Heparin Side Effects in Elderly: Comprehensive Guide to Risks and Management

10.06.202128.07.2023 by alexxlab

What are the common side effects of heparin in elderly patients. How can heparin-induced thrombocytopenia be managed in older adults. What precautions should be taken when administering heparin to elderly individuals. How does heparin interact with other medications commonly used by seniors.

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Understanding Heparin: A Powerful Anticoagulant

Heparin is a widely used anticoagulant medication that plays a crucial role in preventing and treating blood clots. As a member of the anticoagulant class of drugs, heparin works by disrupting the formation of blood clots in veins. It can both prevent new clots from forming and stop existing clots from growing larger. This makes it an invaluable tool in managing various cardiovascular conditions, particularly in elderly patients who may be at higher risk for clotting disorders.

How does heparin achieve its anticoagulant effect? The medication interferes with the body’s natural clotting cascade, specifically by enhancing the activity of antithrombin III. This protein inactivates several clotting factors, effectively reducing the blood’s ability to form clots. While this mechanism is beneficial for preventing dangerous clots, it also introduces potential risks, especially for older adults who may have other health complications.

Forms and Administration of Heparin

Heparin is available in two primary forms:

Injectable solution for subcutaneous administration
Intravenous solution for hospital use

The subcutaneous form allows for self-administration at home after proper training, while the intravenous form is strictly controlled and administered by healthcare professionals in a clinical setting. This flexibility in administration routes makes heparin a versatile option for both acute and chronic anticoagulation needs in elderly patients.

Common Side Effects of Heparin in the Elderly

While heparin is an effective medication, it’s not without potential side effects. Elderly patients may be particularly susceptible to certain adverse reactions due to age-related changes in metabolism and organ function. Understanding these common side effects is crucial for both patients and caregivers.

Bruising and Bleeding

Given heparin’s mechanism of action, increased bruising and prolonged bleeding are among the most frequently observed side effects. Elderly patients may notice:

Easier bruising, even from minor bumps
Bleeding that takes longer to stop, such as from small cuts
Nosebleeds that occur more frequently or are difficult to stop
Heavier menstrual periods in women who are still menstruating

Why are these side effects more pronounced in the elderly? As we age, our skin becomes thinner and blood vessels more fragile, making bruising more likely. Additionally, older adults may have decreased liver function, which can affect how quickly the body metabolizes heparin, potentially prolonging its effects.

Injection Site Reactions

For elderly patients using subcutaneous heparin, injection site reactions are common. These can include:

Irritation or redness at the injection site
Pain or discomfort during or after injection
Small bruises or hematomas at injection sites
In rare cases, skin necrosis (tissue death) at the injection site

To minimize these reactions, rotating injection sites and proper injection technique are essential. Healthcare providers should ensure that elderly patients or their caregivers are well-trained in proper administration methods.

Allergic Reactions

While less common, allergic reactions to heparin can occur and may be more severe in elderly patients. Symptoms to watch for include:

Hives or skin rash
Itching
Fever or chills
Shortness of breath
Swelling of the face, lips, tongue, or throat

Elderly patients with a history of allergies or sensitive immune systems should be closely monitored when starting heparin therapy. Any signs of an allergic reaction should be reported to a healthcare provider immediately.

Heparin-Induced Thrombocytopenia: A Serious Concern for Elderly Patients

One of the most significant risks associated with heparin use, particularly in the elderly, is heparin-induced thrombocytopenia (HIT). This condition represents a paradoxical response to an anticoagulant medication, where instead of preventing clots, it can actually lead to their formation.

HIT occurs when heparin triggers an immune response that causes a dramatic drop in platelet count. Platelets are crucial components of blood that help with clotting. In HIT, the body produces antibodies that activate platelets, leading to their depletion and, counterintuitively, an increased risk of blood clots.

Recognizing HIT in Elderly Patients

Identifying HIT in older adults can be challenging, as its symptoms may be subtle or attributed to other age-related conditions. Key signs to watch for include:

Unexplained drop in platelet count, typically 5-10 days after starting heparin
New blood clots forming despite anticoagulation therapy
Skin changes such as new areas of redness or discoloration
Unexplained pain or swelling in the limbs
Sudden onset of confusion or neurological symptoms (which could indicate a stroke)

Why is HIT particularly dangerous for elderly patients? Older adults often have underlying cardiovascular conditions that increase their risk of complications from blood clots. Additionally, the immune system changes with age, potentially altering how the body responds to heparin and increasing the likelihood of developing HIT.

