Istalol

Generic Name: timolol (Ophthalmic route)

TIM-oh-lol

Commonly used brand name(s)

In the U.S.

• Betimol


• Istalol


• Timoptic Ocudose


• Timoptic Ocumeter


• Timoptic Ocumeter Plus


• Timoptic-XE Ocumeter


• Timoptic-XE Ocumeter Plus

Available Dosage Forms:

• Solution


• Gel Forming Solution

Therapeutic Class: Antiglaucoma

Pharmacologic Class: Beta-Adrenergic Blocker, Nonselective

Uses For Istalol

Timolol is used alone or together with other medicines to treat increased pressure in the eye that is caused by open-angle glaucoma or a condition called ocular (eye) hypertension. This medicine is a beta-blocker .

This medicine is available only with your doctor's prescription .

Before Using Istalol

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

Appropriate studies have not been performed on the relationship of age to the effects of timolol in the pediatric population. Safety and efficacy have not been established .

Geriatric

Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of timolol in the elderly .

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during 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 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.

• Albuterol


• Amiodarone


• Arformoterol


• Bambuterol


• Bitolterol


• Broxaterol


• Clenbuterol


• Clonidine


• Colterol


• Diltiazem


• Dronedarone


• Epinephrine


• Fenoldopam


• Fenoterol


• Formoterol


• Hexoprenaline


• Indacaterol


• Isoetharine


• Levalbuterol


• Metaproterenol


• Pirbuterol


• Procaterol


• Reproterol


• Rimiterol


• Ritodrine


• Salmeterol


• Terbutaline


• Timolol


• Tretoquinol


• Tulobuterol


• Verapamil

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.

• Acarbose


• Aceclofenac


• Acemetacin


• Acetohexamide


• Alclofenac


• Alfuzosin


• Amlodipine


• Apazone


• Arbutamine


• Benfluorex


• Benoxaprofen


• Bromfenac


• Bufexamac


• Bunazosin


• Carprofen


• Chlorpropamide


• Cimetidine


• Clometacin


• Clonixin


• Dexketoprofen


• Diclofenac


• Diflunisal


• Digoxin


• Dipyrone


• Doxazosin


• Droxicam


• Etodolac


• Etofenamate


• Felbinac


• Felodipine


• Fenbufen


• Fenoprofen


• Fentiazac


• Floctafenine


• Flufenamic Acid


• Flurbiprofen


• Gliclazide


• Glimepiride


• Glipizide


• Gliquidone


• Glyburide


• Guar Gum


• Ibuprofen


• Indomethacin


• Indoprofen


• Insulin


• Insulin Aspart, Recombinant


• Insulin Glulisine


• Insulin Lispro, Recombinant


• Isoxicam


• Ketoprofen


• Ketorolac


• Lacidipine


• Lercanidipine


• Lornoxicam


• Manidipine


• Meclofenamate


• Mefenamic Acid


• Meloxicam


• Metformin


• Methyldopa


• Mibefradil


• Miglitol


• Moxisylyte


• Nabumetone


• Naproxen


• Nicardipine


• Nifedipine


• Niflumic Acid


• Nilvadipine


• Nimesulide


• Nimodipine


• Nisoldipine


• Nitrendipine


• Oxaprozin


• Oxyphenbutazone


• Phenoxybenzamine


• Phentolamine


• Phenylbutazone


• Pirazolac


• Piroxicam


• Pirprofen


• Pranidipine


• Prazosin


• Propyphenazone


• Proquazone


• Quinidine


• Repaglinide


• St John's Wort


• Sulindac


• Suprofen


• Tamsulosin


• Tenidap


• Tenoxicam


• Terazosin


• Tiaprofenic Acid


• Tolazamide


• Tolbutamide


• Tolmetin


• Trimazosin


• Troglitazone


• Urapidil


• Zomepirac

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 or


• Bradycardia (slow heartbeat) or


• Chronic obstructive pulmonary disease (COPD), severe or


• Heart block or


• Heart failure—Should not use in patients with these conditions .

• Blood vessel disease (especially blood vessels of the brain) or


• Stroke, history of—Use with caution. This medicine may worsen these conditions .

• Diabetes or


• Hyperthyroidism (overactive thyroid) or


• Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat .

• Lung disease—Use with caution. May cause difficulty with breathing in patients with this condition .

• Myasthenia gravis—May worsen symptoms of this condition, such as muscle weakness .

Proper Use of timolol

This section provides information on the proper use of a number of products that contain timolol. It may not be specific to Istalol. Please read with care.

Shake the regular eye drops well just before each use. If you are using the gel-forming eye drops, turn the bottle upside down and shake it once. You do not need to shake the gel-forming eye drops more than once .

To use the eye drops (solution and gel):

• First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed and apply pressure to the inner corner of the eye with your finger for 1 or 2 minutes to allow the medicine to be absorbed by the eye.


• Immediately after using the medicine, wash your hands to remove any medicine that may be on them.


• To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed. Serious damage to the eye and possible loss of vision may result from using contaminated eye medicines .

If your doctor ordered two different eye medicines to be used together, wait at least 10 minutes after the regular eye drops before using the second medicine. This will help prevent the second medicine from “washing out” the first one. The gel-forming eye drops should always be the last medicine used if two medicines are ordered. Wait 10 minutes before using the gel-forming eye drops .

You should not use the regular eye drops if you have contact lenses in your eyes. Remove your contact lenses before you use this medicine. Wait at least 15 minutes after you use the medicine before putting the contact lenses back in .

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 glaucoma or ocular hypertension:
  
  • For ophthalmic gel-forming solution dosage form (eye drops):
    
    • Adults—One drop in the affected eye(s) once a day.
    
    
    • Children—Use and dose must be determined by your doctor .
    
    
  
  
  • For ophthalmic solution dosage form (eye drops):
    
    • Adults—One drop in the affected eye(s) two times a day.
    
    
    • Children—Use and dose must be determined by your doctor .
    
    
  
  

Missed Dose

If you miss a dose of this medicine, apply 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.

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 Istalol

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects .

If itching, redness, swelling, or other signs of eye or eyelid irritation occur, stop using this medicine and check with your doctor. These signs may mean that you are allergic to this medicine .

Timolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing .

This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests .

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery .

The gel-forming eye drops may cause blurred vision or other vision problems that last about 30 seconds to 5 minutes after you put them in your eye. If any of these occur, do not drive, use machines, or do anything else that could be dangerous if you are not able to see well. If these eye changes are bothersome, check with your doctor .

Istalol 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:

More common

• Blurred vision


• burning or stinging in eye

Less common

• Arm, back, or jaw pain


• blisters, hives, welts, or itching


• blue lips, fingernails, or skin


• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings


• change in vision


• chest pain or discomfort


• chest tightness or heaviness


• confusion about identity, place, and time


• continuing ringing or buzzing or other unexplained noise in ears


• coughing that sometimes produces a pink frothy sputum


• depression


• difficult, fast, noisy breathing, sometimes with wheezing


• difficulty in chewing, swallowing, or talking


• dilated neck veins


• discharge, excessive tearing


• disturbed color perception


• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly


• double vision


• drooping eyelids


• dry or itching eyes


• extreme fatigue


• false sense of well-being


• fast, slow, irregular, pounding, or racing heartbeat or pulse


• fear, nervousness


• feeling of having something in the eye


• fever and chills


• flashes of light, floaters in vision


• general feeling of discomfort or illness


• hair loss


• halos around lights


• headaches


• inability to speak


• increased sweating


• irregular, fast or slow, or shallow breathing


• large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs


• lightheadedness, dizziness, or fainting


• loss of vision


• memory loss


• mood swings


• muscle or joint pain


• muscle weakness


• nausea


• night blindness


• no blood pressure or pulse


• overbright appearance of lights


• pain, tension, and weakness upon walking that subsides during periods of rest


• pale skin


• paleness or cold feeling in fingertips, toes, hands, and feet


• personality changes


• pounding in the ears


• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue


• redness of skin


• redness, pain, swelling or irritation of eye, eyelid, or inner lining of eyelid


