Humorsol (Demecarium)
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Humorsol (Demecarium)

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

DRUG DESCRIPTION

Ophthalmic Solution HUMORSOL® (Demecarium Bromide) is a sterile solution supplied in two dosage strengths: 0.125 percent and 0.25 percent. The inactive ingredients are sodium chloride and water for injection; benzalkonium chloride 1:5000 is added as preservative. Demecarium bromide is a quaternary ammonium compound with a molecular weight of 716.60. Its chemical name is 3,3'-[1,10-decanediylbis [(methylimino)carbonyloxy]] bis [ N,N,N  -trimethylbenzenaminium] dibromide. Its empirical formula is C 32 H 52 Br 2 N 4 O 4. -

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

INDICATIONS

Open-angle glaucoma (HUMORSOL (demecarium) should be used in glaucoma only when shorter-acting miotics have proved inadequate.)

Conditions obstructing aqueous outflow, such as synechial formation, that are amenable to miotic therapy

Following iridectomy

Accommodative esotropia (accommodative convergent strabismus)

DOSAGE AND ADMINISTRATION

HUMORSOL (demecarium) is intended solely for topical use in the conjunctival sac.

As HUMORSOL (demecarium) is an extremely potent drug, the physician should thoroughly familiarize himself with its use and the technic of instillation.

The required dose is applied in the conjunctival sac, with the patient supine, care being taken not to touch the cornea with the tip of the OCUMETER* ophthalmic dispenser. The patient or person administering the medication should apply continuous gentle pressure on the lacrimal duct with the index finger for several seconds immediately following instillation of the drops. This is to prevent drainage overflow of solution into the nasal and pharyngeal spaces, which might cause systemic absorption. Wash the hands immediately after administration.

HUMORSOL (demecarium) should not be used more often than directed. Caution is necessary to avoid overdosage.

Initial titration and dosage adjustments with HUMORSOL (demecarium) must be individualized to obtain maximal therapeutic effect. The patient must be closely observed during the initial period. If the response is not adequate within the first 24 hours, other measures should be considered.

Keep frequency of use to a minimum in all patients, but especially in children, to reduce the chance of iris cyst development (see ADVERSE REACTIONS).

Glaucoma

For initial therapy with HUMORSOL (demecarium) (0.125 percent or 0.25 percent) place 1 drop (children) or 1 or 2 drops (adults) in the glaucomatous eye. A decrease in intraocular pressure should occur within a few hours. During this period, keep the patient under supervision and make tonometric examinations at least hourly for 3 or 4 hours to be sure that no immediate rise in pressure occurs (see ADVERSE REACTIONS ).

Duration of effect varies with the individual. The usual dosage can vary from as much as 1 or 2 drops twice a day to as little as 1 or 2 drops twice a week. The 0.125 percent strength used twice a day usually results in smooth control of the physiologic diurnal variation in intraocular pressure. This is probably the preferred dosage for most wide (open) angle glaucoma patients.

Strabismus

Essentially equal visual acuity of both eyes is a prerequisite to the successful treatment of esotropia with HUMORSOL (demecarium) . For initial evaluation it may be used as a diagnostic aid to determine if an accommodative factor exists. This is especially useful preoperatively in young children and in patients with normal hypermetropic refractive errors. One drop is given daily for 2 weeks, then 1 drop every 2 days for 2 to 3 weeks. If the eyes become straighter, an accommodative factor is demonstrated. This technic may supplement or complement standard testing with atropine and trial with glasses for the accommodative factor.

In esotropia uncomplicated by amblyopia or anisometropia, HUMORSOL (demecarium) may be instilled in both eyes, not more than 1 drop at a time every day for 2 to 3 weeks, as too severe a degree of miosis may interfere with vision. Then reduce the dosage to 1 drop every other day for 3 to 4 weeks and reevaluate the patient's status.

HUMORSOL (demecarium) may be continued in a dosage of 1 drop every 2 days to 1 drop twice a week. (The latter dosage may be maintained for several months.) Evaluate the patient's condition every 4 to 12 weeks. If improvement continues, change the schedule to 1 drop once a week and eventually to a trial without medication. However, if after 4 months, control of the condition still requires 1 drop every 2 days, therapy with HUMORSOL (demecarium) should be stopped.

*Registered trademark of MERCK & CO., INC.

