Amiodarone for irregular heartbeats

Amiodarone is used to treat heart arrhythmias. An arrhythmia is an irregularity in your heartbeat which causes your heart to miss a beat, beat irregularly or beat at the wrong speed. Amiodarone is particularly helpful when other medicines used for the treatment of arrhythmias are unsuitable for some reason.

Amiodarone works by correcting the rhythm of your heart and by slowing your heart if it is beating too fast. It will be prescribed for you by a heart specialist doctor.

Before taking amiodarone
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking amiodarone it is important that your doctor knows:

If you have any heart problems other than your abnormal heart rhythm. In particular, you should let your doctor know if you have been diagnosed with heart failure.
If you have problems with your thyroid gland.
If you know you have low amounts of potassium in your blood.
If you have a rare inherited blood disorder called porphyria.
If you are pregnant or breastfeeding.
If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
If you have ever had an allergic reaction to a medicine. It is particularly important that you tell your doctor if you know you are allergic to iodine.
How to take amiodarone
Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about amiodarone and will provide you with a full list of the side-effects which you may experience from taking it.
Your doctor will tell you what the right dose of amiodarone is for you, and this dose will be printed on the label of the pack of tablets to remind you about what the doctor said to you. It is usual to take 200 mg three times a day for the first week, then 200 mg twice a day for the second week. Your dose may then be reduced to 200 mg each day from the third week. It is very important that you take amiodarone exactly as your doctor tells you to. If you are not sure what dose to take, ask your doctor or pharmacist for advice.
Try to take your doses of amiodarone at the same times each day, as this will help you to remember to take them regularly. You can take amiodarone either before or after meals.
If you forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.
Getting the most from your treatment
Try to keep your regular appointments with your doctor. This is so your doctor can check your heart rhythm and monitor your progress. Your doctor will also want to do some blood tests while you are on amiodarone to check your liver and thyroid function.
Your doctor is likely to recommend that you have an eyesight test each year. This is because you may develop deposits in your eyes. This is not likely to affect your vision, but if you are a driver you may find that you are dazzled by headlights if you drive at night.
Taking amiodarone is likely to cause your skin to become more sensitive to sunlight than normal. Whenever you go outside on bright days (even if it is cloudy, or if it is only for a relatively short period of time), use a sunscreen that has a high sun protection factor and also protects your skin against UVA light. Do not use sunbeds.
Do not drink grapefruit juice while you are on amiodarone. This is because a chemical in grapefruit juice can increase the amount of amiodarone in your bloodstream. This makes side-effects more likely.
Treatment with amiodarone is usually long-term unless you experience an adverse effect. You should continue to take it unless you are advised otherwise by your doctor.
If you are having an operation or any medical/dental treatment, remember to tell the person carrying out the treatment that you are taking amiodarone. It can interfere with some anaesthetics and increase the risk of side-effects.
If you buy any medicines 'over the counter', always check with a pharmacist that they are suitable for you to take alongside your other medicines. Many medicines can interfere with the way amiodarone works.
Can amiodarone cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with amiodarone. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common amiodarone side-effects (these affect more than 1 in 10 people) What can I do if I experience this?
Being dazzled by bright lights, blurred vision If this happens, do not drive and do not use tools or machines
Feeling sick (nausea) or being sick (vomiting) Eat simple meals - avoid rich or spicy food. Taking your doses after you have eaten some food may help
Common amiodarone side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
Changes in the way things taste, shakiness, nightmares, difficulties sleeping, blue/grey marks on areas of your skin exposed to the sun If any of these become troublesome, speak with your doctor
ECG changes, changes to thyroid or liver function tests Your doctor will monitor for these
Important: there have been some reports of amiodarone causing damage to the liver (hepatotoxicity) and damage to the lungs (pneumonitis). The symptoms of liver damage are yellowing of the skin or the whites of the eyes, and feeling very tired or sick. The symptoms of lung damage are a persistent cough and breathlessness. If you experience any of these symptoms, you should contact your doctor for advice straightaway.

If you experience any other symptoms which you think may be due to amiodarone, speak with your doctor or pharmacist for further advice.

How to store amiodarone
Keep all medicines out of the reach and sight of children.
Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

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Manufacturer's PIL, Cordarone® X 100 mg & 200 mg Tablets; Zentiva, The electronic medicines Compendium. Dated September 2016.

