For first-line therapy in mild-to-moderate hypertension

Discover the classic benefits of a beta-blocker and a diuretic ... now at low doses for a side-effect·profile comparable to placeb01 *

ZIAC controls mild-to-moderate hypertension in up to 80% of patients 1t ZIAC controls blood pressure for a full 24 hours for true once-a-day dosing2 ZIAC minimizes traditional beta-blocker- and HCTZ-associated metabolic effects (hypokalemia, hyperuricemia, hypercholesterolemia, hyperglycemia)1 - The two most common side effects - dizziness and fatigue - occurred at rates comparable to placebo. ' Clinical trial response rates were: 2.5 mg-61%; 5 mg-73%; 10 mg-80%.

ZIAC is contraindicated in patients in cardiogenic shock, overt cardiac failure (see WARNINGS section of full Prescribing Information), second- or thirddegree AV block, marked sinus bradycardia, anuria, and hypersensitivity to either component of this product or to other sulfonamide-derived drugs. Please see Brief Summary of Prescribing Information on adjacent page.

(bisoprolol fumarate-hydrochlorothiazide) 2.5,5, &10 mg Tablets with 6.25 mg HCTZ

ZIAC'· (Blloprolol Fumarate and Hydrochlorothiazide) Tabletl

zTAt: (bisoprolol fumarate·hydrochlorothiazide) 2.5, 5, &10 mg Tablets with 615 mg HClZ References: 1. De9uattro V, Weir MR. Bisoprolol fumarate/hydrochlorothiazide 6.25 mg: a new, low·dose optl?n for flrst-hne antihypertensive therapy. Adv Ther. 1993; 10: 197-206. 2. Lewin AJ, Lueg MC, Targum S, et al. A clinical trial evaluating the 24·hour effects of bisoprolol/hydrochlorothiazlde 5 mg!6.25 mg combination in patients with mild to moderate hypertension. Clin Cardiol. 1993;16:732-736.

