Jul
26
Antiemetics
July 26, 2009 | Leave a Comment
Type of Drug
Antiemetics (5HT3 Type)
Brand Names
Generic Ingredient: Aloselron Lotronex
Generic Ingredient: Dolasetron Anzemet
Generic Ingredient: Granisetron Kytril
Generic Ingredient: Ondansetron A
Zofran Zofran ODT
Prescribed For
Nausea and vomiting caused by chemotherapy and other cancer treatments and general anesthesia. Alosetron is prescribed only for women with severe irritable bowel syndrome (IBS) whose main symptom is diarrhea. Ondansetron is also prescribed for psychosis due to levadopa + carbidopa, bulimia, social anxiety disorder, and itching due to morphine treatment.
General Information
These drugs prevent nausea and vomiting by interfering with a form of the neurohormone serotonin (51-11) known as 5HT3. They block its effects in the part of the brain that controls vomiting and in the vagus nerve in the stomach and intestines. These drugs are very effective and often work in cases in which older antiemetics have failed. Aloestrin works against IBS by blocking the action of serotonin in the intestines. This reduces the cramping, abdominal discomfort, urgency, and diarrhea caused by IBS. Blood concentrations of alosetron are 30-50% higher in women than in men.
Cautions and Warnings
Do not use antiemetics if you are allergic or sensitive to any of their ingredients.
Serious and possibly fatal colitis and serious complications of constipation leading to hospitalization, blood transfusions, and surgery have developed in people taking alosetron. People with a history of gastrointestinal difficulties including chronic or severe constipation, colitis, intestinal obstruction, or diverticulitis should not take this drug.
People with heart rhythm problems, especially those taking diuretics and antiarrhythmic drugs, should be cautious about taking dolasetron.
People with liver problems need lower doses of alosetron and may consider using other drugs in this group.
These drugs shwiirj only be used when the risk of nausea and Vomiting is relatively high.
Possible Side Effects
Alosetron
♦ Most common: constipation.
Possible Side Effects (continued)
✓ Common: nausea and abdominal or GI discomfort or pain.
✓ Rare: Rare side effects can occur in any part of the body. Contact your doctor if you experience any side effect not listed above.
Dolasetron
✓ Common: headache, low blood pressure, slowed heart rate, and dizziness.
♦ Less common: high blood pressure, abdominal pain, diarrhea, rapid heartbeat, fever or chills, and tiredness.
✓ Rare: blood in the urine; chest pain; kidney problems; painful or difficult urination; pain; severe stomach pain with nausea or vomiting; rash; hives; itching; swollen face, feet, or lower legs; and breathing difficulties. Contact your doctor if you experience any side effect not listed above.
Granisetron
✓ Most common: headache, constipation, weakness, and low white-blood-cell count.
✓ Common: abdominal pain, diarrhea, nausea, vomiting, appetite loss, chills, and anemia.
✓ Less common: dizziness, fever, anxiety, sleeplessness, hair loss, and low blood-platelet count.
✓ Rare: drug sensitivity reactions, chest pain, and fainting. Contact your doctor if you experience any side effect not listed above.
Ondansetron
✓ Most common: headache, feeling unwell, and constipation.
♦ Less common: anxiety, agitation, dizziness, fever, lightheadedness, diarrhea, gynecological problems, itching, abnormal heart rhythms, and low blood pressure.
Drug Interactions
• Alosetrw may vatme the amount of hydralazine, isoniazid, and procainamide in the blood.
• Fluvoxamine and alosetron should not be taken together.
• Ketoconazole may increase blood concentrations of alosetron by 30%.
• Combining rifampin and dolasetron may reduce the level of antiemetic in the blood.
• Blood levels of dolasetron may be increased when combined with cimetidine or atenolol.
Food Interactions
These drugs may be taken with or without food.
Usual Dose
Alosetron
Adult: 0.5 mg twice a day to start. Dosage may be increased to 1 mg twice a day if the lower dose is not working. Alosetron should be discontinued if adequate results are not seen after 4 weeks at 1 mg twice a day.
Dolasetron
Adult and Child (age 17 and over): a single dose of 100 mg. Child (age 2-16): 0.8 mg per lb. of body weight, up to 100 mg.
Granisetron
Adult and Child (age 17 and over): 1 mg twice a day. Child (age 2-16): riot recommended.
Ondansetron
Adult and Child (age 12 and over): 8 mg twice a day. People with liver failure should take no more than 8 mg a day. A single 24-mg dose 30 minutes before starting chemotherapy may be recommended.
Child (age 4-11): 4 mg 3 times a day.
Child (age 3 and under): not recommended.
Overdosage
Symptoms may include severe constipation, temporary blindness, high blood pressure, fainting, and mild headache. Call your local poison control center or a hospital emergency room for more information. If you go for treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call You( qM%TA you develop chest tightness, wheezing, breathing difficulties, chest pain, or any bothersome or persistent side effect.
Call your doctor at once and immediately stop taking alosetron if you develop constipation or symptoms of ischemic colitis including abdominal pain, cramps, nausea, vomiting, and bloody diarrhea.
Maintain good dental hygiene while taking these drugs. Chronic dry mouth can increase the risk of tooth decay and gum disease.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose; skip the dose you forgot and continue with your regular schedule. Missing more than 1 dose may increase the risk of vomiting.
To use Ondansetron ODT, make sure your hands are dry. Peel back the foil on a blister and gently remove the tablet. Do not push the tablet through the foil. Immediately place the tablet on top of the tongue, where it will dissolve in seconds, then swallow with saliva.
Special Populations
Pregnancy/Breast-feeding: There are no adequate studies of the effects of these drugs in pregnant women. When your doctor considers any of these drugs crucial, its potential benefits must be carefully weighed against its risks.
These drugs may pass into breast milk. Nursing mothers who must take any of these drugs should consider using infant formula.
Seniors: Seniors may take these drugs without special precaution, although elderly women taking alosetron may be at increased risk of serious constipation.
