receptor involved in phototransduction in the retina.^{4 13} No effects on intraocular pressure or pupillometry; changes in color vision reported rarely.¹

  
  

Advice to Patients

• 
  

  Importance of providing a copy of the manufacturer’s patient information.^{1 2}

  
  


• 
  

  Importance of informing clinician of the presence of risk factors for cardiovascular disease prior to initiating any treatment for erectile dysfunction.²

  
  


• 
  

  Importance of informing clinician of stroke history.^{1 2}

  
  


• 
  

  Importance of informing clinician of low or high BP.^{1 2}

  
  


• 
  

  Importance of informing clinician of peptic ulcer disease.^{1 2}

  
  


• 
  

  Importance of advising clinician of blood problems (e.g., sickle cell anemia, leukemia).^{1 2}

  
  


• 
  

  Importance of informing clinician of anatomical deformation of the penis (e.g., Peyronie’s disease, angulation, cavernosal fibrosis) or a history of prolonged erections.²

  
  


• 
  

  Importance of informing clinician of the presence of retinitis pigmentosa.²

  
  


• 
  

  Possibility of visual disturbances (e.g., bluish tinge to objects, difficulty distinguishing between blue and green, visual field changes).^{1 2}

  
  


• 
  

  Importance of informing patients of the potential for life-threatening hypotension and/or hemodynamic compromise with concurrent use of organic nitrates and nitrites in any form, including the recreational use of inhaled nitrites (“poppers”).^{1 2 5 10 34}

  
  


• 
  

  Importance of using caution during concurrent use of α-adrenergic blocking agents because of the potential for hypotension, dizziness, or fainting.^{1 12}

  
  


• 
  

  Importance of refraining from further activity and contacting a clinician if cardiovascular symptoms (e.g., anginal pain, dizziness) occur upon initiation of sexual activity.¹

  
  


• 
  

  Importance of contacting a clinician if anginal pain occurs after using tadalafil.¹

  
  


• 
  

  Importance of seeking immediate medical attention if an erection persists >4 hours or is painful.¹

  
  


• 
  

  Potential for transmission of sexually transmitted diseases (e.g., HIV) and the need to use protective measures to guard against such transmission.^{1 2}

  
  


• 
  

  Importance of contacting clinician for assessment of therapeutic benefit, the need for possible dosage adjustment, and potential adverse effects.^{1 2}

  
  


• 
  

  Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs, and alcohol consumption, as well as any concomitant illnesses.^{1 2} Importance of limiting intake of alcohol-containing beverages or products.^{1 2}

  
  


• 
  

  Importance of informing patients of other important precautionary information.¹ (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Tadalafil

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Tablets, film-coated	5 mg	Cialis	Lilly ICOS
		10 mg	Cialis	Lilly ICOS
		20 mg	Cialis	Lilly ICOS

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Adcirca 20MG Tablets (LILLY): 60/$1225.98 or 180/$3625.92

Cialis 10MG Tablets (LILLY): 10/$201.99 or 30/$596.97

Cialis 2.5MG Tablets (LILLY): 15/$74.99 or 30/$124.97

Cialis 20MG Tablets (LILLY): 10/$201.99 or 30/$596.97

Cialis 5MG Tablets (LILLY): 10/$49.99 or 30/$133.97

Cialis 5MG Tablets (LILLY): 30/$133.97 or 90/$389.95

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions November 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Lilly ICOS. Cialis (tadalafil) tablets prescribing information. Indianapolis, IN; 2005 Mar 31.

