Acenac

Acenac may be available in the countries listed below.

Ingredient matches for Acenac

Aceclofenac

Aceclofenac is reported as an ingredient of Acenac in the following countries:

• Bangladesh

International Drug Name Search

Bicillin L-A

Generic Name: penicillin (Oral route, Injection route, Intravenous route, Intramuscular route)

Commonly used brand name(s)

In the U.S.

• Amoxil


• Bactocill


• Bicillin L-A


• Cloxapen


• Crysticillin


• Dynapen


• Geocillin


• Nafcil


• Pfizerpen


• Pipracil


• Principen


• Staphcillin


• Ticar


• Veetids

In Canada

• Amoxil Pediatric


• Ampicillin Sodium


• Apo-Amoxi


• Apo-Amoxi Sugar-Free


• Apo-Cloxi


• Apo-Pen-Vk


• Gen-Amoxicillin


• Med Amoxicillin


• Nadopen V 200


• Nadopen V 400


• Novamoxin

Available Dosage Forms:

• Powder for Suspension


• Tablet


• Tablet, Chewable


• Tablet for Suspension


• Tablet, Extended Release


• Capsule


• Powder for Solution


• Suspension


• Solution


• Syrup

Uses For Bicillin L-A

Penicillins are used to treat infections caused by bacteria. They work by killing the bacteria or preventing their growth.

There are several different kinds of penicillins. Each is used to treat different kinds of infections. One kind of penicillin usually may not be used in place of another. In addition, penicillins are used to treat bacterial infections in many different parts of the body. They are sometimes given with other antibacterial medicines (antibiotics). Some of the penicillins may also be used for other problems as determined by your doctor. However, none of the penicillins will work for colds, flu, or other virus infections.

Penicillins are available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, penicillins are used in certain patients with the following medical conditions:

• Chlamydia infections in pregnant women—Amoxicillin and ampicillin


• Gas gangrene—Penicillin G


• Helicobacter pylori-associated gastritis or peptic ulcer disease—Amoxicillin


• Leptospirosis—Ampicillin and penicillin G


• Lyme disease—Amoxicillin and penicillin V


• Typhoid fever—Amoxicillin and ampicillin

Before Using Bicillin L-A

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Many penicillins have been used in children and, in effective doses, are not expected to cause different side effects or problems in children than they do in adults.

Some strengths of the chewable tablets of amoxicillin contain aspartame, which is changed by the body to phenylalanine, a substance that is harmful to patients with phenylketonuria.

Geriatric

Penicillins have been used in the elderly and have not been shown to cause different side effects or problems in older people than they do in younger adults.

Pregnancy

Penicillins have not been studied in pregnant women. However, penicillins have been widely used in pregnant women and have not been shown to cause birth defects or other problems in animal studies.

Breast Feeding

Penicillins pass into the breast milk. Even though only small amounts may pass into breast milk, allergic reactions, diarrhea, fungus infections, and skin rash may occur in nursing babies.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Cyclosporine


• Methotrexate


• Vecuronium


• Venlafaxine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergy, general (such as asthma, eczema, hay fever, hives), history of—Patients with a history of general allergies may be more likely to have a severe reaction to penicillins

• Bleeding problems, history of—Patients with a history of bleeding problems may be more likely to have bleeding when receiving carbenicillin, piperacillin, or ticarcillin

• Congestive heart failure (CHF) or


• High blood pressure—Large doses of carbenicillin or ticarcillin may make these conditions worse, because these medicines contain a large amount of salt

• Cystic fibrosis—Patients with cystic fibrosis may have an increased chance of fever and skin rash when receiving piperacillin

• Kidney disease—Patients with kidney disease may have an increased chance of side effects

• Mononucleosis (”mono”)—Patients with mononucleosis may have an increased chance of skin rash when receiving ampicillin, bacampicillin, or pivampicillin

• Phenylketonuria—Some strengths of the amoxicillin chewable tablets contain aspartame, which is changed by the body to phenylalanine, a substance that is harmful to patients with phenylketonuria.

• Stomach or intestinal disease, history of (especially colitis, including colitis caused by antibiotics)—Patients with a history of stomach or intestinal disease may be more likely to develop colitis while taking penicillins

Proper Use of penicillin

This section provides information on the proper use of a number of products that contain penicillin. It may not be specific to Bicillin L-A. Please read with care.

Penicillins (except bacampicillin tablets, amoxicillin, penicillin V, pivampicillin, and pivmecillinam) are best taken with a full glass (8 ounces) of water on an empty stomach (either 1 hour before or 2 hours after meals) unless otherwise directed by your doctor.

For patients taking amoxicillin, penicillin V, pivampicillin, and pivmecillinam:

• Amoxicillin, penicillin V, pivampicillin, and pivmecillinam may be taken on a full or empty stomach.


• The liquid form of amoxicillin may also be taken by itself or mixed with formulas, milk, fruit juice, water, ginger ale, or other cold drinks. If mixed with other liquids, take immediately after mixing. Be sure to drink all the liquid to get the full dose of medicine.

For patients taking bacampicillin:

• The liquid form of this medicine is best taken with a full glass (8 ounces) of water on an empty stomach (either 1 hour before or 2 hours after meals) unless otherwise directed by your doctor.


• The tablet form of this medicine may be taken on a full or empty stomach.

For patients taking penicillin G by mouth:

• Do not drink acidic fruit juices (for example, orange or grapefruit juice) or other acidic beverages within 1 hour of taking penicillin G since this may keep the medicine from working properly.

For patients taking the oral liquid form of penicillins:

• This medicine is to be taken by mouth even if it comes in a dropper bottle. If this medicine does not come in a dropper bottle, use a specially marked measuring spoon or other device to measure each dose accurately. The average household teaspoon may not hold the right amount of liquid.


• Do not use after the expiration date on the label. The medicine may not work properly after that date. If you have any questions about this, check with your pharmacist.

For patients taking the chewable tablet form of amoxicillin:

• Tablets should be chewed or crushed before they are swallowed.

To help clear up your infection completely, keep taking this medicine for the full time of treatment, even if you begin to feel better after a few days. If you have a ”strep” infection, you should keep taking this medicine for at least 10 days. This is especially important in ”strep” infections. Serious heart problems could develop later if your infection is not cleared up completely. Also, if you stop taking this medicine too soon, your symptoms may return.

