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TENSIG

Consumer Medicine Information

What is in this leaflet

This leaflet answers some common questions about TENSIG. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking TENSIG against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What TENSIG is used for

TENSIG belongs to a group of medicines called beta-blockers. It works by affecting the body's response to certain nerve impulses, especially in the heart. As a result, it decreases the heart's need for blood and oxygen and therefore reduces the amount of work the heart has to do. It widens the blood vessels in the body, causing blood pressure to fall. It also helps the heart to beat more regularly.

TENSIG is used to:

lower high blood pressure, which is also called hypertension

prevent angina (chest pain)

treat irregular heart rhythm or beat such as arrhythmia

treat or prevent heart attacks, or reduce your risk of heart complications following a heart attack

widen vessels in the heart which have narrowed

Hypertension : Everyone has blood pressure. This pressure helps get your blood all around your body. Your blood pressure may be different at different times of the day, depending on how busy or worried you are. You have hypertension (high blood pressure) when your blood pressure stays higher than is needed, even when you are calm and relaxed.

There are usually no symptoms of hypertension. The only way of knowing that you have hypertension is to have your blood pressure checked on a regular basis. You may feel fine and have no symptoms, but if high blood pressure is not treated, it can lead to serious health problems. TENSIG helps to lower your blood pressure.

Angina : Angina is a pain or uncomfortable feeling in the chest, often spreading to the arms or neck and sometimes to the shoulders and back. This may be caused by too little blood and oxygen getting to the heart. The pain of angina is usually brought on by exercise or stress, but can also occur at rest. TENSIG helps prevent angina. It is not used to relieve a sudden attack of angina.

Irregular heart beat (arrhythmia): Irregular heart beat, also known as arrhythmia, means that there is a disturbance of the heart's normal rhythm or beat. Arrhythmias may be caused by a number of factors, including some heart diseases, an overactive thyroid gland, or chemical imbalances. TENSIG helps restore the heart's normal rhythm.

Reducing heart complications after heart attack: After a heart attack there is a chance of developing arrhythmias or of further heart attacks occurring. TENSIG helps prevent these conditions from occurring.

TENSIG may be either used alone or in combination with other medicines to treat your condition.

Ask your doctor if you have any questions about why this medicine has been prescribed for you. Your doctor may have prescribed it for another reason.

TENSIG is not recommended for use in children, as there have been no studies of its effects in children.

This medicine is available only with a doctor’s prescription.

There is no evidence that TENSIG is addictive.

Before you take it

When you must not take it

Do not take TENSIG if:

you have an allergy to TENSIG or any of the ingredients listed at the end of this leaflet, or to any other beta-blocker medicine.

you have asthma, wheezing, difficulty breathing or other lung problems, or have had them in the past.

you have the following conditions:

a history of allergic problems, including hay fever

you have low blood pressure

you have a very slow heart beat (less than 45-50 beats/minute)

you have certain other heart conditions

you have phaeochromocytoma (a rare tumour of the adrenal gland) which is not being treated already with other medicines.

you have too much acid in your blood, also called metabolic acidosis

you have a severe blood vessel disorder causing poor circulation in the arms and legs.

you are receiving:

certain anaesthetics for medical or dental procedures

certain heart medicines, called calcium channel blockers or calcium antagonists, such as verapamil

you are receiving/having emergency treatment for shock or severely low blood pressure.

you are pregnant or intend to become pregnant. Like most beta-blocker medicines, TENSIG is not recommended for use during pregnancy.

you are breast-feeding or plan to breast-feed . TENSIG passes into breast milk and therefore there is a possibility that the breast-fed baby may be affected.

If you are not sure whether any of these apply to you, check with your doctor.

Do not take TENSIG if the packaging is torn or shows signs of tampering.

Do not take TENSIG if the expiry date (EXP) printed on the pack has passed. If you take this medicine after the expiry date has passed, it may not work as well.

If you are not sure whether you should start taking TENSIG, contact your doctor.

Before you start to take it

Tell your doctor if:

you have any allergies to:

any other medicine or other beta-blocker medicines

any other substances, such as foods, preservatives or dyes

TENSIG may make allergies worse or make them harder to treat.

you are pregnant or intend to become pregnant.

you are breast-feeding or plan to breast-feed.

you have or have had any medical conditions, especially the following:

diabetes

an overactive thyroid gland

kidney problems

any blood vessel disorders causing poor circulation in the arms and legs

certain types of angina, such as Prinzmetal angina or variant angina

low blood pressure

any form of muscle weakness

have high cholesterol or blood fat levels

any other heart problem

If you have not told your doctor about any of the above, tell them before you take TENSIG.

