Drugs Details

Drugs Info of Bactramycin, Lincocin
Drugs Details
  • Drugs Type  : Multum
  • Date : 17th Feb 2015 05:18 am
  • Brand Name : Bactramycin, Lincocin
  • Generic Name : lincomycin (Pronunciation: LIN koe mye sin)
Descriptions

LINCOCIN Sterile Solution contains lincomycin hydrochloride which is the monohydrated salt of lincomycin, a substance produced by the growth of a member of the lincolnensis group of Streptomyces lincolnensis (Fam. Streptomycetaceae). The chemical name for lincomycin hydrochloride is Methyl 6,8-dideoxy-6-(1-methyl-trans-4-propyl-L2-pyrolidinecarboxamido)-1-thio-D-erythro-α-D-galacto-octopyranoside monohydrochloride monohydrate. The molecular formula of lincomycin hydrochloride is C18H34N2O6S•HCl.H2O and the molecular weight is 461.01.

The structural formula is represented below:

 

Lincocin® (lincomycin) Structural Formula Illustration

Lincomycin hydrochloride is a white or practically white, crystalline powder and is odorless or has a faint odor. Its solutions are acid and are dextrorotatory. Lincomycin hydrochloride is freely soluble in water; soluble in dimethylformamide and very slightly soluble in acetone.

What are the possible side effects of lincomycin (Bactramycin, Lincocin)?

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.

Tell your caregivers right away if you have any of these serious side effects:

  • diarrhea that is watery or bloody;
  • urinating less than usual or not at all;
  • fever, chills, body aches, flu symptoms;
  • severe blistering, peeling, and red skin rash;
  • feeling like you might pass out;
  • easy bruising or bleeding, unusual weakness; or
  • white patches or sores...

Read All Potential Side Effects and See Pictures of Lincocin »

This monograph has been modified to include the generic and brand name in many instances.

Indications

LINCOCIN Sterile Solution is indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci. Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Because of the risk of antibacterial associated pseudomembranous colitis, as described in the WARNING box, before selecting lincomycin the physician should consider the nature of the infection and the suitability of less toxic alternatives (eg, erythromycin).

Indicated surgical procedures should be performed in conjunction with antibacterial therapy.

The drug may be administered concomitantly with other antimicrobial agents when indicated.

Lincomycin is not indicated in the treatment of minor bacterial infections or viral infections.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of LINCOCIN and other antibacterial drugs, LINCOCIN should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Dosage Administration

If significant diarrhea occurs during therapy, this antibacterial should be discontinued. (See WARNING box.)

Intramuscular - Adults: Serious infections600 mg (2 mL) intramuscularly every 24 hours. More severe infections600 mg (2 mL) intramuscularly every 12 hours or more often. Pediatric patients over 1 month of age: Serious infectionsone intramuscular injection of 10 mg/kg (5 mg/lb) every 24 hours. More severe infections one intramuscular injection of 10 mg/kg (5 mg/lb) every 12 hours or more often.

Intravenous - Adults: The intravenous dose will be determined by the severity of the infection. For serious infections doses of 600 mg of lincomycin (2 mL of LINCOCIN) to 1 gram are given every 8 to 12 hours. For more severe infections these doses may have to be increased. In life-threatening situations daily intravenous doses of as much as 8 grams have been given. Intravenous doses are given on the basis of 1 gram of lincomycin diluted in not less than 100 mL of appropriate solution (see Physical Compatibilities) and infused over a period of not less than one hour.

 

Dose Vol. Diluent Time
600 mg 100 mL 1 hr
1 gram 100 mL 1 hr
2 grams 200 mL 2 hr
3 grams 300 mL 3 hr
4 grams 400 mL 4 hr

These doses may be repeated as often as required to the limit of the maximum recommended daily dose of 8 grams of lincomycin.

Pediatric patients over 1 month of age: 10 to 20 mg/kg/day (5 to 10 mg/lb/day) depending on the severity of the infection may be infused in divided doses as described above for adults. NOTE: Severe cardiopulmonary reactions have occurred when this drug has been given at greater than the recommended concentration and rate.

Subconjunctival Injection - 0.25 mL (75 mg) injected subconjunctivally will result in ocular fluid levels of antibacterial (lasting for at least 5 hours) with MICs sufficient for most susceptible pathogens.

