Wellcovorin

Leucovorin (loo-koe-VOR-in) is used as an antidote to the harmful effects of methotrexate (a cancer medicine) that is given in high doses. It is used also to prevent or treat certain kinds of anemia. Leucovorin acts the same way in the body as folic acid, which may be low in these patients.

Leucovorin is also used along with fluorouracil (a cancer medicine) to treat cancer of the colon (bowel).

Leucovorin is available only with a prescription and is to be given only by or under the supervision of your doctor. It is available in the following dosage forms:

                      In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For leucovorin, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to leucovorin. Also tell your health care professional if you are allergic to any other substance, such as foods, sulfites or other preservatives, or dyes.

Pregnancy—Studies on effects in pregnancy have not been done in either humans or animals.

Breast-feeding—It is not known whether leucovorin passes into the breast milk. However, it has not been reported to cause problems in nursing babies.

Children—In children with seizures, leucovorin may increase the number of seizures that occur.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of leucovorin in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other medical problems—The presence of other medical problems may affect the use of leucovorin. If you are taking leucovorin as an antidote to methotrexate, make sure you tell your doctor if you have any other medical problems, especially:

Kidney disease—Levels of methotrexate may be increased because of its slower removal from the body, so the dose of leucovorin may not be enough to block the unwanted effects of methotrexate

Nausea and vomiting—Not enough leucovorin may be absorbed into the body to block the unwanted effects of methotrexate

                                 It is very important that you take leucovorin exactly as directed , especially when it is being taken to counteract the harmful effects of cancer medicine. Do not miss any doses. Also, it is best to take the doses at evenly spaced times day and night . For example, if you are to take 4 doses a day, the doses should be spaced about 6 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your health care professional.

Do not stop taking leucovorin without checking with your doctor . It is very important that you get exactly the right amount.

Dosing—The dose of leucovorin will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of leucovorin. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets or doses of injection that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking leucovorin .

For use as an antidote to methotrexate:

For oral (tablets) or injection dosage forms:

Adults, teenagers, and children—Dose is based on body size and must be determined by your doctor.

For use as an antidote to other medicines:

For oral (tablets) or injection dosage forms:

Adults, teenagers, and children—Dose may range from 0.4 milligrams (mg) to 15 mg a day and must be determined by your doctor.

For certain kinds of anemia:

For oral (tablets) or injection dosage forms:

Adults, teenagers, and children—Up to 1 mg a day.

For colon cancer:

For injection dosage forms:

Adults and teenagers—Dose is based on body size and must be determined by your doctor.

Children—Dose must be determined by your doctor.

Missed dose—If you miss a dose of leucovorin or if you vomit shortly after taking a dose, check with your doctor right away . Your doctor may want you to take extra leucovorin to make up for what you missed. Do not take more medicine on your own, however, since it is very important that you receive just the right dose at the right time.

Storage—To store this medicine:

Keep out of the reach of children.

Store away from heat and direct light.

Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.

Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

                           Along with its needed effects, a medicine may cause some unwanted effects. Leucovorin usually does not cause any side effects.

However, check with your doctor immediately if any of the following side effects occur shortly after you receive this medicine:

Rare

Skin rash, hives, or itching; wheezing

Check with your doctor as soon as possible if the following side effect occurs:

Rare—reported with use in treatment of cancer

Convulsions (seizures)

                        

Valcyte

Valcyte is changed into ganciclovir in the body and may cause severe blood side effects (eg, low platelets, low blood cell counts, anemia). Notify your doctor immediately if you develop unusual fatigue, easy bruising or bleeding, or signs of an infection such as persistent fever or sore throat. Valcyte causes cancer, birth defects, and a lack of sperm production in animals.

                       Valcyte is used for:

Treating cytomegalovirus (CMV) infection of the eye in patients with AIDS. It is used to prevent CMV disease in high risk kidney, heart, and kidney-pancreas transplant patients. It may also be used for other conditions as determined by your doctor.

Valcyte is an antiviral agent. It works by stopping the growth and reproduction of the virus.

                         Some medical conditions may interact with Valcyte . 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 kidney problems, blood cell or platelet problems, or a history of bone marrow problems

if you have a history of chemotherapy or radiation treatment, or you have taken other medicines that may cause bone marrow problems. Ask your doctor if you are unsure if any of your medicines may cause bone marrow problems.

