Precautions While Using gabapentin

It is very important that your doctor check your progress at regular visits, especially in the first few months if you have epilepsy. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

These may be cause serious allergic reactions that may involve multiple organs, such as your liver or kidneys. Check with your doctor right away if you or your child have more than one of the following symptoms: fever, rash, swollen, painful, or tender lymph glands in the neck, armpit, or groin, unusual bleeding or bruising, or yellow eyes or skin.

Gabapentin may cause vision changes, clumsiness, unsteadiness, dizziness, drowsiness, sleepiness, or trouble with thinking. Make sure you know how you react to gabapentin before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, or able to think or see well. If these side effects are especially bothersome, check with your doctor.

gabapentin may cause some people to be agitated, irritable, or display other abnormal behaviors, such as feeling sad or hopeless, getting upset easily, or feeling nervous, restless, or hostile. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor right away.

gabapentin will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicine or narcotics, other medicines for seizures (eg, barbiturates), muscle relaxants, or anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you or your child are using gabapentin.

Do not stop using gabapentin without checking with your doctor. Stopping the medicine suddenly may cause seizures. Your doctor may want you or your child to gradually reduce the amount you are taking before stopping it completely.

Make sure any doctor or dentist who treats you knows that you are using gabapentin. gabapentin may affect the results of certain medical tests.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What you should know before you take Gabapentin

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 gabapentin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to gabapentin or any other medicines. Also tell your health care professional if you have any other types of allergies such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of gabapentin for treating partial seizures in children. However, safety and efficacy have not been established in children younger than 3 years of age.

Appropriate studies have not been performed on the relationship of age to the effects of gabapentin for treating postherpetic neuralgia in children. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of gabapentin in the elderly. However, elderly patients are more likely to have unwanted effects (eg, problems with balance or walking, swelling in the feet or legs) and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving gabapentin.

Pregnancy

PREGNANCY CATEGORY EXPLANATION
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with 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 gabapentin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using gabapentin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Ketorolac
  • Orlistat

Using gabapentin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aluminum Carbonate, Basic
  • Aluminum Hydroxide
  • Aluminum Phosphate
  • Dihydroxyaluminum Aminoacetate
  • Dihydroxyaluminum Sodium Carbonate
  • Ginkgo
  • Magaldrate
  • Magnesium Carbonate
  • Magnesium Hydroxide
  • Magnesium Oxide
  • Magnesium Trisilicate
  • Morphine
  • Morphine Sulfate Liposome

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

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

  • Depression, history of or
  • Mood or mental changes, history of—Use with caution. May make these conditions worse.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Online Gabapentin Dosage

There are several online Gabapentin Dosage Available.

Gabapentin 800mg 180 tab
Gabapentin 600mg 180 tab
Gabapentin 400mg 180 tab
Gabapentin 300mg 180 tab

Normally Gabapentin 800mg is hard to get from online pharmacy because you have to gradually take gabapentin to solve your berve pain problems.

Usual Adult Dose for Postherpetic Neuralgia:

Initial dose: 300 mg orally on day one, 300 mg orally twice a day on day two, then 300 mg orally 3 times a day on day three.

The dose may be titrated up as needed for pain relief to a daily dose of 1800 mg.
Maintenance dose: 900 to 1800 mg orally in 3 divided doses.

Efficacy was demonstrated in clinical studies over a range of 1800 mg/day to 3600 mg/day. However, no additional benefit was demonstrated from the use of doses over 1800 mg/day.

Gabapentin available under the trade name Gralise (R):

Maintenance dose: Gralise (R) should be titrated to 1800 mg orally once daily with the evening meal.

Recommended titration schedule:
Day 1: 300 mg orally with the evening meal
Day 2: 600 mg orally with the evening meal
Days 3 through 6: 900 mg orally with the evening meal
Days 7 through 10: 1200 mg orally with the evening meal
Days 11 through 14: 1500 mg orally with the evening meal
Day 15: 1800 mg orally with the evening meal

Gralise (R) is not interchangeable with other gabapentin products because of differing pharmacokinetic profiles that affect the frequency of administration.