• seeing double


• seeing, hearing, or feeling things that are not there


• seizures


• severe numbness, especially on one side of the face or body


• severe or sudden headache


• severe tiredness


• shortness of breath or troubled breathing


• skin irritation or rash, including rash that looks like psoriasis


• slurred speech


• sore throat


• stopping of heart


• sweating


• swelling of face, fingers, feet, lower legs, and ankles


• swollen glands


• temporary blindness


• tingling or pain in fingers or toes when exposed to cold


• tunnel vision


• unconsciousness


• unusual tiredness or weakness


• weakness in arm and/or leg on one side of the body, sudden and severe


• weight gain


• wheezing

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:

Less common

• Acid or sour stomach


• belching


• body aches or pain


• diarrhea


• dry mouth


• ear congestion


• hearing loss


• heartburn


• indigestion


• lack or loss of strength


• loss of appetite


• loss of voice


• nightmares


• runny nose


• sleepiness or unusual drowsiness


• sleeplessness


• sneezing


• stomach discomfort, upset, or pain


• stuffy nose


• trouble sleeping


• unable to sleep


• weight loss

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.

See also: Istalol side effects (in more detail)

The information contained in the Thomson Reuters 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 Thomson Reuters Healthcare 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. Thomson Reuters Healthcare 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, THOMSON REUTERS HEALTHCARE 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. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

More Istalol resources

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

• Istalol Prescribing Information (FDA)


• Istalol Consumer Overview


• Istalol Drops MedFacts Consumer Leaflet (Wolters Kluwer)


• Timolol Ophthalmic Prescribing Information (FDA)


• Betimol Drops MedFacts Consumer Leaflet (Wolters Kluwer)


• Betimol Prescribing Information (FDA)

Compare Istalol with other medications

• Glaucoma, Open Angle
• Intraocular Hypertension

interferon alfa-2a

Generic Name: interferon alfa-2a ( in ter FEAR on AL fa 2 A)

Brand Names: Roferon-A

What is interferon alfa-2a?

Interferon alfa-2a is a protein. Interferons are released in the body in response to viral infections. Interferons are important for fighting viruses in the body, regulating reproduction of cells, and regulating the immune system.

Interferon alfa-2a is used to treat chronic hepatitis C, hairy cell leukemia, AIDS-related Kaposi's sarcoma, and some types of chronic myelogenous leukemia (CML).

Interferon alfa-2a may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about interferon alfa-2a?

Call your doctor or seek emergency medical attention if you develop symptoms of depression or are contemplating suicide; become unusually irritable, anxious (nervous), or aggressive; or experience other mood or behavior changes. In some cases, interferon alfa-2a has caused serious mood or behavioral problems. Problems with body organs such as the heart, lungs, and eyes have been experienced by people taking interferon alfa-2a or other similar drugs. Contact your doctor immediately if you develop difficulty breathing, chest pain, blurred vision, or loss of vision.

Some patients taking interferon alfa-2a have developed a drop in the number of white blood cells and platelets. If the number of these blood cells are too low, there is an increased risk of infection or bleeding. Contact your doctor immediately if you develop a fever, symptoms of an infection, or unusual bleeding or bruising.

Use caution when driving, operating machinery, or performing other hazardous activities. Interferon alfa-2a may cause drowsiness, dizziness, or impaired alertness. If you experience drowsiness, dizziness, or impaired alertness, avoid these activities.

What should I discuss with my healthcare provider before using interferon alfa-2a?

Do not use interferon alfa -2a without first talking to your doctor if you have had an allergic reaction to an alfa interferon in the past or if you are allergic to E. coli derived products. Also, do not use interferon alfa-2a if you have an allergy to the preservative benzyl alcohol.

Before using interferon alfa-2a, talk to your doctor if you

• 
  

  a history of depression, suicidal thoughts, anxiety, drug or alcohol abuse, or another mental illness;

  
  


• 
  

  an active infection;

  
  


• 
  

  heart disease or history of a heart attack;

  
  


• 
  

  an autoimmune disorder such as rheumatoid arthritis, systemic lupus erythematosus (SLE), or psoriasis;

  
  


• 
  

  have a suppressed immune system or have received an organ transplant,

  
  


• 
  

  have a seizure disorder,

  
  


• 
  

  have diabetes,

  
  


• 
  

  have bone marrow suppression,

  
  


• have kidney disease, or


• have liver disease.

You may not be able to use interferon alfa-2a, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Interferon alfa-2a is in the FDA pregnancy category C. This means that it is not known whether interferon alfa-2a will be harmful to an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known whether interferon alfa-2a passes into breast milk. Do not use this medication without first talking to your doctor if you are breast-feeding.

How should I use interferon alfa-2a?

Use interferon alfa-2a exactly as directed by your doctor. If you do not understand these directions, ask your doctor, nurse, or pharmacist to explain them to you.

Interferon alfa-2a is used as an intramuscular or subcutaneous injection only. Your doctor or nurse will give you detailed instructions on how and where to inject this medication. Do not inject this medication if you are unsure how.

Drink 6 to 8 full glasses of water daily to ensure adequate hydration, especially at the start of treatment.

Flulike symptoms are likely to occur. They are most common at the start of therapy and may decrease with continued use. Over-the-counter fever reducers such as acetaminophen (Tylenol, others), ibuprofen (Motrin, Advil, others), and naproxen (Aleve), plenty of fluid, and taking the medication at bedtime may help to alleviate these symptoms.

Do not inject interferon alfa-2a if it is discolored or has particles in it.

Do not change the brand or generic formulation of interferon alfa-2a that you are using without first talking to your doctor or pharmacist. Some brands of interferon alfa-2a are interchangeable while others are not. Your doctor and/or pharmacist know which brand/generic formulations may be substituted for another.

Do not shake the vial of interferon alfa-2a. If mixing is required, the vial should be gently swirled.

If the interferon alfa-2a you are using is preservative-free, use only one dose from each vial. Throw away any medicine that is not used with the first dose, do not save it for later use

Never reuse a needle or syringe. Dispose of all needles and syringes in an appropriate, puncture-resistant disposal container.

Your doctor may want you to have blood tests performed before and periodically during treatment with an interferon alfa-2a.

It is not known whether treatment with alfa interferon will prevent the transmission of hepatitis to others. It is also not known whether alfa interferons will cure hepatitis or prevent cirrhosis, liver failure, or liver cancer that may be the result of infection with a hepatitis virus.

Do not stop using this medication without first talking to your doctor. Store interferon alfa-2a in the refrigerator between 36 and 46 degrees Fahrenheit (2 and 8 degrees Celsius). Do not allow interferon alfa-2a to freeze. The Roferon-A multidose vials of injectable solution should be used within 30 days after the first dose is taken from the vial.

What happens if I miss a dose?

Use the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and use only the next regularly scheduled dose. Do not use a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.

Symptoms of interferon alfa-2a overdose are not well known but may include decreased appetite, chills, fever, and muscle aches.

What should I avoid while using interferon alfa-2a?

Use caution when driving, operating machinery, or performing other hazardous activities. Interferon alfa-2a may cause drowsiness, dizziness, or impaired alertness. If you experience drowsiness, dizziness, or impaired alertness, avoid these activities.

Interferon alfa-2a side effects

Call your doctor or seek emergency medical attention if you develop symptoms of depression or are contemplating suicide; become unusually irritable, anxious (nervous), or aggressive; or experience other mood or behavior changes. In some cases, interferon alfa-2a has caused serious mood or behavioral problems. Problems with body organs such as the heart, lungs, and eyes have been experienced by people taking interferon alfa-2a or other similar drugs. Contact your doctor immediately if you develop difficulty breathing, chest pain, blurred vision, or loss of vision.

