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ioversol

Generic Name: ioversol (eye oh VERS ol)
Brand Name: Optiray 160, Optiray 240, Optiray 300, Optiray 320, Optiray 350

What is ioversol?

Ioversol is in a group of drugs called radiopaque (RAY dee oh payk) contrast agents. Ioversol contains iodine, a substance that absorbs x-rays. Radiopaque contrast agents are used to allow blood vessels, organs, and other non-bony tissues to be seen more clearly on a CT scan or other radiologic (x-ray) examination.

Ioversol is used to help diagnose certain disorders of the heart, brain, and blood vessels.

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

What is the most important information I should know about ioversol?

You should not receive ioversol if you have any type of active infection.

Tell your doctor if you have asthma, hay fever, or history of food or drug allergies, especially if you have had any type of reaction to another contrast agent.

Drink extra fluids before and after you receive ioversol. This medication can cause you to get dehydrated, which can lead to dangerous effects on your kidneys. Follow your doctor's instructions about the types and amount of fluids you should drink before and after your test.

What should I discuss with my health care provider before receiving ioversol?

Tell your doctor if you have ever had any type of reaction to another contrast agent.

You should not receive ioversol if you have any type of active infection.

Before receiving ioversol, tell your doctor if you have:

  • a brain tumor or hematoma;

  • a recent head or brain injury;

  • epilepsy or other seizure disorder;

  • a bleeding or blood clotting disorder;

  • kidney disease;

  • liver disease;

  • diabetes;

  • heart disease, angina, or congestive heart failure;

  • homocysteinuria;

  • sickle cell disease;

  • a history of stroke, blood clots, or circulation problems;

  • asthma, hay fever, or a history of food or drug allergies;

  • multiple myeloma (bone cancer);

  • pheochromocytoma; or

  • a thyroid disorder.

If you have any of these conditions, you may not be able to receive ioversol, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether ioversol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may need special care in avoiding dehydration by drinking extra fluids before and after the radiologic test. Your kidney function may also need to be watched closely after you have received ioversol.

How is ioversol used?

Ioversol is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting during your radiologic test.

Drink extra fluids before and after you receive ioversol. This medication can cause you to get dehydrated, which can lead to dangerous effects on your kidneys. Follow your doctor's instructions about the types and amount of fluids you should drink before and after your test.

Your doctor or other healthcare provider may want to watch you for a short period of time after your injection. This is to make sure you do not have any unwanted side effects or delayed reactions.

This medication can cause you to have unusual results with certain thyroid tests. If you have such tests within 16 days after receiving ioversol, tell the doctor in charge that you have recently received ioversol.

What happens if I miss a dose?

Since ioversol is used only during your radiologic test, you will not be on a dosing schedule.

What happens if I overdose?

Seek emergency medical attention if you think you have received too much of this medicine. Symptoms of an ioversol overdose may include chest pain, trouble breathing, and slow or uneven heartbeats.

What should I avoid while receiving ioversol?

Do not allow yourself to become dehydrated during the first few days after receiving ioversol. Call your doctor if you have any vomiting or diarrhea during this time. Follow your doctor's instructions about the types and amount of fluids you should drink.

Ioversol side effects

Some of the side effects of ioversol can occur up to 24 hours after you have received the medication.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

  • urinating less than usual or not at all;

  • severe muscle pain or weakness;

  • seizure (convulsions);

  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

  • sudden numbness or weakness, especially on one side of the body;

  • sudden headache, confusion, problems with vision, speech, or balance;

  • feeling light-headed, fainting;

  • wheezing, trouble breathing;

  • fast or slow heartbeat;

  • easy bruising, unusual bleeding, or skin changes; or

  • swelling of your hands, ankles, or feet.

Other less serious side effects are more likely to occur, such as:

  • fever, warmth, or pain;

  • skin rash or redness;

  • headache; or

  • nausea.