Gabapentin enacarbil extended release tablets available under the trade name Horizant (R):

The recommended dosage is 600 mg orally twice daily. Therapy should be initiated at a dose of 600 mg orally in the morning for 3 days of therapy, then increased to 600 mg twice daily (1,200 mg/day) on day four.

Gabapentin enacarbil extended release tablets available under the trade name Horizant (R) and gabapentin are not interchangeable.

Usual Adult Dose for Restless Legs Syndrome:

Gabapentin enacarbil available under the trade name Horizant (R):
600 mg orally once daily with food at about 5 PM

Usual Pediatric Dose for Epilepsy:

Less than 3 years: Effectiveness has not been established.

Greater than or equal to 3 and less than 12 years:
Starting Dose: ranges from 10 to 15 mg/kg/day in 3 divided doses.
Effective Dose: reached by upward titration over a period of approximately 3 days. The effective dose of gabapentin in patients 5 years of age and older is 25 to 35 mg/kg/day and given in divided doses (three times a day). The effective dose in pediatric patients ages 3 and 4 years is 40 mg/kg/day and given in divided doses (three times a day). Gabapentin may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations. Dosages up to 50 mg/kg/day have been well tolerated in a long term clinical study. The maximum time interval between doses should not exceed 12 hours.

Greater than 12 years:
Initial dose: 300 mg orally on day one, 300 mg orally twice a day on day two, then 300 mg orally 3 times a day on day three.
Maintenance dose: 900 to 1800 mg orally in 3 divided doses. If necessary, the dose may be increased using 300 mg or 400 mg capsules three times a day up to 1800 mg/day. Dosages up to 2400 mg/day have been well tolerated in long term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. The maximum time between doses in the three times a day schedule should not exceed 12 hours.

 

Gabapentin is used for nerve pain, migraine, fibromyalgia and epilepsy

Gabapentin is used to control the symptoms of seizures and works by reducing the abnormal electrical activity in the brain, but exactly how it does this is not fully understood. Gabapentin is also used to treat certain types of long-lasting pain caused by damage to nerves.

gabapentin-300Gabapentin belongs to a group of medicines known as anti-epileptic medicines, although it is prescribed for the treatment of several different conditions. You may have been prescribed it for the treatment of partial seizures, which are a type of epilepsy. A seizure is a short episode of symptoms which is caused by a burst of abnormal electrical activity in the brain. With a partial seizure, the burst of electrical activity stays in one part of the brain. Therefore, you tend to have localised or ‘focal’ symptoms. Gabapentin is used to control the symptoms of seizures and works by reducing the abnormal electrical activity in the brain. Exactly how it does this is not fully understood.

Gabapentin is also prescribed to treat certain types of long-lasting pain caused by damage to nerves. This type of pain, called neuropathic pain, can be caused by a number of different diseases. These include diabetes (where it is called diabetic neuropathy) and shingles (where it is called postherpetic neuralgia).

Although gabapentin is only licensed for use in epilepsy and neuropathic pain, it is also prescribed to help to prevent attacks of migraine. If you have been given it for this reason then you should speak with your doctor if you have any questions about your treatment.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking gabapentin it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have any problems with the way your kidneys work.
  • If you have diabetes.
  • If you have ever had a mental health problem known as psychosis.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.

Gabapentin Mechanism of action

The mechanism of the anticonvulsant action of gabapentin has not been fully described. Several possible mechanisms for pain improvement have been discussed. Though similar in structure to the endogenous neurotransmitter GABA, gabapentin has not been shown to bind to GABA receptors at concentrations at or below 1 mM. Gabapentin modulates the action of glutamate decarboxylase (GAD) and branched chain aminotransferase (BCAT), two enzymes involved in GABA biosynthesis. In human and rat studies, gabapentin was found to increase GABA biosynthesis, and to increase non-synaptic GABA neurotransmission in vitro.

Gabapentin has been shown to bind to the α2δ-1 subunit of voltage gated calcium ion channels, which contributes to its pain attenuation effects in diabetic neuropathy and post-herpetic neuralgia. Other neurophysiological findings indicate that gabapentin also interacts with NMDA receptors, protein kinase C, and inflammatory cytokines

What is gabapentin mostly used for?

