Thursday, 29 September 2016

Amsacrine Lactate




Amsacrine Lactate may be available in the countries listed below.


Ingredient matches for Amsacrine Lactate



Amsacrine

Amsacrine Lactate (BANM) is also known as Amsacrine (Prop.INN)

International Drug Name Search

Glossary

BANMBritish Approved Name (Modified)
Prop.INNProposed International Nonproprietary Name (World Health Organization)

Click for further information on drug naming conventions and International Nonproprietary Names.

LMX4 Lidocaine 4% w / w Cream





1. Name Of The Medicinal Product



LMX 4



Lidocaine 4%w/w Cream


2. Qualitative And Quantitative Composition



Lidocaine 4%w/w



For excipients, see 6.1



3. Pharmaceutical Form



Cream



A white to off-white yellowish cream



4. Clinical Particulars



4.1 Therapeutic Indications



Local anaesthetic for topical use to produce surface anaesthesia of the skin prior to venous cannulation or venipuncture.



4.2 Posology And Method Of Administration



For cutaneous use only.



Adults, including elderly, and children over one month of age.



Apply 1g to 2.5g of cream onto the skin to cover a 2.5cm x 2.5cm (6.25cm2) area where venous cannulation or venipuncture will occur. No more than 1g of cream should be applied to infants below the age of 1 year. 1g of cream equates to approximately 5cm of cream squeezed from the 5g tube or 3.5cm from the 30g tube.



The cream should remain undisturbed and the area can be covered with an occlusive dressing to prevent disturbance or interference by the patient or other external factors. Adequate anaesthesia should be obtained after 30 minutes, but the LMX4 Cream may be applied for up to 5 hours under a dressing. Prior to starting the procedure, the LMX 4 Cream should be removed using a clean gauze swab and the site for venous cannulation or venipuncture prepared in the usual manner. The procedure should be initiated approximately 5 minutes after the cream has been removed. Maximum application time for 1 month upto 3 month infant should not exceed 60 minutes. Maximum application time for 3 month upto 12 month infant should not exceed 4 hours. Maximum application for 12 month infant – adult should not exceed 5 hours.



4.3 Contraindications



Hypersensitivity to the active substance, or any of the amide-type local anaesthetics, or any of the excipients.



4.4 Special Warnings And Precautions For Use



For external use only.



Avoid contact with eyes.



Do not apply to irritated skin or if excessive irritation develops. If condition worsens, or if symptoms persist unaltered for more than seven days or clear up and occur again within only a few days, discontinue use of this product and consult a doctor.



Do not use in large quantities, particularly over raw or blistered areas.



LMX 4 contains propylene glycol which may cause skin irritation.



LMX 4 has not been applied to wounds, mucous membranes or in areas of atopic dermatitis as there are no clinical data in relation to these.



Anaesthetic efficacy during the heel lancing of neonates has not been studied.



Application of lidocaine to larger areas or for longer times than those recommended could result in sufficient absorption of lidocaine resulting in serious adverse effects.



Studies in laboratory animals (guinea pigs) have shown that lidocaine has an ototoxic effect when instilled into the middle ear. In these same studies, animals exposed to lidocaine in the external auditory canal only showed no abnormality. Lidocaine should not be used in any clinical situation in which its penetration or migration beyond the tympanic membrane into the middle ear is possible.



Dermal application of lidocaine may cause transient local blanching followed by transient erythema.



PRECAUTIONS



General: Repeated doses of lidocaine may increase blood levels of lidocaine. Lidocaine should be used with caution in patients who may be more sensitive to the systemic effects of lidocaine including acutely ill, debilitated, or elderly patients.



Lidocaine coming in contact with the eye should be avoided because animal studies have demonstrated severe eye irritation. Also the loss of protective reflexes can permit corneal irritation and potential abrasion. Absorption of lidocaine in conjunctival tissues has not been determined. If eye contact occurs, immediately wash out the eye with water or saline and protect the eye until sensation returns.



Patients allergic to para-aminobenzoic acid derivatives (procaine, tetracaine, benzocaine, etc.) have not shown cross sensitivity to lidocaine; however, lidocaine should be used with caution in patients with a history of drug sensitivities, especially if the etiologic agent is uncertain. Patients with severe hepatic disease, because of their inability to metabolize local anaesthetics normally, are at greater risk of developing toxic plasma concentrations of lidocaine.



When lidocaine is used, the patient should be aware that the production of dermal analgesia may be accompanied by the block of all sensations in the treated skin. For this reason, the patient should avoid inadvertent trauma to the treated area by scratching, rubbing, or exposure to extreme hot or cold temperatures until complete sensation has returned.



Lidocaine has bactericidal and antiviral properties in concentrations above 0.5%. For this reason, the results of intra-cutaneous injections of live vaccines (such as BCG vaccination) should be monitored.



4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction



Lidocaine should be used with caution in patients receiving Class I anti-arrhythmic drugs (such as tocainide and mexiletine) since the toxic effects are additive and generally synergistic.



The risk of additional systemic toxicity should be considered when large doses of LMX 4 are applied to patients already using other local anaesthetics.



4.6 Pregnancy And Lactation



There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, lidocaine should be used during pregnancy only if clearly needed.



Lidocaine is not contraindicated in labour and delivery. Should LMX 4 be used concomitantly with other products containing lidocaine, total doses contributed by all formulations must be considered.



Lidocaine can cross the placental barrier.



Lidocaine is excreted in human milk. Therefore, caution should be exercised when LMX 4 is administered to a nursing mother since the milk:plasma ratio of lidocaine is 0.4.



4.7 Effects On Ability To Drive And Use Machines



None known.



4.8 Undesirable Effects



Common side effects (>1/100) can include irritation, redness, itching, or rash.



In rare cases local anaesthetics have been associated with allergic reactions including anaphylactic shock.



Corneal irritation after accidental eye exposure.



4.9 Overdose



Overdose with LMX 4 cream is unlikely but signs of systemic toxicity would be consistent with those of lidocaine.



An indication of systemic toxicity may include blurred vision, dizziness or drowsiness, difficulty breathing, trembling, chest pain, or irregular heartbeat.



5. Pharmacological Properties



5.1 Pharmacodynamic Properties



Anaesthetics for topical use, lidocaine, ATC Code: D04A B 01



Lidocaine applied to intact skin provides dermal analgesia by a release of lidocaine from the cream into the epidermal and dermal layers of the skin, and by the accumulation of lidocaine in the vicinity of pain receptors and nerve endings. Lidocaine is an amide-type local anaesthetic agent which stabilises neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anaesthetic action. The onset, depth and duration of dermal analgesia provided by lidocaine depend primarily on the duration of application. LMX 4 may cause transient peripheral vasoconstriction followed by transient vasodilation at the application site.



