Metolazone

Pronunciation: meh-TOLE-uh-ZONE
Generic Name: Metolazone
Brand Name: Zaroxolyn

Metolazone is used for:

Treating high blood pressure. It may be used with other high blood pressure medicines. It may also be used for other conditions as determined by your doctor.

Metolazone is a quinazoline diuretic with actions similar to thiazide type diuretics (eg, hydrochlorothiazide). It works by causing the kidneys to eliminate certain chemicals, which in turn allow large amounts of water to be eliminated.

Do NOT use Metolazone if:

• you are allergic to any ingredient in Metolazone


• you are unable to urinate


• you have precoma or are in a coma caused by severe liver disease

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

Before using Metolazone:

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

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


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


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


• if you have lupus, kidney or liver disease, low blood sodium or potassium levels, or gout

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

• Nonsteroidal antiinflammatory drugs (NSAIDs) (eg, ibuprofen, naproxen) because they may decrease Metolazone's effectiveness


• Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), diazoxide, ketanserin, loop diuretics (eg, furosemide), NSAIDs (eg, ibuprofen, naproxen) because side effects, such as kidney problems, may occur


• ACE inhibitors (eg, enalapril), allopurinol, amantadine, antineoplastic agents (eg, cyclophosphamide), diazoxide, digitalis glycosides (eg, digoxin), ketanserin, lithium, loop diuretics (eg, furosemide), or nondepolarizing muscle relaxants (eg, vecuronium) because the risk of their side effects may be increased by Metolazone

This may not be a complete list of all interactions that may occur. Ask your health care provider if Metolazone may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Metolazone:

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

• Take Metolazone by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.


• Metolazone may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 pm.


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

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

Important safety information:

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


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


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


• Do not change brands of Metolazone without talking to your doctor. Products made by other companies may not work as well for you.


• Check with your doctor before you use a salt substitute or a product that has potassium in it.


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


• Metolazone should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.


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

Possible side effects of Metolazone:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Abnormal skin sensations; constipation; diarrhea; dizziness; feeling of a whirling motion; headache; impotence; joint pain; lightheadedness; loss of appetite; nausea; purple patches under the skin; skin sensitivity to sunlight; stomach bloating; stomach pain.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain/discomfort; depression; drowsiness; dry mouth; fainting; gout attacks; lightheadedness when rising from a seated position; muscle pain or cramps; rapid or irregular heartbeat; restlessness; unusual thirst; unusual tiredness or weakness; vomiting; yellowing of the skin or eyes.

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

See also: Metolazone side effects (in more detail)

If OVERDOSE is suspected:

Contact 1- 800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include dizziness; drowsiness; dry mouth; excessive urination followed by a decrease in amount of urine; fainting; irregular or weak heartbeat; lightheadedness when rising from a seated position; muscle cramps.

Proper storage of Metolazone:

Store Metolazone at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Metolazone out of the reach of children and away from pets.

General information:

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


• Metolazone is to be used only by the patient for whom it is prescribed. Do not share it with other people.


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Metolazone resources

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

• Metolazone Prescribing Information (FDA)


• Metolazone Professional Patient Advice (Wolters Kluwer)


• Metolazone Monograph (AHFS DI)


• metolazone Advanced Consumer (Micromedex) - Includes Dosage Information


• metolazone Concise Consumer Information (Cerner Multum)


• Mykrox Prescribing Information (FDA)


• Zaroxolyn Prescribing Information (FDA)

Compare Metolazone with other medications

• Edema
• High Blood Pressure

terbutaline

ter-BUE-ta-leen

Commonly used brand name(s)

In the U.S.

• Brethine

Available Dosage Forms:

• Elixir


• Tablet

Therapeutic Class: Bronchodilator

Pharmacologic Class: Sympathomimetic

Uses For terbutaline

Terbutaline is used to prevent bronchospasm in patients 12 years of age and older with asthma, bronchitis, emphysema, and other lung diseases.

Terbutaline belongs to the family of medicines known as bronchodilators. Bronchodilators are medicines that relax the muscles in the bronchial tubes (air passages) of the lungs. They relieve cough, wheezing, shortness of breath, and troubled breathing by increasing the flow of air through the bronchial tubes.

terbutaline is available only with your doctor's prescription.

Before Using terbutaline

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

Allergies

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

Pediatric

Use of terbutaline in children younger than 12 years of age is not recommended.

Geriatric

No information is available on the relationship of age to the effects of terbutaline in geriatric patients.

Pregnancy

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

Breast Feeding

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

Interactions with Medicines

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

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

• Acebutolol


• Alprenolol


• Arotinolol


• Atenolol


• Befunolol


• Betaxolol


• Bevantolol


• Bisoprolol


• Bopindolol


• Brofaromine


• Bucindolol


• Bupranolol


• Carteolol


• Carvedilol


• Celiprolol


• Clorgyline


• Dilevalol


• Esmolol


• Furazolidone


• Iproniazid


• Isocarboxazid


• Labetalol


• Landiolol


• Lazabemide


• Levobetaxolol


• Levobunolol


• Linezolid


• Mepindolol


• Metipranolol


• Metoprolol


• Moclobemide


• Nadolol


• Nebivolol


• Nialamide


• Nipradilol


• Oxprenolol


• Pargyline


• Penbutolol


• Phenelzine


• Pindolol


• Procarbazine


• Propranolol


• Rasagiline


• Selegiline


• Sotalol


• Talinolol


• Tertatolol


• Timolol


• Toloxatone


• Tranylcypromine

Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

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

• Diabetes or


• Heart or blood vessel disease or


• Heart rhythm problems (e.g., arrhythmia) or


• Hypertension (high blood pressure) or


• Hyperthyroidism (overactive thyroid) or


• Hypokalemia (low potassium in the blood) or


• Seizures—Use with caution. May make these conditions worse.

