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ReoPro

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ReoPro uses


INDICATIONS AND USAGE:

ReoPro is indicated as an adjunct to percutaneous coronary intervention for the prevention of cardiac ischemic complications


Safety and efficacy of ReoPro use in patients not undergoing percutaneous coronary intervention have not been established.

ReoPro is intended for use with aspirin and heparin and has been studied only in that setting, as described in CLINICAL STUDIES.

CONTRAINDICATIONS:

Because ReoPro may increase the risk of bleeding, ReoPro is contraindicated in the following clinical situations:


ReoPro is also contraindicated in patients with known hypersensitivity to any component of this product or to murine proteins.

WARNINGS:

Bleeding Events

ReoPro has the potential to increase the risk of bleeding events, rarely including those with a fatal outcome, particularly in the presence of anticoagulation, e.g., from heparin, other anticoagulants, or thrombolytics.

The risk of major bleeds due to ReoPro therapy is increased in patients receiving thrombolytics and should be weighed against the anticipated benefits.

Should serious bleeding occur that is not controllable with pressure, the infusion of ReoPro and any concomitant heparin should be stopped.

Allergic Reactions (including anaphylaxis)

Allergic reactions, some of which were anaphylaxis (sometimes fatal), have been reported rarely in patients treated with ReoPro. Patients with allergic reactions should receive appropriate treatment. Treatment of anaphylaxis should include immediate discontinuation of ReoPro administration and initiation of resuscitative measures.

PRECAUTIONS:

Bleeding Precautions- To minimize the risk of bleeding with ReoPro, it is important to use a low-dose, weight-adjusted heparin regimen, a weight-adjusted ReoPro bolus and infusion, strict anticoagulation guidelines, careful vascular access site management, discontinuation of heparin after the procedure and early femoral arterial sheath removal.

Therapy with ReoPro requires careful attention to all potential bleeding sites including catheter insertion sites, arterial and venous puncture sites, cutdown sites, needle puncture sites, and gastrointestinal, genitourinary, pulmonary (alveolar), and retroperitoneal sites.

Arterial and venous punctures, intramuscular injections, and use of urinary catheters, nasotracheal intubation, nasogastric tubes and automatic blood pressure cuffs should be minimized. When obtaining intravenous access, non-compressible sites (e.g., subclavian or jugular veins) should be avoided. Saline or heparin locks should be considered for blood drawing. Vascular puncture sites should be documented and monitored. Gentle care should be provided when removing dressings.

Femoral artery access site: Arterial access site care is important to prevent bleeding. Care should be taken when attempting vascular access that only the anterior wall of the femoral artery is punctured, avoiding a Seldinger (through and through) technique for obtaining sheath access. Femoral vein sheath placement should be avoided unless needed. While the vascular sheath is in place, patients should be maintained on complete bed rest with the head of the bed ≤ 30° and the affected limb restrained in a straight position. Patients may be medicated for back/groin pain as necessary.

Discontinuation of heparin immediately upon completion of the procedure and removal of the arterial sheath within six hours is strongly recommended if APTT ≤ 50 sec or ACT ≤ 175 sec (see PRECAUTIONS: Laboratory Tests ). In all circumstances, heparin should be discontinued at least two hours prior to arterial sheath removal.

Following sheath removal, pressure should be applied to the femoral artery for at least 30 minutes using either manual compression or a mechanical device for hemostasis. A pressure dressing should be applied following hemostasis. The patient should be maintained on bed rest for six to eight hours following sheath removal or discontinuation of ReoPro, or four hours following discontinuation of heparin, whichever is later. The pressure dressing should be removed prior to ambulation. The sheath insertion site and distal pulses of affected leg(s) should be frequently checked while the femoral artery sheath is in place and for six hours after femoral artery sheath removal. Any hematoma should be measured and monitored for enlargement.

The following conditions have been associated with an increased risk of bleeding and may be additive with the effect of ReoPro in the angioplasty setting: PCI within 12 hours of the onset of symptoms for acute myocardial infarction, prolonged PCI (lasting more than 70 minutes) and failed PCI.

