sacrosidase

Generic Name: sacrosidase (sak ROE si dase)

Brand Names: Sucraid

What is sacrosidase?

Sacrosidase is a yeast-based enzyme that replaces an enzyme called sucrase which is normally produced in the body. Sucrase helps the body breakdown and process certain sugars during digestion.

In people who lack the sucrase enzyme, sugar can pass into the intestines where it can interact with bacteria. This can cause bloating, gas, stomach pain, nausea, and vomiting.

Sacrosidase is used to treat sucrase deficiency that occurs in people with congenital sucrase-isomaltase deficiency (CSID).

CSID is a genetic enzyme deficiency and sacrosidase will not cure this condition.

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

What is the most important information I should know about sacrosidase?

Sacrosidase is used to treat sucrase deficiency that occurs in people with congenital sucrase-isomaltase deficiency (CSID). CSID is a genetic enzyme deficiency and sacrosidase will not cure this condition.

You should not use this medication if you are allergic to yeast, yeast products, glycerin (glycerol), or papain (Accuzyme, Ethezyme, Gladase, Kovia, and others).

Before using sacrosidase, tell your doctor if you have diabetes. Sacrosidase changes the way your body absorbs sugar and your glucose levels may change. Your doctor will tell you if any of your medication doses need to be changed.

This medication sometimes causes an allergic reaction. Before you start the medication, your doctor may recommend a sacrosidase skin test to make sure you are not allergic to the medication.

Sacrosidase is usually taken with each meal or snack. It is best to take one half of the dose when you start eating and take the other half during your meal or snack.

Measure your dose using the scoop provided with this medication.

Sacrosidase liquid should be mixed with 2 to 4 ounces of water, milk, or baby formula that is no hotter than room temperature. Do not mix with warm or hot liquids or the medication will not be as effective. Do not mix sacrosidase with fruit juice or drink fruit juice when taking the medication.

You may need to avoid eating a lot of starch (found mainly in rice, potatoes, corn, pasta, and bread). Follow your doctor's instructions about any special diet while you are taking sacrosidase.

What should I discuss with my health care provider before taking sacrosidase?

You should not use this medication if you are allergic to yeast, yeast products, glycerin (glycerol), or papain (Accuzyme, Ethezyme, Gladase, Kovia, and others).

Before using sacrosidase, tell your doctor if you have diabetes. Sacrosidase changes the way your body absorbs sugar and your glucose levels may change. Your doctor will tell you if any of your medication doses need to be changed.

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. Tell your doctor if you are breast-feeding a baby while taking sacrosidase.

How should I take sacrosidase?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Sacrosidase is usually taken with each meal or snack. It is best to take one half of the dose when you start eating and take the other half during your meal or snack.

Measure your dose using the scoop provided with sacrosidase. Rinse the scoop after each use and allow it to dry thoroughly.

Sacrosidase liquid should be mixed with 2 to 4 ounces of water, milk, or baby formula that is no hotter than room temperature. Do not mix with warm or hot liquids or the medication will not be as effective. Do not mix sacrosidase with fruit juice or drink fruit juice when taking the medication.

This medication sometimes causes an allergic reaction. Before you start the medication, your doctor may recommend a sacrosidase skin test to make sure you are not allergic to the medication.

Your doctor may instruct you to take your first dose of sacrosidase in a place where you have access to emergency medical care. A severe allergic reaction could occur that may require immediate care.

Store this medication in the refrigerator, protected from light. Do not freeze. Recap the bottle after each use.

When you first open a bottle of sacrosidase, write the date on the label. Throw away any unused sacrosidase 4 weeks after first opening the bottle.

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, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

An overdose of sacrosidase is not likely to produce any symptoms.

What should I avoid while taking sacrosidase?

You may need to avoid eating a lot of starch (found mainly in rice, potatoes, corn, pasta, and bread). Follow your doctor's instructions about any special diet while you are taking sacrosidase.

Follow your doctor's instructions about any other restrictions on food or beverages while you are using sacrosidase.

Sacrosidase side effects

Stop using this medication and get emergency medical help if you have any of these signs of an allergic reaction: hives; wheezing, difficulty breathing; swelling of your face, lips, tongue, or throat.

Less serious side effects may include:

• 
  

  stomach pain;

  
  


• 
  

  nausea, vomiting;

  
  


• 
  

  diarrhea, constipation;

  
  


• 
  

  sleep problems (insomnia);

  
  


• 
  

  headache;

  
  


• 
  

  nervous feeling; or

  
  


• 
  

  increased thirst and dry, hot skin.

  
  

Some of these may be symptoms of your condition and not actual side effects of sacrosidase.

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 sacrosidase?

There may be other drugs that can interact with sacrosidase. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More sacrosidase resources

• Sacrosidase Side Effects (in more detail)
• Sacrosidase Use in Pregnancy & Breastfeeding
• Sacrosidase Support Group
• 0 Reviews · Be the first to review/rate this drug

• sacrosidase Advanced Consumer (Micromedex) - Includes Dosage Information


• Sacrosidase MedFacts Consumer Leaflet (Wolters Kluwer)


• Sacrosidase Monograph (AHFS DI)


• Sucraid Prescribing Information (FDA)

Where can I get more information?

• Your pharmacist can provide more information about sacrosidase.

See also: sacrosidase side effects (in more detail)

Sheerfluorx FluorideTreatment

Generic Name: sodium fluoride

Dosage Form: dental film
Product Information

Sheer FluorX™ PEDO fluoride treatment is the ideal way to make in-office fluoride treatments easy, safer, faster, more comfortable, and more practical. Kids will love Sheer FluorX – no more trays, foams or gels that cause gagging and mess. The sheer film molds to teeth delivering fluoride exactly where you want it, eliminating gel running down the throat and being swallowed. The 5% sodium fluoride acidulated formula provides an effective and rapid uptake of fluoride to the teeth. Each film contains 0.4 grams (400 mg) of total composition including 20mg sodium fluoride, active ingredient.

• Avoid eating or drinking while wearing the film.


• Flush with copious amounts of water if accidentally
  
  placed in eye.


• Keep out of reach of young children.


• Not for use by children under the age of 12 without adult supervision.


• Avoid contact with clothing.


• Do not use if you have a known allergy to fluoride.


• Do not wear for more than 60 minutes in a 24 hour period.


• Avoid swallowing.
  

• Attention - Refer to the instructions for use and complete information.


• Use only as directed. Keep out of reach of small children and animals.


