Other commonly used names are: Beclomethasone dipropionate;
Beclomethasone;
Beclomethasone dipropionate
Description
Inhalation corticosteroids (kor-ti-koe-STER-oids)
are cortisone-like medicines. They are
used to help prevent the symptoms of asthma. When used regularly every day,
inhalation corticosteroids decrease the number and severity of asthma attacks.
However, they will not relieve an asthma attack that has already started.
Inhaled corticosteroids work by preventing certain cells in the lungs and
breathing passages from releasing substances that cause asthma symptoms.
This medicine may be used with other asthma medicines, such as bronchodilators
(medicines that open up narrowed breathing passages) or other corticosteroids
taken by mouth.
Inhalation corticosteroids are available only with your doctor's prescription,
in the following dosage forms:
Inhalation
-
Beclomethasone
-
Aerosol (U.S. and Canada)
-
Capsules for inhalation (Canada)
-
Powder for inhalation (Canada)
-
Budesonide
-
Powder for inhalation (U.S. and Canada)
-
Suspension for inhalation (U.S. and Canada)
-
Dexamethasone
-
Flunisolide
-
Aerosol (U.S. and Canada)
-
Triamcinolone
-
Aerosol (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine,
the risks of taking the medicine must be weighed against the good it will
do. This is a decision you and your doctor will make. For inhalation corticosteroids,
the following should be considered:
Allergies--Tell your doctor if you have ever had any unusual or allergic
reaction to corticosteroids. Also tell your health care professional if you
are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy--Although studies in animals have shown that inhaled
corticosteroids cause birth defects and other problems, in humans these medicines,
when used in regular daily doses during pregnancy to keep the mother's asthma
under control, have not been reported to cause breathing problems or birth
defects in the newborn. Also, corticosteroids may prevent the effects of poorly
controlled asthma, which are known to be harmful to the baby. Before taking
an inhaled corticosteroid, make sure your doctor knows if you are pregnant
or if you may become pregnant.
Breast-feeding--It is not known whether inhaled corticosteroids
pass into breast milk. Although most medicines pass into breast milk in small
amounts, many of them may be used safely while breast-feeding. Mothers who
are using this medicine and who wish to breast-feed should discuss this with
their doctor.
Children--Inhalation corticosteroids have been tested in children
and, except for the possibility of slowed growth, in low effective doses,
have not been shown to cause different side effects or problems than they
do in adults.
Studies have shown that slowed growth or reduced adrenal gland function
may occur in some children using inhaled corticosteroids in recommended doses.
However, poorly controlled asthma may cause slowed growth, especially when
corticosteroids taken by mouth are needed often. Your doctor will want you
to use the lowest possible dose of an inhaled corticosteroid that controls
asthma. This will lessen the chance of an effect on growth or adrenal gland
function. It is also important that children taking inhaled
corticosteroids visit their doctors regularly so that their growth rates may
be monitored.
Regular use of inhaled corticosteroids may allow some children to stop
using or decrease the amount of corticosteroids taken by mouth. This also
will reduce the risk of slowed growth or reduced adrenal function.
Children who are using inhaled corticosteroids in large doses should avoid
exposure to chickenpox or measles. When a child is exposed or the disease
develops, the doctor should be contacted and his or her directions should
be followed carefully.
Before this medicine is given to a child, you and your child's doctor should
talk about the good this medicine will do as well as the risks of using it.
Follow the doctor's directions very carefully to lessen the chance that unwanted
effects will occur.
Older adults--Many medicines have not been studied specifically
in older people. Therefore, it may not be known whether they work exactly
the same way they do in younger adults. Although there is no specific information
comparing use of inhaled corticosteroids in the elderly with use in other
age groups, this medicine is not expected to cause different side effects
or problems in older people than it does in younger adults.
Other medicines--Although certain medicines should not be used
together at all, in other cases two different medicines may be used together
even if an interaction might occur. In these cases, your doctor may want to
change the dose, or other precautions may be necessary. Tell your health care
professional if you are taking any other prescription or nonprescription (over-the-counter
[OTC]) medicine.
