What are the common side effects of atorvastatin. How does atorvastatin cause dry mouth. Can statins lead to xerostomia. What is the link between cardiovascular medications and oral health. How to manage dry mouth caused by statins.

What is Xerostomia and How is it Related to Statin Use?

Xerostomia, commonly known as dry mouth, is a condition characterized by a lack of saliva production or altered saliva composition. This oral health issue has been increasingly recognized as a potential side effect of various medications, including statins – a class of drugs widely prescribed for managing cholesterol levels.

There are two primary types of xerostomia:

• Type 1: Associated with severely reduced salivary secretion
• Type 2: Involving normal salivary function but reduced saliva viscosity or mucin concentration (common in elderly individuals)

Research has shown that xerostomia is the most prevalent oral side effect of cardiovascular medications, including statins. This connection warrants closer examination, as it impacts patients’ quality of life and may influence medication adherence.

The Mechanism Behind Statin-Induced Dry Mouth

While the exact mechanism by which statins cause dry mouth is not fully understood, several theories have been proposed:

1. Altered salivary gland function: Statins may interfere with the normal functioning of salivary glands, leading to reduced saliva production.
2. Changes in saliva composition: The drugs might affect the composition of saliva, altering its viscosity and lubricating properties.
3. Neurotransmitter disruption: Statins could potentially impact the neural signals that regulate saliva production.
4. Metabolic effects: The cholesterol-lowering action of statins might indirectly affect salivary gland metabolism.

Further research is needed to elucidate the precise pathways involved in statin-induced xerostomia.

Clinical Case Study: Atorvastatin and Xerostomia

A compelling case study highlights the potential link between statin use and xerostomia:

A 55-year-old Asian woman, non-smoker and teetotaler, with bilateral xanthelasma, was initially prescribed simvastatin for hypercholesterolemia and elevated lipoprotein a. After experiencing adverse effects from nicotinic acid, she was switched to simvastatin 20 mg, later increased to 40 mg.

Within weeks, the patient developed persistent oral dryness, present both day and night. While nocturnal dry mouth can be attributed to factors like snoring and mouth breathing during sleep, daytime xerostomia often indicates an underlying systemic condition or medication side effect.

The patient was temporarily switched from simvastatin to atorvastatin due to persistently high LDL cholesterol. Interestingly, when atorvastatin was discontinued for four weeks, her xerostomia symptoms significantly improved, suggesting a causal relationship between statin use and dry mouth.

Prevalence and Underreporting of Statin-Induced Xerostomia

The true prevalence of statin-induced xerostomia may be underestimated due to several factors:

• Patient perception: Many individuals consider dry mouth a minor inconvenience and fail to report it to their healthcare providers.
• Lack of awareness: Both patients and healthcare professionals may not associate xerostomia with statin use.
• Focus on other side effects: More well-known side effects of statins, such as muscle pain, may overshadow oral health concerns.
• Limited research: There is a need for more comprehensive studies examining the relationship between statins and xerostomia.

These factors highlight the importance of increased awareness and proactive questioning about oral health symptoms in patients taking statins.

Common Side Effects of Statins: Beyond Dry Mouth

While xerostomia is an important consideration, it’s crucial to understand the broader spectrum of potential statin side effects. Common side effects include:

• Headache
• Dizziness
• Nausea
• Feeling unusually tired or physically weak
• Digestive system problems, such as constipation, diarrhea, indigestion, or flatulence
• Muscle pain
• Sleep problems
• Low blood platelet count

Less common side effects may include:

• Skin rash
• Loss of appetite
• Weight gain
• Inflammation of the liver (hepatitis), which can cause flu-like symptoms
• Inflammation of the pancreas (pancreatitis), which can cause stomach pain
• Memory problems

Rare but Serious Side Effects

In rare cases, statins can lead to more severe side effects that require immediate medical attention:

• Muscle weakness (myopathy)
• Loss of sensation or tingling in nerve endings of hands and feet (peripheral neuropathy)
• Tendon problems

Muscle inflammation and damage are of particular concern. Patients experiencing unexplained muscle pain, tenderness, or weakness should consult their healthcare provider promptly.

Managing Xerostomia in Statin Users

For patients experiencing dry mouth as a side effect of statin therapy, several management strategies can be employed:

1. Hydration: Encourage increased water intake throughout the day.
2. Saliva substitutes: Over-the-counter artificial saliva products can provide temporary relief.
3. Sugar-free gum or lozenges: These can stimulate saliva production.
4. Oral hygiene: Maintain excellent oral care to prevent complications like tooth decay.
5. Humidifiers: Using a humidifier, especially at night, can help maintain oral moisture.
6. Medication adjustment: In some cases, changing the statin dose or switching to a different statin may alleviate symptoms.
7. Complementary therapies: Acupuncture or certain herbal remedies may offer relief for some patients.

It’s crucial for patients to discuss any persistent dry mouth symptoms with their healthcare provider to determine the best course of action.

The Importance of Balancing Cardiovascular Benefits and Side Effects

While xerostomia and other side effects are important considerations, it’s essential to weigh these against the significant cardiovascular benefits of statin therapy. Statins have been shown to:

• Lower LDL cholesterol levels
• Reduce the risk of heart attacks and strokes
• Stabilize arterial plaques
• Decrease inflammation in blood vessels

For many patients, the cardiovascular protection offered by statins outweighs the potential risk of side effects. However, individualized assessment is crucial to ensure optimal patient care.

Personalized Medicine Approach

Healthcare providers should consider several factors when prescribing statins:

• Patient’s overall cardiovascular risk
• Presence of other medical conditions
• Potential drug interactions
• Individual susceptibility to side effects
• Patient preferences and quality of life considerations

By taking a personalized approach, clinicians can maximize the benefits of statin therapy while minimizing the impact of side effects like xerostomia.

