IBD Drug Therapies

Adalimumab

Adalimumab (Injection) • Adalimumab (a-da-LIM-ue-mab)
Treats symptoms of rheumatoid arthritis (RA) and slows the joint damage caused by RA. This medicine also treats psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, Ulcerative Colitis, and plaque psoriasis.

Brand Name(s):Humira
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to adalimumab.

How to Use This Medicine:

Injectable

Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot under your skin.

A nurse or other trained health professional will give you this medicine.

You may be taught how to give your medicine at home. Make sure you understand all instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.

Use a new needle and syringe each time you inject your medicine.

You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one. Your doctor might ask you to sign some forms to show that you understand this information.

If a dose is missed:

If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine:

If you store this medicine at home, keep it in the refrigerator. Do not freeze. Protect the medicine from light. Keep your medicine and supplies in the original packages until you are ready to use them.

Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine, containers, and other supplies. You will also need to throw away old medicine after the expiration date has passed.

Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

This medicine should not be taken together with anakinra (Kineret®). Also, make sure your doctor knows if you are using any medicines that weaken the immune system (such as steroids, cancer medicines, or radiation).

Talk to your doctor before getting flu shots or other vaccines while you are receiving this medicine. Vaccines may not work as well, or they could make you ill while you are using this medicine.

Warnings While Using This Medicine:

Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, cancer, congestive heart failure, psoriasis, or any type of infection, including hepatitis B, tuberculosis, or an infection that would not go away or keeps coming back. Tell your doctor if you have problems with your immune system, multiple sclerosis, or a similar nervous system disease. Also tell your doctor if you are scheduled for any surgery.

Serious skin reactions can occur during treatment with this medicine. Check with your doctor right away if you have any of the following symptoms while using this medicine: blistering, peeling, or loosening of the skin; chills; cough; diarrhea; fever; itching; joint or muscle pain; red skin lesions; sore throat; sores, ulcers, or white spots in your mouth or lips; or unusual tiredness or weakness.

You will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis test or been exposed to tuberculosis.

This medicine lowers the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.

Call your doctor right away if you start to have a persistent cough, weight loss, night sweats, shortness of breath, fever, chills, unusual tiredness or weakness, or flu-like symptoms such as a runny or stuffy nose, headache, or feeling generally ill. These may be signs that you have an infection.

Your risk of getting an infection increases when you travel to places where certain organisms (such as fungi, bacteria, viruses, or parasites) are more common. Tell your doctor where you live and if you have any history of travel if you start to have any sign of infection.

Some people who have used this medicine developed lupus-like symptoms during treatment and got better after this medicine was stopped. Make sure your doctor knows if you start having chest pains, shortness of breath, joint pain, or a rash on your cheeks or arms that is sensitive to the sun.

A small number of people (including children and teenagers) who have used this medicine have developed certain types of cancer. Some patients also developed a rare type of cancer called lymphoma. Talk with your doctor if you have unusual bleeding, bruising, or weakness; swollen lymph nodes in the neck, underarms, or groin; or unexplained weight loss. Also, check with your doctor right away if your skin has red, scaly patches, or raised bumps that are filled with pus.

Do not change or stop using this medicine without checking with your doctor first. Your doctor may want you to gradually reduce the amount you are using before stopping it completely.

Your doctor will need to check your blood at regular visits while you are using this medicine. Be sure to keep all appointments.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing

Blistering, peeling, or red skin rash.

Bone pain.

Chest pain, fast or uneven heartbeat.

Cold or flu symptoms such as a runny or stuffy nose, sore throat, or body aches.

Dry mouth, increased thirst, or muscle cramps.

Fever, chills, a cough that does not go away, or unexplained weight loss.

Nausea, vomiting, loss of appetite, or pain in your upper stomach.

Numbness, tingling, or burning pain in your hands, arms, legs, or feet.

Pain in your lower leg (calf).

Pain with urination or a change in how much or how often you urinate.

Raised bumps on the skin filled with pus.

Red, black, or tarry stools, or dark urine.

Red, scaly patches on the skin.

Shortness of breath, cold sweats, and bluish-colored skin.

Sores or white patches on your lips, mouth, or throat.

Swelling in your hands, ankles, or feet.

Swollen lymph nodes in the neck, underarms, or groin.

Unusual bleeding, bruising, weakness, or pale skin.

Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

Back pain or joint pain.

Changes in vision.

Headache.

Mild skin rash.

Redness, itching, bruising, bleeding, pain, or swelling where the shot was given.

Balsalazide

Balsalazide (By mouth) • Balsalazide (bal-SAL-a-zide)

Treats ulcerative colitis (inflammation of the large intestine and rectum) in patients 5 years of age and older.
Brand Name(s):Colazal

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to balsalazide or salicylates such as aspirin.

How to Use This Medicine:

Capsule

Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to

You may take this medicine with or without food.

If you cannot swallow the capsule, you may open it and pour the medicine into a small amount of applesauce. Stir this mixture well and swallow right away. Do not keep the mixture for future use.

This medicine is not for long-term use.

If a dose is missed:

How to Store and Dispose of This Medicine:

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

Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.

Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

Make sure your doctor knows if you are also taking antibiotics.

Warnings While Using This Medicine:

Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease or pyloric stenosis (narrowing of the opening where food moves from the stomach to the intestine).

If your symptoms do not improve or if they get worse, call your doctor.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing.

Increase in how much or how often you urinate, painful urination.

Increased bloody or black diarrhea, fever, stomach pain.

Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

Headache.

Joint pain.

Mild diarrhea or stomach pain.

Nausea or vomiting.

Runny or stuffy nose, sneezing, or cough.

Tiredness or trouble sleeping.

© 1974-2010 Thomson Reuters. All rights reserved. Balsalazide (Oral) (Capsule) – DrugNote, English
Printed on Tuesday, March 16, 2010 10:51:56 AM Tuesday, March 16, 2010 3:51:55 PM GMT

Budesonide

Budesonide (By mouth) • Budesonide (bue-DES-oh-nide)
Treats active Crohn’s disease. This medicine is a steroid.

Brand Name(s):Entocort EC
There may be other brand names for this medicine.
When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to budesonide.

How to Use This Medicine:

Capsule
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• Swallow the capsule whole. Do not chew, crush, or open it.
• This medicine comes with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.
If a dose is missed:
• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine:
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are also using erythromycin (Ery-tab®), medicine to treat a fungal infection (such as itraconazole, ketoconazole, Nizoral®, or Sporanox®), or medicine to treat HIV or AIDS (such as indinavir, ritonavir, saquinavir, Crixivan®, Invirase®, or Norvir®).
• Tell your doctor if you are using a medicine that weakens your immune system, such as other steroids or cancer medicines.
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have liver disease, diabetes, cataracts, glaucoma, high blood pressure, osteoporosis, stomach ulcers, tuberculosis, or a family history of diabetes or glaucoma.
• You may get infections more easily while using this medicine. Avoid people who are sick or have infections. Tell your doctor right away if you have been exposed to someone with chickenpox or measles.
• If your symptoms do not improve or if they get worse, call your doctor.
• Do not stop using this medicine suddenly without asking your doctor. You may need to slowly decrease your dose before stopping it completely.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.