Jul
26
Anthelios SX Cream
July 26, 2009 | Leave a Comment
Brand Name
Anthelios SX Cream (an-THEL-e-ose)
Generic Ingredients
Avobenzone + Ecamsule + Octocrylene
Type of Drug Sunscreen.
Prescribed For Sunburn prevention.
General Information
Anthelios SX is an over-the-counter moisturizer used to help prevent sunburn and to help provide protection from UVA (§hlwk- and long-wave) and UVB rays.
Cautions and Warnings
Do not use this product if you are allergic or sensitive to any of its ingredients.
Do not apply this product to broken or burned skin.
Do not swallow this cream or apply it directly to your eye or to the inside of the mouth, nose or vagina.
Possible Side Effects
♦ Rare: Skin irritation or rash.
Drug Interactions None known.
Food Interactions None known.
Usual Dose
Adult and Child (age 6 months and over): Apply evenly before sun exposure. Reapply as needed or after towel drying, swimming, or perspiring.
Overdosage
Call your local poison control center or hospital emergency room for more information. If you seek treatment, ALWAYS bring the bottle or container with you.
Special Information
One of the ingredients in this product, ecamsule, was approved for use in the US in June, 2007, though it has been available in Europe since 1993.
Do not forget to reapply this product periodically.
Special Populations
Pregnancy/Breast-feeding: No information available.
Seniors: Seniors may use this product without special precaution.
Jul
26
Angiotensin H Blockers
July 26, 2009 | Leave a Comment
Angiotensin H Blockers (AN-jee-oe-TEN-sin)
Brand Names
Generic Ingredient: Candesartan Cilexetil Atacand
Generic Ingredients: Candesartan Cilexetil + Hydrochlorothiazide Atacand HCT
Generic Ingredient: Eprosartan Mesylate Teveten
Generic Ingredients: Eprosartan Mesylate + Hydrochlorothiazide Teveten HCT
Generic Ingredient: Irbesartan Avapro
Generic Ingredients: Irbesartan + Hydrochlorothiazide Avalide
Generic Ingredient: Losartan Potassium Cozaar
Generic Ingredients: Losartan Potassium + Hydrochlorothiazide Hyzaar
Generic Ingredient: Olmesartan Medoxomil Benicar
Generic Ingredients: Olmesartan Medoxomil + Hydrochlorothiazide Benicar HCT
Generic Ingredient: Telmisartan Micardis
Generic Ingredients: Telmisartan + Hydrochlorothiazide Micardis HCT
Generic Ingredient: Valsartan Diovan
Generic Ingredients: Valsartan + Hydrochlorothiazide Diovan HCT
Generic Ingredients: Valsartan + Amlodipine Exforge
Prescribed For
High blood pressure; nephropathy in type 2 diabetes (losartan and Irbesartan); heart failure (candesartan and valsartan: and treatment following heart attack (valsartan).
General Information
These drugs work by blocking the effects of angiotensin 11, a hormone found in blood vessels and other tissue. Angiotensin H plays an important role in regulating blood pressure. Unlike angiotensinconverting enzyme (ACE) inhibitors—another group of bloodpressure-lowering medication—angiotensin If (All) blockers do not cause chronic cough. All blockers can be used alone or with a thiazide diuretic such as hydrochlorothiazide, as in Hyzaar, Avalide, and Diovan HCT, for example. While these are single tablets, your doctor may prescribe an All blocker and a diuretic as separate pills. Combining an All blocker and a diuretic may reduce blood pressure twice as much as an All blocker alone.
AII blockers may be useful in treating heart failure and may slow the progression of kidney disease in people with diabetes and high blood pressure.
Many All blockers contain combinations of anti hypertensives. For more information see Amlodipine, page 65, and Hydrochlorothiazide, page 1113.
Cautions and Warnings
Do not take an All blocker if you are allergic or sensitive to any of its ingredients. You may be sensitive to one All blocker and tolerant of another.
Do not take All blockers if you are or think you might be pregnant.
Patients with heart failure given an All blocker generally experience a drop in blood pressure. If this happens, a temporary dosage reduction may be needed. People being treated with diuretics may also experience a sudden drop in blood pressure (symptoms include dizziness and fainting). Once your body has adjusted to a diuretic-All blocker combination, this problem should subside.
Telmisartan is noticeably less effective in black patients. Irbesartan, candesartan, and losartan are also somewhat less effective in black patients although the addition of a diuretic such as IhVdrodhlorothiazide is usually beneficial.
People with serious liver disease or cirrhosis should receive a lower starting dosage of losartan. Telmisartan should be used with caution by people with liver disease and related problems; alternate drug therapy should be considered. People with liver disease or cirrhosis should be cautious about taking valsartan, although no dosage adjustment is required.
Some people who take an AII blocker develop kidney function changes similar to those associated with ACE inhibitor drugs. Valsartan and telmisartan dosages may have to be modified in the presence of severe kidney disease. No adjustment is required for other AU blockers.
Losartan can be used in children age 6 and over. Other AU blockers have not been studied in children under age 18.
Possible Side Effects
All blockers are generally very well tolerated. In clinical studies, the risk of side effects was about the same for an All blocker as for a placebo (sugar pill).
Candesartan
♦ Common: respiratory infection.
♦ Less common: dizziness, headache, fatigue, diarrhea, nausea and vomiting, abdominal and other pain, joint pain, sinus problems, sore throat, runny nose, bronchitis, chest pain, and swollen arms or legs.
• Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Eprosartan
♦ Common: respiratory infection.
✓ Less common: changes in urinary frequency or painful urination, dizziness, headache, sleeplessness, diarrhea, upset stomach, muscle pain or cramps, cough, sore throat, runny nose, and swelling.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Irbesartan
✓ Less common: dizziness, headache, fatkqme, anxiety, nervousness, diarrhea, \apsel stomach, heartburn, nausea and Vomiting, abdominal and other pain, cough, sinus problems, sore throat, runny nose, flu-like symptoms, swelling, chest pain, rash, rapid heartbeat, and urinary infection.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Possible Side Effects (continued)
Losartan
✓ Common: respiratory infection.
