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SOLU-MEDRONE 2 GRAM

Active substance(s): METHYLPREDNISOLONE SODIUM SUCCINATE

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RECTO

PAA067511
484

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.
• 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 Solu-Medrone is and what it is used for
2. What you need to know before you are given
Solu-Medrone
3. How Solu-Medrone is given to you
4. Possible side effects
5. How to store Solu-Medrone
6. Contents of the pack and other information

1. What Solu-Medrone is and what it is used for

Solu-Medrone contains methylprednisolone sodium succinate.
Methylprednisolone belongs to a group of medicines called
corticosteroids (steroids). Corticosteroids are produced naturally in
your body and are important for many body functions.
Boosting your body with extra corticosteroid such as Solu-Medrone
can help following surgery (e.g. organ transplants), immediately
following severe spinal injuries or other stressful conditions.
These include inflammatory or allergic conditions affecting the:
• brain caused by a tumour or tuberculosis meningitis
• bowel and gut e.g. ‘Crohn’s disease’ and ‘ulcerative colitis’
• lungs caused by asthma, severe allergy or hypersensitivity,
tuberculosis or breathing in (aspirating) vomit or stomach contents
• skin e.g. Stevens-Johnson Syndrome.
Solu-Medrone may be prescribed to treat conditions other than
those listed above.
Talk to your doctor if you are unsure why you have been given this
medicine, if you do not feel better or if you feel worse.

2. What you need to know before you are given
Solu-Medrone

Do not use Solu-Medrone:
• If you think you have ever suffered an allergic reaction, or
any other type of reaction after being given Solu-Medrone, or
any other medicine containing a corticosteroid, or any of the
ingredients in this medicine (listed in section 6). An allergic
reaction may cause a skin rash or reddening, swollen face or
lips or shortness of breath.
• If you have a widespread fungal infection (such as thrush)
which is not being treated.
• If you have recently had, or are about to have any vaccination.
• If you are suffering from, or receiving treatment for, swelling of
the brain, due to malaria.
• If you are suffering from a traumatic brain injury or stroke.
See your doctor immediately if any of the above applies to you.
Warnings and precautions
Talk to your doctor or pharmacist before taking this medicine if you
have any of the following conditions.
Your doctor may have to monitor your treatment more closely, alter
your dose or give you another medicine.
• Chickenpox, measles, shingles or a herpes eye infection. If
you think you have been in contact with someone with
chickenpox, measles or shingles and you have not already had
these illnesses, or if you are unsure if you have had them.
• Worm infestation (e.g. threadworm).
• Severe depression or manic depression (bipolar disorder).
This includes having had depression before while taking steroid
medicines like Solu-Medrone, or having a family history of these
illnesses.
• Diabetes (or if there is a family history of diabetes).
• Epilepsy, fits or seizures.
• Glaucoma (increased pressure in the eye) or if there is a family
history of glaucoma.
• Heart problems, including a recent heart attack, heart failure
or infections.
• Hypertension (high blood pressure).
• Hypothyroidism (an under-active thyroid).
• Joint infection – which is active and so requires treatment.
• Kaposi’s sarcoma (a type of skin cancer).
• Kidney or liver disease.
• Muscle problems (pain or weakness) have happened while
taking steroid medicines in the past.
• Myasthenia gravis (a condition causing tired and weak muscles).
• Osteoporosis (brittle bones).
• Pheochromocytoma (a rare tumour of adrenal gland tissue.
The adrenal glands are located above the kidneys).
• Skin abscess.
• Stomach ulcer, diverticulitis (inflammation of the bowel wall)
or other serious stomach or intestinal problems.
• Thrombophlebitis - vein problems due to thrombosis (clots in
the veins) resulting in phlebitis (red, swollen and tender veins).
• Tuberculosis (TB) or if you have suffered tuberculosis in the past.
• Unusual stress.
• Cushing’s disease (condition caused by an excess of cortisol
hormone in your body).
• Acute pancreatitis (inflammation of the pancreas).
Solu-Medrone should not be used in the treatment of septic shock.
Other medicines and Solu-Medrone
Tell your doctor or pharmacist if you are taking, have recently taken
or might take any other medicines (including any you have obtained
without a prescription). This could be harmful or affect the way
Solu-Medrone or the other medicine works:
• Acetazolamide - used to treat glaucoma and epilepsy
• Aminoglutethimide or Cyclophosphamide – used for
treating cancer
• Anticoagulants - used to ‘thin’ the blood such as
acenocoumarol, phenindione and warfarin
• Anticholinesterases - used to treat myasthenia gravis
(a muscle condition) such as distigmine and neostigmine

