Lipitor 10mg Pfizer Treatment for total cholesterol (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Atorvastatin

Ingredient

Composition informationContent
Atorvastatin10mg

Uses

Indications

Atorvastatin are appointed to support the diet in the treatment of patients with total cholesterol hypertrophy (partial parts), low density lipoprotein cholesterol (LDL-C), apolipoprotein B (APO B) and triglycerides (TG) and help increase cholesterol lipoprotein (HDL-C) In patients with primary hypercholesterol blood cholesterol (hyperlested hyperlly heterozygous and non -family family), hyperlipidemia (mixed) (LLA and LLB group according to Fredrickson classification), hyperliglyceride (group IV, classification of Fredrickson) and in patients with beta lipoprotein (blood lipoprotein -III groups) have a full response to the diet.

Atorvastatin is also indicated to reduce C-total and LDL-C in patients with hypercholesterolemia hyperlested family.

Provisions of cardiovascular complications

For patients without manifestations of cardiovascular disease (CVD) clinically clinically, and patients with or without blood lipid disorders, but there are risk factors for coronary heart disease (CHD) such as smoking, high blood pressure, diabetes, low HDL-C, or family history patients with early coronary coronary artery disease, Atovtasatin are indicated for:

Reduce the risk of death from coronary disease and myocardial infarction (Mi);

Reduce the risk of stroke;

Reduce the risk of vascular re -vascular and angina.

For patients with clinical coronary artery disease, Atorvastatin is used to:

Reduce the risk of myocardial infarction;

Reduce the risk of stroke;

Reduce the risk of vascular re -vessel process;

Reduce the risk of hospitalization due to congestive heart failure (CHF);

Reduce the risk of angina.

In children (10-17 years old)

Atorvastatin is assigned to support diets to reduce total cholesterol, LDL-C, and APO B in boys and girls who have menstruation from 10-17 years old with hyperlested blood cholesterol with heterozygous family and after treatment with appropriate diet patients still have the following characteristics:

LDL-C levels are still 190 mg/dL or LDL-C level> 160 mg/dL and:

Having a family history with early cardiovascular disease or

There are at least 2 other cardiovascular risk factors.

Pharmacokinus

Atorvastatin is a synthetic lipid lowering, which is a 3-hydroxy-3-methylutaryl-coenzymic enzyme inhibitor (HMG-COA). This enzyme catalyzes the transformation of HMG-COA into Mevalonate, is an early stage and limits the speed of cholesterol biosynthesis.

In patients with high cholesterol or heterozygous genetics, non-genetic blood cholesterol and mixed blood lipid disorders, Atorvastatin reduces total amount of cholesterol, low molecular weight lipoprotein lipoprotein (LDL-C) and Apolipoprotein B (APO B). Atorvastatin also reduces lipoprotein cholesterol with very low molecular weight (VLDL-C) and triglycerides (TG) and increases the lipoprotein cholesterol lipoprotein with high molecular weight (HDL-C).

pharmacokinetics

Absorption:

Atorvastatin absorbs quickly after drinking, reaching the peak concentration (CMAX) in plasma within 1 to 2 hours. The level of absorption increases proportional to the dose. After oral, Atorvastatin is about 95 - 99% of the film -based film bags of oral solution. The absolute bioavailability of Atorvastatin is approximately 12% and the system of systemic inhibitors inhibitors HMG-CAA Reductase is about 30%. The low body is due to the clearance of the gastrointestinal mucosa and/ or the first metabolism through the liver.

Distribution:

The average distribution of Atorvastatin is approximately 381L. Atorvastatin binds plasma protein above 98%. Atorvastatin body oil should pass through the bloody barrier.

Metabolism:

Atorvastatin is converted by Cytochrome P450 3A4 into O-and P-Hydroxylation derivatives and many different oxidant beta products. In addition to other roads, these products continue to be metabolized by glucuronid. In vitro, HMG-Coa Reductase inhibitors by O-and P-Hydroxylation metabolites equivalent to Atorvastatin. About 70% of HMG-CoA Reductase inhibitors during circulation are due to active metabolites.