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. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Ioversol dosing information

Usual Adult Dose for Cerebral Arteriography:

Either ioversol injection 51% (marketed as Optiray 240), ioversol injection 64% (marketed as Optiray 300), or ioversol injection 68% (marketed as Optiray 320) is recommended for cerebral arteriography

The usual individual injection for visualization of the carotid or vertebral arteries is 2 to 12 mL, repeated as necessary. Aortic arch injection for a simultaneous four vessel study requires 20 to 50 mL. Total procedural doses should not usually exceed 200 mL.

Extreme caution is advised in patients with advanced arteriosclerosis, severe hypertension, cardiac decompensation, senility, recent cerebral thrombosis or embolism, and migraine. Cardiovascular reactions that may occur with some frequency are bradycardia and either an increase or decrease in systemic blood pressure. Neurological reactions that may occur are: seizures, drowsiness, transient paresis, and mild disturbances in vision.

Central nervous system reactions with ioversol in controlled clinical studies in cerebral arteriography that were considered drug-related and occurred with frequencies greater than 1% were: headache, bradycardia, blood pressure fluctuation, disorientation, nausea, and vertigo.

Usual Adult Dose for Peripheral Arteriography:

Either ioversol injection 64% (marketed as Optiray 300), ioversol injection 68% (marketed as Optiray 320), or ioversol injection 74% (marketed as Optiray 350) is recommended for peripheral arteriography. The usual individual injection volumes for visualization of various peripheral arteries are as follows:

aorta-iliac runoff - 60 mL (range 20 to 90 mL)
common iliac, femoral - 40 mL (range 10 to 50 mL)
subclavian, brachial - 20 mL (range 15 to 30 mL)

These doses may be repeated as necessary. Total procedural doses should not usually exceed 250 mL.

Pulsation should be present in the artery to be injected. In thromboangiitis obliterans, or ascending infection associated with severe ischemia, angiography should be performed with extreme caution, if at all.

Usual Adult Dose for Visceral Arteriography:

Ioversol injection 68% (marketed as Optiray 320) is recommended for visceral arteriography, renal arteriography, and aortography procedures. The usual individual injection volumes for visualization for the aorta and various visceral arteries are as follows:

aorta - 45 mL (range 10 to 80 mL)
celiac - 45 mL (range 12 to 60 mL)
superior mesenteric - 45 mL (range 15 to 60 mL)
renal or inferior mesenteric - 9 mL (range 6 to 15 mL)

These doses may be repeated as necessary. Total procedural doses should not usually exceed 250 mL.

In aortography, depending on the technique employed, the risks of this procedure also include the following: injury to the aorta and neighboring organs, pleural puncture, renal damage including infarction and acute tubular necrosis with oliguria and anuria, retroperitoneal hemorrhage from the translumbar approach and spinal cord injury and pathology associated with the syndrome of transverse myelitis. Under conditions of slowed aortic circulation there is an increased likelihood for aortography to cause muscle spasm. Occasional serious neurologic complications, including paraplegia, have also been reported in patients with aortoiliac obstruction, femoral artery obstruction, abdominal compression, hypotension, hypertension, spinal anesthesia, and injection of vasopressors to increase contrast. In these patients the concentration, volume, and number of repeat injections of the medium should be maintained at a minimum with appropriate intervals between injections. The position of the patient and catheter tip should be carefully monitored.

Entry of a large aortic dose into the renal artery may cause, even in the absence of symptoms, albuminuria, hematuria, and an elevated creatinine and urea nitrogen. Rapid and complete return of function usually follows.

Usual Adult Dose for Renal Arteriography:

Ioversol injection 68% (marketed as Optiray 320) is recommended for visceral arteriography, renal arteriography, and aortography procedures. The usual individual injection volumes for visualization for the aorta and various visceral arteries are as follows:

aorta - 45 mL (range 10 to 80 mL)
celiac - 45 mL (range 12 to 60 mL)
superior mesenteric - 45 mL (range 15 to 60 mL)
renal or inferior mesenteric - 9 mL (range 6 to 15 mL)

These doses may be repeated as necessary. Total procedural doses should not usually exceed 250 mL.

