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LEVERAXO 40 MG PROLONGED-RELEASE TABLETS

Active substance(s): OXYCODONE HYDROCHLORIDE

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Package leaflet: Information for the user

Leveraxo 5 mg, 10 mg, 20 mg,
30 mg, 40 mg, 60 mg, 80 mg
prolonged-release tablets
(oxycodone hydrochloride)

Read all of this leaflet carefully before you start
taking this medicine because it contains important
information for you.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor
or pharmacist.
• This medicine has been prescribed for you only. Do
not pass it on to others. It may harm them, even if
their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or
pharmacist. This includes any possible side effects
not listed in this leaflet. See section 4.

What is in this leaflet

1. What Leveraxo is and what it is used for
2. What you need to know before you take Leveraxo
3. How to take Leveraxo
4. Possible side effects
5. How to store Leveraxo
6. Contents of the pack and other information

1. What Leveraxo is and what it is used for

Leveraxo is a centrally acting, strong painkiller from the
group of opioids.
Leveraxo is used to treat severe pain in adults and
adolescents aged 12 years and older, which can be
adequately managed only with opioid analgesics.

2. What you need to know before you
take Leveraxo
Do not take Leveraxo

• if you are allergic to oxycodone hydrochloride or any
of the other ingredients of this medicine (listed in
section 6)
• if you suffer from severely depressed breathing
(respiratory depression) with too little oxygen in the
blood (hypoxia) and/or too much carbon dioxide
(hypercapnia) in the blood
• if you suffer from severe chronic obstructive lung
disease, cor pulmonale (cardiac changes due to
chronic overload of lung circulation) or acute, severe
bronchial asthma
• if you suffer from intestinal paralysis (paralytic ileus)

Warnings and precautions

Talk to your doctor or pharmacist before taking
Leveraxo if you:
• are older or debilitated
• have severely impaired lung, liver or kidney function
(see also section 3 “Risk patients”)
• suffer from myxoedema (certain illnesses of the thyroid
gland), or an impaired function of the thyroid gland
• suffer from adrenal insufficiency (Addison’s disease)
• suffer from toxic psychosis (e.g. alcohol)
• suffer from enlargement of the prostate
(prostate hypertrophy)
• suffer from alcoholism or are undergoing
alcohol withdrawal
• suffer from known opioid-dependence
• suffer from inflammation of the pancreas (pancreatitis)
• suffer from diseases of the biliary tract
• suffer from inflammatory bowel disorders
• suffer from low blood pressure
• suffer from decreased blood volume (hypovolaemia)
• suffer from head injury
• suffer from epilepsy or have a seizure (fits) tendency
• take MAO inhibitors (for the treatment of depression).
Long term treatment and abuse
Leveraxo has primary dependence potential. When used
for a long time tolerance to the effects may develop and
progressively higher doses may be required to maintain
pain control.
Chronic use of Leveraxo may lead to physical
dependence and a withdrawal syndrome may occur
upon abrupt cessation of therapy. When a patient no
longer requires therapy with oxycodone hydrochloride,
it may be advisable to taper the dose gradually to
prevent symptoms of withdrawal.
When used as directed in patients suffering from
chronic pain the risk of developing physical or
psychological dependence is markedly reduced and
needs to be weighed against the potential benefit.
Please discuss this with your doctor.
Leveraxo is for oral use only. In case of abusive injection
(injection in a vein) the other tablet ingredients may
lead to destruction (necrosis) of the local tissue, change
of lung tissue (granulomas of the lung) or other serious,
potentially lethal events.
Anti-doping warning
Athletes should be aware that this medicine may cause
a positive reaction to “anti-doping tests”. Use of Leveraxo
as a doping agent may become a health hazard.

Children under 12 years of age

Leveraxo should not be used in children under 12 years
of age because of safety and efficacy concerns.

Elderly patients

In elderly patients without impairment of kidney and/or
liver function a dose adjustment is usually not necessary.

