Cépazine may be available in the countries listed below.
Cefuroxime axetil (a derivative of Cefuroxime) is reported as an ingredient of Cépazine in the following countries:
International Drug Name Search
Relieving symptoms of sinus congestion, runny nose, sneezing, and cough due to colds, upper respiratory infections, and allergies. It may also be used for other conditions as determined by your doctor.
Codimal DM Syrup is a decongestant, antihistamine, and cough suppressant combination. The decongestant works by constricting blood vessels and reducing swelling in the nasal passages. The antihistamine works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing. The cough suppressant works in the brain to help decrease the cough reflex to reduce a dry cough.
Contact your doctor or health care provider right away if any of these apply to you.
Some medical conditions may interact with Codimal DM Syrup. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
Some MEDICINES MAY INTERACT with Codimal DM Syrup. Tell your health care provider if you are taking any other medicines, especially any of the following:
This may not be a complete list of all interactions that may occur. Ask your health care provider if Codimal DM Syrup may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Use Codimal DM Syrup as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Ask your health care provider any questions you may have about how to use Codimal DM Syrup.
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Constipation; diarrhea; dizziness; drowsiness; excitability; headache; loss of appetite; nausea; nervousness or anxiety; trouble sleeping; upset stomach; vomiting; weakness.
Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); difficulty urinating or inability to urinate; fast or irregular heartbeat; hallucinations; seizures; severe dizziness, lightheadedness, or headache; tremor; trouble sleeping; vision changes.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
See also: Codimal DM side effects (in more detail)
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include blurred vision; confusion; hallucinations; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; unusually fast, slow, or irregular heartbeat; vomiting.
Store Codimal DM Syrup at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Codimal DM Syrup out of the reach of children and away from pets.
This information is a summary only. It does not contain all information about Codimal DM Syrup. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.
Sandoz Anagrelide may be available in the countries listed below.
Anagrelide hydrochloride (a derivative of Anagrelide) is reported as an ingredient of Sandoz Anagrelide in the following countries:
International Drug Name Search
Generic Name: chlorpheniramine, pyrilamine, and phenylephrine (KLOR fe NEER a meen, pir IL a meen, FEN il EFF rin)
Brand names: AllerTan, Chlorex-A 12, Conal, MyHist-PD, Nalex A 12, Phena-Plus, Phena-S, Poly Hist PD, R-Tannate, Ru-Hist Forte, Tri-Hist Pediatric, Triotann-S Pediatric, Triple Tannate Pediatric, Triplex AD, ...show all 39 brand names.
Chlorpheniramine and pyrilamine are antihistamines that reduce the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.
Phenylephrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).
The combination of chlorpheniramine, phenylephrine, and pyrilamine is used to treat runny or stuffy nose, sneezing, itching, watery eyes, and sinus congestion caused by allergies, the common cold, or the flu.
Chlorpheniramine, phenylephrine, and pyrilamine may also be used for purposes not listed in this medication guide.
severe or uncontrolled high blood pressure;
severe coronary artery disease;
diabetes;
overactive thyroid; or
asthma, pneumonia, or other breathing problems.
Ask a doctor or pharmacist if it is safe for you to take this medicine if you have:
heart disease or high blood pressure;
glaucoma;
enlarged prostate;
bladder obstruction or other urination problems; or
a blockage in your digestive tract (stomach or intestines).
Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Cough or cold medicine is usually taken only for a short time until your symptoms clear up.
Measure liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
See also: Chlorpheniramine, pyrilamine, and phenylephrine dosage (in more detail)
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Overdose symptoms may include dry mouth, dilated pupils, nausea, vomiting, and warmth, redness, or tingly feeling under your skin.
Avoid taking this medication if you also take diet pills, caffeine pills, or other stimulants (such as ADHD medications). Taking a stimulant together with a decongestant can increase your risk of unpleasant side effects.
severe dizziness, anxiety, restless feeling, or nervousness;
fast, pounding, or uneven heartbeats;
confusion, hallucinations, unusual thoughts or behavior;
feeling like you might pass out;
urinating less than usual or not at all;
easy bruising or bleeding, unusual weakness, fever, chills, body aches, flu symptoms;
increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure); or
nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Less serious side effects may include:
upset stomach, constipation;
dry mouth;
blurred vision;
dizziness, drowsiness;
problems with memory;
sleep problems (insomnia); or
feeling restless or excited (especially in children).
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Usual Adult Dose for Allergic Rhinitis:
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-7.5 mg-12.5 mg/5 mL:
5 to 10 mL orally every 4 to 6 hours not to exceed 60 mg of phenylephrine in 24 hours.