Era:

Atorvastatin is mainly eliminated through bile after metabolism by the liver and/ or outside the liver. However, Atorvastatin undergo negligible intestinal cycle. The average selling time in the plasma of Atorvastatin is about 14 hours. Half activity of HMG-CoA Reductase inhibitors about 20 to 30 hours due to the contribution of active metabolites.

pharmacokinetics on special subjects

Elderly:

Atorvastatin concentration and its metabolites in plasma in healthy elderly people are higher than young people, but the effect on lipid is equivalent to young patients.

Children:

Some children's studies show that the oral clearance of Atorvastatin in children is similar to adults, calculated by weight. The corresponding reduction in LDL-C and cholesterol has been observed in the concentrations of Atorvastatin and O-Hydroxyatorvastatin.

Sex:

Atorvastatin concentration and its metabolites in women are different from men (women: CMAX is about 20% higher and about 10% lower AUC). These differences have no clinical significance, so there is no clinical significance on lipid effects between women and men.

kidney failure:

Kidney disease does not affect the concentration and effects on lipids of Atorvastatin and its active metabolites.

Hepatic failure:

Atorvastatin concentration and its active metabolites in plasma increases significantly (an increase of cmax about 16 times and AUC about 11 times) in patients with chronic liver disease due to alcohol (Child-Pugh B).

polymorphism SLCO1B1:

Absorb in the liver of HMG-CA Reductase inhibitors, including atorvastatin, is related to the transport of OATP1B1. In SLCO1B1 polymorphic people, there is a risk of increased Atorvastatin levels, which may increase the risk of muscle pattern. Oatp1b1 encryption gene (SLCO1B1 C.521cc) is related to an increase in Atorvastatin concentration 2.4 times (AUC) compared to people without this genotype variant (C.521TT). Absorption in the liver decreases because genes can also occur in these patients. The consequences of this effect are unknown

Before taking Lipitor 10mg Pfizer Treatment for total cholesterol (3 blisters x 10 tablets)

How to use

Take oral once a day at any time, with or not accompanied by food.

Dosage

Before conducting treatment with Atorvastatin, it is necessary to try to control blood cholesterol hyperplasia by a reasonable diet, exercise and lose weight in obese patients, and treat basic diseases. Patients should maintain a standard diet to reduce cholesterol during Atorvastatin treatment.

The dose is from 10 mg to 80 mg once daily. It is possible to use atorvastatin doses at any time of the day, with or not accompanied by food. The starting and maintenance dose should be concretized for each patient depending on the initial LDL-C level, the goals of treatment, and the patient's response. After the beginning of treatment and/ or during the standard dose process of Atorvastatin, the lipid concentration is needed for 2 to 4 weeks and the dose adjustment accordingly.

Increasing primary blood cholesterol and hyperlipidemia

Most patients are controlled with atorvastatin dose 10mg x 1 time/day.

Meeting with clear treatment within 2 weeks, and maximum response is usually achieved within 4 weeks. This response is maintained in long -term therapy

Hypertlyored blood cholesterol is heterozygous

Patients should start at 10mg x 1 time/day. The dose is determined on each patient and adjusts every 4 weeks of treatment until 40 mg/day. After that, the dose may be increased to a maximum of 80 mg/day or a combination of 40mg x 1 time/day 1 with bile acid -splitting drugs.

Hyper cholesterol is homozygous

There is not much data on this patient object.

Atorvastatin dose in patients with hyperlested hypercholesteroline hypertension is 10 to 80 mg/day, in these patients, Atorvastatin should be used as a supportive drug for other lipid treatments (for example, LDL separation) or if these methods are not available.

Cardiovascular Prevention

Dose in initial backup tests is 10mg/day. Higher doses may be taken to achieve concentration (LDL-) cholesterol according to current instructions.

Patients with renal failure

No dose adjustments in patients with renal failure (see the cautious part when using the drug)

Patients with liver failure

Should be carefully used lipitor in patients with liver failure. Contraindicated lipitor in patients with progressive liver disease (see the contraindications).

Elderly patients

Safety and effectiveness of drugs in patients over 70 years of age using the recommended dose is similar to the common population group

Children

Experience used in groups of patients with children is limited to small numbers of patients (from 10 - 17 years old) with serious blood lipid disorders, such as hypercholesterolemia. The recommended starting dose in this group is 10mg Atorvastatin once a day. The dose may increase to 20mg of Atorvastatin per day depending on the ability to respond and intolerance. Dosage should be concretized for each patient according to the recommended treatment goal. Dose adjustment should be done for 4 weeks or over 4 weeks

Used in combination with other drugs:

In cases where the coordination of Atorvastatin is required with cyclosporin, the dose of Atorvastatin should not exceed 10mg.