Future Research Directions in Statin-Induced Xerostomia

To better understand and address the issue of statin-induced dry mouth, several areas of research warrant further investigation:

1. Prevalence studies: Large-scale epidemiological studies to accurately determine the prevalence of xerostomia among statin users.
2. Mechanism elucidation: In-depth research into the biological pathways by which statins affect salivary function.
3. Comparative studies: Evaluations of different statin types and their propensity to cause xerostomia.
4. Long-term effects: Investigation of the long-term oral health consequences of statin-induced dry mouth.
5. Management strategies: Development and testing of targeted interventions to alleviate statin-related xerostomia.
6. Genetic factors: Exploration of genetic predispositions that may increase susceptibility to this side effect.
7. Quality of life assessments: Studies examining the impact of statin-induced xerostomia on patients’ overall well-being and medication adherence.

Advances in these areas could lead to improved patient care and more tailored approaches to statin therapy.

The Role of Healthcare Providers in Addressing Statin-Induced Xerostomia

Healthcare professionals play a crucial role in identifying, managing, and preventing statin-induced xerostomia. Key responsibilities include:

• Patient education: Informing patients about potential side effects, including dry mouth, before initiating statin therapy.
• Regular monitoring: Incorporating oral health assessments into routine follow-up visits for statin users.
• Prompt intervention: Addressing xerostomia symptoms early to prevent complications and improve quality of life.
• Interdisciplinary collaboration: Working with dental professionals to ensure comprehensive oral health care for statin users.
• Pharmacovigilance: Reporting suspected cases of statin-induced xerostomia to relevant authorities to improve drug safety monitoring.
• Continuing education: Staying informed about the latest research and guidelines regarding statin side effects and management.

By taking a proactive approach, healthcare providers can help patients navigate the challenges of statin therapy while maintaining optimal oral and cardiovascular health.

Patient Communication Strategies

Effective communication between healthcare providers and patients is essential for managing statin-induced xerostomia. Consider the following approaches:

• Use clear, non-technical language when discussing side effects
• Encourage patients to report any unusual symptoms, no matter how minor they may seem
• Provide written information about potential side effects and management strategies
• Use visual aids to explain the relationship between statins and oral health
• Offer regular check-ins to assess medication tolerance and address any concerns

By fostering open dialogue, healthcare providers can ensure that patients feel supported and empowered in their treatment journey.

Integrating Oral Health into Cardiovascular Care

The connection between statin use and xerostomia highlights the need for a more integrated approach to patient care. Consider the following strategies for incorporating oral health into cardiovascular management:

1. Routine oral health screenings: Include basic oral health assessments during cardiovascular check-ups.
2. Collaborative care models: Establish partnerships between cardiologists, primary care physicians, and dental professionals.
3. Patient education programs: Develop comprehensive education materials that address both cardiovascular and oral health.
4. Risk assessment tools: Create screening tools that help identify patients at higher risk for statin-induced xerostomia.
5. Telemedicine options: Utilize remote consultations to provide ongoing oral health support for statin users.
6. Research initiatives: Encourage cross-disciplinary research projects exploring the links between cardiovascular medications and oral health.

By adopting a holistic approach to patient care, healthcare systems can better address the complex interplay between cardiovascular treatments and oral health outcomes.

The Potential of Precision Medicine

As our understanding of pharmacogenomics and individual drug responses advances, there is growing potential for precision medicine approaches in statin therapy. This could include:

• Genetic testing to identify patients at higher risk for xerostomia
• Tailored statin selection based on individual risk profiles
• Personalized dosing strategies to minimize side effects
• Development of novel statin formulations with reduced impact on salivary function

While these approaches are still in the early stages of research, they hold promise for optimizing statin therapy and reducing the incidence of side effects like xerostomia.

Conclusion

Xerostomia, or dry mouth, is an often overlooked but potentially significant side effect of statin therapy. As our understanding of this connection grows, it becomes increasingly important for healthcare providers to consider oral health impacts when prescribing and monitoring statin use.

By raising awareness, conducting further research, and implementing comprehensive management strategies, we can work towards optimizing the balance between cardiovascular protection and oral health preservation in statin users. This holistic approach to patient care not only addresses immediate symptoms but also contributes to improved long-term health outcomes and quality of life for individuals managing hypercholesterolemia with statin therapy.

As we continue to unravel the complex relationships between systemic medications and oral health, the case of statin-induced xerostomia serves as a reminder of the importance of interdisciplinary collaboration and patient-centered care in modern medicine. By remaining vigilant, proactive, and open to new evidence, healthcare providers can ensure that patients receive the full benefits of statin therapy while minimizing potential adverse effects on their oral health and overall well-being.

Xerostomia: an unseen consequence of statin use | SFEBES2015 | Society for Endocrinology BES 2015

Xerostomia can be classified into two different types. One type is associated with severely reduced salivary secretion. The other involves normal salivary function yet reduced viscosity of saliva or reduced mucin concentration within the saliva, a common finding in elderly people. Studies show that xerostomia is the most common oral side-effect of cardiovascular medication. Statins are common cardiovascular drugs used to treat hypercholesterolemia. A 55-year-old Asian lady, non-smoker, and a teetotal with bilateral xanthelasma was commenced on simvastatin in August 2011 due to hypercholesterolemia and elevated lipoprotein a. She was initially started on nicotinic acid as it is the most effective treatment for elevated lipoprotein a however as it caused her adverse side effects it was stopped and she was subsequently commenced on 20 mg simvastatin, increased to 40 mg after 4 weeks. Unfortunately she started to develop oral dryness, within a few weeks. This was present throughout the day, as well as the night. Owing to reduced salivary flow rate as a result of snoring and mouth breathing during sleep, nocturnal oral dryness is a normal entity, yet day-time oral dryness is a finding associated with systemic diseases such as Sjögrens disease, diabetes, vitamins A and E deficiencies for which she was negative or pharmaceutical drug use, one of which are statins. She was temporarily changed from simvastatin to atorvastatin due to persistently high LDL cholesterol and the high risk of both CVD and PVD associated with high lipoprotein A. atorvastatin was also stopped for 4 weeks and it substantially did help to minimize her xerostomia. Unfortunately side effects such as xerostomia remain unreported by patients owing to their perception as a minor side effect. This indicates that studies underestimate its true prevalence in statin treatment therefore more studies are required on the association between statins and xerostomia.

Statins – Side effects – NHS

Like all medicines, statins can cause side effects. But most people tolerate them well and do not have any problems.

