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Welcome to my compendium websites about Prescription Drugs and  Medications and Their Side Effects.

Site No. 1 A-B You are here.  http://www.NewMedicalDirectories.com/Prescription-Drugs-Medications/1-A-B-Side-Effects.html
 

Site No. 2 C-D http://www.NewMedicalDirectories.com/Prescription-Drugs-Medications/2-C-D-Side-Effects.html
 

Site No. 3 E-L
http://www.NewMedicalDirectories.com/Prescription-Drugs-Medications/3-E-L-Side-Effects.html
 

Site No. 4 M-N
http://www.NewMedicalDirectories.com/Prescription-Drugs-Medications/4-M-N-Side-Effects.html
 

Site No. 5 O-R
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Site No. 6. S-Z
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Important words found on this site.

Prescription Drugs Medication Side Effects
You can find this site again  by typing in the  Google search engine  the unique word " 1stceffEediSgurD  "  which is  " DrugSideEffects1 " backwards.

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Click Brian Nelson's www.PartyTentCity.com for party tents, canopies and awnings. Today's Sale 26'x40' Tarp.   Silver. Regular price is $104.00. With this ad it is on sale for only $88.00. Shipping is $15. No charge for shipping if tarp is picked up at  31 Gessner Rd.  in Houston, TX  77024  Use PayPal to Brian@NelsonIdeas.com or Call Brian 713-467-3025.  
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 Do you need a party tent of white or silver tarp? Go to www.PartyTentCity.com or to see all my links go to:  http://www.PartyTentCity.com/PTC/Websites.html

Today's  special sale: Business is slow. Call me right now while this include page is up and get a 23% discount off any www.PartyTentCity.com  order.  No charge for shipping if picked up at  31 Gessner Rd.  in Houston, TX  77024 Use PayPal to Brian@NelsonIdeas.com or Call Brian 713-467-3025. http://www.NelsonIdeas.com/Directory-All-Websites/Alphabetical.html
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713-467-3025  Fax 713-408/29/2009 05:11 PM -050067-3192  Click: E-mail me
1. Hydrocodone*
2. Lexapro
3. Vicodin
4. Xanax
5. Adderall
6. Effexor
Abilify
Acetaminophen
Aciphex
Advair
Albuterol
Allegra
Alprazolam
Altace
Ambien
Amiodarone
Amitriptyline
Amoxicillin
Aspirin
Atenolol
Ativan
Augmentin
Avelox
Baclofen
Bactrim
Benicar
Bextra
Biaxin
Buspar

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Misspelled words used to find this page 1 of 3.

 Page Title, Keywords  Description Metas,

 
Hydrocodone
  • • Hydrocodone is sometimes used to treat back pain.

DESCRIPTION

Hydrocodone bitartrate and acetaminophen is supplied in tablet form for oral administration. Hydrocodone bitartrate is an opioid analgesic and antitussive and occurs as fine, white crystals or as a crystalline powder. It is affected by light. The chemical name is 4,5a-Epoxy-3-methoxy-17-methylmorphinan-6-one tartrate (1:1) hydrate (2:5). It has the following structural formula:

Acetaminophen, 4´-Hydroxyacetanilide, a non-opiate, non-salicylate analgesic and antipyretic. It has the following structural formula:

Hydrocodone Bitartrate and Acetaminophen Tablets USP for oral administration are available in a variety of strengths as described in the following table.

Hydrocodone

Strength Bitartrate Acetaminophen
2.5 mg/500 mg 2.5 mg 500 mg
5 mg/500 mg 5 mg 500 mg
7.5 mg/325 mg 7.5 mg 325 mg
7.5 mg/500 mg 7.5 mg 500 mg
7.5 mg/650 mg 7.5 mg 650 mg
7.5 mg/750 mg 7.5 mg 750 mg
10 mg/325 mg 10 mg 325 mg
10 mg/500 mg 10 mg 500 mg
10 mg/650 mg 10 mg 650 mg
10 mg/660 mg 10 mg 660 mg
10 mg/750 mg 10 mg 750 mg

SIDE EFFECTS

The most frequently observed adverse reactions include lightheadedness, dizziness, sedation, nausea, and vomiting. These effects seem to be more prominent in ambulatory than in nonambulatory patients and some of these adverse reactions may be alleviated if the patient lies down.

Other adverse reactions include:

Central Nervous System: Drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dysphoria, psychic dependence, mood changes.

Gastrointestinal System: The antiemetic phenothiazines are useful in suppression of the nausea and vomiting which may occur; however, some phenothiazine derivatives seem to be antianalgesic and to increase the amount of narcotic required to produce pain relief, while other phenothiazines reduce the amount of narcotic required to produce a given level of analgesia. Prolonged administration of hydrocodone bitartrate and acetaminophen tablets may produce constipation.

Genitourinary System: Ureteral spasm, spasm of vesical sphincters, and urinary retention have been reported.

Respiratory Depression: Hydrocodone bitartrate may produce dose-related respiratory depression by acting directly on the brain stem respiratory center. Hydrocodone also affects the center that controls respiratory rhythm and may produce irregular and periodic breathing.

If significant respiratory depression occurs, it may be antagonized by the use of naloxone hydrochloride. Apply other supportive measures when indicated.

Dermatological: Skin rash, pruritus.

DRUG ABUSE AND DEPENDENCE

Hydrocodone bitartrate and acetaminophen tablets are subject to the Federal Controlled Substance Act (Schedule III).

Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of narcotics; therefore, hydrocodone bitartrate and acetaminophen tablets should be prescribed and administered with caution. However, psychic dependence is unlikely to develop when hydrocodone bitartrate and acetaminophen tablets are used for a short time for the treatment of pain.

Physical dependence, the condition in which continued administration of the drug is required to prevent the appearance of a withdrawal syndrome, assumes clinically significant proportions only after several weeks of continued narcotic use, although some mild degree of physical dependence may develop after a few days of narcotic therapy. Tolerance, in which increasingly large doses are required in order to produce the same degree of analgesia, is manifested initially by a shortened duration of analgesic effect and subsequently by decreases in the intensity of analgesia. The rate of development of tolerance varies among patients.

DRUG INTERACTIONS

Patients receiving other narcotic analgesics, antipsychotics, antianxiety agents, or other CNS depressants (including alcohol) concomitantly with hydrocodone and acetaminophen tablets may exhibit an additive CNS depression. When combined therapy is contemplated, the dose of one or both agents should be reduced.

The use of MAO inhibitors or tricyclic antidepressants with hydrocodone preparations may increase the effect of either the antidepressant or hydrocodone.

The concurrent use of anticholinergics with hydrocodone may produce paralytic ileus.