Gabapentin is an antiepileptic or anticonvulsant treatment originally designed to prevent seizures, but which is now also used to manage certain types of pain and in a variety of other uses.

The medication is also used in veterinary medicine. Note that tablets, capsules or oral solutions designed for human consumption often contain sweeteners which may be poisonous to some species; be sure to buy Gabapentin in veterinary formulations for use in animals.

The medication comes in capsules, which may be opened and mixed into a beverage or soft foods that do not require chewing, though it is difficult to mask its bitter taste.

Preventing Seizures

Gabapentin is most commonly prescribed to prevent certain types of seizures:

  • Focal seizures
  • Mixed Seizures
  • Generalized Seizures

As a preventive treatment, Gabapentin may be used in children as young as 3, but is most often prescribed to people 12 years old and up.

The medication is typically taken 3 times per day, and treatment is usually long-term. Patients are usually started on smaller doses which are then increased if needed. The average dose for adults is 900 to 1800 mg per day.

Daily doses are usually divided into 3 smaller doses, taken morning, afternoon, and at bedtime. Doses should be taken at least 4 hours apart, but not more than 12 hours apart.

It may take several weeks for the medication to become noticeably effective. When working, seizures should occur with significantly less frequency or be eliminated entirely. It does not work on all seizures and is not effective for all patients; if effects are not significant after several weeks of use, speak with doctor about alternative options rather than continuing to buy Gabapentin.

Ending treatment abruptly may cause an increase in seizures; speak with a doctor about tapering off the medication.

Pain Relief

Patients planning to buy Gabapentin for pain relief should understand that it only works on very specific types of pain; namely neuropathic pain, or pain caused by damage to the somatosensory system, including:

  • Postherpetic neuralgia
  • Central neuropathic pain
  • Diabetic neuropathy
  • Fibromyalgia
  • Spinal injuries
  • Cancer

When given for pain, treatment may last just a few days for flare-ups or weeks or months in cases of chronic pain. Dosage rarely exceeds 1800 mg a day; greater amounts may be taken, but rarely produce additional relief.

Some individuals notice effects within the first day or two of treatment, but it may take several weeks to provide consistent pain relief in chronic conditions.

While some patients find Gabapentin tremendously helpful, others find it has little effect, even when treating the same condition. Speak with a doctor about other options if it is not providing significant relief.

Other Uses

Gabapentin is used in a wide range of other conditions, though it is not always the most effective option for certain ailments:

  • Menopausal symptoms
  • Uremic pruritus in liver failure
  • Restless leg syndrome
  • Insomnia
  • Anxiety disorders
  • Migraines

Many of this product’s off-label uses are somewhat controversial, as some claim there is no evidence the medication provides any benefit in some of the above conditions, while others claim it produces good results for some individuals.

In other cases the medication is recognized as being effective, but is not typically the preferred treatment; in these situations Gabapentin may be given when first-line treatments are ill-advised for some reason.

Patients are not advised to buy Gabapentin for off-label use without doctor collaboration, particularly if there are any preexisting major medical conditions.

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Use only the brand and form of gabapentin that your doctor has prescribed. Check your medicine each time you get a refill at the pharmacy, to make sure you have received the correct form of this medication. Do not stop taking Gabapentin unless your doctor tells you to. If your treatment is stopped it should be done gradually over a minimum of 1 week. If you stop taking gabapentin suddenly or before your doctor tells you, there is an increased risk of seizures.

  • Before starting this treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about gabapentin and will provide you with a full list of the side-effects which you may experience from taking it.
  • Take gabapentin exactly as your doctor tells you to. There are several different strengths of gabapentin tablets and capsules available, and you could be prescribed more than one strength.
  • You will be advised to take a low dose when you first start taking gabapentin, and then to increase the dose over a few days. This is to allow your body to get used to it. Most people take three doses a day once they are on a regular maintenance dose. Your doctor will explain all this to you, and the dosing directions will be printed on the label of the pack. If you are still unsure about how to take your doses, ask your pharmacist to advise you.
  • You can take gabapentin before or after food. Swallow the tablets/capsules with a drink of water. If you have been supplied with oral liquid medicine, see the instructions below for using the oral dosing syringe.
  • Once you are taking a regular amount of gabapentin, try to take your doses at the same times each day. This will help you avoid missing doses.
  • If you do forget to take a dose, take one as soon as you remember. Try to take the correct number of doses each day, but do not take two doses at the same time.
  • If you need to take an antacid or indigestion remedy, do not take it during the two hours before or the two hours after you take gabapentin. This is because antacids reduce the amount of gabapentin that your body absorbs.

