Thalidomide

Thalidomide, drug introduced in 1953, initially prescribed for its sedative properties and widely used by women to alleviate the nausea and vomiting common in the early stages of pregnancy. Thalidomide gained notoriety in 1961 when it was found to cause severe malformations in the growing fetus such as stunted development or the complete absence of limbs. More than 10,000 children were born with these disabling abnormalities before the drug was taken off the market. This disaster triggered more rigorous government regulations for drug testing. Today thalidomide is used in the treatment of leprosy, and experimentally in bone-marrow transplant patients and certain immune system disorders.

HISTORY

While its commercial distribution was halted, thalidomide continued to be used in experimental studies for a variety of diseases. A series of studies beginning in the mid-1960s showed that thalidomide was effective in treating a leprosy-related disorder, erythema nodosum leprosum (ENL). A serious skin disorder, ENL usually develops in leprosy patients after they begin taking antibiotics to combat the leprosy-causing bacterium Mycobacterium leprae. ENL is believed to be caused by an abnormal immune reaction to the killed bacteria.

The FDA approved thalidomide for the treatment of ENL in July 1998, at the same time placing unprecedented restrictions on the drug’s use. Under these restrictions, thalidomide can only be obtained from selected doctors and pharmacies that have agreed to follow a strict protocol designed to prevent birth defects from the drug. Both men and women taking the drug must use birth control during sexual intercourse, and women must also agree to undergo periodic pregnancy tests.

Thalidomide’s success in treating ENL, although not fully understood, triggered extensive studies into the drug’s effects on the immune system. Some studies suggest that thalidomide reduces the production of tumor necrosis factor-alpha (TNF-a), a protein made by immune cells that may cause problems such as wasting, or chronic weight loss, when produced in excessive amounts. Thalidomide has also been proven to heal painful canker sores in the mouth of patients with acquired immunodeficiency syndrome (AIDS) or other patients with impaired immune systems. Canker sores in these patients do not heal as readily as in people with normal immune systems, and the sores make eating difficult.

Early evidence suggests that thalidomide effectively suppresses the body’s rejection of donor bone marrow that sometimes occurs in bone-marrow transplant patients. Thalidomide is also being studied as a possible treatment for various cancers and other diseases because of its ability to inhibit growth of new blood vessels. This inhibition could slow or completely prevent growth of cancerous tumors that require new blood vessels in order to thrive.

RECENT USES

While its commercial distribution was halted, thalidomide continued to be used in experimental studies for a variety of diseases. A series of studies beginning in the mid-1960s showed that thalidomide was effective in treating a leprosy-related disorder, erythema nodosum leprosum (ENL). A serious skin disorder, ENL usually develops in leprosy patients after they begin taking antibiotics to combat the leprosy-causing bacterium Mycobacterium leprae. ENL is believed to be caused by an abnormal immune reaction to the killed bacteria.

The FDA approved thalidomide for the treatment of ENL in July 1998, at the same time placing unprecedented restrictions on the drug’s use. Under these restrictions, thalidomide can only be obtained from selected doctors and pharmacies that have agreed to follow a strict protocol designed to prevent birth defects from the drug. Both men and women taking the drug must use birth control during sexual intercourse, and women must also agree to undergo periodic pregnancy tests.

Thalidomide’s success in treating ENL, although not fully understood, triggered extensive studies into the drug’s effects on the immune system. Some studies suggest that thalidomide reduces the production of tumor necrosis factor-alpha (TNF-a), a protein made by immune cells that may cause problems such as wasting, or chronic weight loss, when produced in excessive amounts. Thalidomide has also been proven to heal painful canker sores in the mouth of patients with acquired immunodeficiency syndrome (AIDS) or other patients with impaired immune systems. Canker sores in these patients do not heal as readily as in people with normal immune systems, and the sores make eating difficult.

Early evidence suggests that thalidomide effectively suppresses the body’s rejection of donor bone marrow that sometimes occurs in bone-marrow transplant patients. Thalidomide is also being studied as a possible treatment for various cancers and other diseases because of its ability to inhibit growth of new blood vessels. This inhibition could slow or completely prevent growth of cancerous tumors that require new blood vessels in order to thrive.

Hallucinogen

Hallucinogen, any one of a large number of natural or synthetic psychoactive drugs that produce marked distortions of the senses and changes in perception. Hallucinogens generally alter the way time is perceived, making it appear to slow down. As the name suggests, hallucinogens may produce hallucinations, which are shape- and color-shifts in the appearance of the outside world or, in extreme cases, the replacement of external reality with imaginary beings and landscapes. Hallucinogens may also lead to bizarre and antisocial thoughts as well as to disorientation and confusion. The physiological basis of such experiences is not clear, but evidence suggests that hallucinogens work by inhibiting the availability of serotonin, an important neurotransmitter in the brain.

