Actonel--types of drugs

What is Actonel?

Actonel (risedronate) is in a group of medicines called bisphosphonates (bis FOS fo nayts). Risedronate alters the cycle of bone formation and breakdown in the body. Actonel slows bone loss while increasing bone mass, which may prevent bone fractures.

Actonel is used to treat or prevent osteoporosis in men and women. Actonel is also used to treat Paget's disease of bone.

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

Important information about Actonel

Do not take a Actonel tablet if you cannot sit upright or stand for at least 30 minutes. Actonel can cause serious problems in the stomach or esophagus (the tube that connects your mouth and stomach). You will need to stay upright for at least 30 minutes after taking this medication.

Take the Actonel tablet first thing in the morning with a full glass (6 to 8 ounces) of water, at least 30 minutes before you eat or drink anything or take any other medicine.

Use only plain water (not mineral water) when taking a Actonel tablet.

For at least the first 30 minutes after taking a Actonel tablet, do not lie down or recline; do not eat or drink anything other than plain water; and do not take any other medicines including vitamins, calcium, or antacids.

Some people using medicines similar to Actonel have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms of this condition may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums. You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia (low red blood cells), and pre-existing dental problems.

If you need to have any dental work (especially surgery), tell the dentist ahead of time that you are using Actonel. You may need to stop using the medicine for a short time.

Talk with your doctor about the risks and benefits of using this medication.

Before taking Actonel

Do not take a Actonel tablet if you cannot sit upright or stand for at least 30 minutes. Actonel can cause serious problems in the stomach or esophagus (the tube that connects your mouth and stomach). You will need to stay upright for at least 30 minutes after taking this medication. You should not take this medication if you are allergic to risedronate, or if you have low levels of calcium in your blood (hypocalcemia), or a problem with the movement of muscles in your esophagus.

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

· low blood calcium (hypocalcemia);

· a vitamin D deficiency;

· kidney disease; or

· an ulcer in your stomach or esophagus.

Some people using medicines similar to Actonel have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms of this condition may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums.

You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia (low red blood cells), and dental surgery or pre-existing dental problems.

Talk with your doctor about the risks and benefits of using Actonel.

FDA pregnancy category C. It is not known whether Actonel will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether risedronate passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are taking Actonel.

See also: Actonel pregnancy and breastfeeding warnings (in more detail)

How should I take Actonel?

Take Actonel exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Actonel tablets come in different strengths (number of milligrams per pill). Some tablets are taken once each day. Some tablets are taken once each week, or only 1 or 2 times each month.

Your dosing schedule will depend on the tablet strength your doctor has prescribed. If you change tablet strengths, you may also need to change your schedule. Follow the directions on your prescription label.

Take the Actonel tablet first thing in the morning with a full glass (6 to 8 ounces) of water, at least 30 minutes before you eat or drink anything or take any other medicine.

Use only plain water (not mineral water) when taking a Actonel tablet.

After taking a Actonel tablet, carefully follow these instructions:

· Do not lie down or recline for at least 30 minutes after taking Actonel.

· Do not eat or drink anything other than plain water.

· Do not take any other medicines including vitamins, calcium, or antacids for at least 30 minutes after taking Actonel. It may be best to take your other medicines at a different time of the day. Talk with your doctor about the best dosing schedule for your other medicines.

Do not take two different strengths of Actonel tablet at the same time.

If you take Actonel only once a week, take it on the same day and time each week.

Do not crush, chew, or suck the Actonel tablet. Swallow the pill whole. The enteric coated pill has a special coating to protect your throat and stomach. Breaking the pill will damage this coating.

If you need to have any dental work (especially surgery), tell the dentist ahead of time that you are using Actonel. You may need to stop using the medicine for a short time.

To be sure this medication is helping your condition, your bone mineral density will need to be tested on a regular basis. Visit your doctor regularly.

Actonel is only part of a complete program of treatment that may also include diet changes, exercise, and taking calcium and vitamin supplements. Follow your diet, medication, and exercise routines very closely.

Store Actonel at room temperature away from moisture and heat.

See also: Actonel dosage (in more detail)

What happens if I miss a dose?