Chlorpheniramine/phenylephrine/pyrilamine 4 mg-10 mg-25 mg oral tablet, extended release:
1 tablet orally 2 to 3 times daily.
Chlorpheniramine/phenylephrine/pyrilamine 8 mg-12.5 mg-15 mg/5 mL:
5 to 10 mL orally every 12 hours not to exceed 20 mL in 24 hours.
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-10 mg-10 mg oral tablet:
1 to 2 tablets orally every 4 to 6 hours.
Usual Adult Dose for Cold Symptoms:
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-7.5 mg-12.5 mg/5 mL:
5 to 10 mL orally every 4 to 6 hours not to exceed 60 mg of phenylephrine in 24 hours.
Chlorpheniramine/phenylephrine/pyrilamine 4 mg-10 mg-25 mg oral tablet, extended release:
1 tablet orally 2 to 3 times daily.
Chlorpheniramine/phenylephrine/pyrilamine 8 mg-12.5 mg-15 mg/5 mL:
5 to 10 mL orally every 12 hours not to exceed 20 mL in 24 hours.
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-10 mg-10 mg oral tablet:
1 to 2 tablets orally every 4 to 6 hours.
Usual Pediatric Dose for Allergic Rhinitis:
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-5 mg-12.5 mg/5 mL:
2 years to 6 years: 2.5 to 5 mL orally every 12 hours as needed.
6 years or older: 5 to 10 mL orally every 12 hours as needed.
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-7.5 mg-12.5 mg/5 mL:
2 yrs to 5 yrs: 2.5 mL orally every 4 to 6 hours not to exceed 15 mg of phenylephrine in 24 hours.
6 yrs to 11 yrs: 5 mL orally every 4 to 6 hours not to exceed 30 mg of phenylephrine in 24 hours.
12 years or older: 5 to 10 mL orally every 4 to 6 hours not to exceed 60 mg of phenylephrine in 24 hours.
Chlorpheniramine/phenylephrine/pyrilamine 4 mg-10 mg-25 mg oral tablet, extended release:
6 yrs to 11 yrs: 1/2 tablet orally 2 to 3 times daily.
12 years or older: 1 tablet orally 2 to 3 times daily.
Chlorpheniramine/phenylephrine/pyrilamine 8 mg-12.5 mg-15 mg/5 mL:
2 yrs to 5 yrs: 2.5 mL orally every 12 hours not to exceed 5 mL in 24 hours.
6 yrs to 12 yrs: 5 mL orally every 12 hours not to exceed 10 mL 24 hours.
12 years or older: 5 to 10 mL orally every 12 hours not to exceed 20 mL in 24 hours.
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-10 mg-10 mg oral tablet:
6 yrs to 12 yrs: 1 tablet orally every 4 to 6 hours.
12 years or older: 1 to 2 tablets orally every 4 to 6 hours.
Usual Pediatric Dose for Cold Symptoms:
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-5 mg-12.5 mg/5 mL:
2 years to 6 years: 2.5 to 5 mL orally every 12 hours as needed.
6 years or older: 5 to 10 mL orally every 12 hours as needed.
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-7.5 mg-12.5 mg/5 mL:
2 yrs to 5 yrs: 2.5 mL orally every 4 to 6 hours not to exceed 15 mg of phenylephrine in 24 hours.
6 yrs to 11 yrs: 5 mL orally every 4 to 6 hours not to exceed 30 mg of phenylephrine in 24 hours.
12 years or older: 5 to 10 mL orally every 4 to 6 hours not to exceed 60 mg of phenylephrine in 24 hours.
Chlorpheniramine/phenylephrine/pyrilamine 4 mg-10 mg-25 mg oral tablet, extended release:
6 yrs to 11 yrs: 1/2 tablet orally 2 to 3 times daily.
12 years or older: 1 tablet orally 2 to 3 times daily.
Chlorpheniramine/phenylephrine/pyrilamine 8 mg-12.5 mg-15 mg/5 mL:
2 yrs to 5 yrs: 2.5 mL orally every 12 hours not to exceed 5 mL in 24 hours.
6 yrs to 12 yrs: 5 mL orally every 12 hours not to exceed 10 mL 24 hours.
12 years or older: 5 to 10 mL orally every 12 hours not to exceed 20 mL in 24 hours.
Chlorpheniramine/phenylephrine/pyrilamine 2 mg-10 mg-10 mg oral tablet:
6 yrs to 12 yrs: 1 tablet orally every 4 to 6 hours.
12 years or older: 1 to 2 tablets orally every 4 to 6 hours.
