Kaelis Med · Clinical Pharmacology, Dublin
Read the label first, then the page
Every page here starts from the current prescribing information for one medicine: the approved strengths, the contraindications, the monitoring the label asks for. We write what the label says, mark where Irish practice differs, and have a clinical pharmacologist read it before it goes up. This is a reference library. It is not a pharmacy, a consultation, or a place to buy anything.
Read the label · Check the numbers · Review · Publish
How a page is written
Four passes. The current label decides disputes. A claim with no traceable source is cut instead of softened.
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01
Read
We start with the approved prescribing information for the molecule and write the first draft from it, not from another site's summary.
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02
Check
Every dose, half-life, and contraindication is verified against DailyMed and against Irish product information. Where the two differ, the page says which is which.
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03
Review
Dr. Priya Natarajan reads the draft for clinical sense. Advice that is technically accurate but useless at the bedside gets rewritten.
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04
Publish
The page is dated, linked to its sources, and put up. A label revision sends it back to the Check stage. Full process on the method page.
One question
Ask the label, then stop
Ten questions on each medicine. Sibling pages link across the same tablet. Old shelf and clip addresses stay where they are.
tadalafil
01How do you get tadalafil in the United States?You get tadalafil on a written US order. A licensed clinician writes the tablet. A pharmacy fills that line. Btadalafil02Is there a generic for Cialis?Yes. Generic Cialis is tadalafil. FDA listed the first US tablet on May 22, 2018. That ANDA was Teva Pharmaceutadalafil03Can you buy Cialis over the counter in the United States?No. Cialis is not an over-the-counter medicine in the United States. FDA has not approved a nonprescription tatadalafil04How soon can Cialis work?At or before 30 minutes, 39 of 75 men on CIALIS 20 mg (52%) and 26 of 74 men on placebo (35%) had at least onetadalafil05How long does Cialis last at 24 hours?At 24 hours after the tablet, the mean per-patient percentage of attempts that led to intercourse was 67% on Ctadalafil06Does a meal change how Cialis is taken?CIALIS can be taken without regard to meals. The rate and extent of tadalafil absorption are not influenced bytadalafil07Is Cialis taken daily or only as needed?The US Cialis label writes two erectile-dysfunction routes. As-needed starts at 10 mg before sexual activity atadalafil08Can you drink alcohol with Cialis?Substantial alcohol - 5 units or more - with tadalafil increased orthostatic signs: dizziness, headache, a fastadalafil09How much tadalafil does the US label write?Once-daily erectile dysfunction on this shelf starts at 2.5 mg and may go to 5 mg. As-needed ED starts at 10 mtadalafil10Does Cialis cause back pain?Back pain after CIALIS often starts 12 to 24 hours after the dose. Myalgia sits on the same clock. Both usualltadalafilsildenafil
01How long does Viagra last at 4 hours?When visual sexual stimulation began 4 hours after the tablet, 13 of 16 men on sildenafil 100 mg (81%) and 5 osildenafil02How soon can Viagra start to work?About one hour before sexual activity is the labelled start for most men on Viagra 50 mg. The swallow can sit sildenafil03How do you get sildenafil in the United States?A licensed US clinician writes sildenafil. A pharmacy fills that line. Brand Viagra and generic sildenafil botsildenafil04Is there a generic for Viagra?Yes. Teva launched the first US generic Viagra on December 11, 2017. Those tablets are 25 mg, 50 mg, and 100 msildenafil05Can you buy Viagra over the counter in the US?No. United States pharmacies still need a written order for Viagra. A licensed clinician writes the tablet. A sildenafil06Does food delay Viagra?Yes, when the meal is high-fat. Tmax is delayed about 60 minutes and Cmax is reduced about 29%. Viagra may stisildenafil07What dose of sildenafil does the US label start?Fifty milligrams about one hour before sexual activity is the labelled start for most men. US tablets are 25 msildenafil08Can you drink alcohol with Viagra?Both are vasodilators, so standing pressure can fall farther when they sit together. Postural dizziness is thesildenafil09Can Viagra be taken every day?Once per day is the cap, not a daily-use indication. Viagra is taken as needed, about 1 hour before sexual actsildenafil10What side effects does Viagra list first?Headache, flushing, dyspepsia, nasal congestion, and abnormal vision are the effects the US Viagra label listssildenafilvardenafil