In aortography, depending on the technique employed, the risks of this procedure also include the following: injury to the aorta and neighboring organs, pleural puncture, renal damage including infarction and acute tubular necrosis with oliguria and anuria, retroperitoneal hemorrhage from the translumbar approach and spinal cord injury and pathology associated with the syndrome of transverse myelitis. Under conditions of slowed aortic circulation there is an increased likelihood for aortography to cause muscle spasm. Occasional serious neurologic complications, including paraplegia, have also been reported in patients with aortoiliac obstruction, femoral artery obstruction, abdominal compression, hypotension, hypertension, spinal anesthesia, and injection of vasopressors to increase contrast. In these patients the concentration, volume, and number of repeat injections of the medium should be maintained at a minimum with appropriate intervals between injections. The position of the patient and catheter tip should be carefully monitored.

Entry of a large aortic dose into the renal artery may cause, even in the absence of symptoms, albuminuria, hematuria, and an elevated creatinine and urea nitrogen. Rapid and complete return of function usually follows.

Usual Adult Dose for Coronary Arteriography:

Either ioversol injection 68% (marketed as Optiray 320) or ioversol injection 74% (marketed as Optiray 350) is recommended for this procedure. The usual individual injection volumes for visualization of the coronary arteries and left ventricle are:

left coronary - 8 mL (range 2 to 10 mL)
right coronary - 6 mL (range 1 to 10 mL)
left ventricle - 40 mL (range 30 to 50 mL)

These doses may be repeated as necessary. Total procedural dose for the combined procedures should not usually exceed 250 mL. When large individual volumes are administered, as in ventriculography and aortography, it has been suggested that several minutes be permitted to elapse between each injection to allow for subsidence of possible hemodynamic disturbances.

Mandatory prerequisites to the procedure are specialized personnel, ECG monitoring apparatus and adequate facilities for immediate resuscitation and cardioversion. Electrocardiograms and vital signs should be routinely monitored throughout the procedure.

There were no cardiovascular system reactions with ioversol in controlled clinical studies in coronary arteriography with left ventriculography that were considered drug-related and occurred with a frequency greater than 1%.

Usual Adult Dose for Left Ventriculography:

Either ioversol injection 68% (marketed as Optiray 320) or ioversol injection 74% (marketed as Optiray 350) is recommended for this procedure. The usual individual injection volumes for visualization of the coronary arteries and left ventricle are:

left coronary - 8 mL (range 2 to 10 mL)
right coronary - 6 mL (range 1 to 10 mL)
left ventricle - 40 mL (range 30 to 50 mL)

These doses may be repeated as necessary. Total procedural dose for the combined procedures should not usually exceed 250 mL. When large individual volumes are administered, as in ventriculography and aortography, it has been suggested that several minutes be permitted to elapse between each injection to allow for subsidence of possible hemodynamic disturbances.

Mandatory prerequisites to the procedure are specialized personnel, ECG monitoring apparatus and adequate facilities for immediate resuscitation and cardioversion. Electrocardiograms and vital signs should be routinely monitored throughout the procedure.

There were no cardiovascular system reactions with ioversol in controlled clinical studies in coronary arteriography with left ventriculography that were considered drug-related and occurred with a frequency greater than 1%.

Usual Adult Dose for Intra-arterial Digital Subtraction Angiography:

Ioversol injection 34% (marketed as Optiray 160) is recommended for intra-arterial digital subtraction angiography (IA-DSA). As a general rule, the volume and concentration used for IA-DSA is about 50% or less of that used for conventional procedures. The actual dosage and flow rate will vary depending on the selectivity of the injection site and the area being examined.
The following suggested volumes per injection are intended only as a guide. Injections may be repeated as necessary. It is advisable to inject at rates approximately equal to the flow of the vessel being injected.

Carotid Arteries 6 to 10 mL
Vertebral Arteries 4 to 8 mL
Aorta 25 to 50 mL
Subclavian or Brachial Arteries 2 to 10 mL
Major Branches of the Abdominal Aorta 2 to 20 mL

Dosage should not usually exceed 250 mL.

