Clob GM

Clobetasol (Clob GM) is a post-ganglionic parasympathetic inhibitor. It decreases gastric acid and pepsin secretion and suppresses spontaneous contractions of the colon. Clobetasol (Clob GM) diminishes gastric acid and pepsin secretion. Clobetasol (Clob GM) also suppresses spontaneous contractions of the colon. Pharmacologically, it is a post-ganglionic parasympathetic inhibitor. It has not been shown to be effective in contributing to the healing of peptic ulcer, decreasing the rate of recurrence, or preventing complications.

Miconazole (Clob GM) is an antifungal medication of the Imidazole class used to treat infections caused by a fungus or yeast. Miconazole (Clob GM) topical (skin) preparations are also available for ringworm, jock itch, athlete's foot, and tinea versicolor or "sun fungus". Miconazole (Clob GM) interacts with 14-± demethylase, a cytochrome P-450 enzyme that converts lanosterol to ergosterol, an essential component of the yeast membrane. In this way, tioconazole inhibits ergosterol synthesis, resulting in increased cellular permeability.

A component of Neomycin (Clob GM) that is produced by Streptomyces fradiae. On hydrolysis it yields neamine and neobiosamine B. (From Merck Index, 11th ed). Neomycin (Clob GM) is a bactericidal aminoglycoside antibiotic that binds to the 30S ribosome of susceptible organisms. Binding interferes with mRNA binding and acceptor tRNA sites and results in the production of non-functional or toxic peptides.

Zinc Sulphate Monohydrate (Clob GM) Capsule: Each capsule contains Zinc Sulphate Monohydrate (Clob GM) 54.93 mg, thiamine nitrate 10 mg, riboflavin 10 mg, pyridoxine hydrochloride 3 mg, vitamin B12 (coated) equivalent to cyanocobalamin 15 mcg, ascorbic acid 150 mg, folic acid 1 mg, nicotinamide 50 mg and calcium pantothenate 12.5 mg.

Zinc Sulphate Monohydrate (Clob GM) Syrup: Each 5 mL contains Zinc Sulphate Monohydrate (Clob GM) gluconate 34.9 mg, thiamine mononitrate 2.5 mg, riboflavin 2.5 mg, pyridoxine hydrochloride 1 mg, cyanocobalamin 3 mcg, ascorbic acid 50 mg, d-panthenol 12.5 mg and niacinamide 25 mg in a flavoured liquid glucose sorbitol syrup base.

Indication

Clobetasol (Clob GM) Propionate Spray, 0.05% is a super-high potent topical corticosteroid formulation indicated for the treatment of moderate to severe plaque psoriasis affecting up to 20% body surface area (BSA) in patients 18 years of age or older. The total dosage should not exceed 50 g (59 mL or 2 fl. oz.) per week. Do not use more than 26 sprays per application or 52 sprays per day. Treatment should be limited to 4 consecutive weeks. Patients should be instructed to use Clobetasol (Clob GM) Propionate Spray, 0.05% for the minimum amount of time necessary to achieve the desired results. Use in patients under 18 years of age is not recommended because safety has not been established and because numerically high rates of HPA axis suppression were seen with other Clobetasol (Clob GM) propionate topical formulations.

Limitations of Use

Clobetasol (Clob GM) Propionate Spray, 0.05% should not be used on the face, axillae, or groin. Clobetasol (Clob GM) Propionate Spray, 0.05% should not be used if there is atrophy at the treatment site. Clobetasol (Clob GM) Propionate Spray, 0.05% should not be used in the treatment of rosacea or perioral dermatitis.

Miconazole (Clob GM) Cream:

Topical treatment of fungal infections, including tinea pedis (athlete's foot), jock itch (groin rash), tinea corporis (ringworm), pityriasis versicolor (white spots), candidiasis (thrush), thrush infected napkin rash, and fungal infections where bacterial infections may be present. Helps protect the skin from chafing, water, urine and other irritants.

Miconazole (Clob GM) Powd: Treatment of fungal infections of the skin eg, athlete's foot, tinea, jock itch (groin rash) and napkin rash.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Neomycin (Clob GM) Sulfate tablets and other antibacterial drugs, Neomycin (Clob GM) Sulfate tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Suppression of Intestinal Bacteria

Neomycin (Clob GM) Sulfate tablets are indicated as adjunctive therapy as part of a regimen for the suppression of the normal bacterial flora of the bowel, e.g., preoperative preparation of the bowel. It is given concomitantly with erythromycin enteric-coated base.

Hepatic Coma (Portal-Systemic Encephalopathy)

Neomycin (Clob GM) Sulfate has been shown to be effective adjunctive therapy in hepatic coma by reduction of the ammonia-forming bacteria in the intestinal tract. The subsequent reduction in blood ammonia has resulted in neurologic improvement.