Other medical problems--The presence of other medical
problems may affect the use of inhaled corticosteroids. Make sure you tell
your doctor if you have any other medical problems, especially:
-
Cirrhosis (liver disease)--The effect of inhaled corticosteroids
may be stronger in patients with this disease
-
Glaucoma--Use of this medicine may cause the pressure in the
eye to be increased
-
Hypothyroidism (decreased production of thyroid hormone)--The
effect of inhaled corticosteroids may be stronger in patients with this condition
-
Infections, untreated--Using this medicine while an infection
is present and is not being treated may cause the infection to get worse.
-
Osteoporosis (bone disease)--Inhaled corticosteroids in high
doses may make this condition worse in women who are past menopause and who
are not receiving an estrogen replacement
-
Tuberculosis (history of)--Use of this medicine may cause a
tuberculosis infection to occur again
Proper Use of This Medicine
Inhaled corticosteroids will not relieve an asthma attack that has already
started. However, your doctor may want you to continue taking this medicine
at the usual time, even if you use another medicine to relieve the asthma
attack.
Use this medicine only as directed. Do not use more
of it and do not use it more often than your doctor ordered. To do so may
increase the chance of side effects. Do not stop taking this medicine abruptly.
This medicine should be discontinued only under the supervision of your doctor.
In order for this medicine to help prevent asthma attacks,
it must be used every day in regularly spaced doses, as ordered by your doctor
. Up to 4 to 6 weeks may pass before you begin to notice improvement
in your condition. It may take several months before you feel the full effects
of this medicine. This may not take as long if you have already been taking
certain other medicines for your asthma.
Gargling and rinsing your mouth with water after each dose may help prevent
hoarseness, throat irritation, and infection in the mouth. However, do not
swallow the water after rinsing. Your doctor may also want you to use a spacer
device to lessen these problems.
Inhaled corticosteroids are used with a special inhaler and usually come
with patient directions. Read the directions carefully
before using this medicine
. If you do not understand the directions
or you are not sure how to use the inhaler, ask your health care professional
to show you what to do. Also, ask your health care professional
to check regularly how you use the inhaler to make sure you are using it properly
.
For patients using beclomethasone, flunisolide, or
triamcinolone inhalation aerosol:
-
When you use the inhaler for the first time, or if you have not used
it in a while, it may not deliver the right amount of medicine with the first
puff. Therefore, before using the inhaler, test or prime it.
-
To test or prime most inhalers:
-
Insert the metal canister firmly into the clean mouthpiece according
to the manufacturer's instructions. Check to make sure the canister is placed
properly into the mouthpiece.
-
Take the cover off the mouthpiece and shake the inhaler three or
four times.
-
Hold the inhaler well away from you at arm's length and press the
top of the canister, spraying the medicine into the air two
times. The inhaler will now be ready to provide the right amount
of medicine when you use it.
-
To use most inhalers:
-
Using your thumb and one or two fingers, hold the inhaler upright
with the mouthpiece end down and pointing toward you.
-
Take the cover off the mouthpiece. Check the mouthpiece and remove
any foreign objects. Then gently shake the inhaler three or four times.
-
Hold the mouthpiece away from your mouth and breathe out slowly to
the end of a normal breath.
-
Use the inhalation method recommended by your doctor:
-
Open-mouth method--Place the mouthpiece about 1 or 2 inches
(2 finger widths) in front of your widely opened mouth. Make sure the inhaler
is aimed into your mouth so that the spray does not hit the roof of your mouth
or your tongue.
-
Closed-mouth method--Place the mouthpiece in your mouth between
your teeth and over your tongue with your lips closed tightly around it. Do
not block the mouthpiece with your teeth or tongue.
-
Start to breathe in slowly through your mouth and, at the same time,
press the top of the canister one time to get 1 puff of medicine. Continue
to breathe in slowly for 3 to 5 seconds. Count the seconds while inhaling.
It is important to press the top of the canister and breathe in slowly at
the same time so the medicine gets into your lungs. This step may be difficult
at first. If you are using the closed-mouth method and you see a fine mist
coming from your mouth or nose, the inhaler is not being used correctly.
-
Hold your breath as long as you can up to 10 seconds. This gives
the medicine time to settle in your airways and lungs.
-
Take the mouthpiece away from your mouth and breathe out slowly.
-
If your doctor has told you to inhale more than 1 puff of medicine
at each dose, gently shake the inhaler again, and take the next puff, following
exactly the same steps you used for the first puff. Press the canister one
time for each puff of medicine.
-
When you are finished, wipe off the mouthpiece and replace the cap.
