The maximum time between doses in the three times a day schedule should not exceed 12 hours. What other drugs will affect gabapentin? The relationship between plasma concentration and clinical response is not well documented. One contributing factor is the nonlinear, concentration dependent protein binding of valproate which affects the clearance of the drug. Thus, monitoring of total serum valproate may not provide a reliable index of the bioactive valproate species. Bruni J, Wilder BJ, Perchalski RJ, Hammond EJ, Villarreal HJ. Valproic acid and plasma levels of phenobarbital. fosamax
Wu S, Legido A, De Luca F. "Effects of valproic acid on longitudinal bone growth". J Child Neurol. Chang P, Walker MC, Williams RS 2014. Published epidemiological studies have indicated that children exposed to valproate in utero have lower IQ scores than children exposed to either another antiepileptic drug in utero or to no antiepileptic drugs in utero. While is usually associated with altered physical characteristics this is not always the case. Based on two placebo-controlled clinical trials and their long term extension, valproate was generally well tolerated with most adverse reactions rated as mild to moderate in severity. Of the 202 patients exposed to valproate in the placebo-controlled trials, 17% discontinued for intolerance. This is compared to a rate of 5% for the 81 placebo patients.
Depakote is indicated for prophylaxis of migraine headaches. There is no evidence that Depakote is useful in the acute treatment of migraine headaches. Valproate is excreted in human milk. To relieve sudden angina.
If using Depakote delayed-release tablets for an extended period of time, obtain refills before your supply runs out. The opinions expressed in WebMD Communities are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. Communities are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Gabapentin may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations.
Depakote delayed-release tablets are an anticonvulsant. It works by reducing or preventing the number of seizures by controlling the abnormal activity of nerve impulses in the brain and central nervous system. Exactly how it works to treat bipolar disorder and migraine headache is not known. In patients over two years of age who are clinically suspected of having a hereditary mitochondrial disease, Depakote should only be used after other anticonvulsants have failed. This older group of patients should be closely monitored during treatment with Depakote for the development of acute liver injury with regular clinical assessments and serum liver testing. Depakote ER is a valproate and is indicated for the treatment of acute manic or mixed episodes associated with bipolar disorder, with or without psychotic features. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgment, aggressiveness, and possible hostility. A mixed episode is characterized by the criteria for a manic episode in conjunction with those for a major depressive episode depressed mood, loss of interest or pleasure in nearly all activities. The variability in free fraction limits the clinical usefulness of monitoring total serum valproic acid concentrations. Interpretation of valproic acid concentrations in children should include consideration of factors that affect hepatic metabolism and protein binding. June 1985. "An update on sodium valproate". Pharmacotherapy. Take gabapentin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended. Respiratory System: Hiccup, Rhinitis. Wear a medical alert tag or carry an ID card stating that you take divalproex sodium. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking a seizure medication. The effectiveness of Depakote ER for the treatment of acute mania is based in part on studies establishing the effectiveness of Depakote divalproex sodium delayed release tablets for this indication.