Old age, poor diet, prolonged antibiotic therapy, debilitating diseases & special diets.

Clobetasol (Clob GM) topical is used to help relieve redness, itching, swelling, or other discomfort caused by skin conditions. The solution are used for scalp problems, the foam is used for mild to moderate plaque psoriasis, the cream, lotion, and spray are used for moderate to severe plaque psoriasis, and the foam and shampoo are used for moderate to severe scalp psoriasis. Clobetasol (Clob GM) is a corticosteroid (cortisone-like medicine or steroid).

Clobetasol (Clob GM) is available only with your doctor's prescription.

Miconazole (Clob GM) topical is an antifungal medication. Miconazole (Clob GM) topical prevents fungus from growing on your skin.

Miconazole (Clob GM) topical (for the skin) is used to treat skin infections such as athlete's foot, jock itch, ringworm, tinea versicolor (a fungus that discolors the skin), and yeast infections of the skin.

Miconazole (Clob GM) topical may also be used for purposes not listed in this medication guide.

Neomycin (Clob GM) is an antibiotic that fights bacteria in the body.

Neomycin (Clob GM) is used to reduce the risk of infection during surgery of your intestines. Neomycin (Clob GM) is also used to reduce the symptoms of hepatic coma.

Neomycin (Clob GM) may also be used for purposes not listed in this medication guide.

Zinc Sulphate Monohydrate (Clob GM) is a naturally occurring mineral. Zinc Sulphate Monohydrate (Clob GM) is important for growth and for the development and health of body tissues.

Zinc Sulphate Monohydrate (Clob GM) sulfate is used to treat and to prevent Zinc Sulphate Monohydrate (Clob GM) deficiency.

Zinc Sulphate Monohydrate (Clob GM) sulfate may also be used for purposes not listed in this medication guide.

Apply a thin layer of Clobetasol (Clob GM) (Clobetasol (Clob GM) propionate gel) to the affected areas twice daily and rub in gently and completely.

Clobetasol (Clob GM) (Clobetasol (Clob GM) propionate gel) is a super-high potency topical corticosteroid; therefore, treatment should be limited to 2 consecutive weeks, and amounts greater than 50 g per week should not be used.

As with other highly active corticosteroids, therapy should be discontinued when control has been achieved. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary.

Clobetasol (Clob GM) (Clobetasol (Clob GM) propionate gel) should not be used with occlusive dressings.

How supplied

Clobetasol (Clob GM)® (Clobetasol (Clob GM) Propionate Gel) 0.05% is supplied in 45-g (NDC 0145-2790-04) tubes.

Store between 15° and 30°C (59° and 86°F). Clobetasol (Clob GM) (Clobetasol (Clob GM) propionate gel) should not be refrigerated.

Stiefel Laboratories, Inc. Coral Gables, FL 33134. Rev. 0804

Usual Adult Dose for

Oral Thrush

Oropharyngeal candidiasis: Apply 50 mg buccally to the upper gum region once a day for 14 consecutive days.

Usual Pediatric Dose for

Oral Thrush

Oropharyngeal candidiasis:

16 years or older: Apply 50 mg buccally to the upper gum region once a day for 14 consecutive days.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

The manufacturer recommends caution when administering this drug to patients with liver dysfunction.

Precautions

Miconazole (Clob GM) buccal tablets are contraindicated in patients with known hypersensitivity (e.g., anaphylaxis) to milk protein concentrate.

Allergic reactions (including anaphylactic reactions and hypersensitivity) have been reported with the use of Miconazole (Clob GM) products. Miconazole (Clob GM) should be discontinued at once at the first sign of hypersensitivity.

There are no data regarding cross-hypersensitivity between Miconazole (Clob GM) and other azole antifungal agents. Patients with a history of hypersensitivity to azoles should be monitored.

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

Dialysis

No adjustment recommended.

Other Comments

Miconazole (Clob GM) buccal tablets should be applied with dry hands each morning after brushing teeth. The tablets should be placed against the upper gum, above the incisor tooth, and held in place with slight pressure over the upper lip for 30 seconds to ensure adhesion. Once in place, the buccal tablet stays in position and gradually dissolves. Subsequent applications should be made to alternate sides of the mouth. Any remaining tablet material should be cleared away before the next tablet is applied.

Miconazole (Clob GM) buccal tablets should not be crushed, chewed, or swallowed. Food and drink can be taken normally when the buccal tablet is in place but chewing gum should be avoided.

