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Esomeprazole dosage

Some people who take proton pump inhibitor PPI medicines, including esomeprazole magnesium delayed-release capsules, may develop a kidney problem called acute interstitial nephritis that can happen at any time during treatment with esomeprazole magnesium delayed-release capsules. Call your doctor if you have a decrease in the amount that you urinate or if you have blood in your urine. No carcinoids were seen in these rats. An increased incidence of treatment-related ECL cell hyperplasia was observed at the end of 1 year 94% treated vs. 10% controls. By the second year the difference between treated and control rats was much smaller 46% vs. 26% but still showed more hyperplasia in the treated group. Gastric adenocarcinoma was seen in one rat 2%. No similar tumor was seen in male or female rats treated for 2 years. For this strain of rat no similar tumor has been noted historically, but a finding involving only one tumor is difficult to interpret. A 78 week mouse carcinogenicity study of omeprazole did not show increased tumor occurrence, but the study was not conclusive.

C for up to 12 hours

Esomeprazole Magnesium Delayed-Release Capsules are indicated for the short-term treatment 4 to 8 weeks in the healing and symptomatic resolution of diagnostically confirmed erosive esophagitis. For those patients who have not healed after 4 to 8 weeks of treatment, an additional 4 to 8 week course of Esomeprazole Magnesium Delayed-Release Capsules may be considered. Use the lowest effective dosage and shortest duration of therapy appropriate for the patient's clinical condition. AIDS Information Services AIDSinfo website.

Give the medicine right away

Gastric was seen in one rat 2%. North Chicago, IL; 2012 May. Genetic testing may predict patients at highest risk. Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs NSAIDs. If combined, monitor patients extra closely for signs and symptoms of bleeding. Seek medical attention right away if you experience symptoms of low blood magnesium levels eg, dizziness; fast or irregular heartbeat; involuntary muscle movements; jitteriness or tremors; muscle aches, cramps, pain, spasms, or weakness; seizures.

P2Y12 inhibitors, NSAIDs, SSRIs, etc

Leonard AD, Ho KM, Flexman J. Proton pump inhibitors and diarrhoea related to Clostridium difficile infection in hospitalised patients: a case-control study. Asthma: Contraindicated in patients with aspirin-sensitive asthma; severe and potentially fatal bronchospasm may occur. Use caution in patients with other forms of asthma. Inhibits basal and stimulated gastric acid secretion. Withdraw the appropriate dose from the diluted solution. To make swallowing easier, you may open the esomeprazole capsule and sprinkle the medicine into a spoonful of pudding or applesauce. Swallow right away without chewing. Do not save the mixture for later use.

Esomeprazole ingredients

SSRI effectiveness with concurrent use. Adverse events have been observed in some animal reproduction studies. An increased risk of hypospadias was reported following maternal use of proton pump inhibitors PPIs during pregnancy Anderka, 2012 but this was based on a small number of exposures and the same association was not found in another study Erichsen, 2012. An increased risk of major birth defects following maternal use of PPIs during pregnancy was not observed in an additional study Pasternak, 2010. Esomeprazole is the s-isomer of omeprazole; refer to the omeprazole monograph for additional information. When treating GERD in pregnancy, PPIs may be used when clinically indicated Katz, 2013. Store esomeprazole suspension at room temperature, between 68 and 77 degrees F 20 and 25 degrees C. Store away from heat, moisture, and light. Do not store in the bathroom. Keep esomeprazole suspension out of the reach of children and away from pets. Esomeprazole delayed-release capsules are a proton pump inhibitor PPI. It works by decreasing the amount of acid produced in the stomach. Nexium throughout the following leaflet. Hepatic impairment: Patients with severe hepatic impairment may require dosage reductions. Check with your pharmacist about how to dispose of unused medicine. Kahrilas PJ, Falk GW, Johnson DA et al for the Esomeprazole Study Investigators. Esomeprazole improves healing and symptom resolution as compared with omeprazole in reflux oesophagitis patients: A randomized controlled trial. Aliment Pharmacol Ther. Erlotinib: Proton Pump Inhibitors may decrease the serum concentration of Erlotinib. Serum chromogranin A CgA levels increase secondary to drug-induced decreases in gastric acidity. The increased CgA level may cause false positive results in diagnostic investigations for neuroendocrine tumors. Healthcare providers should temporarily stop esomeprazole treatment at least 14 days before assessing CgA levels and consider repeating the test if initial CgA levels are high. Do not change your dose or stop Nexium without talking to your doctor.

