Drugs Details

Drugs Info of Panhematin
Drugs Details
  • Drugs Type  : Multum
  • Date : 6th Mar 2015 01:19 am
  • Brand Name : Panhematin
  • Generic Name :  hemin (Pronunciation: HEE min)
Descriptions

PANHEMATIN (hemin for injection) is an enzyme inhibitor derived from processed red blood cells. Hemin for injection was known previously as hematin. The term hematin has been used to describe the chemical reaction product of hemin and sodium carbonate solution. Hemin is an iron containing metalloporphyrin. Chemically hemin is represented as chloro [7,12-diethenyl-3,8,13,17-tetramethyl-21H,23Hporphine- 2,18-dipropanoato(2-)-N21,N22,N23,N24] iron. The structural formula for hemin is:

 

Panhematin® (Hemin)  Structural Formula Illustration

PANHEMATIN is a sterile, lyophilized powder suitable for intravenous administration after reconstitution. Each dispensing vial of PANHEMATIN contains the equivalent of 313 mg hemin, 215 mg sodium carbonate and 300 mg of sorbitol. The pH may have been adjusted with hydrochloric acid; the product contains no preservatives. When mixed as directed with Sterile Water for Injection, USP, each 43 mL provides the equivalent of approximately 301 mg hematin (7 mg/mL).

What are the possible side effects of hemin (Panhematin)?

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 using hemin and call your doctor at once if you have a serious side effect such as:

  • urinating less than usual or not at all;
  • swelling, weight gain, feeling short of breath;
  • fever;
  • easy bruising or bleeding; or
  • swelling, pain, or irritation around the IV needle.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or...

Read All Potential Side Effects and See Pictures of Panhematin »

What are the precautions when taking hemin (Panhematin)?

Before using hemin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history.

Though unlikely, it is possible for this medication to contain substances that could cause infections because it is made from human plasma. Notify your doctor immediately if you develop early signs of an infection such as a persistent sore throat or fever, yellowing eyes or skin, or dark urine.

This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.

It is not...

Read All Potential Precautions of Panhematin »


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

Indications

PANHEMATIN (hemin for injection) is indicated for the amelioration of recurrent attacks of acute intermittent porphyria temporally related to the menstrual cycle in susceptible women.

Manifestations such as pain, hypertension, tachycardia, abnormal mental status and mild to progressive neurologic signs may be controlled in selected patients with this disorder.

Similar findings have been reported in other patients with acute intermittent porphyria, porphyria variegata and hereditary coproporphyria. PANHEMATIN is not indicated in porphyria cutanea tarda.

Dosage Administration

Before administering PANHEMATIN, an appropriate period of alternate therapy (i.e., 400 g glucose/day for 1 to 2 days) must be considered. If improvement is unsatisfactory for the treatment of acute attacks of porphyria, an intravenous infusion of PANHEMATIN containing a dose of 1 to 4 mg/kg/day of hematin should be given over a period of 10 to 15 minutes for 3 to 14 days based on the clinical signs. In more severe cases this dose may be repeated no earlier than every 12 hours. No more than 6 mg/kg of hematin should be given in any 24 hour period.

After reconstitution each mL of PANHEMATIN contains the equivalent of approximately 7 mg of hematin. The drug may be administered directly from the vial.

Dosage Calculation Table

1 mg hematin equivalent = 0.14 mL PANHEMATIN
2 mg hematin equivalent = 0.28 mL PANHEMATIN
3 mg hematin equivalent = 0.42 mL PANHEMATIN
4 mg hematin equivalent = 0.56 mL PANHEMATIN

Since reconstituted PANHEMATIN is not transparent, any undissolved particulate matter is difficult to see when inspected visually. Therefore, terminal filtration through a sterile 0.45 micron or smaller filter is recommended.

Preparation of Solution

Reconstitute PANHEMATIN by aseptically adding 43 mL of Sterile Water for Injection, USP, to the dispensing vial. Immediately after adding diluent, the product should be shaken well for a period of 2 to 3 minutes to aid dissolution. NOTE: Because PANHEMATIN contains no preservative and because PANHEMATIN undergoes rapid chemical decomposition in solution, it should not be reconstituted until immediately before use. After the first withdrawal from the vial, any solution remaining must be discarded.

No drug or chemical agent should be added to a PANHEMATIN fluid admixture unless its effect on the chemical and physical stability has first been determined.

How Supplied

PANHEMATIN is supplied as a sterile, lyophilized black powder in single dose dispensing vials (NDC 67386-701-54). When mixed as directed with Sterile Water for Injection, USP, each 43 mL provides the equivalent of approximately 301 mg hematin (7 mg/mL). Store lyophilized powder at 20-25°C (68-77°F). See USP controlled room temperature.