5.2 Pharmacokinetic Properties



The amount of lidocaine systemically absorbed is directly related to both the duration of application and to the area over which it is applied. It is not known if it is metabolized into the skin. Lidocaine is metabolized rapidly by the liver to a number of metabolites including monoethylglycinexylidide (MEGX) and glycinexylidide (GX), both of which have pharmacologic activity similar to, but less potent to that of lidocaine. The metabolite, 2,6-xylidine, has unknown pharmacologic activity but is carcinogenic in rats. Following intravenous administration, MEGX and GX concentrations in serum range from 11 to 36% and from 5 to 11% of concentrations, respectively. The half-life of lidocaine elimination from the plasma following IV administration is approximately 65 to 150 minutes (mean 110, ±24 SD, n=13). This half-life may be increased in cardiac or hepatic dysfunction. More than 98% of an absorbed dose of can be recovered in the urine as metabolites or parent drug. The systemic clearance is 10 to 20 mL/min/kg (mean 13, ±3 SD, n=13).



When applied topically to intact skin, the absorption of lidocaine is very low. Increased absorption is therefore to be expected when applied to mucosa or previously damaged skin.



The maximum plasma level of active ingredient was very low (0.3 µg/ml or less) in a study investigating the application of LMX 4 in children of different ages. It was well below the toxically effective plasma level of ingredients.



5.3 Preclinical Safety Data



The mutagenic potential of lidocaine HCl has been tested in the Ames Salmonella/mammalian microsome test and by analysis of structural chromosome aberrations in human lymphocytes in vitro, and by mouse micronucleus test in vivo. There was no indication in these tests of any mutagenic effects. The mutagenicity of 2,6-xylidine, a metabolite of lidocaine, has been studied in different tests with mixed results. The compound was found to be weakly mutagenic in the Ames test only under metabolic activation conditions. In addition, 2,6-xylidine was observed to be mutagenic at the thymidine kinase locus, with or without activation, and induced chromosome aberrations and sister chromatic exchanges at concentrations at which the drug precipitated out of the solution (1.2 mg/ml). No evidence of genotoxicity was found in the in vivo assays measuring unscheduled DNA synthesis in rat hepatocytes, chromosome damage in polychromatic erythrocytes or preferential killing of DNA repair-deficient bacteria in liver, lung, kidney, testes and blood extracts from mice. However, covalent binding studies of DNA from liver and ethmoid turbinates in rats indicate that 2,6-xylidine may be genotoxic under certain conditions in vivo.



6. Pharmaceutical Particulars



6.1 List Of Excipients



Benzyl Alcohol



Carbomers



Cholesterol



Phospholipon 80H (Hydrogenated Soy Lecithin)



Polysorbate 80 (Tween 80)



Propylene Glycol



Trolamine



Vitamin E Acetate



Purified Water



6.2 Incompatibilities



Not applicable



6.3 Shelf Life








Unopened:




Two years




Opened:




3 months



6.4 Special Precautions For Storage



Do not store above 25°C.



6.5 Nature And Contents Of Container



The pack sizes are 5g and 30g.



Both packs comprise of an aluminium tube with an epoxyphenolic internal lacquer, fitted with a polypropylene cap.



The following packaging options are approved but not all of these packaging options may be marketed:



1) A carton containing one 5g tube.



2) A carton containing five 5g tubes.



3) A carton containing one 5g tube with two Tegaderm® occlusive dressings.



4) A carton containing five 5g tubes with ten Tegaderm® occlusive dressings.



5) A carton containing one 30g tube.



6.6 Special Precautions For Disposal And Other Handling



No special requirements



7. Marketing Authorisation Holder



Ferndale Pharmaceuticals Ltd



12 York Place



Leeds



LS1 2DS



United Kingdom



8. Marketing Authorisation Number(S)



PL 20685/0034



9. Date Of First Authorisation/Renewal Of The Authorisation



20/11/2007



10. Date Of Revision Of The Text



15/03/2011




Anti-Pulgas




Anti-Pulgas may be available in the countries listed below.


In some countries, this medicine may only be approved for veterinary use.

Ingredient matches for Anti-Pulgas



Dimpylate

Dimpylate is reported as an ingredient of Anti-Pulgas in the following countries:


  • Portugal

International Drug Name Search

Innohep 10,000 IU / ml and Innohep Syringe 10,000 IU / ml





1. Name Of The Medicinal Product



innohep® 10,000 IU/ml and innohep® Syringe 10,000 IU/ml


2. Qualitative And Quantitative Composition



Tinzaparin sodium 10,000 anti-Factor Xa IU/ml



3. Pharmaceutical Form



Solution for injection



4. Clinical Particulars



4.1 Therapeutic Indications



For the prevention of thromboembolic events, including deep vein thrombosis, in patients undergoing general and orthopaedic surgery.



For the prevention of clotting in the extracorporeal circuit during haemodialysis in patients with chronic renal insufficiency.



4.2 Posology And Method Of Administration



For prevention of thromboembolic events:



Administration is by subcutaneous injection.



Adults at low to moderate risk, e.g. patients undergoing general surgery:



3,500 anti-Factor Xa IU two hours before surgery and then once daily for 7 to 10 days post-operatively.



Adults at high risk, e.g. patients undergoing orthopaedic surgery:



In this high risk group the recommended dose is either a fixed dose of 4,500 anti-Factor Xa IU given 12 hours before surgery followed by a once daily dose, or 50 anti-Factor Xa IU/kilogram body weight 2 hours before surgery followed by a once daily dose for 7 to 10 days post-operatively.



For haemodialysis:



The dose of innohep® should be given into the arterial side of the dialyser or intravenously. The dialyser can be primed by flushing with 500-1000 ml isotonic sodium chloride (9 mg/ml) containing 5,000 anti-Factor Xa IU innohep® per litre.



Patients with chronic renal insufficiency:



a) Short-term haemodialysis (up to 4 hours)



A bolus dose of 2,000-2,500 anti-Factor Xa IU into the arterial side of the dialyser (or intravenously).



b) Long-term haemodialysis (more than 4 hours)



A bolus dose of 2,500 anti-Factor Xa IU into the arterial side of the dialyser (or intravenously) followed by 750 anti-Factor Xa IU/hour infused into the extracorporeal circuit.



Dosage adjustment



The bolus innohep® dose may be adjusted (increased or decreased) by 250-500 anti-Factor Xa IU until a satisfactory response is obtained.



Additional innohep® (500-1,000 anti-Factor Xa IU) may be given if concentrated red cells or blood transfusions (which may increase the likelihood of clotting in the dialyser) are given during dialysis or additional treatment beyond the normal dialysis duration is employed.



Dose monitoring



Determination of plasma anti-Factor Xa may be used to monitor the innohep® dose during haemodialysis. Plasma anti-Factor Xa, one hour after dosing should be within the range 0.4 - 0.5 IU/ml.



Use in the elderly



No dose modifications are necessary.



Use in children



There is no experience of use in children.



4.3 Contraindications



• Known hypersensitivity to constituents.



