TREXIMET™ (sumatriptan and naproxen sodium) Tablets

TREXIMET 85-500 MG TABLET GLAXOSMITHKLINE Approx. Price: $206.65 per 9Each

All Labeled Uses: Migraine

TREXIMET contains sumatriptan (as the succinate), a selective 5-hydroxytryptamine1 (5-HT₁) receptor subtype agonist, and naproxen sodium, a member of the arylacetic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs).Drug-Drug Interactions

Contraindicated Drug Combination:
Clearly contraindicated in all cases and should not be dispensed or administered to the same patient:
5HT-1D AGONISTS/ERGOTAMINES; METHYSERGIDE -
SELECTED 5HT-1D AGONISTS/MAO INHIBITORS - Adverse reaction of the former drug
SELECTED NEPHROTOXIC AGENTS/CIDOFOVIR - Adverse reaction with both drugs
SEROTONINERGIC AGENTS/SIBUTRAMINE - Adverse reaction of the latter drug
NSAID;ASPIRIN/KETOROLAC - Adverse reaction with both drugs
SEROTONINERGIC AGENTS/DEXFENFLURAMINE; FENFLURAMINE - Adverse reaction with both drugs

Severe Interaction:
Action is required to reduce the risk of severe adverse interaction.
LONG HALF-LIFE NSAIDS; DIFLUNISAL/PEMETREXED -
NSAIDS/METHOTREXATE - Increased effect of the latter drug

Moderate Interaction:
Assess the risk to the patient and take action as needed.
NSAIDS/LOOP DIURETICS - Decreased effect of the latter drug
NSAIDS/LITHIUM - Increased effect of the latter drug
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS/BETA-BLOCKERS - Decreased effect of the latter drug
5HT-1D AGONISTS/SSRI’S; SNRI’S - Adverse reaction of the latter drug
SELECTED NSAIDS/PROBENECID - Increased effect of the former drug
NSAIDS/TENOFOVIR - Additive side effects from both drugs
NSAIDS/DROSPIRENONE - Additive side effects from both drugs
NSAIDS; ASPIRIN/SSRI’S; SNRI’S - Adverse reaction with both drugs
NSAIDS/SELECTED PLATELET AGGREGATION INHIBITORS - Additive side effects from both drugs
NSAIDS/HEPARINS - Additive side effects from both drugs
NSAIDS/ANTICOAGULANTS - Increased effect of the latter drug
NSAIDS/TRIAMTERENE; AMILORIDE - Adverse reaction of the latter drug
NSAIDS/CYCLOSPORINE - Adverse reaction with both drugs
SELECTED NSAIDS/ACE INHIBITORS; ARB’S - Decreased effect of the latter drug

Label Warnings

Pediatric
Warning: SAFETY & EFFICACY NOT ESTABLISHED IN CHILDREN LESS THAN 2 YRS
Relative Contraindication: SAFETY AND EFFICACY NOT ESTABLISHED. NOT RECOMMENDED BY MANUFACTURER.

Lactation
Precaution: AMERICAN ACAD OF PEDIATRICS(AAP) CONSIDERS DRUG COMPATIBLE WITH BREASTFEEDING
Precaution: AMER ACAD PEDS CONSIDERS DRUG COMPATIBLE W BREASTFEEDING. MFR RECOMM CAUTION.

Pregnancy
FDB Contraindicated or Not Recommended: FDA CAT C. NOT RECOM,RISK OF PREMATURE CLOSURE OF DUCT ARTERIOSUS,MISCARRIAGE
Only When Necessary

Geriatric
Contraindication: NOT RECOMMENDED: INCREASED CV RISK FACTORS; INCREASED EFFECTS ON BP
Precaution: (SOM)(BEERS02)RISK OF SERIOUS/FATAL GI BLEED,ULCER; CV/RENAL ADV.EFX

Adverse Effects

Most Frequent:
Abdominal Pain with Cramps, Body Fluid Retention, Constipation, Dizziness, Drowsy, Edema, Headache Disorder, Heartburn, Nausea, Skin Rash, Tinnitus, Urticaria

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TORADOL® (ketorolac tromethamine) Tablets

TORADOL 10 MG TABLET PRESCRIPT PHARM Approx. Price: $12.93 per 6Each

Adult Min/Max Dose: 10.0mg/40.0mg

Common Dosages by Indication:

Postoperative Pain	take 1 tablet (10 mg) by oral route every 4-6 hours as needed not to exceed 40 mg per 24 hours take 1 tablet (10 mg) by oral route every 4 hours as needed not to exceed 40 mg per 24 hours take 1 tablet (10 mg) by oral route every 6 hours as needed not to exceed 40 mg per 24 hours
Severe Pain	take 1 tablet (10 mg) by oral route every 4-6 hours as needed not to exceed 40mg in 24hrs for up to 5 days total use take 1 tablet (10 mg) by oral route every 4 hours as needed not to exceed 40mg in 24hrs for up to 5 days total use take 1 tablet (10 mg) by oral route every 6 hours as needed for up to 5 days total use

