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METHODOLOGY
Referencesusedweref
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ɪ
ꜰᴀᴍᴏʜᴀᴍᴍᴇᴅ
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DRUGI
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ᴘʀᴇᴘᴀʀᴇᴅʙʏ:ᏆᖴA2022
ACKNOWLEDGMENTS
Thankst
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Acet
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Act
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103

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Al
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Al
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Ami
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l
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AMI
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nol
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Ami
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tr
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Amodi
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AMPRENAVI
R223 Amy
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Anaki
nra234 Anast
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dul
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ANI
LERI
DINE241 Apr
epi
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ARDEPARI
N250 Ar
for
mot
erol
253 ARI
PIPRAZOLE256

Ar
modaf
ini
l263 Ar
seni
ctr
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de267 Ar
teet
her270

Ar
temet
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tesunat
e276 Ascor
bicaci
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Asenapi
ne281 Aspi
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n286 At
azanav
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At
enol
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orv
ast
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At
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racur
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e315 At
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At
tapul
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anof
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OGLUCOSE327

AZACI
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NE331 Azat
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ast
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AZFI
CEL-
T342 AZI
LSARTAN344 Azi
thr
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Azt
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TRACI
N356 Bacl
ofen358

Bar
ium Sul
phat
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BELATACEPT371 Benazepr
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BENZATHI
NEPENCI
LLI
NG383 Benzat
hineBenzy
lPeni
cil
l
in389

BENZOCAI
NE391 Benzonat
ate396 Benzt
ropi
ne399

BENZYLALCOHOL402 Benzy
lBenzoat
e405 Benzy
lPeni
cil
l
in406

BEPOTASTI
NE408 Besi
fl
oxaci
n410 Bet
amet
hasone412

Bet
axol
ol416 Bet
hanechol
422 Bev
aci
zumab425

BEXAROTENE428 Bi
cal
utami
de433 Bi
mat
opr
ost436

Bi
per
iden439 Bi
sacody
l443 Bi
sopr
olol
446

BI
TOLTEROL451 BI
TOLTEROL453 Bi
val
i
rudi
n456

Bl
eachi
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cin460 BOCEPREVI
R463

Bor
tezomi
b468 Bosent
an471 Bot
uli
sm i
mmunegl
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BRENTUXI
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UM 480 Br
omocr
ipt
ine482

Br
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rami
ne488 Budesoni
de491 Bumet
ani
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Bupi
vacai
ne500 Bupr
enor
phi
ne503 BUPROPI
ON511

BUSPI
RONE518 Busul
phan521 But
enaf
ine525

But
oconazol
e527 BUTURPHANOL531 C1i
nhi
bit
or(
human)535

C1-
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or537 CABAZI
TAXEL540 Caf
fei
neci
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Cal
ami
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cit
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ol547 Cal
cium acet
ate552

Cal
cium car
bonat
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tr
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Cal
cium Di
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ubi
onat
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Cal
cium Gl
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cium l
act
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numab581

Candesar
tan584 Capeci
tabi
ne589 Capr
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cin593

Capt
opr
il595 Car
bamazepi
ne602 CARBENI
CILLI
N608

Car
bimazol
e610 CARBOPLATI
N612 Car
bopr
ost616

CARGLUMI
CACI
D618 Car
isopr
odol
620 Car
must
ine623

CARTEOLOL626 Car
vedi
l
ol631 CASCARASAGRADA637

Caspof
ungi
n641 Cef
acl
or644 Cef
adr
oxi
l646

CEFAMANDOLE650 Cef
azol
i
n653 Cef
dini
r656

Cef
dit
oren659 Cef
epi
me663 Cef
ixi
me667

CEFMETAZOLE670 CEFONI
CID673 Cef
oper
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CEFOTETAN679 Cef
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TIN685

CEFPODOXI
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L692 CEFTAROLI
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Cef
tazi
dime698 CEFTI
BUTEN701 CEFTI
ZOXI
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Cef
tri
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ME712 CELECOXI
B716

Cent
chr
oman720 CEPHALEXI
N721 CEPHAPI
RIN725

CEPHRADI
NE728 CERI
VASTATI
N731 CERTOLI
ZUMABPEGOL735

CETI
RIZI
NE738 CETUXI
MAB742 CEVI
MELI
NE745
CHLORALHYDRATE748 Chl
orambuci
l752 CHLORAMPHENI
COL756

CHLORDI
AZEPOXI
DE759 CHLORHEXI
DINE763 CHLOROQUI
NE765

CHLOROTHI
AZI
DE771 Chl
oroxy
lenol
775 Chl
orpheni
rami
ne777

Chl
orpr
omazi
ne781 CHLORPROPAMI
DE788 Chl
ort
hal
i
done793

Chl
orzoxazone797 CHOLECALCI
FEROL800 CHOLESTYRAMI
NE803

Chol
i
neandmagnesi
um sal
i
cyl
ates806 Ci
clesoni
de810

CI
DOFOVI
R812 Ci
l
ost
azol
815 Ci
met
idi
ne818

Ci
nacal
cet822 Ci
prof
loxaci
n825 CI
SAPRI
DE832

CI
SATRACURI
UM 834 Ci
spl
ati
n841 Ci
tal
opr
am 843

Cl
adr
ibi
ne848 Cl
ari
thr
omy
cin851 Cl
emast
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Cl
evi
dipi
ne859 Cl
i
ndamy
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obazam 867

Cl
obet
asol
871 Cl
ocor
tol
one874 Cl
ofar
abi
ne877

Cl
ofazi
mine879 CLOMI
PHENE880 Cl
omi
prami
ne884

Cl
onazepam 890 CLONIDI
NE894 Cl
opi
dogrel
901
Cl
orazepat
e905 Cl
otr
imazol
e909 Cl
oxaci
l
li
n912

CLOZAPI
NE915 Coal
tar920 CODEI
NE921

Col
chi
cine925 COLESEVELAM 928 Col
est
ipol
932

COLFOSCERI
LPALMI
TATE935 Col
l
agenasecl
ost
ri
dium hi
stol
yti
cum 937

Comf
rey939 Coni
vapt
an942 CORTI
COTROPI
N945

Cor
ti
sone949 Cosy
ntr
opi
n954 CRI
ZOTI
NIB955

Cr
omol
yn†959 Cy
anocobal
ami
n962 Cy
clobenzapr
ine967

Cy
clophosphami
de970 Cy
closer
ine974 Cy
clospor
ine976

Cy
prohept
adi
ne983 Cy
steami
ne986 Cy
tar
abi
ne988

Cy
tomegal
ovi
rusi
mmunegl
obul
i
n993 DABI
GATRAN995
Dacar
bazi
ne998 DACLI
ZUMAB1002 DACTI
NOMYCI
N1004

Dal
fampr
idi
ne1008 Dal
tepar
in1011 DANAPAROI
D1015

DANAZOL1017 Dant
rol
ene1021 DAPSONE1025

DAPTOMYCI
N1029 Dar
bepoet
in1031 Dar
if
enaci
n1037

DARUNAVI
R1039 DASATI
NIB1047

DAUNORUBI
CINCI
TRATELI
POSOME1052 Daunor
ubi
cinhy
drochl
ori
de1056

Deci
tabi
ne1060 Def
erasi
rox1063 DEFERI
PRONE1066

Def
eroxami
ne1069 DEGARELI
X1071 Del
avi
rdi
ne1074

Deni
l
euki
ndi
ft
it
ox1078 DENOSUMAB1080 Desf
err
ioxami
neMesy
lat
e1084

Desi
prami
ne1085 Desi
rudi
n1091 Desl
orat
adi
ne1094

Desmopr
essi
n1097 Desoni
de1101 Desoxi
met
asone1104

Desv
enl
afaxi
ne1107 Dexamet
hasone1112 Dexl
ansopr
azol
e1117

Dexmedet
omi
dine1020 Dexmet
hyl
pheni
dat
e1122 Dexr
azoxane1127

Dext
ran401130 Dext
roamphet
ami
ne1132

Dext
romet
hor
phan1137 Dext
rose1140 DEZOCI
NE1143

Di
azepam 1146 Di
azoxi
de1150 DI
BUCAI
NE1154

DI
CHLORPHENAMI
DE1158 Di
clof
enac1160

Di
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li
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omi
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DI
ENESTROL1178 Di
ethy
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ETHYLSTI
LBESTROL1183

Di
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orasone1187 Di
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uni
sal
1190 DI
GITOXI
N1194

Di
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goxi
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hydr
oer
got
ami
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Di
l
l1212 Di
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l
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Di
menhy
dri
nat
e1221 Di
mer
capr
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nopr
ost
one1226

Di
phenhy
drami
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idamol
e1235 Di
ri
thr
omy
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Di
sopy
rami
de1241 Di
sul
fi
ram 1246 Di
thr
anol
1249

DI
VALPROEXSODI
UM 1251 Dobut
ami
ne1257

DOCETAXEL1260 Docosanol
1265 Docusat
esodi
um 1267

Dof
eti
l
ide1270 Dol
aset
ron1274 Donepezi
l1278

Dopami
ne1282 Dor
ipenem 1285 Dor
naseal
fa1287

Doxapr
am 1289 Doxazosi
n1293 Doxepi
n1297

Doxer
cal
cif
erol
1304 Doxor
ubi
cin1308 Doxy
cycl
i
ne1314

Dr
onabi
nol
1319 Dr
onedar
one1323 Dr
oper
idol
1328

Dr
otr
ecogi
n1331 Dut
ast
eri
de1333 D-
Peni
cil
l
ami
ne1336

Ecal
l
ant
ide1339 Econazol
e1341 Ecul
i
zumab1344

Edet
atecal
cium di
sodi
um 1348 Edr
ophoni
um 1350

EFALI
ZUMAB1354 Ef
avi
renz1357 Ef
lor
nit
hinet
opi
cal
1363

El
etr
ipt
an1366 El
tr
ombopag1370 Emt
ri
cit
abi
ne1373

Enal
apr
il1377 Enf
uvi
rt
ide1384 ENOXACI
N1387

Enoxapar
in1392 Ent
acapone1397 Ent
ecav
ir1400

Epi
rubi
cin1404 Epl
erenone1410 Epoet
in1414

Epopr
ost
enol
1420 Epr
osar
tan1422 Ept
if
ibat
ide1427

Er
gocal
cif
erol
1430 Er
gonov
ine1434 Er
got
ami
ne1436

ERI
BULI
N1439 Er
lot
ini
b1443 Er
tapenem 1446

ERYTHROMYCI
N1449 Esci
tal
opr
am 1455 Esmol
ol1460

Est
azol
am 1463 ESTRADI
OL1466 Est
ramust
ine1475

Est
ropi
pat
e1477 Eszopi
clone1482 Et
aner
cept1485

Et
hacr
yni
caci
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hambut
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hosuxi
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Et
idr
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odol
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omi
dat
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Et
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rel
1510 Et
oposi
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rav
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Ev
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imi
be1553

EZOGABI
NEa1556 Famci
clov
ir1560 Famot
idi
ne1564

Fatemul
sion1569 Febuxost
at1571 Fel
bamat
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Fel
odi
pine1579 Fenofi
brate1583 Fenofi
bri
cacid1587
Fenol
dopam 1592 Fenoprofen1593 Ferumoxytol
1597

Fesot
erodi
ne1599 Fexof
enadi
ne1602 Fi
daxomi
cin1605

Fi
l
grast
im 1607 Fi
nast
eri
de1610 FI
NGOLI
MOD1613

Fl
avocoxi
d1616 Fl
ecai
nide1618 Fl
oxur
idi
ne1621

Fl
uconazol
e1624 Fl
ucy
tosi
ne1630 Fl
udar
abi
ne1633

Fl
udr
ocor
ti
sone1637 Fl
umazeni
l1640 Fl
uni
sol
i
de1644

Fl
uoci
nol
one1648 Fl
uoci
noni
de1651 Fl
uor
our
aci
l1654

FLUOXETI
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uphenazi
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urandr
enol
i
de1671

Fl
urazepam 1674 Fl
utami
de1678 Fl
uti
casone1680

Fl
uvast
ati
n1687 Fl
uvoxami
ne1690 Fol
i
caci
d1695

Fol
l
itr
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nal
fa1699 Fol
l
itr
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nbet
a1702 FOMI
VIRSEN1706

Fondapar
inux1708 For
mot
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1712 Fosampr
enav
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Foscar
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cin1728 Fosi
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Fospheny
toi
n1735 Fospr
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ovat
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Ful
vest
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de1749 Gabapent
in1755

Gal
ant
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l
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ate1764 Gal
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x1772 Gat
if
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Gef
it
ini
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Gemi
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oxaci
n1788 Gl
ati
ramer1793 Gl
i
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Gl
i
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de1801 Gl
ucagon1806 Gl
ybur
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Gl
ycer
in1815 Gl
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ate1817 Gol
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Gonador
eli
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ate1827 Gonador
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nHy
drochl
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de1829

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eli
n1831 Gr
iseof
ulv
in1834 Guai
fenesi
n1838

Guanabenz1841 Guanadr
el1845 Guanet
hidi
ne1850

guanf
aci
ne1854 Hal
azepam 1860 Hal
cinoni
de1863

Hal
obet
asol
1866 Hal
ofant
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ne1868 Hal
oper
idol
1871

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in1876 Hepat
it
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ast
arch1884 Hy
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azi
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Hy
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drocodone1902

Hy
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ti
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droxocobal
ami
n1917

Hy
droxy
chl
oroqui
ne1922 Hy
droxy
progest
erone1926

Hy
droxy
urea1930 Hy
droxy
zine1935 Hy
oscy
ami
ne1938

I
bandr
onat
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ofen1948 I
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ide1953

I
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sul
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ami
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I
loper
idone1964 I
lopr
ost1969 I
mat
ini
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I
migl
ucer
ase1977 I
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cil
ast
ati
n1979 I
mipr
ami
ne1983

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miqui
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obul
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namr
inone1999

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ncobot
uli
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ndacat
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2005

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e2123

I
ver
mect
in2128 I
xabepi
l
one2131 Kanamy
cin2136

Ket
ami
ne2138 Ket
oconazol
e2141 Ket
opr
ofen2146

Ket
orol
ac2150 Kunecat
echi
ns2155 L-Aspar
agi
nase2159

Labet
alol
2160 Lacosami
de2165 Lact
ulose2168

Lami
vudi
ne2171 Lamot
ri
gine2176 Lanr
eot
ide2186

Lansopr
azol
e2189 Lar
oni
dase2193 Lenal
i
domi
de2195

Lepi
rudi
n(r
DNA)2199 Let
rozol
e2202 Leucov
ori
ncal
cium 2205

Leupr
oli
de2209 Lev
albut
erol
2215 Lev
ami
sol
e2219

Lev
eti
racet
am 2223 Lev
ocet
ir
izi
ne2227 Lev
ofl
oxaci
n2230

Lev
oleucov
ori
ncal
cium 2236 Lev
onor
gest
rel
2240

Lev
orphanol
2242 Lev
othy
roxi
ne2245 Li
docai
ne2249

Li
nagl
i
pti
n2251 Li
ndane2254 Li
nezol
i
d2258

Li
othy
roni
ne2263 Li
otr
ix2267 Li
ragl
uti
de2271

Li
sdexamf
etami
ne2275 Li
sinopr
il2280 Li
thi
um Car
bonat
e2286

Lomef
loxaci
n2291 Lomust
ine2295 Loper
ami
de2299

Lor
acar
bef2302 Lor
atadi
ne2305 Lor
azepam 2308

Losar
tan2311 Lovastat
in2316 Loxapi
ne2321
Lubi
prost
one2325 Lur
asidone2327 Magnesi
um Chl
ori
de2332

Magnesi
um Hy
droxi
de2335 magnesi
um sal
i
cyl
ate2337 Magnesi
um Sul
phat
e2340
Mal
athi
on2342 Manni
tol
2346 Mapr
oti
l
ine2348

Mar
avi
roc2353 Mebendazol
e2358 Mecaser
min2361

Mechl
oret
hami
ne2364 Mecl
i
zine2367 Mecl
ofenamat
e2370

Medr
oxy
progest
erone2374 Mef
enami
cAci
d2379 Megest
rol
2381

Megl
umi
neI
otr
oxat
e2384 Mel
oxi
cam 2386 Mel
phal
an2389

Memant
ine2393 Menadi
oneSodi
um Sul
phat
e2395

Menot
ropi
ns2397 Meper
idi
ne2401 Mepr
obamat
e2406

Mer
capt
opur
ine2409 Mer
openem 2413 Mesna2416

Mesor
idazi
ne2418 Met
apr
oter
enol
2423 Met
axal
one2427

Met
for
min2430 Met
hadone2435 Met
hazol
ami
de2440

Met
himazol
e2442 Met
hocar
bamol
2446 Met
hohexi
tal
2449

Met
hot
rexat
e2451 Met
hot
ri
mepr
azi
ne2456 Met
hot
ri
mepr
azi
ne2460

Met
hyl
dopa2462 Met
hyl
ergonov
ine2467 Met
hyl
nal
tr
exone2469

Met
hyl
pheni
dat
e2472 Met
hyl
Predni
sol
one2479 Met
hyl
eneBl
ue2484

Met
hyser
gide2485 Met
ocl
opr
ami
de2488 Met
olazone2493

Met
opr
olol
2497 Met
roni
dazol
e2503 Mexi
l
eti
ne2508

Mezl
oci
l
li
n2511 Mi
caf
ungi
n2514 Mi
conazol
2516

Mi
dazol
am 2519 Mi
dodr
ine2521 Mi
fepr
ist
one2524

Mi
gli
tol
2527 Mi
glust
at2531 Mi
l
naci
pran2533

Mi
l
rinone2538 Mi
ner
aloi
l2540 Mi
nocy
cli
ne2543

Mi
noxi
dil
2549 Mi
l
tef
osi
ne2553 Mi
rt
azapi
ne2554

Mi
sopr
ost
ol2559 Mi
tomy
cin2562 Mi
tot
ane2566

Mi
toxant
ronea2570 Modaf
ini
l2574 Moexi
pri
l2578

Mol
i
ndone2583 Momet
asone2588 Mont
elukast2590
Mor
ici
zi
ne2593 Mor
phi
ne2596 Moxi
fl
oxaci
n2601

Mul
ti
vi
tami
ninf
usi
on2606 Mupi
roci
n2609 Mur
omonab-
CD32611

My
cophenol
ateMof
eti
l2615My
cophenol
i
caci
d2618 Nabi
l
one2624

Nabumet
one2627 Nadol
ol2631 Naf
arel
i
n2636

Naf
cil
l
in2640 Naf
ti
fi
ne2643 Nal
buphi
ne2645

Nal
i
dixi
cAci
d2649 Nal
mef
ene2651 Nal
oxone2654

Nal
tr
exone2656 Nandr
olonedecanoat
e2661 Napr
oxen2663

Nar
atr
ipt
an2668 Nat
ali
zumab2673 Nat
egl
i
nide2676

Nebi
vol
ol2680 Nedocr
omi
l2685 Nef
azodone2687

Nel
arabi
ne2692 Nel
fi
nav
ir2694 Neomy
cin2700

Neost
igmi
ne2703 Nesi
ri
ti
de2706 Net
ti
lmi
cin2709

Nev
irapi
ne2712 Ni
aci
n2718 Ni
car
dipi
ne2722

Ni
closami
de2728 Ni
cot
ini
caci
d2729 Ni
fedi
pine2731

Ni
l
oti
nib2737 Ni
l
utami
de2743 Ni
modi
pine2745

Ni
tazoxani
de2749 Ni
tr
azepam 2750 Ni
tr
ofurant
oin2752
Ni
tropr
ussi
de2756 Ni
tr
ousOxide2758 Ni
zati
dine2759

Nor
adr
enal
i
ne2763 Nor
epi
nephr
ine2765 Nor
ethi
ndr
one2768

Nor
ethi
ster
one2789 Nor
fl
oxaci
n2791 Nor
tri
pty
li
ne2797

Ny
stat
in2802 Of
atumumab2804 Of
loxaci
n2807

Ol
anzapi
ne2813 Ol
mesar
tan2818 Ol
sal
azi
ne2822

Omal
i
zumab2825 Omepr
azol
e2827 Ondanset
ron2831

Oprel
veki
n2834 Or
li
stat2836 Orphenadr
ine2840
Oselt
amivi
r2843 Oxaci
ll
in2847 Oxal
ipl
ati
n2850

Oxapr
ozi
n2853 Oxazepam 2857 Oxcar
bamazepi
ne2861

Oxi
conazol
e2865 Oxy
gen2868 Oxy
mor
phone2869
Oxy
toci
n2874 Pacl
i
taxel
2877 Pal
i
fer
min2882

Pal
i
per
idone2883 Pal
i
vizumab2890 Pal
onoset
ron2892

Pami
dronat
e2894 Pancr
eli
pase2898 Pani
tumumab2902

Pant
opr
azol
e2905 Papav
eri
ne2907 Par
acet
amol
2910

Par
egor
ic2912 Par
ical
cit
ol2915 Par
omomy
cin2920

Par
oxet
ineHy
drochl
ori
de2922 Pazopani
b2930

Pegapt
ani
b2934 Pegaspar
gase2936 Pegf
il
grast
im 2939

Pegv
isomant2942 Pemol
i
ne2945 Penbut
olol
2948

Penci
clov
ir2953 Peni
cil
l
ami
ne2955 Pent
ami
dine2960

Pent
azoci
ne2963 Pent
obar
bit
al2967 Pent
osan2971

Pent
ost
ati
n2973 Pent
oxi
fyl
l
ine2976 Per
amav
ir2979

Per
gol
i
de2983 Per
indopr
il2985 Per
met
hri
n2991

Per
phenazi
ne2994 Phenazopy
ridi
ne2999 Phenel
zi
ne3002

Pheni
rami
ne3008 Phenobar
bit
one3009 Phenoxy
benzami
ne315

Phenoxy
met
hyl
3019 Phent
ermi
ne3020 Phent
olami
ne3024

Phenyl
ephri
ne3027 Phenylpr
opanol
ami
ne3031 Phenyt
oin3034
Physost
igmine3041 Phytonadi
one3044 Pi
locar
pine3049

Pi
mecr
oli
mus3053 Pi
mozi
de3055 Pi
ndol
ol3062

Pi
ogl
i
tazone3067 Pi
rbut
erol
3071 Pi
roxi
cam 3074

Pi
tav
ast
ati
n3078 Pl
eri
xaf
or3082 Pl
i
camy
cin3085

Pol
i
docanol
3089 Pol
ycar
bophi
l3091 Por
fi
mer3093

Posaconazol
e3098 Pot
assi
um aci
dphosphat
e3101 Pot
assi
um Chl
ori
de3105

Pov
idoneI
odi
ne3106 Pr
alat
rexat
e3108 Pr
ali
doxi
me3111

Pr
ami
pexol
e3115 Pr
aml
i
nti
de3119 Pr
amoxi
ne3123
Pr
asugr
el3127 Pr
avast
ati
n3130 Pr
azi
quant
el3135

Pr
azosi
n3136 pr
edni
car
bat
e3140 Pr
edni
sol
one3143

Pr
edni
sone3148 Pr
egabal
i
n3153 Pr
imaqui
ne3157

Pr
imi
done3159 Pr
obeneci
d3164 Pr
obucol
3166

Pr
ocai
nami
de3169 Pr
ocar
bazi
ne3173 Pr
ochl
orper
azi
ne3178

Pr
ogest
erone3186 Pr
oguani
l3191 Pr
omazi
ne3192

Pr
omet
hazi
ne3197 Pr
opaf
enone3202 Pr
opant
hel
i
ne3206

Pr
opi
omazi
ne3209 Pr
opof
ol3211 Pr
opr
anol
ol3215

Pr
opy
lthi
our
aci
l3221 Pr
opy
li
odone3224 Pr
otami
ne3226

Pseudoephedr
ine3228 Psy
ll
ium 3232 Py
rant
elPamoat
e3234

Py
razi
nami
de3235 Py
ridost
igmi
ne3238 Py
ridoxi
ne3242

Py
rimet
hami
ne3246 Quazepam 3250 Quet
iapi
ne3253

Qui
napr
il3260 Qui
nidi
neGl
uconat
e3266 Qui
nidi
ne3270

Qui
nidi
ne3271 Rabepr
azol
e3276 Ral
oxi
fene3280

Ral
tegr
avi
r3283 Ramel
teon3287 Rami
pri
l3290

Rani
bizumab3296 Rani
ti
dine3297 Rani
ti
dinebi
smut
hci
tr
ate3303

Ranol
azi
ne3305 Rasagi
l
ine3308 Rasbur
icase3313

Remi
fent
ani
l3315 Repagl
i
nide3320 Reser
pine3324

Ret
apamul
i
n3328 Ret
epl
ase3330 Ri
bav
iri
n3333

Ri
bof
lav
in3341 Ri
fabut
in3343 Ri
fampi
cin3347

Ri
fapent
ine3353 Ri
faxi
min3356 Ri
l
onacept3359

Ri
l
piv
iri
ne3362 Ri
l
uzol
e3367 Ri
mant
adi
ne3370

Ri
sedr
onat
e3373 Ri
sper
idone3377 Ri
todr
ine3384

Ri
tonav
ir3386 Ri
tuxi
mab3393 Ri
var
oxaban3398
Ri
vast
igmi
ne3401 Ri
zat
ri
ptan3405 Rocur
oni
um 3410

Rof
ecoxi
b3413 Rof
lumi
l
ast3417 Romi
depsi
n3420

Romi
plost
im 3424 Ropi
nir
ole3426 Ropi
vacai
ne3429

Rosi
gli
tazone3433 Rosuv
ast
ati
n3437 Ruf
inami
de3442

Ruxol
i
tini
b3445 Roxi
thr
omy
cin3449 Sal
but
amol
3450

Sal
i
cyl
i
cAci
d3454 Sal
i
vasubst
it
utes3455 Sal
met
erol
3457

Sal
sal
ate3461 Sapr
opt
eri
n3465 Saqui
nav
ir3467

Sar
gramost
im 3474 Saxagl
i
pti
n3477 Scopol
ami
ne3480

Sel
egi
l
ine3485 Senna3490 Sennosi
des3491

Ser
taconazol
e3494 Ser
tral
i
ne3496 Sev
elamer3502

Si
but
rami
ne3504 Si
l
denaf
il3508 Si
l
verSul
fadi
azi
ne3513

Si
met
hicone3515 Si
mvast
ati
n3517 Si
necat
echi
ns3522

Si
tagl
i
pti
n3525 Sodi
um Bi
car
bonat
e3529 Sodi
um Chl
ori
de3533

Sodi
um f
luor
ide3536 Sodi
um Lact
ate3540 Sodi
um Ni
tr
it
e3541

Sodi
um Ni
tr
opr
ussi
de3543 Sodi
um oxy
bat
e3545

Sodi
um phosphat
e3548 Sodi
um St
ibogl
uconat
e3551

Sodi
um Thi
osul
phat
e3553 Sodi
um Val
proat
e3554

Somat
rem 3556 Sor
afeni
b3560 Spect
inomy
cin3563

Spi
nosad3565 Spi
ronol
act
one3568 St
avudi
ne3573

St
rept
oki
nase3577 St
rept
omy
cin3581 St
rept
ozoci
n3583

St
ront
ium Ranel
ate3586 Succi
nyl
chol
i
ne3588 Succi
nyl
Chol
i
neChl
ori
de3591

Suf
ent
ani
l3593 Sul
conazol
e3597 Sul
famet
hoxazol
e3599

Sul
fasal
azi
ne3602 Sul
fi
npy
razone3606 sul
fi
sxazol
e3609

Sul
phacet
ami
de3612 Sul
phadi
azi
ne3613 Sumat
ri
ptan3615
Suni
ti
nibp3622 Tacr
ine3626 Tacr
oli
mus3629

Tadal
afi
l3632 Tamoxi
fen3639 Tamsul
osi
n3644

Tapent
adol
3646 Tegaser
od3651 Tel
apr
evi
r3654

Tel
avanci
n3660 Tel
biv
udi
ne3664 Tel
i
thr
omy
cin3667

Tel
misar
tan3671 Temazepam 3675 Temozol
omi
de3679

Temsi
rol
i
mus3683 Tenect
epl
ase3686 Teni
posi
de3689

Tenof
ovi
r3693 Ter
azosi
n3697 Ter
but
ali
ne3701

Ter
conazol
e3706 Ter
ipar
ati
de3708 Tesamor
eli
n3711

Test
ost
erone3714 Tet
rabenazi
ne3718 Tet
racai
ne3722

Tet
racy
cli
ne3723 Thal
i
domi
de3729 Theophy
ll
ine3735

Thi
ami
ne3740 Thi
opent
al3743 Thi
ethy
lper
azi
ne3745

Thi
oguani
ne3748 Thi
ori
dazi
ne3752 Thi
otepa3757

Thi
othi
xene3761 Thy
roi
d3765 Ti
agabi
ne3769

Ti
cagr
elor3773 Ti
clopi
dine3777 Ti
gecy
cli
ne3779

Ti
l
udr
onat
e3783 Ti
mol
ol3786 Ti
nidazol
e3791

Ti
nzapar
in3795 Ti
oconazol
e3798 Ti
otr
opi
um 3800

Ti
pranav
ir3803 Ti
rof
iban3808 Ti
zani
dine3811

Tobr
amy
cin3814 Tocai
nide3818 Toci
l
izumab3822

TOLAZAMI
DE3825 TOLBUTAMI
DE3830 Tol
capone3836

Tol
naf
tat
e3839 Tol
ter
odi
ne3841 Tol
vapt
an3843

Topi
ramat
e3847 Topot
ecan3854 Tor
emi
fene3858

Tor
semi
de3861 Tr
amadol
3866 Tr
andol
apr
il3869

Tr
anexami
cAci
d3874 Tr
any
lcy
promi
ne3878 Tr
ast
uzumab3884

Tr
azodone3888 Tr
iamci
nol
one3894 Tr
iamt
erene3898
Tr
iazol
am 3902 Tr
if
luoper
azi
ne3905 Tr
ihexy
pheni
dyl
(Benzhexol
)3910

Tr
imet
hobenzami
de3915 Tr
imet
hopr
im 3917 Tr
imet
rexat
e3920

Tr
imi
prami
ne3924 Tr
ipr
oli
dine3930 Tr
ipt
orel
i
n3934

Tr
ogl
i
tazonear3936 Tr
opi
cami
de3940 Tr
ospi
um 3941

Tr
ovaf
loxaci
n3944 Ur
ea3949 Ur
oki
nase3950

Ur
sodi
ol3953 Ust
eki
numab3955 Val
acy
clov
ir3959

Val
decoxi
b3963 Val
ganci
clov
ir3967 Val
proat
esodi
um 3972

Val
rubi
cin3979 Val
sar
tan3982 Vancomy
cin3987

Vandet
ani
b3991 Var
denaf
il3996 v
areni
cli
ne4001

Vasopr
essi
n4006 Vecur
oni
um 4010 Vel
agl
ucer
aseal
fa4016

Vemur
afeni
b4018 Venl
afaxi
ne4022 Ver
apami
l4028

Ver
tepor
fi
n4034 Vi
gabat
ri
n4037 Vi
l
azodone4041

Vi
nbl
ast
ine4045 Vi
ncr
ist
ine4049 Vi
nor
elbi
ne4052

Vi
tami
nA 4055 Vi
tami
nBcompl
exwi
thv
itami
nC 4059

Vi
tami
nE4062 Vor
iconazol
e4065 Vor
inost
at4071

War
far
in4073 Wat
erf
orI
nject
ion4079 Xy
lomet
azol
i
ne4079

Zaf
ir
lukast4080 Zal
cit
abi
ne4084 Zal
epl
on4087

Zanami
vi
r4091 Zi
conot
ide4094 Zi
dov
udi
ne4097

Zi
l
eut
on4102 Zi
ncOxi
de4105 Zi
ncsul
fat
e4105

Zi
prasi
done4108 Zol
edr
oni
caci
d4113 Zol
mit
ri
ptan4117

Zol
pidem 4122 Zoni
sami
de4126
Abbr
evi
ati
ons
Abbr
evi
ati
onsusedi
npr
esent
ati
onsandchar
tor
der
s,
Note:i
tisalway
ssaf
ert
owr
it
eoutt
hedi
rect
ionwi
thout
abbrev
iati
ng

Abbr
evi
ati
on Expl
anat
ion
a bef
ore
ac bef
oreMal
e
agi
t shake,
sti
r
Aq wat
er
Aqdest di
sti
l
ledwat
er
bi
d t
wiceaday
C wi
th
Cap capsul
e
D5W, dext
rose5%i
nwat
er
di
l di
ssol
ve,
dil
ute
i
sp,
dis di
spense
el
i
x el
i
xir
ext ext
ract
g gr
am
gr gr
ain
gt
t dr
ops
h hour
hs atbedt
ime
i
,i
i,
ii
i,
iv,
etc one,
two,
thr
ee,
four
.Et
c
I
A i
ntr
a-ar
ter
ial
I
M i
ntr
amuscul
ar
I
V i
ntr
avenous
kg ki
l
ogr
am
mcg,
μg mi
crogr
am
mEq,
meq mi
l
li
equi
val
ent
mg mi
l
li
gram
no number
nonr
ep donotr
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OD r
ightey
e
OS,
OL l
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e
от
с ov
ert
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er
OU bot
hey
es
P af
ter
PC af
termeal
s
PO bymout
h
PR perr
ect
um
Pr
n whenneeded
q ev
ery
q2h,
q3h,
etc ev
ery2hour
sev
ery3hour
set
c
qam,
om ev
erymor
ning
qd ev
eryday
gh,
q/h ev
eryhour
ghs ev
eryni
ghtatbedt
ime
qi
d f
ourTi
mesaday
qod ev
eryot
herday
qod suf
fi
cientquant
it
y
Rx t
ake
S wi
thout
SC,
SQ subcut
aneous
Si
g,S l
abel
SOS i
fneeded
Abacav
ir
I
ndi
cat
ions
HIVinf
ecti
onincombinat
ionwi
that
leastt
woot
her
ant
ir
etrov
iral
drugs.

ACTI
ON
Conv ert
edinsidecell
stocarbovi
rt r
iphosphat e,its
acti
vemet abolit
e.Carbovi
rtri
phosphat einhibitsthe
acti
vityofHIV-1reverset
ranscri
ptase, whichint urn
terminatesvi
ralDNAgr owth.Therapeut i
cEf f
ect s:
Slowst heprogressi
onofHI Vinf
ectionand
decreasestheoccur r
enceofitssequel ae.Increases
CD4cel lcountsanddecreasesviralload.

I
NTERACTI
ONS
Dr
ug-Drug:Al
cohol↑ bl
oodlev
els.May↑
methadonemetabol
ism i
nsomepat i
ent
s;sl
i
ght↑ i
n
methadonedosi
ngmaybeneeded.

Av
ail
abi
l
ity
TABLET300mg.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1
Dose
Or
alAdul
t-300mgt
wicedai
l
yor600mgoncedai
l
y.
Chil
d-3mont
hsto12year
s:8mg/kgbodywei
ght
ever
y12h(max.600mgdail
y).

Cont
rai
ndi
cat
ions
Pr
egnancyl
act
ati
onhepat
icdy
sfunct
ionr
enal
di
sease.

Pr
ecaut
ions
Hepati
cimpair
mentrenali
mpairment
;pregnancy
l
actat
ionhyper
sensi
ti
vit
yreact
ion;
int
eract
ions.

ADVERSEREACTI
ONSANDSI
DE
EFFECTS
CNS:headache,i
nsomnia.CV:MYOCARDI AL
I
NFARCTION.GI :
HEPATOMEGALY( WITH
STEATOSIS),
diar
rhea,nausea,
vomiti
ng,anorexi
a.
Derm:r
ashes.FandE: LACTICACIDOSIS.Mi sc:
HYPERSENSITIVI
TYREACTI ONS,fatr
edistr
ibuti
on,
i
mmuner econsti
tut
ionsyndrome.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 2
PATI
ENTTEACHI
NG
Emphasi zethei mportanceoft akingabacav i
ras
dir
ected.Mustal waysbeusedi ncombi nati
on
withotherant i
retrov
iraldrugs.Donott akemor e
thanprescribedamount ,anddonotst optaki
ng
withoutconsultinghealthcar eprofessional
.
Takemi sseddosesassoonasr emember ed;do
notdoubl edoses.
I
nst
ructpat
ientnott
oshar
eabacav
irwi
thot
her
s.
Inform patientthatabacav irdoesnotcur eAIDS
orpr eventassociatedoroppor tunisti
cinfect
ions.
Abacav irdoesnotr educet her i
skof
transmi ssi
onofHI Vtoot hersthroughsexual
contactorbl oodcont ami nati
on.Caut ionpati
ent
touseacondom, andav oidshar i
ngneedl esor
donat i
ngbl oodt opreventspr eadingtheAI DS
virustoot hers.Advisepat i
entthatt helong-t
erm
effectsofabacav i
rareunknownatt histi
me.
Adv i
sepatientofpot ent
ial
forhyper
sensit
ivi
ty
reactionst
hatmayr esul
tindeath.I
nst
ruct
patienttodiscont
inueabacavirandnoti
fyhealt
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 3
 carepr ofessional
immedi atelyi
fsy mpt omsof
hypersensi t
ivit
yorsignsofI mmune
Reconst i
tutionSyndrome( signsandsy mpt oms
ofani nfecti
on)occur .Advisepatienttor ead
Medicat i
ongui dethoroughlywitheachr efil
lin
caseofchanges.Awar ni
ngcardsummar i
zing
sympt omsofabacav irhypersensiti
vi
tyi s
provi
dedwi theachpr escri
pti
on;instructpat i
ent
tocarrycar datallti
mes.
I
nst ructpat ienttonot if
yheal thcarepr of
essional
i
mmedi atelyifsympt omsofl acti
caci dosi
s
(ti
rednessorweakness, unusual muscl epain,
troublebr eat hi
ng,stomachpai nwi thnauseaand
vomi ti
ng, col despeciallyinar msorl egs,
dizziness, fastorirregularhear tbeat)orifsigns
ofhepat otoxici
ty(yellowski norwhi tesofey es,
darkur ine,light-
coloredst ools, l
ackofappet i
te
forsev eral daysorl onger ,nausea, abdomi nal
pain)occur .Thesesy mpt omsmayoccurmor e
frequent lyinpatientst hatar efemal e,obese, or
hav ebeent akingmedi cationsl i
keabacav irfora
l
ongt i
me.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 4
 Inf
orm pati
entthatredistri
buti
onand
accumulati
onofbodyf atmayoccur ,causi
ng
centr
alobesit
y,dorsocer vi
calf
atenlargement
(buff
alohump),peripheralwasting,
breast
enlar
gement,andcushi ngoidappearance.The
causeandlong-ter
m ef fectsarenotknown.
Advisepat ienttonot i
fyhealthcareprofessi
onal
ofallRxorOTCmedi cati
ons, v
itamins,
orherbal
product sbeingt akenandt oconsultwithhealt
h
carepr ofessionalbeforetakingother
medi cations,especial
lymet hadoneandot her
anti
retrov i
ral
s.
Advisefemalepat
ient
stoavoidbreast
feedi
ng
andt onot
if
yhealt
hcareprofessi
onali
f
pregnancyi
splannedorsuspected.
Emphasi
zetheimport
anceofregul
arf
oll
ow-up
examsandbloodcountstodet
ermi
neprogr
ess
andmonit
orforsi
deeffect
s.

St
orage
St
oreatat
emper
atur
enotex
ceedi
ng30⁰
C.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 5
Abar
eli
x
I
NDI
CATI
ONS
AdvancedprostatecancerwhenLHRHagoni stsare
i
nappropri
ateorsurgicalcastr
ati
oni
srefusedandtherei
s
ri
skofneurologi
ccompr omi sefr
om metast
aticdi
sease,
uret
eral
/bl
adderobstructionduetol
ocal
/ metast
ati
c
di
seaseorsev eremetastati
cbonepainunresponsi
veto
adequateopioi
danalgesia.

ACTI
ON
Directl
yandcompet it
ivelyblockspi t
uitaryGnRHr eceptors,
therebysuppr essingpr oductionofl uteinizi
nghormone
(LH)andf oll
icle-st
imul ati
nghor mone( FSH) .Thi
sresult
s
i
ndecr easedpr oductionoft estosteronebyt het
estes,
whi chi
snotaccompani edbyani ni
tialincreasei
n
testoster
one.Ther apeuticEffects:Suppr essedspreadof
met astat
icprost atecancer ,wit
hdecr easedneurologic
compl i
cations,bladderout letobst r
uct i
onandneedf or
opioidanalgesics.

CONTRAINDICATI
ONSAND
PRECAUTIONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 6
 Contr
aindi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Adul
tfemal
esor
chi
ldr
en.

UseCautiouslyi
n:Pati
entswi t
hpr e-exi
sti
ngQTc
prol
ongati
onorconcur r
entuseofCl assIA
anti
arr
hythmics(amiodarone,sotalol)
;Weight>225
pounds(decreasedeff
ectivenessov erti
me).

ADVERSEREACTI
ONSANDSI
DE
EFFECTS
CNS: di
zziness,fatigue,headache,sl
eepdi sturbances.CV:
peripheraledema, prolongedQTcinterval.GI:consti
pati
on,
di
ar rhea,nausea, increasedtr
ansaminases.GU: dysuri
a,
uri
nar yfrequency .Der m:hotfl
ushes.Endo: breast
enlargement /nippletenderness.MS: backpai n.Misc:
al
lergicreactions, decreasedbonemi neraldensity.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.
ROUTE/
DOSAGE
I
M:(
Adult
s) :
100mgonDay1,
15,
and29andt
henev
ery4
wkt
her
eafter
.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 7
Ster
il
epowderforsuspensi
on(r
equi
resreconst
it
uti
on)
113mg/vi
al(yi
elds100mg/ 2mLdose);

PATI
ENTTEACHI
NG
I
nfor
m pat
ientofpur
poseandr
isksofabar
eli
x.

Maycausedizziness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

Adv i
sepati
enttonot
ifyphysi
ciani
mmediat
elyi
f
sympt omsofimmediate-
onsetsyst
emi
call
ergi
c
reacti
onoccur.

Abat
acept
I
NDI
CATI
ONS
Reduct i
onofsigns/ symptomsanddi seasepr ogressi
onin
moder atetoseverelyactiverheumatoidarthri
tisinadult
s
(tobeusedasmonot herapyori nwit
hot herdisease
modi f
yingantir
heumat icdrugs( DMARDS) ,otherthan
tumor -
necrosi
sf actor(TNF)inhibi
tor
s.Reduct ionof
signs/symptomsi nchi l
dren(≥6y r
)wi t
hmoder at
et o
severelyacti
vepol y
arti
cularj
uv eni
lei
diopathicart hr
it
is(
to
beusedasmonot herapyorwi thmethotrexate).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 8
ACTI
ON
I
nhibit
sTcellacti
vat
ion(andtheinfl
ammat oryprocess)
bybindingt
ospecifi
creceptor
s.Therapeuti
cEffects:
Decreasedprogr
essionofrheumatoi
dar t
hri
tis.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Contr
aindi
catedin:Hypersensi
ti
vit
y;Concur
rentuseof
tumornecrosi
sfactor(TNF)antagonist
soranakinr
a;
Lact
ati
on:Disconti
nuedrugorpr ovi
deformula.
UseCauti
ouslyin:Pati
entswit
hchr onicobstruct
ive
pul
monarydisease(↑r iskofexacerbationsandother
adver
seevents);Geri
:↑r i
skofadv ersereacti
ons;Pedi:
Chi
ldr
en<6y r(safet
ynotestabli
shed) ;
OB: Useonlyif
cl
earl
yneeded.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,
dizzi
ness.Mi
sc:hy
persensit
ivi
tyr
eact
ions
i
ncludinganaphyl
axis,
INFECTI
ONS,inf
usion-r
elat
ed
events.

I
NTERACTI
ONS
Drug-
Drug:Concurr
entusewit
htumornecrosi
sfact
or
(TNF)ant
agonistsmay↑ ri
skandseveri
tyofi
nfect
ions.
May↑ incidenceandri
skofadver
sereacti
onsfr
om li
ve-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 9
v
irusv
acci
nes.

DOSAGE
Rheumat
oidAr
thr
it
is
IV:(
Adults)
:<60kg—500mgi ni
ti
all
y;repeatdoseat2wk
and4wkaf teriniti
aldose,t
henq4wkt hereaf
ter;60–100
kg—750mgi ni
ti
ally;r
epeatdoseat2wkand4wkaf t
er
i
niti
aldose,t
henq4wkt hereaft
er;>100kg—1000mg
i
niti
all
y;r
epeatdoseat2wkand4wkaf terini
ti
aldose,
thenq4wkt her eaft
er.
Subcut( Adul
ts):Pati
entshouldreceivesingl
eIVdose
(accordingtoweight-
baseddosinggui del
inesabov e)
,then
give125mgsubcutwi thi
n1day , t
hengive125mgsubcut
onceweekl y;i
fpati
entcannotrecei v
eIVdose, i
nit
iate
onceweekl ysubcutinj
ecti
ons;iftransi
ti
oningfr
om I V
therapy,admini
sternextscheduleddoseassubcut
i
njection.

Juv
eni
l
eIdi
opat
hicAr
thr
it
is
I
V: (
Children6–17y rand≥75kg) :
75–100kg—750mg
i
niti
all
y;repeatdoseat2wkand4wkaf terini
tialdose,
thenq4wkt hereaf
ter;>100kg—1000mgi nit
iall
y;repeat
doseat2wkand4wkaf teri
nit
ialdose,
thenq4wk
ther
eafter.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 10
I
V: (
Chi
ldr
en6–17y
rand<75kg):
10mg/ kgini
ti
all
y;r
epeat
doseat2wkand4wkaft
eri
nit
ialdose,
thenq4wk
ther
eaf
ter
.

AVAI
LABI
LITY
Lyophil
izedpowderf orI
Vadmi nist
rat
ion250mg/ v
ial
;
Soluti
onf orsubcutadmini
str
ation(pr
efi
ll
edsyr
inges)125
mg/ syr
inge;

PATI
ENTTEACHI
NG
I
nstructpati
entonpur poseofabatacept.Advise
pati
enttoreadtheOr enciaPat
ientInf
ormationleaf
let
pri
ortoeachsession.Pr ovi
deanoppor tuni
tyfor
pati
enttoaskquestions.Ifadoseismi ssed,ask
heal
thcareprofessi
onal whentoschedul enextdose.

Advi
sepati
entnottorecei
veli
vevaccinesdur
ingor3
mofoll
owingther
apy.Parent
sshouldbeadv i
sedthat
chi
l
drenshouldcompleteimmuni
zationstodate
bef
oreini
ti
ati
onofabatacept
.

Advi
sepat i
entthatmet
hotr
exat
e,anal
gesi
cs,NSAIDs,
cor
ticoster
oids,
andsal
icy
lat
esmaybecontinued
dur
ingt her
apy.

I
nst
ructpat
ientt
hatabat
aceptshoul
dnotbet
aken

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 11
 wi
thTNFant
agoni
stsmayi
ncr
easer
iskf
ori
nfect
ions.

I
nstructpat
ienttonotifyhealthcarepr
ofessionalif
upperrespi
rator
yorot herinfect
ionsoccur.Therapy
mayneedt obedi scontinuedifseri
ousinf
ection
occurs.

Advi
sepatienttonotif
yhealt
hcar eprofessional
if
pr
egnancyispl annedorsuspected.Cautionpati
entt
o
avoi
dbreastfeedingduri
ngtherapy.

Abci
xi
mab
I
ndi
cat
ions
Usedwi thhepar i
nandaspirintodecreasecardiac
i
schemi ccompl i
cati
onsbeforeoraf t
erpercutaneous
cor onaryinterventi
on(PCI)
,incl
udi
ngper cutaneous
translumi nalcoronaryangi
oplast
y( PTCA).UnlabeledUses:
Incombi nati
onwi thhepari
nandand/ orl
ow-dose
alteplaseorr etepl
asetoenhancecor onaryper f
usioni
n
pat i
entswi thacutecoronarysyndromes( ACS) .

ACTI
ON
Bindstoglycoprot
ein(
GP)receptor
sonpl at
eletsurfaces
(GPIIb/I
II
a),r
esult
ingi
ndecreasedplat
eletaggregation.
Therapeuti
cEffect
s:Decr
easedinci
denceofr estenosisof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 12
cor
onar
yar
ter
iesandi
mpr
ovedmy
ocar
dial
per
fusi
on.

Av
ail
abi
l
ity
I
NJECTI
ON5ml
vial
(2mg/
ml)
.

Dose
IV:(
Adults):250mcg( 0.25mg)/kgbolus10–60mi npr
ior
toPCI,fol
lowedby0.125mcg/ kg/min(upt o10mcg/ min)
conti
nuousinfusi
onfor12hr ;
patient
swi thunstable
angi
nanotr espondi
ngt oconventi
onaltherapyandwho
areplannedtoundergoPCIwithin24hour s—250mcg
(0.
25mg) /kgbolusfol
lowedby10mcg/ mincontinuous
i
nfusionfor18–24hr,ending1hraf t
erPCI .

CONTRAINDICATI
ONSAND
PRECAUTIONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oabci
xi
mabor
mur ine(mouse)pr otei
n;Act i
vei nternalbleeding;Recent
signifi
cantGIorGUbl eeding( within6wk) ;HistoryofCVA
(within2yr)orCVAwi thneur ologicsequel ae;Histor
yof
bleedingdisorder;
Recent( wit
hin7day s)or al
anticoagulantther
apy( PT≥1. 2t imescont r
ol)
; Pl
atel
et
count<100, 000cells/mm3; Recentt raumaormaj or
surgery(within6wk) ;Int
racranial neoplasm; Aneurysm or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 13
AVmal f
ormation;Sever
euncontrol
ledhyper
tensi
on;
Hi
storyofvasculi
ti
s;Concurr
entuseofanotherparenter
al
GPIIb/I
II
ainhi
bitor
;Recentorconcurr
entdextr
antherapy.

UseCaut
iousl
yin:
Pat
ient
swei
ghi
ng<75kgor>65y
r
(i
ncreasedr i
skofbleeding);Hist
oryofprevi
ousGI
pathol
ogy ;Concur
rentthr ombolyt
icorhepari
ntherapy
;PCI
wit
hin12hrofonsetofMIsy mptomsorPCIpr ocedur
e
l
asting>70mi n;OB: Lactati
on:Pedi:
Safetynot
establ
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: abnor malthinking, dizzi
ness,headache.CV:
hypotension,atri
al f
ibril
lation/fl
utt
er,br
adycardia,
compl et
eAVbl ock,supr av entri
cul
artachycar
dia,vascul
ar
disorder
,chestpai n,per i
pher aledema.Hemat :BLEEDING,
thrombocy topenia.Mi sc: all
ergi
creacti
onsincludi
ng
anaphy l
axis.

PATI
ENTTEACHI
NG
Explai
nt hepurposeofthemedicationtopat i
entand
family
.Instructpat
ientt
orepor
thy persensit
ivi
ty
reacti
ons( r
ash,dyspnea)
,bl
eeding,orbruisi
ng.

Expl
ainneedforbedr
est,
legimmobi
l
izati
on,and
mini
mal handl
i
ngduringt
herapyt
oavoidinj
ury.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 14
St
orage
St
orebet
ween2-
8⁰C,
donotf
reeze.

Abel
cet
I
NDI
CATI
ONS
IV:Tr
eat mentofpr ogr essiv e,potenti
allyfatalfungal
i
nfecti
ons.Thechol est erylsulfate,l
ipidcompl ex, and
l
iposomef ormul at
ionsshoul dbeconsi deredforpat ients
whoar eintoler
ant(e. g.,renal dysfunction)orrefractor yt
o
amphot eri
cinBdexy chol ate.Amphot eri
cinBl i
posome:
Managementofsuspect edf ungalinfecti
onsi nfebr i
le
neutr
openicpat i
ents: Tr eatmentofv iscerallei
shmani asi
s,
Treat
mentofcr ypt
ococcal meni ngiti
si nHIVpat ients.

ACTI
ON
Bindst of ungal cel
lmembr ane, all
owingl eakageof
cell
ularcont ents.Toxicity(especi all
yacut einfusi
on
react
ionsandnephr otoxicity)islesswi t
hl ipi
d
formul ati
ons.Ther apeut i
cEf fects:Canbef ungist
aticor
fungi
ci dal (
dependsonconcent rati
onachi evedand
suscept ibil
it
yofor ganism) .Spect rum:Act iveagainst:
Asper gill
osis,Blast
omy cosis,Candi di
asis,
Coccidi oidomy cosi
s,Cr yptococcosi s,Hi
st oplasmosis,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 15
Lei
shmaniasi
s(l
i
posomal
for
mul
ati
ononl
y),
Mucormycosi
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hyper
sensi
ti
vi
ty;
Lact
ati
on:
Pot
ent
ial
fordist
ri
buti
onintobr
eastmi
l
kandt
oxi
cit
yini
nfant
;
discont
inuenur
sing.

UseCaut
iousl
yin:Renali
mpai
rmentorel
ect
rol
yte
abnor
mali
ti
es;
Pat
ient
srecei
vi
ngconcurr
entleukocy
te
tr
ansf
usi
ons(↑ri
skofpulmonar
ytoxi
cit
y);
OB: Hasbeen
usedsaf
ely
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: anxiety,conf usion, headache, insomni a.Resp:
dyspnea, hypoxi a,wheezi ng.CV: chestpain, hy potensi
on,
tachycardia,edema, hyper tension.GI :di
arrhea,
hyperbil
irubinemi a,↑l iverenzy mes, nausea, vomi ti
ng,
abdomi nal pain.GU: nephr otoxicity,hematur i
a.FandE:
hyperglycemi a,hy pocal cemi a,hy pokalemia,
hypomagnesemi a.Hemat : anemi a,leukopeni a,
thrombocy topeni a.Der m: pruri
tis,rashes.Local :phl
ebit
is.
MS: art
hr al
gia, my algia.Mi sc: HYPERSENSI TIVITY
REACTI ONS, chill
s,fev er,acutei nfusionreact ions.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 16
Drug-Drug: ↑r iskofnephr otoxici
ty,br onchospasm, and
hypotensionwi thant i
neoplastics.Concur rentusewi th
corti
costeroids↑ r iskofhy pokalemi a.Concur rentuse
withzidovudinemay↑ t her i
skofmy elotoxicit
yand
nephrotoxicit
y .Concur r
entusewi t
hf lucyt osine↑
anti
fungal activitybutmay↑ t heriskoft oxicit
yfrom
fl
ucy t
osine.Combi nedusewi t
hazol eant ifungalsmay
i
nducef ungal r esistance.↑ riskofnephr otoxici
tywith
othernephr otoxicagent ssuchasami nogl ycosides,
cyclospori
ne, ort acrolimus.Hy pokal emi af r
om
amphot eri
cin↑ t her iskofdigoxint oxicity.Hy pokal
emia
mayenhancet hecur ari
for
m ef fectsofneur omuscular
bl
ocki ngagent s.

DOSAGE
Speci
fi
cdosageanddur
ati
onoft
her
apydependonnat
ure
ofi
nfect
ionbei
ngtr
eat
ed

Amphot
eri
cinDeoxy
chol
ate
I
V: (Adults):Givet
estdoseof1mg.I ftestdoset ol
erated,
i
nit
iatether apywit
h0.25mg/ kg/day(dosesupt o1.5
mg/ kg/daymaybeused, dependingont ypeofinfecti
on)
(al
ternate-daydosi
ngmayal sobeused) ;Bl
adder
i
rri
gation—I nst
il
l50mcg/mLsol utionintobladderdailyfor
5–10day s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 17
I
V: (Inf
antsandChildren)
:Gi
vetestdoseof0. 1mg/ kg
(maxi mum dose1mg)ormayadmi ni
steri
nit
ialdoseof
0.25–1mg/ kg/dayov er6hr(
withouttestdose)(some
i
nf ecti
onsmayr equir
e1.5mg/kg/day;alt
ernate-
day
dosingmaybeused) .
IT(
Adults):25–300mcgq48–72hr,↑to500mcg–1mg
astol
erated(maximum t
otal
dose=15mg)
.
I
T( Chi
ldr
en)
:25–100mcgq48–72hr
;↑t
o500mcgas
t
olerat
ed.

Amphot
eri
cinBChol
est
ery
lSul
fat
e(Amphot
ec)
I
V: (
Adul
tsandChi
l
dren)
:3–4mg/
kgq24hr(
not
estdose
needed)
.

Amphot
eri
cinBLi
pidCompl
ex(
Abel
cet
)
I
V: (
Adul
tsandChi
l
dren)
:2.
5–5mg/
kgq24hr(
not
est
doseneeded)
.

Amphot
eri
cinBLi
posome(
AmBi
some)
I
V: (Adul
tsandChi ldren):Empiricther
apy—3mg/ kgq24
hr;Document edinfections—3–5mg/ kgq24hr;Visceral
l
eishmaniasis( i
mmunocompet entpati
ents)
—3mg/ kgq
24hronday s1–5, then3mg/ kgq24hronday s14and
21;Visceral
leishmani asis(i
mmunosuppr essed
pati
ents)—4mg/ kgq24hronday s1–5, t
hen4mg/ kgq

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 18
24hrondays10,
17,
24,31,
and38;Cr
ypt
ococcal
meni
ngit
isi
nHIVpat
ient
s—6mg/kgq24hr.

AVAI
LABI
LITY
Amphot
eri
cinDeoxy
chol
ate
Powderf
ori
nject
ion50mg/
vial
;

Amphot
eri
cinBChol
est
ery
lSul
fat
e
Powderf
ori
nject
ion50mg/
vial
,100mg/
vial
;

Amphot
eri
cinBLi
pidCompl
ex
Suspensi
onf
ori
nject
ion5mg/
mL;

Amphot
eri
cinBLi
posome
Powderf
ori
nject
ion50mg/
vial
;

PATI
ENTTEACHI
NG
Expl
ainneedf
orl
ongdur
ati
onofI
Vort
opi
cal
ther
apy
.

IV:Inf
orm pati
entofpotenti
alsideeff
ectsand
discomfortatI
Vsite.Advisepatientt
onoti
fyheal
th
careprofessi
onali
fsideef f
ectsoccur.

HomeCar eIssue:I
nstr
uctfamil
yorcaregi
veron
dil
uti
on,
rate,andadminist
rat
ionofdr
ugandpr oper
careofI
Vequi pment.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 19
Abenol
I
NDI
CATI
ONS
PO:RectTr
eatmentof:Mildpai
n,Fev
er.I
V:Tr
eat
mentof
:
Mil
dtomoderatepain,Moderat
etosever
epainwi
th
opi
oidanal
gesi
cs,Fever.

ACTI
ON
Inhibit
sthesynthesisofprostaglandinsthatmayserveas
medi atorsofpainandfever,pri
mar i
lyintheCNS.Hasno
signifi
cantanti
-i
nfl
ammat orypr operti
esorGItoxi
cit
y.
Ther apeuti
cEffect
s:Analgesia.Antipyr
esis.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Pr
evi
oushy
per
sensi
ti
vi
ty;
Product
s
cont ai
ningal
cohol,aspart
ame,sacchari
n,sugar,or
tart
razine(FDCy el
l
owdy e#5)shouldbeav oidedin
patientswhohav ehypersensi
ti
vi
tyorint
olerancetothese
compounds; Sev
erehepaticimpai
rment/acti
veli
v er
disease.

UseCaut
iousl
yin:
Hepat
icdi
sease/
renal
disease(
lower
chr
onicdosesrecommended);
Alcohol
i
sm, chroni
c
malnut
ri
ti
on,severehy
povol
emiaorsever
er enal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 20
i
mpai r
ment( CCr<30mL/ mi n,↑ dosinginter
val and↓
dail
ydosemaybenecessar y )
;Chronicalcoholuse/abuse;
Malnutr
iti
on;OB:Useinpr egnancyonl yi
fclearl
yneeded
(f
orIV);Lact
ati
on:Usecaut iousl
y(forIV);Pedi
: Chil
dren<2
yr(saf
etyandeffect
ivenessnotest abli
shed)(forIV).

I
NTERACTI
ONS
Drug-Drug: Chroni chi gh-doseacet aminophen( >2g/ day)
may↑ r iskofbl eedi ngwi thwar f
arin(INRshoul dnot
exceed4) .Hepat otoxicityisaddi ti
v ewithot her
hepatotoxi csubst ances, includingal cohol.Concur rentuse
ofisoniazid, ri
fampi n, r
if
abut in,pheny t
oin, bar bit
ur ates,
andcar bamazepi nemay↑ t her i
skofacet ami nophen-
i
nducedl iverdamage( li
mi tself-medicat i
on) ;theseagent s
wil
l al
so↓ t herapeut icef f
ect sofacet ami nophen.
Concur rentuseofNSAI Dsmay↑ t heriskofadv erser enal
eff
ect s(av oidchr oni cconcur rentuse).Pr opr anol ol↓
met abolism andmay↑ ef fects.May↓ ef f ectsof
l
amot r
igineandzi dov udine.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: agit
ation(↑inchil
dren)(I
V),anxiety(I
V),headache
(I
V),fati
gue( I
V),
insomnia(I
V).Resp: atel
ectasi
s(↑i n
chil
dren)(IV),
dyspnea(I
V).CV:hypertension(IV),
hypotension(IV)
.GI:HEPATOTOXICI TY( ↑ DOSES) ,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 21
constipati
on(↑i nchil
dren)(I
V),↑li
v erenzymes,nausea
(IV)
,vomi ti
ng(I
V).FandE: hypokal
emi a(IV)
.GU:renal
fail
ure(highdoses/chr
onicuse).Hemat :neut
ropeni
a,
pancytopenia.MS:muscl espasms(IV),tr
ismus(IV).Der
m:
rash,urti
cari
a.

DOSAGE
Chil
dren≤12yrshoul
dnotrecei
ve>5POorr ect
al
doses/24hrwit
houtnot
if
yingphysi
cianorot
herheal
th
careprof
essi
onal
PO:(
Adul
tsandChi
ldren>12yr):
325–650mgq4–6hror
1g3–4ti
mesdail
yor1300mgq8hr( nott
oexceed4gor
2.
5g/24hri
npati
entswithhepati
c/r
enali
mpai
rment)
.
PO:(Chi
l
dr en1–12y r
):10–15mg/kg/doseq4–6hras
needed(nottoexceed5doses/24hr)
.
PO:(I
nfant
s):10–15mg/kg/
doseq4–6hrasneeded(
not
toexceed5doses/24hr
).
PO:
(Neonat
es)
:10–15mg/
kg/
doseq6–8hrasneeded.
I
V:(Adul
tsandChil
dren≥13yrand≥50kg):1000mgq6
hror650mgq4hr( nottoexceed4g/dayorlesst
han4
hrdosi
ngint
erv
al)
.
I
V:(Adul
tsandChil
dren≥13yrand<50kg)
:15mg/ kgq6
hror12.
5mg/ kgq4hr(nott
oexceed75mg/ kg/
dayor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 22
l
esst
han4hrdosi
ngi
nter
val
).
I
V: (
Chil
dren2–12yr)
:15mg/ kgq6hror12.
5mg/kgq4
hr(nottoexceed75mg/kg/
dayorlesst
han4hrdosi
ng
i
nterval
).
Rect(
Adult
sandChi
ldr
en>12y r
):325–650mgq4–6hr
asneededor1g3–4ti
mes/day(nottoexceed4g/
24hr
).
Rect(Chi
ldr
en1–12y
r):
10–20mg/
kg/
doseq4–6hras
needed.
Rect(
Inf
ant
s):
10–20mg/
kg/
doseq4–6hrasneeded.
Rect(
Neonat
es)
:10–15mg/
kg/
doseq6–8hrasneeded.

AVAI
LABI
LITY
Chewabletablets(fruit
,bubblegum, orgrapeflavor)80
mgOTC, 160mgOTC; Tablet
s160mgOTC, 325mgOTC,
500mgOTC, 650mgOTC; Caplets325mgOTC, 500
mgOTC; Soluti
on( berry,f
rui
t,andgr apef l
avor
)100
mg/ mLOTC; Li
quid( mint)160mg/ 5mLOTC, 500mg/ 15
mLOTC; El
ixir(gr
apeandcher ryflav or)160mg/ 5mLOTC;
Drops100mg/mLOTC; Suspensi on100mg/ mLOTC, 160
mg/ 5mLOTC; Sy r
up160mg/ 5mLOTC; Supposit
ories80
mgOTC, 120mgOTC, 325mgOTC, 650mgOTC; Soluti
on
fori
ntr
avenousi nfusion1000mg/ 100mLi n100- mLv ial
s;
I
ncombi nati
onwi th: manyothermedi cati
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 23
PATI
ENTTEACHI
NG
Adv i
sepat i
enttotakemedi cati
onexact l
yasdi rect
ed
andnott ot
akemor ethantherecommendedamount .
Chronicexcessiveuseof>4g/ day(2gi nchr onic
alcoholi
cs)mayl eadtohepat otoxi
city
,renal or
cardiacdamage.Adul tsshouldnott ake
acetaminophenl ongerthan10day sandchi l
dr ennot
l
ongert han5day sunl essdir
ectedbyheal thcar e
professi
onal.Short-t
erm dosesofacet ami nophen
withsalicyl
atesorNSAI Dsshoul dnotexceedt he
recommendeddai lydoseofei t
herdrugal one.

Advisepat i
entt oavoidalcohol(3ormoregl
assesper
dayincreaset heriskofliverdamage)i
ftaki
ngmor e
thananoccasi onal1–2dosesandt oavoidtaki
ng
concurrentl
ywi thsali
cy l
atesorNSAIDsformorethan
afewday s,unlessdirect
edbyheal t
hcare
professi
onal .

Pedi:Adv i
separ entsorcaregiverstocheck
concent r
ationsofliquidpreparati
ons.Errorshav
e
resul
tedi nseriousliverdamage.Hav eparent
sor
caregi
v ersdeterminet hecorrectformulati
onand
dosef ortheirchil
d( basedont hechild'
sage/weight
),
anddemonst ratehowt omeasur eitusi
ngan
appropriatemeasur ingdevice.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 24
 Inf
orm pat
ientswit
hdi abet
esthatacetaminophen
mayalterresul
tsofbloodglucosemoni t
ori
ng.Advise
pati
enttonotif
yhealt
hcar eprof
essionali
fchanges
arenoted.

Cautionpat
ienttochecklabel
sonall
OTCpr oduct
s.
Advisepati
entstoavoidtaki
ngmorethanoneproduct
containi
ngacetaminophenatati
metoprevent
toxi
city.

Adv i
sepatienttoconsul
thealt
hcareprof
essional
if
discomfortorf ev
eri
snotreli
evedbyrout
inedosesof
thisdrugoriffeveri
sgreat
erthan39.
5°C( 103°
F)or
l
ast sl
ongert han3days.

Abi
l
ify
I
NDI
CATI
ONS
Schizophreni
a.Acuteandmai ntenancet herapyofmani c
andmi xedepisodesassoci atedwi thbipol ardi
sorder(as
monot herapyorwithli
thium orv alproate).Adjuncti
ve
tr
eatmentofdepr essi
oni nadul ts.Agitati
onassoci ated
withschizophreni
aorbi polardisorder.Irri
tabil
i
ty
associatedwithauti
sti
cdi sorderinchi l
dr en.

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 25
Psy chotropicactivi
tymaybeduet oagoni stacti
vi
tyat
dopami neD2andser otoni
n5-HT1Ar eceptorsand
antagoni stactivi
tyatthe5-HT2Ar eceptor.Alsohas
alpha1adr energi
cblockingactivi
ty.Therapeuti
cEffects:
Decr easedmani f
estati
onsofschi zophrenia.Decr
eased
mani ainbi polarpati
ents.Decreasedsy mpt omsof
depr ession.Decreasedagitati
onassoci atedwith
schizophr eniaorbipolardi
sorder.Decreasedemot ional
andbehav ioralsymptomsofi rri
tabil
it
y.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Lact
ati
on:
Presumedtobeexcr
etedi
nbr
eastmi
l
k;di
scont
inuedr
ug
orbott
lef
eed.

UseCaut
iousl
yin:
Knowncar
diov
ascul
aror
cerebr ov asculardisease; Condi ti
onswhi chcause
hypot ensi on( dehydrati
on, treatmentwi th
antihyper tensivesordi uretics);Diabet es( may↑ riskof
hypergl ycemi a);Seizuredisor ders; Pat i
entsatri
skf or
aspirationpneumoni a;Concur r
entket oconazoleorother
potent ial CYP3A4i nhibit
or s( ↓ aripiprazoledoseby50%) ;
Concur rentqui ni
dine,fl
uoxet i
ne,par oxetine,orot
her
potent ial CYP2D6i nhibit
or s;Concur rentcarbamazepineor
otherpot ent i
alCYP3A4i nducer s;OB: Neonatesat↑ r i
sk
forext rapy ramidalsy mptomsandwi thdrawalaft
er

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 26
deli
v erywhenexposeddur i
ngthe3rdt ri
mest er;
useonlyif
mat ernal benefi
tout wei ghsrisktofetus;Pedi:May↑ r i
sk
ofsui cideat t
empt /
ideat ionespecial
lydur i
ngdoseear ly
tr
eat mentordoseadj ust ment;ri
skmaybegr eateri
n
chi
ldr en, adol
escent s,andy oungadul tstaking
antidepr essants(saf eusei nchil
dren/adolescent snot
establ i
shed) ;
Geri
: ↑r iskofmor tal
it
yinel derl
ypat i
ent
s
tr
eat edf ordement ia-relatedpsychosis.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SUI CIDALTHOUGHTS, dr owsi ness,
extrapy rami dal reactions, akat hi sia, conf usion,
depr ession, f
atigue, host il
i
ty ,insomni a,
l
ightheadedness, mani cr eact ions, impai redcogni ti
ve
funct i
on, ner vousness, restlessness, seizures, tardi
ve
dyski nesia.Resp: dy spnea.CV: brady cardia, chest
pain, edema, hy pertensi on, orthost atichy pot ension,
tachy cardia.EENT: blurredv i
si on, conj unct i
v i
tis,ear
pain.GI :const i
pat i
on, anor exia, ↑ sal ivation, nausea,
vomi ting, weightl oss.GU: urinar yi ncont inence.
Hemat :ADi bucaine9TOSI S, anemi a, l
eukopeni a,
neutr openi a.Der m: dryski n, ecchy mosi s, skinul cer
,
sweat i
ng.MS: muscl ecr amps, neckpai n.Met ab:
hyper glycemi a.Neur o: abnor mal gai t,t
remor .Mi sc:
NEUROLEPTI CMALI GNANTSYNDROME

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 27
 DOSAGE
Ifusedconcurrent
lywit
hcombinati
onofstrong,
moder at
e,orweakCYP3A4andCYP2D6i nhibit
ors,
↓ aripi
prazol
edoseby75%.Ar i
pipr
azol
edose
shouldbe↓ by75%i nCYP2D6PMswhoar e
concomitantl
yreceiv
ingastr
ongCYP3A4i nhibi
tor.

Schi
zophr
eni
a
PO:(Adul
ts)
:10or15mgdai l
y;dosesupto30
mg/dayhavebeenused;i
ncr
ementsindosing
shoul
dnotbemadebef or
e2wkatagi vendose.

PO:(Chi
ldren13–17yr)
:2mgdai l
y;↑t o5mgdai
ly
af
ter2day s,andt
hentotargetdoseof10mgdail
y
af
teranother2days;mayfurther↑ dosein5-
mg
i
ncrementsifneeded(max:30mg/ day).

Acut
eManicorMixedEpi
sodesAssoci
atedwi
th
Bi
polarIDi
sor
der
PO:
(Adul
ts):15mgdai l
yasmonot herapyor10–15
mgdai
lywit
hlit
hium orval
proate;tar
getdoseis15
mgdai
ly;
may↑ t o30mgdai l
y,ifneeded.

PO:(Chi
ldren10–17yr)
:2mgdai l
y;↑t o5mgdai
l
y
af
ter2day s,andt
hentotargetdoseof10mgdail
y
af
teranother2days;
mayf urther↑ dosei
n5-
mg

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 28
 i
ncr
ement
sifneeded(
max:
30mg/
day
).

Mai
ntenanceTr
eat
mentofBi
pol
arIDi
sor
der

PO:(
Adul
ts):Conti
nuesamedoseneededt
o
st
abi
li
zepat
ientduri
ngacut
etr
eatment.

PO:(Chi
l
dren10–17yr
):Conti
nuesamedose
neededt
ostabi
li
zepat
ientdur
ingacut
etr
eat
ment
.

Depr
essi
on
PO:
(Adul
ts)
:2–5mgdai
l
y,mayt
it
rat
eupwar
dat1-
wk
i
nter
val
sto5–10mgdai
l
y;nott
oexceed15mg/
day
.

Agi
tati
onAssoci
atedwi
thSchi
zophr
eni
aorBi
pol
ar
Di
sorder
I
M: (Adul
ts)
:9.
75mg/ day,
mayuseadoseof5. 25
mgbasedonclini
calsi
tuat
ion.Maygi
veaddit
ional
dosesuptoacumulati
vedoseof30mg/ day
,if
needed.

I
rr
it
abi
l
ityAssoci
atedwi
thAut
ist
icDi
sor
der
PO:(Chi
l
dren6–17yr)
:2mgdaily
; ↑t o5mgdail
y
af
teratl
east1wk;mayfurt
her↑ dosein5–mg
i
ncrementsi
fneededat≥1–wki
nterval
s(max:
15
mg/day)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 29
AVAI
LABI
LITY
Tablets2mg, 5mg, 10mg, 15mg,20mg, 30mg.Orall
y
di
sintegr
ati
ngtabl
ets(vanil
l
af l
avor
)10mg, 15mg.Oral
sol
ut i
on(
orangecream fl
avor)1mg/ mL;
Inject
ion9.
75
mg/ 1.
3mLsi ngl
e-dosevial
s;

PATI
ENTTEACHI
NG
Advisepati
enttotakemedi
cat
ionasdir
ectedandnot
toskipdosesordoubleuponmisseddoses.Take
misseddosesassoonasr ememberedunlessal
most
ti
mef orthenextdose.

Infor
m pat i
entofpossibi
l
ityofextrapyramidal
sympt omsandt ardiv
edyskinesia.Inst
ructpat
ientt
o
reportthesesympt omsimmedi atel
y .

Advi
sepati
entt
omakeposit
ionchangessl
owl
yto
mini
mizeort
host
ati
chy
potensi
on.

Medi cat
ionmaycausedr owsinessand
l
ightheadedness.Cauti
onpati
enttoavoiddriv
ingor
otheractiv
iti
esrequi
ri
ngaler
tnessunti
lresponseto
medi cat
ionisknown.

Advi
sepati
entandfamil
ytonoti
fyheal
thcare
pr
ofessi
onali
fthought
saboutsui
cideordyi
ng,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 30
 att
empt stocommi tsuici
de; neworwor sedepr essi
on;
neworwor seanxiety;
feeli
ngv eryagit
atedorr estl
ess;
panicatt
acks;troublesleeping; neworwor se
i
rri
tabi
li
ty;acti
ngaggr essiv
e; bei ngangryorviolent;
acti
ngondanger ousimpulses; anextr
emei ncreasei n
acti
vit
yandt al
king;otherunusual changesinbehav ior
ormoodoccur .

Instr
uctpatienttonotifyhealt
hcareprofessionalof
allRxorOTCmedi cat
ions,vi
tamins,orherbal
productsbeingtaken, toavoidal
cohol,andtoconsul t
healthcareprofessionalbeforet
akinganynew
medi cat
ions.Cautionpatienttoavoidtaki
ngal cohol
orotherCNSdepr essantsconcurrentl
ywiththis
medi cat
ion.

Advi
sepati
entthatextr
emesintemper
atur
eshoul
d
beavoi
ded,becausethi
sdrugimpai
rsbody
temper
atur
eregulat
ion.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Emphasizetheimportanceofr
outi
nef
oll
ow-upexams
andcontinuedpar
ti
cipati
oninpsy
chot
herapyas
i
ndicat
ed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 31
Abi
rat
erone
I
NDI
CATI
ONS
Withpredni
soneinthetr
eatmentofmetast
ati
ccast r
ati
on-
resi
stantpr
ostat
ecancerinpat
ient
swhohav edisease
progr
essiondespi
techemother
apywhichhasincluded
docetaxel
.

ACTI
ON
Inhibi
tstheenzy me17α- hydroxyl
ase/C17,20–lyase,whi
ch
i
sr equiredforandrogenproduct i
on.Mayal soresulti
n
i
ncr easedmi neral
ocort
ocoidpr oduct
ion.Therapeutic
Effects:Decreasedandrogenpr oducti
onwi thdecreased
spreadofandr ogen-sensit
iveprostat
ecancer .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Sev
erehepat
ici
mpai
rment(
Chi
l
d-
PughClassC)
;OB:Pregnancyorpotent
ial
tobecome
pr
egnant(maycausefet
alharm);OB:Lact
ati
on.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease(
saf
etynot
establi
shedifLVEF<50%orNYHACl assIIIorIVheart
fai
lure;El
ectr
oly
teabnor
mali
tiesorhyper
tension
(corr
ect/t
reatpri
ort
oini
ti
ati
on);Pr
e-exi
sti
ngliverdi
sease

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 32
(dosemodi ficati
onrequi
redforChild-
PughCl assB)
;
Stress,i
nfection,t
rauma,acutediseaseprocess(may
resulti
nadr enocorti
cali
nsuff
ici
encyr equi
ri
ngaddit
ional
corti
costeroids).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Not
edf
orcombi
nat
iont
reat
mentwi
thpr
edni
sone
Resp:cough.CV:arrhy t
hmi a,edema, hypert
ension.GI:
HEPATOXI CITY,
diarrhea,dy spepsia.Derm:hotflush.
Endo:adrenocor
ti
cal insuff
iciency(duet oconcurrent
predni
sone).FandE: hy pokalemia.GU: noctur
ia,uri
nary
fr
equency.MS: j
ointpain/discomf ort.

I
NTERACTI
ONS
Drug- Drug: Actsasani nhibit
oroft heCYP2D6enzy me
system; avoidconcur r
entusewi thagent st hatare
subst ratesofCYP2D6, especi allythosewi thnarrow
therapeut i
ci ndices,includingt hiori
dazi neand
dext romet horphan;ifconcur rentusei snecessar y,dosage
reduct i
onofsubst ratemayber equired.Abi rater
onei sa
subst rateoft heCYP3A4enzy mesy st
em.Concur r
entuse
ofst ronginhi bi
torsincludingat azanav i
r ,
clarit
hromy ci
n,
i
ndi nav i
r,i
traconazol e,ketoconazol e,nefazodone,
nelfinavir,
r i
tonavir
,telit
hromy ci n,andv oriconazole,or
strongi nducer sincludingcar bamazepi ne, phenobar bi
tal
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 33
phenyt
oin,
rif
abut
in,
rif
apent
ine,
orri
fampi
nshoul
dbe
avoi
dedorundert
akenwithcaut
ion.

DOSAGE
PO:(Adul
ts)
:1000mgoncedai
lyusedi
ncombi
nat
ion
wit
h5mgpr edni
sonet
wicedai
l
y.
Hepat
icI
mpai
rment
PO:
(Adul
ts):Chi
l
d-PughClassB—250mgoncedai
l
ywi
th
5mgpredni
sonetwicedai
l
y .

AVAI
LABI
LITY
Tabl
ets250mg;

PATI
ENT TEACHI
NG
Instructpatienttot akemedi cationasdi rectedand
nott ostopabi rateroneorpr ednisonewi thout
consul t
ingheal thcar eprofessional.Ifadosei s
mi ssed,taket hefollowingday .Ifmor et han1doseis
mi ssed,consul thealthcarepr ofessional.Donot
shar emedi cationwi thothers,eveni ftheyhavethe
samesy mpt oms; maybedanger ous.

Instr
uctpat
ientt
onotifyheal
thcar
eprofessional
of
allRxorOTCmedi cat
ions,vi
tami
ns,orherbal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 34
 pr
oductsbei
ngt
akenandtoconsul
twithheal
thcar
e
pr
ofessi
onal
bef
oretaki
ngot
hermedicati
ons.

Advi
sepat
ienttonoti
fyhealt
hcar
eprof
essionalof
si
deeff
ect
st hatar
ebothersomeorper
sist
ent.

Advisefemal epati
enttouseef f
ect i
vecontracepti
on
duri
ngt herapyandfor1wkaf t
ertherapyandt onot i
fy
heal
t hcareprofessi
onal i
mmedi atel
yofpregnancyi s
suspectedori fbr
eastfeeding.Mal epati
entsshoul d
useacondom andanot herform ofcontraception
duri
ngsexwi thawomenofchi l
d-beari
ngpot enti
al
duri
ngandf or1wkaf tertherapy.Pregnantwomen
shouldnott ouchthetabletswithoutwear i
nggl oves.

Expl
ainneedforcont
inuedfol
low-upexamsandl
ab
test
stoassesspossi
blesideeff
ects.

Abobot
uli
numt
oxi
nA
I
NDI
CATI
ONS
Treatmentofcervical
dystoni
ainadult
sinordert
o
decreaseseveri
tyofabnormalheadposit
ionandneck
pain.Temporaryimprovementofmoderatetosever
e
gl
abellar(
frown)li
nesinadultpat
ient
s<65y r
.

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 35
Inhi
bi t
sr el
easeofacetylchol
inefrom peri
pheral
cholinergicnerv
eendings, r
esult
ingchemi cal
denervati
on
oftreatedmuscl e.Therapeuti
cEf f
ects:Local
ized
reductionofmuscl eactivi
ty,
withdecreasedspastici
tyin
cervicaldystoni
a.Decreasedappear anceofglabell
arl
ines.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hyper
sensi
ti
vi
tyt
obot
uli
num t
oxi
n
pr
oductsoraddit
ives;
Al l
ergyt
ocow'
s-
mil
kpr
otei
n;
I
nfect
ionati
nject
ionsite.

UseCaut
iousl
yin:
Prev
ioussur
gical
faci
alal
ter
ati
ons,
mar kedf acialasymmet ry,knownweakness/ at
rophyof
muscl einquest ion,inf
lammat i
onorski nabnor mali
tyat
i
nject i
onsi t
e,ptosis;Peri
pheral mot orneuropathi
c
disorders( mayexacer bateclinicaleffectsand↑ therisk
ofsev eredy sphagiaandr espiratorycompr omise);
Hy perhydrosis(safetynotestabl i
shed) ;Geri
:Use
cautiously;considerconcur r
entdi seasesanddr ugtherapy.
OB: Useonl yifpot enti
albenefitjustif
iespotenti
alri
skto
thef et
us.Pedi :Safetyandef fectivenesshasnotbeen
established.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Cer
vical
dsy
toni
a

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 36
CNS:fati
gue,headache.EENT:dy sphonia,ey
edisor
der
.GI
:
drymouth,dysphagi
a.Local:
injectionsit
epain.MS:
muscularweakness,neckpain.Mi sc:SPREADOFTOXIN
EFFECT.

Gl
abel
l
arl
i
nes
CNS: headache.EENT:nasophar y
ngiti
s,eyel
i
dedema,
ey
el i
dptosis,si
nusit
us.Resp:nasopharyngit
is,dyspnea.
GI
: nausea,dysphagi
a.Local:
injecti
onsitepain/r
eaction.
Misc:SPREADOFTOXI NEFFECT.

I
NTERACTI
ONS
Drug-Drug:Concurr
entuseofaminogl y
cosi desorother
agentsinter
feri
ngwithneuromusculartransmission
i
ncludingcurare-
li
keagentsormuscl erelaxantsmay↑
eff
ect.Concurrentuseofanti
chol
inergics↑ sy st
emi c
anti
choliner
giceff
ects.

DOSAGE
Cer
vical
dyst
oni
a
I
M: (Adul
ts)
:500Unitsasadivi
deddoseamongaf fect
ed
muscles;
mayber epeat
edevery12–16wk,basedon
r
eturnofsymptoms(range250and1000Units).
I
ncrementsmaybemadei n250Unitstepsaccordi
ngto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 37
r
esponse.

Gl
abel
l
arl
i
nes
I
M: (
Adul
ts<65y
r):
50Uni t
s,di
videdi
nfi
veequal
ali
quot
s
of10Uni
ts;
mayber epeat
edevery3mo.

AVAI
LABI
LITY
Fr
eezedri
edpowderf
orr
econst
it
uti
on500Uni
t/v
ial
,300
Uni
t/v
ial
;

PATI
ENTTEACHI
NG
I
nform pat
ientofpur
poseofabotul
i
numtoxi
nAAdv
ise
pati
enttoreadPati
entMedi
cati
onGuidepri
ort
o
tr
eatment.

Inform pat i
entthatef f
ectsofabot ulinumt oxinAmay
spreadbey ondt hesiteoflocalinjection.Adv ise
patientt onotifyhealthcareprofessi onal i
mmedi atel
y
i
fpr oblemsswal lowing,speaking, orbr eathi
ngoccur
orifsignsandsy mptomsofspr ead( astheni
a,
gener al
izedmuscl eweakness, diplopi a,bl
urredvisi
on,
ptosis,dy sphagia,dysart
hria,
ur i
nar yincont i
nence,
breathingdi ff
icult
ies)occur.Mayoccurhr stowks
afterinjecti
on.

Maycausel
ossofst
rengt
h,muscl
eweakness,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 38
 bl
urredv i
sion,
ordr
oopingeyeli
ds.Caut
ionpat
ientt
o
avoi
ddr i
vingandotheract
ivi
ti
esrequi
ri
ngaler
tness
unti
lresponsetomedicati
onisknown.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Abr
axane
I
NDI
CATI
ONS
Pacli
taxel :
Adv ancedovari
ancancer( withci splat
in)
.Non-
small celll
ungcancerwhenpot enti
allycur ativesurgery
and/orr adiationtherapyi
snotanopt i
on.Met astati
c
breastcancerunr esponsi
vetoothert herapy .Node-
positi
v ebreastcancerwhenadmi nisteredsequent i
all
yto
standar dcombi nati
onchemotherapyt hatincludes
doxorubi ci
n.Tr eatmentofAIDS-r
elatedKaposi ’ssarcoma.
Pacli
taxel (albumi n-
bound):
Metastaticbr eastcanceraf t
er
tr
eatmentf ailureorrel
apsewheret herapyi ncludedan
anthracy cl
ine.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 39
ACTI
ON
I
nt er
fereswitht
henormal cel
lul
armicrot
ubulef
unct i
on
thatisrequir
edfori
nter
phaseandmi tosi
s.Therapeuti
c
Effects:Deat
hofrapi
dlyrepli
cat
ingcell
s,par
ti
cularl
y
mal i
gnantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont r
aindicatedi n:Hypersensiti
vi
t ytopacli
taxel
orto
castoroil(non- protei
n-boundv ehiclecontai
ns
polyoxyethy l
atedcast oroil
);Knownal coholi
ntol
erance;
OB: Lactation:Pr egnancyorlactation;ANC≤1500/ mm3i n
patient
swi thov ari
an,lung,orbreastcancer;ANC
≤1000/ mm3i npat ientswit
hAI DS- rel
atedKaposi’
s
sarcoma.
UseCaut i
ouslyin:Moderateorseverehepaticimpairment;
Geri:
↑r iskofneuropathy,myelosuppressi
on, and
cardi
ovascularevent
s; OB:Chil
dbeari
ngpotent ial
;Act
ive
i
nfecti
on; ↓ bonemar r
owr eserve;
Pedi:Safetyand
eff
ectiv
enessnotest abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:di
zzi
ness,headache,sei
zures.CV:ECGchanges,
edema,
hypotensi
on,bradycar
dia.GI:di
arr
hea,↑liver
enzy
mes,mucositi
s,nausea,vomiti
ng,pancr
eat
it
is.Derm:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 40
al
opeci a.Hemat :anemi a,neutr
openia,thrombocy t
openia.
MS: art
hr al
gia,my algi
a.GU: r
enal f
ail
ure.Neuro:peripher
al
neuropat hy.Resp:PULMONARYEMBOLI SM,PULMONARY
FIBROSI S,cough,dy spnea,i
ntersti
ti
alpneumoni a.Local:
i
njecti
onsi tereactions.Misc:hypersensiti
vi
tyreacti
ons
i
ncludinganaphy l
axisandst evens-j
ohnsonsy ndrome,
TOXICEPI DERMALNECROLYSI S.

I
NTERACTI
ONS
Drug- Dr ug: CYP3A4i nhi bi
torsi ncludingat azanav i
r,
clar i
thromy ci
n,indinav i
r,i
traconazol e, ketoconazole,
nef azodone, nelfi
navir,rit
onav ir,saquinav i
r,and
telithromy cinmay↑ l evelsandr iskoft oxici
ty;concurr
ent
useshoul dbeunder takenwi thcaut ion.CYP3A4i nducers
i
ncl udi ngcar bamazepi ne,ri
fampi n,andpheny toi
nmay↓
l
ev el sand↑ r i
skoft reatmentf ail
ure;concur rentuse
shoul dbeunder takenwi t
hcaut i
on.Gemf i
brozilmay↑
l
ev el sandr i
skoft oxicity;concur rentuseshoul dbe
under takenwi thcaut ion.↑ r i
skofmy elosuppr essi
onwi t
h
otherant ineoplasticsorr adiationt herapy .
My elosuppr ession↑ whengi v enaf tercisplat
in.May↑
l
ev el sandt oxi
cityofdoxor ubi
ci n.May↓ ant i
body
responset oand↑ r iskofadv erser eactionsf rom l
ive-
virusv accines.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 41
DOSAGE
Manyot
herr
egi
mensar
eused
Pacl
i
taxel

Ov
ari
anCancer
I
V: (Adul
ts)
:Prev
iousl
yuntreat
edpati
ents—175mg/ m2
over3hrevery3wk,or135mg/ m2ov er24hrevery3wk,
fol
lowedbycispl
ati
n;Pr
eviousl
ytr
eatedpati
ents—135
mg/ m2or175mg/ m2ov er3hrever
y3wk.
Br
eastCancer
IV:(
Adult
s) :Adj
uvanttreatmentofnode-posi
tiv
ebr east
cancer
—175mg/ m2ov er3hrev ery3wkf or4cour ses
admini
steredsequenti
allytodoxorubi
cin-
contai
ning
combinati
onchemot herapy;Fai
lureofi
niti
alt
herapyf or
metastat
icdiseaseorrelapsewithin6moofadj uvant
ther
apy—175mg/ m2ov er3hrev ery3wk.

Non-
Smal
lCel
lLungCancer
I
V:(Adult
s):135mg/
m2ov
er24hrev
ery3wk,
fol
l
owed
byci
splat
in.

AI
DS-
Rel
atedKaposi
’
sSar
coma
I
V:(
Adul
ts):135mg/m2ov
er3hrevery3wkor100
mg/
m2ov er3hrev
ery2wk(dose↓/adj
ust
mentmaybe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 42
necessar
yinpat
ient
swi
thadv
ancedHI
Vinf
ect
ion)
.
Pacl
i
taxel
Prot
ein-
BoundPar
ti
cles(
albumi
n-bound)
I
V:(
Adul
ts)
:260mg/
m2ov
er30mi
nev
ery3wk.

Hepat
icI
mpai
rment
IV:(
Adults):Moder at
ehepatici
mpai r
ment( ASTlevels
<10×ULNandbi li
rubi
nlevel
s1.26–2×ULN) —200mg/ m2
over30mi nev er
y3wk; Severehepati
cimpai r
ment( AST
l
evels<10×ULNandbi li
rubi
nlevels2.
01–5×ULN) —130
mg/ m2ov er30mi nevery3wk; dosemaybe↑ t o200
mg/ m2f orsubsequentcoursesbasedoni ndi
v i
dual
tol
erance;Severehepati
cimpairment(ASTl evel
s>10×
ULNorbi li
rubi
nlevels>5×ULN) —Avoiduse.

AVAI
LABI
LITY
Pacl
i
taxel
(gener
icav
ail
abl
e)
Sol
uti
onf
ori
nject
ion6mg/
mL;
Pacl
i
taxel
Prot
ein-
BoundPar
ti
cles(
albumi
n-bound)
Powderf
ori
nject
ion100mg/
vial
;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofpacl
i
taxel
topat
ient
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 43
Advi
sepat i
enttonot i
fyheal
thcareprofessi
onal
i
mmedi atelyofrash,dif
fi
cul
tybreat
hing,orsymptoms
ofhypersensit
ivi
tyreacti
onoccurs.

Instr
uctpat i
enttonot if
yheal thcar epr ofessional
prompt lyiffever;chil
ls;cough; hoarseness; sore
throat;signsofi nfect
ion; l
owerbackorsi depain;
painfulordi ffi
culturi
nation;bl eedinggums; bruising;
petechiae; bloodinstool s,urine,oremesi s;dyspnea;
oror t
host ati
chy potensionoccur s.Caut ionpat i
entt o
avoidcr owdsandper sonswi thknowni nfecti
ons.
Instr
uctpat i
enttousesof ttoot hbrushandel ectri
c
razorandt oav oi
df al
ls.Caut ionpat ientnott odr i
nk
alcoholicbev eragesort ot akemedi cationcont aining
aspiri
norNSAI Ds;maypr ecipitategast r
icbleeding.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Instr
uctpatienttonot if
yhealthcareprofessi
onali
f
abdomi nalpain,
y ell
owski n,weakness,parest
hesi
a,
gaitdist
urbances, orjointormuscleachesoccur.

Inst
ructpat
ienttoi
nspectoral
mucosaforredness
andulcerat
ion.I
fmouthsoresoccur
,advi
sepatientto
usespongebr ushandri
nsemouthwithwaterafter

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 44
 eat
inganddr
inki
ng.St
omat
it
isusual
l
yresol
vesi
n5–7
days.

Discusswi t
hpatientthepossibi
li
tyofhairl
oss.
Compl etehairl
ossusuallyoccursbetweendays14
and21andi sreversi
bleaft
erdiscont
inuati
onof
therapy.Expl
orecopingstrategi
es.

Advisepatienttouseanonhormonalmet hodof
contracepti
onandt oavoi
dbreast
feedi
ngdur i
ng
ther
apy .Advisemalepati
ent
snottofatherachil
d
whil
er ecei
v i
ngpacli
taxel
.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Abr
eva
I
NDI
CATI
ONS
Treatmentofr
ecur
rentor
al-
faci
alher
pessi
mpl
ex(
col
d
sores,f
everbl
i
ster
s).

ACTI
ON
Pr
event
sher
pessi
mpl
exv
irusf
rom ent
eri
ngcel
l
sby

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 45
preventi
ngvir
alpar t
icl
esfrom f
usi
ngwi t
hcel
lmembr anes.
Therapeuti
cEffects:Reducedheal
ingti
me.Decreased
durati
onofsympt oms( pain,
burni
ng,i
tchi
ng,
tingl
ing)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Contr
aindi
cat
edi
n:Hyper
sensi
ti
v i
tytodocosanolorany
ot
hercomponentsoft
hefor
mul at
ion(benzylal
cohol
,
miner
al oi
l
,pr
opy
lenegl
ycol
,orsucrose)
.
UseCaut i
ouslyi
n:Chi
ldr
en<12yr(saf
etynotest
abl
i
shed)
;
Pregnancy(useonlyi
fcl
ear
lyneeded)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Al
ll
ocal
react
ionsoccur
edatsi
teofappl
i
cat
ion
Local
:acne,
ski
n,i
tchi
ng,
rash.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topi
cal
:(Adul
tsandChi
ldr
en≥12yr
):Appl
ysmallamount
5ti
mesdailyt
osoresonli
psorf
aceunti
lheal
ed.

AVAI
LABI
LITY
Cr
eam 10%cr
eam i
n2gt
ubesOTC;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 46
PATI
ENTTEACHI
NG
I
nstructpati
entoncor rectt
echniqueforapplicati
onof
docosanol.Cream shouldonlybeappliedtolipsand
face.Avoi
dappl icat
ioninorneareyes.Emphasi ze
handwashingf oll
owingappli
cati
on,ortouching
l
esionstoprev entspreadtoothersortootherar eas
ofthebody .