British National Formulary, 75th Edition (Mar 2018); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

Amiloride tablets and liquid medicine

Amiloride belongs to the group of medicines known as potassium-sparing diuretics. A diuretic is a medicine which increases the amount of urine that you pass out from your kidneys. They are often referred to as 'water' tablets. Amiloride is called a potassium-sparing diuretic because, unlike some other diuretics, it does not cause your body to lose potassium. It is used to treat high blood pressure (hypertension) and also water retention (oedema).

Oedema occurs when fluid leaks out of your blood vessels, causing swelling in the tissues of your lungs, feet or ankles. This makes you feel breathless and your legs feel puffy. It is commonly caused by heart failure or liver disease. Amiloride prevents the build-up of this fluid by increasing the amount of urine your kidneys produce.

Amiloride can be prescribed as a treatment on its own, or alongside other diuretics. When it is used with other diuretics, it can be prescribed as a combination tablet to help cut down on the number of tablets you need to take each day. Combination tablets include co-amilozide (amiloride with hydrochlorothiazide) and co-amilofruse (amiloride with furosemide).

Before taking amiloride
Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking amiloride it is important that your doctor knows:

If you are pregnant or breastfeeding.
If you have any problems with the way your kidneys work, or if you have any difficulties passing urine.
If you have diabetes.
If you have been told by a doctor that you have high levels of potassium in your blood.
If you have a problem with your adrenal glands, called Addison's disease.
If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
If you have ever had an allergic reaction to a medicine.
How to take amiloride
Before you start the treatment, read the manufacturer's printed information leaflet from inside your pack. It will give you more information about amiloride and will also provide you with a full list of side-effects which you could experience from taking it.
Take amiloride exactly as your doctor tells you to. Your doctor will ask you to take one dose, or possibly two doses, a day. The directions for taking your doses will be printed on the label of the pack to remind you about what the doctor said to you.
Amiloride is best taken in the morning. This is because you will find you may need to go to the toilet a couple of times after taking it and this will disturb your sleep if you take it too late in the day. If you have been prescribed more than one dose a day, make sure you take your last dose no later than 6 pm.
You can take amiloride either before or after meals.
If you forget to take a dose of amiloride, take it when you remember unless it is late in the day. If it is after 6 pm in the evening, leave out the missed dose completely and take your next dose when it is due on the following day. Do not take two doses at the same time to make up for a missed dose.
Getting the most from your treatment
Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. The balance of salts in your blood may be upset by amiloride so your doctor may want you to have a blood test from time to time to check for this.
Diuretics help you to lose water, so you can breathe and move more easily. If, however, you lose too much fluid, you may become lacking in fluid in the body (dehydrated). This will make you feel thirsty and make your skin look and feel dry. Let your doctor know if this happens, as your dose may need to be adjusted.
Because amiloride is a potassium-conserving diuretic, you should try to avoid things with a high potassium content, such as 'salt substitutes'. This is so the level of potassium in your body does not become too high.
Treatment with diuretics is usually long-term, so continue to take amiloride unless your doctor advises you otherwise.
If you buy any medicines 'over the counter', please check with a pharmacist that they are suitable for you to take alongside your prescribed medicines.
If you are also taking hydrochlorothiazide in combination with this medicine

Studies have suggested that taking higher doses of hydrochlorothiazide for long periods of time may increase the risk of certain skin cancers.
Tell your doctor if you have ever been treated for skin cancer before.
Tell your doctor about any new or changed moles or worrying marks on your skin.
Use a sunscreen in strong sunlight. Do not use sunbeds.
Can amiloride cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the ones associated with amiloride. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Amiloride side-effects What can I do if I experience this?
Stomach upset, stomach ache Stick to simple meals - avoid rich or spicy foods
Dry mouth Try chewing sugar-free gum or sucking sugar-free sweets
Feeling dizzy or faint especially when getting up Getting up more slowly should help. If you begin to feel dizzy, lie down so that you do not faint, then sit for a few minutes before you stand
Muscle cramps, aches or pains, eyesight problems, a ringing in your ears (tinnitus), headache, skin rash, and feeling tired If any of these become troublesome, tell your doctor
Changes to the results of some blood tests Your doctor may check for these from time to time
If you experience any other symptoms which you think may be due to the medicine, please speak with your doctor or pharmacist for further advice.