Lexapro®
(escitalopram oxalate)
TABLETS/ORAL SOLUTION

Suicidality in Children and Adolescents

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Lexapro or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Lexapro is not approved for use in pediatric patients. (See WARNINGS and PRECAUTIONS: Pediatric Use)

Pooled analyses of short-term (4 to 16 weeks) placebo-controlled trials of 9 antidepressant drugs (SSRIs and others) in children and adolescents with major depressive disorder (MDD), obsessive compulsive disorder (OCD), or other psychiatric disorders (a total of 24 trials involving over 4400 patients) have revealed a greater risk of adverse events representing suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. No suicides occurred in these trials.

  • • Lexapro is sometimes used to treat anxiety and depression. Visit WebMD for additional health information on anxiety and depression.

DESCRIPTION

LEXAPRO™ (escitalopram oxalate) is an orally administered selective serotonin reuptake inhibitor (SSRI). Escitalopram is the pure S-enantiomer (single isomer) of the racemic bicyclic phthalane derivative citalopram. Escitalopram oxalate is designated S(+)-1-[3-(dimethyl-amino)propyl]-1-(p-fluorophenyl)- 5-phthalancarbonitrile, with the following structural formula:

Lexapro

The molecular formula is C20H21FN2O • C2H2O4 and the molecular weight is 414.40

Escitalopram oxalate occurs as a fine white to slightly yellow powder and is freely soluble in methanol and dimethyl sulfoxide (DMSO), soluble in isotonic saline solution, sparingly soluble in water and ethanol, slightly soluble in ethyl acetate, and insoluble in heptane.

LEXAPRO (escitalopram oxalate) is available as tablets or as an oral solution.

LEXAPRO tablets are film coated, round tablets containing escitalopram oxalate in strengths equivalent to 5 mg, 10 mg and 20 mg escitalopram base. The 10 and 20 mg tablets are scored. The tablets also contain the following inactive ingredients: talc, croscarmellose sodium, microcrystalline cellulose/colloidal silicon dioxide, and magnesium stearate. The film coating contains hypromellose, titanium dioxide, and polyethylene glycol.

LEXAPRO oral solution contains escitalopram oxalate equivalent to 1 mg/mL escitalopram base. It also contains the following inactive ingredients: sorbitol, purified water, citric acid, sodium citrate, malic acid, glycerin, propylene glycol, methylparaben, propylparaben, and natural peppermint flavor.

Lexapro®
(escitalopram oxalate)
TABLETS/ORAL SOLUTION

Suicidality in Children and Adolescents

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of Lexapro or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Lexapro is not approved for use in pediatric patients. (See WARNINGS and PRECAUTIONS: Pediatric Use)

Pooled analyses of short-term (4 to 16 weeks) placebo-controlled trials of 9 antidepressant drugs (SSRIs and others) in children and adolescents with major depressive disorder (MDD), obsessive compulsive disorder (OCD), or other psychiatric disorders (a total of 24 trials involving over 4400 patients) have revealed a greater risk of adverse events representing suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. No suicides occurred in these trials.

  • • Lexapro is sometimes used to treat anxiety and depression. Visit WebMD for additional health information on anxiety and depression.

DESCRIPTION

LEXAPRO™ (escitalopram oxalate) is an orally administered selective serotonin reuptake inhibitor (SSRI). Escitalopram is the pure S-enantiomer (single isomer) of the racemic bicyclic phthalane derivative citalopram. Escitalopram oxalate is designated S(+)-1-[3-(dimethyl-amino)propyl]-1-(p-fluorophenyl)- 5-phthalancarbonitrile, with the following structural formula:

Lexapro

The molecular formula is C20H21FN2O • C2H2O4 and the molecular weight is 414.40

Escitalopram oxalate occurs as a fine white to slightly yellow powder and is freely soluble in methanol and dimethyl sulfoxide (DMSO), soluble in isotonic saline solution, sparingly soluble in water and ethanol, slightly soluble in ethyl acetate, and insoluble in heptane.

LEXAPRO (escitalopram oxalate) is available as tablets or as an oral solution.

LEXAPRO tablets are film coated, round tablets containing escitalopram oxalate in strengths equivalent to 5 mg, 10 mg and 20 mg escitalopram base. The 10 and 20 mg tablets are scored. The tablets also contain the following inactive ingredients: talc, croscarmellose sodium, microcrystalline cellulose/colloidal silicon dioxide, and magnesium stearate. The film coating contains hypromellose, titanium dioxide, and polyethylene glycol.

LEXAPRO oral solution contains escitalopram oxalate equivalent to 1 mg/mL escitalopram base. It also contains the following inactive ingredients: sorbitol, purified water, citric acid, sodium citrate, malic acid, glycerin, propylene glycol, methylparaben, propylparaben, and natural peppermint flavor.

 

Vicodin

Generic Name: acetaminophen and hydrocodone (a see ta MIN oh fen and hye droe KOE doan)
Brand Names: Anexsia, Anolor DH5, Bancap HC, Dolacet, Lorcet 10/650, Lortab, Norco, T-Gesic, Vicodin, Zydone,

 

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

Do not take Vicodin with alcohol, other narcotic pain medications, sedatives, tranquilizers, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result.

Do not take this medication without first talking to your doctor if you drink more than three alcoholic beverages per day or if you have had alcoholic liver disease (cirrhosis). You may not be able to take medication that contains acetaminophen.

Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. Vicodin should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Keep track of how many tablets have been used from each new bottle of this medicine. Hydrocodone is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Never take more Vicodin than is prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

You may have withdrawal symptoms when you stop using this medication after using it over a long period of time. Do not stop using Vicodin suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

What is Vicodin?

Hydrocodone is in a group of drugs called narcotic pain relievers. It is similar to codeine.

Acetaminophen is a less potent pain reliever that increases the effects of hydrocodone.

The combination of acetaminophen and hydrocodone is used to relieve moderate to severe pain.

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

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

Do not use this medication if you are allergic to acetaminophen or hydrocodone, or other narcotic pain relievers such as fentanyl (Actiq, Duragesic), hydromorphone (Dilaudid, Palladone), methadone (Methadose, Dolophine), morphine (Kadian, MS Contin, Oramorph, and others), oxycodone (Oxycontin), and oxymorphone (Opana).

Before using Vicodin, tell your doctor if you are allergic to any drugs, or if you have:

  • asthma, COPD, sleep apnea, or other breathing disorders;

  • liver disease;
  • kidney disease;
  • underactive thyroid;

  • a history of head injury or brain tumor;

  • epilepsy or other seizure disorder;

  • low blood pressure;
  • gallbladder disease;

  • Addison's disease or other adrenal gland disorders;

  • enlarged prostate, urination problems;

  • mental illness; or

  • a history of drug or alcohol addiction.

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

Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. Vicodin should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Keep track of how many tablets have been used from each new bottle of this medicine. Hydrocodone is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

FDA pregnancy category C. This medication may be harmful to an unborn baby, and could cause addiction or withdrawal symptoms in a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Vicodin 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 this medicine to anyone younger than 18 years old. Older adults may be more sensitive to the effects of this medicine.

