Discontinue therapy if signs & symptoms of neuroleptic malignant syndrome (NMS) or w/ unexplained high fever in the absence of additional clinical manifestation of NMS; if markedly elevated CPK levels are measured &/or indicative rhabdomyolysis signs & symptoms develops. GI disorders eg, diarrhea, nausea & vomiting. Predisposing/risk factors eg, prior history of muscular disorders, uncontrolled hypothyroidism, hepatic or renal impairment & receiving concomitant medications causing rhabdomyolysis (eg, statins, antipsychotics, SSRI/serotonin norepinephrine re-uptake inhibitor). Sick sinus syndrome or other supraventricular cardiac conduction conditions eg, SA or AV block; syncope & seizures. History of ulcer disease or receiving concurrent NSAIDs. Bladder outflow obstruction; generalised convulsions; exacerbate or induce extrapyramidal symptoms. History of asthma or obstructive pulmonary disease. Avoid concomitant use w/ other acetylcholinesterase inhibitors, cholinergic agonists or antagonists. Likely to exaggerate succinylcholine-type muscle relaxation during anaesth. Galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. May affect ability to drive & use machines. Hepatic impairment. Not to be used during pregnancy & lactation. Not recommended in childn.
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