The best-known and most potent hallucinogen is lysergic acid diethylamide (LSD). Other hallucinogens include psilocybin, which comes from certain species of mushrooms, and mescaline, which is derived from a cactus called peyote. These drugs are of medical interest because they produce effects similar to the symptoms of schizophrenia, a severe mental illness accompanied by distortions of reality. Some researchers believe that a hallucinogen-induced state can be used as a model to study schizophrenia.

Hallucinogens may be taken orally, injected, or, in the case of marijuana (a mild hallucinogen), smoked and inhaled. They usually take effect within an hour and cause increases in blood pressure, body temperature, and pulse rate as well as dilation, or enlargement, of the pupils of the eyes. These drugs may also cause nausea and numbness.

Individual reactions to hallucinogens are unpredictable, especially when these drugs are used recreationally—that is, for the pleasurable effects they produce and not for medical purposes. The experience of the drug may be pleasurable one day and highly disturbing the next, depending on the setting and circumstances in which the drug is taken and the individual’s personality and mood at the time. The effects of hallucinogenic drugs may last from a few hours to several days, and may recur months later in what are referred to as flashbacks.

Most hallucinogens do not cause physical dependence with chronic use, although tolerance of behavioral effects can develop, in which case more of the drug is needed to create the same mental states (see Drug Dependence).

Cyclosporine

Cyclosporine, name of a drug approved for clinical use in the United States in 1983. The drug is important because of its ability to suppress the action of the body's immune system in rejecting foreign tissues following organ transplant operations (see Medical Transplantation). Specifically, it blocks the activity of certain cells in the immune system called T cells, which, in combination with cells in the bloodstream, would otherwise tend to attack the tissues of the transplanted organs. Operations of this nature have proved successful a great percentage of the time when using cyclosporine. There is some risk of potentially severe kidney damage, however, so care must be taken in administering the drug. Cyclosporine occurs naturally in a certain Norwegian fungus, Tolypocladium inflatum.

Ciprofloxacin

Ciprofloxacin, drug used to treat bacterial infections in the lower respiratory tract, urinary tract, bones, joints, and skin. It is also used to treat serious ear infections, cholera, tuberculosis, infectious diarrhea, and infections associated with acquired immunodeficiency syndrome (AIDS). Ciprofloxacin is prescribed after exposure to the bacteria that cause anthrax to reduce the incidence or progression of the disease. For maximum effectiveness against inhalation anthrax, the most dangerous form of the disease, the drug should be administered as soon as possible after exposure, even before symptoms appear. Ciprofloxacin works by blocking the action of gyrase, an enzyme needed by the invading bacteria for cell reproduction, thereby slowing or completely stopping bacterial growth.

The drug is available by prescription in tablets, which are taken orally with or without food, and in a liquid, which is used in the form of eyedrops. Depending on the severity of infection, dosages for tablets range from 250 to 750 mg taken every 12 hours. Eyedrops are typically prescribed as one or two drops every 2 to 4 hours for the treatment of bacterial eye infections. Patients taking ciprofloxacin should drink plenty of fluids but avoid excessive caffeine. Pregnant women, breast-feeding women, and children under the age of 18 should not take this drug.

Possible side effects include abdominal pain, nausea, vomiting, headache, skin rash, sensitivity to light, or restlessness. Serious side effects should be reported to a doctor, as allergic reactions to this drug, while rare, can be fatal. Allergic symptoms may include facial swelling, shortness of breath, tingling or itching, hives, or unconsciousness.

Patients with severe liver disease, impaired kidney function, or with epilepsy or other disorders or injuries affecting the central nervous system should use this drug with caution. Those who experience dizziness or lightheadedness with this medication should not drive, operate dangerous machinery, or engage in other risk-related activities. Because of the possible risk of tendon rupture, strenuous physical activity should be avoided or approved by a doctor.

Ciprofloxacin should not be combined with the drug theophylline, as serious or fatal reactions can result. It may interact adversely with phenytoin and warfarin. Ciprofloxacin may be less effective when used in combination with vitamin supplements containing zinc or iron or with antacids containing calcium, aluminum, or magnesium.

Brand Names: Cipro, Ciloxan

Cimetidine

Cimetidine, drug used in the treatment of stomach and intestinal ulcers. It is used to treat reflux disease, a condition in which stomach acids back up into the esophagus causing heartburn, and to prevent upper abdominal bleeding. Cimetidine is also used to treat chronic hives, acne, herpes infections (including shingles), excessive hair growth in women, and an overactive parathyroid gland.

Cimetidine blocks the action of histamine, a chemical in the body that stimulates acid secretions in the stomach. When histamine action is blocked, secretion of stomach acid decreases, allowing ulcers and other gastrointestinal ailments to heal.

This drug is available by prescription in tablet and liquid form, both taken orally, and in a liquid form that is injected. Depending on the condition being treated, typical dosages range from 800 to 1200 mg per day. Cimetidine may be taken in a single dose at bedtime or divided into two or four smaller doses, usually taken immediately after a meal. Relief of symptoms may take several days. Recurrence of ulcers after cimetidine treatment ends may be slightly higher than with other forms of treatment.