Certolizumab

Certolizumab (Injection) • Certolizumab Pegol
Treats symptoms of Crohn’s disease and rheumatoid arthritis.
Brand Name(s):Cimzia

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to certolizumab.

How to Use This Medicine:
Injectable
• Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot under your skin.
• A nurse or other trained health professional will give you this medicine.
• You may be taught how to give your medicine at home. Make sure you understand all instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.
• Use a new needle and syringe each time you inject your medicine.
• You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one. Your doctor might ask you to sign some forms to show that you understand this information.
• This medicine comes with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.

If a dose is missed:
• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.
How to Store and Dispose of This Medicine:
• If you store this medicine at home, keep it in the refrigerator. Do not freeze. Protect the medicine from direct light. Keep your medicine in the original package until you are ready to use it.
• Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine, containers, and other supplies. You will also need to throw away old medicine after the expiration date has passed.
• Keep all medicine away from children and never share your medicine with anyone.
Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are also using azathioprine (Imuran®) or methotrexate (Rheumatrex®). This medicine should not be used together with abatacept (Orencia®), adalimumab (Humira®), anakinra (Kineret®), etanercept (Enbrel®), infliximab (Remicade®), natalizumab (Tysabri®), or rituximab (Rituxan®).
• Talk to your doctor before getting flu shots or other vaccines while you are receiving this medicine. Vaccines may not work as well, or they could make you ill while you are using this medicine.
Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, cancer, congestive heart failure, blood problems, diabetes, psoriasis, or any type of infection, including hepatitis B, HIV, tuberculosis, or an infection that would not go away or keeps coming back. Tell your doctor if you have problems with your immune system, multiple sclerosis, epilepsy, or a similar nervous system disease. Also tell your doctor if you are scheduled for any surgery.
• You will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis test or been exposed to tuberculosis.
• This medicine lowers the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.
• Call your doctor right away if you start to have a persistent cough, weight loss, night sweats, shortness of breath, fever, chills, unusual tiredness or weakness, or flu-like symptoms such as a runny or stuffy nose, headache, or feeling generally ill. These may be signs that you have an infection.
• Your risk of getting an infection increases when you travel to places where certain organisms (such as fungi, bacteria, viruses, or parasites) are more common. Tell your doctor where you live and if you have any history of travel if you start having any signs of infection.
• This medicine may cause other unwanted effects that may not occur until months or years after this medicine is used. A small number of people (including children and teenagers) who have used this medicine have developed certain types of cancer. Some patients also developed a rare type of cancer called lymphoma. Talk with your doctor if you have unusual bleeding, bruising, or weakness; swollen lymph nodes in the neck, underarms, or groin; or unexplained weight loss. Also, check with your doctor right away if your skin has red, scaly patches, or raised bumps that are filled with pus.
• This medicine may cause a serious allergic reaction. Check with your doctor right away if you have a rash; itching; swelling of the face, tongue, and throat; trouble with breathing; or chest pain after you get the injection.
• Some people who have used this medicine developed lupus-like symptoms during treatment and got better after this medicine was stopped. Make sure your doctor knows if you start having chest pains, shortness of breath, joint pain, or a rash on your cheeks or arms that is sensitive to the sun.
• Do not change or stop using this medicine without checking with your doctor first. Your doctor may want you to gradually reduce the amount you are using before stopping it completely.
• Your doctor will need to check your blood at regular visits while you are using this medicine. Be sure to keep all appointments.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:
• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing.
• Blistering, peeling, or red skin rash.
• Bone pain.
• Change in how much or how often you urinate, or painful urination.
• Chest pain, shortness of breath, cold sweat, and bluish-colored skin.
• Dark-colored urine or pale stools.
• Eye pain or any change in vision.
• Fast or uneven heartbeat.
• Fever, chills, cough, runny or stuffy nose, sore throat, and body aches.
• Lightheadedness, dizziness, or fainting.
• Lumps on your neck, armpits, or groin.
• Mood or behavior changes, or thoughts of hurting yourself or others.
• Raised bumps on the skin filled with pus.
• Red, scaly patches on the skin.
• Swelling in your hands, ankles, or feet.
• Swollen lymph nodes in the neck, underarms, or groin.
• Unexplained weight loss.
• Unusual bleeding, bruising, or weakness.
• Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:
• Joint pain.
• Mild skin rash or itching.
• Nausea, vomiting, diarrhea, or stomach pain.
• Redness, pain, or swelling where the shot was given.
If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Certolizumab (Injection) (Injectable) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:01:25 AM Tuesday, March 16, 2010 4:01:24 PM GMT

Cholestyramine

Cholestyramine (By mouth) • Cholestyramine (koe-le-STYE-ra-meen)
Lowers high cholesterol levels. Also treats severe itching caused by liver disease.
Brand Name(s):Prevalite, Questran, Questran Light
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to cholestyramine.

How to Use This Medicine:
Powder for Suspension, Packet
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• Take this medicine just before eating or with meals.
• You should not use the powder in dry form. Mix in 4 to 6 ounces of water, fruit juice, or milk until completely dissolved. Drink this mixture right away. Rinse the glass with more liquid and drink that too, so you get all of the medicine.
• You may also mix the powder medicine in thin soup, with soft fruits such as fruit cocktail or crushed pineapple, or with milk in breakfast cereal.
• Drink several glasses of liquids each day while using this medicine.

If a dose is missed:
• Take the missed dose as soon as possible.
• Skip the missed dose if it is almost time for your next regular dose.
• You should not use two doses at the same time.

How to Store and Dispose of This Medicine:
• Store at room temperature, away from heat, moisture, and direct light.
• Keep all medicine out of the reach of children.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are also using Coumadin®.
• Cholestyramine may change the way many other medicines work. Take other medicines 1 hour before or 4 to 6 hours after you take cholestyramine.
• Talk with your doctor or pharmacist if you need help deciding the best time to take your medicines.