Use of Thrombolytics, Anticoagulants and Other Antiplatelet Agents- In the EPIC, EPILOG, CAPTURE, and EPISTENT trials, ReoPro was used concomitantly with heparin and aspirin. For details of the anticoagulation algorithms used in these clinical trials, see CLINICAL STUDIES: Anticoagulation . Because ReoPro inhibits platelet aggregation, caution should be employed when it is used with other drugs that affect hemostasis, including thrombolytics, oral anticoagulants, non-steroidal anti-inflammatory drugs, dipyridamole, and ticlopidine.

In the EPIC trial, there was limited experience with the administration of ReoPro with low molecular weight dextran. Low molecular weight dextran was usually given for the deployment of a coronary stent, for which oral anticoagulants were also given. In the 11 patients who received low molecular weight dextran with ReoPro, five had major bleeding events and four had minor bleeding events. None of the five placebo patients treated with low molecular weight dextran had a major or minor bleeding event (see CONTRAINDICATIONS ).

Because of observed synergistic effects on bleeding, ReoPro therapy should be used judiciously in patients who have received systemic thrombolytic therapy. The GUSTO V trial randomized patients with acute myocardial infarction to treatment with combined ReoPro and half-dose Reteplase, or full-dose Reteplase alone (15). In this trial, the incidence of moderate or severe nonintracranial bleeding was increased in those patients receiving ReoPro and half-dose Reteplase versus those receiving Reteplase alone (4.6% versus 2.3%, respectively).

Thrombocytopenia- Thrombocytopenia, including severe thrombocytopenia, has been observed with ReoPro administration (see ADVERSE REACTIONS: Thrombocytopenia ). Platelet counts should be monitored prior to, during, and after treatment with ReoPro. Acute decreases in platelet count should be differentiated between true thrombocytopenia and pseudothrombocytopenia (see PRECAUTIONS: Laboratory Tests ). If true thrombocytopenia is verified, ReoPro should be immediately discontinued and the condition appropriately monitored and treated.

In clinical trials, patients who developed thrombocytopenia were followed with daily platelet counts until their platelet count returned to normal. Heparin and aspirin were discontinued for platelet counts below 60,000 cells/μL and platelets were transfused for a platelet count below 50,000 cells/μL. Most cases of severe thrombocytopenia (< 50,000 cells/μL) occurred within the first 24 hours of ReoPro administration.

In a registry study of ReoPro readministration, a history of thrombocytopenia associated with prior use of ReoPro was predictive of an increased risk of recurrent thrombocytopenia (see ADVERSE REACTIONS: Thrombocytopenia ). Readministration within 30 days was associated with an increased incidence and severity of thrombocytopenia, as was a positive human anti-chimeric antibody (HACA) test at baseline, compared to the rates seen in studies with first administration.

Restoration of Platelet Function- In the event of serious uncontrolled bleeding or the need for emergency surgery, ReoPro should be discontinued. If platelet function does not return to normal, it may be restored, at least in part, with platelet transfusions.

Laboratory Tests- Before infusion of ReoPro, prothrombin time, ACT, APTT, and platelet count should be measured to identify pre-existing hemostatic abnormalities.

Based on an integrated analysis of data from all studies, the following guidelines may be utilized to minimize the risk for bleeding:

When ReoPro is initiated 18 to 24 hours before PCI, the APTT should be maintained between 60 and 85 seconds during the ReoPro and heparin infusion period.

During PCI the ACT should be maintained between 200 and 300 seconds.

If anticoagulation is continued in these patients following PCI, the APTT should be maintained between 55 and 75 seconds.

The APTT or ACT should be checked prior to arterial sheath removal. The sheath should not be removed unless APTT ≤ 50 seconds or ACT ≤ 175 seconds.

Platelet counts should be monitored prior to treatment, two to four hours following the bolus dose of ReoPro and at 24 hours or prior to discharge, whichever is first. If a patient experiences an acute platelet decrease (e.g., a platelet decrease to less than 100,000 cells/μL and a decrease of at least 25% from pre-treatment value), additional platelet counts should be determined. Platelet monitoring should continue until platelet counts return to normal.