Managing HIT in the Elderly

If HIT is suspected in an elderly patient, prompt action is crucial:

Immediately discontinue all forms of heparin, including heparin flushes
Initiate alternative anticoagulation therapy, such as direct thrombin inhibitors
Monitor platelet counts closely
Assess for any signs of new or worsening blood clots
Consider specialized testing to confirm HIT diagnosis

Managing HIT in elderly patients requires a delicate balance. While stopping heparin is necessary, these patients still require anticoagulation to prevent further clots. The choice of alternative anticoagulants must take into account age-related changes in kidney and liver function, as well as potential interactions with other medications.

Bleeding Risk: A Critical Consideration in Elderly Heparin Users

While heparin’s primary function is to prevent dangerous blood clots, this anticoagulant effect also increases the risk of bleeding, a risk that is often heightened in elderly patients. Understanding and managing this risk is crucial for safe and effective heparin use in older adults.

Factors Contributing to Increased Bleeding Risk in the Elderly

Several age-related factors can exacerbate the bleeding risk associated with heparin:

Decreased renal function, leading to slower drug clearance
Liver changes affecting drug metabolism
Increased likelihood of falls or injuries
Concomitant use of other medications that affect blood clotting
Pre-existing conditions that increase bleeding risk (e.g., gastrointestinal ulcers)

How can healthcare providers assess bleeding risk in elderly heparin users? A comprehensive evaluation should include a review of medical history, medication list, recent laboratory results (especially renal and hepatic function tests), and an assessment of fall risk. Tools like the HAS-BLED score can help quantify bleeding risk in patients on anticoagulation therapy.

Recognizing Signs of Serious Bleeding

Elderly patients and their caregivers should be educated about the signs of serious bleeding, which may include:

Unexplained bruising or petechiae (small, round, purple spots on the skin)
Blood in urine (appearing pink, red, or brown)
Black, tarry stools (indicating potential gastrointestinal bleeding)
Coughing up blood or blood-tinged sputum
Vomit that resembles coffee grounds
Severe headache or dizziness (which could indicate intracranial bleeding)
Unusual weakness or fatigue (potentially due to blood loss)

Any of these symptoms should prompt immediate medical attention. Elderly patients on heparin therapy should be encouraged to maintain open communication with their healthcare providers and report any unusual bleeding or bruising promptly.

Drug Interactions: Navigating Polypharmacy in Elderly Heparin Users

Polypharmacy, or the use of multiple medications, is common among elderly patients. This practice can significantly complicate heparin therapy due to the potential for drug interactions. Understanding these interactions is crucial for healthcare providers managing anticoagulation in older adults.

Common Medications That Interact with Heparin

Several classes of drugs can interact with heparin, either enhancing its anticoagulant effect or counteracting it:

Antiplatelet drugs (e.g., aspirin, clopidogrel)
Non-steroidal anti-inflammatory drugs (NSAIDs)
Selective serotonin reuptake inhibitors (SSRIs)
Certain antibiotics
Vitamin K antagonists (e.g., warfarin)

Why are these interactions particularly concerning in elderly patients? Older adults often have multiple chronic conditions requiring various medications. This increases the likelihood of potential interactions. Additionally, age-related changes in drug metabolism can amplify the effects of these interactions.

Managing Drug Interactions in Elderly Heparin Users

To minimize the risk of adverse events due to drug interactions, healthcare providers should:

Conduct a thorough medication review before initiating heparin therapy
Consider alternative medications when possible to avoid known interactions
Adjust heparin dosage as needed based on potential interactions
Monitor patients closely for signs of increased bleeding or reduced anticoagulant effect
Educate patients about the importance of informing all healthcare providers about their heparin use

In some cases, the benefits of combining heparin with interacting medications may outweigh the risks. In these situations, close monitoring and careful dose adjustments are essential to maintain the delicate balance between effective anticoagulation and safety.

Optimizing Heparin Therapy in the Elderly: Dosage Considerations

Determining the appropriate heparin dosage for elderly patients requires careful consideration of various factors. Age-related changes in physiology can significantly impact how the body processes and responds to heparin, necessitating a more nuanced approach to dosing.

