Tarascon Pharmacopoeia
Author: Richard J. Hamilton
Date: 2009-05-29 07:00:00+00:00
Keywords: Jones and Bartlett Publishers
Description: The Tarascon Pharmacopoeia 2010 Library Edition is a convenient, organized, and concise reference packed with vital drug information and meticulously peer-reviewed by experts and clinicians of multiple specialties. It details typical drug dosing (both FDA approved and off-label uses), available trade and generic formulations, metabolism, safety in pregnancy, and lactation, relative drug pricing information, Canadian trade names, and an herbal & alternative therapies section. Multiple tables supplement the drug content, including opioid equivalency, emergency drug infusions, cardiac dysrhythmia
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Tarascon Pocket

Pharmacopoeia®

2010 Classic Shirt-Pocket Edition

24TH EDITION

“Desire to take medicines ... distinguishes man from animals.”

—Sir William Osler

Editor in Chief

Richard J. Hamilton, MD, FAAEM, FACMT

Professor and Chair, Department of Emergency Medicine Drexel University College of Medicine

Philadelphia, PA

World Headquarters

Jones and Bartlett

Jones and Bartlett

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Publishers

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Jones and Bartlett’s books and products are available through most bookstores and online booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our website www.jbpub.com.

Substantial discounts on bulk quantities of Jones and Bartlett’s publications are available to corporations, professional associations, and other qualifi ed organizations. For details and specifi c discount information, contact the special sales department at Jones and Bartlett via the above contact information or send an email to specialsales@jbpub.com.

Copyright © 2010 by Jones and Bartlett Publishers, LLC

All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.

The information in the Pocket Pharmacopoeiaa is compiled from sources believed to be reli able, and exhaustive efforts have been put forth to make the book as accurate as possible. The Pocket Pharmacopoeia is edited by a panel of drug information ex-perts with extensive peer review and input from more than 50 practicing clinicians of multiple specialties. Our goal is to provide health professionals focused, core prescribing information in a convenient, or ganized, and concise fashion. We include FDA-ap proved dosing indications and those off-label uses that have a rea son able basis to support their use. However the accuracy and completeness of this work cannot be guar y
p
g
an teed.

Despite our best efforts this book may contain typographical errors and omissions. The Pocket Pharmacopoeia is intended as a quick and conven ient reminder of information you have already learned else where. The contents are to be used as a guide only, and health care professionals should use sound clinical judgment and individualize therapy to each specifi c patient care situation. This book is not meant to be a replacement for training, experience, con tin uing medical edu cation, or studying the latest drug prescribing literature. This book is sold without war ranties of any kind, express or implied, and the publisher and editors disclaim any liability, loss, or damage caused by the contents.

Although drug companies purchase and distribute our books as promo tional items, the Tarascon editorial staff alone determines all book content.

ISSN: 1945-9076

ISBN: 978-0-7637-7439-4

6048

Printed in the United States of America

13 12 11 10 09 10 9 8 7 6 5 4 3 2 1

Production Credits

Chief Executive Offi cer: Clayton Jones

Senior Acquisitions Editor: Nancy

Chief Operating Offi cer: Don W. Jones, Jr.

Anastasi

Duffy

President, Higher Education and

Senior Editorial Assistant: Jessica Acox

Professional Publishing: Robert W.

Production Editor: Wendy Swanson

Holland, Jr.

Senior Marketing Manager: Barb

V.P., Sales and Marketing: William J.

Bartoszek

Kane

Composition: Newgen

V.P., Design and Production: Anne

Text and Cover Design: Anne Spencer

Spencer

Printing and Binding: Cenveo

V.P., Manufacturing and Inventory

Cover Printing: Cenveo

Control: Therese Connell

Publisher: Christopher Davis

If you obtained your Pocket Pharmacopoeia from a bookstore, please send your address to info@tarascon.com. This allows you to be the fi rst to hear of updates!

(We don’t sell or distribute our mailing lists, by the way.) The cover woodcut is The Apothecary by Jost Amman, Frankfurt, 1574. Many of you knew that the answer to last year’s puzzle was one third (a pill bottle contains one pill, either clonazepam or clonidine. A clonidine pill is placed into the bottle, the bottle is shaken, and a clonidine pill is removed. What are the chances that a clonazepam pill remains?). We will send a free copy of next year’s edition to the fi rst 25 who can solve this puzzle:

Three patients are waiting for two nurses to start an IV line (which takes 5 minutes) and infuse an antibiotic (which takes 5 minutes). The total of both of these tasks takes 10 minutes and the nurse must be physically present during the infusion. How fast can these two nurses complete this task?

CONTENTS

ANALGESICS....................... 1

Nitrates ............................ 53

GASTROENTEROLOGY ....... 89

Antirheumatic Agents......... 1

Pressors/Inotropes............ 53

Antidiarrheals .................. 89

Muscle Relaxants ............... 2

Pulmonary Arterial

Antiemetics ...................... 90

Non-Opioid Analgesic

Hypertension.................. 55

Antiulcer........................... 92

Combinations .................. 2

Thrombolytics................... 55

Laxatives.......................... 95

Non-Steroidal Anti-

Volume Expanders ............ 56

Ulcerative Colitis.............. 98

Infl ammatories ................ 3

Other ................................ 56

Other GI Agents ................ 98

Opioid Agonist-

CONTRAST MEDIA............. 57

HEMATOLOGY ................... 99

Antagonists ..................... 6

MRI Contrast .................... 57

Anticoagulants................. 99

Opioid Agonists .................. 6

Radiography Contrast ...... 57

Colony Stimulating

Opioid Analgesic

DERMATOLOGY ................. 58

Factors ........................ 102

Combinations .................. 8

Acne Preparations ............ 58

Other Hematological

Opioid Antagonists........... 11

Actinic Keratosis

Agents ......................... 102

Other Analgesics .............. 11

Preparations.................. 59

HERBAL & ALTERNATIVE

ANESTHESIA ..................... 11

Antibacterials (Topical) .... 60

THERAPIES .................. 103

Anesthetics & Sedatives... 11

Antifungals (Topical)........ 60

IMMUNOLOGY................. 110

Local Anesthetics ............. 12

Antiparasitics (Topical) .... 61

Immunizations ............... 110

Neuromuscular Blockers... 12

Antipsoriatics................... 62

Immunoglobulins ........... 112

ANTIMICROBIALS ............. 13

Antivirals (Topical) ........... 62

Immunosuppression....... 113

Aminoglycosides............... 13

Atopic Dermatitis

Other .............................. 113

Antifungal Agents ............ 13

Preparations .................. 63

NEUROLOGY ................... 114

Antimalarials ................... 15

Corticosteroid /

Alzheimer’s Disease........ 114

Antimycobacterial

Antimicrobial

Anticonvulsants ............. 114

Agents ........................... 16

Combinations ................ 63

Migraine Therapy............ 117

Antiparasitics................... 17

Hemorrhoid Care .............. 63

Multiple sclerosis ........... 118

Antiviral Agents................ 18

Other Dermatologic

Myasthenia Gravis.......... 119

Carbapenems................... 25

Agents ........................... 64

Parkinsonian

Cephalosporins ................ 25

ENDOCRINE & METABOLIC ...

Agents ......................... 119

Macrolides........................ 27

...................................... 67

Other Agents .................. 121

Penicillins ........................ 30

Androgens / Anabolic

OB/GYN .......................... 121

Quinolones ....................... 32

Steroids ......................... 67

Contraceptives ............... 121

Sulfonamides ................... 32

Bisphosphonates.............. 67

Estrogens ....................... 122

Tetracyclines .................... 33

Corticosteroids ................. 68

Hormone Combinations .. 123

Other Antimicrobials ........ 33

Diabetes-Related ............. 70

Labor Induction / Cervical

CARDIOVASCULAR............ 35

Diagnostic Agents ............ 74

Ripening...................... 125

ACE Inhibitors .................. 35

Gout-Related.................... 75

Ovulation Stimulants ..... 125

Aldosterone Antagonists... 36

Minerals ........................... 75

Progestins ...................... 126

Angiotensin Receptor

Nutritionals ...................... 78

Selective Estrogen Receptor

Blockers (ARBs) ............. 37

Phosphate Binders ........... 78

Modulators .................. 126

Antiadrenergic Agents...... 38

Thyroid Agents.................. 79

Uterotonics..................... 126

Anti-Dysrhythmics /

Vitamins........................... 80

Vaginitis Preparations.... 127

Cardiac Arrest ............... 39

Other ................................ 82

Other OB / GYN

Anti-Hyperlipidemic

ENT................................... 83

Agents ......................... 128

Agents ........................... 42

Antihistamines................. 83

ONCOLOGY ..................... 128

Antihypertensive

Antitussives /

OPHTHALMOLOGY........... 129

Combinations ................ 45

Expectorants.................. 84

Antiallergy...................... 130

Antiplatelet Drugs ............ 47

Decongestants ................. 86

Antibacterials................. 130

Beta-Blockers................... 48

Ear Preparations .............. 86

Antiviral Agents.............. 132

Calcium Channel Blockers

Mouth & Lip Preparations 87

Corticosteroid &

(CCBs)........................... 50

Nasal Preparations........... 88

Antibacterial

Diuretics........................... 52

Other ................................ 89

Combinations .............. 132

Contents
v

Corticosteroids ............... 133

Antipsychotics................ 140

Other Pulmonary

Glaucoma Agents ........... 133

Anxiolytics / Hypnotics.... 143

Medications................. 150

Mydriatics &

Combination Drugs ........ 145

TOXICOLOGY................... 152

Cycloplegics ................ 134

Drug Dependence

UROLOGY........................ 154

Non-Steroidal

Therapy........................ 145

Benign Prostatic

Anti-Infl ammatories .... 135

Stimulants / ADHD /

Hyperplasia ................. 154

Other Ophthalmologic

Anorexiants .................. 146

Bladder Agents............... 154

Agents ......................... 135

PULMONARY ................... 148

Erectile

PSYCHIATRY................... 136

Beta Agonists................. 148

Dysfunction ................. 155

Antidepressants ............. 136

Combinations................. 149

Nephrolithiasis ............... 156

Antimanic (Bipolar)

Inhaled Steroids ............. 149

Index.............................. 157

Agents ......................... 139

Leukotriene Inhibitors..... 150

Appendix........................ 186

PAGE INDEX FOR TABLES

GENERAL

ACE inhibitors ..................35

Theraputic goals for

Abbreviations .................... ix

QT interval drugs..............41
anticoagulation .........101

Therapeutic drug levels ..... ix

LDL goals .........................46

Warfarin

Pediatric drugs................... x

Lipid reduction by
interactions ...............101

Conversions....................... xi
class............................43

IMMUNOLOGY

Pediatric vital signs and

Statins lipid response ......46

Tetanus ..........................113

IV drugs ........................ xi

Cardiac parameters .........54

Child immunizations ......112

Formulas .......................... xii

Thrombolysis in MI ...........55 Treatment and prevention Drug therapy reference

Treatment and prevention
of 2009 H1N1.............188
websites ...................... xii
of 2009 H1N1.............188

NEUROLOGY

Adult emergency drugs ...186

DERMATOLOGY

Dermatomes...................118

Cardiac dysrhythmia

Topical steroids ................65

Nerve roots, LS spine......118
protocols....................187

ENDOCRINE

Glasgow coma scale.......119

ANALGESICS

Corticosteroids .................69

OB/GYN

Non-Steroidal .....................3

Diabetes numbers ............71

Oral contraceptives ........124

Opioid equivalency .............7

Insulin..............................72

Emerg contraception ......123

Fentanyl transdermal .........7

IV solutions ......................76

Drugs in pregnancy ........127

ANTIMICROBIALS

Fluoride dose ....................76

PSYCHIATRY

Bacterial Pathogens.........23

Potassium forms ..............77

Antipsychotics................141

STDs/vaginitis..................28

Peds rehydration ..............79

Body mass index ............146

Cephalosporins ................26

ENT

PULMONARY

Penicillins ........................31

ENT combinations ............85

Peak fl ow ........................150

SBE prophylaxis................31

GASTROENTEROLOGY

Inhaled steroids .............151

Quinolones .......................32

Hpylori treatment .............94

Inhaler colors .................152

CARDIOVASCULAR

HEMATOLOGY

TOXICOLOGY

HTN therapy......................37

Heparin dosing...............100

Antidotes........................153
vi

TARASCON POCKET PHARMACOPOEIA EDITORIAL STAFF*

EDITOR IN CHIEF

Richard J Hamilton, MD, FAAEM,FACMT, Professor and Chair, Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA ASSOCIATE EDITORS

Adrienne Z. Ables, PharmD, Associate

David S. Craig, PharmD, BCPS, Clinical

Professor, Spartanburg Family Medicine

Pharmacist Specialist, H Lee Moffi tt

Residency Program, Spartanburg, SC

Cancer Center & Research Institute,

Jill E. Allen, PharmD, BCPS, Drug

Tampa, FL

Information Consultant, Salt Lake

William A. Kehoe, PharmD, MA, BCPS,

City, UT

Professor of Pharmacy Practice and

Kimberly K. Birtcher, MS, PharmD,

Psychology, University of the Pacifi c,

BCPS, CDE, Clinical Associate Professor,

Stockton, CA

University of Houston College of Phar-

Neeta Bahal O’Mara, PharmD, BCPS,
macy, Houston, TX

Coldstream Consulting LLC, Skillman,

Jill S. Burkiewicz, PharmD, BCPS,

NJ.

Professor, Pharmacy Practice,

Director, PGY1 Residency Program,

Midwestern University Chicago College
of Pharmacy, Downers Grove, IL

EDITORIAL BOARD

Steven R. Abel, PharmD, FASHP,

Sandra Harley Counts, PharmD,

Assistant Dean for Clinical Programs,

Associate Professor of Family Medicine,

Buck Professor and Head, Dept. of

AnMed Health Family Medicine

Pharmacy Practice, Purdue University

Residency, Anderson, SC

School of Pharmacy and Pharmaceutical

Gary E. Davis, PharmD, Neuroscience

Sciences, West Lafayette, IN

Clinical Coordinator, Adjunct Assistant

David R. Adams, MD, PharmD, Associate

Professor, University of Utah Hospitals

Professor of Dermatology, Penn State
and Clinics, Salt Lake City, UT

Hershey Medical Center, Hershey, PA

Lori M. Dickerson, PharmD, FCCP,

Heath P. Adams, PharmD, Trover Health

BCPS, Professor of Family Medicine,

System, Regional Medical Center,

Medical University of SC

Madisonville, KY

Joseph S. Esherick, MD, FAAFP, Family

Giovannina M. Anthony, MD, Obstetrics

Medicine, Ventura County Medical
and Gynecology, Women’s Health Center

Center, Ventura, CA
of Jackson, WY

Randall L. Goodman, MD, FACS,

Ouida Antle, PharmD, Carewest,

Ophthalmology, Shepard Eye Center,

Calgary, Alberta, Canada

Santa Maria, CA

Bruce Barrett, MD, PhD, Associate

Holly Gustafson, MD, Park Nicollet

Professor of Family Medicine, University

Internal Medicine, St. Louis Park, MN
of Wisconsin, Madison, WI
vii

EDITORIAL BOARD, cont.

James A. Greenberg, MD, Assistant

Robert C. Owens, Jr., PharmD, Maine

Professor of OB/GYN, Harvard Medical

Medical Center, Portland, ME; Clinical

School, Boston, MA

Assistant Professor, University

James R. Herman, MD, PhD, FACS,
of Vermont College of Medicine,

Urology Associates of Kingsport PC,

Burlington, VT

Kingsport, TN

Mary E. Pickett, MD, Internal Medicine,

Arlyn J. LaBair, MD, Family Medicine,

Associate Professor of Medicine, Oregon

Denver, CO

Health & Science University, Portland,

OR

Marc J. Laufgraben, MD, Endocrinology,

Clinical Associate Professor of Medicine,

Joseph Saseen, PharmD, FCCP, FNLA,

Brown University, Providence, RI

BCPS, CLS, Professor, University of

Colorado, Schools of Pharmacy and

Allen E. Lavee, MD, Anesthesiology, San

Medicine, Denver/Aurora, CO

Francisco, CA

Timothy W. Smith, D.Phil, MD, Associate

Lawrence Loo, MD, Internal Medicine,

Professor of Medicine, Washington

Associate Professor of Medicine, Loma

University School of Medicine, St.

Linda University, CA

Louis, MO

Yun Lu, PharmD, BCPS, Clinical

Ronald L. Swaab, MD, Hematology &

Assistant Professor, University of

Oncology, Pottstown Memorial Regional

Minnesota, Hennepin County Medical

Cancer Center, Pottstown, PA

Center, Minneapolis, MN

Andrew E. Thompson, MD,

Andrea Luisi, PharmD, BCPS,

Rheumatology, Assistant Professor of

Cumberland, RI

Medicine, University of Western Ontario,

Ian R. McNicholl, PharmD, BCPS (AQ –

Canada

Infectious Diseases), AAHIVE, Associate

Kristin Walter, MD, Pulmonary & Critical

Clinical Professor, Clinical Pharmacy

Care Medicine, St. Joseph Hospital,

Specialist, UCSF Positive Health

Chicago, IL

Program, Editor, UCSF HIV InSite Drug

Interaction Datebase, San Francisco, CA

Izak F. Wessels, M Med, FRCSE,

FRCOphth, FACS, Clinical Associate

Susan M. Miller, PharmD, BCPS,

Professor of Ophthalmology,

Pharmacy Clinical Coordinator, Cape

Chattanooga Unit, University of

Fear Valley Health System, Fayetteville,

Tennessee College of Medicine, and

NC

Loma Linda University, Loma Linda, CA

Melissa J. Nirenberg, MD, PhD,

Robert M. Wood, MD, Family Medicine,

Assistant Professor of Neurology, Weill

Santa Maria, CA

Cornell Medical College, New York, NY

David G. Zipes, MD, FHM, Pediatric

John Noviasky, PharmD, Associate

Hospitalist, Peyton Manning Children’s

Director of Pharmacy-Clinical Services,

Hospital at St. Vincent, Indianapolis, IN

SUNY Upstate Medical University,

Syracuse, NY

*Affi liations are given for information purposes only, and no affi liation sponsorship is claimed.

viii

PREFACE TO THE TARASCON POCKET PHARMACOPOEIA®

The Tarascon Pocket Pharmacopoeia arranges drugs by clinical class with a com a
pre -
hensive index in the back. Trade names are italicized and capitalized. Drug doses shown in mg/kg are generally intended for children, while fi xed doses rep re sent typical adult rec ommendations. Brackets indicate currently available for mu la tions, although not all pharmacies stock all formulations. The availability of generic, over-the-counter, and scored formulations are mentioned. We have introduced a new format in this edition and have underlined the disease or indication for the pharmaceutical agent. It is meant to function as an aid to fi nd information quickly. Codes are as follows: METABOLISM & EXCRETION: L = primarily liver, K = primarily kidney, LK = both, but liver > kidney, KL = both, but kidney > liver.

♀ SAFETY IN PREGNANCY: A = Safety established using human studies, B = Pre sumed safety based on animal studies, C = Uncertain safety; no human studies and animal studies show an adverse effect, D = Unsafe - evidence of risk that may in cer tain clinical circumstances be justifi able, X = Highly unsafe - risk of use outweighs any pos sible benefi t. For drugs which have not been assigned a cate gory: + Generally accep ted as safe, ? Safety unknown or controversial, – Gen e rally regarded as unsafe.

 SAFETY IN LACTATION: + Generally accepted as safe, ? Safety unknown or controversial, – Generally regarded as unsafe. Many of our “+” listings are from the AAP policy

“The Transfer of Drugs and Other Chem icals Into Human Milk” (see www.aap.org) and may differ from those recommended by the manufacturer.

© DEA CONTROLLED SUBSTANCES: I = High abuse potential, no accepted use (eg, heroin, marijuana),
i

II = High abuse potential and severe depen dence liability (eg, morphine, codeine, hydromorphone, cocaine, amphetamines, methyl phen idate, secobarbital). Some states require triplicates. III = Moderate de pen dence liability (eg, Tylenol #3, Vicodin), IV = Limited dependence liability (ben zo dia zepines, pro poxy phene, phen ter mine), V =

Limited abuse potential (eg, Lomotil).

l

$ RELATIVE COST: Cost codes used are “per month” of maintenance therapy (eg, antihyper ten sives) or “per course” of short-term therapy (eg, antibiot ics). Codes are calculated using average wholesale pri ces (at press time in US dollars) for the most common in dica tion Code Cost
and route of each drug at a typical adult dosage. For $ < $25
main te nance therapy, costs are calculated based upon $$

$25 to $49
a 30 day supply or the quantity that might typically be $$$

$50 to $99
used in a given month. For short-term therapy (ie, 10

$$$$

$100 to $199
days or less), costs are calculated on a single treat-

$$$$$ ≥

$200
ment course. When multiple forms are available (eg, generics), these codes refl ect the least expensive generally available product. When drugs don’t neatly fi t into the classifi cation scheme above, we have assigned codes based upon the relative cost of other similar drugs. These codes should be used as a rough guide only g g
y,
as (1) they refl ect cost, not charges, (2) pricing often varies substantially from location to location and time to time, and (3) HMOs, Medicaid, and buying groups often negotiate quite different pricing. Check with your local pharmacy if you have any questions.

CANADIAN TRADE NAMES: Unique common Canadian trade names not used in the US
are listed after a maple leaf symbol. Trade names used in both nations or only in the US are displayed without such notation.

Therapeutic Drug Levels ix

ABBREVIATIONS IN TEXT

AAP – American

DPI – dry powder inhaler LFT – liver function test PO – by mouth Academy of Pediatrics EPS – extrapyramidal

LV – left ventricular

PR – by rectum
ac – before meals
symptoms

LVEF – left ventricular
prn – as needed

ADHD – attention defi cit ET – endotracheal
ejection fraction
q – every
hyperactivity disorder
g – gram

MAOI – monoamine
qam – every morning

AHA – American Heart

GERD– gastroesophageal oxidase inhibitor
qhs – at bedtime

.

Association
refl ux disease
mcg – microgram
qid – four times/day

ANC – absolute
gtts – drops

MDI – metered dose
qod – every other day
neutrophil count

GU – genitourinary
inhaler
qpm – every evening

ASA – aspirin
h – hour
mEq – milliequivalent

RA – rheumatoid arthritis
bid – twice per day

HAART – highly active mg – milligram

SC – subcutaneous

BP – blood pressure
antiretroviral therapy

MI – myocardial
sec – second

BPH – benign prostatic

Hb – hemoglobin
infarction
soln – solution
hyperplasia

HCTZ –
min – minute
supp – suppository

CAD – coronary artery
hydrochlorothiazide
mL – milliliter
susp – suspension
disease

HIT – Heparin induced
mm – millimeter
tab – tablet
cap – capsule
thrombocytopenia
mo – months old

TB – tuberculosis
cm – centimeter
hs – bedtime

MRSA- Methicillin

TCA – tricyclic

CMV – cytomegalovirus HSV – herpes simplex

Resistant Staphy-
antidepressant

CNS – central nervous
virus
lococcus Aureus
tid – three times/day
system

HTN – hypertension
ng – nanogram

TNF – tumor necrosis

COPD – chronic obstructive IM – intramuscular

NHLBI – National Heart, factor
pulmonary disease

INR – international

Lung, and Blood Institute TPN - total parenteral

CrCl – creatinine
normalized ratio

NS – normal saline
nutrition
clearance

IU – International units

N/V -nausea/vomiting

UTI – urinary tract

CVA – stroke

IV – intravenous

NYHA – New York Heart infection

CYP – cytochrome P450 JRA – juvenile

Association
wt – weight

D5W – 5% dextrose
rheumatoid arthritis

OA – osteoarthritis
y – year
dL – deciliter
kg – kilogram
pc – after meals
yo – years old

THERAPEUTIC DRUG LEVELS

Drug Level

Optimal

Timing
amikacin peak

20-35 mcg/ml 30 minutes after infusion
amikacin trough

<5 mcg/ml

Just prior to next dose
carbamazepine trough

4-12 mcg/ml

Just prior to next dose
cyclosporine trough

50-300 ng/ml Just prior to next dose
digoxin

0.8-2.0 ng/ml Just prior to next dose
ethosuximide trough

40-100 mcg/ml Just prior to next dose
gentamicin peak

5-10 mcg/ml

30 minutes after infusion
gentamicin trough

<2 mcg/ml

Just prior to next dose
lidocaine

1.5-5 mcg/ml 12-24 hours after start of infusion
lithium trough

0.6-1.2 meq/l Just prior to first morning dose

NAPA

10-30 mcg/ml Just prior to next procainamide dose
phenobarbital trough

15-40 mcg/ml Just prior to next dose
phenytoin trough

10-20 mcg/ml Just prior to next dose
primidone trough

5-12 mcg/ml

Just prior to next dose
procainamide

4-10 mcg/ml

Just prior to next dose
quinidine

2-5 mcg/ml

Just prior to next dose
theophylline

5-15 mcg/ml

8-12 hours after once daily dose
tobramycin peak

5-10 mcg/ml

30 minutes after infusion
tobramycin trough

<2 mcg/ml

Just prior to next dose
valproate trough (epilepsy) 50-100 mcg/ml Just prior to next dose valproate trough (mania)

45-125 mcg/ml Just prior to next dose
vancomycin trough1

10-20 mg/L

Just prior to next dose
zonisamide2

10-40 mcg/ml Just prior to dose

1Maintain trough >10 mg/L to avoid resistance; optimal trough is 10-20 mg/L

2Ranges not firmly established but supported by clinical trial results
x Outpatient Pediatric Drugs

Age | 2mo

6mo

12mo

5yo

4mo

9mo

15mo 2yo 3yo

PEDIATRIC DRUGS Kg \

Lbs\
med
strength freq \ teaspoons of liquid per dose (1 tsp= 5 mL) Tylenol MG

QH\

Tylenol TSP

T QH\

Ð Ð

 Ð

IBUPROFENMG

QH\

† †

IBUPROFENTSP T QH\

Ð† Ð†

 Ð

AMOXICILLINOR

T BID \

 Ð Ð  Ð

Augmentin T BID \ Ð

  Ð 

NOTOTITISMEDIA T BID \

Ð Ð

  Ð

T BID \ 

Ð Ð Ð

AMOXICILLIN

T BID \

 Ð

 Ð

OTITISMEDIA ‡

T BID \ Ð

 Ð Ð  

T BID \ Ð

Ð



Augmentin ES‡T BID \

Ð Ð Ð



AZITHROMYCIN§ T QD \ † †

Ð

Ð

DAY2X

T QD \ †

 





Bactrim 3 eptra BID \ Ð



CEFACLOR

T BID \

 Ð

gg

T BID \

Ð Ð Ð



CEFADROXIL

T BID \

Ð

  Ð 

gg

T BID \



Ð

Ð

Ð

CEFDINIR

T QD \

Ð†

 Ð

CEFIXIME

T QD \

Ð

Ð

Ð



CEFPROZIL

T BID \ Ð†

 
gg

T BID\ †

Ð Ð Ð



CEFUROXIME

T BID \

Ð

Ð

Ð 

CEPHALEXIN

T QID \

Ð

Ð

 Ð
gg

T QID \



 Ð Ð

CLARITHROMYCIN T BID \ † †

Ð

Ð

Ð


gg

T BID \



Ð

DICLOXACILLIN

T QID \ Ð

  Ð

NITROFURANTOIN

T QID \ 

Ð Ð Ð

Pediazole

TID \

Ð Ð



PENICILLIN6TBIDTID\

CETIRIZINE

T

QD \

Benadryl

T QH\

Ð

Ð



PREDNISOLONE

T QD \ 

Ð

Ð

Ð



PREDNISONE

T

QD \

 Ð 

Ð

Robitussin

QH\

o o

Ð Ð

Tylenol w/ codeine

QH\

* Dose shown is for otitis media only; see dosing in text for alternative indications.

† Dosing at this age/weight not recommended by manufacturer.

‡ AAP now recommends high dose (80-90 mg/kg/d) for all otitis media in children; with Augmentin used as ES only.

§Give a double dose of azithromycin the first day.

**AHA dosing for streptococcal pharyngitis. Treat for 10 days.

tsp = teaspoon; t = teaspoon; q = every; h = hour; kg = kilogram; Lbs = pounds; ml = mililiter; bid = twice per day; qd = every day; qid = four times per day; tid = three times per day

Pediatric Vital Signs & IV Drugs xi

PEDIATRIC VITAL SIGNS AND INTRAVENOUS DRUGS

Pre- New-

Age
matr born 2m 4m 6m 9m

12m 15m 2y 3y 5y

Weight

(Kg) 2

3½ 5 6

½ 8 9 10 11 13 15 19

(Lbs) 4½ 7½ 11 15 17 20 22 24 28 33 42

Maint fluids (ml/h) 8 14 20 26 32 36 40 42 46 50 58

ET tube

(mm) 2½ 3/3½ 3½ 3½ 3½ 4

4 4½ 4½ 4½ 5

Defib

(Joules) 4

7 10 13 16 18 20 22 26 30 38

Systolic BP (high) 70 80 85 90 95

100 103 104 106 109 114

(low) 40 60 70 70 70 70 70 70 75 75 80

Pulse rate (high) 145 145 180 180 180 160 160 160 150 150 135

(low) 100 100 110 110 110 100 100 100

90 90 65

Resp rate (high) 60 60 50 50 50 46 46 30 30 25 25

(low) 35 30 30 30 24 24 20 20 20 20 20

adenosine (mg) 0.2 0.3 0.5 0.6 0.8 0.9

1 1.1 1.3 1.5 1.9
atropine

(mg) 0.1 0.1 0.1 0.13 0.16 0.18 0.2 0.22 0.26 0.30 0.38

Benadryl

(mg) -

-

5 6½ 8

9 10 11 13 15 19
bicarbonate (meq) 2 3½ 5 6½ 8

9 10 11 13 15 19
dextrose

(g) 1

2

5 6½ 8

9 10 11 13 15 19
epinephrine (mg) .02 .04 .05 .07 .08 .09 0.1

0.11 0.13 0.15 0.19
lidocaine

(mg) 2 3½ 5 6½ 8

9 10 11 13 15 19
morphine

(mg) 0.2 0.3 0.5 0.6 0.8 0.9

1 1.1 1.3 1.5 1.9
mannitol

(g) 2 3½ 5 6½ 8

9 10 11 13 15 19
naloxone

(mg) .02 .04 .05 .07 .08 .09 0.1

0.11 0.13 0.15 0.19
diazepam (mg) 0.6 1 1.5 2 2.5

2.7 3 3.3

3.9 4.5 5
fosphenytoin* (PE) 40 70 100 130 160 180 200 220 260 300 380
lorazepam (mg) 0.1 0.2 0.3

0.35 0.4 0. 5 0.5 0.6 0.7 0.8 1.0
phenobarb (mg) 30 60 75 100 125 125 150 175 200 225 275
phenytoin* (mg) 40 70 100 130 160 180 200 220 260 300 380

ampicillin

(mg) 100 175 250 325 400 450

500 550 650 750 1000
ceftriaxone (mg) -

- 250 325 400 450 500 550 650 750

1000
cefotaxime (mg) 100 175 250 325 400 450

500 550 650 750 1000
gentamicin (mg) 5

8 12 16 20 22 25 27 32 37 47

*Loading doses; fosphenytoin dosed in “phenytoin equivalents”.

CONVERSIONS

Liquid:

Weight:

Temperature:

FLUIDOUNCEM,

KILOGRAMLBS

& #

TEASPOONM,

OUNCEG

#&

TABLESPOONM,

GRAINMG
xii Formulas, Websites

FORMULAS

Alveolar-arterial oxygen gradient = A-a = 148 - 1.2(PaCO2) - PaO2

[normal = 10-20 mmHg, breathing room air at sea level]

Calculated osmolality = 2Na + glucose/18 + BUN/2.8 + ethanol/4.6

[norm 280-295 meq/L. Na in meq/L; all others in mg/dL]

Pediatric IV maintenance fluids (see table on page 7) 4 ml/kg/hr or 100 ml/kg/day for first 10 kg, plus 2 ml/kg/hr or 50 ml/kg/day for second 10 kg, plus 1 ml/kg/hr or 20 ml/kg/day for all further kg mcg/kg/min =

16.7 x drug conc [mg/ml] x infusion rate [ml/h]

weight [kg]

Infusion rate [ml/h] =
desired mcg/kg/min x weight [kg] x 60
drug concentration [mcg/ml]

Fractional excretion of sodium =
urine Na / plasma Na

[Pre-renal, etc <1%; ATN, etc >1%]

urine creat / plasma creat x 100%

Anion gap = Na – (Cl + HCO3)

[normal = 10-14 meq/L]

Creatinine clearance = (lean kg)(140 - age)(0.85 if female)

[normal >80]

(72)(stable creatinine [mg/dL])

Glomerular filtration rate using MDRD equation (ml/min/1.73 m2)

= 186 x (creatinine)-1.154 x (age)-0.203 x (0.742 if ♀) x (1.210 if African American) Body surface area (BSA) = square root of: height (cm) x weight (kg)

[in m2]

3600

DRUG THERAPY REFERENCE WEBSITES (selected)

Professional societies or governmental agencies with drug therapy guidelines AHRQ Agency for Healthcare Research and Quality
www.ahcpr.gov

AAP

American Academy of Pediatrics
www.aap.org

ACC

American College of Cardiology
www.acc.org

ACCP American College of Chest Physicians
www.chestnet.org

ACCP American College of Clinical Pharmacy
www.accp.com

AHA

American Heart Association
www.americanheart.org

ADA

American Diabetes Association
www.diabetes.org

AMA

American Medical Association
www.ama-assn.org

APA

American Psychiatric

Association www.psych.org APA

American Psychological

Association www.apa.org

ATS

American Thoracic Society
www.thoracic.org

ASHP Amer. Society Health-Systems Pharmacists
www.ashp.org

CDC

Centers for Disease Control and Prevention
www.cdc.gov

CDC

CDC bioterrorism and radiation exposures
www.bt.cdc.gov

IDSA

Infectious Diseases Society of America
www.idsociety.org

MHA

Malignant Hyperthermia Association
www.mhaus.org

NHLBI National Heart, Lung, and Blood Institute
www.nhlbi.nih.gov

Other therapy reference sites

Cochrane library
www.cochrane.org

Emergency Contraception Website
www.not-2-late.com

Immunization Action Coalition
www.immunize.org

Int’l Registry for Drug-Induced Arrhythmias
www.qtdrugs.org

Managing Contraception
www.managingcontraception.com

Nephrology Pharmacy Associates
www.nephrologypharmacy.com

Analgesics

1

ANALGESICS

Antirheumatic Agents—Biologic Response Modifi ers NOTE Death, sepsis, and serious infections (eg, TB & invasive fungal infections) have been reported.

ADALIMUMAB ( Humira) RA, psoriatic arthritis, ankylosing spondylitis:

, p

,
y
g p
y

40 mg SC
q 2 weeks, alone or in combination with methotrexate or other disease-modifying antirheumatic drugs (DMARDs). May increase frequency to once a week if not on methotrexate. Crohn’s disease: 160 mg SC at week 0, 80 mg at week 2, then 40
mg q other week starting with week 4. [Trade only: 40 mg prefi lled glass syringes or vials with needles, 2 per pack.] `Serum ♀B – $$$$$

ANAKINRA ( Kineret )

RA: 100 mg SC daily. [Trade only: 100 mg prefi lled glass syringes with needles, 7 or 28 per box.] `K ♀B ? $$$$$

ETANERCEPT ( Enbrel ) RA, psoriatic arthritis, ankylosing spondylitis:

, p

,
y
g p
y

50 mg

SC once a week. Plaque psoriasis: 50 mg SC 2 times per week for 3 months, then 50 mg SC once a week. JRA age 4 to 17 yo: 0.8 mg/kg SC once a week, to max single dose of 50 mg. Max dose per injection site is 25 mg. [Supplied in a carton containing four dose trays and as single-use prefi lled syringes. Each dose tray contains one 25 mg single-use vial of etanercept, one syringe (1
mL sterile bacteriostatic water for injection, containing 0.9% benzyl alcohol), one plunger, and two alcohol swabs. Single-use syringes contain 50 mg/
mL.] `Serum ♀B – $$$$$

INFLIXIMAB ( Remicade) RA: 3 mg/kg IV in combination with methotrexate at 0, 2, and 6 weeks. Ankylosing spondylitis:

y
g p
y

5 mg/kg IV at 0, 2, and 6 weeks.

Plaque psoriasis, psoriatic arthritis, moderately to severely active Crohn’

q
p

, p

,
y
y
s
disease, ulcerative colitis, or fi

,

,
stulizing disease:

g

5 mg/kg IV infusion at 0, 2,
and 6 weeks, then q 8 weeks. `Serum ♀B ? $$$$$

Antirheumatic Agents—Disease-Modifying Antirheumatic Drugs (DMARDs) AZATHIOPRINE ( Azasan, Imuran,  Immunoprin, Oprisine) RA: Initial dose 1 mg/kg (50 to 100 mg) PO daily or divided bid. Increase after 6 to 8
weeks. [Generic/Trade: Tabs 50 mg, scored. Trade only (Azasan): 75, 100 mg, scored.] `LK ♀D – $$$

HYDROXYCHLOROQUINE ( Plaquenil )

RA: Start 400 to 600 mg PO daily, then
taper to 200 to 400 mg daily. SLE: 400 PO daily to bid to start, then taper to 200 to 400 mg daily. [Generic/Trade: Tabs 200 mg, scored.] `K ♀C + $

LEFLUNOMIDE ( Arava)

RA: 100 mg PO daily for 3 days. Maintenance:

10 to 20 mg PO daily. [Generic/Trade: Tabs 10, 20 mg. Trade only: Tabs 100 mg.] `LK ♀X – $$$$$

METHOTREXATE ( Rheumatrex, Trexall ) RA, psoriasis:

, p

Start with 7.5 mg PO
single dose once a week or 2.5 mg PO q 12 h for 3 doses given once a week.

Max dose 20 mg/week. Supplement with 1 mg/day of folic acid. Chemotherapy doses vary by indication. [Trade only (Trexall): Tabs 5, 7.5, 10, 15 mg. Dose Pak (Rheumatrex) 2.5 mg (#8, 12, 16, 20, 24). Generic/Trade: Tabs 2.5 mg, scored.] `LK ♀X – $$

2 Analgesics

Muscle Relaxants

BACLOFEN ( Lioresal, Kemstro) Spasticity related to MS or spinal cord p
y
p
disease/injury:

j y Start 5 mg PO tid, then increase by 5 mg/dose q 3 day until 20 mg PO tid. Max dose 20 mg qid. [Generic only: Tabs 10, 20 mg. Trade only: (Kemstro) Tabs orally disintegrating 10, 20 mg.] `K ♀C + $$

CARISOPRODOL ( Soma) Acute musculoskeletal pain: p

350 mg PO tid to qid.

Abuse potential. [Generic/Trade: Tabs 350 mg. Trade only: Tabs 250 mg.]

`LK ♀? – $

CHLORZOXAZONE ( Parafon Forte DSC) Musculoskeletal pain: p

500 to 750 mg

PO tid to qid to start. Decrease to 250 mg tid to qid. [Generic/Trade: Tabs 250, 500 mg (Parafon Forte DSC 500 mg tabs scored).] `LK ♀C ? $

CYCLOBENZAPRINE ( Amrix, Flexeril, Fexmid )

Musculoskeletal pain:

p

Start

5 to 10 mg PO tid, max 30 mg/day or 15 to 30 mg (extended-release) PO
daily. Not recommended in elderly. [Generic/Trade: Tabs 5, 10 mg. Generic only: Tabs 7.5 mg. Trade only (Amrix $$$$$): Extended-release caps 15, 30
mg.] `LK ♀B ? $

DANTROLENE ( Dantrium) Chronic spasticity related to spinal cord injury p
y
p
j

,
y,

CVA, cerebral palsy

,
p

, MS:

y,

25 mg PO daily to start, up to max of 100 mg bid
to qid if necessary. Malignant hyperthermia:

g
yp

2.5 mg/kg rapid IV push q 5 to

10 min continuing until symptoms subside or to a maximum 10 mg/kg/dose.

[Generic/Trade: Caps 25, 50, 100 mg.] `LK ♀C – $$$$

METAXALONE ( Skelaxin)

n

Musculoskeletal pain:

p

800 mg PO tid to qid. [Trade
only: Tabs 800 mg, scored.] `LK ♀? ? $$$

METHOCARBAMOL ( Robaxin, Robaxin-750)

0 Acute musculoskeletal pain:

p

1500 mg PO qid or 1000 mg IM/IV tid for 48 to 72 h. Maintenance: 1000 mg PO qid, 750 mg PO q 4 h, or 1500 mg PO tid. Tetanus: Specialized dosing.

[Generic/Trade: Tabs 500, 750 mg. OTC in Canada.] `LK ♀C ? $$

ORPHENADRINE ( Norfl ex) Musculoskeletal pain: p

100 mg PO bid. 60 mg IV/

IM bid. [Generic only: 100 mg extended-release. OTC in Canada.] `LK ♀C

? $$

TIZANIDINE ( Zanafl ex )

Muscle spasticity due to MS or spinal cord injury:

p
y
p
j y 4
to 8 mg PO q 6 to 8 h prn, max 36 mg/day. [Generic/Trade: Tabs 4 mg, scored.

Trade only: Caps 2, 4, 6 mg. Generic only: Tabs 2 mg.] `LK ♀C ? $$$$

Non-Opioid Analgesic Combinations

ASCRIPTIN (ASA + aluminum hydroxide + magnesium hydroxide + calcium carbonate) ( Aspir-Mox) Multiple strengths. 1 to 2 tabs PO q 4 h. [OTC Trade only: Tabs 325 mg ASA/50 mg Mg hydroxide/50 mg Al hydroxide/50 mg Ca carbonate (Ascriptin and Aspir-Mox). 500 mg ASA/33 mg Mg hydroxide/33 mg Al hydroxide/237 mg Ca carbonate (Ascriptin Maximum Strength).] `K ♀D

? $

BUFFERIN (ASA + calcium carbonate + magnesium oxide + magnesium carbonate) 1 to 2 tabs/caplets PO q 4 h. Max 12 in 24 h. [OTC Trade only: Tabs/caplets 325 mg ASA/158 mg Ca carbonate/63 mg of Mg oxide/34 mg of Mg carbonate. Bufferin ES: 500 mg ASA/222.3 mg Ca carbonate/88.9 mg of Mg oxide/55.6 mg of Mg carbonate.] `K ♀D ? $

Analgesics

3

ESGIC (acetaminophen + butalbital + caffeine) 1 to 2 tabs or caps PO
q 4 h. Max 6 in 24 h. [Generic only: Tabs/caps, 325 mg acetaminophen/50 mg butalbital/40 mg caffeine. Oral soln 325/50/40 mg per 15 mL. Generic/Trade: Tabs, Esgic Plus is 500/50/40 mg.] `LK ♀C ? $

EXCEDRIN MIGRAINE (acetaminophen + ASA + caffeine) 2 tabs/caps/
geltabs PO q 6 h while symptoms persist. Max 8 in 24 h. [OTC/Generic/

Trade: Tabs, Caplets, Geltabs 250 mg acetaminophen/250 mg ASA/65 mg caffeine.] `LK ♀D ? $

FIORICET (acetaminophen + butalbital + caffeine) 1 to 2 caps PO q 4 h. Max 6 caps in 24 h. [Generic/Trade: Caps 325 mg acetaminophen/50 mg butalbital/

40 mg caffeine.] `LK ♀C ? $

FIORINAL (ASA + butalbital + caffeine) ( Tecnal, Trianal ) 1 to 2 tabs PO q 4 h. Max 6 tabs in 24 h. [Generic/Trade: Caps 325 mg ASA/50 mg butalbital/40 mg caffeine.] `KL ♀D – ©III $

GOODY’S EXTRA STRENGTH HEADACHE POWDER (acetaminophen + ASA +
caffeine) 1
powder PO followed with liquid, or stir powder into a glass of water or other liquid. Repeat in 4 to 6 h prn. Max 4 powders in 24 h. [OTC
trade only: 260 mg acetaminophen/520 mg ASA/32.5 mg caffeine per powder paper.] `LK ♀D ? $

NORGESIC (orphenadrine + ASA + caffeine) Multiple strengths; write specifi c product on Rx. Norgesic: 1 to 2 tabs PO tid to qid. Norgesic Forte, 1
tab PO tid to qid. [Generic/Trade: Tabs: Norgesic 25 mg orphenadrine/385 mg ASA/30 mg caffeine, Norgesic Forte 50/770/60 mg.] `KL ♀D ? $$

PHRENILIN (acetaminophen + butalbital) Tension or muscle contraction headache: 1 to 2 tabs PO q 4 h. Max 6 in 24 h. [Generic/Trade: Tabs, Phrenilin 325 mg acetaminophen/50 mg butalbital. Caps, Phrenilin Forte 650/50
mg.] `LK ♀C ? $

SEDAPAP (acetaminophen + butalbital) 1 to 2 tabs PO q 4 h. Max 6 tabs in 24 h. [Generic only: Tabs 650 mg acetaminophen/50 mg butalbital.] `LK

♀C ? $

SOMA COMPOUND (carisoprodol + ASA) 1 to 2 tabs PO qid. Abuse potential.

[Generic/Trade: Tabs 200 mg carisoprodol/325 mg ASA.] `LK ♀D – $$$

ULTRACET (tramadol + acetaminophen) ( Tramacet ) Acute pain: 2 tabs PO q 4 to 6 h prn, (up to 8 tabs/day for no more than 5 days). Adjust dose in elderly & renal dysfunction. Avoid in opioid-dependent patients. Seizures may occur if concurrent antidepressants or seizure disorder. [Generic/Trade: Tabs 37.5 mg tramadol/325 mg acetaminophen.] `KL ♀C – $$

Non-Steroidal Anti-Infl ammatories—COX-2 Inhibitors CELECOXIB ( Celebrex ) OA, ankylosing spondylitis:

,
y
g p
y

200 mg PO daily or 100 mg

PO bid. RA: 100 to 200 mg PO bid. Familial adenomatous polyposis: p yp

400 mg PO
bid with food. Acute pain, dysmenorrhea:

p

, y

400 mg single dose, then 200 bid prn.

An additional 200 mg dose may be given on day 1 if needed. JRA: Give 50 mg PO bid for age 2 to 17 yo and wt 10 to 25 kg, give 100 mg PO bid for wt greater than 25 kg. Contraindicated in sulfonamide allergy. [Trade only: Caps 50, 100, 200, 400 mg.] `L ♀C (D in 3rd trimester) ? $$$$$

4 Analgesics

Non-Steroidal Anti-Infl ammatories—Salicylic Acid Derivatives ASA ( Ecotrin, Empirin, Halfprin, Bayer, Anacin, Zorprin, ASA,  Asaphen, Entrophen, Novasen)

n

Analgesia:

g

325 to 650 mg PO/PR q 4 to 6 h. Platelet
aggregation inhibition:

gg g

81 to 325 mg PO daily. [Generic/Trade (OTC): Tabs, 325, 500
mg; Chewable tabs 81 mg; enteric-coated 81, 162 mg (Halfprin), 81, 325, 500 mg (Ecotrin), 650, 975 mg. Trade only: Tabs, controlled-release 650, 800 mg (ZORprin, Rx). Generic only (OTC): Supps 60, 120, 200, 300, 600 mg.] `K ♀D ? $

CHOLINE MAGNESIUM TRISALICYLATE ( Trilisate) RA/OA: 1500 mg PO bid.

[Generic only: Tabs 500, 750, 1000 mg. Soln 500 mg/5 mL.] `K ♀C (D in 3rd trimester) ? $$

DIFLUNISAL ( Dolobid ) Pain: 500 to 1000 mg initially, then 250 to 500 mg PO q 8 to 12 h. RA/OA: 500 mg to 1 g PO divided bid. [Generic/Trade: Tabs 250, 500 mg.] `K ♀C (D in 3rd trimester) – $$$

SALSALATE ( Salfl ex, Disalcid, Amigesic)

RA/OA: 3000 mg/day PO divided
q 8 to 12 h. [Generic only: Tabs 500, 750 mg, scored.] `K ♀C (D in 3rd trimester) ? $$

Non-Steroidal Anti-Infl ammatories—Other

ARTHROTEC (diclofenac + misoprostol)

OA: One 50/200 tab PO tid. RA:

One 50/200 tab PO tid to qid. If intolerant, may use 50/200 or 75/200 PO
bid. Misoprostol is an abortifacient. [Trade only: Tabs 50/200, 75/200 mg diclofenac/mcg misoprostol.] `LK ♀X – $$$$$

DICLOFENAC ( Voltaren, Voltaren XR, Catafl am, Flector, Zipsor, Cambia,

 Voltaren Rapide) Multiple strengths; write specifi c product on Rx.

Immediate- or delayed-release 50 mg PO bid to tid or 75 mg PO bid. Extended-release (Voltaren XR): 100 to 200 mg PO daily. Patch (Flector): apply 1 patch to painful area bid. Gel: 2 to 4 g to affected area qid. Acute migraine with or g
without aura: 50 mg single dose (Cambia) [Generic/Trade: Tabs, immediate-release (Catafl am) 50 mg, extended-release (Voltaren XR) 100 mg. Generic only: Tabs, delayed-release 25, 50, 75 mg. Trade only: Patch (Flector) 1.3%
diclofenac epolamine. Topical gel (Voltaren) 1% 100 g tube. Trade only: Caps, liquid-fi lled (Zipsor) 25 mg. Trade only: Powder for oral soln (Cambia) 50 mg.] `L ♀B (D in 3rd trimester) – $$$

ETODOLAC ( Ultradol ) Multiple strengths; write specifi c product on Rx.

Immediate-release 200 to 400 mg PO bid to tid. Extended-release: 400 to 1200 mg PO daily. [Generic only: Caps immediate-release 200, 300 mg, Tabs immediate-release 400, 500 mg, Tabs extended-release 400, 500, 600 mg.] `L ♀C (D in 3rd trimester) – $$$

FLURBIPROFEN ( Ansaid,  Froben, Froben SR) 200 to 300 mg/day PO
divided bid to qid. [Generic/Trade: Tabs immediate-release 50, 100 mg.] `L

♀B(D in 3rd trimester) + $$$

IBUPROFEN ( Motrin, Advil, Nuprin, Rufen, Neoprofen, Caldolor) r 200 to 800
mg PO tid to qid. Peds older than 6 mo: 5 to 10 mg/kg PO q 6 to 8 h. GI perforation and necrotizing enterocolitis has been reported with NeoProfen.

[OTC: Caps, Liqui-gel caps 200 mg. Tabs 100, 200 mg. Chewable tabs 50, (cont.)

Analgesics 5

100 mg. Susp (infant gtts) 50 mg/1.25 mL (with calibrated dropper), 100
mg/5 mL. Rx Generic/Trade: Tabs 300, 400, 600, 800 mg.] `L ♀B (D in 3rd trimester) + $

INDOMETHACIN ( Indocin, Indocin SR, Indocin IV,  Indocid-P.D.A. ) Multiple strengths; write specifi c product on Rx. Immediate-release preparations 25
to 50 mg cap PO tid. Sustained-release: 75 mg cap PO daily to bid. [Generic/

Trade: Caps, sustained-release 75 mg. Generic only: Caps, immediate-release 25, 50 mg, Suppository 50 mg. Trade only: Oral susp 25 mg/5 mL (237
mL).] `L ♀B (D in 3rd trimester) + $

KETOPROFEN ( Orudis, Orudis KT, Actron, Oruvail,  Orudis SR) Immediate-release: 25 to 75 mg PO tid to qid. Extended-release: 100 to 200 mg cap PO daily. [OTC: Tabs, immediate-release 12.5 mg. Rx Generic only: Caps, extended-release 100, 150, 200 mg, Caps, immediate-release 25, 50, 75 mg.]

`L ♀B (D in 3rd trimester) – $$$

KETOROLAC ( Toradol )

Moderately severe acute pain:

y
p

15 to 30 mg IV/IM q 6 h
or 10 mg PO q 4 to 6 h prn. Combined duration IV/IM and PO is not to exceed 5 days. [Generic only: Tabs 10 mg.] `L ♀C (D in 3rd trimester) + $

MEFENAMIC ACID ( Ponstel,  Ponstann) Mild to moderate pain, primary dysp

, p
y y
menorrhea: 500 mg PO initially, then 250 mg PO q 6 h prn for no more than 1 week. [Trade only: Caps 250 mg.] `L ♀D – $$$$$

MELOXICAM ( Mobic,  Mobicoxx) RA/OA: 7.5 mg PO daily. JRA age 2 yo or older: 0.125 mg/kg PO daily. [Generic/Trade: Tabs 7.5, 15 mg. Susp 7.5 mg/5 mL

(1.5 mg/mL).] `L ♀C (D in 3rd trimester) ? $

NABUMETONE ( Relafen)

n

RA/OA: Initial: Two 500 mg tabs (1000 mg) PO
daily. May increase to 1500 to 2000 mg PO daily or divided bid. [Generic only: Tabs 500, 750 mg.] `L ♀C (D in 3rd trimester) – $$$

NAPROXEN ( Naprosyn, Aleve, Anaprox, EC-Naprosyn, Naprelan, Prevacid, NapraPac) Immediate-release:

250 to 500 mg PO bid. Delayed-release:

375 to 500 mg PO bid (do not crush or chew). Controlled-release: 750 to 1000
mg PO daily. JRA: give 2.5 mL PO bid for wt 13 kg or less, give 5 mL PO bid for 14 to 25 kg, give 7.5 mL PO bid for 26 to 38 kg. 500 mg naproxen equivalent to 550 mg naproxen sodium. [OTC Generic/Trade (Aleve): Tabs immediate-release 200 mg. OTC Trade only (Aleve): Caps, Gelcaps immediate-release 200
mg. Rx Generic/Trade: Tabs immediate-release (Naprosyn) 250, 375, 500 mg, (Anaprox) 275, 550 mg. Tabs delayed-release enteric coated (EC-Naprosyn) 375, 500 mg. Tabs, controlled-release (Naprelan) 375, 500, 750 mg. Susp (Naprosyn) 125 mg/5 mL. Prevacid NapraPac: 7 lansoprazole 15 mg caps packaged with 14 naproxen tabs 375 mg or 500 mg.] `L ♀B (D in 3rd trimester) + $$$

OXAPROZIN ( Daypro) 1200 mg PO daily. [Generic/Trade: Tabs 600 mg, trade scored.] `L ♀C (D in 3rd trimester) – $$$

NSAIDs – If one class fails, consider another. Salicylic acid derivatives y

:

ASA, difl unisal, salsalate, Trilisate. Propionic acids p

: fl urbiprofen, ibuprofen,
ketoprofen, naproxen, oxaprozin. Acetic acids: diclofenac, etodolac, indomethacin, ketorolac, nabumetone, sulindac, tolmetin. Fenamates: meclofenamate.

Oxicams: meloxicam, piroxicam. COX-2 inhibitors: celecoxib.

6 Analgesics

PIROXICAM ( Feldene, Fexicam) 20 mg PO daily. [Generic/Trade: Caps 10, 20 mg.] `L ♀B (D in 3rd trimester) + $$$

SULINDAC ( Clinoril ) 150 to 200 mg PO bid. [Generic/Trade: Tabs 200 mg.

Generic only: Tabs 150 mg.] `L ♀B (D in 3rd trimester) – $$$

TIAPROFENIC ACID ( Surgam, Surgam SR ) Canada only. 600 mg PO daily of sustained-release, or 300 mg PO bid of regular-release. [Generic/Trade: Tabs 300 mg. Trade only: Caps, sustained-release 300 mg. Generic only: Tabs 200 mg.] `K ♀C (D in 3rd trimester) – $$

TOLMETIN ( Tolectin) 200 to 600 mg PO tid. [Generic/Trade: Tabs 200 (trade scored), 600 mg. Caps 400 mg.] `L ♀C (D in 3rd trimester) + $$$$

Opioid Agonist-Antagonists

BUPRENORPHINE ( Buprenex, Subutex ) Analgesia: g

0.3 to 0.6 mg IV/IM q 6 h
prn. Treatment of opioid dependence:

p
p

Induction 8 mg SL on day 1, 16 mg SL on
day 2. Maintenance: 16 mg SL daily. Can individualize to range of 4 to 24 mg SL
daily. [Trade only (Subutex): SL tabs 2, 8 mg.] `L ♀C – ©III $ IV, $$$$$ SL

BUTORPHANOL ( Stadol, Stadol NS ) 0.5 to 2 mg IV or 1 to 4 mg IM q 3 to 4 h prn. Nasal spray (Stadol NS): 1 spray (1 mg) in 1 nostril q 3 to 4 h. Abuse poten tial. [Generic only: Nasal spray 1 mg/spray, 2.5 mL bottle (14–15 doses/
bottle).] `LK ♀C + ©IV $$$

NALBUPHINE ( Nubain)

n

10 to 20 mg IV/IM/SC q 3 to 6 h prn. `LK ♀? ? $

PENTAZOCINE ( Talwin NX ) 30 mg IV/IM q 3 to 4 h prn (Talwin). 1 tab PO q 3
to 4 h. (Talwin NX = 50 mg pentazocine/0.5 mg naloxone). [Generic/Trade: Tabs 50 mg with 0.5 mg naloxone, trade scored.] `LK ♀C ? ©IV $$$

Opioid Agonists

CODEINE

0.5 to 1 mg/kg up to 15 to 60 mg PO/IM/IV/SC q 4 to 6 h. Do not use IV in children. [Generic only: Tabs 15, 30, 60 mg. Oral soln: 15 mg/5 mL.] `LK

♀C – ©II $$

FENTANYL ( Duragesic, Actiq, Fentora, Sublimaze, IONSYS, Onsolis ) Transdermal (Duragesic): 1 patch q 72 h (some with chronic pain may require q 48
h dosing). May wear more than 1 patch to achieve the correct analgesic effect.

Transmucosal lozenge (Actiq) for breakthrouggh cancer pain: p

200 to 1600 mcg,
goal is 4 lozenges on a stick per day in conjunction with long-acting opioid.

Buccal tab (Fentora) for breakthrough cancer pain:

g
p

100 to 800 mcg, titrated
to pain relief. Buccal soluble fi lm (Onsolis) for breakthrough cancer pain: g
p

200
to 1200 mcg, titrated to pain relief. Adult analgesia/procedural sedation: g
p

50
to 100 mcg slow IV over 1 to 2 min; carefully titrate to effect. Analgesia: g

50 to

100 mcg IM q 1 to 2 h prn. [Generic/Trade: Transdermal patches 12.5, 25, 50, 75, 100 mcg/h. Actiq lozenges on a stick, berry fl avored 200, 400, 600, 800, 1200, 1600 mcg. Trade only: IONSYS: Iontophoretic transdermal system: 40
mcg fentanyl per activation; max 6 doses/h. Max per system is eighty 40 mcg doses over 24 h. Trade only: (Fentora) buccal tab 100, 200, 300, 400, 600, 800
mcg. Trade only: (Onsolis) buccal soluble fi lm 200, 400, 600, 800, & 1200 mcg in child-resistant, protective foil.] `L ♀C + ©II $$$$$

HYDROMORPHONE ( Dilaudid, Dilaudid-5,  Hydromorph Contin) n Adults:

2 to

4 mg PO q 4 to 6 h. 0.5 to 2 mg IM/SC or slow IV q 4 to 6 h. 3 mg PR q 6 to 8 h.

(cont.)

Analgesics 7

OPIOID EQUIVALENCY*

Opioid

PO

IV/SC/IM

Opioid

PO

IV/SC/IM
buprenorphine
n/a

0.3–0.4 mg
meperidine

300 mg

75 mg
butorphanol
n/a

2 mg
methadone

5–15 mg

2.5–10 mg
codeine

130 mg

75 mg
morphine

30 mg

10 mg
fentanyl

?

0.1 mg
nalbuphine
n/a

10 mg
hydrocodone

20 mg
n/a
oxycodone

20 mg
n/a
hydromorphone

7.5 mg

1.5 mg
oxymorphone

10 mg

1 mg
levorphanol

4 mg

2 mg
pentazocine

50 mg

30 mg

*Approximate equianalgesic doses as adapted from the 2003 American Pain Society (www.ampainsoc.org) guidelines and the 1992 AHCPR guidelines. Not available = “n/a”. See drug entries themselves for starting doses. Many recommend initially using lower than equivalent doses when switching between different opioids. IV doses should be titrated slowly with appropriate monitoring. All PO dosing is with immediate-release preparations. Individualize all dosing, especially in the elderly, children, and in those with chronic pain, opioid naïve, or hepatic/renal insuffi ciency.

Titrate dose as high as necessary to relieve cancer pain or other types of non-malignant pain where chronic opioids are necessary. Peds age younger than or equal to 12 yo: 0.03 to 0.08 mg/kg PO q 4 to 6 h prn or give 0.015 mg/kg/
dose IV q 4 to 6 h prn. [Generic/Trade: Tabs 2, 4, 8 mg (8 mg trade scored).

Oral soln 5 mg/5 mL. Suppository 3 mg.] `L ♀C ? ©II $$

LEVORPHANOL ( Levo-Dromoran) 2 mg PO q 6 to 8 h prn. [Generic only: Tabs 2 mg, scored.] `L ♀C ? ©II $$$$

MEPERIDINE ( Demerol, pethidine) 1 to 1.8 mg/kg up to 150 mg IM/SC/

PO or slow IV q 3 to 4 h. 75 mg meperidine IV/IM/SC is equivalent to 300
mg meperidine PO. [Generic/Trade: Tabs 50 (trade scored), 100 mg. Syrup 50
mg/5 mL (trade banana fl avored).] `LK ♀C but + + ©II $$$

METHADONE ( Diskets, Dolophine, Methadose,  Metadol ) Severe pain in p
opioid-tolerant
p
patients:

p

2.5 to 10 mg IM/SC/PO q 3 to 4 h prn. Titrate dose
as high as necessary to relieve cancer pain or other types of non-malignant pain where chronic opioids are necessary. Opioid dependence: p
p

20 to 100 mg

PO daily. Treatment longer than 3 weeks is maintenance and only permitted in approved treatment programs. [Generic/Trade: Tabs 5, 10 mg, Dispersible tabs 40 mg (for opioid dependence only). Oral concentrate (Intensol): 10 mg/
mL. Generic only: Oral soln 5, 10 mg/5 mL.] `L ♀C ? ©II $

MORPHINE ( MS Contin, Kadian, Avinza, Roxanol, Oramorph SR, MSIR, DepoDur,  Statex, M.O.S., Doloral ) Controlled-release tabs (MS Contin, Oramorph SR): Start at 30 mg PO q 8 to 12 h. Controlled-release caps (cont.)

FENTANYL TRANSDERMAL DOSE (Dosing based on ongoing morphine requirement. ) Morphine* (IV/IM)

Morphine* (PO)

Transdermal fentanyl*

10–22 mg/d

60–134 mg/d

25 mcg/h

23–37 mg/d

135–224 mg/d

50 mcg/h

38–52 mg/d

225–314 mg/d

75 mcg/h

53–67 mg/d

315–404 mg/d

100 mcg/h

*For higher morphine doses see product insert for transdermal fentanyl equivalencies.

8 Analgesics

(Kadian): 20 mg PO q 12 to 24 h. Extended-release caps (Avinza): Start at 30 mg PO daily. Do not break, chew, or crush MS Contin or Oramorph SR.

Kadian & Avinza caps may be opened & sprinkled in applesauce for easier administration; however, the pellets should not be crushed or chewed: give 0.1 to 0.2 mg/kg up to 15 mg IM/SC or slow IV q 4 h. Titrate dose as high as necessary to relieve cancer pain or other types of non-malignant pain where chronic opioids are necessary. [Generic/Trade: Tabs, immediate-release 15, 30 mg. Oral soln: 10 mg/5 mL, 20 mg/5 mL, 20 mg/mL (concentrate). Rectal supps 5, 10, 20, 30 mg. Controlled-release tabs (MS Contin) 15, 30, 60, 100, 200 mg. Trade only: Controlled-release caps (Kadian) 10, 20, 30, 50, 60, 80, 100, 200 mg, Controlled-release tabs (Oramorph SR) 15, 30, 60, 100 mg.

Extended-release caps (Avinza) 30, 45, 60, 75, 90, 120 mg. Generic only: Tabs, immediate-release 10 mg.] `LK ♀C + ©II $$$$

OXYCODONE ( Roxicodone,

OxyContin, Percolone, OxyIR,

OxyFAST,

 Endocodone, Supeudol ) Immediate-release
preparations: 5 mg PO q 4 to

6 h prn. Controlled-release (OxyContin): 10 to 40 mg PO q 12 h (no supporting data for shorter dosing intervals for controlled-release tabs). Titrate dose as high as necessary to relieve cancer pain or other types of non-malignant pain where chronic opioids are necessary. Do not break, chew, or crush controlled-release preparations. [Generic/Trade: Immediate-release: Tabs (scored), Caps 5 mg. Tabs 15, 30 mg. Oral soln 5 mg/5 mL. Oral concentrate 20 mg/mL.

Generic only: Immediate-release tabs 10, 20 mg. Trade only: Controlled-release tabs: 10, 15, 20, 30, 40, 60, 80 mg.] `L ♀B – ©II $$$$$

OXYMORPHONE ( Opana) 10 to 20 mg PO q 4 to 6 h (immediate-release) or 5
mg q 12 h (extended-release) in opioid-naive patients, 1 h before or 2 h after meals. 1 to 1.5 mg IM/SC q 4 to 6 h prn. 0.5 mg IV q 4 to 6 h prn, increase dose until pain adequately controlled. [Trade only: Extended-release tabs (Opana ER) 5, 7.5, 10, 15, 20, 30, 40 mg, Immediate-release tabs (Opana IR) 5, 10
mg.] `L ♀C ? ©II $$$$

PROPOXYPHENE ( Darvon-N, Darvon Pulvules) 65 to 100 mg PO q 4 h prn.

[Generic/Trade: Caps 65 mg. Trade only: Tabs 100 mg (Darvon-N).] `L ♀C

+ ©IV $$

Opioid Analgesic Combinations

NOTE See individual components for further information. May cause drowsiness and/or sedation, which may be enhanced by alcohol & other CNS depressants.

Opioids, carisoprodol, and butalbital may be habit-forming. Avoid exceeding 4 g/day of acetaminophen in combination products. Caution people who drink 3 or more alcoholic drinks/day to limit acetaminophen use to 2.5 g/day due to additive liver toxicity. Opioids commonly cause constipation; concurrent laxatives are recommended. All opioids are pregnancy class D if used for prolonged periods or in high doses at term.

ANEXSIA (hydrocodone + acetaminophen) Multiple strengths; write specifi c product on Rx. 1 tab PO q 4 to 6 h prn. [Generic/Trade: Tabs 5/325, 5/500, 7.5/325, 7.5/650, 10/750 mg hydrocodone/mg acetaminophen, scored.] `LK ♀C – ©III $$

Analgesics

9

CAPITAL WITH CODEINE SUSPENSION (acetaminophen + codeine) 15 mL

PO q 4 h prn. Give 5 ml q 4 to 6 h prn for age 3 to 6 yo, give 10 mL PO q 4
to 6 h prn pain for age 7 to 12 yo, use adult dose for age older than 12 yo.

[Generic available as oral soln. Trade available as susp. Both contain codeine 12 mg and acetaminophen 120 mg per 5 mL (trade, fruit punch fl avor).] `LK

♀C ? ©V $

COMBUNOX (oxycodone + ibuprofen) 1 tab PO q 6 h prn for no more than 7 days. Max 4 tabs per day. [Generic/Trade: Tabs 5 mg oxycodone/400 mg ibuprofen.] `L ♀C (D in 3rd trimester) ? ©II $$$

DARVOCET (propoxyphene + acetaminophen) Multiple strengths; write specifi c product on Rx. 50/325, 2 tabs PO q 4 h prn. 100/500 or 100/650, 1 tab PO q 4 h prn. [Generic/Trade: Tabs 50/325 (Darvocet N-50), 100/650 (Darvocet N-100), 100/500 (Darvocet A500), mg propoxyphene/mg acetaminophen.] `L

♀C + ©IV $$

EMPIRIN WITH CODEINE (ASA + codeine) ( 292 tabs ) Multiple strengths; write specifi c product on Rx.1 to 2 tabs PO q 4 h prn. [Generic only: Tabs 325/30, 325/60 mg ASA/mg codeine. Empirin brand no longer made.] `LK

♀D – ©III $

FIORICET WITH CODEINE (acetaminophen + butalbital + caffeine +
codeine) 1 to 2 caps PO q 4 h prn. Max 6 caps per day. [Generic/Trade: Caps 325 mg acetaminophen/50 mg butalbital/40 mg caffeine/30 mg codeine.] `LK ♀C – ©III $$$

FIORINAL WITH CODEINE (ASA + butalbital + caffeine + codeine) ( Fiorinal C-1/4, Fiorinal C-1/2, Tecnal C-1/4, Tecnal C-1/2) 1 to 2 caps PO q 4 h prn.

Max 6 caps/24 h. [Generic/Trade: Caps 325 mg ASA/50 mg butalbital/40 mg caffeine/30 mg codeine.] `LK ♀D – ©III $$$

IBUDONE (hydrocodone + ibuprofen) 1 tab PO q 4 to 6 h prn, max dose 5 tabs/day. [Generic/Trade: Tabs 5/200 mg and 10/200 mg hydrocodone/
ibuprofen.] `LK ♀– ? ©III $$$

LORCET (hydrocodone + acetaminophen) 1 to 2 caps (5/500) PO q 4 to 6 h prn, max dose 8 caps/day. 1 tab PO q 4 to 6 h prn (7.5/650 & 10/650), max dose 6 tabs/day. [Generic/Trade: Caps 5/500 mg, Tabs 7.5/650, 10/650 mg hydrocodone/acetaminophen.] `LK ♀C – ©III $

LORTAB (hydrocodone + acetaminophen) 1 to 2 tabs (2.5/500 & 5/500) PO q 4 to 6 h prn, max dose 8 tabs/day. 1 tab (7.5/500 & 10/500 PO) q 4 to 6
h prn, max dose 5 tabs/day. Elixir 15 mL PO q 4 to 6 h prn, max 6 doses/day.

[Generic/Trade: Lortab 5/500 (scored), Lortab 7.5/500 (trade scored), Lortab 10/500 mg hydrocodone/mg acetaminophen. Elixir: 7.5/500 mg hydrocodone/
mg acetaminophen/15 mL. Trade only: Tabs 2.5/500 mg.] `LK ♀C –

©III $$

MAXIDONE (hydrocodone + acetaminophen) 1 tab PO q 4 to 6 h prn, max dose 5 tabs/day. [Trade only: Tabs 10/750 mg hydrocodone/mg acetaminophen.] `LK ♀C – ©III $$$

MERSYNDOL WITH CODEINE (acetaminophen + codeine + doxylamine) Canada only. 1 to 2 tabs PO q 4 to 6 h prn. Max 12 tabs per day. [OTC Canada Trade only: Tabs 325 mg acetaminophen/8 mg codeine phosphate/5 mg doxylamine.] `LK ♀C ? $

10 Analgesics

NORCO (hydrocodone + acetaminophen) 1 to 2 tabs PO q 4 to 6 h prn (5/325), max dose 12 tabs/day. 1 tab (7.5/325 & 10/325) PO q 4 to 6 h prn, max dose 8 & 6 tabs/day respectively. [Trade only: Tabs 5/325, 7.5/325, 10/325 mg hydrocodone/acetaminophen, scored.] `L ♀C ? ©III $$$

PERCOCET (oxycodone + acetaminophen) ( Percocet-demi, Oxycocet, Endocet) Multiple strengths; write specifi c product on Rx. 1 to 2 tabs PO
q 4 to 6 h prn (2.5/325 & 5/325). 1 tab PO q 4 to 6 h prn (7.5/500 & 10/650).

[Trade only: Tabs 2.5/325 oxycodone/acetaminophen. Generic/Trade: Tabs 5/325, 7.5/325, 7.5/500, 10/325, 10/650 mg. Generic only: 2.5/300, 5/300, 7.5/300, 10/300, 2.5/400, 5/400, 7.5/400, 10/400, 10/500 mg.] `L ♀C –

©II $

PERCODAN (oxycodone + ASA) ( Oxycodan, Endodann) 1 tab PO q 6 h prn.

[Generic/Trade: Tabs 4.88/325 mg oxycodone/ASA (trade scored).] `LK ♀D

– ©II $$

ROXICET (oxycodone + acetaminophen) Multiple strengths; write specifi c product on Rx. 1 tab PO q 6 h prn. Soln: 5 mL PO q 6 h prn. [Generic/Trade: Tabs 5/325 mg. Caps/Caplets 5/500 mg. Soln 5/325 per 5 mL, mg oxycodone/
acetaminophen.] `L ♀C – ©II $

SOMA COMPOUND WITH CODEINE (carisoprodol + ASA + codeine) Moderate to severe musculoskeletal pain: 1 to 2 tabs PO qid prn. [Generic/Trade: Tabs 200 mg carisoprodol/325 mg ASA/16 mg codeine.] `L ♀D –©III $$$

SYNALGOS-DC (dihydrocodeine + ASA + caffeine) 2 caps PO q 4 h prn.

[Trade only: Caps 16 mg dihydrocodeine/356.4 mg ASA/30 mg caffeine.

“Painpack”=12 caps.] `L ♀C – ©III $

TALACEN (pentazocine + acetaminophen) 1 tab PO q 4 h prn. [Generic/

Trade: Tabs 25 mg pentazocine/650 mg acetaminophen, trade scored.] `L

♀C ? ©IV $$$

TYLENOL WITH CODEINE (codeine + acetaminophen) ( Lenoltec, Emtec, Triatec) Multiple strengths; write specifi c product on Rx. Give 1 to 2 tabs PO q 4 h prn. Elixir: give 5 ml q 4 to 6 h prn for age 3 to 6 yo, give 10 mL q 4
to 6 h prn for age 7 to 12 yo. [Generic only: Tabs Tylenol #2 (15/300). Tylenol with Codeine Elixir 12/120 per 5 mL, mg codeine/mg acetaminophen. Generic/

Trade: Tabs Tylenol #3 (30/300), Tylenol #4 (60/300). Canadian forms come with (Lenoltec, Tylenol) or without (Empracet, Emtec) caffeine.] `LK ♀C ?

©III (Tabs), V(elixir) $

TYLOX (oxycodone + acetaminophen) 1 cap PO q 6 h prn. [Generic/Trade: Caps 5 mg oxycodone/500 mg acetaminophen.] `L ♀C – ©II $

VICODIN (hydrocodone + acetaminophen) 5/500 (max dose 8 tabs/day) & 7.5/750 (max dose of 5 tabs/day): 1 to 2 tabs PO q 4 to 6 h prn. 10/660: 1 tab PO q 4 to 6 h prn (max of 6 tabs/day). [Generic/Trade: Tabs Vicodin (5/500), Vicodin ES (7.5/750), Vicodin HP (10/660), scored, mg hydrocodone/
mg acetaminophen.] `LK ♀C ? ©III $

VICOPROFEN (hydrocodone + ibuprofen) 1 tab PO q 4 to 6 h prn, max dose 5 tabs/day. [Generic/Trade: Tabs 7.5/200 mg hydrocodone/ibuprofen. Generic only: Tabs 2.5/200, 5/200, 10/200 mg.] `LK ♀– ? ©III $$$

WYGESIC (propoxyphene + acetaminophen) 1 tab PO q 4 h prn. [Generic only: Tabs 65 mg propoxyphene/650 mg acetaminophen.] `L ♀C ? ©IV $

Anesthesia

11

XODOL (hydrocodone + acetaminophen) 1 tab PO q 4 to 6 h prn, max 6 doses/day. [Trade only: Tabs 5/300, 7.5/300, 10/300 mg hydrocodone/
acetaminophen.] `LK ♀C – ©III $$

ZYDONE (hydrocodone + acetaminophen) 1 to 2 tabs (5/400) PO q 4 to 6 h prn, max dose 8 tabs/day. 1 tab (7.5/400, 10/400) q 4 to 6 h prn, max dose 6 tabs/day. [Trade only: Tabs 5/400, 7.5/400, 10/400 mg hydrocodone/mg acetaminophen.] `LK ♀C ? ©III $$

Opioid Antagonists

NALOXONE ( Narcan)

n

Adult opioid overdose:

p

0.4 to 2 mg q 2 to 3 min prn.

Adult post-op reversal:

p
p

0.1 to 0.2 mg q 2 to 3 min prn. Peds opioid overdose: p

0.01 mg/kg IV; may give 0.1 mg/kg if inadequate response. Peds post-op p
p
reversal: 0.005 to 0.01 mg q 2 to 3 min prn. May use IM/SC/ET if IV not available. `LK ♀B ? $

Other Analgesics

ACETAMINOPHEN ( Tylenol, Panadol, Tempra, paracetamol,  Abenol, Atasol, Pediatrix) 325 to 650 mg PO/PR q 4 to 6 h prn. Max dose 4 g/day. OA: 2
extended-release caplets (ie, 1300 mg) PO q 8 h around the clock. Peds: 10 to 15 mg/kg/dose PO/PR q 4 to 6 h prn. [OTC: Tabs 325, 500, 650 mg. Chewable tabs 80 mg. Oral disintegrating Tabs 80, 160 mg. Caps/Gelcaps/Caplets 500
mg. Extended-release caplets 650 mg. Liquid 160 mg/5 mL, 500 mg/15 mL.

Infant gtts 80 mg/0.8 mL. Supps 80, 120, 325, 650 mg.] `LK ♀B + $

TAPENTADOL ( Nucynta) Moderate to severe acute pain: p

50 to 100 mg PO
q 4 to 6 h prn, max 600 mg/day. Adjust dose in elderly, renal & hepatic dysfunction. Avoid in opioid-dependent patients. Seizures may occur with concurrent antidepressants or seizure disorder. [Trade only: Tabs 50, 75, 100
mg.] `LK ♀C – ©II ?

TRAMADOL ( Ultram, Ultram ER, Ryzolt )

Moderate to moderately severe
y
pain:

p

50 to 100 mg PO q 4 to 6 h prn, max 400 mg/day. Chronic pain, p

,
extended-release: 100 to 300 mg PO daily. Adjust dose in elderly, renal & hepatic dysfunction. Avoid in opioid-dependent patients. Seizures may occur with concurrent antidepressants or seizure disorder. [Generic/Trade: Tabs, immediate-release 50 mg. Trade only (Ultram ER, Ryzolt): Extended-release tabs 100, 200, 300 mg.] `KL ♀C – $$$

WOMEN’S TYLENOL MENSTRUAL RELIEF (acetaminophen + pamabrom) 2
caplets PO q 4 to 6 h. [OTC: Caplets 500 mg acetaminophen/25 mg pamabrom (diuretic).] `LK ♀B + $

ANESTHESIA

Anesthetics & Sedatives

DEXMEDETOMIDINE ( Precedex)

x

ICU sedation less than 24 h: Load 1 mcg/
kg over 10 min followed by infusion 0.2 to 0.7 mcg/kg/h titrated to desired sedation endpoint. Beware of bradycardia and hypotension. `LK ♀C ? $$$$

12 Anesthesia

ETOMIDATE ( Amidate)

Induction: give 0.3 mg/kg IV. `L ♀C ? $

FOSPROPOFOL ( Lusedra) Initial dose 6.5 mg/kg IV (not to exceed 16.5 mL), then give 1.6 mg/kg supplemental dose q 4 min (not to exceed 4 mL). `L ♀– ? $$$$

KETAMINE ( Ketalarr) 1 to 2 mg/kg IV over 1 to 2 min or 4 mg/kg IM
induces 10 to 20 min dissociative state. Concurrent atropine minimizes hypersalivation. `L ♀? ? ©III $

METHOHEXITAL ( Brevital ) Induction: give 1 to 1.5 mg/kg IV, duration 5
min. `L ♀B ? ©IV $

MIDAZOLAM ( Versed) Adult
d
sedation/anxiolysis:

y

5 mg or 0.07 mg/kg IM; or

1 mg IV slowly q 2 to 3 min up to 5 mg. Peds: 0.25 to 1 mg/kg to max of 20
mg PO, or 0.1 to 0.15 mg/kg IM. IV route (6 mo to 5 yo): initial dose 0.05 to 0.1 mg/kg IV, then titrated to max 0.6 mg/kg. IV route (6 to 12 yo): initial dose 0.025 to 0.05 mg/kg IV, then titrated to max 0.4 mg/kg. Monitor for respiratory depression. [Generic only: Oral liquid 2 mg/mL.] `LK ♀D – ©IV $

PENTOBARBITAL ( Nembutal ) Pediatric sedation: 1 to 6 mg/kg IV, adjusted in increments of 1 to 2 mg/kg to desired effect, or 2 to 6 mg/kg IM, max 100
mg. `LK ♀D ? ©II $$

PROPOFOL ( Diprivan)

n

Induction dose: 40 mg IV q 10 sec until induction (2 to 2.5 mg/kg). ICU ventilator sedation: Infusion 5 to 50 mcg/kg/min. Deep sedation: p

1 mg/kg IV over 20 to 30 seconds. Repeat 0.5 mg/kg IV prn. `L ♀B – $$$

THIOPENTAL ( Pentothal ) Induction: 3 to 5 mg/kg IV, duration 5 min. `L ♀C

? ©III $

Local Anesthetics

ARTICAINE ( Septocaine, Zorcaine) 4% injection (includes epinephrine).

[4% (includes epinephrine 1:100,000).] `LK ♀C ? $

BUPIVACAINE ( Marcaine, Sensorcaine)

Local and regional anes
g
the
sia.

[0.25%, 0.5%, 0.75%, all with or without epinephrine.] `LK ♀C ? $

DUOCAINE (bupivacaine + lidocaine—local anesthetic) Local anesthesia,

,
nerve block for eye surgery
y
g

.

y [Vials contain bupivacaine 0.375% + lidocaine

1%.] `LK ♀C ? $

LIDOCAINE—LOCAL ANESTHETIC ( Xylocaine) 0.5 to 1% injection with and without epinephrine. [0.5%, 1%, 1.5%, 2%. With epi: 0.5%, 1%, 1.5%, 2%.] `LK ♀B ? $

MEPIVACAINE ( Carbocaine, Polocaine) 1 to 2% injection. [1%, 1.5%, 2%, 3%.] `LK ♀C ? $

Neuromuscular Blockers

CISATRACURIUM ( Nimbex) Paralysis:

y

0.15 to 0.2 mg/kg IV. Peds: 0.1 mg/kg.

Duration 30 to 60 min. `Plasma LB ? $$

ROCURONIUM ( Zemuron)

n

Paralysis:

y

0.6 mg/kg IV. Duration 30 min. `L ♀B ? $$

SUCCINYLCHOLINE ( Anectine, Quelicinn) Paralysis: y

0.6 to 1.1 mg/kg IV.

Peds: 2 mg/kg IV. `Plasma ♀C ? $

VECURONIUM ( Norcuron) 0.08 to 0.1 mg/kg IV. Duration 15 to 30 min. `LK

♀C ? $

Antimicrobials

13

ANTIMICROBIALS

Aminoglycosides

NOTE See also dermatology and ophthalmology

AMIKACIN ( Amikin) 15 mg/kg (up to 1500 mg/day) IM/IV divided q 8 to 12 h. Peak 20 to 35 mcg/mL, trough <5 mcg/mL. Alternative 15 mg/kg IV
q 24 h. `K ♀D ? $$$

GENTAMICIN ( Garamycin)

n

Adults: 3 to 5 mg/kg/day IM/IV divided q 8 h.

Peak 5 to 10 mcg/mL, trough <2 mcg/mL. Alternative 5 to 7 mg/kg IV q 24 h.

Peds: 2 to 2.5 mg/kg q 8 h. `K ♀D + $

STREPTOMYCIN

Combo therapy for TB:

py

15 mg/kg (up to 1 g) IM daily.

10 mg/kg (up to 750 mg) for age 60 yo or older. Peds: 20 to 40 mg/kg (up to 1 g) IM daily. Nephrotoxicity, ototoxicity. `K ♀D + $$$$$

TOBRAMYCIN ( Nebcin, TOBI)

I

Adults: 3 to 5 mg/kg/day IM/IV divided q 8 h.

Peak 5 to 10 mcg/mL, trough <2 mcg/mL. Alternative 5 to 7 mg/kg IV q 24 h.

Peds: 2 to 2.5 mg/kg q 8 h. Cystic fi
y
brosis (TOBI):

(

) 300 mg neb bid 28 days
on, then 28 days off. [Trade only: TOBI 300 mg ampules for nebulizer.] `K

♀D ? $$

Antifungal Agents—Azoles

CLOTRIMAZOLE ( Mycelex,  Canesten, Clotrimaderm m) Oral troches 5 times
per day for 14 days. [Generic/Trade: Oral troches 10 mg.] `L ♀C ? $$$$

FLUCONAZOLE ( Difl ucan)

n

Vaginal candidiasis
g

: 150 mg PO single dose ($). All
other dosing regimens IV/PO. Oropharyngeal candidiasis p
y g

: 100 to 200 mg daily
for 7 to 14 days. Esophageal candidiasis
p g

: 200 to 400 mg daily for 14 to 21 days.

Candidemia: 800 mg on fi rst day, then 400 mg daily. Cryptococcal meningitis yp
g
in AIDS: 400 mg daily. Peds: Oropharyngeal candidiasis p
y g

: 6 mg/kg on fi rst
day, then 3 mg/kg daily for 7 to 14 days. Esophageal candidiasis p g

: 12 mg/kg
on fi rst day, then 6 mg/kg daily for 14 to 21 days. Systemic candidiasis; y

;
cryptococcal meningitis in AIDS
yp
g

: 12 mg/kg on fi rst day, then 6 to 12 mg/kg
daily. [Generic/Trade: Tabs 50, 100, 150, 200 mg. 150 mg tab in single-dose blister pack. Susp 10, 40 mg/mL (35 mL).] `K ♀C + $$$$

ITRACONAZOLE ( Sporanox)

x

Oral caps for onychomycosis “pulse dosing”

p
y
y
p
g : 200 mg

PO bid for fi rst week of month for 2 months (fi ngernails) or 3 to 4 months (toenails).

Fluconazole-refractory oropharyngeal or esophageal candidiasis y
p
y g
p g

: Oral soln

200 mg PO daily for 14 to 21 days. Contraindicated with dofetilide, ergot alkaloids, lovastatin, PO midazolam, pimozide, quinidine, simvastatin, triazolam. Negative inotrope; do not use for onychomycosis if ventricular dysfunction. [Generic/Trade: Caps 100 mg. Trade only: Oral soln 10 mg/mL (150 mL).] `L ♀C – $$$$$

KETOCONAZOLE ( Nizoral ) 200 to 400 mg PO daily. Hepatotoxicity. Contraindicated with midazolam, pimozide, triazolam. H2 blockers, proton pump inhibitors, antacids impair absorption. [Generic/Trade: Tabs 200 mg.] `L ♀C

?+ $$$

POSACONAZOLE ( Noxafi l )

Prevention of invasive Aspergillus or Candida
p g
infection,, age 13 yo or older: 200 mg (5 mL) PO tid. Oropharyngeal candidiasis, p
y g

,

(cont.)

14 Antimicrobials
age 13 yo or older: 100 mg (2.5 mL) PO bid on day 1, then 100 mg PO once daily for 13 days. Oropharyngeal candidiasis resistant to itraconazole/
p
y g
fl uconazole,, age 13 yo or older: 400 mg (10 mL) PO bid. Take with full meal or liquid nutritional supplement. CYP3A4 inhibitor. [Trade only: Oral susp 40 mg/
mL, 105 mL bottle.] `Glucuronidation ♀C – $$$$$

VORICONAZOLE ( Vfend)

d

Aspergillosis, systemic Candida infections:

p g

,
y

6 mg/kg IV q 12 h for 2 doses, then 3 to 4 mg/kg IV q 12 h (use 4 mg/
kg for aspergillosis). Esophageal candidiasis, or maintenance therapy of p g

,
py
aspergillosis/candidiasis:

p g

200 mg PO bid. For wt less than 40 kg, reduce to

100 mg PO bid. Dosage adjustment for efavirenz: Voriconazole 400 mg PO bid with efavirenz 300 mg PO once daily (use caps). Peds, less than 12 yo: 7 mg/
kg IV q 12 h and infuse IV over 2 h. Take tabs and/or susp 1 h before or after meals. CYP3A4 inhibitor. Many drug interactions. [Trade only: Tabs 50, 200 mg (contains lactose), susp 40 mg/mL (75 mL).] `L ♀D ? $$$$$

Antifungal Agents—Echinocandins

ANIDULAFUNGIN ( Eraxiss)

Candidemia: 200 mg IV load on day 1, then 100
mg IV once daily. Esophageal candidiasis:

p g

100 mg IV load on day 1, then

50 mg IV once daily. Max infusion rate of 1.1 mg/min to prevent histamine reactions. `Degraded chemically ♀C ? $$$$$

CASPOFUNGIN ( Cancidas)

s

Infuse over 1 h, give 70 mg IV loading dose on
day 1, then 50 mg once daily. Peds: 70 mg/m2 loading dose on day 1, then 50
mg/m2 once daily (max of 70 mg/day). `KL ♀C ? $$$$$

MICAFUNGIN ( Mycamine) Infuse IV over 1 h. Esophageal candidiasis: p g

150
mg once daily. Prevention of candidal infections in bone marrow transplant p
patients:

p

50 mg once daily. Candidemia, acute disseminated candidiasis,

,

,

Candida peritonitis/abscess:

p

100 mg once daily. `L, feces ♀C ? $$$$$

Antifungal Agents—Polyenes

AMPHOTERICIN B DEOXYCHOLATE ( Fungizone) Test dose 0.1 mg/kg up to 1 mg slow IV. Wait 2 to 4 h, and if tolerated then begin 0.25 mg/kg IV daily and advance to 0.5 to 1.5 mg/kg/day depending on fungal type. Maximum dose 1.5
mg/kg/day. `Tissues ♀B ? $$$$

AMPHOTERICIN B LIPID FORMULATIONS ( Amphotec, Abelcet, AmBisome) Abelcet: 5 mg/kg/day IV at 2.5 mg/kg/h. AmBisome: 3 to 5 mg/kg/day IV over 2 h. Amphotec: Test dose of 10 mL over 15 to 30 min, observe for 30 min, then 3 to 4 mg/kg/day IV at 1 mg/kg/h. `? ♀B ? $$$$$

Antifungal Agents—Other

FLUCYTOSINE ( Ancobon) 50 to 150 mg/kg/day PO divided qid. Myelosuppression. [Trade only: Caps 250, 500 mg.] `K ♀C – $$$$$

GRISEOFULVIN ( Grifulvin V,  Fulvicin) n

Tinea capitis:

p

500 mg PO daily in
adults; 15 to 20 mg/kg (up to 1 g) PO daily in peds. Treat for 4 to 6 weeks, continuing for 2 weeks past symptom resolution. [Generic/Trade: Susp 125
mg/5 mL (120 mL). Trade only: Tabs 250, 500 mg.] `Skin ♀C ? $$$$

Antimicrobials

15

NYSTATIN ( Mycostatin,  Nilstat, Nyaderm, Candistatin) n

Thrush: 4 to 6 mL PO
swish & swallow qid. Infants: 2 mL/dose with 1 mL in each cheek qid. [Generic only: Susp 100,000 units/mL (60, 480 mL).] `Not absorbed ♀B ? $$

TERBINAFINE ( Lamisil ) Onychomycosis:

y
y

250 mg PO daily for 6 weeks to treat
fi ngernails, for 12 weeks to treat toenails. Tinea capitis, p

, age 4 yo or older: Give
granules once daily with food for 6 weeks: 125 mg for wt less than 25 kg, 187.5
mg for wt 25 to 35 kg, 250 mg for wt more than 35 kg. [Generic/Trade: Tabs 250
mg. Trade only: Oral granules 125, 187.5 mg/packet.] `LK ♀B – $

Antimalarials

NOTE For help treating malaria or getting antimalarials, see www.cdc.gov/
malaria or call the CDC “malaria hotline” (770) 488–7788 Monday–Friday 8 am to 4:30 pm EST; after hours or weekend (770) 488–7100. Pediatric doses of antimalarials should never exceed adult doses.

CHLOROQUINE ( Aralen)

n

Malaria prophylaxis, chloroquine-sensitive areas:

p p y

,
q

8
mg/kg up to 500 mg PO q week starting 1 to 2 weeks before exposure to 4 weeks after exposure. Chloroquine resistance is widespread. Can prolong QT interval and cause torsades. [Generic only: Tabs 250 mg. Generic/Trade: Tabs 500 mg (500 mg phosphate equivalent to 300 mg base).] `KL ♀C but + + $

COARTEM (artemether + lumefantrine) ( coartemether) r

Uncomplicated
p
malaria: Take with food bid for 3 days. On day 1, give 2nd dose 8 h after fi rst dose. Dose based on wt: 1 tab for 5 to 14 kg; 2 tabs for 15 to 24 kg; 3 tabs for 25 to 34 kg; 4 tabs for 35 kg or greater. Repeat dose if vomiting occurs within 1 to 2 h. Can prolong QT interval. [Trade only: Tabs, artemether 20 mg

+ lumefantrine 120 mg.] `L ♀C ? $$$

MALARONE (atovaquone + proguanil ) Prevention of malaria: Give indicated
dose PO once daily from 1 to 2 days before exposure until 7 days after. Dose based on wt: ½ ped tab for wt 5 to 8 kg; ¾ ped tab for wt 9 to 10 kg; 1 ped tab for wt 11 to 20 kg; 2 ped tabs for 21 to 30 kg, 3 ped tabs for 31 to 40 kg, 1
adult tab for all patients wt greater than 40 kg. Treatment of malaria: Give the following dose PO once daily for 3 days. Dose based on wt: 2 ped tabs for 5 to 8 kg; 3 ped tabs for 9 to 10 kg; 1 adult tab for 11 to 20 kg; 2 adult tabs for 21
to 30 kg; 3 adult tabs for 31 to 40 kg, 4 adult tabs for all patients wt greater than 40 kg. Take with food or milky drink. [Trade only: Adult tabs atovaquone 250 mg + proguanil 100 mg; pediatric tabs 62.5 mg + 25 mg.] `Fecal excretion; LK ♀C ? $$$$$

MEFLOQUINE ( Lariam)

m

Malaria prophylaxis for chloroquine-resistant areas: p p y
q

250 mg PO once a week from 1 week before exposure to 4 weeks after. Treatment: 1250 mg PO single dose. Peds. Malaria prophylaxis:

p p y

Give the following dose PO
once a week starting 1 week before exposure to 4 weeks after: Dose based on wt: give 5 mg/kg (prepared by pharmacist) once a week for wt 9 kg or less; give ¼ tab once a week for wt greater than 9 kg to 19 kg; give ½ tab once a week for wt greater than 19 kg to 30 kg; give ¾ tab once a week for wt greater than 30 to 45 kg; give 1 tab once a week for wt 45 kg or greater. Treatment: 20 to 25
mg/kg PO single dose or divided into 2 doses given 6 to 8 h apart. Take on full stomach. [Generic/Trade: Tabs 250 mg.] `L ♀C ? $$

16 Antimicrobials

PRIMAQUINE Prevention of relapse, P vivax/ovale malaria: p ,

0.5 mg/kg (up
to 30 mg) base PO daily for 14 days. Do not use unless normal G6PD level.

[Generic only: Tabs 26.3 mg (equiv to 15 mg base).] `L ♀– – $$

QUININE ( Qualaquin)

n

Malaria: 648 mg PO tid. Peds: 25 to 30 mg/kg/day

(up to 2 g/day) PO divided q 8 h. Treat for 3 days (Africa/South America) or 7 days (Southeast Asia). Also give 7 day course of doxycycline, tetracycline, or clindamycin. Nocturnal leg cramps:

g
p 260 to 325 mg PO qhs. FDA believes
risks outweigh benefi ts for this indication. Can cause life-threatening adverse effects: Cinchonism with overdose; hemolysis with G6PD defi ciency; hypersensitivity; thrombocytopenia; QT interval prolongation; many drug interactions. [Trade only: Caps 324 mg. `L ♀C +? $$$$

Antimycobacterial Agents

NOTE Two or more drugs are required for the treatment of active mycobacterial infections. See guidelines at http://www.thoracic.org/sections/publications/
statements/.

DAPSONE ( Aczone)

Pneumocystis prophylaxis, leprosy:

y
p p y

,
p
y 100 mg PO daily.

Pneumocystis treatment:

y

100 mg PO daily with trimethoprim 5 mg/kg PO tid
for 21 days. Acne (Aczone): Apply bid. [Generic only: Tabs 25, 100 mg. Trade only (Aczone): Topical gel 5% 30, 60 g.] `LK ♀C – $

ETHAMBUTOL ( Myambutol,  Etibi)

i

15 to 20 mg/kg PO daily. Dose with whole
tabs: Give 800 mg PO daily for wt 40 to 55 kg, 1200 mg for wt 56 to 75 kg, 1600 mg for wt 76 to 90 kg. Base dose on estimated lean body wt. Peds: 15
to 20 mg/kg (up to 1 g) PO daily. [Generic/Trade: Tabs 100, 400 mg.] `LK

♀C but + + $$$$

ISONIAZID ( INH,  Isotamine) Adults: 5 mg/kg (up to 300 mg) PO daily.

Peds: 10 to 15 mg/kg (up to 300 mg) PO daily. Hepatotoxicity. Consider supplemental pyridoxine up to 50 mg per day to prevent neuropathy. [Generic only: Tabs 100, 300 mg, syrup 50 mg/5 mL.] `LK ♀C but + + $

PYRAZINAMIDE ( PZA,  Tebrazid)

d

20 to 25 mg/kg (up to 2000 mg) PO daily.

Dose with whole tabs: Give 1000 mg PO daily for wt 40 to 55 kg, 1500 mg for wt 56 to 75 kg, 2000 mg for wt 76 to 90 kg. Base dose on estimated lean body wt. Peds: 15 to 30 mg/kg (up to 2000 mg) PO daily. Hepatotoxicity. [Generic only: Tabs 500 mg.] `LK ♀C ? $$$$

RIFABUTIN ( Mycobutin) 300 mg PO daily or 150 mg PO bid. Dosage reduction required with protease inhibitors. [Trade only: Caps 150 mg.] `L

♀B ? $$$$$

RIFAMATE (isoniazid + rifampin) 2 caps PO daily on empty stomach.

[Generic/Trade: Caps isoniazid 150 mg + rifampin 300 mg.] `LK ♀C but

+ + $$$$

RIFAMPIN ( Rimactane, Rifadin,  Rofact ) TB: 10 mg/kg (up to 600 mg) PO/IV daily. Peds: 10 to 20 mg/kg (up to 600 mg) PO/IV daily. Neisseria meningitidis carriers:

g

600 mg PO bid for 2 days. Peds: Age 1 mo or older: 10
mg/kg (up to 600 mg) PO bid for 2 days. Age younger than 1 mo: 5 mg/kg PO
bid for 2 days. IV & PO doses are the same. Take oral doses on empty stomach.

(cont.)

Antimicrobials

17

[Generic/Trade: Caps 150, 300 mg. Pharmacists can make oral susp.] `L

♀C but + + $$$

RIFAPENTINE ( Priftin)

n

600 mg PO twice a week for 2 months, then once a
week for 4 months. Use for continuation therapy only in selected HIV-negative patients. [Trade only: Tabs 150 mg.] Èsterases, fecal ♀C ? $$$$

RIFATER (isoniazid + rifampin + pyrazinamide) 4 tabs daily for wt less than 45 kg, 5 tabs daily for wt 45 to 54 kg, 6 tabs daily for wt 55 kg or greater.

[Trade only: Tabs Isoniazid 50 mg + rifampin 120 mg + pyrazinamide 300
mg.] `LK ♀C ? $$$$$

Antiparasitics

ALBENDAZOLE ( Albenza) Hydatid disease, neurocysticercosis: y

,
y

15 mg/kg/day

(up to 800 mg/day) for wt less than 60 kg, 400 mg PO bid for wt 60 kg or greater. [Trade only: Tabs 200 mg.] `L ♀C ? $$$

ATOVAQUONE ( Mepron)

n

Pneumocystis treatment:

y

750 mg PO bid for 21 days.

Pneumocystis prevention:

y
p

1500 mg PO daily. Take with meals. [Trade only:

Susp 750 mg/5 mL (210 mL), foil pouch 750 mg/5 mL (5, 10 mL).] `Fecal

♀C ? $$$$$

IVERMECTIN ( Stromectol ) Single PO dose of 200 mcg/kg for strongyloidiasis, gy

,

200 mcg/kg for scabies (dose may need to be repeated in 10 to 14 days), 150 mcg/kg for onchocerciasis. (Not for children less than 15 kg.) Take on empty stomach with water. [Trade only: Tabs 3 mg.] `L ♀C + $$

MEBENDAZOLE ( Vermox)

Pinworm: 100 mg PO once; repeat in 2 weeks.

Roundworm, whipworm, hookworm:

,
p

,

100 mg PO bid for 3 days. [Generic only:

Chewable tabs 100 mg.] `L ♀C ? $$

NITAZOXANIDE ( Alinia) Cryptosporidial or Giardial diarrhea: yp
p

100 mg bid for
age 1 to 3 yo, 200 mg bid for 4 to 11 yo, 500 mg bid for adults and children 12 yo or older. Give PO with food for 3 days. Use susp if less than 12 yo. [Trade only: Oral susp 100 mg/5 mL 60 mL bottle, Tab 500 mg.] `L ♀B ? $$$$

PAROMOMYCIN 25 to 35 mg/kg/day PO divided tid with or after meals. [Generic only: Caps 250 mg.] `Not absorbed ♀C – $$$$

PENTAMIDINE ( Pentam, NebuPent ) Pneumocystis treatment: y

4 mg/kg IM/

IV daily for 21 days. Pneumocystis prevention:

y
p

300 mg nebulized q 4 weeks.

[Trade only: Aerosol 300 mg.] `K ♀C – $$$

PRAZIQUANTEL ( Biltricide)

Schistosomiasis: 20 mg/kg PO q 4 to 6 h for 3
doses. Neurocysticercosis:

y

50 mg/kg/day PO divided tid for 15 days (up to 100
mg/kg/day for peds). [Trade only: Tabs 600 mg.] `LK ♀B – $$$

PYRANTEL ( Antiminth, Pin-X, Pinworm,  Combantrin) n

Pinworm, roundworm:

,

11
mg/kg (up to 1 g) PO single dose. Repeat in 2 weeks for pinworm. [OTC Trade only (Pin-X): Susp 144 mg/mL (equivalent to 50 mg/mL of pyrantel base) 30, 60 mL.

