Amphotericin B

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Generic Name: Amphotericin B Brand Name(s): Amphotericin B.

Uses

What is amphotericin B used for?

Amphotericin B is commonly used to treat fungal infections.

How should I take amphotericin B?

Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

It is given as an infusion into a vein over a period of time. Drink lots of non-caffeine liquids unless told to drink less liquid by your doctor.

How do I store amphotericin B?

Amphotericin B is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store amphotericin B in the bathroom or the freezer. There may be different brands of amphotericin B that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush amphotericin B down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using amphotericin B?

Before using this drug, tell your doctor if:

  • You are pregnant or breastfeeding. This is because, while you are expecting or feeding a baby, you should only take medicines on the recommendation of a doctor.
  • You are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • You have allergy with any of active or inactive ingredients of amphotericin B or other medications.
  • You have any other illnesses, disorders, or medical conditions.
  • You are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • You are receiving a transfusion of a certain kind of white blood cell (leukocyte).

Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists.

Have blood work checked as you have been told by the doctor. Talk with the doctor.

Some people have had side effects within a few hours of the start of the infusion. Tell your doctor if you have any bad effects during this time.

Other drugs may be given to help with infusion side effects.

Very bad kidney problems have happened with amphotericin B. Most of the time, kidney problems have gotten better after this medicine was stopped but sometimes they have not gone away. Talk with your doctor.

Is it safe during pregnancy or breastfeeding?

There are no adequate studies in women for determining risk when using amphotericin B during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking amphotericin B. Amphotericin B is pregnancy risk category B, according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk
  • B=No risk in some studies
  • C=There may be some risk
  • D=Positive evidence of risk
  • X=Contraindicated
  • N=Unknown

Side effects

What side effects can occur from amphotericin B?

Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat
  • Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes
  • Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain
  • Signs of electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, seizures, not hungry, or very bad upset stomach or throwing up
  • Fever or chills
  • Very bad dizziness or passing out
  • Very upset stomach or throwing up
  • Fast breathing
  • Feeling very tired or weak
  • Very bad headache

This medicine may irritate the vein. It may burn the skin if the drug leaks from the vein when it is given. Tell your nurse if you have any redness, burning, pain, swelling, or leaking of fluid where the drug is going into your body.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with amphotericin B?

Amphotericin B may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with amphotericin B?

Amphotericin B may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with amphotericin B?

Amphotericin B may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using amphotericin B.

What is the dose of amphotericin B for an adult?

Usual Adult Dose for Ocular Fungal Infection

5 to 10 micrograms INTRAVITREALLY

Use with systemic voriconazole.

Usual Adult Dose for Aspergillosis – Invasive

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to a final daily dose of 0.5 to 0.7 mg/kg IV once a day depending on cardio-renal status.

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Cumulative dose: Up to 3.6 grams

Duration of therapy: Up to 11 months

Usual Adult Dose for Blastomycosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Pulmonary blastomycosis (moderately severe to severe): 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted. Follow with oral itraconazole.

Disseminated extrapulmonary blastomycosis (moderately severe to severe): 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted. Follow with oral itraconazole.

Immunocompromised patients with blastomycosis: 0.7 to 1 mg/kg IV once a day for 1 to 2 weeks or until improvement is noted

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Adult Dose for Candida Urinary Tract Infection

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Patients undergoing urologic procedures: 0.3 to 0.6 mg/kg IV once a day for several days before and after the procedure

Fluconazole-resistant candida glabrata: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days

Symptomatic ascending candida pyelonephritis from fluconazole-resistant candida glabrata: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days. Use with or without flucytosine

Symptomatic ascending candida pyelonephritis from fluconazole-resistant candida kryseu: 0.3 to 0.6 mg/kg IV once a day for 1 to 7 days.

Maximum IV dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Cystitis due to fluconazole-resistant species: 50 mg/mL in sterile water as a bladder irrigation once a day for 5 days.

Candida urinary tract infection with fungus balls in patients with nephrostomy tubes: 25 to 50 mg in 200 to 500 mL sterile water IRRIGATED THROUGH the nephrostomy tubes.

Usual Adult Dose for Candidemia

Candida chorioretinitis without vitreous and with macular involvement: 5 to 10 mcg/0.1 mL sterile water by INTRAVITREAL injection. For use with concomitant antifungal treatment (oral or IV).

Central nervous system candidiasis in patients in whom a ventricular device cannot be removed: 0.01 to 0.5 mg in 2 mL of 5% dextrose administered THROUGH THE DEVICE into the ventricle.

Usual Adult Dose for Coccidioidomycosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Severe, non-meningeal infection: 0.7 to 1 mg/kg/day IV. Duration of therapy: Until clinical improvement. Follow with a triazole.

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Adult Dose for Cryptococcal Meningitis – Immunocompetent Host

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the final daily dose depending on cardio-renal status.

Induction dose: 0.7 to 1 mg/kg IV once a day for at least 4 weeks. Use in combination with flucytosine. Consolidation treatment is done with fluconazole.

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Adult Dose for Histoplasmosis – Immunocompenent Host

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Moderately severe to severe pulmonary histoplasmosis: 0.7 to 1 mg/kg IV once a day. Duration of therapy: 1 to 2 weeks. Follow with itraconazole. May use concomitant methylprednisolone for respiratory complications. Use this formulation if nephrotoxicity risk is low.