Some patients taking interferon alfa-2a have developed a drop in the number of white blood cells and platelets. If the number of these blood cells are too low, there is an increased risk of infection or bleeding. Contact your doctor immediately if you develop a fever, symptoms of an infection, or unusual bleeding or bruising.

If you experience an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives), stop using interferon alfa-2a and seek emergency medical attention.

Flu-like symptoms are likely to occur. They are most common at the start of therapy and may decrease with continued use. Over-the-counter fever reducers such as acetaminophen (Tylenol, others), ibuprofen (Motrin, Advil, others), and naproxen (Aleve), plenty of fluids, and taking the medication at bedtime may help to alleviate these symptoms. Continue to use interferon alfa-2a and notify your doctor if you experience

• 
  

  fever or chills;

  
  


• 
  

  fatigue;

  
  


• 
  

  headache;

  
  


• 
  

  muscle aches or sore joints;

  
  


• 
  

  numbness or tingling;

  
  


• 
  

  nausea, vomiting, or loss of appetite;

  
  


• 
  

  diarrhea;

  
  


• 
  

  dizziness or drowsiness;

  
  


• 
  

  nervousness or anxiety;

  
  


• 
  

  insomnia;

  
  


• 
  

  loss or thinning of hair;

  
  


• 
  

  increased sweating;

  
  


• 
  

  itching or a rash; or

  
  


• 
  

  pain, redness, or bruising at the injection site.

  
  

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Interferon alfa-2a Dosing Information

Usual Adult Dose for Chronic Hepatitis C:

3 million intl units subcutaneously or IM three times a week for 48 to 52 weeks (12 months). Alternatively 6 million intl units three times a week for the first 12 weeks (3 months), followed by 3 million intl units three times a week for 36 weeks (9 months).

Usual Adult Dose for Chronic Myelogenous Leukemia:

9 million intl units daily subcutaneously or IM.

Usual Adult Dose for Hairy Cell Leukemia:

Induction dose: 3 million intl units daily subcutaneously or IM for 16 to 24 weeks.
Maintenance dose: 3 million intl units three times a week for up to 24 consecutive months.

Usual Adult Dose for Kaposi's Sarcoma:

Induction dose: 36 million intl units daily subcutaneously or IM for 10 to 12 weeks.
Maintenance dose: 36 million intl units three times a week.

Usual Adult Dose for Lymphoma:

Study (n=5) - Lymphomatoid Papulosis
3 to 15 million intl units three times per week subcutaneously for up to 13 months.

Usual Adult Dose for Renal Cell Carcinoma:

Study (n=75) Metastatic Renal-Cell Carcinoma
subcutaneous injection three times weekly, 4.5 million units titrated upwards to 18 million units, as tolerated, during the first 4 weeks (weekly dose increases). The individual maintenance dose, based on tolerability of side effects, was continued for 3 weeks (out of a 4-week cycle), up to 2 years if the patient responds or has stable disease.

Usual Pediatric Dose for Chronic Myelogenous Leukemia:

Study (n=15)
2.5 to 5 million intl units/m2/day IM

Study (n=12) Philadelphia Chromosome-Positive CML
5 million intl units/m2/day subcutaneously (combined with Cytarabine 20 mg/m2/day for 10 days monthly).

What other drugs will affect interferon alfa-2a?

Before using interferon alfa-2a, tell your doctor if you are taking theophylline (Theo-Dur, Theochron, Theolair, others). Interferon alfa-2a may increase theophylline levels in the body, which could become dangerous.

Other drugs may also interact with interferon alfa-2a. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

More interferon alfa-2a resources

• Interferon alfa-2a Side Effects (in more detail)
• Interferon alfa-2a Use in Pregnancy & Breastfeeding
• Interferon alfa-2a Drug Interactions
• Interferon alfa-2a Support Group
• 0 Reviews for Interferon alfa-2a - Add your own review/rating

• interferon alfa-2a Subcutaneous Advanced Consumer (Micromedex) - Includes Dosage Information


• Interferon Alfa-2a Solution MedFacts Consumer Leaflet (Wolters Kluwer)


• Interferon Alfa-2a Professional Patient Advice (Wolters Kluwer)


• Roferon-A Prescribing Information (FDA)

Compare interferon alfa-2a with other medications

• Chronic Myelogenous Leukemia
• Hairy Cell Leukemia
• Hepatitis C
• Kaposi's Sarcoma
• Lymphoma
• Renal Cell Carcinoma

Where can I get more information?

• Your pharmacist has additional information about interferon alfa-2a written for health professionals that you may read.

What does my medication look like?

Interferon alfa-2a is available with a prescription under the brand name Roferon-A. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

See also: interferon alfa-2a side effects (in more detail)

Itraconazole

Class: Azoles
VA Class: AM700
Chemical Name: 4 - [4 - [4 - [4 - [[2 - (2,4 - dichlorophenyl) - 2 - (1H - 1,2,4 - triazol - 1 - ylmethyl) - 1,3 - dioxolan - 4 - l]methoxy]phenyl] - 1 - piperazinyl]phenyl] - 2,4 - dihydro - 2 - (1 - methylpropyl) - 3H - 1,2,4 - triazol - 3 - one
CAS Number: 84625-61-6
Brands: Sporanox

• 
  

  Itraconazole capsules should not be used for treatment of onychomycosis in patients with evidence of ventricular dysfunction, including CHF or history of CHF.¹

  
  


• 
  

  Discontinue itraconazole if signs or symptoms of CHF occur.¹ IV itraconazole (no longer commercially available in the US) caused negative inotropic effects in healthy individuals and in dogs.^{1 48}

  
  


• 
  

  Concomitant use with cisapride (currently commercially available in the US only under a limited-access protocol), pimozide, quinidine, dofetilide, or levomethadyl (no longer commercially available in the US) is contraindicated.^{1 48} Itraconazole is a potent inhibitor of CYP3A4 isoenzymes and may increase plasma concentrations of drugs metabolized by CYP3A4.^{1 48} Serious cardiovascular events, including QT prolongation, torsades de pointes, ventricular tachycardia, cardiac arrest, and/or sudden death have occurred in patients using cisapride, pimozide, levomethadyl, or quinidine concomitantly with itraconazole and/or other CYP3A4 inhibitors.^{1 48} (See Interactions.)

  
  

Introduction

Antifungal; azole (triazole derivative).^{1 3 37 48}

Uses for Itraconazole

Aspergillosis

Treatment of invasive aspergillosis.^{1 66 423} Considered an alternative, not a drug of choice.^{1 423 436}

Treatment of pulmonary and extrapulmonary aspergillosis in patients intolerant of, or whose disease is refractory to, IV amphotericin B.^{1 66}

IDSA considers voriconazole the drug of choice for primary treatment of invasive aspergillosis in most patients and IV amphotericin B the preferred alternative.⁴²³ For salvage therapy in patients refractory to or intolerant of primary antifungal therapy, IDSA recommends amphotericin B, caspofungin, micafungin, posaconazole, or itraconazole.⁴²³ For empiric or preemptive therapy of presumed aspergillosis, IDSA recommends amphotericin B, caspofungin, itraconazole, or voriconazole.⁴²³

Not considered a drug of choice or preferred alternative for treatment of invasive aspergillosis in HIV-infected individuals.^{440 441} For treatment of invasive aspergillosis in HIV-infected adults and adolescents, CDC, NIH, and IDSA recommend voriconazole as the drug of choice;⁴⁴⁰ voriconazole also considered the drug of choice for treatment of invasive aspergillosis in HIV-infected children.⁴⁴¹ Because the drugs have similar mechanisms of action and cross-resistance may occur, itraconazole not recommended for treatment of aspergillosis refractory to voriconazole.⁴⁴¹