♦ Less common: dizziness, sleeplessness, diarrhea, upset stomach, heartburn, pain, muscle cramps, muscle aches, cough, stuffy nose. rash, rapid heartbeat, and sinus problems.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Olmesartan
T Common: dizziness and respiratory infection.
✓ Less common: swelling of the arms and legs, weakness, rash, headache, diarrhea, upset stomach, kidney damage. heartburn, pain, muscle cramps, muscle aches, cough, stuffy nose, sinus problems, and vomiting.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Telmisartan
✓ Common: respiratory infection.
✓ Less common: dizziness, headache, fatigue, anxiety or nervousness, diarrhea, upset stomach, heartburn, nausea and vomiting, abdominal pain, back pain, muscle aches, cough, sinus irritation, sore throat, influenza, chest pain, urinary infection, rash, swelling in the arms or legs, and high blood pressure.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Valsartan
✓ Less common: dizziness, sleeplessness, headack-,(_-, %Mqx~e. dNwM a, Upset stomach, heartburn, abdominal pain, joint pain, respiratory infection, cough, sore throat, sinus problems, runny nose, virus infection, and swelling.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Alcohol and narcotic and barbiturate drugs may increase the blood-pressure-lowering effects, such as dizziness or fainting, of AIL blockers.
• Telmisartan may slightly reduce warfarin blood levels, but not enough to require a change in warfarin dosage.
• Combining telmisartan and digoxin can increase digoxin blood levels by up to 50%, leading to possible drug side effects. This combination should be used with caution.
• Rifampin may reduce the effectiveness of losartan.
• Fluconazole may increase the effects of losartan.
• Combining an AU blocker and another blood-pressurelowering drug, especially a diuretic, reduces blood pressure more efficiently than either drug used alone. People taking a diuretic who start an All blocker may initially experience a rapid blood pressure drop and should start with a lower AII blocker dosage.
• Combining losartan with the diuretic hydrochlorothiazide can increase the risk of developing low blood potassium (hypokalemia). Your doctor should check your blood electrolytes periodically if you are taking this combination.
Food Interactions
For optimal effectiveness, take valsartan at least 1 hour before or 2 hours after meals. Other All blockers can be taken with or without food.
Usual Dose
Cantle min
Adult: 8-32 mg once a day. Usual starting dosage is 16 mg a day.
Child: not recommended.
Eprosartan
Adult: 400-800 mg a day in one or two doses. Usual starting dosage is 600 mg.
Child. wDl recommended.
Irbesartan
Adult: 150 mg once a day to start, increasing to 300 mg once a day if necessary. A lower dosage (75 mg) may be prescribed for people who are dehydrated or salt-depleted.
Child: not recommended.
Drug Interactions
• Alcohol and narcotic and barbiturate drugs may increase the blood-pressure-lowering effects, such as dizziness or fainting, of AIL blockers.
• Telmisartan may slightly reduce warfarin blood levels, but not enough to require a change in warfarin dosage.
• Combining telmisartan and digoxin can increase digoxin blood levels by up to 50%, leading to possible drug side effects. This combination should be used with caution.
• Rifampin may reduce the effectiveness of losartan.
• Fluconazole may increase the effects of losartan.
• Combining an AU blocker and another blood-pressurelowering drug, especially a diuretic, reduces blood pressure more efficiently than either drug used alone. People taking a diuretic who start an All blocker may initially experience a rapid blood pressure drop and should start with a lower AII blocker dosage.
• Combining losartan with the diuretic hydrochlorothiazide can increase the risk of developing low blood potassium (hypokalemia). Your doctor should check your blood electrolytes periodically if you are taking this combination.
Food Interactions
For optimal effectiveness, take valsartan at least 1 hour before or 2 hours after meals. Other All blockers can be taken with or without food.
Usual Dose
Cantle min
Adult: 8-32 mg once a day. Usual starting dosage is 16 mg a day.
Child: not recommended.
Eprosartan
Adult: 400-800 mg a day in one or two doses. Usual starting dosage is 600 mg.
Child. wDl recommended.
Irbesartan
Adult: 150 mg once a day to start, increasing to 300 mg once a day if necessary. A lower dosage (75 mg) may be prescribed for people who are dehydrated or salt-depleted.
Child: not recommended.
Losartan
Adult: 25-50 mg once a day to start, increasing gradually up to
100 mg in 1 or 2 doses a day.
Child (age 6 and over): 3 mg per lb. of body weight a day to start
and then adjusted as necessary. Dosage not to exceed 100 mg per
day.
Child (under age 6): not recommended.
Olmesartan
Adult: 20-40 mg a day. Usual starting dose is 20 mg a day.
Child: not recommended.
Telmisartan
Adult: 20-80 mg a day. Usual starting dosage is 40 mg a day. Child: not recommended.
Valsartan
Adult: 40-320 mg a day. Usual starting dosage is 80-160 mg a
day.
Child: not recommended.
Overdosage
Little is known about All blocker overdose, although it could be fatal. The most likely overdose symptoms are very low blood pressure, dizziness, and rapid heartbeat. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Avoid strenuous exercise and very hot weather because heavy sweating or dehydration can cause a rapid blood pressure drop.
People on dialysis who take telmisartan may become dizzy or faint when rising quickly from a sitting or lying position at the beginning of treatment.
Avoid over-the-counter diet pills, decongestants, and stimu-’ lants because they may contain ingredients that ca” raise blood qressqm. Felop% luting losartan should avoid using potassium supplements.
Call your doctor if you develop any of the following symptoms: dry mouth, thirst, weakness, tiredness, drowsiness, restlessness, confusion, seizures, muscle pains or cramps, muscular fatigue. dizziness or fainting, drastically reduced urine output, rapid heartbeat, and nausea or vomiting.
If you take an All blocker once a day and forget a dose, take it as soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule. If you take an AU blocker twice a day and forget a dose, take it as soon as you remember. If it is within 4 hours of your next dose, take 1 dose right away and another in 5 or 6 hours, then go back to your regular schedule. Never take a double dose.
