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While taking spironolactone, excessive potassium intake should be avoided. This includes avoiding potassium-containing supplements in addition to salt substitutes that contain potassium. Coconut water contains high amounts of potassium and should be avoided. Most other foods, including bananas, are safe to consume in moderation. Drinking alcohol may increase certain spironolactone side effects, such as headache or dizziness.

Hyperkalemia (elevated potassium level in your blood) is a reported serious side effect of spironolactone. Hyperkalemia is rarely seen in young, healthy individuals under 45 without underlying kidney or heart disease. Contact your healthcare provider right away if you experience any of the following symptoms of hyperkalemia:

These are not all of the possible side effects of spironolactone. For more information, ask your healthcare provider or pharmacist.

Contract your healthcare provider for medical advice about side effects. You can message a healthcare provider through your Hers account if you have any questions about your treatment, including any side effects you may be experiencing. You may report side effects to FDA by calling 1-800-FDA-1088 or visiting http://www.fda.gov/MedWatch.

Yes, spironolactone can potentially cause birth defects in a developing fetus (e.g., feminization of a male fetus). If you are concerned that your birth control method was ineffective or failed, over-the-counter emergency contraception is available but must be taken within 72 hours (3 days) following the sexual act. Prescription emergency contraception (ella®) is also available through a healthcare provider and must be taken within 5 days following the sexual act.

Oral contraceptive pills are often prescribed with spironolactone as a form of birth control and to help maintain regular menstrual periods while preventing side effects, such as breast tenderness.

If you become pregnant while taking spironolactone, you should immediately stop taking spironolactone and inform a medical professional.

Through the Hers platform, topical finasteride + minoxidil spray is only available to women aged 43 and over, who are on a reliable form of birth control.

Topical finasteride + minoxidil spray is a prescription medication used for the treatment of female pattern hair loss (androgenetic alopecia).

Unlike oral finasteride (which is FDA-approved only for use in men), topical finasteride + minoxidil spray is a compounded product and has not been approved by the FDA. It is only available if prescribed after an online consultation with a medical provider through the Hers platform.

The use of topical finasteride to treat hair loss has not been as comprehensively studied as oral finasteride. While research has shown that serum DHT levels decrease while using topical finasteride, the systemic side effects (e.g., sexual dysfunction) typically associated with oral finasteride were not reported in the studies of topical finasteride.

Do not use other topical minoxidil or topical finasteride products while you are using this topical finasteride 0.3% + minoxidil 6% spray.

Do not allow individuals who are pregnant or breastfeeding, individuals who have the potential to become pregnant, or children handle this medication. Do not allow any of these individuals to come into contact with the treatment site (your scalp) after the medication has been applied. If they do, they should immediately clean the site of contact on their skin with soap and water.

The most common side effects of topical finasteride + minoxidil spray typically occur at the site of medication application (scalp). These side effects include:

These are not all of the possible side effects of topical finasteride + minoxidil spray. For more information, ask your healthcare provider or pharmacist.

Contact your healthcare provider for medical advice about side effects. You can message a healthcare provider through your Hers account if you have any questions about your treatment, including any side effects you may be experiencing. You may report side effects to FDA by calling 1-800-FDA-1088 or visiting http://www.fda.gov/MedWatch.

There is the potential for hair growth to occur on any skin that this medication comes into contact with after repeated use. For this reason, only apply the topical finasteride + minoxidil spray to the scalp, and carefully blot any excess to avoid it running onto your face. If it does get on your face, clean off the medication with gentle soap and water.

These are some of the more common side effects of oral minoxidil:

If you experience any of the above side effects, contact your provider as you may benefit from a dose adjustment or change in treatment.

Oral minoxidil can cause early hair shedding as beneficial hair cycling is triggered. This is an expected side effect that will improve with continued minoxidil use.

Minoxidil may cause changes to your EKG; tell your doctor prior to an EKG if you are taking oral minoxidil.

The above symptoms may be signs of a more serious reaction.