• Current or history of heparin-induced thrombocytopenia.



• Generalised or local haemorrhagic tendency, including uncontrolled severe hypertension, severe liver insufficiency, active peptic ulcer, acute or subacute septic endocarditis, intracranial haemorrhage, or injuries and operations on the central nervous system, eyes and ears, and in women with abortus imminens.



• The innohep® 10,000 IU/ml vial formulation contains 10 mg/ml of the preservative benzyl alcohol. This formulation must not be given to premature babies or neonates.



The innohep® 10,000 IU/ml syringe formulation does not contain the preservative benzyl alcohol.



• An epidural anaesthesia during birth in pregnant women treated with low molecular weight heparin is contraindicated (see section 4.6).



• In patients receiving heparin for treatment rather than prophylaxis, locoregional anaesthesia in elective surgical procedures is contra-indicated because the use of heparin may be very rarely associated with epidural or spinal haematoma resulting in prolonged or permanent paralysis.



4.4 Special Warnings And Precautions For Use



Care should be taken when innohep® is administered to patients with increased risk of bleeding complications.



In patients undergoing peridural or spinal anaesthesia or spinal puncture, the prophylactic use of heparin may be very rarely associated with epidural or spinal haematoma resulting in prolonged or permanent paralysis. The risk is increased by the use of a peridural or spinal catheter for anaesthesia, by the concomitant use of drugs affecting haemostasis such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors or anticoagulants, and by traumatic or repeated puncture.



In decision making on the interval between the last administration of heparin at prophylactic doses and the placement or removal of a peridural or spinal catheter, the product characteristics and the patient profile should be taken into account. Subsequent dose should not take place before at least four hours have elapsed. Re-administration should be delayed until the surgical procedure is completed.



Should a physician decide to administer anti-coagulation in the context of peridural or spinal anaesthesia, extreme vigilance and frequent monitoring must be exercised to detect any signs and symptoms of neurologic impairment, such as back pain, sensory and motor deficits and bowel or bladder dysfunction. Patients should be instructed to inform immediately a nurse or a clinician if they experience any of these.



innohep® should not be administered by intramuscular injection due to the risk of haematoma.



Due to increased bleeding risk care should be taken when giving concomitant intramuscular injections, lumbar puncture and similar procedures.



innohep® should be used with caution in patients with hypersensitivity to heparin or to other low molecular weight heparins.



As there is a risk of antibody-mediated heparin-induced thrombocytopenia, platelet counts should be measured in patients receiving heparin treatment for longer than 5 days and the treatment should be stopped immediately in those who develop thrombocytopenia.



As with other low molecular weight heparins, in some patients undergoing surgical procedures (especially orthopaedic) or presenting with a concomitant inflammatory process, the administration of innohep® has coincided with an asymptomatic increase of platelet count, which in many cases subsided during continued administration. If an increase in platelet count occurs, evaluation of the benefit/risk of continuing therapy for that patient should be made.



Care should be taken when innohep® is administered to patients with kidney insufficiency who are undergoing general or orthopaedic surgery. In such cases a dose reduction should be considered.



Heparin can suppress adrenal secretion of aldosterone leading to hyperkalaemia, particularly in patients such as those with diabetes mellitus, chronic renal failure, pre-existing metabolic acidosis, a raised plasma potassium or taking potassium-sparing drugs. The risk of hyperkalaemia appears to increase with duration of therapy but is usually reversible. Plasma potassium should be measured in patients at risk before starting heparin therapy and monitored regularly thereafter particularly if treatment is prolonged beyond about 7 days.



The innohep® 10,000 IU/ml vial formulation contains the preservative benzyl alcohol 10 mg/ml. This should be administered with caution to infants and children up to 3 years old, as there is a risk that benzyl alcohol may cause toxic reactions and allergic reactions (anaphylactoid) in this age group (see section 4.3 for premature babies and neonates).



Drugs affecting platelet function or the coagulation system should in general not be given concomitantly with innohep® (see section 4.5).



Prosthetic heart valves:



There have been no adequate studies to assess the safe and effective use of tinzaparin sodium in preventing valve thrombosis in patients with prosthetic heart valves; therefore no dosage recommendations can be given. High doses of tinzaparin sodium (175 IU/kg) may not be sufficient prophylaxis to prevent valve thrombosis in patients with prosthetic heart valves. The use of tinzaparin sodium cannot be recommended for this purpose.



4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction



The anticoagulant effect of innohep® may be enhanced by concomitant medication with other drugs affecting platelet function or the coagulation system, e.g. platelet aggregation inhibitors, thrombolytic agents, salicylates, non-steroidal anti-inflammatory drugs, vitamin K antagonists, dextrans, activated protein C.



innohep® does not appear to interact with other drugs used widely in chronic renal failure, including vitamin B supplements, aluminium hydroxide, calcium supplements, alfacalcidol, ranitidine, vitamin C supplements, ferrous sulphate, folic acid, nifedipine, erythropoietin and azatadine.



4.6 Pregnancy And Lactation



Pregnancy



No transplacental passage of innohep® was found (assessed by anti-Factor Xa and anti-Factor IIa activity) in patients given a dose of 35 to 40 anti-Factor Xa IU/kg in the second trimester of pregnancy. In rabbits, no transplacental passage of anti-Factor Xa or anti-Factor IIa activity was observed after doses of 1750 anti-Factor Xa IU/kg. Toxicological studies in rats have shown no embryotoxic or teratogenic effects, although a lower birthweight was found.



Although these animal studies show no hazard, as a precaution innohep® should not be used in pregnancy unless no safer alternative is available.



As benzyl alcohol may cross the placenta, the use of innohep® formulations containing benzyl alcohol should be avoided during pregnancy.



The use of innohep® in women with abortus imminens is contraindicated (see section 4.3).



Prosthetic heart valves:



Therapeutic failures and maternal death have been reported in pregnant women with prosthetic heart valves on full anti-coagulant doses of low molecular weight heparins. In the absence of clear dosing, efficacy and safety information in this circumstance, tinzaparin sodium is not recommended for use in pregnant women with prosthetic heart valves.



Lactation



It is not known whether innohep® is excreted in breast milk. However, patients are advised to stop breast-feeding while receiving innohep®.



4.7 Effects On Ability To Drive And Use Machines



innohep® has no or negligible influence on the ability to drive or use machines.



4.8 Undesirable Effects



Based on reports from clinical trials the frequency rate of all adverse reactions is 17.6%. The most frequently reported undesirable effects are bleeding events, injection site reactions, various skin reactions, reversible thrombocytopenia, allergic reactions, headache and reversible increase in liver enzymes.



Based on pooled study results, from a clinical trial programme where 3167 patients received innohep®, local reactions following subcutaneous administration such as irritation, bruising, pain and ecchymosis were identified in approximately 3.7 % of patients. The overall bleeding risk was approximately 11 % while the risk of major bleeding was approximately 0.5%. Reversible thrombocytopenia was seen in approximately 0.6 % of patients.