How should I take Vicodin?

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

An overdose of acetaminophen can cause serious harm. The maximum amount of acetaminophen for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Taking more acetaminophen could cause damage to your liver. One Vicodin tablet may contain up to 750 mg of acetaminophen. Know the amount of acetaminophen in the specific product you are taking.

If your medicine contains 650 mg of acetaminophen or more per tablet, take no more than 5 tablets in 24 hours. If your medicine contains 500 mg or less of acetaminophen, take no more than 8 tablets in 24 hours. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Take this medicine with a full glass of water. You may take the medication with food or milk if it causes stomach upset.

Measure the liquid form of this medication 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 where you can get one.

Drink 6 to 8 full glasses of water daily to help prevent constipation while you are taking Vicodin. Ask your doctor about ways to increase the fiber in your diet. Do not use a stool softener (laxative) without first asking your doctor.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using Vicodin. You may need to stop using the medicine for a short time.

You may have withdrawal symptoms when you stop using this medication after using it over a long period of time. Do not stop taking Vicodin suddenly without first talking to your doctor. You may need to take less and less before you stop the medication completely. Store Vicodin at room temperature away from moisture and heat.

What happens if I miss a dose?

Since Vicodin is sometimes used as 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. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use 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 Vicodin can be fatal. Symptoms of an overdose may include extreme drowsiness, muscle weakness, nausea, vomiting, sweating, confusion, cold and clammy skin, shallow breathing, slow heart rate, fainting, or coma.

What should I avoid while taking Vicodin?

Do not use any other over-the-counter cough, cold, allergy, or pain medication without first asking your doctor or pharmacist. Acetaminophen is contained in many cold and pain medicines available over the counter. If you take certain products together you may accidentally take too much acetaminophen. Read the label of any other medicine you are using to see if it contains acetaminophen. Do not drink alcohol while you are taking Vicodin. Dangerous side effects or death can occur when alcohol is combined with hydrocodone. Check the label of any other medicines you take to be sure they do not contain alcohol.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by hydrocodone, which could result in extreme drowsiness or coma.

What are the possible side effects of Vicodin?

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

  • shallow breathing, slow heartbeat;

  • seizure (convulsions);
  • cold, clammy skin;
  • confusion;

  • severe weakness or dizziness; or

  • feeling light-headed, fainting.

Less serious side effects are more likely to occur, such as:

  • constipation;
  • urinating less than usual;

  • nausea, vomiting, loss of appetite;

  • dizziness, headache; or
  • itching.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Vicodin?

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

  • an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate); or

  • antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil).

If you are using any of these drugs, you may not be able to use Vicodin, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect Vicodin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has information about Vicodin written for health professionals that you may read.

What does my medication look like?

Acetaminophen and hydrocodone is available with a prescription under many brand names such as Vicodin, Lortab, Lorcet, Zydone, Hydrocet, and Co-Gesic. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Vicodin

  This article is in the process of being merged into Hydrocodone, and it may be outdated.

Vicodin (Hydrocodone or dihydrocodeinone, not to be confused with dihydrocodeine) is a pain killer most commonly seen as a white tablet with the name "Vicodin", "Vicodin ES", or "Vicodin HP" imprinted on one side. It shares its characteristics with many other drugs in chemistry and form; such drugs are also pain killers and may be marketed as Anexsia, Anolor DH5, Bancap HC, Dolacet, Lorcet, Lortab, Norco, T-Gesic, Vicodin, or Zydone.

 

 Manufacturers

Manufacturers of Vicodin (generic or otherwise) include: Abbott Laboratories, Allscripts Healthcare Solutions LLC, Amerisource Health Services Corp, Cardinal Health, Drx Pharmaceutical Consultants Inc, Eckerd Corp, Hospira Inc, Knoll Laboratories Div Knoll Pharmaceutical Co, Pdrx Pharmaceuticals Inc, Physicians Total Care Inc, Rx Pak Div of Mckesson Corp, Sandhills Packaging Inc and Watson Labs. [1] Aggregated, Vicodin production reportedly approaches 20 tons annually.

In the United States, Vicodin production is regulated in part by the Controlled Substances Act of 1970. This guarantees that all manufacturing, importing, possession, and distribution of drugs is to be looked over and regulated by the federal government who are also responsible (along with the Department of Justice and state governments) for the conviction and sentencing of anyone who breaks drug laws. [2]

 Scheduling

Vicodin was put into Schedule III along with anabolic steroids, ketamine, paregoric, Xyrem, Marinol, and hydrocodone/codeine (when "compounded with an NSAID" or with paracetamol); these drugs have high psychological dependence and low to medium physical addiction. [3]

 Surgery

Vicodin is most commonly prescribed for persons experiencing pain after surgery or intense pain. It helps calm a person down and increases their ability to relax and forget about painful ailments (which speeds up recovery).[citation needed]

 Interactions and contraindications

Drugs that should be avoided in order to decrease the chance of side effects are isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), or other monoamine oxidase inhibitors (MAOI’s) 14 days prior to use. Acetaminophen should also be avoided so as to decrease chances of destroying the liver. In addition, alcohol increases the drowsiness already caused by Vicodin and may result in a person's becoming unconscious or, much worse, dead. Aside from alcohol, other drugs that induce drowsiness should also be avoided (e.g., antidepressants, antihistamines, pain killers, muscle relaxants, etc.) so as to decrease chances of contracting Vicodin’s severe side effects. Furthermore, if a person experiences Addison’s Disease, kidney disease, gallbladder diseases, liver disease, complications with the thyroid, severe head injuries, asthma, or alcohol abuse, Vicodin should not be taken for fear of worsening the condition.

 Use during pregnancy and lactation

The Food and Drug Administration (FDA) has put Vicodin in category C. This category includes any and all drugs which have not been tested in pregnancies therefore the effects of the drug on newborns have not been determined. The FDA does ensure a warning to breastfeeding mothers telling them that Vicodin does pass into breast milk, which can have adverse effects on nursing babies.

 Side effects

Side effects for Vicodin include an allergic reaction, weak breathing, seizures, clammy skin, severe weakness, dizziness, unconsciousness, yellowing of eyes or skin, unusual fatigue, bleeding, or bruising, constipation, dry mouth, nausea, vomiting, decreased appetite, muscle twitches, sweating, itching, tinnitus, hearing loss, decreased urination, and decreased sex drive. [4] Vicodin (in terms of hydrocodone) also has depressant effects on the central nervous system. [5] However, some of the less mundane effects can be desirable effects that are sought after by many drug addict victims. Those effects include a great euphoria and drowsiness, as well as slowing the pulse.[6] Vicodin has also been linked to causing stomach ulcers.