Special Populations
PregnancylBreast-feeding: AD blockers should not be taken during the last 6 months of pregnancy because they can cause fetal injury or death. If necessary, you should take another drug for high blood pressure if you are or might be pregnant.
It is not known if AII blockers pass into breast milk, although they do in animal studies. Nursing mothers who must take an AII blocker should use infant formula.
Seniors: Seniors may take All blockers without special precautions.
Jul
26
Anastrozole
July 26, 2009 | Leave a Comment
Generic Name
Anastrozole (ah-NAS-troe-zole)
Brand Name Arimidex
The information in this profile also applies to the following drug:
Generic Ingredient., Letrozole Ferrara
Type of Drug Aromatase inhibitor.
Prescribed For
Breast cancer in postmenopausal women.
General Information
Anastrozole is used for breast cancer that has advanced or spread despite treatment with tamoxifen, as an initial treatment for estrogen-receptor-positive breast cancer or for breast cancer in which the hormone receptor status is unknown. Anastrozole reduces the amount of estradiol, an estrogenic hormone, in the blood. It does this by interfering with the action of the aromatase enzyme, an element involved in the manufacture of estradiol. Most of anastrozole is broken down in the liver.
Cautions and Warnings
Do not take anastrozole if you are allergic or sensitive to any of its ingredients. Anastrozole increases blood-cholesterol levels.
Women with estrogen-receptor negative disease and those who did not respond at all to tamoxifen are not likely to respond to anastrozole.
Deterioration of bone density may occur in women taking anastrozole or letrozole.
People with severe liver disease may need reduced dosages of letrozole.
Possible Side Effects
✓ Most common: weakness, nausea, headache, flushing, pain, and back pain.
✓ Less common: muscle and joint pain; cough; diarrhea; constipation; abdominal pain; appetite loss; bone pain; sore throat; dizziness; rash; dry mouth: swelling in the arms, legs, or feet; pelvic pain; unexpected vaginal bleeding; depression; chest pain; and tingling in the hands or feet.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Usual doses of anastrozole do not affect other medications; however, high doses of anastrozole can reduce the ability of the liver to break down certain drugs.
• Tamoxifen reduces blood levels of anastrozole without increasing treatment benefit. These drugs should riot be taken
together.
• Estrogen-containing therapies should not be used with
anastrozole.
Food Interactions
Anastrozole may be taken with or without food.
Usual Dose
Anastrozole
Adult: I mg once a day.
Letrozole
Adult: 2.5 mg once a day.
Overdosage
Symptoms of overdose can be exaggerated side effects. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if your side effects become severe or intolerable. Use a condom, diaphragm, or other non-hormonal contraceptive while taking anastrozole.
If you forget a dose of anastrozole, take it as soon as you remember if it is within 12 hours of the missed dose. If it is over 12 hours, skip the missed dose and continue with your regular schedule. Call your doctor if you forget more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: Anastrozole is intended only for postmenopausal women. Animal studies have shown that exposure to anastrozole can harm the fetus. Women who think they may become pregnant while taking this drug should use a condom, diaphragm, or other non-hormonal contraceptive.
Seniors: Seniors may take this drug without special precaution.
Jul
26
Anakinra
July 26, 2009 | Leave a Comment
Generic Name
Anakinra (an-ah-KIN-rah)
Brand Name Kineret
Type of Drug
Immune system modulator.
Prescribed For
Moderate to severe, rheumatoid arthritis in adults.
General Information
Anakinra blocks the biological activity of a substance called interleukin-1, which is produced in response to inflammation. Anakinra may be prescribed together with methotrexate, azathioprine, leflunomide, sulfasalazine, or other drugs for the treatment of rheumatoid arthritis. It must be injected under the skin every day.
Cautions and Warnings
Do not use this drug it you are allergic or sensitive to any of its ingredients.
Serious infections and malignancies are possible in people using anakinra because of its ability to suppress the immune response. This may be more common in people with other conditions that predispose them to infections such as asthma or advanced or uncontrolled diabetes.
The safety and effectiveness of anakinra in people whose immune systems are suppressed has not been established.
Levels of some white blood cells may be reduced in rare cases, leading to persistent fever or pale skin color. Contact your doctor if any of these symptoms develop.
Anakinra is cleared through the kidneys. People with severe kidney disease may accumulate anakinra in their blood.
People taking anakinra should not receive any live vaccines, because the body may not be able to respond as expected to the vaccine.
Possible Side Effects
♦ Most common: infections and injection-site reactions.
♦ Common: reduced white-blood-cell counts, headache, nausea, and diarrhea.
• Less common: sinusitis, flu-like symptoms, and abdominal pain.
Drug Interactions
• Do not mix anakinra in the same syringe as another drug.
• Anakinra should not be used in combination with etanercept or any other TNF-blocking agent because of the increased risk of infection.
Food Interactions None know”,
Usual Dose
Adult (age 18 and over): 100 mg a day, at the same time each day, injected under the skin via pre-filled syringe. Inject the entire contents of the syringe.
Child: not recommended.
Overdosage
In animal studies, doses up to 35 times the maximum human dose have been used with no evidence of serious toxicities. Call your doctor or local poison center for more information. If you do go to a hospital emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Do not use a syringe of anakinra if the contents are discolored or contain particles. Keep anakinra dosages refrigerated.
Reactions may develop at the site where anakinra is injected. Injection sites should be rotated among the thigh, abdomen, and upper arm to avoid excessive bruising or other skin damage.
If you forget a dose of anakinra, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.
For more information on how to properly administer this drug, see page 1242.
Special Populations
Pregnancy/Breast-feeding: Animal studies at doses 100 times the human dose indicate no harm to the fetus. However, there is no information on the use of anakinra by pregnant women. When this drug is considered crucial by your doctor, its potential benefits must be weighed against its risks.
It is not known if anakinra passes into breast milk. Nursing mothers who must use anakinra should use infant formula.
Seniors: The risk of anakinra side effects is greater in seniors because of the natural decline in kidney function.