HOW SUPPLIED

Sterile Ophthalmic Solution HUMORSOL (demecarium) is a clear, colorless, aqueous solution and is supplied in a 5 mL white, opaque, plastic OCUMETER ophthalmic dispenser with a controlled-drop tip:

No. 3255 0.125 percent solution.

  NDC 0006-3255-03.

No. 3267 0.25 percent solution.

  NDC 0006-3267-03.

Storage

Protect from freezing and excessive heat.

COPYRIGHT © MERCK & CO., INC., 1987

All rights reserved

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

SIDE EFFECTS

Stinging, burning, lacrimation, lid muscle twitching, conjunctival and ciliary redness, brow ache, headache, and induced myopia with visual blurring may occur.

Activation of latent iritis or uveitis may occur.

As with all miotic therapy, retinal detachment has been reported occasionally.

Iris cysts may form, enlarge, and obscure vision. Occurrence is more frequent in children. The iris cyst usually shrinks upon discontinuance of the miotic. Rarely, the cyst may rupture or break free into the aqueous. Frequent examination for this occurrence is advised.

Lens opacities have been reported in patients on miotic therapy. Routine slit-lamp examinations, including the lens, should accompany prolonged use.

Paradoxical increase in intraocular pressure may follow anticholinesterase instillation. This may be alleviated by pupil-dilating medication.

Prolonged use may cause conjunctival thickening and obstruction of nasolacrimal canals.

Systemic effects, which occur rarely, are suggestive of increased cholinergic activity. Such effects may include nausea, vomiting, abdominal cramps, diarrhea, urinary incontinence, salivation, sweating, difficulty in breathing, bradycardia, or cardiac irregularities. Medical management of systemic effects may be indicated (see TREATMENT OF ADVERSE EFFECTS ).

TREATMENT OF ADVERSE EFFECTS

If HUMORSOL (demecarium) is taken systemically by accident, or if systemic effects occur after topical application in the eye or from accidental skin contact, administer atropine sulfate parenterally (intravenously if necessary) in a dose (for adults) of 0.4 to 0.6 mg or more. The recommended dosage of atropine in infants and children up to 12 years of age is 0.01 mg/kg repeated every two hours as needed until the desired effect is obtained, or adverse effects of atropine preclude further usage. The maximum single dose should not exceed 0.4 mg.

The use of much larger doses of atropine in treating anticholinesterase intoxication in adults has been reported in the literature. Initially 2 to 6 mg may be given followed by 2 mg every hour or more often, as long as muscarinic effects continue. The greater possibility of atropinization with large doses, particularly in sensitive individuals, should be borne in mind.

Pralidoxime** chloride has been reported to be useful in treating systemic effects due to cholinesterase inhibitors. However, its use is recommended in addition to and not as substitute for atropine.

A short-acting barbiturate is indicated if convulsions occur that are not entirely relieved by atropine. Barbiturate dosage should be carefully adjusted to avoid central respiratory depression. Marked weakness or paralysis of muscles of respiration should be treated promptly by artificial respiration and maintenance of a clear airway.

The oral LD 50 of HUMORSOL (demecarium) is 2.96 mg/kg in the mouse.

**PROTOPAM® Chloride (Pralidoxime Chloride). Ayerst Laboratories

Read the Humorsol (demecarium) Side Effects Center for a complete guide to possible side effects »

DRUG INTERACTIONS

See WARNINGS regarding possible drug interactions of HUMORSOL (demecarium) with succinylcholine or with other anticholinesterase agents.

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

WARNINGS

In patients receiving cholinesterase inhibitors such as HUMORSOL (demecarium) , succinylcholine should be administered with extreme caution before and during general anesthesia.

Because of possible adverse additive effects, HUMORSOL (demecarium) should be administered only with extreme caution to patients with myasthenia gravis who are receiving systemic anticholinesterase therapy; conversely, extreme caution should be exercised in the use of an anticholinesterase drug for the treatment of myasthenia gravis patients who are already undergoing topical therapy with cholinesterase inhibitors.

PRECAUTIONS

General

Gonioscopy is recommended prior to medication with HUMORSOL (demecarium) .

HUMORSOL (demecarium) should be used with caution in patients with chronic angle-closure (narrow-angle) glaucoma or in patients with narrow angles, because of the possibility of producing pupillary block and increasing angle blockage.

