Find out why Pristiq is prescribed, side effects of Pristiq, Pristiq warnings, discontinuation symptoms of Pristiq, more - in plain English.

FDA-Approved Medication Guide and Patient Counseling Information

Pristiq (desvenlafaxine) Full Prescribing Information

Pristiq Medication Guide

Pristiq^TM (pris-TEEK) Extended-Release Tablets (desvenlafaxine)

Read the Medication Guide that comes with you or your family member's antidepressant medicine. This Medication Guide is only about the risk of suicidal thoughts and actions with antidepressant medicines. Talk to your, or your family member's, healthcare provider about:

• all risks and benefits of treatment with antidepressant medicines
• all treatment choices for depression or other serious mental illness

What is the most important information I should know about antidepressant medicines, depression and other serious mental illnesses, and suicidal thoughts or actions?

1. Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.

2. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions.

3. How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?

• Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.
• Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
• Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.

Call a healthcare provider right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:

What else do I need to know about antidepressant medicines?

• Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms
• Antidepressants are medicines used to treat depression and other illnesses. It is important to discuss all the risks of treating depression and also the risks of not treating it. Patients and their families or other caregivers should discuss all treatment choices with the healthcare provider, not just the use of antidepressants.
• Antidepressant medicines have other side effects. Talk to the healthcare provider about the side effects of the medicine prescribed for you or your family member.
• Antidepressant medicines can interact with other medicines. Know all of the medicines that you or your family member takes. Keep a list of all medicines to show the healthcare provider. Do not start new medicines without first checking with your healthcare provider.
• Not all antidepressant medicines prescribed for children are FDA approved for use in children. Talk to your child's healthcare provider for more information.

 

This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants.

Important Information about Pristiq

Read the patient information that comes with Pristiq before you take Pristiq and each time you refill your prescription. There may be new information. If you have questions, ask your healthcare provider. This information does not take the place of talking with your healthcare provider about your medical condition or treatment.

What is Pristiq?

• Pristiq is a prescription medicine used to treat depression. Pristiq belongs to a class of medicines known as SNRIs (or serotonin-norepinephrine reuptake inhibitors).
• Pristiq has not been studied orapproved for use in children and adolescents.

Who should not take Pristiq?

Do not take Pristiq if you:

• are allergic to desvenlafaxine, venlafaxine or any of the ingredients in Pristiq. See the end of this Medication Guide for a complete list of ingredients in Pristiq.
• currently take or have taken within the last 14 days, any medicine known as an MAOI. Taking an MAOI with certain other medicines, including Pristiq, can cause serious or even life-threatening side effects. Also, you must wait at least 7 days after you stop taking Pristiq before you take any MAOI.

What should I tell my healthcare provider before taking Pristiq?

Tell your healthcare provider about all your medical conditions, including if you:

• have high blood pressure
• have heart problems
• have high cholesterol or high triglycerides 34
• have a history of a stroke
• have glaucoma
• have kidney problems
• have liver problems
• have or had bleeding problems
• have or had seizures or convulsions
• have mania or bipolar disorder
• have low sodium levels in your blood
• are pregnant or plan to become pregnant. It is not known if Pristiq will harm your unbor baby.
• are breastfeeding. Pristiq can pass into your breast milk and may harm your baby. Talk with your healthcare provider about the best way to feed your baby if you take Pristiq.

Serotonin syndrome

A rare but potentially life-threatening condition called serotonin syndrome can happen when medicines such as Pristiq are taken with certain other medicines. Serotonin syndrome can cause serious changes in how your brain, muscles and digestive system work. Especially tell your healthcare provider if you take the following:

• medicines to treat migraine headaches known as triptans
• medicines used to treat mood disorders, including tricyclics, lithium, selective serotonin reuptake inhibitors (SSRIs), or serotonin norepinephrine reuptake inhibitors (SNRIs)
• silbutramine
• tramadol
• St. John's Wort
• MAOIs (including linezolid, an antibiotic)
• tryptophan supplements

Ask your healthcare provider if you are not sure if you are taking any of these medicines.

Before you take Pristiq with any of these medicines, talk to your healthcare provider about serotonin syndrome. See " What are the possible side effects of Pristiq?"

Pristiq contains the medicine desvenlafaxine. Do not take Pristiq with other medicines containing venlafaxine or desvenlafaxine.

How should I take Pristiq?

• Take Pristiq exactly as your healthcare provider has told you.
• Take Pristiq at about the same time each day.
• Pristiq may be taken either with or without food.
• Swallow Pristiq tablets whole with fluid. Do not crush, cut, chew, or dissolve Pristiq tablets because the tablets are time released.
• When you take Pristiq, you may see something in your stool that looks like a tablet. This is the empty shell from the tablet after the medicine has been absorbed by your body.
• It is common for antidepressant medicines such as Pristiq to take several weeks before you start to feel better. Do not stop taking Pristiq if you do not feel results right away.
• Do not stop taking or change the dose of Pristiq without talking with your healthcare provider, even if you feel better.
• Talk with your healthcare provider about how long you should use Pristiq. Take Pristiq for as long as your healthcare provider tells you to.
• If you miss a dose of Pristiq, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Do not try to "make up" for the missed dose by taking two doses at the same time.
• Do not take more Pristiq than prescribed by your healthcare provider. If you take more Pristiq than the amount prescribed, contact your healthcare provider right away.
• In case of an overdose of Pristiq, call your healthcare provider or poison control center, or go to the emergency room right away.

What should I avoid while taking Pristiq?

• Do not drive a car or operate machinery until you know how Pristiq affects you.
• Avoid drinking alcohol while taking Pristiq.

What are the possible side effects of Pristiq?

Pristiq can cause serious side effects including:

• See the beginning of this Medication Guide - Antidepressant Medicines, Depression and other Serious Mental Illnesses, and Suicidal Thoughts or Actions.
• Serotonin syndrome. See "What should I tell my healthcare provider before taking Pristiq?"

Get medical help right away if you think that you have serotonin syndrome. Signs and symptoms of serotonin syndrome may include one or more of the following:

• Pristiq may also cause other serious side effects including:
• New or worsened high blood pressure (hypertension). Your healthcare provider should monitor your blood pressure before and while you are taking Pristiq. If you have high blood pressure, it should be controlled before you start taking Pristiq.
• Abnormal bleeding or bruising. Pristiq and other SNRIs/ SSRIs may cause you to have an increased chance of bleeding. Taking aspirin, NSAIDs (non-steroidal anti-inflammatory drugs), or blood thinners may add to this risk. Tell your healthcare provider right away about any unusual bleeding or bruising.
• Glaucoma (increased eye pressure)
• Increased cholesterol and triglyceride levels in your blood
• Symptoms when stopping Pristiq (discontinuation symptoms). Side effects may occur when stopping Pristiq (discontinuation symptoms), especially when therapy is stopped suddenly. Your healthcare provider may want to decrease your dose slowly to help avoid side effects. Some of these side effects may include:
  • dizziness
  • nausea
  • headache
  • irritability
  • sleeping problems
  • anxiety
  • abnormal dreams
  • tiredness
  • sweating
  • diarrhea
• Seizures (convulsions)
• Low sodium levels in your blood. Symptoms of this may include: headache, difficulty concentrating, memory changes, confusion, weakness and unsteadiness on your feet. In severe or more sudden cases, symptoms can include: hallucinations (seeing or hearing things that are not real), fainting, seizures and coma. If not treated, severe low sodium levels could be fatal.

Contact your healthcare provider if you think you have any of these side effects.

Common side effects with Pristiq include:

• nausea
• tiredness
• headache
• diarrhea
• dry mouth
• vomiting
• sweating
• anxiety
• dizziness
• tremor
• insomnia
• dilated pupils
• constipation
• decreased sex drive
• loss of appetite
• delayed orgasm and ejaculation
• sleepiness

These are not all the possible side effects of Pristiq. Tell your healthcare provider about any side effect that bothers you or does not go away. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. For more information on these and other side effects associated with Pristiq, talk to your healthcare provider visit our web site at www.pristiq.com or call our toll-free number 1-888-Pristiq.

How should I store Pristiq?

• Store Pristiq at 68° to 77°F (20° to 25°C)
• Do not use Pristiq after the expiration date (EXP), which is on the container. The expiration date refers to the last day of that month.
• Keep Pristiq and all medicines out of the reach of children.

