ADALAT RETARD 20MG TABLETS

Active substance: NIFEDIPINE

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Transcript
If you get side effects
Tell your doctor if any side effect gets
serious, or if you get any effects not listed in this
leaflet.
5. How to store Adalat Retard
Keep this medicine out of the sight and reach of
children.
Store your medicine in its original container.
Protect from strong light and only remove the
tablet from the blister strip when you are about to
take it.
Do not use after the expiry date which is marked
on both the outer carton and on each blister strip
of tablets.
Do not dispose of medicines in household
rubbish. Any unused Adalat Retard tablets
should be returned to a pharmacist (chemist)
who will dispose of them properly.
This helps the environment.
6. Further information
What Adalat Retard contains
Adalat Retard tablets contain the active
ingredient, nifedipine.
Adalat Retard tablets also contain
microcrystalline cellulose, maize starch, lactose,
polysorbate 80, magnesium stearate,
hypromellose, macrogol 4000, red iron oxide
(E172) and titanium dioxide (E171).
What’s in the pack
Each modified-release tablet contains 20 mg of
nifedipine. Each tablet is pink and round with
‘BAYER’ in a cross on one side and ‘A 20’ on the
reverse.
Each pack contains 60 tablets.
Manufactured by Bayer Healthcare AG.
D-51368 Leverkusen, Germany or Bayer Schering
Pharma AG, D-51368 Leverkusen, Germany or
Bayer Pharma AG, D-51368 Leverkusen,
Germany. Procured from within the EU. Product
Licence holder: Quadrant Pharmaceuticals Ltd.
Lynstock House, Lynstock Way, Lostock, Bolton,
BL6 4SA. Repackaged by Maxearn Ltd. Bolton
BL6 4SA.
PL 20774/0762 Adalat Retard 20mg Tablets
Date of preparation 13th March 2013

POM

Adalat® Retard 20mg Tablets
nifedipine
Read all of this leaflet carefully before you
start taking this medicine.
Keep this leaflet. You may need to read it
again.
If you have more questions, ask your doctor
or pharmacist.
This medicine has been prescribed for you.
Do not pass it on to others. It may harm them,
even if their symptoms are the same as
yours.
If any of the side effects gets serious, or if you
notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.
In this leaflet
1. What Adalat Retard is
2. Before you take Adalat Retard
3. How to take Adalat Retard
4. Possible side effects
5. How to store Adalat Retard
6. Further information
1. What Adalat Retard is
Adalat Retard contains nifedipine, which belongs
to a group of medicines called calcium
antagonists.
Adalat Retard is used to treat high blood
pressure or angina (chest pain).
For high blood pressure: Adalat Retard works by
relaxing and expanding the blood vessels. This
makes the blood flow more easily and lowers
blood pressure. Lower blood pressure reduces
the strain on your heart.
For angina: Adalat Retard works by relaxing and
expanding the arteries supplying the heart. This
allows more blood and oxygen to reach the heart
and decreases the strain on it. Your angina
attacks will be less severe and less frequent if
there is less strain on the heart.
2. Before you take Adalat Retard
Do not take Adalat Retard:
If you have had a heart attack within the last
month.
If you get a sudden angina attack. Adalat
Retard will not help relieve symptoms of
angina quickly.
If you have unstable angina.

PP5/0762/V1

If you are allergic to the active ingredient
(nifedipine), to any other similar medicines
(known as dihydropyridines) or to any of the
other ingredients.
The ingredients of Adalat Retard are listed
in section 6.
If you are pregnant.
If you are breastfeeding. If you need to take
Adalat Retard, you should stop breastfeeding
before you start to take this medicine.
If you are taking rifampicin, an antibiotic.
If you have been told that you have a
narrowing of the aortic heart valve
(stenosis).
If you have ever had a collapse caused by
a heart problem (cardiogenic shock), during
which you became breathless, pale and had a
cold sweat and dry mouth.
If your blood pressure continues to rise
despite treatment (malignant hypertension).
If you have been told to avoid lactose, that
you have a hereditary condition called Lapp
lactase deficiency or glucose-galactose
malabsorption.
Tell your doctor and do not take Adalat
Retard if any of these apply to you.
Your doctor will take special care:
If you have low blood pressure and you
were prescribed Adalat Retard for your
angina. Your blood pressure may be
decreased further by this treatment.
If you have a heart condition where your
heart cannot cope with increased strain (poor
cardiac reserve).
If you are a diabetic. The treatment for your
diabetes may need to be adjusted. If you
have any questions about this, ask your
doctor.
If you are on kidney dialysis. If you have a
very high blood pressure and a low blood
volume, you might experience a sudden drop
in blood pressure when you take Adalat
Retard.
If your liver is not working properly. Your
doctor may need to do some blood tests. You
may also be given a lower dose of Adalat
Retard.
Talk to your doctor before you take
Adalat Retard if any of these apply to you.
(leaflet continued overleaf)