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and TENSIG may interfere with each other.

verapamil, a calcium channel blocker or calcium antagonist which is used to treat high blood pressure and angina

clonidine, a medicine used to treat high blood pressure

certain medicines used to treat abnormal or irregular heartbeat, for example disopyramide, quinidine

insulin and tablets used to treat diabetes

certain medicines used to treat arthritis, pain, or inflammation, for example indomethacin and ibuprofen

digoxin, a medicine used to treat heart failure

medicines commonly used during surgery or in emergency situations such as dopamine, adrenaline, noradrenaline and certain anaesthetics.

These medicines may be affected by TENSIG, or may affect how well it works. You may need to take different amounts of your medicine, or you may need to take different medicines. Your doctor will advise you.

Your doctor and pharmacist may have more information on medicines to be careful with or avoid while taking TENSIG.

How to take it

How much to take and how to take it

Follow all directions given to you by your doctor and pharmacist carefully. They may differ from the information contained in this leaflet.

If you do not understand the instructions on the box, ask your doctor or pharmacist for help.

Certain people (eg. elderly patients or those with kidney problems) may require lower doses.

Hypertension : Adults - The usual daily dose is between 50 mg (1 tablet) up to 200 mg (4 tablets). If your dose is 100 mg or less, take your dose once a day. If your dose is greater than 100 mg, take half of your dose in the morning and the rest in the evening.

Angina or Arrhythmia (irregular heart beat): Adults - The usual daily dose is between 50 mg (1 tablet) up to 100 mg (2 tablets), which can be taken as a single dose or half the dose in the morning and the rest in the evening.

Heart attack: The usual dose is 50 mg (1 tablet) to 100 mg (2 tablets) daily for 1 - 3 years following a heart attack for 1 - 3 years.

The doses mentioned may be given after the condition (eg. arrhythmia, heart attack) is brought under control.

TENSIG is not recommended for children.

When to take it

Swallow TENSIG with a glass of water.

It does not matter if you take it before or after food.

Take your tablet(s) at the same time everyday.

How long to take it

TENSIG helps control your high blood pressure, angina and irregular heart beat, but does not cure it. Therefore TENSIG must be taken every day. Continue taking it for as long as your doctor prescribes.

Do not stop taking TENSIG without checking with your doctor. Your doctor may want you to gradually reduce the amount of TENSIG you are taking 2 weeks before stopping completely. This may help reduce the possibility of your angina worsening or other heart complications from occurring.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, and then go back to taking your tablets as you would normally.

Do not take a double dose to make up for the dose that you missed.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26), or go to casualty at your nearest hospital, if you think that you or anyone else may have taken too much TENSIG. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention. Keep these telephone numbers handy.

If you take too much TENSIG, you may feel faint or dizzy or you may find it difficult to breathe.

While you are using it

Things you must do

Be sure to keep all of your doctor’s appointments so that your progress can be checked.

Tell all the doctors, dentists and pharmacists that are treating you that you are taking TENSIG.

If you become pregnant while taking TENSIG, tell your doctor immediately.

If you have a severe allergic reaction to foods, medicines or insect stings, tell your doctor immediately. If you have a history of allergies, there is a chance that TENSIG may cause allergic reactions to be worse and harder to treat.

If you feel light-headed, dizzy or faint when getting out of bed or standing up, get up slowly. You may feel light-headed or dizzy when you begin to take TENSIG. This is because your blood pressure is falling suddenly. If this problem gets worse or continues, talk to your doctor.

To avoid symptoms of low blood pressure, here are some hints that may help:

stand up slowly from a sitting or lying position to help your body get used to the change in position and blood pressure

if you feel dizzy, sit or lie down until you feel better

if you feel faint, bend forward with your head between your knees

take extra care when exercising, driving or standing for long periods, especially in hot weather. Drink plenty if fluids, especially if you sweat a lot.

Make sure you drink enough water during exercise and hot weather when you are taking TENSIG, especially if you sweat a lot. If you do not drink enough water while taking TENSIG, you may feel faint, light-headed or sick. This is because your blood pressure is dropping suddenly. The recommended healthy minimum water intake is 6 - 8 glasses daily.

If you plan to have surgery (even at the dentist) that needs a general anaesthetic, tell your doctor or dentist that you are taking TENSIG. Your blood pressure may drop suddenly.

If you have to have any medical tests while you are taking TENSIG, tell your doctor. TENSIG may affect the results of some tests.

If you are about to be started on any new medicines, remind your doctor or pharmacist.

Tell any other doctors, dentists, and pharmacists who are treating you that you are taking TENSIG.

If you are being treated for diabetes, make sure you check your blood sugar level regularly and report any changes to your doctor. TENSIG may change how well your diabetes is controlled. It may also cover up some of the symptoms of low blood sugar, called hypoglycaemia, such as fast heart beat. TENSIG may make low blood sugar last longer. Your doses of diabetic medicines, including insulin, may need to change.

