Drugs Details

Drugs Info of Silvadene, SSD, SSD AF, Thermazene
Drugs Details
  • Drugs Type  : FDA
  • Date : 8th Jul 2015 07:05 am
  • Brand Name : Silvadene, SSD, SSD AF, Thermazene
  • Generic Name : silver sulfadiazine topical (Pronunciation: SIL ver SUL fa DYE a zeen TOP ik al)
Descriptions

SILVADENE Cream 1% is a soft, white, water-miscible cream containing the antimicrobial agent silver sulfadiazine in micronized form, which has the following structural formula:

 

SILVADENE® CREAM 1% (silver sulfadiazine) Structural Formula Illustration

Each gram of SILVADENE Cream 1% contains 10 mg of micronized silver sulfadiazine. The cream vehicle consists of white petrolatum, stearyl alcohol, isopropyl myristate, sorbitan monooleate, polyoxyl 40 stearate, propylene glycol, and water, with methylparaben 0.3% as a preservative. SILVADENE Cream 1% (silver sulfadiazine) spreads easily and can be washed off readily with water.

What are the possible side effects of silver sulfadiazine topical (Silvadene, SSD, SSD AF, Thermazene)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • fever, chills, body aches, flu symptoms;
  • easy bruising or bleeding, unusual weakness;
  • pale or yellowed skin, dark colored urine;
  • ulcers on treated skin areas;
  • blood in your urine;
  • urinating less than usual or not at all;
  • drowsiness, confusion, mood...

Read All Potential Side Effects and See Pictures of Silvadene »

What are the precautions when taking silver sulfadiazine (Silvadene)?

Before using silver sulfadiazine, tell your doctor or pharmacist if you are allergic to it; or to other sulfa antibiotics (such as sulfamethoxazole); 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, especially of: a certain enzyme deficiency (G6PD or glucose-6-phosphate dehydrogenase deficiency), kidney problems, liver problems, low white blood cell count.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be...

 

Indications

SILVADENE Cream 1% (silver sulfadiazine) is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second-and third-degree burns.

Dosage Administration

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided, and SILVADENE Cream 1% (silver sulfadiazine) is applied under sterile conditions. The burn areas should be covered with SILVADENE Cream 1% at all times. The cream should be applied once to twice daily to a thickness of approximately 1/16 inch. Whenever necessary, the cream should be reapplied to any areas from which it has been removed by patient activity. Administration may be accomplished in minimal time because dressings are not required. However, if individual patient requirements make dressings necessary, they may be used.

Reapply immediately after hydrotherapy.

Treatment with SILVADENE Cream 1% should be continued until satisfactory healing has occurred, or until the burn site is ready for grafting. The drug should not be withdrawn from the therapeutic regimen while there remains the possibility of infection except if a significant adverse reaction occurs.

How Supplied

SILVADENE Cream 1% (silver sulfadiazine) is available in jars containing 50 g (NDC 61570­131-50), 400 g (NDC 61570-131-40), and 1000 g (NDC 61570-131-98) and tubes containing 20 g (NDC 61570-131-20) and 85 g (NDC 61570-131-85).

Side Effects

Several cases of transient leukopenia have been reported in patients receiving silver sulfadiazine therapy.1,2,3 Leukopenia associated with silver sulfadiazine administration is primarily characterized by decreased neutrophil count. Maximal white blood cell depression occurs within 2 to 4 days of initiation of therapy. Rebound to normal leukocyte levels follows onset within 2 to 3 days. Recovery is not influenced by continuation of silver sulfadiazine therapy. An increased incidence of leukopenia has been reported in patients treated concurrently with cimetidine.

Other infrequently occurring events include skin necrosis, erythema multiforme, skin discoloration, burning sensation, rashes, and interstitial nephritis.

Reduction in bacterial growth after application of topical antibacterial agents has been reported to permit spontaneous healing of deep partial-thickness burns by preventing conversion of the partial thickness to full thickness by sepsis. However, reduction in bacterial colonization has caused delayed separation, in some cases necessitating escharotomy in order to prevent contracture.

Interactions

No information provided.

Warnings

Absorption of silver sulfadiazine varies depending upon the percent of body surface area and the extent of the tissue damage. Although few have been reported, it is possible that any adverse reaction associated with sulfonamides may occur. Some of the reactions, which have been associated with sulfonamides, are as follows: blood dyscrasias including agranulocytosis, aplastic anemia, thrombocytopenia, leukopenia, and hemolytic anemia; dermatologic and allergic reactions, including life-threatening cutaneous reactions [Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and exfoliative dermatitis]; gastrointestinal reactions; hepatitis and hepatocellular necrosis; CNS reactions; and toxic nephrosis.