Other medicines and Adalat Retard
Tell your doctor about any other medicines
that you are taking, or took recently. This
includes any products you bought without a
prescription.
Also tell your doctor:
If you are giving a urine sample. Adalat
Retard may interfere with the results of
certain urine tests.
If you are a man who has been unable to
father a child by in vitro fertilisation. Drugs
like Adalat Retard have been shown to impair
sperm function.
Tell your doctor before you take the next
dose if any of these apply to you.
Tell your doctor:
If your chest pain (angina) gets worse
(comes on more often or more severely) over
a matter of hours or days. You may be
advised not to take Adalat Retard.
If you have chest pains after taking your
first dose of Adalat Retard. Your doctor may
wish to change your treatment.
If you notice increased breathlessness.
If you notice swelling of the ankles.
(leaflet continued)

Other side effects
(Frequency unknown)
vomiting
a reduction in the number of white blood cells
(leucopenia)
a more severe decrease in a specific class of
white blood cell (agranulocytosis)
increased blood sugar (hyperglycaemia)
decreased skin sensitivity (hypoaesthesia)
drowsiness (somnolence)
eye pain
chest pain (angina pectoris)
heartburn or indigestion (gastroesophageal
sphincter insufficiency)
yellowing of the whites of the eyes or skin
(jaundice)
sensitivity to light (photosensitivity allergic
reaction)
small, raised areas of bleeding in the skin
(palpable purpura)
joint pain

All of these symptoms usually go away when
treatment with Adalat Retard is stopped.

PP5/0762/V1

Some medicines may affect the way Adalat
Retard works.
Tell your doctor if you are taking:

Rare side effects
(These may affect up to 1 in 1,000 people)
pins and needles
inflammation of the gums, tender or swollen
gums, bleeding gums

PACKAGE LEAFLET: INFORMATION FOR THE USER

Other medicines to treat high blood
pressure.
Rifampicin (an antibiotic).
Cimetidine (to treat stomach ulcers).
Digoxin, diltiazem, quinidine or betablockers (to treat heart conditions).
Quinupristin/dalfopristin (a combination
antibiotic).
Phenytoin, carbamazepine or valproic acid
(to treat epilepsy).
Cisapride (to treat reduced movements of
the gullet and stomach).
Magnesium sulphate injections during
pregnancy (may cause a severe fall in blood
pressure).
Erythromycin (an antibiotic).
Ketoconazole, itraconazole or fluconazole
(antifungal medicines).

low blood pressure when standing up
(symptoms include fainting, dizziness, light
headedness, occasional palpitations, blurred
vision and sometimes confusion)
fainting
irregular heartbeat (palpitations)
dry mouth
indigestion or upset stomach
wind (flatulence)
feeling sick (nausea)
muscle cramps
joint swelling
sleep disorders
anxiety or nervousness
reddening of the skin
nose bleeds
nasal congestion
sensation of spinning or whirling motion
(vertigo)
migraine
dizziness
trembling
increase in the need to pass water (urinate)
painful or difficult urination
inability to achieve or maintain an erection
(impotence)
blurred vision
temporary increase in certain liver enzymes

muscle pain

Indinavir, nelfinavir, ritonavir, saquinavir
or amprenavir (to treat HIV).
Fluoxetine or nefazodone (to treat
depression).