Factors Influencing Heparin Dosage in Older Adults

Several age-related factors can affect heparin dosing in elderly patients:

Decreased renal function, which can slow heparin clearance
Reduced hepatic function, affecting drug metabolism
Changes in body composition, particularly reduced muscle mass and increased adipose tissue
Altered plasma protein levels, which can affect drug binding
Presence of comorbidities that may influence anticoagulation needs

How do these factors impact heparin dosing? Generally, elderly patients may require lower initial doses and more frequent monitoring to achieve therapeutic anticoagulation without increasing bleeding risk. The use of weight-based dosing protocols can help account for some of these age-related changes.

Monitoring and Adjusting Heparin Therapy

Close monitoring is essential when using heparin in elderly patients. This typically involves:

Regular assessment of activated partial thromboplastin time (aPTT) or anti-Factor Xa levels
Frequent platelet count checks to detect HIT early
Ongoing evaluation of renal and hepatic function
Regular assessment for signs of bleeding or thrombosis

Based on these monitoring parameters, heparin doses may need to be adjusted more frequently in elderly patients compared to younger adults. Healthcare providers should be prepared to make prompt dose modifications in response to changes in lab values or clinical status.

Patient Education: Empowering Elderly Heparin Users

Effective patient education is crucial for the safe and successful use of heparin in elderly populations. Older adults and their caregivers need to understand not only how to administer the medication correctly but also how to recognize potential complications and when to seek medical attention.

Key Points for Patient Education

When educating elderly patients about heparin therapy, healthcare providers should focus on the following areas:

Proper technique for subcutaneous injections, if applicable
The importance of adhering to the prescribed dosing schedule
Signs and symptoms of bleeding to watch for
Potential drug interactions and the need to inform all healthcare providers about heparin use
The importance of regular monitoring and follow-up appointments
Lifestyle modifications to reduce the risk of falls and injuries
Dietary considerations, particularly regarding vitamin K intake

Why is patient education particularly important for elderly heparin users? Older adults may face challenges such as cognitive decline, visual impairments, or reduced dexterity that can impact their ability to manage medication effectively. Tailored education approaches, possibly involving family members or caregivers, can help overcome these barriers.

Strategies for Effective Education in Older Adults

To ensure that elderly patients fully understand and retain important information about their heparin therapy, healthcare providers can employ several strategies:

Use clear, simple language and avoid medical jargon
Provide written materials with large, easy-to-read fonts
Use visual aids or demonstrations for injection technique
Encourage patients to ask questions and voice concerns
Involve family members or caregivers in education sessions
Offer follow-up phone calls or visits to reinforce key points
Consider the use of medication reminder apps or devices

By empowering elderly patients with knowledge and tools to manage their heparin therapy effectively, healthcare providers can help improve treatment adherence and reduce the risk of complications. This patient-centered approach is crucial for optimizing outcomes in this vulnerable population.

Side Effects, Dosage, Uses, and More

Highlights for heparin

Heparin injectable solution only comes as a generic drug. It doesn’t have a brand-name version.
Heparin comes in two forms. One is an injectable solution, which you inject under your skin. The other is a solution that’s injected intravenously (into one of your veins). Only your doctor can give you the intravenous form.
Heparin injectable solution is a blood thinner that’s used to treat and prevent blood clots.

Low platelet levels warning. This drug can decrease your platelet levels. This is known as heparin-induced thrombocytopenia (HIT), which can eventually lead to the formation of blood clots in your veins. These clots can form even several weeks after you stop taking heparin. Your doctor will check you for low platelet levels.
Bleeding risk warning. This drug may cause serious bleeding. This happens because this drug reduces your body’s ability to make your blood clot. Heparin may cause you to bruise more easily. It also may take your body longer to stop bleeding. This can cause death in rare cases. Let your doctor know if you have frequent nosebleeds, unusual bleeding from your gums, periods that are heavier than normal, red or brown urine, or dark or tarry stools. Also let your doctor know if you vomit blood, if your vomit looks like coffee grounds, or if you have headaches, dizziness, or weakness.

Heparin is a prescription drug. It comes as a self-injectable solution that you inject under your skin. It also comes as a solution that a healthcare provider injects intravenously (into one of your veins). You can only receive the intravenous form in the hospital.

For the injectable solution, you’ll receive your first injection at a hospital. A healthcare provider will show you how to give yourself the injection. You will give yourself the remaining doses at home.

Heparin injectable solution is only available as a generic drug.

Why it’s used

Heparin is a blood thinner that’s used to treat and prevent blood clots. These can include venous thrombosis, pulmonary embolism, and peripheral arterial embolism.

