Acyclovir has been related to the side effect of Obtundation. If you are taking Acyclovir and have experienced Obtundation this information may be of use to you.
IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug.
Acyclovir is a synthetic nucleoside analogue active against herpesviruses. Each capsule, for oral administration, contains
200 mg of acyclovir. In addition, each capsule contains the following inactive ingredients: corn starch, lactose monohydrate,
magnesium stearate and sodium lauryl sulfate. The capsule shell consists of gelatin, FD&C Blue No. 1, D&C Red No. 28, D&C
Red No. 33 and titanium dioxide. Printed with edible black ink that contains FD&C Blue No. 1, FD&C Blue No. 2, FD&C Red No.
40 and D&C Yellow No. 10. Each tablet, for oral administration, contains 400 mg or 800 mg of acyclovir. In addition, each
tablet contains the following inactive ingredients: colloidal silicon dioxide, lactose monohydrate, magnesium stearate, microcrystalline
cellulose, povidone, pregelatinized starch and sodium starch glycolate. The 400 mg tablets also contain FD&C Blue No. 2.
Acyclovir is a white to off-white, crystalline powder. The maximum solubility in water at 37°C is 2.5 mg/mL. The pka’s of
acyclovir are 2.27 and 9.25.
The chemical name of acyclovir is 2-amino-1,9-dihydro-9-[(2-hydroxyethoxy)methyl]-6H-purin-6-one; it has the following structural formula:
C8H11N5O3 M.W. 225
VIROLOGY
Mechanism of Antiviral Action
Acyclovir is a synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against herpes simplex virus types 1 (HSV-1), 2 (HSV- 2), and varicella-zoster virus (VZV).
The inhibitory activity of acyclovir is highly selective due to its affinity for the enzyme thymidine kinase (TK) encoded
by HSV and VZV. This viral enzyme converts acyclovir into acyclovir monophosphate, a nucleotide analogue. The monophosphate
is further converted into diphosphate by cellular guanylate kinase and into triphosphate by a number of cellular enzymes.
In vitro, acyclovir triphosphate stops replication of herpes viral DNA. This is accomplished in 3 ways: 1) competitive inhibition
of viral DNA polymerase, 2) incorporation into and termination of the growing viral DNA chain, and 3) inactivation of the
viral DNA polymerase. The greater antiviral activity of acyclovir against HSV compared to VZV is due to its more efficient
phosphorylation by the viral TK.
Antiviral Activities
The quantitative relationship between the in vitro susceptibility of herpes viruses to antivirals and the clinical response to therapy has not been established in humans, and
virus sensitivity testing has not been standardized. Sensitivity testing results, expressed as the concentration of drug required
to inhibit by 50% the growth of virus in cell culture (IC50), vary greatly depending upon a number of factors. Using plaque-reduction assays, the IC50 against herpes simplex virus isolates ranges from 0.02 to 13.5 mcg/mL for HSV-1 and from 0.01 to 9.9 mcg/mL for HSV-2. The
IC50 for acyclovir against most laboratory strains and clinical isolates of VZV ranges from 0.12 to 10.8 mcg/mL. Acyclovir also
demonstrates activity against the Oka vaccine strain of VZV with a mean IC50 of 1.35 mcg/mL.
Drug Resistance
Resistance of HSV and VZV to acyclovir can result from qualitative and quantitative changes in the viral TK and/or DNA polymerase.
Clinical isolates of HSV and VZV with reduced susceptibility to acyclovir have been recovered from immunocompromised patients,
especially with advanced HIV infection. While most of the acyclovir-resistant mutants isolated thus far from immunocompromised
patients have been found to be TK-deficient mutants, other mutants involving the viral TK gene (TK partial and TK altered)
and DNA polymerase have been isolated. TK-negative mutants may cause severe disease in infants and immunocompromised adults.
The possibility of viral resistance to acyclovir should be considered in patients who show poor clinical response during therapy.
CLINICAL PHARMACOLOGY
Pharmacokinetics
The pharmacokinetics of acyclovir after oral administration have been evaluated in healthy volunteers and in immunocompromised
patients with herpes simplex or varicella-zoster virus infection. Acyclovir pharmacokinetic parameters are summarized in Table 1.