Do not crush or chew the pellets

Pediatric: Esomeprazole strontium: Strontium competes with calcium for intestinal absorption and is incorporated into bone; use of esomeprazole strontium in pediatric patients is not recommended. USP using a child-resistant closure. Stanek EJ, Aubert RE, Flockhart DA et al. A national study of the effect of individual proton pump inhibitors on cardiovascular outcomes in patients treated with clopidogrel following coronary stenting: the Clopidogrel Medco Outcomes Study. Available from website. AUC and C max were increased by 25% and 18%, respectively, following administration of esomeprazole magnesium. Cmax and AUC of cilostazol by 18% and 26%, respectively. Pezalla E, Day D, Pulliadath I. Initial assessment of clinical impact of a drug interaction between clopidogrel and proton pump inhibitors. JACC. Hepatic effects: Transaminase elevations have been reported with NSAID use; closely monitor patients with any abnormal LFT. Rare sometimes fatal severe hepatic reactions eg, fulminant hepatitis, hepatic necrosis, hepatic failure have occurred with NSAID use; discontinue immediately if signs or symptoms of hepatic disease develop or if systemic manifestations occur. Esomeprazole Magnesium Delayed-Release Capsules are supplied as delayed-release capsules for oral administration. The recommended dosages are outlined in Table 1. Esomeprazole Magnesium Delayed-Release Capsules should be taken at least one hour before meals. Day 5 after 40 mg once daily dosing. The dosage is based on your medical condition and response to treatment. To reduce your risk of stomach bleeding and other side effects, take this medication at the lowest effective dose for the shortest possible time. Do not increase your dose, take it more frequently, or take it for longer than prescribed. Cefditoren: Proton Pump Inhibitors may decrease the serum concentration of Cefditoren. Management: If possible, avoid use of cefditoren with proton pump inhibitors PPIs. Safety and efficacy have not been established in patients younger than 1 month old. Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist. Esomeprazole may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you have difficulty swallowing esomeprazole magnesium delayed-release capsules, you may open the capsule and empty the contents into a tablespoon of applesauce. Do not crush or chew the granules. Be sure to swallow the applesauce right away. Do not store it for later use. Tacrolimus Systemic: Proton Pump Inhibitors may increase the serum concentration of Tacrolimus Systemic. Management: Tacrolimus dose adjustment may be required. daflon

Esomeprazole uses

If you take too much Nexium, tell your doctor right away. You have symptoms that do not adequately improve when treated with medicines. Bezabeh S, Mackey AC, Kluetz P et al. Accumulating evidence for a drug-drug interaction between methotrexate and proton pump inhibitors. Oncologist. Intravenous therapy should be followed by oral acid-suppressive therapy. Use is not recommended in patients with moderate renal impairment. Injection in 375 patients. What should I discuss with my healthcare provider before taking esomeprazole and naproxen? Eplerenone: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone. ormo.info eprex

Esomeprazole side effects

HID. Trissel LA. Handbook on injectable drugs. This medication passes into milk. The effects on a nursing are unknown. Consult your doctor before -feeding. Triple Therapy Esomeprazole Magnesium Delayed-Release Capsules plus amoxicillin and clarithromycin: Esomeprazole Magnesium Delayed-Release Capsules, in combination with amoxicillin and clarithromycin, is indicated for the treatment of patients with H. pylori infection and duodenal ulcer disease active or history of within the past 5 years to eradicate H. pylori. Limaprost: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Note: All dosing is expressed in terms of esomeprazole base, regardless of the salt associated with the dosing information. Esomeprazole strontium is not recommended for use in pediatrics. Consult WARNINGS section for additional precautions. Enzalutamide: May decrease the serum concentration of CYP2C19 Substrates. Conversely, concentrations of active metabolites may be increased for those drugs activated by CYP2C19. Management: Concurrent use of enzalutamide with CYP2C19 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C19 substrate should be performed with caution and close monitoring. Use the lowest effective dose for the shortest duration of time, use vitamin D and calcium supplementation, and follow appropriate guidelines to reduce risk of fractures in patients at risk. What are the possible side effects of esomeprazole Nexium? It has a molecular weight of 749. Esomeprazole delayed-release capsules may cause drowsiness or dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use esomeprazole delayed-release capsules with caution. Hepatic impairment: Use with caution in patients with mild to moderate hepatic impairment; avoid use in severe hepatic impairment. Gastric malignancy: Relief of symptoms does not preclude the presence of a gastric malignancy. Last EJ, Sheehan AH. Review of recent evidence: potential interaction between clopidogrel and proton pump inhibitors. Am J Health Syst Pharm. Stir the granules into the water and leave the mixture alone for 2 to 3 minutes so that it will thicken. Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.

