In the US, Lovaza (omega-3 polyunsaturated fatty acids systemic) is a member of the drug class nutraceutical products and is used to treat ADHD, Dietary Supplementation and Hypertriglyceridemia.
US matches:
Omega-3-acid Ethyl Esters is reported as an ingredient of Lovaza in the following countries:
International Drug Name Search
In the US, Liqui-Char (charcoal systemic) is a member of the following drug classes: antidotes, miscellaneous GI agents and is used to treat Gas and Gastrointestinal Decontamination.
US matches:
Charcoal, Activated is reported as an ingredient of Liqui-Char in the following countries:
International Drug Name Search
Sulfadimidine Natrium may be available in the countries listed below.
In some countries, this medicine may only be approved for veterinary use.
Sulfadimidine sodium salt (a derivative of Sulfadimidine) is reported as an ingredient of Sulfadimidine Natrium in the following countries:
International Drug Name Search
Renivace may be available in the countries listed below.
Enalapril maleate (a derivative of Enalapril) is reported as an ingredient of Renivace in the following countries:
International Drug Name Search
Sunbazon may be available in the countries listed below.
Eperisone hydrochloride (a derivative of Eperisone) is reported as an ingredient of Sunbazon in the following countries:
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Enalapril Naturgen may be available in the countries listed below.
Enalapril is reported as an ingredient of Enalapril Naturgen in the following countries:
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Flustaph may be available in the countries listed below.
Flucloxacillin sodium salt (a derivative of Flucloxacillin) is reported as an ingredient of Flustaph in the following countries:
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Isotretinoin Med-One may be available in the countries listed below.
Isotretinoin is reported as an ingredient of Isotretinoin Med-One in the following countries:
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Hibiscrub may be available in the countries listed below.
UK matches:
Chlorhexidine digluconate (a derivative of Chlorhexidine) is reported as an ingredient of Hibiscrub in the following countries:
International Drug Name Search
Glossary
| SPC | Summary of Product Characteristics (UK) |
Somazine may be available in the countries listed below.
Citicoline is reported as an ingredient of Somazine in the following countries:
International Drug Name Search
Manerix may be available in the countries listed below.
UK matches:
Moclobemide is reported as an ingredient of Manerix in the following countries:
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Som may be available in the countries listed below.
Omeprazole is reported as an ingredient of Som in the following countries:
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Miticocan may be available in the countries listed below.
Benzyl Benzoate is reported as an ingredient of Miticocan in the following countries:
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Axius may be available in the countries listed below.
Meloxicam is reported as an ingredient of Axius in the following countries:
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Klevasin may be available in the countries listed below.
Cefatrizine is reported as an ingredient of Klevasin in the following countries:
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Orakit may be available in the countries listed below.
Potassium Chloride is reported as an ingredient of Orakit in the following countries:
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Sucomet may be available in the countries listed below.
Metformin hydrochloride (a derivative of Metformin) is reported as an ingredient of Sucomet in the following countries:
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Solvolan may be available in the countries listed below.
Ambroxol hydrochloride (a derivative of Ambroxol) is reported as an ingredient of Solvolan in the following countries:
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Valpresan may be available in the countries listed below.
Valsartan is reported as an ingredient of Valpresan in the following countries:
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Syntestan may be available in the countries listed below.
Cloprednol is reported as an ingredient of Syntestan in the following countries:
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Ichtiolo may be available in the countries listed below.
Ichthammol is reported as an ingredient of Ichtiolo in the following countries:
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Fluniveto may be available in the countries listed below.
In some countries, this medicine may only be approved for veterinary use.
Flunixin meglumine (a derivative of Flunixin) is reported as an ingredient of Fluniveto in the following countries:
International Drug Name Search
In the US, Teriparatide (teriparatide systemic) is a member of the drug class parathyroid hormone and analogs and is used to treat Osteoporosis.