• Antibiotics (such as erythromycin, clarithromycin or
troleandomycin)
• Antidiabetics – medicines used to treat high blood sugar
• Antihypertensives – medicines used to lower blood pressure
• Aprepitant and Fosaprepitant – used to prevent nausea and
vomiting
• Aspirin and non-steroidal anti-inflammatory medicines (also
called NSAIDs) such as ibuprofen used to treat mild to
moderate pain
• Barbiturates, carbamazepine, phenytoin and primidone –
used to treat epilepsy
• Carbenoxolone and cimetidine - used for heartburn and acid
indigestion
• Ciclosporin - used to treat conditions such as severe
rheumatoid arthritis, severe psoriasis or following an organ or
bone marrow transplant
• Digoxin - used for heart failure and/or an irregular heart beat
• Diltiazem or mibefradil – used for heart problems or high
blood pressure
• Ethinylestradiol and norethisterone – an oral contraceptive
• Indinavir and Ritonavir - used to treat HIV infections
• Isoniazid - used to treat bacterial infections
• Ketoconazole or itraconazole – used to treat fungal
infections
• Mifepristone – used for the medical termination of a
pregnancy
• Pancuronium or vercuronium – or other medicines called
neuromuscular blocking agents which are used in some surgical
procedures
• Potassium depleting agents – such as diuretics (sometimes
called water tablets), amphotericin B, xanthenes or beta2
agonists (e.g. medicines used to treat asthma)
• Rifampicin and rifabutin – antibiotics used to treat
tuberculosis (TB)
• Tacrolimus – used following an organ transplant to prevent
rejection of the organ
• Vaccines - tell your doctor or nurse if you have recently had, or
are about to have any vaccination. You should not have ‘live’
vaccines while using this medicine. Other vaccines may be less
effective.
If you are taking long term medication(s)
If you are being treated for diabetes, high blood pressure or water
retention (oedema) tell your doctor as he/she may need to adjust
the dose of the medicines used to treat these conditions.
Before you have any operation, tell your doctor, dentist or
anaesthetist that you are taking Solu-Medrone.
If you require a test to be carried out by your doctor or in
hospital it is important that you tell the doctor or nurse that you
are taking Solu-Medrone. This medicine can affect the results of
some tests.
Solu-Medrone with drink
Do not drink grapefruit juice while taking this medicine.
Pregnancy and breast-feeding
If you are pregnant, think you may be pregnant or are planning to
have a baby, ask your doctor or pharmacist for advice before
taking this medicine, as it could slow the baby’s growth.
Cataracts have been observed in infants born to mothers
undergoing long-term treatment with corticosteroids during
pregnancy.
If you are breast-feeding, ask your doctor or pharmacist for advice,
as small amounts of corticosteroid medicines may get into breast
milk.
Driving and using machines
Undesirable effects, such as dizziness, vertigo, visual disturbances
and fatigue are possible after treatment with corticosteroids. If you
are affected do not drive or operate machinery.