When an intraocular inflammatory process is present, the intensity and persistence of miosis and ciliary muscle contraction that result from anticholinesterase therapy require abstention from, or cautious use of, HUMORSOL (demecarium) .

Systemic effects are infrequent when HUMORSOL (demecarium) is instilled carefully. Compression of the lacrimal duct for several seconds immediately following instillation minimizes drainage into the nasal chamber with its extensive absorption surface. Wash the hands immediately after instillation.

Discontinue HUMORSOL (demecarium) if salivation, urinary incontinence, diarrhea, profuse sweating, muscle weakness, respiratory difficulties, shock, or cardiac irregularities occur.

Persons receiving cholinesterase inhibitors who are exposed to organophosphate-type insecticides and pesticides (gardeners, organophosphate plant or warehouse workers, farmers, residents of communities which are undergoing insecticide spraying or dusting, etc.) should be warned of the added systemic effects possible from absorption through the respiratory tract or skin. Wearing of respiratory masks, frequent washing, and clothing changes may be advisable.

Anticholinesterase drugs should be used with extreme caution, if at all, in patients with marked vagotonia, bronchial asthma, spastic gastrointesinal disturbances, peptic ulcer, pronounced bradycardia and hypotension, recent myocardial infarction, epilepsy, parkinsonism, and other disorders that may respond adversely to vagotonic effects.

After long-term use of HUMORSOL (demecarium) , dilation of blood vessels and resulting greater permeability increase the possibility of hyphema during ophthalmic surgery. Therefore, this drug should be discontinued before surgery.

Despite observance of all precautions and the use of only the recommended dose, there is some evidence that repeated administration may cause depression of the concentration of cholinesterase in the serum and erythrocytes, with resultant systemic effects.

There have been reports of bacterial keratitis associated with the use of multiple dose containers of topical ophthalmic products. These containers had been inadvertently contaminated by patients who, in most cases, had a concurrent corneal disease or a disruption of the ocular epithelial surface. (See

PRECAUTIONS

, Information for Patients . )

Information for Patients

Patients should be instructed to avoid allowing the tip of the dispensing container to contact the eye or surrounding structures.

Patients should also be instructed that ocular solutions, if handled improperly, can become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions. (See

PRECAUTIONS

, General . )

Patients should also be advised that if they develop an intercurrent ocular condition (e.g., trauma, ocular surgery or infection), they should immediately seek their physician's advice concerning the continued use of the present multidose container.

The preservative in HUMORSOL (demecarium) , benzalkonium chloride, may be absorbed by soft contact lenses. Patients wearing soft contact lenses should be instructed to wait at least 15 minutes after instilling HUMORSOL (demecarium) before they insert their lenses.

 

Drug Interactions

See

WARNINGS

regarding possible drug interactions of HUMORSOL (demecarium) with succinylcholine or with other anticholinesterase agents.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term studies in animals have not been performed to evaluate the effects of HUMORSOL (demecarium) on fertility or carcinogenic potential.

Pregnancy

Pregnancy Category X:   See CONTRAINDICATIONS.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from HUMORSOL (demecarium) , a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

The occurrence of iris cysts is more frequent in pediatric patients. (See ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION.)

Extreme caution should be exercised in pediatric patients receiving HUMORSOL (demecarium) who may require general anesthesia (see

WARNINGS

).

Since HUMORSOL (demecarium) is a potent cholinesterase inhibitor it should be kept out of the reach of children.

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

OVERDOSE

No Information Provided.

CONTRAINDICATIONS

Hypersensitivity to any component of this product.

Because of the toxicity of cholinesterase inhibitors in general, HUMORSOL (demecarium) is contraindicated in women who are or who may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.

Because miotics may aggravate inflammation, HUMORSOL (demecarium) should not be used in active uveal inflammation and/or glaucoma associated with iridocyclitis.

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

CLINICAL PHARMACOLOGY

HUMORSOL (demecarium) is a cholinesterase inhibitor with sustained activity. It acts mainly on true (erythrocyte) cholinesterase. Application of HUMORSOL (demecarium) to the eye produces intense miosis and ciliary muscle contraction due to inhibition of cholinesterase, allowing acetylcholine to accumulate at sites of cholinergic transmission. These effects are accompanied by increased capillary permeability of the ciliary body and iris, increased permeability of the blood-aqueous barrier, and vasodilation. Myopia may be induced or, if present, may be augmented by the increased refractive power of the lens that results from the accommodative effect of the drug. HUMORSOL (demecarium) indirectly produces some of the muscarinic and nicotinic effects of acetylcholine as quantities of the latter accumulate.