To exclude pseudothrombocytopenia, a laboratory artifact due to in vitro anticoagulant interaction, blood samples should be drawn in three separate tubes containing ethylenediaminetetraacetic acid (EDTA), citrate and heparin, respectively. A low platelet count in EDTA but not in heparin and/or citrate is supportive of a diagnosis of pseudothrombocytopenia.

Readministration- Administration of ReoPro may result in the formation of HACA that could potentially cause allergic or hypersensitivity reactions (including anaphylaxis), thrombocytopenia or diminished benefit upon readministration of ReoPro (see WARNINGS: Allergic Reactions; see ADVERSE REACTIONS: Immunogenicity ).

Readministration of ReoPro to patients undergoing PCI was assessed in a registry that included 1342 treatments in 1286 patients. Most patients were receiving their second ReoPro exposure; 15% were receiving the third or subsequent exposure. The overall rate of HACA positivity prior to the readministration was 6% and increased to 27% post-readministration. There were no reports of serious allergic reactions or anaphylaxis (see WARNINGS: Allergic Reactions ). Thrombocytopenia was observed at higher rates in the readministration study than in the phase 3 studies of first-time administration (see PRECAUTIONS: Thrombocytopenia and Adverse Reactions: Thrombocytopenia ), suggesting that readministration may be associated with an increased incidence and severity of thrombocytopenia.

Drug Interactions- Formal drug interaction studies with ReoPro have not been conducted. ReoPro has been administered to patients with ischemic heart disease treated concomitantly with a broad range of medications used in the treatment of angina, myocardial infarction and hypertension. These medications have included heparin, warfarin, beta-adrenergic receptor blockers, calcium channel antagonists, angiotensin converting enzyme inhibitors, intravenous and oral nitrates, ticlopidine, and aspirin. Heparin, other anticoagulants, thrombolytics, and antiplatelet agents are associated with an increase in bleeding. Patients with HACA titers may have allergic or hypersensitivity reactions when treated with other diagnostic or therapeutic monoclonal antibodies.

Carcinogenesis, Mutagenesis and Impairment of Fertility- In vitro and in vivo mutagenicity studies have not demonstrated any mutagenic effect. Long-term studies in animals have not been performed to evaluate the carcinogenic potential or effects on fertility in male or female animals.

Pregnancy Category C- Animal reproduction studies have not been conducted with ReoPro. It is also not known whether ReoPro can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. ReoPro should be given to a pregnant woman only if clearly needed.

Nursing Mothers- It is not known whether this drug is excreted in human milk or absorbed systemically after ingestion. Because many drugs are excreted in human milk, caution should be exercised when ReoPro is administered to a nursing woman.

Pediatric Use- Safety and effectiveness in pediatric patients have not been studied.

Geriatric Use- Of the total number of 7860 patients in the four Phase 3 trials, 2933 (37%) were 65 and over, while 653 (8%) were 75 and over. No overall differences in safety or efficacy were observed between patients of age 65 to less than 75 as compared to younger patients. The clinical experience is not adequate to determine whether patients of age 75 or greater respond differently than younger patients.

ADVERSE REACTIONS:

Bleeding- ReoPro has the potential to increase the risk of bleeding, particularly in the presence of anticoagulation, e.g., from heparin, other anticoagulants or thrombolytics. Bleeding in the Phase 3 trials was classified as major, minor or insignificant by the criteria of the Thrombolysis in Myocardial Infarction study group. Major bleeding events were defined as either an intracranial hemorrhage or a decrease in hemoglobin greater than 5 g/dL. Minor bleeding events included spontaneous gross hematuria, spontaneous hematemesis, observed blood loss with a hemoglobin decrease of more than 3 g/dL, or a decrease in hemoglobin of at least 4 g/dL without an identified bleeding site. Insignificant bleeding events were defined as a decrease in hemoglobin of less than 3 g/dL or a decrease in hemoglobin between 3-4 g/dL without observed bleeding. In patients who received transfusions, the number of units of blood lost was estimated through an adaptation of the method of Landefeld, et al. (17).