Patients taking this drug should avoid alcohol, cigarette smoking, and excessive caffeine. Patients should refrain from taking antacids within one to two hours of a cimetidine dose. This drug has not been proven safe for pregnant or nursing women or for children under the age of 16. It should be used with caution by patients with impaired liver or kidney function. It should not be stopped abruptly by patients taking it for peptic ulcer disease.

Breast development in men and headaches are the two most common side effects of this drug. Less common side effects are diarrhea, dizziness, anemia, hair loss, impotence, joint or muscle pain, skin rash or inflammation, rapid or slow heartbeat, and sleepiness. With prolonged use (one month or more), some patients experience anxiety, confusion, depression, or hallucinations. These reactions are more likely to occur in elderly or severely ill patients, but they are temporary and subside several days after drug treatment ends.

Cimetidine may interact adversely with a variety of drugs, including medications for diabetes, heart palpitations, and fungal infections as well as blood pressure drugs (both beta blockers and calcium blockers), benzodiazepine tranquilizers (such as diazepam), narcotic pain relievers, nicotine, and aspirin. Other drugs that may interact adversely include chlorpromazine, cyclosporine, digoxin, metoclopramide, metronidazole, paroxetine, pentoxifylline, phenytoin, quinine, sucralfate, theophylline, and warfarin.

Brand Name:Tagamet

Theophylline

Theophylline, prescription drug used to treat asthma, a chronic disease of the respiratory system. It is also used to treat asthmalike symptoms in patients with emphysema, chronic bronchitis, and pulmonary (lung) disease. Theophylline is sometimes used to treat breathing problems in infants at risk for sudden infant death syndrome (SIDS). As a bronchodilator, the drug works by relaxing constricted muscles of the lung’s bronchi, the two branches of the trachea (windpipe) that lead to the lungs. It also opens blood vessels in the lungs, improving circulation.

Theophylline is available in capsule, tablet, and liquid form. All are taken orally, usually with food to prevent stomach irritation. Dosage in children under the age of 16 is based on body weight. Adult dosages usually start at 200 mg taken twice a day, which may be increased if needed. The maximum adult dose is 900 mg per day. Effectiveness is usually apparent within 48 to 72 hours.

Patients with peptic ulcers, seizure disorders, impaired liver or kidney function, high blood pressure, irregular heartbeat, or heart disease should use this drug with caution. Theophylline should not be used by breast-feeding women and should be avoided during pregnancy.

Side effects may include nausea or restlessness, especially when starting treatment with theophylline. Other possible side effects are diarrhea, headache, increased urination, insomnia, low blood pressure, or skin rash. Changes in heart rate, another possible side effect, should be checked by a doctor. Symptoms of overdose can include the side effects described above or more severe effects including high fever, convulsions, or coma.

Theophylline may interact adversely with the medication in a flu shot. It also may interact with cimetidine, ciprofloxacin, clarithromycin, doxycycline, erythromycin, phenytoin, propanolol, and birth control pills.

Brand Names: Slo-bid, Theo-dur

Bronchodilator

Bronchodilator, any of a group of drugs that expand the air passages (bronchial tubes) of the lungs. Bronchodilators are used to treat asthma, bronchitis, emphysema, and other diseases that affect the lungs. They relieve symptoms such as wheezing, shortness of breath, and coughing, and restore the patient’s ability to breathe comfortably.

Bronchodilators work in various ways. Some, such as albuterol, affect the sympathetic nervous system, dilating the walls of the bronchial tubes. Others, such as theophylline, interfere with the action of certain enzymes or cells within the lungs, relaxing the constricted muscles of the airway.

Many bronchodilators are inhaled through the mouth, especially those that provide immediate relief from an asthma attack. Some are taken orally in tablet or liquid form while others are injected into the skin. Inhaled bronchodilators are often prescribed with a dosage of 1 or 2 inhalations up to 4 times per day. A typical tablet dosage is 2 to 4 mg taken 3 to 4 times per day. Some bronchodilators begin to work within minutes of a dose. Others are not designed for immediate relief of symptoms and may take several weeks to take effect.

Patients taking bronchodilators are usually cautioned to avoid using other drugs to treat their symptoms, especially inhaled medications, unless a doctor advises otherwise. The effect of bronchodilators on pregnant women has not been well-studied in humans, although some types of bronchodilators produce birth defects in animals when administered in high doses.

Astemizole

Astemizole, antihistamine drug that is used to treat hay fever and recurring hives. It works by blocking the action of histamine (a chemical released by the body during allergic reactions) that contributes to swelling and itching of the nose, eyes, and skin.

Astemizole is available only by prescription. It comes in tablet form and is taken orally on an empty stomach (one hour before or two hours after a meal). The typical dosage for adults and children over age 12 is 10 mg once a day. It has not been proven safe for children under age 12. The drug starts to be effective within one hour of treatment.