Tell your doctor about all other medications you use, especially:
digoxin (Lanoxin);
blood pressure medication;
an antidepressant;
a barbiturate such as phenobarbital (Solfoton) and others;
a diuretic (water pill);
medication to treat irritable bowel syndrome;
bladder or urinary medications such as oxybutynin (Ditropan, Oxytrol) or tolterodine (Detrol);
aspirin or salicylates (such as Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others); or
a beta-blocker such as atenolol (Tenormin), carteolol (Cartrol), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), timolol (Blocadren), and others.
This list is not complete and there may be other drugs that can interact with chlorpheniramine, phenylephrine, and pyrilamine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.
See also: chlorpheniramine, pyrilamine, and phenylephrine side effects (in more detail)
Equiday E may be available in the countries listed below.
Tocopherol, α- is reported as an ingredient of Equiday E in the following countries:
International Drug Name Search
Insulin Novorapid FlexPen may be available in the countries listed below.
Insulin Aspart is reported as an ingredient of Insulin Novorapid FlexPen in the following countries:
International Drug Name Search
Generic Name: cat's claw (CATS CLAW)
Brand Names:
Cat's claw is also known as Uncaria tomentosa, Uncaria guianensis, life-giving vine of Peru, samento, and una de gato.
Cat's claw has been used in alternative medicine as an aid to treat infections, stomach or intestinal disorders, cancer, arthritis, asthma, hay fever, and chronic fatigue syndrome. Cat's claw has also been used to support the immune system and promote kidney health, and as a contraceptive.
Cat's claw is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.
Cat's claw may also be used for purposes not listed in this product guide.
Cat's claw is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.
Use cat's claw as directed on the label, or as your healthcare provider has prescribed. Do not use this product in larger amounts or for longer than recommended.
Ask a doctor, pharmacist, herbalist, or other healthcare provider if it is safe for you to use this product if you have:
a weak immune system;
leukemia; or
an autoimmune disorder such as lupus, multiple sclerosis, and others.
When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.
If you choose to take cat's claw, use it as directed on the package or as directed by your doctor, pharmacist, or other health care provider.
Cat's claw may be available in tablet, capsule, liquid, tincture, extract, or tea formulations. Do not use different formulations of cat's claw at the same time without medical advice. Using different formulations together increases the risk of an overdose of cat's claw.
Store at room temperature away from moisture and heat.
Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra cat's claw to make up the missed dose.
Follow your healthcare provider's instructions about any restrictions on food, beverages, or activity.
Less serious side effects may include:
dizziness;
headaches; or
vomiting.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Do not take cat's claw without medical advice if you are using any of the following medications:
an antibiotic or antifungal medication;
an antidepressant;
anti-malaria medication;
asthma or allergy medication;
cancer medicine;
cholesterol-lowering drugs such as atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor);
erectile dysfunction medicine
heart or blood pressure medication;
HIV or AIDS medication;
medicine to treat a psychiatric disorder;
medicines used to prevent organ transplant rejection, such as cyclosporine (Gengraf, Neoral, Sandimmune), sirolimus (Rapamune), or tacrolimus (Prograf);
migraine headache medicine;
a sedative such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), flurazepam (Dalmane), midazolam (Versed);
seizure medication;
steroid medication;
stomach acid reducers; or
drugs that weaken your immune system, such as azathioprine (Imuran), basiliximab (Simulect), daclizumab (Zenapax), efalizumab (Raptiva), muromonab-CD3 (Orthoclone), or mycophenolate mofetil (CellCept).
This list is not complete and other drugs may interact with cat's claw. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
See also: cat's claw side effects (in more detail)
Treating high blood pressure and chronic stable angina (chest pain). It may be used alone or in combination with other medicines. It may also be used for other conditions as determined by your doctor.
Cartia XT 24-Hour Sustained-Release Beads Capsules are a calcium channel blocker. It works by relaxing (dilating) your blood vessels, lowering blood pressure, and decreasing heart rate, which lowers the workload of the heart. It also dilates coronary arteries, which increases blood flow to the heart.
Contact your doctor or health care provider right away if any of these apply to you.
Some medical conditions may interact with Cartia XT 24-Hour Sustained-Release Beads Capsules. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
Some MEDICINES MAY INTERACT with Cartia XT 24-Hour Sustained-Release Beads Capsules. Tell your health care provider if you are taking any other medicines, especially any of the following:
This may not be a complete list of all interactions that may occur. Ask your health care provider if Cartia XT 24-Hour Sustained-Release Beads Capsules may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Use Cartia XT 24-Hour Sustained-Release Beads Capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Ask your health care provider any questions you may have about how to use Cartia XT 24-Hour Sustained-Release Beads Capsules.
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Constipation; dizziness; facial flushing; headache; lightheadedness; tiredness; weakness.