• Storage Temperature - Store product at the indicated temperature (32°F/0°C to 100°F/38°C).
  

• Do not store above 100°F (38°C). Do not freeze. Do not use beyond indicated shelf life.


• Do not use if the packaging has been damaged, or if the seals are found to be broken or open.

Shelf Life: 2 years

1. Use enclosed EZ opener to cut wrapper open.
   


2. Remove shrink wrap from tray. Carefully remove film from tray. The sticky gel side faces up. You may use scissors to trim film to desired size.


3. You may use scissors to trim film to desired size.
   


4. Position the film so it is centered on the arch. Firmly apply the film to the teeth, with the edge of the film just extending onto the gums.


5. Starting at the front teeth, wrap the film onto the back side of the teeth. Use your fingers to firmly mold the film to your teeth. Repeat process for other arch.
   


6. Leave the film in place for 15-60 minutes. DO NOT wear for more than 60 minutes in a 24 hour period.


7. To remove, grasp corner of film and begin to loosen away from teeth. Rinsing with water may help.
   


8. Continue removing film from all surfaces. The film may come away in pieces; this is normal. Avoid swallowing gel, rinse to sink.
   


9. Brush teeth and gums to remove any remaining gel. Rinse to sink, avoid swallowing excess gel.
   

COMPLETE INSTRUCTIONS - Back Page

Patent Pending

Caution: Federal law restricts this device to sale by or on the order of a licensed professional.

Disclaimer: CAO Group believes this information to be accurate and is offered only for the benefit of its customers for use of the product under proscribed conditions. This document is not to be considered a warranty or guarantee of product performance, and CAO Group is not legally bound to such claims based on this document.

Manufactured by CAO (China) Medical Equipment Co,. Ltd. for CAO Group. Inc.

P 877.236.4408 F 801.256.9287

4628 West Skyhawk Drive, West Jordan, UT 84084-4501 U.S.A.

www.caogroup.com

SAL-CAI200C.1/28MAR2011

FRONT PANEL

Sheer FluorX PEDO

Fluoride Treatment

Chairside Strength - Home Applied.

Patent Pending

Disclaimer: CAO Group believes this information to be accurate and is offered only for the benefit of its customers for use of the product under proscribed conditions. This document is not to be considered a warranty or guarantee of product performance, and CAO Group is not legally bound to such claims based on this document.

Shelf Life: 2 years

Manufactured by CAO (China) Medical Equipment Co,. Ltd. for CAO Group, Inc.

Phone 877.236.4408 Fax 801.256.9287

4628 West Skyhawk Drive, West Jordan, UT 84084-4501 U.S.A.

www.caogroup.com

SAL-PTI200A.1/15MAR2011

Back panel of Patient Guide

IMMEDIATE PACKAGE DISPLAY PANEL

Sheer FluorX PEDO

Fluoride Treatment

Chairside Strength - Home Applied.

Wear Time 15-60m

LOT: [lot number]

EXP: [expiration date]

Sodium fluoride, 20mg per film

Manufactured by CAO (China) Medical Equipment Co., Ltd. for CAO Group, Inc.

Easier. Faster. Better.

TO REORDER:

Henry Schein

1.800.372.4346

Adult supervision of children is required.

Storage

[32°F/0°C to 100°F/38°C]

Patent Pending

See carton for complete instructions and information. Keep out of reach of children.

For one-time use only.

Introductory Kit  Part #006-00133

Refill Kit  Part #006-00134

PAK-LA0200B.1/23MAR2011

OUTER PACKAGE - Back panel

TO REORDER: Henry Schein 1.800.372.4346

PACKAGE CONTENTS: 6) PEDO Patient Treatment Kits (Ieach containing 4 treatment trays), each contains 2 PEDO treatment films, 1 EZ opening tool.

See package insert for dosage information. Product expiration shown on Date/Lot label (24 months from date of manufacture). Rx Only.

Dispose of properly after use. For complete safety information see product MSDS.

Do not use if the packaging has been damaged, or if the safety seals are broken.

REORDER # 006-00133

Manufactured by CAO (China) Medical Equipment Co., Ltd. for CAO Group, Inc.

4628 West Skyhawk Drive

West Jordan, UT 84084

U.S.A.

877-236-4408 (tel)

801-256-9287 (fax)

www.caogroup.com

Patent Pending

STORAGE: [32°F/0°C to 100°F/38°C]

Expiration Date: [lot and expiration label]

[Barcode: 872320001322]

MADE IN CHINA

Adult supervision of children is required.

OUTER PACKAGE - Side panel

Sheer FluorX PEDO

Ingredients: Water/eau, xylitol, glycerin, sodium fluoride, peppermint oil, sucralose, proprietary polymer.

NDC# 1406000503

Fluoride Treatment

Sheer FluorX PEDO

Fluoride Treatment

Patient Treatment Kit PEDO

Chairside Strength - Home Applied.

Net Qty: 8 - 0.4 grams per film

Active ingredient: Sodium fluoride, 20mg/film

SHEER FLUORX PEDO  FLUORIDE TREATMENT sodium fluoride  film

Product Information Product Type HUMAN PRESCRIPTION DRUG NDC Product Code (Source) 14060-006 Route of Administration DENTAL DEA Schedule

Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength sodium fluoride (fluoride ion) sodium fluoride 20 mg

Inactive Ingredients Ingredient Name Strength Water   Glycerin   Xylitol   Sucralose

Product Characteristics Color      Score      Shape Size Flavor PEPPERMINT (Peppermint Oil) Imprint Code Contains

Packaging # NDC Package Description Multilevel Packaging 1 14060-006-03 4 TRAY In 1 PACKAGE contains a TRAY 1 2 FILM In 1 TRAY This package is contained within the PACKAGE (14060-006-03)

Marketing Information
Marketing Category	Application Number or Monograph Citation	Marketing Start Date	Marketing End Date
unapproved drug other		04/15/2011

Labeler - CAO Group, Inc. (102422578)

Revised: 06/2011CAO Group, Inc.

