Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. In vitro studies show that the effects of Felodipine on contractile processes are selective, with greater effects on vascular smooth muscle than cardiac muscle. ACE inhibitors can cause marked renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic and sometimes excessive hypotension can occur in susceptible individuals, particularly during the initiation of treatment, which may compromise renal and myocardial perfusion. elro.info benicar
This list is not complete. Other drugs may interact with amlodipine and valsartan, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Nicardipine hydrochloride capsules are indicated for the management of patients with chronic stable angina effort-associated angina. They may be used alone or in combination with beta-blockers. CYP2A6, CYP2D6, and CYP2C19 in vitro. Palbociclib: May increase the serum concentration of CYP3A4 Substrates. In a teratology study in cynomolgus monkeys, no reduction in the size of the terminal phalanges was observed, but an abnormal position of the distal phalanges was noted in about 40% of the fetuses.
These events are listed in order of decreasing frequency within each category. To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. If you have diabetes, do not use amlodipine and valsartan together with any medication that contains aliskiren Amturnide, Tekturna, Tekamlo, Valturna.
Nicardipine produced dose-related decreases in both systolic and diastolic blood pressure in clinical trials. The antihypertensive efficacy of Nicardipine administered three times daily has been demonstrated in three placebo ontrolled studies involving 517 patients with mild to moderate hypertension. The blood pressure responses in the three studies were statistically significant from placebo at peak 1 hour post-dosing and trough 8 hours post-dosing although it is apparent that well over half of the antihypertensive effect is lost by the end of the dosing interval. ACE inhibitors should also be used cautiously in patients in whom excessive hypotension may have serious consequences, such as patients with coronary or cerebrovascular insufficiency. Patients at risk for excessive hypotension should initiate ACE inhibitor therapy under very close medical supervision, and followed closely for the first 2 weeks of treatment and whenever the dosage of ACE inhibitor or diuretic is increased.
The presence of other medical problems may affect the use of felodipine. Limited data are available in regard to enalapril overdosage in humans. In a suicide attempt, one patient took 150 mg felodipine together with 15 tablets each of and spironolactone and 20 tablets of nitrazepam. The patient's and were normal on admission to hospital; he subsequently recovered without significant sequelae. This drug may make you dizzy. not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit beverages. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as certain antihistamines such as diphenhydramine anti-seizure drugs such as carbamazepine medicine for sleep or anxiety such as alprazolam, diazepam, zolpidem muscle relaxants, narcotic pain relievers such as codeine psychiatric medicines such as risperidone, amitriptyline, trazodone. Use and dose must be determined by your doctor. Barbiturates: May increase the metabolism of Calcium Channel Blockers. Management: Monitor for decreased therapeutic effects of calcium channel blockers with concomitant barbiturate therapy. Calcium channel blocker dose adjustments may be necessary. Nimodipine Canadian labeling contraindicates concomitant use with phenobarbital. Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. LEXXEL enalapril maleate-felodipine is available for oral use as tablets containing 5 mg of enalapril maleate and 5 mg of felodipine as an extended release formulation.