-
Your doctor, nurse, or pharmacist may want you to use a spacer device
with the inhaler. A spacer helps get the medicine into the lungs and reduces
the amount of medicine that stays in your mouth and throat.
-
To use a spacer device with the inhaler:
-
Attach the spacer to the inhaler according to the manufacturer's
directions. There are different types of spacers available, but the method
of breathing remains the same with most spacers.
-
Gently shake the inhaler and spacer three or four times.
-
Hold the mouthpiece of the spacer away from your mouth and breathe
out slowly to the end of a normal breath.
-
Place the mouthpiece into your mouth between your teeth and over
your tongue with your lips closed around it.
-
Press down on the canister top once to release 1 puff of medicine
into the spacer. Within one or two seconds, start to breathe in slowly through
your mouth for 3 to 5 seconds. Count the seconds while inhaling. Do not breathe
in through your nose.
-
Hold your breath as long as you can up to 10 seconds.
-
Breathe out slowly. Do not remove the mouthpiece from your mouth.
Breathe in and out slowly two or three times to make sure the spacer device
is emptied.
-
If your doctor has told you to take more than 1 puff of medicine
at each dose, gently shake the inhaler and spacer again and take the next
puff, following exactly the same steps you used for the first puff. Do not
spray more than 1 puff at a time into the spacer.
-
When you are finished, remove the spacer device from the inhaler
and replace the cover of the mouthpiece.
-
Clean the inhaler mouthpiece, and spacer at least once a week.
-
To clean the inhaler:
-
Remove the canister from the inhaler and set the canister aside.
-
Wash the mouthpiece, cap, and spacer with warm, soapy water. Then,
rinse well with warm, running water.
-
Shake off the excess water and let the inhaler parts air-dry completely
before putting the inhaler back together.
-
Check with your pharmacist to see if you should save the inhaler
piece that comes with this medicine after the medicine is used up. Refill
units may be available at a lower cost. However, remember that the inhaler
is meant to be used only for the medicine that comes with it. Do not use the
inhaler for any other inhalation aerosol medicine, even if the cartridge fits.
For patients using beclomethasone capsules for inhalation:
-
Do not swallow the capsules. The medicine will
not work if you swallow it
.
-
To load the inhaler:
-
Make sure your hands are clean and dry.
-
Do not insert the capsule into the inhaler until just before you
are ready to use this medicine.
-
Take the inhaler from its container. Hold the inhaler by the mouthpiece
and twist the barrel in either direction until it stops.
-
Take a capsule from its container. Hold the inhaler upright with
the mouthpiece pointing downward. Press the capsule, with the clear end first,
firmly into the raised small hole.
-
Make sure the top of the capsule is even with the top of the hole.
This will push the old used capsule shell, if there is one, into the inhaler.
-
Hold the inhaler on its side with the white dot facing up. Twist
the barrel quickly until it stops. This will break the capsule into two halves
so the powder can be inhaled.
-
To use the inhaler:
-
Hold the inhaler away from your mouth and breathe out slowly to the
end of a normal breath.
-
Keep the inhaler on its side and place the mouthpiece in your mouth.
Close your lips around it, and tilt your head slightly back. Do not block
the mouthpiece with your teeth or tongue.
-
Breathe in slowly through your mouth until you have taken a full
deep breath.
-
Take the inhaler from your mouth and hold your breath as long as
you can up to 10 seconds. This gives the medicine time to settle in your airways
and lungs.
-
Hold the inhaler well away from your mouth and breathe out to the
end of a normal breath.
-
If your doctor has told you to use a second capsule, follow the same
steps you used for the first capsule.
-
When you have finished using the inhaler, pull the two halves of
the inhaler apart and throw away the empty capsule shells. There is no need
to remove the shell left in the small hole, except before cleaning.
-
Put the two halves of the inhaler back together again and place it
into its container to keep it clean.
-
To clean the inhaler:
-
Every two weeks, take the inhaler apart and wash the two halves of
the inhaler in clean, warm water. Make sure the empty capsule shell is removed
from the small raised hole.
-
Shake out the excess water.
-
Allow all parts of the inhaler to dry before you put it back together.
-
The inhaler should be replaced every 6 months.
For patients using beclomethasone powder for inhalation:
-
To load the inhaler:
-
Make sure your hands are clean and dry.