How to store amiloride
Keep all medicines out of the reach and sight of children.
Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you are due to have an operation or any dental treatment, please tell the person carrying out the treatment which medicines you are taking.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

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Manufacturer's PIL, Amiloride 5 mg Tablets; Wockhardt UK Ltd, The electronic Medicines Compendium. Dated July 2015.

Manufacturer's PIL, Amiloride Rosemont 5 mg/5 ml Oral Solution; Rosemont Pharmaceuticals Limited. The electronic Medicines Compendium. Dated December 2016.

British National Formulary, 76th Edition (Sep 2018); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

Ambrisentan for pulmonary hypertension

Ambrisentan is prescribed to treat pulmonary arterial hypertension (PAH). This is a condition where there is too high a blood pressure in the blood vessels that supply the lungs from the heart.

Ambrisentan relaxes the muscle cells in the walls of the blood vessels to your lungs, allowing them to become wider (dilated). This reduces the pressure in these blood vessels and allows blood to flow more easily through them. In turn, this increases the supply of blood to your lungs and improves your ability to do physical activities. It will be prescribed for you by a doctor who is a specialist.

Before taking ambrisentan
Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking ambrisentan it is important that your doctor knows:

If you are or could become pregnant, or if you are breast-feeding.
If you have any problems with the way your liver works, or if you have any problems with the way your kidneys work.
If you have been told you have a reduced number of red blood cells (anaemia).
If you have been told you have a condition called idiopathic pulmonary fibrosis (IPF), where there is scarring in your lungs.
If you have ever had an allergic reaction to a medicine.
If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
How to take ambrisentan tablets
Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about ambrisentan, and it will also provide you with a full list of the side-effects which you could experience from taking it.
Take ambrisentan exactly as your doctor tells you to. The usual dose is one 5 mg tablet daily, although your doctor may increase the strength of your tablets to 10 mg if a higher dose is needed. Unless your doctor tells you otherwise, you can generally take your dose at a time of day that suits you. You should, however, try to take each of your doses at a similar time of day, each day.
Swallow the tablets whole with a drink of water - do not break or chew the tablets. You can take ambrisentan tablets either with or without food.
If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, leave out the forgotten dose from the previous day and take the dose that is due as normal. Do not take two doses at the same time to make up for a missed dose.
Getting the most from your treatment
Try to keep all your regular appointments with your doctor. This is so your doctor can check on your progress. You will need to have regular blood tests while on ambrisentan to check that you do not develop anaemia. Your doctor will also want to check that your liver stays healthy. Signs that your liver may not be working properly are feeling sick, a high temperature, dark urine, jaundice, stomach pain, feeling unusually tired, and flu-like symptoms - let your doctor know straightaway if you develop any of these.
You must avoid getting pregnant while you are taking ambrisentan because it could cause harm to an unborn baby. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner.
It is possible that ambrisentan taken long-term reduces fertility in men by lowering the sperm count. Discuss this with your doctor if you have any concerns about it.
If you are due to have an operation or some other medical treatment, it is important that you tell the person carrying out the treatment that you are taking ambrisentan.
If you buy any medicines 'over the counter', always check with a pharmacist that they are suitable for you to take with ambrisentan.
Can ambrisentan tablets cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the more common ones associated with ambrisentan. The best place to find a full list of the side-effects which can be associated with your medicine, is from the manufacturer's printed information leaflet supplied with the medicine. Alternatively, you can find an example of a manufacturer's information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common ambrisentan side-effects (these affect more than 1 in 10 people)
What can I do if I experience this?
Headache Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headache continues, speak with your doctor
Swollen feet or ankles If this becomes troublesome, speak with your doctor
Common ambrisentan side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
Feeling dizzy, tired or weak Do not drive and do not use tools or machines while affected
Flushing, sinus infections, nosebleeds, feeling short of breath, a stuffy or runny nose, the sensation of having a 'thumping heart' (palpitations), chest pain If any of these become troublesome, speak with your doctor
Feeling sick or being sick (vomiting), stomach ache, diarrhoea Eat simple meals - avoid fatty or spicy food. Drink plenty of water to replace lost fluids
Constipation Eat a healthy balanced diet and drink plenty of water
Changes to some blood tests Your doctor will regularly check for these
If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

How to store ambrisentan
Keep all medicines out of the reach and sight of children.
Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

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Manufacturer's PIL, Volibris®; GlaxoSmithKline UK, The electronic Medicines Compendium. Dated November 2015.

