General Information of the drug

• Miglitol works differently from other oral antidiabetes drugs, which control blood sugar levels by increasing the production of insulin or helping the body to use the hormone more efficiently.
• Miglitol delays the digestion of carbohydrates (sugars) by acting in the cells that line the small intestine, where sugar is absorbed. This results in less sugar being absorbed into the blood and therefore, a lower blood-sugar level.
• Miglitol also has some effect against the enzyme lactase, but usually does not cause lactose intolerance. Hypoglycemia (very low blood sugar) is unlikely with miglitol because of the way the drug works in diabetes.
• Miglitol may be prescribed with another antidiabetic drug if single-drug therapy is not enough to adequately control blood sugar levels.



• People taking miglitol should have their blood sugar checked periodically to see how well the drug is working. Your blood glucose should be carefully monitored if you add or withdraw any of these drugs while taking miglitol or acarbose. It is common for patients to equip themselves with Home Glucose Monitors, which is widely available.
• Thiazides and other diuretics, corticosteroid anti-inflammatory drugs, phenothiazines, thyroid drugs, estrogens, contraceptive drugs, phenytoin, nicotinic acid, stimulants, calcium channel blockers, and isoniazid may increase blood sugar levels.
• Miglitol and acarbose add to the blood-sugar-lowering effect of sulfonylureas, insulin, and other antidiabetes drugs and may increase the risk of hypoglycemia (low blood sugar) associated with these drugs.
• Miglitol may interfere with the absorption of several drugs into the blood, including propranolol, ranitidine, digoxin, glyburide, and metformin. Seek advise with your doctor as he/she may need to adjust your dose of these drugs.
• Digestive enzyme preparations, charcoal, kaolin (an ingredient in Kaopectate), and antacids—as well as other drugs intended to absorb stomach contents—reduce the effects of miglitol and acarbose. Separate dosing of these drugs by at least 2 hours.
• Combining acarbose and digoxin may increase the effects of digoxin.
• As Miglitol prevents the breakdown of table sugar, if you take Miglitol in combination with insulin or a sulfonylurea prescription drugs, make sure to have a quick source of glucose (dextrose) with you to treat hypoglycemia ( symptoms include increased hunger, tiredness, sweating, increased heart rate, and numbness in the arms and legs ).
• Take your dose with the first bite of each meal. The drug has to be present in your intestine to prevent the absorption of sugar into your blood.
• As Miglitol cannot work unless there is food in your stomach, if you do forget to take a dose of miglitol with your meal, skip the dose you forgot. At the beginning of your next meal, continue with your regular dose .
• Before buying any nonprescription drug, seek advice with your pharmacist to be sure if it is safe for diabetics to take together with acarbose.

Cautions

• Do not take miglitol if you are sensitive or allergic to any of its ingredients
• If you have diabetic ketoacidosis, cirrhosis of the liver, inflammatory bowel disease, ulcers in the colon, intestinal obstruction, absorption or digestion diseases, or if intestinal gas, it will be a severe problem. Consult your doctor before taking this prescription.
• Acarbose may lead to liver inflammation.
• People with kidney disease retain higher levels of miglitol in the blood, but this does not affect the drug’s action because it acts locally in cells lining the small intestine. For patients with severe kidney disease should not take this drug due to drug retention in the blood.

Dosage and Possible Overdose ( This Prescription is not for Child )

• Acarbose :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol must be taken with the first bite of each main meal.
• Unlike other antidiabetic medicines, a miglitol overdose does not cause hypoglycemia. Overdose symptoms are likely to include gas, diarrhea, and pain.
• Follow your doctor’s instructions especially for dietary plan, exercise, and blood- sugar testing. ( See Possible Side Effects below )

Possible Side Effects
a. Acarbose
Intestinal side effects of acarbose tend to improve or go away after a few weeks.
Most common:

• stomach gas (in 75% of people who take it),
• abdominal pain,
• and diarrhea.

( These side effects may be worse if you don’t restrict the amount of carbohydrate in your diet. Consult your doctor on proper dietary plan )

Less common or Rarely Occurs :

• skin rashes.
• swelling and itching,
• hepatitis or yellowing of the skin or whites of the eyes,
• abdominal distress,
• abdominal obstruction,
• liver irritation,
• abnormalities in blood tests.

b. Miglitol ( Most side effects of miglitol go away with continued use of the drug )
Most common:  gas, diarrhea, and abdominal pain.
Less common or Rare Effects : rash and low blood iron.