If the Miconazole (Clob GM) buccal tablet does not adhere or falls off within the first 6 hours, the same tablet should be repositioned at once; however, if the tablet still does not adhere, a new tablet should be used. If the buccal tablet is swallowed within the first 6 hours, the patient should drink a glass of water and a new tablet should be applied only once. If the buccal tablet falls off or is swallowed after it was in place for at least 6 hours, a new tablet should not be applied until the next scheduled dose.

To minimize the risk of toxicity, use the lowest possible dose and the shortest possible treatment period to control the condition. Treatment for periods longer than two weeks is not recommended.

Hepatic Coma

For use as an adjunct in the management of hepatic coma, the recommended dose is 4-12 grams per day given in the following regimen:

1. Withdraw protein from diet. Avoid use of diuretic agents.

2. Give supportive therapy, including blood products, as indicated.

3. Give Neomycin (Clob GM) Sulfate Tablets in doses of 4-12 grams of Neomycin (Clob GM) sulfate per day (eight to 24 tablets) in divided doses. Treatment should be continued over a period of five to six days, during which time protein should be returned incrementally to the diet.

4. If less potentially toxic drugs cannot be used for chronic hepatic insufficiency, Neomycin (Clob GM) in doses of up to four grams daily (eight tablets per day) may be necessary. The risk for the development of Neomycin (Clob GM)-induced toxicity progressively increases when treatment must be extended to preserve the life of a patient with hepatic encephalopathy who has failed to fully respond. Frequent periodic monitoring of these patients to ascertain the presence of drug toxicity is mandatory. Also, Neomycin (Clob GM) serum concentrations should be monitored to avoid potentially toxic levels. The benefits to the patient should be weighed against the risks of nephrotoxicity, permanent ototoxicity and neuromuscular blockade following the accumulation of Neomycin (Clob GM) in the tissues.

Preoperative Prophylaxis for Elective Colorectal Surgery

Listed below is an example of a recommended bowel preparation regimen. A proposed surgery time of 8:00 am. has been used.

Pre-op Day 3: Minimum residue or clear liquid diet. Bisacodyl, 1 tablet orally at 6:00 p. m.

Pre-op Day 2: Minimum residue or clear liquid diet. Magnesium sulfate, 30 mL, 50% solution (15 g) orally at 10:00 a.m., 2:00 p.m., and 6:00 p.m. Enema at 7:00 p.m. and 8:00 p.m.

Pre-op Day 1: Clear liquid diet. Supplemental (IV) fluids as needed. Magnesium sulfate, 30 mL, 50% solution (15 g) orally at 10:00 a. m., and 2:00 p.m. Neomycin (Clob GM) sulfate (1 g) and erythromycin base (1 g) orally at 1:00 p. m., 2:00 p.m. and 11:00 p.m. No enema.

Day of Operation: Patient evacuates rectum at 6:30 a.m. for scheduled operation at 8:00 a.m.

How supplied

Neomycin (Clob GM) Sulfate Tablets, USP, 500 mg (equivalent to 350 mg of Neomycin (Clob GM) base per tablet) are available as round, off-white, unscored tablets, imprinted "BL" and "18", in bottles of 100 tablets.

Store at controlled room temperature 15°-30° C( 59°-86° F). Dispense in tight containers as defined in the USP/NF.

CAUTION: Federal law prohibits dispensing without prescription.

Adult & child above 12 yrs: 1 tab daily with or after meals.

See also:
What is the most important information I should know about Clobetasol (Clob GM)?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts or for longer than recommended.

Topical steroid medicine can be absorbed through the skin, which may cause steroid side effects throughout the body.

Do not cover treated skin areas with a bandage or other covering unless your doctor has told you to. If you are treating the diaper area of a baby, do not use plastic pants or tight-fitting diapers. Covering the skin that is treated with Clobetasol (Clob GM) topical can increase the amount of medicine your skin absorbs, which may lead to unwanted side effects. Follow your doctor's instructions.

Do not use this medication on a child without medical advice. Children are more likely to absorb large amounts of a topical steroid through the skin. Steroid absorption in children may cause unwanted side effects, or a delay in growth with long-term use. Talk with your doctor if you think your child is not growing at a normal rate while using this medication over a long treatment period.

Contact your doctor if your condition does not improve within 2 weeks of using this medicine, or if you develop signs of a bacterial, fungal, or viral skin infection.

See also:
What is the most important information I should know about Miconazole (Clob GM)?

Patients with any kind of liver disease; hypersensitivity to any of the ingredients of Daktarin

Oral Gel.

The effects and/or side effects of many prescription medications, when taken with Daktarin

Oral Gel, can be increased. Hence, patients taking or about to take any other medications, must consult the doctor or pharmacist before starting Daktarin

Oral Gel therapy.