Tabs 720.5 mg (equivalent to 250 mg of pyrantel base). OTC Generic only: Caps 180 mg (equivalent to 62.5 mg of pyrantel base).] `Not absorbed ♀– ? $

PYRIMETHAMINE ( Daraprim)

m

CNS toxoplasmosis in AIDS.

p

Acute therapy: First
dose 200 mg PO, then 50 mg PO daily for wt less than 60 kg, use 75 mg PO
once daily for 60 kg or greater. Treat for atleast 6 weeks with pyrimethamine +

(cont.)

18 Antimicrobials
sulfadiazine + leucovorin 10 to 25 mg PO once daily (can increase leucovorin to 50 mg/day or more). Secondary prevention: Pyrimethamine 25 to 50 mg PO
once daily + sulfadiazine + leucovorin 10 to 25 mg PO once daily. [Trade only: Tabs 25 mg.] `L ♀C + $$

THIABENDAZOLE ( Mintezol ) Helminths: 22 mg/kg/dose (up to 1500 mg) PO bid after meals. Treat for 2 days for strongyloidiasis, cutaneous larva migrans. [Trade only: Chewable tabs 500 mg, Susp 500 mg/5 mL (120 mL).] `LK ♀C ? $

TINIDAZOLE ( Tindamax)

x

Adults: 2 g PO daily for 1 day for trichomoniasis or giardiasis,
g

, for 3 days for amebiasis. Bacterial vaginosis:

g

2 g PO once daily
for 2 days or 1 g PO once daily for 5 days. Peds, age older than 3 yo: 50 mg/
kg (up to 2 g) PO daily for 1 day for giardiasis,
g

, for 3 days for amebiasis. Take
with food. [Trade only: Tabs 250, 500 mg. Pharmacists can compound oral susp.] `KL ♀C ?– $

Antiviral Agents—Anti-CMV

CIDOFOVIR ( Vistide)

CMV retinitis in AIDS: 5 mg/kg IV once a week for 2
weeks, then 5 mg/kg every 2 weeks. Severe nephrotoxicity. `K ♀C – $$$$$

FOSCARNET ( Foscavir)

r

CMV retinitis: 60 mg/kg IV (over 1 h) q 8 h or 90
mg/kg IV (over 1.5 to 2 h) q 12 h for 2 to 3 weeks, then 90 to 120 mg/kg/day IV over 2 h. HSV infection: 40 mg/kg (over 1 h) q 8 to 12 h. Nephrotoxicity, seizures. `K ♀C ? $$$$$

GANCICLOVIR ( Cytovene)

CMV retinitis: Induction 5 mg/kg IV q 12 h for 14 to 21 days. Maintenance 6 mg/kg IV daily for 5 days per week. Myelosuppression.

Potential carcinogen, teratogen. May impair fertility. [Generic only: Caps 250, 500 mg.] `K ♀C – $$$$$

VALGANCICLOVIR ( Valcyte) CMV retinitis: 900 mg PO bid for 21 days, then 900 mg PO daily. Prevention of CMV disease in high-risk kidney g

, kidney-
y,
y
pancreas, heart transplant patients:

p

,
p
p

900 mg PO daily given within 10 days
post-transplant until 100 days post-transplant. Greater bioavailability than oral ganciclovir. Give with food. Impaired fertility, myelosuppression, potential carcinogen & teratogen. [Trade only: Tabs 450 mg.] `K ♀C – $$$$$

Antiviral Agents—Anti-Herpetic

ACYCLOVIR ( Zovirax) Genital herpes:

p

400 mg PO tid for 7 to 10 days for fi rst
episode, or for 5 days for recurrent episodes. Chronic suppression of genital pp
g

herpes:

p

400 mg PO bid, in HIV infection use 400 to 800 mg PO bid to tid. Zoster: 800 mg PO 5 times a day for 7 to 10 days. Chickenpox: p

20 mg/kg (up to 800 mg)

PO qid for 5 days. Adult IV: 5 to 10 mg/kg IV q 8 h, each dose over 1 h. Herpes p
encephalitis:

p

20 mg/kg IV q 8 h for 10 days for age 3 mo to 12 yo, 10 mg/kg IV
q 8 h for 10 days for age 12 yo or older. Neonatal herpes: p

20 mg/kg IV q 8 h for

21 days for disseminated/CNS disease, for 14 days for skin/mucous membrane infections. [Generic/Trade: Caps 200 mg, Tabs 400, 800 mg. Susp 200 mg/

5 mL.] `K ♀B + $

FAMCICLOVIR ( Famvir)

First episode genital herpes:

p
g
p

250 mg PO tid for 7 to

10 days. Recurrent genital herpes:

g
p

1000 mg PO bid for 2 doses; give 500 mg

(cont.)

Antimicrobials

19
bid for 7 days if HIV infected. Chronic suppression of genital herpes: pp
g
p

250 mg

PO bid; 500 mg PO bid if HIV-infected. Recurrent herpes labialis: p

1500 mg PO
single dose; 500 mg bid for 7 days if HIV-infected. Zoster: 500 mg PO tid for 7
days. [Generic/Trade: Tabs 125, 250, 500 mg.] `K ♀B ? $$

VALACYCLOVIR ( Valtrex) First episode genital herpes: p
g
p

1 g PO bid for 10
days. Recurrent genital herpes:

g
p

500 mg PO bid for 3 days; if HIV infected give

1 g PO bid for 5 to 10 days. Chronic suppression of genital herpes: pp
g
p

500 to 1000
mg PO daily; if HIV infected give 500 mg PO bid. Reduction of genital herpes g
p
transmission in immunocompetent patients with no more than 9 recurrences p
p
per year:

p
y

500 mg PO daily for source partner, in conjunction with safer sex practices. Herpes labialis,
p

, age 12 yo or older: 2 g PO q 12 h for 2 doses. Zoster: 1000 mg PO tid for 7 days. Chicken pox,
p , age 2 to 18 yo: 20 mg/kg (max of 1
g) PO tid for 5 days. [Generic/Trade: Tabs 500, 1000 mg.] `K ♀B + $$$$$

NOTE FOR ALL ANTI-HIV DRUGS Many serious drug interactions; always check before prescribing. AIDS treatment guidelines available online at www.aidsinfo.

nih.gov.

Antiviral Agents—Anti-HIV—CCR5 Antagonists

MARAVIROC ( Selzentry, MVC

C) 150 mg PO bid with strong CYP3A4
inhibitors (delavirdine, most protease inhibitors, ketoconazole, itraconazole, clarithromycin); 300 mg PO bid with drugs that are not strong CYP3A4
inducers/inhibitors (NRTIs, tipranavir-ritonavir, nevirapine, enfuvirtide); 600 mg PO bid with strong CYP3A4 inducers (efavirenz, rifampin, carbamazepine, phenobarbital, phenytoin). Tropism test before treatment; not for dual/mixed or CXCR4-tropic HIV infection. Hepatotoxicity with allergic features. [Trade only: Tabs 150, 300 mg.] `LK ♀B – $$$$$

Antiviral Agents—Anti-HIV—Combinations

ATRIPLA (efavirenz + emtricitabine + tenofovir) 1 tab PO once daily on empty stomach, preferably at bedtime. [Trade only: Tabs efavirenz 600 mg +
emtricitabine 200 mg + tenofovir 300 mg.] `KL ♀D – $$$$$

COMBIVIR (lamivudine + zidovudine)

Combination therapy of HIV
py

, wt 30 kg
or greater: 1 tab PO bid. [Trade only: Tabs lamivudine 150 mg + zidovudine 300 mg.] `LK ♀C – $$$$$

EPZICOM (abacavir + lamivudine) 1 tab PO daily. [Trade only: Tabs abacavir 600 mg + lamivudine 300 mg.] `LK ♀C – $$$$$

TRIZIVIR (abacavir + lamivudine + zidovudine) 1 tab PO bid. [Trade only: Tabs abacavir 300 mg + lamivudine 150 mg + zidovudine 300 mg.] `LK

♀C – $$$$$

TRUVADA (emtricitabine + tenofovir) 1 tab PO daily. [Trade only: Tabs emtricitabine 200 mg + tenofovir 300 mg.] `K ♀B – $$$$$

Antiviral Agents—Anti-HIV—Fusion Inhibitors

ENFUVIRTIDE ( Fuzeon, T-20)

0

90 mg SC bid. Peds, age 6 yo or older: 2 mg/kg (up
to 90 mg) SC bid. [30 days kit with vials, diluent, syringes, alcohol wipes. Single-dose vials contain 108 mg to provide 90 mg enfuvirtide.] `Serum ♀B – $$$$$

20 Antimicrobials

Antiviral Agents—Anti-HIV—Integrase Strand Transfer Inhibitor RALTEGRAVIR ( Isentress, RAL) 400 mg PO bid. [Trade only: Tabs 400
mg.] `Glucuronidation ♀C – $$$$$

Antiviral Agents—Anti-HIV—Non-Nucleoside Reverse Transcriptase Inhibitors

EFAVIRENZ ( Sustiva, EFV)

V

Adults & children wt 40 kg or greater: 600 mg PO
qhs. With voriconazole: Use voriconazole 400 mg PO bid & efavirenz 300 mg PO once daily. Peds, age 3 yo or older: Give PO qhs 200 mg for wt 10 kg to less than 15 kg; 250 mg for wt 15 kg to less than 20 kg; 300 mg for wt 20 kg to less than 25 kg; 350 mg for wt 25 kg to less than 32.5 kg; 400 mg for wt 32.5
kg to less than 40 kg. Do not give with high-fat meal. [Trade only: Caps 50, 100, 200 mg, Tabs 600 mg.] `L ♀D – $$$$$

ETRAVIRINE ( Intelence, ETR)

R

Combination therapy for treatment-resistant
py

HIV infection: 200 mg PO bid after meals. [Trade only: Tabs 100 mg.] `L ♀B

– $$$$$

NEVIRAPINE ( Viramune, NVP

P) 200 mg PO daily for 14 days initially. If tolerated, increase to 200 mg PO bid. Peds, age 15 days or older: 150 mg/m2

PO once daily for 14 days, then 150 mg/m2 bid (max dose 200 mg bid). Severe skin reactions and hepatotoxicity. [Trade only: Tabs 200 mg, susp 50 mg/5 mL

(240 mL).] `LK ♀C – $$$$$

Antiviral Agents—Anti-HIV—Nucleoside / Nucleotide Reverse Transcriptase Inhibitors

ABACAVIR ( Ziagen, ABC)

C

Adult: 300 mg PO bid or 600 mg PO daily. Peds. Oral soln, age 3 mo or older: 8 mg/kg PO bid (up to 300 mg) PO bid. Peds, tabs: 150
mg PO bid for wt 14 to 21 kg, 150 mg PO q am and 300 mg PO q pm for wt 22 to 29 kg, 300 mg PO bid for wt 30 kg or greater. Potentially fatal hypersensitivity.

HLA-B*5701 predisposes to hypersensitivity; screen before starting and avoid if positive test. Never rechallenge with abacavir after suspected reaction. [Trade only: Tabs 300 mg (scored), oral soln 20 mg/mL (240 mL).] `L ♀C – $$$$$

DIDANOSINE ( Videx, Videx EC, ddI)

I

Videx EC. Give 200 mg PO once daily for
wt 20 to 24 kg, 250 mg PO once daily for wt 25 to 59 kg, 400 mg PO once daily for wt 60 kg or greater. Dosage reduction of Videx EC with tenofovir in adults: 200 mg for wt less than 60 kg, 250 mg for wt 60 kg or greater. Dosage reduction unclear with tenofovir if CrCl <60 mL/min. Buffered powder, peds: 100 mg/
m2 PO bid for age 2 weeks to 8 mo. 120 mg/m2 PO bid for age older than 8
mo. All formulations usually taken on empty stomach. [Generic/Trade: Pediatric powder for oral soln 10 mg/mL (buffered with antacid), delayed-release caps (Videx EC) 125, 200, 250, 400 mg.] `LK ♀B – $$$$$

EMTRICITABINE ( Emtriva, FTC)

C

200 mg cap or 240 mg oral soln PO once
daily. Peds, oral soln: 3 mg/kg PO once daily for age 3 mo or younger, 6 mg/kg PO once daily (up to 240 mg) for age older than 3 mo. Can give 200 mg cap PO once daily if wt greater than 33 kg. [Trade only: Caps 200 mg, oral soln 10
mg/mL (170 mL).] `K ♀B – $$$$$

Antimicrobials

21

LAMIVUDINE ( Epivir, Epivir-HBV, 3TC,  Heptovir) Epivir r
for

HIV infection.

Adults and greater than 16 yo: 150 mg PO bid or 300 mg PO daily. Peds: 4
mg/kg (up to 150 mg) PO bid. Can use tabs if wt 14 kg or greater. Epivir p

-HBV
for hepatitis B:

p

Adults: 100 mg PO daily. Peds: 3 mg/kg (up to 100 mg) PO
daily. [Trade only: Epivir, 3TC: Tabs 150 (scored), 300 mg, oral soln 10 mg/mL.

Epivir-HBV, Heptovir: Tabs 100 mg, oral soln 5 mg/mL.] `K ♀C – $$$$$

STAVUDINE ( Zerit, d4T ) Adults and peds, at least 30 kg: 40 mg PO q 12 h if at least 60 kg; 30 mg q 12 h if less than 60 kg. Peds, less than 30 kg: 1 mg/
kg PO bid. [Generic/Trade: Caps 15, 20, 30, 40 mg, Oral soln 1 mg/mL (200
mL).] `K ♀C – $$$$$

TENOFOVIR ( Viread, TDF) 300 mg PO daily. [Trade only: Tabs 300 mg.] `K

♀B – $$$$$

ZIDOVUDINE ( Retrovir, AZT, ZDV)

V

600 mg per day divided bid or tid for wt 30
kg or greater. Dosing method using wt: give 24 mg/kg/day divided bid or tid for wt 4 to 8 kg, 18 mg/kg/day divided bid or tid for wt 9 to 29 kg. [Generic/Trade: Caps 100 mg, Tabs 300 mg, Syrup 50 mg/5 mL (240 mL).] `LK ♀C – $$$$$

Antiviral Agents—Anti-HIV—Protease Inhibitors

ATAZANAVIR ( Reyataz, ATV)

V

Adults, therapy-naive:

,
py

400 mg PO once daily

(with out ritonavir) OR 300 mg + ritonavir 100 mg PO both once daily. With tenofovir, therapy-naive:

,
py

300 mg + ritonavir 100 mg PO both once daily.

With efavirenz, therapy-naive:

,
py

400 mg + ritonavir 100 mg PO both once daily.

Therapy-experienced:

py
p

300 mg + ritonavir 100 mg PO both once daily. Peds,, therapy-naive, age 6 yo or older:

py

, g
y

Give following dose PO once daily based on
wt: atazanavir 8.5 mg/kg for wt 15 to 19 kg; 7 mg/kg (up to 300 mg) for wt 20 kg or greater. Give with ritonavir 4 mg/kg (up to 100 mg) PO once daily.

Peds, therapy-experienced, age 6 yo or older and wt 25 kg or greater:

,
py
p

, g
y
g
g
atazanavir

7 mg/kg (up to 300 mg) with ritonavir 4 mg/kg (up to 100 mg) PO once daily.

Therapy-naive, ritonavir
py

,

-intolerant, age 13 yo or older and wt 39 kg or greater:

, g
y
g
g

400 mg PO once daily. Give caps with food. Give atazanavir 2 h before or 1 h after buffered didanosine. [Trade only: Caps 100, 150, 200, 300 mg.] `L ♀B – $$$$$

DARUNAVIR ( Prezista, DRV)

V

Therapy-naive:

py

800 mg + ritonavir 100 mg PO
once daily. Therapy-experienced:

py
p

600 mg + ritonavir 100 mg PO bid. Peds, age

6 yo or older: 375 mg + ritonavir 50 mg PO bid for wt 20 to 29 kg: 450 mg +
ritonavir 60 mg PO bid for wt 30 kg to 39 kg: 600 mg + ritonavir 100 mg PO bid for wt 40 kg or greater. Take with food. Do not use without ritonavir. [Trade only: Tabs 75, 300, 400, 600 mg.] `L ♀B – $$$$$

FOSAMPRENAVIR ( Lexiva, FPV,  Telzir) r

Therapy-naive adults:

py

1400 mg PO
bid (without ritonavir) OR 1400 mg + ritonavir 100/200 mg PO both once daily OR 700 mg + ritonavir 100 mg PO both bid. Protease inhibitor-experienced p

adults: 700 mg + ritonavir 100 mg PO both bid. Peds, therapy-naive, 2 to 5 yo:

,
py

,
y

Susp 30 mg/kg PO bid. Therapy-naive, 6 yo or older: py

,
y

Susp 30 mg/kg PO bid OR
susp 18 mg/kg + ritonavir 3 mg/kg PO both bid. Therapy-experienced, 6 yo or py
p

,
y

older: Susp 18 mg/kg + ritonavir 3 mg/kg PO both bid. Do not exceed adult dose in children. For unboosted fosamprenavir, can use tabs for peds patients with wt 47 kg or greater. For ritonavir-boosted fosamprenavir, can use tabs for peds patients wt 39 kg or greater. Take tabs without regard to meals. Adults should

22 Antimicrobials
take susp without food; children should take with food. [Trade only: Tabs 700
mg, susp 50 mg/mL.] `L ♀C – $$$$$

INDINAVIR ( Crixivan, IDV)

V

800 mg PO q 8 h between meals with water (at
least 48 ounces/day to prevent kidney stones). [Trade only: Caps 100, 200, 333, 400 mg.] `LK ♀C – $$$$$

LOPINAVIR-RITONAVIR ( Kaletra, LPV/r)

r Adults: Therapy-naive:

py

400/100 mg

PO bid or 800/200 mg PO once daily (tabs or oral soln). Therapy-experienced: py
p

400/100 mg PO bid (tabs or oral soln). Coadministration of efavirenz, nevirapine, fosamprenavir, or nelfi navir: 500/125 mg tabs (two 200/50 mg + one 100/25
mg tab) or 533/133 mg oral soln (6.5 mL) PO bid. Infants: age 14 days to 6 mo: Lopinavir 16 mg/kg PO bid. Peds: age 6 mo to 12 yo: Lopinavir 12 mg/kg PO bid for wt less than 15 kg, use 10 mg/kg PO bid for wt 15 to 40 kg. Coadministration of efavirenz, nevirapine, fosamprenavir, or nelfi navir: Lopinavir 13 mg/kg PO
bid for wt less than 15 kg, 11 mg/kg PO bid for wt 15 to 45 kg. Do not exceed adult dose in children. No once daily dosing for therapy-experienced, pediatric, or pregnant patients, or with efavirenz, nevirapine, fosamprenavir, or nelfi navir.

Give tabs without regard to meals; give oral soln with food. [Trade only: Tabs 200/50 mg, 100/25 mg; oral soln 80/20 mg/mL (160 mL).] `L ♀C – $$$$$

NELFINAVIR ( Viracept, NFV)

V

750 mg PO tid or 1250 mg PO bid. Peds: 45 to

55 mg/kg PO bid (up to 2500 mg/day). Take with meals. [Trade only: Tabs 250, 625 mg, oral powder 50 mg/g (114 g).] `L ♀B – $$$$$

RITONAVIR ( Norvir, RTV)

V

Adult doses of 100 mg PO daily to 400 mg PO bid used to boost levels of other protease inhibitors. Full-dose regimen (600 mg PO bid) poorly tolerated. Peds, full-dose regimen: Start with 250 mg/m2 bid and increase q 2 to 3 days by 50 mg/m2 bid to achieve usual dose of 350 to 400 mg/m2 (up to 600 mg) PO bid for age older than 1 mo. If 400 mg/m2 twice daily not tolerated, consider other alternatives. See specifi c protease inhibitor entries (atazanavir, darunavir, fosamprenavir, tipranavir) for pediatric boosting doses of ritonavir.

[Trade only: Caps 100 mg, oral soln 80 mg/mL (240 mL).] `L ♀B – $$$$$

SAQUINAVIR ( Invirase, SQV)

V

Take with or after meals. Regimens must contain
ritonavir. Saquinavir 1000 mg + ritonavir 100 mg both PO bid within 2 h after meals. Saquinavir 1000 mg PO + Kaletra 400/100 mg PO both bid. [Trade only: Invirase (hard gel) Caps 200 mg, Tabs 500 mg.] `L ♀B ? $$$$$

TIPRANAVIR ( Aptivus, TPV) 500 mg boosted by ritonavir 200 mg PO bid with food. Peds: 14 mg/kg with 6 mg/kg ritonavir PO bid; do not exceed adult dose.

Hepatotoxicity. [Trade only: Caps 250 mg. Oral soln 100 mg/mL (95 mL in unit-of-use amber glass bottle).] `Feces ♀C – $$$$$

Antiviral Agents—Anti-Infl uenza

AMANTADINE ( Symmetrel,  Endantadine) Parkinsonism: 100 mg PO bid. Max 300 to 400 mg/day divided tid to qid. Prevention/treatment of infl uenza A: give 5 mg/kg/day up to 150 mg/day PO divided bid for age 1 to 9 yo and any child wt less than 40 kg. Give 100 mg PO bid for adults and children age 10 yo or older; reduce to 100 mg PO daily if age 65 yo or older. The CDC generally recommends against amantadine/rimantadine for treatment/prevention of infl uenza A in the United States due to high levels of resistance. However, amantadine/
rimantadine had a role in the management of oseltamivir-resistant H1N1

Antimicrobials

23
infl uenza in 2008–09 US season. [Generic only: Caps 100 mg. Generic/Trade: Tabs 100 mg, syrup 50 mg/5 mL (480 mL).] `K ♀C ? $$

OSELTAMIVIR ( Tamifl u)

u

Infl uenza A/B and 2009 H1N1: For treatment, give each dose bid for 5 days starting within 2 days of symptom onset. For prevention, give each dose once daily for 10 days starting within 2 days of exposure. For adults each dose is 75 mg. For peds, age 1 yo or older, each dose is 30 mg for wt 15 kg or less; 45 mg for wt 16 to 23 kg; 60 mg for wt 24 to 40 kg; and 75 mg for wt 40 kg or greater or age 13 yo or older. 2009 H1N1 infl uenza treatment in infants younger y
g
than 1 yo:

y Treat for 5 days with 12 mg PO bid for age less than 3 mo; 20 mg PO bid for age 3 to 5 mo; 25 mg bid for age 6 to 11 mo. 2009 H1N1 infuenza prophylaxis p p y

in infants younger than
y
g

1 yo:

y Treat for 10 days with 20 mg PO once daily for age 3
to 5 mo; 25 mg once daily for age 6 to 11 mo. Due to limited data, prophylaxis is not recommended for infants younger than 3 mo unless the situation is critical.

Take with food to improve tolerability. See table in Appendix for prevention and treatment of 2009 H1N1. [Trade only: Caps 30, 45, 75 mg, Susp 12 mg/mL (25
mL). Pharmacist compounded susp is 15 mg/mL.] `LK ♀C ? $$$

RIMANTADINE ( Flumadine) Prophylaxis/treatment of infl p y
uenza A: 100 mg PO
bid for adults and peds age 10 yo or older, reduce dose to 100 mg PO once daily for age 65 yo or older. Peds infl uenza A prophylaxis: p p y
give 5 mg/kg/day

(up to 150 mg/day) PO divided bid for age 1 to 9 yo or any child wt less than 40 kg. The CDC generally recommends against amantadine/rimantadine for treatment/prevention of infl uenza A in the United States due to high levels of resistance. However, amantadine/rimantadine had a role in the management of oseltamivir-resistant H1N1 infl uenza in 2008–09 US season. [Generic/Trade: Tabs 100 mg.] `LK ♀C – $$

OVERVIEW OF BACTERIAL PATHOGENS (Selected)

GRAM Positive Aerobic Cocci: Staph epidermidis (coagulase negative), Staph aureus (coagulase positive), Streptococci: S pneumoniae (pneumococcus), S pyogenes (Group A), S agalactiae (Group B), enterococcus

GRAM Positive Aerobic / Facultatively Anaerobic Bacilli: Bacillus, Corynebacterium diphtheriae, Erysipelothrix rhusiopathiae, Listeria monocytogenes, Nocardia GRAM Negative Aerobic Diplococci: Moraxella catarrhalis, Neisseria gonorrhoeae, Neisseria meningitidis

GRAM Negative Aerobic Coccobacilli: Haemophilus ducreyi, Haemoph. Infl uenzae GRAM Negative Aerobic Bacilli: Acinetobacter, Bartonellaa species, Bordetella pertussis, Brucella, Burkholderia cepacia, Campylobacter, Francisella tularensis, Helicobacter pylori, Legionella pneumophila, Pseudomonas aeruginosa, Stenotrophomonas malto-philia, Vibrio cholerae, Yersinia

GRAM Neg Facultatively Anaerobic Bacilli: Aeromonas hydrophila, Eikenella corrodens, Pasteurella multocida, Enterobacteriaceae: E coli, Citrobacter, Shigella, Salmonella, Klebsiella, Enterobacter, Hafnia, Serratia, Proteus, Providencia ANAEROBES: Actinomyces, Bacteroides fragilis, Clostridium botulinum, Clostridium diffi cile, Clostridium perfringens, Clostridium tetani, Fusobacterium, Lactobacillus, Peptostreptococcus

DEFECTIVE Cell Wall Bacteria: Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Coxiella burnetii, Mycoplasma pneumoniae, Rickettsia prowazekii, Rickettsia rickettsii, Rickettsia typhi, Ureaplasma urealyticum SPIROCHETES: Borrelia burgdorferi, Leptospira, Treponema pallidum MYCOBACTERIA: M avium complex, M kansasii, M leprae, M TB

24 Antimicrobials

ZANAMIVIR ( Relenza) Infl uenza A/B and 2009 H1N1 infl uenza treatment: 2 puffs bid for 5 days for all ages 7 yo or older. Infl uenza A/B and 2009 H1N1
infl uenza prevention:

p

2 puffs once daily for 10 days for all ages 5 yo or older starting within 2 days of exposure. Do not use if chronic airways disease. See table for prevention and treatment of 2009 H1N1 in Appendix. Alternative for oseltamivir-resistant infl uenza A (H1N1). [Trade only: Rotadisk inhaler 5 mg/
puff (20 puffs).] `K ♀C ? $$$

Antiviral Agents—Other

ADEFOVIR ( Hepsera) Chronic hepatitis B:

p

10 mg PO daily. Nephrotoxic; lactic
acidosis and hepatic steatosis; discontinuation may exacerbate hepatitis B; may result in HIV resistance in untreated HIV infection. [Trade only: Tabs 10
mg.] `K ♀C – $$$$$

ENTECAVIR ( Baraclude) Chronic hepatitis B: p

0.5 mg PO once daily if treatment-
naive; give 1 mg if lamivudine-resistant, history of viremia despite lamivudine treatment, or HIV coinfected. Give 2 h after last meal or 2 h before next meal.

[Trade only: Tabs 0.5, 1 mg, Soln 0.05 mg/mL (210 mL).] `K ♀C – $$$$$

INTERFERON ALFA-2B ( Intron A) Chronic hepatitis B: p

5 million units/day or

10 million units 3 times per week SC/IM for 16 weeks if HBeAg+, for 48 weeks if HBeAg–. Chronic hepatitis C:

p

3 million units SC/IM 3 times per week for 4
months. Continue for 18 to 24 months if ALT normalized. [Trade only: Powder/
soln for injection 10, 18, 50 million units/vial. Soln for injection 18, 25 million units/multidose vial. Multidose injection pens 3, 5, 10 million units/0.2 mL

(1.5 mL), 6 doses/pen.] `K ♀C ?+ $$$$$

INTERFERON ALFACON-1 ( Infergen)

n

Chronic hepatitis C:

p

9 mcg SC 3 times per
week for 24 weeks. If relapse/no response, increase to 15 mcg SC 3 times per week. If intolerable adverse effects, reduce to 7.5 mcg SC 3 times per week. [Trade only: Vials injectable soln 30 mcg/mL (0.3 mL, 0.5 mL).] `Plasma ♀C ? $$$$$

PALIVIZUMAB ( Synagis)

s Prevention of respiratory syncytial virus pulmonary p
y y y
p
y
disease in high-risk children:

g

15 mg/kg IM once monthly during RSV
season. `L ♀C ? $$$$$

PEGINTERFERON ALFA-2A ( Pegasys)

s

Chronic hepatitis C:

p

180 mcg SC
in abdomen or thigh once a week for 48 weeks with or without PO ribavirin.

Hepatitis B: 180 mcg SC in abdomen or thigh once a week for 48 weeks. May cause or worsen severe autoimmune, neuropsychiatric, ischemic, and infectious diseases. Frequent clinical & lab monitoring. [Trade only: 180 mcg/1 mL soln in single-use vial, 180 mcg/0.5 mL prefi lled syringe.] `LK ♀C – $$$$$

PEGINTERFERON ALFA-2B ( PEG-Intron)

n

Chronic hepatitis C:

p

Give SC once
a week on same day each week. Monotherapy 1 mcg/kg/week. In combo with oral ribavirin: 1.5 mcg/kg/week with ribavirin 800 to 1400 mg/day PO divided bid. Peds, age older than 3 yo: 60 mcg/m2 SC once a week with ribavirin 15 mg/kg/day PO divided bid. May cause or worsen severe autoimmune, neuropsychiatric, ischemic, and infectious diseases. Frequent clinical & lab monitoring. [Trade only: 50, 80, 120, 150 mcg/0.5 mL single-use vials with diluent, 2 syringes, and alcohol swabs. Disposable single-dose Redipen 50, 80, 120, 150 mcg.] `K? ♀C – $$$$$

Antimicrobials

25

RIBAVIRIN—INHALED ( Virazole) Severe respiratory syncytial virus infection p
y y y
in children: Aerosol 12 to 18 h/day for 3 to 7 days. Beware of sudden pulmonary deterioration; ventilator dysfunction due to drug precipitation. `Lung ♀X

– $$$$$

RIBAVIRIN—ORAL ( Rebetol, Copegus, Ribasphere) e

Hepatitis C.

p

Rebetol in
combo with interferon alfa 2b (Intron A): 400 mg q am and 600 q pm for wt 75 kg or less: 600 mg PO bid for wt greater than 75 kg. Rebetol in combo with peginterferon alfa 2b (PEG-Intron): give 400 mg PO bid for wt 65 kg or less, give 400 mg PO q am and 600 mg PO q pm for wt 66 to 85 kg; give 600 mg bid for wt 86 to 105 kg; give 600 mg PO q am and 800 mg PO q pm for wt greater than 105 kg. Peds: Rebetol in combo with peginterferon alfa 2b (PEG-Intron), age 3 yo and older: For wt less than 47 kg or patients who cannot swallow caps: 15 mg/kg/day of soln PO divided bid. Copegus in combo with peginterferon alfa 2a (Pegasys): For genotypes 1 and 4, give 500 mg PO bid for wt less than 75 kg; give 600 mg PO bid for wt 75 kg or greater. For genotypes 2 and 3, give 400 mg PO bid. Take copegus with food. Caps for peds: give 400 mg PO bid for wt 47 to 59 kg; give 400 mg PO q am and 600 mg q pm for 60 to 73 kg; give 600 mg PO
bid for wt greater than 73 kg. Decrease ribavirin dose if Hb decreases. [Generic/

Trade: Caps 200 mg, Tabs 200, 500 mg. Generic only: Tabs 400, 600 mg. Trade only (Rebetol): Oral soln 40 mg/mL (100 mL).] `Cellular, K ♀X – $$$$$

TELBIVUDINE ( Tyzeka)

a

Chronic hepatitis B:

p

600 mg PO once daily. [Trade only:

Tabs 600 mg, oral soln 100 mg/5 mL (300 mL).] `K ♀B – $$$$$

Carbapenems

DORIPENEM ( Doribax) 500 mg IV q 8 h. `K ♀B ? $$$$$

ERTAPENEM ( Invanz) 1 g IV/IM q 24 h. Prophylaxis, colorectal surgery: p y

,
g y 1 g IV

1 h before incision. Peds, less than 13 yo: 15 mg/kg IV/IM q 12 h (up to 1 g/
day). Infuse IV over 30 min. `K ♀B ? $$$$$

IMIPENEM-CILASTATIN ( Primaxinn) 250 to 1000 mg IV q 6 to 8 h. Peds for age older than 3 mo: 15 to 25 mg/kg IV q 6 h. Seizures (especially if given with ganciclovir, elderly with renal dysfunction, or cerebrovascular or seizure disorder). `K ♀C ? $$$$$

MEROPENEM ( Merrem IV)

V

Complicated skin infections:

p

10 mg/kg up to 500
mg IV q 8 h. Intra-abdominal infections: 20 mg/kg up to 1 g IV q 8 h. Peds meningitis:

g

40 mg/kg IV q 8 h for age 3 mo or older; 2 g IV q 8 h for wt greater than 50 kg. `K ♀B ? $$$$$

Cephalosporins—1st Generation

CEFADROXIL ( Duricef)

f

1 to 2 g/day PO once daily or divided bid. Peds: 30
mg/kg/day divided bid. [Generic/Trade: Tabs 1 g, Caps 500 mg, Susp 125, 250, 500 mg/5 mL.] `K ♀B + $$$

CEFAZOLIN ( Ancef)

f

0.5 to 1.5 g IM/IV q 6 to 8 h. Peds: 25 to 50 mg/kg/day di vided q 6 to 8 h (use up to 100 mg/kg/day for severe infections). `K ♀B + $$

CEPHALEXIN ( Kefl ex, Panixine DisperDose) 250 to 500 mg PO qid. Peds: 25 to 50 mg/kg/day. Not for otitis media, sinusitis. [Generic/Trade: Caps 250, (cont.)

26 Antimicrobials

500 mg. Generic only: Tabs 250, 500 mg, susp 125, 250 mg/5 mL. Panixine DisperDose 125, 250 mg scored tabs for oral susp. Trade only: Caps 333, 750 mg.] `K ♀B ? $$$

Cephalosporins—2nd Generation

CEFACLOR ( Ceclor, Raniclor)

r

250 to 500 mg PO tid. Peds: 20 to 40 mg/kg/day

PO divided tid. Otitis media: 40 mg/kg/day PO divided bid. Group A p
streptococcal pharyngitis:

p
p
y g

20 mg/kg/day PO divided bid. Serum sickness-like
reactions with repeated use. [Generic only: Caps 250, 500 mg, Susp, Chewable tabs 125, 187, 250, 375 mg per 5 mL or tab.] `K ♀B ? $$$$

CEFOXITIN ( Mefoxin)

n

1 to 2 g IM/IV q 6 to 8 h. Peds: 80 to 160 mg/kg/day IV
divided q 4 to 8 h. `K ♀B + $$$$$

CEFPROZIL ( Cefzil ) 250 to 500 mg PO bid. Peds otitis media: 15 mg/kg/dose PO bid. Peds group A streptococcal pharyngitis
g
p
p
p
y g

(2nd line to penicillin): 7.5
mg/kg/dose PO bid for 10 days. [Generic/Trade: Tabs 250, 500 mg, Susp 125, 250 mg/5 mL.] `K ♀B + $$$$

CEFUROXIME ( Zinacef, Ceftin)

n

IV: 750 to 1500 mg IM/IV q 8 h. Oral: 250
to 500 mg PO bid. Peds: 50 to 100 mg/kg/day IV divided q 6 to 8 h, not for meningitis. Peds: 20 to 30 mg/kg/day susp PO divided bid. [Generic/Trade: Tabs 125, 250, 500 mg, Susp 125, 250 mg/5 mL.] `K ♀B ? $$$

Cephalosporins—3rd Generation

CEFDINIR ( Omniceff) 14 mg/kg/day up to 600 mg/day PO once daily or divided bid. [Generic/Trade: Caps 300 mg. Susp 125, 250 mg/5 mL.] `K ♀B

? $$$$

CEFDITOREN ( Spectraceff) 200 to 400 mg PO bid with food. [Trade only: Tabs 200, 400 mg.] `K ♀B ? $$$$$

CEFIXIME ( Suprax)

x

400 mg PO once daily. Gonorrhea: 400 mg PO single-
dose. Peds: 8 mg/kg/day once daily or divided bid. [Trade only: Susp 100, 200
mg/5 mL, Tabs 400 mg.] `K/Bile ♀B ? $$

CEFOTAXIME ( Claforan)

n

Usual dose: 1 to 2 g IM/IV q 6 to 8 h. Peds: 50 to 180
mg/kg/day IM/IV divided q 4 to 6 h. AAP dose for pneumococcal meningitis: p
g

225 to 300 mg/kg/day IV divided q 6 to 8 h. `KL ♀B + $$$$$

CEPHALOSPORINS – GENERAL ANTIMICROBIAL SPECTRUM

1st gene
g
ration: gram positive (including Staph aureus); basic gram neg.

coverage

2nd generation
g

: diminished Staph aureus, improved gram negative coverage compared to 1st generation; some with anaerobic coverage 3rd generation
g

: further diminished Staph aureus, further improved gram negative coverage compared to 1st & 2nd generation; some with Pseudomonal coverage & diminished gram positive coverage 4th generation
g

: same as 3rd generation plus coverage against Pseudomonas

Antimicrobials

27

CEFPODOXIME ( Vantin)

n

100 to 400 mg PO bid. Peds: 10 mg/kg/day divided
bid. [Generic/Trade: Tabs 100, 200 mg. Susp 50, 100 mg/5 mL.] `K ♀B ?

$$$$

CEFTAZIDIME ( Ceptaz, Fortaz, Tazicef)

f

1 g IM/IV or 2 g IV q 8 to 12 h. Peds:

30 to 50 mg/kg IV q 8 h. `K ♀B + $$$$$

CEFTIBUTEN ( Cedax)

x

400 mg PO once daily. Peds: 9 mg/kg (up to 400 mg)

PO once daily. [Trade only: Caps 400 mg, susp 90 mg/5 mL.] `K ♀B ?

$$$$$

CEFTIZOXIME ( Cefi zox)

x

1 to 2 g IV q 8 to 12 h. Peds: 50 mg/kg/dose IV q 6
to 8 h. `K ♀B ? $$$$$

CEFTRIAXONE ( Rocephin) 1 to 2 g IM/IV q 24 h. Meningitis: g

2 g IV q 12 h.

Gonorrhea: Single dose 125 mg IM (250 mg if PID). Peds: 50 to 75 mg/kg/
day (up to 2 g/day) divided q 12 to 24 h. Meningitis: g

100 mg/kg/day (up to

4 g/day) IV divided q 12 to 24 h. Otitis media: 50 mg/kg up to 1 g IM single dose. May dilute in 1% lidocaine for IM. Contraindicated in neonates who require (or are expected to require) IV calcium (including calcium in TPN); fatal lung/kidney precipitation of calcium ceftriaxone has been reported in neonates. In other patients, do not give ceftriaxone and calcium-containing solns simultaneously, but sequential administration is acceptable if lines are fl ushed with a compatible fl uid between infusions. `K/Bile ♀B + $$$

Cephalosporins—4th Generation

CEFEPIME ( Maxipime) 0.5 to 2 g IM/IV q 12 h. Peds: 50 mg/kg IV q 8 to 12 h. `K ♀B ? $$$$$

Macrolides

AZITHROMYCIN ( Zithromax, Zmax) 500 mg IV daily. 10 mg/kg (up to 500 mg) PO on day 1, then 5 mg/kg (up to 250 mg) daily for 4 days. Otitis media: 30 mg/
kg PO single dose or 10 mg/kg PO daily for 3 days. Peds sinusitis: 10 mg/kg PO
daily for 3 days. Group A streptococcal pharyngitis p
p
p
y g

(second-line to penicillin): 12
mg/kg (up to 500 mg) PO daily for 5 days. Adult acute sinusitis or exacerbation of chronic bronchitis: 500 mg PO daily for 3 days. Zmax for community-acquired y
q

pneumonia, acute sinusitis:

p

,

60 mg/kg (up to 2 g) PO single dose on empty
stomach; give adult dose of 2 g for wt 34 kg or greater. Chlamydia (including y

(
g
pregnancy), chancroid:

p g
y),

1 g PO single dose. Gonorrhea: 2 g PO single dose.

Prevention of disseminated Mycobacterium avium complex disease: y
p

1200 mg

PO once a week. [Generic/Trade: Tabs 250, 500, 600 mg, Susp 100, 200/5 mL.

Trade only: Packet 1000 mg. Z-Pak: #6, 250 mg tab. Tri-Pak: #3, 500 mg tab. Zmax extended-release oral susp: 2 g in 60 mL single-dose bottle.] `L ♀B ? $$

CLARITHROMYCIN ( Biaxin, Biaxin XL) 250 to 500 mg PO bid. Peds: 7.5
mg/kg PO bid. H pylori:

py

See table in GI section. See table for prophylaxis of bacterial endocarditis. Mycobacterium avium complex disease prevention: y
p
p

7.5 mg/kg up to 500 mg PO bid. Biaxin XL: 1000 mg PO daily with food.

[Generic/Trade: Tabs 250, 500 mg. Extended-release tab 500 mg. Susp 125, 250 mg/5 mL. Trade only: Biaxin XL-Pak: #14, 500 mg tabs. Generic only: Extended-release tabs 1000 mg.] `KL ♀C ? $$$

28 Antimicrobials

SEXUALLY TRANSMITTED DISEASES & VAGINITIS*

Bacterial vaginosis
g

: 1) metronidazole 5 g of 0.75% gel intravaginally daily for 5 days OR 500 mg PO bid for 7 days. 2) clindamycin 5 g of 2% cream intravaginally qhs for 7 days. In pregnancy: 1) metronidazole 500 mg PO bid for 7 days OR 250 mg PO tid for 7 days. 2) clindamycin 300 mg PO bid for 7 days.

Candidal vaginitis
g

: 1) intravaginal clotrimazole, miconazole, terconazole, nystatin, tioconazole, or butoconazole. 2) fl uconazole 150 mg PO single dose.

Chancroid: Single dose of: 1) azithromycin 1 g PO or 2) ceftriaxone 250 mg IM.

d

Chlamydia
y

: First line either azithromycin 1 g PO single dose or doxycycline 100 mg PO bid for 7 days. Second line fl uoroquinolones or erythromycin. In pregnancy: 1) azithromycin 1 g PO single dose. 2) amoxicillin 500 mg PO tid for 7 days. Repeat NAAT‡

3 weeks after treatment.

Epididymitis
p
y

: 1) ceftriaxone 250 mg IM single dose + doxycycline 100 mg PO bid for 10 days. 2) ofl oxacin 300 mg PO bid or levofl oxacin 500 mg PO daily for 10 days if enteric organisms suspected, or negative gonococcal culture or NAAT.†

Gonorrhea: Single dose of: 1) ceftriaxone 125 mg IM§ 2) cefi xime 400 mg PO (not for pharynx).† Treat chlamydia empirically. Consider azithromycin 2 g PO single dose for uncomplicated gonorrhea, but no effi cacy/safety data for this regimen in pregnant women.

Gonorrhea, disseminated

,

:

d Initially treat with ceftriaxone 1 g IM/IV q 24 h until 24 to 48 h after improvement. Second-line alternatives: 1) cefotaxime 1 g IV q8h.§ 2) ceftizoxime 1 g IV q 8 h. Complete 1 week of treatment with: 1) cefi xime tabs 400 mg PO
bid. 2) cefi xime susp 500 mg PO bid. 3) cefpodoxime 400 mg PO bid.†

Gonorrhea, meningitis

,
g

: ceftriaxone 1 to 2 g IV q 12 h for 10 to 14 days.§

Gonorrhea, endocarditis

,

: ceftriaxone 1 to 2 g IV q 12 h for at least 4 weeks.§

Granuloma inguinale
g

: doxycycline 100 mg PO bid for at least 3 weeks and until lesions completely healed. Alternative azithromycin 1 g PO once weekly for 3 weeks.

Herpes simplex
p
p

(genital, fi rst episode): 1) acyclovir 400 mg PO tid for 7 to 10 days.

2) famciclovir 250 mg PO tid for 7 to 10 days. 3) valacyclovir 1 g PO bid for 7 to 10 days.

Herpes simplex
p
p

(genital, recurrent): 1) acyclovir 400 mg PO tid for x

5 days. 2) acy-
clovir 800 mg PO tid for 2 days or bid for 5 days. 3) famciclovir 125 mg PO bid for 5
days. 4) famciclovir 1 g PO bid for 1 day. 5) valacyclovir 500 mg PO bid for 3 days.

6) valacyclovir 1 g PO daily for 5 days.

Herpes simplex
p
p

(suppressive therapy): 1) acyclovir 400 mg PO bid. 2) famciclovir x

250 mg PO bid. 3) valacyclovir 500 to 1000 mg PO daily.

Herpes simplex
p
p

(genital, recurrent in HIV infection): 1) Acyclovir 400 mg PO tid for 5
to 10 days. 2) famciclovir 500 mg PO bid for 5 to 10 days. 3) Valacyclovir 1 g PO bid for 5 to 10 days.

Herpes simplex
p
p

(suppressive therapy in HIV infection): 1) Acyclovir 400 to 800 mg PO
bid to tid. 2) Famciclovir 500 mg PO bid. 3) Valacyclovir 500 mg PO bid.

Herpes simplex
p
p

(prevention of transmission in immunocompetent patients with x

≤9 recurrences/year): Valacyclovir 500 mg PO daily by source partner, in conjunction with safer sex practices.

Lymphogranuloma venereum
y p g

: 1) doxycycline 100 mg PO bid for 21 days. Alternative: erythromycin base 500 mg PO qid for 21 days.

Pelvic infl ammatory disease (PID), inpatient regimens y

(

), p
g

: 1) cefoxitin 2 g IV q6h +
doxycycline 100 mg IV/PO q 12 h. 2) clindamycin 900 mg IV q 8 h + gentamicin 2 mg/
kg IM/IV loading dose, then 1.5 mg/kg IM/IV q 8 h (See gentamicin entry for alternative daily dosing). Can switch to PO therapy within 24 h of improvement.

Pelvic infl ammatory disease (PID), outpatient treatment y

(

),
p
t: 1) ceftriaxone 250 mg IM
single dose + doxycycline 100 mg PO bid +/– metronidazole 500 mg PO bid for 14 days.

(cont.)

Antimicrobials

29

SEXUALLY TRANSMITTED DISEASES & VAGINITIS* (continued) Proctitis, proctocolitis, enteritis

, p

,

: ceftriaxone 125 mg IM single dose + doxycycline

100 mg PO bid for 7 days.

Sexual assault prophylaxis
p p y

: ceftriaxone 125 mg IM single dose + metronidazole 2 g PO
single dose + azithromycin 1 g PO single dose/doxycycline 100 mg PO bid for 7 days.

Consider giving antiemetic.

Syphilis
yp
s (primary and secondary): 1) benzathine penicillin 2.4 million units IM single dose. 2) doxycycline 100 mg PO bid for 2 weeks if penicillin allergic.

Syphilis
yp
s (early latent, i.e. duration less than 1 year): 1) benzathine penicillin 2.4 million units IM single dose. 2) doxycycline 100 mg PO bid for 2 weeks if penicillin allergic.

Syphilis
yp
s (late latent or unknown duration): 1) benzathine penicillin 2.4 million units IM
q week for 3 doses. 2) doxycycline 100 mg PO bid for 4 weeks if penicillin allergic.

Syphilis
yp
s (tertiary): 1) benzathine penicillin 2.4 million units IM q week for 3 doses.

2) doxycycline 100 mg PO bid for 4 weeks if penicillin allergic.

Syphilis
yp
s (neuro): 1) penicillin G 18 to 24 million units/day continuous IV infusion or 3
to 4 million units IV q 4 h for 10 to 14 days. 2) procaine penicillin 2.4 million units IM
daily + probenecid 500 mg PO qid, both for 10 to 14 days.

Syphilis in pregnancy
yp
p g
y: Treat only with penicillin regimen for stage of syphilis as noted above. Use penicillin desensitization protocol if penicillin-allergic.

Trichomoniasis: metronidazole (can use in pregnancy) or tinidazole, each 2 g PO single dose.

Urethritis, Cervicitis

,

: Test for Chlamydia and gonorrhea with NAAT.‡ Treat based on test results or treat presumptively if high-risk of infection (Chlamydia: age 25 yo or younger, new/ multiple sex partners, or unprotected sex; gonorrhea: population prevalence greater than 5%), esp. If NAAT‡ unavailable or patient unlikely to return for follow-up.

Urethritiss (persistent/recurrent): 1) metronidazole/ tinidazole 2 g PO single dose +
azithromycin 2 g PO single dose (if not used in fi rst episode).

* MMWR 2006;55:RR-11 or http://www.cdc.gov/STD/treatment/. Treat sexual partners for all except herpes, candida, and bacterial vaginosis.

† As of April 2007, the CDC no longer recommends fl uoroquinolones for gonorrhea because of high resistance rates. Do not consider fl uoroquinolone unless antimicrobial susceptibility can be documented by culture. If parenteral cephalosporin not feasible for PID (and NAAT
is negative or culture documents fl uoroquinolone susceptibility), can consider levofl oxacin 500 mg PO once daily or ofl oxacin 400 mg PO bid + /− metronidazole 500 mg PO bid for 14 days.

‡ NAAT = nucleic acid amplifi cation test.

§Cephalosporin desensitization advised for cephalosporin-allergic patients (e.g. pregnant women).

ERYTHROMYCIN BASE ( Eryc, E-mycin, Ery-Tab,  Erybid, Erythromid, P.C.E. ) 250 to 500 mg PO qid, 333 mg PO tid, or 500 mg PO bid. [Generic/

Trade: Tabs 250, 333, 500 mg, delayed-release cap 250.] `L ♀B + $

ERYTHROMYCIN ETHYL SUCCINATE ( EES, Erypedd) 400 mg PO qid. Peds: 30
to 50 mg/kg/day PO divided qid. [Generic/Trade: Tabs 400 mg, Susp 200, 400
mg/5 mL. Trade only (EryPed): Susp 100 mg/2.5 mL (50 mL).] `L ♀B + $

ERYTHROMYCIN LACTOBIONATE ( Erythrocin IV) 15 to 20 mg/kg/day (max 4 g) IV divided q 6 h. Peds: 15 to 50 mg/kg/day IV divided q 6 h. `L ♀B

+ $$$$$

PEDIAZOLE (erythromycin ethyl succinate + sulfi soxazole) 50 mg/kg/day (based on EES dose) PO divided tid to qid. [Generic/Trade: Susp, erythromycin ethyl succinate 200 mg + sulfi soxazole 600 mg/5 mL.] `KL ♀C – $$

30 Antimicrobials

Penicillins—1st generation—Natural

BENZATHINE PENICILLIN ( Bicillin L-A,  Megacillin) n

Adults and peds wt
greater than 27 kg: 1.2 million units IM. Peds wt 27 kg or less: 600,000 units IM. Doses last 2 to 4 weeks. Give IM q month for secondary prevention of rheumatic fever (q 3 weeks for high-risk patients). [Trade only: For IM use, 600,000 units/mL; 1, 2, 4 mL syringes.] `K ♀B ? $$

BICILLIN C-R (procaine penicillin + benzathine penicillin) For IM use. Not for treatment of syphilis. [Trade only: For IM use 300/300 thousand units/mL
procaine/benzathine penicillin; 1, 2, 4 mL syringes.] `K ♀B ? $$$

PENICILLIN G Pneumococcal pneumonia and severe infections: p

250,000 to

400,000 units/kg/day (8 to 12 million units/day in adult) IV divided q 4 to 6 h.

Pneumococcal meningitis:

g

250,000 to 400,000 units/kg/day (24 million units/
day in adult) in 4 to 6 divided doses. `K ♀B ? $$$$

PENICILLIN V ( Veetids,  PVF-K, Nadopen-V) Adults: 250 to 500 mg PO qid.

Peds: 25 to 50 mg/kg/day divided bid to qid. AHA doses for pharyngitis: p
y g

250
mg (peds 27 kg or less) or 500 mg (adults and peds greater than 27 kg) PO
bid to tid for 10 days. [Generic/Trade: Tabs 250, 500 mg, oral soln 125, 250
mg/5 mL.] `K ♀B ? $

PROCAINE PENICILLIN ( Wycillinn) 0.6 to 1 million units IM daily (peak 4 h, lasts 24 h). `K ♀B ? $$$$$

Penicillins—2nd generation—Penicillinase-Resistant DICLOXACILLIN ( Dynapen) 250 to 500 mg PO qid. Peds: 12.5 to 25 mg/kg/
day divided qid. [Generic only: Caps 250, 500 mg.] `KL ♀B ? $$

NAFCILLIN 1 to 2 g IM/IV q 4 h. Peds: 50 to 200 mg/kg/day divided q 4 to 6 h. `L ♀B ? $$$$$

OXACILLIN ( Bactocill ) 1 to 2 g IM/IV q 4 to 6 h. Peds 150 to 200 mg/kg/day IM/IV divided q 4 to 6 h. `KL ♀B ? $$$$$

Penicillins—3rd generation—Aminopenicillins

AMOXICILLIN ( Amoxil, DisperMox, Moxatag, Trimox,  Novamoxinn) 250
to

500 mg PO tid, or 500 to 875 mg PO bid. High-dose for community-acquired y
q
pneumonia, acute sinusitis:

p

,

1 g PO tid. Lyme disease:

y

500 mg PO tid for 14
days for early disease, for 28 days for Lyme arthritis. Chlamydia in pregnancy: y
p g
y

500 mg PO tid for 7 days. AHA dosing for group A streptococcal pharyngitis: g
p
p
p
y g

50
mg/kg (max 1 g) PO once daily for 10 days. Group A streptococcal pharyngitis/
p
p
p
y g
tonsillitis: 775 mg ER tab (Moxatag) PO for 10 days for age 12 yo or older.

Peds AAP otitis media: 90 mg/kg/day divided bid. AAP recommends 5 to 7
days of therapy for age 6 yo or older with non-severe otitis media, and 10
days for younger children and those with severe disease. Peds infections other than otitis media: 40 mg/kg/day PO divided tid or 45 mg/kg/day divided bid.

[Generic/Trade: Caps 250, 500 mg, Tabs 500, 875 mg, chews 125, 200, 250, 400 mg, susp 125, 250 mg/5 mL, susp 200, 400 mg/5 mL. Trade only: Infant gtts 50 mg/mL (Amoxil). DisperMox 200, 400, 600 mg tabs for oral susp, Moxatag 775 mg extended-release tab.] `K ♀B + $

Antimicrobials

31

AMOXICILLIN-CLAVULANATE ( Augmentin, Augmentin ES-600, Augmentin XR,

 Clavulin)

n

500 to 875 mg PO bid or 250 to 500 mg tid. Augmentin XR: 2
tabs PO q 12 h with meals. Peds AAP otitis media: Augmentin ES 90 mg/kg/
day divided bid. AAP recommends 5 to 7 days of therapy for age 6 yo or older non-severe otitis media, and 10 days for younger children and those with severe disease. Peds: 45 mg/kg/day PO divided bid or 40 mg/kg/day divided tid for sinusitis, pneumonia, otitis media; 25 mg/kg/day divided bid or 20 mg/kg/day divided tid for less severe infections. [Generic/Trade: (amoxicillin/clavulanate) Tabs 250/125, 500/125, 875/125 mg, Chewable tabs, Susp 200/28.5, 400/57
mg per tab or 5 mL, 250/62.5 mg per 5 mL, (ES) Susp 600/42.9 mg per 5 mL.

Trade only: Chewable tabs, Susp 125/31.25 per tab or 5 mL, 250/62.5 mg per tab. Extended-release tabs (Augmentin XR) 1000/62.5 mg.] `K ♀B ? $$$$

AMPICILLIN ( Principen,  Penbritin)

n

Usual dose: 1 to 2 g IV q 4 to 6 h.

Sepsis, meningitis:

p

,
g

150 to 200 mg/kg/day IV divided q 3 to 4 h. Peds: 50 to 400 mg/kg/day IM/IV divided q 4 to 6 h. [Generic/Trade: Caps 250, 500 mg, susp 125, 250 mg/5 mL.] `K ♀B ? $ PO $$$$$ IV

AMPICILLIN-SULBACTAM ( Unasyn)

n

1.5 to 3 g IM/IV q 6 h. Peds: 100 to 400
mg/kg/day of ampicillin divided q 6 h. `K ♀B ? $$$$$

Penicillins—4th generation—Extended Spectrum

PIPERACILLIN Usual dose: 3 to 4 g IM/IV q 4 to 6 h. `K/BILE ♀B ? $$$$$

PIPERACILLIN-TAZOBACTAM ( Zosyn,  Tazocin) 3.375 to 4.5 g IV q 6 h. Peds appendicitis/peritonitis:

pp
p

80 mg/kg IV q 8 h for age 2 to 9 mo, 100 mg/kg

(cont.)

SUBACUTE BACTERIAL ENDOCARDITIS PROPHYLAXIS

For dental, oral, respiratory tract, or esophageal procedures Standard regimen
amoxicillin 2 g PO 1 h before procedure

Unable to take oral meds
ampicillin 2 g IM/IV within 30 min before procedure Allergic to penicillin
clindamycin 600 mg PO; or cephalexin or cefadroxil 2 g PO; or azithromycin or clarithromycin 500 mg PO 1 h before procedure

Allergic to penicillin
clindamycin 600 mg IV; or cefazolin 1 g IM/IV within 30 min and unable to take
before procedure
oral meds

Pediatric drug doses

Total pediatric dose should not exceed adult dose. Amoxicillin 50 mg/kg, ampicillin 50 mg/kg, azithromycin 15 mg/kg, cephalexin 50 mg/kg, cefadroxil 50 mg/kg, cefazolin 25 mg/
kg, clarithromycin 15 mg/kg, clindamycin 20 mg/kg.

PENICILLINS — GENERAL ANTIMICROBIAL SPECTRUM

1st generation: Most streptococci; oral anaerobic coverage 2nd generation: Most streptococci; Staph aureuss (but not MRSA) 3rd generation: Most streptococci; basic gram negative coverage 4th generation: Pseudomonas

32 Antimicrobials
piperacillin IV q 8 h for age older than 9 mo, use adult dose for wt greater than 40 kg. `K ♀B ? $$$$$

TICARCILLIN-CLAVULANATE ( Timentin) 3.1 g IV q 4 to 6 h. Peds: 50 mg/kg up to 3.1 g IV q 4 to 6 h. `K ♀B ? $$$$$

Quinolones—2nd Generation

CIPROFLOXACIN ( Cipro, Cipro XR, ProQuin XR) R

200 to 400 mg IV q 8 to

12 h. 250 to 750 mg PO bid. Simple UTI:

p

250 mg bid for 3 days or Cipro XR/

Proquin XR 500 mg PO daily for 3 days. Give Proquin XR with main meal of day. Cipro XR for pyelonephritis or complicated UTI: py
p
p

1000 mg PO daily for 7 to

14 days. [Generic/Trade: Tabs 100, 250, 500, 750 mg. Extended-release tabs 500, 1000 mg. Trade only (ProQuin XR): Extended-release tabs 500 mg, blister pack 500 mg (#3 tabs).] `LK ♀C but teratogenicity unlikely ?+ $

NORFLOXACIN ( Noroxin)

n

Simple UTI:

p

400 mg PO bid for 3 days. [Trade only:

Tabs 400 mg.] `LK ♀C ? $

OFLOXACIN ( Floxin) 200 to 400 mg PO bid. [Generic/Trade: Tabs 200, 300, 400 mg.] `LK ♀C ?+ $$$

Quinolones—3rd Generation

LEVOFLOXACIN ( Levaquin)

n

250 to 750 mg PO/IV daily. [Trade only: Tabs 250,

500, 750 mg, Oral soln 25 mg/mL. Leva-Pak: #5, 750 mg tabs.] `KL ♀C

? $$$$

Quinolones—4th Generation

GEMIFLOXACIN ( Factive) 320 mg PO daily for 5 to 7 days. [Trade only: Tabs 320 mg.] `Feces, K ♀C – $$$$

MOXIFLOXACIN ( Avelox) 400 mg PO/IV daily for 5 days (chronic bronchitis exacerbation), 5 to 14 days (complicated intra-abdominal infection p

), 7 days

(uncomplicated skin infections
p

), 10 days (acute sinusitis), 7 to 14 days

(community-acquired pneumonia
y
q
p

), 7 to 21 days (complicated skin infections
p

).

[Trade only: Tabs 400 mg.] `LK ♀C – $$$

Sulfonamides

SULFADIAZINE

CNS toxoplasmosis in
p

AIDS. Acute treatment: 1000 mg PO qid
for wt less than 60 kg to 1500 mg PO qid for wt 60 kg or greater. Secondary (cont.)

QUINOLONES— GENERAL ANTIMICROBIAL SPECTRUM

1st generation: gram negative (excluding Pseudomonas), urinary tract only, no atypicals

2nd generation: gram negative (including Pseudomonas); Staph aureuss (but not MRSA or pneumococcus); some atypicals

3rd generation: gram negative (including Pseudomonas); gram positive, including pneumococcus and
s

Staph aureuss (but not MRSA); expanded atypical coverage 4th generation: same as 3rd generation plus enhanced coverage of pneumococcus, decreased activity vs. Pseudomonas

Antimicrobials

33
prevention: 2000 to 4000 mg/day PO divided bid to qid. Give with pyrimethamine + leucovorin. [Generic only: Tabs 500 mg.] `K ♀C + $$$$

TRIMETHOPRIM-SULFAMETHOXAZOLE ( Bactrim, Septra, Sulfatrim, cotrimoxazole) 1 tab PO bid, double-strength (DS, 160 mg/800 mg) or single-strength (SS, 80 mg/400 mg). Pneumocystis treatment: y

15 to 20 mg/kg/day

(based on TMP) IV divided q 6 to 8 h or PO divided tid for 21 days total.

Pneumocystis prophylaxis:

y
p p y

1 DS tab PO daily. Peds usual dose: 5 mL susp/10
kg (up to 20 mL)/dose PO bid. Community-acquired MRSA skin infections: y
q

Adults: 1 to 2 DS tabs PO bid for 7 to 10 days. Peds: 8 to 12 mg/kg/day (based on TMP) PO divided bid. [Generic/Trade: Tabs 80 mg TMP/400 mg SMX

(single strength), 160 mg TMP/800 mg SMX (double strength; DS), susp 40
mg TMP/200 mg SMX per 5 mL. 20 mL susp = 2 SS tabs = 1 DS tab.] `K

♀C + $

Tetracyclines

DEMECLOCYCLINE ( Declomycinn) Usual dose: 150 mg PO qid or 300 mg PO
bid on empty stomach. SIADH: 600 to 1200 mg/day PO given in 3 to 4 divided doses. [Generic/Trade: Tabs 150, 300 mg.] `K, feces ♀D ?+ $$$$

DOXYCYCLINE ( Adoxa, Doryx, Monodox, Oracea, Periostat, Vibramycin, Vibra-Tabs,  Doxycin)

n

100 mg PO bid on fi rst day, then 50 mg bid or

100 mg daily. Severe infections: 100 mg PO/IV bid. Community-acquired y
q

MRSA skin infections: 100 mg PO bid. Lyme disease:

y

100 mg PO bid for 14
days for early disease, for 28 days for Lyme arthritis.

y

Acne: Up to 100 mg

PO bid. Periostat ($$$$$) for periodontitis:

p

20 mg PO bid. Oracea ($$$$$)

for infl ammatory
y rosacea: 40 mg PO once every morning on empty stomach.

Malaria prophylaxis:

p p y

2 mg/kg/day up to 100 mg PO daily starting 1 to 2 days before exposure until 4 weeks after. Avoid in children age younger than 8 yo due to teeth staining. [Generic/Trade: Tabs 75, 100 mg, Caps 20, 50, 100
mg, Susp 25 mg/5 mL (60 mL). Trade only: (Vibramycin) Syrup 50 mg/5 mL

(480 mL). Delayed-release (Doryx): Tabs 75, 100 mg, Caps 40 mg (Oracea).

Generic only: Caps 75, 150 mg tabs 50, 150 mg.] `LK ♀D ?+ $

MINOCYCLINE ( Minocin, Dynacin, Solodyn,  Enca) 200 mg IV/PO initially, then 100 mg q 12 h. Community-acquired MRSA skin infections: y
q

100 mg PO
bid. Acne (traditional dosing, not Solodyn): 50 mg PO bid. Solodyn ($$$$$) for infl ammatory
y acne: Give 45 mg PO once daily to age 12 yo or older for wt 45 to 59 kg, give 90 mg for wt 60 to 90 kg, give 135 mg for wt 91 to 136 kg.

[Generic/Trade: Caps, Tabs 50, 75, 100 mg. Tabs, Extended-release 45, 90, 135 mg (Solodyn).] `LK ♀D ?+ $$$

TETRACYCLINE ( Sumycin)

n

250 to 500 mg PO qid. [Generic only; Caps 250,

500 mg.] `LK ♀D ?+ $

Other Antimicrobials

AZTREONAM ( Azactam)

m

0.5 to 2 g IM/IV q 6 to 12 h. Peds: 30 mg/kg IV q 6
to 8 h. `K ♀B + $$$$$

CHLORAMPHENICOL ( Chloromycetinn) 50 to 100 mg/kg/day IV divided q 6 h.

Aplastic anemia. `LK ♀C – $$$$$

34 Antimicrobials

CLINDAMYCIN ( Cleocin,  Dalacin C)

C

150 to 450 mg PO qid. 600 to 900 mg

IV q 8 h. Community-acquired MRSA skin infections:

y
q

30 mg/kg/day (up to 300
mg) PO tid. Peds: 20 to 40 mg/kg/day IV divided q 6 to 8 h or give 8 to 25 mg/
kg/day susp PO divided q 6 to 8 h. [Generic/Trade: Caps 75, 150, 300 mg.

Trade only: Oral soln 75 mg/5 mL (100 mL).] `L ♀B ?+ $$$

DAPTOMYCIN ( Cubicin, Cidecinn)

Complicated skin infections (including
p

(
g

MRSA):

) 4 mg/kg IV daily for 7 to 14 days. S. aureus bacteremia (including (
g

MRSA):

) 6 mg/kg IV daily for at least 2 to 6 weeks. Infuse over 30 min. Not for pneumonia (inactived by surfactant). `K ♀B ? $$$$$

DROTRECOGIN ( Xigris)

s

To reduce mortality in sepsis:

p

24 mcg/kg/h IV for

96 h. `Plasma ♀C ? $$$$$

FOSFOMYCIN ( Monurol )

Simple UTI:

p

One 3 g packet PO single-dose. [Trade
only: 3 g packet of granules.] `K ♀B ? $$

LINEZOLID ( Zyvox,  Zyvoxam)

m

Pneumonia, complicated skin infections

,
p

(including MRSA), vancomycin-resistant E faecium infections: (
g

),
y

10 mg/kg (up
to 600 mg) IV/PO q 8 h for age younger than 12 yo, 600 mg IV/PO q 12 h for adults and age 12 yo or older. Myelosuppression, drug interactions due to MAO
inhibition. Limit tyramine foods to <100 mg/meal. [Trade only: Tabs 600 mg, Susp 100 mg/5 mL.] Òxidation/K ♀C ? $$$$$

METRONIDAZOLE ( Flagyl, Flagyl ER,  Florazole ER, Trikacide, Nidazol ) Bacterial vaginosis:

g

500 mg PO bid or Flagyl ER 750 mg PO dailyy for 7 days. H pylori: py

See table
in GI section. Anaerobic bacterial infections: Load 1 g or 15 mg/kg IV, then 500 mg or 7.5 mg/kg (up to 4 g/day) IV/PO q 6 to 8 h, each IV dose over 1 h. Peds: 7.5 mg/
kg IV q 6 h. C. diffi cile associated diarrhea: 500 mg PO tid for 10 to 14 days. Peds: 30 mg/kg/day PO divided qid for 10 to 14 days. Trichomoniasis: 2 g PO single dose for patient & sex partners (may be used in pregnancy per CDC). Giardia: 250 mg (5 mg/kg/dose for peds) PO tid for 5 to 7 days. [Generic/Trade: Tabs 250, 500 mg, Caps 375 mg. Trade only: Tabs, extended-release 750 mg.] `KL ♀B ?– $

NITROFURANTOIN ( Furadantin, Macrodantin, Macrobid) 50 to 100 mg PO
qid. Peds: 5 to 7 mg/kg/day divided qid. Macrobid: 100 mg PO bid. [Generic/

Trade (Macrodantin): Caps 25, 50, 100 mg, (Macrobid): Caps 100 mg. Trade only (Furadantin): Susp 25 mg/5 mL.] `KL ♀B +? $

RIFAXIMIN ( Xifaxan)

n

Travelers diarrhea: 200 mg PO tid for 3 days. [Trade only: Tabs 200 mg.] `Feces, no GI absorption ♀C ? $$

SYNERCID (quinupristin + dalfopristin) 7.5 mg/kg IV q 8 to 12 h, each dose over 1 h. Not active against E faecalis. `Bile ♀B ? $$$$$

TELITHROMYCIN ( Ketek) 800 mg PO daily for 7 to 10 days for community-y
acquired pneumonia.

q
p

No longer indicated for acute sinusitis or acute
exacerbation of chronic bronchitis (risks exceed potential benefi t).

Contraindicated in myasthenia gravis. [Trade only: Tabs 300, 400 mg. Ketek Pak: #10, 400 mg tabs.] `LK ♀C ? $$$

TIGECYCLINE ( Tygacil ) Complicated skin infections, complicated intrap

,
p
abdominal infections, community-acquired pneumonia:

,
y
q
p

100 mg IV fi rst dose,
then 50 mg IV q 12 h. Infuse over 30 to 60 min. `Bile, K ♀D ?+ $$$$$

TRIMETHOPRIM ( Primsol,  Proloprim
m) 100 mg PO bid or 200 mg PO
daily. [Generic only: Tabs 100, 200 mg. Trade only: (Primsol): Oral soln 50 mg/5 mL.] `K ♀C – $

Cardiovascular

35

VANCOMYCIN ( Vancocin)

n

Usual dose: 15 to 20 mg/kg IV q 8 to 12 h; consider loading dose of 25 to 30 mg/kg for severe infection. Infuse over 1 h; infuse over 1.5 to 2 h if dose greater than 1 g. Peds: 10 to 15 mg/kg IV q 6 h. C
diffi cile diarrhea: 40 to 50 mg/kg/day PO up to 500 mg/day divided qid for 10
to 14 days. IV administration ineffective for this indication. [Trade only: Caps 125, 250 mg.] `K ♀C ? $$$$$

CARDIOVASCULAR

ACE Inhibitors

NOTE See also antihypertensive combinations. Hyperkalemia possible, especially if used concomitantly with other drugs that increase K+

K

(including K+

K con-
taining salt substitutes) and in patients with heart failure, diabetes mellitus, or renal impairment. Monitor closely for hypoglycemia, especially during fi rst month of treatment when combined with insulin or oral antidiabetic agents. ACE
inhibitors are contraindicated during pregnancy. Contraindicated with a history of angioedema. Renoprotection and decreased cardiovascular morbidity/mortality seen with some ACE inhibitors are most likely a class effect.

BENAZEPRIL ( Lotensin) HTN: Start 10 mg PO daily, usual maintenance dose 20 to 40 mg PO daily or divided bid, max 80 mg/day. [Generic/Trade: Tabs, unscored 5, 10, 20, 40 mg.] `LK ♀– ? $$

CAPTOPRIL ( Capoten)

n HTN: Start 25 mg PO bid to tid, usual maintenance dose 25 to 150 mg bid to tid, max 450 mg/day. Heart failure: Start 6.25 to 12.5 mg PO

(cont.)

ACE INHIBITOR

HTN

Heart Failure

DOSING

Initial

Max/day

Initial

Max
benazepril ( Lotensin)

10 mg daily*

80 mg

-

-
captopril ( Capoten)

25 mg bid/tid

450 mg

6.25 mg tid

50 mg tid
enalapril ( Vasotec)

5 mg daily*

40 mg

2.5 mg bid

10–20 mg bid
fosinopril ( Monopril )

10 mg daily*

80 mg

5–10 mg daily

40 mg daily
lisinopril ( Zestril/

10 mg daily

80 mg

2.5–5 mg daily

20–40 mg daily

Prinivil )

moexipril ( Univasc)

7.5 mg daily*

30 mg

-

-
perindopril (Aceon)

4 mg daily*

16 mg

2 mg daily

8–16 mg daily
quinapril ( Accupril)

l

10–20 mg

80 mg

5 mg bid

20 mg bid
daily*
ramipril ( Altace)

2.5 mg daily*

20 mg

1.25–2.5 mg bid

10 mg daily
trandolapril ( Mavik)

1–2 mg daily*

8 mg

1 mg daily

4 mg daily

Data taken from prescribing information and Circulation 2009;119:e391–e479.

n

*May require bid dosing for 24-h BP control.

36 Cardiovascular
tid, usual dose 50 to 100 mg PO tid, max 450 mg/day. Diabetic nephropathy: p
p
y 25
mg PO tid. [Generic/Trade: Tabs, scored 12.5, 25, 50, 100 mg.] `LK ♀– + $

CILAZAPRIL ( Inhibace) Canada only. HTN: 1.25 to 10 mg PO daily.

[Generic/Trade: Tabs, scored 1, 2.5, 5 mg.] `LK ♀– ? $

ENALAPRIL ( enalaprilat, Vasotec)

HTN: Start 5 mg PO daily, usual
maintenance dose 10 to 40 mg PO daily or divided bid, max 40 mg/day. If oral therapy not possible, can use enalaprilat 1.25 mg IV q 6 h over 5 min, and increase up to 5 mg IV q 6 h if needed. Renal impairment or concomitant diuretic therapy: Start 2.5 mg PO daily. Heart failure: Start 2.5 mg PO bid, usual 10 to 20 mg PO bid, max 40 mg/day. [Generic/Trade: Tabs, scored 2.5, 5 mg, unscored 10, 20 mg.] `LK ♀– + $$

FOSINOPRIL ( Monopril ) HTN: Start 10 mg PO daily, usual maintenance dose 20 to 40 mg PO daily or divided bid, max 80 mg/day. Heart failure: Start 10
mg PO daily, usual dose 20 to 40 mg PO daily, max 40 mg/day. [Generic/Trade: Tabs, scored 10, unscored 20, 40 mg.] `LK ♀– ? $

LISINOPRIL ( Prinivil, Zestril )

HTN: Start 10 mg PO daily, usual maintenance
dose 20 to 40 mg PO daily, max 80 mg/day. Heart failure, acute MI:

,

Start 2.5
to 5 mg PO daily, usual dose 5 to 20 mg PO daily, max dose 40 mg. [Generic/

Trade: Tabs, unscored (Zestril) 2.5, 5, 10, 20, 30, 40 mg. Tabs, scored (Prinivil) 10, 20, 40 mg.] `K ♀– ? $

MOEXIPRIL ( Univasc) HTN: Start 7.5 mg PO daily, usual maintenance dose 7.5 to 30 mg PO daily or divided bid, max 30 mg/day. [Generic/Trade: Tabs, scored 7.5, 15 mg.] `LK ♀– ? $$

PERINDOPRIL ( Aceon,  Coversyl ) HTN: Start 4 mg PO daily, usual maintenance dose 4 to 8 mg PO daily or divided bid, max 16 mg/day. Reduction of cardiovascular events in stable CAD: Start 4 mg PO dailyy for 2 weeks, max 8 mg/
day. Elderly (age older than 70 yo): 2 mg PO dailyy for 1 week, 4 mg PO dailyy for 1
week, max 8 mg/day. [Trade only: Tabs, scored 2, 4, 8 mg.] `K ♀– ? $$$

QUINAPRIL ( Accupril ) HTN: Start 10 to 20 mg PO daily (start 10 mg/day if elderly), usual maintenance dose 20 to 80 mg PO daily or divided bid, max 80
mg/day. Heart failure: Start 5 mg PO bid, usual maintenance dose 10 to 20 mg bid. [Generic/Trade: Tabs, scored 5, unscored 10, 20, 40 mg.] `LK ♀– ? $$

RAMIPRIL ( Altace)

HTN: 2.5 mg PO daily, usual maintenance dose 2.5 to 20
mg PO daily or divided bid, max 20 mg/day. Heart failure post MI: p

Start 2.5 mg

PO bid, usual maintenance dose 5 mg PO bid. Reduce risk of MI, CV

,

A, death

,
from cardiovascular causes: 2.5 mg PO daily for 1 week, then 5 mg daily for 3 weeks, increase as tolerated to max 10 mg/day. [Generic/Trade: Caps 1.25, 2.5, 5, 10 mg. Trade only: Tabs 1.25, 2.5, 5, 10 mg.] `LK ♀– ? $$$

TRANDOLAPRIL ( Mavik) HTN: Start 1 mg PO daily, usual maintenance dose 2 to 4 mg PO daily or divided bid, max 8 mg/day. Heart failure/post MI: p

Start

0.5 to 1 mg PO daily, usual maintenance dose 4 mg PO daily. [Generic/Trade: Tabs, 1, 2, 4 mg.] `LK ♀– ? $$

Aldosterone Antagonists

EPLERENONE ( Inspra) HTN: Start 50 mg PO daily; max 50 mg bid. Improve survival of stable patients with LV systolic dysfunction (LVEF 40% or less) and (cont.)

Cardiovascular

37
heart failure post MI:

p

Start 25 mg PO daily; titrate to target dose 50 mg daily within 4 weeks, if tolerated. [Generic/Trade: Tabs unscored 25, 50 mg.] `L

♀B ? $$$$

SPIRONOLACTONE ( Aldactone)

HTN: 50 to 100 mg PO daily or divided bid.

Edema: 25 to 200 mg/day. Hypokalemia:

yp

50 to 100 mg PO daily. Primary
y
hyperaldosteronism, maintenance:

yp

,

100 to 400 mg/day PO. Cirrhotic ascites:

Start 100 mg once daily or in divided doses. Maintenance 25 to 200 mg/day.

[Generic/Trade: Tabs, unscored 25 mg scored 50, 100 mg.] `LK ♀D + $

Angiotensin Receptor Blockers (ARBs)

NOTE See also antihypertensive combinations.

CANDESARTAN ( Atacand)

HTN: Start 16 mg PO daily, maximum 32 mg/day.

Reduce cardiovascular death and hospitalizations from heart failure (NYHA p

(

II–IV and LVEF 40% or less):

) Start 4 mg PO daily, maximum 32 mg/day; has
added effect when used with ACE inhibitor. [Trade only: Tabs, unscored 4, 8, 16, 32 mg.] `K ♀– ? $$$

EPROSARTAN ( Teveten) HTN: Start 600 mg PO daily, maximum 800 mg/day given daily or divided bid. [Trade only: Tabs unscored 400, 600 mg.] `Fecal excretion ♀– ? $$$

HTN THERAPY1

Area of Concern

BP Target

Preferred Therapy 2

Comments

General

<140/90

ACEI, ARB, CCB,

Start 2 drugs if systolic
coronary
mm Hg
thiazide, or

BP ≥160 or diastolic BP
artery disease
combination

≥100
prevention

High

<130/80
coronary artery
mm Hg
disease risk3

Stable angina,

<130/80

Beta-blocker4 + (ACEI

May add dihydropyridine
unstable
mm Hg
or ARB)5

CCB or thiazide
angina, MI

Left heart

<120/80

Beta-blocker + (ACEI or ARB) + diuretic8 +
failure6,7
mm Hg
aldosterone antagonist9

1. ACEI = angiotensin converting enzyme inhibitor; ARB = angiotensin-receptor blocker; CCB = calcium-channel blocker; MI = myocardial infarction. Adapted from Circulation 2007;115:2761–2788. 2. All patients should attempt lifestyle modifi cations: optimize wt, healthy diet, sodium restriction, exercise, smoking cessation, alcohol moderation. 3. Diabetes mellitus, chronic kidney disease, known CAD or risk equivalent (eg, peripheral artery disease, abdominal aortic aneurysm, carotid artery disease and prior ischemic CVA/TIA), 10-year Framingham risk score ≥10%. 4. Use only if hemodynamically stable. If beta-blocker contraindications or intolerable side effects (and no bradycardia or heart failure), may substitute verapamil or diltiazem.

5. Preferred if anterior wall MI, persistent HTN, heart failure, or diabetes mellitus. 6. Avoid verapamil, diltiazem, clonidine, beta-blockers. 7. For patients of African descent with NYHA class III or IV HF, consider adding hydralazine/isosorbide dinitrate. 8. Loop or thiazide. 9. Use if NYHA class III or IV, or if clinical heart failure + LVEF < 40%.

38 Cardiovascular

IRBESARTAN ( Avapro)

HTN: Start 150 mg PO daily, maximum 300 mg/day.

Type 2 diabetic nephropathy: Start 150 mg PO daily, target dose 300 mg daily.

[Trade only: Tabs, unscored 75, 150, 300 mg.] `L ♀– ? $$$

LOSARTAN ( Cozaarr) HTN: Start 50 mg PO daily, max 100 mg/day given daily or divided bid. Volume-depleted patients or history of hepatic impairment: Start 25 mg PO daily. CVA risk reduction in patients with HTN & L
p

V hypertrophy:

yp
p y

(may not be effective in patients of African descent): Start 50 mg PO daily. If need more BP reduction add HCTZ 12.5 mg PO daily; then increase losartan to 100 mg/day, then increase HCTZ to 25 mg/day. Type 2 diabetic nephropathy: yp
p
p
y

Start 50 mg PO daily, target dose 100 mg daily. [Trade only: Tabs, unscored 25, 50, 100 mg.] `L ♀– ? $$$

OLMESARTAN ( Benicar)

r

HTN: Start 20 mg PO daily, max 40 mg/day. [Trade
only: Tabs, unscored 5, 20, 40 mg.] `K ♀– ? $$$

TELMISARTAN ( Micardis)

s

HTN: Start 40 mg PO daily, max 80 mg/day. [Trade
only: Tabs, unscored 20, 40, 80 mg.] `L ♀– ? $$$

VALSARTAN ( Diovan)

HTN: Start 80 to 160 mg PO daily, max 320 mg/day.

Heart failure: Start 40 mg PO bid, target dose 160 mg bid; there is no evidence of added benefi t when used with adequate dose of ACE inhibitor. Reduce mortality/morbidity post MI with L
y
y p

V systolic dysfunction/failure:

y
y

Start 20 mg

PO bid, target dose 160 mg bid. [Trade only: Tabs, scored 40 mg, unscored 80, 160, 320 mg.] `L ♀– ? $$$

Antiadrenergic Agents

CLONIDINE ( Catapres, Catapres-TTS,  Dixarit ) HTN: Start 0.1 mg PO bid, usual maintenance dose 0.2 to 1.2 mg/day divided bid to tid, max 2.4 mg/day.

Rebound HTN with abrupt discontinuation, especially at doses that exceed 0.7
mg/day. Transdermal (Catapres-TTS): Start 0.1 mg/24 h patch once a week, titrate to desired effect, max effective dose 0.6 mg/24 h (two 0.3 mg/24 h patches). Transdermal Therapeutic System (TTS) is designed for 7 days use so that a TTS-1 delivers 0.1 mg/day for 7 days. May supplement fi rst dose of TTS
with oral for 2 to 3 days while therapeutic level is achieved. ADHD (unapproved peds): Start 0.05 mg PO qhs, titrate based on response over 8 weeks to max 0.2
mg/day (for wt less than 45 kg) or to max 0.4 mg/day (for wt 45 kg or greater) in 2 to 4 divided doses. Tourette’s syndrome
y

(unapproved peds and adult): 3 to

5 mcg/kg/day PO divided bid to qid. Opioid withdrawal, adjunct: p

,
j

0.1 to 0.3 mg

PO tid to qid or 0.1 to 0.2 mg PO q 4 h for 3 days tapering off over 4 to 10 days.

Alcohol withdrawal, adjunct:

,
j

0.1 to 0.2 mg PO q 4 h prn. Smoking cessation:

g

Start 0.1 mg PO bid, increase 0.1 mg/day at weekly intervals to 0.75 mg/day as tolerated; transdermal (Catapres TTS): 0.1 to 0.2 mg/24 h patch once a week for 2 to 3 weeks after cessation. Menopausal fl
p
ushing:

g 0.1 to 0.4 mg/day PO
divided bid to tid. Transdermal system applied weekly: 0.1 mg/day. [Generic/

Trade: Tabs, unscored 0.1, 0.2, 0.3 mg. Trade only: Transdermal weekly patch 0.1 mg/day (TTS-1), 0.2 mg/day (TTS-2), 0.3 mg/day (TTS-3).] `LK ♀C ? $$

DOXAZOSIN ( Cardura, Cardura XL) BPH: Immediate-release: Start 1 mg PO
qhs, max 8 mg/day. Extended-release (not approved for HTN): 4 mg PO qam (cont.)

Cardiovascular

39
with breakfast, max 8 mg/day. HTN: Start 1 mg PO qhs, max 16 mg/day. Take fi rst dose at bed time to minimize orthostatic hypotension. [Generic/Trade: Tabs, scored 1, 2, 4, 8 mg. Trade only (Cardura XL): Tabs, extended-release 4, 8 mg.] `L ♀C ? $$

GUANFACINE ( Tenex)

HTN: Start 1 mg PO qhs, increase to 2 to 3 mg qhs if needed after 3 to 4 weeks, max 3 mg/day. ADHD in children: Start 0.5 mg PO
daily, titrate by 0.5 mg q 3 to 4 d as tolerated to 0.5 mg PO tid. [Generic/Trade: Tabs, unscored 1, 2 mg.] `K ♀B ? $

METHYLDOPA ( Aldomet ) HTN: Start 250 mg PO bid to tid, maximum 3000
mg/day. May cause hemolytic anemia. [Generic only: Tabs, unscored 125, 250, 500 mg.] `LK ♀B + $

PRAZOSIN ( Minipress)

s

HTN: Start 1 mg PO bid to tid, max 40 mg/day. Take
fi rst dose at bed time to minimize orthostatic hypotension. [Generic/Trade: Caps 1, 2, 5 mg.] `L ♀C ? $$

TERAZOSIN ( Hytrin)

n

HTN: Start 1 mg PO qhs, usual effective dose 1 to 5 mg PO daily or divided bid, max 20 mg/day. Take fi rst dose at bed time to minimize orthostatic hypotension. BPH: Start 1 mg PO qhs, usual effective dose 10 mg/
day, max 20 mg/day. [Generic/Trade: Tabs, Caps 1, 2, 5, 10 mg.] `LK ♀C

? $$

Anti-Dysrhythmics / Cardiac Arrest

ADENOSINE ( Adenocard)

PSVT conversion (not A-fi b):

) Adult and peds wt 50
kg or greater: 6 mg rapid IV & fl ush, preferably through a central line. If no response after 1 to 2 min, then 12 mg. A 3rd dose of 12 mg may be given prn.

Peds wt less than 50 kg: Initial dose 50 to 100 mcg/kg, subsequent doses 100
to 200 mcg/kg q 1 to 2 min prn up to a max single dose of 300 mcg/kg or 12
mg whichever is less. Half-life is less than 10 sec. Give doses by rapid IV push followed by NS fl ush. Need higher dose if on theophylline or caffeine, lower dose if on dipyridamole or carbamazepinèPlasma ♀C ? $$$

AMIODARONE ( Cordarone, Pacerone) Life-threatening ventricular arrhyth-g
y
mia without cardiac arrest: Load 150 mg IV over 10 min, then 1 mg/min for 6 h, then 0.5 mg/min for 18 h. Mix in D5W. Oral loading dose 800 to 1600
mg PO daily for 1 to 3 weeks, reduce to 400 to 800 mg PO daily for 1 month when arrhythmia is controlled, reduce to lowest effective dose thereafter, usually 200 to 400 mg PO daily. Photosensitivity with oral therapy. Pulmonary

& hepatic toxicity. Hypo or hyperthyroidism possible. Coadministration of fl uoroquinolones, macrolides, or azoles may prolong QTc. May increase digoxin levels; discontinue digoxin or decrease dose by 50%. May increase INR with warfarin by up to 100%; decrease warfarin dose by 33 to 50%. Do not use with grapefruit juice. Do not use with simvastatin dose greater than 20 mg/day, lovastatin dose greater than 40 mg/day; caution with atorvastatin; increases risk of myopathy and rhabdomyolysis. Caution with beta-blockers and calcium channel blockers. IV therapy may cause hypotension. Contraindicated with marked sinus bradycardia and 2nd or 3rd degree heart block in the absence of a functioning pacemaker. [Trade only (Pacerone): Tabs, 100, 300 mg. Generic/

Trade: Tabs, scored 200, 400 mg.] `L ♀D – $$$$

40 Cardiovascular

ATROPINE ( AtroPen)

Bradyarrhythmia/CPR:

y
y

0.5 to 1 mg IV q 3 to 5 min to
max 0.04 mg/kg (3 mg). Peds: 0.02 mg/kg/dose; minimum single dose, 0.1
mg; max cumulative dose, 1 mg. AtroPen: Injector pens for insecticide or nerve agent poisoning. [Trade only: Prefi lled auto-injector pen: 0.25 mg (yellow), 0.5
mg (blue), 1 mg (dark red), 2 mg (green).] `K ♀C – $

BICARBONATE

Severe acidosis: 1 mEq/kg IV up to 50 to 100 mEq/dose. `K

♀C ? $

DIGOXIN ( Lanoxin, Lanoxicaps, Digitek)

k

Systolic heart failure/rate control
y
of chronic A-fi b: 0.125 to 0.25 mg PO daily; impaired renal function: 0.0625
to 0.125 mg PO daily. Rapid A-fi
p
b: Load 0.5 mg IV, then 0.25 mg IV q 6 h for

2 doses, maintenance 0.125 to 0.375 mg IV/PO daily. [Generic/Trade: Tabs, scored (Lanoxin, Digitek) 0.125, 0.25 mg; elixir 0.05 mg/mL. Trade only: Caps (Lanoxicaps), 0.1, 0.2 mg.] `KL ♀C + $

DIGOXIN IMMUNE FAB ( Digibind, Digifab)

b Digoxin toxicity:

g
y Dose varies.

Acute ingestion of known amount: 1 vial binds approximately 0.5 mg digoxin.

Acute ingestion of unknown amount: 10 vials IV, may repeat once. Toxicity during chronic therapy: 6 vials usually adequate; one formula is: Number vials is equivalent to (serum dig level in ng/mL) × (kg)/100. `K ♀C ? $$$$$

DISOPYRAMIDE ( Norpace, Norpace CR,  Rythmodan, Rythmodan-LA) Rarely indicated, consult cardiologist. Ventricular arrhythmia: y

400 to 800 mg PO
daily in divided doses (immediate-release is divided q 6 h: extended-release is divided q 12 h). Proarrhythmic. [Generic/Trade: Caps, immediate-release 100, 150 mg; extended-release 150 mg. Trade only: Caps, extended-release 100 mg.] `KL ♀C + $$$$

DRONEDARONE ( Multaq)

q

Reduce risk of CV hospitalization with paroxysmal
p
p
y

or persistent atrial fi
p
b/fl utter, with recent episode of atrial fi b/fl utter and CV risk factors (ie, age older than 70 yo, HTN, diabetes, prior CVA, left atrial diameter 50
mm or greater or LVEF less than 40%), who are in sinus rhythm or will be converted: 400 mg PO BID with morning and evening meals. Do not use with any of the following: 2nd or 3rd degree AV block or sick sinus syndrome without functioning pacemaker; bradycardia <50 bpm; QTc Bazett interval >500 ms; or severe hepatic impairment. Do not use with grapefruit juice; other antiarrhythmic agents; potent inhibitors of CYP 3A4 enzyme system (clarithromycin, erythromycin, itraconazole, ketoconazole, nefazodone, ritonavir, voriconazole); or inducers of CYP 3A4 enzyme system (carbamazepine, phenytoin, phenobarbital, rifampin, St. John’s Wort). May increase digoxin levels; discontinue digoxin or decrease dose by 50%. Caution with beta-blockers and calcium channel blockers. May increase levels of sirolimus, tacrolimus, and CYP3A4 substrates with narrow therapeutic index. [Trade: Tabs, unscored 400 mg.] `L ♀X – $$$$

FLECAINIDE ( Tambocor) Proarrhythmic.

r

Prevention of paroxysmal atrial fi
p
y
b/
fl utter or PSVT, with symptoms & no structural heart disease: Start 50 mg PO
q 12 h, may increase by 50 mg bid q 4 days, max 300 mg/day. Use with AV nodal slowing agent (beta-blocker, verapamil, diltiazem) to minimize risk of 1:1
atrial fl utter. Life-threatening ventricular arrhythmias without structural heart g
y
disease: Start 100 mg PO q 12 h, may increase by 50 mg bid q 4 days, max 400
mg/day. With severe renal impairment (CrCl <35 mL/min): Start 50 mg PO bid.

[Generic/Trade: Tabs, unscored 50, scored 100, 150 mg.] `K ♀C – $$$$

Cardiovascular

41

SELECTED DRUGS THAT MAY PROLONG THE QT INTERVAL
alfuzosin
erythromycin*†
nicardipine
sertraline
amiodarone*†
felbamate
octreotide
sotalol*†
apomorphine
fl ecainide*
ofl oxacin
sunitinib
arsenic trioxide*
foscarnet
ondansetron
tacrolimus
azithromycin*
fosphenytoin
pentamidine*†
tamoxifen
chloroquine*
gemifl oxacin
phenothiazines‡
telithromycin*
chlorpromazine
granisetron
pimozide*†
thioridazine
cisapride*†
haloperidol*‡
polyethylene
tizanidine
clarithromycin*
ibutilide*†
glycol (PEG-salt
tolterodine
clozapine
indapamide*
soln)§
vardenafi l
cocaine*
isradipine
procainamide*
venlafaxine
dasatinib
levofl oxacin*
quetiapine‡
visicol§
disopyramide*†
lithium
quinidine*†
voriconazole*
dofetilide*
mefl oquine
quinine
vorinostat
dolasetron
methadone*†
ranolazine
ziprasidone‡
droperidol*
moexipril/HCTZ
risperidone‡
epirubicin
moxifl oxacin
salmeterol

Note. This table may not include all drugs that prolong the QT interval or cause torsades. Risk of drug-induced QT prolongation may be increased in women, elderly, hypokalemia, hypomagnesemia, bradycardia, starvation, CHF, & CNS injuries. Hepatorenal dysfunction & drug interactions can increase the concentration of QT interval-prolonging drugs. Coadministration of QT interval-prolonging drugs can have additive effects.

Avoid these (and other) drugs in congenital prolonged QT syndrome (www.qtdrugs.org). *Torsades reported in product labeling/case reports. †Increased risk in women. ‡QT prolongation: thioridazine > ziprasidone > risperidone, quetiapine, haloperidol. §May be due to electrolyte imbalance.

IBUTILIDE ( Corvert ) Recent onset A-fi b/fl utter: 0.01 mg/kg up to 1 mg IV
over 10 min, may repeat once if no response after 10 additional min. Keep on cardiac monitor at least 4 h. `K ♀C ? $$$$$

ISOPROTERENOL ( Isuprel ) Refractory bradycardia or 3rd degree A y
y
g

V block:

bolus method: 0.02 to 0.06 mg IV: infusion method, dilute 2 mg in 250 mL

D5W (8 mcg/mL), a rate of 37.5 mL/h delivers 5 mcg/min. Peds infusion method: 0.05 to 2 mcg/kg/min. Using the same concentration as adult for a 10 kg child, a rate of 8 mL/h delivers 0.1 mcg/kg/min. `LK ♀C ? $$$

LIDOCAINE ( Xylocaine, Xylocard)

d

Ventricular arrhythmia:

y

Load 1 mg/kg IV,
then 0.5 mg/kg q 8 to 10 min as needed to max 3 mg/kg. IV infusion: 4 g in 500 mL D5W (8 mg/mL) run at rate of 7.5 to 30 mL/h to deliver 1 to 4 mg/min.

Peds: 20 to 50 mcg/kg/min. `LK ♀B ? $

MEXILETINE ( Mexitil ) Proarrhythmic. Rarely indicated, consult cardiologist.

Ventricular arrhythmia:

y

Start 200 mg PO q 8 h with food or antacid, max dose 1200 mg/day. [Generic only: Caps, 150, 200, 250 mg.] `L ♀C – $$$

PROCAINAMIDE ( Pronestyl ) Ventricular arrhythmia: y

Loading dose: 100 mg

IV q 10 min or 20 mg/min (150 mL/h) until QRS widens more than 50%, dysrhythmia suppressed, hypotension, or total of 17 mg/kg or 1000 mg delivered. Infusion: dilute 2 g in 250 mL D5W (8 mg/mL) rate of 15 to 45 mL/h to deliver 2 to 6 mg/min. Proarrhythmic. `LK ♀C ? $

PROPAFENONE ( Rythmol, Rythmol SR

R) Proarrhythmic. Prevention of
paroxysmal atrial fi
p
y
b/fl utter or PSVT, with symptoms & no structural heart (cont.)

42 Cardiovascular
disease; or life-threatening ventricular arrhythmias: g
y

Start (immediate-
release) 150 mg PO q 8 h; may increase after 3 to 4 days to 225 mg PO q 8 h; max 900 mg/day. Prolong time to recurrence of symptomatic atrial fi b without structural heart disease: 225 mg SR PO q 12 h, may increase after 5 days to 325 mg SR PO q 12 h, max 425 mg SR PO q 12 h. Consider using with AV nodal blocking agent (beta-blocker, verapamil, diltiazem) to minimize risk of 1:1
atrial fl utter. [Generic/Trade: Tabs (immediate-release), scored 150, 225, 300
mg. Trade only: SR, Caps 225, 325, 425 mg.] `L ♀C ? $$$$

QUINIDINE ( Biquin durules)

s

Arrhythmia:

y

Gluconate, extended-release: 324
to 648 mg PO q 8 to 12 h; sulfate, immediate-release: 200 to 400 mg PO q 6 to 8 h; sulfate, extended-release: 300 to 600 mg PO q 8 to 12 h. Proarrhythmic.

[Generic gluconate: Tabs, extended-release unscored 324 mg. Generic sulfate: Tabs, scored immediate-release 200, 300 mg, Tabs, extended-release 300
mg.] `LK ♀C + $$$-gluconate, $-sulfate

SOTALOL ( Betapace, Betapace AF,  Rylosol ) Ventricular arrhythmia y

(Betapace), A-fi b/A-fl utter (Betapace AF): Start 80 mg PO bid, max 640 mg/
day. Proarrhythmic. [Generic/Trade: Tabs, scored 80, 120, 160, 240 mg, Tabs, scored (Betapace AF) 80, 120, 160 mg.] `K ♀B – $$$$

Anti-Hyperlipidemic Agents—Bile Acid Sequestrants CHOLESTYRAMINE ( Questran, Questran Light, Prevalite, LoCHOLEST, LoCHOLEST Light )

Elevated LDL-C: Powder: Start 4 g PO daily to bid before meals, increase up to max 24 g/day. [Generic/Trade: Powder for oral susp, 4 g cholestyramine resin/9 g powder (Questran, LoCHOLEST), 4 g cholestyramine resin/5 g powder (Questran Light), 4 g cholestyramine resin/5.5 g powder (Prevalite, LoCHOLEST Light). Each available in bulk powder and single-dose packets.] `Not absorbed ♀C + $$$

COLESEVELAM ( Welchol )

Glycemic control
y
of type 2 diabetes or reduce
yp
elevated LDL-C: 3 tabs PO bid with meals or 6 tabs once daily with a meal, max dose 6 tabs/day. [Trade only: Tabs, unscored, 625 mg.] `Not absorbed

♀B + $$$$$

COLESTIPOL ( Colestid, Colestid Flavoredd) Elevated LDL-C: Tabs: Start 2 g PO daily to bid, max 16 g/day. Granules: Start 5 g PO daily to bid, max 30 g/
day. [Generic/Trade: Tabs 1 g. Granules for oral susp, 5 g/7.5 g powder.] `Not absorbed ♀B + $$$

Anti-Hyperlipidemic Agents—HMG-CoA Reductase Inhibitors (“Statins”) & combinations

NOTE Hepatotoxicity: Monitor LFTs initially, about 12 weeks after starting/titrating therapy, then annually or more frequently if indicated. Evaluate muscle symptoms & creatine kinase before starting therapy. Evaluate muscle symptoms 6 to 12 weeks after starting/increasing therapy & at each follow-up visit.

Obtain creatine kinase when patient complains of muscle soreness, tenderness, weakness, or pain. These factors increase risk of myopathy: Advanced age (especially age older than 80 yo and female); multisystem disease (eg, (cont.)

Cardiovascular

43
chronic renal insuffi ciency, especially due to diabetes); multiple medications; perioperative periods; alcohol abuse; grapefruit juice (more than 1 quart/day); specifi c concomitant medications: Fibrates (especially gemfi brozil), nicotinic acid (rare), cyclosporine, erythromycin, clarithromycin, itraconazole, ketoconazole, protease inhibitors, nefazodone, verapamil, amiodarone. Weigh potential risk of combination therapy against potential benefi t.

ADVICOR (lovastatin + niacin)

Hyperlipidemia:

yp
p

1 tab PO qhs with a low-
fat snack. Establish dose using extended-release niacin fi rst, or if already on lovastatin substitute combo product with lowest niacin dose. ASA or ibuprofen 30 min prior may decrease niacin fl ushing reaction. [Trade only: Tabs, unscored extended-release lovastatin/niacin 20/500, 20/750, 20/1000, 40/1000 mg.] `LK ♀X – $$$$

ATORVASTATIN ( Lipitor)

r

Hyperlipidemia/prevention of cardiovascular events, yp
p
p

,
including type 2 DM:

g yp

Start 10 to 40 mg PO daily, max 80 mg/day. [Trade only: Tabs, unscored 10, 20, 40, 80 mg.] `L ♀X – $$$

CADUET (amlodipine + atorvastatin) Simultaneous treatment of HTN and hypercholesterolemia:

yp

Establish dose using component drugs fi rst. Dosing interval: Daily [Trade only: Tabs, 2.5/10, 2.5/20, 2.5/40, 5/10, 5/20, 5/40, 5/80, 10/10, 10/20, 10/40, 10/80 mg.] `L ♀X – $$$$

FLUVASTATIN ( Lescol, Lescol XL)

Hyperlipidemia:

yp
p

Start 20 to 80 mg PO qhs,
max 80 mg daily (XL) or divided bid. Post percutaneous coronary intervention: p
y

80 mg of extended-release PO daily, max 80 mg daily. [Trade only: Caps, 20, 40 mg. Tabs, extended-release, unscored 80 mg.] `L ♀X – $$$

LOVASTATIN ( Mevacor, Altoprev)

v

Hyperlipidemia/prevention of cardio-
yp
p
p
vascular events: Start 20 mg PO q pm, max 80 mg/day daily or divided bid.