Jul
26
Anagrelide
July 26, 2009 | Leave a Comment
Generic Name
Anagrelide (ah-NAG-rel-ide)
Brand Name Agrylin
Type of Drug Antiplatelet.
Prescribed For
Essential thrombocythemia (ET), to reduce blood-platelet count and the risk of excess blood clotting associated with high blood-platelet levels.
General Information
Blood platelets play an important role in the body. They help to form blood clots that “seal off” minor cuts and wounds and prevent excessive bleeding. When platelet counts are too high, as in ET, unwanted clots may form almost anywhere in the body. These clots may obstruct blood vessels, leading to leg cramps, heart attack, stroke, or other medical problems. Exactly how anagrelide reduces blood-platelet count is not known, but it may interfere with the formation of new platelets. Anagrelide is not approved for general use by children under age 16, but it has been used without apparent harm by 8 children between the ages of 8 and 17, who took it in doses up to 4 mg a day.
Cautions and Warnings
Do not take anagrelide if you are allergic or sensitive to any of its ingredients. This drug should be used with caution by people who have heart disease. Use of anagrelide may cause heart palpitations, rapid heart rate, and congestive hPartfeAum.
Uau,F~k~& 1vw blood-platelet counts can develop in people treated with anagrelide. Platelet counts should be periodically checked while you are taking this drug; they usually rise soon after the drug is stopped.
People with liver or kidney disease should use this drug with caution. Anagrelide can cause liver or kidney toxicity and worsen diseases of those organs.
Possible Side Effects
♦ Most common: heart palpitations, diarrhea, abdominal pain, nausea, gas; headache, weakness, swelling, pain, dizziness, and difficulty breathing.
♦ Common: chest pain, rapid heartbeat, vomiting, upset stomach, appetite loss, rash or itching, tingling in the hands or feet, back pain, and not feeling well.
V Less common: fever, flu-like symptoms, chills, neck pain, sensitivity to bright light, abnormal heart rhythms, bleeding, heart disease, stroke, angina pain, heart failure, dizziness when rising from a sitting or lying position, flushing, migraine, fainting, depression, confusion, tiredness, high blood pressure, nervousness, memory loss, itching, skin disease, hair loss, stomach bleeding, blood in the stool, stomach irritation, vomiting, anemia, thrombocytopenia (low blood-platelet count), black-and-blue marks, swollen lymph glands, painful urination, blood in the urine, muscle and joint ache, leg cramps, runny nose, nosebleeds, lung disease, sinus inflammation, pneumonia, bronchitis, asthma, double vision, other visual difficulties, ringing or buzzing in the ears, liver inflammation, and dehydration.
Drug Interactions
• Sucralfate may interfere with the absorption of anagrelide. Do not combine these drugs.
Food Interactions
Anagrelide may be taken without regard to food or meals.
Usual Dose
Adult: 0.5 mg 4 times a day or 1 mg twice a day, to start. After at least a week, the lowest effective dose should be sought.
Child (age 17 and under): Limited information is available for the use of anagrelide in children. Children ranging in age from 7-17 have been given starting dosages similar to adults with similar side effects.
Overdosage
Little is known about the effects of anagrelide overdose, but symptoms are likely to include a sudden drop in blood-platelet count and heart or central - nervous- system side effects which could result in abnormal bleeding. Overdose victims should be taken to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Blood-platelet counts should be checked every two days when beginning anagrelide for 1 week. Until a maintenance dose has been established, platelet counts should then be taken once a week.
Women who might become pregnant should use a reliable form of birth control while taking anagrelide.
If you forget a dose, take it as soon as possible. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Call your doctor if you forget 2 or more doses in a row. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: At high doses, anagrelide caused birth defects in animal studies. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if this drug passes into breast milk. Nursing mothers who must take anagrelide should use infant formula.
Seniors. Seniors may take anagrelide without special precaution.
Jul
26
Amprenavir
July 26, 2009 | Leave a Comment
Generic Name
Amprenavir (am-PREN-ah-vere)
Brand Name Agenerase
The information in this profile also applies to the following drug:
Generic Ingredient: Fosamprenavir Lexiva
Type of Drug Protease inhibitor.
Prescribed For
Human immunodeficiency virus (HIV) infection.
General Information
Protease inhibitors revolutionized the fight against acquired immunodeficiency syndrome (AIDS) because, when combined with other drugs, they reduce the amount of HIV virus in the bloodstream to levels that are often undetectable by current methods, such as CD4 cell immune system counts and viral load measurements (amount of virus in the blood). Amprenavir is taken together with other anti-HIV medications in “drug cocktails” to take advantage of different avenues of attack against the HIV virus. Fosamprenavir is rapidly and almost completely converted to amprenavir by the body and then exerts its protease inhibitor effects. It has no anti-KW effect on its own. Triple-drug cocktails were responsible for the reduction in the AIDS death rate that began in 1996. Protease inhibitors are always taken together with 1 or 2 nucleoside antiviral drugs, such as efavirenz, emtricitabine, lamivudine, tenofovir, or zidovudine (AZT). Multiple-drug therapy has changed the current view of HIV from a fatal disease to a manageable chronic illness.
Protease inhibitors work in a unique way, but they are not a cure for HIV infection or AIDS. When the HIV virus attacks a cell, it must be converted into viral DNA. Other drugs, known as reverse transcriptase inhibitors, interfere with this step, but they need help in fighting HIV. Protease inhibitors work at the end of the HIV reproduction process, when proteins are “cut” by a protease enzyme into strands of exactly the right size to duplicate HIV. Protease inhibitors prevent the mature HIV virus from being formed by interfering with this cutting process. Proteins that are cut incorrectly or that remain uncut are inactive.
People taking a protease inhibitor may still develop secondary infections or conditions associated with HIV disease. Because of this, it is very important for you to remain under the care of a doctor or other health care provider. The long-term effects of amprenavir are not known. You may be able to pass the HIV virus to others even if you are on triple-drug therapy.
Cautions and Warnings
Do not take amprenavir if you are allergic or sensitive to any of its ingredients. People allergic to sulfa drugs may also be allergic to amprenavir.