Caution: The packaging (vial stopper) of this product contains natural rubber latex which may cause allergic reactions.

Manufactured by: APP Pharmaceuticals, Raleigh, NC 27616, U.S.A. For: Lundbeck, Deerfield, IL 60015, U.S.A. Revised: November 2012


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

Side Effects

Clinical Trials Experience

Phlebitis with or without leucocytosis and with or without mild pyrexia has occurred after administration of hematin through small arm veins.

Post-marketing Experience

Reversible renal shutdown has occurred with administration of excessive doses (See “PRECAUTIONS” section).

There have been post-marketing literature reports of thrombocytopenia and coagulopathy (including prolonged prothrombin time and prolonged partial thromboplastin time) in patients receiving PANHEMATIN.8 Iron overload and serum ferritin increased have also been reported (See “PRECAUTIONS” section).

To report SUSPECTED ADVERSE REACTIONS, contact Lundbeck at 1-800-455-1141 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Read the Panhematin (hemin) Side Effects Center for a complete guide to possible side effects

Interactions

No information provided.

REFERENCES

8. Morris, D.L., et al., Coagulopathy Associated with Hematin Treatment for Acute Intermittent Porphyria, Ann Intern Med 95:700-701, 1981.


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

Warnings

PANHEMATIN is made from human blood. Products made from human blood may contain infectious agents, such as viruses, that can cause disease. The risk that such products will transmit an infectious agent has been reduced by screening blood donors for prior exposure to certain viruses, by testing for the presence of certain current virus infections, and by inactivating certain viruses. Despite these measures, such products can still potentially transmit disease. There is also the possibility that unknown infectious agents may be present in such products. ALL infections thought by a physician possibly to have been transmitted by this product should be reported by the physician or other healthcare provider to Lundbeck, (1-800-455-1141). The physician should discuss the risks and benefits of this product with the patient.

Because this product is made from human blood, it may carry a risk of transmitting infectious agents, e.g., viruses, and theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

PANHEMATIN therapy is intended to limit the rate of porphyria/heme biosynthesis possibly by inhibiting the enzyme δ-aminolevulinic acid synthetase. For this reason, drugs such as estrogens, barbituric acid derivatives and steroid metabolites which increase the activity of δ-aminolevulinic acid synthetase should be avoided.

Also, because hemin for injection has exhibited transient, mild anticoagulant effects during clinical studies, concurrent anticoagulant therapy should be avoided.9 The extent and duration of the hypocoagulable state induced by PANHEMATIN has not been established.

Precautions

General

Clinical benefit from PANHEMATIN depends on prompt administration. Attacks of porphyria may progress to a point where irreversible neuronal damage has occurred. PANHEMATIN therapy is intended to prevent an attack from reaching the critical stage of neuronal degeneration. PANHEMATIN is not effective in repairing neuronal damage.9

Recommended dosage guidelines should be strictly followed. Reversible renal shutdown has been observed in a case where an excessive hematin dose (12.2 mg/kg) was administered in a single infusion. Oliguria and increased nitrogen retention occurred although the patient remained asymptomatic.4 No worsening of renal function has been seen with administration of recommended dosages of hematin.9

A large arm vein or a central venous catheter should be utilized for the administration of PANHEMATIN to avoid the possibility of phlebitis.

Since reconstituted PANHEMATIN is not transparent, any undissolved particulate matter is difficult to see when inspected visually. Therefore, terminal filtration through a sterile 0.45 micron or smaller filter is recommended.

Because increased levels of iron and serum ferritin have been reported in postmarketing experience, physicians should monitor iron and serum ferritin in patients receiving multiple administrations of PANHEMATIN (See “ADVERSE REACTIONS” section).

Tests for Diagnosis and Monitoring of Therapy

Before PANHEMATIN therapy is begun, the presence of acute porphyria must be diagnosed using the following criteria:9

  1. Presence of clinical symptoms.
  2. Positive Watson-Schwartz or Hoesch test. (A negative Watson-Schwartz or Hoesch test indicates a porphyric attack is highly unlikely. When in doubt quantitative measures of δ-aminolevulinic acid and porphobilinogen in serum or urine may aid in diagnosis.)

Urinary concentrations of the following compounds may be monitored during PANHEMATIN therapy. Drug effect will be demonstrated by a decrease in one or more of the following compounds.3-6

ALA – δ-aminolevulinic acid
UPG – uroporphyrinogen
PBG – porphobilinogen coproporphyrin

Carcinogenesis, Mutagenesis, Impairment of Fertility

PANHEMATIN was not mutagenic in bacteria systems in vitro and was not clastogenic in mammalian systems in vitro and in vivo. No data are available on potential for carcinogenicity or impairment of fertility in animals or humans.

