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pfizer laboratories div pfizer inc - bosutinib monohydrate (unii: 844zje6i55) (bosutinib - unii:5018v4aez0) - bosutinib monohydrate 100 mg - bosulif is indicated for the treatment of: bosulif is contraindicated in patients with a history of hypersensitivity to bosulif. reactions have included anaphylaxis [see adverse reactions (6.1)] . risk summary based on findings from animal studies and its mechanism of action, bosulif can cause fetal harm when administered to a pregnant woman [see clinical pharmacology (12.1)] . there are no available data in pregnant women to inform the drug-associated risk. in animal reproduction studies conducted in rats and rabbits, oral administration of bosutinib during organogenesis caused adverse developmental outcomes, including structural abnormalities, embryo-fetal mortality, and alterations to growth at maternal exposures (auc) as low as 1.2 times the human exposure at the dose of 500 mg/day (see data ). advise pregnant women of the potential risk to a fetus. the background risk of major birth defects and miscarriage for the indicated population is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies are 2–4% and 15–20%, respectively. data animal data in a rat fertility and early embryonic development study, bosutinib was administered orally to female rats for approximately 3 to 6 weeks, depending on day of mating (2 weeks prior to cohabitation with untreated breeder males until gestation day [gd] 7). increased embryonic resorptions occurred at greater than or equal to 10 mg/kg/day of bosutinib (1.6 and 1.2 times the human exposure at the recommended doses of 400 or 500 mg/day, respectively), and decreased implantations and reduced number of viable embryos at 30 mg/kg/day of bosutinib (3.4 and 2.5 times the human exposure at the recommended doses of 400 or 500 mg/day, respectively). in an embryo-fetal development study conducted in rabbits, bosutinib was administered orally to pregnant animals during the period of organogenesis at doses of 3, 10, and 30 mg/kg/day. at the maternally-toxic dose of 30 mg/kg/day of bosutinib, there were fetal anomalies (fused sternebrae, and 2 fetuses had various visceral observations), and an approximate 6% decrease in fetal body weight. the dose of 30 mg/kg/day resulted in exposures (auc) approximately 5.1 and 3.8 times the human exposures at the recommended doses of 400 and 500 mg/day, respectively. fetal exposure to bosutinib-derived radioactivity during pregnancy was demonstrated in a placental-transfer study in pregnant rats. in a rat pre- and postnatal development study, bosutinib was administered orally to pregnant animals during the period of organogenesis through lactation day 20 at doses of 10, 30, and 70 mg/kg/day. reduced number of pups born occurred at greater than or equal to 30 mg/kg/day bosutinib (3.4 and 2.5 times the human exposure at the recommended doses of 400 or 500 mg/day, respectively), and increased incidence of total litter loss and decreased growth of offspring after birth occurred at 70 mg/kg/day bosutinib (6.9 and 5.1 times the human exposure at the recommended doses of 400 or 500 mg/day, respectively). risk summary no data are available regarding the presence of bosutinib or its metabolites in human milk or its effects on a breastfed child or on milk production. however, bosutinib is present in the milk of lactating rats. because of the potential for serious adverse reactions in a nursing child, breastfeeding is not recommended during treatment with bosulif and for 2 weeks after the last dose. animal data after a single radiolabeled bosutinib dose to lactating rats, radioactivity was present in the plasma of suckling offspring for 24 to 48 hours. based on findings from animal studies, bosulif can cause fetal harm when administered to a pregnant woman [see use in specific populations (8.1)] . pregnancy females of reproductive potential should have a pregnancy test prior to starting treatment with bosulif. contraception females advise females of reproductive potential to use effective contraception (methods that result in less than 1% pregnancy rates) during treatment with bosulif and for 2 weeks after the last dose. infertility the risk of infertility in females or males of reproductive potential has not been studied in humans. based on findings from animal studies, bosulif may cause reduced fertility in females and males of reproductive potential [see nonclinical toxicology (13.1)] . the safety and effectiveness of bosulif have been established in pediatric patients 1 year of age and older with newly-diagnosed cp ph+ cml and cp ph+ cml that is resistant or intolerant to prior therapy. use of bosulif for these indications is based on data from bchild [nct04258943]. the study included pediatric patients with newly diagnosed cp ph+ cml in the following age groups: 2 patients 1 year of age to less than 6 years of age, 3 patients 6 years of age to less than 12 years of age, and 10 patients 12 years of age to less than 17 years of age. the study also included pediatric patients with cp ph+ cml that was resistant or intolerant to prior therapy in the following age groups: 4 patients 1 year of age to less than 6 years of age, 10 patients 6 years of age to less than 12 years of age, and 10 patients 12 years of age to less than 17 years of age [see adverse