Depakote ER: asthenia and flu syndrome. Studies have shown that taking can reduce the risk of congenital defects. But many women don't have access to technology, and for them Sidelines and other groups offer telephone support around the clock. Depakote ER extended-release tablets may cause an unusual drop in body temperature hypothermia. Symptoms may include confusion, lack of energy, loss of coordination, shivering, slow heartbeat, slow or shallow breathing, slurred speech, or unusual drowsiness. Contact your doctor right away if you have any of these symptoms. North American Antiepileptic Drug NAAED Pregnancy Registry. The significance of these findings for humans is unknown. IQ. In addition, Depakote is excreted in breast milk; its effect on infants is unknown. The clinical significance of these is unknown. Take Depakote delayed-release tablets by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Valproate in elderly people with dementia caused increased sleepiness. More people stopped the medication for this reason. Additional side effects of weight loss and decreased food intake was also associated in one half of people who become sleepy. Valproate has been found to be a weak inhibitor of some P450 isozymes, epoxide hydrase, and glucuronosyltransferases. Depakote delayed-release tablets are to be used only by the patient for whom it is prescribed. Do not share it with other people. atrovent
Depakote ER or placebo and treated for 12 weeks. Don't stop taking your medicine without your doctor's permission. Sprinkle Capsules divalproex sodium delayed release capsules may be swallowed whole or the capsule contents may be sprinkled onto soft food such as applesauce or pudding. Inflammation of the pancreas is a potentially life-threatening illness associated with Depakote delayed-release tablets. Symptoms include stomach pain, vomiting, or loss of appetite. Contact your doctor at once if any of these symptoms occur. If you are giving this to yourself at home, learn all preparation and usage instructions from your professional. Before using, check this product visually for particles or discoloration. If either is present, not use the liquid. Learn how to store and discard medical supplies safely. Some young people have thoughts about suicide when first taking divalproex sodium. Your doctor will need to check your progress at regular visits while you are using this medicine. Your family or other caregivers should also be alert to changes in your mood or symptoms. Depakote ER extended-release tablets may interfere with certain lab tests, including thyroid function. Be sure your doctor and lab personnel know you are taking Depakote ER extended-release tablets. My boyfriend is a long-time migraine sufferer. While he was recovering from a recent attack, he developed new symptoms such as dizziness and short-of-breath. I searched the internet but did not find these symptoms being commonly associated with migraines, and he didn't have these symptoms in the past. I wonder whether his new condition is related to stress, as he is also a long-term sufferer of anxiety and depression. His job is very stressful. Though I have urged him to see a doctor, due to his busy schedule and pressure from work, he hasn't. I'm getting worried for his health. Moreover, I live in the Rockies elevation of my town is 7200 ft while he lives at sea level. I'm concerned also as he plans to visit me soon. I read that migraines conditions may get worse at high elevations. Hold the capsule so that the end marked "THIS END UP" is straight up and the arrow on the capsule is up. The capsule is extra large to help prevent spilling the DEPAKOTE Sprinkles, but it still must be handled carefully. Your doctor will need to periodically test the function of your and gland if you are taking lithium. price of travatan cream in the philippines travatan
Acta Neurol. Scand. Suppl. There may be other side effects that you experience that are not described above. This article is meant to be educational and is not meant to be all-inclusive or to replace information provided by your doctor. What is the most important information I should know about Depakote and Depakene? Lab tests, including complete blood cell counts, blood ammonia levels, and liver function, may be performed while you use Depakote ER extended-release tablets. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. In the clinical trials, there was no evidence that higher doses led to greater efficacy. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule. IQ in children who were exposed. Check with your pharmacist about how to dispose of unused medicine. Medications are mainstays in controlling epileptic seizures. Surgical procedures are another way epilepsy is treated. Learn about your options. When Depakote is used in this patient group, it should be used with extreme caution and as a sole agent. The benefits of therapy should be weighed against the risks. Above the age of 2 years, experience in epilepsy has indicated that the incidence of fatal hepatotoxicity decreases considerably in progressively older patient groups. Hemic and Lymphatic System: Petechia. Quick-acting forms of nitroglycerin are used to relieve or used just before activities that typically cause angina. The quick-acting forms include tablets or oral sprays. The tablets are placed under the sublingual or between the cheek and gum buccal. Younger children, especially those receiving enzyme inducing drugs, will require larger maintenance doses to attain targeted total and unbound valproate concentrations. Scale MRS; score ranges from 0-52. Musculoskeletal System: Leg cramps and myalgia. alternative anafranil pills
Special Senses: Conjunctivitis, ear disorder, taste perversion, and tinnitus. Your doctor may check medicine blood levels and may need to adjust the dose of one or both medicines. SCE frequency is not known. Digestive System: Constipation, dry mouth, flatulence, and stomatitis. When Depakote ER is used in this patient group, it should be used with extreme caution and as a sole agent. The benefits of therapy should be weighed against the risks. Above the age of 2 years, experience in epilepsy has indicated that the incidence of fatal hepatotoxicity decreases considerably in progressively older patient groups. Use effective birth control while using divalproex sodium, and tell your doctor right away if you become pregnant. Tell your doctor if you start or stop using hormonal contraception that contains estrogen birth control pills, injections, implants, skin patches, and vaginal rings. Estrogen can interact with divalproex sodium and make it less effective in preventing seizures. Johnson GJ, Kilpatrick CJ, Bury RW, Fullinfaw RO, Moulds RF. Unbound phenytoin plasma concentrations in patients comedicated with sodium valproate--the predictive value of plasma albumin concentration. Drowsiness or sleepiness in the elderly. The primary findings were an increase in the incidence of subcutaneous fibrosarcomas in high-dose male rats receiving valproate and a dose-related trend for benign pulmonary adenomas in male mice receiving valproate. The significance of these findings for humans is unknown. Depakote, the two formulations are bioequivalent. If ammonia is increased, valproate therapy should be discontinued.
