In my neck of the woods (Boston---where there are more therapists per capita than anyplace else in the world), the ground shook when Judith Rich Harris' controversial book, The Nurture Assumption: Why Children Turn Out the Way They Do hit the stands at the local Barnes and Noble. This book suggested that if you left children in their homes and social milieus and you switched parents, it would matter little which parents they had.

Of course, all of us (therapists) had been functioning under the assumption that parents do matter, and that they have a powerful effect on the mental health of children (and later, adults). Some, of course, simply dismissed the claim as ludicrous. Years of anecdotal evidence provided by clients suggested to all of us that parents mattered a great deal. Our clients were injured; we could see that. We also knew what parents had said and done to our clients. The connection seemed obvious.

Yet, Steven Pinker of MIT (author of How the Mind Works) who I know and trust supported Harris' claim. In fact, he believed Harris' find would be one of the most important psychological discoveries of our time. With such praise, how could I simply dismiss it?

Most researchers agree that 50% of the variation in personality has genetic causes. This is no surprise to parents who have had more than one child. Children have a core temperament that appears from birth. Can a parent change an extrovert to an introvert? Probably not. It seems to me one would be constantly paddling upstream, and that more sophisticated measurement might still reveal a closet introvert.

But even if parents cannot influence whether a child is an introvert or an extrovert (or other personality variables), does this mean that individually they have little effect? Should we forget all parenting advice? Are we being good enough if we, as Harris suggests, provide the right peer group for our children and help them fit in? In order to answer these questions, I believe we must make a clear distinction between personality and mental health. If personality represents the "infrastructure" of our emotional functioning, mental health reflects, in part, how we employ that infrastructure in response to others. And here, I think, parents can have a substantial effect.

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As I have suggested in many essays on this site, parent-child relationships are replete with subtext. This subtext can be facilitating, damaging, or neutral. A person's generalized response to this subtext is carried from relationship to relationship (the psychoanalysts call this transference; another popular term is "baggage"). However, the "parents matter less" contingent suggest that this is not true: they argue that children adapt to whatever environment they are placed in, and ultimately peers are far more powerful than parents. Still, my clients who were raised by narcissistic parents tell a different story: they say their parents, not their peers, injured them by depriving them of "voice." And this lack of "voice" has affected their capacity to choose appropriate partners and to maintain satisfying relationships. Who's right?

Let me propose a study that might help answer the question. Use the standard subject pool for studies of this kind--identical twins separated at birth (and who are now adults). Conduct a psychological evaluation of the twins' adoptive mothers. Identify two subsets of mothers from within this group: 1) those that are strongly narcissistic, and 2) those that score high in empathy (i.e. capable of giving their child "voice.") Independently, have a professional, expert in the nature and quality of relationships, interview both twins about their current and past adult intimate relationships. After the interviews are completed, ask the expert to pick which twin grew up in the family with the narcissistic mother, and which grew up in the family with the empathic mother.

Could the expert pick the twin who came from the family with the narcissistic mother more than half the time (at a level that reached statistical significance) on the basis of his or her knowledge of the twin's adult relationships? In other words, did the twin's relationship with his or her narcissistic mother affect the quality (and/or choice) of his or her adult attachments in an obvious way? If so, this study would provide evidence that parents (or at least mothers—the same study could be done about fathers as well) do matter. (Of course, this is just the bare bones of a study—the measures and procedures would have to be designed carefully for purposes of validity.)

My bet is that the expert would be right most of the time. What do you think?

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Voice Lessons: Littleton, Colorado

Brand name: Mysoline

Generic name: PRIMIDONE - ORAL (PRY-meh-doan)

Uses: Primidone is used to treat a seizure disorder.

Other uses: This medication may also be used to treat tremors.

Primidone Full Prescribing Information

How to use: Take with food or milk if stomach upset occurs. The liquid form of this medication must be shaken well before measuring each dose. This medication must be taken as prescribed. Do not stop taking this drug suddenly without consulting your doctor as seizures may occur. It is important to take all doses on time to keep the level of medication in your blood constant. Take doses at evenly spaced intervals throughout the day and night.

Side effects: May cause drowsiness or sleepiness. Other side effects include stomach upset, loss of appetite, clumsiness, or fatigue. If any of these effects persist or worsen, notify your doctor. Notify your doctor if the following effects occur: seizures, double vision, fever, sore throat, skin rash. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

Precautions: Tell your doctor your medical history, especially about: liver disease, lung disease, kidney disease, porphyria (a blood disorder), any allergies. Use caution when drinking alcoholic beverages because it may add to the drowsiness effect caused by primidone. Use caution performing tasks requiring alertness such as driving or using machinery because this drug often causes drowsiness. This drug is not recommended for use during pregnancy. Consult your doctor before using this drug. This drug is excreted into breast milk, although its effects on a nursing infant are unknown. Consult your doctor before you breast-feed.

Drug interactions: Tell your doctor of all other medications you may use (both prescription and nonprescription), especially of: other seizure medications, steroids, warfarin, digoxin, griseofulvin, disulfiram, medication for depression, doxycycline, cyclosporine. Tell your doctor if you are taking any drugs that may add to primidone's drowsiness effects such as: narcotic pain medicines (e.g., codeine), muscle relaxants, alcoholic beverages, certain antihistamines (e.g., diphenhydramine). Primidone can decrease the effectiveness of birth-control pills. Consult your doctor about using other methods of birth control. Do not start or stop any medicine without doctor or pharmacist approval.

 

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Overdose: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include confusion, uncontrolled eye movement, and trouble breathing.

Notes: Do not allow anyone else to take this medication. Lab tests may be done, especially in the first few months, to check if the drug is working properly.

Missed dose: If you miss a dose, take as soon as remembered unless it is within 1 hour of your next dose. If so, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Storage: Store at room temperature between 59 and 86 degrees F (between 15 and 30 degrees C) away from moisture and sunlight. Do not store in the bathroom. Do not freeze liquid forms.

Medical alert: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

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Primidone Full Prescribing Information

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

back to: Psychiatric Medication Patient Information Index

Thoughtful quotes about enlightenment and self-discovery.

Words of Wisdom

"It is what you do daily, not occasionally, that ultimately determines your outcomes in life." (E. Edmeades)

"Some people say they haven't yet found themselves. But the self is not something one finds; it is something one creates." (Thomas Szasz)

"We must learn to reawaken and keep ourselves awake." (Thoreau)

"With enlightenment and self-awareness, we can reguide and realign our whole selves: our bodies, by finding new ways of moving and celebrating them and by adding good foods in amounts they tell us they need; our soul, our sense of ourselves as good and worthwhile, by connecting them to the earth and to each other." (Diana Roesch)

"Whatever makes us jump back seems at the very least worthy of being examined carefully for its potential usefulness." (Clarissa Pinkola Estes)

"Adventure is not outside us but within." (Eric Sloane)

"You have to leave the city of your comfort and go into the wilderness of your intuition. What you'll discover will be wonderful. What you'll discover will be yourself." (Alan Alda)

"The more I attempted to be 'me' the more 'me's I found there were." (Hugh Prather)

"The unrest you are experiencing is not individual psychological difficulty but rather, part of a widespread spiritual awakening." (Carol Osborn)

"We can be redeemed only to the extent to which we see ourselves." (Martin Buber)

"Man is a stream whose source is hidden." (Emerson)

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next: Faith

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

Generic name: Paroxetine hydrochloride
Brand name: Paxil

Pronounced: PACKS-ill

Paroxetine Full Prescription Information
Paxil Medication Guide

Why is Paxil prescribed?

