Kamagra Oral Jelly by Generic

What is Kamagra Oral Jelly?
Kamagra Oral Jelly belongs to the drug group within the Kamagra series, which is considered an elite medication among drugs that treat erectile dysfunction (ED) in men. The manufacturer of these drugs “Ajanta Pharma ©” pays a great deal of attention to the quality of its products, raising it to the highest level. Ajanta Pharma© produces Viagra in gel form known as Kamagra Oral Jelly.

Kamagra Oral Jelly is a potency regulator that is delivered to the body in gelatinous form. Such route of administration of drugs does not affect the effect of Kamagra in any way because its active ingredient Sildenafil is the same as in the famous Viagra.

Nowdays you can buy Kamagra Oral Jelly online at any reliable pharmacy. One 5 g sachet of Kamagra Oral Jelly contains 50 or 100 mg of sildenafil.

Kamagra Oral Jelly is worth of your time. Its quality, time of action, and low price give you the ideal opportunity to experience the beauty of a woman’s caress. Kamara is the best generic drug containing Sildenafil citrate.

The main advantage of Kamagra Oral Jelly is its rapid action. This is because within the mouth of a person, under the tongue there are veins that can instantly absorb sildenafil. In contrast, in the case of a tablet, the drug first needs to go to the stomach and digest in order to be absorbed into the bloodstream for the effects to take place. Thus, when using Kamagra Oral Jelly, you are given a head start of at least 10-15 minutes.

In contrast to Viagra or its generic in the form of tablets, which requires the consumption of plenty of water and proper timing, Kamagra Oral Jelly can be taken without considering any other factors. Kamagra Oral Jelly can be taken when you are comfortable, not necessarily having to stress about the right moment.

To understand the action of Kamagra Jelly it is important to realize the anatomy and physiology of erection. In a calm and non-sexually excited state the men’s body releases a potent chemical that works to block powerful blood flow to the penis to prevent erection. However, during sexual arousal the brain activates antagonist chemicals that work to suppress the activity of enzyme-blockers which leads to expansion of blood vessels within the penis followed by an erection.

In men with erectile dysfunction, the ability of the body to produce antagonist chemicals that prevent the action of enzyme-blockers does not work. Therefore, men with erectile dysfunction require the help of medications in order to inhibit the effects of enzyme-blockers. This help comes in the form of Kamagra Jelly. Thanks to Kamagra Jelly, this medication works to selectively suppresses enzyme-blockers, opening the body up for the powerful blood flow needed for an erection.

For most cases of erectile dysfunction 50 mg dosing is enough to fix the problem. However, the exact dosage needed should always be prescribed by a doctor. Also contained within Kamagra Jelly, there are auxiliary components that improve its taste and effectiveness as well as reducing the risk of side effects. Kamagra Oral Jelly can be taken once per day 30-45 minutes before the expected sexual intercourse.

Kamagra should not be taken by patients with epilepsy, glaucoma, and/or leukemia. Patients who have previously experienced a heart attack or a stroke should also not take Kamagra. Kamagra should also not be taken in the presence of anemia, stomach ulcers, under 18 years of age, and/or intolerance to any component of the drug.

It is extremely important to store Kamagra away from the reach of children since the smell and type of jelly can lead to children wanting to eat this medicine.

You should only use Kamagra as prescribed. If Kamagra is not taken as prescribed, it is possible that you may experience side effects such as headache, visual disturbances, dizziness, and/or other negative bodily effects associated with an overdose.

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Kamagra Gold 100mg by Ajanta Pharma

Product Description

Common uses and directions for Kamagra (Sildenafil Citrate):

Normally nerves or blood vessels in men with male erectile dysfunction do not work properly, which prevents them from achieving an erection. It works to restore the blood flow to the penis making it easier to achieve and sustain longer erections.

  It increases the blood flow to the penis by helping the arteries in the penis relax and expand. As the arteries in the penis expand and harden, veins that normally carry away blood flow to the penis are compressed resulting in an erection.

  It takes at least 30 minutes before it starts to work, and remains active for up to 4 hours. The erection goes away after intercourse.

Men who are currently using medicines that contain nitrates, such as nitroglycerin should not use it because taken together they can lower the blood pressure too much. Kobra should not be used by women or children.

Sildenafil Citrate additional information:

Common uses:

  is used to treat erection difficulties, such as erectile dysfunction (ED).

Directions:

  comes as a tablet containing 150 mg. sildenafil citrate, to take by mouth.

For most men, the recommended dose is 50 mg. taken, as needed, approximately 1 hour before sexual activity. However, sildenafil citrate may be taken anywhere from 4 hours to 0.5 hour before sexual activity. Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg. The maximum recommended dosing frequency is once per day.

Precautions:

A starting dose of 25 mg. should be considered individuals of the age 65+ and in individuals with hepatic impairment or severe renal impairment.

Given the extent of the interaction with patients receiving concomitant therapy with ritonavir, it is recommended not to exceed a maximum single dose of 25 mg. of Viagra in any 48 hour period.

Sildenafil citrate potentiates the hypotensive effects of nitrates and its administration in patients who use nitric oxide donors or nitrates in any form is therefore contraindicated.

Treatments for erectile dysfunction, including Kobra/Viagra, should not be generally used in men for whom sexual activity is inadvisable because of their underlying cardiovascular status.

Patients who have suffered a myocardial infarction, stroke, or life-threatening arrhythmia within the last 6 months, patients with resting hypotension or hypertension, patients with cardiac failure or coronary artery disease and patients with retinitis pigmentosa should use Kobra/Viagra with great caution.

The safety of Viagra is unknown in patients with bleeding disorders and patients with active peptic ulceration.

Kobra/Viagra should be used with caution by individuals with anatomical deformation of the penis and by individuals who have conditions which may predispose them to priapism.

The safety and efficacy of combinations of Viagra with other treatments for erectile dysfunction have not been studied. Therefore, the use of such combinations is not recommended.

Possible side effects:

The most frequently observed side effects of Kobra/Viagra includes headache, flushing, dyspepsia and nasal congestion.

Less frequent side effects include erections that will not go away and vision changes. In the event that an erection persists longer than 4 hours, seek immediate medical assistance. Other less frequent side effects include urinary tract infection, abnormal vision, diarrhea, dizziness and rash.

If you notice other effects not listed above, contact your doctor.

Overdose:

If overdose of Kobra/Viagra/Kamagra is suspected, contact your local poison control center or emergency room immediately.

Additional information

Keep Viagra/Kobra/Kamagra in a tightly closed container and out of reach of children. Store  at room temperature and away from excess heat and moisture (not in the bathroom).

 Erectile dysfunction, commonly known as ED, is a condition in men where in they cannot develop or sustain an erection because of several conditions. The main reason here can be a medical condition such as one that impedes the flow of blood in to the penis, a lack of desire or even a side effect of other medications. Whatever the underlying cause may be, erectile dysfunction can be a problem for both a husband and wife especially when the thought of being “impotent” disrupts all other desire for sexual activity and reproduction. This sexual dysfunction becomes more common as men get older but it is not something that you would naturally expect. It is not a natural occurrence in the body.

The great thing in this condition is that it can be managed and cured. A lot of chemists and druggists have researched on possible chemicals that may fix erectile dysfunction and also the emotional and psychological damages that it leaves in its wake. Now, on the market and being sold worldwide, Kamagra sildenafil citrate is a drug that treats erectile dysfunction.

 Kamagra is quick fix for your unsatisfactory days

Kamagra medication whose generic name is Sildenafil Citrate is one of the medications which treats erectile dysfunction. This works by allowing the smooth muscles in the penis to relax allowing greater blood flow in to the penis when it is stimulated therefore developing and sustaining an erection.

Sildenafil Citrate was initially used to improve blood circulation in to the heart to treat symptoms of cardiovascular problems. One of the side effects was a boost in the erection of the penis and therefore it was researched if this drug could be a possible cure for erectile dysfunction. Rising up to the occasion this drug, at a much lowered dose, this drug proved to be quite effective in maintaining the getting the blood to circulate in to the penis therefore curing the symptoms as well as the accompanying frustrations of erectile dysfunction.

Kamagra comes in two preparations - a Kamagra tablet and an oral Kamagra jelly. They are, too, be taken orally as prescribed by your physician. They come in preparations of 25 mg, 50 mg and 100mg pills depending on what dosage was prescribed to you. If you aren't quite sure about what to take then the safest thing to do is to start with the smaller dosage and see if it works for you but usually you cannot buy Kamagra without prescription and buying Kamagra online will still require you to submit a medical profile. Heads up though, Kamagra or any other Sildenafil Citrate product won't work when there is no sexual stimulation.

It is best to take generic Kamagra with an empty stomach because a full stomach can decrease its effectiveness. After taking the drug, it is absorbed within 30 to 60 minutes in to your blood. More specifically, Kamagra pills and jellies increases the effect of nitrous oxides by inhibiting the enzyme phosphodiesterase type 5 or the PDE5 that is found in the penis. This enzyme is the one antagonist for an erection because it works by restricting the muscles of the penis also known as the corpus cavernosum. When Kamagra tabs is fully absorbed, it relaxes the corpus cavernosum therefore allowing blood to pass through and eventually get and maintain an erection. Take note that the drug can last for four hours in your body whether or not you perform any sexual activity. After four hours, the drug is naturally eliminated so you don't have to worry about it staying too long in your system.

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Tonoflox 50mg by Sami

Product Description
Tonoflex 50mg is used to relieve moderate pain. It is similar to narcotic pain medications. It works on certain nerves in the brain that control how you experience pain.

DOSING FOR TRAMADOL:

The recommended Tonoflex 50mg (immediate release tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25 mg every 3 days to reach 100 mg/day (25 mg 4 times daily). Thereafter, doses can be increased by 50 mg every 3 days to reach 200 mg day (50 mg 4 times daily). Tonoflex 100mg may be taken with or without food.

Recommended dose for extended release tablets is 100 mg daily which may be increased by 100 mg every 5 days but not to exceed 300 mg /day. Extended release tablets should be swallowed whole and not crushed or chewed.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

A Tonoflex 50mgoverdose can be fatal. Overdose symptoms may include extreme drowsiness, shallow breathing, muscle weakness, slow heartbeat, cold or clammy skin, fainting, or seizure.

