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Procan SR (procainamide) Disease Interactions

There are 8 disease interactions with Procan SR (procainamide):

Major

Antiarrhythmics (applies to Procan SR) cardiovascular dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure, Hypotension

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

References

  1. Halkin H, Meffin P, Melmon KL, Rowland M "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther 17 (1975): 669-76
  2. Crouthamel WG "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J 90 (1975): 335-9
  3. "Product Information. Quinidex (quinidine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  5. Ravid S, Podrid PJ, Lampert S, Lown B "Congestive heart failure induced by six of the newer antiarrhythmic drugs." J Am Coll Cardiol 14 (1989): 1326-30
  6. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  7. Gottlieb SS, Packer M "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J 118 (1989): 611-2
  8. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
  9. Swiryn S, Kim SS "Quinidine-induced syncope." Arch Intern Med 143 (1983): 314-6
  10. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  11. Singh SN, Fletcher RD, Fisher SG, et al. "Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia." N Engl J Med 333 (1995): 77-82
  12. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. Ochs HR, Grube E, Greenblatt DJ, Arendt R "Intravenous quinidine in congestive cardiomyopathy." Eur J Clin Pharmacol 19 (1981): 173-6
  14. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
  15. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  16. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  17. Prescott LF, Adjepon-Yamoah KK, Talbot RG "Impaired lignocaine metabolism in patients with myocardial infarction and cardiac failure." Br Med J 1 (1976): 939-41
View all 17 references
Major

Antiarrhythmics (applies to Procan SR) proarrhythmic effects

Major Potential Hazard, High plausibility. Applicable conditions: Arrhythmias, Abnormal Electrocardiogram

Antiarrhythmic agents can induce or worsen ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation, and torsades de pointes have occurred in some patients. Patients with underlying cardiac dysfunction, bradycardia, hypokalemia, hypomagnesemia, or high antiarrhythmic serum concentrations are at increased risk for drug-induced arrhythmias. Therapy with antiarrhythmics should be used with extreme caution in patients with or predisposed to arrhythmias. Evidence of improved survival is lacking for use of antiarrhythmic therapy in asymptomatic, non-life-threatening arrhythmias. Therapy with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias.