General Information about the safe and effective use of Pristiq

Medicines are sometimes used for conditions that are not mentioned in Medication Guides. Do not use Pristiq for a condition for which it was not prescribed. Do not give Pristiq to other people, even if they have the same symptoms that you have. It may harm them.

This Medication Guide summarizes the most important information about Pristiq. If you would like more information, talk with your healthcareprovider. You can ask you pharmacist or healthcare provider for information about Pristiq that is written for healthcare professionals. For more information, go to www.pristiq.com or call 1-888-Pristiq (774-7847).

What are the ingredients in Pristiq?

Active ingredient: desvenlafaxine

Inactive ingredients: hypromellose, microcrystalline cellulose, talc, magnesium stearate, a film coating which consists of sodium carboxymethylcellulose, maltodextrin, dextrose, titanium dioxide, stearic acid and iron oxide(s).

This Medication Guide has been approved by the U.S. Food and Drug Administration.

Issued February 2008

Contact Information

Please visit our web site at www.pristiq.com, or call our toll-free number 1-888-Pristiq to receive more information.

This product's label may have been updated. For current package insert and further product information, please visit www.wyeth.com or call our medical communications department toll-free at 1-800-934-5556.

Wyeth®

Wyeth Pharmaceuticals Inc.
Philadelphia, PA 19101

W10529C002
ET01
Rev 04/08

Patient Counseling Information

Advise patients, their families, and their caregivers about the benefits and risks associated with treatment with Pristiq and counsel them in its appropriate use.

Advise patients, their families, and their caregivers to read the Medication Guide and assist them in understanding its contents. The complete text of the Medication Guide is reprinted at the end of this document.

Suicide Risk

Advise patients, their families and caregivers to look for the emergence of suicidality, especially early during treatment and when the dose is adjusted up or down [see Box Warning and Warnings and Precautions (5.1)].

Concomitant Medication

Advise patients taking Pristiq not to use concomitantly other products containing desvenlafaxine or venlafaxine. Healthcare professionals should instruct patients not to take Pristiq with an MAOI or within 14 days of stopping an MAOI and to allow 7 days after stopping Pristiq before starting an MAOI [see Contraindications ( 4.2)].

Serotonin Syndrome

Caution patients about the risk of serotonin syndrome, particularly with the concomitant use of Pristiq and triptans, tramadol, tryptophan supplements or other serotonergic agents [see Warnings and Precautions ( 5.2) and Drug Interactions ( 7.3)].

Elevated Blood Pressure

Advise patients that they should have regular monitoring of blood pressure when taking Pristiq [see Warnings and Precautions ( 5.3)].

Abnormal Bleeding

Patients should be cautioned about the concomitant use of Pristiq and NSAIDs, aspirin, warfarin, or other drugs that affect coagulation since combined use of psychotropic drugs that interfere with serotonin reuptake and these agents has been associated with an increased risk of bleeding. [see Warnings and Precautions ( 5.4)].

Narrow-angle Glaucoma

Advise patients with raised intraocular pressure or those at risk of acute narrow-angle glaucoma (angle-closure glaucoma) that mydriasis has been reported and they should be monitored [see Warnings and Precautions ( 5.5)].

Activation of Mania/Hypomania

Advise patients, their families and caregivers to observe for signs of activation of mania/hypomania [see Warnings and Precautions ( 5.6)].

Cardiovascular/Cerebrovascular Disease

Caution is advised in administering Pristiq to patients with cardiovascular, cerebrovascular, or lipid metabolism disorders [see Adverse Reactions ( 6.1) and Warnings and Precautions ( 5.7)].

Serum Cholesterol and Triglyceride Elevation

Advise patients that elevations in total cholesterol, LDL and triglycerides may occur and that measurement of serum lipids may be considered [see Warnings and Precautions ( 5.8)].

Discontinuation

Advise patients not to stop taking Pristiq without talking first with their healthcare professional. Patients should be aware that discontinuation effects may occur when stopping Pristiq [see Warnings and Precautions ( 5.9) and Adverse Reactions ( 6.1)].

Interference with Cognitive and Motor Performance

Caution patients about operating hazardous machinery, including automobiles, until they are reasonably certain that Pristiq therapy does not adversely affect their ability to engage in such activities.

Alcohol

Advise patients to avoid alcohol while taking Pristiq [see Drug Interactions ( 7.5)].

Allergic Reactions

Advise patients to notify their physician if they develop allergic phenomena such as rash, hives, swelling, or difficulty breathing.

Pregnancy

Advise patients to notify their physician if they become pregnant or intend to become pregnant during therapy [see Use in Specific Populations ( 8.1)].

Nursing

Advise patients to notify their physician if they are breastfeeding an infant [see Use in Specific Populations (8.3)].

Residual Inert Matrix Tablet

Patients receiving Pristiq may notice an inert matrix tablet passing in the stool or via colostomy. Patients should be informed that the active medication has already been absorbed by the time the patient sees the inert matrix tablet.

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Pristiq (desvenlafaxine) Full Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of Depression

Wyeth Pharmaceuticals Inc.
Philadelphia, PA 19101

last updated: 04/08

back to: Psychiatric Medication Patient Information Index

Self-Therapy For People Who ENJOY Learning About Themselves

THE THERAPIST'S WARPED VIEW

Therapists may not know much more than the average person about how to have a GOOD sex life, but we sure do know a lot about how to have a LOUSY one! We've heard every bad idea in the book. Here, then, are the best bad ideas I've heard about sex in my years as a therapist. I'd suggest you put an "X" next to each item you think is correct. (Maybe a REALLY BIG "X" - to signify that you want this idea to go away forever!)

ABOUT NORMALCY AND "STANDARDS"

____ Always be sure that what you do in the bedroom is "normal."

____ Ask yourself often: "What would my parents think if they saw me doing this?"

____ Remember: God didn't give you sex to be enjoyed. He gave it to you as a cruel test!

THE SEXUAL RELATIONSHIP: WITH YOUR PARTNER

____ It's reasonable to be shocked if you are touched sexually away from the bedroom.

____ Don't worry about cleanliness or how you dress once you've "got" your sex partner.

____ Remember that women are passive and men are active. Period.

____ Never have sex unless you feel intense love for each other.

____ Never have sex when you are angry or "down."

AWAY FROM YOUR PARTNER: WHAT YOU THINK

____ If you have a thought about doing something "weird" that proves you want to do it.

____ Don't allow yourself to think about sex away from the bedroom.

____ Don't allow yourself to think about sex with anyone other than your partner.

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AWAY FROM YOUR PARTNER: WHAT YOU DO

____ Never masturbate!

____ Never let your desires grow unless you are with your partner and it's OK with them.

____ Never look sexy in public (unless you are with your partner and they insist).

IN THE BEDROOM: WHAT TO THINK

____ Think of sex as "intercourse only" and as "doing it."

____ Don't have fantasies in bed. Think only about what's going on right now!

____ Remember: Your partner's pleasure is your responsibility, not theirs.

____ Remember: Your pleasure is your partner's responsibility, not yours.

____ Always think of your partner's needs first! Try to forget about your own desires.

____ Never discuss your fantasies, no matter how "accepting" your partner seems to be.

IN THE BEDROOM: WHAT TO DO

____ Build toward orgasm continuously.

____ Try to keep both people's excitement at the same level at all times.

____ Work hard at achieving mutual orgasms.

____ Don't touch anything but genitals, breasts, and maybe buttocks (on a "wild" night!).

____ Never touch your own genitals during sex!

____ Never try to enact "scenes" of any kind. Stick to business!

____ Never have "one way" sex! If either person isn't interested, just forget it!

____ Never "take turns" pleasing each other.

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ABOUT PROBLEMS AND GETTING HELP

____ If you need advice about sex, get it from someone who has taken a vow of celibacy.

____ If your therapist blushes and gets a little tongue-tied when you bring up sex, you've found a good one!

____ Remember that sex is just a normal thing so therapists don't really need any special training in it.

____ If something is wrong in your relationship and you don't know what it is, it probably isn't sex!

PRINCIPLES OF GOOD SEX

I could go on and on with this, but I think I'll remove my tongue from my cheek for the rest of this topic.