A list of undesirable effects is given below. Where frequencies are given, these are based on the clinical trial data, using the stated frequency classification. Where the term 'Not known' is given, these effects are derived from spontaneous reports.



Frequency classification:




































































Very common




>1/10




Common




>1/100 and <1/10




Uncommon




>1/1,000 and <1/100




Rare




>1/10,000 and <1/1,000




Very rare




<1/10,000




Blood and lymphatic system disorders


 


Uncommon:




Thrombocytopenia (type I).




Not known:




Heparin induced thrombocytopenia (HIT), probably of an immuno-allergic nature (see Section 4.4). In some cases, Heparin induced thrombocytopenia has been accompanied by venous or arterial thrombi.




 




Increase in platelet count, asymptomatic and reversible (see section 4.4).




Class effect:




Valve thrombosis in patients with prosthetic heart valves has been reported rarely in patients receiving low molecular weight heparins, usually associated with inadequate dosing (see Section 4.4).




Immune system disorders


 


Uncommon:




Allergic reactions (of all types and severities have been reported).




Metabolism and nutrition disorders


 


Not known:




Hypoaldosteronism associated with hyperkalaemia and metabolic acidosis, especially in patients with renal impairment and diabetes mellitus (see Section 4.4).




Nervous system disorders


 


Uncommon:




Headache.




Vascular disorders


 


Very common:




Haemorrhage. Haemorrhagic complications may affect any organ, and may have different degrees of severity. In some cases haemorrhage has resulted in death or permanent disability. Haemorrhagic complications can occur in particular when high doses are administered. Anaemia can occur as a consequence of haemorrhage.




Not known:




Epidural and spinal haematoma (see Section 4.4).




Hepatobiliary disorders


 


Uncommon:




Raised transaminases. These increases are reversible after drug withdrawal.




Not known:




Raised gamma-GT.




Skin and subcutaneous tissue disorder


 


Uncommon:




Rash (such as erythematous or maculopapular), pruritus, urticaria.




Rare:




Skin necrosis.




Not known:




Angioedema, toxic epidermal necrolysis and Stevens-Johnson syndrome.




Musculoskeletal and connective tissue disorders


 


Not known:




Osteoporosis has been reported in connection with long-term treatment with heparin.




Reproductive system and breast disorders


 


Not known:




Priapism.




General disorders and administration site conditions


 


Common:




Injection site reactions (local irritation, pain, bruising, ecchymosis).



4.9 Overdose



Overdose of innohep® may be complicated by haemorrhage. With recommended dosages there should be no need for an antidote but in the event of accidental administration of an overdose, the effect of innohep® can be reversed by intravenous administration of 1% protamine sulphate solution.



The dose of protamine sulphate required for neutralisation should be accurately determined by titrating with the patient's plasma.



Studies in healthy volunteers indicate that 65-80% of the anti-Xa activity is neutralised by protamine sulphate 1 mg/100 anti-Xa IU of innohep®. A return of innohep® anti-Xa, anti-IIa and APTT activities are seen 3 hours after its reversal probably due to continuous absorption of innohep® from the s.c. depot. It may therefore be necessary to give protamine sulphate intermittently or as a continuous infusion to achieve and maintain neutralisation of s.c. innohep® for at least 24 hours. Potential side-effects of protamine sulphate must be considered and patients carefully observed.



Transfusion of fresh plasma may be used, if necessary. Plasma anti-Factor Xa and anti-Factor IIa activity should be measured during the management of overdose situations.



5. Pharmacological Properties



5.1 Pharmacodynamic Properties



innohep® is an antithrombotic agent. It potentiates the inhibition of several activated coagulation factors, especially Factor Xa, its activity being mediated via antithrombin III.



5.2 Pharmacokinetic Properties



The pharmacokinetics/pharmacodynamic activity of innohep® is monitored by anti-Factor Xa activity.



innohep® has a bioavailability of around 90% following a subcutaneous injection. The absorption half-life is 200 minutes, peak plasma activity being observed after 4 to 6 hours. The elimination half-life is about 90 minutes.



The half-life of innohep® in patients with renal insufficiency given a bolus intravenous dose of 2,500 anti-Factor Xa IU is about 2.5 hours.



There is a linear dose response relationship between plasma activity and the dose administered.



5.3 Preclinical Safety Data



There are no preclinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.



6. Pharmaceutical Particulars



6.1 List Of Excipients



innohep® 10,000 IU/ml:



Benzyl alcohol



Sodium acetate



Sodium hydroxide



Water for injections



innohep® Syringe 10,000 IU/ml:



Sodium acetate



Water for injections



As pH adjuster: sodium hydroxide



6.2 Incompatibilities



innohep® should not be mixed with any other injection.



6.3 Shelf Life



innohep® 10,000 IU/ml:



2 years.



innohep® Syringe 10,000 IU/ml:



3 years.



6.4 Special Precautions For Storage



Do not store above 25°C.



6.5 Nature And Contents Of Container



innohep® 10,000 IU/ml:



2 ml glass vial containing 10,000 anti-Factor Xa IU/ml in packs of 10 vials.



innohep® Syringe 10,000 IU/ml:



A prefilled unit dose syringe with needle safety device containing:



2,500 anti-Factor Xa IU in 0.25 ml



3,500 anti-Factor Xa IU in 0.35 ml



4,500 anti-Factor Xa IU in 0.45 ml



in packs of 10 syringes.



6.6 Special Precautions For Disposal And Other Handling



innohep® 10,000 IU/ml:



The vial should be discarded 14 days after first use.



innohep® Syringe 10,000 IU/ml:



Contains no preservative, any portion of the contents not used at once should be discarded with the syringe.



7. Marketing Authorisation Holder



LEO Laboratories Limited



Longwick Road



Princes Risborough



Bucks HP27 9RR



8. Marketing Authorisation Number(S)



innohep® 10,000 IU/ml: PL 00043/0205



innohep® Syringe 10,000 IU/ml: PL 00043/0204



9. Date Of First Authorisation/Renewal Of The Authorisation








innohep® 10,000 IU/ml:




30 September 1998




innohep® Syringe 10,000 IU/ml:




20 November 1997



10. Date Of Revision Of The Text



1 September 2011



LEGAL CATEGORY


POM




Wednesday, 28 September 2016

Amoxycillin Sandoz




Amoxycillin Sandoz may be available in the countries listed below.


Ingredient matches for Amoxycillin Sandoz



Amoxicillin

Amoxicillin trihydrate (a derivative of Amoxicillin) is reported as an ingredient of Amoxycillin Sandoz in the following countries:


  • Australia

International Drug Name Search

Bradoral




Bradoral may be available in the countries listed below.


Ingredient matches for Bradoral



Domiphen Bromide

Domiphen Bromide is reported as an ingredient of Bradoral in the following countries:


  • Italy

  • Taiwan

International Drug Name Search

Acétylcysteine EG




Acétylcysteine EG may be available in the countries listed below.


