What is high blood pressure?
Imagine that your arteries are pipes that carry blood from your heart to the rest of your body. High blood pressure (also called hypertension) occurs when your blood moves through your arteries at a higher pressure than normal.
What do the numbers mean?
Blood pressure is really two measurements, separated by a slash when written down, such as 120/80. You may also hear someone say a blood pressure is "120 over 80."
The first number is the systolic blood pressure. This is the peak blood pressure when your heart is squeezing blood out. The second number is the diastolic blood pressure. It's the pressure when your heart is filling with blood--relaxing between beats.
A normal blood pressure is 120/80 or lower. High blood pressure is 140/90 or higher. If your blood pressure is between 120/80 and 140/90, you have something called "prehypertension."
How is high blood pressure diagnosed?
Blood pressure is measured by putting a blood pressure cuff around your arm, inflating the cuff and listening for the flow of blood. Your doctor will measure your blood pressure at more than one visit to see if you have high blood pressure.
How often should I have my blood pressure checked?
Even in children, blood pressure should be checked occasionally, beginning at about age 2. After age 21, have your blood pressure checked at least once every 2 years. Do it more often if you have had high blood pressure in the past.
What problems does high blood pressure cause?
High blood pressure damages your blood vessels. This in turn raises your risk of stroke, kidney failure, heart disease and heart attack.
Does it have any symptoms?
Not usually. This is why it's so important to have your blood pressure checked regularly.
How is it treated?
Treatment begins with changes you can make to your lifestyle to help lower your blood pressure and reduce your risk of heart disease (see the box below). If these changes don't work, you may also need to take medicine.
Even if you must take medicine, making some changes in your lifestyle can help reduce the amount of medicine you must take.
Lifestyle changes
•Don't smoke cigarettes or use any tobacco product.
•Lose weight if you're overweight.
•Exercise regularly.
•Eat a healthy diet that includes lots of fruits and vegetables and is low in fat.
•Limit your sodium, alcohol and caffeine intake.
•Try relaxation techniques or biofeedback.
Return to top
More Information
Heart Disease & Stroke
How do tobacco products affect blood pressure?
The nicotine in cigarettes and other tobacco products causes your blood vessels to constrict and your heart to beat faster, which temporarily raises your blood pressure. If you quit smoking or using other tobacco products, you can significantly lower your risk of heart disease and heart attack, as well as help lower your blood pressure.
What about losing weight and exercising?
If you're overweight, losing weight usually helps lower blood pressure. Regular exercise is a good way to lose weight. It also seems to lower high blood pressure by itself.
Is sodium really off limits?
Not everyone is affected by sodium, but sodium can increase blood pressure in some people. Most people who have high blood pressure should limit the sodium in their diet each day to less than 2,400 mg. Your doctor may tell you to limit your sodium even more.
Don't add salt to your food. Check food labels for sodium. While some foods obviously have a lot of sodium, such as potato chips, you may not realize how much sodium is in things like bread and cheese.
Do I need to quit drinking alcohol altogether?
In some people, alcohol causes blood pressure to rise quite a lot. In other people, it doesn't. If you drink alcohol, limit it to no more than 1 or 2 drinks per day. One drink is a can of beer, a glass of wine or 1 jigger of liquor. If your blood pressure increases with alcohol, it's best not to drink any alcohol.
Does stress affect my blood pressure?
Stress may affect blood pressure. To help combat the effects of stress, try relaxation techniques or biofeedback. These things work best when used at least once a day. Ask your family doctor for advice.
What about medicine?
Many different types of medicine can be used to treat high blood pressure (see the box below). These are called antihypertensive medicines.
The goal of treatment is to reduce your blood pressure to normal levels with medicine that's easy to take and has few, if any, side effects. This goal can almost always be met.
If your blood pressure can only be controlled with medicine, you'll need to take the medicine for the rest of your life. Don't stop taking the medicine without talking with your family doctor or you may increase your risk of having a stroke or heart attack.
Types of antihypertensive drugs
•Diuretics: These drugs help your body get rid of extra sodium and fluid so that your blood vessels don't have to hold so much fluid.
•Beta-blockers: These drugs block the effects of adrenaline.
•Alpha-blockers: These drugs help your blood vessels stay open.
•ACE inhibitors: These drugs prevent your blood vessels from constricting by blocking your body from making angiotensin II. Angiotensin II is a chemical that constricts blood vessels.
•Calcium channel blockers: These drugs help prevent your blood vessels from constricting by blocking calcium from entering your cells.
•Combinations: These drugs combine an ACE inhibitor with a calcium channel blocker.
What are the possible side effects of medicine?
Different drugs have different side effects for different people. Side effects of antihypertensive drugs can include feeling dizzy when you stand up after lying down or sitting, lowered levels of potassium in your blood, problems sleeping, drowsiness, dry mouth, headaches, bloating, constipation and depression. In men, some antihypertensive drugs can cause problems with having an erection.
Talk to your family doctor about any changes you notice. If one medicine doesn't work for you or causes side effects, you have other options. Let your doctor help you find the right medicine for you.
Tuesday, May 26, 2009
Low Cholesterol Diet
How to Lower Your Cholesterol
Cholesterol Lowering Drugs and Cholesterol Lowering Diet
Whatever the reasons may be for your high blood cholesterol level - diet, heredity, or both - the treatment your doctor will prescribe first is a diet. If your blood cholesterol level has not decreased sufficiently after carefully following the diet for 6 months, your doctor may consider adding cholesterol-lowering medication to your dietary treatment. Remember, diet is a very essential step in the treatment of high blood cholesterol.
Cholesterol-lowering medications are more effective when combined with diet. Thus they are meant to supplement, not replace, a low-saturated fat, low-cholesterol diet. See also Inherited High Cholesterol
Summary of Diet Guidelines for Lowering High Blood Cholesterol Levels
- Eat less high-fat food (especially those high in saturated fat)
- Replace part of the saturated fat in your diet with unsaturated fat
- Eat less high-cholesterol food
- Choose foods high in complex carbohydrates (starch and fiber)
- Reduce your weight, if you are overweight
Eat Less High-fat Food
Dietary Fat
There are two major types of dietary fat - saturated and unsaturated. Unsaturated fats are further classified as either polyunsaturated or monounsaturated fats. Together, saturated and unsaturated fats equal total fat. All foods containing fat contain a mixture of these fats.
Reduce Total Fat Intake
One of the goals in your blood cholesterol-lowering diet is to eat less total fat, because this is an effective way to eat less saturated fat. Because fat is the richest source of calories, this will also help reduce the number of calories you eat every day. If you are overweight, weight loss is another important step in lowering blood cholesterol levels (as discussed later in this brochure). If you are not overweight, be sure to replace the fat calories by eating more food high in complex carbohydrates.
Remember: When you decrease the amount of total fat you eat, you are likely to reduce the saturated fat and calories in your diet.
Saturated Fat
Saturated fat raises your blood cholesterol level more than anything else in your diet. The best way to reduce your blood cholesterol level is to reduce the amount of saturated fat you eat.
Animal Fats
Animal products as a group are a major source of saturated fat in the average American diet. Butter, cheese, whole milk, ice cream, and cream all contain high amounts of saturated fat. Saturated fat is also concentrated in the fat that surrounds meat and in the white streaks of fat in the muscle of meat (marbling). Poultry, fish, and shellfish also contain saturated fat, although generally less than meat.
Hydrogenated Fat - Known As Trans Fatty Acids or Trans-Fats
Trans fats are created during the food manufacturing process when cheap vegetable oils undergo a process called "hydrogenation" - they have hydrogen added to them to make them solid and less likely to become rancid. Unfortunately, trans fats are even worse for our heart than saturated fat, as they encourage atherosclerosis (narrowing of the arteries). For details of foods containing trans fatty acids, see Trans Fats and Heart Disease
Vegetable Fats
A few vegetable fats - coconut oil, cocoa butter (found in chocolate), palm kernel oil, and palm oil - are high in saturated fat. These vegetable fats are found in many commercially baked goods, such as cookies and crackers, and in nondairy substitutes, such as whipped toppings, coffee creamers, cake mixes, and even frozen dinners. They also can be found in some snack foods like chips, candy bars, and buttered popcorn. Because these vegetable fats are not visible in these foods (unlike the fat in meats) it is important for you to read food labels. The label may tell you how much saturated fat a food contains, which will help you choose foods lowest in saturated fats.
Remember: Saturated fats are found primarily in animal products. But a few vegetable fats and many commercially processed foods also contain saturated fat. Read labels carefully. Choose foods wisely.
Substitute Unsaturated Fat for Saturated Fat
Unsaturated fat actually helps to lower cholesterol levels when it is substituted for saturated fat. Therefore, health professionals recommend that, when you do eat fats, unsaturated fats (polyunsaturated and monounsaturated fats) be substituted for part of the saturated fat whenever possible.
Polyunsaturated fats are found primarily in safflower, corn, soybean, cottonseed, sesame, and sunflower oils, which are common cooking oils. Polyunsaturated fats are also contained in most salad dressings. But be cautious. Commercially prepared salad dressings also may be high in saturated fats, and therefore careful inspection of labels is important. The word "hydrogenated" on a label means that some of the polyunsaturated fat has been converted to saturated fat.
Another type of polyunsaturated fat is found in the oils of fish and shellfish (often referred to as fish oils, or omega-3 fatty acids). This type of polyunsaturated fat is found in greatest amounts in such fatty fish as herring, salmon, and mackerel. There is little evidence that omega-3 fatty acids are useful for reducing LDL-cholesterol levels. However, fish is a good food choice for this diet play anyway because it is low in saturated fat. The use of fish oil supplements are not recommended for the treatment of high blood cholesterol because it is not known whether long-term ingestion of omega-3 fatty acids will lead to undesirable side effects.
Olive and canola oil (rapeseed oil) are examples of oils that are high in monounsaturated fats. Like other vegetable oils, these oils are used in cooking as well as in salads. Recently, research has shown that substituting monounsaturated fat, like substituting polyunsaturated fat, for saturated fat reduces blood cholesterol levels.
Remember: Unsaturated fats when substituted for saturated fats help lower blood cholesterol levels.
Eat Less High-Cholesterol Food
Dietary cholesterol is a waxy, fat-like substance found in foods that come from animals. Although it is not the same as saturated fat, dietary cholesterol also can raise your blood cholesterol level. Therefore, it is important to eat less food that is high in cholesterol. While cholesterol is needed for normal body function, your liver makes enough for your body's needs so that you don't need to eat any cholesterol at all.
Dietary Cholesterol in Food
Cholesterol is found in eggs, dairy products, meat, poultry, fish, and shellfish. Egg yolks and organ meats (liver, kidney, sweetbread, brain) are particularly rich sources of cholesterol. High-fat dairy products, meat, and poultry all have similar amounts of cholesterol. Fish generally has less cholesterol, but shellfish varies in cholesterol content. Foods of plant origin, like fruits, vegetables, grains, cereals, nuts, and seeds, contain no cholesterol.
Since cholesterol is not a fat, you can find it in both high-fat and low-fat animal foods. In other words, even if a food is low in fat, it may be high in cholesterol. For instance, organ meats, like liver, are low in fat, but are high in cholesterol.
Because many foods such as dairy products and some meats are high in both saturated fat and cholesterol, it is important to limit the amount of these high-fat foods that you eat, choosing lean meats and low-fat dairy products whenever possible.
Remember: Organ meats and egg yolks are high in cholesterol. High-fat dairy products, meat, and poultry have similar amounts of cholesterol. Some fish has less. Foods of plant origin like fruits, vegetables, vegetable oils, grains, cereals, nuts, and seeds contain no cholesterol.
Substitute Low GI Carbohydrates for Saturated Fat
Breads, pasta, rice, cereals, dried peas and beans, fruits, and vegetables are good sources of complex carbohydrates (starch and fiber). Low-GI varieties are excellent substitutes for foods that are high in saturated fat and cholesterol. The type of fiber found in foods such as oat and barley bran, some fruits like apples and oranges, and in some dried beans may even help reduce blood cholesterol levels. For details about low-GI foods, see GI Diet.