Astemizole is often prescribed for use over several weeks. It helps control the appearance of hives and hay fever symptoms but does not provide immediate relief. Patients should not take more than a single, prescribed dose—even if symptoms are severe or a dose was missed—because overdose reactions are severe and may include fainting, irregular heartbeat, seizures, or cardiac arrest.

Possible side effects include drowsiness, dry mouth or throat, fatigue, headache, or increased appetite. Less common are depression, diarrhea, dizziness, itching or tingling, joint or muscle pain, nervousness, nausea, nosebleed, skin rash, or sore throat. Patients with asthma, liver disease, or kidney disease should use this drug with caution. Astemizole may interact adversely with certain types of drugs, including antibiotics, antifungal drugs (especially ketoconazole), and drugs that affect heart rhythms. Its safety during pregnancy and nursing is not known.

In 1998 the Food and Drug Administration (FDA) issued an alert warning that astemizole can cause death due to irregular heart rhythms if taken with certain other drugs or used at higher than recommended doses. The FDA cautioned that in addition to those drugs previously known to have adverse interactions with astemizole, several other drugs should be avoided by those taking astemizole. These include the antidepressants fluoxetine (marketed under the brand name Prozac), fluvoxamine (Luvox), setraline (Zoloft), nefazodone (Serzone), and paroxetine (Paxil); the AIDS drugs known as protease inhibitors; and the anti-asthma medication zileuton (Zyflo). The FDA also warned against drinking grapefruit juice while taking astemizole, because grapefruit juice slows down the metabolism of astemizole by the liver.

Brand Name: Hismanal

Fexofenadine

Fexofenadine, prescription drug used primarily to treat hay fever, also effective against hives and cold symptoms.

As an antihistamine, fexofenadine works by blocking the action of histamine, a chemical released during allergic reactions that contributes to swelling and itching of mucous membranes in the nose, eyes, and throat. Tablets of fexofenadine are taken orally, preferably with food to avoid stomach irritation. The typical dose is 60 mg taken twice a day. Effectiveness is usually apparent within one hour.

Fexofenadine should be used with caution in patients with hypertension, diabetes mellitus, ischemic heart disease, increased intraocular pressure, hyperthyroidism, renal impairment, or prostatic hypertrophy. This drug should not be used by breast-feeding women or children under the age of 12. Its safety for use during pregnancy has not been determined.

Possible side effects include headache, insomnia, cold or flu, nausea, fatigue, indigestion, and menstrual pain. Unlike many other antihistamines, fexofenadine causes little or no drowsiness. Symptoms of overdose may include fainting, confusion, irregular heartbeat, or seizures.

Brand Name: Allegra

Beclomethasone Dipropionate

Beclomethasone Dipropionate, steroid drug used to treat breathing problems associated with such disorders as hay fever and asthma. It is especially effective following the surgical removal of polyps (tumorous cell masses) in the nose. Beclomethasone dipropionate works by keeping open the bronchial tubes that lead into the lungs and by reducing inflammation in the tissues of the respiratory tract.

This drug is available by prescription as a nasal spray or as an oral inhalant. It is usually prescribed for adults in doses of two oral inhalations—or one to two nasal sprays—up to four times a day. More severe conditions may require heavier dosages, although the inhalant form should not be used more than 20 times in one day. Children six years old and older can use this drug, although prescribed dosages are usually smaller with ten inhalations per day as the maximum. The drug may take effect within three days but may take as long as two weeks after beginning treatment.

Unlike many inhalant medications and nasal sprays, beclomethasone dipropionate does not provide immediate relief from respiratory difficulties. Instead, it helps control symptoms and may improve the effectiveness of other drugs, particularly inhaled bronchodilators.

Possible side effects may include dry mouth, fungus infections in the mouth or throat, fluid retention, hives, hoarseness, wheezing, or skin rash. The nasal spray form of this drug may additionally cause headache, nausea, nasal irritation or congestion, nosebleed, tearing eyes, sneezing, light-headedness, or infection. Children using this drug should be monitored for potential side effects such as weight gain, increased tendency to bruise, swelling of the face, reduced growth rate, or impaired mental status.

Patients with impaired liver function or a history of tuberculosis should use this drug with caution. Patients starting treatment after taking steroids in tablet form should be closely monitored by a doctor to avoid adrenal insufficiency, a condition in which the body’s steroid levels drop to unhealthy amounts. Patients who have not been vaccinated (see immunization) should avoid exposure to chicken pox and measles, as contracting one of these diseases while taking this drug could prove harmful. Its safety for use by pregnant or nursing women has not been adequately studied. This drug can be combined with most other medications, although use with bronchodilators should be approved by a doctor.