You should discuss the benefits and risks of taking statins with your doctor before you start taking the medicine.

If you find certain side effects particularly troublesome, talk to the doctor in charge of your care. Your dose may need to be adjusted or you may need a different type of statin.

The main side effects of statins are listed here. Some of these will not necessarily apply to the specific statin you’re taking.

For details of the side effects of a particular statin, check the information leaflet that comes with your medicine.

Common side effects

Side effects can vary between different statins, but common side effects include:

Uncommon side effects

Uncommon side effects of statins include:

Rare side effects

Rare side effects of statins include:

• muscle weakness (myopathy)
• loss of sensation or tingling in the nerve endings of the hands and feet (peripheral neuropathy)
• tendon problems (tendons are tough cords of tissue that connect muscles to bones)

Muscle effects

Statins can occasionally cause muscle inflammation (swelling) and damage. Speak to your doctor if you have muscle pain, tenderness or weakness that cannot be explained – for example, pain that is not caused by physical work.

Your doctor may carry out a blood test to measure a substance in your blood called creatine kinase (CK), which is released into the blood when your muscles are inflamed or damaged.

If the CK in your blood is more than 5 times the normal level, your doctor may advise you to stop taking the statin. Regular exercise can sometimes lead to a rise in CK, so tell your doctor if you’ve been exercising a lot.

Once your CK level has returned to normal, your doctor may suggest you start taking the statin again, but at a lower dose.

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you’re taking.

It’s run by a medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA).

See the Yellow Card Scheme website for more information.

Page last reviewed: 19 November 2018
Next review due: 19 November 2021

Lipitor (Atorvastatin) Side Effects | Risks & Warnings

Lipitor is a cholesterol-lowering drug that contains the active ingredient atorvastatin. It belongs to a group of drugs called statins. Doctors prescribe these drugs to patients who are at an increased risk for heart disease or who have cardiovascular risks associated with high cholesterol or triglyceride levels.

Doctors widely prescribe these drugs not only because of their proven effectiveness, but also because of their high tolerability and low likelihood of side effects.

Common Side Effects of Lipitor

Most common side effects of Lipitor are minor. But the medication can cause serious side effects, according to the drug label.

Side effects of Lipitor (atorvastatin) include:

• Cold-like symptoms
• Joint pain
• Diarrhea
• Urinary tract infection
• Stomach pain
• Nausea
• Muscle pain and spasms
• Difficulty falling and staying asleep

Though the reactions occurred less often, people who took the drug during clinical trials also reported nose bleeds, blurred vision and ringing in the ears. Still others reported fever, liver problems, abnormal blood and urine test results, and malaise, which is a general feeling of discomfort or uneasiness.

After the medication became available to the public, people reported additional side effects such as tiredness, tendon problems, memory loss and confusion. Other reported issues included dizziness, depression, peripheral neuropathy, pancreatitis and interstitial lung disease. According to the drug label, the cognitive issues were generally not serious and went away after patients stopped taking the drug.

Diabetes Risk

In February 2012, the U.S. Food and Drug Administration approved safety label changes to statin drugs to warn consumers of an increased risk for diabetes in patients who take the drugs. The agency based its decision in part on the Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis In Myocardial Infarction 22 (PROVE-IT TIMI 22) substudy, which associated high-dose atorvastatin with worsening glycemic control.

The announcement came nearly two decades after the FDA approved Lipitor and about two years after evidence of a minimal diabetes risk from the cholesterol drugs first emerged.

Data collected in 2010 from 91,000 patients who had been treated with either a statin or a placebo revealed that about one in every 255 patients who had taken the medication went on to develop diabetes.

But researchers later found this figure to be inaccurate because the study included weaker statins. The drugs used had been introduced to the market earlier than atorvastatin.

The increased diabetes risk only emerged in studies once researchers looked specifically at more potent statins such as Lipitor, Zocor and Crestor. This heightened risk became especially apparent when doctors prescribed the drugs at higher doses.

Fact

Evidence shows statins can cause diabetes, especially in women, the elderly and people of Asian descent.

A Finnish study published in 2015 in the journal Diabetologia showed men prescribed statins had a nearly 50 percent greater chance of developing diabetes after six years on the cholesterol-lowering drug compared to those who weren’t taking the medication.

The study, which included only white male participants, found statins seemed to make people more resistant to insulin’s effects. Additionally, the medications appeared to cause the pancreas to secrete less insulin into the patients’ bloodstream. Patients who started with the “closest to normal” blood glucose levels were affected most by the medicines, according to the study.

Earlier findings published in 2013 in the journal Current Diabetes Reports found “a wealth of evidence” that showed statins increase the risk of diabetes, possibly by impairing the function of special cells in the pancreas that store and release insulin and by decreasing the body’s sensitivity to insulin.

“Groups at particular risk include the elderly, women, and Asians,” the study’s authors wrote.

People who took Lipitor and developed diabetes sued Pfizer over allegations that the company knew of the risk but failed to warn the public. In 2018, a district court dismissed all remaining Lipitor lawsuits after it had sided with Pfizer.

Muscle and Joint Problems

Some Lipitor patients report various types of muscle injuries after taking the drug. Although the likelihood of muscle disease is minimal with statins alone, researchers determined the risk is substantially elevated among patients who take statins at the same time as other medications such as certain antibiotics, antifungals and treatments for HIV and hepatitis C.

“Lipitor can cause serious muscle problems that can lead to kidney problems, including kidney failure,” according to the drug label. “You have a higher chance for muscle problems if you are taking certain other medicines with Lipitor.”

Did you know?

A 2013 study in JAMA Internal Medicine matched about 7,000 statin users with similar nonusers and found musculoskeletal conditions, joint disease, injuries and pain were more common among the statin group.

Myopathy and Rhabdomyolysis

Lipitor occasionally causes myopathy, a condition where muscle tissue fibers do not function as they should. Early symptoms of myopathy include muscle pain, weakness or tenderness, and dark urine. These signs typically appear within the first few months of statin therapy. Other symptoms might include muscle cramps, stiffness and spasm.