Contrary to popular belief, high-carbohydrate foods (like pasta, rice, potatoes) are lower in calories than foods high in fat. In addition, they are good sources of vitamins and minerals. What adds calories to these foods is the addition of butter, rich sauces, whole milk, or cream, which are high in fat, especially saturated fat. It is important not to add these to the high-carbohydrate foods you are substituting for foods high in fat.
Remember: Foods that are high in complex carbohydrates, if eaten plain, are low in saturated fat and cholesterol as well as being good sources of vitamins, minerals, and fiber.
Maintain a Desirable Weight
People who are overweight frequently have higher blood cholesterol levels than people of desirable weight.
You can reduce your weight by eating fewer calories and by increasing your physical activity on a regular basis. By reducing the amount of fat in your diet, you will be cutting down on the richest source of calories. Substituting foods that are high in complex carbohydrates for high-fat foods will also help you lose weight, because many high-carbohydrate foods contain little fat and thus fewer calories.
Fat Contains Twice the Calories of Carbs and Protein
Fat has more than twice the calories as the same amount of protein or carbohydrate. Protein and carbohydrate both have about 4 calories in each gram, but all fat-saturated, polyunsaturated or monounsaturated fat - has 9 calories in each gram. Thus, foods that are high in fat are high in calories. And all calories count. So, to maintain a desirable weight, it is important to eat no more calories than your body needs. (To find your desirable weight, see Body Mass Index)
Remember: To achieve or maintain a desirable weight, your caloric intake must not exceed the number of calories your body burns.
Further Help in Developing a Low Cholesterol Diet
If you suffer from hyperlipemia, hypercholesterolemia, or hypertriglyceridemia and you want additional help in planning a heart-healthy diet, low in saturated fat and dietary cholesterol, make an appointment with a registered dietitian or qualified nutritionist. The American Dietetic Association maintains a roster of registered dietitians. By calling the Division of Practice (312) 899-0040 you can request names of qualified dietitians in your area.
Sources include: National Cholesterol Education Program National Heart, Lung, and Blood Institute. U.S. Department of Health and Human Services.
Monday, May 25, 2009
Gym work
Gym workout programs can vary dramatically from bodybuilder to bodybuilder. One gym bodybuilding workout for one bodybuilding enthusiast can deliver outstanding results while another gym workout can be a disappointment for another bodybuilder.
After thousands of bodybuilding fitness consulting sessions, and publishing a popular weight training guide, I constantly teach bodybuilders a results proven gym workout routine that builds muscle fast.
All you have to do is follow my 8 Gym Workout Bodybuilding Tips and you will soon see your muscle building results double.
8 Gym Bodybuilding Workout Tips
1. Have a clear weight training routine purpose.
Upon entering the gym it is imperative to have a clear cut bodybuilding routine plan of action. You should know exactly what exercises you will perform, how much weight you will need to lift, and how many reps you must beat. Therefore, your whole bodybuilding routine is 100% planned, set in stone, prior to beginning your gym workout. You must walk into the gym with a definite plan, and purpose.
2. Be in a "warrior" high intensity weight training state of mind.
It is crucial to enter the gym workout focused. I can remember entering the gym and instantly beginning to perspire. I mentally had worked myself up into state of high intensity weight training desire. This is even before I lifted one weight. It is called focus, and anticipation.
Bodybuilding results are only seen when you force yourself to grow. That takes high intensity weight training, as well as ultra high mental focus. Your mind should be totally focused on conquering the next rep. It is important to imagine yourself forcing out that one additional muscle building repetition.
In an effective gym workout, your attitude, and drive will determine your altitude of muscle development.
3. Focus on effective pre- gym workout bodybuilding nutrition.
Make sure you ingest a small amount of complex carbohydrates, and protein approximately 2 hours prior to beginning your gym workout. This will assure you of getting the adequate amounts of energy producing nutrients to expel in your high intensity weight training session.
Another extremely important gym workout tip is to make sure you are properly hydrated with, preferably, water. You should be consuming at least one-half of your bodyweight in ounces each and every day.
Bodybuilding training preparations are similar to space shuttle preparations. Your goal should be to get your system ready for a high intensity weight training blast off.
4. Did you bring your bodybuilding workout log to your gym workout?
One of the biggest mistakes bodybuilders consistently make is neglecting to track their weight lifting progress. Without measuring progress, there generally is little improvement. How do you know what you are suppose to beat if you have no data? How can a department store set sales goals if they don't track sales? It is just absolutely silly seeing bodybuilders completing their gym workouts without recording any data. That what is not measured will not improve.
5. Gym workouts are for training, not socializing.
Remember, you are in the gym to get muscle building results. If you are talking and goofing around, how in the world can you be ultra focused on going to war with the weights? Get your work done, and then socialize if you wish. I tell my clients to stay focused, and don't allow distractions. Focus on conquering that near impossible, muscle growth repetition.
6. Use only proven bodybuilding program principles.
Don't listen to Joe Bodybuilders newest theory on building muscle. Stick to what has been scientifically proven to work. Beware of all the gym chatter floating around. To discover all of the most advanced proven bodybuilding principles visit my muscle building weight training guide presented in digital audio. Bodybuilding Done Right is a how to bodybuilding audio revealing the proven scientific bodybuilding program principle the pros use, but refuse to share.
7. Avoid Overtraining.
Once you have completed your pre-designed 100% high intensity bodybuilding routine, it is time to get out of the gym, and go home and grow. Hold yourself back from doing one extra set. Remember, more is not necessarily better. Stick to your plan. With high intensity weight training you need less volume of work. Any extra basic weight training exercises could be counter productive to your bodybuilding muscle growth.
Get out of the gym, and let your body compensate, and later overcompensate with added fat burning muscle tissue.
Also, make sure your body has fully recovered from the previous gym workout before you train again.
8. Begin the recovery process with optimal bodybuilding nutrition.
You have an hour after your high intensity weight training workout to replenish your glycogen levels, thus, aiding in the muscle building, and recovery process. Take in two parts complex or simple carbohydrates with one part protein. This is an important bodybuilding tip that has been proven to aid in the muscle recovery, and building process. So power your gym workout with these proven tips.
These are 8 important gym workout tips that should be followed. Following these bodybuilding workout tips will do wonders for your weightlifting, muscle building results.
After thousands of bodybuilding fitness consulting sessions, and publishing a popular weight training guide, I constantly teach bodybuilders a results proven gym workout routine that builds muscle fast.
All you have to do is follow my 8 Gym Workout Bodybuilding Tips and you will soon see your muscle building results double.
8 Gym Bodybuilding Workout Tips
1. Have a clear weight training routine purpose.
Upon entering the gym it is imperative to have a clear cut bodybuilding routine plan of action. You should know exactly what exercises you will perform, how much weight you will need to lift, and how many reps you must beat. Therefore, your whole bodybuilding routine is 100% planned, set in stone, prior to beginning your gym workout. You must walk into the gym with a definite plan, and purpose.
2. Be in a "warrior" high intensity weight training state of mind.
It is crucial to enter the gym workout focused. I can remember entering the gym and instantly beginning to perspire. I mentally had worked myself up into state of high intensity weight training desire. This is even before I lifted one weight. It is called focus, and anticipation.
Bodybuilding results are only seen when you force yourself to grow. That takes high intensity weight training, as well as ultra high mental focus. Your mind should be totally focused on conquering the next rep. It is important to imagine yourself forcing out that one additional muscle building repetition.
In an effective gym workout, your attitude, and drive will determine your altitude of muscle development.
3. Focus on effective pre- gym workout bodybuilding nutrition.
Make sure you ingest a small amount of complex carbohydrates, and protein approximately 2 hours prior to beginning your gym workout. This will assure you of getting the adequate amounts of energy producing nutrients to expel in your high intensity weight training session.
Another extremely important gym workout tip is to make sure you are properly hydrated with, preferably, water. You should be consuming at least one-half of your bodyweight in ounces each and every day.
Bodybuilding training preparations are similar to space shuttle preparations. Your goal should be to get your system ready for a high intensity weight training blast off.
4. Did you bring your bodybuilding workout log to your gym workout?
One of the biggest mistakes bodybuilders consistently make is neglecting to track their weight lifting progress. Without measuring progress, there generally is little improvement. How do you know what you are suppose to beat if you have no data? How can a department store set sales goals if they don't track sales? It is just absolutely silly seeing bodybuilders completing their gym workouts without recording any data. That what is not measured will not improve.
5. Gym workouts are for training, not socializing.
Remember, you are in the gym to get muscle building results. If you are talking and goofing around, how in the world can you be ultra focused on going to war with the weights? Get your work done, and then socialize if you wish. I tell my clients to stay focused, and don't allow distractions. Focus on conquering that near impossible, muscle growth repetition.
6. Use only proven bodybuilding program principles.
Don't listen to Joe Bodybuilders newest theory on building muscle. Stick to what has been scientifically proven to work. Beware of all the gym chatter floating around. To discover all of the most advanced proven bodybuilding principles visit my muscle building weight training guide presented in digital audio. Bodybuilding Done Right is a how to bodybuilding audio revealing the proven scientific bodybuilding program principle the pros use, but refuse to share.
7. Avoid Overtraining.
Once you have completed your pre-designed 100% high intensity bodybuilding routine, it is time to get out of the gym, and go home and grow. Hold yourself back from doing one extra set. Remember, more is not necessarily better. Stick to your plan. With high intensity weight training you need less volume of work. Any extra basic weight training exercises could be counter productive to your bodybuilding muscle growth.
Get out of the gym, and let your body compensate, and later overcompensate with added fat burning muscle tissue.
Also, make sure your body has fully recovered from the previous gym workout before you train again.
8. Begin the recovery process with optimal bodybuilding nutrition.
You have an hour after your high intensity weight training workout to replenish your glycogen levels, thus, aiding in the muscle building, and recovery process. Take in two parts complex or simple carbohydrates with one part protein. This is an important bodybuilding tip that has been proven to aid in the muscle recovery, and building process. So power your gym workout with these proven tips.
These are 8 important gym workout tips that should be followed. Following these bodybuilding workout tips will do wonders for your weightlifting, muscle building results.
Sunday, May 17, 2009
Ativan
Ativan is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). It affects chemicals in the brain that may become unbalanced and cause anxiety.
Ativan is used to treat anxiety disorders.
Ativan may also be used for other purposes not listed in this medication guide.
Important information about Ativan
Do not use Ativan if you are allergic to lorazepam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax). This medication can cause birth defects in an unborn baby. Do not use Ativan if you are pregnant.
Before taking Ativan, tell your doctor if you have any breathing problems, glaucoma, kidney or liver disease, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol.
Do not drink alcohol while taking Ativan. This medication can increase the effects of alcohol.
Avoid using other medicines that make you sleepy. They can add to sleepiness caused by this medication.
Ativan may be habit-forming and should be used only by the person it was prescribed for. Ativan should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.
It is dangerous to try and purchase Ativan on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of Ativan purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.
Before taking Ativan
It is dangerous to try and purchase Ativan on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of Ativan purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.
Do not use this medication if you have narrow-angle glaucoma, or if you are allergic to Ativan or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax).
Before taking Ativan, tell your doctor if you are allergic to any drugs, or if you have:
glaucoma;
asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;
kidney or liver disease;
a history of depression or suicidal thoughts or behavior; or
a history of drug or alcohol addiction.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take Ativan.
FDA pregnancy category D. Ativan can cause birth defects in an unborn baby. Do not use Ativan without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. It is not known whether Ativan 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. The sedative effects of this medication may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking Ativan. Do not give this medication to a child younger than 12 years old.
How should I take Ativan?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
Your doctor may occasionally change your dose to make sure you get the best results from this medication.