Pregnancy

Teratogenic effects - Pregnancy Category C

Animal reproduction studies have not been conducted with hematin. It is also not known whether hematin can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. For this reason PANHEMATIN should not be given to a pregnant woman unless the expected benefits are sufficiently important to the health and welfare of the patient to outweigh the unknown hazard to the fetus.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when PANHEMATIN is administered to a nursing woman.

Pediatric Use

Safety and effectiveness in pediatric patients under 16 years of age have not been established.

Geriatric Use

Clinical studies in PANHEMATIN did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in response between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

REFERENCES

3. Lamon, J. M., Hematin Therapy for Acute Porphyria, Medicine 58(3):252-269, 1979.

4. Dhar, G J., et al., Effects of Hematin in Hepatic Porphyria, Ann Intern Med 83:20-30, 1975.

5. Watson, C. J., et al., Use of Hematin in the Acute Attack of the “Inducible” Hepatic Porphyrias, Adv Intern Med 23:265-286, 1978.

6. McColl, K. E., et al., Treatment with Haematin in Acute Hepatic Porphyria, Q J Med, New Series L (198):161-174, Spring, 1981.

9. Pierach, C. A., Hematin Therapy for the Porphyric Attack, Semin Liver Dis 2(2):125-131, May, 1982.


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

OverDose

Reversible renal shutdown has been observed in a case where an excessive hematin dose (12.2 mg/kg) was administered in a single infusion. Treatment of this case consisted of ethacrynic acid and mannitol.7

ContrainDications

PANHEMATIN is contraindicated in patients with known hypersensitivity to this drug.

REFERENCES

7. Dhar, G. J., et al., Transitory Renal Failure Following Rapid Administration of a Relatively Large Amount of Hematin in a Patient with Acute Intermittent Porphyria in Clinical Remission, Acta Med Scand 203:437-443, 1978.


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

Clinical Pharamacology

Heme acts to limit the hepatic and/or marrow synthesis of porphyrin. This action is likely due to the inhibition of δ-aminolevulinic acid synthetase, the enzyme which limits the rate of the porphyrin/heme biosynthetic pathway. The exact mechanism by which hematin produces symptomatic improvement in patients with acute episodes of the hepatic porphyrias has not been elucidated.1,9

Following intravenous administration of hematin in non-jaundiced human patients, an increase in fecal urobilinogen can be observed which is roughly proportional to the amount of hematin administered. This suggests an enterohepatic pathway as at least one route of elimination. Bilirubin metabolites are also excreted in the urine following hematin injections.2

PANHEMATIN (hemin for injection) therapy for the acute porphyrias is not curative. After discontinuation of PANHEMATIN treatment, symptoms generally return although in some cases remission is prolonged. Some neurological symptoms have improved weeks to months after therapy although little or no response was noted at the time of treatment.

Other aspects of human pharmacokinetics have not been defined.

REFERENCES

1. Bickers, D., Treatment of the Porphyrias: Mechanisms of Action, J Invest Dermatol 77(1):107-113, 1981.

2. Watson, C. J., Hematin and Porphyria, editorial, N Engl J Med 293(12):605- 607, September 18, 1975.

9. Pierach, C. A., Hematin Therapy for the Porphyric Attack, Semin Liver Dis 2(2):125-131, May, 1982.


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

Patient Information

No information provided. Please refer to the WARNINGS and PRECAUTIONS sections.


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

Consumer Overview Uses

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

 

HEMIN FOR INJECTION

 

(HEE-min)

 

COMMON BRAND NAME(S): Panhematin

 

USES: This medication is used to treat the symptoms that occur with certain blood disorders (porphyrias). Other treatments are recommended for trial before using hemin, also called hematin.

Hemin is not a cure for porphyria. In some cases, this medication may relieve symptoms such as pain, high blood pressure, rapid heartbeat, or mental changes that may occur during an acute attack of porphyria. If you have any questions about the use of this medication, consult your doctor.

 

HOW TO USE: This medication should only be given in a hospital or clinic setting where you can be monitored closely. It is given by injection into a vein as directed by your doctor, usually once daily.

The dosage is based on your weight, medical conditions, and response to therapy.

Consumer Overview Side Effect

SIDE EFFECTS: Discoloration of the skin or pain, tenderness, or swelling along your veins may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: easy bruising or bleeding.

A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

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

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

 

Read the Panhematin (hemin) Side Effects Center for a complete guide to possible side effects

Learn More »

PRECAUTIONS: Before using hemin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history.

