Redotex NF

Atropine (Redotex NF) Injection Pfizer also contains sodium chloride and water for injections.

Atropine (Redotex NF) sulfate is bis (1R, 3r, 5S)-3-[(RS)-(3-hydroxy-2-phenylpropionyl)oxy]-8-methyl-8-azabicyclo[3.2.1]octane sulfate. It appears as colourless crystals or a white, crystalline powder. It is very soluble in water, freely soluble in alcohol and practically insoluble in ether. It has a molecular formula of (C₁₇H₂₃NO₃)₂,H₂SO₄,H₂O and a molecular weight of 695.

A carbamate with hypnotic, sedative, and some muscle relaxant properties, although in therapeutic doses reduction of anxiety rather than a direct effect may be responsible for muscle relaxation. Cathine (Redotex NF) has been reported to have anticonvulsant actions against petit mal seizures, but not against grand mal seizures (which may be exacerbated). It is used in the treatment of anxiety disorders, and also for the short-term management of insomnia but has largely been superseded by the benzodiazepines. (From Martindale, The Extra Pharmacopoeia, 30th ed, p603) Cathine (Redotex NF) is a controlled substance in the U.S.

constipation

The Atropine (Redotex NF)® (Atropine (Redotex NF)) Auto-injector is indicated for the treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides. The Atropine (Redotex NF) (Atropine (Redotex NF)) auto-injector should be used by persons who have had adequate training in the recognition and treatment of nerve agent or insecticide intoxication. Pralidoxime chloride may serve as an important adjunct to Atropine (Redotex NF) therapy.

The Atropine (Redotex NF)® (Atropine (Redotex NF)) is intended as an initial treatment of the muscarinic symptoms of insecticide or nerve agent poisonings (generally breathing difficulties due to increased secretions); definitive medical care should be sought immediately. The Atropine (Redotex NF)® (Atropine (Redotex NF)) Auto-injector should be administered as soon as symptoms of organophosphorous or carbamate poisoning appear (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.) In moderate to severe poisoning, the administration of more than one Atropine (Redotex NF)® (Atropine (Redotex NF)) may be required until atropinization is achieved (flushing, mydriasis, tachycardia, dryness of the mouth and nose). In severe poisonings, it may also be desirable to concurrently administer an anticonvulsant if seizure is suspected in the unconscious individual since the classic tonic-clonic jerking may not be apparent due to the effects of the poison. In poisonings due to organophosphorous nerve agents and insecticides it may also be helpful to concurrently administer a cholinesterase reactivator such as pralidoxime chloride.

Oral

Obesity

Adult: As extended-release cap: 20-50 mg once daily after breakfast for up to 4 wk.

Atropine (Redotex NF) produces many effects in the body such as reducing muscle spasms and fluid secretions.

Atropine (Redotex NF) is used to help reduce saliva, mucus, or other secretions in your airway during a surgery. Atropine (Redotex NF) is also used to treat spasms in the stomach, intestines, bladder, or other organs.

Atropine (Redotex NF) is sometimes used as an antidote to treat certain types of poisoning.

Atropine (Redotex NF) may also be used for purposes not listed in this medication guide.

CAUTION! PRIMARY PROTECTION AGAINST EXPOSURE TO CHEMICAL NERVE AGENT AND INSECTICIDE POISONING IS THE WEARING OF PROTECTIVE GARMENTS INCLUDING MASKS, DESIGNED SPECIFICALLY FOR THIS USE.

INDIVIDUALS SHOULD NOT RELY SOLELY UPON THE AVAILABILITY OF ANTIDOTES SUCH AS Atropine (Redotex NF) AND PRALIDOXIME TO PROVIDE COMPLETE PROTECTION FROM CHEMICAL NERVE AGENT AND INSECTICIDE POISONING.

Immediate evacuation from the contaminated environment is essential. Decontamination of the poisoned individual should occur as soon as possible.

The Atropine (Redotex NF)® (Atropine (Redotex NF)) Auto-injector is indicated for the treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides. The Atropine (Redotex NF)® (Atropine (Redotex NF)) auto-injector should be used by persons who have had adequate training in the recognition and treatment of nerve agent or insecticide intoxication. Pralidoxime chloride may serve as an important adjunct to Atropine (Redotex NF) therapy.