In the EPIC trial, in which a non-weight-adjusted, longer-duration heparin dose regimen was used, the most common complication during ReoPro therapy was bleeding during the first 36 hours. The incidences of major bleeding, minor bleeding and transfusion of blood products were significantly increased. Major bleeding occurred in 10.6% of patients in the ReoPro bolus plus infusion arm compared with 3.3% of patients in the placebo arm. Minor bleeding was seen in 16.8% of ReoPro bolus plus infusion patients and 9.2% of placebo patients (7). Approximately 70% of Abciximab-treated patients with major bleeding had bleeding at the arterial access site in the groin. Abciximab-treated patients also had a higher incidence of major bleeding events from gastrointestinal, genitourinary, retroperitoneal, and other sites.

Bleeding rates were reduced in the CAPTURE trial, and further reduced in the EPILOG and EPISTENT trials by use of modified dosing regimens and specific patient management techniques. In EPILOG and EPISTENT, using the heparin and ReoPro dosing, sheath removal and arterial access site guidelines described under PRECAUTIONS, the incidence of major bleeding in patients treated with ReoPro and low-dose, weight-adjusted heparin was not significantly different from that in patients receiving placebo.

Subgroup analyses in the EPIC and CAPTURE trials showed that non-CABG major bleeding was more common in ReoPro patients weighing ≤ 75 kg. In the EPILOG and EPISTENT trials, which used weight-adjusted heparin dosing, the non-CABG major bleeding rates for Abciximab-treated patients did not differ substantially by weight subgroup.

Although data are limited, ReoPro treatment was not associated with excess major bleeding in patients who underwent CABG surgery. (The range among all treatment arms was 3-5% in EPIC, and 1-2% in the CAPTURE, EPILOG, and EPISTENT trials.) Some patients with prolonged bleeding times received platelet transfusions to correct the bleeding time prior to surgery. (see PRECAUTIONS: Restoration of Platelet Function .)

The rates of major bleeding, minor bleeding and bleeding events requiring transfusions in the CAPTURE, EPILOG, and EPISTENT trials are shown in Table 4. The rates of insignificant bleeding events are not included in Table 4.

Cases of fatal bleeding have been reported rarely during post-marketing use of ReoPro (see WARNINGS: Bleeding Events ).

Pulmonary alveolar hemorrhage has been rarely reported during use of ReoPro. This can present with any or all of the following in close association with ReoPro administration: hypoxemia, alveolar infiltrates on chest x-ray, hemoptysis, or an unexplained drop in hemoglobin.

a Patients who had bleeding in more than one classification are counted only once according to the most severe classification. Patients with multiple bleeding events of the same classification are also counted once within that classification.
b Patients with major non-CABG bleeding who received packed red blood cells or whole blood transfusion.
c Standard-dose heparin with or without stent (EPILOG and EPISTENT)
d Low-dose heparin with or without stent (EPILOG and EPISTENT)
e Standard-dose heparin (EPILOG)
f Standard-dose heparin (CAPTURE)
EPILOG and EPISTENT:

Placeboc

(n=1748)

ReoPro +

Low-dose Heparind

(n=2525)

ReoPro +

Standard-dose Heparine (n=918)

Majora 18 (1.0) 21 (0.8) 17 (1.9)
Minor 46 (2.6) 82 (3.2) 70 (7.6)
Requiring transfusionb 15 (0.9) 13 (0.5) 7 (0.8)

CAPTURE:

Placebof

(n=635)

ReoProf

(n=630)

Majora 12 (1.9) 24 (3.8)
Minor 13 (2.0) 30 (4.8)
Requiring transfusionb 9 (1.4) 15 (2.4)

Intracranial Hemorrhage and Stroke- The total incidence of intracranial hemorrhage and non-hemorrhagic stroke across all four trials was not significantly different, 9/3023 for placebo patients and 15/4680 for Abciximab-treated patients. The incidence of intracranial hemorrhage was 3/3023 for placebo patients and 7/4680 for ReoPro patients.

Thrombocytopenia- In the clinical trials, patients treated with ReoPro were more likely than patients treated with placebo to experience decreases in platelet counts.