SIDE EFFECTS:

Get emergency medical help if you have any of these signs of an allergic reaction to Tonoflex 100mg:


hives

difficulty breathing

Swelling of your face, lips, tongue, or throat.
Commonly reported side effects include:

 Nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received Tonoflex 100mghave reported seizures. Abrupt withdrawal of Tonoflex 100mgmay result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.

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Testofort 250mg/1ml by Pliva

Testofort 250mg/1ml by Pliva

Product Description
Testoste Enanthate 1 ml/250 mg x 3 Amps Testosterone enanthate, as most trade names already suggest, is a long-acting depot steroid. Depending on the metabolism and the body's initial hormone level it has a duration of effect of two to three weeks so that theoretically very long intervals between injections are possible. Each ml of Testofort contain 250mg Tensosterone Enanthate in oily solution.

Testosterone enanthate is an oil based injectable steroid, designed to release testosterone slowly from the injection site. Once administered, serum concentrations of this hormone will rise for several days, and remain markedly elevated for approximately 2 weeks. It may actually take 3 weeks for the action of this drug to fully diminish. For medical purposes this is the most widely prescribed testosterone, used regularly to treat cases of hypogonadism and other disorders related to androgen deficiency. In past patients generally do not selfadminister such injections, a long acting steroid like this is a very welcome item. Therapy is clearly more comfortable in comparison to an ester like propionate, which requires a much more frequent dosage schedule.

This product has also been researched as a possible male birth control options. Regular injections will efficiently lower sperm production, a state that will be reversible when the drug is removed. With the current stigma surrounding steroids however, it is unlikely that such an idea would actually become an adopted practice. Testofor (Testosterone Enanthate) is a powerful hormone with notably prominent side effects. Much of which stem from the fact that testosterone exhibits a high tendency to convert into estrogen. Related side effects may therefore become a problem during a cycle. For starters, water retention can become quite noticeable. This can produce a clear loss of muscle definition, as subcutaneous fluids begin to build. Storage of excess body fat may further reduce the visibility of muscle features, another common problem with aromatizing steroids. The excess estrogen level during/after your cycle also has the potential to lead up to gynecomastia. The antiaromatase Arimidex, Femara, or Aromasin are a much better choices though. It is believed that the use of an anti-estrogen can slightly lower the anabolic effect of most androgen cycles (estrogen and water weight are often thought to facilitate strength and muscle gain), so one might want to see if such drugs are actually necessary before committing to use. A little puffiness under the nipple is a sign that gynecomastia is developing. If this is left to further develop into pronounced swelling, soreness and the growth of small lumps under the nipples, some form of action should be taken immediately to treat it (obviously quitting the drug or adding ancillaries like Nolvadex). Being a testosterone product, all the standard androgenic side effects are also to be expected. Oily skin, acne, aggressiveness, facial/body hair growth and male pattern baldness are all possible. More sensitive individuals might therefore choose to avoid testosterone products, and look toward milder anabolics like DecaDurabolin or EquipoiseВ® which produce fewer side effects. With blood levels of this metabolite notably reduced, the impact of related side effects should also be reduced. With strong bulking drugs however, the user will generally expect to incur strong side effects and will often just tolerate them.

Most athletes really do not find the testosterones all that uncomfortable (especially in the face of the end result), as can be seen with the great popularity of such compounds. Although this particular ester is active for a much longer duration, most athletes prefer to inject it on a weekly basis in order to keep blood levels more uniform. The usual dosage would be in the range of 250mg to  750mg. This level is quite sufficient, and should provide the user a rapid gain of strength and body weight. Above this level estrogenic side effects will no doubt become much more pronounced, outweighing any new muscle that is possibly gained. Those looking for greater bulk would be better served by adding an oral like Anadrol or Dianabol, combinations which prove to be nothing less than dramatic. If the athlete wishes to use a testosterone yet retain a level of quality and definition to the physique, an injectable anabolic like DecaDurabolin or Equipoise may prove to be a better choice. Here we can use a lower dosage of enanthate, so as to gain an acceptable amount of muscle but keep the buildup of estrogen to a minimum. Of course the excess estrogen that is associated with testosterone makes it a bulking only drug, producing too much water (and fat) retention for use near contest time. With the proper administration of ancillary drugs, much of the new muscle mass can be retained for a long time after the steroid cycle has been stopped. Those who rely solely on a fancy tapering-off schedule to accomplish this are likely to be disappointed. Although a common practice, this is really not an effective way to restore the hormons.

 Although Testosterone enanthate is effective for several weeks, it is injected at least once a week in body building, power lifting, and weight lifting. The decisive advantage of Testosterone enanthate, however, is that this substance has a very strong androgenic effect and is coupled with an intense anabolic component. This allows almost everyone, within a short time, to build up a lot of strength and mass. The, rapid and strong weight gain is combined with distinct water retention since a retention of electrolytes and water occurs. A pleasant effect is that the enormous strength gain goes hand in hand with the water retention. In our opinion the most sensible dosage for most athletes is between 250-1000 mg/week.

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Anavar 10mg by LA Pharma

Anavar 10mg by LA Pharma

Product Description
Anavar (Oxandrolone) Info:
Oxandrolone, also known as oxandrin, is a drug first synthesized by Raphael Pappo while at Searle Laboratories, now Pfizer Inc., under the trademark Anavar, and introduced into the United States in 1964. It is a synthetic anabolic steroid derivative of dihydrotestosterone with an oxygen atom replacing the 2 carbon and methylation in the 17 position.
It has been shown that Oxandrolon, when taken in reasonable dosages, rarely has any side effects. This is appreciated since Oxandrolon was developed mostly for women and children. Oxandrolon is one of the few steroids, which does not cause an early stunting of growth in children since it does not prematurely close the epiphysial growth plates. For this reason Oxandrolon is mostly used in children to stimulate growth and in women to prevent osteoporosis. Oxandrolon causes very light virilization symptoms, if at all. This characteristic makes Oxandrolon a favored remedy for female athletes since, at a daily dose of 10-15 mg, masculinizing symptoms are observed only rarely.

Oxandrolone Facts & Use:
With Oxandrolon the muscle system does not get the typical watery appearance as with many steroids, thus making it very interesting during the preparation for a competition. In this phase it is especially important to keep the estrogen level as low as possible since estrogen programs the body to store water even if the diet is calorie-reduced. In combination with a diet, Oxandrolon helps to make the muscles hard and ripped. Although Oxandrolon itself does not break down fat, it plays an indirect role in this process because the substance often suppresses the athlete's appetite.

Oxandrolon can cause some bloating, which in several athletes, results in nausea and vomiting when the tablets are taken with meals. It w noticed an effect on the activity of the gastrointestinal tract. Some athletes thus report continued diarrhea. Although these symptoms are not very pleasant they still help the athlete break down fat and become harder.

Another advantage of Oxandrolone's non-aromatization is that athletes who suffer from high blood pressure or develop gynecomastia of the thymus glands when taking stronger androgenic steroids will not have these side effects with this compound. The Anavar/Deca-Durabolin stack is a welcome alternative for this group of athletes or for athletes showing signs of poor health during mass buildup with testosterone, Dianabol, or Naposim. Athletes over forty should predominantly use Oxandrolon.

Oxandrolone Effects:
Bodybuilders and power lifters, in particular, like Oxandrolon for 3 reasons. First, Oxandrolon causes a strong strength gain by stimulating the phosphocreatine synthesis in the muscle cell without depositing liquid (water) in the joints and the muscles. Power lifters and weightlifters who do not want to end up in a higher weight class take advantage of this since it allows them to get stronger without gaining body weight at the same time.

The second reason why Oxandrolon is so popular is that this compound does not aromatize in any dosage. As already mentioned, a certain part of the testosterone present in the body is converted into estrogen. This aromatization process, depending on the predisposition, can vary distinctly from one athlete to another. Oxandrolon is one of the few steroids, which cannot aromatize to estrogen. This characteristic has various advantages for the athlete.

The third reason which speaks well for an intake of Oxandrolon is that even in a very high dosage this compound does not influence the body's own testosterone production. To make this clear: Oxandrolon does not suppress the body's own hormone production. The reason is that it does not have a negative feedback mechanism on the hypothalamohypophysial testicular axis, meaning that during the intake of Oxandrolon, unlike during the intake of most anabolic steroids, the testes signal the hypothalamus not to reduce or to stop the release of GnRH (gonadotropin releasing hormone) and LHRH (Luteinizing hormone releasing hormone). This special feature of Oxandrolon can be explained by the fact that the substance is not converted into estrogen , thus when given to normal men in high doses Oxandrolon does not reduce the seminal volume or count, nor can it be converted (aromatized) into estrogen.

Oxandrolone Dosing:
As for the dosage of Oxandrolon, 8-12 tablets in men and 5-6 tablets in women seem to bring the best results. The rule of thumb to take 0.125 mg/pound of body weight daily has proven successful in clinical tests. The tablets are normally taken 2 to 3 times daily after meals thus assuring an optimal absorption of the substance. Those who get the already discussed gastrointestinal pain when taking Oxandrolon are better off taking the tablets 1 to 2 hours after a meal or switching to another compound.

Oxandrolone Stack:
The combination of Oxandrolone and 20 - 50 mg Winstrol daily has proven to be very effective since the muscles also look harder.

Similarly good results can be achieved by a simultaneous intake of Oxandrolone and 120-140 mcg Clenbuterol per day. Although Oxandrolone itself does not cause a noticeable muscle growth it can clearly improve the muscle-developing effect of many steroids like Deca-Durabolin, Naposin, and the various testosterone compounds, in particular, if combined well with Oxandrolone , will lead to a "mass buildup". The strength gained after the intake of these highly tissue-developing and liquid-retaining substances results in an additional muscle mass.

A stack of 200 mg Deca-Durabolin/week, 500 mg Testosterone Enanthate (e.g. Testoviron Depot 250)/week, and 25 mg Oxandrolone/day leads to a good gain in strength and mass in most athletes. Deca-Durabolin has a distinct anabolic effect and stimulates the synthesis of protein; Oxandrolone improves the strength by a higher phosphocreatine synthesis; and Testosterone Enanthate increases the aggressiveness for the workout and accelerates regeneration.

Those who work out for a competition or are interested in gaining quality muscles should combine Oxandrolone with steroids such as Winstrol, Parabolan,Testopin, Primobolan, and Testosterone Propionate. A stack of 50 mg Winstrol every two days, 50 mg Testosterone Propionate every two days, and 25 mg Oxandrolone every day has proven effective.

