imAMINIC-OM Antitussive Expectorant Decongestant
IRIAMINICOL- DM Antitussive Decongestant
D.G. OREOPOULOS, MD, PH D, FRcP[c], FACP Division of nephrology Toronto Western Hospital Toronto, Ont.
References
DOSAGE: Adults: 1-2 tsp. administer 3-4 times a day. Children 6-12 years: ltsp. administer 3-4 times a day. Children 1-6 years: V2 tsp. administer 3-4 limes a day. CONT1LWDICATIONS: (Both products) Hypersensitivity to any of the components, marked hypertension, patients receiving MAO inhibitors. PRECAUTIONS: Patients should be cautioned not to operate vehicles or hazardous machinery until their response to the drug has been determined. Since the depressant effects of antihistamines are additive to those of other drugs affecting the central nervous system, patients should be cautioned against drinking alcoholic beverages or taking hypnotics, sedatives, psychotherapeutic agents or other drugs with CNS depressant effects during antihistaminic therapy. Use with caution in patients with hypertension, diabetes mellitus, thyrotoxicosis, glaucoma, cardiac disease, or peripheral vascular disease. Rarely, prolonged therapy with antihistamine-containing preparations can produce blood dyscrasias. ADVERSE REACTIONS: Drowsiness, blurred vision, cardiac palpitation, flushing, dizziness, nervousness, or gastrointestinal upsets may occur occasionally. TRIAMINIC DM EXPECTORANT Supplied: Eachml of green, mintflavoured liquid contains dextromethorphan HBr 15mg, phenylpropanolamine HCl 12.5mg, pheniramine maleate 6.25mg, pyrilainine maleate 6.25mg, guaifenesin 100mg. Available in 115 and 230 ml bottles. TRIAMINICOL DM Supplied: Each 5in1 of syrup contains phenylpropanolamine HCl 12.5mg, pyrilamine maleate 6.25mg, phemramine maleate 6.25mg, dextromethorphan HBr 15mg, in a fruit-flavoured non-alcoholic vehicle. Available in 115,230,500 and 2,280m1. bottles. Full prescribing information on request
clnccl
Anca Laboratories Whitby, Ontario
try will soon result in a decreased infection rate.
1. POPOVICH RP, MONCRIEF JW, NOLPH KD, et al: Continuous ambulatory peritoneal dialysis. Ann Intern Med 88: 449, 1978 2. OREOPOULOS DG, RoesoN M, IZATT 5, et al: A simple and safe technique for continuous ambulatory peritoneal dialysis (CAPD). Trans Am Soc Artif
Intern Organs 24: 484, 1978
Illicit use of drugs To the editor: The Oct. 21, 1978 issue of CMAJ (page 979) and the Oct. 10, 1978 issue of The Medical Post (page 1) carry warnings about the prescribing of drugs that will be diverted to the illicit drug trade. Anyone who has been in practice for a while knows the pattern of deceit; usually transient new patients attempt to deceive us into prescribing such well known analgesics as hypnotics and cough suppressants. I find the warnings by the federal bureau of dangerous drugs and provincial licensing bodies inadequate, as they do not come to grips with the problem of how to cope with these people. The only advice appears to be to refuse to prescribe such agents. However, we know the addict will just move along to the next physician. Should these people not be considered as having either psychiatric or criminal problems? They are certainly a public health problem to the extent that they encourage the illicit use of drugs. It appears to me that this is a public health problem the authorities have done little about. I have on occasion reported a blatant case to the police drug squad. It would also be interesting to know the long-term prognosis of drug abusers. Do they spend their lives deceiving physicians? What happens to them? R.T. FRANKFORD, MD
2615 Danforth Ave., Ste. 11 Toronto, Ont. [.I.1
