What is Entyvio?

Entyvio (vedolizumab) is a brand-name prescription medication. It’s typically used to treat moderate-to-severe ulcerative colitis (UC) or Crohn’s disease in people who don’t have enough improvement from other medications.

Entyvio is a biologic drug that belongs to a class of medications called integrin receptor antagonists. It comes as a solution that’s given by intravenous (IV) infusion.

For UC, use of Entyvio results in symptom remission in about 17 percent of people after 6 weeks, and 42 percent after a year. For Crohn’s disease, about 15 percent of people have symptom remission after 6 weeks, and about 39 percent have it after one year.

Entyvio generic

Entyvio contains the drug vedolizumab. Vedolizumab isn’t available as a generic drug. It’s only available as Entyvio.

Entyvio side effects

Entyvio can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Entyvio. This list does not include all possible side effects.

For more information on the possible side effects of Entyvio, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects of Entyvio include:

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Allergic reactions. Some people can have allergic reactions when Entyvio is given. These are usually not severe, but may be severe in some cases. Administration of Entyvio will need to be stopped if a severe reaction occurs. Symptoms of an allergic reaction may include:
    • trouble breathing
    • itchy skin
    • flushing
    • rash
  • Liver damage. Some people who receive Entyvio can experience liver damage. If you develop liver damage symptoms, your doctor may stop your treatment with Entyvio. Symptoms of liver damage can include:
    • yellowing of your skin or the whites of your eyes
    • fatigue
    • stomach pain
  • Cancer. During studies of Entyvio, about 0.4 percent of those who received Entyvio developed cancer compared to about 0.3 percent who received a placebo. Whether Entyvio increases the risk of cancer isn’t clear.
  • Infections. People who take Entyvio have an increased risk of infection, such as the common cold or flu. More serious infections may also occur. These might include tuberculosis or an infection in the brain called progressive multifocal leukoencephalopathy (see below). If you develop a severe infection while taking Entyvio, you may need to stop taking the medication until the infection has been treated.

PML

Progressive multifocal leukoencephalopathy (PML) is a serious viral infection of the brain. It typically only happens in people whose immune system isn’t fully functioning.

During studies, PML did not occur in anyone who took Entyvio. However, it has occurred in people receiving medications that are similar to Entyvio, such as Tysabri (natalizumab).

While you take Entyvio, your doctor will monitor you for symptoms of PML. These symptoms may include:

  • weakness on one side of your body
  • vision problems
  • clumsiness
  • memory problems
  • confusion

Hair loss

Hair loss isn’t a side effect that has occurred in studies of Entyvio. However, some people have had hair loss while taking Entyvio. It’s not clear if Entyvio is the cause of hair loss.

Weight gain

Weight gain isn’t a side effect that has occurred in studies of Entyvio. However, some people who take Entyvio say that they gain weight. Gaining weight may be the result of healing in the gut, especially for those who’ve lost weight due to a flare-up of symptoms of the condition being treated.

Skin side effects

Rash and itchy skin can occur in some people who take Entyvio. In studies, rash or itchy skin happened in about 3 percent of those receiving Entyvio.

Joint pain

In studies, about 12 percent of people who received Entyvio experienced joint pain.

Headache

In studies, about 12 percent of people who received Entyvio experienced headaches.

Depression

Depression isn’t a side effect that has occurred in studies of Entyvio. However, some people have had depression while taking Entyvio. It’s not clear if Entyvio was the cause of their depression.

Fatigue

In studies, about 6 percent of people who received Entyvio experienced fatigue.

Muscle pain

In studies, about 3 percent of people who received Entyvio had pain in the muscles of their arms and legs.

Diarrhea

Diarrhea isn’t a side effect that has occurred in studies of Entyvio. However, some people have had diarrhea while taking Entyvio. It’s not clear if Entyvio is the cause of diarrhea.

Severe diarrhea could be a symptom of an infection. If you have severe diarrhea while receiving Entyvio, call your doctor.

Entyvio uses

The Food and Drug Administration (FDA) approves prescription drugs such as Entyvio to treat certain conditions.