The Atropine (Redotex NF)® (Atropine (Redotex NF)) is intended as an initial treatment of the muscarinic symptoms of insecticide or nerve agent poisonings (generally breathing difficulties due to increased secretions); definitive medical care should be sought immediately. The Atropine (Redotex NF)® (Atropine (Redotex NF)) Auto-injector should be administered as soon as symptoms of organophosphorous or carbamate poisoning appear (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.) In moderate to severe poisoning, the administration of more than one Atropine (Redotex NF)® (Atropine (Redotex NF)) may be required until atropinization is achieved (flushing, mydriasis, tachycardia, dryness of the mouth and nose). In severe poisonings, it may also be desirable to concurrently administer an anticonvulsant if seizure is suspected in the unconscious individual since the classic tonic-clonic jerking may not be apparent due to the effects of the poison. In poisonings due to organophosphorous nerve agents and insecticides it may also be helpful to concurrently administer a cholinesterase reactivator such as pralidoxime chloride.

It is recommended that three (3) Atropine (Redotex NF)® (Atropine (Redotex NF)) auto-injectors be available for use in each person at risk for nerve agent or organophosphate insecticide poisoning; one (1) for mild symptoms plus two (2) more for severe symptoms as described below. No more than three (3) Atropine (Redotex NF)® (Atropine (Redotex NF)) injections should be used unless the patient is under the supervision of a trained medical provider. Different dose strengths of the Atropine (Redotex NF)® (Atropine (Redotex NF)) are available depending on the recipient's age and weight.

• Adults and children weighing over 90 lbs (generally over 10 years of age)..............Atropine (Redotex NF)® (Atropine (Redotex NF)) 2 mg (green)
• Children weighing 40 lbs to 90 lbs (generally 4 to 10 years of age)..............Atropine (Redotex NF)® (Atropine (Redotex NF)) 1 mg (dark red)
• Children weighing 15 lbs to 40 lbs (generally 6 months to 4 years of age)..............Atropine (Redotex NF)® (Atropine (Redotex NF)) 0.5 mg (blue)

NOTE: Children weighing under 15 lbs (generally younger than 6 months old) should ordinarily not be treated with the Atropine (Redotex NF)® auto-injector. Atropine (Redotex NF) doses for these children should be individualized at doses of 0.05 mg/kg.

Treatment of MILD SYMPTOMS

One (1) Atropine (Redotex NF)® (Atropine (Redotex NF)) is recommended if two or more MILD symptoms of nerve agent (nerve gas) or insecticide exposure appear in situations where exposure is known or suspected.

Two (2) additional Atropine (Redotex NF)® (Atropine (Redotex NF)) injections given in rapid succession are recommended 10 minutes after receiving the first Atropine (Redotex NF)® (Atropine (Redotex NF)) injection if the victim develops any of the SEVERE symptoms listed below. If possible, a person other than the victim should administer the second and third Atropine (Redotex NF)® (Atropine (Redotex NF)) injections.

Treatment of SEVERE SYMPTOMS:

If a victim is encountered who is either unconscious or has any of the SEVERE symptoms listed below, immediately administer three (3) Atropine (Redotex NF)® (Atropine (Redotex NF)) injections into the victim's mid-lateral thigh in rapid succession using the appropriate weight-based Atropine (Redotex NF)® (Atropine (Redotex NF)) dose.

MILD SYMPTOMS of nerve agent or insecticide exposure include the following:

-Blurred vision, miosis

-Excessive unexplained teary eyes

-Excessive unexplained runny nose

-Increased salivation such as sudden unexplained excessive drooling

-Chest tightness or difficulty breathing

-Tremors throughout the body or muscular twitching

-Nausea and/or vomiting

-Unexplained wheezing or coughing

-Acute onset of stomach cramps

-Tachycardia or bradycardia

SEVERE SYMPTOMS of exposure to nerve agent or insecticides include the following:

-Strange or confused behavior

-Severe difficulty breathing or severe secretions from your lungs/airway

-Severe muscular twitching and general weakness

-Involuntary urination and defecation (feces)

-Convulsions

-Unconsciousness

All victims should be evacuated immediately from the contaminated environment. Medical help should be sought immediately. Protective masks and clothing should be used when available. Decontamination procedures should be undertaken as soon as possible. If dermal exposure has occurred, clothing should be removed and the hair and skin washed thoroughly with sodium bicarbonate or alcohol as soon as possible.