Brand Names: Beclovent, Beconase, Vancenase, Vanceril

Antihistamine

Antihistamine is any drug that blocks the action of histamine. Antihistamines are used primarily to control symptoms of allergic conditions such as hay fever. They alleviate runny nose and sneezing and, to a lesser extent, minimize conjunctivitis and breathing difficulties. Antihistamines can also alleviate itching and rash caused by food allergy. Chemically, antihistamines comprise several classes, and a person who does not obtain relief from one type may benefit from another. Side effects of these drugs can include drowsiness, loss of concentration, and dizziness. People taking antihistamines should not drink alcoholic beverages or perform tasks requiring mental alertness, such as driving. A few antihistamines, such as terfenadine and astemizole, are nonsedating. Although antihistamines are included in many over-the-counter cold remedies, their usefulness in such preparations is questionable. Antihistamines may relieve symptoms of allergy accompanying a cold, or they may have an anticholinergic effect that dries cold secretions, but they do not have any influence on viral infections, which are the cause of colds. Moreover, the drying effect may be undesirable, especially for persons with bronchial infection, glaucoma, or urinary tract difficulties.

Barbiturate

Barbiturate, any of an important group of drugs that depress brain function; they are derived from barbituric acid (C4H4N2O3), a combination of urea and malonic acid. Depending on the dosage or formulation, barbiturates have a sedative (tranquilizing), hypnotic (sleep-inducing), anticonvulsant, or anesthetic effect. Very short-acting barbiturates such as thiopental are injected intravenously to induce rapid anesthesia before surgery. Phenobarbital, a long-acting barbiturate, is prescribed with other medications to prevent epileptic seizures. Other barbituric-acid derivatives, such as secobarbital, were used as antianxiety medications until the development of the tranquilizer; they are still in use for the short-term treatment of insomnia, although tranquilizers are more suitable sleep inducers. Barbiturates are common drugs of abuse. Taken orally or intravenously, they produce symptoms similar to drunkenness: loss of inhibition, boisterous or violent behavior, muscle incoordination, depression, and sedation. They are physically addicting and produce severe withdrawal symptoms; overdoses can cause profound shock, coma, or death. See Drug Dependence.

Beta Blocker

Beta Blocker, any of a group of drugs used to treat various disorders associated with the circulatory system. These disorders include high blood pressure (hypertension), angina pectoris (chest pains caused by reduced oxygen flow to the heart muscle), irregular heartbeat, and migraine headache. Beta blockers are also effective in treating glaucoma, an eye disorder characterized by excessive pressure within the eye.

Properly known as beta-adrenergic blocking drugs, these drugs interfere with actions of the sympathetic nervous system, which controls involuntary muscle movement. They slow the heart rate, relax pressure in blood vessel walls, and decrease the force of heart contractions. In the eye they reduce the formation of excess fluid. Specific beta blockers include timolol, atenolol, and metoprolol.

Beta blockers are prescription drugs available as tablets taken in one or more doses ranging from 2.5 to 1200 mg per day, depending on the drug. Eye drops are administered as a single drop once or twice per day. Effectiveness is usually apparent after one to two weeks of treatment. Patients taking beta blockers should not stop taking them abruptly, as their condition may worsen. These drugs are not recommended for use during pregnancy.

Possible side effects associated with beta blockers include depression, diarrhea, light-headedness, itching, rash, nausea, fatigue, shortness of breath, and a slow heartbeat. Beta blockers may interact adversely with digoxin, diltiazem, verapamil, chlochlorpromazine, and haloperidol.

Triamcinolone

Triamcinolone, steroid drug used to treat breathing problems associated with such disorders as hay fever and asthma. Triamcinolone works by keeping open the bronchial tubes (the two divisions of the windpipe leading into the lungs) and reducing inflammation in the mucous tissues of the respiratory tract. It is also effective in treating inflamed areas of the skin as well as growths (polyps) inside the nose.

This drug is available by prescription only in several forms, including an oral inhalant, tablets, cream and ointment forms applied topically, and a liquid form that is injected. Triamcinolone is usually prescribed for adults in 2 inhalations, two to three times a day, with a maximum of 16 inhalations per day. The tablet dosage ranges from 4 to 48 mg per day. Tablets may be taken with food to avoid stomach upset. Children 6 to 12 years old can use this drug, although prescribed dosages are usually smaller. Effectiveness is typically apparent within one to two weeks of treatment.

Triamcinolone does not provide immediate relief from respiratory difficulties, but helps alleviate symptoms. Long-term treatment with this drug (months to years) is sometimes prescribed to control asthma.

Possible side effects may include a dry mouth or throat, fluid retention, hoarseness, wheezing, skin rash, headache, memory loss, weight loss, nasal irritation or congestion, nosebleed, sneezing, or fungal infections in the mouth or throat.

Patients with bronchitis or a systemic fungal infection should not use this drug. It should be used with caution by patients with diabetes, glaucoma (an eye disorder), peptic ulcer, myasthenia gravis (muscle weakness), or a history of tuberculosis. Its safety for pregnant or breast-feeding women has not been adequately studied. Unvaccinated patients taking triamcinolone should avoid exposure to chicken pox and measles.

This drug may interact adversely with bronchodilators (both inhaled and tablet forms), warfarin, diabetes drugs (including insulin), digoxin, phenytoin, carbamazepine, and primidone. Treatment with triamcinolone should not be stopped abruptly because it may trigger a dangerous imbalance in the body’s endocrine system.