How it works

Heparin belongs to a class of drugs called anticoagulants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Heparin works by disrupting the formation of blood clots in your veins. It can prevent blood clots from forming, or stop clots that have already formed from getting larger.

Heparin injectable solution doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects of this drug include:

bruising more easily
bleeding that takes longer to stop
irritation, pain, redness, or sores at the injection site
allergic reactions, such as hives, chills, and fever
increased liver enzymes on liver function test results

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

Severe bleeding. Symptoms can include:
- bruising more easily
- unexpected bleeding or bleeding that lasts a long time, such as:
  - unusual bleeding from your gums
  - frequent nosebleeds
  - periods that are heavier than normal
- pink or brown urine
- dark, tarry stool (may be a sign of bleeding in your stomach)
- severe bleeding or bleeding that you can’t stop
- coughing up blood or blood clots
- vomit that contains blood or looks like coffee grounds
- headaches
- weakness
- dizziness
Serious allergic reactions. Symptoms can include:
- skin tissue death at the injection site
- chills
- fever
- rash and hives
- itching
- burning
- shortness of breath
- swelling of your face, lips, throat, or tongue
Heparin-induced thrombocytopenia. This is low platelet levels caused by heparin use. It can cause new or worsening clots in your blood vessels. These may lead to a stroke or heart attack. Symptoms of new or worsening blood clots can include:
- reddening and swelling of one leg or arm
- coughing up blood

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Heparin injectable solution can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with heparin are listed below.

Interactions that can increase your risk of side effects

Taking heparin with certain drugs can increase your risk of bleeding and make you bruise more easily. Examples of these drugs include:

aspirin
nonsteroidal anti-inflammatory drugs such as celecoxib, ibuprofen, and naproxen
antiplatelet drugs such as clopidogrel and dipyridamole
hydroxychloroquine
herbal supplements such as ginkgo biloba, fish oil, and garlic

Interactions that can make heparin less effective

When used with heparin, certain drugs can make heparin less effective. Examples of these drugs include:

digoxin
tetracycline antibiotics such as doxycycline and minocycline
nicotine
nitrates, such as isosorbide, mononitrate, and nitroglycerin
antihistamines such as diphenhydramine

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Heparin can cause a severe allergic reaction. Symptoms can include:

skin tissue death at the injection site
chills
fever
rash
hives
itching
burning
shortness of breath
swelling of your face, lips, throat, or tongue

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Heparin is derived from animal tissue. It should be used with caution in people with a history of allergy to this drug or to pig proteins. Taking heparin could be fatal (cause death).

Warnings for people with certain health conditions

For people with pig protein sensitivity: Do not take this drug. This drug is made from pork tissue and can cause a life-threatening allergic reaction in people who are sensitive or allergic to other pig proteins.

For people with uncontrolled high blood pressure: You are at an increased risk of bleeding from this drug. Talk to your doctor before using heparin.

For people with bleeding or clotting problems: If you have abnormal bleeding or a condition that puts you at an increased risk of bleeding, using heparin could increase your risk even more. Use heparin with caution.

For people with a history of stomach ulcers or bleeding: If you have active stomach ulcers, you should not use heparin. It could make your ulcers worse and cause dangerous bleeding. If you have a history of stomach ulcers but don’t have active ulcers, using heparin puts you at an increased risk of bleeding. You should talk to your doctor before using heparin.

For people with kidney disease: If you have severe kidney disease or a history of kidney disease, taking heparin can increase your risk of bleeding. Talk to your doctor before using heparin.

For people with liver disease: If you have severe liver disease or a history of liver disease, taking heparin can increase your risk of bleeding. Talk to your doctor before using heparin.

For people with asthma or sulfite sensitivity: People with asthma are likely to be sensitive to sulfites. Sulfites can cause a life-threatening allergic reaction in some people. Some forms of this drug contain sulfites. Talk to your doctor about using a sulfite-free version of heparin.

Warnings for other groups

For pregnant women: Research in animals has shown negative effects to the fetus when the mother uses heparin. However, there haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or plan to become pregnant. This drug should only be used if the potential benefit justifies the potential risk. Ask your doctor if using the preservative-free version of heparin would be better for you than the version that contains benzyl alcohol.

If you become pregnant while taking this drug, call your doctor right away.

For women who are breastfeeding: Heparin is unlikely to pass into breast milk and be absorbed by an infant who is breastfed. Talk to your doctor about the best way to feed your child while you’re taking heparin.