These are not all of the possible side effects of oral minoxidil. For more information, ask your healthcare provider or pharmacist. Contact your healthcare provider for medical advice about side effects. You can message a healthcare provider through your Hers account if you have any questions about your treatment, including any side effects you may be experiencing. You may report side effects to FDA by calling 1-800-FDA-1088 or visiting http://www.fda.gov/MedWatch.

These are some of the more common side effects of oral minoxidil:

If you experience any of the above side effects, contact your provider as you may benefit from a dose adjustment or change in treatment.

Oral minoxidil can cause early hair shedding as beneficial hair cycling is triggered. This is an expected side effect that will improve with continued minoxidil use.

The above symptoms may be signs of a more serious reaction.

These are not all of the possible side effects of oral minoxidil. For more information, ask your healthcare provider or pharmacist. Contact your healthcare provider for medical advice about side effects. You can message a healthcare provider through your Hers account if you have any questions about your treatment, including any side effects you may be experiencing. You may report side effects to FDA by calling 1-800-FDA-1088 or visiting http://www.fda.gov/MedWatch.

While taking spironolactone, excessive potassium intake should be avoided. This includes avoiding potassium-containing supplements in addition to salt substitutes that contain potassium. Coconut water contains high amounts of potassium and should be avoided. Most other foods, including bananas, are safe to consume in moderation. Drinking alcohol may increase certain spironolactone side effects, such as headache or dizziness.

Hyperkalemia (elevated potassium level in your blood) is a reported serious side effect of spironolactone. Hyperkalemia is rarely seen in young, healthy individuals under 45 without underlying kidney or heart disease. Contact your healthcare provider right away if you experience any of the following symptoms of hyperkalemia:

These are not all of the possible side effects of spironolactone. For more information, ask your healthcare provider or pharmacist.

Contract your healthcare provider for medical advice about side effects. You can message a healthcare provider through your Hers account if you have any questions about your treatment, including any side effects you may be experiencing. You may report side effects to FDA by calling 1-800-FDA-1088 or visiting http://www.fda.gov/MedWatch.

Yes, spironolactone can potentially cause birth defects in a developing fetus (e.g., feminization of a male fetus). If you are concerned that your birth control method was ineffective or failed, over-the-counter emergency contraception is available but must be taken within 72 hours (3 days) following the sexual act. Prescription emergency contraception (ella®) is also available through a healthcare provider and must be taken within 5 days following the sexual act.

Oral contraceptive pills are often prescribed with spironolactone as a form of birth control and to help maintain regular menstrual periods while preventing side effects, such as breast tenderness.

If you become pregnant while taking spironolactone, you should immediately stop taking spironolactone and inform a medical professional.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and recreational drugs.

During treatment with this medication, the side effects of this medication may go away as your body adjusts to the medication. The most common side effects of Escitalopram: headache, nausea, diarrhea, dry mouth, increased sweating, feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia). Sexual side effects, such as problems with orgasm or ejaculatory delay often do not diminish over time.

Escitalopram is a prescription medicine used to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). (May also be helpful when prescribed “off-label” for obsessive compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder.)

If you miss a dose of Escitalopram, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

Do not abruptly stop taking Escitalopram even when you feel better. Abruptly stopping can cause withdrawal symptoms including: vomiting, irritability, dizziness, headaches, sensation of tingling skin, or nightmares.

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

If you no longer need your medication, the best way to dispose of most types of old, unused, unwanted, or expired medicines (both prescription and over the counter) is to drop off the medicine at a drug take back site, location, or program immediately. You can use the DEA DIVERSION CONTROL DIVISION LOOKUP to find your nearest drug disposal site.

If no drug take back sites, locations, or programs are available in your area, and there are no specific disposal instructions (such as flushing) in the medication guide or package insert, you can follow these simple steps to dispose of most medicines in your trash at home:

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and recreational drugs.

During treatment with this medication, the side effects of this medication may go away as your body adjusts to the medication. The most common side effects of Bupropion: constipation, decrease in appetite, dizziness, increased sweating, stomach pain, trembling, and unusual weight loss.

Bupropion (bupropion hydrochloride) is a prescription medicine used to treat major depressive disorder (MDD), seasonal affective disorder (SAD), and to help people quit smoking (smoking cessation). (May also be helpful when prescribed “off-label” for bipolar disorder, attention deficit hyperactivity disorder (ADHD, and sexual dysfunction due to SSRI antidepressants.)