Researchers have linked a particularly severe form of myopathy called rhabdomyolysis to the use of statins. With this potentially life-threatening complication, muscle tissue dies and products of the damaged cells can enter the bloodstream. Some of these products are toxic to the kidneys and may lead to kidney failure. While rhabdomyolysis only occurs in about 0.1 percent of patients who take statins, the risk increases for patients who also take certain other drugs such as macrolides.

“All patients starting therapy with Lipitor should be advised of the risk of myopathy and told to report promptly any unexplained muscle pain, tenderness, or weakness,” according to the drug label.

Grapefruit Juice

The risk of myopathy increases when Lipitor users drink more than 1 liter of grapefruit juice.

Immune-Mediated Necrotizing Myopathy (IMNM)

Some post-marketing reports associate immune-mediated necrotizing myopathy with statin use. This particular myopathy is characterized by muscle weakness along with elevated levels of serum creatine kinase, which is an enzyme found in muscle and the brain. The elevated levels indicate damage to the muscle or brain. The autoimmune disorder can persist even after statin treatment is stopped. Immunosuppressive agents usually help patients improve.

Liver Problems

Doctors advise against statin therapy for patients with liver problems. Clinical studies revealed Lipitor can damage liver function, and the FDA has received rare post-marketing reports of both fatal and nonfatal liver failure. Other reported liver problems include jaundice, hepatitis, chronic liver damage and fatty changes to the liver.

The agency recommends doctors perform liver enzyme tests before they prescribe Lipitor to determine whether the patient can tolerate treatment. Talk to your doctor about stopping treatment immediately if you develop serious liver injury or jaundice.

Strokes

A study published in The New England Journal of Medicine found atorvastatin reduced the recurrence of ischemic and “mini-strokes” in patients who had recently experienced a stroke. But researchers saw a slight increase in the rate of hemorrhagic strokes, or bleeding on the brain, in patients who took 80 mg of Lipitor daily and had experienced a stroke or mini-stroke in the preceding six months.

The 2006 study was a randomized clinical trial that involved nearly 5,000 participants. The serious side effect was not fatal in the majority of patients affected. However, some cases resulted in death.

Please seek the advice of a medical professional before making health care decisions.

Share This Page:

https://www.drugwatch.com/lipitor/side-effects/Copy Link

Side-effects of Atorvastatin (Lipitor) usage

Treatment with Atorvastatin / Lipitor is not without some unwanted side-effects but is frequently well tolerated. Many side-effects experienced are often mild and transient (short-lived).

Not every patient will experience all known side-effects while on a treatment plan. Some side-effects, although not pleasant, may not require additional medical treatment either as they typically resolve once the body adjusts to use of the medication (i.e. temporary discomfort).

If a side-effect is bothersome, it is best to discuss it with the treating doctor. Depending on the side-effect and level of severity, it may be possible to either prevent or reduce the adverse reaction through dosage control or even a change in medication.

Here is a breakdown of side-effects with a known association with this medication…

1. Highly common side-effects (high frequency occurrence)

• Diarrhoea (5-14%)
• Nasopharyngitis (common cold / viral infection of the nose and throat – nasal congestion, runny nose and sore throat) (4-13%)
• Joint pain (arthralgia) (4-12%)

2. Some other side-effects known to occur (in order of percentage frequency)

• Urinary tract infection (including painful / difficulties with urination – increased frequency, urinary urgency or retention and urinary incontinence) (4-8%)
• Nausea (4-7%)
• Limb pain (3-8%)
• Muscle pain (myalgia) (3-8%)
• Indigestion (dyspepsia) (3-6%)
• Muscle spasms (2-5%)
• Musculoskeletal pain (especially the lower back and side, or around the eyes and cheekbones) (2-5%)
• Joint swelling (more than 2%)
• Dizziness (more than 2%)
• Angina pectoris (chest pain) (more than 2%)
• Swelling (peripheral oedema) (more than 2%)
• Fever (less than 2%)
• Neck pain (rigidity) (less than 2%)
• Malaise (less than 2%)
• Generalised swelling (less than 2%)
• Flatulence (gas) (less than 2%)
• Constipation (less than 2%)
• Belching (eructation) (less than 2%)
• Photosensitivity (sun urticaria) (less than 2%)
• Gastroenteritis (less than 2%)
• Colitis (inflammation of the colon (less than 2%)
• Gastritis (less than 2%)
• Vomiting (less than 2%)
• Stomach ulcer (less than 2%)
• Dry mouth (less than 2%)
• Mouth ulceration (less than 2%)
• Glossitis (inflammation of the tongue) (less than 2%)
• Increased appetite (less than 2%)
• Hepatitis (less than 2%)
• Cholestatic jaundice (reduction or cessation of bile flow from the liver) (less than 2%)
• Pancreatitis (less than 2%)
• Pneumonia (less than 2%)
• Dyspnea (breathing difficulties – shortness of breath or laboured breathing) (less than 2%)
• Asthma (less than 2%)
• Epistaxis (nose bleeds) (less than 2%)
• Leg cramps (less than 2%)
• Myositis (muscular inflammation) (less than 2%)
• Tendinous contracture (muscular or joint shortening) (less than 2%)
• Myasthenia (skeletal muscle weakness) (less than 2%)
• Tenosynovitis (tendon sheath inflammation) (less than 2%)
• Bursitis (inflammation of the bursae – fluid-filled sacs near the joints) (less than 2%)
• Contact dermatitis (skin rash) (less than 2%)
• Dry skin (less than 2%)
• Pruritus (itching of the skin) (less than 2%)
• Sweating (less than 2%)
• Hives (urticaria) (less than 2%)
• Eczema (less than 2%)
• Alopecia (less than 2%)
• Acne (less than 2%)
• Tinnitus (ringing / noise in the ears) (less than 2%)
• Dry eyes (less than 2%)
• Glaucoma (vision loss) (less than 2%)
• Deafness (less than 2%)
• Loss of taste (less than 2%)
• Migraine / headache (less than 2%)
• Syncope (fainting) (less than 2%)
• Postural hypotension (low blood pressure when standing up from a lower position – lying down or seated) (less than 2%)
• Palpitations (rapid heartbeat) (less than 2%)
• Arrhythmia (abnormal heart rhythm) (less than 2%)
• Phlebitis (inflammation of the veins) (less than 2%)
• Hyperglycaemia (high blood sugar) and hypoglycaemia (low blood sugar) (less than 2%)
• Gout (less than 2%)
• Weight gain (less than 2%)
• Anaemia (less than 2%)
• Thrombocytopenia (low platelets in the bloodstream) (less than 2%)
• Petechia (bleeding into the skin from broken capillary vessels, forming small spotty discolourations on the skin) (less than 2%)
• Ecchymosis (bruising discolouration caused by bleeding beneath the skin) (less than 2%)
• Pharyngolaryngeal pain (inflammation) and a hoarse voice (1-4%)
• Insomnia (1-5%)

