Porphyria. Hypersensitivity to HMG-CoA reductase inhibitors. Simvastatin: Contraindications. Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. . Nursing considerations. WARNING: Withhold atorvastatin in any acute, serious condition (severe infection, hypotension, major surgery, trauma, severe metabolic or endocrine disorder, seizures) that may suggest myopathy or serve as risk factor for development of renal failure. simvastatin is a topic covered in the Davis's Drug Guide.. To view the entire topic, please sign in or purchase a subscription.. Paul Nestel, in Side Effects of Drugs Annual, 2011. Nursing Diagnoses. These are vital nursing interventions done in patients who are taking cholesterol absorption inhibitors: Monitor serum cholesterol and LDL levels. Interventions Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off opioid analgesics as soon as possible. Primary prevention refers to patients who have one or more cardiovascular risks, but do not show overt clinical signs of atherosclerotic disease. It is recommended to be used only after other measures such as diet, exercise, and weight reduction have not improved cholesterol levels. â¢ Advise patient to avoid or limit alcohol use. Monitor for and report promptly S&S of myopathy (e.g., skeletal muscle pain). Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy: Disturbed sensory perception related to CNS effects; Risk for injury related to CNS effects; Implementation with Rationale. Do not drink grapefruit juice while using this drug. Check and identify if any neurological disorder like seizure etc. If. Check lab test for CBC, blood glucose, BUN, creatinine, platelets, electrolytes, LFT. (Alcohol may affect liver function.) Ib. Adjunct to diet in the treatment of elevated total cholestrol and LDL cholesterol with primary hypercholesterolemia (types IIa and IIb) in those unresponsive to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures, To reduce the risk of coronary disease, mortality, and CV events, including CVA, TIA, MI and reduction in need for bypass surgery and angioplasty in patients with coronary heart disease and hypercholesterolemia, Treatment of patients with isolated hypertriglyceridemia, Treatment of type III hyperlipoproteinemia, Treatment of adolescents 10–17 yr with heterozygous familial hypercholesterolemia. I. SIMVASTATIN MYLAN 1. Simvastatin: Cautions. Combination therapy of cyclosporine, everolimus, or sirolimus with lovastatin, simvastatin, and pitavastatin is potentially harmful and should be avoided. One product, simvastatin, has now become available over the counter from pharmacists. Liver stiffness. In primary prevention intervention the effects of simvastatin-induced changes in lipoprotein levels, including reduction of serum cholesterol, on cardiovascular morbidity or mortality or total mortality have not been established. Nursing Interventions and Rationales. - Primary hypercholesterolaemia. Cipla Simvastatin Tablet is a prescription medicine that is used to decrease the level of low-density lipoproteins, high-density lipoproteins, and triglycerides in the blood. Because of the potential for undesirable side effects in a nursing infant, breastfeeding while taking Simvastatin oral is not recommended. Fibrosis 4 index (FIB-4) score. DESCRIPTION. Id. Range, 10–40 mg/day based on response. Pharmaceutical Form Simvastatin â¦ It is used to lower bad cholesterol and raise good cholesterol (HDL). Do not breast feed while taking this drug. La simvastatine appartient au groupe de médicaments appelés inhibiteurs de l'HMG-CoA réductase (« statines »). The following are the general nursing interventions and considerations when administering hypertonic IV solutions: Document baseline data. Uses of Simvastatin Tablets: It is used to slow the progress of heart disease. Moderate intake of grapefruit juice while taking this medication. cramps, constipation, heartburn, flatur, erectile dysfunction Lowers LDL and triglycerides. Nursing Considerations for Hypertonic Solutions. Hydralazine is effectively used in combination therapy for severe hypertension. Ensure fluid resuscitation “Expansion of extracellular volume is the cornerstone of treatment and must be initiated as soon as possible.” (Source) Record I&O . MELD score. Indicated by decreased serum triglycerides, decreased LDL, cholesterol, and modest increases in HDL cholesterol. Liver diseases. Simvastatin oral tablet is available as the brand-name drug Zocor. Nursing Central is an award-winning, complete mobile solution for nurses and students. 