Patients with diminished renal function: When therapy with LINCOCIN is required in individuals with severe impairment of renal function, an appropriate dose is 25 to 30% of that recommended for patients with normally functioning kidneys.

How Supplied

LINCOCIN Sterile Solution is available in the following strength and package sizes:

300 mg

2 mL Vials — NDC 0009-0555-01
10 mL Vials — NDC 0009-0555-02

Each mL of LINCOCIN Sterile Solution contains lincomycin hydrochloride equivalent to lincomycin 300 mg; also benzyl alcohol, 9.45 mg added as preservative.

Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].

Physical Compatibilities

Physically compatible for 24 hours at room temperature unless otherwise indicated.

Infusion Solutions

5% Dextrose Injection
10% Dextrose Injection
5% Dextrose and 0.9% Sodium Chloride Injection
10% Dextrose and 0.9% Sodium Chloride Injection
Ringer's Injection
1/6 M Sodium Lactate Injection
Travert 10%-Electrolyte No. 1
Dextran in Saline 6% w/v

Vitamins in Infusion Solutions

B-Complex
B-Complex with Ascorbic Acid

Antibacterial in Infusion Solutions

Penicillin G Sodium (Satisfactory for 4 hours)
Cephalothin
Tetracycline HCl
Cephaloridine
Colistimethate (Satisfactory for 4 hours)
Ampicillin
Methicillin
Chloramphenicol
Polymyxin B Sulfate

Physically Incompatible with

Novobiocin
Kanamycin

IT SHOULD BE EMPHASIZED THAT THE COMPATIBLE AND INCOMPATIBLE DETERMINATIONS ARE PHYSICAL OBSERVATIONS ONLY, NOT CHEMICAL DETERMINATIONS. ADEQUATE CLINICAL EVALUATION OF THE SAFETY AND EFFICACY OF THESE COMBINATIONS HAS NOT BEEN PERFORMED.

Distributed by: Pharmacia & Upjohn Company, Division of Pfizer Inc., NY, NY 10017. Revised October 2014

This monograph has been modified to include the generic and brand name in many instances.

Side Effects

The following reactions have been reported with the use of lincomycin:

Gastrointestinal

Glossitis, stomatitis, nausea, vomiting, antibacterial -associated diarrhea and colitis, and pruritus ani. Onset of pseudomembranous colitis symptoms may occur during or after antibacterial treatment (see WARNINGS).

Hematopoietic

Neutropenia, leukopenia, agranulocytosis and thrombocytopenic purpura have been reported. There have been rare reports of aplastic anemia and pancytopenia in which LINCOCIN could not be ruled out as the causative agent.

Hypersensitivity Reactions

Hypersensitivity reactions such as angioneurotic edema, serum sickness and anaphylaxis have been reported. Cases of erythema multiforme, some resembling Stevens-Johnson syndrome, have been associated with LINCOCIN (see WARNINGS).

Skin and Mucous Membranes

Skin rashes, urticaria and vaginitis and rare instances of exfoliative and vesiculobullous dermatitis have been reported.

Liver

Although no direct relationship of LINCOCIN to liver dysfunction has been established, jaundice and abnormal liver function tests (particularly elevations of serum transaminase) have been observed.

Renal

Although no direct relationship of lincomycin to renal damage has been established, renal dysfunction as evidenced by azotemia, oliguria, and/or proteinuria has been observed in rare instances.

Cardiovascular

After too rapid intravenous administration, rare instances of cardiopulmonary arrest and hypotension have been reported. (See DOSAGE AND ADMINISTRATION.)

Special Senses

Tinnitus and vertigo have been reported occasionally.

Local Reactions

Patients have demonstrated excellent local tolerance to intramuscularly administered LINCOCIN. Reports of pain following injection have been infrequent. Intravenous administration of LINCOCIN in 250 to 500 mL of 5% dextrose injection or 0.9% sodium chloride injection produced no local irritation or phlebitis.

Read the Lincocin (lincomycin hcl) Side Effects Center for a complete guide to possible side effects

Learn More »

Interactions

Lincomycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. Therefore, it should be used in caution in patients receiving such agents.

Antagonism between lincomycin and erythromycin in vitro has been demonstrated. Because of possible clinical significance, the two drugs should not be administered concurrently.

This monograph has been modified to include the generic and brand name in many instances.

Warnings

See WARNING box.

Clostridium Difficile Associated Diarrhea

Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Lincomycin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C.diffficile.