Some forms of heparin contain a preservative called benzyl alcohol. This ingredient can slow down the central nervous system in some infants. It has also caused trouble breathing and changes in the blood chemistry in some infants. These effects can be deadly. If you breastfeed your child, talk to your doctor about preservative-free heparin.

For seniors: If you are older than 60 years, you may be at a higher risk of bleeding. Heparin also increases your risk of bleeding, so your doctor may start you on a reduced dosage.

For children: This medication has not been studied in children. Dosage recommendations are based on clinical experience.

Newborns and infants should receive preservative-free heparin. The preservative benzyl alcohol has been linked to serious side effects and even death in newborns and infants.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

your age
the condition being treated
how severe your condition is
other medical conditions you have
how you react to the first dose

Drug forms and strengths

Generic: Heparin

Form: injectable solution, preservative-free
Strengths: 1,000 units/mL, 10,000 units/mL

Form: injectable solution preserved with benzyl alcohol
Strengths: 1,000 units/mL, 5,000 units/mL, 10,000 units/mL, 20,000 units/mL

Dosage for deep vein thrombosis and pulmonary embolism

Adult dosage (ages 18–59 years)

Typical starting dosage: 333 units/kg of body weight injected under your skin.
Typical maintenance dosage: 250 units/kg of body weight injected under your skin every 12 hours. Change the injection site each time to prevent a blood clot from forming at the injection site.

Child dosage (ages 0–17 years)

Your doctor will determine your child’s dosage based on your child’s condition and medical history.

Senior dosage (ages 60 years and older)

You may be at higher risk of bleeding. Your doctor may start you on a reduced dosage.

Dosage for preventing deep vein thrombosis after surgery

Adult dosage (ages 18–59 years)

Typical dosage: Your doctor or nurse will give you 5,000 units about 2 hours before your surgery.
Typical maintenance dosage: 5,000 units injected under your skin every 8–12 hours. You’ll give yourself this dosage for 7 days or until you can start walking.

Child dosage (ages 0–17 years)

Your doctor will determine your child’s dosage based on your child’s condition and medical history.

Senior dosage (ages 60 years and older)

You may be at higher risk of bleeding. Your doctor may start you on a reduced dosage.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Heparin injectable solution is used for short-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: You may develop a blood clot, or an existing blood clot could get worse. These blood clots can be fatal (cause death).

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body, which could lead to serious bleeding. This can be deadly. Symptoms of an overdose of this drug can include:

bruising easily
unexpected bleeding or bleeding that lasts a long time, such as:
- unusual bleeding from your gums
- frequent nosebleeds
- in women: periods that are heavier than normal
pink or brown urine
dark, tarry stool (may be a sign of bleeding in the stomach)
severe bleeding or bleeding that you can’t stop
coughing up blood or blood clots
vomit that contains blood or looks like coffee grounds
headaches
weakness
dizziness

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. If you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects, such as serious bleeding.

How to tell if the drug is working: You should not develop a blood clot, or the clot you currently have should go away.

Keep these considerations in mind if your doctor prescribes heparin for you.

Self-management

Your doctor will show you how to give yourself the injection.
Use this drug only if the solution is clear and the seal is intact. Do not use this drug if the solution is cloudy, discolored, or has particles in it.

Storage

Store heparin at room temperature between 68°F and 77°F (20°F and 25°C).

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
Don’t worry about airport x-ray machines. They can’t harm your medication.
You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.
You need needles and syringes to take this medication. Check for special rules about traveling with your medication, needles, and syringes.

Clinical monitoring

Your doctor will monitor how well heparin is working for you by doing coagulation or clotting tests. The results of these tests will also help your doctor choose the right dosage of heparin for you.

Your doctor should test you to help make sure you stay safe while you take this drug. These tests check your:

Kidney function. If your kidneys are not working well, you may have a higher risk of bleeding. Your doctor will monitor your kidneys to make sure this drug is safe for you to take.
Liver function. If your liver is not working well, you may have a higher risk of bleeding. Your doctor will monitor your liver to make sure this drug is safe for you to take.
Signs of bleeding. Your doctor may check your platelet and hematocrit levels. They may do a test that checks for blood that may be hidden in your stool. This monitoring helps make sure you don’t bleed too much while you take this drug.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Hidden costs

You may need to purchase:

sterile alcohol wipes
needles and syringes
a sharps container (a bin for disposing used needles safely)

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.