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Pronounced: ARE-throw-teck
Generic ingredients: Diclofenac sodium, Misoprostol

Why is this drug prescribed: Arthrotec is designed to relieve the symptoms of arthritis in people who are also prone to ulcers. It contains diclofenac, a nonsteroidal anti-inflammatory drug (NSAID) for control of the inflammation, swelling, stiffness, and joint pain associated with rheumatoid arthritis and osteoarthritis. However, since NSAIDs can cause stomach ulcers in susceptible people, Arthrotec also contains misoprostol, a synthetic prostaglandin that serves to reduce the production of stomach acid, protect the stomach lining, and thus prevent ulcers.

Most important fact about this drug: Be certain to avoid taking Arthrotec during pregnancy. It can cause a miscarriage with potentially dangerous bleeding, sometimes leading to hospitalization, surgery, infertility, and even death. Arthrotec can also deform or kill the developing baby. If you haven't passed menopause, your doctor should do a pregnancy test less than 2 weeks before your therapy begins. Once you've started taking the drug, it is vitally important that you also use reliable contraceptive measures. If you do become pregnant, stop taking Arthrotec and contact your doctor immediately.

How should you take this medication: To minimize diarrhea and related side effects, take Arthrotec with meals, exactly as prescribed. Antacids containing magnesium can make Arthrotec-induced diarrhea worse. If you need an antacid, use one containing aluminum or calcium instead. Arthrotec tablets should be swallowed whole and not chewed, crushed, or dissolved. ---If you miss a dose... If you are following a regular schedule, take the dose as soon as you remember. If it is almost time for the next one, skip the dose you missed and go back to your regular schedule. Do not take 2 doses at once. ---Storage instructions... Store at room temperature in a dry place.

What side effects may occur: Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Arthrotec. More common side effects may include: Abdominal pain, acid indigestion, diarrhea, gas, nausea Less common or rare side effects may include: Abnormal vision or tearing, acne, anxiety, appetite changes, asthma, blood in the urine, breast pain, bruising, change in taste, concentration difficulties, confusion, constipation, coughing, dark tarry stools, decreased breathing, decreased or increased urination, dehydration, depression, difficulty breathing, difficulty swallowing, difficulty urinating, disorientation, dizziness, double vision, dream abnormalities, drowsiness, dry mouth, eczema, excessive or postmenopausal vaginal bleeding, eye infection, fainting, fatigue, fever, frequent urination, gout, hallucinations, hair loss, headache, hearing impairment, heartburn, hemorrhoids, high blood pressure, high blood sugar, hives, impotence, increased heart rate, increased muscle tone, increased nighttime urination, increased sweating, infection, inflammation in the digestive tract, insomnia, irregular or increased menstrual bleeding, irritability, irregular heartbeat, itching, jaundice (yellowing of the skin and eyes), joint pain, loss of appetite, low blood pressure, low blood sugar, migraine, mouth sores, muscle pain, nervousness, night blindness, nosebleed, painful menstruation, paranoia, pelvic pain, pinkeye, rapid breathing, rash, rectal bleeding, rectal itching, ringing in the ears, seizures, sensitivity to light, skin sores, skin rash, skin swelling, stomach or intestinal bleeding, stomach ulcers, taste loss, throat swelling, throbbing heartbeat, tremor, tingling/numbness, urinary tract infection, vertigo, vomiting, weakness, weight changes

Why should this drug not be prescribed: Remember that it is essential to avoid Arthrotec during pregnancy. You should also avoid this medication if you've ever had an allergic reaction to either of its components (diclofenac and misoprostol). Avoid it, too, if you've had a reaction to any other prostaglandin medication, or to any NSAID, including aspirin. Make sure the doctor is aware of any drug reactions you've experienced.

Special warnings about this medication: Although Arthrotec is designed to protect against stomach ulcers and bleeding, they remain a possibility. Contact your doctor immediately if you notice signs of bleeding such as black tarry stools. Also call the doctor if you develop severe diarrhea, cramping, or nausea, or if milder symptoms persist for more than 7 days. This drug should be used with caution if you have kidney problems or liver disease. Your doctor will do a blood test to monitor your liver within 4 to 8 weeks after starting Arthrotec therapy and periodically thereafter. If you develop signs of a liver problem, such as nausea, fatigue, tiredness, itching, yellowed eyes and skin, tenderness in the upper right area of your stomach, or flu-like symptoms, stop taking Arthrotec and notify your doctor at once. Use Arthrotec cautiously if you have systemic lupus or a similar connective tissue disease. Certain rare side effects are more likely to occur. Be cautious, too, if you have heart disease or high blood pressure. Arthrotec can increase water retention. Also exercise caution if you have asthma. In some people, Arthrotec could trigger an attack. Do not take Arthrotec if you're dehydrated (a possibility after severe vomiting or diarrhea). You should also avoid Arthrotec if you have a condition known as porphyria. Arthrotec is not an ordinary pain reliever. It is a potent medication, and poses extreme danger during pregnancy. Never share it with anyone else.

Possible food and drug interactions when taking this medication: If Arthrotec is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Arthrotec with the following: Aspirin Blood pressure medications such as Cardizem, Inderal, Procardia, and Vasotec Cyclosporine (Neoral, Sandimmune) Digoxin (Lanoxin) Diuretics (Lasix, HydroDIURIL) Glipizide (Glucotrol, Glucotrol XL) Glyburide (Diabeta, Micronase) Insulin Lithium (Lithobid, Lithonate) Magnesium-containing antacids such as Maalox and Mylanta Methotrexate (Rheumatrex) Phenobarbital Prednisolone (Delta-Cortef, Pediapred, Prelone) Warfarin (Coumadin)

Special information if you are pregnant or breastfeeding: Arthrotec must be strictly avoided during pregnancy. If you are in your child-bearing years, your doctor will have you take your first dose on the second or third day of your menstrual period to be sure you're not pregnant. Use reliable contraception for the duration of your treatment. Because Arthrotec appears in breast milk, your doctor may have you stop breastfeeding until your treatment is finished.

Recommended dosage: ADULTS: Osteoarthritis The recommended dose is 50 milligrams 3 times daily. Rheumatoid Arthritis The recommended dose is 50 milligrams 3 or 4 times daily. If you can not tolerate the recommended dosage, your doctor can prescribe a dose of 50 or 75 milligrams twice daily. However, such lower dosages are less effective at preventing ulcers. Your doctor may prescribe misoprostol (Cytotec) in addition to Arthrotec for better ulcer protection. CHILDREN: The safety and effectiveness of Arthrotec have not been established in children below the age of 18.

Overdosage: If you suspect an overdose of Arthrotec, seek medical attention immediately. Symptoms of Arthrotec overdose may include: Abdominal pain, confusion, diarrhea, difficulty breathing, digestive discomfort, drowsiness, fever, lack of muscle tone, low blood pressure, tremors, seizures, slow heartbeat, throbbing heartbeat, vomiting

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