Things you must not do

Do not stop taking TENSIG without checking with your doctor. Your doctor may want you to gradually reduce the amount of TENSIG you are taking before stopping completely. This may help reduce the possibility of your angina worsening or other heart complications from occurring.

Do not give your medicine to anyone else even if they have the same condition as you.

Do not use it to treat any other complaints unless your doctor tells you to.

Things to be careful of

Be careful driving or operating machinery until you know how TENSIG affects you. As with other beta-blocker medicines, TENSIG may cause dizziness, light-headedness, tiredness and drowsiness in some people. Make sure you know how you react to TENSIG before you drive a car, operate machinery, or do anything else that could be dangerous if you are dizzy or light-headed. If this occurs do not drive. If you drink alcohol, dizziness or light-headedness may be worse.

Dress warmly during cold weather, especially if you will be outside for a long time (for example, when playing winter sports). TENSIG, like other beta-blocker medicines, may make you more sensitive to cold temperatures, especially if you have blood circulation problems. Beta-blockers tend to decrease blood circulation in the skin, fingers and toes.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking TENSIG.

If you get any side effects, do not stop taking TENSIG without first talking to your doctor. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you notice any of the following and they worry you:

These are the more common side effects of TENSIG. For the most part these have been mild.

Tell your doctor immediately if you notice any of the following:

dizziness or lightheadedness (sometimes with fainting), especially on standing up, which may be due to low blood pressure

shakiness, trembling

buzzing or ringing in the ears, difficulty hearing

confusion, short-term memory loss

vivid dreams or nightmares

changes in mood such as anxiety, agitation, depression

abnormal thinking, hallucinations (seeing, feeling or hearing things that are not there)

difficulty sleeping

cold hands and feet

diarrhoea

headache, aches and pains

dry eyes

irritated eyes (red, runny, itchy or dry), visual disturbances (eg. blurred vision)

hair loss

runny or blocked nose

problems with sexual function

weakness, lack of energy

skin reactions (eg. rash, itching, hives, flaking of skin, worsening of psoriasis)

severe dizziness, spinning sensation (vertigo)

tingling or pins and needles in the hands and/or feet

These are serious side effects. You may need urgent medical attention. Serious side effects are rare.

If any of the following happen, tell your doctor immediately or go to casualty at your nearest hospital:

shortness of breath, sometimes with tiredness, weakness and reduced ability to exercise, swelling of the feet or legs due to fluid buildup

chest pain, changes in heart rate (fast, slow or irregular), palpitations

swelling of the face, lips, tongue or throat which may cause difficulty in swallowing or breathing, which may be signs of a serious allergic reaction

chest tightness, wheezing, rattly breathing

bleeding or bruising more easily than normal

These are very serious side effects. You may need urgent medical attention or hospitalisation. These side effects are rare.

After using it

Storage

Keep your tablets in the pack until it is time to take them. If you take the tablets out of the pack they will not keep well.

Keep the tablets in a cool dry place where the temperature stays below 25 degrees Celsius. Protect from light.

Do not store TENSIG of any other medicine in the bathroom or near the sink.

Do not leave TENSIG in the car or on window sills. Heat and dampness can destroy some medicines.

Keep it where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking TENSIG or the tablets have passed their expiry date, ask your pharmacist what to do with any that are left over.

Product description

What it looks like

TENSIG tablets are white to off-white, round uncoated tablets with “T 50” embossed on one side and a break bar on the other.

TENSIG tablets are available in calendar packs containing 30 tablets.

Ingredients

Each TENSIG tablet contains 50 mg atenolol as the active ingredient.

In addition, each tablet contains:

microcrystalline cellulose

carbomer 974P

calcium hydrogen phosphate

croscarmellose sodium

colloidal silica – anhydrous

purified talc

hydrogenated vegetable oil

magnesium stearate

TENSIG does not contain lactose, sucrose, gluten, tartrazine or any other azo dyes.

Sponsor

TENSIG is supplied in Australia by: Aspen Pharma Pty Ltd 34-36 Chandos Street St Leonards NSW 2065 Australia

The Australian Registration number for TENSIG 50 mg tablets is: AUST R 223020.

This leaflet was revised in May 2014.