Advisepat
ientt
obeginappl
icat
ionofdocosanolat
thefir
stsi
gnofasoreorbli
ster
,evenduring
prodromalst
age(f
eel
ingofburning,
itchi
ng,t
ingl
i
ng,
ornumbness).

I
nf orm pati
entthatdocosanol reducesdur ationof
herpessi mplexvir
usepisodesbutdoesnotcur evir
us.
Viralreacti
vati
onmaybet r
igger edbyultraviolet
radiat
ionorsunexposur e,stress,fati
gue, chill
ing,and
windbur n.Otherpossi
bletr
igger sincl
udef ev er,inj
ury,
menst ruati
on,dentalwork,andi nfect
iousdi seases
(cold,fl
u).

Advi
sepati
entt
onoti
fyheal
thcar
eprofessional
if
l
esi
onsdonotheali
n14day sori
ffev
er,rash,or
swol
lenl
ymphnodesoccur.

Abst
ral
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 47
I
NDI
CATI
ONS
Managementofbr eakt hroughpaini
nopioi
d-t
olerant
cancerpati
ents≥18y rwhoalreadyr
ecei
veopioidsfor
persist
entcancer
-relatedpain(60mg/dayoforal
mor phi
neorequivalent).

ACTI
ON
Bindstoopiat
erecept
orsintheCNS, alt
eri
ngt heresponse
toandthepercepti
onofpain.Therapeuti
cEffects:↓
breakt
hroughpaindur
ingchronicopioi
dtherapy.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Opi
oidnon-
tol
erantpat
ient
s;
Treatmentofacut e/
post-
operati
vepaini ncl
uding
headache/ migr
aine,dent
alpainoremer gencyroom use;
Lactati
on: Maycausesedationand/orrespirat
ory
depression.

UseCaut
iousl
yin:
Ger
i:Maybemor
esensi
ti
vet
odr
ug
eff
ects;Hepatic/r
enali
mpairment;OB:Useonlyif
mat er
nalbenefitout
weighspot
entialr
iskt
of et
us;chr
oni
c
usemayr esultinneonatal
abst
inencesyndrome;Pedi
:
Safetyandeffecti
venesshasnotbeenestabli
shed.
Exer
ciseExt
remeCaut
ioni
n:Pat
ient
satr
iskf
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 48
i
ntracr
ani
alef
fect
sofCO2retent
ion,
incl
udi
nghead
i
njuri
es/↑int
racr
ani
alpr
essure.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Opi
oidsi
deef
fect
s↑ wi
th↑ dosage
CNS: drowsiness, f
atigue,headache, mal ai
se,mood
changes, weakness.EENT: bl
urredv i
sion.Resp:
RESPIRATORYDEPRESSI ON.CV: br
ady car
dia,
hypotension,tachycardia.GI :
const i
pation,anor
exia,
nausea, abdomi nalpain,drymout h,
v omiti
ng.Derm:rash,
sweating.Mi sc:all
ergicreactionincludinganaphyl
axis,
physi
cal dependence, psychologicaldependence.

I
NTERACTI
ONS
Drug-Dr ug:Shouldnotbeusedwi thin14day sofMAO
i
nhibitor sbecauseofpossi bl
esev ereandunpr edictable
reactions.CNSdepr essant s,incl
udi ngot heropi oids,
sedativ e/hypnotics,gener alanesthetics, phenot hiazi
nes,
skeletal musclerelaxants, sedati
ngant ihistami nes, and
alcohol may↑ CNSdepr ession,hy povent ilationand
hypotensi on.Concur rentusewi t
hCYP3A4i nhibitors
i
ncludi ngritonavi
r,ketoconazol e,it
raconazol e,
clari
thromy cin,nelf
inavir,nefazodone, di l
tiazem,
erythromy cin,aprepit
ant,fluconazol e,fosampr enav i
r,and
verapami l
maysi gnifi
cant ly↑ bloodl ev elsand↑ r i
skof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 49
respir
atoryandCNSdepr essi
on;car
efulmoni t
ori
ngand
doseadj ustmentisrecommended.Concur rentuseof
agentsthatinduceCYP3A4enzy meactivi
tymay↓
analgesia.Administr
ati
onofparti
al-
antagonist
opioi
d
analgesicsoropioidantagoni
stswil
lpreci
pitate
withdrawalinphysicall
ydependentpati
ents.
Drug-
Food:
Grapefr
uitjui
ceisamoder at
einhi
bit
oroft
he
CYP3A4enzymesy st
em; concurr
entusemay↑ blood
l
evelsandt
her i
skofrespi
rator
yandCNSdepr essi
on.
Careful
monit
ori
nganddoseadj ustmenti
srecommended.

DOSAGE
SL:(Adul
ts):100mcgi nit
ial
l
y,thenti
trat
eusing100mcg
i
ncrementstopr ovi
deadequateanalgesiawit
houtundue
sideeff
ects(nottoexceed2dosesperepi sode;
nomor e
thanfourdosesperday;separatebyatleast2hrs)
.

AVAI
LABI
LITY
Subl
i
ngualtabl
ets100mcg,
200mcg,
300mcg,
400mcg,
600mcg,800mcg;

PATI
ENTTEACHI
NG
Inst
ructpat
ientt
otakef
ent
any
l subl
i
ngual
tabl
ets
exactl
yasdirect
edandt
ocont
inuetaki
ngthear
ound-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 50
 thecl ockopi oidpai nmedi cine.Donott akemor e
oftent hanpr escri
bed, keepoutofr eachofchi ldr
en,
protecti tfr
om bei ngst olen, anddonotshar ewit
h
other s,eveniftheyhav et hesamesy mpt oms.Explain
thatf entanylsublingual tablet smaybef atalto
childrenandi ndividualsnott ol
er anttoopi oi
ds.Advise
patientt oMedi cationGui der evieweacht imeRxi s
refi
lled;newi nformat ionmaybeav ai
lable.Adv i
se
patientt onot i
fyheal t
hcar epr ofessional if
breakt hroughpai nisnotal lev i
atedorwor sens.

Explai
nABSTRALREMSPr ogram topati
entand
caregi
ver.Pat
ientsmustsi
gnthePat i
ent-
Prescriber
AgreementFor mtoconfi
rmtheyunderstandt herisks,
appropri
ateuse,andst
orageoffentanyl
sublingual.

Advi
sepat i
enttodisposeofunusedfent
anyl
subl
ingualt
abletsbyremovingfr
om bli
sterpackand
fl
ushingdownt oi
let
.

Caut
ionpat
ientt
omakeposit
ionchangessl
owl
yto
mini
mizeor
thostat
ichy
pot
ension.

Medi cati
oncausesdizzi
nessanddr owsi
ness.Advise
patienttocal
lforassi
stanceduri
ngambul ati
onand
transfer
,andtoavoiddrivi
ngorotheract
ivit
ies
requiri
ngaler
tnessuntil
responsetomedicat i
oni
s
known.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 51
 I
nstr
uctpat
ienttoav oi
dconcur
rentuseofal
cohol
or
ot
herCNSdepr essants,
suchassleepai
ds.

Instr
uctpati
enttonotifyhealt
hcareprof
essionalof
allRxorOTCmedi cat
ions,vi
tamins,
orherbal
productsbeingtakenandt oavoi
dconcurrentuseof
Rx,OTC, andherbalproductswit
houtconsult
ing
healthcareprof
essional.

Advi
sepati
entt
onotif
yhealt
hcarepr
ofessi
onalif
pr
egnancyi
splannedorsuspect
edori
fbreast
feeding.

Acampr
osat
ecal
cium
I
NDI
CATI
ONS
Maint
enanceofal
coholabst
inence;
par tofa
comprehensi
veal
cohol
absti
nencepr ogram.

ACTI
ON
I
nter
actswit
handr estoresbalancet
oCNSgl ut
amateand
GABAneurotr
ansmittersystems.Therapeut
icEffect
s:
Cont
inuedal
coholabst i
nence.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
CCr30mL/
minor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 52
l
ess.

UseCaut
iousl
yin:CCr30–50mL/
min(
doser
educt
ion
necessary
);Histor
yofdepressionorsuici
deatt
empt;OB:
Useonlyifpotenti
almater
nalbenef i
toutwei
ghsfet
alri
sk;
Lactat
ion:Pedi:
Safet
ynotest abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: abnor mal thi
nki ng,anxi ety,
depression, drowsi ness,
headache.EENT: abnor mal v i
sion.Resp: cough, dy
spnea,
pharyngitis,rhiniti
s.CV: palpitat
ions,peri
pher al edema,
syncope, v asodi l
ation.GI :abdomi nalpain,anor exia,
constipation, diarr
hea, flatulence,↑ appet i
te, nausea,
tasteperv ersion, vomi t
ing.GU: ↓l i
bido,erectile
dysfunction.Der m: rash.Met ab:weightgai n.MS:
arthr
algia, backpai n,my lagia.Neuro: t
remor .

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
PO:(Adult
s) :
Two333mgt abl
ets(
666mg/dose)t
hree
ti
mesdaily.Lowerdosesmaybeef
fect
ivei
nsome
pati
ents.
Renal
Impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 53
PO:(Adul
ts):
CCr30–50mL/
min—One333mgt
abl
et
thr
eetimesdail
y.

AVAI
LABI
LITY
Tabl
ets333mg;

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakemedicat
ionasdirected,
eveni
f
r
elapseoccurs.Adv
isepat
ientt
odiscussany
r
eneweddr i
nkingwit
hheal
thcareprofessional
.

Maycausedizzinessandchangesinvi
sion.Cauti
on
pat
ientstoavoi
ddr i
vi
ngandotheracti
vi
tiesrequi
ri
ng
al
ertnessunt
ilr
esponsetomedicati
onisknown.

OB: Lact
ation:Advi
sef emalepati
entstonot
ifyheal
th
careprofessionali
fpregnancyisplannedor
suspectedori fbr
eastfeedi
ng.

Encour
agepat i
enttoconti
nueactivecounseli
ngand
suppor
t.Acampr osatehel
psmaintainabst
inenceonly
whenusedaspar tofacomprehensivepsychosoci
al
tr
eatmentprogram

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 54
Acar
bose
I
NDI
CATI
ONS
Managementoftype2di
abetesinconj
uncti
onwithdiet
ary
ther
apy;maybeusedwit
hinsul
inorotherhypogl
ycemic
agents.

ACTI
ON
Lowersbloodglucosebyinhibi
ti
ngt heenzymeal pha-
gl
ucosidaseintheGItract
.Delaysandr educesglucose
absor
ption.Therapeut
icEff
ects:Loweringofblood
gl
ucosei ndi
abeticpat
ient
s,especiall
ypostprandial
hyper
glycemia.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI
:abdomi
nal
pai
n,di
arr
hea,
flat
ulence,
↑tr
ansami
nases.

I
NTERACTI
ONS
Drug- Dr
ug:Thiazi
dediureti
csandl oopdiuret
ics,
corti
costeroi
ds,phenothiazi
nes,thyroi
dpreparat
ions,
estrogens(conjugat
ed),progesti
ns,hormonal
contracepti
ves,phenyt
oin,niaci
n,sympathomi metics,
calcium channelbl
ockers,andisoniazi
dmay↑ gl ucose

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 55
l
ev elsindiabeti
cpat i
entsandl eadto↓ cont rolofblood
glucose.Ef f
ectsare↓ byi ntesti
naladsorbents,
includi
ng
activatedcharcoalanddi gestiv
eenzy mepr epar
ations
(amy lase,pancreat
in);av
oi dconcurrentuse.↑ effectsof
sulfony l
ureahypoglycemicagent s.May↓ absor ptionof
digoxin;mayr equir
edosageadj ustment.
Dr
ug-Natur
alProduct:
Glucosaminemaywor
senbl
ood
gl
ucosecontrol
.Chromium andcoenzy
meQ-10may↑
hy
poglycemiceff
ects.

DOSAGE
PO:(
Adult
s):25mg3t i
mesdai l
y;maybeincreasedq4–8
wkasneeded/t
oler
ated(range50–100mg3t imesdai
ly
;
nott
oexceed50mg3t i
mesdai l
yinpati
ents≤60kgor
100mg3t i
mesdailyinpati
ents>60kg).

AVAI
LABI
LITY
Tabl
ets25mg,
50mg,
100mg;

PATI
ENT TEACHI
NG
I
nstructpat
ienttot
akeacarboseatsameti
meeach
day.Ifadoseismissedandthemeal i
scomplet
ed
wit
houttakingthedose,
ski
pmi sseddoseandtake
nextdosewi t
hthenextmeal.Donotdoubl
edoses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 56
Explaintopat
ientt
hatacar
bosecont
rol
s
hyperglycemi
abutdoesnotcur
ediabet
es.Ther
apyi
s
l
ongt erm.

Rev i
ewsi gnsofhy pogl ycemi aandhy perglycemi a
(bl
ur r
edv ision;dr owsi ness; drymout h;flushed, dry
skin;fr
uit-l
ikebr eat hodor ;increasedur ination;
ketonesinur i
ne; lossofappet i
te;stomachache;
nauseaorv omi ti
ng; ti
redness; rapid,deepbr eathing;
unusual thirst;unconsci ousness)wi thpat ient.If
hypoglycemi aoccur s,adv i
sepat ienttot akeaf orm of
oralglucose( e.g.
, glucoset ablets,li
quidgel glucose)
ratherthansugar( absor pti
onofsugari sbl ockedby
acarbose)andnot i
fyheal thcar eprofessi onal.

Encouragepatientt
ofol
lowpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.

Instructpat
ientinpropertesti
ngofserum glucose
andur ineketones.Monitorclosel
yduri
ngper i
odsof
stressorill
ness.Notif
yheal t
hcareprofessi
onalif
signifi
cantchangesoccur .

Cauti
onpati
enttoav
oidusi
ngot
hermedicat
ions
wit
houtconsul
ti
ngheal
thcar
epr
ofessi
onal.

Adv
isepat
ientt
oinf
orm heal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 57
 medi
cat
ionr
egi
menbef
oret
reat
mentorsur
ger
y.

Advi
sepat ientt
ocarr
yaf orm ofor
algl
ucoseand
i
denti
ficati
ondescri
bingdiseasepr
ocessand
medicationregi
menatalltimes.

Emphasi
zetheimpor
tanceofr
out
inef
oll
ow-
up
exami
nati
ons.

Accol
ate
I
NDI
CATI
ONS
Long-
ter
m cont
rol
agenti
nthemanagementofast
hma.

ACTI
ON
Antagonizestheeffectsofleukotr
ienes,whi chare
component sofslow- r
eacti
ngsubst anceofanaphy laxis
(SRSA).Thesesubst ancesmedi at
et hefollowing:Ai r
way
edema, Smoot hmuscl econstr
icti
on,Alteredcellular
acti
vit
y.Resultisdecreasedinfl
ammat oryprocesst hatis
partofasthma.Ther apeuti
cEffects:Decreasedf requency
andsev eri
tyofasthma.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hyper
sensi
ti
vi
ty;
Hepat
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 58
i
mpai
rment
;Lact
ati
on:
Lact
ati
on.

UseCaut
iousl
yin:Acut
eat
tacksofast
hma;
Pat
ient
s>55
yr(↑riskofinfect
ion)
;Geri
:Mayneedlowerdosest
o
avoi
dsideeffects;OB:Pedi
:Pr
egnancyorchi
ldr
en<7yr
(saf
etynotestabli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SUICIDALTHOUGHTS, headache, agit
ation,
aggression, anxiet
y, depression,dizziness,dream
abnormal i
ties,hall
uci nations,i
nsomni a,i
rr
it
abi l
i
ty,
restl
essness, tremor ,weakness.GI :HEPATOTOXI CITY,
abdomi nalpai n,di
arr hea, dy
spepsia, nausea,vomi t
ing.MS:
arthr
algia,backpai n, my algi
a.Misc: CHURG- STRAUSS
SYNDROME, f
ev er
,inf ect
ion(geriatr
icpat i
ents),pai
n.

I
NTERACTI
ONS
Dr
ug-Drug:Level
sare↑ byaspiri
n.Levelsar
e↓ by
er
ythr
omy ci
nandt heophy
ll
ine.↑ ef
fectsandri
skof
bl
eedi
ngwi thwarfar
in.
Dr
ug-Food:Food(
especi
all
yhi
gh-
fatorhi
gh-
prot
einmeal
)
↓ absor
pti
on.

DOSAGE
PO:
(Adul
tsandChi
l
dren≥12y
r):
20mgt
wicedai
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 59
PO:
(Chi
l
dren7–11y
r):
10mgt
wicedai
l
y.

AVAI
LABI
LITY
Tabl
ets10mg,
20mg;

PATI
ENTTEACHI
NG
Instructpati
enttot akemedi cat
iononanempt y
stomachasdi rected,atevenlyspacedinterval
s,even
i
fnotexper iencingsy mptomsofast hma.Take
mi sseddosesassoonasr emember edunlessalmost
timef ornextdose.Donotdoubl edoses.Donot
discontinuetherapywi t
houtconsulti
ngheal thcare
professional.

Instr
uctpati
entnottodi
scont
inueorreduceother
asthmamedi cat
ionswit
houtconsul
ti
nghealthcare
professi
onal
.

Advi
sepati
entthatzaf
ir
lukasti
snotusedtotr
eat
acut
easthmaat t
acksbutmaybecont i
nuedduri
ngan
acut
eexacerbat
ion.

Advisepati
ent,
famil
y ,
andcar
egiver
st ol
ookfor
sui
cidal
it
y,especi
all
yduri
ngearl
ytherapyordose
changes.Noti
fyheal
thcarepr
ofessi
onalimmediatel
y
i
fthoughtsaboutsuici
deordyi
ng,att
emptsto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 60
 commi tsui
cide,neworwor sedepressi
onoranxi et
y,
agi
tati
onorr est
lessness,panicatt
acks,insomnia,
neworwor seirr
itabi
li
ty,aggressi
veness,acti
ngon
dangerousimpulses,mani a,orot
herchangesi n
moodorbehav i
oroccur.

Advisepatientt
onot ifyhealthcarepr ofessionalif
symptomsofChur g-Strausssy ndrome( general
ized
fl
u-l
ikesyndrome, f
ev er,muscleachesandpai n,
weightl
oss, worseni
ngr espir
atorysy mpt oms)occur .
Occursrarelybutmaybel i
fe-
threatening.Mor elikel
y
tooccurwhenweani ngf rom systemi ccor t
icost
er oi
ds.

Acet
azol
ami
de
I
ndi
cat
ions
Asanadj
unctinthetreatmentofchronicopen-
angl
e
gl
aucoma;secondar
ygl aucoma;aspartofpre-
oper
ati
ve
tr
eat
mentofacuteangle-closur
eglaucoma.

Av
ail
abi
l
ity
Tabl
ets125mg,250mg; Ext
ended-r
eleasecapsul
es500
mg;Powderf
ori
nject
ion500mg/ vi
al;

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 61
PO: (Adults) :
Glaucoma( openangle)—250–1000mg/ day
i
n1–4di vi
deddoses( upto250mgq4hr )or500-mg
extended- rel
easecapsulestwicedail
y.Epilepsy—4–16
mg/ kg/ dayin1–4di vi
deddoses( maxi mum 30
mg/ kg/ dayor1g/ day).Alt
it
udesickness—250mg2–4
ti
mesdai lystart
ed24–48hrbef oreascent ,conti
nuedfor
48hrorl ongertocontrolsymptoms.Ant i
urolit
hic—250mg
atbedt i
me.Edema—250–375mg/ day .Uri
ne
alkal
inization—5mg/ kg/doserepeated2–3t i
mesov er24
hr.
PO:( Chi
ldren):Gl
aucoma—8–30mg/ kg(300–900
mg/ m2/ day)in3div
ideddoses(usualr
ange10–15
mg/ kg/day).Edema—5mg/ kg/doseoncedail
y.
Epi
lepsy —4–16mg/ kg/dayin1–4divi
deddoses
(maxi mum 30mg/ kg/dayor1g/day).
PO:(
Neonates):Hy
drocephal
us—5mg/kg/
doseq6hr↑
by25mg/kg/dayuptoamaximum of100mg/kg/
day
.
I
V: (Adult
s):
Glaucoma(
closedangl
e)—250–500mg,
may
repeatin2–4hrtoamaxi
mum of1g/ day.
Edema—250–375mg/ day.
IV:(
Chil
dren)
:Glaucoma—5–10mg/kgq6hr,notto
exceed1g/day.Edema—5mg/kg/
doseoncedail
y.
I
V:(
Neonat
es)
:Hy
drocephal
us—5mg/
kg/
doseq6hr↑

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 62
by25mg/
kg/
dayupt
oamaxi
mum of100mg/
kg/
day
.

Cont
rai
ndi
cat
ions
Hypersensit
ivi
tytosulfonamides;chronicangle-
closur
e
gl
aucoma( maymaskdet eri
orati
on);
hy pokalaemia,
hyponatr
aemi a,hyperchl
oraemicacidosis;renal
i
mpai rmentsev er
ehepat ici
mpai r
ment ;renal
hyperchl
oremicaci dosi
s,addison’
sdisease.

Pr
ecaut
ions
Elderl
y ;
lactat
ion;di
abetesmel l
it
us;pulmonar yobstr
ucti
on;
moni torbloodcountandel ect
roly
tesifusedf orlong
periods;inter
acti
onspr egnancysev er
er espir
atory
acidosis.Mayi mpairabil
i
tytoperform skil
ledtasks,f
or
exampl eoper at
ingmachinery,dri
vi
ng.

ACTI
ON
Inhibiti
onofcarboni canhydr asei ntheey er esult si
n
decr easedsecretionofaqueoushumor .Inhi bit
ionofr enal
carboni canhydrase,resul
tingi nsel f
-l
imi t
ingur inary
excret i
onofsodi um, pot
assi um, bicarbonat e,andwat er .
CNSi nhibi
ti
onofcar bonicanhy draseandr esultant
diuresismay↓ abnor malneur onal f
iri
ng.Al kalinediuresis
prev entspreci
pitati
onofur icaci dorcy stinei ntheur i
nary
tract.Therapeuti
cEf fect
s:Lower ingofi ntraocul ar

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 63
pressure.Contr
olofsomet ypesofseizures.Prevent
ion
andt r
eatmentofacutealti
tudesickness.Diuresi
sand
subsequentmobi l
izat
ionofexcessf l
uid.Prev
entionof
uri
cacidorcy sti
nerenalcal
culi
.

I
NTERACTI
ONS
Dr
ug-Dr
ug:Excr
eti
onofbarbi
turat
es,aspi
ri
n,andl
i
thi
um i
s
↑ andmayleadto↓ ef
fecti
veness.
Excreti
onofamphet
amine,quini
dine,
procai
nami
de,and
possibl
ytr
icy
cli
cant
idepr
essantsis↓ andmayleadto
toxi
city
.May↑ cycl
ospor
inelevel
s.

Adv
erseEf
fect
s
Nausea, vomi ti
ng, diarrhoea, tastedi sturbance; lossof
appet i
te, par aesthesi a,fl
ushi ng,headache, dizzi
ness,
fati
gue, irritabil
ity,depr essi on; t
hirst,pol yuria;r
educed
l
ibido;met abol i
caci dosisandel ectroly t
edi sturbanceson
l
ongt ermt her apy; occasi onal lydrowsi ness, confusion,
hearingdi sturbances, urticaria,mel aena, glycosuria,
haemat uria; abnor mal liverf unction; renal calculi,
blood
disorder si ncludingagr anul ocy t
osi sand
thrombocy topenia; rashesi ncludingSt ev ensJohnson
syndromeandt oxicepi der mal necrol ysis;transient
my opiar epor t
ed; blooddy scrasias; cryst al
luri
a.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 64
PATI
ENTTEACHI
NG
Instructpati
entt otakeasdir
ected.Takemissed
dosesassoonaspossi bleunl
essalmosttimefor
nextdose.Donotdoubl edoses.Patient
son
anticonvulsanttherapymayneedt ogradual
ly
withdrawmedi cati
on.

Adv i
sepat ienttor eportnumbnessort ingli
ngof
extremi t
ies,weakness, rash, sorethroat ,unusual
bleedingorbr uising, f
ever, orsigns/sy mpt omsofa
sulfonami deadv erser eact i
on( Stevens- Johnson
syndrome[ fl
u-l
ikesy mptoms, spreadingr edr ash, or
skin/mucousmembr anebl ister
ing],toxicepider mal
necrolysis[widespr eadpeel ing/bl
isteri
ngofski n])to
healthcar eprofessi onal.Ifhemat opoi eticreactions,
fever,rash,hepatic, orrenal problemsoccur ,
acetazolami deshoul dbedi scont i
nued.

Mayoccasionallycausedr owsi
ness.Cauti
onpati
ent
toavoiddri
vi
ngandot heracti
vi
ti
esthatrequi
re
aler
tnessunti
lresponset othedrugisknown.

Cauti
onpat
ienttousesunscreenandwearprotect
ive
cl
othi
ngtopreventphot
osensit
ivi
tyr
eact
ions.

Advi
sepat
ientt
onoti
fyheal
thcar
eprof
essi
onalofal
l
RxorOTCmedicat
ions,
vit
amins,
orher
balpr
oducts

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 65
 beingtakenandtoconsul
twit
hheal
thcar
e
professi
onalbef
oret
akingot
hermedi
cati
ons.

I
ntraocularPr
essur e:Advi
sepat
ientoft
heneedf
or
peri
odicophthalmol ogi
cexams;l
ossofvisi
onmaybe
gradualandpainless.

St
orage Storeprotectedfrom l
i
ght
.

Acet
olhexami
de
I
NDI
CATI
ONS
Managementoft
ype2di
abet
esmel
l
itusasanadj
unctt
o
di
et.

ACTI
ON
Lower sbloodsugarbyst imulatingt herel
easeofinsul
i
n
from thepancr easandi ncreasingi nsul
i
nsensiti
vi
tyat
receptorsites.Mayal sodecr easehepat icgl
ucose
production.Ther apeuti
cEffects: Loweri
ngofbloodsugar
i
ndi abeticpatients.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hyper
sensi
ti
vi
ty;
Knownsev
ere
al
l
ergyt
osul
fonami
des(
e.g.sul
fony
lur
eas,
thi
azi
de/
loop

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 66
diuret
ics;Type1diabet
esmel li
tus;Di
abeti
cket
oaci
dosi
s;
OB: Lactati
on:Saf
etynotestabl
ished;i
nsul
in
recommendeddur i
ngpregnancy .

UseCaut
iousl
yin:Ger
i:↑ sensi
ti
vi
ty;
dosage↓ maybe
requi
red;Renalorhepat i
cimpai r
ment( ↑r i
skof
hypoglycemia);I
nfecti
on,stress,orchangesindi
et(may
alt
erbloodsugarandr equirement sforgly
cemiccontr
ol)
;
Impair
edt hy
r oi
d,pit
uit
ary,oradrenal f
uncti
on(↑riskof
hypoglycemia).

ADVERSEREACTI DEEFFECTS
ONSANDSI
CNS:dizziness,drowsiness,headache, weakness.GI :
anor
exia,CHOLESTATI CJAUNDI CE,constipation,cr
amps,
di
arr
hea, drug-i
nducedhepat it
is,epigastri
cf ull
ness,
hear
tburn,↑ appet i
te,nausea, vomiting.Der m:
phot
osensi ti
vi
ty,r
ash.Endo: hy poglycemia, syndromeof
i
nappropriatesecreti
onofant idiureti
chor mone( SI
ADH).
Hemat:APLASTI CANEMI A,agranulocy t
osis,hemol yt
ic
anemia,l
eukopeni a,pancytopenia, t
hrombocy topeni
a.

I
NTERACTI
ONS
Drug-Dr
ug:Ingest i
onofal coholmayresulti
ndisul
fi
ram-
l
ikereacti
on.Effectivenessmaybe↓ byconcur r
entuseof
calci
um channel blockers,chol
est
yramine,cor
ti
coster
oids,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 67
diazoxide, estrogens, pheny toi
n, i
soniazid,hor monal
cont r
acept ives,loopdi ureti
cs,phenot hiazines, rif
ampi n,
sympat homi met i
cs, thiazidediur eti
cs,thyroidhor mones,
andur inaryal kali
nizer s.betabl ockers,chlor ampheni col,
fl
uconazol e, gemf i
brozi l
,histami neH2r ecept or
antagoni sts,met hy l
dopa, MAOi nhibi
tors,NSAI DS,
probeneci d,sal i
cy l
ates, sulfonami des,tri
cy clic
antidepressant s, andur i
naryaci difi
ersmay↑ t heri
skof
hypogly cemi a.Concur rentusewi t
hwar fari
nmayal terthe
responset obot hagent s(↑ effect sofbot hi niti
all
y,then
↓ act i
v i
ty;closemoni toringrecommendeddur ingany
changesi ndosage) .
Dr
ug-
Natur
al Pr
oduct:Glucosaminemayworsen
hy
pogl
ycemia.Fenugreek,chr
omium,andcoenzy
meQ-
10
maypr
oduce↑ hy poglycemicef
fect
s.

DOSAGE
PO: (
Adults)
:250mgoncedai l
y;dosecanbe↑ as
neededby250–500mgdai l
yev ery5–7day s(
notto
exceed1.5g/day;doses>1g/dayshoul dbegivenas
div
ideddoses).Geri
atr
icpat
ientsorhepatic
i
nsuffi
ciency
—dosage↓ mayber equi
red.

Renal
Impai
rment
PO:
(Adul
ts)
:CCr<50mL/
min—Usenotr
ecommended

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 68
(
↑ri
skofhy
pogl
ycemi
a).

AVAI
LABI
LITY
Tabl
ets250mg,
500mg;

PATI
ENT TEACHI
NG
I
nstructpat
ienttotakemedicati
onatsameti
meeach
day.Takemi sseddosesassoonasr emember
ed
unl
essalmostt imefornextdose.Donott
akei
f
unabletoeat.

Explai
nt opat
ientt
hatt
hismedi
cat
ioncontrol
s
hypergly
cemiabutdoesnotcur
edi
abetes.Therapyi
s
l
ong- t
erm.

Reviewsi gnsofhy pogl

y cemiaandhyperglycemia
withpatient.I
fhypoglycemi aoccur
s,advisepati
entto
takeagl assoforangej uiceor2–3tspofsugar ,
honey ,
orcor nsyrupdissolvedinwaterandt onoti
fy
healthcareprofessional.

Encouragepatientt
ofol
lowpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.

Inst
ructpat
ienti
npropertest
ingofserum gl
ucose
andketones.Thesetest
sshouldbeclosel
ymoni t
ored

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 69
 duri
ngperi
odsofstr
essoril
lnessandhealt
hcare
prof
essi
onalnot
if
iedifsi
gni
fi
cantchangesoccur
.

Mayoccasi
onall
ycausedizzi
nessordrowsiness.
Cauti
onpat
ientt
oavoiddrivi
ngorotheract
ivi
ti
es
requi
ri
ngal
ert
nessunti
lresponset
omedi cati
onis
known.

Acet
ohy
droxami
caci
d
I
NDI
CATI
ONS
Adjunctt
her
apyi
nchr
oni
cur
ea-
spl
i
tti
ngur
inar
ytr
act
i
nfecti
on.

ACTI
ON
Rev ersiblyinhi
bitsthebacterial enzymeur ease, which
resultsindecr easedhy drol
ysisofur eaandsubsequent
product ionofammoni ainur i
nei nf
ectedwi thurea-spli
tt
ing
bact eri
a.Ther apeuticEff
ects: Decr easedur i
naryammoni a
l
ev elsanddecr easedur i
nepH, whichi ncreasest he
efficacyofant i-
infecti
vetherapyandcur er ates.Doesnot
directlyalterpHorhav eanydi rectant i
bact erial
activi
ty.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Ur
inar
ytr
acti
nfect
ionwi
thnon-
urea-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 70
spli
tti
ngor ganisms; Uri
narytractinfectionsthatcanbe
control
ledbycul tur
e-specifi
cor alantibioti
cs;Ser
um
creati
nine>2.5mg/ dLorCCr<20mL/ mi n;OB:Causes
birt
hdef ects;
womenofchi l
dbearingpot enti
almustuse
adequat econtraception;Lact
ation:Saf etynotestabl
ished.

UseCaut
iousl
yin:Renali
mpai
rment(
incr
easedr
iskof
adver
sereact
ions;
dosager educti
onrecommended) ;
Hepati
cimpai
rment; Pr
e-exi
sti
ngthrombophlebit
isor
phl
ebothr
ombosis(incr
easedr i
skofadversereacti
ons)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,anxiet
y,depressi
on,malaise,ner
vousness,
tremulousness.CV:palpi
tati
ons,superf
ici
al phl
ebi
ti
sof
thelowerextremiti
es.Derm:alopeci
a,rash( i
nassoci
ation
wi t
halcohol)
.GI:anorexi
a,nausea,vomiti
ng.Hemat :
anemi a,hemolyt
icanemia.

I
NTERACTI
ONS
Drug-
Drug:Decreasesabsorpti
onofi r
on.Ir
ondecreases
theabsor
ptionofacetohydroxamicacid.Concur
rent
i
ngesti
onofal coholi
ncreasestheinci
denceofrash.

DOSAGE
PO:
(Adul
ts)
:250mg3–4t
imesdai
l
y(t
otal
dose10–15

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 71
mg/
kg/
day
)(maxi
mum dai
l
ydose=1500mg)
.
PO:(Chi
l
dren)
:10mg/ kg/
dayi
ndi
vi
deddoses;
fur
ther
ti
tr
ati
onmaybenecessary.

Renal
Impai
rment
PO: (
Adul
ts):
Ser
um cr
eatini
ne1.8–2.
5mg/ dL—donot
exceed1000mg/day(
givenat12hrint
erv
als;f
urt
her
adjust
mentsmaybenecessary
).

AVAI
LABI
LITY
Tabl
ets250mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakemedi
cat
ionexact
lyasdi
rect
ed.

Infor
m pati
entthatmildheadachemayoccurdur i
ng
fir
st48hroft r
eatment.Headachesusuall
yrespondt
o
oralsal
icyl
ates(aspi
ri
n)andusuall
ydisappear
spontaneously.

Adv i
sepat i
entthattakingacetohydroxamicacid
concur r
entlywithalcoholmaycauseanonpr uri
ti
c
macul arskinrashtooccuronupperext r
emitiesand
face.Rashusual lyappears30–45mi naft
eringesti
on
ofalcohol andmaybeassoci atedwithasensat i
onof
warmt h.Itusuall
yspont aneouslydi
sappearsin30–60

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 72
 mi
n.

Emphasi
zet
heimport
anceofper
iodi
clabt
est
sto
moni
torf
orsi
deeff
ects.

Cautionpatientsofchil
dbear
ingpot
enti
alt
ousea
rel
iableform ofcontr
acepti
onwhil
etaki
ng
acetohydroxamicacid.

Acet
ylcy
stei
ne
I
NDI
CATI
ONS
PO: Ant i
dot eforthemanagementofpot ent i
all
y
hepat otoxicov erdoseofacetaminophen( admi ni
ster
withi
n8–10hour s[IV]or24hours[PO]ofi ngesti
on) .
Inhaln: Mucolyticinthemanagementofcondi t
ions
associ atedwi t
ht hickv i
sci
dmucoussecr etions.Unlabel
ed
Uses: Pr eventi
onofr adi
ocont
rast
-i
nducedr enal
dysfunct ion(oral).

ACTI
ON
PO: Decreasesthebuildupofahepat otoxi
cmet aboli
tein
acetaminophenov erdosage.IV:Decreasesthebuildupof
ahepat otoxi
cmet aboli
teinacetaminophenov erdosage.
Inhaln:
Degr adesmucus, all
owingeasiermobili
zationand
expectorati
on.Therapeuti
cEf f
ects:PO: Pr
eventi
onor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 73
l
esseni
ngofli
verdamagefol
l
owi ngacet
aminophen
over
dose.I
nhal
n:Lower
stheviscosi
tyofmucus.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Sev
erer
espi
rat
oryi
nsuf
fi
ciency
,
asthma,orhistor
yofbr
onchospasm;Hi
stor
yofGI
bleedi
ng(oralonl
y);
OB:Lact
ati
on:Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness.CV: vasodilati
on,tachy cardia,
hypotension.EENT: r
hinor r
hea.Resp: bronchospasm,
br
onchi al/
tracheali
rr
itation,chesttightness, ↑ secret
ions.
GI
: nausea, vomit
ing,stomat it
is.Derm: rash,clammi ness,
pr
ur i
tus,urt
icari
a.Misc: all
ergicreacti
ons( pri
maril
ywi t
h
I
V),includi
nganaphy laxis,ANGI OEDEMA, chi
ll
s,fever.

I
NTERACTI
ONS
Drug-
Dr ug:Act
ivat
edcharcoalmayadsor
boral
ly
admini
st er
edacetyl
cyst
eineand↓ it
seff
ect
ivenessasan
anti
dote.

DOSAGE
Acet
ami
nophenOv
erdose

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 74
PO:(
Adul
tsandChil
dren)
:140mg/ kgi
nit
ial
l
y,f
oll
owedby
70mg/kgq4hrfor17addit
ional
doses.
I
V: (
AdultsandChil
dren):
Loadingdose—150mg/kg
(maximum: 15g)over60mi ni
niti
all
yfol
l
owedbyFi r
st
maintenancedose—50mg/ kg(maximum: 5g)over4hr,
thensecondmaintenancedose—100mg/ kg(maximum:
10g)ov er16hr.

Mucol
yti
c
Inhaln:(
Adul tsandChil
dren1–12y rs):
Nebul izati
onv i
a
facemask—3–5mLof20%sol utionor6–10mLoft he
10%sol ution3–4t i
mesdai l
y;nebulizati
onv iatentor
croupette—v olumeof10–20%sol ut
ionr equiredto
mai ntai
nheav ymist;di
recti
nstil
lati
on—1–2mLof
10–20%sol utionq1–4hr ;i
ntr
atracheal i
nstil
lati
onv i
a
tracheostomy —1–2mLof10–20%sol utionq1–4hr( up
to2–5mLof20%sol ut
ionv i
atracheal catheterint
o
particul
arsegment softhebronchopul monar yt r
ee).
I
nhal
n:(
Inf
ant
s):Nebul
i
zat
ion-
1–2mlof20%sol
uti
onor2
-
4mLof10%soluti
on3-4t
imesdai
l
y.
Pr
event
ionofRadi
ocont
rast
-I
nducedRenal
Dysf
unct
ion
PO:(Adul
ts):
600mgt wicedai
l
yfor2day
s,begi
nni
ngt
he
daybefor
ethepr
ocedure.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 75
AVAI
LABI
LITY
Sol
uti
onfori
nhal
ation10%( 100mg/mL)
,20%(
200
mg/mL);
Solut
ionforinj
ect
ion20%(200mg/mL)
;

PATI
ENTTEACHI
NG
Acet
aminophenOver
dose:
Expl
ainpur
poseof
medicat
iont
opati
ent
.

I
nhaln:I
nst
ructpati
entt
oclearair
waybycoughi
ng
deepl
ybeforetaki
ngaer
osoltreat
ment.

Inf
orm patientt
hatunpleasantodorofthi
sdrug
becomesl essnoti
ceableast r
eatmentprogr
esses
andmedi cinedi
ssipat
es.

Acet
ylsal
i
cyl
i
cAci
d
I
ndi
cat
ions
Managementofmi l
dtomoder atepainsuchasheadache,
acutemigraineatt
acks,
transientmuscul oskeletal
pain,
dysmenor r
hoealpainandf orreducingfever ;
painand
i
nflammat i
onofrheumat oidarthri
ti
s;antiplatel
etagentf
or
prophyl
axisofmy ocar
dialinfarct
ion,st
abl eangina
pector
is;str
okeprophylaxi
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 76
ACTI
ON
Produceanalgesiaandr educei nfl
ammat ionandfeverby
i
nhibiti
ngtheproductionofpr ostaglandi
ns.Decreases
pl
ateletaggr
egation.Ther apeuti
cEf fect
s:Anal
gesia.
Reductionofinf
lammat i
on.Reduct ionoffever
.Decreased
i
ncidenceoftransientischemi cattacksandMI

DOSAGE
Pai
n/Fev
er
PO:
Rect(Adul
ts):325–1000mgq4–6hr( nott
oexceed
4g/
day)
.Extended-r
eleaset
abl
ets—650mgq8hror800
mgq12hr .
PO:Rect(
Chil
dren2–11yr
):10–15mg/
kg/
doseq4–6hr
;
maximum dose:4g/
day.

I
nfl
ammat
ion
PO: (
Adult
s):2.4g/dayini
ti
all
y;i
ncr
easedtomaint
enance
doseof3.6–5.4g/dayindivi
deddoses(upto7.
8g/day
foracut
erheumaticfever)
.
PO:(
Chi
l
dren):60–100mg/kg/dayi
ndivi
deddoses(
upt
o
130mg/
kg/dayforacut
erheumati
cfev
er).

Pr
event
ionofTr
ansi
entI
schemi
cAt
tacks

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 77
PO:
(Adul
ts)
:50–325mgoncedai
l
y.
Pr
event
ionofMy
ocar
dial
Inf
arct
ion/
Ant
ipl
atel
etef
fect
s
PO:(
Adul
ts)
:80–325mgoncedail
ySuspect
edacut
eMI
-
160mgassoonasMIissuspect
ed.
PO:(Chi
l
dren)
:3–10mg/ kg/
daygi
venoncedai
l
y(r
ound
dosetoaconv
enientamount
).

Kawasaki
Disease
PO:(Chi
ldren):80–100mg/kg/
dayin4divi
deddosesunt
il
fev
erresol
v es;
maybef ol
l
owedbymai nt
enancedoseof
3–5mg/ kg/dayasasingl
edoseforupto8wk..

AVAI
LABI
LITY
Tablet
s81mgOTC, 162.
5mgOTC, 325mgOTC, 500
mgOTC, 650mgOTC, 975mgOTC; Chewabl etablet
s80
mgOTC, 81mgOTC; Chewinggum 227mgOTC;
Disper
sibl
etablet
s325mgOTC, 500mgOTC; Enter
ic-
coated(del
ayed-r
elease)tabl
ets80mgOTC, 165mgOTC,
300mgOTC, 325mgOTC, 500mgOTC, 600mgOTC, 650
mgOTC, 975mgOTC; Extended-
releasetablets325
mgOTC, 650mgOTC, 800mg; Delay ed-
rel
easecapsul es
325mgOTC, 500mgOTC; Suppositori
es60mgOTC, 120
mgOTC, 125mgOTC, 130mgOTC, 150mgOTC, 160
mgOTC, 195mgOTC, 200mgOTC, 300mgOTC, 320

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 78
mgOTC, 325mgOTC, 600mgOTC, 640mgOTC, 650
mgOTC, 1.
2gOTC; Incombinationwit
h:antihi
stami
nes,
decongestant
s,coughsuppressant
sOTC, andopioi
ds.

Cont
rai
ndi
cat
ions
Hypersensit
ivi
ty(includingast hma; angioedema; urt
icar
ia
orrhi
niti
s)toacety l
salicyli
caci doranyot herNSAI D;
chi
ldr
enandadol escent sunder16y ears(maycause
Reye’
ssy ndrome) ;gastrointestinalulcerat
ion;haemophi l
ia
andotherbleedingdi sorders; notfort r
eatmentofgout ;
sever
er enalorhepat icimpai r
ment ; l
actation.I
tisknown
tocausehaemol yt i
canaemi ai npeopl ewhohav ethe
geneti
cdisease-G- 6-PD- def
iciency.

Pr
ecaut
ions
Asthma,all
ergi
cdisease;i
mpair
edrenalorhepati
c
funct
ionlact
ati
onpr egnancyel
der
ly;
G-6-PD-def
ici
ency
;
dehydrat
ion;i
nter
acti
ons.

Adv
erseEf
fect
s
General
lymildandinfr
equentf orl
owerdoses, but
commonwi t
hanti
-inf
lammat orydoses; gastroi
ntesti
nal
discomfor
tornausea, ul
cer
ationwit hoccultbleeding
(occasi
onall
ymajorhaemor r
hage) ;alsoother
haemorrhage(i
ncludi
ngsubconj unctival
);heari
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 79
di
st urbancessuchast innit
us( r
arel
y,deafness);ver
ti
go;
conf usi
on;hypersensit
ivi
tyreacti
ons(angioedema;
bronchospasm andr ash) ;i
ncreasedbleedingtime,bl
ood
di
sor ders(part
icul
arlythrombocy t
openia);rar
ely,
oedema;
my ocardit
is;Reye’
ssy ndrome.

PATI
ENT TEACHI
NG
I
nstructpati
enttotakesal
icy
lat
eswithaful
lglassof
waterandtor emaininanupri
ghtposi
ti
onfor15–30
minafteradmi ni
str
ati
on.

Advi
sepatientt
or epor
tti
nni
tus;
unusualbl
eedi
ngof
gums;brui
sing;
black,t
arr
ystool
s;orf
everl
asti
ng
l
ongerthan3day s.

Cautionpat ienttoavoidconcur r
entuseofal cohol
withthi smedi cat
iontomi ni
mi zepossiblegastri
c
i
rri
tation;3ormor eglassesofal coholperdaymay
i
ncreaset heriskofGIbleeding.Caut i
onpatientto
avoidt aki
ngconcur rentl
ywithacet aminophenor
NSAIDsf ormor ethanaf ewday s, unl
essdir
ectedby
healt
hcar eprofessi
onal t
opr eventanalgesi
c
nephropat hy.

Teachpati
ent
sonasodium-r
est
ri
cteddiettoavoid
eff
erv
escentt
abl
etsorbuf
fer
ed-
aspir
inpreparat
ions.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 80
 Tabl
etswithanacet
ic(
vinegar
-l
ike)odorshoul
dbe
di
scarded.

Advi
sepatientsonlong-
termt her
apytoinf
orm heal
th
car
eprofessional
ofmedi cat
ionregimenbefor
e
sur
gery
.Aspi ri
nmayneedt obewi thhel
dfor1wk
bef
oresurgery.

Pedi:CentersforDi seaseCont rolandPr ev

enti
on
warnsagai nstgivi
ngaspi ri
nt ochildr
enor
adolescentswi t
hv aricel
la(chickenpox)orinf
luenza-
l
ikeorv i
ralil
lnessesbecauseofapossi ble
associati
onwi thRey e’ssyndrome.

Transi
entIschemicAt t
acksorMI :Advisepat
ient
s
recei
vi
ngaspi r
inprophylacti
call
ytotakeonly
prescr
ibeddose.Increasingthedosehasnotbeen
foundtoprovideadditi
onal benef
it
s.

St
orage
Storepr
otect
edfr
om moi
stur
eatat
emper
atur
enot
exceedi
ng30⁰C.

Aci
tr
eti
n
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 81
Sev
erepsor
iasi
sunr
esponsi
vet
oot
hert
her
api
es.

ACTI
ON
Mechani
sm ofact
ionisnotknown.Ther
apeut
icEf
fect
s:
I
mprovementinpsor
iati
clesi
ons.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oret
inoi
dsor
parabens;Concurrentuseofalcohol ,
inanyform;Pat
ients
taki
ngmet hotrexateoratetr
acy cl
ine;Chr
onical
lyel
evated
bloodli
pids;Severehepati
corr enalimpair
ment ;
OB:
Lactat
ion:Pedi:Safet
ynotestabl i
shed.

UseCaut
iousl
yin:Concur
rentphot
other
apy(
int
ensi
tyof
t
reat
mentmayneedt
obeal
ter
ed)
.
Exer
ciseExt
remeCaut
ioni
n:Womenofchi
l
dbear
ingage.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: r
igors,depr ession,fati
gue, headache, pseudot umor
cerebr
i (
benigni ntracranialhypertension),sleepdi sor
der s.
EENT: dryeyes,epi staxi
s, i
rri
tati
on,blurredv isi
on, ↓ night
vi
sion/nightbli
ndness, drymout h, i
ntolerancetocont act
l
enses, l
ossofl ashesandbr ows, photophobi a,taste
dist
urbances,ti
nni tus.CV: edema.GI :HEPATOTOXI CITY,
PANCREATI TI
S, abdomi nalpain,anorexia,diarrhea,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 82
gingi
vit
is, nausea, stomat i
tis,v
omi ti
ng.Der m: alopecia,dry
skin,
nail disor der,peeli
ng,pruri
ti
s, r
ash,der mat iti
s,
sunburn, sweat i
ng.GU: hemat uri
a.Hemat :anemi a.Metab:
hyperl
ipidemi a(↑t ri
glyceri
des,↑t otalcholester ol,↓HDL),
hyperglycemi a,hyperkalemia,hypermagnesemi a,
hypernatremi a,hyperphosphatemi a,hyperuri
cemi a,
hypoglycemi a,hypomagnesemi a.MS: ar
thralgia,
hyperostosi s, myalgia.Misc:cheil
iti
s,paresthesi a,hot
fl
ashes.

I
NTERACTI
ONS
Drug-Drug:May↓ ef fect
ivenessofhor monal
contracepti
ves( especial
lymi crodosedpr ogestin
preparati
ons).May↑ hy pogl ycemicef fectsof
sulf
ony l
ureas.Alcohol ↑ conv ersi
ont oav erylong-acti
ng
compound( avoiduseofal cohol dur i
ngaci tr
et i
ntherapy
andf or2moaf terdisconti
nuat i
on) .Concur r
entusewi t
h
hi
ghdosesofv i
tami nA↑ r iskofhy pervi
tami nosisA.
Met hotr
exate↑ r iskofhepat otoxicity(avoidconcur r
ent
use).Tetracycl
inesmay↑ i ntracranial pr
essur e(avoid
concurrentuse).
Dr
ug-
Food:
Food↑ absor
pti
on.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 83
PO:
(Adul
ts)
:25or50mgoncedai
l
ywi
thameal
.

AVAI
LABI
LITY
Capsul
es10mg,
17.
5mg,
22.
5mg,
25mg;

PATI
ENTTEACHI
NG
Inst
ructpati
entt otakemedicat
ionasdi r
ected.Ifa
dosei smissed,ski
pdoseandr et urntoregular
schedule.Donotdoubl edoses.Inform pati
entthat
conditi
onmayappeart oworsendur ingini
tialt
herapy
.
Cautionpatientnottosharethi
smedi cati
onwi t
h
others;maybedanger ous.

Expl
aint
heDoYourPar
tpr
ogr
am t
ofemal
epat
ient
.

Cauti
onpati
entnottotakevi
tami
nAsuppl
ements
whil
etaki
ngacit
ret
in.Hyper
vit
aminosi
sAmayr
esult
.

Inst
ructpati
enttoimmediat
elyr epor
tdecr eased
visi
oninthedark,mooddist
ur bances,suicidal
thoughts,
orsignsandsympt omsofsev ereliv
er
damage( yel
lowingofski
norwhi t
esofey es,nausea
andv omit
ing,l
ossofappeti
te,darkurine).

I
nst
ructpat
ientt
ousecaut
ionwhendr
ivi
ngatni
ght
.

I
nstr
uctpati
ent
swithdiabetestoclosel
yfol
l
owblood
gl
ucoselev
elswhi
l
et akingacit
ret
in.andtor
epor
t

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 84
 si
gnif
icantchangesi
nbl
oodgl
ucosel
evel
stoaheal
th
car
epr ovi
der.

I
nform pati
entthatdryskinandchappedl
ipswil
l
occurandtoappl ylubr
icanttol
i
ps.Heal
thcar
e
prof
essionalshouldbenot i
fi
edift
hesesympt
oms
becomebot hersome.

Advisepati
entthatoralr
inses,sugar
lessgum or
candy ,
andfrequentoral
hy gi
enemayhel prel
i
evedr
y
mout h.

Discusspossi
bil
i
tyofexcessiv
elydryeyeswi
th
pati
entwhowear scont
actlenses.Pati
entmayneed
towearglassesduri
ngcourseoftherapy.

Cautionfemalepati
entswit
hr epr
oducti
vepotent
ial
nottoingestbever
agesorproductscontai
ning
al
cohol dur
ingorfor2moaf terdi
sconti
nuati
onof
acit
reti
n;maylengthenthet
imeofef f
ectson
pregnancy.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations,
especial
lySt
.John'sWor t.

Caut
ionpat
ientnott
odonat
ebl
oodwhi
l
etaki
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 85
 acit
ret
inandfor3y
rafterdisconti
nuati
ontoprev
ent
thepossi
bil
i
tyofapregnantpatientr
eceiv
ingt
he
blood.

Caut
ionpati
enttominimizeexposuret
osunl
ight
,to
wearsunscr
een,andtoav oi
dsunlampstopr
event
phot
osensit
ivi
tyr
eact
ions.

Acitretiniscont raindicateddur ingpr egnancyand

breast feeding.Ter atogeni cef fect smayper sistfor
years.Caut ionf emal epat i
ent stouset wor eli
able
formsofcont raceptionf or1mopr iorto, dur i
ng,and
foratl east3y rafterdi scontinuat ionoft her apy.
Patient swhohav eunder goneat ubal l
igat i
onshoul d
alsouseasecondf orm ofcont racept i
on.Pat ient
shoul ddi scusspastuseofaci tr
et inwi thheal thcare
professi onal bef oreat tempt ingpr egnancy .Sor i
atane
PatientRef erral Formi sav ailablet opr ovidepat ient
withi niti
alfreecont racept ivecounsel i
ngand
pregnancyt esting.Pat ientst hatbecomepr egnant
duri
ngorwi thin3y r
soft akingacet retinshoul dreport
thepr egnancyt oSt i
ef elat1- 888- 500- DERM ( 3376)or
totheFoodandDr ugAdmi nistration( FDA)MedWat ch
progr am at1- 800-FDA- 1088.

I
nfor
m pat
ientofneedf
orf
oll
ow-up.Per
iodi
c
opht
hal
micexamsandbonex-raysmayberequi
red.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 86
 Emphasizetheimport
anceofregul
arbl
oodt
est
sto
checkl
ipidsandhepati
cfunct
ion.

Acl
ovat
e
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Contr
aindicat
edin:Hyper
sensi
ti
vit
yorknownintoler
ance
tocor
ticoster
oidsorcomponentsofv
ehicl
e(ointment
baseorpreservati
ves)
;Unt
reat
edbacter
ial
orviral
i
nfect
ions.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
es
mell
itus,
cataract
s,gl
aucoma, ortuber
culosis(i
f
si
gnifi
cantsystemicabsorpti
onoccurs,condit
ionmay
worsen);Pati
entswithpre-exi
sti
ngskinatrophy;OB:
Lact
ati
on:Chr
oni
cuseathi
gh-
dosagesmayr
esul
tin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 87
adr
enalsuppr
essi
oninmotherandgr
owthsuppressi
oni
n
chi
l
dren;Pedi
:Chi
l
drenmaybemor esuscept
ibl
eto
adr
enalandgrowt
hsuppr
ession.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topical
:(Adul
ts)
:Applytoaff
ect
edarea(s)2–3t
imes
dai
ly(dependsoncondit
ionbei
ngtr
eated).

AVAI
LABI
LITY
Cr
eam 0.
05%;
Oint
ment0.
05%;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientoncor
rectt
echni
queofmedi
cat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 88
 admi ni
str
ati
on.Emphasizei
mportanceofavoi
dingt
he
eyes.Applymisseddosesassoonasr emembered
unlessalmostti
mef ort
henextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Caut i
onwoment hatmedicati
onshouldnotbeused
extensiv
ely,
inl
argeamount s,
orforprot
ract
ed
periodsift
heyarepregnantorpl
anningtobecome
pregnant.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onali
f
symptomsofunder l
yingdiseaser
etur
norwor senor
i
fsympt omsofinfect
iondev el
op.

Act
emr
a
I
NDI
CATI
ONS
Treat
mentofadult
swi
thmoder
atel
y-tosever
ely
-act
ive
rheumat
oidar
thri
ti
swhohav
enotrespondedtooneor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 89
moretumornecr osi
sfactor(TNF)ant agonistt
herapies
(maybeusedal oneorwithmet hotrexateorotherdisease-
modify
inganti
rheumaticdrugs[DMARDs] ).Acti
ve
syst
emicjuveni
leidi
opathicart
hrit
is.

ACTI
ON
Actsasi ninhibi
torofi
nterl
eukin-6(I
L-6)recept
orsby
bi
ndingt othem.I L-
6isamedi atorofvarious
i
nflammat oryprocesses.TherapeuticEff
ects:Sl
owed
pr
ogr essi
onofr heumatoidarthri
tisorsystemicj
uveni
le
i
diopathicarthri
ti
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hyper
sensi
ti
vi
ty;
Ser
iousi
nfect
ions;
Acti
vehepati
cdisease/
impairment
;Absol
uteneutr
ophil
count(
ANC)<2000/ mm3( <500/mm3whileontherapy
)or
pl
atel
etcountbelow100,000/mm3(<50,
000/mm3whi le
onther
apy).Lact
ati
on:Notrecommended.

UseCaut
iousl
yin:
Pat
ient
satr
iskf
orGIper
for
ati
on,
i
ncludi
ngpat i
entswi t
hdivert
iculi
ti
s;Renalorhepatic
i
mpai r
ment;Patientswithtubercul
osisri
skf act
ors;Ger
i:
↑r i
skofadv er
ser eacti
ons;OB: Useonlyifpotenti
al
benefi
tjust
if
iespotentialr
isktofetus;Pedi:
Safetyand
nessnotestabli
shed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 90
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,dizziness.EENT: nasophar y ngi
ti
s.Resp:
upperrespirat
orytractinfect
ions.CV: hypertensi
on.GI:
GASTROI NTESTINALPERFORATI ON, ↑l iverenzy mes.
Derm: rash.Hemat :NEUTROPENI A,
THROMBOCYTOPENI A.Met ab:↑l i
pids.Mi sc:SERIOUS
I
NFECTI ONSINCLUDI NGTUBERCULOSI S, DISSEMI NATED
FUNGALI NFECTIONSANDI NFECTI ONSWI TH
OPPORTUNI STICPATHOGENS, hy persensitivi
tyreact
ions
i
ncludinganaphy l
axis,inf
usionreact i
ons.

I
NTERACTI
ONS
Drug-
Dr ug:Mayal t
ertheact ivi
tyofCYP450enzy mes;the
eff
ectsoft hef ollowingdrugsshoul dbemoni tored:
cycl
ospor i
ne,theophy ll
ine,war fari
n, hor monal
contr
acept i
ves, atorvastatinandl ov astati
n.Otherdrugs
whichar esubst ratesforthi ssy stem shoul dalsobe
monitored;effectmayper sistforsev eralweeksaf t
er
di
scont i
nuation.May↓ ant i
bodyr esponset oand↑ r i
sk
ofadverser eactionst oliv
ev i
rusv accines;donot
administerconcur r
ently.

DOSAGE
Rheumat
oidAr
thr
it
is

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 91
I
V:(Adul
ts):4mg/kgev
ery4wk;maybe↑ to8mg/
kg
gi
venevery4wkbasedoncl
ini
cal
response.

Sy
stemi
cJuv
eni
l
eIdi
opat
hicAr
thr
it
is
I
V:(
Chi
l
dren≥2y
rand<30kg)
:12mg/
kgev
ery2wk.
I
V:(
Chi
l
dren≥2y
rand≥30kg)
:8mg/
kgev
ery2wk.

AVAI
LABI
LITY
Sol
uti
onf
orI
Vinf
usi
on(
requi
resdi
l
uti
on)20mg/
mL;

PATI
ENTTEACHI
NG
Inst
ructpati
entont hepurposefortoci
li
zumab.I
fa
doseismi ssed,contactheal
thcareprof
essi
onalt
o
schedulenextinfusi
on.

Caut i
onpat ienttonot ifyheal t
hcar epr ofessional
i
mmedi at
elyifsignsofi nfecti
on( fever,sweat i
ng,
chill
s,muscl eaches, cough, shortnessofbr eath,
bloodi nphlegm, wei ghtl oss,war m, r
edorpai nful
skin
orsor es,diarr
heaorst omachpai n, burningon
urinati
on, uri
naryf r
equency ,feel
ingt i
red),feverand
stomach- areapai nthatdoesnotgoaway ,change
bowel habit
s,sev er
er ash, swol l
enf ace,ordi ff
icul
ty
breathingoccur swhi let aking.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 92
 al
lRxorOTCmedicati
ons,
vit
amins,
orherbal
pr
oductsbei
ngt
akenandconsul
thealt
hcare
pr
ofessi
onal
bef
oretaki
nganynewmedi cat
ions.

I
nst
ructpat
ienttonot
if
yheal
thcarepr
ofessi
onalof
medi
cati
onregimenpri
ortot
reat
mentorsurgery
.

Act
ici
n
I
NDI
CATI
ONS
1%loti
on: Eradicat
ionofPediculushumanuscapiti
s(head
l
iceandt heireggs):Pr
event
ionofi nfest
ati
onofheadli
ce
duri
ngepi demics.5%cream: Eradicati
onofSar
coptes
scabi
ei(scabies).

ACTI
ON
Causesrepolar
izat
ionandparal
ysi
sinli
cebydi
srupti
ng
sodi
um transporti
nnormalnerv
ecell
s.Ther
apeuti
c
Eff
ects:
Deat hofparasi
tes.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oper
met
hri
n,
pyrethr
ins(i
nsect
ici
desorvet
eri
nar
ypesti
cides),
chrysanthemums,orisopr
opy
lal
cohol
;Lactati
on:
Lactati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 93
UseCaut
iousl
yin:OB:Useonl
yifcl
ear
lyneeded;
Pedi
:
Chi
l
dren<2y
r(1%l
oti
on)
;Chi
l
dren<2mo(
5%cr
eam)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm:burni
ng,i
tchi
ng,rash,
redness,
sti
ngi
ng,
swel
l
ing.
Neuro:numbness,t
ingl
i
ng.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nosi
gni
fi
canti
nter
act
ions.

DOSAGE
HeadLi
ce(
Treat
mentandPr
event
ion)
Topical
:(Adul
tsandChi
l
dren>2yr):1%lot
ionappli
edto
thehair
,lef
tonfor10min,
thenr
insed,f
or1applicat
ion.
Scabi
es
Topi
cal
:(Adul
tsandChi
l
dren):
Massage5%cream i
ntoal
l
ski
nsur
faces.Leav
eonfor8–14hr
,thenwashof
f.
Topical:(
Inf
ants>2mo):
Massage5%cr eam i
ntohai
rl
ine,
scalp,neck,
temple,
andfor
ehead.Leav
eonfor8–14hr ,
thenwashof f.

AVAI
LABI
LITY
Li
qui
dcr
eam r
inse(
lot
ion)1%OTC;
Cream 5%;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 94
PATI
ENTTEACHI
NG
Inst
ructpati
entt
onoti
fyheal
thcareprof
essi
onali
f
scal
pi t
ching,
numbness,r
edness,
orrashoccur
s.

I
nstructpat
ienttoavoidgett
ingEli
mit
ecream i
neyes.
I
fthisoccurs,ey
esshoul dbefl
ushedthor
oughl
ywith
water.Heal
thcareprofessi
onalshoul
dbecontact
ed
i
feyei r
ri
tat
ionpersi
sts.

Advi
sepat
ientt
hatother
sresi
dingi
nthehomeshoul
d
al
sobecheckedforl
i
ce.

Instructpatientonmet hodsofpr ev
ent ing
reinfestati
on.Al lclothes,includingout doorappar el
andhousehol dl inens,shoul dbemachi ne-washed
usingv eryhotwat eranddr i
edf oratleast20mi nina
hotdr yer.Dry-cleannonwashabl eclothes.Br ushes
andcombsshoul dbesoakedi nhot( 130° F),soapy
wat erfor5–10mi n.Remi ndpat ientthatbr ushesand
combsshoul dnotbeshar ed.Wi gsandhai rpi
eces
shoul dbeshampooed.Rugsanduphol st
ered
furnitur
eshoul dbev acuumed.Toy sshoul dbe
washedi nhot ,soapywat er.Itemst hatcannotbe
washedshoul dbeseal edinapl asticbagf or2wk.

I
fpati
enti
sachil
d,i
nstr
uctparent
stonot
if
yschool
nur
seordaycar
ecentersothatcl
assmat
esand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 95
 pl
aymat
escanbechecked.

HeadLi ce:Instructpat ientt owashhai rwi thregular

shampoo, r
inse, andt owel dry.Eachcont ainerholds
enoughmedi cationf oronet reatment.Shaket he
containerwell.Thor oughl ywetscal pandhai rwiththe
l
otion.Thepat ientshoul duseasmuchoft hesoluti
on
asneededt ocoatent ireheadofhai r,t
hendi scard
remainderofsol ution.Al lowl otiontoremai nonhai r
for10mi n,
thent horoughl yrinsehairandt owel dry
withacl eantowel .Combhai rwithafine-toothed
combt oremov edeadl iceandeggs( notnecessar y
butmaybedesi redf orcosmet i
ceffects)
.Pr oducts
areavailabl
ef orr emov al ofni t
s( Ri
dLiceEgg
LoosenerGel ®St ep2) .School susuallyrequire
chil
drent obeni t-freepr iort oreturni
ngt oschool .

Explai
nt opat
ientthatper
met hr
inwill
prot
ectfr
om
rei
nfestati
onfor2wk.Theseef fect
sconti
nueeven
whent hepati
entresumesr egul
arshampooing.

Scabies:Instr
uctpatienttomassaget horoughlyinto
theskinfrom headt osolesoffeet.Treatinf
antson
thehairl
ine,neck,
scal p,t
emple,andforehead.
Remov et hecream bywashi ngaft
er8–14hr .Usuall
y
30g( ½t ube)issuffi
cientforadul
ts.Oneappl i
cation
i
scurat i
ve.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 96
Act
inomy
cinD
I
NDI
CATI
ONS
Aloneorwi t
hot hertreatmentmodal i
ti
esinthe
managementof :Wilms’ t
umor ,Rhabdomyosarcoma,
Ewing’
ssar coma, Trophoblasti
cneoplasms,Testi
cular
carci
noma, Met ast
aticnonsemi nomatoustest
icul
ar
cancer,Gestati
onaltrophoblasti
cneoplasi
a.Asa
componentofr egional per
fusionfortr
eatmentoflocal
ly
recur
rentsolidmal i
gnancies.

ACTI
ON
I
nhibit
sRNAsy nt
hesisbyformingacompl exwithDNA
(cel
l-
cycl
ephase–nonspecif
ic)
.Therapeut
icEffect
s:Deat
h
ofrapi
dlyrepl
i
cat
ingcell
s,part
icul
arl
ymalignantones.
Alsohasimmunosuppressiv
epr oper
ti
es.

I
NTERACTI
ONS
Drug-Drug:↑ bonemar rowdepr essionwit
hother
anti
neoplasti
csorr adi
ationtherapy.May↓ anti
body
responsetoli
v e-
vir
usv accinesand↑ r i
skofadver
se
reacti
ons(avoidconcurrentuse).

Av
ail
abi
l
ity
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 97
I
NJECTI
ONVi
al500mg.

Dose
I
ntr
avenousi
nject
ion
Adul
tandchil
dabove6mont hs-15µg/
kg/day
.Pr
inci
pal
l
y
usedt
otreatpaedi
atr
iccancer
s.

Cont
rai
ndi
cat
ions
Seenotesaboveandconsultl
it
erature;
hyper
sensi
tiv
ity
;
l
actati
on;i
nfect
ionwit
hchil
dren;herpeszost
er;
pregnancy
(Appendi
x7c)andlact
ati
on.

Pr
ecaut
ions
Acti
veinf
ecti
ons;I
mmunosupressedpati
ents;
Concurr
ent
radi
ati
onther
apy;Hepati
cdy
sfuncti
on;Pat
ient
swith
chil
dbear
ingpot
enti
al.

Adv
erseEf
fect
s
CNS: l
et hargy,malai
se.GI:anorexi
a,nausea,stomati
tis,
vomiting,abdomi nalpai
n,ascit
es,diar
rhea,dysphagia,
esophagi ti
s,hepatot
oxici
ty,ul
cerat
ion.Derm: acne,
alopecia,eryt
hema

PATI
ENT TEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 98
Instr
uctpat i
enttonotifyhealt
hcar epr ofessionalif
fever;chill
s;sorethroat;si
gnsofi nfection;bleeding
gums; bruisi
ng;petechiae;orbloodinur ine,stool,or
emesi soccur s.Cautionpat i
enttoav oidcr owdsand
personswi thknowni nfecti
ons.Instructpat i
enttouse
softtoot hbrushandel ectr
icrazor.Caut ionpatientnot
todrinkal coholi
cbev eragesort akepr oducts
containingaspi r
inorNSAI Ds; mayincr easeGI
i
r r
it
ation.

Inst
ructpati
entt oinspector
almucosaf oreryt
hema
andulcerat
ion.Ifulcerat
ionoccur
s,advisepati
entto
usespongebr ushandr i
nsemouthwi t
hwat eraft
er
eati
nganddr inking.Stomati
ti
smayr equir
etreatment
withopioi
danal gesics.

I
nf orm patientthatthi
smedicat i
onmaycause
i
rreversiblegonadal suppr
ession.Advisepat
ientt
hat
thi
smedi cationmayhav eteratogeni
ceffect
s.A
nonhor monal methodofcontracepti
onshouldbe
useddur i
ngt herapyandforatleast4moaf ter
therapyisconcl uded.

Discusswithpat
ientthepossi
bil
i
tyofhai
rloss,
whi
ch
usuall
yoccurs7–10day saft
eradmini
str
ati
on.
Explorecopi
ngstrat
egies.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 99
 I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

I
nf orm patientthatthi
smedicat i
onmaycause
i
rreversiblegonadal suppr
ession.Advisepat
ientt
hat
thi
smedi cationmayhav eteratogeni
ceffect
s.A
nonhor monal methodofcontracepti
onshouldbe
useddur i
ngt herapyandforatleast4moaf ter
therapyisconcl uded.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

ALTEPLASE
I
NDI
CATI
ONS
Acutemy ocardi
alinfarct
ion(MI)
.Acuteischemicstr
oke.
Pulmonaryembol i
sm ( PE).Occl
udedcentralv
enous
accessdevices.UnlabeledUses:Deepvenoust hr
ombosis
(DVT).Acuteperi
pher alart
eri
alt
hrombosis.

ACTI
ON
Dir
ectlyconvert
splasminogentoplasmin,
whichthen
degradesclot-
boundfi
brin.Ther
apeuti
cEffect
s:Lysi
sof
thr
ombi incoronar
yarteri
es,wit
himprovementof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 100
ventr
icularfunct
ion,andr
educedri
skofheartfail
ureor
death.Lysisofpulmonaryemboli
.Lysi
softhrombi
causingischemicst r
oke,
reduci
ngri
skofneurologic
sequelae.Restorati
onofcannul
aorcathet
erfuncti
on.

CONTRAI
NDI
CATI
ONS
Cont r
aindicat
edin: Acti
veint er
nalbl
eedi
ng;Historyof
cerebrovascularaccident(forMIandPEonl y);Recent
(withi
n3mo)i ntr
acr ani
alori nt
raspi
nali
njur
yort r
auma;
Int
racranialneoplasm, ar
teriovenousmalfor
mat i
on,or
aneurysm;

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: I
NTRACRANI ALHEMORRHAGE.EENT: epistaxis,
gingi
valbleeding.Resp: bronchospasm, hemopt ysis.CV:
reperf
usionarrhythmias, hypotension,RECURRENT
ISCHEMI A/THROMBOEMBOLI SM.GI :GIBLEEDI NG,
nausea,RETROPERI TONEALBLEEDI NG, v omi t
ing.GU: GU
TRACTBLEEDI NG.Derm: ecchymoses, fl
ushi ng, urt
icaria.
Hemat :BLEEDI NG.Local :hemor r
hageati njecti
onsi te,
phlebi
ti
sati nj
ectionsite.MS: muscul oskel etalpain.Mi sc:
all
ergi
cr eacti
onsi ncl
udinganaphy laxis,fev er.

DOSAGE
My
ocar
dial
Inf
arct
ion(
Accel
erat
edorFr
ont
-Loaded

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 101
Regi
men)
I
V: (
Adults):15mgbolus,then0.
75mg/ kg(upto50mg)
over30mi n,then0.
5mg/ kg(upt
o35mg)ov ernext60
min;usuall
yaccompaniedbyhepari
ntherapy.
My
ocar
dial
Inf
arct
ion(
Standar
dRegi
men)
I
V:(Adults>65kg):60mgover1sthr(
6–10mggivenasa
bol
usov erfi
rst1–2min)
,20mgov ert
he2ndhr
,and20
mgov erthe3rdhrforat
otal
doseof100mg.
I
V: (
Adult
s<65kg):0.
75mg/ kgover1sthr(
0.075–0.
125
mg/ kggi
venasabolusoverfir
st1–2min),
0.25mg/kg
overthe2ndhr
,and0.25mg/ kgovert
he3rdhrforatot
al
doseof1.25mg/kg(nott
oexceed100mgt otal
).
Acut
eIschemi
cSt
roke
I
V: (
Adult
s) :
0.9mg/kg(nott
oexceed90mg),gi
venasan
i
nfusionover1hr,
with10%ofthedosegi
venasabolus
overthe1stmin.
Pul
monar
yEmbol
i
sm
I
V:(
Adul
ts)
:100mgov
er2hr
;fol
l
owwi
thhepar
in.
Occl
udedVenousAccessDev
ices
I
V: (
Adul
tsandChil
dren>30kg) :
2mg/2mLinsti
ll
edi
nto
occl
udedcathet
er;
ifunsuccessf
ul,
mayr
epeatonceaf
ter

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 102
2hr
.
I
V: (
Adul
tsandChil
dren<30kg) :
110%ofthelumen
vol
ume(nottoexceed2mgi n2mL)inst
il
ledi
nto
occl
udedcathet
er;
ifunsuccessf
ul,
mayrepeatonceaf
ter
2hr.

AVAI
LABI
LITY
Powderf
ori
nject
ion2mg/
vial
,50mg/
vial
,100mg/
vial
;

PATI
ENTTEACHI
NG
Explainpurposeofmedi cati
onandtheneedforclose
moni t
oringtopatientandf amil
y.I
nstr
uctpati
entto
reporthypersensi
tivi
tyreacti
ons(r
ash,dyspnea)and
bleedingorbruisi
ng.

Explainneedforbedr
estandminimalhandlingdur
ing
therapytoavoidi
njur
y.Avoi
dallunnecessary
proceduressuchasshavingandvigoroustooth
brushing.

Act
ivat
edChar
coal
I
ndi
cat
ions
Tr
eat
mentofacut
epoi
soni
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 103
ACTI
ON
Bindsdrugsandchemi cal
sintheGItract
.Ther
apeut
ic
Effect
s:Decr
easedintesti
nalabsorpt
ionofdr
ugsor
chemicalsi
ntheoverdosesituati
on.

I
NTERACTI
ONS
Drug-Drug:Otherdrugsincl
udingi
pecacsyrup
andlaxati
veswillbeadsorbedbycharcoalandasar esul
t
wil
lnotbesy stemicall
yabsorbedfr
om theGItract
.
Drug-Food:
Milk,i
cecream,orsher
betwil
ldecr
easet
he
abil
i
tyofcharcoaltoabsor
botheragent
s.

Av
ail
abi
l
ity
POWDER(
foror
alsuspensi
on)
,TABLETS500mg.

Dose
Or
al
Adultandchi
l
dov er12year
s-50g,0.
5g/
kgmaybe
repeat
edevery4-
6hf orupto12-
24h.
Chil
d-Bel
ow12y
ear
s;1g/
kg(
max50g)
.Mayber
epeat
ed
ever
y4h.

Cont
rai
ndi
cat
ions
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 104
Poisoningbyhydr
ocar
bonswi t
hhighpotenti
alforharmif
aspir
at ed;
poi
soni
ngbycorrosi
vesubstances-
maypr event
vi
sualizati
onofl
esi
onscausedbypoison.

Pr
ecaut
ions
Drowsyorunconsci ouspatients-r
iskofaspi
ration
(i
ntubatebef
or eadminist
rationv i
anasogastri
corgastri
c
tube);
noteffecti
veforpoisoningwi thal
cohols,
clof
enotane(dicophane,DDT) ,cyani
des,malathionand
met al
salt
sincludingir
onandl ithi
um.

Adv
erseEf
fect
s
Blackst
ool
s;vomi
ti
ng,consti
pat
ionordi
arr
hoea;
pneumonit
is-
duet
oaspirat
ion

PATI
ENTTEACHI
NG
I
nfor
m pat
ientt
hatst
ool
swi
l
ltur
nbl
ack.

Poisoning:Whencounsel i
ng,discussmet hodsof
preventi
on,needtoconf erwi
thpoi soncontrolcenter
,
physici
an,oremer gencydepartmentbef ore
admi ni
ster
ing,andneedt obri
ngi ngestedsubstance
toemer gencydepartmentforidentif
icati
on.

St
orage

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 105
St
orepr
otect
edf
rom moi
stur
e.

Acy
clov
ir
I
ndi
cat
ions
Treatmentofpri
mar ygeni
talher
pes;
dissemi
nat
ed
Varicel
l
a-zost
erini
mmunocompr omi
sedpati
ent
s;Her
pes
si
mpl exencephal
it
is;chi
ckenpox.

ACTI
ON
I
nterf
ereswit
hv i
ral
DNAsy nthesis.Ther
apeuticEff
ect
s:
I
nhibi
ti
onofviral
repli
cat
ion, decreasedvi
ralsheddi
ng,and
r
educedt i
meforheali
ngofl esions.

Av
ail
abi
l
ity
TABLETSPl
ain/DT200,
400and800mg;SUSPENSION
400mg/5ml;INFUSI
ON100ml (
aft
err
econst
it
uti
on)(
250
mg);OI
NTMENT5g( 3%w/w)
;DROPS5ml (3%w/w);
CREAM 5g(
5%w/ w).

DOSAGE
Or
al
Adul
t-Non-
geni
tal
her
pessi
mpl
ext
reat
ment
,200mg

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 106
 fi
vetimesdailyusual
lyfor5days,l
ongeri
fnew
l
esionsappearduringtreat
mentorifheal
i
ngis
i
ncompl et
e.400mgf orimmunocompromised
pati
entsorifabsorpt
ionisimpai
red.

Genit
alherpessi
mplextr
eatment
;200mg5t i
mes
dai
lyfor5daysor400mgt hreet
imesdail
yforthr
ee
days.Longeri
fnewlesi
onsappearorheal
ingis
i
ncompl et
e.

I
mmunocompr omisedorHIVposi
ti
vepat
ients;
400
mgi sgi
venfi
vetimesdailyf
or7to10daysduring
fi
rstepi
sodeor400mgt hreeti
mesadayf or5to10
daysduri
ngrecurr
entinj
ecti
on.

Her
pessimpl
exprev
entionofrecurr
ence;200mg4
t
imesdail
yor400mgtwi cedai
lyreducedto200mg
t
woort hr
eeti
mesdail
yinter
ruptedevery6to12
months.

Vari
cel
laandher
peszost
er;
800mgf
ivet
imesdai
l
y
for7days.

Chi
ckenpox;
800mgf
ivet
imesdai
l
yfor7t
o10day
s.

I
ntr
avenousi
nfusi
on
Sever
einit
ialgeni
tal
her
pes,Vari
cel
l
azoster,
Herpes
si
mplexinfecti
on;5mg/kgbodyweightev
ery8hfor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 107
 f
iveday
s.

Chil
d-Under2y
ear
s;hal
fdose.Abov
e2y
ear
s;adul
t
dose.

Vari
cell
aandherpeszoster
;20mg/ kgbodywei ght
(max.800mg)fourtimesdail
yfor5days,under2
years200mgfourtimesdail
y,for2to5years;400
mgf ourti
mesdail
y.Over6years;800mgf ourti
mes
dail
y.

Chickenpox;
20mg/ kgbodywei
ght(
max800mg)
fourti
mesdail
yfor5days.

I
NTERACTI
ONS
Drug-Drug:Probenecid↑ bl
oodl ev
elsofacy cl
ovi
r.↑
bl
oodl evelsandr i
skoftoxi
cit
yfrom theophyll
i
ne;dose
adjustmentmaybenecessar y.↓ bloodlevelsandmay↓
eff
ectivenessofv al
proi
cacidorpheny t
oin.Concurrent
useofot hernephrotoxi
cdrugs↑ riskofadv er
ser enal
eff
ects.ZidovudineandITmet hotr
exatemay↑ r iskof
CNSsi deef f
ects.

Cont
rai
ndi
cat
ions
Hyper
sensi
ti
vi
ty;
glaucoma;
psy
chi
atr
icdi
sease;
depr
essi
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 108
Pr
ecaut
ions
Maint
ainadequat
ehy dr
ati
on;
renal
impai
rmentl
act
ati
on
pr
egnancypaediatr
ics.

Adv
erseEf
fect
s
Nausea, vomi ti
ng, abdomi nalpain, di
arrhoea, headache,
fat
igue,rash, urt
icar i
a, prurit
us,phot osensiti
vity;rar
ely,
hepati
tis,jaundice, dyspnoea, angioedema, anaphy l
axis;
neurol
ogi calreactions( i
ncludingdi zzi
ness, conf usi
on,
hal
lucinations,drowsi ness) ,
acuter enalfail
ure; decrease
i
nhaemat ological i
ndi ces; onintravenousi nfusion,severe
l
ocal i
nflammat i
on( somet imesr esul t
inginul cerati
on),
fever
,agi t
ation,tremor ,psychosisandconv ulsi
ons
somnol ence, vi
sual abnor maliti
es.

PATI
ENTTEACHI
NG
I
nst ructpati
entt ot akemedi cati
onasdi r
ect
edforthe
fullcourseoft herapy .Takemi sseddosesassoonas
possi bl
ebutnotj ustbef orenextdosei sdue;donot
doubl edoses.Acy clovirshouldnotbeusedmor e
frequentlyorlongert hanpr escri
bed.

Advi
sepat
ient
sthatt
headdi
ti
onaluseofOTCcreams,
l
oti
ons,
andointment
smaydelayheal
ingandmay

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 109
 causespr
eadi
ngofl
esi
ons.

I
nf or
m pati
entt
hatacycl
ovi
risnotacure.Thevi
rus
l
iesdormantinthegangl
ia,
andacyclov
irwil
lnot
preventt
hespreadofinf
ect
iontoother
s.

Advisepati
entthatcondomsshouldbeuseddur
ing
sexualcontactandthatnosexual
cont
actshoul
dbe
madewhi lelesi
onsarepresent
.

Pat i
entshouldconsulthealt
hcareprof essi
onalif
sy mptomsar enotreli
evedafter7day softopical
therapyoriforalacycl
ovirdoesnotdecr easethe
frequencyandsev eri
tyofrecurr
ences.
Immunocompr omisedpat i
entsmayr equirealonger
ti
me, usuall
y2weeks, f
orcrusti
ngoverofl esi
ons.

I
nstructwomenwi t
hgenital
her
pestohavey
ear
ly
Papanicol
aousmearsbecausetheymaybemor
e
l
ikel
ytodev el
opcervi
cal
cancer
.

Topical:I
nst ructpatienttoapplyointmentinsuffi
cient
quantit
yt ocov erall l
esionsevery3hr ,
6t i
mes/dayf or
7day s.0.5-i
n.r i
bbonofoi ntmentcovers
approximat ely4squar ein.Useaf i
ngercotorglove
whenappl y
ingt opr eventinoculat
ionofotherar
easor
spreadt oot herpeopl e.Keepaffectedareascl
ean
anddr y.Loose- fi
tt
ingcl othi
ngshouldbewor nto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 110
 pr
eventi
rr
it
ati
on.

Avoiddrugcontactinoraroundeyes.Reportany
unexplai
nedeyesy mptomst oheal
thcare
prof
essional
immedi atel
y;ocul
arherpet
icinfect
ion
canleadtobli
ndness.

St
orage
Stor
etablet
sprotectedfrom l
i
ght.Fori
nfusi
on:St
ore
prot
ectedfrom moistur
einaster
iletamperevi
dent
contai
nerseal
edsoast oexcl
udemi cr
o-or
gani
smsata
temperat
urenotexceeding30⁰C.

Adenosi
ne
I
ndi
cat
ions
Coronaryvasodil
ator
;par
oxysmalsupr
avent
ri
cul
ar
tachycar
dia;car
diaci
magingfor
cor
onar
yar
ter
ydi
sease;
angi
napect
ori
s.

ACTI
ON
Restor
esnormalsi
nusrhyt
hm byint
err
upt i
ngre-ent
rant
pathwaysi
ntheAVnode.Slowsconductionti
met hrough
theAVnode.Al
soproducescoronar
yarteryvasodil
ati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 111
Ther
apeut
icEf
fect
s:Rest
orat
ionofnor
mal
sinusr
hyt
hm.

Av
ail
abi
l
ity
TABLETS40,
80and120mg(
DT)
;INJECTI
ON2ml
ampoule(
3mg/ml)
.

DOSAGE
Or
al
40t
o80mg,
3to4t
imesdai
l
y(Max.480mg/day
).

Rapi
dint
rav
enousi
nject
ion(
int
ocent
ral
orl
arge
per
ipher
alv
ein)
3mgev er
y2secondswit
hregularcar
diacmonitori
ng,
if
necessary
,fol
lowedby6mgev ery1to2min.Increment
shouldnotbegiveni
fhi
gherl
evelAVblockoccursatany
part
icul
ardose.

I
NTERACTI
ONS
Drug-Drug: Car
bamazepinemay↑ r i
skofprogressiv
e
heartblock.Dipyri
damole↑ eff
ectsofadenosine(dose↓
ofadenosi nerecommended).Eff
ectsofadenosine↓ by
theophyll
ineorcaf fei
ne(
↑ dosesofadenosinemaybe
requi
red).Concur r
entusewit
hdigoxi
nmay↑ r i
skof
ventr
icularfibr
il
lat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 112
Cont
rai
ndi
cat
ions
Second-ort hird-
degreeAVblockandsicksinussyndrome
(unlesspacemakerf itt
ed)
,acut
emy ocardi
alinf
arct
ion,
cardiovascularshock;ast
hma.

Pr
ecaut
ions
Atri
alfi
bri
ll
ationorfl
utt
erwithaccessor
ypathway
(conducti
ondownanomal ouspathwaymayincr
ease)
;
hearttr
ansplant;
pregnancy(Appendi
x7c).

Adv
erseEf
fect
s
Transi
entfaci
al fl
ush,chestpai
n,dyspnoea,
bronchospasm, chokingsensat
ion,nausea,l
ight
-
headedness;severebr ady
cardi
areported(r
equir
ing
temporarypacing);ECGmayshowt ransi
entrhyt
hm
dist
urbances;edema; consti
pat
ion.

PATI
ENTTEACHI
NG
Cautionpat
ientt
ochangeposi t
ionssl
owl yto
minimizeort
hostat
ichy potensi
on.Doses>12mg
decreaseBPbydecr easingperi
pheralvascul
ar
resi
stance.

I
nst
ructpat
ientt
orepor
tfaci
alf
lushi
ng,
shor
tnessof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 113
 br
eat
h,ordi
zzi
ness.

Adr
enal
i
ne(
Epi
nephr
ine)
I
ndi
cat
ions
Sever
eanaphy
lacti
creacti
on;
sev
ereangi
oedema;
car
diac
arr
est
;hemost
aticagent.

ACTI
ON
Resultsintheaccumul ationofcy cl
icadenosi ne
monophosphat e( cAMP)atbet a-adrener gicreceptors.
Affect
sbot hbet a1( cardiac)-adrenergicrecept orsand
beta2(pulmonar y)-adrener gi
cr ecept orsites.Produces
bronchodilati
on.Al sohasal pha- adrenergicagoni st
properti
es, whi
chr esultinv asoconst ri
ction.Inhibit
sthe
rel
easeofmedi ator sofi mmedi atehy persensiti
vity
reacti
onsf rom mastcel ls.Ther apeut i
cEf fect
s:
Bronchodilati
on.Mai ntenanceofhear trateandBP.
Locali
zation/prolongat ionofl ocal /
spinal anestheti
c.

Av
ail
abi
l
ity
I
NJECTI
ON1ml
ampoul
e(1mg/
ml)
.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 114
I
ntr
amuscul
ari
nject
ion
Anaphyl
axis:
pr ef
erabl
esit
eisthemidpoi
nti
nanter
ior
thi
gh[1:
1000sol ut
ion]
.Thi
srouteshoul
dbeusedby
speci
ali
stsonlywithext
remecare.

Sl
owi
ntr
avenousi
nject
ion
Whent herei
sdoubtregar
dingadequacyofcirculat
ionand
absor
pt i
onfrom t
heint
ramuscul
arsit
e;sl
owi ntravenous
i
nject
ionof1:10000(10mg/ ml
)solut
ionbeinjectedin
sever
elyil
lpati
entsonl
y.

Cont
rai
ndi
cat
ions
Narr
owanglegl
aucoma,organi
cbr
aindamage,
car
diac
di
lat
ion,
cor
onar
yinsuf
fi
ciency.

Pr
ecaut
ions
Hyper
thyr
oidi
sm, hypertensi
on,di
abetesmelli
tus,heart
di
sease,
arrhyt
hmi as,cerebr
ovascul
ardisease;second
st
ageoflabour;el
derl
y ;i
nter
acti
onspregnancylactati
on

Adv
erseEf
fect
s
“Epi
nephri
nefastness”,t
achycardi
aandar r
hythmias,
hyper
tensi
on,tr
emor ,anxi
ety,sweati
ng,nausea,v
omiting,
weakness,hy
perglycaemia,di
zziness,pul
monaryoedema

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 115
hav
eal
lbeenr
epor
ted;
headachecommon.

PATI
ENTTEACHI
NG
Inst
ructpatientt
otakemedi cati
onexactl
yasdirect
ed.
Ifonaschedul eddosingregimen,takeamisseddose
assoonaspossi bl
e;spaceremainingdosesat
regul
arinterval
s.Donotdoubl edoses.Caut
ion
pati
entnott oexceedrecommendeddose; maycause
adverseeffects,
paradoxicalbr
onchospasm,orloss
ofeffect
ivenessofmedi cati
on.

I
nstr
uctpat ienttocont
actheal t
hcareprofessi
onal
i
mmedi atelyifshort
nessofbr eathi
snotreliev
edby
medicati
onori saccompani edbydiaphoresis,
di
zzi
ness, palpit
ati
ons,orchestpain.

Advisepati
enttoconsultheal
thcareprofessi
onal
beforetaki
nganyOTCmedi cat
ionsoralcohol
ic
beveragesconcur
rentl
ywi t
hthisther
apy.Caution
pati
entalsotoavoi
dsmoki ngandot herrespi
rator
y
i
rri
tants.

I
nhaln:Revi
ewcorrectadmi
nist
rat
iont
echni
que
(
aerosoli
zat
ion,
IPPB)withpati
ent
.

Donotspr
ayi
nhal
ernearey
es.

Adv
isepat
ient
stousebr
onchodi
l
atorf
ir
sti
fusi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 116
 ot
herinhalat
ionmedicat
ions,andall
ow5mi nt
o
el
apsebeforeadmini
steri
ngot heri
nhalant
medicat
ions,unl
essotherwisedir
ected.

Advi
sepat
ientt
ori
nsemouthwit
hwateraf
tereach
i
nhal
ati
ondosetomini
mizedr
ymouth.

Advisepati
entt
omai nt
ainadequat
efl
uidintake
(2000–3000mL/ day
)tohelpli
quef
ytenacious
secret
ions.

Adv i
sepati
entt oconsulthealt
hcarepr ofessi
onalif
respir
ator
ysy mptomsar enotr el
ievedorwor senafter
treat
mentori fchestpain,headache,severedizzi
ness,
palpi
tati
ons,nervousness,orweaknessoccur s.

Advi
sepati
entt
onotif
yhealt
hcarepr
ofessi
onalif
pr
egnancyi
splannedorsuspect
edori
fbreast
feeding.

Autoinj
ector :Instr
uctpat i
entsusingaut o-i
njectorfor
anaphylacticr eacti
onst oremov egr aysaf etycap,
pl
acingbl ackt ipont hi
ghatr ightangl etoleg.Pr ess
hardintothi ghunt i
lauto-i
njectorfunctions, holdin
pl
acef or10seconds, r
emov e,anddi scardpr operl
y.
Massagei njectedareaf or10sec.Pedi :Teach
parentsorcar egi
verssignsandsy mpt omsof
anaphlyaxis, howt ouseaut o-inj
ectorsaf ely,andto
getthechi ldt oahospitalassoonaspossi ble.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 117
 I
nstructparentsorcaregiv
er stot eachchildhowt o
managehi sorherallergy
,howt osel f-
inj
ect,
andwhat
todoi nanemer gency.Forchildrent ooyoungt oself
-
i
njectandwhowi l
lbesepar atedf rom parent
,tell
parentstoalwaysdiscussal l
ergyanduseofaut o-
i
njectorwit
hr esponsi
bleadul t
.

St
orage
St
oreprot
ectedf
rom l
i
ghtpr
efer
abl
yincont
ainer
sfi
l
led
wi
thnit
rogen.

Al
bendazol
e
I
ndi
cat
ions
Echinococcusmul ti
loculari
sandE.gr anulosusi nfecti
ons
pri
ortoornotamenabl etosurgery;neurocysticercosi
s;
nemat odeinfecti
ons; f
il
ari
asis;ascari
asis,hookwor m
i
nfections,st
rongyloidi
asis,enter
obiasis,t
richuriasi
s,
tr
ichostrongyl
iasi
sandcapi l
lar
iasi
s;cestodei nfecti
ons;
ti
ssuenemat odei nfecti
ons.

ACTI
ON
Inhibi
tstubul
i
npolymeri
zati
on,r
esult
ingi
nthelossof
cytoplasmicmicr
otubul
es.Ther
apeuti
cEff
ect
s: Deat
hof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 118
affect
edlarval
form ofsuscept
ibleparasi
tes.Spect
rum:
Echinococcusgranul
osus(dogt apeworm).Taeniasol
ium
(porktapeworm).

Av
ail
abi
l
ity
CHEWABLE/PLAI
NTABLET150,200,400mg&1.5g;
CAPSULE400mg;ORALSUSPENSION200mg/5ml ;
SyRUP200mg/5ml;DROPS10ml (
200mg/ml)

DOSAGE
Or
al
Adultandchi
l
dabov
e2y
ear
s-400mgdai
l
yasasi
ngl
e
dose.
Str
ongyloidiasi
s,t
aeniasi
sandH.nanainfecti
on:400mg
oncedailyisgivenfor3consecuti
vedays.Hydati
ddisease:
400mgt wicedail
ywithmealsfor28days(therapymay
berepeatedaf t
er14day sint
hreecycl
es).

Chi
l
d-1t
o2y
ear
s:200mgasasi
ngl
edose.

I
NTERACTI
ONS
Drug-
Drug:Bl
oodlev
elsofalbendazol
esulf
oxi
dear
e
i
ncreasedbyconcur
rentdexamethasoneandpr
azi
quant
el.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 119
Al
bendazol
emaydecr
easebl
oodl
evel
soft
heophy
ll
ine.
Drug-
Food:Bl
oodlevel
sofalbendazol
esul
foxi
deare
i
ncreasedbyconcur
renti
ngesti
onofahigh-
fatmeal
.

Cont
rai
ndi
cat
ions
Pregnancy
, adequatemeasuresmustbet
akenfornon-
hormonalcontracepti
vedur
ingandonemonthaft
er
ther
apy;hypersensi
tiv
ity
.

Pr
ecaut
ions
Pr
egnancy(
seenotesaboveandAppendi x7c);
li
ver
i
mpair
ment,i
ncr
easedint
racrani
alpressur
e;sei
zures;
moni
torbl
oodcountandli
verfunct
ion.

Adv
erseEf
fect
s
Gastrointesti
naldiscomf ort
;headache;adverseef f
ects
associatedwi thuseincest odeinf
ections;r
ev ersi
ble
al
opeci a;leucopenia,neurocyst
ecercosis;
Stev en’
s
Johnsonsy ndrome.

PATI
ENTTEACHI
NG
Inst
ructpat
ientt
otakemedi
cat
ionwi
thaf
att
yfood
exactl
yasdirect
ed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 120
 Emphasi
zethei
mportanceofr
egularbl
oodt
est
sto
checkWBCsandhepati
cfunct
ion.