 Overdose symptoms

Symptoms of a Vicodin overdose may include slow breathing, cold and clammy skin, dizziness, weakness, loss of consciousness, confusion, small pupils, tiredness, coma, nausea, vomiting, and sweating, and an overdose may lead to death.

 Addiction

Addiction to Vicodin is similar to other powerful addictions; cravings for the drug take hold of a person and may even supersede a person’s need for food or water.[7]

The hydrocodone component of Vicodin is the reason for its abuse. Hydrocodone is derived from an opiate, the chemical effects of which are similar to those of heroin (although not quite as strong) and are highly addictive. It increases the activity of the neurotransmitter dopamine, causing a strong euphoria.[8]

 Withdrawal symptoms

The symptoms of Vicodin withdrawal include but are not limited to restlessness, muscle pain, bone pain, insomnia, diarrhea, vomiting, cold flashes, goose bumps, involuntary leg movements, watery eyes, runny nose, loss of appetite, irritability, panic, nausea, chills, and sweating. [9][10]

 Alcohol and abuse

Vicodin's effects of disorientation, relaxation, and euphoria have been tampered with by mixing them with other drugs, but the most common method has been by mixing them with alcohol. Combined, the drunken effects of alcohol are heightened and brought upon faster.

The Do It Now Foundation states that, "Vicodin and other prescription narcotics constitute the most-abused group of prescription drugs, according to the National Household Survey, released in 2001. Of the four million Americans who reported misusing prescription drugs the previous year, nearly 65 percent misused prescription Analgesics. Vicodin use has soared in recent years, partly fueled by the fame of its star user base." The number of 12-17 year-old users jumped 127 percent between 1996 and 2000, according to one national survey.

Brand name:

Vicodin

Pronounced: VY-koe-din
Generic ingredients: Hydrocodone bitartrate, Acetaminophen
Other brand names: Anexsia, Co-Gesic, Hydrocet, Lorcet, Lortab, Maxidone, Norco, Zydone

Why is this drug prescribed?

Vicodin combines a narcotic analgesic (painkiller) and cough reliever with a non-narcotic analgesic for the relief of moderate to moderately severe pain.

Most important fact about this drug

Vicodin can be habit-forming. If you take this drug over a long period of time, you can become mentally and physically dependent on it, and you may find the drug no longer works for you at the prescribed dosage.

How should you take this medication?

Take Vicodin exactly as prescribed. Do not increase the amount you take or the frequency without your doctor's approval. Do not take this drug for any reason other than the one prescribed.

Do not give this drug to others who may have similar symptoms.

--If you miss a dose...

If you take Vicodin regularly, take the forgotten dose as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature in a tightly closed container, away from light.

What side effects may occur?

Side effects cannot be anticipated. ( NOT THAT REALLY HELPS A LOT. )  If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Vicodin.

  • More common side effects may include:
    Dizziness, light-headedness, nausea, sedation, vomiting

If these side effects occur, it may help if you lie down after taking the medication.

Why should this drug not be prescribed?

If you are sensitive to or have ever had an allergic reaction to hydrocodone, similar narcotic painkillers, or acetaminophen (Tylenol), you should not take this medication. Make sure your doctor is aware of any drug reactions you have experienced.

Special warnings about this medication

Vicodin may make you drowsy, less alert, or unable to function well physically. Do not drive a car, operate machinery, or perform any other potentially dangerous activities until you know how this drug affects you.

Use caution in taking Vicodin if you have a head injury. Narcotics tend to increase the pressure of the fluid within the skull, and this effect may be exaggerated by head injuries. Side effects of narcotics can interfere in the treatment of people with head injuries.

Use Vicodin with caution if you have a severe liver or kidney disorder, an underactive thyroid gland, Addison's disease (a disease of the adrenal glands), an enlarged prostate, or urethral stricture (narrowing of the tube carrying urine from the bladder).

Older adults and those in a weakened condition should be careful using this drug, since it contains a narcotic.

Narcotics such as Vicodin may interfere with the diagnosis and treatment of people with abdominal conditions.

Hydrocodone suppresses the cough reflex; therefore, be careful using Vicodin after an operation or if you have a lung disease.

High doses of hydrocodone may produce slowed breathing; if you are sensitive to this drug, you are more likely to experience this effect.

Possible food and drug interactions when taking this medication

Hydrocodone slows the nervous system. Alcohol can intensify this effect.

If hydrocodone is taken with certain other drugs, the effects of either may be increased, decreased, or altered. It is especially important to check with your doctor before combining Vicodin with the following:

Antianxiety drugs such as Valium and Librium
Antidepressant medications classified as "tricyclics," such as Elavil and Tofranil
Antihistamines such as Tavist
Drugs classified as MAO inhibitors, including the antidepressants Nardil and Parnate
Major tranquilizers such as Thorazine and Haldol
Other narcotic analgesics such as Demerol
Other central nervous system depressants such as Halcion and Restoril

Special information if you are pregnant or breastfeeding

The effects of Vicodin in pregnancy have not been adequately studied. Do not take this drug if you are pregnant or plan to become pregnant unless you are directed to do so by your doctor. Drug dependence occurs in newborns when the mother has taken this drug regularly prior to delivery. If you take it shortly before delivery, the baby's breathing may be slowed. Acetaminophen does, and hydrocodone may, appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding your baby until your treatment is finished.

Recommended dosage

ADULTS

Your doctor will adjust the dosage according to the severity of the pain and the way the medication affects you.

The dosages given below are for Vicodin products only. If your doctor prescribes other brands, your daily dose may vary.

All forms of Vicodin are taken every 4 to 6 hours as needed for pain. The usual dose of Vicodin is 1 or 2 tablets, up to a maximum of 8 tablets per day. The usual dose of Vicodin HP is 1 tablet, up to a maximum of 6 tablets per day. For Vicodin ES, the usual dose is 1 tablet, up to a maximum of 5 tablets per day.

CHILDREN

The safety and effectiveness of Vicodin have not been established in children.

Overdosage

Any medication taken in excess can have serious consequences. A severe overdose of Vicodin can be fatal. If you suspect an overdose, seek emergency medical treatment immediately.

  • Symptoms of a Vicodin overdose include:
    Blood disorders, bluish tinge to skin, cold and clammy skin, extreme sleepiness progressing to a state of unresponsiveness or coma, general feeling of bodily discomfort, hearing impairment, heart problems, heavy perspiration, kidney problems, limp muscles, liver failure, low blood pressure, nausea, slow heartbeat, troubled or slowed breathing, vomiting

Xanax

alprazolam (al PRAY zoe lam)

Brand Names: Niravam, Xanax, Xanax XR,
 

What is the most important information I should know about

 Xanax?

Do not use this medication if you are allergic to Xanax or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax). This medication can cause birth defects in an unborn baby. Do not use Xanax if you are pregnant.