This medicine works best when there is a constant amount in the blood or urine. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times, day and night . For example, if you are to take four doses a day, the doses should be spaced about 6 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your health care professional.

Make certain your health care professional knows if you are on a low-sodium (low-salt) diet. Some of these medicines contain enough sodium to cause problems in some people.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

The number of tablets or teaspoonfuls of suspension that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking a penicillin.

• For amoxicillin:
  
  • For bacterial infections:
    
    • For oral dosage forms (capsules, oral suspension, tablets, and chewable tablets):
      
      • Adults, teenagers, and children weighing more than 40 kilograms (kg) (88 pounds)—250 to 500 milligrams (mg) every eight hours or 500 to 875 mg every twelve hours, depending on the type and severity of the infection.
      
      
      • Neonates and infants up to 3 months of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 15 mg per kg (6.8 mg per pound) of body weight or less every twelve hours.
      
      
      • Infants 3 months of age and older and children weighing up to 40 kg (88 lbs.)—Dose is based on body weight and must be determined by your doctor. The usual dose is 6.7 to 13.3 mg per kg (3 to 6 mg per pound) of body weight every eight hours or 12.5 to 22.5 mg per kg (5.7 to 10.2 mg per pound) of body weight every twelve hours.
        
        • For duodenal ulcers (associated with Helicobacter pylori bacterial infection):
          
          • For oral dosage forms (capsules, oral suspension, tablets, and chewable tablets):
            
            • Adults: 1000 mg twice a day every twelve hours for fourteen days, along with the two other medicines, clarithromycin and lansoprazole, as directed by your doctor.
            
            
            • Teenagers and children: Use and dose must be determined by your doctor.
              
              • For dual medicine therapy—
                
                • Adults: 1000 mg three times a day every eight hours for fourteen days, along with the other medicine, lansoprazole, as directed by your doctor.
                
                
                • Teenagers and children: Use and dose must be determined by your doctor.
                
                
              
              
            
            
          
          
        
        
      
      
    
    
  
  

• For ampicillin:
  
  • For bacterial infections:
    
    • For oral dosage forms (capsules and oral suspension):
      
      • Adults, teenagers, and children weighing more than 20 kilograms (kg) (44 pounds)—250 to 500 milligrams (mg) every six hours.
      
      
      • Infants and children weighing up to 20 kg (44 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 12.5 to 25 mg per kg (5.7 to 11.4 mg per pound) of body weight every six hours; or 16.7 to 33.3 mg per kg (7.6 to 15 mg per pound) of body weight every eight hours.
        
        • For injection dosage form:
          
          • Adults, teenagers, and children weighing more than 20 kg (44 pounds)—250 to 500 mg, injected into a vein or muscle every three to six hours.
          
          
          • Infants and children weighing up to 20 kg (44 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 12.5 mg per kg (5.7 mg per pound) of body weight, injected into a vein or muscle every six hours.
          
          
        
        
      
      
    
    
  
  

• For bacampicillin:
  
  • For bacterial infections:
    
    • For oral dosage forms (oral suspension and tablets):
      
      • Adults, teenagers, and children weighing more than 25 kilograms (kg) (55 pounds)—400 to 800 milligrams (mg) every twelve hours.
      
      
      • Children weighing up to 25 kg (55 pounds)—Bacampicillin tablets are not recommended for use in children weighing up to 25 kg (55 pounds). The dose of the oral suspension is based on body weight and must be determined by your doctor. The usual dose is 12.5 to 25 mg per kg (5.7 to 11.4 mg per pound) of body weight every twelve hours.
      
      
    
    
  
  

• For carbenicillin:
  
  • For bacterial infections:
    
    • For oral dosage form (tablets):
      
      • Adults and teenagers—500 milligrams (mg) to 1 gram every six hours.
      
      
      • Children—Dose must be determined by your doctor.
        
        • For injection dosage form:
          
          • Adults and teenagers—Dose is based on body weight and must be determined by your doctor. The usual dose is 50 to 83.3 mg per kilogram (kg) (22.8 to 37.9 mg per pound) of body weight, injected into a vein or muscle every four hours.
          
          
          • Older infants and children—Dose is based on body weight and must be determined by your doctor. The usual dose is 16.7 to 75 mg per kg (7.6 to 34 mg per pound) of body weight, injected into a vein or muscle every four to six hours.
          
          
        
        
      
      
    
    
  
  

• For cloxacillin:
  
  • For bacterial infections:
    
    • For oral dosage form (capsules and oral solution):
      
      • Adults, teenagers, and children weighing more than 20 kilograms (kg) (44 pounds)—250 to 500 milligrams (mg) every six hours.
      
      
      • Infants and children weighing up to 20 kg (44 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 6.25 to 12.5 mg per kg (2.8 to 5.7 mg per pound) of body weight every six hours.
        
        • For injection dosage form:
          
          • Adults, teenagers, and children weighing more than 20 kg—250 to 500 mg, injected into a vein every six hours.
          
          
          • Infants and children weighing up to 20 kg (44 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 6.25 to 12.5 mg per kg (2.8 to 5.7 mg per pound) of body weight, injected into a vein every six hours.
          
          
        
        
      
      
    
    
  
  

• For dicloxacillin:
  
  • For bacterial infections:
    
    • For oral dosage form (capsules and oral suspension):
      
      • Adults, teenagers, and children weighing more than 40 kilograms (kg) (88 pounds)—125 to 250 milligrams (mg) every six hours.
      
      
      • Infants and children weighing up to 40 kg (88 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 3.1 to 6.2 mg per kg (1.4 to 2.8 mg per pound) of body weight every six hours.
      
      
    
    
  
  

• For flucloxacillin:
  
  • For bacterial infections:
    
    • For oral dosage form (capsules and oral suspension):
      
      • Adults, teenagers, and children more than 12 years of age and weighing more than 40 kilograms (kg) (88 pounds)—250 to 500 milligrams (mg) every six hours.
      
      
      • Children less than 12 years of age and weighing up to 40 kg (88 pounds)—125 to 250 mg every six hours; or 6.25 to 12.5 mg per kg (2.8 to 5.7 mg per pound) of body weight every six hours.
      