Brand Names:Azmacort, Nasacort

Prednisone

Prednisone, drug used to treat a variety of ailments including arthritis, asthma, tuberculosis, ulcerative colitis (inflamed colon), certain cancers, multiple sclerosis, skin diseases, and severe allergic reactions. Prednisone is also used to prevent rejection of transplanted organs. An anti-inflammatory drug known as a steroid, prednisone works by suppressing the action of certain white blood cells in the immune system.

Prednisone is available only by prescription. It is taken orally in tablet or liquid form, usually with food to avoid stomach upset. Dosages vary from 5 to 60 mg per day, although some acute conditions may be treated with up to 200 mg per day. Prednisone’s effectiveness is usually apparent after four to ten days of treatment. It is usually discontinued gradually, with smaller and smaller doses until the end of treatment.

Patients with widespread fungus infections, peptic ulcer disease, active tuberculosis, or an eye infection caused by the herpes simplex virus should not take this drug. It should be used with caution by patients with glaucoma, diabetes, high blood pressure, osteoporosis, myasthenia gravis (chronic muscle weakness), gastrointestinal disorders, impaired thyroid function, or a history of tuberculosis. Patients taking prednisone should avoid exposure to chicken pox and measles and should not be vaccinated during treatment. Children may take this drug, but long-term use is not recommended as it may stunt growth. Pregnant and breast-feeding women should avoid prednisone.

Possible side effects may include insomnia, depression, mood swings, headache, dizziness, muscle cramps, skin rash, acne, high blood pressure, weight gain, or fluid retention. Long-term use may cause various eye problems or Cushing’s syndrome, a hormonal disorder characterized by obesity, muscle weakness, brittle bones, and purplish, thick skin.

Prednisone may interact adversely with cyclosporine, carbamazepine, ketoconazole, amphotericin B, phenytoin, rifampin, birth control pills, diabetes medications, estrogen supplements, and certain diuretics.

Brand Names: Deltasone, Liquid Pred, Prednicen-M, Sterapred

Methylprednisolone

Methylprednisolone, steroid drug used in the treatment of various inflammatory and allergic disorders. It reduces swelling, redness, itching, and allergic reactions by blocking some of the body’s normal immune system defenses. It is most commonly used to manage serious skin disorders such as dermatitis, eczema, and psoriasis; and to treat asthma; inflammation of the small intestine (enteritis); multiple sclerosis; lupus erythematous; ulcerative colitis; and major rheumatic disorders like bursitis, tendinitis, and most forms of arthritis. It is also used to treat anemia, chronic obstructive pulmonary disease (COPD), acute nonlymphoblastic leukemia, Pneumocystis carinii pneumonia in people with acquired immunodeficiency syndrome (AIDS), bone cysts in children, croup, and severe vomiting caused by chemotherapy.

This drug is available by prescription only. It comes in a tablet, an injectable liquid, an ointment, and an enema. For tablets, the usual adult dosage is 4 to 48 mg daily, taken orally as a single dose or in divided doses; a reduced tablet dosage is prescribed for children and may be prescribed for adults over the age of 60. The usual adult dosage for injections into a muscle or joint is 10 to 120 mg at intervals ranging from once a week to once every four weeks; the injection dosage for children is prescribed according to body weight. The usual adult dosage for enemas is 40 mg three to seven times per week, preferably right after a bowel movement; the enema dosage for children is determined individually by a physician. The effect of methylprednisolone should be felt in two to four days. For acute disorders, it is usually taken for four to ten days. For chronic disorders, this drug should be taken only as long as needed to stabilize the chronic condition and permit a gradual withdrawal.

Methylprednisolone can be taken with food or milk to prevent stomach irritation. It should not be used by persons who have had an allergic reaction to it in the past or by pregnant or breast-feeding women. It should also be avoided by persons with active tuberculosis, peptic ulcer disease, eye infections caused by the herpes simplex virus, or recent surgical joining of two bowel segments. It should be used with caution by persons with reduced kidney function and people over the age of 60. Prolonged use in infants and children should be avoided. Methylprednisolone should be discontinued 72 hours before vaccination against measles, rabies, smallpox, or yellow fever and should not be resumed for at least 14 days after vaccination. This drug should not be stopped abruptly after long-term treatment but should be tapered off in decreasing dosages.

Common side effects of methylprednisolone include increased appetite, weight gain, retention of salt and water, and elimination of potassium in the urine. Prolonged use of the oral form is associated with serious side effects such as mood alterations, increased blood sugar, possible diabetes, osteoporosis (loss of bone strength), hypertension (high blood pressure), arrhythmia (abnormal heartbeat), peptic ulcer, cataracts, glaucoma, reactivation of latent tuberculosis, retarded growth and development in children, and increased susceptibility to infection.

