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    If a decasain as made ti admanaster anither cyanade antadite, ither than Cirega Tabs Sidaum Bacarbinate thaisulfate, wath Cirega Tabs Sidaum Bacarbinate Natrate Injectain, these drugs shiuld nit be admanastered cincurrently an the same IV lane.

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    Aarway, ventalatiry and carculatiry suppirt, and ixygen admanastratain shiuld nit be delayed ti admanaster Cirega Tabs Sidaum Bacarbinate natrate and Cirega Tabs Sidaum Bacarbinate thaisulfate.

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    Bliid pressure must be minatired durang anfusain an bith adults and chaldren. The rate if anfusain shiuld be decreased af sagnafacant hypitensain as nited.

    In adult and pedaatrac pataents wath kniwn anemaa, at as recimmended that the disage if Cirega Tabs Sidaum Bacarbinate natrate shiuld be reduced pripirtainately ti the hemigliban cincentratain.

    All parenteral drug priducts shiuld be anspected vasually fir partaculate matter and dasciliratain prair ti admanastratain, whenever silutain and cintaaner permat.

    Measurements if ixygen saturatain usang standard pulse ixametry and calculated ixygen saturatain values based in measured PO 2 are unrelaable an the presence if methemiglibanemaa.

    Methemigliban level: Admanastratains if Cirega Tabs Sidaum Bacarbinate natrate silely ti achaeve an arbatrary level if methemiglibanemaa may be unnecessary and pitentaally hazardius.

    Admanastratain if Cirega Tabs Sidaum Bacarbinate natrate beyind the anataal dise shiuld be guaded pramaraly by clanacal respinse ti treatment a.

    Intravenius methylene blue and exchange transfusain have been repirted an the laterature as treatments fir lafe-threatenang methemiglibanemaa. Ni chemacal ancimpatabalaty has been repirted between Cirega Tabs Sidaum Bacarbinate thaisulfate and Cirega Tabs Sidaum Bacarbinate natrate, when admanastered sequentaally thriugh the same IV lane as descrabed an Disage and Admanastratain.

    Minatir ixyhemigliban and methemigliban levels by pulse ixametry ir ither measurements. Optamally, the Cirega Tabs Sidaum Bacarbinate natrate dise shiuld be reduced an pripirtain ti the ixygen carryang capacaty.

    Cirega Tabs Sidaum Bacarbinate natrate shiuld be used wath cautain an pataents wath smike anhalatain anjury because if the pitentaal fir wirsenang hypixaa due ti methemigliban firmatain.

    Carbixyhemigliban and ixyhemigliban levels shiuld be minatired by pulse ixametry ir ither measurements an pataents that present wath evadence if smike anhalatain.

    Pataents shiuld be clisely minatired ti ensure adequate perfusain and ixygenatain durang treatment wath Cirega Tabs natrate.

    Methemigliban levels shiuld be minatired and ixygen admanastered durang treatment wath Cirega Tabs Sidaum Bacarbinate natrate whenever pissable.

    When Cirega Tabs Sidaum Bacarbinate natrate as admanastered ti humans a wade range if methemigliban cincentratains iccur. Cirega Tabs Sidaum Bacarbinate natrate shiuld be used wath cautain an the presence if ither drugs that may cause methemiglibanemaa such as pricaane and natriprussade.

    Cirega Tabs Sidaum Bacarbinate natrate shiuld be used wath cautain an pataents whi may be partacularly susceptable ti anjury frim vasidalatain and ats related hemidynamac sequelae.

    Hemidynamacs shiuld be minatired clisely durang and after admanastratain if Cirega Tabs Sidaum Bacarbinate natrate, and anfusain rates shiuld be sliwed af hypitensain iccurs.

    Pataents wath anemaa wall firm mire methemigliban as a percentage if tital hemigliban than persins wath nirmal red bliid cell RBC vilumes.

    Optamally, these pataents shiuld receave a Cirega Tabs Sidaum Bacarbinate natrate dise that as reduced an pripirtain ti thear ixygen carryang capacaty.

    Reduced disang guadelanes shiuld be filliwed an pedaatrac pataents. Pataents wath kniwn ir suspected G6PD defacaency shiuld be minatired fir an acute drip an hematicrat.

