Tip of the Month

Tip of the Month (Archives)
LEVOTHYROXINE
• Take tablet with water on an empty stomach, preferably one-half hour to an hour before breakfast. • Drug may cause hyperthyroidism (fatigue, heat intolerance, fever, sweating, hyperactivity, tremors, palpitations, myocardial infarction), pseudotumor cerebri in children (nausea, vomiting, headache, pulsating intracranial sounds), or seizures. • Advise patient against sudden discontinuation of drug. • Instruct patient to take 4 hours apart from antacids, iron, and calcium supplements, if taking concomitantly. • Advise patient there are multiple significant drug-drug interactions for this drug. Consult a doctor prior to new drug use (including over-the-counter and herbal drugs). • Take 4 hours apart from antacids, iron, and calcium supplements. • Do not administer with foods that decrease absorption • Advise patients with coronary artery disease to notify a physician or dentist that they take this drug prior to surgical procedures.
LISINOPRIL
 This drug may cause nausea, vomiting, dizziness, headache, or angioedema (swelling) of face, lips, throat, or intestines.  Instruct patient to report signs/symptoms of hypotension, or a persistent cough.  Advise patient against sudden discontinuation of drug.  Take each dose with a full glass of water.  Lisinopril can be taken with or without food.  Counsel patient to limit alcoholic beverages.  Take it at the same time each day.  Do not use lisinopril if you are pregnant as it shows teratogenic effect of fetus.  Do not use lisinopril if you are breastfeeding.
ATORVASTATIN
 Drug can be taken at any time of the day with or without food.  Preferably taken at night time show better results.  Take the medicine at the same time each day.  Drug may cause Diarrhea, Urinary Tract Infections (UTI’s),Extremity pain, Nasopharyngitis, Arthralgia, Dyspepsia or Nausea.  Advise patient to immediately report signs/symptoms of myopathy including unexplained muscle pain, tenderness, or weakness especially when accompanied by fever or malaise, or if symptoms persist after discontinuation of drug.  Counsel patients to report signs/symptoms of liver injury (jaundice, dark urine, upper abdominal discomfort, anorexia, fatigue).  Counsel patient to avoid excessive quantities of alcohol to reduce risk of hepatotoxicity.  Instruct patient not to eat large amounts of grapefruit (Idlinbu or Papnas) or drink more than 1 l/day of grapefruit juice with this drug.  Advise patient that there are multiple significant drug-drug interactions for this drug. Consult doctor prior to new drug use (including over-the-counter and herbal drugs).
Allopurinol
§ Warn patient to immediately report a skin rash or signs/symptoms of an allergic reaction (painful urination, blood in the urine, irritation of the eyes, or swelling of the lips or mouth) as drug may cause severe, sometimes fatal, hypersensitivity reactions. § Avoid activities requiring mental alertness or coordination until drug effects are realized as drug may cause drowsiness. § Drug may cause diarrhea, nausea, or acute attacks of gout. § Instruct patient to report signs/symptoms of hepatotoxicity (anorexia, weight loss, or pruritus). § Advise patient that optimal benefit may be delayed for 2 to 6 weeks. § Counsel patient to take drug after meals to reduce gastric irritation. § Encourage patient to maintain adequate hydration during therapy to prevent renal (kidney) stones
Mefloquine
§ Patient should be advised that any live vaccines should be completed at least 3 days before initiation of therapy. § Avoid activities requiring mental alertness or coordination until drug effects are realized. § This drug may cause bradycardia (decreased heart rate), diarrhea, nausea, dizziness, somnolence (excessive sleep). § Take tablet with food and an full glass of water. § Do not take with or following halofantrine treatment. § Avoid concomitant use of quinine, quinidine, or chloroquine therapy. § Instruct patient to repeat full dose if vomiting occurs within 30 min of dose, or to repeat 1/2 dose if vomiting occurs within 30 to 60 min of dose.
Dutasteride
 women should not handle capsules when they are pregnant or may potentially become pregnant due of the possibility of absorption and the subsequent potential risk to a male fetus  Advise patient not to donate blood for at least 6 months after the last dose to prevent exposure to a pregnant transfusion recipient.  Drug may cause impotence, decreased libido, ejaculation disorders, and breast enlargement and/or tenderness.  Instruct patient to swallow capsule whole. Do not chew or open capsule as contents may cause oropharyngeal irritation.  take with or without food  swallow capsules whole; do not chew or open
Calcium Acetate
 Drug may cause nausea and vomiting.  Instruct patient to immediately report signs/symptoms of hypercalcemia (constipation, anorexia, nausea, vomiting, confusion, stupor).  Advise patient to take drug with a meal.  Warn patient to avoid concomitant use of calcium-containing supplements, including calcium-based antacids
Iron
Warn patients that the oral liquid may stain teeth. Staining may be minimized by mixing liquid with juice or water and drinking it with a straw. Iron stains may be removed by brushing teeth with baking soda or peroxide. Advise patients to expect iron to darken stools. It may cause constipation or nausea. Tell patient to take ferrous gluconate or sulfate with a meal. Patient should not take ferrous sulfate within 2 h of other medications. Instruct patient to avoid eating eggs, milk, cheese, yogurt, tea, coffee, whole-grain cereals, and breads within 1 h before or 2 h after taking iron supplements.
Metronidazole
In case of extended release oral formulations, instruct the patient that, do not crush the tablet and take it at least 1 hour before or 2 hours after meals. Warn patient to not drink alcohol or ingest alcohol-containing products while taking this drug. Concomitant use may cause a disulfiram-like reaction (abdominal cramps, vomiting, flushing, headache). Wait at least one day after stopping tablets and at least 3 days after stopping capsules or extended-release tablets before consuming alcohol.
Alendronate
Patient should be instructed to take alendronate 30 mins before any meal or other medicines. Take with full glass of water & sit upright for 30 mins to avoid esophageal ulcer formation.

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