Ingredient matches for Acétylcysteine EG



Acetylcysteine

Acetylcysteine is reported as an ingredient of Acétylcysteine EG in the following countries:


  • France

International Drug Name Search

Flumates




Flumates may be available in the countries listed below.


Ingredient matches for Flumates



Beclometasone

Beclometasone 17α,21-dipropionate (a derivative of Beclometasone) is reported as an ingredient of Flumates in the following countries:


  • Chile

International Drug Name Search

Ampin




Ampin may be available in the countries listed below.


Ingredient matches for Ampin



Amlodipine

Amlodipine is reported as an ingredient of Ampin in the following countries:


  • Vietnam

International Drug Name Search

Coratol




Coratol may be available in the countries listed below.


Ingredient matches for Coratol



Atenolol

Atenolol is reported as an ingredient of Coratol in the following countries:


  • Thailand

International Drug Name Search

Asnea




Asnea may be available in the countries listed below.


Ingredient matches for Asnea



Anastrozole

Anastrozole is reported as an ingredient of Asnea in the following countries:


  • Slovakia

International Drug Name Search

Desoblite




Desoblite may be available in the countries listed below.


Ingredient matches for Desoblite



Bencyclane

Bencyclane fumarate (a derivative of Bencyclane) is reported as an ingredient of Desoblite in the following countries:


  • Taiwan

International Drug Name Search

Adrenaline Acid Tartare Injection




Adrenaline Acid Tartare Injection may be available in the countries listed below.


Ingredient matches for Adrenaline Acid Tartare Injection



Epinephrine

Epinephrine bitartrate (a derivative of Epinephrine) is reported as an ingredient of Adrenaline Acid Tartare Injection in the following countries:


  • New Zealand

International Drug Name Search

Tuesday, 27 September 2016

Amphetamine




In the US, Amphetamine (amphetamine systemic) is a member of the drug class CNS stimulants and is used to treat ADHD and Narcolepsy.

US matches:

  • Amphetamine

  • Amphetamine/Dextroamphetamine

  • Amphetamine/Dextroamphetamine Extended-Release Capsules

  • Amphetamine and dextroamphetamine

  • Amphetamine Sulfate

Ingredient matches for Amphetamine



Amfetamine

Amphetamine (BAN) is also known as Amfetamine (Rec.INN)

International Drug Name Search

Glossary

BANBritish Approved Name
Rec.INNRecommended International Nonproprietary Name (World Health Organization)

Click for further information on drug naming conventions and International Nonproprietary Names.

Abrobion




Abrobion may be available in the countries listed below.


Ingredient matches for Abrobion



Ambroxol

Ambroxol hydrochloride (a derivative of Ambroxol) is reported as an ingredient of Abrobion in the following countries:


  • Greece

International Drug Name Search

Nelorpin




Nelorpin may be available in the countries listed below.


Ingredient matches for Nelorpin



Pentoxifylline

Pentoxifylline is reported as an ingredient of Nelorpin in the following countries:


  • Spain

International Drug Name Search

Penedil




Penedil may be available in the countries listed below.


Ingredient matches for Penedil



Felodipine

Felodipine is reported as an ingredient of Penedil in the following countries:


  • Israel

International Drug Name Search

Amoxicilina LCH




Amoxicilina LCH may be available in the countries listed below.


Ingredient matches for Amoxicilina LCH



Amoxicillin

Amoxicillin is reported as an ingredient of Amoxicilina LCH in the following countries:


  • Peru

International Drug Name Search

Alcon Ciloxan




Alcon Ciloxan may be available in the countries listed below.


Ingredient matches for Alcon Ciloxan



Ciprofloxacin

Ciprofloxacin is reported as an ingredient of Alcon Ciloxan in the following countries:


  • Romania

International Drug Name Search

Monday, 26 September 2016

Acéclofenac Mylan




Acéclofenac Mylan may be available in the countries listed below.


Ingredient matches for Acéclofenac Mylan



Aceclofenac

Aceclofenac is reported as an ingredient of Acéclofenac Mylan in the following countries:


  • France

International Drug Name Search

Dorobay




Dorobay may be available in the countries listed below.


Ingredient matches for Dorobay



Acarbose

Acarbose is reported as an ingredient of Dorobay in the following countries:


  • Vietnam

International Drug Name Search

Acido clofibrico




Acido clofibrico may be available in the countries listed below.


Ingredient matches for Acido clofibrico



Clofibric Acid

Acido clofibrico (DCIT) is also known as Clofibric Acid (Rec.INN)

International Drug Name Search

Glossary

DCITDenominazione Comune Italiana
Rec.INNRecommended International Nonproprietary Name (World Health Organization)

Click for further information on drug naming conventions and International Nonproprietary Names.

Afeme




Afeme may be available in the countries listed below.


Ingredient matches for Afeme



Dexchlorpheniramine

Dexchlorpheniramine maleate (a derivative of Dexchlorpheniramine) is reported as an ingredient of Afeme in the following countries:


  • Argentina

International Drug Name Search

Acadimox




Acadimox may be available in the countries listed below.


Ingredient matches for Acadimox



Amoxicillin

Amoxicillin trihydrate (a derivative of Amoxicillin) is reported as an ingredient of Acadimox in the following countries:


  • Italy

Clavulanate

Clavulanic Acid potassium (a derivative of Clavulanic Acid) is reported as an ingredient of Acadimox in the following countries:


  • Italy

International Drug Name Search

Fibercon




In the US, Fibercon (polycarbophil systemic) is a member of the drug class laxatives and is used to treat Constipation.

US matches:

  • FiberCon

Ingredient matches for Fibercon



Polycarbophil

Polycarbophil calcium salt (a derivative of Polycarbophil) is reported as an ingredient of Fibercon in the following countries:


  • Israel

International Drug Name Search

Ampicilina / Sulbactam




Ampicilina/Sulbactam may be available in the countries listed below.


Ingredient matches for Ampicilina/Sulbactam



Ampicillin

Ampicillin is reported as an ingredient of Ampicilina/Sulbactam in the following countries:


  • Colombia

  • Peru

  • Venezuela

Ampicillin sodium salt (a derivative of Ampicillin) is reported as an ingredient of Ampicilina/Sulbactam in the following countries:


  • Venezuela

Sulbactam

Sulbactam is reported as an ingredient of Ampicilina/Sulbactam in the following countries:


  • Colombia

  • Peru

  • Venezuela

Sulbactam sodium salt (a derivative of Sulbactam) is reported as an ingredient of Ampicilina/Sulbactam in the following countries:


  • Venezuela

International Drug Name Search

Adco-Contromet




Adco-Contromet may be available in the countries listed below.