Older adults may be more sensitive to the side effects of this drug, especially drowsiness and trouble falling asleep. These side effects can increase the risk of falling. MI in patients with obstructive coronary disease especially in the absence of concurrent beta-blockade. Felodipine, like other calcium channel blockers, may occasionally precipitate significant hypotension and rarely syncope. The frequency and severity of the changes appeared dose related and were noted even at the lowest dose. These changes have been shown to occur with other members of the dihydropyridine class and are possibly a result of compromised uterine blood flow. Similar fetal anomalies were not observed in rats given Felodipine. Lactose: May contain lactose; if necessary, consider alternative agents in patients intolerant of lactose. These doses are 26 times in rats and female mice and 13 times in male mice the maximum recommended human daily dose MRHDD when compared on a body surface area basis. In controlled clinical trials of up to 12 weeks duration in patients with chronic stable angina, Nicardipine increased exercise tolerance and reduced nitroglycerin consumption and the frequency of anginal attacks. The antianginal efficacy of Nicardipine hydrochloride 20 to 40 mg has been demonstrated in four placebo-controlled studies involving 258 patients with chronic stable angina. In exercise tolerance testing, Nicardipine significantly increased time to angina, total exercise duration and time to 1 mm ST segment depression. Included among these four studies was a dose-definition study in which dose-related improvements in exercise tolerance at one and four hours post-dosing and reduced frequency of anginal attacks were seen at doses of 10, 20 and 30 mg TID. Effectiveness at 10 mg TID was, however, marginal. In a fifth placebo-controlled study, the antianginal efficacy of Nicardipine was demonstrated at 8 hours post-dose trough. The sustained efficacy of Nicardipine has been demonstrated over long-term dosing. Al-Niaimi F, Lyon C "Felodipine-induced eruptive telangiectasia following mastectomy and radiotherapy. Using it for long periods or in high doses near the expected delivery date is not recommended because of possible harm to the unborn baby. Discuss the risks and benefits with your doctor. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking felodipine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. proventil
Peripheral edema: The most common side effect is peripheral edema dose dependent; occurs within 2 to 3 weeks of starting therapy. This may interfere with certain laboratory tests including certain urine sugar tests possibly causing false test results. Make sure laboratory personnel and your doctors know you are taking this medication. Human overdoses with any combination of enalapril and felodipine ER have not been reported. Patients in titration studies may have been exposed to more than one level of Felodipine extended-release tablets. Cambell LM, Ross JR, Goves JR, Lees CT, McCullagh A, Barnes P, Timerick SJ, Richardson PD "A dose-finding, placebo-controlled study on extended-release felodipine once daily in treatment of hypertension. Study 3 and patients with MDS MDS pool. The two components of LEXXEL enalapril maleate-felodipine have complementary actions. Enalapril is a pro-drug; following oral administration, it is bioactivated by hydrolysis of the ethyl ester to enalaprilat, which is the active ACE inhibitor. Enalaprilat inhibits angiotensin-converting enzyme in humans and animals. Cmax by 23% and AUCinf by 17%. This medication contains aspirin. Children and teenagers less than 18 years old should not take aspirin if they have chickenpox, flu, or any undiagnosed illness, or if they have just been given a live virus vaccine, without first consulting a doctor about Reye's syndrome, a rare but serious illness. Following administration of Felodipine extended-release tablets to hypertensive patients, mean peak plasma concentrations at steady state are about 20% higher than after a single dose. Blood pressure response is correlated with plasma concentrations of Felodipine. Herbs Hypotensive Properties: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Brimonidine Topical: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Enalapril has been used concomitantly with methyldopa, nitrates, hydralazine, and prazosin without evidence of clinically significant adverse interactions. MANAGEMENT: The manufacturers of nifedipine and nisoldipine recommend avoiding grapefruit juice. Patients treated orally with other calcium channel blockers should be advised to avoid consumption of large amounts of grapefruits and grapefruit juice to prevent any undue fluctuations in serum drug levels. Increased effects on blood pressure may persist for up to 4 days after the consumption of grapefruit juice.
Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Tell your doctor right away if you become pregnant while taking this medication. not use this medication during the last because of possible harm to the unborn baby or problems during delivery. Ask your healthcare professional how you should dispose of any medicine you do not use. Cutler SA, Hammond JJ "A multicenter comparison of isradipine and felodipine in the treatment of mild-to-moderate hypertension. The Physician's Study Group. CNS or other adverse reactions. Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. FDA product labels and may differ in countries outside the USA. Every effort has been made to ensure that the information provided on this page is accurate, up-to-date and complete, but no guarantee is made to that effect. Drugs. CYP2C8 Substrates: CYP2C8 Inhibitors Moderate may decrease the metabolism of CYP2C8 Substrates. This medication may increase the risk of bleeding when taken with other drugs that also may cause bleeding. This drug can speed up the removal of other drugs from your body by affecting certain liver enzymes. These affected drugs include corticosteroids such as prednisone, estrogen, felodipine, quinidine, certain beta blockers such as metoprolol, theophylline, doxycycline. There was no evidence of a mutagenic potential of Nicardipine in a battery of genotoxicity tests conducted on microbial indicator organisms, in micronucleus tests in mice and hamsters, or in a sister chromatid exchange study in hamsters. Weber MA, Goldberg AI, Faison EP, Lipschutz K, Shapiro DA, Nelson EB, Irvin JD "Extended-release felodipine in patients with mild to moderate hypertension. Hanover, New Jersey 07936. Product Information. Plendil felodipine. CYP3A4 Inhibitors-Felodipine is metabolized by CYP3A4. money order furadantin shopping otc
Nicardipine hydrochloride is contraindicated in patients with hypersensitivity to the drug. Consider dose reduction or interruption. Amlodipine and valsartan is not approved for use by anyone younger than 18 years old. Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased. Tell your doctor right away if you have bloating or swelling of the face, arms, hands, lower legs, or feet; tingling of the hands or feet; or unusual weight gain or weight loss. Store the US product at room temperature below 86 degrees F 30 degrees C away from light and moisture. not store in the bathroom. Walton T, Symes LR "Felodipine and isradipine: new calcium-channel-blocking agents for the treatment of hypertension. Do not start, stop, or change the dosage of any medicines without your doctor's approval. GI adverse event is suspected.
Using felodipine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use felodipine, or give you special instructions about the use of food, alcohol, or tobacco. Inactive ingredients include: propyl gallate, polyoxyl 40 hydrogenated castor oil, cellulose compounds, lactose, aluminum silicate, sodium stearyl fumarate, carnauba wax, and black iron oxide. The tablets are imprinted with an ink of synthetic black iron oxide which contains pharmaceutical glaze in SD-45, n-butyl alcohol, propylene glycol, isopropyl alcohol, ammonium hydroxide, and methyl alcohol. In patients treated with enalapril maleate plus a thiazide diuretic, there was essentially no change in serum potassium. In controlled clinical studies, adrenergic beta-receptor blockers have been frequently administered concomitantly with Nicardipine. The combination is well tolerated. Inhibition of ACE results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and to decreased aldosterone secretion. Although the latter decrease is small, it results in small increases of serum potassium. Elderly: Initiate at a lower dose in the elderly. Overdosage might be expected to cause excessive peripheral vasodilation with marked hypotension and possibly bradycardia. Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension for example, patients with diabetes or hyperlipidemia and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal. Anaphylactoid reactions during membrane exposure. Caution should be used when CYP3A4 inhibitors are co-administered with felodipine. Your blood pressure will need to be checked often. Your kidney function may also need to be checked. Monitor blood counts in all patients. AUC and the Cmax, of felodipine. Felodipine extended-release tablets are contraindicated in patients who are hypersensitive to this product. generic prozac order shopping uk
Apply this medication rectally as directed by your doctor, or, if you are self-treating, follow instructions on the product label. If the is too soft to insert, put it in cold water or refrigerate for 30 minutes before removing the foil wrapper. Unwrap the foil and moisten the suppository with a little water. Lie down on your left side with right bent. Insert the suppository into the rectum with your finger. Remain lying down for a few minutes and avoid having a for an hour or longer so the drug will be absorbed. Nicardipine on thyroid function plasma T4 and TSH in man. Aprepitant: May increase the serum concentration of CYP3A4 Substrates. Heart rate increases of 5 - 10 beats per minute may be seen during chronic dosing. The increase is inhibited by beta-blocking agents. Itraconazole: May increase the serum concentration of Felodipine. Six metabolites, which account for 23% of the oral dose, have been identified; none has significant vasodilating activity. Following oral administration of the immediate-release formulation, the plasma levels of felodipine declined polyexponentially with a mean terminal half-life of 11 to 16 hours. Discuss specific use of drug and side effects with patient as it relates to treatment. HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Carruthers SG, Vintreed C "Antihypertensive effect and tolerability of felodipine extended release er tablets in comparison with felodipine plain tablets pt and placebo in hypertensives on a diuretic. Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure. See USP Controlled Room Temperature.