Spontaneous pneumothorax and pregnancy To the editor: Pneumothorax occurs so rarely during pregnancy that only 10 case reports have previously been published.'-8 Textbooks rarely mention this concurrence, and usually do so while describing the pneumomediastinum. However, one text describes this complication as being caused by anesthetic maneuvers such as intercostal block or assisted ventilation in women with normal or abnormal lungs.9 Understandably, no such case has been reported in the literature. Pneumothorax occurring spontaneously in otherwise healthy looking pregnant women has been described in only nine patients (total of 10 episodes). We report the 10th patient with this rare complication of pregnancy. We are certain that many cases have not been reported, and we know of at least two that, unfortunately, cannot be traced (P.F. Beirne: personal communication, 1977). Case report A 26-year-old woman, gravida 1, had an unremarkable past history except for asthma when she was a child. After an uneventful pregnancy she gave birth to a healthy girl following episiotomy and elective lowforceps delivery. She had been in labour for 8 hours. The second stage was normal, lasting 1 hour. Epidural anesthesia was used. While in the recovery room the patient complained of shortness of breath and pain in the right side of her chest. This was attributed to muscle strain. She spent the night in the postpartum unit, still complaining of moderate shortness of breath. Her vital signs were stable. Percussion revealed excessive resonance of the right side of the chest; auscultation detected distant asthmoid wheezing. A chest roentgenogram showed complete right-sided tension pneumothorax and displacement of the trachea to the left. A local anesthetic was administered and a pliable chest tube inserted and connected to an underwater drain. After 5 days the tube was clamped but the
CMA JOURNAL/JANUARY 6, 1979/VOL. 120 19
pneumothorax recurred. Therefore, drainage was continued for another 6 days. This time the pneumothorax did not recur after clamping, so the tube was removed. The patient went home the next day and remained well. Comments In most reported instances pneumothorax during pregnancy has occurred around term. In all but two cases labour had not started; in the two exceptions pneumomediastinum preceded the pneumothorax.5 Our case is also an exception since the pneumothorax became clinically obvious after delivery. Only a few patients have had a past history of contributory illness such as tuberculosis,' pneumothorax' or histoplasmosis.1 The pneumothorax is usually extensive and without tension. Half of the patients were treated conservatively, sometimes for long periods. Treatment can be limited to about 10 days' drainage (e.g., with needle aspiration or a chest tube). Failure of the patient to respond to such treatment renders thoracotomy necessary for poudrage or decortication. In these cases, congenital cysts or emphysematous blebs are usually found. ". Hypoxia in the fetus is a definite threat. Fortunately, all the infants in the reported cases have done well because of early recognition and treatment. Spontaneous pneumothorax should be considered in the differential diagnosis of chest pain and shortness of breath during pregnancy, delivery and the postpartum phase. Conservative treatment should be given only when the pneumothorax is small and steadily decreasing in size, and when no lasting symptoms are present. All other cases require insertion of a chest tube and continuous underwater drainage until the pneumothorax is resolved. The findings should be rechecked after the tube is clamped and before it is removed. Thoracotomy should be reserved for chronic recurrent pneumothorax and persistent air leaks. Low-forceps vaginal delivery with
epidural anesthesia is ideal in these cases. Any operative type of delivery should be reserved for its specific indications. Louis BURGENER, MD, FRcs[c] JAMES GERALD SOLMES, MD, FRCS[c], FACOG Department of obstetrics and gynecology
St. Michael's Hospital
Toronto, Ont.