Before taking Xanax, tell your doctor if you have any breathing problems, glaucoma, kidney or liver disease, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol.

Do not drink alcohol while taking Xanax. This medication can increase the effects of alcohol.

Avoid using other medicines that make you sleepy. They can add to sleepiness caused by Xanax.

Xanax may be habit-forming and should be used only by the person it was prescribed for. Xanax should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

What is Xanax?

Xanax is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). Xanax affects chemicals in the brain that may become unbalanced and cause anxiety.

Xanax is used to treat anxiety disorders, panic disorders, and anxiety caused by depression.

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

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

Do not use this medication if you have:

  • narrow-angle glaucoma;

  • if you are also taking itraconazole (Sporanox) or ketoconazole (Nizoral); or

  • if you are allergic to Xanax or to other benzodiazepines, such as chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).

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

  • asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;

  • glaucoma;

  • kidney or liver disease (especially alcoholic liver disease);

  • a history of depression or suicidal thoughts or behavior; or

  • a history of drug or alcohol addiction.

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

FDA pregnancy category D. Xanax can cause birth defects in an unborn baby. Do not use Xanax without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Xanax 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. The sedative effects of Xanax may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking Xanax. Do not give this medication to anyone under 18 years old.

How should I take Xanax?

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

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

Xanax may be habit-forming and should be used only by the person it was prescribed for. Xanax should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

Measure the liquid form of alprazolam 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.

To take alprazolam orally disintegrating tablets (Niravam):

  • Using dry hands, remove a tablet from the bottle and place the tablet on your tongue. It will begin to dissolve right away.

  • Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

  • Swallow several times as the tablet dissolves. If desired, you may drink liquid after the tablet has completely dissolved.

Contact your doctor if this medicine seems to stop working as well in treating your panic or anxiety symptoms.

Your symptoms may return when you stop using Xanax after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using Xanax. Withdrawal symptoms may include blurred vision, trouble concentrating, loss of appetite, diarrhea, muscle twitching, numbness or tingling, or increased sensations.

Do not stop using Xanax suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

To be sure this medication is helping your condition, your doctor will need to check your progress on a regular basis. Do not miss any scheduled visits to your doctor.

Store Xanax at room temperature away from moisture, heat, and light. Remove any cotton from the bottle of disintegrating tablets, and keep the bottle tightly closed.

Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

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

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of Xanax can be fatal.

Symptoms of an Xanax overdose may include extreme drowsiness, confusion, muscle weakness, loss of balance or coordination, feeling light-headed, fainting, or coma.

What should I avoid while taking Xanax?

Do not drink alcohol while taking Xanax. This medication can increase the effects of alcohol. Xanax can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can increase some of the side effects of Xanax.

Grapefruit and grapefruit juice may interact with Xanax and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

What are the possible side effects of Xanax?

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

  • unusual risk-taking behavior, decreased inhibitions, no fear of danger;

  • depressed mood, thoughts of suicide or hurting yourself;

  • hyperactivity, agitation, hostility;

  • hallucinations;

  • feeling light-headed, fainting;

  • seizure (convulsions);

  • urinating less than usual or not at all;

  • muscle twitching, tremor; or

  • jaundice (yellowing of the skin or eyes).

Less serious side effects are more likely to occur, such as:

  • drowsiness, dizziness;

  • amnesia or forgetfulness, trouble concentrating;

  • feeling irritable;
  • sleep problems (insomnia);

  • muscle weakness, lack of balance or coordination;

  • slurred speech;
  • blurred vision;
  • appetite or weight changes;

  • nausea, vomiting, constipation;

  • dry or watery mouth, increased sweating; or

  • loss of interest in sex.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Xanax?

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

  • birth control pills;
  • cimetidine (Tagamet);

  • diltiazem (Tiazac, Cartia, Cardizem);

  • isoniazid (Nydrazid, Rifamate);

  • propoxyphene (Darvon, Darvocet);

  • seizure medication;

  • antibiotics such as fluconazole (Diflucan), itraconazole (Sporanox) or ketoconazole (Nizoral); or

  • antidepressants such as fluvoxamine (Luvox), desipramine (Norpramin), or imipramine (Janimine, Tofranil).

If you are using any of these drugs, you may not be able to use Xanax, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect Xanax. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has information about Xanax written for health professionals that you may read.

What does my medication look like?

Alprazolam is available with a prescription under the brand names Xanax and Niravam. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

SIDE EFFECTS

Side effects to alprazolam tablets, if they occur, are generally observed at the beginning of therapy and usually disappear upon continued medication. In the usual patient, the most frequent side effects are likely to be an extension of the pharmacological activity of alprazolam (e.g., drowsiness or light-headedness).

The data cited in TABLE 1 and TABLE 2 are estimates of untoward clinical event incidence among patients who participated under the following clinical conditions: relatively short duration (i.e., 4 weeks) placebo-controlled clinical studies with dosages up to 4 mg/day of alprazolam (for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety) and short-term (up to 10 weeks) placebo-controlled clinical studies with dosages up to 10 mg/day of alprazolam in patients with panic disorder, with or without agoraphobia.

These data cannot be used to predict precisely the incidence of untoward events in the course of usual medical practice where patient characteristics, and other factors often differ from those in clinical trials. These figures cannot be compared with those obtained from other clinical studies involving related drug products and placebo as each group of drug trials are conducted under a different set of conditions.

Comparison of the cited figures, however, can provide the prescriber with some basis for estimating the relative contributions of drug and non-drug factors to the untoward event incidence in the population studied. Even this use must be approached cautiously, as a drug may relieve a symptom in one patient but induce it in others. (For example, an anxiolytic drug may relieve dry mouth [a symptom of anxiety] in some subjects but induce it [an untoward event] in others.)

Additionally, for anxiety disorders the cited figures can provide the prescriber with an indication as to the frequency with which physician intervention (e.g., increased surveillance, decreased dosage or discontinuation of drug therapy) may be necessary because of the untoward clinical event (see TABLE 1).

TABLE 1 Anxiety Disorders
  Treatment-Emergent Symptom Incidence * Incidence of Intervention Because of Symptom
  Alprazolam Placebo Alprazolam

Number of Patients

 565 505 565
  % of Patients Reporting
 Central Nervous System
Drowsiness 41.0 21.6 15.1
Light-headedness 20.8 19.3 1.2
Depression 13.9 18.1 2.4
Headache 12.9 19.6 1.1
Confusion 9.9 10.0 0.9
Insomnia 8.9 18.4 1.3
Nervousness 4.1 10.3 1.1
Syncope 3.1 4.0 †
Dizziness 1.8 0.8 2.5
Akathisia 1.6 1.2 †
Tiredness/Sleepiness † † 1.8
 Gastrointestinal
Dry Mouth 14.7 13.3 0.7
Constipation 10.4 11.4 0.9
Diarrhea 10.1 10.3 1.2
Nausea/Vomiting 9.6 12.8 1.7
Increased Salivation 4.2 2.4 †
 Cardiovascular
Tachycardia/Palpitations 7.7 15.6 0.4
Hypotension 4.7 2.2 †
 Sensory
Blurred Vision 6.2 6.2 0.4
 Musculoskeletal
Rigidity 4.2 5.3 †
Tremor 4.0 8.8 0.4
 Cutaneous
Dermatitis/Allergy 3.8 3.1 0.6
 Other
Nasal Congestion 7.3 9.3 †
Weight Gain 2.7 2.7 †
Weight Loss 2.3 3.0 †
* Events reported by 1% or more of alprazolam patients are included.
† None reported.