Cauti
onpati
entstonotif
yhealthcareprofessi
onali
f
si
gnsofhepatotoxi
cit
y(e.g.j
aundice,
darkur i
ne,
li
ght-
col
oredbowelmov ement,anorexi
a,nausea,
abdominal
pain)occur.

OB: Advisepat
ienttousecont r
acept
ionduri
ngandfor
atleast1moaf terdiscont
inuati
onofther
apy.May
causef etal
har
m.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Al
bumi
n
I
ndi
cat
ions
Burns,
hypoprot
einaemi
a,shock,
hypov
olemi
a,acut
eli
ver
fai
l
ure,di
aly
sis.

ACTI
ON
Pr
ovidescoll
oidaloncoti
cpressur
e,whi chser
vest o
mobil
izefl
uidfrom ext
ravascul
art
issuesbacki ntothe
i
ntr
avascul
arspace.Requi r
esconcurrentadministr
ati
onof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 121
appropri
atecr
yst
all
oid.Ther
apeut
icEf
fect
s:I
ncr
easei
n
i
ntravascul
arf
lui
dvolume.

Av
ail
abi
l
ity
SOLUTI
ON5%,
10%,
20%.

DOSAGE
I
ntr
avenousi
nfusi
on
Forhy
pov
olemi
a:Adul
t-25g,
Chi
l
d-1g/
kg.
Max.
-2gof20%/
kgbodywei
ght
.
Forhy
popr
otei
naemi
a:Adul
t-2g/
kgdai
l
y.
Usual
rat
esofinf
usi
on:
upt
o5ml
/mi
n(5%)or1t
o2
ml/mi
n(20%)
.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

Cont
rai
ndi
cat
ions
Congest
ivehear
tfai
l
ure,
sev
er eanaemi
a,hi
stor
yof
al
ler
gicr
eacti
onstohumanalbumin;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 122
Pr
ecaut
ions
Ifdehydrati
onispresentaddit
ionalf
lui
dmustf oll
owt he
administrat
ionofalbumin.Administ
rat
ionofalbumi n
shouldbesuppl ementedorreplacedbypackedr edblood
cell
s,hist
oryofcardiacorcir
culator
ydisease,
increased
capil
lar
yper meabil
ity
.

Adv
erseef
fect
s
All
ergi
c(or
)pyrogeni
creactions,
tachycar
dia,
rash,
anaphyl
act
icshock,i
ncreasedsali
vati
on.

PATI
ENTTEACHI
NG
Expl
aint
hepur
poseoft
hissol
uti
ont
othepat
ient
.
I
nstructpati
enttoreportsi
gnsandsy
mpt
omsof
hypersensi
ti
vit
yreacti
on.

St
orage
Storeprotectedfr
om lightatat empret
urebetween2-25⁰
C.
Humanal buminstoredat2- 8⁰
Cmaybeexpect edto
conti
nuet omeett herequirementsofthemonogr aphfor
fi
vey earsfrom t
hedateonwhi chitwasheatedatat60⁰C
for10hour s.Humanal bumi nstoredatatemperatur
enot
exceeding25⁰ Cmaybeexpect edt omeetthe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 123
requi
rementsofthemonogr
aphfort
hreeyear
sf r
om t
he
dateonwhichitwasheat
edat60⁰Cfor10hours.

Al
endr
onat
e
I
ndi
cat
ions
Treatmentandprevent
ionofpostmenopausal
osteopor
osis,
glucocor
ticoi
d-i
nduced
ost
eopor
osi
s,Paget
’sdi
sease.

ACTI
ON
I
nhibitsresorpt
ionofbonebyi nhibit
ingosteocl
astact
ivi
ty.
Therapeut i
cEff
ects:Reversaloft heprogressi
onof
osteoporosiswithdecreasedfr actur
es.Decreased
progressionofPaget’
sdi sease.

Av
ail
abi
l
ity
Tabl
et-5,
10,
35,
and70mg.

DOSAGE
Or
al
Adul
tTr
eat
mentofpost
menopausal
ost
eopor
osi
s:
5-
10mgdai
l
yor35-
70mgweekl
y.Paget
'sdi
sease:
40mg

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 124
oncedai
l
yforsi
xmont
hs.
Gl
ucocor
ti
coi
d-i
nducedost
eopor
osi
s:
5mgoncedai l
y,exceptf
orpostmenopausal
womennot
recei
vi
ngest
rogen,forwhom t
herecommendeddosei
s
10mgoncedai l
y.

I
NTERACTI
ONS
Dr
ug-Drug:Calci
um supplements,antaci
ds,andotheror
al
medicat
ions↓ t heabsorpti
onofalendronat
e.Doses>10
mg/day↑ riskofadv er
seGIeventswhenusedwi th
NSAIDs.IVranit
idi
ne↑ bl oodl
evels.
Drug-
Food: Foodsignifi
cantl
y↓ absorpti
on.Caff
eine
(cof
fee,tea,col
a),
mi neralwater
,andorangejui
cealso↓
absorpt
ion.

Cont
rai
ndi
cat
ions
Esophageal
dysmot
il
it
y,esophageal
obstr
uct
ion,esophagealul
cer,hypocal
caemia,
hyper
sensit
ivi
ty,
lact
ati
on,pregnancyint
eract
ions.

Pr
ecaut
ions
Hi
storyoful
cer
s,hypocal
caemia,
sever
erenal
i
nsuff
ici
ency
,shoul
dbet akenonanemptystomachand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 125
r
emai
nupr
ightf
ornotl
esst
han30mi
nut
es.

Adv
erseEf
fect
s
Oesophagiti
s,abdomi nal painwithcramps,abdominal
swell
ing,consti
pation,diarrhoea,dy
sphagia,headache,
myalgia,
nausea, vomiting,pepticul
cer,f
lat
ulence,
ret
roster
nalpain,bodyache.

PATI
ENT TEACHI
NG
Instructpat i
entont heimpor tanceoft akingexact l
yas
direct ed,fir
stthinginthemor ning, 30minbef ore
othermedi cati
ons,bever ages,orf ood.Wai t
ingl onger
than30mi nwilli
mpr oveabsor ption.Alendronat e
shoul dbet akenwi th6–8ozpl ainwat er(mi neral
wat er, orangejuice,coffee,andot herbev erages
decr easeabsor pti
on).Ifadosei smi ssed,ski pdose
andr esumet henextmor ning;donotdoubl edosesor
takel at erintheday .I
faweekl ydosei smi ssed, take
themor ningafterremember edandr esumet he
foll
owi ngweekont hechosenday .Donott ake2
tablet sont hesameday .Donotdi sconti
nuewi thout
consul ti
ngheal t
hcar epr ofessi
onal .

Cauti
onpat
ienttor
emai nupr
ightf
or30minf
oll
owing
dosetof
aci
lit
atepassagetostomachandmi
nimize

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 126
 ri
skofesophageali
rri
tat
ion.Adv
isepati
entto
di
sconti
nuealendr
onateandnotifyheal
thcare
provi
deri
fpainordif
fi
cultyswal
lowing,
retr
ost
ernal
pain,
ornew/worseni
nghear t
burnoccur.

Advisepati
enttoeatabal anceddietandconsul
t
heal
t hcar
eprofessionalabouttheneedfor
supplementalcal
cium andv i
taminD.

Encouragepatientt
opart
ici
pateinr
egularexer
cise
andtomodi fybehavi
orst
hatincr
easetheriskof
osteoporosi
s(stopsmoki
ng,reduceal
cohol
consumpt i
on).

Advi
sepati
enttoinf
orm heal
thcarepr
ofessi
onal
of
al
endronat
ether
apypri
ort odent
alsur
gery.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Advi
sepati
enttonoti
fyhealt
hcar
eprof
essionali
f
bl
urr
edvisi
on,eyepai
n,orinfl
ammat
ionoccur.

Advi
sefemalepat i
enttonot
if
yhealthcar
e
pr
ofessi
onalifpregnancyi
splannedorsuspect
edor
i
fsheisbreastf
eeding.

St
orage

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 127
Stor
eprotect
edfrom heat
,li
ghtandmoi
stur
eatr
oom
temper
aturenotexceedi
ng30⁰C.

Al
l
opur
inol
I
ndi
cat
ions
Prophy
laxi
sofgout;
prophyl
axi
sofhyper
uri
caemi
a
associ
atedwi
thcancerchemot
herapy
.

ACTI
ON
Inhi
bit
stheproducti
onofuri
cacidbyinhi
bit
ingt
heact
ion
ofxanthi
neoxidase.Ther
apeut
icEf
fects:
Loweri
ngof
serum ur
icaci
dlevels.

Av
ail
abi
l
li
ty
TABLET100mg.

DOSAGE
Or
al
Adult
-Ini
ti
all
y100mgdai l
yafterfood,t
hereaft
eradjust
accor
dingtouri
caci dconcentrat
ion.(
Usual maint
enance
doseinmildcondit
ions:100to200mgdai ly
,in
moderatel
ysevereconditi
on:300mgdai l
ygivenindivi
ded

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 128
doses)
.
Chi
l
d-Neopl
asti
ccondi
ti
onsandenzy
medi
sor
der
s:10t
o
20mg/kgdai
ly(
max.400mg).

I
NTERACTI
ONS
Drug- Drug: Usewi t
hmer captopurineandazat hiopri
ne↑
bonemar rowdepr essantpr operti
es—dosesoft hese
drugsshoul dbe↓.Usewi t
hampi ci
ll
i
noramoxi ci
ll
i
n↑
ri
skofr ash.Usewi t
hor alhypogl y
cemicagent sand
warf arin↑ ef fectsoft hesedr ugs.Usewi t
ht hiazide
diureticsorACEi nhibi
tors↑ r iskofhypersensitivi
ty
react i
ons.Lar gedosesofal lopuri
nolmay↑ r i
skof
theophy l
l
inet oxicit
y.May↑ cy cl
osporinelevels.

Cont
rai
ndi
cat
ions
Acutegout;i
fanacuteattackoccurswhil
erecei
vi
ng
al
lopuri
nol;
conti
nueprophy l
axisandt
reatat
tack
separat
ely
.Neoplast
iccondit
ionsandenzymedisor
der
s:
10to20mg/ kgdail
y(max.400mg) .

Pr
ecaut
ions
Ensureadequatefl
uidi
ntakeof2-3l
it
resdail
y;l
act
ati
on
renal
andhepat i
cimpair
mentwithdr
awt r
eatmentifr
ash
occurs;
rei
ntroducei
frashismil
dbutdisconti
nue

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 129
i
mmedi
atel
yifi
trecur
s;i
nter
act
ionspr
egnancy
.

Adv
erseEf
fect
s
Rash(seepr ecautionsabov e);
hy per
sensi
ti
vit
yreact
ions
occurrarel
y,andincl udefever;l
ymphadenopathy;
art
hral
gia;eosinophilia;
erythemamul ti
for
me( St
evens-
Johnsonsy ndrome)ort oxi
cepidermalnecrol
ysi
s;
vascul
iti
s;hepatit
is;renalimpairment.

PATI
ENTTEACHI
NG
Instructpati
enttot
akeal l
opuri
nolasdirected.Take
mi sseddosesassoonasr emember ed.Ifdosing
schedul ei
soncedai l
y,donottakeifremember edt
he
nextday .Ifdosi
ngscheduleismoret hanonceaday ,
takeupt o300mgf orthenextdose.

Inst
ructpati
enttoconti
nuetaki
ngall
opuri
nolal
ong
withanNSAI Dorcolchi
cinedur
inganacuteatt
ackof
gout.All
opuri
nol hel
pspr
event,
butdoesnotrel
iev
e,
acutegoutattacks.

Al
kalinedi
etmaybeor dered.Uri
naryacidif
icati
on
wit
hl ar
gedosesofv i
tami nCorot heracidsmay
i
ncreaseki
dneystonef ormat i
on(seeAppendi xM) .
Advisepat
ientofneedf orincr
easedf l
uidintake.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 130
 Mayoccasi onal
l
ycausedr owsi
ness.Caut
ionpati
ent
toavoiddri
v i
ngorotheracti
vi
ti
esrequi
ri
ngaler
tness
unti
lresponsetodrugisknown.

I
nst r
uctpatientt
or eportskinr ash,bl
oodi
nurine,
or
i
nfluenzasy mptoms( chil
ls,fever,muscl
eachesand
pains,nausea,orvomi t
ing)t ohealt
hcare
professi
onal i
mmedi ately
; skinrashmayindi
cate
hypersensit
ivi
ty.

Advi
sepatientt
hatlar
geamount
sofalcohol
incr
ease
ur
icaci
dconcent r
ati
onsandmaydecr
easethe
ef
fect
ivenessofall
opuri
nol
.

Emphasi
zetheimportanceoffol
l
ow-upexamst
o
moni
toref
fect
ivenessandsideeff
ects.

Al
phaI
nter
fer
on
I
ndi
cat
ions
Hai
rycell
leukaemi
a,AIDSr
elat
edKaposi’
ssar
comai
n
pat
ient
sabov e18year
s.Mal
ignantmel
anoma.

Av
ail
abi
l
ity
VI
ALS3,
5&6mi
l
li
onI
U;44µg(
Int
erf
eronB)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 131
DOSaGE
Adult
-Hairycel
lleukaemiainduct
ion:3mi l
li
onIUdail
yfor
16to24weeks.Mai nt
enance3mi ll
ionIUthreet
imesa
week.Treatmentfor6mont hsapprox.Kaposi’
sSarcoma:
36mill
ionIUfor10t o12weeks, maintenance36mill
ionI
U
thr
eetimesaweek.
Chi
l
d-Notr
ecommendedf
orchi
l
dren.

Cont
rai
ndi
cat
ions
Consul
tproductli
ter
atur
e;avoidinj
ecti
onscontai
ning
benzyl
alcoholi
nneonates;pregnancyl
actat
ion.

Pr
ecaut
ions
Consul
tproductl
i
ter
atur
e;hai
rycel
ll
eukaemi
a;r
enal
i
mpairment.

Adv
erseEf
fect
s
Anorexia,nausea, influenza-likesympt omsandl ethargy
.
Ocularside-effectsanddepr essi
on( includingsui ci
dal
behav i
our)hav ealsobeenr eported.My elosuppr ession
mayoccur ,parti
cularlyaf f
ect i
nggr anulocy t
ecount s.
Cardiovascularprobl ems( hypotension, hypertensionand
arr
hythmi as),nephr otoxici
tyandhepat ot oxici
tyhav ebeen

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 132
reported.Hy per
tri
glycer
idaemia, monitori
ngofli
pid
concent rat
ionisrecommended.Hy persensi
ti
vi
tyreact
ions,
thyroidabnor mal
iti
es,hypergl
y caemia, al
opeci
a,
psor i
asifor
mr ash,confusion,comaandsei zur
es(usuall
y
withhi ghdosesint heelderl
y),leucopenia;
thrombocy topenia;mucositi
es; pancreati
ti
s.

St
orage
St
orepr
otect
edf
rom l
i
ghtatorbel
ow-
20⁰
C.

Al
prazol
am
I
ndi
cat
ions
Anxi
etydi
sor
der
s;pani
cat
tacks.

ACTI
ON
Actsatmanyl evel
sintheCNSt oproduceanxi
oly
ticeff
ect
.
Maypr oduceCNSdepr essi
on.Eff
ectsmaybemedi ated
byGABA, aninhi
bitor
yneurotr
ansmitt
er.Ther
apeuti
c
Eff
ects:Reli
efofanxi
ety.

Av
ail
abi
l
ity
TABLETS0.
25,
0.5and1mg.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 133
DOSAGE
Or
al
Adul
t-0.
25t
o0.
5mgdai
l
y2t
o3t
imesaday
.
Chi
l
d-Notr
ecommended.

I
NTERACTI
ONS
Drug-Drug: Al cohol ,antidepr essants,other
benzodi azepi nes, anti
histami nes,andopi oid
analgesics—concur rentuser esult
sin↑ CNSdepr ession.
Hor monal cont racept ives, disulfi
ram, f
luoxet i
ne, i
soniazid,
met oprolol,pr opr anolol, valproicacid,CYP3A4i nhibi
tors
(eryt
hromy cin, ket oconazol e,itr
aconazol e,fl
uv oxami ne,
cimetidine,nef azodone)↑ l evelsandef fects;dose
adjustment smaybenecessar y;concurrentusewi th
ketoconazol eandi t
raconazol econtrai
ndi cated.May↓
effi
cacyofl ev odopa.CYP3A4i nducers(rifampi n,
carbamazepi ne, orbar biturat es)↓ levelsandef fects.
Sedativeef fect smaybe↓ byt heophyll
ine.Ci garette
smoki ng↓ l ev elsandef f
ect s.
Drug-
Nat
ural
Product:Kav
a-kav
a,v
aler
ian,
orchamomi
l
e
can↑ CNSdepressi
on.
Dr
ug-
Food:
Concur
renti
ngest
ionofgr
apef
rui
tjui
ce↑

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 134
l
evel
sandef
fect
s.

Cont
rai
ndi
cat
ions
Respi ratorydepression;mar kedneur omuscul ar
respirator yweaknessi ncludi
ngunst ablemy asthenia
gravis; acutepulmonar yinsuffi
ciency;sleepapnoea
syndr ome; sever
ehepat icimpairment ;notforchroni
c
psychosi s;shoul
dnotbeusedal onei ndepressionorin
anxietywi thdepressi
on; avoidi
njectionscont ai
ningbenzy
l
alcohol i
nneonat es;narrowanglegl aucoma,
hyper sensi ti
vi
ty.

Pr
ecaut
ions
Respi ratorydi sease; muscleweaknessandmy asthenia
gravis; historyofdr ugoral coholabuse;marked
personal i
tydisorder ;pregnancylactat
ion;
reducedosei n
elderlyanddebi l
it
atedandi nhepati
cimpair
ment ,renal
i
mpai r
ment ;
av oi
dpr ol
ongeduse( andabruptwithdrawal
thereaf ter)
; i
nteractionsper i
odicbl
oodcount ;l
i
verf unct
ion
test.
Dr
owsinessmayaf
fectperf
ormanceofski
l
ledt
asks(
e.g.
dr
ivi
ng)
;eff
ect
sofalcohol
enhanced.

Adv
erseEf
fect
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 135
Drowsinessandl i
ghtheadednessont henextday ;
confusionandat axia(especi all
yintheel derly);
amnesi a;
dependence; paradoxical i
ncreasei naggr ession;muscl e
weakness; occasionall
y :headache, verti
go, hypotension,
sali
vati
onchanges, gastro-int
estinaldisturbances,visual
dist
urbances, dysart
hria,tremor ,changesi nli
bido,
i
ncontinence,ur i
naryretention;blooddi sordersand
j
aundicer eported;ski
nr eact i
ons; r
arel
y ,apnoeaand
i
nsomni a.

PATI
ENTTEACHI
NG
Instructpatienttot akemedi cat
ionasdir
ected;donot
skipordoubl euponmi sseddoses.Ifadosei s
mi ssed,takewi thin1hr ;otherwise,
skipthedoseand
returntor egularschedul e.Ifmedicati
onisless
effectiveafteraf ewweeks, checkwithhealthcar
e
professional;donoti ncreasedose.Abruptwi t
hdr
awal
maycausesweat ing,vomi t
ing,musclecramps,
tremor s,andsei zures.

Maycausedr owsi
nessordizziness.Cauti
onpatient
toavoiddri
vingandotheractivi
ti
esr equi
ri
ngalertness
unti
lresponsetothemedicationisknown.Ger i
:
I
nstructpati
entandfamil
yhowt or educefal
l
sriskat
home.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 136
 Advisepat
ientt
oav
oiddr
inki
nggr
apef
rui
tjui
cedur
ing
ther
apy.

Advi
sepat i
enttoav oi
dtheuseofal coholorother
CNSdepr essantsconcurr
entlywit
halprazolam.
I
nstructpati
enttoconsulthealt
hcarepr of
essional
bef
or etaki
ngRx, OTC,orherbalpr
oductsconcur r
entl
y
wit
ht hi
smedi cati
on.

I
nf or
m pati
entthatbenzodi
azepi
nesar
eusuall
y
prescri
bedforshort
-ter
m useanddonotcur
e
underly
ingprobl
ems.

Teachothermethodstodecr
easeanxi
ety(
exer
cise,
suppor
tgroup,r
elaxat
iont
echni
ques).

Adv
isepat
ientt
onotshar
emedi
cat
ionwi
thany
one.

St
orage
St
orepr
otect
edf
rom l
i
ght

Al
tepl
ase
I
NDI
CATI
ONS
Acutemyocardi
alinfar
cti
on(MI)
.Acuteischemicstr
oke.
Pulmonaryemboli
sm (PE).Occl
udedcentralv
enous
accessdevi
ces.Unlabel
edUses:Deepvenoust hr
ombosis

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 137
(
DVT)
.Acut
eper
ipher
alar
ter
ial
thr
ombosi
s.

ACTI
ON
Dir
ectlyconv ertsplasminogentoplasmi n,
whi cht hen
degradesclot -
boundf ibr
in.Ther
apeut i
cEffects:Ly si
sof
thr
ombi incor onaryarteri
es,wit
himpr ovementof
ventr
icularfunction,andreducedri
skofhear tfail
ureor
death.Lysisofpul monar yemboli
.Ly si
soft hrombi
causingischemi cst r
oke,reduci
ngriskofneur ologic
sequelae.Rest orati
onofcannulaorcat het
erf unction.

Av
ail
abi
l
ity
I
NJECTI
ON20and50mg/
vial
.

DOSAGE
I
ntr
avenous
Acut
emy
ocar
dial
inf
arct
ion
Adul
t:Ther
ecommendedtotal
doseis100mg.Admi
nist
er
assoonaspossi
bleaf
tert
heonsetofsy
mptoms.
Accelerat
edinfusion(1.5h):
Max100mg; asa15mg
i
ntravenousbolus, f
oll
owedby50mgi nf
usedovert
he
next30mi nutes,andthen35mgi nfusedovert
henext60
minutes.Pati
ents<67kg: tot
aldoseshouldbe≤1.
5mg/ kg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 138
15mgasi .
vbolus,then0. 75mg/ kg(uptoamaxof50mg)
tobei nfusedover30mi nutes,andt hen0.50mg/ kgov er
thenext60mi nutesnott oexceed35mg.3- HourI nf
usion:
Max100mg; 60mgi nthef i
rsthour( ofwhich6t o10mg
i
sadmi nist
eredasabol us)t hen20mg/ hf or2h.For
patients<65kg, 0.75mg/ kgin1sthour( including0.045-
0.075mg/ kgbolusinfi
rst1- 2mi nutes),
then0. 25
mg/ kg/hx2hour s.
Acut
emassi
vepul
monar
yembol
i
sm
Adult: 100mg( not>1. 5mg/ kgforpati
entswei ghing<65
kg).First10mgasbol usfol
lowedbyi nfusionofthe
remai nderdoseov er2hour s.Heparintherapytobe
i
nstitutedorreinsti
tutedneart heendofori mmedi atel
y
fol
lowi ngthealteplaseinf
usionwhent hepar ti
al
thr
ombopl ast
int i
mer etur
nst otwicenormal orless.
Acut
eischemi
cst
roke
Adult
: Userecommendedwithi
nfi
rst3hofonsetofthe
symptoms.I nf
use0.9mg/kg(upt
oamax.of90mg)ov er
60minut eswith10%oft
hedoseasbolusoverthefi
rst
minute.

I
NTERACTI
ONS
Dr
ug-
Drug:
Aspi
ri
n,ot
herNSAI
Ds,
war
far
in,
hepar
inand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 139
hepar i
n-l
i
keagent s,abcixi
mab, ept
if
ibati
de,t
irofi
ban,
clopidogrel,
ticl
opidi
ne,ordipyri
damole—concur r
entuse↑
ri
skofbl eeding,al
thought heseagentsarefrequentl
yused
togetherorinsequence.Ef fect
smaybe↓ by
antif
ibri
nolyti
cagents,incl
udingami nocapr
oicacidor
tranexami cacid.
Drug-Nat ur
alProduct:
↑ ant i
coagulanteffectandbleedi
ng
ri
skwi thanise,arni
ca,chamomi l
e,clove,dongquai,
fenugreek,feverf
ew,garli
c,gi
nger,ginkgo,Panaxginseng,
l
icori
ce, andothers.

Cont
rai
ndi
cat
ions
Uncontr
olledhypertensi
onwi t
hpossiblecerebrovascul
ar
haemorrhage,recentsurger
yort r
auma, suscepti
bil
it
yto
i
nternal
bleeding,uncontrol
l
edhy per
tension,esophageal
vari
ces,heavyvaginalbl
eeding,bl
eedingdiathesi
s,acti
ve
pepti
culcerat
ion.

Pr
ecaut
ions
Moni t
orforbleedingandBPi nacutestroke.Cauti
oni
n
recentsurgeryorinvasiv
epr ocedures,diabet
ic
hemor r
hagicretinopathy,severehepati
candr enal
i
mpai rment,pregnancyl actati
on,chi
ldren,el
derl
y,
i
nteracti
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 140
Adv
erseEf
fect
s
Hemor rhageincludi
ngintr
acr
anial
,gastroi
ntesti
nal
or
genit
our i
narybleedi
ng,tr
ansi
enthypotension,r
eper
fusi
on
dysry
thmi as,cerebr
aledema,sei
zures,all
ergi
c-t
ype
react
ions,nausea, v
omiti
ng.

St
orage
Storeprotectedfrom heat,
li
ghtandmoistur
eatroom
temperature(<30°C)orunderrefr
iger
ati
on.Use
reconst
itutedsoluti
onwi t
hin8hours.

Al
umi
nium Hy
droxi
de
I
NDI
CATI
ONS
Loweringofphosphatelevelsinpat
ientswithchr
onic
renalf
ail
ure.Adj
unctiv
et herapyint
het r
eatmentofpept
ic,
duodenal,
andgastriculcers.Hyper
acidi
ty,
indi
gesti
on,
refl
uxesophagit
is.

ACTI
ON
BindsphosphateintheGIt r
act .Neutr
ali
zesgastri
caci d
andinacti
vatespepsin.TherapeuticEff
ects:Loweri
ngof
serum phosphat
elevels.Healingofulcersanddecr eased
painassociat
edwithulcersorgast ri
chyperacidi
ty.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 141
Const i
pati
onlimit
suseal
onei
nthetreat
mentoful
cer
disease.Frequent
lyf
oundi
ncombinati
onwi
thmagnesium
-contai
ningcompounds.

AVAI
LABI
LITY
Capsules475mgOTC, 500mgOTC; Tablet
s300mgOTC,
500mgOTC, 600mgOTC; Suspension320mg/ 5mLOTC,
450mg/ 5mLOTC, 600mg/5mLOTC, 675mg/ 5mLOTC;
Incombinati
onwit
h:magnesium carbonate,cal
cium
carbonat
e,si
methi
cone,andmineral oi
l.

DOSAGE
Hy
pophosphat
emi
a
PO:(Adul
ts)
:1.
9–4.
8g( 30–40mLofr egul
arsuspensi
on
or15–20mLofconcent
ratedsuspensi
on)3–4ti
mesdai l
y.
PO:(Chi
ldr
en):50–150mg/ kg/
24hrin4–6di
vi
deddoses;
ti
tr
atetonormalser
um phosphatel
evel
s.
Ant
aci
d
PO:
(Adul
ts)
:500–1500mg(
5–30mL)3–6t
imesdai
l
y.

Cont
rai
ndi
cat
ions
Hypophosphataemia;undiagnosedgastr
oint
estinalor
r
ectalbl
eeding;appendici
tis;
porphy
ria;
hypersensit
ivi
tyt
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 142
al
umi
nium sal
ts.

Pr
ecaut
ions
I
mpai r
edrenalfuncti
onandr enal dial
ysi
s;hepati
c
i
mpai r
mentconst i
pati
on; dehydr ati
on;fl
uidrestr
ict
ion;
gastr
oint
esti
naldisor
der sassoci atedwithdecreased
bowelmot i
l
ityorobstructi
on; pregnancyinteract
ions
oedema,cir
rhosisandl owsodi um di et
s.

Adv
erseEf
fect
s
Constipation, i
ntesti
nal obstruction(l
argedoses) ;
hypophosphat aemi awithincr easedboner esorpti
on,
hypercalciuri
aandr i
skofost eomal aci
a(patientsonlow
phosphat edi etorpr ol
ongedt herapy);
hyperalbumi naemi aresult
ingi nosteomal aci
a,
encephal opathy ,dement i
a, microcyti
canaemi a(inchroni
c
renalfail
uret reatedwi t
hal umi ni
um hy dr
oxideas
phosphat e-bindingagent );l
ossofappet i
te.

PATI
ENTTEACHI
NG
Inst
ructpati
enttot akealuminum hydr
oxideexact
ly
asdirect
ed.Ifonar egul
ardosingscheduleanda
doseismi ssed,takeassoonasr emember edi
fnot
almostti
mef ornextdose;donotdoubledoses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 143
 Advi
sepati
entnottotakealumi
num hydroxi
dewithi
n
1–2hrofothermedicat
ionswit
houtconsult
ingheal
th
car
eprof
essional
.

Advisepati
ent
stochecklabelforsodium content
.
Pati
entswithHForhyper
tension,orthoseonsodium
rest
rict
ion,
shoul
duselow-sodium prepar
ations.

Infor
m pati
entsofpot
ent
ial
forconst
ipat
ionf
rom
aluminum hydr
oxi
de.

Hypophosphatemia:Pati
entstaki
ngal uminum
hydr
oxideforhyperphosphatemiashouldbetaught
thei
mpor t
anceofal ow-phosphatediet.

Antacid:Cautionpat i
enttoconsul thealt
hcare
professionalbeforetakingantacidsformor et
han2
wkifpr oblem isrecurr
ing,i
ftakingot hermedi
cations,
i
freliefisnotobtained,orifsympt omsofgast r
ic
bl
eedi ng(blacktarrystool
s,coffee-groundemesis)
occur .

St
orage
Storepr
otect
edfrom moi
stur
eatatemper
atur
enot
exceedi
ng30⁰C.Donotfr
eezeGel
.

Amant
adi
ne
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 144
I
NDI
CATI
ONS
Symptomaticini
ti
alandadj
unctt
reat
mentofParki
nson’
s
di
sease.Prophyl
axisandtr
eat
mentofinf
luenzaAvi
ral
i
nfect
ions.

ACTI
ON
Potentiatestheacti
onofdopami neintheCNS.Pr events
penetrati
onofi nf
luenzaAv irusint
ohostcell.Ther apeut
ic
Eff
ects: Reli
efofParkinson'
ssy mptoms.Prev enti
onand
decreasedsy mptomsofi nf
luenzaAv i
rali
nfection.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Sei
zur
edi
sor
der
s;Li
verdi
sease;
Psychiatri
cpr oblems;HF;Renal i
mpairment(dose↓/ ↑
dosingintervalrequir
edifCCr≤50mL/ min)
;May↑
susceptibi
lit
yt orubel
lainfect
ions;OB:Lact
ati
on:Safet
y
notestablished;Geri:↑ sensi
tivi
tytoadver
seeffect
s.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: ataxi
a,dizzi
ness,i
nsomni
a,anxi
ety,confusion,
depression,drowsi
ness,psy
chosi
s,sei
zures,urges
(gambling,sexual
).GI:
nausea,
vomiti
ng,anorexia,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 145
consti
pation.EENT:blurr
edv i
sion,drymouth.Resp:
dyspnea.CV: hypot
ension,HF,edema.GU: uri
nary
retent
ion.Derm: mott
li
ng,li
vedor et
icul
ari
s,melanoma,
rashes.Hemat :l
eukopenia,
neut r
openia.

I
NTERACTI
ONS
Drug-Drug:Concur rentuseofantihi
stamines,
phenothiazines,quinidi
ne,di
sopyramide,andt r
icycl
ic
anti
depressant smay↑ ant i
chol
inergi
ceffects( dr
ymout
h,
blurr
edv i
sion,const i
pati
on).↑ r
iskofadv erseCNS
reacti
onswi thalcohol.↑ r
iskofCNSst imulati
onwi th
otherCNSst i
mul ants.

AVAI
LABI
LITY
Li
quid-
fi
ll
edcapsules100mg;
Tabl
ets100mg;
Syr
up(r
aspberr
yflavor
)50mg/5mL;

DOSAGE
Par
kinson’
sDi
sease
PO:
(Adul
ts)
:100mg1–2t
imesdai
l
y(upt
o400mg/
day
).
I
nfl
uenzaAVi
ral
Inf
ect
ion
PO:(
AdultsandChi
l
dren>12yr
):Tr
eatment
—200mg/day
asasingl
edoseor100mgbid(not>100mg/dayi
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 146
ger
iat
ri
cpat
ient
s);
Prophy
laxi
s—100mg/
dayi
n1–2
di
vi
deddoses.
PO:(
Childr
en10–12yr)
:100mgq12hror5mg/kg/
dayi
n
1–2div
ideddoses;
nottoexceed200mg/
day
.
PO:(
Chi
ldren1–9y
r):
5mg/ kg/
dayi
n1–2di
vi
deddoses;
nott
oexceed150mg/day
.

PATI
ENTTEACHI
NG
Advisepat
ientt
otakemedicationaroundt
hecl
ockas
di
rectedandnottoski
pdosesordoubl eupon
misseddoses.I
fadoseismi ssed,donott
akewit
hin
4hrofthenextdose.

Maycausedi zzi
nessorblurredvisi
on.Adv i
sepat
ient
toavoiddri
vi
ngorot heract
ivit
iesthatrequi
re
aler
tnessunti
lresponsetothedr ugisknown.

Advi
sepati
entt
omakeposit
ionchangessl
owl
yto
mini
mizeort
host
ati
chy
potensi
on.

I
nform pat
ientthatfr
equentmouthr i
nses,
goodor al
hygi
ene,andsugar l
essgum orcandymaydecr ease
dr
ymout h.Consultheal
thcareprofessi
onali
fdry
mouthpersist
sf or>2wk.

Adv
isepat
ientt
oconf
erwi
thheal
thcar
epr
ofessi
onal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 147
 befor
et aki
ngOTCmedicati
ons,especial
lycol
d
remedies,ordr
inki
ngal
cohol
icbeverages.

Inst
ructpatientt
onot i
fyhealthcar eprofessionali
f
confusion,moodchanges, di
f ficul
tywithur i
nati
on,
edemaandshor tnessofbreat h,newori ncreased
gambling,sexual
, orot
herintenseur ges, orworseni
ng
ofParkinson’sdi
seasesy mpt omsoccur s.

Anti
vir
al:I
nst
ructpat
ientandfami
lytonoti
fyheal
th
careprof
essi
onalifi
nfl
uenzasymptomsoccurwhen
amantadinei
susedaspr ophyl
axi
sorifsymptomsdo
notimprovei
naf ewday swhenproducti
susedfor
tr
eatment.

Parkinson’
sDisease: Advisepat ientthatupt o2wkof
therapymaybeneededf orfullbenefitofmedi cati
on.
Notifyheal
thcarepr ofessionalifmedi cati
ongr adual
ly
l
osesi tseff
ecti
veness.Amant adi neshouldbe
taperedgradual
ly;abruptwi thdrawal maypr ecipi
tat
e
apar ki
nsoniancri
sis.

Ami
kaci
n
I
ndi
cat
ions
Shor
t-
ter
mtr
eat
mentofser
iousi
nfect
ionsduet
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 148
susceptibl
est rai
nsofGr am- negativ
ebact eri
a, i
ncl
uding
Pseudomonasspeci es,Escher i
chiacol i
,speciesofindol
e-
positi
veandi ndole-negat i
vePr oteus,Providenciaspeci
es,
Klebsiel
la,
Ent erobacter
, Serrati
aspeci esand
Acinetobacter(Mi ma-Her el
lea)species.

ACTI
ON
Inhi bitspr otei
nsy nthesisi nbact eriaatt hel eveloft he30S
ribosome.Resi st st heact ionofenzy mesknownt o
i
nact i
vat eotherami nogly cosides.Ther apeut i
cEf fects:
Bact ericidalactionagai nstsuscept i
bl ebact eri
a.Spect rum:
Not ablef oractivityagai nst :Pseudomonasaer uginosa,
Kl ebsi ellapneumoni ae,Escher ichiacol i,Proteus,
Pr ov idencia, Enter obact er,Citrobact erfreundii,Serrati
a,
Aci netobact er,
My cobact eri
um.Ami kacinisal soact ive
agai nstSt aphylococci (
incl udingmet hicil
li
n-resist
ant
str ains) .Actssy ner gist
icallywi thbet a-l
actam ant i-
i
nf ectivesagai nstgr am-negat iveor gani sms.I nthe
treat mentofent erococcal infections, synergywi tha
peni cil
li
ni srequi r
ed.

Av
ail
abi
l
ity
I
NJECTION10ml
vial
(100mg/
2ml
),2ml
vial
(250mg/
2
ml)
,(500mg/
2ml
).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 149
DOSAGE
I
ntr
amuscul
arori
ntr
avenousi
nject
ionori
nfusi
on
Adult
-15mg/ kgbodywei ghtdai
l
yintwodiv
ideddoses,
i
ncreasedto22.5mg/kgbodywei ghtdai
l
yinthr
eedivi
ded
dosesinseverei
nfect
ions.(max1.5gdai
lyf
or10days,
max.cumulati
vedoseis15g) .
Chi
l
d-15mg/
kgbodywei
ghtdai
l
yint
wodi
vi
deddoses.
Neonat
es-l
oadi
ngdoseis10mg/kgbodyweightf
oll
owed
by15mg/kgbodyweighti
ntwodi
videddoses.

Cont
rai
ndi
cat
ions
My
ast
heni
agr
avi
s;hy
per
sensi
ti
vi
ty.

I
NTERACTI
ONS
Drug-Drug:Inact i
vat edbyextended- spectrum penicil
lins
whencoadmi nist
er edtopatientswi threnal i
nsuffi
ciency.
Maypot entiateef fectsofinhalati
onanest het i
csor
neuromuscul arbl ockers.↑ incidenceofot otoxi
cit
ywi t
h
l
oopdi ureti
cs.↑ i ncidenceofnephr otoxi
citywithot her
nephrotoxicdr ugs, suchasamphot er i
cin,
v ancomy cin,
acyclovi
r,cisplati
n, orcephalosporins.

Pr
ecaut
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 150
Pr
egnancyrenali
mpai
rmentneonat
es,
inf
ant
sandel
der
ly;
cr
ossall
ergeni
cit
y.

Adv
erseEf
fect
s
Vesti
bularandaudi t
orydamage,nephrot
oxi
city
;rarel
y,
hypomagnesaemi aonprol
ongedtherapy
,anti
bioti
c-
associ
atedcoliti
s,stomati
ti
s;al
soreport
ed,nausea,
vomiti
ng,rash,bl
ooddi sor
ders;
acutemuscularparal
ysi
s;
albuminuri
a;azotemia.

PATI
ENTTEACHI
NG
I
nstructpat
ienttoreportsi
gnsofhypersensi
ti
vit
y,
ti
nnit
us,ver
tigo,muscleweakness/t
wit
ching,feel
ing
offull
nessi
nt hehead,orheari
ngloss.

Ami
l
ori
de
I
ndi
cat
ions
Oedemaassociat
edwit
hheartfai
lur
eorhepat
iccir
rhosi
s
(wit
hascit
es)
,usual
l
ywitht
hiazi
deorloopdi
uret
ic;
hypert
ensi
on.

ACTI
ON
I
nhi
bit
ionofsodi
um r
esor
pti
oni
ntheki
dney
,sav
ing

ᏆᖴA2022 Dr
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thyCar
e 151
pot
assium andhy drogenions.Ther
apeuti
cEffect
s:Weak
di
uret
icandantihypertensi
veresponsewhencompar ed
wit
hotherdiur
etics.Conservati
onofpotassi
um.

Av
ail
abi
l
ity
TABLETS5mg( Amil
ori
de)+50mg( Hydr
ochl
orot
hiazi
de)
,
5mg( Ami
lor
ide)+40mg( f
urosemi
de)
.

DOSAGE
Or
al
Oedema: usedalonei
nitial
l
y10mgdai l
yin1or2di v
ided
doses,adjust
edaccordingtoresponse(max.20mgdai l
y).
Combinedwi thathi
azideoraloopdi ur
eti
c:i
nit
ial
l
y5mg
dai
ly,i
ncreasi
ngto10mgi fnecessary(max.20mgdai l
y).

Cont
rai
ndi
cat
ions
Hy
per
kal
aemi
a;r
enal
fai
l
ure;
pot
assi
um suppl
ement
ati
on.

I
NTERACTI
ONS
Drug-Drug:↑r i
skofhy pot ensionwit
hacuteingestionof
al
cohol ,ot
herant i
hypert
ensi v
eagents,ornitr
ates.Use
withACEi nhibi
tors,
angiotensinIIr
eceptor
antagonist
sindomet hacin,potassi
um supplements, or
cyclospori
ne↑ riskofhy perkalemi
a.↓ lit
hium excreti
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 152
Ef
fect
ivenessmaybe↓ byNSAI
Ds.

Pr
ecaut
ions
Monitorelectr
oly
t es;
parti
cularl
ypotassi
um;
hypocholeremia,hepati
ccirr
hosis,r
enalimpairment
(Appendix7d);di
abet esmell
itus;el
derl
y(reducedose)
;
l
actati
on; i
nter
actionspregnancy.

Adv
erseEf
fect
s
Hyperkalaemia;hyponatreamia(forsy mpt
omsoff luidand
el
ectroly
teimbal anceseei nt
roductorynot
es);di
arrhoea;
consti
pation;anorexi
a;paraesthesi
a; di
zzi
ness;minor
psychiat
ricorv i
sualdi
sturbances;rash;pr
urit
us;r
isei n
bl
oodur eanitrogen;headache;abdomi nalpai
n,f
latulence.

PATI
ENTTEACHI
NG
Emphasizet
hei mport
anceofcontinui
ngtotakethi
s
medicat
ionatthesametimeeachday ,
eveni
ffeeli
ng
well
.Takemisseddosesassoonasr emembered
unl
essalmosttimefornextdose.Donotdouble
doses.

Cautionpati
enttoavoi
dsaltsubst
itut
esandf oods
thatcontai
nhighlev
elsofpotassi
um orsodium
unlessprescr
ibedbyheal
thcareprofessi
onal.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 153
Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advisepati
enttoconsultwi
thhealthcare
prof
essionalbef
oretaki
nganyOTCdecongest ants,
coughorcol dpr
eparati
ons,orappeti
tesuppr
essant
s
concurr
entlywit
hthi
smedi cati
on.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advisepati
enttonot
if
yhealthcar
eprofessi
onali
f
muscleweaknessorcramps; f
ati
gue;orsev
ere
nausea,vomit
ing,
ordiar
rheaoccurs.

Emphasizet
heneedf
orf
oll
ow-
upexamst
omoni
tor
pr
ogress.

Hy pert
ension:Reinf
orceneedt ocontinueaddit
ional
therapiesforhypert
ension(weightloss,r
estr
ict
ed
sodium intake,st
ressreducti
on,moder at
ionof
alcohol i
ntake,
regularexer
cise,andcessati
onof
smoki ng).Medicati
onhelpscont r
olbutdoesnotcure
hypertension.

Teachpat
ientandf
amil
ythecor
rectt
echni
quef
or
checki
ngBPweekly.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 154
St
orage
St
orepr
otect
edf
rom l
i
ght
.

Ami
nocapr
oicaci
d
I
NDI
CATI
ONS
Managementofacut e, l
if
e-t
hreateninghemor rhagedueto
systemichyper
fibri
noly si
sorur i
naryf ibri
noly
sis.
Unlabel
edUses: Prevent i
onofr ecurrentsubarachnoid
hemor r
hage.Preventionofbl eedingf oll
owingor al
surger
y
i
nhemophi li
acs.Managementofsev er ehemor r
hage
causedbythrombol yticagents.

ACTI
ON
I
nhi
bit
sacti
vati
onofpl
asminogen.Ther
apeut
icEf
fects:
I
nhi
bit
ionoff
ibri
nol
ysi
s.St
abil
i
zati
onofclotf
ormati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Act
ivei
ntr
avascul
arcl
ott
ing.

UseCaut
iousl
yin:
Upperur
inar
ytr
actbl
eedi
ng;
Car
diac,
renal
,orli
verdi
sease(dosagereducti
onmayber equi
red)
;
Disseminat
edintr
avascul
arcoagulati
on(shoul
dbeused
concurr
entlywi
thhepari
n);OB:Lactat
ion:Saf
etynot

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 155
est
abli
shed;Pedi
:Donotusepr
oduct
scont
aini
ngbenzy
l
al
coholwit
hneonates.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,malai
se.EENT:nasalstuf
fi
ness,ti
nnit
us.
CV: arr
hy thmias,hy
potensi
on(IVonly).GI
:anorexi
a,
bloati
ng, cramping,di
arr
hea,nausea.GU:diur
esis,
renal
fail
ure.MS: myopathy
.

I
NTERACTI
ONS
Dr
ug-Drug:Concurr
entusewi t
hestr
ogens,
conjugat
ed
mayresulti
nahy percoagul
abl
estat
e.Concur
rentusewi
th
cl
ott
ingfactor
smay↑ r i
skofthr
omboses.

DOSAGE
AcuteBleedi
ngSy
ndr
omesduet
oEl
evat
edFi
bri
nol
yti
c
Acti
vit
y
PO: (
Adult
s):5g1sthr,f
oll
owedby1–1. 25gqhrfor8hr
oruntil
hemorrhagei
scontr
olled;or6gover24hraf
ter
prostat
esurgery(
not>30g/day).
I
V: (Adult
s):4–5gover1sthr
, f
oll
owedby1g/ hrf
or8hr
oruntilhemorr
hagei
scontrol
led;or6gover24hraft
er
prostat
esurgery(
not>30g/day).

ᏆᖴA2022 Dr
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nHeal
thyCar
e 156
PO:IV:(
Chil
dren):100mg/ kgor3g/m2over1sthr,
fol
l
owedbycont inuousi
nfusi
onof33.3mg/kg/hr
;or1
g/m2/hr(t
otaldosenot>18g/m2/24hr)
.

Subar
achnoi
dHemor
rhage
PO: (
Adul t
s):Tofoll
owI V—3gq2hr( 36g/
day).I
fno
surgeryisperf
ormed, cont
inuefor21daysaft
erbl
eedi
ng
stops,thendecreaseto2gq2hr( 24g/day)f
or3days,
then1gq2hr( 12g/ day)for3days.
I
V:(
Adul
ts)
:36g/
dayf
or10day
sfol
l
owedbyPO.
Pr
event
ionofBl
eedi
ngFol
l
owi
ngOr
alSur
ger
yin
Hemophil
i
acs
PO: (
Adults):75mg/ kg(upto6g)immediat
elyaf
ter
procedur
e, t
henq6hrf or7–10day
s;sy
rupmayal sobe
usedasanor al
rinseof1.25g(5mL)4timesadayf or
7–10day s.
IV:PO: (
Chil
dren):Al sof orepist
axis—50–100
mg/ kg/doseadmi nisteredI Vevery6hrfor2–3days
starti
ng4hrbef orethepr ocedure.Aft
ercompl
eti
onofI
V
therapy,aminocaproicaci dshouldbegi v
enas50–100
mg/ kg/doseorall
yev er
y6hrf or5–7day s.

AVAI
LABI
LITY
Tabl
ets500mg,
1000mg;
Syr
up(
raspber
ryf
lav
or)1.
25g/
5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 157
mL;
Inj
ect
ion250mg/
mL;

PATI
ENTTEACHI
NG
I
nstructpati
entt
onotif
ythenur
sei
mmediat
elyi
f
bl
eedi ngr
ecursori
fthr
omboembol
icsy
mptoms
develop.

I
V:Cauti
onpati
entt
omakeposit
ionchangessl
owl
y
t
oavoidort
host
ati
chypot
ensi
on.

AMI
NOGLUTETHI
MIDE
I
NDI
CATI
ONS
Short
-ter
m adr
enalsuppr
essi
oninpat
ient
swi t
hCushi
ng’
s
syndrome.Unl
abel
edUses:Metast
ati
cbreastorpr
ost
ate
cancer.

ACTI
ON
Inhibit
st hesynt
hesisofadrenalhormonesi ncludi
ng
glucocor ti
coi
ds,miner
alocorti
coids,
estrogens,and
andr ogens.Therapeut
icEffects:
Decreasedpr oducti
onof
adrenal hormonesinCushing’sdisease.Decreasedspread
ofbr eastorprostat
ecancer .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 158
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ogl
utet
himi
deor
aminogl
utet
himi
de;
Lact
ati
on:
Prov
ideal
ter
nat
ivet
obr
east
mil
k.

UseCaut
iousl
yin:
Str
ess(
trauma,
sur
ger
y,oracut
e
i
llness);
additi
onalmineral
ocort
icoidandhy drocor
ti
sone
mayber equi
red;OB:Alt
houghnor malpregnancieshave
occurred,fet
alharm mayresult
;Pedi:Safetynot
establi
shed;Geri
:Mor esuscept
ibletoadv er
seCNS
reacti
ons.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness, dizziness, headache,weakness.CV:
hypotension,tachy cardia.GI: anorexi
a,nausea,hepati
ti
s,
vomiting.Derm: measl es-l
iker ash,prur
it
us,urt
icari
a.Endo:
adrenalinsuffi
ciency ,hirsuti
sm i nwomen, hypothyr
oidi
sm,
mascul i
nizati
oni nwomen.Hemat :AGRANULOCYTOSI S,
l
eukopeni a,neutropeni a,thrombocy t
openia.MS: myal
gia.
Misc:fever.

I
NTERACTI
ONS
Drug-Dr
ug:I
nduces(stimulat
es)hepati
cP450mi cr
osomal
enzymes,whichareresponsi
bleformetaboli
zi
ngmany
drugs.I
ncr
easesmet aboli
sm anddecreaseseff
ecti
veness
ofdexamethasone.Maydecr easetheef
fectsofwarf
arin,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 159
theophyl
li
ne,megestrolt
amoxi f
en,and
medr oxy
pr ogest
erone.Alcoholpotent
iat
est
heef
fect
sof
aminoglutethi
mide.

DOSAGE
Cushi
ng’
sDi
sease
PO:(Adul
ts):
250mgq6hr ;maybei
ncreasedi
n
i
ncrementsof250mgdailyat1–2wkinter
val
s(maxi
mum
dai
l
ydoseshouldnotexceed2000mg).

Br
eastorPr
ost
ateCancer(
unl
abel
ed)
PO:(Adul
ts):
250mgt wi
cedai
lyf
or2wk(upto2g/
day
;
wit
hhy dr
ocor
tisone)f
oll
owedbyi
ncr
easest
o250mgqid.

AVAI
LABI
LITY
Tabl
ets250mg:

PATI
ENTTEACHI
NG
Inst
ructpati
entt
ot akemedicati
onexactl
yasdirect
ed
andnottotakemor eorlessthanprescr
ibed.I
fadose
i
smi ssed,t
akewithin2–4hrunlessalmosttimefor
nextdose;donotdoubledoses.

Maycausedrowsi
nessordizzi
ness.Cauti
onpati
ent
t
oavoiddri
vi
ngorotheract
ivi
ti
esrequir
ingal
ert
ness

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 160
 unt
ilr
esponset
omedi
cat
ioni
sknown.

I
nstructpat
ienttonoti
fyheal
thcar eprofessional
promptlyi
frash,fai
nti
ng,weakness,orheadache
becomespr onouncedorifi
njur
y,infecti
on,orot her
i
ll
nessoccur sbecauseofri
skofadr enalinsuffi
ciency
.

Advisepat ientthatnauseaandl ossofappet

itemay
occurdur i
ngf i
rst2wkoft herapy.Heal
thcar
e
professional shoul
dbenot if
iedifvomit
ingoccur
s
shortlyafteradosei stakenori ft
hesesymptoms
persistorbecomepr onounced.

Adv
isepat
ientt
oav
oidconcur
rentuseofal
cohol
.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Emphasizei
mportanceofcar
ryi
ngident
if
icat
ion
descr
ibi
ngmedicati
onregi
menatallti
mesandt he
needforcl
osemonitor
ingbyheal
thcareprof
essional
.

Geri
:Instructpat
ientandf
ami
l
yinf
all
prev
ent
ion
st
rategies.

Ami
nol
evul
i
nicaci
d
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 161
Treatmentofnonhyperkerat
oti
cacti
nickerat
osesofthe
faceandscalpinconjucti
onwithbl
uel i
ghtil
l
uminati
on
usingtheBLU-UBlueLightPhotody
nami cTherapy
I
lluminat
or.

ACTI
ON
Whenappliedtopical
ly,
producesanaccumul at
ionof
pr
otoporphyr
inIX,whichwhenexposedt ospecifi
c
wavel
engthsoflightandenergyinthepresenceofoxygen,
pr
oducesacy totoxi
cphotodynamicreacti
on.Therapeut
ic
Ef
fects:
Resoluti
onofnonhy perker
atot
icacti
nickerat
oses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hist
oryof
cut
aneousphot osensi
ti
zat
ion;
Por phyr
ia;
Hy persensi
ti
vi
ty
toporphyr
ins;
OB: Lact
ati
on:Pregnancyorlactati
on;
Chil
dren.

UseCaut
iousl
yin:
Otherphot
oder
mat
oses;
Acqui
redor
i
nher
it
edcoagul
ati
ondef
ect
s.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Local
:burni
ng,
edema,
prur
it
us,
sti
ngi
ng,
oozi
ng,
scal
i
ng,
ul
cerat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 162
I
NTERACTI
ONS
Drug-
Dr ug:Concur r
entuseofot herphot osensi
ti
zi
ng
agentsincludingthi
azidediur
etics,sulfonyl
ureas,
phenothiazines,sul
fonamides,ortetracycli
nesmay↑
i
ntensit
yoft hephotosensi
ti
zingreact i
on.

DOSAGE
Topi
cal
:(Adult
s):
Oneappli
cati
onvi
at heKerast
ick
syst
em (
contai
ns354mgofami nol
evuli
nicaci
d),f
oll
owed
14–18hrlat
erbybluel
i
ghti
ll
uminat
ion.

AVAI
LABI
LITY
Ker
asti
ckappl
i
catorsy
stem 354mgami nol
evul
ini
c
aci
d/ampul
eplus1.
5mLhy droal
cohol
i
csoluti
onvehi
cle;

PATI
ENTTEACHI
NG
Cautionpatienttoav oidsunli
ghtorbr i
ghtindoorli
ght
(examinati
onl amps, operati
ngroom lamps, tanni
ng
beds, l
i
ghtsatcl osepr oxi
mity)betweenappl i
cati
on
andexposur et oacti
v ati
ngli
ght.Skinwillbe
photosensiti
vedur i
ngt hisperi
od.Exposur emay
resulti
nstingingand/ orburni
ngsensat ionandmay
causeer yt
hemaand/ oredemaoft helesions.
Protecti
onshoul dincludeawi de-bri
mmedhator

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 163
 simil
arheadcoveri
ngofli
ghtopaquemateri
al.
Sunscreenswil
lnotpr
otectagai
nstphot
osensit
ivi
ty
react
ionscausedbyvi
sibl
elight
.

Inst
ructpat
ienttoavoi
docclusi
vedr
essi
ngs;
may
causeexcessiveir
ri
tat
ion.

Advisepat
ienttokeeptreat
edacti
nickerat
osesdr
y
andoutofbrightl
ightbetweenappl
icat
ionand
exposuret
oact i
vati
ngli
ght.

Infor
m patientt hatblueli
ghtislowi ntensi
tyandwi l
l
notheatski n.Inform pati
entthattheymayexper ience
tingl
i
ng,sti
ngi ng, pri
ckl
ingorbur ningsensati
onsof
thetreat
edl esions.Actini
cker atosesandsur r
ounding
skinwill
reddenandsomescal ingandswel li
ngmay
occur.Thesel esionchangesar etempor ar
yand
shouldbecompl etel
yresolv
edby4wksaf ter
treat
ment .

I
nstructpati
enttocont actheal
thcareprofessionali
f
theyareunabletor etur
nforblueli
ghtther
apywi t
hin
14-18hr.Cautionpat i
enttoavoidexposur
eof
photosensit
izedlesionstosunli
ghtorprol
ongedor
i
ntenselightforatleast40hr.Ifst
ingi
ngand/ or
burni
ngisnot ed,exposuretoli
ghtshouldber educed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 164
Ami
nophy
ll
ine
I
ndi
cat
ions
Statusasthmaticus,chr
onicobst
ruct
ivepulmonary
di
sease( COPD) ,r
eversi
bleai
rwayobstructi
on,chr
oni
c
bronchi
ti
s, pul
monar yedema,adj
unctintreati
ngCHF,
apnoeainpr ematureinf
ants.

ACTI
ON
Inhi
bitsphosphodi esterase, pr
oducingincreasedt i
ssue
concentrationsofcy cli
cadenosi nemonophosphat e
(cAMP) .Increasedl evelsofcAMPr esul
tin:
Bronchodi l
ation, CNSst imulati
on, Posit
iveinotropi
cand
chronotropicef fects,Diuresis,Gastri
cacidsecr eti
on.
Ami nophy l
li
nei sasal toft heophylli
neandr eleasesfree
theophyll
ineaf teradmi nistrati
on.Therapeut i
cEf f
ects:
Bronchodi l
ation.

Av
ail
abi
l
ity
TABLETS100,200,
225,and350mg;I
NJECTI
ON10ml
(250mg/2ml,25mg/ml);ORALLI
QUI
D105mg/5ml
;
SUPPOSITORy250mg,500mg.

DOSAGE
ᏆᖴA2022 Dr
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nHeal
thyCar
e 165
Par
ent
eral
/Or
al
Adult
-250-
500mgorall
yorbyslowi.vinj
ect
ion.Loadi
ng
dose-5mg/kg.Mai
ntai
nancedose-0.5mg/kg/h.
Chi
ld-(
6months–9y
ear
s)1mg/
kg/
h.(
10–16y
ear
s)
800µg/kg/
h

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
tyt
otheophy
ll
ines.

I
NTERACTI
ONS
Drug- Drug: Additiv
eCVandCNSsi deef fectswi th
adrener gics( sympat homi metic).May↓ t het herapeut i
c
effectofl ithi
um andpheny t
oin.Smoki ng,bar biturates,
carbamazepi ne,phenyt oi
n,nev i
rapineandr ifampi nmay↑
met abol i
sm andmay↓ ef fectiv
eness.Er ythromy ci
n, beta
blocker s,clarit
hromy cin,calci
um channel
blocker scimet i
dine,hormonal cont r
acept ives, disulf
iram,
doxy cycline,estrogens, fl
uvoxami ne, i
soni azid,
ketoconazol e,mexileti
ne, nefazodone, prot easei nhibitor
s,
quinidine, somef l
uoroquinolones, andl argedosesof
all
opur inol ↓ met abolism andmayl eadt ot oxicit
y .
Drug-Nat
ural
Product:Caff
eine-
cont
aini
ngherbs(col
anut,
guarana,
mate,t
ea,coffee)may↑ serum l
evelsandri
skof
CNSandCVsi deeffects.↓ ser
um l
evel
sand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 166
ef
fect
ivenesswi
thSt
.John’
swor
t.
Drug-
Food:
Excessi
veregulari
ntakeofchar
coal
-br
oil
ed
foodsmay↓ eff
ect
iveness.

Pr
ecaut
ions
Alcohol dependence;
hy perthy
roidism; pepti
culcer;f
ebril
e
i
llness;pat i
ent
swithsev er
ehear t,l
iverorkidneydisease;
l
act at
ionr enali
mpair
menti nteractionscongestiveheart
fail
ure;neonatesandel der
lypatients;epil
epsy;highblood
pressure;glaucoma;diabetes;all
ergies,pregnancy.

Adv
erseEf
fect
s
Convulsions;hypokalemia;di
zziness,headache;
pal
pitati
on, t
achycardia,
diarr
hoea; anxi
ety;
urinar
y
ret
ention;restl
essness;tr
emor s;abdominalpain;
exfol
i
at i
veder mati
tis;er
ythema.

PATI
ENTTEACHI
NG
Emphasizetheimportanceoftaki
ngonl
ythe
pr
escribeddoseattheprescri
bedtimei
nter
val
s.
Misseddosesshouldbet akenassoonaspossi
bleor
omitt
edi fcl
osetonextdose.

Encour
agethepat
ientt
odrinkadequateli
qui
ds(2000
mL/dayminimum)todecr
easethev i
scosi
tyoft
he

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 167
 ai
rwaysecr
eti
ons.

Advi
sepatientt
oav oi
dOTCcough, col
d,orbreat
hing
pr
eparati
onswithoutconsul
ti
nghealt
hcare
pr
ofessi
onal.Thesemedicat
ionsmayincreasesi
de
ef
fectsandcausear r
hyt
hmias.

Encouragepat
ient
snott
osmoke.Achangei
n
smokinghabit
smaynecessi
tat
eachangei
ndose.

Advisepatienttomini
mi zeint
akeofxanthine-
contai
ningf oodsorbeverages(col
as,coff
ee,
chocolate)andnottoeatchar coal
-br
oil
edfoodsdai
l
y.

Inst
ructpat
ientnott
ochangebrandswi
thout
consult
inghealt
hcarepr
ofessi
onal
.

Advisepati
enttocontactheal
thcareprof
essional
promptl
yiftheusualdoseofmedi cat
ionfai
lsto
producethedesir
edresult
s,symptomswor senaft
er
tr
eatment,ortoxi
ceff
ectsoccur.

Emphasizetheimport
anceofhav
ingser
um l
evel
s
rout
inel
ytestedev
ery6–12mo.

St
orage
St
oreprotectedfr
om li
ghtandf
rom at
mospheri
ccarbon
di
oxi
de.Injecti
on:St
oreinsi
ngl
edosecont
ainer
s,f
rom

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 168
whichcarbondi
oxi
dehasbeenexcluded.Donotal
low
contactwit
hmetal
s.Tabl
ets:
Stor
epr ot
ectedf
rom l
ight
.

Ami
odar
one
I
ndi
cat
ions
Sever
er hythmicdisorderwhereothertherapiescannotbe
usedincludingtachyarr
hyt
hmi aassociat
edwi t
h
Wolff
Par ki
nson-Whitesyndrome,atri
alfl
utterand
fi
bri
ll
ati
on; all
typesofparoxysmaltachycardia.

ACTI
ON
Prolongsacti
onpot enti
alandr efractor
yperi
od.I nhi
bit
s
adrenergicst
imulati
on.Slowst hesi nusrat
e, i
ncreasesPR
andQTi nt
erv
als,anddecr easesper i
pheralvascular
resi
stance(vasodil
ati
on).Ther apeuticEff
ects:
Suppressionofarrhythmias.

Av
ail
abi
l
ity
TABLETS100and200mg;
INJECTI
ON3ml
ampoul
e(50
mg/ml).

DOSAGE
Or
al

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 169
200mgt hreeti
mesadayf oroneweek,reducedto200
mgt wicedailyf
orfur
theroneweek.Maintenance200mg
dai
lyorreducedt omini
mum requi
redtocont r
ol
arr
hythmi a.

I
ntr
avenousi
nfusi
on(
wit
hcent
ral
venouscat
het
er)
.
Ini
ti
all
y5mg/ kgbodywei ghtover20to120mi nwithECG
monitori
ng,
subsequentinfusi
ongivenifnecessar
y
accordi
ngtoresponse(upt omax1.2gin24h) .

Cont
rai
ndi
cat
ions
Sinusbradycardia,sino-
atri
alhear tblock;unless
pacemakerf i
ttedav oidinsever econduct i
ondi st
urbances
orsinusnodedi sease; t
hyroiddy sfuncti
on;iodine
sensiti
vi
ty;
goi t
re;avoidint
rav enoususei nsev ere
respir
ator
yfai l
ure,ci
rculat
orycol lapse,severearter
ial
hypotensi
on, avoidbolusinjectionincongest iveheart
fail
ureorcardiomy opathy;l
act ati
on; pr
egnancy .

I
NTERACTI
ONS
Drug- Drug:↑r iskofQTpr olongati
onwi th
fl
uor oquinolones,macroli
des, andazoleantif
ungals
(under takeconcurrentusewi t
hcaut i
on).↑ level
sof
digoxin( ↓ doseofdi goxi
nby50%) .↑ level
sofclassI
antiarrhythmics(quini
dine,mexilet
ine,l
idocaine,
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 170
fl
ecai nide—↓ dosesofot herdrugsby30–50%) .↑ l evel
s
ofcy clospor ine,dextromet horphan,met hot r
exat e,
pheny toi n,carvedil
ol,andt heophy l
l
ine.Pheny toi n↓
amiodar onel evels.↑ act i
vit
yofwar farin( ↓ doseof
warfar i
nby33–50%) .↑ r i
skofbr ady arrhythmi as, sinus
arr
est ,orAVhear tblockwi thbet ablocker sorcal cium
channel blocker s.Cholestyraminemay↓ ami odar one
l
evels.Ci met i
dineandr i
tonavir↑ ami odar onelev els.Risk
ofmy ocar dialdepressioni s↑ byv olat i
leanest hetics.↑
ri
skofmy opathywi thlovastatinandsi mv astatin(donot
exceed40mg/ dayofr egular-
releasel ov astati
n, 20
mg/ dayofext ended-releaselov ast
atin, or20mg/ dayof
si
mv ast ati
n).
Drug-NaturalProduct:St
.John'
swortinducesenzy
mes
thatmet abol
izeami odar
one;may↓ level
sand
effect
iveness.Avoidconcurr
entuse.
Drug-Food:Grapef
ruitj
uiceinhi
bit
senzymesint
heGIt
ract
thatmetaboli
zeami odaroneresul
ti
ngin↑ l
evel
sandr
isk
oftoxici
ty;
avoidconcurrentuse.

Pr
ecaut
ions
Liv
er-
funct
ionandthyr
oid-
functi
ontest
sr equi
redbef
ore
tr
eatmentandthenevery6mont hs;
hypokalaemia
(measureser
umpotassium concent
rat
ionbefore

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 171
treatment )
; chestx-rayrequiredbeforet reatment ;heart
fail
ure;elder l
y;severebrady cardi
aandconduct ion
disturbancesi nexcessi vedosage; int
rav enoususemay
causemoder ateandt ransientfall
inbl oodpr essure
(cir
culatorycol l
apsepr ecipitat
edbyr apidadmi nistr
ation
orov erdosage)orsev erehepat ocell
ulartoxicity(moni tor
transami nasescl osely);ECGmoni tori
ngandr esuscitation
facil
it
iesmustbeav ailableduringintr
av enoususe;
porphy ri
a;interacti
ons.

Adv
erseEf
fect
s
Nausea, v omi t
ing,tastedi stur bances, raisedser um
transami nases( mayr equi r
edoser educt ionorwi thdr awal
i
faccompani edbyacut el iverdi sor ders) ,j
aundi ce;
brady cardi a;pulmonar yt oxicity( includi ngpneumoni t i
s
andf ibrosi s);tr
emor ,sleepdi sor der s;hy pothy roidism,
hy per thyroi di
sm; reversi blecor neal micr odeposi ts
(somet i
meswi thnightgl are); phot ot oxicity,per sistent
slat e-
gr eyski ndi scolour at i
on; l
esscommonl yonsetor
wor seningofar r
hy t
hmi a, conduct iondi st urbances,
per ipher al neuropathyandmy opat hy( usual lyr ever sibleon
wi thdr awal );veryrarely, chroni cl iverdi seasei ncludi ng
cirrhosi s, sinusar r
est, br onchospasm ( inpat i
ent swi th
sev erer espi r
atoryfail
ur e) ,ataxi a, benigni ntr
acr ani al
hy per tensi on,headache, verti
go, epi didy mo- orchi ti
s,

ᏆᖴA2022 Dr
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nHeal
thyCar
e 172
i
mpot ence, haemolyti
corapl asti
canaemi a,
thrombocy topenia,
rash( i
ncludi
ngexf oli
ativ
edermat i
ti
s),
hy persensiti
vit
yincludi
ngv asculi
ti
s, al
opecia,impai
red
visionduet oopt icneurit
isoropticneur opathy(i
ncl
uding
blindness) ,
anaphy l
axisonr apidi
njection,also
hy potension,respir
atorydistr
esssy ndrome, sweati
ngand
hotf l
ushes.

PATI
ENTTEACHI
NG
I
nstructpatienttotakeami odaroneasdirect
ed.
AdvisepatienttoreadtheMedi cat
ionGui
depr i
orto
fi
rstdoseandwi theachRxr efi
ll.I
fadoseismissed,
donott akeatall.Consulthealthcarepr
ofessi
onalif
mor ethantwodosesar emi ssed.

Advisepat
ientt
oav
oiddr
inki
nggr
apef
rui
tjui
cedur
ing
ther
apy.

Inf
orm pat
ientt
hatsideef f
ectsmaynotappearunti
l
sever
aldays,weeks,oryrafteri
nit
iat
ionofther
apy
andmayper si
stforseveralmoaf t
erwithdr
awal.

Teachpat
ientstomoni
torpul
sedai
l
yandr
epor
t
abnor
mali
ties.

Advisepati
ent
sthatphot
osensi
ti
vi
tyreact
ionsmay
occurthr
oughwindowglass,
thi
nclot
hing,and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 173
 sunscreens.Prot
ecti
veclot
hingandsunblockar
e
recommendeddur i
ngandfor4moaf t
erther
apy
.If
photosensit
ivi
tyoccur
s,dosagereducti
onmaybe
useful
.

Inform pati
entsthatbl
uishdiscolorati
onofthef ace,
neck,andar msi sapossiblesideeffectofthisdrug
afterprolongeduse.Thi
si susuallyrever
sibl
eandwi l
l
fadeov erseveralmo.Notifyhealt
hcar eprofessional
i
ft hi
soccur s.

Inst
ructmalepatient
stonoti
fyhealthcare
prof
essionali
fsignsofepi
didymiti
s(painand
swell
inginscrot
um)occur.Mayr equir
ereduct
ioni
n
dose.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations,
especial
lySt
.John'swor t.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advi
sepat
ientt
onoti
fyheal
thcar
eprofessi
onali
f
si
gnsandsymptomsofthyr
oiddysf
uncti
onoccur.

Caut
ionf
emal
epat
ient
stoav
oidbr
east
feedi
ngdur
ing

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 174
 t
her
apy
.

Emphasi zet
heimportanceoff
oll
ow-upexams,
i
ncludingchestx-
rayandpulmonaryf
uncti
ontest
s
every3–6moandopht hal
micexamsaft
er6moof
ther
apy ,
andthenannually
.

St
orage
Storepr
otect
edf
rom l
i
ghtatt
emper
atur
enotexceedi
ng
30⁰C.

Ami
tr
ipt
yli
ne
I
ndi
cat
ions
Moder
atetoseveredepressi
on,
migr
ainepr
ophy
laxi
s;
t
ensi
on,headache,enur
esis.

ACTI
ON
Potenti
atestheeff
ectofserotoni
nandnor epinephr
inei
n
theCNS.Hassi gni
fi
cantanti
choliner
gicproperti
es.
Therapeuti
cEffect
s:Ant
idepressantacti
on.

Av
ail
abi
l
ity
TABLETS10,
25,
50and75mg;
INJECTI
ON10ml

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 175
ampoul
e(10mg/
ml)
.

DOSAGE
Or
al
Adult-I
niti
all
y75mg(adolescent
s30to75mg)dail
yin
di
v i
deddosesorasasi ngl
edoseatbedti
meincr
eased
gradual
lyasnecessar
yt o150to200mgdail
y.Pr
ophyl
axi
s
ofmi gr
aine:10-
75mgatni ght
.
Chi
l
d-Under16y
ear
s;notr
ecommended.

Cont
rai
ndi
cat
ions
Recentmy ocardi
ali
nfar
cti
on,arrhythmias(especi
all
y
heartbl
ock);manicphaseinbipolardisor
ders;sev
ereli
ver
di
sease;chil
dren;por
phyri
a;gl
aucoma, pr
ostati
c
hypert
rophy.

I
NTERACTI
ONS
Drug-Dr ug:Ami tr
iptyli
neismetabol i
zedinthel i
verbyt he
cytochr omeP4502D6enzy me,andi t
sact i
onmaybe
affectedbydr ugst hatcompetef ormetabolism bythis
enzy me, i
ncludingot heranti
depressants,phenothiazines,
carbamazepi ne,class1Cant i
arrhythmicsincludi
ng
propaf enone, andf l
ecaini
de;whent hesedrugsar eused
concur rent
lywi thami tr
ipt
yli
ne,dosage↓ ofoneort he

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 176
otherorbot hmaybenecessar y .Concur r
entuseofot her
drugst hati nhibitt heact ivi
tyoft heenzy me, i
ncludi ng
cimet idine, quinidi ne, ami odarone, andr itonav ir,mayr esult
i
n↑ ef fectsofami tr
ipt yli
ne.Maycausehy potensi on,
tachy car dia,andpot ent ial
lyfat al r
eact ionswhenusedwi th
MAOi nhibitors( av oidconcur r
entuse—di scont i
nue2wk
beforest artingami tr
ipt yli
ne).Concur rentusewi t
hSSRI
antidepr essant smayr esultin↑ t oxi cityandshoul dbe
avoided( f
luoxet ineshoul dbest opped5wkbef ore
starti
ngami t
ripty li
ne).Concur rentusewi t hcloni dinemay
resulti nhy per tensi vecr i
sisandshoul dbeav oided.
Concur rentusewi thlev odopamayr esul tindel ay edor↓
absor pt i
onofl ev odopaorhy per tensi on.Bl oodl ev elsand
effectsmaybe↓ byr ifampi n,rifapent i
ne, andr if
abut in.
Concur rentusewi thmoxi floxaci n↑ r i
skofadv erse
cardiov ascul arr eact ions.↑ CNSdepr essi onwi thot her
CNSdepr essant si ncludi ngal cohol , ant i
hi stami nes,
clonidine, opi oids, andsedat ive/hy pnot ics.Bar biturates
mayal terbl oodl ev el
sandef fect s.Adr ener gicand
antichol inergicsi deef fect smaybe↑ wi thot heragent s
hav i
ngant i
chol iner gi
cpr oper t
ies.Phenot hiazinesoror al
cont r
acept ives↑ l ev elsandmaycauset oxicity.Ni cotine
may↑ met abol ism andal teref f
ect s.
Drug-
Natur
al Pr
oduct
:St.John’
swor tmay↓ ser
um
concent
rat
ionsandeff
icacy.Concomit
antuseofkav
a-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 177
kav
a, v
aleri
an,orchamomil
ecan↑ CNSdepr
essi
on.↑
ant
icholi
nergi
ceffect
swit
hji
msonweedandscopol
ia.

Pr
ecaut
ions
Cardiacdisease( seeCont rai
ndi cat i
onsabov e) ;hi
stor
yof
epil
epsy;lactationel derly
; hepat icimpai rmentt hyr
oid
disease;pheochr omocy toma; histor yofmani a,psychoses
(mayaggr av atepsy chot i
csy mpt oms) ;angl e-closure
glaucoma; historyofur i
naryr etent ion;concur rent
el
ect r
oconv ulsi
v et her apy;avoi dabr uptwi t
hdr awal;
anaesthesia( i
ncr easedr i
skofar rhy thmi asand
hypotension) ;i
nter act i
onspr egnancypr e-existing
haemat ol
ogi caldi sor der,abruptdi sor i
ent ati
on.
Mayimpai
rabi
li
tyt
operform ski
l
ledt
asks,
forexampl
e
oper
ati
ngmachi
nery,
dri
ving.

Adv
erseEf
fect
s
Sedation;drymout h;blurredv ision(disturbanceof
accommodat i
on, i
ncreasedi ntraocularpr essure)
;
consti
pat i
on;nausea; diff
icultyinmi ct
urition;
cardi
ov ascul
aradv erseef fectspar ti
cularlywithhigh
dosagei ncl
udingECGchanges, ar
rhy t
hmi as,postur
al
hypotension,tachycardia,syncope; sweat ing,t
remor,r
ash
andhy persensiti
vi
tyreactions( urt
icari
a, photosensi
ti
vit
y);

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 178
behav i
our aldisturbances; hypomani aormani a,confusion
(particularlyinel derly
),interfer
encewi t
hsexual functi
on,
bloodsugarchanges; increasedappet i
teandwei ghtgain
(occasi onal wei ghtloss) ;endocr i
neadv er
seef f
ect ssuch
ast est i
cularenl argement ,gynaecomast iaand
galact orrhoea; conv ulsions,mov ementdi sordersand
dyski nesias,fev er,agranul ocytosis,leukopenia,
eosinophi l
ia,pur pura,thrombocy topenia,hyponat r
aemia
(maybeduet oi nappr opriateant idi
ur et
ichormone
secr eti
on) ;abnor mal liverfunctiont est.

PATI
ENTTEACHI
NG
Instr
uctpat i
enttot akemedi cati
onasdi rected.Ifa
dosei smi ssed,takeassoonaspossi bleunl ess
almostt i
mef ornextdose; ifregimeni sasingl edose
atbedt i
me, donott akei
nt hemor ni
ngbecauseof
sideeffects.Adv i
sepat i
entt hatdrugef f
ectsmaynot
benot i
cedf oratl east2wk.Abr uptdiscontinuati
on
maycausenausea, vomiti
ng, di
arrhea,headache,
troubl
esl eepingwi thviv
iddr eams, andirri
tabili
ty.

Maycausedr owsinessandbl
ur r
edv i
sion.Cauti
on
pat
ienttoavoiddriv
ingandotheracti
viti
esrequi
ring
al
ertnessunt
ilresponsetodr
ugi sknown.

Or
thost
ati
chy
pot
ensi
on,
sedat
ion,
andconf
usi
onar
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 179
 commondur i
ngearl
yther apy,especiall
yingeriat
ri
c
pati
ent s.Prot
ectpati
entf r
om f al
lsandadv i
sepati
ent
tomakeposi t
ionchangessl owl y
.Insti
tutefall
precaut i
ons.Advi
sepatienttomakeposi tionchanges
slowly.Referasappropriatefornutrit
ion/weight
managementandmedi cal management .

Advisepati
enttoav
oidal
cohol orot
herCNS
depressantdr
ugsduri
ngandf or3–7daysaf
ter
ther
apyhasbeendiscont
inued.

Advisepati
ent,fami l
yandcar egiverst olookfor
sui
cidali
ty,
especi all
ydur i
ngear l
ytherapyordose
changes.Notifyhealthcar eprof essionalimmediatel
y
i
fthoughtsaboutsui cideordy ing,attempt st
o
commi tsuici
de, neworwor sedepr essionoranxiet
y,
agit
ati
onorr estlessness, panicattacks, i
nsomnia,
neworwor seirritabi
lit
y ,
aggressi veness,acti
ngon
dangerousimpul ses, mania,orot herchangesi n
moodorbehav ioroccur .

Instructpatientt onoti
fyheal
thcareprof
essionalif
urinaryretention,drymouth,orconsti
pat
ionpersists.
Sugar l
esscandyorgum maydi minishdr
ymout h, and
ani ncreasei nfluidi
ntakeorbul
kmaypr event
const i
pation.Ifsy mptomspersi
st,dosereducti
onor
discont i
nuationmaybenecessar y
.Consulthealt
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 180
 car
epr
ofessi
onal
ifdr
ymout
hper
sist
sfor>2wk.

Cauti
onpati
enttousesunscreenandpr otecti
v e
cl
othi
ngtopreventphot
osensit
ivi
tyreactions.Aler
t
pat
ientt
hatmedicati
onmayt urnuri
nebl ue-greeni
n
col
or.

I
nform pat
ientofneedt
omonitordi
etar
yint
ake.
I
ncreaseinappeti
temayleadt
oundesir
edweight
gai
n.

Advi
sepati
entt
onotif
yhealt
hcarepr
ofessi
onalif
pr
egnancyi
splannedorsuspect
edori
fbreast
feeding.

Advisepatienttonot
if
yhealthcareprof
essi
onalof
medi cat
ionregimenbeforetr
eatmentorsur
gery
.
Medi cat
ionshouldbedisconti
nuedaslongas
possiblebeforesur
gery.

Ther apyfordepressi
oni susuall
ypr ol
ongedand
shoul dbecontinuedforatleast3mot opr event
relapse.Emphasi zet
hei mportanceoff oll
ow-up
examst omoni t
oreff
ectiveness,sideeffects,and
i
mpr ovedcopingskil
ls.Advisepatientandf amilyt
hat
treatmentisnotacur eandsy mpt omscanr ecuraft
er
discontinuat
ionofmedi cati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 181
Aml
odi
pine
I
ndi
cat
ions
Angi
na,
hyper
tensi
on,
cor
onar
yar
ter
ydi
sease.

ACTI
ON
Inhi
bitsthetr
anspor tofcal
cium int
omy ocardialand
vascularsmoothmuscl ecells,r
esulti
ngi ninhi
biti
onof
excit
ation-
contract
ioncoupli
ngandsubsequent
contracti
on.Therapeuti
cEffects:Systemicv asodil
ati
on
resul
tingindecreasedBP.Cor onaryvasodi l
ati
onr esul
ti
ng
i
ndecr easedfrequencyandsev erit
yofat tacksofangina.

Av
ail
abi
l
ity
TABLETS1.
25,
2.5,
5,7.
5,10and20mg.

DOSAGE
Or
al
Angina:Adult
-Ini
ti
all
y5mgoncedai
l
y,i
ncr
easedi
f
necessary;
max.10mgoncedaily
.

Hy
per
tensi
on:Adul
t-I
nit
ial
l
y5mgoncedai
l
y,i
ncr
easedi
f
necessar
y;max.10mgoncedai
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 182
El
der
ly-I
nit
ial
dose-2.
5mgoncedai
l
y.

Cont
rai
ndi
cat
ions
Signi
ficantaort
icstenosi
s, si
noat
ri
alnodedi
sease,
hypersensit
ivi
tytodihydr
opy r
idi
nes,
cardi
ogeni
cshock,
unstableangina;i
nteract
ions.

I
NTERACTI
ONS
Drug-Drug:StrongCYP3A4i nhibi
tors,incl
udi ng
ketoconazole,itraconazole,andr i
tonav i
rmay↑ l ev
els.
Additi
vehy potensi onmayoccurwhenusedconcur rentl
y
withfentanyl,
ot herant i
hypert
ensiv es,nit
rates,acute
i
ngest i
onofal cohol ,orquini
dine.Ant i
hypertensiveeffect
s
maybe↓ byconcur r
entuseofnonst eroi
dal anti
-
i
nf l
ammat oryagent s.May↑ r iskofneur otoxici
tywith
l
ithi
um.↑ r iskofmy opathywithsimv astati
n( donot
exceed20mg/ dayofsi mv astati
n).
Dr
ug-
Food:
Grapef
rui
tjui
ce↑ ser
um l
evel
sandef
fect
.

Pr
ecaut
ions
Hy
pot
ensi
on,
myocar
dial
inf
arct
ion,
i
mpai
redrenalf
unct
ionsick-si
nussyndr
ome,
sev
ere
v
ent
ri
culardysf
unct
ion,
hy pert
rophi
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 183
cardi
omy opathy,sev
ereaorti
cst
enosi
s,el
der
ly,
chi
l
dren,
pregnancylactat
ion;hepat
ici
mpair
ment.

Adv
erseEf
fect
s
Arrhyt
hmi as,posturalhypotension;di
zziness,ankl
eedema,
hypoesthesia,flat
ulence,di
zziness,blur
redv i
sion,
faci
al
fl
ushing,dyspnoea, astheni
a, musclecramps, conduct
ion
system delay,abdomi nalpain,headache;sleep
di
st ur
bances, fati
gue.

PATI
ENTTEACHI
NG
Adv i
sepat
ientt
otakemedi cat
ionasdi
rect
ed,evenif
feeli
ngwell
.Takemisseddosesassoonaspossi bl
e
unlessal
mosttimefornextdose;donotdouble
doses.Mayneedtobedi scont
inuedgr
aduall
y.

Advi
sepati
enttoavoi
dlargeamounts(
6–8gl
assesof
gr
apefr
uitj
uice/
day
)duringther
apy.

I
nst r
uctpat i
entoncorr
ecttechniquef
ormonit
ori
ng
pulse.Instr
uctpati
enttocontactheal
thcar
e
professionali
fheartr
ateis<50bpm.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Maycausedr
owsi
nessordi
zzi
ness.Adv
isepat
ientt
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 184
 avoi
ddr i
vingorot
heract
ivi
ti
esrequi
ri
ngal
ert
ness
unti
lresponsetot
hemedicati
onisknown.

Instr
uctpat i
entonimpor t
anceofmai ntai
ninggood
dentalhygieneandseei ngdenti
stfrequentl
yforteet
h
cleani
ngt opr ev
enttenderness,bl
eeding,andgingi
val
hyperpl
asia( gum enl
argement )
.

Instr
uctpatienttonoti
fyhealt
hcarepr ofessional
of
allRxorOTCmedi cati
ons,vi
tamins,orher bal
productsbeingtaken,toavoidal
cohol, andtoconsul
t
healthcareprofessi
onalbeforet
akinganynew
medi cat
ions,especi
all
ycoldpreparati
ons.

Advisepat i
enttonotif
yhealthcareprofessi
onali
f
i
rregul arheartbeat
s,dyspnea,swell
i
ngofhandsand
feet,pr onounceddizzi
ness,nausea,consti
pati
on,or
hypot ensionoccursorifheadacheissev ereor
persistent.

Cauti
onpat
ienttowearprotect
ivecl
othinganduse
sunscr
eent
opr eventphot
osensit
ivi
tyreact
ions.

Advi
sepatientt
oinf
orm heal
thcar
eprofessionalof
medicat
ionregi
menbeforetr
eatmentorsurgery.

Angi
na:I
nst
ructpat
ientonconcurrentni
tr
ateorbet a-
bl
ockert
her
apytocontinuet
akingbot hmedicat
ions
asdi
rect
edandtouseSLni t
rogly
cer i
nasneededf or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 185
 angi
nal
att
acks.

Advisepati
enttocontacthealt
hcareprofessionali
f
chestpaindoesnotimprov eorworsensafterther
apy,
i
fitoccurswithdi
aphoresis,i
fshort
nessofbr eath
occurs,
orifsever
e,persist
entheadacheoccur s.

Caut
ionpati
enttodi
scussexerci
serestr
ict
ionswi
th
heal
thcar
eprofessi
onalbef
oreexer
tion.

Hypertension:Encouragepat i
enttocompl ywithother
i
nterventionsforhypertensi
on( weightreduct
ion,
low-
sodium diet,smokingcessation,moder ati
onof
al
cohol consumpt i
on, r
egularexercise,
andstress
management ).Medicationcontrol
sbutdoesnotcur e
hypertension.

I
nstructpati
entandf amil
yinpropertechni
quef
or
moni t
ori
ngBP.Adv isepati
enttotakeBPweeklyand
toreportsi
gnif
icantchangestohealthcare
professi
onal
.

St
orage
St
orepr
otect
edf
rom moi
stur
e.

Amodi
aqui
ne

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 186
I
ndi
cat
ions
Treatmentofuncompl
i
cat
edmal
ari
acausedbyP.
fal
cipar
um.

Av
ail
abi
l
ity
TABLET200mg;
SUSPENSI
ON50mg/
5ml
.
DOSAGE

Or
al
Adult
-Prophyl
axi
s:300mgonceweekl
y,star
toneweek
befor
eenteri
ngendemicar
eaandcont
inuefor4weeks
aft
erleavi
ng.
I
nfant
-upto12weeks,bodyweightunder6kg:
37.
5mg
onceweekl
y,1y
earbodyweight6to10kg: 75mgonce
weekl
y.
Chil
d-1to4years,
bodyweight10to16kg: 11to12.5mg
onceweekl
y.4to8y ear
s:bodyweight16to25kg: 150
mgonceaweek.8t o13y ear
s,bodyweightover45kg:
adul
tdoseisused.

Cont
rai
ndi
cat
ions
Hepat
ici
mpai
rmentbl
ooddi
sor
der
s,r
eti
nopat
hy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 187
Pr
ecaut
ions
Pregnancyandlact
ati
on;G-6-
PDdefi
ciency
;av
oid
concurr
entther
apywithhepatot
oxi
cdrugs.
Patientsandt heircar etakersshouldbet ol
dhowt o
recognizet hesi gnsofbl ooddi sor
dersandadv i
sedto
seekmedi cal attent i
onassoonaspossi bleifsy mptoms
suchasf ever, soret hroat,r
ash, mouthulcer
s, purpura,
bruisi
ngorbl eedi ngdev elop.Theyshouldalsobet ol
dhow
torecogni zesi gnsofhepat iti
sandadv i
sedt oseek
medi calattent i
oni fsymptomssuchasanor exia,
abnor mal weightl oss,asthenia,abdominalpains,fever
,
nauseaorv omi t
ingdev el
op.

Adv
erseEf
fect
s
Blooddisor dersincludingl
eukopeni aandagranulocyt
osis;
hepati
ti
s; gast r
ointesti
naldistur
bances,vi
sual
di
sturbances( r
etinopathyassoci at
edwithlong-
term,high-
dosether apy);rarel
y,rash,pruri
tus,ski
npigmentati
on,
neuromy opat hy.

Ammoni
um chl
ori
de
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 188
IV:Treatmentof
:Hy
pochl
oremi
cst
ates,
Met
abol
i
c
alkal
osis.

ACTI
ON
Ammonium ioni
sconv ert
edtoureai ntheli
ver,l
i
ber at
ing
hydr
ogenandchlor
ide.Therapeuti
cEf f
ects:DecreasedpH
andcorr
ect
ionofmet abol
icalkal
osis.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Renal
/hepat
ici
mpai
rment
.

UseCaut
iousl
yin:
Pri
mar
yrespi
rat
oryaci
dosi
s;OB:
/
Lact
ati
on:
Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:coma, confusion,dr
owsi ness,headache,seizure.
Derm:rash.GI:hypokalemia,gastri
cirr
it
ati
on, nausea,
vomit
ing.FandE: metabol
icaci dosi
s.Local:pain/i
rr
itat
ion
atIVsit
e.Metab: ammoni atoxicit
y.MS: t
witching.Resp:
hyper
ventil
ati
on.

I
NTERACTI
ONS
Drug-
Drug:Wi
llhast
enexcret
ionofbasi
cdr
ugs
(amphetami
nes,qui
nidi
ne)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 189
DOSAGE
IV:(Adults):Determinethedoseofammoni um chl orideby
cal
cul ati
ngthepat i
ent'schl or
idedefici
t.Thef ol
lowi ng
for
mul acanbeusedt ocal cul
atet hedosageof
ammoni um chlori
de( NH4Cl ):Dose( mEq)=[ 0.2L/ kg*
bodywei ght(kg)]*[103–( patient'
sserum chloride)].50%
ofthisdoseshoul dbeadmi ni
steredini
tial
lyandt hent he
patientshouldber eevaluated.Theneedf oradditional
dosesshoul dbedet ermi nedaf tereval
uationthepat i
ent'
s
serum bicarbonate.

AVAI
LABI
LITY
Sol
uti
onfori
nject
ion(f
ordi
l
ution)Ammonium 5
mEq/mL(chl
ori
de5mEq/ mL)(equiv
alentt
oammoni
um
chl
ori
de267.
5mg/ mL)i
n20-mLv i
als;

PATI
ENTTEACHI
NG
Expl
ainpur
poseoft
her
apyt
opat
ient
.

Amobar
bit
al
I
NDI
CATI
ONS
Pr
eoper
ati
vesedat
iveandi
not
hersi
tuat
ionsi
nwhi
ch

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 190
sedati
onmayber equired.Hypnoticforshort-
term
tr
eatmentofinsomni a.Unlabel
edUses: Psychiatr
ic
i
ntervi
ews.Wadat esting(int
racaroti
dadmi nistrat
iont
o
deter
minehemi sphericlocusoflanguagedomi nancepri
or
toepil
epsysurgery)
.

ACTI
ON
Producesal ll
evelsofCNSdepr ession:Depr essessensory
cortex,Decreasesmot oracti
vi
ty,Alter
scer ebralfunct
ion.
Inhibi
tstransmissionintheCNSandr aisesseizure
threshold.Therapeuti
cEffect
s:Hy pnosis.Sedation.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Dyspneaorai
rway
obst
ruct
ion;Comatosepati
ents;Pre-
exi
sti
ngCNS
depr
ession;Sev
erehepat
icdysfuncti
on;Porphy
ria;
OB:
Lact
ati
on: Notr
ecommended.

UseCaut
iousl
yin:
Hist
oryofsui
cideat
tempt
sor
substanceabuse; Debil
it
atedpatients(usesmal lerdoses)
;
Pat i
entsusingal cohol ordrugsthatcauseCNS
depression;Pat i
ent swithhepati
corr enal i
mpai r
ment
(doseshoul dber educed);Acuteorchroni cpain
(paradoxicalexcitementmayoccur )
;Hy poadrenali
sm (↓
effectsofcorticost er
oids);Pedi
:Safetynotest abli
shedin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 191
chi
l
dren<6y r
;Geri
:Appear
sonBeer sli
st.Ger
iat
ri
c
pat
ient
sareatincr
easedri
skforexci
tement,confusi
on,
CNSdepressi
on;usesmall
erdoses).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness,abnor mal t
hinking,agitation, at
axia,CNS
depression,confusi
on, dizzi
ness, headache, nightmares,
verti
go.Resp: BRONCHOSPASM ( IVonl y),
LARYNGOSPASM ( I
Vonl y )
,apnea, respiratorydepr essi
on.
CV: bradycardi
a,hypotension,syncope.GI :const i
pation,
nausea, vomiti
ng.Derm: ANGI OEDEMA, exf oli
ativ
e
dermat i
ti
s,purpura,r
ash.Local :painorst eril
eabscessat
IM sit
e,phlebit
isatIVsi t
e.MS: hy perkinesia.Mi sc:
hypersensiti
vit
yreacti
onsi ncludingSt evens- Johnson
syndrome, fever.

I
NTERACTI
ONS
Drug- Drug:Additi
veCNSdepr essionwi t
hot herCNS
depr essantsincludi
ngal cohol ,
ant i
depressants,
antihistamines,opioidanal gesi
cs, andother
sedat ive/hy
pnot i
cs.Sedat ionmaybepr olongedwi t
hMAO
i
nhibi torsandv al
proicaci d.I
nduceshepat i
cenzy mesthat
met abol i
zeotherdrugs,decr easingt hei
reffecti
veness,
i
ncludi nghor monal cont
r aceptives,f
urosemide,
disopy ramide,propafenone, met hadone,cimetidi
ne,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 192
cyclosporine,tacr
oli
mus, ri
fampin,estr
ogen,
chlorampheni col,
acebutolol,pr
opranol
ol,metopr
olol,
ti
mol ol,
doxy cycli
ne,cor
ticoster
oids,t
ri
cycli
c
antidepressants,warfar
in,theophyl
li
ne,andquini
dine.
Drug-Nat
uralPr
oduct:Concomit
antuseofkav
a,valer
ian,
skul
lcap,
chamomi l
e,orhopscan↑ CNSdepression.St.
John'swortmay↓ barbit
urat
eeffect
.

DOSAGE
I
M: IV:
(Adul
ts):Sedat
ive—30–50mg2–3t
imesdai
l
y;
hypnot
ic—65–200mgatbedt i
me.
IV:(
Adults):
Psychiatr
ici
nter
views(unl
abeleduse)50–100
mg/ minfort
otaldoseof200–1000mgorunt i
lpati
ent
experi
encesdrowsiness,
impairedat
tent
ion,sl
urr
ed
speech,ornyst
agmus.
I
ntra-
art
eri
al(
Adult
s):Wadatest(unl
abel
eduse)100mg
over4–5secviaper
cut
aneoustransf
emoralcat
heter
.
I
M:I
V:(
Chil
dren6–12y
r):
Sedati
ve–65–500mg(
3–5
mg/
kg)
,dependi
ngonr
esponse.
I
M:(
Chi
l
dren≥6y
r):
Hypnot
ic—2–3mg/
kg/
dose.

