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political opinions *this news item will not be available after 02/28/2018 Thursday, November 30, 2017 THURSDAY, Nov. 30, 2017 HealthDay News — The epidemic of opioid abuse in the United States has put hospital ERs on the front line, with staffers increasingly battling infections tied to the problem. ERs are seeing an increasing number of patients seeking care for severe infections resulting from injected use of heroin, fentanyl, oxycodone and the like, new research shows. ER radiologists are often the first to diagnose such complications, using X-rays, MRIs, CT scans and ultrasounds to spot infections that typically result from the use of non-sterile needles, the researchers said. Insights into how the opioid epidemic is playing out in the ER stem from a 12-year analysis that focused on more than 1,000 substance abuse patients who sought care for related complications between 2005 and 2016. The findings reflect the fact that “the opioid epidemic is a national emergency,” said study author Dr. Efren Flores. He’s an ER radiologist at Massachusetts General Hospital in Boston. “The results of this study,” he said, “are consistent with our daily practice, where we continue to observe an increase in the number of patients with substance use disorders that present to the emergency department for evaluation of complications related to their illness.” What’s more, Flores said, many of these patients — at an average age of 36 — “are young adults who are in the beginning of their productive lives.” Though not a member of the study team, Dr. Paul Petersen noted that “this increase in infections related to IV [intravenous] drug abuse has been expected and is not surprising to the medical community as the opioid epidemic continues to rise in the United States.” Petersen is a core faculty member of the emergency department at Mount Sinai Medical Center in Miami Beach, Fla. “IV drug abuse can cause local infections at the injection site, either from bacteria mixed in the drug, on a dirty needle or on dirty skin through which the needle passes,” he explained. “The bacteria can also grow in the bloodstream and prefer to accumulate and grow on the heart valves, causing valvular heart disease.” “In addition, from the valves, these vegetative infections or clumps of growing bacteria shoot downstream, commonly to the lungs, brain and spine, where they continue to grow and cause disease,” Petersen said. Complications from these infections are severe, he said. “They are often fatal and commonly cause chronic debilitating diseases of the spine, lungs, heart or brain, requiring multiple surgeries and long-term and/or institutionalized care,” he added. Two-thirds of the patients in the latest analysis were men, and 78 percent were white. Most of the complications seen during the study time frame involved localized soft-tissue infections at needle injection sites, according to the researchers. Sometimes the issue was a bacterial infection such as cellulitis. Other cases involved the onset of abscesses. In some instances, pieces of broken needles were found buried under the surface of a patient’s skin. Bacteria-infected blood vessel blockages known as septic emboli, which have the potential to move into the lung or brain, were another observed concern. Ultimately, 1 in 10 patients who had radiological screening while in the ER died from the complications. “Our research validates the severity of this epidemic and uniqueness of this patient population,” Flores said. ER radiologists need to embrace their front-line position by proactively devising ways to increase the likelihood that those who do make it out of the ER stay out going forward. For example, he suggested that radiologists should consider promoting needle-exchange programs while helping to direct patients into addiction recovery programs once they leave the ER. Petersen seconded the importance of needle exchange programs and the need to prevent new infections down the road. But he suggested that the epidemic’s front line is actually out in the community, rather than in the ER. Petersen places his stock in those who have the “greatest exposure to these patients” — social workers, family practitioners, homeless shelter staff members, community clinic workers and urgent care providers. It’s those individuals, he said, who are best placed to teach at-risk individuals about the most effective ways to limit their infection risk. Flores and his fellow researchers were to present their findings Thursday in Chicago at the Radiological Society of North America’s annual meeting. Research presented at meetings is considered preliminary because it has not been subjected to the rigorous scrutiny given to research published in medical journals. SOURCES: Efren Flores, M.D., emergency radiologist, Massachusetts General Hospital, Boston; Paul Petersen, M.D., core faculty, emergency department, Mount Sinai Medical Center, Miami Beach, Fla.; Nov. 30, 2017, presentation, Radiological Society of North America annual meeting, Chicago HealthDay Copyright c 2017 HealthDay . All rights reserved. News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services. More Health News on Bacterial Infections Emergency Medical Services Opioid Abuse and Addiction Recent Health News tune

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stoning up Dolasetron Injection Generic Name: Dolasetron Injection (doe LAS e tron) Brand Name: Anzemet Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings User Reviews Support Group Q & A Uses of Dolasetron Injection: It is used to treat or prevent upset stomach and throwing up. Slideshow The Ferocity of Chemotherapy – Does The End Justify The Means? What do I need to tell my doctor BEFORE I take Dolasetron Injection? If you have an allergy to dolasetron or any other part of dolasetron injection. If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. If you have heart block or you have been told that you are at risk for heart block. If you have any of these health problems: Long QT on ECG, low magnesium levels, or low potassium levels. This is not a list of all drugs or health problems that interact with this medicine. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take dolasetron injection with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. What are some things I need to know or do while I take Dolasetron Injection? Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists. Have blood work checked as you have been told by the doctor. Talk with the doctor. You may need to have an ECG checked before starting dolasetron injection and while taking it. Talk with your doctor. Do not take more than what your doctor told you to take. Taking more than you are told may raise your chance of very bad side effects. If you are 65 or older, use this medicine with care. You could have more side effects. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using dolasetron injection while you are pregnant. Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby. How is this medicine (Dolasetron Injection) best taken? Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely. It is given as a shot into a vein. What do I do if I miss a dose? Call your doctor to find out what to do. Dosage Information (comprehensive) What are some side effects that I need to call my doctor about right away? WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. Very bad dizziness or passing out. Fast or slow heartbeat. This medicine may cause very bad and sometimes deadly heartbeats that are not normal. Call your doctor right away if you have a heartbeat that does not feel normal. A very bad and sometimes deadly health problem called serotonin syndrome may happen. The risk may be greater if you take dolasetron injection with drugs for depression, migraines, or certain other drugs. Call your doctor right away if you have agitation; change in balance; confusion; hallucinations; fever; fast or abnormal heartbeat; flushing; muscle twitching or stiffness; seizures; shivering or shaking; sweating a lot; very bad diarrhea, upset stomach, or throwing up; or very bad headache. What are some other side effects of Dolasetron Injection? All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: Headache. Dizziness. These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch. Side Effects (complete list) If OVERDOSE is suspected: If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. How do I store and/or throw out Dolasetron Injection? If you need to store this medicine at home, talk with your doctor, nurse, or pharmacist about how to store it. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Check with your pharmacist about how to throw out unused drugs. Consumer Information Use and Disclaimer If your symptoms or health problems do not get better or if they become worse, call your doctor. Do not share your drugs with others and do not take anyone else’s drugs. Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor. Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins. Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about dolasetron injection, please talk with your doctor, nurse, pharmacist, or other health care provider. If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about dolasetron injection. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using dolasetron injection. Review Date: November 1, 2017 Next Side Effects Print this page Add to My Med List More about dolasetron Side Effects During Pregnancy Dosage Information Drug Interactions Support Group 0 Reviews Add your own review/rating Drug class: 5HT3 receptor antagonists Consumer resources Dolasetron Dolasetron injection Dolasetron Tablets Dolasetron (Advanced Reading) Dolasetron Oral, Intravenous (Advanced Reading) Other brands: Anzemet Professional resources Dolasetron Mesylate (AHFS Monograph) Dolasetron (Wolters Kluwer) Related treatment guides Nausea/Vomiting, Postoperative Nausea/Vomiting, Chemotherapy Induced Drug Status Rx Availability Prescription only B Pregnancy Category No proven risk in humans N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Dolasetron Rating No Reviews – Be the first! 10 /10 No Reviews – Be the first! 10 Rate it! Drug Class 5HT3 receptor antagonists Related Drugs Nausea / Vomiting, Chemotherapy Induced lorazepam , ondansetron , Zofran , Ativan , dexamethasone , metoclopramide , Reglan , Decadron , Marinol , dronabinol , More… Nausea / Vomiting, Postoperative ondansetron , Zofran , metoclopramide , Reglan , Zofran ODT , Emend , Aloxi , granisetron , palonosetron , droperidol , Kytril , aprepitant , More… business enterprise