Ingredient matches for Adco-Contromet



Metoclopramide

Metoclopramide hydrochloride (a derivative of Metoclopramide) is reported as an ingredient of Adco-Contromet in the following countries:


  • South Africa

International Drug Name Search

Friday, 23 September 2016

Monamox




Monamox may be available in the countries listed below.


Ingredient matches for Monamox



Amoxicillin

Amoxicillin trihydrate (a derivative of Amoxicillin) is reported as an ingredient of Monamox in the following countries:


  • Bangladesh

International Drug Name Search

Ziprasidone


Pronunciation: zi-PRAS-i-done
Generic Name: Ziprasidone
Brand Name: Geodon

Ziprasidone is an atypical antipsychotic. It may increase the risk of death when used to treat mental problems caused by dementia in elderly patients. Most of the deaths were linked to heart problems or infection. Ziprasidone is not approved to treat mental problems caused by dementia. Discuss any questions or concerns with your doctor.





Ziprasidone is used for:

Treating acute agitation in patients with schizophrenia who require an injectable medicine. It may also be used for other conditions as determined by your doctor.


Ziprasidone is an antipsychotic. It may work by altering the balance of certain chemicals that occur naturally in the brain, which are responsible for thinking and behavior.


Do NOT use Ziprasidone if:


  • you are allergic to any ingredient in Ziprasidone

  • you have recently had a heart attack, have severe heart failure, or have a history of certain types of irregular heartbeat (eg, long QT syndrome)

  • you are taking astemizole, cisapride, dofetilide, droperidol, halofantrine, levomethadyl, a macrolide immunosuppressive (eg, tacrolimus), mefloquine, methadone, nilotinib, pentamidine, certain phenothiazines (eg, thioridazine), pimozide, probucol, procainamide, quinidine, certain quinolone antibiotics (eg, moxifloxacin), a serotonin receptor antagonist antiemetic (eg, dolasetron), sotalol, sparfloxacin, terfenadine, or tetrabenazine

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



Before using Ziprasidone:


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


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

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

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

  • if you have considered or attempted suicide

  • if you have had any problems with fainting or dizziness

  • if you have a history of heart problems (eg, heart failure, slow or irregular heartbeat), low blood potassium or magnesium levels, low blood volume, low white blood cell counts, a drug-induced movement disorder, diabetes, kidney or liver problems, stroke, heart attack, low blood pressure, seizures, difficulty swallowing, neuroleptic malignant syndrome (NMS), Alzheimer disease, or dementia

  • if you have diabetes or a family history of diabetes or if you are very overweight

  • if you have had high blood prolactin levels or a history of certain types of cancer (eg, breast, pancreas, pituitary), or if you are at risk for breast cancer

  • if you are dehydrated, drink alcohol, or will be exposed to high temperatures

Some MEDICINES MAY INTERACT with Ziprasidone. Tell your health care provider if you are taking any other medicines, especially any of the following:


  • Arsenic, astemizole, bepridil, chloroquine, cisapride, class III antiarrhythmics (eg, amiodarone, sotalol), dofetilide, domperidone, droperidol, halofantrine, haloperidol, IA and IC antiarrhythmics (eg, flecainide, procainamide, propafenone, quinidine), kinase inhibitors (eg, lapatinib, nilotinib), levomethadyl , macrolide immunosuppressives (eg, tacrolimus), macrolides and ketolides (eg, azithromycin, erythromycin), maprotiline, mefloquine, methadone, pentamidine, phenothiazines (eg, thioridazine), pimozide, probucol, quinolones (eg, ciprofloxacin, moxifloxacin), serotonin receptor antagonist antiemetics (eg, dolasetron), sparfloxacin, streptogramins (eg, mitomycin, pristinamycin), terfenadine, or tetrabenazine because the risk of side effects such as abnormal heart rhythms may be increased

  • Tramadol because the risk of seizures may be increased

  • Ketoconazole because it may increase the risk of Ziprasidone's side effects

  • Carbamazepine because it may decrease Ziprasidone's effectiveness

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


How to use Ziprasidone:


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


  • Ziprasidone is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Ziprasidone at home, a health care provider will teach you how to use it. Be sure you understand how to use Ziprasidone. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.

  • Do not use Ziprasidone if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.

  • Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.

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

Ask your health care provider any questions you may have about how to use Ziprasidone.



Important safety information:


  • Ziprasidone may cause drowsiness, dizziness, or lightheadedness. These effects may be worse if you take it with alcohol or certain medicines. Use Ziprasidone with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

  • Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Ziprasidone; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.

  • Ziprasidone may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.

  • Do not become overheated in hot weather or while you are being active; heatstroke may occur.

  • Ziprasidone may rarely cause a prolonged, painful erection. This could happen even when you are not having sex. If this is not treated right away, it could lead to permanent sexual problems such as impotence. Contact your doctor right away if this happens.

  • Ziprasidone is intended for short-term control of acute agitation symptoms. If you require continuous treatment for your condition, your doctor may switch you to an oral medicine.

  • Ziprasidone may lower the ability of your body to fight infection. Avoid contact with people who have colds or infections. Tell your doctor if you notice signs of infection like fever, sore throat, rash, or chills.

  • Ziprasidone may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away.

  • Diabetes patients - Ziprasidone may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.

  • Serotonin syndrome is a possibly fatal syndrome that can be caused by Ziprasidone. Your risk may be greater if you take Ziprasidone with certain other medicines (eg, "triptans," monoamine oxidase inhibitors [MAOIs]). Symptoms may include agitation; confusion; hallucinations; coma; fever; fast or irregular heartbeat; tremor; excessive sweating; and nausea, vomiting, or diarrhea. Contact your doctor at once if you have any of these symptoms.

  • NMS is a possibly fatal syndrome that can be caused by Ziprasidone. Symptoms may include fever; stiff muscles; confusion; abnormal thinking; fast or irregular heartbeat; and sweating. Contact your doctor at once if you have any of these symptoms.

  • Ziprasidone may increase the amount of a certain hormone (prolactin) in your blood. Symptoms may include enlarged breast, missed menstrual period, decreased sexual ability, or nipple discharge. Contact your doctor right away if you experience any of these symptoms.

  • Some patients who take Ziprasidone may develop muscle movements that they cannot control. This is more likely to happen in elderly patients, especially women. The chance that this will happen or that it will become permanent is greater in those who take Ziprasidone in higher doses or for a long time. Muscle problems may also occur after short-term treatment with low doses. Tell your doctor at once if you have muscle problems with your arms; legs; or your tongue, face, mouth, or jaw (eg, tongue sticking out, puffing of cheeks, mouth puckering, chewing movements) while taking Ziprasidone.

  • Lab tests, including electrolyte levels, complete blood cell counts (CBC), or fasting blood sugar levels, may be performed while you use Ziprasidone. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

  • Use Ziprasidone with caution in the ELDERLY; they may be more sensitive to its effects, especially dizziness and lightheadedness upon sitting or standing up and uncontrolled muscle movements.

  • Ziprasidone should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.