Brill Summary ZIAC'· (Blloprolol Fumarlle and Hydrochlorotfllazldel Tabllll FOR FULL PRESCRIBING INFORMATION, PLEASE CONSULT PACKAGE INSERT. DESCRIPTION ZIAC (bisoprolol fumarate and hydrochlorothiazide) is indicated lor the treatment of hypertension. It combines two antihypertensive agents in a once·daily dosage: a synthetic beta,'selective (cardloselective) adrenoceptor blocking agent (bisoprolol fumarate) and a benzothiadiazlne diuretic (hydrochlorothiazide). CLINICAL PHARMACOLOGY At doses'" 20 mg bisoprolol fumarate inhibits beta,'adrenoreceptors located In bronchial and vascular musculature. To retain relative selectivity, it is important to use the lowest effective dose. CONTRAINOICATIONS Cardiogenic shock, overt cardiac failure (see WARNINGS), second or third degree AV block, marked sinus bradycardia, anuria, and hypersensitivity to either component of this product or to other sulfonamide·derived drugs. WARNINGS Clrdlac Fillure: Beta·blocking agents should be avoided In patients with overt congestive failure. Pltllnts WIIlIGut I Hillary of Clrdlac Fallura: Continued depreSSion of the myocardium with beta'blockers can precillitate cardiac failure. At the first signs or symptoms of heart failure, discontinuation of ZIAC should be considered. Abrupt Cluilion olTherapy: Abrupt cessation of beta·blockers should be avoided. Even in patients wrthout overt coronary artery disease, it may. be advisable to taper therapy with ZIAq over approximately 1week with the patient under careful observation. If Withdrawal symptoms occur, beta·blocklng agenttherapy should be reinstituted, at least temporarily. Peripheral VIICUI.r Dilla ••: Beta·blockers should be used with caution in patients with penpheral vascular disease. BronchDBpalllc 01.....: PATIENTS WITH BRONCHOSPASTIC PULMONARY DISEASE SHOULD, IN GENERAL, NOT RECEIVE BETA·BlOCKERS. Anilthlli. and Malor Surgery: If used perloperatively, particular care should be taken when anesthetiC agents that depress myocardial function, such as ether, cyclopropane, and trichloroethylene, are used. Dllbetas Ind Hypoglycemia: Beta·blockers may mask some of the manifestations of hypoglycemia, particularly tachycardia. Patlents subjectto spontaneous hypoglycemia, or diabetic patients receiving Insulin or oral hypogly· ~mlC agents, should be cautioned. Also, latent diabetes mellitus may become manifest and diabetic patients ~ven thlazides may require adjustment of their insulin dose. TbbyrDloxlcDBI.: Beta·adrenergic blockade may mask clinical signs of hyperthyroidism. Abrupt withdrawal of betaIockade may be followed by an exacerbation of the symptoms of hyperthyroidism or may precipitate thyroid storm, Re~11 DII.a..: Cumulative effects of the thiazides may develop in patients with impaired renal function. In such paillents, thlazides may precipitate azotemia. In subjects with creatinine clearance less than 40 mLlmin, the Rasma half·life of bisoprolol fumarate is increased up to threefold, as compared to healthy subjects. dl~~:. 01 ..118: ZIAC should be used with caution in patients with impaired hepatic function or progressive liver PRECAUTIONS Genllll: Electrolyte and Fluid Balance Status: Periodic determination of serum electrolytes should be pertormed, and patients should be observed for signs of fluid or electrolyte disturbances. Thlazides have been shown to Increase the urinary excretion of magnesium; this may result In hypomagnesemia. Hypokalemia may develop. Hypokalemia and hypomagnesemia can provoke ventllcular arrhythmias or senslt~e or exaggerate the response of the heart to the toxic ellects of digitalis. Dilutional hyponatremia may occur in edematous patients 10 hot weather; appropriate therapy Is water restriction ratherthan sail administration, except in rare Instances when the h .lponatremia IS life·threatening. In actual salt depletion, appropriate replacement Is the therapy of choice. rarathyrold Disease: Calcium excretion is decreased by thiazldes, and pathologic change... the parathyrOid Qlands, with hypercalcemia and hypophosphatemia, have been observed in afew patients on prolonged thiazide thdlera~y. Hyperuricemia: Hyperullcemia or acute gout may be precipitated in certain patients recelvlng thiazide uretlCS. Blsoprolol fumarate, alone orin combination with HCTZ, has been associated with increases In uric acid. Orug Interlctlona: ZIAC may potentiate the action of other antihypertensive agents used concomitantly. ZIAC should not be combined ~ith other beta-blocking agents. In patients receiving concurrent therapy With clonldlne, if,t~rapy IS to be discontinued, It Is suggested that ZIAC be discontinued for several days before the withdrawal of comdlne. ZIAC should be used with caution when myocardial depressants or Inhibitors of AV conduction or anti· arrhvthmic agents are used concurrently. 8lsoprolol Fumarate: Concurrent use of rlfampln Increases the metabolic clearance of bisoprolol fumarate Shth0rtening Its elimination half-life. Pharmacoklnetic studies document no clinically relevant interactions with Obi er agents given concomitantly, Including thiazide diuretics, digoxin and clmetldlne. There was no effect of soprolol fumarate on prothrombin times in patients on stable doses of warfarin. While taking beta·blockers, patients with a history of severe anaphylactic reaction may be more reactive to re~eated challenge, either accidental, diagnostic, or therapeutic and may be unresponsive to the usual doses of epmephrine used to treatallergic reactions. HYdrochlo~thiazlrle: The following drugs may interact with thiazide diuretics. Alcohol, barbiturates, or narcot· Ics-potentlatlon of orthostatiC hypotenSion may occur. Dosage adiustment of the antidiabetic drugs (oral agents and Insulm) may be required. other antihypertensive drugs-additive effect or potentiation. Cholestyramlne and ~leStiPOI resms-slngle doses of cholestyramine and colestlpol resins bind the hydrochlorothiazide and reduce its af,.~orptlon In the gastrointestinal tract by up to 85 and 43 percent, respectively. Corticosteroids, ACTH-Intensi· ... electrolyte depletion, particularly hypokalentla. Possible decreased response to pressor amlnes but not suf· Ilt~rnt to preclude their use. Possible Increased responsiVeness to muscle relaxants, nondepolarlzlng. Generally, ~m should Mt be_given wi!h .dluretics. Diuretic agents reduce the renal clearance of lithium and add ahigh risk of lithium tOXICity. The administratIOn of a nonsterOidal antf.Jnflammatory agent can reduce the diuretic, natlluretlc. and antihypertensive ellects of loop, potassium-sparing and thiaZide diuretics. lhnpafients receiving thiazides, sensitivity reactions may occur With or without ahistory of allergy or bronchial ast rna. Photosensitivity reactions and possible exacerbation or activation of systemic lupus erythlmatosus have been reported in patients receiVing thiazldes. The antihypertensive effects of thiazides may be enhanced in the post·sympathectomy patient. La~ Tllllnlmctlon.: Based on reports involving thiazides, ZIAC may decrease serum levels of proteinbbofund Iodine without Signs of thyroid disturbance. Because it includes a thiazide, ZIAC should be discontinued eore carrying outtests for parathyroid function (see PRECAUTIONS-Parathyroid Disease). ADVERSE REACTIONS ZlAC : Blsoprolol fumaratelH6.25 mg Is well tolerated In most patients, Most adverse effects (AEs) have been mild an dtransient. In more than 65,000 patients treated worldwide with bisoprolol fumarate, occurrences of broncho· spalsm have .been rare. Discontinuation rates tor AEs were similar for B/H6.25 mg and placebo·treated patients. n the Untied States, 252 patients received bisoprolol fumarate (2.5, 5, 10, or 40 mg)/H6.25 mg and 144 patlents received placebo in two controlled trials. In Study I, bisoprolol fumarate SlH6.25 mg was administered tor 4weeks. In Study 2, bisoprololfumarate 2.5, 10 or401H6.25 mg was administered for 12 weeks. All adverse exPeIJences, whether drug·related or not, and drug·related adverse experiences in patients treated with B2,5-101H6.25 mg, reported during ~mparable, 4 week treatment periods by at least 2% of bisoprolol fumarate! H6.25 mg-treateD patients (plus additional selected adverse experiences) are presented in the following table:

%of Patients w~h Adverse Experiences'

Body System! Adverse Experience

Cardiovascular bradycardia arrhythmia peripheral Ischemia chest pain Respiratory bronchospasm

~~i~~~S

All Adverse Experiences Placebo' 82.5·401H6.251 ~ (n-252)

%

%

0.7 1.4 0.9 0.7

1.1

0.0

1.0 2.0 2.3

Drug'related Adverse Experiences Placebo' B2.5·tO/H6.251 (;i":144j (n ~ 221)

0.4

0.7 1.8

%

%

0.7 0.0 0.9

0.9 0.0

0.0

0.0 1.5 0.9 0.0

0.7

0.0 2.2 0.7 2.1

0.7 0.7

0.4 0.9

URI 0.0 Body as aWhole asthenia 0.0 0.0 0.0 0.0 fatigue 2.7 4.6 1.7 3.0 0.7 1.1 peripheral edema 0.7 0.9 Central Nervous System 5.1 dizziness 1.8 1.8 3.2 4.5 headache 4.7 2.7 0.4 Musculoskeletal 0.7 1.2 muscle cramps 0.7 1.1 myalgia 1.4 2.4 0.0 0.0 Psychiatric 2.4 1.1 msomnta 2.0 1.2 0.7 somnolence 1.1 0.7 0,9 1.2 0.4 loss of libido 1.2 0.4 0.7 1.1 impotence 0.7 1.1 Gastrointestinal 4.3 diarrhea 1.4 1.2 1.1 1.1 nausea 0.9 0.9 0.9 1.2 dyspepsia 0.7 0.7 0.9 •AveraQes adjusted to combine across studies. I Combined across studies. Other adverse experiences that have been reported with the individual components are listed below. BI..prolol Fumlll.te:.ln clinical trials worldwide, avariety of other AEs, In addition to those listed above, have been reported. While 10 many cases It Is not known whether acausalllllatlonShlp exists between blsoprolol and these AEs, they are listed to alert the physlcl~n to apossible relationship. Central Nervous System: Unsteadiness, vertigo, syncope, parestheSia, hyperest~esla, sleep dlsturbancelVivld dreams, depreSSion, anxlety/restlessness, decreased concentratlon/memory. cardiovascular: Palpitations and other rhythm disturbances, cold extremities, claudication, hypotension, orthostatic hypotension. chest pain, congestive heart failure. Gastrointestinal' Gas· tricleplgastrlclabd0ll)inal pain, peptic ulc~r, gastri.tls, vomiting, constipation, dry mouth. Musculoskeletal: Arthralgia, muscleljolnt pam, backineck~alO, twltchlOgl1remor.Skin: Rash,. acne, eczema, psoriaSiS, skin Irrlta· tion, pruntus, purpura, flushing, sweallng, alopecia, dermatitis, exfoliative dermatitis (very rarely). Specill Senses: Visual disturbances,. ocular palnlpr~ssure, abnormallacrlma.tlon, tinnitus, decreased hearing, earache, ta~te abnormalitle,s. Metaboltc: Gout. ReSPiratory: Asthma,. bronchitiS, dyspnea, pharyngitis, sinusitis. Genllo· ~~~~Z~e,,:ronJe s disease (very rarely), cystitiS, renal coilc, polyuria. General: Malaise, edema, weight gain,