For primary prophylaxis of aspergillosis in immunocompromised individuals at high risk of invasive disease (i.e., neutropenic patients with acute myelogenous leukemia [AML] or myelodysplastic syndrome [MDS], hematopoietic stem cell transplant [HSCT] recipients with graft-versus-host disease [GVHD]), IDSA considers posaconazole the drug of choice;⁴²³ alternatives are itraconazole or micafungin.⁴²³

Blastomycosis

Treatment of pulmonary and extrapulmonary blastomycosis caused by Blastomyces dermatitidis.^{1 36 49 50 51 52 53 54 59 62 63 424 436}

Drugs of choice are oral itraconazole or IV amphotericin B.^{36 49 50 51 52 436}

IV amphotericin B is preferred for initial treatment of severe blastomycosis, especially infections involving the CNS^{51 52 55 56 50 51 52 53 54 61 424 436} and for initial treatment of presumptive blastomycosis in immunocompromised patients, including HIV-infected individuals.^{50 55 61 424}

Itraconazole is the drug of choice for treatment of nonmeningeal, non-life-threatening blastomycosis, including mild to moderate pulmonary blastomycosis or mild to moderate disseminated blastomycosis (without CNS involvement), and also is recommended for follow-up therapy in patients with more severe infections after an initial response has been obtained with IV amphotericin B.^{36 61 62 63 424 436}

Azole antifungals should not be relied on for initial treatment of CNS blastomycosis.⁴²⁴ Treatment failures have been reported when an oral antifungal (e.g., ketoconazole) was used in the treatment of cutaneous or pulmonary blastomycosis in patients who had asymptomatic or subclinical CNS involvement at the time of the initial diagnosis.^{57 58}

IDSA states that long-term suppressive or maintenance therapy (secondary prophylaxis)† with itraconazole may be required to prevent relapse or recurrence of blastomycosis in immunocompromised patients and in other patients who experience relapse despite appropriate therapy.⁴²⁴ Such prophylaxis is not addressed in current CDC, NIH, and IDSA guidelines for prevention of opportunistic infections in individuals infected with HIV.^{440 441}

Candidemia and Other Invasive Candida Infections

Not a drug of choice or preferred alternative for treatment of candidemia† or other invasive Candida infections†.^{425 436} Fluconazole or voriconazole usually are recommended when an azole antifungal is used for treatment of candidemia.^{425 436}

Has been used and is recommended as an alternative for initial empiric treatment of suspected invasive candidiasis in neutropenic patients†.⁴²⁵ IV amphotericin B, caspofungin, or voriconazole are drugs of choice in these patients;⁴²⁵ alternatives are fluconazole or itraconazole.⁴²⁵ Do not use an azole antifungal for empiric treatment in patients who previously received an azole for prophylaxis.⁴²⁵

Oropharyngeal Candidiasis

Treatment of oropharyngeal candidiasis.^{48 425}

IDSA recommends topical treatment with clotrimazole lozenges or nystatin oral suspension for mild oropharyngeal candidiasis;⁴²⁵ oral fluconazole is recommended for moderate to severe disease.⁴²⁵ For refractory oropharyngeal candidiasis, including fluconazole-refractory infections, itraconazole oral solution, oral posaconazole, or oral voriconazole is recommended.⁴²⁵ An IV echinocandin (caspofungin, micafungin, anidulafungin) or IV amphotericin B also are recommended as alternatives for refractory infections.⁴²⁵

For treatment of oropharyngeal candidiasis in HIV-infected adults and adolescents, CDC, NIH, and IDSA recommend oral fluconazole as the preferred drug of choice for initial episodes;⁴⁴⁰ other drugs of choice are clotrimazole lozenges or nystatin oral suspension.⁴⁴⁰ Alternatives for initial episodes are itraconazole oral solution or oral posaconazole.⁴⁴⁰ For fluconazole-refractory infections in HIV-infected adults and adolescents, itraconazole oral solution or oral posaconazole is preferred;⁴⁴⁰ alternatives include IV amphotericin B, an IV echinocandin (caspofungin, micafungin, anidulafungin), or oral or IV voriconazole.⁴⁴⁰

Although routine long-term suppressive or maintenance therapy (secondary prophylaxis)† to prevent relapse or recurrence is not usually recommended in patients adequately treated for oropharyngeal candidiasis, patients with frequent or severe recurrences, including HIV-infected adults, adolescents, or children, may benefit from secondary prophylaxis with oral fluconazole or itraconazole oral solution; however, consider the potential for azole resistance.^{425 440 441} Patients with fluconazole-refractory oropharyngeal candidiasis who responded to treatment with an echinocandin should receive voriconazole or posaconazole for secondary prophylaxis until antiretroviral therapy produces immune reconstitution.⁴⁴⁰

Esophageal Candidiasis

Treatment of esophageal candidiasis.^{48 425}

Esophageal candidiasis requires treatment with a systemic antifungal (not a topical antifungal).^{425 440}

IDSA recommends oral fluconazole as the preferred drug of choice for treatment of esophageal candidiasis;⁴²⁵ if oral therapy is not tolerated, IV fluconazole, IV amphotericin B, or an IV echinocandin (caspofungin, micafungin, anidulafungin) is recommended.⁴²⁵ For fluconazole-refractory infections, preferred alternatives are itraconazole oral solution, oral posaconazole, or oral or IV voriconazole;⁴²⁵ other alternatives are an IV echinocandin (caspofungin, micafungin, anidulafungin) or IV amphotericin B.⁴²⁵

For treatment of esophageal candidiasis in HIV-infected adults and adolescents, CDC, NIH, and IDSA recommend oral or IV fluconazole as the preferred drug of choice and itraconazole oral solution as the preferred alternative.⁴⁴⁰ Other alternatives include an IV echinocandin (caspofungin, micafungin, anidulafungin), oral or IV voriconazole, oral posaconazole, or IV amphotericin B.⁴⁴⁰ For refractory esophageal candidiasis, including fluconazole-refractory infections, in HIV-infected adults and adolescents, itraconazole oral solution or oral posaconazole is preferred;⁴⁴⁰ alternatives include IV amphotericin B, an IV echinocandin (caspofungin, micafungin, anidulafungin), or oral or IV voriconazole.⁴⁴⁰

Although routine long-term suppressive or maintenance therapy (secondary prophylaxis)† to prevent relapse or recurrence is not usually recommended in patients adequately treated for esophageal candidiasis, patients with frequent or severe recurrences, including HIV-infected adults, adolescents, or children, may benefit from secondary prophylaxis with oral fluconazole or oral posaconazole; however, consider the potential for azole resistance.^{425 440 441} Patients with fluconazole-refractory esophageal candidiasis who responded to treatment with an echinocandin should receive voriconazole or posaconazole for secondary prophylaxis until antiretroviral therapy produces immune reconstitution.⁴⁴⁰ Itraconazole is not included in current recommendations for secondary prophylaxis of esophageal candidiasis.^{425 440}

Vulvovaginal Candidiasis

Has been used for treatment of uncomplicated vulvovaginal candidiasis†.⁴³⁶

Vulvovaginal candidiasis is usually treated with an intravaginal azole antifungal (e.g., butoconazole, clotrimazole, miconazole, terconazole, tioconazole) or a single-dose oral fluconazole regimen.^{425 436 443 444} Although some clinicians suggest that oral itraconazole or oral ketoconazole can be used as alternatives for treatment of vulvovaginal candidiasis,⁴³⁶ fluconazole is the only oral antifungal included in CDC recommendations for treatment of uncomplicated or complicated vulvovaginal candidiasis.⁴⁴³

Chromomycosis

Has been used for treatment of chromomycosis† (chromoblastomycosis) caused by various dematiaceous fungi (e.g., Cladosporium, Exophiala, Fonsecaea, Phialophora).^{43 60 71 72 73}

Coccidioidomycosis

Treatment and prevention of coccidioidomycosis† caused by Coccidioides immitis or C. posadasii.^{36 56 60 426 436 440 441} A drug of choice.^{426 436 440}