There is potential cross-sensitivity between silver sulfadiazine and other sulfonamides. If allergic reactions attributable to treatment with silver sulfadiazine occur, continuation of therapy must be weighed against the potential hazards of the particular allergic reaction.

Fungal proliferation in and below the eschar may occur. However, the incidence of clinically reported fungal superinfection is low.

The use of SILVADENE Cream 1% (silver sulfadiazine) in some cases of glucose-6-phosphate dehydrogenase-deficient individuals may be hazardous, as hemolysis may occur.

Precautions

General

If hepatic and renal functions become impaired and elimination of drug decreases, accumulation may occur and discontinuation of SILVADENE Cream 1% (silver sulfadiazine) should be weighed against the therapeutic benefit being achieved.

In considering the use of topical proteolytic enzymes in conjunction with SILVADENE Cream 1%, the possibility should be noted that silver may inactivate such enzymes.

Laboratory Tests

In the treatment of burn wounds involving extensive areas of the body, the serum sulfa concentrations may approach adult therapeutic levels (8 mg% to 12 mg%). Therefore, in these patients it would be advisable to monitor serum sulfa concentrations. Renal function should be carefully monitored and the urine should be checked for sulfa crystals. Absorption of the propylene glycol vehicle has been reported to affect serum osmolality, which may affect the interpretation of laboratory tests.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term dermal toxicity studies of 24 months' duration in rats and 18 months' in mice with concentrations of silver sulfadiazine three to ten times the concentration in SILVADENE Cream 1% revealed no evidence of carcinogenicity.

Pregnancy

Teratogenic Effects -Pregnancy Category B

A reproductive study has been performed in rabbits at doses up to three to ten times the concentration of silver sulfadiazine in SILVADENE Cream 1% and has revealed no evidence of harm to the fetus due to silver sulfadiazine. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly justified, especially in pregnant women approaching or at term. (See CONTRAINDICATIONS)

Nursing Mothers

It is not known whether silver sulfadiazine is excreted in human milk. However, sulfonamides are known to be excreted in human milk, and all sulfonamide derivatives are known to increase the possibility of kernicterus. Because of the possibility for serious adverse reactions in nursing infants from sulfonamides, 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.

Geriatric Use

Of the total number of subjects in clinical studies of Silvadene Cream 1%, seven percent were 65 years of age and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, 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.

OverDose

No information provided.

ContrainDications

SILVADENE Cream 1% (silver sulfadiazine) is contraindicated in patients who are hypersensitive to silver sulfadiazine or any of the other ingredients in the preparation.

Because sulfonamide therapy is known to increase the possibility of kernicterus, SILVADENE Cream 1% should not be used on pregnant women approaching or at term, on premature infants, or on newborn infants during the first 2 months of life.

Clinical Pharamacology

Silver sulfadiazine has broad antimicrobial activity. It is bactericidal for many gram-negative and gram-positive bacteria as well as being effective against yeast. Results from in vitro testing are listed below.

Sufficient data have been obtained to demonstrate that silver sulfadiazine will inhibit bacteria that are resistant to other antimicrobial agents and that the compound is superior to sulfadiazine.

Studies utilizing radioactive micronized silver sulfadiazine, electron microscopy, and biochemical techniques have revealed that the mechanism of action of silver sulfadiazine on bacteria differs from silver nitrate and sodium sulfadiazine. Silver sulfadiazine acts only on the cell membrane and cell wall to produce its bactericidal effect.

Results of In Vitro Testing with SILVADENE® Cream 1% (silver sulfadiazine) Concentration of Silver Sulfadiazine Number of Sensitive Strains/Total Number of Strains Tested

Genus & Species 50 μg/mL 100 μg/mL
Pseudomonas aeruginosa 130/130 130/130
Xanthomonas (Pseudomonas) maltophilia 7/7 7/7
Enterobacter species 48/50 50/50
Enterobacter cloacae 24/24 24/24
Klebsiella species 53/54 54/54
Escherichia coli 63/63 63/63
Serratia species 27/28 28/28
Proteus mirabilis 53/53 53/53
Morganella morganii 10/10 10/10
Providencia rettgeri 2/2 2/2
Providencia species 1/1 1/1
Proteus vulgaris 2/2 2/2
Citrobacter species 10/10 10/10
Acinetobacter calcoaceticus 10/11 11/11
Staphylococcus aureus 100/101 100/101
Staphylococcus epidermidis 51/51 51/51
β-Hemolytic Streptococcus 4/4 4/4
Enterococcus species 52/53 53/53
Corynebacterium­diphtheriae 2/2 2/2
Clostridium perfringens 0/2 2/2
Candida albicans 43/50 50/50

Silver sulfadiazine is not a carbonic anhydrase inhibitor and may be useful in situations where such agents are contraindicated.