Paxil relieves a variety of emotional problems. It can be prescribed for serious, continuing depression that interferes with your ability to function. Symptoms of this type of depression often include changes in appetite and sleep patterns, a persistent low mood, loss of interest in people and activities, decreased sex drive, feelings of guilt or worthlessness, suicidal thoughts, difficulty concentrating, and slowed thinking.

Paxil is also used to treat obsessive-compulsive disorder (OCD), a disease marked by unwanted, but stubbornly persistent thoughts, or unreasonable rituals you feel compelled to repeat.

In addition, Paxil is prescribed for panic disorder, a crippling emotional problem characterized by sudden attacks of at least four of the following symptoms: palpitations, sweating, shaking, numbness, chills or hot flashes, shortness of breath, a feeling of choking, chest pain, nausea or abdominal distress, dizziness or faintness, feelings of unreality or detachment, fear of losing control, or fear of dying.

Paxil can be prescribed for generalized anxiety disorder, a disease marked by excessive anxiety and worry that persists for at least 6 months and can't be easily controlled. True cases of generalized anxiety disorder are accompanied by at least three of the following symptoms: restlessness or a keyed-up or on-edge feeling, a tendency to tire easily, difficulty concentrating or spells when the mind goes blank, irritability, muscle tension, or sleep disturbance.

Paxil can be used in the treatment of social anxiety disorder (also known as social phobia), a condition marked by shyness or stage fright so intense that it interferes with an individual's work and social life.

Paxil is also prescribed for posttraumatic stress disorder--a crippling condition that sometimes develops in reaction to a disastrous or horrifying experience. Symptoms, which stubbornly refuse to abate, include unwanted memories and dreams, intense distress when confronted with reminders of the event, a general numbing of interest and enjoyment, jumpiness, irritability, poor sleep, and loss of concentration.

 

Most important fact about Paxil

Your symptoms may seem to improve within 1 to 4 weeks after beginning treatment with Paxil. Even if you feel better, continue to take the medication as long as your doctor tells you to do so.

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How should you take Paxil?

Paxil is taken once a day, with or without food, usually in the morning. Inform your doctor if you are taking or plan to take any prescription or over-the-counter drugs, since they may interact unfavorably with Paxil.

Shake the oral suspension well before using.

--If you miss a dose...

Skip the forgotten dose and go back to your regular schedule with the next dose. Do not take a double dose to make up for the one you missed.

--Storage instructions...

Paxil tablets and suspension can be stored at room temperature.

What side effects may occur with Paxil?

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

Over a 4 to 6 week period, you may find some side effects less troublesome (nausea and dizziness, for example) than others (dry mouth, drowsiness, and weakness).

• More common side effects may include: Abnormal ejaculation, abnormal orgasm, constipation, decreased appetite, decreased sex drive, diarrhea, dizziness, drowsiness, dry mouth, gas, impotence, male and female genital disorders, nausea, nervousness, sleeplessness, sweating, tremor, weakness, vertigo

• Less common side effects of Paxil may include: Abdominal pain, abnormal dreams, abnormal vision, agitation, altered taste sensation, blurred vision, burning or tingling sensation, drugged feeling, emotional instability, headache, increased appetite, infection, itching, joint pain, muscle tenderness or weakness, pounding heartbeat, rash, ringing in ears, sinus inflammation, tightness in throat, twitching, upset stomach, urinary disorders, vomiting, weight gain, vertigo, yawning

• Rare side effects may include: Abnormal thinking, acne, alcohol abuse, allergic reaction, asthma, belching, blood and lymph abnormalities, breast pain, bronchitis, chills, colitis, difficulty swallowing, dry skin, ear pain, exaggerated sense of well-being, eye pain or inflammation, face swelling, fainting, generally ill feeling, hair loss, hallucinations, heart and circulation problems, high blood pressure, hostility, hyperventilation, increased salivation, increased sex drive, inflamed gums, inflamed mouth or tongue, lack of emotions, menstrual problems, migraine, movement disorders, neck pain, nosebleeds, paranoid and manic reactions, poor coordination, respiratory infections, sensation disorders, shortness of breath, skin disorders, stomach inflammation, swelling, teeth grinding, thirst, urinary disorders, vaginal inflammation, vision problems, weight loss

Why should Paxil not be prescribed?

Dangerous and even fatal reactions are possible when Paxil is combined with thioridazine (Mellaril) or drugs classified as monoamine oxidase (MAO) inhibitors, such as the antidepressants Nardil and Parnate. Never take Paxil with any of these medications, or within 2 weeks of starting or stopping use of an MAO inhibitor. You'll also need to avoid Paxil if it gives you an allergic reaction.

Special warnings about Paxil

Paxil should be used cautiously by people with a history of manic disorders and those with high pressure in the eyes (glaucoma).

If you have a history of seizures, make sure your doctor knows about it. Paxil should be used with caution in this situation. If you develop seizures once therapy has begun, the drug should be discontinued.

If you have a disease or condition that affects your metabolism or blood circulation, make sure your doctor is aware of it. Paxil should be used cautiously in this situation.

Paxil may impair your judgment, thinking, or motor skills. Do not drive, operate dangerous machinery, or participate in any hazardous activity that requires full mental alertness until you are sure the medication is not affecting you in this way.

It's best to avoid an abrupt discontinuation of Paxil therapy. It can lead to symptoms such as dizziness, abnormal dreams, and tingling sensations. To prevent such problems, your doctor will reduce your dose gradually.

Possible food and drug interactions when taking Paxil

Remember that Paxil must never be combined with Mellaril or MAO inhibitors such as Nardil and Parnate.

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

Alcohol Antidepressants such as Elavil, Tofranil, Norpramin, Pamelor, Prozac
Cimetidine (Tagamet)
Diazepam (Valium)
Digoxin (Lanoxin)
Flecainide (Tambocor)
Lithium (Eskalith)
Phenobarbital Phenytoin (Dilantin)
Procyclidine (Kemadrin)
Propafenone (Rythmol)
Propranolol (Inderal, Inderide)
Quinidine (Quinaglute)
Sumatriptan (Imitrex)
Tryptophan
Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding

The effects of Paxil during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Paxil appears in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with Paxil is finished.