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); chest pain; fainting; fast, slow, or irregular heartbeat; fever, chills, or sore throat; hallucinations; mental or mood changes; personality changes; reddened, blistered, or swollen skin; severe or persistent dizziness, lightheadedness, nausea, or vomiting; shortness of breath; sudden weight gain; swelling of the feet, ankles, or hands; symptoms of liver problems (eg, dark urine, pale stools, yellowing of the skin or eyes); tender, bleeding, or swollen gums; unusual bleeding or bruising; unusual or persistent tiredness or weakness; vision changes.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
See also: Cartia XT side effects (in more detail)
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include confusion; difficulty breathing, especially when lying down; dizziness; drowsiness; fainting; lightheadedness, especially when standing; loss of consciousness; nausea; nervousness; slurred speech; unusual weakness; very slow heart rate.
Store Cartia XT 24-Hour Sustained-Release Beads Capsules at room temperature, between 59 and 77 degrees F (15 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Cartia XT 24-Hour Sustained-Release Beads Capsules out of the reach of children and away from pets.
This information is a summary only. It does not contain all information about Cartia XT 24-Hour Sustained-Release Beads Capsules. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.
Class: Third Generation Cephalosporins
Chemical Name: [6R-[6α,7β(Z)]]-1-[[7-[[(2-Amino-4-thiazolyl) [(1 - carboxy - 1 - methylethoxy)imino]acetyl]amino] - 2 - carboxy - 8 - oxo - 5 - thia - 1 - azabicyclo[4.2.0]oct - 2 - en - 3 - yl]methyl] pyridinium hydroxide, inner salt, pentahydrate
CAS Number: 78436-06-2
Brands: Fortaz
Antibacterial; β-lactam antibiotic; third generation cephalosporin.1 3 7 10 45 50 53 54 56 147 150 203 217
Treatment of bone and joint infections caused by susceptible Staphylococcus aureus (oxacillin-susceptible strains only) Klebsiella, or Pseudomonas aeruginosa.1 104 118 136 298
Treatment of gynecologic infections (including endometritis, pelvic cellulitis, other infections of the female genital tract) caused by susceptible Escherichia coli.1
Treatment of intra-abdominal infections (including peritonitis) caused by susceptible S. aureus (oxacillin-susceptible strains only), E. coli, or Klebsiella.1
Treatment of polymicrobial intra-abdominal infections caused by susceptible aerobic and anaerobic bacteria and Bacteroides.1 136 137 Consider that many strains of B. fragilis are resistant; generally should not be used alone in serious intra-abdominal infections when this organism may be involved.1 a
Treatment of meningitis caused by susceptible H. influenzae, Neisseria meningitidis, Ps. aeruginosa, or Streptococcus pneumoniae in adults or children.1 46 47 50 137 254
Ceftazidime in conjunction with an aminoglycoside considered a regimen of choice for treatment of meningitis caused by susceptible P. aeruginosa13 14 112 147 218 337 354 or susceptible Enterobacteriaceae† (e.g., E. coli, P. mirabilis, Enterobacter, S. marcescens).46 47 218 222 223 224 335
Cefotaxime or ceftriaxone generally preferred when a third generation cephalosporin is indicated for treatment of meningitis caused by H. influenzae, N. meningitidis, or S. pneumoniae.47 150 216 218 335 336 337 338
Treatment of respiratory tract infections (including pneumonia) caused by susceptible S. aureus (oxacillin-susceptible [methicillin-susceptible] strains only), S. pneumoniae, Citrobacter, Enterobacter, E. coli, Klebsiella, Proteus mirabilis, Pseudomonas (including Ps. aeruginosa), or Serratia.1 103 108 117 118 119 120 137 143 144 146 147 148
For treatment of community-acquired pneumonia (CAP) caused by Ps. aeruginosa, ATS and IDSA recommend a combination regimen that includes an antipseudomonal β-lactam (cefepime, ceftazidime, aztreonam, imipenem, meropenem, piperacillin, ticarcillin) given in conjunction with ciprofloxacin, levofloxacin, or an aminoglycoside.227
Treatment of septicemia caused by susceptible S. aureus (oxacillin-susceptible strains only), S. pneumoniae, Haemophilus influenzae, E. coli, Klebsiella, Ps. aeruginosa, or Serratia.1 115 118 119 120 146
Treatment of skin and skin structure infections caused by susceptible S. aureus (oxacillin-susceptible strains only), S. pyogenes (group A β-hemolytic streptococci), Enterobacter, E. coli, Klebsiella, Proteus (including P. mirabilis), Ps. aeruginosa, or Serratia.1 115 118 119 120 136 146
Treatment of uncomplicated and complicated UTIs caused by susceptible Enterobacter, E. coli, Klebsiella, Proteus (including P. mirabilis), Ps. aeruginosa, or Serratia.1 106 113 115 118 119 137 141 145 153