C.diffficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C.diffficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibacterial use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

If CDAD is suspected or confirmed, ongoing antibacterial use not directed against C.diffficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C.diffficile, and surgical evaluation should be instituted as clinically indicated.

Hypersensitivity

Serious hypersensitivity reactions, including anaphylaxis and erythema multiforme, have been reported with use of LINCOCIN. If an allergic reaction to LINCOCIN occurs, discontinue the drug. (See ADVERSE REACTIONS)

Benzyl Alcohol Toxicity In Pediatric Patients (Gasping Syndrome”)

This product contains benzyl alcohol as a preservative. The preservative benzyl alcohol has been associated with serious adverse events, including the “gasping syndrome”, and death in pediatric patients. Although normal therapeutic doses of this product ordinarily deliver amounts of benzyl alcohol that are substantially lower than those reported in association with the “gasping syndrome”, the minimum amount of benzyl alcohol at which toxicity may occur is not known. The risk of benzyl alcohol toxicity depends on the quantity administered and the hepatic capacity to detoxify the chemical. Premature and low-birth weight infants may be more likely to develop toxicity.

Use in Meningitis

Although lincomycin appears to diffuse into cerebrospinal fluid, levels of lincomycin in the CSF may be inadequate for the treatment of meningitis.

Precautions

General

Review of experience to date suggests that a subgroup of older patients with associated severe illness may tolerate diarrhea less well. When LINCOCIN is indicated in these patients, they should be carefully monitored for change in bowel frequency.

LINCOCIN should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis.

LINCOCIN should be used with caution in patients with a history of asthma or significant allergies.

Certain infections may require incision and drainage or other indicated surgical procedures in addition to antibacterial therapy.

The use of LINCOCIN may result in overgrowth of nonsusceptible organisms— particularly yeasts. Should superinfections occur, appropriate measures should be taken as indicated by the clinical situation. When patients with pre-existing monilial infections require therapy with LINCOCIN, concomitant antimonilial treatment should be given.

The serum half-life of lincomycin may be prolonged in patients with severe impairment of renal function compared to patients with normal renal function. In patients with abnormal hepatic function, serum half-life may be twofold longer than in patients with normal hepatic function.

Patients with severe impairment of renal function and/or abnormal hepatic function should be dosed with caution and serum lincomycin levels monitored during high-dose therapy. (See DOSAGE AND ADMINISTRATION Section.)

Lincomycin should not be injected intravenously undiluted as a bolus, but should be infused over at least 60 minutes as directed in the DOSAGE AND ADMINISTRATION Section.

Prescribing LINCOCIN in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Laboratory Tests

During prolonged therapy with LINCOCIN, periodic liver and kidney function tests and blood counts should be performed.

Carcinogenesis, Mutagenesis, Impairment Of Fertility

The carcinogenic potential of lincomycin has not been evaluated.

Lincomycin was not found to be mutagenic in the Ames Salmonella reversion assay or the V79 Chinese hamster lung cells at the HGPRT locus. It did not induce DNA strand breaks in V79 Chinese hamster lung cells as measured by alkaline elution or chromosomal abnormalities in cultured human lymphocytes. In vivo, lincomycin was negative in both the rat and mouse micronucleus assays and it did not induce sex-linked recessive lethal mutations in the offspring of male Drosophila. However, lincomycin did cause unscheduled DNA syntheses in freshly isolated rat hepatocytes.

Impairment of fertility was not observed in male or female rats given oral 300 mg/kg doses of lincomycin (0.36 times the highest recommended human dose based on mg/m²).

Pregnancy

Pregnancy Category C

LINCOCIN Sterile Solution contains benzyl alcohol as a preservative. Benzyl alcohol can cross the placenta. See WARNINGS.

Teratogenic Effects

There are no studies on the teratogenic potential of lincomycin in animals or adequate and well-controlled studies of pregnant women.

Nonteratogenic Effects

Reproduction studies have been performed in rats using oral doses of lincomycin up to 1000 mg/kg (1.2 times the maximum daily human dose based on mg/m²) and have revealed no adverse effects on survival of offspring from birth to weaning.