      
      • Infants up to 6 months of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 6.25 mg per kg (2.8 mg per pound) of body weight every six hours.
      
      
    
    
  
  

• For methicillin:
  
  • For bacterial infections:
    
    • For injection dosage form:
      
      • Adults, teenagers, and children weighing more than 40 kilograms (kg) (88 pounds)—1 gram injected into a muscle every four to six hours; or 1 gram injected into a vein every six hours.
      
      
      • Children weighing up to 40 kg (88 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 25 milligrams (mg) per kg (11.4 mg per pound) of body weight, injected into a vein or muscle every six hours.
      
      
    
    
  
  

• For mezlocillin:
  
  • For bacterial infections:
    
    • For injection dosage form:
      
      • Adults and teenagers—Dose is based on body weight and must be determined by your doctor. The usual dose is 33.3 to 87.5 milligrams (mg) per kilogram (kg) (15.1 to 39.8 mg per pound) of body weight, injected into a vein or muscle every four to six hours; or 3 to 4 grams every four to six hours.
      
      
      • Infants over 1 month of age and children up to 12 years of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 50 mg per kg (22.7 mg per pound) of body weight, injected into a vein or muscle every four hours.
      
      
    
    
  
  

• For nafcillin:
  
  • For bacterial infections:
    
    • For oral dosage form (capsules and tablets):
      
      • Adults and teenagers—250 milligrams (mg) to 1 gram every four to six hours.
      
      
      • Older infants and children—Dose is based on body weight and must be determined by your doctor. The usual dose is 6.25 to 12.5 mg per kilogram (kg) (2.8 to 5.7 mg per pound) of body weight every six hours.
      
      
      • Newborns—Dose is based on body weight and must be determined by your doctor. The usual dose is 10 mg per kg (4.5 mg per pound) of body weight every six to eight hours.
        
        • For injection dosage form:
          
          • Adults and teenagers—500 mg to 2 grams injected into a vein or muscle every four to six hours.
          
          
          • Infants and children—Dose is based on body weight and must be determined by your doctor. The usual dose is 10 to 25 mg per kg (4.5 to 11.4 mg per pound) of body weight, injected into a muscle every twelve hours; or 10 to 40 mg per kg (4.5 to 18.2 mg per pound) of body weight, injected into a vein every four to eight hours.
          
          
        
        
      
      
    
    
  
  

• For oxacillin:
  
  • For bacterial infections:
    
    • For oral dosage form (capsules and oral solution):
      
      • Adults, teenagers, and children weighing more than 40 kilograms (kg) (88 pounds)—500 milligrams (mg) to 1 gram every four to six hours.
      
      
      • Children weighing up to 40 kg (88 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 12.5 to 25 mg per kg (5.7 to 11.4 mg per pound) of body weight every six hours.
        
        • For injection dosage form:
          
          • Adults, teenagers, and children weighing more than 40 kg (88 pounds)—250 mg to 1 gram injected into a vein or muscle every four to six hours.
          
          
          • Children weighing up to 40 kg (88 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 12.5 to 25 mg per kg (5.7 to 11.4 mg per pound) of body weight, injected into a vein or muscle every four to six hours.
          
          
          • Premature infants and newborns—Dose is based on body weight and must be determined by your doctor. The usual dose is 6.25 mg per kg (2.8 mg per pound) of body weight, injected into a vein or muscle every six hours.
          
          
        
        
      
      
    
    
  
  

• For penicillin G:
  
  • For bacterial infections:
    
    • For oral dosage form (oral solution, oral suspension, and tablets):
      
      • Adults and teenagers—200,000 to 500,000 Units (125 to 312 milligrams [mg]) every four to six hours.
      
      
      • Infants and children less than 12 years of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 4167 to 30,000 Units per kilogram (kg) (189 to 13,636 Units per pound) of body weight every four to eight hours.
        
        • For benzathine injection dosage form:
          
          • Adults and teenagers—1,200,000 to 2,400,000 Units injected into a muscle as a single dose.
          
          
          • Infants and children—300,000 to 1,200,000 Units injected into a muscle as a single dose; or 50,000 Units per kg (22,727 Units per pound) of body weight injected into a muscle as a single dose.
            
            • For injection dosage forms (potassium and sodium salts):
              
              • Adults and teenagers—1,000,000 to 5,000,000 Units, injected into a vein or muscle every four to six hours.
              
              
              • Older infants and children—Dose is based on body weight and must be determined by your doctor. The usual dose is 8333 to 25,000 Units per kg (3788 to 11,363 Units per pound) of body weight, injected into a vein or muscle every four to six hours.
              
              
              • Premature infants and newborns—Dose is based on body weight and must be determined by your doctor. The usual dose is 30,000 Units per kg (13,636 Units per pound) of body weight, injected into a vein or muscle every twelve hours.
                
                • For procaine injection dosage form:
                  
                  • Adults and teenagers—600,000 to 1,200,000 Units injected into a muscle once a day.
                  
                  
                  • Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 50,000 Units per kg (22,727 Units per pound) of body weight, injected into a muscle once a day.
                  
                  
                
                
              
              
            
            
          
          
        
        
      
      
    
    
  
  

• For penicillin V:
  
  • For bacterial infections:
    
    • For the benzathine salt oral dosage form (oral solution):
      
      • Adults and teenagers—200,000 to 500,000 Units every six to eight hours.
      
      
      • Children—100,000 to 250,000 Units every six to eight hours.
        
        • For the potassium salt oral dosage forms (oral solution, oral suspension, and tablets):
          
          • Adults and teenagers—125 to 500 milligrams (mg) every six to eight hours.
          
          
          • Children—Dose is based on body weight and must be determined by your doctor. The usual dose is 2.5 to 16.7 mg per kilogram (kg) (1.1 to 7.6 mg per pound) of body weight every four to eight hours.
          
          
        
        
      
      
    
    
  
  

• For piperacillin:
  
  • For bacterial infections:
    
    • For injection dosage form:
      
      • Adults and teenagers—3 to 4 grams, injected into a vein or muscle every four to six hours.
      
      
      • Infants and children—Dose must be determined by your doctor.
      