** For Unusual Side Effects that you may notice, seek your doctor advise immediately !

Pregnancy/Breast-feeding period :
Nursing Mothers who must take this drug should use infant formula, as the safety of using miglitol during pregnancy is not known, but small amounts of miglitol pass into breast milk. ( Diabetes during pregnancy is usually treated with insulin. )

Seniors Adult Consumption
Seniors with severe kidney disease should avoid this medication.

*Blood levels of acarbose are higher in older adults, but this is usually not considered important. Always consult your doctor if in doubt.

General Information

• Lexxel contains 5 mg of felodipine, a calcium channel blocker, and 5 mg of enalapril, an angiotensin-converting enzyme (ACE) inhibitor. The 2 drugs in this combination belong to widely prescribed groups of hypertension medication.
• Lexxel is not meant for the initial treatment of hypertension.
• Most people taking this product have taken 1 of the ingredients as an individual pill and need more medication to control their blood pressure.
• Felodipine works by blocking the passage of calcium into heart and smooth-muscle tissue, especially the smooth muscle found in arteries. Since calcium is an essential factor in muscle contraction, any drug that affects calcium in this way will interfere with the contraction of these muscles. This causes the veins to dilate (widen), reducing blood pressure. Also, the amount of oxygen used by these muscles is reduced.
• ACE inhibitors such as enalapril work by preventing the conversion of a hormone called angiotensin Ito another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels and helps to reduce blood pressure and relieve the symptoms of heart failure.
• Enalapril’s effect on other hormones may also help to promote blood-vessel dilation. It begins working about 1 hour after you take it and continues to work for 24 hours.

How does the drug reacts ?

• The blood-pressure-lowering effect of Lexxel adds to that of diuretic (agent that increases urination) drugs or beta blockers.
• Any other drug that causes a rapid blood-pressure drop should be used with caution if you are taking Lexxel.
• When taken with Dyazide or other potassium-sparing diuretics, Lexxel may raise blood-potassium levels.
• Lexxel may increase the effects of lithium; this combination should be used with caution.
• Capsaicin may cause or aggravate the cough associated with Lexxel therapy.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may interfere with the blood-pressure-lowering effect of Lexxel.
• Phenothiazine sedatives and antiemetics may increase the effects of Lexxel.
• Rifampin may reduce the effects of Lexxel.
• Combining allopurinol with Lexxel increases the risk of an adverse drug reaction.
• Cimetidine, indinavir, nelfinavir, ritonavir, saquinavir, clarithromycin, nefazodone, ketoconazole, itraconazole, erythromycin, telithromycin, aprepitant, fluconazole, and verapamil increase the amount of felodipine in the blood, causing a slight increase in the drug’s effect and possible side effects.
• Phenytoin and other hydantoin anti-seizure drugs, carbamazepine, and barbiturate sleeping pills and sedatives may decrease the amount of felodipine in the blood, reducing its effect.
• Felodipine may increase the effects of theophylline (a drug used to treat asthma and other respiratory problems) and oral anticoagulant (blood-thinning) drugs.
• Felodipine may increase blood levels of tacrolimus. Tacrolimus dose adjustment may be needed.
• Felodipine may interact with quinidine (an antiarrhythmic) to produce low blood pressure, very slow heart rate, abnormal heart rhythms, and swelling in the arms or legs.

Cautions

• Do not take Lexxel if you are allergic or sensitive to any of its ingredients. It could causes very low blood pressure, although rarely occurs.
• Lexxel should be used with caution by people with kidney disease, as it may also affect your kidneys, especially if you have congestive heart failure (CHF). Your doctor should check your urine for protein content during the first few months of treatment.
• Enalapril may affect white-blood-cell counts, possibly increasing your susceptibility to infection. Your doctor should monitor your blood counts periodically.
• ACE inhibitors can cause injury or death to a developing fetus in the last 2 trimesters. Pregnant women should not take Lexxel or any ACE inhibitor.
• People taking a beta-blocking drug who begin taking felodipine may develop heart failure or increased angina pain. Angina pain may also increase if your felodipine dosage is increased.
• People with severe liver disease break down felodipine much more slowly than those with less severe disease or normal livers.
• While taking any ACE inhibitor, sudden and painless swelling in the hands, face, feet, lips, tongue, or throat may develop. If this happens,  stop taking the medication at once , and contact your doctor. This condition usually goes away on its own, though antihistamines may also prove helpful.