Nursing Mothers

Lincomycin has been reported to appear in human milk in concentrations of 0.5 to 2.4 mcg/mL. Because of the potential for serious adverse reactions in nursing infants from LINCOCIN, 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

LINCOCIN Sterile Solution contains benzyl alcohol as a preservative. Benzyl alcohol has been associated with a fatal “Gasping Syndrome” in premature infants. See WARNINGS. Safety and effectiveness in pediatric patients below the age of one month have not been established. (See DOSAGE AND ADMINISTRATION Section.)

This monograph has been modified to include the generic and brand name in many instances.

OverDose

Serum levels of lincomycin are not appreciably affected by hemodialysis and peritoneal dialysis.

ContrainDications

This drug is contraindicated in patients previously found to be hypersensitive to lincomycin or clindamycin.

This monograph has been modified to include the generic and brand name in many instances.

Clinical Pharamacology

Intramuscular administration of a single dose of 600 mg of lincomycin produces average peak serum levels of 11.6 μg/mL at 60 minutes and maintains therapeutic levels for 17 to 20 hours for most susceptible gram-positive organisms. Urinary excretion after this dose ranges from 1.8 to 24.8 percent (mean: 17.3 percent).

A two hour intravenous infusion of 600 mg of lincomycin achieves average peak serum levels of 15.9 μg/mL and yields therapeutic levels for 14 hours for most susceptible gram-positive organisms. Urinary excretion ranges from 4.9 to 30.3 percent (mean: 13.8 percent).

The biological half-life after intramuscular or intravenous administration is 5.4 ± 1.0 hours. The serum half-life of lincomycin may be prolonged in patients with severe impairment of renal function compared to patients with normal renal function. In patients with abnormal hepatic function, serum half-life may be twofold longer than in patients with normal hepatic function. Hemodialysis and peritoneal dialysis are not effective in removing lincomycin from the serum.

Tissue level studies indicate that bile is an important route of excretion. Significant levels have been demonstrated in the majority of body tissues. Although lincomycin appears to diffuse into cerebrospinal fluid (CSF), levels of lincomycin in the CSF appear inadequate for the treatment of meningitis.

Microbiology

Lincomycin has been shown to be active against most strains of the following organisms both in vitro and in clinical infections: (see INDICATIONS AND USAGE).

Staphylococcus aureus
Streptococcus pneumoniae

The following in vitro data are available; but their clinical significance is unknown.

Lincomycin has been shown to be active in vitro against the following microorganisms; however, the safety and efficacy of LINCOCIN in treating clinical infections due to these organisms have not been established in adequate and well controlled trials.

Gram-positive Bacteria

Corynebacterium diphtheriae
Streptococcus pyogenes
Viridans group streptococci

Anaerobic Bacteria

Clostridium tetani
Clostridium perfringens

Cross resistance has been demonstrated between clindamycin and lincomycin. Resistance is most often due to methylation of specific nucleotides in the 23S RNA of the 50S ribosomal subunit, which can determine cross resistance to macrolides and streptogramins B (MLSB phenotype). Macrolide-resistant isolates of these organisms should be tested for inducible resistance to lincomycin/clindamycin using the D-zone test or other appropriate method.

There are currently no antimicrobial susceptibility testing (AST) interpretive criteria for LINCOCIN

Animal Pharmacology

In vivo experimental animal studies demonstrated the effectiveness of LINCOCIN preparations (lincomycin) in protecting animals infected with Streptococcus viridans, β-hemolytic Streptococcus, Staphylococcus aureus, Diplococcus pneumoniae and Leptospira pomona. It was ineffective in Klebsiella, Pasteurella, Pseudomonas, Salmonella and Shigella infections.

Clinical Studies

Experience with 345 obstetrical patients receiving this drug revealed no ill effects related to pregnancy. (See PRECAUTIONS, Pregnancy)

This monograph has been modified to include the generic and brand name in many instances.

Patient Information

Patients should be counseled that antibacterial drugs including LINCOCIN should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When LINCOCIN is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by LINCOCIN or other antibacterial drugs in the future.

Diarrhea is a common problem caused by antibacterial which usually ends when the antibacterial is discontinued. Sometimes after starting treatment with antibacterial, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibacterial. If this occurs, patients should contact their physician as soon as possible

This monograph has been modified to include the generic and brand name in many instances.

Consumer Overview Uses

No Information Available!

Consumer Overview Side Effect

No Information Available!

Consumer Overview Missed Dose

No Information Available!