  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Ziprasidone while you are pregnant. Using Ziprasidone during the third trimester may result in uncontrolled muscle movements or withdrawal symptoms in the newborn. Discuss any questions or concerns with your doctor. It is not known if Ziprasidone is found in breast milk. Do not breast-feed while taking Ziprasidone.


Possible side effects of Ziprasidone:


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



Anxiety; constipation; diarrhea; dizziness; drowsiness; dry mouth; feeling unusually tired or sleepy; headache; increased cough or runny nose; loss of appetite; nausea; pain at the injection site; restlessness; upset stomach; vomiting; weakness; weight gain.



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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); abnormal thoughts; change in amount of urine produced; confusion; decreased sexual ability; difficulty speaking or swallowing; enlarged breasts; fainting; fast, slow, or irregular heartbeat; fever, chills, or persistent sore throat; inability to move; missed menstrual period; muscle rigidity; muscle spasms or twitching; nipple discharge; pounding in the chest; prolonged or painful erection; seizures; shortness of breath; suicidal thoughts or attempts; sweating; symptoms of high blood sugar (increased thirst, increased urination, confusion, flushing, rapid breathing, or fruity breath odor); tremor; uncontrolled movements (eg, arm or leg movements, twitching of the face or tongue, jerking or twisting); unusual mood or mental changes; vision changes.



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


See also: Ziprasidone side effects (in more detail)


If OVERDOSE is suspected:


Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include fainting; irregular heartbeat; seizure; slurring of speech; uncontrolled movement of the head and neck.


Proper storage of Ziprasidone:

Ziprasidone is usually handled and stored by a health care provider. If you are using Ziprasidone at home, store Ziprasidone as directed by your pharmacist or health care provider. Keep Ziprasidone, as well as needles and syringes, out of the reach of children and away from pets.


General information:


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

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

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

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

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



Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Ziprasidone resources


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


  • Ziprasidone Professional Patient Advice (Wolters Kluwer)

  • Ziprasidone Monograph (AHFS DI)

  • ziprasidone Advanced Consumer (Micromedex) - Includes Dosage Information

  • Geodon Prescribing Information (FDA)

  • Geodon Consumer Overview



Compare Ziprasidone with other medications


  • Autism
  • Bipolar Disorder
  • Body Dysmorphic Disorder
  • Paranoid Disorder
  • Schizoaffective Disorder
  • Schizophrenia
  • Tourette's Syndrome

Alboz




Alboz may be available in the countries listed below.


Ingredient matches for Alboz



Omeprazole

Omeprazole is reported as an ingredient of Alboz in the following countries:


  • Mexico

International Drug Name Search

Ambri-xil




Ambri-xil may be available in the countries listed below.


Ingredient matches for Ambri-xil



Ambroxol

Ambroxol hydrochloride (a derivative of Ambroxol) is reported as an ingredient of Ambri-xil in the following countries:


  • Greece

International Drug Name Search

Thursday, 22 September 2016

Sulcran




Sulcran may be available in the countries listed below.


Ingredient matches for Sulcran



Sucralfate

Sucralfate is reported as an ingredient of Sulcran in the following countries:


  • Chile

  • Peru

International Drug Name Search

Diazepam Injection




Ingredient matches for Diazepam Injection



Diazepam

Diazepam is reported as an ingredient of Diazepam Injection in the following countries:


  • Australia

  • United States

International Drug Name Search

Anthelcide




In some countries, this medicine may only be approved for veterinary use.

Ingredient matches for Anthelcide



Oxibendazole

Oxibendazole is reported as an ingredient of Anthelcide in the following countries:


  • Australia

  • United States

International Drug Name Search

Sertralina Ranbaxygen




Sertralina Ranbaxygen may be available in the countries listed below.


Ingredient matches for Sertralina Ranbaxygen



Sertraline

Sertraline hydrochloride (a derivative of Sertraline) is reported as an ingredient of Sertralina Ranbaxygen in the following countries:


  • Spain

International Drug Name Search

Laskarton




Laskarton may be available in the countries listed below.


Ingredient matches for Laskarton



Elcatonin

Elcatonin is reported as an ingredient of Laskarton in the following countries:


  • Japan

International Drug Name Search

Wednesday, 21 September 2016

Neo-Poly-Dex



neomycin sulfate, polymyxin b sulfate, and dexamethasone

Dosage Form: ophthalmic ointment
Neomycin and Polymyxin B

Sulfates and Dexamethasone

Ophthalmic Ointment USP

(Sterile) 




Rx only



DESCRIPTION:


Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Ointment USP is a multiple dose anti-infective steroid combination in a sterile ointment for topical application. The active ingredient dexamethasone, is represented by the following structural formula:



C22H29FO5               Mol. Wt. 392.47


Chemical Name: Pregna-1,4-diene-3,20-dione, 9-fluoro-11,17,21-trihydroxy-16-methyl-, (11β,16α)-.


Neomycin Sulfate is the sulfate salt of neomycin B and C which are produced by the growth of Streptomyces fradiae Waksman (Fam. Streptomycetaceae). It has a potency equivalent to not less than 600 micrograms of neomycin base per milligram, calculated on an anhydrous basis. The structural formulae are:



Polymyxin B Sulfate is the sulfate salt of polymyxin B1 and B2 which are produced by the growth of Bacillus polymyxa (Prazmowski) Migula (Fam. Bacillaceae). It has a potency of not less than 6,000 polymyxin B units per milligram, calculated on an anhydrous basis.


The structural formulae are:



Each Gram Contains: ACTIVES: Neomycin Sulfate (equivalent to 3.5 mg Neomycin), Polymyxin B Sulfate, equal to 10,000 polymyxin B units; Dexamethasone 1 mg (0.1%). INACTIVES: White Petrolatum, Lanolin, Mineral Oil.


PRESERVATIVES ADDED: Methylparaben 0.05%, Propylparaben 0.01%.



CLINICAL PHARMACOLOGY:


Corticoids suppress the inflammatory response to a variety of agents and they probably delay or slow the healing. Since corticoids may inhibit the body's defense mechanism against infections, a concomitant antimicrobial drug may be used when this inhibition is considered to be clinically significant in a particular case.


When a decision to administer both a corticoid and an antimicrobial is made, the administration of such drugs in combination has the advantage of greater patient compliance and convenience, with the added assurance that the appropriate dosage of both drugs is administered, plus assured compatibility of ingredients when both types of drugs are in the same formulation and, particularly, that the correct volume of drug is delivered and retained.


The relative potency of corticosteroids depends on the molecular structure, concentration, and release from the vehicle.



INDICATIONS AND USAGE:


For steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where bacterial infection or a risk of bacterial ocular infection exists.


Ocular steroids are indicated in inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe where the inherent risk of steroid use in certain cases of infective conjunctivitides is accepted to obtain a diminution in edema and inflammation. They are also indicated in chronic anterior uveitis and corneal injury from chemical radiation or thermal burns; or penetration of foreign bodies.