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and so forth Menostar Generic Name: Estradiol Transdermal Weekly Patch (Osteoporosis) (ES tra DYE ol) Brand Name: Menostar Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings Breastfeeding Warnings User Reviews Support Group Q & A Pricing & Coupons Warning Estrogens may raise the chance of uterine cancer. Progestins may lower this chance. A warning sign for cancer of the uterus is vaginal bleeding. Report any vaginal bleeding to the doctor. Do not use estrogens to prevent heart disease or dementia. Using estrogens may raise the chances of having a heart attack, a stroke, breast cancer, a blood clot, or dementia. Use estrogens with or without progestin for the shortest time needed at the lowest useful dose. Uses of Menostar: It is used to put off soft, brittle bones (osteoporosis) in women after change of life. It may be given to you for other reasons. Talk with the doctor. Slideshow Looking Ahead: New Drug Approvals for 2017 What do I need to tell my doctor BEFORE I take Menostar? If you have an allergy to estradiol or any other part of Menostar (estradiol transdermal weekly patch (osteoporosis)). If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. If you have ever had a very bad or life-threatening reaction called angioedema. Signs may be swelling of the hands, face, lips, eyes, tongue, or throat; trouble breathing; trouble swallowing; unusual hoarseness. If you have had any of these health problems: Bleeding disorder, blood clots, a higher risk of having a blood clot, breast cancer, liver problems or liver tumor, heart attack, stroke, or a tumor where estrogen makes it grow. If you have eyesight problems like loss of eyesight from blood vessel problems in the eye. If you have thickening of the endometrium (lining of the uterus). If you have unexplained vaginal bleeding. If you are pregnant or may be pregnant. Do not take this medicine if you are pregnant. This is not a list of all drugs or health problems that interact with Menostar. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. What are some things I need to know or do while I take Menostar? Tell all of your health care providers that you take Menostar. This includes your doctors, nurses, pharmacists, and dentists. This medicine may raise the chance of blood clots, a stroke, or a heart attack. Talk with the doctor. Talk with your doctor if you will need to be still for long periods of time like long trips, bedrest after surgery, or illness. Not moving for long periods may raise your chance of blood clots. If you are allergic to tartrazine, talk with your doctor. Some products have tartrazine. If you have high blood sugar (diabetes), you will need to watch your blood sugar closely. High blood pressure has happened with drugs like this one. Have your blood pressure checked as you have been told by your doctor. Have blood work checked as you have been told by the doctor. Talk with the doctor. Have your blood work checked. Talk with your doctor. Have a bone density test as you have been told by your doctor. Talk with your doctor. Be sure to have regular breast exams and gynecology check-ups. Your doctor will tell you how often to have these. You will also need to do breast self-exams as your doctor has told you. Talk with your doctor. This medicine may cause dark patches of skin on your face. Avoid sun, sunlamps, and tanning beds. Use sunscreen and wear clothing and eyewear that protects you from the sun. This medicine may affect certain lab tests. Tell all of your health care providers and lab workers that you take this medicine. Do not smoke. Smoking raises the chance of heart disease. Talk with your doctor. Limit your drinking of alcohol. If you drink grapefruit juice or eat grapefruit often, talk with your doctor. This medicine works best when used with calcium/vitamin D and weight-bearing workouts like walking or PT (physical therapy). Follow the diet and workout plan that your doctor told you about. This medicine may affect growth in children and teens in some cases. They may need regular growth checks. Talk with the doctor. If you are 65 or older, use Menostar with care. You could have more side effects. Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby. How is this medicine (Menostar) best taken? Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely. Do not take Menostar by mouth. Use on your skin only. Keep out of your mouth, nose, and eyes (may burn). Use this medicine at the same time of day. Do not use on skin that has any problems. Do not put on the face, breast, or vagina. Wash your hands before and after use. Put patch on clean, dry, healthy skin. Move the site with each new patch. Put patch on a site without hair. Do not place on breast. Place below waistline. Do not put the patch on the waistline. Do not use patches that are cut or do not look right. If the patch falls off, put a new one on. Wear only one patch at a time. What do I do if I miss a dose? Put on a missed patch as soon as you think about it after taking off the old one. Dosage Information (comprehensive) What are some side effects that I need to call my doctor about right away? WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes. Chest pain or pressure. Shortness of breath. Coughing up blood. Swelling, warmth, numbness, change of color, or pain in a leg or arm. Very bad headache. Very bad dizziness or passing out. Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight. Very upset stomach or throwing up. Very bad belly pain. Back pain. Bulging eyes. Change in how contact lenses feel in the eyes. Loss of eyesight. Change in eyesight. A lump in the breast, breast soreness, or nipple discharge. Breast pain. Vaginal itching or discharge. Vaginal bleeding that is not normal. Low mood (depression). Mood changes. Memory problems or loss. Fever. Not able to pass urine or change in how much urine is passed. Pain when passing urine. Swelling. Very bad irritation where Menostar is used. What are some other side effects of Menostar? All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: Headache. Hair loss. Upset stomach or throwing up. Cramps. Bloating. Enlarged breasts. Breast soreness. Vaginal bleeding or spotting. Painful periods. Irritation where this medicine is used. These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch. Side Effects (complete list) If OVERDOSE is suspected: If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. How do I store and/or throw out Menostar? Store at room temperature. Store in a dry place. Do not store in a bathroom. After you take off a skin patch, be sure to fold the sticky sides of the patch to each other. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Check with your pharmacist about how to throw out unused drugs. Consumer Information Use and Disclaimer If your symptoms or health problems do not get better or if they become worse, call your doctor. Do not share your drugs with others and do not take anyone else’s drugs. Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor. Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins. Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about Menostar, please talk with your doctor, nurse, pharmacist, or other health care provider. If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Menostar (estradiol transdermal weekly patch (osteoporosis)). It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using Menostar. Review Date: November 1, 2017 Next Side Effects Print this page Add to My Med List More about Menostar (estradiol) Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Support Group Pricing & Coupons En EspaƱol 0 Reviews Add your own review/rating Drug class: estrogens Consumer resources Menostar Menostar Transdermal (Advanced Reading) Other brands: Estrace , Estradiol Patch , Climara , Estrogel , … +16 more Professional resources Menostar (FDA) Estradiol (AHFS Monograph) Related treatment guides Osteoporosis Postmenopausal Symptoms} Drug Status Rx Availability Prescription only X Pregnancy Category Not for use in pregnancy N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Menostar Rating No Reviews – Be the first! No Reviews – Be the first! Not Rated – Be the first! Manufacturer Bayer HealthCare Pharmaceuticals Inc. Drug Class Estrogens Related Drugs Postmenopausal Symptoms estradiol , Premarin , Estrace , Prempro , conjugated estrogens , Climara , Estrogel , Vivelle , Premarin Vaginal , Vivelle-Dot , More… Osteoporosis hydrochlorothiazide , alendronate , calcium carbonate , estradiol , Fosamax , Prolia , Caltrate , Premarin , Evista , raloxifene , Boniva , More…} } sufficient