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

PATIENT INFORMATION

Patients should be instructed to avoid allowing the tip of the dispensing container to contact the eye or surrounding structures.

Patients should also be instructed that ocular solutions, if handled improperly, can become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions. (See PRECAUTIONS, General . )

Patients should also be advised that if they develop an intercurrent ocular condition (e.g., trauma, ocular surgery or infection), they should immediately seek their physician's advice concerning the continued use of the present multidose container.

The preservative in HUMORSOL (demecarium) , benzalkonium chloride, may be absorbed by soft contact lenses. Patients wearing soft contact lenses should be instructed to wait at least 15 minutes after instilling HUMORSOL (demecarium) before they insert their lenses.

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

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Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

PATIENT INFORMATION

Patients should be instructed to avoid allowing the tip of the dispensing container to contact the eye or surrounding structures.

Patients should also be instructed that ocular solutions, if handled improperly, can become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions. (See PRECAUTIONS, General . )

Patients should also be advised that if they develop an intercurrent ocular condition (e.g., trauma, ocular surgery or infection), they should immediately seek their physician's advice concerning the continued use of the present multidose container.

The preservative in HUMORSOL (demecarium) , benzalkonium chloride, may be absorbed by soft contact lenses. Patients wearing soft contact lenses should be instructed to wait at least 15 minutes after instilling HUMORSOL (demecarium) before they insert their lenses.

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

Humorsol Patient Information Including Side Effects

Brand Names: Humorsol Ocumeter

Generic Name: demecarium bromide ophthalmic (Pronunciation: deh meh KARE ee um)

What is demecarium bromide ophthalmic (Humorsol)?

Demecarium bromide ophthalmic reduces pressure in the eye by increasing the amount of fluid that drains from the eye. Demecarium bromide ophthalmic also causes the pupil to become smaller and reduces its response to light or dark conditions.

Demecarium bromide ophthalmic is used to treat glaucoma by lowering the pressure inside the eye. Demecarium bromide ophthalmic is also used for other conditions that require increased fluid outflow from the eye, after surgical iridectomy, and for certain eye disorders involving eye accommodation (focusing).

Demecarium bromide ophthalmic may also be used for purposes other than those listed in this medication guide.

What are the possible side effects of demecarium bromide ophthalmic (Humorsol)?

Contact your doctor immediately if you notice any decrease in vision or an increase in "floaters" in your visual field. Rarely, demecarium bromide ophthalmic may cause retinal detachment. Retinal detachment can lead to blind spots, floaters in the visual field, and even blindness. Your doctor will want to check your retina before you use this medication to determine if you have an increased risk of retinal detachment.

If you experience any of the following serious side effects, stop using demecarium bromide ophthalmic and seek emergency medical attention or contact your doctor immediately:

  • an allergic reaction (shortness of breath; closing of the throat; swelling of the lips, face, or tongue; or hives);
  • abdominal cramps or diarrhea;
  • watering mouth;
  • excessive sweating;
  • urinary incontinence;
  • muscle weakness;
  • difficulty breathing; or
  • an irregular heart beat.

Other, less serious side effects may be more likely to occur. Continue to use demecarium bromide ophthalmic and talk to your doctor if you experience

  • burning, stinging, red, or tearing eyes;
  • eyelid muscle twitches;
  • headache or brow ache; or
  • decreased vision in poor light.

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

Read the Humorsol (demecarium) Side Effects Center for a complete guide to possible side effects »

What is the most important information I should know about demecarium bromide ophthalmic (Humorsol)?

Contact your doctor immediately if you notice any decrease in vision or an increase in "floaters" in your visual field. Rarely, demecarium bromide ophthalmic may cause retinal detachment. Retinal detachment can lead to blind spots, floaters in the visual field, and even blindness. Your doctor will want to check your retina before you use this medication to determine if you have an increased risk of retinal detachment.

Do not touch the dropper to any surface, including the eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in the eye.

Apply light pressure to the inside corner of the eye (near the nose) after each application to prevent the medicine from draining down the tear duct.