Published by MIMS September 2014

Consumers should be aware that the information provided by the Consumer Medicines Information (CMI) search (CMI Search) is for information purposes only and consumers should continue to obtain professional advice from a qualified healthcare professional regarding any condition for which they have searched for CMI. CMIs are provided by MIMS Australia. CMI is supplied by the relevant pharmaceutical company for each consumer medical product. All copyright and responsibility for CMI is that of the relevant pharmaceutical company. MIMS Australia uses its best endeavours to ensure that at the time of publishing, as indicated on the publishing date for each resource (e. g. Published by MIMS/myDr January 2007), the CMI provided was complete to the best of MIMS Australia's knowledge. The CMI and the CMI Search are not intended to be used by consumers to diagnose, treat, cure or prevent any disease or for any therapeutic purpose. Cirrus Media Pty Limited, its servants and agents shall not be responsible for the continued currency of the CMI, or for any errors, omissions or inaccuracies in the CMI and/or the CMI Search whether arising from negligence or otherwise or from any other consequence arising there from.

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Trazodone Dosage

Additional dosage information:

Usual Adult Dose for Depression

Immediate-release tablets : 150 mg orally per day in divided doses; this may be increased by 50 mg orally per day every 3 to 4 days Maximum dose: 400 mg orally per day in divided doses (outpatients); 600 mg orally per day in divided doses (inpatients)

Extended-release tablets : 150 mg orally once a day; this may be increased by 75 mg orally per day every 3 days (i. e. start 225 mg orally on Day 4 of therapy) Maximum dose: 375 mg orally per day

Comments : - Patients should be monitored for withdrawal symptoms when discontinuing therapy. - After an adequate response has been reached, dosage may be gradually reduced depending on therapeutic response. - If drowsiness develops, a major portion of the daily dose may be administered at bedtime or a reduction of dosage may be necessary. - Immediate release tablets should be taken shortly after a meal or light snack. - Extended release tablets should be taken orally at the same time every day, in the late evening preferably at bedtime, on an empty stomach.

Use: Treatment of major depressive disorder (MDD) in adults

Renal Dose Adjustments

Renal impairment: Use with caution

Liver Dose Adjustments

Hepatic impairment: Use with caution

Precautions

BOXED WARNING(S) : Suicidality and Antidepressant Drugs : - Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. - Anyone considering the use of this drug or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. There was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. - Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and 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. - This drug is not approved for use in pediatric patients.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice : - Tablets can be swallowed whole or administered as a half tablet by breaking the tablet along the score line. - Tablets should not be chewed or crushed. - Tolerability may be improved by taking the drug after a meal.

Monitoring : - Psychiatric: Patients should be monitored for worsening and emergence of suicidal thoughts.

Patient advice : - Patients should be cautioned accordingly since this drug may impair the mental and/or physical abilities required for the performance of operating an automobile or machinery.

Diltiazem

Diltiazem is the generic form of the brand-name drug Cardizem. which is used to treat high blood pressure and control chest pain (known as angina ).

There are several other brand names of this medication, including Cartia, Dilacor XR, Diltzac, Taztia and Tiazac.

Diltiazem works by relaxing blood vessels and increasing the supply of blood and oxygen to the heart. This type of medication is known as a calcium-channel blocker .

Diltiazem comes in a tablet, extended-release tablet, extended-release capsule and injectable form.

It was approved by the Food and Drug Administration (FDA) in 1982.

Some doctors have also prescribed diltiazem to prevent migraines. though the evidence supporting its use among people with migraines is not universally accepted.

Diltiazem Warnings

Diltiazem may prevent chest pain if taken regularly, but it does not stop chest pain once it starts.

Diltiazem controls high blood pressure and chest pain, but it does not cure them.

It may take up to two weeks for you to experience the full benefit of this medicine.

Your doctor will likely start you on a low dose of diltiazem and then gradually increase your dose.

Your blood pressure and pulse will be checked regularly while taking diltiazem to determine your response to the drug.

Before taking diltiazem, you should tell your doctor if you have ever had:

A heart attack

Any condition that causes food to move more slowly through your digestive system

Low blood pressure

Heart, liver, or kidney disease

You should also tell your doctor if you plan to have any type of surgery, including dental surgery.

Pregnancy and Diltiazem

There are not adequate studies to show that this drug is safe in pregnant women.

Diltiazem is excreted in breast milk, so women should not take it while breastfeeding.

Many medications can interact with diltiazem.

Tell your doctor about all prescription, non-prescription, illegal, recreational, herbal, nutritional, or dietary drugs you are taking, especially:

Atazanavir (Reyataz)

Beta blockers such as atenolol (Tenormin), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal)

Buspirone (BuSpar)

Benzodiazepines such as midazolam (Versed) and triazolam (Halcion)

Carbamazepine (Carbatrol, Epitol, Tegretol)

Cimetidine (Tagamet)

Digoxin (Lanoxin, Lanoxicaps)

Cyclosporine (Gengraf, Neoral, Sandimmune)

Rifampin (Rifadin, Rifamate, Rifater, Rimactane)

Lovastatin (Altoprev, Mevacor, Advicor)

Quinidine (Quinidex)

Other Diltiazem Interactions

Grapefruit and grapefruit juice may interact with diltiazem. Your doctor may advise you to follow a low-sodium diet while taking diltiazem.

