Alimta 500mg lilly medicine to treat cases of malignant pleural epithelium, lung cancer

Dosage form Box
Specifications Pemetrexed
Ingredient Eli Lilly & Company

Ingredient

Composition information	Content
Pemetrexed	500mg

Uses

indications

Alimta 500mg Eli Lilly is indicated in the following cases:

Malignant pleural epithelium

Alimta combined with cisplatin is indicated to treat patients with malignant pleural epitheliums that cannot be removed from chemotherapy.

Small cell lung cancer

Alimta combined with cisplatin is a therapeutic step in a treatment for patients with non -small cell lung cancer that progresses on the spot or has metastasized, not the main type is the scales -shaped cell.

Alimta is indicated for treatment for maintenance in patients with non -cell lung cancer, no scaled cells, progressive in place or metastasis without progress immediately after 4 first chemotherapy cycles based on platinum.

Alimta is indicated as a single therapy in the second treatment for patients with non -small cell lung cancer that progresses on the spot or has metastasized, not the main type is the hypopathinalic -shaped sacrifice.

Pharmacology

Pharmaceutical group: Similar substances folic acid, ATC code: L01BA04.

Alimta (Pemetrexed) is a anti -cancer anti -cancer drug with many goals, which works by breaking the metabolic processes mainly dependent on folats needed for cell copying.

In vitro studies show that Pemetrexed has the effect of a multi -target anti -folat drug by inhibiting thymidylat synthase (TS), dihydrofolat reductase (DHFR), and Glycinamid ribonucleotidididide FormyltransFerase (Garft), are enzymes that depend on folat subjects to the key to general biomass of Thymidin and the thymidine biomass and the thymidin Purin nucleotid. Pemetrexed is transported into the sacrifice by both the system of reducing folate and transporting protein folate. Once in the cell, Pemetrexed is quickly converted and with high efficiency into polyglutamat forms by enzyme folylpolyglutamate synthetase. Polyglutamat forms are kept in the sacrifice and are also stronger TS and Garft inhibitors. Multiple glutamatization is a process of time and concentration that occurs in cancer cells, and to a more limited extent, in normal tissues. The metabolites of multi-glutamate chemicals have a half-life increase in the cell, resulting in the prolongation of the effect of the drug in cancer cells.

Clinical effect:

Middle epithelial:

emphacis, a multicolored 3 -center phase study, single blindness that compares alimta combining cisplatin with solitary cisplatin in patients with malignant pleural epithelium unused chemotherapy, showing that patients treated with Alimta and Cisplatin have an average survival of clinical significance 2.8 months compared to patients using Cisplatin only.

In the study, patients were added with folic acid and vitamin B12, low doses to reduce toxicity. The main analysis of this study was conducted on the population of all patients receiving random indications for a group of treatment, taking drugs

Salvation (random and treatment). Group analysis is performed in patients with supplements of folic acid and vitamin B12 in the whole study (fully supplemented).

The improvement has a statistical significant of clinical symptoms (pain and shortness of breath) related to malignant pleural epithelium in the alimta/cisplatin branch (212 label diseases) compared to the branch that uses only Cisplatin (218 patients) that have been proven when using the lung cancer symptom scale. Observed the statistical significance in lung function tests. The indifference between the treatment branches is based on the improvement of the lung function in the Alimta/Cisplatin branch and the worsening of the lung function in the control branch over time.

Patient data with malignant pulmonary epithelium treated with lonely Alimta is limited. Alimta is alone, the dose of 500 mg/m2 is used for 64 patients with malignant lung epithelium epithelium unused chemotherapy. The general response ratio is 14.1%.

Non -submitted lung cancer (NSCLC), Step two therapy:

A phase 3 study, multicolored, open label, randomly comparing Alimta with Docetaxel in patients with NSCLC on the spot or metastatic chemical treatment shows an average survival time of 8.3 months for patients treated with Alimta (intentional population of n = 283) and 7.9 months for patients treated with docetaxel (ITT N = 288). The previous chemotherapy did not include Alimta. An analysis of the influence of Historical NSCLC on the effectiveness of the provincial treatment on the survival time shows that Alimta excels Docetaxel in cases that are not mainly scaled cells (n = 399, 9.3 compared to 8.0 months, HR calibrated = 0.78; 95%Ci = 0.61 - 1.00, P = 0.047) and Docetaxel superior in carcinoma (N = 172, 6.2 compared to 172, 6.2 7.4 months. There is no clinical difference in the safety of Alimta in each hypopster group.