Pralidoxime Chloride

Class: Antidotes
ATC Class: V03AB04
VA Class: AD900
CAS Number: 51-15-0
Brands: ATNAA, DuoDote, Protopam

• Pesticide and Chemical Warfare Agent Poisoning


• 
  

  Primary protection against exposure to chemical nerve agents and insecticide poisoning is the wearing of protective garments (e.g., specialized masks).^e

  
  


• 
  

  Do not rely solely on antidotes such as atropine and pralidoxime to provide complete protection from chemical nerve agents and insecticide poisoning.^e

  
  


• 
  

  Seek immediate medical attention after injection with a pralidoxime auto-injector.^e

  
  


• 
  

  Medical personnel assisting victims of nerve agent poisoning should avoid exposure to the victim’s contaminated clothing.^e

  
  

Introduction

Cholinesterase reactivator; quaternary ammonium oxime.^{a b c d e}

Uses for Pralidoxime Chloride

Pesticide Poisoning

Concomitantly with atropine to reverse muscle paralysis (particularly of respiratory muscles) associated with toxic exposure to organophosphate anticholinesterase pesticides.^{a d e}

Atropine is used to reverse muscarinic effects associated with toxic exposure to carbamate anticholinesterase pesticides; concomitant pralidoxime therapy is usually not necessary.¹⁰⁵

Chemical Warfare Agent Poisoning

Concomitantly with atropine for the treatment of nerve agent (e.g., sarin, soman, tabun, VX [methylphosphonothioic acid]) exposure in the context of chemical warfare or terrorism.^{101 102 103 b c}

Initial management of nerve agent poisoning includes aggressive airway control and ventilation (administration of nebulized β-adrenergic agonist [e.g., albuterol] and antimuscarinics [e.g., ipratropium bromide] may be necessary), and administration of atropine and pralidoxime chloride;^{101 102 103} diazepam may be needed for seizure control.¹⁰¹

Anticholinesterase Overdose

Has been used for the management of overdosage of anticholinesterase agents (ambenonium, neostigmine, pyridostigmine) in patients with myasthenia gravis.^{a d}

Pralidoxime Chloride Dosage and Administration

General

• Pesticide Poisoning


• 
  

  Dose based on severity of symptoms and treatment setting.^{a e}

  
  


• 
  

  Mild symptoms include miosis or blurred vision, tearing, runny nose, hypersalivation or drooling, wheezing, muscle fasciculations, nausea/vomiting.^e

  
  


• 
  

  Severe symptoms include behavioral changes, severe breathing difficulty, severe respiratory secretions, severe muscle twitching, involuntary defecation or urination, seizures, unconsciousness.^e

  
  

• Chemical Warfare Agent Poisoning


• 
  

  Dose and route based on severity of symptoms, victim’s age, and treatment setting.¹⁰¹

  
  


• 
  

  Mild to moderate symptoms include localized sweating, muscle fasciculations, nausea, vomiting, weakness, and/or dyspnea.¹⁰¹

  
  


• 
  

  Severe symptoms include apnea, flaccid paralysis, seizures, and/or unconsciousness.¹⁰¹

  
  

Administration

Administer by IM or IV injection, or by IV infusion.^{a b c d e}

Available as a single-entity preparation (pralidoxime chloride for injection, pralidoxime chloride injection auto-injector) and as a preparation containing atropine and pralidoxime chloride (DuoDote auto-injector, ATNAA auto-injector).^{b c d e}

Pesticide poisoning: Most effective if administered early; may still be effective if administered >48 hours after exposure.¹⁰⁵

Chemical warfare agent poisoning: Administer within minutes to a few hours following exposure.^{101 104}

IV Administration

IV infusion is preferred; slow IV injection used in patients with pulmonary edema, if IV infusion is not practical, or if rapid effect is needed.^{a d}

Reconstitution

Reconstitute vials containing 1 g of pralidoxime chloride by adding 20 mL of sterile water for injection to provide a solution containing approximately 50 mg/mL.^{a d}

Dilution

For IV infusion, dilute appropriate volume of reconstituted solution in 100 mL of 0.9% sodium chloride injection.^{a d}

Rate of Administration

IV infusion: Administer over 15–30 minutes in adults.^{a d} Administer over 30 minutes in children.¹⁰⁵

SlowIV injection as solution containing 50 mg/mL: Administer over ≥5 minutes.^{a d} Administration at a rate ≥200 mg/minute can lead to respiratory and cardiac arrest.¹⁰⁵

IM Administration

Preparation Considerations

Pralidoxime chloride auto-injector: Intended for self-administration or administration by a partner (buddy) by military personnel.^b Also may be administered by civilian emergency responders.^b

Pralidoxime chloride and atropine (DuoDote) auto-injector: Intended for administration by emergency medical service personnel.^e

Pralidoxime chloride and atropine (ATNAA) auto-injector: Intended for self-administration or administration by partner (buddy) by military personnel.^c

Technique for Using Auto-injector

Pralidoxime chloride auto-injector: Inject dose IM into the anterolateral aspect of the thigh.^b

Pralidoxime chloride auto-injector: Remove gray safety cap; place black end on outer thigh and push until injector functions; hold in place for 10 seconds until dose is delivered.^b Massage injection area for several seconds.^b

DuoDote: Inject dose IM into the anterolateral aspect of the thigh.^e

DuoDote: Grasp the prefilled auto-injector with the green tip pointed downward; remove the gray activation (safety) cap.^e Point the green tip toward the outer thigh and jab it firmly into the outer thigh so that the auto-injector is perpendicular (90° angle) to the thigh, and hold firmly in the thigh for at least 10 seconds until the dose is delivered.^e Remove auto-injector and check green tip; if needle is visible, dose has been administered.^e If the needle is not exposed, check that the safety cap was removed and repeat administration but press harder.^e

ATNAA: Inject dose IM into the anterolateral aspect of the thigh or into the buttock.^c

ATNAA: Remove gray safety cap; place front end on outer thigh or buttock and push until injector functions; hold in place for 10 seconds until dose is delivered.^c

Administer through clothing if necessary.^{b c d e}

After use, bend needle back against a hard surface and dispose of properly.^{b c e}

Reconstitution

If pralidoxime chloride for injection is used for an IM dose, reconstitute a vial containing 1 g of drug with 3 mL of sterile water for injection or 0.9% sodium chloride for injection to provide a solution containing 300 mg/mL.¹⁰¹

Dosage

Available as pralidoxime chloride; dosage expressed in terms of the salt.^{b c d e}

Administer pralidoxime after atropine.^{101 d}

Each prefilled DuoDote auto-syringe and each prefilled ATNAA auto-syringe provides a single IM dose of atropine 2.1 mg and pralidoxime chloride 600 mg.^{c e} When activated, the auto-injector sequentially administers atropine and pralidoxime chloride through a single needle.^{c e}