Antifungal treatment may not be necessary for mild, uncomplicated coccidioidal pneumonia since such infections may resolve spontaneously;⁴²⁶ treatment is recommended for patients with more severe or rapidly progressing infections, those with chronic pulmonary or disseminated infections, and immunocompromised or debilitated individuals (e.g., HIV-infected individuals, organ transplant recipients, those receiving immunosuppressive therapy, those with diabetes or cardiopulmonary disease).^{426 440 441}

For initial treatment of symptomatic pulmonary coccidioidomycosis and chronic fibrocavitary or disseminated (extrapulmonary) coccidioidomycosis, IDSA states than an oral azole (fluconazole or itraconazole) usually is recommended.⁴²⁶ IV amphotericin B is recommended as an alternative and is preferred for initial treatment of severely ill patients who have hypoxia or rapidly progressing disease, for immunocompromised individuals, or when azole antifungals cannot be used (e.g., pregnant women).⁴²⁶

For treatment of clinically mild coccidioidomycosis (e.g., focal pneumonia or a positive coccidioidal serologic test alone) in HIV-infected adults or adolescents, CDC, NIH, and IDSA recommend oral fluconazole or oral itraconazole.⁴⁴⁰ For treatment of diffuse pulmonary coccidioidomycosis or extrathoracic disseminated (nonmeningeal) coccidioidomycosis in HIV-infected adults and adolescents, CDC, NIH, and IDSA recommend initial therapy with IV amphotericin B followed by oral azole therapy.⁴⁴⁰ Alternatively, some experts recommend initial therapy with IV amphotericin B used in conjunction with an oral azole (e.g., fluconazole) followed by an oral azole alone.⁴⁴⁰

For treatment of diffuse pulmonary or disseminated coccidioidomycosis in HIV-infected infants and children, CDC, NIH, and IDSA recommend initial treatment with IV amphotericin B followed by oral fluconazole or oral itraconazole.⁴⁴¹ In those with severe disseminated disease, some experts recommend initial therapy with IV amphotericin B used in conjunction with an oral azole (e.g., fluconazole) followed by an oral azole alone.⁴⁴¹ Use of fluconazole or itraconazole alone may be sufficient for treatment of mild coccidioidomycosis in HIV-infected infants and children with only mild disease (e.g., focal pneumonia) and also can be considered an alternative for those with stable pulmonary or disseminated (nonmeningeal) coccidioidomycosis.⁴⁴¹

For treatment of coccidioidal meningitis in HIV-infected adults, adolescents, or children or for other individuals, fluconazole (with or without intrathecal amphotericin B) is the regimen of choice.^{426 440 441} Itraconazole may be an alternative to fluconazole in adults and adolescents.⁴⁴⁰ Consultation with an expert is recommended.^{440 441}

In HIV-infected adults and adolescents who live in areas where coccidioidomycosis is endemic, CDC, NIH, and IDSA recommend primary prophylaxis against coccidioidomycosis† in those who have positive IgM or IgG serologic tests and CD4⁺ T-cell counts <250/mm³ since these individuals may be at increased risk for development of active infections.⁴⁴⁰ Oral fluconazole or oral itraconazole should be used for primary prophylaxis against coccidioidomycosis in these HIV-infected adults and adolescents. ⁴⁴⁰ Primary prophylaxis against coccidioidomycosis is not recommended in HIV-infected children.⁴⁴¹

HIV-infected adults, adolescents, or children who have been adequately treated for coccidioidomycosis should receive long-term suppressive or maintenance therapy (secondary prophylaxis)† to prevent recurrence or relapse.^{440 441} CDC, NIH, and IDSA recommend oral fluconazole or oral itraconazole for secondary prophylaxis of coccidioidomycosis in HIV-infected individuals.^{440 441}

Long-term (life-long) suppressive or maintenance therapy (secondary prophylaxis)† with oral fluconazole or oral itraconazole also is necessary in any individual treated for coccidioidal meningitis.⁴²⁶

Cryptococcosis

Has been used for treatment of cryptococcosis†.^{36 49 68 427 436 440 441} Not a drug of choice or preferred alternative.^{427 440 441}

For treatment of cryptococcal meningitis in HIV-infected adults, adolescents, and children, CDC, NIH, and IDSA state that the preferred regimen is initial (induction) therapy with IV amphotericin B given in conjunction with oral flucytosine, then follow-up (consolidation) therapy with oral fluconazole.^{427 440 441} Although data are limited and use of the drug is discouraged, IDSA and others state that itraconazole can be considered an alternative for induction and consolidation therapy if all other alternative regimens have failed or are not available.^{427 440 441}

For treatment of mild to moderate pulmonary cryptococcosis in immunocompetent individuals, the regimen of choice is oral fluconazole.⁴²⁷ Although data are limited, IDSA states that itraconazole, voriconazole, and posaconazole are acceptable alternatives in immunocompetent individuals if fluconazole is unavailable or contraindicated.⁴²⁷

Severe pulmonary infections, cryptococcemia, and disseminated infections in immunocompetent or immunosuppressed individuals should be treated using regimens recommended for cryptococcal meningitis.⁴²⁷

HIV-infected adults, adolescents, and children who have been adequately treated for cryptococcus should receive long-term suppressive or maintenance therapy (secondary prophylaxis)† to prevent recurrence or relapse.^{427 440 441} CDC, NIH, and IDSA recommend oral fluconazole as the drug of choice for secondary prophylaxis of cryptococcosis in HIV-infected individuals;^{427 440 441} oral itraconazole is considered an alternative in those who cannot tolerate fluconazole, but may be less effective than fluconazole.^{427 440 441}

Although data are limited, IDSA states that recommendations for treatment of CNS or disseminated infections caused by Cryptococcus gattii and recommendations for secondary prophylaxis of C. gattii infections are the same as recommendations for C. neoformans infections.⁴²⁷

Histoplasmosis

Treatment of histoplasmosis caused by Histoplasma capsulatum, including chronic cavitary pulmonary disease and disseminated nonmeningeal disease.^{48 428 436 440 441}

Drugs of choice for treatment of histoplasmosis are IV amphotericin B and oral itraconazole.^{36 49 55 59 60 61 65 428 436 440 441} IV amphotericin B is preferred for initial treatment of severe, life-threatening histoplasmosis, especially in immunocompromised patients such as those with HIV infection.^{36 42 44 45 49 55 56 60 61 64 65 428 436 440 441} Oral itraconazole generally is used for initial treatment of less severe disease (e.g., mild to moderate acute pulmonary histoplasmosis, chronic cavitary pulmonary histoplasmosis) and as follow-up treatment of severe infections after a response has been obtained with IV amphotericin B.^{36 49 56 59 61 65 428 436 440 441}

For treatment of moderately severe to severe acute pulmonary histoplasmosis or progressive disseminated histoplasmosis in HIV-infected adults and adolescents and other adults, CDC, NIH, and IDSA recommend initial treatment with IV amphotericin B and follow-up treatment with oral itraconazole.^{428 440}

For treatment of progressive disseminated histoplasmosis in children, IDSA states that IV amphotericin B or an initial regimen of IV amphotericin B and follow-up treatment with oral itraconazole can be used.⁴²⁸ For treatment of moderately severe to severe disseminated histoplasmosis in HIV-infected infants and children, CDC, NIH, and IDSA recommend initial treatment with IV amphotericin B and follow-up treatment with oral itraconazole.⁴⁴¹ Although oral itraconazole may be used alone for treatment of mild to moderate disseminated histoplasmosis in children, including HIV-infected infants and children, it is not recommended for more severe infections.^{428 441}

HIV-infected adults or adolescents with CD4⁺ T-cell counts <150/mm³ who are at high risk because they reside in areas where histoplasmosis is highly endemic should receive primary prophylaxis† against initial episodes of histoplasmosis.^{428 436 440} Itraconazole is the drug of choice for primary prophylaxis against histoplasmosis in these HIV-infected adults and adolescents.^{428 436 440} Primary prophylaxis against histoplasmosis is not recommended in HIV-infected children.⁴⁴¹