This medication may impair your thinking and reaction time. Be especially careful when driving or performing any activity that may require you to be alert.

You should also try to avoid exposure to sunlight or tanning beds. Diltiazem can increase your skin's sensitivity to light and you may develop sunburns more easily.

Diltiazem Dosage

The typical oral dose for adults with chest pain or high blood pressure ranges from 120 milligrams (mg) to 540 mg a day.

The immediate release tablets are typically given up to four times a day.

The extended-release formula is given once a day and should not be crushed or chewed.

Diltiazem Overdose

If you suspect an overdose, contact a poison control center or emergency room immediately.

You can get in touch with a poison control center at (800) 222-1222.

Missed Dose of Diltiazem

If you miss a dose of diltiazem, take it as soon as you remember.

However, if it is almost time for your next dose, skip the missed dose and continue on your regular schedule.

Do not "double up" to make up for a missed one.

Q: What is the difference between diltiazem HCL and diltiazem ER? What is the difference between CAPINW and CAPSULEMYL?

A: Diltiazem ER is the extended release formulation of diltiazem HCl and is designed to release the medication slowly into the body. It is important to swallow the capsule whole and not to crush, chew, break or open diltiazem ER. Diltiazem should be taken with a full glass of water. The difference between CAPINW and CAPSULEMYL is likely the manufacturer of the capsule. To accurately determine the difference between CAPINW and CAPSULEMYL it is best to contact your doctor or local pharmacy that dispensed the medication to verify. For additional information regarding diltiazem: http://www. everydayhealth. com/drugs/diltiazem Beth Isaac, PharmD

Q: Can diltiazem cause generalized body aches?

A: Generalized body aches are not listed as a side effect of diltiazem in the package insert. Muscle cramps, however, are listed as a possible side effect. Derek Dore, PharmD

Q: Does Diltiazem cause my feet to swell?

A: Diltiazem is a calcium channel blocker used to treat high blood pressure and angina. Diltiazem should be taken with a full glass of water either with or without food. Some reports indicate that grapefruit or grapefruit juice may interfere with the absorption of diltiazem. Some reports of side effects include dizziness, headache, nausea and tiredness. It is possible that edema or swelling may occur from taking diltiazem. Anytime swelling is experienced, it is a good idea to consult with a physician to rule out any serious medical conditions. For more information on diltiazem please visit Everyday Health at http://www. everydayhealth. com/drugs/ Kimberly Hotz, PharmD.

Q: Are these all the same drug: Cartia XT, Dilt-CD, Diltiazem?

A: They are the same drug, but they are not interchangeable. They have different formulations and different AB ratings. What this means is that a pharmacist may not substitute generic diltiazem if Cartia XT is prescribed. Visit us here for more information: http://www. everydayhealth. com/drugs/lisinopril Matt Curley, PharmD

Q: Does diltiazem affect the ability to feel low blood sugar? I take Lantus insulin for type 1 diabetes and sometimes don't feel the low sugar until I'm about to pass out.

A: Your question concerns whether diltiazem (Cardizem) (http://www. everydayhealth. com/drugs/diltiazem ) can affect your ability to feel low blood sugar. There are no documented interactions between diltiazem and Lantus [insulin aspart] (http://www. everydayhealth. com/drugs/lantus ). Studies that were done have concluded that diltiazem does not have any significant effect on lowering blood sugar. It is always a good idea to check with one

Q: I am 75 years old and I have been on diltiazem 180mg for one year. Should I be taking a calcium supplement?

A: Diltiazem (Cardizem and others) is used to lower blood pressure and treat angina (chest pain). The drug belongs to the group of drugs known as calcium-channel blockers because of the way it works. Diltiazem prevents the flow of calcium in muscle tissue to keep the blood vessels from narrowing, making it easier for the heart to pump blood through the body. Calcium levels in the blood do not change as a result of the drug

Q: My feet have been swelling. Could that be from the diltiazem I take?

A: Diltiazem is a calcium channel blocker used to treat high blood pressure and angina. It should be taken with a full glass of water, either with or without food. Some reports indicate that grapefruit or grapefruit juice may interfere with the absorption of diltiazem. Reports of side effects include dizziness, headache, nausea, and fatigue. It's possible that edema, or swelling, may occur from taking diltiazem. Any time you experience swelling, you should consult with your doctor to rule out any serious medical conditions. Kimberly Hotz, PharmD

Q: I have high blood pressure, take diltiazem ER, and feel tired a lot. Could it be from this? And it always seems that my pulse rate is low when I take my pressure with the machine. How low is too low for your pulse rate? I do work out and am in good shape but not an athlete.