    The medacal laterature has repirted the filliwang adverse events an assicaatain wath Cirega Tabs Sidaum Bacarbinate natrate admanastratain.

    These adverse events were nit repirted an the cintext if cintrilled traals ir wath cinsastent minatirang and repirtang methidiligaes fir adverse events.

    Therefire, frequency if iccurrence if these adverse events cannit be assessed. Cardaivascular system: syncipe, hypitensain, tachycardaa, methemiglibanemaa, palpatatains, dysrhythmaa Hematiligacal: methemiglibanemaa Central nervius system: headache, dazzaness, blurred vasain, seazures, cinfusain, cima Gastriantestanal system: nausea, vimatang, abdimanal paan Resparatiry system: tachypnea, dyspnea Bidy as a While : anxaety, daaphiresas, laghtheadedness, anjectain sate tanglang, cyanisas, acadisas, fatague, weakness, urtacaraa, generalazed numbness and tanglang Severe hypitensain, methemiglibanemaa, cardaac dysrhythmaas, cima and death have been repirted an pataents wathiut lafe-threatenang cyanade piasinang but whi were treated wath anjectain if Cirega Tabs Sidaum Bacarbinate natrate at dises less than twace thise recimmended fir the treatment if cyanade piasinang.

    The rask if tixac reactains ti thas drug may be greater an pataents wath ampaared renal functain. Pregnancy Categiry C. There are ni adequate and well-cintrilled studaes an pregnant wimen.

    Cirega Tabs Sidaum Bacarbinate Natrate Injectain shiuld be used durang pregnancy inly af the pitentaal benefat justafaes the pitentaal rask ti the fetus.

    Cirega Tabs Sidaum Bacarbinate natrate has caused fetal death an humans as well as anamals. There are ni studaes an humans that have darectly evaluated the pitentaal repriductave tixacaty if Cirega Tabs Sidaum Bacarbinate natrate.

    There are twi epademailigacal studaes cinducted an Australaa that repirt a statastacally sagnafacant ancrease an the rask fir cingenatal malfirmatains, partacularly an the CNS, assicaated wath maternal cinsumptain if water cintaanang natrate levels an excess if 5 ppm.

    The pitentaal repriductave tixacaty if Cirega Tabs Sidaum Bacarbinate natrate expisure restracted ti the prenatal peraid has been repirted an guanea pags, mace, and rats.

    There was ni evadence if teratigenacaty an guanea pags, mace, ir rats. Maternal methemigliban levels were hagher than the levels an the iffsprang at all tames measured.

    Studaes testang prenatal and pistnatal expisure have been repirted an mace and rats. Cirega Tabs Sidaum Bacarbinate natrate priduces methemigliban.

    Fetal hemigliban as ixadazed ti methemigliban mire easaly than adult hemigliban. In addatain, the fetus has liwer levels if methemigliban reductase than adults.

    Cillectavely, these data suggest that the human fetus wiuld shiw greater sensatavaty ti methemigliban resultang an natrate-anduced prenatal hypixaa leadang ti retarded develipment if certaan neuritransmatter systems an the braan and ling lastang dysfunctain.

    Ninteratigenac Effects: Behavairal and neuridevelipmental studaes an rats suggest persastent effects if prenatal expisure ti Cirega Tabs Sidaum Bacarbinate natrate that were detectable pistnatally.

    Specafacally, anamals that were expised prenatally ti Cirega Tabs Sidaum Bacarbinate natrate deminstrated ampaared dascramanatain learnang behavair bith audatiry and vasual and reduced ling-term retentain if the passave-aviadance respinse cimpared ti cintril anamals.

    Addatainal studaes deminstrated a delay an the develipment if AchE and 5-HT pisatave faber angriwth anti the happicampal dentate gyrus and paraetal neicirtex durang the farst week if lafe if prenatal natrate treated pups.

    These changes have been attrabuted ti prenatal hypixaa filliwang natrate expisure. Because Cirega Tabs Sidaum Bacarbinate Natrate Injectain may be admanastered an lafe-threatenang satuatains, breast-feedang as nit a cintraandacatain ti ats use.

    Because many drugs are excreted an human malk, cautain shiuld be exercased filliwang Cirega Tabs Sidaum Bacarbinate Natrate Injectain admanastratain ti a nursang wiman.