Other medicines and Leveraxo

Tell your doctor or pharmacist if you are taking, have
recently taken or might take any other medicines.
• Medicines that dampen the activity of the central
nervous system, e.g.
** sleeping pills or tranquillisers (sedatives, hypnotics)
** other medicines that act on the nervous system
(phenothiazines, neuroleptics, anaesthetics,
antidepressants, muscle relaxants)
** other opioids or alcohol can enhance the side
effects of oxycodone, in particular depressed
breathing (respiratory depression).
• Medicines with an anticholinergic effect, e.g.
** other medicines that act against parasympathetic
and cholinergic nerve fibres on the central nervous
system (psychotropic medicines)
** medicines used to treat allergies (antihistamines)
or vomiting (antiemetics)
** medicines used to treat Parkinson’s disease can
enhance certain side effects of oxycodone (e.g.
constipation, dry mouth or urinary disturbances).
• Inhibitors of CYP3A4, such as macrolide antibiotics,
azole antifungals, protease inhibitors, cimetidine and
grapefruit juice may cause a reduced clearance of
oxycodone that could cause an increase of the plasma
concentrations of oxycodone. The influence of other
medicines that can markedly affect the metabolism of
oxycodone has not been investigated.
• Strong inhibitors of CYP2D6 may affect the elimination
of oxycodone. The influence of other isoenzyme
inhibitors that can markedly affect the metabolism of
oxycodone is not known.
• CYP3A4 inducers such as rifampicin, carbamazepine,
phenytoin and St John´s Wort may induce the
metabolism of oxycodone and cause an increased
clearance of oxycodone that could cause a reduction
of the plasma concentrations of oxycodone.
• Monoamine oxidase inhibitors (MAOIs) can enhance
the side effects of oxycodone (e.g. excitation, decrease
or increase in blood pressure).
• In individuals a clinically relevant increase or
decrease of blood clotting have been observed if
anticoagulants of the coumarin type (medicinal
products against blood clotting) are co-applied
with Leveraxo.

Oxycodone Hydrochloride 80 mg,40 mg,60 mg,

Description 5 mg,30 mg,10 mg,20 mg 56,28
Component Type Leaflet
Affiliate Item Code 792436
Superceded Affiliate Item Code N/A
TrackWise PR No. 792436
MA No. N/A
Packing Site/Printer N/A
Supplier Code N/A

Pharma Code 1217
SAP No. N/A
Vendor Job No. 272700
Trackwise Proof No. 4
Glams Proof No. N/A
Client Market United Kingdom
Keyline/Drawing No. N/A
Barcode Info N/A

Leveraxo with alcohol

Drinking alcohol whilst taking Leveraxo may make you
feel more sleepy or increase the risk of serious side
effects such as shallow breathing with a risk of stopping
breathing, and loss of consciousness. It is recommended
not to drink alcohol while you are taking Leveraxo.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may
be pregnant or are planning to have a baby, ask your
doctor or pharmacist for advice before taking any
medicine.
Pregnancy
Leveraxo should not be used in pregnancy unless
clearly necessary. There are limited data regarding the
use of oxycodone in pregnant women. Oxycodone
crosses the placenta into the blood circulation of the
baby.
Prolonged use of oxycodone during pregnancy
can cause withdrawal symptoms in newborns. Use
of oxycodone during delivery can cause breathing
problems (respiratory depression) in the newborn.
Breast-feeding
Breast-feeding should be discontinued during
treatment with Leveraxo. Oxycodone passes into breast
milk and may affect your suckling child, especially
following the intake of multiple doses.

Driving and using machines

Oxycodone impairs alertness and reactivity to such an
extent that the ability to drive and operate machinery
is affected or ceases altogether. In these circumstances
Leveraxo has moderate to major influence on the ability
to drive and use machines.
With stable therapy, a general ban on driving a vehicle
may be not necessary. In these circumstances Leveraxo
has minor influence on the ability to drive and use
machines. The treating physician must assess the
individual situation. Please discuss with your doctor
whether or under what conditions you can drive a
vehicle.

Leveraxo contains sucrose

If you have been told by your doctor that you have an
intolerance to some sugars, contact your doctor before
taking this medicinal product.

3. How to take Leveraxo

Always take this medicine exactly as your doctor has
told you. Check with your doctor or pharmacist if you
are not sure.
For doses not realisable/practicable with this medicinal
product other strengths and medicinal products
are available.