      
    
    
  
  

• For pivampicillin:
  
  • For bacterial infections:
    
    • For oral dosage form (oral suspension):
      
      • Adults, teenagers, and children 10 years of age and older—525 to 1050 milligrams (mg) two times a day.
      
      
      • Children 7 to 10 years of age—350 mg two times a day.
      
      
      • Children 4 to 6 years of age—262.5 mg two times a day.
      
      
      • Children 1 to 3 years of age—175 mg two times a day.
      
      
      • Infants 3 to 12 months of age—Dose is based on body weight and must be determined by your doctor. The usual dose is 20 to 30 mg per kilogram (kg) (9.1 to 13.6 mg per pound) of body weight two times a day.
        
        • For oral dosage form (tablets):
          
          • Adults, teenagers, and children 10 years of age and older—500 mg to 1 gram two times a day.
          
          
          • Children up to 10 years of age—Dose must be determined by your doctor.
          
          
        
        
      
      
    
    
  
  

• For pivmecillinam:
  
  • For bacterial infections:
    
    • For oral dosage form (tablets):
      
      • Adults, teenagers, and children weighing more than 40 kilograms (kg) (88 pounds)—200 milligrams (mg) two to four times a day for three days.
      
      
      • Children up to 40 kg (88 pounds)—Dose must be determined by your doctor.
      
      
    
    
  
  

• For ticarcillin:
  
  • For bacterial infections:
    
    • For injection dosage form:
      
      • Adults, teenagers, and children weighing more than 40 kilograms (kg) (88 pounds)—3 grams injected into a vein every four hours; or 4 grams injected into a vein every six hours.
      
      
      • Children up to 40 kg (88 pounds)—Dose is based on body weight and must be determined by your doctor. The usual dose is 33.3 to 75 milligrams (mg) per kg (15 to 34 mg per pound) of body weight, injected into a vein every four to six hours.
      
      
    
    
  
  

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Bicillin L-A

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

Penicillins may cause diarrhea in some patients.

• Check with your doctor if severe diarrhea occurs. Severe diarrhea may be a sign of a serious side effect. Do not take any diarrhea medicine without first checking with your doctor. Diarrhea medicines may make your diarrhea worse or make it last longer.


• For mild diarrhea, diarrhea medicine containing kaolin or attapulgite (e.g., Kaopectate tablets, Diasorb) may be taken. However, other kinds of diarrhea medicine should not be taken. They may make your diarrhea worse or make it last longer.


• If you have any questions about this or if mild diarrhea continues or gets worse, check with your health care professional.

Oral contraceptives (birth control pills) containing estrogen may not work properly if you take them while you are taking ampicillin, amoxicillin, or penicillin V. Unplanned pregnancies may occur. You should use a different or additional means of birth control while you are taking any of these penicillins. If you have any questions about this, check with your health care professional.

For diabetic patients:

• Penicillins may cause false test results with some urine sugar tests. Check with your doctor before changing your diet or the dosage of your diabetes medicine.

Before you have any medical tests, tell the doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.

Bicillin L-A Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Stop taking this medicine and get emergency help immediately if any of the following effects occur:

Less common

• Fast or irregular breathing


• fever


• joint pain


• lightheadedness or fainting (sudden)


• puffiness or swelling around the face


• red, scaly skin


• shortness of breath


• skin rash, hives, itching

Check with your doctor immediately if any of the following side effects occur:

Rare

• Abdominal or stomach cramps and pain (severe)


• abdominal tenderness


• convulsions (seizures)


• decreased amount of urine


• diarrhea (watery and severe), which may also be bloody


• mental depression


• nausea and vomiting


• pain at place of injection


• sore throat and fever


• unusual bleeding or bruising


• yellow eyes or skin

Rare - For penicillin G procaine only

• Agitation or combativeness


• anxiety


• confusion


• fear of impending death


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

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Diarrhea (mild)


• headache


• sore mouth or tongue


• vaginal itching and discharge


• white patches in the mouth and/or on the tongue

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Bicillin L-A side effects (in more detail)

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More Bicillin L-A resources

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

• Bicillin L-A Suspension MedFacts Consumer Leaflet (Wolters Kluwer)


• Bicillin L-A Concise Consumer Information (Cerner Multum)


• Penicillin G Benzathine/Potassium/Sodium Monograph (AHFS DI)

Compare Bicillin L-A with other medications

• Actinomycosis
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• Anthrax Prophylaxis
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• Bacterial Infection
• Clostridial Infection
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• Cutaneous Bacillus anthracis
• Deep Neck Infection
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• Lyme Disease, Arthritis
• Lyme Disease, Carditis
• Lyme Disease, Erythema Chronicum Migrans
• Lyme Disease, Neurologic
• Meningitis
• Meningitis, Meningococcal
• Meningitis, Pneumococcal
• Neurosyphilis
• Otitis Media
• Pneumonia
• Prevention of Perinatal Group B Streptococcal Disease
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• Syphilis, Latent
• Tertiary Syphilis
• Tonsillitis/Pharyngitis
• Upper Respiratory Tract Infection

Botulinum Toxin Type A

Class: Other Miscellaneous Therapeutic Agents
Brands: Botox

Special Alerts:

[UPDATED 08/03/2009] FDA notified healthcare professionals of changes to the established drug names for botulinum toxin Type A (Botox/Botox Cosmetic, Dysport) and botulinum toxin Type B (Myobloc) to reinforce individual potencies and prevent medication errors, and provided recommendations for healthcare professionals to consider, plus information for patients, family members, and caregivers. For more information visit the FDA website at: and .

The marketed trade names and the product formulations have not changed.

Summary of FDA-Approved Botulinum Toxin Products

Trade Name	NEW Drug Name	OLD Drug Name	Indication
Botox	OnabotulinumtoxinA	Botulinum toxin type A	Cervical dystonia, Severe primary axillary hyperhidrosis, Strabismus, Blepharospasm
Botox Cosmetic	OnabotulinumtoxinA	Botulinum toxin type A	Temporary improvement in the appearance of moderate to severe glabellar lines
Dysport	AbobotulinumtoxinA	Botulinum toxin type A	Cervical dystonia, temporary improvement in the appearance to moderate to severe glabellar lines
Myobloc	RimabotulinumtoxinB	Botulinum toxin type B	Cervical dystonia

[Posted 04/30/2009] FDA notified healthcare professionals that after an ongoing safety review initiated in February 2008, the manufacturers of licensed botulinum toxin products [botulinum toxin Type A (Botox and Botox Cosmetic) and botulinum toxin Type B (Myobloc)] will be required by FDA to strengthen warnings in product labeling and add a boxed warning regarding the risk of adverse events when the effects of the toxin spread beyond the site where it was injected.