British National Formulary; 72nd Edition (Sep 2016) British Medical Association and Royal Pharmaceutical Society of Great Britain, London

Adrenaline (epinephrine) for anaphylaxis (Emerade, EpiPen, Jext)

An extreme form of an allergic reaction can cause swelling of your mouth and tongue, breathing problems, flushing, collapse and a loss of consciousness. This type of allergic reaction is called anaphylaxis, and it is a medical emergency. Adrenaline is used as a treatment for anaphylaxis. People who have had a severe allergic or anaphylactic reaction in the past are advised to carry an auto-injection device containing adrenaline with them at all times. The injection device is often referred to as an adrenaline pen. It is a pre-filled syringe which is fitted with a needle so that adrenaline can be injected straightway. This means that in the event of a severe reaction occurring again, adrenaline can be self-injected, or injected by a family member or a health worker.

Triggers such as peanuts, shellfish, and insect bites or stings can cause these severe allergic reactions in some people. Sometimes there is no known cause. An anaphylactic reaction can start very suddenly. Typical early symptoms are breathing difficulties, an itchy skin rash, and swelling of the mouth and throat. If the reaction is not treated straightaway, it can lead to a large fall in blood pressure and to unconsciousness.

Adrenaline is a naturally occurring chemical which is produced by our bodies in response to stress. An injection of adrenaline helps to relieve the symptoms of anaphylaxis by causing blood vessels to narrow, and opening up airways. This stops the blood pressure from dropping and makes breathing easier. It provides time to allow emergency services to arrive.

European Medicines Agency Review 2017
Clinical pharmacist's note 26/08/17 Michael Stewart: Following a review of adrenaline auto-injectors by the European Medicines Agency and subsequent updated advice from the Medicines and Healthcare Products Regulatory Agency (MHRA), I have reviewed and updated the advice given in this leaflet to ensure it is in line with current best practice. The updated MHRA advice is available here.
Before using an adrenaline pen
You should tell your doctor about any medical condition that you have. It is especially important that your doctor knows if you have heart disease, high blood pressure, an overactive thyroid, a circulation problem, increased pressure in your eye (glaucoma), diabetes, or kidney or prostate problems. You should also tell your doctor about any medicines you take.
Your doctor or nurse will explain to you how to use the device. If you are not sure about anything, ask for this to be explained to you again.
Read the manufacturer's printed information leaflet from inside your pack very carefully. The leaflet will give you more information about the specific brand of pen you have been given, and full instructions on how to use it. Some manufacturers may have instructional videos on their websites.
Make sure you (and any close family or friends) know how to use the device so that, if you have to use it in an emergency, you can do it easily. It should be possible for you to practise with a dummy injection device. These are available from the manufacturers free of charge.
Each time you collect a prescription, check to make sure it is the same brand of pen that you have had before. If it is for a child, make sure it is the same strength also.
Carry two pens with you at all times and make sure you know how to use it quickly. Your device will be labelled so that someone else can follow the instructions in case you are unable to use it yourself. Make sure these directions remain clear.
How to use an adrenaline pen
If you need to use the device, inject it into the muscle on your outer thigh. It can be done through light clothing if necessary. It is normal for some liquid to be left in the device after it has been used - don't be concerned that you have not received your full dose. Each device is designed to be used only once.
For some people, one dose of adrenaline may not be enough to control a severe reaction. Always carry two adrenaline pens so that you can give a second dose 5-15 minutes after the first if needed.
After using the injection:
Call 999, ask for an ambulance and state 'anaphylaxis'.
While you are waiting for the ambulance to arrive, lie down with your legs raised and have someone stay with you if at all possible.
If you are having breathing difficulties you may need to sit upright.
If you do not start to feel better, use the second injection 5-15 minutes after the first one.
Take the used device(s) with you in the packaging provided.
How to use Emerade®
Remove the cap protecting the needle.
Hold Emerade® against the outer side of your thigh and press it against your leg. You will hear a click when the adrenaline is injected.
Keep holding the pen against your leg for about 5 seconds. This allows the full dose of adrenaline to be injected.
Massage the area for 10 seconds. This helps the adrenaline to work more quickly.
Make sure you tell the paramedics that you have used an adrenaline pen.
How to use EpiPen®
Pull off the blue safety release cap at the end.
Hold the pen firmly and swing your arm from about 10 cm (4 inches) away, pushing the orange tip against your outer thigh.
The adrenaline will be released automatically into your thigh muscle.
Hold the pen in place for 10 seconds.
As soon as you release pressure, a protective cover will extend over the needle tip.
Massage the area for 10 seconds.
Make sure you tell the paramedics that you have used an adrenaline pen.
How to use Jext®
Grasp the pen in your writing hand, with your thumb closest to the yellow cap.
Pull off the yellow cap.
Push the black tip firmly against your outer thigh. You will hear a click which means the injection has started.
Hold the injector in place against your thigh for 10 seconds, then remove it.
The needle shield will automatically cover the needle when you remove the pen.
Massage the area for 10 seconds.
Make sure you tell the paramedics that you have used an adrenaline pen.
Getting the most from your treatment
If you know what triggers your allergy, be careful to avoid it. You can do this by checking the ingredients in new foods, or by being especially careful outdoors when there are insects around - whichever is appropriate for you.
If the pen has been prescribed for your child, explain to them what they need to do, and what triggers they need to avoid. Discuss it with their teacher so that they can act quickly in an emergency. It is a good idea for their teachers to know how and when to use the pen.
Make sure you check from time to time to make sure that the adrenaline is in date and the solution is clear and colourless. Some manufacturers run a reminder scheme to let you know when you need to order a new device.
It might be a good idea to purchase a MedicAlert® bracelet or necklace (or similar). Any medically trained person, including paramedics, checks to see if a collapsed patient is wearing such an item.
If you are due to have an operation or dental treatment, tell the person carrying out the treatment about your allergy.
If you accidentally inject adrenaline into yourself (and especially if it is into your hands or feet), you should go to the nearest hospital casualty department straightaway for treatment.
Can adrenaline cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. Your doctor will discuss with you the possibility of side-effects occurring. These include sweating, feeling sick (nausea), feeling faint or dizzy, irregular heartbeats, feeling short of breath, and feeling shaky or weak.