A: Diltiazem (Cardizem LA) is a medication used to treat hypertension (high blood pressure) and chest pain. Common side effects with diltiazem are hypotension (abnormally low blood pressure), bradycardia (abnormally low heart beat), headache, fatigue, weakness, drowsiness, constipation or diarrhea, nausea, vomiting, facial flushing, and difficulty sleeping. A normal heart rate or heart beat is 60 to 100 beats per minute. A heart beat less than 60 beats per minute is defined as bradycardia. Some people with a slow heart beat are completely healthy, for example athletes tend to have a slower heart rate. But for other people, a slow heart beat may mean that not enough blood is being pumped to the body. This slow heart beat can cause fatigue and other symptoms. If you are experiencing a slow heart rate, consult with your physician or cardiologist right away. This is not a complete list of the side effects associated with diltiazem. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Tell your health care provider about any negative side effects from prescription drugs. You can also report them to the U. S. Food and Drug Administration by visiting www. fda. gov/medwatch or by calling 1-800-FDA-1088. Leslie Ako-Mbo, PharmD

Q: Can diltiazem cause you to retain fat?

A: According to the manufacturer of diltiazem (Cardizem), the most common side effects reported are dizziness, headache, cough, feeling tired, slowing of the heart rate, and swelling of the legs (peripheral edema). Swelling of the legs can add weight to the body. During clinical trials, peripheral edema occurred in about 4.6 percent out of 3,200 patients on diltiazem. In another study, swelling of the lower limbs occurred in about 6.8 percent out of 311 patients during therapy. The amount of swelling was not indicated by the drug manufacturer. Other side effects reported with diltiazem are weight loss, weight gain, diarrhea or constipation, nausea and vomiting. The manufacturer reports that about 1 to 3 percent of patients are affected. A search of the prescribing information for diltiazem (Cardizem) did not specifically list fat retention as a side effect. Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. This is not a common side effect of diltiazem (Cardizem). For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Mendoza, PharmD

Q: I take Cardizem for high blood pressure, and lately I've had acne on my face. Could that be caused by the medication?

A: A variety of skin rashes and pustules have been reported in patients taking Cardizem (diltiazem). Most aren't serious, but they should be evaluated by your health care provider. If you experience fever, sore throat, and headache with a severe blistering, peeling, and red skin rash, contact your doctor at once. This can be a sign of a serious side effect. For more information, go to http://www. everydayhealth. com/drugs/diltiazem. Sarah Lewis, PharmD

Q: I take Diltiazem ER 180 mg capsule, twice a day. Should this be taken with or without food or on an empty stomach? Two hours before a meal?

A: Diltiazem ER (extended-release) is in a drug class called calcium channel blockers. Diltiazem ER is used alone or combined with other medications to treat high blood pressure. Diltiazem ER is also used to manage angina (chest pain). Diltiazem ER works by relaxing blood vessels, which in turn allows the heart to not have to pump as hard. Diltiazem also increases blood and oxygen supply to the heart. Diltiazem ER (extended-release) capsules are usually prescribed to be taken once or twice daily. The recommended administration of diltiazem ER may vary depending on the individual product being used. Thus, it is important to read all product information and consult with your doctor or pharmacist to determine if the diltiazem ER product you are using should be taken on an empty stomach or with food. In general, it is important to take diltiazem ER around the same time(s) each day and not take more or less of the medication than was prescribed by the doctor. Diltiazem ER, in most situations, should be swallowed whole and not chewed or crushed. Studies show that taking a medication at the same time every day provides a consistent level of the medication in the body. Also, getting into the habit of taking a medication at the same time each day provides a regular routine, which can help prevent missed doses. However, the best time to take a medication may depend on certain patient-specific factors and it's important to take medications exactly as prescribed by your healthcare provider. Thus, for more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Regards, Derek Dore, PharmD

Q: I take diltiazem. Can this cause my blood sugar to go up?

A: Diltiazem (Cardizem) is a calcium channel blocker used to treat hypertension (high blood pressure), angina (chest pain), and some forms of irregular heart rhythms. According to the prescribing information for Cardizem, the brand-name of diltiazem, hyperglycemia (increased blood sugar) is a reported side effect. Common side effects associated with the use of diltiazem may include headache, dizziness, tiredness, nausea, warmth, itching, redness, or a tingly feeling under the skin. This is not a complete list of all possible side effects. Consult with your doctor if you have been experiencing hyperglycemia for proper evaluation. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Patti Brown, PharmD

By Julie Marks | Medically Reviewed by Mona Khanna, MD

Decadurin 200 mg/ml - GEP

Known more commonly as “Deca,” Decadurin is an injectable steroid with a long and relatively positive history. It has been used to effectively treat HIV+ and AIDS and is known as a phenomenal steroid for building muscle mass. Deca is often used in combination with other steroids such as Tren. This combination allows these two anabolics to be used together (even at the same time) without any worries about hormones such as testosterone getting thrown way off balance. It is a very popular steroid that is considered as one of the safest drugs in the world of bodybuilding. This drug is also used to cure anemia associated with unrelieved (long-term) kidney failure. One of the really interesting properties about Deca is its ability to improve collagen synthesis and bone mineral content, which is a huge help to athletes with connective tissue problems or other joint issues. Also, possibly due to its being a progestin, it may have beneficial effects on the immune mediated anti-inflammatory process, thereby soothing joints.