FDA will also require that manufacturers develop and implement a Risk Evaluation and Mitigation Strategy [REMS], including a communication plan to provide more information regarding the risk for distant spread of botulinum toxin effects after local injection, as well as information to explain that botulinum toxin products cannot be interchanged. The REMS would also include a Medication Guide that explains the risks to patients, their families, and caregivers. FDA is requiring the manufacturers to submit safety data after multiple administrations of the product in a specified number of children and adults with spasticity to assess the signal of serious risk regarding distant spread of toxin effects.

FDA’s evaluation of the data continues to support the recommendations made in the 2008 Early Communication. For more information visit the FDA website at: , and .

REMS:

FDA approved a REMS for onabotulinumtoxina (formerly botulinum toxin a) to ensure that the benefits of a drug outweigh the risks. The REMS may apply to one or more preparations of onabotulinumtoxina (formerly botulinum toxin a) and consists of the following: medication guide and communication plan. See the FDA REMS page () or the ASHP REMS Resource Center ().

Introduction

Neurotoxin produced by Clostridium botulinum;^{1 3 5 31 37 70 73 79} 7 structurally similar but antigenically and serologically distinct serotypes (A, B, C, D, E, F, and G) exist.^{3 31 32 37 70 73 75 79}

Botulinum toxin disrupts neurotransmission by inhibiting release of acetylcholine at cholinergic nerve terminals of the peripheral nervous system and at ganglionic nerve terminals of the autonomic nervous system, inducing a chemical denervation and flaccid paralysis and inhibiting glandular secretion.^{1 2 3 5 31 32 37 43 72 73 75 194}

Uses for Botulinum Toxin Type A

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Botulinum toxin type A (Botox, Botox Cosmetic) and type B (Myobloc) currently are commercially available in the US;^{1 2 5} types C and F reportedly under clinical investigation in other countries.⁴

Cervical Dystonia

Management of cervical dystonia (also referred to as spasmodic torticollis) to decrease the severity of associated abnormal head position and neck pain;^{1 3 4 9 14 16 29 30 32 35 37 40 54 65 69 85 95 96 122 123} designated an orphan drug by FDA for this use.⁸¹

Considered first-line therapy for cervical dystonia because of its efficacy, relatively low incidence of adverse effects, and temporary dose-related therapeutic effects (compared with surgery).^{3 15 30 33 34 35 54 83 86 90 296 297 298}

Comparative safety and efficacy of botulinum toxin types A and B in cervical dystonia have not been established.^{14 69}

Blepharospasm and Associated Facial Nerve Disorders

Management of blepharospasm associated with dystonia, including benign essential blepharospasm and seventh cranial (facial) nerve disorders; ^{1 3 24 29 30 33 34 35 37 89 90 94 98 99 100 101 102 103 104 105 106} considered a first-line therapy.^{9 29 33 34 54 65}

Designated an orphan drug by FDA for treatment of blepharospasm associated with dystonia in adults and children ≥12 years of age.⁸¹

Management of Meige’s syndrome† (idiopathic blepharospasm with facial and oromandibular dystonias).^{7 24 90 98 100 102 104 309}

Strabismus and Nystagmus

Management of dystonia-associated strabismus;^{1 4 9 29 30 33 34 35 37 54 65 81 85 89 108 109 110 111 112 113 114 115 123 138 296 297 298} designated an orphan drug by FDA for this use.⁸¹ An effective alternative or adjunct to surgery in selected adults and children with congenital or acquired strabismus.^{33 37 109 296 297 298}

Also has been used in vertical strabismus in dysthyroid ophthalmopathy for which surgery is inappropriate.^{9 33 37 109 110 115 180}

Safety and efficacy not established for treatment of ocular deviations >50 prism diopters†,^{1 115} restrictive strabismus†,^{1 113 115} or Duane’s syndrome with lateral rectus weakness†.^{1 113}

Has been used in surgically overcorrected or undercorrected strabismus;^{4 107 113 115} however, efficacy not established in strabismus secondary to prior surgical overrecession of the ocular antagonist muscle.^{1 115 296 297 298}

Not effective in chronic paralytic strabismus except as an adjunct to surgical repair to reduce ocular antagonist muscle contracture.^{1 4 33 115 296 297 298}

Spasmodic Dysphonia (Laryngeal Dystonia)

Treatment of choice for management of spasmodic dysphonia† (laryngeal dystonia) despite occasional complications and possible risk of reflex laryngeal stridor.^{9 35 54 65 83 85 116 247 296 297 298 308 317} Spasmodic dysphonia involving the adductor muscles appears to be more common;^{30 35 37 83 116} a limited number of patients with abductor muscle spasm have obtained some benefit from EMG-guided injections of the toxin into the posterior cricoarytenoid muscle.^{9 30 35 37 207 308 317}

Oromandibular Dystonias

Has been used successfully in the management of various oromandibular dystonias† (e.g., Meige’s syndrome†);^{3 4 9 29 30 33 34 35 37 84 90 104 118 119 120 309} considered a treatment of choice by some clinicians, although efficacy evidence from well-controlled studies is lacking.^{9 29 33 34 35 37 84 104 118 119 120 296 297 298 309}

Focal Limb Dystonias

Has been used for the management of focal limb dystonias (e.g., writer’s cramp†);^{9 30 33 37 54 65 175 176 177 178} considered first-line therapy.^{9 37 174 175 176 177 178 296}

Tremor

Has been used for the management of various types of tremor†,^{35 36 65 194 195 196 197 248} including hand tremor†.^{36 194 195 196 197}

Axillary Hyperhidrosis

Management of severe primary axillary hyperhidrosis that has not responded adequately to conservative treatments (e.g., topical antiperspirants).^{1 137 138 157 158 159 160 161 162 163 164 170 237 259 277}