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trendy {Peggy Sirota In Hollywood, survival often means being typecast (the best friend, the cop, the bad girl). Few actors, it seems, are willing to turn down a role simply because, well, they ve already played it. But Evangeline Lilly is not one of those actors. In fact, she s distanced herself from the image and style of fresh-faced castaway Kate Austen, the character she played for six seasons on the hit show Lost . I m so sick of people thinking that s who I am, admits Evangeline, 34. As if to underscore the point, today for her interview at a restaurant in Los Angeles, Evangeline is wearing dark pants and a short black jacket over a tank. Her cropped hair is pulled back, with wavy pieces falling into her fine-boned face, and her lips are colored berry red. She laughs and swears a lot. And as soon as she launches into lively conversation about the causes she fervently supports and takes a hearty swig of her cocktail (a house special called Penicillin), it s clear she s got grit to go along with her naturally good looks.} {To read the full interview with Evangeline, pick up a copy of the January/February issue of Women s Health on newsstands today ! More from Women s Health : Drew Barrymore s Laid-Back Lifestyle In the Spotlight with Carrie Underwood Pink: The Fear-Conquering Daredevil celebrity Evangeline Lilly Jan/Feb 2014} to your doorstep

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whenever , What it is: This contraceptive skin implant (Implanon) is a plastic rod the size of a matchstick. It contains only the hormone etonogestrel (a type of progestin) and is inserted underneath the woman’s skin on the inside of the upper arm. This is done by a licensed health-care provider and takes only a few minutes. What it does: Once implanted, the rod releases a hormone into your body. Much like any other hormonal form of contraception (like the Pill), it stops the ovaries from releasing an egg each month. One rod prevents pregnancies for up to three years. Pros: Most women have a different bleeding pattern, and some stop bleeding altogether. Plus, there’s no daily pill to remember or device to insert before intercourse, and nothing is implanted in your uterus. Cons: Some women experience skin changes, mood changes, or weight gain. Also, spotting and breakthrough bleeding is very common in the first six months to a year of use. Some women have swelling or infection at the insertion site. Protects against STDs? No Prescription needed? Yes birth control every so often

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abruptly Back BabyMed Newsletter I am Pregnant Other Four students enrolled in Stanford University s Design for Extreme Affordability course developed an innovative new incubator that mothers in remote villages around the world are using to save the lives of their babies born too soon or too small to maintain healthy body temperature. Many of these babies are born at home to parents who cannot afford hospital-based incubators or the time – often weeks – away from home to tend their incubator-bound babies. Today, thousands of those infants are surviving and thriving, thanks to the Embrace Infant Warmer, designed, developed and distributed globally by the team of students who became medical entrepreneurs. None of the students – Jane Chen, Linus Liang, Naganand Murty, and Rahul Panicker – were parents when the course started. They knew almost nothing about tending to babies. Individually, they were studying electrical engineering, computer science, and business. Once the class was over, the students just didn t have the heart to abandon the project. The team learned that 20 million babies are born prematurely or at low birth weight each year, that one million of them die the day they re born, and that hypothermia is the leading cause of death in these babies born with too little fat to maintain a healthy body temperature. According to Chen, room temperature feels like freezing cold water to them. Brainstorming sessions in a tree led to research trips to Nepal and India. The insights they discovered in the field led to design perfection, happy parents, and healthy babies. The journey transformed their way of thinking, from dedicated students to medical device developers and international distribution experts. Their original Embrace Infant Warmer can be used anywhere and there is an electrical supply to warm it. A newer design uses hot water. Either model can be used at home, is portable, lightweight, and sells for only a tiny fraction of the cost of traditional hospital incubators that can cost $20,000 or more. The ABC News TV show, 20/20, featured the Embrace Infant Warmer in 2010 and told of Nisha, a baby girl born in Bangalore weighing just five pounds. Nisha is thought to be the first life saved by the Embrace Infant Warmer and the team of four dedicated students with too much heart to walk away from a class project that had life-saving potential. Today, more than 3,000 babies have used the Embrace Infant Warmer. The team is working with nonprofit organizations in nine countries and negotiating a global distribution partnership with GE Healthcare. And one of them is now a parent, too. Source: Kelley, Tom and David Kelley. “A Solution for Poor Mothers, When Expensive Hospital Incubators Won’t Do.” Slate . Web. 16 Nov 2013. Keyword Tags: pregnancy news premature baby premature birth research incubator Explore By Category Getting Pregnant Pregnancy Infertility Women’s Topics All Tools Share: Popular on Babymed HOW TO GET PREGNANT FASTER EARLY PREGNANCY SYMPTOMS ONLINE BIRTHING/PRENATAL CARE CLASSES WHAT ARE MY PREGNANCY CHANCES TEST PREGNANCY WEEK-BY-WEEK CERVICAL MUCUS FERTILITY 101 – TAKE THE COURSE PATERNITY TESTING-BEFORE BIRTH CALCULATE: WHEN TO TAKE A PREGNANCY TEST PREGNANCY SYMPTOMS TEST AM I PREGNANT? ONLINE PREGNANCY TEST IMPLANTATION BLEEDING TEST THE BOY OR GIRL TEST FERTILITY CALCULATOR DUE DATE CALCULATOR HOW FAR ALONG AM I? PREGNANCY CALENDAR Get BabyMed Newsletters Sign up you purchased

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these days Doryx MPC (Oral) Generic Name: doxycycline (Oral route) dox-i-SYE-kleen Overview Side Effects Dosage Interactions Pregnancy More Breastfeeding Warnings User Reviews Drug Images Support Group Q & A Pricing & Coupons Commonly used brand name(s) In the U.S. Adoxa Adoxa CK Adoxa Pak Adoxa TT Doryx Doryx MPC Monodox Oracea Periostat Vibramycin Calcium Vibramycin Hyclate Vibra-Tabs Available Dosage Forms: Tablet Powder for Suspension Capsule Capsule, Extended Release Tablet, Delayed Release Capsule, Delayed Release Syrup Therapeutic Class: Antibiotic Chemical Class: Tetracycline (class) Slideshow Aging Issues: 12 of the Most Common Health Concerns Affecting Seniors Uses For Doryx MPC Doxycycline is used to treat bacterial infections in many different parts of the body. It is also used to treat pimples and abscesses (usually on the face) that are caused by rosacea, also known as acne rosacea or adult acne. Doxycycline delayed-release tablets and tablets are also used to prevent malaria and treat anthrax infection after possible exposure and other conditions as determined by your doctor. Doxycycline belongs to the class of medicines known as tetracycline antibiotics. It works by killing bacteria or preventing their growth. However, this medicine will not work for colds, flu, or other virus infections. This medicine is available only with your doctor’s prescription. Before Using Doryx MPC In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered: Allergies Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Pediatric Doxycycline may cause permanent discoloration of the teeth and slow down the growth of bones. This medicine should not be given to children 8 years of age and younger (except for the treatment of exposure to inhalational anthrax or rickettsia infection), unless directed by the child’s doctor. Geriatric Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of doxycycline in the elderly. However, elderly patients are more likely to have kidney, liver, or heart problems which may require caution and an adjustment in the dose for patients receiving doxycycline. Pregnancy Pregnancy Category Explanation All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk. Breast Feeding There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Interactions with Medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Acitretin Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Amoxicillin Ampicillin Bacampicillin Bexarotene Cholera Vaccine, Live Cloxacillin Dicloxacillin Etretinate Isotretinoin Methicillin Methotrexate Methoxyflurane Nafcillin Oxacillin Penicillin G Penicillin G Benzathine Penicillin G Procaine Penicillin V Piperacillin Pivampicillin Sultamicillin Temocillin Tretinoin Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Aluminum Carbonate, Basic Aluminum Hydroxide Aluminum Phosphate Aminolevulinic Acid Bismuth Subsalicylate Calcium Dihydroxyaluminum Aminoacetate Dihydroxyaluminum Sodium Carbonate Iron Magaldrate Magnesium Carbonate Magnesium Hydroxide Magnesium Oxide Magnesium Trisilicate Rifampin Rifapentine Interactions with Food/Tobacco/Alcohol Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. Other Medical Problems The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially: Asthma Vibramycin syrup contains sodium metabisulfite, which can cause allergic and life-threatening