Dalteparin

Tell your doctor you use Dalteparin before you have any type of spinal puncture or epidural/spinal anesthesia. Patients who have these procedures while they use Dalteparin are at risk of developing a blood clot on or near the spinal cord. This could result in long-term or permanent paralysis.

The risk is increased in patients who have an indwelling epidural catheter, traumatic or repeated epidural or spinal puncture, a history of a deformed spine or spinal surgery, and in patients who use medicines that may affect blood clotting such as warfarin, aspirin, platelet inhibitors (eg, clopidogrel), and nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, naproxen).

If you have a spinal puncture or epidural/spinal anesthesia while you use Dalteparin , tell your doctor immediately if you notice any signs or symptoms of nerve problems, such as numbness or tingling, muscle weakness, or paralysis.

           Dalteparin is used for:

Preventing blood clots in patients who have certain illnesses or who will be having certain types of surgeries. It is also used along with aspirin to prevent certain problems caused by heart attacks or unstable angina (chest pain). It is also used to reduce the recurrence of blood clots in certain cancer patients. It may also be used for other conditions as determined by your doctor.

Dalteparin is a low molecular weight heparin (LMWH). It works by blocking the formation of blood clots.

Do NOT use Dalteparin if:

you are allergic to any ingredient in Dalteparin

you are allergic to heparin, benzyl alcohol, or pork products

you have active severe high blood pressure, major bleeding, or a history of low platelets or bleeding problems due to the use of heparin

you are receiving Dalteparin for unstable chest pain or heart attack and will be receiving local anesthesia

Contact your doctor or health care provider right away if any of these apply to you.

Before using Dalteparin :

Some medical conditions may interact with Dalteparin . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

if you have allergies to medicines, foods, or other substances

if you have a history of kidney problems, liver problems, stomach or intestinal problems (eg, ulcers), stroke, or vision problems caused by diabetes or high blood pressure

if you have inflammation of the heart due to a bacterial infection, or severe, uncontrolled high blood pressure

if you have a bleeding disorder, a history of brain bleeding or blood conditions, or von Willebrand disease

if you have recently had or are scheduled to have brain, spine, or eye surgery, an epidural catheter, or a spinal puncture

if you are taking medicines that affect platelets (eg, aspirin, clopidogrel, ticlopidine)

Some MEDICINES MAY INTERACT with Dalteparin . Tell your health care provider if you are taking any other medicines, especially any of the following:

Activated protein C, anticoagulants (eg, warfarin), dextran, dipyridamole, direct factor XA inhibitors (eg, rivaroxaban), direct thrombin inhibitors (eg, dabigatran), injectable cephalosporins (eg, cephazolin), injectable penicillins (eg, ampicillin), NSAIDs (eg, ibuprofen, ketorolac, naproxen), platelet inhibitors (eg, clopidogrel, ticlopidine), salicylates (eg, aspirin), sulfinpyrazone, or thrombolytics (eg, streptokinase) because the risk of side Use Dalteparin as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Dalteparin is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Dalteparin at home, carefully follow the injection procedures taught to you by your health care provider.

Do not use Dalteparin if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.

Dalteparin should be given while sitting or lying down.

Use the proper technique taught to you by your doctor. Inject deep under the skin, NOT into muscle.

Dalteparin may be injected in a U-shape around the navel, the upper outer thigh, or the upper outer section of the buttock. The injection site should be changed daily. When injection around the navel or thigh is used, a fold of skin must be held by the thumb and forefinger while the injection is given. The entire needle should be injected at a 45- to 90-degree angle.

Fixed dose syringes - To ensure delivery of the full dose, do not expel the air bubble from the prefilled syringe before injection. Hold the syringe assembly by the open sides of the device. Remove the needle shield. Insert the needle into the injection area. Depress the plunger of the syringe while holding the finger flange until the entire dose remaining in the syringe has been given. The needle guard will not be activated unless the entire dose has been given. Remove the needle from the patient. Let go of the plunger and allow the syringe to move up inside the device until the entire needle is guarded. Discard the assembly in approved containers.

Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.

If you miss a dose of Dalteparin , contact your doctor immediately.

Ask your health care provider any questions you may have about how to use Dalteparin .

Important safety information:

Dalteparin may reduce the number of clot-forming cells (platelets) in your blood. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.

Tell your doctor or dentist that you take Dalteparin before you receive any medical or dental care, emergency care, or surgery.

Before you begin taking any new prescription or nonprescription medicine, check the label to see if it has aspirin or ibuprofen in it. If it does or you are not sure, contact your doctor or pharmacist.