Swallow the tablet whole. Do not break, crush or chew it.

If you miss a dose of this medicine, for the XL form, do not take an extra tablet to make up for the dose you forgot. Wait and take your next dose at your regular time the next day. Do not double doses.

Do not stop taking bupropion or change your dose without talking with your healthcare provider first.

While depressed mood and lack of interest in activities may need up to 4-6 weeks to improve, disturbances in sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working.

Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

If you no longer need your medication, the best way to dispose of most types of old, unused, unwanted, or expired medicines (both prescription and over the counter) is to drop off the medicine at a drug take back site, location, or program immediately. You can use the DEA DIVERSION CONTROL DIVISION LOOKUP to find your nearest drug disposal site.

If no drug take back sites, locations, or programs are available in your area, and there are no specific disposal instructions (such as flushing) in the medication guide or package insert, you can follow these simple steps to dispose of most medicines in your trash at home:

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and recreational drugs.

During treatment with this medication, the side effects of this medication may go away over the first week or two as your body adjusts to the medication. The most common side effects of Sertraline: Headache, nausea, diarrhea, dry mouth, increased sweating, feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia). Sexual side effects, such as problems with orgasm or ejaculatory delay often do not diminish over time.

Sertraline is a prescription medicine used to treat major depressive disorder (MDD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder, and social anxiety disorder. (May also be helpful when prescribed “off-label” for binge-eating disorder, bulimia nervosa, and generalized anxiety disorder (GAD).)

If you miss a dose of sertraline, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

Do not stop taking sertraline, even when you feel better. Abruptly stopping can cause withdrawal symptoms including: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

If needed, the best way to dispose of most types of old, unused, unwanted, or expired medicines (both prescription and over the counter) is to drop off the medicine at a drug take back site, location, or program immediately. You can use the DEA DIVERSION CONTROL DIVISION LOOKUP to find your nearest drug disposal site.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and recreational drugs.

During treatment with this medication, the side effects of this medication may go away as your body adjusts to the medication. The most common side effects of Fluoxetine: headache, nausea, diarrhea, dry mouth, increased sweating, feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia). Sexual side effects, such as problems with orgasm or ejaculatory delay often do not diminish over time.

Fluoxetine is a prescription medicine used to treat major depressive disorder (MDD), obsessive compulsive disorder (OCD), panic disorder, bulimia nervosa, and premenstrual dysphoric disorder (PMDD). (may also be helpful when prescribed “off-label” for body dysmorphic disorder, dysthymia, or posttraumatic stress disorder (PTSD).)

The delayed release form should be swallowed whole. Do not break, crush or chew it.

If you miss a dose of fluoxetine that you take daily, take it as soon as you remember, unless it is closer to the time of your next dose. If you take fluoxetine once weekly, take it as soon as possible, then go back to your regular schedule the next week. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

Do not stop taking fluoxetine, even when you feel better. Abruptly stopping can cause withdrawal symptoms including: vomiting, irritability, dizziness, headaches, sensation of tingling skin, or nightmares.

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

If you no longer need your medication, the best way to dispose of most types of old, unused, unwanted, or expired medicines (both prescription and over the counter) is to drop off the medicine at a drug take back site, location, or program immediately. You can use the DEA DIVERSION CONTROL DIVISION LOOKUP to find your nearest drug disposal site.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and recreational drugs.

During treatment with this medication, the side effects of this medication may go away as your body adjusts to the medication. The most common side effects of Paroxetine: Headache, nausea, constipation, diarrhea, dry mouth, increased sweating, and dizziness, feeling nervous, restless, fatigued, sleepy, or having trouble sleeping (insomnia). Sexual side effects, such as problems with orgasm or ejaculatory delay often do not diminish over time.

Paroxetine is a prescription medicine used to treat major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (social phobia), panic disorder, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD).

The controlled release form should be swallowed whole. Do not break, crush or chew it.

If you miss a dose of paroxetine, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed.