~n addition, a variety of adverse effects have been reported with other beta·adrenergic blocking agents and should be considered potential adverse effects: Clintral Nervous System: Reversible mental depression progress· 109 to catatonta, hallucmations, an acute reversible sy,ndrome characterized by disorientation to time and place, emotionallablll~, slightly clouded sensonum. Allergic: Fever, combined wltli aching and sore throat, laryngo' spasm, and respJlatory distress. Hemato/oalc: Agranulocytosis, thrombocytopenia. GastrointestiflBI: MesenteriC arterialthrombosis and Ischemic colitis. Miscellaneous: The oculomucocutaneous syndrome associated with the beta:blocker practolol has not been reported with bisoprolol fumarate during investigational use or extensive forelOn marketing exwlence. Hydrochiorolllililde: The following adverse experiences, In addition to thOse listed In the above table, have been reported With hydrochlorothiazide (generally With doses of 25 mg or greater). General: Weakness. cantral Nervous System:. VertigO, paresthl~la, restlessness. cardiovascul,,: OrthostatiC hypotension (may be potentiated by alcohol, barbiturates, or na!co.tlcs) .. Gastrolntesllll~/: Anorexia, Qastnc IlIItatl.on, cramping, constipation,laundice (IOtrahepatIC cholestatl.c laundl~e). pancreatitiS, cholecystitis, slaladentlis, dry mouth. Musculoskeletal: Muscle spasm. Hypersensl/IVeReactlons: Purpura, photosensitivity, rash, urticaria, necrotizing angiitiS (vasculitiS and cutaneous vasculitis), fever, respiratory distress including pneumonitis and pulmonary edema anaphylactiC reactions. Special Senses: Transient blurred vision, xanthopsia. Metabolic: Gout. Genitourinary: Sexual dysfunction, renal failure, renal dysfunction, Interstitial nephritis. LABORATORY ABNORMALInES ZIAC: Because olthe low dose of hydrochlorothiazide in ZIAC, adverse metabolic effects with 8IH6.25 mg are less frequent and of smaller magnitude than with HCTZ 25 mg . Treatment with both beta· blockers and thiazide diuretics is aSSOCiated with Increases in uric acid. Mean Increases In serum trlglycerldes were Observed in patients treated with bisoprOlol fumarate and hydrochlorothiazide 6.25 mg. Total cholesterol was generally unaffected, but small decreases In HDl cholesterol were noted. Other laboratory abnormalities that have been reported with the individual components are listed below. Blloprolol Fumlrate: In clinical trials, the most frequently reported laboratory change was an increase in serum trlQlycerldes, but this was not aconsistent finding. Sporadic liver test abnormalities have been reported. In thl U.S. controlled trials experience with blsoprolol fumaratetreatmentfor 4to 12weeks, the Incidence of concomitant elevations In SGOTand SGPTof between 1to 2 ~~~~ormal was 3.9%, compared to 2.5% for placebo. No patient had concomitantelevatlons greater than twice In the long·term, uncontrolled experience with bisoprolol fumarate treatment for 6·18 months, the incidence of one or more concomitant elevations In SGOT and SGPTof between 1·2 times normal was 6.2%. The Incidence of multiple occurrence was 1.9%. For concomitant elevations in SGOT and SGPT of greater than twice normal the Incidence was t .5%. The Incidence of multiple occurrences was 0.3%. In many cases these elevations were attributed to underlying disorders, or resolved during continued treatment with blsoprolol fumarate. Other laboratory changes included small incr.ases In uric acid, creatinine, BUN, serum potaSSium, glucose, and phosphorus and decreases In WBC and platelets. There have been occasional reports of eosinophilia. These were generally not of clinical Importance and rarely resulted In discontinuation of bisoprolol fumarate. As With other beta·blockers, ANA conversions have also been reported on blsoprolol fumarate. About 15% 01 patients In long·term studies converted to apositive titer, although about one·thlrd of these patients subsequently reconverted to a negative titer while on continued therapy. HydrochlorDtflllllde: Hyperglycemia, glycosuria, hyperuricemia, hypokalemia and other electrolyte imbalances (see PRECAUTIONS), hyperlipidemia, hypercalcemia, leukopenia, agrenulocytosls, thrombocytopenia aplastic anemia, and hemolytiC anemia have been associated with HCTZ therapy. ' . See DOSAGE AND ADMINISTRATION section in package Insert for complete dosing and precautionary mformatlon. ADVANTUS PHARMACEUTICALS and lEDERlE lABORATORIES DIVISION American Cyanamid Company Pearl River, NY 10965 REV. 3/93 Under license of E. MERCK, Darmsladt. Germany L·32073·93

4f1lpr

LEOEIl! LABOIAlOilES ADivision of Amllicon Cvanamld Company Way", No. '""y 01410

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Copromoted by

Prot::tercfLCiaInI:JIe PHARMACEUTICALS

MERCK, Darmsladl, Germany

1994 Lederle Laboratories

May 1994

2407-4

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Release the grip of tension headache

Butalbital50mg: /Acetaminophen Over 50% more analgesic power than the leading products in its class. Well tolerated - Without aspirin-related side effects such as GI irritation and GI bleeding.1-5 The most frequent adverse reactions are drowsiness and dizziness. dIln FOREST PHARMACEUTICALS, INC.

W

UAD LABORAlOAlES •. Louia,-......;13IM5

Please see references and brief summary of full prescribing information on adjacent page.

'In most states .

EsgicplUSNtabiets ButalbitalSOmg (WarrQ ~ be habllorming) /Acetaminophen SOOmg/Caffeme 40rng RI""ncn: 1. Benson GO. He~totoxicity following the therapeutic use of antipyretic analgesics. Am J M«I. 1983:75(suppl 51.):85-93. 2. JlCk H. Effects at aspirin and acetaminophen in gastro·intestinal hemorrhage. ~h Intern M«I. 1981;t41:316·321. 3. Mielke CH Jr. comparative effectS ot aspirin and acetaminophen on hemostaSis. Arch Intern M«i. 1981:141:305-310.4. Hansten PO. Drug Interactions. 5th ed. Philadelphia. PI.: Lea & feblger; 1985, p. 95. 5. Insel PI.. Analgesic·antipyretics and antiinflammatory agents; drugs employed in the treatment of rheumatoid arthritis and goul. In: Gilman loG. Rail TW, Nies AS, Taylor P. eds. The PharmlCOllI9ical Basis of Thlrapeutics. 8th ed. New York. NY: Pergamon Press; 1990:638-681. U.S.~I~ce