The recommended dose is

Adults and adolescents (aged 12 years and older)
The usual initial dose is 10 mg of oxycodone
hydrochloride in 12 hourly intervals. Some patients may
benefit from a starting dose of 5 mg to minimise the
incidence of adverse reactions.
Further determination of the daily dose, the division
into the single doses and any dose adjustments during
the further course of therapy are performed by the
treating physician and depend on the previous dosage.
Patients who have already taken opioids can start
treatment with higher dosages taking into account their
experience with opioid treatment.
Some patients who receive Leveraxo according to a
fixed schedule need rapidly acting painkillers as rescue
medication to control breakthrough pain. Leveraxo is
not intended for the treatment of breakthrough pain.
For the treatment of non-cancer pain a daily dose
of 40 mg of oxycodone hydrochloride is generally
sufficient, but higher dosages may be necessary.
Patients with cancer pain usually require dosages from
80 to 120 mg of oxycodone hydrochloride which may
be increased up to 400 mg in individual cases.
The treatment needs to be controlled regularly with
regard to pain relief and other effects in order to
achieve the best pain therapy possible as well as to be
able to treat any occurring side effects in good time and
to decide whether treatment should be continued.
Risk patients
If you have impaired kidney and/or liver function or if
you have a low body weight your doctor may prescribe
a lower starting dose.
Route and method of administration
Oral use. It is not recommended to take Leveraxo with
alcoholic beverages.
Swallow the prolonged-release tablets with a sufficient
amount of liquid (½ glass of water) with or without food
in the morning and in the evening following a fixed
schedule (e.g. at 8 a.m. and 8 p.m.).
Leveraxo 5 mg prolonged-release tablets:
Leveraxo must not be taken divided, broken, chewed
or crushed as this leads to rapid oxycodone release due
to the damage of the prolonged-release properties. The
administration of divided, broken, chewed or crushed
Leveraxo leads to a rapid release and absorption of a
potentially fatal dose of oxycodone (see section “If you
take more Leveraxo than you should”)
Leveraxo 10 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg
prolonged-release tablets:
The prolonged-release tablet can be divided into
equal doses.
The prolonged-release tablets must not be broken,
chewed or crushed as this leads to rapid oxycodone
release due to the damage of the prolonged-release
properties. The administration of broken, chewed
or crushed Leveraxo leads to a rapid release and
absorption of a potentially fatal dose of oxycodone (see
section “If you take more Leveraxo than you should”).
Opening instruction for the blister
This medicinal product is packed in a child-resistant
perforated unit dose blister. You cannot press out the
prolonged-release tablets through the blister. Please
observe the following opening instruction for the
blister:

1. Tear off a single dose along the perforation line of
the blister.
2. Hereby an unsealed area is accessible which is
located at the position, where the perforation lines
have crossed.
3. Pull at the unsealed "strap" to peel off the cover seal.
Your doctor will adjust the dosage depending on the
pain intensity and how you respond to the treatment.
Take the number of prolonged-release tablets
determined by your doctor twice daily.

If you take more Leveraxo than you should

If you have taken more Leveraxo as prescribed you
should inform your doctor or your local poison control
centre immediately. The following symptoms may
occur: constricted pupils (miosis), depressed breathing
(respiratory depression), skeletal muscle flaccidity and
drop in blood pressure. In severe cases circulatory
collapse, mental and motor inactivity (torpor),
unconsciousness (coma), slowing of the heart rate and
accumulation of water in the lungs (non-cardiogenic
lung oedema) may occur; abuse of high doses of strong
opioids such as oxycodone can be fatal. In no case you
should expose yourself to situations requiring elevated
concentration e.g. driving a car.

Date: 19 May 2016
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1

Time: 11:12
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1/2

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If you forget to take Leveraxo

If you use a smaller dose of Leveraxo than directed
or you miss the intake of Leveraxo, pain relief will
consequently be insufficient or cease altogether.
You can make up for a forgotten dose if the next regular
intake is not due for at least another 8 hours. You can then
continue to take your recommended dose as directed.
You should also take Leveraxo if the time to the regular
next intake is shorter, but postpone the next intake by
8 hours. In principle, you should not take Leveraxo more
than once every 8 hours.
Do not take a double dose to make up for a
forgotten dose.