ABOUT NORMALCY:

Normalcy simply doesn't matter! What matters is whether both of you enjoy what you do.

THE SEXUAL RELATIONSHIP:

The sexual relationship is ALWAYS there, not just in the bedroom but whenever you are together. It occurs between people who are usually equally sexual, and equal in all other ways - regardless of gender. And sex is a good idea whenever you can enjoy it, not just when you feel intensely loving.

WHAT YOU THINK AND DO AWAY FROM YOUR PARTNER:

Keep any promises you have made to your partner. Other than that, remember that your life away from your partner is entirely your own business.

WHAT TO THINK AND DO IN THE BEDROOM:

Think whatever you want! And do whatever your want that your partner hasn't specifically ruled out!

ABOUT PROBLEMS AND GETTING HELP

If something is wrong and you don't know what it is, it likely IS sex! A well-trained therapist - with a good sex life of their own - is what you and your partner need. You can usually tell if your therapist has a good sex life by seeing them with their partner and looking for either an excited smile or a relaxed smile on both faces! (That's how we can tell about you and your partner...!)

 

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next: Couples: Passive and Controlling Partners

Find out why Clozaril is prescribed, side effects of Clozaril, Clozaril warnings, effects of Clozaril during pregnancy, more - in plain English.

Generic name: Clozapine
Brand name: Clozaril

Pronounced: KLOH-zah-ril

Clozaril (clozapine) Full Prescribing Information

Why is Clozaril prescribed?

Clozaril is given to help people with severe schizophrenia who have failed to respond to standard treatments. Clozaril is not a cure, but it can help some people return to more normal lives.

Most important fact about Clozaril

Even though it does not produce some of the disturbing side effects of other antipsychotic medications, Clozaril may cause agranulocytosis, a potentially lethal disorder of the white blood cells. Because of the risk of agranulocytosis, anyone who takes Clozaril is required to have a blood test once a week for the first 6 months. The drug is carefully controlled so that those taking it must get their weekly blood test before receiving the following week's supply of medication. If your blood counts have been acceptable for the 6-month period, you will need to have your blood tested only every other week thereafter. Anyone whose blood test results are abnormal will be taken off Clozaril either temporarily or permanently, depending on the results of an additional 4 weeks of testing.

How should you take Clozaril?

Take e Clozaril exactly as directed by your doctor. Because of the significant risk of serious side effects associated with this drug, your doctor will periodically reassess the need for continued Clozaril therapy. Clozaril is distributed only through the Clozaril Patient Management System, which ensures regular white blood cell testing, monitoring, and pharmacy services prior to delivery of your next supply.

Clozaril may be taken with or without food.

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--If you miss a dose...

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

 

If you stop taking Clozaril for more than 2 days, do not start taking it again without consulting your physician.

--Storage instructions... .

Store at room temperature.

What side effects may occur when taking Clozaril?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Clozaril.

The most feared side effect of Clozaril is agranulocytosis, a dangerous drop in the number of a certain kind of white blood cell. Symptoms include fever, lethargy, sore throat, and weakness. If not caught in time, agranulocytosis can be fatal. That is why all people who take Clozaril must have a blood test every week. About 1 percent develop agranulocytosis and must stop taking the drug.

Seizures are another potential side effect, occurring in some 5 percent of people who take Clozaril. The higher the dosage, the greater the risk of seizures.

• More common side effects of Clozaril may include: Abdominal discomfort, agitation, confusion, constipation, disturbed sleep, dizziness, drowsiness, dry mouth, fainting, fever, headache, heartburn, high blood pressure, inability to sit down, loss or slowness of muscle movement, low blood pressure, nausea, nightmares, rapid heartbeat and other heart conditions, restlessness, rigidity, salivation, sedation, sweating, tremors, vertigo, vision problems, vomiting, weight gain n

• Less common side effects may include: Anemia, angina (severe, crushing chest pain), anxiety, appetite increase, blocked intestine, blood clots, bloodshot eyes, bluish tinge in the skin, breast pain or discomfort, bronchitis, bruising, chest pain, chills or chills and fever, constant involuntary eye movement, coughing, delusions, depression, diarrhea, difficult or labored breathing, difficulty swallowing, dilated pupils, disorientation, dry throat, ear disorders, ejaculation problems, excessive movement, eyelid disorder, fast, fluttery heartbeat, fatigue, fluid retention, frequent urination, glaucoma (high pressure in the eye), hallucinations, heart problems, hives, hot flashes, impacted stool, impotence, inability to fall asleep or stay asleep, inability to hold urine, inability to urinate, increase or decrease in sex drive, involuntary movement, irritability, itching, jerky movements, joint pain, lack of coordination, laryngitis, lethargy, light-headedness (especially when rising quickly from a seated or lying position), loss of appetite, loss of speech, low body temperature, memory loss, muscle pain or ache, muscle spasm, muscle weakness, nosebleed, numbness, pain in back, neck, or legs, painful menstruation, pallor, paranoia, pneumonia or pneumonia-like symptoms, poor coordination, rapid breathing, rash, runny nose, shakiness, shortness of breath, skin inflammation, redness, scaling, slow heartbeat, slurred speech, sneezing, sore or numb tongue, speech difficulty, stomach pain, stuffy nose, stupor, stuttering, swollen salivary glands, thirst, throat discomfort, tics, twitching, urination problems, vaginal infection, vaginal itch, a vague feeling of being sick, weakness, wheezing, yellow skin and eyes

Why should this drug not be prescribed?

Clozaril is considered a somewhat risky medication because of its potential to cause agranulocytosis and seizures. It should be taken only by people whose condition is serious, and who have not been helped by more traditional antipsychotic medications such as Haldol or Mellaril.

You should not take Clozaril if:

You have a bone marrow disease or disorder;
You have epilepsy that is not controlled;
You ever developed an abnormal white blood cell count while taking Clozaril;
You are currently taking some other drug, such as Tegretol, that could cause a decrease in white blood cell count or a drug that could affect the bone marrow;
You have ever had an allergic reaction to any of its ingredients.

Special warnings about Clozaril

Clozaril can cause drowsiness, especially at the start of treatment. For this reason, and also because of the potential for seizures, you should not drive, swim, climb, or operate dangerous machinery while you are taking this medication, at least in the early stages of treatment.

Even though you will have blood tests weekly for the first 6 months of treatment and every other week after that, you should stay alert for early symptoms of agranulocytosis: weakness, lethargy, fever, sore throat, a general feeling of illness, a flu-like feeling, or ulcers of the lips, mouth, or other mucous membranes. If any such symptoms develop, tell your doctor immediately.

Especially during the first 3 weeks of treatment, you may develop a fever. If you do, notify your doctor.

While taking Clozaril, do not drink alcohol or use drugs of any kind, including over-the-counter medicines, without first checking with your doctor.

If you take Clozaril, you must be monitored especially closely if you have either the eye condition called narrow-angle glaucoma or an enlarged prostate; Clozaril could make these conditions worse.

On rare occasions, Clozaril can cause intestinal problems--constipation, impaction, or blockage--that can, in extreme cases, be fatal.

In very rare cases, Clozaril has been known to cause a potentially fatal inflammation of the heart. This problem is most likely to surface during the first month of treatment, but has also occurred later. Warning signs include unexplained fatigue, shortness of breath, fever, chest pain, and a rapid or pounding heartbeat. If you develop these symptoms, see your doctor immediately. Even a suspicion of heart inflammation warrants discontinuation of Clozaril.

Especially when you begin taking Clozaril, you may be troubled by a dramatic drop in blood pressure whenever you first stand up. This can lead to light-headedness, fainting, or even total collapse and cardiac arrest. Clozaril also tends to increase your heart rate. Both problems are more dangerous for someone with a heart problem. If you suffer from one, make sure the doctor knows about it.

Also, if you have kidney, liver, or lung disease, or a history of seizures or prostate problems, you should discuss these with your doctor before taking Clozaril. Nausea, vomiting, loss of appetite, and a yellow tinge to your skin and eyes are signs of liver trouble; call your doctor immediately if you develop these symptoms.