Usual Adult Dose for Venography:

Either ioversol injection 51% (marketed as Optiray 240), ioversol injection 64% (marketed as Optiray 300), ioversol injection 68% (marketed as Optiray 320), or ioversol injection 74% (marketed as Optiray 350), is recommended for venography.

Usual dose: 50 to 100 mL per extremity with smaller or larger volumes indicated in some cases.

Dosage should not usually exceed 250 mL.

Special care is required when venography is performed in patients with suspected thrombosis, phlebitis, severe ischemic disease, local infection or a totally obstructed venous system. In order to minimize extravasation during injection, fluoroscopy is recommended.

Following the procedure, the venous system should be flushed with Sodium Chloride Injection U.S.P. or 5% Dextrose in Water (D5W). Massage and elevation are also helpful for clearing the contrast medium from the extremity.

Usual Adult Dose for Head Imaging:

Usual dosage is 50 to 150 mL of ioversol injection 74%, 68%, or 64% or 100 to 250 mL of ioversol injection 51%. Scanning may be performed immediately after completion of the intravenous administration. Dosage should not usually exceed 150 mL of ioversol injection 74%, 68%, or 64% or 250 mL of ioversol injection 51%.

Tumors: Ioversol may be useful to investigate the presence and extent of certain malignancies such as: gliomas including malignant gliomas, glioblastomas, astrocytomas, oligodendrogliomas and gangliomas, ependymomas, medulloblastomas, meningiomas, neuromas, pinealomas, pituitary adenomas, craniopharyngiomas, germinomas, and metastatic lesions. The usefulness of contrast enhancement for the investigation of the retrobulbar space and in cases of low grade or infiltrative glioma has not been demonstrated. In calcified lesions, there is less likelihood of enhancement. Following therapy, tumors may show decreased or no enhancement. The opacification of the inferior vermis following contrast media administration has resulted in false-positive diagnosis in a number of otherwise normal studies.

Nonneoplastic Conditions: Ioversol may be beneficial in the image enhancement of nonneoplastic lesions. Cerebral infarctions of recent onset may be better visualized with contrast enhancement, while some infarctions are obscured if contrast medium is used. The use of iodinated contrast media results in enhancement in about 60% of cerebral infarctions studied from one to four weeks from the onset of symptoms.

Sites of active infection may also be enhanced following contrast medium administration.

Arteriovenous malformations and aneurysms will show contrast enhancement.

For these vascular lesions the enhancement is probably dependent on the iodine content of the circulating blood pool. Hematomas and intraparenchymal bleeders seldom demonstrate contrast enhancement. However, in cases of intraparenchymal clot, for which there is no obvious clinical explanation, contrast media administration may be helpful in ruling out the possibility of associated arteriovenous malformation.

Usual Adult Dose for Body Imaging:

Ioversol injection 74%, 68%, 64%, or 51% may be administered by bolus injection, by rapid infusion, or by a combination of both.

Usual doses:
ioversol injection 74% (marketed as Optiray 350) - bolus injection: 25 to 75 mL, infusion: 50 to 150 mL
ioversol injection 68% (marketed as Optiray 320) - bolus injection: 25 to 75 mL, infusion: 50 to 150 mL
ioversol injection 64% (marketed as Optiray 300) - bolus injection: 25 to 75 mL, infusion: 50 to 150 mL
ioversol injection 51% (marketed as Optiray 240) - bolus injection: 35 to 100 mL, infusion: 70 to 200 mL
Dosage should not usually exceed 150 mL of ioversol injection 74%, 68% or 64% or 250 mL of 51%.

Ioversol may be useful for enhancement of computed tomographic images for detection and evaluation of lesions in the liver, pancreas, kidneys, aorta, mediastinum, pelvis, abdominal cavity, and retroperitoneal space. Enhancement of computed tomography with ioversol may be of benefit in establishing diagnoses of certain lesions in these sites with greater assurance than is possible with CT alone. In other cases, the contrast agent may allow visualization of lesions not seen with CT alone (i.e., tumor extension) or may help to define suspicious lesions seen with unenhanced CT (i.e., pancreatic cyst).