References 1. GAss RS, ZEIDRERO LD, HUTCHESON
RH: Chronic pulmonary histoplasmosis complicated by pregnancy and spontaneous pneumothorax. Am Rev Tuberc Palm Dis 75: 111, 1957 2. Hsu CT, HUANG PW, LIN CT: A
term delivery complicated by spontaneous pneumothorax. Report of a case. Obstet Gynecol 14: 527, 1959 3. BRANTLEY WM,
DEL VALLE
RA,
SCHOENBUCHER AK: Pneumothorax, bilateral, spontaneous, complicating pregnancy; case report. Am J Obstet Gynecol 81: 42, 1961 4. PETRENKO VM: Pregnancy and labour
in a woman with chronic spontaneous pneumothorax. Pediatr A kush Ginekol 2: 57, 1962 5. DAVIDOvA RI: Two cases of spontaneous pneumothorax in pregnancy. Pediatr Akush Ginekol 3: 62, 1972 6. JONAS G: Spontaneous pneumothorax at term: report of a case. Obstet
Gynecol 23: 799, 1964 7. VANCE JP: Tension pneumothorax in labour. Anaesthesia 23: 94, 1968 8. NAJAFI JA, GUZMAN LG: Spontaneous pneumothorax in labour. Am J
Obstet Gynecol 129: 463, 1977 9. BoNic. JJ: Principles and Practice of Obstetric Analgesia and A naesthesia, Davis, Philadelphia, 1971, pp 666-67, 998
Precautionary labelling on preparations of retinoic acid To the editor: Further to my reply to Dr. F.W. Danby's letter regarding precautionary labelling on preparations of retinoic acid (Can Med AsSoc 1 119: 854, 1978), the health protection branch of Health and Welfare Canada is planning a meeting of nongovernmental medical advisers to consider this matter further. The members of the committee include Dr. Roy P. Forsey, dermatologist-inchief and chairman of the department of dermatology, Montreal General Hospital; Dr. F. Clarke Fraser, director of the department of medical genetics, Montreal General Hospital; and Dr. Robert Jackson, consultant dermatologist, Ottawa Civic Hospital. Dr. Danby will be invited to attend the meeting to present his views.
20 CMA JOURNAL/JANUARY 6, 1979/VOL. 120
Dyazide® To lower blood pressure and conserve potassium. Before prescribing, see complete prescribing information in CPS. The following is a brief summary. ADULT DOSAGE: Hypertension: Starting dosage is one tablet twice daily after meals. Dosage can be subseqaently increased or decreased according to patients need. If two or more tablets per day are needed, they should be given in divided doses. Edema: Starting dosage is one tablet twice daily after meals. When dry weight is reached, the patient may be maintained on one tablet daily. Maximum dosage four tablets daily. INDICATIONS: Mild to moderate hypertension in patients who have developed hypokalemia and in patients in whom potassium depletion is considered especially dangerous (e.g. digitalized patients). Medical opinion is not unanimous regarding the incidence and/or clinical significance of hypokalemia occurring among hypertensive patients treated with thiazide-like diuretics alone, and concerning the use of potassium-sparing combinations as routine therapy in hypertension. Edema of congestive heart failure, cirrhosis, nephrotic syndrome, steroid-induced edema and idiopathic edema. Dyazide is useful in edematous patients whose response to other diuretics is inadequate. CONTRAINDICATIONS: Progressive renal dysfunction (including increasing oliguria and azotemia) or increasing hepatic dysfunctins. Hypersensitivity. Elevated serum potassium. Nursing mothers. WARNINGS: Do not use potassium supplementation or other potassium-conserving agents with Dyazide since hyperkalemia may result. Hyperkalemia (>5.4 mEq/l) has been reported ranging in incidence from 4% in patients less than 60 years of age to 120/a in patients 60 and older, with an overall incidence of less than 80/a. Rare cases have been associated with cardiac irregularities. Make periodic serum potassium determinations, particularly in the elderly, in diabetics, and in suspected or confirmed renal insufficiency. If hyperkalemia develops, withdraw Dyazide and substitute a thiazide alone. Hypokalemia is less common than with thiazides alone, but if it occurs it may precipitate digitalis intoxication. PRECAUTIONS: Check laboratory data (e.g. BUN, serum electrolytes) and ECG's periodically, especially in the elderly, in diabetics, in renal insufficiency, and in those who have developed hyper kalemia on Dyazide' previously. Electrolyte imbalance may occur, especially where salt-restricted diets or prolonged high-dose therapy is used. Observe acutely ill cirrhotic patients for early signs of impending coma. Reversible nitrogen retention may be seen. Observe patients regularly for blood dyscrasias, liver damage or other idiosyncratic