Approved uses for Entyvio

Entyvio is FDA-approved to treat two conditions: ulcerative colitis (UC) and Crohn’s disease.

Entyvio for ulcerative colitis

Entyvio is used to improve symptoms and cause symptom remission in people with moderate-to-severe UC. It’s prescribed for people who don’t have enough improvement with other medications, or who can’t take other medications.

For UC, Entyvio use results in symptom remission in about 17 percent of people after 6 weeks, and 42 percent after a year.

Entyvio for Crohn’s disease

Entyvio is used to improve symptoms and cause symptom remission in people with moderate-to-severe Crohn’s disease. It’s prescribed for people who don’t have enough improvement with other medications, or who cannot take other medications.

For Crohn’s disease, about 15 percent of people have symptom remission after 6 weeks, and about 39 percent have it after one year.

Uses that are not approved

Entyvio isn’t approved to treat other conditions, but your doctor may prescribe it off-label for other purposes. Off-label use is when a drug is approved for one use but is prescribed for a different one.

Entyvio for HIV

Entyvio is currently being studied as a treatment for HIV. It’s too soon to know how well it might work.

Entyvio for psoriasis

Entyvio is a biologic drug that works like some medications do that are used to treat psoriasis. However, there’s no evidence that Entyvio works for improving symptoms of psoriasis.

Entyvio for children

Entyvio is not FDA-approved for use in children. However, some doctors may use Entyvio off-label for treating UC or Crohn’s disease in children.

One study found that Entyvio caused remission of symptoms in 76 percent of children with UC, and 42 percent of children with Crohn’s disease.

Entyvio dosage

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Entyvio dosing schedule

Entyvio is administered by intravenous (IV) infusion, which means it’s slowly injected into your vein. An infusion is a controlled administration of medication into your bloodstream over a period of time.

For each treatment, a dose of 300 mg is given over a period of about 30 minutes. Treatment is started according to this schedule:

  • Week 0 (first week): first dose
  • Week 1: no dose
  • Week 2: second dose
  • Week 6: third dose

After this initial period of six weeks, which is called induction, a maintenance dosing schedule is used. During the maintenance dosing, Entyvio is given every eight weeks.

What if I miss a dose?

This medication will be given by your doctor. If you miss your appointment to receive your dose, call your doctor’s office right away to reschedule your treatment.

Will I need to use this drug long-term?

Yes, Entyvio needs to be used for long-term treatment.

Vaccinations

Before starting Entyvio, you’ll need to be up-to-date on recommended vaccinations. Talk to your doctor about getting any vaccines you need before you start treatment with Entyvio.

Alternatives to Entyvio

There are many different medications used to treat ulcerative colitis (UC) and Crohn’s disease. These other drugs could be considered alternatives to Entyvio.

Entyvio is a biologic drug that’s typically used to treat UC and Crohn’s disease when other medications don’t relieve symptoms enough, or if they cause bothersome side effects. Examples of other biologic medications used to treat UC or Crohn’s disease include:

  • natalizumab (Tysabri), an integrin receptor antagonist
  • ustekinumab (Stelara), an interleukin IL-12 and IL-23 antagonist
  • tofacitinib (Xeljanz), a Janus kinase inhibitor
  • tumor necrosis factor (TNF)-alpha inhibitors such as:

Entyvio vs. other drugs

You may wonder how Entyvio compares to other drugs used to treat ulcerative colitis (UC) or Crohn’s disease. Here are some comparisons.

Entyvio vs. Remicade

Entyvio and Remicade (infliximab) are both brand-name biologic medications, but they’re in different drug classes. Entyvio belongs to a class of drugs called integrin receptor antagonists. Remicade belongs to a class of medications called tumor necrosis factor (TNF)-alpha inhibitors.

Use

Entyvio and Remicade are both FDA-approved for treating UC and Crohn’s disease. Remicade is also approved for treating other conditions, including:

Drug forms

Both Entyvio and Remicade are available as solutions for intravenous (IV) infusion. They’re also administered on similar schedules. After the first three doses, these medications are typically given every eight weeks.

Side effects and risks

Entyvio and Remicade have some similar side effects, and some that differ. Below are examples of these side effects.