AVAI
LABI
LITY
I
nject
ion500-
mgv
ial
s;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 193
PATI
ENTTEACHI
NG
Discusstheimpor
tanceofprepar
ingenvi
ronmentfor
sl
eep( darkr
oom,quiet
,avoi
danceofnicot
ineand
caffei
ne).

Maycauseday ti
medrowsiness.Cauti
onpat
ientto
avoi
ddr i
vingandot
heract
ivit
iesrequi
ri
ngal
ertness
unti
lresponsetomedi
cati
onisknown.

Advi
sepati
entt
omakeposit
ionchangessl
owl
yto
mini
mizeort
host
ati
chy
potensi
on.

Caut
ionpat
ient
stoavoi
dtaki
ngalcohol
orotherCNS
depr
essant
sconcur
rent
lywit
hthi
smedicat
ion.

Advi
sepatientt
ouseanonhormonalmethodof
cont
racepti
onwhil
et aki
ngamobar
bit
alandtonoti
fy
heal
thcareprof
essionalpr
ompt
lyi
fpregnancyi
s
pl
annedorsuspected.

I
nstructpatientt
ocontacthealt
hcar
epr of
essi
onal
i
mmedi atelyifsor
ethr
oat,fever
,mouthsores,
unusualbleedingorbr
uisi
ng,orpet
echiaeoccur.

Amoxapi
ne
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
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thyCar
e 194
Treatmentofvar
iousty
pesofdepressi
on.Unl
abel
edUses:
Anxiety
,insomni
a,neur
opat
hicandchroni
cpain
syndromes.

ACTI
ON
Potenti
atestheeff
ect sofserotoninandnorepinephri
nei
n
theCNS.Hassi gni
ficantanti
choliner
gicproperti
es.Al
so
hasantianxi
etyeff
ectr el
atedtosedativepropert
ies.
Therapeuti
cEffect
s: Anti
depressantandant i
anxiet
yacti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Angl
e-cl
osur
egl
aucoma;
RecentMI
;
Prolongat
ionofQTci
nter
val
;Car
diacar
rhy
thmi
a;Hear
t
fai
lure.

UseCaut
iousl
yin:
Pre-
exi
sti
ngcar
diov
ascul
ardi
sease;
Prostati
chy per pl
asia(
increasedsuscept i
bil
itytourinary
retenti
on);Historyofseizur es(t
hreshol
dmaybel owered);
May↑ r i
skofsui ci
deattempt /i
deati
onespeci all
yduring
doseear l
yt r
eat mentordoseadj ustment
;OB: Useonlyif
clearl
yneededandmat ernal benefi
tsout
wei ghr i
skto
fetus;Lactat
ion: Mayresul tinsedati
onininfant;
disconti
nuedr ugorbottlefeed;Pedi:Sui
cider i
sk,
especiall
yati niti
ati
onoft herapy,maybegr eaterin
childr
enandadol escents;Ger i
:Maybemor esuscept i
ble

ᏆᖴA2022 Dr
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nHeal
thyCar
e 195
t
oadv
erseef
fect
s;dosager
educt
ionr
equi
red.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, fati
gue,
sedati
on, ext rapyr amidalreact ions,tardivedyskinesia.
EENT: blurredv i
sion, dryey es,dr ymout h.CV:
ARRHYTHMI AS, hy potension, ECGchanges.GI :
constipation,incr easedappet ite,weightgai n,paral
ytic
i
leus.GU: testicularswel l
ing, urinaryretenti
on.Der m:
photosensi ti
v i
ty,rash.Endo: gy necomast ia,sexual
dysfunction.Hemat :
blooddy scr asi
as.Mi sc:fever.

I
NTERACTI
ONS
Drug- Drug:Amoxapi neismet abol izedi ntheliverbyt he
cytochr omeP4502D6enzy me, andi tsact i
onmaybe
affectedbydr ugsthatcompet ef ormet aboli
sm byt hi s
enzy me, i
ncludingot herantidepr essant s,phenothiazines,
carbamazepi ne,andcl ass1Cant iarrhythmicsi ncl
udi ng
propaf enone, andflecaini
de; whent hesedr ugsar eused
concur rentl
ywi thamoxapi ne, dosager eductionofoneor
theot herorbot hmaybenecessar y.Concur rentuseof
otherdr ugsthati nhibi
ttheact ivit
yoft heenzy me,
i
ncl udingcimet i
dine,quini
dine, ami odar one,andr i
tonav i
r
mayr esulti
n↑ ef fect
sofamoxapi ne.Maycause
hypot ension,tachycardia,andpot entiallyf
atal r
eactions

ᏆᖴA2022 Dr
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nHeal
thyCar
e 196
whenusedwi thMAOi nhibit
or s(av oidconcurrent
use—di scont inue2wkbef orest arti
ngamoxapi ne).
Concur rentusewi thSSRIant i
depr essant smayr esultin↑
toxici
tyandshoul dbeav oided( fluoxet i
neshoul dbe
stopped5wkbef orest art
ingamoxapi ne).Concurrentuse
withcloni dinemayr esultinhy pertensivecr i
sisandshoul d
beav oided.Concur rentusewi thlev odopamayr esultin
delayed/ decreasedabsor ptionofl ev odopaor
hypertensi on.Bloodl evelsandef fectsmaybe↓ by
ri
famy cins( ri
fapentine, r
if
ampi n, ri
fabutin).Ci
met i
dine,
fl
uoxet i
ne, phenot hi
azines, oror alcont r
aceptives↑ l evel
s
andmaycauset oxicity.I
ncr easedr iskofext r
apy r
ami dal
reacti
onswi t
hot herdrugscausi ngext rapyramidal
reacti
ons( phenot hi
azines).

DOSAGE
PO:(Adult
s):50mg2–3t imesdai
ly,i
ncreaseto100mg
2–3t i
mesdail
ybyendof1week( nottoexceed300mg
dail
yinoutpat
ients,600mgdail
yindivi
deddosesi n
hospit
ali
zedpatients)
.Onceopt
imaldosei sachi
eved,
may
begivenasasi nglebedt
imedose;nosingledoseto
exceed300mg.
PO:(
Geri
atr
icPat
ient
s):
25mg2–3timesdail
y,maybe
i
ncr
easedto50mg2–3t i
mesdai
l
y(not>300mg/day)
.

ᏆᖴA2022 Dr
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thyCar
e 197
AVAI
LABI
LITY
Tabl
ets25mg,
50mg,
100mg,
150mg;

PATI
ENTTEACHI
NG
I
nstructpati
entt
otakemedicat
ionasdirect
ed.Abr
upt
di
scont i
nuat
ionmaycausenausea,headache,
and
malaise.

Infor
m pat i
entoft
hepossi
bil
i
tyofextr
apyrami
dal
sympt omsandt ar
div
edyski
nesia.I
nst
ructpat
ientt
o
reportthesesymptomsimmediatel
y.

Maycausedr owsinessandbl
ur r
edv i
sion.Cauti
on
pat
ienttoavoiddriv
ingandotheracti
viti
esrequi
ring
al
ertnessunt
ilresponsetodr
ugi sknown.

Ort
hostat
ichypot
ensi
on,sedati
on,andconf
usi
onare
commondur i
ngearl
ytherapy,
especial
l
yinger
iat
ri
c
pat
ient
s.Prot
ectpati
entf
rom fal
lsandadvi
sepati
ent
tomakeposit
ionchangesslowly
.

Referpati
enttonut
ri
ti
onalorwei
ghtmanagement
program asappr
opri
ate.

Advisepati
enttoav
oidal
coholorot
herCNS
depressantdr
ugsduri
ngandfor3–7daysaf
ter
ther
apy .

ᏆᖴA2022 Dr
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nHeal
thyCar
e 198
Instructpatienttonot i
fyheal t
hcar eprofessionali
f
drymout horconst ipati
onper sist
sori furi
nar y
retention,uncontroll
edmov ement s,orri
gidit
yoccur .
Sugar l
esscandyorgum maydi minishdrymout h,and
ani ncreasei nfl
uidintakeorbul kmaypr event
const i
pation.Ifthesesy mptomsper sist
,dosage
reduct i
onordi scontinuati
onmaybenecessar y.
Consul thealthcar eprofessionali
fdr ymout hpersist
s
formor ethan2wk.

Advi
sepati
enttoi
nfor
m healt
hcarepr
ofessi
onali
f
br
eastenl
argementorsexual
dysf
unct
ionoccurs.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Inf
orm pat
ientt
omoni
tordi
etar
yintake.I
ncreased
appet
it
emayl eadt
oundesi
redweightgain.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Ther
apyfordepressionisusuall
yprolonged.
Emphasi
zetheimpor tanceoffoll
ow-upexamsto
monit
oreff
ecti
venessandsi deeffectsandto
i
mprovecopingskil
ls.

Tr
eatmentisnotacuresi
ncesymptomscanr
ecur
af
terdi
sconti
nuat
ionofmedicat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 199
 Ref
ert
olocal
suppor
tgr
oup.

Pedi:Cauti
onpar ent
s/ guardi
ansoft eenagersor
chil
drentaki
ngt hismedi cati
onaboutpossi bl
e
i
ncreaseinsui ci
derisk.Teachpar entshowt oassess
forsuici
dalthoughtsandt or epor
tconcerns
i
mmedi at
ely
.

OB: Lact
ation:Advi
sefemalepati
enttonoti
fyheal
th
careprofessionali
fpr
egnancyisplannedor
suspectedori fbr
east
feedi
ng.

Amoxy
cil
l
in
I
ndi
cat
ions
Urinar
y-t
ractinfecti
ons,upperrespiratorytractinfect
ions,
bronchit
is;pneumoni a;ot
iti
smedi a;dent alabscess;
osteomy el
iti
s;Lymedi seaseinchildren;endocar diti
s
prophyl
axis;post-spl
enectomypr ophy laxis;gynaecological
i
nfecti
ons; gonorrhoea;Heli
cobacterpy l
orieradicati
on.

ACTI
ON
Bindstobact er
ialcel
lwall
,causingcelldeat
h.Therapeut
ic
Effect
s: Bact
eri
cidalact
ion;spectr
um isbroaderthan
penici
ll
ins.Spectr
um: Acti
veagainst:St
reptococci
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 200
Pneumococci ,
Enterococci
,Haemophi l
usinfluenzae,
Escher
ichiacoli
,Proteusmirabil
i
s,Neisseri
ameni ngi
ti
dis,
N.gonorrhoeae,Shigel
la,
Chlamy di
atrachomat i
s,
Salmonell
a,Borrel
iaburgdor
f er
i,H.py
lori
.

Av
ail
abi
l
ity
TABLETS250mg, 500mg; KI
DTABLETS125,250mg;
CAPSULES250,500mg; DRySyRUP125and250mgper
5ml;I
NJECTION1ml ampoul
e(100mg/ml)
,250mg/vi
al;
DROP10ml (
100mg/ ml )
.

DOSAGE
Or
al
Adul
t-250mgev
ery8h,
doubl
einsev
erei
nfect
ion.
Ot
it
ismedi
a:1gev
ery8h.
Ent
eri
cfev
er:
2to4gdai
l
yindi
vi
deddosesf
or14t
o21
day
s.
I
ntr
amuscul
ari
nject
ion500mgev
ery8h.

I
ntr
avenousi
nject
ionori
nfusi
on
500mgev er
y8h,incr
easet
o1gev
ery6hi
ncaseof
sever
einf
ecti
on.
Chi
l
dupt
o10y
ear
s-125mgev
ery8h,
doubl
einsev
ere

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 201
i
nfect
ions.
Oti
ti
smedi
a:40mg/
kgbodywei
ghtdai
l
yint
hreedi
vi
ded
doses.
Ent
eri
cfev
er:50to100mg/kgbodywei
ghti
nthr
ee
di
vi
deddosesfor14to21days.
I
ntr
amuscul
arinj
ect
ion50t
o100mg/
kgbodywei
ghti
n
di
vi
deddoses.
I
ntr
avenousi
nject
ionori
nfusi
on
50t
o100mg/
kgbodywei
ghti
ndi
vi
deddoses.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
tyt
openi
cil
l
ins(
seenot
esabov
e).

I
NTERACTI
ONS
Drug-Drug:
Probenecid↓ renalexcr
eti
onand↑ blood
l
ev el
sofamoxicil
li
n—therapymaybecombi nedforthis
purpose.May↑ effectofwarfari
n.May↓ effect
iveness
oforalcontr
acepti
ves.Al
lopuri
nolmay↑ frequencyof
rash.

Pr
ecaut
ions
Hi
stor
yofal
l
ergy
;renal
impai
rment
;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 202
ery
themat ousr ashescommoni nglandul
arfever,chronic
l
ymphat i
cl eukaemi aandpossiblyHIVinfect
ion;
lactati
on
i
nteracti
onspossi bi
li
tyofsuperinfect
ionwithmy cotic
pathogens, mononucleosis,
hepat i
cimpairmentpregnancy .

Adv
erseEf
fect
s
Nauseaandv omiting,diarrhoea; rashes( hypersensiti
v i
ty
ort oxi cresponse, maybeser iousr eaction-disconti
nue
treat ment );hypersensitivit
yreact i
onsincludingSt even’s
Johnsonsy ndrome, urti
car i
a,angi oedema, anaphy l
axis,
ser um si ckness- l
i
ker eact i
ons, haemol yticanaemi a,
i
nt er stit
ialnephriti
s;rarely,antibioti
c-associatedcol i
tis;
neut ropenia,thrombocy t
openi a, coagulationdisorders;
rarel y,centralnervoussy stem di sordersincluding
conv ulsionsassoci atedwi thhi ghdosesori mpairedr enal
funct i
on; mucocut aneouscandi diasis,
wi t
hdi scolouration;
agit ation.

PATI
ENTTEACHI
NG
Inst
ructpatientst
otakemedicationaroundt heclock
andt ofi
nishthedrugcompletelyasdirected,evenif
feel
ingbetter.Advi
sepat
ientsthatsharingoft hi
s
medi cat
ionmaybedanger ous.

Pedi
:Teachpar
ent
sorcar
egi
ver
stocal
cul
ateand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 203
 measuredosesaccuratel
y.Rei
nfor
ceimpor
tanceof
usingmeasuri
ngdev i
cesuppli
edbyphar
macyorwith
product
,nothousehol
di t
ems.

Reviewuseandprepar
ati
onoft
abl
etsf
oror
al
suspensi
on(Di
sperMox).

Advi
sepat
ientt
oreportthesignsofsuperinf
ect
ion
(f
urr
yover
growthonthet ongue,vagi
nali
tchi
ngor
di
schar
ge,l
ooseorfoul-
smel l
ingstool
s)andall
ergy
.

Instructpatientt
onot i
fyhealt
hcar eprofessi
onal
i
mmedi atelyifdi
arrhea,abdominalcramping,fev
er,
or
bloodyst oolsoccurandnott otreatwith
antidiar
rhealswithoutconsult
inghealthcare
professional.

I
nst
ructthepat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
i
fsy
mpt omsdonotimprove.

Teachpatientswi t
hahi stor
yofrheumati
cheart
di
seaseorv al
vereplacementtheimport
anceofusing
anti
microbialprophylaxi
sbefor
einvasi
vemedicalor
dental
procedur es.

Inst
ructfemal epati
entst
akingoralcont
racept
ivest
o
useanal ter
nateoradditi
onalnonhormonalmethodof
contracepti
ondur i
ngther
apywi t
hamoxicill
i
nanduntil
nextmenst rualper
iod.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 204
St
orage
Tabl
et,CapsuleandOr alsuspensi
on:Storeprotectedfrom
moistur
eatat emper at
urenotexceedi
ng30⁰ C.Injecti
on:
Stor
epr otect
edfrom moisturei
nasteril
e,tamperev ident
contai
nersealedsoast oexcludemicro-or
ganismsat
temperaturenotexceedi
ng30⁰ C.

Amoxi
cil
l
in/
clav
ulanat
e
I
NDI
CATI
ONS
Treatmentofav ar i
etyofinf
ecti
onsincluding:Skinand
skinstruct
ureinfections,Ot
it
ismedia,Sinusit
is,
Respirator
ytractinfecti
ons,Geni
touri
narytractinfect
ions.

ACTI
ON
Bindst obacterialcellwall,causi ngcelldeat h;spectrum of
amoxi cil
li
nisbr oadert hanpeni cil
li
n.Clav ul
anateresist
s
actionofbet a-l
actamase, anenzy mepr oducedbybact eria
thatiscapabl eofinact iv
atingsomepeni cil
l
ins.
Ther apeuti
cEf f
ects: Bactericidal acti
onagai nst
suscept i
blebact er
ia.Spect rum: Acti
veagai nst:
Streptococci,Pneumococci , Enterococci, Haemophi l
us
i
nf l
uenzae, Escherichiacoli,Pr oteusmi rabili
s,Neisseri
a
meni ngit
idi
s, N.gonor rhoeae, St aphyl
ococcusaur eus,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 205
Klebsi
ell
apneumoni
ae,
Shi
gel
l
a,Sal
monel
l
a,Mor
axel
l
a
catarr
hal
is.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
openi
cil
l
insor
cl
avulanat
e;Suspensionandchewabl etabl
etscontai
n
aspart
ameandshoul dbeav oidedinphenylket
onuri
cs;
Hist
oryofamoxicil
li
n/clav
ulanate-
associat
edcholest
ati
c
j
aundice.

UseCaut
iousl
yin:
Sev
erer
enal
insuf
fi
ciency(
dose↓
necessar
y);
Inf
ect
iousmononucleosi
s(↑ri
skofrash)
;
Hepatici
mpair
ment(dosecaut
iously
,moni
torl
i
ver
funct
ion)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:SEIZURES( hi
ghdoses) .GI:PSEUDOMEMBRANOUS
COLITI
S, di
arrhea,hepat i
cdy sfunction,nausea, v
omit
ing.
GU:vagi
nal candidiasis.Derm: rash, urt
icaria.Hemat:
bl
ooddy scrasias.Mi sc:al
lergi
cr eact i
onsi ncludi
ng
anaphyl
axisandser um sickness, superinfection.

I
NTERACTI
ONS
Drug-
Drug:Pr
obeneci
d↓ renal
excr
eti
onand↑ bl
ood
l
evelsofamoxici
l
li
n—ther
apymaybecombinedf
orthi
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 206
purpose.May↑ theef
fectofwarfar
in.Concur
rent
al
lopuri
nolther
apy↑ r
iskofrash.May↓ the
eff
ectiv
enessofhormonalcontr
acepti
ves.
Dr
ug-
Food:
Clav
ulanat
eabsor
pti
oni
s↓ byahi
ghf
atmeal
.

DOSAGE
MostI
nfect
ions(
Dosi
ngbasedonamoxi
cil
l
incomponent
)
PO:(
Adult
sandChi
l
dren>40kg)
:250mgq8hror500mg
q12hr.

Ser
iousI
nfect
ionsandRespi
rat
oryTr
actI
nfect
ions
PO:(Adult
sandChi ldren>40kg):875mgq12hror500
mgq8hr ;Acutebacteri
alsi
nusit
is—2000mgq12hrf or
10day sasextendedrelease(XR)product
;Community
-
acqui
redpneumoni a—2000mgev ery12hrfor7–10days
asextendedrelease(XR)product.
Recurrent
/persi
stentacut
eoti
ti
smediaduetoMul t
idr
ug-
resi
stantStr
eptococcuspneumoni
a,
H.inf
luenzae,
orM.
catar
rhali
s
PO:(
Chi
ldr
en<40kg):80–90mg/kg/
dayi
ndivi
deddoses
q12hrf
or10days(asESf or
mul
ati
ononl
y).

Renal
Impai
rment
PO:
(Adul
ts)
:CCr10–30mL/
min—250–500mgq12hr

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 207
(
donotuse875mgt
abl
et)
;CCr<10mL/
min—250–500
mgq24hr.
Oti
ti
sMedia,Si
nusi
ti
s,LowerRespi
rat
oryTr
actI
nfect
ions,
Ser
iousI
nfecti
ons
PO:(Chil
dren≥3mo)
:200mg/5mLor400mg/5mL
suspensi
on—45mg/kg/daydi
vi
dedq12hr;
125mg/5mL
or250mg/ 5mLsuspensi
on—40mg/kg/
daydi
vi
dedq8hr
.

LessSer
iousI
nfect
ions
PO:( Chi
ldr
en≥3mo) :200mg/ 5mLor400mg/ 5mL
suspension—25mg/ kg/daydi
videdq12hror20
mg/ kg/daydiv
idedq8hr( as125mg/5mLor250mg/5
mLsuspensi on).
PO:(Chil
dren<3mo):15mg/ kgq12hr(
125mg/
mL
suspensi
onr ecommended)
.

AVAI
LABI
LITY
Tablets250mgamoxi ci
ll
inwi th125mgcl avul
anate,500
mgamoxi cil
li
nwi t
h125mgcl avulanate,875mg
amoxi ci
ll
inwith125mgcl avulanat e.Chewabl e
tabl
ets(cherry-
bananaf l
avor)200mgamoxi cil
li
nwith28.5
mgcl avulanate,400mgamoxi ci
ll
inwi t
h57mg
clav
ulanat e.Extended-r
eleaset ablets(scored)1000mg
amoxi ci
ll
inwith62.5mgcl avulanate.Powderf ororal

ᏆᖴA2022 Dr
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nHeal
thyCar
e 208
suspension( 125mg/ 5mLi sbananaf lavor
;200mg/ 5ml
i
sf r
uitfl
av or
; 250mg/ 5mLi sorangef l
avor;400mg/ 5mL
i
sf r
uitfl
av or
; 600mg/ 5mLi sorangeorst r
awber ry-
creme
fl
avor)125mgamoxi cill
i
nwi th31.25mgcl av ul
anate/5
mL, 200mgamoxi cil
l
inwi t
h28. 5mgcl avul
anat e/
5mL,
250mgamoxi ci
l
li
nwi th62.5mgcl av
ulanat
e/ 5mL, 400
mgamoxi cil
l
inwi th57mgcl avulanat
e/5mL, 600mg
amoxi ci
l
li
nwi t
h42. 9mgcl avulanate/5mL( ES
for
mul ati
on).

PATI
ENT TEACHI
NG
Inst
ructpatientst
otakemedicationaroundt heclock
andt ofi
nishthedrugcompletelyasdirected,evenif
feel
ingbetter.Advi
sepat
ientsthatsharingoft hi
s
medi cat
ionmaybedanger ous.

Pedi:Teachparentsorcaregi
verst
ocalcul
ateand
measur edosesaccuratel
y.Rei
nfor
ceimportanceof
usingmeasur i
ngdev i
cesuppli
edbypharmacyorwith
product,nothousehol
di t
ems.

Advi
sepat
ientt
oreportthesignsofsuperinf
ect
ion
(f
urr
yover
growthonthet ongue,vagi
nali
tchi
ngor
di
schar
ge,l
ooseorfoul-
smel l
ingstool
s)andall
ergy
.

I
nst
ructpat
ientt
onoti
fyhealt
hcareprof
essional
i
mmediatel
yifdi
arr
hea,abdominal
cramping,f
ever,
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 209
 bl
oodyst ool
soccurandnottotreatwi
th
anti
diar
rheal
swithoutconsul
ti
nghealt
hcar
e
prof
essional
s.

I
nstr
uctthepat
ientt
onoti
fyheal
thcareprof
essi
onal
i
fsymptomsdonotimproveorifnauseaordi
arr
hea
per
sist
swhendr ugi
sadmini
ster
edwi t
hfood.

Inst
ructfemalepati
entst
akingor
al contr
acept
ivesto
useanal ter
nat
eoradditi
onalmethodof
contracepti
onduri
ngther
apyandunt il
nextmenstrual
peri
od.

Amphet
ami
nemi
xtur
es
I
NDI
CATI
ONS
ADHD.Nar
col
epsy
.

ACTI
ON
Causesr el
easeofnor epinephrinefr
om nerveendings.
Phar macol ogiceff
ectsar e:CNSandr espi
ratory
stimulation,Vasoconst r
icti
on,My dr
iasi
s(pupil
lar
ydilat
ion)
.
Ther apeuticEffect
s: I
ncreasedmot oracti
vi
ty,mental
alertness,anddecr easedf at
igueinnarcol
epticpati
ents.
Increasedat tenti
onspani nADHD.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 210
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
exci
tabl
est
atesi
ncl
udi
ng
hyper
thyroidism;Psy choti
cpersonal
iti
es;Sui
cidalor
homicidaltendencies;Chemicaldependence;Glaucoma;
Str
ucturalcardiacabnor mali
ti
es(may↑ t heri
skof
suddendeat h);OB:Pot ent
ial
lyembryotoxi
c.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease(
suddendeat
h
hasoccur redinchildrenwi thstructuralcardiac
abnormal i
tiesorotherser ioushear tproblems) ;
Hi st
oryof
substanceabuse( misusemayr esultinserious
cardi
ov ascularevents/ suddendeat h);Hyper t
ension;
Diabetesmel li
tus;Tour ett
e'ssyndrome( mayexacer bate
ti
cs);Geri:Geriat
ri
cordebi li
tat
edpat ientsmaybemor e
suscept i
bletosideef fects.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: hyper acti
vit
y ,i
nsomni a,rest l
essness, tr
emor ,
behavioral di
sturbances, di
zziness, hall
ucinations,
headache, mani a,irr
itabili
ty,thoughtdi sorder.CV:
SUDDENDEATH, palpitati
ons, tachy cardia,
cardi
omy opathy( i
ncr easedwi t
hpr olongeduse, high
doses) ,
hy pertension, hypotensi on.GI :anorexia,
constipati
on, cramps, diarr
hea, dr ymout h,met al
lictast
e,
nausea, vomi t
ing.GU: erectil
edy sfunction,↑l ibido.Derm:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 211
urt
icari
a.Endo:
growthi
nhi
bit
ion(wit
hlongter
m usei
n
chi
ldren).Mi
sc:psy
chol
ogi
caldependence.

I
NTERACTI
ONS
Drug-Dr ug:Usewi thMAOi nhi bit
orsormeper idinecan
resultinhy per t
ensivecr i
sis.↑ adr energiceffect swith
otheradr ener gicsort hyr
oidpr eparati
ons.Drugst hat
alkali
nizeur ine( sodium bicarbonat e,acetazolami de)↓
excretion, ↑ effects.Drugst hataci dif
yurine( ammoni um
chlori
de, largedosesofascor bicacid)↑ excr etion,↓
effects.↑ r iskofhy pertensionandbr adycardi awi t
hbeta
blockers.↑ r i
skofar r
hythmi aswi thdigoxin.Tr i
cycli
c
antidepressant smay↑ ef fectofamphet ami nebutmay↑
ri
skofar rhythmi as,hypertensi on,orhyperpyrexia.Pr ot
on
pumpi nhibitorsmay↑ ef f
ect s.
Drug-Nat
uralPr
oduct
:Usewit
hSt.John'
swortmay↑
seri
oussideeff
ect
s(avoi
dconcur
rentuse)
.
Dr
ug-Food:Foodst
hatal
kal
ini
zet
heur
ine(
frui
tjui
ces)can
↑ ef
fectofamphet
amine.

DOSAGE
Doseisexpr
essedi
ntotal
amphet
aminecont
ent
(amphet
amine+dextr
oamphet
amine)

ADHD
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 212
PO:(Chi
ldr
en≥6y r)
: 5mg/day1–2t imesdai l
y;↑ dail
y
doseby5mgatweekl yi
nterv
als.Sustained-r
elease
capsul
escanbegi venoncedail
y,tablet
sev ery8–12hr .I
f
star
ti
ngtherapywit
hextended-r
eleasecapsul es,st
artwit
h
10mgoncedai lyand↑ by10mg/ dayatweekl yinter
vals
(upto40mg/ day)
.
PO:(
Adult
s):
20mg/
dayi
nit
ial
l
y(asext
ended-
rel
ease
pr
oduct
).
PO:(Chi
l
dren3–5yr
):2.
5mg/ dayi
nthemorning;
↑ dai
l
y
doseby2.5mgatweekl
yint
erval
snottoexceed40
mg/day.

Nar
col
epsy
PO:(Adul tsandChil
dren≥12y r):
10–60mg/ dayindi
vi
ded
doses; st
ar twi
th10mg/ day,↑ by10mg/ dayatweekl
y
i
ntervals.Sustai
ned-
releasecapsulescanbegiv
enonce
dai
ly,tabletsever
y8–12hr .
PO:
(Chil
dren6–12yr)
:5mgoncedail
y;may↑ by5
mg/dayatweekl
yint
erval
stoamaxi
mum of60mg/day
.

AVAI
LABI
LITY
Tabl
ets5mg,
7.5mg,
10mg,
12.
5mg,
15mg,
20mg,
30mg.
capsul
es5mg,
10mg,
15mg,
20mg,
25mg,
30mg.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 213
PATI
ENTTEACHI
NG
Instr
uctpatientt otakemedi cationatl east6hrbef ore
bedtimet oav oidsleepdi sturbances.Mi sseddoses
shouldbet akenassoonasr emember edupt o6hr
beforebedtime.Wi thextendedr eleasecapsul e,avoi
d
after
noondosest opr ev
enti nsomni a.Donotdoubl e
doses.Adv isepat i
entandpar entstor eadt he
Medi cati
onGui depr iortost arti
ngt herapyandwi t
h
eachRxr ef
ill
.Instr
uctpat ientnott oal terdose
withoutconsul ti
ngheal thcar epr ofessional.Abrupt
cessationofhi ghdosesmaycauseext remef at
igue
andment aldepression.

I
nform pat
ientt
hatshar
ingt
hismedi
cat
ionmaybe
danger
ous.

I
nform pat
ientthatt
heeffect
sofdrug-
induceddr
y
mouthcanbemi ni
mizedbyrinsi
ngfr
equentl
ywit
h
waterorchewingsugarl
essgum orcandies.

Adv
isepat
ientt
oli
mitcaf
fei
nei
ntake.

Mayimpairj
udgment
.Advisepati
enttousecauti
on
whendri
vi
ngorduri
ngotheracti
vi
tiesrequi
ri
ng
al
ert
ness.

I
nfor
m pat
ientt
hatper
iodi
chol
i
day
sfr
om t
hedr
ug

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 214
 maybeusedt oassessprogressanddecrease
dependence.Pedi :Chi
ldr
enshouldbegivenadr ug-
fr
eeholidayeachy eartoreassesssymptomsand
tr
eatment .Doseswi l
lchangeaschil
drenageduet o
pharmacoki neti
cchangessuchassl owerhepati
c
metabolism.

Advi
sepati
entand/orparentstonot
ifyheal
thcar
e
pr
ofessi
onalofbehavi
oralchanges.

Advisepatienttonotif
yhealthcareprofessionali
f
nervousness,rest
lessness,i
nsomnia,dizziness,
anorexi
a,ordr ymouthbecomessev ere.Pedi :
If
reducedappet i
teandwei ghtl
ossareapr oblem,
adviseparentstoprovidehighcalor
iemeal swhen
druglevel
sar elow(atbreakfastandorbedt ime).

Cautionpati
entst
oinfor
m heal
thcareprof
essionali
f
theyhaveeverabusedorbeendependentonalcohol
ordrugs,ori
ftheyarenowabusingordependenton
alcoholordr
ugs.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed,
orif
br
eastf
eedi
ng.

Emphasi
zetheimport
anceofr
out
inef
oll
ow-
upexams
tomonit
orprogr
ess.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 215
 HomeCareI
ssues:Advi
separ
ent
stonot
if
yschool
nur
seofmedi
cati
onregi
men.

Amphot
eri
cinB
I
ndi
cat
ions
Li
fe-thr
eateni
ngfungali
nfecti
onsincl
uding
hi
stoplasmosis,
coccidi
oidomycosis,
paracocci
dioi
domy cosi
s,bl
astomycosis,
aspergil
losi
s,cry
ptaococcosi
s,mucormy cosi
s,
sporotr
ichosisandcandidi
asi
s;vi
sceraland
mucocut aneousleishmani
asi
sunresponsiveto
pentavalentant
imonycompounds; sever
emeni ngi
ti
s,
peri
oralcandidi
asis.

Av
ail
abi
l
ity
VI
ALS10,
25,
50and100mgpl
ain,
50mg/v
ial
(li
posomal
).

DOSAGE
I
ntr
avenousi
nfusi
on(
plai
n)
Adul
t-Syst
emicf
ungali
nfecti
on:250µg/kgbodyweight
dai
ly
,incr
easegr
adual
l
y1mg/kgbodywei ghti
ftol
erat
ed
(max1.5mg/kgbodyweightdai
l
y )oral
ter
natedays.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 216
Chi
l
d-Sameasf
orAdul
tbasedonbodywei
ght
.

I
ntr
avenous(
li
posomal
)
Forf
everi
nneutropeni
cpat
ient
s:3mg/
kg/day
,max.dose
5mg/kg/dayi
.v
.
Forcr
ypt
ococcal
meni
ngi
ti
s:3-
4mg/
kg,
max.6mg/
kg,
i.
v.
oncedai
l
y.
Vi
sceral
lei
smani
asi
s:I
mmunocompet
entpat
ient
s:3
mg/kg.
I
mmunocompr
omi
zedpat
ient
s:4mg/
kg.

Cont
rai
ndi
cat
ions
Toxi
ceffectsmustbewei ghedagainstbenefi
ts.Regul
ar
ki
dney,l
iverfunct
iontest
sandbl oodcountsmustbe
conduct
ed; l
actat
ion;
anti
neoplasti
ctherapy
.

Pr
ecaut
ions
Closemedi calsupervi
siont hroughoutt r
eatmentandi ni
ti
al
testdoserequired(seenot e,below) ;r
enal i
mpairment
pregnancyhepat i
candr enal functi
ont ests;bl
oodcounts
andplasmael ectrol
ytemoni t
oring;corti
costeroi
ds(avoi
d,
excepttocont r
olreacti
ons) ;l
act at
ion;avoidrapi
dinfusi
on
(ri
skofarrhythmias);i
nteractionsger i
atri
cuse.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 217
Anaphylaxisoccursr
arel
y,wi
thi
ntravenousamphoterici
n
Bandat estdoseisadvi
sabl
ebeforethefi
rsti
nfusi
on.
Thepat i
entshouldbeobserv
edforabout30mi nafterthe
testdose.

Adv
erseEf
fect
s
Fev er,headache, anorexia, weightloss,nauseaand
vomi ti
ng, malaise,diarrhoea, muscleandj oi
ntpain,
dy spepsiaandepi gastri
cpai n; r
enalfunctiondistur
bances
i
ncl udinghy pokalaemi a,hy pomagnesaemi aandr enal
toxicit
y ;
blooddi sorders; cardiovascul
art oxi
city(
including
arrhythmi as);neurologicaldisorders(includi
ngper i
pher al
neur opathy);abnor mal l
iverf uncti
on(discontinue
treatment );r
ash; anaphy l
act oidreacti
ons( seeabov e);pai
n
andt hrombophl ebit
isati njecti
onsite;respir
atoryfail
ure.

St
orage
St
oreinat
ight
lyclosedcont
ainerbet
ween2t
o8⁰
C,
pr
otect
edf
rom li
ght.

Ampi
cil
l
in
I
NDI
CATI
ONS
Tr
eat
mentoft
hef
oll
owi
ngi
nfect
ions:
Ski
nandski
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 218
structureinfecti
ons,Soft-
ti
ssueinfecti
ons,Oti
tismedi a,
Sinusiti
s,Respi r
atoryinf
ecti
ons,Genitouri
nar
yi nfecti
ons,
Meni ngit
is,Septicemia.Endocardit
isprophyl
axis.
UnlabeledUses: Prevent
ionofinfecti
onincertainhigh-r
isk
patientsunder goingcesareansection.

ACTI
ON
Bi
ndst obact er
ial
cellwall,r
esul t
ingincelldeath.
Ther apeuti
cEf f
ects:Bacteri
cidal acti
on;spectr
um i s
broadert hanpenicil
l
in.Spectrum: Acti
veagainst:
Streptococci,nonpenici
ll
i
nase- producingstaphy l
ococci,
Li
st eri
a,Pneumococci ,Enterococci ,
Haemophi l
us
i
nfluenzae, Escheri
chiacoli
,Ent erobacter
,Klebsiel
la,
Proteusmi r
abil
is,
Neisseriameni ngiti
dis,N.gonorrhoeae,
Shigella,Sal
monel l
a.

Av
ail
abi
l
ity
TABLETS125and250mg;
CAPSULES250,500mgand1g;
DRySyRUP125and250mg/5ml
;I
NJECTION100,250
and500mg/vial
.

DOSAGE
Or
al
Adul
t-250mgt
o1gev
ery6hatl
east30mi
nbef
oref
ood.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 219
Ur
inar
ytr
acti
nfect
ionAdul
t-500mgev
ery8h.
Chi
l
drenunder10y
ear
s-Hal
fofadul
tdose.
I
ntr
amuscul
arandi
ntr
avenousi
nject
ionori
nfusi
on
500mgev
ery4t
o6h.
Li
ster
iameni
ngiti
s(i
ncombi
nat
ionwit
hanti
biot
ics)
;by
i
ntr
avenousi
nfusi
on2gever
y4hfor10to14days.
Chi
l
d-Hal
foft
headul
tdose.
Li
ster
iameni
ngit
is(i
ncombi nat
ionwit
hanti
bioti
cs)
;
i
nfant
s1to3mont hs;50to100mg/ kgbodyweightevery
6h.3monthsto12y ear
s;100mg/ kgbodyweightever
y
76h(max12gdaily
).

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
tyt
openi
cil
l
ins(
seenot
esabov
e).

I
NTERACTI
ONS
Drug-Drug:Probenecid↓ renalexcret
ionand↑ blood
l
evelsofampi cill
i
n—t her
apymaybecombi nedforthi
s
purpose.Largedosesmay↑ t her i
skofbleedi
ngwi t
h
warfari
n.↑ riskofwi thconcur
rentall
opuri
nolt
herapy.
May↓ t heef fect
ivenessoforalhormonalcont
racepti
ves.

Pr
ecaut
ions
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 220
Histor
yofall
ergy(seenot esabove);renali
mpair
ment
eryt
hematousrashescommoni nglandularf
ever
,acuteor
chroni
cly
mphocy ti
cl eukaemiaandcy t
omegalov
irus
i
nfecti
on;l
actati
oni nter
actionspregnancy.

Adv
erseEf
fect
s
Nauseaandv omi ti
ng,diarrhoea;rashes, hi
ghf ever
(hyper sensi t
ivit
yort oxicr esponse-maybeser i
ous
reaction, discont i
nuet reatment )
;hy per
sensi ti
vit
yreact
ions
i
ncl udingur t
icaria,angioedema, anaphy laxis,serum
sicknessl iker eaction,haemol yti
canaemi a,int
ersti
ti
al
nephr i
t i
s( seeal sonot esabov e)
;rarely
, ant
ibioti
c-
associ atedcol i
ti
s; neutropenia,t
hr ombocy topenia,
coagul ationdi sor ders;soretongue; asthma.

PATI
ENTTEACHI
NG
I
nst r
uctpat
ientt
ot akemedi cat
ionaroundtheclockandto
fi
nishthedrugcompl et
elyasdirect
ed,eveniff
eeling
better
.Advi
sepatientsthatshari
ngoft hi
smedicationcan
bedangerous.
Advi
sepati
enttoreportt
hesignsofsuperi
nfect
ion(f
urr
y
over
growt
hont hetongue,v
aginali
tchi
ngordischar
ge,
l
ooseorfoul
-smell
ingstool
s)andaller
gy.
Caut
ionpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
iff
ever

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 221
anddiar
rheaoccur,especial
lyi
fstoolcontai
nsblood,pus,
ormucus.Advi
sepat ientnottotr
eatdiarr
heawi t
hout
consul
ti
nghealt
hcar eprofessi
onal.Mayoccurupt o
sever
alweeksafterdisconti
nuat
ionofmedi cat
ion.
Inst
ructt
hepat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
if
symptomsdonotimprov
e.
Pati
entswit
hahi st
oryofrheumaticheartdiseaseorval
ve
repl
acementneedtobet aughttheimportanceofusing
anti
microbi
alpr
ophylaxi
sbeforeinvasi
vemedi calor
dentalpr
ocedur
es.
Advi
sepatient
stakingoralcont
racepti
vestousean
al
ter
nateoraddit
ionalnonhormonal methodof
cont
racepti
onwhiletaki
ngampi ci
ll
inandunti
lnext
menstrual
peri
od.
Advi
sefemal
epat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if
br
eastf
eedi
ng.

St
orage
Tablets,Capsul
e,Oralsuspension:St
orepr ot
ectedfrom
moi st
ureandl i
ghtatat emperatur
enotexceedi ng30⁰C.
Inj
ection:St
oreprotectedfrom l
ighti
nast eri
letamper
evidentcontai
nersealedsoast oexcludemi cro-
organismsatat emper atur
enotexceeding30⁰ C.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 222
AMPRENAVI
R
I
NDI
CATI
ONS
ManagementofHI
Vinf
ect
ioni
ncombi
nat
ionwi
thot
her
ant
ir
etr
ovi
ral
s.

ACTI
ON
Inhibi
tstheacti
onofHIVpr ot
easeandpr ev
entsthe
cleavageofvir
alpoly
prot
eins.Ther
apeuticEff
ects:
IncreasedCD4cellcount
sanddecr easedvir
alloadwi
th
subsequentslowedprogressi
onofHI Vanditssequel
ae.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentuseof
bepredil,di
hydroergotamine, ergotami ne,midazol am,and
tri
azolam (maycauseser ious, potenti
allyf
ataltoxi ci
ty);
Concur rentuseofr i
fampinorsuppl ementalvit
ami nE; I
f
ampr enav i
risusedconcur r entl
ywi thrit
onavir,
flecainide
andpr opafenonear econtr aindicated;Lact
ation: Potential
forseriousadv er
ser eacti
onsi nnur si
nginfants(and
potentialHIVtransmi ssi
on) .

UseCaut
iousl
yin:
Hyper
sensi
ti
vi
tyt
osul
fonami
des;
Hepat
ici
mpai
rment(
dosager
educt
ionr
equi
red)
;

ᏆᖴA2022 Dr
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thyCar
e 223
Hemophi
l
ia(mayincr
easebl
eedi
ng);
Diabet
esmell
i
t us
(
mayworsenhypergl
ycemi
a);
OB:Safet
ynotest
abl
ished.
Exer
ciseExtr
emeCaut ionin:
Concurrentuseof
amiodarone,par
ent
eralli
docaine,
tri
cycl
icanti
depr
essant
s,
orquini
dine(mayproducepotenti
all
ylif
e-t
hreat
eni
ngdrug
i
nteract
ions)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: depression/mooddisor
der .GI:diar
rhea,
nausea,
tast
edi sorders,v
omiti
ng.Derm: rash.Endo:
hypergl
y cemia.Metab:hyper
li
pidemi a,
redi
stri
but i
on/accumulat
ionofbodyf at.

I
NTERACTI
ONS
Dr ug- Drug: Increasesbl oodl ev el
sandt her i
skoft oxi city
from mi dazol am, tr
iazolam, ergotder i
vat i
vesand
pimozi de; concur r
entusei scont r
aindicated; mayal so
i
ncr easebl oodl evelsandef f ectsofot her
benzodi azepi nes.Increasesbl oodl evelsandt heriskof
toxi cityf r
om ami odar one, l
idocai ne(par enter al)
,quini dine,
tri
cy cl
icant idepr essant s,andwar f
ari
n; careful monitor ing
i
sr equi red.Ifr i
tonav i
ri susedconcur r
ent l
y, addi t
ional use
off lecai nideorpr opaf enonei scontraindicat ed( i
ncreased
ri
skofar r
hy thmi as).Signifi
cant l
yincreasesbl oodlev elsof
ri
fabut in;decr easedoseby50%i fusedconcur r
ently.May

ᏆᖴA2022 Dr
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nHeal
thyCar
e 224
i
ncreasebl oodl ev elsandt oxi cityofHMGCoAr educt ase
i
nhibitors, er ythr omy cin, dapsone, itr
aconazol e,
ketoconazol ealpr azol am, diazepam, f
lurazepam, cal ci
um
channel blocker s, clozapi ne, car bamazepi me, cyclospor i
ne
andt acrol i
musandl orat adine.Concur r
entusewi th
si
ldenaf ilincr easest her iskofpr i
apism, hy pot ensi on,and
vi
sual changes.Ri fampi nsi gni fi
cant lydecr easesbl ood
l
evelsandef ficacyofampr enav ir;concur rentusei s
contraindi cat ed.Phenobar bital ,pheny toi
n, car bamazepi ne,
dexamet hasoneef av i
renz, del avirdinenev irapi neand
hormonal cont racept ivesdecr easeampr enav irlev elsand
maydecr easeant iretrov iral act i
v i
ty.Cimet i
di ne, indinav i
r,
l
opinav ir,ritonav ir
, andnel f
inav i
rmayi ncr easeampr enavi
r
l
evels( whenusedconconcur rent l
ywi thr itonav i
r,
ampr enav i
rdosageshoul dbedecr eased) .Saqui nav i
rmay
decreasel ev els.Ant aci dsanddi danosi ne( duet obuf f
er
content )maydecr easeabsor ption( separ at e
admi nistrationby1hr ).Met hadonedecr easese
ampr enav i
rl ev elsandampr enav i
rdecr easesmet hadone
l
evels; doseadj ustment smaybenecessar y .
Drug-Natur
alProduct
:Usewi
thSt.John’swor
tmaycause
decreaseddruglevel
sandef
fect
iveness.
Drug-
Food:
Ingest
ionofahi
gh-
fatmeal
maydecr
ease
absor
pti
on.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 225
DOSAGE
PO:(Adul
ts>13yr>50kg):
1200mg( ei
ght150-
mg
capsul
es)twi
cedail
ywit
hot herant
ir
etr
ovi
ral
s.
PO:(Chi
ldr
en4–13y rorAdolescent
s13–16yr≤50kg):
Capsul
es—20mg/ kgtwicedail
yor15mg/ kg3ti
mesdaily
wit
hotherant
ir
etr
oviral
s(nottoexceed2400mg/day)
.

Hepat
icI
mpai
rment
PO:(Adul
ts):
Child-
Pughscore5–8—450mgt wicedai
l
y
wit
hotheranti
ret
rovi
ral
s;Chil
d-Pughscor
e9–12—300mg
twi
cedail
ywithotherant
iret
rovi
ral
s.

AVAI
LABI
LITY
Bothcapsul
esandor alsol
uti
oncontai
namount sof
vi
taminEthatexceedtheReferenceDai
lyI
ntake(RDI
)
Capsul
es150mg;

PATI
ENTTEACHI
NG
Emphasizetheimpor tanceoftaki
ngampr enavi
r
exactl
yasdirect
ed.Itmustal waysbeusedi n
combinati
onwi t
hot heranti
retr
ovi
raldr
ugs.Donot
takemorethanpr escribedamountanddonotst op
taki
ngwithoutconsultingheal
thcareprof
essional
.If

ᏆᖴA2022 Dr
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nHeal
thyCar
e 226
 adosei smissed,t
akeassoonasr ememberedwithi
n
4hr,thenret
urntoregul
arschedule.Ifmorethan4hr
fr
om scheduleddose,omitdoseandt akenext
scheduleddose;donotdoubledoses.

I
nst
ructpat
ientt
hatampr
enav
irshoul
dnotbeshar
ed
wi
thother
s.

Infor
m pat i
entt hatampr enavirdoesnotcur eAIDSor
preventassoci atedoroppor tunisti
cinfecti
ons.
Ampr enav i
rdoesnotr educet heriskoftransmissi
on
ofHIVt oot herst hr
oughsexual contactorblood
contami nati
on.Caut ionpatienttouseacondom and
toavoidshar ingneedl esordonat ingbloodtopr ev
ent
spreadingtheAI DSv i
rustoot hers.Advisepati
entthat
thelong-term effectsofampr enavirar
eunknownat
thi
st i
me.

Emphasi zetheimportanceofpr ovi

dinghealthcare
professionalwit
haccuratecur rentdrughistoryand
notify
inghealthcar
epr ofessionalbeforetakingany
prescripti
onorOTCmedi cationsbecauseof
potential
lyseri
ousdruginteractions.Vit
aminE
supplement sshoul
dbeav oideddur i
ngampr enavi
r
therapy.

Somehor
monalcontracepti
vesdecr
easeampr
enav
ir
l
evel
sandef
fect
iveness;advi
sepati
entt
ousea

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 227
 nonhor
monal
for
m ofcont
racept
iondur
ingt
her
apy
.

I
nstructpat
ienttonoti
fyheal
thcareprof
essi
onal
if
nausea,vomiti
ng,di
arr
hea,orrashoccur
s.

Emphasizetheimport
anceofregul
arfol
l
ow-upexams
andbloodcountstodeter
mineprogr
essandmonitor
forsi
deeffect
s.

Amy
lni
tr
it
e
I
NDI
CATI
ONS
Acut
etreat
mentofangi
napectori
s.Unl
abeledUses:Acut
e
managementofcy
anidepoi
soning.Di
agnosisofcar
diac
murmurs.

ACTI
ON
Reducessy st
emicarter
ialpressure(reducesaft
erl
oad)
.
Formsmet hemoglobin,whichcombi neswi t
hcyani
de,
for
mi nganontoxiccompound( cy
anmet hemoglobi
n).
Therapeuti
cEffect
s:Reli
efofangi napectori
s.Prev
enti
on
offatalout
comei ncyanidepoisoning.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pat
ient
staki
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 228
si
ldenafi
l,
tadal
afil
,orvar
denafi
l;Sev
ereanemi
a;Cer
ebral
hemorrhage;Glaucoma;Recentheadtr
auma;Pr
egnancy
andlactat
ion.

UseCaut
iousl
yin:
Hypot
ensi
on;
Hypov
olemi
a;
Constr
ict
iveperi
car
diti
sorcardiact
amponade;
Hypert
hyroi
dism;RecentMI;Hypert
rophiccardi
omy
opat
hy;
Geri
atr
icpati
ents(i
ncreasedri
skoforthostat
ic
hypot
ension)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,r
estlessness, di
zziness,faint
ing,
weakness.EENT: ↑i nt r
aocularpressure.Resp: shor
tness
ofbreath.CV:hypotension,tachycardia,fl
ushing.Derm:
cyanosisofli
ps,fi
nger nail
s,orpalms( indicat
es
methemogl obi
nemia) .GI:nausea.Hemat :HEMOLYTI C
ANEMI A,METHEMOGLOBI NEMIA.

I
NTERACTI
ONS
Drug-Drug:↑ hypot
ensionwi thanti
hypert
ensiv
esoracut
e
i
ngest i
onofalcohol
.Decr easestheeffect
sof
norepinephr
ine.Ant
ianginalacti
vit
ydecreasedby
epinephri
ne,andphenylephrine.

DOSAGE

ᏆᖴA2022 Dr
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e 229
Ant
iangi
nal
I
ntr
anasal
:Inhal
n:(Adul
ts)
:1ampul
ecrushedandi
nhal
ed;
mayberepeatedin3–5min(1–6i
nhal
ati
ons).

Cy
ani
dePoi
soni
ng
I
nhaln:(
AdultsandChi
ldren):
Inhal
efor15–30secofeach
minuteunt
ilsodi
um ni
tri
teinf
usionispr
epared.

AVAI
LABI
LITY
I
nhal
ant(
ampul
esf
ori
nhal
ati
on)0.
3mL;

PATI
ENTTEACHI
NG
Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Angina:I
nstr
uctpati
entincor
rectt
echniqueforuseof
amyl ni
tr
it
eampules.Reli
efshoul
doccurwi t
hin1–5
min.Ifpai
nisnotrel
iev
ed5mi nafteronedose,the
pati
entorfamil
ymembershoul dcall911immediatel
y.

Instr
uctpati
enttoremai
nseat
edorlyi
ngdur
ingand
afteradmini
str
ati
ontoprev
entdi
zzi
ness.

I
nfor
m pat
ientt
hatheadachei
sacommonsi
deef
fect
.

I
nst
ructpat
ientt
owashhandsaf
terusi
ngt
his
medi
cati
on.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 230
 Cauti
onpat i
entt
oav oi
ddrinki
ngalcoholort
aki
ng
si
ldenafi
l,
tadal
afi
l,
orvardenafi
lconcurr
entl
ywi
th
amy lni
tr
it
e.

Amy lnit
ri
tei
sflammable;
instr
uctpat
ienttoav
oid
exposingtoheatorf
lame(e.g.ci
gar
ettes)
.

Inst
ructpat
ientt
ost
oremedi
cat
ioni
ncool
place
awayf r
om l
ight.

CyanidePoi
soni
ng:Expl
ainpur
poseandpr
ocedur
efor
ther
apytopati
ent
.

Anagr
eli
de
I
NDI
CATI
ONS
Tr
eat
mentofthrombocythemi
asecondar
yto
myel
opr
oli
fer
ati
vedisor
ders.

ACTI
ON
Decreasesmatur
ationofmegakaryocyt
es(pl
atelet
precur
sors)
.Therapeuti
cEff
ects:
Reductioni
nplatelet
countwithr
educedr i
skofcompli
cati
onsassociatedwith
thrombocyt
hemia(thrombosi
s).

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 231
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erehepat
ic
i
mpai
rment
;Lact
ati
on:
Pot
ent
ial
toxi
cef
fect
sini
nfant
.

UseCaut
iousl
yin:
Car
diov
ascul
ar,
renal
ormi
l
dto
moderat
ehepat
icimpai
rment(
monit
orcl
osel
yduring
t
reat
ment);
OB:Pedi:
Hasbeenusedsaf
elyi
npregnant
womenandchil
dren<16yr
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEI ZURES, dizziness, headache, malaise.EENT:
abnor mal v i
sion.Resp: EOSI NOPHI LI
CPNEUMONI A,
INTERSTI TIALPNEUMONI TI S,PULMONARYFI BROSI S,
PULMONARYHYPERTENSI ON, cough, dy spnea,
pharyngi t
is.CV: CARDI OMYOPATHY, CEREBROVASCULAR
ACCI DENT, COMPLETEHEARTBLOCK, HF,MI ,chestpai n,
edema, palpitations,angina, atri
al fi
bril
lati
on, pericarditi
s,
peri
car dialef f
usi on,orthost atichy potensi on,tachycar di
a.
GI:GIBLEEDI NG, HEPATOTOXI CITY, PANCREATI TIS,
abdomi nal pai n,diarr
hea, flat ul
ence, anor exia,const i
pation,
dyspepsi a, nausea, vomi ti
ng.GU: RENALFAI LURE, dysuri
a,
hemat uria.Der m: al
opeci a,pr urit
is,rash.Hemat :
anemi a.
MS: arthralgia, backpai n,my algia,weakness.Neur o:
paresthesi a.Mi sc: f
ev er.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
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thyCar
e 232
Drug-Drug:Absor
pti
onmaybe↓ bysucr al
fate.
Fluvoxaminemay↑ bloodlev
els.May↑ bloodlev
elsof
theophyll
ine.May↑ ef
fect
sofmi l
ri
noneandcil
ostazol
.

DOSAGE
PO:(
Adult
s):0.
5mg4t i
mesdail
yor1mgtwicedai
ly
;may
be↑ weekl
yby0.5mg/day(
nott
oexceed10mg/dayor
2.
5mgasasi ngl
edose)
.
PO:
(Chil
dren)
:0.5mgdail
y;maybe↑ weekl
yby0.
5
mg/day(
nottoexceed10mg/dayor2.
5mgasasingl
e

DOSAGE
Hepat
icI
mpai
rment
PO:(
Adul
ts):I
nit
iat
eat0.
5mgdai
l
y;maybe↑ weekl
yby
0.
5mg/day.

AVAI
LABI
LITY
Capsul
es0.
5mg,
1mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakemedi
cat
ionasdi
rect
ed.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 233
 medi
cat
ioni
sknown.Caut
ionpat
ientt
ost
andsl
owl
y.

Advisepati
enttousecontr
acepti
ondur i
ngt her
apy
andt onoti
fyheal
thcar
eprofessi
onalifpregnancy
i
splannedorsuspected,ori
fbreast
feeding.May
causefetalhar
m.

I
nst
ructpat
ientt
oli
mital
coholi
ntakeasi
tmay
wor
senthesideeff
ect
sofanagrel
ide.

Anaki
nra
I
NDI
CATI
ONS
Reducti
onofthesignsandsymptomsofmoder atel
yto
severel
yacti
verheumatoi
dart
hri
ti
sinpati
entswhohav e
fail
edotherDMARDs( maybeusedincombinati
onwi t
h
otherDMARDsot hert
hantumornecrosi
sfact
or[TNF]
blocki
ngagents)
.

ACTI
ON
Blockst hedestructiv
eef f
ectsofinterl
eukin-
1oncarti
lage
andboner esorpti
onbyi nhibi
ti
ngitsbindingatspeci
fi
c
ti
ssuer eceptorsites.Therapeut
icEf f
ects:Sl
owed
progressionofr heumat oi
darthri
ti
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 234
Cont
rai
ndi
cat
edi
n:Act
ivei
nfect
ions;
Hyper
sensi
ti
vi
ty;
Hyper
sensit
ivi
tyt
oot
herEscher
ichi
acol
i
–der
ived
pr
oducts.

UseCaut
iousl
yin:
Otherchr
oni
cdebi
l
itat
ingi
l
lness;
Underlyi
ngi mmunosuppr essi
on; Renalimpair
ment ;OB:
Lactati
on: Pedi:
Safetynotestabli
shed; Ger
i:Maybemor e
sensit
ivetot oxi
cit
yduet oage-relat
eddeclineinrenal
functi
on;increasedinci
denceofi nfect
ioningeriat
ri
c
populati
on.
Exerci
seExtr
emeCaut i
oni
n:Concur
rentuseofTNF
bl
ockingagentssuchaset
aner
cept(hi
gherri
skofser
ious
i
nfecti
ons)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache.GI:diar
rhea,nausea.Hemat:neut
ropeni
a.
Local
:inj
ecti
onsit
er eacti
ons.Misc:INFECTI
ONS,
hyper
sensit
ivi
tyr
eact i
ons(rare)
.

I
NTERACTI
ONS
Drug-Dr
ug: ↑r i
skofser
iousinfectionwithTNFbl ocking
agents,suchasetaner
cept.May↓ ant i
bodyr esponset o
andincreasetheri
skofadv er
ser eacti
onsf r
om v accines;
avoidconcurr
entadminist
rati
onofl ivevacci
nes.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 235
DOSAGE
Subcut(
Adul
ts≥18y
r):
100mg/
day
.

AVAI
LABI
LITY
Sol
utionfori
nject
ion100mg/
mLi
n1-
mLpr
efi
l
ledgl
ass
syr
inges;

PATI
ENTTEACHI
NG
I
nform pati
entofthesignsandsymptomsof
hypersensi
ti
vi
tyreact
ionsandotheradverser
eact
ions.
Advisepati
entofappropri
ateact
ionsifr
eacti
ons
occur.

Advisepati
entsnott
oreceiveli
vevacci
nesdur
ing
ther
apywi t
hanakinr
awithoutconsul
ti
ngheal
thcare
prof
essional
.

HomeCar eI
ssues:Inst
ructpat i
entandfamil
yon
preparat
ionandcorrecttechniqueforadmini
str
ati
on
ofinj
ecti
onandcar eanddi sposalofequipment
.
Cautionpati
entsandcaregiversnottoreuseneedl
es,
syri
nges,ordrugproduct.

Anast
rozol
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 236
I
NDI
CATI
ONS
Adjuvanttreatmentofpostmenopausal hormonereceptor
-
positi
veear l
ybreastcancer.I
niti
alther apyinwomenwi th
postmenopausal hormoner eceptor-positi
veorhormone
receptorunknown, l
ocall
yadv anced, ormet ast
ati
cbreast
cancer.Adv ancedpostmenopausal br eastcancerin
womenwi thdiseaseprogressiondespi tetamoxif
en
therapy.

ACTI
ON
Inhi
bit
stheenzymear omat ase,whichispar t
ial
ly
responsi
blef
orconversionofpr ecursor
st oestrogen.
Therapeut
icEff
ects:
Lower sl ev
elsofcirculati
ngestrogen,
whichmayhaltprogressionofest r
ogen-sensiti
vebreast
cancer.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:OB:
Pot
ent
ial
har
mtof
etusor
spont
aneousabor
ti
on.

UseCaut
iousl
yin:
Womenwi
thchi
l
dbear
ingpot
ent
ial
;
Ischemicheartdi
sease;
Lact
ati
on:
Pedi
:Saf
etynot
establ
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
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thyCar
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CNS: headache, weakness, dizziness.EENT: pharyngitis.
Resp: cough, dy spnea.CV: MYOCARDI ALINFARCTI ON,
angina, peripher aledema.GI :nausea, abdomi nalpain,
anorexia, const ipation, di
ar r
hea, drymout h,vomiting.GU:
pelvi
cpai n,vagi nalbl eeding, vaginaldryness.Derm: r
ash,
i
ncludingmucocut aneousdi sorders,sweat i
ng.Met ab:
hyperchol ester olemi a,wei ghtgai n.MS: backpain, art
hr i
ti
s,
bonepai n,car pal t
unnel syndr ome, fr
acture.Neuro:
paresthesi a.Mi sc: allergi
cr eactionsincludingangi oedema,
urt
icaria, anaphy l
axis, hotf l
ashes, pain.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
PO:
(Adul
ts)
:1mgdai
l
y.

AVAI
LABI
LITY
Tabl
ets1mg;

PATI
ENT TEACHI
NG
Instructpat
ientt
ot akemedicat
ionasdi
rected.Take
mi sseddosesassoonasr ememberedunlessiti
s
almostt i
mef ornextdose.Donotdoubl
edoses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 238
 Advisepati
entt
oreadthePat
ientInf
ormationleaf
let
beforest
arti
ngandwit
heachRxr efi
l
l;changesmay
occur.

Inform pat i
entofpot ent ialforadversereact i
ons,and
adv i
sepat i
entt onotifyheal thcareprofessional
i
mmedi atelyifall
ergicr eactions(swell
ingoft heface,
l
ips,tongue, and/orthr oat,diffi
cul
tyinswal lowing
and/ orbr eathing)
,liv
erpr oblems( generalfeeli
ngof
notbei ngwel l
,yell
owi ngofski norwhitesofey es,
painont her i
ghtsideofabdomen) ,ski
nr eacti
ons
(lesi
ons, ulcers,orblisters),orchestpai noccur s.

Advisepat
ientt
hatvaginalbleedi
ngmayoccurdur i
ng
fi
rstfewweeksafterchangingov erfr
om other
hormonalther
apy.Continuedbleedingshouldbe
evaluat
ed.

Teachpat
ienttorepor
tincr
easei
npai
nsot
reat
ment
canbeini
ti
ated.

Adv
isepat i
enttonotif
yheal
thcareprof
essional
i
mmedi atel
yifpregnancyi
splannedorsuspected,
or
i
fbreastf
eeding.

Ani
dul
afungi
n

ᏆᖴA2022 Dr
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nHeal
thyCar
e 239
I
NDI
CATI
ONS
Candidemiaandot herser
iouscandidal
infecti
ons
i
ncludingintr
a-abdominal
abscess,peri
tonit
is.Esophageal
candidiasi
s.

ACTI
ON
Inhibi
tsthesynthesi
soffungalcel
l wall
.Therapeuti
c
Effect
s: Deat
hofsusceptibl
efungi.Spectr
um: Acti
ve
againstCandidaalbi
cans,C.gl
abrata,C.parapsi
losi
s,and
C.tropical
is.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Under
lyi
ngl
i
verdi
sease(
maywor
sen)
;
OB:Lactat
ion:
Pregnancyorl
act
ati
on;
Pedi
:Saf
etynot
est
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Resp:bronchospasm,dy
spnea.CV:hypotensi
on.GI:
di
arrhea,↑l i
verenzy
mes.Derm:fl
ushing,r
ash,ur
ti
cari
a.F
andE: hypokal
emia.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 240
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
IV:(
Adults)
:Esophageal
candidiasi
s—100mgloadi
ng
doseonday1, t
hen50mgdai ly.Candi
demiaandot
her
candidal
inf
ecti
ons—200mgl oadingdoseonday1,
then
100mgdai l
y.

AVAI
LABI
LITY
Ly
ophil
i
zedpowderf
orI
Vuse(
requi
resr
econst
it
uti
on)50
mg/v
ial
;

PATI
ENT TEACHI
NG
Expl
ainpur
poseofmedi
cat
iont
opat
ient
.

I
nstr
uctpat
ientt
onoti
fyhealt
hcar
epr
ofessi
onal
if
di
arr
heabecomespronounced.

ANI
LERI
DINE
I
NDI
CATI
ONS
Moder
atet
osev
erepai
n.

ACTI
ON

ᏆᖴA2022 Dr
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thyCar
e 241
Bindstoopiaterecept
orsintheCNS.Alterstheper
cept
ion
ofandr esponsetopainf
ulsti
muli
, whi
leproduci
ng
general
izedCNSdepr essi
on.Therapeuti
cEffect
s:
Decreaseinseverit
yofpain/
apprehension.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Somepr
oduct
s
cont
ainbi
sulf
it
esandshoul
dbeav
oidedi
npat
ient
swi
th
knownint
oler
ance.

UseCaut
iousl
yin:
Headt
rauma;
Incr
easedi
ntr
acr
ani
al
pressur e; Severerenal
,hepatic,orpul monar ydi sease;
Hy pothy roidi
sm; Adrenali
nsuf fi
ciency ;
Al coholi
sm;
Ger i
atricordebi li
tat
edpat i
ents( dosager eduction
suggest ed);Undiagnosedabdomi nal pain;Prost ati
c
hyperpl asia;Pregnancyorlact at
ion( avoidchr oni cuse;has
beenuseddur i
nglaborbutmaycauser espiratory
depressi oni nthenewbor n);Children<12y r(safet ynot
established) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,euphori
a,excitement ,nervousness,
rest
lessness.EENT: di
sturbedv ision.Resp:RESPIRATORY
DEPRESSI ON.GI :
constipati
on, drymout h,nausea,
vomiting.Derm:fl
ushing,it
ching, sweating.Misc:physi
cal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 242
dependence,
psy
chol
ogi
cal
dependence,
tol
erance.

I
NTERACTI
ONS
Drug-
Dr ug:Usewi thextr
emecaut i
oninpat i
entsr ecei
ving
MAOi nhibitors( mayresul ti
nunpr edi
ctable,sev ere
react
ions;decr easeiniti
al doseto25%ofusual dose).
Addit
iveCNSdepr essionwi thalcohol,
sedat iv
e/ hypnoti
cs,
andantihistami nes.Admi nistr
ationofpartial-
antagonist
opioi
danal gesicsmaypr ecipitat
eopioidwi thdrawal i
n
physi
callydependentpat ients.Buprenorphine,nalbuphine,
orpentazoci nemaydecr easeanal gesi
a.
Drug-Nat
uralPr
oduct:Concomi
tantuseofkav
a,v
aler
ian,
skul
lcap,chamomil
e,orhopscanincr
easeCNS
depressi
on.

DOSAGE
Lar
gerdosesmayber
equi
reddur
ingchr
oni
cther
apy
PO:(Adult
s):
25–50mgq6hr ;i
fpainisextr
emelysever
e,
i
nit
ialdosemaybe50mgormor efrequenti
nterv
alsmay
beusedbutshoul
dbereser
vedfornonambulatory
pat
ients.

AVAI
LABI
LITY
Tabl
ets25mg;

ᏆᖴA2022 Dr
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nHeal
thyCar
e 243
PATI
ENTTEACHI
NG
I
nst
ructpat
ienthowandwhent
oaskf
orpai
n
medi
cati
on.

Maycausesedat i
onanddi zzi
ness.Cautionpat
ientt
o
cal
lforassistancewhenambul ati
ngorsmokingand
toavoiddri
v i
ngorotheract i
vi
tiesrequi
ri
ngaler
tness
unti
lresponset omedicat
ioni sknown.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

Caut
ionpat
ienttoav oi
dconcur
rentuseofalcohol
or
ot
herCNSdepr essantswi
ththi
smedi cat
ion.

Ifonpr
olongedbedr
est,encour
agepati
entt
otur
n,
cough,andbreat
hedeeplyever
y2hrtoprev
ent
atel
ect
asis.

Apr
epi
tant
I
NDI
CATI
ONS
Preventi
onofacuteanddel ay
ednauseaandv omiti
ng
causedbyi ni
ti
al/
repeattr
eatmentwithhighl
yemet ogeni
c
chemot her
apy(withotherant
iemeti
cs).Prev
entionof
postoperat
ivenauseaandv omit
ing.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 244
ACTI
ON
Actsasasel ecti
veantagonistatsubstanceP/ neuroki
nin
1(NK1)r ecept or
sinthebrain.Therapeuti
cEf fect
s:
Decreasednauseaandv omiti
ngassoci at
edwi th
chemother apy.Augment stheantiemeticeffectsof
dexamethasoneand5- HT3ant agonists(ondansetron)

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentusewi
th
pimozide(ri
skofli
fe-
thr
eat
eningadver
secardi
ovascul
ar
react
ions)
;Lactati
on:Maycauseunwantedeff
ect
sin
nursi
nginfants.

UseCaut
iousl
yin:
Concur
rentusewi
thanyagent
s
metabol
izedbyCYP3A4( seeDrug-
DrugInt
eracti
ons);OB:
Useonlyifcl
ear
lyneeded;Pedi
:Saf
etynotestabl
ished.
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:di
zzi
ness,
fat
igue,
weakness.GI
:di
arr
hea.Mi
sc:
hi
ccups.

I
NTERACTI
ONS
Drug-
Drug:
Aprepi
tanti
nhibi
ts,
induces,
andismet aboli
zed
bytheCYP3A4enzymesy st
em; i
talsoi
nducesthe
CYP2C9system.Concur
rentusewithothermedicati
ons

ᏆᖴA2022 Dr
ugi
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thyCar
e 245
thatar emet abolizedbyCYP3A4mayr esul tini ncr eased
toxicityfrom t heseagent si ncludi ngdocet axel ,pacl itaxel
,
etoposi de, i
rinotecan, ifosfami de, imat inib,vinor elbine,
vinblastine,v i
ncristi
ne, mi dazol am, tri
azol am, and
alprazolam; concur rentuseshoul dbeunder takenwi th
caut i
on.Concur r
entusewi thdr ugst hatsi gnificant ly
i
nhi bittheCYP3A4enzy mesy st em i ncluding
(ketoconazol e,it
raconazol e,nef azodone, cl
ar i
thr omy cin,
ri
tonav ir,nelfinavir
,anddi l
tiazem)may↑ bl oodl ev el
sand
effectsofapr epi
tant .Concur rentusewi thdr ugst hat
i
nducet heCYP3A4enzy mesy st em incl udingr ifampi n,
carbamazepi ne,andpheny toinmay↓ bl oodl ev elsand
effectsofapr epi
tant .↑ bloodl ev elsandef fect sof
dexamet hasone( regi menr eflect sa50%doser educt ion)
;
asi milaref f
ectoccur swi t
hmet hy l
predni solone( ↓I V
doseby25%, ↓ POdoseby50%whenusedconcur rently
).
May↓ t heef fectsofwar f
ar i
n( car efulmoni toringf or2wk
recommended) ,oral cont r
acept iv es( useal ternat e
met hod) ,tol
but ami de, andpheny toin.

DOSAGE
PO:(Adult
s):Chemother
apy—125mg1hrpr i
orto
chemotherapy,
then80mgoncedail
yfor2days(with
dexamethasone12mgPO30mi npr
iort
ochemot her
apy
,
then8mgoncedai lyf
or3daysandondanset
ron32mgI V

ᏆᖴA2022 Dr
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e 246
30minpri
ort
ochemotherapy)
;Post
operat
ive—40mg
gi
venwit
hin3hrpr
iort
oinducti
onofanest
hesia.

AVAI
LABI
LITY
Capsul
es:
40mg,
80mg,
125mg.
.

PATI
ENTTEACHI
NG
Inst
ructpat i
enttotakeaprepit
antasdirected.Di
rect
pati
enttor eadthepatientpackageinsertbefor
e
start
ingtherapyandt orereaditeachti
met he
prescri
pti
oni srenewed

I
nstructpat
ientt
onotif
yhealt
hcarepr
ofessi
onalif
nauseaandv omit
ingoccurpr
iort
oadminist
rat
ion

Advi
sepati
entt
onotif
yheal
thcar
eprofessi
onalpr
ior
tot
akinganyot
herRx,OTC,
orherbal
products

Caut i
onpatientthataprepi
tantmaydecr easethe
effecti
venessofor alcontr
acept
ives.Advisepatientto
useal t
ernatenonhormonal methodsofcont racepti
on.
Adv i
sepat i
enttonotifyhealt
hcareprofessionalif
pregnancyisplannedorsuspect edorifbreastfeeding

Advi
sepat i
entandfamil
ytousegeneralmeasur est
o
decreasenausea(begi
nwit
hsipsofliquidsandsmall,
nongreasymeals;
provi
deoralhy
giene;remov e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 247
 noxi
ousst
imul
ifr
om env
ironment
)

Adv i
sepat i
entt
onot i
fyheal
thcarepr ofessi
onal
prompt l
yifsymptomsofal l
ergicreacti
ons(hives,
rash,i
tching,di
ff
icul
tybreat
hing,orswal l
owing)occur

APROTI
NIN
I
NDI
CATI
ONS
Reducesi nci
denceandpr eventsbleedinginpatients
undergoingrepeatcoronaryart
eryby passgr af
t(CABG)
surgery,
inhigh-r
iskpati
ents(impairedhemost asis,
presenceofaspirin,
orothercoagul opathy
)under goi
ng
fi
rstti
meCABG, andinpat i
entsforwhom t ransfusi
onsar
e
unavail
ableorunacceptable.

ACTI
ON
Act sasapr oteinaseinhi
bit
or ,r
esul
tingini nhi
bit
ionof
plasmi nandkal l
ikrei
n,i
nhi
bitionofcont actphase
activati
on, andmai nt
enanceoft heplateletmembr ane.
Ov eral
leffectisdecr easedfibri
noly
sisanddecr eased
turnoverofcoagul ati
onfactors.Therapeut i
cEffects:
Decr easedi ncidenceofbleedinganddecr easedneedf or
transfusions.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 248
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Knownhy
per
sensi
ti
vi
ty;
Knownor
suspect
edexposur
etoapr
oti
ninwi
thi
nthepr
evi
ous12mo.

UseCaut
iousl
yin:
Pat
ient
swi
thapr
evi
oushi
stor
yof
al
lergicr eactionstodrugsorot heragents(increasedri
sk
ofallergicreact i
ons);Hist
oryofpr evi
ousexposur eto
aprotinin(increasedr i
skofhy persensi
ti
vi
tyreactionson
subsequentexposur e)
;Mayi ncreasetheri
skof
cardiov ascularorrenaldysfunctionandneedf ordial
ysi
s
i
nt heper i
oper at
iveperi
od;OB: Lactati
on:Pedi:Safet
ynot
established.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GU:renaltubul
arnecr
osis.Local
:phl
ebi
ti
s.Misc:
hypersensi
ti
vit
yreact
ionsincl
udi
nganaphyl
axis(
inci
dence
i
ncreaseswi t
hrepeat
eduse) .

I
NTERACTI
ONS
Dr
ug-
Drug:
Ant
agoni
zest
heef
fect
soft
hrombol
yti
cs.

DOSAGE
I
V:(
Adult
s):Testdose—1mL( 1.
4mgor10,
000kal
li
krei
n
i
nhi
bit
oruni
ts[KI
U])i
sgiven10minbef
orel
oadi
ngdose

ᏆᖴA2022 Dr
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nHeal
thyCar
e 249
(foreit
herhigh-doseorlow-doser egimen).I
fnoal l
ergi
c
reacti
onoccur s,admini
sterloadingdose.Hi gh-dose
regimen–loadingdose—200mL( 280mgor2mi l
l
ionKIU)
foll
owedbycont i
nuousinfusion.Cont inuousinfusi
on—50
mL/ hr(70mg/ hr)or500,000KI U/ hr.“Pump-pri
me”
dose—200mL( 280mgor2mi ll
ionKI U)maybeaddedt o
primingfl
uidofcar di
opulmonar yby passcircuit
.Low-dose
regimen–loadingdose—100mL( 140mgor1mi l
l
ionKIU)
foll
owedbycont i
nuousinfusion.Cont inuousinfusi
on—25
mL/ hr(35mg/ hr)or250,000KI U/ hr.“Pump-pri
me”
dose—100mL( 140mgor1mi ll
ionKI U)maybeaddedt o
primingfl
uidofcar di
opulmonar yby passcircuit
.

AVAI
LABI
LITY
I
nject
ion10,
000KI
U/mL(
100mLand200mLv
ial
s)

PATI
ENTTEACHI
NG
Inf
orm patientsoftheimpor
tanceofnoti
fyi
nghealt
h
careprofessionali
ftheyhav
epr ev
iousl
yrecei
ved
aprot
inin.

ARDEPARI
N
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
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thyCar
e 250
Preventionoft hromboembolicphenomenaincludi
ngdeep
veinthrombosi sandpul monaryemboliaf
tersurgi
cal
procedur esthatareknownt oincr
easetheri
skofsuch
compl i
cat i
ons( knee/
hiprepl
acement,abdominalsur
ger
y).

ACTI
ON
Potent
iatestheinhibi
tor
yeffectofanti
thr
ombinonfact
or
Xaandt hrombin.Therapeut
icEffect
s:Prevent
ionof
thr
ombusf or
mat i
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Uncont
rol
l
ed
bl
eeding;Contai
nssul
fi
tesandshouldbeav
oidedi
n
pat
ientswithknownhypersensi
ti
vi
ty.

UseCaut
iousl
yin:
Sev
erel
i
verorki
dneydi
sease;
Retinopathy(hypertensi
veordiabetic)
;Untreat
ed
hypertension;Recenthist
oryofulcerdisease;
Spinal/epi
duralanesthesia;Hi
storyofcongenitalor
acquiredbleedingdisorder;
Geriat
ricpati
ents;Malignancy;
Pregnancy ,l
actati
on,orchil
dren(safetynotestabli
shed).
Exerci
seExt r
emeCaut i
onin:Severeuncontroll
ed
hypert
ension;Bact
eri
alendocardit
is,bl
eedingdisorder
s;GI
bl
eeding/ulcer
ati
on/pathol
ogy;Hemor rhagi
cstroke;
RecentCNSoropht halmologi
csur gery
; Act
iveGI

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 251
bleedi
ng/ul
cer
ati
on;Hist
oryoft
hrombocy
topeni
arel
ated
toardepari
norhepar
in.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, headache, i
nsomni a.CV: edema.GI :
constipati
on, nausea, r
ev ersibleincreasei nli
verenzymes,
vomiting.GU: ur i
nar yretention.Der m: ecchy moses,
pruri
tus,rash, urti
car i
a.Hemat :BLEEDI NG, anemia,
thrombocy topeni a.Local :erythemaati nj
ect i
onsite,
hemat oma, ir
ritation,pain.Mi sc:fever.

I
NTERACTI
ONS
Drug-Drug:Ri
skofbleedingmaybei ncr
easedby
concurrentuseofwar f
arinordrugsthataffectpl
atel
et
funct
ion,incl
udi
ngaspi r
in,NSAIDs,dipy
ridamole,some
cephalospori
ns,cl
opidogrel,
ticl
opi
dine,epti
fi
bati
de,
ti
rofi
ban,anddextran.

DOSAGE
Subcut(Adul
ts)
: 50anti
-f
actorXauni
ts/kgq12hrf
or14
daysorunti
lambulator
y,star
ti
ngeveni
ngofdayof
procedur
eorfol
lowingmor ni
ng.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
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thyCar
e 252
Solut
ionfori
nject
ion5000ant
i-f
act
orXaIU/
0.5mLinpre-
fi
l
ledsyri
nges,10,
000anti
-f
actorXaIU/
0.5mLinpr
e-f
il
led
syr
inges;

PATI
ENTTEACHI
NG
Advi
sepat i
enttorepor
tanysy mpt omsofunusual
bl
eedingorbruisi
ng,di
zziness,
itching,
rash,
fev
er,
swell
ing,ordi
ff
icul
tybreathi
ngtoheal t
hcare
prof
essionali
mmedi at
ely.

I
nstr
uctpati
entnottotakeaspir
in,napr
oxen,
or
i
buprof
enwithoutconsult
inghealt
hcareprof
essi
onal
whi
leonardepari
ntherapy.

Ar
for
mot
erol
I
NDI
CATI
ONS
Maint
enancet r
eatmenttopr
eventbronchospasm i
n
chr
onicobstruct
ivepul
monarydisease(COPD)incl
udi
ng
chr
onicbronchit
isandemphysema.

ACTI
ON
Producesaccumulat
ionofcycl
i
cadenosine
monophosphate(cAMP)atbeta-adr
ener
gicrecept
ors,
resul
ti
nginrel
axati
onofair
waysmoot hmuscle.Rel
ati
vel
y

ᏆᖴA2022 Dr
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speci
ficforbeta2(
pul
monar
y)r
ecept
ors.Ther
apeut
ic
Eff
ects:bronchodi
l
ati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Acut
ely
det
eri
orat
ingCOPD( onsetofactionisdel
ayed);
Pedi:
Saf
etynotest
abl
ished;Concurrentuseofotherlong-
act
ingbet
a2agonistbronchodi
lators.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sor
der
sincl
udi
ng
coronar yinsuffi
ciency,arr
hythmiasandhy per
tensi
on;
Hepat icimpai r
ment ;Geri:
Maybemor esensit
ivetodr
ug
eff
ect s;OB: Lactati
on: Safet
ynotestabl
ished;useonl
y
whenmat ernalbenefitoutweighsf
etalr
isk,mayinhi
bit
contractionsdur i
ngl abor.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache,i
nsomnia,ner
vousness,weakness.Resp:
ASTHMA- RELATEDDEATH, PARADOXI CAL
BRONCHOSPASM.CV: ECGchanges, t
achycardi
a.GI:
vomit
ing.Derm:r
ash.FandE: hypokal
emia.Hemat :
l
eukocytosi
s.MS:cramps.Neuro:tr
emor.Misc:
hyper
sensit
ivi
tyr
eacti
onsincl
udinganaphyl
axis,
fever.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
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Drug-Drug: Concur r
entusewi t
hMAOi nhibit
ors,tr
icycl
ic
anti
depr essantsorot heragentst hatmaypr olongt heQTc
i
ntervalmayr esulti
nser i
ousar r
hy thmi asandshoul dbe
undertakenwi thext r
emecaut ion.↑ r iskofhy pokalemia
withtheophy l
line,cort
icoster
oids, potassium- l
osing
di
uretics.Betabl ockersmay↓ t herapeut iceffect
s.↑
adrenergiceffectsmayoccurwi thconcur rentuseof
adrenergics.

DOSAGE
I
nhal
n:(
Adul
ts)
:15mcgt
wicedai
l
yvi
anebul
i
zat
ion.

AVAI
LABI
LITY
I
nhal
ati
onsol
uti
onf
ornebul
i
zat
ion15mcg/
2mL;

PATI
ENT TEACHI
NG
Instructpati
entonpr opert echniqueuseandadv i
se
patienttotakearformot erolasdi rect
ed.Donotuse
mor et hantheprescribeddose.I far egul
arly
schedul eddoseismi ssed,skipthedoseandr esume
regularschedule.Donotdoubl edoses.Ifsympt oms
occurbef orenextdosei sdue, usear api
d-acti
ng
i
nhal edbronchodilator(e.g.albuterol
).SeeAppendi x
Df ornebulizeri
nstructions.

ᏆᖴA2022 Dr
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thyCar
e 255
 I
nform pat
ientthatar
formot
erol
mayi
ncr
easet
her
isk
ofast
hma- rel
ateddeath.

Adv i
sepati
entswhohavebeentaki
ngshort-
acting
beta2agonist
sregul
arl
ytodi
sconti
nueregularuse
anduseonl yf
orsymptomati
crel
iefofacut
e
respir
ator
ysymptoms.

Cautionpati
entnott ousearfor
moter
oltotr
eatacut
e
sympt oms.Ar api
d-act
inginhal
edbet
a-adr
energi
c
bronchodil
atorshouldbekeptonhandandusedf or
rel
iefofacuteasthmaat t
acks.

Advi
sepat i
enttonot i
fyheal
thcareprofessional
i
mmedi atel
yifdif
ficul
tyinbr
eathingpersistsaft
eruse
ofarfor
moterol
,ifconditi
onwor sens,
ifmor e
i
nhalati
onsofrapid-acti
ngbronchodil
atorthanusual
areneededtoreli
ev eanacuteat t
ack.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

ARI
PIPRAZOLE
I
NDI
CATI
ONS
Schi
zophr
eni
a.Acut
eandmai
ntenancet
her
apyofmani
c

ᏆᖴA2022 Dr
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e 256
andmi xedepisodesassoci atedwi thbipolardisorder(as
monother apyorwithli
thium orv alproate).Adj
unct i
ve
tr
eatmentofdepr essi
oni nadul ts.Agitati
onassoci ated
withschizophreni
aorbi polardisorder.Irr
itabi
l
ity
associat
edwi thauti
sti
cdi sorderinchi l
dren.

ACTI
ON
Psy chotropicactivi
tymaybeduet oagoni stacti
vi
tyat
dopami neD2andser otoni
n5-HT1Ar eceptorsand
antagoni stactivi
tyatthe5-HT2Ar eceptor.Alsohas
alpha1adr energi
cblockingactivi
ty.Therapeuti
cEffects:
Decr easedmani f
estati
onsofschi zophrenia.Decr
eased
mani ainbi polarpati
ents.Decreasedsy mpt omsof
depr ession.Decreasedagitati
onassoci atedwith
schizophr eniaorbipolardi
sorder.Decreasedemot ional
andbehav ioralsymptomsofi rri
tabil
it
y.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Lact
ati
on:
Presumedtobeexcr
etedi
nbr
eastmi
l
k;di
scont
inuedr
ug
orbott
lef
eed.

UseCaut
iousl
yin:
Knowncar
diov
ascul
aror
cerebrovascul
ardisease;Condi
ti
onswhi
chcause
hypotension(dehy
dr at
ion,t
reat
mentwi
th

ᏆᖴA2022 Dr
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e 257
ant ihyper tensivesordi uretics);Diabet es( may↑ r i
skof
hy per glycemi a);Seizur edi sorders; Pat i
entsatr i
skf or
aspi rationpneumoni a; Concur r
entket oconazol eorother
pot ent i
al CYP3A4i nhi bitors(↓ ar i
piprazoledoseby50%) ;
Concur rentqui nidine, fluoxetine, paroxetine, orot her
pot ent i
al CYP2D6i nhi bitors;Concur rentcarbamazepi neor
otherpot enti
al CYP3A4i nducer s; OB: Neonat esat↑ r i
sk
forext r
apy r
ami dalsy mpt omsandwi thdrawal after
del i
v erywhenexposeddur ingthe3r dt ri
mest er ;useonlyif
mat ernal benef i
tout wei ghsr iskt of etus;Pedi :May↑ r i
sk
ofsui cideat tempt /i
deat i
onespeci al
lydur i
ngdoseear l
y
treat mentordoseadj ust ment ;riskmaybegr eaterin
chi l
dr en, adolescent s,andy oungadul tstaking
ant idepr essants( saf eusei nchildr en/adolescent snot
est abl i
shed) ;Geri:↑r iskofmor talit
yi nelderlypat i
ents
treat edf ordement ia-relatedpsy chosi s.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SUICI DALTHOUGHTS, drowsi ness,extrapyramidal
reacti
ons, akathi
sia, confusi
on, depr essi
on, fat
igue,
hostil
i
ty,insomni a,l
ightheadedness, manicreactions,
i
mpai redcogni ti
vef unction,nervousness, restl
essness,
seizur
es, tardi
vedy skinesia.Resp: dy spnea.CV:
bradycardia,chestpai n,edema, hyper tensi
on, orthost
ati
c
hypotension, t
achycar dia.EENT: blur r
edv i
sion,

ᏆᖴA2022 Dr
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e 258
conjunct ivi
ti
s, earpain.GI:consti
pati
on, anorexia,↑
sali
vat i
on, nausea, vomi ti
ng,wei
ghtloss.GU: uri
nary
i
ncont inence.Hemat :AGRANULOCYTOSI S,anemi a,
l
eukopeni a,neut r
openi a.Der
m: dryskin,ecchy mosis,ski
n
ulcer,sweat ing.MS: muscl ecramps, neckpai n.Metab:
hypergly cemi a.Neuro: abnormalgait
, t
remor .Misc:
NEUROLEPTI CMALI GNANTSYNDROME, ↓ heat
regulation.

I
NTERACTI
ONS
Drug-Drug:Ketoconazol e, cl
arithromy cin,
orot herstr
ong
CYP3A4i nhi bi
tors↓ met abolism and↑ ef f
ect s(↓
ari
piprazoledoseby50%) .Qui nidine,fl
uoxetine,
paroxeti
ne, orotherstrongCYP2D6i nhibi
tors↓
met aboli
sm and↑ ef f
ect s(↓ ar i
piprazol
edosebyat
l
east50%) .Concur rentcar bamazepi neorot herpotenti
al
CYP3A4i nducer s↑ met abolism and↓ ef f
ect s(doubl
e
ari
piprazoledose) )
.

DOSAGE
I
fusedconcurr
entl
ywi thcombinat i
onofstrong,moderat
e,
orweakCYP3A4andCYP2D6i nhibi
tors,
↓ aripi
prazol
e
doseby75%.Aripi
prazoledoseshoul dbe↓ by75%i n
CYP2D6PMswhoar econcomi tantl
yreceiv
ingast r
ong
CYP3A4inhi
bit
or.

ᏆᖴA2022 Dr
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Schi
zophr
eni
a
PO:(Adul
ts)
:10or15mgdaily
;dosesupt
o30mg/ day
hav
ebeenused;i
ncrement
sindosi
ngshoul
dnotbemade
bef
ore2wkatagivendose.
PO:(Childr
en13–17y r)
:2mgdai l
y;↑to5mgdailyaf
ter2
days,andthentotargetdoseof10mgdail
yaf
teranother
2days; mayfur
ther↑ dosein5-mgincr
ement
sifneeded
(max:30mg/ day).
Acut
eManicorMi
xedEpi
sodesAssoci
atedwi
thBi
pol
arI
Di
sorder
PO:(Adult
s) :
15mgdai l
yasmonot her
apyor10–15mg
dai
l
ywi t
hl i
thi
um orv
alproat
e;t
argetdosei
s15mgdail
y;
may↑ t o30mgdai l
y,i
fneeded.
PO:(Childr
en10–17y r)
:2mgdai l
y;↑to5mgdailyaf
ter2
days,andthentotargetdoseof10mgdail
yaf
teranother
2days; mayfur
ther↑ dosein5-mgincr
ement
sifneeded
(max:30mg/ day).

Mai
ntenanceTr
eat
mentofBi
pol
arIDi
sor
der
PO:(Adul
ts):Cont
inuesamedoseneededt
ost
abi
l
ize
pat
ientdur
ingacut
et r
eatment
.
PO:(
Chil
dren10–17yr)
:Conti
nuesamedoseneededt
o
st
abi
li
zepati
entdur
ingacut
etreat
ment.

ᏆᖴA2022 Dr
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e 260
Depr
essi
on
PO:(Adul
ts)
:2–5mgdai
ly,mayti
tr
ateupwar
dat1-
wk
i
nter
valst
o5–10mgdail
y;nott
oexceed15mg/day
.
Agi
tati
onAssoci
atedwi
thSchi
zophr
eni
aorBi
pol
ar
Di
sorder
I
M: (Adul
ts)
:9.75mg/day,mayuseadoseof5. 25mg
basedoncli
nical
sit
uat
ion.Maygiv
eaddi t
ional
dosesup
toacumulat
ivedoseof30mg/ day
,ifneeded.

I
rr
it
abi
l
ityAssoci
atedwi
thAut
ist
icDi
sor
der
PO:(Chi
ldr
en6–17y r)
:2mgdail
y;↑to5mgdail
yaft
erat
l
east1wk; mayf
urther↑ dosei
n5–mgincr
ement
sif
neededat≥1–wkinter
val
s(max:15mg/
day).

AVAI
LABI
LITY
Tabl
ets2mg,
5mg,
10mg,
15mg,
20mg,
30mg.
Or
alsol
uti
on(
orangecr
eam fl
avor
)1mg/
mL;
Inj
ect
ion
9.
75mg/1.3mLsingl
e-dosev
ial
s;

PATI
ENT TEACHI
NG
Advisepati
entt
otakemedi
cat
ionasdir
ectedandnot
toskipdosesordoubl
euponmisseddoses.Take
misseddosesassoonasrememberedunlessal
most

ᏆᖴA2022 Dr
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thyCar
e 261
 t
imef
ort
henextdose.

Infor
m pat i
entofpossibi
l
ityofextrapyramidal
sympt omsandt ardiv
edyskinesia.Inst
ructpat
ientt
o
reportthesesympt omsimmedi atel
y .

Advi
sepati
entt
omakeposit
ionchangessl
owl
yto
mini
mizeort
host
ati
chy
potensi
on.

Medi cat
ionmaycausedr owsinessand
l
ightheadedness.Cauti
onpati
enttoavoiddriv
ingor
otheractiv
iti
esrequi
ri
ngaler
tnessunti
lresponseto
medi cat
ionisknown.

Adv isepat ientandf amilytonot ifyhealthcare

prof essional i
fthoughtsaboutsui cideordy i
ng,
attempt st ocommi tsuicide;neworwor sedepr essi
on;
neworwor seanxiety;f
eel i
ngv eryagi t
atedorr estl
ess;
pani cattacks; tr
oublesleeping; neworwor se
i
rri
t abili
ty;acti
ngaggr essive;bei ngangr yorviolent;
actingondanger ousimpul ses; anext r
emei ncreasei n
activ i
tyandt alki
ng;otherunusual changesinbehav ior
ormoodoccur .

Instr
uctpati
enttonoti
fyhealt
hcareprofessional
of
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtaken,toavoidal
cohol,andtoconsul
t
healthcar
eprofessi
onalbeforet
akinganynew

ᏆᖴA2022 Dr
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thyCar
e 262
 medi
cati
ons.Caut
ionpati
entt
oavoidtaki
ngal
cohol
orot
herCNSdepressant
sconcur
rentl
ywitht
his
medi
cati
on.

Advi
sepati
entthatextr
emesintemper
atur
eshoul
d
beavoi
ded,becausethi
sdrugimpai
rsbody
temper
atur
eregulat
ion.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Emphasizetheimportanceofr
outi
nef
oll
ow-upexams
andcontinuedpar
ti
cipati
oninpsy
chot
herapyas
i
ndicat
ed.

Ar
modaf
ini
l
I
NDI
CATI
ONS
Toimprovewakeful
nessinpat
ientswit
hexcessiv
e
dayt
imedrowsinessduetonar
colepsy,
obstr
ucti
vesleep
apnea/
hypopneasyndromeandshi f
tworkdi
sorder.

ACTI
ON
Pr
oducesCNSsti
mul
ati
on.Ther
apeut
icEf
fect
s:I
mpr
oved
wakef
ulness.

ᏆᖴA2022 Dr
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thyCar
e 263
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
omodaf
ini
lor
ar
modaf
ini
l
.

UseCaut
iousl
yin:
Concur
rental
cohol
ingest
ion;
Hist
ory
ofdrugabuse, especial
lyhi
storyofstimul
antabuse;
Severehepaticimpairment(↓ doser ecommended);
RecentMIorunst abl
eangina;Geri:Bl
oodlev
elsmayby↑
duet o↓ clearance(l
owerdosemaybenecessar y);
OB:
Lactati
on:Pedi:Safetynotestabl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SUICIDALI DEATION, dizzi
ness,headache,insomnia,
aggression,anxiety,
delusions,hall
ucinat
ions,mania.CV:
↑ BP.GI :nausea, dr
ymout h.Derm:STEVENS- JOHNSON
SYNDROME, rash.Misc:MULTI -ORGAN
HYPERSENSI TIVITY,al
lergicreacti
onsincludi
ng
anaphylactoidreacti
onsandangi oedema.

