Wednesday, September 14, 2016

Ergomar


Generic Name: ergotamine (er GOT a meen)

Brand Names: Ergomar


What is Ergomar (ergotamine)?

Ergotamine is in a group of drugs called ergot alkaloids (ER-got AL-ka-loids). It works by narrowing the blood vessels around the brain. Ergotamine also affects blood flow patterns that are associated with certain types of headaches.


Ergotamine is used to treat a migraine type headache.


This medication will only treat a headache that has already begun. It will not prevent migraine headaches or reduce the number of attacks.


Ergotamine should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches.

Ergotamine may also be used for purposes not listed in this medication guide.


What is the most important information I should know about Ergomar (ergotamine)?


This medication can harm an unborn baby or a nursing baby. Do not take ergotamine if you are pregnant or breast-feeding. Do not take this medication if you are allergic to ergotamine or other ergot medicines, or if you have a history of heart disease, angina (chest pain), blood circulation problems, history of a heart attack or stroke, coronary artery disease, uncontrolled high blood pressure, severe liver or kidney disease, or a serious infection. Using certain medications together with ergotamine can cause even greater decreases in blood flow than ergotamine used alone, which can lead to dangerous side effects. Tell your doctor about all other medications you are using.

Also tell your doctor about all of your medical conditions, especially high blood pressure, liver or kidney disease, or risk factors for coronary artery disease (diabetes, high blood pressure or cholesterol, menopause or hysterectomy, smoking, taking birth control pills, being overweight, having a family history of coronary artery disease, or being a man older than 40).


This medication will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.


Never take more than your prescribed dose of ergotamine. An overdose can be fatal.

What should I discuss with my healthcare provider before taking Ergomar (ergotamine)?


Do not take this medication if you are allergic to ergotamine or similar medications such as Cafergot, D.H.E. 45, Migergot, Migranal, or Methergine.

Do not take ergotamine if you are pregnant or breast-feeding, or if you have:



  • a history of heart disease, angina (chest pain), blood circulation problems, or history of a heart attack or stroke;




  • coronary artery disease or "hardening of the arteries";




  • uncontrolled high blood pressure;



  • severe liver disease;

  • severe kidney disease; or


  • a serious infection called sepsis.




Using certain medications together with ergotamine can cause even greater decreases in blood flow than ergotamine used alone, which can lead to dangerous side effects. Do not take ergotamine if you are also using any of the following medications:

  • conivaptan (Vaprisol), imatinib (Gleevec), isoniazid (for treating tuberculosis), or nefazodone (an antidepressant);




  • diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);




  • clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), or telithromycin (Ketek);




  • clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Extina, Ketozole, Nizoral, Xolegal), or voriconazole (Vfend);




  • heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene), quinidine (Quin-G), or verapamil (Calan, Covera, Isoptin, Verelan); or




  • HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase, Fortovase), or ritonavir (Norvir).



Ergotamine can cause rare but serious side effects on the heart, including heart attack or stroke. To make sure you can safely take ergotamine, tell your doctor if you have any of these other conditions:



  • high blood pressure;




  • liver disease;




  • kidney disease; or




  • coronary artery disease (or risk factors that include diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).




FDA pregnancy category X. Ergotamine can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Ergotamine can pass into breast milk and may harm a nursing baby. Ergotamine may also decrease milk production. Do not use if you are breast-feeding a baby.

How should I take Ergomar (ergotamine)?


Take exactly as prescribed by your doctor. Never take more than your prescribed dose of ergotamine. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks. Ergotamine is not for daily use.


Take the first dose of ergotamine as soon as you notice headache symptoms, or after an attack has already begun. Place 1 ergotamine tablet under your tongue.


If your headache does not completely go away, you may take a second tablet after at least 30 minutes have passed, and a third tablet if needed after another 30 minutes have passed (a total of 3 tablets).


If you still have migraine symptoms after taking a total of 3 tablets, call your doctor. Do not take more than a total of 3 tablets in any 24-hour period. Do not take more than a total of 5 tablets over a period of 7 days. Do not give this medication to anyone else, even if they have the same headache symptoms you have. Ergotamine can be dangerous if it is used to treat headache in a person who has not been diagnosed by a doctor as having true migraine headaches. Store at room temperature away from moisture, heat, and light. Do not take any stored ergotamine if the expiration date on the label has passed.

What happens if I miss a dose?


Since ergotamine is taken only when needed, you are not likely to miss a dose.


Do not take more than 3 ergotamine tablets per day or more than 5 tablets per week.

What happens if I overdose?


Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of ergotamine can be fatal.

Overdose can cause vomiting, confusion, drowsiness, weak pulses in your arms and legs, numbness and tingling or pain in your hands or feet, blue-colored fingers or toes, fainting, and seizure (convulsions).


What should I avoid while taking Ergomar (ergotamine)?


Do not take ergotamine within 24 hours before or after using another migraine headache medicine, including:

  • dihydroergotamine (D.H.E. 45, Migranal), caffeine and ergotamine (Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), methysergide (Sansert); or




  • almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex), rizatriptan (Maxalt, Maxalt-MLT), or zolmitriptan (Zomig).



Grapefruit and grapefruit juice may interact with ergotamine and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.


Ergomar (ergotamine) side effects


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ergotamine and call your doctor at once if you have a serious side effect such as:

  • sudden numbness or weakness, especially on one side of the body;




  • sudden headache, confusion, problems with vision, speech, or balance;




  • fast or slow heart rate;




  • muscle pain in your arms or legs;




  • leg weakness;




  • numbness or tingling and a pale or blue-colored appearance in your fingers or toes;




  • severe pain in your stomach or lower back;




  • urinating less than usual or not at all;




  • swelling or itching in any part of your body;




  • cough with stabbing chest pain and trouble breathing; or




  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).



Less serious side effects may include:



  • dizziness, spinning sensation;




  • weakness;




  • nausea, vomiting; or




  • mild itching.



This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


What other drugs will affect Ergomar (ergotamine)?


Many drugs can interact with ergotamine. Below is just a partial list. Talk with your doctor before taking ergotamine if you are also taking:



  • birth control pills;




  • zileuton (Zyflo);




  • cold or allergy medications;




  • nicotine (Nicoderm, Nicorette);




  • diet pills, stimulants, or medication to treat ADHD (such as Ritalin or Adderall);




  • an antidepressant such as fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and others;




  • an antibiotic such as metronidazole (Flagyl);




  • clotrimazole (Mycelex Troche), fluconazole (Diflucan), or other antifungal medication;




  • nitroglycerin or other nitrate medicines such as isosorbide (Isordil, Dilatrate, Imdur, Monoket); or




  • heart or blood pressure medication such as atenolol (Tenormin), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others.



This list is not complete and other drugs may interact with ergotamine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.



More Ergomar resources


  • Ergomar Side Effects (in more detail)
  • Ergomar Use in Pregnancy & Breastfeeding
  • Ergomar Drug Interactions
  • Ergomar Support Group
  • 1 Review for Ergomar - Add your own review/rating


  • Ergomar Monograph (AHFS DI)

  • Ergomar MedFacts Consumer Leaflet (Wolters Kluwer)



Compare Ergomar with other medications


  • Migraine


Where can I get more information?