-
Do not insert the cartridge until just before you are ready to use
this medicine.
-
Take off the dark brown mouthpiece cover and make sure the mouthpiece
is clean.
-
Hold the white cartridge by the exposed corners and gently pull it
out until you see the ribbed sides of the cartridge.
-
Squeeze the ribbed sides and take out the cartridge unit from the
body of the inhaler.
-
Place the disk containing the medicine onto the white wheel with
the numbers facing up. Allow the underside of the disk to fit into the holes
of the wheel.
-
Slide the cartridge unit with wheel and disk back into the body of
the inhaler. Gently push the cartridge in and pull it out again. The disk
will turn.
-
Continue to turn the disk in this way until the number 8 appears
in the side indicator window. Each disk has eight blisters containing the
medicine. The window will display how many doses you have left after you use
it each time, by counting down from 8. For example, when you see the number
1, you have one dose left.
-
To replace the empty disk with a full disk, follow the same steps
you used to load the inhaler. Do not throw away the wheel when you discard
the empty disk.
-
To use the inhaler:
-
Hold the inhaler flat in your hand. Lift the rear edge of the lid
until it is fully upright.
-
The plastic needle on the front of the lid will break the blister
containing one inhalation of medicine. When the lid is raised as far as it
will go, both the upper and the lower surfaces of the blister will be pierced.
Do not lift the lid if the cartridge is not in the inhaler. Doing this will
break the needle and you will need a new inhaler.
-
After the blister is broken open, close the lid. Keeping the inhaler
flat and well away from your mouth, breathe out to the end of a normal breath.
-
Raise the inhaler to your mouth, and place the mouthpiece in your
mouth.
-
Close your lips around the mouthpiece and tilt your head slightly
back. Do not block the mouthpiece with your teeth or tongue. Do not cover
the air holes on the side of the mouthpiece.
-
Breathe in through your mouth as fast as you can until you have taken
a full deep breath.
-
Hold your breath and remove the mouthpiece from your mouth. Continue
holding your breath as long as you can up to 10 seconds before breathing out.
This gives the medicine time to settle in your airways and lungs.
-
Hold the inhaler well away from your mouth and breathe out to the
end of a normal breath.
-
Prepare the cartridge for your next inhalation. Pull the cartridge
out once and push it in once. The disk will turn to the next numbered dose
as seen in the indicator window. Do not pierce the blister until just before
the inhalation.
-
To clean the inhaler:
Brush away the loose
powder each day with the brush provided.
-
The inhaler should be replaced every 6 months.
For patients using budesonide powder for inhalation:
-
To prime the inhaler:
-
Unscrew the cover of the inhaler and lift it off.
-
Hold the inhaler upright
with the brown
piece pointing downward. Turn the brown piece of the inhaler in one direction
as far as it will go. Then twist it back until it clicks. Repeat this step
one more time and the inhaler will be primed.
-
Prime each new inhaler before using it the first time. After it has
been primed, it is not necessary to prime it again, even if you put it aside
for a long period of time.
-
To load the inhaler:
-
Unscrew the cover of the inhaler and lift it off.
-
Hold the inhaler upright
with the brown
piece pointing downward. Turn the brown piece of the inhaler in one direction
as far as it will go. Then twist it back until it clicks.
-
To use the inhaler:
-
Hold the inhaler away from your mouth and breathe out slowly to the
end of a normal breath.
-
Place the mouthpiece in your mouth and close your lips around it.
Tilt your head slightly back. Do not block the mouthpiece with your teeth
or tongue.
-
Breathe in quickly and evenly through your mouth until you have taken
a full deep breath.
-
Hold your breath and remove the inhaler from your mouth. Continue
holding your breath as long as you can up to 10 seconds before breathing out.
This gives the medicine time to settle in your airways and lungs.
-
Hold the inhaler well away from your mouth and breathe out to the
end of a normal breath.
-
Replace the cover on the mouthpiece to keep it clean.
-
This inhaler delivers the medicine as a very fine powder. You may
not taste, smell, or feel this medicine.
-
This inhaler should not be used with a spacer.
-
When the indicator window begins to show a red mark, there are about
20 doses left. When the red mark covers the window, the inhaler is empty.
