Drug monograph for the active ingredient in Paxil

The following information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

PAROXETINE (Systemic)

Some commonly used brand names are:

In the U.S.—

• Paxil
• Paxil CR

In Canada—

• Paxil
• Paxil CR

Category

• Antianxiety agent
• antidepressant
• anti-obsessional agent
• antipanic agent
• posttraumatic stress disorder agent
• social anxiety disorder agent

Description

Paroxetine (pa-ROX-uh-teen) is used to treat mental depression, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder (also known as social phobia), premenstrual dysphoric disorder (PMDD), and posttraumatic stress disorder (PTSD).

Paroxetine belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs). These medicines are thought to work by increasing the activity of the chemical serotonin in the brain.

This medicine is available only with your doctor's prescription, in the following dosage forms:

Oral
• Extended-release tablets (U.S. and Canada)
• Oral suspension (U.S.)
• Tablets (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For paroxetine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to paroxetine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Paroxetine has been shown to cause heart and other problems in infants of mothers who took paroxetine. However, this medicine may be necessary to treat the mother's condition. Be sure you have discussed this with your doctor. Before taking this medicine, make sure your doctor knows if you are pregnant (especially if it is the third trimester) or if you may become pregnant.

Breast-feeding—Paroxetine passes into the breast milk. Before taking this medicine, make sure you doctor knows if you are breast-feeding an infant.

Children—Paroxetine must be used with caution in children with depression. Studies have shown occurrences of children thinking about suicide or attempting suicide in clinical trials for this medicine. More study is needed to be sure paroxetine is safe and effective in children.

Older adults—In studies that have included elderly people, paroxetine did not cause different side effects or problems in older people than it did in younger adults. However, paroxetine may be removed from the body more slowly in elderly people. An older adult may need a lower dose than a younger adult.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking paroxetine, it is especially important that your health care professional know if you are taking any of the following:

• Aspirin or
• Nonsteroidal anti-inflammatory drugs (NSAIDs) (celecoxib [e.g., Celebrex], diclofenac [e.g., Voltaren], diflunisal [e.g., Dolobid], etodolac [e.g., Lodine], fenoprofen [e.g., Nalfon], flurbiprofen [e.g., Ansaid], ibuprofen [e.g., Advil, Motrin, Nuprin], indomethacin [e.g., Indocin], ketoprofen [e.g., Orudis, Oruvail], ketorolac [e.g., Toradol], meclofenamate [e.g., Meclomen], mefenamic acid [e.g., Ponstel], meloxicam [e.g., Mobic], nabumetone [e.g., Relafen], naproxen [e.g., Aleve, Anaprox, Naprosyn], oxaprozin [e.g., Daypro], phenylbutazone, piroxicam [e.g., Feldene], rofecoxib [e.g., Vioxx], sulindac [e.g., Clinoril], tolmetin [e.g., Tolectin], valdecoxib [e.g., Bextra])—Taking any of these medicines with paroxetine may cause bleeding problems.

• Atomoxetine (e.g., Strattera)—The amount of atomoxetine in your body may increase when it is taken with paroxetine, use is not recommended.

• Buspirone (e.g., BuSpar) or
• Bromocriptine (e.g., Parlodel) or
• Dextromethorphan (cough medicine) or
• Levodopa (e.g., Sinemet) or
• Lithium (e.g., Eskalith) or
• Meperidine (e.g., Demerol) or
• Nefazodone (e.g., Serzone) or
• Pentazocine (e.g., Talwin) or
• Selective serotonin reuptake inhibitors, other (citalopram [e.g., Celexa], fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], sertraline [Zoloft]) or
• Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
• Sumatriptan (e.g., Imitrex) or
• Tramadol (e.g., Ultram) or
• Trazodone (e.g., Desyrel) or
• Tryptophan or
• Venlafaxine (e.g., Effexor)—Using these medicines with paroxetine may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome. This syndrome may cause confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching. If you develop these symptoms, contact your doctor as soon as possible.

• Moclobemide (e.g., Manerix)—The risk of developing serious unwanted effects, including the serotonin syndrome, is increased. Use of moclobemide with paroxetine is not recommended. Also, it is recommended that 3 to 7 days be allowed between stopping treatment with moclobemide and starting treatment with paroxetine, and that 2 weeks be allowed between stopping treatment with paroxetine and starting treatment with moclobemide.

• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])—Do not take paroxetine while you are taking or within 2 weeks of taking an MAO inhibitor , or you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, severe convulsions, or the serotonin syndrome. At least 14 days should be allowed between stopping treatment with one medicine (paroxetine or the MAO inhibitor) and starting treatment with the other.

• Pimozide (e.g., Orap)—Taking this medicine with paroxetine may increase the risk of serious heart problems.

• St. John's Wort—Taking this medication with paroxetine may increase the chance of side effects.

• Thioridazine (e.g., Mellaril)—Taking thioridazine with paroxetine may cause serious heart problems.

• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Norpramin], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])—Taking a tricyclic antidepressant together with paroxetine may increase the risk of side effects. Your doctor may need to adjust the dose of either medicine or check blood levels of the tricyclic antidepressant. Also, taking paroxetine with amitriptyline, clomipramine, or imipramine may increase the chance that the serotonin syndrome will develop.

• Warfarin (e.g., Coumadin) or other medications that prevent the blood from clotting—Taking these medicines with paroxetine may cause bleeding problems.

Other medical problems—The presence of other medical problems may affect the use of paroxetine. Make sure you tell your doctor if you have any other medical problems, especially:

• Bipolar disorder (mood disorder with alternating episodes of mania and depression) or risk of—May make condition worse. Your doctor will check you for this condition.

• Brain disease or damage or
• Mental retardation or
• Epilepsy or seizures (history of)—The risk of seizures may be increased.

• Glaucoma, narrow angle—Patients with this condition should use paroxetine with caution.

• Heart disease or
• Heart attack, recent—Use must be determined by your doctor.

• Kidney disease, severe, or
• Liver disease, severe—Higher blood levels of paroxetine may occur, increasing the chance of side effects.

• Mania (history of)—The condition may be activated.

Proper Use of This Medicine

Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

Paroxetine may be taken with or without food or on a full or empty stomach. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed.

You may have to take paroxetine for several weeks before you begin to feel better . Your doctor should check your progress at regular visits during this time. Also, if you are taking paroxetine for depression, you will probably need to continue taking it for at least 6 months to help prevent the depression from returning.

If you are taking the oral suspension form of paroxetine, shake the bottle well before measuring each dose. Use a small measuring cup or a measuring spoon to measure each dose. The teaspoons and tablespoons that are used for serving and eating food do not measure exact amounts.

If you are taking the extended-release tablet form of this medicine, swallow the tablet whole. Do not crush, break, or chew before swallowing.

Dosing—The dose of paroxetine will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of paroxetine. If your dose is different, do not change it unless your doctor tells you to do so.

• For oral suspension dosage form:
  • For treatment of depression:
    • Adults—At first, 20 milligrams (mg) (10 milliliters [mL]) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 50 mg (25 mL) a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg (5 mL) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg (20 mL) a day.
  • For treatment of generalized anxiety disorder:
    • Adults—At first, 20 milligrams (mg) (10 milliliters [mL]) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 50 mg (25 mL) a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg (5 mL) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg (20 mL) a day.
  • For treatment of obsessive-compulsive disorder:
    • Adults—At first, 20 milligrams (mg) (10 milliliters [mL]) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 60 mg (30 mL) a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg (5 mL) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg (20 mL) a day.
  • For treatment of panic disorder:
    • Adults—At first, 10 milligrams (mg) (5 milliliters [mL]) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 60 mg (30 mL) a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg (5 mL) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg (20 mL) a day.
  • For treatment of posttraumatic stress disorder:
    • Adults—At first, 20 milligrams (mg) (10 milliliters [mL]) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 50 mg (25 mL) a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg (5 mL) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg (20 mL) a day.
  • For treatment of social anxiety disorder:
    • Adults—At first, 20 milligrams (mg) (10 milliliters [mL]) once a day, usually taken in the morning.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg (5 mL) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 2 mg (1 mL) a day.