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

Didanosine because risk of severe side effects, such as toxicity, may be increased by Valcyte

Probenecid because the risk of toxic effects of Valcyte may be increased

Zidovudine because the risk of toxic effects, such as severe or life-threatening blood problems, may be increased

Mycophenolate mofetil because it may increase Valcyte 's risk of side effects in patients with kidney problems

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

An additional patient leaflet is available with Valcyte . Talk to your pharmacist if you have questions about this information.

Take Valcyte with food.

Swallow Valcyte whole. Do not break, crush, or chew before swallowing.

Do not get broken or crushed tablets on your skin or in your eyes, nose, or mouth. If contact occurs, wash the skin thoroughly with soap and water and rinse eyes with plenty of clear water.

Any broken or leftover medicine should be placed in a plastic bag and disposed of as instructed by your doctor or pharmacist.

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

If you miss a dose of Valcyte , take 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 take 2 doses at once.

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

                            Valcyte may cause drowsiness or dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Valcyte . Using Valcyte alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.

Valcyte is not a cure for CMV infection. Remain under the care of your doctor.

Valcyte may lower your body's ability to fight infection. Prevent infection by avoiding contact with people with colds or other infections. Notify your doctor of any signs of infection, including fever, sore throat, rash, or chills.

Do not substitute Valcyte for ganciclovir because an overdose may occur. Check with your doctor or pharmacist if you have any questions about the brand or dose of your medicine.

Valcyte may reduce the number of clot-forming cells (platelets) in your blood. To prevent bleeding, avoid situations in which bruising or injury may occur. Report any unusual bleeding, bruising, blood in stools, or dark, tarry stools to your doctor.

Use of Valcyte may increase your risk of developing cancer. Discuss any questions or concerns with your doctor.

When your medicine supply begins to run low, get more from your doctor or pharmacist as soon as possible. The virus may develop resistance to Valcyte and become more difficult to treat if you stop taking it, even for a short period of time.

Valcyte may cause decreased sperm production and decreased fertility.

During sexual intercourse with a woman who may become pregnant, men taking Valcyte should use a condom during treatment with Valcyte and for 90 days after it is stopped.

Lab tests, including eye exams, complete blood cell and platelet counts, and kidney function tests, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.

Use Valcyte with caution in the ELDERLY because they may be more sensitive to its effects.

Use Valcyte with extreme caution in CHILDREN. Safety and effectiveness have not been confirmed.

PREGNANCY and BREAST-FEEDING: Valcyte may cause harm to the fetus. Avoid becoming pregnant while taking Valcyte . Use effective contraception to prevent pregnancy while you are taking Valcyte . If you think you may be pregnant, discuss with your doctor the benefits and risks of using Valcyte during pregnancy. It is unknown if Valcyte is excreted in breast milk. Do not breast-feed while taking Valcyte .

                         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:

Back pain; constipation; diarrhea; dizziness; drowsiness; headache; nausea; stomach pain; trouble sleeping; vomiting.

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); chills; confusion; cough; decreased urination; depression; fever; hallucinations; loss of coordination; numbness or tingling of the skin, hands, or feet; seizures; sore throat; swelling of the legs; tremors; unsteady movements; unusual bruising or bleeding; unusual tiredness or weakness; vision changes.