Recommended dosage for Paxil

DEPRESSION

The usual starting dose is 20 milligrams a day, taken as a single dose, usually in the morning. At intervals of at least 1 week, your physician may increase your dosage by 10 milligrams a day, up to a maximum of 50 milligrams a day.

OBSESSIVE-COMPULSIVE DISORDER

The usual starting dose is 20 milligrams a day, typically taken in the morning. At intervals of at least 1 week, your doctor may increase the dosage by 10 milligrams a day. The recommended long-term dosage is 40 milligrams daily. The maximum is 60 milligrams a day.

PANIC DISORDER

The usual starting dose is 10 milligrams a day, taken in the morning. At intervals of 1 week or more, the doctor may increase the dose by 10 milligrams a day. The target dose is 40 milligrams daily; dosage should never exceed 60 milligrams.

GENERALIZED ANXIETY DISORDER

The recommended dose is 20 milligrams taken once a day, usually in the morning.

SOCIAL ANXIETY DISORDER

The recommended dose is 20 milligrams taken once a day, usually in the morning. For older adults, the weak, and those with severe kidney or liver disease, starting doses are reduced to 10 milligrams daily, and later doses are limited to no more than 40 milligrams a day. Safety and effectiveness in children have not been established.

POSTTRAUMATIC STRESS DISORDER

The recommended dose is 20 milligrams taken once a day, usually in the morning.

Overdosage of Paxil

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

The symptoms of Paxil overdose may include: Coma, dizziness, drowsiness, facial flushing, nausea, sweating, tremor, vomiting

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Paroxetine Full Prescription Information
Paxil Medication Guide

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

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

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

back to: Psychiatric Medication Patient Information Index

Piportil, used to treat Schizophrenia, contains a medication called pipotiazine palmitate. This belongs to a group of medicines called 'phenothiazines'. It works by blocking the effect of a chemical in the brain.

Piportil® Depot 5% w/v Solution for Injection
Pipotiazine palmitate
Is this leaflet hard to see or read?
Phone 01483 505515 for help

Read all of this leaflet carefully before you start using this medicine

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, nurse or pharmacist.
• If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor, nurse or pharmacist.

In this leaflet:

1. What Piportil is and what it is used for
2. Before you are given Piportil
3. How Piportil is given
4. Possible side effects
5. How to store Piportil
6. Further information

 

1. What Piportil is and what it is used for

Piportil contains a medicine called pipotiazine palmitate. This belongs to a group of medicines called 'phenothiazines'. It works by blocking the effect of a chemical in the brain.

Piportil can be used for:

• Schizophrenia - this illness can make you feel, see or hear things which do not exist, have strange and frightening thoughts, change how you act and make you feel alone. Sometimes people with these symptoms may also feel tense, anxious or depressed
• Paranoid psychoses - this illness may make you feel very anxious or afraid for your own well-being. You may also think that other people are 'out to get you' when they are not

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2. Before you are given Piportil

Do not have this medicine and tell your doctor if:

• You are allergic (hypersensitive) to pipotiazine, other phenothiazine medicines or the other ingredient of Piportil (listed in Section 6 below) Signs of an allergic reaction include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue
• You have a blocked artery in the brain
• You have a tumour on the adrenal gland called a 'phaeochromocytoma'
• You have liver or kidney problems
• You have severe heart problems

Do not have this medicine if any of the above apply to you. If you are not sure, talk to your doctor or nurse before being given Piportil. You should not be given Piportil if you are in a coma.

Take special care with Piportil
Check with your doctor or nurse before you have this medicine if:

• You have or have ever had severe breathing problems
• You have or have ever had an enlarged prostate gland
• You have or have ever had problems with your thyroid gland
• You have brain damage
• You have Parkinson's disease
• You have epilepsy or have had fits (seizures)
• Your doctor has told you that you might have a stroke
• You or members of your family have ever had glaucoma (painful eyes with blurred vision)
• You have a form of muscle weakness called 'myasthenia gravis'
• You have low blood levels of potassium, magnesium or calcium. Your doctor may do a blood test to check on these
• You have previously taken other phenothiazine medicines such as chlorpromazine and have ever had side effects when you suddenly stopped taking them
• You have suddenly stopped drinking alcohol and are having signs of withdrawal. This may happen if you suddenly stop after drinking large amounts for a long time, or stop after a period of very heavy drinking
• You are not eating properly
• You are elderly, particularly during very hot or very cold weather

If you are not sure if any of the above applies to you, talk to your doctor or nurse before being given Piportil.

Taking other medicines
Please tell your doctor or nurse if you are taking or have recently taken any other medicines. This includes medicines you buy without a prescription, including herbal medicines. This is because Piportil can affect the way some other medicines work. Also some medicines can affect the way Piportil works.

In particular, do not have this medicine and tell your doctor if you are taking:

• Clozapine - used for mental illness, such as schizophrenia and psychoses

The following medicines can increase the chance of you getting side effects, when taken with Piportil:

• Medicines to control your heartbeat (such as amiodarone, disopyramide or quinidine)
• Some medicines for high blood pressure or prostate problems (such as doxazosin or terazosin)
• Some medicines for severe pain (such as morphine, codeine or pethidine)
• Medicines to help you sleep (sedatives)
• Medicines for depression
• Other medicines used to calm emotional and mental problems (such as olanzapine or prochlorperazine)
• Desferrioxamine - used when you have too much iron in your blood
• Sibutramine - used for weight loss
• Tetrabenazine - used for muscle tremors or tics
• Adrenaline - used for life threatening allergic reactions
• Lithium - used for some types of mental illness
• Anti-cholinergic medicines - includes some medicines for irritable bowel syndrome, asthma or incontinence
• Anaesthetics
• Water tablets (diuretics)

The following medicines can affect the way Piportil works or Piportil can affect the way some of these medicines work:

• Medicines for Parkinson's disease (such as levodopa, apomorphine, pergolide, lisuride, bromocriptine or cabergoline)
• Medicines for indigestion and heartburn (antacids)
• Medicines for diabetes
• Amfetamines - used for Attention Deficit Hyperactivity Disorder (ADHD)
• Guanethidine - used for high blood pressure
• Clonidine - used for migraines or high blood pressure
• Cimetidine - used for stomach ulcers
• Ritonavir - used for HIV infections
• Kaolin - used for diarrhoea

Having Piportil with food and drink
Do not drink alcohol while you are having Piportil. This is because alcohol can increase the effects of Piportil and cause serious breathing problems.

Pregnancy and breast-feeding
Talk to your doctor before having this medicine if you are pregnant, might become pregnant, or think you may be pregnant.
You should not breast-feed if you are having Piportil. This is because small amounts may pass into mothers' milk. If you are breast-feeding or planning to breast-feed, talk to your doctor or pharmacist before having this medicine.
Ask your doctor or nurse for advice before taking any medicine if you are pregnant or breast-feeding.

Driving and using machines

You may feel sleepy after having this medicine. If this happens, do not drive or use any tools or machines.