If you stop taking Leveraxo

Do not stop treatment without informing your doctor.
When a patient no longer requires therapy with
Leveraxo, it may be advisable to taper the dose
gradually to prevent symptoms of withdrawal.
A withdrawal syndrome may occur upon abrupt
cessation of therapy. For symptoms of the withdrawal
syndrome see section 4.
If you have any further questions on the use of this
medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects,
although not everybody gets them.
Significant side effects or signs to consider and
measures to be taken when these side effects of
signs occur
If you experience any of the following side effects, stop
taking Leveraxo and contact your doctor immediately:
• depressed breathing. This is the most significant
risk induced by opioids and is most likely to occur in
elderly or debilitated patients. As a consequence, in
predisposed patients opioids can cause severe drops in
blood pressure. Apart from this oxycodone can cause
constricted pupils, bronchial spasms and spasms in
smooth muscles and suppress the cough reflex.
• agitation, emotional lability, euphoric mood,
hallucinations
• anaphylactic responses.
Other possible side effects
Very common (may affect more than 1 in 10 people)
• sedation (tiredness to drowsiness), dizziness, headache
• constipation, feeling or being sick
• itching.
Common (may affect up to 1 in 10 people)
• loss of appetite
• anxiety, confusional state, depression
• sleeplessness, nervousness, abnormal thinking
• trembling (tremor)
• depressed breathing (dyspnoea)
• dry mouth
• bellyache, diarrhoea, upset stomach (dyspepsia)
• skin disorders such as rash
• sweating including abnormally increased sweating
• powerlessness.
Uncommon (may affect up to 1 in 100 people)
• hypersensitivity
• lack of water in the body (dehydration)
• disturbances of sexual function (reduced sexual desire
and erectile dysfunction)
• drug dependence with withdrawal symptoms like
palpitations
• loss of memory (amnesia), convulsion
• increased muscle tone, involuntary muscle contractions
• reduced sense of touch (hypaesthesia)
• speech disorders
• fainting, paraesthesia, change in taste
• visual impairment, constriction of the pupil
• vertigo
• widening of the blood vessels (vasodilatation)
• respiratory depression
• dysphagia, flatulence, burping, obstruction in the
gut (ileus)
• increased hepatic enzymes
• dry skin
• urinary disorders (urinary retention)
• chills, general discomfort, thirst
• drug tolerance
• swelling of any organ or tissue due to accumulation of
excess fluid (oedema).
Rare (may affect up to 1 in 1,000 people)
• hypotension, orthostatic hypotension
• urticaria.
Frequency not known (cannot be estimated from the
available data)
• aggression
• hyperalgesia
• dental caries
• cholestasis, biliary colic
• absence of menstrual bleeding (amenorrhoea).
Tolerance and dependence may develop with chronic
use and a withdrawal syndrome may occur upon
abrupt cessation of therapy. The withdrawal syndrome
is characterised by some or all of the following:
restlessness, increased production of tears, runny
nose, yawning, sweating, chills, muscle pain, abnormal
dilatation of the pupil and sensation of irregular and
forceful heartbeat. Other symptoms may also develop,
including: irritability, anxiety, backache, joint pain,
weakness, belly cramps, sleeplessness, feeling sick, lack
of appetite, vomiting, diarrhoea, or increased blood
pressure, breathing rate or heart rate.
Counteractive measures
If you observe any of the above listed side effects your
doctor usually will take appropriate measures. The side
effect constipation may be prevented by fibre enriched
diet and increased drinking. If you are suffering from
sickness or vomiting your doctor will prescribe you an
appropriate medicine.

Reporting of side effects

If you get any side effects, talk to your doctor
or pharmacist. This includes any possible side
effects not listed in this leaflet. You can also report
side effects directly via Yellow Card Scheme at
www.mhra.gov.uk/yellowcard. By reporting side effects
you can help provide more information on the safety of
this medicine.