Drugs such as Clozaril can sometimes cause a set of symptoms called Neuroleptic Malignant Syndrome. Symptoms include high fever, muscle rigidity, irregular pulse or blood pressure, rapid heartbeat, excessive perspiration, and changes in heart rhythm. Your doctor will have you stop taking Clozaril while this condition is being treated.

There is also a risk of developing tardive dyskinesia, a condition of involuntary, slow, rhythmical movements. It happens more often in older adults, especially older women.

Clozaril has been known to occasionally raise blood sugar levels, causing unusual hunger, thirst, and weakness, along with excessive urination. If you develop these symptoms, alert your doctor. You may have to switch to a different medication.

In very rare instances, Clozaril may also cause a blood clot in the lungs. If you develop severe breathing problems or chest pain, call your doctor immediately.

Possible food and drug interactions when taking Clozaril

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

Alcohol
Antidepressants such as Paxil, Prozac, and Zoloft
Antipsychotic drugs such as Thorazine and Mellaril
Blood pressure medications such as Aldomet and Hytrin
Caffeine
Chemotherapy drugs
Cimetidine (Tagamet)
Digitoxin (Crystodigin)
Digoxin (Lanoxin)
Drugs that depress the central nervous system such as phenobarbital and Seconal
Drugs that contain atropine such as Donnatal and Levsin
Epilepsy drugs such as Tegretol and Dilantin
Epinephrine (EpiPen)
Erythromycin (E-Mycin, Eryc, others)
Fluvoxamine (Luvox)
Heart rhythm stabilizers such as Rythmol, Quinidex, and Tambocor
Nicotine
Rifampin (Rifadin)
Tranquilizers such as Valium and Xanax
Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding

The effects of Clozaril during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Clozaril treatment should be continued during pregnancy only if absolutely necessary. You should not breastfeed if you are taking Clozaril, since the drug may appear in breast milk.

Recommended dosage for Clozaril

ADULTS

Your doctor will carefully individualize your dosage and monitor your response regularly.

The usual recommended initial dose is half of a 25-milligram tablet (12.5 milligrams) 1 or 2 times daily. Your doctor may increase the dosage in increments of 25 to 50 milligrams a day to achieve a daily dose of 300 to 450 milligrams by the end of 2 weeks. Dosage increases after that will be only once or twice a week and will be no more than 100 milligrams each time. Dosage is increased gradually because rapid increases and higher doses are more likely to cause seizures and changes in heart rhythm. The most you can take is 900 milligrams a day divided into 2 or 3 doses. s.

Your doctor will determine long-term dosage depending upon your response and results of the regular blood tests.

CHILDREN

Safety and efficacy have not been established for children up to 16 years of age.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose of Clozaril, seek emergency medical attention immediately.

• Symptoms of Clozaril overdose may include: Coma, delirium, drowsiness, excess salivation, low blood pressure, faintness, pneumonia, rapid heartbeat, seizures, shallow breathing or absence of breathing

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Clozaril (clozapine) Full Prescribing Information

back to: Psychiatric Medication Patient Information Index

Find out why Klonopin is prescribed, side effects of Klonopin, Klonopin warnings, effects of Klonopin during pregnancy, more - in plain English.

Generic name: Clonazepam
Brand name: Klonopin

Pronounced: KLON-uh-pin

Klonopin (clonazepam) Full Prescribing Information

Why is Klonopin prescribed?

Klonopin is used alone or along with other medications to treat convulsive disorders such as epilepsy. It is also prescribed for panic disorder--unexpected attacks of overwhelming panic accompanied by fear of recurrence. Klonopin belongs to a class of drugs known as benzodiazepines.

Most important fact about Klonopin

Klonopin works best when there is a constant amount in the bloodstream. To keep blood levels as constant as possible, take your doses at regularly spaced intervals and try not to miss any.

How should you take Klonopin?

Take e Klonopin exactly as prescribed. If you are taking it for panic disorder and you find it makes you sleepy, your doctor may recommend a single dose at bedtime.

--If you miss a dose...

If it is within an hour after the missed time, take the dose as soon as you remember. If you do not remember until later, skip the dose and go back to your regular schedule. Never take 2 doses at the same time.

 

--Storage instructions...

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

What side effects may occur with Klonopin?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Klonopin.

• • More common side effects of Klonopin in seizure disorders may include: Behavior problems, drowsiness, lack of muscular coordination
  • Less common or rare side effects in seizure disorders may include: Abnormal eye movements, anemia, bed wetting, chest congestion, coated tongue, coma, confusion, constipation, dehydration, depression, diarrhea, double vision, dry mouth, excess hair, fever, fluttery or throbbing heartbeat, "glassy-eyed" appearance, hair loss, hallucinations, headache, inability to fall or stay asleep, inability to urinate, increased sex drive, involuntary rapid movement of the eyeballs, loss of or increased appetite, loss of voice, memory loss, muscle and bone pain, muscle weakness, nausea, nighttime urination, painful or difficult urination, partial paralysis, runny nose, shortness of breath, skin rash, slowed breathing, slurred speech, sore gums, speech difficulties, stomach inflammation, swelling of ankles and face, tremor, uncontrolled body movement or twitching, vertigo, weight loss or gain

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Klonopin can also cause aggressive behavior, agitation, anxiety, excitability, hostility, irritability, nervousness, nightmares, sleep disturbances, and vivid dreams.

• Side effects due to rapid decrease or abrupt withdrawal from Klonopin may include: Abdominal and muscle cramps, behavior disorders, convulsions, depressed feeling, hallucinations, restlessness, sleeping difficulties, tremors

• More common side effects in panic disorder may include: Allergic reaction, constipation, coordination problems, depression, dizziness, fatigue, inflamed sinuses or nasal passages, flu, memory problems, menstrual problems, nervousness, reduced thinking ability, respiratory infection, sleepiness, speech problems

• Less common or rare side effects in panic disorder may include: Abdominal pain/discomfort, abnormal hunger, acne, aggressive reaction, anxiety, apathy, asthma attack, bleeding from the skin, blood clots, bronchitis, burning sensation, changes in appetite, changes in sex drive, confusion, coughing, difficulty breathing, dizziness when standing, ear problems, emotional changeability, excessive dreaming, excitement, fever, flushing, fluttery or throbbing heartbeat, frequent bowel movements, gas, general feeling of illness, gout, hair loss, hemorrhoids, hoarseness, increased salivation, indigestion, infections, inflamed stomach and intestines, lack of attention, lack of sensation, leg cramps, loss of taste, male sexual problems, migraine, motion sickness, muscle pain/cramps, nightmares, nosebleed, overactivity, pain (anywhere in the body), paralysis, pneumonia, shivering, skin problems, sleep problems, sneezing, sore throat, swelling with fluid retention, swollen knees, thick tongue, thirst, tingling/pins and needles, tooth problems, tremor, twitching, upset stomach, urinary problems, vertigo, vision problems, weight gain or loss, yawning

Why should this drug not be prescribed?

If you are sensitive to or have ever had an allergic reaction to to Klonopin or similar drugs, such as Librium and Valium, you should not take this medication. Make sure your doctor is aware of any reactions you have experienced.

You should not take this medication if you have severe liver disease or the eye condition known as acute narrow-angle glaucoma

Special warnings about Klonopin

Klonopin may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how this drug affects you.

If you have several types of seizures, this drug may increase the possibility of grand mal seizures (epilepsy). Inform your doctor if this occurs. Your doctor may wish to prescribe an additional anticonvulsant drug or increase your dose.

Klonopin can be habit-forming and can lose its effectiveness as you build up a tolerance to it. You may experience withdrawal symptoms--such as convulsions, hallucinations, tremor, and abdominal and muscle cramps--if you stop using this drug abruptly. Discontinue or change your dose only in consultation with your doctor.

Possible food and drug interactions when taking Klonopin

Klonopin slows the nervous system and its effects may be intensified by alcohol. Do not drink while taking this medication.

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

Antianxiety drugs such as Valium
Antidepressant drugs such as Elavil, Nardil, Parnate, and Tofranil
Barbiturates such as phenobarbital
Carbamazepine (Tegretol)
Major tranquilizers such as Haldol, Navane, and Thorazine
Narcotic pain relievers such as Demerol and Percocet
Oral antifungal drugs such as Fungizone, Mycelex, and Mycostatin
Other anticonvulsants such as Dilantin, Depakene, and Depakote
Sedatives such as Halcion

Special information if you are pregnant or breastfeeding

Avoid Klonopin if at all possible during the first 3 months of pregnancy; there is a risk of birth defects. When taken later in pregnancy, the drug can cause other problems, such as withdrawal symptoms in the newborn. If you are pregnant or plan to become pregnant, inform your doctor immediately. Klonopin appears in breast milk and could affect a nursing infant. Mothers taking this medication should not breastfeed.