Both Entyvio and Remicade Entyvio Remicade
More common side effects
  • respiratory infection
  • nausea
  • cough
  • bronchitis
  • rash or itchy skin
  • fatigue
  • headache
  • joint pain
  • fever
  • runny nose
  • sore throat
  • flu
  • back pain
Serious side effects
  • allergic reaction
  • serious infections such as tuberculosis
  • cancer
  • liver damage
(few unique serious side effects)

*Remicade has boxed warnings from the FDA. A boxed warning is the strongest warning that the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Both Entyvio and Remicade are used to treat UC and Crohn’s disease. But Entyvio is typically only used to treat UC and Crohn’s disease in people who don’t have enough improvement with other medications such as Remicade.

The effectiveness of these medications hasn’t been directly compared in clinical studies. However, some researchers have compared results from different studies that look at these drugs.

In an analysis of multiple clinical studies, Entyvio and Remicade were found to work about equally well for reducing symptoms and causing symptom remission in certain people with moderate-to-severe UC. These were people who had not taken biologic drugs before.

However, this same analysis found that Entyvio may work better than Remicade for maintaining improved symptoms and remission.

In a different analysis of clinical studies, Remicade was found to be more effective than Entyvio for causing symptom remission and maintaining remission in certain people with Crohn’s disease. These were people who had not taken biologic drugs before.

Costs

Entyvio and Remicade are both brand-name drugs. They’re not available in generic form. Generic versions of drugs usually cost less than brand-name forms.

Entyvio and Remicade cost about the same amount. However, the actual amount you pay will depend on your insurance.

Entyvio vs. Humira

Entyvio and Humira (adalimumab) are both brand-name biologic medications, but they’re in different drug classes. Entyvio belongs to a class of drugs called integrin receptor antagonists. Humira belongs to a class of medications called tumor necrosis factor (TNF)-alpha inhibitors.

Uses

Entyvio and Humira are both FDA-approved for treating ulcerative colitis (UC) and Crohn’s disease. Humira is also approved for treating other conditions, including:

  • rheumatoid arthritis
  • psoriasis
  • psoriatic arthritis
  • ankylosing spondylitis
  • uveitis

Drug forms

Entyvio comes as a solution for intravenous infusion that’s given in the doctor’s office. After the first three doses, Entyvio is given once every eight weeks.

Humira comes as a subcutaneous injection. This is an injection that’s given under the skin. Humira can be self-administered. After the first four weeks, it’s used every other week.

Side effects and risks

Entyvio and Humira have some similar side effects, and some that differ. Below are examples of these side effects.

Both Entyvio and Humira Entyvio Humira
More common side effects
  • respiratory infection
  • nausea
  • headache
  • back pain
  • rash
  • runny nose
  • sore throat
  • joint pain
  • fever
  • fatigue
  • cough
  • bronchitis
  • flu
  • itchy skin
Serious side effects
  • allergic reaction
  • serious infections
  • cancer
  • liver damage
(few unique serious side effects) heart failure

  • lupus-like syndrome
  • nervous system conditions such as multiple sclerosis and Guillain-Barré syndrome
  • blood disorders such as leukopenia and neutropenia
  • Boxed warnings*: serious infections, and certain types of cancer such as lymphoma

*Humira has a boxed warning from the FDA. This is the strongest warning the FDA requires. A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Entyvio and Humira are used to treat both UC and Crohn’s disease. However, Entyvio is typically only used for people who don’t have enough improvement using other medications, such as Humira.

The effectiveness of these medications hasn’t been directly compared in clinical studies. But certain studies provide some comparative information.

An analysis of several clinical studies found that Entyvio may be more effective than Humira in improving certain symptoms of UC. This was seen in people who had taken other biologics before, and in those who had not.

The analysis also found that Entyvio may work better for maintaining improved symptoms and remission in people who had not taken biologics before.

According to another analysis of clinical studies, Humira may be more effective than Entyvio for causing symptom remission and maintaining remission in certain people with Crohn’s disease. These were also people who had not taken biologic drugs before.

