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The use of Zelnorm (tegaserod) comes with important safety information and warnings. It is crucial that you understand the potential risks and consult your healthcare provider if you have any concerns. Below are key safety points to consider:

• Heart Attacks and Strokes: Zelnorm may increase your risk of serious heart problems, including strokes and heart attacks. Do not use this medication if you have a history of stroke, heart attack, or chest pain. Be particularly cautious if you smoke, have high blood pressure, high cholesterol, diabetes, obesity, or are over 55 years old. Discuss any concerns with your healthcare provider.

• Intestinal Swelling and Injury (Ischemic Colitis): This medication can decrease blood flow to the intestines, leading to swelling and injury, potentially requiring hospitalization. If you have a history of heart disease, high blood pressure, high cholesterol, previous abdominal surgery, or are older than 60, your risk is elevated. Seek immediate medical attention if you experience rectal bleeding, bloody diarrhea, or new or worsening abdominal pain.

• Loss of Body Fluids from Diarrhea: By facilitating bowel movements, Zelnorm can cause severe diarrhea, leading to significant fluid loss. This may result in faintness, dizziness, or fainting, potentially necessitating hospitalization for rehydration. Discontinue use and contact your provider if these symptoms occur.

• Suicidal Thoughts and Behavior: There is an increased risk of suicidal thoughts and behaviors, particularly when taken with antidepressants or if you have a history of such issues. These symptoms are more likely during the initial treatment period. If you or others notice worsening depression or the emergence of suicidal thoughts, stop taking the medication and seek immediate medical help.

Contraindications: Zelnorm should not be used if you have any of the following conditions due to the potential for serious health risks:

• History of heart problems, such as stroke or heart attack.
• History of ischemic colitis (intestinal injury and swelling due to reduced blood flow).
• Severe kidney issues.
• Moderate to severe liver conditions.
• History of bowel blockage.

Always consult your healthcare provider before starting this medication to ensure it is safe for you based on your health history and current conditions.

When taking Zelnorm (tegaserod), it's important to be aware of potential interactions with other medications and substances:

Drug Interactions:

• Quinidine: This medication, used to treat certain heart conditions, can increase the levels of Zelnorm in your body. When taken together, quinidine has been shown to raise the maximum concentration (C_max) of Zelnorm by approximately 44% and the overall exposure (AUC) by about 50%. With multiple doses, these increases can be even higher. The clinical significance of this interaction is not fully understood, so it's essential to consult your healthcare provider if you're prescribed both medications.

• Omeprazole: Commonly used to reduce stomach acid, omeprazole can slightly increase Zelnorm levels. Studies have shown a 15% increase in overall exposure and a 17% increase in maximum concentration when these drugs are taken together. However, this change is generally not considered clinically significant.

• Digoxin: Used for heart conditions, digoxin's effectiveness may be slightly reduced when taken with Zelnorm. The maximum concentration and overall exposure to digoxin can decrease by about 15%. This reduction is typically not clinically significant, but monitoring may be advised.

• Warfarin: An anticoagulant, warfarin's effectiveness does not appear to be significantly affected by Zelnorm. Studies have shown no meaningful changes in warfarin levels or blood clotting times when taken with Zelnorm.

• Oral Contraceptives: Zelnorm does not significantly affect the levels of Ethinyl Estradiol (a common component of birth control pills). However, it can reduce the levels of levonorgestrel by about 8%. This change is generally not considered clinically significant.

Food Interactions:

• Food Intake: Taking Zelnorm with food can decrease its absorption, making it less effective. To ensure optimal absorption, it's recommended to take Zelnorm on an empty stomach, at least 30 minutes before or 2 hours after a meal.

Disease Interactions:

• Intestinal Obstruction: Zelnorm is contraindicated in patients with a history of bowel obstruction.

• Liver Disease: Patients with moderate or severe hepatic impairment should not use Zelnorm.

• Renal Dysfunction: Zelnorm is contraindicated in patients with severe renal impairment or end-stage renal disease.

• Diarrhea: Patients who are currently experiencing or frequently experience diarrhea should avoid using Zelnorm.

Always inform your healthcare provider about all medications, supplements, and health conditions before starting Zelnorm to ensure it's safe and appropriate for you.