Patient Information on Nasonex (Mometasone furoate monohydrate)

 Manufactured by: Merck & Co., Inc.

What is Nasonex utilized for?

Nasonex is used for treating seasonal allergies and flu-like conditions. It is given to following patients;

  • Those who require occasional prophylaxis against unfavorably susceptible rhinitis, which includes the bodily fluid film of nose getting kindled.
  • For treating blockage of the nasal passages which could be the consequence of inflamed and swollen blood vessels of the nose.
  • Those who have developed nasal polyps; growth of small sized benign growths in the inside lining of the nose. These growths do not have cancerous properties.

What is the dosage form and potency (strength) of Nasonex?

You can find Nasonex in the type of a nasal spread holding 50 mcg from claiming mometasone furoate for each 100 microliter spread.

 What should you know about Nasonex?

  • Completely read the prescription aide before taking any pharmaceutical.
  • Before you use it make suure to shake it well.
  • You should discontinue Nasonex on experiencing any kind of allergic reactions e.g. redness, swollen lips, tongue, mouth, wheezing, shortness of breath, rash.
  • Try not to utilize Nasonex on the off chance that you had a nasal surgery, nasal injury or nasal septum ulcers (until mended).Avoid using this drug if you suffer from nose bleeds.
  • While you are using Nasonex, your doctor may need to examine you to make sure the medicine is not harming your nose or sinuses.
  • If you develop any sort of infection in the throat, stop taking Nasonex and get your doctor’s advice.
  • If you are taking Nasonex for more than a week, it is important that you visit your ophthalmologist periodically to make sure you are not developing cataracts.
  • Donot take this drug if you have life-threatening diseases, for example, tuberculosis, viral contaminations.
  • Do not provide this drug to children who are in their growing age.

 How do you take the drug?

  • You should only take the amount told by your doctor. Refrain from taking it in large amounts.
  • Only take Nasonex through nose and not from the mouth.
  • Before using it the first time, shake the bottle and spray two or three mists in the air.
  • Store it at 25°C (77°F).

To use the Nasonex nasal spray:

  • Tilt your head backwards and place the bottle’s nozzle in your nostril while shutting the other nostril with the assistance of your fingers.
  • Gently spray and do not blow your nose for 5-10 minutes to prevent wastage of the drug.

Contra-indications and precautions:

Do not administer this drug if you;

  • Are allergic to the whole drug or any other ingredient present in it.
  • Have nose bleeds, nasal surgery, injured nasal cavity, and ulcerated nasal membranes.
  • Have developed eye related conditions
  • Are currently suffering from pathogenic infections.
  • In children

How does it adversely affect you?

You may experience any of the given effects;

  • respiratory: infectious throat, cough, shortness of breath, flu-like syndrome.
  • eyes and ear: redness in the eyes, infections of the middle ear.
  • muscles: pain in the muscles
  • gastrointestinal system: diarrhea and vomiting.
  • Nose: nose bleeds, nasal fungal infections, burning and irritation of nose.
  • Others: viral infection, painful menstruation, suppressed growth
  • Post-Marketing Experience: nasal burning and irritation, hypersensitive reaction, disturbances in taste and smell.

How can Nasonex interact with the other drugs?

Drug interactions with Nasonex are yet to be conducted. However, CYP3A4 inhibitors (ketoconazole) may affect the metabolism of Nasonex.

Can this drug be used in the specific populations?

  • In pregnancy: this drug belongs to the category It should only be used in pregnant women when truly needed in the absence of other safer alternatives.
  • In Nursing Mothers: corticosteroids get secreted in human milk; therefore, Nasonex should not be used by such women.
  • In pediatrics: you should not give your child Nasonex for sole preventive purposes from flu.
  • In geriatrics: Nasonex can be safely used by elderly.

What is the mode of action of Nasonex?

It is an anti-inflammatory drug i.e. suppresses the immune system of the body. It rectifies the symptoms of rhinitis by depressing various inflammation causing cells, like mast cells and histamine.

What is the pharmacokinetics of this drug? Pharmacokinetics involve all those processes that a drug undergoes after its administration.

Absorption: only small ampunt of this drug gets swallowed

Distribution: about 98% to 99% of this drug binds to the plasma proteins.

Metabolism and Elimination: it gets metabolized by CYP3A4 enzymes of cytochrome system. Mometasone has a half-life of about 5.8 hours and any absorbed portion of the drug gets excreted via the bile.