Measure the liquid form of Ativan with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
Ativan should be used for only a short time. Do not take this medication for longer than 4 months without your doctor's advice. This medication may be habit-forming and should be used only by the person it was prescribed for. Ativan should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Contact your doctor if this medicine seems to stop working as well in treating your symptoms. Do not stop using Ativan suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.
Your symptoms may return when you stop using Ativan after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using Ativan. Withdrawal symptoms may include tremor, sweating, muscle cramps, stomach pain, vomiting, unusual thoughts or behavior, and seizure (convulsions).
To be sure this medication is not causing harmful effects, your doctor may need to check your progress on a regular basis. Do not miss any scheduled visits to your doctor.
Store Ativan at room temperature away from moisture, heat, and light. Store the liquid form of Ativan in the refrigerator.
Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. An overdose of lorazepam can be fatal.
Ativan overdose symptoms may include extreme drowsiness, confusion, muscle weakness, fainting, or coma.
What should I avoid while taking Ativan?
Do not drink alcohol while taking Ativan. This medication can increase the effects of alcohol. Ativan can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Ativan. Tell your doctor if you regularly use any of these other medicines.
What are the possible side effects of Ativan?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
confusion, depressed mood, thoughts of suicide or hurting yourself;
hyperactivity, agitation, hostility;
hallucinations; or
feeling light-headed, fainting.
Less serious side effects may include:
drowsiness, dizziness, tiredness;
blurred vision;
sleep problems (insomnia);
muscle weakness, lack of balance or coordination;
amnesia or forgetfulness, trouble concentrating;
nausea, vomiting, constipation;
appetite changes; or
skin rash.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.
What other drugs will affect Ativan?
Before taking Ativan, tell your doctor if you are using any of the following drugs:
a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton);
an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate);
medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), or thioridazine (Mellaril);
narcotic medications such as butorphanol (Stadol), codeine, hydrocodone (Lortab, Vicodin), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin, Oramorph), naloxone (Narcan), oxycodone (OxyContin), propoxyphene (Darvon, Darvocet); or
antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Asendin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), or trimipramine (Surmontil).
This list is not complete and there may be other drugs that can interact with Ativan. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
Your pharmacist can provide more information about Ativan.
What does my medication look like?
Lorazepam is available with a prescription under the brand name Ativan. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
Ativan 0.5 mg - five-sided, white tablets with a raised "A" on one side
Ativan 1 mg - five-sided, white tablets with a raised "A" on one side
Ativan 2 mg - five-sided, white tablets with a raised "A" on one side
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Ativan is used to treat anxiety disorders.
Ativan may also be used for other purposes not listed in this medication guide.
Important information about Ativan
Do not use Ativan if you are allergic to lorazepam or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax). This medication can cause birth defects in an unborn baby. Do not use Ativan if you are pregnant.
Before taking Ativan, tell your doctor if you have any breathing problems, glaucoma, kidney or liver disease, or a history of depression, suicidal thoughts, or addiction to drugs or alcohol.
Do not drink alcohol while taking Ativan. This medication can increase the effects of alcohol.
Avoid using other medicines that make you sleepy. They can add to sleepiness caused by this medication.
Ativan may be habit-forming and should be used only by the person it was prescribed for. Ativan should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.
It is dangerous to try and purchase Ativan on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of Ativan purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.
Before taking Ativan
It is dangerous to try and purchase Ativan on the Internet or from vendors outside of the United States. Medications distributed from Internet sales may contain dangerous ingredients, or may not be distributed by a licensed pharmacy. Samples of Ativan purchased on the Internet have been found to contain haloperidol (Haldol), a potent antipsychotic drug with dangerous side effects. For more information, contact the U.S. Food and Drug Administration (FDA) or visit www.fda.gov/buyonlineguide.
Do not use this medication if you have narrow-angle glaucoma, or if you are allergic to Ativan or to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), or oxazepam (Serax).
Before taking Ativan, tell your doctor if you are allergic to any drugs, or if you have:
glaucoma;
asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems;
kidney or liver disease;
a history of depression or suicidal thoughts or behavior; or
a history of drug or alcohol addiction.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take Ativan.
FDA pregnancy category D. Ativan can cause birth defects in an unborn baby. Do not use Ativan without your doctor's consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. It is not known whether Ativan 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. The sedative effects of this medication may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking Ativan. Do not give this medication to a child younger than 12 years old.
How should I take Ativan?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
Your doctor may occasionally change your dose to make sure you get the best results from this medication.
Measure the liquid form of Ativan with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
Ativan should be used for only a short time. Do not take this medication for longer than 4 months without your doctor's advice. This medication may be habit-forming and should be used only by the person it was prescribed for. Ativan should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Contact your doctor if this medicine seems to stop working as well in treating your symptoms. Do not stop using Ativan suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.
Your symptoms may return when you stop using Ativan after using it over a long period of time. You may also have seizures or withdrawal symptoms when you stop using Ativan. Withdrawal symptoms may include tremor, sweating, muscle cramps, stomach pain, vomiting, unusual thoughts or behavior, and seizure (convulsions).
To be sure this medication is not causing harmful effects, your doctor may need to check your progress on a regular basis. Do not miss any scheduled visits to your doctor.
Store Ativan at room temperature away from moisture, heat, and light. Store the liquid form of Ativan in the refrigerator.
Keep track of how many pills have been used from each new bottle of this medicine. Benzodiazepines are drugs of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. An overdose of lorazepam can be fatal.
Ativan overdose symptoms may include extreme drowsiness, confusion, muscle weakness, fainting, or coma.
What should I avoid while taking Ativan?
Do not drink alcohol while taking Ativan. This medication can increase the effects of alcohol. Ativan can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Ativan. Tell your doctor if you regularly use any of these other medicines.
What are the possible side effects of Ativan?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
confusion, depressed mood, thoughts of suicide or hurting yourself;
hyperactivity, agitation, hostility;
hallucinations; or
feeling light-headed, fainting.
Less serious side effects may include:
drowsiness, dizziness, tiredness;
blurred vision;
sleep problems (insomnia);
muscle weakness, lack of balance or coordination;
amnesia or forgetfulness, trouble concentrating;
nausea, vomiting, constipation;
appetite changes; or
skin rash.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.
What other drugs will affect Ativan?
Before taking Ativan, tell your doctor if you are using any of the following drugs:
a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton);
an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate);
medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), or thioridazine (Mellaril);
narcotic medications such as butorphanol (Stadol), codeine, hydrocodone (Lortab, Vicodin), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin, Oramorph), naloxone (Narcan), oxycodone (OxyContin), propoxyphene (Darvon, Darvocet); or
antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Asendin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), protriptyline (Vivactil), sertraline (Zoloft), or trimipramine (Surmontil).
This list is not complete and there may be other drugs that can interact with Ativan. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
Your pharmacist can provide more information about Ativan.
What does my medication look like?
Lorazepam is available with a prescription under the brand name Ativan. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
Ativan 0.5 mg - five-sided, white tablets with a raised "A" on one side
Ativan 1 mg - five-sided, white tablets with a raised "A" on one side
Ativan 2 mg - five-sided, white tablets with a raised "A" on one side
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Friday, May 8, 2009
Atenolol
Atenolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).
Atenolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack.
Atenolol may also be used for purposes other than those listed in this medication guide.
Important information about atenolol
Do not stop taking atenolol without first talking to your doctor. Stopping suddenly may make your condition worse.
If you need to have any type of surgery, you may need to temporarily stop using atenolol. Be sure the surgeon knows ahead of time that you are using atenolol.
Atenolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking atenolol.
Atenolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Store atenolol at room temperature away from moisture and heat.
What should I discuss with my healthcare provider before taking atenolol?
You should not use this medication if you are allergic to atenolol, or if you have certain heart conditions such as slow heartbeats, or heart block.
Before taking atenolol, tell your doctor if you have:
asthma, bronchitis, emphysema;
diabetes;
low blood pressure;
a heart problem such as heart block, sick sinus syndrome, slow heart rate, or congestive heart failure;
depression;
liver or kidney disease;
a thyroid disorder;
myasthenia gravis;
pheochromocytoma; or
problems with circulation (such as Raynaud's syndrome).
If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.
FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use atenolol if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Atenolol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
How should I take atenolol?
Take atenolol exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label.
Take this medication with a full glass of water.
Take atenolol at the same time every day.
Do not skip doses or stop taking atenolol without first talking to your doctor. Stopping suddenly may make your condition worse.
To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Do not miss any visits to your doctor.
If you need to have any type of surgery, tell the surgeon that you are using atenolol. You may need to briefly stop using atenolol before having surgery.
Atenolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
If you are being treated for high blood pressure, keep using atenolol even if you feel fine. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Store atenolol at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If your next dose is less than 8 hours away, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include uneven heartbeats, shortness of breath, bluish-colored fingernails, dizziness, weakness, fainting, or seizure (convulsions).
What should I avoid while taking atenolol?
Atenolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking atenolol.
Atenolol side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
slow or uneven heartbeats;
feeling light-headed, fainting;
feeling short of breath, even with mild exertion;
swelling of your ankles or feet;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
depression; or
cold feeling in your hands and feet.
Less serious atenolol side effects may include:
decreased sex drive, impotence, or difficulty having an orgasm;
sleep problems (insomnia);
tired feeling; or
anxiety, nervousness.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect atenolol?
Before taking atenolol, tell your doctor if you are using:
allergy treatments (or if you are undergoing allergy skin-testing);
amiodarone (Cordarone, Pacerone);
clonidine (Catapres);
digoxin (digitalis, Lanoxin);
disopyramide (Norpace);
guanabenz (Wytensin);
an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam);
a diabetes medication such as insulin, glyburide (Diabeta, Micronase, Glynase), glipizide (Glucotrol), chlorpropamide (Diabinese), or metformin (Glucophage);
a heart medication such as nifedipine (Procardia, Adalat), reserpine (Serpasil), verapamil (Calan, Verelan, Isoptin), diltiazem (Cartia, Cardizem);
medicine for asthma or other breathing disorders, such as albuterol (Ventolin, Proventil), bitolterol (Tornalate), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire, Brethine, Bricanyl), and theophylline (Theo-Dur, Theolair); or
cold medicines, stimulant medicines, or diet pills.
If you are using any of these drugs, you may not be able to take atenolol, or you may need dosage adjustments or special tests during treatment.
There may be other drugs not listed that can affect atenolol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
Your pharmacist can provide more information about atenolol.
What does my medication look like?
Atenolol is available with a prescription under the brand name Tenormin. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
Tenormin 25 mg - round, flat, white, uncoated
Tenormin 50 mg - round, flat, white, uncoated
Tenormin 100 mg - round, flat, white, uncoated
Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
Atenolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack.
Atenolol may also be used for purposes other than those listed in this medication guide.
Important information about atenolol
Do not stop taking atenolol without first talking to your doctor. Stopping suddenly may make your condition worse.
If you need to have any type of surgery, you may need to temporarily stop using atenolol. Be sure the surgeon knows ahead of time that you are using atenolol.
Atenolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking atenolol.
Atenolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Store atenolol at room temperature away from moisture and heat.
What should I discuss with my healthcare provider before taking atenolol?
You should not use this medication if you are allergic to atenolol, or if you have certain heart conditions such as slow heartbeats, or heart block.
Before taking atenolol, tell your doctor if you have:
asthma, bronchitis, emphysema;
diabetes;
low blood pressure;
a heart problem such as heart block, sick sinus syndrome, slow heart rate, or congestive heart failure;
depression;
liver or kidney disease;
a thyroid disorder;
myasthenia gravis;
pheochromocytoma; or
problems with circulation (such as Raynaud's syndrome).
If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.
FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use atenolol if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Atenolol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
How should I take atenolol?
Take atenolol exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label.
Take this medication with a full glass of water.
Take atenolol at the same time every day.
Do not skip doses or stop taking atenolol without first talking to your doctor. Stopping suddenly may make your condition worse.
To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Do not miss any visits to your doctor.
If you need to have any type of surgery, tell the surgeon that you are using atenolol. You may need to briefly stop using atenolol before having surgery.
Atenolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
If you are being treated for high blood pressure, keep using atenolol even if you feel fine. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Store atenolol at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If your next dose is less than 8 hours away, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include uneven heartbeats, shortness of breath, bluish-colored fingernails, dizziness, weakness, fainting, or seizure (convulsions).
What should I avoid while taking atenolol?
Atenolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking atenolol.
Atenolol side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
slow or uneven heartbeats;
feeling light-headed, fainting;
feeling short of breath, even with mild exertion;
swelling of your ankles or feet;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
depression; or
cold feeling in your hands and feet.
Less serious atenolol side effects may include:
decreased sex drive, impotence, or difficulty having an orgasm;
sleep problems (insomnia);
tired feeling; or
anxiety, nervousness.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect atenolol?
Before taking atenolol, tell your doctor if you are using:
allergy treatments (or if you are undergoing allergy skin-testing);
amiodarone (Cordarone, Pacerone);
clonidine (Catapres);
digoxin (digitalis, Lanoxin);
disopyramide (Norpace);
guanabenz (Wytensin);
an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam);
a diabetes medication such as insulin, glyburide (Diabeta, Micronase, Glynase), glipizide (Glucotrol), chlorpropamide (Diabinese), or metformin (Glucophage);
a heart medication such as nifedipine (Procardia, Adalat), reserpine (Serpasil), verapamil (Calan, Verelan, Isoptin), diltiazem (Cartia, Cardizem);
medicine for asthma or other breathing disorders, such as albuterol (Ventolin, Proventil), bitolterol (Tornalate), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire, Brethine, Bricanyl), and theophylline (Theo-Dur, Theolair); or
cold medicines, stimulant medicines, or diet pills.
If you are using any of these drugs, you may not be able to take atenolol, or you may need dosage adjustments or special tests during treatment.
There may be other drugs not listed that can affect atenolol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
Your pharmacist can provide more information about atenolol.
What does my medication look like?
Atenolol is available with a prescription under the brand name Tenormin. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
Tenormin 25 mg - round, flat, white, uncoated
Tenormin 50 mg - round, flat, white, uncoated
Tenormin 100 mg - round, flat, white, uncoated
Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
Amoxicillin
Amoxicillin is an antibiotic in the penicillin group of drugs. It fights bacteria in your body.
Amoxicillin is used to treat many different types of infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella infection. Amoxicillin is also sometimes used together with another antibiotic called clarithromycin (Biaxin) to treat stomach ulcers caused by Helicobacter pylori infection. This combination is sometimes used with a stomach acid reducer called lansoprazole (Prevacid).
Amoxicillin may also be used for other purposes not listed in this medication guide.
Important information about amoxicillin
Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic, such as ampicillin (Omnipen, Principen), carbenicillin (Geocillin), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill), penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids), and others.
Before using amoxicillin, tell your doctor if you are allergic to cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others. Also tell your doctor if you have asthma, liver or kidney disease, a bleeding or blood clotting disorder, mononucleosis (also called "mono"), or any type of allergy.
Amoxicillin can make birth control pills less effective, which may result in pregnancy. Before taking amoxicillin, tell your doctor if you use birth control pills. Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Amoxicillin will not treat a viral infection such as the common cold or flu. Do not give this medication to another person, even if they have the same symptoms you do.
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.
Before taking amoxicillin
Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic, such as:
ampicillin (Omnipen, Principen);
carbenicillin (Geocillin);
dicloxacillin (Dycill, Dynapen);
oxacillin (Bactocill); or
penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids, and others).
Before using amoxicillin, tell your doctor if you are allergic to any drugs (especially cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others), or if you have:
asthma;
liver disease;
kidney disease;
a bleeding or blood clotting disorder;
mononucleosis (also called "mono");
a history of diarrhea caused by taking antibiotics; or
a history of any type of allergy.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take amoxicillin.
FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Amoxicillin can make birth control pills less effective, which may result in pregnancy. Before taking amoxicillin, tell your doctor if you use birth control pills. Amoxicillin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
The amoxicillin chewable tablet may contain phenylalanine. Talk to your doctor before using this form of amoxicillin if you have phenylketonuria (PKU).
How should I take amoxicillin?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
If you are taking amoxicillin with clarithromycin and/or lansoprazole to treat stomach ulcer, use all of your medications as directed. Be sure to read the medication guide or patient instructions provided with each of your medications. Do not change your doses or medication schedule without advice from your doctor.
You may take amoxicillin with or without food.
Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
You may place the liquid directly on the tongue, or you may mix it with water, milk, baby formula, fruit juice, or ginger ale. Drink all of the mixture right away. Do not save any for later use.
The chewable tablet should be chewed before you swallow it.
Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.
To be sure this medication is helping your condition, your blood may need to be tested. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.
If you are being treated for gonorrhea, your doctor may also have you tested for syphilis, another sexually transmitted disease.
Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Amoxicillin will not treat a viral infection such as the common cold or flu. Do not give amoxicillin to another person, even if they have the same symptoms you do.
This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using amoxicillin.
Store amoxicillin at room temperature away from moisture, heat, and light. You may store liquid amoxicillin in a refrigerator but do not allow it to freeze. Throw away any liquid amoxicillin that is not used within 14 days after it was mixed at the pharmacy.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include confusion, behavior changes, a severe skin rash, urinating less than usual, or seizure (black-out or convulsions).
What should I avoid while taking amoxicillin?
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.
Amoxicillin side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
diarrhea that is watery or bloody;
fever, chills, body aches, flu symptoms;
easy bruising or bleeding, unusual weakness;
urinating less than usual or not at all;
agitation, confusion, unusual thoughts or behavior; or
seizure (black-out or convulsions).
Less serious side effects are more likely to occur, such as:
nausea, vomiting, stomach pain;
vaginal itching or discharge;
headache;
swollen, black, or "hairy" tongue; or
thrush (white patches inside your mouth or throat).
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 amoxicillin?
Before taking amoxicillin, tell your doctor if you are using any of the following drugs:
methotrexate (Rheumatrex, Trexall);
probenecid (Benemid);
a sulfa drug (such as Bactrim or Septra);
an antibiotic such as azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E.E.S., E-Mycin, Ery-Tab, Erythrocin), telithromycin (Ketek), or troleandomycin (Tao); or
a tetracycline antibiotic such as demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).
This list is not complete and there may be other drugs that can interact with amoxicillin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
Your pharmacist can provide more information about amoxicillin.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Amoxicillin is used to treat many different types of infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella infection. Amoxicillin is also sometimes used together with another antibiotic called clarithromycin (Biaxin) to treat stomach ulcers caused by Helicobacter pylori infection. This combination is sometimes used with a stomach acid reducer called lansoprazole (Prevacid).
Amoxicillin may also be used for other purposes not listed in this medication guide.
Important information about amoxicillin
Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic, such as ampicillin (Omnipen, Principen), carbenicillin (Geocillin), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill), penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids), and others.
Before using amoxicillin, tell your doctor if you are allergic to cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others. Also tell your doctor if you have asthma, liver or kidney disease, a bleeding or blood clotting disorder, mononucleosis (also called "mono"), or any type of allergy.
Amoxicillin can make birth control pills less effective, which may result in pregnancy. Before taking amoxicillin, tell your doctor if you use birth control pills. Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Amoxicillin will not treat a viral infection such as the common cold or flu. Do not give this medication to another person, even if they have the same symptoms you do.
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.
Before taking amoxicillin
Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic, such as:
ampicillin (Omnipen, Principen);
carbenicillin (Geocillin);
dicloxacillin (Dycill, Dynapen);
oxacillin (Bactocill); or
penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids, and others).
Before using amoxicillin, tell your doctor if you are allergic to any drugs (especially cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others), or if you have:
asthma;
liver disease;
kidney disease;
a bleeding or blood clotting disorder;
mononucleosis (also called "mono");
a history of diarrhea caused by taking antibiotics; or
a history of any type of allergy.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take amoxicillin.
FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Amoxicillin can make birth control pills less effective, which may result in pregnancy. Before taking amoxicillin, tell your doctor if you use birth control pills. Amoxicillin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
The amoxicillin chewable tablet may contain phenylalanine. Talk to your doctor before using this form of amoxicillin if you have phenylketonuria (PKU).
How should I take amoxicillin?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
If you are taking amoxicillin with clarithromycin and/or lansoprazole to treat stomach ulcer, use all of your medications as directed. Be sure to read the medication guide or patient instructions provided with each of your medications. Do not change your doses or medication schedule without advice from your doctor.
You may take amoxicillin with or without food.
Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
You may place the liquid directly on the tongue, or you may mix it with water, milk, baby formula, fruit juice, or ginger ale. Drink all of the mixture right away. Do not save any for later use.
The chewable tablet should be chewed before you swallow it.
Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.
To be sure this medication is helping your condition, your blood may need to be tested. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.
If you are being treated for gonorrhea, your doctor may also have you tested for syphilis, another sexually transmitted disease.
Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Amoxicillin will not treat a viral infection such as the common cold or flu. Do not give amoxicillin to another person, even if they have the same symptoms you do.
This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using amoxicillin.
Store amoxicillin at room temperature away from moisture, heat, and light. You may store liquid amoxicillin in a refrigerator but do not allow it to freeze. Throw away any liquid amoxicillin that is not used within 14 days after it was mixed at the pharmacy.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include confusion, behavior changes, a severe skin rash, urinating less than usual, or seizure (black-out or convulsions).
What should I avoid while taking amoxicillin?
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.
Amoxicillin side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
diarrhea that is watery or bloody;
fever, chills, body aches, flu symptoms;
easy bruising or bleeding, unusual weakness;
urinating less than usual or not at all;
agitation, confusion, unusual thoughts or behavior; or
seizure (black-out or convulsions).
Less serious side effects are more likely to occur, such as:
nausea, vomiting, stomach pain;
vaginal itching or discharge;
headache;
swollen, black, or "hairy" tongue; or
thrush (white patches inside your mouth or throat).
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 amoxicillin?
Before taking amoxicillin, tell your doctor if you are using any of the following drugs:
methotrexate (Rheumatrex, Trexall);
probenecid (Benemid);
a sulfa drug (such as Bactrim or Septra);
an antibiotic such as azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E.E.S., E-Mycin, Ery-Tab, Erythrocin), telithromycin (Ketek), or troleandomycin (Tao); or
a tetracycline antibiotic such as demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).
This list is not complete and there may be other drugs that can interact with amoxicillin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Where can I get more information?
Your pharmacist can provide more information about amoxicillin.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Wednesday, May 6, 2009
Amitriptyline
Amitriptyline
Generic Name: amitriptyline (a mee TRIP ti leen)
Brand names: Vanatrip, Elavil, Endep
What is amitriptyline?
Amitriptyline is in a group of drugs called tricyclic antidepressants. It affects chemicals in the brain that may become unbalanced.
Amitriptyline is used to treat symptoms of depression.
Amitriptyline may also be used for other purposes not listed in this medication guide.
Important information about amitriptyline
Do not use this medication if you are allergic to amitriptyline, or if you have recently had a heart attack. Do not use amitriptyline if you have taken cisapride (Propulsid) or used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.
You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Before taking amitriptyline
Do not use this medication if you are allergic to amitriptyline, or if you have recently had a heart attack. Do not use amitriptyline if you have taken cisapride (Propulsid) or used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take amitriptyline before the MAO inhibitor has cleared from your body.
Before taking amitriptyline, tell your doctor if you are allergic to any drugs, or if you have:
>heart disease;
>a history of heart attack, stroke, or seizures;
>bipolar disorder (manic-depression);
>schizophrenia or other mental illness;
>diabetes (amitriptyline may raise or lower blood sugar);
>overactive thyroid;
>glaucoma; or
>problems with urination.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take amitriptyline.
You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.
Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Amitriptyline can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to anyone under 18 years old without the advice of a doctor.