Usual Adult Dose for Intravenous Digital Subtraction Angiography:

Usual dosage: Ioversol injection 74% (marketed as Optiray 350) may be injected centrally, in either the superior or inferior vena cava or right atrium; or peripherally into an appropriate arm vein. For central injections, catheters may be introduced at the antecubital fossa into either the basilic or cephalic vein or at the leg into the femoral vein and advanced to the distal segment of the corresponding vena cava. For peripheral injections, the catheter is introduced at the antecubital fossa into an appropriate size arm vein. In order to reduce the potential for extravasation during peripheral injection, a catheter of approximately 20 cm in length should be employed.
Depending on the area to be imaged, the usual dose range per injection is 30 to 50 mL. Injections may be repeated as necessary. The total procedural dose should not exceed 250 mL.
Injection rates will vary depending on the site of catheter placement and vessel size. Central catheter injections are usually made at a rate of between 10 and 30 mL/second. Peripheral injections are usually made at a rate of between 12 and 20 mL/second. Since the injected medium can sometimes remain in the arm vein for an extended period, it is advisable to flush the vein immediately following injection with an appropriate volume (20 to 25 mL) of sodium chloride injection U.S.P. or 5% dextrose in water (D5W).

Intravenous digital subtraction angiography (IV DSA) is a radiographic modality which allows dynamic imaging of the arterial system following intravenous injection of iodinated x-ray contrast media through the use of image intensification, enhancement of the iodine signal and digital processing of the image data. Temporal subtraction of the images obtained prior to and during the “first arterial pass” of the injected contrast medium yields images which are devoid of bone and soft tissue. IV DSA is most frequently used to examine the heart, including coronary by-pass grafts; the pulmonary arteries; arteries of the brachiocephalic circulation; the aortic arch; the abdominal aorta and its major branches; the iliac arteries; and the arteries of the extremities.

No special patient preparation is required for IV DSA. However, it is advisable to insure that patients are well hydrated prior to examination.

In addition to the general precautions previously described, the risks associated with IV DSA include those usually attendant with catheter procedures and include intramural injections, vessel dissection and tissue extravasation. The potential risk is reduced when small test injections of contrast medium are made under fluoroscopic observation to insure that the catheter tip is properly positioned and, in the case of peripheral placement, that the vein is of adequate size.
Patient motion, including respiration and swallowing, can result in misregistration leading to image degradation and non-diagnostic studies.

Usual Adult Dose for Intravenous Urography:

Either ioversol injection 74% (marketed as Optiray 350), ioversol injection 68% (marketed as Optiray 320), ioversol injection 64% (marketed as Optiray 300), or ioversol injection 51% (marketed as Optiray 240) is recommended for routine and high dose excretory urography. Preparatory dehydration is dangerous and may contribute to acute renal failure.

Usual dose for routine excretory urography: 50 to 75 mL of ioversol injection 74%, 68%, or 64% or 75 to 100 mL of ioversol injection 51%

Higher dosages may be indicated to achieve optimum results where poor visualization is anticipated (e.g., elderly patients or patients with impaired renal function). In these patients, high dose urography may be preferred, using ioversol injection 74% (marketed as Optiray 350) at a dose of 1.4 mL/kg (maximum 140 mL), ioversol injection 68% (marketed as Optiray 320) at a dose of 1.5 to 2 mL/kg (maximum 150 mL), ioversol injection 64% (marketed as Optiray 300) at a dose of 1.6 mL/kg (maximum 150 mL) or ioversol injection 51% (marketed as Optiray 240) at a dose of 2 mL/kg (maximum 200 mL).