Avoid using Atorvastatin simultaneously with Telaprevir, or combined with tipranavir/ ritonavir .

Observed the pharmacokinetic interactions between Atorvastatin and protease inhibitors that cause immunodeficiency in humans (HIV) (Lopinavir in collaboration with Ritonavir, Saquinavir in collaboration with Ritonavir, Darunavir in collaboration with Ritonavir, Fosamprenavir, Fosamprenavir in combination with Ritonavir, NELFINAVIN) Hepatitis C (BoCeprevir), Clarithromycin and Itraconazole led to an increase in Atorvastatin levels during the circulation, need to be cautious when indicating these drugs simultaneously with Atorvastatin and recommend that clinical assessments are suitable to ensure the lowest atorvastatin dosage is applied.

Recommendations to start treatment with the lowest dose work, then, if necessary, can adjust the dose according to the needs and response of each patient by increasing the dose each spaces no less than 4 weeks apart and must monitor the unwanted effects of the drug, especially unwanted effects for the muscle system.

The drug contains the active ingredient Atorvastatin when used in combination with amiodaron, not more than 20 mg/day. Do not use more than 20 mg/day atorvastatin when combined with Darunavir + Ritonavir, Fosamprenavir, Fosamprenir + Ritonavir, Saquinavir + Ritonavir. Do not use more than 40 mg/day atorvastatin when combined with nelfinavir.

What do

do when overdose? In case of overdose, patients need to be treated with symptoms and use necessary support measures. Checking liver function should be performed and serum CK levels need to be controlled. Because most Atorvastatin is attached to plasma proteins, dialysis almost does not increase the elimination of Atovtastatin from the body.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

Common

Parasites and parasites: Nasomitis;

Immune: Allergic reactions;

Metabolism and nutrition: increased blood glucose;

Neurology: headache;

Respiratory, chest and mediastinum: Arching pain, nosebleeds ;

Digestive: constipation, flatulence, indigestion , nausea, diarrhea;

muscle - bone and connective tissue: muscle pain, joint pain, headache, muscle spasm, joint swelling, back pain;

Testing: Abnormal liver function test, increased blood creatin.

rarely

Metabolism and nutrition: lower blood glucose, weight gain, anorexia;

Mental: nightmares, insomnia;

Neurological: dizziness, paresthesia, decrease feeling, rebellion, insomnia;

Eyes: blurred vision;

ears and love: tinnitus ;

Gastrointestinal: vomiting, upper and lower abdominal pain, belching, pancreatitis.

Hepatitis: Hepatitis.

Skin and subcutaneous tissue: urticaria , skin rash, itching, hair loss.

muscle - bone and connective tissue: muscle pain, muscle fatigue.

The whole body and the condition of the drug: fatigue, weakness, chest pain, peripheral edema, tired, fever.

Testing: positive leukemia.

rarely

Blood and lymphatic system: platelets.

Neurology: Peripheral nerve.

Eye: visual disorders.

liver - bile: cholestasis

Skin and subcutaneous tissue: Neuritis, puffiness dermatitis include diverse persimmons, Stevens-Johnson syndrome and poisoned epidermal necrosis.

Muscle - bone and connective tissue: muscle disease, muscle inflammation, muscle pattern, tendon injury, sometimes complications due to blood vessel rupture.

Very rare

immune: Anaphylaxis .

ears and mesmerizing: hearing loss.

Liver: Hepatic failure.

Reproduction and mammary gland: female mammary glands.

unknown frequency

muscle - bone and connective tissue: muscle necrosis through immunity.

As other HMG-Coa Reductase inhibitors, for serum transaminase hyperplation reports in patients with Atorvastatin. These changes are usually mild, transient and do not need to stop treatment. The serum transaminase has clinical significance (> 3 times on normal) encountered at 0.8% of patients using Atorvastatin. This increase is related to the dose and recovery in all patients.

