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By R. Tizgar. Buena Vista University.

Stop taking herbal products immediately if side effects cheap allegra 180mg on-line, a rash 180 mg allegra with visa, or signs of an allergic reaction occur and contact your health care provider. It is important to tell all your health care providers about any herbal products you take, since interactions with prescription drugs are possible. This is true even if herbal products are taken several hours apart from other medications. For example, Ginkgo biloba may increase the risk of bleeding in patients who take warfarin. Ma huang can increase the effects of stimulants, including decongestants, diet aids, and caffeine. It may also interact with theophylline, digoxin, antihypertensives, MAO inhibitors, and antidiabetic drugs. Source: Rx Consultant newsletter article: Traditional Chinese Medicine The Western Use of Chinese Herbs by Paul C. Decisions about your health care are important--including decisions about whether to use complementary and alternative medicine (CAM). The National Center for Complementary and Alternative Medicine (NCCAM) has developed this fact sheet to assist you in your decision-making about CAM. It includes frequently asked questions, issues to consider, and a list of sources for further information. Take charge of your health by being an informed consumer. Find out what scientific studies have been done on the safety and effectiveness of the CAM treatment in which you are interested. Decisions about medical care and treatment should be made in consultation with a health care provider and based on the condition and needs of each person. Discuss information on CAM with your health care provider before making any decisions about treatment or care. If you use any CAM therapy, inform your primary health care provider. This is for your safety and so your health care provider can develop a comprehensive treatment plan. If you use a CAM therapy provided by a practitioner, such as acupuncture, choose the practitioner with care. Check with your insurer to see if the services will be covered. Is it Government, a university, or a reputable medical or health-related association? Is it sponsored by a manufacturer of products, drugs, etc.? Is it based on scientific evidence with clear references? Advice and opinions should be clearly set apart from the science. For More Information Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine. CAM therapies used alone are often referred to as "alternative. For more about these terms, see the NCCAM fact sheet "What Is Complementary and Alternative Medicine? It is not a good idea to use a CAM therapy simply because of something you have seen in an advertisement or on a Web site or because someone has told you that it worked for them. Scientific research on many CAM therapies is relatively new, so this kind of information may not be available for every therapy. However, many studies on CAM treatments are under way, including those that NCCAM supports, and our knowledge and understanding of CAM is increasing all the time. Here are some ways to find scientifically based information:Talk to your health care practitioner(s). Tell them about the therapy you are considering and ask any questions you may have about safety, effectiveness, or interactions with medications (prescription or non-prescription). They may know about the therapy and be able to advise you on its safety and use. If your practitioner cannot answer your questions, he may be able to refer you to someone who can. Your practitioner may also be able to help you interpret the results of scientific articles you have found. Use the Internet to search medical libraries and databases for information. One database called CAM on PubMed (see " For More Information "), developed by NCCAM and the National Library of Medicine, gives citations or abstracts (brief summaries) of the results of scientific studies on CAM. The articles cited in CAM on PubMed are peer-reviewed--that is, other scientists in the same field have reviewed the article, the data, and the conclusions, and judged them to be accurate and important to the field. Another database, International Bibliographic Information on Dietary Supplements, is useful for searching the scientific literature on dietary supplements (see " For More Information "). If you do not have access to the Internet, contact the NCCAM Clearinghouse (see "For More Information"). The staff is available to discuss your needs with you and assist you in searching the peer-reviewed medical and scientific literature. Visit your local library or a medical library to see if there are books or publications that contain scientific articles discussing CAM in general or the treatment in which you are interested. Thousands of articles on health issues and CAM are published in books and scientific journals every year. A reference librarian can help you search for those on the therapy that interests you. However, here are some issues to think about when considering a CAM therapy.