reactions: perform appropriate laboratory studies as required. Sensitivity reactions may occur, particularly in patients with history of allergy or bronchial asthma. Periodic blood studies are recommended in cirrhotics with splenomegaly. Ad(ust dosage of other antihypertensive agents given concomitantly. Antihypertensive effects of Dyazide may be enhanced in the post-sympathectomy patient. Hyperglycemia and glycosuria may occur. Insulin requirement may be altered in diabetics. Hyperuricemia and gout may occur. Thiazides have been reported 10 exacerbate or activate systemic lupus erythematosus. Pathological changes in the parathyroid glands have been reported with prolonged thiazide therapy. Triamterene may cause a decreasing alkali reserve, with the possibility of metabolic acidosis. Serum transaminase elevations sometimes occur with Dyazide'. Thiazides can decrease arterial responsiveness to norepinephrine and increase tubocurarine's paralyzing effect: exercise caution in patients undergoing surgery. Thiazides cross the placental barrier and appear in breast milk: this may result in fetal or neonatal hyperbilirubiogmia, thrombocytopenia, altered carbohydrate metabolism an. possible other adverse reactions that have occurred in the adult. Use in pregnancy only when deemed necessary for the patient's welfare. ADVERSE REACTIONS: The following adverse reactions have been associated with the use of thiazide diuretics ortriamlerene: Gastrointestinal: dry mouth, anorexia, gastric icritation, nausea, vomiting, diarrhea, constipation, (aundice (intra-hepatic cholestatic) pancreatitis, sialadenitis. Nausea can usually be prevented by giving the drug after meals. It should be noted that symptoms of nausea and vomiting can also be indicative of electrolyte imbalance (See Precautions) Central nervous system: dizziness, vertigo, paresthesias, headache, santhopsia. Dermatologic - Hypersensitivity: fever, purpura, anaphylaxis, photosensitivity, rash, urticaria, necrotizing angiitis. Hematologic: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia. Cardiovascular: orthostatic hypotension may occur and may be potentiated by alcohol, barbiturates, or narcotics. Electrolyte imbalance (See Precautions). Miscellaneous: hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weakness, restlessness, transient blurred vision. SUPPLY: Scored light orange compressed tablets monogrammed
Dyazide SKFE93 in bottles of 100, 500, 1,OOOand 2,500. DIN 181528.
25 mg hydrochiorothiazide 50 mg tnamterene
makes sense
[..] L.SYIJ
. Smith Kfine & French Canada Ltd. S Montreal, Quebec H4M 2L6
IRIAMINICOL- DM Antitussive Decongestant
D.G. OREOPOULOS, MD, PH D, FRcP[c], FACP Division of nephrology Toronto Western Hospital Toronto, Ont.
References
DOSAGE: Adults: 1-2 tsp. administer 3-4 times a day. Children 6-12 years: ltsp. administer 3-4 times a day. Children 1-6 years: V2 tsp. administer 3-4 limes a day. CONT1LWDICATIONS: (Both products) Hypersensitivity to any of the components, marked hypertension, patients receiving MAO inhibitors. PRECAUTIONS: Patients should be cautioned not to operate vehicles or hazardous machinery until their response to the drug has been determined. Since the depressant effects of antihistamines are additive to those of other drugs affecting the central nervous system, patients should be cautioned against drinking alcoholic beverages or taking hypnotics, sedatives, psychotherapeutic agents or other drugs with CNS depressant effects during antihistaminic therapy. Use with caution in patients with hypertension, diabetes mellitus, thyrotoxicosis, glaucoma, cardiac disease, or peripheral vascular disease. Rarely, prolonged therapy with antihistamine-containing preparations can produce blood dyscrasias. ADVERSE REACTIONS: Drowsiness, blurred vision, cardiac palpitation, flushing, dizziness, nervousness, or gastrointestinal upsets may occur occasionally. TRIAMINIC DM EXPECTORANT Supplied: Eachml of green, mintflavoured liquid contains dextromethorphan HBr 15mg, phenylpropanolamine HCl 12.5mg, pheniramine maleate 6.25mg, pyrilainine maleate 6.25mg, guaifenesin 100mg. Available in 115 and 230 ml bottles. TRIAMINICOL DM Supplied: Each 5in1 of syrup contains phenylpropanolamine HCl 12.5mg, pyrilamine maleate 6.25mg, phemramine maleate 6.25mg, dextromethorphan HBr 15mg, in a fruit-flavoured non-alcoholic vehicle. Available in 115,230,500 and 2,280m1. bottles. Full prescribing information on request
clnccl
Anca Laboratories Whitby, Ontario
try will soon result in a decreased infection rate.