Treatment of septicemia or pulmonary infections caused by Burkholderia cepacia† (formerly Ps. cepacia);147 208 218 345 alone or in conjunction with an aminoglycoside.147 208 218 345 Co-trimoxazole considered drug of choice; ceftazidime, chloramphenicol, or imipenem are alternatives.218
Treatment of severe melioidosis† caused by B. pseudomallei (formerly Ps. pseudomallei).218 264 266 267 276 277 346 355 356 357 358 Localized or mild disease may be effectively treated with a prolonged regimen of oral anti-infectives (e.g., co-trimoxazole with or without doxycycline).356 Severe illness usually treated with an initial parenteral regimen of ceftazidime, imipenem, or meropenem (some clinicians recommend that co-trimoxazole also be included, especially if the patient is septicemic) followed by prolonged maintenance with oral anti-infectives (e.g., co-trimoxazole with or without doxycycline).261 355 356 357 358 B. pseudomallei is difficult to eradicate (relapse of melioidosis is common).264 266 276 346 355 a
Treatment of malignant otitis externa† caused by Ps. aeruginosa.352 353
Acute bacterial otitis externa localized in the external auditory canal may be effectively treated using topical anti-infectives (e.g., otic preparations of ciprofloxacin or ofloxacin), but malignant otitis externa is an invasive, potentially life-threatening infection (especially in immunocompromised patients such as those with diabetes mellitus or HIV infection) and requires prompt diagnosis and long-term treatment with parenteral anti-infectives (e.g., ceftazidime and/or ciprofloxacin).352 353
Generally considered a drug of choice for treatment of infections caused by Ps. aeruginosa,50 57 147 186 198 including acute exacerbations of bronchopulmonary Ps. aeruginosa infections in children and adults with cystic fibrosis.28 119 125 126 128 129 130 132 134 147 150 154 208 246 313 332 348
In severe infections, especially in immunocompromised patients, concomitant use of ceftazidime and an aminoglycoside (e.g., amikacin, gentamicin, tobramycin) is recommended.218 Consider that ceftazidime-resistant strains of Ps. aeruginosa can emerge during therapy and superinfection with resistant strains has occurred.50 111 115 147
Anti-infective therapy in patients with cystic fibrosis may result in clinical improvement and Ps. aeruginosa may be temporarily cleared from the sputum, but a bacteriologic cure is rarely obtained and should not be expected.28 119 125 126 132 149 150 208 246 313
Treatment of infections caused by Vibrio vulnificus†.219 256
Optimum anti-infective therapy has not been identified; a tetracycline or third generation cephalosporin (e.g., cefotaxime, ceftazidime) is recommended.218 219 256 Because the case fatality rate associated with V. vulnificus is high, initiate anti-infective therapy promptly if indicated.256 262
Empiric treatment of presumed bacterial infections in febrile neutropenic adults or children†.122 123 124 138 139 140 212 228 247 248 249 275 279 280 286 287 288 289 290 291 292 294 295 347 349 Has been used alone or in conjunction with an aminoglycoside (e.g., amikacin, gentamicin, tobramycin).124 138 139 140 212 228 247 248 249 275 290 292 295
Consider that gram-positive bacteria have become a predominant pathogen in febrile neutropenic patients and that ceftazidime is less active against gram-positives than many other cephalosporins and β-lactam antibiotics.122 124 212 222 229 281 282 284 An anti-infective active against staphylococci (e.g., vancomycin) probably should be used concomitantly if ceftazidime is used for empiric therapy.122 124 132 138 139 140 212 222 229 247
Consult published protocols for the treatment of infections in febrile neutropenic patients for specific recommendations regarding selection of the initial empiric regimen, when to change the initial regimen, possible subsequent regimens, and duration of therapy in these patients.282 Consultation with an infectious disease expert knowledgeable about infections in immunocompromised patients also is advised.281 282
Has been used for perioperative prophylaxis† in patients undergoing vaginal hysterectomy,151 intra-abdominal surgery,167 or transurethral resection of the prostate.142
Other cephalosporins or cephamycins (cefazolin, cefotetan, cefoxitin) are preferred drugs for perioperative prophylaxis.220 Ceftazidime and other third generation cephalosporins usually not used for perioperative prophylaxis since they are expensive, some are less active against staphylococci than cefazolin, they have a spectrum of activity wider than necessary for organisms encountered in elective surgery, and their use for prophylaxis promotes emergence of resistant organisms.147 220 221 222
Administer by intermittent IV injection or infusion or by deep IM injection.1 217 Also has been administered by continuous IV infusion†.299 300 301 302 310 332 348