Some forms of Dalteparin contain benzyl alcohol. Do not use medicine with benzyl alcohol in NEWBORNS or INFANTS. It may cause serious and sometimes fatal side effects. If you have questions, check with your doctor or pharmacist.

If you have ever had an allergic reaction to benzyl alcohol, ask your doctor or pharmacist if your medicine has benzyl alcohol in it.

Dalteparin may affect certain lab tests, including liver enzyme tests. Be sure your doctor and lab personnel know you are using Dalteparin .

Lab tests, including complete blood cell counts (eg, platelet counts) and tests for blood in the stool, may be performed while you use Dalteparin . These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

Use Dalteparin with caution in the ELDERLY; they may be more sensitive to its effects, especially bleeding.

Dalteparin should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.

PREGNANCY and BREAST-FEEDING: Dalteparin may contain the preservative benzyl alcohol, which can cause harm to the fetus. If you become pregnant, use a formulation without this preservative. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Dalteparin while you are pregnant. Dalteparin is found in breast milk. If you are or will be breast-feeding while you are using Dalteparin , check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Dalteparin :

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Mild bleeding, bruising, irritation, pain, redness, or swelling at the injection site.

                       Store Dalteparin at room temperature, between 66 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Keep Dalteparin out of the reach of children and away from pets.       

               

Raloxifene

Raloxifene may increase the risk of serious blood clots. Do not take Raloxifene if you have a history of serious blood clots (eg, in the lung, leg, or eye).

Raloxifene may increase the risk of death from stroke in patients who have coronary heart disease or who are at risk for certain serious heart problems. If you have heart problems or are at risk for a serious heart problem, talk with your doctor to be sure that the benefits of using Raloxifene outweigh the risks.

Raloxifene is used for:

Treating and preventing osteoporosis (bone thinning) in women who are past menopause. It is also used to reduce the risk of invasive breast cancer in certain women who are past menopause. It may also be used for other conditions as determined by your doctor.

Raloxifene is a selective estrogen receptor modulator (SERM). It works in osteoporosis by decreasing bone breakdown and thinning that may occur in women after menopause. It works to decrease the risk of invasive breast cancer by blocking estrogen in breast and uterine tissue.

Do NOT use Raloxifene if:

* you are allergic to any ingredient in Raloxifene

* you are pregnant, could become pregnant, or are breast-feeding

* you have not yet gone through menopause

* you have a history of blood clots in your legs, lungs, or eyes

* you are taking an anion exchange resin (eg, cholestyramine, colestipol) or estrogen

Some medical conditions may interact with Raloxifene . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

* if you are pregnant, planning to become pregnant, or are breast-feeding

* if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

* if you have allergies to medicines, foods, or other substances

* if you have a history of liver problems, kidney problems, breast cancer, or any other type of cancer

* if you have a history of stroke, transient ischemic attack (TIA), blood vessel problems, heart problems, (eg, heart failure, irregular heartbeat), or high blood pressure

* if you are at risk for stroke or heart problems

* if you will be having surgery, you smoke or drink alcohol, you are not able to absorb nutrients properly (gastrointestinal malabsorption syndrome), or you have very poor health

* if you are taking an estrogen or have a history of high triglyceride levels while taking an estrogen

* if anyone in your family has a history of serious blood clots

Some MEDICINES MAY INTERACT with Raloxifene . Tell your health care provider if you are taking any other medicines, especially any of the following:

* Anion exchange resins (eg, cholestyramine) because they may decrease Raloxifene 's effectiveness

* Diazepam, diazoxide, or lidocaine because the risk of their side effects may be increased by Raloxifene .

* Anticoagulants (eg, warfarin) because their effectiveness may be decreased by Raloxifene

Use Raloxifene as directed by your doctor. Check the label on the medicine for exact dosing instructions.

* Raloxifene comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Raloxifene refilled.

* Take Raloxifene by mouth with or without food.

* Take Raloxifene on a regular schedule to get the most benefit from it. Taking Raloxifene at the same time each day will help you remember to take it.

* Continue to take Raloxifene even if you feel well. Do not miss any doses.

* If you miss a dose of Raloxifene , use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Raloxifene .

* Follow the diet and exercise program given to you by your health care provider. Talk with your doctor about whether you should take a calcium and vitamin D supplement while you use Raloxifene .

* Talk with your doctor about the use of weight-bearing exercises to help prevent weak bones.