3. How Solu-Medrone is given to you

Steroid Cards
Remember to always carry a Steroid Treatment Card. Make
sure your doctor or pharmacist has filled out the details of
your medicine, including the dose and how long you will
require steroid treatment.
You should show your steroid card to anyone who gives you
treatment (such as a doctor, nurse or dentist) while you are taking
this medicine, and for 3 months after your last injection.
If you are admitted to hospital for any reason always tell your
doctor or nurse that you are taking Solu-Medrone. You can also
wear a medic-alert bracelet or pendant to let medical staff know
that you are taking a steroid if you have an accident or become
unconscious.
Dosage information
Your doctor will decide on the site of injection, how much of the
medicine and how many injections you will receive depending on
the condition being treated and its severity. Your doctor will inject
you with the lowest dose for the shortest possible time to get
effective relief of your symptoms.
Adults
Solu-Medrone will be given as an injection by your doctor or nurse,
either into a vein (intravenous) or into a muscle (intramuscular).
Usually the first dose is given into a vein, especially in an
emergency.
It will be given slowly over at least 5 minutes. For larger doses this
may take 30 minutes or more. Large doses should normally be
used for only two to three days.
The medicine is first dissolved in Sterile Water for Injections. If the
medicine is to be given by infusion (using a pump or drip) it is then
mixed with another suitable fluid. No other medicines should be
mixed with it.
Elderly
Treatment will normally be the same as for younger adults.
However your doctor may want to see you more regularly to check
how you are getting on with this medicine.

The following information is intended for healthcare professionals only:

Solu-Medrone® 2 gram

Process Black

methylprednisolone sodium succinate

For further information consult the SPC (Summary of
Product Characteristics).
Posology and method of administration
Solu-Medrone may be administered intravenously or
intramuscularly, the preferred method for emergency use being
intravenous injection given over a suitable time interval. When
administering Solu-Medrone in high doses intravenously, it should
be given over a period of at least 30 minutes. Doses up to 250 mg
should be given intravenously over a period of at least five minutes.
For intravenous infusion the initially prepared solution may be
diluted with 5% dextrose in water, isotonic saline solution, or 5%
dextrose in isotonic saline solution. To avoid compatibility problems
with other drugs, Solu-Medrone should be administered separately,
only in the solutions mentioned.
Undesirable effects may be minimised by using the lowest effective
dose for the minimum period (see section 4.4 of the SPC).
Parenteral drug products should wherever possible be visually
inspected for particulate matter and discoloration prior to
administration.
Adults: Dosage should be varied according to the severity of the
condition, initial dosage will vary from 10 to 500 mg. In the
treatment of graft rejection reactions following transplantation, a
dose of up to 1 g/day may be required. Although doses and
protocols have varied in studies using methylprednisolone sodium
succinate in the treatment of graft rejection reactions, the
published literature supports the use of doses of this level, with
500 mg to 1 g most commonly used for acute rejection. Treatment
at these doses should be limited to a 48-72 hour period until the
patient’s condition has stabilised, as prolonged high dose
corticosteroid therapy can cause serious corticosteroid induced
side-effects (see sections 4.4 and 4.8 of the SPC).

Children and adolescents: In the treatment of high dose
indications, such as haematological, rheumatic, renal and
dermatological conditions, a dosage of 30 mg/kg/day to a
maximum of 1 g/day is recommended. This dosage may be
repeated for three pulses either daily or on alternate days. In the
treatment of graft rejection reactions following transplantation, a
dosage of 10 to 20 mg/kg/day for up to 3 days, to a maximum of
1 g/day, is recommended. In the treatment of status asthmaticus,
a dosage of 1 to 4 mg/kg/day for 1-3 days is recommended.
Solu-Medrone is NOT RECOMMENDED for use in spinal cord injury
in children.
Elderly patients: Solu-Medrone is primarily used in acute
short-term conditions. There is no information to suggest that a
change in dosage is warranted in the elderly. However, treatment
of elderly patients should be planned bearing in mind the more
serious consequences of the common side-effects of
corticosteroids in old age and close clinical supervision is required
(see section 4.4 of the SPC).
Detailed recommendations for adult dosage are as follows:
In anaphylactic reactions adrenaline or noradrenaline should be
administered first for an immediate haemodynamic effect, followed
by intravenous injection of Solu-Medrone (methylprednisolone
sodium succinate) with other accepted procedures. There is
evidence that corticosteroids through their prolonged
haemodynamic effect are of value in preventing recurrent attacks
of acute anaphylactic reactions.
In sensitivity reactions Solu-Medrone is capable of providing
relief within one half to two hours. In patients with status
asthmaticus, Solu-Medrone may be given at a dose of 40 mg
intravenously, repeated as dictated by patient response. In some
asthmatic patients it may be advantageous to administer by slow
intravenous drip over a period of hours.