US matches:
Rec.INN
H05AA02
0052232-67-4
C181-H291-N55-O51-S2
4117
Calcium regulator
Diagnostic agent
Parathyroid hormone analogue
Treatment of osteoporosis
L-Seryl-L-valyl-L-seryl-L-glutamyl-L-isoleucyl-L-glutaminyl-L-leucyl-L-methionyl-L-histidyl-L-asparaginyl-L-leucylglycyl-L-lysyl-L-histidyl-L-leucyl-L-asparaginyl-L-seryl-L-methionyl-L-glutamyl-L-arginyl-L-valyl-L-glutamyl-L-tryptophyl-L-leucyl-L-arginyl- (WHO)
International Drug Name Search
Glossary
| IS | Inofficial Synonym |
| JAN | Japanese Accepted Name |
| OS | Official Synonym |
| Rec.INN | Recommended International Nonproprietary Name (World Health Organization) |
| USAN | United States Adopted Name |
| WHO | World Health Organization |
Succinylcholin Inresa may be available in the countries listed below.
Suxamethonium Chloride is reported as an ingredient of Succinylcholin Inresa in the following countries:
International Drug Name Search
Generic Name: dextromethorphan and guaifenesin (DEX troe me THOR fan and gwye FEN e sin)
Brand names: Allfen DM, Altarussin DM, Aquatab DM, Benylin Expectorant, Drituss DM, Extuss LA, Fenesin DM IR, Glycotuss-DM, Guaifen DM, Mucinex Children's Cough, Mucinex DM, MucusRelief DM, Naldecon DX Liquigel, Relacon LAX, Respa-DM, Robitussin Cough & Congestion, Tussi-Bid, Tussi-Organidin DM NR, Vicks 44E, ...show all 149 brand names.
Dextromethorphan is a cough suppressant. It affects the signals in the brain that trigger cough reflex.
Guaifenesin is an expectorant. It helps loosen congestion in your chest and throat, making it easier to cough out through your mouth.
The combination of dextromethorphan and guaifenesin is used to treat cough and chest congestion caused by the common cold, infections, or allergies.
Dextromethorphan and guaifenesin may also be used for other purposes not listed in this medication guide.
Ask a doctor or pharmacist if it is safe for you to take this medication if you have emphysema or chronic bronchitis.
Artificially-sweetened liquid forms of cold medicine may contain phenylalanine. This would be important to know if you have phenylketonuria (PKU). Check the ingredients and warnings on the medication label if you are concerned about phenylalanine.
Use this medication exactly as directed on the label, or as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Cold medicine is usually taken only for a short time until your symptoms clear up.
Measure the liquid form of this medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
Dextromethorphan and guaifenesin granules should be sprinkled directly onto the tongue and swallowed right away.
If you need to have any type of surgery, tell the surgeon ahead of time if you have taken a cold medicine within the past few days.
See also: Dextromethorphan and guaifenesin dosage (in more detail)
Since cough or cold medicine is usually taken only as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.
Overdose symptoms may include feeling restless or nervous.
Avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor's advice. Taking a stimulant together with cough or cold medicine can increase your risk of unpleasant side effects.
severe dizziness, anxiety, restless feeling, or nervousness;
confusion, hallucinations; or
slow, shallow breathing.
Less serious side effects may include:
dizziness;
headache;
skin rash or itching; or
nausea, vomiting, or stomach upset.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Usual Adult Dose for Cough:
Immediate release: 10 to 30 mg dextromethorphan orally every 4 to 8 hours as needed, not to exceed 120 mg/day.
Extended release: up to 60 mg dextromethorphan orally every 12 hours.
Usual Pediatric Dose for Cough:
Immediate release:
2 to 5 years: 2.5 to 7.5 mg dextromethorphan orally every 4 to 8 hours as needed, not to exceed 30 mg/day.
6 to 11 years: 10 to 15 mg dextromethorphan orally every 4 to 8 hours as needed, not to exceed 60 mg/day.
12 years or older: 10 to 30 mg dextromethorphan orally every 4 to 8 hours as needed, not to exceed 120 mg/day.
Extended release:
2 to 5 years: up to 15 mg dextromethorphan orally every 12 hours.
6 to 11 years: up to 30 mg dextromethorphan orally every 12 hours.
12 years or older: up to 60 mg dextromethorphan orally every 12 hours.
dextromethorphan-guaifenesin 20 mg-200 mg/10 mL oral liquid:
12 years or older: 1 pre-filled syringe (10 mL) orally every 4 hours, not to exceed 6 doses in 24 hours.