If you take Actonel tablets once daily: If you forget to take this medicine first thing in the morning, do not take it later in the day. Wait until the following morning to take the medicine and skip the missed dose. Do not take two (2) tablets in one day.

If you take Actonel tablets once a week, or once or twice per month: If you forget to take Actonel on your scheduled day, take it first thing in the morning on the day after you remember the missed dose. Then return to your regular weekly schedule on your chosen dose day. Do not take two (2) tablets in one day.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Drink a full glass of milk and call your local poison control center or emergency room right away. Do not make yourself vomit and do not lie down.

Overdose symptoms may include nausea, heartburn, stomach pain, diarrhea, muscle cramps, numbness or tingling, tight muscles in your face, seizure (convulsions), irritability, and unusual thoughts or behavior.

What should I avoid while taking Actonel?

Avoid taking any other medicines including vitamins, calcium, or antacids for at least 30 minutes after taking a Actonel tablet. Some medicines can make it harder for your body to absorb Actonel.

Actonel side effects

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

· chest pain;

· difficulty or pain when swallowing;

· pain or burning under the ribs or in the back;

· new or worsening heartburn;

· severe or ongoing indigestion;

· severe joint, bone, or muscle pain;

· new or unusual pain in your thigh or hip; or

· jaw pain, numbness, or swelling.

Less serious Actonel side effects may include:

· flu symptoms, muscle pain;

· mild stomach pain or upset stomach;

· diarrhea, constipation;

· mild joint or back pain; or

· headache.

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.

See also: Actonel side effects (in more detail)

What other drugs will affect Actonel?

Before using Actonel, tell your doctor if you also use aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as celecoxib (Celebrex), diclofenac (Voltaren), diflunisal (Dolobid), ibuprofen (Motrin, Advil), indomethacin, ketoprofen (Orudis), ketorolac (Toradol), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.

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

Actiq--types of drugs

What is Actiq?

Actiq is a narcotic pain medicine.

Actiq treats "breakthrough" cancer pain that is not controlled by other medicines. This medication is not for short-term pain relief.

Actiq may also be used for purposes other than those listed in this medication guide.

Important information about Actiq

Do not use Actiq if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects could occur.

You should not use Actiq unless you are already being treated with a similar opioid pain medicine and your body is tolerant to it. Talk with your doctor if you are not sure you are opioid-tolerant.

Keep both the used and the unused Actiq units out of the reach of children. The amount of fentanyl in the Actiq unit can be fatal to a child who accidentally sucks on or swallows the unit.

Seek emergency medical attention if you think you have used too much Actiq or if anyone else has accidentally swallowed it. An overdose of this medication can be fatal. Overdose symptoms may include weak pulse, fainting, shallow breathing, or breathing that stops.

Actiq may be habit-forming and should be used only by the person it was prescribed for. Actiq should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Keep track of how many Actiq units have been used from each new supply of this medicine. Fentanyl is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription. Do not use more than four Actiq units per day.

Before taking Actiq

You should not use Actiq unless you are already being treated with a similar opioid pain medicine and your body is tolerant to it. Opioid medicines include fentanyl (Actiq, Duragesic), hydrocodone (Lortab, Vicodin), hydromorphone (Dilaudid, Palladone), morphine (Kadian, MS Contin, Oramorph, and others), oxycodone (Oxycontin), oxymorphone (Numorphan, Opana), and others. Talk with your doctor if you are not sure you are opioid-tolerant.

Do not use Actiq if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you use fentanyl before the MAO inhibitor has cleared from your body.

You should not use this medication if you have had an allergic reaction or severe side effects when using any narcotic pain medicine.

Before using Actiq, tell your doctor if you are allergic to any drugs, or if you have:

· a breathing disorder such as asthma or chronic obstructive pulmonary disease (COPD);

· a seizure disorder;

· a history of head injury or brain tumor;

· liver or kidney disease;

· low blood pressure, heart disease;

· a history of depression or other mental illness; or

· a history of drug or alcohol addiction.

If you have any of these conditions, you may not be able to use this medication, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. It is not known whether Actiq is harmful to an unborn baby. It could cause addiction or withdrawal symptoms in newborn if the mother uses fentanyl citrate during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Tell your doctor if you are pregnant or plan to become pregnant during treatment. This medication can pass into breast milk and may cause sleepiness or breathing problems in a nursing baby. Actiq may also cause addiction and withdrawal symptoms in a nursing infant. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more sensitive to the effects of this medicine.

