Simvastina

Simvastina may be available in the countries listed below.

Ingredient matches for Simvastina

Simvastatin

Simvastatin is reported as an ingredient of Simvastina in the following countries:

• El Salvador


• Panama

International Drug Name Search

Magnevist

In the US, Magnevist (gadopentetate dimeglumine systemic) is a member of the drug class magnetic resonance imaging contrast media and is used to treat CNS Magnetic Resonance Imaging and Vascular Magnetic Resonance Imaging.

US matches:

• Magnevist

Ingredient matches for Magnevist

Gadopentetic Acid

Gadopentetic Acid dimeglumine (a derivative of Gadopentetic Acid) is reported as an ingredient of Magnevist in the following countries:

• Algeria


• Argentina


• Australia


• Austria


• Belgium


• Bosnia & Herzegowina


• Canada


• China


• Colombia


• Croatia (Hrvatska)


• Czech Republic


• Denmark


• Estonia


• Finland


• France


• Georgia


• Germany


• Greece


• Hungary


• Iceland


• Italy


• Japan


• Latvia


• Lithuania


• Luxembourg


• New Zealand


• Norway


• Oman


• Peru


• Poland


• Romania


• Russian Federation


• Serbia


• Slovenia


• Spain


• Sweden


• Switzerland


• Tunisia


• Turkey


• United States

International Drug Name Search

Atenolol / Chlorthalidone Actavis

Atenolol / Chlorthalidone Actavis may be available in the countries listed below.

Ingredient matches for Atenolol / Chlorthalidone Actavis

Atenolol

Atenolol is reported as an ingredient of Atenolol / Chlorthalidone Actavis in the following countries:

• Netherlands

Chlortalidone

Chlortalidone is reported as an ingredient of Atenolol / Chlorthalidone Actavis in the following countries:

• Netherlands

International Drug Name Search

Arcid

Arcid may be available in the countries listed below.

Ingredient matches for Arcid

Ranitidine

Ranitidine hydrochloride (a derivative of Ranitidine) is reported as an ingredient of Arcid in the following countries:

• Spain

International Drug Name Search

Lozap

Lozap may be available in the countries listed below.

Ingredient matches for Lozap

Hydrochlorothiazide

Hydrochlorothiazide is reported as an ingredient of Lozap in the following countries:

• Slovakia

Losartan

Losartan potassium salt (a derivative of Losartan) is reported as an ingredient of Lozap in the following countries:

• Bulgaria


• Czech Republic


• Estonia


• Georgia


• Latvia


• Lithuania


• Poland


• Russian Federation


• Slovakia

International Drug Name Search

Mezide

Mezide may be available in the countries listed below.

Ingredient matches for Mezide

Gliclazide

Gliclazide is reported as an ingredient of Mezide in the following countries:

• Taiwan

International Drug Name Search

Yesan

Yesan may be available in the countries listed below.

Ingredient matches for Yesan

Timolol

Timolol maleate (a derivative of Timolol) is reported as an ingredient of Yesan in the following countries:

• Ethiopia


• Greece


• Malta

International Drug Name Search

Minitro

Minitro may be available in the countries listed below.

Ingredient matches for Minitro

Nitroglycerin

Nitroglycerin is reported as an ingredient of Minitro in the following countries:

• Japan

International Drug Name Search

Senaprost

Senaprost may be available in the countries listed below.

Ingredient matches for Senaprost

Beraprost

Beraprost sodium (a derivative of Beraprost) is reported as an ingredient of Senaprost in the following countries:

• Japan

International Drug Name Search

Helpovion

Helpovion may be available in the countries listed below.

Ingredient matches for Helpovion

Bifonazole

Bifonazole is reported as an ingredient of Helpovion in the following countries:

• Greece

International Drug Name Search

Solavert

Solavert may be available in the countries listed below.

Ingredient matches for Solavert

Sotalol

Sotalol hydrochloride (a derivative of Sotalol) is reported as an ingredient of Solavert in the following countries:

• Australia

International Drug Name Search

Ipramol

Ipramol may be available in the countries listed below.

Ingredient matches for Ipramol

Ipratropium

Ipratropium Bromide is reported as an ingredient of Ipramol in the following countries:

• Ireland


• Netherlands

Ipratropium Bromide monohydrate (a derivative of Ipratropium Bromide) is reported as an ingredient of Ipramol in the following countries:

• Sweden

Salbutamol

Salbutamol sulfate (a derivative of Salbutamol) is reported as an ingredient of Ipramol in the following countries:

• Ireland


• Netherlands


• Sweden

International Drug Name Search

Bucort

Bucort may be available in the countries listed below.

Ingredient matches for Bucort

Hydrocortisone

Hydrocortisone 17α-butyrate (a derivative of Hydrocortisone) is reported as an ingredient of Bucort in the following countries:

• Finland

International Drug Name Search

Aliane

Aliane may be available in the countries listed below.

Ingredient matches for Aliane

Drospirenone

Drospirenone is reported as an ingredient of Aliane in the following countries:

• Latvia


• Malta


• Poland


• Slovakia

Ethinylestradiol

Ethinylestradiol is reported as an ingredient of Aliane in the following countries:

• Latvia


• Malta


• Poland


• Slovakia

International Drug Name Search

Colerin

Colerin may be available in the countries listed below.

Ingredient matches for Colerin

Azintamide

Azintamide is reported as an ingredient of Colerin in the following countries:

• Portugal

International Drug Name Search

Pantoprazol Aristo

Pantoprazol Aristo may be available in the countries listed below.

Ingredient matches for Pantoprazol Aristo

Pantoprazole

Pantoprazole sodium (a derivative of Pantoprazole) is reported as an ingredient of Pantoprazol Aristo in the following countries:

• Germany

International Drug Name Search

Cidomycin Paediatric

Cidomycin Paediatric may be available in the countries listed below.

Ingredient matches for Cidomycin Paediatric

Gentamicin

Gentamicin sulfate (a derivative of Gentamicin) is reported as an ingredient of Cidomycin Paediatric in the following countries:

• Ireland


• United Kingdom

International Drug Name Search

Ondansetron Solution

Pronunciation: on-DAN-se-tron
Generic Name: Ondansetron
Brand Name: Zofran

Ondansetron Solution is used for:

Preventing nausea and vomiting associated with cancer chemotherapy, radiation treatment, or surgery. It may also be used for other conditions as determined by your doctor.

Ondansetron Solution is a serotonin 5-HT₃ receptor blocker. It works by blocking a chemical thought to be a cause of nausea and vomiting in certain situations (eg, chemotherapy).

Do NOT use Ondansetron Solution if:

• you are allergic to any ingredient in Ondansetron Solution


• you are taking apomorphine


• you have a certain type of irregular heartbeat (congenital long QT syndrome)

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

Before using Ondansetron Solution:

Some medical conditions may interact with Ondansetron Solution. 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 had an allergic reaction to another serotonin 5-HT₃ receptor blocker (eg, dolasetron, granisetron)


• if you have liver problems, heart problems (eg, congestive heart failure, slow or irregular heartbeat, QT prolongation), or electrolyte problems (eg, low potassium or magnesium levels)


• if you take medicines that may affect your heartbeat. Check with your doctor if you are unsure if any of your medicines may affect your heartbeat

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

• Apomorphine because the risk of its side effects may be increased by Ondansetron Solution


• Antineoplastic agents (eg, cyclophosphamide) or tramadol because their effectiveness may be decreased by Ondansetron Solution

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

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

• Take Ondansetron Solution by mouth with or without food.


• Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.


• To prevent or reduce the possibility of nausea or vomiting, continue taking Ondansetron Solution for the entire time recommended by your doctor even if you do not notice any nausea.


• If you miss a dose of Ondansetron Solution, 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 Ondansetron Solution.

Important safety information:

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


• Ondansetron Solution should be used with extreme caution in CHILDREN younger than 4 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 Ondansetron Solution while you are pregnant. It is not known if Ondansetron Solution is found in breast milk. If you are or will be breast-feeding while you use Ondansetron Solution, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Ondansetron Solution:

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:

Constipation; diarrhea; dizziness; drowsiness; headache; tiredness; 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, throat, or tongue; wheezing; unusual hoarseness); chest or jaw pain, numbness of an arm or leg,or sudden severe headache or vomiting; fainting; fast, slow, or irregular heartbeat; fever; seizures; severe or persistent dizziness; skin tingling or numbness; stomach pain; trouble urinating; uncontrolled muscle movements; vision changes or loss.

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: Ondansetron 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 fainting; severe dizziness; slowed/irregular heartbeat; sudden, temporary blindness.

Proper storage of Ondansetron Solution:

Store Ondansetron Solution at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store the bottle upright. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Ondansetron Solution out of the reach of children and away from pets.

General information:

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


• Ondansetron Solution 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 Ondansetron Solution. 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 Ondansetron resources

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

Compare Ondansetron with other medications

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• Pruritus

Ibuprofen dura

Ibuprofen dura may be available in the countries listed below.

Ingredient matches for Ibuprofen dura

Ibuprofen

Ibuprofen is reported as an ingredient of Ibuprofen dura in the following countries:

• Germany

International Drug Name Search

Bacampicillina Angenerico

Bacampicillina Angenerico may be available in the countries listed below.

Ingredient matches for Bacampicillina Angenerico

Bacampicillin

Bacampicillin hydrochloride (a derivative of Bacampicillin) is reported as an ingredient of Bacampicillina Angenerico in the following countries:

• Italy

International Drug Name Search

Oksamen

Oksamen may be available in the countries listed below.

Ingredient matches for Oksamen

Tenoxicam

Tenoxicam is reported as an ingredient of Oksamen in the following countries:

• Turkey

International Drug Name Search

Pectox

Pectox may be available in the countries listed below.

Ingredient matches for Pectox

Carbocisteine

Carbocisteine is reported as an ingredient of Pectox in the following countries:

• Ecuador


• Peru


• Spain


• Switzerland

International Drug Name Search

Miconacina

Miconacina may be available in the countries listed below.

Ingredient matches for Miconacina

Natamycin

Natamycin is reported as an ingredient of Miconacina in the following countries:

• Mexico

International Drug Name Search

Omeprazol Bexal

Omeprazol Bexal may be available in the countries listed below.

Ingredient matches for Omeprazol Bexal

Omeprazole

Omeprazole is reported as an ingredient of Omeprazol Bexal in the following countries:

• Spain

International Drug Name Search

Allopurinol RPG

Allopurinol RPG may be available in the countries listed below.

Ingredient matches for Allopurinol RPG

Allopurinol

Allopurinol is reported as an ingredient of Allopurinol RPG in the following countries:

• France

International Drug Name Search

Furosemida Ges

Furosemida Ges may be available in the countries listed below.

Ingredient matches for Furosemida Ges

Furosemide

Furosemide is reported as an ingredient of Furosemida Ges in the following countries:

• Spain

International Drug Name Search

Scopolan

Scopolan may be available in the countries listed below.

Ingredient matches for Scopolan

Metamizole

Metamizole sodium anhydrous (a derivative of Metamizole) is reported as an ingredient of Scopolan in the following countries:

• Poland

Scopolamine

Scopolamine butylbromide (a derivative of Scopolamine) is reported as an ingredient of Scopolan in the following countries:

• Poland

International Drug Name Search

Magnus

Magnus may be available in the countries listed below.

Ingredient matches for Magnus

Sildenafil

Sildenafil is reported as an ingredient of Magnus in the following countries:

• Argentina

Sildenafil citrate (a derivative of Sildenafil) is reported as an ingredient of Magnus in the following countries:

• Argentina

International Drug Name Search

Ocupress

Generic Name: carteolol (Ophthalmic route)

kar-TEE-oh-lol

Commonly used brand name(s)

In the U.S.

• Ocupress

Available Dosage Forms:

• Solution

Therapeutic Class: Antiglaucoma

Pharmacologic Class: Beta-Adrenergic Blocker, Nonselective

Uses For Ocupress

Carteolol is used alone or together with other medicines to treat increased pressure in the eye that is caused by open-angle glaucoma or a condition called intraocular (in the eye) hypertension. This medicine is a beta-blocker .

This medicine is available only with your doctor's prescription .

Before Using Ocupress

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 this medicine, 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

Appropriate studies have not been performed on the relationship of age to the effects of carteolol in the pediatric population. Safety and efficacy have not been established .

Geriatric

No information is available on the relationship of age to the effects of carteolol in geriatric patients. However, elderly patients are more likely to have age-related heart problems, which may require caution in patients receiving carteolol .

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

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while 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 this medicine, 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 medicine 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.

• Albuterol


• Amiodarone


• Arformoterol


• Bambuterol


• Bitolterol


• Broxaterol


• Clenbuterol


• Clonidine


• Colterol


• Diltiazem


• Dronedarone


• Epinephrine


• Fenoldopam


• Fenoterol


• Formoterol


• Hexoprenaline


• Indacaterol


• Isoetharine


• Levalbuterol


• Metaproterenol


• Pirbuterol


• Procaterol


• Reproterol


• Rimiterol


• Ritodrine


• Salmeterol


• Terbutaline


• Tretoquinol


• Tulobuterol


• Verapamil

Using this medicine 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.

• Acarbose


• Aceclofenac


• Acemetacin


• Acetohexamide


• Alclofenac


• Alfuzosin


• Amlodipine


• Apazone


• Arbutamine


• Benfluorex


• Benoxaprofen


• Bromfenac


• Bufexamac


• Bunazosin


• Carprofen


• Chlorpropamide


• Clometacin


• Clonixin


• Dexketoprofen


• Diclofenac


• Diflunisal


• Digoxin


• Dipyrone


• Doxazosin


• Droxicam


• Etodolac


• Etofenamate


• Felbinac


• Felodipine


• Fenbufen


• Fenoprofen


• Fentiazac


• Floctafenine


• Flufenamic Acid


• Flurbiprofen


• Gliclazide


• Glimepiride


• Glipizide


• Gliquidone


• Glyburide


• Guar Gum


• Ibuprofen


• Indomethacin


• Indoprofen


• Insulin


• Insulin Aspart, Recombinant


• Insulin Glulisine


• Insulin Lispro, Recombinant


• Isoxicam


• Ketoprofen


• Ketorolac


• Lacidipine


• Lercanidipine


• Lornoxicam


• Manidipine


• Meclofenamate


• Mefenamic Acid


• Meloxicam


• Metformin


• Mibefradil


• Miglitol


• Moxisylyte


• Nabumetone


• Naproxen


• Nicardipine


• Nifedipine


• Niflumic Acid


• Nilvadipine


• Nimesulide


• Nimodipine


• Nisoldipine


• Nitrendipine


• Oxaprozin


• Oxyphenbutazone


• Phenoxybenzamine


• Phentolamine


• Phenylbutazone


• Pirazolac


• Piroxicam


• Pirprofen


• Pranidipine


• Prazosin


• Propyphenazone


• Proquazone


• Repaglinide


• Rifapentine


• St John's Wort


• Sulindac


• Suprofen


• Tamsulosin


• Tenidap


• Tenoxicam


• Terazosin


• Tiaprofenic Acid


• Tolazamide


• Tolbutamide


• Tolmetin


• Trimazosin


• Troglitazone


• Urapidil


• Zomepirac

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 medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Asthma or


• Bradycardia (slow heartbeat) or


• Chronic obstructive pulmonary disease (COPD), severe or


• Heart block or


• Heart failure—Should not use in patients with these conditions .