Oxandrolone combines very well with Andriol, since Andriol does not aromatize in a dosage of up to 240 mg daily and has only slight influence on the hormone production. The daily intake of 280 mg Andriol and 25 mg Oxandrolone results in a good gain in strength and, in steroid novices, also in muscle mass without excessive water retention and without a significant influence on testosterone production.

Oxandrolone Side Effects & Risks:
Since Oxandrolon is only slightly toxic and usually shows few side effects, several athletes use it over a prolonged period of time. However Oxandrolon should not be taken for several consecutive months, since, as with almost all oral steroids it is 1 7-alpha alkylated and thus liver toxic. Oxandrolon is an all-purpose remedy, which depending on the athlete's goal is very versatile. Women who react sensitively to the intake of anabolic steroids achieve good results when combining Oxandrolone/Primobolan Tabs and/or Clenbuterol, without suffering from the usual virilization symptoms. Women, however, should not take more than 6 tablets daily otherwise, androgenic-caused side effects such as acne, deep voice, clitorial hypertrophy or increased growth of body hair can occur.

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Adderall 30mg (Generic)

Product Description
Adderall is a brand name psychostimulant drug. It belongs to the phenethylamine and amphetamine chemical classes. Adderall is used for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. Adderall is a combination of four amphetamine salts (racemic amphetamine aspartate monohydrate, racemic amphetamine sulfate, dextroamphetamine saccharide, and dextroamphetamine sulfate). It works as a reuptake inhibitor for dopamine and norepinephrine.It is available in two formulations: IR (Instant Release) and XR (Extended Release). The immediate release formulation is indicated for use in attention deficit hyperactivity disorder (ADHD) and narcolepsy, while the XR formulation is approved for use only with attention deficit hyperactivity disorder (ADHD).

Important side effects of therapeutic dextroamphetamine include stunted growth in young people and occasionally a psychosis can occur at therapeutic doses during chronic therapy as a treatment emergent side effect.When abused at high doses the risk of experiencing side effects and their severity increases. May include sweating or shaking.

Like other stimulant drugs, such as methamphetamine and cocaine, Adderall directly affects the mesolimbic reward pathway in the brain. Amphetamine salt preparations are considered to have high abuse potential, and it is classified as Schedule II by the US DEA. With the Safe Streets and Communities Act in Canada, Adderall has been reclassified from Schedule III to Schedule I.

Medical uses:

Adderall is indicated for the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy. It has been used to treat obesity, but The American Society of Health-System Pharmacists does not recommend this use.

Attention deficit hyperactivity disorder:
Adderall has been shown to significantly reduce symptoms associated with attention-deficit hyperactivity disorder (ADHD) and reportedly presents minimal side-effects. Depending on dosage, and ignoring potential side effects from on-going use or "addiction," the beneficial effects of stimulant medications can last several hours, allowing improved performance throughout the day. Compared to the similar medication methylphenidate (sold under the brand name Ritalin and others), studies have suggested that Adderall is slightly more potent and has a longer period of efficacy, especially at lower doses. For those who experience adverse side-effects to Ritalin or for whom Ritalin has become ineffective, Adderall is often recommended as a substitute. A typical adult dosing is between 30–40 mg for Adderall XR.

Other:
Apart from the FDA-approved indications for the treatment of ADHD and narcolepsy, Adderall has also been used off-label to manage cases of treatment-resistant depression, exogenous obesity, and alternate sleep cycle disorders.

Dosing and administration:
Adderall is marketed as either an immediate-release tablet Adderall, or an extended-release capsule Adderall XR.

Adderall XR utilizes the Microtrol extended-release delivery system, incorporating two types of beads. The first dissolves immediately, releasing half of the medication, while the second type dissolves slowly, releasing the remaining medication four hours later. Maximum plasma concentration is achieved in seven hours, compared to instant-release Adderall, which reaches maximum plasma concentration within three hours. As a result of its high bioavailability, Adderall XR's effectiveness is not altered by food absorption in the gastrointestinal tract. However, mean plasma concentration is prolonged by 2.5 hours (using a 900-calorie standard high-fat meal as the control). Medications that alter urinary pH will cause variations in the amount and method of excretion, and usage should be monitored when taken concurrently with Adderall.

Manufacturer's claims of instant release have been disputed. A US patent granted for Adderall was a pharmaceutical composition patent listing a rapid immediate-release oral dosage form. No claim of increased or smooth drug delivery was made. A recent double-blind, placebo-controlled crossover study conducted among 35 children ages 5–12 indicated that patients behaved similarly to those having taken other immediate-release amphetamines. The authors found that sustained-release dexamphetamine (the main isomeric-amphetamine component of Adderall) had a longer duration of action, however D-amphetamine was less effective in the first few hours.

Adverse effects:
See also:
Amphetamine effects and dextroamphetamine effects
Some Adderall side effects include dizziness, nervousness, headache and weight loss, as well as faster heartbeat combined with lower blood pressure. In addition, note reports, taking too much Adderall medicine initially, could make attention-deficit hyperactivity disorder symptoms worse. Studies of long-term use of Adderall and methylphenidate in children have shown a temporary decrease in growth rate that does not affect final adult height. Stimulant medications also decrease appetite in some people, leading to weight loss, and this effect is more common with mixed amphetamine salts than methylphenidate or atomoxetine. Changes in vision have been reported with both Adderall and methylphenidate.Women who are pregnant should avoid taking Adderall, especially during early pregnancy. Studies on rats show long-term neurological and behavioral changes resulting from prenatal and early postnatal exposure to amphetamines. As noted above, other potential side effects in adults include insomnia, headaches, increased muscle tension, irritability, and anxiety.

Contraindications, interactions, and precautions:
The following provides only general guidelines and is not comprehensive. Please refer to a more comprehensive list for further information regarding co-administration of amphetamine with other substances.

MAOIs (monoamine oxidase inhibitors, e.g., phenelzine, selegiline, iproniazid, etc.) — Do not administer amphetamine for a minimum of two weeks after last use of MAOI type drug. High risk for hypertensive crisis. Preliminary trials of low-dose amphetamine and MAOIs being administered together are in progress. However, this is to be done only under strict supervision of the prescribing parties.
SSRIs (selective serotonin reuptake inhibitors, e.g., fluvoxamine, citalopram, paroxetine, etc.) — While a common combination, and although rare, the risk for serotonin syndrome exists. (Use only when directed)
NRIs (norepinephrine reuptake inhibitors, e.g., atomoxetine, etc.) — NRI medications and amphetamine both enhance noradrenergic activity. Possible augmentation/potentiation of effects. (Use only when directed)
SNRIs (selective serotonin-norepinephrine reuptake inhibitors) — See SSRIs and NRIs.
Bupropion  — Both bupropion and amphetamine have noradrenergic and dopaminergic activity. Possible augmentation/potentiation of effects. Bupropion has pro-convulsant properties that may be enhanced or cumulatively potentiated by amphetamine.[18] (Use only when directed)
Tricyclics and related compounds (tricyclic antidepressant)  — See SNRIs and SSRIs. Possible potentiation of serotonin-, dopamine-, and norepinephrine-related drug effects. The combination of tricyclic and amphetamine compounds/other direct-acting sympathomimetics has been associated with increased sympathetic action. Adjustments to dose may be required. Concurrent use not generally recommended due to interaction between direct-acting sympathomimetics such as amphetamine and tricyclics. Indirect-acting sympathomimetics may have decreased efficacy when combined with tricyclics (tricyclic blockade may inhibit the action of some indirect-acting sympathomimetics).
CYP2D6 (liver enzyme) inhibitors, e.g., most SSRIs such as fluoxetine, citalopram, paroxetine, etc. Some anti-psychotics such as thioridazine, haloperidol, and levomepromazine, as well as cocaine, the opioid agonist methadone, and others. It is important to determine if any medication or drug taken is a CYP2D6 inhibitor. Taking a CYP2D6-inhibiting drug along with amphetamine will lead to an elevated level of amphetamine in the system, resulting in the drug's remaining in the body for a longer period, which can lead to undesirable and possibly serious side effects.
Pregnancy:
FDA pregnancy category C. It is not known whether Adderall will harm a developing embryo or fetus. It could cause premature birth, low birth weight, or withdrawal symptoms in a newborn if the mother takes this medication during pregnancy.

Government warnings:
On February 9, 2005, Health Canada suspended all sales of Adderall XR after data collected by manufacturer Shire Pharmaceuticals linked the drug to 12 sudden deaths in American children. Further research found data suggesting use of Adderall resulted in an increased risk of cardiac defect and it is known that amphetamine class drugs like Adderall present a marked increase in heart rate and blood pressure. Although more than 37 million prescriptions for Adderall were filled during the four years prior, the U.S. Food and Drug Administration could find no increased risk of sudden death among Adderall users.In August 2005, Health Canada followed the committee report of three independent physicians and lifted the ban on Adderall XR. Given that persons with ADHD are more likely to engage in risky or dangerous behavior, it has been suggested that stimulant medications for persons with ADHD may actually result in lower incidence of premature death. The use of Adderall is generally not advised in those persons with pre-existing cardiac or mental illnesses. It is also not advised in persons who have a history of drug abuse. Although FDA safety advisors voted 8 to 7 to issue a black box warning, the FDA's pediatric advisory committee refused to give the drug its most severe black box warning in March 2006. A Black Box Warning regarding amphetamine abuse potential is in place, however. In September 2008, Britain's National Institute for Health and Clinical Excellence urged physicians not to prescribe Adderall or similar drugs to children under 5, and to exhaustively consider other approaches to behavioral modification before prescribing such drugs to children 5 and up.

Prolonged use:
Prolonged high doses of amphetamines followed by an abrupt cessation can result in extreme fatigue, insomnia, irritability, weight gain, and mental depression. Chronic abuse of amphetamines can result in the manifestation of amphetamine psychosis; occasionally this psychosis can occur at therapeutic doses during chronic therapy as a treatment emergent side effect.

Chemistry:
Adderall's effects are similar to other CNS stimulants of the same class and preparation. (See amphetamine for details.)

Urinary and stomach pH levels can have a strong effect on DL-amphetamine excretion and absorption. An acidic stomach and GI pH will decrease the absorption of Adderall, and acidic urine levels will decrease the reabsorption of the drug through the renal system. Co-administration of acidic substances (e.g., citric acid) causes decreased renal reabsorption of DL-amphetamine; whereas, alkaline agents (e.g., antacids) may cause a marked increase in renal tubular reabsorption. The increased reabsorption can increase the retention of amphetamines, with potential to result in dangerously high serum levels.