In one multiple-dose, crossover study in healthy subjects (n = 23), it was shown that increases in plasma acyclovir concentrations
were less than dose proportional with increasing dose, as shown in Table 2. The decrease in bioavailability is a function of the dose and not the dosage form.
Table 2: AcyclovirPeak and Trough Concentrations at Steady State
Parameter
200 mg
400 mg
800 mg
Cssmax
0.83 mcg/mL
1.21 mcg/mL
1.61 mcg/mL
Csstrough
0.46 mcg/mL
0.63 mcg/mL
0.83 mcg/mL
There was no effect of food on the absorption of acyclovir (n = 6); therefore, acyclovir capsules and tablets may be administered
with or without food.
The only known urinary metabolite is 9-[(carboxymethoxy)methyl]guanine.
Special Populations
Adults with Impaired Renal Function
The half-life and total body clearance of acyclovir are dependent on renal function. A dosage adjustment is recommended for
patients with reduced renal function (see DOSAGE AND ADMINISTRATION).
Geriatrics
Acyclovir plasma concentrations are higher in geriatric patients compared to younger adults, in part due to age-related changes
in renal function. Dosage reduction may be required in geriatric patients with underlying renal impairment (see PRECAUTIONS, Geriatric Use).
Pediatrics
In general, the pharmacokinetics of acyclovir in pediatric patients is similar to that of adults. Mean half-life after oral
doses of 300 mg/m2 and 600 mg/m2 in pediatric patients aged 7 months to 7 years was 2.6 hours (range 1.59 to 3.74 hours).
Drug Interactions
Coadministration of probenecid with intravenous acyclovir has been shown to increase the mean acyclovir half-life and the
area under the concentration-time curve. Urinary excretion and renal clearance were correspondingly reduced.
Clinical Trials
Initial Genital Herpes
Double-blind, placebo-controlled studies have demonstrated that orally administered acyclovir significantly reduced the duration
of acute infection and duration of lesion healing. The duration of pain and new lesion formation was decreased in some patient
groups.
Recurrent Genital Herpes
Double-blind, placebo-controlled studies in patients with frequent recurrences (6 or more episodes per year) have shown that
orally administered acyclovir given daily for 4 months to 10 years prevented or reduced the frequency and/or severity of recurrences
in greater than 95% of patients.
In a study of patients who received acyclovir 400 mg twice daily for 3 years, 45%, 52%, and 63% of patients remained free
of recurrences in the first, second, and third years, respectively. Serial analyses of the 3 month recurrence rates for the
patients showed that 71% to 87% were recurrence free in each quarter.
Herpes Zoster Infections
In a double-blind, placebo-controlled study of immunocompetent patients with localized cutaneous zoster infection, acyclovir
(800 mg 5 times daily for 10 days) shortened the times to lesion scabbing, healing, and complete cessation of pain, and reduced
the duration of viral shedding and the duration of new lesion formation.
In a similar double-blind, placebo-controlled study, acyclovir (800 mg 5 times daily for 7 days) shortened the times to complete
lesion scabbing, healing, and cessation of pain; reduced the duration of new lesion formation; and reduced the prevalence
of localized zoster-associated neurologic symptoms (paresthesia, dysesthesia, or hyperesthesia).
Treatment was begun within 72 hours of rash onset and was most effective if started within the first 48 hours.
Adults greater than 50 years of age showed greater benefit.
Chickenpox
Three randomized, double-blind, placebo-controlled trials were conducted in 993 pediatric patients aged 2 to 18 years with
chickenpox. All patients were treated within 24 hours after the onset of rash. In 2 trials, acyclovir was administered at
20 mg/kg 4 times daily (up to 3,200 mg per day) for 5 days. In the third trial, doses of 10, 15, or 20 mg/kg were administered
4 times daily for 5 to 7 days. Treatment with acyclovir shortened the time to 50% healing; reduced the maximum number of lesions;
reduced the median number of vesicles; decreased the median number of residual lesions on day 28; and decreased the proportion
of patients with fever, anorexia, and lethargy by day 2. Treatment with acyclovir did not affect varicella-zoster virus-specific
humoral or cellular immune responses at 1 month or 1 year following treatment.
INDICATIONS AND USAGE
Herpes Zoster Infections
Acyclovir is indicated for the acute treatment of herpes zoster (shingles).