Important information about some of the ingredients of Piportil
Piportil contains sesame oil. This may cause severe allergic (hypersensitivity) reactions. The chances of this happening are rare. Tell a doctor or nurse straight away if you get a rash, swallowing or breathing problems and swelling of your lips, face, throat or tongue.

3. How Piportil is given

Piportil is normally given by a doctor or nurse. This is because it needs to be given as a deep injection into a muscle.

How much Piportil is given
If you are not sure why you are being given Piportil or have any questions about how much Piportil is being given to you, speak to your doctor or nurse. The usual dose is:
Adults Piportil is given every 4 weeks.

• Your first dose will be 25mg
• This may be increased up to a maximum dose of 200mg
• The usual dose is 50 to 100mg given every 4 weeks

Elderly Your doctor will start you on a lower dose of 5 to 10mg
Children Piportil should not be given to children.

Exposure to sunlight
Piportil can make your skin more sensitive to sunlight. Keep out of direct sunlight while having this medicine.

Tests
Before and during treatment your doctor may want to carry out some tests. These might include blood tests and an ECG to check your heart is working properly.

If you have more Piportil than you should
It is unlikely that your doctor or nurse will give you too much medicine. Your doctor and nurse will monitor your progress, and check the medicine you are given. Ask them if you are not sure why you are getting a dose of medicine.
Having too much Piportil may make you feel drowsy and you may become unconscious. You may also feel very cold, have a fast or irregular heartbeat or severe muscle spasms. If you start getting any of these symptoms tell your doctor or nurse straight away. If you are away from the hospital, return straight away and speak to your doctor or nurse or go to the casualty department.

If you miss a dose of Piportil
Your doctor or nurse will have instructions on when to give you this medicine. It is unlikely that you will not be given the medicine as it has been prescribed. However, if you do think you have missed a dose, tell your doctor or nurse.

If you stop having Piportil
Keep having Piportil until your doctor tells you to stop. If you stop having Piportil, your illness may come back and you may have other effects after stopping such as feeling or being sick, sweating and difficulty sleeping. You may also get tics (such as muscle spasms in your face, rolling eyes, jerking muscles) or feel restless.

4. Possible side effects

Like all medicines, Piportil can cause side effects, although not everybody gets them.

Tell a nurse or doctor straight away if you have:

• An allergic reaction. The signs may include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue
• Yellowing of the skin or eyes (jaundice)
• A sudden high temperature or an infection due to low numbers of white blood cells. These could be signs of a problem called 'leucopenia'
• You have a high temperature, sweating, stiff muscles, fast heartbeat, fast breathing and feel confused, drowsy or agitated. These could be signs of a serious side effect called 'neuroleptic malignant syndrome'
• An uneven or fast heartbeat
• Breathing problems such as feeling wheezy, short of breath and tightness in the chest
• Movements that you cannot control of the tongue, mouth, jaw, arms and legs

Tell a nurse or doctor as soon as possible if you have any of the following side effects:

• Breathing problems
• Changes in skin or eye colour after having Piportil for a long time
• Feeling dizzy, light-headed or faint when you stand or sit up quickly (due to low blood pressure)
• Feeling restless and unable to sit still
• Rigid or stiff muscles, trembling or shaking, difficulty moving

Talk to your doctor or nurse if any of the following side effects gets serious or lasts longer than a few days:

• Feeling drowsy, especially at the start of treatment
• Abnormal production of breast milk in men and women
• Breast enlargement in men
• Loss of menstrual periods
• Difficulty in getting or keeping an erection (impotence)
• Difficulty sleeping (insomnia)
• Feeling agitated
• Dry mouth
• Weight gain
• Being more sensitive to the sun than usual
• Stuffy nose
• Skin rashes

Talk to your doctor or nurse if any of the side effects gets serious or lasts longer than a few days, or if you notice any side effects not listed in this leaflet.
As with other phenothiazine medicines, there have been very rare reports of sudden death with Piportil. These are possibly caused by heart problems.

5. How to store Piportil

This medicine will be kept by your doctor or pharmacist in a safe place where children cannot see or reach it. Store protected from light.
Do not use Piportil after the expiry date, which is stated on the ampoule and the carton. The expiry date refers to the last day of the month.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6. Further information

What Piportil contains

• Each 1ml of the injection contains 50mg of the active substance, pipotiazine palmitate
• The other ingredient is sesame oil which contains an antioxidant called butylhydroxyanisole (E320)

What Piportil looks like and contents of the pack
Piportil® Depot Injection 5%w/v is a yellow liquid supplied in 10 x 1ml and 10 x 2ml clear glass ampoules.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder
Sanofi-aventis
One Onslow Street
Guildford
Surrey
GU1 4YS
UK
Tel:01483 505515
Fax:01483 535432

email:uk-medicalinformation@sanofi-aventis.com

Manufacturer
Aventis Pharma Ltd
Dagenham
Essex
RM10 7XS
UK

This leaflet does not contain all the information about your medicine. If you have any questions or are not sure about anything, ask your doctor or pharmacist.

This leaflet was last revised in May 2007

© Sanofi-aventis 2007

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Last updated: 05/07

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

back to: Psychiatric Medication Patient Information Index

Brand Name: Orap
Generic Name: Pimozide

Orap, Pimozide is for treatment of tics caused by Tourette's Syndrome, management of chronic psychosis in schizophrenia patients (in Europe). Usage, dosage, side effects of Orap.

Orap (Pimozide) Prescribing Information (PDF)

Contents:

Description
Pharmacology
Indications and Usage
Contraindications
Warnings
Precautions
Drug Interactions
Adverse Reactions
Overdose
Dosage
Supplied

Description

Pimozide (Orap) helps to lessen the muscle and speech tics that are caused by Tourette's syndrome. Pimozide can also treat conditions that may cause you to hear or see things that others do not.

Pharmacology

An antipsychotic, Pimozide (Orap) posesses neuroleptic properties that have been found to be useful in the management of chronic schizophrenic patients. It is relatively non-sedating and can be administered in a single daily dose.

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Indications and Usage

The management of the manifestations of chronic schizophrenia in which the main manifestations do not include excitement, agitation or hyperactivity. Pimozide has relatively little sedative action and can be used as a once daily medication.

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Contraindications

Pimozide is not indicated in the management of patients with mania or acute schizophrenia.

 

CNS depression, comatose states, liver disorders, renal insufficiency, blood dyscrasias, and in individuals who have previously displayed hypersensitivity to the drug. It should not be used in depressive disorders or Parkinson's syndrome.

Contraindicated in patients with congenital long QT syndrome, patients with a history of cardiac arrhythmias, or patients taking other drugs which prolong the QT interval of the ECG.

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Warnings

Visit your prescriber or health care professional for regular checks on your progress. It may be several weeks before you see the full effects of pimozide. Do not suddenly stop taking pimozide. You may need to gradually reduce the dose. Only stop taking pimozide on your prescriber's advice.

You may get dizzy or drowsy. Do not drive, use machinery, or do anything that needs mental alertness until you know how pimozide affects you. Alcohol can increase dizziness and drowsiness. Avoid alcoholic drinks.