Emergency care of the severely poisoned individual should include removal of oral and bronchial secretions, maintenance of a patent airway, supplemental oxygen and, if necessary, artificial ventilation. In general, Atropine (Redotex NF) should not be used until cyanosis has been overcome since Atropine (Redotex NF) may produce ventricular fibrillation and possible seizures in the presence of hypoxia.

Pralidoxime (if used) is most effective if administered immediately or soon after the poisoning. Generally, little is accomplished if pralidoxime is given more than 36 hours after termination of exposure unless the poison is known to age slowly or re-exposure is possible, such as in delayed continuing gastrointestinal absorption of ingested poisons. Fatal relapses, thought to be due to delayed absorption, have been reported after initial improvement. Continued administration for several days may be useful in such patients.

Close supervision of all moderately to severely poisoned patients is indicated for at least 48 to 72 hours.

An anticonvulsant such as diazepam may be administered to treat convulsions if suspected in the unconscious individual. The effects of nerve agents and some insecticides can mask the motor signs of a seizure.

IMPORTANT: PHYSICIANS AND/OR OTHER MEDICAL PERSONNEL ASSISTING EVACUATED VICTIMS OF NERVE AGENTS AND INSECTICIDE POISONING SHOULD AVOID EXPOSING THEMSELVES TO CONTAMINATION BY THE VICTIM'S CLOTHING. AGGRESSIVE AND SAFE DECONTAMINATION IS STRONGLY SUGGESTED.

Instructions for administering Atropine (Redotex NF)® (Atropine (Redotex NF)) (please refer to the illustrated Self Aid and Caregiver Directions for Use elsewhere):

Warning: Giving additional Atropine (Redotex NF)® (Atropine (Redotex NF)) injections by mistake in the absence of actual nerve agent or insecticide poisoning may cause an overdose of Atropine (Redotex NF) which could result in temporary incapacitation (inability to walk properly, see clearly or think clearly for several or more hours). Patients with cardiac disease may be at risk for serious adverse events, including death.

How supplied

The Atropine (Redotex NF)® (Atropine (Redotex NF)) is supplied in three strengths. The Atropine (Redotex NF)® 0.5 mg provides Atropine (Redotex NF) Injection (Atropine (Redotex NF), 0.42 mg/0.7 ml), Atropine (Redotex NF)® 1 mg provides Atropine (Redotex NF) Injection (Atropine (Redotex NF), 0.84 mg/0.7 ml), and Atropine (Redotex NF)® 2 mg provides Atropine (Redotex NF) Injection (Atropine (Redotex NF), 1.67 mg/0.7 ml) in sterile solution for intramuscular injection. The Atropine (Redotex NF)® (Atropine (Redotex NF)) is a self-contained unit designed for self or caregiver administration.

Store at 25° C (77° F); excursions permitted to 15–30° C (59–86° F)

Keep from freezing. Protect from light.

Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC., 10240 Old Columbia Road, COLUMBIA, MD 21046. FDA Rev date: 9/17/2004

Oral

Obesity

Adult: As extended-release cap: 20-50 mg once daily after breakfast for up to 4 wk.

See also:
What is the most important information I should know about Atropine (Redotex NF)?

Known hypersensitivity to Atropine (Redotex NF) or other anticholinergic agents.

Severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; gastrointestinal obstruction eg, pyloroduodenal stenosis, achalasia, cardiospasm, paralytic ileus, intestinal atony; closed-angle glaucoma; obstructive uropathy eg, bladder neck obstruction caused by prostatic hypertrophy; myasthenia gravis; tachycardia secondary to cardiac insufficiency or thyrotoxicosis; acute hemorrhage with unstable cardiovascular status; febrile patients or patients exposed to elevated ambient temperature due to risk of provoking hyperpyrexia and heat prostration; prostatic enlargement; pregnancy-induced hypertension.

Patients treated with MAOI or stopped MAOI within the last 2 wk; moderate or severe hypertension; pulmonary hypertension; structural cardiac abnormalities or advanced arteriosclerosis; adrenal tumour; hyperthyroidism or hyperexcitability; coronary thrombosis; closed-angle glaucoma; pregnancy.

