Tuesday, 17 July 2012

Triaminic Softchews Chest Congestion


Generic Name: guaifenesin and pseudoephedrine (gwye FEN e sin, SOO doe ee FED rin)

Brand Names: Altarussin PE, Ambifed, Ambifed-G, Biotuss PE, Congestac, D-Feda II, Despec-SR, Dynex, Entex PSE, ExeFen, ExeFen-IR, Guiatex II SR, Levall G, Maxifed, Maxifed-G, Medent LD, Medent-LDI, Mucinex D, Mucinex D Max Strength, Nasabid SR, Nasatab LA, Nomuc-PE, Poly-Vent, Poly-Vent IR, Poly-Vent, Jr., Pseudatex, Pseudo GG, Pseudo GG TR, Pseudo Max, Q-Tussin PE, Respaire-120 SR, Respaire-30, Respaire-60 SR, Robitussin PE, Robitussin Severe Congestion, Ru-Tuss Jr., Sinutab Non Drying, Stamoist E, SudaTex-G, Tenar PSE, Touro LA, Touro LA-LD, Triaminic Softchews Chest Congestion, We Mist II LA, We Mist LA


What is Triaminic Softchews Chest Congestion (guaifenesin and pseudoephedrine)?

Guaifenesin is an expectorant. It helps loosen congestion in your chest and throat, making it easier to cough out through your mouth.


Pseudoephedrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).


The combination of guaifenesin and pseudoephedrine is used to treat stuffy nose, sinus congestion, and cough caused by allergies or the common cold.


Guaifenesin and pseudoephedrine may also be used for purposes not listed in this medication guide.


What is the most important information I should know about Triaminic Softchews Chest Congestion (guaifenesin and pseudoephedrine)?


Do not give this medication to a child younger than 4 years old. Alwayss ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children. Do not use a cough or cold medicine if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects. Ask a doctor or pharmacist before using any other cold, cough, or allergy medicine. Guaifenesin and pseudoephedrine are contained in many combination medicines. Taking certain products together can cause you to get too much of a certain drug. Check the label to see if a medicine contains guaifenesin or pseudoephedrine.

What should I discuss with my healthcare provider before taking Triaminic Softchews Chest Congestion (guaifenesin and pseudoephedrine)?


You should not use this medication if you are allergic to guaifenesin or pseudoephedrine, or to other decongestants, diet pills, stimulants, or ADHD medications. Do not use a cough or cold medicine if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

Ask a doctor or pharmacist if it is safe for you to take this medicine if you have:



  • heart disease or high blood pressure;




  • diabetes; or




  • a thyroid disorder.




It is not known whether guaifenesin and pseudoephedrine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Guaifenesin and pseudoephedrine may pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Artificially sweetened liquid cough or cold medicine may contain phenylalanine. If you have phenylketonuria (PKU), check the medication label to see if the product contains phenylalanine.


How should I take Triaminic Softchews Chest Congestion (guaifenesin and pseudoephedrine)?


Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Cough and cold medicine is usually taken only for a short time until your symptoms clear up.


Do not give this medication to a child younger than 4 years old. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children. Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

Measure liquid medicine with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.


Drink extra fluids to help loosen the congestion and lubricate your throat while you are taking this medication. Take with food if this medicine upsets your stomach. Do not take guaifenesin and pseudoephedrine for longer than 7 days in a row. Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a headache, cough, or skin rash.

If you need surgery, tell the surgeon ahead of time if you have taken a cough or cold medicine within the past few days.


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

What happens if I miss a dose?


Since cough or cold medicine is taken when needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.


What happens if I overdose?


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

Overdose symptoms may include nausea, vomiting, dizziness, and feeling restless or nervous.


What should I avoid while taking Triaminic Softchews Chest Congestion (guaifenesin and pseudoephedrine)?


This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Drinking alcohol can increase certain side effects of guaifenesin and pseudoephedrine.

Avoid taking this medication if you also take diet pills, caffeine pills, or other stimulants (such as ADHD medications). Taking a stimulant together with a decongestant can increase your risk of unpleasant side effects.


Ask a doctor or pharmacist before using any other cold, cough, or allergy medicine. Guaifenesin and pseudoephedrine are contained in many combination medicines. Taking certain products together can cause you to get too much of a certain drug. Check the label to see if a medicine contains guaifenesin or pseudoephedrine.

Triaminic Softchews Chest Congestion (guaifenesin and pseudoephedrine) side effects


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

  • fast, pounding, or uneven heartbeat;




  • severe dizziness, anxiety, or nervousness;




  • easy bruising or bleeding, unusual weakness, fever, chills, body aches, flu symptoms; or




  • increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).



Less serious side effects may include:



  • dizziness or headache;




  • feeling restless or excited;




  • sleep problems (insomnia);




  • mild nausea, vomiting, or stomach upset;




  • mild loss of appetite;




  • warmth, redness, or tingly feeling under your skin; or




  • skin rash or itching.



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 Triaminic Softchews Chest Congestion (guaifenesin and pseudoephedrine)?


Tell your doctor about all other medicines you use, especially:



  • methyldopa (Aldomet);




  • blood pressure medications;




  • a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others; or




  • an antidepressant such as amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Janimine, Tofranil), and others.



This list is not complete and other drugs may interact with guaifenesin and pseudoephedrine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.



More Triaminic Softchews Chest Congestion resources


  • Triaminic Softchews Chest Congestion Side Effects (in more detail)
  • Triaminic Softchews Chest Congestion Use in Pregnancy & Breastfeeding
  • Drug Images
  • Triaminic Softchews Chest Congestion Drug Interactions
  • Triaminic Softchews Chest Congestion Support Group
  • 58 Reviews for Triaminic Softchews Chest Congestion - Add your own review/rating


  • Congestac MedFacts Consumer Leaflet (Wolters Kluwer)

  • Entex PSE Controlled-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer)

  • Mucinex D Prescribing Information (FDA)

  • Mucinex D Consumer Overview

  • Pseudovent Consumer Overview

  • Robitussin Severe Congestion MedFacts Consumer Leaflet (Wolters Kluwer)

  • Zephrex LA Sustained-Release Tablets MedFacts Consumer Leaflet (Wolters Kluwer)



Compare Triaminic Softchews Chest Congestion with other medications


  • Cough and Nasal Congestion


Where can I get more information?


  • Your pharmacist can provide more information about guaifenesin and pseudoephedrine.

See also: Triaminic Softchews Chest Congestion side effects (in more detail)


Monday, 16 July 2012

tretinoin


Generic Name: tretinoin (TRET i noin)

Brand Names: Vesanoid


What is tretinoin?

Tretinoin is a cancer medication that interferes with the growth of cancer cells and slows their growth and spread in the body.


Tretinoin is used to treat acute promyelocytic leukemia (a type of blood cancer).


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


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


Do not use vitamin A supplements or multivitamins that contain vitamin A while you are taking tretinoin. Do not use this medication without your doctor's consent if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Tretinoin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my healthcare provider before taking tretinoin?


Before using tretinoin, tell your doctor if you have high cholesterol, or if you have ever had a reaction to another retinoid (such as Accutane, Retin-A, Renova).


If you have any of these conditions, you may not be able to use tretinoin, or you may need a dosage adjustment or special tests during treatment.


FDA pregnancy category D. This medication can cause birth defects, miscarriage, premature birth, or death of a baby. Do not use tretinoin if you are pregnant. Tell your doctor right away if you miss a period or become pregnant during treatment. Use an effective form of birth control while you are using this medication and for at least 1 month after your treatment ends. You may need to have a pregnancy test every month during your treatment. You must use effective birth control while you are taking tretinoin unless you have had a hysterectomy and no longer have a uterus. Use birth control even if you have been infertile (unable to have children) in the past, or if you have gone through menopause. It is not known whether tretinoin passes into breast milk or if it could harm a nursing baby. Do not take tretinoin without telling your doctor if you are breast-feeding a baby.