Recommended dosage for Klonopin

SEIZURE DISORDERS

Adults The starting dose should be no more than 1.5 milligrams per day, divided into 3 doses. Your doctor may increase your daily dosage by 0.5 to 1 milligram every 3 days until your seizures are controlled or the side effects become too bothersome. The most you should take in 1 day is 20 milligrams.

Children

The starting dose for infants and children up to 10 years old or up to 66 pounds should be 0.01 to 0.03 milligram--no more than 0.05 milligram--per 2.2 pounds of body weight daily. The daily dosage should be given in 2 or 3 smaller doses. Your doctor may increase the dose by 0.25 to 0.5 milligram every 3 days until seizures are controlled or side effects become too bad. If the dose cannot be divided into 3 equal doses, the largest dose should be given at bedtime. The maximum maintenance dose is 0.1 to 0.2 milligram per 2.2 pounds daily.

PANIC DISORDER

Adults: The starting dose is 0.25 milligram twice a day. After 3 days, your doctor may increase the dose to 1 milligram daily. Some people need as much as 4 milligrams a day.

Children

For panic disorder, safety and effectiveness have not been established in children under age 18.

Older Adults

Klonopin tends to build up in the body if the kidneys are weak--a common problem among older adults. Higher doses of the drug also tend to cause more drowsiness and confusion in older patients. People over age 65 are therefore started on low doses of Klonopin and watched with extra care.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose of Klonopin, seek medical attention immediately. diately.

The symptoms of Klonopin overdose may include: Coma, confusion, sleepiness, slowed reaction time

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Klonopin (clonazepam) Full Prescribing Information

back to: Psychiatric Medication Patient Information Index

Drug, set or setting - which has the greatest impact upon drug use problems?

Rebecca

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Dear Rebecca:

Good question. Another way of phrasing the question is whether the individual or the group is the primary determinant of addiction. The answer is the "setting" or the "group." Of course, this includes cultural setting, which is a colossal predictor.

In multivariate models (including Cahalan and Room's classic Problem Drinking Among American Men, 1974 ), the best predictors of drinking problems are ethnic, social class, and setting variables, most notably drinking by immediate cohorts (you drink like the people you hang out with). Of course, while everyone is drinking excessively and using drugs, some individuals do take off on independent careers of abuse, like Sid Vicious (as depicted in the film, Sid and Nancy).

In his dishonest book (The Natural History of Alcoholism, 1982), George Vaillant, while skewing his interpretations against his data to find genetic determinism and AA salvation, nonetheless conclusively indicated that his data---about predicting alcoholism over the life courses of several hundred inner-city Boston men---showed cultural background was remarkably determinative: Irish Americans, despite drinking less, were seven times more likely to develop alcohol dependence than Italian (along with Greek and Jewish) Americans.

Overlaying everything in drinking and drug-taking is the cultural milieu. Whenever you review anthropological work with alcohol (see Mac Marshall and Dwight Heath), as in the classic work by MacAndrew and Edgerton, Drunken Comportment (1969), the most striking finding is that people in various cultures drink together and behave in unison while drinking, even as they undergo the most bizarre states and aberrant reactions to alcohol. The same is at least as true of various drugs, none of which is as universally used as alcohol.

Of course, you might argue, it is only "native" cultures which have such uniform reactions to drugs. We in the U.S. and Western World are too fragmented to make similar generalizations. But drug use is nonetheless often highly group centered, even in our civilization. In his book, Drug, Set, and Setting, 1984, Zinberg analyzed primarily individual careers of drug use, showing they were often quite variable. Going way back to his work with heroin users in Vietnam (consider the article he did in the New York Times Magazine, December 5, 1971, "G.I.s and O.J.s in Vietnam"), Zinberg found that withdrawal varied often remarkably among groups such as military units.

Even the great distinctions one finds in individual extremes of use, looked at in the long haul, tend to fluctuate quite remarkably. Examine the longer parabolas of use of even the most severe drug users (this work is now best found among cocaine users and one finds that even addicts will tune down their use as their life circumstances evolve. The same is true of alcoholics. Dawson (1996) found that almost two-thirds of alcohol dependent Americans will eliminate the pathology of their drinking over a 20 year period while still continuing to imbibe. It happened to my father-in-law.

Now the bad news. These things are barely studied in America anymore in the case of alcohol, although as my review shows, for the exotic fauna of cocaine users the government supports a certain amount of field research. Nonetheless, in formulating models of addiction, our peerless leaders seek nothing so much as to pretend that setting and individual career variations in addiction are nonexistent, thereby invalidating their efforts from the get-go. Indeed, my efforts in The Meaning of Addiction were geared specifically to the goal of incorporating settings and careers of drug use into a viable model of addiction.

Best,
Stanton

next: Foreword Coming Clean: Overcoming Addiction Without Treatment by Robert Granfield and William Cloud
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

Find out why Chlorpromazine is prescribed, side effects of Chlorpromazine, Chlorpromazine warnings, effects of Chlorpromazine during pregnancy, more - in plain English.

Pronounced as (klor proe' ma zeen)

Chlorpromazine Full Prescribing Information

Brand names

Largaticil, Promapar and Thorazine were branded products of chlorpromazine that are no longer on the market. Generic alternatives may be available.

IMPORTANT WARNING:

Studies have shown that older adults with dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and that may cause changes in mood and personality) who take antipsychotics (medications for mental illness) such as chlorpromazine have an increased chance of death during treatment.

Chlorpromazine is not approved by the Food and Drug Administration (FDA) for the treatment of behavior problems in older adults with dementia. Talk to the doctor who prescribed this medication if you, a family member, or someone you care for has dementia and is taking chlorpromazine. For more information, visit the FDA website: http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm

Why is this medication prescribed?

Chlorpromazine is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) and other psychotic disorders (conditions that cause difficulty telling the difference between things or ideas that are real and things or ideas that are not real) and to treat the symptoms of mania (frenzied, abnormally excited mood) in people who have bipolar disorder (manic depressive disorder; a condition that causes episodes of mania, episodes of depression, and other abnormal moods).

Chlorpromazine is also used to treat severe behavior problems such as explosive, aggressive behavior and hyperactivity in children 1 to 12 years of age.

Chlorpromazine is also used to control nausea and vomiting, to relieve hiccups that have lasted one month or longer, and to relieve restlessness and nervousness that may occur just before surgery.

Chlorpromazine is also used to treat acute intermittent porphyria (condition in which certain natural substances build up in the body and cause stomach pain, changes in thinking and behavior, and other symptoms).

Chlorpromazine is also used along with other medications to treat tetanus (a serious infection that may cause tightening of the muscles, especially the jaw muscle).

Chlorpromazine is in a class of medications called conventional antipsychotics. It works by changing the activity of certain natural substances in the brain and other parts of the body.

How should this medicine be used?

Chlorpromazine comes as a tablet to take by mouth. Chlorpromazine is usually taken two to four times a day.

When chlorpromazine is used to control nausea and vomiting, it is usually taken every 4-6 hours as needed.

When chlorpromazine is used to relieve nervousness before surgery, it is usually taken 2-3 hours before surgery.

When chlorpromazine is used to relieve hiccups, it is usually taken 3-4 times a day for up to 3 days or until the hiccups stop. If the hiccups do not stop after 3 days of treatment, a different medication should be used.

If you are taking chlorpromazine on a regular schedule, take it at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take chlorpromazine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of chlorpromazine and gradually increase your dose. Your doctor may decrease your dose once your condition is controlled. Be sure to tell your doctor how you are feeling during your treatment with chlorpromazine.

If you are taking chlorpromazine to treat schizophrenia or another psychotic disorder, chlorpromazine may control your symptoms but will not cure your condition. Continue to take chlorpromazine even if you feel well. Do not stop taking chlorpromazine without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking chlorpromazine, you may experience withdrawal symptoms, such as nausea, vomiting, stomach pain, dizziness, and shakiness.