Use Atropine (Redotex NF) drops as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• An extra patient leaflet is available with Atropine (Redotex NF) drops. Talk to your pharmacist if you have questions about this information.
• To use Atropine (Redotex NF) drops in the eye, first, wash your hands. Tilt your head back. Using your index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Immediately use your finger to apply pressure to the inside corner of the eyelid for 1 to 2 minutes. Do not blink. Remove excess medicine around your eye with a clean, dry tissue, being careful not to touch your eye. Wash your hands to remove any medicine that may be on them.
• To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including the eye. Keep the container tightly closed.
• If you miss a dose of Atropine (Redotex NF) drops, 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 Atropine (Redotex NF) drops.

Use: Labeled Indications

Antidote: Antidote for anticholinesterase poisoning (carbamate insecticides, nerve agents, organophosphate insecticides); antidote for muscarine-containing mushroom poisoning.

Adjuvant use with anticholinesterases (eg, edrophonium, neostigmine) to decrease their adverse effects during reversal of neuromuscular blockade.

Cardiovascular conditions: Treatment of symptomatic sinus bradycardia, atrioventricular (AV) nodal block.

Note: Likely not effective for type II second-degree or third-degree AV block (AHA [Hazinski 2015]). Use is no longer recommended in the management of asystole or pulseless electrical activity (PEA) (ACLS 2010).

Respiratory tract: Preoperative/preanesthetic medication to inhibit salivation and secretions.

Off Label Uses

Rapid sequence intubation (premedication)

Clinical experience suggests the utility of Atropine (Redotex NF) in adults who are at risk of developing bradycardia during rapid sequence intubation, such as those receiving conduction-altering drugs (eg, beta-blockers).

Based on the American Heart Association 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, the use of Atropine (Redotex NF) is effective and recommended as a premedication to prevent bradycardia in adults undergoing rapid sequence intubation.

Based on the American Society of Nuclear Cardiology, Atropine (Redotex NF) may be administered as an adjunctive agent to increase heart rate in patients who do not achieve target heart rate with dobutamine alone.

See also:
What other drugs will affect Atropine (Redotex NF)?

Atropine (Redotex NF) may cause increased anticholinergic activity when administered concomitantly with other anticholinergic drugs eg, phenothiazines, antispasmodics, antiparkinsonian drugs, antiarrhythmics with anticholinergic activity eg, disopyramide and quinidine, some antihistamines, tricyclic antidepressants or butyrophenones.

The absorption of other drugs may be affected by the reduction in gastric motility caused by Atropine (Redotex NF).

Atropine (Redotex NF) antagonises the actions of a number of compounds including synthetic choline esters eg, bethanechol and carbachol, anticholinesterase drugs eg, physostigmine, neostigmine and pyridostigmine and cholinomimetic alkaloids eg, pilocarpine.

Ketoconazole: Anticholinergics may increase gastrointestinal pH, possibly resulting in a marked reduction in ketoconazole absorption during concurrent use with anticholinergics; patients should be advised to take these medications at least 2 hrs after ketoconazole.

Cisapride and Metoclopramide: Concurrent use with anticholinergics may antagonise the gastrointestinal motility of cisapride and metoclopramide.

Opioid (Narcotic) Analgesics: Concurrent use with anticholinergics may result in increased risk of severe constipation, which may lead to paralytic ileus and/or urinary retention.

Haloperidol: Antipsychotic effectiveness of haloperidol may be decreased in schizophrenic patients.

Cholinesterase Inhibitors: In view of the pharmacodynamic effects of Atropine (Redotex NF), Atropine (Redotex NF) may interfere with the activity of cholinesterase inhibitors eg, rivastigmine, donepezil.

Incompatibilities: Atropine (Redotex NF) Injection Pfizer has been shown to be incompatible with solutions containing adrenaline HCl, amylobarbitone sodium, pentobarbitone sodium, promazine HCl, ampicillin sodium, chloramphenicol sodium succinate, chlortetracycline HCl, heparin sodium, metaraminol tartrate, methicillin sodium, nitrofurantoin, novobiocin, oxacillin sodium, sodium bicarbonate, sulfadiazine sodium, sulfafurazole diethanolamine, tetracycline HCl, thiopentone sodium, vitamin B complex with ascorbic acid and warfarin sodium. This list is not exhaustive.