STATEMENT OF OWNERSHIP, MANAGEMENT, AND CIRCULATION (required by 39 U.S.C. 3885) 1 Title of Publication: JABFP The Journal of the American Board of Family Practice 2 Publication No.: 002-036. 3. Date of filing: 09/25/94. 4. Freque~cy of issue: Mo~thlY in Jan, Mar, May, July, Sep, and Nov. 5. No. of is.s.ues published annually: 6. 6. Annual subscription price: $35. 7. CO":lplete m~~~~~g~~:~~~f known office of publication: 2228 young Drive, Lexington,. offl t th . 8. Complete mailing address of the headquarters or general bUSiness cas 0 e publishers' 2228 Young Drive, Lexington, KY 40505-4294. . 9 Fuli names and complete mailing addresses of the publisher, edItor, and ma"';glng editor: Publisher: American Board of Family Practice, 2228 Young Drive, Lexington KY 40505-4294. Editor: Paul R. Young, M.D., 2228 Young Drive, Lexington' KY 40505-4294. Managing Editor: Paul R. Young, M.D., .222~ Young Drive Lexington KY 40505-4294. 10. Owner (If owned by a corporation, Its name and ~ddress m~st be stated and also immediately thereunder the names and addresses of stockholders owning or holding 1 percent or more of total ~mou.nt of stock If not owned by a corporation, the names and addresses of the Indlvld~al owne;" must be given. If owned by a partnership or other u~incorporated firm, ItS nama and address, as well as that of each individual must be gIven. If the PUbllcatlo~ is published by a nonprofit organization, its name and address must b~~~CU' American Board of Family Practice, 2228 Young Drive, Lexington, KY. 40 .' 11. Known bondholders, mortgagees, and other security holders owmng or holdIng 1 percent or more of total amount of bonds, mortgages, or other securities (If there . peel I t are none, so state: None. 12 For completion by nonprofit organizations authorized to mall at sara ~s (DMM' Section 424.12 only). The purpose, function, and nonprofit status of thIS organization and the exempt status for Federal Income tax purposes (1) has not changed during preceding 12 months. Actual no. copies of Average no. copies each issue during single issue published preceding 12 months nearest to filing date 15. Extent and nature of circulation A. Total no. copies 52,401 52,707 (net press run) B. Paid circulation 1. Sales through dealers and carriers, street vennla nla dors and counter sales 41,732 42,243 2. Mall subscription 41,372 42,243 C. Total paid circulation D. Free distribution by mall, carrier, or other means, samples, complimentary, 9,879 9,821 and other free copies E. Free distribution outside none none the mail 9,879 9,821 F. Total free distribution 51,611 52,064 G. Total distribution H. Copies not distributed 1. Office usa, left over, unaccounted, spoiled 790 843 after printing nla nla 2. Return from news agents 52,401 52,707 I. Total Percent paid and/or requested 80% circulation 81% I certify thet the stataments made by me aboVe are correct and complete. Paul R. Young, M.D. Executive Editor

ESGIC-PlUS™ Tablats

IButalbltal, Acetaminophen and Caffeine Tabla", USP} Hm....mg/4Om.