(leaflet continued)

(leaflet continued overleaf)
Uncommon side effects
(These may affect up to 1 in 100 people)
stomach pain (abdominal pain)
unspecific pain
chills

To start with, you may be given a lower
strength (10 mg) tablet called Adalat Retard
10 mg. This allows your doctor to monitor
how you are responding so that the best longterm dose can be identified.
3. How to take Adalat Retard
Take the tablets as prescribed by your doctor.
This may be more likely when you first start
treatment, if you change tablets, or if you have
drunk alcohol.
Driving and using machines
Adalat Retard may make you feel dizzy, faint,
extremely tired or have visual disturbances. Do
not drive or operate machinery if you are affected
in this way.
Do not take Adalat Retard if you are
breastfeeding.
If you need to take Adalat Retard, you should
stop breastfeeding before you start taking the
tablets.
Pregnancy and breastfeeding
Do not take Adalat Retard if you are pregnant.
If you are pregnant, think you might be pregnant
or are planning a family, tell your doctor before
taking Adalat Retard. You may be able to use
Adalat Retard after week 20 of your pregnancy,
but only after special consideration and
agreement by your doctor.
Do not drink grapefruit juice or eat grapefruit
while taking Adalat Retard.
Do not start taking Adalat Retard within 3 days of
drinking grapefruit juice or eating grapefruit. Tell
your doctor if you have had grapefruit or
grapefruit juice in this time. Also, do not drink
grapefruit juice or eat grapefruit whilst taking
Adalat Retard. Grapefruit juice is known to
increase the blood levels of the active ingredient,
nifedipine.
This effect can last for at least 3 days.
Food and drink with Adalat Retard
You can take Adalat Retard either with or without
food.
Tacrolimus (to prevent the rejection of
transplanted organs).
Phenobarbital (usually used to treat
insomnia or anxiety).

If you forget to take the tablets
Take your normal dose immediately and continue
taking your tablets as prescribed, waiting 12
hours before taking your next dose.
Do not take a double dose to make up for the
missed dose.
If you take too many tablets
Get medical help immediately. If possible,
take your tablets or the box with you to show the
doctor.
Taking too many tablets may cause your blood
pressure to become too low and your heartbeats
to speed up or slow down. It may also lead to an
increase in your blood sugar level or an increase
in the acidity of your blood, swelling in the lungs,
low blood oxygen levels and disturbances in
consciousness, possibly leading to
unconsciousness.
Use in children: Adalat Retard is not
recommended for use in children and
adolescents below 18 years of age, because
there are only limited data on the safety and
efficacy in this population.
You can take Adalat Retard either with or without
food.
Do not take them with grapefruit juice.
The usual maintenance dose of Adalat
Retard (20 mg strength) is 1 tablet, every 12
hours (i.e. twice per day), but your doctor may
increase or decrease the dose depending on
how well your blood pressure or angina is
being controlled. The maximum dose is 2
tablets (40 mg) every 12 hours.
Lower doses may be prescribed for elderly
patients.
If you have problems with your liver you
are likely to be given Adalat Retard 10 mg, at
least to begin with.
Swallow the tablets whole with a little
water.
Continue to take the tablets for as long as
your doctor has told you to.

Common side effects
(These may affect up to 1 in 10 people)
headache
flushing
general feeling of being unwell
constipation
swelling, particularly of the ankles and legs
Less serious side effects
Apart from the side effects listed above, these
are the other side effects of Adalat Retard,
starting with the more common ones:
Contact your doctor immediately before
you continue treatment as these may be signs
of a severe reaction.
If you develop:
a skin reaction or blistering/peeling of the skin
and/or mucosal reactions (in the mouth/nose
or at the penis/vagina) (Toxic Epidermal
Necrolysis)
Contact your doctor immediately and do
not take the next dose as these may be the first
signs of allergic reaction which may become
severe.
Serious side effects
If you notice:
Severe, sudden generalised allergic reaction
including very rarely life-threatening shock
(e.g. difficulty in breathing, drop of blood
pressure, fast pulse), swelling (including
potentially life-threatening swelling of the
airway)
other allergic reactions causing swelling
under the skin (possibly severe and including
swelling of the larynx that may result in a lifethreatening outcome)
fast heart beat (tachycardia)
shortness of breath or difficulty breathing
mild to moderate allergic reactions
itching (possibly severe), a rash or hives
4. Possible side effects
Like all medicines, Adalat Retard can have side
effects, although not everybody gets them.

