Call your doctor for instructions if you miss a dose of epoetin alfa. What happens if I overdose? The offspring F1 generation of the treated rats were observed postnatally; rats from the F1 generation reached maturity and were mated; no Epogen-related effects were apparent for their offspring F2 generation fetuses. High blood pressure is a common side effect of Epogen in patients with chronic kidney disease. Your blood pressure may go up or be difficult to control with blood pressure medicine while taking Epogen. This can happen even if you have never had high blood pressure before. Your healthcare provider should check your blood pressure often. If your blood pressure does go up, your healthcare provider may prescribe new or more blood pressure medicine.
B12 deficiency: A condition that prevents the body from absorbing enough B12 in the diet. This can be caused by a weakened lining or an autoimmune condition. Besides anemia, can eventually result. High doses of B12 prevent long-term problems. OxyContin may cause severe hypotension, including orthostatic hypotension and syncope in ambulatory patients. If concomitant use is necessary, consider dosage reduction of OxyContin until stable drug effects are achieved. Monitor patients for respiratory depression and sedation at frequent intervals. Do not reuse the single-dose vials, syringes, or needles.
OxyContin relative to original OxyContin. Using the wrong syringe can lead to a mistake in your dose and you could inject too much or too little Epogen. Gingivitis. Using toothpastes containing zinc, with or without an antibacterial agent, appears to prevent plaque and gingivitis. Some evidence also shows that zinc-containing toothpaste can reduce existing plaque. However, other conventional treatments may be more effective. An iron test checks the amount of iron in the blood to see how well iron is in the body. There are no available data with OxyContin in pregnant women to inform a drug-associated risk for major birth defects and miscarriage.
Though blood transfusions are an effective treatment for sickle cell disease complications, they are only used selectively. The risks of and alloimmunization from repeat transfusions makes this procedure more suitable for severe and high-risk conditions. To decrease these risks, and risk of cardio and thrombovascular events, use the lowest dose needed to avoid red blood cell transfusions. Use ESAs in cancer patients only for the treatment of anemia related to concurrent myelosuppressive chemotherapy; discontinue ESA following completion of the chemotherapy course. ESAs are not indicated for patients receiving myelosuppressive therapy when the anticipated outcome is curative.
Dakin's solution is a type of solution. It is made from bleach that has been diluted and treated to decrease irritation. Chlorine, the active ingredient in Dakin's solution, is a strong antiseptic that kills most forms of bacteria and viruses. Lenalidomide: Erythropoiesis-Stimulating Agents may enhance the thrombogenic effect of Lenalidomide. Discuss the risks and benefits of hormone treatment with your doctor. The concomitant use of OxyContin with all cytochrome P450 3A4 inhibitors may result in an increase in oxycodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in an increase in oxycodone plasma concentration. Peptic ulcers. Taking zinc acexamate by mouth seems to help treat and prevent peptic ulcers. Epogen reduced the mean cumulative number of units of blood transfused per patient by approximately 40% as compared to the placebo group. Among those patients who required RBC transfusions at baseline, 43% of patients treated with Epogen versus 18% of placebo-treated patients were RBC transfusion-independent during the second and third months of therapy. Epogen therapy also resulted in significant increases in hemoglobin in comparison to placebo. Truvada may increase your risk of certain infections or autoimmune disorders by changing the way your immune system works. Symptoms may occur weeks or months after you start treatment with Truvada. Epogen. This dose will be measured in Units per mL or cc 1 mL is the same as 1 cc. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. Severe allergic reactions rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness; calf or leg pain, redness, tenderness, or swelling; chest, jaw, or left arm pain; confusion; coughing up blood; depression; fainting; fast or irregular heartbeat; fever, chills, or sore throat; muscle pain, weakness, or cramping; new or worsening pale skin color, or tiredness or weakness; numbness of an arm or leg; one-sided weakness; seizures; severe or persistent pain or irritation at the injection site; shortness of breath; sudden, severe headache, dizziness, or vomiting; sudden trouble walking, or loss of balance or coordination; swelling of the fingers, ankles, or legs; swelling or soreness of the mouth or tongue; symptoms of high blood sugar eg, increased thirst, hunger, or urination; drowsiness; flushing; rapid breathing; fruit-like breath odor; trouble swallowing; vision or speech problems; weight gain. Tell your doctor if you are also taking an oral iron supplement including ferrous gluconate, ferrous fumarate, or ferrous sulfate. Epoetin alfa is used to treat anemia caused by chemotherapy or chronic kidney disease, or anemia caused by taking zidovudine to treat HIV human immunodeficiency virus.
Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose. Benzyl alcohol has been associated with serious adverse events and death, particularly in pediatric patients. Male rats were dosed for 28 days before cohabitation with females, during the cohabitation and until necropsy 2-3 weeks post-cohabitation. Immunomodulators: Blood cancer drugs like thalidomide Thalomid and lenalidomide Revlimid treat anemia in MF. They, too, have side effects, including black or tarry stools, bleeding gums, and tingling pain in your hands or feet. And they lower the type of blood cells that help you fight off infections. Instruct patients not to share OxyContin with others and to take steps to protect OxyContin from theft or misuse. Epogen may cause serious side effects. You are able and willing to donate blood prior to surgery. Know the medicines you take. Get emergency medical help if you have signs of an allergic reaction to Truvada: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. FDA's Richard Pazdur, MD, said in a news conference. Blood transfusion is an effective and proven treatment for some severe complications of sickle cell disease. Epogen is formulated as a sterile, colorless liquid in vials in multiple formulations. May increase dose no more than every 4 weeks; may decrease dose more frequently. Avoid frequent dose adjustments. Blood Institute, National Institutes of Health 2002. The Management of Sickle Cell Disease NIH Publication No. 02-2117.
Evaluate transferrin saturation and serum ferritin prior to and during Epogen treatment. Indigo Carmine Aluminum Lake. Follow all directions on the product package. Physical dependence may not occur to a clinically significant degree until after several days to weeks of continued opioid usage. The potential for these risks should not, however, prevent the proper management of pain in any given patient. Patients at increased risk may be prescribed opioids such as OxyContin, but use in such patients necessitates intensive counseling about the risks and proper use of OxyContin along with intensive monitoring for signs of addiction, abuse, and misuse.
The safety of OxyContin in pediatric patients was evaluated in 155 patients previously receiving and tolerating opioids for at least 5 consecutive days with a minimum of 20 mg per day of oxycodone or its equivalent on the two days immediately preceding dosing with OxyContin. Patients were started on a total daily dose ranging between 20 mg and 100 mg depending on prior opioid dose. Do not shake the medicine. Prepare your dose only when you are ready to give an injection. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine. RBC transfusions during weeks 5-12. For patients who do not respond adequately over a 12-week escalation period, increasing the Epogen dose further is unlikely to improve response and may increase risks. Use the lowest dose that will maintain a hemoglobin level sufficient to reduce the need for RBC transfusions. Evaluate other causes of anemia. Discontinue Epogen if responsiveness does not improve. Mircera is only part of a treatment program that may also include diet, regular dialysis treatments, and special medical care. Follow your doctor's instructions very closely. The following dosing information is for use only in pediatric patients 11 years and older already receiving and tolerating opioids for at least five consecutive days. For the two days immediately preceding dosing with OxyContin, patients must be taking a minimum of 20 mg per day of oxycodone or its equivalent. OxyContin is not appropriate for use in pediatric patients requiring less than a 20 mg total daily dose. Table 1, based on clinical trial experience, displays the conversion factor when switching pediatric patients 11 years and older under the conditions described above from opioids to OxyContin. Nalbuphine hydrochloride is a synthetic opioid agonist-antagonist analgesic of the phenanthrene series. OxyContin is contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus. Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. Serious, life-threatening, or fatal respiratory depression may occur with use of OxyContin. Monitor for respiratory depression, especially during initiation of OxyContin or following a dose increase. Epogen that is written for healthcare professionals. Continue to follow your healthcare provider's instructions for diet, dialysis, and medicines, including medicines for high blood pressure, while taking Epogen. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your doctor before your blood sample is taken. Side Effects List Epogen Vial side effects by likelihood and severity. Yes, must have lived in the US or its territories for 6 months or longer. Because the duration of reversal is expected to be less than the duration of action of oxycodone in OxyContin, carefully monitor the patient until spontaneous respiration is reliably reestablished. OxyContin will continue to release oxycodone and add to the oxycodone load for 24 to 48 hours or longer following ingestion, necessitating prolonged monitoring.