Instructions for using the dosing syringe with Gabapentin Rosemont Oral Solution

  1. Remove the bottle cap, and push the syringe adaptor into the top of the open bottle.
  2. Insert the syringe into the adapter.
  3. Turn the bottle (with the syringe connected to it) upside down.
  4. Gently pull out the plunger of the syringe so that the solution fills the syringe to the mark which corresponds to your dose.
  5. Turn the bottle the correct way up again, and remove the syringe from the bottle.
  6. Put the tip of the syringe into your mouth, and gently push the plunger so that the liquid is released into your mouth.
  7. Replace the bottle cap. Wash the syringe with water after each use.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
  • When you first start a new treatment for epilepsy there may be a change in the number or type of seizures you experience. Your doctor will advise you about this. If you are a woman and want to have a family, make sure that you discuss this with your doctor before you become pregnant. This is so that you can be given advice about your treatment from a specialist.
  • People with epilepsy must stop driving. Your doctor will advise you about when it may be possible for you to start driving again. This will usually be after a year free of seizures.
  • A small number of people have developed mood changes or thoughts about suicide whilst being treated with anti-epileptics. If this happens to you, you must tell your doctor about it straightaway.
  • If you buy any medicines, always check with a pharmacist that they are suitable to take with your other medicines.
  • You must take gabapentin regularly every day. Stopping treatment suddenly can cause problems. If it becomes necessary for the treatment to stop, your doctor will want you to reduce your dose over a few days.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with gabapentin. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common gabapentin side-effects
What can I do if I experience this?
Feeling sleepy, tired, unsteady or dizzy; blurred vision and other eyesight problems Do not drive or use tools or machines
Headache Ask your pharmacist to recommend a suitable painkiller
Feeling or being sick, indigestion, stomach ache Stick to simple foods – avoid rich or spicy meals
Diarrhoea Drink plenty of water to replace the lost fluids
Constipation Try to eat a well-balanced diet and drink several glasses of water each day
Dry mouth Try chewing sugar-free gum or sucking sugar-free sweets
Infections, flu-like symptoms, increased appetite, flushing,
increased blood pressure, changes in weight, changes in emotions or mood, fits, movement difficulties, feeling shaky, difficulties sleeping, breathing difficulties, cough, gum changes, bruises, muscle or joint pains, impotence, and swollen feet or ankles
If any of these become troublesome, speak with your doctor for advice

Important: gabapentin has been associated with a number of unwanted effects which affect the blood, pancreas and liver. Although these occur less commonly than the side-effects listed above, you must let your doctor know straightaway if you notice any of the following as they could be serious:

  • Persistent stomach pain with sickness (these could be symptoms of an inflamed pancreas).
  • A skin rash, or any swelling of your mouth or face (these could be symptoms of an allergic reaction).
  • Any yellowing of your skin or of the whites of your eyes (these could be symptoms of jaundice).
  • Any unusual bruising or bleeding (these could be symptoms of a blood disorder).

If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.
  • Once a bottle of Gabapentin Rosemont Oral Solution has been opened it will keep for one month. Do not use it after this time, and make sure you have a fresh supply.

Gabapentin Side Effects

gabapentinsideeffects

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.