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have thyroid problems, diabetes, gallbladder disease, stomach problems, heart disease, kidney disease, or liver disease.
• Questran Light® contains aspartame (Nutrasweet®). If you have phenylketonuria you should avoid using this product.
• Before you stop using this medicine, talk with your doctor.
• This medicine is used with diet, exercise, and weight loss in overweight patients to control high cholesterol levels. To lower and keep your cholesterol normal, all of these are important.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:
• Rash or hives
• Wheezing or trouble breathing.
• Unusual bleeding such as nosebleeds or bleeding gums
• Severe stomach pain

If you notice these less serious side effects, talk with your doctor:
• Constipation
• Upset stomach
• Heartburn, gas or bloating

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Cholestyramine (Oral) (Powder for Suspension, Packet) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:04:41 AM Tuesday, March 16, 2010 4:04:40 PM GMT

Ciprofloxacin

Ciprofloxacin Betaine/Ciprofloxacin Hydrochloride (By mouth) • Ciprofloxacin (sip-roe-FLOX-a-sin), Ciprofloxacin Hydrochloride (sip-roe-FLOX-a-sin hye-droe-KLOR-ide)
Treats several types of infections including urinary tract infections and gastrointestinal infections that is caused by bacteria. This medicine is a fluoroquinolone (quinolone) antibiotic.
Brand Name(s):Cipro XR, Ciprofloxacin

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to ciprofloxacin or to any other fluoroquinolone antibiotic (such as gatifloxacin, levofloxacin, Ciloxan®, Levaquin®, Tequin®).

How to Use This Medicine:
Long Acting Tablet
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• This extended-release tablet form of ciprofloxacin (Cipro® XR) is NOT the same as other kinds of ciprofloxacin. Use the exact medicine that your doctor prescribed. Do not use a different medicine, even if the names look alike.
• You may take this medicine with or without food. Do not take this medicine with milk, yogurt, or other dairy products. Do not drink any juice with calcium added when you take this medicine. It is okay to have dairy products or juice as part of a larger meal and then take this medicine with that meal.
• Swallow the extended-release tablet whole. Do not crush, break, or chew it.
• Drink extra fluids so you will pass more urine while you are using this medicine. This will keep your kidneys working well and help prevent kidney problems.
• Keep using this medicine for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one. Your doctor might ask you to sign some forms to show that you understand this information.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are using a steroid medicine (such as dexamethasone, prednisolone, prednisone, Medrol®, Decadron®). Using a steroid together with this medicine may increase your chance of having tendon problems.
• Make sure your doctor knows if you are also using theophylline (T-phyl®, Uniphyl®). Your doctor will need to monitor you more closely if you use ciprofloxacin while you are also using theophylline.
• Tell your doctor if you are also using cyclosporine (Sandimmune®, Neoral®), metoclopramide (Reglan®), methotrexate (Trexall®, Rheumatrex®), omeprazole (Prilosec®), phenytoin (Dilantin®), or probenecid (Benemid®).
• Tell your doctor if you are using a blood thinner (such as warfarin, Coumadin®), diabetes medicine (such as glyburide, metformin, Actos®, Diabeta®, Glucotrol®, Glynase®, Micronase®), or pain or arthritis medicine (such as ibuprofen, naproxen, Advil®, Aleve®, Celebrex®).
• Some medicines, including antacids and mineral supplements, can change with the way ciprofloxacin works in your body. Tell your doctor if you use any antacids that contain magnesium or aluminum (such as Maalox® or Mylanta®), or any kind of vitamin or mineral supplement that contains calcium, zinc, or iron. Also talk with your doctor if you use sucralfate (Carafate®) or didanosine (Videx®) powder or chewable buffered tablets. If you use any of these medicines, take them at least 6 hours before or 2 hours after you take ciprofloxacin.
• Avoid caffeine while you are using this medicine. Caffeine is found in foods and drinks such as coffee, sodas, and chocolate. Ciprofloxacin may cause caffeine to stay in your body longer than usual.

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have diabetes, kidney disease, or liver disease. Make sure your doctors knows if you have a history of seizures, epilepsy, head injury, or stroke.
• This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.
• Your tendons may be more easily injured while you are using this medicine. Stop using this medicine and call your doctor if you have pain or swelling in your knee, ankle, shoulder, elbow, hand, or wrist. You may also need to avoid exercise or certain physical activities. Children and elderly patients are more likely to have tendon problems. This risk of tendon problems may also increase if you have rheumatoid arthritis or if you have received an organ (such as heart, kidney, or lung) transplant.
• If you have severe diarrhea, ask your doctor before taking any medicine to stop the diarrhea.
• If your symptoms do not improve or if they get worse, call your doctor.
• This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.
• Use this medicine to treat only the infection your doctor has prescribed it for. Do not use this medicine for any infection that has not been checked by a doctor.

If you notice these less serious side effects, talk with your doctor:
• Feeling nervous, restless, or anxious.
• Headache, bad dreams, or trouble sleeping.
• Nausea, vomiting, or stomach pain.
• Vaginal itching.
If you notice other side effects that you think are caused by this medicine, tell your doctor.
© 1974-2009 Thomson Reuters. All rights reserved.

Cyclosporine

Cyclosporine (By mouth) • Cyclosporine (sye-kloe-SPOR-een)
Helps to prevent organ rejection after a kidney, liver, or heart transplant. Also treats rheumatoid arthritis and psoriasis.
Brand Name(s):Neoral, Sandimmune, Gengraf
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to cyclosporine, or if you have certain kidney problems, uncontrolled high blood pressure, or cancer.