[Generic/Trade: Tabs, unscored 20, 40 mg. Trade only: Tabs, extended-release (Altoprev) 20, 40, 60 mg.] `L ♀X – $

LIPID REDUCTION BY CLASS/AGENT1

Drug class/agent

LDL

HDL

TG

Bile acid sequestrants2

↓ 15–30%

↑ 3–5%

No change or ↑

Cholesterol absorption inhibitor3

↓ 18%

↑ 1%

↓ 8%

Fibrates4

↓ 5–20%

↑ 10–20% ↓ 20–50%

Lovastatin+ext’d release niacin5*

↓ 30–42%

↑ 20–30% ↓ 32–44%

Niacin6*

↓ 5–25%

↑ 15–35% ↓ 20–50%

Omega 3 fatty acids7

No change or ↑

↑ 9%

↓ 45%

Statins8

↓18–63%

↑ 5–15%

↓ 7–35%

Simvastatin+ezetimibe9

↓ 45–60%

↑ 6–10%

↓ 23–31%

1. LDL = low density lipoprotein. HDL = high density lipoprotein. TG = triglycerides. Adapted from NCEP: JAMA 2001; 285:2486 and prescribing information. 2. Cholestyramine (4–16 g), colestipol (5–20 g), colesevelam (2.6–3.8 g). 3. Ezetimibe (10 mg). When added to statin therapy, will ↓ LDL 25%, ↑ HDL 3%,

↓ TG 14% in addition to statin effects. 4. Fenofi brate (145–200 mg), gemfi brozil (600 mg BID). 5. Advicor®

(20/1000–40/2000 mg). 6. Extended release nicotinic acid (Niaspan® 1–2 g), immediate release (crystalline) nicotinic acid (1.5–3 g), sustained release nicotinic acid (Slo-Niacin® 1–2 g). 7. Lovaza (4 g) 8. Atorvastatin (10–80 mg), fl uvastatin (20–80 mg), lovastatin (20–80 mg), pravastatin (20–80 mg), rosuvastatin (5–40 mg), simvastatin (20–80 mg). 9. Vytorin® (10/10–10/80 mg). *Lowers lipoprotein a.

44 Cardiovascular

PRAVASTATIN ( Pravachol ) Hyperlipidemia/prevention of cardiovascular yp
p
p
events: Start 40 mg PO daily, max 80 mg/day. [Generic/Trade: Tabs, unscored 10, 20, 40, 80 mg. Generic only: Tabs 30 mg.] `L ♀X – $$$

ROSUVASTATIN ( Crestor)

r

Hyperlipidemia/slow progression of atherosclerosis: yp
p
p g

Start 10 mg PO daily, max 40 mg/day. [Trade only: Tabs, unscored 5, 10, 20, 40 mg.] `L ♀X – $$$$

SIMCOR (simvastatin + niacin)

Hyperlipidemia:

yp
p

1 tab PO qhs with a low-fat
snack. If niacin-naive or switching from immediate-release niacin, start: 20/500
mg PO q pm. If receiving extended-release niacin, do not start with more than 40/2000 mg PO every evening. Max 40/2000 mg/day. ASA or ibuprofen 30 min prior may decrease niacin fl ushing reaction. [Trade only: Tabs, unscored extended-release simvastatin/niacin 20/500, 20/750, 20/1000 mg.] `LK ♀X – $$$

SIMVASTATIN ( Zocor)

r

Hyperlipidemia:

yp
p

Start 20 to 40 mg PO q pm, max 80
mg/day. Reduce cardiovascular mortality/events in high risk for coronary heart disease event: Start 40 mg PO q pm, max 80 mg/day. [Generic/Trade: Tabs, unscored 5, 10, 20, 40, 80 mg. Generic only: Orally disintegrating tabs 10, 20, 40, 80 mg.] `L ♀X – $$$$

VYTORIN (ezetimibe + simvastatin)

Hyperlipidemia:

yp
p

Start 10/20 mg PO
q pm, max 10/80 mg/day. Start 10/40 mg if goal is >55% LDL reduction.

[Trade only: Tabs, unscored ezetimibe/simvastatin 10/10, 10/20, 10/40, 10/80
mg.] `L ♀X – $$$$

Anti-Hyperlipidemic Agents—Other

BEZAFIBRATE ( Bezalip) Canada
p
only. Hyperlipidemia/hypertriglyceridemia:

yp
p
yp
g y

200 mg immediate-release PO bid to tid, or 400 mg of sustained-release PO
daily. [Canada Trade only: Sustained-release tab 400 mg.] `K ♀D – $$$

EZETIMIBE ( Zetia,  Ezetrol ) Hyperlipidemia: yp
p

10 mg PO daily. [Trade only:

Tabs, unscored 10 mg.] `L ♀C ? $$$$

FENOFIBRATE ( TriCor, Antara, Lipofen, Triglide,  Lipidil Micro, Lipidil Supra, Lipidil EZ)

Z

Hypertriglyceridemia:

yp
g y

Tricor tabs: 48 to 145 mg PO daily, max 145
mg daily. Antara: 43 to 130 mg PO daily; max 130 mg daily. Fenoglide: 40 to 120 mg PO daily; max 120 mg daily. Lipofen: 50 to 150 mg PO daily, max 150
mg daily. Lofi bra: 54 to 200 mg PO daily, max 200 mg daily. Triglide: 50 to 160
mg PO daily, max 160 mg daily. Generic tabs: 54 to 160 mg, max 160 mg daily.

Generic caps: 67 to 200 mg PO daily; max 200 mg daily. Hypercholesterolemia/
yp
mixed dyslipidemia:

y p

Tricor tabs: 145 mg PO daily. Antara: 130 mg PO daily.

Fenoglide: 120 mg daily. Lipofen: 150 mg daily. Lofi bra: 160 to 200 mg daily, max 200 mg daily. Triglide: 160 mg daily. Generic tabs: 160 mg daily. Generic caps 200 mg PO daily. All formulations, except Antara, Tricor, and Triglide should be taken with food. [Generic only: Tabs, unscored 54, 160 mg. Generic caps, 67, 134, 200 mg. Trade only: Tricor tabs, unscored 48, 145 mg. Antara caps 43, 130 mg. Fenoglide unscored tabs 40, 120 mg. Lipofen unscored tabs 50, 100, 150 mg. Lofi bra tabs, unscored 54, 160 mg. Triglide tabs, unscored 50, 160 mg. Lofi bra caps, 67, 134, 200 mg.] `LK ♀C – $$$

FENOFIBRIC ACID ( TriLipixx)

In combination with statin for mixed dyslipidemia
y p
and CHD or CHD risk equivalent:

q

135 mg PO daily. Hypertriglyceridemia:

yp
g y

45 to

(cont.)

Cardiovascular

45

135 mg PO daily, max 135 mg daily. Hypercholesterolemia/mixed dyslipidemia: yp
y p

135 mg PO daily. [TriLipix, delayed-release caps 45, 135 mg.] `LK ♀C

– $$$

GEMFIBROZIL ( Lopid)

d

Hypertriglyceridemia/primary prevention of CAD:

yp
g y
p
y p

600 mg

PO bid 30 min before meals. [Generic/Trade: Tabs, scored 600 mg.] `LK ♀C ? $$$

Antihypertensive Combinations

NOTE Dosage should fi rst be adjusted by using each drug separately. See component drugs for further details.

BY TYPE: ACE Inhibitor/Diuretic:

Accuretic, Capozide, Inhibace Plus,

Lotensin HCT, Monopril HCT, Prinzide, Uniretic, Vaseretic, Zestoretic. ACE

Inhibitor/Calcium Channel Blocker: Lexxel, Lotrel, Tarka. Angiotensin Receptor Blocker/Diuretic: Atacand HCT, Avalide, Benicar HCT, Diovan HCT, Hyzaar, Micardis HCT, Teveten HCT. Angiotensin Receptor Blocker/Calcium Channel Blocker: Exforge. Beta-blocker/Diuretic: Corzide, Dutoprol, Inderide, Lopressor HCT, Tenoretic, Timolide, Ziac. Diuretic combinations: Aldactazide, Dyazide, Maxzide, Moduretic, Triazide. Diuretic/miscellaneous antihypertensive: Aldoril, Apresazide, Clorpres, Minizide.

BY NAME: ACCURETIC (quinapril + HCTZ): Generic/Trade: Tabs, 10/12.5, 20/12.5, 20/25. Aldactazide (spironolactone ⫹ HCTZ): Generic/Trade: Tabs, non-scored 25/25, scored 50/50 mg. Aldoril (methyldopa ⫹ HCTZ): Generic/

Trade: Tabs, non-scored, 250/15 (Aldoril-15), 250/25 mg (Aldoril-25). Trade only: Tabs, non-scored, 500/30 (Aldoril D30), 500/50 mg (Aldoril D50). Apresazide (hydralazine ⫹ HCTZ): Generic only: Caps 25/25, 50/50 mg. Atacand HCT

(candesartan ⫹ HCTZ,  Atacand Plus): Trade only: Tab, non-scored 16/12.5, 32/12.5 mg. Avalidee (irbesartan ⫹ HCTZ): Trade only: Tabs, non-scored 150/12.5, 300/12.5, 300/25 mg. Benicar HCT

T (olmesartan ⫹ HCTZ): Trade only: Tabs,
non-scored 20/ 12.5, 40/12.5, 40/25 Capozidee (captopril ⫹ HCTZ): Generic/

Trade: Tabs, scored 25/15, 25/25, 50/15, 50/25 mg. Clorpress (clonidine ⫹
chlorthalidone): Trade only: Tabs, scored 0.1/15, 0.2/15, 0.3/15 mg.

Corzidee (nadolol ⫹ bendrofl umethiazide): Generic/Trade: Tabs 40/5, 80/5 mg. Diovan HCT

T (valsartan ⫹ HCTZ): Trade only: Tabs, non-scored 80/12.5, 160/12.5, 160/25, 320/12.5, 320/25 mg. Dutoprol l (metoprolol

⫹ HCTZ): Trade only: Tabs, non-scored 25/12.5, 50/12.5 mg. Tabs, scored 100/12.5 mg Dyazidee (triam-terene ⫹ HCTZ): Generic/Trade: Caps, (Dyazide) 37.5/25, (generic only) 50/25 mg. Exforgee (amlodipine ⫹
valsartan): Trade only: Tabs, non-scored 5/160, 5/320, 10/160, 10/320 mg.

Hyzaar
r (losartan ⫹ HCTZ): Trade only: Tabs, non-scored 50/12.5, 100/12.5, 100/25 mg. Inderide (propranolol ⫹ HCTZ): Generic/Trade: Tabs, scored 40/25, 80/25. Inhibace Pluss (cilazapril ⫹ HCTZ): Trade only: Scored tabs 5 mg cilazapril

⫹ 12.5 mg HCTZ. Lexxell (enalapril ⫹ felodipine): Trade only: Tabs, non-scored 5/2.5, 5/5 mg. Lopressor HCTT (metoprolol ⫹ HCTZ): Generic/Trade: Tabs, scored 50/25, 100/25, 100/50 mg. Lotensin HCTT (benazepril ⫹ HCTZ): Generic/

Trade: Tabs, scored 5/6.25, 10/12.5, 20/12.5, 20/25 mg. Lotrell (amlodipine ⫹
benazepril): Generic/Trade: Cap, 2.5/10, 5/10, 5/20, 10/20 mg. Trade only: Cap, (cont.)

46 Cardiovascular

5/40, 10/40 mg. Maxzide
e (triamterene ⫹ HCTZ,  Triazide): Generic/ T
e
rade: Tabs,
scored (Maxzide-25) 37.5/25 (Maxzide) 75/50 mg. Maxzide-25

5 (triamterene

⫹ HCTZ): Generic/Trade: Tabs, scored (Maxzide-25) 37.5/25 (Maxzide) 75/50
mg. Micardis HCT

T (telmisartan ⫹ HCTZ,  Micardis Plus): T
s
rade only: Tabs,
non-scored 40/12.5, 80/12.5, 80/25 mg. Minizidee (prazosin ⫹ polythiazide): Trade only: cap, 1/0.5, 2/0.5, 5/0.5 mg. Moduretic (amiloride ⫹ HCTZ,

 Moduret): Generic/Trade: Tabs, scored 5/50 mg. Monopril HCTT (fosinopril ⫹

HCTZ): Generic/Trade: Tabs, non-scored 10/12.5, scored 20/12.5 mg. Prinzide (lisinopril ⫹ HCTZ): Generic/Trade: Tabs, non-scored 10/12.5, 20/12.5, 20/25
mg. Tarkaa (trandolapril ⫹ verapamil): Trade only: Tabs, non-scored 2/180, 1/240, 2/240, 4/240 mg. Tenoretic (atenolol ⫹ chlorthalidone): Generic/Trade: Tabs, scored 50/25, non-scored 100/25 mg. Teveten HCT (

T eprosartan ⫹ HCTZ):

Trade only: Tabs, non-scored 600/12.5, 600/25 mg. Timolide (
e timolol ⫹ HCTZ):

Trade only: Tabs, non-scored 10/25 mg. Unireticc (moexipril ⫹ HCTZ): Generic/

Trade: Tabs, scored 7.5/12.5, 15/12.5, 15/25 mg. Vaseretic (enalapril ⫹

HCTZ): Generic/Trade: Tabs, non-scored 5/12.5, 10/25 mg. Zestoretic (lisinopril

⫹ HCTZ): Generic/Trade: Tabs, non-scored 10/12.5, 20/12.5, 20/25 mg. Ziac (biso-prolol ⫹ HCTZ): Generic/Trade: Tabs, non-scored 2.5/6.25, 5/6.25, 10/6.25 mg.

Antihypertensives—Other

ALISKIREN ( Tekturna)

HTN: 150 mg PO daily, max 300 mg/day. [Trade only:

Tabs, unscored 150, 300 mg.] `LK ♀– –? $$$

FENOLDOPAM ( Corlopam)

m

Severe HTN: 10 mg in 250 mL D5W (40 mcg/mL),
start at 0.1 mcg/kg/min titrate q 15 min, usual effective dose 0.1 to 1.6 mcg/
kg/min. `LK ♀B ? $$$

STATINS

Minimum Dose for

LDL*

LFT Monitoring**

30–40% LDL Reduction
atorvastatin 10 mg

−39%

Baseline, 12 weeks, semiannually
fl uvastatin 40 mg bid

−36%

Baseline, 12 weeks
fl uvastatin XL 80 mg

−35%

Baseline, 12 weeks
lovastatin 40 mg

−31%

Baseline
pravastatin 40mg

−34%

Baseline
rosuvastatin 5 mg

−45%

Baseline, 12 weeks, semiannually
simvastatin 20 mg

−38%

Baseline for all doses; Get LFTs prior to & 3
months after dose increase to 80 mg, then
semiannually for fi rst year.

*Adapted from Circulation 2004;110:227–239. **Data taken from prescribing information for primary hyper cholesterolemia. LDL= low-density lipoprotein, LFT = l iver function tests. Will get ~6% decrease in LDL with every doubling of dose. ACC/AHA/NHLBI schedule for LFT monitoring: baseline, ~12 weeks after starting/titrating therapy, annually, when clinically indicated. Stop statin therapy if LFTs are >3 times upper limit of normal.

Cardiovascular

47

LDL CHOLESTEROL GOALS1

Lifestyle

Also Consider Meds

Changes2
at LDL (mg/dL)3

Risk Category

LDL Goal

High risk:

g

CHD or equiv a lent

<100 (optional

LDL ≥1008 ≥100 (<100:

risk,4,5,6 10-year risk >20%

< 70)7
consider Rx options)9

Moderately high risk:

y g

2+

<130 (optional

LDL ≥1308 ≥130 (100–129:

risk factors,10 10-year risk

< 100)

consider Rx

10–20%
options)11

Moderate risk: 2+ risk

<130 mg/dL

LDL ≥130 ≥160
factors,10 10-year risk <10%

Lower risk: 0 to 1 risk factor5

<160 mg/dL

LDL ≥160 ≥190 (160–189:

Rx optional)

1.CHD=coronary heart disease. LDL=low density lipoprotein. Adapted from NCEP: JAMA 2001; 285:2486; NCEP Report: Circulation 2004;110:227-239. All 10-year risks based upon Framingham stratifi cation; calculator available at: http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof. 2. Dietary modifi cation, wt reduction, exercise. 3. When using LDL lowering therapy, achieve at least 30-40% LDL reduction. 4.

Equivalent risk defi ned as diabetes, other atherosclerotic disease (peripheral artery disease, abdominal aortic aneurysm, symptomatic carotid artery disease,CKD or prior ischemic CVA/TIA), or ≥2 risk factors such that 10-year risk >20%. 5. History of ischemic CVA or transient ischemic attack=CHD risk equivalents (Stroke 2006;37:577-617). 6. Chronic kidney disease=CHD risk equivalent [Am J Kidney Dis 2003 Apr;41 (4 suppl 3):I-IV,S1-91]. 7. For any patient with atherosclerotic disease, may treat to LDL <70 mg/dL (Circulation 2006;113:2363-72). 8. Regardless of LDL, lifestyle changes are indicated when lifestyle-related risk factors (obesity, physical inactivity, ↑TG, ↓HDL, or metabolic syndrome) are present. 9. If baseline LDL <100, starting LDL lowering therapy is an option based on clinical trials. With ↑TG or ↓HDL, consider combining fi brate or nicotinic acid with LDL lowering drug. 10. Risk factors: Cigarette smoking, HTN (BP ≥140/90 mmHg or on antihypertensive meds), low HDL (<40 mg/dL), family hx of CHD (1° relative: ♂ <55 yo, ♀ <65 yo), age (♂ ≥45 yo, ♀ ≥55 yo). 11. At baseline or after lifestyle changes - initiating therapy to achieve LDL <100
is an option based on clinical trials.

HYDRALAZINE ( Apresoline)

Hypertensive emergency:

yp
g
y 10 to 50 mg IM or 10
to 20 mg IV, repeat prn. HTN: Start 10 mg PO bid to qid, max 300 mg/day.

Headaches, peripheral edema, SLE syndrome. [Generic only: Tabs, unscored 10, 25, 50, 100 mg.] `LK ♀C + $

NITROPRUSSIDE ( Nipride, Nitropress)

s

Hypertensive emergency:

yp
g
y Dilute 50 mg
in 250 mL D5W (200 mcg/mL), rate of 6 mL/h for 70 kg adult delivers starting dose of 0.3 mcg/kg/min. Max 10 mcg/kg/min. Protect from light. Cyanide toxicity with high doses (10 mcg/kg/min), hepatic/renal impairment, and prolonged infusions (longer than 3 to 7 days); check thiocyanate levels. `RBCs ♀C – $

PHENTOLAMINE ( Regitine, Rogitine)

Diagnosis of pheochromocytoma:

g
p
y

5
mg increments IV/IM. Peds 0.05 to 0.1 mg/kg IV/IM up to 5 mg per dose.

Extravasation: 5 to 10 mg in 10 mL NS inject 1 to 5 mL SC (in divided doses) around extravasation site. `Plasma ♀C ? $$$

Antiplatelet Drugs

ABCIXIMAB ( ReoPro) Platelet aggregation inhibition, percutaneous coronary gg g

, p
y
intervention: 0.25 mg/kg IV bolus via separate infusion line before procedure, then 0.125 mcg/kg/min (max 10 mcg/min) IV infusion for 12 h. `Plasma

♀C ? $$$$$

48 Cardiovascular

AGGRENOX (ASA + dipyridamole)

Prevention of CVA after TIA/CVA:

1 cap PO bid. [Trade only: Caps, 25 mg ASA/200 mg extended-release dipyridamole.] `LK ♀D ? $$$$

CLOPIDOGREL ( Plavixx)

Reduction of thrombotic events: Recent acute MI/

CVA, established peripheral arterial disease:

,
p p

75 mg PO daily; non-ST segment
g
elevation acute coronary syndrome:

y y

300 mg loading dose, then 75 mg PO daily
in combination with ASA. ST segment elevation MI:

g

Start with/without 300
mg loading dose, then 75 mg PO daily in combination with ASA, with/without thrombolytics. [Trade: Tabs, unscored 75, 300 mg.] `LK ♀B ? $$$$

DIPYRIDAMOLE ( Persantine)

Antithrombotic: 75 to 100 mg PO qid. [Generic/

Trade: Tabs, unscored 25, 50, 75 mg.] `L ♀B ? $$$

EPTIFIBATIDE ( Integrilin)

n

Acute coronary syndrome:

y y

Load 180 mcg/kg IV
bolus, then infusion 2 mcg/kg/min for up to 72 h. Discontinue infusion prior to CABG. Percutaneous coronary intervention:

y

Load 180 mcg/kg IV bolus just
before procedure, followed by infusion 2 mcg/kg/min and a 2nd 180 mcg/kg IV bolus 10 min after the fi rst bolus. Continue infusion for up to 18 to 24 h (minimum 12 h) after procedure. Reduce infusion dose to 1 mcg/kg/min with CrCl <50 mL/min; contraindicated in dialysis patients. `K ♀B ? $$$$$

PRASUGREL ( Effi ent ) Reduction of thrombotic events after acute coronary y
syndrome managed with percutaneous coronary intervention (PCI): y
g
p
y

(

) 60 mg
loading dose, then 10 mg PO daily in combination with ASA. Patients wt less than 60 kg consider lowering maintenance dose to 5 mg PO daily. [Trade: Tabs, unscored 5, 10 mg.] `LK ♀B ? $$$$

TICLOPIDINE ( Ticlid) Due to high incidence of neutropenia and thrombotic thrombocytopenia purpura, other drugs preferred. Platelet aggregation gg g
inhibition/reduction of thrombotic CVA: 250 mg PO bid with food. [Generic/

Trade: Tabs, unscored 250 mg.] `L ♀B ? $$$$

TIROFIBAN ( Aggrastat ) Acute coronary syndromes: y y

Start 0.4 mcg/kg/min IV
infusion for 30 min, then decrease to 0.1 mcg/kg/min for 48 to 108 h or until 12 to 24 h after coronary intervention. Half dose with CrCl <30 mL/min. Use concurrent heparin to keep PTT 2× normal. `K ♀B ? $$$$$

Beta-Blockers

NOTE See also antihypertensive combinations. Not fi rst line for HTN unless to treat angina, post MI, LV dysfunction. Abrupt discontinuation may precipitate angina, MI, arrhythmias, or rebound HTN; discontinue by tapering over 1 to 2 weeks. Avoid use of non-selective beta-blockers and use agents with beta-1 cautiously in asthma/COPD. Beta-1 selectivity diminishes at high doses. Avoid in decompensated heart failure, sick sinus syndrome, severe peripheral artery disease.

ACEBUTOLOL ( Sectral,  Rhotral ) HTN: Start 400 mg PO daily or 200 mg PO
bid, maximum 1200 mg/day. Beta-1 receptor selective. [Generic/Trade: Caps, 200, 400 mg.] `LK ♀B – $$

ATENOLOL ( Tenormin)

n

Acute MI: 50 to 100 mg PO daily or in divided doses; or 5 mg IV over 5 min, repeat in 10 min. HTN: Start 25 to 50 mg PO daily or divided bid, maximum 100 mg/day. Beta-1 receptor selective. [Generic/Trade: Tabs, unscored 25, 100 mg; scored, 50 mg.] `K ♀D – $

Cardiovascular

49

BETAXOLOL ( Kerlone)

HTN: Start 5 to 10 mg PO daily, max 20 mg/day. Beta-1
receptor selective. [Generic/Trade: Tabs, scored 10 mg, unscored 20 mg.]

`LK ♀C ? $$

BISOPROLOL ( Zebeta,  Monocorr) HTN: Start 2.5 to 5 mg PO daily, max 20 mg/day. Beta-1 receptor selective. [Generic/Trade: Tabs, scored 5 mg, unscored 10 mg.] `LK ♀C ? $$

CARVEDILOL ( Coreg, Coreg CR

R) Heart failure,, immediate-release: Start 3.125 mg PO bid, double dose every 2 weeks as tolerated up to max of 25
mg bid (for wt 85 kg or less) or 50 mg bid (for wt greater than 85 kg). Heart failure,, sustained-release: Start 10 mg PO daily, double dose every 2 weeks as tolerated up to max of 80 mg/day. LV dysfunction following acute MI, immediate-release: Start 3.125 to 6.25 mg PO bid, double dose q 3 to 10
days as tolerated to max of 25 mg bid. LV dysfunction following acute MI, y
g

,
sustained-release: Start 10 to 20 mg PO daily, double dose q 3 to 10 days as tolerated to max of 80 mg/day. HTN,, immediate-release: Start 6.25 mg PO bid, double dose q 7 to 14 days as tolerated to max 50 mg/day. HTN,, sustained-release: Start 20 mg PO daily, double dose q 7 to 14 days as tolerated to max 80 mg/day. Take with food to decrease orthostatic hypotension. Give Coreg CR
in the morning. Alpha-1, beta-1, and beta-2 receptor blocker. [Generic/Trade: Tabs, immediate-release unscored 3.125, 6.25, 12.5, 25 mg. Trade only: Caps, extended-release 10, 20, 40, 80 mg.] `L ♀C ? $$$$

ESMOLOL ( Brevibloc)

SVT/HTN emergency:

g
y Load 500 mcg/kg over 1 min

(dilute 5 g in 500 mL (10 mg/mL) and give 3.5 ml to deliver 35 g bolus for 70 kg patient) then start infusion 50 to 200 mcg/kg/min (40 mL/h delivers 100 mcg/kg/min for 70 kg patient). Half-life is 9 min. Beta-1 receptor selective. `K ♀C ? $

LABETALOL ( Trandate)

HTN: Start 100 mg PO bid, max 2400 mg/day. HTN
emergency:

g
y Start 20 mg IV slow injection, then 40 to 80 mg IV q 10 min prn up to 300 mg or IV infusion 0.5 to 2 mg/min. Peds: Start 0.3 to 1 mg/kg/dose (max 20 mg). Alpha-1, beta-1, and beta-2 receptor blocker. [Generic/Trade: Tabs, scored 100, 200, 300 mg.] `LK ♀C + $$$

METOPROLOL ( Lopressor, Toprol-XL,  Betaloc) Acute MI: 50 to 100 mg PO
q 12 h; or 5 mg increments IV q 5 to 15 min up to 15 mg followed by oral therapy. HTN (immediate-release): Start 100 mg PO daily or in divided doses, increase pm up to 450 mg/day; may require multiple daily doses to maintain 24 h BP control. HTN (extended-release): Start 25 to 100 mg PO daily, increase pm up to 400 mg/day. Heart failure: Start 12.5 to 25 mg (extended-release) PO
daily, double dose q 2 weeks as tolerated up to max 200 mg/day. Angina: g

Start

50 mg PO bid (immediate-release) or 100 mg PO daily (extended-release), increase pm up to 400 mg/day. Beta-1 receptor selective. IV to PO conversion: 1 mg IV is equivalent to 2.5 mg PO (divided qid). Immediate-release form is metoprolol tartrate; extended-release form is metoprolol succinate. Take with food. [Generic/Trade: Tabs, scored 50, 100 mg, extended-release 25, 50, 100, 200 mg. Generic only: Tabs, scored 25 mg.] `L ♀C ? $$

NADOLOL ( Corgard)

d HTN: Start 20 to 40 mg PO daily, max 320 mg/day.

Beta-1 and beta-2 receptor blocker. [Generic/Trade: Tabs, scored 20, 40, 80, 120, 160 mg.] `K ♀C – $$

50 Cardiovascular

NEBIVOLOL ( Bystolic)

HTN: Start 5 mg PO daily, maximum 40 mg/day.

Beta-1 receptor selective at doses of 10 mg or less and in patients who extensively metabolize CYP2D6; otherwise, inhibits both beta-1 and beta-2
receptors. [Trade only: Tabs, unscored 2.5, 5, 10, 20 mg.] `L ♀C – $$$

OXPRENOLOL ( Trasicor, Slow-Trasicorr) Canada only. HTN: Regular-release: Initially 20 mg PO tid, titrate upwards prn to usual maintenance 120
to 320 mg/day divided bid to tid. Alternatively, may substitute an equivalent daily dose of sustained-release product; do not exceed 480 mg/day. [Trade only: Regular-release tabs 40, 80 mg. Sustained-release tabs 80, 160
mg.] `L ♀D – $$

PINDOLOL ( Visken) HTN: Start 5 mg PO bid, max 60 mg/day. Beta-1 and beta-2 receptor blocker. [Generic only: Tabs, scored 5, 10 mg.] `K ♀B ? $$$

PROPRANOLOL ( Inderal, Inderal LA, InnoPran XL) HTN: Start 20 to 40 mg PO bid or 60 to 80 mg PO daily, max 640 mg/day; extended-release (Inderal LA) max 640 mg/day; extended-release (InnoPran XL) 80 mg qhs (10 pm), max 120 mg qhs (chronotherapy). Supraventricular tachycardia or rapid p
y
p
atrial fi brillation/fl utter: 1 mg IV q 2 min. Max of 2 doses in 4 h. Migraine g
prophylaxis:

p p y

Start 40 mg PO bid or 80 mg PO daily (extended-release), max 240 mg/day. Beta-1 and beta-2 receptor blocker. [Generic/Trade: Tabs, scored 40, 60, 80. Caps, extended-release 60, 80, 120, 160 mg. Generic only: Soln 20, 40 mg/5 mL. Tabs, 10, 20 mg. Trade only: (InnoPran XL qhs) 80, 120
mg.] `L ♀C + $$

Calcium Channel Blockers (CCBs)—Dihydropyridines NOTE See also antihypertensive combinations.

AMLODIPINE ( Norvasc)

HTN: Start 2.5 to 5 mg PO daily, max 10
daily. [Generic/Trade: Tabs, unscored 2.5, 5, 10 mg. Generic only: Orally disintegrating tabs 2.5, 5, 10 mg.] `L ♀C ? $$$

CLEVIDIPINE ( Cleviprex)

x HTN: Start 1 to 2 mg/h IV, titrate q 1.5 to 10 min to bp response, usual maintenance dose 4 to 6 mg/h, max 32 mg/h IV. An increase of 1 to 2 mg/h will decrease SBP approximately 2 to 4 mmHg. `KL ♀C ? $$$

FELODIPINE ( Plendil,  Renedil ) HTN: Start 2.5 to 5 mg PO daily, maximum 10 mg/day. [Generic/Trade: Tabs, extended-release, unscored 2.5, 5, 10 mg.]

`L ♀C ? $$

ISRADIPINE ( DynaCirc, DynaCirc CR)

R HTN: Start 2.5 mg PO bid, max 20 mg/
day (max 10 mg/day in elderly). Controlled-release: 5 to 10 mg PO daily. [Trade only: Tabs, controlled-release 5, 10 mg. Generic only: Immediate-release caps 2.5, 5 mg.] `L ♀C ? $$$$

NICARDIPINE ( Cardene, Cardene SR

R)

HTN emergency:

g
y Begin IV infusion at

5 mg/h, titrate to effect, max 15 mg/h. HTN: Start 20 mg PO tid, max 120 mg/
day. Sustained-release: Start 30 mg PO bid, max 120 mg/day. [Generic/Trade: Caps, immediate-release 20, 30 mg. Trade only: Caps, sustained-release 30, 45, 60 mg.] `L ♀C ? $$

NIFEDIPINE ( Procardia, Adalat, Procardia XL, Adalat CC, Afeditab CR,

 Adalat XL, Adalat PA) HTN/angina:

g

Extended-release: 30 to 60 mg PO

(cont.)

Cardiovascular

51
daily, max 120 mg/day. Angina:

g

Immediate-release: Start 10 mg PO tid,
max 120 mg/day. Avoid sublingual administration, may cause excessive hypotension, acute MI, CVA. Do not use immediate-release caps for treating HTN. Preterm labor: Loading dose: 10 mg PO q 20 to 30 min if contractions persist, up to 40 mg within the fi rst h. Maintenance dose: 10 to 20 mg PO q 4
to 6 h or 60 to 160 mg extended-release PO daily. [Generic/Trade: Caps, 10, 20
mg. Tabs, extended-release (Adalat CC, Afeditab CR, Procardia XL) 30, 60 mg, (Adalat CC, Procardia XL) 90 mg.] `L ♀C + $$

NISOLDIPINE ( Sularr) HTN: Start 17 mg PO daily, max 34 mg/day. Take on an empty stomach. [Trade only: Tabs, extended-release 8.5, 17, 25.5, 34 mg.

These replace the former 10, 20, 30, 40 mg tabs. Generic only: Tabs, extended-release 20, 30, 40 mg.] `L ♀C ? $$$

Calcium Channel Blockers (CCBs)—Non-Dihydropyridines NOTE See also antihypertensive combinations.

DILTIAZEM ( Cardizem, Cardizem LA, Cardizem CD, Cartia XT, Dilacor XR, Diltiazem CD, Diltzac, Diltia XT, Tiazac, Taztia XT ) Atrial fi brillation/
fl utter, ,PSVT: Bolus 20 mg (0.25 mg/kg) IV over 2 min. Rebolus 15 min later (if needed) 25 mg (0.35 mg/kg). Infusion 5 to 15 mg/h. HTN,, once daily, extended-release: Start 120 to 240 mg PO daily, max 540 mg/day. HTN,, once daily, graded extended-release (Cardizem LA): Start 180 to 240 mg PO daily, max 540 mg/day. HTN, twice daily, sustained-release: Start 60 to 120 mg PO
bid, max 360 mg/day. Angina
g

, immediate-release: Start 30 mg PO qid, max

360 mg/day divided tid to qid; Angina
g

, extended-release: start 120 to 240
mg PO daily, max 540 mg/day. Angina,
g

, once daily, graded extended-release

(Cardizem LA): start 180 mg PO daily, doses more than 360 mg may provide no additional benefi t. [Generic/Trade: Tabs, immediate-release, unscored (Cardizem) 30, scored 60, 90, 120 mg; Caps, extended-release (Cardizem CD, Cartia XT daily) 120, 180, 240, 300, 360 mg, (Diltzac, Taztia XT, Tiazac daily) 120, 180, 240, 300, 360, 420 mg, (Dilacor XR, Diltia XT) 120, 180, 240 mg.

Trade only: Tabs, extended-release graded (Cardizem LA daily) 120, 180, 240, 300, 360, 420 mg.] `L ♀C + $$

VERAPAMIL ( Isoptin SR, Calan, Covera-HS, Verelan, Verelan PM,

 Veramil )

SVT adults: 5 to 10 mg IV over 2 min; SVT peds (age 1 to 15 yo): 2 to 5 mg (0.1 to 0.3 mg/kg) IV, max dose 5 mg. Angina: g

Immediate-release,
start 40 to 80 mg PO tid to qid, max 480 mg/day; sustained to release, start 120 to 240 mg PO daily, max 480 mg/day (use bid dosing for doses greater than 240 mg/day with Isoptin SR and Calan SR); (Covera-HS) 180 mg PO qhs, max 480 mg/day. HTN: Same as angina, except (Verelan PM) 100 to 200 mg PO
qhs, max 400 mg/day; immediate-release tabs should be avoided in treating HTN. [Generic/Trade: Tabs, immediate-release, scored (Calan) 40, 80, 120
mg; Tabs, sustained-release, unscored (Isoptin SR) 120, scored 180, 240 mg; Caps, sustained-release (Verelan) 120, 180, 240, 360 mg; Caps, extended-release (Verelan PM) 100, 200, 300 mg. Trade only: Tabs, extended-release (Covera HS) 180, 240 mg.] `L ♀C + $$

52 Cardiovascular

Diuretics—Carbonic Anhydrase Inhibitors

ACETAZOLAMIDE ( Diamox, Diamox Sequels)

s Glaucoma: 250 mg PO up to
qid (immediate-release) or 500 mg PO up to bid (sustained-release). Max 1 g/
day. Acute glaucoma:

g

250 mg IV q 4 h or 500 mg IV initially with 125 to 250
mg q 4 h, followed by oral therapy. Mountain sickness prophylaxis: p p y

125 to 250
mg PO bid to tid, beginning 1 to 2 days prior to ascent and continuing at least 5 days at higher altitude. Edema: Rarely used, start 250 to 375 mg IV/PO q am given intermittently (every other day or 2 consecutive days followed by none for 1 to 2 days) to avoid loss of diuretic effect. [Generic only: Tabs, 125, 250 mg.

Generic/Trade: Caps, extended-release 500 mg.] `LK ♀C + $

Diuretics—Loop

BUMETANIDE ( Bumex,  Burinex) Edema: 0.5 to 1 mg IV/IM; 0.5 to 2 mg PO
daily. 1 mg bumetanide is roughly equivalent to 40 mg furosemide. [Generic/

Trade: Tabs, scored 0.5, 1, 2 mg.] `K ♀C ? $

ETHACRYNIC ACID ( Edecrin) Rarely used. May be useful in sulfa-allergic patients. Edema: 0.5 to 1 mg/kg IV, max 100 mg/dose; 25 to 100 mg PO daily to bid. [Trade only: Tabs, scored 25 mg.] `K ♀B ? $$$

FUROSEMIDE ( Lasix) Edema: Initial dose 20 to 80 mg IV/IM/PO, increase dose by 20 to 40 mg q 6 to 8 h until desired response is achieved, max 600
mg/day. Use lower doses in elderly. [Generic/Trade: Tabs, unscored 20, scored 40, 80 mg. Generic only: Oral soln 10 mg/mL, 40 mg/5 mL.] `K ♀C ? $

TORSEMIDE ( Demadex) Edema: 5 to 20 mg IV/PO daily. [Generic/Trade: Tabs, scored 5, 10, 20, 100 mg.] `LK ♀B ? $

Diuretics—Potassium Sparing

NOTE See also antihypertensive combinations and aldosterone antagonists.

Beware of hyperkalemia. Use cautiously with other agents that may cause hyperkalemia (ie, ACE inhibitors, ARBs, aliskiren).

Diuretics—Thiazide Type

NOTE See also antihypertensive combinations.

CHLORTHALIDONE ( Thalitone) HTN: 12.5 to 25 mg PO daily, max 50 mg/day.

Edema: 50 to 100 mg PO daily, max 200 mg/day. Nephrolithiasis p

(unapproved
use): 25 to 50 mg PO daily. [Trade only: Tabs, unscored (Thalitone) 15 mg.

Generic only: Tabs unscored 25, 50 mg.] `L ♀B, D if used in pregnancy-induced HTN + $

HYDROCHLOROTHIAZIDE ( HCTZ, Esidrix, Oretic, Microzide, HydroDiuril ) HTN: 12.5 to 25 mg PO daily, max 50 mg/day. Edema: 25 to 100 mg PO daily, max 200 mg/day. [Generic/Trade: Tabs, scored 25, 50 mg; Caps 12.5 mg.] `L

♀B, D if used in pregnancy-induced HTN + $

INDAPAMIDE ( Lozol,  Lozide) HTN: 1.25 to 5 mg PO daily, max 5 mg/day.

Edema: 2.5 to 5 mg PO qam. [Generic only: Tabs, unscored 1.25, 2.5 mg.] `L

♀B, D if used in pregnancy-induced HTN ? $

Cardiovascular

53

METOLAZONE ( Zaroxolyn)

n

Edema: 5 to 10 mg PO daily, max 10 mg/day in
heart failure, 20 mg/day in renal disease. If used with loop diuretic, start with 2.5 mg PO daily. [Generic/Trade: Tabs 2.5, 5, 10 mg.] `L ♀B, D if used in pregnancy-induced HTN ? $$$

Nitrates

ISOSORBIDE

DINITRATE ( Isordil, Dilatrate-SR,

 Cedocard

SR,

Coronex)

x

Angina prophylaxis:

g
p p y

5 to 40 mg PO tid (7 am, noon, 5 pm),
sustained-release: 40 to 80 mg PO bid (8 am, 2 pm). Acute angina, g

, SL

Tabs: 2.5 to 10 mg SL q 5 to 10 min prn, up to 3 doses in 30 min. [Generic/

Trade: Tabs, scored 5, 10, 20, 30 mg. Trade only: Tabs, (Isordil) 40 mg, Caps, extended-release (Dilatrate-SR) 40 mg. Generic only: Tabs, sustained-release 40 mg, Tabs, sublingual 2.5, 5 mg.] `L ♀C ? $

ISOSORBIDE MONONITRATE ( ISMO, Monoket, Imdur) r Angina:

g

20 mg PO bid

(8 am and 3 pm). Extended-release: Start 30 to 60 mg PO daily, maximum 240 mg/day. [Generic/Trade: Tabs, unscored (ISMO, bid dosing) 20 mg, scored (Monoket, bid dosing) 10, 20 mg, extended-release, scored (Imdur, daily dosing) 30, 60, unscored 120 mg.] `L ♀C ? $$

NITROGLYCERIN INTRAVENOUS INFUSION ( Tridil ) Perioperative HTN, acute p

,

MI/Heart failure, acute angina:

,
g

Mix 50 mg in 250 mL D5W (200 mcg/mL),
start at 10 to 20 mcg/min (3 to 6 mL/h), then titrate upward by 10 to 20 mcg/
min pm. [Brand name “Tridil” no longer manufactured, but retained herein for name recognition.] `L ♀C ? $

NITROGLYCERIN OINTMENT ( Nitro-BID)

D

Angina prophylaxis:

g
p p y

Start 0.5 inch
q 8 h, maintenance 1 to 2 inch q 8 h, maximum 4 inch q 4 to 6 h; 15 mg/inch.

Allow for a nitrate-free period of 10 to 14 h to avoid nitrate tolerance. 1 inch ointment is ~15 mg. [Trade only: Ointment, 2%, tubes 1, 30, 60 g (Nitro-BID).] `L ♀C ? $

NITROGLYCERIN SPRAY ( Nitrolingual, NitroMist ) Acute angina: g

1 to 2
sprays under the tongue prn, max 3 sprays in 15 min. [Trade only: Nitrolingual soln, 4.9, 12 mL. 0.4 mg/spray (60 or 200 sprays/canister); NitroMist aerosol 0.4 mg/spray (230 sprays/canister).] `L ♀C ? $$$$

NITROGLYCERIN SUBLINGUAL ( Nitrostat, NitroQuickk) Acute angina:

g

0.4 mg

SL under tongue, repeat dose q 5 min pm up to 3 doses in 15 min. [Generic/

Trade: Sublingual tabs, unscored 0.3, 0.4, 0.6 mg; in bottles of 100 or package of 4 bottles with 25 tabs each.] `L ♀C ? $

NITROGLYCERIN TRANSDERMAL ( Minitran, Nitro-Dur,  Trinipatchh) Angina g
prophylaxis:

p p y

1 patch 12 to 14 h each day. Allow for a nitrate-free period of 10 to 14 h each day to avoid nitrate tolerance. [Generic/Trade: Transdermal system 0.1, 0.2, 0.4, 0.6 mg/h. Trade only: (Nitro-Dur) 0.3, 0.8 mg/h.] `L

♀C ? $$

Pressors/Inotropes

DOBUTAMINE ( Dobutrexx) Inotropic support:

p
pp

2 to 20 mcg/kg/min. Dilute 250
mg in 250 mL D5W (1 mg/mL), a rate of 21 mL/h delivers 5 mcg/kg/min for a 70 kg patient. `Plasma ♀D – $

54 Cardiovascular

CARDIAC PARAMETERS AND FORMULAS

Cardiac output (CO) = heart rate × CVA volume [normal 4-8 l/min]

Cardiac index (CI) = CO/BSA [normal 2.8-4.2 l/min/m2]

MAP (mean arterial press) = [(SBP - DBP)/3] + DBP [normal 80-100 mmHg]

SVR (systemic vasc resis) = (MAP - CVP)x(80)/CO [normal 800-1200 dyne/sec/cm5]

PVR (pulm vasc resis) = (PAM - PCWP)x(80)/CO [normal 45-120 dyne/sec/cm5]

QTc = QT / square root of RR [normal 0.38-0.42]

Right atrial pressure (central venous pressure) [normal 0-8 mmHg]

Pulmonary artery systolic pressure (PAS) [normal 20-30 mmHg]

Pulmonary artery diastolic pressure (PAD) [normal 10-15 mmHg]

Pulmonary capillary wedge pressure (PCWP) [normal 8-12 mmHg (post-MI ~16 mmHg)]

DOPAMINE ( Intropin)

n

Pressor: Start at 5 mcg/kg/min, increase prn by 5
to 10 mcg/kg/min increments at 10 min intervals, max 50 mcg/kg/min. Mix 400 mg in 250 mL D5W (1600 mcg/mL) a rate of 13 mL/h delivers 5 mcg/
kg/min in a 70 kg patient. Doses in mcg/kg/min: 2 to 4 (traditional renal dose, apparently ineffective) dopaminergic receptors; 5 to 10 (cardiac dose) dopaminergic and beta-1 receptors; more than 10 dopaminergic, beta-1, and alpha-1 receptors. `Plasma ♀C – $

EPHEDRINE

Pressor: 10 to 25 mg slow IV, repeat q 5 to 10 min prn. [Generic only: Caps, 50 mg.] `K ♀C ? $

EPINEPHRINE ( EpiPen, EpiPen Jr, Twinject, adrenalinn) Cardiac arrest: 1 mg

IV q 3 to 5 min. Anaphylaxis: 0.1 to 0.5 mg SC/IM, may repeat SC dose q 10 to 15 min. Acute asthma & hypersensitivity reactions: yp
y

Adults: 0.1 to 0.3 mg of

1:1000 soln SC or IM; Peds: 0.01 mg/kg (up to 0.3 mg) of 1:1000 soln SC or IM.

[Soln for injection: 1:1000 (1 mg/mL in 1 mL amps or 10 mL vial). Trade only: EpiPen Auto-injector delivers one 0.3 mg (1:1000, 0.3 mL) IM dose. EpiPen Jr.

Autoinjector delivers one 0.15 mg (1:2000, 0.3 mL) IM dose. Twinject Autoinjector delivers one 0.15 mg (1:1000, 0.15 mL) or 0.3 mg (1:1000, 0.3 mL) IM/SC dose.] `Plasma ♀C – $

INAMRINONE Heart failure: 0.75 mg/kg bolus IV over 2 to 3 min, then infusion 5 to 10 mcg/kg/min; mix 100 mg in 100 mL NS (1 mg/mL) a rate of 21 mL/h delivers 5 mcg/kg/min for a 70 kg patient. `K ♀C ? $$$$$

MIDODRINE ( Orvaten, ProAmatine,  Amatine) Orthostatic hypotension: yp

10 mg PO tid while awake. [Generic/Trade: Tabs, scored 2.5, 5, 10 mg.] `LK

♀C ? $$$$$

MILRINONE ( Primacor)

Systolic heart failure
y

(NYHA class III, IV): Load

50 mcg/kg IV over 10 min, then begin IV infusion of 0.375 to 0.75 mcg/kg/
min. `K ♀C ? $$

NOREPINEPHRINE ( Levophed)

d

Acute hypotension:

yp
start 8 to 12 mcg/min,
adjust to maintain BP, average maintenance rate 2 to 4 mcg/min, mix 4 mg in 500 mL D5W (8 mcg/mL) rate of 22.5 mL/h delivers 3 mcg/min. Ideally through central line. `Plasma ♀C ? $

PHENYLEPHRINE—IV ( Neo-Synephrine)

e

Severe hypotension:

yp

50 mcg boluses

IV. Infusion: 20 mg in 250 mL D5W (80 mcg/mL), start 100 to 180 mcg/min (75 to 135 mL/h), usual dose once BP is stabilized 40 to 60 mcg/min. `Plasma

♀C – $

Cardiovascular

55

Pulmonary Arterial Hypertension

SILDENAFIL ( Revatio) Pulmonary arterial hypertension: y
yp

20 mg PO tid.

Contraindicated with nitrates. Coadministration is not recommended with ritonavir, potent CYP3A inhibitors, or other phosphodiesterase-5 inhibitors.

Teach patients to seek medical attention for vision loss, hearing loss, or erections lasting longer than 4 h. [Trade only (Revatio): Tabs 20 mg.] `LK

♀B – $$$$

TADALAFIL ( Adcirca) Pulmonary arterial hypertension: y
yp

40 mg PO daily.

Contraindicated with nitrates. Coadministration is not recommended with potent CYP3A inhibitors (itraconazole, ketoconazole), potent CYP3A inducers (rifampin), other phosphodiesterase-5 inhibitors. Caution with ritonavir, see PI for specifi c dose adjustments. Teach patients to seek medical attention for vision loss, hearing loss, or erections lasting longer than 4 h. [Trade only (Adcirca): Tabs 20 mg.] `L ♀B – $$$$

Thrombolytics

ALTEPLASE ( tpa, t-PA, Activase, Cathfl o,  Activase rt-PA) Acute MI: (dose for wt 67 kg or less) give 15 mg IV bolus, then 0.75 mg/kg (max 50 mg) over 30 min, then 0.5 mg/kg (max 35 mg) over the next 60 min; (dose for wt greater than 67 kg) give 15 mg IV bolus, then 50 mg over 30 min, then 35 mg over the next 60; use concurrent heparin infusion. Acute ischemic stroke with symptoms 3 h or less:

y p

0.9 mg/kg (max 90 mg); give 10% of total dose as an IV bolus, and the remainder IV over 60 min. Multiple exclusion criteria. Acute pulmonary embolism:

p
y

100 mg IV over 2 h, then restart heparin when PTT twice normal or less. Occluded central venous access device: 2 mg/mL in catheter for 2 h. May use second dose if needed. `L ♀C ? $$$$$

RETEPLASE ( Retavase) Acute

MI: 10 units IV over 2 min; repeat once in

30 min. `L ♀C ? $$$$$

STREPTOKINASE ( Streptase, Kabikinase)

Acute MI: 1.5 million units IV over

60 min. `L ♀C ? $$$$$

THROMBOLYTIC THERAPY FOR ACUTE MI

Indications (if high-volume cath lab unavailable):: Clinical history & presentation strongly suggestive of MI within 12 h plus ⩾1 of the following: 1 mm ST elevation in ⩾2 contigu-ous leads; new left BBB; or 2 mm ST depression in V1-4 suggestive of true posterior MI.

Absolute contraindications:: Previous cerebral hemorrhage, known cerebral aneurysm or arteriovenous malformation, known intracranial neoplasm, recent (<3 mo) ischemic CVA (except acute ischemic CVA <3 h), aortic dissection, active bleeding or bleeding diath-esis (excluding menstruation), signifi cant closed head or facial trauma (<3 mo).

Relative contraindications:: Severe uncontrolled HTN (>180/110 mm Hg) on presentation or chronic severe HTN; prior ischemic CVA (>3 mo), dementia, other intracranial pathology; traumatic/prolonged (>10 min) cardiopulmonary resuscitation; major surgery (<3 weeks); recent (within 2–4 weeks) internal bleeding; puncture of non-compressible vessel; pregnancy; active peptic ulcer disease; current use of anticoagulants. For streptokinase/anistreplase: prior exposure (>5 days ago) or prior allergic reaction.

Reference: Circulation 2004;110:588–636

56 Cardiovascular

TENECTEPLASE ( TNKase) Acute MI: Single IV bolus dose over 5 sec based on body wt; 30 mg for wt less than 60 kg, 35 mg for wt 60 to 69 kg, 40 mg for wt 70 to 79 kg, 45 mg for wt 80 to 89 kg, 50 mg for wt 90 kg or more. `L

♀C ? $$$$$

UROKINASE ( Kinlytic)

PE: 4400 units/kg IV loading dose over 10 min,
followed by IV infusion 4400 units/kg/h for 12 h. Occluded IV catheter: 5000
units instilled into catheter, remove soln after 5 min. `L ♀B ? $$$$$

Volume Expanders

ALBUMIN ( Albuminar, Buminate, Albumarc,  Plasbumin) n

Shock, burns:

,

500 mL of 5% soln IV infusion as rapidly as tolerated, repeat in 30 min if needed. `L ♀C ? $$$$$

DEXTRAN ( Rheomacrodex, Gentran, Macrodexx) Shock/hypovolemia: yp

20 mL/
kg up to 500 mL IV. `K ♀C ? $$

HETASTARCH ( Hespan, Hextendd) Shock/hypovolemia: yp

500 to 1000 mL IV 6%
soln. `K ♀C ? $$

PLASMA PROTEIN FRACTION ( Plasmanate, Protenate, Plasmatein) n

Shock/
hypovolemia:

yp

5% soln 250 to 500 mL IV prn. `L ♀C ? $$$

Other

BIDIL (hydralazine + isosorbide dinitrate) Heart failure (adjunct to standard therapy in patients of African descent): Start 1 tab PO tid, increase as tolerated to max 2 tabs tid. May decrease to ½ tab tid with intolerable side effects; try to increase dose when side effects subside. [Trade only: Tabs, scored 37.5/

20 mg.] `LK ♀C ? $$$$$

CILOSTAZOL ( Pletal )

Intermittent claudication: 100 mg PO bid on empty
stomach. 50 mg PO bid with CYP 3A4 inhibitors (eg, ketoconazole, itraconazole, erythromycin, diltiazem) or CYP 2C19 inhibitors (eg, omeprazole). [Generic/

Trade: Tabs 50, 100 mg.] `L ♀C ? $$$$

NESIRITIDE ( Natrecor)

r

Hospitalized patients with decompensated heart
p
p
p
failure with dyspnea at rest:

y p

2 mcg/kg IV bolus over 60 sec, then 0.01 mcg/
kg/min IV infusion for up to 48 h. Do not initiate at higher doses. Limited experience with increased doses. Mix 1.5 mg vial in 250 mL D5W (6 mcg/mL) a bolus of 23.3 mL is 2 mcg/kg for a 70 kg patient, infusion set at rate 7 mL/h delivers a 0.01 mcg/kg/min for a 70 kg patient. Symptomatic hypotension.

May increase mortality. Not indicated for outpatient infusion, for scheduled repetitive use, to improve renal function, or to enhance diuresis. `K, plasma

♀C ? $$$$$

PENTOXIFYLLINE ( Trental ) 400 mg PO tid with meals. [Generic/Trade: Tabs, extended-release 400 mg.] `L ♀C ? $$$

RANOLAZINE ( Ranexa) Chronic angina:

g

500 mg PO bid, max 1000 mg bid.

Baseline and follow-up ECGs; may prolong QT interval. Contraindicated with clinically signifi cant hepatic impairment, potent CYP3A4 inhibitors, CYP3A inducers. Max 500 mg bid, if used with diltiazem, verapamil, or moderate CYP3A inhibitors. [Trade only: Tabs, extended-release 500, 1000 mg.] `LK

♀C ? $$$$$

Contrast

Media

57

CONTRAST MEDIA

MRI Contrast—Gadolinium-based

NOTE Avoid gadolinium-based contrast agents if severe renal insuffi ciency (GFR < 30 mL/min/1.73 m2) due to risk of nephrogenic systemic fi brosis/nephrogenic fi brosing dermopathy. Similarly avoid in acute renal insuffi ciency of any severity due to hepatorenal syndrome or during the perioperative phase of liver transplant.

GADOBENATE ( MultiHance)

e Non-iodinated, non-ionic IV contrast for MRI. `K

♀C ? $$$$

GADODIAMIDE ( Omniscan)

n

Non-iodinated, non-ionic IV contrast for MRI. `K

♀C ? $$$$

GADOPENTETATE ( Magnevist ) Non-iodinated IV contrast for MRI. `K ♀C ? $$$

GADOTERIDOL ( Prohance) Non-iodinated, non-ionic IV contrast for MRI. `K

♀C ? $$$$

GADOVERSETAMIDE ( OptiMARKK) Non-iodinated IV contrast for MRI. `K ♀C

– $$$$

MRI Contrast—Other

FERUMOXIDES ( Feridexx) Non-iodinated, non-ionic, iron-based IV contrast for hepatic MRI. `L ♀C ? $$$$

FERUMOXSIL ( GastroMARK)

K

Non-iodinated, non-ionic, iron-based, oral GI
contrast for MRI. `L ♀B ? $$$$

MANGAFODIPIR ( Teslascan)

n

Non-iodinated manganese-based IV contrast
for MRI. `L ♀– – $$$$

Radiography Contrast

NOTE Beware of allergic or anaphylactoid reactions. Avoid IV contrast in renal insuffi ciency or dehydration. Hold metformin (Glucophage) prior to or at the time of iodinated contrast dye use and for 48 h after procedure. Restart after procedure only if renal function is normal.

BARIUM SULFATE

Non-iodinated GI (eg, oral, rectal ) contrast. `Not absorbed ♀? + $

DIATRIZOATE ( Cystografi n, Gastrografi n, Hypaque, MD-Gastroview, RenoCal, Reno-DIP, Reno-60, Renografi n) Iodinated, ionic, high osmolality IV or GI contrast. `K ♀C ? $

IODIXANOL ( Visipaque) Iodinated, non-ionic, iso-osmolar IV contrast. `K

♀B ? $$$

IOHEXOL ( Omnipaque) Iodinated, non-ionic, low osmolality IV and oral/body cavity contrast. `K ♀B ? $$$

IOPAMIDOL ( Isovue) Iodinated, non-ionic, low osmolality IV contrast. `K

♀? ? $$

IOPROMIDE ( Ultravist ) Iodinated, non-ionic, low osmolality IV contrast. `K

♀B ? $$$

58 Dermatology

IOTHALAMATE ( Conray,  Vascoray) Iodinated, ionic, high osmolality IV
contrast. `K ♀B – $

IOVERSOL ( Optiray)

y

Iodinated, non-ionic, low osmolality IV contrast. `K

♀B ? $$

IOXAGLATE ( Hexabrix)

x

Iodinated, ionic, low osmolality IV contrast. `K ♀B

– $$$

IOXILAN ( Oxilan)

n

Iodinated, non-ionic, low osmolality IV contrast. `K ♀B

– $$$

DERMATOLOGY

Acne Preparations

ACANYA (clindamycin + benzoyl peroxide) Apply qd. [Trade only: Gel (clindamycin 1.2% + benzoyl peroxide 2.5%) 50 g.] `K ♀C + $$$$

ADAPALENE ( Differin)

n

Apply qhs. [Trade only: Gel 0.1%, 0.3% (45 g), Cream 0.1% (45 g), Soln 0.1% (30 mL), Swabs 0.1% (60 ea).] `Bile ♀C ? $$$$

AZELAIC ACID ( Azelex, Finacea, Finevin)

n

Apply bid. [Trade only: Cream

20%, 30, 50 g (Azelex), Gel 15% 50 g (Finacea).] `K ♀B ? $$$$

BENZACLIN (clindamycin + benzoyl peroxide) Apply bid. [Trade only: Gel (clindamycin 1% + benzoyl peroxide 5%) 25, 50 g (jar), 50 g (pump).] `K

♀C + $$$$

BENZAMYCIN (erythromycin base + benzoyl peroxide) Apply bid. [Generic/

Trade: Gel (erythromycin 3% + benzoyl peroxide 5%) 23.3, 46.6 g. Trade only: Benzamycin Pak, #60 gel pouches.] `LK ♀C ? $$$

BENZOYL PEROXIDE ( Benzac, Benzagel 10%, Desquam, Clearasil,  Solugel, Benoxyl ) Apply daily; increase to bid to tid if needed. [OTC and Rx generic: Liquid 2.5, 5 mL, 10%. Bar 5 g, 10%. Mask 5%. Lotion 4, 5, 8 g, 10%. Cream 5 g, 10%. Gel 2.5, 4, 5, 6, 10, 20%. Pad 3, 4, 6, 8, 9%, other strengths available.] `LK ♀C ? $

CLENIA (sulfacetamide + sulfur) Apply daily to tid. [Generic only: Lotion (sodium sulfacetamide 10%/sulfur 5%) 25, 30, 45, 60 g. Trade only: Cream (sodium sulfacetamide 10%/sulfur 5%) 28 g. Generic/Trade: Foaming wash 170, 340 g.] `K ♀C ? $$$

CLINDAMYCIN—TOPICAL ( Cleocin T, Clindagel, ClindaMax Vaginal, Evoclin,

 Dalacin T ) Apply daily (Evoclin, Clindagel, Clindamax) or bid (Cleocin T).

[Generic/Trade: Gel 1% 30, 60 g, Lotion 1% 60 mL, Soln 1% 30, 60 mL. Trade only: Foam 1% 50, 100 g (Evoclin), Gel 1% 40, 75 mL (Clindagel).] `L ♀B – $

DIANE-35 (cyproterone + ethinyl estradiol ) Canada only. 1 tab PO daily for 21 consecutive days, stop for 7 days, repeat cycle. [Canada Generic/

Trade: Blister pack of 21 tabs 2 mg cyproterone acetate/0.035 mg ethinyl estradiol.] `L ♀X – $$

DUAC (clindamycin + benzoyl peroxide) (Clindoxyl) Apply qhs. [Trade only: Gel (clindamycin 1% + benzoyl peroxide 5%) 45 g.] `K ♀C + $$$$

EPIDUO (adapalene + benzoyl peroxide) Apply qd. [Trade only: Gel (0.1%
adapalene + benzoyl peroxide 2.5%) 45 g.] `Bile K ♀C ? $$$$$

Dermatology

59

ERYTHROMYCIN—TOPICAL ( Eryderm, Erycette, Erygel, A/T/S,  Sans-Acne, Erysol ) Apply bid. [Generic/Trade: Soln 2% 60 mL, Pads 2%, Gel 2% 30, 60
g, Ointment 2% 25 g. Generic only: Soln 1.5% 60 mL.] `L ♀B ? $

ISOTRETINOIN ( Amnesteem, Claravis, Sotret,  Clarus) s

0.5 to 2 mg/kg/
day PO divided bid for 15 to 20 weeks. Typical target dose is 1 mg/kg/day.

Potent teratogen; use extreme caution. Can only be prescribed by healthcare professionals who are registered with the iPLEDGE program. May cause depression. Not for long-term use. [Generic: Caps 10, 20, 40 mg. Generic only (Sotret and Claravis): Caps 30 mg.] `LK ♀X – $$$$$

ROSULA (sulfacetamide + sulfur) Apply daily to tid. [Trade only: Gel (sodium sulfacetamide 10%/sulfur 5%) 45 g. Aqueous cleanser (sodium sulfacetamide 10%/sulfur 5%) 355 mL. Soap (sodium sulfacetamide 10%/
sulfur 4%) 473 mL.] `K ♀C ? $$$$

SALICYLIC ACID ( Akurza, Clearasil Cleanser, Stridex Padss) Apply/wash area up to tid. [OTC Generic/Trade: Pads, Gel, Lotion, Liquid, Mask scrub, 0.5%, 1%, 2%. Rx Trade only (Akurza): Cream 6% 340 g. Lotion 6%, 355
mL.] `Not absorbed ♀? ? $

SULFACETAMIDE—TOPICAL ( Klaron, Rosula NS)

S

Apply bid. [Generic/Trade

(Klaron): Lotion 10% 118 mL. Trade only: Single-use pads 10%, 30 ea. (Rosula NS).] `K ♀C ? $$$$

SULFACET-R (sulfacetamide + sulfur) Apply daily to tid. [Generic/Trade: Lotion (sodium sulfacetamide 10%/sulfur 5%) 25 g.] `K ♀C ? $$$

TAZAROTENE ( Tazorac, Avage)

Acne (Tazorac): apply 0.1% cream qhs.

Psoriasis: apply 0.05% cream qhs, increase to 0.1% prn. [Trade only (Tazorac): Cream 0.05% and 0.1% 30, 60 g. Gel 0.05% and 0.1% 30, 100 g. Trade only (Avage): Cream 0.1% 15, 30 g.] `L ♀X ? $$$$

TRETINOIN—TOPICAL ( Retin-A, Retin-A Micro, Renova, Retisol-A,  Stieva-A, Rejuva-A, Vitamin A Acid Cream
m) Apply qhs. [Generic/Trade: Cream 0.025%

20, 45 g, 0.05% 20, 45 g, 0.1% 20, 45 g, Gel 0.025% 15, 45 g, 0.1% 15, 45
g. Trade only: Renova cream 0.02% 40, 60 g, Retin-A Micro gel 0.04%, 0.1%

20, 45, 50 g.] `LK ♀C ? $$$

ZIANA (clindamycin + tretinoin) Apply qhs. [Trade only: Gel clindamycin 1.2% + tretinoin 0.025% 30, 60 g.] `LK ♀C ? $$$$

Actinic Keratosis Preparations

DICLOFENAC—TOPICAL ( Solaraze, Voltaren)

n Solaraze: Actinic/solar keratoses:

apply bid to lesions for 60 to 90 days. Voltaren: Osteoarthritis of areas amen able to topical therapy: 2 g (upper extremities) to 4 g (lower extremities) qid. [Trade only: Gel 3% 50 g (Solaraze), 100 g (Solaraze, Voltaren).] `L ♀B ? $$$$$

FLUOROURACIL—TOPICAL ( 5-FU, Carac, Efudex, Fluoroplexx) Actinic keratoses: apply bid for 2 to 6 weeks. Superfi
p cial basal cell carcinomas: apply

5% cream/soln bid. [Trade only: Cream 0.5% 30 g (Carac), 5% 25 g (Efudex), 1% 30 g (Fluoroplex). Generic/Trade: Soln 2%, 5% 10 mL (Efudex). Cream 5%

40 g.] `L ♀X – $$$

METHYLAMINOLEVULINATE ( Metvix, Metvixia) Apply cream to non-hyperkeratotic actinic keratoses
yp
lesion and surrounding area on face or

(cont.)

60 Dermatology
scalp; cover with dressing for 3 h; remove dressing and cream and perform illumination therapy. Repeat in 7 days. [Trade only: Cream 16.8%, 2 g tube.] `Not absorbed ♀C ? ?

Antibacterials (Topical)

BACITRACIN ( Baciguent ) Apply daily to tid. [OTC Generic/Trade: Ointment 500 units/g 1, 15, 30 g.] `Not absorbed ♀C ? $

FUSIDIC ACID—TOPICAL ( Fucidin) Canada only. Apply tid to qid. [Canada trade only: Cream 2% fusidic acid 5, 15, 30 g. Ointment 2% sodium fusidate 5, 15, 30 g.] `L ♀? ? $

GENTAMICIN—TOPICAL ( Garamycinn) Apply tid to qid. [Generic only: Ointment 0.1% 15, 30 g. Cream 0.1% 15, 30 g.] `K ♀D ? $

MAFENIDE ( Sulfamylon)

n

Apply daily to bid. [Trade only: Cream 57, 114, 454 g.

Topical soln 5% 50 g packets.] `LK ♀C ? $$

METRONIDAZOLE—TOPICAL ( Noritate, MetroCream, MetroGel, MetroLotion,

 Rosasol ) Rosacea: Apply daily (1%) or bid (0.75%). [Trade only: Gel (MetroGel) 1% 45, 60 g. Cream (Noritate) 1% 60 g. Generic/Trade: Gel 0.75%

45 g. Cream 0.75% 45 g. Lotion (MetroLotion) 0.75% 59 mL.] `KL ♀B(– in fi rst trimester) – $$$

MUPIROCIN ( Bactroban, Centany)

y

Impetigo/infected wounds:

p g

Apply tid.

Nasal methicillin-resistant S aureus eradication: 0.5 g in each nostril bid for 5 days. [Generic/Trade: Ointment 2% 22 g. Nasal ointment 2% 1 g single-use tubes (for MRSA eradication). Trade only: Cream 2% 15, 30 g.] `Not absorbed

♀B ? $$

NEOSPORIN CREAM (neomycin + polymyxin + bacitracin) Apply daily to tid. [OTC Trade only: neomycin 3.5 mg/g + polymyxin 10,000 units/g 15 g and unit dose 0.94 g.] `K ♀C ? $

NEOSPORIN OINTMENT (bacitracin + neomycin + polymyxin) Apply daily
to tid. [OTC Generic/Trade: bacitracin 400 units/g + neomycin 3.5 mg/g +
polymyxin 5000 units/g 15, 30 g and “to go” 0.9 g packets.] `K ♀C ? $

POLYSPORIN (bacitracin + polymyxin) (Polytopic) Apply ointment/
aerosol/powder daily to tid. [OTC Trade only: Ointment 15, 30 g and unit dose 0.9 g, Powder 10 g.] `K ♀C ? $

RETAPAMULIN ( Altabax)

Impetigo:

p g apply bid for 5 days. [Trade only: Ointment

1% 5, 10, 15 g.] `Not absorbed ♀B ? $$$

SILVER SULFADIAZINE ( Silvadene,  Dermazin, Flamazine, SSD) Apply D
daily
to bid. [Generic/Trade: Cream 1% 20, 50, 85, 400, 1000 g.] `LK ♀B – $$

Antifungals (Topical)

BUTENAFINE ( Lotrimin Ultra, Mentax) Apply daily to bid. [Rx Trade only: Cream 1% 15, 30 g (Mentax). OTC Trade only: Cream 1% 12, 24 g (Lotrimin Ultra).] `L ♀B ? $

CICLOPIROX ( Loprox, Penlac,  Stieprox shampoo) Cream, lotion: apply bid. Nail soln: apply daily to affected nails; apply over previous coat; remove with alcohol every 7 days. Seborrheic dermatitis (Loprox shampoo): Shampoo (cont.)

Dermatology

61
twice weekly for 4 weeks. [Trade only: Shampoo (Loprox) 1% 120 mL. Generic/

Trade: Gel 0.77% 30, 45, 100 g. Nail soln (Penlac) 8% 6.6 mL. Cream (Loprox) 0.77% 15, 30, 90 g. Lotion (Loprox TS) 0.77% 30, 60 mL.] `K ♀B ? $$$$

CLOTRIMAZOLE—TOPICAL ( Lotrimin

AF,

Mycelex,

 Canesten,

Clotrimaderm)

m

Apply bid. [Note that Lotrimin brand cream, lotion, soln are clotrimazole, while Lotrimin powders and liquid spray are miconazole. Rx Generic only: Cream 1% 15, 30, 45 g. Soln 1% 10, 30 mL. OTC Trade only (Lotrimin AF): Cream 1% 12, 24 g. Soln 1% 10 mL.] `L ♀B ? $

ECONAZOLE

Tinea pedis, cruris, corporis, tinea versicolor:

p

,

,
p

,
apply daily.

Cutaneous candidiasis: apply bid. [Generic only: Cream 1% 15, 30, 85 g.] `Not absorbed ♀C ? $$

KETOCONAZOLE—TOPICAL ( Extina, Nizoral, Xolegel,  Ketoderm) Tinea/
candidal infections: apply daily. Seborrheic dermatitis: apply cream daily to bid for 4 weeks or gel daily for 2 weeks or foam bid for 4 weeks. Dandruff: apply 1% shampoo twice a week. Tinea versicolor: apply shampoo to affected area, leave on for 5 min, rinse. [Generic/Trade: Cream 2% 15, 30, 60 g. Shampoo 2% 120 mL. Trade only: Shampoo 1% 120, 210 mL (OTC Nizoral). Gel 2% 15
g (Xolegel). Foam 2% 50, 100 g (Extina).] `L ♀C ? $$

MICONAZOLE—TOPICAL ( Micatin, Lotrimin AF, ZeaSorb AFF) Tinea, candida:

,
apply bid. [Note that Lotrimin brand cream, lotion, soln are clotrimazole, while Lotrimin powders and liquid spray are miconazole. OTC Trade only: Powder 2%

70, 160 g, Spray powder 2% 90, 100, 140 g, Spray liquid 2% 90, 105 mL, Gel 2% 24 g.] `L ♀+ ? $

NAFTIFINE ( Naftin)

n

Tinea: apply daily (cream) or bid (gel). [Trade only: Cream 1% 15, 30, 60, 90 g. Gel 1% 20, 40, 60, 90 g.] `LK ♀B ? $$$

NYSTATIN—TOPICAL ( Mycostatin,

 Nilstat, Nyaderm, Candistatinn)

Candidiasis: apply bid to tid. [Generic/Trade: Cream, Ointment 100,000
units/g 15, 30 g. Powder 100,000 units/g 15, 30, 60 g.] `Not absorbed ♀C

? $

OXICONAZOLE ( Oxistat, Oxizole) Tinea pedis, cruris, and corporis: p

,

,
p
apply
daily to bid. Tinea versicolor (cream only): apply daily. [Trade only: Cream 1%

15, 30, 60 g, Lotion 1% 30 mL.] `? ♀B ? $$$

SERTACONAZOLE ( Ertaczo)

Tinea pedis:

p
apply bid. [Trade only: Cream 2%

30, 60 g.] `Not absorbed ♀C ? $$$

TERBINAFINE—TOPICAL ( Lamisil, Lamisil AT ) Tinea: apply daily to bid.

[OTC Trade only (Lamisil AT): Cream 1% 12, 24 g. Spray pump soln 1% 30 mL.

Gel 1% 6, 12 g.] `L ♀B ? $

TOLNAFTATE ( Tinactin) Apply bid. [OTC Generic/Trade: Cream 1% 15, 30 g.

Soln 1% 10 mL. Powder 1% 45 g. OTC Trade only: Gel 1% 15 g. Powder 1%

90 g. Spray powder 1% 100, 133, 150 g. Spray liquid 1% 100, 113 mL.] `?

♀? ? $

Antiparasitics (Topical)

A-200 (pyrethrins + piperonyl butoxide) ( R&C) Lice: apply shampoo, wash after 10 min. Reapply in 5 to 7 days. [OTC Generic/Trade: Shampoo (0.33% pyrethrins, 4% piperonyl butoxide) 60, 120 mL.] `L ♀C ? $

62 Dermatology

CROTAMITON ( Eurax)

Scabies: apply cream/lotion topically from chin to feet, repeat in 24 h, bathe 48 h later. Pruritus: Massage prn. [Trade only: Cream 10% 60 g. Lotion 10% 60, 480 mL.] `? ♀C ? $$

LINDANE ( Hexit ) Other drugs preferred. Scabies: apply 30 to 60 mL of lotion, wash after 8 to 12 h. Lice: 30 to 60 mL of shampoo, wash off after 4 min. Can cause seizures in epileptics or if overused/misused in children. Not for infants.

[Generic only: Lotion 1% 60, 480 mL. Shampoo 1% 60, 480 mL.] `L ♀B ? $

MALATHION ( Ovide)

Apply to dry hair, let dry naturally, wash off in 8 to 12 h.

[Generic/Trade: Lotion 0.5% 59 mL.] `? ♀B ? $$$$

PERMETHRIN ( Elimite, Acticin, Nix,  Kwellada-P) Scabies: apply cream from head (avoid mouth/nose/eyes) to soles of feet & wash after 8 to 14 h.

30 g is typical adult dose. Lice: Saturate hair and scalp with 1% rinse, wash after 10 min. Do not use in age younger than 2 mo. May repeat therapy in 7
days, as necessary. [Generic/Trade: Cream (Elimite, Acticin) 5% 60 g. OTC

Generic/Trade: Liquid creme rinse (Nix) 1% 60 mL.] `L ♀B ? $$

RID (pyrethrins + piperonyl butoxide) Lice: apply shampoo/mousse, wash after 10 min. Reapply in 5 to 10 days. [OTC Generic/Trade: Shampoo 60, 120, 240 mL. OTC Trade only: Mousse 5.5 oz.] `L ♀C ? $

Antipsoriatics

ACITRETIN ( Soriatane) 25 to 50 mg PO daily. Avoid pregnancy during therapy and for 3 years after discontinuation. [Trade only: Caps 10, 25 mg.] `L ♀X

– $$$$$

ALEFACEPT ( Amevive) 7.5 mg IV or 15 mg IM once a week for 12 doses. May repeat with 1 additional 12-week course after 12 weeks have elapsed since last dose. `? ♀B ? $$$$$

ANTHRALIN ( Drithocreme,

 Anthrascalp, Anthranol, Anthraforte,

Dithranol ) Apply daily. Short contact periods (ie, 15 to 20 min) followed by removal may be preferred. [Trade only: Cream 0.5, 1% 50 g.] `? ♀C – $$$

CALCIPOTRIENE ( Dovonex) Apply bid. [Trade only: Ointment 0.005% 30, 60, 100 g, Cream 0.005% 30, 60, 100 g. Generic/Trade: Scalp soln 0.005% 60
mL.] `L ♀C ? $$$$

TACLONEX (calcipotriene + betamethasone) Apply daily
for up to 4 weeks.

[Trade only: Ointment (calcipotriene 0.005% + betamethasone dipropionate 0.064%) 15, 30, 60, 100 g. Topical susp 15, 30, 60 g.] `L ♀C ? $$$$$

Antivirals (Topical)

ACYCLOVIR—TOPICAL ( Zoviraxx) Herpes genitalis: p
g

Apply ointment q 3 h

(6 times per day) for 7 days. Recurrent herpes labialis: p

Apply cream 5 times
per day for 4 days. [Trade only: Ointment 5% 15 g, Cream 5% 2, 5 g.] `K

♀C ? $$$$$

DOCOSANOL ( Abreva)

Oral-facial herpes
p

(cold sores): Apply 5 times per day
until healed. [OTC Trade only: Cream 10% 2 g.] `Not absorbed ♀B ? $

IMIQUIMOD ( Aldara)

Genital/perianal warts:

p

Apply 3 times per week overnight
for up to 16 weeks. Wash off after 8 h. Non-hyperkeratotic, non-hypertrophic yp

,
yp
p

(cont.)

Dermatology

63
actinic keratoses on face/scalp in immunocompetent adults: p
p

Apply twice a
week overnight for 16 weeks. Wash off after 8 h. Primary superfi y
p cial basal cell
carcinoma: Apply 5 times a week for 6 weeks. Wash off after 8 h. [Trade only: Cream 5% single-use packets.] `Not absorbed ♀C ? $$$$$

PENCICLOVIR ( Denavir)

r

Herpes labialis
p

(cold sores): Apply cream q 2 h while
awake for 4 days. [Trade only: Cream 1% tube 1.5 g.] `Not absorbed ♀B ? $$

PODOFILOX ( Condylox,  Condyline, Wartec) External genital warts (gel g

(g
and soln) and perianal warts (gel only):

)

p

(g
y) Apply bid for 3 consecutive days of a
weeks and repeat for up to 4 weeks. [Generic/Trade: Soln 0.5% 3.5 mL. Trade only: Gel 0.5% 3.5 g.] `? ♀C ? $$$$

PODOPHYLLIN ( Podocon-25, Podofi n, Podofi lm) m Warts: Apply by physician.

[Not to be dispensed to patients. For hospital/clinic use; not intended for outpatient prescribing. Trade only: Liquid 25% 15 mL.] `? ♀– – $$$

SINECATECHINS ( Veregen) Apply tid to external genital warts g
for up to

16 weeks. [Trade only: Ointment 15% 15, 30 g.] Ùnknown ♀C ? $$$$$

Atopic Dermatitis Preparations

PIMECROLIMUS ( Elidel )

Atopic dermatitis:

p

Apply bid. [Trade only: Cream

1% 30, 60, 100 g.] `L ♀C ? $$$$

TACROLIMUS—TOPICAL ( Protopic)

c

Atopic dermatitis:

p

Apply bid. [Trade only:

Ointment 0.03%, 0.1% 30, 60, 100 g.] `Minimal absorption ♀C ? $$$$

Corticosteroid / Antimicrobial Combinations

CORTISPORIN (neomycin + polymyxin + hydrocortisone) Apply bid to qid.

[Trade only: Cream 7.5 g, Ointment 15 g.] `LK ♀C ? $$$

FUCIDIN H (fusidic acid + hydrocortisone) Canada only. apply tid. [Canada Trade only: Cream (2% fusidic acid, 1% hydrocortisone acetate) 30 g.] `L

♀? ? $$

LOTRISONE (clotrimazole + betamethasone) ( Lotriderm) Apply bid.

Do not use for diaper rash. [Generic/Trade: Cream (clotrimazole 1% +
betamethasone 0.05%) 15, 45 g. Lotion (clotrimazole 1% + betamethasone 0.05%) 30 mL.] `L ♀C ? $$$

MYCOLOG II (nystatin + triamcinolone) Apply bid. [Generic only: Cream, Ointment 15, 30, 60, 120, 454 g.] `L ♀C ? $

Hemorrhoid Care

DIBUCAINE ( Nupercainal ) Apply cream/ointment tid to qid prn. [OTC Trade only: Ointment 1% 30, 60 g.] `L ♀? ? $

PRAMOXINE ( Tucks Hemorrhoidal Ointment, Fleet Pain Relief, Proctofoam NS)

S
ointment/pads/foam up to 5 times per day prn. [OTC Trade only: Ointment (Tucks Hemorrhoidal Ointment) 30 g. Pads (Fleet Pain Relief) 100
ea. Aerosol foam (ProctoFoam NS) 15 g.] `Not absorbed ♀+ + $

STARCH ( Tucks Suppositoriess) 1 suppository up to 6 times per day prn. [OTC

Trade only: Supps (51% topical starch; vegetable oil, tocopheryl acetate) 12, 24 ea.] `Not absorbed ♀+ + $

64 Dermatology

WITCH HAZEL ( Tucks)

s

Apply to anus/perineum up to 6 times per day prn.

[OTC Generic/Trade: Pads 50% 12, 40, 100 ea, generically available in various quantities.] `? ♀+ + $

Other Dermatologic Agents

ALITRETINOIN ( Panretin) Apply bid to qid to cutaneous Kaposi’

p
s lesions

[Trade only: Gel 0.1% 60 g.] `Not absorbed ♀D – $$$$$

ALUMINUM CHLORIDE ( Drysol, Certain Dri)

i

Apply qhs. [Rx Trade only: Soln

20% 37.5 mL bottle, 35, 60 mL bottle with applicator. OTC Trade only (Certain Dri): Soln 12.5% 36 mL bottle.] `K ♀? ? $

BECAPLERMIN ( Regranex)

x

Diabetic ulcers: Apply daily. [Trade only: Gel

0.01%, 2, 15 g.] `Minimal absorption ♀C ? $$$$$

CALAMINE

Apply tid to qid prn for poison ivy/oak or insect bite itching.

p
y
g [OTC

Generic only: Lotion 120, 240, 480 mL.] `? ♀? ? $

CAPSAICIN ( Zostrix, Zostrix-HP)

P

Arthritis, post-herpetic or diabetic neuralgia:

, p
p
g

Apply tid to qid. [OTC Generic/Trade: Cream 0.025% 60 g, 0.075% (HP) 60 g.

OTC Generic only: Lotion 0.025% 59 mL, 0.075% 59 mL.] `? ♀? ? $

COAL TAR ( Polytar, Tegrin, Cutar, Tarsum)

m

Apply shampoo at least twice a
week, or for psoriasis
p
apply daily to qid. [OTC Generic/Trade: Shampoo, cream, ointment, gel, lotion, liquid, oil, soap.] `? ♀? ? $

DOXEPIN—TOPICAL ( Zonalonn) Pruritus: Apply qid for up to 8 days. [Trade only: Cream 5% 30, 45 g.] `L ♀B – $$$$

EFLORNITHINE ( Vaniqa) Reduction of facial hair: Apply to face bid. [Trade only: Cream 13.9% 30 g.] `K ♀C ? $$$

EMLA (prilocaine + lidocaine—topical) Topical anesthesia: p

Apply 2.5 g
cream or 1 disc to region at least 1 h before procedure. Cover with occlusive dressing. [Generic/Trade: Cream (2.5% lidocaine + 2.5% prilocaine) 5, 30
g.] `LK ♀B ? $$

HYALURONIC ACID ( Bionect, Restylane, Perlane) e

Moderate to severe facial
wrinkles: Inject into wrinkle/fold (Restylane). Protection of dermal ulcers: Apply gel/cream/spray bid or tid (Bionect). [OTC Trade only: Cream 2% 15, 30 g. Rx Generic/Trade: Soln 3% 30 mL, Gel 4% 30 g, Cream 4% 15, 30, 60 g.] `? ♀? ? $$$

HYDROQUINONE ( Eldopaque, Eldoquin, Eldoquin Forte, EpiQuin Micro, Esoterica, Glyquin, Lustra, Melanex, Solaquin, Claripel,  Ultraquin) n

Hyper
yp -
pig mentation:

p g

Apply bid. [OTC Trade only: Cream 2% 15, 30 g. Rx Generic/Trade: Soln 3% 30 mL. Gel 4% 30 g. Cream 4% 15, 30, 60 g.] `? ♀C ? $

LACTIC ACID ( Lac-Hydrin, Amlactin,  Dermalac) Apply bid. [Trade only: Lotion 12% 150, 360 mL. Generic/OTC: Cream 12% 140, 385 g. AmLactin AP
is lactic acid (12%) with pramoxine (1%).] `? ♀? ? $$

LIDOCAINE—TOPICAL ( Xylocaine, Lidoderm, Numby Stuff, LMX, Zingo,

 Maxilene) Apply prn. Dose varies with anesthetic procedure, degree of anesthesia required and individual patient response. Postherpetic neuralgia: p
g

Apply up to 3 patches to affected area at once for up to 12 h within a 24 h period. Apply 30 min prior to painful procedure
p
p

(ELA-Max 4%). Discomfort
with anorectal disorders: Apply prn (ELA-Max 5%). Intradermal powder p

(cont.)

Dermatology

65

CORTICOSTEROIDS—TOPICAL

Potency* Generic

Trade

Forms

Frequency

Name

Low
alclometasone dipro-

Aclovate

0.05% C/O
bid-tid
pionate

Low
clocortolone pivalate

Cloderm

0.1% C
tid

Low
desonide

DesOwen,

0.05% C/L/O
bid-tid

Tridesilon

Low
hydrocortisone

Hytone,

0.5% C/L/O; 1% C/L/O;
bid-qid
others

2.5% C/L/O

Low
hydrocortisone acetate

Cortaid,

0.5% C/O, 1% C/O/Sp
bid-qid

Corticaine

Medium
betamethasone valerate

Luxiq

0.1% C/L/O; 0.12% F
qd-bid

(Luxiq)

Medium
desoximetasone‡

Topicort

0.05% C
bid

Medium
fl uocinolone

Synalar

0.01% C/S; 0.025% C/O
bid-qid

Medium
fl urandrenolide

Cordran

0.025% C/O; 0.05%
bid-qid

C/L/O/T

Medium
fl uticasone propionate

Cutivate

0.005% O; 0.05% C/L
qd-bid

Medium
hydrocortisone butyrate

Locoid

0.1% C/O/S
bid-tid

Medium
hydrocortisone valerate

Westcort

0.2% C/O
bid-tid

Medium
mometasone furoate

Elocon

0.1% C/L/O
qd

Medium
triamcinolone‡

Aristocort, 0.025% C/L/O; 0.1%
bid-tid

Kenalog

C/L/O/S

High
amcinonide

Cyclocort

0.1% C/L/O
bid-tid

High
betamethasone

Maxivate,

0.05% C/L/O
qd-bid
dipropionate‡
others

(non-Diprolene)

High
desoximetasone‡

Topicort

0.05% G; 0.25% C/O
bid

High
difl orasone diacetate‡

Maxifl or

0.05% C/O
bid

High
fl uocinonide

Lidex

0.05% C/G/O/S
bid-qid

High
halcinonide

Halog

0.1% C/O/S
bid-tid

High
triamcinolone‡

Aristocort, 0.5% C/O
bid-tid

Kenalog

Very high betamethasone dipro-

Diprolene,

0.05% C/G/L/O
qd-bid
pionate‡

Diprolene

AF

Very high clobetasol

Temovate,

0.05% C/G/O/L/S/Sp/F
bid

Cormax,

(Olux)

Olux

Very high difl orasone diacetate‡

Psorcon

0.05% C/O
qd-tid

Very high halobetasol propionate

Ultravate

0.05% C/O
qd-bid

*Potency based on vasoconstrictive assays, which may not correlate with effi cacy. Not all available products are listed, including those lacking potency ratings. ‡These drugs have formulations in more than once potency category. C, cream; O, ointment; L, lotion; T, tape; F, foam; S, solution; G, gel; Sp, spray

66 Dermatology
injection for venipuncture/IV cannulation,
j
p

, 3 to 18 yo (Zingo): 0.5 mg to site

1 to 10 min prior. [For membranes of mouth and pharynx: Spray 10%, Ointment 5%. Liquid, 5%. Soln 2%, 4%. Dental patch. For urethral use: Jelly 2%. Patch (Lidoderm) 5%. Intradermal powder injection system: 0.5 mg (Zingo). OTC

Trade only: Liposomal lidocaine 4% (ELA-Max).] `LK ♀B + $$

MINOXIDIL—TOPICAL ( Rogaine, Women’s Rogaine, Rogaine Extra Strength, Minoxidil for Men, Theroxidil Extra Strength,  Minox, Apo-Gain)

n

Androgenetic alopecia
g
p
in men or women: 1 mL to dry scalp bid. [OTC

Generic/Trade: Soln 2% 60 mL (Rogaine, Womens Rogaine). Soln 5% 60 mL

(Rogaine Extra Strength, Theroxidil Extra Strength—for men only). Foam 5%

60 g (Rogaine Extra Strength).] `K ♀C – $

MONOBENZONE ( Benoquin)

n

Extensive vitiligo:

g

Apply bid to tid. [Trade only:

Cream 20% 35.4 g.] `Minimal absorption ♀C ? $$$

OATMEAL ( Aveeno)

Pruritus from poison ivy/oak, varicella:

p
y

,

Apply lotion
qid prn. Also bath packets for tub. [OTC Generic/Trade: Lotion, Bath packets.] `Not absorbed ♀? ? $

PANAFIL (papain + urea + chlorophyllin copper complex) Debridement of
acute or chronic lesions: Apply to clean wound and cover daily to bid. [Trade only: Ointment 6, 30 g, Spray 33 mL.] `? ♀? ? $$$

PLIAGIS (tetracaine + lidocaine—topical ) Apply 20 to 30 min prior to superfi cial dermatological procedure (60 min for tattoo removal). [Trade only: Cream lidocaine 7% + tetracaine 7%.] `Minimal absorption ♀B ? $$

PRAMOSONE (pramoxine + hydrocortisone) ( Pramox HC) C

Infl ammatory
y
and pruritic manifestations of corticosteroid-responsive dermatoses: p
p
apply
tid to qid. [Trade only: 1% pramoxine/1% hydrocortisone acetate Cream 30, 60
g. Ointment 30 g. Lotion 60, 120, 240 mL. 1% pramoxine/2.5% hydrocortisone acetate Cream 30, 60 g. Ointment 30 g. Lotion 60, 120 mL.] `Not absorbed

♀C ? $$$

SELENIUM SULFIDE ( Selsun, Exsel, Versel ) Dandruff, seborrheic dermatitis:

,

Apply 5 to 10 mL lotion/shampoo twice per week for 2 weeks then less frequently, thereafter. Tinea versicolor: Apply 2.5% lotion/shampoo to affected area daily for 7 days. [OTC Generic/Trade: Lotion/Shampoo 1% 120, 210, 240, 325 mL, 2.5% 120 mL. Rx Generic/Trade: Lotion/Shampoo 2.5% 120 mL.]

`? ♀C ? $

SOLAG (mequinol + tretinoin) ( Solage) Apply to solar lentigines g
bid.

[Trade only: Soln 30 mL (mequinol 2% + tretinoin 0.01%).] `Not absorbed

♀X ? $$$$

SYNERA (tetracaine + lidocaine—topical ) Apply 20 to 30 min prior to superfi cial dermatological procedure. [Trade only: Topical patch (lidocaine 70 mg + tetracaine 70 mg.] `Minimal absorption ♀B ? $$

TRI-LUMA (fl uocinolone + hydroquinone + tretinoin) Melasma of the face: apply qhs for 4 to 8 weeks. [Trade only: Cream 30 g (fl uocinolone 0.01% +
hydroquinone 4% + tretinoin 0.05%).] `Minimal absorption ♀C ? $$$$

VUSION (miconazole—topical + zinc oxide + white petrolatum) Apply to
affected diaper area with each change for 7 days. [Trade only: Ointment 50 g.]

`Minimal absorption ♀C ? $$$$$

Endocrine & Metabolic 67

ENDOCRINE & METABOLIC

Androgens / Anabolic Steroids

NOTE See OB/GYN section for other hormones.

METHYLTESTOSTERONE ( Android, Methitest, Testred, Virilon) Advancing inoperable breast cancer
p
in women who are 1 to 5 years postmenopausal: 50
to 200 mg/day PO in divided doses. Hypogonadism in men: yp g

10 to 50 mg PO
daily. [Generic only: Caps 10 mg, Tabs 10, 25 mg.] `L ♀X ? ©III $$$

NANDROLONE ( Deca-Durabolin)

n

Anemia of renal disease: Women 50 to

100 mg IM once a week, men 100 to 200 mg IM once a week. [Canada only: Injection 50, 100, 200 mg/mL.] `L ♀X – ©III $$

OXANDROLONE ( Oxandrin)

n

Weight gain:

g
g

2.5 mg PO bid to qid for 2 to 4
weeks. [Generic/Trade: Tabs 2.5, 10 mg.] `L ♀X ? ©III $$$$$

TESTOSTERONE ( Androderm, AndroGel, Delatestryl, Depo-Testosterone, Striant, Testim, Testopel, Testro AQ,  Andriol ) Injectable enanthate or cypionate: 50 to 400 mg IM q 2 to 4 weeks. Transdermal: Androderm: 5
mg patch to non-scrotal skin qhs. AndroGel 1%: Apply 5 g from gel pack or 4 pumps (5 g) from dispenser daily to shoulders/upper arms/abdomen.

Testim: 1 tube (5 g) daily to shoulders/upper arms. Pellet: Testopel: 2 to 6

(150 to 450 mg testosterone) pellets SC q 3 to 6 months. Buccal: Striant: 30
mg q 12 h on upper gum above the incisor tooth; alternate sides for each application. [Trade only: Patch 2.5, 5 mg/24 h (Androderm). Gel 1% 2.5, 5 g packet, 75 g multidose pump (AndroGel). Gel 1%, 5 g tube (Testim).

Pellet 75 mg (Testopel). Buccal: Blister packs 30 mg (Striant). Generic/Trade: Injection 100, 200 mg/mL (cypionate), 200 mg/mL (ethanate).] `L ♀X ?

©III $$$$$

Bisphosphonates

ALENDRONATE ( Fosamax, Fosamax Plus D,  Fosavance) Postmenopausal p

osteoporosis prevention
p
p

(5 mg PO daily or 35 mg PO weekly) and treatment

(10 mg daily, 70 mg PO weekly, 70 mg/vit D3 2800 international units PO weekly, or 70 mg/vit D3 5600 international units PO weekly). Treatment of glucocorticoid-g
induced osteoporosis:

p

5 mg PO daily in men and women or 10 mg PO daily in postmenopausal women not taking estrogen. Treatment of osteoporosis in m p
en:

10 mg PO daily, 70 mg PO weekly, or 70 mg/vit D3 2800 international units PO
weekly, or 70 mg/vit D3 5600 international units PO weekly. Paget’

g s disease in men
and women: 40 mg PO daily for 6 months. [Generic/Trade (Fosamax): Tabs 5, 10, 35, 40, 70 mg. Trade only: Oral soln 70 mg/75 mL (single-dose bottle). Fosamax Plus D: 70 mg + either 2800 or 5600 units of vitamin D3.] `K ♀C – $$

CLODRONATE ( Ostac, Bonefoss) Canada only. IV single dose, 1500 mg slow infusion over at least 4 h. IV multiple dose, 300 mg slow infusion daily over 2 to 6 h up to 10 days. Oral, following IV therapy, maintenance 1600 to 2400 mg/day in single or divided doses. Max PO dose 3200 mg/day; duration of therapy is usually 6 months. [Generic/Trade: Caps 400 mg.] `K

♀D – $$$$$

68 Endocrine & Metabolic

ETIDRONATE ( Didronel )

Paget’

g s disease: 5 to 10 mg/kg PO daily for 6
months or 11 to 20 mg/kg daily for 3 months. [Generic/Trade: Tabs 200, 400
mg.] `K ♀C ? $$$$

IBANDRONATE ( Boniva) Treatment/Prevention of postmenopausal osteop
p
porosis.

p

Oral: 2.5 mg PO daily or 150 mg PO once a month. IV: 3 mg IV q 3
months. [Trade only: Tabs 2.5, 150 mg.] `K ♀C ? $$$$

PAMIDRONATE ( Aredia)

Hypercalcemia of malignancy:

yp
g
y 60 to 90 mg IV over

2 to 24 h. Wait at least 7 days before considering retreatment. `K ♀D ?

$$$$$

RISEDRONATE ( Actonel, Actonel Plus Calcium
m) Prevention

& treatment
of postmenopausal osteoporosis:

p
p
p

5 mg PO daily, 35 mg PO weekly, 75 mg

PO on 2 consecutive days each month, or 150 mg once a month. Treatment of osteoporosis
p
in men: 35 mg PO weekly. Prevention & treatment of glucocorticoid-induced osteoporosis:

g
p

5 mg PO daily. Paget’

g s disease: 30 mg

PO daily for 2 months. [Generic/Trade: Tabs 5, 30, 35 mg. Trade only: 75, 150
mg; 35/1250 mg (calcium).] `K ♀C ? $$$

ZOLEDRONIC ACID ( Reclast, Zometa,  Aclasta) Treatment of
osteoporosis:

p

5 mg (Reclast) once yearly IV infusion over 15 min or longer. Prevention and treatment of glucocorticoid-induced osteoporosis:

g
p

5 mg (Reclast) once a year

IV infusion over 15 min or longer. Hypercalcemia
yp

(Zometa): 4 mg IV infusion
over 15 min or longer. Wait at least 7 days before considering retreatment.

Paget’

g s disease (Reclast): 5 mg IV single dose. Multiple myeloma and p
y
metastatic bone lesions from solid tumors (Zometa): 4 mg IV infusion over 15
min or longer q 3 to 4 weeks. `K ♀D ? $$$$$

Corticosteroids

NOTE See also dermatology, ophthalmology.

BETAMETHASONE ( Celestone, Celestone Soluspan,  Betaject ) Anti-infl ammatory/Immunosuppressive:

y
pp

0.6 to 7.2 mg/day PO divided bid to qid;
up to 9 mg/day IM. Fetal lung maturation, maternal antepartum: g

,
p

12 mg IM
q 24 h for 2 doses. [Trade only: Syrup 0.6 mg/5 mL.] `L ♀C – $$$$$

CORTISONE ( Cortone) 25 to 300 mg PO daily. [Generic only: Tabs 5, 10, 25 mg.] `L ♀D – $

DEXAMETHASONE ( Decadron, Dexpak,

 Dexasone) Anti-infl ammatory/
y

Immunosuppressive:

pp

0.5 to 9 mg/day PO/IV/IM, divided bid to qid. Cerebral edema: 10 to 20 mg IV load, then 4 mg IM q 6 h (off-label IV use common) or 1 to 3 mg PO tid. Bronchopulmonary dysplasia in preterm infants: p
y y p
p

0.5 mg/kg

PO/IV divided q 12 h for 3 days, then taper. Croup: p 0.6 mg/kg PO or IM for one
dose. Acute asthma: age older than 2 yo: 0.6 mg/kg to max 16 mg PO daily for 2 days. Fetal lung maturation, maternal antepartum: g

,
p

6 mg IM q 12 h for

4 doses. Antiemetic, prophylaxis:

, p p y

8 mg IV or 12 mg PO prior to chemotherapy;

8 mg PO daily for 2 to 4 days. Antiemetic, treatment:

,

10 to 20 mg PO/IV q 4
to 6 h. [Generic/Trade: Tabs 0.5, 0.75. Generic only: Tabs 0.25, 1.0, 1.5, 2, 4, 6 mg; elixir 0.5 mg/5 mL; Soln 0.5 mg/5 mL, 1 mg/1 mL (concentrate). Trade only: Dexpak 13 days (51 total 1.5 mg tabs for a 13 days taper) Dexpak 6 days (21 total 1.5 mg tabs for 6 days taper).] `L ♀C – $

Endocrine & Metabolic 69

FLUDROCORTISONE ( Florineff ) Mineralocorticoid activity: y 0.1 mg PO 3 times
a week to 0.2 mg PO daily. [Generic only: Tabs 0.1 mg.] `L ♀C ? $

HYDROCORTISONE ( Cortef, Cortenema, Solu-Corteff ) 100 to 500 mg IV/

IM q 2 to 6 h prn (sodium succinate). 20 to 240 mg/day PO divided tid to qid. Ulcerative colitis: 100 mg retention enema qhs (laying on side for 1 h or longer) for 21 days. [Generic/Trade: Tabs 5, 10, 20 mg, Enema 100 mg/60
mL.] `L ♀C – $

METHYLPREDNISOLONE ( Solu-Medrol, Medrol, Depo-Medrol ) Oral (Medrol): Dose varies, 4 to 48 mg PO daily. Medrol Dosepak tapers 24 to 0 mg PO over 7 days. IM/Joints (Depo-Medrol): Dose varies, 4 to 120 mg IM q 1 to 2 weeks.

Parenteral (Solu-Medrol): Dose varies, 10 to 250 mg IV/IM. Peds: 0.5 to 1.7
mg/kg PO/IV/IM divided q 6 to 12 h. Acute spinal cord injury: p
j y 30 mg/kg IV over

15 min, followed in 45 min by a 5.4 mg/kg/h IV infusion for 23 to 47 h. [Trade only: Tabs 2, 16, 32 mg. Generic/Trade: Tabs 4, 8 mg. Medrol Dosepak (4 mg, 21 tabs).] `L ♀C – $

PREDNISOLONE ( Flo-Pred, Prelone, Pediapred, Orapred, Orapred ODT ) 5 to 60 mg PO daily. [Generic/Trade: Syrup 15 mg/5 mL (Prelone; wild cherry fl avor). Soln 5 mg/5 mL (Pediapred, raspberry fl avor), 15 mg/5 mL (Orapred; grape fl avor). Trade only: Orally disintegrating tabs 10, 15, 30 mg (Orapred ODT); Susp 5 mg/5 mL, 15 mg/5 mL (Flo-Pred; cherry fl avor). Generic only: Tabs 5 mg. Syrup 5 mg/5 mL.] `L ♀C + $$

PREDNISONE ( Deltasone, Sterapred,  Winpred ) 1 to 2 mg/kg or 5 to 60
mg PO daily. [Trade only: Sterapred (5 mg tabs: Tapers 30 to 5 mg PO over 6 days or 30 to 10 mg over 12 days), Sterapred DS (10 mg tabs: Tapers 60
to 10 mg over 6 days, or 60 to 20 mg PO over 12 days) taper packs. Generic only: Tabs 1, 2.5, 5, 10, 20, 50 mg. Soln 5 mg/5 mL, 5 mg/mL (Prednisone Intensol).] `L ♀C + $

TRIAMCINOLONE ( Aristospan, Kenalog, Trivariss) 4 to 48 mg PO/IM daily.

Intra-articular 2.5 to 40 mg (Kenalog, Trivaris), 2 to 20 mg (Aristospan).

(cont.)

Approximate

Relative Anti-

Relative

Biological

Equivalent Dose
infl ammatory

Mineralocorti-

Half-life

CORTICO-

(mg)

Potency
coid Potency

(h)

STEROIDS
betamethasone

0.6–0.75

20–30

0

36–54
cortisone

25

0.8

2

8–12
dexamethasone

0.75

20–30

0

36–54
fl udrocortisone
n.a.

10

125

18–36
hydrocortisone

20

1

2

8–12
methylpredni-

4

5

0

18–36
solone
prednisolone

5

4

1

18–36
prednisone

5

4

1

18–36
triamcinolone

4

5

0

12–36
n.a., not available.