I
NTERACTI
ONS
Drug-
Drug:Sincearmodafi
nili
spar t
iall
ymet aboli
zedby
theCPY3A4enzy mesy st
em, concurrentuseofdr ugsthat
i
nducetheCYP3Asy st
em, i
ncludi
ngcar bamazepi ne,
phenobarbi
tal,
andrif
ampinmay↓ l evelsand
eff
ecti
veness.Concurr
entuseofdr ugst hati
nhibi
tt he

ᏆᖴA2022 Dr
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nHeal
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e 264
CYP3Asy stem, i
ncludi ngket oconazol eander ythromy ci
n
may↑ l evelsandef fectiveness.Ar modaf i
ni lalsoi nduces
theCYP3Asy st
em andmay↓ ef fecti
venessofhor monal
contracepti
v es(additional oral t
ernati
vemet hods
recommended, cy cl
ospor ine( doseadj ust mentmaybe
necessary,mi dazolam andt riazolam (excesssedat i
on
mayoccur ,dose↓ maybenecessar y)
.Ar modaf i
nilalso
i
nhibitstheCYP2C19sy stem andmay↑ ef fectsof
pheny t
oin,diazepam, propranol ol
, omepr azol e,and
clomipramine( dose↓ andmoni tori
ngf ort oxicity
recommended) .Usecaut iousl ywithMAOi nhi bit
orsand
otherCNSst imulants.

DOSAGE
PO:(Adults)
:Obstructi
vesleepapnea/
hypopnea
syndr
omeandnar col
epsy—150–250mgoncedai lyi
nthe
morning;Shi
ftworksleepdisorder
—150mgoncedailyone
hourbeforestar
tofwor k.

AVAI
LABI
LITY
Tabl
ets50mg,
150mg,
250mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakemedi
cationasdi
rect
ed.Adv
ise
pat
ientsthatlev
elofwakef
ulnessmaynotretur
nto

ᏆᖴA2022 Dr
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 normal.I
fusedasanadj uncttoCPAP, encourage
pat
ienttoconti
nuet ouseCPAPandot hermodali
ties.
I
nform pati
entthatarmodafi
nildoesnottakethe
pl
aceofget t
ingenoughsleep.Instr
uctpati
enttoread
Pati
entInf
ormat i
onLeafl
etpri
ort other
apy.

Medicati
onmayi mpai
rjudgment.Cauti
onpati
entt
o
avoi
ddr i
vingorot
heracti
vit
iesr
equir
ingal
ert
ness
unti
lresponsetomedicat
ionisknown.

Instructpat ientt onot i

fyhealthcarepr of essional
i
mmedi atelyi frash,hives,mout hsor es, blisters,
peel i
ngski n, swel li
ngoff ace,eyes,l
ips, tongue, or
throat ,
troubl eswal l
owingorbr eathing, hoar sev oice,
orot heral l
er gicreactionsoccur .Patient sshoul dal so
notifyheal thcar eprofessionalifdepr essi on, anxiety,
hallucinations, mani a,thoughtsofsui ci deorot her
ment alproblems( mania,delusions,hal lucinat i
ons,
suicidal i
deat ion, aggression),
orhear tpr oblems,
i
ncl udingchestpai n,occur .

Advisepati
entthatshari
ngthi
smedi
cat
ionwi
th
others,
eventhosewi t
hthesamesympt
oms,i
s
dangerousandill
egal.

Nonhormonalmethodsofcontr
acept
ionshoul
dbe
usedduri
ngandfor1mof oll
owingdi
sconti
nuat
ionof
ther
apy.I
nst
ructpati
entt
onotif
yheal
thcare

ᏆᖴA2022 Dr
ugi
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e 266
 prof
essi
onalpromptlyifpr
egnancyi
spl
annedor
suspect
edorifbreastf
eeding.

Instr
uctpati
enttonoti
fyheal
thcarepr
ofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcar e
professi
onalbef
oretaki
nganynewmedi cat i
ons.
Adv i
sepati
enttoavoidal
coholuseduri
ngt herapy

Ar
seni
ctr
ioxi
de
I
NDI
CATI
ONS
Inducti
onofr emissionandconsolidati
oninpati
ent
swi t
h
acutepromy elocyti
cleukemia(
APL)whodonotr espond
toortoleratereti
noidandanthr
acy cl
inechemother
apyand
whosedi seaseisassociatedwit
ht hepresenceofthet(
15;
17)translocati
onorPML/ RAR-
alphageneexpressi
on.

ACTI
ON
Alt
ersDNAandf usionpr
oteinsi
nleukemiccel
l
s.
Therapeut
icEff
ects:I
mprovedhematologi
cparamet
ersi
n
pati
entswithAPL.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oar
seni
c;OB:
Can

ᏆᖴA2022 Dr
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thyCar
e 267
causef
etal
inj
ury
;Lact
ati
on:
Excr
etedi
nbr
eastmi
l
k.

UseCaut
iousl
yin:
Sev
erer
enal
impai
rment(
dose↓ may
beneededifCCr<30mL/ min)
;Hepati
cimpai
rment;
Concurr
entuseofotherdr
ugsthatcauseQTint
erv
al
pr
olongati
on.
Exerci
seExtr
emeCaut i
oni n:Pre-existi
ngel ect
rolyt
e
abnormali
ti
es(cor
rectpri
ort oadmi nistr
ation);concurr
ent
useofdrugsknownt oprolongQTi nterv
al,concurrentuse
ofpotassi
um wasti
ngdiureti
csoramphot erici
n;Pedi:
Chil
dren<4yr(saf
etynotest abl
ished) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: fat
igue, headache, i
nsomni a,weakness.Resp:
hypoxi a,dy spnea, pleur
al ef
fusion.CV: TORSADEDE
POI NTES, COMPLETEAVBLOCK, atri
alar r
hythmias,QT
i
nter valprol ongat i
on.GI :
abdomi nalpain,const i
pati
on,↑
l
iverenzy mes.GU: r
enal fai
l
ure.Der m:der matiti
s.Endo:
hyper glycemi a,hy poglycemia.FandE: acidosis,
hypocal cemi a, hyperkalemia,hypokalemi a,
hypomagnesemi a.Hemat :NEUTROPENI A, APL
DIFFERENTI ATI ONSYNDROME, DISSEMI NATED
INTRAVASCULARCOAGULATI ON, THROMBOCYTOPENI A,
hyper l
eukocy t osis,anemi a,
leukocy t
osis.MS: backpain,
arthralgi
a, bonepai n,neckpain, l
imbpai n,my algi
a.Misc:

ᏆᖴA2022 Dr
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nHeal
thyCar
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al
l
ergi
creact
ions,
fev
er,
inf
ect
ion/
sepsi
s.

I
NTERACTI
ONS
Drug-
Drug:Usecaut i
ouslywithotheragentsknownt o
causeQTpr olongat
ionincl
udingsomeant i
arr
hythmicsor
thi
ori
dazi
ne.Concur r
entuseofamphot er
ici
nB, pot
assium
-ormagnesium- wasti
ngdiureti
cs(↑r i
skofser i
ous
arr
hythmias).

DOSAGE
I
V:(Adult
sandChi l
dren≥5y r)
: I
nducti
on—0.15mg/kg/day
unt
ilbonemar r
owremi ssi
on( nottoexceed60doses)
;
Consoli
dati
on—star
ting3–6wkaf tercomplet
ionof
i
nducti
on;0.15mg/kg/dayf or25dosesov eraperi
odof5
wk.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion1mg/
mL;

PATI
ENT TEACHI
NG
Expl
ainpur
poseofar
seni
ctr
ioxi
det
opat
ient
.

Caut
ionwomenofchil
dbear
ingy
ear
stouseef
fect
ive
cont
racept
iondur
ingt
her
apy.

ᏆᖴA2022 Dr
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Ar
teet
her
I
ndi
cat
ions
Complicat
edfalci
par
um mal
ari
a;chl
oroqui
ner
esi
stant
malar
ia;cer
ebralmal
ari
a.

Av
ail
abi
l
ity
I
NJECTI
ON2ml
ampoul
e(150mg/
2ml
).
(
Art
eetheri
sanethy
lderi
vati
veofdi
hydr
oar
timisi
nin.I
tis
amixt
ureofαandβarteet
herina30:
70rat
io)

DOSAGE
Adult
-150mgdai l
yi.
m.i
nject
ion,
oncedai
l
yfor3
consecut
iveday
s.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
tyt
oar
temi
sini
nder
ivat
ives;
preganacy

Adv
erser
eact
ions
Itiscl
i
nical
lyverywell
tol
eratedwithoutanysi
gni
fi
cant
sideeff
ects;neurol
ogi
calorbiochemical
.

St
orage
ᏆᖴA2022 Dr
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nHeal
thyCar
e 270
St
oreprot
ect
edfrom l
i
ghti
ntamperevi
dentcont
ainerso
astoav
oidcont
aminati
onbymicr
o-or
gani
sms.

Ar
temet
her
I
ndi
cat
ions
TreatmentofsevereP.falcipar
um mal ar
iai
nar
easwher
e
evidencei
stherethatquinineisinef
fecti
ve;
mul
tidr
ug
resist
antmalar
ia.

ACTI
ON
Consistsofafixedrati
oof1: 6par t
sofar t emet herand
l
umef antr
ine,r
espectivel
y.Artemet herisapr odrugthati
s
rapi
dlyconvert
edt odihydroartemisinin(DHA) ,
itsacti
ve
metabolit
e.Bothcomponent sinhi
bi tnucleicaci dand
prot
einsynthesis.Therapeuti
cEf f
ect s:Ant i
mal ari
al
acti
vit
ydirect
edatt heerythrocyti
cst agesofPl asmodium
fal
cipar
um.

Av
ail
abi
l
ity
TABLET20mgCAPSULE40mg;
INJECTI
ON1ml
ampoul
e
(80mg/ml,
160mg/2ml)
.

DOSAGE

ᏆᖴA2022 Dr
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e 271
Or
al
Adul
t-160mgi
ntwodivi
deddosesonfi
rstdayf
oll
owed
by80mgonceadayfornextf
ourday
s.

I
ntr
amuscul
ari
nject
ion
Adul
t-80mgt
wiceadayf
or3day
s.
Chi
l
d-1.6mg/kgbodywei
ghttwiceadayfol
l
owedby1. 6
mg/kgbodywei
ghtonceadayfor4days,
alt
ernat
ivel
y1.6
mg/kgbodywei
ghttwi
ceadayfor3days.

Cont
rai
ndi
cat
ions
Fi
rstt
ri
mesterofpr
egnancy(
Appendi
x7c)
;
hy
persensi
ti
vi
ty.

I
NTERACTI
ONS
Drug- Drug: Concurrentuseot herant imal arialsshouldbe
avoidedduet olackofsaf etydat a.Concur rentusewi th
anyot herdr ugsthatprolongQTci ncl udi
ngqui nine,cl
ass
IAant iarrhythmics(quinidi
ne, procainami de,
disopy rami de),orcl
assI I
Iantiarrhythmi cs( ami odarone,
sotalol )
,ant i
psychoti
cs( pi
mozi de, ziprasidone) ;
antidepr essants;certainanti-
inf
ect i
ves( macr oli
des,
fl
uor oqui nolones,i
mi dazoles/tr
iazoles) ;somenon-
sedat ingant ihi
staminics(terf
enadi ne, astemi zole),
or

ᏆᖴA2022 Dr
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nHeal
thyCar
e 272
cisapridequi ni
di ne, shoul dbeav oided.Concur rentuseof
subst r
at es,inhibi tors,ori nducer soft heCYP3A4enzy me
system, i
ncludi ngant iretrovir
alsmay↓ ant i
amal arial
effi
cacyorhav eaddi ti
v eeffectsonQTcpr olongat ion; use
cautiousl y.Usecaut iouslywi thCYP3A4I nhibitor sduet o
↑r iskofQTpr ol ongat ion.Effect ivenessmaybe↓ by
mef l
oqui nei fusedi mmedi atelybef oretreatment
(encour agef oodconsumpt i
on) .May↓ ef fectivenessof
hormonal contracept ives( additional met hodofbi rt
h
control shoul dbeused) .Concur rentuseofant iretrovirals
may↑ r i
skofQTcpr olongat ion, ↓ ant i-
retrovir
al effi
cacy ,
or↓ ant imalarial ef
ficacy .Concur rentuseofCYP2D6
subst r
at esincludi ngf lecainide, i
mi pr amine, ami tri
pt yl
ine
andcl omi prami nemay↑ r i
skofadv erser eactionsand/ or
↑r iskofQTcpr olongat ion;av oidconcur rentuse.
Drug-
Food:
Grapef
rui
tjui
cemay↑ bl
oodl
evel
sandr
iskof
QTcprol
ongat
ionandshoul
dbeavoi
ded.

Pr
ecaut
ions
Electr
olytedisturbances,concomi t
antusewi thother
drugsknownt ocauseQT- int
ervalprol
ongation;hepati
c
i
mpai rment ;
renal i
mpai r
ment ;monitorpati
entsunablet o
takefood( greaterri
skofr ecrudescence);i
nteracti
ons
l
act at
ion.Di
zzinessmayi mpairabili
tytoperform ski
ll
ed
tasks,forexampl eoperatingmachi nery,
driv
ing.

ᏆᖴA2022 Dr
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thyCar
e 273
Adv
erseEf
fect
s
Headache, nausea,vomiting,
abdomi nalpai
n,diar
rhoea;
dizzi
ness,ti
nnitus,neutr
openia,el
evatedli
verenzyme
values;
cardiotoxici
ty(af
terhighdoses);neur
otoxici
ty-
in
animalstudies;decreaseinreti
cul
icytecount.

PATI
ENTTEACHI
NG
Instructpati
enttotakemedi cati
onasdi rected.Adv
ise
pat i
enttoresumeeat ingassoonasf oodcanbe
tolerated;
improvesabsor pti
onofmedi cation.Advi
se
pat i
enttonotif
yhealthcar eprof
essionaloff l
u-l
i
ke
sympt oms( chi
ll
s,fever,musclepains,headache)
occuragai naft
erfi
nishingmedi cat
ion.

Adv i
sepati
enttonoti
fyhealt
hcareprof
essi
onalof
theyhavetakenothermedicati
onst
ot r
eatmal
aria
recentl
y.

Advisepat
ientt
oavoiddri
nki
nggrapef
rui
tjui
cedur
ing
ther
apy;maycauseincr
easedconcent
rat
ionsandr
isk
ofarrhy
thmias.

Maycausedizziness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 274
 Advisepat
ientt
onotif
yhealthcar
eprofessionali
f
symptomsofprolongati
onoftheQTinterval
(pr
olongedhear
tpalpi
tati
ons,l
ossofconsciousness)
occur.

I
nst r
uctpat i
entt
onot if
yheal thcareprofessional
i
mmedi atel
yifsi
gnsofhy persensi
tiv
ity(skinrash,
hives,otherski
nreactions,rapidheartbeat,dif
ficul
ty
breathingorswall
owi ng,swel l
ingofthelips,tongue,
face,ti
ghtnessorthroat,hoarseness)occur .

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Rev
iewmethodsofmini
mizi
ngexposur
eto
mosqui
toeswi
thpat
ient
.

Advisefemal epati
entt onotif
yhealthcare
professi
onal i
fpregnancyi splannedorsuspectedor
i
fbr eastf
eeding.Medi cat
ionmaycausel ossof
pregnancyanddecr easedef fecti
venessofhormonal
contracepti
ves;advisepatienttouseanon- hor
monal
form ofbirt
hcont r
ol duri
ngtherapy

St
orage

ᏆᖴA2022 Dr
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thyCar
e 275
St
orepr
otect
edf
rom l
i
ghtandmoi
stur
e.

Ar
tesunat
e
I
ndi
cat
ions
Tr
eatmentofuncompl
i
catedP.f al
cipar
um mal
ari
ain
ar
easofmulti
pledr
ugresi
stance.

Av
ail
abi
l
ity
TABLET25,
50&60mg;
INJECTI
ON50,
60,
1000&2000
mg/vi
al.

DOSAGE
Or
al
Adul
t-t
otaloraldose600mgcanbedivi
dedint
otwo50
mgtablet
stwi ceadayonfi
rstdayt
her
eaft
er50mgtwi
ce
adayfornext4day s.
Chi
l
d-hal
fadul
tdose.
I
ntr
amuscul
ari
nject
ion60mgt
wicedai
l
y.

Cont
rai
ndi
cat
ions
Fi
rstt
ri
mest
erofpr
egnancyhy
per
sensi
ti
vi
ty.

ᏆᖴA2022 Dr
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thyCar
e 276
Pr
ecaut
ions
Riskofr ecurr
enceifusedalonei
nnoni mmunepat i
ents;
hepatic/renali
nsuff
ici
ency,
pregnancylactati
on,
paediatri
cs.Dizzi
nessmayi mpairabil
i
tytoperfor
m skil
l
ed
tasks,forexampleoperati
ngmachi nery,
driv
ing.

Adv
erseEf
fect
s
Headache, nausea, vomit
ing,abdomi nalpain,di
arrhoea,
dizzi
ness, t
inni
tus,neutr
openi a,elevatedl i
verenzyme
values;ECGabnor mal i
ti
es,includingpr olongati
onofQT
i
nt er
v al
;temporarysuppressionofr eti
culocyteresponse
andi nducti
onofbl ackwaterfev erreported;neurotoxi
cit
y-
i
nani mal studi
es.

St
orage
St
orepr
otect
edf
rom l
i
ghtandmoi
stur
e.

Ascor
bicaci
d
I
NDI
CATI
ONS
Treat
mentandpreventi
onofv i
taminCdef
iciency( scur
vy)
withdi
etar
ysupplementat
ion.Suppl
ement
alt herapyin
someGIdiseasesduri
nglong-ter
m par
ent
eral nutr
iti
onor

ᏆᖴA2022 Dr
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thyCar
e 277
chroni
chemodi aly
sis.St
atesofi ncreasedrequir
ements
suchas:Pregnancy,Lactat
ion,Stress,Hyperthyr
oidi
sm,
Trauma,Burns,Inf
ancy.UnlabeledUses: Preventi
onoft
he
commoncol d.

ACTI
ON
Necessaryforcoll
agenf ormat ionandt i
ssuer epai
r.
Invol
vedinoxidati
onr educti
onr eacti
ons;tyr
osine,foli
c
acid,i
ron,
andcar bohy dr
atemet aboli
sm; l
ipi
dandpr ot
ein
synthesi
s;cel
lul
arr espir
ati
on; andr esi
stancetoinfection.
Therapeuti
cEffects:Replacementi ndefi
ciencystates.
Supplementati
ondur ingincreasedr equir
ement s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Tar
trazi
nehy
per
sensi
ti
vi
ty(
some
pr
oduct
scont
aint
art
razi
ne—FDCy
ell
owdy
e#5)
.

UseCaut
iousl
yin:
Recur
rentki
dneyst
ones;
OB:
Avoi
d
chr
oni
cuseofl
argedosesi
npr
egnantwomen.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dr
owsiness, f
ati
gue,headache, i
nsomnia.GI
:cramps,
di
arrhea,hear
tburn,nausea,vomiti
ng.GU: ki
dneystones.
Derm: f
lushi
ng.Hemat :deepv ei
nthrombosis,hemolysi
s
(i
nG6PDdef i
ciency),
sickl
ecellcri
sis.Local
:pai
nat

ᏆᖴA2022 Dr
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nHeal
thyCar
e 278
subcutorI
M si
tes.

I
NTERACTI
ONS
Drug-Drug:Ifur
inar
yacidificati
onoccurs,may↑ excret
ion
and↓ ef fectsofmexil
etine,amphetamine,ortr
icy
cli
c
anti
depressants.Largedoses( >10g/day)may↓
responset owarfar
in.↑ irontoxici
tywhengiven
concurrentl
ywithdeferoxami ne.

DOSAGE
PO:(
Adult
s):Scur
vy —500mg/ dayf
oratl
east14day
s.
Pr
event
ionofdefi
ciency—50–100mg/day.
PO:(Chi
l
dren):Scur
vy—100–300mg/dayf
oratleast14
day
s.Prevent
ionofdef
ici
ency—30–45mg/day
.
I
M: (
Adul
ts)
:Scur
vy—100–500mg/
dayf
oratl
east14
day
s.
I
M: (
Chi
l
dren)
:Scur
vy—100–300mg/
dayf
oratl
east14
day
s.
I
V:(Adul
tsandChil
dren)
:Prev
enti
onof
def
ici
ency—det
erminedbyneed.

AVAI
LABI
LITY
Tabl
ets25mgOTC,
50mgOTC,
100mgOTC,
125mgOTC,

ᏆᖴA2022 Dr
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thyCar
e 279
250mgOTC, 500mgOTC, 1gOTC, 1.
5gOTC; Chewable
tabl
ets60mgOTC, 100mgOTC, 250mgOTC, 500mgOTC,
1gOTC; Extended-releasetabl
ets500mgOTC, 1gOTC, 1.
5
gOTC; Extended-releasecapsules500mgOTC; Sol
uti
on50
mg/ 0.
6mLOTC, 100mg/ mLOTC;Syrup250mg/ 5mLOTC;
Inj
ecti
on222mg/ mL, 250mg/ mL,500mg/mL; In
combi nati
onwi th:otherv i
tami
nsandmi ner
alsin
multiv
itaminpr eparations.

PATI
ENTTEACHI
NG
Adv isepati
entt
otakemedi cat
ionasdir
ect
edandnot
toexceeddosepr escr
ibed.Excessdosesmayleadt
o
diarrheaanduri
naryst
onef ormati
on.I
fadoseis
mi ssed,ski
pdoseandr et
urntodoseschedul
e.

Vi
taminCDef ici
ency:Encouragepat
ienttocomply
wi
thdietrecommendat i
onsofhealthcare
pr
ofessi
onal .Explai
nthatthebestsourceofvi
tamins
i
sawel l
-balanceddiet.

Foodshighinascorbicacidi
ncludecitr
usfr
uit
s,
tomatoes,st
rawberr
ies,cant
aloupe,andrawpeppers.
Graduall
ossofascorbicacidoccurswhenf r
eshfood
i
sst or
ed,butnotwheni ti
sfrozen.Rapidl
ossis
causedbydrying,
salti
ng,andcooking.

Pat
ient
ssel
f-
medi
cat
ingwi
thv
itami
nsuppl
ement
s

ᏆᖴA2022 Dr
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thyCar
e 280
 shoul
dbecaut i
onednott oexceedRDA.The
eff
ecti
venessofmegadosesofv i
taminsfortreat
ment
ofvari
ousmedical condi
ti
onsisunprovenandmay
causesideeff
ects.Abruptwit
hdrawalofmegadoses
ofascorbi
cacidmaycauser ebounddef i
ciency.

Asenapi
ne
I
NDI
CATI
ONS
Acuteandmaint
enancetr
eatmentofschizophreni
a.Acut
e
tr
eatmentofmanic/
mixedepisodesassoci
atedwith
bipol
arIdi
sor
der(asmonotherapyorwit
hlit
hium or
valpr
oate)
.

ACTI
ON
Mayactt hr
oughcombinedantagonism ofdopami ner
gic
(D2)and5-HT2Arecept
ors.Therapeut
icEffects:
Decreasedsymptomsofacuteschizophreniaand
mania/mixedepi
sodesofbipol
arIdisorder.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Dement
ia-
rel
ated
psychoses;
Sev
erehepat
ici
mpai
rment
;Lact
ati
on:
Avoi
d
use.

ᏆᖴA2022 Dr
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e 281
UseCaut
iousl
yin:
Hist
oryofcar
diacar
rhy
thmi
as,
congeni t
al QTpr olongat i
on, electrol yteabnor mal iti
es
(especi allyhypomagnesemi aorhy pokal emi a;cor rectprior
touse)orconcur rentuseofmedi cat i
onsknownt o
prolongt heQTci nt erval(may↑ r iskofl ife-threat ening
arrhy thmi as) ;Hi
st or yofseizur esor
condi ti
ons/ medicat ionsknownt o↓ sei zur ethr eshhol d;
Hist or yofl eukopeni a/neutropeni a; St r
enuousexer cise,
exposur et oextremeheat ,concur rentmedi cationswi th
antichol i
ner gi
cact i
v i
ty,orriskofdehy dration;Hi stor yof
suicideat t
empt ;Ger i:
↑r i
skofadv erser eact i
ons;
consi derage- related↓ i nhepat i
cf unction, cardi ovascul ar
status, andconcur rentmedi cations; Geri:↑r i
skof
mor talit
yi nelder l
ypat i
entst reatedf ordement ia-related
psy chosi s; OB: Neonat esat↑ r iskf orext r
apy rami dal
sympt omsandwi t hdrawal af terdel iverywhenexposed
duringt he3r dtri
mest er;useonl yi fbenef itout wei ghsr isk
tof etus; Pedi :Safet yandef fectivenessnotest abl ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, SEI
ZURES,
SUICIDALTHOUGHTS, akathisia,di
zziness,dr
owsiness,
extr
apyramidalsymptoms, anxiety,
fatigue,sy
ncope,
tar
divedyskinesi
a.CV:brady cardi
a,orthost
atic
hypotensi
on, QTcint
erv
al prolongati
on, t
achycardi
a.GI:

ᏆᖴA2022 Dr
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oralhypoesthesia,dr
ymout h,dyspepsia.Endo:
hyperglycemia,hyperpr
olact
inemia.Met ab: wei
ghtgain,
↑
appet i
te.Misc:
HYPERSENSI TIVI
TY( i
ncludinganaphyl
axis,
angioedema, hypotensi
on,tachycardia,
dy spnea,wheezi
ng,
andr ash),ANGIOEDEMA.

I
NTERACTI
ONS
Drug- Drug: Concur rentuseofQTci nterv alpr olonging
drugsi ncl udi
ngCl ass1Aant i
ar rhythmi cssuchas
quinidineandpr ocai nami deorCl ass3ant iarrhy t
hmi cs
i
ncl udingami odar oneandsot alol orot herant ipsychotics
i
ncl udingzi prasi done, chlor promazi neort hioridazineor
certainant i
bioticssuchasmoxi fl
oxaci n; may↑ r i
skof
torsadedepoi nt esand/ orsuddendeat h.Concur rentuse
shoul dbeav oided.Fl uvoxami ne, ast r
ongi nhi bitorof
CYP1A2, ↑l ev elsandr i
skoft oxicity
; usecaut iously
.
Simi l
aref fectsmayoccurwi thpar oxet ine, aCYP2D6
subst rateandi nhi bit
or.Dr ugshav i
ngsi mi l
arpr opert
ies
(subst rates/inhibi tor
sofCYP2D6)shoul dal sobeused
caut i
ousl ywi thasenapi ne.↑ r iskofCNSdepr essionwi t
h
otherCNSdepr essant sincl udingant ihist ami nes, some
antidepr essant s, sedative/ hypnot ics,andal cohol .

DOSAGE
Schi
zophr
eni
a

ᏆᖴA2022 Dr
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SL:
( Adult
s):Acutetreatment
—5mgt wi
cedai
ly
;
Maintenancetreatment—5mgt wi
cedai
l
y;may↑ t
o10
mgt wicedail
yaf t
er1wk.
Acut
eManic/
MixedEpi
sodesAssoci
atedwi
thBi
pol
arI
Di
sorder
SL:(
Adult
s) :Monotherapy—10mgt wicedail
y;maybe↓
to5mgt wicedail
yiftoler
atedpoorl
y;Adj
uncti
vether
apy
wit
hli
thi
um orvalproate—5mgt wicedail
y;maybe↑ to
10mgt wicedai
ly.

AVAI
LABI
LITY
Subl
i
ngual
tabl
ets5mg,
10mg;

PATI
ENTTEACHI
NG
Advisepati
enttotakemedi
cat
ionasdir
ectedandnot
toskipdosesordoubleuponmisseddoses.Take
misseddosesassoonasr ememberedunlessal
most
ti
mef orthenextdose.

Infor
m pat i
entofpossibi
l
ityofextrapyramidal
sympt omsandt ardiv
edyskinesia.Inst
ructpat
ientt
o
reportthesesympt omsimmedi atel
y .

Advi
sepati
entt
omakeposit
ionchangessl
owl
yto
mini
mizeort
host
ati
chy
potensi
on.

ᏆᖴA2022 Dr
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Medicati
onmaycausedrowsinessanddizzi
ness.
Cauti
onpatientt
oavoi
ddr i
vi
ngorotheracti
vi
ti
es
requi
ri
ngalert
nessunt
ilr
esponsetomedicati
onis
known.

Adv isepat ientandf amilytonot ifyheal t

hcar e
prof essional i
fthought saboutsui ci deordying,
attempt st ocommi tsuicide;neworwor sedepr ession;
neworwor seanxi ety;f
eel i
ngv eryagi tat
edorr estl
ess;
pani cattacks; troublesleeping; neworwor se
i
rritabili
ty;acti
ngaggr essive;bei ngangr yorv i
olent;
actingondanger ousimpul ses; anext remeincreasei n
activ i
tyandt alking;otherunusual changesinbehav ior
ormoodori fsignsandsy mptomsofhy persensiti
vity
react i
ons( diff
icul t
ybreat hi
ng,itchi ng,swel
lingoft he
face, tongueort hroat,feeli
nglight headed)occur .

Instr
uctpati
enttonot i
fyhealt
hcar eprofessional
of
allRxorOTCmedi cati
ons,vit
amins, orherbal
productsbeingtaken,toavoidalcohol,andtoconsul
t
healthcareprof
essionalbeforetakinganynew
medi cat
ionsandtoav oidtaki
ngal coholorotherCNS
depressantsconcurrentl
ywiththismedi cati
on.

Advi
sepati
entthatextr
emesintemper
atur
eshoul
d
beavoi
ded,becausethi
sdrugimpai
rsbody
temper
atur
eregulat
ion.

ᏆᖴA2022 Dr
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 Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Advi
sefemalepat i
entstonoti
fyheal
thcar
e
prof
essi
onalifpregnancyi
splannedorsuspect
edand
toavoi
dbreastfeedi
ngduringther
apy.

Emphasizetheimportanceofr
outi
nef
oll
ow-upexams
andcontinuedpar
ti
cipati
oninpsy
chot
herapyas
i
ndicat
ed.

Aspi
ri
n
I
NDI
CATI
ONS
I
nfl
ammat orydisordersi
ncludi
ng:
Rheumat oidart
hri
ti
s,
Ost
eoart
hrit
is.Mildtomoder at
epain.Fever
.Prophyl
axi
s
oft
ransi
entischemi catt
acksandMI .Unl
abeledUses:
Adj
uncti
vetreatmentofKawasaki di
sease.

ACTI
ON
Produceanalgesiaandr educei nfl
ammat ionandfeverby
i
nhibiti
ngtheproductionofpr ostaglandi
ns.Decreases
pl
ateletaggr
egation.Ther apeuti
cEf fect
s:Anal
gesia.
Reductionofinf
lammat i
on.Reduct ionoffever
.Decreased
i
ncidenceoftransientischemi cattacksandMI .

ᏆᖴA2022 Dr
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CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oaspi
ri
norot
her
sali
cylat
es;
Cross-sensi
ti
vi
tywi t
hot herNSAI
Dsmayexi st
(l
esswi t
hnonaspiri
nsali
cyl
ates);Bleedi
ngdisordersor
thr
ombocy t
openia;Pedi
:Mayi ncreaseri
skofRey e’s
syndromeinchil
drenoradolescentswi t
hvir
alinfect
ions.

UseCaut
iousl
yin:
Hist
oryofGIbl
eedi
ngorul
cerdi
sease;
Chr oni
cal coholuse/abuse;Sever ehepat i
corr enal
disease; OB:Sali
cy l
atesmayhav eadv erseeffectson
fetusandmot herandshoul dbeav oideddur i
ngpr egnancy
,
especiallyduri
ngt he3r dt
ri
mest er;Lactation:Safetynot
established;Geri
:↑r i
skofadver ser eacti
onsespeci al
lyGI
bleeding;mor esensitiv
etotoxi
cl ev els.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT: t
innit
us.GI: GIBLEEDING,dyspepsi
a,epigast
ri
c
distress,nausea,abdomi nalpai
n,anorexi
a,hepatot
oxici
ty,
vomi ti
ng.Hemat :anemia,hemolysi
s.Derm: r
ash,ur
ticar
ia.
Mi sc:all
ergi
cr eactionsi
ncludi
nganaphy l
axi
sand
l
ar yngealedema.

I
NTERACTI
ONS
Drug-
Drug:May↑ t her
iskofbl
eedi
ngwithwarf
ari
n,
hepar
in,hepar
in-
li
keagents,
thr
omboly
ticagent
s,

ᏆᖴA2022 Dr
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dipyri
damol e,
ti
clopi di
ne, cl
opidogr el,tirofi
ban, or
eptif
ibatide,althought heseagent saref r
equent lyused
safelyincombi nationandi nsequence.I buprofen: may
negatet hecar diopr ot
ect i
veant iplatel
etef f
ectsofl ow-
doseaspi r
in.May↑ r iskofbl eedi ngwi thcefoper azone,
cefotetan,andv al
pr oi
caci d.May↑ act ivi
tyofpeni ci l
l
ins,
pheny t
oi n,met hotrexat e,
valproicaci d, oralhypogl ycemi c
agents, andsul fonami des.Ur i
nar yaci difi
cation↑
reabsorpt i
onandmay↑ ser um sal icylatelevels.
Alkali
nizationoft heur ineort hei ngest ionofl arge
amount sofant acids↑ excr eti
onand↓ ser um sal icylat
e
l
ev el
s.Maybl untt het herapeuticr esponset odi ureticsand
ACEi nhibitors.↑ r i
skofGIi rr
itati
onwi thNSAI Ds.
Drug-
Natur
alProduct:↑ anti
coagul
anteff
ectandbleeding
ri
skwithar
nica,chamomi l
e,cl
ove,f
ever
few,garl
i
c,ginger,
gi
nkgo,Panaxginseng,andother
s.
Drug-
Food:
Foodscapabl
eofacidi
fyi
ngtheur
ine(
see
Appendi
xM)may↑ serum sal
i
cy l
atel
evel
s.

DOSAGE
Pai
n/Fev
er
PO:
Rect(Adul
ts):325–1000mgq4–6hr( nott
oexceed
4g/
day)
.Extended-r
eleaset
abl
ets—650mgq8hror800
mgq12hr .

ᏆᖴA2022 Dr
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PO:Rect(
Chil
dren2–11yr
):10–15mg/
kg/
doseq4–6hr
;
maximum dose:4g/
day.

I
nfl
ammat
ion
PO: (
Adult
s):2.4g/dayini
ti
all
y;i
ncr
easedtomaint
enance
doseof3.6–5.4g/dayindivi
deddoses(upto7.
8g/day
foracut
erheumaticfever)
.
PO:(
Chi
l
dren):60–100mg/kg/dayi
ndivi
deddoses(
upt
o
130mg/
kg/dayforacut
erheumati
cfev
er).
Pr
event
ionofTr
ansi
entI
schemi
cAt
tacks
PO:
(Adul
ts)
:50–325mgoncedai
l
y.
Pr
event
ionofMy
ocar
dial
Inf
arct
ion/
Ant
ipl
atel
etef
fect
s
PO:(
Adul
ts)
:80–325mgoncedail
ySuspect
edacut
eMI
-
160mgassoonasMIissuspect
ed.
PO:(Chi
l
dren)
:3–10mg/ kg/
daygi
venoncedai
l
y(r
ound
dosetoaconv
enientamount
).
Kawasaki
Disease
PO:(Chi
ldren):80–100mg/kg/
dayin4divi
deddosesunt
il
fev
erresol
v es;
maybef ol
l
owedbymai nt
enancedoseof
3–5mg/ kg/dayasasingl
edoseforupto8wk.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
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Tablet
s81mgOTC, 162.
5mgOTC, 325mgOTC, 500
mgOTC, 650mgOTC, 975mgOTC; Chewabl et ablets80
mgOTC, 81mgOTC; Chewinggum 227mgOTC;
Disper
sibl
et ablet
s325mgOTC, 500mgOTC; Enteri
c-
coated(delayed-r
elease)tabl
ets80mgOTC, 165mgOTC,
300mgOTC, 325mgOTC, 500mgOTC, 600mgOTC, 650
mgOTC, 975mgOTC; Extended-releasetablet s325
mgOTC, 650mgOTC, 800mg; Delay ed-
rel
easecapsul es
325mgOTC, 500mgOTC; Supposi tori
es60mgOTC, 120
mgOTC, 125mgOTC, 130mgOTC, 150mgOTC, 160
mgOTC, 195mgOTC, 200mgOTC, 300mgOTC, 320
mgOTC, 325mgOTC, 600mgOTC, 640mgOTC, 650
mgOTC, 1.2gOTC; I
ncombi nationwi t
h:antihistamines,
decongestants,coughsuppr essant sOTC, andopi oi
ds.

At
azanav
ir
I
NDI
CATI
ONS
HI
Vinf
ect
ion(
wit
hot
herant
ir
etr
ovi
ral
s).

ACTI
ON
I
nhibi
tst
heactionofHIVpr otease,prev
entingmaturat
ion
ofvi
ri
ons.Therapeut
icEff
ects: ↑ CD4cel l
countsand↓
vi
rall
oadwithsubsequentslowedpr ogressionofHI
Vand

ᏆᖴA2022 Dr
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i
tssequel
ae.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erehepat
ic
i
mpai r
ment ;Concurr
entuseofergotderi
vati
ves,
midazolam (PO),pi
mozide,t
ri
azolam,alf
uzosi
n, sil
denaf
il
(
Rev at
io),r
if
ampi n,
iri
not
ecan,l
ovastati
n,si
mv astati
n,
i
ndinavir
,orSt.John'swort
;Pedi
:↑r iskofkernicter
usin
i
nfants<3mo.

UseCaut
iousl
yin:
Mil
dtomoder
atehepat
ici
mpai
rment
;
Pre-exi
stingconduct i
onsy stem di sease( markedf i
rst-
degreeAVbl ockorsecond-ort hird-degreeAVbl ock)or
concurrentuseofot herdr ugst hatincreaset hePRi nter
val
(especial
lythosemet abolizedbyCYP3A4, i
ncluding
verapami lordil
ti
azem) ;Diabetesmel l
it
us; Hemophi li
a(↑
ri
skofbl eeding);Pedi
: Chil
dren<6y r(safetynot
establi
shed);OB: Useonl yifcl
ear lyneeded; Breastf
eeding
i
snotr ecommendedi fHIV-inf
ect ed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Whenusedi
ncombi
nat
ionwi
thot
herant
ir
etr
ovi
ral
s
CNS:headache, depression,di
zziness,i
nsomnia.CV:↑
PRint
erval
, heartblock.GI:nausea,abdominalpai
n,
↑bil
ir
ubin,choleli
thiasi
s,diarr
hea,jaundi
ce,vomit
ing,
↑

ᏆᖴA2022 Dr
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t
ransaminases.Der
m:rash.Endo:hy
pergly
cemi
a.Met
ab:
f
atredi
stri
buti
on.MS:my al
gia.Mi
sc:fev
er.

I
NTERACTI
ONS
Drug- Dr ug: Atazanav iri sani nhibitorofCYP3Aand
UGT1A1enzy mesy st ems.I tisal soasubst rateofCYP3A.
↑ bloodl evelsandr iskoft oxi cit
yf rom er gotder i
vat i
ves
(ergot ami ne, ergonov ine, dihy droer got amine,
met hy lergonov ine),mi dazol am ( PO) ,pi mozide, tri
azol am,
l
ov ast atin,simv astatin, sil
denaf il(Rev at i
o),alfuzosin, and
i
rinotecan; concur rentusei scont raindi cated.Concur rent
usewi thi ndinav i
rmay↑ r iskofhy perbi l
ir
ubinemi a;
concur rentusei scont rai
ndi cat ed.Lev elsaresi gnificantl
y
↓ byr ifampi n; maypr omot ev ir
al resi
st ance; concur rent
usei scont raindicated.Combi nationt herapywi thtenof ovi
r
mayl eadt o↓ v i
rologi cresponseandpossi bler esistance
(100mgr it
onav irshoul dbeaddedt oboostbl oodl ev els
anddoseofat azanav i
r↓ t o300mg/ day )
.Lev elsar e
significant l
y↓ byomepr azol e; donotexceedomepr azol
e
doseof20mg/ daywhenusedwi that azanav i
rand
ri
tonav irintreatment -naivepat i
ent s(shoul dbet akenat
l
east12hrbef oreat azanav irandr i
tonav ir
);shoul dnotbe
usedi nt reatment -exper i
encedpat i
ents.Concur rentuse
withdi danosi nebuf fer edt abl etswi l
l↓ absor ptionand
l
ev els; giveat azanav irwi thf ood2hrbef oreor1hraf ter

ᏆᖴA2022 Dr
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didanosi ne.Ef avi
renz↓ l ev elsandmaypr omot ev ir
al
resistance; 600mgef avir
enzshoul dbegi venwi th
atazanav ir400mg/ dayandr itonav i
r100mg/ dayt o
count er actt hisef fecti ntreat ment -naivepat ient s( should
notbeusedwi that azanav irint reat ment -exper ienced
pat i
ent s) .↑ saqui nav irl
evel s.Lev el sare↑ byr itonavir;↓
atazanav irdoset o300mg/ day .Nev ir
apinemay↓ l ev el
s
andat azanav i
rmay↑ nev irapinel evels;av oidconcur rent
use.Ant acidsorbuf feredmedi cationswi ll↓ absor pti
on;
atazanav irshoul dbegi v
en2hrbef oreor1hraf ter.↑
l
ev elsofl i
docai ne,ami odarone, orqui ni
dine; bloodl evel
moni tor ingi sr ecommended.↑ r iskofbl eedi ngwi th
war farin.↑ oft ri
cy cl
icant idepr essant s;bl oodl ev el
moni tor ingi sr ecommended.↑ l ev elsofr ifabut in;↓
ri
fabut indoseby75%( 150mgev er yot herdayor3t i
mes
weekl y) .↑ l ev el
sofdi lti
azem andi tsactiv emet abol it
e;↓
dil
tiazem doseby50%andECGmoni tori
ngr ecommended.
Simi l
arpr ecaut i
onsmaybeneededwi thfel odi pine,
nifedipine, nicardipine, andv erapami l.↑ l ev elsof
fl
ut i
casone; consideral t
ernat ivether apy ;shoul dnotbe
usedwhenat azanav irusedwi thr i
tonav ir.↓ l ev elsof
voriconazol ewhenat azanav irisusedwi thr i
tonav i
r;avoid
concur rentuse.Vor i
conazol emayal so↑ l evelsof
atazanav ir(whenusedwi thoutr i
tonav ir
).↑ l ev elsof
ketoconazol eoritraconazol ewhenat azanav i
ri susedwi t
h

ᏆᖴA2022 Dr
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ri
tonav i
r.↑ l ev elsoft razodone; ↓ doseoft r
azodone.↑
l
ev elsofsi l
denaf il,vardenaf il
,andt adal af il
;↓ sildenaf i
l
doset o25mgev ery48hr ; ↓v ardenaf ildoset o2. 5mg
ever y72hr( whenat azanav irusedwi thr itonav i
r)or2. 5mg
ever y24hr( whenat azanav irusedal one) ; ↓t adalafi
l dose
to10mgev er y72hr .Exer cisecaut ionandmoni t
orfor
hyper tension, v i
sual changes, andpr iapi sm.↑ l evelsand
ri
skofmy opat hyf rom at or vast atinorr osuv astatin(use
l
owestdoseoft heseagent sorconsi derf luvastatinor
prav astatin).Lev elsmaybe↓ byhi stami neH2
antagoni st s, promot ingv i
ral resistance; separ atedosesby
atleast10hr .↑ l ev elsofcy clospor ine, si roli
mus, and
tacrolimus; moni tori mmunosuppr essantbl oodl evels.↑
l
ev elsofcl arithromy cin; ↓ cl ar i
thromy cindoseby50%or
consi deral ter nativet her apy .May↓ l ev elsofsome
estrogensf oundi nhor monal cont racept iv es;use
alt
er nativenonhor monal met hodofcont r aception.May↑
l
ev elsofbupr enor phine; consi der↓ doseof
bupr enor phi ne.Concur rentuseofot herdr ugsknownt o↑
PRi nterv al may↑ r i
skofhear tblock.May↑ r i
skof
adv erseef fect swi thsal met erol ;
concur rentusenot
recommended.May↑ bosent anl ev els; initi
atebosent an
at62. 5mgoncedai l
yorev eryot herday ;ifpat i
entalready
receivingbosent an, discont inuebosent anatl east36hr
befor einitiationofat azanav irandt henr est artbosent anat

ᏆᖴA2022 Dr
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nHeal
thyCar
e 294
l
east10day slaterat62. 5mgoncedai l
yorev eryot herday;
donotusewi that azanav iralone(shoul dbeusedwi th
atazanav irandritonav ir
).May↑ t adal afi
l(Adcirca)levels;
i
nitiat
et adalafil
(Adci rca)at20mgoncedai l
y;ifpat i
ent
alr
eadyr eceiv i
ngt adalfi
l (Adcirca),disconti
nuet adal af
il
(Adcirca)atleast24hrbef oreinit
iati
onofat azanav i
rand
thenrest arttadalafil
(Adci rca)atleast7day slat erat20
mgoncedai ly.May↑ col chi
cinelev els;↓ doseof
colchici
ne; donotadmi nistercolchicineifpatient shave
renalorhepat i
cimpai rment .
Dr
ug-Nat
uralPr
oduct:St
.John’
swortsi
gni
fi
cant
ly↓
bl
oodlev
els;
concurr
entuseiscont
rai
ndi
cat
ed.

DOSAGE
PO: (Adul
ts):Ther apy-naive—400mgoncedai lyor300mg
oncedai l
ywi t
hr i
tonav i
r100mgoncedai ly(mustbeused
withrit
onavirinpregnancy )
;shouldbeusedatadoseof
300mgoncedai l
ywi t
hr i
tonav i
r100mgoncedai l
yifused
concomi t
antlywitht enofov i
r,H2receptorantagonist,
or
protonpumpi nhi
bitor;shouldbeusedatadoseof400mg
oncedai l
ywi t
hr i
tonav i
r100mgoncedai lyifused
concomi t
antlywithef avir
enz.Ther apy-
experienced—300
mgoncedai l
ywi thritonavir100mgoncedai l
y;shouldbe
usedatdoseof400mgoncedai l
ywit
hr i
tonav i
r100mg
oncedai l
yifusedwi thtenofov i
randaH2r eceptor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 295
antagonist;
inpregnantpati
entsin2ndor3rdtr
imester
,
shouldbeusedatadoseof400mgoncedai l
ywith
ri
tonavir100mgoncedai lyifusedwit
htenofovi
roraH2
receptorantagoni
st.
PO: (
Chi l
dren≥6y r)
: 15–19kg—150mgoncedai l
ywi t
h
ri
tonavir100mgoncedai l
y;20–39kg—200mgoncedai l
y
withri
tonav i
r100mgoncedai l
y;≥40kg—300mgonce
dail
ywi thrit
onavir100mgoncedai ly;≥13yrand≥40kg
andunabl etot ol
erater i
tonavi
r—400mgoncedai l
y;≥13y
r
and≥40kgandr eceivingconcomi tanttenof
ovir
,H2
receptorantagonists,orpr ot
onpumpi nhibi
tor
s—Needsto
beadmi nisteredwithritonavir
.

Renal
Impai
rment
PO:(Adul
ts):Ther
apy-
Nai
veandHD—300mgoncedai l
y
wit
hrit
onavi
r100mgoncedaily
;Ther
apy
-Exper
iencedand
HD—contrai
ndicat
ed.

Hepat
icI
mpai
rment
PO:(Adul
ts):Moder
atehepat
icimpai
rment
—300mgonce
dai
l
y( donotusewit
hrit
onavi
r)
.

AVAI
LABI
LITY
Capsul
es100mg,
150mg,
200mg,
300mg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 296
PATI
ENTTEACHI
NG
Emphasi zet heimpor tanceoftaki
ngatazanav irwith
foodasdi rected.Adv isepati
enttoreadthePat i
ent
Informati
onbef oretakingandwi t
heachRxr efi
ll
; may
beupdat ed.At azanavirmustalway sbeusedi n
combi nati
onwi t
hot heranti
ret
rovir
aldrugs.Donot
takemor et hanpr escribedamountanddonotst op
takingwithoutconsul tingheal
thcareprofessional.
Takemi sseddosesassoonasr emember ed, t
hen
returntoregulardoseschedul e.Ifwit
hin6hrofnext
dose, omitdoseandt akenextdoseatr egulartime.
Donotdoubl edoses.

I
nst
ructpat
ientt
hatat
azanav
irshoul
dnotbeshar
ed
wi
thother
s.

Infor
m pat i
entt hatatazanavirdoesnotcur eHI Vor
preventassoci atedoropportuni sti
cinfecti
ons.
Atazanav i
rdoesnotr educether i
skoft r
ansmi ssion
ofHIVt oot hersthroughsexual contactorblood
contami nati
on.Caut i
onpat i
entt ouseacondom and
toavoidshar i
ngneedl esordonat ingbloodtopr ev ent
spreadingtheHI Vvir
ust oother s.Advisepatientthat
atazanav i
rmaycausel i
podystrophy( r
edist
ributionor
accumul ati
onofbodyf at
)andt hel ong-t
erm effects
ofatazanav irareunknownatt hist i
me.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 297
Instr
uctpati
entt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandconsulthealthcare
professi
onalbef
oretaki
nganynewmedi cations,
especial
lySt
.John'swort;
int
eracti
onsmaybef at
al.

Maycausedizziness.Cauti
onpati
enttonoti
fyhealth
car
eprofessi
onal i
fthisoccur
sandt oav
oiddr i
vi
ng
andot
heractivi
tiesrequi
ri
ngaler
tnessunti
lresponse
tomedi
cationisknown.

Notif
yhealt
hcareprof
essi
onal
immediat
elyi
f
yell
owingofeyes,
changei
nheartr
hyt
hm,orhigh
bloodsugaroccur
.

Inf
orm pat i
entthatr
edi st
ribut
ionandaccumul at
ionof
bodyf atmayoccur ,causingcentralobesi
ty,
dorsocer v
ical
fatenlargement( buff
alohump),
peri
pher alwasti
ng,breastenlargement,and
cushingoidappearance.Thecauseandl ong-t
erm
eff
ectsar enotknown.

Inst
ructfemal esusinghormonal contr
acepti
vesto
useanal ter
nat i
venonhor monalmethodof
contracepti
on.Adv i
sepat i
enttonotif
yhealt
hcare
prof
essionalifpregnancyi spl
annedorsuspectedor
i
fbreast f
eeding.Ifpregnantpati
entisexposedto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 298
 at
azanavi
r,r
egi
sterpati
enti
nAnt i
ret
rov
iral
Pregnancy
Regi
str
ybycall
i
ng1- 800-
258-4263.

Emphasizetheimport
anceofregul
arfol
l
ow-upexams
andbloodcountstodeter
mineprogr
essandmonitor
forsi
deeffect
s.

At
enol
ol
I
ndi
cat
ions
Anginaandmyocardial
infar
cti
on;
arr
hyt
hmi
as;
hypert
ensi
on;
migraineprophyl
axi
s.

ACTI
ON
Blocksst i
mulat
ionofbet a1(my ocardial
)-
adrenergic
receptors.Doesnotusual l
yaf f
ectbet a2(
pulmonar y,
vascul ar
,ut
eri
ne)-
receptorsites.TherapeuticEffect
s:
Decr easedBPandhear trate.Decr easedfrequencyof
attacksofanginapectoris.PreventionofMI .

Av
ail
abi
l
ity
TABLETS12.
5,25,
50,
and100mg;
INJECTI
ONampoul
e5
mg/ml(10ml)
.

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 299
Or
al
Adult-50mgoncedai l
y,incr
easedi fnecessar
yto50mg
twi
cedai lyor100mgoncedai ly.Angina:50mgdaily
admi ni
steredal
oneorwithadi ureti
c,dosecanbe
i
ncreasedt o100mg( over100mghasnoadded
advantage).Mayalsobeadmi nister
edincombinat
ionwi
th
aml odipi
nebesylat
e2.5or5mg.
Chil
d-1t
o1.3mg/
kgbodywei
ghtoncedai
l
yordi
vi
ded
ever
y12h.

I
ntr
avenousi
nject
ion
2.
5mgatarateof1mg/
min,
repeatat5mi
nint
erv
alt
oa
max.10mg.

Cont
rai
ndi
cat
ions
Ast hmaorhi st
oryofobst ructiv
eai r
way sdisease( unless
noal t
ernative,thenwi t
hext remecaut ionandunder
speciali
stsuper vision);uncont rol
ledhear tfai
l
ure,
Prinzmet alangina, mar kedbr adycardi
a, hypotension,sick
si
nussy ndr ome, second-andt hir
d-degreeat r
ioventri
cular
block,cardiogenicshock; met abolicacidosis;severe
peripheralarteri
al disease; pheochromocy t
oma( unless
usedwi thal phablocker ).

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 300
Drug-Dr ug: Gener alanest hesi
a,IVpheny toin,andv er apamil
maycauseaddi t
ivemy ocardi
aldepression.Addi ti
ve
brady cardiamayoccurwi thdigoxin.Addi ti
vehy pot ension
mayoccurwi thot herant i
hypert
ensives,acut ei ngest i
onof
alcohol ,ornitrates.Concur rentusewi thamphet ami ne,
cocaine, ephedr i
ne, epinephri
ne,norepinephr ine,
pheny lephrine, orpseudoephedr i
nemayr esultin
unopposedal pha- adrenergicsti
mul ati
on( excessi ve
hypert ension,br adycar di
a).Concur r
entthy roid
admi nistrati
onmay↓ ef fecti
veness.Mayal t
ert he
effectivenessofi nsulinsoror alhypoglycemi cagent s
(dosageadj ust ment smaybenecessar y).May↓ t he
effectivenessoft heophy l
li
ne.May↓ t hebenef i
cial bet
a1-
cardiov ascularef fectsofdopami neordobut ami ne.Use
cautiousl ywithi n14day sofMAOi nhibit
ort herapy( may
resultinhy pert ension).

Pr
ecaut
ions
Avoidabruptwi thdrawal especiallyi nangina;may
preci
pitat
eorwor senhear tf ai
l
ur e;acut emy ocardi
al
i
nfarcti
on,pregnancyt hyrotoxicosi s,pheochromocy toma;
l
actati
onf i
rst-
degr eeatrioventricularblock;liverf
unction
deteri
orat
esi npor tal
hy pertension; reducedosei nrenal
i
mpai rment;diabetesmel l
i
tus( smal ldecr
easei nglucose
tol
erance,maski ngofsy mpt omsofhy poglycaemia);

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 301
hi
stor
yofhy persensit
ivi
ty(
increasedreact
iont
oal
ler
gens,
al
soreducedr esponsetoepinephrine(adr
enal
i
ne)
;
myastheni
agr avi
s;int
eract
ions.

Adv
erseEf
fect
s
Gast r
ointest i
naldist
urbances( nausea, vomi ting,di
arrhoea,
const i
pation,abdomi nalcramp) ;fatigue; coldhandsand
feet;exacer bati
onofi nt
ermi t
tentcl audicat i
onand
Ray naudphenomenon; bronchospasm; br adycardia,
hear t
fail
ure,conduct iondisorders,hypot ension; sl
eep
disturbances, i
ncludi
ngni ghtmar es; depressi on,confusion;
hypogl ycaemi aorhyperglycaemi a;exacer bationof
psor i
asis;rarereportsofrashesanddr yey es
(oculomucocut aneoussy ndrome- rev er
sibl eon
withdrawal ).

PATI
ENT TEACHI
NG
Instr
uctpati
enttot
akeat enololasdirectedatthe
samet i
meeachday,eveni ffeel
ingwell;donotskip
ordoubl euponmisseddoses.Takemi sseddosesas
soonaspossi bl
eupto8hrbef orenextdose.Abr upt
withdrawalmaycauseli
f e-t
hreateni
ngar rhy
thmias,
hypertensi
on,ormyocardiali
schemi a.

Adv
isepat
ientt
omakesur
eenoughmedi
cat
ioni
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 302
 avai
lablef orweekends,
hol
i
days,
andv
acati
ons.A
writ
tenpr escri
pti
onmaybekepti
nwal
leti
ncaseof
emer gency .

Teachpat i
entandfamil
yhowt ocheckpul
seandBP.
Inst
ructthem t
ocheckpulsedailyandBPbi
weekl
y
andtor epor
tsigni
fi
cantchanges.

Maycausedr owsinessordizzi
ness.Cauti
onpat
ient
s
toavoiddri
vi
ngorot heract
ivi
ti
esthatrequi
re
aler
tnessunti
lresponsetothedrugisknown.

Advi
sepati
entst
ochangeposi
ti
onssl
owl
yto
mini
mizeort
host
ati
chypot
ensi
on.

Cauti
onpat
ientt
hatat
enol
olmayi
ncr
easesensi
ti
vi
ty
tocol
d.

Instr
uctpatienttonoti
fyhealt
hcarepr ofessional
of
allRxorOTCmedi cati
ons,vi
tamins,orher bal
productsbeingtaken,toavoidal
cohol, andtoconsul
t
healthcareprofessi
onalbeforet
akinganynew
medi cat
ions,especi
all
ycoldpreparati
ons.

Patientswit
hdi abet
esshouldcl
oselymonit
orbl
ood
glucose,especial
lyi
fweakness,malai
se,
irr
it
abi
l
ity
,or
fati
gueoccur s.Medicat
iondoesnotbl
ocksweati
ng
asasi gnofhy pogly
cemia.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 303
 Advi
sepati
enttonot if
yheal thcareprofessi
onalif
sl
owpulse,di
ffi
cultybreathing,wheezing,coldhands
andfeet
,di
zziness,li
ght-headedness,confusion,
depr
essi
on,rash,fever,sorethroat,
unusual bl
eeding,
orbr
uisi
ngoccurs.

I
nst
ructpat
ienttoi
nfor
m healt
hcareprofessi
onal
of
medi
cati
onregimenbefor
etreatmentorsurger
y.

Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Hypertension:Reinforcet heneedt oconti

nue
additi
onaltherapiesf orhy pertension(wei
ghtl
oss,
sodium restri
cti
on,st ressr educti
on, r
egul
arexerci
se,
moder ati
onofal cohol consumpt ion,andsmoking
cessation)
.Medi cationcont r
olsbutdoesnotcur e
hypertensi
on.

At
omoxet
ine
I
NDI
CATI
ONS
At
tent
ion-
Def
ici
t/Hy
per
act
ivi
tyDi
sor
der(
ADHD)
.

ACTI
ON
Sel
ect
ivel
yinhi
bit
sthepr
esy
napt
ict
ranspor
terof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 304
norepi
nephr
ine.Ther
apeut
icEf
fect
s:I
ncr
easedat
tent
ion
span.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentorwi
thi
n
2wkt herapywi
thMAOi
nhi
bit
ors;
Angl
e-cl
osur
egl
aucoma;
Pheochromocyt
oma.

UseCaut
iousl
yin:
Hyper
tensi
on,
tachy
car
dia,
cardiovascularorcer ebr
ovasculardi sease;Pre-exist
ing
psychiatri
cill
ness;Pedi :May↑ r iskofsui ci
de
att
empt /i
deati
onespeci all
ydur i
ngdoseear lyt r
eatmentor
doseadj ustment ;
riskmaybegr eat erinchil
dr enor
adolescents;Concur r
ental
but er
ol orv asopressors(↑r i
sk
ofadv ersecardiovascularreacti
ons) ;OB: Useonl yif
benef i
tsoutweighr iskstofetus;Lact ati
on:Pedi :
Safety
notest abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SUICIDALTHOUGHTS, dizziness,fat
igue,mood
swings,behav i
oraldi
sturbances, hal l
uci
nations,mani a,
thoughtdisorder,Adult
s—i nsomni a.CV:hypertension,
orthost
atichypotension,sy ncope, tachy
cardia.GI:
dyspepsia,severeli
verinjury(rare) ,
nausea,vomi t
ing,
Adults—drymout h,constipation.Der m:rash,urti
car i
a.GU:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 305
Adul t
s—dysmenor rhea,ejacul
atoryproblems,↓l i
bido,
erecti
ledysfuncti
on, ur
inaryhesit
ati
on, uri
nar
yr etenti
on.
Met ab:↓ appetit
e, wei
ght /
growthloss.Neuro:
Adul t
s—paresthesia.Misc:all
ergi
cr eacti
onsincluding
angioneurot
icedemaandanaphy laxis.

I
NTERACTI
ONS
Drug-Drug:Concurrentusewi t
hMAOi nhibitorsmayr esult
i
nser i
ous,potenti
allyfat
alreactions( donotusewi t
hin2
wkofeachot her)
.↑ riskofcardi ovascularef f
ectswith
albut
erolorvasopressors(usecaut i
ously
) .Drugswhich
i
nhibitt
heCYP2D6enzy mepat hway( qui
ni di
ne,fl
uoxetine,
paroxet
ine)wi l
li
ncreasebloodl ev el
sandef fect
s,dose↓
recommended.

DOSAGE
PO: (
Chi l
drenandadol escents<70kg) :0.5mg/ kg/day
i
niti
ally
,maybe↑ ev ery3day stoadai l
ytargetdoseof
1.2mg/ kg, givenasasi ngl
edosei nt hemor ningorev enl
y
divi
deddosesi nt
hemor ni
ngandl ateaf t
ernoon/early
evening( nottoexceed1. 4mg/ kg/dayor100mg/ day
whichev erisless)
.IftakingconcurrentCYP2D6i nhibi
tor
(qui
nidine,fluoxet
ine,paroxet
ine)—0.5mg/ kg/dayinit
iall
y,
may↑ i fneededt o1.2mg/ kg/dayaf ter4wk.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 306
PO: (
Adults,adol
escents,andchildren>70kg) :40mg/ day
i
niti
ally
,maybe↑ ev ery3dayst oadai l
yt argetdoseof80
mg/ daygivenasasi ngledoseint hemor ningorev enl
y
divi
deddosesi nthemor ningandl ateaft
er noon/earl
y
evening;maybef urt
her↑ af t
er2–4wkupt o100mg/ day.
Ift
akingconcur r
entCYP2D6i nhibitor(
quini di
ne,fl
uoxeti
ne,
paroxeti
ne)—40mg/ dayi ni
ti
all
y,may↑ i fneededt o80
mg/ dayafter4wk.

Hepat
icI
mpai
rment
PO:(AdultsandChil
dren)
:Moder atehepat
icimpai
rment
(Chi
ld-PughClassB)
—↓ init
ialandt ar
getdoseby50%;
Severehepati
cimpair
ment(Child-PughClassC)—↓ i
nit
ial
andtargetdoseto25%ofnor mal.

AVAI
LABI
LITY
Capsul
es10mg,
18mg,
25mg,
40mg,
60mg,
80mg,
100
mg;

PATI
ENT TEACHI
NG
I
nstructpat
ientt
otakemedi cat
ionasdir
ected.Take
misseddosesassoonaspossi ble,
butshouldnot
takemor et
hanthetotaldai
l
yamounti nany24-hr
peri
od.Advisepat
ientandparentst
oreadthe
Medicati
onGuidepriort
ostarti
ngther
apyandwi th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 307
 eachRxr
efi
l
l.

I
nform pat
ientt
hatshar
ingt
hismedi
cat
ionmaybe
danger
ous.

Adv
isepati
enttonot
if
yhealt
hcareprof
essi
onal
i
mmediatel
yifsi
gnsofli
veri
njur
yoccur
.

Adv isepat ientandf amilytonot ifyhealthcare

prof essional i
fthoughtsaboutsui cideordy i
ng,
attempt st ocommi tsuicide;neworwor sedepr essi
on;
neworwor seanxiety;f
eel i
ngv eryagi t
atedorr estl
ess;
pani cattacks; tr
oublesleeping; neworwor se
i
rri
t abili
ty;acti
ngaggr essive;bei ngangr yorviolent;
actingondanger ousimpul ses; anext r
emei ncreasei n
activ i
tyandt alki
ng;otherunusual changesinbehav ior
ormoodoccur .

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advi
sefemal
epatient
stonot
ifyheal
thcar
e
pr
ofessi
onal
ifpr
egnancyi
splannedorsuspect
edor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 308
 i
ftheyar
ebr
east
feedi
ng.

Pedi
:Advi
separ
ent
stonot
if
yschool
nur
seof
medi
cati
onregi
men.

At
orv
ast
ati
n
I
ndi
cat
ions
Pri
mar yandsecondaryhyperchol
est
erol
emia,pr
event
ion
ofcerebrovascul
aracci
dents,pr
imar
yprevent
ionof
coronaryheartdi
sease.

ACTI
ON
Inhibits3- hy droxy-3-
met hy l
glutaryl
-coenzymeA( HMG- CoA)
reduct ase, anenzy mewhi chi sresponsibleforcatalyzi
ng
anear lyst epint hesy nthesisofchol esterol
.Therapeutic
Effect s: Lower ingoft ot
al andLDLchol esteroland
tri
glycer ides.Sl ightl
yincreasesHDLchol est
er ol
.
Reduct ionofl ipids/cholesterolreducest heriskof
my ocar di al i
nfarcti
onandst rokesequel ae.Slowst he
progr essi onofcor onaryat herosclerosi
swi t
hr esult
ant
decr easei ncor onaryhear tdisease–r el
atedev ents.

Av
ail
abi
l
ity
TABLETS5,
10,
20,
40and80mg.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 309
DOSAGE
Or
al
Adul
t-10mgdai
l
y,i
ncr
easedat4weeksi
nter
val
.Max
dose80mg.

Cont
rai
ndi
cat
ions
Hypersensit
ivi
ty;
acti
veli
verdi
seasesorunexpl
ained
per
sistentelev
ationofser
um t
ransaminase;
pregnancy
l
actati
on.

I
NTERACTI
ONS
Drug-Drug: Met aboli
zedbyt hehepat icCYP3A4enzy me
system.Chol esterol
-l
ower i
ngef fectmaybeaddi t
ivewit
h
bi
leaci dsequest r
ants( cholestyrami ne,colestipol)
.
Bioavailabil
itymaybe↓ bybi l
eaci dsequest r
ant s.↑ ri
sk
ofmy opat hywi thconcur rentuseof cyclosporine,
gemf i
br ozi
l,erythromy cin,clar
ithr omy cin,
ri
tonavir/saquinav i
r,l
opi navir/
ritonav i
rl
argedosesof
ni
acin,andazol eant i
fungal s(combi nedusewi th
gemf i
br ozi
l notrecommended; tempor arydiscont i
nuati
on
ofatorv astati
nr ecommendeddur ingazol eantifungals)
.
Maysl ightly↑ ser um digoxi nlev els.May↑ l ev el
soforal
contraceptives.May↑ ef fectsofwar fari
n.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 310
Drug-Food:Grapefr
uitj
uice↑ l
evel
sandr
iskof
rhabdomy ol
ysis.

Pr
ecaut
ions
Pati
entswhoconsumesubst anti
alquanti
ti
esofal
cohol
andhaveahistoryofl
iverdi
seases,Chi
ldr
enbelow10
year
s,premenarcheal
females;i
nter
acti
ons.

Adv
erseEf
fect
s
My opat
hyistheseriousadv erseef f
ect;headache;
i
nfrequentel
evati
onofcr eatininephosphokinase;
rhabdomyoly
sis;i
nsomni a;dizziness;abdominalpai
n,
consti
pati
on,diar
rhoea,dyspepsi a,fl
atul
enceandnausea.

PATI
ENTTEACHI
NG
Instr
uctpati
enttotakemedicati
onexact l
yasdir
ected,
nottoskipdosesordoubleuponmi sseddoses.
Adv i
sepati
enttoavoiddri
nkingmor et hanonequart
ofgrapefr
uitj
uiceperdayduringtherapy .Medi
cati
on
helpscontr
olbutdoesnotcur eel
ev atedserum
cholest
eroll
evels.

Adv i
sepatientthatthi
smedicationshoul
dbeusedin
conjuncti
onwi t
hdi etr
estr
ict
ions(fat
,chol
est
erol
,
carbohydrates,
alcohol)
,exer
cise,andcessat
ionof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 311
 smoki
ng.

I
nstructpati
enttonotif
yhealt
hcar eprof
essi
onalif
unexplai
nedmuscl epain,
tenderness,
orweakness
occurs,especi
all
yifaccompaniedbyfeverormalai
se.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Emphasizet
heimportanceoffol
l
ow-
upexamsto
deter
mineef
fect
ivenessandtomoni
torf
orsi
de
eff
ects.

Inst
ructfemalepati
entstonotif
yheal
thcare
prof
essionalpromptl
yifpregnancyi
splannedor
suspected,ori
fbreast
feeding.

St
orage
Storepr
otect
edfr
om moi
stur
eatat
empr
etur
enot
exceedi
ng30⁰C.

At
ovaquone
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 312
I
NDI
CATI
ONS
Treat
mentofmi l
dtomoder atePneumocy st
isji
rov
ecii
pneumonia(PJP)inpat
ientswhoar eunabletotol
erat
e
tr
imethopr
im/sul
famethoxazole.Pr
ophylaxi
sofPJP.

ACTI
ON
Inhi
bitstheact
ionofenzymesnecessar
ytonuclei
caci
d
andATPsy nt
hesi
s.Therapeut
icEf
fect
s:Act
iveagai
nstP.
j
irovecii
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Lact
ati
on:
May
appeari
nbr
eastmi
l
k.

UseCaut
iousl
yin:
↓ hepat
ic,
renal
,orcar
diacf
unct
ion
(dosemodi f
icat
ionmaybenecessar
y);GIdi
sorder
s
(absorpt
ionmaybel i
mi t
ed);
OB:
Safetynotest
abli
shed;
Pedi:Safet
ynotestabl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,i
nsomni
a.Resp:
cough.GI
:di
arr
hea,
nausea,vomiti
ng.Derm:
rash.Mi
sc:f
ever.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 313
Drug-Drug:Mayinter
actwit
hdrugsthatar
ehighl
ybound
toplasmapr ot
eins(doesnotappeart
oint
eractwi
th
phenytoin)
.
Dr
ug-
Food:
Food↑ absor
pti
on.

DOSAGE
Tr
eat
ment
PO:
(Adul
ts)
:750mgt
wicedai
l
yfor21day
s.
PO:
(Chi
l
dren)
:40mg/
kg/
day(
unl
abel
ed)
.

Pr
event
ion
PO:(Adul
tsandAdol
escent
s13–16y
r):
1500mgonce
dai
l
y.

AVAI
LABI
LITY
Suspensi
on750mg/
5mL;
Incombi
nat
ionwi
th:
proguani
l
(Malar
one).

PATI
ENTTEACHI
NG
I
nstructpatienttot akeatovaquoneexactl
yas
dir
ectedaroundt hecl ockfortheful
lcourseof
ther
apy ,ev
eni ffeelingbett
er.Emphasizethe
i
mpor tanceoft akingatovaquonewithfood,especi
all
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 314
 foodshi
ghinfat
;takingwi
thoutfoodmaydecr
ease
plasmaconcent
rati
onsandeffecti
veness.

Advisepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if
rashoccur
s.

At
racur
ium Besy
lat
e
I
ndi
cat
ions
Usedadjunct
ivel
yinanaest
hesiatof
aci
l
itateendotracheal
i
ntubati
onandt oprov
ideskel
etal
muscl
er elaxat
ionduring
surger
yormechanicalvent
il
ati
on.

ACTI
ON
Preventneur
omusculart
ransmissionbyblockingthe
eff
ectofacetyl
chol
ineatthemy oneur
aljunct
ion.Hav eno
anal
gesicoranxiol
yti
cproper
ti
es.Therapeuti
cEf f
ects:
Skel
etalmuscleparal
ysi
s.

Av
ail
abi
l
ity
I
NJECTI
ON2.
5and5ml
ampoul
e(10mg/ml
).

DOSAGE
I
ntr
avenousi
nject
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 315
Adultandchildover1mont h-Sur
geryori
ntubat
ion:
300to
600µg/ kgbodywei ght,
mai nt
enanceby100to200µgas
requi
red.Int
ensiv
ecar e:300to600µg/kgbodyweight
.

I
ntr
avenousi
nfusi
on
Adul
tandchil
d-5t
o10µg/
kgbodywei
ght
/mi
n(300t
o
600µg/kg/
h).

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
ty.

I
NTERACTI
ONS
Drug-Dr ug:Intensityanddur ationofpar alysismaybe
prolongedbypr etr
eatmentwi thsucci nylcholine,gener al
anesthesi a(inhalation),ami nogl ycosi des, vancomy cin,
tetr
acy cli
nes, polymy xinB, colisti
n, clindamy cin,lidocaine,
andot herl ocal anesthetics,li
thium, qui nidi
ne,
procainami de, beta-adrenergicbl ocki ngagent s,pot assium
-l
osingdi uretics,ormagnesi um.Ef fect sofci sat racurium
maybeenhancedbyconcur rentenf luraneori soflurane
(dosager equi rement smaybedecr easedby30–40%;
smal l
erbol usesandl oweri nf usionr at esmaybe
necessar y).Hi gherinfusionr atesmayber equi r
edand
durationofact ionmaybeshor tenedi npat ientsr eceiving
l
ong- t
er m carbamazepi neorpheny t oin.Rocur onium

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 316
associ
atedwit
hQTcinterval
prolongat
ionwhen
admini
steredwi
thgeneral
anesthesia.

Pr
ecaut
ions
All
ergiccross-reacti
vit
ybet weenneur omuscul arblocki
ng
agentshasbeenr eported;cautioni sadv i
sedi ncasesof
hypersensiti
vit
y.Theiractivi
tyispr olongedi npat ientswit
h
my astheniagravisandi nhypothermi a,therefor elower
dosesar erequired.Nondepol ari
singmuscl er elaxants
shouldbeusedwi t
hgr eatcareinthosewi thot her
neuromuscul ardisordersandt hosewi t
hf l
uidand
el
ect r
olytedist
urbances, asresponsei sunpr edictable.
Resistancemaydev elopin
pati
ent
swithburnswhomayr equi
reincr
easeddoses;l
ow
pl
asmacholinester
aseact
ivi
tyinthesepati
ent
srequir
es
doseti
tr
ati
onf or
mivacuri
um, renalorhepat i
cdy sfunction,severelectr
olyt
e
di
sturbance,smoki ng,pregnancyl actati
on,peripheral
neuropathy,
demy el
inati
nglesions, denervati
ons.
Neonates,severeCVSdi sorder,severeelectr
olyte
i
mbal ance,r
espiratoryinsuffi
ciencyorpul monar ydisease.

Adv
erseEf
fect
s
Ski
nfl
ushi
ng;
hypot
ensi
on,
tachy
car
dia;
bronchospasm

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 317
andv er
yrarel
y;anaphylactoidreactions,acut
emy opat
hy
havealsobeenr eport
edaf terprolongedusei nint
ensi
ve
care;pr
olongedmuscul oskeletalblock,wheezingor
bronchi
alsecret
ion,erythema, dyspnoea.

PATI
ENTTEACHI
NG
Expl
ainallprocedurestopati
entrecei
ving
neuromuscularblockerther
apywithoutgener
al
anesthesi
a,becauseconsciousnessisnotaff
ect
edby
neuromuscularblocki
ngagentsalone.

Reassur
epati
entt
hatcommunicat
ionabi
l
iti
eswi
l
l
ret
urnasthemedi
cati
onwear
sof f
.

St
orage
St
orepr
otect
edf
rom l
i
ghti
nsi
ngl
edosecont
ainer
s.

At
ropi
ne
I
ndi
cat
ions
Organophosphateandcarbamatepoi
soni
ng;
premedicat
ion;ant
ispasmodi
c;asmydri
ati
c;cy
clopl
egi
c
refr
act
ionprocedures.

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 318
Inhibitstheact ionofacet ylchol i
neatpost ganglionicsites
l
ocat edin: Smoot hmuscl e, Secretoryglands, CNS
(antimuscar ini
cact ivi
ty).Lowdosesdecr ease: Sweat i
ng,
Salivat i
on, Respiratorysecr et i
ons.Intermediatedoses
resul tin:My dri
asis( pupill
arydi lat
ion),Cycloplegia(lossof
visual accommodat ion),Incr easedhear trate.GIandGU
tractmot il
ityaredecr easedatl argerdoses.Ther apeuti
c
Effect s:Increasedhear tr ate.Decr easedGIandr espi r
ator
y
secr etions.Rev ersalofmuscar ini
cef fect
s.Mayhav ea
spasmol y t
icactionont hebi liar
yandgeni touri
narytracts.

Av
ail
abi
l
ity
I
NJECTI
ON1ml
ampoul
esand50ml
vial
(0.
6mg/
ml)
.

DOSAGE
I
ntr
amuscul
arandi
ntr
avenousi
nject
ion
Adult-1.8-3.0mgi ntravenousbol usfol
lowedbydoubling
doseev ery3t o5mi nutesdependi nguponresponse.End-
pointforatropini
zat
ioni ncl
udeclearchestwithnowheeze,
systoli
cBP>80mm Hg, pulse>80beat s/min.
,pupil
sno
l
ongerpi npointanddryaxi l
lae.Fol
lowingthatinf
usi
onof
atropi
neat10- 20%oft otalini
ti
aldoserequir
ed/hour;
may
requir
ebol usesduri
ngi nfusion.
Chi
l
d-20-
30µg/
kgi
nit
ial
l
ywi
thsameschedul
easabov
e.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 319
Cont
rai
ndi
cat
ions
I
nmy astheniagravis(butmaybeusedt odecr ease
muscarini
cside-effectsofanti
chol
inesterases),paral
yti
c
i
leus,py
lori
cst enosisandprostat
icenlargement ;refl
ux
oesophagit
is;unstablecardi
acrhyt
hm.

I
NTERACTI
ONS
Drug-Drug:↑ ant icholi
ner gi
cef f
ectswi thot her
anti
cholinergics,incl
udingant ihi
stami nes,tricy
cli
c
anti
depressant s,quinidine,anddisopy rami de.
Anti
cholinergicsmayal tertheabsor ptionofot herorall
y
administereddr ugsbysl owingmot ilityoft heGItract.
Antacids↓ absor pti
onofant i
choliner gics.May↑ GI
mucosal l
esionsi npatientstakingor alpotassium chlori
de
tabl
ets.Mayal terresponset obet a-blocker s.

Pr
ecaut
ions
El
derl
y,Downsy ndrome;angl
e-closuregl
aucoma;
myastheni
agravis;pr
ostat
icenlargement
;pyrexi
a;
l
actat
ionint
eracti
onspregnancy.

Adv
erseEf
fect
s
Consti
pati
on,tr
ansientbr
adycardi
a(f
oll
owedby
tachy
cardi
a,palpi
tati
onandarrhyt
hmias)
,reduced

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 320
bronchi al
secretions,
uri
naryurgencyandr etent
ion,
dil
atationofthepupi l
swithlossofaccommodat ion,
photophobi a,drymouth,fl
ushinganddrynessoft heskin.
Occasi onall
y,confusi
on(parti
cularl
yint
heel der
ly),nausea,
vomi t
ingandgi ddiness;
veryrarely
,angl
e-closur
e
glaucomamayoccur .

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakeasdi
rect
ed.Takemissed
dosesassoonasr emember
edunlessalmostti
mef
or
nextdose.Donotdoubl
edoses.

Maycausedr owsiness.Cautionpati
ent
stoavoi
d
driv
ingorotheracti
vi
tiesrequir
ingal
ert
nessunt
il
responsetomedicationisknown.

Inst
ructpat
ientthator
alri
nses,
sugar
lessgum or
candy ,
andfrequentor
alhygi
enemayhelprel
i
ev edr
y
mout h.

Cauti
onpati
entsthatat
ropi
nei
mpairsheatr
egul
ati
on.
Str
enuousacti
vi
tyinahotenvi
ronmentmaycause
heatst
roke.

Inst
ructpati
enttoconsul
theal
thcar
eprofessional
beforetaki
nganyOTCmedi cat
ionsorher
bal product
s
concurrent
lywit
hatropi
ne.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 321
 Pedi
:Instr
uctparent
sorcaregiv
ersthatmedicat
ion
maycausef everandtonot
ifyheal
thcare
prof
essionalbef
oreadmini
steri
ngtoaf ebr
il
echil
d.

Geri:
Infor
m mal epati
entswi
thbeni
gnprostati
c
hyperpl
asiathatatr
opinemaycauseuri
naryhesit
ancy
andretent
ion.Changesinuri
nar
ystream shoul
dbe
report
edtohealthcareprof
essi
onal
.

At
tapul
git
e
I
NDI
CATI
ONS
Adj
uncti
nthesymptomati
cmanagementofmi
l
dto
moderat
eacut
ediar
rhea.

ACTI
ON
Appear
stoactbyadsorbingbact
eriaandtoxi
nsand
decr
easi
nglossofwater.Ther
apeuticEf
fect
s:Decr
eased
numberandwatercont
entofstools.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
catedi
n:Hyper
sensi
ti
vi
ty;Sever
edehydrati
on;
Di
arr
heathatmaybecausedbyparasit
es;Dy
sentery
.

UseCaut
iousl
yin:
Pedi
:Ger
i:Chi
l
dren<3y
rorger
iat
ri
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 322
pat
ient
shav
eincr
easedr
iskofdehy
drat
ion.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI
:const
ipat
ion.

I
NTERACTI
ONS
Drug-
Drug:Maydecr
easethegast r
oint
estinal
absorpti
on
ofconcur
rentl
yadmini
ster
edoralmedi cat
ions(admini
ster
2–3hrbeforeor2–4hrafterat
tapulgi
te).

DOSAGE
PO:(Adul
ts):
1.2–3gaf
tereachl
oosest
ool
(nott
o
exceed9g/24hr).
PO:(
Childr
en6–12yr)
:600–1500mgaf
tereachl
oose
st
ool(nott
oexceed4.
5g/ 24hr
).
PO: (
Chil
dren3–6yr
):300–750mgaf
tereachl
oosest
ool
(nottoexceed2.
25g/24hr).

AVAI
LABI
LITY
Oral
suspensi
on600mg/ 15mLOTC,750mg/
5mLOTC,
900mg/15mLOTC; Tabl
ets630mgOTC;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 323
 Inst
ructpat
ienttonotif
yhealt
hcarepr
ofessional
if
diar
rheapersi
stslongerthan48hrori
ffeveror
abdominalpaindevelops.

Advi
sepat
ientorparentnott
ouseatt
apulgit
eandto
not
if
yheal
thcareprofessi
onali
fst
oolcontai
nsbl
ood
ormucusorisaccompaniedbyfev
er.

Aur
anof
in
I
NDI
CATI
ONS
Treat
mentofprogressi
ver
heumat
oidar
thr
it
isr
esi
stantt
o
convent
ional
ther
apy .

ACTI
ON
I
nhibit
sinfl
ammat or yprocess.Modifi
esimmuner esponse
(i
mmunomodul at
ingpr operti
es).Ther
apeut
icEf
fects:
Reli
efofpainandi nflammat i
on.Slowi
ngofthedisease
processinrheumat oidart
hrit
is.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Prev
iousgol
d
toxici
ty(
e.g.anaphyl
axi
s,necroti
zi
ngenterocol
it
is,
pulmonaryfibr
osis,
exfol
iati
vedermati
ti
s,bonemar row
aplasi
a,hematologi
cdisorders)
;OB:Potenti
alf
or

ᏆᖴA2022 Dr
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thyCar
e 324
congeni
tal
anomal
ies;
Lactat
ion:Appear
sinbr
eastmi
l
k.
Useformul
aordi
sconti
nueauranofi
n.

UseCaut
iousl
yin:
Hist
oryofbl
ooddy
scr
asi
as;
Rashes;
Severehepat
icorr
enaldy
sfunct
ion;
Infl
ammatorybowel
di
sease;Pati
ent
staki
ngotheri
mmunosuppressantdr
ugs;
Pedi:
Effi
cacyandsaf
etynotest
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: peripheralneuropat hy .EENT: conj unct i
viti
s, corneal
golddeposi ti
on.GU: proteinuri
a, hemat uria.Resp:
bronchiti
s,pulmonar yf ibrosis,pneumoni tis.CV:
bradycardia.GI:GIBLEEDI NG,abdomi nal pain, crampi ng,
diarr
hea, gi
ngiv i
ti
s,glossitis,met al
li
ct aste, stomat i
ti
s,
anorexia,diff
icult
yswal l
owi ng,↑l iverenzy mes,
dyspepsia, f
latul
ence, nausea, v omiting.Der m: dermat it
is,
rash,alopecia,urti
caria,phot osensiti
v i
tyr eactions,
pruri
tus.Hemat :AGRANULOCYTOSI S, APLASTI CANEMI A,
thrombocy topenia,anemi a,eosinophi l
ia,leukopeni a.Misc:
all
ergicreactions,includinganaphy l
axi s,ANGI OEDEMA.

I
NTERACTI
ONS
Drug-Drug: Bonemar rowtoxici
tymaybeadditivewit
h
othermy elosuppressiveagents(ant
ineopl
ast
ics,r
adiat
ion
therapy
, azathiopr
ine)orhighdosesofcorti
coster
oids.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 325
Concurr
entusewit
hpeni
cil
lamine↑ t
heri
skofadver
se
hematol
ogicorr
enalr
eact
ions.May↑ bl
oodlev
elsof
phenyt
oin.

DOSAGE
PO:
(Adult
s):
6mg/ dayi
n1–2doses;
may↑ to9mg/
day
i
n3divi
deddosesi
fnoimpr
ovementaft
er6mo.

AVAI
LABI
LITY
Capsul
es3mg;

PATI
ENTTEACHI
NG
Inst
ructpat
ienttot
akemedicati
onexactl
yasdir
ected;
donotskipordoubledoses.Takemisseddoseas
soonaspossi bl
eexcepti
fnextdoseisal
mostdue.

Concur renttherapywi t
hsalicyl
atesorotherNSAIDs
orcor t
icosteroi
dsisusual l
ynecessary,especial
ly
duringthef i
rstfewmont hsofgol dt
herapy.Pati
ents
shouldcont inuephy si
caltherapyandensure
adequat erest.Explainthatj
ointdamagewi llnotbe
reversed;thegoal i
st osloworst opthedisease
process.

Emphasizetheimpor
tanceofgoodor
alhy
gienet
o
reducestomati
ti
s.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 326
 Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

I
nst ructpati
entt orepor tsympt omsofleukopenia
(fever,sor
et hroat,signsofi nfect
ion)
;
thrombocy topenia( bleedinggums; brui
sing;
petechiae;bloodi nst ools,uri
ne,oremesis);orgol
d
toxicit
yimmedi at
ely.Di arr
heamayber esolv
edby
decr easi
ngt hedose.

Emphasizetheimpor t
anceofregularvisi
tst
oheal
th
careprof
essionaltomonitorpr
ogressandev al
uat
e
bloodandurinetestsforsi
deeffects.

Discusstheneedforcontr
acept
ionwhilerecei
vi
ng
thi
smedi cati
on.Adv
isefemalepati
ent
st onoti
fy
healt
hcar eprof
essi
onalpromptl
yifpr
egnancyis
suspected.

AUROTHI
OGLUCOSE
I
NDI
CATI
ONS
Treat
mentofprogressi
ver
heumat
oidar
thr
it
isr
esi
stantt
o
convent
ional
ther
apy .

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 327
I
nhibit
sinfl
ammat or yprocess.Modifi
esimmuner esponse
(i
mmunomodul at
ingpr operti
es).Ther
apeut
icEf
fects:
Reli
efofpainandi nflammat i
on.Slowi
ngofthedisease
processinrheumat oidart
hrit
is.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erehepat
icor
renaldysfunct
ion;Previ
ousheav ymet alt
oxici
ty;Hi
stor
yof
coli
ti
sorexf ol
iati
vedermatit
is;Uncontrol
leddiabet
es
melli
tus;Tuberculosi
s;HF;Systemiclupuser y
thematosus;
Recentradiati
ontherapy;Debil
i
tatedpat i
ents;Pr
egnancy
orlactat
ion.

UseCaut
iousl
yin:
Hist
oryofbl
ooddy
scr
asi
as;
Hy
per
tensi
on;
Rashes.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness,headache,neur opathy,syncope.EENT:
corneal golddepositi
on,corneal ulcerat
ions.Resp:
pneumoni ti
s.CV: br
adycardia.GI:abdomi nalpain,
crampi ng,diarr
hea,metall
ict aste,stomatit
is,anorexi
a,
di
f f
icultyswallowing,dr
ug-inducedhepat i
ti
s,dyspepsia,
fl
atulence, nausea,vomit
ing.Der m: dermatiti
s,rash,
phot osensiti
vit
yreacti
ons,pr uri
tus.Hemat :
AGRANULOCYTOSI S,APLASTI CANEMI A,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 328
thrombocyt openia,
eosi
nophi
li
a,l
eukopeni
a.Mi
sc:al
l
ergi
c
reacti
ons,includi
nganaphyl
axi
s,ANGIONEUROTICEDEMA,
nit
rit
oidreactions.

I
NTERACTI
ONS
Drug-Drug:Bonemar r
owt oxi
cit
ymaybeaddi t
ivewith
othermy el
osuppressi
veagents(ant
ineoplasti
cs,radi
ati
on
therapy
).Concurrentusewithpeni
cil
lamineincreasesthe
ri
skofadv ersehematologi
correnalreacti
ons.

DOSAGE
I
M:(Adul
ts):10mg1stwk, t
hen25mg2ndand3rdwks,
t
hen25–50mg/ wkunti
li
mpr ov
ementort
oxi
cit
yoccur
s
(
upto1gt ot
al)
.Maint
enancedosei
s25–50mgq2wk
f
orupto20wk, t
henq3–4wk.
IM:(
Chil
dren6–12y r)
:2.5mg1stweek, t
hen6.25mg2nd
and3rdwks,then12.5mgweekl yunt
ilatotal
of200–250
mghasbeengi ven.Maintenancedoseis6.25–12.
5mgq
3–4wk.

AVAI
LABI
LITY
Suspensi
onf
ori
nject
ion50mg/
mL;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 329
Discussneedforcont
inuedtherapy.I
nit
ial
l
y,
i
njecti
onsaregivenweekly
.Laterinj
ecti
onsar
e
spaced3–4wkapar t.

I
nfor
m patientthatarthral
giamayoccurf oradayor
t
woaf t
erthef i
rstfewi nj
ecti
ons.Increasein
r
heumaticsy mptomsi susual l
ytransientandmildbut
maybesev ereandr equiredisconti
nuat i
onoftherapy
.

Concurrenttherapywi t
hsalicyl
atesorotherNSAIDs
orcort
icosteroi
dsisusual l
ynecessary,especial
ly
duri
ngthef i
rstfewmont hsofgol dt
herapy.Pati
ents
shoul
dcont inuephy si
caltherapyandensure
adequaterest.Explainthatj
ointdamagewi llnotbe
rev
ersed;thegoal i
st osloworst opdiseaseprocess.

Emphasizetheimpor
tanceofgoodor
alhy
gienet
o
reducestomati
ti
s.

Cautionpati
enttousesunscr eenandpr ot
ecti
ve
cl
othingtopreventphotosensiti
vi
tyreacti
ons.
Chrysiasi
s(bl
ue-graypi
gment ati
on)mayoccur ,
especiall
yonphotoexposedar eas.

I
nst ructpati
entt orepor tsympt omsofleukopeni
a
(fever,sor
et hroat,signsofi nfect
ion)
;
thrombocy topenia( bleedinggums; brui
sing;
petechiae;bloodi nst ools,uri
ne,oremesis);
orgol
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 330
 toxi
cit
yimmedi
atel
y.Di
arr
heamayber
esol
vedby
decreasi
ngt
hedose.

Discusstheneedforcontr
acept
ionwhilereceiv
ing
thi
smedi cat
ion.Adv
isepati
enttonoti
fyhealthcar
e
professi
onalprompt
lyifpr
egnancyissuspected.

Emphasizetheimpor t
anceofregularvisi
tst
oheal
th
careprof
essionaltomonitorpr
ogressandev al
uat
e
bloodandurinetestsforsi
deeffects.

AZACI
TIDI
NE
I
NDI
CATI
ONS
Myelodyspl
asti
csyndr
omesincl
udi
ng:someref
ract
ory
anemias,chr
onicmyel
omonocyt
icl
eukemia.

ACTI
ON
I
nhi
bit
sDNSsy nt
hesi
s.Ther
apeuti
cEff
ects:Deat
hof
r
api
dlyrepl
i
cat
ingcel
l
s,part
icul
arl
ymali
gnantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Adv
ancedmal
i
gnant
hepati
ctumor
s;OB:Pot
ent
ialforcongenit
alanomal
i
es;
Lactat
ion:
Pot
enti
alf
orser
ioussideeffect
sininf
ant
s.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 331
UseCaut
iousl
yin:
Renal
impai
rment
;Li
verdi
sease;
OB:
Pati
ent
swithchi
l
d-beari
ngpot
enti
al(maleandfemale)
duetopot
enti
alf
etalhar
m;Pedi:
Safetynotest
abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: fati
gue.GI :HEPATOTOXI CITY, const i
pati
on,diarr
hea,
nausea, vomiting.GU:nephrotoxi
city,renaltubular
aci
dosi s.Derm: acutefebri
leneutrophili
cder matosis,
ecchy mosis.FandE: hypokal
emi a.Hemat :anemia,
neut r
openia,thrombocy t
openia.Local: i
njecti
onsite
erythema.Mi sc: al
l
ergicreact
ionsincludinganaphy laxi
s,
fever.

I
NTERACTI
ONS
Dr
ug-
Drug:Addi
ti
vebonemarr
owdepr
essi
onmayoccur
wi
thot
heranti
neopl
ast
ics.

DOSAGE
SubcutIV:(Adult
s):75mg/ m2/dayf
or7day sev
ery4wk;
maybe↑ t o100mg/ m2/ dayfor7daysevery4wki fno
benefi
cial
ef f
ectoccursafter2cycl
es.Cont
inueforas
l
ongaspat ientbenefi
ts.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
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nHeal
thyCar
e 332
Suspensi
onf
ori
nject
ion(
requi
resr
econst
it
uti
on)100
mg/vial
;

PATI
ENTTEACHI
NG
Instr
uctpat i
entt onot if
yheal t
hcar eprofessional
prompt lyiffev er
;chi lls;cough; hoarseness;sor e
throat;signsofi nf ection; l
owerbackorsi depai n;
painfulordi ffi
cultur ination; bleedinggums; brui
sing;
petechiae; bloodi nst ool s,urine,oremesi s;increased
fati
gue; dy spnea; oror t
host atichypotensionoccur s.
Caut i
onpat i
entt oav oidcr owdsandper sonswi th
knowni nfections.I nstructpat ientt ousesof t
toothbrushandel ectr i
cr azorandt oav oidfall
s.
Caut i
onpat i
entnott odr inkal cohol i
cbev er
agesor
takemedi cationcont ainingaspi r
inorNSAI Ds; may
precipi
tat egast r
icbl eedi ng.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advisepat
ientt
onoti
fyhealt
hcareprofessi
onal
if
theyhaveunder
lyi
ngl
iverorrenal
disease.

Advi
sebothmaleandfemalepat
ient
soft
heneedf
or
cont
racept
iondur
ingt
herapy.

ᏆᖴA2022 Dr
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thyCar
e 333
Azat
hiopr
ine
I
ndi
cat
ions
Topreventr
eject
ioni
nt r
ansplantreci
pients;r
heumatoi
d
art
hri
ti
s;i
nfl
ammat or
ybowel disease;Multipl
escl
erosi
s;
autoi
mmunehepat i
ti
s;atopi
cder mati
ti
s( AD).

I
NDI
CATI
ONS
Preventi
onofr enaltr
ansplantr ej
ecti
on( wi
th
corti
coster
oids,localr
adiation,orothercyt
otoxicagents).
Treatmentofsev ere,
acti
v e,erosiverheumatoi
dar thri
ti
s
unresponsi
vet omor econv entionalt
herapy.Unlabeled
Uses:ManagementofCr ohn’ sdiseaseorulcerati
vecolit
is.