Usual Dose and Intakes

• This drug is for adult only.
• 1 tablet a day. ( May be increased to 2 tablets if further blood pressure reduction is necessary after 1-2 weeks of treatment. )
• Overdose may cause low blood pressure. ( In case of overdose, contact your doctor or go to a hospital for emergency attention. ALWAYS bring the prescription bottle or container. )
• Lexxel may be taken without regard to food or meals ( you may take it with food if it upsets your stomach. )
• Avoid grapefruit juice while you are on Lexxel.
• Do not break, crush, or chew Lexxel tablets.
• Maintain good dental hygiene while taking Lexxel and use extra care when brushing or flossing teeth because of the increased risk of oral infection associated with Lexxel.
• Avoid over-the-counter diet pills, decongestants. and stimulants while taking Lexxel; they may raise blood pressure.

Possible Side Effects and Notes

*Side effects are more common with higher dosages and increasing age.
Most common side effects includes :-

• swelling in the ankles, feet, and legs;
• dizziness;
• lightheadedness;
• muscle weakness or cramps;
• facial flushing;
• headache;
• fatigue;
• nausea;
• chronic- (long-term) cough.  ( The cough usually goes away a few days after you stop taking the medication. )

Rare and Less common side effects ( Contact Your Doctor for advise )  :-

• respiratory infection,
• cough,
• tingling in the hands or feet,
• upset stomach,
• abdominal pain,
• chest pain,
• constipation,
• diarrhea,
• heart palpitations,
• sore throat,
• runny nose,
• back pain, rash,
• angina (condition characterized by brief attacks of chest pain),
• vomiting,
• bronchitis,
• urinary tract infection,
• breathing difficulties,
• Unusual condition affecting your heart, muscles and joints, stomach and intestines, sexual function, kidney or liver, and other body parts.

Hypertension may be present without symptoms, thus continue taking your medication and follow any instructions for diet restriction or other treatments to help maintain lower blood pressure, even if you feel well.

Do not take a double dose.

- If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.

For those under Pregnancy/Breast-feeding period

Women who are or might be pregnant should not take Lexxel. ACE inhibitors have caused low blood pressure, kidney failure, slow skull formation, and death in the fetus when taken during the last 6 months of pregnancy.

Women of childbearing age who must take Lexxel must use an effective contraceptive method.

If you become pregnant, stop taking the medication and call your doctor immediately.
Nursing mothers who must take Lexxel should use infant formula, as small amounts of enalapril + felodipine are known to pass into breast milk.

Seniors citizen :-

• Especially those with liver disease, may be more sensitive to the drug’s effects. Take it with care., it is best to consult doctor before taking it.

General Information

• Amiodarone works by decreasing the sensitivity of heart tissue to nervous impulses within the heart. It should be prescribed only in situations where the abnormal rhythm is so severe as to be life-threatening and does not respond to other drug treatments.
• It has not been proven that people taking this drug will live longer than those with similar conditions who do not take it.
• Amiodarone may exert its effects 2-5 days after you start taking it, but often takes 1-3 weeks to affect your heart.
• Amiodarone’s antiarrhythmic effects can last for weeks or months after you stop taking it.

How does the drug Interact ?

• Amiodarone increases the effects of metoprolol and other beta blockers, calcium channel blockers such as verapamil and dittiazem, cyclosporine, dextromethorphan, digoxin, disopyramide, flecainide, fentanyl, lidocaine, methotrexate, procainamide, quinidine, theophylline, and warfarin and other anticoagulants. These interactions can take from 2 or 3 days to several weeks to develop. Some can be life threatening, and for others, drug dosage adjustments may be enough to avoid a serious problem.
• Fluoroquinolones, azole antifungals, and macrolide antibiotics increase the effects of amiodarone. which can cause life-threatening abnormal heart rhythms.
• When amiodarone and phenytoin are taken together, both drugs can be affected. Amiodarone can be antagonized by phenytoin and other hydantoin anticonvulsants, and the effect of phenytoin can be increased by amiodarone.
• Cholestyramine interferes with the absorption of amiodarone into the bloodstream.
• Cimetidine and ritonavir interfere with the breakdown of amiodarone, leading to high drug blood levels and the increased possibility of side effects.
• Azithromycin can interfere with the effectiveness of amiodarone. This interaction may lead to dizziness and cardiac instability.