reactions (6.1) and clinical studies (14.3) ] . bsa-normalized apparent clearance in 27 pediatric patients aged 4 to <17 years (141.3 l/h/m2 ) was 29% higher than bsa-normalized apparent clearance in adult patients with cp ph+ cml (109.2 l/h/m2 ) [see clinical pharmacology (12.3)] . the recommended dosage of bosulif in pediatric patients is based on body-surface area (bsa) [see dosage and administration (2.1)]. the safety and effectiveness of bosulif in pediatric patients younger than 1 year of age with newly diagnosed cp ph+ cml, pediatric patients younger than 1 year of age with cp ph+ cml that is resistant or intolerant to prior therapy, and pediatric patients with ap ph+ cml or bp ph+ cml have not been established. in the single-arm study in patients with cml who were resistant or intolerant to prior therapy of bosulif in patients with ph+ cml, 20% were age 65 and over, 4% were 75 and over. of the 268 patients who received bosutinib in the study for newly diagnosed cml, 20% were age 65 and over, 5% were 75 and over. no overall differences in safety or effectiveness were observed between these patients and younger patients, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. reduce the bosulif starting dose in patients with moderate (creatinine clearance [clcr ] 30 to 50 ml/min, estimated by cockcroft-gault (c-g)) and severe (clcr less than 30 ml/min, c-g) renal impairment at baseline. for patients who have declining renal function while on bosulif who cannot tolerate the starting dose, follow dose adjustment recommendations for toxicity [see dosage and administration (2.3, 2.5) and clinical pharmacology (12.3)] . bosulif has not been studied in patients undergoing hemodialysis. reduce the bosulif dosage in patients with hepatic impairment (child-pugh a, b, or c) [see dosage and administration (2.3, 2.5) and clinical pharmacology (12.3)]. bosulif® (bah-su-lif) (bosutinib) capsules this instructions for use contains information on how to prepare and give a dose of bosulif capsules by opening the capsules and mixing the contents with applesauce or yogurt for people who cannot swallow capsules whole. read this instructions for use before you prepare or give the first dose of bosulif, and each time you get a refill. ask your healthcare provider or pharmacist if you have any questions. important information you need to know before preparing a dose of bosulif capsules: preparing a dose of bosulif capsules: gather the following supplies: giving a dose of bosulif capsules: step 1: choose a clean, flat work surface. place all supplies on the work surface. step 2: wash and dry your hands well. step 3: put on disposable gloves step 4: get the prescribed number of bosulif capsule(s) needed to prepare the dose. step 5: add the amount of applesauce or yogurt needed for the prescribed dose to the container. dose amount of applesauce or yogurt 100 mg 10 ml (2 teaspoons) 150 mg 15 ml (3 teaspoons) 200 mg 20 ml (4 teaspoons) 250 mg 25 ml (5 teaspoons) 300 mg 30 ml (6 teaspoons) 350 mg 30 ml (6 teaspoons) 400 mg 35 ml (7 teaspoons) 450 mg 40 ml (8 teaspoons) 500 mg 45 ml (9 teaspoons) 550 mg 45 ml (9 teaspoons) 600 mg 50 ml (10 teaspoons) step 6: carefully open each of the bosulif capsule(s) needed for the dose and empty the entire contents into the applesauce or yogurt. mix the entire capsule contents with the applesauce or yogurt in the container. step 7: swallow all of the mixture right away, without chewing. step 8: dispose of (throw away) the empty bosulif capsule shell(s) in the household trash. step 9: wash teaspoon and the container with soap and warm water. step 10: remove disposable gloves and throw them away in the household trash. step 11: wash and dry your hands. how should i store bosulif capsules? keep bosulif and all medicines out of the reach of children. lab-0639-12.0 for more information, go to www.bosulif.com or www.pfizermedicalinformation.com or call 1-800-438-1985. this instructions for use has been approved by the u.s. food and drug administration. issued: 9 2023

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aphena pharma solutions - tennessee, llc - quetiapine fumarate (unii: 2s3pl1b6uj) (quetiapine - unii:bgl0jsy5si) - quetiapine 25 mg - quetiapine tablets, usp are indicated for the treatment of schizophrenia. the efficacy of quetiapine fumarate tablets in schizophrenia was established in three 6-week trials in adults and one 6-week trial in adolescents (13 to 17 years). the effectiveness of quetiapine fumarate tablets for the maintenance treatment of schizophrenia has not been systematically evaluated in controlled clinical trials [see clinical studies (14.1) ]. quetiapine tablets, usp are indicated for the acute treatment of manic episodes associated with bipolar i disorder, both as monotherapy and as an adjunct to lithium or divalproex. efficacy was established in two 12-week monotherapy trials in adults, in one 3-week adjunctive trial in adults, and in one 3-week monotherapy trial in pediatric patients (10 to 17 years) [see clinical studies (14.2) ]. quetiapine tablets, usp are indicated as monotherapy for the acute treatment of depressive episodes associated with bipolar disorder. efficacy was established in two 8-week monotherapy trials