Before taking this medication, tell your doctor if you are using any of the following drugs:
celecoxib (Celebrex);
cinacalcet (Sensipar);
darifenacin (Enablex);
imatinib (Gleevec);
quinidine (Quinaglute, Quinidex);
ranolazine (Ranexa);
ritonavir (Norvir);
sibutramine (Meridia);
terbinafine (Lamisil);
medicines to treat high blood pressure; or
an antidepressant such as amitriptyline (Elavil, Etrafon), bupropion (Wellbutrin, Zyban), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Janimine, Tofranil), paroxetine (Paxil), sertraline (Zoloft), and others.
This list is not complete and there may be other drugs that can interact with dextromethorphan and guaifenesin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
See also: dextromethorphan and guaifenesin side effects (in more detail)
Urso Heumann may be available in the countries listed below.
Ursodeoxycholic Acid is reported as an ingredient of Urso Heumann in the following countries:
International Drug Name Search
Cinnarizine Katwijk may be available in the countries listed below.
Cinnarizine is reported as an ingredient of Cinnarizine Katwijk in the following countries:
International Drug Name Search
Atenolo Denk may be available in the countries listed below.
Atenolol is reported as an ingredient of Atenolo Denk in the following countries:
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Céfuroxime Teva may be available in the countries listed below.
Cefuroxime sodium salt (a derivative of Cefuroxime) is reported as an ingredient of Céfuroxime Teva in the following countries:
International Drug Name Search
Dorsof may be available in the countries listed below.
Dorzolamide is reported as an ingredient of Dorsof in the following countries:
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Generic Name: triamterene (try AM teh reen)
Brand Names: Dyrenium
Triamterene is a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.
Triamterene is used to treat fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or a kidney condition called nephrotic syndrome.
Triamterene is also used to treat edema caused by having too much aldosterone in your body. Aldosterone is a hormone produced by the adrenal glands to help regulate the salt and water balance in your body.
Triamterene may also be used for purposes other than those listed in this medication guide.
Before using this medication, tell your doctor if you have heart or liver disease, diabetes, gout, or a history of kidney stones. Tell your doctor if you are using another diuretic.
Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
severe liver disease;
high potassium levels (hyperkalemia); or
if you are taking potassium supplements, or another potassium-sparing diuretic such as Dyazide, Maxzide, amiloride (Midamor, Moduretic), or spironolactone (Aldactone, Aldactazide).
Before using triamterene, tell your doctor if you have:
diabetes;
heart disease;
liver disease;
gout;
a history of kidney stones; or
if you are using another diuretic.
If you have any of these conditions, you may not be able to use triamterene, or you may need a dosage adjustment or special tests during treatment.
Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.
To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. It is important that you not miss any scheduled visits to your doctor.
Triamterene can interfere with the results of certain medical tests. Tell any doctor who treats you that you are using triamterene.
If you need to have any type of surgery, tell the surgeon ahead of time that you are taking triamterene. You may need to stop using the medicine for a short time.
See also: Dyrenium dosage (in more detail)
Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
Avoid using other medicines that make you light-headed (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to the side effects of triamterene.
Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
numbness or tingly feeling;
muscle pain or weakness;
slow, fast, or uneven heartbeat;
feeling drowsy, restless, or light-headed;
urinating less than usual or not at all;
shallow breathing;
tremors, confusion; or
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Continue using triamterene and talk with your doctor if you have any of these less serious side effects:
mild nausea, vomiting, or diarrhea;
dizziness, headache;
dry mouth; or
skin rash.
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. You may report side effects to FDA at 1-800-FDA-1088.
Before taking this medication, tell your doctor if you are using any of the following drugs:
lithium;
insulin or diabetes medicine taken by mouth;
an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others; or
indomethacin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Motrin, Advil), diclofenac (Voltaren), naproxen (Aleve, Naprosyn), piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others.
If you are using any of these drugs, you may not be able to use triamterene, or you may need dosage adjustments or special tests during treatment.
There may be other drugs not listed that can affect triamterene. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
See also: Dyrenium side effects (in more detail)
Nicergoline RPG may be available in the countries listed below.
Nicergoline is reported as an ingredient of Nicergoline RPG in the following countries:
International Drug Name Search
Sucral may be available in the countries listed below.
Sucralfate is reported as an ingredient of Sucral in the following countries:
International Drug Name Search
Shetlazorna may be available in the countries listed below.