Proper Use of terbutaline

Take terbutaline exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Do not change or stop using terbutaline without checking first with your doctor.

You may be taking other medicines for asthma together with terbutaline. Do not stop taking these medicines and do not reduce the dose, even if your asthma seems better, unless you are told to do so by your doctor.

Dosing

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

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

• For oral dosage form (tablets):
  
  • For prevention of bronchospasm:
    
    • Adults and teenagers—5 milligrams (mg) three times a day. terbutaline is taken only during the hours the patient is usually awake. Your doctor may adjust your dose as needed. However, the dose is usually not more than 15 mg per 24 hours.
    
    
    • Children and teenagers 12 to 15 years of age—2.5 mg three times a day. Your doctor may adjust your dose as needed up. However, the dose is usually not more than 7.5 mg per 24 hours.
    
    
    • Children younger than 12 years of age—Use is not recommended.
    
    
  
  

Missed Dose

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

Storage

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

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

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

Precautions While Using terbutaline

It is very important that your doctor check the progress of you or your child at regular visits. This will allow your doctor to see if the medicine is working properly and to check for any unwanted effects.

Using terbutaline to prevent or treat preterm labor can harm pregnant women. terbutaline may increase risk of heart problems and other serious side effects when given to a pregnant woman for a long time. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Check with your doctor at once if difficulty with breathing continues after using a dose of terbutaline or if your condition gets worse.

You may also be taking an anti-inflammatory medicine (e.g., corticosteroids) for asthma along with terbutaline. Do not stop taking the anti-inflammatory medicine even if your asthma seems better, unless you are told to do so by your doctor.

If you develop a skin rash, hives, or any allergic reaction to terbutaline, stop using the medicine and check with your doctor right away.

Hypokalemia may occur with terbutaline. Check with your doctor right away if you or your child have more than one of the following symptoms: convulsions; decreased urine; dry mouth; increased thirst; irregular heartbeat; loss of appetite; mood changes; muscle pain or cramps; nausea or vomiting; numbness or tingling in the hands, feet, or lips; shortness of breath; or unusual tiredness or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.

terbutaline Side Effects

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

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

More common

• Shakiness in the legs, arms, hands, or feet


• trembling or shaking of the hands or feet

Less common

• Extra heartbeat


• feeling faint, dizzy, or lightheadedness


• feeling of warmth or heat


• flushing or redness of the skin, especially on the face and neck


• headache


• sweating

Rare

• Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings


• excessive muscle tone


• muscle stiffness


• muscle tension or tightness

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

• Arm, back, or jaw pain


• blurred vision


• chest pain or discomfort


• chest tightness or heaviness


• confusion


• convulsions


• decreased urine


• dizziness


• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position


• dry mouth


• fainting


• fast, pounding, or irregular heartbeat or pulse


• general feeling of discomfort or illness


• increased thirst


• loss of appetite


• mood changes


• muscle pain or cramps


• nausea or vomiting


• nervousness


• numbness or tingling in the hands, feet, or lips


• pounding in the ears


• seizures


• shortness of breath


• sleeplessness


• slow or fast heartbeat


• trouble sleeping


• unable to sleep


• unusual tiredness or weakness

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

More common

• Sleepiness or unusual drowsiness

Less common

• Anxiety


• lack or loss of strength

Rare

• Fever


• rash


• redness, soreness, or itching skin


• seeing, hearing, or feeling things that are not there


• sores, welting, or blisters

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

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

See also: terbutaline side effects (in more detail)

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

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

More terbutaline resources

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

• terbutaline Concise Consumer Information (Cerner Multum)


• Terbutaline MedFacts Consumer Leaflet (Wolters Kluwer)


• Terbutaline Prescribing Information (FDA)


• Brethaire Concise Consumer Information (Cerner Multum)


• Terbutaline Sulfate Monograph (AHFS DI)

Compare terbutaline with other medications

• Asthma, acute
• Asthma, Maintenance
• Premature Labor

Metro

Pronunciation: MET-roe-NYE-da-zole
Generic Name: Metronidazole
Brand Name: Generic only. No brands available.

Long-term use of Metro has caused cancer in mice and rats. Discuss any questions or concerns with your doctor. Do not use Metro for a condition other than the one for which it was prescribed.

Metro is used for:

Treating infections caused by certain bacteria and preventing infection before, during, and after certain surgeries. It may also be used for other conditions as determined by your doctor.

Metro is an antibacterial agent. It is thought to work by entering the bacterial cell, acting on some components of the cell, and destroying the bacteria.