Pediatric Patients

Pesticide Poisoning†

Organophosphate Anticholinesterase Pesticides

IV

Usual initial dose: 20–40 mg/kg; may repeat in 1 hour if muscle weakness not relieved.^{105 a} Additional doses may be needed.^{105 a}

Chemical Warfare Agent Poisoning†

Organophosphate Anticholinesterase Nerve Agents

Administer IV in emergency department.¹⁰¹

Administer IM in out-of-hospital setting.¹⁰¹

IV

Children 0–10 years of age and adolescents >10 years of age who present with mild/moderate symptoms or severe symptoms: 15 mg/kg.¹⁰¹

IM

Children 0–10 years of age and adolescents >10 years of age who present with mild/moderate symptoms: 15 mg/kg.¹⁰¹

Children 0–10 years of age and adolescents >10 years of age who present with severe symptoms: 25 mg/kg.¹⁰¹

Adults

Pesticide Poisoning

Organophosphate Anticholinesterase Pesticides

IV

Usual initial dose: 1–2 g; may repeat in 1 hour if muscle weakness not relieved.^{105 a d} Additional doses may be needed.^{105 a d}

Alternatively, 500 mg/hr as continuous IV infusion.^a

IM

DuoDote: For ≥2 mild symptoms, inject contents of 1 auto-injector (atropine 2.1 mg and pralidoxime chloride 600 mg).^e If severe symptoms develop, inject 2 additional doses (i.e., contents of 2 auto-injectors) in rapid succession.^e

DuoDote: For severe symptoms, inject contents of 3 auto-injectors (total dose: atropine 6.3 mg and pralidoxime chloride 1800 mg) in rapid succession.^e

Additional doses (i.e., >3) should not be administered unless definitive medical care is available.^e

Chemical Warfare Agent Poisoning

Organophosphate Anticholinesterase Nerve Agents

Administer IV in emergency department.¹⁰¹

Administer IM in out-of-hospital setting.¹⁰¹

IV

Adults who present with mild/moderate symptoms or severe symptoms: 15 mg/kg (up to 1 g).¹⁰¹

IM

Adults who present with mild/moderate symptoms: 600 mg.¹⁰¹

Adults who present with severe symptoms: 1800 mg.¹⁰¹

Pralidoxime chloride auto-injector: Following atropine administration, pralidoxime chloride 600 mg.^b If symptoms are still present after 15 minutes, repeat injections.^b If symptoms remain after an additional 15 minutes, repeat injections.^b If symptoms persist after the third dose, seek medical attention.^b

DuoDote, ATNAA: For ≥2 mild symptoms, inject contents of 1 auto-injector (atropine 2.1 mg and pralidoxime chloride 600 mg).^{c e} If severe symptoms develop, inject 2 additional doses (i.e., contents of 2 auto-injectors) in rapid succession.^{c e}

DuoDote, ATNAA: For severe symptoms, inject contents of 3 auto-injectors (total dose: atropine 6.3 mg and pralidoxime chloride 1800 mg) in rapid succession.^{c e}

Additional doses (i.e., >3) should not be administered unless definitive medical care is available.^e

Anticholinesterase Overdose

IV

1–2 g initially, followed by 250 mg every 5 minutes.^{a d}

Prescribing Limits

Adults

Pesticide Poisoning and Chemical Warfare Agent Poisoning

IV

Maximum rate of administration: 200 mg/minute.^{d 105}

IM

Out-of-hospital setting: Maximum 3 doses (total 1800 mg).^{b c e} Additional doses require medical supervision (e.g., hospitalization, respiratory support).^{b c e}

Special Populations

Renal Impairment

Reduce dosage in patients with renal impairment.^{a b c d e}

Geriatric Patients

When used for the treatment of nerve agent poisoning in frail geriatric patients with mild to moderate symptoms in an out-of-hospital setting, the usual IM dose is 10 mg/kg.¹⁰¹ The usual IM dose for those with severe symptoms is 25 mg/kg.¹⁰¹

When used for the treatment of nerve agent poisoning in frail geriatric patients with mild to moderate or severe symptoms in an emergency room, the usual IV dose is 5–10 mg/kg.¹⁰¹

Select dosage with caution (generally starting at the low end of the dosage range) because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.^d

Cautions for Pralidoxime Chloride

Contraindications

• 
  

  No absolute contraindications to use in life-threatening conditions (e.g., poisoning by organophosphate nerve agents and pesticides).^{c d e}

  
  


• 
  

  Relative contraindications include hypersensitivity to pralidoxime or any component of the product.^{b d}

  
  

Warnings/Precautions

Warnings

When used concomitantly with atropine, consider the cautions, precautions, and contraindications associated with atropine.^{b c d e}

Not effective in the treatment of toxic exposure to phosphorus, inorganic phosphates, or organophosphates that do not possess anticholinesterase activity.^{a b c}

General Precautions

Concomitant Drug Therapy

Avoid administration of barbiturates, morphine, aminophylline, theophylline, succinylcholine, reserpine, or phenothiazines in patients with toxic exposures to acetylcholinesterase compounds.^{a b c d e}

Cardiovascular Effects

Hypertension reported.^{101 a e} If possible, monitor BP during treatment.^{a e}

Monitor cardiac rhythm.^{101 d}

Laboratory Monitoring

When organophosphate or nerve agent poisoning is known or suspected, initiate treatment without waiting for laboratory test results.^{101 b c d e} The most useful test to confirm exposure is RBC cholinesterase activity.¹⁰⁵ If this test is not available, measure plasma cholinesterase.¹⁰¹

Myasthenia Gravis

Use with caution in patients with myasthenia gravis receiving anticholinesterase agents.^{a d} May precipitate a myasthenic crisis.^{a d}

Specific Populations

Pregnancy

Category C.^{b c d e}

Lactation

Not known whether pralidoxime is distributed into human milk.^{a b c d e} Caution advised.^{b c d e}

Pediatric Use

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

Geriatric Use

Pralidoxime chloride for injection: Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults; select dose with caution.^d Dosage adjustment recommended in frail geriatric patients.¹⁰¹ (See Geriatric Patients under Dosage and Administration.)