How should I use tretinoin?


Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.


Take each dose with a full glass of water.

You may need to continue taking tretinoin for up to 90 days. Follow your doctor's instructions.


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

What happens if I miss a dose?


Contact your doctor if you miss a dose of tretinoin.


What happens if I overdose?


Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include headache, dizziness, weakness, facial flushing, stomach pain, or dry, cracked lips.

What should I avoid while using tretinoin?


Do not use vitamin A supplements or multivitamins that contain vitamin A while you are taking tretinoin. Tretinoin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Tretinoin side effects


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

  • fever, breathing problems, weight gain, swelling of your hands or feet;




  • sudden and severe pain behind your eyes, with nausea, vomiting, and vision problems;




  • black, bloody, or tarry stools; or




  • vomit that looks like blood or coffee grounds.



Less serious side effects may include:



  • feeling tired or weak;




  • headache;




  • fever;




  • dry skin, mouth, or nose;




  • bone pain;




  • nausea and vomiting;




  • rash or itching;




  • white patches or sores inside your mouth or on your lips;




  • increased sweating;




  • vision problems; or




  • hair loss or skin changes.



This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.


Tretinoin Dosing Information


Usual Adult Dose for Acute Promyelocytic Leukemia:

45 mg/m2/day administered as two evenly divided doses until complete remission is documented. Therapy should be discontinued 30 days after achievement of complete remission or after 90 days of treatment, whichever comes first.

Usual Pediatric Dose for Acute Promyelocytic Leukemia:

There are limited clinical data on the pediatric use of tretinoin. The safety and efficacy of tretinoin in patients
45 mg/m2/day administered as two evenly divided doses until complete remission is documented. Therapy should be discontinued 30 days after achievement of complete remission or after 90 days of treatment, whichever comes first.


What other drugs will affect tretinoin?


Before taking tretinoin, tell your doctor if you are using any of the following drugs:



  • cimetidine (Tagamet);




  • cyclosporine (Neoral, Sandimmune, Gengraf);




  • troleandomycin (Tao);




  • rifampin (Rifadin, Rimactane, Rifater);




  • phenobarbital (Luminal);




  • fluoxetine (Prozac), fluvoxamine (Luvox);




  • steroids (prednisone and others);




  • itraconazole (Sporanox), ketoconazole (Nizoral);




  • clarithromycin (Biaxin), erythromycin (Erythrocin, Ery-Tab, E.E.S.);




  • a tetracycline antibiotic such as minocycline (Dynocin, Minocin, Vectrin), doxycycline (Doryx, Vibramycin), demeclocycline (Declomycin);




  • amiodarone (Cordarone), mibefradil (Posicor), diltiazem (Tiazac, Cardizem), verapamil (Covera, Calan); or




  • HIV medicines such as indinavir (Crixivan), saquinavir (Invirase), ritonavir (Norvir), saquinavir (Invirase), or nelfinavir (Viracept).



This list is not complete and there may be other drugs that can interact with tretinoin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.



More tretinoin resources


  • Tretinoin Dosage
  • Tretinoin Use in Pregnancy & Breastfeeding
  • Drug Images
  • Tretinoin Drug Interactions
  • Tretinoin Support Group
  • 1 Review for Tretinoin - Add your own review/rating


  • tretinoin Advanced Consumer (Micromedex) - Includes Dosage Information

  • Tretinoin Prescribing Information (FDA)

  • Tretinoin Monograph (AHFS DI)

  • Tretinoin MedFacts Consumer Leaflet (Wolters Kluwer)

  • Vesanoid Prescribing Information (FDA)



Compare tretinoin with other medications


  • Acute Promyelocytic Leukemia


Where can I get more information?


  • Your pharmacist can provide more information about tretinoin.


Saturday, 14 July 2012

Insulin Protaphane




Insulin Protaphane may be available in the countries listed below.


Ingredient matches for Insulin Protaphane



Insulin, Isophane

Insulin, Isophane human (a derivative of Insulin, Isophane) is reported as an ingredient of Insulin Protaphane in the following countries:


  • Finland

  • Luxembourg

  • New Zealand

International Drug Name Search

Sunday, 8 July 2012

Zaroxolyn



Generic Name: metolazone (me TOL a zone)

Brand Names: Zaroxolyn


What is Zaroxolyn (metolazone)?

Metolazone is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.


Metolazone treats fluid retention (edema) in people with congestive heart failure, or a kidney disorder such as nephrotic syndrome. This medication is also used to treat high blood pressure (hypertension).


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


What is the most important information I should know about Zaroxolyn (metolazone)?


Do not use this medication if you are unable to urinate, or if you have severe liver disease.

Before using this medication, tell your doctor if you have liver disease, kidney disease, asthma, allergies, gout, diabetes, or an allergy to sulfa drugs.


Avoid drinking alcohol, which can increase some of the side effects of metolazone.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.


There are many other medicines that can interact with metolazone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.


If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.


What should I discuss with my doctor before taking Zaroxolyn (metolazone)?


Do not use this medication if you are allergic to metolazone, or if you have:
  • severe liver disease; or

  • if you are unable to urinate.

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before using metolazone, tell your doctor if you have:


  • kidney disease;

  • liver disease;


  • gout;




  • diabetes; or




  • an allergy to sulfa drugs.




FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Metolazone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Zaroxolyn (metolazone)?


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


Your doctor may occasionally change your dose to make sure you get the best results from this medication.


To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.


Your blood and urine may both be tested if you have been vomiting or are dehydrated.


If you need to have any type of surgery, tell the surgeon ahead of time that you are taking metolazone. You may need to stop using the medicine for a short time.


If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.


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

See also: Zaroxolyn dosage (in more detail)

What happens if I miss a dose?


Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.


What happens if I overdose?


Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, weakness, dizziness, dry mouth, thirst, muscle pain or weakness, feeling light-headed, or fainting.


What should I avoid while taking Zaroxolyn (metolazone)?


Avoid drinking alcohol, which can increase some of the side effects of metolazone.

Avoid using other medicines that make you light-headed (narcotic pain medication, muscle relaxers, and medicine for seizures). They can add to the side effects of metolazone. Tell your doctor if you regularly use any of these medicines, or any other blood pressure medications.


Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.


Zaroxolyn (metolazone) side effects


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

  • dry mouth, thirst, nausea, vomiting;




  • feeling weak, drowsy, restless, or light-headed;




  • fast or uneven heartbeat;




  • muscle pain or weakness;




  • chest pain;




  • urinating less than usual or not at all; or




  • numbness or tingly feeling.



Less serious side effects may include:



  • dizziness;




  • headache;




  • joint pain;




  • a red, blistering, peeling skin rash; or




  • blurred vision.



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 Zaroxolyn (metolazone)?


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



  • lithium (Lithobid, Eskalith);




  • digoxin (Lanoxin);




  • methenamine (Hiprex, Mandelamine, Urex);




  • steroids (prednisone and others);




  • insulin or diabetic medicine you take by mouth;




  • a blood thinner such as warfarin (Coumadin);




  • furosemide (Lasix) or other blood pressure medications;




  • salicylates such as aspirin, Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others; or




  • NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Motrin, Advil), diclofenac (Voltaren), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others.



This list is not complete and there may be other drugs that can interact with metolazone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.



More Zaroxolyn resources


  • Zaroxolyn Side Effects (in more detail)
  • Zaroxolyn Dosage
  • Zaroxolyn Use in Pregnancy & Breastfeeding
  • Drug Images
  • Zaroxolyn Drug Interactions
  • Zaroxolyn Support Group
  • 1 Review for Zaroxolyn - Add your own review/rating


  • Zaroxolyn MedFacts Consumer Leaflet (Wolters Kluwer)

  • Zaroxolyn Monograph (AHFS DI)

  • Zaroxolyn Advanced Consumer (Micromedex) - Includes Dosage Information

  • Zaroxolyn Prescribing Information (FDA)

  • Metolazone Professional Patient Advice (Wolters Kluwer)

  • Metolazone Prescribing Information (FDA)

  • Mykrox Prescribing Information (FDA)



Compare Zaroxolyn with other medications


  • Edema
  • High Blood Pressure


Where can I get more information?