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

Ultiva

Ultiva is used for:
Preventing and treating pain during and after procedures and surgery.
Ultiva is a narcotic pain reliever. It works by dulling the pain perception center in the brain.
  Do NOT use Ultiva if:
you are allergic to any ingredient in Ultiva or to similar medicines (eg, fentanyl)
you are taking sodium oxybate (GHB)
Contact your doctor or health care provider right away if any of these apply to you.
  Some medical conditions may interact with Ultiva . 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 heart or breathing problems
if you have a history of substance abuse or dependence problems
Some MEDICINES MAY INTERACT with Ultiva . Tell your health care provider if you are taking any other medicines, especially any of the following:
Alcohol, amiodarone, benzodiazepines (eg, alprazolam), cimetidine, or sodium oxybate (GHB) because the side effects of Ultiva may be increased
Naltrexone because the effectiveness of Ultiva may be decreased
  Use Ultiva as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Ultiva is usually administered as an injection at your doctor's office, hospital, or clinic. Ask your doctor or pharmacist any questions you may have about Ultiva .
If you miss a dose of Ultiva , contact your doctor immediately.
  Ultiva may cause dizziness or blurred vision. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Ultiva . Using Ultiva alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.
Avoid drinking alcohol or taking other medications that cause drowsiness (eg, sedatives, tranquilizers) while taking Ultiva . Ultiva will add to the effects of alcohol and other depressants. Ask your pharmacist if you have questions about which medicines are depressants.
Use Ultiva with caution in the ELDERLY because they may be more sensitive to its effects.
PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Ultiva during pregnancy. It is unknown if Ultiva is excreted in breast milk. If you are or will be breast-feeding while you are using Ultiva , check with your doctor or pharmacist to discuss the risks to your baby.
When used for long periods of time or at high doses, Ultiva may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Ultiva stops working well. Do not take more then prescribed.
When used for long periods of time or at high doses, some people develop a need to continue taking Ultiva . This is known as DEPENDENCE or addiction.
If you suddenly stop taking Ultiva , you may experience WITHDRAWAL symptoms, including anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing, or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.
  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:
Changes in vision; chills; dizziness; drowsiness; fever; headache; itching; nausea; shivering; sweating; vomiting.
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); fast or slow heartbeat; interrupted breathing; lightheadedness; muscle tightness; pain, redness, or swelling at the injection site; seizures.
  Ultiva is usually handled and stored by a health care provider. If you are using Ultiva at home, store Ultiva as directed by your pharmacist or health care provider. Keep Ultiva , as well as needles and syringes, out of the reach of children and away from pets.
   

Tace

Chlorotrianisene is a form of estrogen. Estrogen is a female sex hormone necessary for many processes in the body.

Chlorotrianisene is used to treat symptoms of menopause, deficiencies in ovary function (including underdevelopment of female sexual characteristics and some types of infertility), and prostate cancer.

Chlorotrianisene may also be used for purposes other than those listed in this medication guide.

Have yearly physical exams and examine your breasts for lumps on a monthly basis while taking chlorotrianisene.

Take chlorotrianisene with food or milk to lessen stomach upset. Do not take chlorotrianisene if you are pregnant.

Do not take chlorotrianisene if you

have breast cancer. Tell your doctor if you have (or have ever had) breast cancer.

have vaginal bleeding that has not been diagnosed. It will be necessary to determine if any abnormal bleeding has a hormonal cause.

have a bleeding or blood-clotting disorder. Chlorotrianisene may increase the risk that a blood clot will form.

Before taking this medication, tell your doctor if you

* have any type of liver or gallbladder disease,

are diabetic,

* suffer from migraines,

have epilepsy or seizures,

have heart disease, or

have kidney disease.

You may need a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Chlorotrianisene is in the FDA pregnancy category X. This means that chlortrianisene will cause birth defects in an unborn baby. Do not take this medication if you are pregnant or are planning a pregnancy. Chlorotrianisene may decrease milk flow and have other effects on milk composition. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.

Take this medication exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Take chlorotrianisene with food or milk to lessen stomach upset.

Try to take each dose at the same time each day, preferably in the morning. You may be taking it every day, or you may be taking it every day for 3 weeks with 1 week off each month to mimic your body's natural cycle. Follow the directions on your prescription label.

If you are taking chlorotrianisene to treat cancer, you may be taking it several times a day in very large doses.

Store chlorotrianisene at room temperature away from moisture and heat.

Take the missed dose as soon as you remember. Do not take a double dose of this medication unless otherwise directed by your doctor.

Avoid prolonged exposure to sunlight. Chlorotrianisene may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.

If you experience any of the following serious side effects, stop taking chlorotrianisene and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

a blood clot (pain, redness, and swelling in an arm or leg, shortness of breath, chest pain, headache, blurred vision, or confusion);

a lump in a breast; or

liver damage (yellowing of the skin or eyes, nausea, abdominal pain or discomfort, unusual bleeding or bruising, severe fatigue).

Other, less serious side effects may be more likely to occur. Continue to take chlorotrianisene and talk to your doctor if you experience

decreased appetite, nausea, or vomiting;

swollen breasts;

acné or skin color changes;

decreased sex drive;

migraine headaches or dizziness;

water retention (swollen hands, feet, or ankles);

depression; or

changes in your menstrual cycle or breakthrough bleeding.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Chlorotrianisene may decrease the effects of the following drugs:

anticoagulants (blood thinners) such as warfarin (Coumadin). This could lead to blood clots. Your doctor will want to monitor your anticoagulant therapy.

thyroid medications. A larger dose of thyroid medication may be needed.

insulin. Monitor your blood sugar levels and discuss any unusual changes with your doctor.

tamoxifen. Chlorotrianisene should not be taken during therapy with tamoxifen.