  • Your pharmacist can provide more information about ergotamine.

See also: Ergomar side effects (in more detail)


ertapenem


Generic Name: ertapenem (er ta PEN em)

Brand Names: INVanz, INVanz ADD-Vantage


What is ertapenem?

Ertapenem is an antibiotic that fights bacteria.


Ertapenem is used to treat severe infections of the skin, lungs, stomach, pelvis, and urinary tract. It is also used to prevent infection in people having certain types of surgery.


Ertapenem may also be used for purposes not listed in this medication guide.


What is the most important information I should know about ertapenem?


You should not use this medication if you are allergic to ertapenem or to any other antibiotic.

Before using ertapenem, tell your doctor if you have kidney disease, a seizure disorder such as epilepsy, a history of head injury or brain tumor, or if you are allergic to numbing medicine such as lidocaine or Novocain..


To be sure this medication is not causing harmful effects, your blood may need to be tested often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.


Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking ertapenem and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.


Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Ertapenem will not treat a viral infection such as the common cold or flu.


What should I discuss with my healthcare provider before taking ertapenem?


You should not use this medication if you are allergic to ertapenem or to any other antibiotic, especially:

  • meropenem (Merrem);




  • imipenem (Primaxin);




  • a cephalosporin such as cefdinir (Omnicef), cefprozil (Cefzil), cefuroxime (Ceftin), cephalexin (Keflex), and others; or




  • a penicillin such as amoxicillin (Amoxil, Augmentin), ampicillin (Omnipen, Principen), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill), or penicillin (Bicillin C-R, PC Pen VK, Pen-V, Pfizerpen, and others).



To make sure you can safely take ertapenem, tell your doctor if you have any of these other conditions:


  • kidney disease;


  • epilepsy or other seizure disorder;




  • a history of head injury or brain tumor; or




  • if you are allergic to a numbing medicine such as lidocaine or Novocain.




FDA pregnancy category B. Ertapenem is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Ertapenem can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to a child younger than 3 months old.

How should I use ertapenem?


Ertapenem is injected into a muscle or into a vein through an IV. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, syringes, IV tubing, and other items used to inject the medicine.


Ertapenem is a powder medicine that must be mixed with a liquid (diluent) before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medication. Shake the mixture well just before you measure a dose.

When injected into a vein, ertapenem must be given slowly and can take at least 30 minutes to complete.


Ertapenem is usually given as a daily injection for 3 to 14 days. Follow your doctor's instructions.


To be sure this medication is not causing harmful effects, your blood may need to be tested often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.


Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Ertapenem will not treat a viral infection such as the common cold or flu.


Do not share this medication with another person, even if they have the same symptoms you have. Store ertapenem powder at room temperature away from moisture and heat.

You may store the mixture for up to 6 hours at room temperature, or up to 24 hours in a refrigerator. Use the mixed medicine within 4 hours after removing it from a refrigerator. Do not freeze.


What happens if I miss a dose?


Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.


What happens if I overdose?


Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, diarrhea, or dizziness.


What should I avoid while using ertapenem?


Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking ertapenem and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.


Ertapenem side effects


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

  • fever;




  • skin rash, bruising, severe tingling, numbness, pain, muscle weakness;




  • tremors, twitching, or rigid (very stiff) muscles;




  • seizures (black-out or convulsions); or




  • diarrhea that is watery or bloody.



Less serious side effects may include:



  • mild nausea or diarrhea, constipation;




  • vaginal itching or discharge;




  • headache; or




  • pain, redness, or mild swelling where the medicine was injected.



This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


Ertapenem Dosing Information


Usual Adult Dose for Intraabdominal Infection:

Complicated: 1 gram IV or IM once daily for 5 to 14 days

Usual Adult Dose for Pelvic Infections:

1 gram IV or IM once daily for 3 to 10 days

Usual Adult Dose for Pneumonia:

Community-acquired: 1 gram IV or IM once daily
The recommended total duration of antibiotic treatment is 10 to 14 days, which includes a possible conversion to oral therapy after at least 3 days of parenteral therapy and once clinical improvement occurs.

Usual Adult Dose for Pyelonephritis:

1 gram IV or IM once daily
The recommended total duration of antibiotic treatment is 10 to 14 days, which includes a possible conversion to oral therapy after at least 3 days of parenteral therapy and once clinical improvement occurs.

Usual Adult Dose for Skin or Soft Tissue Infection:

Complicated: 1 gram IV or IM once daily for 7 to 14 days
The recommended total duration of antibiotic treatment for diabetic foot infections without osteomyelitis is up to 28 days, which includes a possible conversion to oral therapy.

Usual Adult Dose for Urinary Tract Infection:

Complicated: 1 gram IV or IM once daily
The recommended total duration of antibiotic treatment is 10 to 14 days, which includes a possible conversion to oral therapy after at least 3 days of parenteral therapy and once clinical improvement occurs.

Usual Adult Dose for Infection Prophylaxis:

Prophylaxis of surgical site infection following elective colorectal surgery: 1 gram IV one time, one hour prior to surgical incision

Usual Pediatric Dose for Intraabdominal Infection:

Complicated infection:
3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or older: 1 gram IV or IM once daily

Duration: 5 to 14 days

Usual Pediatric Dose for Pelvic Infections:

3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or older: 1 gram IV or IM once daily

Duration: 3 to 10 days

Usual Pediatric Dose for Pneumonia:

Community-acquired:
3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or older: 1 gram IV or IM once daily

Duration: 10 to 14 days

Usual Pediatric Dose for Pyelonephritis:

3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or more: 1 gram IV or IM once daily

Duration: 10 to 14 days

Usual Pediatric Dose for Skin or Soft Tissue Infection:

Complicated:
3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or older: 1 gram IV or IM once daily

Duration: 7 to 14 days

Usual Pediatric Dose for Urinary Tract Infection:

Complicated:
3 months to 12 years: 15 mg/kg IV or IM every 12 hours
Maximum dose: 1 g/day

13 years or more: 1 gram IV or IM once daily

Duration: 10 to 14 days


What other drugs will affect ertapenem?


Tell your doctor about all other medicines you use, especially:



  • divalproex (Depakote);




  • valproic acid (Depakene); or




  • probenecid (Benemid).



This list is not complete and other drugs may interact with ertapenem. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.



More ertapenem resources


  • Ertapenem Side Effects (in more detail)
  • Ertapenem Use in Pregnancy & Breastfeeding
  • Ertapenem Drug Interactions
  • Ertapenem Support Group
  • 0 Reviews for Ertapenem - Add your own review/rating


  • ertapenem Injection Advanced Consumer (Micromedex) - Includes Dosage Information

  • Ertapenem MedFacts Consumer Leaflet (Wolters Kluwer)

  • Ertapenem Professional Patient Advice (Wolters Kluwer)

  • Ertapenem Sodium Monograph (AHFS DI)

  • Invanz Prescribing Information (FDA)



Compare ertapenem with other medications


  • Infection Prophylaxis
  • Intraabdominal Infection
  • Kidney Infections
  • Pelvic Infections
  • Pneumonia
  • Skin Infection
  • Urinary Tract Infection


Where can I get more information?


  • Your pharmacist can provide more information about ertapenem.