AVAI
LABI
LITY
Tabl
ets50mg,
75mg,
100mg;
Inj
ect
ion100mg/
vial
;

DOSAGE
Renal
All
ogr
aftRej
ect
ionPr
event
ion
PO:
IV:(Adul
tsandChi
ldr
en)
:3–5mg/
kg/
dayi
nit
ial
l
y;
mai
ntenancedose1–3mg/kg/
day
.

Rheumat
oidAr
thr
it
is

ᏆᖴA2022 Dr
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thyCar
e 334
PO:(Adult
sandChildr
en):
1mg/ kg/dayfor6–8wk,↑ by
0.
5mg/ kg/dayq4wkunt i
lresponseorupto2.5
mg/kg/day,then↓ by0.
5mg/ kg/dayq4–8wkt o
mini
mal eff
ectiv
edose.
I
nfl
ammat or
yBowel Disease(Crohn'
sDi
seaseor
Ul
cerat
iveCol
it
is)(
unlabeleduse)
PO:
( Adul
tsandChi
ldr
en)
:50mgoncedail
y;may↑ by25
mg/dayevery1–2wkastol
erat
edt
otar
getdoseof2–3
mg/kg/day.

Cont
rai
ndi
cat
ions
Hyper
sensit
ivi
tyt
oazat
hiopr
ineandmer
capt
opur
ine;
l
actat
ion.

I
NTERACTI
ONS
Drug-
Dr ug:Additivemy el
osuppressionwith
anti
neoplastics,cyclosporine,andmy el
osuppressi
ve
agents.All
opur i
nol i
nhibitsthemet abol
ism ofazat
hiopr
ine,
i
ncreasingtoxicity.Doseofazat hi
opri
neshouldbe↓ t o
25–33%oft heusual dosewhenusedwi thall
opuri
nol.
May↓ ant ibodyr esponset ol
ive-v
irusvacci
nesand↑ t he
ri
skofadv ersereact ions.
Drug-
Natural
Product:
Concommit
antusewi
thechinacea
andmelatoni
nmayi nt
erf
erewi
thi
mmunosuppression.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 335
Pr
ecaut
ions
Moni t
orfort
oxicitythr
oughouttreatment;f
ull
blood
countsnecessaryev er
yweek( ormor efr
equentlywi t
h
higherdosesandi nrenalorhepati
cimpairment)f orfi
rst4
weeksoft r
eatmentandatl eastev er
y3mont hst hereaft
er;
reducedoseinel der
ly;r
enalimpairment;
li
verdisease
i
nt er
acti
onslactati
onpr egnancy.
Pati
ent
sshoul
dbewar nedtorepor
timmediatel
yany
si
gnsorsymptomsofbonemar rowsuppr
ession,f
or
exampl
eunexplai
nedbrui
singorbl
eedi
ng,i
nfecti
on.

Adv
erseEf
fect
s
Hy persensiti
v it
yreact ionsincludingmal aise,dizzi
ness,
vomi t
ing,fev er,muscul arpai
ns, arthralgia;rash;
hypotensionori nterstiti
alnephr it
iscall fori
mmedi ate
withdrawal; haemat ologicalt
oxi cit
yincl udesleukopenia
andt hrombocy topeni a( r
eversibleuponwi thdrawal);l
iver
i
mpai rment ,chol estaticjaundice; hai
rloss; increased
suscept i
bil
ityt oinfect i
onsandcol iti
sinpat ientsalso
receivingcor ti
coster oids;nausea; rarel
y ,pancreatit
is,
pneumoni tis, hepaticv enoocclusi vedisease;
microcy st
osi s.

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
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thyCar
e 336
I
nst r
uctpat ienttotakeazat hiopri
neasdi r
ected.I
fa
dosei smi ssedonaonce- dai l
yregimen,omitdose;i
f
onsev eral-t
imes- a-
daydosi ng,takeassoonas
possibleordoubl enextdose.Consul thealt
hcar e
professional i
fmor ethan1dosei smissedorif
vomi t
ingoccur sshor t
lyafterdosei staken.Donot
disconti
nuewi thoutconsultinghealthcare
professional.

Advi
sepat i
enttorepor
tunusualti
rednessor
weakness;coughorhoarseness;feverorchil
l
s;lower
backorsidepain;pai
nful
ordiff
iculturi
nati
on;sever
e
di
arrhea;bl
ack,t
arryst
ools;bl
oodi nurine;
or
tr
ansplantr
eject
iontohealt
hcarepr ofessi
onal
i
mmedi atel
y.

Reinf
orcetheneedforl
i
fel
ongt
her
apyt
opr
event
tr
ansplantr
eject
ion.

Instr
uctpati
enttonot i
fyheal
thcar eprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orher bal
productsbeingtakenandconsul thealt
hcar e
professi
onalbeforetaki
nganynewmedi cationsor
receivi
nganyv acci
nati
onswhi l
et aki
ngthis
medi cat
ion.

Adv
isepat
ientt
oav
oidcont
actwi
thper
sonswi
th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 337
 contagi
ousdi
seasesandpersonswhohaverecent
ly
takenoral
pol
iov
irusvacci
neorotherl
i
vev
iruses.

Thi
sdr ugmayhaveterat
ogeni
cproper
ti
es.Advi
se
pat
ienttousecontr
acept
iondur
ingandforatl
east4
moaf t
erther
apyiscomplet
ed.

Emphasi
zet
hei
mpor
tanceoff
oll
ow-
upexamsand
l
abtest
s.

Rheumat oidArthri
ti
s:Concurrentther
apywith
sal
icyl
ates,NSAI Ds,orcort
icoster
oidsmaybe
necessary.Pati
entshouldcont i
nuephy si
calt
herapy
andadequat erest.Expl
ainthatjoi
ntdamagewi llnot
bereversed;goal i
stosloworst opdiseaseprocess.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Azel
ast
ine
I
NDI
CATI
ONS
Seasonalall
ergi
crhini
ti
s(Ast
eli
nandAstepro)
.Perenni
al
all
ergi
crhinit
is(
Asteproonl
y).Managementofvasomotor
rhi
niti
s(Astel
inonl
y).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 338
ACTI
ON
Local
lyantagonizest
heeffect
sofhi stamineatH- r
eceptor
si
tes;doesnotbi ndt
oorinacti
vatehistamine.Therapeuti
c
Eff
ects:Decreasedsneezi
ng,nasalrhini
ti
s,pruri
tusand
post-
nasaldrip.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
OB:
Lact
ati
on:
Saf
etynotest
abl
i
shed;
Pedi
:Saf
etynotest
abl
i
shedi
nchi
l
dren<5y
r(Ast
eli
n)or
<12yr(
Astepr
o).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:drowsiness,dizzi
ness,dysesthesia,
fati
gue,
headache.EENT:epi st
axi
s,nasal bur
ning,phary
ngiti
s,
si
nusit
is,sneezi
ng.GI :
bit
tertaste,dr
ymout h,nausea.
Metab:weightgain.MS: myalgia.

I
NTERACTI
ONS
Drug-Drug:
Addit
iveCNSdepr essionwithCNS
depressant
s,i
ncludi
ngalcohol,sedat
ive/hy
pnoti
cs,and
opioi
danalgesi
cs.Concurr
entuseofci metidi
ne↑ blood
l
evels.

ᏆᖴA2022 Dr
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thyCar
e 339
Drug-Nat
ural
Product:Concomi
tantuseofkav
a,valer
ian,
skul
lcap,
chamomi l
e,orhopscan↑ CNSdepression.

DOSAGE
Seasonal
All
ergi
cRhi
nit
is
Intr
anasal:(
AdultsandChil
dren≥12yr):Astel
i
n—1–2
sprays/nostr
ilt
wicedai
ly;
Astepro—1–2spr ays/nost
ri
l
twicedail
yof0.1%or0.15%sol ut
ion;
0.15%sol uti
onmay
alsobegi v
enas2spr ays/
nostri
loncedaily
.
I
ntr
anasal
:(Chi
l
dren5–11y
r):
Ast
eli
n—1spr
ay/
nost
ri
l
t
wicedail
y.

Per
enni
alAl
l
ergi
cRhi
nit
is
Int
ranasal:(
Adult
sandChil
dren≥12yr
):Ast
epr
o—2
sprays/nost
ril
twicedai
l
yof0.15%sol
uti
on.

Vasomot
orRhi
nit
is
Int
ranasal:(
Adult
sandChil
dren≥12y
r):
Ast
eli
n—2
sprays/nost
ril
twicedai
l
y.

AVAI
LABI
LITY
Nasalspray(Ast
eli
n)137mcg/spr
ay(
200spray
s/bot
tl
e);
Nasalspray(Ast
epro)0.
1%(137mcg/
spray
),0.
15%(205.
5
mcg/spray);

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 340
PATI
ENTTEACHI
NG
Instr
uctpati
enti
nthepr opert
echni
quef or
admi ni
str
ati
onofazelasti
ne.Keepheadt i
l
ted
downwar dtowar
dy ourtoesduri
nginsti
ll
ati
onof
i
nt r
anasalspr
aytodecreasebitt
ertast
e.

Maycausedrowsiness.Cauti
onpati
entt
oavoid
dr
ivi
ngorotheracti
vit
iesr
equiri
ngal
ert
nessunt
il
ef
fect
softhemedi cati
onareknown.

Advi
sepati
entt
oavoidt
akingal
coholorot
herCNS
depr
essant
sconcur
rent
lywit
hthi
sdrug.

Advisepatientthatgoodoralhy
giene,fr
equentr
insi
ng
ofthemout h,andsugarlessgum orcandymayhel p
rel
i
ev edrymout h.Pati
entshoul
dnot i
fydenti
sti
fdry
mout hpersist
s>2wk.

I
nstr
uctpati
enttoconsul
theal
thcarepr
ofessi
onal
bef
oretaki
ngotherRx.OTC,orher
balpr
oducts.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Inst
ructpat
ientt
ocont
actheal
thcar
epr
ofessi
onal
if
symptomsper si
st.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 341
AZFI
CEL-
T
I
NDI
CATI
ONS
Toimprov
et heappearanceofmoder
atet
osev
ere
wri
nkl
esinthenasolabialf
old

ACTI
ON
UnknownTher
apeut
icEf
fect
s:Decr
easednasol
abi
alf
old
wri
nkles

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Pr
evi
oushy
per
sensi
ti
vi
tyt
oazf
icel
-
THypersensi
ti
vit
ytoamphoter
icin,
dimethy
lsul
foxi
de
(DMSO) ,
gentamici
normateri
alsofbovi
neori
ginAcut
e
l
ocalskininf
ecti
on(maycausespr eadofl
ocali
nfect
ion
orsyst
emi ci
nfecti
on)

UseCaut
iousl
yin:
Genet
icdi
sor
der
saf
fect
ingder
mal
fi
broblast
sorf romati
onofnormal col
lagenmat rices
(abnormalresponsesmayoccur )
Immunosuppr essed
pati
ents,pati
entsundergoi
ngchemot herapyor
i
mmunomodul aryt
herapy(
incr
easedr i
skofi nf
ect i
onand
decreasedheal i
ng)
Concurr
entuseofant i
coagulants
(i
ncreasedriskofbleedi
ng)OB:Useinpr egnancyonlyif

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 342
cl
earl
yneededPedi
:Saf
eandef
fect
iveusei
nchi
l
drenhas
notbeenest
abli
shed

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Local:ery
thema, br
uisi
ng,edema, bl
eeding,der
matit
is,
i
rri
tati
on,nodules,papul
es,prur
itus,
redness,
kel
oid/hypert
rophicscarr
ing.Misc:HYPERSENSI TI
VITY
REACTI ONSINCLUDI NGANALPHYAXI S, basal
cell
cancer
,
herpeslabial
i
s,vasculi
ti
s.

I
NTERACTI
ONS
Drug-
Drug:Concurr
entuseonanti
neoplasti
ces,
i
mmunosuppr essantsandi
mmunomodul at
ors↑ r
iskof
i
nfecti
onandpoorheal i
ngConcur
rentuseof
anti
coagul
ants↑ riskofbl
eedi
ng

DOSAGE
Int
radermal(Adul
ts):
0.1mL/l inearcent
imeteri
nto
nasolabi
alfol
dwrinkl
es.Courseisthreet
reat
ment
sessions(upto2mL/ sessi
on)at3–6weeki nter
val
s

AVAI
LABI
LITY
Suspensi
onfori
ntr
adermalinj
ecti
on18mil
li
onautol
ogous
fi
brobl
ast
s/1.
2ml suf
fi
cienttodel
iver1mLofpr
oduct;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 343
AZI
LSARTAN
I
NDI
CATI
ONS
Tr
eat
mentofhy
per
tensi
on,
aloneorwi
thot
heragent
s.

ACTI
ON
Bl
ocksv asoconstr
ictorandaldost
erone-
producingeffect
s
ofangiotensi
nIIatreceptorsi
tes,
incl
udi
ngv ascular
smoothmuscl eandt headrenalgl
ands.Therapeutic
Eff
ects:LoweringofBP.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:OB:
Cancausei
njur
yordeat
hof
f
etus;
Lact
ati
on:
Discont
inuedr
ugorpr
ovi
def
ormul
a.

UseCaut
iousl
yin:
Blackpat
ient
s(maynotbeef
fect
ive)
;
HF( mayr esul
ti npot enti
all
yli
fe-
threateningr enal fai
lure)
;
Renal i
mpai r
ment ; maywor senrenal function; Volumeor
saltdepleti
on,includinguseofhi gh-doseorpot ent
diuret
icsmay↑ r iskofser i
oushy potension; cor r
ectprior
touse; Womanofchi ldbear
ingpotential;Geri:Mayhav e
greatersensit
ivity
, especial
lyt
oadv erser enal effects;Pedi:
Safetyandef fecti
v enesshasnotbeenest ablished.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 344
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness,fat
igue,weakness.CV:hy
potension.Fand
E:hyperkalemia.GI:di
arrhea,
nausea.GU:i
mpairedr enal
funct
ion.MS: muscl espasm.

I
NTERACTI
ONS
Drug-Drug:NSAI Dsandselecti
veCOX-2inhibit
orsmay
bl
untt heantihyper
tensiv
eeffectand↑ ther i
skofrenal
dysfuncti
on.↑ ant i
hypert
ensiv
eeffectwit
hot her
anti
hypertensiv
esordi ur
eti
cs.

DOSAGE
PO:(Adul
ts):80mgoncedail
y,i
nit
ial
dosemaybe↓ t
o
40mgoncedai lyi
fhi
ghdosesofdiur
eti
csar
eused
concur
rent
ly.

AVAI
LABI
LITY
Tabl
ets40mg,
80mg;
Incombi
nat
ionwi
th:
chl
ort
hal
i
done

PATI
ENTTEACHI
NG
Emphasi
zet heimportanceofcontinui
ngtotakeas
di
rect
ed,eveniffeel
i
ngwel l
.Takemisseddosesas
soonasremember edifnotal mostbef
orenextdose;
donotdoubledoses.Medi cati
oncontr
olsbutdoes

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 345
 notcurehy pertensi
on.Instr
uctpat
ienttotake
medicati
onatt hesamet imeeachday .Warnpat
ient
nottodiscont i
nuetherapyunlessdir
ectedbyhealt
h
car
epr ofessional.

Encour agepatienttocompl ywithaddit

ional
i
ntervent i
onsforhy pertensi
on( weightreduct
ion,
low-
sodium di et
,smokingcessat i
on,moder ati
onof
al
cohol consumption, r
egularexercise,
andstress
management ).Medi cationcontrol
sbutdoesnotcur e
hypertension.

I
nstr
uctpat
ientandfamil
yonpr opertechni
quefor
monit
ori
ngBP.Adv i
sethem tocheckBPatl east
weekl
yandtoreportsi
gnif
icantchanges.

Cautionpati
enttoav oi
dsuddenposi ti
onchangesto
decreaseorthostat
ichypotension.Useofal
cohol,
standingf
orl ongperi
ods,exercisi
ng,andhotweather
may↑ or thostati
chypotension.

Maycausedizziness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

Instr
uctpati
entt
onotifyheal
thcarepr
ofessional
of
allRxorOTCmedi cat
ions,vi
tami
ns,orherbal
productsbei
ngtakenandt oavoi
dconcurr
entuseof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 346
 Rx,OTC, andherbalproducts,especi
all
yNSAIDsand
cough,cold,orall
ergymedications,wi
thout
consul
tinghealthcareprofessional
.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Emphasi
zethei
mpor t
anceoff
oll
ow-upexamst
o
eval
uat
eeff
ecti
venessofmedi
cati
on.

Advisewomenofchi l
dbeari
ngagetouse
contracepti
onandnot i
fyheal
thcareprofessional
if
pregnancyisplannedorsuspected,ori
f
breastfeedi
ng.Azi
lsar
tanshouldbediscontinuedas
soonaspossi blewhenpregnancyisdetected

Azi
thr
omy
cin
I
ndi
cat
ions
Treatmentoft hef ollowinginfecti
onsduet osusceptibl
e
organisms: Upperr espirator
yt r
actinfections, i
ncludi
ng
streptococcalphary ngit
is,acutebact er
ial exacerbati
onsof
chronicbronchiti
sandt onsill
it
is,Lowerr espi r
atorytr
act
i
nfect i
ons,incl
udingbr onchiti
sandpneumoni a,Acute
oti
t i
smedi a,Ski
nandski nstr
uctureinfect ions,
Nongonococcal urethrit
is,cervi
citi
s,gonor rhea,and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 347
chancr oid.Pr event
ionofdi sseminatedMy cobact
erium
avi
um compl ex( MAC)infectioninpat i
entswi t
hadv anced
HIVinf ecti
on.Ext ended-rel
easesuspensi on(ZMax)Acut e
bacterialsinusitisandcommuni ty-
acquiredpneumoni ain
adults.Unl abeledUses: Preventi
onofbact eri
al
endocar ditis.Treatmentofcy sti
cfibrosislungdisease.

ACTI
ON
Inhi bitsproteinsy nthesi
satt hel evel oft he50Sbact eri
al
ribosome.Ther apeut i
cEf f
ect s: Bacter i
ost aticaction
agai nstsuscept i
blebact eria.Spect rum: Act iveagainstthe
fol l
owi nggr am- posi ti
veaer obi cbact eria: Staphylococcus
aur eus, Streptococcuspneumoni ae,S.py ogenes( groupA
str ep).Act i
veagai nstthesegr am- negat iv eaerobic
bact eri
a: Haemophi l
usinfluenzae, Mor axel lacatarrhali
s,
Nei sseriagonor r
hoeae.Al soact iveagai nst:My coplasma,
Legi onell
a,Chl amy diapneumoni ae,Ur eapl asma
ur eal y
ticum, Bor reli
abur gdor feri,M.av ium.Notact iv
e
agai nstmet hicill
in-resi
stantS.aur eus.

Av
ail
abi
l
ity
TABLETS100,250and500mg;CAPSULES250and500
mg;INJECTI
ON500mg/ vi
alDRySy
RUP100,200mg/5ml.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 348
DOSAGE
Or
al
Adult
-500mgoncedail
yfor3daysor500mgonf
ir
stday
then250mgoncedai
lyfor4days.
Chil
d-ov
er6mont
hs:
10mg/
kgbodywei
ghtoncedai
l
yfor
thr
eedays.
Bodywei
ght15t
o20kg:200mgoncedai
l
yfor3day
s;
bodywei
ght26t
o35kg:
300mgdailyf
or3days.
Uncomplicat
edgenitalchl
amy
diai
nfect
ionandnon-
gonococcali
nfect
ion:500mgoncedail
yfor7days.

Cont
rai
ndi
cat
ions
Hepat
ici
mpai
rmenthy
per
sensi
ti
vi
tyt
oer
ythr
omy
cin.

I
NTERACTI
ONS
Drug-Drug: Alumi num-andmagnesi um- cont aining
antacids↓ peakl evels.Nelfi
navi
r↑ levels( moni t
or
carefull
y);azithromy cinal so↓ nel
fi
navirlevel s.Efavi
renz
↑l evels.May↑ t heef fectsandri
skoft oxicityofwar fari
n
andzi dovudine.Ot hermacr oli
deanti
-i
nfectiv eshav ebeen
knownt o↑ lev elsandef fect
sofdigoxin,theophy lli
ne,
ergotami ne,dihydr oergotamine,t
ri
azolam, car bamazepi ne,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 349
cy
clospori
ne,t
acrol
imus,andpheny
toi
n;car
eful
monit
oringofconcur
rentusei
srecommended.

Pr
ecaut
ions
Pr
egnancyandlact
ati
onrenali
mpair
ment,prol
ongat
ionof
QTint
ervali
nter
acti
onsexacer
bat
ionofsymptomsof
myast
heniagrav
is;
impai
redhepat
icfunct
ion.

Adv
erseEf
fect
s
Fewergast r
ointesti
nal effectsascompar edt o
erythromy ci
n,alsoanor exia,dyspepsia,constipation;
dizziness,headache, drowsiness;phot osensiti
vit
y ;
hepat i
ti
s, i
nter
st i
ti
alnephr iti
s,acuterenal fail
ure,asthenia,
paraesthesia,conv ulsionsandmi ldneut r
openiar eported;
rarely,t
innit
us,hepat icnecr osi
s,hepat i
cf ail
ureandt aste
disturbances;flatul
ence, somnol ence, angioedema;
eczema, pharyngiti
s;ar t
halgia,conjuncti
viti
s.

PATI
ENTTEACHI
NG
I
nstructpat
ientstotakemedicationasdirectedand
tofi
nishthedrugcompl et
ely,ev
eni ft
heyar efeel
ing
bett
er.Takemisseddosesassoonaspossi ble
unl
essalmostt i
mef ornextdose; donotdouble
doses.Advisepati
entsthatshari
ngoft hi
smedi cati
on
maybedanger ous.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 350
Inst
ructpat
ientnott
otakeazi
thr
omy
cinwi
thf
oodor
antaci
ds.

Maycausedr owsi
nessanddizziness.Caut
ionpati
ent
toavoiddri
vingorotheracti
vi
tiesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

Advi
sepati
enttousesunscreenandprot
ectiv
e
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

Adv i
sepat ienttoreportsymptomsofchestpai n,
palpit
ations, y
ell
owingofski noreyes,orsignsof
super i
nfection(bl
ack,furryover
growthont hetongue;
vaginalitchingordischarge;l
ooseorfoul-smell
ing
stools)orr ash.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv isepatientnottotreat
diarr
heawithoutadvi
ceofheal t
hcar eprofessional.

Advi
sepati
entsbei
ngtreat
edf ornongonococcal
ur
ethr
it
isorcerv
ici
ti
sthatsexualpart
nersshouldal
so
betr
eated.

Inst
ructparent
s,car
egi
ver
s,orpat
ientt
onoti
fyheal
th
careprofessi
onali
fsympt
omsdonoti mpr
ove.

Pedi
:Tel
lpar
ent
sorcar
egi
ver
sthatmedi
cat
ioni
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 351
 general
lywel
ltol
eratedi
nchil
dren.Mostcommon
si
deef f
ectsi
nchil
drenaremilddiarr
heaandrash.
Tell
parentst
onotifyheal
thcarepracti
ti
oneri
fthese
occur.

St
orage
St
orepr
otect
edf
rom moi
stur
e.

Azt
reonam
I
NDI
CATI
ONS
Treatmentofser iousgram- negativei nfectionsincluding:
Septi
cemi a, Skinandski nstructurei nfections,Intra-
abdomi nalinfections,Gynecologi cinfections, Respirator
y
tr
actinfections, Uri
narytractinfecti
ons.Usef ulfor
tr
eatmentofmul ti-
resi
stantstrainsofsomebact eri
a
i
ncludingaer obicgr am-negativepat hogens.I nhaln:To
i
mpr over espiratorysympt omsi ncy st i
cfibr osi
s( CF)
pati
entswi thPseudomonasaer uginosa.

ACTI
ON
Bindstothebacteri
alcellwal
lmembr ane,causingcell
death.Therapeut
icEffect
s:Bact
eri
cidalactionagainst
suscepti
blebacter
ia.Spectr
um:Displayssignif
icant

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 352
acti
vit
yagai nstgram- negat i
veaerobicorganismsonl y
:
Escherichiacoli
,Serratia,Klebsi
ell
aoxy t
ocaor
pneumoni ae,Citr
obact er,Proteusmirabil
is,Pseudomonas
aerugi
nosa, Enterobact er
,Haemophi lusinfl
uenzae.Not
acti
veagai nst:St
aphy lococcusaur eus,Enterococcus,
Bacteroidesfragi
lis,
St reptococci
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Renal
impai
rment(
dosage↓ r
equi
red
i
fCCr30mL/ minorl ess) ;Cross- sensi
tivit
ywi thpeni ci
ll
ins
orcephal osporinsmayoccurr arely.Hasbeenusedsaf ely
i
npat ientswi t
hahi st
oryofpeni cil
li
norcephal ospor i
n
al
lergy ;Pati
entswi thFEV1<25%or>75%pr edicted,or
patientscolonizedwi thBur kholder i
acepaci a( safetyand
eff
ect ivenessnotest ablished) ;OB: Lactation:Saf etynot
established;Pedi :
Children<7y r(inhal
ation)or<9mo
(i
njection)(safetyandef f ecti
venessnotest ablished);Geri
:
Consi derage-related↓ i nr enal functi
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:SEI ZURES.EENT:nasalcongest
ion(inhalat
ion)
,
nasophar y
ngealpai
n(i
nhalat
ion).CV:chestdiscomfort
(i
nhalat
ion).GI
:PSEUDOMEMBRANOUSCOLI TIS,

ᏆᖴA2022 Dr
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abdominalpain(i
nhalat
ion),al
teredtast e,
diarr
hea, nausea,
vomiti
ng.Resp:cough(inhalati
on),wheezi ng(i
nhal at
ion),
bronchospasm (
inhal
ati
on) .Derm: r
ash.Local :painatI M
si
te,phlebi
ti
satIVsit
e.Mi sc:all
ergi
cr eactionsincluding
anaphylaxi
s,f
ever(i
nhalati
on),superinfecti
on.

I
NTERACTI
ONS
Dr
ug-Drug:Ser
um l
evel
smaybe↑ byf
urosemi
deor
pr
obenecid.

DOSAGE
I
M: IV:(Adult
s):Moderatel
ysevereinfecti
ons—1–2gq
8–12hr ;sever
eorlif
e-t
hreat
eninginfecti
ons(i
ncl
udi
ng
thoseduet oPseudomonasaer ugi
nosa) —2gq6–8
hr;
urinar
ytracti
nfect
ions—0.5–1gq8–12hr .
I
V:(Chil
dren9mo–16y r
):Mi
ldtomoder
ateinfect
ions
i
nfecti
ons—30mg/ kgq8hr;
moderat
etosev er
e
i
nfecti
onsinf
ect
ions—30mg/kgq6–8hr;cy
st i
c
f
ibrosi
s—50mg/ kgq6–8hr.
I
nhal
n:(
Adult
sandChi
l
dren>7y
r):
75mgt
hreet
imesdai
l
y
f
or28days.

Renal
Impai
rment
I
V:(
Adul
ts)
:CCr10–30mL/
min—1–2gi
nit
ial
l
y,t
hen50%

ᏆᖴA2022 Dr
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nHeal
thyCar
e 354
ofusualdosageatusuali
nter
val
;CCr<10mL/ min—500
mg-2giniti
all
y,t
hen25%ofusualdosageatusualint
erv
al
(1/
8ofiniti
aldoseshoul
dalsobegiv
enaftereach
hemodialy
sissessi
on).

AVAI
LABI
LITY
Inj
ecti
on500mg/ vial
,1g/vi
al,
2gv i
al;Pr
emi xed
contai
ners1g/50mL, 2g/50mL; Lyphil
i
zedpowderf or
usewithdil
uentprovi
dedinAlt
eraNebulizerSy st
em onl
y
(Cayst
on)75mg/ vial
wit
h1mLampul eofdiluent(0.
17%
sodium chl
ori
de)
;

PATI
ENTTEACHI
NG
Advi
sepat
ientt
oreportthesignsofsuperinf
ect
ion
(f
urr
yover
growthonthet ongue,vagi
nali
tchi
ngor
di
schar
ge,l
ooseorfoul-
smel l
ingstool
s)andall
ergy
.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Advisepat
ientt
onoti
fyheal
thcar
eprof
essi
onali
f
neworwor seni
ngsy
mpt omsorsi
gnsofanaphy
laxi
s
occur.

ᏆᖴA2022 Dr
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thyCar
e 355
 Inhal n: I
nst r
uctpat i
enttouseazt reonam asdi rected
fort hef ull
28–daycour se,ev eni ffeel
ingbett er.I
fa
dosei smi ssed, t
akeal l
3dai lydoses, aslongas
dosesar eatleast4hr sapar t.Ski ppi
ngdosesornot
compl etingfullcourseoft herapymaydecr ease
effect ivenessandi ncreasel i
kelihoodofbact eri
al
resist ancenott reat
ablei nthef uture.Inform pat i
ent
oft hei mpor t
anceofusi ngabr onchodi l
atorpr i
orto
treatmentandi nuseandcl eaningornebul i
zer .

BACI
TRACI
N
I
NDI
CATI
ONS
IM:Treatmentofinfant
swi thpneumoni aandempyema
causedbysuscept i
bleStaphylococci
.Topical
:Opht
h
Treatmentoflocal
izedinfecti
onsduet osuscept
ibl
e
organisms.

ACTI
ON
Inhibi
tsbact
eri
al cel
lwal l
synthesi
sbypreventi
ngtransf
er
ofmucopept i
desi nt
ogr owingcell
wall
.Therapeut
ic
Effect
s:Bacter
icidalacti
on.Spectr
um:Notableforacti
vi
ty
against:
Staphylococci,
Strept
ococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 356
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Renal
impai
rment
.

UseCaut
iousl
yin:
Dehy
drat
ion;
OB:
Lact
ati
on:
Saf
etyand
ef
fect
ivenessunknown.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm:rash.GI
:PSEUDOMEMBRANOUSCOLI TIS,nausea,
vomit
ing.GU:r
enalfai
l
ure.Local
:pai
nati
nject
ionsite.

I
NTERACTI
ONS
Drug-
Drug:
↑inci
denceofnephrot
oxici
tywi
thot
her
nephr
otoxi
cdr
ugs;av
oidconcur
rentuse.

DOSAGE
Topi
cal
:(Adul
tsandChi
l
dren)
:Appl
y1–5t
imesdai
l
y.
I
M: (I
nfant
s>2.
5kg)
:1000uni
ts/
kg/
dayi
n2–3di
vi
ded
doses.
I
M: (I
nfant
s≤2.
5kg)
:900uni
ts/
kg/
dayi
n2–3di
vi
ded
doses.

AVAI
LABI
LITY
Powderforinj
ect
ion(
forr
econst
it
uti
on)50,
000uni
ts/
vial
;
Topi
caloint
ment500unit
s/g;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 357
PATI
ENT TEACHI
NG
I
nstructpat
ientt
ouseonl
yasl
ongaspr
escr
ibed;
pr
olongedusemaycauseover
growt
hofr
esi
stant
or
ganisms.

Cautionpatienttonot
ifyhealthcareprofessionalif
feveranddiarrheaoccur,especi
all
yifstoolcont ai
ns
blood,pus,ormucus.Adv isepati
entnott otreat
diarr
heawithoutconsulti
ngheal t
hcarepr ofessional
.
Mayoccurupt oseveralweeksaf t
erdiscontinuation
ofmedi cat
ion.

Topi
cal:
Advisepati
entt
oonlyforuseonmi norcut
s
orbur
ns.Donotuseonani malbi
tes,punct
ure
wounds,ser
iousbur
ns,ordeepcuts.

I
nfor
m pat
ientt
hattopi
cal
for
m maycausecont
act
der
mati
ti
sorpruri
tus.

Bacl
ofen
I
NDI
CATI
ONS
PO:Treatmentofreversi
blespastici
tyduetomultipl
e
scl
erosisorspi
nalcordlesions.I
TTr eatmentofsevere
spasti
cit
yofcerebralorspi
nal or
igin(shoul
dbereserved

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 358
forpati
entswhodonotrespondorar eintoler
anttoor
al
baclof
en)(shoul
dwaitatleastoneyearinpatientswi
th
traumati
cbraini
njur
ybeforeconsi
deringtherapy).
Unlabel
edUses:Managementofpai nintrigeminal
neural
gia.

ACTI
ON
I
nhibit
sr ef
lexesatthespi
nal l
evel
.Ther
apeut
icEf
fect
s:
Decreasedmuscl espasti
cit
y;bowelandbl
adderf
uncti
on
mayal sobei mprov
ed.

Av
ail
abi
l
ity
TABLETS10and25mg;I
NJECTI
ONS20ml
ampoul
e(50
µg/ml
).

DOSAGE
Or
al
Adul
t-5-
10mgt
hri
cedai
l
yto25mgt
hri
cedai
l
yMax.100
mgdaily
.
Chi
l
d-0.
75-
2.0mg/
kgdai
l
y.

I
ntr
athecal
Adult
:Scr
eeningdose:50µgadmi
nist
eredi
ntoi
ntrat
hecal
spacebybarbotageov
ernotl
esst
han1mi nut
e,observ
e

ᏆᖴA2022 Dr
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nHeal
thyCar
e 359
for4-8hour s.Increasedoseby25µgnotmor eof tenevery
24hour sunt i
l appropr
iat
er esponseisobt ai
nedora
maxi mum doseof100µgi sachi ev
ed.Nonr esponder sto
100µgdosear enotsuit
ableforint
rathecalbacl ofen
therapy.Forresponder swithresponsel asti
ng>8- 12hours
thescreeningdosecanbegi venas24houri nfusion,if
responselast ed≤8- 12hour sthenadoseequi valentto
twicethescr eeningdosei sgivenas24houri nfusion.
Chil
d-Si
mil
artothatofadultexceptt
hatt
hescr
eeni
ng
dosetobestar
tedini
ti
all
yis25µg.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
ty;
act
ivepept
icul
cerdi
sease.

I
NTERACTI
ONS
Drug-Drug:↑ CNSdepr essi
onwi t
hotherCNSdepr essant
s
i
ncludingalcohol,
anti
histamines,opi
oidanalgesi
cs,and
sedative/
hypnoti
cs.Usewi thMAOi nhibi
tor
smayl eadt o
↑ CNSdepr essi
onorhy pot
ension.
Drug-
Natur
alPr
oduct
:Concomi
tantuseofkava-
kav
a,
val
eri
an,
orchamomil
ecan↑ CNSdepr essi
on.

Pr
ecaut
ions
Cer
ebr
ovascul
ardi
sor
der
;epi
l
epsy
;sev
erepsy
chot
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 360
di
sorder
;respi
rat
orydepr
ession;
hepat
icorr
enal
i
mpairment;el
derl
y;pr
egnancyavoi
dsuddenwit
hdr
awal
;
i
nter
acti
ons.

Adv
erseEf
fect
s
Drowsiness; mentalconf usion;weakness;at
axia;r
isein
serum transaminases, suddenwi thdrawalaf
terchronic
usemaycausehal l
ucinations;tachycardi
aandseizures,
respi
ratoryorcardiovascul ardepression.

PATI
ENT TEACHI
NG
Instructpatientt
ot akebaclof enasdi r
ected.Takea
mi sseddosewi t
hin1hr ;donotdoubl edoses.
Caut ionpatientt
oav oidabr uptwithdrawal ofthi
s
medi cationbecausei tmaypr ecipi
tateanacut e
withdr awalreact
ion( hal
luci
nat i
ons,increased
spast ici
ty,
seizur
es, ment al
changes, restlessness).
Discont i
nuebaclofengr aduallyover2wkormor e.

Maycausedi zzi
nessanddrowsiness.Advi
sepati
ent
toavoiddri
vingorotheract
ivi
ti
esrequi
ri
ngaler
tness
unti
lresponsetodrugisknown.

I
nstr
uctpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 361
 Advi
sepat
ientt
oav oi
dconcur
rentuseofal
coholor
ot
herCNSdepressant
swhilet
akingthi
smedicat
ion.

Instr
uctpatientt
onot i
fyhealt
hcareprofessi
onalif
frequenturgetourinateorpainf
uluri
nat
ion,
constipati
on,nausea,headache,i
nsomnia,ti
nni
tus,
depression,orconfusi
onpersist
s.

Advisepati
enttorepor
tsignsandsymptomsof
hypersensi
ti
vi
ty(r
ash,i
tching)pr
omptl
y.

ITCaut i
onpat i
entandcar egi
vernottodiscontinueI T
therapyabr uptly
.Mayr esulti
nfever,
ment al st
at us
changes, exagger at
edr eboundspasti
cit
y, andmuscl e
ri
gidit
y.Adv isepat i
entnottomissschedul edref i
ll
appointment sandt onot if
yhealt
hcarepr ofessional
prompt l
yifsi gnsofwi t
hdrawaloccur.

Bar
ium Sul
phat
e
I
ndi
cat
ions
Radi
ogr
aphi
cexami
nat
ionoft
hegast
roi
ntest
inal
tract
.

Av
ail
abi
l
ity
DRYPOWDER(tobeadmi
nist
eredwit
hwaterbef
ore
pr
ocedur
e);
SUSPENSI
ONS100%w/ v
,250%w/v.

ᏆᖴA2022 Dr
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thyCar
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DOSAGE
Adul
tandChi
l
d:
Radiogr
aphicexaminat
ionofgast
roi
ntesti
nalt
ract
:rout
e
anddosagedependonpr ocedur
eandpr epar
ati
onused
(consul
tli
ter
atur
e).

Cont
rai
ndi
cat
ions
Int
estinalobstr
uction;condit
ionssuchaspy l
oricst enosi
s
orlesi
onswhi chpr edisposetoobst r
uction; i
ntestinal
perfor
ationorcondi ti
onswi t
hriskofper forati
on; suchas
acuteulcerati
vecol i
ti
s;diver
ti
culi
ti
s; orafterrectal or
coloni
cbi opsy;si
gmoi doscopyorr adiot
her apy;
hypersensiti
vi
ty;gastroi
ntesti
nalhaemor rhage;
i
nflammat i
on.

Pr
ecaut
ions
Adequatehydr
ati
onaf
terpr
ocedur
etopr
eventsev
ere
const
ipati
on.

Adv
erseEf
fect
s
Constipati
onordiarr
hoea;abdominalcrampsandbl eedi
ng;
perfor
ationofbowel r
esul
tinginperi
tonit
is;adhesions;
granul
omasandhi ghmortali
tyrat
e;elect
rocardiographi
cal

ᏆᖴA2022 Dr
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thyCar
e 363
changes-mayoccurwithrectaladmi ni
str
ati
on;
pneumoniti
sorgranulomaf ormat i
on-f
oll
owingacci
dental
aspi
rati
onintol
ungs;bloati
ng; consti
pati
on;st
omachpai n;
ri
nginginear
s;nausea;vomiting;paleski
n;weakness.

Becapl
ermi
n
I
NDI
CATI
ONS
Treatmentoflowerextremi
tydi
abeti
cneuropathi
culcer
s
extendi
ngtosubcuttissueorbeyondandhavingadequate
bloodsupply
.

ACTI
ON
Promoteschemotaxisofcell
sinvol
vedi
nwoundrepai
r
andenhancesformationofgranul
ati
ont
issue.
Therapeut
icEf
fects:
Improvedheali
ng.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Knownhy
per
sensi
ti
vi
tyt
o
becapler
minorparabens;
Knownneopl
asm atsi
teof
appli
cati
on;Woundsthatcl
osebypr
imaryi
ntent
ion.

UseCaut
iousl
yin:
Knownmal
i
gnancy
;OB:
Lact
ati
on:
Pedi
:Saf
etynotest
abl
i
shed.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 364
ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm:eryt
hematousr
ashatappl
i
cat
ionsi
te.Mi
sc:
MALIGNANCY( MAYLEADTO↑ MORTALI TY,
ESPECIALLYWITHUSEOF≥3TUBES) .

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

DOSAGE
Topical
:(Adul
ts):Lengt
hofgel ini
nchesfrom 15-or7.5-
g
tube=length×widthofulcerarea×0.6;f
rom the2-gtube
=length×widthofulcerarea×1.3.Lengt
hofgel i
n
centimet
ersfr
om 15-or7.5-gtube=length×wi dt
hof
ulcerar
ea÷4; fr
om the2-gtube=length×widthofulcer
area÷2; f
or12hreachday .

AVAI
LABI
LITY
Gel
100mcg/
g(0.
01%)i
n2-
,7.
5-,
and15-
gtubes;

PATI
ENTTEACHI
NG
Inst
ructpat
ientonpropertechni
quef orappli
cati
on.
Washhandsbef oreapplyi
nggel andusecot t
onswab
ortonguedepressortoaidinappli
cation.Ti
poftube
shouldnotcomei ncontactwit
hul ceroranyother

ᏆᖴA2022 Dr
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nHeal
thyCar
e 365
 surface; r
ecapti
ghtlyaf
tereachuse.Squeeze
calculatedamountofgel ontoaclean,fi
rm,
nonabsor bablesurf
ace(waxpaper )
.Spreadgel wi
th
swabort onguedepressorovertheulcersurf
aceinan
evenl ayertothethi
cknessofadi me.Cov erwit
ha
sali
ne- moist
enedgauzedr essi
ng.

Donotapplymorethancalculat
edamount ;hasnot
beenshownt obebenefi
cial
.Ifadoseismissed,
applyassoonasremember ed.I
fnotremember ed
unti
lnextday
,ski
pdoseandr eturntoregul
ardosing
schedul
e.Donotdoubledoses.

After12hr,
r i
nseulcergent
lywit
hsal
ineorwaterto
remov er
esidualgelandcoverwit
hsali
ne-
moistened
gauze.

Emphasi
zetheimpor
tanceofst
ri
ctwoundcar
eand
non–wei
ght
-beari
ngprogr
am.

Becl
omet
hasone
I
ndi
cat
ions
Chroni
casthmanotcont rol
l
edbyshor tacti
ngβ2-
adr
enoceptoragonists.Maintenancetreatmentofasthma
asprophyl
acti
ctherapy .Maydecreaser equi
rementforor
el
iminat
euseofsy stemi ccorti
coster
oidsinpati
entswith

ᏆᖴA2022 Dr
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thyCar
e 366
ast
hma.

ACTI
ON
Pot
ent,l
ocal
lyacti
nganti-i
nflammatoryandimmune
modif
ier
.Therapeut
icEffects:Decr
easesfrequencyand
sev
eri
tyofasthmaattacks.Improvesasthmasy mptoms.

Av
ail
abi
l
ity
I
NHALER100and200µgperact
uat
ion;
CREAM 5,
10,
15(
0.025%)and20g(
0.0125%)
;
OI
NTMENT20g.

DOSAGE
Aer
osol
inhal
ati
on
Adul
t:Meter
eddoseinhaler
:200µgt wi
cedailyor100µg3
to4ti
mesdaily(
inmor eseverecases,ini
ti
all
y600to800
µgdai
ly)
.Highdoseinhal
er:500µgt wicedail
yor250µg4
ti
mesdail
y;i
fnecessarymaybei ncreasedto500µg4
ti
mesdail
y.
Child:
Meter
eddosei
nhal
er:
50to100µg2t o4t i
mes
dail
yor100to200µgtwi
cedai
l
y.Highdoseinhal
er:
not
recommended.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 367
Cont
rai
ndi
cat
ion
Acne;r
espi
rat
oryt
racti
nfect
ion;
pul
monar
ytuber
cul
osi
s;
ul
cer;
peri
oral
dermati
ti
s.

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

Pr
ecaut
ions
Seenot esabov e;acti
veorqui escenttuberculosis;
syst
emi ct herapymayber equi r
eddur i
ngper i
odsofst r
ess
orwhenai rwayobstructi
onormucuspr eventdrugaccess
tosmal l
erai rways;
notforr eliefofacut esympt oms;
monitorhei ghtofchil
drenr eceivingprolongedt reatment-
if
growthsl owed; r
evi
ewt herapy ;
untreatedfungal ,bact
eri
al
andsy stemi cvir
ali
nfecti
on, lactati
onpr egnancy .

Adv
erseEf
fect
s
Orophar yngeal candi
dosis;coughanddy sphoni a(usuall
y
onlywi t
hhi ghdoses) ;adrenalsuppr essi on;growth
ret
ar dati
oni nchildr
enandadol escent s; i
mpai redbone
met aboli
sm; gl
aucomaandcat aract(wi thhighdoses; but
l
essf r
equentt hanwi t
hsy stemiccor ti
cost er
oids);
paradoxical bronchospasm- requiresdi scontinuationand
alt
ernativether apy(i
fmi l
d;maybepr ev entedbyi nhalati
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 368
ofβ2-adr enoceptoragonistorbyt r
ansferfr
om aerosolt
o
powderi nhalat
ion);r
arely
,;ur
ti
cari
a; r
ash;angioedema;
tel
angiectasia;i
ncreasedintr
aocularpressur
e; der
mal
thi
nni
ng. Candidosiscanber educedbyuseofaspaci ng
devi
ce( seenot esabov e)
;ri
nsingthemout hwi t
hwater
aft
erinhalati
onmayhel ptopreventcandidosis.

PATI
ENTTEACHI
NG
Adv i
sepatienttotakemedi cati
onexactlyasdirect
ed.
Ifadosei smi ssed,takeassoonasr emember ed
unlessalmostt imef ornextdose.Adv i
sepatientnot
todisconti
nuemedi cati
onwi thoutconsult
inghealt
h
careprofessional;gradualdecreaseisrequir
ed.

Advisepatientsusinginhal
ati
oncorticoster
oidsand
bronchodil
atortousebr onchodi
lat
orf i
rstandtoall
ow
5mi ntoelapsebef oreadminist
eri
ngt he
corti
costeroi
d,unlessotherwi
sedirectedbyhealth
careprofessional
.

Advisepat
ientt
hatinhalat
ioncorti
cost
eroidsshoul
d
notbeusedt ot
reatanacut easthmaattackbut
shouldbeconti
nuedev enifotheri
nhal
ationagents
areused.

Pat
ient
susi
nginhalat
ioncor
ti
cost
eroidstocontr
ol
ast
hmamayr equi
resystemi
ccort
icoster
oidsfor

ᏆᖴA2022 Dr
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nHeal
thyCar
e 369
 acut
eatt
acks.Advi
sepat
ientt
ouseregul
arpeakf
low
monit
ori
ngtodeter
miner
espir
ator
ystat
us.

Caut
ionpati
enttoavoi
dsmoking,
knownal
l
ergens,
andotherr
espi
rator
yir
ri
tant
s.

Adv
isepati
entt
onot
if
yphy
sici
ani
fsor
ethr
oator
mouthoccur
s.

Instr
uctpat i
entwhosesy st
emi ccorti
cost
eroidshave
recentl
ybeenr educedorwi thdr
awnt ocarryawar ni
ng
cardindicati
ngtheneedf orsupplementalsystemic
corti
costeroidsi
ntheev entofstressorsevere
asthmaat tackunresponsivetobronchodi
lators.

Met er
ed- DoseI nhaler:Inst r
uctpat ienti nthepr oper
useoft hemet ered-dosei nhaler.Cani stermustbe
pri
medpr iortof i
rstuse.Dot hisbyr eleasi ng2
actuati
onsi ntoai rawayf rom f ace.Cani sterwi ll
remainpr imedf or10day s.Ifnotusedf ormor et han
10day s,reprimewi th2act uations.Shakei nhal erwel l
.
Exhalecompl etelyandt hencl oselipsf i
rml yar ound
mout hpiece.Whi lebr eathingi ndeepl yandsl owl y,
pressdownoncani ster.Hol dbr eathf orasl ongas
possiblet oensur edeepi nstil
lationofmedi cat i
on.
Remov eri nhalerfrom mout handbr eatheoutgent ly
.
All
ow1–2mi nbet weeni nhalations.Ri nsemout hwith
waterormout hwashaf tereachuset omi nimi ze

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 370
 fungali
nfect
ions,dr
ymouth,andhoar
seness.Cl
ean
onlythemouthpieceweekl
ywithcl
eandryti
ssueor
clot
h.Donotpl acei
nwater

St
orage
Storepr
otect
edfr
om moi
stur
eatat
emper
atur
enot
exceedi
ng30⁰C.

BELATACEPT
I
NDI
CATI
ONS
Pr
eventionoforganrej
ectionfoll
owingki
dneytr
ansplant
i
nadultpatient
s;i
ncombi nati
onwi t
hbasi
li
ximabinducti
on,
mycofenolateandcort
icoster
oids.

ACTI
ON
BindstoCD80andCD86si tes,t
her ebyblockingT-cel
l
costimulati
on,r
esultisinhi
bit
ionofT- l
ymphocy t
e
proli
fer
ationandcy t
okineproduction.TherapeuticEff
ects:
Prolongedgraftsurvi
valwit
hdecr easedpr oductionofanti
-
donorant i
bodi
esf ol
lowingkidneyt ranspl
antati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Ebst
ein-
Bar
rVi
rus(
EBV)

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 371
seronegat
ivi
tyorunknownEBVser
ost
atus;Liver
tr
ansplant
ati
on;Lactat
ion:
Avoi
dbr
east
feeding.

UseCaut
iousl
yin:
Cyt
omegal
ovi
rus(
CMV)i
nfect
ion/
T-
celldepleti
ngt herapy( ↑r i
skofpost -tr
anspl ant
l
y mphopr oli
fer
at i
vedi sorder[ PTLD]),
CMVpr ophylaxis
recommendedf or3mosf ol
lowingtranspl ant;Changein
bodywei ght>10%( doseadj ustmentr ecommended) ;
Unknownt uberculosisst atus( l
atenti
nf ectionshouldbe
treatedpriortouse) ;
Ev idenceofpol yomav ir
us-
associatednephr opat hy( PVAN) ,↓i mmunosuppr essi
on
maybenecessar y;OB: Useonl yifpotentialbenefitto
mot herout wei
ghspot ent i
alrisktofetus; Pedi:Safetyand
effecti
venessnotest ablished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: PROGRESSI VEMULTI FOCAL
LEUKOENCEPHALOPATHY( PML) ,
headache.Resp: cough.
CV: hypert
ension,peripheraledema.GI :constipati
on,
diarr
hea,nausea,v omi t
ing.GU: pr
oteinuri
a.Endo: new-
onsetdiabetesmel li
tus.FandE: hyperkal
emi a,
hypokalemia.Hemat : anemia,leukopenia.Misc: POST-
TRANSPLANTLYMPHOPROLI FERATI VEDI SORDER
(PTLD) ,
↑ RISKOFMALI GNANCY, SERIOUSI NFECTI ONS,
fever,gr
aftdysfuncti
on.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 372
I
NTERACTI
ONS
Drug-Drug:Maypot enti
all
yal
tert
heeff
ectsofdrugs
metabolizedbyt heCYP450enzy mesyst
em.May↓
anti
bodyr esponsetoand↑ r i
skofadver
sereacti
ons
fr
om liv
ev i
rusvacci
nes;avoi
duseduri
ngtreat
ment .May
↑ bloodl evel
s,eff
ectsandtoxi
cit
yofmycophenoli
cacid.

DOSAGE
Prescri
beddosemustbeev
enl
ydi
vi
sibl
eby12.
5toensur
e
accurat
eprepar
ati
on
I
V: (Adul
ts):I
nit
ial
phase—10mg/ kgondayof
transpl
ant/
pri
ortoimplantat
ion,day5(96hraft
erday1
dose),endofweek2, 4,8and12posttranspl
antat
ion;
mai nt
enancephase—10mg/ kgendofweek16andev ery
fourweeks(±3day s)t
hereaf
ter.

AVAI
LABI
LITY
Lyophi
l
izedpowderf
ori
nject
ion(
requi
resr
econst
it
uti
on)
250mg/ vi
al;

PATI
ENT TEACHI
NG
Reinf
orcetheneedf orl
i
fel
ongther
apyt
oprevent
tr
ansplantr
eject
ion.Revi
ewsymptomsofr
ejecti
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 373
 fort
hetranspl
antedor gan,andstr
essneedt
onoti
fy
heal
thcareprofessionali
mmedi at
elyi
fsi
gnsof
rej
ect
ionorinfecti
onoccur.

Advi
sepat
ienttoavoi
dcont
actwi
thper
sonswi
th
cont
agi
ousdiseases.

Inform pati
entoftheincreasedri
skofskincancerand
othermal i
gnancies.Advi
sepat i
enttousesunscreen
withahi ghprotecti
onfactorandwearprotect
ive
clothi
ngt odecreaseri
skofski ncancer
.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

Advi
sepat i
enttonoti
fyheal
thcareprofessi
onal
i
mmedi atel
yifsi
gnsorsy mptomsofi nf
ecti
on,post
-
tr
ansplantl
ymphoproli
fer
ati
vedisorderorprogr
essi
ve
mult
ifocall
eukoencephal
opathyoccur.

Adv
isepat
ient
stoav
oidl
i
vev
acci
nesdur
ingt
her
apy
.

Advisefemalepat i
entstonoti
f yhealt
hcare
professi
onali
fpr egnancyisplannedorsuspectedor
i
fbr east
feedi
ng.Encour agepatientswhobecome
pregnantorwhosepar t
nershav erecei
vedbel
atacept
toregist
erwit
ht heNat i
onal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 374
 Emphasi
zetheimpor
tanceofr
out
inef
oll
ow-
up
l
abor
ator
ytests.

Benazepr
il
I
NDI
CATI
ONS
Al
oneorwit
hotheragent
sint
hemanagementof
hy
pert
ensi
on.

ACTI
ON
Angiotensin-convertingenzy me( ACE)inhibit
orsbl ockthe
conversionofangi otensi nItot hevasoconstri
ctor
angiot
ensinI I.ACEi nhibitor
sal sopreventthedegr adati
on
ofbradykininandot herv asodil
atoryprostagl
andi ns.ACE
i
nhibit
orsal so↑ pl asmar eninlevel
sand↓ al dost erone
l
evels.Netr esulti
ssy stemicv asodil
ati
on.Ther apeutic
Eff
ects:Lower i
ngofBPi npatientswithhypertension.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hist
oryof
angioedemawithorwithoutprevi
oususeofACEi nhi
bit
ors;
OB: Cancauseinj
uryordeathoffetus—i
fpregnancy
occurs,di
scont
inueimmediately
;Lactat
ion:
Appearsin
breastmil
k;pat
ientmustdisconti
nuebenazepri
lorprovi
de

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 375
al
ter
nat
etobr
eastmi
l
k.

UseCaut
iousl
yin:
Pat
ient
swi
thr
enal
impai
rment
,
hypov olemia, hyponatremi a,
andconcur rentdiureti
c
therapy; Bl
ackpat i
ents( monot her
apyforhy pertensi
on
l
essef f
ective, mayrequi r
eaddi ti
onalt
her apy;higherri
sk
ofangi oedema) ;Surgery/anesthesi
a(hypot ensionmaybe
exagger ated);/Lactation:Safetynotestablished;Pedi:
Children<6y r(safetynotest abli
shed)
;Ger i
: I
nit
ialdose↓
recommended.
Exer
ciseExt
remeCaut
ioni
n:Fami
l
yhi
stor
yof
angi
oedema.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:dizzi
ness,drowsiness,fati
gue,headache.Resp:
cough.CV:hypotension.GI:
nausea.GU: impairedrenal
funct
ion.Der
m: rash.FandE: hy
perkalemia.Misc:
ANGIOEDEMA.

I
NTERACTI
ONS
Drug-Drug:Excessivehy potensi
onmayoccurwi th
concurrentuseofdi ureti
cs.Additi
vehypotensionwi t
h
otherantihy
per t
ensives.↑ r i
skofhyperkal
emi awith
concurrentuseofpot assium supplements,potassi
um-
shari
ngdi ur
etics,potassium-contai
ningsaltsubsti
tutes,
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 376
angiotensi
nIIrecept
orantagoni
sts.NSAIDsandselecti
ve
COX- 2inhi
bit
orsmaybl untt
heantihypert
ensi
veef
fectand
↑t her i
skofrenaldysf
uncti
on.↑ levelsandmay↑ r i
sk
ofli
thium t
oxicit
y.

DOSAGE
PO:(Adults):10mgoncedai
l
y,↑ graduall
yto
maintenancedoseof20–40mg/dayin1–2di v
ideddoses
(i
nit
iatether
apyat5mgoncedai
lyinpatientsr
eceiv
ing
di
ureti
cs).
PO:
(Chi
ldr
en≥6y r
):0.2mg/kgoncedai
l
y;maybet
it
rat
ed
upt
o0.6mg/kg/
day( or40mg/day)
.

Renal
Impai
rment
PO:(Adul
ts):
CCr<30mL/
min—I
nit
iat
ether
apywi
th5mg
oncedail
y.

Renal
Impai
rment
PO:
(Chi
l
dren≥6y
r):
CCr<30mL/
min—-
Cont
rai
ndi
cat
ed.
AVAI
LABI
LITY(
GENERI
CAVAI
LABLE)
Tabl
ets5mg, 10mg, 20mg,40mg;Incombinat
ionwi
th:
amlodi
pine(
Lotrel
)andhydr
ochl
orot
hiazi
de

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 377
Inst
ructpatienttotakemedi cati
onasdirect
edatthe
samet imeeachday ,ev
eni ffeel
ingwell
.Takemissed
dosesassoonasr emember edbutnotifalmostti
me
fornextdose.Donotdoubl edoses.War npat
ientnot
todisconti
nuebenazepr il
unlessdirect
edbyhealth
careprofessional
.

Encour agepatientt
ocompl ywithadditi
onal
i
nterventionsforhypertension(weightreduct
ion,low
sodium diet,di
scontinuati
onofsmoki ng, moderation
ofalcohol consumption, r
egularexer
cise,andstress
management ).Medicationcontrol
sbutdoesnotcur e
hypertension.

Inst
ructpatientandf amil
yoncor rectt
echni
quefor
monitori
ngBP.Adv isethem tocheckBPatleast
weeklyandt or epor
tsignif
icantchangestoheal
th
careprofessional.

Cautionpat i
enttoavoidsal
tsubst i
tut
escont
aini
ng
potassium, orfoodscontai
ninghighlevel
sof
potassium orsodium unl
essdi r
ectedbyheal
thcare
professional.

Caut
ionpat
ienttochangeposi
ti
onssl
owlyto
mini
mizehypotensi
on.Useofal
cohol
,st
andi
ngf
or
l
ongperi
ods,exerci
sing,
andhotweat
hermay

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 378
 i
ncr
easeor
thost
ati
chy
pot
ensi
on.

Instr
uctpati
enttonot i
fyhealt
hcar epr
of essionalof
allRxorOTCmedi cati
ons,vit
amins,orher bal
productsbeingtakenandconsul theal
thcar e
professi
onalbeforetakinganynewmedi cations,
especial
lycough,cold,oral
lergyremedies.

Maycausedizziness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

Advi
sepatientt
oinf
orm heal
thcar
eprofessionalof
medicat
ionregi
menbeforetr
eatmentorsurgery.

Inst
ructpat ienttonot i
fyheal t
hcar eprofessional i
f
rash;mout hsor es;sorethr oat;f
ever;swellingof
handsorf eet;i
rregularhear t
beat;chestpai n;dry
cough; hoarseness; swelli
ngoff ace, eyes,li
ps,or
tongue; orifdiff
icul
tyswal lowingorbr eathingoccur s.
Persist
entdr ycoughmayoccurandmaynotsubsi de
unti
l medicat i
oni sdiscontinued.Consul thealthcare
professional i
fcoughbecomesbot hersome.Al so
notif
yheal thcarepr ofessionalifnausea, vomi t
ing,or
diarr
heaoccur sandcont inues.

Advi
sewomenofchi l
dbeari
ngagetouse
cont
racept
ionandnoti
fyheal
thcar
eprof
essi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 379
 pr
egnancyi
spl
annedorsuspect
ed.

Emphasizetheimport
anceoff
oll
ow-
upexami
nat
ions
toev
aluateeff
ecti
venessofmedi
cat
ion.

Bendamust
ine
I
NDI
CATI
ONS
Chroni
clymphocyt
icleukemia.I
ndolentB-cel
lnon-
Hodgki
n'slymphomat hathasprogressedduri
ngorwi t
hin
6moofr eceiv
ingr
it
uximaborar i
tuxi
mab-contai
ning
regi
men.

ACTI
ON
DamagesDNAr esul
ti
ngindeathofr
api
dlyrepl
i
cati
ng
cel
l
s.Therapeut
icEf
fect
s:Decr
easedprol
if
erat
ionof
l
eukemiccell
s.Deat
hoflymphomacell
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
obendamust
ineor
mannit
ol;
CCr<40mL/ min.Usewithcautioni
nlesser
degr
eesofrenal
impairment;
Moder ateorsev
erehepati
c
i
mpairment;
OB:Pregnancyorlact
ation.

UseCaut
iousl
yin:
Pat
ient
satr
iskf
ort
umorl
ysi
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 380
syndrome( concurrentall
opuri
nolr
ecommended);Mil
d
hepaticimpair
ment ;Mildtomoderater
enalimpai
rment;
Patientswit
hchild-beari
ngpotent
ial
;Geri
:Maybemor e
susceptibl
etoadv ersereacti
ons;
Pedi:Saf
etynot
establi
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: fat
igue,
weakness.Resp: cough.GI :nausea, vomit
ing,
diarr
hea.Derm:TOXICEPIDERMALNECROLYSI S,
STEVENS- JOHNSONSYNDROME, skinreactions.Hemat :
anemi a,
LEUKOPENI A,NEUTROPENI A,
THROMBOCYTOPENI A.Metab: hyperur
icemi a.Misc:
MALI GNANCY, TUMORLYSI SSYNDROME, aller
gic
reacti
onsincl
udinganaphyl
axis, f
ever,i
nfusionr eacti
ons.

I
NTERACTI
ONS
Drug-Drug: Concurr
entuseofCYP1A2i nducers/inhibi
tors
canal t
erlev el
sofbendamust i
ne.Inhibi
torsofCYP1A2
i
ncludingf l
uv oxamineandciprofl
oxacinmay↑ l ev el
sof
bendamust i
neand↓ l evel
sofact i
vemet aboli
tes.
InducersofCYP1A2i ncl
udingomepr azoleandsmoki ng
may↓ l ev elsofbendamust i
neand↑ l evelsofit
sact ive
met aboli
tes.Consideralt
ernati
vetreatments.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 381
Chr
oni
cLy
mphocy
ticLeukemi
a
I
V:(
Adul
ts)
:100mg/ m2ondays1and2ofa28-
daycycl
e,
upt
o6cycl
es;dosemodi
fi
cat
ionr
equi
redf
ort
oxi
cit
y.

Non-
Hodgki
n'
sLy
mphoma
I
V:(
Adul
ts)
:120mg/ m2ondays1and2ofa21-
daycycl
e,
upt
o8cycl
es;dosemodi
fi
cat
ionr
equi
redf
ort
oxi
cit
y.

AVAI
LABI
LITY
Lyophi
l
izedpowderf
ori
nject
ion(
requi
resr
econst
it
uti
on)
100mg/ vi
al;

PATI
ENTTEACHI
NG
Instructpat i
entt onot if
yhealthcar eprofessionalif
fever ;chill
s; soret hroat;
signsofi nfecti
on;lowerback
orsi depai n; diff
icultorpainfulurinati
on;shor t
nessof
breat h; f
atigue; bleedinggums; br ui
sing;petechiae;or
bloodi nur i
ne, stool,oremesi soccur s.Caution
pat i
entt oav oidcr owdsandper sonswi thknown
i
nf ections.I nstructpat i
enttousesof ttoothbrushand
electricr azor .Caut i
onpat i
entstoav oidalcoholic
bev eragesandpr oductscontainingaspi r
inorNSAI Ds;
maypr ecipitategast ri
cbleeding.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 382
 i
mmediat
elyi
fsymptomsofaller
gicr
eacti
ons(rash,
f
aci
alswel
li
ng,ordi
ff
icul
tybr
eathi
ng)ornausea,
v
omiti
ngordiar
rheaoccur
.

Maycauseti
redness.Cauti
onpati
enttoavoi
ddriv
ing
andot
heracti
vit
iesrequi
ri
ngaler
tnessunt
ilr
esponse
tomedi
cati
onisknown.

Adv i
sepat i
entthismedi cat
ionmayhaveterat
ogeni
c
effect
s.Cont r
acept i
onshoul dbeusedbybothmen
andwomendur ingandf oratleast3mofol
lowi
ng
compl eti
onoft herapy.Advisewomennotto
breastfeedduri
ngt herapy.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasi
zeneedf
orper
iodi
clabt
est
stomoni
torf
or
si
deeff
ects.

BENZATHI
NEPENCI
LLI
NG
I
NDI
CATI
ONS
Treat
mentofawi devari
etyofinfecti
onsincluding:
Pneumococcalpneumonia,St
r eptococcalpharyngi
tis,
Syphi
li
s,Gonor
rheastrai
ns.Treatmentofent erococcal
i
nfecti
ons(r
equir
estheadditi
onofanami noglycoside).

ᏆᖴA2022 Dr
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nHeal
thyCar
e 383
Prevent
ionofr heumaticfever
.Shoul
dnotbeusedasa
si
ngleagentt otreatanthr
ax.Unl
abeledUses: Treat
ment
ofLymedi sease,preventi
onofrecur
rentStreptococcal
pneumoniaesept icemiainchi
ldr
enwi t
hsickle-cel
ldisease.

ACTI
ON
Bindt obact er
ialcellwall,resulti
ngi ncelldeath.
Ther apeuti
cEf fects:Bacter i
cidalactionagai nst
suscept ibl
ebact eri
a.Spect rum: Activeagai nst:
Mostgr am
-positi
v eorganisms, i
ncludi ngmanyst reptococci
(Streptococcuspneumoni ae, gr
oupAbet a-
hemol yti
c
streptococci),staphylococci (non–peni ci
lli
nase-produci
ng
strains)andBaci ll
usant hracis,Somegr am- negative
organi sms,suchasNei sser iameni ngit
idisandN.
gonor rhoeae(onl ypenicil
l
insuscept ibl
est rai
ns),Some
anaer obicbacteriaandspi rochet esincludingBor ell
i
a
burgdor fer
i.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Pr
evi
oushy
per
sensi
ti
vi
tyt
o
penici
l
li
ns(cr
oss-sensit
ivi
tyexist
swithcephal
ospori
ns
andotherbet
a-l
actam anti
bioti
cs);Hyper
sensi
ti
vi
tyto
procai
neorbenzathine(pr
ocaineandbenzathi
ne
prepar
ati
onsonly);
Somepr oductsmaycontai
ntart
razi
ne
andshouldbeavoidedinpat i
entswit
hknown

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 384
hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Sev
erer
enal
insuf
fi
ciency(
dosage
reducti
onrecommended) ;OB:Alt
houghsafetynot
establ
ished,hasbeenusedsaf ely;Lact
ati
on:Safet
ynot
establ
ished;Geri
:Considerdecreasedbodymass, age-
rel
ateddecreaseinrenal/hepati
c/cardi
acfunct
ion,
i
ntercurr
entdiseasesanddr ugtherapy.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES.GI :di
arr
hea,epigastr
icdist
ress,nausea,
vomiting,pseudomembr anouscoliti
s.GU: i
nter
sti
tial
nephriti
s.Derm: r
ash,urt
icar
ia.Hemat :eosi
nophili
a,
l
eukopeni a.Local
:painatIM sit
e,phlebit
isatIVsit
e.Misc:
all
ergi
cr eacti
onsincludi
nganaphy l
axisandser um
si
ckness, superi
nfecti
on.

I
NTERACTI
ONS
Drug-Drug:Penici
ll
i
nmay↓ ef fect
ivenessofor al
contracepti
veagents.Probenecid↓ renalexcreti
onand↑
bloodlevelsofpenici
ll
i
n( t
herapymaybecombi nedfor
thispurpose).Neomycinmay↓ absor pti
onofpeni ci
l
li
n.
Concur r
entusewi t
hmet hotr
exate↓ met hotrexate
eli
minationand↑ r i
skofserioustoxici
ty.

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 385
AqueousPeni
cil
l
inG
I
M: I
V:(
Adul
ts)
:Mosti
nfect
ions—1–5mi
l
li
onuni
tsq4–6
hr
.
I
M: I
V:(Chi
l
dren):8333–16,667uni
ts/
kgq4hr ;
12,
550–25,
000uni t
s/kgq6hr ;
upto250,000unit
s/kg/
day
i
ndivi
deddoses,somei nf
ecti
onsmayr equi
reupto
300,
000unit
s/kg/day.
IV:(
Inf
ants>7days):75,
000uni
ts/
kg/dayi
ndiv
ideddoses
every8hr;meni
ngit
is—200,
000–300,
000uni
ts/
kg/dayi
n
divi
deddosesq6hr .
I
V:(Infant
s<7days):50,
000unit
s/kg/
dayi
ndivi
deddoses
q12hr ;Str
ept
ococcusB,meningi
ti
s—100,
000–150,
000
uni
ts/kg/dayi
ndivi
deddoses.

Benzat
hinePeni
cil
l
inG
I
M: (Adult
s) :Str
eptococcalinf
ecti
ons/ er
ysi
peloid—1.2
mil
li
onuni t
ssi ngledose.Pri
mar y,
secondary,andear l
y
l
atentsyphili
s—2.4mi l
li
onuni t
ssingledose.Tertiar
yand
l
atelatentsyphili
s(notneurosyphil
i
s)—2.4mi l
li
onuni t
s
onceweekl yfor3wk.Pr eventi
onofr heumati
cf ever—1.2
mil
li
onuni t
sq3–4wk.
I
M: (Chi
ldr
en>27kg):St
rept
ococcal
i
nfecti
ons/er
ysi
pel
oid—900,
000–1.2mi
l
li
onuni
ts(
singl
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 386
dose)
.Primar y
, secondary
,andearlylatentsyphi
li
s—upto
2.
4mi l
li
onuni tssingledose.Latelat
entorlatentsyphi
l
is
ofundet
er mineddur ati
on—50,000units/kgweeklyfor3
wk.Preventi
onofr heumati
cfever—1.2mi l
li
onunitsq2–3
wk.
I
M: (Chi
ldr
en<27kg) :Streptococcal
i
nfecti
ons/er
ysipeloi
d—300, 000–600,000uni t
ssingl
edose.
Pri
mar y
,secondary,andearlylatentsyphi
lis—upto2.4
mill
i
onunitssingl
edose.Lat elat
entorlatentsyphi
li
sof
undeter
mineddur ati
on—50,000uni ts/
kgweekl yfor3wk.
Prevent
ionofrheumat i
cf ev
er —1.2mill
ionunitsq2–3wk.

Pr
ocai
nePeni
cil
l
inG
I
M: (
Adults):Moderateorsev
ereinf
ections—600,
000–1.
2
mil
li
onunits/day
,singl
edoseor2divideddoses.
Neurosy
phili
s—2.4mi l
li
onuni
ts/
daywi t
h500mg
pr
obenecidPO4t imesdailyf
or10–14day s.
I
M:(Chi
ldr
en)
:Congeni
tal
syphi
l
is—50,
000uni
ts/
kg/
day
f
or10–14day
s.

AVAI
LABI
LITY
Peni
cil
l
inGPot
assi
um
Powderfori
njecti
on5mi l
li
onunits/v
ial
,20mill
ion
uni
ts/
vial
;Pr
emi xed(
frozen)sol
uti
onforinj
ect
ion1mi
l
li
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 387
uni
ts/
50mL,
2mi
l
li
onuni
ts/
50mL,
3mi
l
li
onuni
ts/
50mL;
Peni
cil
l
inGSodi
um
Powderf
ori
nject
ion5mi
l
li
onuni
ts/
vial
;
Pr
ocai
nePeni
cil
l
inG
Suspensi
onforI
Mi nj
ecti
on600,
000uni
ts/
mLi
n1-and
2–ml pr
efi
ll
edsy
ringes;
Benzat
hinePeni
cil
l
inG
Suspensi
onforI
Mi nject
ion600,
000uni
ts/
mLi
n1-
,2-
,and
4-
mLpr ef
il
ledsy
ringes;

PATI
ENT TEACHI
NG
Inst
ructpatienttot
akemedicationaroundt hecl
ock
andt ofi
nishdrugcompletel
yasdi r
ected,ev eni
f
feel
ingbetter.Advi
sepat
ientthatshari
ngt his
medi cat
ionmaybedanger ous.

Adv i
sepati
entt
oreportsignsofsuper infect
ion(black,
furryov
ergr
owthontongue; vaginali
tchingor
dischar
ge;l
ooseorfoul-
smellingstools)andal l
ergy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 388
 Inst
ructpat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
if
symptomsdonoti mpr
ove.

Advisepatientt
akingor
alcontr
acept
ivestousean
addi
t i
onalnonhormonalmethodofcontracept
ion
duri
ngt her
apywi t
hpenici
l
li
nanduntilnextmenstrual
peri
od.

Pati
entwi t
hanall
ergyt
openi
cil
l
inshoul
dbe
i
nstructedtoal
wayscarr
yani
denti
fi
cati
oncar
dwi
th
thi
sinformati
on.

Benzat
hineBenzy
lPeni
cil
l
in
I
ndi
cat
ions
Mil
dtomoderat
ei nf
ect
ionsofupperrespi
rat
orytr
actdue
t
osuscept
ibl
estrept
ococci
,Syphi
li
s,prophyl
axi
sof
r
heumati
cfever
.

Av
ail
abi
l
ity
I
NJECTABLESUSPENSI
ON-1200,
000uni
ts/
2ml
.

DOSAGE
Strept
ococcalURTI:1.
2mill
ionuni
t(>27kg)si
ngledose
(deepIMinj)af
tersensi
ti
vi
tytest(
AST);0.
6mill
ionuni
t

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 389
(
<27kg)si
ngl
edose(
deepI
Minj
)AST.
Secondaryprophyl
axi
sofRheumat i
cf ev
er:1.
2mill
ionuni
t
(>27kg)singledose(deepI
Mi nj
)aftersensi
ti
vi
tytest
(AST)every21days;0.6mil
l
ionunit(
<27kg)singledose
(deepIMinj)ASTevery15days.

Sy
phi
l
is:Pr
imar
y,secondar
y,orear
lyl
atent
:Si
ngl
edose
of2.4mil
li
onUni tI
M; Lat
elatent(orl
atentofuncer
tai
n
durat
ion)
,car
diovascular
,orbenignter
tiar
y:2.
4mi l
l
ion
Uni
tIM weekl
yf or3weeks.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
ty,
neur
osy
phi
l
is.

Pr
ecaut
ions
Hyper
sensit
ivi
tyt
ocephal
ospor
insor/andpenici
l
li
ns,
el
derl
y,i
nfant
s,ast
hma,ki
dneydisease,
lact
ati
on
i
nter
acti
ons.

Adv
erseEf
fect
s
Hy persensit
ivi
tyreact
ionssuchasexf oli
ativ
edermatiti
s,
painati nj
ecti
onsi t
e,thr
ombophl ebit
isofinj
ectedvei
n,
diarrhoea,nausea,joi
ntpain,angi
oedema, serum si
ckness
l
iker eacti
ons;haemol yt
icanaemi a,
inter
sti
ti
alnephri
ti
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 390
BENZOCAI
NE
I
NDI
CATI
ONS
Topi cal: Reliefofpr uritusorpai nassoci atedwi thminor
skindi sor der sincl
udi ngbur ns,abrasi ons, bruises,
insect
stings/ bites, dermat i
tis,hemor rhoids, orot herformsof
skini r
ritation.Mucosal :Provi
del ocal anest hesiato
mucosal sur facesbef or ei
nstrument ation, minor
procedur es, orendoscopy .Decr easei rritati
oncausedby
mi normout handt hroatcondi ti
onsi ncl udingsor ethroat
,
gingivitis,stomat i
ti
s,ort eething.Alsousedt osuppr ess
thegagr eflexdur i
ngendoscopyori ntubat i
on.

ACTI
ON
I
nhibiti
nit
iat
ionandconductionofsensorynerv
eimpul
ses.
Therapeuti
cEffect
s:Localanest
hesiawit
hsubsequent
l
ossofsensat i
onorreli
efofpainand/orprur
it
us.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.Cr
oss-
sensi
ti
vi
ty
mayoccuramongr elatedagent s(ami dety
pes—di bucai
ne;
est
ertypes—benzocaine,tetr
acaine);Hypersensit
ivi
tyto
anycomponentsofpr eparati
onsi ncludi
ngst abi
l
izer
s,
col
orants,
orbases;Active,untr
eat edinf
ectionofaffect
ed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 391
area;
Nottobeusedi ntheey e;Somepr oductscont
ain
al
coholandshouldbeav oidedinpatient
swi t
hknown
al
coholi
ntol
erance;
Pedi :Topicalbenzocai
neproducts
shoul
dnotbeusedi nchildren<2y r
.

UseCaut
iousl
yin:
Debi
l
itat
edpat
ient
s;Lar
georsev
erel
y
abradedar easofskinormucousmembr ane;Pr
olonged
use(notr ecommended) ;Pedi
:↑r i
skofsy stemictoxi
cit
y,
safetynotestabli
shedforsomepr oducts;usesmal l
er
dosesduet opotent
ialf
ormet hemoglobinemia;Geri
:↑
ri
skoft oxici
ty;
usesmal l
erdoses.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:mucosal use—↓ orabsentgagref
lex.Der
m: topi
cal
use—burning,edema,irr
it
ati
on,st
ingi
ng,t
enderness,
urt
icar
ia.Misc:all
ergi
creact
ionsincl
udi
nganaphy l
axis.

I
NTERACTI
ONS
Drug-
Drug:Toxi
cit
yofest
er-t
ypeagent
smaybei ncr
eased
byconcurr
entuseofchol
inest
erasei
nhi
bit
ors.

DOSAGE
Benzocai
ne
Topi
cal
/Mucosal(
AdultsandChildren):
Applycr
eam,
oi
ntment
,topi
cal
solut
ions,ordental/or
alpr
oductsas

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 392
needed.Lozengesmaybeusedhour
ly(
nott
oexceed12
l
ozenges/day).Rect
alpr
oduct
smaybeusedtwi
cedai
ly
.

Di
bucai
ne
Topical
:(Adult
sandChi
l
dren):
Applyasneeded(nott
o
exceed30g/ dayi
nadul
tsor7.5g/
dayinchil
dren)
.Canbe
used3–4t i
mesdaily
.

Dy
cloni
ne
Mucosal(Adul
ts)
:2-or3-
mgl ozengemaybedissol
vedi
n
themouthq2hr(nottoexceed10lozenges/
day)
,or
solut
ionmaybeused4timesdaily.
Mucosal
(Chi
ldr
en≥2yr)
:1.2-mglozengemaybe
di
ssol
vedinmouthq2hr(nottoexceed10l
ozenges/
day
).

Pr
amoxi
ne
Topi
cal
/Mucosal(
Adult
s):Topi
calpr
oduct
smaybeused
q3hrasneeded.Rect
alpr
oductsmaybeusedupt
o5
ti
mesdail
y.

AVAI
LABI
LITY
Benzocai
ne
Lozenges6mgOTC, 10mgOTC,15mgOTC,
18mgOTC;
Oraloi
ntment20%OTC;Or
alpast
e20%OTC;
Oral
swab

ᏆᖴA2022 Dr
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nHeal
thyCar
e 393
7.5%OTC, 20%OTC; Topi calswab20%OTC; Rectal
oint
ment20%OTC; Oralgel6.5%OTC, 7.
5%OTC, 10%OTC,
15%OTC, 20%OTC; Oralcream 20%OTC; Oral l
iquid
6.3%OTC; Oralaer
osol 20%OTC; Topicalaerosol 20%OTC;
Topicalcream 6%OTC, 20%OTC; Topicalgel 7.5%OTC,
10%OTC, 20%OTC; Topicaloint
ment5%OTC, 6%OTC,
20%OTC; Topicalsoluti
on2%OTC, 5%OTC, 20%OTC; In
combi nat
ionwith:butambenandt etracaine(Cet acai
ne),
andphenol OTC.

Di
bucai
ne
Topi
cal
oint
ment1%OTC;

Dy
cloni
ne
Lozenges1.
2mgOTC,
2mgOTC,
3mgOTC;

Pr
amoxi
ne
Topicalcr
eam 1%OTC; Topical
gel1%OTC; Topical
soluti
on1%OTC; Topical
spray1%OTC; Rectal
aer osol
foam 1%OTC; Rectal
oint
ment1%OTC; Incombi nationwi
th:
hydrocort
isone(Anal
pram HC,Pramosome, ProctoFoam
HC) .

PATI
ENTTEACHI
NG
I
nst
ructpat
ientoncor
rectappl
i
cat
iont
echni
que.Hi
gh

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 394
 Al
ert
:Inf
orm pat
ientofpot
ent
ial
har
mfrom over
use.
Emphasi
zeneedt oavoi
dcont
actwi
theyes.

Cauti
onpat ientthattheseagent sshoul dnotbe
appli
edf orprolongedperiodsort ol ar
gear eas,
especial
lyifskinisabradedorbr oken, wi t
hout
consulti
ngheal thcar
epr ofessional.Patientshoul
d
alsoconsultheal t
hcarepr of
essional beforeusing
theseagent sforconditi
onsot herthani ndicat
ed.

Advisepat i
entt odisconti
nueuseandnot ifyhealt
h
carepr ofessionalifer y
thema, r
ash,ori
rr
itati
onatsit
e
ofadmi nist
rationoccur s;ar
eabecomesi nfected;
medi cationisswal lowed; orcondi
ti
onwor sensor
doesnoti mpr ovewi thi
n7day s.

Caut
ionpati
enttor eadl
istofacti
vei ngredi
ent
son
OTCproducts.Brandnamesf requentlychangeand
maybemi sl
eadingast oactualcontents.

Advi
seadul
tsusi
ngli
quidfor
m ar
oundt
hemout
hto
avoi
dsmoki
nguntil
solut
ioni
sdry.

TeethingGel :I
nstructpati
entstonotifyhealthcar
e
professionali
fpaini sexcessiv
eorpr olonged.Advi
se
parentst oavoidfeedingimmedi at
elyaf t
erappli
cat
ion
toprev entchokingfrom dimini
shedgagr ef
lex.

Lozenge:
Inst
ructpat
ientt
osuckonl
ozengeand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 395
 al
lowi tt
oslowlydi
ssol
ve.Consultheal
thcar
e
prof
essionali
fthr
oatpai
npersist
smor ethan2days.
Avoiduseinyoungchil
drenbecauseofdangerof
choking.

Benzonat
ate
I
NDI
CATI
ONS
Reli
efofnonpr
oduct
ivecoughduetominort
hroator
bronchi
ali
rr
it
ati
onfr
om inhal
edir
ri
tant
sorcol
ds.

ACTI
ON
Anesthet
izescoughorst retchreceptorsi
nv agalner
ve
aff
erentfi
bersfoundinlungs, pleura,
andrespirat
ory
passages.Mayalsodecr easet r
ansmi ssi
onofthecough
ref
lexcentral
l
y.TherapeuticEffects:Decr
easeincough.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
obenzonat
ate.
Cross-sensi
tiv
itywithotherest
er-
typel
ocal
anest
het
ics
(t
etracaine,
procaine,andother
s)mayoccur.

UseCaut
iousl
yin:
OB:
Lact
ati
on:
Saf
etynotest
abl
i
shed;
Pedi
:Saf
etynotest
abl
i
shedi
nchi
l
dren<10y
r.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 396
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,mil
ddizziness,sedation.EENT: bur
ning
sensationineyes,
nasal congesti
on.GI :consti
pati
on,GI
upset,nausea.Derm:prurit
us,ski
ner uptions.Misc:chest
numbness, chi
ll
ysensation,hypersensiti
vit
yreacti
ons.

I
NTERACTI
ONS
Drug-
Drug:
Addi
tiv
eCNSdepr essionmayoccurwith
anti
hist
ami
nes,
alcohol
,opi
oids,andsedat
ive/
hypnoti
cs.

DOSAGE
PO:(Adul
tsandChi
l
dren≥10y
r):
100mg3t
imesdai
l
y(up
to600mg/ day
).

AVAI
LABI
LITY
Capsul
es100mg;

PATI
ENTTEACHI
NG
I
nstructpati
entt
otakeexact
lyasdir
ect
ed.Ifadosei
s
missed,takeassoonaspossibl
eunl
essalmostti
me
f
ornextdose.Donotdoubledoses.

Caut
ionpat
ientnott
ochewcapsul
es.

Adv
isepar
ent
stokeepbenzonat
atei
nachi
l
d-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 397
 resist
antcont ai
nerandst orei
toutofr eachof
childr
en.Ov erdosewi t
hbenzonat at
einchi l
drenless
than2y ear sofagehasbeenr eport
edf oll
owing
accidentalingesti
onofasf ewas1or2capsul es.Ifa
childaccidentall
yingestsbenzonatate,seekmedi cal
attenti
oni mmedi atel
y.

I
nst
ructpati
entt
ocougheff
ecti
vel
y:Si
tupri
ghtand
t
akeseveral
deepbr
eathsbefor
eatt
emptingtocough.

Advisepat i
entt
omi nimizecoughbyav oi
dingir
ri
tant
s,
suchasci garet
tesmoke, fumes,anddust.
Humi dif
icati
onofenv i
ronmental
air,
frequentsi
psof
water,andsugarlesshardcandymayal sodecrease
thefrequencyofdr y
,ir
rit
ati
ngcough.

Caut
ionpat
ientt
oavoidtaki
ngal
coholorotherCNS
depr
essant
sconcur
rentl
ywitht
hismedicat
ion.

Mayoccasi
onall
ycausedizzi
nessordrowsiness.
Cauti
onpat
ientt
oavoiddrivi
ngorotheract
ivi
ti
es
requi
ri
ngal
ert
nessunti
lresponset
ot hemedicati
oni
s
known.

Advisepat
ientt
hatanycoughlasti
ngmor ethan1wk
oraccompaniedbyfever
,chestpai
n,per
sist
ent
headache,
orskinrashwarr
antsmedicalatt
enti
on.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 398
 sympt
omsofov erdose(
sei
zur
es,
rest
lessness,
tr
embl
ing)occur
.

Benzt
ropi
ne
I
NDI
CATI
ONS
Adjunctiv
et reatmentofal
lfor
msofParki
nson’
sdisease,
i
ncludingdr ug-i
nducedext
rapyrami
dal
eff
ectsandacute
dystonicreactions.

ACTI
ON
Blockscholinergicacti
vi
tyi ntheCNS,whichisparti
all
y
responsibl
ef orthesy mptomsofPar ki
nson’sdisease.
Restoresthenat uralbal
anceofneur ot
ransmitt
ersinthe
CNS.Ther apeuticEffect
s: Reducti
onofri
gidi
tyand
tremors.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
raindi
catedi
n:Hypersensi
ti
vi
ty;
Chi
ldr
en<3y
r;Angl
e-
cl
osureglaucoma;Tar
div
edy ski
nesi
a.
UseCauti
ousl
yin:Pr
ostati
chy per
plasi
a;Sei
zur
edisor
ders;
Car
diacarr
hythmi
as;OB:Lactati
on:Safet
ynotest
abli
shed;
Ger
i:↑riskofadv
ersereacti
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 399
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: confusion,depression,dizzi
ness,hal
lucinati
ons,
headache, sedation,weakness.EENT: blur
redv isi
on,dry
eyes,my dri
asis.CV: ar
rhythmias,hypotension,palpi
tati
ons,
tachycardi
a.GI :consti
pation,drymouth,il
eus, nausea.GU:
hesit
ancy ,
ur i
naryretenti
on.Mi sc:decr
easedsweat i
ng.

I
NTERACTI
ONS
Drug-Drug:Addit
iveantichol
i
nergiceffectswithdrugs
shari
ngant i
choli
nergi
cpr opert
ies,suchasant i
histamines,
phenothiazi
nes,quini
dine,di
sopy r
ami de,andtri
cycli
c
anti
depressants.Counteract
sthechol inergi
ceffectsof
bethanechol.Antaci
dsandant i
diarrhealsmay↓
absorpti
on.
Drug-
Nat
ural
Product
:↑ ant
ichol
i
nergi
cef
fectwi
thangel
'
s
tr
umpet,
ji
msonweed,andscopoli
a.

DOSAGE
Par
kinsoni
sm
PO:(
Adul
ts):
1–2mg/
dayi
n1–2di
vi
deddoses(
range
0.
5–6mg/day).

Acut
eDy
stoni
cReact
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 400
I
M:I
V:(
Adul
ts)
:1–2mg,
then1–2mgPOt
wicedai
l
y.

Dr
ug-
InducedExt
rapy
rami
dal
React
ions

PO:IM:
IV:
(Adul
ts)
:1–4mggiv
enonceort
wicedai
l
y
(1–2mg2–3ti
mesdail
ymayal
sobeusedPO).

AVAI
LABI
LITY
Tabl
ets0.
5mg,
1mg,
2mg;
Inj
ect
ion1mg/
mL

PATI
ENT TEACHI
NG
Encour agepatienttot akebenztropineasdir
ected.
Takemi sseddosesassoonaspossi bl
e,upto2hr
beforet henextdose.Tapergr adual l
ywhen
discontinuingorawi thdrawalreactionmayoccur
(anxiety,t
achycardia,insomnia,returnofpar
kinsoni
an
orext r
apy r
amidal sympt oms).

Maycausedr owsi
nessordizzi
ness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heract
ivi
ti
esthatrequi
real
ert
ness
unti
lresponsetot
hedrugisknown.

I
nstructpati
entthatfrequentrinsingofmout h,good
oral
hy gi
ene,andsugar l
essgum orcandymay
decreasedrymout h.Patientshoul dnoti
fyhealt
hcare
prof
essionali
fdrynessper sist
s( sali
vasubstit
utes
maybeused) .Also,notif
yt hedent i
stifdry
ness

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 401
 i
nter
fer
eswi
thuseofdent
ures.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Instructpati
enttonoti
fyhealthcareprof
essionali
f
diff
icultywit
hur i
nat
ion,consti
pati
on,abdominal
discomf ort
,rapi
dorpoundi ngheart
beat,confusi
on,
eyepai n,orrashoccurs.

Advisepatientt
oconf
erwithhealthcareprofessi
onal
beforetaki
ngOTCmedi cat
ions,especial
lycold
remedies,ordri
nki
ngal
coholicbeverages.

Cautionpat i
entthatthi
smedicat
iondecr
eases
perspirati
on.Overheati
ngmayoccurduri
nghot
weat her.Pati
entshouldnot
if
yhealt
hcare
professionali
funabletoremaini
ndoorsi
nanair-
condi t
ionedenvir
onmentduringhotweat
her.

Advi
sepati
entt
oav oi
dtaki
ngant
aci
dsor
ant
idi
arr
heal
swithi
n1–2hrofthi
smedi
cati
on.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

BENZYLALCOHOL
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 402
Topi
cal
treat
mentofheadl
i
cei
npat
ient
s≥6mo.

ACTI
ON
Ki
ll
sheadli
ce(pedicul
oci
dal
);notov
oci
dal
.Ther
apeut
ic
Ef
fect
s:Er
adicat
ionofheadl
ice.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Nonenot
ed;
Pedi
:Chi
l
dren<6mo
(saf
etynotest
abl
i
shed;
riskofgaspi
ngsy
ndr
omei
n
neonates)
.

UseCaut
iousl
yin:
OB:
Lact
ati
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT: oculari
rr
itati
on.Derm:contactdermati
ti
s,er
ythema,
pruri
tus,pyoderma.Local:appl
icat
ionsit
eanesthesi
a,
appli
cationsit
ehy poesthesi
a,appl
icat
ionsit
eirr
it
ati
on,
pain.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
Topi
cal
:(Adul
tsandChi
ldr
en≥6mo):
Shorthai
r0–2i
n
l
ong—apply4–6oz(1/
2–3/4bot
tl
e)r
epeati
n7days;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 403
Shorthai
r2–4i nlong—apply6–8oz( 3/4–1bottl
e)repeat
i
n7day s;Medium hair4–8inlong—apply8–12oz( 1–1
1/2bottl
es)repeatin7days;Medium hair8–16in
l
ong—appl y12–24oz( 11/2–3bot t
les)
,repeati
n7day s;
Longhair16–22i nlong—apply24–32oz( 3–4bottl
es),
repeati
n7day s;Longhair>22inlong—apply32–48oz
(4–6bottl
es),r
epeatin7day s.

AVAI
LABI
LITY
5%l
oti
oni
n8-
ozbot
tl
es;

PATI
ENTTEACHI
NG
Instructpat i
ent /parentt
ousebenzy l
alcohol as
directed.I fl
otioncomesi ncont actwithey es, flush
them immedi at elywithwater.Not i
fyhealthcar e
professional ifirri
tati
onpersists.Emphasi zet he
i
mpor tanceofsecondt r
eatment1wkaf teri nitial
application.Inst r
uctpatient
/ parenttoreadPat ient
Informat ionbef oreusingbenzy l al
coholandwi th
eachRxr efi
l
l;newi nf
ormationmaybeav ailabl e.

Advisepat i
ent
/parentt
owashi nhotwat erordr
y
cl
eanal lr
ecentl
ywor nclot
hing,hats,usedbedding,
andt owels.Washpersonalcareitemssuchascombs,
brushes,andhaircli
psinhotwat er.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 404
 Advisefemalepati
ent
sorpar entst
onoti
fyheal
th
careprofessi
onali
fpregnancyispl
annedor
suspectedorifbr
eastfeedi
ng.

Benzy
lBenzoat
e
I
ndi
cat
ions
Scabi
es;
head,
bodyandpubi
cli
ce;
pedi
cul
osi
s.

Av
ail
abi
l
ity
LOTI
ON100ml
(25%w/
v);
OINTMENT25%w/
w(25g)
.

DOSAGE
Adul
t-Scabi
es:
appl
yfr
om neckdownatnightf
or2ni
ght
s;
oneachoccasi
onwashof
fafteratl
east24h.
Pedicul
osi
s:applytoaf
fect
edar eaandwashof
f24hlater
;
fur
therappl
icat
ionspossi
blyneededaft
er7and14days.

Cont
rai
ndi
cat
ions
I
rr
it
atedski
n;neonat
es;
pregnancy
.

Pr
ecaut
ions
Donotuseoni
nfl
amedorbr
okenski
n;av
oidcont
actwi
th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 405
eyesandmucousmembr anes;
notr
ecommendedfor
chil
dren;
lact
ati
on(wi
thholdduri
ngt
reat
ment
);appl
ybel
ow
neckonly;el
der
ly.

Adv
erseEf
fect
s
Local
irr
it
ati
on;
par
ti
cul
arl
yinchi
l
dren.

St
orage
St
orepr
otect
edf
rom l
i
ghtandai
rinwel
lfi
l
ledcont
ainer
s.

Benzy
lPeni
cil
l
in
I
ndi
cat
ions
Mil
dtomoderat
ei nf
ect
ionsofupperrespir
ator
ytr
actdue
t
osuscept
ibl
estrept
ococci
,syphi
li
s,prophyl
axi
sof
r
heumati
cfever
.

Av
ail
abi
l
ity
I
NjECTABLESUSPENSI
ON-6,12,
24Lacunit
s;
I
NjECTABLESUSPENSI
ON-1200,
000uni
ts/
2ml.

DOSAGE
Strept
ococcalURTI:1.
2mill
ionuni
t(>27kg)si
ngledose
(deepIMinj)af
tersensi
ti
vi
tytest(
AST);0.
6mill
ionuni
t

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 406
(
<27kg)si
ngl
edose(
deepI
Minj
)AST.
Secondaryprophy
laxi
sofRheumati
cf ev
er:1.
2mi ll
ionuni
t
(>27kg)singl
edose(deepIMinj
)aft
ersensit
ivit
ytest
(AST)every21days;0.6mi
ll
ionuni
t(<27kg)singledose
(deepIMinj)ASTevery15days.
Syphi
lis:Pri
mar y ,
secondary,orear
lylatent
:Si
ngledoseof
2.
4mi lli
onUni tIM; Lat
elatent(orl
atentofuncer
tai
n
durat
ion),cardiovascular
,orbenigntert
iary
:2.4mil
li
on
UnitI
M weekl yf or3weeks.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
ty,
neur
osy
phi
l
is.