  • Your pharmacist can provide more information about metolazone.

See also: Zaroxolyn side effects (in more detail)


Norinyl-1 Tablets





1. Name Of The Medicinal Product



Norinyl-1.


2. Qualitative And Quantitative Composition



Each tablet contains 1 milligram norethisterone and 50 micrograms mestranol.



3. Pharmaceutical Form



White, flat, circular, bevel-edged tablet inscribed 'SEARLE' on one side and '1' on the other side.



4. Clinical Particulars



4.1 Therapeutic Indications



Norinyl-1 is indicated for oral contraception.



4.2 Posology And Method Of Administration



Oral Administration: The dosage of Norinyl-1 for the initial cycle of therapy is 1 tablet taken at the same time each day from the first day of the menstrual cycle. For subsequent cycles, no tablets are taken for 7 days, then a new course is started of 1 tablet daily for the next 21 days. This sequence of 21 days on treatment, seven days off treatment is repeated for as long as contraception is required.



Patients unable to start taking Norinyl-1 tablets on the first day of the menstrual cycle may start treatment on any day up to and including the 5th day of the menstrual cycle.



Patients starting on day 1 of their period will be protected at once. Those patients delaying therapy up to day 5 may not be protected immediately and it is recommended that another method of contraception is used for the first 7 days of tablet-taking. Suitable methods are condoms, caps plus spermicides and intra-uterine devices. The rhythm, temperature and cervical-mucus methods should not be relied upon.



Tablet omissions



Tablets must be taken daily in order to maintain adequate hormone levels and contraceptive efficacy.



If a tablet is missed within 12 hours of the correct dosage time then the missed tablet should be taken as soon as possible, even if this means taking 2 tablets on the same day, this will ensure that contraceptive protection is maintained. If one or more tablets are missed for more than 12 hours from the correct dosage time it is recommended that the patient takes the last missed tablet as soon as possible and then continues to take the rest of the tablets in the normal manner. In addition, it is recommended that extra contraceptive protection, such as a condom, is used for the next 7 days.



Patients who have missed one or more of the last 7 tablets in a pack should be advised to start the next pack of tablets as soon as the present one has finished (i.e. without the normal seven day gap between treatments). This reduces the risk of contraceptive failure resulting from tablets being missed close to a 7 day tablet free period.



Changing from another oral contraceptive



In order to ensure that contraception is maintained it is advised that the first dose of Norinyl-1 tablets is taken on the day immediately after the patient has finished the previous pack of tablets.



Use after childbirth, miscarriage or abortion



Providing the patient is not breast feeding the first dose of Norinyl-1 tablets should be taken on the 21st day after childbirth. This will ensure the patient is protected immediately. If there is any delay in taking the first dose, contraception may not be established until 7 days after the first tablet has been taken. In these circumstances patients should be advised that extra contraceptive methods will be necessary.



After a miscarriage or abortion patients can take the first dose of Norinyl-1 tablets on the next day; in this way they will be protected immediately.



4.3 Contraindications



As with all combined progestogen/oestrogen oral contraceptives, the following conditions should be regarded as contra-indications:



i. History of confirmed venous thromboembolic disease (VTE), family history of idiopathic VTE and other known risk factors of VTE



ii. Thrombophlebitis, cerebrovascular disorders, coronary artery disease, myocardial infarction, angina, hyperlipidaemia or a history of these conditions.



iii. Acute or severe chronic liver disease, including liver tumours, Dubin-Johnson or Rotor syndrome.



iv. History during pregnancy of idiopathic jaundice, severe pruritus or pemphigoid gestationis.



v. Known or suspected breast or genital cancer



vi. Known or suspected oestrogen-dependent neoplasia.



vii. Undiagnosed abnormal vaginal bleeding.



viii. A history of migraines classified as classical focal or crescendo.



ix. Pregnancy.



4.4 Special Warnings And Precautions For Use



Assessment of women prior to starting oral contraceptives (and at regular intervals thereafter) should include a personal and family medical history of each woman. Physical examination should be guided by this and by the contraindications (section 4.3) and warnings (section 4.4) for this product. The frequency and nature of these assessments should be based upon relevant guidelines and should be adapted to the individual woman, but should include measurement of blood pressure and, if judged appropriate by the clinician, breast, abdominal and pelvic examination including cervical cytology.



Women taking oral contraceptives require careful observation if they have or have had any of the following conditions: breast nodules; fibrocystic disease of the breast or an abnormal mammogram; uterine fibroids; a history of severe depressive states; varicose veins; sickle-cell anaemia; diabetes; hypertension; cardiovascular disease; migraine; epilepsy; asthma; otosclerosis; multiple sclerosis; porphyria; tetany; disturbed liver functions; gallstones; kidney disease; chloasma; any condition that is likely to worsen during pregnancy. The worsening or first appearance of any of these conditions may indicate that the oral contraceptive should be stopped. Discontinue treatment if there is a gradual or sudden, partial or complete loss of vision or any evidence of ocular changes, onset or aggravation of migraine or development of headache of a new kind which is recurrent, persistent or severe.



Gastro-intestinal upsets, such as vomiting and diarrhoea, may interfere with the absorption of the tablets leading to a reduction in contraceptive efficacy. Patients should continue to take Norinyl-1, but they should also be encouraged to use another contraceptive method during the period of gastro-intestinal upset and for the next 7 days.



Progestogen oestrogen preparations should be used with caution in patients with a history of hepatic dysfunction or hypertension.



An increased risk of venous thromboembolic disease (VTE) associated with the use of oral contraceptives is well established but is smaller than that associated with pregnancy, which has been estimated at 60 cases per 100,000 pregnancies. Some epidemiological studies have reported a greater risk of VTE for women using combined oral contraceptives containing desogestrel or gestodene (the so-called 'third generation' pills) than for women using pills containing levonorgestrel or norethisterone (the so-called 'second generation' pills).



The spontaneous incidence of VTE in healthy non-pregnant women (not taking any oral contraceptive) is about 5 cases per 100,000 per year. The incidence in users of second generation pills is about 15 per 100,000 women per year of use. The incidence in users of third generation pills is about 25 cases per 100,000 women per year of use; this excess incidence has not been satisfactorily explained by bias or confounding. The level of all of these risks of VTE increases with age and is likely to be further increased in women with other known risk factors for VTE such as obesity).The excess risk of VTE is highest during the first year a woman ever uses a combined oral contraceptive.



Patients receiving oral contraceptives should be kept under regular surveillance, in view of the possibility of development of such conditions as thromboembolism.



The risk of coronary artery disease in women taking oral contraceptives is increased by the presence of other predisposing factors such as cigarette smoking, hypercholesterolaemia, obesity, diabetes, history of pre-eclamptic toxaemia and increasing age. After the age of thirty-five years, the patient and physician should carefully re-assess the risk/benefit ratio of using combined oral contraceptives as opposed to alternative methods of contraception.



Norinyl-1 should be discontinued at least four weeks before, and for two weeks following, elective operations and during immobilisation. Patients undergoing injection treatment for varicose veins should not resume taking Norinyl-1 until 3 months after the last injection.



Benign and malignant liver tumours have been associated with oral contraceptive use. The relationship between occurrence of liver tumours and use of female sex hormones is not known at present. These tumours may rupture causing intra-abdominal bleeding. If the patient presents with a mass or tenderness in the right upper quadrant or an acute abdomen, the possible presence of a tumour should be considered.