Has been administered intraperitoneally in dialysis solutions.1 27 217 Should not be administered by intra-arterial injection since arteriospasm and necrosis can occur.1 217
IV route preferred for treatment of septicemia, meningitis, peritonitis, or other severe or life-threatening infections and in patients with lowered resistance resulting from malnutrition, trauma, surgery, diabetes, heart failure, or malignancy, particularly if shock is present or impending.1 217
The commercially available frozen ceftazidime injection in dextrose should be used only for IV infusion.1
For intermittent IV injection, reconstitute vials containing 500 mg, 1 g, or 2 g with 5.3 mL, 10, or 10 mL, respectively, of sterile water for injection to provide solutions containing approximately 100, 100, or 170mg/mL, respectively.1 217
Shake vial after adding the diluent;1 217 carbon dioxide is released as drug dissolves and the solution will become clear within 1–2 minutes.1 217 When withdrawing a dose from reconstituted vials, consider that the solution may contain some carbon dioxide bubbles which should be expelled from the syringe before injection.1 217
Inject appropriate dose of reconstituted solution into a vein over a period of 3–5 minutes or slowly into the tubing of a compatible IV solution.1 217
Reconstitute vials of containing 1 or 2 g of ceftazidime with 100 mL of sterile water for injection or compatible IV solution.1 217 Shake the vial after adding the diluent;1 217 carbon dioxide is released as the drug dissolves and the solution will become clear within 1–2 minutes.1 217 The appropriate dose of the drug should then be added to a compatible IV solution.1 217
Reconsitute pharmacy bulk packages according to the manufacturer's directions and then further dilute in a compatible IV infusion solution prior to administration.1 233
ADD-Vantage vials labeled as containing 1 or 2 g of ceftazidime should be reconstituted according to the manufacturer’s directions.1 217
Thaw the commercially available injection (frozen) at room temperature or in a refrigerator; do not force thaw by immersion in a water bath or by exposure to microwave radiation.1 A precipitate may have formed in the frozen injection, but should dissolve with little or no agitation after reaching room temperature.1 Discard thawed injection if an insoluble precipitate is present or if container seals or outlet ports are not intact.1 231 232 The injection should not be used in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete.1 231 232
Intermittent IV infusions generally have been infused over 15–30 minutes in adults,8 102 104 105 115 116 118 119 133 137 139 144 neonates,34 and children.108 157
If a Y-type administration set is used, the other solution flowing through the tubing should be discontinued while ceftazidime is being infused.1 217 262
IM injections should be made deeply into a large muscle mass, such as the upper outer quadrant of the gluteus maximus or lateral part of the thigh.1 217
IM injections are prepared by adding 1.5 or 3 mL of sterile or bacteriostatic water for injection or 0.5 or 1% lidocaine hydrochloride injection to vials containing 500 mg or 1 g of ceftazidime, respectively, to provide solutions containing approximately 280 mg/mL.1
Shake the vial after adding the diluent;1 217 carbon dioxide is released as the drug dissolves and the solution will become clear within 1–2 minutes.1 217 When withdrawing a dose from reconstituted vials, consider that the solution may contain some carbon dioxide bubbles which should be expelled from the syringe before injection.1 217
Reconstitute with sterile water for injection as for IV infusion221 and then further dilute in a compatible peritoneal dialysis solution to provide a solution containing 250 mg of ceftazidime in each 2 L of dialysis solution.1 217
Available as ceftazidime pentahydrate and as ceftazidime sodium; dosage expressed as anhydrous ceftazidime.1 3 217
Neonates ≤4 weeks of age: manufacturer recommends 30 mg/kg every 12 hours.1 217
Neonates <1 week of age: AAP recommends 50 mg/kg every 12 hours in those weighing ≤2 kg and 50 mg/kg every 8 or 12 hours in those weighing >2 kg.261
Neonates 1–4 weeks of age: AAP recommends 50 mg/kg every 12 hours in those weighing <1.2 kg and 50 mg/kg every 8 hours in those weighing ≥1.2 kg.261
25–50 mg/kg every 8 hours.1 38 103 107 217 254 261 Use 50 mg/kg every 8 hours in immunocompromised children or children with cystic fibrosis.1 28 30 108 126 128 129 149 217
AAP recommends 75–100 mg/kg daily in 3 equally divided doses for the treatment of mild to moderate infections or 125–150 mg/kg daily in 3 equally divided doses for the treatment of severe infections.261
Use usual adult dosage.1 217 (See Adult Dosage under Dosage and Administration.)
