Armodafinil reduces extreme sleepiness due to narcolepsy and other sleep disorders, such as periods of stopped breathing during sleep (obstructive sleep apnea). It is also used to help you stay awake during work hours if you have a work schedule that keeps you from having a normal sleep routine (shift work sleep disorder).

This medication does not cure these sleep disorders and may not get rid of all your sleepiness. Armodafinil does not take the place of getting enough sleep. It should not be used to treat tiredness or hold off sleep in people who do not have a sleep disorder.

Armodafinil is readily absorbed after oral administration. The absolute oral bioavailability was not determined due to the aqueous insolubility of armodafinil, which precluded intravenous administration. Peak plasma concentrations are attained at approximately 2 hours in the fasted state. Food effect on the overall bioavailability of armodafinil is considered minimal; however, time to reach peak concentration may be delayed 2–4 hours in the fed state. Since the delay in T_max is also associated with elevated plasma concentration later in time, food can potentially affect the onset and time course of pharmacologic action of armodafinil.

Usual Adult Dose for Narcolepsy

150 to 250 mg orally once a day in the morning

Comments:
-In obstructive sleep apnea (OSA), doses up to 250 mg/day have been well-tolerated but there is no consistent evidence of additional benefit beyond the 150 mg/day dose.
-In OSA, this drug is not a treatment for the underlying obstruction.
-In cases where continuous positive airway pressure (CPAP) is the treatment of choice for excessive sleepiness, a maximal effort to treat with CPAP for an adequate period of time should be made prior to initiating this drug.

Use: Treatment to improve wakefulness in patients with excessive sleepiness associated with OSA and narcolepsy.

Usual Adult Dose for Obstructive Sleep Apnea/Hypopnea Syndrome

150 to 250 mg orally once a day in the morning

Comments:
-In obstructive sleep apnea (OSA), doses up to 250 mg/day have been well-tolerated but there is no consistent evidence of additional benefit beyond the 150 mg/day dose.
-In OSA, this drug is not a treatment for the underlying obstruction.
-In cases where continuous positive airway pressure (CPAP) is the treatment of choice for excessive sleepiness, a maximal effort to treat with CPAP for an adequate period of time should be made prior to initiating this drug.

Use: Treatment to improve wakefulness in patients with excessive sleepiness associated with OSA and narcolepsy.

Usual Adult Dose for Shift Work Sleep Disorder

150 mg orally once a day approximately 1 hour prior to the start of the work shift

Use: Treatment to improve wakefulness in patients with excessive sleepiness associated with shift work disorder.

Headache, nausea, dry mouth, nervousness, dizziness, or difficulty sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Modafinil tablets are indicated to improve wakefulness in adult patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD).

Modafinil is a stimulant drug marketed as a ‘wakefulness promoting agent’ and is one of the stimulants used in the treatment of narcolepsy.

Although the mechanism of action of modafinil was initially unknown, it now appears that the drug acts as a selective, relatively weak, atypical dopamine reuptake inhibitor. However, it appears that other additional mechanisms may also be at play.

Modafinil is also used off-label to treat sedation and fatigue in many conditions, including depression, fibromyalgia, chronic fatigue syndrome, myotonic dystrophy, opioid-induced sleepiness, spastic cerebral palsy, and Parkinson’s disease. Modafinil has been shown to improve excessive daytime somnolence and fatigue in primary biliary cirrhosis.

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PROVIGIL (modafinil) is a wakefulness-promoting agent for oral administration. Modafinil is a racemic compound. The chemical name for modafinil is 2-[(diphenylmethyl)sulfinyl]acetamide.
The molecular formula is C15H15NO2S and the molecular weight is
Modafinil is a white to off-white, crystalline powder that ispractically insoluble in water and cyclohexane. It is sparingly to slightly soluble in methanol and acetone. PROVIGIL tablets
contain 200 mg of modafinil and the following inactive ingredients: lactose, microcrystalline cellulose, pregelatinized starch, croscarmellose sodium, povidone, and magnesium stearate.