Do not freeze Epogen. Do not use a vial of Epogen that has been frozen. Tmax and CL were similar 13. Taking iron supplements for tiredness can mask an iron problem. The plasma concentrations of oxycodone are only nominally affected by age, being 15% greater in elderly as compared to young subjects age 21-45. Although the risk of addiction in any individual is unknown, it can occur in patients appropriately prescribed OxyContin. Addiction can occur at recommended doses and if the drug is misused or abused. RBC transfusions. In each trial, no benefits occurred for the cardiovascular or end-stage renal disease outcomes. If the previous weekly epoetin alfa dose was less than 8000 units per week or the previous weekly darbepoetin alfa dose was less than 40 mcg per week, then the epoetin beta-methoxy polyethylene glycol dose would be 120 mcg per month or 60 mcg every two weeks. Patient education on lifestyle changes and self-care to promote wellness. Epogen passes into breast milk. Remember that your doctor has prescribed this because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication not have serious side effects. Wash your hands well with soap and water before preparing the medicine.
Store at room temperature away from light and moisture. not store in the bathroom. Keep all away from children and pets. Ask you to review the Epogen Medication Guide. DVT prophylaxis is recommended in perisurgery patients due to the increased risk of DVT. Increased mortality was also observed in patients undergoing coronary artery bypass surgery who received epoetin alfa; these deaths were associated with thrombotic events. Epoetin alfa is not approved for reduction of red blood cell transfusion in patients undergoing cardiac or vascular surgery and is not indicated for surgical patients willing to donate autologous blood. How should I dispose of the vials, syringes, and needles? Ask your health care provider any questions you may have about how to use epoetin alfa. The data below were obtained in Study C1, a 16-week, double-blind, placebo-controlled study that enrolled 344 patients with anemia secondary to chemotherapy. Tylenol, Advil, and Aleve. Flip off the protective color cap on the top of the vial. Do not remove the grey rubber stopper. Wipe the top of the grey rubber stopper with an alcohol wipe. Asthma. Zinc intake does not appear to be linked to the risk for developing asthma in children. Alcohol-related liver disease. Taking zinc sulfate by mouth might improve liver function in people with alcohol-related liver disease. Instead of using the drugs to bring patients' red blood cell counts up to minimum levels, they began using it to bring blood cell counts as close to normal as possible. Fueling the process was a rebate scheme in which the companies making the drugs paid doctors millions of dollars to give the drugs to their patients. Do not change your dose. Take OxyContin exactly as prescribed by your healthcare provider. Use the lowest dose possible for the shortest time needed. Loss in brain function due to liver problems Hepatic encephalopathy. Research suggests that taking zinc acetate improves some measures of mental function in people with hepatic encephalopathy. However, other research suggests that zinc sulfate does not improve brain function in people with this condition. Taking more than 100 mg of supplemental zinc daily or taking supplemental zinc for 10 or more years doubles the risk of developing prostate cancer. There is also concern that taking large amounts of a multivitamin plus a separate zinc supplement increases the chance of dying from prostate cancer.
Monitor platelet count regularly during the first 8 weeks of therapy. PERISURGERY: Due to increased risk of Deep Venous Thrombosis DVT DVT prophylaxis is recommended. According to the BMJ report, the company re-analyzed in 2012, finding that blood-level monitoring and adjusting the dose could lower major bleeding problems by 30% or 40% compared to warfarin -- but regulators and doctors weren't informed, the report says. The company refutes this. OxyContin, like other opioids, can be diverted for non-medical use into illicit channels of distribution. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests, as required by state and federal law, is strongly advised. The tablet strengths describe the amount of oxycodone per tablet as the hydrochloride salt. The oxycodone in OxyContin may cause spasm of the sphincter of Oddi. Opioids may cause increases in the serum amylase. Monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms. Holistic practitioners use a variety of treatment techniques to help their patients take responsibility for their own well-being and achieve optimal health. The 60 mg tablets also contain polysorbate 80, red iron oxide and black iron oxide. OxyContin may reduce respiratory drive, and the resultant CO 2 retention can further increase intracranial pressure. Monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy with OxyContin. Feraheme ferumoxytol is a type of iron. You normally get iron from the foods you eat. In your body, iron becomes a part of your hemoglobin HEEM o glo bin and myoglobin MY o glo bin. Hemoglobin carries oxygen through your blood to tissues and organs. Myoglobin helps your muscle cells store oxygen. Chemotherapy that will be used for at least two months after starting Epogen. In rare cases, the vein may become swollen after the blood sample is taken. Pull the needle out of the skin and press a cotton ball or gauze over the injection site and hold it there for several seconds. Do not recap the needle. Pressure ulcers. Taking zinc by mouth or applying zinc paste appears to help improve pressure ulcer healing. X-rays, to reduce the size of your spleen. Marijuana is an herb. It contains chemicals called cannabinoids that affect the central nervous system. Cannabinoids are found in the highest concentration in the leaves and flowers, the parts that are used to make medicine.