Some clinicians recommend 100–150 mg/kg daily in 2 or 3 equally divided doses for neonates ≤7 days of age and 150 mg/kg daily in 3 divided doses in older neonates and children.354
Because of a high rate of relapse, treatment duration should be ≥3 weeks for meningitis caused by gram-negative bacilli.335 337 354 In neonates, some clinicians recommend that treatment be continued for 2 weeks beyond the first sterile CSF culture or at least 3 weeks, whichever is longer.354
60 mg/kg daily in 2 equally divided doses recommended by some clinicians for children <2 months of age or 100 mg/kg daily in 3 equally divided doses for children ≥2 months of age.357 Concomitant co-trimoxazole or doxycycline may be indicated in septicemic or other severe cases.357
Continue initial parenteral regimen for at least 14 days and until there is clinical improvement.355 356 357 When appropriate, switch to an oral maintenance regimen (e.g., oral co-trimoxazole with or without oral doxycycline) and continue for at least 3–6 months to prevent recrudence or relapse.355 356 357 More prolonged oral maintenance therapy (up to 12 months) may be necessary, depending on the response to therapy and severity of initial illness.356 357
50 mg/kg (maximum 2 g) every 8 hours has been used in pediatric patients ≥2 years of age.347
1 g every 8–12 hours.1 217
2 g every 8 hours,1 especially in immunocompromised patients.1
2 g every 12 hours.1 104 217
2 g every 8 hours.1 217
2 g every 8 hours.1 217 354 Duration of treatment is ≥3 weeks for meningitis caused by susceptible gram-negative bacilli.335 337 354
0.5–1 g every 8 hours.1 217
30–50 mg/kg every 8 hours (up to 6 g daily).1 28 30 50 125 126 128 129 149 217 246 348
Clinical improvement may occur, but bacteriologic cures should not be expected in patients with chronic respiratory disease and cystic fibrosis.1 28 119 125 126 132 149 150 208 217
0.5–1 g every 8 hours.1 104 217
250 mg every 12 hours.1 104 217
500 mg every 8–12 hours.1 104 217
40 mg/kg every 8 hours recommended by US Army Medical Research Institute of Infectious Diseases (USAMRIID).356 Others recommend 2 g every 8 hours (up to 6 g daily)357 or 50 mg/kg (up to 2 g) every 6 hours.355 358 Concomitant co-trimoxazole or doxycycline may be indicated in septicemic or other severe cases.355 356 357 358
Continue initial parenteral regimen for at least 14 days and until there is clinical improvement.355 356 357 358 When appropriate, switch to an oral maintenance regimen (e.g., oral co-trimoxazole with or without oral doxycycline) and continue for at least 3–6 months to prevent recrudence or relapse.355 356 357 358 More prolonged oral maintenance therapy (up to 12 months) may be necessary, depending on the response to therapy and severity of initial illness.356 357
Maximum 6 g daily.1
Maximum 6 g daily.1 217 221 225
Dosage adjustments not required unless renal function also impaired.1 150 217
Reduce dosage in patients with Clcr ≤50 mL/minute.1 217
Manufacturers recommend that adults with Clcr ≤50 mL/minute receive an initial loading dose of 1 g and a maintenance dosage based on Clcr.1 217 (See Table.)
Clcr (mL/minute) | Dosage |
|---|---|
31–50 | 1 g every 12 h |
16–30 | 1 g every 24 h |
6–15 | 500 mg every 24 h |
<5 | 500 mg every 48 h |
Patients with renal impairment and severe infections who would generally receive 6 g daily if renal function were normal: increase dosage in table by 50% or dosing interval may be increased appropriately.1
Patients undergoing hemodialysis: given an initial loading dose of 1 g followed by 1 g after each hemodialysis period.1 217 221
Patients undergoing intraperitoneal dialysis or CAPD: given an initial loading dose of 1 g followed by 500 mg every 24 hours.1 217 221
Cautious dosage selection because of age-related decreases in renal function.1 (See Renal Impairment under Dosage and Administration.)
Known hypersensitivity to ceftazidime or other cephalosporins.1
Possible emergence and overgrowth of nonsusceptible organisms with prolonged therapy.1 Careful observation of the patient is essential.1 217 Institute appropriate therapy if superinfection occurs.1 217
Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile.1 C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) has been reported with nearly all anti-infectives, including ceftazidime, and may range in severity from mild diarrhea to fatal colitis.1 217 Hypertoxin producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.1
Consider CDAD if diarrhea develops and manage accordingly.1 Careful medical history is necessary since CDAD has been reported to occur as late as 2 months or longer after anti-infective therapy is discontinued.1
If CDAD is suspected or confirmed, the anti-infective may need to be discontinued.1 Some mild cases of CDAD may respond to discontinuance alone.1 217 339 340 341 342 343 Manage moderate to severe cases with fluid, electrolyte, and protein supplementation, anti-infective therapy active against C. difficile (e.g., oral metronidazole or vancomycin), and surgical evaluation when clinically indicated.1 217 339 340 341 342 343
Possibility of seizures, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia if inappropriately high dosage used in patients with renal impairment.1 (See Renal Impairment under Cautions.)