Modafinil is usually taken each morning to prevent daytime sleepiness, or 1 hour before the start of a work shift to treat work-time sleep disorders.

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (tablets):

For narcolepsy or obstructive sleep apnea/hypopnea syndrome:

Adults and teenagers 17 years of age and older—200 milligrams (mg) once a day, in the morning. Your doctor may increase your dose as needed.

Teenagers and children younger than 17 years of age—Use and dose must be determined by your doctor.

For shift work sleep disorder:

Adults and teenagers 17 years of age and older—200 milligrams (mg) one hour before you begin working.

Teenagers and children younger than 17 years of age—Use and dose must be determined by your doctor.

• • Missed Dose

    If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

    If you miss a dose of modafinil and you remember it before 12:00 noon the same day, take the missed dose as soon as possible.

    Storage

    Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

    Keep out of the reach of children.

    Do not keep outdated medicine or medicine no longer needed.

    Ask your healthcare professional how you should dispose of any medicine you do not use.

Modafinil may cause serious side effects. Call your doctor or get emergency help if you get any of the following:

• a serious rash or serious allergic reaction. (See, “What is the most important information I should know about Modafinil.”)
• mental (psychiatric) symptoms. Symptoms include depression, anxiety, hallucinations, mania, thoughts of suicide or other mental problems.
• heart problems including chest pain

The most common side effects of Modafinil are headache, nausea, nervousness, stuffy nose, diarrhea, back pain, anxiety, trouble sleeping, dizziness, and upset stomach. Modafinil may cause allergic reactions. If you get a rash, hives or other allergic reaction, stop taking Modafinil and call your doctor right away.
If you have either of the problems listed below or any other serious side effects while taking Modafinil stop taking Modafiniland call your doctor or get emergency help:

• chest pain.
• mental problems.

Some effects of Modafinil on the brain are the same as other medicines called “stimulants”. These effects may lead to abuse or dependence on Modafinil. Before starting Modafinil, tell your doctor if you have ever abused drugs, including other stimulant medicines.

The active substance tablets “Zhewitra 20 / 40” – Vardenafil. It is known as an effective inhibitor of type 5 phosphodiesterase. From Sildenafil (Viagra) it is distinguished by a more powerful effect and a prolonged effect. Vardenafil is well tolerated and is quickly excreted through the kidneys. In plasma, the maximum amount of active substance is observed after 2 hours.

Due to the inhibition of PDE-5, the smooth muscles of the penis relax. This allows a large amount of blood to freely penetrate to the genitals. Here it is absorbed into the cavernous bodies of the penis, providing a stable erection.

The Zhewitra is in the form of tablets for oral administration. The whole tablet or part of it is taken inside for half an hour before sexual activity once every 24 hours and washed down with a small amount of water.

Generic Zhewitra 20 mg or 40mg does not lose its activity when combined with food and alcohol. And this is his huge advantage over other similar means, because sex is often preceded by a romantic dinner with fatty foods and alcohol.

But, when taking alcohol, you need to remember about the measure. The fact that he itself inhibits sexual processes and is a big load on the body. It is better if the amount of alcohol is limited to one or two glasses of wine.

Tell your doctor as soon as possible if you notice any of the following:
Headaches, Persistent nausea, Mood changes, Vomiting, Painful erection or a prolonged erection that persists for more than 4 hours(that can be damaging for penis) etc.
In above cases you must go for immediate medical help. Do not get alarmed by the list. You may /may not experience all of them. Tell your doctor immediately in the above situations.

Tramadol is a synthetic opioid of the benzenoid class (it contains a benzene ring). In the body it is metabolized to O-desmethyltramadol, which is a more potent opioid.