• Diabetes or


• Hyperthyroidism (overactive thyroid) or


• Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat .

• Lung disease—Use with caution. May cause difficulty with breathing in patients with this condition .

• Myasthenia gravis—May worsen symptoms of this condition, such as muscle weakness .

Proper Use of Ocupress

Shake the medicine well just before each use .

To use the eye drops (solution):

• First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed and apply pressure to the inner corner of the eye with your finger for 1 or 2 minutes to allow the medicine to be absorbed by the eye.


• Immediately after using the medicine, wash your hands to remove any medicine that may be on them.


• To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed. Serious damage to the eye and possible loss of vision may result from using contaminated eye medicines .

If your doctor ordered two different eye medicines to be used together, wait several minutes before using the second medicine. This will help prevent the second medicine from “washing out” the first one .

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 ophthalmic solution dosage form (eye drops):
  
  • For glaucoma or hypertension of the eye:
    
    • Adults—One drop in the affected eye(s) two times a day.
    
    
    • Children—Use and dose must be determined by your doctor .
    
    
  
  

Missed Dose

If you miss a dose of this medicine, apply 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.

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 Ocupress

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects .

If itching, redness, swelling, or other signs of eye or eyelid irritation occur, stop using this medicine and check with your doctor. These signs may mean that you are allergic to this medicine .

Carteolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing .

This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests .

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery .

Ocupress 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:

Less common

• Blurred vision


• chest pain or discomfort


• confusion


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


• shortness of breath


• slow or irregular heartbeat


• sweating


• unusual tiredness or weakness

Incidence not determined

• Blue lips, fingernails, or skin


• blurred, cloudy, or yellow vision


• change in color vision


• confusion


• cough


• decreased urine output


• decreased vision after sunset and before sunrise


• difficult or labored breathing


• difficulty seeing at night


• dilated neck veins


• discoloration of white part of eye


• disturbed color perception


• drainage from the eye


• drooping upper eyelids


• double vision


• extreme fatigue


• eye redness, irritation, pain, burning, or tearing


• fast heartbeat


• fever


• halos around lights


• hives


• hoarseness


• inability to speak


• increase in blood flow to the whites of the eyes


• increased sensitivity of eyes to sunlight


• irregular, fast or slow, or shallow breathing


• irritation


• itching


• joint pain, stiffness, or swelling


• loss of vision


• night blindness


• noisy breathing


• overbright appearance of lights


• pain or tenderness around eyes and cheekbones


• pounding or rapid pulse


• rash


• redness of skin


• redness, swelling, and/or itching of eye and eyelid


• seeing double


• seizures


• severe numbness, especially on one side of the face or body


• severe or sudden headache


• slurred speech


• stuffy or runny nose


• swelling of eyelids, face, fingers, lips, hands, feet, or lower legs


• temporary blindness


• tightness in chest


• tiredness


• troubled breathing


• tunnel vision


• unusual feeling in the eyes


• weakness in arm and/or leg on one side of the body, sudden and severe


• weight gain


• wheezing

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:

Incidence not determined

• Change in taste or bad, unusual, or unpleasant (after) taste


• discouragement


• feeling sad or empty


• headache


• irritability


• lack of appetite


• lack or loss of strength


• loss of interest or pleasure


• nausea


• sleeplessness


• trouble concentrating


• trouble sleeping


• unable to sleep

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: Ocupress 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 Ocupress resources

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

• Ocupress Prescribing Information (FDA)


• Ocupress Concise Consumer Information (Cerner Multum)

Compare Ocupress with other medications

• Glaucoma, Open Angle
• Intraocular Hypertension

Minocain

Minocain may be available in the countries listed below.

In some countries, this medicine may only be approved for veterinary use.

Ingredient matches for Minocain

Procaine

Procaine hydrochloride (a derivative of Procaine) is reported as an ingredient of Minocain in the following countries:

• Germany

International Drug Name Search

Biocronil

Biocronil may be available in the countries listed below.

Ingredient matches for Biocronil

Enalapril

Enalapril maleate (a derivative of Enalapril) is reported as an ingredient of Biocronil in the following countries:

• Colombia

International Drug Name Search

Oxazepam Accordhealthcare

Oxazepam Accordhealthcare may be available in the countries listed below.

Ingredient matches for Oxazepam Accordhealthcare

Oxazepam

Oxazepam is reported as an ingredient of Oxazepam Accordhealthcare in the following countries:

• Netherlands

International Drug Name Search

Neo Balgin

Neo Balgin may be available in the countries listed below.

Ingredient matches for Neo Balgin

Barium Sulfate

Barium Sulfate is reported as an ingredient of Neo Balgin in the following countries:

• Japan

International Drug Name Search

Melotop

Melotop may be available in the countries listed below.

Ingredient matches for Melotop

Meloxicam

Meloxicam is reported as an ingredient of Melotop in the following countries:

• Greece

International Drug Name Search

Pheniramine

Scheme

Rec.INN

ATC (Anatomical Therapeutic Chemical Classification)

R06AB05

CAS registry number (Chemical Abstracts Service)

0000086-21-5

Chemical Formula

C16-H20-N2

Molecular Weight

240

Therapeutic Categories

Antiallergic agent

Histamine, H₁-receptor antagonist

Chemical Name

2-Pyridinepropanamine, N,N-dimethyl-þ-phenyl-

Foreign Names

• Pheniraminum (Latin)
• Pheniramin (German)
• Phéniramine (French)
• Feniramina (Spanish)

Generic Names

• Femiramina (OS: DCIT)
• Phéniramine (OS: DCF)
• Histapyridamine (IS)
• Prophenpyridamine (IS)
• Tripoton (IS)
• Pheniramine Maleate (OS: USAN, BANM)
• Prophenpyridamine maleate (IS)
• Phéniramine (maléate de) (PH: Ph. Eur. 6)
• Pheniramine Maleate (PH: BP 2010, USP 32, Ph. Eur. 6)
• Pheniraminhydrogenmaleat (PH: Ph. Eur. 6)
• Pheniramini maleas (PH: Ph. Eur. 6)

Brand Names

• Avil
  Hoechst, Ethiopia



• Alervil
  Incepta, Bangladesh



• Avil
  Aventis, India; Aventis, Sri Lanka; Aventis, Luxembourg; Jugoremedija, Serbia; Sandoz, Turkey; Sanofi-Aventis, Australia; Sanofi-Aventis, Bangladesh; Sanofi-Aventis, Indonesia



• Dristan Nasal Mist (Pheniramine and Phenylephrine)
  Wyeth Consumer Healthcare, Canada