How do different patient populations affect the Pharmacokinetics of this drug?

  • Levels and effects of Nasonex can increase in hepatic impairment.
  • gender, race, age, and renal impairment effects on this drug are still to be studied.

 What is the toxicology profile of this drug?

  • When it was subjected to non-human testing, Nasonex did not produce tumors or mutations in them.
  • It didn’t create any reproductive insufficiencies in rats subjected to testing of this medication. Nasonex produced difficulties in labor and caused a reduction in the birth weight of the animals treated with this drug.

What should you inform your doctor before using Nasonex?

Before taking Nasonex, a patient should inform his/her doctor about;

  • Infections if any
  • Cataracts
  • Tuberculosis infection
  • If had a nasal surgery, trauma or sores.





Patient Information on Myrbetriq (mirabegron)

Manufactured by: Astellas Pharma Inc.

When is Myrbetriq used? You will need to use Myrbetriq if you develop urinary incontinence due to an enlarged or over functioning bladder which leads to frequent bathroom visits and sometimes leakage of the urine on coughing, sneezing or laughing. It can be used by all genders.

How is it supplied? It is an orally taken dosage form as 25mg and 50 mg tablets. You can easily differentiate the two forms by looking at their colors. 25mg is of brown color whereas 50mg tablet is in the yellow coloring.

What is the drug’s dosing information? Never take Myrbetriq if you are in the end stage renal disease or have a severe liver failure.

How should the tablets be taken? You can ingest these tablets either on an empty stomach or within or after the meal (as suitable). Always swallow the tablet as a whole with a glass of water without chewing or breaking it. Make sure to stick to the regimen for full time as counseled by the doctor as this drug can take up to eight weeks to fully show its anticipated actions. Keep the tablets at the room temperature.

Which things should you be cautioned of about Myrbetriq?

While using this drug you should readily consult a pharmacist or a physician if you develop skin associated reactions (swollen lips, throat, face or tongue), any breathing difficulties, an uncontrollable rise in blood pressure, or inability to pass the urine. You should regularly measure your blood pressure to ensure no ascent in it due to this medicine.

What types of side effects Myrbetriq has? It can have the following noxious and disturbing adverse actions and you may experience one or more than one of these side effects.

High blood pressure, urethral infections, constipation, pain in the muscles particularly back muscles, flu, lightheadedness, bladder inflammation, stomachache, loose watery stools, throat inflammation and infections, rapid heartbeats, tiredness, increased ocular pressure, abnormal liver enzymes functioning, stone formation in the kidneys, skin rash, hives, vaginal infections, angioedema, headache, sinus blockage, heart burn, purple coloring of the skin, and abnormal cell growth.

What kind of medications does it interact with? It can safely be given with rifampicin (anti-TB), tamsulosin (for prostate enlargement), and ketoconazole (anti-fungal), oral contraceptives (birth control pills), solifenacin (incontinence).

The drugs with which it requires alterations include digoxin (start at lowest dosage of digoxin), metoprolol and desipramine (use alternative or closely monitor owing to the fact that mirabegron is a CYP2D6 enzyme inhibitor and these two drugs undergo metabolism via this specific class of isoenzymes), warfarin (may increase the levels of it, thus requires monitoring).

What precautionary measures should be taken with Myrbetriq?

Firstly, you should absolutely never take Myrbetriq in the cases of allergies to one of its components, if your blood pressure is not under control, if have any sort of a blockade in the bladder, if you are using anti-muscarinic drugs (atropine, scopolamine etc.) to prevent failure of urine expulsion and with any other such drugs with which Myrbetriq can interact.

What is the toxicological report of Myrbetriq? Mirabegron has not proven to be carcinogenic or mutagenic at non-lethal doses in the rats and has not affected their reproduction either.

Pups born to the mothers who were given Myrbetriq had enlarged heart and bone deformities. And the baby rats and mice who were subjected to breast milk of such mothers had mirabegron accumulated in their kidneys, lungs, and liver.

What is the pharmacodynamics of this drug?

Pharmacodynamics involves the processes that take place during the drug’s activities. Mirabegron attaches to the beta-3 adrenergic receptors residing in the bladder and on activation, these receptors relaxes the smooth muscles of the bladder and expands its urine holding capacity.