Genital Herpes
Acyclovir is indicated for the treatment of initial episodes and the management of recurrent episodes of genital herpes.
Chickenpox
Acyclovir is indicated for the treatment of chickenpox (varicella).
CONTRAINDICATIONS
Acyclovir is contraindicated for patients who develop hypersensitivity to acyclovir or valacyclovir.
WARNINGS
Acyclovir capsules and tablets are intended for oral ingestion only. Renal failure, in some cases resulting in death, has
been observed with acyclovir therapy (see ADVERSE REACTIONS, Observed During Clinical Practice and OVERDOSAGE). Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), which has resulted in death, has occurred in immunocompromised
patients receiving acyclovir therapy.
PRECAUTIONS
Dosage adjustment is recommended when administering acyclovir to patients with renal impairment (see DOSAGE AND ADMINISTRATION). Caution should also be exercised when administering acyclovir to patients receiving potentially nephrotoxic agents since
this may increase the risk of renal dysfunction and/or the risk of reversible central nervous system symptoms such as those
that have been reported in patients treated with intravenous acyclovir. Adequate hydration should be maintained.
Information for Patients
Patients are instructed to consult with their physician if they experience severe or troublesome adverse reactions, they become
pregnant or intend to become pregnant, they intend to breastfeed while taking orally administered acyclovir, or they have
any other questions. Patients should be advised to maintain adequate hydration.
Herpes Zoster
There are no data on treatment initiated more than 72 hours after onset of the zoster rash. Patients should be advised to
initiate treatment as soon as possible after a diagnosis of herpes zoster.
Genital Herpes Infections
Patients should be informed that acyclovir is not a cure for genital herpes. There are no data evaluating whether acyclovir
will prevent transmission of infection to others. Because genital herpes is a sexually transmitted disease, patients should
avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners. Genital herpes
can also be transmitted in the absence of symptoms through asymptomatic viral shedding. If medical management of a genital
herpes recurrence is indicated, patients should be advised to initiate therapy at the first sign or symptom of an episode.
Chickenpox
Chickenpox in otherwise healthy children is usually a self-limited disease of mild to moderate severity. Adolescents and adults
tend to have more severe disease. Treatment was initiated within 24 hours of the typical chickenpox rash in the controlled
studies, and there is no information regarding the effects of treatment begun later in the disease course.
Drug Interactions
See CLINICAL PHARMACOLOGY, Pharmacokinetics.
Carcinogenesis, Mutagenesis, Impairment of Fertility
The data presented below include references to peak steady-state plasma acyclovir concentrations observed in humans treated
with 800 mg given orally 5 times a day (dosing appropriate for treatment of herpes zoster) or 200 mg given orally 5 times
a day (dosing appropriate for treatment of genital herpes). Plasma drug concentrations in animal studies are expressed as
multiples of human exposure to acyclovir at the higher and lower dosing schedules (see CLINICAL PHARMACOLOGY, Pharmacokinetics).
Acyclovir was tested in lifetime bioassays in rats and mice at single daily doses of up to 450 mg/kg administered by gavage.
There was no statistically significant difference in the incidence of tumors between treated and control animals, nor did
acyclovir shorten the latency of tumors. Maximum plasma concentrations were 3 to 6 times human levels in the mouse bioassay
and 1 to 2 times human levels in the rat bioassay.
Acyclovir was tested in 16 in vitro and in vivo genetic toxicity assays. Acyclovir was positive in 5 of the assays.
Acyclovir did not impair fertility or reproduction in mice (450 mg/kg/day, p.o.) or in rats (25 mg/kg/day, s.c.). In the mouse
study, plasma levels were 9 to 18 times human levels, while in the rat study, they were 8 to 15 times human levels. At higher
doses (50 mg/kg/day, s.c.) in rats and rabbits (11 to 22 and 16 to 31 times human levels, respectively) implantation efficacy,
but not litter size, was decreased. In a rat peri- and post-natal study at 50 mg/kg/day, s.c., there was a statistically significant
decrease in group mean numbers of corpora lutea, total implantation sites, and live fetuses.
No testicular abnormalities were seen in dogs given 50 mg/kg/day, IV for 1 month (21 to 41 times human levels) or in dogs
given 60 mg/kg/day orally for 1 year (6 to 12 times human levels). Testicular atrophy and aspermatogenesis were observed in
rats and dogs at higher dose levels.