5. How to store Leveraxo

Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is
stated on the blister or label, and the carton after “EXP”.
The expiry date refers to the last day of that month.
This medicinal product does not require any special
storage conditions.
Do not throw away any medicines via wastewater or
household waste. Ask your pharmacist how to throw
away medicines you no longer use. These measures will
help protect the environment.

• Leveraxo 10 mg prolonged-release tablets: Each
prolonged-release tablet contains 10 mg oxycodone
hydrochloride as active substance, equivalent to 9 mg
oxycodone.
Other ingredients are the tablet core consisting of
sugar spheres (sucrose, maize starch), hypromellose,
talc, ethyl cellulose, hydroxypropylcellulose, propylene
glycol, carmellose sodium, cellulose microcrystalline,
magnesium stearate (Ph. Eur.), silica colloidal
anhydrous and the tablet coating consisting of
polyvinyl alcohol, titanium dioxide (E171), macrogol
3350, iron oxide red (E172), talc.
• Leveraxo 20 mg prolonged-release tablets: Each
prolonged-release tablet contains 20 mg oxycodone
hydrochloride as active substance, equivalent to
17.9 mg oxycodone.
Other ingredients are the tablet core consisting of
sugar spheres (sucrose, maize starch), hypromellose,
talc, ethyl cellulose, hydroxypropylcellulose, propylene
glycol, carmellose sodium, cellulose microcrystalline,
magnesium stearate (Ph. Eur.), silica colloidal
anhydrous and the tablet coating consisting of
polyvinyl alcohol, titanium dioxide (E171), macrogol
3350, talc.
• Leveraxo 30 mg prolonged-release tablets: Each
prolonged-release tablet contains 30 mg oxycodone
hydrochloride as active substance, equivalent to
26.9 mg oxycodone.
Other ingredients are the tablet core consisting of
sugar spheres (sucrose, maize starch), hypromellose,
talc, ethyl cellulose, hydroxypropylcellulose, propylene
glycol, carmellose sodium, cellulose microcrystalline,
magnesium stearate (Ph. Eur.), silica colloidal
anhydrous and the tablet coating consisting of
polyvinyl alcohol, titanium dioxide (E171), iron oxide
yellow (E172), macrogol 3350, talc.
• Leveraxo 40 mg prolonged-release tablets: Each
prolonged-release tablet contains 40 mg oxycodone
hydrochloride as active substance, equivalent to
36 mg oxycodone.
Other ingredients are the tablet core consisting of
sugar spheres (sucrose, maize starch), hypromellose,
talc, ethyl cellulose, hydroxypropylcellulose, propylene
glycol, carmellose sodium, cellulose microcrystalline,
magnesium stearate (Ph. Eur.), silica colloidal
anhydrous and the tablet coating consisting of
polyvinyl alcohol, titanium dioxide (E171), iron oxide
red (E172), macrogol 3350, talc.
• Leveraxo 60 mg prolonged-release tablets: Each
prolonged-release tablet contains 60 mg oxycodone
hydrochloride as active substance, equivalent to
53.8 mg oxycodone.
Other ingredients are the tablet core consisting of
sugar spheres (sucrose, maize starch), hypromellose,
talc, ethyl cellulose, hydroxypropylcellulose, propylene
glycol, carmellose sodium, cellulose microcrystalline,
magnesium stearate (Ph. Eur.), silica colloidal
anhydrous and the tablet coating consisting of
polyvinyl alcohol, macrogol 3350, iron oxide yellow
(E172), talc.
• Leveraxo 80 mg prolonged-release tablets: Each
prolonged-release tablet contains 80 mg oxycodone
hydrochloride as active substance, equivalent to
72 mg oxycodone.
Other ingredients are the tablet core consisting of
sugar spheres (sucrose, maize starch), hypromellose,
talc, ethyl cellulose, hydroxypropylcellulose, propylene
glycol, carmellose sodium, cellulose microcrystalline,
magnesium stearate (Ph. Eur.), silica colloidal
anhydrous and the tablet coating consisting of
polyvinyl alcohol, iron oxide red (E172), macrogol
3350, talc.