Clinical data is limited from an independent control 3 -phase -3 -phase study, which shows the clinical effect (the full life, the time of illness) of the similar Pemetrexed Pemetrexed in patients who had previously been treated with Docetaxel (n = 41) and patients who were not yet treated with Docetaxel (N = 540).

Non -cell lung cancer, step one:

A random study, multi -central, open label 3 compares alimta combined with cisplatin with gemcitabin combined with cisplatin to treat patients with non -subtle lung cancer (NSCLC) on the spot or metastatic (stage IIIB or IV) shows that Alimta in combination with Cisplatin (the number of treatment patients (ITT) N = 862) N = 862) The clinical effect is similar to gemcitabin in combination with cisplatin (ITTN = 863) on the full life time (the risk ratio of adjustment 0.94; 95%CI = 0.84 - 1.05).

Effective analysis is mainly based on the ITT population. The sensitivity analysis of the effectiveness is also mainly evaluated on the population to achieve the research proposal (PQ population). Effective analysis on the PQ population gives homogeneous results with the ITT population analysis and shows that AC is not inferior to GC.

The time of life is not progressive (PFS) and the same general response ratio between the treatment branches: The PFS median is 4.8 months for Alimta in combination with Cisplatin and is 5.1 months for Gemcitabin in combination with Cisplatin (Risk of correction risk 1.04; 95% CI = 0.94 - 1.15), and the general response rate is 30.6% (95% CI = 27 With Alimta + Cisplatin group and 28.2% (95% CI = 25.0 - 31.4) with Gemcitabin + Cisplatin group. Sexic chalk PFS data is confirmed by an independent assessment (400/1725 patients are chosen by randomly for evaluation).

Analysis of the influence of histological NSCLC on the total survival rate for the clinical difference in terms of survival rates depending on histology. There is no clinical difference that is noticeable about the safety of Alimta in combination with cisplatin in each hypopateral group.

patients treated with Alimta combined Cisplatin IT must be transmitted (16.4% compared to 28.9%, P

Non -cell lung cancer, maintenance treatment:

A multi -centered study, phase 3, random, open label, with a fake control that is compared with the effect and effect of the maintenance treatment with Alimta with the best supporting squirrel (BSC) (n = 441) with fake treatment with BSC (n = 222) in patients with non -small cell lung cancer metastasis (phase 4) or in place 3) Cisplatin or carboplatin combined with gemcitabin, paclitaxel, or docetaxel. Excluding therapy for a pair for Alimta. All patients include in this study with ECOG 0 or 1.

The patient is treated until the disease progresses. Efficiency and safety are assessed from the random time after completing the first step. The patient is treated on average 5 cycles of maintenance therapy with Alimta and 3.5 cycles with placebo. A total of 213 patients (48.3%) completed ≥ 6 cycles and a total of 103 patients (23.4%) completed ≥ 10 treatment cycles with Alimta.

The study responded to the basic ending score and showed the statistical improvement of the PFS in the Alimta group compared to the placebo group (n = 581, the independent assessment team; an average of 4.0 months and 2.0 months respectively) (Risk ratio = 0.6, 95% Ci = 0.49 - 0.73, P

Suitable for other Alimta studies, the difference in effectiveness according to histological NSCLC is observed in JMEN. In patients with NSCLC except for scaled cell tissue (n = 430, an independent assessment group) PFS averages 4.4 months with Alimta group and 1.8 months with a placebo group, risk ratio = 0.47 (95% Ci = 0.37 - 0.60, P = 0.00001). The average survival rate in patients with NSCLC except for scaled cell tissue (n = 481) is 15.5% monthly with Alimta group and 10.3 months with a placebo group, risk ratio = 0.70 (95% Ci = 0.56 - 0.88, P = 0.002). Including the starting phase of the average survival rate for patients with NSCLC except for the scaled cell tissue of 18.6 months with the Alimta group and 13.6 months with the placebo group, the risk ratio = 0.71 (95% CI = 0.56 - 0.88, P = 0.002).