01How do you get vardenafil in the United States?A clinician writes the order. A licensed US pharmacy fills that line. Brand Levitra and generic vardenafil botvardenafil02Is there a generic for Levitra?Yes. Generic vardenafil tablets exist in 2.5 mg, 5 mg, 10 mg, and 20 mg. They are the same INN as brand Levitrvardenafil03Can you buy Levitra over the counter in the US?No. United States Levitra stays a prescription tablet. Generic vardenafil does too. A clinician writes the linvardenafil04How soon can Levitra start to work?About sixty minutes for the labelled start. Ten milligrams is swallowed roughly an hour before activity. One tvardenafil05How long does Levitra last?Four to five hours is the terminal half-life of vardenafil and its main metabolite M1. That is how long the pavardenafil06Does food change Levitra?You can swallow Levitra with or without food. A high-fat meal can delay how fast it comes on. In the US food-evardenafil07What dose of vardenafil does the US label start?Ten milligrams for most patients. That is the US start, once a day. This shelf locks 10 mg. Later nights can mvardenafil08Can you drink alcohol with Levitra?Alcohol can add a standing-pressure drop when it sits next to vardenafil. It can also blunt the erection you cvardenafil09Can Levitra be taken every day?Once per day is the cap. US Levitra is an as-needed tablet. The label does not write a 2.5 mg or 5 mg every-movardenafil10What side effects does Levitra list first?Headache, flushing, rhinitis, and dyspepsia lead the LEVITRA list. Those four showed a dose effect across 5 mgvardenafilmethocarbamol
01How do you get methocarbamol in the United States?A licensed clinician writes methocarbamol in the United States and a pharmacy fills that line. Robaxin and genmethocarbamol02Is there a generic for Robaxin?Yes. Generic methocarbamol is the usual US fill when the order names Robaxin. The tablets are 500 mg and 750 mmethocarbamol03Can you buy Robaxin over the counter in the US?No. You cannot buy Robaxin over the counter in the United States. Methocarbamol tablets are a human prescriptimethocarbamol04How soon can methocarbamol start to work?Oral effects can show up in the first hours after methocarbamol. The US tablet label does not publish a 20-minmethocarbamol05How long does methocarbamol last?Mean plasma elimination half-life in healthy volunteers is 1 to 2 hours. That is the labelled duration read fomethocarbamol06Does food change methocarbamol?Food can sit with methocarbamol if the stomach is upset. The US tablet label does not publish a food-versus-famethocarbamol07How much methocarbamol does the US label write?1500 mg four times a day is the adult opening on 750 mg tablets: two tablets each time, for 48 to 72 hours. Thmethocarbamol08Can you drink alcohol with methocarbamol?No. Do not drink alcohol with methocarbamol. The tablet may possess a general CNS-depressant effect, and patiemethocarbamol09Does methocarbamol make you drowsy?Yes. Methocarbamol can make you drowsy. Dizziness or lightheadedness sit on the same nervous-system list. Patimethocarbamol10Can methocarbamol change urine color?Yes. Methocarbamol may turn urine brown, black, or green. The tint can show as the urine stands. It can also imethocarbamolpregabalin
01How do you get pregabalin in the United States?A written US order. A licensed clinician puts pregabalin on the chart, and a pharmacy fills that line. Brand Lpregabalin02Is there a generic for Lyrica?Yes. On July 19, 2019 the FDA approved the first US generics of Lyrica. Those bottles say pregabalin. They arepregabalin03Can you buy Lyrica over the counter in the US?No. US pharmacies do not sell Lyrica over the counter. Pregabalin is a prescription capsule and a Schedule V cpregabalin04How soon can pregabalin start to work?Week 1. Some people in the labelled pain studies had less pain that early, and the drop held through the rest pregabalin05How long does pregabalin last?About 6.3 hours. That is the mean elimination half-life in people with normal kidney function. The capsule is pregabalin06Does food change pregabalin?No. The capsule can be swallowed with food or without. A meal slows the peak - Cmax drops about 25% to 30% andpregabalin07How much pregabalin does the US label start?150 mg a day. That is the usual adult start on the US label for the pain uses, given as 75 mg twice a day or 5pregabalin08Can you drink alcohol with pregabalin?No. The Medication Guide says do not drink alcohol while taking LYRICA. The two can increase sleepiness and dipregabalin09Is pregabalin a controlled substance?Yes. Pregabalin is a Schedule V controlled substance in the United States. Brand Lyrica and generic capsules spregabalin10Does pregabalin cause weight gain?Yes. Weight gain is a listed effect. In controlled trials lasting up to 14 weeks, a gain of 7% or more from bapregabalinfurosemide