Other common effects a doctor may pick up on include:

• Increased serum transaminase levels (alanine aminotransferase / ALT, aspartate transaminase / AST)
• Increased blood bilirubin
• Elevated levels of blood serum alkaline phosphatase
• Increased levels of creatine phosphokinase

3. Some other adverse reactions to note but which do not have a defined frequency (‘incidence unknown’) include:

• Increased thirst
• Black / tarry stool
• Cloudy or bloody urine
• Difficulties with night vision (seeing at night)
• Sensitivity to light (vision disturbances)
• Excessive muscle tension or tone
• Increased body movements
• Sensitivity to touch or pain
• Breath changes – fruit-like odour
• Pain in the groin area or scrotum
• Erectile dysfunction
• Low sex drive, desire or ability
• Menstrual bleeding abnormalities (menstrual periods becoming irregular or longer bleeding)
• Pale skin complexion
• Slurred speech
• Swollen lymph glands (in the neck, armpit or groin)
• Abnormal bleeding or bruising
• Increased nervousness
• Paranoia
• Weight loss

4. Adverse reactions which require urgent medical attention

• Breathing difficulties
• Wheezing
• Swelling affecting the facial area, lips, tongue and throat
• Hives (allergic reaction)
• Unexplained muscle pain, tenderness and weakness
• Fever
• Extreme tiredness / fatigue
• Dark coloured urine
• Fainting / syncope (loss of consciousness)

5. Signs which may signal problems with the liver and thus require prompt medical evaluation include:

• Upper stomach pain
• Body weakness
• Fatigue
• Loss of appetite
• Dark coloured urine
• Jaundice

6. Signs which may signal problems with the kidneys and thus require prompt medical evaluation include:

• Decreased urination (little to none)
• Swollen feet and ankles (fluid retention)
• Fatigue and drowsiness
• Shortness of breath

7. Signs of overdose

• Peripheral neuropathy
• Elevated potassium levels (K+) in the blood
• Diarrhoea
• Myopathy
• Rhabdomyolysis
• Acute renal failure / acute renal injury (decreased urination, fluid retention, drowsiness, shortness of breath, fatigue, confusion, nausea, chest pain or pressure and seizures)
• Eye lens opacities, such as cataracts
• Elevations indicated in liver function tests

Signs of over-dosage must be evaluated by a medical professional as soon as possible. Once a thorough evaluation has taken place, a doctor is likely to treat a patient in a supportive manner according to the combination of overdose symptoms displayed. There is no specific / set treatment procedure for Atorvastatin / Lipitor medication overdose.

Medication Use and Xerostomia – Dimensions of Dental Hygiene

Today, many people manage their ailmentsvia prescription and over–the–counter (OTC) medications, and oftentimes these medications cause oral manifestations including xerostomia, gingival inflammation, oral candidiasis, ulcerations, and mucositis. Xerostomia is the most common oral side effect caused by medication use.¹ The subjective feeling of dry mouth related to a reduction in salivary production and/or alteration of saliva’s chemical composition, xerostomia symptoms include burning mouth, thirst, altered speech, dry lips, and ulcerated mucosa.^2,3

Saliva is essential for the comfort and function of the oral cavity as it lubricates and protects hard and soft tissues and aids in chewing, swallowing, and digestion. It also decreases infection risk and prevents dental caries.^4,5 Saliva is produced by three major glands: the parotid, submandibular, and sublingual (Figure 1).⁴ Salivary gland dysfunction is often associated with hyposalivation, an unstimulated salivary flow (USF) below 0.1 ml/min and a stimulated salivary flow (SSF) below 0.5 ml/min, that results in a 40% to 50% reduction of typical salivary gland secretion.³ This leads to the formation of a thin layer of residual saliva on the hard palate, which triggers the sensation of dry mouth. ³

Figure 1. The parotid (1), submandibular (2), and sublingual (3) glands.

MEDICATIONS THAT CAUSE XEROSTOMIA

According to the United States Surgeon General’s Report on Oral Health in America, dry mouth is a side effect of more than 400 prescription and OTC medications.⁴ The Academy of General Dentistry reports that xerostomia affects approximately one in four Americans, which means that about 25% of the US population is at an increased risk of oral complications due to dry mouth. Older adults are at the greatest risk of xerostomia because of their increased use of medications. As such, dental hygienists need to be familiar with the most frequently prescribed medications that cause xerostomia. The most common groups of medications that cause oral dryness are: cholesterol-lowering drugs; antihypertensives; antihistamines; antidepressants; antianxiety drugs; analgesics; drugs used to treat respiratory, gastrointestinal, and hormonal conditions; and chemotherapeutics. 6,7 Table 1 provides a list of commonly used medications that cause xerostomia.