Adderall XR consists of the following amphetamine compounds in equal proportions: dextroamphetamine saccharate, dextroamphetamine sulfate, racemic amphetamine aspartate monohydrate, and racemic amphetamine sulfate. Breakdown rates are affected by many factors including urinary and stomach pH, weight, sex, other medications being taken, and age. Alkalinity increases bioavailability, while acidity causes the drug to be excreted more quickly. Manufacturers claim that the mixture of salts in Adderall XR makes its effects smoother (that is, makes softer highs and lows).The mixture of salts and their ratios are as follows:

1/4 dextroamphetamine saccharate
1/4 dextroamphetamine sulfate, USP
1/4 (racemic) amphetamine aspartate monohydrate
1/4 (racemic) amphetamine sulfate, USP
Metabolism:
"The mean elimination half-life for d-amphetamine is 10 hours in adults; 11 hours in adolescents aged 13–17 years and weighing less than or equal to 75 kg/165 lbs; and 9 hours in children aged 6 to 12 years. For the l-amphetamine, the mean elimination half-life in adults is 13 hours; 13 to 14 hours in adolescents; and 11 hours in children aged 6 to 12 years. On a mg/kg body weight basis children have a higher clearance than adolescents or adults.

Both Adderall IR and Adderall XR are available in generic forms. Adderall IR is available as a generic drug, while Adderall XR is available as an authorized generic. Authorized generics are still manufactured by the brand name manufacturer but marketed and sold by a different company. Authorized generics are exactly the same as the brand name product both in active and inactive ingredients. They go through exactly the same brand manufacturing line, but different labels are put on at the end of the manufacturing process. On June 25, 2012 Actavis received approval from the USFDA to start manufacturing and distributing generic extended-release formulations of all available strengths.

Mechanism of action:


The molecular structure of amphetamine:
Main article:
Dextroamphetamine mechanism of action
With respect to central stimulant actions, the S(+) isomer (i.e., dextroamphetamine) is several times more potent than its R(-)enantiomer (i.e., levoamphetamine); this is not necessarily the case with other actions produced by amphetamine, in particular those produced in the periphery such as cardiovascular actions. Dextroamphetamine induces more euphoria, whereas levoamphetamine induces more depression. The overall greater potency of the dextro form to central actions suggests that this form may have a higher potential for abuse.

Adderall’s inclusion of levoamphetamine provides the pharmaceutical with a quicker onset and longer clinical effect compared to pharmaceuticals formulated exclusively of dextroamphetamine. Although it seems the human brain has a preference for dextroamphetamine over levoamphetamine, it has been reported that certain children have a better clinical response to levoamphetamine. Amphetamines are believed to exert their effects by binding to the monoamine transporters and increasing extracellular levels of the biogenic amines dopamine, norepinephrine, and serotonin[citation needed] .

It is hypothesized that D-amphetamine acts primarily on the dopaminergic (DA) systems, while L-amphetamine is comparatively norepinephrinergic (NE)[citation needed]. The primary reinforcing and behavioral-stimulant effects of amphetamine, however, are linked to enhanced dopaminergic activity, primarily in the mesolimbic dopaminergic pathway. Amphetamine binds to the dopamine transporter (DAT) and blocks the transporter's ability to clear DA from the synaptic space. In addition, amphetamine is transported into the cell, which leads to dopamine efflux (DA is transported out of the cell and into the synaptic space via reverse transport of the DAT).

Amphetamine also possesses the ability to inhibit the enzymes monoamine oxidase-A and -B (MAO-A and MAO-B) in high doses[citation needed]. MAO-A is responsible for the breakdown of serotonin, dopamine, norepinephrine, and epinephrine. MAO-B is responsible for breaking down dopamine (more potently than MAO-A) and phenylethylamine (PEA), which has actions similar to those of amphetamine itself, and is thought to be involved in feelings of lust, confidence, obsession, and sexuality. Some of the first antidepressants successfully marketed are, in fact, monoamine oxidase inhibitors. However, MAO inhibition seen with amphetamine is not substantial enough in duration and quantity to entail the need for a tyramine-limited diet, unlike the more potent and long-lived MAO-inhibiting antidepressants.

Amphetamine's ability to cause the inhibition of MAO results in the accumulation of monoamines: Amphetamine directly stimulates the release of these neurochemicals, resulting in a potent elevation in monoamine neurotransmission. In sum, the effect of amphetamines is to increase neurotransmitter availability in the synapse, by both releasing more neurotransmitters and prolonging their availability in the synapse by slowing their removal.

Performance-enhancing use:
In addition to treatment of juveniles with ADHD, Adderall is sometimes prescribed for children who are not doing well in school but who don't have ADHD. These are often children from economically-deprived backgrounds for whom alternatives such as therapy or tutoring is not available.

Adderall is widely used as a "study drug" at many universities, due to Adderall's reported ability to help focus energy and concentration to a much higher level than normal.[citation needed] It enables the user to focus and stay awake. Stories of students writing papers continuously for an unusually long time or "cramming" all night for an exam with no loss of energy or concentration are common. College campuses known to be highly competitive or have a high rate of binge drinking had up to 25% of students use an ADHD medication within one year, a survey of students at 119 colleges across the country concluded.[citation needed]

Adderall use as an academic advantage has become increasingly common amongst college students. Illegal Adderall use is highest among students from the northeastern region of the United States and students from colleges with more competitive admission standards.[44] Students with ADHD sell Adderall on college campuses for anywhere from $5 to $25 a pill depending on the time of the academic year.[45] The legal consequences for selling Adderall include prison time because it is classified as a controlled substance.[46] It is often difficult to catch illegal Adderall sales because the pills are “easily concealed, odorless, and can be perceived as prescribed drugs” Of these sales, 62% of buyers report using Adderall for concentration and study help.

Many athletic organizations have restricted the usage of Adderall by athletes. The NCAA has banned the use of Adderall for its collegiate athletes without a prescription and adequate records of evaluation and diagnosis of ADHD. Nevada State Athletic Commission has also banned athletes in the state from using Adderall. Tim Credeur was removed from a UFC fight on the finale of The Ultimate Fighter 7 because of a positive drug test due to his use of it. In the National Football League, New Orleans Saints kicker Garrett Hartley served a four-game suspension when the 2009 NFL regular season began because he tested positive for the banned stimulant. The Arizona Cardinals tight end Ben Patrick received a four-game suspension as a result of using Adderall.

The New York Giants running back Andre Brown (American football) faced a four-game suspension for violating NFL's performance-enhancing substance ban. Brown said: “It was something that I've been on since I've been in the league, which was Adderall. I just forgot to fill out some paperwork and that was it.Brown eventually won an appeal, and had his suspension lifted.Another Giants player, Tyler Sash, was suspended for four games by the NFL in July 2012 after testing positive for Adderall four months earlier. The safety said in a statement that he took the drug legally and "under a doctor's care for an anxiety condition" to help him with public speaking.The New York Giants safety Will Hill (American football) was charged a four-game suspension for violating NFL's performance-enhancing substance ban. Hill said: “"I received a doctor's prescription for Adderall prior to signing with the Giant Tampa Bay Buccaneers cornerback Aqib Talib has been suspended four games by the NFL for violating the league's policy on performance enhancing substances. Talib released a statement saying his suspension was a result of testing positive for Adderall: "Around the beginning of training camp, I made a mistake by taking an Adderall pill without a prescription,

Recreational use:
Adderall, as an amphetamine product, is used recreationally for its euphoric and stimulant properties.Prescription amphetamines are often obtained by those with a prescription and diverted and sold to those who do not have a prescription. As a Schedule II drug, Adderall is considered to have a high potential for misuse and a high liability for dependence. Amphetamine has the potential to cause withdrawal (mainly psychological) symptoms when ceasing use.

Detection of use:
Amphetamine is frequently measured in hair, oral fluid, sweat, or urine as part of a drug abuse testing program. Techniques such as immunoassay may cross-react with a number of sympathomimetics drugs, so chromatographic methods specific for amphetamine should be employed to prevent false-positive results. Chiral techniques may be employed to help distinguish the source of the drug, whether obtained legally (by prescription) or illegally or possibly as a result of formation from a prodrug such as lisdexamfetamine or selegiline. Chiral separation can be used to differentiate Adderall use from use of another prescription form of amphetamine or from use of illicit amphetamine, since Adderall is unique in having a 3:1 mixture of the d- and l-isomers.

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Ketarol 500mg/10ml by Global Pharmaceuticals

Ketarol 500mg/10ml by Global Pharmaceuticals

Product Description
What is ketamine?
Ketamine is an anesthetic medication.
Ketamine is used as a general anesthetic to prevent pain and discomfort during certain medical tests or procedures, or minor surgery.

Ketamine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about ketamine?
Before you receive ketamine, tell your doctor if you are allergic to any drugs, or if you have a history of alcoholism.

It may take you longer to recover from anesthesia with ketamine if you have recently used a barbiturate such as phenobarbital (Luminal) or secobarbital (Seconal), or a narcotic medication such as fentanyl (Actiq, Duragesic), hydrocodone (Lortab, Vicodin), oxycodone (OxyContin), propoxyphene (Darvocet, Darvon), and others.

Ketamine may be harmful to an unborn baby. Before you receive ketamine, tell your doctor if you are pregnant.

You may feel strange or slightly confused when you first come out of anesthesia. Tell your caregivers if these feelings are severe or unpleasant.

Ketamine can cause side effects that may impair your thinking or reactions for 24 hours or longer. Be careful if you drive or do anything that requires you to be awake and alert. You will probably not be allowed to drive yourself home after your surgery or medical procedure.

Follow your doctor's instructions about any restrictions on food, beverages, or activity after you recover from anesthesia.

What should I discuss with my health care provider before receiving ketamine?
Before you receive ketamine, tell your doctor if you are allergic to any drugs, or if you have a history of alcoholism.

Ketamine may be harmful to an unborn baby. Before you receive ketamine, tell your doctor if you are pregnant.

How is ketamine given?
Ketamine is given as an injection through a needle placed into a vein or muscle. You will receive this injection in a clinic or hospital setting.

Your caregivers will monitor your heart function, blood pressure, and breathing while you are under the effects of ketamine.