Call your doctor at once if you have:

  1. increased seizures;
  2. severe weakness or tiredness;
  3. upper stomach pain;
  4. chest pain, new or worsening cough with fever, trouble breathing;
  5. severe tingling or numbness;
  6. rapid back and forth movement of your eyes;
  7. kidney problems–little or no urination, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath; or
  8. severe skin reaction–fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Gabapentin is an Addiction Treatment Medication

Gabapentin is used to treat cases of addiction in an off-label manner. Different companies, including Parke-Davis, Greenstone, and Teva, manufacture several varieties of the generic drug. Other drugs that have been used to treat the symptoms of addiction withdrawal, for specific substances, include:

  • Clondine
  • Other anticonvulsants, such as Tegretol and Depakote
  • Methadone and buprenorphine
  • Naltrexone

Typical Application

Available in capsules, tablets, and as an oral liquid, dosages range from 100 mg to 800 mg. The frequency with which a dose is repeated depends on the specific dose, which is usually based on the severity of withdrawal and the client’s weight. The drug’s half-life is around 5-7 hours.

Generally, it is used during medical detox and throughout subsequent treatment modalities to support relapse prevention while clients adjust to their new sober lifestyles.

Treating Substance Abuse

According to Medscape, gabapentin can inflict users with suicidal thoughts and abrupt changes in behavior. For this reason, it should only be used under medical supervision. It can also cause elevated blood pressure, fever, sleep problems, appetite changes, and chest pain.

While it has been used to treat addictions to other substances, gabapentin is most often used to treat alcoholism — an addiction some 16.6 million adults suffered from in 2013, per the National Institute on Alcohol Abuse and Alcoholism.

During withdrawal from alcohol abuse or dependency, clients may experience anxiety, tremors, agitation, and irritability. In order to understand how gabapentin works, there must be a basic understanding of how the brain works first. Nervous system activity is partially controlled by GABA neurotransmitters. Gabapentin works by reducing activity among GABA. As a result, signals for pain, agitation, and anxiety are reduced, too.

An American Journal of Psychiatry study showed impressive results during the 16-week treatment of 150 people who were dependent on alcohol, noting better results among those who were treated with both gabapentin and naltrexone than the latter alone. TheJournal of Clinical Psychiatry reported on another study in which individuals treated for alcoholism with gabapentin showed a significant reduction in how much they drank and a greater rate of abstinence than those in the placebo group.

Gabapentin has the same calming effect on individuals who are detoxing from marijuana and benzodiazepines. Despite claims from fans of the plant-based drug, marijuana is indeed addictive. In 2012, 305,560 people checked into rehab citing cannabis as their primary drug of abuse, per the Substance Abuse and Mental Health Services Administration. One Neuropsychopharmacology study that analyzed the use of gabapentin in the treatment of marijuana addiction and withdrawal noted individuals in the gabapentin treatment group used less marijuana, had fewer withdrawal symptoms, and experienced improvements in cognitive functioning, compared to the placebo group.

Gabapentin is also used to treat Alcohol Withdrawal

I am still on gabapentin. Dose is 600mg three times a day – total 1800mg in a 24 hour period. I had not had a drink “craving” since August 11, 2014 when I quit. (I did this within one week of starting gabapentin). I did have a glass of wine at Christmas, one beer on my birthday, and one glass of wine at Easter. That’s it. I use to have 10 beers a day, and three glasses of wine or gin for bad panic attacks and generalized anxiety. So for me (not everyone) I can have that occasional drink with friends, at party or any social event – then come home and not touch the stuff and WITHOUT ANY CRAVINGS AT ALL – as I had during my 40-year binge. Still, this drug is amazing. AA never worked for me.

“I went on gabapentin for alcoholism that troubled me for 10 years when nothing including Alcoholics Anonymous barely worked. I read anecdotal information that it helped with alcoholism, went on 600mg twice daily and it was the first thing that helped me. Now I take 1200mg twice daily and find it works great! Afterwards I read a study in the Journal of American Medicine, Gabapentin in Alcohol Dependance, 2014 that confirmed it works well in many people for cravings and binge drinking. This medicine should be further studied to confirm it works well. On this site it is obvious it helps a lot of people struggling with alcoholism which I have, along with Bipolar Disorder. I call Gabapentin my” happy pills” that also takes away my anxiety

I’ve detoxed several times. The last one was really bad. This time My Dr. put me gabapentin 300 mg. 3 times a day and Lithium. I usually suffer withdrawals for 5-7 days. I did have anxiety for two days, but I’m on day 3, no anxiety and no cravings

If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty, so the doctor knows what has been taken.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.