Chlorotrianisene may also increase the effects of some medications. The following drugs may have increased or dangerous side effects if taken with chlorotrianisene:

* tricyclic antidepressants such as amitriptyline (Elavil) and doxepin (Sinequan);

* other commonly used tricyclic antidepressants, including amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil); and

didanosine (Videx).

Before taking this medication, tell your doctor if you are taking any of the medicines listed above.

Other drugs may also affect chlorotrianisene. The effects of chlorotrianisene are decreased by

phenytoin (Dilantin) and ethotoin (Peganone),

carbamazepine (Tegretol),

phenobarbital (Solfoton, Luminal),

primidone (Mysoline), and

rifampin (Rifadin).

You may need larger doses of chlorotrianisene if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with chlorotrianisene. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Chlorotrianisene is available with a prescription under the brand name Tace. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Tace 12 mg--green, hard-gelatin capsules

Salmeterol

Long-acting beta-agonists such as Salmeterol have been rarely associated with an increased risk of asthma-related death. Salmeterol should only be used by certain patients with severe asthma or by patients who cannot get adequate control of asthma symptoms by using other asthma-controller medicines (eg, inhaled corticosteroids).

Salmeterol is used for:

Long-term treatment of asthma. It may be used to prevent breathing problems in certain patients, including patients with nighttime asthma, or breathing problems caused by exercise. It may be used for long-term treatment of chronic obstructive pulmonary disease (COPD). It may also be used for other conditions as determined by your doctor.

Salmeterol is a long-acting beta-agonist bronchodilator. It widens the airways in the lungs, which helps you breathe more easily.

Do NOT use Salmeterol if:

* you are allergic to any ingredient in Salmeterol

* you are using another medicine that has a long-acting beta-agonist (eg, fluticasone/salmeterol, formoterol) in it

* you are taking an azole antifungal (eg, ketoconazole), an HIV protease inhibitor (eg, ritonavir), a macrolide antibiotic (eg, clarithromycin), nefazodone, or telithromycin

* you are having an asthma attack (eg, sudden severe onset or worsening of asthma symptoms such as chest tightness, cough, shortness of breath, wheezing)

Some medical conditions may interact with Salmeterol . 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 had a severe allergic reaction to milk protein

* if you have a history of liver problems, diabetes, heart problems (eg, fast or irregular heartbeat, heart blood vessel problems), high blood pressure, low blood potassium levels, seizures, an adrenal gland tumor (pheochromocytoma), or an overactive thyroid

* if you have recently been to an emergency room for asthma, have a history of frequent hospitalizations for asthma, or have ever had a life-threatening asthma attack

* if you have had an unusual reaction to a sympathomimetic medicine (eg, albuterol, pseudoephedrine), such as fast or irregular heartbeat, overexcitement, or severe trouble sleeping

* if you are taking a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) or a tricyclic antidepressant (eg, amitriptyline), or you have taken any of these medicines within the last 14 days

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

* Azole antifungals (eg, ketoconazole), HIV protease inhibitors (eg, ritonavir), macrolide antibiotics (eg, clarithromycin), nefazodone, or telithromycin because the risk of fast or irregular heartbeat may be increased

* Diuretics (eg, furosemide, hydrochlorothiazide) because the risk of low blood potassium or irregular heartbeat may be increased

* Catechol-O-methyltransferase (COMT) inhibitors (eg, entacapone), long-acting beta-agonists (eg, fluticasone/salmeterol, formoterol), MAOIs (eg, phenelzine), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Salmeterol 's side effects

* Beta-blockers (eg, propranolol) because they may decrease Salmeterol 's effectiveness or worsen your condition

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

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

* Always activate and use this device in a level, horizontal position. Do NOT try to use a spacer device with Salmeterol .

* To prepare the device for use, open the protective foil pouch and remove the inhaler device. Hold the device in one hand. Use the thumb of the opposite hand to push the thumbgrip as far away from you as it will go. The mouthpiece will appear and snap into position.

* Hold the device in a level, flat position with the mouthpiece towards you. Use your thumb to slide the lever away from you as far as it will go. You should hear a click. The device is now ready for use.

* Do NOT close or tilt the device, play with the lever, or move the lever more than once. You may accidentally release or waste a dose.