You may feel strange or slightly confused when you first come out of anesthesia. Tell your caregivers if these feelings are severe or unpleasant.

What happens if I miss a dose?
Since ketamine is usually given for anesthesia, you are not likely to be on a dosing schedule.

What happens if I overdose?
An overdose of ketamine is unlikely to occur since the medication is given by a doctor. Your vital signs will be closely watched while you are under anesthesia to make sure the medication is not causing any harmful effects.

What should I avoid after receiving ketamine?
Ketamine can cause side effects that may impair your thinking or reactions for 24 hours or longer. Be careful if you drive or do anything that requires you to be awake and alert. You will probably not be allowed to drive yourself home after your surgery or medical procedure.

Follow your doctor's instructions about any restrictions on food, beverages, or activity after you recover from anesthesia.

Ketamine side effects:
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have any of these serious side effects within 24 hours after you receive ketamine:

severe confusion;

hallucinations;

unusual thoughts; or

extreme fear.

Less serious side effects may include:

dream-like feeling;

double vision;

jerky muscle movements;

dizziness, drowsiness;

nausea, vomiting, loss of appetite; or

sleep problems (insomnia).

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Generic Diazepam 5mg

Product Description

Diazepam (daɪˈæzɨpæm/), first marketed as Valium (ˈvæliəm/) by Hoffmann-La Roche, is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex.

It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms (such as in cases of tetanus), restless legs syndrome, alcohol withdrawal, benzodiazepine withdrawal and Ménière's disease. It may also be used before certain medical procedures (such as endoscopies) to reduce tension and anxiety, and in some surgical procedures to induce amnesia. It possesses anxiolytic, anticonvulsant, hypnotic, sedative, skeletal muscle relaxant, and amnestic properties.The pharmacological action of diazepam enhances the effect of the neurotransmitter GABA by binding to the benzodiazepine site on the GABAA receptor (via the constituent chlorine atom) leading to central nervous system depression  Adverse effects of diazepam include anterograde amnesia (especially at higher doses) and sedation as well as paradoxical effects such as excitement, rage or worsening of seizures in epileptics. Benzodiazepines also can cause or worsen depression.

Long-term effects of benzodiazepines such as diazepam include tolerance, benzodiazepine dependence as well as a benzodiazepine withdrawal syndrome upon dose reduction; additionally after cessation of benzodiazepines cognitive deficits may persist for at least 6 months and may not fully return to normal, however it was suggested that longer than 6 months may be needed for recovery from some deficits.Diazepam also has physical dependence potential and can cause serious problems of physical dependence with long term use. However, compared to other benzodiazepines, physical withdrawal from diazepam following long term use is usually far more mild due to its long elimination half life. Nevertheless, urgent action by National Governments to improve prescribing practices has been recommended.  Advantages of diazepam are a rapid onset of action and high efficacy rates which is important for managing acute seizures, anxiety attacks and panic attacks; benzodiazepines also have a relatively low toxicity in overdose.Diazepam is a core medicine in the World Health Organization's "Essential Drugs List", which is a list of minimum medical needs for a basic health care system. Diazepam was first synthesized by Leo Sternbach, is used to treat a wide range of conditions, and has been one of the most frequently prescribed medications in the world since its launch in 1963.

Medical uses:

Diazepam is mainly used to treat anxiety, insomnia, and symptoms of acute alcohol withdrawal. It is also used as a premedication for inducing sedation, anxiolysis or amnesia before certain medical procedures (e.g., endoscopy).  Intravenous diazepam or lorazepam are first line treatments for status epilepticus; However, lorazepam has advantages over diazepam including a higher rate of terminating seizures and a more prolonged anticonvulsant effect.Diazepam is rarely used for the long-term treatment of epilepsy because tolerance to the anticonvulsant effects of diazepam usually develops within 6 to 12 months of treatment, effectively rendering it useless for that purpose. Diazepam is used for the emergency treatment of eclampsia, when IV magnesium sulfate and blood pressure control measures have failed. Benzodiazepines do not have any pain relieving properties of themselves and are generally recommended to be avoided in individuals with pain. However, benzodiazepines such as diazepam can be used for their muscle relaxant properties to alleviate pain which is caused by muscle spasms, caused by various dystonias, including blepharospasmTolerance often develops to the muscle relaxant effects of benzodiazepines such as diazepam. Baclofenor tizanidine is sometimes used as an alternative to diazepam. Tizanidine has been found to be equally effective as other antispasmodic drugs and have superior tolerability than baclofen and diazepam.  The anticonvulsant effects of diazepam, can help in the treatment of seizures, due to a drug overdose or chemical toxicity as a result of exposure to sarin, VX, soman (or other organophosphate poisons; See #CANA), lindane, chloroquine, physostigmine, or pyrethroids Diazepam is sometimes used intermittently for the prophylaxis of febrile seizures which occur as a result of a high fever in children and neonates under 5 years of age.Long-term use of diazepam for the management of epilepsy is not recommended; however, a subgroup individuals with treatment resistant epilepsy benefit from long-term benzodiazepines and for such individuals clorazepate has been recommended due to its slower onset of tolerance to the anticonvulsant effects.

 Diazepam has a broad spectrum of indications (most of which are off-label), including:

Treatment of anxiety, panic attacks, and states of agitation     Treatment of neurovegetative symptoms associated with vertigo     Treatment of the symptoms of alcohol, opiate and benzodiazepine withdrawal     Short-term treatment of insomnia     Treatment of tetanus, together with other measures of intensive-treatment     Adjunctive treatment of spastic muscular paresis (para-/tetraplegia) caused by cerebral or spinal cord conditions such as stroke, multiple sclerosis, spinal cord injury (long-term treatment is coupled with other rehabilitative measures)     Palliative treatment of stiff person syndrome     Pre-/postoperative sedation, anxiolysis and/or amnesia (e.g., before endoscopic or surgical procedures)     Treatment of complications with a hallucinogen crisis and stimulant overdoses and psychosis, such as LSD, cocaine, or methamphetamine.     Prophylactic treatment of oxygen toxicity during hyperbaric oxygen therapy  Dosages should be determined on an individual basis, depending upon the condition to be treated, the severity of symptoms, the body weight of the patient, and any comorbid conditions the patient may have. Availability  Diazepam is marketed in over 500 brands throughout the world.It is supplied in oral, injectable, inhalation and rectal forms.  The United States military employs a specialized diazepam preparation known as CANA (Convulsive Antidote, Nerve Agent), which contains a mixture of diazepam, atropine and pralidoxime (2-PAM). One CANA kit is typically issued to service members, along with three Mark I NAAK kits, when operating in circumstances where chemical weapons in the form of nerve agents are considered a potential hazard. Both of these kits deliver drugs using auto-injectors. They are intended for use in "buddy aid" or "self aid" administration of the drugs in the field prior to decontamination and delivery of the patient to definitive medical care.

Contraindications  Use of diazepam should be avoided, when possible, in individuals with the following conditions:      Ataxia.     Severe hypoventilation.     Acute narrow-angle glaucoma.     Severe hepatic deficiencies (hepatitis and liver cirrhosis decrease elimination by a factor of 2).     Severe renal deficiencies (for example, patients on dialysis).     Liver disorders.     Severe respiratory disorders.     Severe sleep apnea.     Severe depression, particularly when accompanied by suicidal tendencies.     Psychosis.     Pregnancy or breast feeding.     Caution required in elderly or debilitated patients.     Coma or shock.     Abrupt discontinuation of therapy.     Acute intoxication with alcohol, narcotics, or other psychoactive substances (with the exception of some hallucinogens and/or stimulants, where it is occasionally used as a treatment for overdose).     History of alcohol or drug dependence.     Myasthenia gravis, or MG, an autoimmune disorder causing marked fatiguability.     Hypersensitivity or allergy to any drug in the benzodiazepine class.  Special caution needed      Benzodiazepines require special precaution if used in the alcohol- or drug-dependent individuals and individuals with comorbid psychiatric disorders.      Pediatric patients         Less than 18 years of age – Treatment usually not indicated, except treatment of epilepsy, and pre-/postoperative treatment. The smallest possible effective dose should be used for this group of patients.         Under 6 months of age – Safety and effectiveness have not been established; diazepam should not be given to individuals in this age group.      Elderly and very ill patients – Possibility that apnea and/or cardiac arrest may occur. Concomitant use of other central nervous system depressants increases this risk. The smallest possible effective dose should be used for this group of patients. The elderly metabolise benzodiazepines much more slowly than younger adults and are also more sensitive to the effects of benzodiazepines even at similar blood plasma levels. Doses of diazepam are recommended to be about half of those given to younger individuals and treatment limited to a maximum of 2 weeks. Long-acting benzodiazepines such as diazepam are not recommended for the elderly.Diazepam may also be dangerous in geriatric patients owing to a significant increased risk of falls.      I.V. or I.M. injections in hypotensive individuals or those in shock should be administered carefully and vital signs should be monitored.

Benzodiazepines such as diazepam are lipophilic and rapidly penetrate membranes, and, therefore, rapidly cross over into the placenta with significant uptake of the drug. Use of benzodiazepines including diazepam in late pregnancy, especially high doses, may result in floppy infant syndrome.  Pregnancy  Diazepam when taken late in pregnancy, during the third trimester, causes a definite risk of a severe benzodiazepine withdrawal syndrome in the neonate with symptoms including hypotonia, and reluctance to suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. Floppy infant syndrome and sedation in the newborn may also occur. Symptoms of floppy infant syndrome and the neonatal benzodiazepine withdrawal syndrome have been reported to persist from hours to months after birth. Adverse effects  Adverse effects of benzodiazepines such as diazepam include anterograde amnesia and confusion (especially pronounced in higher doses) and sedation. The elderly are more prone to adverse effects of diazepam such as confusion, amnesia, ataxia and hangover effects as well as falls. Long-term use of benzodiazepines such as diazepam is associated with tolerance, benzodiazepine dependence as well as a benzodiazepine withdrawal syndrome.Like other benzodiazepines, diazepam can impair short-term memory and learning of new information. While benzodiazepine drugs such as diazepam can cause anterograde amnesia, they do not cause retrograde amnesia; information learned before benzodiazepines is not impaired. Tolerance to the cognitive impairing effects of benzodiazepines does not tend to develop with long-term use. The elderly are more sensitive to the cognitive impairing effects of benzodiazepines.Additionally after cessation of benzodiazepines cognitive deficits may persist for at least six months; it is unclear whether these impairments take longer than six months to abate or if they are permanent. Benzodiazepines may also cause or worsen depression.Infusions or repeated intravenous injections of diazepam when managing seizures for example may lead to drug toxicity including respiratory depression, sedation as well as hypotension. Tolerance may also develop to infusions of diazepam if it is given for longer than 24 hours.Adverse effects such as sedation, benzodiazepine dependence and abuse potential limit the use of benzodiazepines.  Diazepam has a range of side-effects that are common to most benzodiazepines.