An increased risk of congenital abnormalities, including heart defects and limb defects, has been reported following the use of sex hormones, including oral contraceptives, in pregnancy. If the patient does not adhere to the prescribed schedule, the possibility of pregnancy should be considered at the time of the first missed period and further use of oral contraceptives should be withheld until pregnancy has been ruled out. It is recommended that for any patient who has missed two consecutive periods, pregnancy should be ruled out before continuing the contraceptive regimen. If pregnancy is confirmed the patient should be advised of the potential risks to the foetus and the advisability of continuing the pregnancy should be discussed in the light of these risks. It is advisable to discontinue Norinyl-1 three months before a planned pregnancy.



The risk of arterial thrombosis associated with combined oral contraceptives increases with age, and this risk is aggravated by cigarette smoking. The use of combined oral contraceptives by women in the older age group, especially those who are cigarette smokers, should therefore be discouraged and alternative methods advised.



The use of this product in patients suffering from epilepsy, migraine, asthma or cardiac dysfunction may result in exacerbation of these disorders because of fluid retention. Caution should also be observed in patients who wear contact lenses.



Decreased glucose tolerance may occur in diabetic patients on this treatment, and their control must be carefully supervised.



The use of oral contraceptives has also been associated with a possible increased incidence of gall bladder disease.



Women with a history of oligomenorrhoea or secondary amenorrhoea or young women without regular cycles may have a tendency to remain anovulatory or to become amenorrhoeic after discontinuation of oral contraceptives. Women with these pre-existing problems should be advised of this possibility and encouraged to use other contraceptive methods.



Numerous epidemiological studies have been reported on the risks of ovarian, endometrial, cervical and breast cancer in women using combined oral contraceptives. The evidence is clear that combined oral contraceptives offer substantial protection against both ovarian and endometrial cancer.



An increased risk of cervical cancer in long-term users of combined oral contraceptives has been reported in some studies, but there continues to be controversy about the extent to which this is attributable to the confounding effects of sexual behaviour and other factors.



A meta-analysis from 54 epidemiological studies reported that there is a slightly increased relative risk (RR = 1.24) of having breast cancer diagnosed in women who are currently using combined oral contraceptives (COCs). The observed pattern of increased risk may be due to an earlier diagnosis of breast cancer in COC users, the biological effects of COCs or a combination of both. The additional breast cancers diagnosed in current users of COCs or in women who have used COCs in the last ten years are more likely to be localised to the breast than those in women who never used COCs.



Breast cancer is rare among women under 40 years of age whether or not they take COCs. Whilst this background risk increases with age, the excess number of breast cancer diagnoses in current and recent COC users is small in relation to the overall risk of breast cancer (see bar chart).



The most important risk factor for breast cancer in COC users is the age women discontinue the COC; the older the age at stopping, the more breast cancers are diagnosed. Duration of use is less important and the excess risk gradually disappears during the course of the 10 years after stopping COC use such that by 10 years there appears to be no excess.



The possible increase in risk of breast cancer should be discussed with the user and weighed against the benefits of COCs taking into account the evidence that they offer substantial protection against the risk of developing certain other cancers (e.g. ovarian and endometrial cancer).



Estimated cumulative numbers of breast cancers per 10,000 women diagnosed in 5 years of use and up to 10 years after stopping COCs, compared with numbers of breast cancers diagnosed in 10,000 women who had never used COCs.







 



4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction



The herbal remedy St John's wort (Hypericum perforatum) should not be taken concomitantly with this medicine as this could potentially lead to a loss of contraceptive effect.



Some drugs may modify the metabolism of Norinyl-1 reducing its effectiveness; these include certain sedatives, antibiotics, anti-epileptic and anti-arthritic drugs. During the time such agents are used concurrently, it is advised that mechanical contraceptives also be used.



The results of a large number of laboratory tests have been shown to be influenced by the use of oestrogen containing oral contraceptives, which may limit their diagnostic value. Among these are: biochemical markers of thyroid and liver function; plasma levels of carrier proteins, triglycerides, coagulation and fibrinolysis factors.



4.6 Pregnancy And Lactation



Contra-indicated in pregnancy.



Patients who are fully breast-feeding should not take Norinyl-1 tablets since, in common with other combined oral contraceptives, the oestrogen component may reduce the amount of milk produced. In addition, active ingredients or their metabolites have been detected in the milk of mothers taking oral contraceptives. The effect of Norinyl-1 on breast-fed infants has not been determined.



4.7 Effects On Ability To Drive And Use Machines



Not applicable.



4.8 Undesirable Effects



As with all oral contraceptives, there may be slight nausea at first, weight gain or breast discomfort, which soon disappear.



Other side-effects known or suspected to occur with oral contraceptives include gastro-intestinal symptoms, changes in libido and appetite, headache, exacerbation of existing uterine fibroid disease, depression, and changes in carbohydrate, lipid and vitamin metabolism.



Spotting or bleeding may occur during the first few cycles. Usually menstrual bleeding becomes light and occasionally there may be no bleeding during the tablet-free days.



Hypertension, which is usually reversible on discontinuing treatment, has occurred in a small percentage of women taking oral contraceptives.



4.9 Overdose



Overdosage may be manifested by nausea, vomiting, breast enlargement and vaginal bleeding. There is no specific antidote and treatment should be symptomatic. Gastric lavage may be employed if the overdose is large and the patient is seen sufficiently early (within four hours).



5. Pharmacological Properties



5.1 Pharmacodynamic Properties



The mode of action of Norinyl-1 is similar to that of other progestogen/oestrogen oral contraceptives and includes the inhibition of ovulation, the thickening of cervical mucus so as to constitute a barrier to sperm and the rendering of the endometrium unreceptive to implantation. Such activity is exerted through a combined effect on one or more of the following: hypothalamus, anterior pituitary, ovary, endometrium and cervical mucus.



5.2 Pharmacokinetic Properties



Norethisterone is rapidly and completely absorbed after oral administration, peak plasma concentrations occurring in the majority of subjects between 1 and 3 hours. Due to first-pass metabolism, blood levels after oral administration are 60% of those after i.v. administration. The half life of elimination varies from 5 to 12 hours, with a mean of 7.6 hours. Norethisterone is metabolised mainly in the liver. Approximately 60% of the administered dose is excreted as metabolites in urine and faeces.



Mestranol is rapidly absorbed and extensively metabolised to ethinyloestradiol. Ethinyloestradiol is rapidly and well absorbed from the gastro-intestinal tract but is subject to some first-pass metabolism in the gut-wall. Compared to many other oestrogens it is only slowly metabolised in the liver. Excretion is via the kidneys with some appearing also in the faeces.



5.3 Preclinical Safety Data



The toxicity of norethisterone is very low. Reports of teratogenic effects in animals are uncommon. No carcinogenic effects have been found even in long-term studies.



Long-term continuous administration of oestrogens in some animals increases the frequency of carcinoma of the breast, cervix, vagina and liver.



6. Pharmaceutical Particulars



6.1 List Of Excipients



Norinyl-1 tablets contain:



Maize starch, polyvidone, magnesium stearate and lactose.



6.2 Incompatibilities



None stated.



6.3 Shelf Life



The shelf life of Norinyl-1 tablets is 5 years.



6.4 Special Precautions For Storage



Store in a dry place below 25oC away from direct sunlight.



6.5 Nature And Contents Of Container



Norinyl-1 tablets are supplied in pvc/foil blister packs of 21 and 63 tablets.



6.6 Special Precautions For Disposal And Other Handling



None.



7. Marketing Authorisation Holder



Pharmacia Limited



Ramsgate Road



Sandwich



Kent CT13 9NJ



UK



8. Marketing Authorisation Number(S)



PL 00032/0412



9. Date Of First Authorisation/Renewal Of The Authorisation



May 16th 1996



10. Date Of Revision Of The Text



May 2007



NR2_0




Tuesday, 3 July 2012

Novox





Dosage Form: FOR ANIMAL USE ONLY
Novox® CAPLETS

(carprofen)

Non-steroidal anti-inflammatory drug

For oral use in dogs only



CAUTION:


Federal law restricts this drug to use by or on the order of a licensed veterinarian.