How to store adrenaline pens
Store in a cool, dry place, away from direct heat and light.
Make a note of the expiry date of each pen and make sure you replace it with a new one before this date.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have received an overdose of this medicine, go to the accident and emergency department of your local hospital at once. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you buy any medicines, check with a pharmacist that they are safe to take with your other medicines.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Did you find this information useful?
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PIL Emerade® adrenaline auto-injector; Bausch & Lomb U.K Limited, the electronic Medicines Compendium. Dated September 2016.

Manufacturer's PIL, EpiPen® Adrenaline (Epinephrine) Auto-Injector 0.3 mg; Meda Pharmaceuticals, The electronic Medicines Compendium. Dated February 2016.

Manufacturer's PIL, Jext® 150 and 300 micrograms Solution for Injection in pre-filled pen; ALK-Abello Ltd, The electronic Medicines Compendium. Dated September 2016.

British National Formulary 73rd Edition (Mar 2017); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

Acipimox capsules

Lipids, or fats, are made naturally in your body from the food you eat. They are easily stored in your body and serve as a source of energy. Cholesterol and triglycerides are types of lipid. If the concentration of these lipids in your blood becomes too high, it leads to a condition called hyperlipidaemia. Although a high blood concentration of lipids will not make you feel ill, it can cause a problem if it is left untreated.

People with high lipid levels can develop small fatty patches called atheroma. These patches develop when excess fat is deposited on to the walls of blood vessels. Over time, these patches can make a blood vessel narrower and this is called atherosclerosis (sometimes referred to as 'hardening of the arteries'). The narrowing reduces the blood flow through the artery and increases the risk of a number of heart and blood vessel diseases, such as heart attack and stroke.

Some people are able to control high lipid levels by following a healthy diet and taking regular exercise. Medicines like acipimox are prescribed when additional help is needed. Acipimox lowers the levels of lipids in your blood. It does this by preventing the release of fats from the tissues in your body which act as storage areas. It is usually given alongside other medicines to lower lipid levels.