Do NOT use Metro if:

• you are allergic to any ingredient in Metro or to other nitroimidazoles (eg, tinidazole)


• you are in the first 3 months of pregnancy


• you are taking busulfan, an ergot alkaloid (eg, ergotamine), or you have taken disulfiram within the past 2 weeks


• you are taking an HIV protease inhibitor that contains alcohol (eg, amprenavir solution); check with your pharmacist if you are unsure if the medicine contains alcohol


• you drink alcohol

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

Before using Metro:

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

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


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


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


• if you have nerve, brain, or blood problems; Crohn disease; or a history of liver problems or seizures


• if you have heart problems (eg, congestive heart failure) or a history of swelling of the hands, legs, or feet

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

• Disulfiram because side effects, such as mental or mood changes, may occur


• Amiodarone because the risk of irregular heartbeat may be increased


• Barbiturates (eg, phenobarbital) or phenytoin because they may decrease Metro's effectiveness


• Anticoagulants (eg, warfarin), busulfan, cyclosporine, ergot alkaloids (eg, ergotamine), HIV protease inhibitors containing alcohol (eg, amprenavir solution), lithium, or macrolide immunosuppressants (eg, tacrolimus) because the risk of their side effects may be increased by Metro


• Corticosteroids (eg, prednisone) because the risk of side effects may be increased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Metro may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Metro:

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

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


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


• To clear up your infection completely, use Metro for the full course of treatment. Keep using it even if you feel better in a few days.


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


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

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

Important safety information:

• Metro may cause dizziness. This effect may be worse if you take it with alcohol or certain medicines. Use Metro with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not drink alcohol while you are using Metro and for at least 1 day after the last dose.


• Contact your doctor right away if stomach pain or cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea without first checking with your doctor.


• Metro only works against bacteria; it does not treat viral infections (eg, the common cold).


• Be sure to use Metro for the full course of treatment. If you do not, the medicine may not clear up your infection completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future.


• Long-term or repeated use of Metro may cause a second infection. Tell your doctor if signs of a second infection occur. Your medicine may need to be changed to treat this.


• Some patients have developed persistent nerve problems (peripheral neuropathy) after using Metro for a long period of time. Tell your doctor right away if you develop signs of nerve problems (eg, numbness; tingling; burning of the arms, hands, legs, feet). Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.


• Metro may interfere with certain lab tests. Be sure your doctor and lab personnel know you are using Metro.


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


• Use Metro with caution in the ELDERLY; they may be more sensitive to its effects.


• Metro should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Metro while you are pregnant. Do not use Metro in the first 3 months of pregnancy. Metro is found in breast milk. Do not breast-feed while using Metro.

Possible side effects of Metro:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Appetite loss; constipation; diarrhea; dizziness; headache; metallic taste; nausea; pain, swelling, or redness at the injection site; stomach upset; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; fever; flushing; stuffy nose; very dry mouth or vagina); bloody stools; decreased coordination; increased or decreased urination; numbness, tingling, or burning of the arms, hands, legs, or feet; red, swollen, blistered, or peeling skin; seizures; severe diarrhea; severe or persistent dizziness or headache; sore throat, chills, or fever; speech problems; stiff neck; stomach pain or cramps; vaginal itching, odor, or discharge; vision loss or other vision changes; white patches in the mouth.

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

See also: Metro side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include nausea; seizures; vomiting.

Proper storage of Metro:

Metro is usually handled and stored by a health care provider. If you are using Metro at home, store Metro as directed by your pharmacist or health care provider.

General information:

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


• Metro is to be used only by the patient for whom it is prescribed. Do not share it with other people.


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Metro resources

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

Compare Metro with other medications

• Amebiasis
• Aspiration Pneumonia
• Bacteremia
• Bacterial Infection
• Bacterial Vaginitis
• Bone infection
• Clostridial Infection
• Crohn's Disease, Acute
• Crohn's Disease, Maintenance
• Deep Neck Infection
• Dental Abscess
• Diverticulitis
• Dracunculiasis
• Endocarditis
• Giardiasis
• Helicobacter Pylori Infection
• Intraabdominal Infection
• Joint Infection
• Meningitis
• Pelvic Inflammatory Disease
• Peritonitis
• Pneumonia
• Pseudomembranous Colitis
• Skin Infection
• Surgical Prophylaxis
• Trichomoniasis

Methscopolamine Bromide

Class: Antimuscarinics/Antispasmodics
VA Class: AU350
Chemical Name: [7(S) - 1α,2β,4β,5α,7β] - 7 - (3 - hydroxy - 1 - oxo - 2 - phenylpropoxy) - 9,9 - dimethyl - 3 - oxa - 9 - azoniatricyclo[3,3,1,02,4] nonane bromide
Molecular Formula: C₁₈H₂₄BrNO₄
CAS Number: 155-41-9
Brands: Pamine

Introduction

Antimuscarinic; semisynthetic quaternary ammonium derivative of scopolamine.^{a b d}

Uses for Methscopolamine Bromide

Peptic Ulcer Disease

Adjunctive therapy in the treatment of peptic ulcer disease;^{a b c d} however, no conclusive data that antimuscarinics aid in the healing, decrease the rate of recurrence, or prevent complications of peptic ulcers.^{a b c d}