More than 97 million Americans have high cholesterol.⁸ Commonly known as statins, HMG-CoA reductase inhibitors are used to lower cholesterol levels. Zocor and Lipitor are two commonly prescribed statins. Side effects include increased enzymes, myopathy (muscle weakness), and xerostomia. Hypertension affects approximately 50 million Americans—causing 40,000 deaths per year and contributing to another 200,000. Diuretics were the first drugs used to treat hypertension in the 1950s.⁸ 

Today, angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed to treat hypertension. Xerostomia is a frequent side effect of both ACE inhibitors and diuretics.⁸ Antihistamines are a group of drugs used to treat allergies.⁹ Diphenhydramine is a sedating antihistamine with anticholinergic effects that increases the risk of xerostomia. Loratadine, on the other hand, is a nonsedating antihistamine that creates less of an anticholinergic effect, which decreases the risk of xerostomia. ⁹

Analgesics provide varying levels of pain management depending on their strength.⁹ There are two types of analgesics: nonnarcotic and narcotic. Salicylates, acetaminophen, and nonsteroidal anti-inflammatory drugs are examples of nonnarcotic analgesics.¹⁰ An opioid analgesic (eg, hydrocodone) is a natural or synthetic morphine-like substance used for reducing moderate to severe pain.⁹

Depression affects approximately 5% to 10% of the population.¹⁰ There are three major drug groups used to treat depression: monamine oxidase inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors.¹⁰ Anxiety disorders are the most common type of psychiatric illness in the US, but less than 30% of people seek treatment. ⁸ There are several medications used to treat anxiety disorders; and prescription drugs, such as benzodiazepines and barbiturates, are recommended based on the severity of the condition. ⁹

Respiratory diseases commonly treated with medication include asthma, chronic obstructive pulmonary disease, and upper respiratory tract infections.⁹ Respiratory drugs come from a wide range of medication types ranging from adrenergic drugs for bronchodilation to corticosteroids.⁹ Gastrointestinal drugs are available OTC or are prescribed based on the severity of the condition. Gastroesophageal reflux disease or heartburn is the most prevalent gastrointestinal disease in the US.⁹ Several groups of drugs are used to treat hormonal conditions such as diabetes, thyroid disorders, adrenal gland dysfunction, and contraceptives, including insulin (oral and injectable), antithyroids, estrogens, and steroids.¹⁰

Used in conjunction with surgery and radiation therapy, chemotherapeutic drugs treat various types of cancers or abnormally growing cells. These include alkylating agents, antimetabolites, hormones, antitumor antibiotics, immunomodulators, and plant extracts.  These drugs exert varying types of oral side effects, but all can cause xerostomia. Dental hygienists should educate their patients about xerostomia management by actively engaging them during the comprehensive examination and oral hygiene instruction.

RECOMMENDATIONS FOR DENTAL HYGIENISTS

The clinical signs and symptoms of xerostomia are subjective and depend on patient perception.⁵ However, early detection and prompt intervention decrease the effects of xerostomia and improve quality of life. Oral health professionals should encourage patients to investigate the possible side effects of medications by providing easy–to–use resources. Websites are available that discuss the side effects created by various medications and offer strategies to mitigate them (Table 2).

In addition, prescription medications always include an information sheet that lists any possible side effects. The American Dental Hygienists’ Association offers a “Hyposalivation with Xerostomia” screening tool for oral health professionals to use as a guide when identifying a patient’s xerostomia risk level (here). ¹¹ The tool is designed for use during the assessment process and is composed of three major categories: source, symptoms, and signs. From the interview questions, clinicians can establish whether a patient’s risk of xerostomia is low, moderate, or high.¹¹

ALLEVIATE SYMPTOMS

Patients diagnosed with xerostomia are at increased risk of dental caries, fungal infections, periodontal diseases, and other oral problems. ^6,8 The US Food and Drug Administration has approved several prescription drugs to relieve dry mouth caused by medical treatments or conditions. For example, pilocarpine HCL (Salagen) and cevimeline (Evoxac) are cholinergic drugs that increase salivary secretions.⁸ Saliva substitutes may help patients manage their symptoms and they come in a variety of formats, such as mouthrinses, sprays, swabs, gels, and tablets that dissolve in the mouth.⁴ To improve salivary flow, patients should drink plenty of water or sugarless/neutral acid drinks, chew sugar–free chewing gum containing xylitol, and use a fluoride mouthrinse. ⁴ Patients should also avoid alcohol–containing products, caffeine, and all forms of tobacco.^4,6

CONCLUSION

Xerostomia is a condition experienced by many patients, and treating it requires a collaborative approach. Xerostomia can occur at any age, but patients who take multiple medications are at increased risk, which means it disproportionately affects older adults. As the American population ages, dental professionals will see more patients with xerostomia. Practitioners need to stay current on common xerostomia–inducing medications, ask descriptive questions, use screening tools during assessments, and provide patients with eas–to–access resources to help mitigate the consequences of this condition.

REFERENCES

1. Kalmar J, James WD. Oral manifestations of drug reactions. Xerostomia.Medscape Reference. Available at: www.emedicine.medscape.com/article/1080772–overview. Accessed October 19, 2012.
2. Leal SC, Bittar J, Portugal A, Falcão DP, Faber J, Zanotta P. Medication inelderly people: its influence on salivary pattern, signs and symptoms of drymouth. Gerodontology. 2010;27:129—133.
3. Gueiros LA, Soares MS, Leão JC. Impact of aging and drug consumption onoral health. Gerodontology. 2009;26:297—301.
4. United States Department of Health and Human Services. Dry mouth? Don’tdelay treatment. Available at: www.fda.gov/forconsumers/consumerupdates/ucm254273.htm. Accessed October 19, 2012.
5. Cho MA, Ko JY, Kim YK, Kho HS. Salivary flow rate and clinical characteristicsof patients with xerostomia according to its aetiology. J Oral Rehabil.2010;37:185—193.
6. Guggenheimer J, Moore PA. Xerostomia: etiology, recognition andtreatment. J Am Dent Assoc. 2003;134:61—69.
7. Medications that cause dry mouth. NeuroTalk. Available at: www.neurotalk.psychcentral.com/showthread.php?t=25830. Accessed October 19, 2012.
8. Weinburg MA, Theile CM, Fine JB. In: Cohen M, ed. Oral Pharmacology forthe Dental Hygienist. 2nd ed. Upper Saddle River, NJ: Pearson Education Inc;2012.
9. Haveles BE. Applied Pharmacology for the Dental Hygienist. 6th ed. MarylandHeights, Mich: Mosby Elsevier; 2011.
10. Weinburg MA, Westphal C, Fine JB. In: Cohen M, ed. Oral Pharmacology forthe Dental Hygienist.Upper Saddle River, NJ: Pearson Education Inc; 2008.
11. Fehrenbach MJ. American Dental Hygienists’ Association hyposalivationwith xerostomia screening tool. Access. 2010;24:22—25.