Do not stop taking paroxetine, even when you feel better. Abruptly stopping can cause withdrawal symptoms including: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances as electric shock sensations, tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, ringing in the ears, and seizures.

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

If you no longer need your medication, the best way to dispose of most types of old, unused, unwanted, or expired medicines (both prescription and over the counter) is to drop off the medicine at a drug take back site, location, or program immediately. You can use the DEA DIVERSION CONTROL DIVISION LOOKUP to find your nearest drug disposal site.

Please stop the treatment that you are currently using and continue using the Anti-Aging treatment in the same fashion. While using the Anti-Aging treatment, please do not use any other treatments on your face that contain a retinoid (including over-the-counter products)

You may experience side effects with this medication. These side effects are common and typically go away with time and regular use:

You should also avoid other products known to cause skin irritation on the area of treatment, such as medicated or abrasive (rough) soaps, products with alcohol or astringents, chemical hair removers, and cosmetics with a strong drying effect. If you are having any treatments such as a facial, electrolysis, or waxing, please inform the individual providing the service that you are using a product with tretinoin.

No - the treatment is meant to be applied no more than once a day in the evening

This treatment may make your skin more susceptible to sunburn and other adverse effects of the sun (this includes the use of tanning beds, artificial sunlamps, etc.). It is important to apply sunscreen on a daily basis with an SPF of at least 15 while using this treatment.

Stop your treatment until your skin has recovered

Use a mild, non-medicated cleanser. Abrasive, or rough soaps, may irritate the skin. Wait 20-30 minutes after washing your face before you apply this treatment.

Once this treatment is stopped, the improvement may gradually disappear.

What is the most important information that I should know about the Acne Treatment?

*We offer a variety of formulas to address specific skin concerns in addition to acne, including dark spots and redness. The formulas may contain some or all of the ingredients listed above. If you are allergic to any of these ingredients, please discuss which formula is right for you with your healthcare provider.

We offer 2 acne formulas for pregnant and breastfeeding women that do not contain tretinoin. Tretinoin should not be used during pregnancy and breastfeeding. Topical clindamycin, niacinamide, azelaic acid, and zinc pyrithione are all generally considered safe for use during pregnancy and breastfeeding. Please inform the healthcare provider who is overseeing your pregnancy and/or postpartum period that you are using this product. The Acne treatment is free of the following ingredients:

Please stop the treatment that you are currently using and continue using the Acne Treatment in the same fashion. While using the Acne Treatment, please do not use any other treatments on your face that contain a retinoid (including over-the-counter products)

You may experience side effects with this medication. These side effects are common and typically go away with time and regular use:

You should also avoid other products known to cause skin irritation on the area of treatment, such as medicated or abrasive (rough) soaps, products with alcohol or astringents, chemical hair removers, and cosmetics with a strong drying effect. If you are having any treatments such as a facial, electrolysis, or waxing, please inform the individual providing the service that you are using a product with tretinoin.

NALTREXONE is a prescription medication that is FDA approved to: treat alcohol dependence prevent relapse to opioid dependence, after opioid detoxification.

VITAMIN B12 is a dietary supplement utilized in many areas of the body principally for the proper function of your red blood cells, nerve cells, energy levels and mood. Additionally it is used to supplement B12 when other drugs may possibly decrease its level.

NALTREXONE + VITAMIN B12 is a prescription medicine that is prescribed off-label and may help some adults with overweight and obesity lose weight and keep the weight off.

IMPORTANT SAFETY INFORMATION NALTREXONE + VITAMIN B12 can cause serious side effects, including:

Talk to your healthcare provider about naloxone, a medicine that is available to patients for the emergency treatment of an opioid overdose. Call 911 or get emergency medical help right away in all cases of known or suspected opioid overdose, even if naloxone is administered.

You must stop taking opioids before you start taking NALTREXONE + VITAMIN B12. It is not known if NALTREXONE + VITAMIN B12 is safe and effective in children.

What should I tell my healthcare provider before taking NALTREXONE + VITAMIN B12? Before you take NALTREXONE + VITAMIN B12, tell your healthcare provider if you:

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take any opioid-containing medicines for pain, cough or colds, or diarrhea.