Moderately severe to severe progressive disseminated histoplasmosis: 3 mg/kg IV once a day. Duration of therapy: 1 to 2 weeks. Follow with itraconazole. Use this formulation if nephrotoxicity risk is low.

Progressive disseminated histoplasmosis: 1 mg/kg IV once a day for 4 to 6 weeks OR 1 mg/kg IV once a day for 2 to 4 weeks, followed by itraconazole. Longer therapy may be needed for severe disease, immunosuppression, or primary immunodeficiency disorders.

CNS histoplasmosis: 1 mg/kg IV once a day. Duration of therapy: 4 to 6 weeks. Follow with itraconazole. Use this formulation if nephrotoxicity risk is low.

Histoplasmosis in pregnancy: 3 to 5 mg/kg IV once a day. Duration of therapy: 4 to 6 weeks. Use this formulation if nephrotoxicity risk is low.

Progressive disseminated histoplasmosis: 1 mg/kg IV once a day. Duration of therapy: 4 to 6 weeks; 2 to 4 weeks if followed by itraconazole. Longer therapy may be needed for severe disease, immunosuppression, or primary immunodeficiency.

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Adult Dose for Oral Thrush

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Fluconazole-refractory oropharyngeal candidiasis: 0.3 mg/kg IV once a day

Esophageal candidiasis: 0.3 to 0.7 mg/kg IV once a day. Use only if patients cannot tolerate oral therapy. Switch to oral fluconazole therapy when the patient can tolerate oral intake.

Fluconazole-refractory esophageal candidiasis: 0.3 to 0.7 mg/kg IV once a day. Duration of therapy: 21 days.

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Adult Dose for Sporotrichosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

-Gradually increase dose by 5 to 10 mg/day to the final daily dose of 0.5 to 0.7 mg/kg IV once a day.

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED.

Cumulative dose: Up to 2.5 grams total.

Duration of therapy: Up to 9 months.

Usual Adult Dose for Leishmaniasis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

-Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Visceral Leishmaniasis: 0.75 to 1 mg/kg IV once a day or every other day for 20 to 30 doses

Mucosal Leishmaniasis: 0.1 to 1 mg/kg IV once a day for 20 to 45 doses

Cutaneous Leishmaniasis: 0.7 mg/kg IV once a day for 25 to 30 doses

Mucocutaneous Leishmaniasis: 0.7 to 1 mg/kg IV every other day for up to 25 to 45 doses

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Adult Dose for Mucormycosis – Invasive

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to a final daily dose of 0.5 to 0.7 mg/kg depending on cardio-renal status.

A cumulative dose of at least 3 grams is recommended; although 3 to 4 grams infrequently cause lasting renal impairment, the dose is considered reasonable if clinical evidence of deep tissue infection is present, as this infection usually follows a rapidly fatal course.

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED.

Usual Adult Dose for Systemic Fungal Infection

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes

If initial dose is well tolerated, increase over a period of 2 days to:

  • Maintenance dose: 0.25 to 1 mg/kg slow IV daily
  • Duration of therapy: 10 to 14 days

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED.

What is the dose of amphotericin B for a child?

Usual Pediatric Dose for Blastomycosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the recommended daily dose.

Children with severe blastomycosis: 0.7 to 1 mg/kg IV once a day. Follow with fluconazole

Newborns with evidence of infection: 1 mg/kg IV once a day

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Pediatric Dose for Candidemia

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the maintenance dose.

Maintenance dose: 1 mg/kg IV once a day. An infusion time of 3 to 6 hours is recommended

Duration of therapy: 2 weeks after documented clearance of candida from the bloodstream, if neutropenia and candidemia symptoms have resolved

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Pediatric Dose for Cryptococcal Meningitis – Immunosuppressed Host

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose (patients with good cardio-renal function and well tolerated test dose): 0.25 mg/kg slow IV daily

Initial dose (severe and rapidly progressive infection): 0.3 mg/kg slow IV daily

Initial dose (patients with impaired cardio-renal function OR severe reaction to test dose): use smaller doses (e.g. 5 to 10 mg)

Gradually increase dose by 5 to 10 mg/day to the final daily dose.

Induction dose: 0.7 to 1 mg/kg IV once a day – with concomitant fluconazole or flucytosine

Duration of therapy: 5 to 7 days

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Pediatric Dose for Systemic Fungal Infection

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes

If initial dose is well tolerated, increase over a period of 2 days to:

  • Maintenance dose: 0.25 to 1 mg/kg slow IV daily
  • Duration of therapy: 10 to 14 days

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

Usual Pediatric Dose for Sporotrichosis

**VERIFY PRODUCT NAME AND DOSAGE, ESPECIALLY IF DOSE EXCEEDS 1.5 MG/KG**

Test dose: 1 mg in 20 mL dextrose, slow IV over 20 to 30 minutes, with monitoring for 2 to 4 hours afterward.

Initial dose: 1 mg in 50 mL dextrose IV over 30 minutes

If initial dose is well tolerated, increase over a period of 2 days to final dosing.

Disseminated sporotrichosis: 0.7 mg/kg IV once a day

After a favorable response is seen, switch to itraconazole.

Maximum dose: 1.5 mg/kg total daily dose – UNDER NO CIRCUMSTANCES SHOULD THIS DOSE BE EXCEEDED

How is amphotericin B available?

Amphotericin B is available in the following dosage forms and strengths:

  • IV infusion

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of amphotericin B, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: October 5, 2017 | Last Modified: October 5, 2017

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