(leaflet continued)
low blood pressure when standing up
(symptoms include fainting, dizziness, light
headedness, occasional palpitations, blurred
vision and sometimes confusion)
fainting
irregular heartbeat (palpitations)
dry mouth
indigestion or upset stomach
wind (flatulence)
feeling sick (nausea)
muscle cramps
joint swelling
sleep disorders
anxiety or nervousness
reddening of the skin
nose bleeds
nasal congestion
sensation of spinning or whirling motion
(vertigo)
migraine
dizziness
trembling
increase in the need to pass water (urinate)
painful or difficult urination
inability to achieve or maintain an erection
(impotence)
blurred vision
temporary increase in certain liver enzymes
Rare side effects
(These may affect up to 1 in 1,000 people)
pins and needles
inflammation of the gums, tender or swollen
gums, bleeding gums
Other side effects
(Frequency unknown)
vomiting
a reduction in the number of white blood cells
(leucopenia)
a more severe decrease in a specific class of
white blood cell (agranulocytosis)
increased blood sugar (hyperglycaemia)
decreased skin sensitivity (hypoaesthesia)
drowsiness (somnolence)
eye pain
chest pain (angina pectoris)
heartburn or indigestion (gastroesophageal
sphincter insufficiency)
yellowing of the whites of the eyes or skin
(jaundice)
sensitivity to light (photosensitivity allergic
reaction)
small, raised areas of bleeding in the skin
(palpable purpura)
joint pain

muscle pain
All of these symptoms usually go away when
treatment with Adalat Retard is stopped.
If you get side effects
Tell your doctor if any side effect gets
serious, or if you get any effects not listed in this
leaflet.
5. How to store Adalat Retard
Keep this medicine out of the sight and reach of
children.
Store your medicine in its original container.
Protect from strong light and only remove the
tablet from the blister strip when you are about to
take it.
Do not use after the expiry date which is marked
on both the outer carton and on each blister strip
of tablets.
Do not dispose of medicines in household
rubbish. Any unused Adalat Retard tablets
should be returned to a pharmacist (chemist)
who will dispose of them properly.
This helps the environment.
6. Further information
What Adalat Retard contains
Adalat Retard tablets contain the active
ingredient, nifedipine.
Adalat Retard tablets also contain
microcrystalline cellulose, maize starch, lactose,
polysorbate 80, magnesium stearate,
hypromellose, macrogol 4000, red iron oxide
(E172) and titanium dioxide (E171).
What’s in the pack
Each modified-release tablet contains 20 mg of
nifedipine. Each tablet is pink and round with
‘BAYER’ in a cross on one side and ‘A 20’ on the
reverse.
Each pack contains 60 tablets.
Manufactured by Bayer Healthcare AG.
D-51368 Leverkusen, Germany or Bayer Schering
Pharma AG, D-51368 Leverkusen, Germany or
Bayer Pharma AG, D-51368 Leverkusen,
Germany. Procured from within the EU. Product
Licence holder: Quadrant Pharmaceuticals Ltd.
Lynstock House, Lynstock Way, Lostock, Bolton,
BL6 4SA. Repackaged by Maxearn Ltd. Bolton
BL6 4SA.
PL 20774/0762 Adalat Retard 20mg Tablets
Date of preparation 13th March 2013

POM

PACKAGE LEAFLET: INFORMATION FOR THE USER

PP5/0762/V1

Adalat® Retard 20mg Tablets
nifedipine
Read all of this leaflet carefully before you
start taking this medicine.
Keep this leaflet. You may need to read it
again.
If you have more questions, ask your doctor
or pharmacist.
This medicine has been prescribed for you.
Do not pass it on to others. It may harm them,
even if their symptoms are the same as
yours.
If any of the side effects gets serious, or if you
notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.
In this leaflet
1. What Adalat Retard is
2. Before you take Adalat Retard
3. How to take Adalat Retard
4. Possible side effects
5. How to store Adalat Retard
6. Further information
1. What Adalat Retard is
Adalat Retard contains nifedipine, which belongs
to a group of medicines called calcium
antagonists.
Adalat Retard is used to treat high blood
pressure or angina (chest pain).
For high blood pressure: Adalat Retard works by
relaxing and expanding the blood vessels. This
makes the blood flow more easily and lowers
blood pressure. Lower blood pressure reduces
the strain on your heart.
For angina: Adalat Retard works by relaxing and
expanding the arteries supplying the heart. This
allows more blood and oxygen to reach the heart
and decreases the strain on it. Your angina
attacks will be less severe and less frequent if
there is less strain on the heart.
2. Before you take Adalat Retard
Do not take Adalat Retard:
If you have had a heart attack within the last
month.
If you get a sudden angina attack. Adalat
Retard will not help relieve symptoms of
angina quickly.
If you have unstable angina.