This product passes into milk. While there have been no reports of harm to nursing infants, consult your doctor before -feeding. How often did hospital staff describe possible side effects in a way you could understand? Epogen arm 96% vs. 58%. American Stroke Association. Stroke. The name Epogen appears on the carton and vial label. Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. The 20 mg tablets also contain polysorbate 80 and red iron oxide. This list is not complete. Other drugs may interact with emtricitabine and tenofovir, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Not every urine drug test for “opioids” or “opiates” detects oxycodone reliably, especially those designed for in-office use. Further, many laboratories will report urine drug concentrations below a specified “cut-off” value as “negative”. Therefore, if urine testing for oxycodone is considered in the clinical management of an individual patient, ensure that the sensitivity and specificity of the assay is appropriate, and consider the limitations of the testing used when interpreting results. However, body weight of these pups recovered. Contact your doctor if these problems occur. Clean the skin with an alcohol wipe where the injection is to be made. Be careful not to touch the skin that has been wiped clean. Oxycodone may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.
Discard 21 days after initial entry. Note that many zinc products also contain another metal called cadmium. This is because zinc and cadmium are chemically similar and often occur together in nature. Exposure to high levels of cadmium over a long time can lead to kidney failure. The concentration of cadmium in zinc-containing supplements can vary as much as 37-fold. Look for zinc-gluconate products. Zinc gluconate consistently contains the lowest cadmium levels. Effective for. Epoetin alfa contains albumin, which comes from human blood. There is a very rare risk of getting a viral disease or a central nervous system disease called Creutzfeldt-Jakob disease from products with albumin. No cases of these problems have been found in patients who have used epoetin alfa. F. Do not freeze. Do not shake. Protect from light. Opioids are sought by drug abusers and people with addiction disorders and are subject to criminal diversion. Consider these risks when prescribing or dispensing OxyContin. In rare cases, too much iron may be lost through the because of a disease such as or in the urine. Follow a conservative approach to dose initiation and adjust according to the clinical situation. OxyContin oxycodone hydrochloride extended-release tablets 30 mg are film-coated, round, brown-colored, bi-convex tablets debossed with OP on one side and 30 on the other and are supplied as child-resistant closure, opaque plastic bottles of 100 NDC 59011-430-10 and unit dose packaging with 10 individually numbered tablets per card; two cards per glue end carton NDC 59011-430-20. Blood transfusions reduce the risk of some complications of sickle cell disease and reduce symptoms of severe anemia. Zinc is a metal. It is called an "essential trace element" because very small amounts of zinc are necessary for human health. Hemoglobin reaches a level needed to avoid RBC transfusion. People with anemia have a lower-than-normal number of RBCs. Last-known RBC transfusion status carried forward for patients who discontinued treatment.
Consider how comfortable you are with the provider. Does he or she make you feel at ease? Disseminated intravascular coagulation DIC: A condition that causes tiny blood clots and areas of bleeding throughout the body simultaneously; severe infections, surgery, or complications of are conditions that can lead to DIC. The multiple-dose vials are formulated with benzyl alcohol. The incidence of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody including neutralizing antibody positivity in an assay may be influenced by several factors, including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to Epogen with the incidence of antibodies to other products may be misleading. An checks the amount of iron in the blood to see how well iron is in the body. AZT used to treat HIV infection. The 15 mg tablets also contain black iron oxide, yellow iron oxide, and red iron oxide. If you are using the liquid form, use a medication-measuring device or spoon to carefully measure the prescribed dose. not use a household spoon because you may not get the correct dose. While using Truvada, you may need frequent blood tests. Your kidney and liver function, or bone mineral density may also need to be checked.