Do not drink grapefruit juice products while taking pimozide. An ingredient in grapefruit juice can increase the chance of developing serious heart problems from pimozide.

If you are going to have surgery tell your prescriber or health care professional that you are taking pimozide.

Pregnancy and Lactation:
The safety of use of pimozide in pregnancy and lactation has not been established. Therefore, it should not be administered to nursing mothers or to women of child-bearing potential, particularly during the first trimester of pregnancy, unless, in the opinion of the physician, the expected benefits of the drug to the patient outweigh the potential risk to the fetus or child.

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Precautions

Clinical trials with pimozide (orap) indicate that it is not effective in, and therefore should not be used in the management of, manifestations of chronic schizophrenia in which the main symptoms include agitation, excitement and anxiety.

Sudden, unexpected deaths have occurred with pimozide, mainly at doses above 20 mg/day. ECG changes have been reported in association with the use of pimozide.

Jaundice of the cholestatic type of hepatitis or liver damage have been reported with other antipsychotics; therefore, administer pimozide with caution to patients with liver disease.

Tardive Dyskinesia:
Tardive dyskinesia is known to occur in patients treated with antipsychotic drugs and other drugs with substantial antipsychotic activity. Although the dyskinetic syndrome may remit partially or completely if the medication is withdrawn, it is irreversible in some patients. At the present time there is uncertainty as to whether antipsychotic drugs differ in their potential to cause tardive dyskinesia.

Since there is a significant prevalence of this syndrome associated with the use of antipsychotic drugs, and since there is no known effective treatment, chronic use of these drugs should generally be restricted to patients for whom antipsychotics are known to be effective and for whom there is no alternative therapy available with better risk acceptability. If manifestations of tardive dyskinesia are detected during the use of a neuroleptic, the drug should be discontinued.

The risk of a patient developing tardive dyskinesia and of the syndrome becoming irreversible appear to increase with the duration of treatment and the total amount of drugs administered, although, in some instances, tardive dyskinesia may develop after relatively short periods of treatment at low doses. The risk of developing tardive dyskinesia may, therefore, be minimized by reducing the dose of the antipsychotic drug used and its duration of administration, consistent with the effective management of the patient's condition. Continued use of antipsychotics should be periodically reassessed.

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Drug Interactions

BEFORE USING THIS MEDICINE: INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. Also tell your prescriber or health care professional if you are a frequent user of grapefruit juice, drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

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Adverse Reactions

Side effects that you should report to your prescriber or health care professional as soon as possible:

Rare or uncommon: Side effects that you should report to your prescriber or health care professional as soon as possible:

• change in emotion or behavior such as feeling depressed, angry, or anxious
• change in vision - difficulty breathing
• difficulty swallowing
• fast or irregular heartbeat (palpitations)
• fever - inability to control muscle movements in the face, hands, arms, or legs
• increased thirst
• loss of balance or difficulty walking
• menstrual changes
• rash - seizures
• stiff muscles or jaw
• seizures
• sexual difficulties
• skin rash
• spasms of the face, tongue, or mouth
• uncontrollable tongue or mouth movements

More common:

• dizziness or lightheadedness
• restlessness or need to keep moving
• tremors or trembling

Other Side Effects:

The following additional adverse reactions have been reported:

• changes in sexual desire
• constipation
• difficulty sleeping
• difficulty urinating
• excessive watering or drooling of mouth
• headache -nausea or vomiting
• trouble in controlling urine
• weight gain More Common
• dizziness; especially on standing from a sitting or lying position
• drowsiness
• dry mouth
• weight loss.

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Overdose

Signs and Symptoms

In general, the signs and symptoms of overdosage with pimozide would be an exaggeration of known pharmacologic effects and adverse reactions, the most prominent of which would be: ECG abnormalities, severe extrapyramidal reactions, hypotension, and a comatose state with respiratory depression. The risk of cardiac arrhythmias should be considered.

Treatment

Establish and maintain an airway to ensure adequate ventilation and oxygenation. Gastric lavage should be considered. Cardiac and vital sign monitoring are recommended, along with general symptomatic and supportive measures. Because of the long half-life of pimozide, patients who take an overdose should be observed for at least 4 days.

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Dosage

HOW TO USE THIS MEDICINE:

DO NOT EXCEED THE RECOMMENDED DOSE or take this medicine for longer than prescribed.

Do not drink alcoholic beverages or grapefruit juice products while taking pimozide, orap.

• Follow the directions for using this medicine provided by your doctor.
• Orap, Pimozide should be administered once daily, in the morning with or without food. Follow the directions on the prescription label.
• Store this medicine at room temperature, away from heat and light.
• If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take double or extra doses. Follow your prescriber or health care professional's advice on missed doses.
• Do not stop taking this medicine without first checking with your doctor.

Adults: The initial recommended dose in patients with chronic schizophrenia for whom pimozide might be indicated is: 2 to 4 mg once daily, with weekly increments of 2 to 4 mg until a satisfactory level of therapeutic effect is attained or excessive adverse effects occur. Average maintenance dose: 6 mg daily; usual range is 2 to 12 mg/day. Daily doses above 20 mg are not recommended.

Additional Information:: Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children.

IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out.

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How Supplied

Each round, hard, uncoated tablet, scored on one side and imprinted "McNEIL" on the other, contains: Pimozide 2 mg (white), 4 mg (green), or 10 mg (peach). Also contains tartrazine (4 mg). Energy: 2 mg: 1.784 kJ (0.424 kcal); 4 mg: 1.750 kJ (0.415 kcal); 10 mg: 6.208 kJ (1.474 kcal). Sodium: <1 mmol (<1 mg)/tablet. Bottles of 100.

All tablets also contain lactose and are gluten-free and sodium metabisulfite-free. Store in well-closed containers.

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The information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse. Last updated 3/03.

Copyright © 2007 Healthyplace Inc. All rights reserved.

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Orap (Pimozide) Prescribing Information (PDF)

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Find out why Zyprexa (Olanzapine) is prescribed, side effects of Zyprexa, Zyprexa warnings, effects of Zyprexa during pregnancy, more - in plain English.

Generic name: Olanzapine
Brand name: Zyprexa

Pronounced: Zye-PRECKS-ah

Full Zyprexa Prescribing Information

Why is Zyprexa prescribed?

Zyprexa helps manage symptoms of schizophrenia, the manic and mixed phases of bipolar disorder, and other psychotic disorders. Zyprexa may also be used with lithium or valproate for short-term treatment of acute manic episodes of bipolar disorder.

Zyprexa is thought to work by opposing the action of serotonin and dopamine, two of the brain's major chemical messengers. The drug is available as Zyprexa tablets and Zyprexa Zydis, which dissolves rapidly with or without liquid.