What is the pharmacokinetics of Myrbetriq? Pharmacokinetics involves the processes that undergo after the drug has shown its actions. Mirabegron, about 29-35% gets available in the body, with highest concentrations available after 4 hours. It has 1670L Vd (volume for distribution in the tissues) and undergoes hepatic metabolism. It is a moderate inhibitor of 2D6 isoenzymes of cytochrome enzymatic systems. Has a half-life of 50 hours (stays in the body for a longer time) and gets removed by feces (34%) and urine (55%) from the body.

Can Myrbetriq be used in different patients?

It belongs to C category and should only be used by pregnant or lactating women if truly required in the absence of any other options. Its use is safe for elderly people but is marked harmful for kids. Japanese people have more levels of Myrbetriq in their blood as compared to Americans. In terms of body weight, females have more exposure than their male partners.

What should you inform your doctor about? Before taking Myrbetriq tell your doctor if you have any eye, kidney, liver, heart, bladder diseases. If your blood pressure ranges to 180/120.  If pregnant or feeding.

Which compounds are used in the tablets? It has mirabegron, yellow ferric oxide, and red ferric oxide, polyethylene glycol, hydroxypropyl cellulose, magnesium stearate, hypromellose, butylated hydroxytoluene, polyethylene oxide.










Patient Information on L OTEMAX (loteprednol etabonate)

 Company: Bausch & Lomb Incorporated

Uses of this medicine: After an eye surgery, you require Lotemax to prevent the case of severe inflammatory reaction because during surgery the normal layers of cells get breached which could lead to complications. It is usable in both men and women.

Dosage form: it is an ophthalmic gel containing loteprednol etabonate as an active which is responsible for the pharmacological actions.

Dosing: as prescribed by your ophthalmologist.

Correct usage: before you instill the product into your eyes, make sure your hands are clean and that the bottle is shaken well. Do not touch the tip or end of the bottle to dirty places to prevent the transfer of germs to the eyes. Always remember to take out your contact lenses before using the drug. Place it in a cool place.


Lotemax is contra-indicated in viral infections e.g. varicella, so if you develop any sort of an infection during its use, readily inform your doctor. Do not use Lotemax if you have glaucoma or any other such condition that is raising the pressure in your eyes. Consult medical help if your eyes get very irritating, painful, red or watery on the use of Lotemax.

Warnings: If you are recommended to use Lotemax for a prolonged period, have your eyes checked after 10 days to ensure that this drug is not causing any negative effects on your vision. If you feel any change in your sight, talk to your doctor as this drug can lead to cataracts. Never put the product with a contact lens in as it could harm and damage the contacts. Lotemax being a corticosteroid can delay the healing and make you prone to infections.

Adverse effects: Below mentioned conditions are the side effects of Lotemax;

Sensitivity to light, glaucoma, cataracts, increased pressure, damage to the nerves, opportunistic infections, itching, burning, redness, and stinging in the eyes, late wound healing.

During pregnancy: It belongs to the category C. Only administer Lotemax if your doctor prescribes it.

During lactation: Not to be used by nursing mothers unless truly required and recommended by the doctor.

In children: Corticosteroids can stunt the growth and development of children, hence not to be used by young people.

In elderlies: It is considered safe in this population of patients.

Toxicology: In pregnant rats and mice, systemic administration of loteprednol etabonate caused bone deformations and arterial abnormalities and spinal defects. In lactating animals, it stopped the young’s growth and decreased its survival chances. It was not discovered lethal or destructive to qualities and generation of the creatures.

Mechanism of action: It stops and lessens the inflammatory process by preventing the movement of leukocytes, prostaglandins to the affected areas. It also impedes scar formation, collagen accumulation, dilatation of capillary membranes, fibrin deposition. All these take place by binding of the drug to its glucocorticoid receptors.

Absorption: It has only minimal absorption into the blood when topically applied.

Inform the doctor about your: If you have any sort of infection, eye related problems such as glaucoma or cataracts, if pregnant or breast-feeding, about your past allergies, if you are taking other medicines.

Ingredients: It contains loteprednol etabonate, Purified Water, Tyloxapol, Edetate, glycerin Disodium, and Povidone.



Patient Information on EPIDUO (adapalene and benzoyl peroxide gel)

Manufactured by: Galderma Laboratories, L.P.