Costs

Entyvio and Humira are both brand-name drugs. They’re not available in generic form. Generic versions of drugs usually cost less than brand-name forms.

Humira typically costs more than Entyvio. However, the actual amount you pay will depend on your insurance.

Entyvio vs. Stelara

Entyvio and Stelara (ustekinumab) are both brand-name biologic medications, but they’re in different drug classes. Entyvio belongs to a class of drugs called integrin receptor antagonists. Stelara belongs to a class of medications called interleukin IL-12 and IL-23 antagonists.

Uses

Entyvio and Stelara are both FDA-approved for treating Crohn’s disease.

Entyvio is also approved to treat ulcerative colitis (UC). And Stelara is also approved for treating psoriasis and psoriatic arthritis.

Drug forms

Entyvio comes as a solution for intravenous (IV) infusion that’s given in the doctor’s office. After the first three doses, Entyvio is given once every eight weeks.

Stelara is first given as a single intravenous infusion in the doctor’s office. After that, subcutaneous doses, which are injected under the skin, can be given at home every eight weeks.

Side effects and risks

Entyvio and Stelara have some similar side effects, and some that differ. Below are examples of these side effects.

Both Entyvio and Stelara Entyvio Stelara
More common side effects
  • runny nose
  • respiratory infection
  • headache
  • fatigue
  • back pain
  • itchy skin
  • bronchitis
  • sore throat
  • joint pain
  • nausea
  • fever
  • cough
  • flu
  • rash

  • diarrhea
  • dizziness
  • muscle pain
  • depression
  • vomiting
  • yeast infection
  • urinary tract infection
Serious side effects
  • allergic reaction
  • serious infections
  • cancer
  • liver damage
  • lung disease

Effectiveness

Both Entyvio and Stelara are used to treat Crohn’s disease.

The effectiveness of these medications for this purpose hasn’t been directly compared in clinical studies.

However, an indirect comparison found that Entyvio may be more effective for symptom remission in people with Crohn’s disease who have not used biologic drugs before.

Costs

Entyvio and Stelara are both brand-name drugs. They’re not available in generic form. Generic versions of drugs usually cost less than brand-name forms.

Stelara typically costs much more than Entyvio. However, the actual amount you pay will depend on your insurance.

Entyvio vs. Cimzia

Entyvio and Cimzia (certolizumab) are both brand-name biologic medications, but they’re in different drug classes. Entyvio belongs to a class of drugs called integrin receptor antagonists. Cimzia belongs to a class of medications called tumor necrosis factor (TNF)-alpha inhibitors.

Uses

Entyvio and Cimzia are both approved for treating Crohn’s disease.

Entyvio is also approved to treat ulcerative colitis (UC). And Cimzia is also approved to treat other conditions including:

  • rheumatoid arthritis
  • psoriasis
  • psoriatic arthritis
  • ankylosing spondylitis

Drug forms

Entyvio comes as a solution for intravenous (IV) infusion that’s given in the doctor’s office. After the first three doses, Entyvio is given once every eight weeks.

Cimzia is given at home as a subcutaneous injection, which is given under the skin. Six doses are given during the first four weeks of treatment. If symptoms improve, Cimzia may be given once every four weeks after that.

Side effects and risks

Entyvio and Cimzia have some similar side effects, and some that differ. Below are examples of these side effects.

Both Entyvio and Cimzia Entyvio Cimzia
More common side effects
  • respiratory infection, such as bronchitis and sinusitis
  • joint pain
  • headache
  • runny nose
  • back pain
  • fever
  • rash
  • fatigue
  • sore throat
  • nausea
  • cough
  • flu
  • itchy skin
  • stomach pain
  • diarrhea
  • urinary tract infections
  • high blood pressure
Serious side effects
  • liver damage
  • allergic reaction
  • serious infections
  • cancer
(few unique serious side effects)
  • heart failure
  • lupus-like syndrome
  • nervous system conditions such as multiple sclerosis and Guillain-Barré syndrome
  • blood disorders leukopenia and thrombocytopenia
  • Boxed warnings*: serious infections, and certain types of cancer such as lymphoma

*Cimzia has a boxed warning from the FDA. This is the strongest warning that the FDA requires. A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Both Entyvio and Cimzia are used to treat Crohn’s disease. However, Entyvio is typically only used for people who don’t have enough improvement with other medications, such as Cimzia.