Most important fact about Zyprexa

At the start of Zyprexa therapy, the drug can cause extreme low blood pressure, increased heart rate, dizziness, and, in rare cases, a tendency to faint when first standing up. These problems are more likely if you are dehydrated, have heart disease, or take blood pressure medicine. To avoid such problems, your doctor may start with a low dose of Zyprexa and increase the dosage gradually.

How should you take Zyprexa?

Zyprexa should be taken once a day with or without food. To use Zyprexa Zydis, open the sachet, peel back the foil on the blister pack, remove the tablet, and place the entire tablet in the mouth. Do not push the tablet through the foil. The medication can be taken with or without water; the saliva in your mouth will cause the tablet to dissolve.

 

--If you miss a dose...

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

--Storage instructions...

Store at room temperature away from light and moisture.

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What side effects may occur with Zyprexa?

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

• More common side effects of Zyprexa may include: Abdominal pain, abnormal gait, accidental injury, agitation, anxiety, back pain, behavior problems, blood in urine, blurred vision, chest pain, constipation, cough, dehydration, dizziness, drowsiness, dry mouth, extreme low blood pressure, eye problems, feeling of well-being, fever, headache, high blood pressure, hostility, increased appetite, increased cough, indigestion, inflammation of the nasal passages and throat, insomnia, joint pain, movement disorders, muscle rigidity, nausea, nervousness, pain in arms and legs, rapid heartbeat, restlessness, tension, tremor, weakness, weight gain

• Less common side effects may include: Abnormal dreams, decreased sex drive, dental pain, diabetes, difficulty breathing, emotional instability, eye infection, increased salivation, intentional injury, involuntary movement, joint stiffness, low blood pressure, menstrual irregularities, nasal stuffiness, sleepiness, sore throat, suicide attempts, sweating, swelling of arms and legs, thirst, twitching, urinary problems, vaginal infection, vomiting

• Rare side effects may include: Abnormal ejaculation, black bowel movements, bleeding, blood clots, bone pain, breast growth in males, breast pain, burping, chills, congestive heart failure, difficulty swallowing, dry eyes, dry skin, ear pain, change in taste sensation, enlarged abdomen, fever, gas, stomach upset, hair loss, hangover feeling, heart attack, inability to control bowel movements, migraine, mouth sores, neck pain, neck rigidity, osteoporosis, pallor, rash, rectal bleeding, rheumatoid arthritis, ringing in the ears, sensitivity to light, stroke, sudden death, swelling of face, swollen gums, yeast infection

Why should Zyprexa not be prescribed?

If Zyprexa gives you an allergic reaction, you cannot take the drug.

Special warnings about Zyprexa

Increased chance of death in elderly persons. Elderly patients treated with atypical antipsychotics, such as Zyprexa, for dementia had a higher chance for death than patients who did not take the medicine. Zyprexa is not approved for dementia.

Drugs such as Zyprexa sometimes cause a condition called Neuroleptic Malignant Syndrome. Symptoms include high fever, muscle rigidity, irregular pulse or blood pressure, rapid heartbeat, excessive perspiration, and changes in heart rhythm. If these symptoms appear, your doctor will have you stop taking Zyprexa while the condition is under treatment.

There is also a risk of developing tardive dyskinesia, a condition marked by slow, rhythmical, involuntary movements. This problem is more likely to surface in older adults, especially elderly women. When it does, use of Zyprexa is usually stopped.

High blood sugar and diabetes. Patients with diabetes or who have a higher chance for diabetes should have their blood sugar checked often.

Strokes have happened in older patients treated for mental illness from dementia. Zyprexa is not approved for this use.

Zyprexa sometimes causes drowsiness and can impair your judgment, thinking, and motor skills. Use caution while driving and don't operate dangerous machinery until you know how the drug affects you.

Medicines such as Zyprexa can interfere with regulation of the body's temperature. Do not get overheated or become dehydrated while taking Zyprexa. Avoid extreme heat and drink plenty of fluids.

Use Zyprexa with caution if you have any of the following conditions: Alzheimer's disease, Parkinson's disease, trouble swallowing, narrow angle glaucoma (high pressure in the eye), an enlarged prostate, heart irregularities, heart disease, heart failure, liver disease, or a history of heart attack, seizures, or intestinal blockage.

If you have a child with phenylketonuria (the inability to process phenylalanine, a condition that quickly leads to mental retardation) you should be aware that Zyprexa contains this substance.

Possible food and drug interactions when taking Zyprexa

 

Avoid alcohol while taking Zyprexa. The combination can cause a sudden drop in blood pressure.

If Zyprexa is taken with certain other drugs, the effects of either can be increased, decreased, or altered. Ask your doctor before taking any prescription or over-the-counter drugs. It is especially important to check before combining Zyprexa with the following: Blood pressure medications Carbamazepine (Tegretol) Diazepam (Valium) Drugs that boost the effect of dopamine, such as the Parkinson's medications Mirapex, Parlodel, Permax, and Requip Fluvoxamine (Luvox) Levodopa (Larodopa) Omeprazole (Prilosec) Rifampin (Rifadin, Rimactane)

Special information if you are pregnant or breastfeeding

If you are pregnant or plan to become pregnant, inform your doctor immediately. Zyprexa should be used during pregnancy only if absolutely necessary. The drug may appear in breast milk; do not breastfeed while on Zyprexa therapy.

Recommended dosage for Zyprexa

ADULTS

Schizophrenia

The usual starting dose is 5 to 10 milligrams once a day. If you start at the lower dose, after a few days the doctor will increase it to 10. After that, the dosage will be increased no more than once a week, 5 milligrams at a time, up to a maximum of 20 milligrams a day.

Those most likely to start at 5 milligrams are the debilitated, people prone to low blood pressure, and nonsmoking women over 65 (because they tend to have a slow metabolism).

Manic Episodes in Manic-Depression

The usual starting dose is 10 to 15 milligrams once a day. The drug is typically taken for no more than 3 or 4 weeks at a time.

Overdosage of Zyprexa

An overdose of Zyprexa is usually not life-threatening, but fatalities have been reported. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Zyprexa overdose may include: Agitation, drowsiness, rapid or irregular heartbeat, slurred or disrupted speech, stupor.

Overdoses of Zyprexa have also led to breathing difficulties, changes in blood pressure, excessive perspiration, fever, muscle rigidity, cardiac arrest, coma, and convulsions.

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Full Zyprexa Prescribing Information

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Find out why Pamelor (Nortriptyline) is prescribed, side effects of Pamelor, Pamelor warnings, effects of Pamelor during pregnancy, more - in plain English.

Generic name: Nortriptyline hydrochloride
Brand names: Aventyl, Pamelor

Aventyl (nortriptyline hcl) Full Prescribing Information

Pamelor (nortriptyline hcl) Full Prescribing Information

Why Is Nortriptyline Prescribed?

Nortriptyline is used to treat depression. Nortriptyline is in a group of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.

How Should Nortriptyline Be Used?

Nortriptyline comes as a capsule and an oral liquid to take by mouth. It is usually taken one to four times a day and may be taken with or without food. Take nortriptyline at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nortriptyline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of nortriptyline and gradually increase your dose.