2. Lilly ICOS. Cialis (tadalafil) tablets patient information. Indianapolis, IN; 2005 Mar 31.

3. Rosen RC, Kostis JB. Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Am J Cardiol. 2003; 92:9M-18M. [IDIS 508058] [PubMed 14609619]

4. Anon. Tadalafil (cialis) for erectile dysfunction. Med Lett Ther. 2003; 45:101-2.

5. Kloner RA, Mitchell M, Emmick JT. Cardiovascular effects of tadalafil. Am J Cardiol. 2003; 92:37M-46M. [IDIS 508061] [PubMed 14609622]

6. Saenz de Tejada I, Knight JR, Anglin G et al. Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care. 2002; 25:2159-64. [PubMed 12453954]

7. Brock GB, McMahon CG, Chen KK et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol. 2002; 165:1332-6.

8. Curran M, Keating G. Tadalafil. Drugs. 2003;63:2203-12.

9. Porst H, Padma-Nathan H, Giuliano F et al. Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial. Urology. 2003; 62:121-5. [PubMed 12837435]

10. Kloner RA, Hutter AM, Emmick JT et al. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003; 42:1855-60. [PubMed 14642699]

11. Yamamoto T, Bing RJ et al. Nitric oxide donors. Proc Soc Exp Biol Med. 2000; 25:200-6.

12. Kloner RA, Mitchell M, Emmick JT. Cardiovascular effects of tadalafil in patients on common antihypertensive therapies. Am J Cariol. 203; 92(suppl.):47M-57M.

13. Porst H. Editorial comments on tadalafil. Drugs. 2003; 63:2213.

14. National Institutes of Health Office of Medical Applications of Research. Consensus Conference: impotence. JAMA. 1993; 270:83-90. [IDIS 316686] [PubMed 8510302]

15. Wagner G, de Tejada IS. Update on male erectile dysfunction. BMJ. 1998; 316:678-82. [IDIS 406621] [PubMed 9522795]

16. Pfizer Inc, New York, NY: Personal communication on sildenafil.

17. Reviewers’ comments on sildenafil (personal observations).

18. The Process of Care Consensus Panel. Position paper: the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:59-70.

19. Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol. 1999; 10:1381-8. [PubMed 10361878]

20. Meinhardt W, Kropman RF, Vermeij P. Comparative tolerability and efficacy of treatments for impotence. Drug Saf. 1999; 20:133-146. [PubMed 10082071]

21. Petak SM, Baskin HJ, Bergman DA. AACE clinical practice guidelines for the evaluation and treatment of hypogonadism in adult male patients. From American Association of Clinical Endocrinologists web site. ().

22. Guay AT, Nankin AR et al. AACE clinical practice guidelines for the evaluation and treatment of male sexual dysfunction. From American Association of Clinical Endocrinologists web site. ()

23. Whitehead ED, Klyde BJ, Zussman S et al. Treatment alternatives for impotence. Postgrad Med. 1990; 88:139-52. [IDIS 269901] [PubMed 2199954]

24. Gerber GS, Levine LA. Pharmacological erection program using prostaglandin E1. J Urol. 1991; 146:786-9. [IDIS 287641] [PubMed 1875494]

25. Porst H. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11: 72-3.

26. Sarramon JP. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:73.

27. Vermeuler A. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:74.

28. Sohn MHH. Editorial comments on the process of care model for evaluation and treatment of erectile dysfunction. Int J Impotence Res. 1999; 11:72.

29. Sefetl AD. Phosphodiesterase type 5 inhibitor differentiation based on selectivity, pharmacokinetic, and efficacy profiles. Clin Cardiol. 2004; 27(Suppl. 1):I-14-9.

30. Padma-Nathan H. A new era in the treatment of erectile dysfunction. Am J Cardiol. 1999; 84:18-23N. [PubMed 10404845]

31. Wespes E, Amar E, Hatzichtistou D et al. Guidelines on reactile dysfunction. Arnhem: European Association of Urology, 2004 Mar. Available at . Accessed 2004 Aug.

32. Lilly, Indianapolis, IN: Personal communication.

33. Panel on Clinical Practices for Treatment of HIV infection of the Department of Health and Human Services (DHHS). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents (Apr 7, 2005). From the US Department of Health and Human Services HIV/AIDS Information Services (AIDSinfo) website ().

34. Smith KM, Romanelli F. Recreational use and misuse of phosphodiesterase 5 inhibitors. J Am Pharm Assoc. 2005; 45:63-72/

a. Bristol-Myers Squibb. Reyataz (atazanavir sulfate) prescribing information. Princeton, NJ; 2004 Jul.

b. Merck & Company Inc. Crixivan (indinavir sulfate) capsules prescribing information. West Point, PA; 2004 May.