How to Use This Medicine:
Capsule, Liquid
• Your doctor will tell you how much of this medicine to use and how often. Your dose may need to be changed several times in order to find out what works best for you. Do not use more medicine or use it more often than your doctor tells you to. Take this medicine at the same time(s) every day. You may take this medicine with or without food, just be sure to take it the same way every day in relationship to your meals.
• It is important that you do not stop taking this medicine suddenly, unless your doctor tells you to.
• Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.
• This medicine may be used with other medicines that prevent organ rejection. Take all other medicines your doctor prescribed as part of your combination treatment.
• To measure the oral liquid, use the measuring device provided with the medicine, or use a marked measuring spoon, oral syringe, or medicine cup.
• Mix the oral liquid in a drinking glass, not a plastic cup. You can mix it with apple or orange juice to make it taste better. Do not mix it with very cold or hot drinks. Stir well, and drink your medicine right away. Rinse the glass with more juice or water and drink that too, so you get all of the medicine.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Tell your doctor if you are using medicine that weakens the immune system such as methylprednisolone (Decadron®) or other steroids, chemotherapy, or radiation therapy. Make sure your doctor knows if you are taking medicine to treat HIV or AIDS. Tell your doctor if you are taking a medicine for inflammation, pain, or arthritis (such as azapropazon, colchicine, diclofenac, naproxen, sulindac, Clinoril®, Naprosyn®, or Voltaren®).
• Make sure your doctor knows if you are using water pills (such as spironolactone, triamterene, or Aldactone®) or medicine for seizures (such as carbamazepine, oxcarbazepine, phenobarbital, phenytoin, Depakote®, Dilantin®, Tegretol®, or Trileptal®). Tell your doctor if you are also using melphalan (Alkeran®), sirolimus (Rapamune®), tacrolimus (Protopic®), or medicine that can be hard on your kidneys. Make sure your doctor knows if you are using medicine for your heart or blood pressure (such as diltiazem, nicardipine, nifedipine, verapamil, Calan®, Cardene®, Cardizem®, Isoptin®, Lotrel®, Procardia®, or Verelan®). Make sure your doctor knows if you are also receiving medicine or treatment for psoriasis, such as PUVA or UVB therapy, methotrexate (Rheumatrex®), or coal tar therapy.
• Make sure your doctor knows if you are using medicines to treat infections (such as azithromycin, ciprofloxacin, clarithromycin, erythromycin, gentamicin, nafcillin, quinupristin/dalfopristin, rifabutin, rifampin, trimethoprim/sulfamethoxazole, tobramycin, vancomycin, Bactrim®, Biaxin®, Cipro®, Cotrim®, E-mycin®, Ery-tab®, Garamycin®, Mycobutin®, Nebcin®, Rifadin®, Septra®, Synercid®, Unipen®, or Vancocin®) or for fungal infections (such as amphotericin B, fluconazole, itraconazole, ketoconazole, terbinafine, voriconazole, Diflucan®, Fungizone®, Lamisil®, Nizoral®, Sporanox®, or Vfend®). Tell your doctor if you are using stomach medicine (such as cimetidine, ranitidine, Pepcid®, Tagamet®, or Zantac®).
• Make sure your doctor knows if you are also using birth control pills, medicine to lower cholesterol (such as atorvastatin, bezafibrate, fenofibrate, fluvastatin, lovastatin, pravastatin, simvastatin, Bezalip®, Lescol®, Lipitor®, Pravachol®, Tricor®, or Zocor®), allopurinol (Zyloprim®), amiodarone (Cordarone®, Pacerone®), bosentan (Tracleer®), bromocriptine (Parlodel®), danazol (Danocrine®), digoxin (Lanoxin®), imatinib (Gleevec®), metoclopramide (Reglan®), octreotide (Sandostatin®), orlistat (Xenical®), sulfinpyrazone (Anturane®), or ticlopidine (Ticlid®).
• Do not take anything containing St. John’s Wort while you are using this medicine.
• There are many other drugs that can interact with cyclosporine. Make sure your doctor knows about all other medicines you are using.
• Talk to your doctor before getting flu shots or other vaccines while you are receiving this medicine. Vaccines may not work as well, or they could make you ill while you are using this medicine.
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant, breastfeeding, or if you have ever been treated for psoriasis. Tell your doctor if you have cancer, a history of liver disease, kidney problems, or high blood pressure. Make sure your doctor knows if you have heart problems, high cholesterol, or any other medical problems.
• This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds. Also, avoid excessive exposure to ultraviolet (UV) light, such as staying out in the sun for long periods of time.
• This medicine may increase your risk of developing other rare but serious conditions, such as certain types of cancer. This medicine may also cause an increase in your blood pressure.
• Your doctor will need to check your blood or urine at regular visits while you are using this medicine. Be sure to keep all appointments.
• This medicine lowers the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.

If you notice these less serious side effects, talk with your doctor:
• Acne, or excess growth of hair around your lips, over your chin, chest, hands, or legs.
• Headache, joint pain, or muscle aches.
• Runny or stuffy nose.
• Stomach upset, diarrhea, constipation, nausea, vomiting, or loss of appetite.
• Swelling and bleeding of your gums.
• Tremors (shaking).

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Cyclosporine (Oral) (Capsule, Liquid) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:15:44 AM Tuesday, March 16, 2010 4:15:42 PM GMT

Hydrocortisone

Hydrocortisone (Rectal) • Hydrocortisone (hye-droe-KOR-ti-sone)
Treats inflammation, itching, and discomfort of the rectum including inflamed hemorrhoids. Belongs to a class of drugs called corticosteroids.
Brand Name(s):Anucort-HC, Proctosol-HC, Proctozone-Hc, Cortifoam, Procto-Kit 1%, Procto-Kit 2.5%, Rectasol-Hc, Anu-Med Hc, Anucort HC, Anusol-HC, Proctosert HC, Proctocort, Encort, Hemril-30, Anusol-Hc
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to hydrocortisone or recent colostomy surgery.

How to Use This Medicine:
Cream, Suppository, Foam
• Your doctor will tell you how much to take and how often.
• Read and follow the instructions that came with this medicine.
• Wash your hands before and after using.
• The cream medicine may be used outside the rectal area. Put a thin layer on the affected area. Rub in gently.
• The cream may also be used inside the rectum by using the plastic applicator that comes in the box. Screw the applicator to the tube of medicine. Gently insert the applicator into the rectum. Squeeze the tube of medicine. After applying the correct amount of medicine, remove the applicator from the rectum.
• Insert the foam into your rectum using the applicator that comes with your medicine. Do not put any part of the foam container into your rectum.

Follow the directions that came with your medicine.
• Wash the cream or foam applicator and put it back in the box.
• Remove the wrapper from the suppository if one is present.
• Moisten the suppository with water.
• To use the suppository, lie on your side with your lower leg straightened out and your upper leg bent up towards your stomach.
• Spread your buttocks and insert the suppository into the rectum about 1 inch with your finger. Hold your buttocks together for about 1 minute.
• Remain lying down for at least 15 minutes to keep the suppository from coming out.
• If you have any questions about this medicine, ask your doctor or pharmacist.

If a dose is missed:
• Use the missed dose as soon as possible.
• Skip the missed dose if it is almost time for your next regular dose.
• You should not use two doses at the same time.

How to Store and Dispose of This Medicine:
• Store at room temperature, away from heat, moisture, and direct light. Do not freeze.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
• Keep all medicine out of the reach of children.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• You should not use other rectal medicines while using this medicine without first checking with your doctor.

Warnings While Using This Medicine:
• Talk with your doctor before using if you are pregnant or have an infection such as herpes.
• You should not use more often or for a longer time than your doctor ordered.
• You should not use this medicine for other rectal conditions without first checking with your doctor.
• The suppository may cause staining of your clothes. Use a minipad to avoid staining your clothes.

Possible Side Effects While Using This Medicine:

If you notice these less serious side effects, talk with your doctor:
• Rectal irritation, burning, or itching
If you notice other side effects that you think are caused by this medicine, tell your doctor.
© 1974-2009 Thomson Reuters. All rights reserved.