Tramadol was launched and marketed as “Tramal” by the German pharmaceutical company Grünenthal GmbH in 1977 in West Germany, and 20 years later it was launched in countries such as the UK, US, and Australia. It is marketed under many brand names worldwide.

Tramadol is used primarily to treat mild–severe pain, both acute and chronic.

Its analgesic effects take about one hour to come into effect and 2 h to 4 h to peak after oral administration with an immediate-release formulation. On a dose-by-dose basis tramadol has about one-tenth the potency of morphine and is approximately equally potent when compared to pethidine and codeine.

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For pain moderate in severity its effectiveness is equivalent to that of morphine; for severe pain it is less effective than morphine.These painkilling effects peak at about 3 h, post-oral administration and last for approximately 6 h.

Available dosage forms include liquids, syrups, drops, elixirs, effervescent tablets and powders for mixing with water, capsules, tablets including extended release formulations, suppositories, compounding powder, and injections.

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For chronic pain:
  • For oral dosage form (extended-release tablets):
    • Adults—At first, 100 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 300 mg per day.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults and teenagers 16 years of age and older—At first, 50 to 100 milligrams (mg) every four to six hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 400 mg per day.
    • Children younger than 16 years of age—Use and dose must be determined by your doctor.

• For moderate to severe pain:
  • For oral dosage form (disintegrating tablets):
    • Adults and teenagers 16 years of age and older—At first, 50 to 100 milligrams (mg) every four to six hours as needed. Your doctor may increase your dose as needed. However, the dose is usually not more than 400 mg per day.
    • Children younger than 16 years of age—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults and teenagers 16 years of age and older—At first, 25 milligrams (mg) per day, taken every morning. Your doctor may increase your dose as needed. However, the dose is usually not more than 400 mg per day.
    • Children younger than 16 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Serious side effects may include seizures, increased risk of serotonin syndrome, decreased alertness, and drug addiction, although the risk of serotonin syndrome appears to be low. Common side effects include: constipation, itchiness and nausea, among others. A change in dosage may be recommended in those with kidney or liver problems. It is not recommended in those who are at risk of suicide. While not recommended in women who are breastfeeding, those who take it should not stop breastfeeding.

Sildenafil citrate is the active ingredient in Cenforce.

Cenforce 100mg is used for treatment of men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.

Cenforce is used to treat erectile dysfunction (ED). ED is the inability to get or maintain an erection.

Cenforce 100mg (Sildenafil 100mg) belongs to a group of medicines called phosphodiesterase type 5 inhibitors. It works by helping to relax the blood vessels in your penis, allowing blood to flow into your penis when you get sexually excited.

In order for Sildenafil to be effective, sexual stimulation is required.

While ED is a common occurrence in men, if it is a chronic problem, it is important to get a checkup. Chronic ED can be a symptom of a serious medical condition.

When taking Cenforce, follow your doctor’s instructions. Do not start, stop, or change your dosage without consulting with your doctor.

One Cenforce tablet should be taken with a full glass of water. Do not chew, crush, or break the tablets.

There is little chance of experiencing an accidental overdose of Cenforce; as it is only taken when needed, not to exceed one tablet within a 24 hour period.

Like all medicines, Cenforce 100mg can cause side effects although not everybody gets them. The side effects reported in association with the use of Cenforce 100mg are usually mild to moderate and of a short duration.

All medicines, including Cenforce 100mg can cause allergic reactions. You should contact your doctor immediately if you experience any of the following symptoms after taking Sildenafil: sudden wheeziness, difficulty in breathing or dizziness, swelling of the eyelids, face, lips or throat.

Cenforce should not be taken if you have or are:

• allergic to sildenafil citrate or any of its ingredients
• chronic bladder infections
• diabetes
• heart disease
• kidney disease
• thyroid disorder

Tadarise is indicated for treatment of erectile dysfunction, for signs and symptoms of benign prostate hyperplasia in male adult patients, and is also marketed as Adcirca (R) Cialis (R) for the treatments of pulmonary arterial hypertension (PAH).