Most common side-effects include:

Suppression of REM sleep     Impaired motor function         Impaired coordination         Impaired balance         Dizziness and nausea     Depression     Reflex tachycardia  Less commonly paradoxical side-effects can occur and include nervousness, irritability, excitement, worsening of seizures, insomnia, muscle cramps, changes in libido (increased or decreased libido) and in some cases, rage, and violence. These adverse reactions are more likely to occur in children, the elderly, individuals with a history of drug or alcohol abuse and people with a history of aggression.Diazepam may increase, in some people, the propensity toward self-harming behaviours and, in extreme cases, may provoke suicidal tendencies or acts.Very rarely dystonia can occur.  Diazepam may impair the ability to drive vehicles or operate machinery. The impairment is worsened by consumption of alcohol, because both act as central nervous system depressants.  During the course of therapy, tolerance to the sedative effects usually develops, but not to the anxiolytic and myorelaxant effects.  Patients with severe attacks of apnea during sleep may suffer respiratory depression (hypoventilation) leading to respiratory arrest and death.  Diazepam in doses of 5 mg or more causes significant deterioration in alertness performance combined with increased feelings of sleepiness. Tolerance and dependence  Diazepam as with other benzodiazepine drugs can cause tolerance, physical dependence, addiction and what is known as the benzodiazepine withdrawal syndrome. Withdrawal from diazepam or other benzodiazepines often leads to withdrawal symptoms that are similar to those seen during barbiturate or alcohol withdrawal. The higher the dose and the longer the drug is taken the greater the risk of experiencing unpleasant withdrawal symptoms. Withdrawal symptoms can occur from standard dosages and also after short-term use and can range from insomnia and anxiety to more serious symptoms including seizures and psychosis. Withdrawal symptoms can sometimes resemble pre-existing conditions and be misdiagnosed. Diazepam may produce less intense withdrawal symptoms due to its long elimination half-life. Benzodiazepine treatment should be discontinued as soon as possible via a slow and gradual dose reduction regime.Tolerance develops to the therapeutic effects of benzodiazepines; for example tolerance occurs to the anticonvulsant effects and as a result benzodiazepines are not generally recommended for the long-term management of epilepsy. Dose increases may overcome the effects of tolerance, however, tolerance may then develop to the higher dose and adverse effects may increase.

The mechanism of tolerance to benzodiazepines includes: uncoupling of receptor sites, alterations in gene expression, down-regulation of receptor sites, and desensitisation of receptor sites to the effect of GABA. Approximately one third of individuals who take benzodiazepines for longer than 4 weeks become dependent and experience a withdrawal syndrome upon cessation.The difference in rates of withdrawal (50–100%) varies depending on the patient sample being investigated. For example, a random sample of long-term benzodiazepine users typically finds that around 50% will experience little or no withdrawal symptoms, with the other 50% experiencing notable withdrawal symptoms. Certain select patient groups will show a higher rate of notable withdrawal symptoms, up to 100%.Rebound anxiety, more severe than baseline anxiety, is also a common withdrawal symptom when discontinuing diazepam or other benzodiazepines.Diazepam is therefore only recommended for short-term therapy at the lowest possible dose owing to risks of severe withdrawal problems from low doses even after gradual reduction.There is a significant risk of pharmacological dependence on diazepam and patients experiencing symptoms of benzodiazepine withdrawal syndrome if it is taken for 6 weeks or longer.In humans tolerance to the anticonvulsant effects of diazepam occurs frequently. Dependence  Improper or excessive use of Diazepam can lead to psychological dependence/drug addiction.At a particularly high risk for diazepam misuse, abuse or psychological dependence are:      People with a history of alcohol or drug abuse or dependenceDiazepam increases craving for alcohol in problem alcohol consumers. Diazepam also increases the volume of alcohol consumed by problem drinkers.     People with severe personality disorders, such as Borderline Personality Disorder  Patients from the aforementioned groups should be monitored very closely during therapy for signs of abuse and development of dependence. Therapy should be discontinued if any of these signs are noted, although if physical dependence has developed therapy must still be discontinued gradually to avoid severe withdrawal symptoms. Long-term therapy in these people is not recommended.  People suspected of being physiologically dependent on benzodiazepine drugs should be very gradually tapered off the drug. Although rare, withdrawals can be life-threatening particularly when excessive doses have been taken for extended periods of time. Equal prudence should be used whether dependence has occurred in therapeutic or recreational contexts.  Diazepam in and of itself is not a recreational drug, but may be used to either enhance or "come down" from the effects of other recreational drugs. For example, diazepam increases the euphoriant effects of heroin (and other recreational opiates), yet decreases the undesirable side-effects of cocaine and/or methamphetamine come-down.

Overdose Main article:

Benzodiazepine overdose  An individual that has consumed too much diazepam will typically display one or more of the following symptoms in a period of approximately four hours immediately following a suspected overdose:      Drowsiness     Mental confusion     Hypotension     Impaired motor functions         Impaired reflexes         Impaired coordination         Impaired balance         Dizziness     Coma  Although not usually fatal when taken alone, a diazepam overdose is considered a medical emergency and generally requires the immediate attention of medical personnel. The antidote for an overdose of diazepam (or any other benzodiazepine) is flumazenil (Anexate). This drug is only used in cases with severe respiratory depression or cardiovascular complications. Because flumazenil is a short-acting drug, and the effects of diazepam can last for days, several doses of flumazenil may be necessary. Artificial respiration and stabilization of cardiovascular functions may also be necessary. Although not routinely indicated, activated charcoal can be used for decontamination of the stomach following a diazepam overdose. Emesis is contraindicated. Dialysis is minimally effective. Hypotension may be treated with levarterenol or metaraminol.  The oral LD50 (lethal dose in 50% of the population) of diazepam is 720 mg/kg in mice and 1240 mg/kg in rats.D. J. Greenblatt and colleagues reported in 1978 on two patients who had taken 500 and 2000 mg of diazepam, respectively, went into moderately deep comas, and were discharged within 48 hours without having experienced any important complications, in spite of having high concentrations of diazepam and its metabolites, esmethyldiazepam, oxazepam, and temazepam; according to samples taken in the hospital and as follow-up.  Overdoses of diazepam with alcohol, opiates and/or other depressants may be fatal.  An Australian study has found people who take sleeping pills or anti-anxiety medications are more dangerous on the roads than drunk drivers. Interactions  If diazepam is to be administered concomitantly with other drugs, attention should be paid to the possible pharmacological interactions. Particular care should be taken with drugs that enhance the effects of diazepam, such as barbiturates, phenothiazines, narcotics and antidepressants.  Diazepam does not increase or decrease hepatic enzyme activity, and does not alter the metabolism of other compounds. There is no evidence that would suggest diazepam alters its own metabolism with chronic administration.  Agents that have an effect on hepatic cytochrome P450 pathways or conjugation can alter the rate of diazepam metabolism. These interactions would be expected to be most significant with long-term diazepam therapy, and their clinical significance is variable.

Diazepam increases the central depressive effects of alcohol, other hypnotics/sedatives (e.g., barbiturates), narcotics, other muscle relaxants, certain antidepressants, sedative antihistamines, opiates, and antipsychotics as well as anticonvulsants such as phenobarbital, phenytoin and carbamazepine. The euphoriant effects of opioids may be increased, leading to increased risk of psychological dependence.     Cimetidine, omeprazole, oxcarbazepine, ticlopidine, topiramate, ketoconazole, itraconazole, disulfiram, fluvoxamine, isoniazid, erythromycin, probenecid, propranolol, imipramine, ciprofloxacin, fluoxetine and valproic acid prolong the action of diazepam by inhibiting its elimination.     Alcohol (ethanol) in combination with diazepam may cause a synergistic enhancement of the hypotensive properties of benzodiazepines and alcohol.     Oral contraceptives ("the pill") significantly decrease the elimination of desmethyldiazepam, a major metabolite of diazepam.     Rifampin, phenytoin, carbamazepine and phenobarbital increase the metabolism of diazepam, thus decreasing drug levels and effects. Dexamethasone and St John's wort also increase the metabolism of diazepam.     Diazepam increases the serum levels of phenobarbital.     Nefazodone can cause increased blood levels of benzodiazepines.     Cisapride may enhance the absorption, and therefore the sedative activity, of diazepam.     Small doses of theophylline may inhibit the action of diazepam.     Diazepam may block the action of levodopa (used in the treatment of Parkinson's Disease).     Diazepam may alter digoxin serum concentrations.     Other drugs that may have interactions with diazepam include: Antipsychotics (e.g. chlorpromazine), MAO inhibitors, ranitidine.     Caffeine may antagonise the effects of diazepam and vice versa.     Smoking tobacco can enhance the elimination of diazepam and decrease its action.     Because it acts on the GABA receptor the herb Valerian may produce an adverse effect.     Foods that acidify the urine can lead to faster absorption and elimination of diazepam, reducing drug levels and activity.     Foods that alkalinize the urine can lead to slower absorption and elimination of diazepam, increasing drug levels and activity.     There are conflicting reports as to whether food in general has any effects on the absorption and activity of orally administered diazepam.

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pregnyl 1500 iu by Organon

pregnyl 1500 iu by Organon

Product Description
HCG Pregnyl 1500 IU by Schering-Plough

ONE ORDER UNIT INCLUDES: 1 1500 IU ampoule containing hCG and 1 ml ampoule containing water solution

1 AMPOULE CONTAINS: 1500 IU

TOTAL AMPULES PER ONE ORDER UNIT: 1

TOTAL IU PER ONE ORDER UNIT: 1500 IU

ALTERNATIVE DRUG NAMES: A.P.L., Chorex, Pregnyl, Profasi, Pregnyl IM, hCG, HCG, Human chorionic gonadotropin

ACTIVE SUBSTANCE:

Human chorionic gonadotropin

DESCRIPTION:
hCG (Human chorionic gonadotropin) is used to cause ovulation and to treat infertility in women, and to increase sperm count in men. HCG is also used in young boys when their testicles have not dropped down into the scrotum normally. This can be caused by a pituitary gland disorder.

hCG (Human chorionic gonadotropin) may also be used for other purposes not listed in this medication guide.