References

  1. Andrivet P, Beaslay V, Canh VD "Torsades de pointe with flecainide-amiodarone therapy." Intensive Care Med 16 (1990): 342-3
  2. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals, St. Paul, MN.
  3. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals, Wilmington, DE.
  4. Cheesman M, Ward DE "Exacerbation of ventricular tachycardia by tocainide." Clin Cardiol 8 (1985): 47-50
  5. Nora MO, Chandrasekaran K, Hammill SC, Reeder GS "Prolongation of ventricular depolarization: ECG manifestation of mexiletine toxicity." Chest 95 (1989): 925-8
  6. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  8. Said SAM, Somer ST, Luttikhuis HAO "Flecainide-induced JT prolongation, t wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation." Int J Cardiol 44 (1994): 285-7
  9. Lo KS, Gantz KB, Stetson PL, et al "Disopyramide-induced ventricular tachycardia." Arch Intern Med 140 (1980): 413-4
  10. "Product Information. Rhythmol (propafenone)." Knoll Pharmaceutical Company, Whippany, NJ.
  11. Morganroth J, Horowitz LN "Incidence of proarrhythmic effects from quinidine in the outpatient treatment of benign or potentially lethal ventricular arrhythmias." Am J Cardiol 56 (1985): 585-7
  12. Ben-Sorek ES, Wiesel J "Ventricular fibrillation following adenosine administration. A case report." Arch Intern Med 153 (1993): 2701-2
  13. Raehl CL, Patel AK, LeRoy M "Drug-induced torsade de pointes." Clin Pharm 4 (1985): 675-90
  14. Boriani G, Biffi M, Frabetti L, Azzolini U, Sabbatani P, Bronzetti G, Capucci A, Magnani B "Ventricular fibrillation after intravenous amiodarone in wolff-parkinson-white syndrome with atrial fibrillation." Am Heart J 131 (1996): 1214-6
  15. Meurer MK "A 21-year-old woman with rapid atrial fibrillation after adenosine administration." J Emerg Nurs 17 (1991): 135-6
  16. Anderson JL, Popat KD "Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy." Arch Intern Med 141 (1981): 801-2
  17. Tzivoni D, Keren A, Stern S, Gottlieb S "Disopyramide-induced Torsade de pointes." Arch Intern Med 141 (1981): 946-7
  18. Hii JT, Wyse DG, Gillis AM, et al "Propafenone-induced torsade de pointes: cross-reactivity with quinidine." Pacing Clin Electrophysiol 14 (1991): 1568-70
  19. Riccioni N, Castiglioni M, Bartolomei C "Disopyramide-induced QT prolongation and ventricular tachyarrhythmias." Am Heart J 105 (1983): 870-1
  20. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. Celiker A, Tokel K, Cil E, Ozkutlu S, Ozme S "Adenosine induced torsades de pointes in a child with congenital long QT syndrome." Pacing Clin Electrophysiol 17 (1994): 1814-7
  22. Sulke AN, Holt P, Sowton GE "Acceleration of conduction within an accessory pathway with propafenone." Int J Cardiol 28 (1990): 105-7
  23. Romer M, Candinas R "Adenosine-induced non-sustained polymorphic ventricular tachycardia." Eur Heart J 15 (1994): 281-2
  24. Exner DV, Muzyka T, Gillis AM "Proarrhythmia in patients with the Wolff-Parkinson-White Syndrome after standard doses of intravenous adenosine." Ann Intern Med 122 (1995): 351-2
  25. Silverman AJ, Machado C, Baga JJ, Meissner MD, Lehmann MH, Steinman RT "Adenosine-induced atrial fibrillation." Am J Emerg Med 14 (1996): 300-1
  26. Damle R, Levine J, Matos J, et al "Efficacy and risks of moricizine in inducible sustained ventricular tachycardia." Ann Intern Med 116 (1992): 375-81
  27. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  28. "Product Information. Tonocard (tocainide)." Merck & Co, Inc, West Point, PA.
  29. Cocco G, Strozzi C, Chu D, Pansini R "Torsades de pointes as a manifestation of mexiletine toxicity." Am Heart J 100 (1980): 878-80
  30. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  31. Stavens CS, McGovern B, Garan H, Ruskin JN "Aggravation of electrically provoked ventricular tachycardia during treatment with propafenone." Am Heart J 110 (1985): 24-9
  32. Faggiano P, Gardini A, Daloia A, Benedini G, Giordano A "Torsade de pointes occurring early during oral amiodarone treatment." Int J Cardiol 55 (1996): 205-8
  33. Wesley RC Jr, Turnquest P "Torsades de pointe after intravenous adenosine in the presence of prolonged QT syndrome." Am Heart J 123 (1992): 794-6
  34. Hohnloser SH, Vandeloo A, Baedeker F "Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine." J Am Coll Cardiol 26 (1995): 852-8
  35. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  36. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  37. Au PK, Bhandari AK, Bream R, et al "Proarrhythmic effects of antiarrhythmic drugs during programmed ventricular stimulation in patients without ventricular tachycardia." J Am Coll Cardiol 9 (1987): 389-97
  38. Sclarovsky S, Lewin RF, Kracoff O, Strasberg B, Arditti A, Agmon J "Amiodarone-induced polymorphous ventricular tachycardia." Am Heart J 105 (1983): 6-12
  39. Dhein S, Schott M, Gottwald E, Klaus W "Electrocardiological profile and proarrhythmic effects of quinidine, verapamil and their combination: a mapping study." Naunyn Schmiedebergs Arch Pharmacol 352 (1995): 94-101
  40. Williamson BD, Hummel J, Niebauer M, Man C, Strickberger SA, Daoud E, Morady F "Bradycardia-facilitated polymorphic ventricular tachycardia caused by amiodarone after radiofrequency modification of atrioventricular conduction." Am Heart J 130 (1995): 399-401
  41. Heisler BE, Ferrier GR "Proarrhythmic actions of flecainide in an isolated tissue model of ischemia and reperfusion." J Pharmacol Exp Ther 279 (1996): 317-24
  42. Morganroth J, Pratt CM "Prevalence and characteristics of proarrhythmia from moricizine (themozine)." Am J Cardiol 63 (1989): 172-6
  43. Engler RL, LeWinter M "Tocainide-induced ventricular fibrillation." Am Heart J 101 (1981): 494-6
  44. Strasberg B, Sclarovsky S, Erdberg A, et al "Procainamide-induced polymorphous ventricular tachycardia." Am J Cardiol 47 (1981): 1309-14
  45. Kinney EL, Field EH, Salmon MP, Zelis R "Cardiac arrhythmias associated with disopyramide." N Engl J Med May (1990): 1146
  46. Hohnloser SH, Klingenheben T, Singh BN "Amiodarone-associated proarrhythmic effects - a review with special reference to torsade de pointes tachycardia." Ann Intern Med 121 (1994): 529-35
  47. Chia BL "Disopyramide induced atypical ventricular tachycardia." Aust N Z J Med 10 (1980): 665-8
  48. Oberg KC, Otoole MF, Gallastegui JL, Bauman JL "''late'' proarrhythmia due to quinidine." Am J Cardiol 74 (1994): 192-4
  49. Orebaugh SL, Handy M "Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia." Am J Emerg Med 10 (1992): 326-30
  50. Schweitzer P, Mark H "Torsade de pointes caused by disopyramide and hypokalemia." Mt Sinai J Med 49 (1982): 110-4
  51. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals, Wilmington, DE.
  52. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  53. Reed R, Falk JL, O'Brien J "Untoward reaction to adenosine therapy for supraventricular tachycardia." Am J Emerg Med 9 (1991): 566-70
  54. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH "Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs." JAMA 270 (1993): 2590-7
  55. Strickberger SA, Man KC, Daoud EG, et al. "Adenosine-induced atrial arrhythmia: a prospective analysis." Ann Intern Med 127 (1997): 417-22
  56. "Product Information. Norpace (disopyramide)." Searle, Skokie, IL.
  57. Stratmann H, Walter K, Kennedy H "Torsade de pointes associated with elevated N-acetylprocainamide levels." Am Heart J 109 (1985): 375-6
  58. Buss J, Neuss H, Bilgin Y, Schlepper M "Malignant ventricular tachyarrhythmias in association with propafenone treatment." Eur Heart J 6 (1985): 424-8
  59. Nathan AW, Hellestrand KJ, Bexton RS, Camm AJ "Fatal ventricular tachycardia in association with propafenone, a new class IC antiarrhythmic agent." Postgrad Med J 60 (1984): 155-6
  60. Bauman JL, Bauernfeind RA, Hoff JV, et al "Torsade de pointes due to quinidine: observations in 31 patients." Am Heart J 107 (1984): 425-30
  61. Koenig W, Schinz AM "Spontaneous ventricular flutter and fibrillation during quinidine medication." Am Heart J 105 (1983): 863-5
  62. Dougherty AH, Gilman JK, Wiggins S, Jalal S, Naccarelli GV "Provocation of atrioventricular reentry tachycardia: a paradoxical effect of adenosine." Pacing Clin Electrophysiol 16 (1993): 8-12
View all 62 references
Major