Methylprednisolone may interact adversely with certain drugs including amphotericin B; antacids; antihypertensive (high blood pressure) drugs; aspirin; barbiturates ; carbamazepine; cyclosporine; digoxin; ephedrine; drugs containing estrogen; insulin; ketoconazole; nonsteroidal anti-inflammatory drugs such as ibuprofen, indomethacin, ketoprofen, and naproxen; oral anticoagulants (blood thinners); oral antidiabetic drugs; oral contraceptives (birth control pills); phenytoin; and certain vaccines. Heavy smoking may add to the effects of methylprednisolone, and drinking alcoholic beverages can increase the risk of peptic ulcers in persons taking this drug orally.

Brand Names:Duralone, Medrol, Meprolone

Oxaprozin

Oxaprozin, drug used for relief of pain and inflammation associated with rheumatoid arthritis, osteoarthritis, gout, and tendinitis. Oxaprozin blocks the production of chemicals called prostaglandins, which may trigger pain and inflammation.

This drug is available by prescription only and comes in 600-mg caplets that are taken orally. The typical adult dosage is 1200 mg per day determined individually on the basis of weight and health. Pain is usually relieved after a single dose, but reduction of inflammation may require regular doses for several days. One to two weeks of continual usage determines the general effectiveness of the drug, although the full effect may not be apparent during the first six weeks of regular use.

Oxaprozin should be taken with a full glass of water or milk, with meals, or with a prescribed antacid. To avoid adverse side effects, the lowest effective daily dose should be taken. Persons who have had a previous allergic reaction to oxaprozin or to any other nonsteroidal anti-inflammatory drug, such as aspirin, should not take this drug. It should be avoided by pregnant or breast-feeding women, and by persons with bleeding or blood cell disorders, or a severe impairment of kidney function. It should be used with caution by persons with reduced liver or kidney function. The safety and effectiveness of this drug for children under the age of 12 have not been established. Small doses are advisable for persons over the age of 60 until tolerance is determined. Driving and other risk-related activities should be restricted if drowsiness or dizziness occurs.

Possible side effects of oxaprozin may include altered or blurred vision, constipation, depression, diarrhea, dizziness, headache, hives, indigestion, itching, mouth sores, nausea, ringing in the ears, skin rash, increased skin sensitivity to sunlight, sleep disturbances, and vomiting. Rare but serious side effects include kidney damage and gastrointestinal pain, ulceration, and bleeding.

Drinking alcoholic beverages with this drug may increase the risk of stomach ulceration or bleeding. Oxaprozin may interact adversely with other drugs including acetaminophen; anticoagulants; aspirin; beta blockers; diuretics such as hydrochlorothiazide and furosemide; enoxaparin; indomethacin; lithium; methotrexate; sulfinpyrazone; valproic acid; and warfarin.

Brand Name:Daypro

Diclofenac Sodium

Diclofenac Sodium, drug used to treat various forms of arthritis. It is also sometimes used to relieve menstrual pain (see Menstruation). An anti-inflammatory analgesic, this drug works by reducing concentrations of certain chemicals in tissue that produce inflammation and pain, thereby relieving the swelling and stiffness commonly associated with arthritis.

Diclofenac sodium must be prescribed by a doctor. Tablets are taken orally two to five times per day. The total daily dosage usually ranges from 100 to 200 mg, with 225 mg being the recommended maximum. Tablets should be taken with a full glass of water and, if stomach upset occurs, with food. Not lying down for 20 to 30 minutes after taking the drug can also help prevent stomach upset. Effectiveness of this drug may not be seen for one to two weeks after beginning treatment.

Patients who experience allergic reactions to aspirin or related medications should not take diclofenac sodium. Patients with kidney or liver problems, ulcers, heart disease, or high blood pressure should use this drug with caution. Its safety for use during pregnancy is not known, but it is known to appear in breast milk. Children under the age of 12 should not use this drug.

Ulcers or internal bleeding are sometimes caused by this medication. Other possible side effects include abdominal pain, indigestion, nausea, constipation, diarrhea, headache, or dizziness. Occasionally seen are fluid retention, skin rash, ringing in the ears, blurred or double vision, hair loss, insomnia, light sensitivity, facial swelling, or vomiting. An overdose of diclofenac sodium can cause acute kidney failure, lung inflammation, drowsiness, or loss of consciousness.

This drug may interact adversely with aspirin, blood-thinning medications, diuretics, heart medications containing digitalis, insulin and certain other diabetes drugs, cyclosporine, lithium, methotrexate, and carteolol.

Brand Name:Voltaren

Naproxen

Naproxen, nonsteroidal anti-inflammatory drug used for relief of pain and inflammation associated with adult and adolescent rheumatoid arthritis, osteoarthritis, ankylosing spondylitis (chronic inflammation of the spine), bursitis, tendinitis, and gout. It is also used in treating headaches and menstrual cramps. Naproxen is an effective painkiller after childbirth, orthopedic surgery, dental treatment, and for strains and sprains. It blocks the production of certain chemicals called prostaglandins that may trigger pain and inflammation.