Among patients in the EPILOG and EPISTENT trials who were treated with ReoPro plus low-dose heparin, the proportion of patients with any thrombocytopenia (platelets less than 100,000 cells/μL) ranged from 2.5 to 3.0%. The incidence of severe thrombocytopenia (platelets less than 50,000 cells/μL) ranged from 0.4 to 1.0% and platelet transfusions were required in 0.9 to 1.1%, respectively. Modestly lower rates were observed among patients treated with placebo plus standard-dose heparin. Overall higher rates were observed among patients in the EPIC and CAPTURE trials treated with ReoPro plus longer duration heparin: 2.6 to 5.2% were found to have any thrombocytopenia, 0.9 to 1.7% had severe thrombocytopenia, and 2.1 to 5.5% required platelet transfusion, respectively.

In a readministration registry study of patients receiving a second or subsequent exposure to ReoPro (see PRECAUTIONS: Readministration ) the incidence of any degree of thrombocytopenia was 5%, with an incidence of profound thrombocytopenia of 2% (<20,000 cell/μL). Factors associated with an increased risk of thrombocytopenia were a history of thrombocytopenia on previous ReoPro exposure, readministration within 30 days, and a positive HACA assay prior to the readministration.

Among 14 patients who had thrombocytopenia associated with a prior exposure to ReoPro, 7 (50%) had recurrent thrombocytopenia. In 130 patients with a readministration interval of 30 days or less, 25 (19%) developed thrombocytopenia. Severe thrombocytopenia occurred in 19 of these patients. Among the 71 patients who had a positive HACA assay at baseline, 11 (15%) developed thrombocytopenia, 7 of which were severe.

Allergic Reactions- There have been rare reports of allergic reactions, some of which were anaphylaxis (see WARNINGS: Allergic Reactions ).

Other Adverse Reactions- Table 5 shows adverse events other than bleeding and thrombocytopenia from the combined EPIC, EPILOG and CAPTURE trials which occurred in patients in the bolus plus infusion arm at an incidence of more than 0.5% higher than in those treated with placebo.


Event

Placebo

(n=2226)

Bolus + Infusion

(n=3111)

Number of Patients (%)
Cardiovascular system
Hypotension 230 (10.3) 447 (14.4)
Bradycardia 79 (3.5) 140 (4.5)
Gastrointestinal system
Nausea 255 (11.5) 423 (13.6)
Vomiting 152 ( 6.8) 226 (7.3)
Abdominal pain 49 ( 2.2) 97 (3.1)
Miscellaneous
Back pain 304 (13.7) 546 (17.6)
Chest pain 208 (9.3) 356 (11.4)
Headache 122 (5.5) 200 (6.4)
Puncture site pain 58 (2.6) 113 (3.6)
Peripheral edema 25 (1.1) 49 (1.6)

The following additional adverse events from the EPIC, EPILOG and CAPTURE trials were reported by investigators for patients treated with a bolus plus infusion of ReoPro at incidences which were less than 0.5% higher than for patients in the placebo arm.

Cardiovascular System: ventricular tachycardia (1.4%), pseudoaneurysm (0.8%), palpitation (0.5%), arteriovenous fistula (0.4%), incomplete AV block (0.3%), nodal arrhythmia (0.2%), complete AV block (0.1%), embolism (limb) (0.1%); thrombophlebitis (0.1%);

Gastrointestinal System: dyspepsia (2.1%), diarrhea (1.1%), ileus (0.1%), gastroesophogeal reflux (0.1%);

Hemic and Lymphatic System: anemia (1.3%), leukocytosis (0.5%), petechiae (0.2%);

Nervous System: dizziness (2.9%), anxiety (1.7%), abnormal thinking (1.3%), agitation (0.7%), hypesthesia (0.6%), confusion (0.5%), muscle contractions (0.4%), coma (0.2%), hypertonia (0.2%), diplopia (0.1%);

Respiratory System: pneumonia (0.4%), rales (0.4%), pleural effusion (0.3%), bronchitis (0.3%), bronchospasm (0.3%), pleurisy (0.2%), pulmonary embolism (0.2%), rhonchi (0.1%);

Musculoskeletal System: myalgia (0.2%);

Urogenital System: urinary retention (0.7%), dysuria (0.4%), abnormal renal function (0.4%), frequent micturition (0.1%), cystalgia (0.1%), urinary incontinence (0.1%), prostatitis (0.1%);

Miscellaneous: pain (5.4%), sweating increased (1.0%), asthenia (0.7%), incisional pain (0.6%), pruritus (0.5%), abnormal vision (0.3%), edema (0.3%), wound (0.2%), abscess (0.2%), cellulitis (0.2%), peripheral coldness (0.2%), injection site pain (0.1%), dry mouth (0.1%), pallor (0.1%), diabetes mellitus (0.1%), hyperkalemia (0.1%), enlarged abdomen (0.1%), bullous eruption (0.1%), inflammation (0.1%), drug toxicity (0.1%).