From Dimensions of Dental Hygiene. November 2012; 10(11): 34, 36, 38.

Ask the doctor: Is my blood pressure medicine changing my ability to taste?

Q. My sense of taste isn’t as good as it was a few months ago. The only big change in my health is that I started taking Capoten on top of the diuretic I have been taking for some time to control my blood pressure. Am I imagining this, or could the new drug be affecting my sense of taste? If it is, what can I do about it?

A.  Hundreds of prescription and over-the-counter medicines can alter the sense of taste. They usually do this by directly affecting taste receptors, by changing the way the taste buds send and receive nerve impulses, or by changing the amount or chemical composition of saliva.

The ACE inhibitor captopril (Capoten) is in this group. In some people, captopril causes a long-lasting sensation of bitterness or saltiness. In others, it makes sweet foods taste salty. Some people notice a diminished sense of taste.

Although captopril is a likely suspect, it is possible that your diuretic may be causing or contributing to the problem. Because diuretics prompt the kidneys to remove water from the body, they can make the mouth dry. The potassium-sparing diuretic amiloride can cause a persistent bitter taste. Fortunately, changes in taste are not as common with the most frequently used diuretics, hydrochlorothiazide and chlorthalidone.

Other cardiovascular drugs that have been reported to alter taste include statins, clopidogrel (Plavix), and various beta blockers, calcium-channel blockers, and rhythm-controlling drugs (see list). Noncardiac drugs with this side effect include antibiotics, steroids, antidepressants and other mood- or behavior-stabilizing medications, and thyroid drugs.

Two other possibilities: The first has to do with age. Beginning around age 60, many people experience a gradual loss of taste and smell. It is conceivable that your starting to take captopril is a red herring and you might be noticing a change even if you weren’t taking the drug.

The second involves the sense of smell, which largely dictates the flavor of most foods. Volatile molecules moving from the mouth to the nasal passages produce the complicated flavors of chocolate, steak sauce, pizza, banana, peppermint, coffee, and many other foods. Damage from viruses, bacteria, pollution, and other insults can weaken the sense of smell.

Smell, and thus taste, can also be affected by nasal obstruction and inflammation caused by an allergy, secondhand smoke or other irritants, a persistent sinus infection, or polyps. Conditions such as diabetes, liver disease, kidney disease, Alzheimer’s disease, and Parkinson’s disease can also diminish the senses of taste and smell.

If the change you have noticed in your sense of taste is indeed due to captopril, switching to another ACE inhibitor or a different type of blood pressure drug may fix the problem. If it is because of a dry mouth from your diuretic, try sipping water between bites of food.

Just don’t stop taking your medications without talking with your doctor. As you know, high blood pressure is a leading cause of stroke, which can permanently alter all the senses, not just taste and smell.

“” Richard L. Doty, Ph.D.Director, Smell and Taste Center, University of Pennsylvania Medical Center

Image: © Meinzahn/Getty Images

As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
Please note the date of last review or update on all articles. No content on this site, regardless of date,
should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Xerostomia Dry Mouth and Drugs Blog

Xerostomia (dry mouth), is a serious dental problem affecting millions of people.
Saliva has antibacterial properties and when we don’t have enough of it we can suffer
from increased tooth decay and  gum disease. Additionally,  dry mouth makes it difficult for denture wearers to tolerate their appliances and affects our ability to taste the foods we enjoy.

According to a study by Clinical Research Associates, of the top 20 most prescribed drugs in the U. S. in 2010, the following 15 have been associated  with Xerostomia:

1. Hydrocodone/Acetaminophen – a narcotic
2. Lisinopril (Prinivil,Zestril) – an antihypertensive
3. Simvastatin (Zocor) – an antiperlipidemic to fight cholesterol
4. Amlodipine (Norvasc) – an antihypertensive
5. Alprazolam (Xanax) – an anti-anxiety medication
6. Hydrochlorothiazide – a diuretic
7. Omeprazole (Prilosec) – an anti-ulcer agent
8. Atorvastatin calcium (Lipitor)– an antihyperlipidemic to fight cholesterol
9. Furosemide (Lasix) – a diuretic
10. Metoprolol Tartrate (Lopressor) – an antihypertensive
11. Sertraline HCL (Zoloft) – an antidepressant
12. Metoprolol Succinate (Toprol) – an antihypertensive
13. Zolpidem (Ambien) – a sedative/hypnotic
14. Oxycodone/Acetaminophen (Percocet) – a narcotic
15. Citalopram Hydrobromide (Celexa) – an antidepressant

The average 60-year-old in this country is taking at least three prescription medications daily. If you believe you suffer from drug-induced Xerostomia or just feel like you have a dry mouth in general, ask us about it. There are many treatments available to help with this  potentially serious problem.

Any questions? Don’t hesitate to contact me or the office, Dr. Laurence Stone in Doylestown, PA, today to schedule your next appointment and we can talk more about this. See you soon!

Please follow and like us:

90,000 contraindications, side effects, dosages, composition – tablets, cover. a shell in the reference book of medicines

From the nervous system: > 1% – insomnia, dizziness;

From the senses: <1% - amblyopia, ringing in the ears, dry conjunctiva, impaired accommodation, retinal hemorrhage, deafness, glaucoma, parosmia, loss of taste, taste perversion.

From the cardiovascular system: > 1% – chest pain;

From the side of the hematopoietic system: <1% - anemia, lymphadenopathy, thrombocytopenia.

Respiratory system: > 1% – bronchitis, rhinitis;

From the digestive system: > 1% – nausea;

From the musculoskeletal system: > 1% – arthritis;

<1% - leg muscle cramps, bursitis, tendosynovitis, myositis, myopathy, arthralgia, myalgia, rhabdomyolysis, torticollis, muscle hypertonia, joint contractures, joint swelling, tendopathy (in some cases with tendon rupture).