reactions in patients with this condition. Diarrhea or Intracranial hypertension (pseudotumor cerebri), or history of or Vaginal candidiasis (yeast) infections Use with caution. May make these conditions worse. Kidney problems Use with caution. The effects may be increased because of slower removal of the medicine from the body. Proper Use of doxycycline This section provides information on the proper use of a number of products that contain doxycycline. It may not be specific to Doryx MPC. Please read with care. Take this medicine exactly as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects. This medicine comes with patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions. If you are using delayed-release tablets or tablets : It may be taken with food or milk, if it upsets your stomach. You may take this medicine by breaking the tablets. Hold the tablet between your thumb and index fingers close to the appropriate score (separation) line. Then, apply enough pressure to snap the tablet segments apart. Do not use the tablet if it does not break on the scored lines. You may also take this medicine by sprinkling the equally broken tablets onto cold, soft food, such as applesauce. This mixture must be swallowed immediately without chewing and followed with a glass of cool water to ensure complete swallowing of the pellets. Do not store the mixture for later use. Swallow the capsule whole. Do not break, crush, chew, or open it. Shake the oral liquid well just before each use. Measure the dose with a marked measuring spoon, oral syringe, or medicine cup. Drink plenty of fluids to avoid throat irritation and ulceration. If you are using this medicine to prevent malaria while traveling, start taking the medicine 1 or 2 days before you travel. Take the medicine every day during your trip and continue taking it for 4 weeks after you return. However, do not use the medicine for longer than 4 months. If you are using Oracea delayed-release capsules: You should take this medicine on an empty stomach, preferably at least 1 hour before or 2 hours after meals. You should take this medicine with a full glass of water while sitting or standing. To prevent throat irritation, do not lay down right after taking this medicine. Use only the brand of this medicine that your doctor prescribed . Different brands may not work the same way. To switch from Doryx delayed-release tablets to Doryx MPC delayed-release tablets : Replace a 50 milligram (mg) dose of Doryx delayed-release tablet with a 60 mg dose of Doryx MPC delayed-release tablet. Replace a 100 mg dose of Doryx delayed-release tablet with a 120 mg dose of Doryx MPC delayed-release tablet. To help clear up your infection completely, keep taking this medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop taking this medicine too soon, your symptoms may return. Dosing The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For oral dosage forms (capsules, Doryx delayed-release tablets, suspension, syrup, tablets): For infections: Adults 100 milligrams (mg) every 12 hours on the first day, then 100 mg once a day or 50 to 100 mg every 12 hours. Children older than 8 years of age and weighs 45 kilograms (kg) or more 100 mg every 12 hours on the first day, then 100 mg once a day or 50 to 100 mg every 12 hours. Children older than 8 years of age and weighs less than 45 kg Dose is based on body weight and must be determined by your doctor. The dose is usually 4.4 mg per kg of body weight per day and divided into 2 doses on the first day of treatment. This is followed by 2.2 mg per kg of body weight per day, taken as a single dose or divided into two doses on the following days. Children up to 8 years of age Use is not recommended. For the prevention of malaria: Adults 100 milligrams (mg) once a day. You should take the first dose 1 or 2 days before traveling to an area where malaria may occur, and continue taking the medicine every day throughout your travel and for 4 weeks after you leave the malarious area. Children older than 8 years of age Dose is based on body weight and must be determined by your doctor. The dose is usually 2 milligrams (mg) per kilogram (kg) of body weight per day, taken as a single dose. You should take the first dose 1 or 2 days before travel to an area where malaria may occur, and continue taking the medicine every day throughout travel and for 4 weeks after you leave the malarious area. Children up to 8 years of age Use is not recommended. For anthrax after possible exposure: Adults and children weighing 45 kilograms (kg) or more 100 milligrams (mg) two times a day (taken every 12 hours) for 60 days. Children weighing less than 45 kg Dose is based on body weight and must be determined by your doctor. The dose is usually 2.2 milligrams (mg) per kilogram (kg) of body weight per day, two times a day for 60 days. For oral dosage form (delayed-release capsules): For the treatment of pimples from rosacea: Adults 40 milligrams (mg) or one capsule once a day, in the morning. Children Use and dose must be determined by your doctor. For oral dosage form (Doryx MPC delayed-release tablet): For infections: Adults and children older than 8 years of age and weighs 45 kilograms (kg) or more, with or without severe or life-threatening infections 120 milligrams (mg) every 12 hours on the first day, then 120 mg once a day or 60 to 120 mg every 12 hours. Children older than 8 years of age and weighs less than 45 kg Dose is based on body weight and must be determined by your doctor. The dose is usually 5.3 mg per kg of body weight per day and divided into 2 doses on the first day of treatment. This is followed by 2.6 mg per kg of body weight per day, taken as a single dose or divided into two doses on the following days. Children weighing less than 45 kg with severe or life-threatening infections Dose is based on body weight and must be determined by your doctor. The dose is usually 2.6 mg per kg of body weight per day given every 12 hours. Children 8 years of age and younger Use is not recommended. For prevention of malaria: Adults and children weighing more than 45 kilograms (kg) 120 milligrams (mg) once a day. You should take the first dose 1 or 2 days before traveling to an area where malaria may occur, and continue taking the medicine every day throughout your travel and for 4 weeks after you leave the malarious area. Children 8 years of age and older Dose is based on body weight and must be determined by your doctor. The dose is usually 2.4 milligrams (mg) per kilogram (kg) of body weight per day, taken as a single dose. You should take the first dose 1 or 2 days before traveling to an area where malaria may occur, and continue taking the medicine every day throughout your travel and for 4 weeks after you leave the malarious area. Children up to 8 years of age Use is not recommended. For anthrax after possible exposure: Adults and children weighing 45 kilograms (kg) or more 120 milligrams (mg) two times a day for 60 days. Children weighing less than 45 kg Dose is based on body weight and must be determined by your doctor. The dose is usually 2.6 milligrams (mg) per kilogram (kg) of body weight per day, two times a day for 60 days. Missed Dose If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Storage Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Ask your healthcare professional how you should dispose of any medicine you do not use. Precautions While Using Doryx MPC If your symptoms do not improve within a few days, or if they become worse, check with your doctor. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. This medicine may darken the color of your skin, nails, eyes, teeth, gums, or scars. Talk with your doctor if you have any concerns. Doxycycline may cause diarrhea, and in some cases it can be severe. It may occur 2 months or more after you stop taking this medicine. Do not take any medicine to treat diarrhea without first checking with your doctor. Diarrhea medicines may make the diarrhea worse or make it last longer. If you have any questions about this or if mild diarrhea continues or gets worse, check with your doctor. Birth control pills (containing estrogen) may not work properly while you are using doxycycline. To keep from getting pregnant, use other forms of birth control. These include condoms, a diaphragm, or a contraceptive foam or jelly. Doxycycline may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for short periods of time, may cause skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine: Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible. Wear protective clothing, including a hat. Also, wear sunglasses. Apply a sunblock product that has a sun protection factor (SPF) number of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor. Apply a sunblock lipstick that has an SPF of at least 15 to protect your lips. Do not use a sun lamp or tanning bed or booth. If you have a severe reaction from the sun, check with your doctor. This medicine may cause intracranial hypertension. This is more likely to occur in women of childbearing age who are overweight or have a history of intracranial hypertension. Tell your doctor right away if you have a headache, blurred vision, or changes in vision. Contact your doctor immediately if fever, rash, joint pain, or tiredness occurs. These could be symptoms of an autoimmune syndrome where the body attacks itself. You should not take antacids that contain aluminum, calcium or magnesium, or any product that contains iron, such as vitamin or mineral supplements. If you are using this medicine to prevent malaria , take extra care not to get bitten by mosquitoes. Use protective clothing, mosquito netting or screens, and an insect repellent. Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Doryx MPC Side Effects Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur: Incidence not known Bloating chills clay-colored stools constipation cough dark urine decreased appetite diarrhea diarrhea, watery and severe, which may also be bloody difficulty with swallowing dizziness fast heartbeat feeling of discomfort fever headache hives, itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue hives or welts, itching, or rash increased thirst indigestion inflammation of the joints joint or muscle pain large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs loss of appetite nausea and vomiting numbness or tingling of the face, hands, or feet pain in the stomach, side, or abdomen, possibly radiating to the back redness and soreness of the eyes redness of the skin sore throat sores in the mouth stomach cramps stomach pain or tenderness swelling of the feet or lower legs swollen lymph glands tightness in the chest unusual tiredness or weakness unusual weight loss yellow eyes or skin Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Incidence not known Back, leg, or stomach pains black, tarry stools bleeding gums blood in the urine or stools blurred vision bulging soft spot on the head of an infant change in the ability to see colors, especially blue or yellow chest pain, discomfort, or burning cracks in the skin decrease in vision difficulty breathing discoloration of the thyroid glands double vision general body swelling heartburn increased sensitivity of the skin to sunlight loss of heat from the body lower back or side pain nosebleeds pain or burning in the throat pain with swallowing painful or difficult urination pale skin pinpoint red spots on the skin rash with flat lesions or small raised lesions on the skin red, swollen skin redness or other discoloration of the skin redness, swelling, or soreness of the tongue scaly skin severe nausea severe stomach pain severe sunburn sores, ulcers, or white spots on the lips or tongue or inside the mouth unusual bleeding or bruising vomiting blood Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. Side Effects (complete list) The information contained in the Truven Health Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you. The use of the Truven Health products is at your sole risk. These products are provided “AS IS” and “as available” for use, without warranties of any kind, either express or implied. Truven Health and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Copyright 2017 Truven Health Analytics, Inc. All Rights Reserved. Next Side Effects Print this page Add to My Med List More about Doryx MPC (doxycycline) Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Images Drug Interactions Support Group Pricing & Coupons 0 Reviews Add your own review/rating Consumer resources Other brands: Vibramycin , Monodox , Adoxa , Oracea , … +14 more Professional resources Doxycycline Monohydrate (AHFS Monograph) Doxycyline Suspension (FDA) Related treatment guides Acne Actinomycosis Amebiasis Anthrax … +51 more} Drug Status Rx Availability Prescription only D Pregnancy Category Positive evidence of risk N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Related Drugs Upper Respiratory Tract Infection amoxicillin , azithromycin , doxycycline , cephalexin , Augmentin , Zithromax , More… Bacterial Infection ciprofloxacin , amoxicillin , azithromycin , doxycycline , cephalexin , More… Acne doxycycline , clindamycin topical , erythromycin topical , minocycline , tretinoin topical , tetracycline topical , More… Chlamydia Infection amoxicillin , azithromycin , doxycycline , Zithromax , Levaquin , levofloxacin , More… 51 more conditions… Doryx MPC Rating No Reviews – Be the first! No Reviews – Be the first! Not Rated – Be the first! Doryx MPC Images Doryx MPC 120 mg (DC ) View larger images Help and Support Looking for answers? Ask a question or go join the Doryx MPC support group to connect with others who have similar interests.} } coloration

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Photo :Speaking Up for Yourself

that particular Speaking Up for Yourself Posted under Health Guides . Updated 1 June 2017. +Related Content Key Facts Learning how to speak up will help you gain confidence. Speaking up allows you to voice your opinion about important issues. Listening to the response is just as important as speaking up. Have you ever wanted to tell someone that you re worried, sad, or mad, but you felt nervous or didn t know what to say? Have you ever seen something happen that you disagreed with but didn t know what to do about it? We all get these feelings at times even adults! Why should I care about speaking up for myself? Learning how to speak up for yourself is an important part of growing up. Your voice and opinions matter! Letting others know your thoughts and feelings will help you feel stronger and more confident. What does it mean to speak up ? Here are some examples: Letting others know when you re feeling sad, angry, or upset Asking a teacher to explain something in a different way if you re confused Letting a health care provider or nurse know when you don t understand what they re telling you Letting a teacher, parent, or coach know when you think a classmate or friend is being bullied or made fun of Talking to a family member or friend about something they did or said that you disagree with Calling 911 in an emergency, or telling a responsible adult when you think someone is in danger Why is speaking up difficult sometimes? Sometimes it may seem easier to keep your feelings inside to avoid becoming embarrassed or having a hard conversation, but it s just a short term solution. It can be tricky to know when the best time is to speak up for yourself. For example, should you speak to a teacher privately or raise your hand in front of the classroom? Learning how to speak up can change your life in a very positive way. How can I learn to speak up for myself? Steps to speaking up: First, figure out what the issue is and whether you want to do something about it. Having a clear idea of what you want to say and why is the first step in speaking up. What are you hoping will happen once you speak up? Think about what you d like to say. Sometimes it helps to practice what you re going to say before you say it. This can be as simple as thinking it through or practicing out loud with a friend. Think about how you are going to start the conversation- it s important to use words that won t make the other person feel like they re being attacked. For example, say I want or I need instead of You should or You did . Think about the best time to speak up. Speaking up doesn t necessarily mean raising your hand to talk in class, and sometimes this isn t always the best time to speak your mind anyway! Decide whether the conversation is best to have with one person or in front of a group. If you get nervous in front of groups, maybe it s best to make an appointment with a teacher or guidance counselor, or have a private conversation with a friend or parent. Listen to the response. We don t always get our way when we speak up. It may be that the other person doesn t see eye to eye with you, but it s still important to listen to their thoughts and let them speak without interrupting. Make eye contact with them and let them know that you re listening. Safety first! There may be times when you feel like you want to speak up about something you observe in a public place; however it may not be safe to do so. For example: If you observe someone being treated unfairly, it is still good to speak up to a safe person, someone who will not harm you such as a police officer, store manager or other trustworthy adult and who can handle the situation and not put you or others in danger. Most importantly, stay positive! It gets easier to speak up for yourself with practice, and every time you do, you ll get better at it. If you don t get the solution that you were hoping for after speaking up, take a moment to congratulate yourself for taking this big step! Then, think about what you said, how you said it, and what you d want to say differently the next time. Speaking up can be hard to do, but don t give up! You ll find that with practice it gets easier. Get tips from friends, siblings, parents, coaches and teachers about how they learned to speak up. Tags: open communication subtle enough