The effectiveness of these medications for treating Crohn’s disease hasn’t been directly compared in clinical studies. However, an indirect comparison found that Entyvio and Cimzia work about equally well for symptom remission in people who have not used biologic drugs before.

Costs

Entyvio and Cimzia are both brand-name drugs. They’re not available in generic form. Generic versions of drugs usually cost less than brand-name forms.

Cimzia typically costs more than Entyvio. However, the actual amount you pay will depend on your insurance.

Entyvio and alcohol

Entyvio doesn’t interact with alcohol. However, drinking alcohol might worsen some of the side effects of Entyvio, such as:

  • nausea
  • headache
  • runny nose

Also, consuming excessive alcohol might increase the risk of liver damage from Entyvio.

It’s also important to note that alcohol use might worsen some symptoms of ulcerative colitis (UC) or Crohn’s disease. These symptoms include:

  • nausea
  • vomiting
  • stomach or intestinal bleeding
  • diarrhea

Entyvio interactions

Entyvio can interact with several other medications. Below is a list of medications that can interact with Entyvio. This list does not contain all drugs that may interact with Entyvio.

Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Before taking Entyvio, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Tumor necrosis factor inhibitors

Taking Entyvio with tumor necrosis factor inhibitors can increase your risk of infections. Examples of these drugs include:

  • adalimumab (Humira)
  • certolizumab (Cimzia)
  • golimumab (Simponi)
  • infliximab (Remicade)

Natalizumab (Tysabri)

Taking Entyvio with natalizumab might increase the risk of a serious brain infection called progressive multifocal leukoencephalopathy (PML).

Live vaccines

Some vaccines contain active but weakened viruses or bacteria. These are often called live vaccines. If you take Entyvio, you should not receive live vaccines. These may increase your risk of getting the infection that the vaccine is meant to prevent. Examples of these vaccines include:

  • nasal spray flu vaccine (FluMist)
  • rotavirus vaccines (Rotateq, Rotarix)
  • measles, mumps, rubella (MMR)
  • chickenpox vaccine (Varivax)
  • yellow fever vaccine (YF Vax)

How to prepare for an Entyvio infusion

Entyvio is given as an intravenous (IV) infusion. This means it needs to be given in your doctor’s office, hospital, or infusion center.

Before your appointment

Your doctor or nurse will give your specific instructions on how to prepare for the infusion, but here are some tips:

  • Drink fluids. Be sure to drink plenty of fluids the day or two before your infusion appointment. For most people, this should be six to eight glasses of water or fluids daily. Try to avoid drinking too much caffeine, which can cause fluid loss.
  • Tell your doctor. If you have symptoms of an infection, such as cough or fever, be sure to let your doctor know. Also tell your doctor if you’re taking antibiotics. In either case, you may need to reschedule your infusion.
  • Arrive early. For your first infusion, plan to arrive 15 to 20 minutes early to complete paperwork, if needed.
  • Come prepared. This includes:
    • Dressing in layers. Some people feel cold while receiving their infusion.
    • Bringing a snack or lunch. Although the infusions don’t last very long, you may want to eat if you’re having the infusion over your lunch break.
    • Bringing your mobile device, headphones, or a book if you want to have entertainment during the infusion.
    • Knowing your schedule. If you have an upcoming vacation or other times you’ll be unavailable, your appointment is a good time to finalize future infusion dates.

What to expect

  • During your appointment, you’ll receive an IV. Once the IV is inserted into your vein, the infusion itself usually lasts about 30 minutes.
  • Once the infusion is completed, you can return to work or normal daily activities. Some people have mild side effects following an infusion, such as:
    • tenderness or bruising at the IV site
    • cold-like symptoms
    • headache
    • fatigue
    • nausea
    • joint pain
    • rash

These symptoms usually go away within a day or two. If they don’t go away, call your doctor. If you develop symptoms of an allergic reaction, such as trouble breathing or swelling around the face, lips, or mouth, call 911 or have someone take you to the emergency room.