Do not use amprenavir oral solution in children under age 4 due to the risk of toxicity.
People with liver disease may require reduced dosage.
Severe and life-threatening skin reactions can develop in people taking amprenavir. Call your doctor right away if this happens.
Amprenavir may raise your blood sugar, worsen diabetes, or bring out latent diabetes. Treatment with insulin or an oral diabetes drug may be required in such cases.
The risk of bleeding may be increased in people with hemophilia who take protease inhibitors.
Protease inhibitors can cause the redistribution of body fat, leading to buffalo hump, breast enlargement, abnormal thinness, or a round, moon-shaped face. The long-term effects of this are unknown.
Possible Side Effects
Amprenavir is always taken with other drugs, so the side effects listed here are associated with multiple-drug therapy rather than amprenavir taken alone. Amprenavir has been Possible Side Effects (continued)
studied in children age 4-12 and side effects are the same as in adults.
T Most common: nausea, vomiting, diarrhea, mild rash, itching, high blood sugar, and high blood -triglycerid e levels.
✓ Common: changes in sense of taste and tingling in or around the mouth or in the hands or feet.
✓ Less common: depression and high blood - cholesterol levels.
♦ Rare: life-threatening rash, diabetes, and buffalo hump. Contact your doctor immediately if you notice signs of a worsening rash, especially if it is accompanied by fever, flu-like symptoms, swelling, blisters, red eyes, or if you experience any side effect not listed above.
Drug Interactions
Amprenavir can interact with many drugs. Be sure to tell your doctor about all the medications you are taking.
• Astemizole, bepridil, dihydroergotamine, ergotamine, lidocaine injection, midazolam, triazolam, ergot derivatives, tricyclic antidepressants, and quinidine should never be combined with amprenavir because of the risk of severe, life-threatening reactions.
• St. John’s wort should not be used with amprenavir because it can cause amprenavir resistance.
• You may require dosage adjustments of amiodarone, lidocaine
injection, and warfarin when you start taking amprenavir.
• Do not combine rifampin with amprenavir because it reduces drug levels by 90%. Rifabutin reduces the amount of amprenavir in the blood by 15%.
• Combining amprenavir and sildenafil or vardenafil drastically increases the risk of their side effects including low blood pressure, visual changes, and apeusislent and painful erection.
• Amprenavir can reduce the effectiveness of birth control pills.’ Use another means of contraception while taking amprenavir.
• Amprenavir must be taken at least 1 hour before or after antacids.
• Combining amprenavir with statin cholesterol-lowering drugs increases the risk of drug toxicity.
• Carbamazepine, phenytoin, and phenobarbital reduce the effectiveness of amprenavir.
• Other drugs that could interact with amprenavir and should
be used with caution are erythromycin, itraconazole, alpra-
zolam, clorazepate, diazepam, flurazepam, calcium channel
blockers, delavirdine, efavirenz, nevirapine, estrogens, pro-
gestogens, corticosteroids, clozapine, loratidine, and pimo-
zide.
• Ritonavir must be added to the combination of fosamprenavir and nevirapine, an NNRI-type antiviral; they are prescribed together to obtain maximum benefit.
• Fosamprenavir should be used with caution with anti-arrhythmic drugs, bepridil, trazodone, anticonvulsant drugs, ketoconazole, itraconazole, rifabutin, diltiazem, felodipine, nifedipine, nicardipine, nimodipine, verapamil, dexamethasone, drugs for excess stomach acidity, statins, immune suppressants, methadone, contraceptive drugs, and erectile dysfunction drugs because of the increased risk of drug side effects.
• Amprenavir capsules contain large amounts of vitamin E. Do
not take a vitamin E supplement while taking this drug.
Food Interactions
This drug can be taken without regard to food or meals, but high-fat foods may reduce the effectiveness of amprenavir.
Usual Dose
Amprenavir Capsules
Adult and Child (age 13-16): 1200 mg (8 capsules) twice a day with other anti-HIV drugs. Adults with moderate to severe liver disease should take 300-450 mg twice a day.
Child (age 4-12): 9 mg per lb. twice day or 6.8 mg per lb. 3 times a day with other anti-HIV drugs, up to 2400 mg a day. This dosage also applies to older children who weigh less than 110 lbs.
Child (under age 4): not recommemSed.
Amprenavir Oral Solution
Child (age 4-12): 10.2 mg per lb. twice a day or 7.7 mg per lb.
3 times a day with other anti-HIV drugs, up to 2800 mg a day. This
dosage also applies to older children who weigh less than 110 lbs. Child (under age 4): not recommended.
Fosamprenavir
Adult: first-time treatment-1400 mg twice daily (without riton-
avir); or 1400 mg once daily with 200 mg ritonavir once daily; or 700 mg twice daily with 100 mg ritonavir twice daily. Previous treatment with another protease inhibitor-700 mg twice daily plus ritonavir 100 mg twice daily.
Child: not recommended.
Overdosage
Overdose symptoms are likely to be exaggerated side effects. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Amprenavir is not a cure for HIV. It will not prevent you from transmitting the HIV virus to another person; you must still practice safe sex. You may still develop opportunistic infections or other complications associated with advanced HIV disease.
Amprenavir oral solution is absorbed less efficiently than the capsules. They cannot be interchanged for each other on a milligram for milligram basis. Avoid.alcohol while taking amprenavir oral solution.
Tell your doctor about all other prescription and over-the-counter drugs you are taking because of the risk of drug interactions.
It is very important to take amprenavir exactly as prescribed. If you forget a dose of amprenavir, take it as soon as you remember. If you miss a dose by more than 4 hours, skip the forgotten dose and continue with your regular schedule. Never take a double dose.
Contact your doctor if you have a rash, nausea, diarrhea, or vomiting, or any intolerable drug side effect.
Special Populations
Pregnancy/Breast-feeding: Amprenavir caused abortions and birth defects in pregnant animals. Its effect on pregnant women is not known and the drug should be taken only after risks and possible benefits WAVE been discussed with your doctor.