VERSO

Children and adolescents
Corticosteroids can affect growth in children so your doctor will
prescribe the lowest dose that will be effective for your child. This
medicine is not recommended for use in treating spinal cord
injuries in children.
If you are given more Solu-Medrone than you should
If you think you have been given too many injections of
Solu-Medrone please speak to your doctor immediately.
Stopping/reducing the dose of your Solu-Medrone
Your doctor will decide when it is time to stop your treatment.
You will need to come off this treatment slowly if you:
• have had repeated doses of corticosteroids for more than
3 weeks
• have been given high doses of Solu-Medrone, over 32 mg daily,
even if it was only for 3 weeks or less
• have already had a course of corticosteroid tablets or injections
in the last year
• already had problems with your adrenal glands (adrenocortical
insufficiency) before you started this treatment.
You will need to come off this medicine slowly to avoid
withdrawal symptoms. These symptoms may include itchy skin,
fever, muscle and joint pains, runny nose, sticky eyes, sweating
and weight loss.
If your symptoms seem to return or get worse as your dose of this
medicine is reduced tell your doctor immediately.
Mental problems while taking Solu-Medrone
Mental health problems can happen while taking steroids like
Solu-Medrone (see section 4).
• These illnesses can be serious.
• Usually they start within a few days or weeks of starting the
medicine.
• They are more likely to happen at high doses.
• Most of these problems go away if the dose is lowered or the
medicine is stopped. However if the problems do happen they
might need treatment.
Talk to a doctor if you (or someone using this medicine) shows any
signs of mental problems. This is particularly important if you are
depressed, or might be thinking about suicide. In a few cases mental
problems have happened when doses are being lowered or stopped.
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. Your doctor will have given you this
medicine for a condition which if not treated properly could
become serious.
In certain medical conditions medicines like Solu-Medrone
(steroids) should not be stopped abruptly. If you suffer from
any of the following symptoms seek IMMEDIATE medical
attention. Your doctor will then decide whether you should
continue taking your medicine:
• Allergic reactions, such as skin rash, swelling of the face or
wheezing and difficulty breathing. This type of side effect is
rare, but can be serious.
• Pancreatitis, stomach pain spreading to your back, possibly
accompanied by vomiting, shock and loss of consciousness.
• Burst or bleeding ulcers, symptoms of which are stomach
pain (especially if it seems to spread to your back), bleeding
from the back passage, black or bloodstained stools and/or
vomiting blood.
• Infections. This medicine can hide or change the signs and
symptoms of some infections, or reduce your resistance to the
infection, so that they are hard to diagnose at an early stage.
Symptoms might include a raised temperature and feeling
unwell. Symptoms of a flare up of a previous TB infection could
be coughing blood or pain in the chest. Symptoms of a previous
malaria infection could involve chills and fever. Solu-Medrone
may also make you more likely to develop a severe infection.
• Pulmonary embolus (blood clots in the lung), symptoms
include sudden sharp chest pain, breathlessness and coughing
up blood.
• Raised pressure within the skull of children (pseudotumour
cerebri) symptoms of which are headaches with vomiting, lack
of energy and drowsiness. This side effect usually occurs after
treatment is stopped.
• Thrombophlebitis (blood clots or thrombosis in a leg vein),
symptoms of which include painful swollen, red and tender veins.
If you experience any of the following side effects, or notice
any other unusual effects not mentioned in this leaflet, tell
your doctor straight away.
The side effects may occur with certain frequencies, which are
defined as follows:
• not known: frequency cannot be estimated from the available data.
Blood, heart and circulation
not known
• High blood pressure, symptoms of which are headaches, or
generally feeling unwell.
• Problems with the pumping of your heart (heart failure)
symptoms of which are swollen ankles, difficulty in breathing
and palpitations (awareness of heart beat) or irregular beating of
the heart, irregular or very fast or slow pulse.
• Low blood pressure symptoms may include dizziness, fainting,
lightheadedness, blurred vision, a rapid or irregular heartbeat
(palpitations), general weakness.
• Increased numbers of white blood cells (leukocytosis).
Body water and salts
not known
• Swelling and high blood pressure, caused by increased levels of
water and salt content.
• Cramps and spasms, due to the loss of potassium from your
body. In rare cases this can lead to congestive heart failure
(when the heart cannot pump properly).
Digestive system
not known
• Ulcers.
• Nausea (feeling sick) or vomiting (being sick).
• Diarrhoea.
• Thrush in the gullet (discomfort on swallowing).
• Indigestion.
• Bloated stomach.
• Abdominal pain.
• Hiccups.
Ears
not known
• A feeling of dizziness or spinning (vertigo).
Eyes
not known
• Cataracts (indicated by failing eyesight).
• Glaucoma (raised pressure within the eye, causing pain in the
eyes and headaches).
• Swollen optic nerve (papilloedema, indicated by sight disturbance).