70 Endocrine & Metabolic

[Trade only: Injection 10 mg/mL, 40 mg/mL (Kenalog), 5 mg/mL, 20 mg/mL

(Aristospan), 8 mg (80 mg/mL) syringe (Trivaris).] `L ♀C – $

Diabetes-Related—Alpha-Glucosidase Inhibitors

ACARBOSE ( Precose,  Glucobayy) Start 25 mg PO tid with meals, and gradually increase as tolerated to maintenance 50 to 100 mg tid. [Generic/

Trade: Tabs 25, 50, 100 mg.] `Gut/K ♀B – $$$

MIGLITOL ( Glyset ) Start 25 mg PO tid with meals, maintenance 50 to 100
tid. [Trade only: Tabs 25, 50, 100 mg.] `K ♀B – $$$

Diabetes-Related—Combinations

ACTOPLUS MET (pioglitazone + metformin) 1 tab PO daily or bid. If in -
adequate control with metformin monotherapy, start 15/500 or 15/850 PO daily or bid. If inadequate control with pioglitazone monotherapy, start 15/500 bid or 15/850 daily. Max 45/2550 mg/day. Obtain LFTs before therapy and periodically thereafter. [Trade only: Tabs 15/500, 15/850 mg.] `KL ♀C ? $$$$$

AVANDAMET (rosiglitazone + metformin) Initial therapy (drug-naive): Start

2/500 mg PO daily or bid. If inadequate control with metformin alone, select tab strength based on adding 4 mg/day rosiglitazone to existing metformin dose. If inadequate control with rosiglitazone alone, select tab strength based on adding 1000 mg/day metformin to existing rosiglitazone dose. Max 8/2000
mg/day. Obtain LFTs before therapy & periodically thereafter. [Trade only: Tabs 2/500, 4/500, 2/1000, 4/1000 mg.] `KL ♀C ? $$$$$

AVANDARYL (rosiglitazone + glimepiride) Initial therapy (drug-naive): Start 4/1 mg PO daily. If switching from monotherapy with a sulfonylurea or glitazone, consider 4/2 mg PO daily. Max 8/4 mg/day. Obtain LFTs before therapy & periodically thereafter. [Trade only: Tabs 4/1, 4/2, 4/4, 8/2, 8/4 mg rosiglitazone/glimepiride.] `LK ♀C ? $$$$

DUETACT (pioglitazone + glimepiride) Start 30/2 mg PO daily. Start up to 30/4 mg PO daily if prior glimepiride therapy, or 30/2 mg PO daily if prior pioglitazone therapy; max 30/4 mg/day. Obtain LFTs before therapy

& periodically thereafter. [Trade only: Tabs 30/2, 30/4 mg pioglitazone/
glimepiride.] `LK ♀C – $$$$

GLUCOVANCE (glyburide + metformin) Initial
therapy (drug-naive): Start

1.25/250 mg PO daily or bid with meals; max 10/2000 mg daily. Inadequate control with a sulfonylurea or metformin alone: Start 2.5/500 or 5/500 mg PO bid with meals; max 20/2000 mg daily. [Generic/Trade: Tabs 1.25/250, 2.5/500, 5/500 mg.] `KL ♀B ? $$$

JANUMET (sitagliptin + metformin) 1 tab PO bid. Individualize based on patient’s current therapy. If inadequate control with metformin monotherapy, start 50/500 or 50/1000 bid based on current metformin dose. If inadequate control on sitagliptin, start 50/500 bid. Max 100/2000 mg/day. Give with meals.

[Trade only: Tabs 50/500, 50/1000 mg sitagliptin/metformin.] `K ♀B ? $$$$

METAGLIP (glipizide + metformin) Initial therapy (drug-naive): Start 2.5/250 mg PO daily to 2.5/500 mg PO bid with meals; max 10/2000 mg daily.

Inadequate control with a sulfonylurea or metformin alone: Start 2.5/500 or (cont.)

Endocrine & Metabolic 71

DIABETES NUMBERS*

Criteria for diagnosis
g

:

Self-monitoring glucose goals
g g
g

Pre-diabetes: Fasting glucose 100–125 mg/dL

Diabetes:† Fasting glucose ⩾126 mg/dL,

Preprandial 70–130
mg/dL
random glucose with symptoms: ⩾200 mg/dL,

Postprandial

<180 mg/dL
or ⩾200 mg/dL 2 h after 75 g oral glucose load

A1C goal <7%;

Critically ill glucose goal
y
g
g

<140 mg/dL (surgical pts ideal glucose ~110 mg/dL
g

(
g
p
g
g

Estimated average
g glucose (eAG):

g

(

) eAG (mg/dL) = (28.7 ×A1C) − 46.7

Complications prevention & management
p
p
g

: ASA‡ (75–162 mg/day) in T
t
ype 1 & 2 adults for
primary prevention (those with an increased cardiovascular risk, including >40 yo or additional risk factors) and secondary prevention (those with vascular disease); statin therapy to achieve 30–40% LDL reduction regardless of baseline LDL (for those with vascular disease, those >40 yo and additional risk factor, or those <40 yo but LDL >100 mg/dL); ACE inhibitor or ARB if hypertensive or micro-/macro-albuminuria; pneumococcal vaccine (revaccinate one time if age ⩾65 and previously received vaccine at age <65 and >5 yr ago). Everyy visit: Measure wt & BP (goal <130/80 mm Hg); visual foot exam; review self-monitoring glucose record; review/adjust meds; review self-mgmt skills, dietary needs, and physical activity; smoking cessation counseling. Twice a year y

: A1C in those meeting treatment goals
r
with stable glycemia (quarterly if not); dental exam. Annuallyy: Fasting lipid profi le** [goal LDL <100 mg/dL; cardiovascular disease consider LDL <70mg/dL, HDL >40 mg/dL (>50
mg/dL in women), TG <150 mg/dL], q 2 yr with low-risk lipid values; creatinine; albumin to creatinine ratio spot collection; dilated eye exam; fl u vaccine; foot exam.

*See recommendations at: care.diabetesjournals.org. Reference: Diabetes Care 2009;32 (Suppl 1):S13-S61.

e

Glucose values are plasma. †Confi rm diagnosis with glucose testing on subsequent day. ‡Avoid ASA if <21
yo due to Reye’s Syndrome risk; use if <30 yo has not been studied. **LDL is primary target of therapy.

5/500 mg PO bid with meals; max 20/2000 mg daily. [Generic/Trade: Tabs 2.5/250, 2.5/500, 5/500 mg.] `KL ♀C ? $$$

PRANDIMET (repaglinide + metformin) Initial therapy

(drug-naive): Start

1/500 mg PO daily before meals; max 10/2500 mg daily or 4/1000 mg/meal.

May start higher if already taking higher coadministered doses of repaglinide and metformin. [Trade: Tabs 1/500, 2/500 mg.] `KL ♀C ? $$$

Diabetes-Related—“Glitazones” (Thiazolidinediones) PIOGLITAZONE ( Actoss) Start 15 to 30 mg PO daily, max 45 mg/day. Monitor LFTs. [Trade only: Tabs 15, 30, 45 mg.] `L ♀C – $$$$$

ROSIGLITAZONE ( Avandia) Diabetes monotherapy or in combination with py
metformin or sulfonylurea:

y

Start 4 mg PO daily or divided bid, max 8 mg/day.

Obtain LFTs before therapy & periodically thereafter. [Trade only: Tabs 2, 4, 8
mg.] `L ♀C – $$$$

Diabetes-Related—Insulins

INSULIN—INJECTABLE COMBINATIONS (Humalog Mix 75/25, Humalog Mix 50/50, Humulin 70/30, Humulin 50/50, Novolin 70/30, Novolog Mix 70/30, Novolog Mix 50/50)

Diabetes: Doses vary, but typically total insulin 0.3 to 1 unit/kg/day SC in divided doses (Type 1
yp

), and 0.5 to 1.5 unit/kg/day SC in

(cont.)

72 Endocrine & Metabolic
divided doses (Type 2
yp

). Administer rapid-acting insulin mixtures (Humalog, NovoLog) within 15 min before or immediately after a meal. Administer regular insulin mixtures 30 min before meals. [Trade only: Insulin lispro protamine susp/insulin lispro (Humalog Mix 75/25, Humalog Mix 50/50). Insulin aspart protamine/insulin aspart (Novolog Mix 70/30, Novolog Mix 50/50). NPH and regular mixtures (Humulin 70/30, Novolin 70/30 or Humulin 50/50). Insulin available in pen form: Novolin 70/30 InnoLet, Novolog Mix 70/30, Novolog Mix 50/50, FlexPen, Humulin 70/30, Humalog Mix 75/25 KwikPen, Humalog Mix 50/50 KwikPen.] `LK ♀B/C + $$$$

INSULIN—INJECTABLE INTERMEDIATE/LONG-ACTING ( Novolin N, Humulin N, Lantus, Levemir)

r

Diabetes: Doses vary, but typically total insulin 0.3 to 0.5
unit/kg/day SC in divided doses (Type 1
yp

), and 1 to 1.5 unit/kg/day SC in divided
doses (Type 2
yp

). Generally, 50 to 70% of insulin requirements are provided by rapid or short-acting insulin and the remainder from intermediate- or long-acting insulin. Lantus: Start 10 units SC daily (same time everyday) in insulin-naive patients. Levemir: Type 2 DM
yp

(inadequately controlled on oral
meds): Start 0.1 to 0.2 units/kg once daily in evening or 10 units SC daily or BID. [Trade only: Injection NPH (Novolin N, Humulin N). Insulin glargine (Lantus). Insulin detemir (Levemir). Insulin available in pen form: Novolin N

InnoLet, Humulin N Pen, Lantus OptiClik (reusable), Lantus SoloStar (prefi lled-disposable), Levemir InnoLet, Levemir FlexPen. Premixed preparations of NPH
and regular insulin also available.] `LK ♀B/C + $$$$

INSULIN—INJECTABLE SHORT/RAPID-ACTING ( Apidra, Novolin R, NovoLog, Humulin R, Humalog,  NovoRapid)

d

Diabetes: Doses vary, but typically

(cont.)

INJECTABLE INSULINS*

Onset (h)

Peak (h)

Duration (h)

Insulin aspart (NovoLog)

<0.2

1–3

3–5

Rapid/short-

Insulin glulisine (Apidra)

0.30–0.4

1

4–5
acting:

Insulin lispro (Humalog)

0.25–0.5

0.5–2.5

≤5

Regular (Novolin R, Humulin R)

0.5–1

2–3

3–6

NPH (Novolin N, Humulin N)

2–4

4–10

10–16

Intermediate/

Insulin detemir (Levemir)

n.a.

fl at action
up to 23†
long-acting:

profi le

Insulin glargine (Lantus)

2–4
peakless

24

Insulin aspart protamine susp/

0.25

1–4
up to 24
aspart (NovoLog Mix 70/30,

(biphasic)

NovoLog Mix 50/50)

Insulin lispro protamine susp/

10–20

Mixtures:

<0.25

1–3
insulin lispro (HumaLog Mix

(biphasic)

75/25, HumaLog Mix 50/50)

NPH/Reg (Humulin 70/30,

0.5–1

2–10

10–20

Humulin 50/50, Novolin 70/30)

(biphasic)

*These are general guidelines, as onset, peak, and duration of activity are affected by the site of injection, physical activity, body temperature, and blood supply. † Dose dependent duration of action, range from 6 to 23 h. n.a., not available.

Endocrine & Metabolic 73
total insulin 0.3 to 0.5 unit/kg/day SC in divided doses (Type 1
yp

), and 1 to

1.5 unit/kg/day SC in divided doses (Type 2
yp

). Generally, 50 to 70% of insulin
requirements are provided by rapid or short-acting insulin and the remainder from intermediate- or long-acting insulin. Administer rapid-acting insulin (Humalog, NovoLog, Apidra) within 15 min before or immediately after a meal.

Administer regular insulin 30 min before meals. Severe hyperkalemia: yp

5 to 10
units regular insulin plus concurrent dextrose IV. Profound hyperglycemia yp g y

(eg,

DKA): 0.1 unit regular/kg IV bolus, then initial infusion 100 units regular in 100 mL NS (1 unit/mL), at 0.1 units/kg/h. 70 kg: 7 units/h (7 mL/h). [Trade only: Injection regular (Novolin R, Humulin R). Insulin glulisine (Apidra).

Insulin lispro (Humalog). Insulin aspart (NovoLog). Insulin available in pen form: Novolin R InnoLet, Humulin R, Apidra OptiClik, Humalog KwikPen, Novolog FlexPen.] `LK ♀B/C + $$$

Diabetes-Related—Meglitinides

NATEGLINIDE ( Starlix)

x

120 mg PO tid within 30 min before meals; use

60 mg PO tid in patients who are near goal A1C. [Trade only: Tabs 60, 120
mg.] `L ♀C ? $$$$

REPAGLINIDE ( Prandin,  Gluconorm)

m

Start 0.5 to 2 mg PO tid before
meals, maintenance 0.5 to 4 mg tid to qid, max 16 mg/day. [Trade only: Tabs 0.5, 1, 2 mg.] `L ♀C ? $$$$

Diabetes-Related—Sulfonylureas—2nd Generation

GLICLAZIDE ( Diamicron, Diamicron MRR) Canada only. Immediate-release: Start 80 to 160 mg PO daily, max 320 mg PO daily (160 mg or more per day should be in divided doses). Modifi ed-release: Start 30 mg PO daily, max 120 mg PO daily. [Generic/Trade: Tabs 80 mg (Diamicron). Trade only: Tabs, modifi ed-release 30 mg (Diamicron MR).] `KL ♀C ? $

GLIMEPIRIDE ( Amaryl ) Start 1 to 2 mg PO daily, usual 1 to 4 mg/day, max 8 mg/day. [Generic/Trade: Tabs 1, 2, 4 mg. Generic only: Tabs 3, 6, 8 mg.] `LK

♀C – $$

GLIPIZIDE ( Glucotrol, Glucotrol XL) Start 5 mg PO daily, usual 10 to 20 mg/
day, max 40 mg/day (divide bid if more than 15 mg/day). Extended-release: Start 5 mg PO daily, usual 5 to 10 mg/day, max 20 mg/day. [Generic/Trade: Tabs 5, 10 mg; Extended-release tabs 2.5, 5, 10 mg.] `LK ♀C ? $

GLYBURIDE ( DiaBeta, Glynase PresTab,  Euglucon) Start 1.25 to 5 mg PO
daily, usual 1.25 to 20 mg daily or divided bid, max 20 mg/day. Micronized tabs: Start 1.5 to 3 mg PO daily, usual 0.75 to 12 mg/day divided bid, max 12 mg/day. [Generic/Trade: Tabs (scored) 1.25, 2.5, 5 mg. Micronized Tabs (scored) 1.5, 3, 4.5, 6 mg.] `LK ♀B ? $

Diabetes-Related—Other

A1C HOME TESTING ( Metrika A1CNow
w) For home A1C testing [Fingerstick
blood.] `None ♀+ + $

74 Endocrine & Metabolic

DEXTROSE ( Glutose, B-D Glucose, Insta-Glucose, Dex-4) 4 Hypoglycemia:

yp g y

0.5 to 1 g/kg (1 to 2 mL/kg) up to 25 g (50 mL) of 50% soln IV. Dilute to 25%
for pediatric administration. [OTC Generic/Trade: Chewable tabs 4 g (Dex-4), 5 g (Glutose). Trade only: Oral gel 40%.] `L ♀C ? $

EXENATIDE ( Byetta) Type 2 DM adjunctive therapy yp
j
py when inadequate control
on metformin, a sulfonylurea, or a glitazone (alone or in combination): 5 mcg SC bid (within 1 h before the morning and evening meals, or 1 h before the two main meals of the day at least 6 h apart). May increase to 10 mcg SC bid after 1 month. [Trade only: Prefi lled pen (60 doses each) 5 mcg/dose, 1.2 mL; 10 mcg/dose, 2.4 mL.] `K ♀C ? $$$$$

GLUCAGON ( GlucaGen)

n

Hypoglycemia:

yp g y

1 mg IV/IM/SC, onset 5 to 20 min.

Diagnostic aid:

g

1 mg IV/IM/SC. [Trade only: Injection 1 mg.] `LK ♀B ? $$$

GLUCOSE HOME TESTING ( Accu-Chek Active, Accu-Check Advantage, Accu-Check Aviva, Accu-Check Compact, Accu-Check Compact Plus, Accu-Check Complete, Accu-Check Voicemate, FreeStyle Flash, FreeStyle Freedom, FreeStyle Freedom Lite, FreeStyle Lite, OneTouch Ultra, OneTouch UltraMini, OneTouch UltraSmart, Precision Xtra, ReliOn, Sidekick, True Track Smart System, Clinistix, Clinitest, Diastix, Tes-Tape) Use for home
glucose monitoring. [Plasma: Accu-Check meters, FreeStyle meters, OneTouch meters, Precision Xtra, ReliOn, Sidekick, True Track. Urine: Clinistix, Clinitest, Diastix, Tes-Tape.] `None ♀+ + $$

METFORMIN ( Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet ) Diabetes, type 2:

, yp

Immediate-release: Start 500 mg PO daily to bid
or 850 mg PO daily with meals, may gradually increase to max 2550 mg/
day. Extended-release: Glucophage XR: 500 mg PO daily with evening meal; increase by 500 mg once a week to max 2000 mg/day (may divide bid).

Glumetza: 1000 mg PO daily with evening meal; increase by 500 mg once a week to max 2000 mg/day (may divide bid). Fortamet: 500 to 1000 mg daily with evening meal; increase by 500 mg once a week to max 2500 mg/
day. Polycystic ovary syndrome
y y
y y

(unapproved, immediate-release): 500 mg PO
tid. [Generic/Trade: Tabs 500, 850, 1000 mg, extended-release 500, 750 mg.

Trade only, extended-release: Fortamet 500, 1000 mg; Glumetza 500, 1000
mg. Trade only: Oral soln 500 mg/5 mL (Riomet).] `K ♀B ? $

PRAMLINTIDE ( Symlin, Symlinpen)

n Type 1 DM
yp
with mealtime insulin therapy:

Initiate 15 mcg SC immediately before major meals and titrate by 15 mcg increments (if signifi cant nausea has not occurred for at least 3 day) to maintenance 30 to 60 mcg as tolerated. Type 2 DM
yp
with mealtime insulin therapy: Initiate 60 mcg

SC immediately before major meals and increase to 120 mcg as tolerated (if signifi cant nausea has not occurred for 3 to 7 days). [Trade only: 600 mcg/mL in 5
mL vials, 1000 mcg/mL pen injector (Symlinpen) 1.5, 2.7 mL.] `K ♀C ? $$$$

SITAGLIPTIN ( Januvia)

Type 2 DM:

yp

100 mg PO daily. [Trade only: Tabs 25, 50,

100 mg.] `K ♀B ? $$$$

Diagnostic Agents

COSYNTROPIN ( Cortrosyn,  Synacthenn) Rapid screen for adrenocortical p
insuffi ciency:

y 0.25 mg (0.125 mg if age younger than 2 yo) IM/IV over 2 min; measure serum cortisol before and 30 to 60 min after. `L ♀C ? $

Endocrine & Metabolic 75

Gout-Related

ALLOPURINOL ( Aloprim, Zyloprim)

m

Mild gout or recurrent calcium oxalate
g
stones: 200 to 300 mg PO daily to bid, max 800 mg/day. [Generic/Trade: Tabs 100, 300 mg.] `K ♀C + $

COLBENEMID (colchicine + probenecid) 1 tab PO daily for 1 week, then 1
tab PO bid. [Generic only: Tabs 0.5 mg colchicine + 500 mg probenecid.] `KL

♀C ? $

COLCHICINE ( Colcrys)

s Rapid treatment of acute gouty arthritis: p
g
y

2 tabs PO at
fi rst sign of attack then 1 tab 1 h later (max 3 tabs). Gout prophylaxis: p p y

0.6 mg

PO bid if CrCl ≥50 mL/min, 0.6 mg PO daily if CrCl 35 to 49 mL/min, 0.6 mg PO
q 2 to 3 days if CrCl 10 to 34 mL/min. [Trade only: Tabs 0.6 mg.] `L ♀C ? $

FEBUXOSTAT ( Uloric)

Hyperuricemia with gout:

yp
g

Start 40 mg PO daily, max

80 mg daily. [Trade only: Tabs 40, 80 mg.] `LK ♀C ? $$$$

PROBENECID ( Benuryl ) Gout: 250 mg PO bid for 7 days, then 500 mg bid. Adjunct j

to penicillin injection:

p
j

1 to 2 g PO. [Generic only: Tabs 500 mg.] `KL ♀B ? $

Minerals

CALCIUM ACETATE ( PhosLo) Hyperphosphatemia: yp p
p

Initially 2 tabs/caps PO
with each meal. [Generic/Trade: Gelcaps 667 mg (169 mg elem Ca).] `K

♀+ ? $$$$

CALCIUM CARBONATE ( Caltrate, Mylanta Children’s, Os-Cal, Oyst-Cal, Tums, Surpass, Viactiv,  Calsan)

n

Supplement: 1 to 2 g elem Ca/day or more PO
with meals divided bid to qid. Antacid: 1000 to 3000 mg PO q 2 h prn or 1
to 2 pieces gum chewed prn, max 7000 mg/day. [OTC Generic/Trade: Tabs 500, 650, 750, 1000, 1250, 1500 mg, Chewable tabs 400, 500, 750, 850, 1000, 1177, 1250 mg, Cap 1250 mg, Gum 300, 450 mg, Susp 1250 mg/5
mL. Calcium carbonate is 40% elem Ca and contains 20 mEq of elem Ca/g calcium carbonate. Not more than 500 to 600 mg elem Ca/dose. Available in combination with sodium fl uoride, vitamin D and/or vitamin K. Trade examples: Caltrate 600 + D is equivalent to 600 mg elemental Ca/200 units vit D, Os-Cal 500 + D is equivalent to 500 mg elemental Ca/200 units vit D, Os-Cal Extra D is equivalent to 500 mg elemental Ca/400 units vit D, Tums (regular strength) is equivalent to 200 mg elemental Ca, Tums (ultra) is equivalent to 400 mg elemental Ca, Viactiv (chewable) 500 mg elemental Ca+ 100 units vit D + 40 mcg vit K.] `K ♀+ (? fi rst trimester) ? $

CALCIUM CHLORIDE 500 to 1000 mg slow IV q 1 to 3 days. [Generic only: Injectable 10% (1000 mg/10 mL) 10 mL ampules, vials, syringes.] `K ♀+ + $

CALCIUM CITRATE ( Citracal ) 1 to 2 g elem Ca/day or more PO with meals divided bid to qid. [OTC Trade only (mg elem Ca): 200, 250 mg with 200 units vitamin D and 250 mg with 125 units vitamin D and 80 mg of magnesium.

Chewable tabs 500 mg with 200 units vitamin D. OTC Generic/Trade: Tabs 200
mg, 315 mg with 200 units vitamin D.] `K ♀+ + $

CALCIUM GLUCONATE 2.25 to 14 mEq slow IV. 500 to 2000 mg PO bid to qid.

[Generic only: Injectable 10% (1000 mg/10 mL, 4.65 mEq/10 mL) 1, 10, 50, 100, 200 mL. OTC Generic only: Tabs 50, 500, 650, 975, 1000 mg. Chewable tabs 650 mg.] `K ♀+ + $

76 Endocrine & Metabolic

FERRIC GLUCONATE COMPLEX ( Ferrlecit ) 125 mg elem iron IV over 10 min or diluted in 100 mL NS IV over 1 h. Peds age 6 yo or older: 1.5 mg/kg (max 125 mg) elem iron diluted in 25 mL NS & administered IV over 1 h. `KL ♀B ? $$$$$

FERROUS GLUCONATE ( Fergon) 800 to 1600 mg ferrous gluconate PO
divided tid. [OTC Generic/Trade: Tabs 240 mg ferrous gluconate equivalent to 27 mg elem iron. Generic only: Tabs 27, 300, 324, 325 mg.] `K ♀+ + $

FERROUS SULFATE ( Fer-in-Sol, Feosol,  Ferodan, Slow-Fe) 500 to 1000
mg ferrous sulfate (100 to 200 mg elem iron) PO divided tid. Liquid: Adults 5 to 10 mL tid, non-infant children 2.5 to 5 mL tid. Many other available formulations. [OTC Generic/Trade (mg ferrous sulfate): Tabs, extended-release 160 mg; tabs 324, 325 mg; gtts 75 mg/0.6 mL. OTC Generic only: Tabs, extended-release 50 mg; elixir 220 mg/5 mL.] `K ♀+ + $

FERUMOXYTOL ( Feraheme) Iron defi ciencyy in chronic kidney disease: Give 510 mg IV push, followed by 510 mg IV push once given 3 to 8 days after initial injection. `KL ♀C ? $$$$$

FLUORIDE ( Luride,  Fluor-A-Day, Fluotic) Adult dose: 10 mL of topical rinse swish and spit daily. Peds daily dose based on fl uoride content of drinking water (table). [Generic only: Chewable tabs 0.5, 1 mg, Tab 1 mg, gtts 0.125
mg, 0.25 mg, and 0.5 mg/dropperful, Lozenges 1 mg, Soln 0.2 mg/mL, Gel 0.1%, 0.5%, 1.23%, Rinse (sodium fl uoride) 0.05, 0.1, 0.2%).] `K ♀? ? $

IRON DEXTRAN ( INFeD, DexFerrum,  Dexiron, Infufer) r

25 to 100 mg IM
daily prn. Equations available to calculate IV dose based on wt & Hb. `KL

♀– ? $$$$

IRON POLYSACCHARIDE ( Niferex, Niferex-150, Nu-Iron 1500) 50 to 200 mg PO divided daily to tid. [OTC Trade only: Caps 60 mg (Niferex). OTC Generic/

(cont.)

FLUORIDE SUPPLEMENTATION

Age

<0.3 ppm in drinking 0.3–0.6 ppm in drinking

>0.6 ppm in drinking
water
water
water

0–0.5 yo
none
none
none

0.5–3 yo

0.25 mg PO qd
none
none

3–6 yo

0.5 mg PO qd

0.25 mg PO qd
none

6–16 yo

1 mg PO qd

0.5 mg PO qd
none

IV SOLUTIONS

Calories/

Solution

Dextrose

Liter

Na*

K*

Ca*

Cl*

Lactate*

Osm*

0.9 NS

0 g/L

0

154

0

0

154

0

310

LR

0 g/L

9

130

4

3

109

28

273

D5 W

50 g/L

170

0

0

0

0

0

253

D5 0.2 NS

50 g/L

170

34

0

0

34

0

320

D5 0.45 NS

50 g/L

170

77

0

0

77

0

405

D5 0.9 NS

50 g/L

170

154

0

0

154

0

560

D5 LR

50 g/L

179

130

4

2.7

109

28

527

* All given in mEq/L

Endocrine & Metabolic 77

Trade: Caps 150 mg (Niferex-150, Nu-Iron 150), liquid 100 mg/5 mL (Niferex).

1 mg iron polysaccharide = 1 mg elemental iron.] `K ♀+ + $$

IRON SUCROSE ( Venofer)

r

Iron defi ciency with hemodialysis:

y
y

5 mL (100 mg
elem iron) IV over 5 min or diluted in 100 mL NS IV over 15 min or longer. Iron defi ciency in non-dialysis chronic kidney disease: y
y
y

10 mL (200 mg elem iron) IV
over 5 min. `KL ♀B ? $$$$$

MAGNESIUM CHLORIDE ( Slow-Mag ) 2 tabs PO daily. [OTC Trade only: Enteric coated tab 64 mg. Slow-Mag 64 mg tab equivalent to 64 mg elem magnesium.] `K ♀A + $

MAGNESIUM GLUCONATE ( Almora, Magtrate, Maganate,  Maglucate) 500
to 1000 mg PO divided tid. [OTC Generic only: Tabs 500 mg, liquid 54 mg elem Mg/5 mL.] `K ♀A + $

MAGNESIUM OXIDE ( Mag-200, Mag-Ox 400)

0

400 to 800 mg PO daily. [OTC

Generic/Trade: Caps 140, 250, 400, 420, 500 mg.] `K ♀A + $

MAGNESIUM SULFATE

Hypomagnesemia:

yp
g

1 g of 20% soln IM q 6 h for 4
doses, or 2 g IV over 1 h (monitor for hypotension). Peds: 25 to 50 mg/kg IV/

IM q 4 to 6 h for 3 to 4 doses, max single dose 2 g. Eclampsia: p

4 to 6 g IV
over 30 min, then 1 to 2 g/h. Drip: 5 g in 250 mL D5W (20 mg/mL), 2 g/h is a rate of 100 mL/h. Preterm labor: 6 g IV over 20 min, then 1 to 3 g/h titrated to decrease contractions. Monitor respirations & refl exes. If needed, may reverse toxic effects with calcium gluconate 1 g IV. Torsades de pointes: p

1 to 2 g IV in

D5W over 5 to 60 min. `K ♀A + $

PHOSPHORUS ( Neutra-Phos, K-Phos) 1 cap/packet PO qid. 1 to 2 tabs PO qid. Severe hypophosphatemia
yp p
p

(eg, <1 mg/dL): 0.08 to 0.16 mmol/kg

IV over 6 h. [OTC Trade only: (Neutra-Phos, Neutra-Phos K) tab/cap/packet 250 mg (8 mmol) phosphorus. Rx: Trade only: (K-Phos) tab 250 mg (8 mmol) phosphorus.] `K ♀C ? $

POTASSIUM ( Cena-K ) ( Effer-K, K+

K 8, K+

K 10, Kaochlor, Kaon, Kaon Cl, Kay

Ciel, Kaylixir, K+

K Care, K+

K Care ET, K-Dur, K-G Elixir, K-Lease, K-Lor, Klorcon, Klorvess, Klorvess Effervescent, Klotrix, K-Lyte, K-Lyte Cl, K-Norm, Kolyum, K-Tab, K-vescent, Micro-K, Micro-K LS, Slow-K, Ten-K, Tri-K) K IV
infusion 10 mEq/h (diluted). 20 to 40 mEq PO daily or bid. [Injectable, many different products in a variety of salt forms (ie, chloride, bicarbonate, citrate, acetate, gluconate), available in tabs, caps, liquids, effervescent tabs, packets. Potassium gluconate is available OTC.] `K ♀C ? $

POTASSIUM (oral forms)

Effervescent Granules: 20 mEq:

q Klorvess Effervescent, K-vescent

Effervescent Tabs: 25 mEq:

q Effer-K, K+Care ET, K-Lyte, K-Lyte/Cl, Klor-Con/EF

50 mEq:

q K-Lyte DS, K-Lyte/Cl 50

Liquids: 20 mEq/15 mL:

q

Cena-K, Kaochlor S-F, K-G Elixir, Kaochlor 10%, Kay Ciel, Kaon, Kaylixir, Klorvess, Kolyum, Potasalan, Twin-K

30 mEq/15 mL:

q

Rum-K 40 mEq/15 mL: Cena-K, Kaon-Cl 20% 45 mEq/15 mL: q

Tri-K

Powders: 15 mEq/pack:

q p

K+Care 20 mEq/pack:

q p

Gen-K, K+Care, Kay Ciel, K-Lor, Klor-Con

25 mEq/pack:

q p

K+Care, Klor-Con 25

Tabs/Caps: 8 mEq:

q K+8, Klor-Con 8, Slow-K, Micro-K 10 mEq:

q K+10, K-Norm, Kaon-Cl 10,

Klor-Con 10, Klotrix, K-Tab, K-Dur 10, Micro-K 10 20 mEq: q Klor-Con M20, K-Dur 20

78 Endocrine & Metabolic

ZINC ACETATE ( Galzinn) Dietary supplement: y
pp

8 to 12 mg (elemental) daily.

Zinc defi ciency:

y 25 to 50 mg (elemental) daily. Wilson’s disease: 25 to 50
mg (elemental) tid. [Trade only: Caps 25, 50 mg elemental zinc.] `Minimal absorption ♀A – $$$

ZINC SULFATE ( Orazinc, Zincate) Dietary supplement: y
pp

8 to 12 mg

(elemental) daily. Zinc defi ciency:

y 25 to 50 mg (elemental) daily. [OTC Generic/

Trade: Tabs 66, 110, 200 mg. Rx Generic/Trade: Caps 220 mg.] `Minimal absorption ♀A – $

Nutritionals

BANANA BAG, RALLY PACK

Alcoholic malnutrition (one formula): Add thiamine

100 mg + folic acid 1 mg + IV multivitamins to 1 liter NS and infuse over 4 h. Magnesium sulfate 2 g may be added. “Banana bag” and “rally pack”

are jargon and not valid drug orders. Specify individual components. `KL ♀+

+ $

FAT EMULSION ( Intralipid, Liposyn) Dosage
varies.

`L ♀C ? $$$$$

FORMULAS—INFANT ( Enfamil, Similac, Isomil, Nursoy, Prosobee, Soyalac, Alsoy, Nutramigen Lipil ) Infant meals. [OTC: Milk-based (Enfamil, Similac, SMA) or soy-based (Isomil, Nursoy, ProSobee, Soyalac, Alsoy).] `L

♀+ + $

LEVOCARNITINE ( Carnitorr) 10 to 20 mg/kg IV at each dialysis session.

[Generic/Trade: Tabs 330 mg, Oral soln 1 g/10 mL.] `KL ♀B ? $$$$$

OMEGA-3 FATTY ACID ( fi sh oil, Lovaza, Promega, Cardio-Omega 3, Sea-Omega, Marine Lipid Concentrate, MAX EPA, SuperEPA 1200) 0 Hypertriglyceridemia:

yp
g y

Lovaza: 4 caps PO daily or divided bid; 2 to 4 g EPA + DHA content daily.

Lovaza is only FDA approved fi sh oil, previously known as Omacor. Marine Lipid Concentrate, Super EPA 1200 mg cap contains EPA 360 mg + DHA 240
mg, daily dose is equivalent to 4 to 8 caps. [Trade only: (Lovaza) 1 g cap (total 840 mg EPA + DHA). Generic/Trade: Caps, shown as EPA + DHA mg content, 240 (Promega Pearls), 300 (Cardi-Omega 3, Max EPA), 320 (Sea-Omega), 400 (Promega), 500 (Sea-Omega), 600 (Marine Lipid Concentrate, SuperEPA 1200), 875 mg (SuperEPA 2000).] `L ♀C ? $

Phosphate Binders

LANTHANUM CARBONATE ( Fosrenol ) Hyperphosphatemia in end stage renal yp p
p
g
disease: Start 1500 mg/day PO in divided doses with meals. Titrate dose q 2
to 3 weeks in increments of 750 mg/day until acceptable serum phosphate is reached. Most will require 1500 to 3000 mg/day to reduce phosphate <6.0
mg/dL. [Trade only: Chewable tabs 500, 750, 1000 mg.] `Not absorbed ♀C

? $$$$$

SEVELAMER ( Renagel, Renvela) Hyperphosphatemia: yp p
p

800 to 1600 mg PO
tid with meals. [Trade only (Renagel—sevelamer hydrochloride): Tabs 400, 800 mg. (Renvela—sevelamer carbonate): Tabs 800 mg.] `Not absorbed

♀C ? $$$$$

Endocrine & Metabolic 79

PEDIATRIC REHYDRATION SOLUTIONS

Calories/

Brand

Glucose

Liter

Na*

K*

Cl*

Citrate* Phos* Ca* Mg*
g

CeraLyte 50

0 g/L

160

50

20

40

30

0

0

0

(premeasured
powder packet)

CeraLyte 70

0 g/L

160

70

20

60

30

0

0

0

(premeasured
powder packet)

CeraLyte 90

0 g/L

160

90

20

80

30

0

0

0

(premeasured
powder packet)

Infalyte

30 g/L

140

50

25

45

34

0

0

0

Kao Lectrolyte

20 g/L

90

50

20

40

30

0

0

0

(premeasured
powder packet)

Lytren (Canada)

20 g/L

80

50

25

45

30

0

0

0

Naturalyte

25 g/L

100

45

20

35

48

0

0

0

Pedialyte and

25 g/L

100

45

20

35

30

0

0

0

Pedialyte

Freezer Pops

Rehydralyte

25 g/L

100

75

20

65

30

0

0

0

Resol

20 g/L

80

50

20

50

34

5

4

4

* All given in mEq/L

Thyroid Agents

LEVOTHYROXINE ( L-Thyroxine, Levolet, Levo-T, Levothroid, Levoxyl, Novothyrox, Synthroid, Thyro-Tabs, Tirosint, Unithroid, T4,  Eltroxin, Euthyrox) Start 100 to 200 mcg PO daily (healthy adults) or 12.5 to 50
mcg PO daily (elderly or CV disease), increase by 12.5 to 25 mcg/day at 3 to 8
weeks intervals. Usual maintenance dose 100 to 200 mcg/day, max 300 mcg/
day. [Generic/Trade: Tabs 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg. Trade only: Caps: 25, 50, 75, 100, 125, 150 mcg in 7 days blister packs, Tabs: 13 mcg (Tirosint).] `L ♀A + $

LIOTHYRONINE ( T3, Cytomel, Triostat ) Start 25 mcg PO daily, max 100 mcg/
day. [Generic/Trade: Tabs 5, 25, 50 mcg.] `L ♀A ? $$

METHIMAZOLE ( Tapazole) Start 5 to 20 mg PO tid or 10 to 30 mg PO daily, then adjust. [Generic/Trade: Tabs 5, 10. Generic only: Tabs 15, 20 mg.] `L

♀D + $$$

PROPYLTHIOURACIL ( PTU,  Propyl Thyracil ) Start 100 mg PO tid, then adjust. Thyroid storm:

y

200 to 300 mg PO qid, then adjust. [Generic only: Tabs 50 mg.] `L ♀D (but preferred over methimazole) + $

80 Endocrine & Metabolic

SODIUM IODIDE I-131 ( Hicon, Iodotope, Sodium Iodide I-131 Therapeutic) Specialized dosing for hyperthyroidism and thyroid carcinoma.

[Generic/Trade: Caps, Oral soln: Radioactivity range varies at the time of calibration. Hicon is a kit containing caps and a concentrated oral soln for dilution and cap preparation.] `K ♀X – $$$$$

Vitamins

ASCORBIC ACID ( vitamin C,  Redoxon) 70 to 1000 mg PO daily. [OTC

Generic only: Tabs 25, 50, 100, 250, 500, 1000 mg, Chewable tabs 100, 250, 500 mg, Timed-release tabs 500, 1000, 1500 mg, Timed-release caps 500
mg, Lozenges 60 mg, Liquid 35 mg/0.6 mL, Oral soln 100 mg/mL, Syrup 500
mg/5 mL.] `K ♀C ? $

CALCITRIOL ( Rocaltrol, Calcijex)

x

0.25 to 2 mcg PO daily. [Generic/Trade:

Caps 0.25, 0.5 mcg. Oral soln 1 mcg/mL. Injection 1, 2 mcg/mL.] `L ♀C

? $$

CYANOCOBALAMIN ( vitamin B12, CaloMist, Nascobal ) Defi ciency y states:

100 to 200 mcg IM once a month or 1000 to 2000 mcg PO daily for 1 to 2
weeks followed by 1000 mcg PO daily, 500 mcg intranasal weekly (Nascobal: 1 spray 1 nostril once a week), or 50 to 100 mcg intranasal daily (CaloMist: 1
to 2 sprays each nostril daily). [OTC Generic only: Tabs 100, 500, 1000, 5000
mcg; lozenges 100, 250, 500 mcg. Rx Trade only: Nasal spray 500 mcg/spray (Nascobal 2.3 mL), 25 mcg/spray (CaloMist, 18 mL).] `K ♀C + $

DIATX (folic acid + niacinamide + cobalamin + pantothenic acid +
pyridoxine + D-biotin + thiamine + ascorbic acid + ribofl avin) 1 tab PO
daily. [Trade only: Each tab contains folic acid 5 mg + niacinamide 20 mg +
cobalamin 1 mg + pantothenic acid 10 mg + pyridoxine 50 mg + D-biotin 300 mcg + thiamine 1.5 mg + vitamin C 60 mg + ribofl avin 1.5 mg. Diatx Fe: Adds 100 mg ferrous fumarate per tab. Diatx Zn adds 25 mg of zinc oxide per tab.] `LK ♀? ? $$$

DOXERCALCIFEROL ( Hectorol )

Secondary hyperparathyroidism on dialysis:

y yp p
y
y

Oral: 10 mcg PO 3 times a week. May increase every 8 weeks by 2.5 mcg/dose; max 60 mcg/week. IV: 4 mcg IV 3 times a week. May increase dose every 8
weeks by 1 to 2 mcg/dose; max 18 mcg/week. Secondary hyperparathyroidism y yp p
y
not on dialysis: Start 1 mcg PO daily, may increase by 0.5 mcg/dose q 2 weeks.

Max 3.5 mcg/day. [Trade only: Caps 0.5, 2.5 mcg.] `L ♀B ? $$$$$

FOLGARD (folic acid + cyanocobalamin + pyridoxine) 1 tab PO daily. [OTC

Trade only: Folic acid 0.8 mg + cyanocobalamin 0.115 mg + pyridoxine 10
mg tab.] `K ♀? ? $

FOLIC ACID ( folate, Folvite) 0.4 to 1 mg IV/IM/PO/SC daily. [OTC Generic only: Tabs 0.4, 0.8 mg. Rx Generic 1 mg.] `K ♀A + $

FOLTX (folic acid + cyanocobalamin + pyridoxine) 1 tab PO daily. [Trade only: Folic acid 2.5 mg/cyanocobalamin 2 mg/pyridoxine 25 mg tab.] `K ♀A

+ $$

MULTIVITAMINS ( MVI)

I

Dose varies with product. Tabs come with and without iron. [OTC and Rx: Many different brands and forms available with and without iron (tabs, caps, chewable tabs, gtts, liquid).] `LK ♀+ + $

Endocrine & Metabolic 81

NEPHROCAPS (ascorbic acid + folic acid + niacin + thiamine + ribofl avin +
pyridoxine + pantothenic acid + biotin + cyanocobalamin) 1 cap PO daily.

If on dialysis, take after treatment. [Generic/Trade: Vitamin C 100 mg/folic acid 1 mg/niacin 20 mg/thiamine 1.5 mg/ribofl avin 1.7 mg/pyridoxine 10 mg/
pantothenic acid 5 mg/biotin 150 mcg/cyanocobalamin 6 mcg.] `K ♀? ? $

NEPHROVITE (ascorbic acid + folic acid + niacin + thiamine + ribofl avin

+ pyridoxine + pantothenic acid + biotin + cyanocobalamin) 1 tab PO
daily. If on dialysis, take after treatment. [Generic/Trade: Vitamin C 60 mg/folic acid 1 mg/niacin 20 mg/thiamine 1.5 mg/ribofl avin 1.7 mg/pyridoxine 10 mg/
pantothenic acid 10 mg/biotin 300 mcg/cyanocobalamin 6 mcg.] `K ♀? ? $

NIACIN ( vitamin B3, nicotinic acid, Niacor, Nicolar, Slo-Niacin, Niaspan)

n

Niacin defi ciency:

y 10 to 500 mg PO daily. Hyperlipidemia:

yp
p

Start

50 to 100 mg PO bid to tid with meals, increase slowly, usual maintenance range 1.5 to 3 g/day, max 6 g/day. Extended-release (Niaspan): Start 500 mg qhs, increase monthly pm up to max 2000 mg. Extended-release formulations not listed here may have greater hepatotoxicity. Titrate slowly and use ASA or NSAID 30 min before niacin doses to decrease fl ushing reaction. [OTC Generic only: Tabs 50, 100, 250, 500 mg, timed-release cap 125, 250, 400 mg, timed-release tab 250, 500 mg, liquid 50 mg/5 mL. Trade only: 250, 500, 750 mg (Slo-Niacin). Rx: Trade only: Tabs 500 mg (Niacor), Timed-release caps 500
mg, Timed-release tabs 500, 750, 1000 mg (Niaspan, $$$$).] `K ♀C ? $

PARICALCITOL ( Zemplar) Prevention/treatment r
of secondary hyperparathy-
y
yp p
y
roidism with renal insuffi ciency:

y 1 to 2 mcg PO daily or 2 to 4 mcg PO 3 times
a week; increase dose by 1 mcg/day or 2 mcg/week until desired PTH level is achieved. Prevention/treatment of secondary hyperparathyroidism with renal y yp p
y

failure (CrCl <15 mL/min): PO: To calculate initial dose divide baseline iPTH by 80 and then administer this dose in mcg 3 times a week. To titrate dose based on response, divide recent iPTH by 80 then administer this dose in mcg 3 times a week. IV: 0.04 to 0.1 mcg/kg (2.8 to 7 mcg) IV 3 times a week at dialysis; increase dose by 2 to 4 mcg q 2 to 4 weeks until desired PTH level is achieved. Max dose 0.24 mcg/kg (16.8 mcg). [Trade only: Caps 1, 2, 4 mcg.] `L ♀C ? $$$$$

PHYTONADIONE ( vitamin K, Mephyton, AquaMephyton) Single dose of 0.5
to 1 mg IM within 1 h after birth. Excessive oral anticoagulation: g

Dose varies
based on INR. INR 5 to 9: 1 to 2.5 mg PO (up to 5 mg PO may be given if rapid reversal necessary); INR >9 with no bleeding: 5 to 10 mg PO; Serious bleeding & elevated INR: 10 mg slow IV infusion. Adequate daily intake: q
y

120 mcg (males)

and 90 mcg (females). [Trade only: Tabs 5 mg.] `L ♀C + $

PYRIDOXINE ( vitamin B6)

6

10 to 200 mg PO daily. INH overdose: 1 g IV/IM
over 30 min, repeat until total dose of 1 g for each gram of INH ingested.

[OTC Generic only: Tabs 25, 50, 100 mg, timed-release tab 100 mg.] `K ♀A + $

RIBOFLAVIN ( vitamin B2)

2

5 to 25 mg PO daily. [OTC Generic only: Tabs 25,

50, 100 mg.] `K ♀A + $

THIAMINE ( vitamin B1) 10 to 100 mg IV/IM/PO daily. [OTC Generic only: Tabs 50, 100, 250, 500 mg, enteric coated tab 20 mg.] `K ♀A + $

TOCOPHEROL ( vitamin E,  Aquasol E) E

RDA is 22 units (natural, D-alpha-
tocopherol) or 33 units (synthetic, D,L-alpha-tocopherol) or 15 mg (alpha-

(cont.)

82 Endocrine & Metabolic
tocopherol). Max recommended 1000 mg (alpha-tocopherol). Antioxidant: 400
to 800 units PO daily. [OTC Generic only: Tabs 200, 400 units, Caps 73.5, 100, 147, 165, 200, 330, 400, 500, 600, 1000 units, gtts 50 mg/mL.] `L ♀A ? $

VITAMIN A

RDA: 900 mcg RE (retinol equivalents) (males), 700 mcg RE

(females). Treatment of defi ciency states:

y

100,000 units IM daily for 3 days,
then 50,000 units IM daily for 2 weeks. 1 RE is equivalent to 1 mcg retinol or 6 mcg beta-carotene. Max recommended daily dose 3000 mcg. [OTC Generic only: Caps 10,000, 15,000 units. Trade only: Tabs 5000 units. Rx: Generic: 25,000 units. Trade only: Soln 50,000 units/mL.] `L ♀A (C if exceed RDA, X
in high doses) + $

VITAMIN D ( vitamin D2, ergocalciferol, Calciferol, Drisdol,  Osteoforte) Familial hypophosphatemia (Vitamin D Resistant Rickets): yp p
p

(

) 12,000 to 500,000
units PO daily. Hypoparathyroidism:

yp p
y

50,000 to 200,000 units PO daily.

Adequate daily intake adults:

q
y

19 to 50 yo: 5 mcg (200 units) ergocalciferol;

51 to 70 yo: 10 mcg (400 units); older than 70 yo: 15 mcg (600 units). [OTC

Generic: 200 units, 400 units, 800 units, 1000 units, 2000 units (cap/tab).

Trade only: Soln 8000 units/mL. Rx: Trade only: Caps 50,000 units, inj 500,000
units/mL.] `L ♀A (C if exceed RDA) + $

Other

BROMOCRIPTINE ( Cycloset, Parlodel ) Type 2 DM: yp

0.8 mg PO qam (within

2 h of waking), may increase weekly by 0.8 mg to max tolerated dose of 1.6
to 4.8 mg. Hyperprolactinemia:

yp p

Start 1.25 to 2.5 mg PO qhs, then increase
every 3 to 7 days to usual effective dose of 2.5 to 15 mg/day, max 40 mg/day.

Acromegaly:

g y Usual effective dose is 20 to 30 mg/day, max 100 mg/day. Doses greater than 20 mg/day can be divided bid. Also approved for Parkinson’s disease, but rarely used. Take with food to minimize dizziness and nausea.

[Generic/Trade: Tabs 2.5 mg. Caps 5 mg.] `L ♀B – $$$$$

CABERGOLINE ( Dostinex) Hyperprolactinemia: yp p

0.25 to 1 mg PO twice a
week. [Generic/Trade: Tabs 0.5 mg.] `L ♀B – $$$$$

CALCITONIN ( Miacalcin, Fortical,  Calcimar, Caltine) Skin test before using injectable product: 1 unit intradermally and observe for local reaction.

Osteoporosis:

p

100 units SC/IM every other day or 200 units (1 spray) intranasal daily (alternate nostrils). Paget’

g s disease: 50 to 100 units SC/IM
daily. Hypercalcemia:

yp

4 units/kg SC/IM q 12 h. May increase after 2 days to max of 8 units/kg q 6 h. [Generic/Trade: Nasal spray 200 units/activation in 3.7 mL bottle (minimum of 30 doses/bottle).] `Plasma ♀C ? $$$$

DESMOPRESSIN ( DDAVP, Stimate,  Minirin, Octostim m)

Diabetes insipidus:

p

10 to 40 mcg intranasally daily or divided bid to tid, 0.05 to 1.2 mg/day PO or divided bid to tid, or 0.5 to 1 mL/day SC/IV in 2 divided doses. Hemophilia A, p

,
von Willebrand’s disease: 0.3 mcg/kg IV over 15 to 30 min, or 150 to 300 mcg intranasally. Enuresis: 0.2 to 0.6 mg PO qhs. Not for children younger than 6
yo. [Trade only: Stimate nasal spray 150 mcg/0.1 mL (1 spray), 2.5 mL bottle (25 sprays). Generic/Trade (DDAVP nasal spray): 10 mcg/0.1 mL (1 spray), 5 mL bottle (50 sprays). Note difference in concentration of nasal solns. Rhinal Tube: 2.5 mL bottle with 2 fl exible plastic tube applicators with graduation marks for dosing. Generic only: Tabs 0.1, 0.2 mg.] `LK ♀B ? $$$$

ENT

83

SODIUM POLYSTYRENE SULFONATE ( Kayexalate) Hyperkalemia: yp

1 g/kg up to

15 to 60 g PO or 30 to 50 g retention enema (in sorbitol) q 6 h prn. Irrigate with tap water after enema to prevent necrosis. [Generic only: Susp 15 g/60
mL. Powdered resin.] `Fecal excretion ♀C ? $$$$

SOMATROPIN ( human
growth hormone, Genotropin, Humatrope,

Norditropin, Norditropin NordiFlex, Nutropin, Nutropin AQ, Nutropin Depot, Omnitrope, Protropin, Serostim, Serostim LQ, Saizen, Tev-Tropin, Valtropin, Zorbtive) Dosages vary by indication and product. [Single-dose vials (powder for injection with diluent). Tev-Tropin: 5 mg vial (powder for injection with diluent, stable for 14 days when refrigerated). Genotropin: 1.5, 5.8, 13.8
mg cartridges. Humatrope: 6, 12, 24 mg pen cartridges, 5 mg vial (powder for injection with diluent, stable for 14 days when refrigerated). Nutropin AQ: 10
mg multiple-dose vial, 5, 10, 20 mg/pen cartridges. Norditropin: 5, 10, 15 mg pen cartridges. Norditropin NordiFlex: 5, 10, 15 mg prefi lled pens. Omnitrope: 1.5, 5.8 mg vial (powder for injection with diluent). Saizen: Preassembled reconstitution device with autoinjector pen. Serostim: 4, 5, 6 mg single-dose vials, 4, 8.8 mg multidose vials and 8.8 mg cartridges for autoinjector.

Valtropin: 5 mg single-dose vials, 5 mg prefi lled syringe. Zorbtive: 8.8 mg vial (powder for injection with diluent, stable for 14 days when refrigerated).] `LK

♀B/C ? $$$$$

TERIPARATIDE ( Forteo) T
o
reatment
of
postmenopausal osteoporosis,
p
p
p

, treatment
of men and women with glucocorticoid-induced osteoporosis g
p
or to increase
bone mass in men with primary or hypogonadal osteoporosis yp g
p
and high risk for
fracture: 20 mcg SC daily in thigh or abdomen for no longer than 2 years. [Trade only: 28 dose pen injector (20 mcg/dose).] `LK ♀C – $$$$$

VASOPRESSIN ( Pitressin, ADH,  Pressyn AR) R

Diabetes insipidus:

p

5 to

10 units IM/SC bid to qid prn. Cardiac arrest: 40 units IV; may repeat if no response after 3 min. Septic shock:

p

0.01 to 0.1 units/min IV infusion, usual
dose less than 0.04 units/min. Variceal bleeding:

g 0.2 to 0.4 units/min initially

(max 0.8 units/min). `LK ♀C ? $$$$$

ENT

Antihistamines—Non-Sedating

DESLORATADINE ( Clarinex,  Aeriuss) 5 mg PO daily for age older than 12 yo.

Peds: 2 ml (1 mg) PO daily for age 6 to 11 mo, ½ teaspoonful (1.25 mg) PO
daily for age 12 mo to 5 yo, 1 teaspoonful (2.5 mg) PO daily for age 6 to 11
yo. [Trade only: Tabs 5 mg. Fast-dissolve RediTabs 2.5, 5 mg. Syrup 0.5 mg/
mL.] `LK ♀C + $$$

FEXOFENADINE ( Allegra) 60 mg PO bid or 180 mg daily. Peds: 30 mg PO bid for age 2 to 11 yo. [Generic/Trade: Tabs 30, 60, 180 mg, Caps 60 mg. Trade only: Susp 30 mg/5 mL, orally disintegrating tab 30 mg.] `LK ♀C + $$$

LORATADINE ( Claritin, Claritin Hives Relief, Claritin RediTabs, Alavert, Tavist ND)

D

10 mg PO daily for age older than 6 yo, 5 mg PO daily for age 2 to 5 yo. [OTC Generic/Trade: Tabs 10 mg. Fast-dissolve tabs (Alavert, Claritin (cont.)

84 ENT

RediTabs) 5, 10 mg. Syrup 1 mg/mL. Rx Trade only (Claritin): Chewable tabs 5
mg, Liqui-gel caps 10 mg.] `LK ♀B + $

Antihistamines—Other

CETIRIZINE ( Zyrtec,  Reactine, Aller-Relief) f

5 to 10 mg PO daily for age
older than 6 yo. Peds: give 2.5 mg PO daily for age 6 to 23 mo, give 2.5 mg PO
daily to bid for age 2 to 5 yo. [OTC Generic/Trade: Tabs 5, 10 mg. Syrup 5 mg/5
mL. Chewable tabs, grape-fl avored 5, 10 mg.] `LK ♀B – $$$

CHLORPHENIRAMINE ( Chlor-Trimeton, Aller-Chlor) r

4 mg PO q 4 to 6 h. Max

24 mg/day. Peds: give 2 mg PO q 4 to 6 h for age 6 to 11 yo. Max 12 mg/day.

[OTC Trade only: Tabs, extended-release 12 mg. Generic/Trade: Tabs 4 mg.

Syrup 2 mg/5 mL. Tabs, extended-release 8 mg.] `LK ♀B – $

CLEMASTINE ( Tavist-1) 1.34 mg PO bid. Max 8.04 mg/day. [OTC Generic/

Trade: Tabs 1.34 mg. Rx: Generic/Trade: Tabs 2.68 mg, Syrup 0.67 mg/5 mL.

Rx: Generic only: Syrup 0.5 mg/5 mL.] `LK ♀B – $

CYPROHEPTADINE ( Periactin) Start 4 mg PO tid. Max 32 mg/day. [Generic only: Tabs 4 mg. Syrup 2 mg/5 mL.] `LK ♀B – $

DEXCHLORPHENIRAMINE ( Polaramine) 2 mg PO q 4 to 6 h. Timed-release tabs: 4 or 6 mg PO at q hs or q 8 to 10 h. [Generic only: Tabs, immediate-release 2 mg, timed-release 4, 6 mg. Syrup 2 mg/5 mL.] `LK ♀? – $$

DIPHENHYDRAMINE ( Benadryl, Banophen, Allermax, Diphen, Diphenhist, Dytan, Siladryl, Sominex,  Allerdryl, Nytol ) Allergic rhinitis, urticaria, g

,

,
hypersensitivity reactions:

yp
y

25 to 50 mg IV/IM/PO q 4 to 6 h. Peds: 5 mg/kg/
day divided q 4 to 6 h. EPS: 25 to 50 mg PO tid to qid or 10 to 50 mg IV/IM
tid to qid. Insomnia: 25 to 50 mg PO qhs. [OTC Trade only: Tabs 25, 50 mg, Chewable tabs 12.5 mg. OTC and Rx: Generic only: Caps 25, 50 mg, softgel cap 25 mg. OTC Generic/Trade: Soln 6.25 or 12.5 mg per 5 mL. Rx: Trade only: (Dytan) Susp 25 mg/mL, Chewable tabs 25 mg.] `LK ♀B – $

HYDROXYZINE ( Atarax, Vistaril ) 25 to 100 mg IM/PO daily to qid or prn.

[Generic only: Tabs 10, 25, 50, 100 mg, Caps 100 mg, Syrup 10 mg/5 mL.

Generic/Trade: Caps 25, 50 mg, Susp 25 mg/5 mL (Vistaril). (Caps = Vistaril, Tabs = Atarax).] `L ♀C – $$

LEVOCETIRIZINE ( Xyzal ) Give 2.5 mg PO daily for age 6 to 11 yo, give 5 mg PO
daily for age 12 or older. [Trade only: Tabs 5 mg, scored, Oral soln 2.5 mg/5 mL

(148 mL).] `K ♀B – $$$

MECLIZINE ( Antivert, Bonine, Medivert, Meclicot, Meni-D,  Bonamine) Motion sickness: 25 to 50 mg PO 1 h prior to travel, then 25 to 50 mg PO
daily. Vertigo:

g 25 mg PO q 6 h prn. [Rx/OTC/Generic/Trade: Tabs 12.5, 25 mg, Chewable tabs 25 mg. Rx/Trade only: Tabs 50 mg.] `L ♀B ? $

Antitussives / Expectorants

BENZONATATE ( Tessalon, Tessalon Perles) 100 to 200 mg PO tid. Swallow whole. Do not chew. Numbs mouth; possible choking hazard. [Generic/Trade: Softgel caps: 100, 200 mg.] `L ♀C ? $$

DEXTROMETHORPHAN ( Benylin, Delsym, Dexalone, Robitussin Cough, Vick’s 44 Cough)

h

10 to 20 mg PO q 4 h or 30 mg PO q 6 to 8 h. Sustained action (cont.)

ENT

85

ENT COMBINATIONS

Decon- Antihis-

Anti-

Typical Adult

(selected)

gestant tamine tussive

Doses

OTC

Actifed Cold & Allergy

PE

CH

-

1 tab q 4-6 h

Actifed Cold & Sinus‡

PS

CH

2 tabs q 6 h

Allerfrim, Aprodine

PS

TR

-

1 tab or 10 mL q 4-6 h

Benadryl Allergy/Cold‡

PE

DPH

2 tabs q 4 h

Benadryl-D Allergy/Sinus Tablets

PE

DPH

1 tab q 4 h

Claritin-D 12 h, Alavert D-12

PS

LO

-

1 tab q 12 h

Claritin-D 24 h

PS

LO

-

1 tab daily

Dimetapp Cold & Allergy Elixir

PE

BR

-

20mL q 4 h

Dimetapp DM Cold & Cough

PE

BR

DM

20mL q 4 h

Drixoral Cold & Allergy

PS

DBR

-

1 tab q 12 h

Mucinex-DM Extended-Release

-

-

GU,DM

1-2 tab q 12 h

Robitussin CF

PE

-

GU, DM

10 mL q 4 h*

Robitussin DM, Mytussin DM

-

-

GU, DM

10 mL q 4 h*

Robitussin PE, Guiatuss PE

PE

-

GU

10 mL q 4 h*

Triaminic Cold & Allergy

PE

CH

10 mL q 4 h

Rx Only

Allegra-D 12- h

PS

FE

-

1 tab q 12 h

Allegra-D 24- h

PS

FE

-

1 tab daily

Bromfenex

PS

BR

-

1 cap q 12 h

Clarinex-D24-h

PS

DL

-

1 tab daily

Deconamine

PS

CH

-

1 tab or 10 mL tid-qid

Deconamine SR, Chlordrine SR

PS

CH

-

1 tab q 12 h

Deconsal II

- PE

-

GU

1-2 tabs q 12 h

Dimetane-DX

PS

BR

DM

10 mL PO q 4 h

Duratuss

PE

-

GU

1 tab q 12 h

Duratuss HD©III

PE

-

GU, HY

5-10mL q 4-6 h

Entex PSE, Guaifenex PSE 120

PS

-

GU

1 tab q 12 h

Histussin D ©III

PS

-

HY

5 mL qid

Histussin HC ©III

PE

CH

HY

10 mL q 4 h

Humibid DM

-

-

GU, DM

1 tab q 12 h

Hycotuss ©III

-

-

GU, HY

5mL pc & qhs

Phenergan/Dextromethorphan

-

PR

DM

5 mL q 4-6 h

Phenergan VC

PE

PR

-

5 mL q 4-6 h

Phenergan VC w/codeine©V

PE

PR

CO

5 mL q 4-6 h

Robitussin AC ©V (generic only)

-

-

GU, CO

10 mL q 4 h*

Robitussin DAC ©V (generic only)

PS

-

GU, CO

10 mL q 4 h*

Rondec Syrup

PE

CH

-

5 mL qid†

Rondec DM Syrup

PE

CH

DM

5 mL qid†

Rondec Oral Drops

PE

CH

-

0.75 to 1 mL qid

Rondec DM Oral Drops

PE

CH

DM

0.75 to 1 mL qid

Rynatan

PE

CH

-

1-2 tabs q 12 h

Rynatan-P Pediatric

PE

CH

-

2.5-5 mL q 12 h*

Semprex-D

4-6 h

PS AC

-

1cap

q

Tanafed (generic only)

PS

CH

-

10-20 mL q 12 h*

Tussionex ©III

-

CH

HY

5 mL q 12 h

AC=acrivastine

DL= desloratadine

FE=fexofenadine PE=phenylephrine

BR=brompheniramine DM=dextromethorphan

GU=guaifenesin PR=promethazine

CH=chlorpheniramine DBR=dexbrompheniramine HY=hydrocodone PS=pseudoephedrine CO=codeine

DPH=diphenhydramine

LO=loratadine

TR=triprolidine

*5 mL/dose if 6-11 yo. 2.5 mL if 2-5 yo. †2.5 mL/dose if 6-11 yo. 1.25 mL if 2-5 yo. ‡Also contains acetaminophen.

86 ENT
liquid 60 mg PO q 12 h. [OTC Trade only: Caps 15 mg (Robitussin), 30 mg (DexAlone), Susp, extended-release 30 mg/5 mL (Delsym). Generic/Trade: Syrup 5, 7.5, 10, 15 mg/5 mL. Generic only: Lozenges 5, 10 mg.] `L ♀+

+ $

GUAIFENESIN ( Robitussin, Hytuss, Guiatuss, Mucinex) x

100 to 400 mg PO
q 4 h. 600 to 1200 mg PO q 12 h (extended-release). Peds: 50 to 100 mg/dose for age 2 to 5 yo, give 100 to 200 mg/dose for age 6 to 11 yo. [Rx Generic/

Trade: Extended-release tabs 600, 1200 mg. OTC Generic/Trade: Liquid, Syrup 100 mg/5 mL. OTC Trade only: Caps 200 mg (Hytuss), Extended-release tabs 600 mg (Mucinex). OTC Generic only: Tabs 100, 200, 400 mg.] `L ♀C + $

Decongestants

NOTE See ENT—Nasal Preparations for nasal spray decongestants. Deaths have occurred in children younger than 2 yo attributed to toxicity from cough and cold medications; the FDA does not recommend their use in this age group.

PHENYLEPHRINE ( Sudafed PE ) 10 mg PO q 4 h. [OTC Trade only: Tabs 10 mg.] `L ♀C + $

PSEUDOEPHEDRINE ( Sudafed, Sudafed 12 H, Efi dac/24,  Pseudofrin) n

Adult: 60 mg PO q 4 to 6 h. Extended release tabs: 120 mg PO bid or 240 mg PO daily. Peds: give 15 mg PO q 4 to 6 h for age 2 to 5 yo, give 30 mg PO q 4
to 6 h for age 6 to 12 yo. [OTC Generic/Trade: Tabs 30, 60 mg, Tabs, extended-release 120 mg (12 h), Soln 15, 30 mg/5 mL. Trade only: Chewable tabs 15
mg, Tabs, extended-release 240 mg (24 h).] `L ♀C + $

Ear Preparations

AURALGAN (benzocaine + antipyrine) 2 to 4 gtts in ear(s) tid to qid prn.

[Generic/Trade: Otic soln 10, 15 mL.] `Not absorbed ♀C ? $

CARBAMIDE PEROXIDE ( Debrox, Murine Ear) 5 to 10 gtts in ear(s) bid for 4 days. [OTC Generic/Trade: Otic soln 6.5%, 15, 30 mL.] `Not absorbed ♀?

? $

CIPRO HC OTIC (ciprofl oxacin + hydrocortisone) 3 gtts in ear(s) bid for 7 days for age 1 yo to adult. [Trade only: Otic susp 10 mL.] `Not absorbed

♀C – $$$$

CIPRODEX OTIC (ciprofl oxacin + dexamethasone) 4 gtts in ear(s) bid for 7
days for age 6 mo to adult. [Trade only: Otic susp 5, 7.5 mL.] `Not absorbed

♀C – $$$$

CIPROFLOXACIN ( Cetraxal ) 1 single-use container in ear(s) bid for 7 days for age 1 yo to adult. [Trade only: 0.25 mL single-use containers w/0.2%
ciprofl oxacin soln, #14.] `Not absorbed ♀C – $$$$

CORTISPORIN OTIC (hydrocortisone + polymyxin + neomycin) ( Pediotic) 4 gtts in ear(s) tid to qid up to 10 days of soln or susp. Peds: 3 gtts in ear(s) tid to qid up to 10 days. Caution with perforated TMs or tympanostomy tubes (cont.)

ENT

87
as this increases the risk of neomycin ototoxicity, especially if use prolonged or repeated. Use susp rather than acidic soln. [Generic only: Otic soln or susp 7.5, 10 mL.] `Not absorbed ♀? ? $

CORTISPORIN TC OTIC (hydrocortisone + neomycin + thonzonium +
colistin) 4 to 5 gtts in ear(s) tid to qid up to 10 days. [Trade only: Otic susp, 10 mL.] `Not absorbed ♀? ? $$$

DOMEBORO OTIC (acetic acid + aluminum acetate) 4 to 6 gtts in ear(s) q 2 to 3 h. Peds: 2 to 3 gtts in ear(s) q 3 to 4 h. [Generic only: Otic soln 60
mL.] `Not absorbed ♀? ? $

FLUOCINOLONE—OTIC ( DermOtic) 5
gtts in affected ear(s) bid for 7 to 14
days for age 2 yo to adult. [Trade only: Otic oil 0.01% 20 mL.] `L ♀C ? $$

OFLOXACIN—OTIC ( Floxin Otic)

Otitis externa: 5 gtts in ear(s) daily for age

1 to 12 yo, 10 gtts in ear(s) daily for age 12 or older. [Generic/Trade: Otic soln 0.3% 5, 10 mL. Trade only: “Singles”: Single-dispensing containers 0.25 mL

(5 gtts), 2 per foil pouch.] `Not absorbed ♀C – $$$

SWIM-EAR (isopropyl alcohol + anhydrous glycerin) 4 to 5 gtts in ears after swimming. [OTC Trade only: Otic soln 30 mL.] `Not absorbed ♀? ? $

VOSOL HC (acetic acid + propylene glycol + hydrocortisone) 5 gtts in ear(s) tid to qid. Peds age older than 3 yo: 3 to 4 gtts in ear(s) tid to qid.

[Generic/Trade: Otic soln 2%/3%/1% 10 mL.] `Not absorbed ♀? ? $

Mouth & Lip Preparations

AMLEXANOX ( Aphthasol, OraDisc A) Aphthous ulcers: p

Apply ¼ in paste or
mucoadhesive patch to affected area qid after oral hygiene for up to 10 days.

Up to 3 patches may be applied at one time. [Trade only: Oral paste 5%, 3, 5
g tube. Mucoadhesive patch 2 mg, #20.] `LK ♀B ? $

CEVIMELINE ( Evoxac) Dry mouth due to Sjogren’

j g
s syndrome:

y

30 mg PO tid.

[Trade only: Caps 30 mg.] `L ♀C – $$$$$

CHLORHEXIDINE GLUCONATE ( Peridex, Periogard,  Denticare) Rinse with

15 mL of undiluted soln for 30 sec bid. Do not swallow. Spit after rinsing.

[Generic/Trade: Oral rinse 0.12% 473 to 480 mL bottles.] `Fecal excretion

♀B ? $

DEBACTEROL (sulfuric acid + sulfonated phenolics) Aphthous stomatitis, p

,
mucositis: Apply to dry ulcer. Rinse with water. [Trade only: 1 mL prefi lled, single-use applicator.] `Not absorbed ♀C + $$

GELCLAIR (maltodextrin + propylene glycol ) Aphthous ulcers, mucositis, p

,

,
stomatitis: Rinse mouth with 1 packet tid or prn. Do not eat or drink for 1 h after treatment. [Trade only: 21 packets/box.] `Not absorbed ♀+ + $$$

LIDOCAINE—VISCOUS ( Xylocaine)

Mouth or lip pain
p p
in adults only: 15 to 20
mL topically or swish & spit q 3 h. [Generic/Trade: Soln 2%, 20 mL unit dose, 100 mL bottle.] `LK ♀B + $

MAGIC MOUTHWASH (diphenhydramine + Mylanta + sucralfate) 5 mL PO
swish & spit or swish & swallow tid before meals and prn. [Compounded susp.

A standard mixture is 30 mL diphenhydramine liquid (12.5 mg/5 mL)/60 mL

Mylanta or Maalox/4 g Carafate.] `LK ♀B(– in fi rst trimester) – $$$

88 ENT

PILOCARPINE ( Salagen)

n

Dry mouth
y
due to radiation of head & neck or

Sjogren’

j g
s syndrome:

y

5 mg PO tid to qid. [Generic/Trade: Tabs 5, 7.5 mg.] `L

♀C – $$$$

Nasal Preparations—Corticosteroids

BECLOMETHASONE ( Vancenase, Vancenase AQ Double Strength, Beconase AQ)

Q

Vancenase: 1 spray per nostril bid to qid. Beconase AQ: 1 to 2 spray(s) per nostril bid. Vancenase AQ Double Strength: 1 to 2 spray(s) per nostril daily. [Trade only: Vancenase 42 mcg/spray, 80 or 200 sprays/bottle. Beconase AQ 42 mcg/spray, 200 sprays/bottle. Vancenase AQ Double Strength 84 mcg/
spray, 120 sprays/bottle.] `L ♀C ? $$$$

BUDESONIDE—NASAL ( Rhinocort Aqua) 1 to 4 sprays per nostril daily.

[Trade only: Nasal inhaler 120 sprays/bottle.] `L ♀B ? $$$$

CICLESONIDE ( Omnaris)

s

2 sprays per nostril daily. [Trade only: Nasal spray, 50 mcg/spray, 120 sprays/bottle.] `L ♀C ? $$$

FLUNISOLIDE ( Nasalide, Nasarel,  Rhinalar) Start 2 sprays/nostril bid. Max 8 sprays/nostril/day. [Generic/Trade: Nasal soln 0.025%, 200 sprays/bottle.

Nasalide with pump unit. Nasarel with meter pump and nasal adapter.] `L

♀C ? $$

FLUTICASONE—NASAL ( Flonase, Veramyst ) 2 sprays per nostril daily. [Generic/

Trade: Flonase: Nasal spray 0.05%, 120 sprays/bottle. Trade only: (Veramyst): Nasal spray susp: 27.5 mcg/spray, 120 sprays/bottle.] `L ♀C ? $$$

MOMETASONE—NASAL ( Nasonexx) Adult: 2 sprays/nostril daily. Peds 2 to 11
yo: 1 spray/nostril daily. [Trade only: Nasal spray, 120 sprays/bottle.] `L ♀C

? $$$$

TRIAMCINOLONE—NASAL ( Nasacort AQ, Nasacort HFA, Tri-Nasal, AllerNaze) Nasacort HFA, Tri-Nasal, AllerNaze: 2 sprays per nostril daily to bid. Max 4 sprays/nostril/day. Nasacort AQ: 1 to 2 sprays per nostril daily.

[Trade only: Nasal inhaler 55 mcg/spray, 100 sprays/bottle (Nasacort HFA).

Nasal spray, 55 mcg/spray, 120 sprays/bottle (Nasacort AQ). Nasal spray 50
mcg/spray, 120 sprays/bottle (Tri-Nasal, AllerNaze).] `L ♀C – $$$$

Nasal Preparations—Other

AZELASTINE—NASAL ( Astelin, Astepro) 1 to 2 sprays/nostril bid. [Generic: Nasal spray, 200 sprays/bottle.] `L ♀C ? $$$$

CROMOLYN—NASAL ( NasalCrom)

m

1 spray per nostril tid to qid. [OTC

Generic/Trade: Nasal inhaler 200 sprays/bottle 13, 26 mL.] `LK ♀B + $

IPRATROPIUM—NASAL ( Atrovent Nasal Spray)

y

2 sprays per nostril bid
to qid. [Generic/Trade: Nasal spray 0.03%, 345 sprays/bottle, 0.06%, 165
sprays/bottle.] `L ♀B ? $$

LEVOCABASTINE—NASAL ( Livostin Nasal Sprayy) Canada only. 2 sprays in each nostril bid, increase prn to tid to qid. [Trade only: Nasal spray 0.5 mg/
mL, plastic bottles of 15 mL. Each spray delivers 50 mcg.] `L (but minimal absorption) ♀C – $$

OLOPATADINE—NASAL ( Patanase) 2 sprays/nostril bid.[Trade only: Nasal spray, 240 sprays/bottle.] `L ♀C ? $$$

Gastroenterology

89

OXYMETAZOLINE ( Afrin, Dristan 12 Hr Nasal, Nostrilla, Vicks Sinex 12 Hr) r

2 to 3 gtts/sprays per nostril bid prn nasal congestion for no more than 3 days.

[OTC Generic/Trade: Nasal spray 0.05% 15, 30 mL, Nose gtts 0.025%, 0.05%

20 mL with dropper.] `L ♀C ? $

PHENYLEPHRINE—NASAL ( Neo-Synephrine, Vicks Sinexx) 2 to 3 sprays/
gtts per nostril q 4 h prn × 3 days. [OTC Generic/Trade: Nasal gtts/spray 0.25, 0.5, 1% (15 mL).] `L ♀C ? $

SALINE NASAL SPRAY ( SeaMist, Entsol, Pretz, NaSal, Ocean,  HydraSense) Nasal dryness: 1 to 3 sprays or gtts per nostril prn. [Generic/Trade: Nasal spray 0.4, 0.5, 0.65, 0.75%, Nasal gtts 0.4, 0.65%. Trade only: Preservative Free-Nasal spray 3% (Entsol).] `Not metabolized ♀A + $

Other

CETACAINE (benzocaine + tetracaine + butamben) Topical anesthesia
p
of
mucous membranes: Spray: Apply for no more than 1 sec. Liquid or gel: Apply with cotton applicator directly to site. [Trade only: (14%/2%/2%) Spray 56
mL. Topical liquid 56 mL. Topical gel 5, 29 g.] `LK ♀C ? $$

GASTROENTEROLOGY

Antidiarrheals

BISMUTH SUBSALICYLATE ( Pepto-Bismol, Kaopectate) 2 tabs/caplets or 30 mL (262 mg/15 mL) PO q 30 min to 1 h up to 8 doses per day. Peds: 5 mL (262 mg/15 mL) or 1/3 tab/caplet PO for age 3 to 6 yo, 10 mL (262 mg/15 mL) or 2/3 tab/caplet PO for age 6 to 9 yo. Risk of Reye’s syndrome in children.

[OTC Generic/Trade: Chewable tabs 262 mg. Susp 87 mg/5 mL (Kaopectate Children’s Liquid). Susp 525 mg/15 mL. Liquid 130, 262, 524, 525 mg/15 mL.

OTC Trade only: Caplets 262 mg (Pepto-Bismol).] `K ♀D ? $

IMODIUM ADVANCED (loperamide + simethicone) 2 tabs/caplets PO
initially, then 1 tab/caplet PO after each unformed stool to a max of 4 tabs/
caplets per day. Peds: 1 tab/caplet PO initially, then ½ caplet PO after each unformed stool (up to 2 tabs/caplets PO per day for age 6 to 8 yo or wt 48 to 59 lbs or up to 3 tabs/caplets PO per day for age 9 to 11 yo or wt 60 to 95
lbs). [OTC Generic/Trade: Caplets, Chewable tabs 2 mg loperamide/125 mg simethicone.] `L ♀B – $

LOMOTIL (diphenoxylate + atropine) 2 tabs or 10 mL PO qid. [Generic/

Trade: Oral soln or tab 2.5 mg/0.025 mg diphenoxylate/atropine per 5 mL or tab.] `L ♀C – ©V $

LOPERAMIDE ( Imodium, Imodium AD,  Loperacap, Diarr-eze) 4 mg PO
initially, then 2 mg PO after each unformed stool to a maximum of 16 mg per day. Peds: 1 mg PO tid for wt 13 to 20 kg, 2 mg PO bid for wt 21 to 30 kg, 2 mg PO for wt greater than 30 kg. [OTC Generic/Trade: Tabs 2 mg. Oral soln 1 mg/5 mL. OTC Trade only: Oral soln 1 mg/7.5 mL.] `L ♀B + $

MOTOFEN (difenoxin + atropine) 2 tabs PO initially, then 1 tab after each loose stool q 3 to 4 h prn (up to 8 tabs per day). [Trade only: Tabs difenoxin 1 mg + atropine 0.025 mg.] `L ♀C – ©IV $$

90 Gastroenterology

OPIUM (opium tincture, paregoric) 5
to

10 mL paregoric PO daily (up to
qid) or 0.3 to 0.6 mL PO opium tincture qid. [Trade only: Opium tincture 10%

(deodorized opium tincture, 10 mg morphine equivalent per mL). Generic only: paregoric (camphorated opium tincture, 2 mg morphine equivalent/

5 mL).] `L ♀B (D with long-term use) ? ©II (opium tincture), III (paregoric) $$

Antiemetics—5-HT3 Receptor Antagonists

DOLASETRON ( Anzemet )

Nausea with chemo: 1.8 mg/kg (up to 100 mg) IV/

PO single dose. Post-op nausea:

p

12.5 mg IV in adults and 0.35 mg/kg IV in
children as single dose. Alternative for prevention: 100 mg (adults) PO or 1.2
mg/kg (children) PO 2 h before surgery. [Trade only: Tabs 50, 100 mg.] `LK

♀B ? $$$

GRANISETRON ( Kytril, Sancuso) Nausea with chemo: 10 mcg/kg IV over 5 min, 30 min prior to chemo. Oral: 1 mg PO bid for 1 day only. Radiation-induced nausea and vomiting:

g 2 mg PO 1 h before fi rst irradiation fraction
of each day. Transdermal (Sancuso): 1 patch to upper outer arm at least 24 h (but up to 48 h) before chemotherapy. Remove 24 h after completion of chemotherapy. Can be worn up to 7 days depending on the duration of chemo. [Generic/Trade: Tabs 1 mg. Oral soln 2 mg/10 mL (30 mL). Trade only (Sancuso): Transdermal patch 34.3 mg of granisetron delivering 3.1 mg/24
h.] `L ♀B ? $$$$

ONDANSETRON ( Zofran)

n

Nausea with chemo: IV: 32 mg IV over 15 min, or

0.15 mg/kg dose 30 min prior to chemo and repeated at 4 and 8 h after fi rst dose for age 6 mo or older. PO: Give 4 mg PO 30 min prior to chemo and repeat at 4 and 8 hrs for age 4 to 11 yo, give 8 mg PO and repeated 8 h later for age 12 yo or older. Prevention of post-op nausea: p
p

4 mg IV over 2 to

5 min or 4 mg IM or 16 mg PO 1 h before anesthesia. Give 0.1 mg/kg IV over 2 to 5 min as a single dose for age 1 mo to 12 yo if wt 40 kg or less; 4 mg IV
over 2 to 5 min as a single dose if wt greater than 40 kg. Prevention of N/V
associated with radiotherapy:

py 8 mg PO tid. [Generic/Trade: Tabs 4, 8, 24 mg.

Orally disintegrating tab 4, 8 mg. Oral soln 4 mg/5 mL. Generic only: Tabs 16
mg. Orally disintegrating tab 16, 24 mg.] `L ♀B ? $$$$$

PALONOSETRON ( Aloxi)

Nausea with chemo: 0.25 mg IV over 30 sec, 30 min
prior to chemo or 0.5 mg PO 1 h before start of chemotherapy. Prevention of post-op N/V: 0.075 mg IV over 10 sec just prior to anesthesia. [Trade only: Caps 0.5 mg.] `L ♀B ? $$$$$

Antiemetics—Other

APREPITANT ( Emend, fosaprepitant ) Prevention of nausea with moderately to highly emetogenic chemo,
g y
g

, in combination with dexamethasone and
ondansetron: 125 mg PO on day 1 (1 h prior to chemo), then 80 mg PO qam on day 2 & 3. Alternative for fi rst dose only is 115 mg IV (fosaprepitant form) over 15 min given 30 min prior to chemo. Prevention of post-op N/V
p
p

: 40 mg PO
within 3 h prior to anesthesia. [Trade only: Caps 40, 80, 125 mg. IV prodrug form is fosaprepitant.] `L ♀B ? $$$$$

Gastroenterology

91

DICLECTIN (doxylamine + pyridoxine) Canada only. 2 tabs PO qhs. May add 1 tab in am and 1 tab in afternoon, if needed. [Canada Trade only: Delayed-release tab doxylamine 10 mg + pyridoxine 10 mg.] `LK ♀A ? $

DIMENHYDRINATE ( Dramamine,  Gravol ) 50 to 100 mg PO/IM/IV q 4 to 6 h prn (max 400 mg/24 h). [OTC Generic/Trade: Tabs 50 mg. Trade only: Chewable tabs 50 mg. Generic only: Oral soln 12.5 mg/5 mL. Canada only: Suppository 50, 100 mg.] `LK ♀B – $

DOMPERIDONE ( Motilium) Canada
m
only.

Postprandial dyspepsia:

p
y p p

10 to 20
mg PO tid to qid, 30 min before a meal. [Canada only. Trade/generic: Tabs 10, 20 mg.] `L ♀? – $$

DOXYLAMINE ( Unisom Nighttime Sleep Aid, others) s

12.5 mg PO bid; often
used in combination with pyridoxine. [Generic/Trade: Tabs 10 mg.] `L ♀A

? $

DRONABINOL ( Marinol ) Nausea with chemo: 5 mg/m2 PO 1 to 3 h before chemo then 5 mg/m2/dose q 2 to 4 h after chemo for 4 to 6 doses/day. Anorexia associated with AIDS: initially 2.5 mg PO bid before lunch and dinner. [Generic/

Trade: Caps 2.5, 5, 10 mg.] `L ♀C – ©III $$$$$

DROPERIDOL ( Inapsine) 0.625 to 2.5 mg IV or 2.5 mg IM. May cause fatal QT prolongation, even in patients with no risk factors. Monitor ECG before. `L

♀C ? $

METOCLOPRAMIDE ( Reglan,  Maxeran)

n

10 mg IV/IM q 2 to 3 h prn. 10 to 15
mg PO qid, 30 min before meals and qhs. Caution with long-term (more than 3 months) use. [Generic/Trade: Tabs 5, 10 mg. Generic only: Oral soln 5 mg/5
mL.] `K ♀B ? $

NABILONE ( Cesamet ) 1 to 2 mg PO bid, 1 to 3 h before chemotherapy. [Trade only: Caps 1 mg.] `L ♀C – ©II $$$$$

PHOSPHORATED CARBOHYDRATES ( Emetrol ) 15 to 30 mL PO q 15 min prn, max 5 doses. Peds: 5 to 10 mL per dose. [OTC Generic/Trade: Soln containing dextrose, fructose, and phosphoric acid.] `L ♀A + $

PROCHLORPERAZINE ( Compazine,  Stemetil ) 5 to 10 mg IV over at least 2
min. 5 to 10 mg PO/IM tid to qid. 25 mg PR q 12 h. Sustained-release: 15 mg PO q am or 10 mg PO q 12 h. Peds: 0.1 mg/kg/dose PO/PR tid to qid or 0.1 to 0.15 mg/kg/dose IM tid to qid. [Generic only: Tabs 5, 10, 25 mg. Suppository 25 mg.] `LK ♀C ? $

PROMETHAZINE ( Phenergan) Adults: 12.5 to 25 mg PO/IM/PR q 4 to 6 h.

Peds: 0.25 to 1 mg/kg PO/IM/PR q 4 to 6 h. Contraindicated if age younger than 2 yo; caution in older children. IV use common but not approved. [Generic only: Tabs/Suppository 12.5, 25, 50 mg. Syrup 6.25 mg/5 mL.] `LK ♀C – $

SCOPOLAMINE ( Transderm-Scop, Scopace,  Transderm-V) Motion sickness: Apply 1 disc (1.5 mg) behind ear 4 h prior to event; replace every 3
days. Tab: 0.4 to 0.8 mg PO 1 h before travel and q 8 h prn. [Trade only: Topical disc 1.5 mg/72 h, box of 4. Oral tab 0.4 mg.] `L ♀C + $$

THIETHYLPERAZINE ( Torecan) 10 mg PO/IM 1 to 3 times a day. [Trade only: Tabs 10 mg.] `L ♀? ? $

TRIMETHOBENZAMIDE ( Tigan) 250 mg PO q 6 to 8 h, 200 mg IM q 6 to 8 h.

Peds: 100 to 200 mg/dose PO q 6 to 8 h if wt 13.6 to 40.9 kg. [Generic/Trade: Caps 300 mg.] `LK ♀C ? $

92 Gastroenterology

Antiulcer—Antacids

ALKA-SELTZER (ASA + citrate + bicarbonate) 2 regular-strength tabs in 4 oz water q 4 h PO prn (up to 8 tabs/day for age younger than 60 yo, up to 4 tabs/day for age 60 yo or greater) or 2 extra-strength tabs in 4 oz water q 6 h PO prn (up to 7 tabs/day for age less than 60 yo, up to 4 tabs/day for age 60 yo or greater). [OTC Trade only: Regular strength, original: ASA 325 mg +
citric acid 1000 mg + sodium bicarbonate 1916 mg. Regular-strength lemon lime and cherry: 325 mg + 1000 mg + 1700 mg. Extra-strength: 500 mg

+ 1000 mg + 1985 mg. Not all forms of Alka Seltzer contain ASA (eg, Alka Seltzer Heartburn Relief).] `LK ♀? (– 3rd trimester) ? $

ALUMINUM HYDROXIDE ( Alternagel, Amphojel, Alu-Tab, Alu-Cap,  Basalgel, Mucaine) 5
to

10 mL or 1 to 2 tabs PO up to 6 times per day. Constipating.

[OTC Generic/Trade: Susp 320, 600 mg/5 mL.] `K ♀+ (? fi rst trimester) ? $

CITROCARBONATE (bicarbonate + citrate) 1 to 2 teaspoons in cold water PO 15 min to 2 h after meals prn. [OTC Trade only: Sodium bicarbonate 0.78
g + sodium citrate anhydrous 1.82 g in each 1 teaspoon dissolved in water 150, 300 g.] `K ♀? ? $

GAVISCON (aluminum hydroxide + magnesium carbonate) 2 to 4 tabs or 15 to 30 mL (regular strength) or 10 mL (extra strength) PO qid prn. [OTC

Trade only: Tabs: Regular-strength (Al hydroxide 80 mg + Mg carbonate 20 mg), Extra-strength (Al hydroxide 160 mg + Mg carbonate 105 mg).

Liquid: Regular-strength (Al hydroxide 95 mg + Mg carbonate 358 mg per 15 mL), Extra-strength (Al hydroxide 508 mg + Mg carbonate 475 mg per 30 mL).] `K ♀? ? $

MAALOX (aluminum hydroxide + magnesium hydroxide) 10 to 20 mL or 1
to 4 tabs PO prn. [OTC Generic/Trade: Regular-strength chewable tabs (Al hydroxide + Mg hydroxide 200/200 mg). Susp (225/200 mg per 5 mL). Other strengths available.] `K ♀+ (? fi rst trimester) ? $

MAGALDRATE ( Riopan) 5 to 10 mL PO prn. [OTC Trade only: Susp 540 mg/

5 mL. Riopan Plus (with simethicone) available as susp 540/20 mg/5 mL, double-strength susp 1080/40 mg/5 mL. Chewable tabs 540/20 mg. Double-strength tabs 1080/40 mg.] `K ♀+ (? fi rst trimester) ? $

MYLANTA (aluminum hydroxide + magnesium hydroxide + simethicone) 2 to 4 tabs or 10 to 45 mL PO prn. [OTC Generic/Trade: Liquid, Double-strength liquid. Tabs, Double-strength tabs. Trade only: Tabs sodium + sugar +
dye-free.] `K ♀+ (? fi rst trimester) ? $

ROLAIDS (calcium carbonate + magnesium hydroxide) 2 to 4 tabs PO q 1 h prn, max 12 tabs/day (regular strength) or 10 tabs/day (extra-strength). [OTC

Trade only: Tabs regular-strength (calcium carbonate 550 mg, magnesium hydroxide 110 mg), extra-strength (calcium carbonate 675 mg, magnesium hydroxide 135 mg).] `K ♀? ? $

Antiulcer—H2 Antagonists

CIMETIDINE ( Tagamet, Tagamet HB)

B

300 mg IV/IM/PO q 6 to 8 h, 400 mg PO
bid, or 400 to 800 mg PO qhs. Erosive esophagitis:

p g

800 mg PO bid or 400 mg

(cont.)

Gastroenterology

93

PO qid. Continuous IV infusion 37.5 to 50 mg/h (900 to 1200 mg/day). [Tabs 200, 300, 400, 800 mg. Rx Generic only: Oral soln 300 mg/5 mL. OTC Generic/

Trade: Tabs 200 mg.] `LK ♀B + $

FAMOTIDINE ( Pepcid, Pepcid AC, Maximum Strength Pepcid AC

C) 20 mg IV
q 12 h. 20 to 40 mg PO qhs, or 20 mg PO bid. [Generic/Trade: Tabs 10 mg (OTC, Pepcid AC Acid Controller), 20 mg (Rx and OTC, Maximum Strength Pepcid AC) 40 mg. Rx Trade only: Susp 40 mg/5 mL.] `LK ♀B ? $

NIZATIDINE ( Axid, Axid AR)

R

150 to 300 mg PO qhs, or 150 mg PO bid. [OTC

Trade only (Axid AR): Tabs 75 mg. Rx Trade only: Oral soln 15 mg/mL (120, 480 mL). Rx Generic/Trade: Caps 150, 300 mg.] `K ♀B ? $$$$

PEPCID COMPLETE (famotidine + calcium carbonate + magnesium hydroxide) Treatment
of heartburn: 1 tab PO prn. Max 2 tabs/day. [OTC

Trade only: Chewable tab, famotidine 10 mg with calcium carbonate 800 mg/
magnesium hydroxide 165 mg.] `LK ♀B ? $

RANITIDINE ( Zantac, Zantac 25, Zantac 75, Zantac 150, Peptic Relief) 150
f
mg

PO bid or 300 mg PO qhs. 50 mg IV/IM q 8 h, or continuous infusion 6.25 mg/h (150 mg/day). [Generic/Trade: Tabs 75 mg (OTC: Zantac 75), 150 mg (OTC and Rx: Zantac 150), 300 mg. Syrup 75 mg/5 mL. Rx Trade only: Effervescent Tabs 25, 150 mg. Rx Generic only: Caps 150, 300 mg.] `K ♀B ? $$$

Antiulcer—Helicobacter pylori Treatment

HELIDAC

C (bismuth subsalicylate + metronidazole + tetracycline) 1 dose PO qid for 2 weeks. To be given with an H2 antagonist. [Trade only: Each dose consists of bismuth subsalicylate 524 mg (2 × 262 mg) chewable tab +
metronidazole 250 mg tab + tetracycline 500 mg cap.] `LK ♀D – $$$$$

PREVPAC (lansoprazole + amoxicillin + clarithromycin) (HP-Pac) 1 dose PO bid for 10 to 14 days. [Trade only: Each does consists of lansoprazole 30
mg cap + amoxicillin 1 g (2 × 500 mg caps), + clarithromycin 500 mg tab.] `LK ♀C ? $$$$$

PYLERA (biskalcitrate + metronidazole + tetracycline) 3 caps PO qid (after meals and at bed time) for 10 days. Use with omeprazole 20 mg PO
bid. [Trade only: Each cap contains bismuth subcitrate potassium 140 mg +
metronidazole 125 mg + tetracycline 125 mg.] `LK ♀D – $$$$$

Antiulcer—Proton Pump Inhibitors

DEXLANSOPRAZOLE ( Kapidex)

x

Erosive esophagitis:

p g

60 mg PO daily for up to

8 weeks. Maintenance therapy after healing of erosive esophagitis: p g

30 mg PO
daily for up to 6 months. GERD: 30 mg PO daily for up to 4 weeks. [Trade only: Delayed-release cap 30, 60 mg.] `L ♀B ? $$$$

ESOMEPRAZOLE ( Nexium)

m

Erosive esophagitis:

p g

20 to 40 mg PO daily for 4
to 8 weeks. Maintenance of erosive esophagitis:

p g

20 mg PO daily. Zollinger-

Ellison: 40 mg PO bid for 4 to 8 weeks, may repeat for additional 4 to 8 weeks.

GERD: 20 mg PO daily for 4 weeks. GERD with esophagitis: p g

20 to 40 mg IV
daily for 10 days until taking PO. Prevention of NSAID-associated gastric g
ulcer: 20 to 40 mg PO daily for up to 6 months. H. pylori eradication: py

40 mg PO

(cont.)

94 Gastroenterology

HELICOBACTER PYLORII THERAPY

• Triple therapy PO for 10 to 14 days: clarithromycin 500 mg bid + amoxicillin 1 g bid (or met-ronidazole 500 mg bid) + PPI*

•

Quadruple therapy PO for 14 days: bismuth subsalicylate 525 mg (or 30 mL) tid to qid plus metronidazole 500 mg tid to qid plus tetracycline 500 mg tid to qid plus a PPI*
or a H2 blocker†

• PPI or H2 blocker may need to be continued past 14 days to heal the ulcer.

*PPIs include esomeprazole 40 mg qd, lansoprazole 30 mg bid, omeprazole 20 mg bid, pantoprazole 40 mg bid, rabeprazole 20 mg bid. †H blockers include cimetidine 400 mg bid, famotidine 20 mg bid, nizatidine 2

150 mg bid, ranitidine 150 mg bid. Adapted from Medical Letter Treatment Guideliness 2008:55.

daily with amoxicillin 1000 mg PO bid & clarithromycin 500 mg PO bid for 10
days. [Trade only: Delayed-release cap 20, 40 mg. Delayed-release granules for oral susp 10, 20, 40 mg per packet.] `L ♀B ? $$$$

LANSOPRAZOLE ( Prevacid, Prevacidd)

Duodenal ulcer or maintenance
therapy after healing of duodenal ulcer, erosive esophagitis, NSAID-induced p g

,
gastric ulcer:

g

30 mg PO daily for 8 weeks (treatment), 15 mg PO daily for up to 12 weeks (prevention). GERD: 15 mg PO daily. Gastric ulcer: 30 mg PO daily. Erosive esophagitis:

p g

30 mg PO daily or 30 mg IV daily for 7 days
or until taking PO. [Trade only: Caps 15, 30 mg. Susp 15, 30 mg packets.

Orally disintegrating tab 15, 30 mg. Prevacid NapraPac: 7 lansoprazole 15
mg caps packaged with 14 naproxen tabs 250 mg, 375 mg or 500 mg.] `LK

♀B ? $$$$

OMEPRAZOLE ( Prilosec,  Losec) GERD, duodenal ulcer

,

, erosive esophagitis:

,
p g

20 mg PO daily. Heartburn (OTC): 20 mg PO daily for 14 days. Gastric ulcer: 40 mg PO daily. Hypersecretory conditions:

yp
y

60 mg PO daily. [Rx Generic/Trade:

Caps 10, 20, 40 mg. Trade only: Granules for oral susp 2.5 mg, 10 mg. OTC

Trade only: Tabs, delayed-release 20 mg.] `L ♀C ? OTC $, Rx $$$$

PANTOPRAZOLE ( Protonix,  Pantoloc) GERD: 40 mg PO daily. Zollinger g -

Ellison syndrome:

y

80 mg IV q 8 to 12 h for 6 days until taking PO. GERD
associated with a history of erosive esophagitis:

p g

40 mg IV daily for 7 to 10
days until taking PO. [Generic/Trade: Tabs 20, 40 mg. Trade only: Granules for susp 40 mg/packet.] `L ♀B ? $$$$

RABEPRAZOLE ( AcipHex,  Pariet ) 20 mg PO daily. [Trade: Tabs 20 mg.] `L

♀B ? $$$$

ZEGERID (omeprazole + bicarbonate)

Duodenal ulcer, GERD, erosive

,

,

esophagitis:

p g

20 mg PO daily for 4 to 8 weeks. Gastric ulcer: 40 mg PO once daily for 4 to 8 weeks. Reduction of risk of upper GI bleed in critically ill pp
y (susp only): 40
mg PO, then 40 mg 6 to 8 h later, then 40 mg once daily thereafter for 14 days.

[Trade only: Caps 20/1, 100, 40/1, 100 mg omeprazole/sodium bicarbonate, powder packets for susp 20/1, 680, 40/1, 680 mg.] `L ♀C ? $$$$

Antiulcer—Other

DICYCLOMINE ( Bentyl, Bentylol, Antispas,  Formulex, Protylol, Lomine) 10 to 20 mg PO/IM qid up to 40 mg PO qid. [Generic/Trade: Tabs 20 mg, Caps 10 mg, Syrup 10 mg/5 mL. Generic only: Caps 20 mg.] `LK ♀B – $

Gastroenterology

95

DONNATAL (phenobarbital + atropine + hyoscyamine + scopolamine) 1 to 2 tabs/caps or 5 to 10 mL PO tid to qid. 1 extended-release tab PO q 8 to 12 h.

[Trade only: Phenobarbital 16.2 mg + hyoscyamine 0.1 mg + atropine 0.02
mg + scopolamine 6.5 mcg in each tab or 5 mL. Extended-release tab 48.6

+ 0.3111 + 0.0582 + 0.0195 mg.] `LK ♀C – $$$

GI COCKTAIL (green goddess)

Acute GI upset:

p

Mixture of Maalox/Mylanta

30 mL + viscous lidocaine (2%) 10 mL + Donnatal 10 mL administered PO
in a single dose. `LK ♀See individual See individual $

HYOSCINE ( Buscopan) Canada:

n

GI or bladder spasm:

p

10 to 20 mg PO/

IV up to 60 mg daily (PO) or 100 mg daily (IV). [Canada Trade only: Tabs 10 mg.] `LK ♀C ? $$

HYOSCYAMINE ( Anaspaz, A-spaz, Cystospaz, ED Spaz, Hyosol, Hyospaz, Levbid, Levsin, Levsinex, Medispaz, NuLev, Spacol, Spasdel, Symax)

x Bladder spasm, control gastric secretion, GI hypermotility p

,
g

,
yp

, irritable
y,
bowel syndrome:

y

0.125 to 0.25 mg PO/SL q 4 h or prn. Extended-release: 0.375
to 0.75 mg PO q 12 h. Max 1.5 mg/day. [Generic/Trade: tabs 0.125, 0.15 mg.

Sublingual Tabs 0.125 mg. Chewable tabs 0.125 mg. Extended-release Tabs, Caps 0.375 mg. Elixir 0.125 mg/5 mL. Drops 0.125 mg/1 mL.] `LK ♀C – $

MEPENZOLATE ( Cantil ) 25 to 50 mg PO tid to qid, with meals and qhs.

[Trade only: Tabs 25 mg.] `LK ♀B ? $$$$$

MISOPROSTOL ( PGE1, Cytotec) Prevention of NSAID-induced gastric ulcers: g

Start 100 mcg PO bid, then titrate as tolerated up to 200 mcg PO qid. Cervical ripening:

p
g 25 mcg intravaginally q 3 to 6 h (or 50 mcg q 6 h). First trimester pregnancy failure:

p g
y

800 mcg intravaginally, repeat on day 3 if expulsion incomplete. [Generic/Trade: Oral tabs 100, 200 mcg.] `LK ♀X – $$$$

PROPANTHELINE ( Pro-Banthine,  Propanthel ) 7.5 to 15 mg PO 30 min after meals and at bed time. [Generic only: Tabs 15 mg.] `LK ♀C – $$$

SIMETHICONE ( Mylicon, Gas-X, Phazyme,  Ovol ) 40 to 160 mg PO qid prn.

Infants: 20 mg PO qid prn [OTC Generic/Trade: Chewable tabs 80, 125 mg, drops 40 mg/0.6 mL. Trade only: Softgels 125 mg (Gas-X) 180 mg (Phazyme, Gas-X). Strips, oral (Gas-X) 62.5 mg (adults), 40 mg (children).] `Not absorbed ♀C but + ? $

SUCRALFATE ( Carafate,  Sulcrate) 1 g PO 1 h before meals (2 h before other medica tions) and at bed time. [Generic/Trade: Tabs 1 g, susp 1 g/10
mL.] `Not absorbed ♀B ? $$

Laxatives—Bulk-Forming

METHYLCELLULOSE ( Citrucel ) 1 heaping tablespoon in 8 oz. water PO daily (up to tid). [OTC Trade only: Regular and sugar-free packets and multiple-use canisters, Clear-mix soln, Caplets 500 mg.] `Not absorbed ♀+ ? $

POLYCARBOPHIL ( FiberCon, Fiberall, Konsyl Fiber, Equalactinn) Laxative:

1 g PO qid prn. Diarrhea: 1 g PO q 30 min. Max daily dose 6 g. [OTC Generic/

Trade: Tabs/Caplets 625 mg. OTC Trade only: Chewable tabs 625 mg (Equalactin).] `Not absorbed ♀+ ? $

PSYLLIUM ( Metamucil, Fiberall, Konsyl, Hydrocil,  Prodium Plain) n

1 teaspoon in liquid, 1 packet in liquid or 1 to 2 wafers with liquid PO daily (up (cont.)