More Cialis resources

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

• Cialis Prescribing Information (FDA)


• Cialis Advanced Consumer (Micromedex) - Includes Dosage Information


• Cialis MedFacts Consumer Leaflet (Wolters Kluwer)


• Cialis Consumer Overview


• Tadalafil Professional Patient Advice (Wolters Kluwer)


• Adcirca MedFacts Consumer Leaflet (Wolters Kluwer)


• Adcirca Prescribing Information (FDA)


• Adcirca Consumer Overview

Compare Cialis with other medications

• Benign Prostatic Hyperplasia
• Erectile Dysfunction

ChlorTan

Generic Name: chlorpheniramine (KLOR fen IR a meen)

Brand Names: AHist, Aller-Chlor, Allergy Relief, C.P.M., Chlo-Amine, Chlor-Mal, Chlor-Trimeton, Chlor-Trimeton Allergy SR, Chlorphen, ChlorTan, Ed Chlor-Tan, Ed ChlorPed, PediaTan, TanaHist-PD, Triaminic Allergy, Wal-finate

What is ChlorTan (chlorpheniramine)?

Chlorpheniramine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.

Chlorpheniramine is used to treat sneezing, itching, watery eyes, and runny nose caused by allergies or the common cold.

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

What is the most important information I should know about ChlorTan (chlorpheniramine)?

Do not give this medication to a child younger than 4 years old. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children. Do not take chlorpheniramine if you are allergic to it.

Ask a doctor or pharmacist before taking chlorpheniramine if you have glaucoma, a stomach ulcer, severe constipation, kidney disease, urination problems, an enlarged prostate, or a thyroid disorder.

Ask a doctor or pharmacist before using any other cold, cough, or allergy medicine. Chlorpheniramine is contained in many combination medicines. Taking certain products together can cause you to get too much of a certain drug. Check the label to see if a medicine contains an antihistamine.

Chlorpheniramine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Drinking alcohol can increase certain side effects of chlorpheniramine.

What should I discuss with my healthcare provider before taking ChlorTan (chlorpheniramine)?

Do not take this medication if you are allergic to chlorpheniramine. Do not use chlorpheniramine if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

Ask a doctor or pharmacist if it is safe for you to take this medicine if you have:

• 
  

  glaucoma;

  
  


• 
  

  a stomach ulcer;

  
  


• 
  

  severe constipation;

  
  


• 
  

  kidney disease;

  
  


• 
  

  urination problems or an enlarged prostate; or

  
  


• 
  

  a thyroid disorder.

  
  

FDA pregnancy category B. Chlorpheniramine is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Chlorpheniramine 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 likely to have side effects from this medication.

How should I take ChlorTan (chlorpheniramine)?

Use 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. Cold or allergy medicine is usually taken only for a short time until your symptoms clear up.

Take this medication with a full glass of water. Take chlorpheniramine with food or milk if it upsets your stomach. Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

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.

This medication can cause unusual results with allergy skin tests. Tell any doctor who treats you that you are taking an antihistamine.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Since cold or allergy medicine is taken when needed, you may not be on a dosing schedule. If you are taking the medication regularly, 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 feeling restless or nervous, nausea, vomiting, stomach pain, dizziness, drowsiness, dry mouth, warmth or tingly feeling, or seizure (convulsions).

What should I avoid while taking ChlorTan (chlorpheniramine)?

Ask a doctor or pharmacist before using any other cold, cough, or allergy medicine. Chlorpheniramine is contained in many combination medicines. Taking certain products together can cause you to get too much of a certain drug. Check the label to see if a medicine contains an antihistamine.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Chlorpheniramine can decrease perspiration and you may be more prone to heat stroke.

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Drinking alcohol can increase certain side effects of chlorpheniramine.