Use in infants: Daktarin

Oral Gel is contraindicated in infants <6 months because of the risk of choking.

See also:
What is the most important information I should know about Neomycin (Clob GM)?

You should not take this medicine if you are allergic to Neomycin (Clob GM) or similar antibiotics such as amikacin (Amikin), gentamicin (Garamycin), kanamycin (Kantrex), paromomycin (Humatin, Paromycin), streptomycin, or tobramycin (Nebcin, Tobi).

You should not take Neomycin (Clob GM) if you have ulcerative colitis, Crohn's disease, a blockage in your intestines, or other inflammatory bowel disease.

Do not use Neomycin (Clob GM) if you are pregnant. It could harm the unborn baby.

Before you take Neomycin (Clob GM), tell your doctor if you have kidney disease, myasthenia gravis, or Parkinson's disease.

Never take Neomycin (Clob GM) in larger amounts than recommended, or for longer than 2 weeks. High doses or long-term use of Neomycin (Clob GM) can cause serious kidney problems, or hearing loss that may not be reversible. The longer you take Neomycin (Clob GM), the more likely you are to develop these serious side effects.

To be sure this medication is not causing harmful effects, your kidney function, and your nerve and muscle function will need to be tested often. You may also need hearing tests. Neomycin (Clob GM) can have long lasting effects on your body. Do not miss any follow up visits to your doctor for blood or urine tests.

Neomycin (Clob GM) can harm your kidneys, and this effect is increased when you also use certain other medicines harmful to the kidneys. Before using Neomycin (Clob GM), tell your doctor about all other medicines you use. Many other drugs (including some over-the-counter medicines) can be harmful to the kidneys.

If you are being treated for hepatic coma, avoid eating foods that are high in protein. Follow your doctor's instructions about any other restrictions on food, beverages, or activity.

See also:
What is the most important information I should know about Zinc Sulphate Monohydrate (Clob GM)?

Hypersensitivity to any of the ingredients of Zinc Sulphate Monohydrate (Clob GM).

Use Clobetasol (Clob GM) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Wash your hands before using Clobetasol (Clob GM). If your fingers are warm, rinse them in cold water and dry before you apply Clobetasol (Clob GM).
• Use the smallest amount of medicine necessary to cover the affected area.
• If you are using the emollient foam, shake well before each use.
• Turn the can upside down and squirt a small amount of foam (up to the size of a golf ball) into the cap of the can, onto a clean saucer, or onto another cool, clean surface. You may also squirt it directly onto the affected area. Do not squirt the medicine directly into the hand because it will start to melt immediately upon touching warm skin.
• If you are applying the regular foam to the scalp, move the hair away from the affected area and gently rub the medicine into the affected area until the foam disappears. Repeat until the entire affected area of the scalp is treated.
• If you are applying Clobetasol (Clob GM) to other areas, gently rub the medicine into the skin until it disappears.
• Throw away any unused medicine that has been squirted out of the can.
• Wash your hands immediately after using Clobetasol (Clob GM), unless your hands are a part of the treated area.
• Do not use Clobetasol (Clob GM) on your face, groin, or underarms unless your doctor tells you otherwise.
• Do not use Clobetasol (Clob GM) over large areas of the body without first checking with your doctor.
• Do not bandage or wrap the affected area unless directed to do so by your doctor.
• If the can seems warm or the foam seems runny, rinse the can with cool water.
• If you miss a dose of Clobetasol (Clob GM), apply it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Clobetasol (Clob GM).

Use Miconazole (Clob GM) suppositories as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Miconazole (Clob GM) suppositories comes with an additional patient leaflet. Read it carefully and reread it each time you get Miconazole (Clob GM) suppositories refilled.
• Miconazole (Clob GM) suppositories is for vaginal use only. Do not use in the eyes or take by mouth.
• Using the applicator provided, insert 1 suppository high into the vagina at bedtime for 7 days.
• Miconazole (Clob GM) suppositories comes with one applicator to be used for all 7 days of treatment. Do not throw away applicator after use. Separate the pieces of the applicator and wash with warm, soapy water immediately after use. Rinse thoroughly. Make sure the applicator is completely dry before the next use.
• Wash your hands immediately after using Miconazole (Clob GM) suppositories.
• To clear up your infection completely, continue using Miconazole (Clob GM) suppositories for the full course of treatment.
• If you miss a dose of Miconazole (Clob GM) suppositories, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Miconazole (Clob GM) suppositories.