Use of Epiduo: we all suffer from acne now and then.  Acne is a very common problem, especially among younger people. Acne means the development of red spots, pimples, and blemishes on the skin. The skin of the face, arms and back are the sites which usually get affected. Despite the fact that they vanish all alone yet now and again can get pustulated and erupt, this emits and deserts a dreadful scar. You may wonder why these horrid bulges get formed on the body, well the answer is simple. Due to the blockage of the sebaceous glands present in our skin which is responsible for the production of oil gets infected by the adjacent germs. Also, pubescence doesn’t help the condition either… hormones, for example, androgens increase during the adolescence and triggers these glands to produce more sebum.

And here comes the Epiduo gel for the treatment of acne vulgaris in patients of 12 years and more. It is manufactured as an aqueous based gel containing 25 mg of benzoyl peroxide and 1 mg of Adapalene.

Administration: the right way of applying the gel is given below;

  • Wash your hands every time before applying the gel.
  • Take out a very small quantity of the gel and apply it on the skin having pimples.
  • Repeat this process once daily after washing.
  • When on treatment with Epiduo, do not subject to waxing or epilating.
  • Ensure you don not insert it into the eyes, nose or mouth. The gel should not be applied in the vagina for any comparable condition.
  • Place the container in a cool and dry place which will not come in contact to direct light and will be away from the children’s reach.

Use in other populaces:

  • Pregnancy: it falls in the category Abstain from using this medicament during pregnancy as none trials or tests have been conducted with Epiduo gel neither in animals nor in human.
  • Breast-feed: should not be used during the lactating period as it is not known whether the agents present in this gel get secreted into the mother’s milk or not.
  • Pediatrics: not safe for youngsters less than 12 years old.
  • Geriatrics: more studies need to be conducted to determine the effectiveness and safety in older patients.


  • Application of this gel should be avoided in the case of hypersensitivity to the ingredients used in it.
  • During the first few weeks of initiation of the application of the gel can cause your skin to burn, sting, dry or itch. Try using a moisturizer to abate these reactions. If you feel that these impacts are deteriorating, end the gel and counsel your skin expert.
  • You should not apply the gel more than one time a day or in larger quantities.
  • Do not apply the gel on the areas of the skin which are broken, scratched, wounded, burnt, or bleeding.
  • Avoid using Epiduo with medicated soaps, lotions or cosmetics, which could otherwise prompt more intense irritation.
  • Stay away or protect your skin from coming in direct contact with the sunlight and sunlamps. Use sunscreen and wear proper protection for it.
  • Attempt to go less outside when the climate is extremely cool or excessively hot as the atmosphere furthest points can also play a role in irritating your skin.
  • The contents of Epiduo gel can fade the color of the clothes and hair.

Interactions with other medicines:

You should not apply other preparations for acne with Epiduo as it could cause severe irritation and inflammation of the skin.

Adverse reactions: most of the side effects appear on the skin, such as scarring, redness, allergic reaction, burning, stinging, blistering, swelling, sunburns, rash, discoloration, dryness of the skin. Apart from the skin-related side effects, Epiduo can also cause eye infection, swelling of the eyelids, scratchy and irritation in the throat.

Toxicology: toxicology provided details regarding Epiduo gel in general are not present but rather such tests have been led by the individual agents. Following results were found in animals;

  • Benzoyl peroxide: does not itself cause tumors but rather acts as a marker or supporter to other carcinogens (cancer causing substances). It was also found to be able to cause changes in the DNA of the human lung cells.
  • Adapalene: it did not transform the reproductive functioning of the rats and mice and also didn’t cause any genetic aberrations in them but it did cause tumors in the adrenal glands of the male rats.

Mode of performance:

  • Adapalene: exact method how it fights acne is not determined. But it brings down inflammation by acting upon the retinoic receptors and suppressing the inflammatory processes.
  • Benzoyl peroxide: it targets the bacteria infecting the skin and glands by releasing free oxygen radicals that scavenge these bugs.

Absorption and secretion: benzoyl peroxide on assimilation from the skin is initially changed into benzoic acid. Benzoyl peroxide and adapalene are excreted through the urine and bile, respectively.

Before using Epiduo inform your doctors: if you are pregnant or had a delivery and if breast-feeding.

Ingredients: adapalene and benzoyl peroxide, purified water, sorbitan oleate, edetate disodium, glycerin, isohexadecane, acrylamide/sodium acryloyldimethyltaurate copolymer, docusate sodium, poloxamer 124, polysorbate 80, propylene glycol.

Patient Information on Diovan (Valsartan)

Manufacturing company:  Novartis Pharmaceuticals Corp.