Infliximab

Infliximab (Injection) • Infliximab (in-FLIX-i-mab)
Treats rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, plaque psoriasis, and ulcerative colitis.
Brand Name(s):Remicade
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to infliximab or murine (mouse) proteins. In some cases, you should not receive this medicine if you have a history of heart failure.

How to Use This Medicine:
Injectable
• Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given through a needle placed in one of your veins.
• A nurse or other trained health professional will give you this medicine.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one. Your doctor might ask you to sign some forms to show that you understand this information.
• This medicine needs to be given slowly. The needle will need to remain in place for at least 2 hours.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are using anakinra (Kineret®) or etanercept (Enbrel®). Tell your doctor if you have received infliximab before. Make sure your doctor knows about all other medicines you are using, including nonprescription (over-the-counter) medicines and herbal products.
• Talk to your doctor before getting flu shots or other vaccines while you are receiving this medicine. Vaccines may not work as well, or they could make you ill while you are using this medicine.
Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have liver disease, kidney disease, heart problems, bleeding disorder, any type of infection or an infection that would not go away or keeps coming back, a weakened immune system, or if you have ever been treated with medicines that weaken your immune system (such as steroids or cancer medicines). Tell your doctor if you have a history of seizures, multiple sclerosis, Guillain-barre syndrome, or a similar nervous system disease. Make sure your doctor knows if you have a history of hepatitis B infection, or if you have recently received a vaccine.
• Serious skin reactions can occur during treatment with this medicine. Check with your doctor right away if you have any of the following symptoms while taking this medicine: blistering, peeling, or loosening of the skin; chills; cough; diarrhea; fever; itching; joint or muscle pain; red skin lesions; sore throat; sores, ulcers, or white spots in your mouth or lips; or unusual tiredness or weakness.
• You will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis test.
• A small number of people who have used this medicine have developed certain types of cancer. This is more common among patients who have lung diseases or are heavy smokers, and in psoriasis patients who have had phototherapy treatment for a long time. Some patients with Crohn’s disease also developed a rare type of cancer called lymphoma. Talk with your doctor if you are concerned.
• This medicine lowers the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.
• Call your doctor right away if you start to have signs of infection such as persistent cough, fever, chills, weight loss, night sweats, shortness of breath, unusual tiredness or weakness, or flu-like symptoms such as a runny or stuffy nose, headache, or feeling generally ill. Tell your doctor if you have been exposed to chickenpox or any other virus.
• Your risk of getting an infection increases when you travel to places where certain organisms (such as fungi, bacteria, viruses, or parasites) are more common. Tell your doctor where you live and if you have any history of travel if you start to have any sign of infection.
• If your symptoms do not improve or if they get worse, call your doctor.
• Your doctor will need to check your blood at regular visits while you are using this medicine. Be sure to keep all appointments.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:
• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing.
• Blistering, peeling, or red skin rash.
• Change in how much or how often you urinate.
• Chest pain or shortness of breath.
• Cold or flu symptoms such as runny or stuffy nose, sore throat, fever, chills, or body aches.
• Dry mouth, increased thirst, or muscle cramps.
• Fast, slow, or irregular heartbeat.
• Joint pain or swelling.
• Lightheadedness, dizziness, or fainting.
• Nausea, vomiting, loss of appetite, or pain in your upper stomach.
• Numbness, tingling, or burning pain in your hands, arms, legs, or feet.
• Pain in your lower leg (calf).
• Pain when urinating, or dark-colored urine or pale stools.
• Red or black stools.
• Severe confusion, or thoughts of hurting yourself or others.
• Sores or white patches on your lips, mouth, or throat.
• Stiff neck or seizures.
• Sudden or severe headache, problems with vision, speech, or walking.
• Swelling in your hands, ankles, or feet.
• Trouble breathing or swallowing.
• Unusual bleeding or bruising.
• Unusual tiredness or weakness.
• Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:
• Cough that does not go away.
• Diarrhea or upset stomach.
• Mild headache.
• Mild muscle or joint pain.
• Mild skin rash or itching.
• Redness, pain, or swelling where the needle is placed.
• Warmth or redness in your face, neck, arms, or upper chest.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
© 1974-2009 Thomson Reuters. All rights reserved.

Loperamide

Loperamide/Simethicone (By mouth) • Loperamide (loe-PER-a-mide), Simethicone (sye-METH-i-kone)
Treats diarrhea, cramps, bloating, and pressure in your lower intestines.
Brand Name(s):Imodium Multi-Symptom Relief, Leader Anti-Diarrheal Plus Anti-Gas, Imodium Advanced
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to loperamide or simethicone. Do not use this medicine if you have a fever, if you have blood in your stools, or if you are bleeding from your rectum.

How to Use This Medicine:
Tablet, Chewable Tablet
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• If you are using this medicine without a prescription, follow the instructions on the medicine label.
• Be sure to drink plenty of fluids whenever you are having diarrhea. This will help keep you from becoming dehydrated.

How to Store and Dispose of This Medicine:
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are also using any type of antibiotic. Diarrhea is a side effect of many antibiotics. In most cases, you should not take medicine to stop diarrhea that is caused by certain antibiotics. Talk with your doctor if you think your diarrhea may be caused by your recent use of an antibiotic medicine.

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breast feeding, or if you have a history of liver disease.
• Tell your doctor if you are still having diarrhea after using this medicine for 2 days. Also tell your doctor if your diarrhea gets worse.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Loperamide/Simethicone (Oral) (Tablet, Tablet, Chewable) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:27:32 AM Tuesday, March 16, 2010 4:27:30 PM GMT

Mesalamine_oral

Mesalamine (By mouth) • Mesalamine (me-SAL-a-meen)
Treats an inflammatory bowel disease called ulcerative colitis.
Brand Name(s):Asacol, Pentasa, Apriso, Lialda, Asacol HD
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to mesalamine, aminosalicylates, or salicylates.

How to Use This Medicine:
Long Acting Capsule, Tablet, Delayed Release Tablet, Coated Tablet
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• Swallow the medicine whole. Do not open, break, crush, or chew it.
• It is best to take the delayed-release tablets with food. All other brands of capsules and tablets can be taken with or without food.
• Do not change to another brand without checking with your doctor. The number of capsules or tablets that you take depends on the brand and strength of the medicine. If you refill your medicine and it looks different, check with your pharmacist.
• While taking the extended-release form of this medicine, part of the tablet may pass into your stools. This is normal and is nothing to worry about.
If a dose is missed:
• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine:
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Store the delayed-release tablets in a tightly-closed container to protect them from moisture. Putting desiccant pouches in the container may also help to keep the tablets from getting moist.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are also using azathioprine (Imuran®), 6-mercaptopurine (Purinethol®), or pain or arthritis medicine, sometimes called “NSAIDs” (such as aspirin, ibuprofen, naproxen, Advil®, or Aleve®). Tell your doctor if you are also using antacids (such as Amphojel®, Maalox®, Mylanta®, or Tums®).