Other uses for this medicine

This medication may be prescribed for other uses; talk to your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking chlorpromazine,

tell your doctor and pharmacist if you are allergic to chlorpromazine; other phenothiazines such as fluphenazine, perphenazine, prochlorperazine (Compazine), promethazine (Phenergan), thioridazine, and trifluoperazine; or any other medications.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants (blood thinners) such as warfarin (Coumadin); antidepressants; antihistamines; atropine (in Motofen, in Lomotil, in Lonox); barbiturates such as pentobarbital (Nembutal), phenobarbital (Luminal), and secobarbital (Seconal); cancer chemotherapy; diuretics (water pills); epinephrine (Epipen); guanethidine (not available in the US); ipratropium (Atrovent); lithium (Eskalith, Lithobid); medications for anxiety, irritable bowel disease, mental illness, motion sickness, Parkinson's disease, ulcers, or urinary problems; medications for seizures such as phenytoin (Dilantin); narcotic medications for pain; propranolol (Inderal); sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

tell your doctor if you have or have ever had asthma; emphysema (a lung disease that causes shortness of breath); an infection in your lungs or bronchial tubes (tubes that bring air to the lungs); trouble keeping your balance; glaucoma (condition in which increased pressure in the eye can lead to gradual loss of vision); breast cancer; pheochromocytoma (tumor on a small gland near the kidneys); seizures; an abnormal electroencephalogram (EEG; test that records electrical activity in the brain); any condition that affects the production of blood cells by your bone marrow; or heart, liver, or kidney disease.

Also tell your doctor

if you have ever had to stop taking a medication for mental illness due to severe side effects or

if you plan to work with organophosphorus insecticides (a type of chemical used to kill insects)./

if you will be using chlorpromazine to treat nausea and vomiting, it is important to tell your doctor about any other symptoms you are experiencing, especially listlessness; drowsiness; confusion; aggression; seizures; headaches; problems with vision, hearing, speech, or balance; stomach pain or cramps; or constipation. Nausea and vomiting that is experienced along with these symptoms may be a sign of a more serious condition that should not be treated with chlorpromazine.

tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or if you plan to become pregnant or are breastfeeding. If you become pregnant while taking chlorpromazine, call your doctor. Chlorpromazine may cause problems in newborns following delivery if it is taken during the last months of pregnancy.

if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking chlorpromazine.

if you are having a myelogram (x-ray examination of the spine), tell your doctor and the radiographer that you are taking chlorpromazine. Your doctor will probably tell you not to take chlorpromazine for 2 days before the myelogram and for one day after the myelogram.

you should know that this medication may make you drowsy and may affect your thinking and movements. Do not drive a car or operate machinery until you know how this medication affects you. ask your doctor about the safe use of alcohol during your treatment with chlorpromazine. Alcohol can make the side effects of chlorpromazine worse.

plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Chlorpromazine may make your skin sensitive to sunlight.

you should know that chlorpromazine may cause dizziness, lightheadedness, fast heartbeat, and fainting, especially when you get up too quickly from a lying position. This is most common at the beginning of treatment with chlorpromazine, especially after the first dose. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

you should know that chlorpromazine may make it harder for your body to cool down when it gets very hot. Tell your doctor if you plan to do vigorous exercise or be exposed to extreme heat.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you are taking chlorpromazine on a regular schedule and you miss a dose, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Chlorpromazine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness, feeling unsteady, or having trouble keeping your balance
• blank facial expression
• shuffling walk
• restlessness
• agitation
• nervousness
• unusual, slowed, or uncontrollable movements of any part of the body
• difficulty falling asleep or staying asleep
• increased appetite
• weight gain
• breast milk production
• breast enlargement
• missed menstrual periods
• decreased sexual ability
• changes in skin color
• dry mouth
• stuffed nose
• difficulty urinating
• widening or narrowing of the pupils (black circles in the middle of the eyes)

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• fever
• muscle stiffness
• falling
• confusion
• fast or irregular heartbeat
• sweating
• yellowing of the skin or eyes
• flu-like symptoms
• sore throat, chills, and other signs of infection
• unusual bleeding or bruising
• neck cramps tongue that sticks out of the mouth
• tightness in the throat
• difficulty breathing or swallowing
• fine, worm-like tongue movements
• uncontrollable, rhythmic face, mouth, or jaw movements
• seizures
• blisters
• rash
• hives
• itching
• swelling of the eyes, face, mouth, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
• vision loss, especially at night
• seeing everything with a brown tint

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Chlorpromazine may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• sleepiness
• loss of consciousness
• unusual, slowed, or uncontrollable movements of any part of the body
• agitation
• restlessness
• fever
• seizures
• dry mouth
• irregular heartbeat

What other information should I know?

Keep all appointments with your doctor and your eye doctor. You should have regularly scheduled eye exams during your treatment with chlorpromazine because chlorpromazine may cause eye disease.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking chlorpromazine.

Chlorpromazine may interfere with the results of home pregnancy tests. Talk to your doctor if you think you might be pregnant during your treatment with chlorpromazine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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Chlorpromazine Full Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of Bipolar Disorder

Detailed Info on Signs, Symptoms, Causes, Treatments of Schizophrenia

Detailed Info on Parenting Difficult or Special Children

back to: Psychiatric Medication Patient Information Index

Find out why Librium is prescribed, side effects of Librium, Librium warnings, effects of Librium during pregnancy, more - in plain English.

Generic name: Chlordiazepoxide
Brand name: Librium, Libritabs

Librium Pronounced: LIB-ree-um

Librium (chlordiazepoxide) Full Prescribing Information

Why is Librium prescribed?

Librium is used in the treatment of anxiety disorders. It is also prescribed for short-term relief of the symptoms of anxiety, symptoms of withdrawal in acute alcoholism, and anxiety and apprehension before surgery. It belongs to a class of drugs known as benzodiazepines.

Most important fact about Librium

Librium is habit-forming and you can become dependent on it. You could experience withdrawal symptoms if you stopped taking it abruptly (See "What side effects may occur?"). Discontinue or change your dose only on advice of your doctor.

How should you take Librium?

Take this medication exactly as prescribed.

--If you miss a dose...

Take it as soon as you remember if it is within an hour or so of your scheduled time. If you do not remember until later, skip the dose you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store away from heat, light, and moisture.

What side effects may occur with Librium?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Librium.

• Side effects of Librium may include: Confusion, constipation, drowsiness, fainting, increased or decreased sex drive, liver problems, lack of muscle coordination, minor menstrual irregularities, nausea, skin rash or eruptions, swelling due to fluid retention, yellow eyes and skin

• Side effects due to rapid decrease or abrupt withdrawal from Librium include: Abdominal and muscle cramps, convulsions, exaggerated feeling of depression, sleeplessness, sweating, tremors, vomiting

Why should this drug not be prescribed?

 

If you are sensitive to or have ever had an allergic reaction to Librium or similar tranquilizers, you should not take this medication.

Anxiety or tension related to everyday stress usually does not require treatment with Librium. Discuss your symptoms thoroughly with your doctor.

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Special warnings about Librium

Librium may cause you to become drowsy or less alert; therefore, you should not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how you react to this drug.

If you are severely depressed or have suffered from severe depression, consult with your doctor before taking this medication.

This drug may cause children to become less alert.

If you have a hyperactive, aggressive child taking Librium, inform your doctor if you notice contrary reactions such as excitement, stimulation, or acute rage.

Consult with your doctor before taking Librium if you are being treated for porphyria (a rare metabolic disorder) or kidney or liver disease.

Possible food and drug interactions when taking Librium

Librium is a central nervous system depressant and may intensify the effects of alcohol or have an additive effect. Do not drink alcohol while taking this medication.

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

Antacids such as Maalox and Mylanta
Antidepressant drugs known as MAO inhibitors, including Nardil and Parnate
Barbiturates such as phenobarbital Blood-thinning drugs such as Coumadin
Cimetidine (Tagamet)
Disulfiram (Antabuse)
Levodopa (Larodopa)
Major tranquilizers such as Stelazine and Thorazine
Narcotic pain relievers such as Demerol and Percocet
Oral contraceptives

Special information if you are pregnant or breastfeeding

Do not take Librium if you are pregnant or planning to become pregnant. There may be an increased risk of birth defects. This drug may appear in breast milk and could affect a nursing infant. If the medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with the drug is finished.