Requires repeated treatment but avoids associated morbidity (e.g., pneumothorax, Horner’s syndrome, compensatory hyperhidrosis) of surgical procedures.^{137 162 163 164 170 296}

Gustatory Sweating

Used with good results in patients with gustatory sweating† (e.g., Frey syndrome, diabetic gustatory sweating);^{4 50 157 168} considered a treatment of choice by some clinicians, although efficacy data are limited.^{50 157 296 297 298}

Cosmesis of Glabellar Facial (“Frown”) Lines

Used for temporary improvement in the appearance of moderate to severe glabellar facial (“frown”) lines associated with corrugator and/or procerus muscle activity.^{5 37 64 68 79 85 123 140 141 142 143 144 145 146 147 148 149 150 157 305}

A treatment of choice in individuals wishing to avoid major procedure.^{145 296 297 298}

Cosmetic effects generally persist at least 4–6 months.^{140 143 144 146 150}

May not be appropriate when a wide range of facial expressions is required for professional or personal reasons.^{145 296 297 298}

Cosmesis of Lateral Canthal Wrinkles (“Crow’s Feet”)

Has been used for temporary improvement in the appearance of facial wrinkles associated with hyperactivity of the orbiculus oculi muscle† (lateral canthal wrinkles†, also known as “crow’s feet”†).^{66 68 123 140 141 146 152 153 311}

Cosmesis of Horizontal Forehead Lines

Has been used for temporary improvement in the appearance of hyperfunctional facial lines caused by frontalis muscle hyperactivity† (horizontal forehead lines).^{142 143 146 183 186 303}

Young individuals (usually females) with expressive horizontal forehead lines reportedly exhibit the best response.^{143 296 297 298}

Spasticity Associated with Cerebral Palsy

Has been used for the treatment of dynamic muscle contracture in pediatric patients with cerebral palsy†;^{155 166 169 229 230 231 232 233 234 269 270 271 272 273 275 279 280 281 315 321} designated an orphan drug by the FDA for this use.⁸¹ Some clinicians suggest conjunctive use of physical therapy and orthotics (e.g., casting).^{155 166 169 229 270 315 342 343}

Also has been used as an adjunct to analgesics for relief of postoperative pain secondary to muscle spasm associated with cerebral palsy† following orthopedic surgery.^{219 229 275}

Spasticity Associated with Stroke

Has been used to decrease spasticity, improve posture and range of motion, and relieve painful muscle spasms in patients with spasticity associated with stroke†.^{218 219 220 221 223 224 225 226 236 276 296 297 298 341}

Spasticity Associated with Multiple Sclerosis

Has been used for treatment of spasticity associated with multiple sclerosis† (e.g., hip adductor spasms†, spastic ankles†).^{37 123 166 198 204 219 220 223 224 229 235 236 276 297 360}

Anal Sphincter Disorders

Has been used effectively to treat uncomplicated cases of chronic anal fissure†;^{123 124 125 126 127 128 129 130 131 132 133 134 217 286} circumvents potential complications of surgery.^{125 126 127 128 129 130 133 217 296 297 298 365 366}

Has been used for pain reduction following hemorrhoidectomy†, presumably as a result of reducing spasm of the anal sphincter.²⁵⁶

Neurogenic Voiding Dysfunction

Has been used for the treatment of detrusor-sphincter dyssynergia† (generally detrusor-external sphincter dyssynergia†) associated with spinal cord disease or injury.^{33 34 35 37 85 123 199 200 201 202 203 206 208 209 210 211 212 296 297 298}

Voiding Dysfunction Associated with Benign Prostatic Hyperplasia

Has been used to treat voiding dysfunction associated with benign prostatic hyperplasia† (benign prostatic hypertrophy, BPH).²⁶⁸

Achalasia

Has been used successfully in a limited number of patients to relieve dysphagia, pain, and regurgitation¹⁸⁹ associated with achalasia†;^{34 35 37 85 123 184 185 187 188 189 190 191 192 193 296 297 298} much less effective in achalasia secondary to gastroesophageal junction carcinoma or other malignancy than in idiopathic achalasia.^{188 189}

Musculoskeletal Pain Disorders

Has been used for pain relief in a variety of pain disorders of musculoskeletal origin, including myofascial pain syndrome†,^{34 47 120 240 241 242 243 293 313 324 329} chronic neck pain†,^{313 331} chronic lower back pain†,^{35 85 240 241 243 244 245 313 324 332 333} and whiplash-associated disorder†.^{243 313 336}

Has also been used for treatment of tennis elbow†.^{35 97 322}

Prophylaxis of Disabling Headache

Has been used to reduce the frequency of and/or pain associated with migraine headache† in certain patients who require an alternative to conventional drug therapies because of inefficacy, intolerance, contraindications, and/or poor compliance.^{296 313 327 328}

Has been used with relatively inconsistent benefit in post-whiplash (cervicogenic) headache†.^{238 241 267 324 330 334}

Botulinum Toxin Type A Dosage and Administration

General

• 
  

  Adjust dosage carefully according to response and particular condition treated.^{4 120}

  
  


• 
  

  Generally, the effective IM dose depends on muscle mass: the larger the muscle, the higher the required dose.^{4 120}

  
  


• 
  

  Individual susceptibility to the toxin varies;⁴ and optimal dosages for a number of conditions have not been fully elucidated.^{37 133 138 142 156 218 219 238 243 301 302 313 321 337 338}

  
  


• 
  

  Lower doses may be required in patients with preexisting weakness or when there is concern about weakness, in those with milder disease severity, and in women and patients with lower body weights.⁴

  
  


• 
  

  If a patient fails to respond, consider possibility of an inadequate drug dose, incorrectly reconstituted and/or improperly stored drug solution, and/or misinjection.^{65 296 348}

  
  


• 
  

  Manufacturer recommends ≥12 weeks between treatment sessions for cosmesis.⁵

  
  


• 
  

  Some clinicians state strict adherence to recommended treatment interval of 12 weeks is not critical with low doses administered for cosmesis (e.g., 100 units total dose); such clinicians repeat injections after 2 weeks if desired results are not achieved after initial treatment.^{5 143 296 297 298}