PFS and OS results in patients with scaled cell tissue do not show the benefits of Alimta compared to fake. There is no clinical difference in the safety of Alimta in histological subgroups.

paramount

A multi -centered 3 -center phase study, random, double blind, control with placebo (paramount), comparing the effectiveness and safety of continuous maintenance treatment by

Alimta plus the best support care (BSC) (n = 359) with the best support for support (n = 180) in patients with non -small cell lung cancer (NSCLC) on the spot (phase IIIB) or metastatic (phase IV) other than the main scales of scaled cells, who have not progressed after 4 dual cycles of dual treatment in a single -step treatment with Cisplatin. Of the 939 patients treated with Alimta plus cisplatin, 539 patients were randomly selected to the maintenance group with Pemetrexed or placebo groups. Among patients who are randomly selected, 44.9% have a complete response/partial response and 51.9% have a stable response to the starting treatment with Alimta plus cisplatin. Patients who are randomly selected in the maintenance group need to have a score of physical activity according to the scale of ECOG (Eastern Cancer Cooperative Group) is 0 or 1. The average time from the beginning of the initial treatment with Alimta plus Cisplatin until the start of maintenance treatment is 2.96 months in the whole group using Pemetrexed and the placebo group. Randomly selected patients have been maintained until the disease progresses. Efficiency and safety have been assessed from the time of random selection after completing the therapy (starting) step one. Patients receive an average of 4 cycles maintained by Alimta and 4 steps with placebo. A total of 169 patients (47.1%) have completed ≥ 6 treatment cycles maintained by Alimta, representing at least a total of 10 Alimta cycles.

The research has achieved basic goals and shows that improvement is statistically significant of the survival time without progressing the disease (PFS) in the Alimta group more than the placebo group (N = 472, the group is considered independently; average 3.9 months and 2.6 months, according to the corresponding appropriate) (Ratio of risk = 0.64, trust range (CI) 95% = 0.51 - 0.81, P = 0.0002). Independent assessment of photographing Patients has confirmed the results of the researcher's evaluation of the time of life without progressing the disease. For randomly selected patients, as evaluated from the beginning of the beginning of the first step with Alimta plus cisplatin, the average life period of life is 6.9 months for the group using Alimta and 5.6 months for the placebo group (risk ratio = 0.59, reliable interval (C1) 95%= 0.47 - 0.74).

After the initial therapy with Alimta plus cisplatin (4 cycles), the dominant Alimta treatment is statistically significant than the total life time (OS) (on average 13.9 months compared to 11.0 months, risk ratio = 0.78, reliable range (CI) 95% = 0.64 - 0.96, P = 0.0195). At the time of the last survival analysis, 28.7% of patients were still alive or monitored in the Alimta group compared to 21.7% in the placebo group. Alimta's relative treatment effect is the best between subgroups (including the stage, responding to the beginning therapy, the physical activity according to the scale of ECOG, the smoking, gender, learning and age) and the same as it has been seen in the analysis of the full life time (OS) and the unproductive life time (PFS). The survival rate for an additional 1 year and 2 years for patients is using Alimta is 58% and 32% in the corresponding appropriate, compared to 45% and 21% for patients with placebo. From the beginning of the first step in the first step with Alimta plus cisplatin, the average survival of the patient was 16.9 months for the Alimta group and 14 months for the placebo group (risk ratio = 0.78, reliable range (CI) 95% = 0.64 - 0.96). The percentage of patients received after the study was 64.3% for the Alimta group and 71.7% for the fake group.

Dynamic pharmacokinetics

Pemetrexed pharmacokinetic properties after using the single dose that have been assessed on 426 cancer patients with dense tumors with doses from 0.2 to 838 mg/m2 are transferred for 10 minutes. Pemetrexed can be distributed in equilibrium state of 9 liters/m2. In vitro studies have shown that Pemetrexed Lao has a plasma protein about 81%. The connection is not significantly affected by different levels of renal failure. Pemetrexed less metabolic in the liver. Pemetrexed is excreted mainly in urine, with 70% to 90% of the dose is reproduced in a constant form in the urine within the first 24 hours after transmission. The total clearance coefficient of Pemetrexed is 91.8 ml/min and half -life eliminates from plasma is 3.5 hours in patients with rewarding kidney function (creatinine clearance is 90 ml/min). The vibration of clearance between patients is in a medium level, 19.3%. Systemic exposure level (AUC) of Pemetrexed and maximum concentration in plasma increases proportional to the dose. Pemetrexed pharmacokinetics do not change in many treatment cycles.