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aphena pharma solutions - tennessee, llc - sertraline hydrochloride (unii: uti8907y6x) (sertraline - unii:quc7nx6wmb) - sertraline 50 mg - zoloft (sertraline hydrochloride) is indicated for the treatment of major depressive disorder in adults. the efficacy of zoloft in the treatment of a major depressive episode was established in six to eight week controlled trials of adult outpatients whose diagnoses corresponded most closely to the dsm-iii category of major depressive disorder (see clinical trials under clinical pharmacology). a major depressive episode implies a prominent and relatively persistent depressed or dysphoric mood that usually interferes with daily functioning (nearly every day for at least 2 weeks); it should include at least 4 of the following 8 symptoms: change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and a suicide attempt or suicidal ideation. the antidepressant action of zoloft in hospitalized depressed patients has not been adequately st

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novartis pharmaceuticals corporation - eltrombopag olamine (unii: 4u07f515lg) (eltrombopag - unii:s56d65xj9g) - eltrombopag 12.5 mg - promacta is indicated for the treatment of thrombocytopenia in adult and pediatric patients 1 year and older with persistent or chronic immune thrombocytopenia (itp) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. promacta should be used only in patients with itp whose degree of thrombocytopenia and clinical condition increase the risk for bleeding. promacta is indicated for the treatment of thrombocytopenia in patients with chronic hepatitis c to allow the initiation and maintenance of interferon-based therapy. promacta should be used only in patients with chronic hepatitis c whose degree of thrombocytopenia prevents the initiation of interferon-based therapy or limits the ability to maintain interferon-based therapy. - promacta is indicated in combination with standard immunosuppressive therapy (ist) for the first-line treatment of adult and pediatric patients 2 years and older with severe aplastic anemia. - promacta is indicated for the treatment of patients with severe aplastic anemia who have had an insufficient response to immunosuppressive therapy. - promacta is not indicated for the treatment of patients with myelodysplastic syndromes (mds) [see warnings and precautions (5.3)] . - safety and efficacy have not been established in combination with direct-acting antiviral agents used without interferon for treatment of chronic hepatitis c infection. none. risk summary available data from a small number of published case reports and postmarketing experience with promacta use in pregnant women are insufficient to assess any drug-associated risks for major birth defects, miscarriage, or adverse maternal or fetal outcomes. in animal reproduction and developmental toxicity studies, oral administration of eltrombopag to pregnant rats during organogenesis resulted in embryolethality and reduced fetal weights at maternally toxic doses. these effects were observed at doses resulting in exposures that were six times the human clinical exposure based on area under the curve (auc) in patients with persistent or chronic itp at 75 mg/day, and three times the auc in patients with chronic hepatitis c at 100 mg/day (see data). the estimated background risk of major birth defects and miscarriage for the indicated population is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and of miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. data animal data in an early embryonic development study, female rats received oral eltrombopag at doses of 10, 20, or 60 mg/kg/day (0.8, 2, and 6 times, respectively, the human clinical exposure based on auc in patients with itp at 75 mg/day and 0.3, 1, and 3 times, respectively, the human clinical exposure based on auc in patients with chronic hepatitis c at 100 mg/day). increased pre- and post-implantation loss and reduced fetal weight were observed at the highest dose which also caused maternal toxicity. in an embryo-fetal development study eltrombopag was administered orally to pregnant rats during the period of organogenesis at doses of 10, 20, or 60 mg/kg/day (0.8, 2, and 6 times, respectively, the human clinical exposure based on auc in patients with itp at 75 mg/day and 0.3, 1, and 3 times, respectively, the human clinical exposure based on auc in patients with chronic hepatitis c at 100 mg/day). decreased fetal weights (6% to 7%) and a slight increase in the presence of cervical ribs were observed at the highest dose which also caused maternal toxicity. however, no evidence of major structural malformations was observed. in an embryo-fetal development study eltrombopag was administered orally to pregnant rabbits during the period of organogenesis at doses of 30, 80, or 150 mg/kg/day (0.04, 0.3, and 0.5 times, respectively, the human clinical exposure based on auc in patients with itp at 75 mg/day and 0.02, 0.1, and 0.3 times, respectively, the human clinical exposure based on auc in patients with chronic hepatitis c at 100 mg/day). no evidence of fetotoxicity, embryolethality, or teratogenicity was observed. in a pre- and post-natal developmental toxicity study in pregnant rats (f0), oral eltrombopag was administered from gestation day 6 through lactation day 20. no adverse effects on maternal reproductive function or on the development of the offspring (f1) were observed at doses up to 20 mg/kg/day (2 times the human clinical exposure based on auc in patients with itp at 75 mg/day and similar to the human clinical exposure based on auc in patients with chronic hepatitis c at 100 mg/day). eltrombopag was detected in the plasma of offspring (f1). the plasma concentrations in pups increased with dose following administration of drug to the f0 dams. risk summary there are no data regarding the presence of eltrombopag or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production. however, eltrombopag was detected in the pups of lactating rats 10 days postpartum suggesting the potential for transfer during lactation. due to the potential for serious adverse reactions in a breastfed child from promacta, breastfeeding is not recommended during treatment. contraception based on animal reproduction studies, promacta can cause fetal harm when administered to a pregnant woman. sexually-active females of reproductive potential should use effective contraception (methods that result in less than 1% pregnancy rates) when using promacta during treatment and for at least 7 days after stopping treatment with promacta. the safety and efficacy of promacta have been established in pediatric patients 1 year and older with persistent or chronic itp and in pediatric patients 2 years and older with ist-naïve severe aplastic anemia (in combination with h-atg and cyclosporine). safety and efficacy in pediatric patients below the age of 1 year with itp have not been established. safety and efficacy in pediatric patients with thrombocytopenia associated with chronic hepatitis c and refractory severe aplastic anemia have not been established. the safety and efficacy of promacta in pediatric patients 1 year and older with persistent or chronic itp were evaluated in two double-blind, placebo-controlled trials [see adverse reactions (6.1), clinical studies (14.1)] . the pharmacokinetics of eltrombopag have been evaluated in 168 pediatric patients 1 year and older with itp dosed once daily [see clinical pharmacology (12.3)] . see dosage and administration (2.1) for dosing recommendations for pediatric patients 1 year and older. the safety and efficacy of promacta in combination with h-atg and cyclosporine for the first-line treatment of severe aplastic anemia in pediatric patients 2 years and older were evaluated in a single-arm, open-label trial [see adverse reactions (6.1), clinical studies (14.3)] . a total of 26 pediatric patients (ages 2 to < 17 years) were evaluated; 12 children (aged 2 to < 12 years) and 14 adolescents (aged 12 to < 17). see dosage and administration (2.3) for dosing recommendations for pediatric patients 2 years and older. the safety and efficacy of promacta in combination with h-atg and cyclosporine in pediatric patients younger than 2 years for the first-line treatment of severe aplastic anemia have not yet been established. in patients 2 to 16 years of age, 69% of patients experienced serious adverse events compared to 42% in patients 17 years and older. among the 12 patients who were 2 to 11 years of age in the promacta d1-m6 cohort and reached the 6-month assessment or withdrew earlier, the complete response rate at month 6 was 8% versus 46% in patients age 12 to 16 years and 50% in patients 17 years of age and older. of the 106 patients in two randomized clinical trials of promacta 50 mg in persistent or chronic itp, 22% were 65 years of age and over, while 9% were 75 years of age and over. of the 1439 patients in two randomized clinical trials of promacta in patients with chronic hepatitis c and thrombocytopenia, 7% were 65 years of age and over, while < 1% were 75 years of age and over. of the 196 patients who received promacta for the treatment of severe aplastic anemia, 18% were 65 years of age and over, while 3% were 75 years of age and over. no overall differences in safety or effectiveness were observed between these patients and younger patients. patients with persistent or chronic itp and severe aplastic anemia reduce the initial dose of promacta in patients with persistent or chronic itp (adult and pediatric patients 6 years and older only) or refractory severe aplastic anemia who also have hepatic impairment (child-pugh class a, b, c) [see dosage and administration (2.1, 2.3), warnings and precautions (5.2), clinical pharmacology (12.3)] . in a clinical trial in patients with severe aplastic anemia who had not received prior definitive immunosuppressive therapy, patients with baseline alt or ast > 5 x uln were ineligible to participate. if a patient with hepatic impairment (child-pugh class a, b, c) initiates therapy with promacta for the first-line treatment of severe aplastic anemia, reduce the initial dose [see dosage and administration (2.3), warnings and precautions (5.2), clinical pharmacology (12.3)] . patients with chronic hepatitis c no dosage adjustment is recommended in patients with chronic hepatitis c and hepatic impairment [see clinical pharmacology (12.3)] . reduce the initial dose of promacta for patients of east-/southeast-asian ancestry with itp (adult and pediatric patients 6 years and older only) or severe aplastic anemia [see dosage and administration (2.1, 2.3), clinical pharmacology (12.3)] . no reduction in the initial dose of promacta is recommended in patients of east-/southeast-asian ancestry with chronic hepatitis c [see clinical pharmacology (12.3)] .