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the women [2:2 hours, resume at next regularly scheduled dose Dosage adjustments for indinavir when administered in combination therapy: Note: Delavirdine, itraconazole, or ketoconazole: Reduce indinavir dose to 600 mg every 8 hours Rifabutin: Reduce rifabutin to 1 / 2 the standard dose plus increase indinavir to 1,000 mg every 8 hours Dosing: Geriatric Refer to adult dosing. Dosing: Pediatric HIV-1 infection, treatment: Oral: Adolescents (off-label dose): Unboosted regimen: 800 mg every 8 hours (HHS [adult] 2015) Ritonavir-boosted regimen: Indinavir 800 mg twice daily plus ritonavir 100 to 200 mg twice daily (HHS [adult] 2015; HHS [pediatric] 2016) Dosage adjustments for indinavir when administered in combination therapy: The manufacturer labeling recommendations for adults should also be considered in adolescent patients receiving adult dose (HHS [adult] 2015). Dosing: Renal Impairment There are no dosage adjustments provided in the manufacturer s labeling (has not been studied). Dosing: Hepatic Impairment Mild to moderate impairment due to cirrhosis (unboosted regimen): 600 mg every 8 hours Severe impairment: There are no dosage adjustments provided in the manufacturer s labeling (has not been studied). Extemporaneously Prepared A 10 mg/mL oral solution may be prepared using capsules. First, prepare a 100 mg/mL indinavir concentrate by adding the contents of fifteen 400 mg capsules and 60 mL purified water to a 100 mL amber glass bottle. Place bottle in an ultrasonic bath filled with water at 37 C for 60 minutes, stirring the solution every 10 minutes. Filter solution; wash bottle and filter with 6 mL purified water; cool solution to room temperature. Add 50 mL of 100 mg/mL indinavir concentrate to 360 mL viscous sweet base, 90 mL simple syrup, 1.8 g citric acid, 45 mg azorubine, 0.1M sodium hydroxide solution to pH 3, and 12 drops of lemon oil, to make a final volume of 500 mL. Mix to a uniform solution. Label refrigerate . Stable for 2 weeks refrigerated. Hugen PW, Burger DM, ter Hofstede HJ, et al, “Development of an Indinavir Oral Liquid for Children,” Am J Health Syst Pharm , 2000, 57(14):1332-9.10918923 Administration Drink at least 48 oz of water daily. Administer with water, 1 hour before or 2 hours after a meal. May also be administered with other liquids (eg, skim milk, juice, coffee, tea) or a light meal (eg, toast, corn flakes). Administer around-the-clock to avoid significant fluctuation in serum levels. May be taken with food when administered in combination with ritonavir. Dietary Considerations Should be taken without food but with water 1 hour before or 2 hours after a meal. Administration with lighter meals (eg, dry toast, skim milk, corn flakes) resulted in little/no change in indinavir concentration. If taking with ritonavir, may take with food. Patient should drink at least 48 oz of water daily. Storage Store at 15 C to 30 C (59 F to 86 F); protect from moisture. Dispense in original container (desiccant should remain in the bottle). Drug Interactions Abacavir: Protease Inhibitors may decrease the serum concentration of Abacavir. Monitor therapy Abemaciclib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Abemaciclib. Management: In patients taking abemaciclib at a dose of 200 mg or 150 mg twice daily, reduce the dose to 100 mg twice daily when combined with strong CYP3A4 inhibitors. In patients taking abemaciclib 100 mg twice daily, decrease the dose to 50 mg twice daily. Consider therapy modification Acalabrutinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Acalabrutinib. Avoid combination Ado-Trastuzumab Emtansine: CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Ado-Trastuzumab Emtansine. Specifically, strong CYP3A4 inhibitors may increase concentrations of the cytotoxic DM1 component. Avoid combination Alfuzosin: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Alfuzosin. Avoid combination Alfuzosin: Protease Inhibitors may increase the serum concentration of Alfuzosin. Avoid combination Alitretinoin (Systemic): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Alitretinoin (Systemic). Management: Consider reducing the alitretinoin dose to 10 mg when used together with strong CYP3A4 inhibitors. Monitor for increased alitretinoin effects/toxicities if combined with a strong CYP3A4 inhibitor. Consider therapy modification Almotriptan: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Almotriptan. Management: Limit initial almotriptan adult dose to 6.25 mg and maximum adult dose to 12.5 mg/24-hrs when used with a strong CYP3A4 inhibitor. Avoid concurrent use in patients with impaired hepatic or renal function. Consider therapy modification Alosetron: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Alosetron. Monitor therapy ALPRAZolam: Indinavir may increase the serum concentration of ALPRAZolam. Avoid combination Amiodarone: Indinavir may increase the serum concentration of Amiodarone. Avoid combination AmLODIPine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of AmLODIPine. Monitor therapy Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy Apixaban: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Apixaban. Monitor therapy Aprepitant: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Aprepitant. Avoid combination ARIPiprazole: CYP3A4 Inhibitors (Strong) may increase the serum concentration of ARIPiprazole. Management: See full interaction monograph for details. Consider therapy modification ARIPiprazole Lauroxil: CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of ARIPiprazole Lauroxil. Management: Please refer to the full interaction monograph for details concerning the recommended dose adjustments. Consider therapy modification Astemizole: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Astemizole. Avoid combination Asunaprevir: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Asunaprevir. Avoid combination Atazanavir: May enhance the adverse/toxic effect of Indinavir. Indinavir may enhance the adverse/toxic effect of Atazanavir. Avoid combination AtorvaSTATin: Protease Inhibitors may increase the serum concentration of AtorvaSTATin. Management: See full monograph for recommended dose limits. Avoid atorvastatin with tipranavir/ritonavir. Consider therapy modification Atovaquone: May decrease the serum concentration of Indinavir. Monitor therapy Avanafil: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Avanafil. Avoid combination Axitinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Axitinib. Management: Avoid concurrent use of axitinib with any strong CYP3A inhibitor whenever possible. If a strong CYP3A inhibitor must be used with axitinib, a 50% axitinib dose reduction is recommended. Avoid combination Barnidipine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Barnidipine. Avoid combination Bedaquiline: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bedaquiline. Management: Limit the duration of concomitant administration of bedaquiline with CYP3A4 inhibitors to no more than 14 days, unless the benefit of continued administration is judged to outweigh the possible risks. Monitor for toxic effects of bedaquiline. Consider therapy modification Benperidol: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Benperidol. Monitor therapy Blonanserin: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Blonanserin. Avoid combination Boceprevir: May decrease the serum concentration of Protease Inhibitors. Protease Inhibitors may decrease the serum concentration of Boceprevir. Management: Some combinations are not recommended. See full drug interaction monograph for details. Consider therapy modification Bortezomib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bortezomib. Monitor therapy Bosentan: Indinavir may increase the serum concentration of Bosentan. Bosentan may decrease the serum concentration of Indinavir. Management: Initiate bosentan at, or adjust bosentan to, 62.5 mg once daily or every other day (based on tolerability) in indinavir-treated patients (see ritonavir for dosing if that agent is used). Additionally, monitor for possible reduced response to indinavir. Consider therapy modification Bosutinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bosutinib. Avoid combination Brentuximab Vedotin: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be increased. Monitor therapy Brexpiprazole: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Brexpiprazole. Management: Reduce brexpiprazole dose to 50% of usual with a strong CYP3A4 inhibitor; reduce to 25% of usual if used with both a moderate CYP3A4 inhibitor and a CYP2D6 inhibitor, or if a strong CYP3A4 inhibitor is used in a CYP2D6 poor metabolizer. Consider therapy modification Brigatinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Brigatinib. Management: Avoid concurrent use of brigatinib with strong CYP3A4 inhibitors when possible. If combination cannot be avoided, reduce the brigatinib dose by approximately 50%, rounding to the nearest tablet strength (ie, from 180 mg to 90 mg, or from 90 mg to 60 mg). Consider therapy modification Brinzolamide: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Brinzolamide. Monitor therapy Bromocriptine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Bromocriptine. Avoid combination Budesonide (Nasal): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Budesonide (Nasal). Monitor therapy Budesonide (Oral Inhalation): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Budesonide (Oral Inhalation). Monitor therapy Budesonide (Systemic): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Budesonide (Systemic). Avoid combination Budesonide (Topical): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Budesonide (Topical). Management: Per US prescribing information, avoid this combination. Canadian product labeling does not recommend strict avoidance. If combined, monitor for excessive glucocorticoid effects as budesonide exposure may be increased. Consider therapy modification Buprenorphine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Buprenorphine. Monitor therapy BusPIRone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of BusPIRone. Management: Limit the buspirone dose to 2.5 mg daily and monitor patients for increased buspirone effects/toxicities if combined with strong CYP3A4 inhibitors. Consider therapy modification Cabazitaxel: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cabazitaxel. Management: Concurrent use of cabazitaxel with strong inhibitors of CYP3A4 should be avoided when possible. If such a combination must be used, consider a 25% reduction in the