Pregnancy
Teratogenic Effects
Pregnancy category B
Acyclovir administered during organogenesis was not teratogenic in the mouse (450 mg/kg/day, p.o.), rabbit (50 mg/kg/day,
s.c. and IV), or rat (50 mg/kg/day, s.c.). These exposures resulted in plasma levels 9 and 18, 16 and 106, and 11 and 22 times,
respectively, human levels.
There are no adequate and well-controlled studies in pregnant women. A prospective epidemiologic registry of acyclovir use
during pregnancy was established in 1984 and completed in April 1999. There were 749 pregnancies followed in women exposed
to systemic acyclovir during the first trimester of pregnancy resulting in 756 outcomes. The occurrence rate of birth defects
approximates that found in the general population. However, the small size of the registry is insufficient to evaluate the
risk for less common defects or to permit reliable or definitive conclusions regarding the safety of acyclovir in pregnant
women and their developing fetuses. Acyclovir should be used during pregnancy only if the potential benefit justifies the
potential risk to the fetus.
Nursing Mothers
Acyclovir concentrations have been documented in breast milk in 2 women following oral administration of acyclovir and ranged
from 0.6 to 4.1 times corresponding plasma levels. These concentrations would potentially expose the nursing infant to a dose
of acyclovir up to 0.3 mg/kg/day. Acyclovir should be administered to a nursing mother with caution and only when indicated.
Pediatric Use
Safety and effectiveness of oral formulations of acyclovir in pediatric patients younger than 2 years of age have not been
established.
Geriatric Use
Of 376 subjects who received acyclovir in a clinical study of herpes zoster treatment in immunocompetent subjects ≥ 50 years
of age, 244 were 65 and over while 111 were 75 and over. No overall differences in effectiveness for time to cessation of
new lesion formation or time to healing were reported between geriatric subjects and younger adult subjects. The duration
of pain after healing was longer in patients 65 and over. Nausea, vomiting, and dizziness were reported more frequently in
elderly subjects. Elderly patients are more likely to have reduced renal function and require dose reduction. Elderly patients
are also more likely to have renal or CNS adverse events. With respect to CNS adverse events observed during clinical practice,
somnolence, hallucinations, confusion, and coma were reported more frequently in elderly patients (see CLINICAL PHARMACOLOGY; ADVERSE REACTIONS, Observed During Clinical Practice; and DOSAGE AND ADMINISTRATION).
ADVERSE REACTIONS
Herpes Simplex
Short-Term Administration
The most frequent adverse events reported during clinical trials of treatment of genital herpes with acyclovir 200 mg administered
orally 5 times daily every 4 hours for 10 days were nausea and/or vomiting in 8 of 298 patient treatments (2.7%). Nausea and/or
vomiting occurred in 2 of 287 (0.7%) patients who received placebo.
Long-Term Administration
The most frequent adverse events reported in a clinical trial for the prevention of recurrences with continuous administration
of 400 mg (two 200 mg capsules) 2 times daily for 1 year in 586 patients treated with acyclovir were nausea (4.8%) and diarrhea
(2.4%). The 589 control patients receiving intermittent treatment of recurrences with acyclovir for 1 year reported diarrhea
(2.7%), nausea (2.4%), and headache (2.2%).
Herpes Zoster
The most frequent adverse event reported during 3 clinical trials of treatment of herpes zoster (shingles) with 800 mg of
oral acyclovir 5 times daily for 7 to 10 days in 323 patients was malaise (11.5%). The 323 placebo recipients reported malaise
(11.1%).
Chickenpox
The most frequent adverse event reported during 3 clinical trials of treatment of chickenpox with oral acyclovir at doses
of 10 to 20 mg/kg 4 times daily for 5 to 7 days or 800 mg 4 times daily for 5 days in 495 patients was diarrhea (3.2%). The
498 patients receiving placebo reported diarrhea (2.2%).
Observed During Clinical Practice
In addition to adverse events reported from clinical trials, the following events have been identified during post-approval
use of acyclovir. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be
made. These events have been chosen for inclusion due to either their seriousness, frequency of reporting, potential causal
connection to acyclovir, or a combination of these factors.
