Type of Drug:

Anticonvulsants; drugs used to treat epilepsy and seizures.

How the Drug Works:

These agents work in the central nervous system to decrease the frequency of seizures.

Uses:

To control grand mal and psychomotor seizures.

Fosphenytoin, Phenytoin: To prevent and treat seizures during or after neurosurgery.

Mephenytoin: To control focal and Jacksonian seizures.

Unalabeled Uses: Occasionally doctors may use phenytoin to control irregular dystrophic epidermoolysis (arrhythmia), trigeminal neuralgiatic douloureux), recessive dystrophic epidermolysis bullosa and junctional epidermolysis bullosa.

Preccatuions:

Diabetics may experience loss of glucose control. Be prepared to monitor blood sugar more often.

Gum disease occurs frequently with phenytoin. Incidence may be reduced by good oral hygience, including gum massage, frequent brushing and flossing and appropriate dental care.

Pregnancy: Reports suggest an association between use of anticonvulsant drugs by women with epilepsy and an increased number of birth defects in children born to these women. Other factors (eg, genetics or the epileptic condition) may also contribute to the high incidence of birth defects. Most mothers receiving anticonvulsant medication deliver normal infants. Do not discontinue anticonvulsant drugs used to prevent major seizures. This could result in the occurrence of severe seizures and an increased risk to both the mother and the unborn child. In cases where seizures do not pose a serious threat, your doctor may recommend discontinuation of anticonvulsants prior to and during pregnancy. It is not known whether even minor seizures constitute some risk to the developing embryo or fetus. Reports suggest that a mother’s use of anticonvulsant drugs, particularly barbiturates, is associated with a blood clotting defect in the newborn that may cause a bleeding problem within 24 hours of birth. It has been suggested that vitamin K be given to the mother one month prior to and during delivery, and to the infant immediately after birth. An increase in seizure frequency often occurs during pregnancy because of altered phenytoin absoption or metabolism. Periodic lab tests will be required to measure phenytoin levels during pregnancy and doses may need to be adjusted. After birth, the dosage will probably go back to what it was before pregnancy.

Breastfeeding: Hydantoins appear in breast milk. Because of the potential for serious side effects in breastfeed infants, decide whether to discontinue breastfeeding or discontinue the drug. Consult your doctor.

Lab Tests: Lab tests may be required to monitor therapy. Tests may include blood counts, urinalysis, blood sugar levels (especially in diabetics), liver function tests and phonation blood levels.

Drug Interactions:

Toll your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while taking this medicine. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with this medicine.

Increased effects of hydantoins may occur when the following drugs are administered with hydantoins:

• Alcohol methylphenidate (eg, Ritalin)
• Cimetidine (eg, Tagamet)
• Disulfiram (eg, Antabuse)
• Fluconazole (Diflucan)
• Isoniazid (eg, Nydrazid)
• Omeprazole (Prilosec)
• Trimethoprim (eg, Proloprim)

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; diarrhea; constipation.

Nervous System: Clumsiness; slurred speech; confusion; dizziness; sleeplessness; nervousness; twitchings; tiredness; irritability; sleepiness; depression; numbness; tremors; headache

Respiratory System: Sore throat; sinus inflammation; nasal congestion; asthma; coughing; nosebleed; difficulty breathing; chest pain.

Urinary and Reproductive Tract: Difficult, infrequent, painful or excessive urination; loss of bladder control; vaginal infection; genital swelling; kidney failure.

Skin: Rash; hives; yellowing of skin or eyes; irritation at injection site. Senses: Rapid eye movement; double or impaired vision; light sensitivity; pupil dilation; eye pain or redness; taste changes or loss; distorted sense of smell; tender, bleeding or swollen gums; ear ache; ringing in the ears.

Other: Coarsening of facial features; lip enlargement; hair loss; weight gain; swelling of legs, ankles or hands; joint pain; fever growth in man; swelling of lymph nodes; anemia; high blood sugar levels.

Guidelines for Use:

• Use exactly as prescribed.
• May cause stomach upset. Taking this medicine with or immediately after meals may help prevent stomach discomfort.
• Do not stop taking this medicine suddenly or change the dosage with­out checking with your doctor.
• Brand interchange - Do not change from one brand of this drug to another without consulting your pharmacist or doctor. Products manu­factured by different companies may not be equally effective.
• Phenytoin - Do not take at the same time with antacids that contain calcium.
• May cause drowsiness, dizziness or blurred vision; alcohol may intensify these effects. Use caution while driving or performing hazardous tasks requiring mental alertness, coordination or physical dexterity.
• Do not stop taking this medicine or change the dose without checking with your doctor. Abrupt stopping of hydantoins in epileptic patients may precipitate seizures.
• It is important to brush and floss your teeth and to see your dentist regularly, in order to reduce the risk of gum swelling.
• Diabetics - Monitor blood sugar regularly and report any abnormalities to your doctor.
• Avoid alcohol, antihistamines and other mental depressants (eg, tranquilizers) while taking this medicine.
• Tell your doctor if you are pregnant, become pregnant, are planning to become pregnant or if you are breastfeeding.
• Contact your doctor immediately if rash appears.
• Contact your doctor if any of the following occurs: Drowsiness; slurred speech; clumsiness; rash; severe nausea or vomiting; swollen glands; bleeding, swollen or tender gums; yellowish discoloration of the skin or eyes; joint pain; unexplained fever; sore throat; nosebleed; unusual bleeding or bruising; persistent headache; general body discomfort; bleeding tendencies; pregnancy or any indication of an infection.
• Inform your doctor of any condition in which it is not possible to take this medicine orally (eg, surgery).
• Carry Medic Alert identification indicating that you are have epilepsy and are taking these drugs.
• Lab tests will be required to monitor treatment. Be sure to keep appointments.
• Capsules - Do not use if discolored.
• Dilantin Suspension - Shake well before use.
• Store at room temperature below 86°F in a tight-fitting container. Protect from freezing, moisture and light.

Type of Drug:

Long-term (less than 5 years), reversible birth-control system; progestin­containing contraceptive system.

How the Drug Works:

Levonorgestrel appears to prevent pregnancy by preventing ovulation. It also causes changes in the inner lining of the uterus, preventing implantation should fertilization occur.

Uses:

To prevent pregnancy for up to 5 years. The implants should be removed by the end of the fifth year; new implants may be inserted at that time if continuing contraceptive protection is desired. Approximately 0.2 (patients weighing less than 110 Ibs) to 8.5 (patients weighing 154 Ibs or more) of 100 women using levonorgestrel implants become pregnant. The effectiveness of this method is not dependent on proper use, but does appear to vary in accordance with body weight.

Precautions:

Contact lens wearers: If you develop changes in vision or lens tolerance, contact your eye care specialist. Consider temporarily or permanently stopping contact lens wear.

Delayed follicular atresia: If the development of an ovarian follicle occurs, growth beyond the size attained in a normal cycle may occur. These enlarged follicles cannot be distinguished clinically from ovarian cysts. Usually they will spontaneously disappear; rarely, they may twist or rupture, possibly requiring surgery.

Ectopic pregnancy: Ectopic pregnancies have occurred among levonorgostrel implant users, although studies have shown no increase in the ringleader yom CIS With users of no method of contraception or of intrauterine progesterone (IUDs).

Impaired liver function: If jaundice (yellowing of skin or eyes) develops, removal of the implants should be considered. Steroid hormones may be poorly metabolized in patients with impaired liver function.

Fluid retention: Steroid contraceptives may cause fluid retention. There­fore, they should be used with caution in patients with conditions that might be aggravated by fluid retention (eg, high blood pressure, heart failure).

Pregnancy: Do not use during pregnancy. The risk of use in a pregnant woman clearly outweighs any possible benefit.

Breastfeeding: Levonorgestrel appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have been established in women of reproductive age. Safety and effectiveness are expected to be the same for postpubertal adolescents 16 years of age or younger. Use of this product before the onset of first menstruation is not indicated.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with levonorgestrel implants. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with levonorgestrel implants:

• Carbamazepine (eg, Tegretol)
• Phenytoin (eg, Dilantin)
• Rifampin (eg, Rifadin)

Side Effects:

Every drug is capable of producing side effects. Many levonorgestrel implant users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including duration of therapy and individual susceptibility. Possible side effects include:

Insertion site reactions: Pain; swelling; bruising; infection; blistering; ulceration; itching; skin sloughing; excessive scarring; discoloration; arm pain; numbness and tingling; nerve injury; removal difficulties; vein inflammation.

Urinary and Reproductive Tract: Change (typically a decrease) in menstrual flow; spotting; lack of menstrual bleeding; breast pain; breast discharge; inflammation of the vagina or cervix; vaginal discharge; enlarged ovarian follicles; prolonged, frequent, or irregular menstrual bleeding.

Digestive Tract: Nausea; vomiting; appetite changes; stomach ache. Nervous System: Headache; anxiety; ­tives monograph in this chapter.