Nursing mothers who must take amprenavir should use infant formula.
Seniors: Amprenavir was not studied in seniors. Seniors taking this drug must use caution.
Jul
26
Amlodipine
July 26, 2009 | Leave a Comment
Generic Name
Amlodipine (am-LOE-dih-pene) CGI
Brand Name Norvasc
Combination Products
Generic Ingredients: Amlodipine + Atorvastatin Caduet
Generic Ingredients: Amlodipine + Benazepril 91 Lotrel
Generic Ingredients: Amlodipine + Valsartan Exforge
Type of Drug
Calcium channel blocker.
Prescribed For
Angina pectoris, Prinzmetal’s angina, and high blood pre%zw% N)as also been studied for heaq%N~mie and Raynaud’s phenomenon.
General Information
Amlodipine is one of many calcium channel blockers available in the United States. These drugs block the passage of calcium, an essential factor in muscle contraction, into the heart and smooth muscles. Such blockage interferes with the contraction of these muscles, which in turn dilates (widens) the veins and vessels that supply blood to them. This dilating effect reduces blood pressure, the amount of oxygen used by the heart muscles, and the risk of blood-vessel spasm. Amlodipine is therefore useful in treating not only high blood pressure but also angina pectoris (brief attacks of chest pain), a condition related to poor oxygen supply to the heart muscles.
Amlodipine affects the movement of calcium only into muscle cells; it has no effect on calcium in the blood.
The brand-name products Caduet, Lotrel, and Exforge contain combinations of amlodipine and other anti hypertensives. For more information for Caduet, see Statin Cholesterol-Lowering Agents, page 1052; for Lotrel, see Benazepril, page 145; for Exforge, see Angiotensin U Blockers, page 80.
Cautions and Warnings
Do not take amlodipine if you are allergic or sensitive to any of its ingredients.
Amlodipine may, in rare instances, cause low blood pressure in some people taking it for reasons other than hypertension. This is more of a problem with other calcium channel blockers.
Amlodipine may worsen heart failure in some people and should be used with caution if heart failure is present. This drug does not protect against the side effects of suddenly stopping beta-blocking drugs.
Calcium channel blockers, alone and with aspirin, have caused bruises, black-and-blue marks, and bleeding due to an anticoagulant effect. This is mostly a problem with nifedipine but should be considered for all members of the group.
Amlodipine may cause angina when treatment is first started, when the dosage is increased, or if the drug is rapidly withdrawn. This can be avoided by gradually reducing the dosage.
Studies have shown that people taking calcium channel blockers—usually those taken several times a day, not those taken only once daily—have a greater chance of having a heart attack than people taking beta blockers or another medicine for the same purposes, Dzuss this with your doctor to be sure you are receiving the best possible treatment.
People with severe liver disease may require reduced dosage. People taking the combination product Caduet may be more likely to develop liver problems because of the addition of atorvastatin, a drug that has been associated with liver disease.
Possible Side Effects
♦ Most common: headache, dizziness or lightheadedness (especially with Caduet), anxiety, nausea, swelling in the arms or legs, heart palpitations, and flushing.
♦ Less common: sleepiness, muscle weakness, cramps or abdominal discomfort, itching, rash, sexual difficulties, wheezing or shortness of breath, muscle cramps, pain, and inflammation.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Amlodipine may interact with beta-blocking drugs to cause heart failure, very low blood pressure, or an increased incidence of angina.
• Amlodipine may cause unexpected blood-pressure reduction when combined with other antihypertensive drugs and with erectile dysfunction drugs: however, this interaction is more likely with other calcium channel blockers.
• The combination of quinidine (prescribed for abnormal heart rhythms) and amlodipine must be used with caution because it can produce low blood pressure, very slow heart rate, abnormal heart rhythms, and swelling in the arms or legs.
• Amlodipine can increase the effects of theophyllineprescribed for asthma and other respiratory problems—and related drugs.
• Patients taking amlodipine who are given fentanyl as a short-term surgical anesthetic may experience very low blood pressure.
• Calcium channel blockers may cause bleeding when taken alone or combined with aspirin.
Food Interactions
Gmpk%A)6ce may increase the effects of amlodipine. Usual Dose
Adults: 5-10 mg once a day. Do not stop taking amlodipine abruptly. The dosage should be gradually reduced over a period of time.
Child (age 6-17 years): 2.5-5 mg once a day for high blood pressure. Doses larger than 5 mg have not been studied in children.
Overdosage
Overdose of amlodipine can cause nausea, weakness, dizziness, confusion, and slurred speech. Take overdose victims to a hospital emergency room, or call your local poison control center for directions. You may be asked to make the patient vomit to remove the medication from the stomach. If you go to the emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop constipation, nausea, weakness or dizziness, swelling in the hands or feet, breathing difficulties, or increased heart pains, or if other side effects are bothersome or persistent.
The combination of amlodipine and atorvastatin may cause dizziness, especially when rising from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall. Also, use caution when driving or performing hazardous activities until you know how the medication affects you.
Make sure the doctor who prescribed the combination product Caduet for you knows if you have liver disease.
If you are taking amlodipine for high blood pressure, be sure to continue taking your medication even if you feel well, and follow any instructions for diet restriction or other treatments.
It is important to maintain good dental hygiene while taking amlodipine and to use extra care when using your toothbrush or dental floss because of the chance that the drug will make you more susceptible to certain infections.
If you forget a dose of amlodipine, take it as soon as you remember If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy0least-feeding.- Animal studies of amlodipine show that it may damage a fetus. Other calcium channel blockers can be used to treat severe high blood pressure associated with pregnancy, so there is no reason for women who are or might become pregnant to take amlodipine. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if amlodipine passes into breast milk. Nursing mothers who take amlodipine should use infant formula.
Seniors: Seniors, especdly those with liver disease, are more sensitive to the effects of this drug and may require reduced dosage. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Jul
26
Amlexanox
July 26, 2009 | Leave a Comment
Amlexanox
Generic Name
Amlexanox (am-LEX-an-ox)
Brand Name Aphthasol
Type of Drug Skin-ulcer treatment.