In addition to the relatively common (i.e., greater than 1%) untoward events enumerated in TABLE 1, the following adverse events have been reported in association with the use of benzodiazepines: dystonia, irritability, concentration difficulties, anorexia, transient amnesia or memory impairment, loss of coordination, fatigue, seizures, sedation, slurred speech, jaundice, musculoskeletal weakness, pruritus, diplopia, dysarthria, changes in libido, menstrual irregularities, incontinence, and urinary retention (see TABLE 2).

TABLE 2 Panic Disorders
  Treatment-Emergent Symptom Incidence*
  Alprazolam Placebo

Number of Patients

 1388 1231
  % of Patients Reporting
 Central Nervous System
Drowsiness 76.8 42.7
Fatigue and Tiredness 48.6 42.3
Impaired Coordination 40.1 17.9
Irritability 33.1 30.1
Memory Impairment 33.1 22.1
Light-headedness/Dizziness 29.8 36.9
Insomnia 29.4 41.8
Headache 29.2 35.6
Cognitive Disorder 28.8 20.5
Dysarthria 23.3 6.3
Anxiety 16.6 24.9
Abnormal Involuntary Movement 14.8 21.0
Decreased Libido 14.4 8.0
Depression 13.8 14.0
Confusional State 10.4 8.2
Muscular Twitching 7.9 11.8
Increased Libido 7.7 4.1
Change in Libido (Not Specified) 7.1 5.6
Weakness 7.1 8.4
Muscle Tone Disorders 6.3 7.5
Syncope 3.8 4.8
Akathisia 3.0 4.3
Agitation 2.9 2.6
Disinhibition 2.7 1.5
Paresthesia 2.4 3.2
Talkativeness 2.2 1.0
Vasomotor Disturbances 2.0 2.6
Derealization 1.9 1.2
Dream Abnormalities 1.8 1.5
Fear 1.4 1.0
Feeling Warm 1.3 0.5
 Gastrointestinal
Decreased Salivation 32.8 34.2
Constipation 26.2 15.4
Nausea/Vomiting 22.0 31.8
Diarrhea 20.6 22.8
Abdominal Distress 18.3 21.5
Increased Salivation 5.6 4.4
 Cardio-Respiratory
Nasal Congestion 17.4 16.5
Tachycardia 15.4 26.8
Chest Pain 10.6 18.1
Hyperventilation 9.7 14.5
Upper Respiratory Infection 4.3 3.7
 Sensory
Blurred Vision 21.0 21.4
Tinnitus 6.6 10.4
 Musculoskeletal
Muscular Cramps 2.4 2.4
Muscle Stiffness 2.2 3.3
 Cutaneous
Sweating 15.1 23.5
Rash 10.8 8.1
 Other
Increased Appetite 32.7 22.8
Decreased Appetite 27.8 24.1
Weight Gain 27.2 17.9
Weight Loss 22.6 16.5
Micturition Difficulties 12.2 8.6
Menstrual Disorders 10.4 8.7
Sexual Dysfunction 7.4 3.7
Edema 4.9 5.6
Incontinence 1.5 0.6
Infection 1.3 1.7
* Events reported by 1% or more of alprazolam patients are included.

In addition to the relatively common (i.e., greater than 1%) untoward events enumerated in TABLE 2, the following adverse events have been reported in association with the use of alprazolam: seizures, hallucinations, depersonalization, taste alterations, diplopia, elevated bilirubin, elevated hepatic enzymes, and jaundice.

There have also been reports of withdrawal seizures upon rapid decrease or abrupt discontinuation of alprazolam tablets (see WARNINGS).

To discontinue treatment in patients taking alprazolam, the dosage should be reduced slowly in keeping with good medical practice. It is suggested that the daily dosage of alprazolam be decreased by no more than 0.5 mg every 3 days (see DOSAGE AND ADMINISTRATION). Some patients may benefit from an even slower dosage reduction. In a controlled postmarketing discontinuation study of panic disorder patients which compared this recommended taper schedule with a slower taper schedule, no difference was observed between the groups in the proportion of patients who tapered to zero dose; however, the slower schedule was associated with a reduction in symptoms associated with a withdrawal syndrome.

Panic disorder has been associated with primary and secondary major depressive disorders and increased reports of suicide among untreated patients. Therefore, the same precaution must be exercised when using doses of alprazolam greater than 4 mg/day in treating patients with panic disorders as is exercised with the use of any psychotropic drug in treating depressed patients or those in whom there is reason to expect concealed suicidal ideation or plans.

As with all benzodiazepines, paradoxical reactions such as stimulation, increased muscle spasticity, sleep disturbances, hallucinations, and other adverse behavioral effects such as agitation, rage, irritability, and aggressive or hostile behavior have been reported rarely. In many of the spontaneous case reports of adverse behavioral effects, patients were receiving other CNS drugs concomitantly and/or were described as having underlying psychiatric conditions. Should any of the above events occur, alprazolam should be discontinued. Isolated published reports involving small numbers of patients have suggested that patients who have borderline personality disorder, a prior history of violent or aggressive behavior, or alcohol or substance abuse may be at risk for such events. Instances of irritability, hostility, and intrusive thoughts have been reported during discontinuation of alprazolam in patients with post¾traumatic stress disorder.

Laboratory analyses were performed on patients participating in the clinical program for alprazolam. The following incidences of abnormalities shown in TABLE 3 were observed in patients receiving alprazolam and in patients in the corresponding placebo group. Few of these abnormalities were considered to be of physiological significance.

TABLE 3
  Alprazolam Placebo
  Low High Low High
 Hematology
Hematocrit * * * *
Hemoglobin * * * *
Total WBC Count 1.4 2.3 1.0 2.0
Neutrophil Count 2.3 3.0 4.2 1.7
Lymphocyte Count 5.5 7.4 5.4 9.5
Monocyte Count 5.3 2.8 6.4 *
Eosinophil Count 3.2 9.5 3.3 7.2
Basophil Count * * * *
 Urinalysis
Albumin ¾ * ¾ *
Sugar ¾ * ¾ *
RBC/HPF ¾ 3.4 ¾ 5.0
WBC/HPF ¾ 25.7 ¾ 25.9
 Blood Chemistry
Creatinine 2.2 1.9 3.5 1.0
Bilirubin * 1.6 * *
SGOT * 3.2 1.0 1.8
Alkaline Phosphatase * 1.7 * 1.8
* Less than 1%.