ChlorTan (chlorpheniramine) 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 taking chlorpheniramine and call your doctor at once if you have a serious side effect such as:

• 
  

  urinating less than usual or not at all;

  
  


• 
  

  confusion, extreme drowsiness;

  
  


• 
  

  severe dizziness, anxiety, restless feeling, nervousness; or

  
  


• 
  

  weak or shallow breathing.

  
  

Less serious side effects may include:

• 
  

  mild dizziness, drowsiness;

  
  


• 
  

  blurred vision;

  
  


• 
  

  dry mouth;

  
  


• 
  

  nausea, stomach pain, constipation;

  
  


• 
  

  problems with memory or concentration; or

  
  


• 
  

  feeling restless or excited (especially in children).

  
  

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 ChlorTan (chlorpheniramine)?

Other cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by chlorpheniramine. Tell your doctor if you regularly use any of these medicines.

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

• 
  

  glycopyrrolate (Robinul);

  
  


• 
  

  mepenzolate (Cantil);

  
  


• 
  

  probenecid (Benemid, Probalan);

  
  


• 
  

  rifampin (Rifadin, Rifater, Rifamate, Rimactane);

  
  


• 
  

  zidovudine (Retrovir, AZT);

  
  


• 
  

  a diuretic (water pill);

  
  


• 
  

  atropine (Atreza, Sal-Tropine), belladonna (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-Scop);

  
  


• 
  

  bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

  
  


• 
  

  bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);

  
  


• 
  

  irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Hyomax), or propantheline (Pro-Banthine); or

  
  


• 
  

  salicylates such as aspirin, Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan's Pills Extra Strength, Pepto-Bismol, Tricosal, and others;

  
  

This list is not complete and other drugs may interact with chlorpheniramine. 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 ChlorTan resources

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

• Ahist MedFacts Consumer Leaflet (Wolters Kluwer)


• Aller-Chlor Syrup MedFacts Consumer Leaflet (Wolters Kluwer)


• Chlorpheniramine Maleate/Tannate, Dexchlorpheniramine Maleate Monograph (AHFS DI)


• Ed ChlorPed Suspension Drops MedFacts Consumer Leaflet (Wolters Kluwer)


• Pediox-S Suspension MedFacts Consumer Leaflet (Wolters Kluwer)


• QDALL AR Sustained-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)

Compare ChlorTan with other medications

• Allergic Reactions
• Cold Symptoms
• Hay Fever
• Urticaria

Where can I get more information?

• Your pharmacist can provide more information about chlorpheniramine.

See also: ChlorTan side effects (in more detail)

cholecalciferol

Generic Name: cholecalciferol (vitamin D3) (KOE le kal SIF e role)

Brand names: D 1000 IU, D3-5, D3-50, Delta D3, Vitamin D3, ...show all 15 brand names.D400, Enfamil D-Vi-Sol, Maximum D3, Carlson D, D2000, Replesta, Liquid Vitamin D-3, Thera-D 2000, Thera-D 4000, Thera-D Rapid Repletion

What is cholecalciferol?

Cholecalciferol is a vitamin D3. Vitamin D is important for the absorption of calcium from the stomach and for the functioning of calcium in the body.

Cholecalciferol is used to treat or prevent many conditions caused by a lack of vitamin D, especially conditions of the skin or bones.

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

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

Do not use this medication if you have ever had an allergic reaction to vitamin D, or if you have high levels of calcium or vitamin D in your blood, or if you have any condition that makes it hard for your body to absorb nutrients from food (malabsorption).

Before taking cholecalciferol, tell your doctor if you are allergic to any drugs, or if you have heart disease, kidney disease, or an electrolyte imbalance.

Do not take other vitamin or mineral supplements unless your doctor has told you to.

Avoid using calcium supplements or antacids without your doctor's advice. Use only the specific type of supplement or antacid your doctor recommends. 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.

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamin D can cause serious or life-threatening side effects.

Overdose symptoms may include headache, weakness, drowsiness, dry mouth, nausea, vomiting, constipation, muscle or bone pain, metallic taste in the mouth, weight loss, itchy skin, changes in heart rate, loss of interest in sex, confusion, unusual thoughts or behavior, severe pain in your upper stomach spreading to your back, or fainting.