cabazitaxel dose. Consider therapy modification Cabozantinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cabozantinib. Management: Avoid use of a strong CYP3A4 inhibitor with cabozantinib if possible. If combined, cabozantinib dose adjustments are recommended and vary based on the cabozantinib product used and the indication for use. See monograph for details. Consider therapy modification Calcifediol: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Calcifediol. Monitor therapy Calcium Channel Blockers (Nondihydropyridine): Protease Inhibitors may decrease the metabolism of Calcium Channel Blockers (Nondihydropyridine). Increased serum concentrations of the calcium channel blocker may increase risk of AV nodal blockade. Management: Avoid concurrent use when possible. If used, monitor for CCB toxicity. The manufacturer of atazanavir recommends a 50% dose reduction for diltiazem be considered. Saquinavir, tipranavir, and darunavir/cobicistat use with bepridil is contraindicated. Consider therapy modification Cannabidiol: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cannabidiol. Monitor therapy Cannabis: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be increased. Monitor therapy CarBAMazepine: May increase the metabolism of Protease Inhibitors. Protease Inhibitors may decrease the metabolism of CarBAMazepine. Consider therapy modification Cariprazine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cariprazine. Management: Cariprazine dose reductions of 50% are required; specific recommended management varies slightly for those stable on cariprazine versus those just starting cariprazine. See prescribing information or full interaction monograph for details. Consider therapy modification Ceritinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ceritinib. Management: If such combinations cannot be avoided, the ceritinib dose should be reduced by approximately one-third (to the nearest 150 mg). Resume the prior ceritinib dose after cessation of the strong CYP3A4 inhibitor. Avoid combination Cilostazol: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cilostazol. Management: Consider reducing the cilostazol dose to 50 mg twice daily in adult patients who are also receiving strong inhibitors of CYP3A4. Consider therapy modification Cisapride: Protease Inhibitors may increase the serum concentration of Cisapride. This may result in QTc prolongation and malignant cardiac arrhythmias. Avoid combination Clarithromycin: Protease Inhibitors may diminish the therapeutic effect of Clarithromycin. Specifically, certain protease inhibitors may decrease formation of the active 14-hydroxy-clarithromycin metabolite, which may negatively impact clarithromycin effectiveness vs. H. influenzae and other non-MAC infections. Protease Inhibitors may increase the serum concentration of Clarithromycin. Clarithromycin dose adjustment in renally impaired patients may be needed. Clarithromycin may increase the serum concentration of Protease Inhibitors. Management: Avoid clarithromycin adult doses greater than 1000 mg/day when used with a protease inhibitor. Further dose reductions may be needed in patients with impaired renal function. Consider alternative antimicrobial for any non-MAC infection. Consider therapy modification CloZAPine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of CloZAPine. Monitor therapy Cobimetinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cobimetinib. Avoid combination Colchicine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Colchicine. Management: Colchicine is contraindicated in patients with impaired renal or hepatic function who are also receiving a strong CYP3A4 inhibitor. In those with normal renal and hepatic function, reduce colchicine dose as directed. Consider therapy modification Conivaptan: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Conivaptan. Avoid combination Copanlisib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Copanlisib. Management: If concomitant use of copanlisib and strong CYP3A4 inhibitors cannot be avoided, reduce the copanlisib dose to 45 mg. Monitor patients for increased copanlisib effects/toxicities. Consider therapy modification Corticosteroids (Orally Inhaled): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Corticosteroids (Orally Inhaled). Management: Orally inhaled fluticasone propionate with a strong CYP3A4 inhibitor is not recommended. Exceptions: Beclomethasone (Oral Inhalation); Triamcinolone (Systemic). Monitor therapy Corticosteroids (Systemic): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Corticosteroids (Systemic). Exceptions: MethylPREDNISolone; PrednisoLONE (Systemic); PredniSONE. Monitor therapy Crizotinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Crizotinib. Avoid combination Cyclophosphamide: Protease Inhibitors may enhance the adverse/toxic effect of Cyclophosphamide. Specifically, the incidences of neutropenia, infection, and mucositis may be increased. Monitor therapy CycloSPORINE (Systemic): Protease Inhibitors may increase the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Protease Inhibitors. Consider therapy modification CycloSPORINE (Systemic): CYP3A4 Inhibitors (Strong) may increase the serum concentration of CycloSPORINE (Systemic). Consider therapy modification CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification CYP3A4 Substrates (High risk with Inhibitors): CYP3A4 Inhibitors (Strong) may decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). Exceptions: Alitretinoin (Systemic); AmLODIPine; Buprenorphine; Gefitinib; HYDROcodone; Praziquantel; Telithromycin; Vinorelbine. Consider therapy modification Dabrafenib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dabrafenib. Avoid combination Daclatasvir: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Daclatasvir. Management: Decrease the daclatasvir dose to 30 mg once daily if combined with a strong CYP3A4 inhibitor. No dose adjustment is needed when daclatasvir is used with darunavir/cobicistat. Consider therapy modification Dapoxetine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dapoxetine. Avoid combination Dasatinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dasatinib. Management: Use of this combination should be avoided; consider reducing dasatinib dose if a strong CYP3A4 inhibitor must be used. If using dasatinib 100 mg/day, consider reduction to 20 mg/day; if using dasatinib 140 mg/day, consider reduction to 40 mg/day. Consider therapy modification Deferasirox: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Deflazacort: CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Deflazacort. Management: Administer one third of the recommended deflazacort dose when used together with a strong or moderate CYP3A4 inhibitor. Consider therapy modification Delamanid: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Delamanid. Management: Increase electrocardiogram (ECG) monitoring frequency if delamanid is combined with strong CYP3A4 inhibitors because the risk for QTc interval prolongation may be increased. Continue frequent ECG assessments throughout the full delamanid treatment period. Consider therapy modification Delavirdine: Protease Inhibitors may decrease the serum concentration of Delavirdine. Delavirdine may increase the serum concentration of Protease Inhibitors. Consider therapy modification Dexamethasone (Ophthalmic): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dexamethasone (Ophthalmic). Monitor therapy Didanosine: May decrease the serum concentration of Indinavir. Management: Indinavir should be administered on an empty stomach at least 1 hour apart from administration of buffer-containing formulations of didanosine. Consider therapy modification Dienogest: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dienogest. Monitor therapy DOCEtaxel: CYP3A4 Inhibitors (Strong) may increase the serum concentration of DOCEtaxel. Management: Avoid the concomitant use of docetaxel and strong CYP3A4 inhibitors when possible. If combined use is unavoidable, consider a 50% docetaxel dose reduction and monitor for increased docetaxel toxicities. Consider therapy modification Dofetilide: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dofetilide. Monitor therapy Domperidone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Domperidone. Avoid combination Doxercalciferol: CYP3A4 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Doxercalciferol. Monitor therapy DOXOrubicin (Conventional): CYP3A4 Inhibitors (Strong) may increase the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to strong CYP3A4 inhibitors in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided. Consider therapy modification Dronabinol: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dronabinol. Monitor therapy Dronedarone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dronedarone. Avoid combination Drospirenone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Drospirenone. Monitor therapy Dutasteride: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Dutasteride. Monitor therapy Efavirenz: May decrease the serum concentration of Indinavir. Management: The appropriate dose adjustments for indinavir when used together with efavirenz are unknown. The use of higher unboosted indinavir doses is not likely an adequate approach. Use of a ritonavir-boosted indinavir regimen could be considered. Consider therapy modification Eletriptan: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Eletriptan. Avoid combination Eliglustat: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Eliglustat. Management: Use should