Journal of Child Neurology. Rarely, this medication has caused serious sometimes fatal liver problems, usually within the first 6 months of starting treatment. Laboratory tests should be performed before you start treatment and periodically during treatment, especially within the first 6 months, to monitor this side effect. Please share wisdom -- what I can do to help him? During the placebo controlled pediatric mania trial, one 1 in twenty 20 adolescents 5% treated with valproate developed increased plasma ammonia levels compared to no 0 patients treated with placebo. Get emergency medical help if you have signs of an allergic reaction to gabapentin: hives; difficult breathing; swelling of your face, lips, tongue, or throat. When valproate is used in this patient group, it should be used with extreme caution and as a sole agent. The benefits of therapy should be weighed against the risks. Above the age of 2 years, experience in epilepsy has indicated that the incidence of fatal hepatotoxicity decreases considerably in progressively older patient groups. Complete the What is a document? Depakote divalproex sodium delayed release tablets for this indication. What should I tell my healthcare provider before taking Depakote or Depakene? generic vidalta order online pharmacy
Valproate should not be used to treat women with epilepsy or bipolar disorder who are pregnant or who plan to become pregnant unless other treatments have failed to provide adequate symptom control or are otherwise unacceptable. In such women, the benefits of treatment with valproate during pregnancy may still outweigh the risks. When treating a pregnant woman or a woman of childbearing potential, carefully consider both the potential risks and benefits of treatment and provide appropriate counseling. Limited, three case reports support its efficacy, however. Matsuoka M, Igisu H 1993. "Comparison of the effects of L-carnitine, D-carnitine and acetyl-L-carnitine on the neurotoxicity of ammonia". Biochem. Pharmacol. Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Behaviors of concern should be reported immediately to healthcare providers. Hyperammonemia has been reported in association with valproate therapy and may be present despite normal liver function tests. Retrieved 18 January 2014. In animal studies, offspring with prenatal exposure to valproate had structural malformations similar to those seen in humans and demonstrated neurobehavioral deficits. Use the spray under your tongue or on top of your tongue. Push the spray canister button once. Close your right away. The relative risk for suicidal thoughts or behavior was higher in clinical trials for epilepsy than in clinical trials for psychiatric or other conditions, but the absolute risk differences were similar for the epilepsy and psychiatric indications. Equivalent oral doses of Depakote divalproex sodium products and Depakene valproic acid capsules deliver equivalent quantities of valproate ion systemically. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor. First off, Debbie is right. The WebMD message boards have had technical difficulties that we've been trying to work out. But there is some good news! Experience employing dosing regimens from once-a-day to four-times-a-day, as well as studies in primate epilepsy models involving constant rate infusion, indicate that total daily systemic bioavailability extent of absorption is the primary determinant of seizure control and that differences in the ratios of plasma peak to trough concentrations between valproate formulations are inconsequential from a practical clinical standpoint. Whether or not rate of absorption influences the efficacy of valproate as an antimanic or antimigraine agent is unknown. Anyone considering prescribing Depakote ER or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated. Liver failure and death from liver failure has occurred in patients taking Depakote delayed-release tablets. This has usually occurred within the first 6 months of treatment. Tell your doctor right away if you notice symptoms of liver problems eg, a general feeling of discomfort, sluggishness, unusual tiredness or weakness, swelling of the face, loss of appetite, vomiting, stomach pain, dark urine, pale stools, or yellowing of the skin or eyes. In patients who have seizures, loss of seizure control may occur. You should have lab tests done before and during treatment to check for liver problems. Be sure to keep all doctor and lab appointments. generic propecia greece propecia