With the advent of more effective therapies for the treatment of peptic ulcer disease, antimuscarinics have only limited usefulness in this condition. ^{a c}

Methscopolamine Bromide Dosage and Administration

Administration

Administer orally 30 minutes before meals and at bedtime.^{a b d}

Dosage

Available as methscopolamine bromide; dosage expressed in terms of the salt.^{a b}

As with other antimuscarinics, may require a higher than recommended dosage for therapeutic effect.^c Titrate dosage carefully according to individual requirements and response.^{a d} Administer lowest effective dosage to minimize risk and occurrence of adverse effects.^{a c d}

Pediatric Patients

Peptic Ulcer Disease†

Oral

0.2 mg/kg or 6 mg/m² daily in 4 equally divided doses has been recommended by some clinicians.^a (See Pediatric Use under Cautions.)

Adults

Peptic Ulcer Disease

Oral

Initially, 2.5 mg 3 times daily before meals and 2.5–5 mg at bedtime.^{a b d} Manufacturer states that an initial total daily dosage of 12.5 mg is effective in most patients.^{a b d}

Patients with severe symptoms (e.g., abdominal pain, cramping): Initially, 5 mg 3 times daily before meals and once at bedtime (total daily dosage of 20 mg).^{a b d} If patient experiences adverse effects, reduce dosage; if symptoms are unrelieved and there are no adverse effects, may increase dosage.^{b d} Some patients may tolerate a total daily dosage up to 30 mg.^{a b d}

Patients who experience severe adverse effects without appreciable relief of symptoms should be considered unsuitable candidates for continued therapy and likely will be intolerant of other antimuscarinics.^{b d} If methscopolamine is used in patients with a history of increased susceptibility to adverse effects from antimuscarinics, initiate drug at a low dosage.^{a b d}

Special Populations

No special population dosage recommendations at this time.^{a b d}

Cautions for Methscopolamine Bromide

Contraindications

• 
  

  Glaucoma (to avoid mydriasis).^{b c d}

  
  


• 
  

  Obstructive uropathy (e.g., bladder neck obstruction caused by prostatic hypertrophy).^{b c d}

  
  


• 
  

  Obstructive GI disease (e.g., pyloroduodenal stenosis, paralytic ileus).^{b c d}

  
  


• 
  

  Intestinal atony (especially in geriatric and debilitated patients).^{b c d}

  
  


• 
  

  Unstable cardiovascular status in acute hemorrhage.^{b c d}

  
  


• 
  

  Severe ulcerative colitis or toxic megacolon complicating ulcerative colitis.^{b c d}

  
  


• 
  

  Myasthenia gravis.^{b c d}

  
  


• 
  

  Known hypersensitivity to methscopolamine or to similar drugs.^{b c d}

  
  

Warnings/Precautions

Warnings

Thermoregulatory Effects

High environmental temperatures may result in heat prostration (e.g., fever, heat stroke) due to decreased sweating.^{b c d}

Diarrhea

May be an early sign of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy.^{b c d} Do not use in such patients; use would be inappropriate and possibly harmful.^{b d}

CNS Effects

Risk of drowsiness or blurred vision.^{b c d} Performance of activities requiring mental alertness (e.g., operating machinery, driving a motor vehicle, performing hazardous work) may be impaired.^{b c d} (See Advice to Patients.)

Overdosage

A curare-like action may occur (i.e., neuromuscular blockade leading to muscular weakness and possible paralysis).^{b d}

Sensitivity Reactions

Hypersensitivity Reactions

Severe allergic reactions and drug idiosyncrasies including anaphylaxis have been reported.^{b d}

General Precautions

GI Effects

Caution in patients with gastric ulcer because of delayed gastric emptying and possible antral stasis.^c

Caution in patients with ulcerative colitis; large doses may suppress intestinal motility, resulting in paralytic ileus and toxic megacolon.^{b c d}

Caution in patients with known or suspected GI infections (e.g., Clostridium difficile-associated diarrhea and colitis, shigellosis, dysentery).^c

Concomitant Illnesses

Use with caution in patients with hyperthyroidism, autonomic neuropathy, CHD, CHF, tachyarrhythmia, hypertension, or prostatic hypertrophy.^{b d}

Laboratory Monitoring

Perform radiography (contrast examination of upper GI tract) or endoscopy to ensure ulcer healing during therapy.^{b d}

Perform periodic hematocrit and hemoglobin tests and test for occult blood in stool during therapy to rule out bleeding from the ulcer.^{b d}

Specific Populations

Pregnancy

Category C.^{b d}

Lactation

Not known whether methscopolamine is distributed into human milk.^{b d} Caution if used in nursing women.^{b d}

May suppress lactation.^{b c d}

Pediatric Use

Safety and efficacy not established.^{b c d}

Geriatric Use

Use with caution.^{b c d}

Hepatic Impairment

Use with caution in patients with hepatic disease.^{b c d}

Renal Impairment

Use with caution in patients with renal disease.^{b c d}

Common Adverse Effects

Xerostomia,^b decreased sweating,^b adverse ocular effects (e.g., blurred vision, mydriasis, cycloplegia, increased ocular tension).^{b c d}