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Tadalafil is recommended as an ‘as needed’ medication.

Generic Cialis is the only one of the three that is also offered as a once-daily medication.

The Sunrise Remedies has manufactures Tadarise within more than 15 year, from 1998 year.

The most commonly reported adverse reactions were headache, nausea, dyspepsia, back pain, myalgia, flushing, nasopharyngitis, and pain in the extremity. These adverse reactions were dose dependent, transient, and generally mild or moderate.

Usual Adult Dose for Erectile Dysfunction

Use as needed for ED:
Initial dose: 10 mg orally once a day, as needed, prior to sexual activity
Maintenance dose: 5 to 20 mg orally once a day, as needed, prior to sexual activity based on individual efficacy and tolerability.

Usual Adult Dose for Pulmonary Hypertension

Tadarise:
40 mg orally once a day

Comment: Dividing the 40 mg dose over the course of the day is not recommended.

Zopiclone (brand names Zimovane and Imovane) is a nonbenzodiazepine hypnotic agent used in the treatment of insomnia. It is a cyclopyrrolone, which increases the normal transmission of the neurotransmitter gamma-Aminobutyric acid in the central nervous system, as benzodiazepines do, but in a different way.

As zopiclone is sedating, it is marketed as a sleeping pill. It works by causing a depression or tranquilization of the central nervous system. After prolonged use, the body can become accustomed to the effects of zopiclone. When the dose is then reduced or the drug is abruptly stopped, withdrawal symptoms may result. These can include a range of symptoms similar to those of benzodiazepine withdrawal. Although withdrawal from therapeutic doses of zopiclone and its isomers (i.e. eszopiclone) do not typically present with convulsions and are therefore not considered life-threatening, patients may experience such significant agitation or anxiety that they seek emergency medical attention.

Insomnia, or poor sleep, is fairly common but it does not usually last for long. It may mean that you have difficulty getting off to sleep, or you may wake up for long periods during the night, or you may wake up too early in the morning. ‘Sleeping tablets’ like zopiclone are considered to be a last resort, but they are sometimes prescribed for a short period of time to help with a particularly bad patch of insomnia.

Zopiclone belongs to a class of medicines commonly called Z drugs. It works by acting on the way messages are sent in your brain, which help you to sleep. It reduces the time it takes for you to fall asleep and increases the length of time you spend sleeping.

Zopiclone will often work well in the short term, but it is not normally prescribed for more than two to four weeks. This is because your body gets used to it within a short period of time and after this it is unlikely to have the same effect. Your body may also become dependent on it when it is taken for longer periods of time than this.

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Carisoprodol is a prescription drug. It comes in the form of a tablet you take by mouth.

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Carisoprodol is often used for the acute treatment of severe muscle spasm. It is metabolized to an active metabolite, meprobamate, which is highly addictive due to its effect on GABA_A receptors in the brain. Carisoprodol is used for short-term management of acute spasm due to its potential for abuse.

Pregabalin, marketed under the brand name Lyrica among others, is a medication used to treat epilepsy, neuropathic pain, fibromyalgia, and generalized anxiety disorder. Its use for epilepsy is as an add-on therapy for partial seizures with or without secondary generalization in adults. Some off-label uses of pregabalin include restless leg syndrome, prevention of migraines, social anxiety disorder, and alcohol withdrawal.

Seizure

Pregabalin is useful when added to other treatments, when those other treatments are not controlling partial epilepsy. Its use alone is less effective than some other seizure medications. It is unclear how it compares to gabapentin for this use.

Neuropathic pain

The European Federation of Neurological Societies recommends pregabalin as a first line agent for the treatment of pain associated with diabetic neuropathy, post-herpetic neuralgia, and central neuropathic pain. A minority obtain substantial benefit, and a larger number obtain moderate benefit. Other first line agents, including gabapentin and tricyclic antidepressants, are given equal weight as first line agents, and unlike pregabalin, are available as less expensive generics.