  
  


• 
  

  Some clinicians suggest a treatment interval ≥8–12 weeks for noncosmetic indications.⁵

  
  

Administration

Administer by IM injection into affected muscles,^{1 3 4 5 120} intradermally^{30 35 60 67 79 85 123 157 158 160 170 259} , intracutaneously†,^{60 157 163 164 165 296 297 298} sub-Q†,^{60 157 163 164 165 296 297 298} or directly into affected glands†.^{4 320}

IM Administration

Administer by IM injection into affected muscles.^{1 3 4 5 120}

Just before administration, withdraw a volume of reconstituted drug slightly greater than the volume of the intended dose into an appropriately sized sterile syringe and expel any air bubbles in the syringe barrel; attach a new needle appropriate for the injection site to the syringe and confirm needle patency.^{1 5}

Reconstitution

Formulations of Botox and Botox Cosmetic of botulinum toxin type A are identical and are interchangeable provided the appropriate dilutions and administration techniques for a given indication are used.²⁹⁸

For noncosmetic uses, reconstitute vial containing 100 units of vacuum-dried drug with 1, 2, 4, or 8 mL of 0.9% sodium chloride injection without preservatives to provide a solution containing 10, 5, 2.5, or 1.25 units per 0.1 mL, respectively.^{1 298}

For cosmetic uses, reconstitute 50- or 100-unit vials of vacuum-dried drug with 1.25 mL or 2.5 mL, respectively, of 0.9% sodium chloride injection without preservatives to provide solutions containing 4 units of botulinum toxin type A per 0.1 mL. ^{5 64 296 298}

Use a new, sterile needle and syringe to enter the vial during reconstitution and for withdrawal of each dose.^{1 5}

To prevent possible toxin inactivation,²⁹⁸ allow stopper of vial to dry thoroughly after cleansing with alcohol before entering vial with a needle.^{121 142 296 297}

Vials may be reentered to treat the same patient within 4 hours of reconstitution; refrigerate during this time.^{1 5 298}

Direct 0.9% sodium chloride diluent toward side of vial using an appropriately sized syringe with a 21-gauge, 2.5-inch needle.^{1 5 121 296 297 298} Gently swirl to avoid excessive foaming of solution; do not shake.^{1 5 121 296 297 298}

Record date and time of reconstitution on drug vial.^{1 5}

Carefully dispose of all used vials, including expired vials and/or equipment used in preparation and administration, as medical waste.^{1 5}

Dilution

The optimum dilution to produce maximal effect not established;²²⁹ however, some clinicians state that use of concentrated solution (e.g., 100 units/mL) avoids many complications related to more extensive spread of toxin when less concentrated solutions (e.g., 10 units/mL) used.¹⁴¹

Prepare desired dose for administration by using a fixed concentration of the drug (e.g., 20–100 units/mL) and varying the volume of the injection to obtain the appropriate dose (e.g., decrease administered injection volume from 0.1 mL to 0.05 mL per dose to decrease dose by 50%, or increase administered injection volume from 0.1 mL to 0.15 mL to increase dose by 50%) or by diluting the appropriate dose in a fixed volume (e.g., 2–4 mL) of diluent (e.g., 0.9% sodium chloride injection without preservatives).^{1 5 229 270 298}

Lidocaine reportedly used as diluent to reduce pain on injection†;^{138 296 297 298 323} however, manufacturer states that diluents other than 0.9% sodium chloride injection without preservatives are not recommended because of potential for unknown interactions or adverse effects of other components.^{1 2 5 298}

Bacteriostatic (i.e., preserved with benzyl alcohol) 0.9% sodium chloride injection used as a diluent† reportedly is associated with less pain upon injection.^{62 64 138 296 298} However, manufacturer states that diluents other than 0.9% sodium chloride injection without preservatives are not recommended.^{1 5 298}

IM Injection Techniques

Targeting injection to the appropriate muscle(s) may be facilitated by active electromyography (EMG), ultrasonography, palpation of the muscle belly, and/or use of anatomic landmarks (e.g., evidence of muscular hypertrophy, stiffness, tenderness, visible abnormal muscular activity).^{4 120 147 229}

EMG-guided injections often recommended to ensure optimal placement of toxin for efficacy, particularly in patients who have not responded adequately to previous injections, and to minimize adverse effects on nonaffected tissue.^{120 140 143 147 296 297 298}

EMG guidance may allow more accurate identification of neural motor end plate, facilitating more precise injection and improving effectiveness of lower doses.^{240 360}

Injection into the midbelly of larger muscles where the motor end plates are located may enhance benefit.^{240 296 360}

Cervical Dystonia

Total dose administered at each treatment session is given as several injections divided among affected muscles.^{1 65}

Identify affected muscles by careful clinical evaluation, including physical examination and palpation (e.g., for areas of hypertrophy, pain).^{9 33 65} Palpation of contracting muscles while the patient’s head is placed in the position most favored by dystonic pulling of the neck muscles reportedly is helpful.^{9 65}

EMG guidance also may be useful in delineating involved muscles for injection, particularly in obese patients or for muscles difficult to identify by palpation.^{1 35 37 39 56 65}

Blepharospasm and Hemifacial Spasm

For the treatment of blepharospasm, the initial recommended dose is injected at each site without EMG guidance into the medial and lateral pretarsal orbicularis oculi of the upper lid and into lateral pretarsal orbicularis oculi of the lower lid.^{1 4 65}

Reduce or prevent ecchymosis of adnexa by using very fine-gauge needles (e.g., 30- , 32-gauge), limiting repeat use of needles to ≤4 times, appropriate discontinuance of medications and supplements that affect platelet function (e.g., aspirin, vitamin E) prior to injection, and by applying pressure and/or ice to the injection site immediately post-injection.^{1 296}

Reduce risk of ptosis by avoiding injection near the levator palpebrae superioris.^{1 22 37 141 296 297 298}

Reduce risk of diplopia by avoiding medial lower lid injections, thereby reducing drug diffusion into the inferior oblique muscle.¹