Aggressive behavior, agitation, ataxia, coma, confusion, decreased consciousness, delirium, dizziness, dysarthria, encephalopathy,
hallucinations, paresthesia, psychosis, seizure, somnolence, tremors. These symptoms may be marked, particularly in older
adults or in patients with renal impairment (see PRECAUTIONS).
Overdoses involving ingestion of up to 100 capsules (20 g) have been reported. Adverse events that have been reported in association
with overdosage include agitation, coma, seizures, and lethargy. Precipitation of acyclovir in renal tubules may occur when
the solubility (2.5 mg/mL) is exceeded in the intratubular fluid. Overdosage has been reported following bolus injections
or inappropriately high doses and in patients whose fluid and electrolyte balance were not properly monitored. This has resulted
in elevated BUN and serum creatinine and subsequent renal failure. In the event of acute renal failure and anuria, the patient
may benefit from hemodialysis until renal function is restored (see DOSAGE AND ADMINISTRATION).
DOSAGE AND ADMINISTRATION
Acute Treatment of Herpes Zoster
800 mg every 4 hours orally, 5 times daily for 7 to 10 days.
Genital Herpes
Treatment of Initial Genital Herpes
200 mg every 4 hours, 5 times daily for 10 days.
Chronic Suppressive Therapy for Recurrent Disease
400 mg 2 times daily for up to 12 months, followed by re-evaluation. Alternative regimens have included doses ranging from
200 mg 3 times daily to 200 mg 5 times daily.
The frequency and severity of episodes of untreated genital herpes may change over time. After 1 year of therapy, the frequency
and severity of the patient’s genital herpes infection should be re-evaluated to assess the need for continuation of therapy
with acyclovir.
Intermittent Therapy
200 mg every 4 hours, 5 times daily for 5 days. Therapy should be initiated at the earliest sign or symptom (prodrome) of
recurrence.
Treatment of Chickenpox
Children (2 years of age and older)
20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Children over 40 kg should receive the adult dose for chickenpox.
Adults and Children over 40 kg
800 mg 4 times daily for 5 days.
Intravenous acyclovir is indicated for the treatment of varicella-zoster infections in immunocompromised patients.
When therapy is indicated, it should be initiated at the earliest sign or symptom of chickenpox. There is no information about
the efficacy of therapy initiated more than 24 hours after onset of signs and symptoms.
Patients with Acute or Chronic Renal Impairment
In patients with renal impairment, the dose of acyclovir capsules and tablets should be modified as shown in Table 3:
Table 3: Dosage Modification for Renal Impairment
Normal Dosage Regimen
Creatinine Clearance (mL/min/1.73 m2)
Adjusted Dosage Regimen
200 mg every 4 hours
> 10 0 to 10
200 200
every 4 hours, 5x daily every 12 hours
400 mg every 12 hours
> 10 0 to 10
400 200
every 12 hours every 12 hours
800 mg every 4 hours
> 25 10 to 25 0 to 10
800 800 800
every 4 hours, 5x daily every 8 hours every 12 hours
Hemodialysis
For patients who require hemodialysis, the mean plasma half-life of acyclovir during hemodialysis is approximately 5 hours.
This results in a 60% decrease in plasma concentrations following a 6 hour dialysis period. Therefore, the patient’s dosing
schedule should be adjusted so that an additional dose is administered after each dialysis.
Peritoneal Dialysis
No supplemental dose appears to be necessary after adjustment of the dosing interval.
Bioequivalence of Dosage Forms
Acyclovir suspension was shown to be bioequivalent to acyclovir capsules (n = 20) and 1 acyclovir 800 mg tablet was shown
to be bioequivalent to 4 acyclovir 200 mg capsules (n = 24).
HOW SUPPLIED
Acyclovir capsules USP are available containing 200 mg acyclovir. Each opaque blue cap and body size #1 hard gelatin capsule
is imprinted with black ink N 940 and 200 on opposing cap and body portion of the capsule.
They are supplied as follows:
NDC 0093-8940-01 Bottles of 100
NDC 0093-8940-05 Bottles of 500
Acyclovir tablets USP are available containing 400 mg acyclovir. Each blue colored, biconvex, capsule shaped, compressed unscored
tablet is debossed with N943 on one side and 400 on the other side.