Usual Pediatric Dose for Pediatric Angiocardiography:

Either ioversol injection 74% (marketed as Optiray 350) or ioversol injection 68% (marketed as Optiray 320) is recommended for this procedure. The usual single ventricular injection of ioversol injection 74% or ioversol injection 68% is 1.25 mL/kg of body weight with a range of 1 mL/kg to 1.5 mL/kg. When multiple injections are given, the total administered dose should not exceed 5 mL/kg up to a total volume of 250 mL.

Mandatory prerequisites to the procedure are specialized personnel, ECG monitoring apparatus, and adequate facilities for immediate resuscitation and cardioversion. Electrocardiograms and vital signs should be routinely monitored throughout the procedure. Pediatric patients at higher risk of experiencing adverse events during contrast medium administration may include those having asthma, a sensitivity to medication and/or allergens, congestive heart failure, a serum creatinine greater than 1.5 mg/dL, or those less than 12 months of age.

Usual Pediatric Dose for Head Imaging:

Recommended dose: 1 mL/kg to 3 mL/kg of ioversol injection 68% (marketed as Optiray 320)

Tumors: Ioversol may be useful to investigate the presence and extent of certain malignancies such as: gliomas including malignant gliomas, glioblastomas, astrocytomas, oligodendrogliomas and gangliomas, ependymomas, medulloblastomas, meningiomas, neuromas, pinealomas, pituitary adenomas, craniopharyngiomas, germinomas, and metastatic lesions. The usefulness of contrast enhancement for the investigation of the retrobulbar space and in cases of low grade or infiltrative glioma has not been demonstrated. In calcified lesions, there is less likelihood of enhancement. Following therapy, tumors may show decreased or no enhancement. The opacification of the inferior vermis following contrast media administration has resulted in false-positive diagnosis in a number of otherwise normal studies.

Nonneoplastic Conditions: Ioversol may be beneficial in the image enhancement of nonneoplastic lesions. Cerebral infarctions of recent onset may be better visualized with contrast enhancement, while some infarctions are obscured if contrast medium is used. The use of iodinated contrast media results in enhancement in about 60% of cerebral infarctions studied from one to four weeks from the onset of symptoms.

Sites of active infection may also be enhanced following contrast medium administration.

Arteriovenous malformations and aneurysms will show contrast enhancement.

For these vascular lesions the enhancement is probably dependent on the iodine content of the circulating blood pool. Hematomas and intraparenchymal bleeders seldom demonstrate contrast enhancement. However, in cases of intraparenchymal clot, for which there is no obvious clinical explanation, contrast media administration may be helpful in ruling out the possibility of associated arteriovenous malformation.

Usual Pediatric Dose for Body Imaging:

Recommended dose: 1 mL/kg to 3 mL/kg of ioversol injection 68% (marketed as Optiray 320), with a usual dose of 2 mL/kg.

Ioversol may be useful for enhancement of computed tomographic images for detection and evaluation of lesions in the liver, pancreas, kidneys, aorta, mediastinum, pelvis, abdominal cavity, and retroperitoneal space. Enhancement of computed tomography with ioversol may be of benefit in establishing diagnoses of certain lesions in these sites with greater assurance than is possible with CT alone. In other cases, the contrast agent may allow visualization of lesions not seen with CT alone (i.e., tumor extension) or may help to define suspicious lesions seen with unenhanced CT (i.e., pancreatic cyst).

Usual Pediatric Dose for Intravenous Urography:

Children: Ioversol injection 68% (marketed as Optiray 320) at doses of 0.5 mL/kg to 3 mL/kg of body weight has produced diagnostic opacification of the excretory tract.

Usual dose for children: 1 mL/kg to 1.5 mL/kg. Dosage for infants and children should be administered in proportion to age and body weight. The total administered dose should not exceed 3 mL/kg.

Preparatory dehydration is dangerous and may contribute to acute renal failure.

What other drugs will affect ioversol?

There may be other drugs that can affect ioversol. 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.

Where can I get more information?

  • Your doctor or pharmacist has more information about ioversol written for health professionals that you may read.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum'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. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum 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.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.04. Revision Date: 2010-12-15, 5:01:39 PM.

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