DESCRIPTION:


Carprofen is a non-steroidal anti-inflammatory drug (NSAID) of the propionic acid class that includes ibuprofen, naproxen, and ketoprofen. Carprofen is the nonproprietary designation for a substituted carbazole, 6-chloro-∞-methyl-9H-carbazole-2-acetic acid. The empirical formula is C15H12ClNO2 and the molecular weight 273.72. The chemical structure of carprofen is:



Carprofen is a white, crystalline compound. It is freely soluble in ethanol, but practically insoluble in water at 25°C.



CLINICAL PHARMACOLOGY:


Carprofen is a non-narcotic, non-steroidal anti-inflammatory agent with characteristic analgesic and antipyretic activity approximately equipotent to indomethacin in animal models.1


The mechanism of action of carprofen, like that of other NSAlDs, is believed to be associated with the inhibition of cyclooxygenase activity. Two unique cyclooxygenases have been described in mammals.2


The constitutive cyclooxygenase, COX-1, synthesizes prostaglandins necessary for normal gastrointestinal and renal function. The inducible cyclooxygenase, COX-2, generates prostaglandins involved in inflammation. Inhibition of COX-l is thought to be associated with gastrointestinal and renal toxicity while inhibition of COX-2 provides anti-inflammatory activity. The specificity of a particular NSAID for COX-2 versus COX-1 may vary from species to species.3 In an in vitro study using canine cell cultures, carprofen demonstrated selective inhibition of COX-2 versus COX-1.4 Clinical relevance of these data has not been shown. Carprofen has also been shown to inhibit the release of several prostaglandins in two inflammatory cell systems: rat polymorphonuclear leukocytes (PMN) and human rheumatoid synovial cells, indicating inhibition of acute (PMN system) and chronic (synovial cell system) inflammatory reactions.1 Several studies have demonstrated that carprofen has modulatory effects on both humoral and cellular immune responses.5-9 Data also indicate that carprofen inhibits the production of osteoclast-activating factor (OAF), PGE1, and PGE2 by its inhibitory effects on prostaglandin biosynthesis.1


Based upon comparison with data obtained from intravenous administration, carprofen is rapidly and nearly completely absorbed (more than 90% bioavailable) when administered orally.l0 Peak blood plasma concentrations are achieved in 1-3 hours after oral administration of 1, 5, and 25 mg/kg to dogs. The mean terminal half-life of carprofen is approximately 8 hours (range 4.5-9.8 hours) after single oral doses varying from 1-35 mg/kg of body weight. After a 100 mg single intravenous bolus dose, the mean elimination half-life was approximately 11.7 hours in the dog. Carprofen is more than 99% bound to plasma protein and exhibits a very small volume of distribution.


Carprofen is eliminated in the dog primarily by biotransformation in the liver followed by rapid excretion of the resulting metabolites (the ester glucuronide of carprofen and the ether glucuronides of 2 phenolic metabolites, 7-hydroxy-carprofen and 8-hydroxy carprofen) in the feces (70-80%) and urine (10-20%). Some enterohepatic circulation of the drug is observed.



INDICATIONS:


Carprofen is indicated for the relief of pain and inflammation associated with osteoarthritis and for the control of postoperative pain associated with soft tissue and orthopedic surgeries in dogs.



CONTRAINDICATIONS:


Carprofen should not be used in dogs exhibiting previous hypersensitivity to carprofen.



PRECAUTIONS:


As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, renal and hepatic toxicity. Effects may result from decreased prostaglandin production and inhibition of the enzyme cyclooxygenase which is responsible for the formation of prostaglandins from arachidonic acid.11-14 When NSAlDs inhibit prostaglandins that cause inflammation they may also inhibit those prostaglandins which maintain normal homeostatic function. These anti-prostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease more often than in healthy patients.12,14 NSAID therapy could unmask occult disease which has previously been undiagnosed due to the absence of apparent clinical signs. Patients with underlying renal disease for example, may experience exacerbation or decompensation of their renal disease while on NSAID therapy.11-14 The use of parenteral fluids during surgery should be considered to reduce the potential risk of renal complications when using NSAlDs perioperatively.


Carprofen is an NSAID, and as with others in that class, adverse reactions may occur with its use. The most frequently reported effects have been gastrointestinal signs. Events involving suspected renal, hematologic, neurologic, dermatologic, and hepatic effects have also been reported. Patients at greatest risk for renal toxicity are those that are dehydrated, on concomitant diuretic therapy, or those with renal, cardiovascular, and/or hepatic dysfunction. Concurrent administration of potentially nephrotoxic drugs should be approached cautiously, with appropriate monitoring. Since NSAIDs possess the potential to induce gastrointestinal ulcerations and/or gastrointestinal perforations, concomitant use of carprofen and other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. If additional pain medication is needed after administration of the total daily dose of carprofen, a non-NSAID or non-corticosteroid class of analgesia should be considered. The use of another NSAID is not recommended. Sensitivity to drug-associated adverse reactions varies with the individual patient. Dogs that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Carprofen treatment was not associated with renal toxicity or gastrointestinal ulceration in well-controlled safety studies of up to ten times the dose in dogs.


Novox® Caplets is not recommended for use in dogs with bleeding disorders (e.g., Von Willebrand's disease), as safety has not been established in dogs with these disorders. The safe use of Novox® Caplets in animals less than 6 weeks of age, pregnant dogs, dogs used for breeding purposes, or in lactating bitches has not been established. Studies to determine the activity of carprofen when administered concomitantly with other protein-bound or similarly metabolized drugs have not been conducted.


Drug compatibility should be monitored closely in patients requiring additional therapy. Such drugs commonly used include cardiac, anticonvulsant and behavioral medications. It has been suggested that treatment with carprofen may reduce the level of inhalant anesthetics needed.15


If additional pain medication is warranted after administration of the total daily dose of Novox® Caplets, alternative analgesia should be considered. The use of another NSAID is not recommended. Consider appropriate washout times when switching from one NSAID to another or when switching from corticosteroid use to NSAID use.



WARNINGS:


Keep out of reach of children. Not for human use. Consult a physician in cases of accidental ingestion by humans. For use in dogs only. Do not use in cats.


All dogs should undergo a thorough history and physical examination before initiation of NSAID therapy. Appropriate laboratory tests to establish hematological and serum biochemical baseline data prior to, and periodically during, administration of any NSAID should be considered. Owners should be advised to observe for signs of potential drug toxicity (see Information for Dog Owners, Adverse Reactions, Animal Safety and Post-Approval Experience).



INFORMATION FOR DOG OWNERS:


Novox® Caplets, like other drugs of its class, is not free from adverse reactions. Owners should be advised of the potential for adverse reactions and be informed of the clinical signs associated with drug intolerance. Adverse reactions may include decreased appetite, vomiting, diarrhea, dark or tarry stools, increased water consumption, increased urination, pale gums due to anemia, yellowing of gums, skin or white of the eye due to jaundice, lethargy, incoordination, seizure, or behavioral changes.


Serious adverse reactions associated with this drug class can occur without warning and in rare situations result in death (see Adverse Reactions). Owners should be advised to discontinue Novox® Caplets therapy and contact their veterinarian immediately if signs of intolerance are observed.


The vast majority of patients with drug related adverse reactions have recovered when the signs are recognized, the drug is withdrawn and veterinary care, if appropriate, is initiated. Owners should be advised of the importance of periodic follow up for all dogs during administration of any NSAID.



ADVERSE REACTIONS:


During investigational studies of osteoarthritis with twice daily administration of 1 mg/lb, no clinically significant adverse reactions were reported. Some clinical signs were observed during field studies (n=297) which were similar for carprofen caplet- and placebo-treated dogs. Incidences of the following were observed in both groups: vomiting (4%), diarrhea (4%), changes in appetite (3%), lethargy (1.4%), behavioral changes (1 %), and constipation (0.3%). The product vehicle served as control.