Why should you use Diovan?

It is utilized for the decrease of hypertension, heart-related occasions like heart attack and stroke. It is effective in both men and women. It can be taken as a solitary treatment or alongside other antihypertensive.

Complete effective treatment of the above conditions not only involves the management of elevated blood pressure but also includes proper control of diabetes, cholesterol, smoking, alcoholism, and exercise and sodium intake.

It is essential to treat hypertension since it can generally prompt various organ-related harms.

What is the potency of Diovan?

It is a 40mg, 80mg, 160mg and 320mg tablets.

What should be the dosing? Follow the dosing regimen prescribed by your specialist.

What should you know about Diovan?

  • You should have your blood pressure monitored regularly and it is great if you can keep a record if conceivable.
  • This medicine alone will not benefit you if you are of the dark race.
  • Take it after food.
  • Do not give it to children.
  • This medicine has proven to be beneficial in reducing heart failure events.
  • Never use this drug if you are bearing a child and terminate its use after talking to your doctor if you become pregnant during the use.
  • If your blood pressure levels do not return to normal after taking Diovan, do not self-medicate or increase the dose without consulting your doctor.
  • If you are diabetic and using a medicine Tekturna (Aliskiren), do not co-administer Diovan with it due to the high risks of acute failure and damage to the kidneys.
  • Get medical help if you develop rash on your skin.
  • Diovan is used with extreme care when the liver is compromised.
  • If you lose too much of your body fluid or blood through hemorrhage, vomiting, kidney failure, third-degree burns inform your respective doctor as it may require changes in your regimen.
  • If on the use of Diovan either alone or with other blood lowering agents, you start experiencing hypotensive symptoms such as fainting, lightheadedness, nausea, extreme tiredness, rapid deep breaths, and headache firstly intake something salty and follow-up on your doctor for any changes if required.
  • You may need your kidney tests directed after some season of beginning Diovan treatment as it can demonstrate harmful to the kidneys in elderly patients with advancing kidney capacity decrease and heart problems.
  • Do not take potassium supplements (until recommended) with Diovan as it could lead to extensively high levels of potassium in the body.

Can Diovan be used in different situations?

  • Pregnancy: it is a category D drug which means it has proven evidence of fetal harm in humans. A woman should be put off immediately after the confirmation of pregnancy. DO NOT USE IN PREGNANCY.
  • Lactation: valsartan was found present in rats’ milk during animal tests; no such tests are done in humans. Diovan should not be used by breast-feeders until truly medically essential.
  • Pediatrics: it is not for children’s use.
  • Geriatrics: it is considered safe.

What side-effects can Diovan produce?

System specific side effects are listed below;

  • Muscles: muscle cramps, pain in the back, tenderness in the muscles.
  • Ear: severe dizziness.
  • Gastric: gas accumulation, dry mouth, dyspepsia, and constipation, pain.
  • Lungs: labored breathing
  • Urogenital: sterility
  • Skin: rash, irritation, baldness.
  • Heart and vessels: Palpitations, low blood pressure, inflamed blood vessels.
  • Lab results: elevated blood urea, a decline in neutrophils, deranged liver enzymes, increased potassium levels.

Is this drug toxic?

Diovan did not demonstrate any harmful or mutagenic impacts in animals on which the medication was tried.

What are its contents? Diovan consists of valsartan, titanium dioxide, gelatin, cellulose compounds, crospovidone, iron oxides, sodium lauryl sulfate, povidone, magnesium stearate.

When is Diovan contra-indicated?

BLACK BOX WARNING: it should not be used by pregnant mothers.


  • if allergic to the Angiotensin-receptor blocker class.
  • If using a renin inhibitor Aliskiren.

PRECAUTIONS: required in

  • liver diseases
  • kidney failure
  • heart failure
  • With other anti-hypertensive
  • body fluid loss
  • renal obstruction
  • hyperkalemia
  • Myocardial infarction
  • Surgery
  • With anesthetics

How does Diovan behave pharmacologically (mode of action)?

It lowers blood pressure by preventing blood vessel constriction and aldosterone (component involved in playing one of the major roles in hypertension) secretion by blocking angiotensin receptors.

What is the pharmacokinetics of Diovan?

  • Absorption and distribution: its actions start within 2 hours of ingestion of the tablets and continue until 24 hours. More than 90% of the drug binds to our blood proteins.
  • Metabolism and elimination: it is subjected to the liver for metabolism and to feces for its maximum removal.