Reduced effect of guanethidine. Increased risk of arrhythmia in patients treated with digitalis due to its sympathomimetic effects. Increased risk of arrhythmia with choroform, cyclopropane, halothane or other halogenated anesthetics. The effect of Cathine (Redotex NF) may be reduced/enhanced by tricyclic anti-depressants.

Potentially Fatal: Cathine (Redotex NF) should not be used in patients treated with a MAOI or within 14 days of stopping MAOI as hypertensive crisis may occur if used.

See also:
What are the possible side effects of Atropine (Redotex NF)?

Mild to moderate pain may be experienced at the site of injection.

The major and most common side effects of Atropine (Redotex NF) can be attributed to its antimuscarinic action. These include dryness of the mouth, blurred vision, photophobia, confusion, headache, dizziness, tachycardia, palpitations, flushing, urinary hesitance or retention, constipation, abdominal distention, nausea, vomiting, loss of libido and impotency. Anhidrosis may produce heat intolerance and impairment of temperature regulation especially in a hot environment. Larger or toxic doses may produce such central effects as restlessness, tremor, fatigue, locomotor difficulties, delirium, followed by hallucinations, depression and ultimately, medullary paralysis and death. Large doses can also lead to circulatory collapse. In such cases, blood pressure declines and death due to respiratory failure may ensue following paralysis and coma. Hypersensitivity reactions will occasionally occur with Atropine (Redotex NF): these are usually seen as skin rashes, on occasion progressing to exfoliation. Adverse events seen in pediatrics are similar to those that occur in adult patients although central nervous system complaints are often seen earlier and at lower doses.

When Atropine (Redotex NF) and pralidoxime are used together, the signs of atropinization may occur earlier than might be expected than when Atropine (Redotex NF) is used alone. This is especially true if the total dose of Atropine (Redotex NF) has been large and the administration of pralidoxime has been delayed. Excitement and manic behavior immediately following recovery of consciousness have been reported in several cases. However, similar behavior has occurred in cases of organophosphate poisoning that were not treated with pralidoxime.

Amitai et el (JAMA 1990) evaluated the safety of Atropine (Redotex NF)® (Atropine (Redotex NF)) 0.5 mg, 1 mg and 2 mg in a case series of 240 children who received Atropine (Redotex NF)® (Atropine (Redotex NF)) inappropriately (i.e., no nerve agent exposure) during the 1990 Gulf War Period. Overall, severity of atropinization followed a nonlinear correlation with dose. Estimated doses up to 0.045 mg/kg produced no signs of atropinization. Estimated doses between 0.045 mg/kg to 0.175 mg/kg and even greater than 0.175 mg/kg were associated with mild and severe effects respectively. Actual dosage received by children may have been considerably lower than estimated since incomplete injection in many cases was suspected. Regardless, adverse events reported were generally mild and self-limited. Few children required hospitalization. Adverse reactions reported were dilated pupils (43%), tachycardia (39%), dry membranes (35%), flushed skin (20%), temperature 37.8° C or 100° F (4%) and neurologic abnormalities (5%). There was also local pain and swelling. In 91 children with ECGs, no abnormalities were noted other than sinus tachycardia; 22 children had severe tachycardia of 160-190 bpm. Neurologic abnormalities consisted of irritability, agitation, confusion, lethargy, and ataxia.

The following adverse reactions were reported in published literature for Atropine (Redotex NF) in both adults and children:

Cardiovascular: Sinus tachycardia, supraventricular tachycardia, junctional tachycardia, ventricular tachycardia, bradycardia, palpitations, ventricular arrhythmia, ventricular flutter, ventricular fibrillation, atrial arrhythmia, atrial fibrillation, atrial ectopic beats, ventricular premature contractions, bigeminal beats, trigeminal beats, nodal extrasystole, ventricular extrasystole, supraventricular extrasystole, asystole, cardiac syncope, prolongation of sinus node recovery time, cardiac dilation, left ventricular failure, myocardial infarction, intermittent nodal rhythm (no P wave), prolonged P wave, shortened PR segment, R on T phenomenon, shortened RT duration, widening and flattening of QRS complex, prolonged QT interval, flattening of T wave, repolarization abnormalities, altered ST-T waves, retrograde conduction, transient AV dissociation, increased blood pressure, decreased blood pressure, labile blood pressure, weak or impalpable peripheral pulses.