Increasing creatin kinase (CK) serum more than 3 times normal occurs in 2.5% of patients using Atorvastatin, similar to other HMG-COA inhibitors in clinical trials. The concentration of more than 10 times on normal limits is encountered at 0.4% of patients treated with Atorvastatin.

Children

Children 10 -17 years old treated with Atorvastatin have unwanted effects similar to patients treated with placebo, the most unwanted unwanted effects have been reported in both patients, regardless of the cause and effect assessment, is infection. Safety information and tolerance in children's patients similar to adults

Warnings

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

Contraindicated

Hypersensitivity to any ingredients of the drug.

Having progressive liver disease or increased serum transaminase is not explained in excess of the upper limits of normal levels.

During pregnancy, breastfeeding and in women is likely to not use appropriate contraception.

Be cautious when using

effect on the liver

should conduct liver function tests before the beginning of treatment and periodically later. Patients should be tested for liver function when there are any signs or symptoms that suggest liver damage. Patients increase the concentration of transaminase should be monitored until the abnormalities are resolved. If transaminase increased 3 times higher than the normal limit (ULN), the dose should be reduced or discontinued with Atorvastatin. Be cautious when using Atorvastatin in patients drinking a lot of alcohol and/ or a history of liver disease.

Prevention of stroke by sharply reducing cholesterol levels (SparCl)

In a post -testing analysis on a stroke group in patients without coronary artery disease (CHD) with stroke or recent brain anemia (TIC) recently, the risk of stroke due to hemorrhage in patients starting treatment with Atorvastatin 80mg is higher than placebo.

The risk increases more in patients who have had previous bleeding strokes or hole infarction. For patients who have had previous hemorrhagic strokes or defective infarction, the balance between the risk and benefits of Atorvastatin 80mg is not certain, and should carefully consider the risk of hemorrhagic stroke before the beginning of treatment.

Mechanical impact

As other HMG-Coa Reductase inhibitors, Atorvastatin can sometimes affect skeletal muscles and cause muscle aches, muscle inflammation and muscle disease, which can progress to muscle and muscle, a condition that can be fatal, characterized by a significant increase in creatin kinase (CK) (> 10 times ULN), Myoglobin blood and myoglobin, which can lead to kidney, can lead to kidney.

There have been very rare reports that have muscle necrosis through the immunity (IMNM) during or after treatment with some statins. IMNM is clinically characterized by prolonged thigh muscle weakness and increased serum creatin concentration, not out of treatment with statin.

Before treatment

Be cautious when taking Atorvastatin for patients with risk factors for muscle pattern. Measure the concentration of crostin kinase before starting treatment for patients with the following conditions:

  • Renal failure.
  • Hypothyroidism.

    • There is a personal history or family with genetic disorders.

    History of muscle poisoning with statin or fibrat before.

  • There is a history of liver disease and/or drink plenty of alcohol.
  • In the elderly (> 70 years old), it is recommended to consider the need for the above assessment, depending on the risk factors for existing muscle and elimination.

    • Conditions that can increase the concentration of drugs in plasma, such as interactions and on special objects.

    In these conditions, risks should be considered in relationships with treatment benefits, and clinical monitoring recommendations.

    If the concentration of Creatin Kinase is significantly (> 5 times ULN) at the beginning, it should not start treatment.

    Tracking Creatin Kinase: Should not measure creatin kinase after high intensity exercise or when there is any other reliable cause causing increased creatin kinase because it can affect the test. If Creatin Kinase concentration increases significantly compared to the original (> 5 times ULN), it is advisable to measure within 5 to 7 days to confirm the results.

    during treatment

    Ask the patient to promptly notify the doctor if there is muscle pain, cramps or weakness, especially when there is an uncomfortable or fever.

    If these symptoms appear while patients are being treated with Atorvastatin, patients need to be evaluated for creatin kinase levels, if Creatin Kinase increases significantly (> 5 times ULN), should stop treatment.

    If the symptoms of severe and daily discomfort are, even if the creatin kinase concentration increases ≤ 5 times ULN, should consider stopping treatment.

    If the symptoms are resolved and the creatin kinase level returns to normal, then the reuse of Atorvastatin or the replacement statin may be considered at the lowest dose and under the close supervision.