01How do you get furosemide in the United States?A licensed clinician writes furosemide. A pharmacy fills that line. Brand Lasix and generic furosemide both mofurosemide02Is there a generic for Lasix?Yes. Generic furosemide tablets have been the usual US fill for years. They carry the same active ingredient afurosemide03Can you buy Lasix over the counter in the US?No. Lasix is a US prescription tablet. A grocery aisle does not sell 20 mg, 40 mg, or 80 mg furosemide. A clinfurosemide04How soon can Lasix start to work?About 1 hour. After an oral Lasix tablet, diuresis starts within that first hour. The peak sits in the first ofurosemide05How long does Lasix last?About 6 to 8 hours. That is the labelled duration of the diuretic effect after an oral Lasix tablet. Onset is furosemide06Does food change Lasix?You can swallow the Lasix tablet with food. The US label does not ask for an empty stomach. Morning still setsfurosemide07How much furosemide does the US label write?US Lasix tablets are 20 mg, 40 mg, and 80 mg. For edema the usual first oral dose is 20 to 80 mg as a single sfurosemide08Does Lasix lower potassium?Yes. Lasix can lower potassium. The same watch covers sodium, magnesium, and volume. Serum electrolytes belongfurosemide09When should you take Lasix?Morning. If a second swallow is written, the label example is 8 am and 2 pm. Bedtime is not the default, becaufurosemide10Can you drink alcohol with Lasix?Alcohol can add volume loss and dizziness on a Lasix day. The label already flags postural hypotension, and alfurosemideenalapril
01How do you get enalapril in the United States?A licensed US clinician writes enalapril. A pharmacy then fills that line. Brand Vasotec and generic enalaprilenalapril02Is there a generic for Vasotec?Yes. Generic enalapril maleate tablets are the usual US fill. Vasotec is the brand name on the same 2.5 mg, 5 enalapril03Can you buy enalapril over the counter in the US?No. Enalapril is not sold over the counter in the United States. Vasotec and generic enalapril maleate tabletsenalapril04How soon can enalapril start to work?One hour after a single oral dose, onset of the antihypertensive effect was seen in most patients studied. Peaenalapril05How long does enalapril last?At recommended doses, antihypertensive effects have been maintained for at least 24 hours. In some people the enalapril06Does food change enalapril?Food does not change how much enalapril is absorbed. The label says absorption is not influenced by food in thenalapril07How much enalapril does the US label write?Five milligrams once daily is the usual hypertension start when no diuretic is already on board. If a diureticenalapril08Does enalapril cause a cough?Yes. A persistent dry cough is a listed ACE-inhibitor effect. The label ties it to slowed breakdown of bradykienalapril09Can you take enalapril in pregnancy?No. Stop the tablet when pregnancy is detected. Vasotec's boxed warning is fetal toxicity. Drugs that act direenalapril10Does enalapril raise potassium?Yes. Serum potassium can rise on enalapril. In people treated with Vasotec alone for up to 48 weeks, the mean enalaprilmetformin
01How do you get metformin in the United States?A licensed US clinician writes metformin. A pharmacy fills that line. Brand Glucophage and generic metformin bmetformin02Is there a generic for Glucophage?Yes. Generic metformin is the usual US fill when someone asks for Glucophage. Immediate-release tablets still metformin03Can you buy metformin over the counter in the US?No. Metformin is a US prescription tablet. Glucophage and generic metformin both need a licensed clinician andmetformin04How soon can metformin start to work?Glucose can move over days to weeks. A1c moves over months. Metformin is not a one-swallow fix. Adult immediatmetformin05How long does metformin last?Immediate-release metformin is usually split twice daily. The plasma half-life after an oral dose is about 6.2metformin06Should metformin be taken with food?Yes. Immediate-release metformin is taken with meals. The US Glucophage label puts the 500 mg twice-daily starmetformin07How much metformin does the US label start?Adult starts often open at 500 mg twice daily with meals. 500 mg once daily, or 850 mg once daily with a meal,metformin08Can you drink alcohol with metformin?Excessive alcohol raises the lactic acidosis risk that already sits in metformin's boxed warning. Alcohol potemetformin09Does metformin lower vitamin B12?About 7% of people in 29-week Glucophage trials dropped from a previously normal serum vitamin B12 into the sumetformin10Does metformin cause diarrhea?Yes. Diarrhea is the most common start reaction on immediate-release metformin. Taking the tablet with food anmetforminmetronidazole