Patient Detailed Side Effect

Brand Names: Bactramycin, Lincocin

Generic Name: lincomycin (Pronunciation: LIN koe mye sin)

  • What is lincomycin (Lincocin)?
  • What are the possible side effects of lincomycin (Lincocin)?
  • What is the most important information I should know about lincomycin (Lincocin)?
  • What should I discuss with my health care provider before receiving lincomycin (Lincocin)?
  • How is lincomycin given (Lincocin)?
  • What happens if I miss a dose (Lincocin)?
  • What happens if I overdose (Lincocin)?
  • What should I avoid while receiving lincomycin (Lincocin)?
  • What other drugs will affect lincomycin (Lincocin)?
  • Where can I get more information?

What is lincomycin (Lincocin)?

Lincomycin is an antibiotic that fights serious infections caused by bacteria.

Lincomycin is used to treat severe bacterial infections in people who cannot receive penicillin antibiotics.

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

What are the possible side effects of lincomycin (Lincocin)?

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.

Tell your caregivers right away if you have any of these serious side effects:

  • diarrhea that is watery or bloody;
  • urinating less than usual or not at all;
  • fever, chills, body aches, flu symptoms;
  • severe blistering, peeling, and red skin rash;
  • feeling like you might pass out;
  • easy bruising or bleeding, unusual weakness; or
  • white patches or sores inside your mouth or on your lips.

Less serious side effects include:

  • nausea, vomiting;
  • swollen or painful tongue;
  • vaginal itching or discharge;
  • mild itching or skin rash;
  • ringing in your ears; or
  • dizziness, spinning feeling.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Read the Lincocin (lincomycin hcl) Side Effects Center for a complete guide to possible side effects

Learn More »

What is the most important information I should know about lincomycin (Lincocin)?

Before receiving lincomycin, tell your doctor if you have asthma or allergies, a stomach or intestinal disorder such as colitis, liver or kidney disease, or epilepsy or other seizure disorder.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Serious side effects of lincomycin include fever, chills, body aches, flu symptoms, white patches or sores inside your mouth or on your lips, severe blistering or peeling skin rash, feeling like you might pass out, easy bruising or bleeding, unusual weakness, or urinating less than usual or not at all.

Side Effects Centers
  • Lincocin

Patient Detailed How Take

What should I discuss with my health care provider before receiving lincomycin (Lincocin)?

You should not receive this medication if you are allergic to lincomycin or clindamycin (Cleocin).

Before receiving lincomycin, tell your doctor if you have:

  • asthma or allergies;
  • a stomach or intestinal disorder, such as colitis;
  • liver or kidney disease; or
  • epilepsy or other seizure disorder.

If you have any of these conditions, you may not be able to receive lincomycin, or you may need a dose adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Lincomycin can pass into breast milk and may harm a nursing baby. Do not receive this medication without telling your doctor if you are breast-feeding a baby.

How is lincomycin given (Lincocin)?

Lincomycin is given as an injection into a muscle, or through a needle placed into a vein. Your doctor, nurse, or other healthcare provider will give you this injection. You may be given instructions on how to inject your medicine at home. Do not use this medicine at home if you do not fully understand how to give the injection and properly dispose of needles and other items used in giving the medicine.

Lincomycin is usually given every 12 to 24 hours. Follow your doctor's instructions.

Use each disposable needle only one time. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Use this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Lincomycin will not treat a viral infection such as the common cold or flu.

To be sure this medication is not causing harmful effects, your blood may need to be tested on a regular basis. Your kidney or liver function may also need to be tested.

If you store this medication at home, keep at room temperature away from moisture and heat.

Side Effects Centers
  • Lincocin

Patient Detailed Avoid Taking

What happens if I miss a dose (Lincocin)?

Since lincomycin is usually given by a healthcare professional, it is not likely that you will miss a dose. If you are using lincomycin at home, call your doctor for instructions if you miss a dose.

What happens if I overdose (Lincocin)?

Tell your caregivers right away if you think you have received too much of this medicine. Overdose symptoms may include chest pain, feeling light-headed, or fainting.

What should I avoid while receiving lincomycin (Lincocin)?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

What other drugs will affect lincomycin (Lincocin)?

Before receiving lincomycin, tell your doctor if you are also using erythromycin (E-Mycin, E.E.S., Ery-Tab, Erythrocin, and others).

There may be other drugs that can interact with lincomycin. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your doctor or pharmacist can provide more information about lincomycin.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

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