Patient Information

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

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.

 

SILVER SULFADIAZINE - TOPICAL

 

(SIL-ver SIL-fa-DYE-a-zeen)

 

COMMON BRAND NAME(S): Silvadene

 

USES: This medication is used with other treatments to help prevent and treat wound infections in patients with serious burns. Silver sulfadiazine works by stopping the growth of bacteria that may infect an open wound. This helps to decrease the risk of the bacteria spreading to surrounding skin, or to the blood where it can cause a serious blood infection (sepsis). Silver sulfadiazine belongs to a class of drugs known as sulfa antibiotics.

Silver sulfadiazine must not be used on premature babies or on newborns during the first 2 months of life because of the risk of serious side effects.

 

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This drug may also be used to help prevent and treat other skin and wound infections (such as skin ulcers).

 

HOW TO USE: This medication is for use on the skin only.

Your health care professional will clean and remove the dead tissue from the wound to help the healing process.

Apply this medication to the wound using sterile technique (such as wearing sterile gloves and using sterile application tools), as directed by your doctor, usually 1 to 2 times daily. The layer of medication should be about one-sixteenth of an inch (1-2 millimeters) thick or as directed. The wound should be covered with the cream at all times. Dressings may be applied over the cream, but only if needed. If some of the cream rubs off the wound, reapply it immediately. The cream should also be reapplied immediately after hydrotherapy.

Treatment usually continues until the wound is completely healed or until the site is ready for skin grafting.

Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time(s) each day.

Tell your doctor if your condition persists or if it worsens.

Consumer Overview Side Effect

SIDE EFFECTS: Pain, burning, or itching of the treated skin may occur. Skin and mucous membranes (such as the gums) may become blue/gray in color. If any of these effects persist or worsen, tell 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 rare but serious side effects occur: signs of infection (such as fever, chills, persistent sore throat), easy bruising/bleeding, signs of anemia (such as unusual tiredness/weakness, rapid breathing, fast heartbeat), change in the amount of urine, pink/bloody urine, signs of liver problems (such as stomach/abdominal pain, persistent nausea, vomiting, dark urine, yellowing eyes/skin), mental/mood changes.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe 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 Silvadene (silver sulfadiazine) Side Effects Center for a complete guide to possible side effects

Learn More »

PRECAUTIONS: Before using silver sulfadiazine, tell your doctor or pharmacist if you are allergic to it; or to other sulfa antibiotics (such as sulfamethoxazole); 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, especially of: a certain enzyme deficiency (G6PD or glucose-6-phosphate dehydrogenase deficiency), kidney problems, liver problems, low white blood cell count.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be used only when clearly needed. This medication must not be used near the expected delivery date because of possible harm to the unborn baby. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. However, similar drugs pass into breast milk and may harm nursing infants who are ill, premature, less than 2 months old, or who have certain disorders (such as jaundice, high blood levels of bilirubin, G6PD deficiency). Therefore, breast-feeding while using this drug is not recommended in infants with these conditions. Consult your doctor before breast-feeding.

Consumer Overview Missed Dose

DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.

Some products that may interact with this drug include: cimetidine, phenytoin, skin products containing sodium sulfacetamide, enzyme products used to break down and remove dead skin/tissue from burns and wounds (such as collagenase, papain, trypsin).

An inactive ingredient in some brands of this medication (propylene glycol) may be absorbed and may interfere with certain laboratory tests, possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

 

OVERDOSE: This medicine may be harmful if swallowed. If swallowing or 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.

 

NOTES: Do not share this medication with others.

Laboratory and/or medical tests (such as white blood cell count, kidney function tests, blood tests) should be performed periodically to check for side effects. Consult your doctor for more details.

Keep all regular medical and laboratory appointments.

 

MISSED DOSE: If you miss a dose, use it as soon as you remember. This medicine should be on the wounds at all times as directed by your doctor.

 

STORAGE: Store the US product at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom.

Store the Canadian product between 46-77 degrees F (8-25 degrees C) away from light and moisture. To ensure that the medication is sterile, the Canadian 250- and 500-gram jars should be discarded 24 hours after opening. The Canadian tubes should be discarded 7 days after opening. Do not store in the bathroom.

Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Patient Detailed Side Effect

Brand Names: Silvadene, SSD, SSD AF, Thermazene

Generic Name: silver sulfadiazine topical (Pronunciation: SIL ver SUL fa DYE a zeen TOP ik al)

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

What is silver sulfadiazine topical (Silvadene)?