Use caution when driving, operating machinery, or performing other hazardous activities. Demecarium bromide ophthalmic may cause decreased vision at night. If you experience decreased vision, avoid these activities.

Side Effects Centers

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

Humorsol Patient Information including How Should I Take

What should I discuss with my healthcare provider before using demecarium bromide ophthalmic (Humorsol)?

Rarely, demecarium bromide ophthalmic may cause retinal detachment. Tell your doctor if you have any type of retinal disease, if you have had a retinal tear, if you are nearsighted, or if you have had cataract surgery. These conditions may increase the risk of retinal detachment.

Before using this medication, tell your doctor if you

  • have heart failure,
  • have high or low blood pressure,
  • have ever had a heart attack,
  • have asthma,
  • have a stomach ulcer or stomach spasms,
  • have epilepsy,
  • have hyperthyroidism (an overactive thyroid),
  • have blockage of your urinary tract or difficulty urinating, or
  • have Parkinson's disease.

You may not be able to use demecarium bromide ophthalmic, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

If you wear contact lenses, remove them before applying demecarium bromide ophthalmic. Ask your doctor if contact lenses can be reinserted after application of the medication.

Demecarium bromide ophthalmic is in the FDA pregnancy category X. This means that it is known to cause birth defects in an unborn baby. Do not use demecarium bromide ophthalmic if you are pregnant or could become pregnant during treatment.

It is not known whether demecarium bromide passes into breast milk. Do not use demecarium bromide ophthalmic without first talking to your doctor if you are breast-feeding a baby.

How should I use demecarium bromide ophthalmic (Humorsol)?

Use demecarium bromide ophthalmic eye drops exactly as directed by your doctor. If you do not understand the instructions, ask your doctor, pharmacist, or nurse to explain them to you.

Wash your hands immediately before using the eye drops.

If you wear contact lenses, remove them before applying demecarium bromide ophthalmic. Ask your doctor if contact lenses can be reinserted after application of the medication.

To apply the eye drops:

  • Tilt the head back slightly and pull down on the lower eyelid. Position the dropper above the eye. Look up and away from the dropper. Squeeze out a drop and close the eye. Apply gentle pressure to the inside corner of the eye (near the nose) for about 1 minute to prevent the liquid from draining down the tear duct. If you are using more than one drop in the same eye, repeat the process with about 5 minutes between drops. If you are using drops in both eyes, repeat the process in the other eye.

Do not touch the dropper to any surface, including the eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in the eye.

Do not use any eyedrop that is discolored or has particles in it.

Store demecarium bromide ophthalmic at room temperature away from moisture and heat. Keep the bottle properly capped.

Side Effects Centers

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

Humorsol Patient Information including If I Miss a Dose

What happens if I miss a dose (Humorsol)?

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

What happens if I overdose (Humorsol)?

Flush the eye with water and seek emergency medical attention.

Symptoms of a demecarium bromide ophthalmic overdose may include sweating, nausea, vomiting, diarrhea, watering mouth, tearing eyes, fainting, difficulty breathing, and an irregular heartbeat.

What should I avoid while using demecarium bromide ophthalmic (Humorsol)?

Use caution when driving, operating machinery, or performing other hazardous activities. Demecarium bromide ophthalmic may cause decreased vision at night. If you experience decreased vision, avoid these activities.

Do not touch the dropper to any surface, including the eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in the eye.

If you wear contact lenses, remove them before applying demecarium bromide ophthalmic. Ask your doctor if contact lenses can be reinserted after application of the medication.

Do not use other eye medications during treatment with demecarium bromide ophthalmic except under the direction of your doctor.

What other drugs will affect demecarium bromide ophthalmic (Humorsol)?

Do not use other eye medications during treatment with demecarium bromide ophthalmic except under the direction of your doctor.

Organophosphates may increase the effects of demecarium bromide ophthalmic. If you are a gardener, an organophosphate plant or warehouse worker, or a farmer, you may be exposed to organophosphates. Follow the directions of your doctor and workplace safety guides regarding respiratory masks and the washing and changing of clothes.

Drugs other than those listed here may also interact with demecarium bromide ophthalmic. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

Where can I get more information?

Your pharmacist has additional information about demecarium bromide ophthalmic written for health professionals that you may read.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2009 Cerner Multum, Inc. Version: 3.01. Revision date: 1/30/04.

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