Nitrendipine is reported as an ingredient of Shetlazorna in the following countries:
International Drug Name Search
Norfloxacina Klonal may be available in the countries listed below.
Norfloxacin is reported as an ingredient of Norfloxacina Klonal in the following countries:
International Drug Name Search
Sinvastatina Zera may be available in the countries listed below.
Simvastatin is reported as an ingredient of Sinvastatina Zera in the following countries:
International Drug Name Search
Gliquidone OGB Dexa may be available in the countries listed below.
Gliquidone is reported as an ingredient of Gliquidone OGB Dexa in the following countries:
International Drug Name Search
Serenata may be available in the countries listed below.
Sertraline is reported as an ingredient of Serenata in the following countries:
Sertraline hydrochloride (a derivative of Sertraline) is reported as an ingredient of Serenata in the following countries:
International Drug Name Search
Betahistine Teva may be available in the countries listed below.
Betahistine dihydrochloride (a derivative of Betahistine) is reported as an ingredient of Betahistine Teva in the following countries:
International Drug Name Search
Generic Name: guaifenesin (gwye FEN e sin)
Brand Names: Duratuss G, Ganidin NR, GG 200 NR, GuaiFENesin LA, Liquibid, Muco-Fen 1200, Organidin NR, Q-Bid LA, Robitussin, Scot-Tussin
Guaifenesin is an expectorant. It helps loosen congestion in your chest and throat, making it easier to cough out through your mouth.
Guaifenesin is used to reduce chest congestion caused by the common cold, infections, or allergies.
Guaifenesin may also be used for purposes not listed in this medication guide.
Use this medication exactly as directed on the label, or as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended.
Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.
Measure the liquid form of guaifenesin with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
Since cough medicine is taken when needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Less serious side effects may include:
dizziness or headache,
a rash, or
nausea, vomiting, or stomach upset.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
There may be other drugs that can interact with guaifenesin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
See also: Organidin NR side effects (in more detail)
Tabernil Insecticida may be available in the countries listed below.
In some countries, this medicine may only be approved for veterinary use.
Piperonyl Butoxide is reported as an ingredient of Tabernil Insecticida in the following countries:
Pyrethrin I is reported as an ingredient of Tabernil Insecticida in the following countries:
International Drug Name Search
Amadiab may be available in the countries listed below.
Glimepiride is reported as an ingredient of Amadiab in the following countries:
International Drug Name Search
MAOtil may be available in the countries listed below.
Selegiline hydrochloride (a derivative of Selegiline) is reported as an ingredient of MAOtil in the following countries:
International Drug Name Search
Vérapamil G Gam may be available in the countries listed below.
Verapamil is reported as an ingredient of Vérapamil G Gam in the following countries:
International Drug Name Search
In some countries, this medicine may only be approved for veterinary use.
Moxidectin is reported as an ingredient of Proheart in the following countries:
International Drug Name Search
In some countries, this medicine may only be approved for veterinary use.
Imidacloprid is reported as an ingredient of Advantage DUO in the following countries:
Ivermectin is reported as an ingredient of Advantage DUO in the following countries:
International Drug Name Search
Glimepirid AL may be available in the countries listed below.
Glimepiride is reported as an ingredient of Glimepirid AL in the following countries:
International Drug Name Search
Zipol may be available in the countries listed below.
Zinc Sulfate is reported as an ingredient of Zipol in the following countries:
International Drug Name Search
Vinca-treis may be available in the countries listed below.
Vincamine is reported as an ingredient of Vinca-treis in the following countries:
International Drug Name Search
Sucotab may be available in the countries listed below.
Gliclazide is reported as an ingredient of Sucotab in the following countries:
International Drug Name Search
In the US, Symlin (pramlintide systemic) is a member of the drug class amylin analogs and is used to treat Diabetes - Type 1 and Diabetes - Type 2.
US matches:
Pramlintide acetate (a derivative of Pramlintide) is reported as an ingredient of Symlin in the following countries:
International Drug Name Search
Class: Antineoplastic Agents
VA Class: AN200
CAS Number: 9041-93-4
Brands: Blenoxane
Administer only under supervision of qualified clinicians experienced in use of cytotoxic therapy and only in a setting where adequate diagnostic and treatment facilities are readily available.121
Risk of developing pulmonary toxicity (e.g., pneumonitis, pulmonary fibrosis), particularly in geriatric patients >70 years of age and in patients receiving total bleomycin dosage >400 units.121 (See Pulmonary Toxicity under Cautions.)