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

Do not use this medication if you have ever had an allergic reaction to vitamin D, or if you have:

• 
  

  high levels of calcium in your blood (hypercalcemia);

  
  


• 
  

  high levels of vitamin D in your body (hypervitaminosis D); or

  
  


• 
  

  any condition that makes it hard for your body to absorb nutrients from food (malabsorption).

  
  

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use cholecalciferol:

• 
  

  heart disease;

  
  


• 
  

  kidney disease; or

  
  


• 
  

  an electrolyte imbalance.

  
  

Your cholecalciferol dose needs may change if you are pregnant or breast-feeding. Tell your doctor if you are pregnant or plan to become pregnant during treatment, or if you are breast-feeding a baby.

How should I take cholecalciferol?

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

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

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.

Cholecalciferol is only part of a complete program of treatment that may also include a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you must eat or avoid to help control your condition.

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

See also: Cholecalciferol 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. An overdose of vitamin D can cause serious or life-threatening side effects.

Overdose symptoms may include headache, weakness, drowsiness, dry mouth, nausea, vomiting, constipation, muscle or bone pain, metallic taste in the mouth, weight loss, itchy skin, changes in heart rate, loss of interest in sex, confusion, unusual thoughts or behavior, severe pain in your upper stomach spreading to your back, or fainting.

What should I avoid while taking cholecalciferol?

Do not take other vitamin or mineral supplements unless your doctor has told you to.

Avoid using calcium supplements or antacids without your doctor's advice. Use only the specific type of supplement or antacid your doctor recommends.

Cholecalciferol side effects

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

• 
  

  thinking problems, changes in behavior, feeling irritable;

  
  


• 
  

  urinating more than usual;

  
  


• 
  

  chest pain, feeling short of breath; or

  
  


• 
  

  early signs of vitamin D overdose (weakness, metallic taste in your mouth, weight loss, muscle or bone pain, constipation, nausea, and vomiting).

  
  

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.

Cholecalciferol Dosing Information

Usual Adult Dose for Vitamin D Insufficiency:

400 to 1000 international units orally once a day.

Usual Adult Dose for Vitamin D Deficiency:

1000 international units orally once a day.

Usual Adult Dose for Prevention of Falls:

800 international units orally every day (with calcium).

Usual Geriatric Dose for Prevention of Fractures:

For patients over 65 years of age:

100,000 international units orally every 4 months

Usual Pediatric Dose for Vitamin D Insufficiency:

Neonates, infants and children: 200 international units orally once daily.

Alternate dosing:

Premature neonates: 400 to 800 international units orally once daily or 150 to 400 international units/kg/day.

Breastfed neonates and infants (fully or partially breastfed): 400 international units orally once daily beginning in the first few days of life. Continue supplementation until the infant is weaned to greater than or equal to 1000 ml/day or 1 qt/day of vitamin D fortified formula or whole milk (after 12 months of age).

Formula fed neonates and infants ingesting less than 1000 ml of vitamin D fortified formula: 400 international units orally once daily.

Children ingesting less than 1000 ml of vitamin D fortified milk: 400 international units orally once daily.

Adolescents without adequate intake: 400 international units orally once daily.

Children with increased risk of vitamin D deficiency (chronic fat malabsorption, maintained on chronic antiseizure medications): Higher doses may be required; use laboratory testing [25(OH)D, PTH, bone mineral status] to evaluate.

Usual Pediatric Dose for Vitamin D Deficiency:

Treatment of Vitamin D deficiency and/or rickets:

Infants 1 to 12 months: 1000 to 5000 international units/day for 2 to 3 months; once radiologic evidence of healing is observed, dose should be decreased to 400 international units/day.

Children older than 12 months: 5000 to 10,000 international units/day for 2 to 3 months; once radiologic evidence of healing is observed, dose should be decreased to 400 international units/day.