Taking 450 mg or more of zinc daily can cause problems with blood iron. Single doses of 10-30 grams of zinc can be fatal. The starting dosage for patients who are not opioid tolerant is OxyContin 10 mg orally every 12 hours. Oncology: The American Society of Clinical Oncology ASCO and American Society of Hematology ASH 2010 updates to the clinical practice guidelines for the use of ESAs in patients with cancer indicate that ESAs are appropriate when used according to the parameters identified within the FDA approved labeling for epoetin and darbepoetin alfa Rizzo 2010. Store Mircera in the refrigerator. Do not freeze. Keep the medicine in the original container until you are ready to give an injection. Use the other hand to pinch a fold of skin at the cleaned injection site. Do not touch the cleaned area of skin. Chronic use of opioids may cause reduced fertility in females and males of reproductive potential. Amount of iron needed to bind to all of the transferrin. This value is called the total iron-binding capacity TIBC. Attach a tube to the needle to fill it with blood. Oxycodone was genotoxic in the in vitro mouse lymphoma assay. Oxycodone was negative when tested at appropriate concentrations in the in vitro chromosomal aberration assay, the in vitro bacterial reverse mutation assay Ames test and the in vivo bone marrow micronucleus assay in mice. Amount of iron bound to transferrin in the blood serum. If your symptoms do not improve or if they become worse, check with your doctor. OxyContin should be taken 1 tablet at a time. Do not pre-soak, lick, or wet the tablet before placing in your mouth to avoid choking on the tablet. No trial has identified a hemoglobin target level, E SA dose, or dosing strategy that does not increase these risks. Taking in the 48 hours before the iron test.
This medication is usually taken by with each meal. The dosage is based on your medical condition and response to treatment. This medication is injected into a muscle as directed by your doctor, usually every 3 to 4 weeks. The dosage is based on your medical condition and response to treatment. All patients received oral iron and a low-dose, warfarin regimen. Wang WC 2009. Sickle cell anemia and other sickling syndromes. Inform patients that chronic use of opioids may cause reduced fertility. See “What are the possible side effects of Epogen? Do not dilute epoetin alfa. Do not mix it with other solutions unless your doctor directs you otherwise. Advise patients to flush the unused tablets down the toilet when OxyContin is no longer needed. Keep the needle inside the vial. Turn the vial and syringe upside down. Be sure the tip of the needle is in the Epogen liquid. Keep the vial upside down. Slowly pull back on the plunger to fill the syringe with Epogen liquid to the number mL or cc that matches the dose your healthcare provider prescribed. Use Mircera exactly as it was prescribed for you. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Never use more than your recommended dose. If you are using this medication at home, learn all preparation and usage instructions from your professional. Your should be checked often. Ask your doctor if you should learn how to check your own pressure. If develops or worsens, follow your doctor's instructions about diet changes and starting or adjusting your medication.
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Epogen and other ESAs increased the risk of death, myocardial infarction, stroke, congestive heart failure, thrombosis of hemodialysis vascular access, and other thromboembolic events in the higher target groups. Refer to storage information printed on the package. Be sure that you read, understand, and follow the “Instructions for Use” that come with Epogen. The rate of hemoglobin increase varies among patients and is dependent upon the dose of Epogen administered. Some people use marijuana recreationally to create a sense of well being or to alter the senses. It is either taken by mouth or smoked inhaled.
Lower the risk of in infants and children. Concomitant use of OxyContin with CYP3A4 inducers or discontinuation of a CYP3A4 inhibitor could decrease oxycodone plasma concentrations, decrease opioid efficacy or, possibly, lead to a withdrawal syndrome in a patient who had developed physical dependence to oxycodone. Take Epogen exactly as your healthcare provider tells you to. Do not change the dose of Epogen unless told to do so by your healthcare provider. Limit dosages and durations to the minimum required. To enroll in the ESA APPRISE Oncology Program, visit www.
Anaphylaxis: Anaphylaxis has been reported with ingredients contained in OxyContin. Lai says Procrit, Epogen, and Aranesp have complex effects on tumors -- effects that are not yet fully known. The drugs seem to have different effects on different tumors. With anemia, your body has too few red blood cells.
Follow your doctor's instructions exactly. Seek counseling from a therapist to help you cope with having cancer. Talking to other people who have the disease or their caregivers may help you handle yours better, too. The Leukemia and Lymphoma Society and American Cancer Society both offer online support and local groups. Epogen caused slight increases in pre-implantation loss, post-implantation loss and decreases in the incidence of live fetuses. It is not clear whether these effects reflect a drug effect on the uterine environment or on the conceptus. Interferon alfa-2a: Injections may help with this condition.