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, or a stomach problem called pyloric stenosis.
• Tell your doctor if you have had an allergic reaction to sulfasalazine (Azulfidine®).
• Check with your doctor right away if you have abdominal or stomach pain, bloody diarrhea, cramps, fever, headache, or a rash while you are using this medicine. These may be symptoms of a condition called mesalamine-induced acute intolerance syndrome.
• The Apriso™ extended-release capsules contain aspartame, which may be a problem for people who have phenylketonuria (PKU). Tell your doctor if you have PKU before taking these capsules.
• Your doctor will need to check your blood or urine at regular visits while you are using this medicine. Be sure to keep all appointments.

If you notice these less serious side effects, talk with your doctor:
• Constipation or mild diarrhea.
• Dizziness.
• Dry mouth.
• Headache.
• Joint or muscle pain.
• Mild skin rash.
• Nausea, vomiting, bloating, or stomach pain or upset.
• Runny or stuffy nose or sneezing.
• Tiredness or trouble sleeping.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Mesalamine (Oral) (Capsule, Extended Release, Tablet, Tablet, Delayed Release, Tablet, Enteric Coated) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:30:49 AM Tuesday, March 16, 2010 4:30:47 PM GMT

Mesalamin_rectal

Mesalamine (Rectal) • Mesalamine (me-SAL-a-meen)
Treats ulcerative proctitis, a bowel disease.
Brand Name(s):Canasa, Rowasa, sfRowasa
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to mesalamine. You should not use this medicine if you are allergic to aspirin. Do not use the rectal suppository if you are allergic to saturated vegetable fat such as shortening.

How to Use This Medicine:
Suppository, Enema
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• Never take rectal suppositories by mouth.
• Before inserting a suppository, go to the bathroom and empty your bladder and, if possible, have a bowel movement.
• This medicine will stain any surface it touches (clothing, bedsheets, floors, countertops, etc.). To protect your clothing, consider wearing a sanitary napkin or adult undergarment such as Depends®. Protect your sheets by placing a waterproof pad on your bed. These pads, often called Chux pads or underpads, are available from a medical supply store.
• Wash your hands with soap and water before and after using this medicine. Remove the foil or wrapper from the suppository before inserting it.
• Do not keep the suppository in your hand too long or it may begin to melt. To make the suppository easier to insert, you may use a lubricating gel such as K-Y® Jelly, but do not use petroleum jelly (Vaseline®).
• Lie on your left side with your left leg straight or slightly bent, and your right knee bent upward. Gently push the pointed end of the suppository into the rectum about 1 inch.
• The medicine needs to remain in your body for 3 hours or longer, depending on your doctor’s advice. Try not to use the bathroom for at least that length of time after inserting the suppository.
• Use the enema at bedtime, unless your doctor tells you otherwise. Wash your hands with soap and water. Shake the bottle and then remove the cap.
• Lie on your left side with your left leg straight or slightly bent, and your right knee bent upward. Insert the applicator tip into your rectum about an inch. Gently squeeze the bottom of the bottle to release the enema.
• Remove the bottle and throw it away.
• You may need to hold the liquid in your rectum for several minutes or hours. This may be difficult or feel uncomfortable. It should become easier to do as you continue to use the medicine.
If a dose is missed:
• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.
How to Store and Dispose of This Medicine:
• You may store the suppositories in the refrigerator, but do not freeze them. Store the enema at room temperature. Keep away from heat, moisture, or direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of the used medicine applicator(s), containers, and any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.
• Keep all medicine away from children and never share your medicine with anyone.
Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are also taking mesalamine by mouth (Asacol®, Pentasa®) or a similar medicine called sulfasalazine (Azulfidine EN-Tabs®).
Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breast feeding. Tell your doctor if you have kidney disease, heart disease, or a history of an inflamed pancreas. Make sure your doctor knows if you have an allergy to a food, dye, or preservative. Tell your doctor if you have had an allergic reaction to sulfasalazine (Azulfidine EN-Tabs®).
• Stop using this medicine and call your doctor right away if you have bloody diarrhea and sudden or severe stomach cramps. You may also notice a fever, headache, or a skin rash along with these symptoms.
• If you have severe diarrhea, ask your doctor before taking any medicine to stop the diarrhea.
• If your symptoms do not improve or if they get worse, call your doctor.
• Your doctor will need to check your blood or urine at regular visits while you are using this medicine. Be sure to keep all appointments.

If you notice these less serious side effects, talk with your doctor:
• Mild hair loss.
• Mild stomach pain, nausea, diarrhea, or gas.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Mesalamine (Rectal) (Suppository, Enema) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:32:48 AM Tuesday, March 16, 2010 4:32:46 PM GMT

Methotrexate

Methotrexate (Injection) • Methotrexate (meth-oh-TREX-ate)
Treats several kinds of cancer, including cancer of the blood, bone, lung, breast, head, or neck. Also treats rheumatoid arthritis and psoriasis (a skin disease).
Brand Name(s):
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to methotrexate or if you are breastfeeding. You should not use this medicine for arthritis or psoriasis if you are pregnant, or if you have liver disease or certain problems with your blood or immune system. Make sure your doctor knows if you drink alcohol of any kind on a regular basis.

How to Use This Medicine:
Injectable
• Medicines used to treat cancer are very strong and can have many side effects. Before receiving this medicine, make sure you understand all the risks and benefits. It is important for you to work closely with your doctor during your treatment.
• Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot under your skin, into a muscle, into an artery, or into your spine (back or neck). Your schedule for this medicine will vary depending on your reason for using it.
• You will receive this medicine while you are in a hospital or cancer treatment center. A nurse or other trained health professional will give you this medicine.
• You may be taught how to give your medicine at home. Make sure you understand all instructions before giving yourself an injection. Do not use more medicine or use it more often than your doctor tells you to.
• Use a new needle and syringe each time you inject your medicine.

If a dose is missed:
• This medicine needs to be given on a fixed schedule. If you miss a dose, call your doctor, home health caregiver, or treatment clinic for instructions.