Fetal plasma levels of felodipine are similar to maternal plasma levels. LEXXEL enalapril maleate-felodipine is warranted. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. Simeprevir: May increase the serum concentration of CYP3A4 Substrates. Swallow the extended-release tablet whole. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Because of the potential for serious adverse reactions from enalapril and felodipine in the infant, a decision should be made either to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Therefore, caution should be exercised when LEXXEL enalapril maleate-felodipine is given to a nursing mother. Talk to your doctor or about lifestyle changes that might benefit you. In patients with hepatic disease, the clearance of felodipine was reduced to about 60% of that seen in normal young volunteers. Check the labels on all your medicines such as cough-and-cold products because they may contain caffeine or drowsiness-causing ingredients. Also keep in mind that certain beverages such as coffee, colas, tea, energy drinks contain caffeine. Ask your pharmacist about using those products safely. The dosage is based on your medical condition, age, and response to treatment. This medication works best if it is used as the first signs of a headache occur. If you wait until the headache has worsened, the medication may not work as well. Felodipine is a member of the dihydropyridine class of calcium channel antagonists calcium channel blockers. Aortic stenosis: Use with extreme caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia. The patients enrolled included 89 males and 77 females. Musculoskeletal side effects have included arthralgia, back pain, leg pain, foot pain, muscle cramps, myalgia, arm pain, knee pain, and hip pain. The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and Drugs. pletal
In controlled clinical trials with enalapril-felodipine ER, clinically important changes in standard laboratory parameters associated with administration of LEXXEL enalapril maleate-felodipine were rare. No changes peculiar to the combination treatment were observed. In patients with chronic kidney disease CKD regardless of race or diabetes status, the use of an ACE inhibitor ACEI or angiotensin receptor blocker ARB as initial therapy is recommended to improve kidney outcomes. In the general nonblack population without CKD including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker, ACEI, or ARB. In the general black population without CKD including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic or a calcium channel blocker instead of an ACEI or ARB. 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. JADENU can cause renal failure. When given concomitantly with felodipine ER, the pharmacokinetics of digoxin in patients with heart failure were not significantly altered. Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. The administration of intravenous fluids may be useful to treat hypotension due to overdosage with calcium antagonists. At first, 5 milligrams mg once a day. Your doctor may adjust your dose if needed. It is insoluble in water and is freely soluble in acetone and in methanol; very slightly soluble in heptane. Felodipine is a racemic mixture. Remember that your doctor has prescribed this because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication not have serious side effects. GENERALLY AVOID: The consumption of grapefruit juice may be associated with significantly increased plasma concentrations of some calcium channel blockers CCBs when they are administered orally. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. This interaction has been reported with the dihydropyridine CCBs in roughly decreasing order of magnitude felodipine, nisoldipine, nifedipine, and nimodipine, often with a high degree of interindividual variability. Grapefruit juice resulted in more than twofold increases in felodipine, nifedipine, and nisoldipine AUCs. CDC. Measuring Blood Pressure. Nicardipine and included myocardial infarction, atrial fibrillation, exertional hypotension, pericarditis, heart block, cerebral ischemia and ventricular tachycardia. It is possible that some of these events were drug-related.