Possible hypersensitivity reactions, including rash (maculopapular or erythematous), pruritus, fever, eosinophilia, urticaria, anaphylaxis, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis.1 217 a
If an allergic reaction occurs, discontinue and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway and oxygen).1 217
Partial cross-sensitivity among cephalosporins and other β-lactam antibiotics, including penicillins and cephamycins.1 217 a
Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs.1 217 Cautious use recommended in individuals hypersensitive to penicillins:1 217 a avoid use in those who have had an immediate-type (anaphylactic) hypersensitivity reaction and administer with caution in those who have had a delayed-type (e.g., rash, fever, eosinophilia) reaction.a
Use with caution in patients with a history of GI disease, particularly colitis.1 217 (See Superinfection/Clostridium difficile-associated Diarrhea and Colitis under Cautions.)
Possibility of prolonged PT.1 217
Monitor PT in patients at risk, including those with renal or hepatic impairment, poor nutritional state, receiving prolonged therapy, or stabilized on anticoagulant therapy.1 217 Administer vitamin K when indicated.1 217
To reduce development of drug-resistant bacteria and maintain effectiveness of ceftazidime and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.1 217
When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.1 217 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.1 217
Resistance caused by inducible type I β-lactamases can develop in some gram-negative bacilli (e.g., Enterobacter, Pseudomonas, Serratia) during treatment, leading to clinical failure in some cases.1
When treating infections caused by these bacteria, perform periodic in vitro susceptibility testing when clinically appropriate.1 If patient fails to respond to monotherapy, an aminoglycoside or similar agent should be considered.1
Possibility of distal necrosis after inadvertent intra-arterial administration.1
Vials, pharmacy bulk packages, and ADD-Vantage vials contain ceftazidime admixed with sodium carbonate to facilitate dissolution.1 217 233 These preparations contain approximately 54 mg (2.3 mEq) of sodium per g of ceftazidime.1 217 233
Category B.1
Distributed into milk in low concentrations; use with caution.1
No overall differences in safety and efficacy in those ≥65 years of age compared with younger adults, but the possibility of increased sensitivity in some geriatric individuals cannot be ruled out.1
Substantially eliminated by kidneys; risk of toxicity may be greater in those with impaired renal function.1 Select dosage with caution and assess renal function periodically because of age-related decreases in renal function.1 (See Renal Impairment under Dosage and Administration.)
Pharmacokinetics not affected.1
Possible decreased clearance and increased serum half-life.1
Neurotoxicity reported in some patients with renal impairment who received dosage inappropriately high for their renal status.1 (See Neurotoxicity under Cautions.)
Dosage adjustments necessary in patients with Clcr ≤50 mL/minute.1 See Renal Impairment under Dosage and Administration.
GI effects, hypersensitivity reactions, local reactions at IV injection sites.1
Drug or Test | Interaction | Comments |
|---|---|---|
Aminoglycosides | Nephrotoxicity reported with concomitant use of some cephalosporins and aminoglycosides1 209 217 In vitro evidence of additive or synergistic antibacterial activity against Pseudomonas and Enterobacteriaceae1 50 63 90 147 186 187 191 217 | Carefully monitor renal function, especially if high aminoglycoside dosage is used or if therapy is prolonged1 217 |
Chloramphenicol | In vitro evidence of antagonism against gram-negative bacilli1 270 271 272 273 274 | Avoid concomitant use1 274 |
Probenecid | No appreciable effect on pharmacokinetics of ceftazidime1 5 10 24 50 130 147 164 217 | |
Tests for glucose | Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution1 173 a | Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix, Tes-Tape)1 173 a |
Not absorbed from GI tract; must be given parenterally.3 50
Following IM administration, peak serum concentrations attained in approximately 1 hour.1 6 12 217 May be absorbed more slowly in women than in men following IM injection into the gluteus maximus or vastus lateralis.6 In women, peak serum concentrations may be lower following IM injection into the gluteus maximus than into the vastus lateralis.6
In patients with end-stage chronic renal failure who receive a single dose of the drug via an intraperitoneal catheter, peak serum concentrations attained 2.75 hours after the dose.27
Widely distributed into body tissues and fluids including the gallbladder,24 169 255 bone,1 3 23 147 168 203