How to Store and Dispose of This Medicine:
• If you store this medicine at home, keep it at room temperature, away from heat, moisture, and direct light. This medicine may come as a powder or a liquid. This powder or liquid must be mixed with another, special liquid before you use it. Do not mix the medicine and the special liquid together until right before using the medicine. Ask your doctor or home health caregiver if you have questions.
• Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets. Follow any special instructions about how to throw away empty medicine bottles, tubes, or bags.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• There are many drugs that can interact with methotrexate. Some of these drugs are aspirin, phenytoin (Dilantin®), theophylline (Theo-Dur®), antibiotics (such as penicillin, tetracycline, Bactrim®, Septra®), and vitamin supplements that contain folic acid. Make sure your doctor knows about ALL other medicines you are using.
• If you have bone cancer, ask your doctor if you need to avoid using pain or arthritis medicine (such as aspirin, diclofenac, ibuprofen, indomethacin, Advil®, Aleve®, Bextra®, Celebrex®) or steroid medicines (such as prednisone).
• If you have arthritis, make sure your doctor knows about all other medicines you are using to treat arthritis (such as aspirin, gold, ibuprofen, prednisone, sulfasalazine, Azulfidine®, Celebrex®, Plaquenil®).
• Make sure your doctor knows about any cancer treatments you are using, including cisplatin (Platinol®) or radiation.
• Tell your doctor if you have used methotrexate before for any reason.
• Talk to your doctor before getting flu shots or other vaccines while you are receiving methotrexate. Vaccines may not work as well while you are using this medicine.

Warnings While Using This Medicine:
• Using this medicine while you are pregnant can harm your unborn baby. The medicine may also cause birth defects if the father is using it when his sexual partner becomes pregnant. Use an effective form of birth control during treatment with methotrexate. For a man, continue birth control for at least 3 months after stopping treatment. For a woman, continue birth control until you have had two menstrual periods after stopping treatment. If a pregnancy occurs while you are using this medicine, tell your doctor right away.
• Make sure your doctor knows if you have kidney disease, liver disease, a stomach ulcer, colitis, diabetes, hepatitis, HIV or AIDS, problems with your immune system, or any kind of problem with your blood (such as anemia). Tell your doctor if you get an infection of any kind.
• This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.Tell your doctor if you have increased skin redness or other problems.
• You may get infections more easily while you are using this medicine. Stay away from people with colds, flu, or other infections. Wash your hands often.
• Your doctor will need to check your progress at regular visits while you are using this medicine. You may need to have blood tests or other medical tests. Be sure to keep all appointments.

If you notice these less serious side effects, talk with your doctor:
• Hair loss

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Methotrexate (Injection) (Injectable) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:36:08 AM Tuesday, March 16, 2010 4:36:06 PM GMT

Metronidazole

Metronidazole (By mouth) • Metronidazole (met-roe-NYE-da-zole)
Treats infections. Belongs to a class of drugs called antibiotics.
Brand Name(s):Helidac Therapy, Flagyl, Flagyl 375, Flagyl ER
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have ever had an allergic reaction to metronidazole.

How to Use This Medicine:
Tablet, Capsule, Long Acting Tablet, Liquid
• Your doctor will tell you how much medicine to take and how often.
• You may take the capsule, tablet, or oral liquid with food or milk to avoid stomach upset.
• It is best to take the extended-release tablet on an empty stomach, one hour before you eat a meal or two hours after a meal.
• Swallow the extended-release tablet whole. Do not crush, break, or chew it.
• Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup.
• Take your medicine as scheduled until it is all gone, even if your symptoms go away. If you stop taking metronidazole too soon, your infection may return.
• If you do not get better in a few days or if your symptoms get worse, call your doctor.
If a dose is missed:
• Take the missed dose as soon as possible.
• If it is nearly time for your next dose, wait until then to take the medicine and skip the missed dose.
• You should not use two doses at one time.

How to Store and Dispose of This Medicine:
• Keep the medicine at room temperature in a tightly closed container, away from heat, direct light, and moisture.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
• Keep all medicine away from children.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Do not drink alcohol or take medicine with alcohol in it, such as cold or cough medicines. Wait at least one day after stopping metronidazole before drinking alcohol.
• Make sure your doctor knows if you are taking blood thinners such as Coumadin®, disulfiram (Antabuse®), phenobarbital (Donnatal®), phenytoin (Dilantin®), or cimetidine (Tagamet®).
Warnings While Using This Medicine:
• If you are pregnant or breastfeeding, talk to your doctor before taking this medicine.
• Check with your doctor before taking metronidazole if you have liver or heart disease, a nerve disease (such as epilepsy), or a blood disorder.
• If you are taking this medicine for a genital infection, make sure that your sexual partner also gets treated, even if he or she has no symptoms.
• Because this medicine makes some people dizzy or lightheaded, be careful when driving a car or using machinery.
• This medicine may turn your urine a reddish-brown color. This is normal.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:
• Skin rash or hives
• Unexplained sore throat or fever
• Joint pain
• Tingling, pain, or weakness in hands or feet

If you notice these less serious side effects, talk with your doctor:
• Mild diarrhea, nausea, vomiting, stomach pain
• Dizziness or lightheadedness
• Dry mouth, metallic taste
• Pain during sex or when going to the bathroom (urinating)
• Vaginal swelling, itching, or discharge
• Loss of appetite

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Metronidazole (Oral) (Tablet, Capsule, Tablet, Extended Release, Liquid) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:39:48 AM Tuesday, March 16, 2010 4:39:46 PM GMT

Prednisone

Prednisone (By mouth) • Prednisone (PRED-ni-sone)
Treats asthma, serious skin problems, arthritis, and allergic reactions. Belongs to a class of drugs called corticosteroids.
Brand Name(s):PredniSONE Intensol, Prednicot, Sterapred DS, Sterapred, Deltasone
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to prednisone or related drugs such as hydrocortisone, betamethasone, dexamethasone, or triamcinolone. Before you take prednisone, make sure your doctor knows if you have peptic ulcers, tuberculosis (TB), or fungal infections.

How to Use This Medicine:
Tablet, Liquid
• Your doctor will tell you how much to take and how often.
• Measure your oral liquid medicine with a clearly marked measuring spoon.
• If this medicine upsets your stomach, take it with food or milk.

If a dose is missed:
• Prednisone can be given on many different schedules.
• If you miss a dose, talk with your doctor or pharmacist about the best time to take the missed dose.

How to Store and Dispose of This Medicine:
• Store at room temperature, away from heat, moisture, and direct light. Do not freeze the oral liquid.
• Keep all medicine out of the reach of children.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Unless approved by your doctor, do not drink alcohol (beer, wine, or liquor).
• Check with your doctor before you receive any immunizations or vaccinations.