Highlights for esomeprazole

The safety and effectiveness of esomeprazole magnesium for other pediatric uses have not been established. This medication may rarely cause a severe intestinal condition -associated due to a type of bacteria. Do not use anti- products or pain if you have any of the following symptoms because these products may make them worse. Store at room temperature away from moisture and heat. What happens if I miss a dose? Posaconazole: Proton Pump Inhibitors may decrease the serum concentration of Posaconazole. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Shah S, Lewis A, Leopold D et al. Gastric acid suppression does not promote clostridial diarrhoea in the elderly. QJM. cost micronase wiki

It has a molecular weight of 749

Certain types of lupus erythematosus. QT interval. 1 34 318 319 321 322 323 325 327 328 329 Paresthesia, muscle weakness, muscle cramps, lethargy, fatigue, and unsteadiness may occur. 319 320 321 325 330 Most patients required magnesium replacement and discontinuance of the proton-pump inhibitor. 1 34 317 319 321 322 323 324 325 326 327 330 Hypomagnesemia resolved within 1 week median following discontinuance and recurred within 2 weeks median of rechallenge. Aliskiren: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Management: Monitor renal function periodically in patients receiving aliskiren and any nonsteroidal anti-inflammatory agent. Patients at elevated risk of renal dysfunction include those who are elderly, are volume depleted, or have pre-existing renal dysfunction. US Food and Drug Administration. Proton pump inhibitor drugs PPIs: Drug safety communication- Low magnesium levels can be associated with long-term use. Rockville, MD; 2011 March 2. From FDA website. Exposure to the active metabolite of clopidogrel was reduced by 35% to 40% over this time period. Pharmacodynamic parameters were also measured and demonstrated that the change in inhibition of platelet aggregation was related to the change in the exposure to clopidogrel active metabolite. Uses: Short-term treatment in the healing and symptomatic resolution of diagnostically confirmed erosive esophagitis; short term treatment of erosive esophagitis due to acid-mediated GERD in infants What other drugs will affect esomeprazole? buy zebeta from mexico

What are the possible side effects of esomeprazole

Low blood magnesium levels have been reported rarely in patients taking PPIs for at least 3 months. In most cases, this effect was seen after a year of treatment. If you will be taking esomeprazole suspension for a long time, or if you take certain other medicines eg, digoxin, diuretics your doctor may perform lab tests to check for low blood magnesium levels. Seek medical attention right away if you experience symptoms of low blood magnesium levels eg, dizziness; fast or irregular heartbeat; involuntary muscle movements; jitteriness or tremors; muscle aches, cramps, pain, spasms, or weakness; seizures. Do not share it with other people. Sehested said. "They should think about quitting those drugs. Carcinoma: No reports of enterochromaffin-like ECL cell carcinoids, dysplasia, or neoplasia have occurred. Broeren MA, Geerdink EA, Vader HL et al. Hypomagnesemia induced by several proton-pump inhibitors. Ann Intern Med. Minerals with ADEK, Folate, Iron. Specifically, the absorption of iron may be decreased. Reference or local telephone book. Fundoplication surgery is most often used to treat that are likely to be caused in part by a and that have not been well controlled by medicines. The surgery may also be used for some people who do not have a hiatal hernia. McTavish D, Buckley MM, Heel RC. Omeprazole. An updated review of its pharmacology and therapeutic use in acid-related disorders. Drugs. Changes in blood tests that check how the liver is working. Before you take esomeprazole, tell your doctor if you have severe liver disease or low levels of magnesium in your blood. Talk with your doctor or pharmacist about the risks and benefits of treatment with this medication. You get stomach pain or indigestion. Esomeprazole Tablets if you are breastfeeding. Velpatasvir: Proton Pump Inhibitors may decrease the serum concentration of Velpatasvir. Use esomeprazole delayed-release capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Esomeprazole overdose