* To use a dose of Salmeterol , hold the inhaler level and away from your mouth. Breathe out fully. Do NOT exhale into the device for any reason. Put the mouthpiece to your lips. Breathe in quickly and deeply through your mouth and hold your breath. Remove the inhaler from your mouth. Continue to hold your breath for 10 seconds or as long as possible. Then, breathe out slowly.

* Close the device when you are finished taking a dose. Slide the thumbgrip back towards you as far as it will go. The device will click shut, and the lever will return to its original position.

* Salmeterol delivers your dose as a very fine powder. Most, but not all, patients can taste or feel it. Even if you cannot feel it, do not use more than the recommended dose. If you are not sure if you are receiving your dose, contact your doctor or pharmacist.

* If you are using Salmeterol to prevent breathing problems caused by exercise, use it at least 30 minutes before you start to exercise. Do not use another dose for at least 12 hours. If you already use Salmeterol twice daily on a regular basis, do NOT take an extra dose before you exercise.

* Discard the inhaler 6 weeks after removing it from the protective foil pouch or after all the blisters have been used, whichever comes first.

* The dose indicator on the device will tell you how many doses are left. The dose indicator will read "0" when all the blisters have been used.

* Never wash the mouthpiece or any other part of the inhaler. Keep it dry and always store it in a dry place.

* Do NOT try to take the unit apart.

* Continue to use Salmeterol even if you feel well. Do not miss any doses.

* If you miss a dose of Salmeterol , skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

* Salmeterol may cause dizziness. This effect may be worse if you take it with alcohol or certain medicines. Use Salmeterol with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

* Salmeterol will not stop an asthma attack once it has already started. Be sure to carry a short-acting bronchodilator with you at all times to treat any breathing problems that may occur between doses of Salmeterol (eg, severe or sudden onset of wheezing or shortness of breath). If you have any questions about which medicines stop asthma attacks, check with your doctor or pharmacist.

* If you have been regularly using a short-acting bronchodilator inhaler (eg, albuterol), talk with your doctor about how to use it with Salmeterol . Short-acting bronchodilators are normally only used with Salmeterol to treat breathing problems that may occur between doses.

* The risk of serious heart problems (eg, irregular heartbeat) may be greater if you use Salmeterol in high doses. Do NOT use more than the recommended dose or use more often than prescribed.

* If your symptoms do not get better within 1 week of starting Salmeterol , or if they get worse, contact your doctor right away.

* Tell your doctor at once if you notice that your short-acting bronchodilator inhaler does not work as well, if you need to use it often (eg, 4 or more times a day for more than 2 days in a row; more than 1 canister in 8 weeks), or if you have a decrease in your peak flow meter results.

* Contact your doctor or seek medical care right away if you have breathing problems that worsen quickly, or if you use your short-acting bronchodilator and do not get relief.

* Salmeterol is not to be used in place of a corticosteroid. If you are using a corticosteroid medicine for asthma, do not stop or reduce the dose unless your doctor tells you to.

* Talk with your doctor or pharmacist about all of your asthma medicines and how to use them. Do not start, stop, or change the dose of any asthma medicine unless your doctor tells you to.

* Salmeterol may sometimes cause severe breathing problems right after you use a dose. If this happens, use your short-acting bronchodilator. Contact your doctor or seek other medical care at once.

* Diabetes patients - Salmeterol may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.

* Lab tests, including lung function tests and blood pressure, may be performed while you use Salmeterol . These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.

* Use Salmeterol with caution in the ELDERLY; they may be more sensitive to its effects, especially effects on the heart.

* Salmeterol should be used with extreme caution in CHILDREN younger than 4 years old; safety and effectiveness in these children have not been confirmed.

* PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Salmeterol while you are pregnant. It is not known if Salmeterol is found in breast milk. If you are or will be breast-feeding while you use Salmeterol , check with your doctor. Discuss any possible risks to your baby.

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:

Headache; nasal or sinus congestion; nervousness; stuffy nose; throat irritation; tremor.

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, tongue, or throat; unusual hoarseness); chest pain; choking; fast or irregular heartbeat; fever; new or worsening asthma symptoms (eg, coughing, increased chest tightness, shortness of breath, or wheezing); overexcitement; severe or persistent headache or dizziness; severe or persistent muscle pain or cramps.

Store Salmeterol at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store Salmeterol away from heat, moisture, and direct sunlight. Throw Salmeterol away 6 weeks after it is removed from the foil pouch. Keep Salmeterol out of the reach of children and away from pets.