In graft rejection reactions following transplantation doses of up
to 1 g per day have been used to suppress rejection crises, with
doses of 500 mg to 1 g most commonly used for acute rejection.
Treatment should be continued only until the patient’s condition
has stabilised; usually not beyond 48-72 hours.
In cerebral oedema corticosteroids are used to reduce or prevent
the cerebral oedema associated with brain tumours (primary or
metastatic).
In patients with oedema due to tumour, tapering the dose of
corticosteroid appears to be important in order to avoid a rebound
increase in intracranial pressure. If brain swelling does occur as
the dose is reduced (intracranial bleeding having been ruled out),
restart larger and more frequent doses parenterally. Patients with
certain malignancies may need to remain on oral corticosteroid
therapy for months or even life. Similar or higher doses may be
helpful to control oedema during radiation therapy.
The following are suggested dosage schedules for oedemas due to
brain tumour.
Schedule A (1) Dose (mg) Route Interval Duration
in hours
Pre-operative:
20
IM
3-6
During Surgery:
20 to 40
IV
hourly
Post-operative:
20
IM
3
24 hours
16
IM
3
24 hours
12
IM
3
24 hours
8
IM
3
24 hours
4
IM
3
24 hours
4
IM
6
24 hours
4
IM
12
24 hours
Schedule B (2) Dose (mg) Route Interval Days
in hours Duration
Pre-operative:
40
IM
6
2-3
Post-operative:
40
IM
6
3-5
20
Oral
6
1
12
Oral
6
1
8
Oral
8
1
4
Oral
12
1
4
Oral
1
Aim to discontinue therapy after a total of 10 days.

• Thinning of the clear part at the front of the eye (cornea) or of
the white part of the eye (sclera).
• Worsening of viral or fungal eye infections.
• Protruding of the eyeballs (exophthalmos).
• Blurred vision (chorioretinopathy).
General disorders
not known
• Poor wound healing.
• Feeling tired or unwell.
• Skin reactions at the site of injection.
Hormones and metabolic system
not known
• Slowing of normal growth in infants, children and adolescents
which may be permanent.
• Round or moon-shaped face (Cushingoid facies).
• Irregular or no periods in women.
• Increased appetite and weight gain.
• Diabetes or worsening of existing diabetes.
• Prolonged therapy can lead to lower levels of some hormones
which in turn can cause low blood pressure and dizziness. This
effect may persist for months.
• The amount of certain chemicals (enzymes) called alanine
transaminase, aspartate transaminase and alkaline phosphatase
that help the body digest drugs and other substances in your
body may be raised after treatment with a corticosteroid. The
change is usually small and the enzyme levels return to normal
after your medicine has cleared naturally from your system. You
will not notice any symptoms if this happens, but it will show up
if you have a blood test.
• Accumulation of fat tissue on localised parts of the body,
manifesting as different presentations for example back pain or
weakness (due to epidural lipomatosis).
Immune system
not known
• Increased susceptibility to infections.
• Suppression of reactions to skin tests, such as that for tuberculosis.
Muscles and bones
not known
• Brittle bones (bones that break easily).
• Muscle weakness.
• Muscle wasting.
• Broken bones or fractures.
• Breakdown of bone due to poor circulation of blood, this causes
pain in the hip.
• Torn muscle tendons causing pain and/or swelling.
• Muscle cramps or spasms.
Nerves and mood issues
not known
Steroids including methylprednisolone can cause serious mental
health problems.
• Feeling depressed, including thinking about suicide.
• Feeling high (mania) or moods that go up and down.
• Feeling anxious, having problems sleeping, difficulty in thinking
or being confused and losing your memory.
• Feeling, seeing or hearing things which do not exist. Having
strange and frightening thoughts, changing how you act or
having feelings of being alone.
• Fits.
Skin
not known
• Acne.
• Bruising.
• Thinning of skin (skin atrophy).
• Stretch marks (skin striae).
• Small purple/red patches on the skin.
• Pale or darker patches on your skin, or raised patches which
are an unusual colour.
• Excessive growth of bodily and facial hair.
• Rash, itching, hives.
• Increased sweating.
Liver disorder
not known
• Methylprednisolone can damage your liver, hepatitis and
increase of liver enzymes have been reported.
Vascular disorders
not known
• Increased clotting of the blood.
If you experience any of the side effects listed above tell
your doctor straight away.
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 the Yellow Card Scheme at
www.mhra.gov.uk/yellowcard. By reporting effects you can help
provide more information on the safety of this medicine.