Eye: Mydriasis, blurred vision, pupils poorly reactive to light, photophobia, decreased contrast sensitivity, decreased visual acuity, decreased accommodation, cycloplegia, strabismus, heterophoria, cyclophoria, acute angle closure glaucoma, conjunctivitis, keratoconjunctivitis sicca, blindness, tearing, dry eyes/dry conjunctiva, irritated eyes, crusting of eyelid, blepharitis.

Gastrointestinal: Nausea, abdominal pain, paralytic ileus, decreased bowel sounds, distended abdomen, vomiting, delayed gastric emptying, decreased food absorption, dysphagia.

General:Hyperpyrexia, lethargy, somnolence, chest pain, excessive thirst, weakness, syncope, insomnia, tongue chewing, dehydration, feeling hot, injection site reaction.

Immunologic: Anaphylactic reaction.

Special Investigations: Leukocytosis, hyponatremia, elevated BUN, elevated hemoglobin, elevated erythrocytes, low hemoglobin, hypoglycemia, hyperglycemia, hypokalemia, increase in photic stimulation on EEG, signs of drowsiness on EEG, runs of alpha waves on EEG, alpha waves (EEG) blocked upon opening eyes.

Metabolic: Failure to feed.

Central Nervous System: Ataxia, hallucinations (visual or aural), seizures (generally tonic clonic), abnormal movements, coma, confusion, stupor, dizziness, amnesia, headache, diminished tendon reflexes, hyperreflexia, muscle twitching, opisthotnos, Babinski's reflex/Chaddock's reflex, hypertonia, dysmetria, muscle clonus, sensation of intoxication, difficulty concentrating, vertigo, dysarthria.

Psychiatric: Agitation, restlessness, delirium, paranoia, anxiety, mental disorders, mania, withdrawn behavior, behavior changes.

Genitourinary: Difficulty in micturation, urine urgency distended urinary bladder, urine retention, bed-wetting.

Pulmonary: Tachypnea, slow respirations, shallow respirations, breathing difficulty, labored respirations, inspiratory stridor, laryngitis, laryngospasm, pulmonary edema, respiratory failure, subcostal recession.

Dermatologic: Dry mucous membranes, dry warm skin, flushed skin, oral lesions, dermatitis, petechiae rash, macular rash papular rash, maculopapular rash, scarlatiniform rash, erythematous rash, sweating/moist skin, cold skin, cyanosed skin, salivation.

Drug Abuse And Dependence

Atropine (Redotex NF) possesses no known potential for dependence.

In large doses giddiness, headache, nausea, vomiting, sweating, dryness of the mouth and thirst, tachycardia, precordial pain, palpitation, difficulty in micturition, muscular weakness and tremors, anxiety, restlessness and insomnia may occur.

Some patients may exhibit these symptoms with the therapeutic dose. These agents may produce psychotic reactions, agitation and excitability. They should be used with caution in patients with history of psychiatric illness. Prolonged administration has no cumulative effect but tolerance with dependence has been reported.

Use with caution in patients receiving chloroform, cyclopropane, halothane or other halogenated anaesthetics.

this medicine may diminish the effects of guanethidine and may increase the possibility of arrythmias in digitalised patients. this medicine should be taken with caution by patients with organic heart disease, cardiac decompensation or angina of effort in patients receiving digitalis.

The effects of this medicine may be diminished or enhanced by tricyclic anti-depressants.

In patients with prostatic enlargement, it may increase difficulty with micturition.

The preparation should not be taken late in the afternoon because of its stimulant effect on the central nervous system.

These agents are liable to be abused. They should be used with extreme caution in patients with a history of drug or alcohol abuse and in patients with personality disorders. There is a lack of evidence for efficacy in the long-term management of obesity.

Systolic and diastolic blood pressure may be increased, especially with high doses and anginal pain or cardiac arrhythmia’s may occur.

These agents should be administered cautiously to patients suffering from cardiovascular disease (especially coronary insufficiency), hypertension, thyrotoxicosis and narrow angle glaucoma.