• Flamergi (Pheniramine and Naphazoline)
  Sanbe, Indonesia



• Histol
  Julphar, Oman



• Isotic Azora (Pheniramine and Naphazoline)
  Fahrenheit, Indonesia



• Naphcon A (Pheniramine and Naphazoline)
  Alcon, Canada; Alcon, New Zealand



• Naphcon (Pheniramine and Naphazoline)
  Alcon, Oman; Alcon, United States



• Opcon-A (Pheniramine and Naphazoline)
  Bausch & Lomb, United States



• Pevil
  ACI, Bangladesh



• Visine Allergy with Antihistamine (Pheniramine and Naphazoline)
  Johnson & Johnson, New Zealand



• Visine Advance Allergy (Pheniramine and Naphazoline)
  Johnson & Johnson, Canada



• Visine-A (Pheniramine and Naphazoline)
  Johnson & Johnson, United States

International Drug Name Search

Glossary

BANM	British Approved Name (Modified)
DCF	Dénomination Commune Française
DCIT	Denominazione Comune Italiana
IS	Inofficial Synonym
OS	Official Synonym
PH	Pharmacopoeia Name
Rec.INN	Recommended International Nonproprietary Name (World Health Organization)
USAN	United States Adopted Name

Click for further information on drug naming conventions and International Nonproprietary Names.

Micolis

Micolis may be available in the countries listed below.

Ingredient matches for Micolis

Econazole

Econazole nitrate (a derivative of Econazole) is reported as an ingredient of Micolis in the following countries:

• Argentina


• Chile


• Peru

Fluconazole

Fluconazole is reported as an ingredient of Micolis in the following countries:

• Argentina

International Drug Name Search

Diphedryl

Generic Name: diphenhydramine (DYE fen HYE dra meen)

Brand Names: Aler-Tab, Allergy, Allermax, Altaryl, Benadryl Allergy, Benadryl DF, Benadryl Dye Free Allergy, Benadryl Ultratab, Children's Allergy, Diphen Cough, Diphenhist, Dytuss, PediaCare Children's Allergy, Q-Dryl, Q-Dryl A/F, Siladryl, Siladryl Allergy, Silphen Cough, Simply Sleep, Sleep-ettes, Sleep-ettes D, Sominex Maximum Strength Caplet, Theraflu Thin Strips Multi Symptom, Triaminic Thin Strips Cough & Runny Nose, Unisom Sleepgels Maximum Strength, Valu-Dryl

What is Diphedryl (diphenhydramine)?

Diphenhydramine is an antihistamine. Diphenhydramine blocks the effects of the naturally occurring chemical histamine in the body.

Diphenhydramine is used to treat sneezing; runny nose; itching, watery eyes; hives; rashes; itching; and other symptoms of allergies and the common cold.

Diphenhydramine is also used to suppress coughs, to treat motion sickness, to induce sleep, and to treat mild forms of Parkinson's disease.

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

What is the most important information I should know about Diphedryl (diphenhydramine)?

Use caution when driving, operating machinery, or performing other hazardous activities. Diphenhydramine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking diphenhydramine.

What should I discuss with my healthcare provider before taking Diphedryl (diphenhydramine)?

Do not take diphenhydramine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. A very dangerous drug interaction could occur, leading to serious side effects.

Before taking this medication, tell your doctor if you have

• 
  

  glaucoma or increased pressure in the eye;

  
  


• 
  

  a stomach ulcer;

  
  


• 
  

  an enlarged prostate, bladder problems or difficulty urinating;

  
  


• 
  

  an overactive thyroid (hyperthyroidism);

  
  


• 
  

  hypertension or any type of heart problems; or

  
  


• 
  

  asthma.

  
  

You may not be able to take diphenhydramine, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Diphenhydramine is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not take diphenhydramine without first talking to your doctor if you are pregnant. Infants are especially sensitive to the effects of antihistamines, and side effects could occur in a breast-feeding baby. Do not take diphenhydramine without first talking to your doctor if you are nursing a baby. If you are over 60 years of age, you may be more likely to experience side effects from diphenhydramine. You may require a lower dose of this medication.

How should I take Diphedryl (diphenhydramine)?

Take diphenhydramine exactly as directed on the package or as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water.

Diphenhydramine can be taken with or without food.

For motion sickness, a dose is usually taken 30 minutes before motion, then with meals and at bedtime for the duration of exposure.

As a sleep aid, diphenhydramine should be taken approximately 30 minutes before bedtime.

To ensure that you get a correct dose, measure the liquid forms of diphenhydramine with a special dose-measuring spoon or cup, not with a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

Never take more of this medication than is prescribed for you. The maximum amount of diphenhydramine that you should take in any 24-hour period is 300 mg.

Store diphenhydramine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.

Symptoms of a diphenhydramine overdose include extreme sleepiness, confusion, weakness, ringing in the ears, blurred vision, large pupils, dry mouth, flushing, fever, shaking, insomnia, hallucinations, and possibly seizures.

What should I avoid while taking Diphedryl (diphenhydramine)?

Use caution when driving, operating machinery, or performing other hazardous activities. Diphenhydramine may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking diphenhydramine.

Diphedryl (diphenhydramine) side effects

Stop taking diphenhydramine and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives).

Other, less serious side effects may be more likely to occur. Continue to take diphenhydramine and talk to your doctor if you experience

• 
  

  sleepiness, fatigue, or dizziness;

  
  


• 
  

  headache;

  
  


• 
  

  dry mouth; or

  
  


• 
  

  difficulty urinating or an enlarged prostate.

  
  

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

What other drugs will affect Diphedryl (diphenhydramine)?

Do not take diphenhydramine if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. A very dangerous drug interaction could occur, leading to serious side effects.

Talk to your pharmacist before taking other over-the-counter cough, cold, allergy, or insomnia medications. These products may contain medicines similar to diphenhydramine, which could lead to an antihistamine overdose.

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

• 
  

  anxiety or sleep medicines such as alprazolam (Xanax), diazepam (Valium), chlordiazepoxide (Librium), temazepam (Restoril), or triazolam (Halcion);

  
  


• 
  

  medications for depression such as amitriptyline (Elavil), doxepin (Sinequan), nortriptyline (Pamelor), fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil); or

  
  


• 
  

  any other medications that make you feel drowsy, sleepy, or relaxed.

  
  

Drugs other than those listed here may also interact with diphenhydramine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

More Diphedryl resources

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

• Banophen MedFacts Consumer Leaflet (Wolters Kluwer)


• Ben-Tann Suspension MedFacts Consumer Leaflet (Wolters Kluwer)


• Benadryl Consumer Overview


• Benadryl Cream MedFacts Consumer Leaflet (Wolters Kluwer)


• Benadryl Allergy Chewable Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Children's Allergy Prescribing Information (FDA)


• Diphen Advanced Consumer (Micromedex) - Includes Dosage Information


• Diphenhydramine MedFacts Consumer Leaflet (Wolters Kluwer)


• Diphenhydramine Prescribing Information (FDA)


• Diphenhydramine Hydrochloride Monograph (AHFS DI)


• Diphenoxylate Hydrochloride Monograph (AHFS DI)


• Dytuss Elixir MedFacts Consumer Leaflet (Wolters Kluwer)


• Simply Sleep MedFacts Consumer Leaflet (Wolters Kluwer)


• Sominex MedFacts Consumer Leaflet (Wolters Kluwer)

Compare Diphedryl with other medications

• Allergic Reactions
• Cold Symptoms
• Cough
• Extrapyramidal Reaction
• Hay Fever
• Insomnia
• Motion Sickness
• Nausea/Vomiting
• Pruritus
• Urticaria

Where can I get more information?