1. POPOVICH RP, MONCRIEF JW, NOLPH KD, et al: Continuous ambulatory peritoneal dialysis. Ann Intern Med 88: 449, 1978 2. OREOPOULOS DG, RoesoN M, IZATT 5, et al: A simple and safe technique for continuous ambulatory peritoneal dialysis (CAPD). Trans Am Soc Artif
Intern Organs 24: 484, 1978
Illicit use of drugs To the editor: The Oct. 21, 1978 issue of CMAJ (page 979) and the Oct. 10, 1978 issue of The Medical Post (page 1) carry warnings about the prescribing of drugs that will be diverted to the illicit drug trade. Anyone who has been in practice for a while knows the pattern of deceit; usually transient new patients attempt to deceive us into prescribing such well known analgesics as hypnotics and cough suppressants. I find the warnings by the federal bureau of dangerous drugs and provincial licensing bodies inadequate, as they do not come to grips with the problem of how to cope with these people. The only advice appears to be to refuse to prescribe such agents. However, we know the addict will just move along to the next physician. Should these people not be considered as having either psychiatric or criminal problems? They are certainly a public health problem to the extent that they encourage the illicit use of drugs. It appears to me that this is a public health problem the authorities have done little about. I have on occasion reported a blatant case to the police drug squad. It would also be interesting to know the long-term prognosis of drug abusers. Do they spend their lives deceiving physicians? What happens to them? R.T. FRANKFORD, MD
2615 Danforth Ave., Ste. 11 Toronto, Ont. [.I.1
Spontaneous pneumothorax and pregnancy To the editor: Pneumothorax occurs so rarely during pregnancy that only 10 case reports have previously been published.'-8 Textbooks rarely mention this concurrence, and usually do so while describing the pneumomediastinum. However, one text describes this complication as being caused by anesthetic maneuvers such as intercostal block or assisted ventilation in women with normal or abnormal lungs.9 Understandably, no such case has been reported in the literature. Pneumothorax occurring spontaneously in otherwise healthy looking pregnant women has been described in only nine patients (total of 10 episodes). We report the 10th patient with this rare complication of pregnancy. We are certain that many cases have not been reported, and we know of at least two that, unfortunately, cannot be traced (P.F. Beirne: personal communication, 1977). Case report A 26-year-old woman, gravida 1, had an unremarkable past history except for asthma when she was a child. After an uneventful pregnancy she gave birth to a healthy girl following episiotomy and elective lowforceps delivery. She had been in labour for 8 hours. The second stage was normal, lasting 1 hour. Epidural anesthesia was used. While in the recovery room the patient complained of shortness of breath and pain in the right side of her chest. This was attributed to muscle strain. She spent the night in the postpartum unit, still complaining of moderate shortness of breath. Her vital signs were stable. Percussion revealed excessive resonance of the right side of the chest; auscultation detected distant asthmoid wheezing. A chest roentgenogram showed complete right-sided tension pneumothorax and displacement of the trachea to the left. A local anesthetic was administered and a pliable chest tube inserted and connected to an underwater drain. After 5 days the tube was clamped but the
CMA JOURNAL/JANUARY 6, 1979/VOL. 120 19
pneumothorax recurred. Therefore, drainage was continued for another 6 days. This time the pneumothorax did not recur after clamping, so the tube was removed. The patient went home the next day and remained well. Comments In most reported instances pneumothorax during pregnancy has occurred around term. In all but two cases labour had not started; in the two exceptions pneumomediastinum preceded the pneumothorax.5 Our case is also an exception since the pneumothorax became clinically obvious after delivery. Only a few patients have had a past history of contributory illness such as tuberculosis,' pneumothorax' or histoplasmosis.1 The pneumothorax is usually extensive and without tension. Half of the patients were treated conservatively, sometimes for long periods. Treatment can be limited to about 10 days' drainage (e.g., with needle aspiration or a chest tube). Failure of the patient to respond to such treatment renders thoracotomy necessary for poudrage or decortication. In these cases, congenital cysts or emphysematous blebs are usually found. ". Hypoxia in the fetus is a definite threat. Fortunately, all the infants in the reported cases have done well because of early recognition and treatment. Spontaneous pneumothorax should be considered in the differential diagnosis of chest pain and shortness of breath during pregnancy, delivery and the postpartum phase. Conservative treatment should be given only when the pneumothorax is small and steadily decreasing in size, and when no lasting symptoms are present. All other cases require insertion of a chest tube and continuous underwater drainage until the pneumothorax is resolved. The findings should be rechecked after the tube is clamped and before it is removed. Thoracotomy should be reserved for chronic recurrent pneumothorax and persistent air leaks. Low-forceps vaginal delivery with
epidural anesthesia is ideal in these cases. Any operative type of delivery should be reserved for its specific indications. Louis BURGENER, MD, FRcs[c] JAMES GERALD SOLMES, MD, FRCS[c], FACOG Department of obstetrics and gynecology
St. Michael's Hospital
Toronto, Ont.
