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Dapoxetine online india ubicacion - chronic Stable Angina (Classical Effort-Associated Angina): PROCARDIA is indicated fc the management of chronic stable angina (effort-associated angina) without evidence ol vasospasr n patients who remain symptomatic despite adequate doses of beta blockers and or organic nitrate or who cannot tolerate those agents In chronic stable angina (effort-associated angina) PROCARDIA has been effective in controlle trials of up to eight weeks duration in reducing angina frequency and increasing exercise tolerance but confirmation ot sustained effectiveness and evaluation of long-term safety in those patients ar Controlled studies in small numbers ot patients suggest concomitant use ot PROCARDIA an beta blocking agents may be beneficial in patients with chronic stable angina but available infor mation is not sufficient to predict with confidence the effects ot concurrent treatment especially patients with compromised left ventricular function or cardiac conduction abnormalities When ir troducmg such concomitant therapy care must be taken to monitor blood pressure closely sine severe hypotension can occur from the combined effects of the drugs (See Warnings I CONTRAINDICATIONS: Known hypersensitivity reaction to PROCARDIA WARNINGS: Excessive Hypotension: Although in most patients the hypotensive effect c PROCARDIA is modest and well tolerated occasional patients have had excessive and poorly to erated hypotension These responses have usually occurred during initial titration or at the time r subsequent upward dosage adjustment and may be more likely in patients on concomitant bet Severe hypotension and or increased fluid volume requirements have been reported in patientreceiving PROCARDIA together with a beta blocking agent who underwent coronary artery bypas surgery using high dose fentanyl anesthesia The interaction with high dose tentanyl appears to b due to the combination ot PROCARDIA and a beta blocker but the possibility that it may occur wit PROCARDIA alone with low doses ot fentanyl in other surgical procedures or with other narcof analgesics cannot be ruled out In PROCARDIA treated patients where surgery using high dos fentanyl anesthesia is contemplated the physician should be aware ot these potential problemsant PROCARDIA to be washed out ot the body prior to surgery Increased Angina: Occasional patients have developed well documented increased frequency, di ration or severity of angina on starting PROCARDIA or at the time ot dosage increases The meet amsm ot this response is not established but could result from decreased coronary perfusio associated with decreased diastolic pressure with increased heart rate, or from increased deman resulting from increased heart rate alone Beta Blocker Withdrawal: Patients recently withdrawn from beta blockers may develop a wilt drawal syndrome with increased angina probably related to increased sensitivity to catecho amines Initiation of PROCARDIA treatment will not prevent this occurrence and might be expecte to exacerbate it by provoking reflex catecholamine release There have been occasional reports! increased angina in a selling of beta blocker withdrawal and PROCARDIA initiation It is importar to taper beta blockers if possible rather than stopping them abruptly before beginnin Congestive Heart Failure: Rarely patients, usually receiving a beta blocker have developed heai PRECAUTIONS: General: Hypotension: Because PROCARDIA decreases peripheral vascul; resistance careful monitoring of blood pressure during the initial administration and titratio ol PROCARDIA is suggested Close observation is especially recommended tor patients alreao taking medications that are known to lower blood pressure (See Warnings ) Peripheral edema: Mild to moderate peripheral edema, typically associated with arterial vast dilation and not due to left ventricular dysfunction, occurs in about one in ten patients treated wit PROCARDIA This edema occurs primarily in the lower extremities and usually responds to diuret therapy With patients whose angina is complicated by congestive heart failure care should betake Drug interactions: Beta-adrenergic blocking agents (See Indications and Warnings I Experienc ot PROCARDIA and beta-blocking agents is usually well tolerated but there have been occasion, literature reports suggesting that the combination may increase the likelihood of congestive bea failure, severe hypotension or exacerbation of angina Long-acting nitrates PROCARDIA may be safely co administered with nitrates but there hav been no controlled studies to evaluate the antianginal effectiveness ot this combination Digitalis Administration of PROCARDIA with digoxm increased digoxm levels in nine of twelv goxm levels in thirteen patients with coronary artery disease In an uncontrolled study ol over tw hundred patients with congestive heart failure during which digoxm blood levels were not mea: ured digitalis toxicity was not observed Since there have been isolated reports of patients wil elevated digoxm levels, it is recommended that digoxm levels be monitored when initiating adius mg, and discontinuing PROCARDIA to avoid possible over or under-digitalization Carcinogenesis, mutagenesis, impairment of fertility When given to rats prior to mating nifi Pregnancy Category C Please see full prescribing information with reference to teratogenicity rats embryotoxicity in rats, mice and rabbits and abnormalities in monkeys ADVERSE REACTIONS: The most common adverse events include dizziness or light-headednes' Syncopal episodes did not recur with reduction in the dose of PROCARDIA or concomitant antia, gmal medication Additionally the following have been reported muscle cramps nervousnes dyspnea, nasal and chest congestion, diarrhea constipation inflammation toint stiffness shak ness sleep disturbances, blurred vision, difficulties in balance dermatitis pruritus urticaria t ver, sweating, chills, and sexual difficulties Very rarely, introduction of PROCARDIA therapy w: associated with an increase in anginal pain, possibly due to associated hypotension In addition more serious adverse events were observed, not readily distinguishable from the n; ural history, of the disease in these patients It remains possible however, that some or many Laboratory Tests: Rare mild to moderate transient elevations of enzymes such as alkaline pho: phatase, CPK LDH SGOT. 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