Pr
ecaut
ions
Hyper
sensit
ivi
tyt
ocephalospori
nsor/andpeni
cil
l
ins,
el
derl
y,i
nfant
s,ast
hma,renalimpai
rmentlact
ati
on
pr
egnancy.

Adv
erseEf
fect
s
Hy persensit
ivi
tyreact
ionssuchasexf ol
i
ativ
edermatiti
s,
painati nj
ecti
onsi t
e;thr
ombophl ebi
ti
sofinj
ectedvei
n,
diarrhoea,nausea,joi
ntpain,angi
oedema,serum si
ckness
l
iker eacti
ons,haemol yt
icanaemia,i
nter
sti
ti
alnephri
ti
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 407
St
orage
Storepr
otect
edfr
om moi
stur
eatat
emper
atur
enot
exceedi
ng30⁰C.

BEPOTASTI
NE
I
NDI
CATI
ONS
Tr
eat
mentofi
tchi
ngassoci
atedwi
thal
l
ergi
cconj
unct
ivi
ti
s.

ACTI
ON
Actsasahi st
amineH1r eceptorantagonist;al
soinhibi
ts
thereleaseofhistaminefrom mastcells;doesnotbi ndto
orinactivat
ehist
ami ne.Ther
apeuticEffects:Decreased
ocularitchi
ngassociatedwit
hal l
ergicconjuncti
vi
tis.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Cont
actl
ensuse;
OB:
Usedur
ing
pregnancypotent
ial
mater
nalbenef
itjust
if
iest
hepot
ent
ial
ri
sktof et
us;Lact
ati
on:
Usecauti
ouslyduri
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 408
breast
feedi
ng;
Pedi
:Safeandef
fect
iveusei
nchi
l
dren<2
yrhasnotbeenest
abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache.EENT:nasophar
yngi
ti
s.GI
:tast
einmout
h
fol
l
owinginsti
l
lat
ion.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
Opht
h(Adul
ts)
:Onedr
opi
naf
fect
edey
e(s)t
wicedai
l
y.

AVAI
LABI
LITY
Opht
hal
micsol
uti
on1.
5%;

PATI
ENTTEACHI
NG
Instructpat
ientt
oinsti
l
lbepotasti
nedropsas
directed.Donottouchdroppertoeyeortoany
sur f
ace.

Advi
sepat i
enttoremovecont actlenspriorto
i
nsti
l
lati
on.Donotusebepot asti
nef ort
reatmentof
i
rr
it
ati
onr el
atedtocontactlens.Donotwearcont act
l
ensifeyesarered.Contactlensmayber ei
nser
ted

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 409
 10mi
nfol
l
owi
ngi
nst
il
lat
ion.

Advi
sefemalepati
enttonot
if
yhealthcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Besi
fl
oxaci
n
I
NDI
CATI
ONS
Tr
eat
mentofbact
eri
alconj
unct
ivi
ti
s.

ACTI
ON
Inhibit
sbact erialDNAsy nthesisbyinhibit
ingDNAgy rase.
Ther apeuticEf f
ect s:Deathofsuscept i
blebact er
iawith
decr easedsy mpt omsandsequel aeofbact eri
al
conjunct i
vit
is.Spect r
um: Acti
veagainstCDCcor yneform
groupG, Corynebact er
ium pseudodiphtherit
icum,
Cor ynebacterium st ri
atum, Haemophi l
usinfluenzae,
Mor axel l
alacunat a,Staphylococcusaur eus,
Staphy lococcusepi dermidi
s,Staphylococcushomi ni
s,
Staphy lococcusl ugdunensi s,Str
eptococcusmi t
isgroup,
Streptococcusor alis,Str
eptococcuspneumoni aeand
Streptococcussal ivari
us.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 410
Cont
rai
ndi
cat
edi
n:Cont
actl
ensuse.

UseCaut
iousl
yin:
OB:
Usedur
ingpr
egnancyonl
yif
pot
enti
albenef
itj
usti
fi
espot
ent
ial
risktofet
us;
Lact
ati
on:
Usecauti
ousl
yduringl
act
ati
on;
Pedi:Safeusei
nchi
ldr
en
<1yrnotest
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
headache.EENT:conj
unct
ivalr
edness,
blur
redv
isi
on,
ey
eir
ri
tat
ion,
eyepain,
ey epr
uri
tus.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
Ophth(
Adult
sandChi
ldr
en≥1yr
):Onedropi
naffect
ed
eye(
s)t
hreeti
mesdai
l
y(4–12hapart
)for7day
s.

AVAI
LABI
LITY
Opht
hal
micsuspensi
on0.
6%5mLi
n7.
5mLbot
tl
e;

PATI
ENTTEACHI
NG
I
nst
ructpatientt
ousebesifl
oxaci
nasdirect
ed,evenif
f
eel
ingbetter.Donotski
pdosesorstoptherapyearl
y;
mayleadtodecreasedeff
ecti
venessandresist
ant

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 411
 i
nfect
ions.Avoi
dtouchi
ngappli
cat
ortoeye,
finger
,or
ot
herareas;maycontaminat
e.Washhandspriort
o
i
nsti
ll
ati
on.

Cauti
onpati
entt
oav
oidwear
ingcont
actl
enses
dur
ingther
apy.

Adv i
sepati
entt
odisconti
nueimmedi at
elyandnotif
y
healthcar
eprof
essionali
fsignsorrashorall
ergi
c
reacti
on(hi
ves,
dif
fi
cultybreat
hing,
swelli
ngofthroat)
occur.

Bet
amet
hasone
I
ndi
cat
ions
Sev er
einfl
ammat oryskincondit
ionsi
nludingcontact
dermat i
ti
s,atopi
cdermat i
ti
s(eczema),seborr
hoeic
dermat i
ti
s,l
ichenplanus,psor
iasi
softhescalp,handsand
feet,i
ntr
actablepruri
tus;
Addison’sdi
sease,Simmond’s
disease,bursi
ti
s.

ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 412
Av
ail
abi
l
ity
TABLETS0.5mg;I
NJECTI
ON1mlampoul
e(4mg/
ml)
;
CREAM 0.
1%;OI
NTMENT0.1%.

DOSAGE
Adul
tandchi
l
d:
Inf
lammatoryski
ncondit
ions,
ov er2year
sofage:
apply
smallquant
it
ytotheaff
ectedarea1t o2ti
mesdail
yunti
l
i
mpr ovementoccur
s,t
henlessfrequent
ly.

Cont
rai
ndi
cat
ions
Unt
reatedskininfect
ionsorbrokenski
n;rosacea;acne;
per
ioraldermati
ti
s;systemi
cinfect
ionsunlessspecif
ic
ant
i-
infecti
vether
apyi sempl
oy ed.

I
NTERACTI
ONS
Drug-Dr ug:Addit
ivehypokalemiawiththiazi
deand
l
oopdi ureti
cs,oramphot eri
cinB.Hypokal emiamay↑ r i
sk
ofdigitali
sglycosidetoxici
ty.May↑ r equir
ementfor
i
nsulinsoror alhypoglycemicagents.
Pheny toin,
phenobarbit
al,andrif
ampinst imulat
e
metabol ism;may↓ ef f
ecti
veness.Oral cont
racept
ives
maybl ockmet aboli
sm.↑ r i
skofadv erseGIeffect
swith

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 413
NSAIDs( includingaspi
rin)
.Atchroni
cdosesthatsuppr
ess
adrenal
f unct i
on,may↓ ant i
bodyresponsetoand↑ ri
sk
ofadverser eact i
onsfr
om li
ve-v
irusvacci
nes.

Pr
ecaut
ions
Chil
dren(avoidprol
ongeduse) ;
adr enalsuppr essioni
f
usedonal argeareaofthebodyorf oralongt i
me;
part
icul
arl
ywi thanocclusi
vedressi ngoronbr okenski
n;
avoi
duseont hefaceformor ethan7day s;secondary
i
nfecti
onrequirestreat
mentwi t
hanappr opriate
anti
microbi
al;mayimpai rt
heabi l
i
tyt oresistand
counter
actinfect
ions;di
abetesmel lit
us;pregnancyelderl
y;
l
act
ati
on.

Adv
erseEf
fect
s
Exacerbat i
onofl ocal i
nfect i
on;local atr
ophicchanges
part
icular l
yont hef aceandi nskinfolds;characteri
zedby
thi
nningoft heder mis;depi gment ati
on;dilatat
ionof
superficialbloodv esselsandf ormat ionofst ri
ae;peri
oral
dermat it
is;acneatsi teofappl ication;suppressionofthe
hypothal amic-pituitary-
adr enalaxiswi t
hpr olongedor
widespr eaduse( par t
icularlyunderoccl usion);
subcapsul arcat aract ;
ost eoporosis;glaucoma; i
ntr
acrani
al
hypertension; psy chicinstabili
ty.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 414
PATI
ENTTEACHI
NG
Instructpati
entoncor recttechni queofmedi cation
admi nistr
ati
on.Adv i
sepat i
entt ot akemedi cat i
onas
directed.Takemi sseddosesassoonasr emember ed
unlessal mostt i
mef ornextdose.Donotdoubl e
doses.St oppingt hemedi cationsuddenl ymayr esult
i
nadr enali
nsuf f
iciency(anorexi a,nausea, weakness,
fatigue,dyspnea, hypotension, hypoglycemi a).I
ft hese
signsappear ,
notifyhealthcar epr ofessi
onal
i
mmedi at
ely.Thiscanbel i
fe-threatening.

Glucocort
icoidscauseimmunosuppr essi
onandmay
masksy mpt omsofinfecti
on.Instr
uctpatienttoavoi
d
peoplewithknowncont agi
ousi l
lnessesandt orepor
t
possibl
einfecti
onsimmedi at
ely.

Cauti
onpat
ienttoav
oidvacci
nati
onswi
thoutf
ir
st
consul
ti
nghealt
hcarepr
ofessi
onal.

Revi
ewsi deef f
ectswithpati
ent.Instr
uctpat i
entto
i
nform healthcareprofessi
onalprompt l
yi fsever
e
abdominal pai
nort ar
rystool
soccur Patientshould
al
sorepor tunusualswelli
ng,weightgain,tir
edness,
bonepain, br
uisi
ng,nonheali
ngsor es,vi
sual
di
stur
bances, orbehaviorchanges.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 415
 medi
cat
ionr
egi
menbef
oret
reat
mentorsur
ger
y.

Discusspossi
bleef
fect
sonbodyi
mage.Expl
ore
copingmechanisms.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onalif
symptomsofunder l
yingdiseaser
etur
norwor sen.

Advi
sepatienttocar
ryi
dent
if
icat
iondescr
ibing
di
seaseprocessandmedicat
ionregimenintheev
ent
ofanemergencyinwhichpat
ientcannotr
elate
medical
history
.

Explainneedforconti
nuedmedicalf
oll
ow-upto
assessef f
ecti
venessandpossi
blesi
deef f
ect
sof
medi cat
ion.Per
iodi
clabtest
sandey eexamsmaybe
needed.

Long-
ter
m Therapy:
Encouragepat
ientt
oeatadi
et
hi
ghinprot
ein,
calci
um, andpot
assium,andl
owi
n
sodi
um andcarbohydr
ates

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Bet
axol
ol
I
NDI
CATI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 416
Managementofhy
per
tensi
onandGl
aucoma.

ACTI
ON
Blockssti
mulat
ionofbet a1(my ocardial
)adrenergi
c
recept
ors.Doesnotusual l
yaffectbeta2(pulmonary,
vascular
,ut
eri
ne)receptorsit
es.Ther apeut
icEffect
s:
DecreasedBPandhear trate.

Av
ail
abi
l
ity
Ey
EDROPS5ml
(0.
5%w/
v).
Tabl
ets10mg,
20mg;

DOSAGE
I
nst
il
lat
ioni
ntot
heey
e:
Adul
t-1t
o2dr
ops,
twi
cedai
l
y.
Chi
l
d-Notr
ecommended.

PO:(
Adul
ts)
:10mgoncedai
l
y,maybe↑ t
o20mgaf
ter
7day
s;st
artwi
th5mgi
nger
iat
ri
cpat
ient
sorpat
ient
swi
th
r
enali
mpair
ment.

Renal
Impai
rment
PO:
(Adul
ts)
:St
artwi
th5mgoncedai
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 417
Cont
rai
ndi
cat
ions
Systemicabsor ptionmayf ol
lowtopi
calappli
cati
ontothe
eyes,thereforetheyarecontrai
ndi
catedinpati
entswit
h
br
ady cardia,heartblock,
oruncontr
oll
edheartfai
lur
e;
hypersensiti
vity
.Uncompensat edHF;Pulmonaryedema;
Cardiogenicshock; Bradycar
diaorhear
tblock.

I
NTERACTI
ONS
Drug-Drug: Gener al anesthet i
cs, I
Vpheny toin,and
verapami lmaycauseaddi t
ivemy ocar dial depressi on.
Addi t
ivebr ady cardiamayoccurwi thdi goxi n,ver apami l
,or
dil
tiazem.Addi ti
vehy pot ensionmayoccurwi thot her
antihypertensi ves, acutei ngestionofal cohol ,
orni t
rates.
Concur rentusewi thamphet amines, cocai ne,epi nephr i
ne,
norepinephr ine, pheny lephr i
ne,orpseudoephedr inemay
resultinunopposedal pha- adrener gicst i
mul ati
on
(excessivehy per t
ensi on,br adycar di
a) .Concur rentt hyroi
d
preparationadmi nistrati
onmay↓ ef fect iveness.Mayal ter
theef f
ect i
venessofi nsul i
noror alhy pogl ycemi cagent s
(dosageadj ust ment smaybenecessar y)
.May↓ t he
effecti
venessoft heophy ll
ine.May↓ t hebenef icialbeta1-
cardiovascul aref fectsofdopami neor dobut ami ne.Use
caut i
ouslywi thi n14day sofMAOi nhi bitortherapy( may
resultinhy pert ension) .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 418
Pr
ecaut
ions
Ayedr
opAvoi
dinasthma, poorcardi
acreser
ve,
hepat
ic
i
mpair
ment
;notfori
nject
ion;pregnancy
.
PO: Renal orhepaticimpairment ;Pulmonar ydisease
(i
ncl udingast hma; beta1selectivi
tymaybel ostathigher
doses) ;av oi
dusei fpossi
ble;Diabetesmel l
it
us;
Thy rotoxicosis;Historyofsevereal l
ergicreacti
ons
(i
ntensi tyofr eacti
onsmaybe↑) ;Untreated
pheochr omocy toma( ini
ti
ateonl yafteralphablocker
therapyst arted);OB: Lact
ation:Pedi: Safetynot
establ i
shed; crossest hepl
acent aandmaycause
fetal/neonat albradycardi
a,hy potension,hypoglycemia,or
respi r
atorydepr ession;Geri
: ↑ sensitivi
tytobeta-bl
ockers;
i
nitialdose↓ r ecommended.

Adv
erseEf
fect
s
Ocularstinging,burning, pain,it
ching,erythema, dryeyes
andallergicreactionsincl udinganaphy laxisand
bl
ephar oconjunct i
vi
tis;occasi onallycornealdisorders
havebeenr eported;crust ytaste,photophobia, corneal
punctuatest ai
ning,decr easedcor nealsensiti
vity,
kerati
ti
s,
ani
socor ia;headache; sleepdi sturbances.

PO:
CNS:
fat
igue,
weakness,
anxi
ety
,depr
essi
on,
dizzi
ness,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 419
drowsiness,insomni a,memor yloss, ment al status
changes,nightmar es.EENT: blurredv ision, stuff
ynose.
Resp:bronchospasm, wheezi ng.CV: BRADYCARDI A,
HF,
PULMONARYEDEMA, hy potension, peripher al
vasoconstri
ction.GI:const i
pation,diar r
hea, ↑l i
ver
enzymes, nausea,v omiting.GU: erectiledy sfunct i
on,
↓
l
ibido,uri
naryfrequency .Derm: rashes.Endo:
hypergly
cemi a,hypoglycemi a.MS: arthral
gi a,backpain,
j
ointpain.Misc: dr
ug- i
nducedl upussy ndr ome.

PATI
ENT TEACHI
NG
Instr
uctpat i
enttotakemedicati
onasdi r
ected,
atthe
samet i
meeachday ,ev
eniffeel
ingwell;
donotskip
ordoubl euponmi sseddoses.Takemi sseddosesas
soonaspossi bl
eupt o4hrbeforenextdose.Abrupt
withdrawal mayprecipi
tat
eli
fe-t
hreat
ening
arrhyt
hmi as,hyper
tensi
on,ormy ocar
diali
schemia.

Advisepat ienttomakesur
eenoughmedicati
onis
avai
lablef orweekends,
holi
days,
andv
acations.A
writ
tenpr escript
ionmaybekepti
nwal
letincaseof
emer gency .

Teachpat i
entandfamil
yhowt ocheckpul
seandBP.
Inst
ructthem t
ocheckpulsedailyandBPbi
weekl
y
andtor epor
tsigni
fi
cantchanges.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 420
Maycausedr owsinessordizzi
ness.Cauti
onpat
ient
s
toavoiddri
vi
ngorot heract
ivi
ti
esthatrequi
re
aler
tnessunti
lresponsetothedrugisknown.

Advi
sepati
entst
ochangeposi
ti
onssl
owl
yto
mini
mizeort
host
ati
chypot
ensi
on.

Cauti
onpat
ientt
hatt
hismedi
cat
ionmayi
ncr
ease
sensi
ti
vi
tyt
ocold.

Instr
uctpati
enttonot i
fyheal
thcarepr of
essionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbeingtakenandt oconsultheal
t hcare
professi
onalbeforetaki
nganyOTCmedi cati
ons,
especial
lycoldpreparat
ions,
concur r
entl
ywi t
hthis
medi cat
ion.

Patient
swi t
hdi abetesshoul
dclosel
ymoni t
orblood
glucose,especial
lyifweakness,
malaise,
irr
it
abi
lit
y,or
fati
gueoccur s.Betaxol
olmaymasksomesi gnsof
hypoglycemia,butsweat i
nganddizzi
nessmayoccur .

Advi
sepat i
enttonotif
yheal thcareprofessi
onali
f
sl
owpul se,di
ff
icul
tybreathing,wheezing,col
dhands
andfeet,di
zzi
ness,confusion,depression,r
ash,f
ever
,
sor
et hr
oat,unusualbl
eeding, orbrui
singoccurs.

I
nst
ructpat
ienttoi
nfor
m healt
hcareprofessi
onal
of
medi
cati
onregimenbefor
etreatmentorsurger
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 421
 Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Hypertension:Reinforcet heneedt oconti

nue
additi
onaltherapiesf orhy pertension(wei
ghtl
oss,
sodium restri
cti
on,st ressr educti
on, r
egul
arexerci
se,
moder ati
onofal cohol consumpt ion,andsmoking
cessation)
.Medi cationcont r
olsbutdoesnotcur e
hypertensi
on.

Bet
hanechol
I
NDI
CATI
ONS
Post par
tum andpostoper
ativ
enonobstr
ucti
veur
inary
retenti
onorurinar
yretent
ioncausedbyneur
ogenic
bladder.

ACTI
ON
Stimulateschol i
nergicreceptors.Effectsincl
ude:
Cont r
actionoft heurinarybladder,Decreasedbl adder
capaci t
y,Increasedfrequencyofur eteralperistalt
icwav es,
Increasedt oneandper istal
sisintheGIt ract,Increased
pressurei ntheloweresophageal sphincter,I
ncr eased
gast r
icsecretions.TherapeuticEffects:Bladderempt y
ing.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 422
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Mechani
cal
obst
ruct
ionoft
heGIorGUt
ract
.

UseCaut
iousl
yin:
Hist
oryofast
hma;
Ulcerdi
sease;
Cardi
ovascul
ardisease;Epil
epsy
;Hypert
hyroi
dism;
Sensi
tiv
ityt
ocholinergi
cagentsoref
fects;
OB: Lact
ati
on:
Pedi:
Safetynotestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache,malaise.EENT: lacr
imation,miosis.Resp:
br
onchospasm.CV: HEARTBLOCK, SYNCOPE/ CARDIAC
ARREST,bradycar
dia, hy
potension.GI:abdomi nal
di
scomfort
, di
arr
hea, nausea,sali
vati
on,vomiting.GU:
ur
gency.Misc:fl
ushing,sweating,hypothermia.

I
NTERACTI
ONS
Drug-Drug:Quinidineandpr ocai
nami demayant agonize
choli
nergiceffects.Additi
vecholi
nergicef f
ectswi th
choli
nesteraseinhi bi
tor
s.Usewi t
hgangl ionicblocking
agentsmayr esultinseverehypotension.Donotusewi th
depolar
izingneur omuscularblockingagent s.
Eff
ectiv
enesswi l
l bedecreasedbyant icholi
nergics.
Dr
ug-
Nat
ural
Product
:Chol
i
ner
gicef
fect
smaybe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 423
ant
agoni
zedbyangel
'
str
umpet
,ji
msonweed,
orscopol
i
a.

DOSAGE
PO: (
Adults):25–50mg3t imesdai
ly
.Dosemaybe
determinedbyadmi ni
steri
ng5–10mgq1–2hrunt il
responseisobtainedortotalof50mgadminist
eredorby
start
ingwith10mg, giv
ing25mg6hrl at
er,
then,i
fneeded,
50mg6hrl ater.
PO:(
Chil
dren)
:0.
2mg/
kg3t
imesdai
l
yor0.
15mg/
kg4
ti
mesdail
y.
Subcut( Adul
ts):
5mg3–4t i
mesdai
ly.Dosemaybe
determinedbyadmini
steri
ng2.5mgq15–30mi nunti
l
responseisobtai
nedortotal
of4dosesadmini
ster
ed.
Subcut(
Chil
dren)
:0.
06mg/
kg3t
imesdai
l
yor0.
05
mg/kg4timesdai
ly.

AVAI
LABI
LITY
Tabl
ets5mg,
10mg,
25mg,
50mg;
Inj
ect
ion5mg/
mL;

PATI
ENT TEACHI
NG
I
nstructpat
ientt
otakemedicat
ionexact
lyasdir
ected.
Misseddosesshouldbetakenassoonaspossible
wi
thin2hr ;
other
wise,
ret
urntoregul
ardosing

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 424
 schedul
e.Donotdoubl
edoses.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Advisepat i
enttoreportabdominal
discomfor
t,
sali
vation,sweati
ng,orflushi
ngtohealt
hcare
professional
.

Bev
aci
zumab
I
NDI
CATI
ONS
Met astat
iccolonorrectalcar
cinoma( wit
hIV
5–fluorouraci
l)
.Fir
stli
netreatmentofpatientswith
unresectable,
local
lyadvanced,recurr
entormet ast
ati
c
non-squamous, non-smallcel
llungcancerwi t
h
carboplati
nandpacl i
taxel
.Pati
entswi t
hprogressiv
e
gli
oblastomaf ol
lowingpri
ortherapy.Metastati
crenalcel
l
carcinoma( wit
hinterf
eronalf
a).

ACTI
ON
Amonocl onalantibodythatbindst ovascularendotheli
al
growthfactor(
VEGF) ,preventi
ngi tsatt
achmentt obinding
si
tesonv ascul
arendot heli
um, t
her ebyinhibi
ti
nggrowt hof
newbl oodvessels(angiogenesis).Therapeuti
cEffects:
Decreasedmet astati
cdiseasepr ogressionand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 425
mi
crov
ascul
argr
owt
h.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Recenthemopt
ysi
s
orot herseriousr ecentbl eedingepisode;Fi
rst28day s
aftermaj orsur gery;OB:Angi ogenesisiscrit
icaltothe
dev elopi
ngf etus.Cont r
ai ndi
catedunl essbenefitto
mot herout weighspot ent ial
fetalharm.Lactati
on:
Discont i
nuenur si
ngdur ingt r
eatmentand, duet olonghal
f
-l
i
fe, forseveral weeksf ollowingtreatment.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease;
Pedi
:Saf
ety
notest
abl
ished;Ger
i:↑r
iskofser
iousadver
ser
eact
ions
i
ncludi
ngarter
ial
thr
omboemboli
cevents.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: r
ever si
blepost eri
orleukoencephalopat hysyndrome
(RPLS).CV: HF,THROMBOEMBOLI CEVENTS,
hypert
ensi on,hypotension.Resp: HEMOPTYSI S,non-
gastr
ointestinalfi
stulas,nasalseptum perforati
on.GI: GI
PERFORATI ON.GU: nephroti
csy ndrome,ov ari
anfail
ure,
prot
einuria.Hemat :BLEEDI NG.Mi sc:WOUND
DEHISCENCE, impairedwoundheal ing,
infusionreactions.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 426
Drug-Drug:↑ bloodlevelsofSN38( t
heacti
vemetabol
i
te
ofir
inotecan);si
gnif
icanceisnotknown.↑ r
iskof
microangiopathi
chemol yti
canemiawhenusedwith
sunit
ini
b; concurr
entuseshouldbeav oi
ded.

DOSAGE
Col
onCancer
I
V:(
Adul
ts)
:5mg/
kgi
nfusi
onev
ery14day
s.

LungCancer
I
V:(
Adul
ts)
:15mg/
kgi
nfusi
onev
ery3wk.
Gl
i
obl
ast
oma
I
V:(
Adul
ts)
:10mg/
kgi
nfusi
onq14day
s.

Renal
Cel
lCar
cinoma
I
V:(
Adul
ts)
:10mg/
kgi
nfusi
onq14day
s.

AVAI
LABI
LITY
Sol
uti
onfori
nject
ion(r
equi
resdi
l
uti
on)100mg/
4mLv
ial
,
400mg/16mLv i
al;

PATI
ENT TEACHI
NG
I
nfor
m pat
ientofpur
poseofmedi
cat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 427
 Advisepati
entoftheneedformoni
tor
ingBP
peri
odical
lydur
ingther
apy;not
if
yheal
thcar
e
prof
essionali
fBPi sel
evat
ed.

Adv isepati
enttor eportanysignsofbleeding,unusual
bleeding,hi
ghfev er,ri
gors,suddenonsetof
wor seningneurol
ogi calfunct
ion,orpersi
stentor
sever eabdominal pain,sever
econst i
pati
on,or
vomi ti
ngimmedi atelytohealthcareprofessional
.

Inf
orm pat
ientofi
ncr
easedri
skofwoundheal
ing
compli
cati
onsandarter
ial
thr
omboemboli
cevents.

Bevacizumabi sterat
ogenic.Advi
sefemalepati
ents
touseef fecti
vecont r
aceptionduri
ngandforatleast
6moaf terlastdose.Inf
ormf emalepati
entofri
skof
ovari
anf ail
uret hatmayleadt ost
eri
li
tyf
oll
owing
ther
apy .

BEXAROTENE
I
NDI
CATI
ONS
Oral
—Tr eat
mentofcut aneousT-celll
ymphoma
(cut
aneousmani fest
ati
ons)inpatient
swhohavef ai
ledat
l
eastonepr ev
ioussy st
emictherapy.Topi
cal
—Treatment
ofcutaneousT-celll
ymphoma( cutaneousmani
festati
ons)

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 428
i
nSt ageI
AorIBpati
entswhohaver
efr
actor
y/per
sist
ent
l
esionsandhavenotr
espondedt
oortol
erat
edother
t
reatments.

ACTI
ON
Bindsandinactiv
at esselectedreti
noidXr eceptors(RXRs)
thatareul
timatel
yr esponsibleforcell
ulardif
ferenti
ati
on
andproli
ferat
ion.Inhibi
tsgrowt hofsomet umorcellli
nes
i
ncludingli
nesofhemat opoeticandsquamouscel lori
gin.
Therapeuti
cEffects:Decreasedspr eadofcut aneousT-cel
l
l
y mphoma.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentuseof
gemfi
brozi
l;
OB:Pr
egnancy(
maycausef
etal
har
m);
Lact
ati
on:Avoi
dbr
eastf
eedi
ng.

UseCaut
iousl
yin:
Hepat
ici
mpai
rment(
may↓
eli
mination);Renalimpair
ment( mayalterprotei
nbi ndi
ng);
Diabeti
cpat i
ents(concurrentusewi thsomeant i
diabeti
cs
mayi ncreasetheriskofhy poglycemia);Pati
entswi thchi
ld
-beari
ngpot enti
al/
mal epatientswi t
hpartnerswhohav e
chil
d-bearingpotenti
al;Geri
: El
derlypati
entsmaybemor e
sensiti
vetodr ugeffect
s;Pedi :
Saf eandef f
ectiv
eusei n
pediatr
icpatientshasnotbeenest abli
shed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 429
ADVERSEREACTI
ONSANDSI
DEEFFECTS
Or
al
CNS: headache, weakness, i
nsomni a.EENT:
new/ worseningcataracts.CV: peripher aledema.GI :
PANCREATI TIS,abdomi nalpain,nausea, anorexia,
diarr
hea,li
verf unct
ionabnor mal i
ties, vomiti
ng.Derm: dry
skin,r
ash,alopecia,exfoli
ativ
eder mat iti
s,photosensit
ivi
ty.
Endo: hy
perlipi
demi a,hypercholest erolemia,
hypothyroi
dism.Hemat :anemi a,leukopeni a.Mi sc:f
lu-
li
ke
syndrome.

Topi
cal
CNS:headache.CV:edema.Derm:
pain,
prur
it
us,ski
n
di
sorder,
rash.Endo:
hyperl
i
pidemi
a.Hemat:
leukopeni
a.
Misc:l
ymphadenopathy.

I
NTERACTI
ONS
Drug-Drug: I
nteract ionsarenotedforor al
use,butmay
occurwi t
ht opical useespeci al
lywithhigh
dose/prolongedt reatment .↑ l
evelsandr i
skoftoxi
cit
y
withgemf ibrozil
; concur r
entusenotr ecommended.
Combi nati
onr egi menofpacl i
taxelandcarbopl
atin↑
l
ev el
s.Mayactasani nduceroftheCYP3A4enzy me
system; may↓ l ev elsandeffecti
venessofsubstrat
esof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 430
theCYP3A4sy stem includingatorvastati
n,t
amoxifen,
paclit
axel andhor monal contr
acept i
ves.Vi
taminAmay↑
ri
skoft oxicit
y( l
imitsuppl ementationto<15,000IU/ day
).
Concur rentuseofi nsul i
n,sulf
onylureasor
thiazol
idinedionesi ndiabeticpati
ent smay↑ r i
skof
hypoglycemi a.Topi cal—Concur r
entusewi thDEET( N,N-
diethyl
-m- t
oluami de)-contai
ninginsectrepell
ent
smay↑
ri
skofDEETt oxicit
yandshΩbeav oided.

DOSAGE
PO:(Adul
ts):300mg/m2oncedaily;dosaget
obe
adj
ustedbasedontol
erance/
toxi
cit
y.
Topical:(
Adult
s) :Applyonceever
yotherdayforoneweek,
i
ncreaseatweekl yinterv
altooncedai
ly,t
hentwicedai
l
y,
thenthreetimesdailyandfinal
l
yfourti
mesdai l
yas
tol
erated,cont
inuedasl ongasbenefi
tisder
ived.

AVAI
LABI
LITY
Capsul
es75mg;Topical
gel1.0%(
contai
nsdehydr
ated
al
coholandpr
opy
leneglycol
in60gram t
ubes;

PATI
ENTTEACHI
NG
I
nstructpati
entt
ot akeorappl
ybexar
oteneas
di
rected.Takemisseddosesassoonasr emember
ed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 431
 unl
esscloset
oti
mef
ornextdose;
donotdoubl
e
doses.

Advisepatienttoavoi
dt ouchingbrokenorleaki
ng
capsulesandnot i
fypharmaci st.I
fcont
entsgeton
ski
n, i
mmedi atel
ywashar eawi t
hsoapandwat erand
noti
fyhealthcareprofessional.Donotusecapsules
aft
erexpirati
ondate.

Adv i
sepat i
enttonot
ifyheal
thcarepr
ofessi
onal
i
mmedi atel
yifsi
gnsandsy mptomsofpancreati
ti
s
(persi
stentnausea,v
omi t
ingandabdominalorback
pain)occur.

Caut
ionpati
entt
owearpr ot
ectiv
eclothi
ngandavoi
d
sunl
i
ghtandarti
fi
cialult
ravi
oletl
ightt
oprevent
phot
otoxoci
tyr
eactions.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations,
especial
lyvi
tami
nA.

Caut i
onpatientthatbexar ot
eneisteratogeni
cand
shouldbeav oidedduringpr egnancy.Pregnancytest
s
will
bet akenbeforestar t
ingandmont hl
yduring
therapy.Eff
ectiv
econt racepti
onmustbeused1mo

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 432
 beforebeginningther apy,
dur i
ng,and1mof oll
owing
therapy.Twof ormsofcont raceptionare
recommendedwi t
hatl east1bei ngcondom,
diaphragm, cervi
cal cap,
IUD, orsper maci
de.Pati
ents
shouldnotbr eastfeedduringt herapy.Malepat
ients
whosepar t
nerispr egnantorcapabl eofbecoming
pregnantshoul ddiscusspr ecauti
onswi thheal
thcare
professional.

Expl
ainneedf
orr
egul
arbl
oodt
est
stopat
ient
.

Topical:Advisepatienttoavoidshowering,bathi
ng,or
swimmi ngforatleast3hr saft
erappli
cation.Avoid
i
nsectr epel
lentcont ai
ningDEETorot herproducts
contai
ningDEETdur i
ngt her
apy.Keepgel awayfrom
fl
ame; containsalcohol.

Inf
orm pat
ientt
hatredness,it
chi
ng,bur
ning,i
rri
tat
ion,
andscali
ngatappli
cati
onar eamayoccur;noti
fy
healt
hcareprof
essi
onal i
ftheybecomet r
oublesome.

Bi
cal
utami
de
I
NDI
CATI
ONS
Treatmentofmet
astati
cprost
atecar
cinomai n
conjunct
ionwi
thl
uteini
zi
nghormone–releasi
nghor
mone

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 433
(
LHRH)anal
ogs(
goser
eli
n,l
eupr
oli
de)
.

ACTI
ON
Antagonizestheef
fect
sofandrogenatthecell
ularlev
el.
TherapeuticEff
ect
s:Decr
easedspreadofprost
at e
car
cinoma.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Women.

UseCaut
iousl
yin:
Moder
atet
osev
erel
i
veri
mpai
rment
;
Pedi
:Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: weakness, dizziness,headache, i
nsomni a.Resp:
dyspnea.CV: chestpai n,hyper t
ensi on, per i
pheraledema.
GI: HEPATOTOXI CI TY,constipati
on, diarrhea,nausea,
abdomi nal pain,↑l i
verenzymes, vomi t
ing.GU: hemat ur
ia,
erectiledy sfuncti
on, inconti
nence, noct uria,uri
naryt r
act
i
nf ections.Der m: alopecia,rashes, sweat ing.Endo: breast
pain,gy necomast i
a.Hemat :anemi a.Met ab:
hyper glycemi a,wei ghtloss.MS: backpai n,pelvicpain,
bonepai n.Neur o:par esthesia.Mi sc: gener ali
zedpai n,hot
fl
ashes, fl
u-li
kesy ndr ome, i
nfection.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 434
I
NTERACTI
ONS
Dr
ug-
Drug:
May↑ t
heef
fectofwar
far
in.

DOSAGE
PO:(Adult
s):50mgoncedail
y(mustbegiv
en
concurr
entl
ywithLHRHanal
ogorfol
lowi
ngsur
gical
castr
ati
on).

AVAI
LABI
LITY
Tabl
ets50mg;

PATI
ENTTEACHI
NG
Instr
uctpati
enttotakebical
utamidealongwiththe
LHRHanal ogasdi r
ectedatthesamet i
meeachday .
Ifadoseismi ssed,omitandtakethenextdoseat
regulart
ime;donotdoubl edoses.Donotdisconti
nue
withoutconsult
inghealt
hcareprofessi
onal
.

Advisepat ienttostopt aki

ngbi
calutamideandnotif
y
healthcar eprofessionalimmedi
atelyofsy mptomsof
l
iverdy sfuncti
on( nausea,vomi
ti
ng, abdominalpai
n,
fat
igue, anorexia,“f
lu-
li
ke”symptoms, darkuri
ne,
j
aundi ce,orrightupperquadranttenderness)
.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
ofal
l

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 435
 RxorOTCmedi cat
ions,
vitamins,orherbal
product
s
bei
ngtakenandtoconsulthealthcareprof
essi
onal
bef
oretaki
nganynewmedi cat
ions.

I
nst
ructpat
ientt
orepor
tsev
ereorper
sist
entdi
arr
hea.

Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

Emphasi
zet heimpor
tanceofr
egul
arfol
low-
upexams
andbl
oodt est
stodetermi
neprogr
ess;moni
torf
or
si
deeff
ects.

Bi
mat
opr
ost(
lash,
opht
hal
mic)
I
NDI
CATI
ONS
Tr
eat
mentofey
elashhy
pot
ri
chosi
s.

ACTI
ON
Incr
easestheper
centofhairi
neyelashesandprolongs
thedurat
ionofgr
owthphase.TherapeuticEff
ects:
Incr
easeseyel
ashgrowth,
improvi
ngl ength,
thi
ckness,
anddarkness.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 436
UseCaut
iousl
yin:
Act
ivei
ntr
aocul
ari
nfl
ammat
ion;
Patient
swi t
haphakia,pseudoaphakiawi t
hat ornposter
ior
l
enscapsul e,orknowriskfactorsformacularedema; OB:
Usei npregnancyonl
yifpotentialbenef
itjust
if
iespotenti
al
ri
skt othefetus;
Lactat
ion:Usecaut i
ouslyduri
nglactati
on;
Pedi:Safeandef f
ect
iveusei nchil
drenhasnotbeen
establi
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:conjunct
ival
hyperemia,
eyeprur
it
us,
hyper
pigmentati
onofeyeli
ds,macul
aredema,
per
manent
pi
gment at
ionoftheir
is.

I
NTERACTI
ONS
Drug-Dr
ug:
May↓ theint
raocul
arpr
essur
elower
ingef
fect
ofprost
agl
andi
nanal
ogs.

DOSAGE
Topi
cal
:(Adul
ts)
:Appl
ytoupperey
eli
dmar
ginni
ght
ly.

AVAI
LABI
LITY
Opht
hal
micsol
uti
on0.
3mg/
mLpr
ovi
dedas3mLi
na5-
mLbott
le;

PATI
ENTTEACHI
NG
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 437
Inst ructpat ientoncor rectappl icat i
onofbi mat oprost.
Ifadosei smi ssed, omi tandappl ynextev ening;do
notdoubl edose.Pat ientshoul dwashf aceand
remov eal lmakeupandcont actl ensespr iorto
appl icati
on.Cont actl ensesmayber einser ted15mi n
followi ngadmi nist
rat i
on.Pl aceonedr opof
medi cationont hedi sposabl est eril
eappl icatorand
br ushcaut iousl yalongt heski noft heupperey eli
d
mar ginatt hebaseoft heey el
ashes.Useonl ythe
appl icatorsuppl iedwi t
ht hepr oduct .Useeach
appl icatorf oroneey et hendi scar d;reusemayr esul
t
i
ncont ami nationandi nf ection.I fsol uti
onget sinto
theey e,itisnothar mf ul anddoesnotneedt obe
rinsed.Donotappl yt ol owerl ashl i
ne.Blotany
excesssol utionout sideupperey eli
dmar ginwi tha
tissueorot herabsor bentmat erial.Donotal l
owt ipof
bot tleorappl icatort ocomei ncont actwi th
sur roundi ngst r
uctur es, fingers, oranyot her
uni ntendedsur facet oav oidcont ami nati
on.I nstruct
pat ienttor eadt hePat i
entI nformat iongui depr iorto
useandwi theachRxr ef il
l,i
ncaseofnewi nformat i
on.

I
nfor
m patientthateyel
idskinmaydar kenwithuseof
bi
matoprost;mayber eversi
blewithdiscont
inuati
on
ofmedicat
ion.Insti
l
lati
ondirect
lyi
ntoey emayr esul
t
i
nincr
easedbr owni r
ispigmentati
on;usuall
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 438
 per
manent
.

I
nform pat
ientofpotent
ialforhai
rgr
owt
hoccurr
ing
outsi
detargett
reatmentareaifmedi
cat
ionr
epeatedl
y
touchedsamear eaofskin.

Adv i
sepatienttonotif
yhealthcar eprofessi
onal
i
mmedi at
elyifeyetraumaori nfecti
on,sudden
decreaseinv i
sualacuit
y,conjunctiv
iti
s,oreyel
id
reacti
onsoccurori fhavi
ngocul arsurgery.

Inst
ructpatientt
onoti
fyhealt
hcarepr
ofessi
onal
of
bimatoprostusepri
ortoint
raocul
arpr
essure
examinations.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Bi
per
iden
I
ndi
cat
ions
Medicine-
inducedextr
apyr
amidalsy
mptoms(butnot
tar
divedyskinesi
as)andadj
uncti
vetr
eat
mentof
parki
nsonism.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 439
Blockscholinergicacti
vi
tyi ntheCNS,whichisparti
all
y
responsibl
ef orthesy mptomsofPar ki
nson’sdisease.
Restoresthenat uralbal
anceofneur ot
ransmitt
ersinthe
CNS.Ther apeuticEffect
s: Reducti
onofri
gidi
tyand
tremors.

Av
ail
abi
l
ity
TABLET2mg;
INJECTI
ON1ml
ampoul
e(5mg/
ml)
.

DOSAGE
Or
al
Adult-Medici
ne-i
nducedextr
a-py
ramidalsympt oms,
parki
nsonism:ini
ti
all
y1mgt wicedail
y,i
ncreased
graduall
yto2mgt hr
icedai
l
y;usualmaintenancedose3
to12mgdai l
yindivi
deddoses.

I
ntr
amuscul
ari
nject
ionorSl
owi
ntr
avenousi
nject
ion

Adul
t-Medici
ne-
inducedext
ra-
pyrami
dal
sympt oms,
par
kinsoni
sm:2.
5t o5mgr epeat
edasnecessaryt
omax.
20mgi n24h.

Cont
rai
ndi
cat
ions
Angl
e-closur
egl
aucoma;bowelobstr
ucti
on;megacol
on;
unt
reateduri
nar
yret
ent
ion;pr
ostat
ichypert
rophy
;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 440
my
ast
heni
agr
avi
s;gast
roi
ntest
inal
obst
ruct
ion.

I
NTERACTI
ONS
Drug-
Dr ug:Addit
iveantichol
i
nergicef fectswithdrugs
shari
ngant i
choli
nergi
cpr opert
ies, suchasant i
histamines,
phenothiazi
nes,quini
dine,di
sopy rami de,andtri
cycli
c
anti
depressants.Counteract
sthechol inergi
ceffects
ofbet
hanechol.Antacidsorantidiar r
healsmay↓
absorpti
on.
Drug-
Natur
alPr
oduct
:↑ ant
ichol
i
nergi
ceffect
swit
h
angel
’st
rumpetandj
i
msonweed, andscopoli
a.

Pr
ecaut
ions
El
der
ly;car
diovascul
ardi
sease,
hepat
icorr
enal
i
mpair
ment ;av
oidabruptwit
hdr
awal;
paedi
atr
icuse;
pr
egnancylact
ation.
Mayimpai
rabi
li
tyt
operform ski
l
ledt
asks,
forexampl
e
oper
ati
ngmachi
nery,
dri
ving.

Adv
erseEf
fect
s
Drowsiness,dr
ymout h,consti
pati
on,blurr
edv i
sion;
hesit
ancyofmi ct
uri
ti
on, di
zzi
ness,tachycardi
a,
arr
hythmias;conf
usion,euphori
a,excit
ement ,
agitati
on,
hall
ucinat
ionsandpsy chi
atr
icdist
urbanceswi t
hhi gh

ᏆᖴA2022 Dr
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nHeal
thyCar
e 441
dosage,especi
all
yintheelderlyandothersuscepti
ble
pati
ents,mayrequir
ewi t
hdrawal oftr
eatment;impair
ed
memor y,mil
dposturalhypotension;
urinar
yretent
ion.

PATI
ENTTEACHI
NG
Advisepat ienttotakemedi cati
onexactlyasdi rect
ed.
Takemi sseddosesassoonaspossi bleupt o2hr
beforethenextdose.Dr ugshoul dbetapered
graduallywhendi sconti
nuingorawi t
hdrawal react
ion
mayoccur( anxi
ety,t
achycardia,i
nsomnia,returnof
parkinsonianorext r
apyrami dalsymptoms).

Maycausedr owsiness,di
zziness,orblur
redvisi
on.
Advisepati
enttoavoiddri
vingorot heracti
vi
ti
esthat
requir
ealer
tnessuntil
responset othedrugisknown.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Advi
sepat ientthatfr
equentmout hrinses,goodoral
hygi
ene,andsugar l
essgum orcandymaydecr ease
dr
ymout h.Pati
entshouldnot i
fyhealthcare
pr
ofessional i
fdrymouthper si
sts(saliv
asubstit
utes
maybeused) .Alsonoti
fythedentistifdrymouth
i
nter
fereswi thuseofdentures.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 442
 di
ff
icul
tywit
hur i
nat
ion,consti
pati
on,abdominal
di
scomfort
,rapi
dorpoundi ngheart
beat,conf
usi
on,
ey
epain,orrashoccurs.

Advi
sepati
enttoconf
erwi t
hhealthcar
eprofessional
bef
oretaki
ngRx,OTC,orherbalpr
oduct
s,especiall
y
col
dremedies,
ordri
nkingalcohol
icbever
ages.

Cautionpat i
entthatthi
smedicati
ondecreases
perspirati
on.Overheati
ngmayoccurdur i
nghot
weat her.Pati
entsshouldnoti
fyheal
thcare
professionali
ftheycannotremainindoor
sinanai
r-
condi t
ionedenvir
onmentdur i
nghotweather.

Advi
sepati
entt
oav oi
dantaci
dsorant
idi
arr
heal
s
wit
hin1–2hrofthi
smedicati
on.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Bi
sacody
l
I
ndi
cat
ions
Treat
mentofconst
ipat
ion.Evacuati
onofthebowelbef
ore
radi
ologi
cst
udi
esorsurgery.Partofabowelregi
menin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 443
spi
nal
cor
dinj
urypat
ient
s.

ACTI
ON
Sti
mulatesperi
stalsi
s.Altersfl
uidandel
ect
rol
yte
tr
ansport,
producingfluidaccumulati
oni
nthecolon.
Therapeut
icEff
ect s:
Ev acuati
onofthecol
on.

Av
ail
abi
l
ity
TABLETS5mg;
SUPPOSI
TORI
ES5and10mg.

DOSAGE
Or
al/
Rect
al
Adultandchildov er10years-5to10mgdail
yatnight
.
Beforeradi
ologicalprocedureandsur
ger
y:16to20mgat
ni
ghtbef or
epr ocedure.

Cont
rai
ndi
cat
ions
Intesti
nalobst
ructi
on(causesabdomi nalcr
amps)
,acute
surgicalabdominalcondit
ions,acut
einfl
ammator
ybowel
disease,sever
edehy drat
ion;faecal
impacti
on,
chr
onicuse.

I
NTERACTI
ONS
Drug-
Drug:Ant
aci
ds,hi
stamineH2-
recept
orantagoni
sts,
andgastr
icaci
d–pumpinhibi
tor
smayr emoveenteri
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 444
coati
ngoftablet
sresult
ingingastr
icir
ri
tat
ion/dyspepsi
a.
May↓ t heabsorpt
ionofotheroral
lyadminist
ereddrugs
becauseof↑ mot i
li
tyand↓ transi
ttime.
Drug-
Food:Mi
l
kmayr emoveenter
iccoati
ngoft
abl
ets,
resul
ti
ngi
ngastr
ici
rr
it
ati
on/dy
spepsia.

Pr
ecaut
ions
Excessi v
euseofst imulantlaxativ
escancausedi arr
hoea
andr elat
edef f
ectssuchashy pokalaemia;however,
prol
ongedusemaybej usti
fi
ableinsomeci rcumstances;
don’tgiveantacidwithin1hour ,pregnancyinf
lammat or
y
bowel disease,pre-
existi
nghear tdiseaseorboweldisease,
al
lergies,int
eract
ions.

Adv
erseEf
fect
s
Tablet
s-gr i
ping;
suppositor
ies-
locali
rri
tat
ion;
fai
nti
ng,
di
zziness,sorenessinanalregi
onduet osupposit
ory
l
eakage; abdominaldiscomfort
,elect
rol
y t
eimbal
ance,
hypokalaemia.

PATI
ENTTEACHI
NG
Advisepatients,ot
herthanthosewit
hspinalcord
i
njuri
es,t
hatl axati
vesshouldbeusedonlyforshort
-
ter
mt herapy.Prolongedtherapymaycause

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 445
 el
ect
rol
ytei
mbal
anceanddependence.

Advi
sepatientt
oincreasefl
uidint
aketoatleast
1500–2000mL/ dayduringt
herapytoprev
ent
dehydr
ati
on.

Encouragepati
entstouseot herformsofbowel
regul
ati
on(incr
easingbulkint hediet
,incr
easingf
lui
d
i
ntake,ori
ncreasi
ngmobi li
ty).Normal bowelhabi
ts
mayv aryf
rom 3ti
mes/ dayto3t i
mes/ wk.

Instr
uctpati
ent
swithcar
diacdi
seasetoavoi
d
strai
ningdur
ingbowelmovements(Val
sal
va
maneuv er
).

Advisepati
entthatbi
sacodyl
shoul
dnotbeused
whenconst i
pati
onisaccompani
edbyabdominal
pai
n,
fev
er ,
nausea,orvomit
ing.

Bi
sopr
olol
I
NDI
CATI
ONS
Managementofhy
per
tensi
on.

ACTI
ON
Blockssti
mulat
ionofbeta1(myocar
dial
)-
adr
ener
gic
recept
ors.Doesnotusuall
yaff
ectbeta2(
pul
monary,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 446
vascular
,ut
eri
ne)
-r
eceptorsit
es.Ther
apeut
icEf
fect
s:
DecreasedBPandheartrate.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Uncompensat
edHF;
Pul
monar
y
edema;
Car
diogeni
cshock;
Brady
car
diaorhear
tbl
ock.

UseCaut
iousl
yin:
Renal
impai
rment(
dosage↓
recommended) ; Hepat icimpai r
ment( dosage↓
recommended) ; Pulmonar ydi sease( includingasthma;
beta1sel ecti
v i
tymaybel ostathi gherdoses) ;avoiduseif
possible;Diabet esmel li
tus( maymasksi gnsof
hypoglycemi a) ;Thy rotoxicosis( maymasksy mptoms) ;
Patient
swi t
hahi storyofsev ereal ler
gicr eacti
ons
(i
ntensityofr eact ionsmaybe↑) ; OB: Lactati
on:Pedi:
Safetynotest ablished; crossest hepl acentaandmay
causef etal/
neonat albrady cardia, hypotension,
hypoglycemi a, orr espiratorydepr ession; Geri
:↑
sensiti
vit
yt obet abl ockers; i
ni t
ialdosage↓
recommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:fati
gue,weakness,anxi
ety
,depressi
on,di
zziness,
drowsi
ness,i
nsomni a,
memor yloss,mental
status
changes,ner
vousness,ni
ghtmares.EENT:bl
urredvisi
on,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 447
stuf
fynose.Resp: bronchospasm,wheezing.CV:
BRADYCARDI A,HF,PULMONARYEDEMA, hypotension,
peri
pheralvasoconstri
cti
on.GI:consti
pati
on, di
arrhea,↑
l
iverfuncti
ontests,nausea,vomiti
ng.GU:erectil
e
dysfuncti
on,↓l i
bido,uri
naryfr
equency.Der m:rash.Endo:
hypergl
ycemia,hypoglycemia.MS: ar
thral
gia,backpain,
j
ointpain.Misc:drug-i
nducedlupussyndrome.

I
NTERACTI
ONS
Drug-Dr ug: Gener al anesthet ics,IVpheny toi
n,and
verapami l maycauseaddi ti
v emy ocardi al depression.
Additivebr ady car diamayoccurwi thdi goxi n,dil
ti
azem,
verapami l,orcl oni di
ne.Addi tivehypot ensi onmayoccur
withot herant ihy pertensives, acutei ngest i
onofal cohol,or
nit
rates.Concur rentusewi thamphet ami ne,cocaine,
ephedr ine,epinephr ine,nor epinephrine, pheny lephrine,or
pseudoephedr inemayr esul tinunopposedal pha-
adrener gicst i
mul ati
on( excessi vehy per tension,
brady cardia).Concur r
entt hy r
oidprepar ation
admi nistrati
onmay↓ ef fect i
veness.Mayal t
erthe
effectivenessofi nsul insoror alhypogl ycemi cagent s
(doseadj ust ment smaybenecessar y).May↓ t he
effectivenessoft heophy ll
ine.May↓ t hebet a1-
cardiovascul aref fect sofdopami neordobut ami ne.Use
cautiouslywi thi n14day sofMAOi nhibi tortherapy( may

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 448
r
esul
tinhy
per
tensi
on)
.

DOSAGE
PO:(Adul
ts)
:5mgoncedail
y,maybe↑ t
o10mgonce
dai
l
y( r
ange2.
5–20mg/day
).
Renal
Impai
rment
Hepat
icI
mpai
rment
PO:
(Adult
s):CCr<40mL/ mi
n—I
nit
iat
ether
apywi
th2.
5
mg/day
,ti
tr
atecaut
iousl
y.

AVAI
LABI
LITY
Tabl
ets5mg,10mg; I
ncombi
nat
ionwi
th:
hydr
ochl
orot
hiazi
de

PATI
ENTTEACHI
NG
Instructpatientt otakemedi cati
onexactlyasdirected,
att hesamet imeeachday ,eveniffeeli
ngwell;donot
skipordoubl euponmi sseddoses.I fadoseis
mi ssed,itshoul dbet akenassoonaspossi bl
eupt o4
hrbef orenextdose.Abr uptwi t
hdrawalmay
precipit
atelife-threat
eningar r
hythmias,hyper
tension,
ormy ocardi
al ischemi a.

Teachpat
ientandf
ami
l
yhowt
ocheckpul
seandBP.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 449
 Inst
ructthem t
ocheckpulsedail
yandBPbiweekl
y
andtor epor
tsigni
fi
cantchangest
oheal
thcare
prof
essional
.

Maycausedr owsiness.Caut
ionpati
ent
stoavoid
driv
ingorotheracti
vi
ti
esthatrequi
real
ert
nessunti
l
responsetothedrugisknown.

Advi
sepati
entst
ochangeposi
ti
onssl
owl
yto
mini
mizeort
host
ati
chypot
ensi
on.

Cauti
onpat
ientt
hatt
hismedi
cat
ionmayi
ncr
ease
sensi
ti
vi
tyt
ocold.

Instr
uctpat i
enttonot i
fyhealthcareprofessionalof
allRxorOTCmedi cati
ons,v i
tamins,orherbal
productsbei ngtakenandt oconsul thealt
hcar e
professionalbeforet aki
nganyRx, OTC, orherbal
products,especiallycoldpr eparati
ons,concurrentl
y
withthismedi cation.Patientsonant i
hypertensive
therapyshoul dalsoav oidexcessi v
eamount sof
coffee,tea,andcol a.

Diabeti
csshouldclosel
ymonitorbl
oodgl ucose,
especial
lyi
fweakness,malai
se,ir
ri
tabil
i
ty,orfat
igue
occurs.Medicat
iondoesnotblockdizzi
nessor
sweatingassignsofhypogly
cemia.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 450
 sl
owpulse,di
ffi
cultybreathing,wheezing,
coldhands
andfeet
,di
zziness,li
ght-headedness,confusi
on,
depr
essi
on,rash,fever,sorethr
oat,unusualbleedi
ng,
orbr
uisi
ngoccurs.

I
nst
ructpat
ienttoi
nfor
m healt
hcareprofessi
onal
of
medi
cati
onregimenbefor
etreatmentorsurger
y.

Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Hypertension:Reinforcet heneedt oconti

nue
additi
onaltherapiesf orhy pertension(wei
ghtl
oss,
sodium restri
cti
on,st ressr educti
on, r
egul
arexerci
se,
moder ati
onofal cohol consumpt ion,andsmoking
cessation)
.Medi cationcont r
olsbutdoesnotcur e
hypertensi
on.

BI
TOLTEROL
I
NDI
CATI
ONS
Usedasaquick-
rel
i
efagentinthemanagementof
rev
ersi
bleai
rwaydi
seasecausedbyasthmaorCOPD.

ACTI
ON
Resul
tsi
ntheaccumul
ati
onofcy
cli
cadenosi
ne

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 451
monophosphat e(cAMP)atbet a-adrenergi crecept
ors.
Producesbr onchodilat
ion.I
nhibitst hereleaseof
medi at
orsofi mmedi at
ehy persensi ti
vit
yr eacti
onsfrom
mastcel l
s.Relativ
elyselecti
vef orbet a2-adrenergi
c
(pulmonary)receptorsiteswithlessef f
ecton
beta1(car
diac)-adrener
gicrecept ors.Ther apeuticEf
fect
s:
Bronchodil
ation.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oadr
ener
gic
ami
nes;
Knownhy
per
sensi
ti
vi
tyori
ntol
erancet
oal
cohol
.

UseCaut
iousl
yin:
Car
diacdi
sease;
Hyper
tensi
on;
Hypert
hyroi
dism;Diabetes;Glaucoma; Geriat
ri
cpat i
ent
s
(moresuscepti
bletoadv er
ser eacti
ons; mayrequi
re
dosagereducti
on);Excessi
veusemayl eadtotol
erance
andparadoxi
calbronchospasm; Pregnancy(nearterm)
,
l
actati
on,andchil
dren<2y r(safetynotestabli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: nervousness, r
est l
essness, t
remor,headache,
i
nsomni a,li
ght-
headedness.Resp: PARADOXI CAL
BRONCHOSPASM.CV: chestpain,pal
patati
ons,
tachy
car di
a,arrhythmi as,hyper
tension.GI:nausea,
vomiting.Endo: hy
per glycemia,hypokalemia.Neuro:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 452
t
remor
.

I
NTERACTI
ONS
Drug-Drug:Concur rentusewithot heradr
energic
agents(sympat homi meti
c)willcauseadditi
veadr energi
c
sideef f
ect
s.Usewi thMAOi nhi bi
torsmayleadt o
hypertensi
v ecrisi
s.Betablocker smaynegatet herapeuti
c
effect.I
ncreasedr i
skofhy perkalemiawit
hpot assium-
l
osi ngdiur
etics.Hypokalemiai ncreasest
her i
skofdi goxi
n
toxici
ty.

DOSAGE
Met
ered-
DoseI
nhal
er
I
nhaln:( Adul
tsandChildr
en≥12y r)
:Tr eat
ment —2
i
nhalations(1–3mi napart)
,fol
l
owedbyanaddi t
ional
i
nhalationifneeded(nottoexceed2i nhalat
ionsq4hror
3inhalationsq6hr).Prophyl
axis—2inhalati
onsq8hr( 370
mcg/ spray).
Sol
uti
onf
orI
nhal
ati
on
I
nhaln:(Adul
tsandChil
dr en≥12yr):0.5–1.0mL(1–2mg)
3–4t i
mesdaily;
int
erv
al betweentreatmentsshoul
dnot<4
hr(nottoexceed8mg/ daybyi nt
ermittentfl
ow
nebuli
zati
onor14mg/ daybycont inuousf l
ow
nebuli
zati
on).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 453
AVAI
LABI
LITY
Metered-
doseaerosol
370mcg/ spray(≥300
i
nhalati
ons/
15-mLcontai
ners)
;Soluti
onf ori
nhal
ati
ons
0.
2%i n30-and60-mLcontai
ner;

PATI
ENTTEACHI
NG
Inst
ructpatientt
otakemedi cati
onexactl
yasdi r
ect
ed.
Ifonaschedul eddosingregimen,takemisseddose
assoonaspossi bl
e;spaceremainingdosesat
regul
arinterval
s.Donotdoubl edoses.Cauti
on
pati
entnott oexceedrecommendeddose; maycause
adverseeffects,
paradoxicalbr
onchospasm, orl
oss
ofeffect
ivenessofmedi cati
on.

Revi
ewcor rectadmini
str
ationtechniquewit
hpat i
ent.
SeeAppendi xDforadministr
ati
onwi thmetered-
dose
i
nhaler
.Wai t1–5minbefor eadminister
ingnextdose.
Mouthpieceshouldbewashedaf t
ereachuse.Donot
spr
ayinhalerneareyes.

Instructpati
entt
ousebr onchodilat
orf i
rsti
fusing
otherinhalat
ionmedicati
ons, andall
ow5mi nto
elapsebet weenadministeri
ngotherinhalati
on
medi cati
ons,unl
essother wi
sedirected.Advise
patientstaki
ngcort
icosteroidsconcurrentl
ynotto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 454
 reducecorticoster
oiddosewi
thoutadviceofheal
th
careprofessional,
eveniff
eel
i
ngbet t
er.Adrener
gic
bronchodil
at orsar
enotasubsti
tut
efor
corti
costeroids.

Advi
sepat
ientt
ori
nsemouthwit
hwateraf
tereach
i
nhal
ati
ondosetomini
mizedr
ymouth.

Cautionpati
entnottouse2ormor eadrener
gic
bronchodi
lat
orssimult
aneouslybecauseoft
he
potenti
alf
oradditi
veeff
ects.

Maycausel i
ght-headedness.Caut
ionpati
entt
oavoi
d
driv
ingorotheractiv
iti
esrequi
ri
ngaler
tnessunt
il
responsetomedi cati
onisknown.

Inst
ructpat
ientt
omai ntai
nadequatefl
uidi
ntake
(2000–3000mL/ day
)t ohel
pli
quefytenaci
ous
secret
ions.

Adv i
sepati
entt oconsulthealt
hcarepr ofessi
onalif
respir
ator
ysy mptomsar enotr el
ievedorwor senafter
treat
mentori fchestpain,headache,severedizzi
ness,
palpi
tati
ons,nervousness,orweaknessoccur s.

Inst
ructpati
entt
onotif
yhealt
hcar
eprof
essi
onal
if
contentsofonecani
sterar
eusedupi
nlesst
han2wk.

Adv
isepat
ientt
osav
einhal
er;
ref
il
lcani
ster
smaybe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 455
 av
ail
abl
e.

Advisepati
enttoconsultheal
thcareprofessi
onal
beforetaki
nganyOTCmedi cat
ionsoralcohol
ic
beveragesconcur
rentl
ywi t
hthisther
apy.Caution
pati
entalsotoavoi
dsmoki ngandot herrespi
rator
y
i
rri
tants.

Bi
val
i
rudi
n
I
NDI
CATI
ONS
Usedi nconjunctionwithaspirintoreducetheriskofacute
i
schemi ccompl icati
onsinpat ient
swi t
hunstableangina
whoar eunder goingpercutaneoust r
ansluminal
angioplast
y( PCTA)orper cutaneouscor onar
yinter
vention
(PCI).Pati
entswi thoratriskofheparin-i
nduced
thr
ombocy t
openi a(HIT)andt hrombosissyndrome(HI TTS)
whoar eunder goingPCI .

ACTI
ON
Specif
ical
lyandr ev er
sibl
yinhibi
tsthrombinbybindi
ngto
i
tsreceptorsi
t es.Inhibi
ti
onoft hr
ombi nprev
ents
acti
vati
onoff actorsV, VII
I,andXII
;theconversi
onof
fi
bri
nogent ofibrin;pl
atel
etadhesionandaggr egat
ion.
Therapeuti
cEf fects:Decreasedacuteischemic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 456
compl
i
cationsinpati
entswithunstableangina(deat
h,MI
,
ort
heurgentneedforrevascul
ari
zationprocedures)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Act
ivemaj
orbl
eedi
ng;
Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Anydi
seasest
ateassoci
atedwi
than
↑r iskofbleeding; Hepari
n-inducedt hrombocy t
openiaor
heparin-i
nducedt hrombocy topenia-thrombosi ssyndrome;
Patientswithunst ableanginanotunder goingPTCA;
Patientswithotheracut ecor onarysy ndromes; Concurr
ent
usewi thotherplateletaggregationinhibitors(safet
ynot
establi
shed);Renal impairment( ↓i nfusionr at
eifGFR<30
mL/ min);Lactat
ion: Pedi:
Saf etynotest abli
shed; OB:Use
onlyifclear
lyneeded.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, anxi
ety,insomnia,ner
vousness.CV:
hypotension,bradycardia,hypert
ensi
on.GI:nausea,
abdomi nalpain,dyspepsia,vomiti
ng.Hemat :
BLEEDING.
Local:i
njecti
onsi t
epai n.MS: backpai
n.Misc:pain,
fev
er,
pelv
icpain.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 457
Drug-
Dr ug:Ri
skofbleedingmaybe↑ byconcur rentuse
ofabciximab,hepar
in,l
owmol ecul
arweighthepari
ns,
cl
opidogrel,t
hromboly
tics,oranyotherdrugsthatinhi
bit
coagulati
on.
Drug-NaturalPr
oduct:↑r i
skofbleedi
ngwithar
nica,
chamomi le,cl
ove,dongquai,
feverf
ew,gar
li
c,gi
nger,
gingko,Panaxginseng,andother
s.

DOSAGE
IV:(Adult
s) :0.75mg/ kgasabol usinjecti
on,foll
owedby
aninfusionatar ateof1. 75mg/ kg/hrf orthedurati
onof
thePCIpr ocedure.Anact ivat
edcl ot
tingt i
me( ACT)should
beper for
med5mi naf terbolusdoseandanaddi ti
onal
bolusdoseof0. 3mg/ kgmaybeadmi nist
eredifneeded.
Cont i
nuati
onoft hei nfusion(atar ateof1. 75mg/ kg/hr)
forupt o4hrpost -
procedur eisopt i
onal .I
fneeded,the
i
nfusionmaybecont i
nuedbey ondt hisiniti
al4hratar ate
of0.2mg/ kg/hrforupt o20hr .Therapyshoul dbe
i
niti
atedpr iort
ot hepr ocedureandgi veninconjunction
withaspiri
n.
Renal
Impai
rment
I
V:(Adult
s):No↓ int
hebolusdoseisneededi nany
pati
entwit
hrenal
impai
rment.GFR10–29mL/ min—↓
i
nfusionr
ateto1mg/kg/hr
;Dial
ysi
s-dependentpati
ent
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 458
(of
fdi
aly
sis)
—↓ i
nfusi
onrateto0.25mg/kg/
hr.ACT
shoul
dbemonit
oredinal
lpati
entswit
hrenali
mpair
ment
.

AVAI
LABI
LITY
Powderf
ori
nject
ion250mg/
vial
;

PATI
ENTTEACHI
NG
I
nfor
m pat
ientoft
hepur
poseofbi
val
i
rudi
n.

I
nst
ructpat
ientt
onoti
fyheal
thcareprof
essi
onal
i
mmediatel
yifanybl
eedi
ngisnoted.

Bl
eachi
ngPowder
I
ndi
cat
ions
Di
sinf
ect
ionofsur
faces,
equi
pment
s,wat
er.

Av
ail
abi
l
ity
POWDERFORSOLUTI
ON1gchl
ori
ne/
li
tr
e(1000par
tsper
mil
l
ion;
0.1%)
.

DOSAGE
Sur
facedi
sinf
ecti
on(minorcontami
nat
ion)
:appl
y
sol
uti
onscontai
ning1000part
spermil
li
on.I
nstr
ument

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 459
di
sinfecti
on:
soakinsol
uti
oncontai
ning1000part
sper
mill
ionforamini
mum of15mi n;
toav oi
dcorr
osi
ondonot
soakf ormor
ethan30min;ri
nsewit
hst eri
l
ewater
.

St
orage
St
orepr
otect
edf
rom moi
stur
einat
ight
lycl
osedcont
ainer
.

Bl
eomy
cin
I
ndi
cat
ions
Adjuncttosur geryandradiother
apyi npall
iati
vet r
eatment
ofHodgki n’sandnon- Hodgkin’
slymphomas; reti
culum
cel
l sarcomaandl ymphoma; carci
nomasoft hehead,
neck,larynx,cervi
x,peni
s,skin,v
ulva,test
iclesincludi
ng
embr yonalcellcarci
noma, chori
ocarcinomaandt erat
oma;
malignantef f
usions.

ACTI
ON
I
nhibi
tsDNAandRNAsynthesi
s.Therapeut
icEf
fect
s:
Deathofr
api
dlyr
epl
i
cat
ingcell
s,part
icul
arl
ymali
gnant
ones.

Av
ail
abi
l
ity
I
NJECTI
ON15and30mg/
vial
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 460
DOSAGE
I
ntr
amuscul
arandsubcut
aneousi
nject
ion
30mgt wi
ceaweek,dosecanalsovar
yf r
om 15mgdai ly
to15mgweekl
y ;
tot
al300to400mg.Smal lcel
lcancer
;
0.25t
o0.5mg/kgbodyweightonceortwiceaweek.

Cont
rai
ndi
cat
ions
Seenotesaboveandlit
erat
ure;
preexi
sti
ngl
ungdi
sease;
pregnancyandl
actat
ion.

I
NTERACTI
ONS
Drug-
Dr ug: Hemat ol
ogict
oxi cit
y↑ wi t
hconcur rentuseof
radi
ationther apyandotherant ineoplastics.Concur rent
usewi thcisplati
n↓ eliminationofbl eomy cinandmay↑
toxi
cit
y .↑ riskofpulmonar ytoxicitywithot her
anti
neoplast i
csort hor
acicradiationther apy .Gener al
anesthesia↑ t her i
skofpulmonar ytoxicit
y .↑ riskof
Raynaud’sphenomenonwhenusedwi thv inblastine.

Pr
ecaut
ions
Seenot
esaboveandconsul
tli
ter
atur
e;r
enal
impai
rment
;
i
nter
act
ions.

Adv
erseEf
fect
s
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 461
Seenotesaboveandconsultli
ter
atur
e.Der
mat
it
is;
nephr
otoxi
cit
y;hepat
otoxi
cit
y.

PATI
ENTTEACHI
NG
Instr
uctpat i
enttonoti
fyhealthcareprof
essional
if
fever,chil
l
s,wheezing,faint
ness,di
aphoresi
s,
shortnessofbr eat
h,prolongednauseaandv omit
ing,
ormout hsoresoccur.

Encour
agepat
ientnott
osmokebecauset
hismay
worsenpul
monarytoxi
cit
y.

Explai
ntothepatientthatskintoxici
tymaymani fest
i
tselfasskinsensit
ivi
ty,hyperpi
gment at
ion
(especi
all
yatskinfoldsandpoi ntsofskinir
ri
tat
ion),
andskinrashesandt hickening.

Inst
ructpati
enttoi nspectoralmucosaforeryt
hema
andulcerat
ion.Ifulcerati
onoccurs,advi
sepati
entto
usespongebr ushandr i
nsemout hwithwateraft
er
eati
nganddr inki
ng.Opi oidanal
gesicsmaybe
requi
redifpaininterfer
eswi t
heating.

Discusswithpat
ientthepossi
bil
i
tyofhai
rloss.
Explorecopi
ngstrat
egies.

Advisepat
ientoft
heneedf
orcont
racept
iondur
ing
ther
apy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 462
 I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasi
zeneedf
orper
iodi
clabt
est
stomoni
torf
or
si
deeff
ects.

St
orage
St
orepr
otect
edf
rom l
i
ghti
naseal
edcont
ainer
.

BOCEPREVI
R
I
NDI
CATI
ONS
Treat
mentofchr oni
chepat it
isC(genotype1)infect
ioni
n
combinat
ionwi t
hpeginterfer
onalfaandr i
bavi
rininadul
t
pati
entswit
hcompensat edli
verdi
seasewhoar e
previ
ousl
yuntreatedorwhohav efai
ledprevi
ous
tr
eatmentwithinter
fer
onandr i
bavir
in.

ACTI
ON
Actsasani nhibitorofvir
alproteaseresulti
ngi
nadi r
ect
anti
vir
alef
fect; effecti
saddi t
ivewit
hot herant
ivi
ral
s.
Therapeut
icEf fects:Decreasedprogressionofhepati
c
damageandi mpr ovedvirol
ogicresponse.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 463
Cont
rai
ndi
cat
edi
n:Concur
rentwi
tht
hedr
ugshi
ghl
y
dependantonCYP3A4/ 5enzy mesy stem f
orclearance
wher eincreasedl evelsareassoci atedwithseri
ous/li
fe-
threateningtoxicit
y;Concur rentusewi thpotenti
nducers
ofCYP3A4/ 5enzy mesy stems( mayreduce
l
ev els/effi
cacy)
; OB: Avoidusingi npregnantpati
entsand
i
nmal epat i
entswhosepar t
ner sarepregnant(dueto
concur rentusewi thribavi
rin);Lactati
on:Avoidbreast-
feeding.

UseCaut
iousl
yin:
Concur
renti
nfect
ionwi
thHI
Vor
Hepati
tisB(safet
yandef fi
cacynotestabli
shed)
;
Decompensatedcirrhosi
s/organ/co-i
nfect
ionwith
HIV/Hepati
ti
sB( safet
yandef fi
cacyhavenotbeen
establ
i
shed);Pedi:Safeandeffect
iveuseinchil
drenhas
notbeenestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:f
ati
gue,
headache.GI:dy
sgeusia,nausea,
diar
rhea,
vomi
ti
ng.Hemat:
anemi a,
neutropeni
a.

I
NTERACTI
ONS
Dr
ug-Drug:Act
sasastronginhi
bit
orandi
spart
ial
l
y
metabol
izedbytheCYP3A4/5enzymesyst
em.Concurr
ent
wi
thdrugshighl
ydependantonCYP3A4/5enzy
mesy st
em

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 464
forclear ancemayr esul tin↑ l ev el sandser ious/ life-
threateni ngt oxi cityandshoul dbeav oi dedi ncludi ng
alfuzosin( mayr esulti nhy pertensi on); dihydr oergot ami ne,
ergonov i
ne, er got ami ne, andmet hy l
ergonov ine( may
causeper ipher al vasospasm) ; cisapr ine( maypr eci pitate
arrhythmi as); l
ov ast at i
nandsi mv ast atin( ↑r i
skof
my opat hy );dr osper inone( mayr esul ti nhy per kalemi a);
sil
denaf il ortadal afilwhenusedf orpul monar y
hypert ensi on( ↑r i
skofv isual abnor mal iti
es, hypot ension,
prolongeder ect ion, sy ncope) ;triazol am and
oralmi dazol am ( mayr esul tinpr ol onged
sedat i
on/ respi ratorydepr essi on) .↑ l ev elsofsi ldenaf il,
tadalaf i
l
, orv ar denaf i
l whenusedf orer ect i
l
edy sf unct ion;
l
owerdosesr ecommended.↓ l ev elsandcont racept ive
effectivenessofet hi ny lest radiol ; twoaddi t
ional met hods
ofcont r
acept ionar enecessar y .May↑ l evelsof
atorvast at i
n; dai l
ydoseshoul dnotexceed20mg.
Concur r
entusewi thpot enti nducer sofCYP3A4/ 5enzy me
system may↓ l ev elsandef fi
cacyofbocepr avirshoul dbe
avoided, i
ncl udi ngcar bamazepi ne, phenobar bi t
al, and
pheny toin.Concur rentusewi thpegi nt erferonal faand
ri
bav i
r i
nmaywor senexpect edneut ropeni a.May↑ l evels
andr iskofadv ersecar diov ascul arr eact ionswi th
ami odar one, beper il,flecai nide, pr opaf enone, qui nidi ne,or
digoxin; under takeconcur rentusewi thcaut ion; dr ugl evel

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 465
moni toringr ecommended.Mayal terresponset owar f ar
in;
INRmoni toringr ecommended.May↑ l ev elsof
i
traconazol e, ketoconazol e, posi conazol e, orv oriconazol e;
dosesofket oconazol eori traconazol eshoul dnotexceed
200mg/ day .May↑ l evelsofdesi prami neort razodone
andr esul tindi zziness, hy pot ensi onorsy ncope, consi der
l
owerdoses.↑ l ev elsandr iskoft oxicitywi thcol chi cine;
avoidconcur rentusei nhepat i
c/ renal impai rment , dosage
reduct i
onr ecommendedf orot her s.↑ r ifabut inl ev els;
ri
fubut i
nmay↓ bocepr av irlev els; concur rentuseshoul d
beav oi
ded.May↑ l ev elsandr iskofadv er se
cardiov ascul arr eact i
onswi thf elodi pi
ne, nifedipine, or
nicardipine; caut ionandcl inical moni toringr ecommended.
Concur rentusewi thdexamet hasonemay↓ l ev elsand
effectiveness; av oi
di fpossi ble.May↑ bl oodl ev el sof
i
nhal edbudenosi deorf l
uticasoner esultingi n↓ cor tisol
l
ev els;av oidedext endedconcur rentuse.Concur rentuse
withsal met erol may↑ r iskofadv ersecar diov ascul ar
event s.Mayal terlev elsmet hadoneorbupr enor phi ne;
moni toref fect s.May↑ l ev elsandr i
skoft oxicitywi th
bosent an, cy clospor ine, sirolimus, ort
acr olimus; car ef ul
moni toringi sr equi red.Ef av irenzmay↑ l ev els;av oid
concur rentuse.
Drug-Natur
alProduct
:Concur
rentuseofSt.John'
swor
t
(hyperi
cum per
forat
um)↑ met abol
ism andmay↓

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 466
ef
fect
ivenessandshoul
dbeav
oided.

DOSAGE
PO:
(Adul
ts)
:800mgt
hreet
imesdai
l
y.

AVAI
LABI
LITY
Capsul
es200mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakeboceprevi
rasdir
ect
ed.Ifa
doseismi ssedanditi
slessthan2hrsbeforenext
dose,ski
pdose; i
fmor et
han2hr sbefor
enextdose,
takedoseandr esumenormal dosi
ngschedule.

I
nform pat
ientt
hatr
ibav
iri
nmaynotreducetheri
skof
t
ransmissi
onofHCVt oother
s;pr
ecaut
ionsshoul
dbe
t
aken.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations,
especial
lySt
.John'sWor t.

Inf
ormfemalepati
ent
soft
heimport
anceof
simul
taneousl
yusi
ngtwor
eli
abl
efor
msof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 467
 contraception,unlessabst
inenceisthechosen
met hod,dur i
ngtherapyandfor6mopost -t
herapy.
Advisepr egnantwomenandmenwhosef emal e
partnersarepr egnanttoavoidthi
stherapyduet o
bi
rthdef ectsandf etal
deathwithri
baviri
n.Encourage
pregnantpat ient
s

Bor
tezomi
b
I
NDI
CATI
ONS
Mult
ipl
emy eloma(asini
ti
al t
herapyoraft
erpr
ogressi
on)
;
wi
thmelphalanandprednisone.Mantlecel
ll
ymphoma
af
teratl
eastoneothertherapy.

ACTI
ON
Inhi
bit
spr oteasome, aregulat
orofintr
acell
ularprotei
n
cataboli
sm, resulti
ngindisr
uptionofvari
ousi nt
racell
ular
processes.Cy totoxi
ctoav ari
etyofcancerouscells.
TherapeuticEffects:Deathofrapidl
yrepl
icati
ngcel l
s,
parti
cular
lymal ignantones

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
obor
tezomi
b,bor
on,
ormanni
tol
;OB:
Pot
ent
ial
fet
alhar
m.Lact
ati
on:
Pot
ent
ial

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 468
f
orser
iousadv
erser
eact
ioni
nnur
singi
nfant
s.

UseCaut
iousl
yin:
OB:
Womenwi
thchi
l
dbear
ing
potenti
al;Moder atetosev erehepat
icimpai
rment(may↑
l
evels,ri
skoft oxici
ty);
Hi stor
yoforriskf
act
orsforHF;
Pedi:Safetynotest abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: REVERSI BLEPOSTERI ORLEUKOENCEPHALOPATHY
SYNDROME( RPLS), f
atigue,malaise,weakness, dizziness,
syncope.EENT: bl
urredv i
sion,di
plopia.CV:hypot ension,
HF.Resp:pneumoni a.GI :LI
VERFAI LURE, anorexia,
consti
pati
on, diarr
hea, nausea,vomi t
ing.Hemat :
BLEEDING, anemi a,neutropenia,t
hrombocy topenia.Neur o:
peri
pheralneur opathy.Misc:fever,t
umorl ysi
ssy ndr ome.

I
NTERACTI
ONS
Drug-Drug:Concurrentneur
otoxi
cmedicati
onsincl
uding
amiodar one,someant i
vi
ral
s,ni
tr
ofur
atoin,
isoni
azi
d,or
HMG- CoAr eductaseinhi
bit
orsmay↑ riskofperi
pheral
neuropat hy
.

DOSAGE
IV:
(Adul
ts)
:1.
3mg/m2twiceweeklyfor2wk( days1,
4,8,
and11)f
oll
owedbya10-
dayrest
;fur
thercy
cles/doses

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 469
dependonr
esponseandt
oxi
cit
y.
Hepat
icI
mpai
rment
I
V: (
Adult
s) :
Moder at
eorsev
erehepati
cimpai
rment
—0.
7
mg/m2peri nject
ionfort
hef
ir
stcycl
e,t
hen↑ to1mg/m2
perinj
ect
ion.

AVAI
LABI
LITY
Ly
ophi
l
izedpowderf
ori
nject
ion(
requi
resr
econst
it
uti
on)
3.
5mg/vial
;

PATI
ENTTEACHI
NG
Caut i
onthepatientthatdehydrat
ionmayoccurwith
vomi ti
ngordi
arr hea.Advi
sepat i
enttomaint
ainf
lui
d
i
nt akeandtonot if
yhealthcareprofessi
onal
if
dizzinessorf
aint i
ngoccurs.

Instr
uctpati
enttocont acthealthcar eprofessi onali
f
theyexperi
enceneworwor seningsi gnsofper i
pheral
neuropathy(t
ingli
ng,numbness, pain,burningf eeli
ng
i
nt hefeetorhands, weaknessi nthear msorl egs)or
i
fsy mptomsofdehy drati
on( di
zziness,fainting)due
tovomi t
ingordiarr
hea; rash;shortnessofbr eath;
cough;swell
ingoff eet,ankles,orlegs;conv ulsions;
persist
entheadache; r
educedey esight;
increasei nBP
orblurr
edv i
sionoccur.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 470
 Maycausedi zzi
nessandblur
redvi
sion.Caut
ion
pat
ienttoavoiddriv
ingorot
heract
ivi
ti
esrequir
ing
al
ertnessunt
ilresponsetomedi
cati
onisknown.

Advi
sepati
entt
onot i
fyhealt
hcar eprofessional ofal
l
RxorOTCmedi cat
ions,vi
tamins,orherbalpr oducts
bei
ngtakenandconsulthealt
hcar eprofessional
bef
oretaki
ngRx,OTC, orher
bal pr
oducts.

Advisediabet
icpati
entst
akingoralhypogl
ycemic
agentstomoni t
orbloodgl
ucosefrequentl
yandnotif
y
heal
t hcarepr
ofessi
onalofchangesinbloodsugar.

Advisepatientoft heneedforcont
raceptionandt
o
avoidbreastfeedingduringther
apy
.Pat i
entshoul
d
noti
fyhealthcar eprofessi
onali
mmedi atelyi
f
pregnancyissuspect ed.

Bosent
an
I
NDI
CATI
ONS
Pul
monar
yar
ter
ial
hyper
tensi
on(
WHOGr
oup1)
.

ACTI
ON
Ant
agoni
zest
heeff
ect
softheneur
ohormoneendot
hel
i
n
bybi
ndi
ngtoi
tsr
ecept
orsi
tesi
nendothel
i
um and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 471
vascul
arsmoothmuscle.Therapeut
icEffect
s:Improved
exerci
secapaci
tyanddecreasedcli
nical
deteri
orat
ion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentuseof
cy cl
osporineorglybur ide; Concurrentusewi thaCYP2C9
i
nhi bit
orandast r
ongormoder ateCYP3A4i nhi
bitor;
Moder at
et oseverel i
veri mpairment ;OB:Highr i
skf orf
etal
har m( malfor
mat i
on, stil
lbirt
h)ifadmi ni
steredtopr egnant
women.Pr egnancymustber uledoutbef orestartof
treatmentandr eli
abl econt r
aceptionusedt hroughout
treatment.Hor monal cont r
aceptives(al
l f
orms)cannotbe
thesol eform ofcont racept i
on( seedrug-drug
i
nt eracti
ons).Mont hlypr egnancyt estsforwomenwi t
h
chi l
dbeari
ngpot entialisr ecommendedt hroughoutcour se
oft herapy.
Lactati
on: Lact ati
on.

UseCaut
iousl
yin:
Mil
dlyi
mpai
redl
i
verf
unct
ionor
hi
storyofl
i
verdi
sease;
Womenwi
thchi
l
dbear
ingpot
ent
ial
.
Pedi:
Safet
ynotest
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,fati
gue.EENT: nasophar
yngit
is.CV:
edema, hypotensi
on, palpi
tat
ions.GI
:HEPATOTOXI CITY,
dyspepsia.Derm: f
lushing,pr
urit
us.GU:↓ sperm counts.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 472
Hemat
:anemi
a.

I
NTERACTI
ONS
Drug- Dr ug: Bosent ani smet abol izedbyandi nducest he
CYP3A4and2C9enzy mesy stems.May↓ ef fecti
veness
ofhor monal cont racept i
ves( addi t
ional methodof
cont racept ionr ecommended) .Signi ficant l
y↓
cyclospor i
nel evels; cyclospor inesi gni f i
cantly↑ bosent an
l
ev els( concur r
entusecont rai ndicat ed) .↑ r i
skof
hepat ot oxicit
ywi t
hgl ybur i
de( concur r entuse
cont raindicat ed).Lopi nav i
r/ritonav irorot her
ri
tonav i
r—cont ainingr egi menssi gnif icantly↑ l evel
s
(i
nitiatebosent anat62. 5mgoncedai lyorev eryotherday
i
fr ecei vingr i
tonav ir-cont ai
ni ngr egi menf or≥10day s)(i
f
i
nitiatingr i
t onav i
rinpat iental readyr ecei vi
ngbosent an,
discont inuebosent anf or≥36hrbef or einit
iatingrit
onav i
r;
canr esumebosent anaf ter≥10day sat62. 5mgoncedai l
y
orev er yotherday ) .Ket oconazol e↑ l ev el
s.↓ l evel
sof
si
mv ast ati
n, lovast atin,andat orvast at in.↓ lev el
sof
war farin.May↓ l ev elsoft acr oli
musandsi rolimus.

DOSAGE
PO:(
Adults):
62.5mgtwicedai
l
yf or4wkini
ti
all
y,t
hen↑
tomaint
enancedoseof125mgt wicedai
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 473
PO:(Adult
s<40kgand>12y r
):62.
5mgt
wicedai
l
yas
i
nit
ialandmaint
enancedose.

AVAI
LABI
LITY
Tabl
ets62.
5mg,
125mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakebosentanasdirected.Take
misseddosesassoonasr emember edunl essal
most
ti
mef ornextdose;donotdoubledoses.Donotst op
taki
ngbosentanwi t
houtconsult
inghealthcare
professi
onal
;maycauseani ncreaseinsy mptoms.
Explaint
herequir
ementsoft heTRACLEERAccess
Program.

Adv i
sepatienttonoti
fyheal
thcar
epr ofessi
onal
i
mmedi at
elyifnausea,v
omiti
ng,f
ever,abdomi nal
pain,unusualti
redness,
stomachpain,orjaundice
occursorifswel l
i
ngofanklesorl
egsordi ffi
culty
breathi
ngoccur s.

Instr
uctpati
entt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsulthealt
hcar e
professi
onalbef
oretaki
nganyRx, OTC, orherbal
products.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 474
 Advi
sepati
entofther
equi
rementofmont
hlyl
abt
est
s
tomoni
torforl
iv
erdysf
uncti
on.

Cautionpremenopausal womenaboutt hei

mpor tance
ofeffect
ivecontracept i
on,theinter
acti
onofbosent an
withhormonal contraceptives,
andt heneedf or
mont hl
yserum orur inepregnancyt est
s.Crushedor
brokentablet
sshoul dnotbehandl edbypregnant
women.I nfor
m ment hatbosentanmaycause
decreasedsperm count .

Bot
uli
sm i
mmunegl
obul
i
n
I
NDI
CATI
ONS
I
nfantbot
uli
sm causedbyt
ypeAorBt
oxi
ninchi
l
dren<1
y
r.

ACTI
ON
Contai
nsanti
bodi
escapableofneut
ral
i
zingneur
otoxins
ty
peAandB.Ther apeut
icEff
ect
s:Decr
easedsequelaeof
i
nfantbot
uli
sm.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hi
stor
yofsev
erer
eact
ionst
oot
her
i
mmunogl
obul
i
ns;
Sel
ect
ivei
mmunogl
obul
i
nAdef
ici
ency
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 475
UseCaut
iousl
yin:
Pre-
exi
sti
ngr
enal
impai
rment
,
di
abetesmel l
i
tus,vol
umedepl eti
on,sepsi
s,
par
aproteinemi a,
concurrentnephrot
oxicagents(↑ri
skof
adver
ser enalreacti
ons;uselowestconcentrat
ionand
sl
owestinf usi
onr at
e).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Der
m:r
ash.Mi
sc:
inf
usi
onr
eact
ions.

I
NTERACTI
ONS
Drug-
Drug:Mayint
erf
erewithi
mmuneresponset
oli
ve-
vi
rusvacci
nes;
deferforatl
east5mo.

DOSAGE
I
V:(Chi
ldr
en<1y
r):
1mL/
kg(
50mg/
kg)asasi
ngl
e
i
nfusi
on.

AVAI
LABI
LITY
Lyophi
l
izedpowderf
ori
nject
ion(
requi
resr
econst
it
uti
on)
100mg/ vi
al;

PATI
ENTTEACHI
NG
I
nfor
m par
ent
sofpur
poseofmedi
cat
ion.

Caut
ionpar
ent
stoav
oidl
i
vev
acci
nat
ionsshor
tl
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 476
 bef
oreorwi
thi
n5moofadmi
nist
rat
ion

BRENTUXI
MAB
I
NDI
CATI
ONS
TreatmentofHodgkinly mphomai npat i
entswhohave
fai
ledautol
ogousstem cell t
ranspl
ant( ASCT)orwhohave
fai
ledtwopr i
ormulti
-agentchemot herapiesandar
enot
candidat
esf orACST.Treatmentofsy stemicanapl
asti
c
l
argecellly
mphomaaf terfai
lureofatleastonemulti
-
agentchemot her
apy.

ACTI
ON
Anant i
body-
drugconj ugat
e(ADC)madeupt hr eepar ts: an
ant
ibodyspecifi
cf orhumanCD30( cAC10, acel l
membr aneproteinoft hetumornecr osi
sf actorr eceptor ),
ami cr
otubul
edi sruptingagentmonomet hylaur ist
ati
n
(MMAE)andapr otease-cl
eavabl
elinkerthatat taches
MMAEcov al
entlyt ocAC10.Thecombi nationdi sruptst he
i
ntracel
lul
armicr otubulenetworkcausingcel l
-cy cl
ear rest
andapoptoti
ccel lulardeat
h.TherapeuticEf f
ect s:
Decreasedspreadofl ymphoma.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 477
Cont
rai
ndi
cat
edi
n:Pr
egnancy
;Lact
ati
on:
Breastf
eedi
ng
shoul
dbeav
oided.

UseCaut
iousl
yin:
Ger
i:Saf
eandef
fect
iveusehasnot
beenest
abli
shed;Pedi:Saf
eandef
fect
iveusei
nchi
l
dren
hasnotbeenestabl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: anxiet y,dizziness,fati
gue, headache, i
nsomi a.Resp:
cough, dyspnea, orophar yngealpai n.CV: peripheraledema.
GI: abdomi nal pain,const i
pati
on, decr easedappet it
e,
diarrhea, nausea, vomi t
ing.Der m: alopecia,nightsweat s,
prur i
tus,rash, dr yskin.Hemat : NEUTROPENI A,
THROMBOCYTOPENI A,anemi a.MS: arthral
gia,backpai n,
extremi typai n, my al
gia,muscl espasm.Met ab:weight
l
oss.Neur o: PROGRESSI VEMULTI FOCAL
LEUKOENCEPHALOPATHY, peripheral sensor yneuropathy.
Mi sc: i
nfusi onr eactionsincludinganaphy laxis,STEVENS-
JOHNSONSYNDROME, TUMORLYSI SSYNDROME, fever,
l
ymphadenopat hy,chill
s.

I
NTERACTI
ONS
Drug-Drug:
MMAEi sbothasubst
rat
eandinhibit
orofthe
CYP3A4/ 5enyzymesy st
em.Str
ongCYP3A4i nhi
bitor
s,
i
ncludingketoconazol
emay↑ bloodlev
elsandt heri
skof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 478
adver
sereact
ions.Str
ongCYP3A4inducers,i
ncl
udi
ng
ri
fampin,
may↓ bl oodlev
elsandef
fect
iveness.

DOSAGE
I
V: (
Adult
s):1.
8mg/ kgev
erythr
eeweeksuptoa
maximum of16cycl
es,di
seaseprogr
essi
onor
unaccept
abl
etoxi
cit
y.

AVAI
LABI
LITY
Lyophi
l
izedpowderf
orI
Vinj
ect
ion(
requi
resr
econst
it
uti
on)
50mg/ vi
al;

PATI
ENTTEACHI
NG
Inst
ructpat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
of
anynumbnessort i
ngl
i
ngofhandsorf
eetorany
muscleweakness.

Advisepat i
entt onotif
yhealthcareprofessi
onal
i
mmedi atelysignsandsy mptomsofi nf
ecti
on(fev
er
of≥100. 5F° ,
chill
s,cough,painonur i
nati
on)or
i
nfusionr eacti
ons( fever
,chil
ls,r
ash,breat
hing
problemswi t
hin24hrofi nfusion)occur.

Cautionf emaleofchil
dbeari
ngagetouseeffect
ive
contraceptionduri
ngtherapy.Av
oidpr
egnancyand
breastfeeding.I
fpregnancyi
ssuspect
ed,noti
fyhealt
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 479
 car
epr
ofessi
onal
prompt
ly.

BRETYLI
UM
I
NDI
CATI
ONS
Treat
mentofv entr
icul
artachycar
dia.Pr
ophyl
axisagai
nst
ventr
icul
arfi
bri
ll
ati
on.Treatmentofotherser
ious
ventr
icul
ararr
hythmiasresist
anttoli
docai
ne.

ACTI
ON
I
niti
all
yrel
easesnorepinephri
ne,thenblocksit
srelease.
Alsohasposit
iveinot
ropiceffects.Ther
apeuti
cEffects:
Suppressi
onofv ent
ri
culartachycardi
aandf i
bri
ll
ati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Nosi
gni
fi
cantcont
rai
ndi
cat
ions.

UseCaut
iousl
yin:
Ger
iat
ri
cpat
ient
s(>65y
r;i
ncr
eased
ri
skofhy potensionwi thrapidinfusionr ates);
Suspected
di
goxintoxici
ty(increasedriskofar rhythmi as);
Patient
s
withfi
xedcar diacout put(maypr oducesev ere
hypotensionrequiri
ngsuppor t
ivetherapy );Renal
i
nsuffici
ency( i
ncreaseddosi nginterval recommended) ;
Pregnancy ,l
actati
on,andchi l
dren( safetynotest abli
shed)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 480
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,faintness.EENT: nasalstuf
finess.CV:
posturalhypotension,angina,bradycar
dia,tr
ansient
hypertensi
on.GI :nausea,vomi t
ing,di
arrhea.Misc:
hyperthermia.

I
NTERACTI
ONS
Drug-Drug:Combi nati
onwi t
hot herantiarr
hyt
hmicsmay
beadditiveorant agonistic.Av oi
dusi nginsuspect
ed
digoxi
nt oxi
city(init
ialrel
easeofnor epinephr
inemay
aggravatearrhy t
hmi as).Enhancesact i
onsofadrener
gic
vasopressors( dopami ne, norepinephri
ne).