96 Gastroenterology
to tid). [OTC Generic/Trade: Regular and sugar-free powder, Granules, Caps, Wafers, including various fl avors and various amounts of psyllium.] `Not absorbed ♀+ ? $

Laxatives—Osmotic

GLYCERIN ( Fleet ) 1 adult or infant suppository PR prn. [OTC Generic/Trade: Suppository infant and adult, Soln (Fleet Babylax) 4 mL/applicator.] `Not absorbed ♀C ? $

LACTULOSE ( Enulose, Kristalose)

Constipation:

p

15 to 30 mL (syrup) or 10
to 20 g (powder for oral soln) PO daily. Hepatic encephalopathy: p
p
p
y 30 to 45
mL (syrup) PO tid to qid, or 300 mL retention enema. [Generic/Trade: Syrup 10 g/15 mL. Trade only (Kristalose): 10, 20 g packets for oral soln.] `Not absorbed ♀B ? $$

MAGNESIUM CITRATE ( Citro-Mag ) 150 to 300 mL PO divided bid. Give 2 to 4 mL/kg/day for age younger than 6 yo. [OTC Generic only: Soln 300 mL/bottle.

Low-sodium and sugar-free available.] `K ♀+ ? $

MAGNESIUM HYDROXIDE ( Milk of Magnesia) Laxative: 30 to 60 mL regular-strength liquid PO. Antacid: 5 to 15 mL regular-strength liquid or 622 to 1244
mg PO qid prn. [OTC Generic/Trade: Susp 400 mg/5 mL. Trade only: Chewable tabs 311, 500 mg. Generic only: Susp 400 mg/5 mL, (concentrated) 1200 mg/

5 mL.] `K ♀+ ? $

POLYETHYLENE GLYCOL ( MiraLax, GlycoLax)

x

17 g (1 heaping tablespoon) in

4 to 8 oz water, juice, soda, coffee, or tea PO daily. [OTC Trade only (MiraLax): Powder for oral soln 17 g/scoop. Rx Generic/Trade: Powder for oral soln 17 g/
scoop.] `Not absorbed ♀C ? $

POLYETHYLENE GLYCOL WITH ELECTROLYTES ( GoLytely, Colyte, TriLyte, NuLytely, Moviprep, HalfLytely and Bisacodyl Tablet Kit,  Klean-Prep, Electropeg, Peg-Lyte OCL) Bowel prep:

p p 240 mL q 10 min PO or 20 to 30
mL/min per NG until 4L is consumed. Moviprep: Follow specifi c instructions.

[Trade: Powder for oral soln in disposable jug Moviprep (2L), CoLyte (1 gal or 4L), NuLytely (4L), TriLyte (4L), OCL (1500 mL), GoLytely (packet for oral soln to make 3.785 liters or jug). Also, as a kit of 2L bottle of polyethylene glycol with electrolytes and 4 bisacodyl tabs 5 mg (HalfLytely and Bisacodyl Tablet Kit), Generic.] `Not absorbed ♀C ? $

SODIUM PHOSPHATE ( Fleet enema, Fleet Phospho-Soda, Fleet EZ-Prep, Accu-Prep, Osmoprep, Visicol,  Enemol, Phoslax) 1 adult or pediatric enema PR or 20 to 30 mL of oral soln PO prn (max 45 mL/24 h). Visicol: Evening before colonoscopy: 3 tabs with 8 oz clear liquid q 15 min until 20
tabs are consumed. Day of colonoscopy: Starting 3 to 5 h before procedure, 3
tabs with 8 oz clear liquid q 15 min until 20 tabs are consumed. Osmoprep: 32 tabs (48 g of sodium phosphate) PO with total of 2 quarts clear liquids as follows: pm before procedure: 4 tabs PO with 8 ounces of clear liquids q 15 mins for a total of 20 tabs; day of procedure: 3 to 5 h before procedure, 4 tabs with 8 ounces of clear liquids q 15 mins for a total of 12 tabs. [OTC

Generic/Trade: Adult enema, oral soln. OTC Trade only: Pediatric enema, bowel prep. Rx Trade only: Visicol, Osmoprep tab ($$$$) 1.5 g.] `Not absorbed ♀C ? $

Gastroenterology

97

SORBITOL 30 to 150 mL (of 70% soln) PO or 120 mL (of 25 to 30% soln) PR
as a single dose. Cathartic: 1 to 2 mL/kg PO. [Generic only: Soln 70%.] `Not absorbed ♀+ ? $

Laxatives—Stimulant

BISACODYL ( Correctol, Dulcolax, Feen-a-Mint, Fleett) 10 to 15 mg PO prn, 10 mg PR prn, 5 to 10 mg PR prn if 2 to 11 yo. [OTC Generic/Trade: Tabs 5
mg, suppository 10 mg. OTC Trade only (Fleet): Enema, 10 mg/30 mL.] `L

♀+ ? $

CASCARA 325 mg PO qhs prn or 5 mL of aromatic fl uid extract PO qhs prn.

[OTC Generic only: Tabs 325 mg, liquid aromatic fl uid extract.] `L ♀C + $

CASTOR OIL 15 to 60 mL of castor oil or 30 to 60 mL emulsifi ed castor oil PO
qhs, 5 to 15 mL/dose of castor oil PO or 7.5 to 30 mL emulsifi ed castor oil PO
for child. [OTC Generic only: Oil 60, 120 mL.] `Not absorbed ♀– ? $

SENNA ( Senokot, SenokotXTRA, Ex-Lax, Fletcher’s Castoria,  Glysennid) d

2 tabs or 1 teaspoon granules or 10 to 15 mL syrup PO. Max 8 tabs, 4 teaspoon granules, 30 mL syrup/day. Take granules with full glass of water. [OTC Generic/

Trade (All dosing is based on sennosides content; 1 mg sennosides = 21.7 mg standardized senna concentrate): Syrup 8.8 mg/5 mL, Liquid 3 mg/mL (Fletcher’s Castoria), Tabs 8.6, 15, 17, 25 mg, Chewable tabs 15 mg.] `L ♀C + $

Laxatives—Stool Softener

DOCUSATE ( Colace, Surfak, Kaopectate Stool Softener, Enemeez) z Docusate
calcium: 240 mg PO daily. Docusate sodium: 50 to 500 mg/day PO divided in 1 to 4 doses. Peds: Give 10 to 40 mg/day for age younger than 3 yo, give 20
to 60 mg/day for age 3 to 6 yo, give 40 to 150 mg/day for age 6 to 12 yo. In all cases doses are divided up to qid. Cerumen impaction: p

Instill 1 mL in
affected ear. [Docusate calcium OTC Generic/Trade: Caps 240 mg. Docusate sodium OTC Generic/Trade: Caps 50, 100, 250 mg, liquid 50 mg/5 mL, syrup 20 mg/5 mL. Docusate sodium OTC Trade only (Enemeez): Enema, rectal 283
mg/5 mL.] `L ♀+ ? $

Laxatives—Other or Combinations

LUBIPROSTONE ( Amitiza)

Chronic idiopathic constipation:

p
p

24 mcg PO bid
with meals. Irritable bowel syndrome
y
with constipation in women age 18 yo or
older: 8 mcg PO bid. [Trade only: 8, 24 mcg caps.] `Gut ♀C ? $$$$$

MINERAL OIL ( Kondremul, Fleet Mineral Oil Enema, Liqui-Doss,

 Lansoyl ) 15 to 45 mL PO. Peds: 5 to 15 mL/dose PO. Mineral oil enema: 60 to 150 mL PR. Peds 30 to 60 mL PR. [OTC Generic/Trade: Oil (30, 480 mL), Enema (Fleet). OTC Trade only: Oral liquid (Liqui-Doss) 13.5 mg/15 mL, Oral microemulsion (Kondremul) 2.5 mg/5 mL.] `Not absorbed ♀C ? $

PERI-COLACE (docusate + sennosides) 2 to 4 tabs PO once daily or in divided doses prn. [OTC Generic/Trade: Tabs 50 mg docusate + 8.6 mg sennosides.] `L ♀C ? $

SENOKOT-S (senna + docusate) 2 tabs PO daily. [OTC Generic/Trade: Tabs 8.6 mg senna concentrate/50 mg docusate.] `L ♀C + $

98 Gastroenterology

Ulcerative Colitis

BALSALAZIDE ( Colazal ) 2.25 g PO tid for 8 to 12 weeks. [Generic/Trade: Caps 750 mg.] `Minimal absorption ♀B ? $$$$$

MESALAMINE ( 5-aminosalicylic acid, Apriso, 5-ASA, Asacol, Lialda, Pentasa, Canasa, Rowasa,  Mesasal, Salofalk) k

Apriso: 1.5 g (4 caps) PO qam.

Asacol: 800 to 1600 mg PO tid. Pentasa: 1000 mg PO qid. Lialda: 2.4 to 4.8 g PO daily with a meal. Canasa: 500 mg PR bid to tid or 1000 mg PR qhs. [Trade only: Delayed-release tabs 400, 800 mg (Asacol), controlled-release cap 250, 500 mg (Pentasa), delayed-release tab 1200 mg (Lialda), rectal suppositories 1000 mg (Canasa), controlled-release caps 0.375 mg (Apriso). Generic/Trade: Rectal susp 4 g/60 mL (Rowasa).] `Gut ♀B ? $$$$$

OLSALAZINE ( Dipentum)

m

Ulcerative colitis: 500 mg PO bid. [Trade only: Caps 250 mg.] `L ♀C – $$$$$

SULFASALAZINE ( Azulfi dine, Azulfi dine EN-tabs,  Salazopyrin En-tabs, S.A.S. )

Colitis: 500 to 1000 mg PO qid. Peds: 30 to 60 mg/kg/day divided q 4
to 6 h. RA: 500 mg PO bid after meals up to 1 g PO bid. May turn body fl uids, contact lenses or skin orange-yellow. [Generic/Trade: Tabs 500 mg, scored.

Enteric coated, Delayed-release tabs (EN-tabs) 500 mg.] `L ♀B – $$

Other GI Agents

ALOSETRON ( Lotronex)

x

Diarrhea-predominant Irritable Bowel Syndrome
p
y
in
women who have failed conventional therapy: 0.5 mg PO bid for 4 weeks; in patients who become constipated, decrease to 0.5 mg PO once daily. If well tolerated after 4 weeks, may increase to 1 mg PO bid. Discontinue if symptoms not controlled in 4 weeks on 1 mg PO bid. [Trade only: Tabs 0.5, 1 mg.] `L ♀B ? $$$$$

ALPHA-GALACTOSIDASE ( Beano) 5 gtts per ½ cup gassy food, 3 tabs PO

(chew, swallow, crumble) or 10 gtts per typical meal. [OTC Trade only: Oral gtts 150 GalU/5 gtts, Tabs 150 GalU.] `Minimal absorption ♀? ? $

ALVIMOPAN ( Entereg ) Short-term (up to 15 doses) in hospitalized patients undergoing partial large or small bowel resection surgery with primary anastomosis: 12 mg PO 30 min to 5 h prior to surgery, then 12 mg bid for up to 7 days. [Trade only: Caps 12 mg.] Ìntestinal fl ora ♀B ? ?

BUDESONIDE ( Entocort EC)

C

9 mg PO daily for 8 weeks (remission induction)

or 6 mg PO daily for 3 months (maintenance). [Trade only: Caps 3 mg.] `L

♀C ? $$$$$

CERTOLIZUMAB ( Cimzia)

Crohn’s: 400 mg SC at 0, 2, and 4 weeks. If response occurs, then 400 mg SQ q 4 weeks. [Trade only: 200 mg kit.] `Plasma, K ♀B

? $$$$$

CHLORDIAZEPOXIDE-CLIDINIUM ( Libraxx) 1 cap PO tid to qid. [Generic/

Trade: Caps, chlordiazepoxide 5 mg + clidinium 2.5 mg.] `L ♀D – $$$

GLYCOPYRROLATE ( Robinul, Robinul Forte) 0.1 mg/kg PO bid to tid, max 8 mg/day. [Generic/Trade: Tabs 1, 2 mg.] `K ♀B ? $$$$

LACTASE ( Lactaid)

d

Swallow or chew 3 caplets (Original strength), 2 caplets (Extra strength), 1 caplet (Ultra) with fi rst bite of dairy foods. Adjust dose based on response. [OTC Generic/Trade: Caplets, Chewable tabs.] `Not absorbed ♀+ + $

Hematology

99

LIBRAX (chlordiazepoxide + methscopolamine) 1 cap PO tid to qid.

[Trade only: caps methscopolamine 2.5 mg + chlordiazepoxide 5 mg.] `K

LD - $$$$$

METHYLNALTREXONE ( Relistorr) Give 8 mg SC every other day for wt 38 to 61 kg, give 12 mg SC every other day for wt 62 to 114 kg, give 0.15 mg/
kg SC every other day for wt 115 kg or greater. [Injectable soln 12 mg/0.6
mL.] ùnchanged ♀B ? $$$$$

NEOMYCIN—ORAL ( Neo-Fradinn)

Hepatic encephalopathy:

p
p
p
y 4 to 12 g/day PO
divided q 6 to 8 h. Peds: 50 to 100 mg/kg/day PO divided q 6 to 8 h. [Generic only: Tabs 500 mg. Trade only: Soln 125 mg/5 mL.] `Minimally absorbed ♀D

? $$$

OCTREOTIDE ( Sandostatin, Sandostatin LAR)

R

Variceal bleeding:

g Bolus 50 to

100 mcg IV followed by infusion 25 to 50 mcg/h. AIDS diarrhea: 100 to 500 mcg SC tid. [Generic/Trade: Injection vials 0.05, 0.1, 0.2, 0.5, 1 mg. Trade only: Long-acting injectable susp (Sandostatin LAR) 10, 20, 30 mg.] `LK ♀B ? $$$$$

ORLISTAT ( Alli, Xenical )

Weight loss:

g

120 mg PO tid with meals. [OTC Trade
only (Alli): Caps 60 mg. Rx Trade only (Xenical): Caps 120 mg.] `Gut ♀B ? $$$

PANCREATIN ( Creon, Ku-Zyme,  Entozyme) 8000 to 24,000 units lipase (1 to 2 tabs/caps) PO with meals and snacks. [Tabs, Caps with varying amounts of pancreatin, lipase, amylase, and protease.] `Gut ♀C ? $$$

PANCRELIPASE ( Viokase, Pancrease, Pancrecarb, Cotazym, Ku-Zyme HP)

P

4000 to 33,000 units lipase (1 to 3 tabs/caps) PO with meals and snacks. [Tabs, Caps, Powder with varying amounts of lipase, amylase, and protease.] `Gut ♀C ? $$$

PINAVERIUM ( Dicetel ) Canada
only. 50 to 100 mg PO tid. [Trade only: Tabs

50, 100 mg.] `? ♀C – $$$

SECRETIN ( SecreFlo, SecreMax)

x

Test dose 0.2 mcg IV. If tolerated, 0.2 to

0.4 mcg/kg IV over 1 min. `Serum ♀C ? $$$$$

URSODIOL ( Actigall, URSO, URSO Forte)

Gallstone dissolution (Actigall): 8 to

10 mg/kg/day PO divided bid to tid. Prevention of gallstones associated with g
rapid weight loss
p
g

(Actigall): 300 mg PO bid. Primary biliary cirrhosis y
y

(URSO):

13 to 15 mg/kg/day PO divided in 2 to 4 doses. [Trade: Caps 300 mg (Actigall).

Tabs 250 (URSO), 500 mg scored (URSO Forte).] `Bile ♀B ? $$$$

HEMATOLOGY

Anticoagulants—Heparin, LMW Heparins, and Fondaparinux NOTE See cardiovascular section for antiplatelet drugs & thrombolytics.

DALTEPARIN ( Fragmin)

n

DVT prophylaxis, acute medical illness with restricted p p y

,
mobility:

y 5000 units SC daily. DVT prophylaxis, abdominal surgery: p p y

,
g y 2500 units

SC 1 to 2 h preop & daily post-op. DVT prophylaxis, abdominal surgery in p p y

,
g y
patients with malignancy:

p
g
y 5000 units SC evening before surgery and daily
post-op, or 2500 units 1 to 2 h preop and 12 h later, then 5000 units daily.

DVT prophylaxis, hip replacement:

p p y

, p p

Preop start: 2500 units SC given 2 h preop,

(cont.)

100 Hematology

WEIGHT-BASED HEPARIN DOSING FOR DVT/PE*

Initial dose: 80 units/kg IV bolus, then 18 units/kg/h. Check PTT in 6 h.

PTT less than 35 sec (less than 1.2 × control): 80 units/kg IV bolus, then increase infusion rate by 4 units/kg/h.

PTT 35–45 sec (1.2–1.5 × control): 40 units/kg IV bolus, then increase infusion by 2 units/kg/h.

PTT 46–70 sec (1.5–2.3 × control): No change.

PTT 71–90 sec (2.3–3 × control): decrease infusion rate by 2 units/kg/h.

PTT greater than 90 sec (greater than 3 × control): Hold infusion for 1 h, then decrease infusion rate by 3 units/kg/
g h.

*PTT = Activated partial thromboplastin time. Reagent-specifi c target PTT may differ; use institutional nomogram when available. Consider establishing a max bolus dose/max initial infusion rate or use an adjusted body wt in obesity. Monitor PTT 6 h after heparin initiation and 6 h after each dosage adjustment.

When PTT is stable within therapeutic range, monitor every morning. Therapeutic PTT range corresponds to anti-factor Xa activity of 0.3–0.7 units/mL. Check platelets between days 3 and 5. Can begin warfarin on fi rst day of heparin; continue heparin for ≥4 to 5 days of combined therapy. Adapted from Ann Intern Med 1993;119:874; Chest 2008:133:463S-464S, Circulation 2001; 103:2994.

4 to 8 h post-op, then 5000 units daily starting at least 6 h after 2nd dose, or 5000 units 10 to 14 h preop, 4 to 8 h post-op, then daily (approximately 24 h between doses). Post-op start: 2500 units 4 to 8 h post-op, then 5000 units daily starting at least 6 h after fi rst dose. Treatment of DVT/PE in cancer: 200 units/kg SC daily for 1 month, then 150 units/kg SC daily for 5 months; max 18,000 units/day. Unstable angina or non-Q-wave MI: g

120 units/kg up to

10,000 units SC q 12 h with ASA (75 to 165 mg/day PO) until clinically stable.

[Trade only: Single-dose syringes 2500, 5000 anti-Xa units/0.2 mL, 7500 anti-Xa/0.3 mL, 10,000 anti-Xa units/1 mL, 12,500 anti-Xa units/0.5 mL, 15,000
anti-Xa units/0.6 mL, 18,000 anti-Xa units/0.72 mL; multidose vial 10,000
units/mL, 9.5 mL and 25,000 units/mL, 3.8 mL.] `KL ♀B + $$$$$

ENOXAPARIN ( Lovenox)

DVT prophylaxis, acute medical illness with restricted p p y

,

mobility:

y 40 mg SC daily (if CrCl <30 mL/min): give 30 mg SC daily). Hip/knee p

replacement:

p

30 mg SC q 12 h starting 12 to 24 h post-op (if CrCl <30 mL/min: give 30 mg SC daily). Alternative for hip replacement: 40 mg SC daily starting 12 h preop. Abdominal surgery:

g y 40 mg SC daily starting 2 h preop (if CrCl <30
mL/min: give 30 mg SC daily). Outpatient treatment of DVT without pulmonary p
p
y
embolus: 1 mg/kg SC q 12 h. Continue for at least 5 days and until therapeutic oral anticoagulation established. Inpatient treatment of DVT with/without p

pulmonary embolus:

p
y

1 mg/kg SC q 12 h or 1.5 mg/kg SC q 24 h (CrCl <30 mL/
min: 1 mg/kg SC daily). Continue for at least 5 days and until therapeutic oral anticoagulation established. Unstable angina or non-Q-wave MI: g

1 mg/kg SC q

12 h with ASA (100 to 325 mg PO daily) for at least 2 days and until clinically stable (if CrCl <30 mL/min: give 1 mg/kg SC daily). Acute ST-elevation MI: For age 75 yo or younger: give 30 mg IV bolus, followed 15 min later by 1 mg/kg SC, then 1 mg/kg SC (max 100 mg/dose for the fi rst two doses) q 12 h (if CrCl <30
mL/min: give 30 mg IV bolus followed 15 min later by 1 mg/kg SC dose then 1
mg/kg SC daily); if older than 75 yo: 0.75 mg/kg (max 75 mg/dose for the fi rst (cont.)

Hematology

101
two doses, no bolus) SC q 12 h (CrCl <30 mL/min: 1 mg/kg SC daily, no bolus).

[Trade only: Multidose vial 300 mg; Syringes 30, 40 mg; graduated syringes 60, 80, 100, 120, 150 mg. Concentration is 100 mg/mL except for 120, 150 mg which are 150 mg/mL.] `KL ♀B + $$$$$

FONDAPARINUX ( Arixtra)

DVT prophylaxis, hip/knee replacement or hip
p p y

,
p
p
p
fracture surgery
g

, abdominal surgery:

y,
g y 2.5 mg SC daily starting 6 to 8 h post-op.

DVT/PE treatment based on wt: 5 mg (if wt less than 50 kg), 7.5 mg (if 50
to 100 kg), 10 mg (if wt greater than 100 kg) SC daily for at least 5 day & therapeutic oral anticoagulation. [Trade only: Prefi lled syringes 2.5 mg/0.5
mL, 5 mg/0.4 mL, 7.5 mg/0.6 mL, 10 mg/0.8 mL.] `K ♀B ? $$$$$

HEPARIN ( Hepalean)

n

Venous thrombosis/pulmonary embolus
p
y
treatment:

Load 80 units/kg IV, then initiate infusion at 18 units/kg/h. Adjust based on coagulation testing (PTT). Peds: Load 50 units/kg IV, then infuse 25 units/kg/h.

DVT prophylaxis:

p p y

5000 units SC q 8 to 12 h. [Generic only: 1000, 5000, 10,000, 20,000 units/mL in various vial and syringe sizes.] `Reticuloendothelial system ♀C but + + $$

TINZAPARIN ( Innohep)

p

DVT with/without pulmonary embolus:

p
y

175 units/kg SC
daily for at least 6 days and until adequate anticoagulation with warfarin. [Trade only: 20,000 anti-Xa units/mL, 2 mL multidose vial.] `K ♀B + $$$$$

Anticoagulants—Other

ARGATROBAN

HIT: Start 2 mcg/kg/min IV infusion. Get PTT at baseline and 2 h after starting infusion. Adjust dose (max dose: 10 mcg/kg/min) until PTT
is 1.5 to 3× baseline (not >100 sec). `L ♀B – $$$$$

BIVALIRUDIN ( Angiomax)

x

Anticoagulation during PCI
g
g

(patients with or at
risk of HIT): 0.75 mg/kg IV bolus prior to intervention, then 1.75 mg/kg/h for duration of procedure (with provisional Gp IIb/IIIa inhibition). For CrCl <30
mL/min, reduce infusion dose to 1 mg/kg/h after bolus. Use with ASA 300
to 325 mg PO daily. Additional bolus of 0.3 mg/kg if activated clotting time

<225 sec. `proteolysis/K ♀B ? $$$$$

LEPIRUDIN ( Refl udan)

n

Anticoagulation in HIT
g
and associated throm-
boembolic disease: Bolus 0.4 mg/kg up to 44 mg IV over 15 to 20 sec, then (cont.)

THERAPEUTIC GOALS FOR ANTICOAGULATION

INR Range*

Indication

Atrial fi brillation, deep venous thrombosis†, pulmonary embolism†, bio-2.0–3.0
prosthetic heart valve, mechanical prosthetic heart valve (aortic position, bileafl et or tilting disk with normal sinus rhythm and normal left atrium) Mechanical prosthetic heart valve: (1) mitral position, (2) aortic position 2.5–3.5
with atrial fi brillation, (3) caged ball or caged disk

*Aim for an INR in the middle of the INR range (eg, 2.5 for range of 2 to 3 and 3.0 for range of 2.5 to 3.5).

Adapted from: Chestt 2008; 133: 456-7S, 459S, 547S, 594-5S; see this manuscript for additional information and other indications. †For fi rst-event unprovoked DVT/PE, after 3 months of therapy at goal INR 2 to 3, may consider low-intensity therapy (INR range 1.5 to 2.0) in patients with strong preference for less frequent INR testing.

102 Hematology
infuse 0.15 mg/kg/h up to 16.5 mg/h. Adjust dose to maintain APTT ratio of 1.5 to 2.5. `K ♀B ? $$$$$

WARFARIN ( Coumadin, Jantovenn) Start 2 to 5 mg PO daily for 1 to 2 days, then adjust dose to maintain therapeutic PT/INR. [Generic/Trade: Tabs 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg.] `L ♀X + $

Colony Stimulating Factors

DARBEPOETIN ( Aranesp, NESP)

P

Anemia of chronic renal failure: 0.45 mcg/kg

IV/SC once a week, or 0.75 mcg/kg q 2 weeks in some nondialysis patients.

Cancer chemo anemia: 2.25 mcg/kg SC weekly, or 500 mcg SC every 3 weeks.

Adjust dose based on Hb. [Trade only: All forms are available with or without albumin. Single-dose vials 25, 40, 60, 100, 200, 300, 500 mcg/1 mL, and 150
mcg/0.75 mL. Single-dose prefi lled syringes or autoinjectors 25 mcg/0.42 mL, 40 mcg/0.4 mL, 60 mcg/0.3 mL, 100 mcg/0.5 mL, 150 mcg/0.3 mL, 200 mcg/0.4
mL, 300 mcg/0.6 mL, 500 mcg/1 mL.] `cellular sialidases, L ♀C ? $$$$$

EPOETIN ALFA ( Epogen, Procrit, erythropoietin alpha,  Eprexx) Anemia: 1
dose IV/SC 3 times a week. Initial dose if renal failure is 50 to 100 units/kg, Zidovudine-induced anemia is 100 units/kg, or chemo-associated anemia is 150 units/kg. Alternate for chemo-associated anemia: 40,000 units SC once a week. Adjust dose based on Hb. [Trade only: Single-dose 1 mL vials 2000, 3000, 4000, 10,000, 40,000 units/mL. Multidose vials 10,000 units/mL 2 mL, 20,000 units/mL 1 mL.] `L ♀C ? $$$$$

FILGRASTIM ( G-CSF, Neupogenn) Neutropenia: p

5 mcg/kg SC/IV daily. [Trade
only: Single-dose vials 300 mcg/1 mL, 480 mcg/1.6 mL. Single-dose syringes 300 mcg/0.5 mL, 480 mcg/0.8 mL.] `L ♀C ? $$$$$

OPRELVEKIN ( Neumega)

a

Chemotherapy-induced
py
thrombocytopenia
y p
in adults:

50 mcg/kg SC daily. [Trade only: 5 mg single-dose vials with diluent.] `K

♀C ? $$$$$

PEGFILGRASTIM ( Neulasta) 6 mg SC once each chemo cycle. [Trade only: Single-dose syringes 6 mg/0.6 mL.] `Plasma ♀C ? $$$$$

SARGRAMOSTIM ( GM-CSF, Leukine) Specialized dosing for marrow transplant. `L ♀C ? $$$$$

Other Hematological Agents

NOTE See endocrine section for vitamins and minerals.

AMINOCAPROIC ACID ( Amicar) Hemostasis: 4 to 5 g PO/IV over 1 h, then 1 g/h prn. [Generic/Trade: Syrup 250 mg/mL, Tabs 500 mg. Trade only: Tabs 1000 mg.] `K ♀D ? $ IV $$$$$ Oral

ANAGRELIDE ( Agrylin)

n

Thrombocythemia due to myeloproliferative disorders: y
y
p

Start 0.5 mg PO qid or 1 mg PO bid, then after 1 week adjust to lowest effective dose. Max 10 mg/day. [Generic/Trade: Caps 500 mg. Generic only: Caps 1000 mg.] `LK ♀C ? $$$$$

DEFERASIROX ( Exjade) Chronic iron overload: 20 mg/kg PO daily; adjust dose q 3 to 6 months based on ferritin trends. Max 40 mg/kg/day. [Trade only: Tabs for dissolving into oral susp 125, 250, 500 mg.] `L ♀B ? $$$$$

Herbal & Alternative Therapies 103

HYDROXYUREA ( Hydrea, Droxia)

a

Sickle cell anemia (Droxia): Start 15 mg/kg PO
daily while monitoring CBC every 2 weeks. If no marrow depression, then increase dose every 12 weeks by 5 mg/kg/day (max 35 mg/kg/day). Give concomitant folic acid 1 mg/day. Chemotherapy:

py Doses vary by indication. [Generic/Trade: Caps 500
mg. Trade only: (Droxia) Caps 200, 300, 400 mg.] `LK ♀D – $ varies by therapy PROTAMINE

Reversal of heparin:

p

1 mg antagonizes about 100 units heparin.

Reversal of low-molecular-weight heparin:

g
p

1 mg protamine per 100 anti-Xa
units of dalteparin or tinzaparin. 1 mg protamine per 1 mg enoxaparin. Give IV

(max 50 mg) over 10 min. May cause allergy/anaphylaxis. `Plasma ♀C ? $

HERBAL & ALTERNATIVE THERAPIES

NOTE In the United States, herbal & alternative therapy products are regulated as dietary supplements, not drugs. Premarketing evaluation and FDA approval are not required unless specifi c therapeutic claims are made. Since these products are not required to demonstrate effi cacy, it is unclear whether many of them have health benefi ts. In addition, there may be considerable variability in content from lot to lot or between products. See www.tarascon.com/herbals for the evidence-based effi cacy ratings used by Tarascon editorial staff.

ALOE VERA ( acemannan, burn plant ) Topical: Effi cacy unclear for seborrheic dermatitis, psoriasis, genital herpes, skin burns. Gel possibly effective for oral lichen planus. Do not apply to surgical incisions; impaired healing reported.

Oral: Effi cacy unclear for mild to moderate active ulcerative colitis, type 2
diabetes. OTC laxatives containing aloe were removed from US market due to possible increased risk of colon cancer. [Not by prescription.] `LK ♀oral–
topical+? oral– topical+? $

ARNICA ( Arnica montana, leopard’s bane, wolf’s bane) Do not take by mouth or use on open wounds. Topical promoted for treatment of skin wounds, bruises, aches, and sprains; but insuffi cient data to assess effi cacy. [Not by prescription.] `? ♀– – $

ARTICHOKE LEAF EXTRACT ( Cynara-SL, Cynara scolymus) s

May reduce total
cholesterol, but clinical signifi cance is unclear. Cynara-SL is promoted as digestive aid (possibly effective for dyspepsia) at a dose of 1 to 2 caps PO daily (320 mg dried artichoke leaf extract/cap). [Not by prescription.] `? ♀? ? $

ASTRAGALUS ( Astragalus membranaceus, huang qi, vetch, Jinfukang) g Used
in combination with other herbs in traditional Chinese medicine for CHD, CHF, chronic liver disease, kidney disease, viral infections, and upper respiratory tract infection. Possibly effective for improving survival and performance status with platinum-based chemotherapy for non-small cell lung cancer.

However, astragalus-based herbal formula (Jinfukang) did not affect survival or pharmacokinetics of docetaxel in phase II study of patients with non-small cell lung cancer. [Not by prescription.] `? ♀? ? $

BILBERRY ( Vaccinium myrtillus, huckleberry, Tegens, VMA extract

)

Insuffi cient data to evaluate effi cacy for macular degeneration or prevention (cont.)

104 Herbal & Alternative Therapies of cataracts. Does not appear effective for improving night vision. [Not by prescription.] `Bile, K ♀– – $

BITTER MELON ( Momordica charantia, ampalaya, karela) Effi cacy unclear for type 2 diabetes. Dose unclear; juice may be more potent than dried fruit powder.

Hypoglycemic coma reported in 2 children ingesting tea. Seeds can cause hemolytic anemia in G6PD defi ciency. [Not by prescription.] `? ♀– – $$

BUTTERBUR ( Petesites hybridus, Petadolex, Petaforce, Tesalin, ZE

339)

9

Migraine prophylaxis
g
p p y

(possibly effective): Petadolex 50 to 75 mg PO
bid. Allergic rhinitis prophylaxis
g
p p y

(possibly effective): Petadolex 50 mg PO bid
or Tesalin 1 tab PO qid or 2 tabs tid. Effi cacy unclear for asthma or allergic skin disease. [Not by prescription. Standardized pyrrolizidine-free extracts: Petadolex (7.5 mg of petasin and isopetasin/50 mg tab). Tesalin (ZE 339; 8
mg petasin/tab).] `? ♀– – $

CHAMOMILE ( Matricaria recutita—German chamomile, Anthemis nobilis—

Roman chamomile) Promoted as a sedative or anxiolytic, to relieve GI distress, for skin infections or infl ammation, many other indications. Effi cacy unclear for any indication. [Not by prescription.] `? ♀– ? $

CHASTEBERRY ( Vitex agnus castus fruit extract, Femaprinn) Premenstrual syndrome
y

(possibly effective): 20 mg PO daily of extract ZE 440. [Not by prescription.] `? ♀– – $

CHONDROITIN Does not appear effective for relief of knee OA pain, but possibly reduces joint space narrowing. Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) did not fi nd overall improvement in pain of knee OA with chondroitin 400 mg PO tid ± glucosamine. Chondroitin + glucosamine improved pain in subgroup of patients with moderate to severe knee OA. [Not by prescription.] `K ♀? ? $

COENZYME Q10 ( CoQ-10, ubiquinone)

Heart failure: 100 mg/day PO divided
bid to tid (confl icting clinical trials; AHA does not recommend). Statin-induced myalgia:

y g 100 to 200 mg PO daily (effi cacy unclear; confl icting clinical trials).

Parkinson’s disease: 1200 mg/day PO divided qid ($$$$; effi cacy unclear; might slow progression slightly, but the American Academy of Neurology does not recommend). Effi cacy unclear for improving athletic performance. Appears ineffective for diabetes. [Not by prescription.] `Bile ♀– – $

CRANBERRY ( Cranactin, Vaccinium macrocarpon) n Prevention of UTI

(possibly effective): 300 mL/day PO cranberry juice cocktail. Usual dose of cranberry juice extract caps/tabs is 300 to 400 mg PO bid. Insuffi cient data to assess effi cacy for treatment of UTI. Potential increase in INR with warfarin.

[Not by prescription.] `? ♀? ? $

CREATINE Promoted to enhance athletic performance. No benefi t for endurance exercise; modest benefi t for intense anaerobic tasks lasting <30 sec.

Usual loading dose of 20 g/day PO for 5 days, then 2 to 5 g/day divided bid.

[Not by prescription.] `LK ♀– – $

DEHYDROEPIANDROSTERONE ( DHEA, Aslera, Fidelin, Prasterone) Does not
improve cognition, quality of life, or sexual function in elderly. To improve well-being in women with adrenal insuffi ciency: 50 mg PO daily (possibly effective; confl icting clinical trials). [Not by prescription.] `Peripheral conversion to estrogens and androgens ♀– – $

Herbal & Alternative Therapies 105

DEVIL’S CLAW ( Harpagophytum procumbens, Phyto Joint, Doloteffi n, Harpadol ) OA, acute exacerbation of chronic low-back pain

,
p

(possibly
effective): 2400 mg extract/day (50 to 100 mg harpagoside/day) PO divided bid to tid. [Not by prescription. Extracts standardized to harpagoside (iridoid glycoside) content.] `? ♀– – $

DONG QUAI ( Angelica sinensis) Appears ineffective for postmenopausal symptoms; North American Menopause Society recommends against use.

May increase bleeding risk with warfarin; avoid concurrent use. [Not by prescription.] `? ♀– – $

ECHINACEA ( E purpurea, E angustifolia, E pallida, cone fl ower, EchinaGuard, Echinacin Madaus) Confl icting clinical trials for prevention or treatment of upper respiratory infections. [Not by prescription.] `? ♀– – $

ELDERBERRY ( Sambucus nigra, Rubini, Sambucol, Sinupret ) Effi cacy
unclear
for infl uenza, sinusitis, and bronchitis. [Not by prescription.] `? ♀– – $

EVENING PRIMROSE OIL ( Oenothera biennis)

s

Appears ineffective for
premenstrual syndrome, postmenopausal symptoms, atopic dermatitis. [Not by prescription.] `? ♀? ? $

FENUGREEK ( Trigonelle foenum-graecum)

m

Effi cacy unclear for diabetes or
hyperlipidemia. [Not by prescription.] `? ♀– ? $$

FEVERFEW ( Chrysanthemum parthenium, MIG-99, Migra-Lief, MigraSpray, Tanacetum parthenium L. ) Prevention of migraine g

(possibly effective):

50 to 100 mg extract PO daily; 2 to 3 fresh leaves PO with or after meals daily; 50 to 125 mg freeze-dried leaf PO daily. May take 1 to 2 months to be effective. Inadequate data to evaluate effi cacy for acute migraine. [Not by prescription.] `? ♀– – $

FLAVOCOXID ( Limbrel, UP446)

6

OA (effi cacy unclear): 250 to 500 mg PO
bid. [Caps 250, 500 mg. Marketed as medical food by prescription only (not all medical foods require a prescription). Medical foods are intended to be given under physician supervision to meet distinctive nutritional needs of a disease, but they do not undergo an approval process to establish safety and effi cacy.] `? ♀– – $$$

GARCINIA ( Garcinia cambogia, Citri Lean)

n

Appears ineffective for wt loss.

[Not by prescription.] `? ♀– – $

GARLIC SUPPLEMENTS ( Allium sativum, Kwai, Kyolic) Ineffective for hyperlipidemia. Small reductions in BP, but effi cacy in HTN unclear. Does not appear effective for diabetes. Signifi cantly decreases saquinavir levels. May increase bleeding risk with warfarin with/without increase in INR. [Not by prescription.] `LK ♀– – $

GINGER ( Zingiber offi
cinale)

Prevention of motion sickness (effi cacy
unclear): 500 to 1000 mg powdered rhizome PO single dose 1 h before exposure. American College of Obstetrics and Gynecology considers ginger 250 mg PO qid a non-pharmacologic option for N/V of pregnancy p g

.

y Does not
appear effective for post-op N/V. [Not by prescription.] `? ♀? ? $

GINKGO BILOBA ( EGb 761, Ginkgold, Ginkoba)

a

Dementia (effi

( cacy unclear):

y

)

40 mg PO tid of standardized extract containing 24% ginkgo fl avone glycosides and 6% terpene lactones. The American Psychiatric Association and others (cont.)

106 Herbal & Alternative Therapies fi nd evidence too weak for Alzheimer’s or other dementias. Does not prevent dementia in elderly or improve memory in people with normal cognitive function.

Does not appear effective for intermittent claudication or prevention of acute altitude sickness. Possible risk of stroke. [Not by prescription.] `K ♀– – $

GINSENG—AMERICAN ( Panax quinquefolius L. )

Reduction of postprandial
p
p
glucose in type 2 diabetes
g
yp

(possibly effective): 3 g PO taken with or up to 2 h before meal. [Not by prescription.] `K ♀– – $

GINSENG—ASIAN ( Panax ginseng, Ginsana, G115, Korean red ginseng ) Promoted to improve vitality and well-being: 200 mg PO daily. Ginsana: 2 caps PO daily or 1 cap PO bid. Ginsana Sport: 1 cap PO daily. Preliminary evidence of effi cacy for erectile dysfunction. Effi cacy unclear for improving physical or psychomotor performance, diabetes, herpes simplex infections, cognitive or immune function. American College of Obstetrics and Gynecologists and North American Menopause Society recommend against use for postmenopausal hot fl ashes. [Not by prescription.] `? ♀– – $

GINSENG—SIBERIAN ( Eleutherococcus senticosus, Ci-wu-jia) Does not appear effective for improving athletic endurance, or chronic fatigue syndrome. May interfere with some digoxin assays. [Not by prescription.] `?

♀– – $

GLUCOSAMINE ( Afl exa, Cosamin DS, Dona, Flextend, ProMotion) Effi n

cacy
for OA is unclear (confl icting data). Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) did not fi nd overall improvement in pain of knee OA with glucosamine HCl 500 mg ± chondroitin 400 mg both PO tid. Glucosamine

+ chondroitin did improve pain in subgroup of patients with moderate to severe OA. Some earlier studies reported improved pain with glucosamine sulfate (Dona 1500 mg PO once daily ). Glucosamine sulfate was ineffective for hip OA in GOAL study. [Not by prescription.] `L ♀– – $

GOLDENSEAL ( Hydrastis canadensiss) Often used in attempts to achieve false-negative urine test for illicit drug use (effi cacy unclear). Often combined with echinacea in cold remedies; but insuffi cient data to assess effi cacy for common cold or URIs. [Not by prescription.] `? ♀– – $

GRAPE SEED EXTRACT ( Vitis vinifera L., procyanidolic oligomers, PCO)

O

Small clinical trials suggest benefi t in chronic venous insuffi ciency. No benefi t in single study of seasonal allergic rhinitis. [Not by prescription.] `?

♀? ? $

GREEN TEA ( Camellia sinensis)

s

Effi cacy unclear for cancer prevention, wt
loss, hypercholesterolemia. Large doses might decrease INR with warfarin due to vitamin K content. Contains caffeine. [Not by prescription. Green tea extract available in caps standardized to polyphenol content.] `? ♀+ in moderate amount in food, – in supplements + in moderate amount in food,

– in supplements $

GUARANA ( Paullinia cupana) Marketed as an ingredient in wt-loss dietary supplements. Seeds contain caffeine. Guarana in wt loss dietary supplements may provide high doses of caffeine. [Not by prescription.] `? ♀+ in food, –
in supplements + in food, – in supplements $

GUGGULIPID ( Commiphora mukul extract, guggul ) Does not appear effective for hyperlipidemia. [Not by prescription.] `? ♀– – $$

Herbal & Alternative Therapies 107

HAWTHORN ( Crataegus laevigata, monogyna, oxyacantha, standardized ex
tract WS 1442—Crataegutt novo, HeartCare) Mild heart failure (possibly effec tive): 80 mg PO bid to 160 mg PO tid of standardized extract (19% oligomeric procyanidins; WS 1442; HeartCare 80 mg tabs). [Not by prescription.] `? ♀– – $

HONEY ( Medihoney)

y

Topical for burn/wound (including diabetic foot, stasis p

(
g

,
leg ulcers, pressure ulcers, 1st and 2nd degree partial thickness burns): g

, p

,
g
p

)

Apply Medihoney for 12 to 24 h/day. Oral for nocturnal cough due to upper g
pp
respiratory tract infection in children
p
y

(effi cacy unclear): Give PO within 30
min before sleep. Dose is ½ tsp for 2 to 5 yo, 1 tsp for 6 to 11 yo, 2 tsp for 12 to 18 yo. Do not feed honey to children younger than 1 yo due to risk of infant botulism. [Mostly not by prescription. Medihoney is FDA approved y
y p
p
product.] `? ♀+ + $ for PO $$$ for Medihoney

HORSE CHESTNUT SEED EXTRACT ( Aesculus hippocastanum, HCE50, Venastat ) Chronic venous insuffi ciencyy (effective): 1 cap Venastat (16% aescin standardized extract) PO bid with water before meals. Am College of Cardiology found evidence insuffi cient to recommend for peripheral arterial disease. [Not by prescription.] `? ♀– – $

LICORICE ( Cankermelt, Glycyrrhiza glabra, Glycyrrhiza uralensiss) Insuffi -
cient data to assess effi cacy for postmenopausal vasomotor symptoms.

Chronic high doses can cause pseudo-primary aldosteronism (with HTN, edema, hypokalemia). Cancermelt (dissolving oral patch; effi cacy unclear for aphthous ulcers): Apply patch to ulcer for 16 h/day until healed. [Not by y p
prescription.] `Bile ♀– – $

MELATONIN ( N-acetyl-5-methoxytryptamine)

To reduce jet lag after fl
j
g
ights
g
over more than 5 time zones (possibly effective): 0.5 to 5 mg PO qhs for 3 to 6
q
nights starting on day of arrival. [Not by prescription.] `L ♀– – $

METHYLSULFONYLMETHANE ( MSM, dimethyl sulfone, crystalline DMSO2) 2

Insuffi cient data to assess effi cacy of oral and topical MSM for arthritis pain.

y

[Not by prescription.] `? ♀– – $

MILK THISTLE ( Silybum marianum, Legalon, silymarin, Thisylin) n

Hepatic
p
cirrhosis (possibly effective): 100 to 200 mg PO tid of standardized extract with 70 to 80% silymarin. [Not by prescription.] `LK ♀– – $

NETTLE ROOT ( stinging nettle, Urtica dioica radixx) Effi cacy unclear for treatment of BPH. [Not by prescription.] `? ♀– – $

NONI ( Morinda citrifolia) Promoted for many medical disorders; but insuffi -
cient data to assess effi cacy. Potassium content comparable to orange juice; hyperkalemia reported in chronic renal failure. Case reports of hepatotoxicity.

[Not by prescription.] `? ♀– – $$$

PEPPERMINT OIL ( Mentha-x piperita oill)

Irritable bowel syndrome
y

(possibly
effective): 0.2 to 0.4 mL enteric-coated caps PO tid. Peds, 8 yo or older: 0.1 to 0.2 mL enteric-coated caps PO tid. T
p
ake before meals) ` LK L+ in food, ? in
supplements + in food, ? in supplements $

POLICOSANOL ( CholeRx, Cholestinn) Ineffective for hyperlipidemia. A Cuban formulation (unavailable in the United States) 5 mg bid reduced LDL
cholesterol in studies by a single group of researchers, but studies by other groups found no benefi t. Clinical study of a US formulation also found no y
benefi t. [Not by prescription.] `? ♀– – $

108 Herbal & Alternative Therapies PROBIOTICS ( Acidophilus, Align, Bifantis, Bifi dobacteria, Lactobacillus, Bacid, Culturelle, Florastor, IntestiFlora, Lactinex, LiveBac, Power-Dophilus, Primadophilus, Probiotica, Saccharomyces boulardii, VSL#33) Prevention of antibiotic-associated diarrhea (effective): Forastor (Saccharomyces boulardii) 2 caps PO bid for adults; 1 cap PO bid for peds. Culturelle (Lactobacillus GG) 1 cap PO once daily or bid for peds. Give 2 h before/after antibiotic. Peds rotavirus gastroenteritis
g

(effective): Lactobacillus GG at least

10 billion cells/day PO started early in illness. VSL#3 (approved as medical food) for ulcerative colitis or pouchitis:

p

1 to 8 packets/day or 4 to 32 caps/day
for adults; peds dose based on wt and number of bowel movements. Irritable bowel syndrome:

y

VSL#3 either ½ to 1 packet PO daily or 2 to 4 caps PO daily to relieve gas/bloating. Align: 1 cap PO once daily to relieve abdominal pain/
bloating. Safety and effi cacy of probiotics unclear for prevention of recurrent C diffi cile diarrhea. [Not by prescription. Culturelle contains Lactobacillus GG 10 billion cells/cap. Florastor contains Saccharomyces boulardii 5 billion cells/250 mg cap. Probiotica contains Lactobacillus reuteri 100 million cells/
chewable tab. VSL#3 contains 450 billion cells/packet, 225 billion cells/2
caps (Bifi dobacterium breve, longum, infantis; Lactobacillus acidophilus, plantarum, casei, bulgaricus; Streptococcus thermophilus). Align contains Bifi dobacterium infantis 35624 1 billion cells/cap. VSL#3 is marketed as non-prescription medical food. Medical foods are intended to be given under physician supervision to meet distinctive nutritional needs of a disease, but they do not undergo an approval process to establish safety and effi cacy.] `?

♀+ + $

PYCNOGENOL ( French maritime pine tree bark) Promoted for many medical disorders; but effi cacy unclear for chronic venous insuffi ciency, HTN, sperm dysfunction, melasma, OA, diabetes, and ADHD. [Not by prescription.] `L

♀? ? $

PYGEUM AFRICANUM ( African plum tree, Prostatonin ) BPH (may have modest effi cacy): 50 to 100 mg PO bid or 100 mg PO daily of standardized extract containing 14% triterpenes. Prostatonin (also contains Urtica dioica): 1 cap PO bid with meals up to 6 weeks for full response. [Not by prescription.] `? ♀– – $

RED CLOVER ( red clover isofl avone extract, Trifolium pratense, trefoil, Promensil, Rimostil, Trinovin)

n

Postmenopausal vasomotor symptoms
p
y p

(confl icting evidence; does not appear effective overall, but may have modest benefi t for severe symptoms): Promensil 1 tab PO daily to bid with meals.

[Not by prescription. Isofl avone content (genistein, daidzein, biochanin, formononetin) is 40 mg/tab in Promensil and Trinovin, 57 mg/tab in Rimostil.] `Gut, L, K ♀– – $$

RED YEAST RICE ( Monascus purpureus, Xuezhikang, Zhibituo, Hypocol, Lipolysar) Effi cacy of currently available US products for hyperlipidemia is unclear. Some products were removed from the market because they contained up to 10 mg/day of lovastatin. Others, such as Cholestin, were reformulated with policosanol (ineffective for hyperlipidemia). Myopathy has been reported with red yeast rice supplements. [Not by prescription. Xuezhikang marketed in Asia, Norway (HypoCol), Italy (Lipolysar).] `L ♀– – $$

Herbal & Alternative Therapies 109

S-ADENOSYLMETHIONINE ( SAM-e, sammyy)

Depression
p

(possibly effective):

400 to 1600 mg/day PO. OA (possibly effective): 400 to 1200 mg/day PO. Onset of response in OA in 2 to 4 weeks. [Not by prescription.] `L ♀? ? $$$

SAINT JOHN’S WORT ( Hypericum perforatum, Kira, Movana, LI-160, St John’s wort ) Mild depression
p

(effective): 300 mg PO tid of standardized extract

(0.3% hypericin). Confl icting clinical trials for moderate major depression.

Does not appear effective for ADHD. May decrease effi cacy of other drugs (eg, ritonavir, or oral contraceptives) by inducing liver metabolism. May cause serotonin syndrome with SSRIs, MAOIs. [Not by prescription.] `L

♀– – $

SAW PALMETTO ( Serenoa repens, Quanterra)

BPH (possibly effective for
mild to moderate only): 160 mg PO bid or 320 mg PO daily of standardized liposterolic extract. Take with food. Brewed teas may not be effective. [Not by prescription.] `? ♀– – $

SHARK CARTILAGE ( BeneFin, Cartilade) Appears ineffective for palliative care of advanced cancer. [Not by prescription.] `? ♀– – $$$$$

SOY ( Genisoy, Healthy Woman, Novasoy, Phytosoya, Supro) Cardiovascular
risk reduction: at least 25 g/day soy protein (50 mg/day isofl avones) PO.

Hypercholesterolemia:

yp
about 50 g/day soy protein PO reduces LDL cholesterol by about 3%; no apparent benefi t for isofl avone supplements. Postmenopausal p
vasomotor symptoms
y p

(modest benefi t if any): 20 to 60 g/day soy protein PO

(40 to 80 mg/day isofl avones). Confl icting clinical trials for postmenopausal bone loss. [Not by prescription.] `Gut, L, K ♀+ for food, ? for supplements

+ for food, ? for supplements $

STEVIA ( Stevia rebaudiana) Leaves
traditionally used as sweetener. Effi cacy
unclear for treatment of type 2 diabetes or HTN. [Not by prescription.] `L

♀– ? $

TEA TREE OIL ( melaleuca oil, Melaleuca alternifolia) Not for oral use;

CNS toxicity reported. Effi cacy unclear for onychomycosis, tinea pedis, acne vulgaris, dandruff, pediculosis. [Not by prescription.] `? ♀– – $

VALERIAN ( Valeriana offi cinalis, Alluna, Sleep-Tite) Insomnia (possibly modestly effective; confl icting clinical trials): 400 to 900 mg of standardized extract PO 30 min qhs. Alluna: 2 tabs PO 1 h qhs. [Not by prescription.] `?

♀– – $

WILD YAM ( Dioscorea villosa) Ineffective as topical “natural progestin”.

Was used historically to synthesize progestins, cortisone, and androgens; it is not converted to them or dehydroepiandrosterone (DHEA) in the body. [Not by prescription.] `L ♀? ? $

WILLOW BARK EXTRACT ( Salix alba, Salicis cortex, Assalix, salicin) n OA, ,
low-back pain
p

(possibly effective): 60 to 240 mg/day salicin PO divided bid to tid. [Not by prescription. Some products standardized to 15% salicin content.] `K ♀– – $

YOHIMBE ( Corynanthe yohimbe, Pausinystalia yohimbe, Potent V) V Non-prescription yohimbe promoted for impotence and as aphrodisiac, but these products rarely contain much yohimbine. FDA considers yohimbe bark in herbal (cont.)

110 Immunology
remedies an unsafe herb. [Yohimbine is the primary alkaloid in the bark of the yohimbe tree. Yohimbine HCl is a prescription drug in the United States; yohimbe bark is available without prescription. Yohimbe bark (not by prescription) and prescription yohimbine HCl are not interchangeable.] `L ♀– – $

IMMUNOLOGY

Immunizations

NOTE For vaccine info see CDC website (www.cdc.gov). See table for prevention and treatment of 2009 H1N1 infl uenza in appendix.

AVIAN INFLUENZA VACCINE H5N1—INACTIVATED INJECTION

1 mL IM for 2
doses, separated by 21 to 35 days. Ìmmune system ♀C ? ?

BCG VACCINE ( Tice BCG,  Oncotice, Immucystt) 0.2 to 0.3 mL
percutaneously. Ìmmune system ♀C ? $$$$

COMVAX (hemophilus B vaccine + hepatitis B vaccine) Infants born of HBsAg (negative) mothers: 0.5 mL IM for 3 doses, given at 2, 4, and 12 to 15 months. Ìmmune system ♀C ? $$$

DIPHTHERIA TETANUS AND ACELLULAR PERTUSSIS VACCINE ( DTaP, Tdap, Tripedia, Infanrix, Daptacel, Boostrix, Adacel,  Tripacel ) 0.5 mL IM. Do not use Boostrix or Adacel for primary childhood vaccination series. Ìmmune system ♀C – $$

DIPHTHERIA-TETANUS TOXOID ( Td, DT,  D2T55) 0.5 mL IM. [Use DT injection for pediatric patients 6 weeks to 6 yo. Use Td for children 7 yo or older, and adults.] Ìmmune system ♀C ? $

HAEMOPHILUS B VACCINE ( ActHIB, HibTITER, PedvaxHIB) B

0.5 mL IM.

Dosing schedule varies depending on formulation used and age of child at fi rst dose. Ìmmune system ♀C ? $$

HEPATITIS A VACCINE ( Havrix, Vaqta,  Avaxim, Epaxall) Adult formulation

1 mL IM, repeat in 6 to 12 months. Peds: 0.5 mL IM for age 1 yo or older, repeat 6 to 18 months later. [Single-dose vial (specify pediatric or adult).] Ìmmune system ♀C + $$$

HEPATITIS B VACCINE ( Engerix-B, Recombivax HB) B

Adults: 1 mL IM,
repeat in 1 and 6 months later. Separate pediatric formulations and dosing. Ìmmune system ♀C + $$$

HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE ( Gardasil) l

0.5 mL IM,
then repeat at 2 and 6 months later. Ìmmune system ♀B ? $$$$$

INFLUENZA VACCINE—INACTIVATED INJECTION ( Afl uria, Fluarix, FluLaval, Fluzone, Fluvirin,  Fluviral, Vaxigrip) p

0.5 mL IM. Fluarix and FluLaval not
indicated for age younger than 18 yo, Fluvirin not indicated if age younger than 4 yo. Ìmmune system ♀C + $

INFLUENZA VACCINE—LIVE INTRANASAL ( FluMist) 1 dose (0.2 mL) intranasally. Use only if 2 to 49 yo. Ìmmune system ♀C + $

JAPANESE ENCEPHALITIS VACCINE ( JE-Vax)

x

1 mL SC for 3 doses on day 0, 7,
and 30. Ìmmune system ♀C ? $$$$

MEASLES MUMPS & RUBELLA VACCINE ( M-M-R II,  Priorix) x

0.5 mL (1 vial)

SC. Ìmmune system ♀C + $$$

Immunology

111

MENINGOCOCCAL VACCINE ( Menomune-A/C/Y/W-135, Menactra,

 Menjugate) 0.5 mL SC (Menomune) or IM (Menactra). Ìmmune system

♀C ? $$$$

PEDIARIX (diphtheria tetanus and acellular pertussis vaccine + hepatitis B vaccine + polio vaccine) 0.5 mL IM at 2, 4, 6 mo. Ìmmune system

♀C ? $$$

PLAGUE VACCINE 1 mL IM fi rst dose, then 0.2 mL IM 1 to 3 months after the fi rst injection, then 0.2 mL IM 5 to 6 months later for age 18 to 61
yo. Ìmmune system ♀C + $

PNEUMOCOCCAL 23-VALENT VACCINE ( Pneumovax,  Pneumo 23) 0.5

3
mL

IM/SC. Ìmmune system ♀C + $$

PNEUMOCOCCAL 7-VALENT CONJUGATE VACCINE ( Prevnar) r

0.5 mL IM for 3
doses 6 to 8 weeks apart starting at age 2 to 6 mo, followed by a 4th dose at 12 to 15 mo. Ìmmune system ♀C ? $$$

POLIO VACCINE ( IPOL) 0.5 mL IM or SC. Ìmmune system ♀C ? $$

PROQUAD (measles mumps & rubella vaccine + varicella vaccine) (MMRV) 0.5 mL (1 vial) SC for age 12 mo to 12 yo. Ìmmune system ♀C

? $$$$

RABIES VACCINE ( RabAvert, Imovax Rabies, BioRab, Rabies Vaccine Adsorbed) 1 mL IM in deltoid region on day 0, 3, 7, 14, 28. Ìmmune system ♀C ? $$$$$

ROTAVIRUS VACCINE ( RotaTeq, Rotarix)

x

RotaTeq: Give the fi rst dose (2 mL

PO) between 6 to 12 weeks of age, and then 2nd and 3rd doses at 4 to 10
weeks intervals thereafter (last dose no later than 32 weeks). Rotarix: Give fi rst dose (1 mL) at 6 weeks of age, and 2nd dose (1 mL) at least 4 weeks later, and last dose prior to 24 weeks of age. [Trade only: Oral susp 2 mL (RotaTeq), 1 mL (Rotarix).] Ìmmune system ♀? $$$$$

TETANUS TOXOID 0.5 mL IM/SC. Ìmmune system ♀C + $$

TRIHIBIT (hemophilus B vaccine + diphtheria tetanus and acellular pertussis vaccine) Use for 4th dose only, age 15 to 18 mo: 0.5 mL IM.

Ìmmune system ♀C – $$$

TWINRIX (hepatitis A vaccine + hepatitis B vaccine) Adults: 1 mL IM in
deltoid, repeat 1 and 6 months later. Accelerated dosing schedule: 0, 7, 21 to 30 days and booster dose at 12 months. Ìmmune system ♀C ? $$$$

TYPHOID VACCINE—INACTIVATED INJECTION ( Typhim Vi,  Typherix) 0.5
x
mL IM single dose. May revaccinate q 2 to 5 years if high risk. Ìmmune system ♀C ? $$

TYPHOID VACCINE—LIVE ORAL ( Vivotif Berna) 1 cap every other day for 4
doses. May revaccinate q 2 to 5 years if high risk. [Trade only: Caps.] Ìmmune system ♀C ? $$

VARICELLA VACCINE ( Varivax,  Varilrix) x

Children 1 to 12 yo: 0.5 mL SC.

Repeat dose at ages 4 to 6 yo. Age 13 yo or older: 0.5 mL SC, repeat 4 to 8
weeks later. Ìmmune system ♀C + $$$$

YELLOW FEVER VACCINE ( YF-Vax)

x

0.5 mL SC. Ìmmune system ♀C +

$$$

ZOSTER VACCINE—LIVE ( Zostavax) 0.65 mL SC single dose for age 60 yo or older. Ìmmune system ♀C ? $$$$

112 Immunology

Immunoglobulins

ANTIVENIN—CROTALIDAE IMMUNE FAB OVINE POLYVALENT ( CroFabb) Rattlesnake envenomation: Give 4 to 6 vials IV infusion over 60 min, within 6 h of bite if possible. Administer 4 to 6 additional vials if no initial control of envenomation syndrome, then 2 vials q 6 h for up to 18 h (3 doses) after initial control has been established. `? ♀C ? $$$$$

BOTULISM IMMUNE GLOBULIN ( BabyBIG

G)

Infant botulism: give 1 mL/kg (50
mg/kg) IV for age younger than 1 yo. `L ♀? ? $$$$$

HEPATITIS B IMMUNE GLOBULIN ( H-BIG, HyperHep B, HepaGam B, NABI-HB)

B

0.06 mL/kg IM within 24 h of needlestick, ocular

,

, or mucosal

,
exposure,
p

, repeat in 1 month. `L ♀C ? $$$

IMMUNE GLOBULIN—IM ( Baygam,  Gamastann) Hepatitis A prophylaxis: p
p p y

0.02 to 0.06 mL/kg IM depending on length of travel to endemic area. Measles (within 6 days post-exposure): 0.2 to 0.25 mL/kg IM. `L ♀C ? $$$$

IMMUNE GLOBULIN—IV ( Carimune, Polygam, Panglobulin, Octagam, Flebogamma, Gammagard, Gamunex, Iveegam, Privigen, Venoglobulin) n IV
dosage varies by indication and product. `L ♀C ? $$$$$

IMMUNE GLOBULIN—SC ( Vivaglobulin) 100 to 200 mg/kg SC weekly. `L

♀C ? $$$$$

LYMPHOCYTE IMMUNE GLOBULIN ( Atgam) Specialized dosing. `L ♀C ? $$$$$

CHIL DHOOD IMMUNIZATION SCHEDULE*

Months

Years

Age

Birth

1

2

4

6

12

15

18

2

4–6

11–12

Hepatitis B

HB

HB

HB

Rotavirus

Rota

Rota

Rota@

DTP

DTaP

DTaP

DTaP

DTaP

DTaP DTaP***

H infl uenza b

Hib

Hib

Hib

Hib

Pneumococci**

PCV

PCV

PCV

PCV

Polio

IPV

IPV

IPV

IPV

Infl uenza†

Infl uenza (yearly)†

MMR

MMR

MMR

Varicella

Varicella

Vari

Hepatitis A¶

Hep A × 2¶

Papillomavirus§

HPV × 3§

Meningococcal^

MCV^

*2009 schedule from the CDC, ACIP, AAP, & AAFP, see CDC website (www.cdc.gov/vaccines/recs/schedules/
default.htm).

**Administer 1 dose to all healthy children 24-59 months having an incomplete schedule.

***When immunizing adolescents 10 yo or older consider DTaP if patient has never received a pertussis booster ( Boostrix if 10-18 yo, Adacel if 11-64 yo).

l

@If using Rotarixx at 2 and 4 months, dose at 6 months is not indicated.

†For healthy patients age 2 yo or greater can use intranasal form. If age less than 9 yo and receiving for fi rst time, administer 2 doses 4 or more weeks apart for injected form and 6 or more weeks apart for intranasal form.

¶ Two doses at least 6 months apart.

§Second and third doses 2 and 6 months after fi rst dose.

^For children 2-10 yo at high risk for meningococcal disease, vaccinate with meningococcal polysaccharide vaccine ( Menactra).

Immunology

113

TETANUS WOUND CARE (www.cdc.gov)

Unknown or less than 3 prior

3 or more prior tetanus
tetanus immunizations
immunizations

Non-tetanus prone wound

Td (DT age younger

Td if more than

(e.g., clean and minor)

than 7 yo)

10 years since last dose

Tetanus prone wound (e.g., Td (DT age younger than 7 yo), Td if more than
dirt, contamination, punc-
tetanus immune globulin 250

5 years since last dose
tures, crush components)

units IM at site other than Td.

If patient age 10 yo or older has never received a pertussis booster consider DTaP ( Boostrix if 10-18 yo, Adacel if 11-64 yo).

RABIES IMMUNE GLOBULIN HUMAN ( Imogam Rabies-HT, HyperRAB S/D) D 20
units/kg, as much as possible infi ltrated around bite, the rest IM. `L ♀C

? $$$$$

RSV IMMUNE GLOBULIN ( RespiGam)

m IV infusion for RSV. `Plasma ♀C ? $$$$$

TETANUS IMMUNE GLOBULIN ( BayTet,  Hypertet ) Prophylaxis: 250 units IM. `L ♀C ? $$$$

VARICELLA-ZOSTER

IMMUNE GLOBULIN ( VariZIG, VZIG

G) Specialized
dosing. `L ♀C ? $$$$$

Immunosuppression

BASILIXIMAB ( Simulect ) Specialized dosing for organ transplantation.

g
p

`Plasma ♀B ? $$$$$

CYCLOSPORINE ( Sandimmune, Neoral, Gengraf ) Specialized dosing for organ transplantation, RA, and psoriasis.

g
p

,

,
p

[Generic/Trade: Microemulsion

Caps 25, 100 mg. Generic/Trade: Caps (Sandimmune) 25, 100 mg. Soln (Sandimmune) 100 mg/mL, Microemulsion soln (Neoral, Gengraf) 100 mg/
mL.] `L ♀C – $$$$$

DACLIZUMAB ( Zenapax) Specialized dosing for organ transplantation.

g
p

`L

♀C ? $$$$$

MYCOPHENOLATE MOFETIL ( Cellcept, Myfortic) Specialized dosing for organ transplantation.

g
p

[Generic/Trade: Caps 250 mg. Tabs 500 mg. Trade
only (CellCept): Oral susp 200 mg/mL. Trade only (Myfortic): Tabs, Extended-release: 180, 360 mg.] `? ♀D ? $$$$$

SIROLIMUS ( Rapamune) Specialized dosing for organ transplantation.

g
p

[Trade only: Oral soln 1 mg/mL (60 mL). Tabs 1, 2 mg.] `L ♀C – $$$$$

TACROLIMUS ( Prograf, FK 506)

6

Specialized dosing for organ transplantation
g
p

.

[Trade only: Caps 0.5, 1, 5 mg.] `L ♀C – $$$$$

Other

HYMENOPTERA VENOM Specialized desensitization dosing protocol. `Serum

♀C ? $$$$

TUBERCULIN PPD ( Aplisol, Tubersol, Mantoux, PPD) 5 TU (0.1 mL) intradermally, read 48 to 72 h later. `L ♀C + $

114 Neurology

NEUROLOGY

Alzheimer’s Disease—Cholinesterase Inhibitors

DONEPEZIL ( Aricept ) Start 5 mg PO qhs. May increase to 10 mg PO qhs in 4 to 6 weeks. For severe disease (MMSE 10 or less), the recommended dose is 10 mg/day. [Generic/Trade: Tabs 5, 10 mg. Trade only: Orally disintegrating tabs 5, 10 mg.] `LK ♀C ? $$$$

GALANTAMINE ( Razadyne, Razadyne ER,  Reminyl ) Extended-release: Start 8 mg PO qam with food; increase to 16 mg qam after 4 weeks. May increase to 24 mg qam after another 4 weeks. Immediate-release: Start 4
mg PO bid with food; increase to 8 mg bid after 4 weeks. May increase to 12
mg bid after another 4 weeks. [Generic/Trade: Tabs (Razadyne) 4, 8, 12 mg.

Extended-release caps (Razadyne ER) 8, 16, 24 mg. Oral soln 4 mg/mL. Prior to April 2005 was called Reminyl.] `LK ♀B ? $$$$

RIVASTIGMINE ( Exelon, Exelon Patch)

h

Alzheimer’s disease: Start 1.5 mg PO
bid with food. Increase to 3 mg bid after 2 weeks. Max 12 mg/day. Patch: Start 4.6 mg/24 h once daily; may increase after 1 month or more to max 9.5 mg/24
h. Dementia associated with Parkinson’s disease: Start 1.5 mg PO bid with food. Increase by 3 mg/day at intervals greater than 4 weeks to max 12 mg/
day. Patch: Start 4.6 mg/24 h once daily; may increase after 1 month or more to max 9.5 mg/24 h. [Generic/Trade: Caps 1.5, 3, 4.5, 6 mg. Trade only: Oral soln 2 mg/mL (120 mL). Transdermal patch: 4.6 mg/24 h (9 mg/patch), 9.5
mg/24 h (18 mg/patch).] `K ♀B ? $$$$$

Alzheimer’s Disease—NMDA Receptor Antagonists

MEMANTINE ( Namenda,  Ebixa) Start 5 mg PO daily. Increase by 5 mg/day at weekly intervals to max 20 mg/day. Doses greater than 5 mg/day should be divided bid. [Trade only: Tabs 5, 10 mg. Oral soln 2 mg/mL.] `KL ♀B

? $$$$

Anticonvulsants

CARBAMAZEPINE ( Tegretol, Tegretol XR, Carbatrol, Epitol, Equetro) Epilepsy: p p y

200 to 400 mg PO bid to qid. Extended-release: 200 mg PO bid. Age younger than 6 yo: 10 to 20 mg/kg/day PO divided bid to qid. Age 6 to 12 yo: 100 mg PO
bid or 50 mg PO qid; increase by 100 mg/day at weekly intervals divided tid to qid (regular-release), bid (extended-release), or qid (susp). Bipolar disorder p

,

,
acute manic/mixed episodes
p

(Equetro): Start 200 mg PO bid; increase by 200
mg/day to max 1600 mg/day. Aplastic anemia, agranulocytosis, many drug interactions. [Generic/Trade: Tabs 200 mg, Chewable tabs 100 mg, Susp 100
mg/5 mL. Extended-release tabs (Tegretol XR) 100, 200, 400 mg. Generic only: Tabs 100, 300, 400 mg, Chewable tabs 200 mg. Trade only: Extended-release caps (Carbatrol and Equetro): 100, 200, 300 mg.] `LK ♀D + $$

CLOBAZAM ( Frisium)

m

Canada only. Adults: Start 5 to 15 mg PO daily.

Increase prn to max 80 mg/day. Children younger than 2 yo: 0.5 to 1 mg/kg PO

(cont.)

Neurology

115
daily. Children age 2 to 16 yo: Start 5 mg PO daily. May increase prn to max 40 mg/day. [Generic/Trade: Tabs 10 mg.] `L ♀X (fi rst trimester) D (2nd/3rd trimesters) – $

ETHOSUXIMIDE ( Zarontin)

Absence seizures,, age 3 to 6 yo: Start 250 mg

PO daily (or divided bid). Age older than 6 yo: Start 500 mg PO daily or bid.

Max 1.5 g/day. [Generic/Trade: Caps 250 mg. Syrup 250 mg/5 mL.] `LK ♀C

+ $$$$

FELBAMATE ( Felbatol ) Start 400 mg PO tid. Max 3600 mg/day. Peds: Start 15 mg/kg/day PO divided tid to qid. Max 45 mg/kg/day. Aplastic anemia, hepatotoxicity. Not fi rst line. Requires written informed consent. [Trade only: Tabs 400, 600 mg. Susp 600 mg/5 mL.] `KL ♀C – $$$$$

FOSPHENYTOIN ( Cerebyx)

x

Load: 15 to 20 mg “phenytoin equivalents”

(PE) per kg IM/IV no faster than 150 PE mg/min. Maintenance: 4 to 6 PE/kg/
day. `L ♀D + $$$$$

GABAPENTIN ( Neurontin)

n

Partial seizures, adjunctive therapy:

,
j
py Start 300
mg PO qhs. Increase gradually to 300 to 600 mg PO tid. Max 3600 mg/day.

Postherpetic neuralgia:

p
g Start 300 mg PO on day 1; increase to 300 mg bid on day 2, and to 300 mg tid on day 3. Max 1800 mg/day. Partial seizures, initial

,
monotherapy:

py Titrate as above. Usual effective dose is 900 to 1800 mg/day.

[Generic only: Tabs 100, 300, 400 mg. Generic/Trade: Caps 100, 300, 400 mg.

Tabs (scored) 600, 800 mg. Soln 50 mg/mL.] `K ♀C ? $$$$

LACOSAMIDE ( Vimpat ) Partial onset seizures, adjunctive:

,
j

Start 50 mg PO/IV
bid. Increase by 50 mg bid to recommended dose of 100 to 200 mg bid. Max 600 mg/day or 300 mg/day in mild/mod hepatic or severe renal impairment.

[Trade only: Tabs 50, 100, 150, 200 mg.] `KL ♀C ? ?

LAMOTRIGINE ( Lamictal, Lamictal CD, Lamictal ODT

) Partial seizures,

,

Lennox-Gastaut syndrome, or generalized tonic-clonic seizures adjunctive y

,
g
j
therapy with a single enzyme-inducing anticonvulsant.

py
g
y
g

Age 2 to 12 yo: dosing
is based on wt and concomitant meds (see package insert). Age older than 12
yo: 50 mg PO daily for 2 weeks, then 50 mg bid for 2 weeks, then gradually increase to 150 to 250 mg PO bid. Also approved for conversion to monotherapy (age 16 yo or older): See package insert. Drug interaction with valproate (see package insert for adjusted dosing guidelines). Potentially life-threatening rashes reported in 0.3% of adults and 0.8% of children; discontinue at fi rst sign of rash. [Generic/Trade: Chewable dispersible tabs (Lamictal CD) 2, 5, 25 mg. Tabs, 25, 100, 150, 200 mg. Trade only: Orally disintegrating tabs (Lamictal ODT) 25, 50, 100, 200 mg. Chewable dispersible tabs (Lamictal CD) 2 mg may not be available in all pharmacies; obtain through manufacturer representative, or by calling 1–888-825-5249.] `LK ♀C (see notes) – $$$$

LEVETIRACETAM ( Keppra, Keppra XR) Partial seizures, juvenile myoclonic

, j
y
epilepsy (JME), or primary generalized tonic-clonic seizures (GTC), adjunctive: p p y (

),
p
y g

(

),
j

Start 500 mg PO/IV bid or 1000 mg/day (Keppra XR, partial seizures only); increase by 1000 mg/day q 2 weeks prn to max 3000 mg/day (partial seizures) or to target dose of 3000 mg/day (JME or GTC). IV route not approved for GTC
or if age less than 16 yo. [Generic/Trade: Tabs 250, 500, 750, 1000 mg, Oral soln 100 mg/mL. Trade only: Tabs, extended-release 500, 750 mg.] `K ♀C

? $$$$$

116 Neurology

OXCARBAZEPINE ( Trileptal ) Start 300 mg PO bid. Titrate to 1200 mg/day (adjunctive) or 1200 to 2400 mg/day (monotherapy). Peds 2 to 16 yo: Start 8 to 10 mg/kg/day divided bid. Life-threatening rashes & hypersensitivity reactions. [Generic/Trade: Tabs (scored) 150, 300, 600 mg. Trade only: Oral susp 300 mg/5 mL.] `LK ♀C – $$$$$

PHENOBARBITAL ( Luminal ) Load:

20 mg/kg IV at rate no faster than 60 mg/
min. Maintenance: 100 to 300 mg/day PO given once daily or divided bid. Peds 3 to 5 mg/kg/day PO divided bid to tid. Many drug interactions. [Generic only: Tabs 15, 16.2, 30, 32.4, 60, 100 mg. Elixir 20 mg/5 mL.] `L ♀D – ©IV $

PHENYTOIN ( Dilantin, Phenytek)

k

Status epilepticus:

p p

Load 10 to 15 mg/kg IV
no faster than 50 mg/min, then 100 mg IV/PO q 6 to 8 h. Epilepsy: p p y Oral load:

400 mg PO initially, then 300 mg in 2 h and 4 h. Maintenance: 5 mg/kg (or 300
mg PO) given once daily (extended-release) or divided tid (standard-release) and titrated to a therapeutic level. [Generic/Trade: Extended-release caps 30, 100 mg (Dilantin). Susp 125 mg/5 mL. Trade only: Extended-release caps 200, 300 mg (Phenytek). Chewable tabs 50 mg (Dilantin Infatabs). Generic only: Extended-release caps 200, 300 mg.] `L ♀D + $$

PREGABALIN ( Lyrica)

Painful diabetic peripheral neuropathy:

p p
p
y Start 50
mg PO tid; may increase within 1 week to max 100 mg PO tid. Postherpetic p
neuralgia:

g

Start 150 mg/day PO divided bid to tid. May increase within 1
week to 300 mg/day divided bid to tid; max 600 mg/day. Partial seizures (adjunctive): Start 150 mg/day PO divided bid to tid; increase prn to max 600
mg/day divided bid to tid. Fibromyalgia:

y g

Start 75 mg PO bid; may increase to

150 mg bid within 1 week; max 225 mg bid. [Trade only: Caps 25, 50, 75, 100, 150, 200, 225, 300 mg.] `K ♀C ? ©V $$$$$

PRIMIDONE ( Mysoline) Start 100 to 125 mg PO qhs. Increase over 10 days to 250 mg tid to qid. Max 2 g/day. Metabolized to phenobarbital. [Generic/

Trade: Tabs 50, 250 mg.] `LK ♀D – $$$$

RUFINAMIDE ( Banzel ) Start 400 to 800 mg/day PO divided bid. Increase by 400 to 800 mg/day q 2 day to max 3200 mg/day. [Trade only: Tabs 200, 400
mg.] `K ♀C ? $$$$$

TIAGABINE ( Gabitril ) Start 4 mg PO daily. Increase by 4 to 8 mg/day at weekly intervals prn to max 32 mg/day for age 12 to 18 yo or max 56 mg/day for age older than 18 yo divided bid to qid. Avoid off-label use. [Trade only: Tabs 2, 4, 12, 16 mg.] `L ♀C ? $$$$$

TOPIRAMATE ( Topamax)

x

Partial seizures or primary generalized tonic-clonic p
y g
seizures, monotherapy

,
py for age older than 10 yo: Start 25 mg PO bid (week 1), 50
mg bid (week 2), 75 mg bid (week 3), 100 mg bid (week 4), 150 mg bid (week 5), then 200 mg bid as tolerated. Partial seizures, primary generalized tonic-

, p
y g
clonic seizures, or Lennox-Gastaut syndrome, adjunctive therapy:

,
y

,
j
py Start 25 to

50 mg PO qhs. Increase weekly by 25 to 50 mg/day to usual effective dose of 200 mg PO bid. Doses greater than 400 mg/day not shown to be more effective.

Migraine prophylaxis:

g
p p y

Titrate to 50 mg PO bid over 4 weeks. [Generic/Trade: Tabs 25, 50, 100, 200 mg. Sprinkle Caps 15, 25 mg.] `K ♀C ? $$$$$

VALPROIC ACID ( Depakene, Depakote, Depakote ER, Depacon, Stavzor, di valproex, sodium valproate,  Epival, Deproic) c

Epilepsy:

p p y 10 to 15 mg/kg/day

(cont.)

Neurology

117

PO/IV divided bid to qid (standard-release, delayed-release, or IV) or given once daily (Depakote ER). Titrate to max 60 mg/kg/day. Use rate no faster than 20 mg/min when given IV. Migraine prophylaxis: g
p p y

Start 250 mg PO bid

(Depakote or Stavzor) or 500 mg PO daily (Depakote ER) for 1 week, then increase to max 1000 mg/day PO divided bid (Depakote or Stavzor) or given once daily (Depakote ER). Hepatotoxicity, drug interactions, reduce dose in elderly. [Generic/Trade: Immediate-release caps 250 mg (Depakene), syrup (Depakene, valproic acid) 250 mg/5 mL. Delayed-release tabs (Depakote) 125, 250, 500 mg, Extended-release tabs (Depakote ER) 250, 500 mg, Delayed-release sprinkle caps (Depakote) 125 mg. Trade only (Stavzor): Delayed-release caps 125, 250, 500 mg.] `L ♀D + $$$$

ZONISAMIDE ( Zonegran) Start 100 mg PO daily. Titrate every 2 weeks to 200 to 400 mg/day given once daily or divided bid. Max 600 mg/day. Drug interactions. Contraindicated in sulfa allergy. [Generic/Trade: Caps 25, 50, 100 mg.] `LK ♀C ? $$$$

Migraine Therapy—Triptans (5-HT1 Receptor Agonists) NOTE May cause vasospasm. Avoid in ischemic or vasospastic heart disease, cerebrovascular syndromes, peripheral arterial disease, uncontrolled HTN, and hemiplegic or basilar migraine. Do not use within 24 h of ergots or other triptans. Risk of serotonin syndrome if used with SSRIs or MAOIs.

ALMOTRIPTAN ( Axert ) 6.25 to 12.5 mg PO. May repeat in 2 h prn. Max 25 mg/day. Avoid MAOIs. [Trade only: Tabs 6.25, 12.5 mg.] `LK ♀C ? $$

ELETRIPTAN ( Relpax) 20 to 40 mg PO. May repeat in 2 h prn. Max 40 mg/dose or 80 mg/day. Drug interactions. Avoid MAOIs. [Trade only: Tabs 20, 40 mg.]

`LK ♀C ? $$

FROVATRIPTAN ( Frova) 2.5 mg PO. May repeat in 2 h prn. Max 7.5 mg/24 h.

[Trade only: Tabs 2.5 mg.] `LK ♀C ? $

NARATRIPTAN ( Amerge) 1 to 2.5 mg PO. May repeat in 4 h prn. Max 5 mg/

24 h. [Trade only: Tabs 1, 2.5 mg.] `KL ♀C ? $$$

RIZATRIPTAN ( Maxalt, Maxalt MLT ) 5 to 10 mg PO. May repeat in 2 h prn. Max 30 mg/24 h. MLT form dissolves on tongue without liquids. Avoid MAOIs. [Trade only: Tabs 5, 10 mg. Orally disintegrating tabs (MLT) 5, 10 mg.] `LK ♀C ? $$

SUMATRIPTAN ( Imitrex)

x

4 to 6 mg SC. May repeat in 1 h prn. Max 12 mg/

24 h. Tabs: 25 to 100 mg PO (50 mg most common). May repeat q 2 h prn with 25 to 100 mg doses. Max 200 mg/24 h. Intranasal spray: 5 to 20 mg q 2 h.

Max 40 mg/24 h. Avoid MAOIs. [Generic/Trade: Tabs 25, 50, 100 mg. Injection (single-dose vial) 6 mg/0.5 mL. Trade only: Nasal spray 5, 20 mg/spray.

Injection (STATdose System) 4, 6 mg prefi lled cartridges.] `LK ♀C + $$$

TREXIMET (sumatriptan + naproxen) 1 tab PO at onset; may repeat in 2 h.

Max 2 tabs/24 h. [Trade only: Tabs 85 mg sumatriptan + 500 mg naproxen sodium.] `LK ♀C – $$

ZOLMITRIPTAN ( Zomig, Zomig ZMT ) 1.25 to 2.5 mg PO q 2 h. Max 10 mg/

24 h. Orally disintegrating tabs (ZMT) 2.5 mg PO. May repeat in 2 h prn. Max 10 mg/24 h. Nasal spray: 5 mg (1 spray) in 1 nostril. May repeat in 2 h. Max (cont.)

118 Neurology

10 mg/24 h. [Trade only: Tabs 2.5, 5 mg. Orally disintegrating tabs (ZMT) 2.5, 5 mg. Nasal spray 5 mg/spray.] `L ♀C ? $$

Migraine Therapy—Other

CAFERGOT (ergotamine + caffeine) 2 tabs (1/100 mg each) PO at onset, then 1 tab q 30 min prn. Max 6 tabs/attack or 10/week. Drug interactions. Fibrotic complications. [Trade only: Tabs 1/100 mg ergotamine/caffeine.] `L ♀X – $

DIHYDROERGOTAMINE ( D.H.E. 45, Migranal ) Soln (DHE 45) 1 mg IV/IM/SC.

May repeat in 1 h prn. Max 2 mg (IV) or 3 mg (IM/SC) per d. Nasal spray (Migranal): 1 spray in each nostril. May repeat in 15 min prn. Max 6 sprays/24
h or 8 sprays/week. Drug interactions. Fibrotic complications. [Trade only: Nasal spray 0.5 mg/spray (Migranal). Self-injecting soln (D.H.E 45): 1 mg/
mL.] `L ♀X – $$

FLUNARIZINE ( Sibelium)

m

Canada only. 10 mg PO qhs. [Generic/Trade:

Caps 5 mg.] `L ♀C – $$

MIDRIN (isometheptene + dichloralphenazone + acetaminophen) ( Amidrine, Duradrin, Migquin, Migratine, Migrazone, Va-Zone) e

Tension and vascular
headache treatment: 1 to 2 caps PO q 4 h. Max 8 caps/day. Migraine treatment: g

2 caps PO single dose, then 1 cap q 1 h prn to max 5 caps within 12 h. [Trade only: Caps (isometheptene/dichloralphenazone/acetaminophen) 65/100/325
mg.] `L ♀? ? ©IV $

Multiple sclerosis

GLATIRAMER ( Copaxone)

Multiple sclerosis:

p

20 mg SC daily. [Trade only:

Injection 20 mg single-dose vial.] `Serum ♀B ? $$$$$

INTERFERON BETA-1A ( Avonex, Rebif ) Multiple sclerosis: p

Avonex 30 mcg

(6 million units) IM q week. Rebif start 8.8 mcg SC 3 times a week; titrate (cont.)

Dermatomes

MOTOR FUNCTION BY NERVE ROOTS

Level

Motor Function

C3/C4/C5

Diaphragm

C5/C6

Deltoid/biceps

C7/C8

Triceps

C8/T1

Finger fl exion/intrinsics

T1–T12

Intercostal/abd
muscles

L2/L3

Hip fl exion

L2/L3/L4

Hip adduction/quads

L4/L5

Ankle dorsifl exion

S1/S2

Ankle plantarfl exion

S2/S3/S4

Rectal tone

Neurology

119

Root

Motor

Sensoryy

Refl ex

LUMBOSACRAL

L4
quadriceps
medial foot
knee-jerk

NERVE ROOT COM-

PRESSION

L5
dorsifl exors
dorsum of foot
medial hamstring

S1
plantarfl exors
lateral foot
ankle-jerk

GLASGOW COMA SCALE

Motor Activityy

Verbal Activityy

6. Obeys commands

Eye Opening
y
p
g

5. Oriented

5. Localizes pain

4. Spontaneous

4. Confused

4. Withdraws to pain

3. To command

3. Inappropriate

3. Flexion to pain

2. To pain

2. Incomprehensible

2. Extension to pain

1. None

1. None

1. None
over 4 weeks to maintenance dose of 44 mcg 3 times a week. Suicidality, hepatotoxicity, blood dyscrasias. Follow LFTs and CBC. [Trade only (Avonex): Injection 30 mcg single-dose vial with or without albumin. Prefi lled syringe 30
mcg. Trade only (Rebif): Starter kit 20 mcg prefi lled syringe. Prefi lled syringe 22, 44 mcg.] `L ♀C ? $$$$$

INTERFERON BETA-1B ( Betaseron)

Multiple sclerosis:

p

Start 0.0625 mg SC
every other day; titrate over 6 weeks to 0.25 mg (8 million units) SC every other day. Suicidality, hepatotoxicity. Follow LFTs. [Trade only: Injection 0.3 mg (9.6
million units) single-dose vial.] `L ♀C ? $$$$$

Myasthenia Gravis

EDROPHONIUM ( Tensilon, Enlonn)

Evaluation for myasthenia gravis:

y
g

2 mg IV
over 15 to 30 sec (test dose) while on cardiac monitor, then 8 mg IV after 45 sec. Atropine should be readily available in case of cholinergic reaction.

Duration of effect is 5 to 10 min. [AWP= $2.00 for 10 mg Enlon (use 15 mL

MDV vial), RB (1/09).] `Plasma ♀C ? $

NEOSTIGMINE ( Prostigmin)

n

15 to 375 mg/day PO in divided doses, or 0.5
mg IM/SC. [Trade only: Tabs 15 mg.] `L ♀C ? $$$

PYRIDOSTIGMINE ( Mestinon, Mestinon Timespan, Regonal

)

Myasthenia
y
gravis:

g

60 to 200 mg PO tid (standard-release) or 180 mg PO daily or divided bid (extended-release). [Generic/Trade: Tabs 60 mg. Trade only: Extended-release tabs 180 mg. Syrup 60 mg/5 mL.] `Plasma, K ♀C + $$

Parkinsonian Agents—Anticholinergics

BENZTROPINE MESYLATE ( Cogentin)

n

Parkinsonism: 0.5 to 2 mg IM/PO/IV
given once daily or divided bid. Drug-induced extrapyramidal disorders: g
py

1 to

4 mg PO/IM/IV given once daily or divided bid. [Generic only: Tabs 0.5, 1, 2
mg.] `LK ♀C ? $

BIPERIDEN ( Akineton)

n

2 mg PO tid to qid, max 16 mg/day. [Trade only: Tabs 2 mg.] `LK ♀C ? $$$

TRIHEXYPHENIDYL ( Artane) Start 1 mg PO daily. Gradually increase to 6 to 10 mg/day divided tid. Max 15 mg/day. [Generic only: Tabs 2, 5 mg. Elixir 2 mg/

5 mL.] `LK ♀C ? $

120 Neurology

Parkinsonian Agents—COMT Inhibitors

ENTACAPONE ( Comtan)

n

Start 200 mg PO with each dose of carbidopa/
levodopa. Max 8 tabs (1600 mg)/d. [Trade only: Tabs 200 mg.] `L ♀C ?

$$$$$

Parkinsonian Agents—Dopaminergic Agents & Combinations APOMORPHINE ( Apokyn) Start 0.2 mL SC prn. May increase in 0.1 mL
increments every few day. Monitor for orthostatic hypotension after initial dose and with dose escalation. Max 0.6 mL/dose or 2 mL/d. Potent emetic, pretreat with trimethobenzamide 300 mg PO tid starting 3 days prior to use, and continue for age 2 mo or older. Contains sulfi tes. [Trade only: Cartridges (for injector pen, 10 mg/mL) 3 mL. Ampules (10 mg/mL) 2 mL.] `L ♀C ?

$$$$$

CARBIDOPA-LEVODOPA ( Sinemet, Sinemet CR, Parcopa) Start 1 tab (25/100 mg) PO tid. Increase q 1 to 4 days prn. Sustained-release: Start 1 tab (50/200 mg) PO bid; increase q 3 days prn. [Generic/Trade: Tabs (carbidopa/
levodopa) 10/100, 25/100, 25/250 mg. Tabs, sustained-release (Sinemet CR, carbidopa-levodopa ER) 25/100, 50/200 mg. Trade only: Orally disintegrating tab (Parcopa) 10/100, 25/100, 25/250.] `L ♀C – $$$$

PRAMIPEXOLE ( Mirapex)

x

Parkinson’s disease: Start 0.125 mg PO tid.

Gradually increase to 0.5 to 1.5 mg PO tid. Restless legs syndrome: g
y

Start 0.125
mg PO 2 to 3 h prior to hs. May increase q 4 to 7 days to max 0.5 mg/dose.

[Generic/Trade: Tabs 0.125, 0.25, 0.5, 1, 1.5 mg. Trade only: Tabs 0.75 mg.]

`K ♀C ? $$$$$

ROPINIROLE ( Requip, Requip XL)

Parkinson’s disease: Start 0.25 mg PO tid,
then gradually increase to 1 mg PO tid. Extended-release: Start 2 mg PO daily, then gradually titrate dose at weekly intervals. Max 24 mg/day. Restless legs g
syndrome:

y

Start 0.25 mg PO 1 to 3 h before sleep for 2 d, then increase to 0.5
mg/day on day 3 to 7. Increase by 0.5 mg/day at weekly intervals prn to max 4
mg/day given 1 to 3 h before sleep. [Generic/Trade: Tabs, immediate-release 0.25, 0.5, 1, 2, 3, 4, 5 mg. Trade only: Tabs extended-release 2, 3, 4, 6, 8
mg.] `L ♀C ? $$$$$

STALEVO (carbidopa + levodopa + entacapone) Parkinson’s disease (converting from prior treatment using carbidopa-levodopa with or without entacapone): Start Stalevo tab that contains the same amount of carbidopa-levodopa as the patient was previously taking, and titrate to desired response.

May need to reduce levodopa dose if not already taking entacapone. [Trade only: Tabs (carbidopa/levodopa/entacapone): Stalevo 50 (12.5/50/200 mg), Stalevo 75 (18.75/75/200), Stalevo 100 (25/100/200 mg), Stalevo 125

(31.25/125/200), Stalevo 150 (37.5/150/200 mg), Stalevo 200 (50/200/200
mg).] `L ♀C – $$$$$

Parkinsonian Agents—Monoamine Oxidase Inhibitors (MAOIs) RASAGILINE ( Azilect ) Parkinson’s disease, monotherapy:

,
py 1 mg PO qam.

Parkinson’s disease, adjunctive: 0.5 mg PO qam. Max 1 mg/day. Requires an MAOI diet. [Trade only: Tabs 0.5, 1 mg.] `L ♀C ? $$$$$

OB/GYN

121

SELEGILINE ( Eldepryl, Zelapar) 5 mg PO q am and q noon, max 10 mg/day.

Zelapar ODT: 1.25 to 2.5 mg qam, max 2.5 mg/day. [Generic/Trade: Caps 5 mg. Tabs 5 mg. Trade only: Oral disintegrating tabs (Zelapar ODT) 1.25
mg.] `LK ♀C ? $$$$

Other Agents

BOTULINUM TOXIN TYPE A ( Botox, Botox Cosmetic) c Dose varies based on
indication. [Trade only: 100 unit single-use vials.] `Not absorbed ♀C ? $$$$$

MANNITOL ( Osmitrol, Resectisol )

Intracranial HTN: 0.25 to 2 g/kg IV over 30
to 60 min. `K ♀C ? $$

MILNACIPRAN ( Savella) Day 1: 12.5 mg PO once. Days 2 to 3: 12.5 mg BID.

Days 4 to 7: 25 mg bid, then 50 mg bid thereafter. Max 200 mg/day. [Trade only: Tabs 12.5, 25, 50, 100 mg.] `KL ♀C ? ?

NIMODIPINE ( Nimotop)

p

Subarachnoid hemorrhage:

g

60 mg PO q 4 h for

21 days. [Generic only: Caps 30 mg.] `L ♀C – $$$$$

OXYBATE ( Xyrem, GHB, gamma hydroxybutyrate) Narcolepsy-associated p y
cataplexy or excessive daytime sleepiness:

p
y
y
p

2.25 g PO qhs. Repeat in 2.5 to

4 h. May increase by 1.5 g/day at 2 week intervals to max 9 g/day. From a centralized pharmacy. [Trade only: Soln 180 mL (500 mg/mL) supplied with measuring device and child-proof dosing cups.] `L ♀B ? ©III $$$$$

RILUZOLE ( Rilutek) ALS: 50 mg PO q 12 h. Monitor LFTs. [Trade only: Tabs 50
mg.] `LK ♀C – $$$$$

TETRABENAZINE ( Xenazine,  Nitoman)

n

Start 12.5 mg PO qam. Increase
after 1 week to 12.5 mg PO bid. May increase by 12.5 mg/day weekly. For doses greater than 37.5 to 50 mg/day divide doses tid. For doses greater than 50
mg/day genotype for CYP2D6 and titrate by 12.5 mg/day weekly and divide tid to max 100 mg/day and 37.5 mg/dose (extensive/intermediate metabolizers) or 50 mg/day and 25 mg/dose (poor metabolizers). [Trade only: Tabs 12.5, 25
mg.] `L ♀C ? ? $$$$$

OB/GYN

Contraceptives

ETONOGESTREL ( Implanon) 1 subdermal implant q 3 years. [Trade only: Single rod implant, 68 mg etonogestrel.] `L ♀X + $$$$$

LEVONORGESTREL ( Plan B) Emergency contraception: g
y
p

1 tab PO ASAP but
within 72 h of intercourse. 2nd tab 12 h later. [OTC if age 18 yo or older Generic/Trade: Kit contains 2 tabs 0.75 mg.] `L ♀X – $$

LEVONORGESTREL ( Plan B One-Step)

p

Emergency contraception:

g
y
p

1 tab PO

ASAP but within 72 h of intercourse. [OTC if age 17 yo or older Trade only: Tabs 1.5 mg.] `L ♀X – $$

NUVARING (ethinyl estradiol vaginal ring + etonogestrel ) 1 ring intravaginally for 3 weeks each month. [Trade only: Flexible intravaginal ring, 15
mcg ethinyl estradiol/0.120 mg etonogestrel/d in 1, 3 rings/box.] `L ♀X

– $$$

122 OB/GYN

ORTHO EVRA (norelgestromin + ethinyl estradiol transdermal ) (Evra) Contraception:

p

1 patch q week for 3 weeks, then 1 week patch-free. [Trade only: Transdermal patch: 150 mcg norelgestromin + 20 mcg ethinyl estradiol/d in 1, 3 patches/box.] `L ♀X – $$$

Estrogens

NOTE See also hormone combinations.

ESTERIFIED ESTROGENS ( Menest ) 0.3 to 1.25 mg PO daily. [Trade only: Tabs 0.3, 0.625, 1.25, 2.5 mg.] `L ♀X – $$

ESTRADIOL ( Estrace, Gynodiol ) 1 to 2 mg PO daily. [Generic/Trade: Tabs, micronized 0.5, 1, 2 mg, scored. Trade only: 1.5 mg (Gynodiol).] `L ♀X – $

ESTRADIOL ACETATE ( Femtrace) 0.45 to 1.8 mg PO daily. [Trade only: Tabs, 0.45, 0.9, 1.8 mg.] `L ♀X – $$

ESTRADIOL ACETATE VAGINAL RING ( Femring) Insert & replace after 90 days.

[Trade only: 0.05 mg/day and 0.1 mg/day.] `L ♀X – $$$

ESTRADIOL CYPIONATE ( Depo-Estradiol ) 1 to 5 mg IM q 3 to 4 weeks. `L

♀X – $

ESTRADIOL GEL ( Divigel, Estrogel, Elestrin) n

Thinly apply contents of 1
complete pump depression to one entire arm (Estrogel) or upper arm (Elestrin) or contents of 1 foil packet (Divigel) to one upper thigh. [Trade only: Gel 0.06%
in non-aerosol, metered-dose pump with #64 or #32 1.25 g doses (Estrogel),

#100 0.87 g doses (Elestrin). Gel 0.1% in single-dose foil packets of 0.25, 0.5, 1.0 g, carton of 30 (Divigel).] `L ♀X – $$$

ESTRADIOL TOPICAL EMULSION ( Estrasorb) Rub in contents of 1 pouch each to left and right legs (spread over thighs & calves) qam. Daily dose is equivalent to two 1.74 g pouches. [Trade only: Topical emulsion, 56 pouches/
carton.] `L ♀X – $$

ESTRADIOL TRANSDERMAL PATCH ( Alora, Climara, Esclim, Estraderm, FemPatch, Menostar, Vivelle, Vivelle Dot,  Estradot, Oesclim) Apply m

1 patch weekly (Climara, FemPatch, Estradiol, Menostar) or twice a week (Esclim, Estraderm, Vivelle, Vivelle Dot, Alora). [Generic/Trade: Transdermal patches doses in mg/d: Climara (q week) 0.025, 0.0375, 0.05, 0.06, 0.075, 0.1. Trade only: FemPatch (q week) 0.025. Esclim (twice a week) 0.025, 0.0375, 0.05, 0.075, 0.1. Vivelle, Vivelle Dot (twice a week) 0.025, 0.0375, 0.05, 0.075, 0.1. Estraderm (twice a week) 0.05, 0.1. Alora (twice a week) 0.025, 0.05, 0.075, 0.1.] `L ♀X – $$

ESTRADIOL TRANSDERMAL SPRAY ( Evamist ) 1 to 3 sprays daily to forearm.

[Trade only: Spray: 1.53 mg estradiol per 90 mcL spray, 56 sprays per metered-dose pump.] `L ♀X – $$$

ESTRADIOL VAGINAL RING ( Estring) Insert and replace after 90 days. [Trade only: 2 mg ring single pack.] `L ♀X – $$$

ESTRADIOL VAGINAL TAB ( Vagifem
m) 1 tab vaginally daily for 2 weeks, then 1 tab vaginally twice a week. [Trade only: Vaginal tab: 25 mcg in disposable single-use applicators, 8, 18/pack.] `L ♀X – $-$$

(cont.)

OB/GYN

123

ESTRADIOL VALERATE ( Delestrogen) 10 to 20 mg IM q 4 weeks. `L ♀X

– $$

ESTROGEN VAGINAL CREAM ( Premarin, Estrace) Menopausal atrophic p
p
vaginitis:

g

Premarin: 0.5 to 2 g daily. Estrace: 2 to 4 g daily for 2 weeks, then reduce. Moderate to severe menopausal dyspareunia:

p
y p

Premarin: 0.5 g daily,
then reduce to twice a week. [Trade only: Vaginal cream (Premarin) 0.625
mg conjugated estrogens/g in 42.5 g with or without calibrated applicator.

Estrace: 0.1 mg estradiol/g in 42.5 g with calibrated applicator. Generic only: Cream 0.625 mg synthetic conjugated estrogens/g in 30 g with calibrated applicator.] `L ♀X ? $$$$

ESTROGENS CONJUGATED ( Premarin, C.E.S., Congest ) 0.3 to 1.25 mg PO
daily. Abnormal uterine bleeding:

g 25 mg IV/IM. Repeat in 6 to 12 h if needed.

[Trade only: Tabs 0.3, 0.45, 0.625, 0.9, 1.25 mg.] `L ♀X – $$$

ESTROGENS SYNTHETIC CONJUGATED A ( Cenestin) n

0.3 to 1.25 mg PO daily.

[Trade only: Tabs 0.3, 0.45, 0.625, 0.9, 1.25 mg.] `L ♀X – $$$

ESTROGENS SYNTHETIC CONJUGATED B ( Enjuvia) 0.3 to 1.25 mg PO daily.

[Trade only: Tabs 0.3, 0.45, 0.625, 0.9, 1.25 mg.] `L ♀X – $$

ESTROPIPATE ( Ogen, Ortho-Est ) 0.75 to 6 mg PO daily. [Generic/Trade: Tabs 0.75, 1.5, 3, 6 mg of estropipate.] `L ♀X – $

Hormone Combinations

NOTE See also estrogens.

ACTIVELLA (estradiol + norethindrone) 1 tab PO daily. [Trade only: Tabs 1/0.5 mg and 0.5/0.1 mg estradiol/norethindrone acetate in calendar dial pack dispenser.] `L ♀X – $$$

ANGELIQ (estradiol + drospirenone) 1 tab PO daily. [Trade only: Tabs 1 mg estradiol/0.5 mg drospirenone.] `L ♀X – $$$

CLIMARA PRO (estradiol + levonorgestrel ) 1 patch weekly. [Trade only: Transdermal 0.045/0.015 estradiol/levonorgestrel in mg/day, 4 patches/
box.] `L ♀X – $$$

COMBIPATCH (estradiol + norethindrone) (Estalis) 1 patch twice a week.