HCG (Human chorionic gonadotropin) is given as an injection under the skin or into a muscle. Your doctor, nurse, or other health care provider will give you this injection. You may be shown how to inject your medicine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

DOSAGE AND DIRECTIONS FOR USE:

Dosage in the female:
Ovulation induction or preparation of follicles for puncture
Usually, one injection of 5 000-10 000 I.U. Pregnyl, to complete treatment with an FSH-containing preparation.
Luteal phase support
Two to three repeat injections of 1000 to 3000 I.U. each may be given within nine days following ovulation or embryo transfer (for example on day 3, 6 and 9 after ovulation induction).

Dosage in the male:
Hypogonadotrophic hypogonadism
1000-2000 I.U. Pregnyl, two to three times per week. If the main complaint is subfertility, additional doses of an FSH-containing preparation (75 I.U. FSH) daily or two to three times a week, may be given. This treatment should be continued for at least three months before any improvement in spermatogenesis can be expected. During this treatment testosterone replacement therapy should be suspended. Once achieved, the improvement may sometimes be maintained by hCG alone.
Delayed puberty
1500 I.U. two to three times a week for at least six months.

Cryptorchidism:
- under 2 years of age: 250 I.U. twice weekly for six weeks
- under 6 years of age: 500-1000 I.U. twice weekly for six weeks
- over 6 years of age: 1500 I.U. twice weekly for six weeks
If necessary, this treatment can be repeated.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS:
Reactions at the site of injection, such as bruising, pain, redness, swelling and itching, have been reported with the use of urinary gonadotrophin preparations. Occasionally allergic reactions have been reported, mostly manifesting as pain and/or rash at the injection site. In rare cases generalized rash or fever may occur.
In the female:
Unwanted ovarian hyperstimulation, ovarian hyperstimulation syndrome. Characteristic symptoms of unwanted ovarian hyperstimulation and the ovarian hyperstimulation syndrome are included above, under "Warnings".
In the male:
Water and sodium retention is occasionally seen after administration of high dosages; this is regarded as a result of excessive androgen production.
HCG treatment may sporadically cause gynaecomastia.

Effects on ability to drive and use machines:
As far as known this medicine has no influence on alertness and concentration.

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT
The acute toxicity of urinary gonadotrophin preparations has been shown to be very low. There are no symptoms of an acute parenteral overdose known in humans.

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Clenbuterol 20mg by LA Pharma

Clenbuterol 20mg by LA Pharma

Product Description
Clenbuterol:
Chemical Name:
 Clenbuterol Hydrochloride
Drug Class:
Lipolytic (fat burner)
Clenbuterol (often called just “Clen”) is used by athletes and bodybuilders for it’s ability as a beta-2 agonist. It therefore stimulates your beta-2 receptors, which in turn help you to lose fat by allowing your body to release and burn more stored fat. Clen has been used for literally decades in the foreign veterinary world, for increasing the lean yield of livestock. It is clearly a very effective agent for this purpose, although its long half life and tendency to stay active in the body for long periods of time mean that vets in the United States aren’t able to use it. This is also the reason why (although it’s an asthma medication) it’s not available to asthmatics in the US of A. Albuterol is Clen’s shorter acting cousin, and that’s the FDA’s drug of choice here. But in the world of athletics, Clenbuterol has a much longer history of use.

  Specifically, it’s used for fat loss, and since we’re talking about fat loss here, and this purpose is what it’s most often used for by athletes. Briefly stated, Clenis used as a repartitioning agent, and what this means is simply that it will increase your ratio of Fat Free Mass (FFM) to Fat Mass (FM) (1). When you useClenbuterol, besides (of course) noticing some fat loss, you’ll feel your body temperature rise a bit, and your appetite will be slightly repressed. (2)

Anyway, as you may have guessed, because the FDA doesn’t allow Clenbuterol use in asthmatics, and the USDA doesn’t allow it in livestock, there aren’t a lot of human studies to really examine with regards to Clenbuterol. Unfortunately this makes research a bit difficult, as it’s well known that animals have a some important differences in their beta-receptor type and concentrations, but animal studies are still quite useful here.

Clenbuterol is quite anti-catabolic and/or anabolic in almost every (animal) study ever done on it, although this hasn’t been studied or confirmed in human studies (3). Also, a trend we see with Clenbuterol administration in animals is that the doses used are very high- more than anyone I’ve ever heard of actually taking. So, what I’m saying is that if Clenbuterol is anabolic or anti-catabolic in humans, only mild anabolic or anti-catabolic effects can realistically be expected. We can take a look at horses given a human-like dose of clen (slightly over 1mcg/lb x2 a day) and exercised for nearly human-like times (20mins, 3x a week) showed very significant decreases in %fat (-17.6%) and fat mass (-19.5%). Interestingly, this significantly increased (+4.4%) at week 6 (1). This has been one of the reasons I have never believed in the 2 weeks on and 2 weeks theory of Clenbuterol administration. Why wouldn’t we want to use it for at least 6 weeks, considering the fact that it seems to have some profound effects during later administration. A “second wind” so to speak (get it? “second wind”? it’s an asthma med! Ha! Ok…moving along…).

One of the primary drawbacks of Clenbuterol is that after a couple of weeks, it seems to stop working for most people. This is because it can cause a downregulation of pulmonary, cardiac and central nervous system beta-adrenergic receptors(4). This is why it seems to stop burning fat for most people at that point. To counteract this, you can take some Ketotifen, Benadryl, or Periactim every 3rd or 4th week that you remain on Clenbuterol. These are prescription anti-histimines, so they’ll make you drowsy (take before bedtime).

Also, bear in mind that clen isn’t great for your heart, and can cause some issues there (enlargement of ventricles, etc…) but most studies showing Clen to cause heart problems are with animals, and even though the dosing is almost similar to what humans take (in some studies its within range of what would be double of a large human dose...). Again, it’s important to remember that animals have more beta-2 receptors and they cause certain event chains that humans’ beta-2 receptors may not, due to their relatively high concentrations. Clen causes cardiac hypertrophy to some degree, in some cases and even dose-dependent apoptotic and necrotic myocyte death (5). And since Clen depletes taurine (6) as do most if not all beta-agonists, you may want to supplement your Clen use with some Taurine.

One of the weirdest things about Clenbuterol is that even though it’s an asthma medication, studies have shown reduced exercise (cardiovascular) performance with Clen (7), but some also show that Clen can alleviate exercise induced asthma (8)!

Clenbuterol is one of the easiest drugs to find proper dosing for, and I’ve always made the same recommendations as to finding the appropriate dose for you. Basically, start with 20mcgs upon rising. If the side effects (possible anxiety, and shaking or sweating) aren’t too pronounced, then repeat that same dose again later in the day, and then once again in that day (again, if you find you can tolerate the effects). If you start experiencing intolerable sides, then decrease the does to where it’s tolerable. If not, then start increasing the dose more, very gradually.

Don’t go over 200mcgs, though…and keep your Blood Pressure at (or under) 140/90. If your Blood Pressure goes over that, reduce your dose. If side effects are intolerable, decrease your dose.

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Ciproxin 500mg by Bayer

Ciproxin 500mg by Bayer

Product Description
Generic Name:

 Ciprofloxacin

 WHAT CIPROXIN IS AND WHAT IT IS USED FOR:

Ciproxin is an antibiotic belonging to the fluoroquinolone family. The active substance is ciprofloxacin. Ciprofloxacin works by killing bacteria that cause infections. It only works with specific strains of bacteria.

For Adults:

Ciproxin is used in adults to treat the following bacterial infections:

respiratory tract infections
long lasting or recurring ear or sinus infections
urinary tract infections
infections of the testicles
genital organ infections in women
gastro-intestinal tract infections and intra-abdominal infections
skin and soft tissue infections
bone and joint infections
to treat infections in patients with a very low white blood cell count (neutropenia)
to prevent infections in patients with a very low white blood cell count (neutropenia)
to prevent infections due to the bacterium Neisseria meningitidis
anthrax inhalation exposure
If you have a severe infection or one that is caused by more than one type of bacterium, you may be given additional antibiotic treatment in addition to Ciproxin.

For Children and adolescents:

Ciproxin is used in children and adolescents, under specialist medical supervision, to treat the following bacterial infections:

lung and bronchial infections in children and adolescents suffering from cystic fibrosis
complicated urinary tract infections, including infections that have reached the kidneys (pyelonephritis)
anthrax inhalation exposure
Ciproxin may also be used to treat other specific severe infections in children and adolescents when your doctor considered this necessary.

BEFORE YOU TAKE CIPROXIN:
Do not take Ciproxin if you are:
allergic (hypersensitive) to the active substance, to other quinolone drugs or to any of the other ingredients of Ciproxin (see section 6)
taking tizanidine (see Section 2: Taking other medicines)
Take special care with Ciproxin:
Before taking Ciproxin:

Tell your doctor if you:

have ever had kidney problems because your treatment may need to be adjusted
suffer from epilepsy or other neurological conditions
have a history of tendon problems during previous treatment with antibiotics such as Ciproxin
have myasthenia gravis (a type of muscle weakness)
have a history of abnormal heart rhythms (arrythmias)
While taking Ciproxin:

Tell your doctor immediately, if any of the following occurs while taking Ciproxin. Your doctor will decide whether treatment with Ciproxin needs to be stopped.