Pemetrexed dynamic properties are not affected by Cisplatin simultaneously. Additional oral folic acid and intramuscular vitamin B12 does not affect the pharmacokinetics of Pemetrexed.

Before taking Alimta 500mg lilly medicine to treat cases of malignant pleural epithelium, lung cancer

How to use

Freezing powder mixed with intravenous injection solution according to medical dosage. Alimta should be transmitted for 10 minutes on the first day of each 21 -day cycle.

Dosage

only use Alimta under the supervision of a doctor with experience using anti -cancer chemotherapy.

Alimta in combination with Cisplatin: Alimta's recommended dose is 500 mg/m2 of the body surface area (BSA), intravenously for 10 minutes on the first day of each 21 -day cycle. The recommended dose of cisplatin is 75 mg/m2 BSA transmitted for two hours, about 30 minutes after the infusion is complete Pemetrexed on the first day of each 21 -day cycle. Patients must receive adequate anti -vomiting therapy and appropriate water rehydration before and/or after cisplatin infusion.

Alimta is used alone: In patients with non -small cell lung cancer, the previous chemotherapy, the recommended dose of Alimta is 500 mg/m2 BSA, intravenously for 10 minutes on the first day of each 21 -day cycle.

Preparation before treatment:

To reduce the frequency and severity of the skin reactions, it is necessary for patients to use a corticosteroid on the previous day, the date of infusion, and the date after the Pemetrexed infusion. Use corticosteroids with the same dose dexamethasone 4 mg orally 2 times daily.

To reduce the toxicity of the drug, patients treated with Pemetrexed must use vitamin supplements. Patients must take folic acid or a high -vitamin preparation containing folic acid (350 to 1,000 micrograms) daily. At least 5 doses of folic acid must be taken for 7 days before taking the first pemetrexed dose, and must continue to take it in the entire treatment and in 21 days after the last dose of Pemetrexed. Patients must also be intramuscularly in the first week of the first week of Pemetrexed dose and then once every 3 cycles. The next vitamin B12 injections can be on the same day as Pemetrexed.

track:

Before each Pemetrexed dose, the patient must be checked for the entire number of blood cells including leukocytes and platelets. Before each chemotherapy, it is necessary to test blood chemistry to assess kidney and liver function. Before starting each chemotherapy cycle, the standard of patients need to be achieved as follows: Number of neutrophils (ANC) must be ≥ 1,500/mm3 and the amount of platelet should ≥ 100,000/mm3.

Creatinine clearance must> 45 ml/min.

The total bilirubin must be ≤ 1.5 times the upper limit of normal. Alkaline phosphatase (AP), Aspartat Transaminase (AST or SGOT) and Alanin Transaminase (ALT or SGPT) must be ≤ 3 times the upper limit of normal. Alkaline phosphatase, AST and ALT ≤ 5 times the upper limit of normal can be acceptable in case of metastasis approaching.

The elderly: In clinical research, there is no sign that patients aged 65 and older are at risk of unwanted effects than patients under 65 years old. There is no need for any reduction other than the recommended dose mode for all patients.

Children and teenagers: Alimta is not recommended for patients under 18 years old because they have not determined the safety and effectiveness in this group of patients.

Patients with renal impairment: (Cockcroft and standard Gault or glomerular filtration speed by TC99M-DPTA serum clearance method): Pemetrexed is eliminated mainly in a constant form of renal excretion. In clinical research, patients have creatinin clearance coefficient ≥ 45ml/minute without any adjustments other than the recommended adjustment for all patients. No, although the data on the use of Pemetrexed in patients with creatinine clearance is below 45 ml/minute; Therefore, it is not recommended to use Pemetrexed.

Patients with hepatic impairment: There is no association between AST (SGOT), ALT (SGPT), or total bilirubin and pemetrexed pharmacokinetics. However, patients with liver failure with bilirubin> 1.5 times the upper limit of normal and/or transaminase> 3.0 times the upper limit of the bonus (without liver metastases) or> 5.0 times the upper limit of normal (with liver metastases) has not been studied separately.

What to do when overdose? Expected complications of the overdose include bone marrow inhibition manifested by neutropenia, reducing the number of platelets and anemia. In addition, there may be or no fever, diarrhea and/or mucous inflammation. In case of an overdose, patients must monitor, check the blood formula and perform supportive therapy when needed. Consider using calcium folinat/folinic acid in the treatment of Pemetrexed overdose.