See also: ertapenem side effects (in more detail)


Erivedge





Dosage Form: capsule
FULL PRESCRIBING INFORMATION
WARNING: EMBRYO-FETAL DEATH AND SEVERE BIRTH DEFECTS

Erivedge (vismodegib) capsule can result in embryo-fetal death or severe birth defects. Erivedge is embryotoxic and teratogenic in animals. Teratogenic effects included severe midline defects, missing digits, and other irreversible malformations.


Verify pregnancy status prior to the initiation of Erivedge. Advise male and female patients of these risks. Advise female patients of the need for contraception and advise male patients of the potential risk of Erivedge exposure through semen [see Warnings and Precautions (5.1), Use in Specific Populations (8.1, 8.6)].




Indications and Usage for Erivedge


Erivedge capsule is indicated for the treatment of adults with metastatic basal cell carcinoma, or with locally advanced basal cell carcinoma that has recurred following surgery or who are not candidates for surgery, and who are not candidates for radiation.



Erivedge Dosage and Administration


The recommended dose of Erivedge is 150 mg taken orally once daily until disease progression or until unacceptable toxicity [see Clinical Studies (14)].


Erivedge may be taken with or without food. Swallow capsules whole. Do not open or crush capsules.


If a dose of Erivedge is missed, do not make up that dose; resume dosing with the next scheduled dose.



Dosage Forms and Strengths


Erivedge (vismodegib) capsules, 150 mg. The capsule has a pink opaque body and a grey opaque cap, with “150 mg” printed on the capsule body and “VISMO” printed on the capsule cap in black ink.



Contraindications


None.



Warnings and Precautions



Embryo-Fetal Death and Severe Birth Defects


Erivedge capsules can cause fetal harm when administered to a pregnant woman based on its mechanism of action. Vismodegib is teratogenic, embryotoxic, and fetotoxic in rats at maternal exposures lower than the human exposures at the recommended dose of 150 mg/day. In rats, malformations included craniofacial anomalies, open perineum, and absent or fused digits. Fetal retardations and variations were also observed.


Verify pregnancy status prior to the initiation of Erivedge. Advise male and female patients of the risks of embryo-fetal death and severe birth defects and the need for contraception during and after treatment. Advise patients to contact their healthcare provider immediately if they suspect they (or, for males, their female partner) may be pregnant. Female and male patients of reproductive potential should be counseled regarding pregnancy prevention and planning. If Erivedge is used during pregnancy or if a patient becomes pregnant while taking (or for a male patient, if his female partner is exposed to) Erivedge, the patient should be apprised of the potential hazard to the fetus. Report immediately exposure to Erivedge during pregnancy to the Genentech Adverse Event Line at 1-888-835-2555. Encourage women who may have been exposed to Erivedge during pregnancy, either directly or through seminal fluid, to participate in the Erivedge pregnancy pharmacovigilance program by contacting the Genentech Adverse Event Line at 1-888-835-2555 [see Boxed Warning, Use in Specific Populations (8.1, 8.6)].



Blood Donation


Advise patients not to donate blood or blood products while receiving Erivedge and for at least 7 months after the last dose of Erivedge.



Adverse Reactions



Clinical Trials Experience


Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.


Erivedge capsule was administered as monotherapy at doses ≥ 150 mg orally daily in four open-label, uncontrolled, dose-ranging or fixed single dose clinical trials enrolling a total of 138 patients with advanced basal cell carcinoma (BCC). The median age of these patients was 61 years (range 21 to 101), 100% were White (including Hispanics), and 64% were male. The median duration of treatment was approximately 10 months (305 days; range 0.7 to 36 months); 111 patients received Erivedge for 6 months or longer.


The most common adverse reactions (≥ 10%) were muscle spasms, alopecia, dysgeusia, weight loss, fatigue, nausea, diarrhea, decreased appetite, constipation, arthralgias, vomiting, and ageusia (Table 1).























































































Table 1: Adverse Reactions Occurring in ≥10% of Advanced BCC Patients

*

MedDRA = Medical Dictionary for Regulatory Activities.


aBCC = Advanced Basal Cell Carcinoma.


Grading according to NCI-CTCAE v3.0.

MedDRA Preferred Term*All aBCC Patients (N = 138)
All Grades (%)Grade 3 (%)Grade 4 (%) 
Gastrointestinal disorders
    Nausea42 (30.4%)1 (0.7%)-
    Diarrhea40 (29.0%)1 (0.7%)-
    Constipation29 (21.0%)--
    Vomiting19 (13.8%)--
General disorders and administration site conditions
    Fatigue55 (39.9%)7 (5.1%)1 (0.7%)
    Investigations
    Weight loss62 (44.9%)10 (7.2%)-
Metabolism and nutrition disorders
    Decreased appetite35 (25.4%)3 (2.2%)-
Musculoskeletal and connective tissue disorders
    Muscle spasms99 (71.7%)5 (3.6%)-
    Arthralgias22 (15.9%)1 (0.7%)
Nervous system disorders
    Dysgeusia76 (55.1%)--
    Ageusia15 (10.9%)--
Skin and subcutaneous tissue disorders
    Alopecia88 (63.8%)--

Amenorrhea:


In clinical trials, a total of 3 of 10 pre-menopausal women developed amenorrhea while receiving Erivedge [see Non-Clinical Toxicology (13.1)].


Laboratory Abnormalities:


Treatment-emergent Grade 3 laboratory abnormalities observed in clinical trials were hyponatremia in 6 patients (4%), hypokalemia in 2 patients (1%), and azotemia in 3 patients (2%).



Drug Interactions



Effects of Other Drugs on Vismodegib


Drugs that Inhibit or Induce Drug Metabolizing Enzymes


Vismodegib elimination involves multiple pathways. Vismodegib is predominantly excreted as an unchanged drug. Several minor metabolites are produced by multiple CYP enzymes. Although vismodegib is a substrate of CYP2C9 and CYP3A4 in vitro, CYP inhibition is not predicted to alter vismodegib systemic exposure since similar steady-state plasma vismodegib concentrations were observed in patients in clinical trials concomitantly treated with CYP3A4 inducers (i.e., carbamazepine, modafinil, phenobarbital) and those concomitantly treated with CYP3A4 inhibitors (i.e., erythromycin, fluconazole).


Drugs that Inhibit Drug Transport Systems


In vitro studies indicate that vismodegib is a substrate of the efflux transporter P-glycoprotein (P-gp). When Erivedge is coadministered with drugs that inhibit P-gp (e.g. clarithromycin, erythromycin, azithromycin), systemic exposure of vismodegib and incidence of adverse events of Erivedge may be increased.


Drugs that Affect Gastric pH


Drugs that alter the pH of the upper GI tract (e.g. proton pump inhibitors, H2-receptor antagonists, and antacids) may alter the solubility of vismodegib and reduce its bioavailability. However, no formal clinical study has been conducted to evaluate the effect of gastric pH altering agents on the systemic exposure of vismodegib. Increasing the dose of Erivedge when coadministered with such agents is not likely to compensate for the loss of exposure. When Erivedge is coadministered with a proton pump inhibitor, H2-receptor antagonist or antacid, systemic exposure of vismodegib may be decreased and the effect on efficacy of Erivedge is unknown.