2. Severe Interactions. Consider reducing dose if cholesterol falls below target. The effects of ezetimibe coadministered with simvastatin compared to simvastatin monotherapy were evaluated in 142 boys and 106 postmenarchal girls, aged 10 to 17 years, with heterozygous familial hypercholesterolemia. GROUP I: Patients receive simvastatin orally (PO) once daily (QD). simvastatin Nursing Considerations & Management, I am only one, but still I am one. Continue monitoring of ECG for any change. Serum IL-6. Nursing Intervention for Atrial Fibrillation Disease: Various nursing intervention for atrial fibrillation are mentioned in the following: Monitor vital signs hourly, if patient in critical care unit. Interventions and (Rationales) Patient Teaching/Discharge Planning • Monitor development of eye pain. Atorvastatin is an inhibitor of reductase 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA), which is essential to hepatic production of cholesterol. Simvastatin is used to control elevated cholesterol, or hypercholesterolemia. - Homozygous familial hypercholesterolaemia or combined hyperlipidaemia in patients who have not responded enough to dietary changes. (Smoking may decrease HDL levels and thereby counteract effects of medication.) Commonly prescribed statins include lovastatin (Mevacor), simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), and rosuvastatin (Crestor). Complete Product Information. The addition of niacin to a statin has not been shown to reduce cardiovascular morbidity or mortality. Monitor results of liver functions tests. Follow your doctor's orders or the directions on the label. FloLipid is used to reduce elevated total cholesterol (total-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), and triglycerides (TG), and to increase high-density lipoprotein cholesterol (HDL-C). reductase inhibitors increase HDL cholesterol, and decrease LDL cholesterol, and total cholesterol synthesis. Because a small amount of another drug in this class is excreted in human milk and because of the potential for serious adverse reactions in nursing infants, women taking simvastatin should not nurse their infants. Hypersensitivity to simvastatin; active liver disease; pregnancy (category X), lactation. Do not drink large amounts of alcohol with simvastatin. Simvastatin (Zocor) is used to treat high cholesterol and to reduce risk of heart disease. Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug. The Welsh guidance, developed by the Cardiac Network,15 recommends simvastatin as first choice. Simvastatin nursing responsibilities. Assessment & Drug Effects. Severe Interactions. You may experience these side effects: Nausea (eat frequent small meals); headache, muscle and joint aches and pains (may lessen); sensitivity to light (use a suncreen and wear protective clothing). To evaluate the effect of a simvastatin intervention versus placebo at 6 months on the change in: Ia. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase; similar in action to lovastatin but more potent. Homozygous familial hypercholesterolemia, history of liver disease, alcoholics. Excipient(s) with known effect: Simvastatin Mylan tablets contain lactose. Statins lower low-density lipoprotein cholesterol (LDL-C)-the so-called bad cholesterol-by slowing its production and boosting the … Ic. 10 mg/day PO in the evening. - Heterozygous familial hypercholesterolaemia. In patients with coronary heart disease (CHD) or at high risk of CHD, Simvastatin tablets can be started simultaneously with diet. Myopathy risk increases when statins are taken with medications known to inhibit their metabolism .11, 17, 18, 21 – 32 Serum levels of simvastatin and lovastatin are increased four- … Brand Name: Apo-Simvastatin (CAN), Gen-Simvastatin (CAN), CO Simvastatin (CAN), Novo-Simvastatin (CAN), ratio-Simvastatin (CAN), Zocor, Classification: Antihyperlipidemic, HMG-CoA reductase inhibitor Patients on high dose simvastatin and those taking certain other medicines have an increased risk of developing myopathy (muscle weakness) and, more rarely, rhabdomyolysis 1. The