Cautions ( This drug has fatal effects ! )

• Amiodarone can cause potentially fatal drug side effects too ! At high doses, 10% or more of people taking this drug can develop potentially fatal lung and respiratory effects, beginning with cough and progressive breathing difficulties.
• Do not take amiodarone if you are allergic or sensitive to any of its ingredients or if you have heart block or a very slow heart rate.
• Amiodarone can also cause heart block, a drastic slowing of electrical impulse movement between major areas of the heart, or extreme slowing of the heart rate. Amiodarone heart block occurs about as often as heart block caused by some other antiarrhythmic drugs, but its effects may last longer than those of the other drugs.
• Amiodarone can also worsen existing abnormal heart rhythms in 2-5% of people who take the drug. These effects can be fatal.
• Liver damage caused by amiodarone is usually mild. In rare cases. amiodarone has been associated with liver failure that resulted in death.
• People taking amiodarone may develop optic nerve irritation, leading to partial or complete loss of vision. Most adults who take amiodarone for 6 months or more develop tiny deposits in the corneas of their eyes. These deposits may cause blurred vision or halos in up to 10% of people taking amiodarone. Some people develop dry eyes and sensitivity to bright light.
• One in ten people taking amiodarone can experience unusual sensitivity to the effects of the sun. Use an appropriate sunscreen product and reapply it frequently.
• Amiodarone can cause thyroid abnormalities. It may worsen an already sluggish thyroid gland in 2-10% of people taking the drug, and increase thyroid activity in 2% of people taking it.
• Amiodarone has also been associated with an increase in risk of thyroid tumors.
• Antiarrhythmic drugs are less effective and cause abnormal rhythms if blood potassium is low.

Other Possible Side Effects

• Side effects are very common with amiodarone. About 75% of people taking 400 mg or more of amiodarone a day develop some drug side effects. As many as 18% have to stop taking the drug because of a side effect.
• Amiodarone stays in the body for months, so side effects may remain even after the drug is stopped.
• Unusual sun sensitivity is the most common skin reaction to amiodarone, but people taking this drug can develop a blue skin discoloration that may not go away completely when the drug is stopped.
• Other skin reactions are sun rashes, hair loss, and black-and-blue spots.
• Amiodarone can cause heart failure, reduced heart rate, and abnormal rhythms.
• Up to 9% of people taking amiodarone develop abnormalities in liver function

See your doctor for an eye exam if your vision changes at all while taking amiodarone.

Call your doctor if you develop chest pain. breathing difficulties, spitting up blood, nausea, vomiting, abnormal heartbeat, bloating in your feet or legs. tremors, fever, chills, sore throat, unusual bleeding or bruising, changes in skin color, unusual sunburn, or any other unusual side effect.

Common Side Effects of the drug :-

• fatigue,
• not feeling well,
• tremors,
• unusual involuntary movements,
• loss of coordination,
• an unusual walk,
• muscle weakness,
• low blood pressure,
• dizziness,
• tingling in the hands or feet,
• reduced sex drive,
• sleeplessness,
• headache,
• nervous-system problems,
• nausea,
• vomiting,
• constipation,
• appetite loss,
• abdominal pain,
• dry eyes,
• unusual sensitivity to bright light,
• seeing halos around bright lights.

Rare Side Effects :-

• inflammation of the lung or fibrous deposits in the lungs,
• changes in thyroid function,
• changes in taste or smell,
• bloating,
• unusual salivation,
• changes in blood clotting.

Note

• Amiodarone can make you dizzy or lightheaded. Take care while driving a car or performing complex tasks.
• If you take amiodarone once a day and forget to take a dose, but remember within 12 hours, take it as soon as possible.
• If you do not remember until later, skip the dose you forgot and continue with your regular schedule.
• If you take amiodarone twice a day and remember within 6 hours of your regular dose, take it as soon as you remember.
• Call your doctor if you forget to take 2 or more doses in a row, ask for doctor advise on what to do next – Do not take a double dose.
• Pregnancy and/or Breast-feeding : In high doses, amiodarone has been found to be toxic to animal fetuses. Women of childbearing age should use an effective contraceptive while taking amiodarone. If you are or might be pregnant and this drug is considered crucial by your doctor, its potential benefits must be weighed against its risks.
  Amiodarone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
• Seniors : Dosage reduction may be needed in seniors with poor liver function.

Usual Dose ( Doctor Instruction Should Be followed Closely )

• Starting dose 800-1600 mg a day, taken in 1 or 2 doses, usually for 1-3 weeks. Then, 600-800 mg a day for approximately a month. Maintenance dose 400 mg a day.
• You should take the lowest effective dose in order to minimize side effects.
• Amiodarone should be taken on an empty stomach, as food delays its absorption into your bloodstream.
• If amiodarone upsets your stomach, however, you may take it with food but then always take it with food to be consistent.
• Do not drink grapefruit juice during treatment with amiodarone because grapefruit juice affects how amiodarone is absorbed in the stomach.

Over Dosage Effect(s)

• The effects of amiodarone overdose include low blood pressure. shock, slow heartbeat, and liver toxicity.
• Overdose victims should be taken to a hospital emergency room for treatment.
• ALWAYS bring the prescription bottle or container.