Risk of severe idiosyncratic reaction (e.g., hypotension, mental confusion, fever, chills, wheezing) in patients with Hodgkin’s or non-Hodgkin’s disease.121 (See Sensitivity Reactions under Cautions.)
Antineoplastic agent; mixture of basic cytotoxic glycopeptide antibiotics produced by Streptomyces verticillus (bleomycin A2 and bleomycin B2 are the major components).121
Treatment of Hodgkin’s disease.121 122 142 143 144 217
Combination therapy for induction of remissions is superior to single-drug therapy.142 143 144
Various combination regimens are used.142 143 144
Commonly used in combination with doxorubicin, vinblastine, and dacarbazine (ABVD regimen).121 122 142 143 144 217
Has been used for treatment of non-Hodgkin’s lymphoma.121 122
Second- or third-generation combination regimens containing bleomycin no more effective than the standard CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) for the treatment of advanced intermediate-grade or high-grade non-Hodgkin’s lymphoma.235 236 237 238 239
Treatment of testicular embryonal cell carcinoma, choriocarcinoma, and teratocarcinoma.121 123 126 127 128 129 130 132 140
Combination chemotherapy with bleomycin, cisplatin, and etoposide is a regimen of choice for the treatment of advanced nonseminomatous testicular carcinoma.122 123 126 127 128 129 130 132
Combination chemotherapy with bleomycin, cisplatin, and etoposide is used for the treatment of disseminated seminoma testis.123 128 129 131 132 140
Intracavitary injection as a sclerosing agent for intrapleural management and prevention of recurrent pleural effusions (pleurodesis) caused by metastatic tumors.121
At least as effective and possibly better tolerated than intrapleural tetracycline.121 147 148 149 151 154 155 156
Intrapleural talc may be preferred because of cost considerations.c d e f g
Has been used for intrapleural management of pneumothorax† associated with AIDS Pneumocystis jiroveci (Pneumocystis carinii) pneumonia.108 112
Palliative treatment of squamous cell carcinomas of the head and neck (including mouth, tongue, tonsils, nasopharynx, oropharynx, sinuses, palate, lip, buccal mucosa, gingiva, epiglottis, larynx, skin).121
Poorer response to bleomycin in patients who have received prior radiation therapy for the treatment of head and neck cancer.121
Combination chemotherapy with cisplatin, methotrexate, and vincristine for advanced head and neck cancer.122 225
Has been used for palliative treatment of squamous cell carcinoma of the cervix.121
Not considered a drug of choice for the treatment of advanced cervical cancer.232
Palliative treatment of squamous cell carcinomas of the penis and vulva (in combination with other antineoplastic agents).121 234
Has been used for the palliative treatment of AIDS-related Kaposi’s sarcoma† (alone or in combination with doxorubicin, and a vinca alkaloid).122 146 172 173 174 175 176 177
Has been used as monotherapy for palliative treatment of early-stage disease.146 169 170 171
Bleomycin combination chemotherapy has been considered a regimen of choice for advanced disease,122 146 175 177 but a liposomal anthracycline currently considered first-line therapy.146 185
Has been used for the treatment of ovarian germ cell tumors† (in combination with cisplatin and etoposide).122 216
Has been used for the treatment of intracranial germ cell tumors† (in combination with cisplatin and vinblastine).122 178
Individualize dosage carefully according to individual requirements and response.121
Consult specialized references for procedures for proper handling and disposal of antineoplastics.121
Risk of anaphylactoid reactions in lymphoma patients (e.g., those with Hodgkin’s and non-Hodgkin’s disease).121
Administer 2 test doses (i.e., ≤2 units of bleomycin) before initiating full-dose therapy.121
After each test dose, monitor carefully for severe idiosyncratic reactions (see Boxed Warning).121 If no acute reaction occurs, recommended dosage regimen may then be administered.121
Take precautions to treat potential allergic reactions.121
Intrapleural injection of local anesthetics or systemic administration of opiates prior to the intrapleural procedure may relieve pain associated with pleurodesis104 120 153 160 163 164 166 but generally are not considered necessary.121
Administer by IV, IM, sub-Q, or intrapleural (intracavitary) injection.121
Administer by IV injection once or twice weekly.121
For solution and drug compatibility information, see Compatibility under Stability.