The active ingredient in both products is valproic acid. Hematologic: Relative lymphocytosis, macrocytosis, leukopenia, anemia including macrocytic with or without folate deficiency, bone marrow suppression, pancytopenia, aplastic anemia, agranulocytosis, and acute intermittent porphyria. Depakote ER divalproex sodium extended release tablets are administered orally, and must be swallowed whole. Depakote ER has not been systematically studied as initial therapy. Do not start, stop, or change the dosage of any medicine before checking with them first. Chemically it is designated as sodium hydrogen bis2-propylpentanoate. This medication has rarely caused severe sometimes fatal disease of the pancreas pancreatitis. This may occur at any time during treatment and can quickly worsen. While using divalproex sodium, you may need frequent blood tests. Lonergan E, Luxenberg J 2009. PDF. Cochrane Database Syst Rev 3: CD003945. In epileptic patients previously receiving Depakene valproic acid therapy, Depakote tablets should be initiated at the same daily dose and dosing schedule. After the patient is stabilized on Depakote tablets, a dosing schedule of two or three times a day may be elected in selected patients. Because the study was observational in nature, conclusions regarding a causal association between in utero valproate exposure and an increased risk of autism spectrum disorder cannot be considered definitive. Metabolic and Nutritional Disorders: Edema, peripheral edema. travatan
Body as a Whole: Chest pain, chills, chills and fever, fever, neck pain, neck rigidity. Birth defects may occur even in children born to women who are not taking any medicines and do not have other risk factors. Some of the side effects that can occur with divalproex sodium may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. In much of Europe, Dépakine and Depakine Chrono tablets are equivalent to Epilim and Epilim Chrono above. IQ scores following in utero exposure. The following adverse reactions occurred in greater than 5% of Depakote ER-treated patients and at a greater incidence for placebo than for Depakote ER: asthenia and flu syndrome. See “What is the most important information I should know about Depakote or Depakene?
Older adults may be more sensitive to the side effects of this drug, especially problems. Depakote ER is an extended-release product intended for once-a-day oral administration. Depakote ER tablets should be swallowed whole and should not be crushed or chewed. Patel IH, Levy RH, Cutler RE. Phenobarbital--valproic acid interaction. Divalproex sodium may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Windorfer A Jr, Sauer W, Gadeke R. Elevation of diphenylhydantoin and primidone serum concentration by addition of dipropylacetate, a new anticonvulsant drug. cost proventil in mexico
Administration of a single oral 50 mg dose of amitriptyline to 15 normal volunteers 10 males and 5 females who received valproate 500 mg BID resulted in a 21% decrease in plasma clearance of amitriptyline and a 34% decrease in the net clearance of nortriptyline. Rare postmarketing reports of concurrent use of valproate and amitriptyline resulting in an increased amitriptyline level have been received. Concurrent use of valproate and amitriptyline has rarely been associated with toxicity. Monitoring of amitriptyline levels should be considered for patients taking valproate concomitantly with amitriptyline. DRESS may be fatal or life-threatening. Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection. Maximum concentrations were generally achieved within 14 days. Most of the time, this reaction has signs like fever, rash, or swollen glands with problems in body organs like the liver, kidney, blood, heart, muscles and joints, or lungs. Talk with the doctor. May TW, Rambeck B, Jurgens U. Serum concentrations of lamotrigine in epileptic patients: the influence of dose and comedication. Many medications are available for treating epilepsy in children, and advances in the past years have made a difference. Cases of life-threatening pancreatitis have been reported in both children and adults receiving valproate. Some of the cases have been described as hemorrhagic with a rapid progression from initial symptoms to death. Cases have been reported shortly after initial use as well as after several years of use. If clinically indicated, alternative treatment may be considered. Fredly H, Gjertsen BT, Bruserud O 2013. PDF. Clin Epigenetics. If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not drink alcohol or use medicines that may cause drowsiness eg, sleep aids, muscle relaxers while you are using Depakote ER extended-release tablets; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. msis.info suprax