Severe, sudden allergic reaction (an anaphylactic reaction/shock, angio-oedema). Even with the first dose, there is a small chance that you may experience a severe allergic reaction with the following symptoms: tightness in the chest, feeling dizzy, sick or faint, or experiencing dizziness when standing up. If this happens, stop taking Ciproxin and contact your doctor immediately.
Pain and swelling in the joints and tendinitis may occur occasionally, particularly if you are elderly and are also being treated with corticosteroids. At the first sign of any pain or inflammation stop taking Ciproxin and rest the painful area. Avoid any unnecessary exercise, as this might increase the risk of a tendon rupture.
If you suffer from epilepsy or other neurological conditions such as cerebral ischemia or stroke, you may experience side effects associated with the central nervous system. If this happens, stop taking Ciproxin and contact your doctor immediately.
You may experience psychiatric reactions the first time you take Ciproxin. If you suffer from depression or psychosis, your symptoms may become worse under treatment with Ciproxin. If this happens, stop taking Ciproxin and contact your doctor immediately.
You may experience symptoms of neuropathy such as pain, burning, tingling, numbness and/or weakness. If this happens, stop taking Ciproxin and contact your doctor immediately.
Diarrhoea may develop while you are taking antibiotics, including Ciproxin, or even several weeks after you have stopped taking them. If it becomes severe or persistent or you notice that your stool contains blood or mucus, stop taking Ciproxin immediately, as this can be life-threatening. Do not take medicines that stop or slow down bowel movements and contact your doctor.
Tell the doctor or laboratory staff that you are taking Ciproxin if you have to provide a blood or urine sample.
Ciproxin may cause liver damage. If you notice any symptoms such as loss of appetite, jaundice (yellowing of the skin), dark urine, itching, or tenderness of the stomach, stop taking Ciproxin and contact your doctor immediately.
Ciproxin may cause a reduction in the number of white blood cells and your resistance to infection may be decreased. If you experience an infection with symptoms such as fever and serious deterioration of your general condition, or fever with local infection symptoms such as sore throat/pharynx/mouth or urinary problems you should see your doctor immediately. A blood test will be taken to check possible reduction of white blood cells (agranulocytosis). It is important to inform your doctor about your medicine.
Tell your doctor if you or a member of your family is known to have a deficiency in glucose-6-phosphate dehydrogenase (G6PD), since you may experience a risk of anemia with ciprofloxacin.
Your skin becomes more sensitive to sunlight or ultraviolet (UV) light when taking Ciproxin. Avoid exposure to strong sunlight, or artificial UV light such as sunbeds.
Taking other medicines:
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including any that you obtained without a prescription.

Do not take Ciproxin together with tizanidine, because this may cause side effects such as low blood pressure and sleepiness (see Section 2: "Do not take Ciproxin").

The following medicines are known to interact with Ciproxin in your body. Taking Ciproxin together with these medicines can influence the therapeutic effect of those medicines. It can also increase the probability of experiencing side effects.

Tell your doctor if you are taking:

warfarin or other oral anti-coagulants (to thin the blood)
probenecid (for gout)
methotrexate (for certain types of cancer, psoriasis, rheumatoid arthritis)
theophylline (for breathing problems)
tizanidine (for muscle spasticity in multiple sclerosis)
clozapine (an antipsychotic)
ropinirole (for Parkinson’s disease)
phenytoin (for epilepsy)
Ciproxin may increase the levels of the following medicines in your blood:

pentoxifylline (for circulatory disorders)
caffeine
Some medicines reduce the effect of Ciproxin. Tell your doctor if you take or wish to take:

antacids
mineral supplements
sucralfate
a polymeric phosphate binder (e.g. sevelamer)
medicines or supplements containing calcium, magnesium, aluminium or iron
If these preparations are essential, take Ciproxin about two hours before or no sooner than four hours after them.

Taking Ciproxin with food and drink:
Unless you take Ciproxin during meals, do not eat or drink any dairy products (such as milk or yoghurt) or drinks with added calcium when you take the tablets, as they may affect the absorption of the active substance.

Pregnancy and breast-feeding:
It is preferable to avoid the use of Ciproxin during pregnancy. Tell your doctor if you are planning to get pregnant.

Do not take Ciproxin during breast feeding because ciprofloxacin is excreted in breast milk and can be harmful for your child.

Driving and using machines:
Ciproxin may make you feel less alert. Some neurological adverse events can occur. Therefore, make sure you know how you react to Ciproxin before driving a vehicle or operating machinery. If in doubt, talk to your doctor.

HOW TO TAKE CIPROXIN:
Your doctor will explain to you exactly how much Ciproxin you will have to take as well as how often and for how long. This will depend on the type of infection you have and how bad it is.

Tell your doctor if you suffer from kidney problems because your dose may need to be adjusted.

The treatment usually lasts from 5 to 21 days, but may take longer for severe infections. Take the tablets exactly as your doctor has told you. Ask your doctor or pharmacist if you are not sure how many tablets to take and how to take Ciproxin.

Swallow the tablets with plenty of fluid. Do not chew the tablets because they do not taste nice.
Do try to take the tablets at around the same time every day.
You can take the tablets at mealtimes or between meals. Any calcium you take as part of a meal will not seriously affect uptake. However, do not take Ciproxin tablets with dairy products such as milk or
yoghurt or with fortified fruit juices (e.g. calcium-fortified orange juice).
Remember to drink plenty of fluids while you are taking Ciproxin.

If you take more Ciproxin than you should:
If you take more than the prescribed dose, get medical help immediately. If possible, take your tablets or the box with you to show the doctor.
If you forget to take Ciproxin:
Take the normal dose as soon as possible and then continue as prescribed. However, if it is almost time for your next dose, do not take the missed dose and continue as usual. Do not take a double dose to make up for a forgotten dose. Be sure to complete your course of treatment.
If you stop taking Ciproxin:
It is important that you finish the course of treatment even if you begin to feel better after a few days. If you stop taking this medicine too soon, your infection may not be completely cured and the symptoms of the infection may return or get worse. You might also develop resistance to the antibiotic.
POSSIBLE SIDE EFFECTS:

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

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, tell your doctor or pharmacist.

Common side effects:

nausea, diarrhoea
joint pains in children
Uncommon side effects:

fungal superinfections
a high concentration of eosinophils, a type of white blood cell
loss of appetite (anorexia)
hyperactivity or agitation
headache, dizziness, sleeping problems, or taste disorders
vomiting, abdominal pain, digestive problems such as stomach upset (indigestion/heartburn), or wind
increased amounts of certain substances in the blood (transaminases and/or bilirubin)
rash, itching, or hives
joint pain in adults
poor kidney function
pains in your muscles and bones, feeling unwell (asthenia), or fever
increase in blood alkaline phosphatase (a certain substance in the blood)
Rare side effects:

inflammation of the bowel (colitis) linked to antibiotic use (can be fatal in very rare cases) (see Section 2: Take special care with Ciproxin)
changes to the blood count (leukopenia, leukocytosis, neutropenia, anaemia), increased or decreased amounts of a blood clotting factor (thrombocytes)
allergic reaction, swelling (oedema), or rapid swelling of the skin and mucous membranes (angio-oedema)
increased blood sugar (hyperglycaemia)
confusion, disorientation, anxiety reactions, strange dreams, depression, or hallucinations
pins and needles, unusual sensitivity to stimuli of the senses, decreased skin sensitivity, tremors, seizures (see Section 2: Take special care with Ciproxin), or giddiness
eyesight problems
tinnitus, loss of hearing, impaired hearing
rapid heartbeat (tachycardia)
expansion of blood vessels (vasodilation), low blood pressure, or fainting
shortness of breath, including asthmatic symptoms
liver disorders, jaundice (cholestatic icterus), or hepatitis
sensitivity to light (see Section 2: Take special care with Ciproxin)
muscle pain, inflammation of the joints, increased muscle tone, or cramp
kidney failure, blood or crystals in the urine (see Section 2: Take special care with Ciproxin), urinary tract inflammation
fluid retention or excessive sweating
abnormal levels of a clotting factor (prothrombin) or increased levels of the enzyme amylase
Very rare side effects:

a special type of reduced red blood cell count (haemolytic anaemia); a dangerous drop in a type of white blood cells (agranulocytosis ); a drop in the number of red and white blood cells and platelets (pancytopenia), which may be fatal; and bone marrow depression, which may also be fatal (see Section 2: Take special care with Ciproxin)
severe allergic reactions (anaphylactic reaction or anaphylactic shock, which can be fatal - serum sickness) (see Section 2: Take special care with Ciproxin)
mental disturbances (psychotic reactions) (see Section 2: Take special care with Ciproxin)
migraine, disturbed coordination, unsteady walk (gait disturbance), disorder of sense of smell (olfactory disorders), pressure on the brain (intracranial pressure)
visual colour distortions
inflammation of the wall of the blood vessels (vasculitis)
pancreatitis
death of liver cells (liver necrosis) very rarely leading to life-threatening liver failure
small, pin-point bleeding under the skin (petechiae); various skin eruptions or rashes (for example, the potentially fatal Stevens-Johnson syndrome or toxic epidermal necrolysis)
muscle weakness, tendon inflammation, tendon rupture – especially of the large tendon at the back of the ankle (Achilles tendon) (see Section 2: Take special care with Ciproxin)
Frequency not known (cannot be estimated from the available data)

troubles associated with the nervous system such as pain, burning, tingling, numbness and/or weakness in extremities
severe cardiac rhythm abnormalities, irregular heart beat (Torsades de Pointes)
HOW TO STORE CIPROXIN:
Keep out of the reach and sight of children.

Do not use Ciproxin after the expiry date, which is stated on the blister and carton after “EXP”: The expiry date refers to the last day of that month.

This medicinal product does not require any special storage conditions.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of any medicines no longer required. These measures will help to protect the environment.

FURTHER INFORMATION:
What Ciproxin contains
The active substance is ciprofloxacin.

Each film-coated tablet contains 500 mg ciprofloxacin (as hydrochloride).

The other ingredients are:

Tablet core:

cellulose microcrystalline, crospovidone, magnesium stearate, maize starch, silica colloidal anhydrous.

Film-coat:

hypromellose, macrogol 4000, titanium dioxide.

Advice/medical education:
Antibiotics are used to cure bacterial infections. They are ineffective against viral infections.

If your doctor has prescribed antibiotics, you need them precisely for your current illness.

Despite antibiotics, some bacteria may survive or grow. This phenomenon is called resistance: some antibiotic treatments become ineffective.

Misuse of antibiotics increases resistance. You may even help bacteria become resistant and therefore delay your cure or decrease antibiotic efficacy if you do not respect appropriate:

dosages
schedules
duration of treatment
Consequently, to preserve the efficacy of this drug:

1 - Use antibiotics only when prescribed.
2 - Strictly follow the prescription.
3 - Do not re-use an antibiotic without medical prescription, even if you want to treat a similar illness.
4 - Never give your antibiotic to another person; maybe it is not adapted to her/his illness.
5 - After completion of treatment, return all unused drugs to your chemist’s shop to ensure they will be disposed of correctly.

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