The use of a combination drug with an anti-infective component is indicated where the risk of infection is high or where there is an expectation that potentially dangerous numbers of bacteria will be present in the eye.


The particular anti-infective drugs in this product is active against the following common bacterial eye pathogens: Staphylococcus aureus, Escherichia coli, Haemophilus influenzae, Klebsiella/Enterobacter species, Neisseria species, Pseudomonas aeruginosa.


This product does not provide adequate coverage against Serratia marcescens, and Streptococci, including Streptococcus pneumoniae.



CONTRAINDICATIONS:


Epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella and many other viral diseases of the cornea and conjunctiva. Mycobacterial infection of the eye. Fungal diseases of ocular structures. Hypersensitivity to a component of the medication. (Hypersensitivity to the antibiotic component occurs at a higher rate than for other components.)



WARNINGS:


NOT FOR INJECTION. Do not touch tube tip to any surface, as this may contaminate the contents. Prolonged use may result in glaucoma, with damage to the optic nerve, defects in visual acuity and fields of vision, and posterior subcapsular cataract formation. Prolonged use may suppress the host response and thus increase the hazard of secondary ocular infections. In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of topical steroids. In acute purulent conditions of the eye, steroids may mask infection or enhance existing infection. If these products are used for 10 days or longer, intraocular pressure should be routinely monitored even though it may be difficult in children and uncooperative patients.


Products containing neomycin sulfate may cause cutaneous sensitization.


Employment of steroid medication in the treatment of herpes simplex requires great caution.



PRECAUTIONS:



General


The initial prescription and renewal of the medication order beyond 8 grams should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy and, where appropriate, fluorescein staining.


The possibility of persistent fungal infections of the cornea should be considered after prolonged steroid dosing.



Information for Patients:


Do not touch tube tip to any surface, as this may contaminate the contents.



Pregnancy:


Pregnancy Category C. Dexamethasone has been shown to be teratogenic in mice and rabbits following topical ophthalmic application in multiples of the therapeutic dose.


In the mouse, corticosteroids produce fetal resorptions and a specific abnormality, cleft palate. In the rabbit, corticosteroids have produced fetal resorptions and multiple abnormalities involving the head, ears, limbs, palate, etc.


There are no adequate or well-controlled studies in pregnant women. Neomycin, Polymyxin B Sulfates and Dexamethasone Ophthalmic Ointment should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the embryo or fetus. Infants born of mothers who have received substantial doses of corticosteroids during pregnancy should be observed carefully for signs of hypoadrenalism.



Nursing Mothers:


Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human milk. Because many drugs are excreted in human milk, caution should be exercised when Neomycin, Polymyxin B Sulfates and Dexamethasone Ophthalmic Ointment, is administered to a nursing woman.



Pediatric Use:


Safety and effectiveness in pediatric patients have not been established.



ADVERSE REACTIONS:


Adverse reactions have occurred with steroid/anti-infective combination drugs which can be attributed to the steroid component, the anti-infective component, or the combination. Exact incidence figures are not available since no denominator of treated patients is available.


Reactions occurring most often from the presence of the anti-infective ingredients are allergic sensitizations. The reactions due to the steroid component are: elevation of intraocular pressure (IOP) with possible development of glaucoma, and infrequent optic nerve damage; posterior subcapsular cataract formation; and delayed wound healing.


Secondary Infection: The development of secondary infection has occurred after use of combinations containing steroids and antimicrobials. Fungal infections of the cornea are particularly prone to develop coincidentally with long-term applications of steroids. The possibility of fungal invasion must be considered in any persistent corneal ulceration where steroid treatment has been used.


Secondary bacterial ocular infection following suppression of host responses also occurs.



DOSAGE AND ADMINISTRATION:


Apply a small amount into the conjunctival sac(s) up to three or four times daily, or may be used adjunctively with Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Suspension at bedtime.


How to apply Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Ointment:


1. Tilt your head back.


2. Place a finger on your cheek just under your eye and gently pull down until a "V" pocket is formed between your eyeball and your lower lid.


3. Place a small amount (about 1/2 inch) of Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Ointment in the "V" pocket. Do not let the tip of the tube touch your eye.


4. Look downward before closing your eye.


Not more than 8 grams should be prescribed initially and the prescription should not be refilled without further evaluation as outlined in PRECAUTIONS above.



HOW SUPPLIED:


Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Ointment USP is supplied in an ophthalmic tube in the following size:


3.5 gram tube – Prod. No. 04034



Storage:


Store between 15°-30° C (59°-86° F).


KEEP OUT OF REACH OF CHILDREN.


DO NOT USE IF CAP AND NECKRING ARE NOT INTACT.


FOR OPHTHALMIC USE ONLY.


Revised November 2007


Bausch & Lomb Incorporated

Tampa, FL 33637

©Bausch & Lomb Incorporated


9114000 (Folded)

9114100 (Flat)



Principal Display Panel



NDC 11695-1436-6


Neo-Poly-Dex


Neomycin and Polymyxin B Sulfates and Dexamethasone Ophthalmic Ointment USP


Rx only


STERILE


Net wt. 1/8 oz. (3.5g)


Reorder No. 002600


Distributed Exclusively by:


Butler AHS Dublin, OH 43017


OPHTHIMAL









Neo-Poly-Dex 
neomycin sulfate, polymyxin b sulfate, and dexamethasone  ointment










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)11695-1436
Route of AdministrationOPHTHALMICDEA Schedule    














Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
NEOMYCIN SULFATE (NEOMYCIN)NEOMYCIN SULFATE3.5 mg  in 1 g
POLYMYXIN B SULFATE (POLYMYXIN B)POLYMYXIN B SULFATE10000 [USP'U]  in 1 g
DEXAMETHASONE (DEXAMETHASONE)DEXAMETHASONE1 mg  in 1 g














Inactive Ingredients
Ingredient NameStrength
LANOLIN 
METHYLPARABEN 
MINERAL OIL 
PROPYLPARABEN 
PETROLATUM 


















Product Characteristics
Color    Score    
ShapeSize
FlavorImprint Code
Contains      














Packaging
#NDCPackage DescriptionMultilevel Packaging
111695-1436-61 TUBE In 1 CARTONcontains a TUBE
13.5 g In 1 TUBEThis package is contained within the CARTON (11695-1436-6)










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
ANDAANDA06406307/25/1994


Labeler - Butler Animal Health Supply (017880659)

Registrant - Bausch & Lomb Incorporated (196603781)









Establishment
NameAddressID/FEIOperations
Bausch & Lomb Incorporated807927397MANUFACTURE
Revised: 11/2010Butler Animal Health Supply




More Neo-Poly-Dex resources


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


Compare Neo-Poly-Dex with other medications


  • Blepharitis
  • Conjunctivitis, Bacterial
  • Keratitis
  • Keratoconjunctivitis
  • Uveitis