Add a minimum of 5 or 10 mL of 0.9% sodium chloride injection to the vial labeled as containing 15 or 30 units, respectively, to provide a solution containing not more than 3 units/mL.121
Administer IV slowly over a 10-minute period.121
Administer by IM injection once or twice weekly.121
Add 1–5 or 2–10 mL of sterile water for injection, 0.9% sodium chloride injection, or bacteriostatic water for injection to the vial containing 15 or 30 units, respectively, to provide solutions containing 3–15 units/mL.121
Administer by sub-Q injection once or twice weekly.121
Add 1–5 or 2–10 mL of sterile water for injection, 0.9% sodium chloride injection, or bacteriostatic water for injection to the vial containing 15 or 30 units, respectively, to provide solutions containing 3–15 units/mL.121
Administer as a single bolus dose by intrapleural (intracavitary) injection through a thoracostomy tube.121
Drain pleural fluid via the thoracostomy by gravity or suction prior to instillation;102 103 104 110 118 119 120 121 confirmation of complete expansion of the lungs is recommended.121 148 153
Initiate therapy when chest tube drainage <100 mL in a 24 hour period or 100–300 mL in 24 hours under certain special circumstances.121
Dissolve 60 units in 50–100 mL of 0.9% sodium chloride injection.121
Available as bleomycin sulfate; dosage expressed in terms of bleomycin.121
Consult published protocols for the dosage of bleomycin and other chemotherapeutic agents and the method and sequence of administration.121
Increased sensitivity risk in lymphomas; administer test doses.121 (See Sensitivity Testing under Dosage and Administration.)
0.25–0.5 units/kg (10–20 units/m2) once or twice weekly.121
Following a 50% regression of tumor size, a maintenance dose of 1 unit daily or 5 units weekly can be given.121
Improvement unlikely to occur if not evident by week 2 of therapy.121
Increased sensitivity risk in lymphomas; administer test doses.121 (See Sensitivity Testing under Dosage and Administration.)
0.25–0.5 units/kg (10–20 units/m2) once or twice weekly.121
0.25–0.5 units/kg (10–20 units/m2) once or twice weekly.121
Improvement in testicular cancer disease unlikely to occur if not evident by week 2 of therapy.121
0.25–0.5 units/kg (10–20 units/m2) once or twice weekly.121
Improvement in squamous cell carcinomas may not be evident for 3 weeks after initiation of therapy.121
50–60 units diluted and instilled into the chest through a thoracostomy tube followed by clamping of the tube, periodic rotation (optional)148 149 of the patient during the next 4 hours, and subsequent removal of the fluid.101 104 105 107 110 113 118 119 120 121
Length of time the chest tube remains in the pleural space after instillation of the drug should be individualized depending on the clinical status of the patient;121 allowing the chest tube to remain for at least 4 days after instillation may prevent pneumothorax.153
Pulmonary: |
Clinical manifestations or radiologic evidence of pulmonary toxicity unless drug excluded as cause |
Pulmonary diffusion capacity for carbon monoxide (DLco) <30–35% of the pretreatment value |
Cardiovascular: |
Intractable pain or ECG changes suggestive of pericarditis |
Dermatologic: |
Mucocutaneous toxicity (e.g., erythema, rash, striae, vesiculation, hyperpigmentation, and skin tenderness) |
Pulmonary: |
Rapid decline in forced vital capacity |
Cardiovascular: |
Acute chest pain syndrome suggestive of pleuropericarditis |
Further courses of bleomycin therapy do not appear to be contraindicated, but careful evaluation of the patient must precede continuation of therapy.121 |
Pulmonary toxicity: Administer cumulative dosages >400 units with great caution.121
When bleomycin is used in conjunction with other antineoplastic agents, pulmonary toxicity may occur at lower cumulative dosages of bleomycin.121
Generally, maximum of 1 unit/kg or 40 units/m2 in geriatric patients.b
No dosage adjustment established by manufacturer for mild to moderate renal impairment; use with extreme caution in severe renal impairment.121
Known hypersensitivity or idiosyncrasy to bleomycin or any ingredient in the formulation.121
Has a low therapeutic index; monitor patients carefully and frequently during and after therapy.121
Potentially life-threatening, severe idiosyncratic (anaphylactoid) reactions (see Boxed Warning);121 may be immediate or delayed for several hours, and usually occurs after the first or second dose.121 Monitor carefully.121 (See Sensitivity Testing under Dosage and Administration.)