All Labeled Uses: Postoperative Pain, Severe Pain
Unlabeled Uses: Renal Colic

Ketorolac or ketorolac tromethamine (marketed under the trademarks Toradol and Acular in the US, where generics have also been approved

Drug-Drug Interactions

Contraindicated Drug Combination:
Clearly contraindicated in all cases and should not be dispensed or administered to the same patient:
KETOROLAC/PROBENECID - Increased effect of the former drug
KETOROLAC/NSAID;ASPIRIN - Adverse reaction with both drugs
SELECTED NEPHROTOXIC AGENTS/CIDOFOVIR - Adverse reaction with both drugs
KETOROLAC/PENTOXIFYLLINE - Adverse reaction with both drugs

Severe Interaction:
Action is required to reduce the risk of severe adverse interaction.
KETOROLAC/ANTICOAGULANTS -
NSAID’S/ORAL SODIUM PHOSPHATE - Adverse reaction of the latter drug
SELECTED NSAIDS; ASPIRIN/PEMETREXED - Increased effect of the latter drug
NSAIDS/METHOTREXATE - Increased effect of the latter drug

Moderate Interaction:
Assess the risk to the patient and take action as needed.
NSAIDS/LOOP DIURETICS - Decreased effect of the latter drug
NSAIDS/LITHIUM - Increased effect of the latter drug
NSAIDS/TENOFOVIR - Additive side effects from both drugs
NSAIDS/DROSPIRENONE - Additive side effects from both drugs
NSAIDS; ASPIRIN/SSRI’S; SNRI’S - Adverse reaction with both drugs
NSAIDS/SELECTED PLATELET AGGREGATION INHIBITORS - Additive side effects from both drugs
NSAIDS/TRIAMTERENE; AMILORIDE - Adverse reaction of the latter drug
NSAIDS/CYCLOSPORINE - Adverse reaction with both drugs
SELECTED NSAIDS/ACE INHIBITORS; ARB’S - Decreased effect of the latter drug

Label Warnings

Pediatric
Relative Contraindication: NOT INDICATED IN PEDIATRICS PER MANUFACTURER. NO SAFETY DATA AVAILABLE.

Lactation
Precaution: CONTRAINDICATED BY MFR,POSS ADV EFF NEONATE;COMPATIBL W/BREASTFEEDING PER AAP

Pregnancy
FDB Contraindicated or Not Recommended: FDA CAT C. NOT RECOM,RISK OF PREMATURE CLOSURE OF DUCT ARTERIOSUS,MISCARRIAGE

Geriatric
Contraindication: (SOM)(BEERS02)RISKS:GI BLEED;CV/RENAL ADV EFX.ADJ.DOSE TO DECR.RISK.

Adverse Effects

Most Frequent:
Abdominal Pain with Cramps, Diarrhea, Dizziness, Drowsy, Edema, Headache Disorder, Injection Site Sequelae, Nausea

Drug-Disease Contraindications

Most Significant
Acute Gastrointestinal Ulcer with Perforation, Blood Coagulation Disorder, Cerebrovascular Hemorrhage, Gastrointestinal Hemorrhage, Hypovolemia, Intraoperative Pain Management, Post-operative from CABG Surgery, Pregnancy, Preoperative Pain Management, Severe Renal Disease

Significant
Cerebrovascular Accident, Chronic Heart Failure, Disease of Cardiovascular System, Duodenal Ulcer, Gastric Ulcer, Gastrointestinal Ulcer, Increased Cardiovascular Event Risk, Labor Pain, Myocardial Infarction, Tobacco Smoking, Ulcerative Colitis

Possibly Significant
Anemia, Bronchial Asthma, Disease of Liver, Hypertension, Renal Disease with Mild to Moderate Renal Function Impairment

TOPROL-XL® (metoprolol succinate) Extended-Release Tablets

TOPROL XL 25 MG TABLET SA ASTRAZENECA Approx. Price: $117.1 per 100Each

Adult Min/Max Dose: 12.5mg/400.0mg

Common Dosages by Indication:

Chronic Angina Pectoris	take 2 tablets (100 mg) by oral route once daily take 1 tablet (100 mg) by oral route once daily take 2 tablets (200 mg) by oral route once daily take 1 tablet (200 mg) by oral route once daily take 2 tablets (400 mg) by oral route once daily
Chronic Heart Failure	take 2 tablets (50 mg) by oral route once daily take 1 tablet (25 mg) by oral route once daily take 1 tablet (50 mg) by oral route once daily take 2 tablets (100 mg) by oral route once daily take 1 tablet (100 mg) by oral route once daily take 2 tablets (200 mg) by oral route once daily take 1 tablet (200 mg) by oral route once daily
Hypertension	take 2 tablets (50 mg) by oral route once daily take 1 tablet (50 mg) by oral route once daily take 2 tablets (100 mg) by oral route once daily take 1 tablet (100 mg) by oral route once daily take 2 tablets (200 mg) by oral route once daily take 1 tablet (200 mg) by oral route once daily take 2 tablets (400 mg) by oral route once daily