Depressed mood. Sometimes this leads to suicide, or suicidal thoughts, and suicidal behavior. Tell your family members and people closest to you that you are taking NALTREXONE + VITAMIN B12.
Pneumonia. Some people receiving NALTREXONE + VITAMIN B12 treatment have had a type of pneumonia that is caused by an allergic reaction. If this happens to you, you may need to be treated in the hospital.
Serious allergic reactions. Serious allergic reactions can happen during or soon after an injection of NALTREXONE + VITAMIN B12. Tell your healthcare provider or get medical help right away if you have any of these symptoms:

These are not all the side effects of NALTREXONE + VITAMIN B12. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. You are encouraged to report all side effects to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. This is only a summary of the most important information about NALTREXONE + VITAMIN B12.

Need more information? Ask your healthcare provider or pharmacist.

When prescribed off-label Bupropion may help some adults with overweight and obesity lose weight and keep the weight off.

Although BUPROPION XL is not a treatment for quitting smoking, it contains the same active ingredient (bupropion) as ZYBAN, which is used to help patients quit smoking.

Some people have had serious side effects while taking bupropion to help them quit smoking, including:

New or worse mental health problems, such as changes in behavior or thinking, aggression, hostility, agitation, depression, or suicidal thoughts or actions. Some people had these symptoms when they began taking bupropion, and others developed them after several weeks of treatment, or after stopping bupropion. These symptoms happened more often in people who had a history of mental health problems before taking bupropion than in people without a history of mental health problems.

Stop taking BUPROPION XL and call your healthcare provider right away if you, your family, or caregiver notice any of these symptoms. Work with your healthcare provider to decide whether you should continue to take BUPROPION XL. In many people, these symptoms went away after stopping BUPROPION XL, but in some people, symptoms continued after stopping BUPROPION XL. It is important for you to follow-up with your healthcare provider until your symptoms go away.

What Other Important Information Should I Know About BUPROPION XL? Before taking BUPROPION XL, tell your healthcare provider if you have ever had depression or other mental health problems. You should also tell your healthcare provider about any symptoms you had during other times you tried to quit smoking, with or without bupropion. What Other Important Information Should I Know About BUPROPION XL?

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Many medicines increase your chances of having seizures or cause other serious side effects if you take them while you are using BUPROPION XL.

The most common side effects of BUPROPION XL include: trouble sleeping, stuffy nose, dry mouth, dizziness, feeling anxious, nausea, constipation, and joint aches.

These are not all the side effects of BUPROPION XL. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. The product information provided is intended only for residents of the United States. The products discussed herein may have different product labeling in different countries.

METFORMIN XR is a prescription medicine that is FDA approved to treat Type 2 diabetes mellitus when hyperglycemia cannot be managed with diet and exercise alone.

When prescribed off-label METFORMIN XR may help some adults with overweight or obesity lose weight and keep the weight off.

IMPORTANT SAFETY INFORMATION What is the most important information I should know about METFORMIN XR tablets?

Lactic Acidosis. Metformin, the medicine in METFORMIN XR tablets, can cause a rare, but serious, side effect called lactic acidosis (a build-up of lactic acid in the blood) that can cause death. Lactic acidosis is a medical emergency and must be treated in a hospital.

Stop taking METFORMIN XR tablets and call your healthcare provider right away if you get any of the following symptoms of lactic acidosis:

What should I tell my healthcare provider before taking METFORMIN XR tablets? Before taking METFORMIN XR tablets, tell your healthcare provider if you:

Common side effects of METFORMIN XR tablets include diarrhea, nausea, and upset stomach. These side effects generally go away after you take the medicine for a while. Taking your medicine with meals can help reduce these side effects. Tell your healthcare provider if the side effects bother you a lot, last for more than a few weeks, come back after they've gone away, or start later in therapy. You may need a lower dose or need to stop taking the medicine for a short period or for good.

About 3 out of every 100 people who take METFORMIN XR tablets have an unpleasant metallic taste when they start taking the medicine. It lasts for a short time.