    Stop treatment with Atorvastatin if Creatin Kinase increases significantly clinically (> 10 times ULN) or if diagnosed or suspected of pattern.

    Mimeting treatment with other drugs

    Increasing risk of muscle pattern when using Atorvastatin simultaneously and some drugs can increase plasma Atorvastatin levels such as strong CYP3A4 inhibitors or shipping proteins (such as Ciclosporin, Telithromycin, Clarithromycin, Delavirdin, Stiripentol, Ketoconazol, Voriconazol, ITRACONZIL, ITRACONZOL,,,, ITRACONZOL,, ITRACONZOL,,, ITRACONZOL,, ITRACONZOL,, ITRACONZOL,, ITRACONZOL,, ITRACONZOL,, ITRACONZOL,,,,,, ITRACONZOM Posaconazole and HIV protease inhibitors include Ritonavir, Lopinavir, Atazanavir, Indinavir, Darunavir, ...). The risk of muscle disease may also increase when using Gemfibrozil simultaneously and other fibric acid derivatives, BoCeprevir, Erythromycin, Niacin, Ezetimib, Telaprevir, or Tipranavir/ Ritonavir. If possible, alternative (non -interactive) should be considered instead of the above drugs.

    If the concurrent use of the above drugs with Atorvastatin is necessary, carefully consider the benefits and risks of simultaneous treatment. Patients with simultaneous use of drugs that increase Atorvastatin levels, recommend to reduce the dose of Atorvastatin to the lowest doses effectively. In addition, consider reducing the starting dose of Atorvastatin and appropriate clinical monitoring in patients taking strong CYP3A4 inhibitors.

    Atorvastatin is not used simultaneously with fusidic acid preparations for systemic effects or within 7 days after stopping treatment with fusidic acid. If the use of fusidic acid -acting is really necessary, should stop treating with Atorvastatin during treatment with fusidic acid. There has been a report on the pattern (including a number of deaths) in patients with combination of fusidic acid and statins. It is recommended that patients seek medical support immediately if there is muscle weakness, pain or pain. Can continue to reuse the statins after 7 days of stopping fusidic acid. In some special cases, it is necessary to use prolonged fusidic acid, as in the treatment of severe infections, it is necessary to consider combining atorvastatin and fusidic acid in each specific case and under strict medical supervision.

    Interstitial lung disease

    There has been an interstitial lung disease report when using some statins in some cases, especially when treated for prolonged treatment. The expression may include breathing, dry cough and general health reduction (fatigue, weight loss and fever). Stop taking the drug if there is a suspected patient with interstitial pneumonia.

    diabetes

    Some evidence shows that statins may increase blood glucose and in some patients, at high risk of future diabetes, can increase blood glucose causing diabetes. However, the benefits of reducing cardiovascular risk thanks to statin are superior to blood sugar risks, so do not stop treating with statin. Patients with high risk (Glucose blood glucose at 5.6 to 6.9 mmol/l, BMI> 30 kg/m2, increased triglycerides, hypertension) should be closely monitored both clinically and biochemical.

    The ability to drive and operate machinery

    Atorvastatin is not significantly affecting the ability to drive and operate machinery. However, it is necessary to be cautious.

    Pregnancy

    contraindicated use of Atorvastatin during pregnancy. The safety of the drug in pregnant women has not been proven. Animal research shows reproductive toxicity.

    Atorvastatin treatment for pregnant women can reduce the concentration of Mevalonate's fetus, a premature biosynthesis of cholesterol. Atherosclerosis is a chronic process and stopping the use of hypoglycemia during pregnancy often has little effect on the risk of long -term associated with increased primary cholesterol. Treatment should be temporarily suspended with Atorvastatin during pregnancy or until the patient is not pregnant.

    The period of breastfeeding

    unknown Atorvastatin or its active metabolites go into breast milk, in mice, Atorvastatin levels and its active metabolites in plasma are similar to breast milk. To avoid the risk of unwanted effects for children, it is recommended that children should not breastfeed during medication. Contraindicated drugs in breastfeeding women

    Drug interaction

    The impact of simultaneous drugs on Atorvastatin.