Effects of Vismodegib on Other Drugs


Results of a drug-drug interaction study conducted in cancer patients demonstrated that the systemic exposure of rosiglitazone (a CYP2C8 substrate) or oral contraceptives (ethinyl estradiol and norethindrone) is not altered when either drug is co-administered with vismodegib.


In vitro studies indicate that vismodegib is an inhibitor of CYP2C8, CYP2C9, CYP2C19 and the transporter BCRP. Vismodegib does not induce CYP1A2, CYP2B6, or CYP3A4/5 in human hepatocytes.



USE IN SPECIFIC POPULATIONS



Pregnancy


Pregnancy Category D


Erivedge capsule can cause fetal harm when administered to a pregnant female based on its mechanism of action. Vismodegib is teratogenic in rats at doses corresponding to an exposure of 20% of the exposure at the recommended human dose (estimated AUC0-24hr steady-state exposure). In rats, malformations included craniofacial anomalies, open perineum, and absent or fused digits. Fetal retardations and variations were also observed. Vismodegib is embryolethal in rats at exposures within the range achieved at the recommended human dose. If Erivedge is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the embryo or fetus. Report immediately exposure to Erivedge during pregnancy to the Genentech Adverse Event Line at 1-888-835-2555. Encourage women who may have been exposed to Erivedge during pregnancy, either directly or through seminal fluid, to participate in the Erivedge pregnancy pharmacovigilance program by contacting the Genentech Adverse Event Line at 1-888-835-2555 [see Boxed Warning, Warnings and Precautions (5.1)].


In an embryo-fetal developmental toxicity study, pregnant rats were administered oral vismodegib at doses of 10, 60, or 300 mg/kg/day during the period of organogenesis. Pre- and post-implantation loss were increased at doses of ≥ 60 mg/kg/day (approximately ≥ 2 times the systemic exposure (AUC) in patients at the recommended human dose), which included early resorption of 100% of the fetuses. A dose of 10 mg/kg/day (approximately 0.2 times the AUC in patients at the recommended dose) resulted in malformations (including missing and/or fused digits, open perineum and craniofacial anomalies) and retardations or variations (including dilated renal pelvis, dilated ureter, and incompletely or unossified sternal elements, centra of vertebrae, or proximal phalanges and claws).



Nursing Mothers


It is not known whether vismodegib is excreted in human breast milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Erivedge, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.



Pediatric Use


The safety and effectiveness of Erivedge capsule have not been established in pediatric patients.


In repeat-dose toxicology studies in rats, administration of oral vismodegib resulted in toxicities in bone and teeth. Effects on bone consisted of closure of the epiphyseal growth plate when oral vismodegib was administered for 26 weeks at ≥ 50 mg/kg/day (approximately ≥ 0.4 times the systemic exposure (AUC) in patients at the recommended human dose). Abnormalities in growing incisor teeth (including degeneration/necrosis of odontoblasts, formation of fluid-filled cysts in the dental pulp, ossification of the root canal, and hemorrhage resulting in breakage or loss of teeth) were observed after administration of oral vismodegib at ≥ 15 mg/kg/day (approximately ≥ 0.2 times the AUC in patients at the recommended human dose).



Geriatric Use


Clinical studies of Erivedge capsule did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients.



Females of Reproductive Potential and Males


Erivedge capsule can cause harm to the embryo or fetus when administered during pregnancy. Counsel female and male patients regarding pregnancy prevention and planning. Advise patients to contact their healthcare provider immediately if they suspect they (or, for males, their female partner) may be pregnant [see Boxed Warning, Warnings and Precautions (5.1), Use in Specific Populations (8.1)].


Female patients


Determine pregnancy status within 7 days prior to initiation of treatment in females of reproductive potential. For females with a negative pregnancy test, initiate a highly effective form of contraception (failure rate of less than 1%) prior to the first dose. Continue highly effective contraception during therapy and for 7 months after the last dose of Erivedge. If a patient becomes pregnant while taking Erivedge, or during the 7 months after the last dose of treatment, report the pregnancy to the Genentech Adverse Event Line at 1-888-835-2555. Encourage pregnant females to participate in the Erivedge pregnancy pharmacovigilance program by calling the Genentech Adverse Event Line at 1-888-835-2555. Counsel pregnant females about the teratogenic risk to the fetus.


Amenorrhea has been observed in clinical trials in females of reproductive potential. Reversibility of amenorrhea is unknown [see Adverse Reactions (6), Nonclinical Toxicology (13.1)].


Male patients


Male patients should use condoms with spermicide, even after a vasectomy, during sexual intercourse with female partners while being treated with Erivedge capsule and for 2 months after the last dose to avoid exposing an embryo or fetus to vismodegib.



Hepatic Impairment


The safety and effectiveness of Erivedge capsule have not been established in patients with hepatic impairment [see Clinical Pharmacology (12.3)].



Renal Impairment


The safety and effectiveness of Erivedge capsule have not been established in patients with renal impairment [see Clinical Pharmacology (12.3)].



Overdosage


There is no information on overdosage in humans. In clinical trials, Erivedge capsule was administered at 540 mg orally once daily; exposure did not increase between 150 mg and 540 mg daily.



Erivedge Description


Vismodegib is an inhibitor of the hedgehog (Hh) signaling pathway, which is described chemically as 2‑Chloro‑N‑(4‑chloro‑3‑(pyridin‑2‑yl)phenyl)‑4‑(methylsulfonyl)benzamide. The molecular formula is C19H14Cl2N2O3S. The molecular weight is 421.30 g/mol and the structural formula is:



Vismodegib is a crystalline free base with a pKa (pyridinium cation) of 3.8, appearing as a white to tan powder. The solubility of vismodegib is pH dependent with 0.1 μg/mL at pH 7 and 0.99 mg/mL at pH 1. The partition coefficient (log P) is 2.7.


Each Erivedge (vismodegib) capsule for oral administration contains 150 mg vismodegib and the following inactive ingredients: microcrystalline cellulose, lactose monohydrate, sodium lauryl sulfate, povidone, sodium starch glycolate, talc, and magnesium stearate (non-bovine). The capsule shell contains gelatin, titanium dioxide, red iron oxide, and black iron oxide. The black printing ink contains shellac and black iron oxide.



Erivedge - Clinical Pharmacology



Mechanism of Action


Vismodegib is an inhibitor of the Hedgehog pathway. Vismodegib binds to and inhibits Smoothened, a transmembrane protein involved in Hedgehog signal transduction.



Pharmacokinetics


Absorption


Vismodegib is a highly permeable compound with low aqueous solubility (BCS Class 2). The single dose absolute bioavailability of vismodegib is 31.8%. Absorption is saturable as evidenced by the lack of dose proportional increase in exposure after a single dose of 270 mg or 540 mg vismodegib. Erivedge capsule may be taken without regard to meals because the systemic exposure of vismodegib at steady state is not affected by food.


Distribution


The volume of distribution of vismodegib ranges from 16.4 to 26.6 L. Vismodegib plasma protein binding in patients is greater than 99%. Vismodegib binds to both human serum albumin and alpha-1-acid glycoprotein (AAG) and binding to AAG is saturable.