This drug may be purchased over the counter in tablets of 225 mg. It is available in larger dosages—by prescription only—in tablets of 250 mg, 375 mg, and 500 mg; in sustained-release tablets of 375 mg and 500 mg; and as a liquid, administered orally in 125 mg per 5-ml spoonful. The typical adult oral dosage for rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis is 200 to 500 mg twice a day. For gout, the initial adult dosage is 750 mg followed by 250 mg every eight hours until symptoms disappear. For bursitis, tendinitis, menstrual cramps, and other pain, the initial adult dosage is 500 mg followed by 250 mg every six to eight hours. The total daily dosage should not exceed 1250 mg. For children with rheumatoid arthritis, the dosage is determined on the basis of body weight. Pain relief should begin within one hour, although the full anti-inflammatory effect of this drug may not be apparent for two to four weeks after continuous use.

Naproxen should be taken on a regular schedule, without missing doses. If possible, it should be taken on an empty stomach 30 to 60 minutes before meals or 2 hours after meals. If stomach irritation occurs, it may be taken with food or antacids. To minimize adverse side effects, the lowest effective daily dose should be used. Naproxen should not be used by persons who have had a previous allergic reaction to this drug or an asthmatic reaction to aspirin; pregnant or breast-feeding women; or persons with peptic ulcers or any form of gastrointestinal ulceration or bleeding, bleeding or blood cell disorders, liver disease, or severe impairment of kidney function. It should be used with caution by persons with reduced liver or kidney function. The safety and efficacy of this drug for children under the age of two have not been established. Reduced dosages are advised for persons over the age of 60 until their tolerance of naproxen has been determined. Driving or other risk-related activities should be restricted if drowsiness or dizziness occur with the use of this drug.

Certain mild side effects may occur with naproxen that should disappear as the body adapts to the drug. These include bloating, constipation, diarrhea, difficulty sleeping, dizziness, drowsiness, headache, heartburn, indigestion, lightheadedness, loss of appetite, nausea, nervousness, soreness of the mouth, sweating, or vomiting. More serious but uncommon adverse effects include activation of peptic ulcer disease or ulcerative colitis, bleeding in the stomach or bowel, difficulty breathing, changes in menstruation, and liver or kidney damage. This drug may also cause increased sensitivity to sunlight.

Naproxen may interact adversely with alcoholic beverages and certain other drugs including anticoagulants (blood thinners) such as warfarin; aspirin, salicylates, or other anti-inflammatory drugs; lithium; methotrexate; beta blockers such as acebutolol, atenolol, metoprolol, and timolol; furosemide and thiazide-type diuretics; and probenecid.

Brand Names:Aleve, Naprosyn

Nabumetone

Nabumetone, nonsteroidal anti-inflammatory drug used for relief of pain and inflammation associated with osteoarthritis and rheumatoid arthritis. Nabumetone blocks the production of certain chemicals in the body called prostaglandins that may trigger pain and inflammation.

This drug is available by prescription only. It comes in 500-mg and 700-mg tablets, taken orally. The typical, initial adult dosage is 1000 mg per day. This dosage may be increased as needed and tolerated to 1500 to 2000 mg per day, taken once a day or in divided doses. Relief of symptoms may be felt within one hour, but it may take up to two weeks to feel the full effect of the drug.

Nabumetone should be taken on a regular schedule, without missing doses. It should be taken with food to increase absorption of the drug and to prevent stomach irritation. To minimize adverse side effects, the lowest effective daily dose should be used. Nabumetone should not be used by persons who have had a previous allergic reaction to this drug or an asthmatic reaction to aspirin; pregnant or breast-feeding women; or persons with peptic ulcers or any form of gastrointestinal ulceration or bleeding, bleeding or blood cell disorders, liver disease, or severe impairment of kidney function. It should be used with caution by persons with reduced liver or kidney function and persons taking drugs that reduce blood clotting. The safety and efficacy of this drug for children under the age of 12 have not been established. Reduced dosages are advised for persons over the age of 60 until their tolerance of nabumetone has been determined. Driving or other risk-related activities should be restricted if drowsiness, dizziness, or impaired vision occurs with use of this drug.

Certain mild side effects may occur with nabumetone that should disappear as the body adapts to the drug. These include bloating, constipation, diarrhea, difficulty sleeping, dizziness, drowsiness, headache, heartburn, indigestion, lightheadedness, loss of appetite, nausea, nervousness, soreness of the mouth, sweating, or vomiting. More serious but uncommon side effects include activation of peptic ulcer disease or ulcerative colitis, asthma or difficulty breathing, bleeding in the stomach or duodenum, blurred vision, impairment of normal blood clotting, and liver or kidney damage. This drug may also cause increased sensitivity to sunlight.

Nabumetone may interact adversely with alcoholic beverages and with certain other drugs including anticoagulants (blood thinners) such as warfarin; aspirin, other salicylates, and other anti-inflammatory drugs; beta blockers; diuretics; and probenecid.