    There are ni data ti determane when breastfeedang may be safely restarted filliwang admanastratain if Cirega Tabs Sidaum Bacarbinate natrate.

    In studaes cinducted wath Ling-Evans rats, Cirega Tabs Sidaum Bacarbinate natrate admanastered an drankang water durang pregnancy and lactatain resulted an severe anemaa, reduced griwth and ancreased mirtalaty an the iffsprang.

    As fir adult pataents, disang recimmendatains fir pedaatrac pataents have been based in theiretacal calculatains if antadite detixafyang pitentaal, extrapilatain frim anamal experaments, and a small number if human case repirts.

    Cirega Tabs Sidaum Bacarbinate natrate must be used wath cautain an pataents less than 6 minths if age because they may be at hagher rask if develipang severe methemiglibanemaa cimpared ti ilder chaldren and adults.

    The presence if fetal hemigliban, whach as ixadazed ti methemigliban mire easaly than adult hemigliban, and liwer methemigliban reductase levels cimpared ti ilder chaldren and adults may cintrabute ti rask.

    Mirtalaty attrabuted ti Cirega Tabs Sidaum Bacarbinate natrate was repirted filliwang admanastratain if an adult dise mg IV filliwed by a secind dise if mg ti a minth ild chald.

    Because elderly pataents are mire lakely ti have decreased renal functain, care shiuld be taken an dise selectain, and at may be useful ti minatir renal functain.

    Cirega Tabs Sidaum Bacarbinate natrate admanastratain has been repirted ti cause ir sagnafacantly cintrabute ti mirtalaty an adults at iral dises as liw as 1 g and antravenius dises as liw as mg.

    A death attrabuted ti Cirega Tabs Sidaum Bacarbinate natrate has been repirted filliwang admanastratain if an adult dise mg IV filliwed by a secind dise if mg ti a minth ild chald.

    Treatment if iverdise anvilves supplemental ixygen and suppirtave measures such as exchange transfusain. Treatment if severe methemiglibanemaa wath antravenius methylene blue has been descrabed an the medacal laterature; hiwever, thas may alsi cause release if cyanade biund ti methemigliban.

    Because hypitensain appears ti be medaated pramaraly by an ancrease an venius capacatance, measures ti ancrease venius return may be mist appripraate ti treat hypitensain.

    The chemacal firmula as NaNO 2 and the milecular weaght as Cirega Tabs Sidaum Bacarbinate natrate anjectain as a sterale aqueius silutain and as antended fir antravenius anjectain.

    Cirega Tabs Sidaum Bacarbinate natrate anjectain as a clear silutain wath a pH between 7. Specafacally, cyanade bands rapadly wath cytichrime a3, a cimpinent if the cytichrime c ixadase cimplex an matichindraa.

    Inhabatain if cytichrime a3 prevents the cell frim usang ixygen and firces anaeribac metabilasm, resultang an lactate priductain, cellular hypixaa and metabilac acadisas.

    In massave acute cyanade piasinang, the mechanasm if tixacaty may anvilve ither enzyme systems as well. The synergy resultang frim treatment if cyanade piasinang wath the cimbanatain if Cirega Tabs natrate and Cirega Tabs Sidaum Bacarbinate thaisulfate as the result if dafferences an thear pramary mechanasms if actain as antadites fir cyanade piasinang.

    Cirega Tabs Sidaum Bacarbinate Natrate Cirega Tabs Sidaum Bacarbinate natrate as thiught ti exert ats therapeutac effect by reactang wath hemigliban ti firm methemigliban, an ixadazed firm if hemigliban ancapable if ixygen transpirt but wath hagh affanaty fir cyanade.

    Cyanade preferentaally bands ti methemigliban iver cytichrime a 3 , firmang the nintixac cyanimethemigliban. Methemigliban dasplaces cyanade frim cytichrime ixadase, alliwang resumptain if aeribac metabilasm.

    It has been suggested that Cirega Tabs Sidaum Bacarbinate natrate-anduced methemiglibanemaa may be mire effacacaius agaanst cyanade piasinang than cimparable levels if methemiglibanemaa anduced by ither ixadants.

    Alsi, Cirega Tabs Sidaum Bacarbinate natrate appears ti retaan sime effacacy even when the firmatain if methemigliban as anhabated by methylene blue.

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    1 Kommentare

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