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rebel distributors corp - quetiapine fumarate (unii: 2s3pl1b6uj) (quetiapine - unii:bgl0jsy5si) - quetiapine fumarate 25 mg - seroquel is indicated for the treatment of schizophrenia. the efficacy of seroquel in schizophrenia was established in three 6-week trials in adults and one 6–week trial in adolescents (13–17 years). the effectiveness of seroquel for the maintenance treatment of schizophrenia has not been systematically evaluated in controlled clinical trials [see clinical studies (14.1)] seroquel is indicated for the acute treatment of manic episodes associated with bipolar i disorder, both as monotherapy and as an adjunct to lithium or divalproex. efficacy was established in two 12-week monotherapy trials in adults, in one 3-week adjunctive trial in adults, and in one 3-week monotherapy trial in pediatric patients (10-17 years) [see clinical studies (14.2)]. seroquel is indicated as monotherapy for the acute treatment of depressive episodes associated with bipolar disorder. efficacy was established in two 8-week monotherapy trials in adult patients with bipolar i and bipolar ii disorder [see clinical studies (14.2)]. sero

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contract pharmacy services-pa - levetiracetam (unii: 44yrr34555) (levetiracetam - unii:44yrr34555) - levetiracetam 500 mg - levetiracetam tablets usp are indicated as adjunctive therapy in the treatment of partial onset seizures in adults and children 1 month of age and older with epilepsy. levetiracetam tablets usp are indicated as adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy. levetiracetam tablets usp are indicated as adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy. levetiracetam is contraindicated in patients with a hypersensitivity to levetiracetam. reactions have included anaphylaxis and angioedema [see warnings and precautions (5.4)] levetiracetam blood levels may decrease during pregnancy [see warnings and precautions ( 5.10)].   pregnancy category c there are no adequate and controlled studies in pregnant women. in animal studies, levetiracetam prod

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contract pharmacy services-pa - divalproex sodium (unii: 644vl95ao6) (valproic acid - unii:614oi1z5wi) - valproic acid 500 mg - divalproex sodium extended-release tablets, usp are valproates and are indicated for the treatment of acute manic or mixed episodes associated with bipolar disorder, with or without psychotic features. a manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgment, aggressiveness, and possible hostility. a mixed episode is characterized by the criteria for a manic episode in conjunction with those for a major depressive episode (depressed mood, loss of interest or pleasure in nearly all activities). the efficacy of divalproex sodium extended-release tablets, usp are based in part on studies of divalproex sodium delayed-release tablets in this indication, and was confirmed in a 3-week trial with patients meeting dsm-iv tr criteria for bipolar i disorder, manic or mixed type, who were hospitalized for acute mania

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avpak - bupropion hydrochloride (unii: zg7e5poy8o) (bupropion - unii:01zg3tpx31) - bupropion hydrochloride 75 mg - bupropion hydrochloride tablets are indicated for the treatment of major depressive disorder (mdd), as defined by the diagnostic and statistical manual (dsm). the efficacy of bupropion hydrochloride tablets in the treatment of a major depressive episode was established in two 4-week controlled inpatient trials and one 6-week controlled outpatient trial of adult subjects with mdd [see clinical studies ( 14)]. - bupropion hydrochloride tablets are contraindicated in patients with a seizure disorder. - bupropion hydrochloride tablets are contraindicated in patients with a current or prior diagnosis of bulimia or anorexia nervosa as a higher incidence of seizures was observed in such patients treated with bupropion hydrochloride tablets [see warnings and precautions ( 5.3)]. - bupropion hydrochloride tablets are contraindicated in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs [see warnings and precautions ( 5.3) , drug interactions ( 7.3)].  - the use of maois (intended to treat psychiatric disorders) concomitantly with bupropion hydrochloride tablets or within 14 days of discontinuing treatment with bupropion hydrochloride tablets are contraindicated. there is an increased risk of hypertensive reactions when bupropion hydrochloride tablets are used concomitantly with maois. the use of bupropion hydrochloride tablets within 14 days of discontinuing treatment with an maoi is also contraindicated. starting bupropion hydrochloride tablets in a patient treated with reversible maois such as linezolid or intravenous methylene blue is contraindicated [see dosage and administration ( 2.4, 2.5), warnings and precautions ( 5.4), drug interactions ( 7.6)] . - bupropion hydrochloride tablets are contraindicated in patients with known hypersensitivity to bupropion or other ingredients of bupropion hydrochloride tablets. anaphylactoid/anaphylactic reactions and stevens-johnson syndrome have been reported [see warnings and precautions ( 5.8)].  