In case of emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double doses to compensate for missed dose.

Side Effects

Unwanted effects have been reported the most common related to Pemetrexed, used in the form of single or coordinated treatment, including marrow failure with manifestations such as anemia, neutropenia, leukopenia, thrombocytopenia and gastrointestinal toxicity with manifestations such as anorexia, nausea, vomiting, diarrhea, constipation, sore throat, mucositis and stomatitis. Other undesirable effects include toxicity for receiving, increasing aminotransferase, hair loss, fatigue, dehydration, rash, infection/infection and neurological disease.

Rare side effects include Stevens-Johnson syndrome and poisoned symbolic necrosis.

Notify the physician the unwanted effects when using the drug.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Alimta 500mg Eli Lilly is contraindicated in the following cases:

Hypersensitivity to Pemetrexed or any excipients.

Caution when using

pemetrexed can inhibit the bone marrow function manifest by neutropenia, reducing the number of platelets and anemia. The inhibition of the marrow is usually the toxicity limit of the dose. The marrow inhibitor must be monitored during the treatment of patients and not for patients to use Pemetrexed until the number of neutrophils (ANC) reaches ≥ 1,500/mm3 and the number of platelets reaches ≥ 100,000/mm3. The decrease in the following cycles based on ANC, the lowest number of platelets and maximum blood toxicity notice from the previous treatment cycle.

When treated first with folic acid and vitamin B12, the patient is less likely to be toxicity and reduces blood toxicity and outside the blood level 3/4 such as neutrophils, neutropenia fever and neutropenia with neutropenia 3/4. Therefore, patients should be treated with Pemetrexed that using folic acid and vitamin B12 is a preventive measure to reduce drug -related toxicity.

Skin reactions have been reported in untreated patients with corticosteroids. Pre -treatment with dexamethasone (or equivalent) may reduce the frequency and severity of the skin reaction.

A limited number of patients studied with creatinine clearance below 45 ml/min. Therefore, it is not recommended to use Pemetrexed for patients with creatinine clearance

Patients with mild to medium to medium renal impairment (creatinine clearance from 45 to 79 ml/min) to avoid nonsteroidal anti -inflammatory drugs (NSAIDs) such as ibuprofen and aspirin (> 1.3 g/day) for 2 days before use, and 2 days after using Pemetrexed. All patients who meet the criteria for treatment with Pemetrexed must avoid using NSAIDs with half -life eliminated for at least 5 days before use, and at least 2 days after using Pemetrexed.

Serious kidney events, including acute renal failure, have been reported when using solitary pemetrexed or coordinated with other chemicals. Many of the patients who encounter these events have potential risk factors for kidney disease such as dehydration or hypertension or diabetes before.

The effect of fluid in the third cavity, such as pleural spills or ascites (ice) on unknown pemetrexed. In patients with epidemics in the third cavity, clinical significance must be considered for drainage before using Pemetrexed.

Due to the gastrointestinal toxicity of Pemetrexed used in combination with cisplatin, heavy dehydration has been recorded. Therefore, patients must be fully prevented and appropriate for water to be rehydrated before and/or after treatment.

Serious unexpected events on the heart include myocardial infarction and rarely occurring of clinical studies with Pemetrexed, often occurring when used in combination with another toxic cell drug. Most patients have these effects that have the first cardiovascular risk factors.

The common immunodeficiency condition in cancer patients. Therefore, it is not recommended to use simultaneously with a living vaccine reduced toxicity. Pemetrexed can cause genetic damage. Genital mature men are advised not to fertilize during treatment and until 6 months later. Contraceptive or intercourse methods are recommended. Because treatment with Pemetrexed can cause infertility not recovered, men are advised to find instructions on sperm storage before starting treatment.

Women who are likely to be pregnant must use effective contraception during treatment with pemetrexed.

Cases of localized radiotherapy pneumonia have been reported in patients treating radiation before, during or after using pemetrexed. Special attention should be paid to these patients and cautious when using other radiation sensitive chemicals.

Some cases of radiation have been reported in patients treating radiation for a few weeks or few years earlier.

The drug contains about 54 mg of sodium per jar. Caution for patients who need to control the salt mode.