Metabolism


Greater than 98% of the total circulating drug-related components are the parent drug. Metabolic pathways of vismodegib in humans include oxidation, glucuronidation, and pyridine ring cleavage. The two most abundant oxidative metabolites recovered in feces are produced in vitro by recombinant CYP2C9 and CYP3A4/5.


Elimination


Vismodegib and its metabolites are eliminated primarily by the hepatic route with 82% of the administered dose recovered in the feces and 4.4% recovered in urine. The estimated elimination half-life (t1/2) of vismodegib is 4 days after continuous once-daily dosing and 12 days after a single dose.


Pharmacokinetics in Specific Populations


Hepatic Impairment: The effect of hepatic impairment on the systemic exposure of vismodegib has not been studied.


Renal Impairment: The effect of renal impairment on the systemic exposure of vismodegib has not been studied.


Population pharmacokinetic analyses showed that weight (range: 41-140 kg), age (range: 26-89 years), creatinine clearance (range: 30 to 80 mL/min), and sex do not have a clinically meaningful influence on the systemic exposure of vismodegib.



Cardiac Electrophysiology


In a thorough QTc study in 60 healthy subjects, there was no effect of therapeutic doses of Erivedge on the QTc interval.



Nonclinical Toxicology



Carcinogenesis, Mutagenesis, Impairment of Fertility


Carcinogenicity studies with vismodegib have not been conducted. Pilomatricoma (a benign cutaneous neoplasm) was observed in rats administered oral vismodegib for 26 weeks at 100 mg/kg/day (approximately 0.8 times the systemic exposure (AUC) in patients at the recommended human dose).


Vismodegib was not mutagenic in the in vitro bacterial reverse mutation (Ames) assay and was not clastogenic in the in vitro human chromosomal aberration assay in human peripheral blood lymphocytes or in the in vivo rat bone marrow micronucleus assay.


Studies to assess the potential of vismodegib to affect fertility have not been conducted; however, data from repeat-dose toxicology studies in rats and dogs indicate that male and female reproductive function and fertility may be impaired in patients receiving Erivedge capsule. In a 26-week toxicology study in rats, a relative decrease in percent motile sperm was observed at ≥ 15 mg/kg/day (approximately ≥ 0.3 times the AUC in patients at the recommended human dose). In dogs, increased numbers of degenerating germ cells and hypospermia were observed in young animals administered oral vismodegib for 4 weeks at ≥ 50 mg/kg/day (approximately ≥ 2 times the AUC in patients at the recommended human dose). No corresponding findings were observed in sexually mature dogs at similar doses in 13-week and 26-week toxicology studies. A decrease in the number of corpora lutea was observed in female rats administered oral vismodegib for 26 weeks at 100 mg/kg/day (approximately 0.8 times the AUC in patients at the recommended human dose).



Animal Toxicology


Neurologic effects characterized as limb or body tremors or twitching were observed in rats administered oral vismodegib for 4 weeks or longer at ≥ 50 mg/kg/day (approximately ≥ 0.4 times the AUC in patients at the recommended human dose). These observations resolved upon discontinuation of dosing and were not associated with microscopic findings.



Clinical Studies


A single, international, single-arm, multi-center, open-label, 2-cohort trial was conducted in 104 patients with either metastatic basal cell carcinoma (mBCC) (n = 33) or locally advanced BCC (laBCC) (n = 71). Patients with laBCC were required to have lesions that had recurred after radiotherapy, unless radiotherapy was contraindicated or inappropriate (e.g. Gorlin syndrome; limitations because of location of tumor or cumulative prior radiotherapy dose), and where the lesions were either unresectable or surgical resection would result in substantial deformity. Patients were to receive 150 mg vismodegib per day orally until disease progression or unacceptable toxicity.


The major efficacy outcome measure of the trial was objective response rate (ORR) as assessed by an independent review facility (IRF). In the mBCC cohort, tumor response was assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0. In the laBCC cohort, tumor response evaluation included measurement of externally assessable tumor (including scar) and assessment for ulceration in photographs, radiographic assessment of target lesions (if appropriate), and tumor biopsy. An objective response in laBCC required at least one of the following criteria and absence of any criterion for disease progression: (1) ≥ 30% reduction in lesion size [sum of the longest diameter (SLD)] from baseline in target lesions by radiographic assessment; (2) ≥ 30% reduction in SLD from baseline in externally visible dimension of target lesions; (3) complete resolution of ulceration in all target lesions. Complete response was defined as objective response (as defined above) with no residual BCC on sampling tumor biopsy. Disease progression was defined as any of the following: (1) ≥ 20% increase in the SLD from nadir in target lesions (either by radiography or by externally visible dimension); (2) new ulceration of target lesions persisting without evidence of healing for at least 2 weeks; (3) new lesions by radiographic assessment or physical examination; (4) progression of non-target lesions by RECIST.


Of the 104 patients enrolled, 96 patients were evaluable for ORR. Twenty-one percent of patients carried a diagnosis of Gorlin syndrome. The median age of the efficacy evaluable population was 62 years (46% were at least 65 years old), 61% male and 100% White. For the mBCC cohort (n = 33), 97% of patients had prior therapy including surgery (97%), radiotherapy (58%), and systemic therapies (30%). For the laBCC cohort (n = 63), 94% of patients had prior therapies including surgery (89%), radiotherapy (27%), and systemic/topical therapies (11%). The median duration of treatment was 10.2 months (range 0.7 to 18.7 months).


The key outcome measures are presented in Table 2, below.























Table 2: Objective Response Rate: Efficacy-Evaluable Patients*

*

Patients who received at least one dose of Erivedge with independent pathologist-confirmed diagnosis of BCC


IRF = Independent Review Facility


For laBCC, complete response was defined as objective response with no residual BCC on sampling tumor biopsy.

§

CI = Confidence Interval


NE = Not estimable

mBCC

(n = 33)
laBCC

(n = 63)
IRF-Confirmed ORR, n (%)

    (95%CI)

10 (30.3)

(15.6, 48.2)
27 (42.9)

(30.5, 56.0)
    Complete response

0 (0.0)13 (20.6)
    Partial response

10 (30.3)14 (22.2)
Median Response Duration (months)

7.67.6
    (95% CI§)(5.6, NE)(5.7, 9.7)

How Supplied/Storage and Handling


Each Erivedge (vismodegib) capsule has a pink opaque body and a grey opaque cap with “150 mg” printed on the capsule body and “VISMO” printed on the capsule cap in black ink. Erivedge capsules are available in bottles of 28 capsules (NDC 50242-140-01).


Store at room temperature 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature].



Patient Counseling Information


See FDA-approved patient labeling (Medication Guide).


  • Advise patients that Erivedge exposure during pregnancy can cause embryo-fetal death or severe birth defects.

  • Instruct female patients of reproductive potential to use a highly effective form of contraception (failure rate of less than 1%) while taking Erivedge and for at least 7 months after the last dose of Erivedge.

  • Instruct all male patients, even those with prior vasectomy, to use condoms with spermicide, during sexual intercourse with female partners while taking Erivedge and for at least 2 months after the last dose of Erivedge.

  • Instruct patients to immediately contact their healthcare provider if they (or, for males, their female partner) become pregnant or if pregnancy is suspected following exposure to Erivedge.