When treatment with alprazolam is protracted, periodic blood counts, urinalysis, and blood chemistry analyses are advisable.

Minor changes in EEG patterns, usually low-voltage fast activity have been observed in patients during therapy with alprazolam and are of no known significance.

Post Introduction Reports: Various adverse drug reactions have been reported in association with the use of alprazolam since market introduction. The majority of these reactions were reported through the medical event voluntary reporting system. Because of the spontaneous nature of the reporting of medical events and the lack of controls, a causal relationship to the use of alprazolam cannot be readily determined. Reported events include: liver enzyme elevations, hepatitis, hepatic failure, Stevens¾Johnson syndrome, hyperprolactinemia, gynecomastia, and galactorrhea.

DRUG ABUSE AND DEPENDENCE

Physical and Psychological Dependence

Withdrawal symptoms similar in character to those noted with sedative/hypnotics and alcohol have occurred following discontinuance of benzodiazepines, including alprazolam. The symptoms can range from mild dysphoria and insomnia to a major syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors, and convulsions. Distinguishing between withdrawal emergent signs and symptoms and the recurrence of illness is often difficult in patients undergoing dose reduction. The long term strategy for treatment of these phenomena will vary with their cause and the therapeutic goal. When necessary, immediate management of withdrawal symptoms requires re-institution of treatment at doses of alprazolam sufficient to suppress symptoms. There have been reports of failure of other benzodiazepines to fully suppress these withdrawal symptoms. These failures have been attributed to incomplete cross-tolerance but may also reflect the use of an inadequate dosing regimen of the substituted benzodiazepine or the effects of concomitant medications.

While it is difficult to distinguish withdrawal and recurrence for certain patients, the time course and the nature of the symptoms may be helpful. A withdrawal syndrome typically includes the occurrence of new symptoms, tends to appear toward the end of taper or shortly after discontinuation, and will decrease with time. In recurring panic disorder, symptoms similar to those observed before treatment may recur either early or late, and they will persist.

While the severity and incidence of withdrawal phenomena appear to be related to dose and duration of treatment, withdrawal symptoms, including seizures, have been reported after only brief therapy with alprazolam at doses within the recommended range for the treatment of anxiety (e.g., 0.75-4 mg/day). Signs and symptoms of withdrawal are often more prominent after rapid decrease of dosage or abrupt discontinuance. The risk of withdrawal seizures may be increased at doses above 4 mg/day (see WARNINGS).

Patients, especially individuals with a history of seizures or epilepsy, should not be abruptly discontinued from any CNS depressant agent, including alprazolam. It is recommended that all patients on alprazolam who require a dosage reduction be gradually tapered under close supervision (see WARNINGS and DOSAGE AND ADMINISTRATION).

Psychological dependence is a risk with all benzodiazepines, including alprazolam. The risk of psychological dependence may also be increased at doses greater than 4 mg/day and with longer term use, and this risk is further increased in patients with a history of alcohol or drug abuse. Some patients have experienced considerable difficulty in tapering and discontinuing from alprazolam, especially those receiving higher doses for extended periods. Addiction-prone individuals should be under careful surveillance when receiving alprazolam. As with all anxiolytics, repeat prescriptions should be limited to those who are under medical supervision.

Controlled Substance Class

Alprazolam is a controlled substance under the Controlled Substance Act by the Drug Enforcement Administration and alprazolam tablets have been assigned to Schedule IV.

DRUG INTERACTIONS

The benzodiazepines, including alprazolam, produce additive CNS depressant effects when co-administered with other psychotropic medications, anticonvulsants, antihistaminics, ethanol, and other drugs which themselves produce CNS depression.

The steady state plasma concentrations of imipramine and desipramine have been reported to be increased an average of 31% and 20%, respectively, by the concomitant administration of alprazolam tablets in doses up to 4 mg/day. The clinical significance of these changes is unknown.

Drugs That Inhibit Alprazolam Metabolism Via Cytochrome P450 3A: The initial step in alprazolam metabolism is hydroxylation catalyzed by cytochrome P450 3A (CYP 3A). Drugs which inhibit this metabolic pathway may have a profound effect on the clearance of alprazolam (see CONTRAINDICATIONS and WARNINGS for additional drugs of this type).

Drugs Demonstrated to be CYP 3A Inhibitors of Possible Clinical Significance on the Basis of Clinical Studies Involving Alprazolam (caution is recommended during coadministration with alprazolam):

Fluoxetine: Coadministration of fluoxetine with alprazolam increased the maximum plasma concentration of alprazolam by 46%, decreased clearance by 21%, increased half-life by 17%, and decreased measured psychomotor performance.
Propoxyphene: Coadministration of propoxyphene decreased the maximum plasma concentration of alprazolam by 6%, decreased clearance by 38%, and increased half-life by 58%.
Oral Contraceptives: Coadministration of oral contraceptives increased the maximum plasma concentration of alprazolam by 18%, decreased clearance by 22%, and increased half-life by 29%.

Drugs and other substances demonstrated to be CYP 3A inhibitors on the basis of clinical studies involving benzodiazepines metabolized similarly to alprazolam or on the basis of in vitro studies with alprazolam or other benzodiazepines (caution is recommended during coadministration with alprazolam): Available data from clinical studies of benzodiazepines other than alprazolam suggest a possible drug interaction with alprazolam for the following: diltiazem, isoniazid, macrolide antibiotics such as erythromycin and clarithromycin, and grapefruit juice. Data from in vitro studies of alprazolam suggest a possible drug interaction with alprazolam for the following: sertraline and paroxetine. Data from in vitro studies of benzodiazepines other than alprazolam suggest a possible drug interaction for the following: ergotamine, cyclosporine, amiodarone, nicardipine, and nifedipine. Caution is recommended during the coadministration of any of these with alprazolam (see WARNINGS).

 Adderall
 

ADDERALLÒ CII

AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS, AND THE DRUGS SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY.

MISUSE OF AMPHETAMINE MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EVENTS.

  Patient Information from WebMD
  • • Adderall is sometimes used to treat ADHD. Visit WebMD for additional health information on ADHD.

DESCRIPTION

A single entity amphetamine product combining the neutral sulfate salts of dextroamphetamine and amphetamine, with the dextro isomer of amphetamine saccharate and d, l-amphetamine aspartate monohydrate.