There were no serious adverse events reported during clinical field studies with once daily oral administration of 2 mg/lb. The following categories of abnormal health observations were reported. The product vehicle served as control.











































Percentage of Dogs with Abnormal Health Observations Reported in Clinical Field Study (2 mg/lb once daily)
ObservationCarprofen (n=129)Placebo (n=132)
Inappetence1.61.5
Vomiting3.13.8
Diarrhea/Soft stool3.14.5
Behavior change0.80.8
Dermatitis0.80.8
PU/PD0.8--
SAP increase7.88.3
ALT increase5.44.5
AST increase2.30.8
BUN increase3.11.5
Bilirubinuria16.312.1
Ketonuria14.79.1

Clinical pathology parameters listed represent reports of increases from pre-treatment values; medical judgment is necessary to determine clinical relevance.


During investigational studies of surgical pain for the caplet formulation, no clinically significant adverse reactions were reported. The product vehicle served as control.









































Percentage of Dogs with Abnormal Health Observations Reported in Surgical Pain Field Studies with Caplets (2 mg/lb once daily)

*A single dog may have experienced more than one occurrence of an event.


Observation*Carprofen (n=148)Placebo (n=149)
Vomiting10.113.4
Diarrhea/Soft stool6.16.0
Ocular disease2.70
Inappetence1.40
Dermatitis/skin lesion2.01.3
Dysrhythmia0.70
Apnea1.40
Oral/periodontal disease1.40
Pyrexia0.71.3
Urinary tract disease1.41.3
Wound drainage1.40

Post-Approval Experience:


Although not all adverse reactions are reported, the following adverse reactions are based on voluntary post-approval adverse drug experience reporting. The categories of adverse reactions are listed in decreasing order of frequency by body system.


Gastrointestinal: Vomiting, diarrhea, constipation, inappetence, melena, hematemesis, gastrointestinal ulceration, gastrointestinal bleeding, pancreatitis.


Hepatic: Inappetence, vomiting, jaundice, acute hepatic toxicity, hepatic enzyme elevation, abnormal liver function test(s), hyperbilirubinemia, bilirubinuria, hypoalbuminemia. Approximately one-fourth of hepatic reports were in Labrador Retrievers.


Neurologic: Ataxia, paresis, paralysis, seizures, vestibular signs, disorientation.


Urinary: Hematuria, polyuria, polydipsia, urinary incontinence, urinary tract infection, azotemia, acute renal failure, tubular abnormalities including acute tubular necrosis, renal tubular acidosis, glucosuria.


Behavioral: Sedation, lethargy, hyperactivity, restlessness, aggressiveness.


Hematologic: Immune-mediated hemolytic anemia, immune-mediated thrombocytopenia, blood loss anemia, epistaxis.


Dermatologic: Pruritus, increased shedding, alopecia, pyotraumatic moist dermatitis (hot spots), necrotizing panniculitis/vasculitis, ventral ecchymosis.


Immunologic or hypersensitivity: Facial swelling, hives, erythema.


In rare situations, death has been associated with some of the adverse reactions listed above. To report a suspected adverse reaction call 1-888-708-3326.



DOSAGE AND ADMINISTRATION:


Always provide Client Information Sheet with prescription. Carefully consider the potential benefits and risk of Novox and other treatment options before deciding to use Novox. Use the lowest effective dose for the shortest duration consistent with individual response. The recommended dosage for oral administration to dogs is 2 mg/lb (4.4 mg/kg) of body weight daily. The total daily dose may be administered as 2 mg/lb of body weight once daily or divided and administered as 1 mg/lb (2.2 mg/kg) twice daily. For the control of postoperative pain, administer approximately 2 hours before the procedure. Caplets are scored and dosage should be calculated in half-caplet increments.



EFFECTIVENESS:


Confirmation of the effectiveness of carprofen for the relief of pain and inflammation associated with osteoarthritis and for the control of postoperative pain associated with soft tissue and orthopedic surgeries, was demonstrated in 5 placebo-controlled, masked studies examining the anti-inflammatory and analgesic effectiveness of carprofen in various breeds of dogs.


Separate placebo-controlled, masked, multicenter field studies confirmed the anti-inflammatory and analgesic effectiveness of carprofen when dosed at 2 mg/lb once daily or when divided and administered at 1 mg/lb twice daily. In these two field studies, dogs diagnosed with osteoarthritis showed statistically significant overall improvement based on lameness evaluations by the veterinarian and owner observations when administered carprofen at labeled doses.


Separate placebo-controlled, masked, multicenter field studies confirmed the effectiveness of carprofen for the control of postoperative pain when, dosed at 2 mg/lb once daily in various breeds of dogs. In these studies, dogs presented for ovariohysterectomy, cruciate repair and aural surgeries were administered carprofen preoperatively and for a maximum of 3 days (soft tissue) or 4 days (orthopedic) postoperatively. In general, dogs administered carprofen showed statistically significant improvement in pain scores compared to controls.



ANIMAL SAFETY STUDIES:


Laboratory studies in unanesthetized dogs and clinical field studies have demonstrated that carprofen is well tolerated in dogs after oral administration.


In target animal safety studies, carprofen was administered orally to healthy Beagle dogs at 1, 3, and 5 mg/lb twice daily (1, 3 and 5 times the recommended total daily dose) for 42 consecutive days with no significant adverse reactions. Serum albumin for a single female dog receiving 5 mg/lb twice daily decreased to 2.1 g/dL after 2 weeks of treatment, returned to the pre-treatment value (2.6 g/dL) after 4 weeks of treatment, and was 2.3 g/dL at the final 6-week evaluation. Over the 6-week treatment period, black or bloody stools were observed in 1 dog (1 incident) treated with 1 mg/lb twice daily and in 1 dog (2 incidents) treated with 3 mg/lb twice daily. Redness of the colonic mucosa was observed in 1 male that received 3 mg/lb twice daily.


Two of 8 dogs receiving 10 mg/lb orally twice daily (10 times the recommended total daily dose) for 14 days exhibited hypoalbuminemia. The mean albumin level in the dogs receiving this dose was lower (2.38 g/dL) than each of 2 placebo control groups (2.88 and 2.93 g/dL, respectively). Three incidents of black or bloody stool were observed in 1 dog. Five of 8 dogs exhibited reddened areas of duodenal mucosa on gross pathologic examination. Histologic examination of these areas revealed no evidence of ulceration, but did show minimal congestion of the lamina propria in 2 of the 5 dogs.


In separate safety studies lasting 13 and 52 weeks, respectively, dogs were administered orally up to 11.4 mg/lb/day (5.7 times the recommended total daily dose of 2 mg/lb) of carprofen. In both studies, the drug was well tolerated clinically by all of the animals. No gross or histologic changes were seen in any of the treated animals. In both studies, dogs receiving the highest doses had average increases in serum L-alanine aminotransferase (ALT) of approximately 20 IU.


In the 52-week study, minor dermatologic changes occurred in dogs in each of the treatment groups but not in the control dogs. The changes were described as slight redness or rash and were diagnosed as non-specific dermatitis. The possibility exists that these mild lesions were treatment related, but no dose relationship was observed.