purpose of this course is designed for nurses to understand the pathophysiology, risk and protective factors, signs and symptoms, diagnosis, treatment/management (both dietary changes and pharmacology), nursing care/implications, and future research/trends in Cholesterol Management, Coaching, and Patient Education. Serum bile acid levels. Myocardial infarction nursing management and medication lecture NCLEX review. Patients may need dialysis if oliguria is present. Ensure that patient has tried a cholesterol-lowering diet regimen for 3–6 mo before beginning therapy. Simvastatin is a prescription drug. Macrolide antibiotics. Does Simvastatin Interact with other Medications? Determine CPK level at onset of muscle pain. The breakdown of muscle fibres resulting in the release of muscle fibre contents (myoglobin) into the bloodstream. Simvastatin is a prodrug metabolised in the liver to form the active β-hydroxyacid derivative. Starting dose, 5 mg/day PO; increase dose slowly, monitoring response. Hydralazine is used as a hypertensive emergency. Nursing Mothers. - Prevention of coronary events. Interventions In patients with drug-induced myopathy, implement gradual strengthening and other therapeutic exercises to facilitate recovery from muscle pain and weakness. The amount of urine output, or lack thereof, may dictate various treatment regimens. ... and there may be other adverse effects to the nursing infant. On lâutilise également, peu importe si les taux de cholestérol sont élevés ou non, pour réduire le risque de crise cardiaque, dâaccident vasculaire cérébral ou de décès chez les personnes atteintes de maladies coronariennes et chez celles qui ont dâautres artâ¦ It is unknown if Simvastatin oral passes into breast milk. Lovastatin (Mevacor) and Simvastatin (Zocor) are both used to lower cholesterol in the bloodstream, which is implicated in coronary artery disease and a number of other cardiovascular problems. Therapy with lipid-altering agents should be only one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. Simvastatin is used to control elevated cholesterol, or hypercholesterolemia. Pregnancy, lactation. Inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase; similar in action to lovastatin but more potent. FloLipid (simvastatin) Oral Suspension is a lipid-lowering agent that is derived synthetically from a fermentation product of Aspergillus terreus. Simvastatin exposure is approximately doubled with concomitant use of lomitapide; therefore, the dose of Simvastatin tablets should be reduced by 50% if initiating lomitapide. Erythromycin interacts with simvastatin, probably by inhibiting its metabolism by CYP3A4. What nursing interventions should the nurse follow for JQ? FloLipid (simvastatin) Oral Suspension is a lipid-lowering agent that is derived synthetically from a fermentation product of Aspergillus terreus. Simvastatin tablets are an HMG-CoA reductase inhibitor (statin) indicated as an adjunctive therapy to diet to: Reduce the risk of total mortality by reducing CHD deaths and reduce the risk of non-fatal myocardial infarction, stroke, and the need for revascularization procedures in patients at high risk of coronary events. The purpose of this study was to compare the effectiveness of 2 different pharmacist-conducted educational interventions on appropriate simvastatin use in the primary care setting. Pregnancy and nursing period. I cannot do everything, but still I can do something; and because I cannot do everything, I will not refuse to do something that I can do. Simvastatin tablets should be used as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis) in these patients or if such treatments are unavailable. HMG-CoA