METFORMIN XR tablets rarely cause hypoglycemia (low blood sugar) by themselves. However, hypoglycemia can happen if you do not eat enough, if you drink alcohol, or if you take other medicines to lower blood sugar.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. The product information provided is intended only for residents of the United States. The products discussed herein may have different product labeling in different countries.

TOPIRAMATE + VITAMIN B12 is a compounded product and is not FDA-approved. The FDA does not verify the safety or effectiveness of compounded drugs.

TOPIRAMATE (Topamax®) is FDA approved to:

VITAMIN B12 is a dietary supplement utilized in many areas of the body principally for the proper function of your red blood cells, nerve cells, energy levels and mood. Additionally it is used to supplement B12 when other drugs may possibly decrease its level.

TOPIRAMATE + VITAMIN B12 is prescribed off-label and may help some adults with overweight and obesity lose weight and keep the weight off.

TOPIRAMATE + VITAMIN B12 may cause eye problems. Serious eye problems include:

These eye problems can lead to permanent loss of vision if not treated.

You should call your healthcare provider right away if you have any new eye symptoms, including any new problems with your vision.

TOPIRAMATE + VITAMIN B12 may cause decreased sweating and increased body temperature (fever). People, especially children, should be watched for signs of decreased sweating and fever, especially in hot temperatures. Some people may need to be hospitalized for this condition. If a high fever, a fever that does not go away, or decreased sweating develops, call your healthcare provider right away.

TOPIRAMATE + VITAMIN B12 can increase the level of acid in your blood (metabolic acidosis). If left untreated, metabolic acidosis can cause brittle or soft bones (osteoporosis, osteomalacia, osteopenia), kidney stones, can slow the rate of growth in children, and may possibly harm your baby if you are pregnant. Metabolic acidosis can happen with or without symptoms. Sometimes people with metabolic acidosis will:

Your healthcare provider should do a blood test to measure the level of acid in your blood before and during your treatment with TOPIRAMATE + VITAMIN B12. If you are pregnant, you should talk to your healthcare provider about whether you have metabolic acidosis.

TOPIRAMATE + VITAMIN B12 may lower bone mineral density. TOPIRAMATE + VITAMIN B12 may decrease the density of bones when used over a long period.

TOPIRAMATE + VITAMIN B12 may have negative effects on growth in children TOPIRAMATE + VITAMIN B12 may slow height increases and weight gain in children and adolescents when used over a long period

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. TOPIRAMATE + VITAMIN B12 and other medicines may affect each other causing side effects. Especially tell your healthcare provider if you take:

Ask your healthcare provider if you are not sure if your medicine is listed above. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist each time you get a new medicine. Do not start a new medicine without talking with your healthcare provider.

High blood ammonia levels. High ammonia in the blood can affect your mental activities, slow your alertness, make you feel tired, or cause vomiting. This has happened when TOPIRAMATE + VITAMIN B12 is taken with a medicine called valproic acid (Depakene® or Depakote®).
Effects on thinking and alertness. TOPIRAMATE + VITAMIN B12 may affect how you think and cause confusion, problems with concentration, attention, memory, or speech. TOPIRAMATE + VITAMIN B12 may cause depression or mood problems, tiredness, and sleepiness.
Dizziness or loss of muscle coordination.
Serious skin reactions. TOPIRAMATE + VITAMIN B12 may cause a severe rash with blisters and peeling skin, especially around the mouth, nose, eyes, and genitals (Stevens-Johnson syndrome). TOPIRAMATE + VITAMIN B12 may also cause a rash with blisters and peeling skin over much of the body that may cause death (toxic epidermal necrolysis). Call your healthcare provider right away if you develop a skin rash or blisters.
Kidney stones. Drink plenty of fluids when taking TOPIRAMATE + VITAMIN B12 to decrease your chances of getting kidney stones.
Low body temperature. Taking TOPIRAMATE + VITAMIN B12 when you are also taking valproic acid can cause a drop in body temperature to less than 95°F, feeling tired, confusion, or coma.

Call your healthcare provider right away if you have any of the symptoms above.

Tell your healthcare provider about any side effect that bothers you or that does not go away. You are encouraged to report all side effects to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

These are not all the possible side effects of TOPAMAX