All Labeled Uses: Chronic Angina Pectoris, Chronic Heart Failure, Hypertension
Unlabeled Uses: Diastolic Heart Failure, Hypertrophic Cardiomyopathy, Migraine Prevention, Myocardial Reinfarction Prevention, Prevention of Congenital Long QT Syndrome associated Ventricular Arrhythmia, Prevention of Recurrent Atrial Fibrillation, Ventricular Rate Control in Atrial Fibrillation

TOPROL-XL, metoprolol succinate, is a beta₁-selective (cardioselective) adrenoceptor blocking agent, for oral administration, available as extended release tablets. TOPROL-XL has been formulated to provide a controlled and predictable release of metoprolol for once-daily administration. The tablets comprise a multiple unit system containing metoprolol succinate in a multitude of controlled release pellets. Each pellet acts as a separate drug delivery unit and is designed to deliver metoprolol continuously over the dosage interval

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TOPAMAX® (topiramate) Tablets TOPAMAX® (topiramate) Capsules & Sprinkle Capsules

TOPAMAX 25 MG TABLET STAT RX USA Approx. Price: $79.0 per 30Each

Drug Alert

September 27, 2006: Name Similarities With Toprol Results in Medication Errors

December 30, 2003:Topiramate Decreases Serum Bicarbonate

September 25, 2001:Topamax – Warnings and precautions

Mechanism of Action The precise mechanisms by which topiramate exerts its anticonvulsant and migraine prophylaxis effects are unknown; however, preclinical studies have revealed four properties that may contribute to topiramate’s efficacy for epilepsy and migraine prophylaxis. Electrophysiological and biochemical evidence suggests that topiramate, at pharmacologically relevant concentrations, blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the GABA-Areceptor, antagonizes the AMPA/kainate subtype of the glutamate receptor, and inhibits the carbonic anhydrase enzyme, particularly isozymes II and IV. Dosage and Uses

Adult Min/Max Dose: 100.0mg/1600.0mg
Pediatric Min/Max Dose: 4.0mg/kg/12.0mg/kg

Common Dosages by Indication:

Complex-Partial Epilepsy	take 2 tablets (50 mg) by oral route 2 times per day in the morning and evening take 1 tablet (50 mg) by oral route 2 times per day take 2 tablets (100 mg) by oral route 2 times per day take 2 tablets (200 mg) by oral route 2 times per day take 1 tablet (200 mg) by oral route 2 times per day
Lennox-Gastaut Epilepsy	take 2 tablets (50 mg) by oral route 2 times per day in the morning and evening take 1 tablet (50 mg) by oral route 2 times per day take 2 tablets (100 mg) by oral route 2 times per day take 2 tablets (200 mg) by oral route 2 times per day take 1 tablet (200 mg) by oral route 2 times per day
Migraine Prevention	take 2 tablets (50 mg) by oral route 2 times per day in the morning and evening take 1 tablet (50 mg) by oral route 2 times per day
Partial Epilepsy Treatment Adjunct	take 2 tablets (100 mg) by oral route 2 times per day take 1 tablet (100 mg) by oral route 2 times per day take 2 tablets (200 mg) by oral route 2 times per day take 1 tablet (200 mg) by oral route 2 times per day
Simple-Partial Epilepsy	take 2 tablets (50 mg) by oral route 2 times per day in the morning and evening take 1 tablet (50 mg) by oral route 2 times per day take 2 tablets (100 mg) by oral route 2 times per day take 2 tablets (200 mg) by oral route 2 times per day take 1 tablet (200 mg) by oral route 2 times per day
Tonic-Clonic Epilepsy	take 2 tablets (50 mg) by oral route 2 times per day in the morning and evening take 1 tablet (50 mg) by oral route 2 times per day take 2 tablets (100 mg) by oral route 2 times per day take 2 tablets (200 mg) by oral route 2 times per day take 1 tablet (200 mg) by oral route 2 times per day
Tonic-Clonic Epilepsy Treatment Adjunct	take 2 tablets (400 mg) by oral route 2 times per day

All Labeled Uses: Complex-Partial Epilepsy, Lennox-Gastaut Epilepsy, Migraine Prevention, Partial Epilepsy Treatment Adjunct, Simple-Partial Epilepsy, Tonic-Clonic Epilepsy, Tonic-Clonic Epilepsy Treatment Adjunct
Unlabeled Uses: Alcoholism, Essential Tremor

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