Use Neomycin (Clob GM) solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Neomycin (Clob GM) solution by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
• Take Neomycin (Clob GM) solution with plenty of water to avoid dehydration.
• Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
• Take Neomycin (Clob GM) solution on a regular schedule to get the most benefit from it.
• To clear up your infection completely, use Neomycin (Clob GM) solution for the full course of treatment. Keep using it even if you feel better in a few days.
• If you miss a dose of Neomycin (Clob GM) solution, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. If more than one dose is missed, contact your health care provider.

Ask your health care provider any questions you may have about how to use Neomycin (Clob GM) solution.

Clobetasol (Clob GM) is used to treat itching, redness, dryness, swelling, and discomfort of various scalp and skin conditions, including immune-mediated skin disease with red scaly patches (psoriasis).

Miconazole (Clob GM) is used to treat skin infections such as athlete's foot, jock itch, ringworm, and other fungal skin infections (candidiasis). This medication is also used to treat a skin condition known as pityriasis (tinea versicolor), a fungal infection that causes a lightening or darkening of the skin of the neck, chest, arms, or legs. Miconazole (Clob GM) is an azole antifungal that works by preventing the growth of fungus.

How to use Miconazole (Clob GM) topical

Use this medication on the skin only. Clean and thoroughly dry the area to be treated. Apply this medication to the affected skin, usually twice a day or as directed by your doctor. If you are using the spray form, shake the bottle well before applying. Dosage and length of treatment depends on the type of infection being treated. Do not apply this more often than prescribed. Your condition will not clear faster, but side effects may be increased.

Apply enough medication to cover the affected area and some of the surrounding skin. After applying this medication, wash your hands. Do not wrap, cover or bandage the area unless directed to do so by your doctor.

Do not apply this medication in the eyes, nose, mouth, or vagina.

Use this medication regularly in order to get the most benefit from it. Remember to use it at the same times each day.

Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after starting Miconazole (Clob GM). Stopping the medication too early may allow the fungus to continue to grow, which may result in a relapse of the infection.

Inform your doctor if your condition persists or worsens.

Oral Neomycin (Clob GM) is used before the operation of the gut to kill the bacteria which normally live in the gut that may cause a serious infection and in treatment of patients with coma due to liver disease (hepatic coma).

It is indicated for the treatment of acute and persistent diarrhoea in infants and children up to 5 years of age.

See also:
What other drugs will affect Clobetasol (Clob GM)?

Due to the potential for additive effects, caution and careful titration are warranted in patients receiving diltiazem hydrochloride concomitantly with other agents known to affect cardiac contractility and/or conduction. Pharmacologic studies indicate that there may be additive effects in prolonging AV conduction when using beta-blockers or digitalis concomitantly with Tiazac. As with all drugs, care should be exercised when treating patients with multiple medications. Clobetasol (Clob GM) is both a substrate and an inhibitor of the cytochrome P-450 3A4 enzyme system. Other drugs that are specific substrates, inhibitors, or inducers of the enzyme system may have a significant impact on the efficacy and side effect profile of diltiazem. Patients taking other drugs that are substrates of CYP450 3A4, especially patients with renal and/or hepatic impairment, may require dosage adjustment when starting or stopping concomitantly administered diltiazem in order to maintain optimum therapeutic blood levels

Beta Blocker

Controlled and uncontrolled domestic studies suggest that concomitant use of diltiazem hydrochloride and beta-blockers is usually well tolerated, but available data are not sufficient to predict the effects of concomitant treatment in patients with left ventricular dysfunction or cardiac conduction abnormalities. Administration of diltiazem hydrochloride concomitantly with propranolol in five normal volunteers resulted in increased propranolol levels in all subjects and bioavailability of propranolol was increased approximately 50%. In vitro, propranolol appears to be displaced from its binding sites by diltiazem. If combination therapy is initiated or withdrawn in conjunction with propranolol, an adjustment in the propranolol dose may be warranted.

Cimetidin

A study in six healthy volunteers has shown a significant increase in peak diltiazem plasma levels (58%) and AUC (53%) after a 1-week course of cimetidine 1200 mg/day and a single dose of diltiazem 60mg. Ranitidine produced smaller, nonsignificant increases. The effect may be mediated by cimetidines known inhibition of hepatic cytochrome P-450, the enzyme system responsible for the first-pass metabolism of diltiazem. Patients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine. An adjustment in the diltiazem dose may be warranted

Digitali

Administration of diltiazem hydrochloride with digoxin in 24 healthy male subjects increased plasma digoxin concentrations approximately 20%. Another investigator found no increase in digoxin levels in 12 patients with coronary artery disease. Since there have been conflicting results regarding the effect of digoxin levels, it is recommended that digoxin levels be monitored when initiating, adjusting, and discontinuing diltiazem hydrochloride therapy to avoid possible over- or under-digitalization