• Your pharmacist can provide more information about diphenhydramine.

See also: Diphedryl side effects (in more detail)

Medacin

Medacin may be available in the countries listed below.

Ingredient matches for Medacin

Clindamycin

Clindamycin dihydrogen phosphate (a derivative of Clindamycin) is reported as an ingredient of Medacin in the following countries:

• Oman

International Drug Name Search

Prosade

Prosade may be available in the countries listed below.

Ingredient matches for Prosade

Probucol

Probucol is reported as an ingredient of Prosade in the following countries:

• Japan

International Drug Name Search

Cantharides Tincture

Cantharides Tincture may be available in the countries listed below.

Ingredient matches for Cantharides Tincture

Cantharidin

Cantharidin is reported as an ingredient of Cantharides Tincture in the following countries:

• Japan

International Drug Name Search

Vermiplex

In some countries, this medicine may only be approved for veterinary use.

Ingredient matches for Vermiplex

Dichlorophen

Dichlorophen is reported as an ingredient of Vermiplex in the following countries:

• United States

Toluene

Toluene is reported as an ingredient of Vermiplex in the following countries:

• United States

International Drug Name Search

Arfen

Arfen may be available in the countries listed below.

Ingredient matches for Arfen

Ibuprofen

Ibuprofen is reported as an ingredient of Arfen in the following countries:

• Portugal

Ibuprofen lysine (a derivative of Ibuprofen) is reported as an ingredient of Arfen in the following countries:

• Italy

Paracetamol

Paracetamol is reported as an ingredient of Arfen in the following countries:

• Hong Kong


• Iraq


• Jordan


• Oman


• Sudan


• Taiwan


• Yemen

International Drug Name Search

Clisma-Lax

Clisma-Lax may be available in the countries listed below.

Ingredient matches for Clisma-Lax

Sodium Phosphate

Sodium Phosphate Monobasic anhydrous (a derivative of Sodium Phosphate) is reported as an ingredient of Clisma-Lax in the following countries:

• Italy

International Drug Name Search

Hekzoton

Hekzoton may be available in the countries listed below.

Ingredient matches for Hekzoton

Hexetidine

Hexetidine is reported as an ingredient of Hekzoton in the following countries:

• Turkey

International Drug Name Search

Miconazolnitrat Creme-1A Pharma

Miconazolnitrat Creme-1A Pharma may be available in the countries listed below.

Ingredient matches for Miconazolnitrat Creme-1A Pharma

Miconazole

Miconazole nitrate (a derivative of Miconazole) is reported as an ingredient of Miconazolnitrat Creme-1A Pharma in the following countries:

• Germany

International Drug Name Search

Bicarbonato Sod Orravan

Bicarbonato Sod Orravan may be available in the countries listed below.

Ingredient matches for Bicarbonato Sod Orravan

Sodium Bicarbonate

Sodium Bicarbonate is reported as an ingredient of Bicarbonato Sod Orravan in the following countries:

• Spain

International Drug Name Search

Apillerg

Apillerg may be available in the countries listed below.

Ingredient matches for Apillerg

Antazoline

Antazoline hydrochloride (a derivative of Antazoline) is reported as an ingredient of Apillerg in the following countries:

• Oman

Tetryzoline

Tetryzoline hydrochloride (a derivative of Tetryzoline) is reported as an ingredient of Apillerg in the following countries:

• Oman

International Drug Name Search

Depo-Medrol

methylprednisolone acetate

Dosage Form: injection, suspension
Depo-Medrol®

methylprednisolone acetate injectable suspension, USP

Single-Dose Vial

Not For Intravenous Use

Depo-Medrol Description

Depo-Medrol is an anti-inflammatory glucocorticoid for intramuscular, intra-articular, soft tissue or intralesional injection. It is available as single-dose vials in two strengths: 40 mg/mL; 80 mg/mL.

Each mL of these preparations contains:

Methylprednisolone acetate	40 mg	80 mg
Polyethylene glycol 3350	29 mg	28 mg
Myristyl-gamma-picolinium chloride	0.195 mg	0.189 mg

Sodium Chloride was added to adjust tonicity.

When necessary, pH was adjusted with sodium hydroxide and/or hydrochloric acid.

The pH of the finished product remains within the USP specified range; e.g., 3.5 to 7.0.

The chemical name for methylprednisolone acetate is pregna-1,4-diene-3,20-dione, 21-(acetyloxy)-11,17-dihydroxy-6-methyl-,(6α,11β)-and the molecular weight is 416.51. The structural formula is represented below:

Depo-Medrol Sterile Aqueous Suspension contains methylprednisolone acetate which is the 6-methyl derivative of prednisolone. Methylprednisolone acetate is a white or practically white, odorless, crystalline powder which melts at about 215° with some decomposition. It is soluble in dioxane, sparingly soluble in acetone, alcohol, chloroform, and methanol, and slightly soluble in ether. It is practically insoluble in water.

Depo-Medrol - Clinical Pharmacology

Glucocorticoids, naturally occurring and synthetic, are adrenocortical steroids.

Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt retaining properties, are used in replacement therapy in adrenocortical deficiency states. Their synthetic analogs are used primarily for their anti-inflammatory effects in disorders of many organ systems.

Indications and Usage for Depo-Medrol

A. For Intramuscular Administration

When oral therapy is not feasible and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intramuscular use of Depo-Medrol Sterile Aqueous Suspension is indicated as follows:

Allergic States: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, seasonal or perennial allergic rhinitis, serum sickness, transfusion reactions.

Dermatologic Diseases: Bullous dermatitis herpetiformis, exfoliative dermatitis, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome).

Endocrine Disorders: Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsupportive thyroiditis.

Gastrointestinal Diseases: To tide the patient over a critical period of the disease in regional enteritis (systemic therapy), ulcerative colitis.

Hematologic Disorders: Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond blackfan anemia), pure red cell aplasia, select cases of secondary thrombocytopenia.

Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy.

Neoplastic Diseases: For palliative management of: leukemias and lymphomas.

Nervous System: Acute exacerbations of multiple sclerosis. Cerebral edema associated with primary or metastatic brain tumor or craniotomy.

Ophthalmic Diseases: Sympathetic opthalmia, temporal arteritis, uveitis, ocular inflammatory conditions unresponsive to topical corticosteroids.

Renal Diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome, or that due to lupus erythematosus.

Respiratory Diseases: Berylliosis, symptomatic sarcoidosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis.

Rheumatic Disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute rheumatic carditis, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus.

B. For Intra-articular Or Soft Tissue Administration

(See WARNINGS)

Depo-Medrol is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.

C. For Intralesional Administration

Depo-Medrol is indicated for intralesional use in alopecia areata, discoid lupus erythematosus; keloids, localized hypertrophic, infiltrated inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis) and psoriatic plaques; necrobiosis lipoidica diabeticorum.

Depo-Medrol also may be useful in cystic tumors of an aponeurosis or tendon (ganglia).

Contraindications

Depo-Medrol is contraindicated in patients with known hypersensitivity to the product and its constituents.

Intramuscular corticosteroid preparations are contraindicated for idiopathic thrombocytopenic purpura.