Brief Prescribing Information: (Pitase see package insert for tull prescribing information) Each Esgic-plus" Tablet contains: Sulalbital. USP 50 mg. WARNING: May be habil forming. Acetaminophen, USP 500 mg. Caffeine, USP 40 mg. In addition each tablet contains the following 'lnactive ingredients: microcryslalline cellulose. croscarmellose sodium, colloidal silicon dioxide and slearic acid. COIllllAlNDtCATtOllS·. This product is contraindiCate«! under the following condrtions: • HypersensrtiVity or intolerance to any componenl of this product.• Patients wrth porphyria. WMMIIIGS: Sutalbital is habrt·forming and potentially abusable. Consequently, the extended use of this product is not recommended. I'RECAUTlOIIS: a_rll: Esgic·plus" Tablels should be prescribed with caution in certain special· riSk patients. such as the elderly or debilitated, and those with severe impairment of renal or hepatic function. or acute abdominal condrtions. 1il10l1li111011 for Pltlnlt: This product may impair mental and/or physical abilnies required for lhe performance of potentially hazardous tasks such as driving a car or operating machinery. Such taSks should be avoidel1 while taking this product. Alcohol and other CNS depressants may produce an addrtlVe CNS depres· sion, when taken with this combination product. and should be aVOided. Butalbilal may be habit·forming. Patients should take the drug only for as long as rt IS prescribed. in the amounls prescribed, and no more fre· quently than prescribed. LaIlollIGly Tall: In patients with severe hepatic or renal disease. effeCl$ of lherapy shoutd be monilored wrth serial liver and/or renal function tests. Orug IlIIIracllOM: The CNS effects of butalbltal may be enhanced by monoamine oxidase (MAO) inhibilo~. Esgic·plus'" Tablets may enhance the effects of: other narcotiC analgesiCS, alcohOl. general anesthetics, tranqujfize~ such as chlor11iazepoxide. sedalive·hypnotics. or other CNS depressanls. causing increased CNS depression. Orullliboratory Tilt IntlrlclloRI: Acetaminophen may produce false·posrtive tesl results for urinary 5·hydroXYlndoleacetic acid. Clrclnoglllllll, Mulll_I., Impllrmlnt ,. FI"lIlt,: No adequate studies have been conducted in animals to determine whether acetaminophen or butalbital have a pottntial for carcinogenesis, mutagenesis. or impairment of fenility. PrIg.lncy: TeratogeniC Effects: Pregnancy Category C'. Animal reproduction studies have not been conducted with this combination product. n is also not known whether Esgic·plus" Tablets can cause fetal harm when administered 10 a pregnant woman or can affect reproduction capacity. This product should be given 10 a preg· nant woman only when clea~y netded. Nonteral~nic EfltlclS: Withdrawal seizures were reponed in a two·dayold male infant whose mother had taken a butalbital-containin~ drug during the last two months of pregnancy. 8utalbital was found in the infant's serum. The infanf was given phenobarbital 5 mg/l
PtENDIl IS corcrainclicated In petienIs who 1ft hypaKnsItlve to IhIs prociJct. PIaIsf: 5« brief soownery of Ptescribire InfooMtIon on page following next page.

75% of primary care physicians have treated patients with mv infection. Do you have the information you need? Every month, AIDS Clinical Care brings you the latest clinically relevant information in a concise, easy-to-read newsletter. Feature articles written by leading AIDS clinicians provide hands-on information about the management of HIV-related diseases. Topics include:

•

• AIDS/HlY Clinical Trial Updates • Antiretroviral Therapy Controversies • Treating and Preventing Opportunistic Infections • HIV Infection in Women • NIH Recommendations • Pediatric AIDS • Drug Interactions • Psychosocial Is ues • Nutrition in HIY The new Case History column answers clinical questions on the complex, overlapping manifestations of HIY infection by presenting actual case histories with diagnoses and patient follow-up. Research Notes summarize and comment on the most relevant articles from the mectical literature. Charts and tables clearly show clinical pre entations, diagnostic methods, treatment regimens, and epidemiologic trends.

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Compari.na: 1M FINt Ilt'Id Sew loo.oooAlDS c... PMIIII (l/I.ll AlPS c... ", OM.,I> CIwIl"I1OItfIlIl(f

::::-":"""':.:::"':"'''':'''

EDITOR Deborah J. Cotton, MD, MPH Infectious Disease Unit. Massachusetts General Hospital; Assistant Profes~or of Medicine. Harvard Medical School; Assistant Profe or of Health Policy and Management. Harvard School of Public Health. Boston.

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