See also: Actiq pregnancy and breastfeeding warnings (in more detail)

If you are diabetic, you should know that each Actiq lozenge contains 2 grams (one-half teaspoon) of sugar.

How should I take Actiq?

Actiq (fentanyl citrate oral transmucosal) comes with a kit and instructions for storing and disposing of the Actiq units. It is very important to keep both the used and the unused Actiq units out of the reach of children. The amount of fentanyl citrate in the Actiq unit can be fatal to a child who accidentally sucks on or swallows the unit.

You will also receive instructions for using the medicine. Follow these instructions carefully. Do not use the medication in larger amounts or for longer than prescribed by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication.

The Actiq transmucosal unit is a fentanyl citrate lozenge attached to a plastic handle. Each unit is wrapped in a child-proof blister pack. Cut the blister pack open with scissors when you are ready to use the unit.

Place the medicine in your mouth between your cheek and gum, and hold the handle with your fingers. Twirl the handle to move the medicine around in your mouth while sucking on it.

Allow the medicine to dissolve in your mouth for 15 minutes. Swallow when needed. Do not bite or chew the lozenge. Do not eat or drink anything while the unit is in your mouth. If you need to use a second unit, wait at least 15 minutes after you have finished the first unit.

Do not use more than four Actiq units per day.

If you feel dizzy or sick to your stomach before the medicine has completely dissolved, stop using the unit and call your doctor.

If you switch from using Actiq to using other forms of fentanyl, you will not use the same dose. Many forms of fentanyl are given at lower doses than Actiq. If you use the same dose of each medication, you may have life-threatening overdose symptoms.

Do not stop using any other pain medicines your doctor has prescribed for you. Call your doctor if this medication does not relieve your pain.

Actiq may be habit-forming and should be used only by the person it was prescribed for. Never share Actiq with another person, especially someone with a history of drug abuse or addiction. Keep this medicine in a place where others cannot get to it.

Keep track of how many Actiq units have been used from each new supply of this medicine. Fentanyl is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Do not stop using Actiq suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using fentanyl citrate.

Store Actiq at room temperature away from moisture and heat. Leave each unit in its child-proof blister pack until you are ready to use it.

Pay special attention to your dental hygiene. Actiq can cause dry mouth leading to tooth decay.

What happens if I miss a dose?

Since Actiq is used as needed, you may not be on a dosing schedule. If you are using the medication regularly, use the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

Do not use more than four (4) Actiq units per day.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. The amount of fentanyl citrate in the Actiq unit can be fatal to a child who accidentally sucks on or swallows the unit.

Symptoms of a Actiq overdose may include weak pulse, fainting, shallow breathing, or breathing that stops.

What should I avoid while taking Actiq?

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

Actiq side effects

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

· shallow breathing, slow heart rate;

· extreme sleepiness; or

· feeling light-headed, fainting.

Less serious Actiq side effects may include:

· dry mouth;

· headache, dizziness, weakness, anxiety; or

· nausea, vomiting, or constipation.

Side effects other than those listed here may also occur. Call your doctor for medical advice about side effects.You may report side effects to FDA at 1-800-FDA-1088.

See also: Actiq side effects (in more detail)

What other drugs will affect Actiq?

Cold or allergy medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by Actiq. Tell your doctor if you regularly use any of these medicines, or any other narcotic pain medicine.

There are many other medicines that can cause serious medical problems if you take them together with Actiq, especially:

· aprepitant (Emend);

· diltiazem (Cardizem, Cartia, Dilacor, Tiazac);

· verapamil (Calan, Covera, Isoptin, Verelan);

· an antibiotic such as clarithromycin (Biaxin) or erythromycin (E-Mycin, Ery-Tab, E.E.S.);

· an antifungal medication such as fluconazole (Diflucan), ketoconazole (Nizoral), or itraconazole (Sporanox); or

· HIV medicines such as indinavir (Crixivan), fosamprenavir (Lexiva), nelfinavir (Viracept), or ritonavir (Norvir).

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