Depo-Medrol is contraindicated for intrathecal administration. This formulation of methylprednisolone acetate has been associated with reports of severe medical events when administered by this route.

Depo-Medrol is contraindicated in systemic fungal infections, except when administered as an intra-articular injection for localized joint conditions (see WARNINGS, Infections, Fungal Infections).

Warnings

General

This product is not suitable for multi-dose use. Following administration of the desired dose, any remaining suspension should be discarded.

Injection of Depo-Medrol may result in dermal and/or subdermal changes forming depressions in the skin at the injection site.

In order to minimize the incidence of dermal and subdermal atrophy, care must be exercised not to exceed recommended doses in injections. Multiple small injections into the area of the lesion should be made whenever possible. The technique of intra-articular and intramuscular injection should include precautions against injection or leakage into the dermis. Injection into the deltoid muscle should be avoided because of a high incidence of subcutaneous atrophy.

It is critical that, during administration of Depo-Medrol, appropriate technique be used and care taken to assure proper placement of drug.

Rare instances of anaphylactoid reactions have occurred in patients receiving corticosteroid therapy (see ADVERSE REACTIONS).

Increased dosage of rapidly acting corticosteroids is indicated in patients on corticosteroid therapy subjected to any unusual stress before, during, and after the stressful situation.

Results from one multicenter, randomized, placebo controlled study with methylprednisolone hemisuccinate, an IV corticosteroid, showed an increase in early (at 2 weeks) and late (at 6 months) mortality in patients with cranial trauma who were determined not to have other clear indications for corticosteroid treatment. High doses of systemic corticosteroids, including Depo-Medrol, should not be used for the treatment of traumatic brain injury.

Cardio-renal

Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. These effects are less likely to occur with synthetic derivatives when used in large doses. Dietary salt restriction and potassium supplementation may be necessary. All corticosteroids increase calcium excretion.

Literature reports suggest an apparent association between use of corticosteroids and left ventricular free wall rupture after a recent myocardial infarction; therefore, therapy with corticosteroids should be used with great caution in these patients.

Endocrine

Hypothalamic-pituitary adrenal (HPA) axis suppression. Cushing's syndrome, and hyperglycemia. Monitor patients for these conditions with chronic use.

Corticosteroids can produce reversible HPA axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of treatment. Drug induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted.

Infections

General

Persons who are on corticosteroids are more susceptible to infections than are healthy individuals. There may be decreased resistance and inability to localize infection when corticosteroids are used. Infections with any pathogen (viral, bacterial, fungal, protozoan, or helminthic) in any location of the body, may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents.

These infections may be mild, but can be severe and at times fatal. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. Do not use intra-articularly, intrabursally, or for intratendinous administration for local effect in the presence of an acute infection. Corticosteroids may mask some signs of infection and new infections may appear during their use.

Fungal Infections

Corticosteroids may exacerbate systemic fungal infections and therefore should not be used in the presence of such infections unless they are needed to control drug interactions. There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure (see CONTRAINDICATIONS and PRECAUTIONS, Drug Interactions, Amphotericin B injection and potassium-depleting agents).

Special Pathogens

Latent disease may be activated or there may be an exacerbation of intercurrent infections due to pathogens, including those caused by Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, and Toxoplasma.

It is recommended that latent amebiasis or active amebiasis be ruled out before initiating corticosteroid therapy in any patient who has spent time in the tropics or in any patient with unexplained diarrhea.

Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation. In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia.

Corticosteroids should not be used in cerebral malaria. There is currently no evidence of benefit from steroids in this condition.

Tuberculosis

The use of corticosteroids in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen.

If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary, as reactivation of the disease may occur. During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis.

Vaccinations

Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines can not be predicted.

Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy, e.g., for Addison's disease.

Viral Infections

Chicken pox and measles can have a more serious or even fatal course in pediatric and adult patients on corticosteroids. In pediatric and adult patients who have not had these diseases, particular care should be taken to avoid exposure. The contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated. If exposed to measles, prophylaxis with immunoglobulin (IG) may be indicated (see the respective package inserts for complete VZIG and IG prescribing information). If chicken pox develops, treatment with antiviral agents should be considered.

Ophthalmic

Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses. The use of systemic corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes. Corticosteroids should be used cautiously in patients with ocular herpes simplex because of corneal perforation. Corticosteroids should not be used in active ocular herpes simplex.

Precautions

General

This product, like many other corticosteroids, is sensitive to heat. Therefore, it should not be autoclaved when it is desirable to sterilize the exterior of the vial.

The lowest possible dose of corticosteroid should be used to control the condition under treatment. When reduction in dosage is possible, the reduction should be gradual.

Since complications of treatment with glucocorticosteroids are dependent on the size of the dose and the duration of treatment, a risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used.

Karposi's sarcoma has been reported to occur in patients receiving corticosteroid therapy, most often for chronic conditions. Discontinuation of corticosteroids may result in clinical improvement.

Cardio-renal

As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure or renal insufficiency.

Endocrine

Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted. Since mineralocorticoid secretion may be impaired, salt and/or a mineralocorticoid should be administered concurrently.

Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients. Changes in thyroid status of the patient may necessitate adjustment in dosage.

Gastrointestinal

Steroids should be used with caution in active or latent peptic ulcer, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since they may increase the risk of perforation.

Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent.

There is an enhanced effect due to decreased metabolism of corticosteroids in patients with cirrhosis.

Parenteral Administration

Intra-articularly injected corticosteroids may be systemically absorbed.

Appropriate examination of any joint fluid present is necessary to exclude a septic process.

A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise are suggestive of septic arthritis. If this complication occurs and diagnosis of sepsis is confirmed, appropriate antimicrobial therapy should be instituted.

Injection of a steroid into an infected site is to be avoided. Local injection of a steroid into a previously infected joint is not usually recommended.

Musculoskeletal

Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation (e.g., decreasing absorption and increasing excretion) and inhibition of osteoblast function. This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to an inhibition of bone growth in pediatric patients and the development of osteoporosis at any age. Special consideration should be given to increased risk of osteoporosis (e.g., postmenopausal women) before initiating corticosteroid therapy.

Neuro-psychiatric

Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not show that corticosteroids affect the ultimate outcome or natural history of the disease. The studies do show that relatively high doses of corticosteroids are necessary to demonstrate a significant effect (see DOSAGE AND ADMINISTRATION).

An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (e.g., myasthenia gravis), or in patients receiving concomitant therapy with neuromuscular blocking drugs (e.g., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevation of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.

Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.

Ophthalmic

Intraocular pressure may become elevated in some individuals. If steroid therapy is continued long-term, intraocular pressure should be monitored.

Corticosteroids should be used cautiously in patients with ocular herpes simplex for fear of corneal perforation.

Information for the Patient

Patients should be warned not to discontinue the use of corticosteroids abruptly or without medical supervision, to advise any medical attendants that they are taking corticosteroids and to seek medical advice at once should they develop a fever or other signs of infection.

Persons who are on corticosteroids should be warned to avoid exposure to chicken pox or measles. Patients should also be advised that if they are exposed, medical advice should be sought without delay.

Drug Interactions

Aminoglutethimide

Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression.

Amphotericin B injection and potassium-depleting agents

When corticosteroids are administered concomitantly with potassium depleting agents (e.g., amphotericin B, diuretics), patients should be observed closely for development of hypokalemia. There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure.