They are supplied as follows:
NDC 0093-8943-01 Bottles of 100
NDC 0093-8943-05 Bottles of 500
Acyclovir tablets USP are available containing 800 mg acyclovir. Each white to off-white colored, biconvex, capsule shaped,
compressed unscored tablet is debossed with N947 on one side and 800 on the other side.
They are supplied as follows:
NDC 0093-8947-01 Bottles of 100
NDC 0093-8947-05 Bottles of 500
Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature]. Protect from light and moisture.
MedlinePlus Drug Information: Acyclovir TopicalOther uses for this medicine. What special precautions ... is best to begin using acyclovir ointment as soon as possible ... Use topical acyclovir exactly ...
Drug Information for Acyclovir Oral - WebMD... for Acyclovir Oral including side effects, drug interactions, images and pictures, medication uses, warnings, user ... Use caution while driving, using ...
Acyclovir (84:04.06) - 381036For other uses of acyclovir, see 8:18.32. Dosage and Administration. Administration ... Clinical studies using topical acyclovir 5% cream or ointment did not include ...
General Information on Acyclovir related to Obtundation
Approximately 1% of patients receiving intravenous Acyclovir have manifested encephalopathic changes characterized by either lethargy, obtundation, tremors, confusion ...
View complete and up to date Acyclovir information - part of the Drugs.com trusted ... Headache, agitation, coma, confusion, delirium, dizziness, hallucinations, obtundation ...
Approximately 1% of patients receiving intravenous acyclovir have manifested encephalopathic changes characterized by either lethargy, obtundation, tremors, confusion ...
Acyclovir Settlements
GravityXP.net - elfwoo2's profileyou are allergic to any ingredient in Valtrex or to acyclovir. ... open sachets containing settlements effexor nc unused portion of cream should be ...
Listing | Atlanta Party Serviceshtml', 'While most people have no problems with acyclovir cream, side effects are possible. ... ELI LILLY CYMBALTA SETTLEMENTS ...
MSU - Events for 2003-11-03The drug acyclovir has long been used to suppress outbreaks of oral and genital herpes. ... of codeine toxicity are respiratory depression and obtundation. ...
Clickjujuy - Recorriendo JujuyshowDescription(event, '/acyclovir-cream/what-is-acyclovir-cream-used-for. ... As importantly, our settlements confer a meaningful benefit to U. LNG terminal ...
Complete Acyclovir information from Drugs.comDrug Interactions Probenecid. IV acyclovir plasma levels may be increased, and the duration of action ... agitation, coma, confusion, delirium, dizziness, hallucinations, obtundation ...
Acyclovir Official FDA information, side effects and uses.Accurate, FDA approved Acyclovir ... Drug Interactions. Coadministration of probenecid with Acyclovir has been shown to increase ... characterized by either lethargy, obtundation ...
The library table of contents The Table of contents listsing for the Library section of ...AcyclovirRecall. AcyclovirRecall #2. Advocate, The COPD. Alkalosis, respiratory. Allegra Recall...
Acyclovir Topical; Greenville North Carolina NC Acyclovir Topical - University Health Systems of Greenville North Carolina serves tarboro, ahoskie, ... Future of Medicine Health Observances Product Recalls...
Search for Pet Food Recalls announced a voluntary recall of the Glowin Dino and Glowin Doggy Animal Flashlight. ... Information Acyclovir Information Capital One - acquired ...
AUGUST 2000 ... the most up-to-date list of products under recall by Phyne Pharmaceuticals. ... PRODUCT: a) ACYCLOVIR FOR INJECTION 500 MG, 10 ML VIAL, NDC 59911-2465-02, RX. ...
www.anellomedicalwriting.comacyclovir sodium. amantadine hydrochloride. amprenavir ... encephalopathic changes, including lethargy, obtundation ... other prescription or OTC drugs, including herbal remedies
SE: Detroit Photo Gallery - Last additions/IMG 0055 ... to recall, for such a depth valtrex except sergei acyclovir ... codeine toxicity are respiratory depression and obtundation. ... or times a group educational claritin medicine remedies ...
Autopsy Report Words: Single Words. AUTOPSY REPORT WORDS: SINGLE WORDS. Version 1.0. G. William Moore, MD, PhD. Jules J. Berman, PhD, MD. Grover M. Hutchins, MD. Robert E. Miller, MD.