pregnancy category c risk summary data from epidemiological studies of pregnant women exposed to bupropion in the first trimester indicate no increased risk of congenital malformations overall. all pregnancies, regardless of drug exposure, have a background rate of 2% to 4% for major malformations, and 15% to 20% for pregnancy loss. no clear evidence of teratogenic activity was found in reproductive developmental studies conducted in rats and rabbits; however, in rabbits, slightly increased incidences of fetal malformations and skeletal variations were observed at doses approximately equal to the maximum recommended human dose (mrhd) and greater and decreased fetal weights were seen at doses twice the mrhd and greater. bupropion hydrochloride tablets should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. clinical considerations consider the risks of untreated depression when discontinuing or changing treatment with antidepressant medications during pregnancy and postpartum. human data data from the international bupropion pregnancy registry (675 first-trimester exposures) and a retrospective cohort study using the united healthcare database (1,213 first trimester exposures) did not show an increased risk for malformations overall. no increased risk for cardiovascular malformations overall has been observed after bupropion exposure during the first trimester. the prospectively observed rate of cardiovascular malformations in pregnancies with exposure to bupropion in the first trimester from the international pregnancy registry was 1.3% (9 cardiovascular malformations/675 first-trimester maternal bupropion exposures), which is similar to the background rate of cardiovascular malformations (approximately 1%). data from the united healthcare database and a case-control study (6,853 infants with cardiovascular malformations and 5,763 with non-cardiovascular malformations) from the national birth defects prevention study (nbdps) did not show an increased risk for cardiovascular malformations overall after bupropion exposure during the first trimester. study findings on bupropion exposure during the first trimester and risk for left ventricular outflow tract obstruction (lvoto) are inconsistent and do not allow conclusions regarding a possible association. the united healthcare database lacked sufficient power to evaluate this association; the nbdps found increased risk for lvoto (n = 10; adjusted or = 2.6; 95% ci: 1.2, 5.7), and the slone epidemiology case control study did not find increased risk for lvoto. study findings on bupropion exposure during the first trimester and risk for ventricular septal defect (vsd) are inconsistent and do not allow conclusions regarding a possible association. the slone epidemiology study found an increased risk for vsd following first trimester maternal bupropion exposure (n = 17; adjusted or = 2.5; 95% ci: 1.3, 5.0) but did not find increased risk for any other cardiovascular malformations studied (including lvoto as above). the nbdps and united healthcare database study did not find an association between first trimester maternal bupropion exposure and vsd. for the findings of lvoto and vsd, the studies were limited by the small number of exposed cases, inconsistent findings among studies, and the potential for chance findings from multiple comparisons in case control studies. animal data in studies conducted in rats and rabbits, bupropion was administered orally during the period of organogenesis at doses of up to 450 and 150 mg per kg per day, respectively (approximately 11 and 7 times the mrhd, respectively, on a mg per m 2 basis). no clear evidence of teratogenic activity was found in either species; however, in rabbits, slightly increased incidences of fetal malformations and skeletal variations were observed at the lowest dose tested (25 mg per kg per day, approximately equal to the mrhd on a mg per m 2 basis) and greater. decreased fetal weights were observed at 50 mg per kg and greater. when rats were administered bupropion at oral doses of up to 300 mg per kg per day (approximately 7 times the mrhd on a mg per m 2 basis) prior to mating and throughout pregnancy and lactation, there were no apparent adverse effects on offspring development. bupropion and its metabolites are present in human milk. in a lactation study of 10 women, levels of orally dosed bupropion and its active metabolites were measured in expressed milk. the average daily infant exposure (assuming 150 ml per kg daily consumption) to bupropion and its active metabolites was 2% of the maternal weight-adjusted dose. exercise caution when bupropion hydrochloride tablets are administered to a nursing woman. safety and effectiveness in the pediatric population have not been established [see boxed warning, warnings and precautions ( 5.1)] . of the approximately 6,000 subjects who participated in clinical trials with bupropion sustained-release tablets (depression and smoking cessation trials), 275 were aged ≥65 years and 47 were aged ≥75 years. in addition, several hundred subjects aged ≥65 years participated in clinical trials using the immediate-release formulation of bupropion (depression trials). no overall differences in safety or effectiveness were observed between these subjects and younger subjects. reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. bupropion is extensively metabolized in the liver to active metabolites, which are further metabolized and excreted by the kidneys. the risk of adverse reactions may be greater in patients with impaired renal function. because elderly patients are more likely to have decreased renal function, it may be necessary to consider this factor in dose selection; it may be useful to monitor renal function [see dosage and administration ( 2.3), use in specific populations (8.6),  clinical pharmacology ( 12.3)] . consider a reduced dose and/or dosing frequency of bupropion hydrochloride tablets in patients with renal impairment (glomerular filtration rate: less than 90 ml per min). bupropion and its metabolites are cleared renally and may accumulate in such patients to a greater extent than usual. monitor closely for adverse reactions that could indicate high bupropion or metabolite exposures [see dosage and administration ( 2.3), clinical pharmacology ( 12.3)] . in patients with moderate to severe hepatic impairment (child-pugh score: 7 to 15), the maximum dose of bupropion hydrochloride tablets is 75 mg daily. in patients with mild hepatic impairment (child-pugh score: 5 to 6), consider reducing the dose