Warnings While Using This Medicine:
• If you are pregnant or breastfeeding, talk to your doctor before taking this medicine.
• Talk with your doctor before taking prednisone if you have diabetes, high blood pressure, heart disease, glaucoma, kidney disease, liver disease, an eye infection caused by herpes, or any other infections.
• Do not stop taking this medicine without first talking with your doctor. You may need to take smaller and smaller doses before completely stopping this medicine.
• Avoid being around people with viral infections such as measles or chickenpox. If you are exposed to these infections, check with your doctor as soon as possible.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:
• Skin rash
• Blurred vision
• Swelling of feet or legs or weight gain
• Muscle cramps or weakness
• Severe stomach pain
• Bloody vomit or blood in stools
• Increased thirst or urination

If you notice these less serious side effects, talk with your doctor:
• Increased appetite
• Nervousness
• Indigestion, nausea, or vomiting
• Trouble sleeping
• Fullness or roundness of face
• Skin infections
• Confusion, depression, or mood changes
• Seeing or hearing unusual things

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Prednisone (Oral) (Tablet, Liquid) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:44:31 AM Tuesday, March 16, 2010 4:44:28 PM GMT

Probiotic

VSL#3 Probiotic Supplement

Description
VSL#3® is a high-potency medical food probiotic consisting of live freeze-dried lactic acid bacteria. Each dose contains 450 billion live lactic acid bacteria per packet in defined ratios of lyophilized Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, Lactobacillus bulgaricus, Streptococcus thermophilus.

Intended Use
VSL#3® is intended to be used in the dietary management of medically diagnosed ulcerative colitis, Irritable Bowel Syndrome, or an ileal pouch. VSL#3® is a medical food that is intended to be used under the supervision of a physician.

Physiology
VSL#3® provides specifically modified nutritional support for the management of medically diagnosed ulcerative colitis (UC), Irritable Bowel Syndrome, or an ileal pouch by delivering a high concentration of several strains of live bacteria in a formulation that survives gastric fluid, bile, and pancreatic secretions, and colonizes the gastrointestinal tract.19,20,44,66 Studies have demonstrated that the gut microflora modulate intestinal inflammation, reduce colonic permeability, and enhance barrier function. 22,35,39,49,64 Patients with pouchitis who received VSL#3® were found to have increased concentrations of the anti-inflammatory cytokine IL-10 and reduction of the pro-inflammatory cytokines IL-1α, interferon-γ, and tumor necrosis factor- α, as well as inducible nitric oxide synthase and matrix metalloproteinase activity to concentrations similar to those found in non-inflamed pouches64.
Product Specifications

VSL#3® comes in a powder that is intended to be mixed with at least 4 ounces of cold water and consumed. VSL#3® has a light lemon cream flavor. Ingredients – 450 billion lactic acid bacteria, maltose, natural lemon flavor, silicon dioxide.
VSL#3® is also available as an unflavored powder that is intended to be mixed with yogurt, ice-cream, apple sauce or any other cold food and consumed. Ingredients – 450 billion lactic acid bacteria, cornstarch.

Storage – Packets should be refrigerated (39-46° F). The product may be stored at room temperature for up to a week without adversely affecting potency.

Shelf life – 2 years from manufacturing date when stored properly (39-46° F).

Drug Interactions
Avoid taking together with antibiotics. Antibiotics may inactivate the live bacteria in VSL#3®.

Side Effects
Should be avoided in patients whose immune system is impaired

Cost
About $80.00/month

References:
Tursi A et al: Med Sci Monit 2004;10:PI126-131.
Bibiloni R et al: Am J Gastroenterology 2005;100:1-8..
Venturi A et al: Ailment Pharmacol Ther 1999; 13:1103-1108.
Mimura T et al: Gut 2004; 53:108-114.
Gionchetti P et al: Gastroenterology 2003; 124:1202-09.
Gionchetti P et al: Gastroenterology 2000; 119:305-309

Rifaximin

Rifaximin (By mouth) • Rifaximin (rif-AX-i-min)
Treats traveler’s diarrhea caused by a bacteria called E coli.
Brand Name(s):Xifaxan
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to rifaximin, or similar drugs like rifampin or rifabutin. Do not use it if you have diarrhea with blood in it, or if you have a fever.

How to Use This Medicine:
Tablet
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to. The usual dose of this medicine is one tablet, 3 times each day, for 3 days.
• You may take this medicine with or without food.
How to Store and Dispose of This Medicine:
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breast feeding, or if you have recently been taking an antibiotic (such as Cipro®, Keflex®, or pencillin).
• Call your doctor if your diarrhea gets worse, or continues after using this medicine for 1 to 2 days.

If you notice these less serious side effects, talk with your doctor:
• Constipation.
• Headache.
• Nausea, vomiting, or stomach pain.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Rifaximin (Oral) (Tablet) – DrugNote, English
Printed on Tuesday, March 16, 2010 11:59:30 AM Tuesday, March 16, 2010 4:59:27 PM GMT

Sulfasalazine

Sulfasalazine (By mouth) • Sulfasalazine (sul-fa-SAL-a-zeen)
Treats ulcerative colitis. Also treats rheumatoid arthritis. This medicine is a sulfa drug.
Brand Name(s):Sulfazine EC, Azulfidine Entabs, Sulfazine, Azulfidine
There may be other brand names for this medicine.

When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to sulfasalazine or any other sulfa drug, or to aspirin or any other salicylate drugs. You should not use this medicine if you have anything blocking your intestines or bladder, or if you have porphyria.

How to Use This Medicine:
Tablet, Coated Tablet
• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• It is best to take this medicine with food. Take each dose at evenly spaced times throughout the day and night. Try not to let more than 8 hours go by between doses, even at night.
• Swallow the tablet with a full glass (8 ounces) of water. Swallow the enteric-coated tablet whole. Do not break, crush, or chew it.
• Drink extra fluids so you will pass more urine while you are using this medicine. This may help prevent kidney problems.
• Tell your doctor if you see the enteric-coated tablet in your stools. This could mean your body did not absorb (use) the medicine.

How to Store and Dispose of This Medicine:
• Store the medicine at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.
• Keep all medicine away from children and never share your medicine with anyone.

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have liver disease, kidney disease, bleeding problems, asthma, severe allergies, or G6PD deficiency (not having enough of an enzyme called glucose-6-phosphate dehydrogenase in your blood).
• If you are a man, this medicine may cause your body to make less sperm than normal. You may not be able to father a child while you are using this medicine. Your sperm should go back to normal after you stop using this medicine.
• Your doctor will need to check your blood or urine at regular visits while you are using this medicine. Be sure to keep all appointments.
• Your skin or urine may turn an orange or yellow color while you are using this medicine. This is normal and nothing to worry about.
• If you are using this medicine for rheumatoid arthritis, it may take 4 to 12 weeks before you start feeling better.

If you notice these less serious side effects, talk with your doctor:
• Dizziness
• Headache
• Loss of appetite, nausea, vomiting, or upset stomach (for more than a few days)

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088
© 1974-2010 Thomson Reuters. All rights reserved.
Sulfasalazine (Oral) (Tablet, Tablet, Enteric Coated) – DrugNote, English
Printed on Tuesday, March 16, 2010 12:05:06 PM Tuesday, March 16, 2010 5:05:03 PM GMT