Children with increased risk of vitamin D deficiency (chronic fat malabsorption, maintained on chronic antiseizure medications): Higher doses may be required; use laboratory testing [25(OH)D, PTH, bone mineral status] to evaluate.
Note: If poor compliance, single high dose may be used or repeated periodically.

Treatment of Vitamin D insufficiency or deficiency associated with CKD (stages 2 to 5, 5D): serum 25 hydroxyvitamin D [25(OH)D] level less than or equal to 30 ng/mL:

Serum 25(OH)D level 16 to 30 ng/mL: Children: 2000 international units/day for 3 months or 50,000 international units every month for 3 months.

Serum 25(OH)D level 5 to 15 ng/mL: Children: 4000 international units/day for 12 weeks or 50,000 international units every other week for 12 weeks.

Serum 25(OH)D level less than 5 ng/mL: Children: 8000 international units/day for 4 weeks then 4000 international units/day for 2 months for total therapy of 3 months or 50,000 international units/week for 4 weeks followed by 50,000 international units 2 times/month for a total therapy of 3 months.

Maintenance dose [once repletion accomplished; serum 25(OH)D level greater than 30 ng/mL]: 200 to 1000 international units/day.

Dosage adjustment: Monitor serum 25(OH)D, corrected total calcium and phosphorus levels 1 month following initiation of therapy, every 3 months during therapy and with any Vitamin D dose change.

Prevention and treatment of Vitamin D Deficiency in cystic fibrosis:

Recommended daily intake:

Infants less than 1 year: 400 international units/day.

Children older than 1 year: 400 to 800 international units/day.

Alternate dosing:

Infants less than 1 year: 8000 international units/week.

Children older than 1 year: 800 international units/day.

Note: If serum 25 hydroxyvitamin D [25(OH)D] level remains less than or equal to 30 ng/mL (75 nmol/L) and patient compliance established; then medium dose regimen may be used:

Medium Dose Regimen:

Patients less than 5 years: 12,000 international units/week for 12 weeks.

Patients 5 years or older: 50,000 international units/week for 12 weeks.

Note: If repeat 25 hydroxyvitamin D [25(OH)D] level remains less than or equal to 30 ng/mL (75 nmol/L) and patient compliance established; then high dose regimen may be used:

High Dose Regimen:

Patient less than 5 years: 12,000 international units twice weekly for 12 weeks.

Patient 5 years or older: 50,000 international units twice weekly for 12 weeks.

What other drugs will affect cholecalciferol?

Before taking cholecalciferol, tell your doctor if you are taking any of the following medicines:

• 
  

  seizure medication;

  
  


• 
  

  cholestyramine (Prevalite, Questran);

  
  


• 
  

  colestipol (Colestid);

  
  


• 
  

  steroids (prednisone and others);

  
  


• 
  

  digoxin (digitalis, Lanoxin); or

  
  


• 
  

  a diuretic (water pill) such as chlorothiazide (Diuril), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor, Vasoretic, Zestoretic), chlorthalidone (Hygroton, Thalitone), indapamide (Lozol), metolazone (Mykrox, Zaroxolyn), and others.

  
  

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

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

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Chlorpromazine

Pronunciation: klor-PROE-ma-zeen
Generic Name: Chlorpromazine
Brand Name: Thorazine

Chlorpromazine is an antipsychotic. It may increase the risk of death when used to treat mental problems caused by dementia in elderly patients. Most of the deaths were linked to heart problems or infection. Chlorpromazine is not approved to treat mental problems caused by dementia. Discuss any questions or concerns with your doctor.

Chlorpromazine is used for:

Treating certain mental or mood disorders (eg, schizophrenia), the manic phase of manic-depressive disorder, anxiety and restlessness before surgery, the blood disease porphyria, severe behavioral and conduct disorders in children, nausea and vomiting, and severe hiccups. It is also used with other medicines to treat symptoms associated with tetanus. It may also be used for other conditions as determined by your doctor.

Chlorpromazine is a phenothiazine. The exact way Chlorpromazine works is not known.