What Leveraxo looks like and contents of the pack

Leveraxo 5 mg prolonged-release tablets
White to off-white, round, biconvex, film-coated tablets.
The height of the tablet is between 3.3 and 4.3 mm, the
diameter is 5.2 mm.
Leveraxo 10 mg prolonged-release tablets
Pink, oblong, biconvex, film-coated tablets with break
scores on both sides. The height of the tablet is between
4 and 5 mm, the width is 4.8 mm and the length
is 10.3 mm.
The tablet can be divided into equal doses.
Leveraxo 20 mg prolonged-release tablets
White to off-white, oblong, biconvex, film-coated
tablets with break scores on both sides. The height
of the tablet is between 3.3 and 4.3 mm, the width is
4.8 mm and the length is 10.3 mm.
The tablet can be divided into equal doses.
Leveraxo 30 mg prolonged-release tablets
Yellow, oblong, biconvex, film-coated tablets with break
scores on both sides. The height of the tablet is between
3.8 and 4.8 mm, the width is 5.3 mm and the length
is 11.3 mm.
The tablet can be divided into equal doses.
Leveraxo 40 mg prolonged-release tablets
Pink, oblong, biconvex, film-coated tablets with break
scores on both sides. The height of the tablet is between
4.8 and 5.8 mm, the width is 5.8 mm and the length
is 12.4 mm.
The tablet can be divided into equal doses.
Leveraxo 60 mg prolonged-release tablets
Dark yellow, oblong, biconvex, film-coated tablets with
break scores on both sides. The height of the tablet
is between 5 and 6 mm, the width is 6.8 mm and the
length is 14.5 mm.
The tablet can be divided into equal doses.
Leveraxo 80 mg prolonged-release tablets
Red, oblong, biconvex, film-coated tablets with break
scores on both sides. The height of the tablet is between
5.8 and 6.8 mm, the width is 7.4 mm and the length
is 15.5 mm.
The tablet can be divided into equal doses.
Pack sizes:
10x1, 14x1, 20x1, 28x1, 30x1, 50x1, 56x1, 60x1, 98x1,
100x1 prolonged-release tablets in child resistant, white
opaque perforated unit dose blister.
10, 20, 30, 50, 100 prolonged-release tablets in bottles
with child-resistant closure.
Not all pack sizes may be marketed.

Marketing Authorisation Holder

Mylan, Potters Bar, Hertfordshire, EN6 1TL,
United Kingdom

Manufacturer

Develco Pharma GmbH, Grienmatt 27,
79650 Schopfheim, Germany
This leaflet was last revised in 05/2016.

6. Contents of the pack and other
information
What Leveraxo contains

The active substance is oxycodone hydrochloride.
• Leveraxo 5 mg prolonged-release tablets: Each
prolonged-release tablet contains 5 mg oxycodone
hydrochloride as active substance, equivalent to
4.5 mg oxycodone.
Other ingredients are the tablet core consisting of
sugar spheres (sucrose, maize starch), hypromellose,
talc, ethyl cellulose, hydroxypropylcellulose, propylene
glycol, carmellose sodium, cellulose microcrystalline,
magnesium stearate (Ph. Eur.), silica colloidal
anhydrous and the tablet coating consisting of
polyvinyl alcohol, titanium dioxide (E171), macrogol
3350, talc.

Oxycodone Hydrochloride 80 mg,40 mg,60 mg,

Description 5 mg,30 mg,10 mg,20 mg 56,28
Component Type Leaflet
Affiliate Item Code 792436
Superceded Affiliate Item Code N/A
TrackWise PR No. 792436
MA No. N/A
Packing Site/Printer N/A
Supplier Code N/A

Pharma Code 1217
SAP No. N/A
Vendor Job No. 272700
Trackwise Proof No. 4
Glams Proof No. N/A
Client Market United Kingdom
Keyline/Drawing No. N/A
Barcode Info N/A

792436

Date: 19 May 2016
No. of colours
Colours

1

Time: 11:12
Page Count

2/2

Black

Non-Print
Colours
Equate CMYK
with
Main Font Myriad Pro
Dimensions 165 x 500 mm

Body Text Size 9 pt
Min Text Size used 9 pt

Sign-offs

v1/May 2015

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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