Continue to take nortriptyline even if you feel well. Do not stop taking nortriptyline without talking to your doctor. If you suddenly stop taking nortriptyline, you may experience withdrawal symptoms such as headache, nausea, and weakness. Your doctor will probably want to decrease your dose gradually.

Other Uses for This Medicine

Nortriptyline is also sometimes used to treat panic disorders and post-herpetic neuralgia (the burning, stabbing pains, or aches that may last for months or years after a shingles infection). Nortriptyline is also sometimes used to help people stop smoking. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information

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What special precautions should I follow?

Before taking nortriptyline,

• tell your doctor and pharmacist if you are allergic to nortriptyline and other tricyclic antidepressants such as desipramine (Norpramin), clomipramine (Anafranil), imipramine (Tofranil), trimipramine (Surmontil),any other medications, or any of the ingredients in nortriptyline capsules or liquid. Ask your doctor or pharmacist for a list of the ingredients.
• tell your doctor if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have stopped taking an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take nortriptyline. If you stop taking nortriptyline, you should wait at least 14 days before you start to take an MAO inhibitor.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven); antihistamines; chlorpropamide (Diabinese); cimetidine (Tagamet); flecainide (Tambocor); guanethidine (Ismelin); lithium (Eskalith, Lithobid); medication for high blood pressure, seizures, Parkinson's disease, diabetes, asthma, nausea, mental illness, colds, or allergies; methylphenidate (Ritalin); muscle relaxants; propafenone (Rhythmol); quinidine; sedatives; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft);sleeping pills; thyroid medication; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have recently had a heart attack. Your doctor may tell you not to take nortriptyline.
• tell your doctor if you have or have ever had an enlarged prostate (a male reproductive gland), difficulty urinating, diabetes, seizures, schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), an overactive thyroid gland, or liver, kidney, or heart disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking nortriptyline, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking nortriptyline.
• you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• talk to your doctor about the safe use of alcohol while you are taking this medication.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Nortriptyline may make your skin sensitive to sunlight.
• you should know that nortriptyline may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.

What special dietary instructions should I follow?

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

What should I do if I forget a dose?

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

What side effects can this medication cause?

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

• nausea
• drowsiness
• weakness or tiredness
• excitement or anxiety
• nightmares
• dry mouth
• changes in appetite or weight
• constipation
• difficulty urinating
• frequent urination
• changes in sex drive or ability
• excessive sweating

Some side effects may be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment:

• jaw, neck, and back muscle spasms
• slow or difficult speech
• shuffling walk
• uncontrollable shaking of a part of the body
• fever
• difficulty breathing or swallowing
• rash
• yellowing of the skin or eyes
• irregular heartbeat

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

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

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

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

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

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

In case of emergency/overdose

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

Symptoms of overdose may include

• irregular heartbeat
• seizures
• coma (loss of consciousness for a period of time)
• confusion
• hallucination (seeing things that do not exist)
• widened pupils (dark circles in the middle of the eyes)
• drowsiness
• agitation
• fever
• low body temperature
• stiff muscles
• vomiting

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to nortriptyline.

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

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

Brand names

Aventyl® and Pamelor®

Last Revised - 08/15/2017

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Aventyl (nortriptyline hcl) Full Prescribing Information

Pamelor (nortriptyline hcl) Full Prescribing Information

Detailed Info on Signs, Symptoms, Causes, Treatments of Depression
Detailed Info on Signs, Symptoms, Causes, Treatments of ADHD
Detailed Information on Parenting Difficult or Special Children

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

Generic name: Gabapentin
Brand name: Neurontin

Pronounced: NUHR-on-tin

Neurontin (gabapentin) Full Prescribing Information

Why is this drug prescribed?

 

Neurontin has two uses. First, it may be prescribed with other medications to treat partial seizures (the type in which symptoms are limited). It can be used whether or not the seizures eventually become general and result in loss of consciousness.

Second, it can be used to relieve the burning nerve pain that sometimes persists for months or even years after an attack of shingles (herpes zoster).

Most important fact about this drug

Take Neurontin exactly as directed by your doctor. To effectively control your seizures, it is important that you take Neurontin 3 times a day, approximately every 8 hours. You should not go longer than 12 hours without a dose of medication.

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How should you take this medication?

Do not increase or decrease dosage of this medication without your doctor's approval; and do not suddenly stop taking it, as this may cause an increase in the frequency of your seizures. If you are taking an antacid such as Maalox, take Neurontin at least 2 hours after the antacid.

You may take Neurontin with or without food.

--If you miss a dose...

Try not to allow more than 12 hours to pass between doses. Do not double doses.

--Storage instructions...

Store capsules and tablets at room temperature. Keep the oral solution refrigerated.

What side effects may occur?

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

• When taken for epilepsy, more common side effects may include: Blurred, dimmed, or double vision, bronchitis (in children), dizziness, drowsiness, fatigue, fever (in children), involuntary eye movement, itchy, runny nose, lack of muscular coordination, nausea, tremor, viral infection (in children), vomiting, weight increase (in children)

• When taken for nerve pain, more common side effects may include: Accidental injury, constipation, diarrhea, dizziness, drowsiness, dry mouth, headache, infection, lack of muscular coordination, nausea, swelling in arms and legs, vomiting, weakness

A wide variety of uncommon and rare side effects have also been reported. If you develop any new or unusual symptoms while taking Neurontin, be sure to let your doctor know.

Why should this drug not be prescribed?

You should not take Neurontin if you have ever had an allergic reaction to it.

Special warnings about this medication

Neurontin causes some people to become drowsy and less alert. Combining it with morphine makes this more likely. Do not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you are certain Neurontin does not have this effect on you.

In children, Neurontin occasionally triggers behavioral problems such as unstable emotions, hostility, aggression, hyperactivity, and lack of concentration. However, such problems (if they occur) are usually mild.

Be sure to tell your doctor if you have any kidney problems or are on hemodialysis, as your doctor will need to adjust your dosage of Neurontin.

Tell your doctor about any medications you are taking, including over-the-counter drugs.

Possible food and drug interactions when taking this medication

If Neurontin is taken with certain other drugs, the effects of either can be increased, decreased, or altered. It is especially important to check with your doctor before combining Neurontin with the following: Antacids such as Maalox Hydrocodone (Lortab, Vicodin) Naproxen (Naprosyn) Morphine (Kadian, MS Contin)

Special information if you are pregnant or breastfeeding Return to top

The effects of Neurontin on pregnant women have not been adequately studied, although birth defects have occurred in babies whose mothers took an antiepileptic medication while they were pregnant. The drug should be used during pregnancy only if clearly needed. If you are pregnant or plan to become pregnant, tell your doctor immediately. This medication may appear in breast milk and could affect a nursing infant. It should be used by mothers who nurse their babies only if its benefits clearly outweigh the risks.