The incidence rates of adverse effects in anginal patients were derived from multicenter, controlled clinical trials. American Heart Association. Why Blood Pressure Matters. Do not use amlodipine and valsartan if you are pregnant. Stop using this medicine and tell your doctor right away if you become pregnant. Valsartan can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking this medicine. Although 20 mg per day increased the antihypertensive effect of felodipine, a disproportionate increase in side effects, especially those associated with vasodilatory effects, was reported. ACE inhibitors, and the patient should be hemodynamically stable. One ingredient in this product is acetaminophen. Taking too much acetaminophen may cause serious possibly fatal liver disease. Adults should not take more than 4000 milligrams 4 grams of acetaminophen a day. People with liver problems and children should take less acetaminophen. Ask your doctor or pharmacist how much acetaminophen is safe to take. ER causal relationship unknown. If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Hypertrophic cardiomyopathy HCM with outflow tract obstruction: Use with caution in patients with HCM and outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition. buy eutirox safely online
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. About 7% of patients in short term placebo-controlled angina trials have developed increased frequency, duration or severity of angina on starting Nicardipine or at the time of dosage increases, compared with 4% of patients on placebo. Comparisons with beta-blockers also show a greater frequency of increased angina, 4% vs 1%. The mechanism of this effect has not been established. Plasma concentrations of felodipine increase with advancing age. Clearance of felodipine in elderly hypertensive patients was 45% of that observed in young volunteers. Steady-state mean area under curve in young patients was 39% of that observed in elderly patients. Nicardipine is a calcium entry blocker slow channel blocker or calcium ion antagonist which inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle without changing serum calcium concentrations. The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. The effects of Nicardipine are more selective to vascular smooth muscle than cardiac muscle. In animal models, Nicardipine produces relaxation of coronary vascular smooth muscle at drug levels which cause little or no negative inotropic effect. How often did hospital staff describe possible side effects in a way you could understand? If you need surgery, tell the surgeon ahead of time that you are using amlodipine and valsartan. If severe hypotension occurs, symptomatic treatment should be instituted. The patient should be placed supine with the legs elevated.
Use with caution. The effects may be increased because of slower removal of the medicine from the body. Felodipine did not display any mutagenic activity in vitro in the Ames microbial mutagenicity test or in the mouse lymphoma forward mutation assay. Do not keep outdated medicine or medicine no longer needed. Most adverse effects were expected consequences of the vasodilator effects of Nicardipine. Keep container tightly closed. Protect from moisture and light. Dispense in a tight container, if product package is subdivided. Nausea, vomiting, abdominal pain, constipation, dry mouth, shaking tremor shortness of breath, increased urination, lightheadedness, dizziness, drowsiness, or trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Ask your pharmacist about using those products safely. Cimetidine: May increase the serum concentration of Calcium Channel Blockers. Management: Consider alternatives to cimetidine. Ocular system side effects have included visual disturbances. Adverse events were similar to those described with the individual components. online salbutamol dose
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Disclaimer: 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. Some enalapril-treated patients with hypertension or heart failure, with no apparent pre-existing renal vascular disease, have developed increases in blood urea and serum creatinine, usually minor and transient, especially when enalapril has been given concomitantly with a diuretic. This is more likely to occur in patients with pre-existing renal impairment. Dosage reduction of enalapril or discontinuation of the diuretic may be required. cytoxan
Amlodipine and valsartan may be taken with or without food. Co-administration of an antacid containing 600 mg aluminum hydroxide and 300 mg magnesium hydroxide had no effect on Nicardipine absorption. Hypertension: Oral: Initial: 5 mg once daily; adjust dose as needed at no less than 2-week intervals. They are available in cartons of 30 sachets.
Sarilumab: May decrease the serum concentration of CYP3A4 Substrates. Felodipine may lead to several-fold increases in the plasma levels of Felodipine, either due to an increase in bioavailability or due to a decrease in metabolism. These increases in concentration may lead to increased effects, lower blood pressure and increased heart rate. These effects have been observed with co-administration of itraconazole a potent CYP3A4 inhibitor. Caution should be used when CYP3A4 inhibitors are co-administered with Felodipine. A conservative approach to dosing Felodipine should be taken. This may occur at any time during treatment.
Each of the non-placebo combinations was significantly more effective than placebo in reducing seated systolic and diastolic blood pressure at peak 3 to 5 hours after dosing and trough 24 hours after dosing. Enalapril and felodipine contributed additively to the effect, so that each active-active combination was significantly more effective than either of its component monotherapies. Most of the drug effect seen at peak was still present at trough. The efficacy of combination therapy relative to monotherapy was not significantly affected by race, sex, or age. 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.