Do NOT use Chlorpromazine if:

• you are allergic to any ingredient in Chlorpromazine or to other phenothiazines (eg, thioridazine)


• you have severe drowsiness


• you have recently taken large amounts of alcohol or medicines that may cause drowsiness, such as barbiturates (eg, phenobarbital) or narcotic pain medicines (eg, codeine)


• you are also taking amiodarone, bretylium, astemizole, cabergoline, cisapride, dofetilide, metoclopramide, pergolide, quinidine, sotalol, terfenadine, or tramadol

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

Before using Chlorpromazine:

Some medical conditions may interact with Chlorpromazine. 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 developed severe side effects (eg, blood problems, yellowing of the skin or eyes) while taking another phenothiazine (eg, thioridazine)


• if you have a history of heart problems (eg, angina, mitral valve problems), high or low blood pressure, blood problems (eg, anemia), bone marrow problems (eg, low white blood cell count), diabetes, liver problems (eg, cirrhosis), kidney problems, neuroleptic malignant syndrome (NMS), tardive dyskinesia (TD), an enlarged prostate gland, seizures, trouble urinating, mental or mood problems (eg, depression), or an adrenal gland tumor (pheochromocytoma)


• if you have asthma, a lung infection, or other lung or breathing problems (eg, emphysema); or increased pressure in the eyes or glaucoma, or if you are at risk of glaucoma


• if you have Alzheimer disease, dementia, Parkinson disease, or Reye syndrome


• if you have had high blood prolactin levels or a history of certain types of cancer (eg, breast, pancreas, pituitary, brain), or if you are at risk of breast cancer


• if you are in poor health or are regularly exposed to extreme heat or certain insecticides (organophosphorus insecticides)


• if you have a history of alcohol abuse, drink alcohol, or are in alcohol withdrawal


• if you will be having or have recently had a myelogram (x-ray of the spinal cord)


• if you take any medicine that may increase the risk of a certain type of irregular heartbeat (prolonged QT interval). Check with your doctor or pharmacist if you are unsure if any of your medicines may increase the risk of this type of irregular heartbeat

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

• Many prescription and nonprescription medicines (eg, used for allergies, blood clotting problems, cancer, infections, inflammation, aches and pains, heart problems, high blood pressure, high cholesterol, irregular heartbeat, mental or mood problems, nausea or vomiting, Parkinson disease, seizures, stomach or bowel problems, overactive bladder), multivitamin products, and herbal or dietary supplements (eg, herbal teas, coenzyme Q10, garlic, ginseng, gingko, St. John's wort) may interact with Chlorpromazine. Ask your doctor if you are unsure if any of your medicines may interact with Chlorpromazine.

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

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

• Chlorpromazine is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Chlorpromazine at home, a health care provider will teach you how to use it. Be sure you understand how to use Chlorpromazine. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.


• Do not use Chlorpromazine if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.


• Chlorpromazine may irritate skin. Avoid contact with skin or clothing. Wear rubber gloves while using Chlorpromazine.


• Do not suddenly stop taking Chlorpromazine.


• Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.


• If you miss a dose of Chlorpromazine and you are using it regularly, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

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

Important safety information:

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


• Chlorpromazine may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.


• Do NOT take more than the recommended dose without checking with your doctor.


• Do not drink alcohol while you are using Chlorpromazine.


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


• Tell your doctor or dentist that you take Chlorpromazine before you receive any medical or dental care, emergency care, or surgery.


• Do not become overheated in hot weather or while you are being active; heatstroke may occur.


• Some of these products contain sulfites. Sulfites may cause an allergic reaction in some patients (eg, asthma patients). If you have ever had an allergic reaction to sulfites, ask your pharmacist if your product has sulfites in it.


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


• Chlorpromazine may 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.


• Some patients who take Chlorpromazine may develop muscle movements that they cannot control. This is more likely to happen in elderly patients, especially women. The chance that this will happen or that it will become permanent is greater in those who take Chlorpromazine in higher doses or for a long time. Muscle problems may also occur after short-term treatment with low doses. Tell your doctor at once if you have muscle problems with your arms; legs; or your tongue, face, mouth, or jaw (eg, tongue sticking out, puffing of cheeks, mouth puckering, chewing movements) while taking Chlorpromazine.