If you are allergic to the active ingredient
(nifedipine), to any other similar medicines
(known as dihydropyridines) or to any of the
other ingredients.
The ingredients of Adalat Retard are listed
in section 6.
If you are pregnant.
If you are breastfeeding. If you need to take
Adalat Retard, you should stop breastfeeding
before you start to take this medicine.
If you are taking rifampicin, an antibiotic.
If you have been told that you have a
narrowing of the aortic heart valve
(stenosis).
If you have ever had a collapse caused by
a heart problem (cardiogenic shock), during
which you became breathless, pale and had a
cold sweat and dry mouth.
If your blood pressure continues to rise
despite treatment (malignant hypertension).
If you have been told to avoid lactose, that
you have a hereditary condition called Lapp
lactase deficiency or glucose-galactose
malabsorption.
Tell your doctor and do not take Adalat
Retard if any of these apply to you.
Your doctor will take special care:
If you have low blood pressure and you
were prescribed Adalat Retard for your
angina. Your blood pressure may be
decreased further by this treatment.
If you have a heart condition where your
heart cannot cope with increased strain (poor
cardiac reserve).
If you are a diabetic. The treatment for your
diabetes may need to be adjusted. If you
have any questions about this, ask your
doctor.
If you are on kidney dialysis. If you have a
very high blood pressure and a low blood
volume, you might experience a sudden drop
in blood pressure when you take Adalat
Retard.
If your liver is not working properly. Your
doctor may need to do some blood tests. You
may also be given a lower dose of Adalat
Retard.
Talk to your doctor before you take
Adalat Retard if any of these apply to you.

PP5/0762/V1

(leaflet continued overleaf)

Indinavir, nelfinavir, ritonavir, saquinavir
or amprenavir (to treat HIV).
Fluoxetine or nefazodone (to treat
depression).
Other medicines to treat high blood
pressure.
Rifampicin (an antibiotic).
Cimetidine (to treat stomach ulcers).
Digoxin, diltiazem, quinidine or betablockers (to treat heart conditions).
Quinupristin/dalfopristin (a combination
antibiotic).
Phenytoin, carbamazepine or valproic acid
(to treat epilepsy).
Cisapride (to treat reduced movements of
the gullet and stomach).
Magnesium sulphate injections during
pregnancy (may cause a severe fall in blood
pressure).
Erythromycin (an antibiotic).
Ketoconazole, itraconazole or fluconazole
(antifungal medicines).
Some medicines may affect the way Adalat
Retard works.
Tell your doctor if you are taking:
Other medicines and Adalat Retard
Tell your doctor about any other medicines
that you are taking, or took recently. This
includes any products you bought without a
prescription.
Also tell your doctor:
If you are giving a urine sample. Adalat
Retard may interfere with the results of
certain urine tests.
If you are a man who has been unable to
father a child by in vitro fertilisation. Drugs
like Adalat Retard have been shown to impair
sperm function.
Tell your doctor before you take the next
dose if any of these apply to you.
Tell your doctor:
If your chest pain (angina) gets worse
(comes on more often or more severely) over
a matter of hours or days. You may be
advised not to take Adalat Retard.
If you have chest pains after taking your
first dose of Adalat Retard. Your doctor may
wish to change your treatment.
If you notice increased breathlessness.
If you notice swelling of the ankles.
(leaflet continued)

(leaflet continued overleaf)
Uncommon side effects
(These may affect up to 1 in 100 people)
stomach pain (abdominal pain)
unspecific pain
chills