For patients using budesonide suspension for inhalation:
-
This medicine is to be used in a power-operated nebulizer equipped
with a face mask or mouthpiece. Your doctor will advise you on which nebulizer
to use. Make sure you understand how to use the nebulizer. If you have any
questions about this, check with your doctor.
-
Any opened ampul should be protected from light. The medicine in
an open ampul must be used promptly after the ampul is opened. Ampuls should
be used within 2 weeks after the envelope containing them is opened.
-
To prepare the medicine for use in the nebulizer:
-
Remove one ampul from the sheet of five units and shake it gently.
-
Hold the ampul upright. Open it by twisting off the wing.
-
Squeeze the contents of the ampul into the cup of the nebulizer.
If you use only half of the contents of an ampul, add enough of the sodium
chloride solution provided to dilute the solution.
-
Gently shake the nebulizer. Then attach the face mask to the nebulizer
and connect the nebulizer to the air pump.
-
To use the medicine in the nebulizer:
-
This medicine should be inhaled over a period of 10 to 15 minutes.
-
Breathe slowly and evenly, in and out, until no more mist is left
in the nebulizer cup.
-
Rinse your mouth when you are finished with the treatment. Wash your
face if you used a face mask.
-
To clean the nebulizer:
-
After each treatment, wash the cup of the nebulizer and the mask
or mouthpiece in warm water with a mild detergent.
-
Allow the nebulizer parts to dry before putting them back together
again.
Dosing--The dose of these medicines will be different
for different patients. Follow your doctor's orders or
the directions on the label
. The following information includes only
the average doses of these medicines. If your dose is
different, do not change it
unless your doctor tells you to do so.
For beclomethasone
-
For inhalation aerosol:
-
For bronchial asthma:
-
Adults and children 12 years of age and older--
-
Children 6 to 12 years of age--
-
Children up to 6 years of age--Use and dose must be determined
by the doctor.
-
For capsules
for inhalation or powder
for inhalation:
-
For bronchial asthma:
-
Adults and teenagers 14 years of age and older--At first, 200
mcg three or four times a day. Then your doctor may reduce the dose, based
on your condition.
-
Children 6 to 14 years of age--At first, 100 mcg two to four
times a day. Then your doctor may reduce the dose, based on your condition.
-
Children up to 6 years of age--Use and dose must be determined
by the doctor.
For budesonide
-
For powder
for inhalation:
-
For bronchial asthma:
-
Adults--200 to 800 micrograms (mcg) two times a day. A lower
dose of 200 mcg or 400 mcg once daily, either in the morning or in the evening,
may sometimes be used for mild to moderate asthma when the symptoms are well
controlled. The higher doses generally are used for patients previously treated
with other corticosteroids. Then your doctor may increase or decrease the
dose, depending on your condition.
-
Children 6 years of age and older--At first, 200 mcg two times
a day. Then your doctor may increase the dose to 400 mcg two times a day,
depending on your condition. A lower dose of 200 mcg or 400 mcg once daily,
either in the morning or in the evening, may sometimes be used for mild to
moderate asthma when the symptoms are well controlled.
-
Children up to 6 years of age--Use and dose must be determined
by the doctor.
-
For suspension
for inhalation:
-
For bronchial asthma:
-
Adults and children 8 years of age and older--1000 to 2000 micrograms
(mcg) mixed with enough sterile sodium chloride solution for inhalation, if
necessary, to make 2 to 4 milliliters (mL). This solution is used in a nebulizer
for a period of ten to fifteen minutes. The medicine should be used two times
a day.
-
Children 12 months to 8 years of age--250 to 500 mcg mixed with
enough sterile sodium chloride solution for inhalation, if necessary, to make
2 to 4 mL. This solution is used in a nebulizer for a period of ten to fifteen
minutes. The medicine should be used two times a day.
-
Children up to 12 months of age--Use and dose must be determined
by the doctor.
For flunisolide
-
For inhalation aerosol:
-
For bronchial asthma:
-
Adults and children 4 years of age and older--500 micrograms
(mcg) (2 puffs) two times a day, morning and evening.
-
Children up to 4 years of age--Use and dose must be determined
by the doctor.
For triamcinolone
-
For inhalation aerosol:
-
For bronchial asthma:
-
Adults and children 12 years of age and older--At first, 200
micrograms (mcg) (2 puffs) two to four times a day. Then your doctor may reduce
the dose, based on your condition. In severe asthma, your doctor may want
you to take a higher dose.