The effect of the drug on driving and operating machinery

There is no research on the effects on driving and operating machinery. However, there is a report that Pemetrexed can cause fatigue. Therefore, patients must be reminded of driving or operating machinery if this effect happens.

Use drugs for women during pregnancy and lactation

There is no data from the use of pemetrexed in pregnant women but pemetrexed, as well as other anti -metabolic substances, suspected to cause serious birth defects when used during pregnancy. Animal research shows that there is toxicity on the reproductive system. Pemetrexed is not used during pregnancy unless it is really necessary after careful consideration of the need for treatment for the mother and the risk of pregnancy.

Women who are likely to get pregnant must use effective contraception during treatment with pemetrexed.

Pemetrexed can cause genetic damage. Genital mature men are advised not to be a father during treatment and until 6 months later. Contraceptive measures or abstain from sex are recommended. Due to treatment with Pemetrexed, it is likely that infertility does not recover, men are advised to find advice on sperm storage before starting treatment.

It is unknown whether Pemetrexed is excreted in human milk or not and cannot exclude unwanted effects on breastfed babies. Must stop breastfeeding during treatment with pemetrexed.

Drug interaction

pemetrexed is eliminated mainly in the form of unchanged by the kidneys by excretion in the renal tubules and partly thanks to the filtration of the glomeruli. Concentrated with kidney poison (such as aminoglycosides, strap diuretics, platinum compounds, cyclosporin) can slow down Pemetrexed clearance. Be careful when combining these drugs. If needed, closely monitor creatinine.

Concentrated use with substances is also excreted by renal tubules (such as probenecid, penicillin) capable of slowing the Pemetrexed clearance. Be cautious when using these drugs in combination with Pemetrexed. If needed, closely monitor creatinine clearance. In patients with normal renal function (Creatinine clearance ≥ 80 ml/min), high doses of nonsteroidal anti -inflammatory drugs (NSAID, such as ibuprofen> 1,600 mg/day) and aspirin at high doses (≥ 1.3 g/day) can reduce the exhaust of Pemetrexed, and thereby increasing unwanted effects of Pemetrexed. Therefore, it is necessary to be cautious when taking high doses of NSAID, or aspirin simultaneously with pemetrexed for patients with normal kidney function (creatinine clearance ≥ 80 ml/min).

In patients with mild to medium to medium renal failure (creatinine clearance from 45 to 79 ml/min), must avoid simultaneous use of NSAID (such as ibuprofen), or aspirin at high doses in the previous 2 days, dates, and 2 days after using Pemetrex.

While there is no data on the risk of interacting with NSAIDs with half -life eliminated longer like Piroxicam or Rofecoxib, to avoid simultaneous use with Pemetrexed for at least 5 days before use, and at least 2 days after using Pemetrexed. If it is necessary to use simultaneously with NSAID drugs, it is necessary to closely monitor toxicity, especially myeloma and gastrointestinal poisoning.

Pemetrexed is less metabolized in the liver. In vitro research results with human liver microsom shows that Pemetrexed may not cause clinical inhibition of the metabolism of drugs metabolized by CYP3A, CYP2D6, CYP2C9, and CYP1A2.

Interactive common with all cytotoxic drugs: because of the increased risk of thrombosis in cancer patients, anticoagulants are often used. Due to the large oscillation between individual coagulation in diseases and due to the ability to interact between oral anticoagulants and anti -cancer chemotherapy, Inr (International Normalise Ratio: International normalization ratio), if deciding to use oral anti -dynamic drugs for patients.

Contraindications to simultaneously use with yellow fever vaccine: The risk of death from the disease due to the body -developed vaccine.

It is not recommended to simultaneously use the Vaccine to reduce toxicity (except for yellow fever, contraindicated use): The risk of systemic disease, may cause death. The risk of increased in subjects has been immunodefits by hidden illness. Use inactivated vaccines if any (polio).

Storage

Leave a cool place, avoid light, temperature below 30⁰C.

To be out of reach of children, read the user manual carefully before use.

Other drugs

Disclaimer

Every effort has been made to ensure that the information provided by Drugslib.com is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Drugslib.com information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Drugslib.com does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Drugslib.com's drug information does not endorse drugs, diagnose patients or recommend therapy. Drugslib.com's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugslib.com does not assume any responsibility for any aspect of healthcare administered with the aid of information Drugslib.com provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.