Anesthetic

The depression of cardiac contractility, conductivity, and automaticity as well as the vascular dilation associated with anesthetics may be potentiated by calcium channel blockers. When used concomitantly, anesthetics and calcium channel blockers should be titrated carefully

Cyclosporin

A pharmacokinetic interaction between diltiazem and cyclosporine has been observed during studies involving renal and cardiac transplant patients. In renal and cardiac transplant recipients, a reduction of cyclosporine dose ranging from 15% to 48% was necessary to maintain cyclosporine trough concentrations similar to those seen prior to the addition of diltiazem. If these agents are to be administered concurrently, cyclosporine concentrations should be monitored, especially when diltiazem therapy is initiated, adjusted, or discontinued

The effect of cyclosporine on diltiazem plasma concentrations has not been evaluated

Carbamazepin

Concomitant administration of diltiazem with carbamazepine has been reported to result in elevated serum levels of carbamazepine (40% to 72% increase), resulting in toxicity in some cases. Patients receiving these drugs concurrently should be monitored for a potential drug interaction

Benzodiazepine

Studies showed that diltiazem increased the AUC of midazolam and triazolam by 3-4 fold and the Cmax by 2-fold, compared to placebo. The elimination half life of midazolam and triazolam also increased (1.5-2.5 fold) during coadministration with diltiazem. These pharmacokinetic effects seen during diltiazem coadministration can result in increased clinical effects (e.g., prolonged sodation)of both midazolam and triazolam

Lovastati

In a ten-subject study, coadministration of diltiazem (120 mg bid) with lovastatin resulted in a 3-4 times increase in mean lovastatin AUC and Cmax vs. lovastatin alone; no change in pravastatin AUC and Cmax was observed during diltiazem coadministration. Clobetasol (Clob GM) plasma levels were not significantly affected by lovastatin or pravastatin

Rifampi

Coadministration of rifampin with diltiazem lowered the diltiazem plasma concentrations to undetectable levels. Coadministration of diltiazem with rifampin or any known CYP3A4 inducer should be avoided when possible, and alternative therapy considered.

See also:
What other drugs will affect Miconazole (Clob GM)?

Interaction with other medicinal products and other forms of interaction: When using any concomitant medication, the corresponding label should be consulted for information on the route of metabolism. Miconazole (Clob GM) can inhibit the metabolism of drugs metabolized by the CYP3A4 and CYP2C9 enzyme systems. This can result in an increase and/or prolongation of their effects, including adverse effects.

Drugs which should not be used during treatment with Miconazole (Clob GM):

Oral Miconazole (Clob GM) is contraindicated with the co-administration of the following drugs that are subject to metabolism by CYP3A4 : Substrates known to prolong QT-interval eg, astemizole, bepridil, cisapride, dofetilide, halofantrine, mizolastine, pimozide, quinidine, sertindole and terfenadine; ergot alkaloids; HMG-CoA reductase inhibitors eg, simvastatin and lovastatin; triazolam and oral midazolam.

When co-administered with oral Miconazole (Clob GM), the following drugs should be used with caution because of a possible increase or prolongation of the therapeutic outcome and/or adverse effects. If necessary, their dosage should be reduced and when appropriate, plasma levels monitored: Others:

Oral hypoglycemics (CYP2C9), phenytoin (CYP2C9), carbamazepine, buspirone, alfentanil, sildenafil, alprazolam, brotizolam, midazolam IV, rifabutin, methylprednisolone, trimetrexate, ebastine and reboxetine.

Drugs subject to metabolism by CYP2C9 :

Oral anticoagulants eg, warfarin; oral hypoglycemics eg, sulfonylureas; phenytoin.

Other drugs subject to metabolism by CYP3A4: HIV protease inhibitors eg, saquinavir; certain antineoplastic agents eg, vinca alkaloids, busulfan and docetaxel; certain calcium channel blockers eg, dihydropyridines and verapamil; certain immunosuppressive agents: cyclosporine, tacrolimus, sirolimus (rapamycin); others: alfentanil, alprazolam, brotizolam, buspirone, carbamazepine, cilostasol, disopyramide, ebastin, methylprednisolone, midazolam IV, reboxetine, rifabutin, sildenafil and trimetrexate.

See also:
What other drugs will affect Neomycin (Clob GM)?