Treatment of anaphylactoid reactions is supportive and symptomatic and may include volume expansion, vasopressor therapy, antihistamines, and corticosteroids.121
Risk of dose- and age-related pulmonary toxicity (see Boxed Warning); use with extreme caution in compromised pulmonary function.121
Most severe toxicity.121
Pneumonitis can progress to potentially fatal pulmonary fibrosis.121
Most frequently with total dosages >400 units, but can occur with lower dosages.121
Risk may be increased with filgrastim or other cytokines.121
Dyspnea and fine rales are early manifestations.121
Perform chest radiographs every 1–2 weeks and sequential measurement of pulmonary diffusion capacity for carbon monoxide (DLco) monthly during therapy.121
Dosage modification or drug discontinuance may be necessary.121 (See Dosage Modification for Toxicity under Dosage and Administration.)
Risk of pleuropericarditis and/or vascular toxicities (e.g., MI, cerebrovascular accident, thrombotic microangiography, cerebral arteritis).121
Sudden onset of acute chest pain may be first sign of pleuropericarditis.121
Dosage modification may be necessary in patients experiencing acute chest pain syndrome suggestive of pleuropericarditis.121 133
Raynaud's phenomenon, possibly due to bleomycin, combination therapy (e.g., vinblastine, cisplatin), underlying cancer or vascular compromise, or combination of factors.121 134 135 136 137
Risk of developing dose-related adverse mucocutaneous effects (e.g., erythema, rash, striae, vesiculation, hyperpigmentation, skin tenderness, and less commonly hyperkeratosis, nail changes, alopecia, pruritus, stomatitis).121
Usually occurs during the second or third week of bleomycin therapy after a cumulative dose of 150–200 units.121
Most frequent toxicity, occurring in 50% of patients.121
Discontinuance of bleomycin may be necessary.121
Begins as deterioration in renal or liver function tests; may occur anytime after bleomycin initiation.121
Fever and chills are frequent, mainly with large single doses within a few hours of administration and persisting for 4–12 hours.b
Sensitizes lung tissue to damaging effects of oxygen administered during surgery; lung damage can occur at Fl O2 concentrations that are usually considered safe.121
Maintain Fl O2 at concentrations approximating that of room air (25%) during surgery and the postoperative period and monitor carefully fluid replacement, focusing more on colloid administration rather than crystalloid.121
Rarely, pulmonary toxicity.121
Local pain.121
Hypotension, which may require treatment.121
Very rarely, death, but patients were very seriously ill prior to treatment.121
Category D.121
Not known whether bleomycin is distributed into milk.121 Use not recommended.121
Safety and efficacy not established in pediatric patients.121
Greater risk of pulmonary toxicity in patients >70 years of age than in younger patients.240
Titrate dosage carefully.240
Use with extreme caution in patients with clinically important renal impairment.121
With IV administration, fever, chills, vomiting, and anorexia/weight loss (which may persist long after discontinuance of therapy).121 Mucocutaneous and dermatologic effects are most common and pulmonary toxicity is most serious.121 (See Major Toxicities under Cautions.)