EACH TABLET CONTAINS:
5 mg
7.5 mg
10 mg
12.5 mg
15 mg
20mg
30 mg
Dextroamphetamine Saccharate
1.25 mg
1.875 mg
2.5 mg
3.125 mg
3.75 mg
5 mg
7.5 mg
Amphetamine Aspartate Monohydrate
1.25 mg
1.875 mg
2.5 mg
3.125 mg
3.75 mg
5 mg
7.5 mg
Dextroamphetamine Sulfate USP
1.25 mg
1.875 mg
2.5 mg
3.125 mg
3.75 mg
5 mg
7.5 mg
Amphetamine Sulfate USP
1.25 mg
1.875 mg
2.5 mg
3.125 mg
3.75 mg
5 mg
7.5 mg
Total amphetamine base equivalence
3.13 mg
4.7 mg
6.3 mg
7.8 mg
9.4 mg
12.6 mg
18.8 mg

 Use

Adderall was introduced in 1996 as instant-release tablets, which has since become available as the generic formulation "mixed amphetamine salts." The active ingredients of Adderall include a combination of dextroamphetamine and racemic amphetamine salts. Shire later introduced a gradual-release preparation of these ingredients, Adderall XR (extended release), and retains patent rights on Adderall XR that will expire in 2007.

In particular, Adderall XR is comprised of the following proportions of active ingredients:

The four component salts are claimed to be metabolized at different rates, thereby imparting a more gradual and "smoother" build-up and decline in effect compared to amphetamine preparations comprising only a single salt.

The average elimination half-life for dextroamphetamine is 10 hours in adults, and for levoamphetamine, 13 hours. Its effects are otherwise similar to other central nervous system stimulants (see amphetamine for details.).

The manufacturer claims that the mixture of salts makes Adderall's effects smoother, with softer highs and lows, than those of other treatments for the same disorders.

There is little evidence, however, to support this claim for immediate-release. A recent patent application for Adderall (USP #6,384,020) was a pharmaceutical composition patent listing a rapid immediate release oral dosage form. No claim of increased or smooth drug delivery was made. A recent double-blind, placebo-controlled crossover study, conducted among children, indicated that patients behaved similarly to other immediate release amphetamines. The authors found that sustained-release dexamphetamine (the main isomeric-amphetamine component of Adderall) had a longer duration of action, and cost less than Adderall, though dexamphetamine was less effective in the first few hours.[1]

Adderall is now sold in either an immediate-release tablet or an extended-release capsule, marketed as Adderall XR (for "eXtended Release"). Doses for both immediate-release and extended-release form come in 5, 10, 15, 20, 25 and 30 mg increments.

Adderall XR utilizes the Microtrol® delivery system to achieve the extended-release mechanism. This delivery system incorporates two beads: the first type of bead dissolves immediately and the second type releases four hours later. Maximum plasma concentration is achieved in seven hours, compared to regular Adderall IR (immediate-release) which reaches maximum plasma concentration within three hours. As a result of its high bioavailability, Adderall XR's effectiveness is not altered by food absorption in the gastrointestinal tract. However, tmax (mean plasma concentration) is prolonged by 2.5 hours (using a standard high-fat meal as the control). Acidic beverages should not be ingested with Adderall XR as they alter the pH balance of the stomach.[2]

 Effects

While the exact mechanism is unknown, it is believed that Adderall works by blocking the reuptake of dopamine and norepinephrine into the presynaptic neuron and increasing their release from the presynaptic neuron into the extraneuronal space. In other words, Adderall reverses the reuptake mechanism, turning it into a pump instead of a vacuum. Sources note that amphetamine and related compounds (ephedrine, etc.) displace noradrenaline from the presynaptic neuron and do not act as reuptake inhibitors as referenced above. [citation needed]

The increased flow of dopamine and norepinephrine into the extraneuronal space causes the patients' brain, as one psychiatrist explains,[citation needed] to experience a more intense level of concentration, causing an increased ability to focus for extended periods of time, and a heightened interest in performing focus based tasks.

Some patients feel they are less creative while taking Adderall, while others report that it can aid in creative work.[citation needed] The famous Beat generation writer Jack Kerouac, for instance, is said to have written much of his classic On The Road in a span of three weeks, aided by amphetamine (an active ingredient in Adderall) from Benzedrine inhalers; country music star Johnny Cash had a long period of amphetamine use in the 1960s; and mathematician Paul Erdős was noted for habitual use of prescription amphetamine throughout the final decades of his life; Smile was written by Brian Wilson and Van Dyke Parks with heavy amphetamine use, among others. All of these probably knew the drug by its common name, speed.

Double-blind, placebo-controlled studies of dextroamphetamine in normal subjects have shown significant performance increases on cognitive tasks and decreased reaction time. http://www.sciencemag.org/cgi/content/abstract/199/4328/560

Amphetamines have been shown to pass through into breast milk. Because of this, mothers taking medications containing amphetamines are advised to avoid nursing during their course of treatment. (http://www.fda.gov/cder/foi/label/2004/021303s005lbl.pdf)

 Side effects

Common side effects of Adderall used as prescribed include: dry mouth, loss of appetite, difficulty falling asleep, headache, weight loss and erectile dysfunction

 Less common side effects

Some information in this article or section has not been verified and may not be reliable.
Please check for inaccuracies, and modify and cite sources as needed.

Less common side effects of Adderall used as prescribed include:Upset stomach, Nervousness, Mydriasis, Bruxism (teeth grinding), Urinary retention, Pyrexia, Tachycardia, Tics, Urticaria, Erectile Disorder, Increased urination, Blunted affect, Impaired growth in children

 Rare side effects

Some information in this article or section has not been verified and may not be reliable.
Please check for inaccuracies, and modify and cite sources as needed.

Rare side effects of Adderall used as prescribed include:Amphetamine psychosis[citation needed], high blood pressure, tourettism[citation needed], cardiomyopathy[citation needed], and hair loss[citation needed].

 Contraindications

Using any amphetamine, (including Adderall, methamphetamine or MDMA) within 1-2 weeks of taking a monoamine oxidase inhibitor (MAOI) can cause a potentially fatal condition known as serotonin syndrome.

 Performance-enhancing use

Because Adderall uses amphetamine stimulants to help the user concentrate for extended periods of time, many students today request Adderall from doctors in order to use it as a study aid. Thus, it is increasingly popular on college campuses. The largest benefit to students, however, is Adderall's ability to give students the power to focus on and learn what would usually be uninteresting material. Because of the appetite-suppressing properties of amphetamines, it is also sought after by those wishing to lose weight. Another less common use for students is to take Adderall before or during a night of heavy drinking in order to remain alert and active despite being intoxicated.

Research done by the National Institute of Drug Abuse (NIDA) shows the more competitive the college, the higher the incidence of stimulant use. An article published stated the findings of a nationwide survey of thousands of college students[3]. The findings of this past April 2006 survey shows 5.9% use rates among the more competitive campuses, compared to 1.3% use rates among less competitive campuses. Breaking down the use pattern