How should I take amitriptyline?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
If you need to have any type of surgery, tell the surgeon ahead of time that you are taking amitriptyline. You may need to stop using the medicine for a short time.
Do not stop using amitriptyline without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take up to 4 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment. Store amitriptyline at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. An overdose of amitriptyline can be fatal.
Overdose symptoms may include uneven heartbeats, extreme drowsiness, confusion, agitation, vomiting, blurred vision, feeling hot or cold, sweating, muscle stiffness, feeling light-headed, fainting, seizure (convulsions), or coma.
What should I avoid while taking amitriptyline?
Avoid drinking alcohol. It can cause dangerous side effects when taken together with amitriptyline.
Grapefruit and grapefruit juice may interact with amitriptyline. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet.
Amitriptyline can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Amitriptyline can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.
Amitriptyline side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have any of these serious side effects:
>fast, pounding, or uneven heart rate, chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
>sudden numbness or weakness, especially on one side of the body;
>sudden headache, confusion, problems with vision, speech, or balance;
>hallucinations, or seizures (convulsions), feeling light-headed, fainting;
>restless muscle movements in your eyes, tongue, jaw, or neck, uncontrollable shaking or tremor;
>skin rash, severe tingling, numbness, pain, muscle weakness;
>easy bruising or bleeding;
>extreme thirst with headache, nausea, vomiting, and weakness; or
>urinating less than usual or not at all.
Less serious side effects may include:
>nausea, vomiting, constipation, diarrhea, loss of appetite;
>dry mouth, unpleasant taste;
>feeling dizzy, drowsy, or tired;
>trouble concentrating;
>nightmares;
>blurred vision, headache, ringing in your ears;
>breast swelling (in men or women); or
>decreased sex drive, impotence, or difficulty having an orgasm.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.
What other drugs will affect amitriptyline?
Tell your doctor if you regularly use other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants).
Before taking amitriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).
Before taking amitriptyline, tell your doctor if you are currently using any of the following drugs:
>cimetidine (Tagamet);
>guanethidine (Ismelin);
>disulfiram (Antabuse); or
>heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute).
This list is not complete and there are many other medicines that can interact with amitriptyline. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.
Where can I get more information?
Your pharmacist can provide more information about amitriptyline.
Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
Generic Name: amitriptyline (a mee TRIP ti leen)
Brand names: Vanatrip, Elavil, Endep
What is amitriptyline?
Amitriptyline is in a group of drugs called tricyclic antidepressants. It affects chemicals in the brain that may become unbalanced.
Amitriptyline is used to treat symptoms of depression.
Amitriptyline may also be used for other purposes not listed in this medication guide.
Important information about amitriptyline
Do not use this medication if you are allergic to amitriptyline, or if you have recently had a heart attack. Do not use amitriptyline if you have taken cisapride (Propulsid) or used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.
You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Before taking amitriptyline
Do not use this medication if you are allergic to amitriptyline, or if you have recently had a heart attack. Do not use amitriptyline if you have taken cisapride (Propulsid) or used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take amitriptyline before the MAO inhibitor has cleared from your body.
Before taking amitriptyline, tell your doctor if you are allergic to any drugs, or if you have:
>heart disease;
>a history of heart attack, stroke, or seizures;
>bipolar disorder (manic-depression);
>schizophrenia or other mental illness;
>diabetes (amitriptyline may raise or lower blood sugar);
>overactive thyroid;
>glaucoma; or
>problems with urination.
If you have any of these conditions, you may need a dose adjustment or special tests to safely take amitriptyline.
You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.
Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Amitriptyline can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to anyone under 18 years old without the advice of a doctor.
How should I take amitriptyline?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
If you need to have any type of surgery, tell the surgeon ahead of time that you are taking amitriptyline. You may need to stop using the medicine for a short time.
Do not stop using amitriptyline without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take up to 4 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment. Store amitriptyline at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. An overdose of amitriptyline can be fatal.
Overdose symptoms may include uneven heartbeats, extreme drowsiness, confusion, agitation, vomiting, blurred vision, feeling hot or cold, sweating, muscle stiffness, feeling light-headed, fainting, seizure (convulsions), or coma.
What should I avoid while taking amitriptyline?
Avoid drinking alcohol. It can cause dangerous side effects when taken together with amitriptyline.
Grapefruit and grapefruit juice may interact with amitriptyline. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet.
Amitriptyline can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Amitriptyline can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.
Amitriptyline side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have any of these serious side effects:
>fast, pounding, or uneven heart rate, chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
>sudden numbness or weakness, especially on one side of the body;
>sudden headache, confusion, problems with vision, speech, or balance;
>hallucinations, or seizures (convulsions), feeling light-headed, fainting;
>restless muscle movements in your eyes, tongue, jaw, or neck, uncontrollable shaking or tremor;
>skin rash, severe tingling, numbness, pain, muscle weakness;
>easy bruising or bleeding;
>extreme thirst with headache, nausea, vomiting, and weakness; or
>urinating less than usual or not at all.
Less serious side effects may include:
>nausea, vomiting, constipation, diarrhea, loss of appetite;
>dry mouth, unpleasant taste;
>feeling dizzy, drowsy, or tired;
>trouble concentrating;
>nightmares;
>blurred vision, headache, ringing in your ears;
>breast swelling (in men or women); or
>decreased sex drive, impotence, or difficulty having an orgasm.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.
What other drugs will affect amitriptyline?
Tell your doctor if you regularly use other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants).
Before taking amitriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).
Before taking amitriptyline, tell your doctor if you are currently using any of the following drugs:
>cimetidine (Tagamet);
>guanethidine (Ismelin);
>disulfiram (Antabuse); or
>heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute).
This list is not complete and there are many other medicines that can interact with amitriptyline. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.
Where can I get more information?
Your pharmacist can provide more information about amitriptyline.
Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.
Tuesday, May 5, 2009
How to keep your body fit
Fitness is just as imperative as health. As a matter of fact, fitness is linked directly with your health. If you are not taking care of your body, you will get sick. Here are some great suggestions that will help you to keep your body fit:
1. Bicycling
It is a sad thing that many people do not take advantage of this excellent option for exercise. Bike riding exercise your body and build a stronger cardiovascular system. Also, it allows you to get out and enjoy nature and fresh air.
2. Jogging or Walking
Both jogging and walking are wonderful ways to get fit. They tone the muscles, relieve stress, create a healthier heart, and improve lung capability.
3. Swimming
Swimming is an exceptional way to get into and stay in shape. Swimming will help you tighten your body, lose weight, and get a good overall workout.
4. Tennis
Tennis is a great way to exercise. Just running after the ball alone will help get you into shape. This is a great way to strengthen your cardiovascular system and lose weight.
5. Dancing
Dancing is so much fun and as long as you are moving, it really does not matter what type of dance or music. The whole idea is to move your body. Dancing has long been recommended as an avenue to fitness.
6. VCR
If you have a VCR or DVD, try sticking in some good workout tapes. Even taking 15 minutes every day to workout will get you started. Try that for two weeks and you will be surprised at the results.
7. Abdominal Crunches
Crunches have long been a favorite for many athletes for the very reason that they work. Lying on your back with knees bent, keeping feet flat on the floor, cross your hands across your chest and then curl your torso, rolling from your sternum toward your hips. Do this slowly and start out with a set of ten crunches in three reps. As you get accustomed to these, you can increase both the number of sets and reps.
8. Squats
Squats are excellent for glutes, hamstrings, quads, and calves. With your feet standing firm and spread apart about two feet, bend your knees slightly. Then, very smoothly, you will squat toward the floor without going all the way down.
9. Tricep Press
For an Overhead Tricep Press, standing on the floor with your feet about two feet apart, knees slightly bent, you will extend your arms over your head. Keep your elbows locked and then very slowly lower your hands behind your head. You want to do this with some type of weight, but small weights like one to five pounds.
1. Bicycling
It is a sad thing that many people do not take advantage of this excellent option for exercise. Bike riding exercise your body and build a stronger cardiovascular system. Also, it allows you to get out and enjoy nature and fresh air.
2. Jogging or Walking
Both jogging and walking are wonderful ways to get fit. They tone the muscles, relieve stress, create a healthier heart, and improve lung capability.
3. Swimming
Swimming is an exceptional way to get into and stay in shape. Swimming will help you tighten your body, lose weight, and get a good overall workout.
4. Tennis
Tennis is a great way to exercise. Just running after the ball alone will help get you into shape. This is a great way to strengthen your cardiovascular system and lose weight.
5. Dancing
Dancing is so much fun and as long as you are moving, it really does not matter what type of dance or music. The whole idea is to move your body. Dancing has long been recommended as an avenue to fitness.
6. VCR
If you have a VCR or DVD, try sticking in some good workout tapes. Even taking 15 minutes every day to workout will get you started. Try that for two weeks and you will be surprised at the results.
7. Abdominal Crunches
Crunches have long been a favorite for many athletes for the very reason that they work. Lying on your back with knees bent, keeping feet flat on the floor, cross your hands across your chest and then curl your torso, rolling from your sternum toward your hips. Do this slowly and start out with a set of ten crunches in three reps. As you get accustomed to these, you can increase both the number of sets and reps.
8. Squats
Squats are excellent for glutes, hamstrings, quads, and calves. With your feet standing firm and spread apart about two feet, bend your knees slightly. Then, very smoothly, you will squat toward the floor without going all the way down.
9. Tricep Press
For an Overhead Tricep Press, standing on the floor with your feet about two feet apart, knees slightly bent, you will extend your arms over your head. Keep your elbows locked and then very slowly lower your hands behind your head. You want to do this with some type of weight, but small weights like one to five pounds.
Tips To Home Gym Equipment
A Guide To Home Gym Equipment
If you are planning to set up a home gym, there are too many choices available, and the decision is mainly based on your budget, availability of space and extent of usage. There is huge variety of exercise equipments
available in stores these days that can meet any requirement, and fit any budget.
Some Important Considerations For Home Gym Equipment
Each of us is looking for easier ways to squeeze in the workouts in our usually busy routines. Having suitable home gym equipment gives the flexibility of working out at the time convenient to you, in the comfort of your own home. But, choosing the right kind of home gym equipment can be a daunting task.
Enjoy and be comfortable of using the equipments. Just buying the equipment does not mean that you are going to use it. You need to buy the home gym equipment as per the exercise activities you enjoy the most. And if you are a beginner, it is better to start small. Need of investments in the equipment and a good pair of shoes and some weights.
When buying the home gym equipment, know how much you are willing to spend. Good exercise equipment does not have to be expensive, but it should be able to provide the kind of workout you are looking for. Resistance bands, exercise balls, and dumbbells can provide a good exercise without spending a fortune.
When you go to buy the home gym equipment, the sales people will promise anything to sell you the products. It is good to be informed about what equipment can and cannot do. Don’t get seduced by the terms such as spot reduction, just few minutes a day, guaranteed to lose inches and so on. These equipments are usually expensive, and it is better to avoid them.
Many people buy things just because others have them. Just keep in mind that there is no perfect exercise. As long as you are following a daily regime of 20-30 minutes of workout, any one exercise is just as good as another. The only thing to keep in mind is that home gym fitness equipment should be able to increase your heart rate. Bike and elliptical trainer provide low-impact exercise, but it is also important to lift weights for strength training.
For setting up home gym, allocate a specific place such as garage, or basement. Based on the space available, buy the equipment so that there is enough space left for stretching before and after the workout.
If you are planning to set up a home gym, there are too many choices available, and the decision is mainly based on your budget, availability of space and extent of usage. There is huge variety of exercise equipments
available in stores these days that can meet any requirement, and fit any budget.
Some Important Considerations For Home Gym Equipment
Each of us is looking for easier ways to squeeze in the workouts in our usually busy routines. Having suitable home gym equipment gives the flexibility of working out at the time convenient to you, in the comfort of your own home. But, choosing the right kind of home gym equipment can be a daunting task.