Concomitant administration of esomeprazole and a combined inhibitor of CYP2C19 and CYP3A4, such as voriconazole, may result in more than doubling of the esomeprazole exposure. Dose adjustment of esomeprazole is not normally required. Thirty-eight healthy subjects were included in the study. Swelling of the feet and ankles. Gilard M, Cornily JC, Boschat J. Initial assessment of clinical impact of a drug interaction between clopidogrel and proton pump inhibitors. JACC. For some antiretroviral drugs, such as atazanavir and nelfinavir, decreased serum levels have been reported when given together with omeprazole. Following multiple doses of nelfinavir 1250 mg, twice daily and omeprazole 40 mg daily AUC was decreased by 36% and 92%, C max by 37% and 89% and C min by 39% and 75% respectively for nelfinavir and M8. Following multiple doses of atazanavir 400 mg, daily and omeprazole 40 mg, daily, 2 hours before atazanavir AUC was decreased by 94%, C max by 96%, and C min by 95%. Concomitant administration with omeprazole and drugs such as atazanavir and nelfinavir is therefore not recommended. Proton pump inhibitor treatment should only be initiated and continued if the benefits outweigh the risks of treatment. Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease. Capsules: Open capsule, empty intact granules into 60-mL catheter-tipped syringe, and mix with 50 mL of water. 1 Replace plunger and shake well for 15 seconds. 1 Hold syringe with tip upright and check tip for remaining granules. 1 Administer immediately through NG tube; flush with additional water. 1 Do not administer if pellets have dissolved or disintegrated. PPI. Low blood magnesium levels have been reported rarely in patients taking PPIs for at least 3 months. In most cases, this effect was seen after a year of treatment. Capsules should not be chewed or crushed. Use 10 mL water for the 10 mg, 20 mg and 40 mg packets. Shake the syringe and let thicken for 2 to 3 minutes. Shake syringe prior to injecting through the NG or gastric tube using a French size 6 or larger. Use mixture within 30 minutes. Refill the syringe with equal amount of water originally used, shake, and flush any remaining contents from NG or gastric tube. Intravenous therapy is aimed solely at the acute initial management of bleeding gastric or duodenal ulcers and does not constitute full treatment. Esomeprazole is the S-isomer of omeprazole and limited data indicate that maternal doses of omeprazole 20 mg daily produce low levels in human milk. No studies in lactating women have been performed. Potassium-Sparing Diuretics: Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. purchase indocin rezeptfrei

How to use esomeprazole

PAZOPanib: Proton Pump Inhibitors may decrease the serum concentration of PAZOPanib. For some people, the side effects of surgery-bloating caused by gas buildup, swallowing problems, pain at the surgical site-are as bothersome as GERD symptoms. The fundoplication procedure cannot be reversed, and in some cases it may not be possible to relieve the symptoms of these complications, even with a second surgery. Granules: Delayed release oral suspension granules can also be given by nasogastric or gastric tube. Capsule can be swallowed whole. -or- Capsule can be opened and mixed with applesauce. Practice Guidelines. Am J Gastroenterol. Skin rash, lumpy rash hives and itchy skin. Following administration of equimolar doses, the S- and R-isomers are metabolized differently by the liver, resulting in higher plasma levels of the S- than of the R-isomer. If a single dose requires 2 packets, reconstitute oral suspension with twice the water needed for 1 packet. You should not take this medication if you are allergic to esomeprazole or to any other benzimidazole medication such as Albenza or Vermox. Those treated with the highest doses of PPIs had the highest risk of stroke. Data were obtained from two independent studies. Esomeprazole and naproxen is usually taken 2 times each day, at least 30 minutes before a meal. Therefore, you should not take Nexium if you are breastfeeding. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Lumacaftor: May decrease the serum concentration of CYP2C19 Substrates. sinequan vs generic brand

Prescribing information for esomeprazole

If you have any questions about esomeprazole suspension, please talk with your doctor, pharmacist, or other health care provider. This information should not be used to decide whether or not to take esomeprazole suspension or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about esomeprazole suspension. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to esomeprazole suspension. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using esomeprazole suspension. Before you start any new medicine, check the label to see if it has naproxen or any other NSAID eg, ibuprofen in it too. If it does or if you are not sure, check with your doctor or pharmacist. Children: Administer by intermittent infusion 10 to 30 minutes; the manufacturer recommends that children receive intravenous esomeprazole by intermittent infusion only. Several published observational studies suggest that proton pump inhibitor PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist, or spine. The risk of fracture was increased in patients who received high-dose, defined as multiple daily doses, and long-term PPI therapy a year or longer. Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated. Risedronate: Proton Pump Inhibitors may diminish the therapeutic effect of Risedronate. Proton Pump Inhibitors may increase the serum concentration of Risedronate. This applies specifically to use of delayed-release risedronate. Data presented are geometric means for AUC, C max and t ½λz, and median value for t max. Hold the syringe with the tip up and check for pellets in the tip. You pass black stools blood-stained faeces. The maximum dose is 80 mg twice a day.