References 1. GAss RS, ZEIDRERO LD, HUTCHESON
RH: Chronic pulmonary histoplasmosis complicated by pregnancy and spontaneous pneumothorax. Am Rev Tuberc Palm Dis 75: 111, 1957 2. Hsu CT, HUANG PW, LIN CT: A
term delivery complicated by spontaneous pneumothorax. Report of a case. Obstet Gynecol 14: 527, 1959 3. BRANTLEY WM,
DEL VALLE
RA,
SCHOENBUCHER AK: Pneumothorax, bilateral, spontaneous, complicating pregnancy; case report. Am J Obstet Gynecol 81: 42, 1961 4. PETRENKO VM: Pregnancy and labour
in a woman with chronic spontaneous pneumothorax. Pediatr A kush Ginekol 2: 57, 1962 5. DAVIDOvA RI: Two cases of spontaneous pneumothorax in pregnancy. Pediatr Akush Ginekol 3: 62, 1972 6. JONAS G: Spontaneous pneumothorax at term: report of a case. Obstet
Gynecol 23: 799, 1964 7. VANCE JP: Tension pneumothorax in labour. Anaesthesia 23: 94, 1968 8. NAJAFI JA, GUZMAN LG: Spontaneous pneumothorax in labour. Am J
Obstet Gynecol 129: 463, 1977 9. BoNic. JJ: Principles and Practice of Obstetric Analgesia and A naesthesia, Davis, Philadelphia, 1971, pp 666-67, 998
Precautionary labelling on preparations of retinoic acid To the editor: Further to my reply to Dr. F.W. Danby's letter regarding precautionary labelling on preparations of retinoic acid (Can Med AsSoc 1 119: 854, 1978), the health protection branch of Health and Welfare Canada is planning a meeting of nongovernmental medical advisers to consider this matter further. The members of the committee include Dr. Roy P. Forsey, dermatologist-inchief and chairman of the department of dermatology, Montreal General Hospital; Dr. F. Clarke Fraser, director of the department of medical genetics, Montreal General Hospital; and Dr. Robert Jackson, consultant dermatologist, Ottawa Civic Hospital. Dr. Danby will be invited to attend the meeting to present his views.