Does Diovan have drug-interactions?

  • It neither alters nor gets altered by cimetidine, atenolol, hydrochlorothiazide, glyburide, furosemide, amlodipine, digoxin, warfarin, and indomethacin.
  • Its use should be avoided with pain-relieving medications known as NSAIDs in elderly patients as it could hasten renal dysfunction.
  • Valsartan with other antihypertensive medicines can cause hypotensive conditions.
  • Diovan with potassium-containing nutriceuticals, potassium expanding diuretics builds potassium levels to clinical huge levels.
  • Drugs like ritonavir, cyclosporine, and rifampicin which modulate OATP1B1 type of transporters in our body can cause fluctuations in Valsartan’s levels when used together.

Before taking Valsartan talk to your doctor if you have any conditions listed below;

  • Heart failure
  • Renal impairment
  • Liver impairment
  • Pregnancy or planning to become pregnant
  • Breast-feeding
  • Other medications
  • Allergies (food or medicine)
  • If you are on a sodium-restricted diet.

Patient information on Combigan

 Manufactured by: Allergan.

What is Combigan used for?

Combigan treats open-angle glaucoma, a condition involving a rise in the eyes pressure because of the inability of the ocular fluid to get discharged.

What is the dosage form Combigan? It is a solution intended to be inserted in the eyes only.

What should you know about Combigan?

  • Monitor blood glucose levels regularly if you are diabetic and using blood glucose lowering medications, as this drug can mask the signs of reduced blood sugar which can prove fatal to the patient.
  • Combigan eye drops are not to be used unless told by the ophthalmologist if you have asthma or another sort of obstructive condition in your lungs.
  • Combigan should not be administered if you have developed a serious heart condition, or are suffering from heart failure.
  • Children should not use Combigan.
  • Combigan can produce hypersensitivity reactions in susceptible patients which may require medical help.
  • Systemic adverse effects of this drug can occur even on topical use.
  • Consult your doctor before using Combigan, if you suffer from depression or conditions that reduce the blood flow to brain or heart or any other area of the body, or if you experience severe orthostatic hypotension i.e. a headache or dizziness on standing up from sitting or lying posture because of the rushing and pooling of blood to the lower extremities.
  • You might be asked to have a thyroid test if your doctor suspects an effect of Combigan on them.
  • Do not use Combigan in the situations or conditions which may have traumatized or injured your eye.
  • Remove contact lenses before instilling Combigan drops in the damaged eye.
  • This drug can make you tired and sleepy; avoid performing activities that require mental skills.

Dosing Considerations: as told by the ophthalmologist.

How to take the drug?

  • Your hands should be washed before and after using Combigan.
  • Administer the drug in exact quantity as prescribed.
  • Do not use it longer than recommended before consulting your ophthalmologist.
  • Agents in Combigan can discolor contact lenses, so remove the contacts before instilling the drops and wait for about 15 minutes before reinserting them.
  • Store this product at 15°-25°C.

What kind of side-effects does this drug have?

Inflamed conjunctiva, Itching, burning and stinging dryness, redness, pain in the eyes, Blurry vision, Visual disturbances, General feeling of weakness, Erosion of the cornea, a condition in which corneal outermost layer fails to attach to the underlying basement membrane, Depressive mood swings, Watery discharge from the eyes, Swollen eyelids, Foreign body sensation, fatigue, Headache, High blood pressure.

Contra-indications and precautions:

  • Combigan is prohibited in patients with heart failure and in blockage of cardiac vessels.
  • Combigan use is unsafe in children.
  • Timolol used in this drug can worsen the active respiratory conditions of asthma and chronic obstructive pulmonary disease.
  • Combigan is not to be used alone for acute angle-closure glaucoma treatment.
  • Avoid its use unless recommended by your physician if you have muscle weakness or paralysis.
  • Diabetic patients require regular blood sugar monitoring as this drug may hide the hypoglycemic i.e. low sugar levels.
  • It can also mask the symptoms of hyperthyroidism, which could be clinically significant.
  • It can cause syncope, severe dizziness and low pulse which may require monitoring.

How can Combigan interact with the other drugs?