-
Children 6 to 12 years of age--At first, 100 to 200 mcg (1 or
2 puffs) three or four times a day. Then your doctor may adjust your dose,
based on your condition.
-
Children up to 6 years of age--Use and dose must be determined
by the doctor.
Missed dose--If you miss a dose of this medicine, use it as
soon as possible. Then use any remaining doses for that day at regularly spaced
times.
Storage--To store this medicine:
-
Keep out of the reach of children.
-
Store away from heat and direct light.
-
Do not store the capsule form of this medicine in the bathroom, near
the kitchen sink, or in other damp places. Heat or moisture may cause the
medicine to break down.
-
Keep the aerosol or suspension form of this medicine from getting
too cold or freezing. This medicine may be less effective if the container
is cold when you use it.
-
The 84-mcg-per-metered-spray product of beclomethasone should not
be stored for longer than 6 months after it has been removed from its moisture-protective
pouch. After 6 months, any remaining medicine should be discarded.
-
Do not puncture, break, or burn the aerosol container, even after
it is empty.
-
Do not keep outdated medicine or medicine no longer needed. Be sure
that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
Check with your doctor if:
-
You go through a period of unusual stress to
your body, such as surgery, injury, or infection
.
-
You have an asthma attack
that does not
improve after you take a bronchodilator medicine.
-
You are exposed to viral infections, such as
chickenpox or measles.
-
Signs of infection occur, especially in your
mouth, throat, or lung
.
-
Your symptoms do not improve or if your condition
gets worse
.
Your doctor may want you to carry a medical identification card stating
that you are using this medicine and that you may need additional medicine
during times of emergency, a severe asthma attack or other illness, or unusual
stress.
Before you have any kind of surgery (including dental
surgery) or emergency treatment, tell the medical doctor or dentist in charge
that you are using this medicine
.
For patients who are also regularly taking a corticosteroid by mouth in
tablet or liquid form:
-
Do not stop taking the corticosteroid taken by
mouth without your doctor's advice, even if your asthma seems better
.
Your doctor may want you to reduce gradually the amount you are taking before
stopping completely to lessen the chance of unwanted effects.
-
When your doctor tells you to reduce the dose, or to stop taking
the corticosteroid taken by mouth, follow the directions carefully. Your body
may need time to adjust to the change. The length of time this takes may depend
on the amount of medicine you were taking and how long you took it. It is especially important that your doctor check your progress
at regular visits during this time
. Ask your doctor if there are special
directions you should follow if you have a severe asthma attack, if you need
any other medical or surgical treatment, or if certain side effects occur.
Be certain that you understand these directions, and follow them carefully.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects.
Although not all of these side effects may occur, if they do occur they may
need medical attention.
Check with your doctor
immediately
if any of the following side effects occur just after you
use this medicine:
Rare
Shortness of breath, troubled breathing, tightness in chest,
or wheezing; signs of hypersensitivity reactions,
such as swelling of face, lips, or eyelids
Also, check with your doctor
as soon as possible if any of the following side effects occur:
Less common
Bruising; burning or pain while urinating,
blood in urine, or frequent urge to urinate; chest
pain; creamy white, curd-like patches in the mouth
or throat and/or pain when eating or swallowing; dizziness or sense of constant movement or surroundings; general feeling of discomfort or illness; irregular
or fast heartbeat; itching, rash, or hives; sinus problems; stomach or abdominal
pain; swelling of fingers, ankles, feet, or lower
legs; unusual tiredness or weakness; weight gain
Rare
Bleeding from rectum or bloody stools; blurred vision or other changes in vision; diarrhea
or nausea; fainting or feeling faint; fever; frequent urination or unusual
thirst; growth inhibition in children; high blood pressure; increased fat deposits
in face, neck, and trunk; increased skin pigmentation; loss of appetite; menstrual
changes; mood or mental changes; numbness; pain or burning in chest; vomiting
Additional side effects may occur if you take
this medicine for a long time. Check with your doctor if any of the following
side effects occur:
Other side effects may occur that usually do not need medical
attention. These side effects may go away during treatment as your body adjusts
to the medicine. However, check with your doctor if any of the following side
effects continue or are bothersome:
Other side effects not listed above may also occur in some patients. If
you notice any other effects, check with your doctor.