Treatment of hemifacial spasm, which sometimes occurs in conjunction with blepharospasm,^{3 9 20 29 30 33 34 35 37 65 83 100 102 106} should be individualized.²⁶³ Initially inject only those muscles considered most disturbing to the patient, such as the orbicularis oculi (as for blepharospasm); affected muscles of the lower face may respond through drug diffusion or cessation of eyelid contractions that act as a trigger for spasm.^{4 21 37}

Strabismus

To ensure optimum placement of the needle within targeted extraocular muscles, injection with EMG guidance or into exposed muscles during surgery is recommended;^{1 56 296} however, some clinicians suggest that the drug can be safely administered by clinicians with sufficient experiential knowledge of orbital anatomy.²⁹⁶

Spasmodic Dysphonia Involving the Adductor Muscles

Inject into the thyroarytenoid vocalis complex via the cricothyroid cartilage with EMG guidance;^{4 9 35 37 65 83 117 296 297 298 308 317} use a hollow, Teflon-coated needle.^{9 35 37 83 116 117 308}

Also has been given by indirect laryngeal endoscopy (without EMG guidance) in some (e.g., post-surgical) patients.^{4 35 117 296 297 298 308}

While injections have been given into both vocal cords,^{9 35 37 83 308} some clinicians prefer unilateral injections to minimize adverse effects;^{6 65 83 205 296 297 298} controversy exists regarding the optimal method.²⁹⁶

Spasmodic Dysphonia Involving the Abductor Muscles

Inject into the posterior cricothyroid muscle using EMG guidance.^{37 116 117}

Dynatuss Liquid

Pronunciation: car-bi-NOX-ah-meen/dex-troe-meth-OR-fan/sue-doe-eh-FED-rin
Generic Name: Carbinoxamine/Dextromethorphan/Pseudoephedrine
Brand Name: Examples include Cordron-DM and Dynatuss

Dynatuss Liquid is used for:

Relieving symptoms of sinus congestion, runny nose, sneezing, cough due to colds, upper respiratory infections, and allergies. It may also be used for other conditions as determined by your doctor.

Dynatuss Liquid is a decongestant, antihistamine, and cough suppressant combination. It works by constricting blood vessels and reducing swelling in the nasal passages. The antihistamine works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing while the cough suppressant works in the brain to help decrease the cough reflex to reduce a dry cough.

Do NOT use Dynatuss Liquid if:

• you are allergic to any ingredient in Dynatuss Liquid


• you have severe high blood pressure, severe heart blood vessel disease, rapid heartbeat, or severe heart problems


• you are unable to urinate or are having an asthma attack


• you take sodium oxybate (GHB) or if you have taken furazolidone or a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the last 14 days

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

Before using Dynatuss Liquid:

Some medical conditions may interact with Dynatuss Liquid. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

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


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


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


• if you have a fast, slow, or irregular heartbeat


• if you have a history of adrenal gland problems (eg, adrenal gland tumor); heart problems; high blood pressure; diabetes; heart blood vessel problems; stroke; glaucoma; a blockage of your stomach, bladder, or intestines; ulcers; trouble urinating; an enlarged prostate or other prostate problems; seizures; or an overactive thyroid


• if you have a history of asthma, chronic cough, lung problems (eg, chronic bronchitis, emphysema), chronic obstructive pulmonary disease (COPD), or if your cough occurs with large amounts of mucus

Some MEDICINES MAY INTERACT with Dynatuss Liquid. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Beta-blockers (eg, propranolol), catechol-O-methyltransferase (COMT) inhibitors (eg, tolcapone), furazolidone, indomethacin, MAOIs (eg, phenelzine), sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Dynatuss Liquid's side effects


• Digoxin or droxidopa because the risk of irregular heartbeat or heart attack may be increased


• Bromocriptine or hydantoins (eg, phenytoin) because the risk of their side effects may be increased by Dynatuss Liquid


• Guanethidine, guanadrel, methyldopa, mecamylamine, or reserpine because their effectiveness may be decreased by Dynatuss Liquid

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

How to use Dynatuss Liquid:

Use Dynatuss Liquid as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Dynatuss Liquid by mouth with or without food.


• Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.


• If you miss a dose of Dynatuss Liquid, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Dynatuss Liquid.

Important safety information:

• Dynatuss Liquid may cause dizziness, drowsiness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Dynatuss Liquid with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.


• Do not take diet or appetite control medicines while you are taking Dynatuss Liquid without checking with you doctor.


• Dynatuss Liquid has pseudoephedrine in it. Before you start any new medicine, check the label to see if it has pseudoephedrine in it too. If it does or if you are not sure, check with your doctor or pharmacist.


• Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.


• If your symptoms do not get better within 5 to 7 days or if they get worse, check with your doctor.


• Dynatuss Liquid may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Dynatuss Liquid. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.


• Dynatuss Liquid may interfere with skin allergy tests. If you are scheduled for a skin test, talk to your doctor. You may need to stop taking Dynatuss Liquid for a few days before the tests.


• Tell your doctor or dentist that you take Dynatuss Liquid before you receive any medical or dental care, emergency care, or surgery.


• Use Dynatuss Liquid with caution in the ELDERLY; they may be more sensitive to its effects.


• Caution is advised when using Dynatuss Liquid in CHILDREN; they may be more sensitive to its effects.


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

Possible side effects of Dynatuss Liquid:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; excitability; headache; loss of appetite; nausea; nervousness or anxiety; trouble sleeping; upset stomach; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); difficulty urinating or inability to urinate; fast or irregular heartbeat; hallucinations; seizures; severe dizziness, lightheadedness, or headache; tremor; trouble sleeping; vision changes.

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

See also: Dynatuss side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include blurred vision; confusion; hallucinations; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; unusually fast, slow, or irregular heartbeat; vomiting.

Proper storage of Dynatuss Liquid:

Store Dynatuss Liquid at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Dynatuss Liquid out of the reach of children and away from pets.

General information:

• If you have any questions about Dynatuss Liquid, please talk with your doctor, pharmacist, or other health care provider.


• Dynatuss Liquid is to be used only by the patient for whom it is prescribed. Do not share it with other people.


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


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

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

Issue Date: February 1, 2012

Database Edition 12.1.1.002

Copyright © 2012 Wolters Kluwer Health, Inc.

More Dynatuss resources

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

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