Renal Impairment

Use with caution.^{a b c e} (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Blurred vision, diplopia, impaired accommodation, headache, drowsiness, nausea, tachycardia, increased BP, hyperventilation, muscle weakness.^{b d} Injection site pain following IM injection.^{b d}

Pralidoxime Chloride Pharmacokinetics

Absorption

Bioavailability

Following IM administration, peak plasma concentrations achieved in about 28 minutes.^{c e}

Distribution

Extent

Distributed to extracellular water^{a b c d} and tissues.^e

Not known if pralidoxime is distributed into milk.^{a b c d e}

Plasma Protein Binding

Not bound to plasma proteins.^{a b c d e}

Elimination

Metabolism

Not completely known; however, believed to be metabolized in the liver.^a

Elimination Route

Excreted in urine as unchanged drug and as a metabolite.^{b c d e}

Half-life

1–2.5 hours.^{b c d e}

Stability

Storage

Parenteral

Powder for Injection

20–25°C (may be exposed to 15–30°C).^d

Injection

Auto-injector: 25°C (may be exposed to 15–30°C).^{b c e} Protect from freezing.^{b c e} Protect from light.^{c e}

ActionsActions

• 
  

  Reactivates cholinesterase that has been recently inactivated by phosphorylation as the result of exposure to certain organophosphates (e.g., pesticide, nerve agent).^{a b c d e}

  
  


• 
  

  Removes the phosphoryl group from the active site of the inhibited enzyme by nucleophilic attack, regenerating active cholinesterase and forming an oxime complex.^a

  
  


• 
  

  Also detoxifies certain organophosphates by direct chemical reaction and may react directly with cholinesterase to protect it from inhibition.^{a b c d}

  
  


• 
  

  Must be administered before aging of the inhibited enzyme occurs.^a After aging is complete, phosphorylated cholinesterase cannot be reactivated.^a

  
  

Advice to Patients

• 
  

  Seek immediate medical attention after injection with pralidoxime in an out-of-hospital setting.^{b c d e}

  
  


• 
  

  For IM administration in an out-of-hospital setting for nerve gas and pesticide poisoning, importance of ensuring adequate understanding of the recognition and treatment of such poisoning and when concomitant therapy may be necessary.^{b c e}

  
  


• 
  

  For IM administration in an out-of-hospital setting for nerve gas and pesticide poisoning, importance of not exceeding 3 doses unless under medical supervision.^{b c e}

  
  


• 
  

  Advise patients that primary protection against exposure to chemical nerve agents and pesticide poisoning is the wearing of protective garments (e.g., masks).^{b c d e}

  
  


• 
  

  For IM administration in an out-of-hospital setting for nerve gas and pesticide poisoning, proper techniques for storage, attention to expiration dating (replacing before expiration), use, and disposal of the prefilled auto-injector.^{b c e}

  
  


• 
  

  For IM administration in an out-of-hospital setting for nerve gas and pesticide poisoning, importance of seeking immediate medical attention once the initial dose(s) is administered because respiratory and other supportive care may be needed.^{b c e}

  
  


• 
  

  In the event of nerve gas and pesticide poisoning, importance of not contaminating other individuals (e.g., medical and emergency personnel) by clothing exposure; aggressive and safe decontamination by trained personnel is strongly suggested.^{b c d e}

  
  


• 
  

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

  
  


• 
  

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

  
  


• 
  

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

  
  

Preparations

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

Pralidoxime chloride injection auto-injector is supplied through the Directorate of Medical Materiel, Defense Supply Center Philadelphia or other local, state or federal agency.^b ATNAA is supplied through the Directorate of Medical Materiel, Defense Supply Center Philadelphia.^c Duodote is available for hospitals and emergency responders through Meridian Medical Technology (800-638-8093).^f

Pralidoxime Chloride

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	For injection	1 g	Protopam Chloride	Baxter
	Injection	600 mg	Pralidoxime Chloride Injection Auto-Injector	Meridian

Pralidoxime Chloride and Atropine

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	Injection	600 mg/2 mL Pralidoxime Chloride and 2.1 mg/0.7 mL Atropine	ATNAA Auto-Injector (each drug is in a separate chamber)	Meridian
		600 mg/2 mL Pralidoxime Chloride and 2.1 mg/0.7 mL Atropine	DuoDote Auto-Injector (each drug is in a separate chamber)	Meridian

Disclaimer

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

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

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions February 01, 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

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

References

Only references cited for selected revisions after 1984 are available electronically.

101. Agency for Toxic Substances and Disease Registry. Nerve agents: tabun (GA) CAS 77-81-6; sarin (GB) CAS 107-44-8; soman (GD) CAS 96-64-0; and VX CAS 50782-69-9. From the CDC website (). Accessed Nov 19, 2007.

102. DeLorenzo RA. Exposed: signs, symptoms & EMS management of nerve-agent poisoning. J Emerg Med Serv JEMS. 2001; 26:48-57. [PubMed 11409202]

103. In Ellenhorn MJ, Schonwald S, Ordog G, Wasserberger J, eds. Ellenhorn’s medical toxicology: diagnosis and treatment of human poisoning. 2nd ed. Baltimore: Williams & Wilkins; 1997:1267-90.

104. Anon. Prevention and treatment of nerve gas poisoning. Med Lett Drugs Ther. 1990; 32:103-5. [PubMed 2233511]

105. Goldfrank’s toxicologic emergencies. 7th ed. Goldfrank LR, Howland MA, Flomenbaum NE et al, eds. New York: McGraw-Hill; 2002:1346-66.

a. AHFS Drug Information 2007. McEvoy GK, ed. Pralidoxime. Bethesda, MD: American Society of Health-System Pharmacists; 2007: 3665-7.

b. Meridian Medical Technologies, Inc. Pralidoxime chloride injection (auto-injector) prescribing information. Columbia, MD; 2002 May

c. Meridian Medical Technologies, Inc. ATNAA (Antidote Treatment- Nerve Agent, Auto Injector) pralidoxime chloride injection (600mg/2mL) and atropine injection (2.1mg/0.7mL) auto-injector prescribing information. Columbia, MD; 2002 Mar.

d. Baxter Healthcare. Pralidoxime injection. Bloomington, IN; 2004 May.

e. Meridian Medical Technologies, Inc. DuoDote™ (pralidoxime chloride and atropine) auto-injector prescribing information. Columbia, MD; 2007. From Meridain Medical Technologies website (). Accessed 2007 Nov 14.

f. Meridian Medical Technologies. Columbia, MD: Personal communication.

More Pralidoxime Chloride resources

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

Compare Pralidoxime Chloride with other medications

• Anticholinesterase Overdose
• Nerve Agent Poisoning
• Organophosphate Poisoning

Severent

Generic Name: salmeterol (Inhalation route)

sal-ME-ter-ol zye-NAF-oh-ate

Commonly used brand name(s)

In the U.S.