HIV-infected adults, adolescents, or children and other immunosuppressed individuals who have been adequately treated for histoplasmosis should receive long-term suppressive or maintenance therapy (secondary prophylaxis)† to prevent recurrence or relapse.^{428 440 441} Itraconazole is the drug of choice for secondary prophylaxis against histoplasmosis†.^{428 440}

Microsporidiosis

Treatment of microsporidiosis†.^{135 136 440 442}

Has been effective in a few cases of keratoconjunctivitis or sinusitis caused by Encephalitozoon.^{135 136} Regimen of choice for ocular microsporidiosis is fumagillin (not commercially available in the US) used in conjunction with albendazole.^{440 441 442}

Alternative for disseminated microsporidiosis, especially infections caused by Trachipleistophora or Anncaliia;^{440 442} used in conjunction with albendazole.^{440 442} Albendazole usually is the drug of choice for intestinal or disseminated microsporidiosis (except infections caused by Enterocytozoon bienuesi or Vittaforma corneae).^{440 441 442}

Onychomycosis

Treatment of onychomycosis of the toenails (with or without fingernail involvement) and onychomycosis of the fingernails caused by dermatophytes (tinea unguium).^{1 132 133 436}

Paracoccidioidomycosis

Treatment of paracoccidioidomycosis† (South American blastomycosis) caused by Paracoccidioides brasiliensis.^{36 43 56 436}

IV amphotericin B is the drug of choice for initial treatment of severe paracoccidioidomycosis.⁴³⁶ Oral itraconazole is the drug of choice for treatment of less severe or localized paracoccidioidomycosis and for follow-up in more severe infections after initial treatment with IV amphotericin B.^{56 60}

Penicilliosis

Treatment of penicilliosis† caused by Penicillium marneffei.^{115 116 117 119 440}

For treatment of severe or disseminated P. marneffei infections, including in HIV-infected adults or adolescents, an initial regimen of IV amphotericin B followed by oral itraconazole is recommended.^{115 116 119 440} Oral itraconazole can be used alone for treatment of mild infections.⁴⁴⁰

Chronic suppressive or maintenance therapy (secondary prophylaxis) with oral itraconazole is recommended to prevent relapse of penicilliosis† in HIV-infected adults or adolescents who respond to an initial treatment regimen of IV amphoterin B and/or oral itraconazole.^{116 117 440}

Sporotrichosis

Treatment of sporotrichosis† caused by Sporothrix schenckii.^{43 49 55 56 61 67 429 436}

IV amphotericin B is the drug of choice for initial treatment of severe, life-threatening sporotrichosis and sporotrichosis that is disseminated or has CNS involvement.^{56 60 61 67 429 436} Oral itraconazole is the drug of choice for treatment of cutaneous, lymphocutaneous, or mild pulmonary or osteoarticular sporotrichosis and for follow-up treatment of severe infections after a response has been obtained with IV amphotericin B.^{43 56 60 61 67 429 436}

Zygomycosis

Treatment of GI basidiobolomycosis†, a zygomycosis caused by Basidiobolus ranarum.^{38 104 105 106 107}

Has been effective in a few patients for the treatment of subcutaneous basidiobolomycosis.^{124 125}

GI basidiobolomycosis has been successfully treated with oral itraconazole after partial surgical resection of the GI tract; unclear whether a clinical response would have been obtained if itraconazole had been used alone without surgical intervention.^{38 105}

Empiric Therapy in Febrile Neutropenic Patients

Has been used for empiric therapy of presumed fungal infections in febrile neutropenic patients.^{48 93 425}

Itraconazole Dosage and Administration

Administration

Administer orally.^{1 3 30 36 37 38 48}

Has been administered by IV infusion,⁷⁶ but an IV preparation is no longer commercially available in the US.

Oral Administration

Oral bioavailability varies depending on whether the drug is administered as capsules or the oral solution; these preparations should not be used interchangeably.^{1 48}

The possibility that GI absorption may be decreased in patients with hypochlorhydria (e.g., HIV-infected individuals) should be considered.^{1 10} (See Absorption under Pharmacokinetics.)

Capsules

The capsules should be administered with a full meal to ensure maximal absorption of the drug.¹

Capsules should not be used for treatment of oropharyngeal or esophageal candidiasis;^{425 440 441} efficacy not established,¹ may be less effective than oral solution for these infections.^{425 440 441}

If capsules are given in a dosage >200 mg daily, daily dosage should be divided into 2 doses.¹

Oral Solution

The oral solution should be administered without food to ensure maximal absorption of the drug.⁴⁸

For treatment of oropharyngeal or esophageal candidiasis, the recommended dosage of itraconazole oral solution should be vigorously swished in the mouth (10 mL at a time) for several seconds and then swallowed.⁴⁸

Manufacturer states that data are limited to date regarding the safety of long-term use of itraconazole oral solution (i.e., >6 months).⁴⁸

Dosage

Because of differences in oral bioavailability, itraconazole capsules and oral solution should not be used interchangeably.^{1 48}

Only the oral solution (not capsules) is indicated for treatment of oropharyngeal or esophageal candidiasis.⁴⁸

To ensure adequate plasma concentrations of itraconazole (especially in patients with life-threatening fungal infections), IDSA and others recommend that itraconazole plasma concentrations be determined, usually after 2 weeks of therapy.^{423 424 425 428 429}

Pediatric Patients

Blastomycosis†

Treatment of Blastomycosis†

Oral

Mild to moderate blastomycosis: IDSA recommends 10 mg/kg daily (up to 400 mg daily) for 6–12 months.⁴²⁴

Moderately severe to severe blastomycosis: IDSA recommends an initial regimen of IV amphotericin B given for 1–2 weeks, followed by itraconazole 10 mg/kg daily (up to 400 mg daily) for a total treatment duration of 12 months.⁴²⁴

Candida Infections†

Treatment of Oropharyngeal Candidiasis†

Oral

HIV-infected infants and children (oral solution): 2.5 mg/kg twice daily (up to 200 mg daily) for 7–14 days.⁴⁴¹

HIV-infected infants and children with fluconazole-refractory infections (oral solution): 2.5 mg/kg twice daily (up to 200–400 mg daily) for 7–14 days.⁴⁴¹

HIV-infected adolescents (oral solution): 200 mg daily for 7–14 days.⁴⁴⁰ Same dosage can be used for fluconazole-refractory infections.⁴⁴⁰

Prevention of Recurrence (Secondary Prophylaxis) of Oropharyngeal Candidiasis†

Oral

HIV-infected adolescents (oral solution): 200 mg daily.⁴⁴⁰

Secondary prophylaxis not usually recommended; use only if patient has frequent or severe recurrences.⁴⁴⁰ Consider discontinuing secondary prophylaxis if CD4⁺ T-cell count increases to ≥200/mm³ in response to antiretroviral therapy.⁴⁴⁰

Treatment of Esophageal Candidiasis†

Oral

HIV-infected infants and children (oral solution): 2.5 mg/kg twice daily or 5 mg/kg once daily for 14–21 days.⁴⁴¹

HIV-infected adolescents (oral solution): 200 mg daily for 14–21 days.⁴⁴⁰

Treatment of Vulvovaginal Candidiasis†

Oral

HIV-infected adolescents (oral solution): 200 mg daily for 3–7 days.⁴⁴⁰

Coccidioidomycosis†

Treatment of Coccidioidomycosis (Nonmeningeal)†

Oral

HIV-infected infants and children with mild coccidioidomycosis (e.g., focal pneumonia): 5–10 mg/kg twice daily for 3 days, then 2–5 mg/kg twice daily.⁴⁴¹

HIV-infected infants and children with diffuse pulmonary or disseminated coccidioidomycosis: Initial regimen of IV amphotericin B given until a response is obtained, followed by itraconazole 5–10 mg/kg twice daily for 3 days, then 2–5 mg/kg twice daily (up to 400 mg daily).⁴⁴¹