  • Instruct patients to immediately report any pregnancy exposure to Erivedge and encourage participation in the Erivedge pregnancy pharmacovigilance program by calling the Genentech Adverse Event Line at 1-888-835-2555.

  • Inform female patients of the potential for serious adverse reactions in nursing infants from Erivedge, taking into account the importance of the drug to the mother.

  • Advise patients not to donate blood or blood products while taking Erivedge and for at least 7 months after the last dose of Erivedge.

  • Advise patients to swallow Erivedge capsules whole and not to crush or open the capsules.





Erivedge™ [vismodegib] capsule

Manufactured by:

Patheon, Inc.

Mississauga, Canada


Distributed by:

Genentech USA, Inc.

A Member of the Roche Group

1 DNA Way

South San Francisco, CA 94080-4990
Erivedge is a registered trademark of Genentech, Inc.

©2012 Genentech, Inc.

10135493

MEDICATION GUIDE


Erivedge™ (EH-rih-vej)

(vismodegib)

capsule


Read this Medication Guide before you start taking Erivedge and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking with your healthcare provider about your medical condition or your treatment.


What is the most important information I should know about Erivedge?


Erivedge can cause your baby to die before it is born (be stillborn) or cause your baby to have severe birth defects.


For females who can become pregnant:


  • You should talk with your healthcare provider about the risks of Erivedge to your unborn child.

  • Your healthcare provider should do a pregnancy test within 7 days before you start taking Erivedge to find out if you are pregnant.

  • In order to avoid pregnancy, you should start using highly effective birth control before you start Erivedge, and continue to use highly effective birth control during treatment, and for 7 months after your last dose of Erivedge. Talk with your healthcare provider about what birth control method is right for you during this time.

  • Talk to your healthcare provider right away if you have unprotected sex or if you think that your birth control has failed.

  • Tell your healthcare provider right away if you become pregnant or think that you may be pregnant.

For males:


  • You should always use a condom with a spermicide, even if you have had a vasectomy, during sex with female partners while you are taking Erivedge and for 2 months after your last dose to protect your female partner from being exposed to Erivedge.

  • Tell your healthcare provider right away if your partner becomes pregnant or thinks she is pregnant while you are taking Erivedge.

Exposure to Erivedge during pregnancy:


If you think that you or your female partner may have been exposed to Erivedge during pregnancy, talk to your healthcare provider right away. Pregnant women are encouraged to participate in a program that collects information about exposure to Erivedge during pregnancy, and the effects on the mother and her unborn child. This program is called the Erivedge pregnancy pharmacovigilance program. You may participate in this program by calling the Genentech Adverse Event Line at 1-888-835-2555.


What is Erivedge?


Erivedge is a prescription medicine used to treat adults with a type of skin cancer, called basal cell carcinoma, that has spread to other parts of the body or that has come back after surgery or that your healthcare provider decides cannot be treated with surgery or radiation.


It is not known if Erivedge is safe and effective in children.


What should I tell my healthcare provider before taking Erivedge?


Before taking Erivedge, tell your healthcare provider if you:


  • are pregnant or plan to become pregnant. See “What is the most important information I should know about Erivedge?”

  • are breastfeeding or plan to breastfeed. It is not known if Erivedge passes into your breast milk. You and your healthcare provider should decide if you will take Erivedge or breastfeed. You should not do both.

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.


Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.


How should I take Erivedge?


  • Take Erivedge exactly as your healthcare provider tells you.

  • You can take Erivedge with or without food.

  • Swallow Erivedge capsules whole. Do not open or crush the capsules.

  • Take Erivedge one time each day.

  • If you miss a dose, skip the missed dose. Just take your next scheduled dose.

What should I avoid while taking Erivedge?


  • Do not donate blood or blood products while you are taking Erivedge and for 7 months after your last dose.

What are the possible side effects of Erivedge?


Erivedge can cause serious side effects, including:


  • See “What is the most important information I should know about Erivedge?”

The most common side effects of Erivedge are:


  • muscle spasms

  • hair loss

  • change in how things taste or loss of taste

  • weight loss

  • tiredness

  • nausea

  • diarrhea

  • decreased appetite

  • constipation

  • vomiting

  • joint aches

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.


These are not all the possible side effects of Erivedge. For more information, ask your healthcare provider or pharmacist.


Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


You may also report side effects to Genentech, Inc. at 1-888-835-2555.


How should I store Erivedge?


  • Store Erivedge at room temperature between 68°F to 77°F (20°C to 25°C).

Keep Erivedge and all medicines out of the reach of children.


General information about Erivedge


Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Erivedge for a condition for which it was not prescribed. Do not give Erivedge to other people, even if they have the same symptoms that you have. It may harm them.


This Medication Guide summarizes the most important information about Erivedge. If you would like more information, ask your health care provider. You can ask your healthcare provider or pharmacist for the FDA-approved information about Erivedge that is written for healthcare professionals.


For more information, call 1-855-737-4833 or visit www.Erivedge.com


What are the ingredients in Erivedge?


Active ingredient: vismodegib


Inactive ingredients: microcrystalline cellulose, lactose monohydrate, sodium lauryl sulfate, povidone, sodium starch glycolate, talc, magnesium stearate (non bovine). The capsule shell contains gelatin, titanium dioxide, red iron oxide, and black iron oxide. The black printing ink contains shellac and black iron oxide.


This Medication Guide has been approved by the U.S. Food and Drug Administration.


MG Issued: 01/2012


Manufactured by:

Patheon, Inc.

Mississauga, Canada


Distributed by:

Genentech USA, Inc.

A Member of the Roche Group

1 DNA Way

South San Francisco, CA 940804990


Erivedge is a registered trademark of Genentech, Inc.


©2012 Genentech, Inc.


10135493



PRINCIPAL DISPLAY PANEL - Erivedge Capsules 150 mg Folding Carton


NDC 50242-140-01


Erivedge™


(vismodegib) capsules


150 mg


Each capsule contains 150 mg of vismodegib


Rx only


Attention Pharmacist: Dispense the accompanying Medication Guide to each patient.


28 capsules


Genentech


10135488


Erivedge Principal Display Panel










Erivedge 
vismodegib  capsule










Product Information
Product TypeHUMAN PRESCRIPTION DRUGNDC Product Code (Source)50242-140
Route of AdministrationORALDEA Schedule    








Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
vismodegib (vismodegib)vismodegib150 mg






























Inactive Ingredients
Ingredient NameStrength
cellulose, microcrystalline 
lactose monohydrate 
sodium lauryl sulfate 
povidone K29/32 
sodium starch glycolate type a potato 
talc 
magnesium stearate 
water 
gelatin 
titanium dioxide 
ferric oxide red 
ferrosoferric oxide 
shellac 


















Product Characteristics
ColorGRAY (gray opaque) , PINK (pink opaque)Scoreno score
ShapeCAPSULE (hard capsule)Size19mm
FlavorImprint CodeVISMO;150;mg
Contains      














Packaging
#NDCPackage DescriptionMultilevel Packaging
150242-140-011 BOTTLE In 1 CARTONcontains a BOTTLE, PLASTIC
128 CAPSULE In 1 BOTTLE, PLASTICThis package is contained within the CARTON (50242-140-01)










Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDANDA20338801/30/2012


Labeler - Genentech, Inc. (080129000)









Establishment
NameAddressID/FEIOperations
Patheon Inc.240769596MANUFACTURE, PACK, LABEL









Establishment
NameAddressID/FEIOperations
Patheon Inc.259484350ANALYSIS









Establishment
NameAddressID/FEIOperations
Siegfried Ltd480004571API MANUFACTURE
Revised: 01/2012Genentech, Inc.