• Serevent

In Canada

• Serevent Diskhaler Disk


• Serevent Diskus


• Severent


• Severent Diskhaler


• Severent Diskus

Available Dosage Forms:

• Powder


• Disk


• Aerosol Powder

Therapeutic Class: Bronchodilator

Pharmacologic Class: Salmeterol

Uses For Severent

Salmeterol is used together with other medicines (such as inhaled corticosteroids) to treat asthma and prevent bronchospasm in patients with asthma. When used regularly every day, inhaled salmeterol decreases the number and severity of asthma attacks. However, it will not relieve an asthma attack that has already started.

Salmeterol is also used to treat air flow blockage and prevent the worsening of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. This medicine is also used to prevent wheezing caused by exercise (exercise-induced bronchospasm or EIB).

Salmeterol is a long-acting bronchodilator. Bronchodilators are medicines that are breathed in through the mouth to open up the bronchial tubes (air passages) in the lungs. They relieve cough, wheezing, shortness of breath, and troubled breathing by increasing the flow of air through the bronchial tubes.

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

Before Using Severent

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

Allergies

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

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of salmeterol in children above 4 years of age. Safety and efficacy have not been established in children younger than 4 years of age.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of salmeterol in the elderly. However, elderly patients with heart problems may require special caution when receiving salmeterol.

Pregnancy

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

Breast Feeding

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

Interactions with Medicines

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

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Cisapride


• Dronedarone


• Fluconazole


• Mesoridazine


• Pimozide


• Posaconazole


• Sparfloxacin


• Thioridazine

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

• Acebutolol


• Alfuzosin


• Alprenolol


• Amiodarone


• Apomorphine


• Arotinolol


• Arsenic Trioxide


• Asenapine


• Astemizole


• Atazanavir


• Atenolol


• Azithromycin


• Befunolol


• Betaxolol


• Bevantolol


• Bisoprolol


• Boceprevir


• Bopindolol


• Brofaromine


• Bucindolol


• Bupranolol


• Carteolol


• Carvedilol


• Celiprolol


• Chloroquine


• Chlorpromazine


• Ciprofloxacin


• Citalopram


• Clarithromycin


• Clorgyline


• Clozapine


• Crizotinib


• Darunavir


• Dasatinib


• Dilevalol


• Disopyramide


• Dofetilide


• Dolasetron


• Droperidol


• Esmolol


• Flecainide


• Fosamprenavir


• Furazolidone


• Gatifloxacin


• Gemifloxacin


• Granisetron


• Halofantrine


• Haloperidol


• Ibutilide


• Iloperidone


• Indinavir


• Iproniazid


• Isocarboxazid


• Itraconazole


• Ketoconazole


• Labetalol


• Landiolol


• Lapatinib


• Lazabemide


• Levobetaxolol


• Levobunolol


• Levofloxacin


• Linezolid


• Lopinavir


• Lumefantrine


• Mefloquine


• Mepindolol


• Methadone


• Metipranolol


• Metoprolol


• Moclobemide


• Moxifloxacin


• Nadolol


• Nebivolol


• Nefazodone


• Nelfinavir


• Nialamide


• Nilotinib


• Nipradilol


• Norfloxacin


• Octreotide


• Ofloxacin


• Ondansetron


• Oxprenolol


• Paliperidone


• Pargyline


• Pazopanib


• Penbutolol


• Perflutren Lipid Microsphere


• Phenelzine


• Pindolol


• Procainamide


• Procarbazine


• Prochlorperazine


• Promethazine


• Propafenone


• Propranolol


• Protriptyline


• Quetiapine


• Quinidine


• Quinine


• Ranolazine


• Rasagiline


• Ritonavir


• Saquinavir


• Selegiline


• Sodium Phosphate


• Sodium Phosphate, Dibasic


• Sodium Phosphate, Monobasic


• Solifenacin


• Sorafenib


• Sotalol


• Sunitinib


• Talinolol


• Telaprevir


• Telavancin


• Telithromycin


• Terfenadine


• Tertatolol


• Tetrabenazine


• Timolol


• Tipranavir


• Toloxatone


• Toremifene


• Tranylcypromine


• Trazodone


• Trifluoperazine


• Vandetanib


• Vardenafil


• Vemurafenib


• Voriconazole


• Ziprasidone

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

• Erythromycin

Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

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

• Asthma attack, acute or


• Bronchospasm (difficulty with breathing), acute or


• COPD flare-up—Should not be used in patients with these conditions.

• Diabetes or


• Heart or blood vessel disease or


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


• Hypertension (high blood pressure) or


• Hyperthyroidism (overactive thyroid) or


• Hypokalemia (low potassium in the blood) or


• Ketoacidosis (high ketones in the blood) or


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

Proper Use of salmeterol

This section provides information on the proper use of a number of products that contain salmeterol. It may not be specific to Severent. Please read with care.

Inhaled salmeterol is used to prevent asthma attacks and to treat chronic obstructive pulmonary disease (COPD). It is not used to relieve an asthma attack that has already started. For relief of an asthma attack that has already started, you should use another medicine. If you do not have another medicine to use for an attack or if you have any questions about this, check with your doctor.

This medicine comes with patient directions or a medication guide. Read the directions carefully before using this medicine. If you do not understand the directions or you are not sure how to use the Diskus®, ask your doctor or pharmacist to show you what to do.

Use this medicine only as directed by your doctor. Do not use more of it and do not use it more often than your doctor ordered. Also, do not stop using this medicine without telling your doctor. To do so may increase the chance of having breathing problems.

In order for this medicine to help prevent asthma or COPD attacks, it must be used every day in regularly spaced doses, as ordered by your doctor.

To use the Diskus®:

• Open the foil pouch containing the Diskus®.


• To open the Diskus®, push the thumb grip away from you as far as it will go. You will hear a click and feel a snap. When open, the mouthpiece will appear.


• Slide the mouthpiece lever away from you as far as it will go until it clicks. The Diskus® is now ready to use. If you close the Diskus® or push the lever again, you will lose medicine.


• Turn your head away from the Diskus®, and breathe out to the end of a normal breath. Do not breathe into the Diskus®.


• Holding the Diskus® level, put the mouthpiece between your lips and teeth, and close your lips around the mouthpiece. Do not bite down on the mouthpiece. Do not block the mouthpiece with your teeth or tongue.


• Breathe in through your mouth as deeply as you can until you have taken a full deep breath. Do not breathe through your nose.