  • Calcium Antagonists: calcium channel blockers e.g. amlodipine, nifedipine, diltiazem, verapamil etc. when given together with Combigan can result in failure of the left side of the heart, severe low blood pressure.
  • Other beta-blockers: Timolol itself is a beta receptor blocker, and use of more than one such agent can lead to augmented response/effects.
  • CYP2D6 Inhibitors: collective treatment of CYP2D6 inhibitors (e.g., quinidine, SSRIs) and Timolol results in decreased heart rate and depression medically designated as systemic beta-blockade.
  • Alcohol: use of alcohol with Combigan can cause profound CNS depression.
  • Monoamine Oxidase Inhibitors: when given with the agent brimonidine can lead to severely low blood pressure conditions.
  • Antihypertensives/Cardiac Glycosides: co-use of these medicines can reduce the blood pressures to a dangerously low level.

Can this drug be used by all kinds of people?

  • In pediatrics: it is not safe to give Combigan to children under 2.
  • In geriatrics: Combigan is safe for elderlies unless objected by the professionals.
  • In nursing mothers: not known if brimonidine gets secreted in human milk but it is well known that timolol gets secreted in it. Your doctor will only prescribe this drug when it is truly required and no other alternatives can be used.
  • In pregnancy: It should only be used when your doctor is certain of the benefits of this drug during your pregnancy as it is a category C

What is its mechanism of action?

Combigan possesses two active agents namely; Timolol and Brimonidine.

Combigan is a moderately particular alpha-2 adrenergic receptor agonist with a non-specific beta-adrenergic receptor inhibitor. Both brimonidine and timolol have a quick onset of activity.

What is the pharmacokinetics of the drug?

Absorption: brimonidine and timolol reach their peak plasma levels after absorption within 1-4 hours and 1-3 hours respectively.

Distribution: the binding of brimonidine to proteins present in the plasma is yet to be studied whereas about 60% of timolol binds to these proteins.

Metabolism and excretion: brimonidine is vastly metabolized by enzymatic systems present in the liver. Contrary, timolol has limited metabolism in the liver. The chief route of excretion for these compounds is urine.

Toxicology of brimonidine: it is not cancer causing drug. Brimonidine tartrate was not found mutagenic and did not cause alterations at the chromosomal level.

Toxicology of Timolol:

Test subjects developed adrenal tumors by timolol. Animal subjects also developed lung cancer and females developed mammary gland tumors after receiving timolol at higher doses.

Neither of the drugs had any adverse action on the reproducing organs of the animals.

What are the ingredients used in Combigan?

Active ingredients: brimonidine tartrate 0.2% and timolol 0.5%.

Inactive ingredients: benzalkonium chloride 0.005%; sodium phosphate, monobasic; sodium phosphate, dibasic; purified water; and hydrochloric acid and/or sodium hydroxide to adjust pH.

What is important for your doctor to be aware of?

You should always inform your doctor about the other health problems (if you have any) and if you are undergoing treatment with other medications for a condition diagnosed previously.

Patient Information on Celebrex (Celecoxib)


What is Celebrex used for?

It is a non-steroidal anti-inflammatory drug used for the relief of pain in the following scenarios;

  • Acute onset of pain
  • Familial adenomatous polyposis (FAP) which involves the formation of several polyps in intestines and colon.
  • In painful menstruation
  • Rheumatoid arthritis (inflammation of the joints)
  • Ankylosing Spondylitis (arthritis involving the spinal cord)
  • Juvenile Rheumatoid Arthritis JRA (occurs in children)
  • Osteoarthritis (degeneration of the joints and bones)

In which form is Celebrex available on the market?

It is a capsule formulation having potencies of 50mg, 100mg, 200mg and 400mg.

What is the dosing of this drug?

You should use Celebrex according to the recommendations of your doctor. The dosing of this medicine is done by keeping in perspective distinctive variables of an individual patient.

What should you know about Celebrex contra-indicatory and precautionary use?

BLACK BOX WARNINGS: Celecoxib can cause bleeding in the gastric tract and can lead to negative cardiac events.

  • It is better if you take it after a meal or a snack.
  • Do report an unexpected gain in weight to your doctor.
  • Immediately consult your doctor on developing any one or more of the below-given conditions;

Breathing problems, rash, itchy and irritated skin, stomachache, burning sensations in the stomach, upper gastric pain, yellowing of the skin, dark colored urine, high blood pressure, bleeding, accumulation of fluid in the appendages, chest pain.