* Raloxifene should be stopped at least 72 hours before surgery or any time you will be confined to a bed or chair for a long period of time (eg, long car ride, long plane flight, bedrest, illness). Tell your doctor or dentist that you take Raloxifene before you receive any medical or dental care, emergency care, or surgery. Tell your doctor if you will be traveling, or any other time you may be confined to a bed or chair.

* If you are traveling (eg, long car ride or plane ride), try to avoid sitting in one place for a long time. Be sure to get up and move around as often as possible to help avoid the risk of blood clots.

* Raloxifene is not recommended for use in men.

* Lab tests and medical exams, including bone density, breast exams, and mammograms, may be performed while you use Raloxifene . They may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

* Raloxifene should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.

* PREGNANCY and BREAST-FEEDING: Do not use Raloxifene if you are pregnant. It may cause harm to the fetus. Avoid becoming pregnant while you are taking it. If you think you may be pregnant, contact your doctor right away. It is not known if Raloxifene is found in breast milk. Do not breast-feed while taking Raloxifene .

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Hot flashes; increased sweating; joint aches; leg cramps.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abnormal vaginal bleeding; back or side pain; blurred vision, loss of vision, or other vision changes; breast pain, tenderness, swelling, lump or discharge; chest pain; coughing up blood; confusion; flu-like symptoms; leg or calf pain, warmth, or swelling; one-sided weakness; shortness of breath; slurred speech; swelling of the hands, arms, legs or feet; unexplained bleeding.

Store Raloxifene at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Raloxifene out of the reach of children and away from pets.

Warfarin

Warfarin is an anticoagulant (blood thinner). It reduces the formation of blood clots by blocking the formation of certain clotting factors.

Warfarin is used to prevent heart attacks, strokes, and blood clots in veins, arteries and lungs. It treats or prevents clots that may occur because of a type of abnormal heartbeat (atrial fibrillation) or heart valve replacement. Warfarin is also used to reduce the risk of death or blood clotting events (eg, stroke) after a heart attack.

Warfarin may also be used for purposes other than those listed here.

This medication can cause birth defects in an unborn baby. Do not use if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Never take a double dose of warfarin.

If you need to have a lumbar puncture (spinal tap) or any type of surgery, you may need to temporarily stop using warfarin. Be sure the surgeon knows ahead of time that you are using this medication.

Carry an ID card or wear a medical alert bracelet stating that you are taking warfarin, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking this medication. Warfarin interacts with many other drugs, and these interactions can be dangerous, even fatal. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. You should not take acetaminophen (Tylenol), aspirin, or NSAIDs (non-steroidal anti-inflammatory drugs) unless your doctor has told you to. NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others. These medicines may affect blood clotting and could cause serious bleeding in your stomach or intestines.

Avoid sudden changes in your diet. Vitamin K decreases the effects of warfarin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other green leafy vegetables. Do not change the amount of these foods in your diet without first talking to your doctor.

Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products.

Avoid drinking alcohol, which can increase some of the side effects of warfarin.

Take warfarin exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from warfarin. Follow the directions on your prescription label.

Take each dose with a full glass of water. Take warfarin at the same time every day. Warfarin can be taken with or without food.

Your body's response to warfarin can be affected by your diet, environment, physical well-being, and other medicines or herbal (botanical) products you use.

Avoid dieting to lose weight while taking warfarin. Tell your doctor if your body weight changes for any reason.

It is important to take warfarin regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

If you need to have a lumbar puncture (spinal tap) or any type of dental work or surgery, you may need to temporarily stop using warfarin. Be sure your doctors know ahead of time that you are using warfarin.

Carry an ID card or wear a medical alert bracelet stating that you are taking warfarin, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking warfarin. Store this medication at room temperature away from heat, moisture, and light.

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include bruising, broken blood vessels under the skin, excessive bleeding from cuts or wounds, blood in the urine or stools, and heavy menstrual periods in women.

You should not take acetaminophen (Tylenol), aspirin, or NSAIDs (non-steroidal anti-inflammatory drugs) unless your doctor has told you to. NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others. These medicines may affect blood clotting and could cause serious bleeding in your stomach or intestines.

Avoid sudden changes in your diet. Vitamin K decreases the effects of warfarin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other green leafy vegetables. Do not change the amount of these foods in your diet without first talking to your doctor.

Avoid eating cranberries, drinking cranberry juice, or taking cranberry herbal products.

Avoid drinking alcohol, which can increase some of the side effects of this medication.

Avoid sports or activities that could result in a bruising or bleeding injury. Use extra caution to avoid cuts when brushing your teeth or shaving.