• Neuroleptic malignant syndrome (NMS) is a possibly fatal syndrome that can be caused by Chlorpromazine. Symptoms may include fever; stiff muscles; confusion; abnormal thinking; fast or irregular heartbeat; and sweating. Contact your doctor at once if you have any of these symptoms.


• Chlorpromazine may increase the amount of a certain hormone (prolactin) in your blood. Symptoms may include enlarged breasts, missed menstrual period, decreased sexual ability, or nipple discharge. Contact your doctor right away if you experience any of these symptoms.


• Chlorpromazine may raise or lower your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your vision change; give you a headache, chills, or tremors; or make you more hungry. If these symptoms occur, tell your doctor right away.


• Diabetes patients - Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.


• Chlorpromazine may cause the results of some pregnancy tests to be wrong. Check with your doctor if you have questions or concerns about your pregnancy test results.


• Chlorpromazine may interfere with certain lab tests, including phenylketonuria (PKU) tests. Be sure your doctor and lab personnel know you are taking Chlorpromazine.


• Lab tests, including liver and kidney function tests, complete blood cell counts, and eye exams, may be performed while you use Chlorpromazine. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.


• Use Chlorpromazine with caution in the ELDERLY; they may be more sensitive to its effects, especially confusion; dizziness or light-headedness, especially upon standing; drowsiness; fainting; trouble urinating; uncontrolled muscle movements; and constipation.


• Chlorpromazine should not be used in CHILDREN younger than 6 months old; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Chlorpromazine while you are pregnant. Using Chlorpromazine during the third trimester may result in uncontrolled muscle movements or withdrawal symptoms in the newborn. Discuss any questions or concerns with your doctor. Chlorpromazine is found in breast milk. Do not breast-feed while using Chlorpromazine.

If you stop taking Chlorpromazine suddenly and you have been taking it regularly or in high doses, you may have WITHDRAWAL symptoms. These may include nausea, vomiting, dizziness, stomach upset, and tremors.

Possible side effects of Chlorpromazine:

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:

Agitation; constipation; dizziness; drowsiness; dry mouth; enlarged pupils; jitteriness; nausea; stuffy nose.

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 or throat; swelling of the mouth, face, lips, or tongue; unusual hoarseness; wheezing); chest pain; confusion; decreased coordination; drooling; fainting; fast, slow, or irregular heartbeat; mask-like face; muscle spasms of the face, neck, or back; muscle weakness; new or worsening mental or mood problems; numbness of an arm or leg; prolonged or painful erection; restlessness; seizures; severe or persistent constipation; severe or persistent dizziness, drowsiness, or headache; shuffling walk; sleeplessness; stiff or rigid muscles; sudden shortness of breath or vomiting; swelling of the hands, ankles, or feet; symptoms of infection (eg, fever, chills, persistent sore throat); symptoms of liver problems (eg, yellowing of the skin or eyes; dark urine; pale stools; severe or persistent nausea, stomach pain, or loss of appetite); tremor; trouble urinating; twisting or twitching movements; uncontrolled muscle movements (eg, twitching of the face or tongue; loss of balance; uncontrolled movements of arms or legs; trouble speaking, breathing, or swallowing); unusual bruising or bleeding; unusual eye movements or inability to move eyes; unusual or excessive sweating; unusual tiredness or weakness; unusually pale skin; vision changes (eg, 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: Chlorpromazine 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 agitation; coma; confusion; difficulty breathing; fainting; fast, slow, or irregular heartbeat; loss of consciousness; muscle spasms or uncontrolled muscle movements; restlessness; seizures; severe constipation or stomach pain; severe drowsiness or dizziness; tremors; trouble urinating.

Proper storage of Chlorpromazine:

Store Chlorpromazine at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Chlorpromazine out of the reach of children and away from pets.

General information:

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


• Chlorpromazine 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 Chlorpromazine. 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.

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