Interactions for Methscopolamine Bromide

Drugs with Anticholinergic Effects

Additive adverse effects resulting from cholinergic blockade (e.g., xerostomia, blurred vision, constipation).^c Advise of possibility of increased anticholinergic effects.^c

Orally Administered Drugs

Potential pharmacokinetic interaction (altered GI absorption of various drugs).^c Antimuscarinics may inhibit GI motility, delay gastric emptying, and prolong GI transit time.^c

Specific Drugs

Drug	Interaction	Comments
Amantadine	Possible additive adverse anticholinergic effectsc	Inform patient of possibilityc
Antacids	Possible decreased absorption of methscopolamineb c d	Administer methscopolamine at least 1 hour before antacidsc
Antiarrhythmic agents (e.g., disopyramide, procainamide, quinidine)	Possible additive adverse anticholinergic effectsc	Inform patient of possibilityc
Anticholinergic agents	Risk of additive adverse anticholinergic effectsc	Inform patient of riskc
Antidepressants, tricyclic	Possible additive adverse anticholinergic effectsb c d	Inform patient of possibilityc
Antihistamines	Possible additive adverse anticholinergic effectsc	Inform patient of possibilityc
Antiparkinsonian agents	Possible additive adverse anticholinergic effectsc	Inform patient of possibilityc
Corticosteroids	Possible increased IOPc
Ketoconazole	Possible decreased ketoconazole absorptionc	Administer antimuscarinic ≥2 hours after ketoconazolec
Levodopa	Possible increased gastric levodopa metabolism, resulting in decreased levodopa absorptionc	Possible levodopa toxicity if antimuscarinic is discontinued without a concomitant reduction in levodopa dosagec
Meperidine	Possible additive adverse anticholinergic effectsc	Inform patient of possibilityc
Phenothiazines	Possible additive adverse anticholinergic effectsb c d	Inform patient of possibilityc
Potassium chloride	Antimuscarinics may slow GI transit, increasing risk of potassium chloride GI mucosal toxicityc	Administer concomitantly with caution (especially with wax matrix potassium chloride preparations)c
Skeletal muscle relaxants	Possible additive adverse anticholinergic effectsc	Inform patient of possibilityc

Methscopolamine Bromide Pharmacokinetics

Absorption

Bioavailability

Incompletely absorbed from the GI tract because completely ionized.^{a b d}

Onset

Following oral administration, drug effects occur in about 1 hour.^{b d}

Duration

Effects persist 4–6 hours after oral administration.^{b d}

Distribution

Extent

Quaternary ammonium antimuscarinics are completely ionized and possess poor lipid solubility; do not readily cross blood-brain barrier or penetrate the CNS or eye.^{a b c d}

Not known whether methscopolamine crosses the placenta or is distributed into human milk.^{b c d}

Elimination

Elimination Route

Principally in urine and bile (as unchanged drug and metabolites) and in feces (as unabsorbed drug).^{a b d}

Stability

Storage

Oral

Tablets

Tight containers at 15–30°C.^{a b}

ActionsActions

• 
  

  Competitively inhibits acetylcholine or other cholinergic stimuli at autonomic effectors innervated by postganglionic cholinergic nerves and, to a lesser extent, on smooth muscles that lack cholinergic innervation.^c

  
  


• 
  

  At usual doses, antimuscarinics principally antagonize cholinergic stimuli at muscarinic receptors and have little or no effect on cholinergic stimuli at nicotinic receptors. ^c

  
  


• 
  

  Antimuscarinics also have been referred to as anticholinergics (cholinergic blocking agents), but this term is appropriate only when it describes the antagonism of cholinergic stimuli at any cholinergic receptor, whether muscarinic or nicotinic.^c

  
  


• 
  

  Antimuscarinics also have been referred to as parasympatholytics since the antagonized functions principally are under the parasympathetic division of the nervous system.^c

  
  


• 
  

  Methscopolamine reduces volume and total acid content of gastric secretions.^{b d}

  
  


• 
  

  Inhibits GI motility and salivary excretion.^{b d}

  
  


• 
  

  Dilates the pupil and inhibits accommodation.^{b d}

  
  

Advice to Patients

• 
  

  Potential for hyperthermia and heat prostration; avoid exposure to high environmental temperature and use with caution when febrile.^{b c d}

  
  


• 
  

  Risk of drowsiness or blurred vision; exercise caution when performing activities requiring mental alertness (e.g., driving a motor vehicle, operating machinery) or when performing other hazardous work.^{b d}

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.^{b d}

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^{b d}

  
  


• 
  

  Importance of informing patients of other important precautionary information.^{b d} (See Cautions.)

  
  

Preparations

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

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Methscopolamine Bromide

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Tablets	2.5 mg*	Methscopolamine Bromide Tablets	Boca
			Pamine	Kenwood
		5 mg*	Methscopolamine Bromide Tablets	Boca
			Pamine Forte	Kenwood

Disclaimer

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

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

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions June 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

a. AHFS Drug Information 2008. McEvoy GK, ed. Methscopolamine. Bethesda, MD: American Society of Health-System Pharmacists; 2008:1319.

b. Kenwood Therapeutics. Pamine Forte and Pamine (methscopolamine bromide) prescribing information. Fairfield, NJ; 2005 May.

c. AHFS Drug Information 2008. McEvoy GK, ed. Antimuscarinics/Antispasmodics General Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2008:1293-1300.

d. Boca Pharmacal, Inc. Methscopolamine bromide tablets prescribing information. Coral Springs, FL; 2006 Jan.