• Hold your breath and remove the mouthpiece from your mouth. Continue holding your breath as long as you can up to 10 seconds before breathing out slowly. This gives the medicine time to settle in your airways and lungs.


• Turn your head away from the Diskus®, and breathe out slowly to the end of a normal breath. Do not breathe into the Diskus®.


• If your doctor has told you to inhale more than one puff of medicine at each dose, take the second puff using exactly the same steps you used for the first puff.


• When you are finished, close the Diskus®. Place your thumb on the thumb grip, and slide it back toward you as far as it will go. You will hear it click shut.


• Keep the Diskus® dry. Do not wash the mouthpiece, or any other part of the Diskus®. You may use a dry cloth to wipe it clean.


• The Diskus® has a window that shows the number of doses that are left. This tells you when you are getting low on medicine. When the Diskus® has 5 doses left, the numbers from 5 to 0 will show up in red to remind you to refill your prescription.

Dosing

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

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

• For inhalation dosage form (powder):
  
  • For preventing an asthma attack:
    
    • Adults, teenagers, and children 4 years of age and older—One inhalation (50 micrograms [mcg]) two times per day (morning and evening). The doses should be at least 12 hours apart.
    
    
    • Children younger than 4 years of age—Use and dose must be determined by your doctor.
    
    
  
  
  • For maintenance treatment of COPD:
    
    • Adults—One inhalation (50 micrograms [mcg]) two times per day (morning and evening). The doses should be at least 12 hours apart.
    
    
    • Children—Use and dose must be determined by your doctor.
    
    
  
  
  • For preventing exercise-induced bronchospasm (EIB):
    
    • Adults, teenagers, and children 4 years of age and older—One inhalation (50 micrograms [mcg]) taken 30 minutes before exercise.
    
    
    • Children younger than 4 years of age—Use and dose must be determined by your doctor.
    
    
  
  

Missed Dose

If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep the medicine in the foil pouch until you are ready to use it. Store at room temperature, away from heat and direct light. Do not freeze.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

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

Throw the medicine away 6 weeks after it is removed from the foil pouch or after all the blisters have been used.

Precautions While Using Severent

If you will be taking this medicine for a long time, it is very important that your doctor check the progress of you or your child at regular visits. This will allow your doctor to see if the medicine is working properly and to check for any unwanted effects.

Tell your doctor if you are also using other medicines for your COPD. Your doctor may want you to stop using the medicine and use it only during a severe COPD attack. Follow your doctor's instructions on how you should take your medicine.

This medicine should not be used if you are having a severe COPD attack, or if symptoms of COPD attack has already started. Your doctor may prescribe another medicine for you to use in case of an acute COPD attack. If the other medicine does not work as well, tell your doctor right away.

This medicine should only be used as an additional treatment for patients who cannot be treated with other asthma medicines (such as inhaled corticosteroids) or for asthma patients that require two medicines, including salmeterol. Ask your doctor if you have any questions.

Although this medicine decreases the number of asthma attacks, it may increase the chance for a severe asthma attack when they do occur. Be sure to read about these risks in the Medication Guide and talk to your doctor or pharmacist about any questions or concerns you may have.

You should not use this medicine if your asthma attack has already started. Your doctor will prescribe another medicine (e.g., a short-acting inhaler) for you to use in case of an acute asthma attack. Make sure you understand how to use the short-acting inhaler. Talk to your doctor if you need instructions.

Do not use any other asthma medicine or medicine for breathing problems without talking to your doctor. This medicine should not be used with other inhalers that contain budesonide and formoterol combination (Symbicort®), fluticasone and salmeterol combination (e.g., Advair® Diskus®, Advair® HFA), formoterol (Foradil® Aerolizer®, Perforomist™), or arformoterol (Brovana™).

Talk to your doctor or get medical care right away if:

• Your or your child's symptoms do not improve after using this medicine for 1 week or if they become worse.


• Your short-acting inhaler does not seem to be working as well as usual and you or your child need to use it more often (e.g., you use 1 whole canister of the short-acting inhaler in 8 weeks time, or you need to use 4 or more inhalations of the short-acting inhaler for 2 or more days in a row).


• You or your child have a big decrease in your peak flow when measured as directed by your doctor.

Do not change your dose or stop using your medicine without first asking your doctor.

Your doctor may want you to carry a medical identification (ID) card stating that you or your child are using this medicine. The card will say that you may need additional medicine during an emergency, a severe asthma attack or other illness, or unusual stress.

This medicine may cause paradoxical bronchospasm, which means your breathing or wheezing will get worse. Paradoxical bronchospasm may be life-threatening. Stop using this medicine and check with your doctor right away if you or your child are having a cough, difficulty with breathing, shortness of breath, or wheezing after using this medicine.

If you or your child develop a skin rash, hives, or any allergic reaction to this medicine, stop using the medicine and check with your doctor as soon as possible.

Check with your doctor right away if you or your child have chest pain, a fast heartbeat, nervousness, shaking of the hands or feet, noisy breathing, a feeling of choking, or tightness or irritation of the throat while using this medicine.

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

This medicine may affect blood sugar levels. If you or your child are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Severent Side Effects

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

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

More common

• Cough producing mucus


• difficulty with breathing


• headache


• irritation of the throat


• runny nose


• shortness of breath


• sneezing


• stuffy nose


• tightness in the chest


• wheezing

Less common

• Abdominal or stomach pain


• blurred vision


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


• chills


• colds


• cough or hoarseness


• diarrhea


• difficulty breathing


• dizziness


• dry mouth


• fever


• flu-like symptoms


• flushed, dry skin


• fruit-like breath odor


• general feeling of discomfort or illness


• increased hunger


• increased thirst


• increased urination


• joint pain


• loss of appetite


• muscle aches and pains


• nausea


• nervousness


• noisy breathing


• pain


• pain or tenderness around the eyes and cheekbones


• pounding in the ears


• shivering


• slow or fast heartbeat


• sore mouth or tongue


• sore throat


• sweating


• swelling


• trouble with sleeping


• troubled breathing


• unexplained weight loss


• unusual tiredness or weakness


• vomiting


• white patches in the mouth or on the tongue

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

Symptoms of overdose

• Arm, back, or jaw pain


• confusion


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


• fainting


• fast or irregular heartbeat


• fast, slow, pounding, or irregular heartbeat or pulse


• seizures


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


• sleeplessness


• trembling or shaking of the hands or feet


• unable to sleep

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

Less common

• Acid or sour stomach


• anxiety


• belching


• blistering, burning, crusting, dryness, or flaking of the skin


• bone pain


• burning, dry, or itching eyes


• difficulty with moving


• discharge or excessive tearing


• eye redness, irritation, or pain


• headache, severe and throbbing


• heartburn


• hives or welts


• indigestion


• itching, scaling, severe redness, soreness, or swelling of the skin


• mouth or tooth pain


• muscle cramps and spasm


• muscle stiffness or tightness


• redness of the skin


• redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid


• skin rash


• skin rash, encrusted, scaly and oozing


• stomach discomfort, upset, or pain

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

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

See also: Severent side effects (in more detail)