HIV-infected adolescents with mild coccidioidomycosis (e.g., focal pneumonia or positive coccidioidal serologic test alone): 200 mg 3 times daily for 3 days, then 200 mg twice daily.⁴⁴⁰

Treatment of Coccidioidal Meningitis†

Oral

HIV-infected adolescents with meningeal coccidioidomycosis: 200 mg 3 times daily for 3 days, then 200 mg twice daily.⁴⁴⁰

Consultation with an expert experienced in treating coccidioidal meningitis is recommended.⁴⁴¹

Primary Prophylaxis to Prevent First Episode of Coccidioidomycosis†

Oral

HIV-infected adolescents living in areas endemic for coccidioidomycosis who have positive IgM or IgG serologic test and CD4⁺ T-cell count <250/mm³: 200 mg twice daily.⁴⁴⁰

Consider discontinuing primary prophylaxis if CD4⁺ T-cell count is >250/mm³ for 6 months.⁴⁴⁰ Reinitiate primary prophylaxis against coccidioidomycosis if CD4⁺ T-cell count decreases to <250/mm³.⁴⁴⁰

Prevention of Recurrence (Secondary Prophylaxis) of Coccidioidomycosis†

Oral

HIV-infected infants and children: 2–5 mg/kg (up to 200 mg) twice daily.⁴⁴¹

HIV-infected adolescents: 200 mg twice daily.⁴⁴⁰

Initiate secondary prophylaxis after primary infection has been adequately treated.^{440 441}

HIV-infected infants and children: Continue life-long, secondary prophylaxis against coccidioidomycosis, regardless of antiretroviral therapy or immune reconstitution.⁴⁴¹

HIV-infected adolescents with history of focal coccidioidal pneumonia who responded to antifungal treatment, are receiving antiretroviral therapy, and have CD4⁺ T-cell counts >250/mm³: Consider discontinuing secondary prophylaxis against coccidioidomycosis after 12 months, but continue monitoring for recurrence (e.g., serial chest radiographs, coccidioidal serology).⁴⁴⁰

HIV-infected adolescents with history of diffuse pulmonary or disseminated coccidioidomycosis or history of coccidioidal meningitis: Continue life-long secondary prophylaxis against coccidioidomycosis, regardless of antiretroviral therapy or immune reconstitution.⁴⁴⁰

Cryptococcosis†

Treatment of Cryptococcosis†

Oral

HIV-infected infants and children with CNS cryptococcosis: Initial (induction) regimen of IV amphotericin B given for at least 2 weeks, then follow-up (consolidation) regimen of itraconazole 200 mg 3 times daily for 3 days, then 5–10 mg/kg (maximum 200 mg) once or twice daily for at least 8 weeks.⁴⁴¹

HIV-infected adolescents with CNS cryptococcosis: Initial (induction) regimen of IV amphotericin B given for at least 2 weeks, then follow-up (consolidation) regimen of itraconazole 200 mg twice daily for 8 weeks or until CD4⁺ T-cell count is ≥200/mm³ for at least 6 months as the result of antiretroviral therapy.⁴⁴⁰

Some clinicians suggest the oral solution may be preferred (instead of capsules) for treatment of cryptococcosis.⁴²⁷

Prevention of Recurrence (Secondary Prophylaxis) of Cryptococcosis†

Oral

HIV-infected infants and children (oral solution): 5 mg/kg (up to 200 mg) daily.⁴⁴¹

HIV-infected adolescents: 200 mg daily.⁴⁴⁰

Initiate secondary prophylaxis after primary infection has been adequately treated.^{440 441}

HIV-infected infants and children with a history of cryptococcosis usually should receive life-long suppressive therapy to prevent recurrence.⁴⁴¹ Consideration can be given to discontinuing secondary prophylaxis in HIV-infected children ≥6 years of age who are asymptomatic for cryptococcosis, have received secondary prophylaxis for ≥6 months, have been receiving antiretroviral therapy for ≥6 months, and have CD4⁺ T-cell counts ≥200/mm³ for ≥6 months.⁴⁴¹ Reinitiate secondary prophylaxis against cryptococcosis if CD4⁺ T-cell count decreases to <200/mm³.⁴⁴¹

HIV-infected adolescents with a history of cryptococcosis usually should receive life-long secondary prophylaxis to prevent recurrence.⁴⁴⁰ Some experts state that consideration can be given to discontinuing secondary prophylaxis in HIV-infected adolescents who are asymptomatic for cryptococcosis, are receiving antiretroviral therapy, and have CD4⁺ T-cell counts ≥200/mm³ for >6 months.⁴⁴⁰ Reinitiate secondary prophylaxis against cryptococcosis if CD4⁺ T-cell count decreases to <200/mm³.⁴⁴⁰

Histoplasmosis†

Treatment of Histoplasmosis†

Oral

Acute pulmonary histoplasmosis: IDSA recommends 5–10 mg/kg daily (up to 400 mg daily) given in 2 divided doses.⁴²⁸

Progressive disseminated histoplasmosis: IDSA recommends initial regimen of IV amphotericin B given for 2–4 weeks, followed by itraconazole 5–10 mg/kg daily (up to 400 mg daily) given in 2 divided doses for a total duration of 3 months.⁴²⁸ A longer duration may be necessary in children with severe disease or with immunosuppression or primary immunodeficiency syndromes.⁴²⁸

HIV-infected infants and children with mild disseminated histoplasmosis (oral solution): 2–5 mg/kg (up to 200 mg) 3 times daily for 3 days, then 2–5 mg/kg (up to 200 mg) twice daily for 12 months.⁴⁴¹

HIV-infected infants and children with moderately severe to severe disseminated histoplasmosis: Initial regimen of IV amphotericin B given for at least 1–2 weeks, followed by itraconazole (oral solution) 2–5 mg/kg (up to 200 mg) 3 times daily for 3 days, then 2–5 mg/kg (up to 200 mg) twice daily for 12 months.⁴⁴¹

HIV-infected infants and children with CNS histoplasmosis: Initial regimen of IV amphotericin B given for 4–6 weeks, followed by itraconazole (oral solution) 2–5 mg/kg (up to 200 mg) 3 times daily for 3 days, then 2–5 mg/kg (up to 200 mg) twice daily for at least 12 months and until CSF abnormalities resolve and histoplasmal antigen is undetectable.⁴⁴¹

HIV-infected adolescents with less severe disseminated histoplasmosis: 200 mg 3 times daily for 3 days, then 200 mg twice daily for at least 12 months.⁴⁴⁰

HIV-infected adolescents with moderately severe to severe disseminated histoplasmosis: Initial regimen of IV amphotericin B given for at least 2 weeks or until a response is obtained, followed by itraconazole 200 mg 3 times daily for 3 days, then 200 mg twice daily for a total duration of at least 12 months and until histoplasmal antigen is undetectable.⁴⁴¹

HIV-infected adolescents with CNS histoplasmosis: Initial regimen of IV amphotericin B given for 4–6 weeks or until a response is obtained, followed by itraconazole 200 mg 2 or 3 times daily for at least 12 months and until CSF abnormalities resolve and histoplasmal antigen is undetectable.⁴⁴¹

Some clinicians suggest the oral solution may be preferred (instead of capsules) f

influenza a virus vaccine, h1n1, live Nasal

in-floo-EN-za AY VYE-rus VAX-een, H1N1, lyve

Available Dosage Forms:

• Spray

Therapeutic Class: Vaccine

Uses For influenza a virus vaccine, h1n1, live

Influenza virus vaccine, H1N1 is used to prevent an infection caused by the influenza A (H1N1) 2009 virus. The vaccine works by causing your body to produce its own protection (antibodies) against the disease.