With intracavitary administration into the pleural space, chest pain and fever.104 121 147 148 150 153 159 160 161 166
Drug | Interaction | Comments |
|---|---|---|
Antineoplastic agents | Increased risk of bleomycin-induced pulmonary toxicity121 | Use with caution; pulmonary toxicity possible at lower total bleomycin dosages121 |
Filgrastim and other cytokines | Increased risk of bleomycin-induced pulmonary toxicity121 | Use with caution; pulmonary toxicity possible at lower total bleomycin dosages121 |
Vitamins (e.g., vitamin C, riboflavin) | Bleomycin shown to be inactivated in vitro by ascorbic acid and riboflavin233 |
Not appreciably absorbed orally; must be administered parenterally for systemic effect.121
Following intrapleural administration, systemic absorption is about 45%.121 150 153
Improvement in Hodgkin’s disease or testicular cancer usually evident within 2 weeks.121
Improvement in squamous cell carcinoma usually evident within 3 weeks.121
Distributed mainly into skin, lungs, kidneys, peritoneum, and lymphatics in animals.121
Concentrations higher in tumor cells of skin and lungs relative to hematopoietic tissue.b
Metabolic fate not determined.b
Excreted principally in urine (60–70%) as active drug.b
Clcr>35 mL/minute: serum or plasma terminal half-life of about 2 hours.121
Clcr<35 mL/minute: terminal half-life inversely related to creatinine clearance.121
Moderately severe renal impairment (Clcr <35 mL/minute) decreases renal clearance; accumulation may occur with severe renal impairment.112 121
2–8°C; do not use after the expiration date is reached.121
Use reconstituted solutions stored at room temperature within 24 hours.121 b
Although stable for 2 weeks at room temperature or 4 weeks at 2–8°C, reconstituted solutions contain no preservatives; discard within 24 hours of reconstitution.b
For information on systemic interactions resulting from concomitant use, see Interactions.
Inactivated by agents containing sulfhydryl groups, hydrogen peroxide, and ascorbic acid.b
Forms Schiff base-type adducts with dextrose.106
CompatibleHID 121 |
|---|
Sodium chloride 0.9% |
Incompatible106 121 |
Dextrose 5% in water |
Compatible |
|---|
Amikacin sulfate |
Dexamethasone sodium phosphate |
Diphenhydramine HCl |
Fluorouracil |
Gentamicin sulfate |
Heparin sodium |
Hydrocortisone sodium phosphate |
Streptomycin sulfate |
Tobramycin sulfate |
Vinblastine sulfate |
Vincristine sulfate |
Incompatible |
Aminophylline |
Ascorbic acid injection |
Cefazolin sodium |
Diazepam |
Hydrocortisone sodium succinate |
Methotrexate |
Mitomycin |
Nafcillin sodium |
Penicillin G sodium |
Terbutaline sulfate |
Compatible |
|---|
Allopurinol sodium |
Amifostine |
Aztreonam |
Cefepime HCl |
Cisplatin |
Cyclophosphamide |
Doxorubicin HCl |
Doxorubicin HCl liposome injection |
Droperidol |
Etoposide phosphate |
Filgrastim |
Fludarabine phosphate |
Fluorouracil |
Gemcitabine HCl |
Granisetron HCl |
Heparin sodium |
Leucovorin calcium |
Melphalan HCl |
Methotrexate sodium |
Metoclopramide HCl |
Mitomycin |
Ondansetron HCl |
Paclitaxel |
Piperacillin sodium–tazobactam sodium |
Sargramostim |
Teniposide |
Thiotepa |
Vinblastine sulfate |
Vincristine sulfate |
Vinorelbine tartrate |
Antineoplastic antibiotic; active against gram-positive and gram-negative bacteria and fungi, but its cytotoxicity precludes its use as an anti-infective agent.b
Precise mechanism(s) of action not fully known but may involve inhibition of DNA synthesis and to a lesser extent inhibition of RNA and protein synthesis.121
Inhibits incorporation of thymidine into DNA.b
Exhibits no immunosuppressive activity.b
Advise patients about risk of pulmonary toxicity and to report any changes in pulmonary function (e.g., wheezing) to their clinician.b 121
Advise lymphoma patients of risk of severe idiosyncratic reactions (hypotension, mental confusion, fever, chills, wheezing).121
Advise patients to report any sudden onset of chest pain to their clinician.b 121
Advise patients of dermatologic and mucocutaneous effects and that they may not be apparent for several weeks after 100–200 units have been given.b 121
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.121
Importance of women informing clinicians if they are or plan to become pregnant or to breast-feed.121
Importance of informing patients of other important precautionary information.121 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Parenteral | For injection | 15 units (of bleomycin)* | Blenoxane | Bristol-Myers Squibb |
Bleomycin Sulfate for Injection | Bedford, Mayne, Sicor | |||
30 units (of bleomycin)* | Blenoxane | Bristol-Myers Squibb | ||
Bleomycin Sulfate for Injection | Bedford, Mayne, Sicor |
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions August 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
Only references cited for selected revisions after 1984 are available electronically.
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