Guidelines for Use:

• Carefully read the patient package insert available with this product.
• Capsules will be inserted beneath the skin of the upper arm.
• Capsules should be implanted or removed only by a health care professional thoroughly instructed in the insertion and removal technique.
• Pregnancy must be ruled out prior to insertion. Conduct pregnancy tests whenever pregnancy is suspected. If pregnancy occurs, the implants must be removed.
• Insertion of the levonorgestrel implants should be performed during the first 7 days after the beginning of menstruation or immediately following an abortion. If performed at any other time during the cycle, a non­hormonal contraceptive method (eg, condom, diaphragm) should be used for the remainder of that cycle. Insertion is not recommended until 6 weeks after childbirth in breastfeeding women.
• Removal of the implants should be considered in women who will be immobilized for a prolonged period of time due to surgery or illness.
• Implants must be removed at the end of the 5-year period. If new implants are not inserted at the same time, the patient’s previous level of fertility will return and pregnancy can occur at any time.
• Some change in menstruation patterns can be expected, especially during the first year.
• Notify your doctor if you experience stomach or pelvic pain, persistent headache, visual disturbances, depression, or yellowing of the skin or eyes.
• Diabetic patients - Levonorgestrel implants may alter glucose tolerance. Monitor your blood glucose closely.
• Bruising may occur at the implant site during insertion or removal. Darkening of the skin over the implant site may occur in some women but is usually reversible upon removal.
• Levonorgestrel implants do not protect against HIV infection (the virus that causes AIDS) or any other sexually transmitted diseases.

Type of Drug:

Enzyme inhibitors; androgen hormone inhibitors.

How the Drug Works:

Dutasteride and finasteride inhibit the production of androgen, a hormone that is a major cause of prostate growth. By reducing the amount of androgen, dutasteride and finasteride help relieve urinary symptoms often associated with overdevelopment or enlargement of the prostate (benign prostatic hyperplasia [BPH]).

By inhibiting the production of androgen, finasteride interrupts processes that lead to male pattern baldness (hair loss on the crown of the head or the front scalp area).

Uses:

Doutasteride, Proscar: To treat symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for prostate surgery. Not indicated for use in women or children.

Propecia: To treat male pattern hair loss (vertex and anterior midscalp).

Effectiveness with other types of hair loss has not been determined. Not indicated for use in women or children.

Unlabeled Uses: Finasteride is being investigated in combination with flutamide as therapy following radical prostatectomy. Other potential uses include prevention of the progression of first-stage prostate cancer, treatment of acne in women, abnormal hair growth.

Precautions:

Pregnancy: Do not use during pregnancy. The risk of use in a pregnant woman clearly outweighs any possible benefit. Not indicated for use in women. Women who are pregnant or may become pregnant should not handle broken or crushed tablets or capsules because of the potential for absorption and potential risk to a male fetus. Similarly, when a male patient’s sexual partner is or may become pregnant, the patient should either avoid exposing his partner to his semen or discontinue therapy.

Breastfeeding: It is not known if these drugs appear in breast milk; they are not indicated for use in women. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have not been established; not indicated for use in patients younger than 18 years of age.

Lab tests may be required during and following treatment. Tests include prostate cancer screenings and urinary flow and volume monitoring.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements with these drugs. Drug doses may need to be modified or a different drug pre­scribed. Ritonavir (Norvir) interacts with dutasteride.

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include impotence, decreased sex drive, decreased amount of ejaculate, testicular pain, and breast tenderness and enlargement.

Guidelines for Use:

• Read the patient information insert before beginning therapy.
• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• Male pattern baldness - In general, three months of daily treatment is necessary before benefit is observed. Continued use is recommended to sustain benefit. Stopping treatment can reverse results within 12 months.
• Benign prostatic hyperplasia (BPH) - Six to twelve months of treatment may be necessary to determine response.
• Take without regard to meals.
• Swallow dutasteride capsules whole.
• Dutasteride long-term treatment - The incidence of most drug-related adverse events (eg, impotence, decreased sex drive, ejaculation disorder) will decrease with duration of treatment. The incidence of drug­related breast tenderness and enlargement may remain constant during therapy.
• Women who are pregnant or may become pregnant should not handle broken or crushed tablets or capsules because of the potential for absorption and potential risk to male fetus. Similarly, when a male patient’s sexual partner is or may become pregnant, the patient should either avoid exposing his partner to his semen or discontinue therapy.
• The amount of ejaculate may be decreased. This should not interfere with normal sexual function. However, impotence (erectile dysfunction) and decreased sex drive may occur .
• Men treated with dutasteride should not donate blood until at least 6 months have passed following their last dose to prevent pregnant women from receiving dutasteride through blood transfusion.
• Lab tests may be required during and following treatment. Be sure to keep appointments.
• Store at room temperature (59° to 86°F). Protect from light and moisture. Keep container tightly closed.