• For oral tablet dosage form:
  • For treatment of depression:
    • Adults—At first, 20 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 50 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg a day.
  • For treatment of generalized anxiety disorder:
    • Adults—At first, 20 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 50 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg a day.
  • For treatment of obsessive-compulsive disorder:
    • Adults—At first, 20 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 60 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg a day.
  • For treatment of panic disorder:
    • Adults—At first, 10 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 60 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg a day.
  • For treatment of posttraumatic stress disorder:
    • Adults—At first, 20 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 50 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 40 mg a day.
  • For treatment of social anxiety disorder:
    • Adults—At first, 20 milligrams (mg) once a day, usually taken in the morning.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 10 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 2 mg a day.

• For oral extended-release tablet dosage form:
  • For treatment of depression:
    • Adults—At first, 25 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 62.5 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 12.5 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 50 mg a day.
  • For treatment of panic disorder:
    • Adults—At first, 12.5 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 75 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 12.5 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 50 mg a day.
  • For treatment of social anxiety disorder:
    • Adults—At first, 12.5 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 37.5 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—At first, 12.5 mg once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 37.5 mg a day.
  • For treatment of premenstrual dysphoric disorder:
    • Adults—At first, 12.5 milligrams (mg) once a day, usually taken in the morning. Your doctor may increase your dose if needed. However, the dose usually is not more than 25 mg a day.
    • Children—Use and dose must be determined by your doctor.
    • Older adults—Use and dose must be determined by your doctor.

Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store the tablet form of this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the oral suspension form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

It is important that your doctor check your progress at regular visits, to allow for changes in your dose and to help reduce any side effects.

Tell your doctor right away if you develop any allergic reactions, such as skin rash or hives, while taking paroxetine .

Paroxetine may cause some people to be agitated, irritable or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these adverse effects, tell your doctor right away.

Paroxetine may cause some people to be agitated, irritable or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these adverse effects, tell your doctor right away.

Do not suddenly stop taking your paroxetine . If you have been instructed to stop taking paroxetine, ask your healthcare professional how to slowly decrease the dose. This is to decrease the chance of having discontinuation symptoms such as agitation, breathing problems, chest pain, confusion, diarrhea, dizziness or light-headedness, fast heartbeat, headache, increased sweating, muscle pain, nausea, restlessness, runny nose, trouble in sleeping, trembling or shaking, unusual tiredness or weakness, vision changes, or vomiting.

Do not take paroxetine if you have taken a monoamine oxidase (MAO) inhibitor (furazolidone, phenelzine, procarbazine, selegiline, tranylcypromine) in the past 2 weeks. Do not start taking an MAO inhibitor within 2 weeks of stopping paroxetine . If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, severe convulsions, or the serotonin syndrome.

Paroxetine has not been shown to add to the effects of alcohol. However, use of alcohol is not recommended in patients who are taking paroxetine.

Paroxetine may cause some people to become drowsy or have blurred vision. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert or able to see clearly .

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. One rare but serious unwanted effect that may occur with paroxetine use is the serotonin syndrome. This syndrome (group of symptoms) is more likely to occur shortly after the dose of paroxetine is increased.

Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common

Agitation; chest congestion; chest pain; chills; cold sweats; confusion; difficulty breathing; dizziness, faintness, or lightheadedness when getting up from a lying or sitting position; fast, pounding, or irregular heartbeat or pulse; muscle pain or weakness; skin rash

Rare

Absence of or decrease in body movements; bigger, dilated, or enlarged pupils [black part of eye]; difficulty in speaking; inability to move eyes; incomplete, sudden, or unusual body or facial movements; increased sensitivity of eyes to light; low blood sodium (confusion, convulsions [seizures], drowsiness, dryness of mouth, increased thirst, lack of energy); red or purple patches on skin; serotonin syndrome (confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking and acting with excitement you cannot control, trembling or shaking, twitching); talking, feeling, and acting with excitement and activity you cannot control