[Trade only: Transdermal patch 0.05 estradiol/0.14 norethindrone and 0.05
estradiol/0.25 norethindrone in mg/day, 8 patches/box.] `L ♀X – $$$

EMERGENCY CONTRACEPTION Emergency contraception within 72 h of unprotected sex.

Progestin-only methods (causes less nausea & may be more effective): Plan B One-Step (levonorgestrel 1.5 mg tab, OTC for age at least 17 yo): take one pill. Plan B (levonorgestrel 0.75 mg, OTC for age at least 18 yo): take one tab ASAP and 2nd dose 12 h later.

Progestin and estrogen method: Dose is defi ned as 2 pills of Ovral or Ogestrel, 4 pills of Cryselle, Levlen, Levora, Lo/Ovral, Nordette, Tri-Levlen*, Triphasil*, Trivora*, or Low Ogestrel, or 5 pills of Alesse, Aviane, Lessina, or Levlit: Take fi rst dose ASAP and 2nd dose 12 h later. If vomiting occurs within 1 h of taking dose, consider repeating that dose with an antiemetic 1 h prior. More info at: www.not-2-late.com.

*Use 0.125 mg levonorgestrel/30 mcg ethinyl estradiol tabs.

124 OB/GYN

ORAL CONTRACEPTIVES* `L ♀X

Estrogen

Progestin

Monophasic

(mcg)

(mg)

Norinyl 1+50, Ortho-Novum 1/50, Necon 1/50

50 mestranol

1 norethindrone

Ovcon-50

Demulen 1/50, Zovia 1/50E

50 ethinyl estradiol

1 ethynodiol

Ovral, Ogestrel

0.5 norgestrel

Norinyl 1+35, Ortho-Novum 1/35, Necon 1/35,

1 norethindrone

Nortrel 1/35

Brevicon, Modicon, Necon 0.5/35, Nortrel 0.5/35

0.5 norethindrone

Ovcon-35, Femcon Fe, Balziva

35 ethinyl estradiol

0.4 norethindrone

Previfem

0.18 norgestimate

Ortho-Cyclen, MonoNessa, Sprintec-28

0.25 norgestimate

Demulen 1/35, Zovia 1/35E, Kelnor 1/35

1 ethynodiol

Loestrin 21 1.5/30, Loestrin Fe 1.5/30, Junel

1.5 norethindrone

1.5/30, Junel 1.5/30 Fe, Microgestin Fe 1.5/30

Cryselle, Lo/Ovral, Low-Ogestrel

0.3 norgestrel

30 ethinyl estradiol

Apri, Desogen, Ortho-Cept, Reclipsen

0.15 desogestrel

Levlen, Levora, Nordette, Portia, Solia

0.15 levonorgestrel

Yasmin, Ocella

3 drospirenone

Loestrin 21 1/20, Loestrin Fe 1/20,Loestin 24 Fe, 1 norethindrone

Junel 1/20, Junel Fe 1/20, Microgestin Fe 1/20

Alesse, Aviane, Lessina, Levlite, Lutera, Sronyx 20 ethinyl estradiol

0.1 levonorgestrel

Lybrel†

0.09 levonorgestrel

Yaz

3 drospirenone

Kariva, Mircette

20/10 eth estrad

0.15 desogestrel

Progestin-only

Micronor, Nor-Q.D., Camila, Errin, Jolivette, Nora-BE
none

0.35 norethindrone

Biphasicc (estrogen & progestin contents vary) Ortho Novum 10/11, Necon 10/11

35 eth estradiol

0.5/1 norethindrone

Triphasic (estrogen & progestin contents vary) c

Cyclessa, Velivet, Cesia

25 ethinyl estradiol

0.100/0.125/0.150
desogestrel

Ortho-Novum 7/7/7, Necon 7/7/7, Nortrel 7/7/7

0.5/0.75/1 norethindr

35 ethinyl estradiol

Tri-Norinyl, Leena, Aranelle

0.5/1/0.5 norethindr

Enpresse, Tri-Levlen, Triphasil, Trivora-28

30/40/30 ethinyl

0.5/0.75/0.125
estradiol
levonorgestrel

Ortho Tri-Cyclen, Trinessa, Tri-Sprintec, Tri-Previfem 35 eth estradiol

00.18/0.215/0.25

Ortho Tri-Cyclen Lo

25 eth estradiol
norgestimate

Estrostep Fe, Tri-Legest, Tri-Legest Fe, Tilia Fe 20/30/35 eth estr

1 norethindrone

Extended Cycle††

Seasonale, Quasense, Jolessa

30 ethinyl

0.15 levonorgestrel
estradiol

Seasonique

30/10 eth estrad

0.15 levonorgestrel

LoSeasonique

20 ethinyl

0.1 levonorgestrel
estradiol

*All: Not recommended in smokers. Increase risk of thromboembolism, CVA, MI, hepatic neoplasia & gallbladder disease. Nausea, breast tenderness, & breakthrough bleeding are common transient side effects. Effectiveness reduced by hepatic enzyme-inducing drugs such as certain anticonvulsants and barbiturates, rifampin, rifabutin, griseofulvin, & protease inhibitors. Coadministration with St. John’s wort may decrease effi cacy. Vomiting or diarrhea may also increase the risk of contraceptive failure. Consider an additional form of birth control in above circumstances. See product insert for instructions on missing doses. Most available in 21 and 28 day packs. Progestin only g
y: Must
be taken at the same time every day. Because much of the literature regarding OC adverse effects pertains mainly to estrogen/progestin combinations, the extent to which progestin-only contraceptives cause these effects is unclear. No signifi cant interaction has been found with broad-spectrum antibiotics. The effect of St. John’s wort is unclear. No placebo days, start new pack immediately after fi nishing current one. Available in 28 day packs. Readers may fi nd the following website useful: www.managingcontraception.com. † Approved for continuous use without a “pill-free” period. †† 84 active pills and 7 placebo pills.

OB/GYN

125

ESTRATEST (esterifi ed estrogens + methyltestosterone) 1 tab PO daily.

[Trade only: Tabs 1.25 mg esterifi ed estrogens/2.5 mg methyltestosterone.] `L

♀X – $$$$

ESTRATEST H.S. (esterifi ed estrogens + methyltestosterone) 1 tab PO
daily. [Trade only: Tabs 0.625 mg esterifi ed estrogens/1.25 mg methyltestosterone.] `L ♀X – $$$

FEMHRT (ethinyl estradiol + norethindrone) 1 tab PO daily. [Trade only: Tabs 5/1, 2.5/0.5 mcg ethinyl estradiol/mg norethindrone, 28/blister card.]

`L ♀X – $$$

PREFEST (estradiol + norgestimate) 1 pink tab PO daily for 3 days followed by 1 white tab PO daily for 3 days, sequentially throughout the month.

[Generic/Trade: Tabs in 30 days blister packs 1 mg estradiol (15 pink), 1 mg estradiol/0.09 mg norgestimate (15 white).] `L ♀X – $$$

PREMPHASE (estrogens conjugated + medroxyprogesterone) 1 tab PO
daily. [Trade only: Tabs in 28 days EZ-Dial dispensers: 0.625 mg conjugated estrogens (14), 0.625 mg/5 mg conjugated estrogens/medroxyprogesterone (14).] `L ♀X – $$$

PREMPRO (estrogens conjugated + medroxyprogesterone) ( Premplus) 1
s
tab PO daily. [Trade only: Tabs in 28 days EZ-Dial dispensers: 0.625 mg/5 mg, 0.625 mg/2.5 mg, 0.45 mg/1.5 mg (Prempro low dose), or 0.3 mg/1.5 mg conjugated estrogens/medroxyprogesterone.] `L ♀X – $$$

SYNTEST D.S. (esterifi ed estrogens + methyltestosterone) 1 tab PO daily.

[Generic only: Tabs 1.25 mg esterifi ed estrogens/2.5 mg methyltestosterone.]

`L ♀X – $$

SYNTEST H.S. (esterifi ed estrogens + methyltestosterone) 1 tab PO daily.

[Generic only: Tabs 0.625 mg esterifi ed estrogens/1.25 mg methyltestosterone.]

`L ♀X – $$

Labor Induction / Cervical Ripening

DINOPROSTONE ( PGE2, Prepidil, Cervidil, Prostin E2) 2

Cervical ripening:

p
g 1
syringe of gel placed directly into the cervical os for cervical ripening or 1
insert in the posterior fornix of the vagina. [Trade only: Gel (Prepidil) 0.5 mg/3
g syringe. Vaginal insert (Cervidil) 10 mg. Vaginal suppositories (Prostin E2) 20 mg.] `Lung ♀C ? $$$$$

MISOPROSTOL ( PGE1, Cytotec) Cervical ripening: p
g 25 mcg intravaginally
q 3 to 6 h (or 50 mcg q 6 h). First trimester pregnancy failure: p g
y

800 mcg
intravaginally, repeat on day 3 if expulsion incomplete. [Generic/Trade: Oral tabs 100, 200 mcg.] `LK ♀X – $$$$

OXYTOCIN ( Pitocin)

n

Labor induction: 10 units in 1000 mL NS (10 milliunits/
mL), start at 6 to 12 mL/h (1 to 2 milliunits/min). Postpartum bleeding: p
g

10 units IM or 10 to 40 units in 1000 mL NS IV, infuse 20 to 40 milliunits/
min. `LK ♀? – $

Ovulation Stimulants

CLOMIPHENE ( Clomid, Serophene) Specialized dosing for ovulation induction. [Generic/Trade: Tabs 50 mg, scored.] `L ♀D ? $$$$$

126 OB/GYN

Progestins

HYDROXYPROGESTERONE CAPROATE

Amenorrhea, dysfunctional uterine

,
y
bleeding, metrorrhagia:

g,
g 375 mg IM. Production of secretory endometrium and y
desquamation:

q

125 to 250 mg IM on 10th day of the cycle, repeat q 7 days until suppression no longer desired. `L ♀X ? $

MEDROXYPROGESTERONE ( Provera) 10 mg PO daily for last 10 to 12 days of month, or 2.5 to 5 mg PO daily. Secondary amenorrhea, abnormal uterine y

,
bleeding:

g 5 to 10 mg PO daily for 5 to 10 days. Endometrial hyperplasia: yp p

10 to

30 mg PO daily. [Generic/Trade: Tabs 2.5, 5, 10 mg, scored.] `L ♀X + $

MEDROXYPROGESTERONE—INJECTABLE ( Depo-Provera, depo-subQ provera 104)

4

Contraception/Endometriosis:

p

150 mg IM in deltoid or gluteus maximus
or 104 mg SC in anterior thigh or abdomen q 13 weeks. `L ♀X + $

MEGESTROL ( Megace, Megace ES)

S

Endometrial hyperplasia:

yp p

40 to 160 mg

PO daily for 3 to 4 months. AIDS anorexia: 800 mg (20 mL) susp PO daily or 625
mg (5 mL) ES daily. [Generic/Trade: Tabs 20, 40 mg. Susp 40 mg/mL in 240 mL.

Trade only: Megace ES susp 125 mg/mL (150 mL).] `L ♀D ? $$$$$

NORETHINDRONE ( Aygestin, Micronor, Nor-Q.D., Camila, Errin, Jolivette, Nora-BE)

Amenorrhea, abnormal uterine bleeding:

,
g 2.5 to 10 mg PO daily
for 5 to 10 days during the 2nd half of the menstrual cycle. Endometriosis: 5
mg PO daily for 2 weeks. Increase by 2.5 mg every 2 weeks to 15 mg. [Generic/

Trade: Tabs 5 mg, scored. Trade only: 0.35 mg tabs.] `L ♀D/X –$

PROGESTERONE GEL ( Crinone, Prochieve) Secondary amenorrhea: y

45 mg

(4%) intravaginally every other day up to 6 doses. If no response, use 90 mg (8%) every other day up to 6 doses. Infertility: Special dosing. [Trade only: 4%, 8% single-use, prefi lled applicators.] `Plasma ♀– ? $$$

PROGESTERONE MICRONIZED ( Prometrium) 200 mg PO qhs 10 to 12 days per month or 100 mg qhs daily. Secondary amenorrhea: y

400 mg PO qhs for

10 days. Contraindicated in peanut allergy. [Trade only: Caps 100, 200 mg.]

`L ♀B + $$

PROGESTERONE VAGINAL INSERT ( Endometrin) Infertility: y Special dosing.

[Trade only: 100 mg vaginal insert.] `Plasma ♀– ? $$$$

Selective Estrogen Receptor Modulators

RALOXIFENE ( Evista)

Osteoporosis
p
prevention/treatment, breast cancer
prevention:

p

60 mg PO daily. [Trade only: Tabs 60 mg.] `L ♀X – $$$$

TAMOXIFEN ( Nolvadex, Soltamox, Tamone,  Tamofen) n

Breast cancer
prevention:

p

20 mg PO daily for 5 years. Breast cancer: 10 to 20 mg PO bid.

[Generic/Trade: Tabs 10, 20 mg. Trade only (Soltamox): Sugar-free soln 10
mg/5 mL (150 mL).] `L ♀D – $$

Uterotonics

CARBOPROST ( Hemabate, 15-methyl-prostaglandin F2 alpha) Refractory
y
postpartum uterine bleeding:

p
p
g 250 mcg deep IM. `LK ♀C ? $$$

METHYLERGONOVINE ( Methergine) Refractory postpartum uterine bleeding: y p
p
g

0.2 mg IM/PO tid–qid prn. [Trade only: Tabs 0.2 mg.] `LK ♀C ? $$

OB/GYN

127

DRUGS GENERALLY ACCEPTED AS SAFE IN PREGNANCY (selected) Analgesics:

g
acetaminophen, codeine*, meperidine*, methadone*. Antimicrobials: penicillins, cephalosporins, erythromycins (not estolate), azithromycin, nystatin, clotrimazole, metronidazole, nitrofurantoin***, Nix. Antivirals: acyclovir, valacyclovir, famciclovir. CV: labetalol, methyldopa, hydralazine, nifedipine. Derm: erythromycin, clindamycin, benzoyl peroxide. Endo: insulin, liothyronine, levothyroxine. ENT: chlorpheniramine, diphenhydramine, dimenhydrinate, dextromethorphan, guaifenesin, nasal steroids, nasal cromolyn.

GI: trimethobenzamide, antacids*, simethicone, cimetidine, famotidine, ranitidine, nizatidine, psyllium, metoclopramide, bisacodyl, docusate, doxylamine, meclizine. Heme: Heparin, low molecular wt heparins. Psych:

y
desipramine, doxepin. Pulmonary:

y short-
acting inhaled beta-2 agonists, cromolyn, nedocromil, beclomethasone, budesonide, theophylline, prednisone**.

*Except if used long-term or in high does at term.

**Except 1st trimester
t

. ***Contraindicated at term and during labor and delivery.

Vaginitis Preparations

NOTE See also STD/vaginitis table in antimicrobial section.

BORIC ACID

Resistant vulvovaginal candidiasis:

g

1 vag suppository qhs for

2 weeks. [No commercial preparation; must be compounded by pharmacist.

Vaginal supps 600 mg in gelatin caps.] `Not absorbed ♀? – $

BUTOCONAZOLE ( Gynazole, Mycelex-3)

3 Vulvovaginal candidiasis:

g

Mycelex 3:

1 applicatorful qhs for 3 to 6 days. Gynazole-1: 1 applicatorful intravaginally once at bed time. [OTC Trade only (Mycelex 3): 2% vaginal cream in 5 g prefi lled applicators (3s), 20 g tube with applicators. Rx: Trade only (Gynazole-1): 2%
vaginal cream in 5 g prefi lled applicator.] `LK ♀C ? $(OTC), $$$(Rx) CLINDAMYCIN—VAGINAL ( Cleocin, Clindesse,  Dalacin) Bacterial vaginosis: g

Cleocin: 1 applicatorful cream qhs for 7 days or 1 vaginal suppository qhs for 3 days. Clindesse: 1 applicatorful once. [Generic/Trade: 2% vaginal cream in 40 g tube with 7 disposable applicators (Cleocin). Vag suppository (Cleocin Ovules) 100 mg (3) with applicator. 2% vaginal cream in a single-dose prefi lled applicator (Clindesse).] `L ♀– + $$

CLOTRIMAZOLE—VAGINAL ( Mycelex 7, Gyne-Lotrimin,  Canesten, Clotrimaderm) m

Vulvovaginal candidiasis:

g

1 applicatorful 1% cream qhs for 7 days. 1 applicatorful 2% cream qhs for 3 days. 1 vag suppository 100 mg qhs for 7 days. 200 mg suppository qhs for 3 days. [OTC Generic/Trade: 1% vaginal cream with applicator (some prefi lled). 2% vaginal cream with applicator and 1% topical cream in some combination packs. OTC Trade only (Gyne-Lotrimin): Vaginal suppositorys 100 mg (7), 200 mg (3) with applicators.] `LK ♀B ? $

METRONIDAZOLE—VAGINAL ( MetroGel-Vaginal, Vandazole) Bacterial vaginosis:

g

1 applicatorful qhs or bid for 5 days. [Generic/Trade: 0.75% gel in 70 g tube with applicator.] `LK ♀B ? $$

MICONAZOLE ( Monistat, Femizol-M, M-Zole, Micozole, Monazole) Vulvovaginal candidiasis:

g

1 applicatorful qhs for 3 (4%) or 7 (2%) days. 100 mg vag suppository qhs for 7 days. 400 mg vag suppository qhs for 3 days. 1200
mg vag suppository once. [OTC Generic/Trade: 2% vaginal cream in 45 g with 1 applicator or 7 disposable applicators. Vaginal suppositories 100 mg (7) OTC Trade only: 400 mg (3), 1200 mg (1) with applicator. Generic/Trade: 4%

(cont.)

128 OB/GYN
vaginal cream in 25 g tubes or 3 prefi lled applicators. Some in combination packs with 2% miconazole cream for external use.] `LK ♀+ ? $

NYSTATIN—VAGINAL ( Mycostatin,

 Nilstat, Nyaderm
m)

Vulvovaginal
g
candidiasis: 1 vag tab qhs for 14 days. [Generic only: Vaginal tabs 100,000
units in 15s with applicator.] `Not metabolized ♀A ? $$

TERCONAZOLE ( Terazol ) Vulvovaginal candidiasis: g

1 applicatorful of 0.4%
cream qhs for 7 days, or 1 applicatorful of 0.8% cream qhs for 3 days, or 80 mg vag suppository qhs for 3 days. [All forms supplied with applicators: Generic/Trade: Vag cream 0.4% (Terazol 7) in 45 g tube, 0.8% (Terazol 3) in 20
g tube. Vag suppository (Terazol 3) 80 mg (#3).] `LK ♀C – $$

TIOCONAZOLE ( Monistat 1-Day, Vagistat-1)

Vulvovaginal candidiasis:

g

1 applicatorful of 6.5% ointment intravaginally qhs single-dose. [OTC

Trade only: Vaginal ointment: 6.5% (300 mg) in 4.6 g prefi lled single-dose applicator.] `Not absorbed ♀C – $

Other OB / GYN Agents

DANAZOL ( Danocrine,  Cyclomen)

n

Endometriosis: Start 400 mg PO bid,
then titrate downward to maintain amenorrhea for 3 to 6 months. Fibrocystic breast disease: 100 to 200 mg PO bid for 4 to 6 months. [Generic only: Caps 50, 100, 200 mg.] `L ♀X – $$$$$

MIFEPRISTONE ( Mifeprex, RU-486)

6

600 mg PO 1 followed by 400 mcg
misoprostol on day 3, if abortion not confi rmed. [Trade only: Tabs 200 mg.] `L

♀X ? $$$$$

PREMESIS-RX (pyridoxine + folic acid + cyanocobalamin + calcium carbonate) Pregnancy-induced nausea:

g
y

1 tab PO daily. [Trade only: Tabs

75 mg vitamin B6 (pyridoxine), sustained-release, 12 mcg vitamin B12

(cyanocobalamin), 1 mg folic acid, and 200 mg calcium carbonate.] `L ♀A

+ $$

RHO IMMUNE GLOBULIN ( HyperRHO S/D, MICRhoGAM, RhoGAM, Rhophylac, WinRho SDF ) 300 mcg vial IM to mother at 28 weeks gestation followed by a second dose within 72 h of delivery (if mother Rh– and baby is or might be Rh+). Microdose (50 mcg, MICRhoGAM) is appropriate if spontaneous abortion less than 12 weeks gestation. `L ♀C ? $$$$$

ONCOLOGY

ALKYLATING AGENTS altretamine ( Hexalen), bendamustine ( Treanda), busulfan ( Myleran, Busulfex),
x carmustine ( BCNU, BiCNU, Gliadel), chlorambucil l

( Leukeran), cyclophosphamide ( Cytoxan, Neosarr), dacarbazine ( DTIC-Dome), ifosfamide ( Ifex), lomustine (
x

CeeNu, CCNU

U), mechlorethamine ( Mustargen),
melphalan ( Alkeran), procarbazine ( Matulane), streptozocin ( Zanosar), temozolomide ( Temodar,
r

 Temodal), thiotepa (
l

Thioplex).

x

ANTIBIOTICS:

bleomycin ( Blenoxane), dactinomycin ( Cosmegen), daunorubicin ( DaunoXome, Cerubidine), doxorubicin liposomal ( Doxil, l  Caelyx, Myocet) t , doxorubicin

(cont.)

Ophthalmology

129
non-liposomal ( Adriamycin, Rubex), epirubicin ( Ellence,  Pharmorubicin), idarubicin ( Idamycin), mitomycin ( Mutamycin, Mitomycin-C

C), mitoxantrone

( Novantrone), valrubicin ( Valstar,
r  Valtaxin). ANTIMETABOLITES: azacitidine ( Vidaza), capecitabine ( Xeloda), cladribine ( Leustatin, chlorodeoxyadenosine), clofarabine ( Clolar), cytarabine (
r

Cytosar-U, Tarabine, Depo-Cyt, AraC

C),
decitabine ( Dacogen), fl oxuridine ( FUDR), fl udarabine ( Fludara), fl uorouracil ( Adrucil, 5-FU), gemcitabine ( Gemzar), hydroxyurea (
r

Hydrea, Droxia),
mercaptopurine ( 6-MP, Purinethol), nelarabine (
l

Arranon), pemetrexed ( Alimta),
pentostatin ( Nipent), thioguanine ( Tabloidd,  Lanvis). CYTOPROTECTIVE

AGENTS: amifostine ( Ethyoll), dexrazoxane ( Zinecard), mesna ( Mesnexx,

 Uromitexan), palifermin ( Kepivance). HORMONES: abarelix ( Plenaxis), anastrozole ( Arimidex), bicalutamide (
x

Casodexx), cyproterone,  Androcur,

Androcur Depott, estramustine ( Emcytt), exemestane ( Aromasin), fl utamide ( Eulexin,  Eufl exx), fulvestrant ( Faslodex), goserelin ( Zoladex), histrelin ( Vantas, Supprelin LA), letrozole ( Femara), leuprolide ( Eligard, Lupron, Lupron Depot, Oaklide, Viadur),
r nilutamide ( Nilandron), toremifene ( Fareston), triptorelin ( Trelstar Depot).

t

IMMUNOMODULATORS: aldesleukin ( Proleukin,
interleukin-2), alemtuzumab (

2

Campath,  MabCampath), BCG ( Bacillus of Calmette & Guerin, Pacis, TheraCys, Tice BCG,  Oncotice, Immucyst) t ,
bevacizumab ( Avastin), cetuximab ( Erbitux), dasatinib ( Sprycell), denileukin ( Ontak), erlotinib (
k

Tarceva), gemtuzumab ( Mylotargg), ibritumomab ( Zevalin), imatinib ( Gleevec), interferon alfa-2a ( Roferon-A), lapatinib ( Tykerb), nilotinib ( Tasigna), panitumumab ( Vectibix), rituximab (
x

Rituxan), sunitinib ( Sutentt),
temsirolimus ( Torisel), tositumomab ( Bexxar), trastuzumab ( Herceptin).

MITOTIC INHIBITORS: docetaxel ( Taxotere), etoposide ( VP-16, Etopophos, Toposar, VePesid), ixabepilone (
d

Ixempra), paclitaxel ( Taxol, Abraxane, Onxol), l
teniposide ( Vumon, VM-26), vinblastine (

6

Velban, VLB

B), vincristine ( Oncovin,

Vincasar, VCR), vinorelbine (

R

Navelbine). PLATINUM-CONTAINING AGENTS:

carboplatin ( Paraplatin), cisplatin ( Platinol-AQ), oxaliplatin (

Q

Eloxatin).

RADIOPHARMACEUTICALS: samarium 153 ( Quadramett), strontium-89

( Metastron). MISCELLANEOUS: arsenic trioxide ( Trisenoxx), asparaginase ( Elspar,
r

 Kidrolase), bexarotene ( Targretin), bortezomib ( Velcade), dexrazoxane ( Totect), gefi tinib ( Iressa), irinotecan ( Camptosarr), lenalidomide ( Revlimid), leucovorin ( Wellcovorin, folinic acid), levoleucovorin (
d

Fusilev),
mitotane ( Lysodren), pegaspargase ( Oncaspar), porfi r

mer ( Photofrin),
sorafenib ( Nexavarr), thalidomide ( Thalomid), topotecan (
d

Hycamtin), tretinoin

( Vesanoid), vorinostat (
d

Zolinza).

OPHTHALMOLOGY

NOTE Most eye medications can be administered 1 gtt at a time despite common manufacturer recommendations of 1 to 2 gtts concurrently. Even a single drop is typically more than the eye can hold, and thus a 2nd drop is wasteful and increases the possibility of systemic toxicity. If more medication is desired separate single drops by at least 5 min.

(cont.)

130 Ophthalmology

Antiallergy—Decongestants & Combinations

NAPHAZOLINE ( Albalon, All Clear, AK-Con, Naphcon, Clear Eyess) 1 to 2 gtts qid for up to 3 days. [OTC Generic/Trade: Soln 0.012, 0.025% (15, 30 mL). Rx Generic/Trade: 0.1% (15 mL).] `? ♀C ? $

NAPHCON-A (naphazoline + pheniramine) (Visine-A) 1 gtt qid prn for up to 3 days. [OTC Trade only: Soln 0.025% + 0.3% (15 mL).] `L ♀C ? $

VASOCON-A (naphazoline + antazoline) 1 gtt qid prn for up to 3 days. [OTC

Trade only: Soln 0.05% + 0.5% (15 mL).] `L ♀C ? $

Antiallergy—Dual Antihistamine & Mast Cell Stabilizer AZELASTINE—OPHTHALMIC ( Optivarr) 1 gtt in each affected eye bid. [Trade only: Soln 0.05% (6 mL).] `L ♀C ? $$$

EPINASTINE ( Elestat ) 1 gtt in each affected eye bid. [Trade only: Soln 0.05% (5 mL).] `K ♀C ? $$$

KETOTIFEN—OPHTHALMIC ( Alaway, Zaditor) 1 gtt in each eye q 8 to 12 h.

[OTC Generic/Trade: Soln 0.025% (5 mL).] `Minimal absorption ♀C ? $

OLOPATADINE ( Pataday, Patanol ) 1 gtt of 0.1% soln in each eye bid (Patanol) or 1 gtt of 0.2% soln in each eye daily (Pataday). [Trade only: Soln 0.1% (5 mL, Patanol), 0.2% (2.5 mL, Pataday).] `K ♀C ? $$$

Antiallergy—Pure Antihistamines

EMEDASTINE ( Emadine) 1 gtt daily to qid. [Trade only: Soln 0.05%

(5 mL).] `L ♀B ? $$$

LEVOCABASTINE—OPHTHALMIC ( Livostin)

n

1 gtt daily to qid for 2 weeks.

[Trade only: Susp 0.05% (5, 10 mL).] `Minimal absorption ♀C ? $$$

Antiallergy—Pure Mast Cell Stabilizers

CROMOLYN—OPHTHALMIC ( Crolom, Opticrom)

m

1 to 2 gtts in each eye 4 to

6 times a day. [Generic/Trade: Soln 4% (10 mL).] `LK ♀B ? $$

LODOXAMIDE ( Alomide) 1 to 2 gtts in each eye qid. [Trade only: Soln 0.1%

(10 mL).] `K ♀B ? $$$

NEDOCROMIL—OPHTHALMIC ( Alocril ) 1 to 2 gtts in each eye bid. [Trade only: Soln 2% (5 mL).] `L ♀B ? $$$

PEMIROLAST ( Alamast ) 1 to 2 gtts in each eye qid. [Trade only: Soln 0.1%

(10 mL).] `? ♀C ? $$$

Antibacterials—Aminoglycosides

GENTAMICIN—OPHTHALMIC ( Garamycin, Genoptic, Gentak,  Diogent ) 1 to 2 gtts q 2 to 4 h; ½ inch ribbon of ointment bid to tid. [Generic/Trade: Soln 0.3% (5, 15 mL). Ointment 0.3% (3.5 g tube).] `K ♀C ? $

TOBRAMYCIN—OPHTHALMIC ( Tobrexx) 1 to 2 gtts q 1 to 4 h or ½ inch ribbon of ointment q 3 to 4 h or bid to tid. [Generic/Trade: Soln 0.3% (5 mL). Trade only: Ointment 0.3% (3.5 g tube).] `K ♀B – $

Ophthalmology

131

Antibacterials—Fluoroquinolones

BESIFLOXACIN ( Besivance) 1 gtt tid for 7 days. [Trade: Soln 0.6% (5 mL).]

`LK ♀C ? ?

CIPROFLOXACIN—OPHTHALMIC ( Ciloxann) 1 to 2 gtts q 1 to 6 h or ½ inch ribbon ointment bid to tid. [Generic/Trade: Soln 0.3% (2.5, 5, 10 mL). Trade only: Ointment 0.3% (3.5 g tube).] `LK ♀C ? $$

GATIFLOXACIN—OPHTHALMIC ( Zymar) 1 to 2 gtts q 2 h while awake (up to 8 times per day) on day 1 & 2, then 1 to 2 gtts q 4 h (up to qid) on days 3 to 7.

[Trade only: Soln 0.3%.] `K ♀C ? $$$

LEVOFLOXACIN—OPHTHALMIC ( Iquix, Quixinn) Quixin: 1 to 2 gtts q 2 h while awake (up to 8 times per day) on days 1 & 2, then 1 to 2 gtts q 4 h (up to qid) on days 3 to 7. Iquix: 1 to 2 gtts q 30 min to 2 h while awake and q 4 to 6 h overnight on days 1 to 3, then 1 to 2 gtts q 1 to 4 h while awake on day 4 to completion of therapy. [Trade only: Soln 0.5% (Quixin, 5 mL), 1.5% (Iquix, 5
mL).] `KL ♀C ? $$$

MOXIFLOXACIN—OPHTHALMIC ( Vigamox) 1 gtt tid for 7 days. [Trade only: Soln 0.5% (3 mL).] `LK ♀C ? $$$

OFLOXACIN—OPHTHALMIC ( Ocufl oxx) 1 to 2 gtts q 1 to 6 h for 7 to 10 days.

[Generic/Trade: Soln 0.3% (5, 10 mL).] `LK ♀C ? $$

Antibacterials—Other

AZITHROMYCIN—OPHTHALMIC ( Azasite) 1 gtt bid for 2 days, then 1 gtt once daily for 5 more days. [Trade only: Soln 1% (2.5 mL).] `L ♀B ? $$$

BACITRACIN—OPHTHALMIC ( AK Tracin) Apply ¼ to ½ inch ribbon of ointment q 3 to 4 h or bid to qid for 7 to 10 days. [Generic/Trade: Ointment 500
units/g (3.5 g tube).] `Minimal absorption ♀C ? $

ERYTHROMYCIN—OPHTHALMIC ( Ilotycin, AK-Mycin) n

½ inch ribbon of
ointment q 3 to 4 h or 2 to 6 times per day. [Generic only: Ointment 0.5% (1, 3.5 g tube).]`L ♀B + $

NEOSPORIN OINTMENT—OPHTHALMIC (neomycin + bacitracin + polymyxin) ½ inch ribbon of ointment q 3 to 4 h for 7 to 10 days or ½ inch ribbon 2 to 3 times per day for mild to moderate infection. [Generic only: Ointment. (3.5 g tube).] `K ♀C ? $

NEOSPORIN SOLUTION—OPHTHALMIC (neomycin + polymyxin + gramicidin) 1 to 2 gtts q 4 to 6 h for 7 to 10 days. [Generic/Trade: Soln (10 mL).] `KL

♀C ? $$

POLYSPORIN—OPHTHALMIC (polymyxin + bacitracin) ½ inch ribbon of ointment q 3 to 4 h for 7 to 10 days or ½ inch ribbon bid to tid for mild to moderate infection. [Generic only: Ointment (3.5 g tube).] `K ♀C ? $$

POLYTRIM—OPHTHALMIC (polymyxin + trimethoprim) 1 to 2 gtts q 4 to 6 h (up to 6 gtts/day) for 7 to 10 days. [Generic/Trade: Soln (10 mL).] `KL

♀C ? $

SULFACETAMIDE—OPHTHALMIC ( Bleph-10, Sulf-100) 1 to 2 gtts q 2 to 6 h for 7 to 10 days or ½ inch ribbon of ointment q 3 to 8 h for 7 to 10 days.

(cont.)

132 Ophthalmology

[Generic/Trade: Soln 10% (15 mL). Ointment 10% (3.5 g tube). Generic only: Soln 30% (15 mL).] `K ♀C – $

Antiviral Agents

TRIFLURIDINE ( Viroptic) Herpes: 1 gtt q 2 to 4 h for 7 to 14 days, max 9
gtts per day and max of 21 days of therapy. [Generic/Trade Soln 1% (7.5
mL).] `Minimal absorption ♀C – $$$

Corticosteroid & Antibacterial Combinations NOTE Recommend that only ophthalmologists or optometrists prescribe due to infection, cataract, corneal/scleral perforation, and glaucoma risk from prolonged use. Monitor intraocular pressure.

BLEPHAMIDE (prednisolone—ophthalmic + sulfacetamide) 1 to 2 gtts q 1
to 8 h or ½ inch ribbon to lower conjunctival sac 3 to 4 times per day and 1 to 2
times at bed time. [Generic/Trade: Soln/Susp (5, 10 mL). Trade only: Ointment (3.5 g tube).] `KL ♀C ? $

CORTISPORIN—OPHTHALMIC (neomycin + polymyxin + hydrocortisone—
ophthalmic) 1 to 2 gtts or ½ inch ribbon of ointment q 3 to 4 h or more frequently prn. [Generic only: Susp (7.5 mL). Ointment (3.5 g tube).] `LK ♀C

? $

FML-S LIQUIFILM (prednisolone—ophthalmic + sulfacetamide) 1 to 2
gtts q 1 to 8 h or ½ inch ribbon of ointment daily to qid. [Trade only: Susp (10
mL).] `KL ♀C ? $$

MAXITROL (dexamethasone—ophthalmic + neomycin + polymyxin) Ointment: small amount (about ½ inch) in affected eye 3 to 4 times per day or qhs as an adjunct with drops. Susp: 1 to 2 gtts into affected eye(s) q 3 to 4 h; in severe disease, drops may be used hourly and tapered to discontinuation. [Generic/Trade: Susp (5 mL). Ointment (3.5 g tube).] `KL

♀C ? $

PRED G (prednisolone—ophthalmic + gentamicin) 1 to 2 gtts q 1 to 8 h daily to qid or ½ inch ribbon of ointment bid to qid. [Trade only: Susp (2, 5, 10
mL). Ointment (3.5 g tube).] `KL ♀C ? $$

TOBRADEX (tobramycin + dexamethasone—ophthalmic) 1 to 2 gtts q 2
to 6 h or ½ inch ribbon of ointment bid to qid. [Trade only (tobramycin 0.3%/
dexamethasone 0.1%): Susp (2.5, 5, 10 mL). Ointment (3.5 g tube).] `L ♀C

? $$$

TOBRADEX ST (tobramycin + dexamethasone—ophthalmic) 1 gtt q 2 to 6 h. [Trade only: Tobramycin 0.3%/dexamethasone 0.05%: Susp (2.5, 5, 10
mL).] `L ♀C ? $$$

VASOCIDIN (prednisolone—ophthalmic + sulfacetamide) 1 to 2 gtts q 1
to 8 h or ½ inch ribbon of ointment daily to qid. [Generic only: Soln (5, 10
mL).] `KL ♀C ? $

ZYLET (loteprednol + tobramycin) 1 to 2 gtts q 1 to 2 h for 1 to 2 days then 1 to 2 gtts q 4 to 6 h. [Trade only: Susp 0.5% loteprednol + 0.3% tobramycin (2.5, 5, 10 mL).] `LK ♀C ? $$$

Ophthalmology

133

Corticosteroids

NOTE Recommend that only ophthalmologists or optometrists prescribe due to infection, cataract, corneal/scleral perforation, and glaucoma risk. Monitor intraocular pressure.

DIFLUPREDNATE ( Durezol ) 1 gtt into affected eye qid, beginning 24 h after surgery for 2 weeks, then 1 gtt into affected eye bid for 1 week, then taper based on response. [Trade only: Ophthalmic emulsion 0.05% (2.5, 5
mL).] `Not absorbed ♀C ? $$$$

FLUOROMETHOLONE ( FML, FML Forte, Flarex) 1 to 2 gtts q 1 to 12 h or ½
inch ribbon of ointment q 4 to 24 h. [Trade only: Susp 0.1% (5, 10, 15 mL), 0.25% (2, 5, 10, 15 mL). Ointment 0.1% (3.5 g tube).] `L ♀C ? $$

LOTEPREDNOL ( Alrex, Lotemax) 1 to 2 gtts qid. [Trade only: Susp 0.2%

(Alrex 5, 10 mL), 0.5% (Lotemax 2.5, 5, 10, 15 mL).] `L ♀C ? $$$

PREDNISOLONE—OPHTHALMIC ( Pred Forte, Pred Mild, Infl amase Forte, Econopred Plus,  AK Tate, Diopred) Soln: 1 to 2 gtts (up to q 1 h during day and q 2 h at night), when response observed, then 1 gtt q 4 h, then 1 gtt tid to qid. Susp: 1 to 2 gtts bid to qid. [Generic/Trade: Soln, Susp 1% (5, 10, 15 mL). Trade only (Pred Mild): Susp 0.12% (5, 10 mL). Susp (Pred Forte) 1%

(1 mL).] `L ♀C ? $$

RIMEXOLONE ( Vexol ) 1 to 2 gtts q 1 to 6 h. [Trade only: Susp 1% (5, 10
mL).] `L ♀C ? $$

Glaucoma Agents—Beta-Blockers (Use caution in cardiac conditions and asthma.)

BETAXOLOL—OPHTHALMIC ( Betoptic, Betoptic S) S

1 to 2 gtts bid. [Trade
only: Susp 0.25% (5, 10, 15 mL). Generic only: Soln 0.5% (5, 10, 15 mL).] `LK

♀C ? $$

CARTEOLOL—OPHTHALMIC ( Ocupresss) 1 gtt bid. [Generic only: Soln 1% (5, 10, 15 mL).] `KL ♀C ? $

LEVOBUNOLOL ( Betagan) 1 to 2 gtts daily to bid. [Generic/Trade: Soln 0.25%

(5, 10 mL) 0.5% (5, 10, 15 mL). Trade only: 2 mL.] `? ♀C – $$

METIPRANOLOL ( Optipranolol ) 1 gtt bid. [Generic/Trade: Soln 0.3% (5, 10 mL).] `? ♀C ? $

TIMOLOL—OPHTHALMIC ( Betimol, Timoptic, Timoptic XE, Istalol, Timoptic Ocudose) 1 gtt bid. Timoptic XE, Istalol: 1 gtt daily. [Generic/Trade: Soln 0.25, 0.5% (5, 10, 15 mL). Preservative-free soln* 0.25% (0.2 mL). Gel-forming soln^ 0.25, 0.5% (2.5, 5 mL). Note: *Timoptic Ocudose ^Timoptic XE.] `LK ♀C + $$

Glaucoma Agents—Carbonic Anhydrase Inhibitors

NOTE Sulfonamide derivatives; verify absence of sulfa allergy before prescribing.

BRINZOLAMIDE ( Azopt ) 1 gtt tid. [Trade only: Susp 1% (5, 10, 15 mL).] `LK

♀C ? $$$

134 Ophthalmology

DORZOLAMIDE ( Trusopt ) 1 gtt tid. [Generic/Trade: Soln 2% (5, 10 mL).] `KL

♀C – $$$

METHAZOLAMIDE ( Neptazane) 25 to 50 mg PO daily (up to tid). [Generic only: Tabs 25, 50 mg.] `LK ♀C ? $$

Glaucoma Agents—Miotics

PILOCARPINE—OPHTHALMIC ( Pilopine HS, Isopto Carpine,  Diocarpine, Akarpine) 1 to 2 gtts tid to qid (up to 6 times per day) or ½ inch ribbon of gel qhs. [Generic only: Soln 0.5% (15 mL), 1% (2 mL), 2% (2 mL), 3% (15 mL), 4% (2 mL), 6% (15 mL). Generic/Trade: Soln 1% (15 mL), 2% (15 mL), 4% (15
mL). Trade only (Pilopine HS): Gel 4% (4 g tube).] `Plasma ♀C ? $

Glaucoma Agents—Prostaglandin Analogs

BIMATOPROST ( Lumigan, Latisse) 1 gtt qhs. [Trade only: Soln 0.03%

(Lumigan, 2.5, 5, 7.5 mL), (Latisse, 3 mL with 60 sterile, disposable applicators).] `LK ♀C ? $$$

LATANOPROST ( Xalatan)

n

1 gtt qhs. [Trade only: Soln 0.005% (2.5 mL).]

`LK ♀C ? $$$

TRAVOPROST ( Travatan, Travatan Z) 1 gtt qhs. [Trade only: Soln (Travatan), benzalkonium chloride-free (Travatan Z) 0.004% (2.5, 5 mL).] `L ♀C ? $$$

Glaucoma Agents—Sympathomimetics

BRIMONIDINE ( Alphagan P,  Alphagan) 1 gtt tid. [Trade only: Soln 0.1% (5, 10, 15 mL). Generic/Trade: Soln 0.15% (5, 10, 15 mL). Generic only: 0.2% Soln (5, 10, 15 mL).] `L ♀B ? $$

Glaucoma Agents—Combinations and Other

COMBIGAN (brimonidine + timolol ) 1 gtt q 12 h. [Trade only: Soln brimonidine 0.2% + timolol 0.5% (5, 10 mL).] `LK ♀C – $$$

COSOPT ( dorzolamide + timolol ) 1 gtt bid. [Generic/Trade: Soln dorzolamide 2% + timolol 0.5% (5, 10 mL).] `LK ♀D – $$$

Mydriatics & Cycloplegics

ATROPINE—OPHTHALMIC ( Isopto Atropine, Atropine Care) 1 to 2 gtts before procedure or daily to qid or 1⁄8 to ¼ inch ointment before procedure or daily to tid. Cycloplegia may last up to 5 to 10 days and mydriasis may last up to 7 to 14 days. [Generic/Trade: Soln 1% (2, 5, 15 mL). Generic only: Ointment 1% (3.5 g tube).] `L ♀C + $

CYCLOPENTOLATE ( AK-Pentolate, Cyclogyl, Pentolair) r

1 to 2 gtts for 1 to 2
doses before procedure. Cycloplegia may last 6 to 24 h; mydriasis may last 1
day. [Generic/Trade: Soln 1% (2, 15 mL). Trade only (Cyclogyl): 0.5% (15 mL), 1% (5 mL) and 2% (2, 5, 15 mL).] `? ♀C ? $

HOMATROPINE ( Isopto Homatropine) 1 to 2 gtts before procedure or bid to tid. Cycloplegia & mydriasis lasts 1 to 3 days. [Trade only: Soln 2% (5 mL), 5%

(15 mL). Generic/Trade: Soln 5% (5 mL).] `? ♀C ? $

Ophthalmology

135

PHENYLEPHRINE—OPHTHALMIC ( AK-Dilate, Altafrin, Mydfrin, Refreshh) 1 to 2 gtts before procedure or tid to qid. No cycloplegia; mydriasis may last up to 5 h. [Rx Generic/Trade: Soln 2.5% (2, 3, 5, 15 mL), 10% (5 mL). OTC Trade only (Altafrin and Refresh): Soln 0.12% (15 mL).] `Plasma, L ♀C ? $

TROPICAMIDE ( Mydriacyl, Tropicacyl ) 1 to 2 gtts before procedure.

Mydriasis may last 6 h. [Generic/Trade: Soln 0.5% (15 mL), 1% (3, 15 mL).

Generic only: Soln 1% (2 mL).] `? ♀? ? $

Non-Steroidal Anti-Infl ammatories

BROMFENAC—OPHTHALMIC ( Xibrom
m) 1 gtt bid for 2 weeks. [Trade only:

Soln 0.09% (2.5, 5 mL).] `Minimal absorption ♀C, D (3rd trimester) ?

$$$$$

DICLOFENAC—OPHTHALMIC ( Voltaren,  Voltaren Ophtha) 1
gtt daily to
qid. [Generic/Trade: Soln 0.1% (2.5, 5 mL).] `L ♀B, D (3rd trimester) ? $$$

KETOROLAC—OPHTHALMIC ( Acular, Acular LS)

S

1 gtt qid. [Trade only: Soln

Acular LS 0.4% (5 mL), Acular 0.5% (3, 5, 10 mL), preservative-free Acular 0.5% unit dose (0.4 mL).] `L ♀C ? $$$

NEPAFENAC ( Nevanac) 1 gtt tid for 2 weeks. [Trade only: Susp 0.1%

(3 mL).] `Minimal absorption ♀C ? $$$

Other Ophthalmologic Agents

ARTIFICIAL TEARS ( Tears Naturale, Hypotears, Refresh Tears, GenTeal, Systane) 1 to 2 gtts tid to qid prn. [OTC Generic/Trade: Soln (15, 30 mL
among others).] `Minimal absorption ♀A + $

CYCLOSPORINE—OPHTHALMIC ( Restasiss) 1 gtt in each eye q 12 h. [Trade only: Emulsion 0.05% (0.4 mL single-use vials).] `Minimal absorption ♀C

? $$$$

HYDROXYPROPYL CELLULOSE ( Lacrisert ) Moderate–severe dry eyes: y
y

1
insert in each eye daily. Some patients may require bid use. [Trade only: Ocular insert 5 mg.] `Minimal absorption ♀+ + $$$

LIDOCAINE—OPHTHALMIC

( Akten) Do not prescribe for unsupervised or prolonged use. Corneal toxicity and ocular infections may occur with repeated use. 2 gtts before procedure, repeat prn. [Generic only: Gel 3.5% (5 mL).] `L

♀B ? ?

PETROLATUM ( Lacrilube, Dry Eyes, Refresh PM,  Duolube) Apply ¼ to ½ inch ointment to inside of lower lid prn. [OTC Trade only: Ointment (3.5, 7 g) tube.] `Minimal absorption ♀A + $

PROPARACAINE ( Ophthaine, Ophthetic,  Alcaine) Do not prescribe for unsupervised or prolonged use. Corneal toxicity and ocular infections may occur with repeated use. 1 to 2 gtts before procedure. [Generic/Trade: Soln 0.5% (15 mL).] `L ♀C ? $

TETRACAINE—OPHTHALMIC ( Pontocaine) Do not prescribe for unsupervised or prolonged use. Corneal toxicity and ocular infections may occur with repeated use. 1 to 2 gtts or ½ to 1 inch ribbon of ointment before procedure.

[Generic only: Soln 0.5% (15 mL), unit-dose vials (0.7, 2 mL).] `Plasma ♀C

? $

136 Psychiatry

PSYCHIATRY

Antidepressants—Heterocyclic Compounds

AMITRIPTYLINE ( Elavil ) Start 25 to 100 mg PO qhs; gradually increase to usual effective dose of 50 to 300 mg/day. Primarily inhibits serotonin reuptake.

Demethylated to nortriptyline, which primarily inhibits norepinephrine reuptake. [Generic: Tabs 10, 25, 50, 75, 100, 150 mg. Elavil brand name no longer available; has been retained in this entry for name recognition purposes only.] `L ♀D – $$

CLOMIPRAMINE ( Anafranil ) Start 25 mg PO qhs; gradually increase to usual effective dose of 150 to 250 mg/day. Max 250 mg/day. Primarily inhibits serotonin reuptake. [Generic/Trade: Caps 25, 50, 75 mg.] `L ♀C + $$$

DESIPRAMINE ( Norpramin)

n

Start 25 to 100 mg PO given once daily or in
divided doses. Gradually increase to usual effective dose of 100 to 200 mg/
day, max 300 mg/day. Primarily inhibits norepinephrine reuptake. [Generic/

Trade: Tabs 10, 25, 50, 75, 100, 150 mg.] `L ♀C + $$

DOXEPIN ( Sinequan)

n

Start 75 mg PO qhs. Gradually increase to usual
effective dose of 75 to 150 mg/day, max 300 mg/day. Primarily inhibits norepinephrine reuptake. [Generic/Trade: Caps 10, 25, 50, 75, 100, 150 mg.

Oral concentrate 10 mg/mL.] `L ♀C – $$

IMIPRAMINE ( Tofranil, Tofranil PM)

M

Depression:

p

Start 75 to 100 mg PO qhs
or in divided doses; gradually increase to max 300 mg/day. Enuresis: 25 to 75
mg PO qhs. [Generic/Trade: Tabs 10, 25, 50 mg. Trade only: Caps 75, 100, 125, 150 mg (as pamoate salt).] `L ♀D – $$$

NORTRIPTYLINE ( Aventyl, Pamelor) Start 25 mg PO given once daily or divided bid to qid. Usual effective dose is 75 to 100 mg/day, max 150 mg/day.

Primarily inhibits norepinephrine reuptake. [Generic/Trade: Caps 10, 25, 50, 75 mg. Oral Soln 10 mg/5 mL.] `L ♀D + $$$

PROTRIPTYLINE ( Vivactil ) Depression:

p

15 to 40 mg/day PO divided tid to
qid. Max 60 mg/day. [Trade only: Tabs 5, 10 mg.] `L ♀C + $$$$

Antidepressants—Monoamine Oxidase Inhibitors (MAOIs) NOTE Must be on tyramine-free diet throughout treatment, and for 2 weeks after discontinuation. Numerous drug interactions; risk of hypertensive crisis and serotonin syndrome with many medications, including OTC. Allow ≥ 2 weeks wash-out when converting from an MAOI to an SSRI (6 weeks after fl uoxetine), TCA, or other antidepressant

ISOCARBOXAZID ( Marplan) Start 10 mg PO bid; increase by 10 mg q 2 to 4 days. Usual effective dose is 20 to 40 mg/day. MAOI diet. [Trade only: Tabs 10 mg.] `L ♀C ? $$$

PHENELZINE ( Nardil ) Start 15 mg PO tid. Usual effective dose is 60 to 90
mg/day in divided doses. MAOI diet. [Trade only: Tabs 15 mg.] `L ♀C ? $$$

SELEGILINE—TRANSDERMAL ( Emsam)

m

Depression:

p

Start 6 mg/24 h patch
q 24 h. Max 12 mg/24 h. MAOI diet for doses 9 mg/day or higher. [Trade only: Transdermal patch 6 mg/24 h, 9 mg/24 h, 12 mg/24 h.] `L ♀C ? $$$$$

Psychiatry

137

TRANYLCYPROMINE ( Parnate) Start 10 mg PO qam; increase by 10 mg/day at 1 to 3 week intervals to usual effective dose of 10 to 40 mg/day divided bid.

MAOI diet. [Generic/Trade: Tabs 10 mg.] `L ♀C – $$

Antidepressants—Selective Serotonin Reuptake Inhibitors (SSRIs) CITALOPRAM ( Celexa)

Depression:

p

Start 20 mg PO daily; usual effective
dose is 20 to 40 mg/day, max 60 mg/day. Suicidality. [Generic/Trade: Tabs 10, 20, 40 mg. Oral soln 10 mg/5 mL. Generic only: Oral disintegrating tab 10, 20, 40 mg.] `LK ♀C but – in 3rd trimester – $$$

ESCITALOPRAM ( Lexapro,  Cipralex)

x

Depression-generalized anxiety disorder
p
g
y

,
adults and age 12 yo or older: Start 10 mg PO daily; max 20 mg/day. Suicidality.

[Generic/Trade: Tabs 5, 10, 20 mg. Trade only: Oral soln 1 mg/mL.] `LK ♀C
but – in 3rd trimester – $$$

FLUOXETINE ( Prozac, Prozac Weekly, Sarafem) m Depression, OCD:

p

,

Start

20 mg PO qam; usual effective dose is 20 to 40 mg/day, max 80 mg/day.

Depression,
p

, maintenance: 20 to 40 mg/day (standard-release) or 90 mg PO
once a week (Prozac Weekly) starting 7 days after last standard-release dose.

Bulimia: 60 mg PO daily; may need to titrate slowly, over several days. Panic disorder: Start 10 mg PO qam; titrate to 20 mg/day after 1 week, max 60 mg/
day. Premenstrual Dysphoric Disorder
y p

(Sarafem): 20 mg PO daily, given either
throughout the menstrual cycle or for 14 days prior to menses; max 80 mg/
day. Doses greater than 20 mg/day can be divided bid (in morning and at noon). Bipolar depression
p
p

, olanzapine + fl uoxetine: Start 5 mg olanzapine

+ 20 mg fl uoxetine daily in the evening. Increase to usual range of 5 to 12.5 mg olanzapine plus 20 to 50 mg fl uoxetine as tolerated. Treatment-resistant depression,
p

, olanzapine + fl uoxetine: Start 5 mg olanzapine + 20
mg fl uoxetine daily in the evening. Increase to usual range of 5 to 20 mg olanzapine plus 20 to 50 mg fl uoxetine as tolerated. Suicidality, many drug interactions. [Generic/Trade: Tabs 10 mg. Caps 10, 20, 40 mg. Oral soln 20
mg/5 mL. Caps (Sarafem) 10, 20 mg. Trade only: Tabs (Sarafem) 10, 15, 20
mg. Caps, delayed-release (Prozac Weekly) 90 mg. Generic only: Tabs 20, 40
mg.] `L ♀C but – in 3rd trimester – $$$

FLUVOXAMINE ( Luvox, Luvox CR)

R

OCD: Start 50 mg PO qhs; usual effective
dose is 100 to 300 mg/day divided bid, max 300 mg/day. OCD and Social Anxiety Disorder (CR):

y

(

) Start 100 mg PO qhs; increase by 50 mg/day q week prn to max 300 mg/day. OCD (children age 8 yo or older): Start 25 mg PO qhs; usual effective dose is 50 to 200 mg/day divided bid, max 200 mg/day. Don’t use with thioridazine, pimozide, alosetron, cisapride, tizanidine, tryptophan, or MAOIs; use caution with benzodiazepines, TCAs, theophylline, and warfarin.

Suicidality. [Generic/Trade: Tabs 25, 50, 100 mg. Trade only: Caps, extended-release 100, 150 mg.] `L ♀C but – in 3rd trimester – $$$$

PAROXETINE ( Paxil, Paxil CR, Pexeva) Depression: p

Start 20 mg PO qam, max

50 mg/day. Depression, controlled-release: Start 25 mg PO qam, max 62.5 mg/
day. OCD: Start 10 to 20 mg PO qam, max 60 mg/day. Social anxiety disorder: y

Start 10 to 20 mg PO qam, max 60 mg/day. Social anxiety disorder y

, controlled-

(cont.)

138 Psychiatry
release: Start 12.5 mg PO qam, max 37.5 mg/day. Generalized anxiety y
disorder: Start 20 mg PO qam, max 50 mg/day. Panic disorder: Start 10 mg PO
qam, increase by 10 mg/day at intervals of 1 week or more to usual effective dose of 10 to 60 mg/day; max 60 mg/day. Panic disorder, controlled-release: Start 12.5 mg PO qam, max 75 mg/day. Post-traumatic stress disorder: Start 20 mg PO qam, max 50 mg/day. Premenstrual dysphoric disorder y p

(PMDD),
continuous dosing: Start 12.5 mg PO qam (controlled-release); may increase dose after 1 week to max 25 mg qam. PMDD,, intermittent dosing (given for 2
weeks prior to menses): 12.5 mg PO qam (controlled-release), max 25 mg/day.

Suicidality, many drug interactions. [Generic/Trade: Tabs 10, 20, 30, 40 mg.

Oral Susp 10 mg/5 mL. Controlled-release tabs 12.5, 25 mg. Trade only: (Paxil CR) 37.5 mg.] `LK ♀D ? $$$

SERTRALINE ( Zoloft )

Depression, OCD:

p

,

Start 50 mg PO daily; usual effective
dose is 50 to 200 mg/day, max 200 mg/day. Panic disorder, post-traumatic

, p
stress disorder, social anxiety disorder:

,
y

Start 25 mg PO daily, max 200 mg/
day. Premenstrual dysphoric disorder (PMDD),
y p

(

), continuous dosing: Start 50 mg

PO daily, max 150 mg/day. PMDD,, intermittent dosing (given for 14 days prior to menses): Start 50 mg PO daily for 3 days, then increase to 100 mg/day.

Suicidality. [Generic/Trade: Tabs 25, 50, 100 mg. Oral concentrate 20 mg/mL

(60 mL).] `LK ♀C but – in 3rd trimester + $$$

Antidepressants—Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) DESVENLAFAXINE ( Pristiq) 50 mg PO daily. Max 400 mg/day. [Trade only: Tabs, extended-release 50, 100 mg.] `LK ♀C ? $$$$

DULOXETINE ( Cymbalta) Depression:

p

20 mg PO bid; max 60 mg/day given
once daily or divided bid. Generalized anxiety disorder: y

Start 30 to 60 mg

PO daily, max 120 mg/day. Diabetic peripheral neuropathic pain: p p
p
p

60 mg PO
daily. Fibromyalgia:

y g

Start 30 to 60 mg PO daily, max 60 mg/day. Suicidality, hepatotoxicity, many drug interactions. [Trade only: Caps 20, 30, 60 mg.] `L

♀C ? $$$$

VENLAFAXINE ( Effexor, Effexor XR

R)

Depression/anxiety:

p
y Start 37.5 to 75
mg PO daily (Effexor XR) or 75 mg/day divided bid to tid (Effexor). Usual effective dose is 150 to 225 mg/day, max 225 mg/day (Effexor XR) or 375
mg/day (Effexor). Generalized anxiety disorder:

y

Start 37.5 to 75 mg PO daily

(Effexor XR), max 225 mg/day. Social anxiety disorder: y

75 mg PO daily (Effexor

XR). Panic disorder: Start 37.5 mg PO daily (Effexor XR), may titrate by 75
mg/day at weekly intervals to max 225 mg/day. Suicidality, seizures, HTN.

[Trade only: Caps, extended-release 37.5, 75, 150 mg. Generic/Trade: Tabs 25, 37.5, 50, 75, 100 mg. Generic only: Tabs, extended-release 37.5, 75, 150, 225
mg.] `LK ♀C but – in 3rd trimester ? $$$$

Antidepressants—Other

BUPROPION ( Wellbutrin, Wellbutrin SR, Wellbutrin XL, Aplenzin, Zyban, Buproban)

n

Depression:

p

Start 100 mg PO bid (immediate-release tabs); can
increase to 100 mg tid after 4 to 7 days. Usual effective dose is 300 to 450 mg/

(cont.)

Psychiatry

139
day, max 150 mg/dose and 450 mg/day. Sustained-release: Start 150 mg PO
qam; may increase to 150 mg bid after 4 to 7 days, max 400 mg/day. Give last dose no later than 5 pm. Extended-release: Start 150 mg PO qam; may increase to 300 mg qam after 4 days, max 450 mg qam. Extended-release (Aplenzin): Start 174 mg PO qam; increase to target dose of 348 mg/day after 4 days or more. May increase to max dose of 522 mg/day after 4 weeks or more. Seasonal affective disorder: Start 150 mg of extended-release PO qam in autumn; can increase to 300 mg qam after 1 week, max 300 mg/day. In the spring, decrease to 150 mg/day for 2 weeks and then discontinue. Smoking cessation g

(Zyban,

Buproban): Start 150 mg PO qam for 3 days, then increase to 150 mg PO bid for 7 to 12 weeks. Max 150 mg PO bid. Give last dose no later than 5 pm. Seizures, suicidality. [Generic/Trade (for depression, bupropion HCl): Tabs 75, 100 mg.

Sustained-release tabs 100, 150, 200 mg. Extended-release tabs 150, 300 mg (Wellbutrin XL). Generic/Trade (smoking cessation): Sustained-release tabs 150 mg (Zyban, Buproban). Trade only: Extended-release (Aplenzin, bupropion hydrobromide) tabs 174, 348, 522 mg.] `LK ♀C – $$$$

MIRTAZAPINE ( Remeron, Remeron SolTab)

b

Start 15 mg PO qhs. Usual
effective dose is 15 to 45 mg/day. Agranulocytosis in 0.1% of patients.

Suicidality. [Generic/Trade: Tabs 15, 30, 45 mg. Tabs, orally disintegrating (SolTab) 15, 30, 45 mg. Generic only: Tabs 7.5 mg.] `LK ♀C ? $$

TRAZODONE

Depression:

p

Start 50 to 150 mg/day PO in divided doses; usual
effective dose is 400 to 600 mg/day. Insomnia: 50 to 150 mg PO qhs. [Generic only: Tabs 50, 100, 150, 300 mg.] `L ♀C – $

Antimanic (Bipolar) Agents

LAMOTRIGINE ( Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR) R Adults
with bipolar disorder
p

(maintenance): Start 25 mg PO daily
r

, 50 mg PO daily if on
enzyme-inducing drugs, or 25 mg PO every other day if on valproate; titrate to 200 mg/day, 400 mg/day divided bid if on enzyme-inducing drugs, or 100 mg/
day if on valproate. Potentially life-threatening rashes in 0.3% of adults and 0.8% of children; discontinue at fi rst sign of rash. Drug interaction with valproic acid; see product information for adjusted dosing guidelines. [Generic/Trade: Chewable dispersible tabs (Lamictal CD) 5, 25 mg. Tabs 25, 100, 150, 200 mg.

Trade only: Orally disintegrating tabs (ODT) 25, 50, 100, 200 mg. Extended-release tabs (XR) 25, 50, 100, 200 mg.] `LK ♀C (see notes) – $$$$

LITHIUM ( Eskalith, Eskalith CR, Lithobid,  Lithane) Acute mania: Start 300
to 600 mg PO bid to tid; usual effective dose is 900 to 1800 mg/day. Steady state is achieved in 5 days. Bipolar maintenance usually 900 to 1200 mg/day titrated to therapeutic trough level of 0.6 to 1.2 mEq/L. [Generic/Trade: Caps 300, Extended-release tabs 300, 450 mg. Generic only: Caps 150, 600 mg, Tabs 300 mg, Syrup 300/5 mL.] `K ♀D – $

TOPIRAMATE ( Topamax)

x

Bipolar disorder
p

(unapproved): Start 25 to 50 mg/
day PO. Titrate prn to max 400 mg/day divided bid. [Generic/Trade: Tabs 25, 50, 100, 200 mg. Sprinkle caps 15, 25 mg.] `K ♀C ? $$$$$

VALPROIC ACID ( Depakote, Depakote ER, Stavzor, divalproex,  Epiject, Epival, Deproic) Mania: 250 mg PO tid (Depakote) or 25 mg/kg once daily (cont.)

140 Psychiatry

(Depakote ER); max 60 mg/kg/day. Hepatotoxicity, drug interactions, reduce dose in the elderly. [Generic only: Syrup (Valproic acid) 250 mg/5 mL. Generic/

Trade: Delayed-release tabs (Depakote) 125, 250, 500 mg. Extended-release tabs (Depakote ER) 250, 500 mg. Delayed-release sprinkle caps (Depakote) 125 mg. Trade only (Stavzor): Delayed-release caps 125, 250, 500 mg.] `L

♀D + $$$$

Antipsychotics—1st Generation (Typical)

CHLORPROMAZINE ( Thorazine) Start 10 to 50 mg PO/IM bid to tid, usual dose 300 to 800 mg/day. [Generic only: Tabs 10, 25, 50, 100, 200 mg. Generic/

Trade: Oral concentrate 30 mg/mL, 100 mg/mL. Trade only: Syrup 10 mg/5 mL.

Suppositorys 25, 100 mg.] `LK ♀C – $$$

FLUPHENAZINE ( Prolixin,  Modecate, Modeten) 1.25 to 10 mg/day IM divided q 6 to 8 h. Start 0.5 to 10 mg/day PO divided q 6 to 8 h. Usual effective dose 1 to 20 mg/d. Depot (fl uphenazine decanoate/enanthate): 12.5
to 25 mg IM/SC q 3 weeks is equivalent to 10 to 20 mg/day PO fl uphenazine.

[Generic/Trade: Tabs 1, 2.5, 5, 10 mg. Elixir 2.5 mg/5 mL. Oral concentrate 5 mg/mL.] `LK ♀C ? $$$

HALOPERIDOL ( Haldol ) 2 to 5 mg IM. Start 0.5 to 5 mg PO bid to tid, usual effective dose 6 to 20 mg/day. Therapeutic range 2 to 15 ng/mL. Depot haloperidol (haloperidol decanoate): 100 to 200 mg IM q 4 weeks is equivalent to 10 mg/day oral haloperidol. [Generic only: Tabs 0.5, 1, 2, 5, 10, 20 mg. Oral concentrate 2 mg/mL.] `LK ♀C – $$

PERPHENAZINE Start 4 to 8 mg PO tid or 8 to 16 mg PO bid to qid (hospitalized patients), maximum 64 mg/day PO. Can give 5 to 10 mg IM q 6 h, maximum 30 mg/day IM. [Generic only: Tabs 2, 4, 8, 16 mg. Oral concentrate 16 mg/

5 mL.] `LK ♀C ? $$$

PIMOZIDE ( Orap)

p

Tourette’s: Start 1 to 2 mg/day PO in divided doses, increase q 2 days to usual effective dose of 1 to 10 mg/day. [Trade only: Tabs 1, 2 mg.] `L ♀C – $$$

THIORIDAZINE ( Mellaril,  Rideril ) Start 50 to 100 mg PO tid, usual dose 200 to 800 mg/day. Not fi rst line therapy. Causes QTc prolongation, torsade de pointes, and sudden death. Contraindicated with SSRIs, propranolol, pindolol.

Monitor baseline ECG and potassium. Pigmentary retinopathy with doses

>800 mg/day. [Generic only: Tabs 10, 15, 25, 50, 100, 150, 200 mg. Oral concentrate 30, 100 mg/mL.] `LK ♀C ? $$

THIOTHIXENE ( Navane) Start 2 mg PO tid. Usual effective dose is 20 to 30 mg/day, maximum 60 mg/day PO. [Generic/Trade: Caps 1, 2, 5, 10. Oral concentrate 5 mg/mL. Trade only: Caps 20 mg.] `LK ♀C ? $$$

TRIFLUOPERAZINE ( Stelazine) Start 2 to 5 mg PO bid. Usual effective dose is 15 to 20 mg/day. [Generic/Trade: Tabs 1, 2, 5, 10 mg. Trade only: Oral concentrate 10 mg/mL.] `LK ♀C – $$$

Antipsychotics—2nd Generation (Atypical)

ARIPIPRAZOLE ( Abilify, Abilify Discmelt ) Schizophrenia: p

Start 10 to 15 mg

PO daily. Max 30 mg daily. Bipolar disorder:

p

Start 15 mg PO daily. Max 30 mg/day.

(cont.)

Psychiatry

141

Agitation associated with schizophrenia or bipolar disorder: g
p
p

9.75 mg IM
recommended. May consider 5.25 to 15 mg if indicated. May repeat in 2 h up to max 30 mg/day. Depression, adjunctive therapy:

p

,
j
py Start 2 to 5 mg PO daily.

Max 15 mg/day. [Trade only: Tabs 2, 5, 10, 15, 20, 30 mg. Oral soln 1 mg/mL

(150 mL). Orally disintegrating tabs (Discmelt) 10, 15, 20, 30 mg.] `L ♀C

? $$$$$

CLOZAPINE ( Clozaril, FazaClo ODT ) Start 12.5 mg PO daily or bid.

Usual effective dose is 300 to 450 mg/day divided bid, max 900 mg/day.

Agranulocytosis 1 to 2%; check WBC and ANC weekly for 6 months, then q 2 weeks. Seizures, myocarditis, cardiopulmonary arrest. [Generic/Trade: Tabs 25, 100 mg. Generic only: Tabs 12.5, 50, 200 mg. Trade only: Orally disintegrating tab (Fazaclo ODT) 12.5, 25, 100 mg (scored).] `L ♀B – $$$$$

ILOPERIDONE ( Fanapt ) Start 1 mg PO bid. Increase to 2 mg PO bid on day 2, then by 2 mg per dose each day to usual effective range of 6 to 12 mg PO bid.

Max 24 mg/day. [Trade: Tabs 1, 2, 4, 6, 8, 10, 12 mg.] `L ♀C – ?

ANTIPSYCHOTIC RELATIVE ADVERSE EFFECTSa

Hy-

Diabetes/

Gener-

Anticho- Seda-

Weight

Dyslipi-

Antipsychotic
poten-

EPS

Hyperg-
ation
linergic
tion

Gain
demia
sion
lycemia

1st
chlorprom-
chlorp
chlor

+++

+++

++

++

++

?

?

azine

1st
fl uphenazine

++

+

+

++++

++

?

?

1st
haloperidol

+

+

+

++++

++

0

?

1st
loxapine

++

+

+

++

+

?

?

1st
molindone

++

++

+

++

+

?

?

1st
perphenazine

++

++

+

++

+

+/?

?

1st
pimozide

+

+

+

+++

?

?

?

1st
thioridazine

++++

+++

+++

+

+++

+/?

?

1st
thiothixene

+

++

++

+++

++

?

?

1st
trifl uopera-
trifl u
trifl

++

+

+

+++

++

?

?

zine

2nd
aripiprazole

++

+

0

0

0/+

0

0

2nd
clozapine

++++

+++

+++

0

+++

+

+

2nd
olanzapine

+++

++

+

0b

+++

+

+

2nd
risperidone

+

++

+

+b

++

?

?

2nd
quetiapine

+

+++

++

0

++

?

?

2nd
ziprasidone

+

+

0

0

0/+

0

0
aRisk of specifi c adverse effects is graded from 0 (absent) to ++++ (high). ? = Limited or inconsistent comparative data. bEPS (EPS) are dose-related and are more likely for risperidone >6-8 mg/day / olanzapine

>20 mg/day. Akathisia risk remains unclear and may not be refl ected in these ratings. There are limited comparative data for aripiprazole relative to other second generation antipsychotics.

References: Goodman & Gilman 11e p461-500, Applied Therapeutics 8e p78, APA schizophrenia practice guideline, Psychiatry Q 2002; 73:297, Diabetes Care 2004; 27:596.

142 Psychiatry

OLANZAPINE ( Zyprexa, Zyprexa Zydis)

s

Agitation in acute bipolar mania or
g
p
schizophrenia:

p

Start 10 mg IM (2.5 to 5 mg in elderly or debilitated patients); may repeat in 2 h to max 30 mg/day. Schizophrenia, oral therapy: p

,
py Start 5 to

10 mg PO daily; usual effective dose is 10 to 15 mg/day. Bipolar disorder p

,
maintenance treatment or monotherapy for acute manic or mixed episodes: p

Start 10 to 15 mg PO daily. Increase by 5 mg/day at intervals after 24 h to usual effective dose of 5 to 20 mg/day, max 20 mg/day. Bipolar disorder p

,
adjunctive for acute manic or mixed episodes:

p

Start 10 mg PO daily; usual
effective dose is 5 to 20 mg/day, max 20 mg/day. Bipolar depression, p
p

,
olanzapine + fl uoxetine: Start 5 mg olanzapine + 20 mg fl uoxetine daily in the evening. Increase to usual range of 5 to 12.5 mg olanzapine plus 20
to 50 mg fl uoxetine as tolerated. Treatment-resistant depression, p

, olanzapine

+ fl uoxetine: Start 5 mg olanzapine + 20 mg fl uoxetine daily in the evening.

Increase to usual range of 5 to 20 mg olanzapine plus 20 to 50 mg fl uoxetine as tolerated. [Trade only: Tabs 2.5, 5, 7.5, 10, 15, 20 mg. Tabs, orally-disintegrating (Zyprexa Zydis) 5, 10, 15, 20 mg.] `L ♀C – $$$$$

PALIPERIDONE ( Invega, 9-hydroxyrisperidone) Schizophrenia:

p

Start 6 mg

PO qam. 3 mg/day may be suffi cient in some. Max 12 mg/day. [Trade only: Extended-release tabs 1.5, 3, 6, 9 mg.] `KL ♀C – $$$$$

QUETIAPINE ( Seroquel, Seroquel XR)

Schizophrenia: Start 25 mg PO bid

(regular tabs); increase by 25 to 50 mg bid to tid on day 2 and 3, and then to target dose of 300 to 400 mg/day divided bid to tid on day 4. Usual effective dose is 150 to 750 mg/day, max 800 mg/day. Schizophrenia, extended-release tabs: Start 300 mg PO daily in evening, increase by up to 300 mg/day at intervals of more than 1 day to usual effective range of 400 to 800 mg/day.

Acute bipolar mania: Start 50 mg PO bid on day 1, then increase to no higher than 100 mg bid on day 2, 150 mg bid on day 3, and 200 mg bid on day 4.

May increase prn to 300 mg bid on day 5 and 400 mg bid thereafter. Usual effective dose is 400 to 800 mg/day. Bipolar depr
p ession: 50 mg PO hs on day

1, 100 mg hs day 2, 200 mg hs day 3, and 300 mg hs day 4. May increase prn to 400 mg hs on day 5 and 600 mg hs on day 8. Bipolar maintenance: Continue dose required to maintain remission. Eye exam for cataracts recommended q 6 months. [Trade only: Tabs 25, 50, 100, 200, 300, 400 mg. Extended-release tabs 50, 150, 200, 300, 400 mg.] `LK ♀C – $$$$$

RISPERIDONE ( Risperdal, Risperdal Consta)

Schizophrenia
p

(adults):

Start 2 mg/day PO given once daily or divided bid (0.5 mg bid in the elderly, debilitated, or with hypotension, severe renal or hepatic disease); increase by 1 to 2 mg/day (no more than 0.5 mg bid in elderly and debilitated) at intervals of 24 h or more to usual effective dose of 4 to 8 mg/day given once daily or divided bid, max 16 mg/day. Long-acting injection (Consta): Schizophrenia, Bipolar type 1
p

,
p
yp
maintenance; Start 25 mg IM q 2 weeks while
continuing oral dose for 3 weeks. May increase at 4 week intervals to max 50
mg q 2 weeks. Schizophrenia
p

(13 to 17 yo): Start 0.5 mg PO daily; increase by

0.5 to 1 mg/day at intervals of 24 h or more to target dose of 3 mg/day. Max 6 mg/day. Bipolar mania
p

(adults): Start 2 to 3 mg PO daily; may increase by 1 mg/day at 24 h intervals to max 6 mg/day. Bipolar mania (10 to 17 yo): (cont.)

Psychiatry

143

Start 0.5 mg PO daily; increase by 0.5 to 1 mg/day at intervals of 24 h to recommended dose of 2.5 mg/day. Max 6 mg/day. Autistic disorder irritabilityy (age 5 to 16 yo): Start 0.25 mg (for wt less than 20 kg) or 0.5 mg (wt 20 kg or greater) PO daily. May increase after 4 days to 0.5 mg/day (for wt less than 20 kg) or 1.0 mg/day (wt 20 kg or greater). Maintain at least 14 days.

May then increase at 14 days intervals or more by increments of 0.25 mg/
day (for wt less than 20 kg) or 0.5 mg/day (wt 20 kg or greater ) to max 1.0
mg/day (for wt less than 20 kg), 2.5 mg/day (20 to 44 kg) or 3.0 mg/day (wt more than 45 kg). [Generic/Trade: Tabs 0.25, 0.5, 1, 2, 3, 4 mg. Oral soln 1 mg/mL (30 mL). Orally disintegrating tabs 0.5, 2, 3, 4 mg. Trade only: Orally disintegrating tabs (M-TAB) 1 mg.] `LK ♀C – $$$$$

ZIPRASIDONE ( Geodon)

n

Schizophrenia:

p

Start 20 mg PO bid with food; may
adjust at more than 2 day intervals to max 80 mg PO bid. Acute agitation: 10 to 20 mg IM, max 40 mg/day. Bipolar mania: Start 40 mg PO bid with food; may increase to 60 to 80 mg bid on day 2. Usual effective dose is 40
to 80 mg bid. [Trade only: Caps 20, 40, 60, 80 mg, Susp 10 mg/mL.] `L ♀C

– $$$$$

Anxiolytics / Hypnotics—Benzodiazepines—Long Half-Life (25–100 h) BROMAZEPAM ( Lectopam) Canada only. 6 to 18 mg/day PO in divided doses. [Generic/Trade: Tabs 1.5, 3, 6 mg.] `L ♀D – $

CHLORDIAZEPOXIDE ( Librium) Anxiety:

y 5 to 25 mg PO or 25 to 50 mg IM/

IV tid to qid. Acute alcohol withdrawal: 50 to 100 mg PO/IM/IV, repeat q 3 to 4 h prn up to 300 mg/day. Half-life 5 to 30 h. [Generic/Trade: Caps 5, 10, 25
mg.] `LK ♀D – ©IV $$

CLONAZEPAM ( Klonopin, Klonopin Wafer,  Rivotril, Clonapam) m Panic
disorder: Start 0.25 to 0.5 mg PO bid to tid, max 4 mg/day. Half-life 18 to 50
h. Epilepsy:

p p y Start 0.5 mg PO tid. Max 20 mg/day. [Generic/Trade: Tabs 0.5, 1, 2
mg. Orally disintegrating tabs (approved for panic disorder only) 0.125, 0.25, 0.5, 1, 2 mg.] `LK ♀D – ©IV $

CLORAZEPATE ( Tranxene, Tranxene SD)

D

Start 7.5 to 15 mg PO qhs or bid
to tid, usual effective dose is 15 to 60 mg/day. Acute alcohol withdrawal: 60
to 90 mg/day on fi rst day divided bid to tid, reduce dose to 7.5 to 15 mg/day over 5 days. [Generic/Trade: Tabs 3.75, 7.5, 15 mg. Trade only (Tranxene SD): Extended-release Tabs 11.25, 22.5 mg.] `LK ♀D – ©IV $

DIAZEPAM ( Valium, Diastat, Diastat AcuDial,

 Vivol, E Pam,

Diazemuls)

Active seizures: 5 to 10 mg IV q 10 to 15 min to max 30 mg, or 0.2 to 0.5 mg/kg rectal gel PR. Skeletal muscle spasm, spasticity related p

, p
y
to cerebral palsy
p

, paraplegia, athetosis, stiff man syndrome:

y, p
p g ,

,
y

2 to 10 mg PO/

PR tid to qid. Anxiety:

y 2 to 10 mg PO bid to qid. Half-life 20 to 80 h. Alcohol withdrawal: 10 mg PO tid to qid for 24 h then 5 mg PO tid to qid prn. [Generic/

Trade: Tabs 2, 5, 10 mg. Generic only: Oral soln 5 mg/5 mL. Oral concentrate (Intensol) 5 mg/mL. Trade only: Rectal gel (Diastat) 2.5, 5, 10, 15, 20 mg.

Rectal gel (Diastat AcuDial) 10, 20 mg.] `LK ♀D – ©IV $

FLURAZEPAM ( Dalmane) 15 to 30 mg PO qhs. Half-life 70 to 90 h. [Generic/

Trade: Caps 15, 30 mg.] `LK ♀X – ©IV $

144 Psychiatry

Anxiolytics / Hypnotics—Benzodiazepines—Medium Half-Life (10 to 15 h) ESTAZOLAM ( ProSom)

m

1 to 2 mg PO qhs. [Generic/Trade: Tabs 1, 2 mg.] `LK

♀X – ©IV $$

LORAZEPAM ( Ativan) Anxiety:

y 0.5 to 2 mg IV/IM/PO q 6 to 8 h, max 10 mg/
day. Half-life 10 to 20 h. Status epilepticus:

p p

4 mg IV over 2 min; may repeat in

10 to 15 min. Peds status epilepticus:

p p

0.05 to 0.1 mg/kg (max 4 mg) IV over

2 to 5 min; may repeat 0.05 mg/kg once in 10 to 15 min. [Generic/Trade: Tabs 0.5, 1, 2 mg. Generic only: Oral concentrate 2 mg/mL.] `LK ♀D – ©IV $

TEMAZEPAM ( Restoril ) 7.5 to 30 mg PO qhs. Half-life 8 to 25 h. [Generic/

Trade: Caps 15, 30 mg. Trade only: Caps 7.5, 22.5 mg.] `LK ♀X – ©IV $

Anxiolytics / Hypnotics—Benzodiazepines—Short Half-Life ((< 12 h) NOTE To avoid withdrawal, gradually taper when discontinuing after prolonged use. Sedative-hypnotics have been associated with severe allergic reactions and complex sleep behaviors, including sleep driving. Use caution and discuss with patients.

ALPRAZOLAM ( Xanax, Xanax XR, Niravam) 0.25 to 0.5 mg PO bid to tid. Half-life 12 h. Multiple drug interactions. [Generic/Trade: Tabs 0.25, 0.5, 1, 2 mg. Tabs, extended-release 0.5, 1, 2, 3 mg. Orally disintegrating tab (Niravam) 0.25, 0.5, 1, 2 mg. Generic only: Oral concentrate (Intensol) 1 mg/mL.] `LK ♀D – ©IV $

OXAZEPAM ( Serax)

x

10 to 30 mg PO tid to qid. Half-life 8 h. [Generic/Trade: Caps 10, 15, 30 mg. Trade only: Tabs 15 mg.] `LK ♀D – ©IV $$$

TRIAZOLAM ( Halcion)

n

0.125 to 0.5 mg PO qhs. 0.125 mg/day in elderly. Half-life 2 to 3 h. [Generic/Trade: Tabs 0.125, 0.25 mg.] `LK ♀X – ©IV $

Anxiolytics / Hypnotics—Other

BUSPIRONE ( BuSpar, Vansparr)

Anxiety:

y Start 15 mg “dividose” daily (7.5
mg PO bid), usual effective dose 30 mg/day. Max 60 mg/day. [Generic/Trade: Tabs 5, 10, Dividose Tabs 15, 30 mg (scored to be easily bisected or trisected).

Generic only: Tabs 7.5 mg.] `K ♀B – $$$

CHLORAL HYDRATE ( Aquachloral Supprettes, Somnote) 25 to 50 mg/kg/
day up to 1000 mg PO/PR. Many physicians use higher than recommended doses in children (eg, 75 mg/kg). [Generic only: Syrup 500 mg/5 mL, rectal suppositorys 500 mg. Trade only: Caps 500 mg. Rectal suppositorys: 325, 650
mg.] `LK ♀C + ©IV $

ESZOPICLONE ( Lunesta) 2
mg PO qhs prn. Max 3 mg. Elderly: 1 mg PO qhs
prn, max 2 mg. [Trade only: Tabs 1, 2, 3 mg.] `L ♀C ? ©IV $$$$

RAMELTEON ( Rozerem)

m

Insomnia: 8 mg PO qhs. [Trade only: Tabs 8 mg.] `L

♀C ? $$$$

ZALEPLON ( Sonata,  Starnoc) 5
to

10 mg PO qhs prn, max 20 mg. Do not
use for benzodiazepine or alcohol withdrawal. [Generic/Trade: Caps 5, 10
mg.] `L ♀C – ©IV $$$$

ZOLPIDEM ( Ambien, Ambien CR, Zolpimist, Edluarr) Adult: Insomnia: Standard tabs: 10 mg PO qhs. For age older than 65 yo or debilitated: 5 mg (cont.)

Psychiatry

145

PO qhs. Oral spray: 10 mg PO qhs. For age older than 65 yo or debilitated: 5 mg PO qhs. Control-release tabs: 12.5 mg PO qhs. For age older than 65 yo or debilitated: give 6.25 mg PO qhs. Do not use for benzodiazepine or alcohol withdrawal. [Generic/Trade: Tabs 5, 10 mg. Trade only: Controlled-release tabs 6.25, 12.5 mg, oral spray 5 mg/actuation (Zolpimist), sublingual tab 5, 10 mg (Edluar).] `L ♀B + ©IV $$$$

ZOPICLONE ( Imovane) Canada only. Adults: 5 to 7.5 mg PO qhs. Reduce dose in elderly. [Generic/Trade: Tabs 5, 7.5 mg. Generic only: Tabs 3.75
mg.] `L ♀D – $

Combination Drugs

SYMBYAX (olanzapine + fl uoxetine) Bipolar type 1 with depression and p
yp
p
treatment-resistant depression:

p

Start 6/25 mg PO qhs. Max 18/75 mg/day.

[Trade only: Caps (olanzapine/fl uoxetine) 3/25, 6/25, 6/50, 12/25, 12/50
mg.] `LK ♀C – $$$$$

Drug Dependence Therapy

ACAMPROSATE ( Campral )

Maintenance of abstinence from alcohol: 666 mg

(2 tabs) PO tid. Start after alcohol withdrawal and when patient is abstinent.

[Trade only: Tabs, delayed-release 333 mg.] `K ♀C ? $$$$

DISULFIRAM ( Antabuse)

Sobriety:

y 125 to 500 mg PO daily. Patient must
abstain from any alcohol for ≥12 h before using. Metronidazole and alcohol in any form (cough syrups, tonics, etc.) contraindicated. [Trade only: Tabs 250, 500 mg.] `L ♀C ? $$$

NALTREXONE ( ReVia, Depade, Vivitrol ) Alcohol/opioid dependence: p
p

25
to 50 mg PO daily. Avoid if recent ingestion of opioids (past 7 to 10 days).

Hepatotoxicity with higher than approved doses. [Generic/Trade: Tabs 50 mg.

Trade only (Vivitrol): Extended-release injectable susp kits 380 mg.] `LK ♀C

? $$$$

NICOTINE GUM ( Nicorette, Nicorette DS)

S Smoking cessation:

g

Gradually
taper: 1 piece q 1 to 2 h for 6 weeks, 1 piece q 2 to 4 h for 3 weeks, then 1 piece q 4 to 8 h for 3 weeks, max 30 pieces/day of 2 mg or 24 pieces/day of 4 mg.

Use Nicorette DS 4 mg/piece in high cigarette use (more than 24 cigarettes/
day). [OTC/Generic/Trade: Gum 2, 4 mg.] `LK ♀C – $$$$$

NICOTINE INHALATION SYSTEM ( Nicotrol Inhaler,  Nicorette inhaler) 6
r
to

16 cartridges/day for 12 weeks [Trade only: Oral inhaler 10 mg/cartridge (4
mg nicotine delivered), 42 cartridges/box.] `LK ♀D – $$$$$

NICOTINE LOZENGE ( Commit, Nicorette)

Smoking cessation:

g

In those who
smoke within 30 min of waking use 4 mg lozenge; others use 2 mg. Take 1 to 2
lozenges q 1 to 2 h for 6 weeks, then q 2 to 4 h in week 7 to 9, then q 4 to 8 h in weeks 10 to 12. Length of therapy 12 weeks. [OTC Generic/Trade: Lozenge 2, 4 mg in 48, 72, 168 count packages.] `LK ♀D – $$$$$

NICOTINE NASAL SPRAY ( Nicotrol NS)

S

Smoking cessation:

g

1 to 2 doses each
h, each dose is 2 sprays, 1 in each nostril (1 spray contains 0.5 mg nicotine).

Minimum recommended: 8 doses/day, max 40 doses/day. [Trade only: Nasal soln 10 mg/mL (0.5 mg/inhalation); 10 mL bottles.] `LK ♀D – $$$$$

146 Psychiatry

NICOTINE PATCHES ( Habitrol, NicoDerm CQ, Nicotrol,  Prostepp) Smoking g
cessation: Start 1 patch (14 to 22 mg) daily, taper after 6 weeks. Ensure patient has stopped smoking. [OTC/Rx/Generic/Trade: Patches 11, 22 mg/24
h. 7, 14, 21 mg/24 h (Habitrol and NicoDerm). OTC/Trade: 15 mg/16 h (Nicotrol).] `LK ♀D – $$$$

SUBOXONE (buprenorphine + naloxone) Treatment of opioid dependence:

p
p

Maintenance: 16 mg SL daily. Can individualize to range of 4 to 24 mg SL
daily. [Trade only: SL tabs 2/0.5 mg and 8/2 mg buprenorphine/naloxone.] `L

♀C – ©III $$$$$

VARENICLINE ( Chantix)

x

Smoking cessation:

g

Start 0.5 mg PO daily for day 1
to 3, then 0.5 mg bid days 4 to 7, then 1 mg bid thereafter. Take after meals with full glass of water. Start 1 week prior to cessation and continue for 12
weeks. [Trade only: Tabs 0.5, 1 mg.] `K ♀C ? $$$$

Stimulants / ADHD / Anorexiants

ADDERALL (dextroamphetamine + amphetamine) ( Adderall XR) ADHD,
standard-release tabs: Start 2.5 mg (3 to 5 yo) or 5 mg (age 6 yo or older) PO
daily to bid, increase by 2.5 to 5 mg q week, max 40 mg/day. ADHD, extended-release caps (Adderall XR): If age 6 to 12 yo, then start 5 to 10 mg PO daily to a max of 30 mg/day. If 13 to 17 yo, then start 10 mg PO daily to a max of 20
mg/day. If adult, then 20 mg PO daily. Narcolepsy
p ,
y standard-release: Start 5 to

10 mg PO qam, increase by 5 to 10 mg q week, max 60 mg/day. Avoid evening doses. Monitor growth and use drug holidays when appropriate. [Generic/

Trade: Tabs 5, 7.5, 10, 12.5, 15, 20, 30 mg. Trade only: Caps, extended-release (Adderall XR) 5, 10, 15, 20, 25, 30 mg.] `L ♀C – ©II $$$$

ARMODAFINIL ( Nuvigil ) Obstructive sleep apnea/hypopnea syndrome and p p
yp p
y
narcolepsy:

p y 150 to 250 mg PO qam. Inconsistent evidence for improved effi cacy of 250 mg/day dose. Shift work sleep disorder: 150 mg PO 1 h prior to start of shift. [Trade only: Tabs 50, 100, 150, 200, 250 mg.] `L ♀C ?

©IV $$$$$

ATOMOXETINE ( Strattera)

ADHD: All ages wt greater than 70 kg: Start 40 mg

PO daily, then increase after more than 3 days to target of 80 mg/day divided daily to bid. Max 100 mg/day. [Trade only: Caps 10, 18, 25, 40, 60, 80, 100
mg.] `K ♀C ? $$$$$

BODY MASS INDEX*

Heights are in feet and inches; weights are in pounds BMI

Class.

4′ 10″

0

5′ 0″

5′ 4″

5′ 8″

6′ 0″

6′ 4″

<19

Underweight

<91

<97

<110

<125

<140

<156

19–24

Healthy

91–119

97–127

110–144 125–163 140–183 156–204

Weight

25–29

Overweight

120–143 128–152 145–173 164–196 184–220 205–245

30–40

Obese

144–191 153–204 174–233 197–262 221–293 246–328

>40

Very Obese

>191

>204

>233

>262

>293

>328

*BMI = kg/m2 = (wt in pounds)(703)/(height in inches)2. Anorectants appropriate if BMI ≥30 (with comori-bidities ≥27); surgery an option if BMI >40 (with comorbidities 35–40). www.nhlbi.nih.gov

Psychiatry

147

CAFFEINE ( NoDoz, Vivarin, Caffedrine, Stay Awake, Quick-Pep, Cafcit ) 100
to 200 mg PO q 3 to 4 h prn. [OTC Generic/Trade: Tabs/Caps 200 mg. Oral soln caffeine citrate (Cafcit) 20 mg/mL. OTC Trade only: Extended-release tabs 200
mg. Lozenges 75 mg.] `L ♀B/C ? $

DEXMETHYLPHENIDATE ( Focalin, Focalin XR

R) ADHD,, extended-release, not
already on stimulants: 5 mg (children) or 10 mg (adults) PO qam. Immediate-release, not already on stimulants: 2.5 mg PO bid. Max 20 mg/day for both.

If taking racemic methylphenidate use conversion of 2.5 mg for each 5 mg of methylphenidate, max 20 mg/day. [Generic/Trade: Tabs, immediate-release 2.5, 5, 10 mg. Trade only: Extended-release caps (Focalin XR) 5, 10, 15, 20
mg.] `LK ♀C ? ©II $$$

DEXTROAMPHETAMINE ( Dexedrine, Dextrostat ) Narcolepsy: p y Age 6 to 12 yo:

Start 5 mg PO qam, increase by 5 mg/day q week. Age older than 12 yo: Start 10 mg PO qam, increase by 10 mg/day q week. Usual dose range 5 to 60
mg/day in divided doses (tabs) or daily (extended-release). ADHD: 2.5 to 5
mg PO qam, usual max 40 mg/day. Avoid evening doses. Monitor growth and use drug holidays when appropriate. [Generic/Trade: Caps, extended-release 5, 10, 15 mg. Generic only: Tabs 5, 10 mg. Oral soln 5 mg/5 mL.] `L ♀C

– ©II $$$$

LISDEXAMFETAMINE ( Vyvanse) ADHD adults and children ages 6 to 12 yo: Start 30 mg PO qam. May increase weekly by 10 to 20 mg/day to max 70
mg/day. Avoid evening doses. Monitor growth and use drug holidays when appropriate. [Trade: Caps 20, 30, 40, 50, 60, 70 mg.] `L ♀C – ©II $$$$

METHYLPHENIDATE ( Ritalin, Ritalin LA, Ritalin SR, Methylin, Methylin ER, Metadate ER, Metadate CD, Concerta, Daytrana,  Biphentin) n

ADHD/

Narcolepsy:

p y 5 to 10 mg PO bid to tid or 20 mg PO qam (sustained and extended-release), max 60 mg/day. Or 18 to 36 mg PO qam (Concerta), max 72 mg/day.

Avoid evening doses. Monitor growth and use drug holidays when appropriate.

[Trade only: Tabs 5, 10, 20 mg (Ritalin, Methylin, Metadate). Extended-release tabs 10, 20 mg (Methylin ER, Metadate ER). Extended-release tabs 18, 27, 36, 54 mg (Concerta). Extended-release caps 10, 20, 30, 40, 50, 60 mg (Metadate CD) May be sprinkled on food. Sustained-release tabs 20 mg (Ritalin SR).

Extended-release caps 10, 20, 30, 40 mg (Ritalin LA). Chewable tabs 2.5, 5, 10 mg (Methylin). Oral soln 5 mg/5 mL, 10 mg/5 mL (Methylin). Transdermal patch (Daytrana) 10 mg/9 h, 15 mg/9 h, 20 mg/9 h, 30 mg/9 h. Generic only: Tabs 5, 10, 20 mg, extended-release tabs 10, 20 mg, sustained-release tabs 20 mg.] `LK ♀C ? ©II $$

MODAFINIL ( Provigil,  Alertec) Narcolepsy and sleep apnea/hypopnea: p y
p p
yp p

200
mg PO qam. Shift work sleep disorder:

p

200 mg PO 1 h before shift. [Trade only:

Tabs 100, 200 mg.] `L ♀C ? ©IV $$$$$

PHENTERMINE ( Adipex-P, Ionamin, Pro-Fast ) 8 mg PO tid or 15 to 37.5 mg/
day qam or 10 to 14 h before retiring. For short-term use. [Generic/Trade: Caps 15, 30, 37.5 mg. Tabs 37.5 mg. Trade only: Caps, extended-release 15, 30 mg (Ionamin). Generic only (Pro-Fast): Caps 18.75 mg, Tabs 8 mg.] `KL

♀C – ©IV $$

SIBUTRAMINE ( Meridia) Start 10 mg PO qam, max 15 mg/day. Monitor pulse and BP. [Trade only: Caps 5, 10, 15 mg.] `KL ♀C – ©IV $$$$

148 Pulmonary

PULMONARY

Beta Agonists—Short-Acting

ALBUTEROL ( AccuNeb, Ventolin HFA, Proventil HFA, ProAir HFA, VoSpire ER,  Airomir, Asmavent, salbutamol ) MDI 2 puffs q 4 to 6 h prn. 0.5 mL
of 0.5% soln (2.5 mg) nebulized tid to qid. One 3 mL unit dose (0.083%) nebulized tid to qid. Caps for inhalation 200 to 400 mcg q 4 to 6 h. 2 to 4 mg PO tid to qid or extended-release 4 to 8 mg PO q 12 h up to 16 mg PO q 12 h.

Peds: 0.1 to 0.2 mg/kg/dose PO tid up to 4 mg tid for age 2 to 5 yo, 2 to 4 mg or extended-release 4 mg PO q 12 h for age 6 to 12 yo. Prevention of exercise-induced bronchospasm:

p

MDI: 2 puffs 15 to 30 min before exercise. [Trade
only: MDI 90 mcg/actuation, 200 metered doses/canister. “HFA” inhalers use hydrofl uoroalkane propellant instead of CFCs but are otherwise equivalent.

Generic/Trade: Soln for inhalation 0.021% (AccuNeb), 0.042% (AccuNeb), and 0.083% in 3 mL vials, 0.5% (5 mg/mL) in 20 mL with dropper. Tabs extended-release 4, 8 mg (VoSpire ER). Generic only: Syrup 2 mg/5 mL. Tabs immediate-release 2, 4 mg.] `L ♀C ? $$

FENOTEROL ( Berotec) Canada only. 1 to 2 puffs prn tid to qid. Nebulizer: Up to 2.5 mg q 6 h. [Trade only: MDI 100 mcg/actuation. Soln for inhalation: 20
mL bottles of 1 mg/mL (with preservatives that may cause bronchoconstriction in those with hyperreactive airways).] `L ♀C ? $

LEVALBUTEROL ( Xopenex, Xopenex HFA) MDI

2 puffs q 4 to 6 h prn.

Nebulizer 0.63 to 1.25 mg q 6 to 8 h. Peds: 0.31 mg nebulized tid for age 6
to 11 yo. [Generic/Trade: Soln for inhalation 0.31, 0.63, 1.25 mg in 3 mL and 1.25 mg in 0.5 mL unit-dose vials. Trade only: HFA MDI 45 mcg/actuation, 15 g 200/canister. “HFA” inhalers use hydrofl uoroalkane propellant.] `L ♀C

? $$$

METAPROTERENOL ( Alupent,  orciprenaline) MDI 2 to 3 puffs q 3 to 4 h.

0.2 to 0.3 mL 5% soln nebulized q 4 h. Peds: 20 mg PO tid to qid age older than 9 yo, 10 mg PO tid to qid if age 6 to 9 yo, 1.3 to 2.6 mg/kg/day divided tid to qid if age 2 to 5 yo. [Trade only: MDI 0.65 mg/actuation, 14 g 200/
canister. Generic/Trade: Soln for inhalation 0.4%, 0.6% in 2.5 mL unit-dose vials. Generic only: Syrup 10 mg/5 mL, Tabs 10, 20 mg.] `L ♀C ? $$

PIRBUTEROL ( Maxair Autohaler)

r

MDI: 1 to 2 puffs q 4 to 6 h. [Trade only:

MDI 200 mcg/actuation, 14 g 400/canister.] `L ♀C ? $$$$

Beta Agonists—Long-Acting

ARFORMOTEROL ( Brovana) COPD: 15 mcg nebulized bid. [Trade only: Soln for inhalation 15 mcg in 2 mL vial.] `L ♀C ? $$$$$

FORMOTEROL ( Foradil, Perforomist,  Oxeze Turbuhalerr) 1 puff bid.

Nebulized: 20 mcg q 12 h. Not for acute bronchospasm. Use only in combination with corticosteroids. [Trade only: DPI 12 mcg, 12, 60 blisters/
pack (Foradil). Soln for inhalation: 20 mcg in 2 mL vial (Perforomist). Canada only (Oxeze): DPI 6, 12 mcg 60 blisters/pack.] `L ♀C ? $$$

Pulmonary

149

SALMETEROL ( Serevent Diskus)

s

1 puff bid. Not for acute bronchospasm.

Use only in combination with corticosteroids. [Trade only: DPI (Diskus): 50
mcg, 60 blisters.] `L ♀C ? $$$$

Combinations

ADVAIR ( Advair HFA) (fl uticasone—inhaled + salmeterol) Asthma: DPI: 1
puff bid (all strengths). MDI: 2 puffs bid (all strengths). COPD: DPI: 1 puff bid (250/50 only). [Trade only: DPI: 100/50, 250/50, 500/50 mcg fl uticasone/
salmeterol per actuation; 60 doses/DPI. Trade only (Advair HFA): MDI 45/21, 115/21, 230/21 mcg fl uticasone/salmeterol per actuation; 120 doses/
canister.] `L ♀C ? $$$$$

COMBIVENT (albuterol + ipratropium) 2 puffs qid, max 12 puffs/day.

Contraindicated with soy or peanut allergy. [Trade only: MDI: 90 mcg albuterol/18 mcg ipratropium per actuation, 200/canister.] `L ♀C ? $$$$

DUONEB (albuterol + ipratropium) ( Combivent inhalation solnn ) 1
unit
dose qid. [Generic/Trade: Unit dose: 2.5 mg albuterol base/0.5 mg ipratropium per 3 mL vial, premixed; 30, 60 vials/carton.] `L ♀C ? $$$$$

SYMBICORT (budesonide + formoterol ) Asthma: 2 puffs bid (both strengths). COPD: 2 puffs bid (160/4.5). [Trade only: MDI: 80/4.5, 160/4.5 mcg budesonide/formoterol per actuation; 120 doses/canister.] `L ♀C ? $$$$

Inhaled Steroids

NOTE See Endocrine-Corticosteroids when oral steroids necessary.

BECLOMETHASONE—INHALED ( QVAR) 1 to 4 puffs bid (40 mcg). 1 to 2 puffs bid (80 mcg). [Trade only: HFA MDI: 40, 80 mcg/actuation, 100 actuations/
canister.] `L ♀C ? $$$

BUDESONIDE—INHALED ( Pulmicort Respules, Pulmicort Flexhalerr) 1
to

2 puffs daily up to 4 puffs bid. Respules: 0.5 to 1 mg daily or divided bid.