Drowsiness, dizziness, unsteadiness can increase the risk of falling. Due to a decrease in unbound clearance of valproate and possibly a greater sensitivity to somnolence in the elderly, the starting dose should be reduced in these patients. Dosage should be increased more slowly and with regular monitoring for fluid and nutritional intake, dehydration, somnolence, and other adverse reactions. Dose reductions or discontinuation of valproate should be considered in patients with decreased food or fluid intake and in patients with excessive somnolence. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, depression, or if you feel agitated, hostile, restless, hyperactive mentally or physically or have thoughts about suicide or hurting yourself. In most cases, symptoms and signs abated with discontinuation of either drug. MYE-toe-KON-dree-al disorder such as Alpers' disease or Alpers-Huttenlocher syndrome, especially in a child younger than 2 years old. Special Senses: Hearing loss. Usually the benefits of the medicine are more important than any minor side effects. The following adverse reactions occurred in greater than 5% of Depakote-treated patients and at a greater incidence for placebo than for Depakote: flu syndrome and pharyngitis. Depakote or Depakene. See the end of this leaflet for a complete list of ingredients in Depakote and Depakene. Take Depakote or Depakene exactly as your healthcare provider tells you. Candace Hurley understands those issues all too well, having spent about half of each of her two pregnancies lying down. Evidence suggests that folic acid supplementation prior to conception and during the first trimester of pregnancy decreases the risk for congenital neural tube defects in the general population. It is not known whether the risk of neural tube defects or decreased IQ in the offspring of women receiving valproate is reduced by folic acid supplementation. Dietary folic acid supplementation both prior to conception and during pregnancy should be routinely recommended for patients using valproate. Nitroglycerin comes in quick-acting forms and long-acting forms. Respiratory System: Dyspnea, and sinusitis. No patients above the age of 65 years were enrolled in double-blind prospective clinical trials of mania associated with bipolar illness. In a case review study of 583 patients, 72 patients 12% were greater than 65 years of age. A higher percentage of patients above 65 years of age reported accidental injury, infection, pain, somnolence, and tremor. Discontinuation of valproate was occasionally associated with the latter two events. It is not clear whether these events indicate additional risk or whether they result from preexisting medical illness and concomitant medication use among these patients. It works by stopping the growth of bacteria. tofranil
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Do not stop taking any medications without consulting your healthcare provider. There is no body of evidence available from controlled trials to guide a clinician in the longer term management of a patient who improves during Depakote ER treatment of an acute manic episode. Manic Syndrome Scale MSS and the Behavior and Ideation Scale BIS. Available prenatal diagnostic testing to detect neural tube and other defects should be offered to pregnant women using valproate. lopid ingredients
Tell your doctor or dentist that you take Depakote ER extended-release tablets before you receive any medical or dental care, emergency care, or surgery. Also i know a girl who is on 60 mgs of methadone and she also takes lithium with no methadone withdrawls. I know for sure it because you were on a very high dose of methadone then dropped down to 60 mgs methadone way to fast. Methadone has suxh a long freakin Half-Life that it takes an unbelievable amount of time to tapper off of. And still you will have really bad withdrawls! In developmental toxicity studies conducted in mice, rats, rabbits, and monkeys, increased rates of fetal structural abnormalities, intrauterine growth retardation, and embryo-fetal death occurred following treatment of pregnant animals with valproate during organogenesis at clinically relevant doses calculated on a body surface area basis. Valproate induced malformations of multiple organ systems, including skeletal, cardiac, and urogenital defects. In mice, in addition to other malformations, fetal neural tube defects have been reported following valproate administration during critical periods of organogenesis, and the teratogenic response correlated with peak maternal drug levels. Behavioral abnormalities including cognitive, locomotor, and social interaction deficits and brain histopathological changes have also been reported in mice and rat offspring exposed prenatally to clinically relevant doses of valproate. plaquenil store in manila
Valproate had no effect on any of the pharmacokinetic parameters of acetaminophen when it was concurrently administered to three epileptic patients. Increased thirst and increased need to urinate. If your doctor changes your brand, strength, or type of gabapentin, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of gabapentin you receive at the pharmacy. Depakote delayed-release tablets may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Depakote delayed-release tablets with caution.
May T, Rambeck B. Fluctuations of unbound and total phenytoin concentrations during the day in epileptic patients on valproic acid comedication. F has been reported in association with valproate therapy both in conjunction with and in the absence of hyperammonemia. Do not consider Communities as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.