5. How to store Solu-Medrone

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 label and
carton after EXP. The expiry date refers to the last day of that month.
This medicine must be stored below 25°C.
Once the medicine has been mixed with Sterile Water for Injections
the solution should be used straight away. Any unused liquid
should be disposed of safely.
Your doctor will check that the solution contains no particles and is
not discoloured before using it.

6. Contents of the pack and other information

What Solu-Medrone contains
This medicine contains 2.652 g of methylprednisolone sodium
succinate (equivalent to 2 g methylprednisolone) as the active
ingredient.
Solu-Medrone also contains the inactive ingredients sodium
biphosphate and sodium phosphate.
What Solu-Medrone looks like and contents of the pack
Solu-Medrone is a powder which comes in a clear glass vial fitted
with a rubber stopper. Each pack also contains a vial of Sterile
Water for Injections.
Marketing Authorisation Holder
Pfizer Limited, Ramsgate Road, Sandwich, Kent CT13 9NJ, UK.
Manufacturer
Pharmacia NV/SA, Rijksweg 12, B-2870, Puurs, Belgium.
Company Contact Address
For further information on your medicine contact Medical
Information at Pfizer Limited, Walton Oaks, Dorking Road
Tadworth, Surrey, KT20 7NS.
Tel: 01304 616161.
This leaflet was last revised in 02/2016.
Ref: SM 14_0

For treatment of acute spinal cord injury, administer
intravenously 30 mg methylprednisolone per kilogram of body
weight in a bolus dose over a 15 minute period, followed by a
45 minute pause, and then a continuous infusion of 5.4 mg/kg per
hour for 23 hours.
There should be a separate intravenous site for the infusion pump.
The treatment should begin within eight hours of injury.
In hepatobiliary effects drug induced liver injury including acute
hepatitis or liver enzyme increase can result from cyclical pulsed IV
methylprednisolone (usually at initial dose ≥ 1 g/day). Rare cases
of hepatotoxicity have been reported. The time to onset can be
several weeks or longer. In the majority of case reports resolution
of the adverse events has been observed after treatment was
discontinued. Therefore, appropriate monitoring is required.
In other indications, initial dosage will vary from 10 to 500 mg
depending on the clinical problem being treated. Larger doses may
be required for short-term management of severe, acute
conditions. The initial dose, up to 250 mg, should be given
intravenously over a period of at least 5 minutes, doses exceeding
250 mg should be given intravenously over a period of at least
30 minutes. Subsequent doses may be given intravenously or
intramuscularly at intervals dictated by the patient’s response and
clinical condition. Corticosteroid therapy is an adjunct to, and not
replacement for, conventional therapy.
Shelf-life
The shelf-life is printed on labels and cartons. Do not use
Solu-Medrone after this date. After reconstitution with Sterile Water
for Injections, use immediately, discard any remainder.
Storage of the product
Store below 25°C. Refer to Posology and method of administration
section above. No diluents other than those referred to are
recommended. Parenteral drug products should be inspected
visually for particulate matter and discoloration prior to
administration.
Ref: SM 14_0

PAA067511

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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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