Enjoy and be comfortable of using the equipments. Just buying the equipment does not mean that you are going to use it. You need to buy the home gym equipment as per the exercise activities you enjoy the most. And if you are a beginner, it is better to start small. Need of investments in the equipment and a good pair of shoes and some weights.
When buying the home gym equipment, know how much you are willing to spend. Good exercise equipment does not have to be expensive, but it should be able to provide the kind of workout you are looking for. Resistance bands, exercise balls, and dumbbells can provide a good exercise without spending a fortune.
When you go to buy the home gym equipment, the sales people will promise anything to sell you the products. It is good to be informed about what equipment can and cannot do. Don’t get seduced by the terms such as spot reduction, just few minutes a day, guaranteed to lose inches and so on. These equipments are usually expensive, and it is better to avoid them.
Many people buy things just because others have them. Just keep in mind that there is no perfect exercise. As long as you are following a daily regime of 20-30 minutes of workout, any one exercise is just as good as another. The only thing to keep in mind is that home gym fitness equipment should be able to increase your heart rate. Bike and elliptical trainer provide low-impact exercise, but it is also important to lift weights for strength training.
For setting up home gym, allocate a specific place such as garage, or basement. Based on the space available, buy the equipment so that there is enough space left for stretching before and after the workout.
How to be Fit by going for Walk?
If anyone says that you can stay fit and healthy without even moving a muscle, be assured that he is not a fitness expert! This is really basic common sense: if you don’t move your body, your body won’t burn the extra calories it received from foods. According to the law of thermodynamics, energy can either be created or stored but NOT destroyed. In this case, since your body cannot use the calories to produce energy, it would store them as fat, and you would become fat! Pretty simple explanation, isn’t it? You see, it doesn’t take a rocket scientist to figure out the relation between exercise and fitness!
Oh okay, I know that you panic on hearing the very name of ‘exercise’. But don’t worry, I would not ask you to go to an expensive gym and waste your money and energy there, nor I would ask you to jog or run for hours. All I ask you is to WALK! Yes, as simple as it is, waking is indeed the key to staying fit and healthy without much hassle.
You see, unless you are absolutely lame or too old to stand erect, walking shouldn’t be a big deal for you! From my experience, this is one exercise which anyone can do, whether he is an 8-year old child or an 80-year old veteran!
There are many ways in which walking helps you. Firstly, it moves your muscles, and when muscles and bones move, they stay fit and healthy. Secondly, it takes you away from the dark room you are cooped up in to the fresh air and sunlight outside; once again, these are good for your health!
Thirdly, it rids you of stress and depression; you would notice that when you start walking, you would forget your worries and just enjoy the walk. Fourthly, it is cheap - heck, it is totally free, since you don’t need to buy any special exercise equipment or gadget to walk! All you need is a pair of comfortable, athletic shoes and you are ready to put your first step forward!
It walking is not a perfect workout for you, I don’t know what is!
Now, if you have never walked in life, you would be facing one major difficulty at the outset (in fact, it is faced by almost everyone who are in your shoes) - that of motivating yourself to walk daily. Let’s say that on one occasion, you notice that either it is too hot or raining outside. Under such circumstances, it is too easy to stay in the comfort zone of your room and too hard to take out those walking shoes and go for an outdoor trip! But as you continue walking day after day, it would soon become a habit. Studies point out that it takes a human at least 21 days to form a new habit; however, once a habit is formed, it becomes difficult to drop it.
The same applies to walking as well! Once walking becomes a habit for you, you would feel uneasy on any day you don’t venture out to walk! You would feel a weird disturbance going on inside your body that would be solved only when you take your regular walk.
Yep, that is exactly how a habit motivates you to keep on doing what you have been doing! So, while the first 21 days might be tough for you, you would find that from the 22nd day onwards, walking has become a part of your nature!
Now, if you currently visit a gym or exercise with a home-exercise equipment, that is fine. But please don’t forsake your daily walking routine for them! You see, walking helps you burn calories for sure; but more importantly, it keeps you in touch with the fresh air and sunlight of nature, which is a crucial part of maintaining a healthy body and mind!
Now here is one bitter truth I need to tell you: no matter how much you walk, until and unless you change your unhealthy food habits, you won’t see much difference in your body weight. If regular walking is important, equally important is getting rid of junk foods and gorging on natural fruits and vegetables instead! Junk foods not only ruin your digestive system but also your overall health. When you eat junk and rubbish stuff, your body’s hormonal equilibrium is lost, and you start gaining weight!
So, regardless of whether you have a breakfast, lunch, dinner, or just want to snack, always and always eat only natural and organic foods. Also make sure that the foods you eat are fresh, as stale foods would do more harm than good to your body!
Oh okay, I know that you panic on hearing the very name of ‘exercise’. But don’t worry, I would not ask you to go to an expensive gym and waste your money and energy there, nor I would ask you to jog or run for hours. All I ask you is to WALK! Yes, as simple as it is, waking is indeed the key to staying fit and healthy without much hassle.
You see, unless you are absolutely lame or too old to stand erect, walking shouldn’t be a big deal for you! From my experience, this is one exercise which anyone can do, whether he is an 8-year old child or an 80-year old veteran!
There are many ways in which walking helps you. Firstly, it moves your muscles, and when muscles and bones move, they stay fit and healthy. Secondly, it takes you away from the dark room you are cooped up in to the fresh air and sunlight outside; once again, these are good for your health!
Thirdly, it rids you of stress and depression; you would notice that when you start walking, you would forget your worries and just enjoy the walk. Fourthly, it is cheap - heck, it is totally free, since you don’t need to buy any special exercise equipment or gadget to walk! All you need is a pair of comfortable, athletic shoes and you are ready to put your first step forward!
It walking is not a perfect workout for you, I don’t know what is!
Now, if you have never walked in life, you would be facing one major difficulty at the outset (in fact, it is faced by almost everyone who are in your shoes) - that of motivating yourself to walk daily. Let’s say that on one occasion, you notice that either it is too hot or raining outside. Under such circumstances, it is too easy to stay in the comfort zone of your room and too hard to take out those walking shoes and go for an outdoor trip! But as you continue walking day after day, it would soon become a habit. Studies point out that it takes a human at least 21 days to form a new habit; however, once a habit is formed, it becomes difficult to drop it.
The same applies to walking as well! Once walking becomes a habit for you, you would feel uneasy on any day you don’t venture out to walk! You would feel a weird disturbance going on inside your body that would be solved only when you take your regular walk.
Yep, that is exactly how a habit motivates you to keep on doing what you have been doing! So, while the first 21 days might be tough for you, you would find that from the 22nd day onwards, walking has become a part of your nature!
Now, if you currently visit a gym or exercise with a home-exercise equipment, that is fine. But please don’t forsake your daily walking routine for them! You see, walking helps you burn calories for sure; but more importantly, it keeps you in touch with the fresh air and sunlight of nature, which is a crucial part of maintaining a healthy body and mind!
Now here is one bitter truth I need to tell you: no matter how much you walk, until and unless you change your unhealthy food habits, you won’t see much difference in your body weight. If regular walking is important, equally important is getting rid of junk foods and gorging on natural fruits and vegetables instead! Junk foods not only ruin your digestive system but also your overall health. When you eat junk and rubbish stuff, your body’s hormonal equilibrium is lost, and you start gaining weight!
So, regardless of whether you have a breakfast, lunch, dinner, or just want to snack, always and always eat only natural and organic foods. Also make sure that the foods you eat are fresh, as stale foods would do more harm than good to your body!
Monday, May 4, 2009
H5N1 bird flu
Introduction
Background
Influenza virus infection, one of the most common infectious diseases, is a highly contagious airborne disease that causes an acute febrile illness and results in variable degrees of systemic symptoms, ranging from mild fatigue to respiratory failure and death. These symptoms contribute to significant loss of workdays, human suffering, mortality, and significant morbidity. The 1918-1919 H1N1 type influenza pandemic killed an estimated 20-50 million persons, with 549,000 deaths in the United States alone.
Accurately diagnosing influenza A or B infection based solely on clinical criteria is difficult because of the overlapping symptoms caused by the various viruses associated with upper respiratory tract infection (URTI). In addition, several serious viruses, including adenoviruses, enteroviruses, and paramyxoviruses, may initially cause influenzalike symptoms. The early presentation of mild or moderate cases of flavivirus infections (eg, dengue) may initially mimic influenza. For example, some cases of West Nile fever acquired in New York in 1999 were clinically misdiagnosed as influenza.
Patients with influenza frequently present with various symptoms shared by many other viral infections. In the northern and southern hemispheres, these symptoms are more common in the winter months. As a result, during the winter, clinics and emergency department waiting rooms fill with patients who have influenza or other URTIs.
For supplementary information, see Medscape’s Influenza Resource Center.
Pathophysiology
Influenza results from infection with 1 of 3 basic types of influenza virus—A, B, or C—which are classified within the family Orthomyxoviridae. These single-stranded RNA viruses are structurally and biologically similar but vary antigenically.
The RNA core consists of 8 gene segments surrounded by a coat of 10 (influenza A) or 11 (influenza B) proteins. Immunologically, the most significant surface proteins include hemagglutinin and neuraminidase. The viruses are typed based on these proteins. For example, influenza A subtype H3N2 expresses hemagglutinin 3 and neuraminidase 2.
The most common prevailing influenza A subtypes that infect humans are H1N1 and H3N2. Each year, the trivalent vaccine used worldwide contains A strains from H1N1 and H3N2, along with an influenza B strain.
Influenza virus infection occurs after transfer of respiratory secretions from an infected individual to a person who is immunologically susceptible. If not neutralized by secretory antibodies, the virus invades airway and respiratory tract cells. Once within host cells, cellular dysfunction and degeneration occur, along with viral replication and release of viral progeny. Systemic symptoms result from inflammatory mediators, similar to other viruses. The incubation period of influenza ranges from 18-72 hours.
Influenza A is generally more pathogenic than influenza B. Influenza A is a zoonotic infection, and more than 100 types of influenza A infect most species of birds, pigs, horses, dogs and seals. Indeed, the 1918 pandemic that resulted in millions of human deaths worldwide is believed to have originated from a virulent strain of H1N1 from pigs or birds. Recently, scientists obtained and sequenced the 1918 H1N1 strain from a frozen corpse found in Alaska. The virus was reconstructed at the Centers for Disease Control and Prevention (CDC) laboratory in Atlanta and was found to be highly lethal when tested in mice; the virus was also found to be lethal to chicken embryos. This unique N1 neuraminidase is being studied in order to provide better insight into the N1 found in H5N1, the type responsible for avian influenza (also known as bird flu).
H5N1 bird flu
In 1997, an avian subtype of influenza A, H5N1, was first described in Hong Kong. Infection was confirmed in only 18 individuals, but 6 died. Since then, sporadic cases of H5N1 infection have continued to be described in southern China. In January 2004, an epidemic occurred among domesticated birds in Southeast Asia, initially in Vietnam. In nearly all cases of H5N1 bird flu in humans, the virus is transmitted from birds. As of fall 2008, more than 390 human cases had been documented and more than 246 persons had died following H5N1 outbreaks among poultry and resulting bird-to-human transmission. Most human deaths due to bird flu have occurred in Indonesia. Sporadic outbreaks among humans have continued elsewhere, including China, Egypt, Thailand, and Cambodia.
Experts are concerned that a slight mutation could convert H5N1 to a strain that would be easily transferred from human to human. Such a strain has the potential to spread rapidly and precipitate a catastrophic worldwide pandemic. Because of this concern, efforts to develop an effective vaccine are currently underway. In addition, studies to expand the number of drugs that are effective against influenza are underway. Ribavirin has shown activity in animal models.
Other types of avian influenza
In March 1999, infection with another avian influenza subtype, H9N2, was described in 2 young children. Despite concern, no additional cases of H9N2 infection were reported. As with the H5N1 influenza, experts are concerned that a virulent strain of H9N2 influenza may mutate to allow human-to-human infection and that such a strain may possess the triad of infectivity, lethality, and transmissibility.