[Trade only: DPI (Flexhaler) 90, 180 mcg powder/actuation 60, 120 doses respectively/canister, Respules 1 mg/2 mL unit dose. Generic/Trade: Respules 0.25, 0.5 mg/2 mL unit dose.] `L ♀B ? $$$$

CICLESONIDE—INHALED ( Alvesco) 80 mcg/puff: 1 to 4 puffs bid. 160 mcg/
puff: 1 to 2 puffs bid. [Trade only: 80 mcg/actuation, 60 per canister. 160 mcg/
actuation, 60, 120 per canister.] `L ♀C ? $$$$

FLUNISOLIDE—INHALED ( AeroBid, AeroBid-M, Aerospan) 2 to 4 puffs bid.

[Trade only: MDI: 250 mcg/actuation, 100 metered doses/canister. AeroBid-M

(AeroBid + menthol fl avor). Aerospan HFA MDI: 80 mcg/actuation, 60, 120
metered doses/canister.] `L ♀C ? $$$

FLUTICASONE—INHALED ( Flovent HFA, Flovent Diskus) 2 to 4 puffs bid.

[Trade only: HFA MDI: 44, 110, 220 mcg/actuation 120/canister. DPI (Diskus): 50, 100, 250 mcg/actuation delivering 44, 88, 220 mcg respectively.] `L ♀C

? $$$$

MOMETASONE—INHALED ( Asmanex Twisthaler) 1 to 2 puffs in the evening or 1 puff bid. If prior oral corticosteroid therapy: 2 puffs bid. [Trade only: DPI: 110 mcg/actuation with #30 dosage units, 220 mcg/actuation with #30, 60, 120 dosage units.] `L ♀C ? $$$$

150 Pulmonary

TRIAMCINOLONE—INHALED ( Azmacort ) 2 puffs tid to qid or 4 puffs bid; max dose 16 puffs/day. [Trade only: MDI: 75 mcg/actuation, 240/canister.

Built-in spacer.] `L ♀C ? $$$$

Leukotriene Inhibitors

MONTELUKAST ( Singulair)

r

Adults: 10 mg PO daily. Chronic asthma, allergic

,
g
rhinitis: give 5 mg PO daily for age 6 to 14 yo, give 4 mg (chew tab or oral granules) PO daily for age 2 to 5 yo. Asthma age 12 to 23 mo: 4 mg (oral granules) PO daily. Allergic rhinitis
g
age 6 to 23 mo: 4 mg (oral granules)

PO daily. Prevention of exercise-induced bronchoconstriction: 10 mg PO 2 h before exercise. [Trade only: Tabs 10 mg. Oral granules 4 mg packet, 30/box.

Chewable tabs (cherry fl avored) 4, 5 mg.] `L ♀B ? $$$$

ZAFIRLUKAST ( Accolate) 20 mg PO bid. Peds age 5 to 11 yo, 10 mg PO bid.

Take 1 h before or 2 h after meals. Potentiates warfarin & theophylline. [Trade only: Tabs 10, 20 mg.] `L ♀B – $$$$

ZILEUTON ( Zyfl o CR ) 1200 mg PO bid. Hepatotoxicity, potentiates warfarin, theophylline, and propranolol. [Trade only: Tabs, extended-release 600 mg.] `L ♀C ? $$$$$

Other Pulmonary Medications

ACETYLCYSTEINE—INHALED ( Mucomyst ) Mucolytic: y

3 to 5 mL of 20% or 6
to 10 mL of 10% soln nebulized tid to qid. [Generic/Trade: Soln for inhalation 10, 20% in 4, 10, 30 mL vials.] `L ♀B ? $

AMINOPHYLLINE ( Phyllocontin)

n

Acute asthma: Loading dose: 6 mg/kg IV
over 20 to 30 min. Maintenance 0.5 to 0.7 mg/kg/h IV. [Generic only: Tabs 100, 200 mg. Oral liquid 105 mg/5 mL. Canada Trade only: Tabs controlled-release (12 h) 225, 350 mg, scored.] `L ♀C ? $

CROMOLYN—INHALED ( Intal, Gastrocrom,  Nalcrom) Asthma: 2 to 4 puffs qid or 20 mg nebs qid. Prevention of exercise-induced bronchospasm: p

2 puffs

10 to 15 min prior to exercise. Mastocytosis:

y

Oral concentrate 200 mg PO
qid for adults, 100 mg qid in children 2 to 12 yo. [Trade only: MDI 800 mcg/
actuation, 112, 200/canister. Oral concentrate 100 mg/5 mL in 8 amps/foil pouch (Gastrocrom). Generic/Trade: Soln for nebs: 20 mg/2 mL.] `LK ♀B

? $$$

PREDICTED PEAK EXPIRATORY FLOW (liters/min)

Am Rev Resp Diss 1963; 88:644

Age

Women (height in inches)

Men (height in inches)

Child

(yr)

55″ 60″ 65″

70″

75″

60″ 65″ 70″

75″ 80″

(height in
inches)

20 yr

390 423

460

496

529

554 602 649

693 740

44″

160

30 yr

380 413

448

483

516

532 577 622

664 710

46″

187

40 yr

370 402

436

470

502

509 552 596

636 680

48″

214

50 yr

360 391

424

457

488

486 527 569

607 649

50″

240

60 yr

350 380

412

445

475

463 502 542

578 618

52″

267

70 yr

340 369

400

432

461

440 477 515

550 587

54″

293

Pulmonary

151

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80 mcg/puff

90 mcg/dos

180
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250 mc

80

44 mc

110

220 mcg/puff

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100

250 mcg/dos

220 mcg/dos

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152 Toxicology

INHALER COLORS (Body then cap—Generics may differ) Advair:

r
purple

Atrovent HFA: clear/

Proventil HFA: yellow/

Advair HFA:

purple/light
green
orange

purple

Azmacort: white/white Pulmicort: white/brown Aerobid: grey/purple
d

Combiventt: clear/

QVAR 40 mcgg: beige/grey

Aerobid-M: grey/green

orange

QVAR 80 mcgg:

mauve/

Aerospan
purple/grey Flovent HFA: orange/
grey

Alupent : clear/blue

peach

Serevent

Alvesco
brown/red

Foradill: grey/beige

Diskus:

green

80 mcg :

Intal: white/blue
l

Spiriva: grey

Alvesco
red/red

Maxairr: white/white

Ventolin HFA: light
blue/

160 mcg :

Maxair Autohaler: white/white
navy

Asmanex: white/pink
x

ProAir HFA: red/white

Xopenex HFA: blue/red

DORNASE ALFA ( Pulmozyme)

Cystic fi
y
brosis: 2.5 mg nebulized daily to bid.

[Trade only: Soln for inhalation: 1 mg/mL in 2.5 mL vials.] `L ♀B ? $$$$$

EPINEPHRINE RACEMIC ( S-2,  Vaponefrin) n

Severe croup:

p 0.05 mL/kg/dose
diluted to 3 mL w/NS. Max dose 0.5 mL. [Trade only: Soln for inhalation: 2.25%
epinephrine in 15, 30 mL.] `Plasma ♀C – $

IPRATROPIUM—INHALED ( Atrovent, Atrovent HFA) 2 puffs qid, or one 500 mcg vial neb tid to qid. Contraindicated with soy or peanut allergy (Atrovent MDI only). [Trade only: Atrovent HFA MDI: 17 mcg/actuation, 200/
canister. Generic/Trade: Soln for nebulization: 0.02% (500 mcg/vial) in unit dose vials.] `Lung ♀B ? $$$$

KETOTIFEN ( Zaditen) Canada only. For age 6 mo to 3 yo: give 0.05 mg/
kg PO bid. Age older than 3 yo: give 1 mg PO bid. [Generic/Trade: Tabs 1 mg.

Syrup 1 mg/5 mL.] `L ♀C – $$

THEOPHYLLINE ( Elixophyllin, Uniphyl, Theo-24, T-Phyl,

 Theo-Dur,

Theolair)

r

5 to 13 mg/kg/day PO in divided doses. Max dose 900 mg/day.

Peds dosing variable. [Generic/Trade: Elixir 80 mg/15 mL. Trade only: Caps: Theo-24: 100, 200, 300, 400 mg. T-Phyl: 12 Hr SR Tabs 200 mg. Theolair: Tabs 125, 250 mg. Generic only: 12 Hr Tabs 100, 200, 300, 450 mg, 12 Hr Caps 125, 200, 300 mg.] `L ♀C + $

TIOTROPIUM ( Spiriva) COPD: Handihaler: 18 mcg inhaled daily. [Trade only: Caps for oral inhalation 18 mcg. To be used with “Handihaler” device only.

Packages of 5, 30, 90 caps with Handihaler device.] `K ♀C – $$$$

TOXICOLOGY

ACETYLCYSTEINE ( N-acetylcysteine, Mucomyst, Acetadote,  Parvolex) x

Contrast nephropathy prophylaxis:

p
p
y p p y

600 mg PO bid on the day before and on
the day of contrast. Acetaminophen toxicity:

p
y Mucomyst: Loading dose 140 mg/
kg PO or NG, then 70 mg/kg q 4 h for 17 doses. May be mixed in water or soft drink diluted to a 5% soln. Acetadote (IV): Loading dose 150 mg/kg in 200 mL
of D5W infused over 60 min; maintenance dose 50 mg/kg in 500 mL of D5W
infused over 4 h followed by 100 mg/kg in 1000 mL of D5W infused over 16 h.

[Generic/Trade: Soln 10%, 20%. Trade only: IV (Acetadote).] `L ♀B ? $$$$

Toxicology

153

ANTIDOTES

TOXIN

Antidote/Treatment

Toxin

Antidote/Treatment
acetaminophen

N-acetylcysteine
digoxin
dig immune Fab

TCAs
sodium
ethylene glycol
fomepizole
bicarbonate
arsenic, mercury
dimercaprol (BAL)

heparin
protamine
benzodiazepine
fl umazenil
iron
deferoxamine
beta blockers
glucagon
lead

BAL, EDTA, succimer
calcium channel
calcium chloride,
methanol
fomepizole
blockers
glucagon
methemoglobin
methylene blue
cyanide
cyanide antidote kit,
opioids/opiates
naloxone

Cyanokit (hydroxo- organophosphates
atropine+pralidoxime
cobalamin)

warfarin
vitamin K, FFP

CHARCOAL (activated charcoal, Actidose-Aqua, CharcoAid, EZ-Char,

 Charcodate)

e

25 to 100 g (1 to 2 g/kg) PO or NG as soon as possible. May repeat q 1 to 4 h prn at doses equivalent to 12.5 g/h. When sorbitol is coadministered, use only with the fi rst dose if repeated doses are to be given. [OTC/Generic/

Trade: Powder 15, 30, 40, 120, 240 g. Soln 12.5 g/60 mL, 15 g/75 mL, 15 g/120
mL, 25 g/120 mL, 30 g/120 mL, 50 g/240 mL. Susp 15 g/120 mL, 25 g/120 mL, 30
g/150 mL, 50 g/240 mL. Granules 15 g/120 mL.] `Not absorbed ♀+ + $

CYANIDE ANTIDOTE KIT (amyl nitrite + sodium nitrite + sodium thiosulfate) Induce methemoglobinemia with inhaled amyl nitrite 0.3 mL followed by sodium nitrite 300 mg IV over 2 to 4 min. Then administer sodium thiosulfate 12.5 g IV. [Package contains amyl nitrite inhalant (0.3 mL), sodium nitrite (300 mg/10
mL), sodium thiosulfate (12.5 g/50 mL).] `? ♀– ? $$$$$

DEFEROXAMINE ( Desferal )

Chronic iron overload: 500 to 1000 mg IM daily
and 2 g IV infusion (no faster than 15 mg/kg/h) with each unit of blood or 1 to 2 g SC daily (20 to 40 mg/kg/day) over 8 to 24 h via continuous infusion pump.

Acute iron toxicity: IV infusion up to 15 mg/kg/h (consult poison center). `K

♀C ? $$$$$

FLUMAZENIL ( Romazicon) Benzodiazepine sedation reversal: p

0.2 mg IV over

15 sec, then 0.2 mg q 1 min prn up to 1 mg total dose. Overdose reversal: 0.2 mg IV over 30 sec, then 0.3 to 0.5 mg q 30 sec prn up to 3 mg total dose.

Contraindicated in mixed drug OD or chronic benzodiazepine use. `LK ♀C

? $$$$

HYDROXOCOBALAMIN ( Cyanokit ) Cyanide poisoning: y
p
g 5 g IV over 15 min;
may repeat prn. `K ♀C ? $$$$$

IPECAC SYRUP Emesis:

30 mL PO for adults, 15 mL age 1 to 12 yo. [OTC

Generic only: Syrup 30 mL.] `Gut ♀C ? $

METHYLENE BLUE ( Urolene blue)

Methemoglobinemia:

g

1 to 2 mg/kg IV over

5 min. Dysuria:

y

65 to 130 mg PO tid after meals with liberal water. May turn urine/contact lenses blue. [Trade only: Tabs 65 mg.] `K ♀C ? $

PRALIDOXIME ( Protopam, 2-PAM )

Organophosphate poisoning;
g
p
p
p
g; consult
poison center: 1 to 2 g IV infusion over 15 to 30 min or slow IV injection over (cont.)

154 Urology

5 min or longer (max rate 200 mg/min). May repeat dose after 1 h if muscle weakness persists. High dose regimen (unapproved): 2 g over 30 min, followed by 1 g/h for 48 h, then 1 g/h every 4 h until improved. Peds: 20 to 50 mg/kg/dose IV over 15 to 30 min. `K ♀C ? $$$$

SUCCIMER ( Chemet )

Lead toxicityy in children 1 yo or older: Start 10 mg/
kg PO or 350 mg/m2 q 8 h for 5 days, then reduce the frequency to q 12 h for 2 weeks. [Trade only: Caps 100 mg.] `K ♀C ? $$$$$

UROLOGY

Benign Prostatic Hyperplasia

ALFUZOSIN ( UroXatral,  Xatral ) 10
mg PO daily after a meal. [Trade only:

Extended-release tab 10 mg.] `KL ♀B – $$$

DUTASTERIDE ( Avodart ) 0.5 mg PO daily. [Trade only: Caps 0.5 mg.]

`L ♀X – $$$$

FINASTERIDE ( Proscar, Propecia) Proscar: 5 mg PO daily alone or in combination with doxazosin to reduce the risk of symptomatic progression of BPH. Androgenetic alopecia
g
p
in men: Propecia: 1 mg PO daily. [Generic/Trade:

Tabs 1 mg (Propecia), 5 mg (Proscar).] `L ♀X – $$$

TAMSULOSIN ( Flomax) 0.4 mg PO daily, 30 min after a meal. Maximum 0.8 mg/day. [Trade only: Caps 0.4 mg.] `LK ♀B – $$$$

Bladder Agents—Anticholinergics & Combinations DARIFENACIN ( Enablex)

x

Overactive bladder with symptoms of urinary
y p
y
urgency
g

, frequency
y,
q

, and urge incontinence:

y,
g

7.5 mg PO daily. May increase to
max dose 15 mg PO daily in 2 weeks. Max dose 7.5 mg PO daily with moderate liver impairment or when coadministered with potent CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, nelfi navir, clarithromycin & nefazodone).

[Trade only: Extended-release tabs 7.5, 15 mg.] `LK ♀C – $$$$

FESOTERODINE ( Toviaz)

z

Overactive bladder: 4 to 8 mg PO daily. [Trade only: Tabs, extended-release 4, 8 mg.] `plasma ♀C – $$$$

OXYBUTYNIN ( Ditropan, Ditropan XL, Gelnique, Oxytrol,  Oxybutyn, Uromax) Bladder instability:

y 2.5 to 5 mg PO bid to tid, max 5 mg PO qid.

Extended-release tabs: 5 to 10 mg PO daily, increase 5 mg/day q week to 30 mg/day. Oxytrol: 1 patch twice a week on abdomen, hips, or buttocks.

Gelnique: Apply gel once daily to abdomen, upper arms/shoulders, or thighs.

[Generic/Trade: Tabs 5 mg. Syrup 5 mg/5 mL. Extended-release tabs 5, 10, 15
mg. Trade only: Transdermal patch (Oxytrol) 3.9 mg/day. Gelnique 10% gel, 1
g unit dose.] `LK ♀B ? $

PROSED/DS (methenamine + phenyl salicylate + methylene blue + benzoic acid + hyoscyamine)

Bladder spasm:

p

1 tab PO qid with liberal fl uids. May
turn urine/contact lenses blue. [Trade only: Tabs (methenamine 81.6 mg/
phenyl salicylate 36.2 mg/methylene blue 10.8 mg/benzoic acid 9.0 mg/
hyoscyamine sulfate 0.12 mg).] `KL ♀C ? $$

Urology

155

SOLIFENACIN ( VESIcare) Overactive bladder with symptoms of urinary y p
y
urgency
g

, frequency
y,
q

, or urge incontinence:

y,
g

5 mg PO daily. Max dose: 10 mg daily

(5 mg daily if CrCl <30 mL/min, moderate hepatic impairment, or concurrent ketoconazole or other potent CYP3A4 inhibitors). [Trade only: Tabs 5, 10 mg.]

`LK ♀C – $$$$

TOLTERODINE ( Detrol, Detrol LA,  Unidet ) Overactive bladder: 1 to 2 mg PO
bid (Detrol) or 2 to 4 mg PO daily (Detrol LA). [Trade only: Tabs 1, 2 mg. Caps, extended-release 2, 4 mg.] `L ♀C – $$$$

TROSPIUM ( Sanctura, Sanctura XR,  Trosec) Overactive bladder with urge g
incontinence: 20 mg PO bid; give 20 mg qhs if CrCl <30 mL/min. If age 75 yo or older may taper down to 20 mg daily. Extended-release: 60 mg PO qam, 1
h before food. [Trade only: Tabs 20 mg, Caps, extended-release, 60 mg.] `LK

♀C ? $$$$

URISED (methenamine + phenyl salicylate + atropine + hyoscyamine +
benzoic acid + methylene blue)

Dysuria:

y

2 tabs PO qid. May turn urine/
contact lenses blue, don’t use with sulfa. [Trade only: Tabs (methenamine 40.8 mg/phenyl salicylate 18.1 mg/atropine 0.03 mg/hyoscyamine 0.03 mg/

4.5 mg benzoic acid/5.4 mg methylene blue).] `K ♀C ? $

UTA (methenamine + sodium phosphate + phenyl salicylate + methylene blue + hyoscyamine) Bladder
spasm: 1 cap PO qid with liberal fl uids. [Trade
only: Caps (methenamine 120 mg/sodium phosphate 40.8 mg/phenyl salicylate 36 mg/methylene blue 10 mg/hyoscyamine 0.12 mg).] `KL ♀C ? $

UTIRA-C (methenamine + sodium phosphate + phenyl salicylate +
methylene blue + hyoscyamine) Bladder
spasm: 1 cap PO qid with liberal
fl uids. [Trade only: Tabs (methenamine 81.6 mg/sodium phosphate 40.8
mg/phenyl salicylate 36.2 mg/methylene blue 10.8 mg/hyoscyamine 0.12
mg).] `KL ♀C ? $$

Bladder Agents—Other

BETHANECHOL ( Urecholine, Duvoid,  Myotonachol ) Urinary retention: y

10
to 50 mg PO tid–qid. [Generic/Trade: Tabs 5, 10, 25, 50 mg.] `L ♀C ?

$$$$

PHENAZOPYRIDINE ( Pyridium, Azo-Standard, Urogesic, Prodium, Pyridiate, Urodol, Baridium, UTI Relief,  Phenazo) Dysuria: y

200 mg PO tid for 2
days. May turn urine/contact lenses orange. [OTC Generic/Trade: Tabs 95, 97.2 mg. Rx Generic/Trade: Tabs 100, 200 mg.] `K ♀B ? $

Erectile Dysfunction

ALPROSTADIL ( Muse, Caverject, Caverject Impulse, Edex, Prostin VR

Pediatric, prostaglandin E1,  Prostin VR ) 1 intraurethral pellet (Muse) or intracavernosal injection (Caverject, Edex) at lowest dose that will produce erection. Onset of effect is 5 to 20 min. [Trade only: Syringe system (Edex) 10, 20, 40 mcg. (Caverject) 5, 10, 20, 40 mcg. (Caverject Impulse) 10, 20
mcg. Pellet (Muse) 125, 250, 500, 1000 mcg. Intracorporeal injection of (cont.)

156 Urology
locally-compounded combination agents (many variations): “Bi-mix” can be 30 mg/mL papaverine + 0.5 to 1 mg/mL phentolamine, or 30 mg/mL
papaverine + 20 mcg/mL alprostadil in 10 mL vials. “Tri-mix” can be 30 mg/
mL papaverine + 1 mg/mL phentolamine + 10 mcg/mL alprostadil in 5, 10
or 20 mL vials.] `L ♀– – $$$$

SILDENAFIL ( Viagra) Start 50 mg PO 0.5 to 4 h prior to intercourse. Max 1 dose/day. Usual effective range 25 to 100 mg. Start at 25 mg if for age 65 yo or older or liver/renal impairment. Pulmonary hypertension: y yp

20 mg PO
tid. Contraindicated with nitrates. [Trade only (Viagra): Tabs 25, 50, 100 mg.

Unscored tab but can be cut in half. Trade only (Revatio): Tabs 20 mg.] `LK

♀B – $$$$

TADALAFIL ( Cialis)

s

2.5 to 5 mg PO daily without regard to timing of sexual activity. As needed dosing: Start 10 mg PO at least 30 to 45 min prn prior to sexual activity. May increase to 20 mg or decrease to 5 mg prn. Max 1 dose/day. Start 5 mg (max 1 dose/day) if CrCl 31 to 50 mL/min. Max 5
mg/d if CrCl <30 mL/min on dialysis. Max 10 mg/day if mild to moderate hepatic impairment; avoid in severe hepatic impairment. Max 10 mg once in 72 h if concurrent potent CYP3A4 inhibitors. Pulmonary hypertension: y yp

40 mg PO daily. Contraindicated with nitrates & alpha-blockers (except tamsulosin 0.4 mg daily). Not FDA approved for women. [Trade only (Cialis): Tabs 2.5, 5, 10, 20 mg. Trade only (Adcirca): Tabs 20 mg.]

`L ♀B – $$$$

VARDENAFIL ( Levitra) Start 10 mg PO 1 h before sexual activity. Usual effective dose range 5 to 20 mg. Max 1 dose/day. Use lower dose (5 mg) if age 65 yo or older or moderate hepatic impairment (max 10 mg). Contraindicated with nitrates and alpha-blockers. Not FDA-approved in women. [Trade only: Tabs 2.5, 5, 10, 20 mg.] `LK ♀B – $$$$

YOHIMBINE ( Yocon, Yohimex) 5.4 mg PO tid. Not FDA approved. [Generic/

Trade: Tabs 5.4 mg.] `L ♀– – $

Nephrolithiasis

CITRATE ( Polycitra-K, Urocit-K, Bicitra, Oracit, Polycitra, Polycitra-LC ) Urinary alkalinization:

y

1 packet in water/juice PO tid–qid. [Generic/Trade: Polycitra-K packet 3300 mg potassium citrate/ea, Polycitra-K oral soln (1100 mg potassium citrate/5 mL, 480 mL). Oracit oral soln (490 mg sodium citrate/5 mL, 15, 30, 480 mL). Bicitra oral soln (500 mg sodium citrate/5 mL, 480 mL). Urocit-K wax (potassium citrate) Tabs 5, 10 mEq. Polycitra-LC oral soln (550 mg potassium citrate/500 mg sodium citrate per 5 mL, 480 mL).

Polycitra oral syrup (550 mg potassium citrate/500 mg sodium citrate per 5 mL, 480 mL.] `K ♀C ? $$$

INDEX

To facilitate speed of use, index entries are shown with page number and approximate position on the page (“t” is top; “m” is middle; “b” is bottom). Although the PDA edition of the Tarascon Pocket Pharmacopoeia contains more than 6000 drug names, it is physically impossible to include all in pocket-sized manuals. Therefore, rarely used or specialized drugs appear in the PDA only (noted as

“PDA” in the index) or in both the PDA and Deluxe edition (noted as “D” in the index).

2-PAM

M ............. 153b

Accu-Check

Actoss ................. 71b
aggrenox ............ 48t

3TC..................... 21t

Voicematee........ 74t

Actron................... 5t

Agrylinn............. 102b

5-aminosalicylic

Accu-Chek Activee......

Acular.............

r

135m

Airomirr ............. 148t
acid ................. 98t

......................... 74t

Acular LSS........ 135m

Akarpinee........... 134t

5-ASA ................. 98t

AccuNebb ........... 148t
acyclovirr ............ 18b

AK-Conn ............. 130t

5-FU

Accu-Prep.......... 96b
acyclovir—topical...

AK-Dilatee.......... 135t

Dermatology ... 59b

Accuprill..... 35b, 36b

....................... 62b

Akinetonn .......... 119b

Oncology........ 129t

Accureticc ......... 45tm

Aczonee.............. 16m

AK-Mycinn ......... 131b

6-MPP ................ 129t

Accutanee ............ 59t

Adacell .............. 110t

AK-Pentolatee ... 134b

8-MOP ................... D
acebutolol ......... 48b

Adalatt ............... 50b

AK Tatee ........... 133m

9-hydroxyrisperidone
acemannan .... 103m

Adalat CC

C.......... 50b

Aktenn.............. 135m

.................... 142m

Aceonn ....... 35b, 36m

Adalat PA .......... 50b

AK Tracinn ........ 131m

15-methyl-prosta-

Acetadotee ........ 152b

Adalat XL........... 50b

Akurzaa .............. 59m
glandin F2 alpha ..

acetaminophen
adalimumab......... 1t

Alamast.

t .......... 130b

..................... 126b

Analgesics ... 3tmb,
adapalene ........ 58tb

Alavert...............

t

83b

292 tabs............... 9t

........... 8b, 9tmb, Adcircaa............... 55t Alavert D-122....... 85t

....10tmb, 11tmb

Adderall.l......... 146m

Alaway.

y ........... 130m

A

Neurology..... 118m

Adderall XR

R .... 146m

Albalonn............. 130t
acetazolamide.... 52t
adefovir.............. 24t
albendazole........ 17t

A/T/SS .................. 59t
acetic acid ...... 87tm

Adenocardd ........ 39m

Albenzaa .............. 17t

A1C home testing .....

acetohydroxamic
adenosine......... 39m

Albumarc............ 56t

.........................73b
acid .................... D

ADH

H .................. 83m
albumin.............. 56t

A-200 ................ 61b
acetylcholine ......... D

Adipex-PP.......... 147b

Albuminarr .......... 56t
abacavir ... 19b, 20m
acetylcysteine.. 152b

Adoxaa ............... 33m
albuterol..148t, 149t
abarelix ............ 129t
acetylcysteine—
adrenalin.......... 54m

Alcainee ............ 135b
abatacept.............. D
inhaled ........ 150m

Adriamycinn ....... 129t
alclometasone

ABC

C .................. 20m

Acidophiluss ...... 108t

Adrucil..............

l

129t
dipropionate .... 65t
abciximab ......... 47b

AcipHexx ............. 94b

Advair......

r

149t, 152t
alcohol .................. D

Abelcett .............. 14b
acitretin ........... 62m

Advair HFA....... 149t, Aldactazidee ........ 45t Abenoll .............. 11m

Aclastaa............. 68m

...................... 152t

Aldactonee ........... 37t

Abilifyy.............. 140b

Aclovate ............. 65t

Advatee................... D

Aldaraa ............... 62b

Abilify Discmeltt .......

acrivastine ............ D

Advicorr ............... 43t
aldesleukin..... 129m

..................... 140b

ActHIB

B ............ 110m

Advill.................... 4b

Aldomett.............. 39t

Abraxanee ........ 129m

Acticinn................ 62t

Aeriuss................ 83b

Aldoril.................

l

45t

Abreva............... 62b

Actidose-Aquaa.. 153t

AeroBid.

d .. 149b, 152t

Aldurazyme........ PDA

ACAM 2000............ D

Actifed Cold &

AeroBid-M

M ...... 149b, alefacept.......... 62m
acamprosate .. 145m

Allergyy ............. 85t

...................... 152t
alemtuzumab.. 129m
acanya ............... 58t

Actifed Cold & Sinus

Aerospann ........ 149b, alendronate....... 67b acarbose ............ 70t

........................ 85t

...................... 152t

Alertecc............. 147b

Accolatee ......... 150m

Actigall..............

l

99b

Aesculus hip-

Alesse... 123b, 124m

Accu-Check

Actiq.................... 6b
pocastanum
m .. 107t

Alevee ................... 5b

Advantagee ..... 74m

Activasee ........... 55m

Afeditab CR

R....... 50b

Aleve Cold & Sinuss..D

Accu-Check Avivaa....

Activase rt-PA .. 55m

Afl exaa ............. 106m

Alfentaa .................. D

........................ 74t
activated charcoal ..

Afl uriaa ............. 110b
alfentanil .............. D

Accu-Check

...................... 153t

African plum treee ....

Alferon N

N ............... D

Compactt.......... 74t
activella ......... 123m

.................... 108m
alfuzosin

Accu-Check

Actonell ............... 68t

Afrinn ................... 89t

Cardiovascular .....

Compact Pluss .. 74t

Actonel Plus
agalsidase beta

..................... 41t

Accu-Check

Calcium
m........... 68t

....................... PDA

Urology ........ 154m

Completee ......... 74t

ACTOPLUS Met.

t ... 70t

Aggrastatt ......... 48m
alglucerase ....... PDA

Alternagel...........

l

92t

Amnesteem
m ........ 59t

Antaraa ............... 44b

158

Altoprevv............. 43b
amobarbital ...... PDA
antazoline ........ 130t

Index
altretamine ..... 128b
amoxapine............. D

Anthemis nobiliss—
t = top of page

Alu-Cap.............. 92t
amoxicillin

Roman chamomile
m = middle of page
aluminum acetate ...

Antimicrobials ......

...................... 104t
b = bottom of page

........................ 87t

............ 30b, 31b

Anthrafortee........ 62b

D,PDA = see page 157 aluminum chloride ..

Gastroenterology...

anthralin ........... 62b

........................ 64t

................... 93m

Anthranoll .......... 62b
alglucosidase alfa .....

aluminum hydroxide
amoxicillin-

Anthrascalp....... 62b

...........................PDA

Analgesics........ 2b
clavulanate ..... 31t
anti-inhibitor co-

Align................. 108t

Gastroenterology...

Amoxill ............... 30b
agulant complex.

x . D

Alimtaa .............. 129t

..................92tm
ampalaya ......... 104t

Antilirium
m .............. D

Alinia................ 17m

Alupent...

t 148b, 152t

Amphadasee ....... PDA

Antiminthh .......... 17b
aliskiren ........... 46m

Alu-Tab............... 92t
amphetamine ...146m
antipyrine .......... 86b
alitretinoin ......... 64t

Alvescoo............ 149b

Amphojell ............ 92t

Antispass............ 94b

Alka-Seltzerr........ 92t

Alvesco 160 mcgg .....

Amphotecc .......... 14b
antivenin—crotalidae

Alkerann............ 128b

...................... 152t
amphotericin B
immune fab ovine

All Clearr ........... 130t

Alvesco 80 mcgg .......

deoxycholate... 14b
polyvalnet ........ 112t

Allegra............... 83b

...................... 152t
amphotericin B lipid
antivenin—latro-

Allegra-D 12-hh... 85m
alvimopan ........ 98m
formulations... 14b
dectus mactans .. D

Allegra-D 24-hh... 85m
amantadine....... 22b
ampicillin......... 31tb

Antivertt ............. 84b

Aller-Chlorr.......... 84t

Amaryll............... 73b
ampicillin-

Antizoll ...................D

Allerdryll............ 84m

Amatine............. 54b
sulbactam ..... 31m

Anusol-HC

C ............. D

Allerfrim
m ............. 85t
ambenonium ..... PDA

Amrixx.................... 2t

Anzemett ............. 90t

Allermaxx ........... 84m

Ambienn............ 144b
amyl nitrite..... 153m

Aphthasoll......... 87m

AllerNazee ........... 88b

Ambien CR

R ...... 144b

Anacinn.................. 4t

Apidraa ............... 72b

Aller-Relieff ......... 84t

AmBisomee ......... 14b

Anadrol-500 ........ PDA

Aplenzinn .......... 138b

AlleRx .................... D
ambrisentan...... PDA
anaerobes ......... 23b

Aplisoll ............. 113b

Alli....................

i

99m
amcinonide ...... 65m

Anafranill .......... 136t

Apo-Gainn ............ 66t

Allium sativum 105b

Amergee............ 117b
anagrelide....... 102b

Apokyn.............. 120t
allopurinol.......... 75t
amethocain ....... PDA
anakinra............... 1t
apomorphine

Alluna.............. 109b

Amevive............ 62m

Analpram-HC

C ........ D

Cardiovascularr..41t

Almora................ 77t

Amicar.............

r

102b

Anaproxx ............... 5b

Neurology....... 120t
almotriptan .... 117m

Amidate.............. 12t

Anaspazz ............. 95t
apraclonidine ........ D

Alocrill.............. 130b

Amidrine......... 118m
anastrozole....... 129t
aprepitant ......... 90b
aloe vera ........ 103m
amifostine........ 129t

Anceff................. 25b

Apresazide.......... 45t

Alomidee ........... 130b

Amigesicc ............ 4m

Ancobonn ............ 14b

Apresolinee ......... 47b

Aloprim............... 75t
amikacin ............ 13t

Andriol..............

l

67m

Aprii ................ 124m

Alora................ 122b

Amikin ................

n

13t

Androcur...........

r

129t

Aprisoo................. 98t
alosetron .......... 98m
amiloride............ 47t

Androcur Depott ... 129t

Aprodinee............. 85t

Aloxii .................. 90b
aminocaproic acid...

Androderm........ 67m

Aptivuss.............. 22b
alpha-1 antitrypsin..D

..................... 102b

AndroGel...........

l

67m

Aquachloral
alpha-1 proteinase
aminoglutethimide ..D

Android.

d .............. 67t

Supprettess.... 144b
inhibitor .............. D
aminohippurate..... D

Androxy.

y ................. D

AquaMephyton... 81b
alpha-galactosidase
aminolevulinic acid...D

Anectinee ............ 12b

Aquasol EE .......... 81b

...................... 98m
aminophylline ...150b
anexsia................ 8b

AraC

C ................. 129t

Alphagan........ 134m
aminosalicylic acid .

Angelica sinensiss ....

Aralastt .................. D

Alphagan P.....

P

134m

....................... PDA

...................... 105t

Aralen............... 15m

Alphanate.............. D
amiodarone ...... 39b, Angeliqq............ 123b Aranellee........... 124b
alprazolam ..... 144m

........................ 41t

Angiomaxx ....... 101m

Aranespp............ 102t
alprostadil....... 155b

Amitizaa.............. 97b

Angiotensin receptor

Arava................... 1b

Alrexx ................. 133t
amitriptyline..... 136t
blockers (ARBs)..37t

Arcalystt ............. PDA

Alsoy.

y ................ 78m

Amlactin............ 64b
anhydrous glycerin ..

Aredia................. 68t

Altabaxx.............. 60b
amlexanox ........ 87m

..........................87m
arformoterol .... 148b

Altacee........ 35b, 36b
amlodipine ...... 43m,
anidulafungin....14m
argatroban ..... 101m

Altafrinn............. 135t

............. 45b, 50m

Ansaidd................. 4b

Aricept.

t ............. 114t
alteplase .......... 55m

Ammonull............... D

Antabusee........ 145m

Arimidexx ........... 129t
aripiprazole .... 140b, atomoxetine..... 146b Azasann ................ 1b

159

..................... 141b
atorvastatin .... 43tm

Azasitee ........... 131m

Index

Aristospann......... 69b
atovaquone..15m, 17m
azathioprine ........ 1b

Arixtraa .............. 101t
atracurium ............ D
azelaic acid...... 58m
t = top of page
armodafi nil...... 146b
atripla ............... 19b
azelastine—nasal ..

m = middle of page

Armour Thyroidd ...... D

AtroPen............... 40t

....................... 88b
b = bottom of page
arnica.............. 103b
atropine
azelastine—

D,PDA = see page 157

Arnica montanaa . 103b

Cardiovascular .....

ophthalmic .... 130t

Aromasin........ 129m

..................... 40t

Azelexx ............... 58m

Baygam
m.......... 112m

Arranon ................. D

Gastroenterology...

Azilectt ............. 120b

BayTett .............. 113t
arsenic trioxide

............. 89b, 95t
azithromycin

BCG ................ 129m

Cardiovascularr..41t

Ophthalmalogy .....

Antimicrobials ......

BCG vaccine..... 110t

Ophthalmology .....

.................. 134b

............ 27b, 31b

BCNU.

U .............. 128b

..................129m

Toxicology ...... 153t

Cardioivascular.

r .41t

B-D Glucosee ....... 74t

Artanee ............. 119b

Urology ........ 155m
azithromycin—

Beanoo............... 98m
artemether ....... 15m
atropine—ophthal-
ophthalmic .. 131m
becaplermin ....... 64t
arthrotec ............ 4m
mic ............... 134b

Azmacortt ... 150t, 152t
beclomethasone ....88t
articaine........... 12m

Atropine Caree .. 134b

Azoptt ............... 133b
beclomethasone HFA
artichoke leaf

Atrovent..........

t

152m

Azorr .......................D

MDI................ 151t
extract .......... 103b

Atrovent HFA.. 152tm

Azo-Standardd .. 155b
beclomethasone—
artifi cial tears 135m

Atrovent Nasal

AZTT..................... 21t
inhaled ........ 149m

ASA

Sprayy .............. 88b
aztreonam ......... 33b

Beconase AQ

Q ...... 88t

Analgesics ....... 2b,

Attenuvaxx .......... PDA

Azulfi dinee ......... 98m
belladonna ............ D

...... 3tmb, 4t, 9t, ATV................... 21m Azulfi dine EN-tabs...

Bellergal-SS ............ D

..................10tm
augmented

...................... 98m

Bellergal Spacetabs

Cardiovascular ..48t
betamethasone

........................... D

Gastroenterology...

dipropionate ....... D

Benadryll........... 84m

..................... 92t

Augmentin.......... 31t

B

Benadryl Allergy/

Asacoll ................ 98t

Augmentin

Coldd................. 85t

Asaphenn ............... 4t

ES-6000 .........31t

B&O Supprettes..... D

Benadryl-D Allergy &
ascorbic acid.. 80tm,

Augmentin XR

R .... 31t

BabyBIG

G ........... 112t

Sinuss .................. D

....................... 81t
auralgan ........... 86b

Bacid.

d ............... 108t

Benadryl-D Allergy/

Ascriptin.............. 2b
auranofi n............... D

Baciguent...........

t

60t

Sinus Tabletss... 85t

Asleraa.............. 104b

Avagee ............... 59m

Bacillus of Calmette
benazepril ..... 35mb,

Asmanex.

x .......... 152t

Avalidee ............... 45t

& Guerinn ...... 129m

....................... 45b

Asmanex Twisthaler

Avandamett....... 70m
bacitracin
bendamustine . 128b

..................... 149b

Avandaryll ......... 70m

Dermatologyy.. 60tm
bendrofl umethiazide

Asmaventt ......... 148t

Avandiaa............. 71b

Ophthalmology........

y

.

....................... 45b
asparaginase .. 129b

Avaproo................ 38t

.........................131b

BeneFinn ............ 109t

A-spazz................ 95t

Avastinn........... 129m
bacitracin—

Benefi xx .................. D

Aspir-Moxx ............ 2b

Avaxim
m ........... 110m
ophthalmic .. 131m

Benicar...............

r

38t

Assalix.............

x

109b

Aveenoo................ 66t
baclofen ............... 2t

Benicar HCTT ....... 45t

Astelinn............... 88b

Aveloxx................ 32b

Bactocilll............ 30b

Benoquinn............ 66t

Asteproo.............. 88b

Aventyll ........... 136m

Bactrim
m .............. 33t

Benoxyll............. 58m
astragalus....... 103b

Aviane....

e . 123b, 124m

Bactrobann ........ 60m

Bentyll................ 94b

Astragalus mem-
avian infl uenza vac-

BAL in oil............... D

Bentyloll ............. 94b
branaceuss .... 103b
cine H5N1—inactiv-
balsalazide......... 98t

Benuryll............... 75t

Atacand..............

d

37t
ated injection...110t

Balzivaa ............. 124t

Benylinn .............. 84b

Atacand HCTT ...... 45t

Avinzaa ................. 7b
banana bag........ 78t

Benylin DMEE .......... D

Atacand Pluss.... 45m

Avodartt........... 154m

Banophenn......... 84m

Benzacc ............. 58m

Atarax.

x ............... 84b

Avonexx............. 118b

Banzell ............ 116m
benzaclin.......... 58m

Atasoll............... 11m

Axertt............... 117m

Baraclude........... 24t

Benzagel 10%.. 58m
atazanavir ........ 21m

Axidd .................... 93t

Baridium
m ......... 155b
benzamycin ...... 58m
atenolol ...... 47t, 48b

Axid AR

R............... 93t
barium sulfate .. 57b
benzathine

Atgam
m ............ 112m

Aygestinn ......... 126m

Basalgell............. 92t
penicillin ......... 30t

Atinitorr .................. D
azacitidine ....... 129t
basiliximab .... 113m
benzocaine ..............

Ativan............... 144t

Azactam
m ............ 33b

Bayerr.................... 4t

.............. 86b, 89m

Bicillin C-R......... 30t Brevitall .............. 12t

Caelyx..............

x

128b

160

Bicillin L-A ......... 30t

Bricanyl Turbuhaler..

r D

Cafcitt ............... 147t

Index

Bicitraa ............. 156b
brimonidine.. 134mb

Cafergott ........... 118t
t = top of page

BiCNU..............

U

128b
brinzolamide ... 133b

Caffedrinee ........ 147t
m = middle of page

BiDiLL ................ 56m
bromazepam .. 143m
caffeine
b = bottom of page

Biest..................

t

PDA
bromfenac—

Analgesics ..... 3tm,

D,PDA = see page 157 Bifantiss ............ 108t ophthalmic .... 135t

............ 9m, 10m
bifi dobacteria... 108t

Bromfenexx ........ 85m

Neurology....... 118t
benzoic acid ... 154b,
bilberry ............ 103b

Bromfenex PD

D........ D

Psychiatry ...... 147t

.................... 155m
bile acid seques-
bromocriptine... 82m
calamine ............ 64t
benzonatate ...... 84b
trants ............. 43b
brompheniramine .. D

Calcibind.

d .............. D
benzoyl peroxidee..58tm

Biltricidee ........... 17b

Brovana........... 148b

Calciferol............

l

82t
benzphetamine...... D
bimatoprost.... 134m
budesonide

Calcijexx .............. 80t
benztropine

Bionectt.............. 64b

Gastroenterology...

Calcimarr ........... 82b
mesylate....... 119b

BioRabb ........... 111m

.................... 98b
calcipotriene ..... 62b
beractant .............. D
biotin.................. 81t

Pulmonary .. 149m, calcitonin .......... 82b

Berotecc........... 148m
biperiden ......... 119b

................. 151m
calcitriol............. 80t
besifl oxacin ...... 131t

Biphentinn ....... 147m
budesonide DPI .......

calcium acetate ....75t

Besivance......... 131t

Biquin durules.... 42t

...................... 151t
calcium carbonate

Betaderm
m .............. D

Bisacodyl.l........... 97t
budesonide—

Analgesics ........ 2b

Betagann .......... 133b
biskalcitrate...... 93b
inhaled ........ 149m

Endocrine &
betahistine............ D
bismuth subsalicy-
budesonide—nasal
metabolic.... 75m
betaine .............. PDA
late....... 89m, 93m

........................ 88t

Gastroenterology...

Betaject.............

t

68b
biso-prolol... 47m, 49t
bufferin ............... 2b

............. 92b, 93t

Betalocc.............. 49b
bitter melon...... 104t
bumetanide...... 52m

OB/GYN........ 128m
betamethasone
bivalirudin...... 101m

Bumexx .............. 52m
calcium chloride

Dematology.... 62b, bladder agents 155b Buminatee ........... 56t Endocrine &

.................... 63b

Blenoxane........ 128b
bupivacaine ..... 12m
metabolic..... 75b

Endocrine &
bleomycin........ 128b

Buprenexx .............. 6t

Toxicology ...... 153t
metabolic .... 68b, Bleph-100.........131b buprenorphine calcium citrate .. 75b

.................... 69b

Blephamidee...... 132t

Analgesics....6t, 7t
calcium gluconate...

betamethasone

Blocadrenn.............. D

Psychiatry ...... 146t

....................... 75b
dipropionate ... 65b
blood transfusion ....

Buprobann ........ 138b

Caldolor...............

r

4b
betamethasone

....................... PDA
bupropion........ 138b
calfactant ............. D
valerate ........... 65t

Bonaminee.......... 84b

Burinexx............. 52m

CaloMistt............. 80t

Betapacee.......... 42m

Bonefoss ............. 67b
burn plant ...... 103m

Calsan.............. 75m

Betapace AFF ..... 42m

Boninee............... 84b

Buscopann ........... 95t

Caltinee .............. 82b

Betaseronn....... 119m

Bonivaa................ 68t

BuSparr ........... 144m

Caltratee............ 75m

Beta-Val ............. 65t

Bontrill ................... D
buspirone ....... 144m

Cambiaa .............. 4m
betaxolol............. 49t

Bontril Slow Release..

e D
busulfan.......... 128b

Camellia sinensis....

betaxolol—ophthal-
mic ............... 133b

Boostrixx ............ 110t

Busulfexx .......... 128b

..................... 106b
bethanechol .... 155b
boric acid ....... 127m
butabarbital ...... PDA

Camila...

a 124m, 126m

Betimol............

l

133b
bortezomib ..... 129b
butalbital ....... 3tmb, Campathh ........ 129m Betoptic........... 133b
bosentan ............... D

........................ 9m

Camprall ......... 145m

Betoptic S........

S

133b

Botoxx ................ 121t
butamben......... 89m

Camptosarr ...... 129b
bevacizumab.. 129m

Botox Cosmetic 121t
butenafi ne......... 60b

Canasa............... 98t
bexarotene....... 129b
botulinum toxin

Butisol. l.............. PDA

Cancidass.......... 14m

Bexxarr ............ 129m
type A ............ 121t
butoconazole .. 127m
candesartan...... 37t,
bezafi brate ....... 44m
botulinum toxin
butorphanol... 6m, 7t

...................... 45m

Bezalipp ............. 44m
type B ................. D
butterbur .......... 104t

Candistatin

Biaxinn................ 27b
botulism immune

Byetta................. 74t

Antimicrobials ......

Biaxin XLL ........... 27b
globulin ......... 112t

Bystolicc .............. 50t

..................... 15t
bicalutamide.... 129t

Bravellee................. D

Dermatology ... 61b
bicarbonate

Brethinee ................ D

Canesten

C

Cardiovascularr..40t

Breviblocc .......... 49m

Antimicrobials ......

Gastroenterology...

Breviconn ........... 124t
cabergoline ...... 82m

................... 13m

............. 92t, 94b

Brevicon 1/355........ D

Caduett ............. 43m

Dermatology .... 61t

OB/GYN........ 127m

Catafl am
m ............ 4m

Certain Dri..........

i

64t

161

Cankermelt.

t .... 107m

Catapress ........... 38b
certolizumab ..... 98b

Index

Cannibis sativa L.

Catapres-TTSS .... 38b

Cerubidine....... 128b
extractt ................ D

Cathfl o ............. 55m

Cervidil............

l

125b
t = top of page

Cantill ............... 95m

Caverjectt......... 155b

C.E.S. ............... 123t
m = middle of page

Capastatt ........... PDA

Caverject Impulsee......

Cesamett........... 91m
b = bottom of page
capecitabine .... 129t

......................... 155b

Cesiaa............... 124b D,PDA = see page 157

Capexx .................... D

CCNU.

U .............. 128b

Cetacainee......... 89m

Capital with Codeine Ceclorr................. 26t cetirizine ............ 84t

Suspension........ 9t

Cedaxx ................. 27t

Cetraxal.............

l

86b
chlorthalidone .. 45b,

Capoten............ 35m

Cedocard SR....... 53t
cetrorelix acetate... D

................ 47t, 52b

Capozidee ............ 45t

CeeNu.............. 128b

Cetrotidee ............... D

Chlor-Trimetonn ... 84t
capreomycin...... PDA
cefaclor .............. 26t
cetuximab ...... 129m
chlorzoxazone ....... 2t

Caprexx................... D
cefadroxil .. 25b, 31b
cevimeline........ 87m

CholeRxx ........... 107b
capsaicin ........... 64t
cefazolin.... 25b, 31b
chamomile ....... 104t
cholesterol absorp-
captopril..35mb, 45m
cefdinir.............. 26b

Chantix.............

x

146t
tion inhibitor... 43b

Caracc ................ 59b
cefditoren.......... 26b

CharcoAid.

d ........ 153t

Cholestinn......... 107b

Carafatee............ 95b
cefepime .......... 27m
charcoal ........... 153t
cholestyramine....42m
carbachol .............. D
cefi xime............. 26b

Charcodate....... 153t
choline magnesium
carbamazepine ..114b

Cefi zoxx................ 27t
chasteberry .... 104m
trisalicylate ....... 4t
carbamide peroxide ...

cefotaxime......... 26b

Chemet.............

t

154t
chondroitin..... 104m

...........................86b
cefotetan............... D

Cheracol D Cough.. D
choriogonadotropin

Carbapenemss... 25m
cefoxitin ............. 26t

Cheratussin AC

C ..... D
alfa..................... D

Carbatroll......... 114b
cefpodoxime ....... 27t

Cheratussin DAC

C ... D
chorionic gonadotro-
carbidopa........ 120b
cefprozil ........... 26m

Children’s Advil Cold
pin ...................... D
carbidopa-levodopa
ceftazidime ........ 27t

........................... D

Chrysanthemum

.................... 120m
ceftibuten........... 27t
chloral hydrate ...144b
parthenium
m.. 105m
carbinoxamine....... D

Ceftinn ............... 26m
chlorambucil ... 128b

Cialis.............. 156m

Carbocainee........ 12b
ceftizoxime ......... 27t
chloramphenicol ..33b
ciclesonide ......... 88t

Carbodec DM

M......... D
ceftriaxone ......... 27t
chlordiazepoxide
ciclesonide—
carboplatin..... 129m
cefuroxime........ 26m

Gastroenterology...

inhaled ......... 149b
carboprost....... 126b

Cefzill................ 26m

..................... 99t
ciclopirox........... 60b

Cardene............. 50b

Celebrexx .............. 3b

Psychiatry .... 143m

Cidecinn............... 34t

Cardene SR

R ....... 50b
celecoxib ............. 3b
chlordiazepoxide-
cidofovir ........... 18m

Cardio-Omega 33......

Celestonee .......... 68b
clidinium ........ 98b
cigarette............ PDA

..................... 78m

Celestone Soluspann.

Chlordrine SR

R ... 85m
cilazapril .... 36t, 45b

Cardizem
m.......... 51m

....................... 68b
chlorhexidine gluco-
cilostazol.......... 56m

Cardizem CD

D .... 51m

Celexaa .............. 137t
nate................ 87b

Ciloxann ............. 131t

Cardizem LA ..... 51m

Cellceptt........... 113b
chlorodeoxyadenos-
cimetidine ......... 92b

Carduraa............. 38b
cellulose sodium
ine ................. 129t

Cimziaa............... 98b

Cardura XLL ........ 38b
phosphate .......... D

Chloromycetinn ... 33b
cinacalcet ............. D

Carimunee ....... 112m

Celontin............. PDA
chlorophyllin copper

Cipralexx............ 137t
carisoprodol ... 2t, 3b

Cena-KK .............. 77b
complex ......... 66m

Ciproo .................. 32t

...................... 10m

Cenestinn......... 123m
chloroprocaine... PDA
ciprodex otic...... 86b

Carmol 400 ............. D

Centanyy............ 60m
chloroquine
ciprofl oxacin

Carmol HC

C............. D
cephalexin...............

Antimicrobials ......

Antibicrobials .. 32t
carmustine...... 128b

............... 25b, 31b

................... 15m

ENT................. 86b

Carnitorr............ 78m

Ceprotinn ............ PDA

Cardiovascular .....

ciprofl oxacin—
carteolol—ophthal-

Ceptazz................ 27t

..................... 41t
ophthalmic .... 131t
mic ............... 133b

CeraLyte 500 ........ 79t
chlorothiazide ........ D

Cipro HC Otic..... 86b

Cartia XTT .......... 51m

CeraLyte 700 ........ 79t
chlorpheniramine ..84t

Cipro XR

R ............. 32t

Cartiladee .......... 109t

CeraLyte 900 ........ 79t
chlorpromazine
cisapride ............ 41t
carvedilol ........... 49t

Cerebyx.

x ............ 115t

Cardiovascular .....

cisatracurium.... 12b
cascara .............. 97t

Ceredasee ........... PDA

..................... 41t
cisplatin......... 129m

Casodex............

x

129t

Cerefolin................ D

Psychiatry..... 140t, citalopram........ 137t
caspofungin ..... 14m

Cerefolin with NAC
n

...D

................. 141m

Citanestt ............ PDA
castor oil ............ 97t

Cerezymee........... PDA
chlorpropamide ..... D

Citracall ............. 75b
clindamycin
coartemether.... 15m

Correctol.............

l

97t

162

Antimicrobials ......

cobalamin ........ 80m

Cortaidd ............... 65t

Index

............. 31b, 34t
cocaine............... 41t

Cortamedd .............. D
t = top of page

Dermatology .........

codeine..........6m, 7t

Cortatee .................. D
m = middle of page

........ 58tmb, 59b

............9tmb, 10m

Corteff ................. 69t
b = bottom of page
clindamycin—
coenzyme Q10...104m

Cortenema.......... 69t

D,PDA = see page 157
topical ............ 58b

Cogentin.......... 119b

Corticaine........... 65t
clindamycin—

Cognexx .............. PDA
corticosteroid ..... 65t
citrate
vaginal ........ 127m

Colacee .............. 97m
corticotropin .......... D

Gastroenterology...

Clindessee ....... 127m

Colazall ............... 98t

Cortifoam
m .............. D

..................... 92t

Clinistixx............ 74m

Colbenemidd ........ 75t
cortisone ... 68b, 69b

Urology ......... 156b

Clinitestt ........... 74m
colchicine........... 75t
cortisporin........ 63m

Citri Leann ........ 105b

Clinorill ................. 6t
colesevelam ...... 42b
cortisporin—
citrocarbonate .... 92t
clobazam......... 114b

Colestidd............. 42b
ophthalmic .. 132m

Citro-Magg........... 96t
clobetasol.......... 65b

Colestid Flavored.

d . 42b

Cortisporin Oticc.... 86b

Citrucell ............. 95b

Clobexx ................... D
colestipol........... 42b

Cortisporin TC Oticc ..

Ci-wu-jiaa.......... 106t
clocortolone pivalate
colistimethate ... PDA

........................ 87t
cladribine......... 129t

........................ 65t
colistin ............... 87t

Cortizonee ............... D

Claforann ............ 26b

Cloderm.............. 65t

Colyy- Mycin M

Cortoderm
m ............. D

Claravis.............. 59t
clodronate ......... 67b

Parenterall....... PDA

Cortone.............. 68b

Clarinexx............. 83b
clofarabine....... 129t

Colytee ............... 96m

Cortrosynn........... 74b

Clarinex-D 12 hour.

r ..D
clofazimine............ D

Combantrinn ....... 17b

Corvertt ............. 41m

Clarinex-D24-hh ... 85m

Clolarr ............... 129t
combigan ........ 134b

Corynanthe yohimbe

Claripell ............. 64b

Clomid.............

d

125b

CombiPatch..... 123b

......................... 109b
clarithromycin
clomiphene...... 125b

Combiventt....... 149t, Corzidee ............... 45t Antimicrobials ......

clomipramine ... 136t

...................... 152t

Cosamin DS.

S ... 106m

............ 27b, 31b

Clonapam....... 143m

Combivir............

r

19b

Cosmegenn ....... 128b

Cardiovascular .....

clonazepam.... 143m

Combunoxx ............ 9t

Cosoptt............. 134b

..................... 41t
clonidine ... 38b, 45b

Commiphora mukul
cosyntropin........ 74b

Gastroenterology...

clonidine—epidural
extractt .......... 106b

Cotazym
m ........... 99m

................... 93m

....................... PDA

Committ ........... 145b
cotrimoxazole ..... 33t

Claritinn.............. 83b
clopidogrel ......... 48t

Compazinee ........ 91b

Coumadin......... 102t

Claritin-D 12 hh ... 85t

Clopixoll ................. D

Comtann ............ 120t

Covera-HSS ......... 51b

Claritin-D 24 hh ... 85t

Clopixol Accuphasee..D

Comvaxx ............ 110t

Coversyl............

l

36m

Claritin Hives Relieff..

Clopixol Depott ....... D

Concerta......... 147m

Cozaarr................ 38t

......................... 83b
cloquinol ............... D

Condylinee ........... 63t

Cranactinn ........ 104b

Claritin RediTabss........

clorazepate..... 143m

Condyloxx............. 63t
cranberry......... 104b

............................ 83b

Clorpres.............. 45t
cone fl ower ....... 105t

Crataegus laevigata

Claruss ................ 59t

Clotrimaderm

Congestt............ 123t

...................... 107t

Clavulin.............. 31t

Antimicrobials..13m
conivaptan ............ D
creatine........... 104b

Clearasil...........

l

58m

Dermatology .... 61t

Conrayy................ 58t

Creon................ 99m

Clearasil Cleanserr...

OB/GYN........ 127m

Copaxone......... 118b

Crestorr ............... 44t

...................... 59m
clotrimazole

Copeguss ............. 25t

Crinone........... 126m

Clear Eyess ........ 130t

Antimicrobials ..13m

CoQ-100........... 104m

Crixivann.............. 22t
clemastine ......... 84t

Dermatology ... 63b

Cordarone.......... 39b

CroFab.............. 112t
clenia ................ 58b
clotrimazole—

Cordran ............ 65m

Crolom............. 130b

Cleocin
topical ............. 61t

Cordran SPP ............ D
cromolyn—inhaled .

Antimicrobials ......

clotrimazole—

Coreg..................

g

49t

..................... 150b

..................... 34t
vaginal ........ 127m

Coreg CR

R ............ 49t
cromolyn—nasal

OB/GYN........ 127m
cloxacillin .............. D

Corgardd ............. 49b

....................... 88b

Cleocin TT ........... 58b
clozapine

Coricidin HBP Con-
cromolyn—ophthal-
clevidipine......... 50b

Cardiovascular .....

gestion & Coughh ...D
mic ............... 130b

Cleviprexx ........... 50b

..................... 41t

Coricidin HBP Cough Crotamitonn ......... 62t Climaraa ........... 122b

Psychiatry .... 141tb

& Coldd ................ D

Cryselle

Climara Proo ..... 123b

Clozarill............. 141t

Corlopam.......... 47m

.......... 123b, 124m

Clindagel...........

l

58b
coal tar............. 64m

Cormaxx.............. 65b
crystalline DMSO2 ...

ClindaMaxx ......... 58b

Coartem
m ........... 15m

Coronexx .............. 53t

..................... 107b

Cubicin............... 34t dehydroepiandros-163

Culturellee ......... 108t

D
terone ........... 104b

Index

Cupriminee ............. D

Delatestryll........ 67m

Curosurff ................ D

D2T5.

5 .............. 110m
delavirdine ........ PDA
t = top of page

Cutarr................ 64m
d4TT..................... 21t

Delestrogenn ...... 123t
m = middle of page

Cutivatee ........... 65m
dacarbazine .... 128b

Delsym
m .............. 84b
b = bottom of page

Cutterr.................... D
daclizumab ..... 113b

Deltasonee .......... 69b D,PDA = see page 157
cyanide antidote kit

Dacogenn ........... 129t

Demadexx .......... 52m

...................153tm
dactinomycin... 128b
demeclocycline....33m

DesOwenn ............ 65t
cyanocobalamin

Dalacin........... 127m

Demeroll.............. 7m

Desoxi. i................... D

Endocrine &

Dalacin C

C ........... 34t

Demserr.................. D
desoximetasone.. 65t
metabolic ... 80tb, Dalacin TT........... 58b Demulenn................ D

Desoxynn ............. PDA

..................... 81t
dalfopristin ....... 34b

Demulen 1/35...

5 124t

Desquam
m.......... 58m

OB/GNY........ 128m

Dalmane......... 143m

Demulen 1/50... 124t
desvenlafaxine..138m

Cyanokitt .......... 153b
dalteparin ......... 99b

Denavir.

r .............. 63t

Detroll ............... 155t

Cyclenn ................... D
danazol .......... 128m
denileukin ...... 129m

Detrol LA........... 155t

Cyclessaa.......... 124b

Danocrinee....... 128m

Denticare........... 87b
devil’s claw ...... 105t
cyclobenzaprine.... 2t
danshen ................ D

Depaconn .......... 116b

Dex-4.................. 74t

Cyclocortt .......... 65m

Dantrium
m............ 2m

Depadee........... 145m

Dexalone............ 84b

Cyclogyll........... 134b
dantrolene.......... 2m

Depakenee ........ 116b
dexamethasone

Cyclomen........ 128m
dapsone ........... 16m

Depakote

Endocrine &
cyclopentolate

Daptacel.l.......... 110t

Neurology...... 116b
metabolic .... 68b,

..................... 134b
daptomycin ........ 34t

Psychiatry ..... 139b

.................... 69b
cyclophosphamide...

Daraprim
m........... 17b

Depakote ER

ENT................. 86b

..................... 128b
darbepoetin...... 102t

Neurology...... 116b
dexamethasone—
cycloserine ........ PDA
darifenacin..... 154m

Psychiatry ..... 139b
ophthalmic ...........

Cycloset............

t

82m
darunavir .......... 21b

Depenn.................... D

.................. 132mb
cyclosporine ... 113m
darvocet ............... 9t

Depo-Cytt .......... 129t

Dexasonee........... 68b
cyclosporine—

Darvon-N

N............. 8b

DepoDurr .............. 7b
dexchlorphe-
ophthalmic .. 135m

Darvon Pulvuless .. 8b

Depo-Estradioll ........

niramine.......... 84t

Cyklokapron........... D
dasatinib

.................... 122m

Dexedrinee ......... 147t

Cymbalta......... 138b

Cardiovascular .....

Depo-Medroll....... 69t

DexFerrum
m ......... 76b

Cynara scolymuss .....

..................... 41t

Depo-Provera.... 126t

Dexironn .............. 76b

..................... 103b

Oncology...... 129m
depo-subQ
dexlansoprazole 93b

Cynara-SLL ....... 103b
daunorubicin ... 128b
provera 1044.... 126t
dexmedetomidinee .11b
cyproheptadine

DaunoXomee ..... 128b

Depot..............

t

129m
dexmethylphenidate .

........................ 84t

Dayproo................. 5b

Depo-Testosteronee...

...................... 147t
cyproterone

Daytranaa ........ 147m

...................... 67m

Dexpakk .............. 68b

Dermatology ... 58b
d-biotin ............ 80m

Deproic
dexrazoxane.... 129m

Oncology........ 129t

DDAVP ...............

P

82b

Neurology...... 116b
dextran ............... 56t

Cystadanee ......... PDA
ddI.....................

I

20b

Psychiatry ..... 139b
dextroamphetamine

Cystografi nn........ 57b

Debacteroll......... 87b

Dermalac........... 64b

........... 146m, 147t

Cystospazz........... 95t

Debroxx ............... 86b

Derma-Smoothe/FSS..D
dextromethorphan .84b

Cytadren................ D

Decadronn........... 68b

Dermasonee ............ D
dextrose.............. 74t
cytarabine ........ 129t

Deca-Durabolinn .. 67t

Dermatopp .............. D

Dextrostat.........

t

147t

Cytogam
m................ D
decitabine ........ 129t

Dermazinn........... 60b

D.H.E. 455 .......... 118t
cytomegalovirus

Declomycinn....... 33m

Dermolate.............. D

DHEA ............... 104b
immune globulin

Deconaminee ..... 85m

DermOticc ............ 87t

DiaBetaa ............. 73b
human................ D

Deconamine SR

Desferal..........

l

153m

Diabinesee .............. D

Cytomell ............. 79b

...................... 85m
desfl urane ......... PDA

Diamicron.......... 73b

Cytosar-U

U ......... 129t

Deconsal III ....... 85m
desipramine ... 136m

Diamicron MR.... 73b

Cytotec

DEET...................... D
desloratadine .... 83b

Diamorphine...... PDA

Gastroenterology...

defective cell wall
desmopressin .... 82b

Diamoxx ............... 52t

................... 95m
bacteria.......... 23b

Desogenn ......... 124m

Diamox Sequelss.. 52t

OB/GYN......... 125b
deferasirox ...... 102b
desogestrel............ D

Diane-355 ........... 58b

Cytovene........... 18m
deferoxamine .. 153tm

Desonatee ............... D

Diarr-ezee ........... 89b

Cytoxann ........... 128b
degarelix ............... D
desonide............. 65t

Diastatt ............ 143b

Dilaudidd .............. 6b Disalcidd.............. 4m
doxorubicin non-

164

Dilaudid-55........... 6b

Disketss ................ 7b
liposomal...... 128b

Index

Diltia XTT ........... 51m
disopyramide... 40m, Doxycinn............. 33m t = top of page
diltiazem .......... 51m

........................ 41t
doxycycline ....... 33m
m = middle of page

Diltiazem CD

D .... 51m

DisperMox.

x ......... 30b
doxylamine
b = bottom of page

Diltzacc.............. 51m
disulfi ram....... 145m

Analgesics ........ 9b

D,PDA = see page 157 dimenhydrinate ..91t Dithranoll ........... 62b Gastroenterology...

dimercaprol (BAL) ...

Ditropann .......... 154b

..................... 91t

Diastat AcuDiall.. 143b

...................... 153t

Ditropan XLL ..... 154b

Dramaminee ........ 91t

Diastixx.............. 74m

Dimetane-DXX.... 85m

Diurill .....................D

Drisdol................

l

82t
diatrizoate......... 57b

Dimetane-DX Cough
divalproex

Dristan 12 Hr Nasal

Diatx.................

x

80m

Syrupp .................. D

Neurology...... 116b

........................ 89t

Diazemulss ....... 143b

Dimetapp Cold &

Psychiatry..... 139b

Drithocreme....... 62b
diazepam ........ 143b

Allergyy ................ D

Divigell............ 122m

Drixoral Cold &
diazoxide ............... D

Dimetapp Cold &

Dixaritt ............... 38b

Allergyy ............. 85t

Dibenzylinee............ D

Allergy Elixirr..... 85t

DLV....................PDA
dronabinol........ 91m
dibucaine .......... 63b

Dimetapp Cold &

DMSO

O .................... D
dronedarone ..... 40m

Dicell...................... D

Coughh................. D
dobutamine....... 53b
droperidol

Dicetell............... 99b

Dimetapp

Dobutrexx............ 53b

Cardiovascular .....

dichloralphenazone .

Decongestant Infant docetaxel.................

..................... 41t

.................... 118m

Dropss................ 86m

.................... 129m

Gastroenterology...

diclectin ............. 91t

Dimetapp DM Cold
docosanol.......... 62b

................... 91m
diclofenac .......... 4m

& Coughh .......... 85t
docusate ........ 97mb
drospirenone ... 123b
diclofenac—

Dimetapp Nighttime
dofetilide............ 41t
drotrecogin......... 34t
ophthalmic .... 135t

Cold & Congestion
dolasetron

Droxia
diclofenac—topical

........................... D

Cardiovascular .....

Herbal & alterna-

....................... 59b
dimethyl sulfone......

..................... 41t
tive therapy ........

dicloxacillin....... 30b

..................... 107b

Gastroenterology...

................... 103t
dicyclomine ....... 94b
dimethyl sulfoxide....D

..................... 90t

Oncology........ 129t
didanosine ........ 20b
dinoprostone ... 125b

Dolobidd................. 4t

DRV ................... 21b

Didrexx.................... D

Diocarpinee........ 134t

Dolophinee ............ 7b

Dry Eyes........... 135b

Didronel.l............. 68t

Diodoquinn.......... PDA

Doloral.l................ 7b

Drysoll ................. 64t
diethylpropion ....... D

Diogent............

t

130b

Doloteffi n.......... 105t

DT...................

T

110m
difenoxin ........... 89b

Diopred...........

d

133m

Domeboro Oticc.... 87t

DTaPP................. 110t

Differinn............... 58t

Dioscorea villosaa .....

domperidone ...... 91t

DTIC-Domee ...... 128b
difl orasone ............ D

..................... 109b

Dona............... 106m

Duac.................. 58b
difl orasone

Diovann.............. 38m
donepezil.......... 114t

Duetactt ............. 70b
diacetate ........ 65b

Diovan HCT.

T ........ 45t
dong quai......... 105t

Dulcolaxx ............. 97t

Difl ucan............ 13m

Dipentum
m ........... 98t

Donnatall ............ 95t
duloxetine........ 138b
difl unisal.............. 4t

Diphen.............. 84m
dopamine ........... 54t

Duocainee .......... 12m
difl uprednate.... 133t

Diphenhist.

t ....... 84m

Dopram
m ................. D

Duodotee................. D

Digibindd ............. 40t
diphenhydramine ....

Doribaxx............. 25m

Duolubee........... 135b

Digifabb ............... 40t

.............. 84m, 87b
doripenem ........ 25m

DuoNeb........... 149m
dig immune Fab.........

diphenoxylate .... 89b
dornase alfa... 152m

Duovent UDVV ......... D

..........................153t
diphenydramine .... D

Doryxx ................ 33m

Duraclon............ PDA

Digitek................

k

40t
diphtheria tetanus
dorzolamide.... 134tb

Duradrinn......... 118m
digoxin ............... 40t
and acellular

Dostinexx ........... 82m

Duragesicc............ 6b
digoxin immune fab
pertussis vaccine ....

Dovonexx............. 62b

Duratusss .......... 85m

........................ 40t

.............110t, 111tm
doxapram .............. D

Duratuss GPP .......... D
dihydrocodeine...10m
diphtheria-tetanus
doxazosin .......... 38b

Duratuss HD

D.......... D
dihydroergotamine ..

toxoid ........... 110m
doxepin........... 136m

Duratuss HD (c)III.I...

...................... 118t
dipivefrin............... D
doxepin—topical ....

...................... 85m
diiodohydroxyquin....

Diprivann ........... 12m

...................... 64m

Durezoll ............. 133t

....................... PDA

Diprolenee........... 65b
doxercalciferol ... 80b

Duriceff .............. 25b

Dilacor XR

R ........ 51m

Diprolene AFF ...... 65b

Doxill ................ 128b
dutasteride..... 154m

Dilantinn ............ 116t

Diprosonee .............. D
doxorubicin

Dutoproll ............. 45t

Dilatrate-SR

R ....... 53t
dipyridamole ...... 48t
liposomal...... 128b

Duvoidd............. 155b

Dyazide............... 45t Eligardd ........... 129m

Entex LA ................ D

165

Dynacinn ............. 33b

Elimite................ 62t

Entex Liquidd .......... D

Index

DynaCirc............ 50b

Elitekk..................... D

Entex PSEE ......... 85m

DynaCirc CR

R ...... 50b

Elixophyllinn...... 152b

Entocort EC

C ....... 98b
t = top of page

Dynapenn ............ 30b

Ellencee ............. 129t

Entonoxx ............. PDA
m = middle of page

Dyrenium
m............... D

Elmiron.................. D

Entozymee.......... 99m
b = bottom of page

Dytan................ 84m

Elocom
m .................. D

Entrophen............. 4t D,PDA = see page 157

Elocon .............. 65m

Entsoll................. 89t

Eloxatinn .......... 129m

Enulosee .............. 96t

Erycettee .............. 59t

E

Elspar..............

r

129b

E pallida........... 105t

Eryderm
m.............. 59t

E angustifolia... 105t
eltrombopag...... PDA

E Pam.............. 143b

Erygell ................. 59t

Ebixaa .............. 114m

Eltroxinn.............. 79b

Epaxall ............ 110m

Erypedd ............... 29b

Echinaceaa ........ 105t

Emadinee......... 130m
ephedrine ........... 54t

Erysoll ................. 59t

Echinacin madauss ..

Emcytt ............... 129t

Epiduoo............... 58b

Ery-Tabb.............. 29b

...................... 105t
emedastine .... 130m

Epifoam................. D

Erythrocin IVV...... 29b

EchinaGuardd .... 105t

Emendd............... 90b

Epijectt............. 139b

Erythromid.

d ........ 29b
echothiophate

Emetrol.l............ 91m
epinastine ........ 130t
erythromycin..... 41m
iodide ................. D

EMLA ................. 64b
epinephrine ...... 54m
erythromycin base

EC-Naprosynn ....... 5b

Emo-Cortt............... D
epinephrine racemic

Antimicrobials ......

econazole ........... 61t

Empirinn ................ 4t

.................... 152m

.................... 29b

Econopred Plus........

Empirin with

EpiPenn.............. 54m

Dermatology .. 58m

.................... 133m

Codeine ............. 9t

EpiPen Jrr .......... 54m
erythromycin

Ecotrin.................. 4t

Emsam
m............ 136b

EpiQuin Microo.... 64b
estolate .............. D

Ecstacy..............

y

PDA

Emtecc............... 10m
epirubicin
erythromycin ethyl
eculizumab........ PDA
emtricitabine.... 19b,

Cardiovascular .....

succinate........ 29b

Edecrinn............. 52m

....................... 20b

..................... 41t
erythromycin
edetate.................. D

Emtrivaa ............. 20b

Oncology........ 129t
lactobionate ... 29b

Edexx ................ 155b

E-mycinn............. 29b

Epitol...............

l

114b
erythromycin—

Edluarr ............. 144b

Enablexx .......... 154m

Epival
ophthalmic ... 131b
edrophonium .. 119m
enalapril.... 35b, 36t,

Neurology...... 116b
erythromycin—

ED Spazz.............. 95t

.............. 45b, 47m

Psychiatry..... 139b
topical ............. 59t

EDTA................. 153t
enalaprilat ......... 36t

Epivir.

r ................. 21t
erythropoietin alpha

EES....................

S

29b

Enbrel...................

l

1t

Epivir-HBVV.......... 21t

.................... 102m
efavirenz .... 19b, 20t

Encaa.................. 33b
eplerenone......... 36b
erythropoietin beta...D

Effer-KK............... 77b

Endantadine...... 22b
epoetin alfa.... 102m
escitalopram .... 137t

Effexorr............. 138b

Endocett .............. 10t
epoetin beta .......... D

Esclim
m ............. 122b

Effexor XR........ 138b

Endocodonee........ 8m

Epogenn ........... 102m

Esgicc .................... 3t

Effi entt .............. 48m

Endodann............. 10t
epoprostenol.......... D

Esidrixx ............... 52b

Efi dac/24.......... 86m

Endometrin..............

Eprexx .............. 102m

Eskalithh........... 139b
efl ornithine....... 64m

.................... 126m
eprosartan..........37m, Eskalith CR

R ..... 139b

Efudexx ............... 59b

Endratee ................. D

............................41t
esmolol............. 49m

EFVV..................... 20t

Enduron................. D
eptifi batide......... 48t
esomeprazole .... 93b

EGb 761 .......... 105b

Enemeezz........... 97m

E purpureaa ....... 105t

Esotericaa ........... 64b

Elaprasee............ PDA

Enemoll .............. 96b

Epzicom............. 19b
estazolam......... 144t

Elavill................ 136t

Enfamill ............ 78m

Equalactin......... 95b
esterifi ed estrogens.

Eldepryll ............ 121t
enfl urane........... PDA

Equetro............ 114b

..........122t, 125tm
elderberry ......... 105t
enfuvirtide......... 19b

Eraxiss ............... 14m

Estracee.. 122t, 123m

Eldopaquee ......... 64b

Engerix-B

B ........ 110b

Erbitux............

x

129m

Estraderm
m ....... 122b

Eldoquinn............ 64b

Enjuviaa........... 123m
ergocalciferol ..... 82t
estradiol.......... 122t,

Eldoquin Fortee ... 64b

Enlonn.............. 119m

Ergomarr ............ PDA

........... 123m, 125t

Electropegg ........ 96m
enoxaparin ..... 100m
ergotamine....... 118t
estradiol acetate .....

Elestat.

t ............. 130t

Enpressee ......... 124b
erlotinib.......... 129m

...................... 122t

Elestrin........... 122m
entacapone .............

Errinn .... 124m, 126m
estradiol acetate
eletriptan ....... 117m

.................. 120mb

Ertaczoo .............. 61b
vaginal ring... 122t

Eleutherococcus
entacapone .... 120m
ertapenem........ 25m
estradiol cypionate ....

senticosuss ..... 106t
entecavir ............ 24t

Erybidd................ 29b

........................122m

Elidell................ 63m

Entereg.

g ............ 98m

Erycc ................... 29b
estradiol gel ... 122m

Etibii ................. 16m Feiba VH

H................ D

Finevinn ............. 58m

166
etidronate........... 68t

Feiba VH Immunoo .. D

Fioricett ................. 3t

Index
etodolac .............. 4b
felbamate

Fioricett with
t = top of page
etomidate........... 12t

Cardiovascular .....

Codeinee ........... 9m
m = middle of page
etonogestrel .... 121b

..................... 41t

Fiorinall................. 3t
b = bottom of page

Etopophoss ...... 129m

Neurology....... 115t

Fiorinal C-1/22..... 9m

D,PDA = see page 157 etoposide........ 129m Felbatoll ............ 115t Fiorinal C-1/44..... 9m ETR..................... 20t

Feldene................. 6t

Fiorinal with
l
estradiol topical
etravirine............ 20t
felodipine .. 45b, 50b

Codeinee ........... 9m
emulsion...... 122m

Eufl exx ............... 129t

Femaprinn........ 104m
fi sh oil .............. 78m
estradiol transder-

Eugluconn ........... 73b

Femaraa........... 129m

FK 5066............. 113b
mal patch..... 122b

Eulexinn ............. 129t

Femcon Fee ........ 124t

Flagyll ............... 34m
estradiol transder-

Euraxx.................. 62t

FemHRT............ 125t

Flagyl ER

R .......... 34m
mal spray ..... 122b

Euthyroxx ............ 79b

Femizol-M.

M ....... 127b

Flamazine.......... 60b
estradiol vaginal

Evamistt........... 122b

FemPatchh ........ 122b

Flarexx ............... 133t
ring............... 122b
evening primrose oil

Femringg............ 122t
fl avocoxid ....... 105m
estradiol vaginal

.................... 105m

Femtracee .......... 122t
fl avoxate................ D
tab................ 122b
everolimus............. D
fenofi brate......... 44b

Flebogammaa .. 112m
estradiol valerate ....

Evistaa.............. 126b
fenofi bricacid .... 44b
fl ecainide ... 40b, 41t

...................... 123t

Evithrom................ D
fenoldopam ...... 47m

Flectorr ................ 4m

Estradott .......... 122b

Evoclinn .............. 58b
fenoprofen......... PDA

Fleett ............ 96t, 97t
estramustine .... 129t

Evoxacc.............. 87m
fenoterol......... 148m

Fleet Enemaa ...... 96b

Estrasorb........ 122m

Evra.................. 122t
fentanyl .......... 6b, 7t

Fleet EZ-Prep..... 96b

Estratestt .......... 125t

Excedrin Migraine 3t

Fentoraa................ 6b

Fleet Mineral Oil

Estratest H.S. ... 125t

Exelon............. 114m
fenugreek ....... 105m

Enemaa ............ 97b

Estringg ............ 122b

Exelon Patch... 114m

Feosoll................. 76t

Fleet Pain Relief 63b
estriol................ PDA
exemestane ...... 129t

Ferahemee ......... 76m

Fleet Phospho-Soda

Estrogell.......... 122m
exenatide............ 74t

Fergonn ................ 76t

....................... 96b
estrogens conju-

Exforgee ............... 45t

Feridex.

x ............. 57m

Fletcher’s Castoria 97t
gated....123t, 125t

Exforge HCTT........... D

Fer-in-Soll ........... 76t

Flexeril..................

l

2t
estrogens synthetic

Exjadee ............. 102b

Ferodann .............. 76t

Flextend..........

d

106m
conjugated AA..123m

Ex-Laxx ................ 97t
ferric gluconate

Flixonasee ............... D
estrogens synthetic

Exsel..................

l

66b
complex ........... 76t

Flixotide................. D
conjugated B..123m

Extinaa................. 61t

Ferrlecitt.............. 76t

Flolann ....................D
estrogen vaginal

EZ-Char.

r ........... 153t
ferrous fumarate ... D

Flomax.

x ........... 154m
cream ............ 123t
ezetimibe........ 44mb
ferrous gluconatee ...76t

Flonase............. 88m
estrone .............. PDA

Ezetroll ............... 44b
ferrous sulfate.... 76t

Flo-Pred............

d

69m
estropipate..... 123m

Fertinexx ................. D

Florastorr........... 108t

Estrostep Fee .... 124b
ferumoxides...... 57m

Florazole ER...... 34m

F
eszopiclone...... 144b
ferumoxsil ........ 57m

Florineff............... 69t
etanercept............ 1t

Fabrazymee......... PDA
ferumoxytol....... 76m

Flovent Diskuss. 149b
ethacrynic acid 52m

Factivee .............. 32b
fesoterodine .... 154b

Flovent HFA .... 149b,
ethambutol....... 16m
factor IX ................ D
feverfew ......... 105m

...................... 152t
ethanol .................. D
factor VIIa ............. D

Fexicam
m................ 6t

Floxin.................. 32t
ethinyl estradiol
factor VIII .............. D

Fexmid..................

d

2t

Floxin Oticc .......... 87t

Dermatology ... 58b
famciclovir ........ 18b
fexofenadine...... 83b
fl oxuridine ........ 129t

OB/GYN.......... 125t
famotidine.......... 93t

FFPP ................... 153t

Fluanxol.l................ D
ethinyl estradiol

Famvirr............... 18b

Fiberalll.............. 95b

Fluanxol Depot.......

t

D
transdermal ... 122t

Fanapt.

t ........... 141m

FiberConn............ 95b

Fluarixx ............. 110b
ethinyl estradiol

Fansidarr................ D
fi ber—dietary ... PDA
fl uconazole ....... 13m
vaginal ring.. 121b

Farestonn ......... 129m

Fibratess............. 43b
fl ucytosine......... 14b
ethionamide ...... PDA

Faslodexx ........... 129t
fi brinogen concen-

Fludara............. 129t
ethosuximide.... 115t

Fasturtecc............... D
trate ............... PDA
fl udarabine....... 129t
ethotoin............. PDA
fat emulsion..... 78m

Fidelinn ............. 104b
fl udrocortisone . 69tb

Ethranee ............. PDA

FazaClo ODTT ..... 141t

Filgrastim....... 102m

FluLavall .......... 110b
ethynodiol.............. D

Febuxostat..........

t

75t

Finaceaa ............ 58m

Flumadinee ........ 23m

Ethyoll ............... 129t

Feen-a-Mintt ....... 97t
fi nasteride...... 154m
fl umazenil ...... 153tb
fl umethasone ........ D

Focalinn ............. 147t

Freezer Popss ..... 79m

167

FluMistt ............ 110b

Focalin XR

R ........ 147t

French maritime pine

Index
fl unarizine ...... 118m
folate................. 80b
tree barkk.........108m
fl unisolide .......... 88t

Folgardd.............. 80b

Frisium
m............ 114b
t = top of page
fl unisolide HFA MDI....

folic acid

Frobenn ................. 4b
m = middle of page

........................151m

Endocrine &

Froben SR

R............ 4b
b = bottom of page

Frovaa ............... 117b
fl unisolide—inhaled
metabolics .........

D,PDA = see page 157
frovatriptan..... 117b

..................... 149b

.......... 80mb, 81t

FSH........................D
fl unisolide MDI..151m

OB/GYN........ 128m

FTC

C.................... 20b
fl uocinolone..... 65m, folinic acid ...... 129b

Garcinia cambogiaa..

Fucidinn ............... 60t

....................... 66b

Follistim-Antagon

..................... 105b

Fucidin H

H........... 63b
fl uocinolone—
e otic

—

..87t

Kitt....................... D

Gardasill .......... 110b

Fucithalmicc ........... D
fl uocinonide..........65b

Follistim AQ

Q........... D
garlic supplements .

FUDR

R ................ 129t

Fluor-A-Dayy ...... 76m
follitropin alfa ....... D

..................... 105b

Ful-Gloo .............. PDA
fl uorescein......... PDA
follitropin beta ...... D

Gastrocrom...... 150b
fulvestrant ....... 129t
fl uoride............. 76m

Foltxx .................. 80b

Gastrografi nn ...... 57b

Fulvicinn ............. 14b

Fluor-I-Stripp ...... PDA

Folvitee ............... 80b

GastroMARKK ..... 57m

Fungizonee.......... 14b

Fluor-I-Strip AT.. PDA
fomepizole........ 153t

Gas-XX ................ 95b

Furadantinn ....... 34m
fl uorometholone.......

fondaparinux.... 101t
gatifl oxacin—
furosemide ....... 52m

...................... 133t
food ................... PDA
ophthalmic .... 131t
fusidic acid ....... 63b

Fluoroplexx.......... 59b

Foradill.... 148b, 152t

Gavisconn .......... 92m
fusidic acid—
fl uorouracil....... 129t

Foranee ............... PDA

G-CSFF............. 102m
topical ............. 60t
fl uorouracil—
formoterol....... 148b,
gefi tinib........... 129b

Fusilev.

v ............ 129b
topical ............ 59b

.................... 149m

Gelclair.

r ............. 87b

Fuzeonn............... 19b

Fluothanee .......... PDA

Formulex............

x

94b

Gelniquee.......... 154b

Fluoticc .............. 76m

Fortamet.

t .......... 74m
gemcitabine ..... 129t
fl uoxetinee ..137m, 145t

Fortazz ................. 27t
gemfi brozil ......... 45t

G
fl uoxymesterone..... D

Forte DSC

C ............. 2t
gemifl oxacin
fl upenthixol ........... D

Forteoo ............... 83m

G1155 ................106t

Antimicrobials ......

fl upentixol ............. D

Forticall.............. 82b
gabapentin....... 115t

.................... 32b
fl uphenazine.... 140t, Fosamaxx............ 67b Gabitrill............ 116b

Cardiovascular .....

Fosamax Plus D

D ... 67b

.................... 141m
gadobenate ........ 57t

..................... 41t
fosamprenavir... 21b
fl urandrenolide........

gadodiamide ...... 57t
gemtuzumab .. 129m
fosaprepitant .... 90b

...................... 65m
gadopentetate.... 57t

Gemzarr............. 129t

Fosavancee ......... 67b
fl urazepam ...... 143b
gadoteridol......... 57t

Gengraff .......... 113m
foscarnet
fl urbiprofen ......... 4b
gadoversetamide.....

Genisoy.

y .......... 109m

Analgesics..... 18m
fl utamide.......... 129t

........................ 57t

Gen-KK ................ 77b

Cardiovascular .....

fl uticasone DPI 151b
galantamine..... 114t

Genopticc.......... 130b

..................... 41t
fl uticasone HFA MDI
gallium.................. D

Genotropin.......... 83t

Foscavir.

r ........... 18m

..................... 151b
galsulfase ......... PDA

Gentak.............

k

130b
fosfomycin.......... 34t
fl uticasone—

Galzinn................. 78t
gentamicin
fosinopril.......... 35b,
inhaled ........ 149tb

Gamastann ...... 112m

Antimicrobials .. 13t

.................36t, 47t
fl uticasone—nasal .

Gammagardd ... 112m

Ophthalmology .....

fosphenytoin

........................ 88t
gamma hydroxybu-

.................. 132b

Cardiovascular .....

fl uticasone propio-
tyrate........... 121m
gentamicin—

..................... 41t
nate............... 65m

Gamunexx ........ 112m
ophthalmic ... 130b

Neurology....... 115t
fl uticasone-topical
ganciclovir ....... 18m
gentamicin—
fospropofol ......... 12t

........................... D
ganirelix ................ D
topical ............. 60t

Fosrenol.............

l

78b
fl uvastatin........ 43m

Ganitee ................... D

GenTeall .......... 135m

FPVV.................... 21b

Fluvirall............ 110b

Gani-Tuss NR

R ........ D

Gentrann .............. 56t

Fragmin............. 99b

Fluvirin ............ 110b

Gantrisin Pediatricc...D

Geodonn ............. 143t

FreeStyle Flashh ........

fl uvoxamine..... 137b

Garamycin

GHB

B................ 121m

........................ 74t

Fluzonee............ 110b

Antimicrobials . 13t

GI cocktail .......... 95t

FreeStyle Freedom
m ...

FML ..................

L

133t

Dermatology .... 60t
ginger.............. 105b

........................ 74t

FML Forte.......... 133t

Ophthalmology .....

ginkgo biloba .. 105b

FreeStyle Freedom

FML-S LIQUIFILM

M .....

74t

.................. 130b

Ginkgoldd.......... 105b

Litee ..................

.................... 132m

FreeStyle Litee...... 74t
garcinia........... 105b

Ginkobaa........... 105b

GoLytelyy............ 96m Guiatuss PE......

E

85m
hepatitis B immune

168
gonadotropins ....... D

Gynazolee......... 127m
globulin ......... 112t

Index

Gonal-FF ................. D

Gyne-Lotriminn ... 127m
hepatitis B vaccine
t = top of page

Gonal-F RFF Penn.... D

Gynodioll ........... 122t

.........110tb, 111tb
m = middle of page

Goody’s Extra Strength

Hepseraa.............. 24t
b = bottom of page

Headache Powderr .

H

Heptovir..............

r

21t

D,PDA = see page 157

........................ 3m

Herceptin........ 129m

Habitroll ............ 146t
goserelin .......... 129t
heroin................ PDA

Haemophilus B

Ginsana............ 106t
gramicidin....... 131b

Hespann............... 56t
vaccine........ 110m
ginseng—American

Gram negative

Hetastarchh ......... 56t
halcinonide ....... 65b

...................... 106t
aerobic bacilli ...23b

Hexabrixx ............. 58t

Halcionn........... 144m
ginseng—Asian..106t

Gram negative aero-

Hexalenn ........... 128b

Haldol.l............ 140m
ginseng—Ssiberian
bic coccobacilli.....

Hexitt................... 62t

HalfLytely and

...................... 106t

....................... 23b

Hextendd .............. 56t

Bisacodyl Tablet

Glasgow Coma

Gram negative

HibTITER......... 110m

Kitt.................. 96m
aerobic diplococci .

Hiconn.................. 80t

Scale ............. 119t

Halfprinn................ 4t

....................... 23b

Hiprexx................ PDA
glatiramer ....... 118b
halobetasol propi-

Gram neg faculta-

Histinex HC............ D

Gleevec........... 129m
onate .............. 65b
tively anaerobic
histrelin............ 129t

Gliadel.............

l

128b
halofantrine ...... PDA
bacilli ............. 23b

Histussin D............ D
gliclazide........... 73b

Halog.................

g

65b

Gram positive aero-

Histussin D (c)IIII .....

glimepiride....... 70m
haloperidol
bic/facultatively

...................... 85m

GLIMEPIRIDE ..... 73b

Cardiovascular .....

anaerobic bacilli...

Histussin HC

C ......... D
glipizide .... 70b, 73b

..................... 41t

....................... 23b

Histussin HC (c)IIII ...

GlucaGen............ 74t

Psychiatry ... 140m,

Gram positive

...................... 85m
glucagon

................. 141m
aerobic cocci .. 23b
homatropine.... 134b

Endocrine &

Halotestin.............. D
granisetron
honey................ 107t
metabolic ...... 74t
halothane .......... PDA

Cardiovascular .....

horse chestnut seed

Toxicology ...... 153t

Halotussin AC........ D

..................... 41t
extract ........... 107t

Glucobayy ............ 70t

Halotussin DAC

C ..... D

Gastroenterology...

H.P. Acthar Gel.......

l

D

Gluconorm
m........ 73m

Harpadoll .......... 105t

................... 90m
huang qi.......... 103b

Glucophagee ...... 74m

Harpagophytum
grapefruit juice ....PDA
huckleberry...... 103b

Glucophage XR

R. 74m
procumbenss... 105t
grape seed extract.....

Humalog............

g

72b
glucosamine... 106m

Havrixx............. 110m

.........................106b

Humalog Mix 50/500 .

glucose home testing
hawthorn .......... 107t

Gravol.................

l

91t

............... 71b, 72b

........................ 74t

H-BIG

G ............... 112t
green goddess.... 95t

Humalog Mix 75/25

Glucotrol............

l

73b

HCE500 .............. 107t
green tea......... 106b

....................... 71b

Glucotrol XLL....... 73b
hCG

G .......................D

Grifulvin VV ......... 14b

HumaLog Mix 75/25

Glucovance........ 70b

HCTZZ...... 45mb, 47tm,
griseofulvin ....... 14b

....................... 72b

Glumetzaa.......... 74m

...........................52b
griseofulvin ultrami-
human growth

Glutosee............... 74t

Healthy Womann .......

hormone .......... 83t
crosize ................ D
glyburide ... 70b, 73b

.................... 109m
human papilloma-

Gris-PEG................ D
glycerin .............. 96t

HeartCaree......... 107t
guaiacolsulfonate.. D
virus recombinant

GlycoLaxx ........... 96m

Hectoroll............. 80b
guaifenesin ........ 86t
vaccine......... 110b
glycopyrrolate.... 98b
helicobacter pylori

Guaifenex DM

M ........ D

Humate PP .............. D

Glycyrrhiza glabraa ...

therapy ............ 94t

Guaifenex PSEE ....... D

Humatropee ......... 83t

.................... 107m
helidac ............. 93m

Guaifenex PSE 1200 ..

Humibid DM

M ..... 85m

Glycyrrhiza uralensis

Helixatee ................. D

...................... 85m

Humibid LA............ D

.................... 107m

Hemabate........ 126b

Guaitex II SR/PSEE .. D

Humira ................. 1t

Glynase PresTabb... 73b

Hemofi l M

M .............. D
guanabenz ............ D

Humulin 50/500 ........

Glyquinn.............. 64b
guanfacine......... 39t
hemophilus B vaccine

............... 71b, 72b

Glysennidd ........... 97t
guarana .......... 106b

........... 110t, 111m

Humulin 70/300 ........

Glysett ................. 70t
guggul............. 106b

HepaGam B

B ...... 112t

............... 71b, 72b

GM-CSFF ........... 102b
guggulipid....... 106b

Hepaleann.......... 101t

Humulin N

N ........ 72m

Goldenseall ..... 106m

Guiatuss............. 86t
heparin............. 101t

Humulin R

R ......... 72b
gold sodium

Guiatuss AC

C .......... D
hepatitis A vaccine..

Hyalgann................. D
thiomalate.......... D

Guiatussin DAC

C ..... D

.......... 110m, 111b
hyaluronate ........... D
hyaluronic acid.. 64b
hydroxyprogesterone
imipenem-cilastatin

169
hyaluronidase.... PDA
caproate ........ 126t

....................... 25b

Index

Hycamtinn......... 129b
hydroxypropyl
imipramine..... 136m

Hycoclear Tuss....... D
cellulose ...... 135m
imiquimod......... 62b
t = top of page

Hycodann ................ D
hydroxyurea

Imitrexx............. 117b
m = middle of page

Hycortt.................... D

Herbal & alterna-

Immucyst
b = bottom of page

Hycotuss................ D
tive therapies.....

Immunology... 110t D,PDA = see page 157

Hycotuss (c)IIII .. 85m

................... 103t

Oncology...... 129m

Hyderm
m.................. D

Oncology........ 129t
immune globulin—

INH

H ................... 16m
hydralazine...... 45m, hydroxyzine ........ 84b

IM ................ 112m

Inhibacee ............. 36t

.............. 47b, 56m
hylan GF-20........... D
immune globulin—

Inhibace Plus ..... 45t

HydraSensee ........ 89t
hymenoptera venom

IV................. 112m

Innohepp .......... 101m

..................... 113b
immune globulin—

Hydrastis canaden-

InnoPran XLL...... 50m
hyoscine ............. 95t

SC................ 112m
siss ............... 106m

INOmax..................

x

D
hyoscyamine

Immunine VH.........

H

D

Hydrea

Inspra................ 36b

Gastroenterology...

Immunoprin......... 1b

Hernal & alterna-

Insta-Glucosee..... 74t

..................... 95t

Imodium
m............ 89b
tive therapies.....

insulin—injectable

Urology ........ 154b, Imodium AD....... 89b

................... 103t
combinations .. 71b

................. 155m

Imodium Advanced..

d

Oncology........ 129t
insulin—injectable

Hyosol.................

l

95t

....................... 89b
hydrochlorothiazide .

intermediate/long-

Hyospazz.............. 95t

Imogam Rabies-HT..

T

....................... 52b
acting............ 72m

Hypaquee ............ 57b

...................... 113t

Hydrocill ............. 95b
insulin—injectable

HyperHep B....... 112t

Imovanee ........... 145t
hydrocodone ... 7t, 8b
short/rapid-acting

Hypericum

Imovax Rabies 111m

......9bm, 10tb, 11t

....................... 72b
perforatum
m .... 109t

Implanonn......... 121b
hydrocortisone
insulins ............ 72m

HyperRAB S/D

D... 113t

Imurann ................ 1b

Dermatology .........

insulin aspart.... 72b

HyperRHO S/D 128m
inamrinone....... 54m

...63m, 65t, 66m
insulin aspart prot-

Hyperstat...............

t

D

Inapsinee ........... 91m

Endocrine &
amine susp/aspart .

Hypertet.

t ........... 113t

Increlex..................

x

D
metabolic .... 69tb

72b

Hypocol............

l

108b
indapamide 41t, 52b

ENT.......... 86b, 87t
insulin detemir.. 72b

Hypotearss ....... 135m

Inderal..............

l

50m
hydrocortisone
insulin glargine ..72b

Hytonee ................ 65t

Inderal LA......... 50m
acetate ............ 65t
insulin glulisine ...72b

Hytrinn ............... 39m

Inderidee.............. 45t
hydrocortisone
insulin lispro .....72mb

Hytusss ................ 86t

Indigo Carmine.. PDA
butyrate......... 65m
insulin lispro

Hyzaarr ................ 45t
indigotindisulfonate
hydrocortisone—
protamine susp ....

....................... PDA
ophthalmic .. 132m

....................... 72b
indinavir............. 22t

I
hydrocortisone—

Intall ....... 150b, 152t

Indium DTPA...... PDA
topical ................ D

Integrilinn ............ 48t

I-1600 ................ 109t

Indocid-P.D.A........ 5t
hydrocortisone—

Intelencee ............ 20t
ibandronate........ 68t

Indocinn ................. 5t
valerate .............. D
interferon alfa-2a
ibritumomab .. 129m

Indocin IVV ............. 5t
hydrocortisone

Antimicrobials ......

ibudone .............. 9m

Indocin SR

R............ 5t
probutate............ D

................... 24m
ibuprofen............ 4b, indomethacin .......5t
hydrocortisone

...............9tm, 10b

Oncology...... 129m

Infalytee............... 79t
valerate ......... 65m
ibutilide........... 41tm
interferon

Infanrix.............

x

110t

HydroDiurill ........ 52b

Idamycinn .......... 129t
alfacon-1 ....... 24m

Infasurff ................. D

Hydromorph Contin..

idarubicin......... 129t

76b
interferon alfa-n3 .. D

InFedd .................

......................... 6b
idursulfase........ PDA

Infergen............ 24m
interferon beta-1A ...

hydromorphone........

IDVV ..................... 22t

Infl amase Fortee .......

..................... 118b

.................... 6b, 7t

Ifexx .................. 128b

.................... 133m
interferon beta-1B...

hydroquinone.... 64b, ifosfamide....... 128b
infl iximab ........... 1m

.................... 119m

....................... 66b
iloperidone ..... 141m
infl uenza vaccine—
interleukin-2 .. 129m

Hydrovall ................ D
iloprost.................. D
inactivated

IntestiFloraa....... 108t
hydroxocobalamin ...

Ilotycinn ............ 131b
injection ....... 110b

Intralipidd .......... 78m

.................... 153tb
imatinib ......... 129m
infl uenza vaccine—

Intron A ............ 24m
hydroxychloroquine..

Imdurr ................. 53t
live intranasal . 110b

Intropinn .............. 54t

......................... 1b
imiglucerase ..... PDA

Infuferr ............... 76b

Invanzz .............. 25m

Isordill................. 53t Kaopectate Stool

Klorvess

170
isosorbide dinitrate .

Softenerr......... 97m

Effervescentt ... 77b

Index

............... 53t, 56m

Kapidexx ............. 93b

Klotrixx................ 77b
t = top of page
isosorbide mononi-
karelaa............... 104t

K-Lytee ................ 77b
m = middle of page
trate ................ 53t

Kariva............. 124m

K-Lyte/Cll ........... 77b
b = bottom of page
isosulfan blue ... PDA

Kay Ciell ............. 77b

K-Lyte/Cl 500 ...... 77b

D,PDA = see page 157 Isotaminee......... 16m Kayexalatee.......... 83t K-Lyte DSS........... 77b isotretinoin......... 59t

Kaylixirr .............. 77b

K-Norm
m.............. 77b

Invegaa ............ 142m

Isovue................ 57b

K-Dur.................

r

77b

Koatee.....................D

Inversinee ............... D
isoxsuprine............ D

K-Dur 10............ 77b

Kogenatee ............... D

Invirasee ............. 22b
isradipine ... 41t, 50b

K-Dur 20............ 77b

Kolyum
m .............. 77b
iodixanol............ 57b
kombucha tea...107m

Istaloll.............. 133b

Kefl ex.

x ................ 25b

Kondremull......... 97b
iodoquinol ......... PDA

Isuprell.............. 41m

Kelnor 1/35.

5 ...... 124t

Konsyl.l............... 95b

Iodotopee ............. 80t
itraconazole....... 13b

Kemstroo................ 2t

Konsyl Fiberr....... 95b
iohexol............... 57b

Iveegam
m ......... 112m

Kenalog

Korean red ginseng .

Ionaminn........... 147b
ivermectin ........ 17m

Dermatology .. 65m

...................... 106t

IONSYSS ................ 6b
ixabepilone..... 129m

Endocrine &

K-Phos.............. 77m
iopamidol .......... 57b

Ixempraa .......... 129m
meabolic ...... 69b

Kristalosee ........... 96t

Iopidinee ................. D

Kenalogg in Orabasee ..D

K-Tab................. 77b
iopromide .......... 57b

Kepivance......... 129t

J

Kuvann................PDA

Iosatt...................... D

Keppra............. 115b

Ku-Zymee........... 99m
iothalamate........ 58t

Jantovenn........... 102t

Keppra XR

R ....... 115b

Ku-Zyme HP.