    Atorvastatin is metabolized by Cytochrome P450 3A4 (CYP3A4) and is a substrate of transport protein like OatP1B1 transport protein. Concomitance with CYP3A4 inhibitors or transportation proteins can increase plasma Atorvastatin levels and increase the risk of muscle disease. The risk can also increase when using atorvastatin simultaneously with other drugs can also cause muscle disease such as fibric acid derivatives and ezetimib

    CYP3A4 inhibitors

    Strong CYP3A4 inhibitors may significantly increase Atorvastatin levels. If possible, should avoid simultaneous use of strong CYP3A4 inhibitors (such as Ciclosporin, Telithromycin, Clarithromycin, Delavirdin, Stiripentol, Ketoconazol, Voricazol, Itraconazol, Posaconazol and HIV protease inhibitors include Ritonavir, Lopinavir, AcazanAr, Atazana Indinavir, Darunavir ...). If it is necessary to use simultaneously, it is advisable to consider reducing the starting dose and maximum dose of Atorvastatin and patients should be appropriate clinical monitoring.

    Average CYP3A4 inhibitors (such as erythromycin, diltiazem, verapamil and fluconazole) may increase plasma Atorvastatin levels. Therefore, consider the minimum dosage of Atorvastatin and appropriate clinical monitoring when used simultaneously with the average inhibitors atorvastatin. Appropriate clinical monitoring recommendations after the beginning and when adjusting the dose of CYP3A4 inhibitors.

    CYP3A4 induction drugs

    Simultaneous use Atorvastatin with CYP3A4 induction drugs (such as Efavirenz, Rifampin,
    St. John’s Wort) can reduce plasma Atorvastatin levels. Due to the double interactive mechanism of rifampin (CYP3A4 inhibitors and OATP1B1 shipping protein), simultaneous use of Atorvastatin and Rifampin are recommended, because the delay of the use of Atorvastatin after using Rifampin is involved in reducing Atorvastatin concentration significantly. However, the impact of rifampin on Atorvastatin concentration in the liver is unknown, if the simultaneous use is inevitable, the patient should be carefully monitored effectively. Transport protein inhibitors (such as ciclosporin) may increase Atorvastatin levels.

    gemfibrozil/ Fibric acid derivatives

    Only use fibrats sometimes related to mechanical events, including muscle pattern. The risk of these variables may increase when used simultaneously fibric acid derivatives with Atorvastatin. If it is necessary to use Atorvastatin with fibric acid derivatives, the lowest dose of Atorvastatin should be used effectively and monitor the appropriate patient.

    ezetimibe

    Only use Ezetimibe sometimes related to mechanical events, including muscle pattern. This risk may increase when using Ezetimibe simultaneously with Atorvastatin. Appropriate clinical monitoring recommendations for these patients.

    Colestipol

    Atorvastatin concentration and its active metabolites in a lower plasma (radioactive Atorvastatin concentration: 0.74) when simultaneously used Colestipol with Atorvastatin.However, the effect on lipid when using Atorvastatin with Colestipol is higher than when using only one of the two drugs.

    Fusidic acid

    The risk of muscle disease, including muscle pilot increases when using fusidic acid system with systemic sugar with statins. The mechanism of this interaction is unclear. There has been a report on the pattern (including a number of deaths) in patients with fusidic acid and statin.

    If treated with fusidic acid is really necessary, should stop treating with Atorvastatin during treatment with fusidic acid.

    colchicin

    Be cautious when using due to a report on muscle disease

    The impact of Atorvastatin on simultaneous drugs

    digoxin

    When using simultaneously, the dose repeats digoxin and 10mg of atorvastatin, the concentration of Digoxin stability increases slightly. Proper monitoring for patients who are using digoxin.

    Oral contraceptives

    Simultaneous use of Atorvastatin with oral contraceptives can increase the concentration of Norethindron and Ethinyl Oestradiol.

    warfarin

    should determine prothrombin time before starting Atorvastatin in patients who are taking Coumarin antifiers and regularly during the first time of treatment to ensure no significant change in prothrombin time occurs. Atorvastatin is not related to bleeding or changing the time of prothrombin in patients who do not take antifinal drugs.

    Children

    Medicine interaction - The drug is only done on adults. Drug interaction in children is unknown. Drug interactions and related warnings atorvastatin in adults should be considered for children.

    Storage

    Store in closed packaging, dry place, avoid moisture, temperature below 30 ° C.

    Other drugs

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