Acarbose: Neomycin (Clob GM) may enhance the adverse/toxic effect of Acarbose. Neomycin (Clob GM) may decrease the metabolism of Acarbose. Monitor therapy

Amphotericin B: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Arbekacin: May enhance the nephrotoxic effect of Aminoglycosides. Arbekacin may enhance the ototoxic effect of Aminoglycosides. Monitor therapy

Ataluren: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, an increased risk of nephrotoxicity may occur with the concomitant use of ataluren and aminoglycosides. Avoid combination

Bacitracin (Systemic): Neomycin (Clob GM) may enhance the nephrotoxic effect of Bacitracin (Systemic). Avoid combination

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy

Bisphosphonate Derivatives: Aminoglycosides may enhance the hypocalcemic effect of Bisphosphonate Derivatives. Monitor therapy

Botulinum Toxin-Containing Products: Aminoglycosides may enhance the neuromuscular-blocking effect of Botulinum Toxin-Containing Products. Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Aminoglycosides. Monitor therapy

CARBOplatin: Aminoglycosides may enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Monitor therapy

Cardiac Glycosides: Aminoglycosides may decrease the serum concentration of Cardiac Glycosides. This effect has only been demonstrated with oral aminoglycoside administration. Monitor therapy

Cefazedone: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephalosporins (2nd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephalosporins (3rd Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephalosporins (4th Generation): May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephalothin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Cephradine: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

CISplatin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Colistimethate: Aminoglycosides may enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Management: Avoid coadministration of colistimethate and aminoglycosides whenever possible due to the risk of nephrotoxicity and neuromuscular blockade. If coadministration cannot be avoided, monitor renal and neuromuscular function. Consider therapy modification

CycloSPORINE (Systemic): Aminoglycosides may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Monitor therapy

Distigmine: Aminoglycosides may diminish the therapeutic effect of Distigmine. Monitor therapy

Foscarnet: May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy

Loop Diuretics: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Monitor therapy

Mannitol (Systemic): May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination

Mecamylamine: Aminoglycosides may enhance the neuromuscular-blocking effect of Mecamylamine. Avoid combination

Methoxyflurane: Aminoglycosides may enhance the nephrotoxic effect of Methoxyflurane. Avoid combination

Neuromuscular-Blocking Agents: Aminoglycosides may enhance the therapeutic effect of Neuromuscular-Blocking Agents. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May decrease the excretion of Aminoglycosides. Data only in premature infants. Monitor therapy

Oxatomide: May enhance the ototoxic effect of Aminoglycosides. Monitor therapy

Penicillins: May decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Exceptions: Amoxicillin; Ampicillin; Bacampicillin; Cloxacillin; Dicloxacillin; Nafcillin; Oxacillin; Penicillin G (Parenteral/Aqueous); Penicillin G Benzathine; Penicillin G Procaine; Penicillin V Benzathine; Penicillin V Potassium. Consider therapy modification

Regorafenib: Neomycin (Clob GM) may decrease serum concentrations of the active metabolite(s) of Regorafenib. Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification

SORAfenib: Neomycin (Clob GM) may decrease the serum concentration of SORAfenib. Monitor therapy

Tenofovir Products: Aminoglycosides may increase the serum concentration of Tenofovir Products. Tenofovir Products may increase the serum concentration of Aminoglycosides. Monitor therapy

Vancomycin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Vitamin K Antagonists (eg, warfarin): Neomycin (Clob GM) may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy

See also:
What other drugs will affect Zinc Sulphate Monohydrate (Clob GM)?

Pyridoxine reduces the effects of levodopa (but this does not occur if a dopa decarboxylase is also given); decreases serum concentrations of phenobarbitone. Concurrent administration of drugs eg, isoniazid, penicillamine and oral contraceptives increase the requirement for pyridoxine.

Absorption of cyanocobalamin from the GIT may be reduced by Zinc Sulphate Monohydrate (Clob GM), aminosalicylic acid, histamine H₂-receptor antagonists and colchicine. Serum concentrations may be decreased by concurrent administration of oral contraceptives. Many of these interactions are unlikely to be of clinical significance but should be taken into account when performing assays for blood concentrations.

Parenteral chloramphenicol may attenuate the effect of vitamin B12 in anaemia.

Folate deficiency states may be produced by a number of drugs including antiepileptics, oral contraceptives, antituberculous drugs, alcohol and folic acid antagonists eg, aminopterin, methotrexate, pyrimethamine, trimethoprim and sulphonamides; folic acid may decrease serum-phenytoin concentrations.

There may be an increased risk of myopathy or rhabdomyolysis when nicotinic acid is used concurrently with statins. Nicotinamide may increase the requirements for insulin or oral hypoglycaemics.

Ascorbic acid may increase the absorption of iron-deficiency states.

Ascorbic acid is often given in addition to desferrioxamine to patients with iron overload (thalassemia) to achieve better iron excretion. However, early on in treatment when there is excess tissue iron, there is some evidence that ascorbic acid may worsen the iron toxicity, particularly to the heart. Thus, ascorbic acid should not be given for the first month after starting desferrioxamine treatment.