Antibiotics

Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance (see Drug Interactions, Hepatic Enzyme Inhibitors).

Anticholinesterases

Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy.

Anticoagulants, oral

Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect.

Antidiabetics

Because corticosteroids may increase blood glucose concentration, dosage adjustments of antidiabetic agents may be required.

Antitubercular drugs

Serum concentrations of isoniazid may be decreased.

Cholestyramine

Cholestyramine may increase the clearance of oral corticosteroids.

Cyclosporine

Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use.

Digitalis glycosides

Patients on digitalis glycosides may be at risk of arrhythmias due to hypokalemia.

Estrogens, including oral contraceptives

Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect.

Hepatic Enzyme Inducers (e.g., barbiturates, phenytoin, carbamazepine, rifampin)

Drugs which induce cytochrome P450 3A4 enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased.

Hepatic Enzyme Inhibitors (e.g., ketoconazole, macrolide antibiotics such as erythromycin and troleandomycin)

Drugs which inhibit cytochrome P450 3A4 have the potential to result in increased plasma concentrations of corticosteroids.

Ketoconazole

Ketoconazole has been reported to significantly decrease the metabolism of certain corticosteroids by up to 60%, leading to an increased risk of corticosteroid side effects.

Non-steroidal anti-inflammatory agents (NSAIDs)

Concomitant use of aspirin (or other non-steroidal anti-inflammatory agents) and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids.

Skin tests

Corticosteroids may suppress reactions to skin tests.

Vaccines

Patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. Routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued if possible (see WARNINGS, Infections, Vaccinations).

Carcinogenesis, Mutagenesis, Impairment of Fertility

No adequate studies have been conducted in animals to determine whether corticosteroids have a potential for carcinogenesis or mutagenesis.

Steroids may increase or decrease motility and number of spermatozoa in some patients.

Pregnancy

Teratogenic Effects

Pregnancy Category C

Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to the human dose. Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring. There are no adequate and well-controlled studies in pregnant women. Corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers who have received corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.

Nursing Mothers

Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. Because of the potential for serious adverse reactions in nursing infants from corticosteroids, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

The efficacy and safety of corticosteroids in the pediatric population are based on the well-established course of effect of corticosteroids which is similar in pediatric and adult populations. Published studies provide evidence of efficacy and safety in pediatric patients for the treatment of nephritic syndrome (patients >2 years of age), and aggressive lymphomas and leukemias (patients >1 month of age). Other indications for pediatric use of corticosteroids, e.g., severe asthma and wheezing, are based on adequate and well-controlled clinical trials conducted in adults, on the premises that the course of the diseases and their pathophysiology are considered to be substantially similar in both populations.

The adverse effects of corticosteroids in pediatric patients are similar to those in adults (see ADVERSE REACTIONS). Like adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis. Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity. This negative impact of corticosteroids on growth has been observed at low systemic doses and in the absence of laboratory evidence of hypothalamic-pituitary-adrenal (HPA) axis suppression (e.g., cosyntropin stimulation and basal cortisol plasma levels). Growth velocity may therefore be a more sensitive indicator of systemic corticosteroid exposure in pediatric patients than some commonly used tests of HPA axis function. The linear growth of pediatric patients treated with corticosteroids should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the ability of treatment alternatives. In order to minimize the potential growth effects of corticosteroids, pediatric patients should be titrated to the lowest effective dose.

Geriatric Use

Clinical studies did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Adverse Reactions

The following adverse reactions have been reported with Depo-Medrol or other corticosteroids:

Allergic reactions: Allergic or hypersensitivity reactions, anaphylactoid reaction, anaphylaxis, angioedema.

Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction (see WARNINGS), pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis.

Dermatologic: Acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scaly skin, ecchymoses and petechiae, edema, erythema, hyperpigmentation, hypopigmentation, impaired wound healing, increased sweating, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria.

Endocrine: Decreased carbohydrate and glucose tolerance, development of cushingoid state, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients.

Fluid and electrolyte disturbances: Congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis, potassium loss, sodium retention.

Gastrointestinal: Abdominal distention, bowel/bladder dysfunction (after intrathecal administration), elevation in serum liver enzymes levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible subsequent perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis.

Metabolic: Negative nitrogen balance due to protein catabolism.

Musculoskeletal: Aseptic necrosis of femoral and humeral heads, calcinosis (following intra-articular or intra-lesional use), Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, postinjection flare (following intra-articular use), steroid myopathy, tendon rupture, vertebral compression fractures.

Neurologic/Psychiatric: Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo.

Ophthalmic: Exophthalmoses, glaucoma, increased intraocular pressure, posterior subcapsular cataracts.

Other: Abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreased motility and number of spermatozoa, injection site infections following non-sterile administration (see WARNINGS), malaise, moon face, weight gain.

The following adverse reactions have been reported with the following routes of administration:

Intrathecal/Epidural: Arachnoiditis, bowel/bladder dysfunction, headache, meningitis, parapareisis/paraplegia, seizures, sensory disturbances.

Intranasal: Allergic reactions, rhinitis, temporary/permanent visual impairment including blindness.

Ophthalmic: Increased intraocular pressure, infection, ocular and periocular inflammation including allergic reactions, residue or slough at injection site, temporary/permanent visual impairment including blindness.

Miscellaneous injection sites: (scalp, tonsillar fauces, sphenopalatine ganglion): blindness.

Overdosage

Treatment of acute overdosage is by supportive and symptomatic therapy. For chronic overdosage in the face of severe disease requiring continuous steroid therapy, the dosage of corticosteroid may be reduced only temporarily, or alternate day treatment may be introduced.

Depo-Medrol Dosage and Administration

Because of possible physical incompatibilities, Depo-Medrol Sterile Aqueous Suspension should not be diluted or mixed with other solutions.

The initial dosage of parenterally administered Depo-Medrol will vary from 4 to 120 mg depending on the specific disease entity being treated. However, in certain overwhelming, acute, life-threatening situations, administrations in dosages exceeding the usual dosages may be justified and may be in multiples of the oral doses.

It Should Be Emphasized that Dosage Requirements are Variable and Must Be Individualized on the Basis of the Disease Under Treatment and the Response of the Patient. After a favorable response is noted, the proper maintenance dose should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. Situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient's individual drug responsiveness, and the effect of patient exposure to stressful situations not directly related to the disease entity under treatment. In this latter situation it may be necessary to increase the dosage of the corticosteroid for a period of time consistent with the patient's condition. If after long term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly.

A. Administration for Local Effect

Therapy with Depo-Medrol does not obviate the need for the conventional measures usually employed. Although this method of treatment will ameliorate symptoms, it is in no sense a cure and the hormone has no effect on the cause of the inflammation.