01How do you get metronidazole in the United States?A licensed clinician writes metronidazole in the United States. A pharmacy then fills that course. Brand Flagymetronidazole02Is there a generic for Flagyl?Yes. Generic Flagyl is metronidazole. That is the usual US fill. Tablets are 250 mg and 500 mg; this shelf locmetronidazole03Can you buy Flagyl over the counter in the US?No. Flagyl is not sold over the counter in the United States. Metronidazole tablets, 250 mg and 500 mg, need ametronidazole04How soon can Flagyl start to work?Days. Metronidazole reaches peak plasma levels one to two hours after a swallow. That is absorption, not a curmetronidazole05How long does Flagyl last?About eight hours. That is the average elimination half-life of metronidazole in healthy adults. It describes metronidazole06Should Flagyl be taken with food?Yes. You may take Flagyl with food to cut stomach upset. Regular metronidazole tablets are not locked to an emmetronidazole07How much metronidazole does the US label write?Five hundred milligrams is the tablet this shelf locks. US Flagyl tablets also come as 250 mg. Trichomoniasis metronidazole08Can you drink alcohol with Flagyl?No. Do not drink alcohol with Flagyl. The US label keeps alcoholic drinks and propylene glycol products off dumetronidazole09Does Flagyl leave a metallic taste?Yes. A sharp, unpleasant metallic taste is a listed oral reaction to Flagyl. The US label says it is not unusumetronidazole10How long is a Flagyl course?Seven days, or one day, depending on the infection. Trichomoniasis on the US Flagyl tablet label is 2 g once ometronidazolefinasteride
01How do you get finasteride in the United States?A licensed US clinician writes the 1 mg tablet. A pharmacy fills that line. Brand Propecia and generic finastefinasteride02Is there a generic for Propecia?Yes. Generic finasteride 1 mg exists in the United States. A pharmacy can fill that tablet when the written orfinasteride03Can you buy Propecia over the counter in the US?No. Propecia is not over the counter in the United States. Finasteride 1 mg stays behind the pharmacy. A licenfinasteride04How soon can finasteride start to work?Three months or more. The Dosage line says daily use for three months or more is necessary before benefit is ofinasteride05How long do you stay on finasteride?Daily use holds the benefit. Withdrawal of treatment leads to reversal of effect within 12 months. At 12 monthfinasteride06Does food change finasteride?With or without meals. The Administration line allows both. Food does not affect bioavailability of the 1 mg tfinasteride07How much finasteride does the US hair label write?One tablet. The US hair label writes 1 mg once daily. Propecia may be taken with or without meals. Daily use ffinasteride08Can pregnant people take or handle finasteride?No. Propecia is contraindicated in women who are or may become pregnant. The tablet is not indicated for use ifinasteride09Does finasteride change PSA?Yes. PSA falls on finasteride. In the 1 mg hair studies, mean serum PSA decreased from 0.7 ng/mL at baseline tfinasteride10What side effects does finasteride list first?Decreased libido, erectile dysfunction, and ejaculation disorder are the reactions reported in 1 percent or mofinasterideShort notes
One practical question at a time
Timing, monitoring bloods, meals, and reading a brand carton. Each note links back to the full page for the same medicine.
01LEVITRA stays closed with nitratesClip · ED02Nitrates stay off the chart with CIALISClip · ED03CIALIS 20 mg as needed versus placebo in two programsClip · ED04VIAGRA stays closed with organic nitratesClip · ED05LEVITRA 10 mg after radical prostatectomyClip · ED06VIAGRA after spinal cord injuryClip · ED07Hold the keys until you know how methocarbamol sitsClip · CNS08Six grams first, then about four, as an adjunctClip · CNS
Reviewer
Dr. Priya Natarajan reviews the drug pages
Clinical pharmacology, Dublin. Every medicine page passes her review before it is dated and published. She does not prescribe through this site and accepts no industry funding.
Medicines
Ten medicines, ten labelled strengths
One molecule per page. Brand names appear as they are printed on a real carton, which is not the same thing as an offer to sell.
Muscle relaxant · half-life
Methocarbamol plasma half-life in healthy volunteers
Loop diuretic · parenteral rate
High-dose parenteral LASIX stays at 4 mg per minute
Type 2 diabetes · GI program
GLUCOPHAGE gastrointestinal rates in a U.S. program
Fibromyalgia · global impression
LYRICA fibromyalgia program: any improvement on the global impression
Heart failure · mortality program
VASOTEC survival in NYHA Class IV heart failure
ED · once-daily strength
CIALIS 5 mg once daily versus placebo in two programs
Anti-infective · alcohol hold
FLAGYL stays closed with disulfiram and with alcohol
ED · first tablet
VIAGRA 25 mg versus placebo in two programs
ED · usual starting dose
LEVITRA 10 mg versus placebo in two programs
Male pattern hair loss
PROPECIA 1 mg investigator ratings at 12 months
Sources
Where we look before writing
- DailyMed - the controlling US prescribing information.
- HPRA - Irish product information, for when the US label is not the box in the local pharmacy.
- PubMed - the named trials behind any rate we quote.
- Full source list and how to challenge a citation.