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It is 93% bound to plasma proteins over the concentration range of 7 to 1100 ng/mL purchase 180mg allegra with mastercard, binding primarily to albumin and (alpha) 1 -acid glycoprotein discount allegra 180 mg with visa. Metabolism and Elimination -- Following a single oral dose of 14 C labeled olanzapine, 7% of the dose of olanzapine was recovered in the urine as unchanged drug, indicating that olanzapine is highly metabolized. Approximately 57% and 30% of the dose was recovered in the urine and feces, respectively. In the plasma, olanzapine accounted for only 12% of the AUC for total radioactivity, indicating significant exposure to metabolites. Both metabolites lack pharmacological activity at the concentrations observed. Direct glucuronidation and cytochrome P450 (CYP) mediated oxidation are the primary metabolic pathways for olanzapine. In vitro studies suggest that CYPs 1A2 and 2D6, and the flavin-containing monooxygenase system are involved in olanzapine oxidation. CYP2D6 mediated oxidation appears to be a minor metabolic pathway in vivo, because the clearance of olanzapine is not reduced in subjects who are deficient in this enzyme. ZYPREXA IntraMuscular results in rapid absorption with peak plasma concentrations occurring within 15 to 45 minutes. Based upon a pharmacokinetic study in healthy volunteers, a 5 mg dose of intramuscular olanzapine for injection produces, on average, a maximum plasma concentration approximately 5 times higher than the maximum plasma concentration produced by a 5 mg dose of oral olanzapine. Area under the curve achieved after an intramuscular dose is similar to that achieved after oral administration of the same dose. The half-life observed after intramuscular administration is similar to that observed after oral dosing. The pharmacokinetics are linear over the clinical dosing range. Metabolic profiles after intramuscular administration are qualitatively similar to metabolic profiles after oral administration. Renal Impairment -- Because olanzapine is highly metabolized before excretion and only 7% of the drug is excreted unchanged, renal dysfunction alone is unlikely to have a major impact on the pharmacokinetics of olanzapine. The pharmacokinetic characteristics of olanzapine were similar in patients with severe renal impairment and normal subjects, indicating that dosage adjustment based upon the degree of renal impairment is not required. The effect of renal impairment on metabolite elimination has not been studied. Hepatic Impairment -- Although the presence of hepatic impairment may be expected to reduce the clearance of olanzapine, a study of the effect of impaired liver function in subjects (n=6) with clinically significant (Childs Pugh Classification A and B) cirrhosis revealed little effect on the pharmacokinetics of olanzapine. Age -- In a study involving 24 healthy subjects, the mean elimination half-life of olanzapine was about 1. Race -- In vivo studies have shown that exposures are similar among Japanese, Chinese and Caucasians, especially after normalization for body weight differences. Dosage modifications for race are, therefore, not recommended. Combined Effects -- The combined effects of age, smoking, and gender could lead to substantial pharmacokinetic differences in populations. The clearance in young smoking males, for example, may be 3 times higher than that in elderly nonsmoking females. Dosing modification may be necessary in patients who exhibit a combination of factors that may result in slower metabolism of olanzapine ( see DOSAGE AND ADMINISTRATION ). For specific information about the pharmacology of lithium or valproate, refer to the CLINICAL PHARMACOLOGY section of the package inserts for these other products. The efficacy of oral olanzapine in the treatment of schizophrenia was established in 2 short-term (6-week) controlled trials of inpatients who met DSM III-R criteria for schizophrenia. A single haloperidol arm was included as a comparative treatment in one of the two trials, but this trial did not compare these two drugs on the full range of clinically relevant doses for both. Several instruments were used for assessing psychiatric signs and symptoms in these studies, among them the Brief Psychiatric Rating Scale (BPRS), a multi-item inventory of general psychopathology traditionally used to evaluate the effects of drug treatment in schizophrenia. The BPRS psychosis cluster (conceptual disorganization, hallucinatory behavior, suspiciousness, and unusual thought content) is considered a particularly useful subset for assessing actively psychotic schizophrenic patients. A second traditional assessment, the Clinical Global Impression (CGI), reflects the impression of a skilled observer, fully familiar with the manifestations of schizophrenia, about the overall clinical state of the patient. In addition, two more recently developed scales were employed; these included the 30-item Positive and Negative Symptoms Scale (PANSS), in which are embedded the 18 items of the BPRS, and the Scale for Assessing Negative Symptoms (SANS). The trial summaries below focus on the following outcomes: PANSS total and/or BPRS total; BPRS psychosis cluster; PANSS negative subscale or SANS; and CGI Severity. The results of the trials follow:(1) In a 6-week, placebo-controlled trial (n=149) involving two fixed olanzapine doses of 1 and 10 mg/day (once daily schedule), olanzapine, at 10 mg/day (but not at 1 mg/day), was superior to placebo on the PANSS total score (also on the extracted BPRS total), on the BPRS psychosis cluster, on the PANSS Negative subscale, and on CGI Severity. There was no clear advantage for the high dose group over the medium dose group. Examination of population subsets (race and gender) did not reveal any differential responsiveness on the basis of these subgroupings. In a longer-term trial, adult outpatients (n=326) who predominantly met DSM-IV criteria for schizophrenia and who remained stable on olanzapine during open label treatment for at least 8 weeks were randomized to continuation on their current olanzapine doses (ranging from 10 to 20 mg/day) or to placebo. The follow-up period to observe patients for relapse, defined in terms of increases in BPRS positive symptoms or hospitalization, was planned for 12 months, however, criteria were met for stopping the trial early due to an excess of placebo relapses compared to olanzapine relapses, and olanzapine was superior to placebo on time to relapse, the primary outcome for this study. Thus, olanzapine was more effective than placebo at maintaining efficacy in patients stabilized for approximately 8 weeks and followed for an observation period of up to 8 months. Monotherapy -- The efficacy of oral olanzapine in the treatment of acute manic or mixed episodes was established in 2 short-term (one 3-week and one 4-week) placebo-controlled trials in patients who met the DSM-IV criteria for Bipolar I Disorder with manic or mixed episodes. These trials included patients with or without psychotic features and with or without a rapid-cycling course. The primary rating instrument used for assessing manic symptoms in these trials was the Young Mania Rating Scale (Y-MRS), an 11-item clinician-rated scale traditionally used to assess the degree of manic symptomatology (irritability, disruptive/aggressive behavior, sleep, elevated mood, speech, increased activity, sexual interest, language/thought disorder, thought content, appearance, and insight) in a range from 0 (no manic features) to 60 (maximum score). The primary outcome in these trials was change from baseline in the Y-MRS total score. The results of the trials follow:(1) In one 3-week placebo-controlled trial (n=67) which involved a dose range of olanzapine (5-20 mg/day, once daily, starting at 10 mg/day), olanzapine was superior to placebo in the reduction of Y-MRS total score.

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