Tuesday, September 13, 2016

ergotamine


Generic Name: ergotamine (er GOT a meen)

Brand Names: Ergomar


What is ergotamine?

Ergotamine is in a group of drugs called ergot alkaloids (ER-got AL-ka-loids). It works by narrowing the blood vessels around the brain. Ergotamine also affects blood flow patterns that are associated with certain types of headaches.


Ergotamine is used to treat a migraine type headache.


This medication will only treat a headache that has already begun. It will not prevent migraine headaches or reduce the number of attacks.


Ergotamine should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches.

Ergotamine may also be used for purposes not listed in this medication guide.


What is the most important information I should know about ergotamine?


This medication can harm an unborn baby or a nursing baby. Do not take ergotamine if you are pregnant or breast-feeding. Do not take this medication if you are allergic to ergotamine or other ergot medicines, or if you have a history of heart disease, angina (chest pain), blood circulation problems, history of a heart attack or stroke, coronary artery disease, uncontrolled high blood pressure, severe liver or kidney disease, or a serious infection. Using certain medications together with ergotamine can cause even greater decreases in blood flow than ergotamine used alone, which can lead to dangerous side effects. Tell your doctor about all other medications you are using.

Also tell your doctor about all of your medical conditions, especially high blood pressure, liver or kidney disease, or risk factors for coronary artery disease (diabetes, high blood pressure or cholesterol, menopause or hysterectomy, smoking, taking birth control pills, being overweight, having a family history of coronary artery disease, or being a man older than 40).


This medication will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.


Never take more than your prescribed dose of ergotamine. An overdose can be fatal.

What should I discuss with my healthcare provider before taking ergotamine?


Do not take this medication if you are allergic to ergotamine or similar medications such as Cafergot, D.H.E. 45, Migergot, Migranal, or Methergine.

Do not take ergotamine if you are pregnant or breast-feeding, or if you have:



  • a history of heart disease, angina (chest pain), blood circulation problems, or history of a heart attack or stroke;




  • coronary artery disease or "hardening of the arteries";




  • uncontrolled high blood pressure;



  • severe liver disease;

  • severe kidney disease; or


  • a serious infection called sepsis.




Using certain medications together with ergotamine can cause even greater decreases in blood flow than ergotamine used alone, which can lead to dangerous side effects. Do not take ergotamine if you are also using any of the following medications:

  • conivaptan (Vaprisol), imatinib (Gleevec), isoniazid (for treating tuberculosis), or nefazodone (an antidepressant);




  • diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);




  • clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), or telithromycin (Ketek);




  • clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Extina, Ketozole, Nizoral, Xolegal), or voriconazole (Vfend);




  • heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene), quinidine (Quin-G), or verapamil (Calan, Covera, Isoptin, Verelan); or




  • HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase, Fortovase), or ritonavir (Norvir).



Ergotamine can cause rare but serious side effects on the heart, including heart attack or stroke. To make sure you can safely take ergotamine, tell your doctor if you have any of these other conditions:



  • high blood pressure;




  • liver disease;




  • kidney disease; or




  • coronary artery disease (or risk factors that include diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).




FDA pregnancy category X. Ergotamine can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. Ergotamine can pass into breast milk and may harm a nursing baby. Ergotamine may also decrease milk production. Do not use if you are breast-feeding a baby.

How should I take ergotamine?


Take exactly as prescribed by your doctor. Never take more than your prescribed dose of ergotamine. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks. Ergotamine is not for daily use.


Take the first dose of ergotamine as soon as you notice headache symptoms, or after an attack has already begun. Place 1 ergotamine tablet under your tongue.


If your headache does not completely go away, you may take a second tablet after at least 30 minutes have passed, and a third tablet if needed after another 30 minutes have passed (a total of 3 tablets).


If you still have migraine symptoms after taking a total of 3 tablets, call your doctor. Do not take more than a total of 3 tablets in any 24-hour period. Do not take more than a total of 5 tablets over a period of 7 days. Do not give this medication to anyone else, even if they have the same headache symptoms you have. Ergotamine can be dangerous if it is used to treat headache in a person who has not been diagnosed by a doctor as having true migraine headaches. Store at room temperature away from moisture, heat, and light. Do not take any stored ergotamine if the expiration date on the label has passed.

See also: Ergotamine dosage (in more detail)

What happens if I miss a dose?


Since ergotamine is taken only when needed, you are not likely to miss a dose.


Do not take more than 3 ergotamine tablets per day or more than 5 tablets per week.

What happens if I overdose?


Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of ergotamine can be fatal.

Overdose can cause vomiting, confusion, drowsiness, weak pulses in your arms and legs, numbness and tingling or pain in your hands or feet, blue-colored fingers or toes, fainting, and seizure (convulsions).


What should I avoid while taking ergotamine?


Do not take ergotamine within 24 hours before or after using another migraine headache medicine, including:

  • dihydroergotamine (D.H.E. 45, Migranal), caffeine and ergotamine (Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), methysergide (Sansert); or




  • almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex), rizatriptan (Maxalt, Maxalt-MLT), or zolmitriptan (Zomig).



Grapefruit and grapefruit juice may interact with ergotamine and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.


Ergotamine side effects


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ergotamine and call your doctor at once if you have a serious side effect such as:

  • sudden numbness or weakness, especially on one side of the body;




  • sudden headache, confusion, problems with vision, speech, or balance;




  • fast or slow heart rate;




  • muscle pain in your arms or legs;




  • leg weakness;




  • numbness or tingling and a pale or blue-colored appearance in your fingers or toes;




  • severe pain in your stomach or lower back;




  • urinating less than usual or not at all;




  • swelling or itching in any part of your body;




  • cough with stabbing chest pain and trouble breathing; or




  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).



Less serious side effects may include:



  • dizziness, spinning sensation;




  • weakness;




  • nausea, vomiting; or




  • mild itching.



This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


Ergotamine Dosing Information


Usual Adult Dose for Migraine:

Initial dose: 2 mg orally in fixed combination with caffeine given as quickly as possible after the first symptom of headache. Additional 1-2 mg doses can be given every 30 minutes until the headache has stopped or until a total dose of 6 mg has been reached. The total dose should not exceed 6 mg/day or 10 mg/week.

Initial dose: 2 mg under the tongue given as quickly as possible after the first symptom of headache. Additional 1-2 mg doses can be given every 30 minutes until the headache has stopped or until a total dose of 6 mg has been reached. The total dose should not exceed 6 mg/day or 10 mg/week.

Initial dose: 2 mg rectally in fixed combination with caffeine given as quickly as possible after the first symptom of headache. Additional 2 mg doses can be given 1 hour later if the first dose fails to stop headache. The total dose should not exceed 4 mg for one attack or 10 mg/week.