  • Do not use any other NSAIDs (over the counter) with Celebrex as it can double the risks of acquiring adverse effects. Talk to your pharmacist about which medicines are to be avoided during Celebrex use.
  • Do not use this drug if you are allergic to other NSAIDs, aspirin or sulfonamide group of medicines.
  • You should avoid Celebrex if you have to undergo bypass.
  • This drug can increase your blood pressure, always report your doctor if your blood pressure remains rose and stops responding to your anti-hypertensive.
  • Celebrex will inhibit the blood pressure lowering effects of diuretics, angiotensin receptor blockers, and ACE inhibitors. If the use of Celebrex is necessary with these drugs; make sure to have your blood pressure observed frequently.
  • Your doctor may ask you to have your liver enzyme levels checked during your treatment with Celebrex due to the reason that it can elevate the liver enzymes, cause damage to the liver and liver cells.
  • This medication whenever amid its utilization can bring about serious digestive tract related issues such as ulceration, bleeding whose rate increases with progressing age, already existing hyperactive conditions in the stomach, with the use of alcohol, glucocorticoids.
  • It can cause clotting in the blood vessels, precipitate heart attack, and stroke.
  • When to be used for a prolonged time or in old age, you may need to have some kidney functioning tests to ensure that your kidneys have not been affected by this drug. It can by inhibit the production of renal prostaglandins can cause damage to the kidneys.
  • Do not give Celebrex to children.
  • If on treatment with Celebrex you get pregnant, immediately consult your doctor.

How does Celebrex interact with other drugs?

  • CYP2C9 inhibitors: it is metabolized through this very enzyme, so the agents (e.g. fluconazole, omeprazole) inhibiting it will alter the levels of celecoxib in the body.
  • Methotrexate: these two drugs do not affect the functioning of each other.
  • NSAIDs: concomitant use of Celecoxib with other members of the same group increases the risks of adverse events to a greater extent.
  • Anti-hypertensive: do not use ACEinh, ARBS, and diuretics with celecoxib due to the risk of antagonism of these drugs and elevation in the blood pressure.
  • Aspirin: the concurrent use of these two agents should be avoided and if required only lowest doses of aspirin should be used.
  • Lithium: should be avoided otherwise monitored proficiently because of the danger of an increase in the lithium concentrations.
  • Warfarin: observing is required as both the medications are known for bleeding risks.

What are the side effects of this drug?

It has following adverse effects;

Dyspepsia, diarrhea, stomachic, pain in the back muscles, dizziness, skin reactions, liver enzyme abnormalities, headache, raised blood pressure levels, cough, vomiting, jaundice, acidity, ulceration, bleeding, cardiac problems, liver toxicity, kidney injury, muscle ache, infections, bloating, rash, dermatitis, hepatitis, severe life-threatening allergic reaction, constriction of bronchioles in lungs.

 How does Celebrex depict its actions?

Celecoxib is an anti-inflammatory drug having pain relieving and body temperature lowering effects. It can realize these impacts by impeding the cyclooxygenase 2, a protein required for the development of provocative prostaglandins. It has no effects on the COX-1 enzyme.

How does it behave pharmacokinetically?

Pharmacokinetics of a drug involves the following processes through which it passes during its stay in the body;

  • Absorption: it reaches its optimal plasma concentrations after 3 hours.
  • Distribution: its binding is with albumin
  • Metabolism: takes place in CYP2C9 and inhibits COX-2
  • Removal: its half-life varies with the varying degree of liver and kidney performance in each patient. Feces and urine both play routes for the excretion of celecoxib from the body.

What type of ingredients is present in the capsules?

Along with Celecoxib, it contains povidone, lactose monohydrate, sodium lauryl sulfate, croscarmellose sodium, gelatin, lactose monohydrate, edible inks.

How is it used in various patient populations?

  • In children and elderlies: Celebrex is harmful to children below 2 years and in elderly the dosing is usually started at the lowest doses because of their deteriorating kidney functions.
  • Race: black descendants have some variations in their levels in comparison to Caucasians.
  • During pregnancy and lactation: pregnant women can only use Celebrex if prescribed by their doctors as it can cause abnormal organ development in the fetus. Nursing mothers should avoid this drug as low levels of it are eliminated in the milk.
  • Poor CYP2C9 metabolizers: patients having metabolic problems or variations are not given Celebrex until recommended by the specialist.

What should you tell your doctor?

Always tell your doctor about all your health problems, your medications, allergies, past significant family history before taking Celecoxib.