Though unlikely, it is possible for this medication to contain substances that could cause infections because it is made from human plasma. Notify your doctor immediately if you develop early signs of an infection such as a persistent sore throat or fever, yellowing eyes or skin, or dark urine.

This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.

It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

Consumer Overview Missed Dose

DRUG INTERACTIONS: Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: barbiturates (e.g., pentobarbital, phenobarbital), "blood thinners" (anticoagulants such as heparin, warfarin), corticosteroids (e.g., prednisone), estrogens.

Do not start or stop any medicine without doctor or pharmacist approval.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

 

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: signs of kidney problems (such as change in the amount of urine).

 

NOTES: Laboratory and/or medical tests (e.g., blood tests, urine tests) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

This drug will not fix nerve damage that can occur with untreated acute porphyria attacks. If given early enough, though, it can decrease the amount of permanent nerve damage.

 

MISSED DOSE: If you miss a dose, contact your doctor or pharmacist immediately to establish a new dosing schedule.

 

STORAGE: Not applicable. This medication is given in a hospital or clinic and will not be stored at home.

 

Information last revised December 2013. Copyright(c) 2013 First Databank, Inc.

Patient Detailed Side Effect

Brand Names: Panhematin

Generic Name: hemin (Pronunciation: HEE min)

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

What is hemin (Panhematin)?

Hemin is an enzyme inhibitor that is made from red blood cells. It works by lowering the production of a certain enzyme in the body.

Hemin is used to treat the symptoms of occasional attacks of porphyria related to the menstrual cycle in women. Hemin helps control symptoms such as pain, increased heart rate or blood pressure, and changes in mental status.

Hemin should not be used to treat porphyria cutanea tarda.

Hemin is not a cure for porphyria. It will only control the symptoms of a porphyria episode.

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

What are the possible side effects of hemin (Panhematin)?

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 using hemin and call your doctor at once if you have a serious side effect such as:

  • urinating less than usual or not at all;
  • swelling, weight gain, feeling short of breath;
  • fever;
  • easy bruising or bleeding; or
  • swelling, pain, or irritation around the IV needle.

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 Panhematin (hemin) Side Effects Center for a complete guide to possible side effects

Learn More »

What is the most important information I should know about hemin (Panhematin)?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Using too much hemin could be harmful to your kidneys. Follow the directions on your prescription label.

You should not use this medication if you are allergic to hemin.

Before using hemin, tell your doctor if you are allergic to latex rubber.

Also tell your doctor if you take birth control pills, hormone replacement therapy, a blood thinner, steroids, or a barbiturate sedative.

Hemin is made from human blood and may contain viruses and other infectious agents that can cause disease. Although donated human blood is screened, tested, and treated to reduce the risk of it containing anything that could cause disease, there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

Side Effects Centers
  • Panhematin

Patient Detailed How Take

What should I discuss with my health care provider before using hemin (Panhematin)?

You should not use this medication if you are allergic to hemin.

Before using hemin, tell your doctor if you are allergic to latex rubber.

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

It is not known whether hemin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Hemin is made from human blood and may contain viruses and other infectious agents that can cause disease. Although donated human blood is screened, tested, and treated to reduce the risk of it containing anything that could cause disease, there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

How should I use hemin (Panhematin)?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Using too much hemin could be harmful to your kidneys. Follow the directions on your prescription label.

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

For best results from this medication, start using it at the first sign of a porphyria attack.

Hemin injected through an IV infusion can take 10 or 15 minutes to complete. You may need to use hemin daily for up to 2 weeks depending on how your body responds to the medication.

Hemin powder must be mixed with a liquid (diluent) just before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medication.

After mixing hemin with the diluent, shake the mixture for 2 or 3 full minutes to help the medication dissolve completely.

Give the injection right away after mixing the medication. Do not save it for later use. Throw away any unused mixture after giving your injection.

To be sure this medication is helping your condition, your urine may need to be tested on a regular basis. Do not miss any scheduled appointments.

Store unmixed hemin powder in the refrigerator.

Side Effects Centers
  • Panhematin

Patient Detailed Avoid Taking

What happens if I miss a dose (Panhematin)?

Use the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose (Panhematin)?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include urinating less than usual or not at all.

What should I avoid while using hemin (Panhematin)?

Follow your doctor's instructions about any restrictions on food, beverages, or activity while you are using hemin.

What other drugs will affect hemin (Panhematin)?

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

  • a blood thinner such as warfarin (Coumadin);
  • birth control pills or hormone replacement therapy;
  • a steroid medication; or
  • a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Solfoton).

This list is not complete and there may be other drugs that can interact with hemin. 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 hemin.


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.

Copyright 1996-2013 Cerner Multum, Inc. Version: 1.03. Revision date: 12/15/2010.

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