Incidence not determined

Back, leg, or stomach pains; bleeding gums; blindness; blistering, peeling, loosening of skin; bloated, full feeling; bloody or black, tarry stools; bloody urine; blue-yellow color blindness; blurred vision; coma; constipation; cough or hoarseness; dark urine; decreased frequency or amount of urine; decreased vision; depression; difficulty opening the mouth; difficulty swallowing; electric shock sensations; epileptic seizure that will not stop; excessive muscle tone; eye pain; fainting; fixed position of eye; fluid-filled skin blisters; general body swelling; general feeling of tiredness or weakness; headache; high fever; hives; inability to move arms and legs; inability to sit still; increased blood pressure; increased sweating; increased thirst; incremental or ratchet-like movement of muscle; indigestion; itching skin; joint pain; lab results that show problems with liver; light-colored stools; lockjaw; loss of appetite; loss of bladder control; low blood pressure; lower back or side pain; muscle spasm, especially of neck and back; muscle tension or tightness; nausea; need to keep moving; nosebleeds; painful knees and ankles; painful or difficult urination; painful or prolonged erection of the penis; pale skin; puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue; raised red swellings on the skin, the buttocks, legs, or ankles; red irritated eyes; rigid muscles; seizure or coma late in pregnancy; sensitivity to the sun; skin redness or soreness; skin sores, welts or blisters; skin thinness; sore throat; sores, ulcers, or white spots on lips or in mouth; swelling of breasts; swollen or painful glands; shortness of breath; slow heart rate; slow movement; slow reflexes; spasms of throat; stiff muscles; stomach pain; sudden numbness and weakness in the arms and legs; swelling of face, fingers, lower legs; tightness in chest; unexpected or excess milk flow from breasts; unusual bleeding or bruising; unusual or decreased blood cell production; unusual tiredness or weakness; vomiting; weight gain; wheezing; yellowing of the eyes or skin

Symptoms of overdose

Dizziness; drowsiness; dryness of mouth; flushing of face; irritability; large pupils; nausea; racing heartbeat; trembling or shaking; vomiting

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

More common

Acid or sour stomach; belching; decreased appetite; decreased sexual ability or desire; excess air or gas in stomach or intestines; heartburn; nervousness; pain or tenderness around eyes and cheekbones; passing gas; problems in urinating; runny or stuffy nose; sexual problems, especially ejaculatory disturbances; sleepiness or unusual drowsiness; stomach discomfort, upset, or pain; sweating; trauma; trembling or shaking; trouble in sleeping

Less common

Abnormal dreams; anxiety; bladder pain; body aches or pain; change in sense of taste; changes in vision; cloudy urine; confusion; congestion; difficulty in focusing eyes; difficulty in moving; discouragement, feeling sad or empty; drugged feeling; dryness of throat; excessive muscle tone; fainting or loss of consciousness; fast or irregular breathing; feeling of unreality; feeling of warmth or heat; flushing or redness of skin, especially on face and neck; frequent urge to urinate; headache, severe and throbbing; heavy bleeding; increase in body movements; increased appetite; irritability; itching, pain, redness, or swelling of eye or eyelid; itching of the vagina or genital area; lack of emotion; loss of interest or pleasure; loss of memory; lump in throat; menstrual changes; menstrual pain or cramps; muscle twitching or jerking; pain during sexual intercourse; problems with memory; problems with tooth; rhythmic movement of muscles; sense of detachment from self or body; severe sunburn; slow heartbeat; sneezing; thick, white vaginal discharge with no odor or with a mild odor; tightness in throat; tingling, burning, or prickling sensations; trouble concentrating; voice changes; watering of eyes; weight loss; yawn

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this period of time check with your doctor if you notice any of the following side effects:

Abnormal dreams; actions that are out of control; agitation, confusion, or restlessness; burning, crawling, itching, numbness, prickling, "pins and needles" , or tingling feelings; crying; depersonalization; diarrhea; dizziness or light-headedness; dysphoria; electric shock sensations; euphoria; fear; feeling unwell or unhappy; headache; increased sweating; irritability; mental depression; muscle pain; nausea or vomiting; nervousness; paranoia; quick to react or overreact emotionally; rapidly changing moods; runny nose; talking, feeling, and acting with excitement; trembling or shaking; trouble in sleeping; unusual drowsiness, dullness or feeling of sluggishness; unusual tiredness or weakness; vision changes

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Revised: 12/30/2005

The information contained in the Thomson Healthcare products is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Healthcare makes no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Healthcare does not assume any responsibility or risk for your use of the Thomson Healthcare products.

Copyright © 2004 Thomson Healthcare Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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