P ..... 99m
ioversol............... 58t
janumet............. 70b

Kerlonee ............... 49t

K-vescentt .......... 77b
ioxaglate ............ 58t

Januvia.............. 74b

Ketalarr ............... 12t

Kwaii ................ 105b
ioxilan ................ 58t

Japanese encephali-
ketamine ............ 12t

Kwellada-PP......... 62t
ipecac syrup.... 153b
tis vaccine .... 110b

Ketekk ................. 34b

Kyolic............... 105b

IPOL.................. 111t

JE-Vaxx ............. 110b
ketoconazole...... 13b

Kytril.................

l

90m
ipratropium ...... 149t

Jinfukangg ........ 103b
ketoconazole—
ipratropium—

Jolessaa ............ 124b
topical ............. 61t
inhaled ........ 152m

L

Jolivettee .. 124m, 126m

Ketoderm
m............ 61t
ipratropium—nasal

Junel 1.5/300 ... 124m
ketoprofen ............ 5t
labetalol........... 49m

....................... 88b

Junel 1.5/30 Fee........

ketorolac .............. 5t

Lac-Hydrin......... 64b

Iquixx ................. 131t

.................... 124m
ketorolac—ophthal-
lacosamide..... 115m
irbesartan.... 38t, 45m

Junel 1/200 ...... 124m
mic .............. 135m

Lacrilubee ......... 135b

Iressaa .............. 129b

Junel Fe 1/200.. 124m
ketotifen......... 152m

Lacrisertt......... 135m
irinotecan........ 129b
ketotifen—ophthal-

Lactaidd.............. 98b
iron dextran....... 76b
mic .............. 130m

K
lactase .............. 98b
iron polysaccharide .

K-G Elixirr ........... 77b
lactic acid ......... 64b

....................... 76b

K+ 8................... 77b

Kidrolasee ......... 129b

Lactinex............

x

108t
iron sucrose........ 77t

K+ 100................. 77b

Kineret..................

t

1t

Lactobacillus.... 108t

Isentresss ............ 20t

K+ Caree............. 77m

Kinlyticc ............... 56t
lactulose ............ 96t

ISMO................... 53t

K+Care ETT......... 77b

Kiraa .................. 109t

Lamictal
isocarboxazid .. 136b

Kabikinasee ........ 55b

Klaron............... 59m

Neurology ..... 115m
isofl urane .......... PDA

Kadian................. 7b

Klean-Prepp ....... 96m

Psychiatry .... 139m
isometheptene..118m

Kaletraa ............... 22t

K-Leasee ............. 77b

Lamictal CD

Isomill ............... 78m
kanamycin......... PDA

Klonopinn ......... 143m

Neurology..... 115m
isoniazid.. 16mb, 17t

Kantrexx.............. PDA

Klonopin Wafer 143m

Psychiatry.... 139m
isoniazid........... 16m

Kaochlorr ............ 77b

K-Lorr ................. 77b

Lamictal ODT
isopropyl alcohol.. 87m

Kaochlor 10%.... 77b

Klorconn .............. 77b

Neurology..... 115m
isoproterenol .... 41m

Kaochlor S-FF..... 77m

Klor-Conn ............ 77b

Psychiatry .... 139m

Isoptin SR.......... 51b

Kao Lectrolytee... 79m

Klor-Con/EFF ....... 77b

Lamictal XR.... 139m

Isopto Atropinee.. 134b

Kaonn.................. 77b

Klor-Con 88 ......... 77b

Lamisil

Isopto Carbacholl ... D

Kaon Cl..............

l

77b

Klor-Con 100 ....... 77b

Antimicrobials .. 15t

Isopto Carpinee.. 134t

Kaon-Cl 100 ........ 77b

Klor-Con 255 ....... 77b

Dermatology ... 61b

Isopto Homatropinee .

Kaon-Cl 200 ........ 77b

Klor-Con M200 .... 77b

Lamisil AT ......... 61b

..................... 134b

Kaopectatee ....... 89m

Klorvess............. 77b
lamivudine..19b, 21t
lamotrigine
levofl oxacin

Lipolysar..........

r

108b

171

Neurology..... 115m

Antimicrobials ......

Liposynn............. 78m

Index

Psychiatry .... 139m

................... 32m

Liqui-Dosss......... 97b

Lamprenee .............. D

Cardiovascular .....

lisdexamfetamine....

t = top of page

Lanoxicapss ......... 40t

..................... 41t

.................... 147m
m = middle of page

Lanoxin............... 40t
levofl oxacin—
lisinopril .. 35b, 36m, b = bottom of page
lanreotide.......... PDA
ophthalmic .... 131t

........................ 47t D,PDA = see page 157
lansoprazole.... 93m, Levolet.

t .............. 79b

Lithanee............ 139b

...................... 94m
levoleucovorin...129b
lithium

Lansoyll.............. 97b
levonorgestrel ..121b,

Cardiovascular .....

losartan.............. 38t
lanthanum carbon-

...................... 123b

..................... 41t

LoSeasoniquee .. 124b
ate.................. 78b

Levophedd........... 54b

Psychiatry ..... 139b

Losecc................ 94m

Lantuss.............. 72m

Levoraa ... 123b, 124m

Lithobidd........... 139b

Lotemax............

x

133t

Lanviss .............. 129t
levorphanol ....... 7tm

Lithostat.

t ............... D

Lotensinn ........... 35m
lapatinib ........ 129m

Levo-TT ............... 79b

LiveBacc ............ 108t

Lotensin HCTT ...... 45t

Lariam............... 15b

Levothroidd ......... 79b

Livostinn .......... 130m
loteprednol ..... 132b,
laronidase ......... PDA
levothyroxine ..... 79b

Livostin Nasal Spray

...................... 133t

Lasix.

x ................ 52m

Levoxyl.l.............. 79b

....................... 88b

Lotrell.................. 45t
latanoprost..... 134m

Levsin................. 95t

L-methylfolate....... D

Lotriderm........... 63b

Latissee ........... 134m

Levsinexx ............. 95t

LMXX ................... 64b

Lotrimin AFF......... 61t

Lectopam
m ....... 143m

Levulan Kerastickk.. D

Lo/Ovrall.. 123b, 124m

Lotrimin Ultraa.... 60b

Leenaa .............. 124b

Lexapro............. 137t

Locacorten Vioform..

lotrisone ............ 63b
lefl unomide ......... 1b

Lexivaa................ 21b

........................... D

Lotronex.

x ........... 98m

Legalonn ........... 107b

Lexxell ................. 45t

LoCHOLESTT....... 42m
lovastatin......... 43tb
lenalidomide ... 129b

Lialdaa................. 98t

LoCHOLEST Lightt.....

lovastatin+ext’d

Lenoltec............ 10m

Libraxx ......... 98b, 99t

...................... 42m
release niacin ..43b
leopard’s bane. 103b

Librium........... 143m

Locoid...............

d

65m

Lovazaa.............. 78m
lepirudin.......... 101b

Licorice........... 107m

Locoid Lipocream
m .. D

Lovenoxx .......... 100m

Lescoll............... 43m

Lidemoll ................. D

Lodosynn ................. D

Low Ogestrel.l.. 123b,

Lescol XLL .......... 43m

Lidex..................

x

65b
lodoxamide...... 130b

.................... 124m

Lessina 123b, 124m

Lidex-EE .................. D

Loestin 24 Fee.. 124m

Loxapacc................. D

Letairiss.............. PDA
lidocaine ........... 41b

Loestrin 21 1.5/ 30

/

...

loxapine.......... 141m
letrozole.......... 129m
lidocaine—local

.................... 124m

Loxitane................. D
leucovorin........ 129b
anesthetic ... 12mb

Loestrin 21 1/200......

Lozidee................ 52b

Leukerann ......... 128b
lidocaine—ophthal-

.................... 124m

Lozoll.................. 52b

Leukine............ 102b
mic .............. 135m

Loestrin 24 Fe........ D

LPV/rr .................. 22t
leuprolide ....... 129m
lidocaine—topical ..

Loestrin Fe............. D

L-Thyroxinee........ 79b

Leustatinn.......... 129t

......... 64mb, 66mb

Loestrin Fe 1.5/300 ...

lubiprostone ...... 97b
levalbuterol .... 148m
lidocaine—viscous .

................... 124m

Lucentiss ................ D

Levaquinn .......... 32m

....................... 87b

Loestrin Fe 1/200 ......

Ludiomill ............ PDA

Levatoll .................. D

Lidoderm
m ........... 64b

.................... 124m
lumbosacral nerve

Levbidd ................ 95t

Limbitrol................

l

D

Lominee .............. 94b
root compression ..

Levemirr ............ 72m

Limbitrol DSS .......... D
lomotil............... 89b

...................... 119t
levetiracetam .. 115b

Limbrell........... 105m
lomustine .............. D
lumefantrine .... 15m

Levitraa............. 156b

Lincocin................. D

Lonitenn .................. D

Lumigann......... 134m

Levlen... 123b, 124m
lincomycin............. D

Loperacapp ......... 89b

Luminall............ 116t

Levlitt ............... 123b
lindane............... 62t
loperamide ........ 89b

Lunestaa ........... 144b

Levlitee ............ 124m
linezolid............ 34m

Lopidd .................. 45t

Lupronn............ 129m
levobunolol...... 133b

Lioresall ................ 2t
lopinavir-ritonavir ...

Lupron Depott......... D
levocabastine—
liothyronine ........... D

........................ 22t

Luridee............... 76m
nasal .............. 88b

Lipidil EZZ........... 44b

Lopressor.

r .......... 49b

Lusedraa .............. 12t
levocabastine—

Lipidil Microo ...... 44b

Lopressor HCTT .... 45t

Lustra................ 64b
ophthalmic .. 130m

Lipidil Supra...... 44b

Loprox.

x ............... 60b

Lutera............. 124m
levocarnitine .... 78m
lipid reduction by
loratadine.......... 83b
lutropin alfa .......... D
levocetirizine ..... 84b
class/agent .... 43b
lorazepam ........ 144t

Luveriss .................. D
levodopa.......... 120b

Lipitor.

r ................ 43t
lorcet ................... 9b

Luvoxx............... 137b

Levo-Dromorann... 7m

Lipofenn .............. 44b

Lortab.................. 9b

Luvox CR

R ......... 137b

Magtratee .......... 77m

Medispazz............ 95t

Mesnexx ............. 129t

172
malarone.......... 15m

Medivertt ............ 84b

Mestinonn ......... 119b

Index
malathion........... 62t

Medroll ................ 69t

Mestinon Timespann .

t = top of page
maltodextrin...... 87b
medroxyprogester-

..................... 119b
m = middle of page

Manchurian or
one .......125t, 126t

Metadate CD

D .. 147m
b = bottom of page

Kargasok tea 107m
medroxyprogesterone

Metadate ER... 147m

D,PDA = see page 157 Mandelaminee ....PDA

—injectable.. 126t

Metadoll ............... 7b

Manerixx ................. D
mefenamic acid....5m
metaglip............ 70b
mangafodipir ... 57m
mefl oquine

Metamucill ......... 95b

Luxiqq .................. 65t
mannitol........... 121t

Antimicrobials ......

Metanxx .................. D

Lybrell ............. 124m

Mantouxx .......... 113b

.................... 15b
metaproterenol 148b

Lymphazurinn...... PDA
maprotiline........ PDA

Cardiovascular .....

Metastronn........ 129b
lymphocyte immune
maraviroc......... 19m

..................... 41t
metaxalone......... 2m
globulin ....... 112m

Marcainee .......... 12m

Mefoxin............... 26t
metformin..... 70tmb,

Lyricaa ............. 116m
marijuana ......... PDA

Megace............. 126t

.............. 71m, 74m

Lysodrenn.......... 129b
marine lipid concen-

Megace ES........

S

126t
metformin ........ 74m

Lytrenn ............... 79m
trate .............. 78m

Megacillinn .......... 30t
methacholine ........ D

Marinoll............. 91m
megestrol ......... 126t
methadone

M

Marplan........... 136b

Melaleuca alternifo-

Analgesics....... 7tb

Marvelonn ............... D
liaa................ 109m

Cardiovascular .....

Maalox..............

x

92m

Matricaria
melaleuca oil.. 109m

..................... 41t

MabCampathh . 129m
recutita—German

Melanexx............. 64b

Methadose........... 7b

Macrobidd .......... 34m
chamomile..... 104t
melatonin....... 107m
methamphetamine..

Macrodantinn..... 34m

Matulanee......... 128b

Mellarill............ 140b

....................... PDA

Macrodexx............ 56t

Mavikk ........ 35b, 36b
meloxicam.......... 5m
methazolamide ...134t

Macugenn ............... D

Maxairr .............. 152t
melphalan....... 128b
methenamine....154b,
mafenide............ 60t

Maxair Autohalerr .....

memantine..... 114m

........................155m

Mag-2000 ............ 77t

............ 148b, 152t

Membrane Bluee ..... D
methenamine
magaldrate ....... 92b

Maxaltt ............. 117b

Menactraa.......... 111t
hippurate........ PDA

Maganatee........... 77t

Maxalt MLT ...... 117b

Menestt ............. 122t
methenamine
magic mouthwash .87b

MAX EPA........... 78m

Meni-D

D .............. 84b
mandelate ...... PDA

Maglucatee .......... 77t

Maxerann ........... 91m
meningococcal

Metherginee ...... 126b

Magnacett .............. D
maxidone............. 9b
vaccine.......... 111t
methimazole...... 79b
magnesium car-

Maxifl orr ................. D

Menjugatee ........ 111t

Methitestt............ 67t
bonate

Maxilenee............ 64b

Menomune-A/C/Y/
methocarbamol .. 2m

Analgesics........ 2b

Maximum Strength

W-1355............ 111t
methohexital ...... 12t

Gastroenterology...

Pepcid AC

C ........ 93t

Menopurr ................ D
methotrexate ....... 1b

................... 92m

Maxipime.......... 27m

Menostarr ......... 122b
methotrimeprazine D
magnesium chloride

Maxitroll .......... 132m
menotropins .......... D
methoxsalen.......... D

........................ 77t

Maxivate............ 65b

Mentaxx .............. 60b
methscopolamine....

magnesium citrate..

Maxzidee ....... 45t, 47t
mepenzolate..... 95m

........................ 99t

........................ 96t

Maxzide-25.........

5

47t
meperidine ........ 7mt
methsuximide.... PDA
magnesium gluco-

MD-Gastroview
w.. 57b
mephobarbital... PDA
methyclothiazide ... D
nate................. 77t

MDMA................ PDA

Mephyton........... 81b
methylaminolevuli-
magnesium hydr-
measles mumps &
mepivacaine...... 12b
nate................ 59b
oxide
rubella vaccine.....

Mepronn ............. 17m
methylcellulose...95b

Analgesics........ 2b

.......... 110b, 111m
mequinol ........... 66b
methylcobalamin... D

Gastroenterology...

measles vaccine..PDA
mercaptopurine ..129t
methyldopa . 39t, 45m

...92mb, 93t, 96t

Mebarall............. PDA

Meridiaa............ 147b
methylene blue
magnesium oxide
mebendazole .... 17m
meropenem ....... 25b

Toxicology .... 153tb

Analgesics........ 2b
mecamylamine...... D

Merrem IVV.......... 25b

Urology .................

Endocrine &
mecasermin .......... D

Mersyndoll with

....... 154b, 155m
metabolics .... 77t
mechlorethamine.

e 128b

Codeinee ............ 9b
methylenedioxyme-
magnesium sulfate ...

Meclicot.............

t

84b

Meruvax II..........

I

PDA
thamphetamine....

..........................77m
meclizine.......... 84m
mesalamine ....... 98t

....................... PDA

Magnevistt .......... 57t
meclofenamate ..... D

Mesasal..............

l

98t
methylergonovine ....

Mag-Ox 400...... 77m

Medihoneyy ........ 107t
mesna .............. 129t

..................... 126b

Methylinn ......... 147m
micrhogam..... 128m

Gastroenterology...

173

Methylin ER

R .... 147m

Microgestin Fee....... D

................... 95m

Index
methylnaltrexone .....

Microgestin Fe

OB/GYN......... 125b

........................ 99t

1.5/300.......... 124m
mitomycin ........ 129t
t = top of page
methylphenidate .....

Microgestin Fe 1/20

Mitomycin-C

C..... 129t
m = middle of page

.................... 147m

.................... 124m
mitotane.......... 129b
b = bottom of page
methylprednisolone .

Micro-K.

K ............. 77b
mitoxantrone .... 129t D,PDA = see page 157

...................... 69tb

Micro-K LSS......... 77b

M-M-R III.......... 110b
methylsulfonyl-

Micronorr ..................

Mobann ................... D

M.O.S................... 7b
methane ....... 107b

......... 124m, 126m

Mobicc ................. 5m

Motilium
m............. 91t
methyltestosterone

Microzidee........... 52b

Mobicoxx .............. 5m

Motofenn ............. 89b

Endocrine &

Midamorr................ D
moclobemide......... D
motor function by
metabolic...... 67t
midazolam ......... 12t
modafi nil......... 147b
nerve roots.... 118b

OB/GYN....... 125tm
midodrine.......... 54b

Modecate.......... 140t

Motrin.................. 4b
metipranolol.... 133b

Midrin............. 118m

Modetenn ........... 140t

Movanaa ............ 109t
metoclopramide ......

Mifeprexx ......... 128m

Modicon............ 124t

Moviprepp .......... 96m

...................... 91m
mifepristone ... 128m

Modurett.............. 47t

Moxatagg ............ 30b
metolazone......... 53t

MIG-999 ........... 105m

Modureticc .... 45t, 47t
moxifl oxacin

Metopironee ............ D
miglitol............... 70t
moexipril . 35b, 36m,

Antimicrobials ......

metoprolol ...............

miglustat .......... PDA

...................... 47m

.................... 32b

............... 45b, 49b
moexipril/HCTZ... 41t

Migquinn.......... 118m

Cardiovascular .....

Metrika A1CNow
w ......

Mogadonn ............... D

Migra-Lieff ...... 105m

..................... 41t

....................... 73b
molindone ...... 141m

Migranal.l.......... 118t
moxifl oxacin—

MetroCream...... 60m
mometasone DPI .....

MigraSprayy..... 105m
ophthalmic .. 131m

MetroGell........... 60m

..................... 151b

Migratine........ 118m

Mozobill.................. D

MetroGel-Vaginall ....

mometasone furoate

Migrazone....... 118m

MS Contin............ 7b

..................... 127b

...................... 65m

Milk of Magnesiaa.....

MetroLotionn ...... 60m
mometasone—

MSIR.................... 7b

........................ 96t
metronidazole
inhaled ......... 149b

MSM

M ................ 107b
milk thistle...... 107b

Antimicrobials ......

mometasone—

Mucainee ............. 92t
milnacipran...... 121t

................... 34m
nasal ............. 88m

Mucinexx.............. 86t
milrinone........... 54b

Gastroenterology...

mometasone—

Mucinex D.............. D
mineral oil......... 97b

................. 93mb
topical ................ D

Mucinex DM

M........... D

Minestrin 1/20....... D
metronidazole—

Momordica

Mucinex-DM

Minipresss ........... 39t
topical ........... 60m
charantiaa....... 104t

Extended-Releasee.

Minirin............... 82b
metronidazole—

Monarc-M

M.............. D

........................ 85t

Minitrann ............ 53b
vaginal ......... 127b

Monascus

Mucomystt...... 150m,

Minizide....... 45t, 47t

Metvix.

x ............... 59b
purpureuss..... 108b

..................... 152b

Minocinn ............. 33b

Metvixia............. 59b

Monazolee ......... 127b

Multaq.............. 40m
minocycline ....... 33b
metyrapone ........... D

Monistatt.......... 127b

MultiHancee......... 57t

Min-Ovrall .............. D
metyrosine............. D

Monistat 1-Dayy ... 128t
multivitamins.... 80b

Minox.

x ................. 66t

Mevacor.............

r

43b
monobenzone ..... 66t
mumps vaccine ...PDA
minoxidil ............... D
mexiletine.......... 41b

Monoclate P...........

P

D

Mumpsvaxx......... PDA
minoxidil—topical ..

Mexitill ............... 41b

Monocor.

r ............. 49t
mupirocin......... 60m

........................ 66t

Miacalcinn .......... 82b

Monodoxx ........... 33m

Murine Ear.........

r

86b

Minoxidil for Men

Micafunginn....... 14m
monogyna......... 107t

Musee ............... 155b

........................ 66t

Micardiss ........... 38m

Monoket..............

t

53t

Mustargenn....... 128b

Mintezol..............

l

18t

Micardis HCTT..... 45t,

MonoNessaa....... 124t

Mutamycinn ....... 129t

Miochol-EE .............. D

........................ 47t

Mononine............... D

MVC.................. 19m

Miostatt.................. D

Micardis Pluss ..... 47t

Monoprill ..... 35b, 36t

MVII.................... 80b

Micatinn............. 61m

MiraLaxx ............ 96m

Monopril HCTT..... 45t, Myambutoll ....... 16m miconazole ...... 127b

Mirapexx .......... 120m

........................ 47t

Mycaminee......... 14m
miconazole—

Mirceraa.................. D
montelukast ..... 150t

Mycelex
topical ... 61m, 66b

Mircettee.......... 124m

Monuroll .............. 34t

Antimicrobials ......

Micort-HC
mirtazapine.... 139m

Morinda citrifolia.....

................... 13m

Lipocream
m........... D
misoprostol

..................... 107b

Dermatology .... 61t

Micozolee .......... 127b

Analgesics....... 4m
morphine............ 7tb

Mycelex-33 ....... 127m

Naglazyme......... PDA

Neo-Fradinn ......... 99t

Nicolar................

r

81t

174
nalbuphine.... 6m, 7t
neomycin

Nicorette.......... 145b

Index

Nalcrom........... 150b

Dermatology .........

Nicorette DSS .... 145b
t = top of page

Nalfonn ............... PDA

........ 60mb, 63m

Nicorette inhaler......

r
m = middle of page
naloxone

ENT.......... 86b, 87t

..................... 145b
b = bottom of page

Analgesics....... 11t

Ophthalmology .....

nicotine gum ... 145b

D,PDA = see page 157

Psychiatry....... 146

....... 131b, 132m
nicotine inhalation

Toxicology ...... 153t
neomycin—oral....99t
system.......... 145b

Mycelex 7........

7

127m
naltrexone ...... 145m

Neoprofenn............ 4b
nicotine lozenge ......

mycobacteria..... 23b

Namenda........ 114m

Neoral.............

l

113m

..................... 145b

Mycobutin.......... 16b
nandrolone ......... 67t

Neosarr............. 128b
nicotine nasal spray

Mycolog III .......... 63b
naphazoline...... 130t
neosporin cream......

..................... 145b
mycophenolate

Naphconn........... 130t

...................... 60m
nicotine patches......

mofetil .......... 113b

Naphcon-A ....... 130t
neosporin ointment .

...................... 146t

Mycostatin

NapraPacc ............ 5b

....................... 60b
nicotinic acid ..... 81t

Antimicrobials .. 15t

Naprelann ............. 5b
neosporin oint-

Nicotrol.............

l

146t

Naprosynn ............. 5b
ment—ophthalmic

Nicotrol Inhaler...

r 145b

Dermatology ... 61b
naproxen

........................ 131b

Nicotrol NSS ...... 145b

OB/GYN.......... 128t

Analgesics........ 5b
neosporin solu-

Nidazoll ............. 34m

Mydfrinn............. 135t

Neurology...... 117b
tion—ophthalmic.

nifedipine.......... 50b

Mydriacyll.......... 135t

Naratriptann ..... 117b

..................... 131b

Niferexx............... 76b

Myforticc ........... 113b

Narcann ............... 11t
neostigmine .... 119b

Niferex-1500 ....... 76b

Mylanta

Nardill .............. 136b

Neo-Synephrine

Nilandronn ....... 129m

ENT................. 87b

Naropinn ............. PDA

Cardiovascular .....

nilotinib.......... 129m

Gastroenterology...

Nasacort AQ

Q ...... 88b

.................... 54b

Nilstat

.................... 92b

Nasacort HFA..... 88b

ENT.................. 89t

Antimicrobials . 15t

Mylanta Children’s ..

NaSall ................. 89t

Neovisc.................. D

Dermatology ... 61b

...................... 75m

NasalCrom
m ........ 88b
nepafenac ...... 135m

OB/GYN.......... 128t

Mylerann ........... 128b

Nasalidee............. 88t
nephrocap .......... 81t
nilutamide ..... 129m

Myliconn.............. 95b

Nasarel...............

l

88t
nephrovite .......... 81t

Nimbexx .............. 12b

Mylotargg ......... 129m

Nascoball ............ 80t

Neptazanee ........ 134t
nimodipine ..... 121m

Myoblocc ................. D

Nasonex............

x

88m

Nesacainee ......... PDA

Nimotop.......... 121m

Myocett............. 128b
natalizumab.......... D
nesiritide........... 56b

Nipentt .............. 129t

Myochrysine........... D
nateglinide....... 73m

NESPP ................ 102t

Nipridee .............. 47b

Myotonacholl .... 155b

Natrecorr ............ 56b
nettle root........ 107b

Niravam
m ......... 144m

Myozymee............ PDA

Naturalytee ........ 79m

Neulasta.......... 102b
nisoldipine ......... 51t

Mysolinee ......... 116m

Navanee............ 140b

Neumegaa........ 102m
nitazoxanide..... 17m

Mytelasee............ PDA

Navelbinee ....... 129m

Neupogenn ....... 102m
nitisinone .............. D

Mytussin DM.

M ...... 85t

Nebcinn................ 13t

Neupro................... D

Nitomann ......... 121m

M-Zolee............. 127b
nebivolol............. 50t

Neurontinn ......... 115t
nitrazepam............ D

NebuPent...........

t

17b

Neutra-Phoss ..... 77m
nitric oxide ............ D

N

Necon .................... D

Nevanacc ......... 135m

Nitro-BID

D .......... 53m

Necon 0.5/355.... 124t
nevirapine ........ 20m

Nitro-Durr ........... 53b

NABI-HB

B ........... 112t

Necon 1/355....... 124t

Nexavarr ........... 129b
nitrofurantoin... 34m
nabilone ........... 91m

Necon 1/500....... 124t

Nexium
m .............. 93b
nitroglycerin intra-
nabumetone ....... 5m

Necon 10/11... 124m

NFV...................

V

22m
venous infusion ....

N-acetyl-5-

Necon 7/7/7.....

7

124b
niacin

...................... 53m
methoxytryptamine
nedocromil—

Cardiovascular .....

nitroglycerin

.................... 107m
inhaled ............... D

............43tb, 44t
ointment........ 53m

N-acetylcysteine ......

nedocromil—

Endocrine &
nitroglycerin

............ 152b, 153t
ophthalmic ... 130b
metabolic...... 81t
spray .............. 53b
nadolol ...... 45b, 49b
nefazodone............ D
niacinamide ..... 80m
nitroglycerin

Nadopen-VV ....... 30m
nelarabine........ 129t

Niacor.................

r

81t
sublingual ...... 53b
nafarelin ............... D
nelfi navir.......... 22m

Niaspan.............. 81t
nitroglycerin
nafcillin............. 30b

Nemasol Sodium
m .....

Niastasee................ D
sustained releaseD
naftifi ne ........... 61m

....................... PDA
nicardipine ..41t, 50b
nitroglycerin

Naftinn............... 61m

Nembutall ......... 12m

NicoDerm CQ

Q .... 146t
transdermal.... 53b

Nitrolinguall ....... 53b Novasenn ............... 4t

Octagam
m ........ 112m

175

NitroMistt ........... 53b

Novasoyy.......... 109m

Octostim............ 82b

Index

Nitropress.......... 47b

Novocainn ........... PDA
octreotide ........... 41t
nitroprusside..... 47b

Novolin 70/300... 71b, octreotide ...........99t t = top of page

NitroQuickk ......... 53b

....................... 72b

Ocufen................... D
m = middle of page

Nitrostatt............ 53b

Novolin N

N.......... 72m

Ocufl oxx ........... 131m
b = bottom of page
nitrous oxide...... PDA

Novolin R

R........... 72b

Ocupresss ......... 133b D,PDA = see page 157

Nixx...................... 62t

NovoLog.

g ............ 72b

Oenothera bienniss ...

nizatidine ........... 93t

NovoLog Mix 50/500 ..

.................... 105m

Onsoliss ................ 6b

Nizoral

............... 71b, 72b

Oesclim
m ........... 122b

Ontakk ............. 129m

Antimicrobials ......

NovoLog Mix 70/300 ..

Offf.........................D

Onxoll .............. 129m

.................... 13b

...................... 72b
ofl oxacin

Opanaa ................ 8m

Dermatology .... 61t

NovoRapidd......... 72b

Antimicrobials ......

Ophthainee ....... 135b

N- N-diethyl- m-

NovoSevenn............. D

..................32tm

Ophtheticc ........ 135b
toluamide ........... D

NovoSeven RT........ D

Cardiovascular .....

opioid antagonists. 11t

NoDozz ............... 147t

Novothyroxx......... 79b

..................... 41t
opium................. 90t

Nolvadex..........

x

126b

Noxafi ll ............... 13b
ofl oxacin—ophthal-
opium tincture.... 90t

NONII................ 107b

Nozinann ................. D
mic .............. 131m
oprelvekin....... 102m

Nora-BE.........

E

124m, NPH

H ................... 72b
ofl oxacin—otic... 87t

Oprisine............... 1b

.................... 126m

NPH/Regg........... 72m

Ogen............... 123m

Opticrom
m ......... 130b
norco .................. 10t

Nplatee ................... D

Ogestrell .. 123b, 124t

OptiMARKK ........... 57t

Norcuron............ 12b

NSAIDSs .............. 5b
olanzapine...... 141b, Optipranololl .... 133b Nordette..

e 123b, 124m

Nubainn ............... 6m

.............142t, 145t

Optirayy ............... 58t

Norditropinn ......... 83t

Nucyntaa............ 11m
olmesartan.. 38t, 45m

Norditropin

76b

Optivarr ............. 130t

Nu-Iron 1500.......

olopatadine .... 130m

NordiFlexx.......... 83t

NuLevv ................. 95t
olopatadine—nasal

Oracea.............. 33m
norelgestromin . 122t

NuLytelyy............ 96m

....................... 88b

Oracitt .............. 156b
norepinephrine .. 54b

Numby Stufff ...... 64b
olsalazine........... 98t

Oracortt .................. D
norethindrone..........

Nupercainal.......

l

63b

Oluxx................... 65b

OraDisc A ......... 87m

.....123mb, 125tm,

Nuprinn ................. 4b
omalizumab .......... D

Oramorph SR

R....... 7b

................... 126m

Nursoyy .............. 78m
omega-3b fatty acid

Orapp ............... 140m

Norfl exx ................ 2m

Nutramigen Lipill .....

...................... 78m

Orapredd ............ 69m

Norfl oxacinn ......... 32t

...................... 78m
omega 3 fatty acids

Orapred ODTT..... 69m
norgesic ............. 3m

Nutropinn ............. 83t

....................... 43b

Oraquix..................

x

D
norgestimate.... 125t

Nutropin AQ

Q........ 83t
omeprazole..... 94mb

Orazincc............... 78t
norgestrel.............. D

Nutropin Depott ... 83t

Omnariss ............. 88t
orciprenaline ... 148b

Norinyl 1+355 .... 124t

NuvaRingg ........ 121b

Omnicef.............

f

26b

Orencia.................. D

Norinyl 1+500 .... 124t

Nuvigil.l............ 146b

Omnipaque........ 57b

Oreticc ................ 52b

Noritatee ............ 60m

NVPP .................. 20m

Omniscann........... 57t

Orfadinn.................. D

Noroxinn ............... 32t

Nyaderm

Omnitropee .......... 83t

Orgalutran............. D

Norpacee............ 40m

Antimicrobials .. 15t

Oncaspar.........

r

129b

Orlistatt............. 99m

Norpace CR

R ...... 40m

Dermatology ... 61b

Oncotice
orphenadrinee..2m, 3m

Norpraminn ...... 136m

OB/GYN.......... 128t

Immunology... 110t

Ortho-Ceptt ..... 124m

Nor-Q.D. ........ 124m, NYSTATIN ............ 15t Oncology...... 129m

Ortho-Cyclenn .... 124t

.................... 126m
nystatin............. 63b

Oncovinn .......... 129m

Ortho-Est........

t

123m

Nortrel ................... D
nystatin—topical....

ondansetron

Ortho Evraa ........ 122t

Nortrel 0.5/355... 124t

....................... 61b

Cardiovascular .....

Ortho-Novum 1/35

Nortrel 1/355...... 124t
nystatin—vaginal...

..................... 41t

..................... 124t

Nortrel 7/7/7....

7

124b

...................... 128t

Gastroenterology...

Ortho-Novum 1/50
nortriptyline.... 136m

Nytoll................. 84m

................... 90m

..................... 124t

Norvascc ............ 50m

One-a-Day Bedtime

Ortho Novum 10/11

Norvirr ............... 22m

& Restt .......... 109b

O

Nostrillaa ............. 89t

OneTouch Ultraa... 74t

.................... 124m

Novafed A.............. D

Oaklidee........... 129m

OneTouch UltraMinii .

Ortho-Novum 7/7/7

Novamoxin......... 30b
oatmeal.............. 66t

........................ 74t

..................... 124b

Novantronee....... 129t

Oceann................. 89t

OneTouch

Ortho Tri-Cyclen.......

Novarell.................. D

Ocellaa............. 124m

UltraSmartt..... 74m

..................... 124b
oxymorphone ....... 7t, paroxetin ......... 137b pentetate indium.....

176

........................ 8m

Parvolex...........

x

152b

....................... PDA

Index
oxytocin ........... 125b

PAS....................PDA
pentobarbital ... 12m
t = top of page

Oxytroll ............. 154b

Paserr................. PDA

Pentolair..........

r

134b
m = middle of page

Oyst-Call ........... 75m

Patadayy.......... 130m
pentosan ............... D
b = bottom of page

Patanasee........... 88b
pentostatin....... 129t

D,PDA = see page 157

P

Patanol...........

l

130m

Pentothal..........

l

12m

Paullinia cupanaa.....

pentoxifylline..... 56b

Paceronee ........... 39b

..................... 106b

Pepcidd ................ 93t

Ortho Tri-Cyclen Loo ..

Paciss .............. 129m

Pausinystalia

Pepcid AC

C........... 93t

..................... 124b
paclitaxel ...... 129m
pepcid complete ...93t
yohimbee........ 109b

Orthoviscc............... D

PAH ....................... D

Peptic Relieff..... 93m

Pavulonn ................. D

Orudiss .................. 5t

Palgicc.................... D

Pepto-Bismol....

l

89m

Paxill ................ 137b

Orudis KT.

T ............. 5t

Palgic DS...............

S

D

Percocett ............. 10t

Paxil CR........... 137b

Orudis SR

R ............. 5t
palifermin ........ 129t

Percocet-demii .... 10t

PCO

O ................. 106b

Oruvaill ................. 5t
paliperidone ... 142m
percodan ............ 10t

PediaCare Infants’

Orvatenn ............. 54b
palivizumab ...... 24b

Percolone............ 8m

Decongestant

Os-Call.............. 75m
palonosetron ..... 90b

Perforomist......

t

148b

Dropss............. 86m
oseltamivir ......... 23t
pamabrom......... 11b

Pergonall................ D

Pedialyte and

Osmitroll ........... 121t

Pamelorr.......... 136m

Periactin............. 84t

Pedialytee........ 79m

Osmoprepp.......... 96b
pamidronate....... 68t

Peri-Colace........ 97b

Pediapredd......... 69m

Ostac................. 67b

Paminee.................. D

Peridexx .............. 87b
pediarix ............ 111t

Osteoforte........... 82t

Pamine Fortee ......... D
perindopril

Pediatrixx........... 11m

Ovcon-35.

5 ......... 124t

Panadoll............ 11m

.............. 35b, 36m
pediazole........... 29b

Ovcon-50.......... 124t

Panafi l..............

l

66m

Periogard...........

d

87b

62t

Pedioticc ............. 86b

Ovidee..................

Panax ginsengg .... 106t

Periostat...........

t

33m

PedvaxHIB

B ...... 110m

Ovidrel...................

l

D

Panax quinquefolius

Perlanee.............. 64b

Ovoll................... 95b

Peganonee .......... PDA

L. ................... 106t
permethrin ......... 62t

123b, 124t
pegaptanib............ D

Ovrall ......

Pancreasee ........ 99m
perphenazine...........

oxacillin............. 30b
pegaspargase 129b
pancreatin........ 99m

......... 140m, 141m
oxaliplatin ..... 129m

Pegasyss............. 24b

Pancrecarbb....... 99m

Persantinee.......... 48t

Oxandrin............. 67t
pegfi lgrastim... 102b
pancrelipase .... 99m

Petadolex..........

x

104t
oxandrolone........ 67t
peginterferon
pancuronium......... D

Petaforcee.......... 104t
oxaprozin ............. 5b
alfa-2A ........... 24b

Pandell................... D

Petesites hybriduss...

oxazepam ....... 144m
peginterferon

Panglobulinn.... 112m

...................... 104t
oxcarbazepine .. 116t
alfa-2B........... 24b
panitumumab ..129m
pethidine............ 7m

Oxeze Turbuhalerr .....

PEG-Intron......... 24b

Panixine DisperDose
petrolatum ...... 135b

..................... 148b

Peg-Lytee ........... 96m

....................... 25b

Pexevaa............. 137b
oxiconazole........ 61b
pegvisomant ......... D

Panretinn ............. 64t

PGE1

Oxilann................. 58t
pemetrexed....... 129t

Pantolocc ............ 94b

Gastroenterology...

Oxistat...............

t

61b
pemirolast....... 130b
pantoprazole ..... 94b

................... 95m

Oxizolee............... 61b

Penbritinn ............ 31t
pantothenic acid .....

OB/GYN......... 125b
oxprenolol........... 50t
penbutolol ............. D

...............80m, 81t

PGE22 ............... 125b

Oxsoralen-Ultraa ..... D
penciclovir.......... 63t
papain.............. 66m

Pharmorubicin.. 129t
oxyacantha....... 107t
penicillamine ........ D
papaverine ............ D

Phazymee............ 95b
oxybate........... 121m
penicillin G ......... 30t
para-aminosalicylic

Phenazo........... 155b

Oxybutyn.......... 154b
penicillin V ....... 30m
acid ................ PDA
phenazopyridine ......

oxybutynin ....... 154b
paracetamol..... 11m
penicillins ......... 31b

..................... 155b

Oxycocett ............. 10t

Parafonn ................ 2t

Penlacc ............... 60b
phendimatrizine .... D

Oxycodann............ 10t

Paraplatinn ...... 129m

Pentam.............. 17b
phenelzine....... 136b
oxycodone....7t, 9tm, Parcopaa.......... 120m pentamidine

Phenergann......... 91b

................... 10tmb
paregoric............ 90t

Antimicrobials ......

Phenergan/

OxyContinn ........... 8m
paricalcito........ 81m

.................... 17b

Dextromethorphan

OxyFASTT .............. 8m

Pariett ................ 94b

Cardiovascularr..41t

....................... 85b

OxyIR

R .................. 8m

Parlodell............ 82m

Pentasaa.............. 98t

Phenergan VC.... 85b
oxymetazoline..... 89t

Parnatee ............ 137t
pentazocine... 6m, 7t

Phenergan VC w/
oxymetholone..... PDA
paromomycin..... 17b

...................... 10m
codeine (c)VV.... 85b

Phenergann with
pirbutero ......... 148b

Ophthalmology .....

177

Codeinee .............. D
piroxicam ............. 6t

....... 131b, 132m

Index
pheniramine..... 130t

Pitocinn............. 125b
polysporin.......... 60b
phenobarbital

Pitressinn........... 83m
polysporin—
t = top of page

Gastroenterology...

plague vaccine. 111t
ophthalmic ... 131b
m = middle of page

..................... 95t

Plan B

B ... 121b, 123b

Polytarr.............. 64m
b = bottom of page

Neurology....... 116t

Plan B One-Step
polythiazide........ 47t D,PDA = see page 157
phenothiazines... 41t

........... 121b, 123b
polytrim—ophthal-
phenoxybenzamine ..D

Plaquenill............. 1b
mic ............... 131b
premesis-RX... 128m
phentermine.... 147b

Plasbuminn.......... 56t

Ponstann.............. 5m
premphase ....... 125t
phentolamine .... 47b
plasma.............. PDA

Ponstell ............... 5m

Prempluss........ 125m
phenylephrine... 86m

Plasmanatee...... 56m

Pontocainee ...... 135b
prempro.......... 125m
phenylephrine—IV ..

plasma protein
poractant .............. D

Prepidil.l........... 125b

....................... 54b
fraction.......... 56m
porfi mer .......... 129b

Pressyn AR

R ....... 83m
phenylephrine—

Plasmateinn....... 56m

Portiaa ............. 124m

Pretzz................... 89t
nasal ............... 89t

Platinol-AQ

Q..... 129m
posaconazole..... 13b

Prevacid
phenylephrine—

Plavixx ................. 48t

Potaba............... PDA

Analgesics........ 5b
ophthalmic .... 135t

Plenaxis............ 129t

Potasalann.......... 77b

Gastroenterology...

phenyl salicylate .....

Plendill............... 50b
potassium ......... 77b

................... 94m

.......... 154b, 155m
plerixafor............... D
potassium iodide... D

Prevalitee........... 42m

Phenytek...........

k

116t

Pletal................

l

56m
potassium p-amin-

Prevex-HC.............. D
phenytoin ......... 116t
pliagis.............. 66m
obenzoate ....... PDA

Phoslax..............

x

96b

Pneumo 233 ....... 111t

Potent V...........

V

109b

Previfem
m........... 124t

PhosLo.............. 75m
pneumococcal

Power-Dophiluss... 108t

Prevnar.............

r

111t

Phospholine Iodidee .D

7b-valent conjugate

PPD

D ................... 113

Prevpacc ............ 93m
phosphorated
vaccine.............111t
pralidoxim ....... 153b

Prezistaa ............. 21b
carbohydrates ..91m
pneumococcal 23b-
pralidoxime ...... 153t

Prialtt .................PDA
phosphorus ...... 77m
valent vaccine..111t
pramipexole.... 120m

Priftinn................. 17t

Photofrinn ......... 129b

Pneumovaxx....... 111t
pramlintide ....... 74b
prilocaine .......... 64b
phrenilin............. 3m

Podocon-255 ........ 63t
pramosone ....... 66m

Prilosecc ............ 94m

Phyllocontin..... 150b

Podofi lm
m ............. 63t

Pramox HC........ 66m

Primacor............

r

54b
physostigmine....... D
podofi lox............. 63t
pramoxine .. 63b, 66m

Primadophiluss.. 108t

Phyto Jointt........ 105t

Podofi nn ............... 63t
prandimet ........ 71m
primaquine......... 16t
phytonadione..... 81b
podophyllin......... 63t

Prandinn ............ 73m

Primaxinn............ 25b

Phytosoyaa ....... 109m

Polaraminee......... 84t

Prasteronee....... 104b
primidone....... 116m
pilocarpine ......... 88t
policosanol...... 107b
prasugrel.......... 48m

Primsoll.............. 34b
pilocarpine—
polio vaccine .... 111t

Pravacholl ........... 44t

Principenn............ 31t
ophthalmic .... 134t

Polocaine........... 12b
pravastatin ........ 44t

Prinivil......

l

35b, 36m

Pilopine HSS....... 134t
polycarbophil..... 95b
praziquantel...... 17b

Prinzidee ....... 45t, 47t
pimecrolimus ... 63m

Polycitraa .......... 156b
prazosin ......39t, 47t

Priorixx.............. 110b
pimozide

Polycitra-K.......

K

156b

Precedexx............ 11b

Pristiqq ............ 138m

Cardiovascular .....

Polycitra-LC..... 156b

Precision Xtraa... 74m

Privigenn.......... 112m

..................... 41t
polyethylene glycol

Precose............... 70t

ProAir HFA.. 148t, 152t

Psychiatry... 140m,

(PEG-salt soln)

Pred Fortee....... 133m

ProAmatine........ 54b

................. 141m

Cardiovascular .....

Pred G

G ............. 132b

Pro-Banthinee.... 95m
pinaverium........ 99b

..................... 41t

Pred Mildd........ 133m
probenecid ......... 75t
pindolol .............. 50t

Gastroenterology...

prednicarbate........ D

Probioticaa......... 108t

Pinworm
m ............ 17b

................... 96m
prednisolone... 69mb
probiotics ......... 108t

Pin-XX ................. 17b
polyethylene glycol
prednisolone—
procainamide ... 41tb
pioglitazone.... 70tm,
with electrolytes ...

ophthalmic..............

procaine ............ PDA

....................... 71b

...................... 96m

........132tmb, 133m
pioglitazone....... 71b

Polygam
m ......... 112m
prednisone ........ 69b
procaine penicillin...

piperacillin....... 31m
poly-L-lactic acid .. D

Prefest..............

t

125t

..................... 30tm
piperacillin-
polymyxin
pregabalin...... 116m
procarbazine ... 128b
tazobactam ... 31m

Dermatology .........

Pregnyll .................. D

Procardia........... 50b
piperonyl butoxide ...

........ 60mb, 63m

Prelonee ............. 69m

Procardia XLL...... 50b

................ 61b, 62t

ENT................. 86b

Premarinn .......... 123t

Prochieve........ 126m
propranolol....... 45b, Pulmozymee ..... 152m 178

...................... 50m

Puregonn................. D

R

Index

Propulsidd............... D

Purinethol.........

l

129t
t = top of page

R&C................... 61b
propylene glycol.......

PVF-KK ............... 30m
m = middle of page

RabAvert ........ 111m

.................... 87mb
pycnogenol ..... 108m
b = bottom of page
rabeprazole ....... 94b
propylthiouracil . 79b

Pygeum africanum
m ..

D,PDA = see page 157
rabies immune

Propyl Thyracill... 79b

.................... 108m
globulin human ....

ProQuadd ......... 111m

Pyleraa ................ 93b

...................... 113t

ProQuin XR

R ......... 32t
pyrantel............. 17b
prochlorperazine......

rabies vaccine ...111m

Proscarr........... 154m
pyrazinamide.... 16b,

....................... 91b

Radiogardasee.... PDA

Prosed/DS........

S

154b

........................ 17t

Procritt ............ 102m

RAL..................... 20t

Prosobee........... 78m
pyrethrins... 61b, 62t

Proctocream HC..... D
rally pack ........... 78t

ProSom
m............. 144t

Pyridiatee.......... 155b

Proctofoam HC

C ...... D
raloxifene ........ 126b
prostaglandin E1.....

Pyridium
m.......... 155b

Proctofoam NS...

S 63b
raltegravir .......... 20t

..................... 155b
pyridostigmine 119b
procyanidolic
ramelteon........ 144b

Prostatonin..... 108m
pyridoxal phosphate
oligomers ...... 106b
ramipril ..... 35b, 36b

Prostepp............. 146t

........................... D

Prodium........... 155b

Ranexaa .............. 56b

Prostigmin....... 119b
pyridoxine

Prodium Plain... 95m
ranibizumab .......... D

Prostin E2........

2

125b

Endocrine & meta-

Pro-Fastt .......... 147b

Raniclor.

r ............. 26t

Prostin VR

R ....... 155b
bolic...................

Progestt.............. PDA
ranitidine ......... 93m

Prostin VR Pediatric

.........80mt, 81tb
progesterone gel......

ranolazine .. 41t, 56b

..................... 155b

Gastroenterology...

.................... 126m

Rapamune....... 113b
protamine

..................... 91t
progesterone in oil...

rasagiline........ 120b

Herbal & alerna-

OB/GYN........ 128m

........................... D
rasburicase ........... D
tive therapies.....

pyrilamine ............. D
progesterone

Razadyne.......... 114t

................... 103t
pyrimethamine .. 17b

Razadyne ER

R .... 114t
micronized... 126m

Toxicology ...... 153t

PZA.................... 16b

Reactinee............. 84t
progesterone
protein C concen-

Rebetoll............... 25t
vaginal insert .......

trate ............... PDA

Q

Rebiff ............... 118b

.................... 126m

Protenate.......... 56m

Reclastt............. 68m

Proglycem.............. D

Protonixx ............. 94b

QT interval drugs.....

Prograff ............ 113b

Protopam......... 153b

........................ 41t Reclipsenn ....... 124m proguanil.......... 15m

Protopicc............ 63m

Quadramett ..... 129m

Recombinatee ......... D
protriptyline.... 136m

Qualaquinn .......... 16t

Recombivax HB

B.. 110b

Prohancee ............ 57t

Protropinn ............ 83t

Quanterraa......... 109t

Recothrom
m............. D

Prolastin................ D

Protyloll .............. 94b

Quanterra Mental
red clover ........ 108b

Proleukinn ........ 129m

Proventil HFA... 148t,

Sharpnesss .... 105b
red clover isofl avone

Prolixinn ............. 140t

...................... 152t

Quasensee ........ 124b
extract .......... 108b

Proloprim........... 34b

Proveraa............. 126t

Quelicinn............. 12b

Redoxon.............. 80t

Promacta........... PDA

Provigill............ 147b

Questrann .......... 42m
red wine ............ PDA

Promegaa........... 78m

Provocholinee.......... D

Questran Lightt.... 42m
red yeast rice... 108b

Promensill ........ 108b

Prozacc ............ 137m
quetiapine

ReFactoo ................. D
promethazine .... 91b

Prozac Weeklyy. 137m

Cardiovascular .....

Refl udan.......... 101b

Prometrium
m .... 126m
prussian blue .... PDA

..................... 41t

Refresh............. 135t

ProMotionn ....... 106m

Pseudo-Chlor.........

r

D

Psychiatry .... 141b, Refresh PM

M...... 135b

Pronestyll ........... 41b
pseudoephedrine.....

................. 142m

Refresh Tearss.. 135m
propaderm............. D

...................... 86m

Quick-Pep......... 147t

Regitine............. 47b
propafenone ...... 41b

Pseudofrinn........ 86m
quinapril .. 35b, 36b, Reglan.............. 91m Propanthel.l....... 95m

Psorconn ............. 65b

...................... 45m

Regonall........... 119b
propantheline... 95m

Psorcon EE .............. D
quinidine.....41t, 42t

Regranexx ............ 64t
proparacaine... 135b
psyllium ............ 95b
quinine........16t, 41t

Rehydralytee ...... 79m

Propasi HP.............

P

D

PTU....................

U

79b
quinolones......... 32b

Rejuva-A ........... 59b

Propeciaa ......... 154m

Pulmicort..........

t

152t
quinupristin ...... 34b

Relafen............... 5m

Propinee.................. D

Pulmicort Flexhaler..

r

Quixinn............... 131t

Relenzaa .............. 24t
propofol............ 12m

.................... 149m

QVAR

R .............. 149m

ReliOnn .............. 74m
propoxyphene ..... 8b, Pulmicort Respuless .

QVAR 40 mcgg ... 152t

Relistor...............

r

99t

.................. 9t, 10b

.................... 149m

QVAR 80 mcgg ... 152t

Relpaxx ............ 117m

Remeronn......... 139m
ribavirin—inhaled ..

Rocephinn ............ 27t

179

Remeron SolTab.......

........................ 25t
rocuronium........ 12b

Index

.................... 139m
ribavirin—oral... 25t

Rofactt ............... 16b

Remicadee ........... 1m
ribofl avin...80m, 81tb

Roferon-A ....... 129m
t = top of page
remifentanil .......... D

RID

D ..................... 62t

Rogainee.............. 66t
m = middle of page

Reminyll ............ 114t

Ridauraa ................. D

Rogaine Extra
b = bottom of page

Remodulinn............. D

Riderill ............. 140b

Strengthh .......... 66t D,PDA = see page 157

Renagell............. 78b
rifabutin............ 16b

Rogitine............. 47b

Renedill.............. 50b

Rifadinn .............. 16b

Rolaidss.............. 92b

Rythmoll............. 41b

Reno-600 ............ 57b
rifamate ............ 16b

Romazicon....... 153b

Rythmol SR........ 41b
rifampin ..... 16b, 17t
romiplostin............ D

RenoCal.............

l

57b

Ryzoltt ................ 11b
rifapentine ......... 17t

Rondecc .................. D

Reno-DIPP ........... 57b
rifater................. 17t

Rondec DM

M ............ D

Renografi n......... 57b
rifaximin............ 34b

S

Rondec DM Oral

Renovaa .............. 59b
rilonacept.......... PDA

Dropss.............. 85b

Renvelaa ............. 78b

S-22 ................. 152m

Rilutek............

k

121m

Rondec DM Syrupp ....

ReoProo............... 47b

Sabril .................... D
riluzole ........... 121m

....................... 85b
repaglinide...... 71m,

Saccharomyces

Rimactane......... 16b

Rondec Oral Drops...

...................... 73m
boulardiii........ 108t
rimantadine ..... 23m

....................... 85b

Repell..................... D
s-adenosylmethion-
rimexolone...... 133m

Rondec Syrupp .... 85b

Repronexx ............... D
ine ................. 109t

Rimostil...........

l

108b
ropinirole......... 120b

Requip............. 120b

Saint John’s wort .....

Rimso-500 .............. D
ropivacaine ....... PDA

Requip XLL........ 120b

...................... 109t

Riomet..............

t

74m

Rosasoll ............ 60m

Rescriptor..........

r

PDA

Saizenn ................ 83t

Riopan............... 92b
rosiglitazone............

Resectisol.........

l

121t

Salagenn.............. 88t
risedronate......... 68t

.............. 70m, 71b
reserpine ............... D

Salazopyrin En-tabs

Risperdal.........

l

142b

Rosulaa................ 59t

Resoll ................ 79m

...................... 98m

Risperdal Consta.....

Rosula NS.........

S

59m

RespiGam......... 113t
salbutamol....... 148t

..................... 142b
rosuvastatin....... 44t

Restasiss ......... 135m

Salfl exx ................ 4m
risperidone

Rotarix............

x

111m

Restoril.l............ 144t
salicin ............. 109b

Cardiovascular .....

RotaTeqq .......... 111m

Restylanee .......... 64b

Salicis cortexx... 109b

..................... 41t
rotavirus vaccine.....

retapamulin ...... 60b
salicylic acid .... 59m

Psychiatry.... 141b,

.................... 111m

Retavasee ........... 55b
saline nasal spray...

.................. 142b
rotigotine............... D
reteplase ........... 55b

........................ 89t

Ritalinn ............ 147m

Rowasaa .............. 98t

Retin-A .............. 59b

Salix albaa ........ 109b

Ritalin LA ....... 147m

Roxanoll ............... 7b

Retin-A Microo .... 59b
salmeterol

Ritalin SR

R....... 147m

Roxicett ............... 10t

Retisertt ............. PDA

Cardiovascular .....

ritonavir ........... 22m

Roxicodonee ......... 8m

Retisol-A ........... 59b

..................... 41t

Rituxan........... 129m

Rozerem
m .......... 144b

Retrovirr .............. 21t

Pulmonary ..... 149t
rituximab........ 129m

RSV immune

Revatio

Salofalkk.............. 98t
rivastigmine... 114m
globulin ......... 113t

Cardiovascular .....

salsalate ............ 4m

Rivotrill ........... 143m

RTV................... 22m

..................... 55t

Salvia miltiorrhiza....D
rizatriptan ....... 117b

RU-486........... 128m

Urology .......... 156t

Robaxinn .............. 2m
rubella vaccine.. PDA
samarium 153 .. 129m

ReVia.............. 145m

Robaxin-750....... 2m

Rubexx ............... 129t

Sambucoll ......... 105t

Revlimidd.......... 129b

Robinul..............

l

98b

Rubinii .............. 105t

Sambucus nigraa......

Reyatazz ............ 21m

Robinul Fortee..... 98b

Rufenn .................. 4b

...................... 105t

Rheomacrodexx.... 56t

Robitussinn.......... 86t
rufi namide...... 116m

SAM-e............... 109t

Rheumatrexx......... 1b

Robitussin AC (c)VV ..

Rum-KK............... 77b
sammy ............. 109t

Rhinalarr ............. 88t

....................... 85b

Rylosol..............

l

42m

Sancturaa .......... 155t

Rhinocort Aqua... 88t

Robitussin CFF..... 85t

Ryna-12 SS ............. D

Sanctura XR

R ..... 155t

RhoGAM..........

M

128m

Robitussin Coughh....

Rynatan............. 85b

Sancusoo ........... 90m
rho immune globulin

....................... 84b

Rynatan Pediatric

Sandimmunee.. 113m

.................... 128m

Robitussin DAC (c)V

Suspensionn......... D

Sandostatin........ 99t

Rhophylacc ...... 128m

....................... 85b

Rynatan-P Pediatric

Sandostatin LAR

R ... 99t

Rhotrall .............. 48b

Robitussin DM

M.... 85t

....................... 85b

Sans-Acnee.......... 59t

RiaSTAPP............. PDA

Robitussin PEE... 85m

Rythmodann....... 40m
sapropterin........ PDA

Ribaspheree......... 25t

Rocaltrol.............

l

80t

Rythmodan-LA.. 40m
saquinavir......... 22b

Serostim LQ

Q........ 83t
sodium nitrite 153m

SSKI.......................

I

D

180

Serpasill................. D
sodium phenylac-

Stadol.................

l

6m

Index
sertaconazole .... 61b
etate................... D

Stadol NSS ........... 6m
t = top of page
sertraline
sodium phosphate

Stalevoo ............ 120b
m = middle of page

Cardiovascular .....

Gastroenterology...

standardized extract
b = bottom of page

..................... 41t

.................... 96b

WS 1442—Cra-

D,PDA = see page 157

Psychiatry.... 138m

Urology ........ 155m
taegutt novo .. 107t
sevelamer.......... 78b
sodium polystyrene
starch................ 63b
sevofl urane........ PDA
sulfonate ......... 83t

Starlix...............

x

73m

Sarafem
m ......... 137m

Sevoranee ........... PDA
sodium thiosulfate ..

Starnoc............ 144b
sargramostim.. 102b
shark cartilage. 109t

.................... 153m

Statexx.................. 7b

S.A.S................. 98m

Sibelium
m......... 118m
sodium valproate ....

Statinss .............. 43b

Sativexx .................. D
sibutramine..... 147b

..................... 116b
stavudine ........... 21t

Savellaa ............. 121t

Sidekick............

k

74m

Solagg................. 66b

Stavzor
saw palmetto ... 109t

Siladryll............. 84m

Solage ............... 66b

Neurology...... 116b

Scopace............. 91b
sildenafi l

Solaquinn............ 64b

Psychiatry..... 139b
scopolamine..... 91b,

Cardiovascular .....

Solarazee ............ 59b

Stay Awakee....... 147t

........................ 95t

..................... 55t

Soliaa............... 124m

Stelazinee ......... 140b

Sculptraa ................ D

Urology .......... 156t
solifenacin ....... 155t

Stemetil.............

l

91b

SeaMistt .............. 89t

Silvadenee .......... 60b

Soliriss................PDA

Sterapredd .......... 69b

Sea-Omegaa ...... 78m
silver sulfadiazine...

Solodyn.............. 33b
stevia ............. 109m

Seasonale........ 124b

....................... 60b

Soltamoxx ......... 126b

Stevia rebaudianaa...

Seasonique...... 124b

Silybum marianum
m..

Solu-Corteff......... 69t

.................... 109m
secobarbital ...... PDA

..................... 107b

Solugell ............. 58m

Stieprox shampooo....

Seconall ............. PDA
silymarin ......... 107b

Solu-Medroll........ 69t

....................... 60b

SecreFlo............. 99b
simcor ................ 44t

Somaa.................... 2t

Stieva-A ............ 59b

SecreMaxx........... 99b
simethicone...... 89b, soma compound.. 3b

Stimatee ............. 82b
secretin ............. 99b

............... 92b, 95b
soma compound
stinging nettle.........

Sectral...............

l

48b

Similacc............. 78m
with codeine .. 10m

..................... 107b

Sedapapp.............. 3b

Simulectt......... 113m
somatropin......... 83t

Strattera.......... 146b

Select 1/35............ D
simvastatin...... 43b, Somatuline Depott....

Streptase........... 55b
selegiline.......... 121t

.....................44tm

....................... PDA
streptokinase .... 55b
selegiline—
sinecatechins..... 63t

Somavertt............... D
streptomycin ...... 13t
transdermal ...136b

Sinemett.......... 120m

Sominex............

x

84m
streptozocin..... 128b
selenium sulfi de ..66b

Sinemet CR

R .... 120m

Somnotee .......... 144b

Striantt.............. 67m

Selsunn ............... 66b

Sinequann........ 136m

Sonata............. 144b

Stridex Padss ..... 59m

Selzentry.

y .......... 19m

Singulairr .......... 150t
sorafenib......... 129b

Stromectoll........ 17m

Semprex-D......... 85b

Sinuprett ........... 105t
sorbitol............... 97t
strontium-89......... D
senna ................. 97t
sirolimus ......... 113b

Soriatane.......... 62m

Sublimazee ........... 6b
sennosides ........ 97b
sitagliptin .. 70b, 74b
sotalol ....... 41t, 42m

Suboxonee.......... 146t

Senokott .............. 97t

Skelaxin.............. 2m

Sotrett ................. 59t

Subutexx ................ 6t

Senokot-SS.......... 97b

Skelidd .................... D
soy.................. 109m
succimer....153t, 154t

SenokotXTRA ...... 97t

Sleep-Titee ........ 109b

Soyalac............. 78m
succinylcholine ........

Sensiparr................ D

Slo-Niacinn .......... 81t

Spacoll ................ 95t

........................12b

Sensorcaine...... 12m

Slow-Fee .............. 76t

Spasdell .............. 95t
sucralfate

Septocainee ....... 12m

Slow-KK............... 77b

Spectraceff......... 26b

ENT................. 87b

Septraa ................ 33t

Slow-Magg ........... 77t

Spiriva............ 152tb

Gastroenterology...

Seraxx .............. 144m

Slow-Trasicor......

r

50t
spirochetes........ 23b

.................... 95b

Sercc....................... D
smallpox vaccine... D
spironolactone... 37t, Sudafed............

d

86m

Serenoa repens 109t
smoking ............ PDA

...................... 45m

Sudafed 12 H

H ..........

Serevent Diskus.......

sodium benzoate ... D

Sporanoxx ........... 13b

...................... 86m

............. 149t, 152t
sodium bicarbonate

Sprintec................. D

Sudafed PE.......

E

86m

Seromycin.......... PDA

...................... 153t

Sprintec-288 ...... 124t

Sufentaa ................. D

Serophenee ....... 125b

Sodium Iodide I-131

Sprycell ........... 129m
sufentanil.............. D

Seroquell ......... 142m

........................ 80t

SQVV ................... 22b

Sularr .................. 51t

Seroquel XR

R.... 142m

Sodium Iodide I-131

Sronyx.............

x

124m

Sulcrate............. 95b

Serostim
m............. 83t

Therapeuticc ..... 80t

SSD

D ................... 60b

Sulf-100............ 131b
sulfacetamide

Synercidd ............ 34b

Tazoracc............. 59m

181

Dermatology .. 58b, Synphasic..............D

Taztia XT...........

T

51m

Index

..................59tm

Syntest D.S..... 125m

Tdd................... 110m

Ophthalmology .....

Syntest H.S..... 125m

Tdapp................. 110t
t = top of page

................... 132t

Synthroidd........... 79b

TDFF..................... 21t
m = middle of page
sulfacetamide—

Synviscc.................. D

Tears Naturale...

e 135m
b = bottom of page
ophthalmi ..... 131b

Syprinee .............. PDA
tea tree oil...... 109m D,PDA = see page 157
sulfacetamide—

Systanee .......... 135m

Tebrazid.............

d

16b
topical ........... 59m

Tecnal...................

l

3t

Tes-Tapee........... 74m

Sulfacet-R

R........ 59m

Tecnal C-1/2.......

2

9m

T

Testim
m .............. 67m
sulfadiazine ...... 32b

Tecnal C-1/4....... 9m

Testopell............ 67m
sulfadoxine............ D

T-20................... 19b
tegaserod .............. D
testosterone ..... 67m

Sulfamylonn ......... 60t

T33...................... 79b

Tegenss............. 103b

Testredd ............... 67t
sulfasalazine.... 98m

T44...................... 79b

Tegretoll ........... 114b

Testro AQ

Q .......... 67m

Sulfatrim
m............ 33t

Tabloidd ............. 129t

Tegretol XR

R ...... 114b
tetanus immune
sulfi soxazole...... 29b
taclonex............. 62b

Tegrinn ............... 64m
globulin ......... 113t
sulfonated
tacrine............... PDA

Tegrin-HC

C .............. D
tetanus toxoid 111m
phenolics........ 87b
tacrolimus

Tekturnaa ........... 47m
tetrabenazine....121m
sulfur ......... 58b, 59t

Cardiovascular.

r 41t

Tekturna HCTT......... D
tetracaine
sulfuric acid...... 87b

Immunology.. 113b
telbivudine ....... 25m

Dermatology .........

sulindac ............... 6t
tacrolimus—topical
telithromycin

................. 66mb
sumatriptan .... 117b

...................... 63m

Antimicrobials ......

ENT................ 89m

Sumycinn ............ 33b
tadalafi l

.................... 34b
tetracaine—
sunitinib

Cardiovascular.

r 55t

Cardiovascular .....

ophthalmic ... 135b

Cardiovascular .....

Urology ........ 156m

..................... 41t
tetracycline

..................... 41t

Tagamett ............ 92b
telmisartan ..... 38m,

Antimicrobials ......

Oncology...... 129m

Tagamet HB....... 92b

........................ 47t

.................... 33b
sunscreen.......... PDA

Talacen............. 10m

Telzir..................

r

21b

Gastroenterology...

Supartz..................

z

D

Talwin NXX ........... 6m
temazepam ...... 144t

................... 93m

SuperEPA 12000 ..78m

Tambocor...........

r

40b

Temodal...........

l

128b

Tevetenn............. 37m

Supeudoll ............ 8m

Tamifl uu ............... 23t

Temodarr .......... 128b

Teveten HCTT .. 45t, 47t

Supprelin LA... 129m

Tamofenn .......... 126b

Temovatee........... 65b

Tev-Tropin........... 83t

Suprane............. PDA

Tamone............ 126b
temozolomide .. 128b
thalidomide .... 129b

Supraxx............... 26b
tamoxifen

Tempraa ............. 11m

Supro.............. 109m

Cardiovascularr..41t
temsirolimus . 129m

Thalitonee ........... 52b

Surfakk .............. 97m

OB/GYN......... 126b
tenecteplase....... 56t

Thalomidd ......... 129b

Surgam
m ................ 6t
tamsulosin ..... 154m

Tenexx .................. 39t

Theo-244........... 152b

Surgam SR

R ........... 6t

Tanacetum parthe-
teniposide ...... 129m

Theo-Durr ......... 152b

Surmontill .......... PDA
nium L. ........ 105m

Ten-KK................. 77b

Theolairr ........... 152b

Surpasss............ 75m

Tanafedd ............. 85b
tenofovir..... 19b, 21t
theophylline..... 152b

Survantaa ............... D

Tapazolee ............ 79b

Tenoretic...... 45t, 47t

TheraCyss ........ 129m

Sustivaa............... 20t
tapentadol........ 11m

Tenorminn ........... 48b

Theroxidil Extra

Sutentt ............ 129m

Tarabinee ........... 129t

Tensilonn.......... 119m

Strengthh .......... 66t

Swim-EAR

R ........ 87m

Tarceva........... 129m

Tenuatee ................. D
thiabendazole..... 18t

Symax.................

x

95t

Targretin.......... 129b

Tenuate Dospan..... D
thiamine .. 80m, 81tb

Symbicortt ....... 149m

Tarkaa ........... 45t, 47t

Terazoll.............. 128t
thiethylperazine 91b

Symbyaxx ........... 145t

TARO-sonee............. D
terazosin .......... 39m
thioguanine ...... 129t

Symlinn ............... 74b

Tarsum
m ............. 64m
terbinafi ne.......... 15t

Thiolaa ................PDA

Symlinpenn ......... 74b

Tasignaa .......... 129m
terbinafi ne—topical
thiopental......... 12m

Symmetrell ......... 22b

Tasmarr .............. PDA

....................... 61b

Thioplexx........... 128b

Synacortt ................ D

Tavist-1.............. 84t
terbutaline ............ D
thioridazine ....... 41t,

Synacthenn ......... 74b

Tavist ND

D........... 83b
terconazole....... 128t

........... 140b, 141b

Synagiss ............. 24b

Taxoll............... 129m
teriparatide ...... 83m
thiotepa........... 128b

Synalarr............. 65m

Taxoteree.......... 129m

Tesalin.............. 104t
thiothixene ..... 140b,

Synalgos-DC..... 10m
tazarotene ........ 59m

Teslascann ......... 57m

..................... 141b

Synarell .................. D

Taziceff................ 27t

Tessalonn ............ 84b

Thisylin............ 107b

Syneraa ............... 66b

Tazocinn ............. 31m

Tessalon Perles.. 84b
thonzonium ........ 87t
tinzaparin....... 101m
tpaa ................... 55m

Triaminic Chest and

182
tioconazole ....... 128t
t-PA.................. 55m

Nasal Congestionn...D

Index
tiopronin............ PDA

T-Phyll .............. 152b

Triaminic Cold &
t = top of page
tiotropium ....... 152b

TPVV.................... 22b

Allergyy ........... 85m
m = middle of page
tipranavir .......... 22b

Tracleerr ................. D

Triaminic Cough &
b = bottom of page
tirofi ban ........... 48m

Tracrium
m................ D

Sore Throatt ......... D

D,PDA = see page 157 Tirosintt .............. 79b Tramacett ............. 3b Triaminic Day Time tizanidine
tramadol

Cold & Coughh ..... D

Analgesics........ 2b

Analgesics........ 3b

Thorazine.......... 140t

Triaminic Flu Cough

Cardiovascularr..41t

Anesthesia...... 11b

Thrombin-JMII ........ D
and Feverr............ D

TNKasee ............... 56t

Trandatee........... 49m
thrombin—topical ..

Triaminic Night Time
tobacco ............. PDA
trandolapril ...... 35b,

........................... D

Cold & Coughh ..... D

TOBII ................... 13t

................ 36b, 47t

Thrombolytic therapy

Triaminic Oral Infant

TobraDex..........

x

132b
tranexamic acid .... D

....................... 55b

Dropss............. 86m

TobraDex STT..... 132b
transdermal

Thyrogen............ PDA
triamterene .. 45b, 47t
tobramycin
fentanyl ............ 7b
thyroid—desiccated

Antimicrobials ......

3t

Transderm-Scop...

p 91b

Trianall..................

........................... D

..................... 13t

Transderm-V......

V

91b

Triatecc .............. 10m

Thyroid USPP ........... D

Ophthalmalogy .....

Tranxenee......... 143m

Triavill ....................D

Thyrolarr ................. D

.................. 132b

Tranxene SD.... 143m

Triazide........ 45t, 47t

Thyrosafe............... D
tobramycin—
tranylcypromine ..137t
triazolam........ 144m

Thyroshieldd............ D
ophthalmic ... 130b

Trasicorr .............. 50t

TriCor.................

r

44b

Thyro-Tabs......... 79b

Tobrexx.............. 130b
trastuzumab... 129m

Tri-Cyclenn .............. D
thyrotropin alfa . PDA
tocopherol ......... 81b

Travatann......... 134m

Tridesilon............ 65t
tiagabine......... 116b

Tofranill........... 136m

Travatan ZZ...... 134m

Tridill................. 53m

Tiamoll ................... D

Tofranil PM

M ..... 136m
travoprost....... 134m
trientine ............ PDA
tiaprofenic acid.... 6t
tolbutamide........... D
trazodone ....... 139m

Triesencee ........... PDA

Tiazacc............... 51m
tolcapone .......... PDA

Treandaa ........... 128b

Triestt ................. PDA
ticarcillin-clavulan-

Tolectin................. 6t

Trecatorr ............. PDA
trifl uoperazine .........

ate................... 32t

Tolinasee................. D
trefoil .............. 108b

........... 140b, 141b

Tice BCG
tolmetin................ 6t

Trelstar Depott.... 129m
trifl uridine ........ 132t

Immunology ... 110t
tolnaftate .......... 61b

Trentall............... 56b

Trifolium pratensee ...

Oncology...... 129m
tolterodine
treprostinil ............ D

..................... 108b

Ticlidd ................ 48m

Cardiovascular .....

tretinoin

Triglidee .............. 44b
ticlopidine ........ 48m

..................... 41t

Dermatology .........

Trigonelle foenum-

Tigann ................. 91b

Urology .......... 155t

............ 59b, 66b
graecum
m ...... 105m
tigecycline......... 34b

Topamax

Oncology....... 129b
trihexyphenidyl ........

Tikosynn .................. D

Neurology...... 116b
tretinoin—topical ...

..................... 119b

Tiladee .................... D

Psychiatry..... 139b

....................... 59b

Tilia Fe............. 124b
trihibit............ 111m

Topicortt ............. 65b

Trexall..................

l

1b
tiludronate ............ D

Tri-KK .................. 77b

Topicort LP..........

P

65t
treximet........... 117b

Timentinn ............. 32t

Trikacide........... 34m

Topilene Glycol.......

l

D

Triaderm
m................ D

Timolide....... 45t, 47t

Tri-Legestt ........ 124b
topiramate
triamcinolone
timolol

Tri-Legest Fe.... 124b

Neurology...... 116b

Dermatology .. 63b,

Cardiovascular .....

Psychiatry..... 139b

................... 65m

Trileptal............ 116t

..................... 47t

Toposar...........

r

129m

Endocrine &

Tri-Levlenn ....... 123b,

Ophthalmology .....

topotecan ........ 129b
metabolic..... 69b

..................... 124b

.................. 134b

Toprol-XLL ........... 49b
triamcinolone—

TriLipix.

x .............. 44b
timolol—ophthal-

Topsynn ................... D
inhaled .......... 150t

Trilisatee ................ 4t
mic ............... 133b

Toradoll ................. 5t
triamcinolone—

Tri-Luma............ 66b

Timopticc .......... 133b

Torecan.............. 91b
nasal .............. 88b

TriLytee............... 96m

Timoptic Ocudosee ....

toremifene...... 129m
triamcinolone—
trimethobenzamide .

..................... 133b

Torisel.............

l

129m
topical ................ D

....................... 91b

Timoptic XEE ..... 133b
torsemide ......... 52m
triamcinolone—
trimethoprim

Tinactinn ............. 61b
tositumomab.. 129m
vitreous .......... PDA

Antimicrobials ..34b

Tindamax.

x ........... 18t

Totectt .............. 129b
triamcinolone MDI ...

Ophthalmology .....

tinidazole ........... 18t

Toviazz .............. 154b

..................... 151b

.................. 131b
trimethoprim-

Typhim Vi.........

i

111b

183
sulfamethoxazole..

typhoid vaccine—

V

Index

........................ 33t
inactivated
vaccinia vaccine ... D
trimipramine ..... PDA
injection ....... 111b
t = top of page

Vaccinium macro-

Trimox................

x

30b
typhoid vaccine—
m = middle of page
carponn .......... 104b

Tri-Nasall ........... 88b
live oral ........ 111b
b = bottom of page

Vaccinium myrtillus

Trinessa........... 124b
tyramine-rich foods.

D,PDA = see page 157

..................... 103b

Trinipatchh.......... 53b

....................... PDA

Vagifem
m........... 122b

Tri-Norinyl........

l

124b

Tysabri...................

i

D

Vagistat-1 ........ 128t

Vasodilann .............. D

Trinovinn ........... 108b

Tyzeka............... 25m
valacyclovir ........ 19t
vasopressin...... 83m

Triostatt.............. 79b

Valcytee .............. 18b

Vasotecc ...... 35b, 36t

Tripacell ............ 110t

U
valerian........... 109b

Vaxigripp ........... 110b

Tripediaa ............ 110t

Valeriana offi cinalis

Va-Zonee.......... 118m

Triphasil...

l 123b, 124b
ubiquinone ..... 104m

..................... 109b

VCR

R ................ 129m

Tri-Previfem..... 124b

Uloric.................. 75t
valganciclovir.... 18b
triprolidine ............ D

PDA

Vectibixx .......... 129m

Ultanee ...............

Valium
m............. 143b
triptorelin ....... 129m

Ultivaa .................... D
vecuronium ....... 12b
valproic acid

Triquilar.................

r

D

Ultracett ............... 3b

Veetidss ............. 30m

Neurology...... 116b

Trisenoxx ........... 129b

Ultradoll ............... 4b

Velbann ............ 129m

Psychiatry ..... 139b

Tri-Sprintecc ..... 124b

Ultram
m............... 11b

Velcadee ........... 129b
valrubicin ......... 129t

Trivariss .............. 69b

Ultram ER.......... 11b

Velivett ............. 124b
valsartan.... 38m, 45b

Trivoraa ............. 123b

Ultraquinn........... 64b

Venastatt........... 107t

Valstarr ............. 129t

Trivora-28........

8

124b

Ultrathonn............... D
venlafaxine

Valtaxinn ............ 129t
trizivir................ 19b

Ultravatee ........... 65b

Cardiovascular .....

Valtrexx ................ 19t

Tropicacyll ......... 135t

Ultravistt ............ 57b

..................... 41t

Valtropinn ............ 83t
tropicamide...... 135t

Unasynn ............. 31m

Psychiatry..... 138b

Vancenasee.......... 88t

Trosecc............... 155t

Unidett .............. 155t

Venoferr............... 77t

Vancenase AQ
trospium........... 155t

Uniphyll............ 152b

Venoglobulinn .. 112m

Double Strengthh....

True Track Smart

Unireticc .............. 45t

Ventaviss ................ D

........................ 88t

System
m........... 74m

Unisom Nighttime

Ventolin HFA .... 148t,

Vancocinn ............ 35t

Trusoptt ............. 134t

Sleep Aidd ......... 91t

...................... 152t
vancomycin ........ 35t

Truvadaa ............. 19b

Unithroidd ........... 79b

VePesidd .......... 129m
trypan blue............ D

Univascc .... 35b, 36m

Vandazolee........ 127b

Veramill.............. 51b

Tryptann .................. D

UP4466 ............ 105m

Vaniqaa.............. 64m

Veramystt .......... 88m
tryptophan............. D
urea.................. 66m

Vanoss .................... D
verapamil... 47t, 51b
tuberculin PPD...113b

Urecholinee ....... 155b

Vansparr.......... 144m

Verdesoo .............. 65t

Tubersol...........

l

113b

Urexx................... PDA

Vantass............ 129m

Veregenn .............. 63t

Tuckss.................. 64t

Urised.............

d

155m

Vantinn ................ 27t

Verelann .............. 51b

Tucks Hemorrhoidal

Urispas.................. D

Vaponefrinn...... 152m

Verelan PM

M ........ 51b

Ointmentt ........ 63b

Urocit-KK........... 156b

Vaprisoll ................. D

Vermoxx ............. 17m

Tucks Suppositories

Urodol..............

l

155b

Vaqtaa ............. 110m

Versedd ................ 12t

....................... 63b
urofollitropin ......... D
vardenafi l

Versell ................ 66b

Tuinall ................ PDA

Urogesicc .......... 155b

Cardiovascular .....

versenate .............. D

Tumss ................ 75m
urokinase ........... 56t

..................... 41t
verteporfi n............. D

Tuss-HC................. D

Urolene bluee .... 153b

Urology ........ 146m

Vesanoidd ......... 129b

Tussicapss .............. D

Uromaxx............ 154b
varenicline ....... 146t

VESIcaree........... 155t

Tussionex (c)IIII .. 85b

Uromitexann....... 129t
varicella vaccine .....

vetch ............... 103b

Twinjectt............ 54m

Uroquid-acid No. 2...

2 D

.................. 111mb

Twin-KK ............... 77b

UroXatrall........ 154m
varicella-zoster

Vexoll............... 133m
twinrix ............. 111b

URSO

O................. 99b
immune globulin ..

Vfend..................

d

14t

Tygacill............... 34b
ursodiol ............. 99b

.................... 113m

Viactivv.............. 75m

Tykerbb............. 129m

URSO Fortee ........ 99b

Varilrixx............. 111b

Viadurr ............ 129m

Tylenoll .............. 11m

Urtica dioica radixx...

VariZIG

G ........... 113m

Viagraa .............. 156t

Tylenoll with codeine

..................... 107b

Vascorayy............. 58t

Vibramycinn ....... 33m

...................... 10m

UTA................. 155m

Vasereticc ... 45t, 47m

Vibra-Tabs........ 33m
tylox................... 10b

UTIRA-C.......... 155m

Vasocidinn ........ 132b

Vick’s 44 Coughh ... 84b

Typherixx ........... 111b

UTI Relief.........

f

155b

Vasocon-A ........ 130t

Vicks Sinexx ......... 89t

Vitis vinifera L.... 106b WinRho SDFF.... 128m

184

Vivactill........... 136m
witch hazel......... 64t

Z

Index

Vivaglobulinn ... 112m
wolf’s bane...... 103b
t = top of page

Zaditen........... 152m

Vivarin.............. 147t

Women’s Rogainee ...

m = middle of page

Zaditorr ........... 130m

Vivellee ............. 122b

....................... 66t
b = bottom of page
zafi rlukast ...... 150m

Vivelle Dott ....... 122b

Women’s Tylenol

D,PDA = see page 157
zaleplon........... 144b

Vivitrol............

l

145m

Menstrual Relieff ...

Zanafl exx .............. 2b

Vivoll ................ 143b

....................... 11b
zanamivir ........... 24t

Vivotif Bernaa ... 111b

Vicks Sinex 12 Hr.

r ....

Wycillin............. 30m

Zanosarr........... 128b

VLB................. 129m

........................ 89t

Wygesicc ............. 10b

Zantac.............. 93m

VM-266 ............ 129m

Vicodinn .............. 10b

Wytensin................ D

Zantac 25.........

5

93m

VMA extractt ..... 103b

Vicoprofenn ......... 10b

Zantac 75.........

5

93m

Voltaren

Vidazaa .............. 129t

X

Zantac 150....... 93m

Analgesics....... 4m

Videxx ................. 20b

Zarontinn ........... 115t

Dermatology ... 59b

Videx EC

C ............ 20b

Xalatann .......... 134m

Zaroxolynn............ 53t

Ophthalmology .....

vigabatrin ............. D

Xanaxx ............. 144m

Zavesca............. PDA

................... 135t

Vigamoxx ......... 131m

Xanax XR

R........ 144m

ZDVV .................... 21t

Voltaren Ophthaa ......

Vimpatt ........... 115m

Xatrall ............. 154m

ZE 339.............. 104t

...................... 135t
vinblastine ..... 129m

Xelodaa .............. 129t

ZeaSorb AFF ....... 61m

Voltaren Rapidee.......

Vincasarr......... 129m

Xenazine......... 121m

Zebetaa................ 49t

........................ 4m
vincristine ...... 129m

Xenicall ............. 99m

4m

Zegeridd.............. 94b

Voltaren XR

R ........

vinorelbine ..... 129m
voriconazole

Xibrom.............. 135t

Zelapar.............

r

121t

Viokase............. 99m

Antimicrobials .. 14t

Xifaxann.............. 34b

Zelnorm
m................. D

Viracept.

t ........... 22m

Cardiovascular .....

Xigris.................. 34t

Zemaira................. D

Viramune.......... 20m

..................... 41t

Xodoll .................. 11t

Zemplar............

r

81m

Virazolee .............. 25t
vorinostat

Xolair.....................

r

D

Zemuronn............ 12b

Viread.

d ................ 21t

Cardiovascular .....

Xolegell ............... 61t

Zenapaxx .......... 113b

Virilon................. 67t

..................... 41t

Xopenexx.......... 148m

Zephrex-LA ............ D

Viroptic............. 132t

Oncology....... 129b

Zeritt ................... 21t

Xopenex HFA .. 148m,
visicol................. 41t

VoSol HC

C........... 87m

Zestoreticc .... 45t, 47m

...................... 152t

Visicoll ............... 96b

VoSpire ER

R........ 148t

Zestril.l...... 35b, 36m

Xuezhikang......

g

108b

Vision Bluee ............ D

VP-166 ............. 129m

Zetia.................. 44b

Xylocaine

Visipaquee .......... 57b

VSL#33............... 108t

Zevalinn ........... 129m

Anesthesia...... 12b

Viskenn ................ 50t

Vumonn............ 129m

Zhibituo........... 108b

Cardiovascular .....

Vistarill .............. 84b

Vusionn ............... 66b

Ziacc........... 45t, 47m

.................... 41b

Vistidee.............. 18m

Vytorinn.............. 44m

Ziagenn.............. 20m

Dermatology ... 64b

Visudyne................ D

Vyvansee.......... 147m

Ziana................. 59b

ENT................. 87b
vitamin A............ 82t

VZIG

G ............... 113m
ziconotide.......... PDA

Xylocardd ............ 41b

Vitamin A Acid
zidovudine.. 19b, 21t

Xynthaa................... D

Cream
m............. 59b

W
zileuton .......... 150m
vitamin B1 ........ 81b

Xyrem
m ............. 121m

Zinaceff............. 26m
vitamin B2 ........ 81b

Xyzal..................

l

84b
warfarin ........... 102t
zinc acetate........ 78t
vitamin B3 ......... 81t

Wartecc................ 63t

Zincatee............... 78t
vitamin B6 ........ 81b

Welcholl.............. 42b

Y
zinc oxide .......... 66b
vitamin B12 ....... 80t

Wellbutrinn........ 138b
zinc sulfate ........ 78t
vitamin C ........... 80t

Yasminn ........... 124m

Wellbutrin SR

R .. 138b

Zinecardd........... 129t
vitamin D ........... 82t

Yaz ................. 124m

Wellbutrin XLL... 138b

Zingiber offi cinalee ...

vitamin D2 ......... 82t
yellow fever vaccine

Wellcovorinn...... 129b

..................... 105b
vitamin E........... 81b

Westcortt ........... 65m

..................... 111b

Zingoo................. 64b
vitamin K
white petrolatum.....

YF-Vaxx ............. 111b
ziprasidone

Endocrine &

....................... 66b

Yocon............... 156b

Cardiovascular .....

metabolic..... 81b
wild yam.......... 109b

Yodoxinn.............. PDA

..................... 41t

Toxicology ...... 153t
willow bark extract ..

yohimbe........... 109b

Psychiatry .... 141b,

Vitex agnus castus

..................... 109b
yohimbine........ 156b

................... 143t
fruit extractt .... 104m

Winpredd............. 69b

Yohimexx........... 156b

Zipsorr................. 4m

Zithromaxx.......... 27b

Zomig ZMTT ...... 117b

Zovia 1/35EE...... 124t

185

Zmaxx ................. 27b

Zonalonn ............ 64m

Zovia 1/50EE...... 124t

Index

Zocorr .................. 44t

Zonegrann........ 117m

Zovirax

Zofrann .............. 90m
zonisamide..... 117m

Antimicrobials ......

t = top of page

Zoladex.

x ............ 129t
zopiclone .......... 145t

.................... 18b
m = middle of page
zoledronic acid ........

Zorbtivee.............. 83t

Dermatology ... 62b
b = bottom of page

...................... 68m

Zorcainee ........... 12m
zuclopenthixol ....... D D,PDA = see page 157

Zolinzaa ............ 129b

Zorprinn ................. 4t

Zybann .............. 138b
zolmitriptan..... 117b

Zostavax..........

x

111b

Zydone................ 11t

Zyprexa Zydiss ..........

Zoloft..............

t

138m
zoster vaccine—live

Zyfl o CR

R.......... 150m

...................... 142t
zolpidem.......... 144b

..................... 111b

Zylett ................ 132b

Zyrtecc ................. 84t
zolpimist ......... 144b

Zostrixx ................ 64t

Zyloprim
m ............. 75t

Zyrtec-D

D ................ D

Zometaa............. 68m

Zostrix-HPP .......... 64t

Zymarr............... 131t

Zyvoxx ................ 34m

Zomigg.............. 117b

Zoviaa ..................... D

Zyprexa............. 142t

Zyvoxam
m ........... 34m

APPENDIX

ADULT EMERGENCY DRUGS (selected)

diphenhydramine ( Benadryl): 50 mg IV/IM.

epinephrine: 0.1-0.5 mg IM (1:1000 solution), may repeat after 20 minutes.

ALLERGY methylprednisolone ( Solu-Medrol): 125 mg IV/IM.

esmolol ( Brevibloc): 500 mcg/kg IV over 1 minute, then titrate 50-200
mcg/kg/minute

SION fenoldopam ( Corlopam): Start 0.1 mcg/kg/min, titrate up to 1.6 mcg/kg/min labetalol ( Normodyne): Start 20 mg slow IV, then 40-80 mg IV q10 min prn up TEN
to 300 mg total cumulative dose
nitroglycerin ( Tridil): Start 10-20 mcg/min IV infusion, then titrate prn up to 100 mcg/minute

HYPER nitroprusside ( Nipride): Start 0.3 mcg/kg/min IV infusion, then titrate prn up to 10 mcg/kg/minute
adenosine ( Adenocard): PSVT (not A-fib): 6 mg rapid IV & flush, preferably through a central line or proximal IV. If no response after 1-2 minutes then 12 mg. A third dose of 12 mg may be given prn.

amiodarone ( Cordarone, Pacerone): V-fib or pulseless V-tach: 300 mg IV/IO; may repeat 150 mg just once. Life-threatening ventricular arrhythmia: Load 150 mg IV over 10 min, then 1 mg/min x 6h, then 0.5 mg/min x 18h.

atropine: 0.5 mg IV, repeat prn to maximum of 3 mg.

diltiazem ( Cardizem): Rapid A-fib: bolus 0.25 mg/kg or 20 mg IV over 2 min.

May repeat 0.35 mg/kg or 25 mg 15 min after 1st dose. Infusion 5-15 mg/h.

epinephrine: 1 mg IV/IO q3-5 minutes for cardiac arrest. [1:10,000 solution]

lidocaine ( Xylocaine): Load 1 mg/kg IV, then 0.5 mg/kg q8-10min prn to max DYSRHYTHMIAS / ARREST

3 mg/kg. Maintenance 2g in 250ml D5W (8 mg/ml) at 1-4 mg/min drip (7-30 ml/h).

dobutamine ( Dobutrex): 2-20 mcg/kg/min. 70 kg: 5 mcg/kg/min with 1 mg/mL
concentration (eg, 250 mg in 250 mL D5W) = 21 mL/h.

dopamine ( Intropin): Pressor: Start at 5 mcg/kg/min, increase prn by 5-10
mcg/kg/min increments at 10 min intervals, max 50 mcg/kg/min. 70 kg: 5
mcg/kg/min with 1600 mcg/mL concentration (eg, 400 mg in 250 ml D5W)

= 13 mL/h. Doses in mcg/kg/min: 2-4 = (traditional renal dose, apparently ineffective) dopaminergic receptors; 5-10 = (cardiac dose) dopaminergic PRESSORS
and beta1 receptors; >10 = dopaminergic, beta1, and alpha1 receptors.

norepinephrine ( Levophed): 4 mg in 500 ml D5W (8 mcg/ml) at 2-4 mcg/min.

22.5 ml/h = 3 mcg/min.

phenylephrine ( Neo-Synephrine): 50 mcg boluses IV. Infusion for hypotension: 20 mg in 250ml D5W (80 mcg/ml) at 40-180 mcg/min (35-160ml/h).

etomidate ( Amidate): 0.3 mg/kg IV.

methohexital ( Brevital): 1-1.5 mg/kg IV.

propofol ( Diprivan): 2.0-2.5 mg/kg IV.

rocuronium ( Zemuron): 0.6-1.2 mg/kg IV.

succinylcholine ( Anectine): 1 mg/kg IV. Peds (<5 yo): 2 mg/kg IV.

INTUBATION thiopental ( Pentothal): 3-5 mg/kg IV.

diazepam ( Valium): 5-10 mg IV, or 0.2-0.5 mg/kg rectal gel up to 20 mg PR.

fosphenytoin ( Cerebyx): Load 15-20 “phenytoin equivalents” per kg either IM, or IV no faster than 100-150 mg/min.

lorazepam ( Ativan): 0.05-0.15 mg/kg up to 3-4 mg IV/IM.

SEIZURES phenobarbital: 200-600 mg IV at rate 60 mg/min; titrate prn up to 20 mg/kg phenytoin ( Dilantin): 15-20 mg/kg up to 1000 mg IV no faster than 50 mg/min.

Appendix

187

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188 Appendix

Antiviral Drugs for 2009

Treatment*

Prevention

Infl uenza A (H1N1)

(Duration of 5

(Duration of 10 days
days)

post-exposure)

OSELTAMIVIR ( Tamifl u)

Adults and adolescents age 13 years and older

75 mg PO bid

75 mg PO once daily

Children, 1 year of age and older†

Body weight ≤15 kg

30 mg PO bid

30 mg PO once daily

Body weight >15 to 23 kg

45 mg PO bid

45 mg PO once daily

Body weight >23 to 40 kg

60 mg PO bid

60 mg PO once daily

Body weight >40 kg

75 mg PO bid

75 mg PO once daily

Infants, newborn to 11 months of age†

Age 6 to 11 months old

25 mg PO bid

25 mg PO once daily

Age 3 to 5 months old

20 mg PO bid

20 mg PO once daily

Age less than 3 months

12 mg PO bid

Not for routine prophy-
old
laxis in infants <3 mo

ZANAMIVIR ( Relenza)§

Adults and children (age 7 years and older for treatment, age 5 years of age and older for prophylaxis)

10 mg (two 5-mg 10 mg (two 5-mg
inhalations) bid
inhalations) once daily

Adapted from http://www.cdc.gov/h1n1fl u/recommendations.htm

*Start treatment as soon as possible; benefi t is greatest when started within 2 days of symptom onset. Hospitalized patients with severe infection might require treatment for longer than 5 days.

†A dosing syringe with graduations of 30, 45, and 60 mg is provided with Tamifl uu oral suspension. The 75 mg dose can be measured by combining 30 mg and 45 mg. For infants less than 1 year old, a different oral syringe must be used to measure the dose.

The concentration of oseltamivir differs between commercial Tamifu suspension (12 mg/
mL) and pharmacist-compounded suspension (15 mg/mL). Capsules can be opened and mixed with sweetened fl uids.

§Zanamivir should not be used by patients with underlying pulmonary disease. Do not attempt to use Relenza in a nebulizer or ventilator; lactose in the formulation may cause the device to malfunction.

Appendix

189

2009 Infl uenza A (H1N1)

Indications/Dose

Monovalent Vaccine

Parenteral Vaccines

CSL Limited (mfr)

Adults 18 yo or older: 0.5 mL IM

Novartis (mfr)

Age 4 to 9 yo: 0.5 mL IM; repeat dose at
least 28 days later

Age 10 or older: 0.5 mL IM

Sanofi Pasteur (mfr)

Age 6 to 35 mo: 0.25 mL IM; repeat dose
at least 28 days later

Age 4 to 9 yo: 0.5 mL IM; repeat dose at
least 28 days later

Age 10 or older: 0.5 mL IM

Intranasal Vaccine (Live)*

MedImmune (mfr)

Age 2 to 9 yo: 0.2 mL intranasal; repeat
dose at least 28 days later

Age 10 to 49 yo: 0.2 mL intranasal

(dose is administered as 0.1 mL per nostril)

*Infl uenza antiviral drugs might inhibit replication of live infl uenza vaccine virus. Avoid antivirals from 48 hours before until 2 weeks after a dose of live intranasal infl uenza vaccine unless medically necessary.

Document Outline

Title
Copyright
Contents

Analgesics

- Antirheumatic Agents
- Muscle Relaxants
- Non-Opioid Analgesic Combinations
- Non-Steroidal Anti-Inflammatories
- Opioid Agonist-Antagonists
- Opioid Agonists
- Opioid Analgesic Combinations
- Opioid Antagonists
- Other Analgesics

Anesthesia

- Anesthetics and Sedatives
- Local Anesthetics
- Neuromuscular Blockers

Antimicrobials

- Aminoglycosides
- Antifungal Agents
- Antimalarials
- Antimycobacterial Agents
- Antiparasitics
- Antiviral Agents
- Carbapenems
- Cephalosporins
- Macrolides
- Penicillins
- Quinolones
- Sulfonamides
- Tetracyclines
- Other Antimicrobials

Cardiovascular

- ACE Inhibitors
- Aldosterone Antagonists
- Angiotensin Receptor Blockers (ARBs)
- Antiadrenergic Agents
- Anti-Dysrhythmics / Cardiac Arrest
- Anti-Hyperlipidemic Agents
- Antihypertensive Combinations
- Antiplatelet Drugs
- Beta-Blockers
- Calcium Channel Blockers (CCBs)
- Diuretics
- Nitrates
- Pressors/Inotropes
- Pulmonary Arterial Hypertension
- Thrombolytics
- Volume Expanders
- Other

Contrast Media

- MRI Contrast

- Radiography Contrast

Dermatology

- Acne Preparations
- Actinic Keratosis Preparations
- Antibacterials (Topical)
- Antifungals (Topical)
- Antiparasitics (Topical)
- Antipsoriatics
- Antivirals (Topical)
- Atopic Dermatitis Preparations
- Corticosteroid / Antimicrobial Combinations
- Hemorrhoid Care
- Other Dermatologic Agents

Endocrine and Metabolic

- Androgens / Anabolic Steroids
- Bisphosphonates
- Corticosteroids
- Diabetes-Related
- Diagnostic Agents
- Gout-Related
- Minerals
- Nutritionals
- Phosphate Binders
- Thyroid Agents
- Vitamins
- Other

ENT

- Antihistamines
- Antitussives / Expectorants
- Decongestants
- Ear Preparations
- Mouth and Lip Preparations
- Nasal Preparations
- Other

Gastroenterology

- Antidiarrheals
- Antiemetics
- Antiulcer
- Laxatives
- Ulcerative Colitis
- Other GI Agents

Hematology

- Anticoagulants
- Colony Stimulating Factors
- Other Hematological Agents

Herbal and Alternative Therapies Immunology

Immunizations

- Immunizations
- Immunoglobulins
- Immunosuppression
- Other

Neurology

- Alzheimer’s Disease
- Anticonvulsants
- Migraine Therapy
- Multiple sclerosis
- Myasthenia Gravis
- Parkinsonian Agents
- Other Agents

OB/GYN

- Contraceptives
- Estrogens
- Hormone Combinations
- Labor Induction / Cervical Ripening
- Ovulation Stimulants
- Progestins
- Selective Estrogen Receptor Modulators
- Uterotonics
- Vaginitis Preparations
- Other OB / GYN Agents

Oncology

Ophthalmology

- Antiallergy
- Antibacterials
- Antiviral Agents

- Corticosteroid and Antibacterial Combinations

- Corticosteroids
- Glaucoma Agents
- Mydriatics and Cycloplegics
- Non-Steroidal Anti-Inflammatories
- Other Ophthalmologic Agents

Psychiatry

- Antidepressants
- Antimanic (Bipolar) Agents
- Antipsychotics
- Anxiolytics / Hypnotics
- Combination Drugs
- Stimulants / ADHD / Anorexiants

Pulmonary

- Beta Agonists
- Combinations
- Inhaled Steroids
- Leukotriene Inhibitors
- Other Pulmonary Medications

Toxicology

Urology

- Benign Prostatic Hyperplasia
- Bladder Agents
- Erectile Dysfunction
- Nephrolithiasis

Index

Appendix

Table of Contents

Title
Copyright
Contents

Analgesics

- Antirheumatic Agents
- Muscle Relaxants
- Non-Opioid Analgesic Combinations
- Non-Steroidal Anti-Inflammatories
- Opioid Agonist-Antagonists
- Opioid Agonists
- Opioid Analgesic Combinations
- Opioid Antagonists
- Other Analgesics

Anesthesia

- Anesthetics and Sedatives
- Local Anesthetics
- Neuromuscular Blockers

Antimicrobials

- Aminoglycosides
- Antifungal Agents
- Antimalarials
- Antimycobacterial Agents
- Antiparasitics
- Antiviral Agents
- Carbapenems
- Cephalosporins
- Macrolides
- Penicillins
- Quinolones
- Sulfonamides
- Tetracyclines
- Other Antimicrobials

Cardiovascular

- ACE Inhibitors
- Aldosterone Antagonists
- Angiotensin Receptor Blockers (ARBs)
- Antiadrenergic Agents
- Anti-Dysrhythmics / Cardiac Arrest
- Anti-Hyperlipidemic Agents
- Antihypertensive Combinations
- Antiplatelet Drugs
- Beta-Blockers
- Calcium Channel Blockers (CCBs)
- Diuretics
- Nitrates
- Pressors/Inotropes
- Pulmonary Arterial Hypertension
- Thrombolytics
- Volume Expanders
- Other

Contrast Media

- MRI Contrast

- Radiography Contrast

Dermatology

- Acne Preparations
- Actinic Keratosis Preparations
- Antibacterials (Topical)
- Antifungals (Topical)
- Antiparasitics (Topical)
- Antipsoriatics
- Antivirals (Topical)
- Atopic Dermatitis Preparations
- Corticosteroid / Antimicrobial Combinations
- Hemorrhoid Care
- Other Dermatologic Agents

Endocrine and Metabolic

- Androgens / Anabolic Steroids
- Bisphosphonates
- Corticosteroids
- Diabetes-Related
- Diagnostic Agents
- Gout-Related
- Minerals
- Nutritionals
- Phosphate Binders
- Thyroid Agents
- Vitamins
- Other

ENT

- Antihistamines
- Antitussives / Expectorants
- Decongestants
- Ear Preparations
- Mouth and Lip Preparations
- Nasal Preparations
- Other

Gastroenterology

- Antidiarrheals
- Antiemetics
- Antiulcer
- Laxatives
- Ulcerative Colitis
- Other GI Agents

Hematology

- Anticoagulants
- Colony Stimulating Factors
- Other Hematological Agents

Herbal and Alternative Therapies Immunology

Immunizations

- Immunizations
- Immunoglobulins
- Immunosuppression
- Other

Neurology

- Alzheimer’s Disease
- Anticonvulsants
- Migraine Therapy
- Multiple sclerosis
- Myasthenia Gravis
- Parkinsonian Agents
- Other Agents

OB/GYN

- Contraceptives
- Estrogens
- Hormone Combinations
- Labor Induction / Cervical Ripening
- Ovulation Stimulants
- Progestins
- Selective Estrogen Receptor Modulators
- Uterotonics
- Vaginitis Preparations
- Other OB / GYN Agents

Oncology

Ophthalmology

- Antiallergy
- Antibacterials
- Antiviral Agents

- Corticosteroid and Antibacterial Combinations

- Corticosteroids
- Glaucoma Agents
- Mydriatics and Cycloplegics
- Non-Steroidal Anti-Inflammatories
- Other Ophthalmologic Agents

Psychiatry

- Antidepressants
- Antimanic (Bipolar) Agents
- Antipsychotics
- Anxiolytics / Hypnotics
- Combination Drugs
- Stimulants / ADHD / Anorexiants

Pulmonary

- Beta Agonists
- Combinations
- Inhaled Steroids
- Leukotriene Inhibitors
- Other Pulmonary Medications

Toxicology

Urology

- Benign Prostatic Hyperplasia
- Bladder Agents
- Erectile Dysfunction
- Nephrolithiasis

Index

Appendix