More Methscopolamine Bromide resources

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

• Methscopolamine Prescribing Information (FDA)


• methscopolamine Concise Consumer Information (Cerner Multum)


• Methscopolamine MedFacts Consumer Leaflet (Wolters Kluwer)


• Pamine Prescribing Information (FDA)

Compare Methscopolamine Bromide with other medications

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• Peptic Ulcer

Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets

Pronunciation: KLOR-fen-IR-a-meen/FEN-il-EF-rin/METH-skoe-POL-a-meen
Generic Name: Chlorpheniramine/Phenylephrine/Methscopolamine
Brand Name: Examples include Aerohist Plus and Dallergy

Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets are used for:

Relieving congestion, sneezing, runny nose, and itchy, watery eyes due to colds, flu, or hay fever. It may also be used for other conditions as determined by your doctor.

Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets are an antihistamine, decongestant, and anticholinergic combination. It works by blocking histamine, a substance in the body that causes sneezing, runny nose, and watery eyes. It also relieves nasal congestion by shrinking the nasal mucous membranes, which promotes nasal drainage, and dries the chest by decreasing lung secretions.

Do NOT use Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets if:

• you are allergic to any ingredient in Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets


• you are pregnant or breast-feeding


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


• you have a history of narrow-angle glaucoma, blockage in the stomach or intestines, peptic ulcer disease, intestinal or bowel problems, difficulty urinating, inflammation of the esophagus from reflux disease, difficulty swallowing, or uncontrolled bleeding


• you have severe heart disease or severe high blood pressure

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

Before using Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets:

Some medical conditions may interact with Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

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


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


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


• if you are taking or have taken medicine for high blood pressure or depression in the last 14 days


• if you have diabetes, an enlarged prostate, a history of bladder or kidney problems, high blood pressure, diarrhea, asthma, nerve problems, heart problems, blood clots, a hiatal hernia, an adrenal gland tumor, glaucoma or increased pressure in the eye, breathing problems during sleep, myasthenia gravis (muscle weakness), lung problems, liver problems, Down syndrome, blood vessel problems, or an overactive thyroid

Some MEDICINES MAY INTERACT with Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Alpha-blockers (eg, guanethidine, methyldopa, prazosin), beta-blockers (eg, atenolol), diuretics (eg, furosemide, hydrochlorothiazide), furazolidone, or MAOIs (eg, phenelzine) because the risk of high or low blood pressure may be increased


• Alkalizers (eg, calcium or magnesium antacids), anticholinergics (eg, atropine, benztropine, dicyclomine), carbonic anhydrase inhibitors (eg, acetazolamide), ergotamine, sodium bicarbonate, or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets's side effects


• Bromocriptine, catechol-O-methyltransferase (COMT) inhibitors (eg, entacapone), certain stimulants (eg, doxapram, pseudoephedrine), cocaine, digoxin, droxidopa, potassium chloride, or sodium oxybate ( GHB) because the risk of their side effects may be increased by Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets


• Guanadrel, guanethidine, mecamylamine, methyldopa, or reserpine because their effectiveness may be decreased by Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets

This may not be a complete list of all interactions that may occur. Ask your health care provider if Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets:

Use Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.


• Swallow Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets whole. Do not break, crush, or chew before swallowing. Some brands of Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may be broken in half before taking. If you have difficulty swallowing the whole tablet, ask your pharmacist if your brand of medicine may be broken in half.


• Do not take Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets at the same time as antacids, certain medicines for diarrhea (eg, attapulgite, bismuth, kaolin, pectin), or ketoconazole. Take these medicines 2 or 3 hours before or after you take Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets.


• If you miss a dose of Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets.

Important safety information:

• Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.


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


• If your symptoms do not get better within 7 days or if you develop a high fever or persistent headache, check with your doctor.


• Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets.


• Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may interfere with skin allergy tests. If you are scheduled for a skin test, talk to your doctor. You may need to stop taking Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets for a few days before the tests.


• Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may cause dry mouth. To relieve dry mouth, suck on sugarless hard candy or ice chips, chew sugarless gum, drink water, or use a saliva substitute.


• Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may make your eyes more sensitive to sunlight. It may help to wear sunglasses.


• Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may reduce sweating. Do not become overheated in hot weather or while you are being active; heatstroke may occur.


• Do not take diet or appetite control medicines while you are taking Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets without checking with your doctor.


• If you have trouble sleeping, ask your doctor or pharmacist about the best time of the day to take Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets.


• Diabetes patients - Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.


• Use Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets with caution in the ELDERLY; they may be more sensitive to its effects.


• Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets should not be used in CHILDREN younger than 6 years old; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets while you are pregnant. Do not use Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets during labor or delivery because it may cause harm to the fetus. Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets are found in breast milk. Do not breast-feed while taking Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets.