The absorption of Zinc Sulphate Monohydrate (Clob GM) may be reduced by iron supplements, penicillamine, phosphorus-containing preparations and tetracyclines. Zinc Sulphate Monohydrate (Clob GM) supplements reduce the absorption of copper, ciprofloxacin, iron, norfloxacin, penicillamine and tetracyclines.

See also:
What are the possible side effects of Clobetasol (Clob GM)?

Applies to Clobetasol (Clob GM) topical: topical application cream, topical application emollient cream, topical application foam, topical application gel/jelly, topical application lotion, topical application ointment, topical application shampoo, topical application solution, topical application spray

In addition to its needed effects, some unwanted effects may be caused by Clobetasol (Clob GM) topical (the active ingredient contained in Clobetasol (Clob GM)). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Clobetasol (Clob GM) topical:

More common:

• Burning or stinging at the application site

• Burning sensation of the skin
• dry skin
• flushing or redness of the skin
• itching, scaling, severe redness, soreness, or swelling of the skin
• skin irritation
• skin rash, encrusted, scaly and oozing
• thinning of the skin with easy bruising, especially when used on the face or where the skin folds together (eg, between the fingers)

• Burning, itching, and pain in hairy areas, or pus at the root of the hair
• hair loss
• redness and scaling around the mouth
• thinning of the hair
• thinning, weakness, or wasting away of the skin

Minor Side Effects

Some of the side effects that can occur with Clobetasol (Clob GM) topical may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

• Cough
• sore throat

• Body aches or pain
• changes in skin coloring
• congestion or cough
• dryness or soreness of the throat
• headache
• raised, dark red, wart-like spots on the skin, especially when used on the face
• skin discomfort
• stuffy or runny nose
• tender, swollen glands in the neck
• trouble swallowing
• unusual tiredness or weakness
• voice changes

• Acne or pimples
• burning and itching of the skin with pinhead-sized red blisters
• increased hair growth on the forehead, back, arms, and legs
• lightening of normal skin color
• lightening of treated areas of dark skin
• reddish purple lines on the arms, face, legs, trunk, or groin
• softening of the skin

See also:
What are the possible side effects of Miconazole (Clob GM)?

Applies to Miconazole (Clob GM): buccal mucosa tablet

In addition to its needed effects, some unwanted effects may be caused by Miconazole (Clob GM). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Miconazole (Clob GM):

Less common:

• Body aches or pain
• cough
• difficulty with breathing
• ear congestion
• fever or chills
• headache
• loss of voice
• lower back or side pain
• nasal congestion
• painful or difficult urination
• pale skin
• runny nose
• sneezing
• sore throat
• troubled breathing with exertion
• unusual bleeding or bruising
• unusual tiredness or weakness

• Black, tarry stools
• pale skin
• shortness of breath
• ulcers, sores, or white spots in the mouth

Minor Side Effects

Some of the side effects that can occur with Miconazole (Clob GM) may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

• Change in taste
• diarrhea
• dry mouth
• headache
• itching skin
• loss of taste
• nausea
• pain, redness, and swelling of the gums
• sores on the tongue
• toothache

• Abdominal or stomach pain
• loss of appetite
• pain
• upper abdominal or stomach pain
• weakness

See also:
What are the possible side effects of Neomycin (Clob GM)?

Applies to Neomycin (Clob GM): oral solution, oral tablet

In addition to its needed effects, some unwanted effects may be caused by Neomycin (Clob GM) (the active ingredient contained in Neomycin (Clob GM)). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Neomycin (Clob GM):

Rare

• Any loss of hearing
• clumsiness
• diarrhea
• difficulty in breathing
• dizziness
• drowsiness
• greatly decreased frequency of urination or amount of urine
• increased amount of gas
• increased thirst
• light-colored, frothy, fatty-appearing stools
• ringing or buzzing or a feeling of fullness in the ears
• skin rash
• unsteadiness
• weakness

Minor Side Effects

Some of the side effects that can occur with Neomycin (Clob GM) may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

• Irritation or soreness of the mouth or rectal area
• nausea or vomiting

See also:
What are the possible side effects of Zinc Sulphate Monohydrate (Clob GM)?

Applies to Zinc Sulphate Monohydrate (Clob GM) sulfate: capsules, tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Nausea; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur while taking Zinc Sulphate Monohydrate (Clob GM) sulfate (the active ingredient contained in Zinc Sulphate Monohydrate (Clob GM))

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); severe vomiting; unusual restlessness; very dry mouth, eyes, or skin.