Procainamide (applies to Procan SR) myelosuppression

Major Potential Hazard, Moderate plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts

Bone marrow suppression inducing granulocytopenia, anemia, and thrombocytopenia has occurred during administration of procainamide. Most event occurred at recommended dosages and within twelve weeks of initiation of procainamide therapy. Agranulocytosis has resulted in death in 20% to 25% of reported cases. Therapy with procainamide should be administered cautiously in patients with or predisposed to myelosuppression or any type of cytopenia. Clinical monitoring of hematopoietic function including complete blood counts prior to initiation of therapy and at weekly intervals for the first 3 months of therapy and periodically after that is necessary.

References

  1. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  2. Berger B, Hauser D "Agranulocytosis due to new sustained-release procainamide." Am Heart J 105 (1983): 1035-6
  3. Danielly J, Dejong R, Radkemitchell LC, Uprichard ACG "Procainamide-associated blood dyscrasias." Am J Cardiol 74 (1994): 1179-80
  4. Fleet S "Agranulocytosis, procainamide, and phenytoin." Ann Intern Med 100 (1984): 616-7
  5. Hoyt R "Severe neutropenia due to sustained-release procainamide." South Med J 80 (1987): 1196-7
  6. Meisner DJ, Carlson RJ, Gottlieb AJ "Thrombocytopenia following sustained-release procainamide." Arch Intern Med 145 (1985): 700-2
  7. Christensen D, Palma L, Phelps K "Agranulocytosis, thrombocytopenia, and procainamide." Ann Intern Med 100 (1984): 918
  8. Gabrielson RM, Leininger NR "Procainamide and neutropenia." Ann Intern Med 100 (1984): 766-7
  9. Ellrodt A, Murata G, Riedinger M, et al "Severe neutropenia associated with sustained-release procainamide." Ann Intern Med 100 (1984): 197-201
  10. Landrum EM, Siegert EA, Hanlon JT, Currie MS "Prolonged thrombocytopenia associated with procainamide in an elderly patient." Ann Pharmacother 28 (1994): 1172-6
  11. Scifman R, Garewal H, Shillinton D "Reticulocytopenic, Coombs' positive anemia induced by procainamide." Am J Clin Pathol 80 (1983): 66-8
  12. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  13. Reidy T, Upshaw J "Procainamide-induced agranulocytosis." South Med J 77 (1984): 1582-4
  14. Eisner E, Shahidi N "Immune thrombocytopenia due to a drug metabolite." N Engl J Med 287 (1972): 376-81
View all 14 references
Major

Procainamide (applies to Procan SR) sinus-AV node dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Heart Block

The use of procainamide is contraindicated in patients with complete AV node block because of its effects in suppressing nodal or ventricular pacemakers and the hazard of asystole. Therapy with procainamide should be avoided in patients with second-degree AV block or various hemiblocks in the absence of a functional artificial pacemaker.