Possible side effects of Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; clumsiness; constipation; dizziness; drowsiness; dry mouth, nose, or throat; excitability or irritability (especially in children); flushing; giddiness; headache; lack of energy; nausea; nervousness; tearing; trouble sleeping; unusual tiredness or weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; difficulty swallowing; fast or irregular heartbeat; hallucinations; mental or mood changes; pounding in the chest; sore throat with fever; trouble urinating; unusual bleeding or bruising; vomiting.

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

See also: Chlorpheniramine/Phenylephrine/Methscopolamine side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include deep sleep or loss of consciousness; hot or cool skin; irregular heartbeat; irritability, anxiety, or panic; large pupils; numbness or tingling in the arms or legs; seizures; slowed or shallow breathing; vomiting.

Proper storage of Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets:

Store Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets at room temperature, between 59 and 86 degrees F (15 and 30 degrees C) in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets out of the reach of children and away from pets.

General information:

• If you have any questions about Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets, please talk with your doctor, pharmacist, or other health care provider.


• Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets are to be used only by the patient for whom it is prescribed. Do not share it with other people.


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


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

This information is a summary only. It does not contain all information about Chlorpheniramine/Phenylephrine/Methscopolamine Sustained-Release and Long-Acting Tablets. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Chlorpheniramine/Phenylephrine/Methscopolamine resources

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

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• Nasal Congestion
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Vitamin C Powder

Generic Name: ascorbic acid (Oral route)

as-KORE-bik AS-id

Commonly used brand name(s)

In the U.S.

• Ascocid


• C-500


• Cecon


• Cemill 1000


• Cemill 500


• Cevi-Bid


• C-Time w/Rose Hips


• Mega-C


• One-Gram C


• Protexin


• Sunkist Vitamin C

In Canada

• Ce-Vi-Sol


• Revitalose-C-1000


• Revitonus C-1000 Yellow Ampule


• Vitamin C Powder

Available Dosage Forms:

• Tablet


• Powder


• Powder for Solution


• Capsule, Liquid Filled


• Tablet, Chewable


• Granule


• Capsule


• Syrup


• Powder for Suspension


• Liquid


• Solution


• Tablet, Extended Release


• Lozenge/Troche


• Capsule, Extended Release


• Wafer

Therapeutic Class: Nutritive Agent

Pharmacologic Class: Vitamin C

Uses For Vitamin C Powder

Vitamins are compounds that you must have for growth and health. They are needed in small amounts only and are usually available in the foods that you eat. Ascorbic acid, also known as vitamin C, is necessary for wound healing. It is needed for many functions in the body, including helping the body use carbohydrates, fats, and protein. Vitamin C also strengthens blood vessel walls.

Lack of vitamin C can lead to a condition called scurvy, which causes muscle weakness, swollen and bleeding gums, loss of teeth, and bleeding under the skin, as well as tiredness and depression. Wounds also do not heal easily. Your health care professional may treat scurvy by prescribing vitamin C for you.

Some conditions may increase your need for vitamin C. These include:

• AIDS (acquired immune deficiency syndrome)


• Alcoholism


• Burns


• Cancer


• Diarrhea (prolonged)


• Fever (prolonged)


• Infection (prolonged)


• Intestinal diseases


• Overactive thyroid (hyperthyroidism)


• Stomach ulcer


• Stress (continuing)


• Surgical removal of stomach


• Tuberculosis

Also, the following groups of people may have a deficiency of vitamin C:

• Infants receiving unfortified formulas


• Smokers


• Patients using an artificial kidney (on hemodialysis)


• Patients who undergo surgery


• Individuals who are exposed to long periods of cold temperatures

Increased need for vitamin C should be determined by your health care professional.

Vitamin C may be used for other conditions as determined by your health care professional.

Claims that vitamin C is effective for preventing senility and the common cold, and for treating asthma, some mental problems, cancer, hardening of the arteries, allergies, eye ulcers, blood clots, gum disease, and pressure sores have not been proven. Although vitamin C is being used to reduce the risk of cardiovascular disease and certain types of cancer, there is not enough information to show that these uses are effective.

Injectable vitamin C is given by or under the supervision of a health care professional. Other forms of vitamin C are available without a prescription.

Once a medicine or dietary supplement has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, vitamin C is used in certain patients with the following medical conditions:

• Overdose of iron (to help another drug in decreasing iron levels in the body)


• Methemoglobinemia (a blood disease)

Importance of Diet

For good health, it is important that you eat a balanced and varied diet. Follow carefully any diet program your health care professional may recommend. For your specific dietary vitamin and/or mineral needs, ask your health care professional for a list of appropriate foods. If you think that you are not getting enough vitamins and/or minerals in your diet, you may choose to take a dietary supplement.

Vitamin C is found in various foods, including citrus fruits (oranges, lemons, grapefruit), green vegetables (peppers, broccoli, cabbage), tomatoes, and potatoes. It is best to eat fresh fruits and vegetables whenever possible since they contain the most vitamins. Food processing may destroy some of the vitamins. For example, exposure to air, drying, salting, or cooking (especially in copper pots), mincing of fresh vegetables, or mashing potatoes may reduce the amount of vitamin C in foods. Freezing does not usually cause loss of vitamin C unless foods are stored for a very long time.