Before taking acipimox
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking acipimox it is important that your doctor knows:

If you are pregnant or breastfeeding.
If you have any problems with the way your kidneys work.
If you have a stomach ulcer.
If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
If you have ever had an allergic reaction to a medicine.
How to take acipimox
Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about acipimox and will provide you with a full list of the side-effects which you could experience from taking it.
Take the capsules exactly as your doctor tells you to. It is usual to take one 250 mg capsule either two or three times a day. Your doctor will tell you which is the right dose for you, and the dose will also be printed on the label of the pack to remind you about what the doctor said.
Take the capsule with a snack, or just after eating a meal. It is a good idea to swallow the capsule with a drink of water.
Try to take your doses at the same times of day each day, as this will help you to remember to take the capsules regularly. If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two capsules at the same time to make up for a forgotten dose.
Getting the most from your treatment
Try to keep your regular appointments with your doctor. This is so that your doctor can check on your progress. You will need to have some blood tests from time to time. These are to measure your lipid levels and also to check that your liver and kidneys are working well.
Your doctor will give you advice about eating a healthy diet, cutting down on the amount of alcohol you normally drink, reducing the amount of salt in your diet, stopping smoking, and taking regular exercise. Following this advice will help you to reduce your risk of developing heart and blood vessel disease, and is an important part of managing your condition.
Treatment with acipimox is usually long-term unless you experience an adverse effect. You should continue to take it regularly.
Can acipimox cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common side-effects associated with acipimox. You will find a full list in the manufacturer's information leaflet supplied with your medicine. Unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common acipimox side-effects (these affect more than 1 in 10 people)
What can I do if I experience this?
Headache This is more likely in the first few days of treatment. Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, let your doctor know
Facial flushing This is more likely in the first few days of treatment and should settle as your body gets used to acipimox
Indigestion Try to stick to simple meals (avoid rich or spicy foods), and remember to take the capsules after food.
Common acipimox side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
Itchy skin reactions, feeling weak, stomach pain If any of these become troublesome, speak with your doctor
If you experience any other symptoms which you think may be due to the capsules, speak with your doctor or pharmacist for further advice.

How to store acipimox
Keep all medicines out of the reach and sight of children.
Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you buy any medicines, check with a pharmacist that they are safe to take with your other medicines.

If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

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Manufacturer's PIL, Olbetam® Capsules 250 mg; Pfizer Limited, The electronic Medicines Compendium. Dated June 2017.

British National Formulary, 76th Edition (Sep 2018); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

Acenocoumarol - an anticoagulant

Acenocoumarol is an anticoagulant medicine, which means that it increases the time it takes for your blood to clot. It works by reducing the effects of vitamin K, which is a vitamin your body uses to make blood-clotting factors.

Acenocoumarol is prescribed to prevent unwanted clots from forming if you have a condition that puts you at risk of this happening, such as atrial fibrillation, or if you have had a heart valve replacement. It is also given to prevent any clots that may have already formed in the blood vessels of your legs, lungs or heart from becoming larger and causing problems. Another anticoagulant, called warfarin, is usually prescribed in preference to acenocoumarol. However, if warfarin is not suitable for you, you may be prescribed acenocoumarol instead.

Before taking acenocoumarol
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking acenocoumarol it is important that your doctor knows:

If you are pregnant, trying for a baby or breastfeeding.
If you have any cuts or wounds.
If you have a condition that increases your risk of bleeding, such as a stomach ulcer, or if you have had surgery recently, or if you have recently had a stroke.
If you have any problems with the way your liver works, or with the way your kidneys work.
If you have high blood pressure.
If you have been told you have an infection of your heart, called bacterial endocarditis.
If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
If you have ever had an allergic reaction to a medicine.
How to take acenocoumarol
Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack of tablets and any additional information you have been given by your doctor. These will give you more information about acenocoumarol and will provide you with a full list of the side-effects which you may experience from taking it.
Take acenocoumarol once a day, exactly as you have been advised by your doctor or anticoagulant clinic. You should aim to take acenocoumarol at the same time each day. This will help keep the levels of the medicine in your blood steady and will also help you to avoid missing any doses. Your doctor will tell you how many tablets to take for each dose. Swallow the tablet(s) whole with a drink of water.
If you forget to take a dose at your usual time, take it as soon as you remember if it is still the same day. If you do not remember until the following day, do not take the missed dose but do remember to take the dose that is due on that day. Remember to let your doctor know about any missed doses when you next have your blood test.
Continue to take acenocoumarol tablets regularly until your doctor tells you to stop. A course of treatment typically lasts from six weeks to three months, although some people may be advised to continue taking the tablets long-term.
Getting the most from your treatment
You will be given a yellow 'Oral Anticoagulant Therapy' booklet; please read this carefully as it gives you important information such as when you should contact a doctor for advice. You will also be given an 'Anticoagulant Alert Card' which you should carry with you at all times. In case of an emergency, a doctor will need to know that you are taking acenocoumarol.
You will need to have regular blood tests to check on how quickly your blood clots. Blood tests may be needed quite often at first but should reduce in frequency quite quickly. The extent to which acenocoumarol is working is measured by the International Normalised Ratio (INR), which is a measure of the ability of your blood to prevent clotting. The amount of acenocoumarol that you need to take will depend upon the result of these blood tests and this is why your dose may change from time to time. The aim is to get the dose of acenocoumarol just right so your blood does not clot as easily as normal but not so much as to cause bleeding problems.
Changing your diet suddenly can affect your INR, especially if you begin to eat more vegetables and salad than before. You should not begin a weight-reducing diet without discussing it with your doctor first. A major change in diet will mean that you need closer monitoring as your dose may need to be adjusted.
Only drink alcohol in small amounts, as this can affect the levels of the medicine in your body. Limit the amount of alcohol that you drink to a maximum of one or two units in any day and never binge drink.
Drinking cranberry juice can interfere with acenocoumarol and affect your INR, so it is best if you avoid cranberry juice and other cranberry products altogether.
If you buy any medicines, check with a pharmacist that they are safe to take with acenocoumarol. For example, you should not take some painkillers (such as aspirin and other anti-inflammatory painkillers) and some vitamin and herbal preparations. If you need to take a painkiller, you may take paracetamol but you should let your doctor know if you need to take it regularly.
Because acenocoumarol is used to prevent blood clots from forming, you should try to avoid activities that could cause you to cut or bruise yourself, such as contact sports. Let your doctor know if you have any falls or injuries.
You should avoid getting pregnant while you are taking acenocoumarol as it may cause harm to an unborn baby. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner.
If you are due to have any injections, or any medical or dental treatment, please tell the person carrying out the treatment that you are taking an anticoagulant and show them your treatment booklet. It is important that they know you may take longer to stop bleeding. If you are due to have surgery, you may be advised to stop taking acenocoumarol for a few days and be given injections instead.
Can acenocoumarol cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the side-effects associated with acenocoumarol - the most common ones are bleeding and bruising. You will find a full list in the manufacturer's information leaflet supplied with your medicine. Speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common acenocoumarol side-effects What can I do if I experience this?
Unusual bleeding or bruising, blood in your urine or stools See your doctor straightaway - your dose will probably need to be reduced
Rare acenocoumarol side-effects (these affect less than 1 in 10,000 people) What can I do if I experience this?
Feeling sick (nausea) or being sick (vomiting), loss of appetite Let your doctor know if this continues
Loss of hair If this becomes troublesome, speak with your doctor
Skin rash See your doctor straightaway - this could be a sign of an allergic reaction to acenocoumarol
If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

How to store acenocoumarol
Keep all medicines out of the reach and sight of children.
Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

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Manufacturer's PIL, Sinthrome® Tablets 1 mg; Merus Labs Luxco S.a.R.L., The electronic Medicines Compendium. Dated October 2015.

British National Formulary, 75th Edition (Mar 2018); British Medical Association and Royal Pharmaceutical Society of Great Britain, London

Acebutolol - a beta-blocker

Acebutolol belongs to the group of medicines known as beta-blockers. It works on the heart and blood vessels.

Acebutolol slows down the activity of your heart by stopping messages sent by some nerves to your heart. It does this by blocking tiny areas (called beta-adrenergic receptors) where the messages are received by your heart. As a result, your heart beats more slowly and with less force. This allows the pressure of blood within your blood vessels to be reduced if you have high blood pressure (hypertension), and helps to prevent abnormally fast and uneven heartbeats if you have a heart rhythm disorder (arrhythmia). Because your heart is using less energy, it helps to reduce chest pain if you have angina.