References

  1. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  2. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
Major

Procainamide (applies to Procan SR) systemic lupus erythematosus

Major Potential Hazard, High plausibility.

The use of procainamide is contraindicated in patients with established systemic lupus erythematosus (SLE), since aggravation of the symptoms is highly likely. A positive antinuclear antibody test (+ANA), with or without symptoms of SLE, often results from chronic therapy with procainamide in patients without SLE. An SLE-like syndrome, rarely involving pathologic renal changes, can occur following prolonged procainamide therapy. The benefit versus risk should be evaluated in the presence of a +ANA in a patient without a history of or predisposition to SLE.

References

  1. Amadio P, Cummings D, Dashow L "Procainamide, quinidine, and lupus erythematosus." Ann Intern Med 102 (1985): 419-20
  2. McDonald E, Marino C "Procainamide-induced lupus in the elderly." Hosp Pract (Off Ed) 28 (1993): 95-8
  3. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  4. Zech P, Colon S, Labeeuw M, et al "Nephrotic syndrome in procainamide induced lupus nephritis." Clin Nephrol 11 (1979): 218-21
  5. Heyman MR, Flores RH, Edelman BB, Carliner NH "Procainamide-induced lupus anticoagulant." South Med J 81 (1988): 934-6
  6. Rubin RL, Nusinow SR, Johnson AD, et al "Serologic changes during induction of lupus-like disease by procainamide." Am J Med 80 (1986): 999-1002
  7. Li G, Greenberg C, Currie M "Procainamide-induced lupus anticoagulants and thrombosis." South Med J 81 (1988): 262-4
  8. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
View all 8 references
Moderate

Antiarrhythmics (applies to Procan SR) electrolyte imbalance

Moderate Potential Hazard, High plausibility. Applicable conditions: Hypokalemia, Hyperkalemia, Magnesium Imbalance

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

References

  1. "Product Information. Tonocard (tocainide)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Norpace (disopyramide)." Searle, Skokie, IL.
  3. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  4. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  5. "Product Information. Quinidex (quinidine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  7. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals, Wilmington, DE.
  8. "Product Information. Rhythmol (propafenone)." Knoll Pharmaceutical Company, Whippany, NJ.
  9. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals, St. Paul, MN.
  10. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  11. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  12. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 13 references
Moderate

Procainamide (applies to Procan SR) anticholinergic activity

Moderate Potential Hazard, High plausibility. Applicable conditions: Myasthenia Gravis

Procainamide decreases the release of acetylcholine from skeletal muscle motor nerve endings. Procainamide can worsen the symptoms of myasthenia gravis. Therapy with procainamide should be administered cautiously in patients with myasthenia gravis.

References

  1. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  2. Miller CD, Oleshansky MA, Gibson KF, Cantilena LR "Procainamide-induced myasthenia-like weakness and dysphagia." Ther Drug Monit 15 (1993): 251-4
  3. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  4. Niakan E, Bertorini T, Acchirardo S, Werner M "Procainamide-induced myasthenia-like weakness in a patient with periperal neuropathy." Arch Neurol 38 (1981): 378-9
View all 4 references
Moderate

Procainamide (applies to Procan SR) renal dysfunction

Moderate Potential Hazard, High plausibility.

Procainamide is primarily eliminated by the kidney. The serum concentration of procainamide is increased and the half-life prolonged in patients with renal impairment. Therapy with procainamide should be administered cautiously in patients with renal dysfunction and dosage modifications should be made based on the degree of renal impairment.

References

  1. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  2. Gibson TP, Atkinson AJ, Matusik E, et al "Kinetics of procainamide and N-acetylprocainamide in renal failure." Kidney Int 12 (1977): 422-9
  3. Stec GP, Atkinson AJ, Nevin MJ, et al "N-acetylprocainamide pharmacokinetics in functionally anephric patients before and after perturbation by hemodialysis." Clin Pharmacol Ther 26 (1979): 618-28
  4. Gibson TP, Matusik EJ, Briggs WA "N-acetylprocainamide levels in patients with end-stage renal failure." Clin Pharmacol Ther 19 (1975): 206-12
  5. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  6. Galeazzi RL, Sheiner LB, Lockwood T, Benet LZ "The renal elimination of procainamide." Clin Pharmacol Ther 19 (1975): 55-62
View all 6 references

Procan SR (procainamide) drug interactions

There are 332 drug interactions with Procan SR (procainamide)

Procan SR (procainamide) alcohol/food interactions

There is 1 alcohol/food interaction with Procan SR (procainamide)

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.