and/or frequency of dosing [see dosage and administration ( 2.2), clinical pharmacology ( 12.3)] . bupropion is not a controlled substance. humans controlled clinical trials conducted in normal volunteers, in subjects with a history of multiple drug abuse, and in depressed subjects showed some increase in motor activity and agitation/excitement, often typical of central stimulant activity. in a population of individuals experienced with drugs of abuse, a single oral dose of 400 mg of bupropion produced mild amphetamine-like activity as compared with placebo on the morphine-benzedrine subscale of the addiction research center inventories (arci) and a score greater than placebo but less than 15 mg of the schedule ii stimulant dextroamphetamine on the liking scale of the arci. these scales measure general feelings of euphoria and drug liking which are often associated with abuse potential. findings in clinical trials, however, are not known to reliably predict the abuse potential of drugs. nonetheless, evidence from single-dose trials does suggest that the recommended daily dosage of bupropion when administered orally in divided doses is not likely to be significantly reinforcing to amphetamine or cns stimulant abusers. however, higher doses (which could not be tested because of the risk of seizure) might be modestly attractive to those who abuse cns stimulant drugs. bupropion hydrochloride tablets are intended for oral use only. the inhalation of crushed tablets or injection of dissolved bupropion has been reported. seizures and/or cases of death have been reported when bupropion has been administered intranasally or by parenteral injection. animals studies in rodents and primates demonstrated that bupropion exhibits some pharmacologic actions common to psychostimulants. in rodents, it has been shown to increase locomotor activity, elicit a mild stereotyped behavior response, and increase rates of responding in several schedule-controlled behavior paradigms. in primate models assessing the positive-reinforcing effects of psychoactive drugs, bupropion was self-administered intravenously. in rats, bupropion produced amphetamine-like and cocaine-like discriminative stimulus effects in drug discrimination paradigms used to characterize the subjective effects of psychoactive drugs.

United States - English - NLM (National Library of Medicine)

avpak - pantoprazole sodium (unii: 6871619q5x) (pantoprazole - unii:d8tst4o562) - pantoprazole 20 mg - pantoprazole sodium delayed-release tablets, usp are indicated for: pantoprazole is indicated in adults and pediatric patients five years of age and older for the short-term treatment (up to 8 weeks) in the healing and symptomatic relief of erosive esophagitis (ee). for those adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of pantoprazole may be considered. safety of treatment beyond 8 weeks in pediatric patients has not been established. pantoprazole is indicated for maintenance of healing of ee and reduction in relapse rates of daytime and nighttime heartburn symptoms in adult patients with gerd. controlled studies did not extend beyond 12 months. pantoprazole is indicated for the long-term treatment of pathological hypersecretory conditions, including zollinger-ellison (ze) syndrome. - pantoprazole is contraindicated in patients with known hypersensitivity to any component of the formulation or any substituted benzimidazole. hypersensitivity reactions may includ

United States - English - NLM (National Library of Medicine)

avpak - naproxen (unii: 57y76r9atq) (naproxen - unii:57y76r9atq) - naproxen 250 mg - naproxen tablets are indicated for: the relief of the signs and symptoms of: - rheumatoid arthritis - osteoarthritis - ankylosing spondylitis - polyarticular juvenile idiopathic arthritis - tendonitis - bursitis - acute gout the management of: - pain - primary dysmenorrhea naproxen is contraindicated in the following patients: - known hypersensitivity (e.g., anaphylactic reactions and serious skin reactions) to naproxen or any components of the drug product [see warnings and precautions (5.7, 5.9)] - history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other nsaids. severe, sometimes fatal, anaphylactic reactions to nsaids have been reported in such patients [see warnings and precautions (5.7, 5.8)] - in the setting of coronary artery bypass graft (cabg) surgery [see warnings and precautions (5.1)] risk summary use of nsaids, including naproxen, during the third trimester of pregnancy increases the risk of premature closure of the fetal ductus arteriosus. avoid use of nsaids, including naproxen, in pregnant women starting at 30 weeks of gestation (third trimester). there are no adequate and well-controlled studies of naproxen in pregnant women. data from observational studies regarding potential embryofetal risks of nsaid use in women in the first or second trimesters of pregnancy are inconclusive. in the general u.s. population, all clinically recognized pregnancies, regardless of drug exposure, have a background rate of 2% to 4% for major malformations, and 15% to 20% for pregnancy loss. in animal reproduction studies in rats, rabbits, and mice no evidence of teratogenicity or fetal harm when naproxen was administered during the period of organogenesis at doses 0.13, 0.26, and 0.6 times the maximum recommended human daily dose of 1,500 mg/day, respectively [see data] . based on animal data, prostaglandins have been shown to have an important role in endometrial vascular permeability, blastocyst implantation, and decidualization. in animal studies, administration of prostaglandin synthesis inhibitors such as naproxen, resulted in increased pre- and post-implantation loss. clinical considerations labor or delivery there are no studies on the effects of naproxen during labor or delivery. in animal studies, nsaids, including naproxen, inhibit prostaglandin synthesis, cause delayed