Does esomeprazole interact with other medications

If you get any side effects talk to your doctor or pharmacist. Do not give the granules if they have dissolved or have broken into pieces. Esomeprazole magnesium is contraindicated in patients with known hypersensitivity to substituted benzimidazoles or to any component of the formulation. Omeprazole, of which esomeprazole is an enantiomer, has been reported to interact with some antiretroviral drugs. The clinical importance and the mechanisms behind these interactions are not always known. Increased gastric pH during omeprazole treatment may change the absorption of the antiretroviral drug. Other possible interaction mechanisms are via CYP2C19. Educate patient about signs of a significant reaction eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. IV: Mild-to-severe impairment: No dosage adjustment necessary. Safety and efficacy not established beyond 10 days; discontinue IV administration as soon as patient can take the drug orally. Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs NSAIDs. If combined, monitor patients extra closely for signs and symptoms of bleeding. Capsule can be swallowed whole. Ask your health care provider any questions you may have about how to use esomeprazole delayed-release capsules. grifulvin

What conditions does esomeprazole treat

Bone fractures. People who take multiple daily doses of PPI medicines for a long period of time a year or longer may have an increased risk of fractures of the hip, wrist, or spine. You should take esomeprazole magnesium delayed-release capsules exactly as prescribed, at the lowest dose possible for your treatment and for the shortest time needed. Talk to your doctor about your risk of bone fracture if you take esomeprazole magnesium delayed-release capsules. Nexium may hide the symptoms of other diseases. COX-2 selective NSAIDs. A total of 1429 patients were randomized across the 2 studies. Store in carton until time of use. Cerner Multum, Inc. "Australian Product Information. stromectol

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ATPase in the gastric cell

What is esomeprazole

Graul A, Castaner R, Castaner J. Esomeprazole magnesium. Drugs Future. Some people who take PPI medicines, including esomeprazole magnesium delayed-release capsules, may develop certain types of lupus erythematosus or have worsening of the lupus they already have. Call your doctor right away if you have new or worsening joint pain or a rash on your cheeks or arms that gets worse in the sun. Esomeprazole Magnesium Delayed-Release Capsules are indicated to maintain symptom resolution and healing of erosive esophagitis. Controlled studies do not extend beyond 6 months. P450 CYP enzyme system. Administration of omeprazole 20 mg twice daily for 4 days and a single 1000 mg dose of MMF approximately one hour after the last dose of omeprazole to 12 healthy subjects in a cross-over study resulted in a 52% reduction in the C max and 23% reduction in the AUC of MPA.

How should i store esomeprazole

No new safety concerns were identified in pediatric patients. Defined as 7 consecutive days with no heartburn reported in daily patient diary. 2. Defined as the cumulative proportion of patients who have reached the start of sustained resolution. Dosage regimens should be adjusted to individual patient needs. Dispense in a tight container as defined in the USP, with a child-resistant closure as required.

How to take esomeprazole

Take Nexium exactly as prescribed by your doctor. Digoxin: Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin. Mild to moderate hepatic insufficiency Child-Pugh class A and B: No adjustment recommended. Less than 1% of parent drug is excreted in the urine. Sodium Chloride Injection, USP for intravenous use.

What should i avoid while taking esomeprazole

DeVault KR, Castell DO, Practice Parameters Committee of the American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. Dexilant lansoprazole Prevacid omeprazole Prilosec, Zegerid pantoprazole Protonix rabeprazole AcipHex any other medications, or any of the ingredients in esomeprazole capsules or powder. Ask your pharmacist for a list of the ingredients. Low levels of sodium in the blood.

The estimated background risks of major birth defects and miscarriage for the indicated population are unknown. All pregnancies have a background risk of birth defect, loss or other adverse outcomes. Inflammation in the gut leading to diarrhoea. Take this medication by as directed by your doctor, usually once daily, before a meal. If you are self-treating, follow all directions on the product package. Dosage and length of treatment are based on your medical condition and response to treatment. Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Systemic lupus erythematosus SLE is less commonly reported than CLE in patients receiving PPIs. PPI associated SLE is usually milder than non-drug induced SLE. Onset of SLE typically occurred within days to years after initiating treatment primarily in patients ranging from young adults to the elderly. The majority of patients presented with rash; however, arthralgia and cytopenia were also reported.

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