What makes Decadurin so popular is that any Decadurin side effect is rare and easily controllable. Deca Durabolin side effects include acne formation, not only on the face but also on the back and chest, aggression and insomnia. As mentioned, Deca Durabolin is a progestin. Being a progestin means that there won't be any Deca Durabolin side effects caused by estrogen activity.

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anger

Word Origin & History

anger c.1200, from O. N. angra "to grieve, vex;" the noun is mid-13c. from O. N. angr "distress, grief, affliction," from P. Gmc. *angus (cf. O. E. enge "narrow, painful," M. Du. enghe, Goth. aggwus "narrow"), from PIE base *angh - "stretch round, tight, painfully constricted, painful" (cf. Skt. amhu - "narrow," amhah "anguish;" Armenian anjuk "narrow;" Lith. ankstas "narrow;" Gk. ankhein "to squeeze," ankhone "a strangling;" L. angere "to throttle, torment;" O. Ir. cum-ang "straitness, want"). In M. E. also of physical pain.

Example Sentences for anger

But great was Hatteras's anger at finding the way to the north closed!

They dwarfed the cause of her anger ; they left her calm and serene, a cousin to the Superwoman.

The anger had ebbed from Dan's brain, although his attitude had not relaxed.

She was quivering still with anger and she did not answer him.

Al's anger and contempt were so great that he had lost all sense of discretion.

It was Father Pat's voice, lacking breath, but deep with anger .

Chavignis dignity, like his prudence, became lost in his anger .

He found the old man agitated, and almost crying with anger and vexation.

When she realized the significance of our words, she gave way to a frenzy of anger .

Captain Candage knew it, and that fact did not soften his anger in the least.

Loxapine

Loxapine is an antipsychotic medication. It affects the actions of chemicals in your brain.

Loxapine is used to treat schizophrenia.

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

Loxapine is not approved for use in psychotic conditions related to dementia. Loxapine may increase the risk of death in older adults with dementia-related conditions.

You should not use loxapine if you have decreased alertness caused by taking certain medications or drinking alcohol.

You should not use this medicine if you are allergic to loxapine, or if you have decreased alertness caused by taking certain medications or drinking alcohol.

Loxapine is not approved for use in psychotic conditions related to dementia. Loxapine may increase the risk of death in older adults with dementia-related conditions.

Long-term use of loxapine can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include uncontrollable muscle movements of your lips, tongue, eyes, face, arms, or legs. The longer you take loxapine, the more likely you are to develop this movement disorder. The risk of this side effect is higher in women and older adults.

To make sure loxapine is safe for you, tell your doctor if you have:

epilepsy or other seizure disorder;

a history of low white blood cell (WBC) counts;

glaucoma;

urination problems;

Parkinson's disease;

heart disease; or

a history of breast cancer.

Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. If you become pregnant while taking loxapine, do not stop taking it without your doctor's advice.

It is not known whether loxapine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Loxapine Side Effects

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

Stop using loxapine and call your doctor at once if you have:

uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement);

confusion, slurred speech;

seizure (convulsions);

sudden weakness or ill feeling, fever, chills, sore throat, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough;

little or no urinating;

severe constipation; or

severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Common side effects may include:

dizziness or drowsiness;

problems with balance or walking;

blurred vision;

feeling restless or agitated;

constipation;

dry mouth, stuffy nose; or

sleep problems (insomnia).

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

Loxapine Interactions

Loxapine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid drinking alcohol. You should not take loxapine if you are under the effects of alcohol.

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

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking loxapine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with loxapine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Loxapine Dosage

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take loxapine with a full glass of water.

You may not start feeling better right away when you start taking loxapine. Call your doctor if your symptoms do not improve, or if they get worse while using loxapine.

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

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Copyright 1996-2016 Cerner Multum, Inc.

Latest Update: 5/16/2016, Version: 10.01

Loxapine Pictures

Loxapine 5 mg-WAT, white, capsule,

Loxapine 10 mg-WAT, white/yellow, capsule,

Loxapine 25 mg-WAT, green/white, capsule,

Loxapine 50 mg-WAT, blue/white, capsule,

Loxapine 5 mg-MYL, green, capsule,

Loxapine 10 mg-MYL, green/yellow, capsule,

Loxapine 25 mg-MYL, green, capsule,

Loxapine 50 mg-MYL, blue/green, capsule,

Loxapine 25 mg-WAT, green/white.