Prescribed For
Canker sores in people with normal immune systems.
General Information
Amlexanox slows the production or release of factors involved in the body’s inflammatory response. It aids in the healing of mouth ulcers, but the exact way that it accelerates the healing process is not known.
Cautions and Warnings
Do not use amlexanox if you are allergic or sensitive to it or to any ingredient in the paste. Stop using this drug if you develop a persistent rash or irritation.
Drug Interactions None known.
Food Interactions
Do not apply amlexanox while you have any food in your mouth.
Usual Dose
Adult: Apply a small amount (1/4 in.) to each mouth ulcer 4 times a day, preferably after breakfast, lunch, and dinner, and at bedtime. Child: not recommended.
Overdosage
Swallowing even a whole tube of amlexanox would probably cause only upset stomach, nausea, diarrhea, and vomiting. Call your local poison control center or hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
Begin using amlexanox as soon as possible after noticing a mouth ulcer and use it until your ulcers heal. Call your doctor if the pain does not get the sores do not heal after 10 days of using amlexanox.
Make sure your teeth and mouth are clean before applying amlexanox paste. Squeeze 1/4 in. of the paste onto your finger and apply it to each mouth ulcer using gentle pressure.
Wash your hands immediately after using amlexanox. If you get the paste into your eyes, wash it out at once using cool water.
experience local pain, stinging, or burning
n, diarrhea, and nausea. Contact your ence any side effect not listed above.
Possible Side Effects
♦ Less common: transien
• application.
✓ Rare: mouth irritation
• if you If you forget a dose of amlexanox, use it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not apply more than the recommended amount at any time.
Special Populations
Pregnancy/Breast-feeding: The effect of amlexanox on pregnancy is not known; use it only after discussing the possible risks and benefits with your doctor.
Amlexanox passes into the milk of nursing animals, but its effect in humans is not known. Nursing mothers should use this drug with caution.
Seniors: Seniors may use amlexanox without special precaution.
Jul
23
ALPROSTADIL
July 23, 2009 | Leave a Comment
ALPROSTADIL
Generic Name
Alprostadil (al-PROS-tuh-dil)
Brand Names
Caverject Edex Muse
Type of Drug
Erectile dysfunction agent.
Prescribed For
Erectile dysfunction; also prescribed for atherosclerosis (hardening of the arteries), gangrene, and pain due to blood vessel disease.
General Information
A male erection happens when blood flows into blood vessels and holding areas inside the penis. Problems occur when blood cannot move into the penis as it normally should. Alprostadil (prostaglandin El or PGE1) helps men get and keep an erection by dilating blood vessels that supply the penis and by relaxing muscles to help expand holding areas. Alprostadil also dilates other vessels and reduces platelet stickiness—which slows blood-clotting rates—and relaxes some muscle groups. Alprostadil must be injected into the tissue of the penis or inserted into the urethra.
Cautions and Warnings
Do not take alprostadil if you are allergic or sensitive to any of its ingredients or to other prostaglandin drugs. Alprostadil can cause priapism (painful erection lasting more than 6 hours). People with diseases where priapism is a possibility—sickle cell anemia or trait, multiple myeloma, leukemia—those with penile deformities, or penile implants, women, children, or those for whom sexual activity could be dangerous should not use alprostadil.
Penile pain is common after using either form of alprostadil, al-hough it is usually mild or moderate.
Possible Side Effects
Injection
• Most common: penile pain.
♦ Less common: prolonged erection; penile fibrosis (deformity); blood blister or black-and-blue marks at the injection site, usually caused by poor injection technique; Possible Side Effects (continued)
penis disorders, including yeast infection, numbness, irritation, sensitivity, itching, redness, and torn skin; penile rash or swelling; headache; dizziness’, fainting; respiratory infection; flu-like symptoms; sinus inflammation; runny or stuffed nose; cough; blood pressure changes; local pain; prostate problems’, back pain; and general pain.
♦ Rare: Rare side effects can affect the penis, kidney and uri-
nary tract, heart and blood, skin, and eyes. Contact your
doctor if you experience any side effect not listed above. Pellets
• Most common: penile pain.
♦ Common: urethral pain, burning or bleeding, and testicular pain.
♦ Less common: headache, dizziness, respiratory infection, flu-like symptoms, runny nose, sinus inflammation, low blood pressure, back pain, pelvic pain, and general pain.
♦ Rare: Rare side effects can affect the kidney and urinary tract, heart and blood, skin, and eyes. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Alprostadil can increase the effect of anticoagulant (blood-thinning) drugs. Your doctor may have to adjust the dose of your anticoagulant.
• Alprostadil may decrease the amount of cyclosporine in your blood.
• The safety of combining alprostadil with other drugs that affect blood vessels is not known. These combinations should be used with caution.
Food Interactions None known.
Usual Dose
Dosage must be individualized to your need and response.
Overdosage
Alprostadil overdose can lead to an extended and painful erection, as well as other side effects. If this occurs, call your doctor or go to the nearest emergency room. Overdose victims should seek medical attention. ALWAYS bring the prescription container.
Special Information
Patient information leaflets are included with each alprostadil prescription. Read this information before you use your prescription.
You must be trained in proper injection technique by your doctor. Self-injection should be permitted only after your doctor has made sure you know how to do it properly. For more information on how to properly administer this drug, see page 1242.
Alprostadil begins working within 5-10 minutes after taking it. Dosage should be set so that your erection lasts for about 30-60 minutes. Use the lowest dose that works.
You should generally not use alprostadil more than 3 times a week, and wait at least 24 hours betv4een uses.
Do not increase the dosage without consulting your doctor. Contact your doctor or seek medical assistance if your erection lasts longer than 4 hours.
Special Populations
Pregnancy/Breast-feeding: This product should not be used by women. Men using alprostadil must use a condom if they have intercourse with a pregnant woman. Alprostadil passes into semen and will affect the development of a fetal heart if a condom is not worn.
Seniors: Seniors may use alprostadil without special precaution.