To start with, you may be given a lower
strength (10 mg) tablet called Adalat Retard
10 mg. This allows your doctor to monitor
how you are responding so that the best longterm dose can be identified.
3. How to take Adalat Retard
Take the tablets as prescribed by your doctor.
This may be more likely when you first start
treatment, if you change tablets, or if you have
drunk alcohol.
Driving and using machines
Adalat Retard may make you feel dizzy, faint,
extremely tired or have visual disturbances. Do
not drive or operate machinery if you are affected
in this way.
Do not take Adalat Retard if you are
breastfeeding.
If you need to take Adalat Retard, you should
stop breastfeeding before you start taking the
tablets.
Pregnancy and breastfeeding
Do not take Adalat Retard if you are pregnant.
If you are pregnant, think you might be pregnant
or are planning a family, tell your doctor before
taking Adalat Retard. You may be able to use
Adalat Retard after week 20 of your pregnancy,
but only after special consideration and
agreement by your doctor.
Do not drink grapefruit juice or eat grapefruit
while taking Adalat Retard.
Do not start taking Adalat Retard within 3 days of
drinking grapefruit juice or eating grapefruit. Tell
your doctor if you have had grapefruit or
grapefruit juice in this time. Also, do not drink
grapefruit juice or eat grapefruit whilst taking
Adalat Retard. Grapefruit juice is known to
increase the blood levels of the active ingredient,
nifedipine.
This effect can last for at least 3 days.
Food and drink with Adalat Retard
You can take Adalat Retard either with or without
food.
Tacrolimus (to prevent the rejection of
transplanted organs).
Phenobarbital (usually used to treat
insomnia or anxiety).

If you forget to take the tablets
Take your normal dose immediately and continue
taking your tablets as prescribed, waiting 12
hours before taking your next dose.
Do not take a double dose to make up for the
missed dose.
If you take too many tablets
Get medical help immediately. If possible,
take your tablets or the box with you to show the
doctor.
Taking too many tablets may cause your blood
pressure to become too low and your heartbeats
to speed up or slow down. It may also lead to an
increase in your blood sugar level or an increase
in the acidity of your blood, swelling in the lungs,
low blood oxygen levels and disturbances in
consciousness, possibly leading to
unconsciousness.
Use in children: Adalat Retard is not
recommended for use in children and
adolescents below 18 years of age, because
there are only limited data on the safety and
efficacy in this population.
You can take Adalat Retard either with or without
food.
Do not take them with grapefruit juice.
The usual maintenance dose of Adalat
Retard (20 mg strength) is 1 tablet, every 12
hours (i.e. twice per day), but your doctor may
increase or decrease the dose depending on
how well your blood pressure or angina is
being controlled. The maximum dose is 2
tablets (40 mg) every 12 hours.
Lower doses may be prescribed for elderly
patients.
If you have problems with your liver you
are likely to be given Adalat Retard 10 mg, at
least to begin with.
Swallow the tablets whole with a little
water.
Continue to take the tablets for as long as
your doctor has told you to.

Common side effects
(These may affect up to 1 in 10 people)
headache
flushing
general feeling of being unwell
constipation
swelling, particularly of the ankles and legs
Less serious side effects
Apart from the side effects listed above, these
are the other side effects of Adalat Retard,
starting with the more common ones:
Contact your doctor immediately before
you continue treatment as these may be signs
of a severe reaction.
If you develop:
a skin reaction or blistering/peeling of the skin
and/or mucosal reactions (in the mouth/nose
or at the penis/vagina) (Toxic Epidermal
Necrolysis)
Contact your doctor immediately and do
not take the next dose as these may be the first
signs of allergic reaction which may become
severe.
Serious side effects
If you notice:
Severe, sudden generalised allergic reaction
including very rarely life-threatening shock
(e.g. difficulty in breathing, drop of blood
pressure, fast pulse), swelling (including
potentially life-threatening swelling of the
airway)
other allergic reactions causing swelling
under the skin (possibly severe and including
swelling of the larynx that may result in a lifethreatening outcome)
fast heart beat (tachycardia)
shortness of breath or difficulty breathing
mild to moderate allergic reactions
itching (possibly severe), a rash or hives
4. Possible side effects
Like all medicines, Adalat Retard can have side
effects, although not everybody gets them.

Expand view ⇕

Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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