Vitamins alone will not take the place of a good diet and will not provide energy. Your body also needs other substances found in food such as protein, minerals, carbohydrates, and fat. Vitamins themselves often cannot work without the presence of other foods.

The daily amount of vitamin C needed is defined in several different ways.

• For U.S.—


• Recommended Dietary Allowances (RDAs) are the amount of vitamins and minerals needed to provide for adequate nutrition in most healthy persons. RDAs for a given nutrient may vary depending on a person's age, sex, and physical condition (e.g., pregnancy).


• Daily Values (DVs) are used on food and dietary supplement labels to indicate the percent of the recommended daily amount of each nutrient that a serving provides. DV replaces the previous designation of United States Recommended Daily Allowances (USRDAs).

• For Canada—


• Recommended Nutrient Intakes (RNIs) are used to determine the amounts of vitamins, minerals, and protein needed to provide adequate nutrition and lessen the risk of chronic disease.

Normal daily recommended intakes for vitamin C are generally defined as follows:

Persons	U.S. (mg)	Canada (mg)
Infants and children Birth to 3 years of age	30–40	20
4 to 6 years of age	45	25
7 to 10 years of age	45	25
Adolescent and adult males	50–60	25–40
Adolescent and adult females	50–60	25–30
Pregnant females	70	30–40
Breast-feeding females	90–95	55
Smokers	100	45–60

Before Using Vitamin C Powder

If you are taking this dietary supplement without a prescription, carefully read and follow any precautions on the label. For this supplement, the following should be considered:

Allergies

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

Pediatric

Problems in children have not been reported with intake of normal daily recommended amounts.

Geriatric

Problems in older adults have not been reported with intake of normal daily recommended amounts.

Pregnancy

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

Breast Feeding

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

Interactions with Medicines

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

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

• Amygdalin


• Deferoxamine

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

• Indinavir

Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

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

• Blood problems—High doses of vitamin C may cause certain blood problems

• Type 2 diabetes mellitus—Very high doses of vitamin C may interfere with tests for sugar in the urine

• Glucose-6-phosphate dehydrogenase (G6PD) deficiency—High doses of vitamin C may cause hemolytic anemia

• Kidney stones (history of)—High doses of vitamin C may increase risk of kidney stones in the urinary tract

Proper Use of ascorbic acid

This section provides information on the proper use of a number of products that contain ascorbic acid. It may not be specific to Vitamin C Powder. Please read with care.

Dosing

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

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

• For oral dosage form (capsules, tablets, oral solution, syrup):
  
  • To prevent deficiency, the amount taken by mouth is based on normal daily recommended intakes:
    
    • For the U.S.
    
    
    • Adult and teenage males—50 to 60 milligrams (mg) per day.
    
    
    • Adult and teenage females—50 to 60 mg per day.
    
    
    • Pregnant females—70 mg per day.
    
    
    • Breast-feeding females—90 to 95 mg per day.
    
    
    • Smokers—100 mg per day.
    
    
    • Children 4 to 10 years of age—45 mg per day.
    
    
    • Children birth to 3 years of age—30 to 40 mg per day.
    
    
    • For Canada
    
    
    • Adult and teenage males—25 to 40 mg per day.
    
    
    • Adult and teenage females—25 to 30 mg per day.
    
    
    • Pregnant females—30 to 40 mg per day.
    
    
    • Breast-feeding females—55 mg per day.
    
    
    • Smokers—45 to 60 mg per day.
    
    
    • Children 4 to 10 years of age—25 mg per day.
    
    
    • Children birth to 3 years of age—20 mg per day.
    
    
  
  
  • To treat deficiency:
    
    • Adults and teenagers—Treatment dose is determined by prescriber for each individual based on the severity of deficiency. The following dose has been determined for scurvy: 500 mg a day for at least 2 weeks.
    
    
    • Children—Treatment dose is determined by prescriber for each individual based on the severity of deficiency. The following dose has been determined for scurvy: 100 to 300 mg a day for at least 2 weeks.
    
    
  
  

For those individuals taking the oral liquid form of vitamin C:

• This preparation is to be taken by mouth even though it comes in a dropper bottle.


• This dietary supplement may be dropped directly into the mouth or mixed with cereal, fruit juice, or other food.

Missed Dose

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

If you miss taking a vitamin for one or more days there is no cause for concern, since it takes some time for your body to become seriously low in vitamins.

Storage

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

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Vitamin C Powder

Vitamin C is not stored in the body. If you take more than you need, the extra vitamin C will pass into your urine. Very large doses may also interfere with tests for sugar in diabetics and with tests for blood in the stool.

Vitamin C Powder Side Effects

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

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

Less common or rare - with high doses

• Side or lower back pain

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

Less common or rare - with high doses

• Diarrhea


• dizziness or faintness (with the injection only)


• flushing or redness of skin


• headache


• increase in urination (mild)


• nausea or vomiting


• stomach cramps

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

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

See also: Vitamin C side effects (in more detail)

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More Vitamin C Powder resources

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

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• Dietary Supplementation
• Scurvy
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