H1N1 swine flu
On April 26, 2009, the US Department of Health and Human Services issued a nationwide public health emergency regarding swine influenza A (H1N1) virus infections in humans.1 Over the past several weeks, an outbreak of a new strain of influenza virus, which contains a combination of swine, avian, and human influenza virus genes, has been reported in Mexico (approximately 1600 cases) and in the United States (40 cases, according to the CDC as of the time of this writing on April 27, 2009). In Mexico, 103 deaths are suspected to have been caused by the recent swine influenza outbreak. The infection has been confirmed in patients in California (7), Kansas (2), New York City (28), Ohio (1), and Texas (2). No deaths attributable to the swine influenza virus have been confirmed in the United States.2 Internationally, confirmed cases have also been reported in Canada, New Zealand, Spain, and the United Kingdom (Scotland), with suspected cases in Brazil, Israel, and France.3
Upon suspicion of swine flu, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact the state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.4
The new virus is resistant to the antiviral agents amantadine and rimantadine but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Initiation of antiviral agents within 48 hours of symptom onset is imperative to provide treatment efficacy against influenza virus. The usual vaccine for influenza administered at the beginning of the flu season is not effective for this viral strain.
Initial symptoms of swine influenza include high fever, myalgias, rhinorrhea, and sore throat. Nausea, diarrhea, and vomiting have also been reported. Infection control precautions (ie, handwashing, covering mouth with tissue when sneezing or coughing) are encouraged. If suspected swine flu occurs, isolation is recommended for infected individuals and household contacts. For more information, see updated information from the US Centers for Disease Control and Prevention.
Viral shedding
Viral shedding occurs at the onset of symptoms or just before the onset of illness (0-24 h). Shedding continues for 5-10 days. Young children may shed virus longer, placing others at risk for contracting infection with the virus.
Frequency
United States
Influenza epidemics typically occur in winter months and vary in severity and attack rates depending on the virus subtype involved. Millions of people may develop infection during a given year. The pandemics of 1918-1919 and 1957, which resulted in higher infection rates and profound morbidity and mortality rates, demonstrate the impact of the disease.
In the United States, significant influenza activity occurred during the winter of 1999-2000 and 2003-2004. Influenza A/Fujian/411/2002 (H3N2) was the major strain involved in 2003-2004. During the 2000-2003 and 2004-2005 seasons, influenza activity was relatively low in the United States. However, the activity increased during the 2007-2008 season to the highest levels in years.
International
In tropical areas, influenza occurs throughout the year.
Mortality/Morbidity
The CDC estimates that influenza is responsible for an average of more than 20,000 deaths annually.
Sex
Women in the third trimester of pregnancy are at higher risk for complications of influenza A and B.
Age
•Elderly people are at higher risk for complications of influenza A and B.
•For more information on pediatric influenza, see the Influenza article in eMedicine’s Pediatrics: General Medicine volume.
Clinical
HistoryThe presentation of influenza virus infection varies; however, it usually includes many of the symptoms described below. Patients with influenza who have pre-existing immunity or who have received vaccine may have milder symptoms.
•Abrupt onset of illness is common. Many patients with influenza are able to report the time when the illness began.
•Fever may vary widely among patients, with some having low fevers (in the 100°F range) and others developing fevers as high as 104°F. Some patients report feeling feverish and a feeling of chilliness.
•Sore throat may be severe and may last 3-5 days. The sore throat may be a significant reason why patients seek medical attention.
•Myalgias are common and range from mild to severe.
•Frontal/retro-orbital headache is common and is usually severe. Ocular symptoms develop in some patients with influenza and include photophobia, burning sensations, and/or pain upon motion.
•Some patients with influenza develop rhinitis of varying severity but is generally not the chief symptom.
•Weakness and severe fatigue may prevent patients from performing their normal activities or work. In some cases, patients with influenza may find activity difficult and may require bedrest.
•Cough and other respiratory symptoms may be initially minimal but frequently progress as the infection evolves. Patients may report nonproductive cough, cough-related pleuritic chest pain, and dyspnea. In children, diarrhea may be a feature.
•Acute encephalopathy has recently been associated with influenza A virus. In a case series of 21 patients, Steininger et al described clinical, CSF, MRI, and EEG findings.5 Clinical features included altered mental status, coma, seizures, and ataxia. Of those who underwent further testing, most had abnormal CSF, MRI, and EEG findings.
Physical
The general appearance varies among patients who present with influenza. Some patients may appear acutely ill, with some weakness and respiratory findings, while others may appear only mildly ill. Upon examination, patients may have some or all of the following findings:
•Fever may range from 100-104°F. The fever in elderly patients is not generally as severe as that in young adults.
•Tachycardia most likely results from hypoxia, fever, or both.
•Pharyngitis may be present. Even in patients who report a severely sore throat, findings vary from minimal infection to more severe inflammation.
•Eyes may be red and watery.
•Nasal discharge is absent in most patients.
•Skin may be warm-to-hot, as reflected by the temperature status. Patients who have been febrile with poor fluid intake may show signs of mild volume depletion with dry skin.
•Pulmonary findings during the physical examination may include dry cough with clear lungs or rhonchi.
Background
Influenza virus infection, one of the most common infectious diseases, is a highly contagious airborne disease that causes an acute febrile illness and results in variable degrees of systemic symptoms, ranging from mild fatigue to respiratory failure and death. These symptoms contribute to significant loss of workdays, human suffering, mortality, and significant morbidity. The 1918-1919 H1N1 type influenza pandemic killed an estimated 20-50 million persons, with 549,000 deaths in the United States alone.
Accurately diagnosing influenza A or B infection based solely on clinical criteria is difficult because of the overlapping symptoms caused by the various viruses associated with upper respiratory tract infection (URTI). In addition, several serious viruses, including adenoviruses, enteroviruses, and paramyxoviruses, may initially cause influenzalike symptoms. The early presentation of mild or moderate cases of flavivirus infections (eg, dengue) may initially mimic influenza. For example, some cases of West Nile fever acquired in New York in 1999 were clinically misdiagnosed as influenza.
Patients with influenza frequently present with various symptoms shared by many other viral infections. In the northern and southern hemispheres, these symptoms are more common in the winter months. As a result, during the winter, clinics and emergency department waiting rooms fill with patients who have influenza or other URTIs.
For supplementary information, see Medscape’s Influenza Resource Center.
Pathophysiology
Influenza results from infection with 1 of 3 basic types of influenza virus—A, B, or C—which are classified within the family Orthomyxoviridae. These single-stranded RNA viruses are structurally and biologically similar but vary antigenically.
The RNA core consists of 8 gene segments surrounded by a coat of 10 (influenza A) or 11 (influenza B) proteins. Immunologically, the most significant surface proteins include hemagglutinin and neuraminidase. The viruses are typed based on these proteins. For example, influenza A subtype H3N2 expresses hemagglutinin 3 and neuraminidase 2.
The most common prevailing influenza A subtypes that infect humans are H1N1 and H3N2. Each year, the trivalent vaccine used worldwide contains A strains from H1N1 and H3N2, along with an influenza B strain.
Influenza virus infection occurs after transfer of respiratory secretions from an infected individual to a person who is immunologically susceptible. If not neutralized by secretory antibodies, the virus invades airway and respiratory tract cells. Once within host cells, cellular dysfunction and degeneration occur, along with viral replication and release of viral progeny. Systemic symptoms result from inflammatory mediators, similar to other viruses. The incubation period of influenza ranges from 18-72 hours.
Influenza A is generally more pathogenic than influenza B. Influenza A is a zoonotic infection, and more than 100 types of influenza A infect most species of birds, pigs, horses, dogs and seals. Indeed, the 1918 pandemic that resulted in millions of human deaths worldwide is believed to have originated from a virulent strain of H1N1 from pigs or birds. Recently, scientists obtained and sequenced the 1918 H1N1 strain from a frozen corpse found in Alaska. The virus was reconstructed at the Centers for Disease Control and Prevention (CDC) laboratory in Atlanta and was found to be highly lethal when tested in mice; the virus was also found to be lethal to chicken embryos. This unique N1 neuraminidase is being studied in order to provide better insight into the N1 found in H5N1, the type responsible for avian influenza (also known as bird flu).
H5N1 bird flu
In 1997, an avian subtype of influenza A, H5N1, was first described in Hong Kong. Infection was confirmed in only 18 individuals, but 6 died. Since then, sporadic cases of H5N1 infection have continued to be described in southern China. In January 2004, an epidemic occurred among domesticated birds in Southeast Asia, initially in Vietnam. In nearly all cases of H5N1 bird flu in humans, the virus is transmitted from birds. As of fall 2008, more than 390 human cases had been documented and more than 246 persons had died following H5N1 outbreaks among poultry and resulting bird-to-human transmission. Most human deaths due to bird flu have occurred in Indonesia. Sporadic outbreaks among humans have continued elsewhere, including China, Egypt, Thailand, and Cambodia.
Experts are concerned that a slight mutation could convert H5N1 to a strain that would be easily transferred from human to human. Such a strain has the potential to spread rapidly and precipitate a catastrophic worldwide pandemic. Because of this concern, efforts to develop an effective vaccine are currently underway. In addition, studies to expand the number of drugs that are effective against influenza are underway. Ribavirin has shown activity in animal models.
Other types of avian influenza
In March 1999, infection with another avian influenza subtype, H9N2, was described in 2 young children. Despite concern, no additional cases of H9N2 infection were reported. As with the H5N1 influenza, experts are concerned that a virulent strain of H9N2 influenza may mutate to allow human-to-human infection and that such a strain may possess the triad of infectivity, lethality, and transmissibility.
H1N1 swine flu
On April 26, 2009, the US Department of Health and Human Services issued a nationwide public health emergency regarding swine influenza A (H1N1) virus infections in humans.1 Over the past several weeks, an outbreak of a new strain of influenza virus, which contains a combination of swine, avian, and human influenza virus genes, has been reported in Mexico (approximately 1600 cases) and in the United States (40 cases, according to the CDC as of the time of this writing on April 27, 2009). In Mexico, 103 deaths are suspected to have been caused by the recent swine influenza outbreak. The infection has been confirmed in patients in California (7), Kansas (2), New York City (28), Ohio (1), and Texas (2). No deaths attributable to the swine influenza virus have been confirmed in the United States.2 Internationally, confirmed cases have also been reported in Canada, New Zealand, Spain, and the United Kingdom (Scotland), with suspected cases in Brazil, Israel, and France.3
Upon suspicion of swine flu, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact the state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.4
The new virus is resistant to the antiviral agents amantadine and rimantadine but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Initiation of antiviral agents within 48 hours of symptom onset is imperative to provide treatment efficacy against influenza virus. The usual vaccine for influenza administered at the beginning of the flu season is not effective for this viral strain.
Initial symptoms of swine influenza include high fever, myalgias, rhinorrhea, and sore throat. Nausea, diarrhea, and vomiting have also been reported. Infection control precautions (ie, handwashing, covering mouth with tissue when sneezing or coughing) are encouraged. If suspected swine flu occurs, isolation is recommended for infected individuals and household contacts. For more information, see updated information from the US Centers for Disease Control and Prevention.
Viral shedding
Viral shedding occurs at the onset of symptoms or just before the onset of illness (0-24 h). Shedding continues for 5-10 days. Young children may shed virus longer, placing others at risk for contracting infection with the virus.
Frequency
United States
Influenza epidemics typically occur in winter months and vary in severity and attack rates depending on the virus subtype involved. Millions of people may develop infection during a given year. The pandemics of 1918-1919 and 1957, which resulted in higher infection rates and profound morbidity and mortality rates, demonstrate the impact of the disease.
In the United States, significant influenza activity occurred during the winter of 1999-2000 and 2003-2004. Influenza A/Fujian/411/2002 (H3N2) was the major strain involved in 2003-2004. During the 2000-2003 and 2004-2005 seasons, influenza activity was relatively low in the United States. However, the activity increased during the 2007-2008 season to the highest levels in years.