How Entyvio works

Symptoms of ulcerative colitis (UC) and Crohn’s disease are caused by inflammation in the gut. This inflammation is caused by the movement of certain white blood cells into the gut (intestines).

Entyvio works by blocking some of the signals that cause these white blood cells to move into the gut. This action can decrease the inflammation and other symptoms of UC and Crohn’s disease.

Entyvio and pregnancy

No studies in humans have evaluated whether Entyvio is safe to use during pregnancy. Animals studies have not found any harmful effects, but studies in animals don’t always predict what would happen in humans.

If there are risks to the fetus, they may be greatest during the second and third trimesters. During this time, the fetus would likely be exposed to more of the drug.

If you’re taking Entyvio and are pregnant or thinking about becoming pregnant, talk with your doctor. They can tell you about the risks and benefits of continuing your Entyvio treatment or stopping it.

If you do receive Entyvio while pregnant, you can sign up for a registry that will help gather information about your experience. Pregnancy exposure registries help healthcare professionals learn more about how certain drugs affect women and their pregnancies. To sign up, call 877-825-3327.

Entyvio and breastfeeding

Small amounts of Entyvio are present in breast milk. However, small studies have not found any harmful effects on children who are breastfed by mothers receiving Entyvio.

If you’re receiving Entyvio and want to breastfeed your child, talk with your doctor about the potential risks.

Common questions about Entyvio

Here are answers to some frequently asked questions about Entyvio.

Is Entyvio a biologic?

Yes, Entyvio is a biologic drug. Biologics are made from a biological source, such as living cells.

How long does Entyvio take to work?

Treatment with Entyvio is broken into two parts. The first three starting doses are given during the induction phase, which lasts a total of six weeks. During this phase, the second dose is given two weeks after the first dose. The third dose is given four weeks after the second dose.

Although symptoms may begin to improve right away after the first infusion, it may take the full six-week period to get symptoms under control.

The maintenance phase follows the induction phase. During the maintenance phase, doses are given every eight weeks to keep symptoms under control.

Can you take Entyvio if you’ll be having surgery?

If you have a scheduled surgery, including dental surgery, you may need to delay or reschedule your Entyvio infusion.

Is Entyvio chemotherapy?

When someone says “chemotherapy,” they usually mean drug treatment for cancer (although technically the term can apply to any drug). In this sense, Entyvio is not considered chemotherapy. It’s not used to treat cancer.

Entyvio warnings

Before taking Entyvio, talk with your doctor about any medical conditions you have. Entyvio may not be appropriate for you if you have certain medical conditions.

  • For people with infections: Entyvio can worsen infections. If you have symptoms of an infection, such as a fever or cough, you may not be able to use Entyvio until the infection has cleared.
  • For people with liver disease: Entyvio may worsen liver problems in those who already have liver disease. It can also cause liver damage.

Professional information for Entyvio

The following information is provided for clinicians and other healthcare professionals.

Mechanism of action

Entyvio is a monoclonal antibody that binds alpha-4-beta-7 integrin and blocks its interaction with a cell adhesion molecule in the gastrointestinal tract. This results in inhibition of a specific subset of memory T-lymphocytes that are preferentially attracted to gastrointestinal tissues.

Pharmacokinetics and metabolism

At week six, after starting Entyvio, mean serum levels were 26.3 mcg/mL in patients with ulcerative colitis, and 27.4 mcg/mL in patients with Crohn’s disease. At week 46 of the maintenance phase, mean levels were 11.2 mcg/mL in those with ulcerative colitis and 13 mcg/mL in those with Crohn’s disease.

There is a potential for antibody formation to Entyvio. Serum levels may be undetectable in those who develop Entyvio antibodies.

The Entyvio half-life is about 25 days.

Contraindications

Entyvio is contraindicated in those who have previously had a severe hypersensitivity reaction to Entyvio or any excipients.

Storage

Entyvio should be stored in its original packaging and protected from light. Unopened Entyvio vials should be stored in a refrigerator.

Disclaimer: MedicalNewsToday has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.