Pregabalin is not recommended for certain other types of neuropathic pain such as pain that of trigeminal neuralgia and its use in cancer-associated neuropathic pain is controversial. There is no evidence for its use in the prevention of migraines and gabapentin has been found not to be useful. It has been examined for the prevention of post-surgical chronic pain, but its utility for this purpose is controversial.

Pregabalin is generally not regarded as efficacious in the treatment of acute pain. Trials examining the utility of pregabalin for the treatment of acute post-surgical pain, no effect on overall pain levels was observed, but people did require less morphine and had fewer opioid-related side effects. Several possible mechanisms for pain improvement have been discussed.

Anxiety disorders

The World Federation of Biological Psychiatry recommends pregabalin as one of several first line agents for the treatment of generalized anxiety disorder, but recommends other agents such as SSRIs as first line treatment for obsessive-compulsive disorder and post-traumatic stress disorder. It appears to have anxiolytic effects similar to benzodiazepines with less risk of dependence.

The effects of pregabalin appear after 1 week of use and is similar in effectiveness to lorazepam, alprazolam, and venlafaxine, but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychosomatic anxiety symptoms. Long-term trials have shown continued effectiveness without the development of tolerance, and, in addition, unlike benzodiazepines, it has a beneficial effect on sleep and sleep architecture, characterized by the enhancement of slow-wave sleep. It produces less severe cognitive and psychomotor impairment compared to those drugs; it also has a low potential for abuse and dependence and may be preferred over the benzodiazepines for these reasons.

Usual Adult Dose for Diabetic Neuropathy

-Initial dose: 50 mg orally 3 times a day
-Titration: The dose may be increased to 100 mg orally 3 times a day within 1 week based on efficacy and tolerability
-Maximum dose: 100 mg orally 3 times a day in patients with a creatinine clearance of at least 60 mL/min

Comment:
-This drug may be taken with or without food.

Use: Management of neuropathic pain associated with diabetic peripheral neuropathy

Usual Adult Dose for Postherpetic Neuralgia

-Initial dose: 75 mg orally 2 times a day OR 50 mg orally 3 times a day
-Titration: The dose may be increased to 100 mg orally 3 times a day within 1 week based on efficacy and tolerability
-Maintenance dose: 75 to 150 mg orally 2 times a day OR 50 to 100 mg orally 3 times a day (150 to 300 mg/day) in patients with a creatinine clearance of at least 60 mL/min
-Maximum dose: Patients who do not experience sufficient pain relief following 2 to 4 weeks of treatment with 300 mg/day and who are able to tolerate this drug, may be treated with up to 300 mg orally 2 times a day or 200 mg orally 3 times a day (due to the dose-dependent adverse effects and the higher rate of treatment discontinuation due to adverse events, dosing above 300 mg/day should be reserved only for those patients who have ongoing pain and are tolerating 300 mg daily)

Comment:
-This drug may be taken with or without food.

Use: Management of postherpetic neuralgia

Usual Adult Dose for Epilepsy

-Initial dose: 75 mg orally 2 times a day OR 50 mg orally 3 times a day
-Maintenance dose: 150 mg/day to 600 mg/day (the total daily dose should be divided and given either 2 or 3 times a day)
-Maximum dose: 600 mg/day in 2 or 3 divided doses based on individual patient response and tolerability

Comments:
-This drug may be taken with or without food.
-The efficacy of add-on therapy in patients taking gabapentin has not been evaluated in controlled trials; therefore, dosing recommendations for the use of this combination cannot be offered.

Use: Adjunctive therapy for adult patients with partial onset seizures

Usual Adult Dose for Fibromyalgia

-Initial dose: 75 mg orally 2 times a day (150 mg/day)
-Titration: The dose may be increased to 150 mg orally 2 times a day (300 mg/day) within 1 week based on efficacy and tolerability
-Maintenance dose: 300 to 450 mg/day in 2 divided doses
-Maximum dose: Patients who do not experience sufficient benefit with 300 mg/day may be further increased to 225 mg orally 2 times a day (450 mg/day)

Comments:
-This drug may be taken with or without food.