Recommended dosage

EPILEPSY

Adults and Children 12 Years and Over

The recommended starting dose is 300 milligrams three times a day. After that, the usual daily dosage ranges from 900 to 1,800 milligrams divided into 3 doses.

If Neurontin is discontinued or another drug is added to therapy, your doctor will do this gradually, over a 1-week period.

Children 3 to 12 Years of Age

Daily dosage is calculated according to the child's weight. The usual starting dosage is 10 to 15 milligrams per 2.2 pounds. Dosage is then increased over a period of three days to 40 milligrams per 2.2 pounds for children aged 3 and 4, and 25 to 35 milligrams per 2.2 pounds for children aged 5 and over. The total daily dosage is taken as 3 smaller doses throughout the day.

PAIN FOLLOWING A SHINGLES ATTACK

Treatment typically starts with a single 300-milligram dose on the first day, two 300-milligram doses on the second day, and three 300-milligram doses on the third day. If necessary, the doctor may increase the daily total to as much as 1,800 milligrams, divided into three doses.

Whether you are taking Neurontin for epilepsy or pain, the doctor will adjust the dosage downward if you have poor kidney function.

Overdosage

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

• Symptoms of Neurontin overdose may include: Diarrhea, double vision, drowsiness, lethargy, slurred speech

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Neurontin (gabapentin) Full Prescribing Information

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

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

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Find out why Nefazodone (Serzone) is prescribed, side effects of Serzone, Serzone warnings, effects of Serzone during pregnancy, more - in plain English.

Generic name: Nefazodone hydrochloride
Brand name: Serzone

Pronounced: sur-ZONE

Full Serzone Prescribing Information

Why is Serzone prescribed?

Serzone is prescribed for the treatment of depression severe enough to interfere with daily functioning. Possible symptoms include changes in appetite, weight, sleep habits, and mind/body coordination, increased fatigue, feelings of guilt or worthlessness, difficulty concentrating, slowed thinking, and suicidal thoughts.

Most important fact about Serzone

Sale of Serzone was discontinued in 2003 in some countries (U.S., Canada and others), due to the small possibility of hepatic (liver) injury, which could lead to the need for a liver transplant, or even death. Several generic formulations of nefazodone are still available.

It may be several weeks before you feel the full antidepressant effect of Serzone. Once you do begin to feel better, it is important to keep taking the drug.

How should you take Serzone?

Take Serzone exactly as prescribed by your doctor even if you no longer feel depressed. Your doctor should check your progress periodically.

 

--If you miss a dose...

Take it as soon as you remember. If it is within 4 hours of your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store at room temperature in a tightly closed container.

What side effects may occur with Serzone?

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

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• More common side effects of Serzone may include: Blurred or abnormal vision, confusion, constipation, dizziness, dry mouth, light-headedness, nausea, sleepiness, weakness

• Less common side effects may include: Abnormal dreams, cough, decreased concentration, diarrhea, dizziness on getting up, flu-like symptoms, headache, increased appetite, water retention

• Rare side effects may include: Abnormal bleeding, anxiety, blisters in mouth and eyes, breast pain, breast-milk discharge, breast enlargement in males, chills, coma, decreased sex drive, difficulty urinating, exaggerated reflexes, fever, frequent urination, lack of coordination, liver disease, prolonged erections, rigidity, ringing in ears, seizures, severe allergic reactions, spasms, stiff neck, sweating, taste change, thirst, tremors, urinary tract infection, vaginal inflammation

Why should Serzone not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Serzone or similar drugs, such as Desyrel, you should not take this medication. You should also avoid it permanently if previous treatment had to be stopped due to signs of liver injury.

Serious, sometimes fatal reactions have occurred when Serzone is used in combination with drugs known as MAO inhibitors, including the antidepressants Nardil and Parnate. Never take Serzone with one of these drugs; and do not begin therapy with Serzone within 14 days of discontinuing treatment with one of them. Also, allow at least 7 days between the last dose of Serzone and the first dose of an MAO inhibitor.

Serzone should also be avoided if you are taking Halcion or Tegretol, and should never be combined with Orap, as heart problems could result.

Special warnings about Serzone

Your doctor will prescribe Serzone with caution if you have a history of seizures or mania (extreme agitation or excitability) or heart or liver disease. Serzone should also be used with caution if you have had a heart attack, stroke, or angina; take drugs for high blood pressure; or suffer from dehydration. Under these circumstances, Serzone could cause an unwanted drop in blood pressure. Be sure to discuss all of your medical problems with your doctor before taking this drug.

Serzone has also been known to produce very rare cases of potentially fatal liver failure. Ordinarily, the drug is not prescribed for people with liver disease, and your doctor may periodically test your liver function. If you develop warning signs of liver problems--such as loss of appetite, stomach upset, a generally ill feeling, or yellowing of the skin and eyes--alert your doctor immediately. Treatment with Serzone will probably have to be stopped.

Serzone may cause you to become drowsy or less alert and may affect your judgment. Do not drive or operate dangerous machinery or participate in any hazardous activity that requires full mental alertness until you know how the drug affects you.

Before having surgery, dental treatment, or any diagnostic procedure requiring anesthesia, tell the doctor or dentist you are taking Serzone. If you develop an allergic reaction such as a skin rash or hives while taking Serzone, notify your doctor. If you are male and experience a prolonged or inappropriate erection while taking Serzone, discontinue this drug and call your doctor.

If you have ever been addicted to drugs, tell your doctor before you start Serzone.

Possible food and drug interactions when taking Serzone

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

Alcohol
Alprazolam (Xanax)
Antidepressants that boost serotonin levels, including Celexa, Luvox, Paxil, Prozac, and Zoloft
Buspirone (BuSpar)
Carbamazepine (Tegretol)
Cyclosporine (Neoral and Sandimmune)
Digoxin (Lanoxin)
Haloperidol (Haldol)
MAO inhibitors, including Nardil and Parnate
Pimozide (Orap)
The cholesterol-lowering drugs Lipitor, Mevacor, and Zocor
Triazolam (Halcion)

Special information if you are pregnant or breastfeeding

The effects of Serzone during pregnancy have not been adequately studied. If you are pregnant or are planning to become pregnant, tell your doctor immediately. Serzone should be used during pregnancy only if clearly needed. Serzone may appear in breast milk. If this medication is essential to your health, your doctor may tell you to discontinue breastfeeding until your treatment with Serzone is finished.

Recommended dosage for Serzone

ADULTS

The usual starting dose for Serzone is 200 milligrams a day, divided into 2 doses. If needed, your doctor may increase your dose gradually to 300 to 600 milligrams a day.

CHILDREN

The safety and effectiveness of Serzone have not been established in children under 18 years of age.

OLDER ADULTS

The usual starting dose for older people and those in a weakened condition is 100 milligrams a day, taken in 2 doses. Your doctor will adjust the dose according to your response.

Overdosage of Serzone

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

Symptoms of Serzone overdose include:

• Nausea, sleepiness, vomiting

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