be avoided under some circumstances. See full drug interaction monograph for details. Consider therapy modification Enfuvirtide: Protease Inhibitors may increase the serum concentration of Enfuvirtide. Enfuvirtide may increase the serum concentration of Protease Inhibitors. Monitor therapy Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Consider therapy modification Eplerenone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Eplerenone. Avoid combination Ergot Derivatives: Protease Inhibitors may increase the serum concentration of Ergot Derivatives. Exceptions: Cabergoline; Nicergoline; Pergolide. Avoid combination Erlotinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Erlotinib. Management: Avoid use of this combination when possible. When the combination must be used, monitor the patient closely for the development of severe adverse reactions, and if such severe reactions occur, reduce the erlotinib dose (in 50 mg decrements). Consider therapy modification Estazolam: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Estazolam. Monitor therapy Eszopiclone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Eszopiclone. Management: Limit the eszopiclone dose to 2 mg daily when combined with strong CYP3A4 inhibitors and monitor for increased eszopiclone effects and toxicities (eg, somnolence, drowsiness, CNS depression). Consider therapy modification Etizolam: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Etizolam. Management: Consider use of lower etizolam doses when using this combination; specific recommendations concerning dose adjustment are not available. Monitor clinical response to the combination closely. Consider therapy modification Etravirine: Protease Inhibitors may decrease the serum concentration of Etravirine. This effect is anticipated with darunavir, saquinavir, and lopinavir (with low-dose ritonavir). Etravirine may increase the serum concentration of Protease Inhibitors. This effect is anticipated with nelfinavir. Management: Low-dose ritonavir boosting must be used when any protease inhibitor is used with etravirine. Avoid use of etravirine in combination with atazanavir, fosamprenavir, full-dose ritonavir (600 mg twice daily, in adults), or tipranavir. Monitor therapy Everolimus: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Everolimus. Avoid combination Evogliptin: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Evogliptin. Monitor therapy FentaNYL: CYP3A4 Inhibitors (Strong) may increase the serum concentration of FentaNYL. Management: Monitor patients closely for several days following initiation of this combination, and adjust fentanyl dose as necessary. Consider therapy modification Fesoterodine: CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Fesoterodine. Management: Avoid fesoterodine doses greater than 4 mg daily in adult patients who are also receiving strong CYP3A4 inhibitors. Consider therapy modification Flibanserin: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Flibanserin. Avoid combination Fluticasone (Nasal): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Fluticasone (Nasal). Avoid combination Fluticasone (Oral Inhalation): CYP3A4 Inhibitors (Strong) may increase the serum concentration of Fluticasone (Oral Inhalation). Management: Use of orally inhaled fluticasone propionate with strong CYP3A4 inhibitors is not recommended. Use of orally inhaled fluticasone furoate with strong CYP3A4 inhibitors should be done with caution. Monitor patients using such a combination more closely. Consider therapy modification Garlic: May decrease the serum concentration of Protease Inhibitors. Management: Concurrent use of garlic supplements with protease inhibitors is not recommended. If this combination is used, monitor closely for altered serum concentrations/effects of protease inhibitors, and particularly for signs/symptoms of therapeutic failure. Consider therapy modification Gefitinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Gefitinib. Monitor therapy GuanFACINE: CYP3A4 Inhibitors (Strong) may increase the serum concentration of GuanFACINE. Management: Reduce the guanfacine dose by 50% when initiating this combination. Consider therapy modification Halofantrine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Halofantrine. Avoid combination Histamine H2 Receptor Antagonists: May decrease the serum concentration of Indinavir. Monitor therapy HYDROcodone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of HYDROcodone. Monitor therapy HydrOXYzine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of HydrOXYzine. Management: This combination is specifically contraindicated in some non-U.S. labeling. Consider therapy modification Ibrutinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ibrutinib. Management: Avoid concomitant use of ibrutinib and strong CYP3A4 inhibitors. If a strong CYP3A4 inhibitor must be used short-term (eg, anti-infectives for 7 days or less), interrupt ibrutinib therapy until the strong CYP3A4 inhibitor is discontinued. Avoid combination Idelalisib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Idelalisib. Monitor therapy Ifosfamide: CYP3A4 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Ifosfamide. Monitor therapy Iloperidone: CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Iloperidone. Specifically, concentrations of the metabolites P88 and P95 may be increased. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Iloperidone. Management: Reduce iloperidone dose by half when administered with a strong CYP3A4 inhibitor. Consider therapy modification Imatinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Imatinib. Monitor therapy Imidafenacin: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Imidafenacin. Monitor therapy Irinotecan Products: CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Irinotecan Products. Specifically, serum concentrations of SN-38 may be increased. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Irinotecan Products. Avoid combination Irinotecan Products: UGT1A1 Inhibitors may increase serum concentrations of the active metabolite(s) of Irinotecan Products. Specifically, concentrations of SN-38 may be increased. UGT1A1 Inhibitors may increase the serum concentration of Irinotecan Products. Avoid combination Isavuconazonium Sulfate: CYP3A4 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Isavuconazonium Sulfate. Specifically, CYP3A4 Inhibitors (Strong) may increase isavuconazole serum concentrations. Management: Combined use is considered contraindicated per US labeling. Lopinavir/ritonavir (and possibly other uses of ritonavir doses less than 400 mg every 12 hours) is treated as a possible exception to this contraindication despite strongly inhibiting CYP3A4. Avoid combination Itraconazole: May increase the serum concentration of Indinavir. Indinavir may increase the serum concentration of Itraconazole. Management: Reduce the normal indinavir adult dose to 600 mg every 8 hours when given with itraconazole. Monitor for increased systemic effects (including adverse/toxic effects) of itraconazole. Consider therapy modification Ivabradine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ivabradine. Avoid combination Ivacaftor: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ivacaftor. Management: Ivacaftor dose reductions are required; consult full monograph content for specific age- and weight-based recommendations. Consider therapy modification Ixabepilone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Ixabepilone. Consider therapy modification Ketoconazole (Systemic): May increase the serum concentration of Indinavir. Indinavir may increase the serum concentration of Ketoconazole (Systemic). Management: Reduce the normal indinavir adult dose to 600 mg every 8 hours when given with ketoconazole. Monitor for increased systemic effects (including adverse/toxic effects) of ketoconazole. Consider therapy modification Lacosamide: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lacosamide. Monitor therapy Lapatinib: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lapatinib. Management: If an overlap in therapy cannot be avoided, consider reducing lapatinib adult dose to 500 mg/day during, and within 1 week of completing, treatment with the strong CYP3A4 inhibitor. Avoid combination Lercanidipine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lercanidipine. Avoid combination Levobupivacaine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Levobupivacaine. Monitor therapy Levomilnacipran: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Levomilnacipran. Management: Do not exceed a maximum adult levomilnacipran dose of 80 mg/day in patients also receiving strong CYP3A4 inhibitors. Consider therapy modification Lomitapide: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lomitapide. Avoid combination Lovastatin: Protease Inhibitors may increase the serum concentration of Lovastatin. Avoid combination Lovastatin: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lovastatin. Avoid combination Lumefantrine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lumefantrine. Monitor therapy Lurasidone: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Lurasidone. Avoid combination Macitentan: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Macitentan. Avoid combination Manidipine: CYP3A4 Inhibitors (Strong) may increase the serum concentration of Manidipine. Management: Consider avoiding concomitant use of manidipine and strong CYP3A4 inhibitors. If combined, monitor closely for increased manidipi pictures

of fantastic Indinavir the majority