parturition, and increase the incidence of stillbirth. data human data there is some evidence to suggest that when inhibitors of prostaglandin synthesis are used to delay preterm labor, there is an increased risk of neonatal complications such as necrotizing enterocolitis, patent ductus arteriosus, and intracranial hemorrhage. naproxen treatment given in late pregnancy to delay parturition has been associated with persistent pulmonary hypertension, renal dysfunction, and abnormal prostaglandin e levels in preterm infants. because of the known effects of nonsteroidal anti-inflammatory drugs on the fetal cardiovascular system (closure of ductus arteriosus), use during pregnancy (particularly starting at 30-weeks of gestation, or third trimester) should be avoided. animal data reproduction studies have been performed in rats at 20 mg/kg/day (0.13 times the maximum recommended human daily dose of 1,500 mg/day based on body surface area comparison), rabbits at 20 mg/kg/day (0.26 times the maximum recommended human daily dose, based on body surface area comparison), and mice at 170 mg/kg/day (0.6 times the maximum recommended human daily dose based on body surface area comparison) with no evidence of impaired fertility or harm to the fetus due to the drug. based on animal data, prostaglandins have been shown to have an important role in endometrial vascular permeability, blastocyst implantation, and decidualization. in animal studies, administration of prostaglandin synthesis inhibitors such as naproxen, resulted in increased pre- and post-implantation loss. r isk summary the naproxen anion has been found in the milk of lactating women at a concentration equivalent to approximately 1% of maximum naproxen concentration in plasma. the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for naproxen and any potential adverse effects on the breastfed infant from the naproxen or from the underlying maternal condition. inferrtility females based on the mechanism of action, the use of prostaglandin-mediated nsaids, including naproxen, may delay or prevent rupture of ovarian follicles, which has been associated with reversible infertility in some women. published animal studies have shown that administration of prostaglandin synthesis inhibitors has the potential to disrupt prostaglandin-mediated follicular rupture required for ovulation. small studies in women treated with nsaids have also shown a reversible delay in ovulation. consider withdrawal of nsaids, including naproxen, in women who have difficulties conceiving or who are undergoing investigation of infertility. safety and effectiveness in pediatric patients below the age of 2 years have not been established. pediatric dosing recommendations for polyarticular juvenile idiopathic arthritis are based on well-controlled studies [see dosage and administration (2)] . there are no adequate effectiveness or dose-response data for other pediatric conditions, but the experience in polyarticular juvenile idiopathic arthritis and other use experience have established that single doses of 2.5 to 5 mg/kg as naproxen suspension, , with total daily dose not exceeding 15 mg/kg/day, are well tolerated in pediatric patients over 2 years of age. the hepatic and renal tolerability of long-term naproxen administration was studied in two double-blind clinical trials involving 586 patients. of the patients studied, 98 patients were age 65 and older and 10 of the 98 patients were age 75 and older. naproxen was administered at doses of 375 mg twice daily or 750 mg twice daily for up to 6 months. transient abnormalities of laboratory tests assessing hepatic and renal function were noted in some patients, although there were no differences noted in the occurrence of abnormal values among different age groups. elderly patients, compared to younger patients, are at greater risk for nsaid-associated serious cardiovascular, gastrointestinal, and/or renal adverse reactions. if the anticipated benefit for the elderly patient outweighs these potential risks, start dosing at the low end of the dosing range, and monitor patients for adverse effects [see warnings and precautions (5.1, 5.2,5.3, 5.6, 5.13)]. studies indicate that although total plasma concentration of naproxen is unchanged, the unbound plasma fraction of naproxen is increased in the elderly. the clinical significance of this finding is unclear, although it is possible that the increase in free naproxen concentration could be associated with an increase in the rate of adverse events per a given dosage in some elderly patients. caution is advised when high doses are required and some adjustment of dosage may be required in elderly patients. as with other drugs used in the elderly, it is prudent to use the lowest effective dose. experience indicates that geriatric patients may be particularly sensitive to certain adverse effects of nonsteroidal anti-inflammatory drugs. elderly or debilitated patients seem to tolerate peptic ulceration or bleeding less well when these events do occur. most spontaneous reports of fatal gi events are in the geriatric population [see warnings and precautions (5.2)] . naproxen is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function [see clinical pharmacology (12.3)] . geriatric patients may be at a greater risk for the development of a form of renal toxicity precipitated by reduced prostaglandin formation during administration of nonsteroidal anti-inflammatory drugs [see warnings and precautions (5.6)] . caution is advised when high doses are required and some adjustment of dosage may be required in these patients. it is prudent to use the lowest effective dose [see clinical pharmacology (12.3)] . naproxen-containing products are not recommended for use in patients with moderate to severe and severe renal impairment (creatinine clearance <30 ml/min) [see warnings and precautions (5.6), clinical pharmacology (12.3)] .