To this end, we analyzed the influence of simvastatin on the cell growth and adhesion of HCC and evaluated the yet poorly characterized mechanism of action of simvastatin in HCC. zocor ... nursing responsibilities of Combivir Read More. every two months), later sporadic controls suffice. One product, simvastatin, has now become available over the counter from pharmacists. Learn about its side effects, dosage, uses, and more. Search. Continue monitoring during and after the infusion. Simvastatin/Zocor Oral Tab: 5mg, 10mg, 20mg, 40mg, 80mg. Use caution during early stages to avoid fatigue of affected muscles, and implement assistive devices (walker, cane, crutches) as needed to prevent falls and assist mobility. Combined with cyclosporine, start with 5 mg/day; do not exceed 20 mg/day. Not for use with strong CYP3A4 inhibitors. Advise patient that this drug cannot be taken during pregnancy; advise patient to use barrier contraceptives. Does Simvastatin Interact with other Medications? Familial hypercholesterolemia: 40 mg/day PO in the evening, or 80 mg/day divided into doses of 20 mg, 20 mg, and 40 mg in the evening. Because a small amount of another drug in this class is excreted in human milk and because of the potential for serious adverse reactions in nursing infants, women taking simvastatin should not nurse their infants. FloLipid is used to reduce elevated total cholesterol (total-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), and triglycerides (TG), and to increase high-density lipoprotein cholesterol (HDL-C). In addition, lipid-modifying doses (1 g/day or more) of niacin increase the risk of myopathy and rhabdomyolysis when combined with rosuvastatin. Combination therapy: Do not combine with other statins; if used with fibrates or niacin, do not exceed 10 mg/day; regular dose if combined with bile acid sequestrants. Arrange for regular follow-up during long-term therapy. It is used to lower triglycerides. Most potent, oral HMG-CoA reductase inhibitor Approved for primary hypercholesterolemia, hyperlipoproteinemia and/or hypertriglyceridemia, heterozygous familial hypercholesterolemia (for patients 8 to 17 years), homozygous familial hypercholesterolemia (for patients 7 years and older), and primary prevention of cardiovascular disease Interventions: Administer to women who are nursing a baby 4–6 hr before the next scheduled feeding to minimize the amount in milk. HMG-CoA reductase inhibitors increase HDL cholesterol, and decrease LDL cholesterol, and total cholesterol synthesis. Pregnant Women and Nursing Women). Insert Foley and prevent infection . Lovastatin and simvastatin are administered as lactone pro‐drugs, and are enzymatically hydrolysed in vivo to their active, hydroxy‐acid form . Maximum dose, 80 mg/day. Announcement!! It reduces total cholesterol, LDL-cholesterol and triglycerides and increases HDL-cholesterol levels. Initially, 20 mg PO; up to 80 mg PO daily in the evening. Product Name Simvastatin Mylan 10 mg, 20 mg, 40 mg and 80 mg film coated tablets. The dose of this medicine will be different for different patients. Some key pharmacokinetic properties of the individual statins are summarized in Table II. Slightly increase HDL. Withhold drug and notify physician if CPK levels are markedly elevated (10xULN) or if myopathy is diagnosed or suspected. These medications are not usually taken together. Our Simvastatin â¦ ENOXAPARIN (Lovenox) is a low-molecular-weight heparin commonly used to prevent or treat acute deep vein thrombosis. Lab tests: Obtain baseline and periodic (q6mo) liver function during the first year and yearly thereafter. Ensure fluid resuscitation âExpansion of extracellular volume is the cornerstone of treatment and must be initiated as soon as possible.â (Source) Record I&O . PT may be prolonged. Ie. Lipitor increases the number of hepatic low-density-lipid (LDL) receptors, thus increasing LDL uptake and catabolism of LDL. The other statins are administered as the active hydroxy acid [9, 24, 27]. Simvastatin (5-80 mg/day) reduces the levels of total cholesterol (19- 36%), LDL-cholesterol (26-47%), apolipoprotein B (19-38%), and triglycerides (12-33%), in patients with mild to severe hyperlipidemia (Fredrickson Types IIa and IIb). Interventions. Dans l'étude 4S (Scandinavian Simvastatin Survival Study), l'effet du traitement par simvastatine sur la mortalité totale a été évalué chez 4 444 patients coronariens et ayant un cholestérol total basal de 2,12 à 3,09 g/l (5,5 à 8,0 mmol/l). It is not known whether simvastatin is excreted in human milk. The patients received ezetimibe 10 mg coadministered with simvastatin (10 mg, 20 mg, or 40 mg) or simvastatin alone for 6 weeks, 10 mg ezetimibe and 40 mg simvastatin or 40 â¦ Qualitative and Quantitative Composition Each Simvastatin Mylan tablet contains 10 mg, 20 mg, 40 mg or 80 mg of simvastatin. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams), Salicylates Nursing Considerations & Management, ritonavir Nursing Considerations & Management, Antiviral Drugs Nursing Considerations & Management. Patients need to be educated about signs and symptoms that require immediate physician intervention. Many nurses are playing now! Nursing Central is an award-winning, complete mobile solution for nurses and students. Monitor LFT's. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. (May indicate worsening of condition.) Enquire the complete health history of the patient including allergy, drug interactions, and family background of depression. Simvastatin oral is not recommended for use during pregnancy; it may harm a fetus. Simvastatin also raises HDL-cholesterol (8-16%) and therefore lowers the LDLC/ HDL-C and total-C/HDL-C ratios. Acute liver disease or unexplained persistent elevations of serum transaminases. Reduces risk of
Ensure that patient has tried a cholesterol-lowering diet regimen for 3â6 mo before beginning therapy. Common Questions and Answers about Simvastatin nursing responsibilities. These are vital nursing interventions done in patients who are taking HMG-CoA reductase inhibitors: Interventions and (Rationales) Patient Education/Discharge Planning â¢ Monitor for concurrent alcohol use. Pravastatin, lovastatin, and simvastatin are indicated for patients with documented CAD to slow progression of the disease. Primary prevention refers to patients who have one or more cardiovascular risks, but do not show overt clinical signs of atherosclerotic disease. and Nursing Women). Safety and effectiveness in children and adolescents
OBJECTIVES: Primary. Niacin; Simvastatin: (Major) There is no clear indication for routine use of niacin in combination with rosuvastatin. For the full list of excipients, see section 6.1. These medications are not usually taken together. The amount of urine output, or lack thereof, may dictate various treatment regimens. Complete Product Information. ... Simvastatin is in a gathering of medications called HMG CoA reductase inhibitors, or "statins." Hypersensitivity, Active liver disease, ^ AST or ALT, Simvastatin: concurrecnt use of CYP3A4 inhibitors ^ risk of myopathy/rhabdomyolysis Amnesia, confusion, dizziness, chest pain, peripheral edema, rhinitis, blurred vision, bronchitis, abd. In the ARBITER 6-HALTS ER niacin + simvastatin was compared with ezetimibe + simvastatin [3 C].It was expected that both interventions would lower LDL cholesterol beyond that due to the statin but that niacin would additionally raise HDL cholesterol more than ezetimibe. Hypercholesterolemia (alone or in combination with bile acid sequestrants), familial hypercholesterolemia. Our hottest nursing game is out now in the App Store. Study appraisal and synthesis methods: Studies on statins (atorvastatin, rosuvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, and simvastatin + ezetimibe) in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2019 were analyzed. HYDRALAZINE: ARTERIAL VASODILATOR GENERAL DESCRIPTION Hydralazine is a hydrazine derivatives and is a direct acting vasodilator. Patients may need dialysis if oliguria is present. Because of the risk of respiratory depression, bradycardia, and hypotension, use caution during aerobic exercise and other forms of therapeutic exercise. This inhibits the conversion of HMG-CoA to mevalonic acid by blocking HMG-CoA reductase, an early and rate-limiting step in cholesterol biosynthesis. RATIONALE: Chemoprevention is the use of certain drugs to keep cancer from forming, growing, or coming back. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Combination with amiodarone or verapamil, dose should not exceed 10 mg/day. Nursing Central is an award-winning, complete mobile solution for nurses and students. Serum AFP. BLACK BOX WARNING: Keep opioid antagonist and facilities for assisted or controlled respiration readily available during parenteral administration. Nursing Implications. Liver function must be monitored regularly in the first year of treatment (e.g. A patient taking enoxaparin is at risk for bleeding, including retroperitoneal and intracranial bleeding, so monitor her carefully. 