Clinical field studies were conducted with 549 dogs of different breeds at the recommended oral doses for 14 days (297 dogs were included in a study evaluating 1 mg/lb twice daily and 252 dogs were included in a separate study evaluating 2 mg/lb once daily). In both studies the drug was clinically well tolerated and the incidence of clinical adverse reactions for carprofen-treated animals was no higher than placebo-treated animals (placebo contained inactive ingredients found in carprofen caplets). For animals receiving 1 mg/lb twice daily, the mean post-treatment serum ALT values were 11 IU greater and 9 IU less than pre-treatment values for dogs receiving carprofen and placebo, respectively. Differences were not statistically significant. For animals receiving 2 mg/lb once daily, the mean post-treatment serum ALT values were 4.5 IU greater and 0.9 IU less than pre-treatment values for dogs receiving carprofen and placebo, respectively. In the latter study, 3 carprofen-treated dogs developed a 3-fold or greater increase in (ALT) and/or (AST) during the course of therapy. One placebo-treated dog had a greater than 2-fold increase in ALT. None of these animals showed clinical signs associated with the laboratory value changes. Changes in clinical laboratory values (hematology and clinical chemistry) were not considered clinically significant. The 1 mg/lb twice daily course of therapy was repeated as needed at 2-week intervals in 244 dogs, some for as long as 5 years.


Clinical field studies were conducted in 297 dogs of different breeds undergoing orthopedic or soft tissue surgery. Dogs were administered 2 mg/lb of carprofen caplets two hours prior to surgery then once daily, as needed for 2 days (soft tissue surgery) or 3 days (orthopedic surgery). Carprofen was well tolerated when used in conjunction with a variety of anesthetic-related drugs. The type and severity of abnormal health observations in carprofen- and placebo-treated animals were approximately equal and few in number (see Adverse Reactions). The most frequent abnormal health observation was vomiting and was observed at approximately the same frequency in carprofen- and placebo-treated animals. Changes in clinicopathologic indices of hematopoetic, renal, hepatic, and clotting function were not clinically significant. The mean post-treatment serum ALT values were 7.3 IU and 2.5 IU less than pre-treatment values for dogs receiving carprofen and placebo, respectively. The mean post-treatment AST values were 3.1 IU less for dogs receiving carprofen and 0.2 IU greater for dogs receiving placebo.



STORAGE:


Store at controlled room temperature 15°-30°C (59° - 86°F).



HOW SUPPLIED:


Novox® Caplets are scored, and contain 25 mg, 75 mg, or 100 mg of carprofen per caplet. Each caplet size is packaged in bottles containing 30, 60, or 180 caplets.



REFERENCES:


  1. Baruth H, et al: In Anti-Inflammatory and Anti-Rheumatic Drugs, Vol. II, Newer Anti-Inflammatory Drugs, Rainsford KD, ed. CRC Press, Boca Raton, pp. 33-47, 1986.

  2. Vane JR, Botting RM: Mechanism of action of anti-inflammatory drugs. Scand J Rheumatol 25:102, pp. 9-21.

  3. Grossman CJ, Wiseman J, Lucas FS, et al: Inhibition of constitutive and inducible cyclooxygenase activity in human platelets and mononuclear cells by NSAlDs and COX-2 inhibitors. Inflammation Research 44:253-257, 1995.

  4. Ricketts AP, Lundy KM, Seibel SB: Evaluation of selective inhibition of canine cyclooxygenase 1 and 2 by carprofen and other nonsteroidal anti-inflammatory drugs. Am J Vet Res 59:11, pp. 1441-1446, November 1998.

  5. Ceuppens JL, et al: Non-steroidal anti-inflammatory agents inhibit the synthesis of IgM rheumatoid factor in vitro. Lancet 1:528, 1982.

  6. Ceuppens JL, et al: Endogenous prostaglandin E2 enhances polyclonal immunoglobulin production by ionically inhibiting T suppressor cell activity. Cell Immunol 70:41, 1982.

  7. Schleimer RP, et al: The effects of prostaglandin synthesis inhibition on the immune response. Immunopharmacology 3:205, 1981.

  8. Leung KH, et al: Modulation of the development of cell mediated immunity: possible roles of the products of cyclooxygenase and lipoxygenase pathways of arachidonic acid metabolism. Int J Immunopharmacology 4:195, 1982.

  9. Veit BC: Immunoregulatory activity of cultured-induced suppressor macrophages. Cell Immunol 72:14, 1982.

  10. Schmitt M, et al: Biopharmaceutical evaluation of carprofen following single intravenous, oral, and rectal doses in dogs. Biopharm Drug Dispos 11(7):585-94,1990.

  11. Kore AM: Toxicology of nonsteroidal anti-inflammatory drugs. Veterinary Clinics of North America, Small Animal Practice 20, March 1990.

  12. Binns SH: Pathogenesis and pathophysiology of ischemic injury in cases of acute renal failure. Compend for Cont Ed 16:1, January 1994.

  13. Boothe DM: Prostaglandins: Physiology and clinical implications. Compend for Cont Ed 6:11, November 1984.

  14. Rubin SI: Nonsteroidal anti-inflammatory drugs, prostaglandins, and the kidney. JAVMA 188:9, May 1986.

  15. Ko CH, Lange DN, Mandsager RE, et al: Effects of butorphanol and carprofen on the minimal alveolar concentration of isoflurane in dogs. JAVMA 217:1025-1028, 2000.

For a copy of the Material Safety Data Sheet (MSDS) or to report adverse reactions call Vedco, Inc. at 1-888-708-3326.


ANADA 200-498, Approved by FDA


Distributed by:

Vedco, Inc.

St. Joseph, MO 64507


®Novox is a registered trademark of Vedco, Inc.


VEDCO



Dog Owner Information about Novox® CAPLETS (carprofen) for Osteoarthritis and Post-Surgical Pain Generic name: carprofen (”car-prĂ´-fen”)


This summary contains important information about Novox® Caplets. You should read this information before you start giving your dog Novox® Caplets and review it each time the prescription is refilled. This sheet is provided only as a summary and does not take the place of instructions from your veterinarian. Talk to your veterinarian if you do not understand any of this information or if you want to know more about Novox® Caplets.


What is Novox® Caplets?


Novox® Caplets is a nonsteroidal anti-inflammatory drug (NSAID) that is used to reduce pain and inflammation (soreness) due to osteoarthritis and pain following surgery in dogs. Novox® Caplets is a prescription drug for dogs. It is available as a caplet and is given to dogs by mouth. Osteoarthritis (OA) is a painful condition caused by "wear and tear" of cartilage and other parts of the joints that may result in the following changes or signs in your dog:


  • Limping or lameness

  • Decreased activity or exercise (reluctance to stand, climb stairs, jump or run, or difficulty in performing these activities)

  • Stiffness or decreased movement of joints

To control surgical pain (e.g. for surgeries such as spays, ear procedures or orthopedic repairs) your veterinarian may administer Novox® Caplets before the procedure and recommend that your dog be treated for several days after going home.


What kind of results can I expect when my dog is on Novox® Caplets?


While Novox® Caplets is not a cure for osteoarthritis, it can relieve the pain and inflammation of OA and improve your dog's mobility.


  • Response varies from dog to dog but can be quite dramatic.

  • In most dogs, improvement can be seen in a matter of days.

  • If Novox® Caplets is discontinued or not given as directed, your dog's pain and inflammation may come back.

Who should not take Novox® Caplets?


Your dog should not be given Novox® Caplets if he/she:


  • Has had an allergic reaction to carprofen, the active ingredient of Novox® Caplets.

  • Has had an allergic reaction to aspirin or other NSAIDs (for example deracoxib, etodalac, firocoxib, meloxicam, phenylbutazone or tepoxalin) such as hives, facial swelling, or red or itchy skin.

Novox® Caplets should be given to dogs only. Cats should not be given Novox® Caplets. Call your veterinarian immediately if your cat receives Novox® Caplets. People should not take Novox® Caplets. Keep Novox® Caplets and all medicines out of reach of children. Call your physician immediately if you accidentally take Novox® Caplets.


How to give Novox® Caplets to your dog.


Novox® Caplets should be given according to your veterinarian's instructions. Your veterinarian will tell you what amount of Novox® Caplets is right for your dog and for how long it should be given. Novox® Caplets should be given by mouth and may be given with or without food.