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

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

More Severent resources

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

Compare Severent with other medications

• Asthma, Maintenance
• Bronchospasm Prophylaxis
• COPD, Maintenance

Sodium Chloride Drops

Pronunciation: SOE-dee-um KLOR-ide
Generic Name: Sodium Chloride
Brand Name: Examples include Altachlore and Muro 128

Sodium Chloride Drops are used for:

Temporarily treating swelling of the cornea of the eye.

Sodium Chloride Drops are a hypertonic salt solution. It works by drawing water out of the cornea, decreasing swelling.

Do NOT use Sodium Chloride Drops if:

• you are allergic to any ingredient in Sodium Chloride Drops

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

Before using Sodium Chloride Drops:

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

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


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


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

Some MEDICINES MAY INTERACT with Sodium Chloride Drops. However, no specific interactions with Sodium Chloride Drops are known at this time.

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

How to use Sodium Chloride Drops:

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

• To use Sodium Chloride Drops in the eye, first, wash your hands. Tilt your head back. Using your index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Immediately use your finger to apply pressure to the inside corner of the eye for 1 to 2 minutes. Do not blink. Remove excess medicine around your eye with a clean tissue, being careful not to touch your eye. Wash your hands to remove any medicine that may be on them. To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including your eye. Keep the container tightly closed.


• Do not use Sodium Chloride Drops if it changes color or is cloudy.


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

Ask your health care provider any questions you may have about how to use Sodium Chloride Drops.

Important safety information:

• Sodium Chloride Drops may be harmful if swallowed. If you may have taken Sodium Chloride Drops by mouth, contact your local poison control center or emergency room immediately.


• PREGNANCY and BREAST-FEEDING: If you plan on becoming pregnant, discuss with your doctor the benefits and risks of using Sodium Chloride Drops during pregnancy. If you are or will be breast-feeding while you are using Sodium Chloride Drops, check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects of Sodium Chloride Drops:

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

Mild burning or irritation.

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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in vision; continued redness, burning, or irritation; eye pain; feeling that something is in the eye.

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

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Sodium Chloride Drops:

Store Sodium Chloride Drops at room temperature, between 59 and 86 degrees F (15 and 30 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Sodium Chloride Drops out of the reach of children and away from pets.

General information:

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


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


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

Sodium Phosphates Enema

Pronunciation: SOE-dee-um FOS-fates
Generic Name: Sodium Phosphates
Brand Name: Fleet

Sodium Phosphates Enema is used for:

Treating constipation or cleansing the bowel before certain medical procedures. It may also be used for other conditions as determined by your doctor.

Sodium Phosphates Enema is a saline laxative enema. It works by pulling water from the body into the bowel, which helps to soften the stool and cause a bowel movement.

Do NOT use Sodium Phosphates Enema if:

• you are allergic to any ingredient in Sodium Phosphates Enema


• you have a blockage of the bowel or other severe bowel problems, congestive heart failure, kidney failure, or too much phosphate in the blood

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

Before using Sodium Phosphates Enema:

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

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


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


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


• if you are on a sodium-restricted diet or have a history of stomach or bowel problems


• if you have appendicitis, liver or kidney problems, high blood pressure, low parathyroid function, bone problems (eg, osteomalacia), muscle problems (eg, rhabdomyolysis), pancreas problems, a kidney or bladder infection, kidney stones, electrolyte problems (eg, low blood calcium), a colostomy, nausea, vomiting, stomach pain, or a sudden change in bowel movements lasting longer than 2 weeks


• if you have already used a laxative for more than 1 week

Some MEDICINES MAY INTERACT with Sodium Phosphates Enema. However, no specific interactions with Sodium Phosphates Enema are known at this time.

Ask your health care provider if Sodium Phosphates Enema may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Sodium Phosphates Enema:

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

• Remove the protective shield from the enema tip before inserting.


• With steady pressure, gently insert the enema tip into the rectum with a slight side-to-side movement, with the tip pointing toward the navel. Insertion may be easier if you bear down, as if having a bowel movement. This helps relax the muscles around the anus.


• Do not force the enema tip into the rectum. This can cause injury.


• Squeeze the bottle until nearly all the liquid is gone. It is not necessary to empty the bottle completely. It contains more liquid than needed.


• Remove the tip from the rectum and maintain the position until the urge to evacuate is strong (usually 2 to 5 minutes).


• Do not use more than 1 enema in 24 hours.


• If you miss a dose of Sodium Phosphates Enema, contact your doctor immediately.

Ask your health care provider any questions you may have about how to use Sodium Phosphates Enema.

Important safety information:

• Stop using Sodium Phosphates Enema and contact your doctor if you have rectal bleeding or fail to have a bowel movement after using Sodium Phosphates Enema. These symptoms may indicate a serious condition.


• Sodium Phosphates Enema should not be used in CHILDREN younger than 2 years old; safety and effectiveness in these children have not been confirmed.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Sodium Phosphates Enema while you are pregnant. It is not known if Sodium Phosphates Enema is found in breast milk. If you are or will be breast-feeding while you use Sodium Phosphates Enema, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Sodium Phosphates Enema:

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

Anal irritation; diarrhea; gas; nausea; stomach cramps.

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blood in the stool; continued constipation; dizziness; vomiting; weakness.

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

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Sodium Phosphates Enema:

Store Sodium Phosphates Enema at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Keep Sodium Phosphates Enema out of the reach of children and away from pets.

General information:

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


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


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Sodium Phosphates resources

• Sodium Phosphates Use in Pregnancy & Breastfeeding
• Sodium Phosphates Drug Interactions
• Sodium Phosphates Support Group
• 14 Reviews for Sodium Phosphates - Add your own review/rating

Compare Sodium Phosphates with other medications

• Bowel Preparation
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