Recommended dosage for Librium

ADULTS

Mild or Moderate Anxiety

The usual dose is 5 or 10 milligrams, 3 or 4 times a day.

Severe Anxiety

The usual dose is 20 to 25 milligrams, 3 or 4 times a day.

Apprehension and Anxiety before Surgery

On days preceding surgery, the usual dose is 5 to 10 milligrams, 3 or 4 times a day.

Withdrawal Symptoms of Acute Alcoholism

The usual starting oral dose is 50 to 100 milligrams; the doctor will repeat this dose, up to a maximum of 300 milligrams per day, until agitation is controlled. The dose will then be reduced as much as possible.

CHILDREN

The usual dose for children 6 years of age and older is 5 milligrams, 2 to 4 times per day. Some children may need to take 10 milligrams, 2 or 3 times per day. The drug is not recommended for children under 6.

OLDER ADULTS

Your doctor will limit the dose to the smallest effective amount in order to avoid oversedation or lack of coordination. The usual dose is 5 milligrams, 2 to 4 times per day.

Overdosage

Any medication taken in excess can cause symptoms of overdose. If you suspect a Librium overdose, seek medical attention immediately.

• The symptoms of Librium overdose may include: Coma, confusion, sleepiness, slow reflexes

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Librium (chlordiazepoxide) Full Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of Anxiety Disorders
Detailed Info on Signs, Symptoms, Causes, Treatments of Addictions

back to: Psychiatric Medication Patient Information Index

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The term sibling refers to children who are related and living in the same family. Sibling rivalry has existed as long as families. Think back to Biblical times and Joseph's problems with his brothers or of the dreadful time Cinderella had with her stepsisters!

It seems strange that whenever the word sibling comes up, the word rivalry seems sure to follow despite the fact that there are many solid sibling relationships in families (brothers and sisters who like and enjoy one another). However, it is the rivalry that gets attention the proverbial squeaky wheel.

What causes sibling rivalry? Think about it. Siblings don't choose the family they are born into, don't choose each other. They may be of different sex, are probably of different age and temperament, and. worst of all, they have to share the one person or the two people they most want for themselves: their parents. Other factors include:

• Position in the family, for example, the oldest child may be burdened with responsibilities for the younger children or the younger child spends his life trying to catch up with an older sibling;
• Sex, for instance, a son may hate his sister because his father seems more gentle with her. On the other hand, a daughter may wish she could go on the hunting trip with her father and brother;
• Age, a five and an eight year old can play some games together but when they become ten and thirteen, they will probably be poles apart.

The most important factor, however, is parental attitude. Parents have been taught that they must be impartial but this can be extremely difficult. It's inevitable that parents will feel differently about children who have different personalities with differing needs, dispositions. and place in the family. Picture the age-old conflict of the young child whining. "It's not fair. Why can't I stay up until nine-thirty like Johnny?" Fairness has nothing to do with it. Susie is younger and needs more sleep. It's as simple as that, and parents are advised never to give in to the old "it's not fair" strategy. Besides, when Susie is finally allowed to stay up until nine-thirty, it will seem a real privilege to her.

Many parents feel that in order to be fair they must try to treat their children equally. It's simply not possible, and it can be dehumanizing If a mother feels that when she hugs one child. she must stop and hug all of her children, hugs soon become somewhat meaninglessin that family. When Susie has a birthday or is ill, she is the one who merits the special attention and presents. You can be sure that the other youngsters in the family no matter what they may say, recognize the inherent "fairness" of the situation.

Ever since we decided that sibling rivalry is normal, we've had a terrible time figuring out what to do about it. However, here are some do's and don'ts that may be helpful in dampening down sibling rivalry within a family:

1. Don't make comparisons. ("I don't understand it. When Johnny was her age, he could already tie his shoes.") Each child feels he is unique and rightly so-he is unique, and he resents being evaluated only in relation to someone else. Instead of comparison, each child in the family should be given his own goals and levels of expectation that relate only to him.

2. Don't dismiss or suppress your children's resentment or angry feelings. Contrary to what many people think, anger is not something we should try to avoid at all costs. It's an entirely normal part of being human, and it's certainly normal for siblings to get furious with one another. They need the adults in their lives to assure them that mothers and fathers get angry, too, but have learned control and that angry feelings do not give license to behave in cruel and dangerous ways. This is the time to sit down, acknowledge the anger ("I know you hate David right now but you cannot hit him with a stick"). and talk it through.

3. Try to avoid situations that promote guilt in siblings. First we must teach children that feelings and actions are not synonymous. It may be normal to want to hit the baby on the head, but parents must stop a child from doing it. The guilt that follows doing something mean is a lot worse than the guilt of merely feeling mean. So parental intervention must be quick and decisive.

4. When possible, let brothers and sisters settle their own differences. Sounds good but it can be terribly unfair in practice. Parents have to judge when it is time to step in and mediate, especially in a contest of unequals in terms of strength and eloquence (no fair hitting below the belt literally or figuratively). Some long-lasting grudges among grown siblings have resulted when their minority rights were not protected.

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When One Sibling is Handicapped

Quite different considerations must come into play when there is a handicapped child in the family, especially if it is a youngster who requires a lot of extra services both in and out of the home. In this case non-handicapped siblings can be resentful of the time spent on their brother or sister. They sense the parent's preoccupation. They feel that often they are receiving only surface attention, that the parent is not really alert to their needs.

There is one critical point that should be made and emphasized in all such cases. Whatever time and effort is spent with the handicapped child, it is done with the goal of improvement-of making the young- better able to function independently. As he improves. the demands on his parents will decrease commensurately, freeing them to devote more time to other members of the family. It actually boils down to, "Come on, let's everyone help-and everyone will ultimately benefit."

However, there are other measures to be taken to lessen sibling rivalry and tension in families with a handicapped child. Every child deserves a certain amount of quality time with a parent. It needn't be long but it should be undivided. Maybe a short quiet chat before bedtime-or lunch at a special restaurant. And when one of the non-handicapped siblings is involved in a school or community function, the parents should make every effort to be there no matter how much advance planning is required. Should the handicapped child go, too? Take your clue from the youngster who is involved in the function-it's his night. Sometimes yes. Sometimes no.

When One Sibling Is Gifted

Different people, including gifted children, have abilities and talents in different areas. Talk openly about this reality with your children so they can begin to develop appropriate expectations for themselves. You can do this by comparing your own strengths with those of your husband/wife or other family members or friends. There are two important points to be emphasized: (1) Don't expect to be great in everything; (2) recognize and develop those areas of strength you do have, Help your children make similar comparisons among themselves in the hope that they will have greater understanding and respect for each other. ("My brother gets all A's in school but he sure can't hit a baseball.")

It's also okay to mention your weaknesses. This can be especially effective if there is something you don't do as well as your non-gifted youngster. ("I wish I could make brownies as good as yours.")

Above all, honesty and acceptance are the greatest consideration you can give your children when the ways in which they are alike and unlike come under discussion.

Some Useful Behavior Management Strategies

Common Mistakes Parents Make in Managing Sibling Rivalry

• Taking sides such as attempting to punish the child who is at fault, usually the one seen pounding on the other child. (How long has this child put up with the taunting of the other child before taking drastic measures?)
• Ignoring appropriate behavior. Parents often ignore their children when they are playing nicely. They only pay attention when a problem arises. (Behavior Mod 101 teaches that behaviors that are ignored (go unrewarded) decrease while behaviors which receive attention (are rewarded) increase.

Simple Parenting Techniques That Work

1. When the rivalry progresses to excessive physical or verbal violence OR when the number incidents of rivalry seem excessive, take action. (Action does speak louder than words). Talk with your children about what is going on. Provide suggestions on how they can handle the situation when it occurs such as:

• Ignoring the teasing.
• Kidding back in a way that is humorous.
• Simply agreeing (in a kidding way) that whatever the teaser is saying is true.
• Telling the teaser that enough is enough.
• When these measures aren't working ask the person in charge (parent, baby sitter) for help.