International
In tropical areas, influenza occurs throughout the year.
Mortality/Morbidity
The CDC estimates that influenza is responsible for an average of more than 20,000 deaths annually.
Sex
Women in the third trimester of pregnancy are at higher risk for complications of influenza A and B.
Age
•Elderly people are at higher risk for complications of influenza A and B.
•For more information on pediatric influenza, see the Influenza article in eMedicine’s Pediatrics: General Medicine volume.
Clinical
HistoryThe presentation of influenza virus infection varies; however, it usually includes many of the symptoms described below. Patients with influenza who have pre-existing immunity or who have received vaccine may have milder symptoms.
•Abrupt onset of illness is common. Many patients with influenza are able to report the time when the illness began.
•Fever may vary widely among patients, with some having low fevers (in the 100°F range) and others developing fevers as high as 104°F. Some patients report feeling feverish and a feeling of chilliness.
•Sore throat may be severe and may last 3-5 days. The sore throat may be a significant reason why patients seek medical attention.
•Myalgias are common and range from mild to severe.
•Frontal/retro-orbital headache is common and is usually severe. Ocular symptoms develop in some patients with influenza and include photophobia, burning sensations, and/or pain upon motion.
•Some patients with influenza develop rhinitis of varying severity but is generally not the chief symptom.
•Weakness and severe fatigue may prevent patients from performing their normal activities or work. In some cases, patients with influenza may find activity difficult and may require bedrest.
•Cough and other respiratory symptoms may be initially minimal but frequently progress as the infection evolves. Patients may report nonproductive cough, cough-related pleuritic chest pain, and dyspnea. In children, diarrhea may be a feature.
•Acute encephalopathy has recently been associated with influenza A virus. In a case series of 21 patients, Steininger et al described clinical, CSF, MRI, and EEG findings.5 Clinical features included altered mental status, coma, seizures, and ataxia. Of those who underwent further testing, most had abnormal CSF, MRI, and EEG findings.
Physical
The general appearance varies among patients who present with influenza. Some patients may appear acutely ill, with some weakness and respiratory findings, while others may appear only mildly ill. Upon examination, patients may have some or all of the following findings:
•Fever may range from 100-104°F. The fever in elderly patients is not generally as severe as that in young adults.
•Tachycardia most likely results from hypoxia, fever, or both.
•Pharyngitis may be present. Even in patients who report a severely sore throat, findings vary from minimal infection to more severe inflammation.
•Eyes may be red and watery.
•Nasal discharge is absent in most patients.
•Skin may be warm-to-hot, as reflected by the temperature status. Patients who have been febrile with poor fluid intake may show signs of mild volume depletion with dry skin.
•Pulmonary findings during the physical examination may include dry cough with clear lungs or rhonchi.
Why is swine flu now infecting humans?
What is swine flu?
(Note: U.S. researchers are trying to term 2009 swine flu viruses as H1N1 flu viruses as of April 2009.)
Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans. Unfortunately, this cross-species situation with influenza viruses has had the potential to change. Some investigators think the 2009 swine flu strain, first seen in Mexico, should be termed H1N1 flu since it is mainly found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type1).
Why is swine flu now infecting humans?
Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans.
First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus (see Figure 1). It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes in an individual RNA segment in flu viruses are termed antigenic drift and result in minor changes in the virus. However, these can accumulate over time to produce enough minor changes that cumulatively change the virus' antigenic makeup over time (usually years).
Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a "mixing pot" for flu RNA segments (see Figure 1). Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment and seem to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.
What are the symptoms of swine (H1N1) flu?
Symptoms of swine flu are similar to most influenza infections: fever (100F or greater), cough, nasal secretions, fatigue, and headache, with fatigue being reported in most infected individuals. Some patients also get nausea, vomiting, and diarrhea. In Mexico, many of the patients are young adults, which made some investigators speculate that a strong immune response may cause some collateral tissue damage. Some patients develop severe respiratory symptoms and need respiratory support (such as a ventilator to breathe for the patient). Patients can get pneumonia (bacterial secondary infection) if the viral infection persists, and some can develop seizures. Death often occurs from secondary bacterial infection of the lungs; appropriate antibiotics need to be used in these patients. The usual mortality (death) rate for typical influenza A is about 0.1%, while the 1918 "Spanish flu" epidemic had an estimated mortality rate ranging from 2%-20%. Swine flu in Mexico (as of April 2009) has had about 160 deaths and about 2,500 confirmed cases, which would correspond to a mortality rate of about 6%, but it is far too early to be sure this is the true mortality rate because the data is still being collected and there are new infections being reported in Mexico and, as of April 2009, in least in five other countries (U.S., Canada, Scotland, New Zealand, and Spain).
SYMPTOMS OF SWINE FLU
What is the swine flu?
The swine influenza A (H1N1) virus that has infected humans in the U.S. and Mexico is a novel influenza A virus that has not previously been identified in North America. This virus is resistant to the antiviral medications amantadine (Symmetrel) and rimantadine (Flumadine), but is sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Investigations of these cases suggest that on-going human-to-human swine influenza A (H1N1) virus is occurring.
What are the symptoms of swine flu?
Although uncomplicated influenza-like illness (fever, cough or sore throat) has been reported in many cases, mild respiratory illness (nasal congestion, rhinorrhea) without fever and occasional severe disease also has been reported. Other symptoms reported with swine influenza A virus infection include vomiting, diarrhea, myalgia, headache, chills, fatigue, and dyspnea. Conjunctivitis is rare, but has been reported. Severe disease (pneumonia, respiratory failure) and fatal outcomes have been reported with swine influenza A virus infection. The potential for exacerbation of underlying chronic medical conditions or invasive bacterial infection with swine influenza A virus infection should be considered.
The swine influenza A (H1N1) virus that has infected humans in the U.S. and Mexico is a novel influenza A virus that has not previously been identified in North America. This virus is resistant to the antiviral medications amantadine (Symmetrel) and rimantadine (Flumadine), but is sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Investigations of these cases suggest that on-going human-to-human swine influenza A (H1N1) virus is occurring.
What are the symptoms of swine flu?
Although uncomplicated influenza-like illness (fever, cough or sore throat) has been reported in many cases, mild respiratory illness (nasal congestion, rhinorrhea) without fever and occasional severe disease also has been reported. Other symptoms reported with swine influenza A virus infection include vomiting, diarrhea, myalgia, headache, chills, fatigue, and dyspnea. Conjunctivitis is rare, but has been reported. Severe disease (pneumonia, respiratory failure) and fatal outcomes have been reported with swine influenza A virus infection. The potential for exacerbation of underlying chronic medical conditions or invasive bacterial infection with swine influenza A virus infection should be considered.
SWINE FLU TREATMENT
Infection Control
Recommended Infection Control for a non-hospitalized patient (ER, clinic or home visit):
1.Separation from others in single room if available until asymptomatic. If the ill person needs to move to another part of the house, they should wear a mask. The ill person should be encouraged to wash hand frequently and follow respiratory hygiene practices. Cups and other utensils used by the ill person should be thoroughly washed with soap and water before use by other persons.
Antiviral Treatment
Suspected Cases
Empiric antiviral treatment is recommended for any ill person suspected to have swine influenza A (H1N1) virus infection. Antiviral treatment with either zanamivir alone or with a combination of oseltamivir and either amantadine or rimantadine should be initiated as soon as possible after the onset of symptoms. Recommended duration of treatment is five days. Recommendations for use of antivirals may change as data on antiviral susceptibilities become available. Antiviral doses and schedules recommended for treatment of swine influenza A (H1N1) virus infection are the same as those recommended for seasonal influenza:
Confirmed Cases
For antiviral treatment of a confirmed case of swine influenza A (H1N1) virus infection, either oseltamivir (Tamiflu) or zanamivir (Relenza) may be administered. Recommended duration of treatment is five days. These same antivirals should be considered for treatment of cases that test positive for influenza A but test negative for seasonal influenza viruses H3 and H1 by PCR.
Pregnant Women
Oseltamivir, zanamivir, amantadine, and rimantadine are all "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Only two cases of amantadine use for severe influenza illness during the third trimester have been reported. However, both amantadine and rimantadine have been demonstrated in animal studies to be teratogenic and embryotoxic when administered at substantially high doses. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, these four drugs should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers' package inserts should be consulted. However, no adverse effects have been reported among women who received oseltamivir or zanamivir during pregnancy or among infants born to such women.
Antiviral Chemoprophylaxis
For antiviral chemoprophylaxis of swine influenza A (H1N1) virus infection, either oseltamivir or zanamivir are recommended. Duration of antiviral chemoprophylaxis is 7 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. Antiviral dosing and schedules recommended for chemoprophylaxis of swine influenza A (H1N1) virus infection are the same as those recommended for seasonal influenza:
Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir is recommended for the following individuals:
1.Household close contacts who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) of a confirmed or suspected case.
2.School children who are at high-risk for complications of influenza (persons with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed or suspected case.
3.Travelers to Mexico who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
4.Border workers (Mexico) who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
5.Health care workers or public health workers who had unprotected close contact with an ill confirmed case of swine influenza A (H1N1) virus infection during the case's infectious period.
Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir can be considered for the following:
•Any health care worker who is at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) who is working in an area with confirmed swine influenza A (H1N1) cases, and who is caring for patients with any acute febrile respiratory illness.
•Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.
Recommended Infection Control for a non-hospitalized patient (ER, clinic or home visit):
1.Separation from others in single room if available until asymptomatic. If the ill person needs to move to another part of the house, they should wear a mask. The ill person should be encouraged to wash hand frequently and follow respiratory hygiene practices. Cups and other utensils used by the ill person should be thoroughly washed with soap and water before use by other persons.
Antiviral Treatment
Suspected Cases
Empiric antiviral treatment is recommended for any ill person suspected to have swine influenza A (H1N1) virus infection. Antiviral treatment with either zanamivir alone or with a combination of oseltamivir and either amantadine or rimantadine should be initiated as soon as possible after the onset of symptoms. Recommended duration of treatment is five days. Recommendations for use of antivirals may change as data on antiviral susceptibilities become available. Antiviral doses and schedules recommended for treatment of swine influenza A (H1N1) virus infection are the same as those recommended for seasonal influenza:
Confirmed Cases
For antiviral treatment of a confirmed case of swine influenza A (H1N1) virus infection, either oseltamivir (Tamiflu) or zanamivir (Relenza) may be administered. Recommended duration of treatment is five days. These same antivirals should be considered for treatment of cases that test positive for influenza A but test negative for seasonal influenza viruses H3 and H1 by PCR.
Pregnant Women
Oseltamivir, zanamivir, amantadine, and rimantadine are all "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Only two cases of amantadine use for severe influenza illness during the third trimester have been reported. However, both amantadine and rimantadine have been demonstrated in animal studies to be teratogenic and embryotoxic when administered at substantially high doses. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, these four drugs should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers' package inserts should be consulted. However, no adverse effects have been reported among women who received oseltamivir or zanamivir during pregnancy or among infants born to such women.
Antiviral Chemoprophylaxis
For antiviral chemoprophylaxis of swine influenza A (H1N1) virus infection, either oseltamivir or zanamivir are recommended. Duration of antiviral chemoprophylaxis is 7 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. Antiviral dosing and schedules recommended for chemoprophylaxis of swine influenza A (H1N1) virus infection are the same as those recommended for seasonal influenza:
Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir is recommended for the following individuals:
1.Household close contacts who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) of a confirmed or suspected case.
2.School children who are at high-risk for complications of influenza (persons with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed or suspected case.
3.Travelers to Mexico who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
4.Border workers (Mexico) who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
5.Health care workers or public health workers who had unprotected close contact with an ill confirmed case of swine influenza A (H1N1) virus infection during the case's infectious period.
Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir can be considered for the following:
•Any health care worker who is at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) who is working in an area with confirmed swine influenza A (H1N1) cases, and who is caring for patients with any acute febrile respiratory illness.
•Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.
Subscribe to:
Posts (Atom)
Posts