Product Description Common use This medicine is a proton pump inhibitor (PPI) used to treat ulcers, heartburn, gastroesophageal reflux, erosive esophagitis, or Zollinger-Ellison syndrome and also ulcers generated by long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). To treat ulcers caused by bacterial infections this medicine may be used in combination with antibiotics such as amoxicillin or clarithromycin. Prilosek significantly alleviates such their symptoms as heartburn, difficulty swallowing, coughing, and sleep problems. Prilosek works by blocking acid production in the stomach. The medicine may be used to treat other conditions diagnosed by your doctor.

Dosage and directions Follow all the directions provided by your doctor. Take this medication (15-30 mg) orally once a day in morning before a meal with a full glass of water or according to your doctor's recommendations. Swallow the tab whole, do not chew, crush, or open the capsule as may destroy the drug and/or increase side effects. Antacids drugs can be taken together with this medicine, if necessary. Dosage and duration of treatment depends on your medical condition and response to the therapy. Take it the same time each day to avoid missing a dose. In the case of aggravation or worsening of your illness notify your doctor immediately. It may take 1 - 4 days before Prilosek acts in full measure. Treatment with Prilosec should not be stopped even if certain amelioration is achieved. Improvement of symptoms is observed within 4 to 8 weeks in treatment of gastric ulcers or reflux disease. Treatment of heartburn usually lasts for 14 days. If heartburn persists after this period of time or even worsens, or if you need more than one course of treatment every 4 months, contact your doctor or pharmacist.

Precautions Prilosec is not recommended during pregnancy. Breastfeeding when using this drug is not recommended as it is not known whether it gets into breast milk. Tell your doctor if allergic reaction appears. Your doctor or pharmacist should be aware of your health problems, to provide health care, especially if you have problems such as liver disease, other stomach problems (e. g. tumors), heartburn over 3 months, unexplained weight loss, constant nausea/vomiting /stomach pain, blood in vomit or black stools. Some symptoms may witness about a more serious condition. This medicine may cause dizziness. Be careful performing work associated with concentration of attention, such as driving or operating mechanisms. Restrict consumption of alcoholic beverages. Start or interruption in taking any medicine should be be approved by your doctor. If you do not notice any improvement of your symptoms or if they even become worse, inform your doctor about it. Do not share this medicine with anybody with similar symptoms. Do not use this medicine to treat other diseases.

Possible side effects Adverse reactions that may disappear during treatment include headache, constipation, cough, dizziness, or rash. If they continue or are bothersome, let your doctor know about it. An allergic reaction to this medicine is not expected, but seek immediate medical help if it happens. Symptoms of an allergic reaction appear as rash, itching, dizziness, swelling, or difficult breathing. If you notice other reactions of your body which are not listed above, contact your doctor or pharmacist.

Prilosec can decreases elimination of diazepam, warfarin and phenytoin. These are medications metabolized in the liver by oxidation. Drugs which are metabolized with help of cytochrome P-450 system (e. g. cyclosporine, disulfiram, benzodiazepines) may also interact with Prilosec because it is metabolized the same way. Clarithromycin is also metabolized by cytochrome P450, concomitant administration of clarithromycin with Prilosec may result in increases in plasma levels of Prilosec. Concomitant use of Prilosec and clarithromycin may result in increases in plasma levels of erithromycin, and 14-hydroxy-clarithromycin. You may need additional monitoring of your condition if you are taking ampicillin, cilostazol, cyclosporine, diazepam, digoxin, disulfiram, iron, itraconazole, ketoconazole, moclobemide, phenytoin, sucralfate, vorconizole, or warfarin. This medicine may be combined with antacids if they were prescribed by your doctor. Potent acid-reducing drugs such as Prilosec diminish the effectiveness of sucralfate, and other medicaitons such as the antifungals ketoconazole and itraconazole. If instructed to take any of these medicines while taking Prilosec, consult your doctor or pharmacist regarding the proper timing of each dose, usually Prilosec is taken 30 minutes before sucralfate.

Missed dose If you missed a dose take the medication as soon as you remember. If it is almost time of your next dose, just skip its intake and return to your regular schedule.

Overdose If suppose that took too much of Prilosec contact your local poison control center or emergency room immediately. Symptoms of overdose are confusion, blurred vision, unusual sweating, or unusually fast heartbeat.

Storage Store at room temperature between 59-77 F (15-25 C). Do not expose to high humidity or keep in a bathroom. Hide Prilosec away from children and pets. If your treatment requires an extended period of time, take care about refills before your supply is over.

Disclaimer We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

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