Immunogenicity

As with all therapeutic proteins, there is a potential for immunogenicity. In the EPIC, EPILOG, and CAPTURE trials, positive HACA responses occurred in approximately 5.8% of these patients receiving a first exposure to ReoPro. No increase in hypersensitivity or allergic reactions was observed with ReoPro treatment (see WARNINGS: Allergic Reactions ).

In a study of readministration of ReoPro to patients (see PRECAUTIONS: Readministration ) the overall rate of HACA positivity prior to the readministration was 6% and increased post-readministration to 27%. Among the 36 subjects receiving a fourth or greater ReoPro exposure, HACA positive assays were observed post-readministration in 16 subjects (44%). There were no reports of serious allergic reactions or anaphylaxis (see WARNINGS: Allergic Reactions ). HACA positive status was associated with an increased risk of thrombocytopenia (see PRECAUTIONS: Thrombocytopenia ).

The data reflect the percentage of patients whose test results were considered positive for antibodies to ReoPro using an ELISA assay, and are highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody positivity in an assay may be influenced by several factors including sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to ReoPro with the incidence of antibodies to other products may be misleading.

OVERDOSAGE:

There has been no experience of overdosage in human clinical trials.

DOSAGE AND ADMINISTRATION:

The safety and efficacy of ReoPro have only been investigated with concomitant administration of heparin and aspirin as described in CLINICAL STUDIES.

In patients with failed PCIs, the continuous infusion of ReoPro should be stopped because there is no evidence for ReoPro efficacy in that setting.

In the event of serious bleeding that cannot be controlled by compression, ReoPro and heparin should be discontinued immediately.

The recommended dosage of ReoPro in adults is a 0.25 mg/kg intravenous bolus administered 10-60 minutes before the start of PCI, followed by a continuous intravenous infusion of 0.125 μg/kg/min for 12 hours.

Patients with unstable angina not responding to conventional medical therapy and who are planned to undergo PCI within 24 hours may be treated with an ReoPro 0.25 mg/kg intravenous bolus followed by an 18- to 24-hour intravenous infusion of 10 μg/min, concluding one hour after the PCI.

Instructions for Administration

HOW SUPPLIED:

ReoPro (ReoPro®) 2 mg/mL is supplied in 5 mL vials containing 10 mg (NDC 0002-7140-01).

Vials should be stored at 2 to 8 °C (36 to 46 °F). Do not freeze. Do not shake. Do not use beyond the expiration date. Discard any unused portion left in the vial.

REFERENCES:


Product of The Netherlands

Manufactured by:

Janssen Biotech, Inc.

Horsham, PA 19044

U.S. License Number: 1864

Distributed by:

Eli Lilly and Company

Indianapolis, IN 46285

Revision Date: August 2016

ReoPro pharmaceutical active ingredients containing related brand and generic drugs:


ReoPro available forms, composition, doses:


ReoPro destination | category:


ReoPro Anatomical Therapeutic Chemical codes:


ReoPro pharmaceutical companies:


References

  1. Dailymed."REOPRO (ABCIXIMAB) INJECTION, SOLUTION [ELI LILLY AND COMPANY]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  2. "Abciximab". https://pubchem.ncbi.nlm.nih.gov/su... (accessed August 28, 2018).
  3. "Abciximab - DrugBank". http://www.drugbank.ca/drugs/DB0005... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming ReoPro?

Depending on the reaction of the ReoPro after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider ReoPro not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is ReoPro addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

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The information was verified by Dr. Rachana Salvi, MD Pharmacology


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