What to tell/ask your veterinarian before giving Novox® Caplets.


Talk to your veterinarian about:


  • The signs of OA you have observed (for example limping, stiffness).

  • The importance of weight control and exercise in the management of OA.

  • What tests might be done before Novox® Caplets is prescribed.

  • How often your dog may need to be examined by your veterinarian.

  • The risks and benefits of using Novox® Caplets.

Tell your veterinarian if your dog has ever had the following medical problems:


  • Experienced side effects from Novox® Caplets or other NSAIDs, such as aspirin

  • Digestive upset (vomiting and/or diarrhea)

  • Liver disease

  • Kidney disease

  • A bleeding disorder (for example, Von Willebrand's disease)

Tell your veterinarian about:


  • Any other medical problems or allergies that your dog has now or has had.

  • All medicines that you are giving your dog or plan to give your dog, including those you can get without a prescription.

Tell your veterinarian if your dog is:


  • Pregnant, nursing or if you plan to breed your dog.

What are the possible side effects that may occur in my dog during Novox® Caplets therapy?


Novox® Caplets, like other drugs, may cause some side effects. Serious but rare side effects have been reported in dogs taking NSAIDs, including Novox® Caplets. Serious side effects can occur with or without warning and in rare situations result in death.


The most common NSAID-related side effects generally involve the stomach (such as bleeding ulcers), and liver or kidney problems. Look for the following side effects that can indicate your dog may be having a problem with Novox® Caplets or may have another medical problem:


  • Decrease or increase in appetite

  • Vomiting

  • Change in bowel movements (such as diarrhea, or black, tarry or bloody stools)

  • Change in behavior (such as decreased or increased activity level, incoordination, seizure or aggression)

  • Yellowing of gums, skin, or whites of the eyes (jaundice)

  • Change in drinking habits (frequency, amount consumed)

  • Change in urination habits (frequency, color, or smell)

  • Change in skin (redness, scabs, or scratching)

It is important to stop therapy and contact your veterinarian immediately if you think your dog has a medical problem or side effect from Novox® Caplets therapy. If you have additional questions about possible side effects, talk to your veterinarian.


Can Novox® Caplets be given with other medicines?


Novox® Caplets should not be given with other NSAIDs (for example aspirin, deracoxib, etodalac, firocoxib, meloxicam, tepoxalin) or steroids (for example cortisone, dexamethasone, prednisone, triamcinolone). Tell your veterinarian about all medicines you have given your dog in the past, and any medicines that you are planning to give with Novox® Caplets. This should include other medicines that you can get without a prescription. Your veterinarian may want to check that all of your dog's medicines can be given together.


What do I do in case my dog eats more than the prescribed amount of Novox® Caplets?


Contact your veterinarian immediately if your dog eats more than the prescribed amount of Novox® Caplets.


What else should I know about Novox® Caplets?


This sheet provides a summary of information about Novox® Caplets. If you have any questions or concerns about Novox® Caplets, or osteoarthritis, or postoperative pain, talk to your veterinarian.


As with all prescribed medicines, Novox® Caplets should only be given to the dog for which it was prescribed. It should be given to your dog only for the condition for which it was prescribed.


It is important to periodically discuss your dog's response to Novox® Caplets at regular check ups. Your veterinarian will best determine if your dog is responding as expected and if your dog should continue receiving Novox® Caplets.


To report a suspected adverse reaction call Vedco, Inc. at 1-888-708-3326.


Made in the UK

Manufactured By:

Norbrook Laboratories Limited

Newry, Northern Ireland


Distributed by:

Vedco, Inc.

St. Joseph, MO 64507


® Novox is a registered trademark of Vedco, Inc.


001762I02


VEDCO



Principal Display Panel - Bottle Label – 25 mg


NDC 50989-236-86

Novox® CAPLETS

(carprofen)

Non-steroidal anti-inflammatory drug

For oral use in dogs only

25 MG

180 CAPLETS

Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

VEDCO

ANADA #200-498, Approved by FDA




Principal Display Panel - Carton Label – 25 mg


NDC 50989-236-86

Novox® CAPLETS

(carprofen)

Non-steroidal anti-inflammatory drug

For oral use in dogs only

25 MG

180 CAPLETS

Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

VEDCO

ANADA #200-498, Approved by FDA




Principal Display Panel - Bottle Label – 75 mg


NDC 50989-238-86

Novox® CAPLETS

(carprofen)

Non-steroidal anti-inflammatory drug

For oral use in dogs only

75 MG

180 CAPLETS

Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

VEDCO

ANADA #200-498, Approved by FDA




Principal Display Panel - Carton Label – 75 mg


NDC 50989-238-86

Novox® CAPLETS

(carprofen)

Non-steroidal anti-inflammatory drug

For oral use in dogs only

75 MG

180 CAPLETS

Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

VEDCO

ANADA #200-498, Approved by FDA




Principal Display Panel - Bottle Label – 100 mg


NDC 50989-245-86

Novox® CAPLETS

(carprofen)

Non-steroidal anti-inflammatory drug

For oral use in dogs only

100 MG

180 CAPLETS

Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

VEDCO

ANADA #200-498, Approved by FDA




Principal Display Panel - Carton Label – 100 mg


NDC 50989-245-86

Novox® CAPLETS

(carprofen)

Non-steroidal anti-inflammatory drug

For oral use in dogs only

100 MG

180 CAPLETS

Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

VEDCO

ANADA #200-498, Approved by FDA










Novox 
carprofen  tablet










Product Information
Product TypePRESCRIPTION ANIMAL DRUGNDC Product Code (Source)50989-236
Route of AdministrationORALDEA Schedule    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
carprofen (carprofen)carprofen25 mg





Inactive Ingredients
Ingredient NameStrength
No Inactive Ingredients Found


















Product Characteristics
Colororange (orange)Score2 pieces
ShapeOVAL (OVAL)Size12mm
FlavorImprint Code25;mg
Contains      






























Packaging
#NDCPackage DescriptionMultilevel Packaging
150989-236-021 BOTTLE In 1 CARTONcontains a BOTTLE
130 TABLET In 1 BOTTLEThis package is contained within the CARTON (50989-236-02)
250989-236-501 BOTTLE In 1 CARTONcontains a BOTTLE
260 TABLET In 1 BOTTLEThis package is contained within the CARTON (50989-236-50)
350989-236-861 BOTTLE In 1 CARTONcontains a BOTTLE
3180 TABLET In 1 BOTTLEThis package is contained within the CARTON (50989-236-86)










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANADAANADA20049802/01/2010







Novox 
carprofen  tablet










Product Information
Product TypePRESCRIPTION ANIMAL DRUGNDC Product Code (Source)50989-238
Route of AdministrationORALDEA Schedule    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
carprofen (carprofen)carprofen75 mg





Inactive Ingredients
Ingredient NameStrength
No Inactive Ingredients Found


















Product Characteristics
Colororange (orange)Score2 pieces
ShapeOVAL (OVAL)Size15mm
FlavorImprint Code75;mg
Contains      






























Packaging
#NDCPackage DescriptionMultilevel Packaging
150989-238-021 BOTTLE In 1 CARTONcontains a BOTTLE
130 TABLET In 1 BOTTLEThis package is contained within the CARTON (50989-238-02)
250989-238-501 BOTTLE In 1 CARTONcontains a BOTTLE
260 TABLET In 1 BOTTLEThis package is contained within the CARTON (50989-238-50)
350989-238-861 BOTTLE In 1 CARTONcontains a BOTTLE
3180 TABLET In 1 BOTTLEThis package is contained within the CARTON (50989-238-86)










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANADAANADA20049802/01/2010




Novox 
carprofen  tablet










Product Information
Product TypePRESCRIPTION ANIMAL DRUGNDC Product Code (Source)50989-245
Route of AdministrationORALDEA Schedule    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
carprofen (carprofen)carprofen100 mg


Inactive Ingredients