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2. When the above does not work, introduce a family plan to help with the situation that provides negative and positive consequences for all concerned such as:

• When there is any fighting or shouting, all involved will have a consequence such as a time out or writing sentences ("I will play nicely with my brother).
• However, when we can go the whole day or afternoon or evening (whatever makes sense for your situation), then everyone will earn a privilege such as (1) you can have a snack, (2) I will read you a story, (3) we will all play a game together, (4) I will play outside with you (catch, etc) or (5) you can stay up later. (Note that several of these provide parental attention for appropriate behavior).

3. Develop a system for evenly distributing coveted privileges. In other words, a system for taking turns for such things as:

• Who gets to ride "shot gun" in the car. (It's amazing how many teenagers and young adult siblings still make this an important issue).
• Who gets to push the button in the elevator;
• Who gets to chose where to go to eat lunch or dinner,
• Who gets to chose the television show,
• Who does the dishes or takes out the trash (rotate on a weekly or monthly basis)

For more parenting techniques visit Parenting 101. For help in improving your ability to cope with the rigors of parenting we suggest Stress Management For Parents.

Yes, siblings ran create certain stresses but if they are overcome successfully, they will give your children resources that will serve them well later in life. Siblings learn how to share, how to come face to face with jealousy, and how to accept their individual strengths and weaknesses.

Best of all. as they watch you handle sibling rivalry with equanimity and fairness, they will be pining knowledge that will be valuable when they, too, become parents.

Useful Books on Sibling Rivalry

Siblings Without Rivalry : How to Help Your Children Live Together So You Can Live Too (an excellent resource for parents)

I'd Rather Have an Iguana (for children 4-6 having to cope with a new baby in the family)

Birth Order Blues : How Parents Can Help Their Children Meet the Challenges of Birth Order (The author raises parents' awareness of the impact of birth order upon children and suggests ways to resolve or circumvent potential problems relating to birth order issues).

Brothers and Sisters : Born to Bicker? (Teen Issues) (An intriguing entry in the Teen Issues series focuses on the interaction between brothers and sisters: ``The sibling relationship has much to do with how we feel about ourselves, as well as how we relate to others throughout our lives.")

Other Helpful Resources

You may also want to consider reading When Anger Hurts Your Kids.

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Find out why Celexa is prescribed, side effects of Celexa, Celexa warnings, effects of Celexa during pregnancy, more - in plain English.

Pronounced: sell-EX-ah

Celexa (citalopram) Full Prescribing Information

Why is Celexa prescribed?

Celexa is used to treat major depression--a stubbornly low mood that persists nearly every day for at least 2 weeks and interferes with everyday living. Symptoms may include loss of interest in your usual activities, insomnia or excessive sleeping, a change in weight or appetite, constant fidgeting or a slowdown in movement, fatigue, feelings of worthlessness or guilt, difficulty thinking or concentrating, and repeated thoughts of suicide.

Like the antidepressant medications Paxil, Prozac, and Zoloft, Celexa is thought to work by boosting serotonin levels in the brain. Serotonin, one of the nervous system's primary chemical messengers, is known to elevate mood.

Most important fact about Celexa

Be careful to avoid taking Celexa for 2 weeks before or after using an antidepressant known as an MAO inhibitor. Drugs in this category include Marplan, Nardil, and Parnate. Combining Celexa with one of these medications could lead to a serious--even fatal--reaction.

How should you take Celexa?

Celexa is available in tablet and liquid forms. Take either formulation once a day, in the morning or evening, with or without food. Although your depression will begin to lift in 1 to 4 weeks, you should continue taking Celexa regularly. It takes several months for the medication to yield its full benefits.

 

--If you miss a dose...

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

--Storage instructions...

Store at room temperature.

What side effects may occur when taking Celexa?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Celexa.

• • More common side effects of Celexa may include: Abdominal pain, agitation, anxiety, diarrhea, drowsiness, dry mouth, ejaculation disorders, fatigue, impotence, indigestion, insomnia, loss of appetite, nausea, painful menstruation, respiratory tract infection, sinus or nasal inflammation, sweating, tremor, vomiting

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• Less common side effects may include: Amnesia, attempted suicide, confusion, coughing, decreased sexual drive, depression, excessive urination, fever, gas, impaired concentration, increased appetite, increased salivation, itching, joint pain, lack of emotion, loss of menstruation, low blood pressure, migraine, muscle pain, rapid heartbeat, rash, skin tingling, taste disturbances, visual disturbances, weight gain, weight loss, yawning

• Rare side effects may include: Abnormal dreams, acne, aggressive behavior, alcohol intolerance, angina (chest pain), arthritis, belching, bone pain, breast enlargement, breast pain, bronchitis, bruising, chills, conjunctivitis (pinkeye), decreased muscle movements, delusions, dermatitis, difficulty breathing, difficulty swallowing, dizziness, drug dependence, dry eyes, dry skin, eczema, emotional instability, excessive milk flow, excessive muscle tone, eye pain, fainting, feeling of well-being, flu-like symptoms, flushing, frequent urination, gum inflammation, hair loss, hallucinations, heart attack, heart failure, hemorrhoids, high blood pressure, hives, hot flashes, inability to hold urine, inability to urinate completely, increased sex drive, increased urination, involuntary muscle movements, leg cramps, mouth sores, muscle weakness, nosebleeds, numbness, painful erection, painful urination, panic, paranoia, pneumonia, psoriasis, psychosis, ringing in the ears, sensitivity to light, skin discoloration, slow heartbeat, stomach and intestinal inflammation, stroke, swelling, teeth grinding, thirst, uncontrollable muscle movements, unsteady or abnormal walk, vaginal bleeding

Why should this drug not be prescribed?

If Celexa gives you an allergic reaction, you cannot continue using it. Also remember that Celexa must never be combined with an MAO inhibitor (see "Most important fact about this drug," above).

Special warnings about Celexa

Read FDA warning covering all antidepressants and the possibility of suicidal thoughts and behaviors in children, adolescents and adults. More details here.

In recommended doses, Celexa does not seem to impair judgment or motor skills. However, a theoretical possibility of such problems remains, so you should use caution when driving or operating dangerous equipment until you are certain of Celexa's effect.

There is a slight chance that Celexa will trigger a manic episode. Use Celexa with caution if you suffer from manic-depression (bipolar disorder). Use caution, too, if you are over 60 years old, have liver or kidney problems, suffer from heart disease or high blood pressure, or have ever had seizures.

Possible food and drug interactions when taking Celexa

Celexa does not increase the effects of alcohol. Nevertheless, it's considered unwise to combine Celexa with alcohol or any other drug that affects the brain. (Be particularly careful to avoid MAO inhibitors.)

If Celexa is taken with certain other drugs, the effects of either could be increased, decreased, or altered. Tell your doctor about any prescription or over-the-counter drugs you are planning to take, and be especially certain to check with him before combining Celexa with the following:

Carbamazepine (Tegretol) Cimetidine (Tagamet)
Erythromycin (Eryc, Ery-Tab)
Fluconazole (Diflucan)
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Lithium (Lithobid, Lithonate)
Metoprolol (Lopressor)
Omeprazole (Prilosec)
Other antidepressants such as Elavil, Norpramin, Pamelor, and Tofranil
Sumatriptan (Imitrex)
Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding

The effects of Celexa during pregnancy have not been adequately studied, and the potential for harm has not been ruled out. If you are pregnant or plan to become pregnant while on Celexa therapy, tell your doctor immediately.

Celexa appears in breast milk and will affect the nursing infant. You should consider discontinuing either breastfeeding or Celexa. Talk with your doctor about the pros and cons of each option.

Recommended dosage for Celexa

ADULTS

The recommended starting dose of Celexa tablets or oral solution is 20 milligrams once a day. Dosage is usually increased to 40 milligrams once daily after at least a week has passed. Do not exceed 40 milligrams a day. For older adults and those who have liver problems, the recommended dose is 20 milligrams once a day.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Celexa overdose may include: Amnesia, bluish or purplish discoloration of the skin, coma, confusion, convulsions, dizziness, drowsiness, hyperventilation, nausea, rapid heartbeat, sweating, tremor, vomiting

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Celexa (citalopram) Full Prescribing Information
Celexa medication guide

back to: Psychiatric Medication Patient Information Index