Influenza is a virus infection of the throat, bronchial tubes, and lungs. Influenza infection causes fever, chills, cough, headache, muscle aches, and pains in your back, arms, and legs. In addition, adults and children weakened by other diseases or medical conditions, and persons 50 years of age and over, even if they are healthy, may get a much more serious illness that may have to be treated in a hospital. Each year thousands of people die as a result of an influenza infection.

This vaccine is to be administered only by or under the supervision of your doctor or other health care professional.

Before Using influenza a virus vaccine, h1n1, live

In deciding to use a vaccine, the risks of taking the vaccine must be weighed against the good it will do. This is a decision you and your doctor will make. For this vaccine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to influenza a virus vaccine, h1n1, live 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

Appropriate studies have not been performed on the relationship of age to the effects of nasal influenza virus vaccine, H1N1 in children up to 2 years of age. Safety and efficacy have not been established.

Children under 5 years of age with one or more episodes of wheezing in the past year should not receive this vaccine.

Geriatric

Appropriate studies have not been performed on the relationship of age to the effects of nasal influenza virus vaccine, H1N1 in adults 50 years of age and older. Safety and efficacy have not been established.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

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. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

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 vaccine. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergy to eggs, egg products, or gelatin, history of—Should not be used in patients with these conditions.

• Asthma, severe or


• Wheezing—Use with caution. May make these conditions worse.

• Guillain-Barré syndrome, history of—May cause the symptoms of this condition to return.

• Immune system problems (e.g., cancer, HIV)—This vaccine may not work as well if you have weak immune system.

Proper Use of influenza a virus vaccine, h1n1, live

A nurse or other trained health professional will give you or your child this vaccine. This vaccine is given as a nasal spray.

Use the nasal spray only in the nose. Do not get any of it in your eyes or on your skin. If it does get on these areas, rinse it off right away.

Before using the nasal spray, gently blow your nose to clear the nostrils.

Children 2 to 9 years of age who have not received the nasal vaccine before should receive 2 doses at least 1 month apart.

Precautions While Using influenza a virus vaccine, h1n1, live

It is very important that your child return to your doctor's office at the right time for the second dose. Be sure to notify your doctor of any side effects that occur after your child receives this vaccine.

This vaccine should not be given to children and teenagers (2 to 17 years of age) who are also using aspirin or any medicine that contains aspirin (e.g., Aggrenox®, Soma® Compound, Norgesic®, and many cold medicines).

Children under 2 years of age are usually not given the flu vaccine nasal spray. Young children who need the flu vaccine are usually given the flu vaccine injection (a shot).

This vaccine should not be given to pregnant women.

The nasal influenza virus vaccine, H1N1 contains a live virus. Avoid contact with people who are sick or at increased risk of getting the infection after you receive this vaccine. Talk to your doctor about this if you have concerns.

This vaccine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash, itching, swelling of the tongue and throat, or trouble breathing after you receive the vaccine.

This vaccine will not treat flu symptoms if you already have the virus. Also, this vaccine may not protect all persons given the vaccine.

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.

influenza a virus vaccine, h1n1, live 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:

More common

• Chills


• cough


• fever


• runny nose


• sore throat


• stuffy nose


• wheezing

Less common

• Headache


• pain or tenderness around the eyes and cheekbones


• shortness of breath or troubled breathing


• tightness of the chest

Incidence not known

• Bloody nose


• difficulty with swallowing


• dizziness


• fast heartbeat


• hives


• inability to move the arms and legs


• itching


• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue


• skin rash


• sudden numbness and weakness in the arms and legs


• unusual tiredness or weakness


• weakness of the muscles in your face

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:

More common

• Abdominal or stomach pain


• decreased appetite


• irritability


• muscle aches


• tiredness or weakness


• unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Less common

• Earache


• redness or swelling in the ear

Incidence not known

• Diarrhea


• nausea


• vomiting

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.

The information contained in the Thomson Reuters 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 Thomson Reuters Healthcare 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. Thomson Reuters Healthcare 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, THOMSON REUTERS HEALTHCARE 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. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

Imodium Multi-Symptom Relief

Pronunciation: loe-PER-a-mide/sye-METH-i-kone
Generic Name: Loperamide/Simethicone
Brand Name: Imodium Multi-Symptom Relief

Imodium Multi-Symptom Relief is used for:

Treating the symptoms of diarrhea plus bloating, pressure, and cramps from gas.

Imodium Multi-Symptom Relief is an antidiarrheal and antiflatulent combination. It works by slowing the movement of bowel contents. It also breaks up gas bubbles to make gas easier to eliminate.

Do NOT use Imodium Multi-Symptom Relief if:

• you are allergic to any ingredient in Imodium Multi-Symptom Relief


• you have stomach pain without diarrhea


• you have constipation; stomach bloating; bloody stools; or dark, tarry stools.

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

Before using Imodium Multi-Symptom Relief:

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

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


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


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


• if you have bloody diarrhea; mucus in your stool; fever; bowel problems (eg, inflammation, blockage, enlarged colon); or diarrhea caused by food poisoning, antibiotic use, or bacterial infection.


• if you have AIDS or liver problems


• if you are taking an antibiotic

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

• Quinidine or ritonavir because they may increase the risk of Imodium Multi-Symptom Relief's side effects


• Saquinavir because its effectiveness may be decreased by Imodium Multi-Symptom Relief

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

How to use Imodium Multi-Symptom Relief:

Use Imodium Multi-Symptom Relief as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Imodium Multi-Symptom Relief by mouth with or without food.


• Drinking extra fluids is recommended while you have diarrhea. Check with your doctor if you have questions.


• If you miss a dose of Imodium Multi-Symptom Relief, take it as soon as you remember. Continue to take it as directed by your doctor or on the package label.

Ask your health care provider any questions you may have about how to use Imodium Multi-Symptom Relief.

Important safety information:

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


• Do not take more than the recommended dose or use for longer than 48 hours without checking with your doctor.


• If your diarrhea does not get better within 48 hours or if it gets worse, contact your doctor.


• If you develop a fever, stomach bloating or swelling, or blood in your stools, contact your doctor.


• Imodium Multi-Symptom Relief is used to treat the symptoms of diarrhea, but will not treat the condition causing the diarrhea. Check with your doctor if you have any questions or concerns about the cause of your diarrhea.


• Caution is advised when using Imodium Multi-Symptom Relief in CHILDREN; they may be more sensitive to its effects, especially dehydration.


• Do not use Imodium Multi-Symptom Relief in CHILDREN younger than 6 years old without checking with the child's doctor.


• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Imodium Multi-Symptom Relief while you are pregnant. Imodium Multi-Symptom Relief is found in breast milk. Do not breast-feed while taking Imodium Multi-Symptom Relief.

Possible side effects of Imodium Multi-Symptom Relief:

All medicines may cause side effects, but many people have no, or minor, side effects. No COMMON side effects have been reported with this product. Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); constipation; decreased urination; red, swollen, blistered, or peeling skin; stomach bloating, swelling, or pain.

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

See also: Imodium Multi-Symptom Relief side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include decreased urination; nausea; severe constipation or drowsiness; vomiting.

Proper storage of Imodium Multi-Symptom Relief:

Store at room temperature, between 59 and 77 degrees F (15 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Imodium Multi-Symptom Relief out of the reach of children and away from pets.

General information:

• If you have any questions about Imodium Multi-Symptom Relief, please talk with your doctor, pharmacist, or other health care provider.


• Imodium Multi-Symptom Relief is to be used only by the patient for whom it is prescribed. Do not share it with other people.


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Imodium Multi-Symptom Relief resources

• Imodium Multi-Symptom Relief Side Effects (in more detail)
• Imodium Multi-Symptom Relief Use in Pregnancy & Breastfeeding
• Imodium Multi-Symptom Relief Drug Interactions
• 0 Reviews for Imodium Multi-Symptom Relief - Add your own review/rating

Compare Imodium Multi-Symptom Relief with other medications

• Diarrhea, Acute