3. Report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever, to physician. ... Labs/interventions. Assess for and report unexplained muscle pain. Interventions Obtain LFTs as a baseline and periodically during therapy; discontinue drug if AST or ALT levels increase to 3 times normal levels. Monitor coagulation studies with patients receiving concurrent warfarin therapy. GENERIC NAME: Hydralazine BRAND NAME: Apresoline MECHANISM OF ACTION Hydralazine is … OUTLINE: Patients are randomized to 1 of 2 groups. The use of simvastatin may keep cancer from coming back in women who are at high risk for a new breast cancer after undergoing surgery for ductal carcinoma in situ or stage I, stage II, or stage III breast cancer. Ensure pt has tried using a cholesterol lowering diet for 3 to 6 months before starting tx. Nursing Interventions and Rationales. Report signs of bleeding to physician promptly when taking concurrent warfarin. Elle complémente un régime alimentaire et des exercices physiques instaurés pour abaisser un taux trop élevé de cholestérol sanguin. Adjust at 4-wk intervals. levels throughout therapy. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Both forms are taken by mouth. To determine the effectiveness of drug therapy. - To slow progress of coronary atherosclerosis in patients with coronary heart disease. Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM. This drug cannot be taken during pregnancy; using barrier contraceptives is recommended. Comparative studies. Monitor heart sounds and apical pulse rate. Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM. It is not known whether simvastatin is excreted in human milk. Describe changes from baseline in a panel of biomarkers (high-sensitivity C-reactive protein [hsCRP], lipid profile, circulating estrogens, and contralateral breast density) in women at high risk of developing new breast cancer who have undergone surgical resection for history of ductal carcinoma in situ or stage I-III invasive breast cancer treated with simvastatin. coronary death and nonfatal MI. • Use proper technique to instill eye … Nursing Responsibilities of ACE inhibitors and angiotensin II receptor inhibitors (ARBs) - monitor VS, 1st dose => severe drops in B/P => best to adm 1st dose at bed time, use pump when IV - don't give in 2nd and 3rd trimesters - careful monitor in renal failure, BUN & creatinine Toute reproduction ou représentation totale ou partielle de ce site par quelque procédé que ce â¦ The following information includes only the average doses of … Monitor cholesterol
The use of lovastatin, pitavastatin, and simvastatin should be avoided in patients receiving cyclosporine, tacrolimus, everolimus, or sirolimus as consistent with product labeling. are not established. Ce document intitulé « Simvastatine - Indications, posologie et effets secondaires » issu de Journal des Femmes (sante-medecine.journaldesfemmes.fr) est soumis au droit d'auteur. Headache, nausea, flatulence, heartburn, abdominal pain, diarrhea/constipation, dysgeusia; myopathy features like myalgia and muscle weakness; serum transaminases and CPK elevations; hypersensitivity; lens opacities; blurring of vision; dizziness; sexual dysfunction; insomnia; depression and upper respiratory symptoms. • Instruct patient to immediately report occurrence of persistent eye pain to health care provider. Drug therapy is indicated as an adjunct to diet when the response to a diet restricted in saturated fat and cholesterol and other nonpharmacologic measures alone has been inadequate. Start studying Simvastatin. Before infusion, assess the patient’s vital signs, edema status, lung sounds, and heart sounds. Frustrated with the nursing education process, Jon started NURSING.com in 2014 with a desire to provide tools and confidence to nursing students around the globe. At NURSING.com, we believe Black Lives Matter , No Human Is Illegal , Love Is Love ️, Women's Rights Are Human Rights , Science Is Real , Water Is Life , Injustice Anywhere Is A Threat To Justice Everywhere ☮️. Women taking Simvastatin oral should discuss contraception with their doctor. Dosing . Secondary prevention refers to those who have had a myocardial infarction or angina or intermittent claudication (Reid et al, 2001). Nursing Mothers. The importance of continued simvastatin therapy to the mother should be considered in making the decision whether to discontinue breast-feeding or to discontinue the medication. This could cause unwanted effects on the liver.