Use: Management of fibromyalgia

Although pregabalin was also studied at 600 mg/day, there is no evidence that this dose confers additional benefit and this dose was less well tolerated. In view of the dose-dependent adverse reactions, treatment with doses above 450 mg/day is not recommended.

Usual Adult Dose for Neuropathic Pain

-Initial dose: 75 mg orally 2 times a day
-Titration: The dose may be increased to 150 mg orally 2 times a day within 1 week based on efficacy and tolerability
-Maintenance dose: 150 to 600 mg/day in divided doses
-Maximum dose: Patients who do not experience sufficient pain relief after 2 to 3 weeks of treatment with 150 mg orally 2 times a day and who tolerate this drug may be treated with up to 300 mg orally 2 times a day

Comments:
-This drug may be taken with or without food.

Use: Neuropathic pain associated with spinal cord injury

Renal Dose Adjustments

-CrCl less than 15 mL/min:
Initial dose: 25 mg orally once daily
Maintenance dose: 25 to 75 mg orally once daily
-CrCl 15 to 30 mL/min:
Initial dose: 25 to 50 mg orally per day in 1 to 2 divided doses
Maintenance dose: 25 to 150 mg orally per day in 1 to 2 divided doses
-CrCl 30 to 60 mL/min:
Initial dose: 75 mg orally per day in 2 or 3 divided doses
Maintenance dose: 75 to 300 mg orally per day in 2 to 3 divided doses

For patients undergoing hemodialysis, adjust the daily dose based on renal function; in addition to the daily dose adjustment, administer a supplemental dose immediately following every 4-hour hemodialysis treatment:
-Patients on the 25 mg/day regimen: take one supplemental dose of 25 mg or 50 mg
-Patients on the 25 to 50 mg/day regimen: take one supplemental dose of 50 mg or 75 mg
Patients on the 50 to 75 mg/day regimen: take one supplemental dose of 75 mg or 100 mg
Patients on the 75 mg/day regimen: take one supplemental dose of 100 mg or 150 mg

Pregabalin has been shown to produce therapeutic effects that are similar to other controlled substances. In a study with recreational users of sedative and hypnotic drugs, a 450 mg dose of pregabalin resulted in subjective ratings of a “good drug effect” and “high” and “liking” similar to 30 mg of diazepam. In clinical studies, pregabalin showed a side effect profile similar to other central nervous system depressants.

Acamprosate is thought to stabilize the chemical balance in the brain that would otherwise be disrupted by alcohol withdrawal or benzodiazepine withdrawal, possibly by antagonizing glutaminergic N-methyl-D-aspartate receptors (NMDA) and agonizing gamma-aminobutyric acid (GABA) type A receptors. Treating alcohol addiction by helping certain patients to avoid alcohol. Acamprosate is used in combination with a treatment program that includes social support.

Treating alcohol addiction by helping certain patients to avoid alcohol. Acamprosate is used in combination with a treatment program that includes social support.

Acamprosate is an anti-alcohol agent. It is thought to work by restoring the balance of certain chemicals in the brain of patients who have used large amounts of alcohol.

Usual Adult Dose for Alcohol Dependence

666 mg orally three times a day

Usual Geriatric Dose for Alcohol Dependence

666 mg orally three times a day

Since geriatric patients may be more prone to a decrease in renal function, the manufacturer advises greater care in dose selection and close monitoring of renal function during therapy in this population.

Diarrhea, nausea, vomiting, gas, stomach pain, loss of appetite, headache, drowsiness, dizziness, constipation, fatigue, weight gain/loss, muscle/joint pain, change in sexual desire or decreased sexual ability may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.