From the genitourinary system: > 1% – urogenital infections, peripheral edema;

Dermatological reactions: > 1% – alopecia, xeroderma, photosensitization, increased sweating, eczema, seborrhea, ecchymosis, petechiae.

From the endocrine system: <1% - gynecomastia, mastodynia.

From the side of metabolism: <1% - weight gain, exacerbation of gout.

Allergic reactions: <1% - pruritus, skin rash, contact dermatitis, rarely - urticaria, angioedema, facial edema, anaphylaxis, erythema multiforme exudative (incl.including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome).

Laboratory indicators: <1% - hyperglycemia, hypoglycemia, increased serum CPK, albuminuria.

Association of dry mouth with prescription drugs | Dry mouth

Prescription drugs and dry mouth

Over the past 20 years, most Americans believe that prescription drugs improve the quality of life of people (73 percent of those surveyed), as well as the quality of life of their loved ones (63 percent).More than half of the adult population currently takes prescription drugs, and one in five people takes four or more drugs a day.

Dry mouth or xerostomia is a condition that occurs when the human salivary glands do not function properly, which leads to insufficient secretion of saliva into the oral cavity. There are three pairs of large salivary glands in the mouth, and prescription drugs can affect each of them.If you are taking prescription drugs, please tell your doctor and dentist.

What medications cause dry mouth?
More than 500 different drugs cause dry mouth, and if the patient takes several different drugs, the likelihood of dry mouth increases. 2, 3 The following classes of prescription drugs affect the salivary glands:

• Antihistamines: Medicines in this category affect saliva production.They include: diphenhydramine, claritin, zyrtec, etc.
• Antidepressants: People taking antidepressants will also experience dry mouth. These types of medications affect the amount of saliva produced. These include Zoloft, Flexeril, and Amitriptyline.
• Antiemetic drugs: These are drugs that are prescribed to prevent nausea and vomiting during chemotherapy or radiation therapy, as well as motion sickness (for example: anzemet, domperidone).
• Antihypertensives: Antihypertensive medications (eg aerosol salbutamol, Norvasc, and nivil) are taken to control blood pressure.
• Antiparkinsonian drugs: Drugs in this category are prescribed to relieve symptoms of Parkinson’s disease and other forms of parkinsonism (eg, levodopa, cyclodol).
• Antispasmodics: These drugs are used to treat and relieve colic and cramps in the stomach, small intestine, colon, and bladder (eg dicyclomine).
• Antipsychotics: Drugs used for mental disorders, anxiety and depression (for example: Zoloft, Lexapro).
• Sedatives: These are drugs that induce sedation by reducing agitation and irritability, relieving anxiety (for example: amytal, valium, lunesta).

If you are taking any of these medications, talk with your doctor and dentist to find ways to cope with your dry mouth. There are prescription and over-the-counter medications available to relieve dry mouth. Just check with your doctor or dentist.

Bibliography:
1 USA Today / Kaiser Family Foundation / Harvard School of Public Health, The Public on Prescription Drugs and Pharmaceutical Companies, January 3-23,2008.
2 Porter SR, Scully C, Hegarty AM: An Update of the etiology and management of xerostomia, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97: 28-46, 2004.
3 Sreebny LM, Schwartz SS: A reference guide to drugs and dry mouth, ed 2, Gerodontology 14: 33-47, 1997.

© Copyright 2011 Colgate-Palmolive

Azilsartan and Chlorthalidone | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Edarbyclor

Trade names: Canada

Edarbyclor

Warning

• Not for use by pregnant women. The use of the drug during pregnancy can cause birth defects or intrauterine death of the child. If you become pregnant or plan to become pregnant while taking this drug, call your doctor right away.

What is this drug used for?

• Used to treat high blood pressure.

What do I need to tell my doctor BEFORE taking this drug?

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
• If you have dehydration or difficulty urinating.
• If you are taking a drug containing aliskiren if you have diabetes or kidney disease.
• If you are breastfeeding.Do not breast-feed while taking this drug.

This list of drugs and diseases that can be adversely combined with the use of this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking.Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

• Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• Avoid driving vehicles and other activities that require increased attention until you see how this drug affects you.
• To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position. Use caution when going up and down stairs.
• Consult a physician before drinking alcohol.
• It may take several weeks for the full result to be obtained.
• Check blood pressure as directed.
• Perform blood tests as directed by your doctor. Please consult your doctor.
• If you are using a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium supplement, consult your doctor.
• If you are on a salt-free or low-salt diet, consult your doctor.
• Talk to your doctor before taking an over-the-counter drug that can increase blood pressure. These drugs include medicines for coughs and colds, diet pills, stimulants, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and some naturally occurring drugs.
• Watch for gout attacks.
• Caution should be exercised in hot weather and during vigorous activity. Drink plenty of fluids to prevent dehydration.
• Tell your doctor if you experience excessive sweating, fluid loss, vomiting, or loose stools. This can lead to a drop in blood pressure.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can cause serious and sometimes deadly side effects.Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Signs of kidney problems, including lack of urination, change in urine volume, blood in the urine, or rapid weight gain.
• Signs of imbalance in fluid and electrolytes, incl. sudden changes in mood, confusion of thought, muscle pain or weakness, a feeling of disturbed heartbeat, severe dizziness or loss of consciousness, rapid heartbeat, intense thirst, seizures, feeling very tired or weak, lack of appetite, inability to urinate or change in the amount of urine excreted, dryness in mouth, dry eyes, severe stomach upset, or vomiting.
• Sleepiness.
• Constipation.
• Anxiety.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

• Feeling dizzy, tired, or weak.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

• Take this drug with or without food.
• Take this drug at approximately the same time of the day.
• Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.
• This drug may cause frequent urination. This can lead to sleep disturbances, so try not to take the drug shortly before going to bed.
• Drink plenty of decaffeinated fluids, unless your doctor tells you to drink less fluids.

What to do if a dose of a drug is missed?

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal schedule.
• Do not take 2 doses on the same day.

How do I store and / or discard this drug?

• Store tablets in their original packaging at room temperature. The cap must be tightly closed.
• Protect from light.
• Store in a dry place. Do not store in the bathroom.
• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may have other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may have other patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by the consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional.Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

.