1. Rheumatoid and Osteoarthritis

The dose for intra-articular administration depends upon the size of the joint and varies with the severity of the condition in the individual patient. In chronic cases, injections may be repeated at intervals ranging from one to five or more weeks depending upon the degree of relief obtained from the initial injection. The doses in the following table are given as a general guide:

Size of Joint	Examples	Range of Dosage
Large	Knees Ankles Shoulders	20 to 80 mg
Medium	Elbows Wrists	10 to 40 mg
Small	Metacarpophalangeal Interphalangeal Sternoclavicular Acromioclavicular	4 to 10 mg

Procedure

It is recommended that the anatomy of the joint involved be reviewed before attempting intra-articular injection. In order to obtain the full anti-inflammatory effect, it is important that the injection be made into the synovial space. Employing the same sterile technique as for a lumbar puncture, a sterile 20 to 24 gauge needle (on a dry syringe) is quickly inserted into the synovial cavity. Procaine infiltration is elective. The aspiration of only a few drops of joint fluid proves the joint space has been entered by the needle. The injection site for each joint is determined by that location where the synovial cavity is most superficial and most free of large vessels and nerves. With the needle in place, the aspirating syringe is removed and replaced by a second syringe containing the desired amount of Depo-Medrol. The plunger is then pulled outward slightly to aspirate synovial fluid and to make sure the needle is still in the synovial space. After injection, the joint is moved gently a few times to aid mixing of the synovial fluid and the suspension. The site is covered with a small sterile dressing.

Suitable sites for intra-articular injection are the knee, ankle, wrist, elbow, shoulder, phalangeal, and hip joints. Since difficulty is not infrequently encountered in entering the hip joint, precautions should be taken to avoid any large blood vessels in the area. Joints not suitable for injection are those that are anatomically inaccessible such as the spinal joints and those like the sacroiliac joints that are devoid of synovial space. Treatment failures are most frequently the result of failure to enter the joint space. Little or no benefit follows injection into surrounding tissue. If failures occur when injections into the synovial spaces are certain, as determined by aspiration of fluid, repeated injections are usually futile.

If a local anesthetic is used prior to injection of Depo-Medrol, the anesthetic package insert should be read carefully and all the precautions observed.

2. Bursitis

The area around the injection site is prepared in a sterile way and a wheal at the site made with 1 percent procaine hydrochloride solution. A 20 to 24 gauge needle attached to a dry syringe is inserted into the bursa and the fluid aspirated. The needle is left in place and the aspirating syringe changed for a small syringe containing the desired dose. After injection, the needle is withdrawn and a small dressing applied.

3. Miscellaneous: Ganglion, Tendinitis, Epicondylitis

In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken, following application of a suitable antiseptic to the overlying skin, to inject the suspension into the tendon sheath rather than into the substance of the tendon. The tendon may be readily palpated when placed on a stretch. When treating conditions such as epicondylitis, the area of greatest tenderness should be outlined carefully and the suspension infiltrated into the area. For ganglia of the tendon sheaths, the suspension is injected directly into the cyst. In many cases, a single injection causes a marked decrease in the size of the cystic tumor and may effect disappearance. The usual sterile precautions should be observed, of course, with each injection.

The dose in the treatment of the various conditions of the tendinous or bursal structures listed above varies with the condition being treated and ranges from 4 to 30 mg. In recurrent or chronic conditions, repeated injections may be necessary.

4. Injections for Local Effect in Dermatologic Conditions

Following cleansing with an appropriate antiseptic such as 70% alcohol, 20 to 60 mg of the suspension is injected into the lesion. It may be necessary to distribute doses ranging from 20 to 40 mg by repeated local injections in the case of large lesions. Care should be taken to avoid injection of sufficient material to cause blanching since this may be followed by a small slough. One to four injections are usually employed, the intervals between injections varying with the type of lesion being treated and the duration of improvement produced by the initial injection.

B. Administration for Systemic Effect

The intramuscular dosage will vary with the condition being treated. When employed as a temporary substitute for oral therapy, a single injection during each 24-hour period of a dose of the suspension equal to the total daily oral dose of MEDROL® Tablets (methylprednisolone tablets, USP) is usually sufficient. When a prolonged effect is desired, the weekly dose may be calculated by multiplying the daily oral dose by 7 and given as a single intramuscular injection.

In pediatric patients, the initial dose of methylprednisolone may vary depending on the specific disease entity being treated. Dosage must be individualized according to the severity of the disease and response of the patient. The recommended dosage may be reduced for pediatric patients, but dosage should be governed by the severity of the condition rather than by strict adherence to the ratio indicated by age or body weight.

In patients with the adrenogenital syndrome, a single intramuscular injection of 40 mg every two weeks may be adequate. For maintenance of patients with rheumatoid arthritis, the weekly intramuscular dose will vary from 40 to 120 mg. The usual dosage for patients with dermatologic lesions benefited by systemic corticoid therapy is 40 to 120 mg of methylprednisolone acetate administered intramuscularly at weekly intervals for one to four weeks. In acute severe dermatitis due to poison ivy, relief may result within 8 to 12 hours following intramuscular administration of a single dose of 80 to 120 mg. In chronic contact dermatitis, repeated injections at 5 to 10 day intervals may be necessary. In seborrheic dermatitis, a weekly dose of 80 mg may be adequate to control the condition.

Following intramuscular administration of 80 to 120 mg to asthmatic patients, relief may result within 6 to 48 hours and persist for several days to two weeks. Similarly in patients with allergic rhinitis (hay fever), an intramuscular dose of 80 to 120 mg may be followed by relief of coryzal symptoms within six hours persisting for several days to three weeks.

If signs of stress are associated with the condition being treated, the dosage of the suspension should be increased. If a rapid hormonal effect of maximum intensity is required, the intravenous administration of highly soluble methylprednisolone sodium succinate is indicated.

In treatment of acute exacerbations of multiple sclerosis, daily doses of 160 mg of methylprednisolone for a week followed by 64 mg every other day for 1 month have been shown to be effective.

For the purpose of comparison, the following is the equivalent milligram dose of the various glucocorticoids:

Cortisone, 25	Triamcinolone, 4
Hydrocortisone, 20	Paramethasone, 2
Prednisolone, 5	Netamethasone, 0.75
Prednisone, 5	Dexamethasone, 0.75
Methylprednisolone, 4

These dose relationships apply only to oral or intravenous administration of these compounds. When these substances or their derivatives are injected intramuscularly or into joint spaces, their relative properties may be greatly altered.

How is Depo-Medrol Supplied

Depo-Medrol Sterile Aqueous Suspension is available as single-dose vials in the following strengths and package sizes:

40 mg per mL		80 mg per mL
1 mL vials	NDC 0009-3073-01	1 mL vials	NDC 0009-3475-01
25 × 1 mL vials	NDC 0009-3073-03	25 × 1 mL vials	NDC 0009-3475-03

Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].

Rx only

LAB-0160-5.0

July 2009

PRINCIPAL DISPLAY PANEL - 40 mg Vial Label

NDC 0009-3073-01

1 mL

Single-Dose Vial

Rx only

Depo-Medrol®

methylprednisolone

acetate injectable

suspension, USP

40 mg/mL

PRINCIPAL DISPLAY PANEL - 80 mg Vial Label

NDC 0009-3475-01

1 mL

Single-Dose Vial

Rx only

Depo-Medrol®

methylprednisolone

acetate injectable

suspension, USP

80 mg/mL

Depo-Medrol  methylprednisolone acetate  injection, suspension

Product Information Product Type HUMAN PRESCRIPTION DRUG NDC Product Code (Source) 0009-3073 Route of Administration INTRAMUSCULAR, INTRA-ARTICULAR, INTRALESIONAL, SOFT TISSUE DEA Schedule

Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength methylprednisolone acetate (methylprednisolone) methylprednisolone 40 mg  in 1 mL

Inactive Ingredients Ingredient Name Strength polyethylene glycol 3350 29 mg  in 1 mL sodium chloride   sodium hydroxide   hydrochloric acid

Product Characteristics Color      Score      Shape Size