Silver sulfadiazine is an antibiotic. It fights bacteria and fungus on the skin.

Silver sulfadiazine topical (for the skin) is used to treat or prevent infections on areas of burned skin.

Silver sulfadiazine topical may also be used for purposes other than those listed in this medication guide.

What are the possible side effects of silver sulfadiazine topical (Silvadene)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • fever, chills, body aches, flu symptoms;
  • easy bruising or bleeding, unusual weakness;
  • pale or yellowed skin, dark colored urine;
  • ulcers on treated skin areas;
  • blood in your urine;
  • urinating less than usual or not at all;
  • drowsiness, confusion, mood changes, nausea and vomiting;
  • swelling, weight gain; or
  • fever, sore throat, and headache with a severe blistering, peeling, and red skin rash.

Less serious side effects may include:

  • brown or gray discoloration of treated skin;
  • mild itching or burning; or
  • upset stomach.

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

Read the Silvadene (silver sulfadiazine) Side Effects Center for a complete guide to possible side effects

Learn More »

What is the most important information I should know about silver sulfadiazine topical (Silvadene)?

You should not use this medication if you are allergic to silver sulfadiazine or another sulfa medication.

Before using this medication, tell your doctor if you have liver disease, kidney disease, or an enzyme deficiency called glucose-6-phosphate dehydrogenase deficiency (G6PD).

The person applying this medication to burn wounds should wear sterile disposable gloves. Take care to keep the treatment area as clean as possible to prevent further infection.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared.

Avoid exposing treated skin areas to sunlight, sunlamps, or tanning beds. Silver sulfadiazine can make your skin more sensitive to sunlight, and a sunburn may result. Wear protective clothing when you are outdoors.

Call your doctor at once if you have a serious side effect such as fever, chills, flu symptoms, easy bruising or bleeding, unusual weakness, pale or yellowed skin, dark colored urine, ulcers on treated skin areas, swelling or weight gain, urinating less than usual, or a severe blistering or peeling red skin rash.

Patient Detailed How Take

What should I discuss with my healthcare provider before using silver sulfadiazine topical (Silvadene)?

You should not use this medication if you are allergic to silver sulfadiazine or another sulfa medication.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication:

  • liver disease;
  • kidney disease; or
  • an enzyme deficiency called glucose-6-phosphate dehydrogenase deficiency (G6PD).

FDA pregnancy category B. Silver sulfadiazine is not expected to 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 silver sulfadiazine 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.

How should I use silver sulfadiazine topical (Silvadene)?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Wash your hands before and after applying silver sulfadiazine cream.

The person applying this medication to burn wounds should wear sterile disposable gloves. Take care to keep the treatment area as clean as possible to prevent further infection.

Clean the area to be treated as directed by your doctor. Apply enough of the medication to cover the affected area evenly. Silver sulfadiazine cream should be applied in a layer about one 16th of an inch thick (1.5 millimeter).

Silver sulfadiazine cream is usually applied 1 or 2 times daily. Burn wounds must be kept covered with this medication at all times. Treated skin areas can be left uncovered, or you may use a gauze bandage if directed by your doctor.

If needed, apply more cream to replace any medication that has come off on bandages, clothing, or bed linens. Reapply the cream after bathing or water therapy.

To be sure this medication is not causing harmful effects, your blood may need to be tested on a regular basis. Your kidney function may also need to be tested. Do not miss any follow-up visits to your doctor.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared.

Store silver sulfadiazine topical at room temperature away from moisture and heat.

Patient Detailed Avoid Taking

What happens if I miss a dose (Silvadene)?

Apply the missed dose as soon as you remember. Your burn wounds should be kept covered with silver sulfadiazine cream at all times.

What happens if I overdose (Silvadene)?

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

An overdose of silver sulfadiazine is not likely to cause life-threatening symptoms.

What should I avoid while using silver sulfadiazine topical (Silvadene)?

Avoid exposing treated skin areas to sunlight, sunlamps, or tanning beds. Silver sulfadiazine can make your skin more sensitive to sunlight, and a sunburn may result. Wear protective clothing when you are outdoors.

Avoid getting this medication in your mouth or eyes. If it does get into any of these areas, rinse with water. Do not use silver sulfadiazine topical on sunburned, windburned, dry, chapped, irritated, or broken skin.

What other drugs will affect silver sulfadiazine topical (Silvadene)?

Tell your doctor about all other medications you use, especially cimetidine (Tagamet).

This list is not complete and there may be other drugs that can interact with silver sulfadiazine. 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 pharmacist can provide more information about silver sulfadiazine topical.


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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