Usual Pediatric Dose for Migraine:

Older children: 1 mg orally or under the tongue (depending on dosage form) at the onset of attack, then 1 mg every 30 minutes as needed up to a maximum of 3 mg/attack.


What other drugs will affect ergotamine?


Many drugs can interact with ergotamine. Below is just a partial list. Talk with your doctor before taking ergotamine if you are also taking:



  • birth control pills;




  • zileuton (Zyflo);




  • cold or allergy medications;




  • nicotine (Nicoderm, Nicorette);




  • diet pills, stimulants, or medication to treat ADHD (such as Ritalin or Adderall);




  • an antidepressant such as fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and others;




  • an antibiotic such as metronidazole (Flagyl);




  • clotrimazole (Mycelex Troche), fluconazole (Diflucan), or other antifungal medication;




  • nitroglycerin or other nitrate medicines such as isosorbide (Isordil, Dilatrate, Imdur, Monoket); or




  • heart or blood pressure medication such as atenolol (Tenormin), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others.



This list is not complete and other drugs may interact with ergotamine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.



More ergotamine resources


  • Ergotamine Side Effects (in more detail)
  • Ergotamine Dosage
  • Ergotamine Use in Pregnancy & Breastfeeding
  • Ergotamine Drug Interactions
  • Ergotamine Support Group
  • 2 Reviews for Ergotamine - Add your own review/rating


  • Ergotamine MedFacts Consumer Leaflet (Wolters Kluwer)

  • Ergomar Monograph (AHFS DI)



Compare ergotamine with other medications


  • Migraine


Where can I get more information?


  • Your pharmacist can provide more information about ergotamine.

See also: ergotamine side effects (in more detail)


Erbitux


Generic Name: cetuximab (se TUX i mab)

Brand Names: Erbitux


What is cetuximab?

Cetuximab is a cancer medication that interferes with the growth of cancer cells and slows their growth and spread in the body.


Cetuximab is used to treat cancers of the colon and rectum. It is also used to treat head and neck cancer.


Cetuximab may also be used for purposes not listed in this medication guide.


What is the most important information I should know about cetuximab?


Cetuximab is often used in combination with other cancer medications and/or radiation treatments.


You should not use this medication if you are allergic to cetuximab or to mouse protein.

Before receiving cetuximab, tell your doctor if you have heart rhythm problems, congestive heart failure, breathing problems, coronary artery disease, or low levels of potassium or magnesium in your blood.


After your cetuximab infusion, your doctor will need to watch you for about an hour. This is to make sure you do not have any serious side effects from the medicine.

Some people receiving a cetuximab injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your caregiver right away if you feel short of breath, weak or dizzy, nauseated, itchy, or have wheezing, noisy breathing, or a hoarse voice during the injection.


To make sure this medication is helping your condition and not causing harmful effects, your blood will need to be tested often. Your cancer treatments may be delayed based on the results of these tests. Do not miss any follow-up visits to your doctor. Avoid exposure to sunlight or tanning beds while you are receiving cetuximab and for at least 2 months after your treatment ends. Cetuximab can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

What should I discuss with my healthcare provider before I receive cetuximab?


You should not use this medication if you are allergic to cetuximab or to mouse protein.

To make sure you can safely receive cetuximab, tell your doctor if you have any of these other conditions:



  • heart rhythm problems;




  • lung disease or a breathing disorder;




  • congestive heart failure;




  • coronary artery disease (clogged arteries); or




  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood).




FDA pregnancy category C. It is not known whether cetuximab will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Whether you are a man or a woman, use effective birth control to prevent pregnancy while you are receiving cetuximab, and for at least 6 months after your treatment ends. It is not known whether cetuximab passes into breast milk or if it could harm a nursing baby. You should not breast-feed a baby while you are receiving cetuximab and for at least 60 days after your treatment ends. If you use a breast pump during this time, throw out any milk you collect. Do not feed it to your baby.

How is cetuximab given?


Cetuximab is injected into a vein through an IV. You will receive this injection in a clinic or hospital setting. Cetuximab must be given slowly, and the IV infusion can take up to 2 hours to complete. You may be given other medications to prevent certain side effects while you are receiving cetuximab.


Cetuximab is usually given once every week for 6 to 7 weeks or until your body no longer responds to the medication. Follow your doctor's dosing instructions very carefully.


Cetuximab is often used in combination with other cancer medications and/or radiation treatments. You may receive another cancer medicine 1 hour after your cetuximab injection.


After your cetuximab infusion, your doctor will need to watch you for about an hour. This is to make sure you do not have any serious side effects from the medicine.

If you are also being treated with radiation, you will receive your first cetuximab injection 1 week before your radiation treatment. Later doses are usually given 1 hour before radiation treatments.


To make sure this medication is helping your condition and not causing harmful effects, your blood will need to be tested often. Your cancer treatments may be delayed based on the results of these tests. Do not miss any follow-up visits to your doctor.

You may need to have blood tests for several weeks after your cetuximab treatment has ended.


What happens if I miss a dose?


Call your doctor for instructions if you miss an appointment for your cetuximab infusion.


What happens if I overdose?


Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while receiving cetuximab?


Avoid exposure to sunlight or tanning beds while you are receiving cetuximab and for at least 2 months after your treatment ends. Cetuximab can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Cetuximab side effects


Some people receiving a cetuximab injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your caregiver right away if you feel short of breath, weak or dizzy, nauseated, itchy, or have wheezing, noisy breathing, or a hoarse voice during the injection.


Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

  • an acne-like skin rash or any severe skin rash;




  • redness, swelling, or puffiness under your skin;




  • chest tightness, dry cough, wheezing, feeling short of breath;




  • feeling like you might pass out;




  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;




  • fever, chills, flu symptoms, mouth and throat ulcers, rapid heart rate, rapid and shallow breathing;




  • feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin; or




  • slow heart rate, weak pulse, fainting, slow breathing (breathing may stop).



Less serious side effects may include:



  • dry, cracked, or swollen skin;




  • changes in your fingernails or toenails;




  • headache;




  • diarrhea;




  • mild nausea, vomiting, upset stomach;




  • sore throat;




  • weight loss; or




  • weakness.



This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


What other drugs will affect cetuximab?


There may be other drugs that can interact with cetuximab. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.



More Erbitux resources


  • Erbitux Side Effects (in more detail)
  • Erbitux Use in Pregnancy & Breastfeeding
  • Erbitux Drug Interactions
  • Erbitux Support Group
  • 2 Reviews for Erbitux - Add your own review/rating


  • Erbitux Prescribing Information (FDA)

  • Erbitux Monograph (AHFS DI)

  • Erbitux Advanced Consumer (Micromedex) - Includes Dosage Information

  • Erbitux Consumer Overview

  • Erbitux MedFacts Consumer Leaflet (Wolters Kluwer)

  • Cetuximab Professional Patient Advice (Wolters Kluwer)



Compare Erbitux with other medications


  • Colorectal Cancer
  • Head and Neck Cancer
  • Squamous Cell Carcinoma


Where can I get more information?


  • Your doctor or pharmacist can provide more information about cetuximab.

See also: Erbitux side effects (in more detail)