Before taking acebutolol
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking acebutolol it is important that your doctor knows:

If you are pregnant, trying for a baby or breastfeeding.
If you have any problems with the way your kidneys work.
If you have asthma or any other breathing disorder.
If you have diabetes.
If you have been told you have a slow heartbeat or a slow and irregular heartbeat (heart block).
If you have been told you have chest pain caused by spasms of your heart's blood vessels, a condition called Prinzmetal's angina.
If you have low blood pressure, heart failure, or poor circulation.
If you have a skin problem called psoriasis.
If you have a condition causing muscle weakness, called myasthenia gravis.
If you have a tumour on your adrenal gland, called phaeochromocytoma.
If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
If you have ever had an allergic reaction to a medicine, or if you have ever had any other serious allergic reaction.
How to take acebutolol
Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about acebutolol and will provide you with a full list of the side-effects which you may experience from taking it.
Your doctor will tell you what dose is right for you, and this information will be printed on the label of the pack to remind you. Take acebutolol exactly as your doctor tells you to. You may be asked to take a dose once, twice or three times a day.
Swallow the tablet/capsule with a drink of water. Acebutolol will work the same whether you take your doses before or after food; however, taking your doses after a meal will help to reduce the risk of stomach upset. Try to take your doses of acebutolol at the same times each day. This will help you to remember to take them regularly.
Acebutolol is available in several different strengths. When starting your treatment your doctor may give you a small dose at first and then gradually increase it. Each time you collect a fresh supply, it's a good idea to check the strength on the packet to make sure they are what you are expecting.
If you forget to take a dose, take it as soon as you remember. If when you remember, it is nearly time for your next dose then take your next dose when it is due but leave out the missed dose. Do not take two doses together to make up for a forgotten dose.
Getting the most from your treatment
Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
Treatment with acebutolol can often be long-term. Continue to take the tablets/capsules unless your doctor tells you to stop. Stopping treatment suddenly can cause problems in some people, so your doctor may want you to reduce your dose gradually if this becomes necessary.
If you are due to have an operation or dental treatment, it is important to tell the person carrying out the treatment that you are taking a beta-blocker. This is because some anaesthetics may increase the risk of unwanted effects.
If you drink alcohol, ask your doctor for advice. Alcohol will add to the blood pressure-lowering effect of acebutolol and so may not be advisable for you.
If you have diabetes, acebutolol can mask the symptoms of low blood sugar. Your doctor will advise you about this.
If you buy any medicines, check with a pharmacist that they are suitable for you to take. Some medicines (including some painkillers, cold and flu remedies) may not be.
Your doctor may give you dietary and lifestyle advice about eating a healthy diet, not smoking, and taking regular exercise. If so, it is important that you follow the advice you are given.
Can acebutolol cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with acebutolol. You will find a full list in the manufacturer's information leaflet supplied with your tablets/capsules. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common acebutolol side-effects (these affect around 1 in 10 people) What can I do if I experience this?
Feeling tired or dizzy, blurred vision Do not drive and do not use tools or machines until you feel more awake or able to see clearly
Feeling sick (nausea) or being sick (vomiting), diarrhoea Stick to simple meals - avoid rich and spicy foods. If you are not already doing so, try taking your doses after meals
Headache Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, let your doctor know
Cold hands or feet, feeling short of breath, disturbed sleep, mood changes, nightmares, skin rash If any of these become troublesome, speak with your doctor
Changes to your immune system Let your doctor know if you feel unwell or experience any unusual aches or pains
If you experience any other symptoms which you think may be due to acebutolol, speak with your doctor or pharmacist for further advice.

How to store acebutolol
Keep all medicines out of the reach and sight of children.
Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Did you find this information useful?
yes
no

Manufacturer's PIL, Sectral® 100 mg and 200 mg capsules; Sanofi, The electronic Medicines Compendium. Dated August 2014.

Manufacturer's PIL, Sectral® 400 mg Tablets; Sanofi, The electronic Medicines Compendium. Dated August 2014.

British National Formulary 74th Edition (Sep 2017); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.