20 CMA JOURNAL/JANUARY 6, 1979/VOL. 120
Dyazide® To lower blood pressure and conserve potassium. Before prescribing, see complete prescribing information in CPS. The following is a brief summary. ADULT DOSAGE: Hypertension: Starting dosage is one tablet twice daily after meals. Dosage can be subseqaently increased or decreased according to patients need. If two or more tablets per day are needed, they should be given in divided doses. Edema: Starting dosage is one tablet twice daily after meals. When dry weight is reached, the patient may be maintained on one tablet daily. Maximum dosage four tablets daily. INDICATIONS: Mild to moderate hypertension in patients who have developed hypokalemia and in patients in whom potassium depletion is considered especially dangerous (e.g. digitalized patients). Medical opinion is not unanimous regarding the incidence and/or clinical significance of hypokalemia occurring among hypertensive patients treated with thiazide-like diuretics alone, and concerning the use of potassium-sparing combinations as routine therapy in hypertension. Edema of congestive heart failure, cirrhosis, nephrotic syndrome, steroid-induced edema and idiopathic edema. Dyazide is useful in edematous patients whose response to other diuretics is inadequate. CONTRAINDICATIONS: Progressive renal dysfunction (including increasing oliguria and azotemia) or increasing hepatic dysfunctins. Hypersensitivity. Elevated serum potassium. Nursing mothers. WARNINGS: Do not use potassium supplementation or other potassium-conserving agents with Dyazide since hyperkalemia may result. Hyperkalemia (>5.4 mEq/l) has been reported ranging in incidence from 4% in patients less than 60 years of age to 120/a in patients 60 and older, with an overall incidence of less than 80/a. Rare cases have been associated with cardiac irregularities. Make periodic serum potassium determinations, particularly in the elderly, in diabetics, and in suspected or confirmed renal insufficiency. If hyperkalemia develops, withdraw Dyazide and substitute a thiazide alone. Hypokalemia is less common than with thiazides alone, but if it occurs it may precipitate digitalis intoxication. PRECAUTIONS: Check laboratory data (e.g. BUN, serum electrolytes) and ECG's periodically, especially in the elderly, in diabetics, in renal insufficiency, and in those who have developed hyper kalemia on Dyazide' previously. Electrolyte imbalance may occur, especially where salt-restricted diets or prolonged high-dose therapy is used. Observe acutely ill cirrhotic patients for early signs of impending coma. Reversible nitrogen retention may be seen. Observe patients regularly for blood dyscrasias, liver damage or other idiosyncratic reactions: perform appropriate laboratory studies as required. Sensitivity reactions may occur, particularly in patients with history of allergy or bronchial asthma. Periodic blood studies are recommended in cirrhotics with splenomegaly. Ad(ust dosage of other antihypertensive agents given concomitantly. Antihypertensive effects of Dyazide may be enhanced in the post-sympathectomy patient. Hyperglycemia and glycosuria may occur. Insulin requirement may be altered in diabetics. Hyperuricemia and gout may occur. Thiazides have been reported 10 exacerbate or activate systemic lupus erythematosus. Pathological changes in the parathyroid glands have been reported with prolonged thiazide therapy. Triamterene may cause a decreasing alkali reserve, with the possibility of metabolic acidosis. Serum transaminase elevations sometimes occur with Dyazide'. Thiazides can decrease arterial responsiveness to norepinephrine and increase tubocurarine's paralyzing effect: exercise caution in patients undergoing surgery. Thiazides cross the placental barrier and appear in breast milk: this may result in fetal or neonatal hyperbilirubiogmia, thrombocytopenia, altered carbohydrate metabolism an. possible other adverse reactions that have occurred in the adult. Use in pregnancy only when deemed necessary for the patient's welfare. ADVERSE REACTIONS: The following adverse reactions have been associated with the use of thiazide diuretics ortriamlerene: Gastrointestinal: dry mouth, anorexia, gastric icritation, nausea, vomiting, diarrhea, constipation, (aundice (intra-hepatic cholestatic) pancreatitis, sialadenitis. Nausea can usually be prevented by giving the drug after meals. It should be noted that symptoms of nausea and vomiting can also be indicative of electrolyte imbalance (See Precautions) Central nervous system: dizziness, vertigo, paresthesias, headache, santhopsia. Dermatologic - Hypersensitivity: fever, purpura, anaphylaxis, photosensitivity, rash, urticaria, necrotizing angiitis. Hematologic: leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia. Cardiovascular: orthostatic hypotension may occur and may be potentiated by alcohol, barbiturates, or narcotics. Electrolyte imbalance (See Precautions). Miscellaneous: hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weakness, restlessness, transient blurred vision. SUPPLY: Scored light orange compressed tablets monogrammed
Dyazide SKFE93 in bottles of 100, 500, 1,OOOand 2,500. DIN 181528.
25 mg hydrochiorothiazide 50 mg tnamterene
makes sense
[..] L.SYIJ
. Smith Kfine & French Canada Ltd. S Montreal, Quebec H4M 2L6