DOSAGE
Vent
ri
cul
arFi
bri
l
lat
ion/
Vent
ri
cul
arTachy
car
dia
I
V:(Adul
ts):5mg/ kgbolusover15–30seci ni
ti
all
y;i
fno
r
esponse,i
ncreaseto10mg/ kg,repeatasnecessar y(
not
t
oexceed30mg/ kg/24hr)
.Formai ntenance—5–10
mg/kgq6hror1–2mg/ mincontinuousinfusi
on.
Ot
herVent
ri
cul
arAr
rhy
thmi
as
IV:(
Adults):5–10mg/kgq1–2hr
;thenq6hras
maintenance;mayal
sobegiv
enasaconti
nuousi
nfusi
on
at1–2mg/ min.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 481
I
M: (
Adult
s):5–10mg/
kg,
repeatq1–2hri
far
rhy
thmi
a
per
sist
s,t
henq6–8hr.

AVAI
LABI
LITY
I
nject
ion50mg/
mL;Pr
emi
xedi
nject
ioni
nD5W 1mg/
mL,
2mg/ mL,4mg/
mL;

PATI
ENTTEACHI
NG
I
nstr
uctpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Br
omocr
ipt
ine
I
NDI
CATI
ONS
Adjuncttolev
odopai nt het r
eatmentofpar kinsonism
(Parl
odelonly)
.Tr eatmentofhy per prolacti
nemi a
(amenorrhea/galactorrhea),includingassoci atedfemale
i
nferti
li
ty(Par
lodel only).Treatmentofpr ol
act i
n-secret
ing
adenomas( Parlodel only).Treatmentofacr omegal y
(Parl
odelonly)
.Tr eatmentoft ype2di abetes( asadjunct
todietandexercise)( Cyclosetonl y).Unlabel edUses:
Managementofneur olepticmal ignantsy ndr ome.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 482
Acti
vatesdopaminer eceptorsi
nt heCNS.Decr eases
prol
acti
nsecreti
on.Ther apeuti
cEf fect
s:Reli
efofrigi
dit
y
andtremorinparkinsonism.Rest orati
onoffert
il
it
yi n
hyper
prolact
inemia.Reductionint umorsize.Decreased
growthhormoneinacr omegal y.Lower i
ngofbloodsugar
i
ndiabeticpati
ents.

Av
ail
abi
l
ity
TABLETS1.
25,
2.5and5mg.

DOSAGE
Or
al
Adul
t-Fi
rstweek1t o1.25mgatni ght
,secondweek2to
2.
5mgatni ght,t
hir
dweek2. 5mgt wicedail
y,f
ourt
hweek
2.
5mg3t i
mesdai l
y,t
heni ncreasi
ngby2.5mgev ery3to
14daysaccordi
ngtor esponset oausualrangeof10to
40mgdai l
y.Takewithfood.
Chi
l
d-Under15y
ear
s;notr
ecommended.

Cont
rai
ndi
cat
ions
Hypersensit
ivi
tytobr omocript
ineorot
herergotalkal
oids;
i
schaemi cheartdisease;toxaemiaofpregnancyand
hyper
tensioninpost part
um womenori npuer per
ium.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 483
Shoul dnotbeusedpost par t
um ori npuerperium i n
womenwi thhighbl oodpr essure,coronaryar terydi sease
orsympt oms( orhistory)ofser i
ousment aldisor der ;
moni torbloodpr essurecar efull
y(especiallydur i
ngf ir
st
fewday s)inpostpar t
um women.Ver yrarely,hyper tension,
my ocardial i
nfar
ction,seizuresorst roke(bothsomet i
mes
precededbysev ereheadacheorv isualdisturbances)and
ment aldisordershav ebeenr eportedinpost partum
womengi venbromocr ipti
nef orlactati
onsuppr essi on-
cautionwi thantihypertensivetherapyandav oidot her
ergotalkaloids.Discont i
nuei mmedi atel
yi fhyper tension,
unremi t
t i
ngheadacheorsi gnsofCNSt oxicit
ydev el op.

I
NTERACTI
ONS
Drug-Drug: Addi t
ivehypotensionwi thant i
hypert
ensives.
Additi
veCNSdepr essi
onwi thantihistamines,alcohol,
opioidanal gesics,andsedat i
ve/hy pnoti
cs.Addit i
ve
neurologicef fectswithlevodopa.Ef fectsmaybe
antagonizedbyphenot hi
azines,haloperidol,cl
ozapine,
ol
anzapi ne, zi
prasidone,aripi
razole,andmet ocl
oprami de.
↑r iskofsi deef fectswhenusedwi thergotderi
v ati
ves(do
notusewi thin6hour sofeachot her).CYP3A4i nhibit
ors
may↑ ef fects.CYP3A4i nducersmay↓ ef f
ects.

Pr
ecaut
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 484
Specialistev aluation- monitorforpituitaryenl argement ,
parti
cular lydur ingpr egnancy,annual gy naecol ogical
assessment( post menopausal ,every6mont hs) ,
moni tor
forpept icul cer ati
oni nacromegal icpat ients;
contracept i
veadv i
cei fappropriate(or al contracept i
ves
mayi ncr easepr olactinconcent rati
on); av oi
dl actati
onf or
about5day si fl actationprevent i
onf ails; hi
storyofser ious
ment aldi sorder s(especi al
lypsy choticdi sorder s)or
cardiovascul ardi seaseorRay naud' ssy ndr ome; monitor
forretr
oper itoneal fi
brosis;porphy r
ia;hepat i
ci mpai r
ment ;
i
nteractions. Hy pot ensivereacti
onsmaybedi st urbi
ngin
somepat ientsdur ingt hefir
stfewday soft reat mentand
parti
cularcar eshoul dbeexer cisedwhendr i
v i
ngor
operatingmachi ner y;tol
erancemayber educedbyal cohol.

Adv
erseEf
fect
s
Nausea, const ipation,headache, drowsi ness, nasal
congest ion; l
esscommonl yv omi ti
ng, post ural
hypot ension, fatigue,dizziness,dy skinesi a,drymout h,l
eg
cramps; also, par ti
cularlywi t
hhi ghdoses, conf usion,
psychomot orexci tati
on,hal l
ucinations; rarely,const r
ict
ive
pericarditi
s, pericardialeffusion,pleur alef f
usion( may
necessi t
at ediscont i
nuation),retroperitoneal f
ibrosis
reported( moni tori
ngr equired),hairlossandal lergicski
n
reactions;v eryr arely,gastro-
intestinal bleeding, gastri
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 485
ulcer,vasospasm offi
ngersandtoespart
icul
arl
yin
pat i
entswithRaynaud'
ssy ndr
omeandef f
ectsli
ke
neur ol
epti
cmal i
gnantsyndromeonwi t
hdrawal,
increased
l
ibidoandhy per
sexual
it
yalsoreport
ed;
conjunct
ival
i
nf ecti
on.

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakemedi cati
onasdirect
ed.Take
misseddoseswithi
n4hroft heschedul
eddoseor
omit.Donotdoubledoses.Adv i
sepati
enttoreadthe
Pati
entPackageInser
tbeforetakingandwitheachRx
ref
il
l,i
ncaseofchanges.

Maycausedrowsinessanddizzi
ness.Cauti
on
pat
ientstoavoi
ddriv
ingandotheracti
vi
ti
esrequi
ri
ng
al
ertnessunt
ilr
esponsetomedicati
onisknown.

Cauti
onpat i
enttochangeposi
tionsslowlyt
o
minimizeort
hostat
ichypot
ension.Healt
hcar e
pr
ofessionalshoul
dbenotif
iedifort
hostati
c
hypotensi
onoccurs.

Cauti
onpati
entt
oavoidconcur
rentuseofal
cohol
dur
ingthecour
seofther
apy.

I
nst
ructpat
ientt
oinf
orm heal
thcar
eprofessi
onal
i
mmediatel
yifsi
gnsofMI(sever
echestpain,
fai
nti
ng,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 486
 fasthear t
beat,i
ncreasedsweat ing,cont
inuingor
sev erenauseaandv omiting,nervousness,short
ness
ofbr eath,weakness)orincreasi
ngshor tnessof
breathisnot ed;pul
monar yinfi
lt
ratesandpl eur
al
effusionsmayoccurwi t
hl ong-
termt her
apy .

Advi
sewoment oconsul
twi t
hhealthcare
pr
ofessi
onalregar
dinganonhormonal methodof
bi
rt
hcontrol
.Womenshoul dcontactheal
thcare
pr
ofessi
onalpromptlyi
fpregnancyissuspected.

Emphasi
zetheimport
anceofregul
arfol
low-
up
exami
nati
onstodeter
mineeff
ecti
venessandmoni
tor
si
deeff
ects.

I
nfert
il
it
y:I
nstructwoment r
eat
edfori
nfer
ti
lit
yto
obtai
ndail
ybasal bodytemper
atur
est
odet ermi
ne
whenov ul
ati
onoccur s.

Pitui
tar
yTumor s:I
nstructpati
entstaking
bromocripti
neforpit
uitar
ytumor stoinfor
m heal
th
careprofessi
onali
mmedi at
elyi
fsignsoft umor
enlar
gement( bl
urr
edv isi
on,suddenheadache,sever
e
nausea,andv omit
ing)occur.

Type2Di abet
es:Explaint
opat i
entt
hatthi
s
medicati
oncont r
olshyper
glycemiabutdoesnotcur
e
di
abetes.Therapyislongter
m.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 487
 Revi
ewsi gnsofhy pogl
ycemiaandhy perglycemia
wit
hpat i
ent.I
fhypoglycemiaoccurs,advisepati
entto
dri
nkagl assoforangejuiceoringest2–3t spof
sugar,honey,
orcor nsyrupdissol
vedinwat eroran
appropri
atenumberofgl ucosetablet
sandnot if
y
heal
thcar epr
ofessional
.

Encouragepatientt
ofol
lowpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.

Inst
ructpati
enti
npropertesti
ngofser um gl
ucose
andketones.Thesetestsshouldbeclosel
ymoni t
ored
duri
ngper i
odsofstr
essorill
nessandheal thcar
e
prof
essionalnot
if
iedifsi
gnif
icantchangesoccur.

Advisepatienttocarr
yaform ofsugar(sugarpacket
s,
candy)andi denti
fi
cati
ondescri
bingdi
seaseprocess
andmedi cationregi
menatallti
mes.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Br
ompheni
rami
ne
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 488
Symptomati
crel
iefofal
ler
gicsy
mpt
oms(
rhi
nit
is,
urt
icar
ia)
causedbyhi
staminerel
ease.

ACTI
ON
Antagonizestheeffectsofhist
amineatH1-receptorsi
tes;
doesnotbi ndtoorinacti
vatehist
amine.Therapeuti
c
Effect
s:Decreasedsy mptomsofhi st
amineexcess
(sneezi
ng, r
hinor
rhea,nasalandocularpr
uri
tus,ocular
teari
ngandr edness).

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Acut
eat
tacksof
asthma;Knownalcohol
int
olerance(someel
ixi
rs);
Lactat
ion:
Potent
ialf
oradversereact
ioni
nnursinginf
ant
s.

UseCaut
iousl
yin:
Angl
e-cl
osur
egl
aucoma;
Liv
erdi
sease;
OB:Safetynotest
abli
shed;Geri
:Moresuscepti
bleto
adver
sereacti
ons;uselowerini
ti
aldose;Pedi
:Chil
dren<4
yr(
OTCcoughandcol dproduct
scontaini
ngthi
s
medicati
onshouldbeav oi
ded).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:drowsiness,sedati
on,dizzi
ness,excit
ation(i
n
chi
ldr
en).EENT: bl
urredvi
sion.CV: hy
pertension,
arr
hyt
hmi as,hypot
ension,pal
pitat
ions.GI:drymouth,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 489
const
ipat
ion,
obstr
uct
ion.GU:
ret
ent
ion,
uri
nar
yhesi
tancy
.
Derm:sweati
ng.

I
NTERACTI
ONS
Drug-Drug:Additi
v eCNSdepr essionwithotherCNS
depressantsincludingalcohol
,opioids,and
sedativ
e/ hy
pnot i
cs.MAOi nhi
bit
orsintensif
yandpr
olong
theantichol
inergiceffect
sofant i
histamines.

DOSAGE
PO:(Adult
sandChil
dren≥12y
r):
4mgq4–6hrdai
l
yas
needed(nott
oexceed24mg/day).
PO:(Chi
ldr
en6–12yr
):2mgq4–6hrasneeded(
nott
o
exceed12mg/day
).
PO:(Chi
ldr
en4–6yr
):1mgq4–6hrasneeded(
nott
o
exceed6mg/day
).

AVAI
LABI
LITY
Tablet
s4mgOTC; Capsules(li
qui-
gels)4mg; Eli
xi
r2mg/5
mLRx, OTC;I
ncombinat
ionwi th:
Incombi nati
onwith:
pseudoephedr
ine(
Andehist,TuoroAller
gy)and
pseudoephedr
inewi
thdextromethorphan

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 490
 I
nstructpat
ientt
otakemedi
cat
ionasdi
rect
ed;
donot
doubledoses.

Commonl ycausesdrowsi
ness.Cautionpati
entto
avoi
ddr i
vingorot
heracti
vit
iesrequi
ri
ngaler
tness
unti
lresponsetot
hemedi cati
onisknown.

Advi
sepati
entt
oavoidt
akingal
coholorot
herCNS
depr
essant
sconcur
rent
lywit
hthi
sdrug.

Frequentor
alr
inses,
goodoral
hygi
ene,
andsugar
less
gum orcandymayhelprel
i
evedrymout
h.

Inst
ructpat
ientt
ocont
actheal
thcar
epr
ofessi
onal
if
symptomsper si
st.

Budesoni
de
I
NDI
CATI
ONS
Nebul i
zation—Maintenancetreatmentandpr ophyl
acti
c
therapyofast hma.Oralinhal
ation—Chroniccontr
ol of
persistentbronchi
alasthma.Maydecr easer equi
rement
fororel i
mi nat
euseofsy stemiccort
icosteroi
dsov ert
ime
i
npat i
entswi t
hasthma.

ACTI
ON
Pot
ent
,local
l
yact
ingant
i-
inf
lammat
oryandi
mmune

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 491
modif
ier.Ther
apeut
icEff
ect
s:Decreases
fr
equency/sev
eri
tyofast
hmaattacks.Impr
ovesast
hma
symptoms.

Av
ail
abi
l
ity
I
NHALER100and200µg,
ROTACAP100,
200and400µg,
NASALSPRAy0.
02%w/v.

DOSAGE
Ast
hma
Adul
t-200-
400µgMeterDoseI nhal
ertwicedai
l
yby
i
nhalat
ion,
asdrypowderi
nhaler200-800µginsingl
eor
twodivi
deddoses,
asnebul
isedsoluti
on0.5-1mgt wi
ce
dai
ly
.
Chil
d-50-400µgMeterDoseI
nhal
ert
wicedai
l
y,as
nebul
isedsolut
ion0.
25-
0.5mgtwi
cedail
y.
Nasal
poly
psandal
l
ergi
crhi
nit
is:
200-
400µg/
dayby
i
ntr
anasal
spr
ay.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
ty;
presenceofi
nfect
ionsornasal
ulcer
s.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 492
Drug-Drug:StrongCYP3A4i nhibit
ors,incl
udingri
tonavir
,
atazanavir
,clari
thromyci
n,indi
nav i
r,i
traconazol
e,
ketoconazole,nefazodone,nel
finavi
r,saquinavi
r,and
tel
ithr
omy ci
n↓ met aboli
sm and↑ l evelsofbudesonide.

Pr
ecaut
ions
Paradoxical
bronchospasm;chi
ldr
en,
elderl
y,pregnancy
(Appendix7c),
lact
ati
on;act
iveorqui
escenttubercul
osi
s,
i
nteract
ions.

Adv
erseEf
fect
s
I
nhalati
onleadst
ohoar
senessofvoi
ce,opportuni
sti
c
fungali
nfect
ioni
nor
ophar
ynx,r
espir
ator
yinfecti
on,
headache.

PATI
ENTTEACHI
NG
Advisepat i
enttotakemedi cati
onasdi r
ected.Take
misseddosesassoonasr emember edunlessalmost
ti
mef ornextdose.Advisepat i
entnottodisconti
nue
medi cati
onwi t
houtconsultinghealt
hcare
professional
;gradualdecreaseisrequir
ed.Instr
uct
pati
entt oreadthePat i
entInformati
onand
I
nstructionsforUsebef or
eusi ngandwi t
heachRx
refi
l
l,incaseofnewi nformat i
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 493
Advisepatientsusinginhal
ati
oncorticoster
oidsand
bronchodil
atortousebr onchodi
lat
orf i
rstandtoall
ow
5mi ntoelapsebef oreadminist
eri
ngt he
corti
costeroi
d,unlessotherwi
sedirectedbyhealth
careprofessional
.

Advisepat
ientt
hatinhalat
ioncorti
cost
eroidsshoul
d
notbeusedt ot
reatanacut easthmaattackbut
shouldbeconti
nuedev enifotheri
nhal
ationagents
areused.

Patientsusi
nginhalat
ioncorti
coster
oidst ocontr
ol
asthmamayr equir
esystemiccorti
costeroidsfor
acuteat t
acks.Advi
sepatientt
ouser egularpeakflow
moni tor
ingtodetermi
ner espi
rat
orystatus.

Advisepat
ientt
or i
nsemouthwit
hwaterafter
tr
eatmenttodecreaser
iskofdev
elopi
nglocal
candidi
asi
s.

Caut
ionpati
enttoavoi
dsmoking,
knownal
l
ergens,
andotherr
espi
rator
yir
ri
tant
s.

Adv i
sepat i
enttonoti
fyhealt
hcar
eprofessionali
f
sorethroatormout horsymptomsofanaphy laxi
s
(rash,severei
tchi
ng,swell
ingoft
heface,mout h,and
tongue, t
roubl
ebreathi
ngorswall
owi
ng, chestpain,
anxietyorfeel
ingofdoom)occur.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 494
Instr
uctpat i
entwhosesy st
emi ccorti
cost
eroidshave
beenr ecentl
yreducedorwi thdr
awnt ocarryawar ni
ng
cardindicati
ngtheneedf orsupplementalsystemic
corti
costeroidsi
ntheev entofstressorsevere
asthmaat tackunresponsivetobronchodi
lators.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Pulmicor tFlexhaler:Adv isepatienttof ollow

i
nstructionssuppl ied.Bef or
ef i
rst
-timeuse, pri
meuni t
byturningcov erandl if
tingof f;
hol duprightwi th
mout hpieceupandt wistbr owngr i
pfullyt ori
ght,then
ful
lytolef tuntili
tclicks.Toadmi nisterdose, hold
upri
ght ,twistbrowngr ipf ul
lytoright,t
henf ull
ytol eft
,
unti
litclicks.Turnheadawayf rom inhalerandexhal e
(donotbl owi ntoi nhaler).Donotshakei nhaler.Place
mout hpiecebet weenl i
psandi nhaledeepl yand
for
cef ul
ly.Remov einhal erfrom mout handexhal e( do
notexhal eintomout hpiece) .Repeatpr ocedur eif2nd
doser equired.Repl acecov er.

PulmocortRespules:
Admi ni
sterwithaj etnebuli
zer
connect
edt oadequateairfl
ow, equippedwitha
mouthpieceorfacemask.Adj ustfacemaskt oav oi
d
exposi
ngey estonebuli
zedmedi cation.Washf ace

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 495
 aft
eruseoffacemask.Ul
trasoni
cnebul
izer
sar
enot
adequat
eforadmini
str
ati
onandnotrecommended.

I
nstr
uctpar
enttoreadandfol
lowthePati
ents
I
nstr
ucti
onsforUseincl
udedi
neachpackage.Donot
mixwit
hothermedicati
onsi
nthenebul
izer
.

Storerespulesupri
ght ,awayfrom heatandprotect
ed
fr
om light.Donotref r
igerat
eorfreeze.Respulesar
e
stabl
ef or2wksatr oom temperatur
eaf t
eropening
al
umi num foilenv
elope.Openr espulesmustbeused
prompt l
y.Unusedr espulesshouldbereturnedto
al
umi num foilenv
elope.

Bumet
ani
de
I
NDI
CATI
ONS
Edemaduet oheartfai
l
ure,
hepati
cdisease,orr
enal
i
mpai r
ment.Unlabel
edUses:Rev
ersalofoli
guri
ain
pret
erm neonat
es.

ACTI
ON
Inhi
bit
st hereabsorpti
onofsodium andchloridefrom t
he
l
oopofHenl eanddi st
alr
enal t
ubule.I
ncr
easesr enal
excret
ionofwat er,
sodium chlori
de,magnesium,
potassium,andcalcium.Effecti
venessper
sistsin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 496
i
mpai r
edrenal
funct
ion.Ther
apeut
icEffect
s:Di
uresi
sand
subsequentmobi
li
zati
onofexcessfl
uid(edema,pl
eural
eff
usions)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
wit
hthi
azidesandsul
fonami
desmayoccur
;Hepat
iccoma
oranur
ia.

UseCaut
iousl
yin:
Sev
erel
i
verdi
sease(
maypr
eci
pit
ate
hepat i
ccoma; concurrentusewi thpot assium- sparing
diureti
csmaybenecessar y);Electrol
ytedepl etion;
Diabetesmel li
tus;Increasingazot emia;Lact ati
on: Pedi:
Saf et
ynotest abli
shed; bumet anideisapot entdispl acer
ofbi l
i
rubinandshoul dbeusedcaut i
ouslyincr iti
call
yi l
lor
j
aundi cedneonat esbecauseofr i
skofker nicterus.
Inject
ioncont ainsbenzy lalcohol ,whichmaycause
gaspingsy ndromei nneonat es; Geri:Mayhav e↑ r iskof
sideef f
ects,especiall
yhy potensi onandel ect rolyt
e
i
mbal ance, atusual doses.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,encephalopathy,headache.EENT: hear
ing
l
oss,tinnitus.CV: hypotensi
on.GI :
diar
rhea,drymout h,
nausea, vomi t
ing.GU: ↑ BUN, excessi
veurinati
on.Derm:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 497
STEVENS- JOHNSONSYNDROME, TOXICEPI DERMAL
NECROLYSI S, photosensit
ivi
ty,pruri
ti
s,r
ash.Endo:
hypergl
ycemi a,hyperuri
cemi a.FandE: dehydrati
on,
hypocal
cemi a, hy
pochloremi a,hypokal
emi a,
hypomagnesemi a,hyponatremi a,
hypovolemia,metabol
i
c
al
kalosi
s.MS: art
hralgi
a,muscl ecramps, myalgi
a.

I
NTERACTI
ONS
Drug-Drug: ↑r iskofhypot ensionwi thantihy per
tensives,
ni
trates,oracut eingesti
onofal cohol.↑ riskof
hypokalemi awi thotherdiuretics,amphot ericinB,
st
imul antlaxatives,andcor ti
cost er
oids.Hy pokalemi amay
↑r iskofdi goxintoxici
ty.↓ lithium excreti
on, maycause
l
it
hium t oxi
city.↑ ri
skofot otoxicit
ywithami noglycosides.
NSAI DS↓ ef fectsofbumet anide.

DOSAGE
PO:(Adult
s):0.5–2mg/daygi
venin1–2doses;
tit
rat
eto
desi
redresponse(maxi
mum dail
ydose=10mg/ day)
.
PO:(
Inf
ant
sandChi
l
dren)
:0.
015–0.
1mg/
kg/
doseev
ery
6–24hrs(
maxi
mum:10mg/day)
.
PO:(Neonat
es):
0.01–0.
05mg/kg/
doseever
y12- 24in
ter
m neonat
esorever
y24–48hrsi
npret
erm neonates.
I
M:I
V:(
Adul
ts)
:0.
5–1mg/
dose,
mayr
epeatq2–3hras

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 498
needed(
upt
o10mg/
day
).
IM:I
V:(
Inf
ant
sandChi
ldr
en):0.
015–0.1mg/
kg/
dose
ever
y6–24hr
s(maxi
mum: 10mg/ day
).
I
M:IV:(Neonat
es):
0.01–0.
05mg/kg/
doseev er
y12-24i
n
t
erm neonat
esorever
y24–48hr
sinpret
erm neonat
es.

AVAI
LABI
LITY
Tabl
ets0.
5mg,
1mg,
2mg,
5mg;
Inj
ect
ion0.
25mg/
mL;

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakebumet
anideasdi
rect
ed.Take
misseddosesassoonaspossibl
e;donotdoubl
e
doses.

Cautionpatientt
ochangeposi ti
onsslowl
yto
minimi zeort
hostat
ichypotensi
on.Cauti
onpati
ent
thatdrinki
ngalcohol,
exerci
singduri
nghotweather
,or
standingforlongperi
odsmayenhanceor thost
ati
c
hypotension.

I
nst
ructpat
ientt
oconsul
theal
thcar
epr
ofessi
onal
r
egardi
ngadiethi
ghinpot
assi
um.SeeAppendi
xM.

Advi
sepat
ientt
ocont
actheal
thcar
epr
ofessi
onal
of
gai
nmorethan3lbsi
noneday.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 499
Instr
uctpati
enttonoti
fyhealthcareprofessionalof
allRxorOTCmedi cati
ons, vi
tamins,orherbal
productsbeingt
akenandt oconsultheal
thcar e
professi
onalbef
oretakinganyOTCmedi cations
concurrent
lywit
hthistherapy.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Advisepatienttocontactheal
thcareprof
essi
onal
i
mmedi atelyifrash,muscleweakness,cr
amps,
nausea,dizziness,numbness,
ortingl
ingof
ext
remiti
esoccur s.

Advi
sepat
ient
swit
hdiabetestomonit
orblood
gl
ucosecl
osel
y;maycauseincr
easedlev
els.

Emphasi
zetheimpor
tanceofr
out
inef
oll
ow-
up
exami
nati
ons.

Ger
i:Cautionol
derpatient
sorthei
rcaregi
versabout
i
ncreasedr i
skf
orfal
ls.Suggestst
rat
egiesforf
all
pr
evention.

Bupi
vacai
ne
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 500
I
ndi
cat
ions
I
nfi
lt
rati
onanaesthesia;
peri
pheral
andsympatheti
cner
ve
bl
ock;spi
nalanaesthesi
a;post
operat
ivepai
nrel
ief
.

ACTI
ON
Localanestheti
csinhibi
tini
ti
ati
onandconduct i
onof
sensorynerveimpulsesbyalteri
ngtheinf
luxofsodium
andeffluxofpotassium i
nneurons,sl
owingorst opping
paintr
ansmi ssi
on.Therapeuti
cEffect
s:Decreasedpai nor
i
nductionofanesthesia;l
owdoseshav emi ni
mal effecton
sensoryormot orfuncti
on;hi
gherdosesmaypr oduce
completemot orblockade.

Av
ail
abi
l
ity
I
NJECTI
ON20ml
vial
(0.
25%;
0.5%and1%)
.

DOSAGE
Adult-
Local:Infi
lt
rati
onusi ng2.5mg/ml soluti
on(max.60
ml).Peripher
al nerveblock:2.5mg/ml solut i
on(max.20
ml)or5. 0mg/ ml solut
ion( max.30ml).Epi dural
block:
Lubri
cantsur gery5mg/ ml sol
uti
on(max.20ml )
.
Sympat heti
cner veblock:2.5mg/ mlsolution( max.50ml)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 501
Cont
rai
ndi
cat
ions
Adjacentskini
nfecti
on;i
nf l
amedskin;concomit
ant
anticoagul
antt
herapy;severeanaemiaorheartdi
sease;
spinalorepi
duralanaesthesiai
ndehydratedor
hypov ol
aemicpati
ent.

I
NTERACTI
ONS
Drug-Drug:Additi
vetoxi
citymayoccurwit
hconcur r
entuse
ofotherami delocal
anestheti
cs(i
ncl
udi
nglidocai
ne,
mepi v
acaine,andpri
locaine)
.Useofsolut
ioncontai
ning
epinephri
newi t
hMAOi nhibi
tor
smaycausehy pert
ension.

Pr
ecaut
ions
Respirat
oryi
mpairment
;hepat
ici
mpair
mentepil
epsy;
porphyri
a;myast
heni
agravi
s;l
act
ati
on;i
nter
act
ions
pregnancy.

Adv
erseEf
fect
s
Withexcessivedosageorf ollowingi ntr
av ascularinjecti
on;
l
ight-
headedness; dizzi
ness; blurredv i
sion; r
estlessness;
tr
emor sandoccasi onall
yconv ulsionsrapi dl
yfol l
owedby
drowsiness;
unconsci ousnessandr espiratoryfailur
e;
cardi
ovasculartoxicit
yincludeshy potension;hear tblock
andcar di
acarrest;hypersensi t
ivi
tyandal l
ergicreact i
ons

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 502
al
sooccur ;epidural
anaest
hesiaoccasional
lycompli
cat
ed
byurinaryretent
ion;f
aecal
inconti
nence;headache;
backacheorl ossofperi
nealsensati
on;tr
ansient
paraesthesiaandparapl
egiaveryrar
e.

PATI
ENTTEACHI
NG
I
nstr
uctpati
entt
onotif
ynursei
fsi
gnsorsy
mpt
oms
ofsy
stemictoxi
cit
yoccur
.

Advi
sepatienttorequestassi
stanceduri
ng
ambulat
ionunt i
lort
hostat
ichypotensi
onandmot
or
def
ici
tsareruledout.

St
orage
St
oreinsi
ngl
edoseormul
ti
-dosecont
ainer
spr
efer
abl
yof
Ty
pe-Igl
ass.

Bupr
enor
phi
ne
I
NDI
CATI
ONS
IM: I
V:Managementofmoder at
et osevereacutepain.
Transder
mal :
Managementofmoder at
et oseverechroni
c
paininpati
entsr
equi
ringuseofacont i
nuousar ound-t
he-
clockopi
oidanal
gesicforanextendedper i
odoftime.SL:
Treatmentofopi
oiddependence;suppresseswithdrawal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 503
sy
mpt
omsi
nopi
oiddet
oxi
fi
cat
ion.

ACTI
ON
Bindst oopi atereceptorsint heCNS.Al terstheper cepti
on
ofandr esponset opai nf
ul sti
mul iwhil
epr oduci ng
gener ali
zedCNSdepr ession.Haspar ti
al antagonist
proper ti
est hatmayr esultinopi oi
dwi t
hdr awal in
physi call
ydependentpat i
ent swhenusedasananal gesi
c.
Ther apeuticEffects:I
M: IV: Transdermal: Decreased
sever it
yofpai n.SL:Suppr essionofwi t
hdr awal symptoms
duringdet oxifi
cati
onandmai ntenancefrom her oi
nor
otheropi oids.Producesar elati
velymil
dwi t
hdr awal
compar edt ootheragent s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Signi
fi
cant
respi
rator
ydepr essi
on( t
ransdermal);Severebronchial
asthma( t
ransdermal);Paral
yticil
eus(tr
ansder mal)
;Acute,
mild,i
nter
mi tt
ent,orpostoperati
vepain(transdermal);
LongQTsy ndrome( t
ransdermal);Concurrentuseofclass
IorII
Ianti
ar r
hythmics(tr
ansder mal)
;Lactation:Ent
ers
breastmil
k; avoi
duseordi scontinuenursing.

UseCaut
iousl
yin:
↑int
racr
ani
alpr
essur
e;Sev
erer
enal
,
hepat
ic,
orpul
monar
ydi
sease;
Hypot
hyr
oidi
sm;
Sei
zur
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 504
disorder s;Adrenal i
nsuf fi
ciency ;Al
cohol ism; Bili
arytract
disease; Acut epancr eatit
is; Debil
it
atedpat ient s(dose↓
required) ;
Undi agnosedabdomi nalpain;Prost ati
c
hyperpl asia;OB: Safetynotest abli
shed; neonat al
withdrawal mayoccuri ninf antsbor ntopat ientsr eceivi
ng
SLbupr enorphinedur i
ngpr egnancy ;Pedi:Safet ynot
establishedi nchi l
dren( sublingual andtransder mal)or
chil
dren<2y r(parenteral);Geri:Dose↓ r equired.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: confusion,dy sphor i
a, hal
lucinations,sedation,
dizziness, euphoria,fl
oat ingfeeling,headache, unusual
dreams.EENT: blurredv ision,diplopi
a, miosis(highdoses).
Resp: r
espi r
atorydepr essi on.CV: hypertension,
hypot ension,palpitati
ons, QTinterval prol
ongation
(tr
ansder mal ).GI:nausea, constipati
on, drymout h,i
leus,
↑l i
verenzy mes, vomi ting.GU: ur i
naryr et
ention.Derm:
sweat i
ng,clammyf eeling, eryt
hema, pruri
tis,r
ash.Mi sc:
phy sicaldependence, psy chologicaldependence,
tolerance.

I
NTERACTI
ONS
Dr
ug-Drug:Useofhigh-
doset r
ansdermalbuprenorphi
ne
wi
thclassIanti
arr
hythmicsorclassIant
iarr
hythmicsmay
↑riskofQTi nt
erv
al pr
olongat
ion;av
oidconcurrentuse.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 505
Usewi thext remecaut i
oni npat ientsr eceivingMAO
i
nhibitors( ↑ CNSandr espiratorydepr essionand
hypotensi on—↓ bupr enorphi nedoseby50%; mayneedt o
↓ MAOi nhibitordose; donotuset r
ansder mal formul at
ion
within14day sofMAOi nhibitor).↑ CNSdepr essionwi th
al
cohol ,antihistami nes, antidepressant s,
and
sedative/hy pnot i
cs.May↓ ef f
ect i
venessofot heropi oi
d
analgesics.I nhibit
or soft heCYP3A4enzy mesy stem
i
ncludingi traconazol e,ket oconazol e,er yt
hr omy cin,
ri
tonav i
r,indinav i
r,saqui navir,atazanav ir,
orf osampr enavi
r
may↑ bl oodl evel
sandef fects;mayneedt o↓
buprenor phinedose.I nducer soft heCYP3A4enzy me
system includi ngcar bamazepi ne, ri
fampi n, orpheny toin
may↓ bl oodl evel
sandef fects;bupr enor phinedose
modi fi
cat i
onmaybenecessar ydur i
ngconcur rentuse.
Concur rentabuseofbupr enor phineandbenzodi azepines
mayr esul ti
ncomaanddeat h.
Drug-
Natur
alPr
oduct:Concomi
tantuseofkav
a-kava,
val
eri
an,
chamomile,
orhopscan↑ CNSdepr essi
on.

DOSAGE
Anal
gesi
a
I
M: IV:(
Adult
s):0.
3mgq4–6hrasneeded.Mayrepeat
i
nit
ialdoseaft
er30mi
n(upt
o0.3mgq4hror0. 6mgq6

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 506
hr
);0.
6-mgdosesshoul
dbegi
venonl
yIM.
I
M:IV:
(Chil
dren2–12y
r):
2–6mcg(
0.002–0.
006mg)
/kg
q4–6hr.
Transder mal :
( Adults):Opioid-naive-Transder mal system
deli
v eri
ng5–20mcg/ hrappl i
edev ery7day s.Ini
tiatewi th
5mcg/ hrsy stem; eachdoset it
rationmayoccuraf t
er72
hr;donotexceeddoseof20mcg/ hr(duet o↑ r iskofQT
i
nterv alpr
olongat ion);Previouslytaking<30mg/ dayof
mor phineorequi valent-
Init
iatewi t
h5mcg/ hrsyst em;
eachdoset itr
at i
onmayoccuraf t
er72hr ;donotexceed
doseof20mcg/ hr( duet o↑ r i
skofQTi nt erval
prolongation);appl ypatchev ery7day s;Prev iouslyt aking
30–80mg/ dayofmor phineorequi v
alent-I
ni t
iatewi th10
mcg/ hrsystem; eachdoset i
tr
at i
onmayoccuraf ter72hr ;
donotexceeddoseof20mcg/ hr(duet o↑ r i
skofQT
i
nterv alpr
olongat ion);applypat chev ery7day s.

Hepat
icI
mpai
rment
Tr
ansder
mal:(
Adult
s):Mi
l
dtomoderatehepat
ic
i
mpair
ment-
Ini
ti
atewit
h5mcg/
hrsystem.
Tr
eat
mentofopi
oiddependence
SL:
(Adul
ts)
:12–16mg/
dayasasi
ngl
edose.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 507
Subli
ngual t
abl
ets(Subut
ex)2mg, 8mg; I
ncombinati
on
with:nal
oxone(Suboxone).SeeAppendixB.Inj
ect
ion
(Buprenex)300mcg( 0.
3mg) /
mL; Tr
ansdermalsy
stem
(Butr
ans)5mcg/ hr,10mcg/ hr,20mcg/hr;

PATI
ENTTEACHI
NG
Medicat
ionmaycausedr owsinessordizzi
ness.
Advi
sepatienttocallforassi
stancewhenambul at
ing
andtoavoiddrivi
ngorot heracti
vi
ti
esrequir
ing
al
ert
nessunt i
lresponsetomedi cat
ionisknown.

Advi
sepat
ientt
oav oi
dconcur
rentuseofal
cohol
or
ot
herCNSdepressant
s.

Instr
uctpati
enttonoti
fyhealthcareprofessionalof
allRxorOTCmedi cati
ons, vi
tamins,orherbal
productsbeingt
akenandt oconsultheal
thcar e
professi
onalbef
oretakinganyOTCmedi cations
concurrent
lywit
hthistherapy.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed,
orif
br
eastf
eedi
ng.

Pai
n:Instr
uctpat
ientonhowandwhent
oaskf
orpai
n
medicati
on.

Encour
agepat
ient
sonbedr
estt
otur
n,cough,
and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 508
 deep-
breat
heev
ery2hrt
opr
eventat
elect
asi
s.

I
nstr
uctpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Advisepati
entt
hatgoodoralhygi
ene,
frequentmout
h
ri
nses,andsugarl
essgum orcandymaydecreasedr
y
mout h.

Transder mal:Instructpat ientincor rectmet hodfor

applicati
on, r
emov al,storage, anddi sposalof
transdermal system.Wearpat chesf or7day s.Maybe
wor nwhi lebathing, shower ing, orswimmi ng.Donot
discontinueorchangedosewi thoutconsultingheal
th
carepr ofessi
onal .Instructpat ienttoreadt he
Medi cationGuidepr iortost arti
ngandwi t
heachRx
refi
ll
.

Adv i
sepat i
ent sandcar egivers/fami l
ymember sof
thepotentialsideef fect
s.Instructpat ientt onot i
fy
healthcarepr ofessionalifpainisnotcont roll
edori f
bothersomesi deef f
ectsoccur .Cont acti mmedi at
ely
i
fdi f
fi
cultyorchangesi nbreat hi
ng, unusual deep
“si
ghing”br eathingsloworshal l
owbr eat hing,newor
unusual snoring,slowhear tbeat,sev eresl eepiness,
cold,cl
ammyski n,feeli
ngfaint,dizzy ,
conf used,or
cannotthink, walk,ortalknormal ly,ori fswel l
ingor
bli
steri
ngar oundpat choccurs.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 509
Advisepati
entthatfever,el
ect
ri
cblanket
s,heat
ing
pads,saunas,hottubs,andheatedwaterbeds
i
ncreasethereleaseoff ent
anylf
rom t
hepatch.

Adv i
sepatientref
erredforMRItesttodiscusspat
ch
withref
erri
ngheal t
hcarepr of
essional
andMRIf aci
li
ty
todeter
mi neifremov al
ofpatchisnecessarypri
orto
testandfordirect
ionsforrepl
acingpatch.

Opi oi
dDependence: Instructpatientinthecor r
ectuse
ofmedi cat
ion;direct
ionsf orusemustbef oll
owed
exactly.Medi cati
onmustbeusedr egular
ly,not
occasional l
y.Takemi sseddosesassoonas
remember ed; i
falmostt i
mef ornextdose, ski
p
mi sseddoseandr et
urntor egulardosingschedul e.
Donott ake2dosesatonceunl essdirectedbyhealth
car eprofessional
.Donotdi scontinueusewi t
hout
consultingheal t
hcar eprofessional;abrupt
discont i
nuati
onmaycausewi thdrawal sy
mpt oms.If
medi cationisdiscontinued,flushunusedt abl
ets
downt hetoil
et.

Cauti
onpat i
entthatbupr enorphi
nemaybeat ar
get
forpeoplewhoabusedr ugs;storemedicat
ionsi
na
safeplacetoprotectthem from thef
t.Sel
li
ngorgiv
ing
thi
smedi cat
iontoot hersisagainstt
helaw.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 510
 Cauti
onpat
ientt
hati
njecti
onofSuboxonecanl
eadt
o
sever
ewit
hdrawalsy
mpt oms.

Advisepat i
enti
fadmi t
tedt
otheemergencyroom to
i
nformt reati
ngphysici
anandemergencyroom st
aff
ofphysicaldependenceonopioi
dsandoft r
eat
ment
regi
men.

Adv i
sepatientt
onot i
fyheal
thcarepr ofessi
onal
promptlyiffai
ntness,di
zzi
ness,confusion,sl
owed
breathi
ng,skinorwhitesofeyesturny ell
ow,uri
ne
turnsdark,li
ght
-color
edstool
s,decreasedappet i
te,
nausea,orabdomi nalpai
noccur.

BUPROPI
ON
I
NDI
CATI
ONS
Treat
mentofdepr ession(
withpsychotherapy).
Depressi
oni npati
entswit
hseasonal af
fecti
vedi sorder
(XLonly).Smokingcessat
ion(Zybanonly).Unlabeled
Uses:TreatmentofADHDi nadults(SRonly).Toi ncrease
sexualdesir
einwomen.

ACTI
ON
Decr
easesneur
onal
reupt
akeofdopami
nei
ntheCNS.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 511
Dimini
shedneuronal uptakeofserot
oninand
norepi
nephri
ne(lesst hantr
icycl
i
cantidepressant
s).
Therapeut
icEff
ects: Dimini
sheddepression.Decr
eased
cravi
ngforci
garettes.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hist
oryofbul
i
mia,
andanorexianervosa; Concurr
entMAOi nhi
bit
oror
ri
tonavi
rtherapy;
Lact ati
on:Potent
ial
forser
iousadver
se
react
ionsinnursi
ngi nfants.

UseCaut
iousl
yin:
Renal
/hepat
ici
mpai
rment(
↓ dose
recommended) ;RecenthistoryofMI ;Historyofsuici
de
attempt;Unstablecar di
ovascularstatus;May↑ r iskof
suici
deat t
empt /ideati
onespeci al
lydur i
ngearlytr
eatment
ordoseadj ustment ;t
hisri
skappear st obegr eat
eri n
adolescentsorchi ldr
en;OB: Useonlyi fbenefi
ttopat i
ent
outweighspot entialr
isktofetus;Geri:↑r iskofdrug
accumul at
ion;↑ sensi t
ivi
tytoef f
ects.
ExerciseExtr
emeCaut ionin:Histor
yofsei zures,head
traumaorconcur rentmedi cati
onst hat↓ sei zur e
threshold(t
heophy l
li
ne, anti
psychotics,antidepressant
s,
sy st
emiccorti
costeroids);Severehepat i
cci rrhosis(
↓
doser equi
red);
Pedi :↑r i
skofsuicidalthinkingand
behav i
or.Observecarefully,
especiallyatiniti
ationof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 512
t
her
apyanddur
ing↑ or↓ i
ndose.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, SUICI
DALTHOUGHTS/ BEHAVI OR,
agit
ation,headache, aggression, anxiety,delusions,
depression,halluci
nations,hostil
ity, i
nsomni a,mania,
panic,paranoia,psychoses.GI :dr ymout h, nausea,
vomi t
ing,changei nappet i
te,weightgai n, weightloss.
Derm: photosensi t
ivi
ty.Endo:hy per gl
ycemi a,
hypoglycemia, syndromeofi nappr opri
ateADHsecr et
ion.
Neuro: t
remor.

I
NTERACTI
ONS
Drug-Drug: ↑r iskofadv erser eacti
onswhenusedwi th
amant adine,levodopa, orMAOi nhibit
or s( concur rentuse
ofMAOi nhibitorsiscont raindicated).↑ r iskofsei zures
withphenot hiazines,ant i
depr essants, theophy lli
ne,
corti
cost er
oids, OTCst imul ants/anorect ics, orcessat ion
ofalcohol orbenzodi azepi nes( avoidormi nimi zeal cohol
use).Ritonavir,lopi
nav i
r/ri
tonav ir,
andef av i
renzmay↓
l
evels;mayneedt o↑ bupr opi ondose.May↑ ci t
alopr am
l
evels.Car bamazepi nemay↓ bl oodl ev elsand
eff
ectiveness.Concur rentusewi thnicot iner eplacement
maycausehy per t
ension.↑ r iskofbl eedi ngwi thwar fari
n.
Bupropionandoneofi tsmet abol i
tesi nhi bittheCYP2D6

ᏆᖴA2022 Dr
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thyCar
e 513
enzymesy stem andmay↑ l evel
sandr iskoft oxi
cit
yfrom
anti
depr essants(SSRIsandt ri
cycl
ic),haloperi
dol,
ri
speridone,thi
oridazi
ne,haloperi
dol,betabl ocker
s,
fl
ecainide,andpr opaf
enone.May↓ l evelsandef f
icacyof
tamoxi f
en.May↓ t heeff
icacyoft amoxi fen.

DOSAGE
Depr
essi
on
PO: (
Adul ts) :
Immedi at e-
rel
ease—100mgt wicedai l
y
i
nitially
; after3day smay↑ t o100mg3t i
mesdai l
y;af
ter
atleast4wkoft herapy ,may↑ upt o450mg/ dayi n
divideddoses( nott oexceed150mg/ dose; waitatleast6
hrbet weendosesatt he300mg/ daydoseoratl east4hr
bet weendosesatt he450- mg/ daydose) .Sustained-
release—150mgoncedai l
yint hemor ning;after3day s,
may↑ t o150mgt wicedai l
ywi t
hatl east8hrbet ween
doses; afteratl east4wkoft herapy,may↑ t oa
maxi mum dai lydoseof400mggi v
enas200mgt wice
daily.Ext ended- rel
ease( Well
but r
inXL) —150mgoncedai l
y
i
nt hemor ning, maybe↑ af t
er4day st o300mgonce
daily;somepat ientsmayr equireupt o450mg/ dayasa
singledai l
ydose.Ext ended-release( Aplenzi n)
—174mg
oncedai lyint hemor ning,maybe↑ af t
er4day st o348
mgoncedai ly;somepat i
entsmayr equir eupt o522
mg/ dayasasi ngledai l
ydose.

ᏆᖴA2022 Dr
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nHeal
thyCar
e 514
Seasonal
Aff
ect
iveDi
sor
der
PO: (
Adults)
:150mg/dayinthemorning;i
fdoseiswell
tol
erated,↑to300mg/dayinonewk.Dosesshoul dbe
taperedto150mg/dayfor2wkbeforediscont
inui
ng.

Smoki
ngcessat
ion
PO:(
Adult
s):Zyban—150mgoncedai
lyfor3days,
then
150mgtwicedail
yfor7–12wk(
dosesshouldbeatleast
8hrapar
t).

AVAI
LABI
LITY
Tabl
ets75mg,100mg;Sustai
ned-r
eleaset
abl
ets100mg,
150mg,200mg;Ext
ended-r
eleasetabl
ets(
Well
butri
nXL)
150mg,300mg;Ext
ended-r
eleasetabl
ets(
Apl
enzin)174
mg,348mg,522mg;

PATI
ENTTEACHI
NG
I
nstructpatienttotakebupr opi
onasdi rected.Take
misseddosesassoonaspossi bleandspaceday ’
s
remainingdosesev enl
yatnotlesst han4-hrinterval
s.
Misseddosesf orsmoki ngcessationshouldbe
omitted.Donotdoubl edosesort akemor ethan
prescri
bed.Mayr equir
e4wkorl ongerforfulleff
ects.
Donotdi scontinuewi t
houtconsul t
inghealthcare

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 515
 pr
ofessi
onal
.Mayrequi
regr
adual
reduct
ionbef
ore
di
sconti
nuat
ion.

Mayimpairjudgmentormot orandcogni
ti
veskil
ls.
Cauti
onpatientt
oavoiddrivi
ngandotheract
ivi
ti
es
requi
ri
ngalert
nessunti
lresponsetomedicat
ionis
known.

Advisepati
ent,fami l
y ,andcar egiverstolookfor
sui
cidali
ty,
especi all
ydur ingear l
ytherapyordose
changes.Notifyhealthcar eprofessionalimmediatel
y
i
fthoughtsaboutsui cideordy ing,attemptsto
commi tsuici
de, neworwor sedepr essi
onoranxi et
y,
agit
ati
onorr estlessness, panicattacks,insomnia,
neworwor seirritabi
lit
y ,aggressiveness,acti
ngon
dangerousimpul ses, mani a,orotherchangesi n
moodorbehav ioroccur .

Instructpatientt
onotifyheal
thcareprof essionalof
allRxorOTCmedi cat
ions,vi
tamins,orher bal
product sbeingtaken,toavoidal
cohol duringtherapy
andt oconsul twit
hheal t
hcareprofessional bef
ore
takingot hermedicati
onswi t
hbupropion, suchas
Zyban.

I
nform pat
ientt
hatfr
equentmouthri
nses,
goodoral
hygi
ene,andsugarl
essgum orcandymaymini
mize
dr
ymout h.Ifdr
ymouthpersi
stsformoret
han2wk,

ᏆᖴA2022 Dr
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nHeal
thyCar
e 516
 consul
theal
thcarepr
ofessi
onal
regar
dinguseof
sal
ivasubst
it
ute.

Advisepati
enttonot
if
yheal
thcar
eprofessi
onal
if
rashorothert
roubl
esomesi
deeffect
soccur.

Inf
orm pati
entthatunusedshel
lofXLt
abl
etsmay
appearinstool
;thi
sisnormal.

Advi
sepati
enttousesunscreenandprot
ectiv
e
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

I
nstructfemalepati
entstoinf
orm healt
hcare
pr
ofessionali
fpregnancyisplannedorsuspect
edor
i
fbreastfeedi
ngorplanni
ngt obreast
feed.

Emphasizetheimportanceoffol
l
ow- upexamsto
monit
orprogress.Encouragepat
ientpart
ici
pat
ioni
n
psy
chotherapy.

SmokingCessat
ion:
Smokingshoul
dbestopped
duri
ngthe2ndweekofther
apytoal
lowfortheonset
ofbupropi
onandtomaximizet
hechancesofquit
ti
ng.

Advi
sepati
entt
ostopt aki
ngbupr
opionandcont acta
heal
thcar
eprof
essionalimmedi
atel
yifagi
tati
on,
depr
essedmood,andanychangesinbehaviorthat

ᏆᖴA2022 Dr
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thyCar
e 517
 arenottypi
cal
ofni
coti
newithdr
awal
,ori
fsui
cidal
thought
sorbehavi
oroccur
.

BUSPI
RONE
I
NDI
CATI
ONS
Managementofanxi
ety
.

ACTI
ON
Bi
ndst oserot
oninanddopami nereceptor
sinthebrai
n.
I
ncreasesnorepi
nephrinemetabol
ism inthebr
ain.
Therapeut
icEff
ects:Reli
efofanxi
ety.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erehepat
icor
r
enali
mpairment;
Concur
rentuseofMAOi nhi
bit
ors;
I
ngest
ionoflar
geamountsofgrapef
rui
tjui
ce.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngot
herant
ianxi
ety
agents(ot
heragentsshoul
dbeslowlywi
thdr
awnto
preventwit
hdrawalorr
eboundphenomenon)
;Pat
ients
recei
vingotherpsy
chotr
opi
cs;Lact
ati
on:OB:
Pedi
: Saf
ety
notestabl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
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nHeal
thyCar
e 518
CNS: dizziness, drowsi ness, exci tement ,
fatigue, headache,
i
nsomni a,ner v ousness, weakness, personal i
tychanges.
EENT: blur redv i
si on,nasal congest ion,soret hroat ,
ti
nnit
us, alt eredt asteorsmel l
, conj unctivi
tis.Resp: chest
congest ion, hy per ventilation,shor tnessofbr eath.CV:
chestpai n, palpi tations, tachycar dia, hypertension,
hypotensi on, sy ncope.GI :nausea, abdomi nalpai n,
constipat i
on, di arrhea, dr ymout h, vomi ti
ng.GU: changes
i
nlibi
do, dy suria, urinaryf requency ,ur i
naryhesi tancy .
Derm: rashes, al opeci a, bli
sters, dryski n,easybr uising,
edema, f l
ushi ng, pruritus.Endo: irregularmenses.MS:
my al
gia.Neur o: incoor dinat i
on, numbness, parest hesia,
tr
emor .Mi sc: clammi ness, sweat i
ng, fever.

I
NTERACTI
ONS
Drug-Drug: Usewi thMAOi nhi
bitor
smayr esul ti
n
hypertensionandi snotr ecommended.Er ythromycin,
nefazodone, ketoconazol e, i
tr
aconazole,r
itonavir
,and
otherinhibit
or sofCYP3A4↑ bl oodlevel
sandef fectsof
buspirone;doser educt ionisrecommended( ↓t o2.5mg
twicedailywi ther ythromy cin;↓t o2.5mgoncedai l
ywith
nefazodone) .Ri f
ampi n,dexamet hasone,pheny t
oin,
phenobar bital,carbamazepi ne,andotherinducersof
CYP3A4↓ bl oodl ev elsandef fect
sofbuspi rone;dose
adjustmentmaybenecessar y.Avoi
dconcur r
entusewi t
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 519
al
cohol
.
Drug-
Natur
alPr
oduct
:Concomi
tantuseofkava-
kav
a,
val
eri
an,
orchamomil
ecan↑ CNSdepr essi
on.
Drug-
Food:Grapef
rui
tjui
ce↑ serum l
evelsandef
fect
;
i
ngesti
onoflargeamountsofgrapef
rui
tjuicei
snot
recommended.

DOSAGE
PO:(Adul
ts):7.
5mgt wi
cedail
y;↑ by5mg/dayq2–4
daysasneeded(nott
oexceed60mg/ day
).Usual
dosei
s
20–30mg/ day(i
n2divi
deddoses)
.

AVAI
LABI
LITY
Tabl
ets5mg,
7.5mg,
10mg,
15mg,
30mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakebuspironeexactl
yasdir
ected.
Takemi sseddosesassoonaspossi bl
eifnotj
ust
beforenextdose;donotdoubl edoses.Donottake
mor ethanamountpr escr
ibed.

Maycausedi zzi
nessordrowsi ness.Cauti
onpati
ent
toavoiddri
vingorotheractiv
iti
esrequir
ingal
ert
ness
unti
lresponsetothemedi cati
onisknown.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 520
 Advi
sepat
ientt
oav oi
dconcur
rentuseofal
cohol
or
ot
herCNSdepressant
s.

Instr
uctpati
entt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsulthealt
hcar e
professi
onalbef
oretaki
nganyRx, OTC, orherbal
products.

Inst
ructpati
enttonoti
fyhealthcareprofessi
onalif
anychronicabnormalmov ement soccur(dyst
onia,
motorrestl
essness,i
nvoluntar
ymov ement soffaci
al
orcervi
calmuscles)orifpregnancyissuspected.

Emphasizet
heimportanceoff
ollow-upexamst
o
det
ermineef
fect
ivenessofmedicati
on.

Busul
phan
I
ndi
cat
ions
Chroni
cgranul
ocyti
cleukaemia,chr onicmy elogenous
l
eukaemia,pol
ycyt
haemi aver
a, my elofi
brosis,
thr
ombocythaemiaandbonemar rowdi sorder s.I
V:With
cycl
ophosphamideasaconditioningr egimenbef ore
all
ogeni
chematopoieti
cprogenitorcelltransplantat
ionfor
CML.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 521
ACTI
ON
Disr
uptsnucl
eicaci
df uncti
onandpr otei
nsy nthesi
s(cel
l
-
cycl
ephase–nonspecifi
c).Therapeuti
cEffects:Deathof
rapi
dlygr
owingcell
s,especial
lymal i
gnantones.

Av
ail
abi
l
ity
TABLET2mg.Sol
uti
onf
ori
nject
ion6mg/
mL;

DOSAGE
Or
al
PO:Chroni
cmyeloi
dleukaemi
a,i
nduct
ionofremi
ssion:
60
µg/kgbodywei
ghtdail
y(max4mg)mai nt
enancedose
0.
5t o2mgdail
y.
IV:
(Adults):0.
8mg/ kgq6hr( dosebasedonidealbody
weightoractualwei
ght,whichev
erisl
ess;i
nobese
pati
ents,dosageshouldbebasedonadjustedideal
body
weight)f
or4day s(t
otalof16doses);gi
venin
combinationwit
hcyclophosphamide.

Cont
rai
ndi
cat
ions
Pr
egnancybonemarr
owsuppressi
on;
chr
oni
c
l
ymphocyt
icl
eukaemi
a;l
act
ati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 522
Pr
ecaut
ions
Monitorcardi
acfuncti
on;pregnancy;l
act
ati
onprev
ious
r
adiationther
apy;avoi
dinpor phy
ria,
hepati
cimpai
rment;
i
nteracti
ons(Appendix6c).

Adv
erseEf
fect
s
Hepatot
oxici
ty(includinghepati
cvenooccl
usivedi sease,
hyper
bil
ir
ubinaemi a,jaundi
ceandfibr
osis)
;cardiac
tamponadeathighdosesi nthal
assaemicpatients;
pneumonia;ski
nhy perpi
gmentati
on;hyper
uraecemi a;
pulmonar
yf i
brosis.

PATI
ENTTEACHI
NG
Inst
ructpati
entt
ot akemedi cat
ionasdi r
ected,atthe
samet i
meeachday ,evenifnauseaandv omi t
ingare
aproblem.Consulthealthcareprofessi
onalif
vomiti
ngoccursshor tl
yaft
erdosei staken.Ifadose
i
smi ssed,donottakeatall;donotdoubl edoses.

Adv i
sepatienttonot i
fyheal
thcareprofessionali
f
fever;sor
et hroat;signsofinfect
ion;l
owerbackor
sidepain;diff
icultorpainfuluri
nati
on;soresinthe
mout horont hel ips;chi
ll
s;dyspnea;persi
stentcough;
bleedi
nggums; bruisi
ng;petechi
ae;orbloodinurine,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 523
 stool,oremesisoccurs.I
nstr
uctpati
entt
ousesof t
toothbrushandelect
ri
cr azor
.Cauti
onpati
entnotto
drinkalcohol
i
cbev er
agesort akepr
oduct
scontaini
ng
aspiri
norNSAI Ds.

Cauti
onpati
enttoavoi
dcrowdsandpersonswith
knowninf
ecti
ons.Healt
hcarepr
ofessi
onalshoul
dbe
i
nformedimmediatel
yifsy
mptomsofinfecti
onoccur
.

Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Advisepat ienttonot i
fyheal t
hcar eprofessionalif
unusual bl
eedi ng; bruisi
ng; orfl
ank, st
omach, orj
oint
pai
noccur s.Adv i
sepat ientsonl ong-t
ermt herapyto
noti
fyheal thcar epr ofessionalimmedi atel
yi fcough,
shortnessofbr eath, andf everoccurorifdar keni
ngof
ski
n, di
arrhea, dizziness, f
atigue,anorexia,confusi
on,
ornauseaandv omi t
ingbecomepr onounced.

I
nfor
m pati
entofi
ncr
easedri
skofasecond
mali
gnancywit
hbusul
fan.

Revi
ewwithpat
ienttheneedforcont
racept
iondur
ing
ther
apy
.Womenneedt ousecontr
acepti
onevenif
amenorr
heaoccurs.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 524
St
orage
St
orepr
otect
edf
rom l
i
ght
.

But
enaf
ine
I
NDI
CATI
ONS
Treat
mentofav ari
etyofcut aneousfungali
nfect
ions,
i
ncludi
ngtineapedi
s( athl
ete’sfoot
),t
ineacr
uris(j
ockit
ch)
,
ti
neacorpori
s(ri
ngwor m),andtineaversi
col
or.

ACTI
ON
Af
fect
sthesynt
hesi
soft
hefungal
cellwall
.Therapeut
ic
Ef
fect
s:Decr
easei
nsymptomsoffungal
infect
ion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oact
ivei
ngr
edi
ent
s,
addi
ti
ves,pr
eservati
ves,
orbases;
Someproduct
scontai
n
al
coholorbisul
fit
esandshoul
dbeavoi
dedinpati
ent
swith
knownint
olerance.

UseCaut
iousl
yin:
Nai
landscal
pinf
ect
ions(
mayr
equi
re
additi
onalsy
stemi
cther
apy
);OB:
Lact
ati
on:
Saf
etynot
establ
ished.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 525
ADVERSEREACTI
ONSANDSI
DEEFFECTS
Local:burni
ng,i
tchi
ng,
local
hyper
sensi
ti
vi
tyr
eact
ions,
redness,sti
ngi
ng.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topical
:(Adul
tsandChildr
en>12y r)
:Applyoncedailyfor
2wkf orpati
entswitht
ineacorpor
is,
tineacrur
is,
ortinea
ver
sicol
or.Applyoncedail
yfor4wkort wicedail
yfor7
daysforpati
entswitht
ineapedis.

AVAI
LABI
LITY
Cr
eam 1%Rx,
OTC;

PATI
ENTTEACHI
NG
I
nstructpat i
enttoapplymedicationasdirect
edfor
ful
lcourseoft herapy
,eveniffeelingbet
ter.
Emphasi zetheimportanceofav oidingt
heey esor
vagi
nal area.

Cauti
onpati
entthatsomeproduct
smayst ai
nfabri
c,
ski
n,orhai
r.Checklabel
inf
ormati
on.Fabr
icsst
ained

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 526
 f
rom cr
eam canusual
l
ybecleanedbyhandwashi
ng
wit
hsoapandwarm water
.

Pati
entswi
thathlet
e’sf
ootshoul
dbetaughttowear
well
-f
it
ti
ng,vent
il
atedshoes,
towashaff
ectedareas
thor
oughl
y,andtochangeshoesandsocksatleast
onceaday.

Advi
sepatientt
oreportincr
easedski
nir
ri
tat
ionor
l
ackofresponsetotherapytoheal
thcar
e
pr
ofessi
onal.

Earlyrel
iefofsympt omsmaybeseeni n2–3days.
Fortineacruri
s,t
ineacor pori
s,andtineaversi
col
or,2
wkar eneeded,andf ort
ineapedis,t
herapeuti
c
responsemayt ake4wk.Recur rentfungali
nfect
ions
maybeasi gnofsy stemicil
lness.

But
oconazol
e
I
NDI
CATI
ONS
Tr
eat
mentofv
ulv
ovagi
nal
candi
diasi
s.

ACTI
ON
Aff
ectst
hepermeabil
it
yofthef
ungalcel
lwal
l,al
l
owing
l
eakageofcel
l
ularcont
ent
s.Notacti
veagai
nstbact
eri
a.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 527
Therapeuti
cEff
ects:
Inhi
bit
edgrowthanddeathof
susceptibl
eCandi
da,wit
hdecreasei
naccompanying
sympt omsofvulv
ovagi
nit
is(v
aginal
burni
ng,i
tchi
ng,
discharge)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oact
ivei
ngr
edi
ent
s,
addi
ti
ves,
orpr
eser
vat
ives.

UseCaut
iousl
yin:
OB:
Lact
ati
on:
Saf
etynotest
abl
i
shed,
l
i
mituset
o2ndand3r
dtr
imest
ers.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GU:i
tchi
ng,
pel
vi
cpai
n,sor
eness,
swel
l
ing,
vul
vov
agi
nal
bur
ning.

I
NTERACTI
ONS
Dr
ug-
Drug:
Notknown.

DOSAGE
Vag(Adul
tsandChi l
dren≥12yr)
:Vaginalcr
eam—1
appl
i
cator
ful(5g)atbedti
mef or3days( Mycel
ex-
3)orone
appl
i
cator
fulsingl
edose(Gynezole–1).

AVAI
LABI
LITY

ᏆᖴA2022 Dr
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nHeal
thyCar
e 528
Vagi
nalcream Gynazol
e–1: 2%(5g-
prefi
ll
edappl
i
cat
or)
Rx,
Mycel
ex-3:2%(5g-pref
il
ledappl
i
cator)OTC;

PATI
ENTTEACHI
NG
Instr
uctpat
ienttoapplymedi
cati
onasdirectedf
or
full
courseoftherapy
,eveni
ffeel
ingbett
er.Ther
apy
shouldbecontinuedduri
ngmenstrual
peri
od.

Advisepat
ientt
oav
oidusi
ngt
amponswhi
l
eusi
ng
thi
sproduct.

I
nstructpat
ientonpr operuseofv aginal
appli
cator.
Medicati
onshoul dbeinsertedhighintothevaginaat
bedti
me.Instructpati
enttor emainrecumbentforat
l
east30mi naf t
erinsert
ion.Adviseuseofsanitary
napkinstopreventstai
ningofclothingorbedding.

Advisepat i
entt oconsultheal
thcar eprofessional
regardingintercourseduri
ngtherapy .Vaginal
medi cati
onmaycausemi norskinirri
tat
ioninsexual
partner.Advisepatienttorefr
ainfrom sexual contact
duri
ngt herapy .Advisepati
entthatthismedi cati
on
mayweakenl atexorrubbercontracepti
vepr oducts.
Anot hermethodofcont r
aceptionshouldbeused
duri
ngt reatment .

Adv
isepat
ientt
orepor
ttoheal
thcar
epr
ofessi
onal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 529
 i
ncreasedski
nir
ri
tat
ionorl
ackofr
esponset
other
apy
.
Asecondcoursemaybenecessar
yifsy
mptoms
per
sist.

Adv
isepat
ientt
odi
sposeofappl
i
cat
oraf
tereachuse.

Inf
orm pati
entt
hatt
her
apeut
icr
esponsei
susual
l
y
seenafter1wk.

PATI
ENTTEACHI
NG
Instr
uctpat
ienttoapplymedi
cati
onasdirectedf
or
full
courseoftherapy
,eveni
ffeel
ingbett
er.Ther
apy
shouldbecontinuedduri
ngmenstrual
peri
od.

Advisepat
ientt
oav
oidusi
ngt
amponswhi
l
eusi
ng
thi
sproduct.

I
nstructpat
ientonpr operuseofv aginal
appli
cator.
Medicati
onshoul dbeinsertedhighintothevaginaat
bedti
me.Instructpati
enttor emainrecumbentforat
l
east30mi naf t
erinsert
ion.Adviseuseofsanitary
napkinstopreventstai
ningofclothingorbedding.

Advisepat i
enttoconsul
thealthcar eprofessional
regardingint
ercour
seduringtherapy .Vaginal
medi cati
onmaycausemi norskinirri
tat
ioninsexual
partner.Advisepat
ientt
or efr
ainfrom sexual contact
duri
ngt herapy.Advi
sepatientthatthismedi cati
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 530
 mayweakenl at
exorrubbercontr
acept
ivepr
oducts.
Anothermethodofcontr
acepti
onshouldbeused
dur
ingtreat
ment.

Advisepat
ienttoreportt
ohealt
hcareprof
essional
i
ncreasedskinir
ri
tati
onorlackofr
esponsetotherapy
.
Asecondcour semaybenecessaryifsy
mpt oms
per
si st
.

Adv
isepat
ientt
odi
sposeofappl
i
cat
oraf
tereachuse.

Inf
orm pati
entt
hatt
her
apeut
icr
esponsei
susual
l
y
seenafter1wk.

BUTURPHANOL
I
NDI
CATI
ONS
Managementofmoder at
etosev
erepai
n.Anal
gesi
a
dur
inglabor
.Sedati
onbefor
esur
gery
.Suppl
ementin
bal
ancedanesthesi
a.

ACTI
ON
BindstoopiatereceptorsintheCNS.Alt
ersthepercept
ion
ofandr esponsetopai nf
ulsti
muliwhi
leproducing
general
izedCNSdepr essi
on.Haspart
ialantagoni
st
propert
iesthatmayr esulti
nopioi
dwithdrawalin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 531
physical
l
ydependentpat
ient
s.Ther
apeut
icEf
fect
s:
Decreasedsev
erit
yofpain.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pat
ient
sphy
sical
l
y
dependentonopi
oids(
maypr
eci
pit
atewi
thdr
awal
).

UseCaut
iousl
yin:
Headt
rauma;
↑int
racr
ani
alpr
essur
e;
Severer enal,hepati
c,orpulmonar ydi
sease( ↑i nt
erval
to
q6–8hri nit
iall
yinhepatic/renalimpairment )
;
Hypothy roi
dism; Adrenalinsuffi
ciency
; Alcoholi
sm;
Undiagnosedabdomi nalpain;Prostat
ichy perpl
asi
a;OB:
Lactat
ion: Pedi:Safetynotest abl
ishedbuthasbeenused
duri
ngl abor( maycauser espiratorydepressioninthe
newbor n);Ger i
:↓ usualdoseby50%; giv
eatt wicethe
usualintervalini
ti
all
y.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: conf usi
on, dysphoria,hallucinati
ons, sedati
on,
euphor i
a,float
ingf eel
ing, headache, unusual dreams.
EENT: blurredvision,diplopia,mi osi
s( hi
ghdoses) .Resp:
respir
atorydepr ession.CV: hypertension,hypotension,
palpi
tations.GI:nausea, const ipati
on, drymout h,i
leus,
vomi t
ing.GU: urinaryretention.Der m: sweating,cl
ammy
feeli
ng.Mi sc:phy si
caldependence, psychological

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 532
dependence,
tol
erance.

I
NTERACTI
ONS
Drug-
Dr ug:Usewithext r
emecaut i
oni npati
ent sreceiving
MAOi nhibit
ors(maypr oducesev ere, pot
enti
al l
yf at
al
react
ions—r educeiniti
aldoseofbut orphanol t
o25%of
usualdose) .Additi
veCNSdepr essionwi thalcohol ,
anti
depr essants,
ant i
hist
amines, andsedat iv
e/ hypnotics.
Maypr ecipi
tat
ewi t
hdrawal i
npat ientswhoar ephy si
cally
dependentonopi oi
dsandhav enotbeendet oxified.May
↓ effect sofconcurrentl
yadmi nisteredopioids.
Drug-
Natur
alPr
oduct:Concomi
tantuseofkav
a-kava,
val
eri
an,
chamomile,
orhopscan↑ CNSdepr essi
on.

DOSAGE
I
M:(
Adul
ts)
:2mgq3–4hrasneeded(
range1–4mg)
.
I
V:(
Adul
ts)
:1mgq3–4hrasneeded(
range0.
5–2mg)
.
I
M:I
V:(
Ger
iat
ri
cPat
ient
s):
1mgq4–6hr
,↑ asnecessar
y.
Int
ranasal
: (
Adult
s) :1mg(1sprayin1nost ri
l
)init
ial
ly
.An
addit
ionaldosemaybegi ven60–90mi nlater.Thi
s
sequencemayber epeat
edin3–4hr .I
fpainissevere,an
i
niti
aldoseof2mg( 1sprayineachnostr
il)maybegi ven.
Mayber epeatedin3–4hr .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 533
I
ntr
anasal
:(Ger
iatr
icPatient
s):1mg(1sprayi
n1nost
ri
l)
i
nit
ial
l
y.Anaddi
tionaldosemaybegi v
en90–120mi
nlater
.
Thi
ssequencemayber epeat
edin3–4hr
.

AVAI
LABI
LITY
I
njecti
on1mg/ mL,2mg/mL;I
ntr
anasal
sol
uti
on10
mg/ mL,i
n2.
5-mLmet er
ed-
dosespr
aypump(14–15
doses;1mg/spray
);

PATI
ENTTEACHI
NG
I
nst
ructpat
ientonhowandwhent
oaskf
orpai
n
medi
cati
on.

Medicat
ionmaycausedr owsi nessordizzi
ness.
Advi
sepatienttocallforassistancewhenambul at
ing
andtoavoiddrivi
ngorot heract i
vi
ti
esrequir
ing
al
ert
nessunt i
lresponsetot hemedi cat
ionisknown.

Encour
agepati
ent
sonbedr
esttotur
n,cough,and
deep-
breat
heever
y2hrt
opreventat
elect
asis.

I
nstr
uctpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Caut
ionpat
ienttoav oi
dconcur
rentuseofalcohol
or
ot
herCNSdepr essantswi
ththi
smedi cat
ion.

Adv
isepat
ientt
hatgoodor
alhy
giene,
frequentmout
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 534
 r
inses,
andsugar
lessgum orcandymaydecr
easedr
y
mouth.

Intr
anasal:Instructpat i
entonpr operuseofnasal
spray.Seepackagei nsertf ordetail
edinstructi
ons.
Instr
uctpat i
entt oreplacepr otecti
veclipandcl ear
coverafteruseandt ost oretheuni ti
nt hechild
resi
stantcont ainer.Caut ionpat i
entthatmedi cation
shouldnotbeusedbyany oneot herthantheper son
forwhom i twaspr escribed.Excessmedi cation
shouldbedi sposedofassoonasi ti
snol onger
needed.Todi sposeof ,unscr ewcap, ri
nsebot t
leand
pumpwi thwat er,anddi sposeofi nwast ecan.

If2-mgdosei sprescri
bed,admi
nisteraddit
ional
sprayinot hernostri
l.Maycausedizzinessand
dysphor i
a.Patientshouldr
emainrecumbentaf ter
admi nist
rati
onof2- mgdoseuntilresponseto
medi cati
oni sknown.

C1i
nhi
bit
or(
human)
I
NDI
CATI
ONS
Routi
neprophylaxi
sagainstangi
oedemaattacksinadul
t
andadolescentpati
ent
swi t
hHeredit
aryAngioedema
(HAE).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 535
ACTI
ON
ReplacesC1i nhi
bitorwhichisdefi
cientinpat
ientswith
HAE.C1i nhi
bitorisnecessaryinpreventi
ngthechainof
eventswhi chaltervascularpermabil
it
yresult
inginli
fe-
thr
eateningswel li
ngi npati
entswithHAE.Ther apeut
ic
Eff
ects: Decreasedf r
equency,int
ensityanddurati
onof
HAEat tacks.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Li
fe-
thr
eat
eni
ngi
mmedi
ate
hy
per
sensi
ti
vi
tyr
eact
ions.

UseCaut
iousl
yin:
Pat
ient
swi
thknownr
iskof
thr
omboti
cev ent
s;OB:Lact
ati
on:Useduri
ngpregnancy
onl
yifcl
earl
yneeded;usecaut
iousl
yduri
nglact
ati
on;Pedi
:
Safet
ynotestabl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache.CV: THROMBOEMBOLI CEVENTS.Der
m:
rash.Misc:Hypersensit
ivi
tyr
eact
ionsi
ncl
udi
ng
anaphylaxi
s.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 536
DOSAGE
I
V:(
Adul
tsandadol
escent
s):
1000uni
tsev
ery3or4day
s.

AVAI
LABI
LITY
Powderfori
nject
ions(
requi
resr
econst
it
uti
on)500
uni
ts/
vial
;

PATI
ENTTEACHI
NG
Infor
m pati
entthatc1inhi
bitori
smadef r
om human
plasmaandmaycont ai
ninfecti
ousagent
sthatcan
causedisease.

Inst
ructpatienttonot i
fyhealt
hcar epr
ofessi
onal
i
mmedi at
elyifsignsandsy mptomsofaller
gic
hypersensi
tivi
t yreact
ionsorthrombosis(newonset
swell
ingandpai ninli
mbsorabdomen, newonset
chestpain,shor t
nessofbr eat
h, l
ossofsensati
onor
motorpower ,alt
eredconsciousnessorspeech)occur
.

Advi
sefemalepati
entstonot
ifyi
fheal
thcare
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

C1-
est
erasei
nhi
bit
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 537
I
NDI
CATI
ONS
Treatmentofacuteabdominalorf
aci
alat
tacksof
heredi
tar
yangioedema( HAE).

ACTI
ON
Replacesmal f
unctioningormi ssi
ngC1est eraseinhibi
tor
i
npat i
entswi t
hHAE.Suppr essionofthecontact
acti
vati
onsy stem byC1est eraseini
hiborpreventsthe
cascadeofev entsthatleadst oatt
acksofangi oedemai n
HAEt hataremar kedbyi ncreasedvascul
arper meabili
ty,
swelli
ng,edemaandl aryngospasm.TherapeuticEffects:
Lessenedsev eri
tyofHAE.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hi
stor
yofl
i
fe-
thr
eat
eni
ngi
mmedi
ate
hypersensit
ivi
tyreacti
ons,i
ncl
udinganaphy
laxi
stoC1
ester
asei nhi
bitorprepar
ati
ons.

UseCaut
iousl
yin:
Pat
ientwi
thr
iskf
act
orsf
or
thromboti
cev ent
s;OB:Lact
at i
on:Useduri
ng
pregnancy
/ l
actat
iononl
yifclearl
yneeded;Pedi
:Chi
l
dren
<12y r(
safet
yandef f
ecti
venessnotestabl
ished)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 538
CNS: headache.CV: THROMBOEMBOLI CEVENTS.GI :
abdomi nalpain,di
arr
hea,nausea,vomiti
ng,abnormal
taste.MS:muscl espasms.Mi sc:hyper
sensit
ivi
ty
reacti
onsincludingANAPHYLAXI SandEXACERBATI ON
OFHAE, ↑ sev er
it
yofpai
nf rom HAE.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
I
V:(
Adul
ts)
:20uni
ts/
kg.

AVAI
LABI
LITY
Lyophil
i
zedpowderf orint
ravenoususe(
requi
res
reconst
itut
ion)500unit
s/vi
al;

PATI
ENT TEACHI
NG
Expl
ainpur
poseofmedi
cat
iont
opat
ient
.

I
nform pati
entthatthismedi cationi
smadef r
om
humanbl oodandmaycar ryar iskoftransmitt
ing
i
nfecti
ousagent s(v
irusesandpossi blyCr eut
zfel
dt-
Jakob[CJD]).Reportalli
nfectionstotheCSLBehr ing
Pharmacov i
gil
anceDepar t
mentat1- 866-915-
6958.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 539
 Adv i
sepatienttonoti
fyhealthcareprofessi onal
i
mmedi at
elyofsignsofhy persensi
ti
vi
t yreact i
onsor
thrombosis(newonsetofswel li
ngandpai ninlimbs
orabdomen, newonsetofchestpai n,shor t
nessof
breath,l
ossofsensat i
onormot orpower, alter
ed
consciousness,vi
sion,orspeech)occur .

Caut
ionpati
enttoconsul
theal
thcar
epr
ofessi
onal
of
pl
anningt
otravel
.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

CABAZI
TAXEL
I
NDI
CATI
ONS
Hormone-ref
ract
orymet astat
icpr
ost
atecancerpr
evi
ousl
y
tr
eatedwitharegi
meni ncludi
ngdocet
axel(usedi
n
combinat
ionwithpredni
sone) .

ACTI
ON
Bi
ndstointr
acell
ulart
ubul
inandpr omotesi
tsassembly
i
ntomicrot
ubuleswhil
einhibi
ti
ngdisassembly
.Resulti
s
i
nhibi
ti
onofmitoti
sandinterphase.Ther
apeut
icEff
ects:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 540
Deathofrapi
dlyr
epli
cat
ingcel
l
s,par
ticul
arl
ymali
gnant
ones,wi
th↓ spreadofmetast
ati
cprostat
ecancer
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Sev
erehy
per
sensi
ti
vi
tyt
ocabazi
taxel
orpolysor
bate80;Neut rophi
ls≤1,
500/ mm3; Hepatic
i
mpai r
ment(tot
albi l
i
rubin≥upperlimit
sofnor mal,orAST
and/orALT≥1.5×upperl i
mitsofnormal );
Concur r
entuse
ofstr
ongCYP3A4i nhibi
tors,
inducersandSt .John'swort;
OB:Avoiduseduringpr egnancy(maycausef etal
har m);
Lact
ation:Br
eastf
eedi ngshouldbeav oided.

UseCaut
iousl
yin:
Concur
rentuseofmoder
ateCYP3A4
i
nhibi
tor
s;OB:Pati
ent
swi t
hchild-
bearingpotenti
al
(pr
egnancyshoul
dbeav oi
ded);Pati
entswi t
hsevererenal
i
mpairment(CCr<30mL/ min)orend-stagerenaldi
sease;
Geri
:Pati
ent
s>65y r↑ r
iskofadverser eact
ions;
Pedi:
Safeandeff
ecti
veuseinchildr
enhasnotbeen
est
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: weakness,f
ati
gue.Resp: dyspnea.CV: ar
rhythmias,
hypotensi
on.GI:DI
ARRHEA, abdomi nalpai
n,abnormal
tast
e,anorexi
a,const
ipat
ion, nausea,vomiti
ng,dyspepsia.
GU:RENALFAI LURE,hemat uria.Derm:alopeci
a.FandE:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 541
el
ectr
oly
teimbalance.Hemat :
NEUTROPENI A,
THROMBOCYTOPENI A,anemia,l
eukopenia.MS: art
hralgi
a,
backpai
n,musclespasms.Neur o:per
ipheralneuropathy.
Misc:
all
ergi
creacti
onsincludi
nganaphy l
axis,f
ever.

I
NTERACTI
ONS
Drug- Drug: Concomi tantadmi nist r
ationofstrongCYP3A
i
nhi bit
or sincludingket oconazol e,i
traconazole,
cl
ar it
hromy ci
n, atazanav i
r,indinav i
r,nefazodone, nel
fi
navi
r,
ri
tonav ir,saquinav i
r,teli
t hromy cinandv or
iconazole↑
l
ev elsandr i
skoft oxicityandshoul dbeav oided.
Concomi t
antadmi nistrat i
onofst rongCYP3Ai nducers
i
ncl udingpheny toin,car bamazepi ne, ri
fampin,ri
fabuti
n,
ri
fapent in,andphenobar bit
al may↓ l evelsand
effectivenessandshoul dbeav oided.
Dr
ug-NaturalPr
oduct
:St
.John'
swor tmay↓ l
evel
sand
ef
fect
ivenessandshoul
dbeavoided.

DOSAGE
PO:(Adul
ts)
:25mg/ m2ever
ythr
eewksasaone-
hour
i
nfusi
on(wit
hpredni
sone10mgPOdail
y).

AVAI
LABI
LITY
Vi
scoussol
uti
onf
ori
nject
ion(
requi
rest
wodi
l
uti
onspr
ior

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 542
toIVadmi
nistr
ati
on)60mg/1.
5mL( cont
ainspol
ysorbat
e
80)comeswithdil
uent(
5.7mLof13%[w/w]ethanol
in
waterf
ori
nject
ion)
.

PATI
ENTTEACHI
NG
Instructpati
enttotakeoralprednisoneaspr
escri
bed
andt onot i
fyhealt
hcareprofessionali
fadoseis
mi ssedornott akenint
ime.

Adv i
sepat i
entt onot i
fyhealthcar eprofessional
i
mmedi atel
yi fsi gnsorsy mpt omsofhy persensi ti
vit
y
reacti
ons, f
ev er; sorethroat;signsofi nfection; l
ower
backorsi depai n;diff
icultorpai nfuluri
nation; sores
ont hemout horont hel i
ps;bl eedinggums; bruising;
petechiae;bloodi nurine,stool ,
oremesi s;
unusual
swel l
i
ngoccur s.Caut ionpat i
entt oavoidcrowdsand
personswi thknowni nfecti
ons.I nstructpat i
entt ouse
softtoothbrushandel ectri
cr azorandt oav oidfalls.
Patientshouldal sobecaut i
onednott odr i
nk
alcoholi
cbev er agesort otakepr oductscont aining
aspiri
norNSAI Ds; maypr ecipitateGIhemor r
hage.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 543
 Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advi
sefemalepati
entsoftheneedforcontr
acept
ion
andtoavoi
dbreastf
eedingduri
ngtherapy
.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasizeneedf
orper
iodiclabt
est
stomoni
torf
or
si
deeffect
s.Advi
sepat
ienttomonit
ort
emper
atur
e
fr
equentl
y.

Caf
fei
neci
tr
ate
I
NDI
CATI
ONS
Short
-ter
mt r
eatmentofi
diopat
hicapneaofpremat
uri
tyi
n
i
nfantsbetween28and<33wkgest ati
onalage.

ACTI
ON
I
ncreaseslevelsofcy cl
i
cAMPbyi nhi
bit
ing
phosphodiester
ase.Actsasabr onchi
alsmoot hmuscle
rel
axant.Suggestedmechani smsofacti
oni ncl
ude:
Sti
mulationofther espi
rator
ycent
er,I
ncreasedmi nut
e
venti
l
ati
on, Decreasedthreshol
dtohypercapnea,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 544
I
ncreasedresponset ohypercapnea,I
ncreasedskel
etal
muscletone,Decreaseddiaphragmaticfati
gue,
Incr
eased
metaboli
crate,I
ncreasedoxy genconsumpt i
on.
Therapeut
icEff
ects:Decreasei nper
iodsofapnea.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Hist
oryofsei
zur
edi
sor
der
s;Hi
stor
yof
cardi
ovascul
ardi
sease;
Pedi:
Incr
easedriskoftoxi
cit
yin
neonateswit
himpair
edhepati
correnal
functi
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: insomnia, i
rri
tabil
i
ty,ji
tt
eriness,r
estl
essness.CV:
tachycardi
a.GI :NECROTI ZINGENTEROCOLI TIS,feedi
ng
i
ntolerance,gastrit
is,GIbleeding.GU:incr
easedur i
ne
output.Derm: dryskin,rash,skinbreakdown.Endo:
hypoglycemia, hypergly
cemi a.MS: muscletr
emor s,
twit
ches.

I
NTERACTI
ONS
Drug-Dr
ug:Cimeti
dine,f
luconazol
e,andket
oconazol
e↓
metaboli
sm (dosereducti
onofcaffei
nemaybe
necessary
).Phenobarbi
talandphenytoi
nmay↑ caffei
ne
metaboli
sm (↑ dosesofcaffei
nemaybenecessary).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 545
Becausecaff
einei
sasignif
icantmetaboli
teof
theophy
ll
ine,
concur
rentadminist
rat
ionisnot
recommended.

DOSAGE
I
V:(
Neonat
es):Loadi
ngdose—20mg/
kgcaf
fei
neci
tr
ate
(
10mg/kgcaf
feinebase)
.
IV:PO:(Neonat
es):
Maintenancedose—star
ti
ng24hr
aft
erloadi
ngdose5mg/ kgcaffei
necit
rat
e(2.5mg/
kg
caffei
nebase)q24hr.

AVAI
LABI
LITY
Sol
utionf
orinject
ion20mg/ mLcaff
einecitr
ate(10
mg/ mLcaff
einebase)in3-mLvi
als;
Or alsol
uti
on20
mg/ mLcaff
einecitr
ate(10mg/mLcaf fei
nebase)i
n3-
mL
vi
als;

PATI
ENTTEACHI
NG
Inst
ructparentoncorrecttechniquefor
administr
ation.Measureoraldoseaccur at
elywitha1
-mLsy ri
nge.Ifapneaeventscont i
nue,consultheal
th
careprofessional
;donotincreasedose.

Adv
iseparentt
oconsul
theal
thcar
epr
ofessi
onal
i
mmediatelyi
fsi
gnsofnecr
oti
zi
ngent
erocol
i
tisoccur
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 546
Cal
ami
ne
I
ndi
cat
ions
Mi
l
dpr
uri
tus.

Av
ail
abi
l
ity
LOTI
ON50and100ml
(8%)
;CREAM 1g.

DOSAGE
Mi
l
dpr
uri
tus:
appl
yli
ber
all
y3t
o4t
imesdai
l
y.

St
orage
Forlot
ionandCream:St
oreatatemper
atur
enot
exceeding30⁰
C.Donotfr
eeze.

Cal
cit
ri
ol
I
NDI
CATI
ONS
Managementofhy pocalcemi ai
npat i
entsunder going
chroni
crenaldial
y sis( I
VandPO) .Tr
eatmentof
hypocal
cemiainpat ientswithhypoparathyroi
dism or
pseudohypoparathy roidi
sm (POonl y
).Managementof
secondar
yhy perpar athyroi
dism andresult
ingmet abol
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 547
bonediseaseinpredial
ysispati
entswi
thmoderat
eto
severechroni
ckidneydisease(CCr15–55mL/min)(
PO
only)
.Unlabel
edUses: Ricket
s.Managementof
hypocalcemiai
npr ematureinf
ants.

ACTI
ON
Calcit
ri
olistheact i
v efor
m ofvitaminD.Pr omotesthe
absorpti
onofcal cium anddecreasespar athyr
oidhormone
concentrati
ons.Ther apeuti
cEffects:Tr
eatmentand
preventi
onofdef iciencystat
es,parti
cul
arlybone
mani f
estati
ons.Impr ovedcalci
um andphosphor ous
homeost asi
sinpat ientswithchronicki
dneydisease.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
cal
cemi
a;
Vit
aminDt oxi
cit
y;Concurr
entuseofmagnesi
um-
contai
ningant
acidsorothervi
tami
nDsupplement
s;
Lactat
ion:Pot
enti
alforser
iousadv
erser
eacti
onsi
ninf
ant
.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngdi
goxi
n;OB:
No
adequat
e,wel
l
-cont
rol
ledst
udies;
useonl
yifbenef
it
outwei
ghspot
enti
alri
sktof
etus.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Seenpr
imar
il
yasmani
fest
ati
onsoft
oxi
cit
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 548
(
hyper
cal
cemi
a)
CNS: headache, somnol ence, weakness.EENT:
conjunct i
viti
s, phot ophobi a, r
hinorrhea.CV: ar r
hythmias,
hypertensi on.GI :abdomi nal pain,anorexia,const i
pati
on,
drymout h, l
i
v erfunct i
ont estelevation,met alli
ctaste,
nausea, PANCREATI TIS,polydipsia,vomiting, weightl
oss.
GU: albumi nur i
a, azot emia, decreasedl i
bido, nocturi
a,
polyuria.Der m: pr urit
us.FandE: hy per
calcemi a.Local:
painati njectionsi te.Met ab: hyper t
hermia.MS: bonepain,
met astaticcal ci
ficat i
on, muscl epai n.Misc: all
ergic
reacti
ons( prurit
is, rash,ur t
icaria)
.

I
NTERACTI
ONS
Drug-Drug:Cholestyrami
ne, col
est i
pol,ormi neraloil↓
absorptionofv i
taminDanal ogues.Usewi t
ht hiazide
di
ureticsmayr esultinhypercalcemi a.Cor
ticost er
oids↓
eff
ectivenessofv it
aminDanal ogues.Usewi t
hdi goxin↑
ri
skofar rhyt
hmi as.Concurrentuseofmagnesi um-
containi
ngdr ugsmayl eadtohy permagnesemi a.Calci
um-
containi
ngdr ugsmay↑ r i
skofhy percal
cemi a.Concur r
ent
useofot herVitaminDsuppl ement s(↑r i
skof
hypercalcemia).
Drug-
Food:
Ingest
ionoffoodshi
ghincal
cium cont
ent(
see
Appendi
xM)mayl eadtohyper
cal
cemia.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 549
DOSAGE
Hy
pocal
cemi
aDur
ingDi
aly
sis
PO:(Adul
ts):0.
25mcg/dayorev
eryotherday
;ifneeded,
may↑ by0. 25mcg/
dayat4–8wki nt
erval
s(t
ypical
dosage=0.5–1mcg/day)
.
PO:(
Childr
en<10kg):0.
05mcgev
eryot
herday
;10–20kg:
0.
1–0.15mcgdail
y;>20kg0.
25mcgdai
ly.
I
V: (
Adult
s) :0.
5mcg( 0.
01mcg/ kg)3ti
mesweeklydur
ing
di
alysi
s.Maybei ncr
easedby0.25–0.5mcg/
doseat2-to
4-wkint
erval
s( t
ypi
calmaint
enancedose=0.5–3mcg3
ti
mesweekl y(0.
01–0.05mcg/kg3t i
mesweekly
).
I
V:(Chil
dren)
:0.
01–0.
05mcg/
kg3t
imesweekl
ydur
ing
di
aly
sis.

Hy
popar
athy
roi
dism
PO:(Adult
sandChil
dren≥6yr
):0.
25mcg/ dayi
nit
ial
l
y;i
f
needed,may↑ doseby0.25mcg/dayat2–4wki nt
erv
als
(t
ypical
dosage=0.5–2mcg/day)
.
PO:(
Chi
ldr
en≤5yr)
:<1y
r-0.
04–0.
08mcg/
kg/
day
1–5y
r-
0.
25–0.
75mcg/day.

Pr
edi
aly
sisPat
ient
s
PO:
(Adul
tsandChi
l
dren≥3y
r):
0.25mcg/
day
;ifneeded,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 550
may↑ dosageupt
o0.
5mcg/
day
.

Ri
cket
s
PO: (
AdultsandChil
dren):
Vit
ami nD-dependent
-1mcg
dail
y;Vit
aminD-resi
stant
-I
nit
al0.015–0.02mcg/kgdai
l
y;
range:0.
03–0.06mcg/ kgdai
ly;maximum dose:2mcg
dail
y.

Hy
pocal
cemi
ainPr
emat
ureI
nfant
s
PO:
(Neonat
es)
:1mcgdai
l
yforf
ir
st5day
sofl
i
fe.
I
V:(
Neonat
es)
:Tet
any
-0.
05mcg/
kgdai
l
yfor5–12day
s.

AVAI
LABI
LITY
Capsul
es0.25mcg,0.
5mcg;Or
alsol
uti
on1mcg/mLi
n15
-
mLbot t
le;
Inj
ect
ion1mcg/
mLin1-mLampules;

PATI
ENTTEACHI
NG
Advisepat
ientt
otakemedicati
onasdir
ected.Take
misseddosesassoonasr ememberedthatday,
unl
essalmosttimefornextdose;
donotdoubleupon
doses.

Revi
ewdietmodi
fi
cati
onswi t
hpat
ient.SeeAppendi
x
Mforfoodshi
ghincal
cium andvi
taminD.Renal
pat
ient
smuststi
l
lconsiderr
enalf
ail
uredieti
nfood

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 551
 sel
ecti
on.Heal
thcar eprofessi
onal
mayor
der
concur
rentcal
cium supplement.

Encouragepatienttocompl ywi
thdietar
y
recommendat ionsofhealthcar
epr of
essional
.Explai
n
thatthebestsour ceofvi
taminsisawell-
balanced
dietwithfoodsfrom the4basicfoodgroupsandt he
i
mpor tanceofsunl i
ghtexposur
e.SeeAppendi xM for
foodshighinv i
taminD.

Pati
entsself
-medi
cati
ngwi t
hv i
taminsuppl
ement
s
shoul
dbecaut i
onednottoexceedRDA.The
eff
ecti
venessofmegadosesf ortr
eatmentofv
ari
ous
medicalcondi
ti
onsisunprovedandmaycauseside
eff
ects.
 Advi
sepati
entt
oavoidconcur
rentuseofant
aci
ds
cont
aini
ngmagnesi
um

Revi
ewsy mpt
omsofov erdosageandinst
ruct
pati
entt
orepor
tthesepromptlytoheal
thcare
prof
essi
onal
.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
eval
uat
eprogr
ess.

Cal
cium acet
ate

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 552
I
NDI
CATI
ONS
Cont
rol
ofhy
per
phosphat
emi
ainend-
stager
enal
disease.

ACTI
ON
Bindstodietaryphosphat etof or
m ani nsolubl
ecalcium
phosphatecompl ex,whichisexcretedint hefeces,
resul
ti
ngindecr easedserum phosphor usconcent rat
ions.
Therapeuti
cEf fects:Controlofhyperphosphat emiainend-
stagerenaldiseasewi thoutpromotingal uminum
absorpti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
cal
cemi
a;Renal
cal
cul
i
;
Ventr
icul
arf
ibr
il
lat
ion;
Concur
rentuseofcal
cium
suppl
ements.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngdi
git
ali
sgl
ycosi
des;
Sev er
erespi
rat
oryinsuf f
ici
ency
; Renaldisease;Cardi
ac
disease;OB:Hypercalcemiamay↑ r iskofmat ernaland
fetalcompli
cat
ions;Lactati
on:Breastfeedingnotexpected
tohar minf
antprovidedthatserum calcium l
evels
moni tor
ed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 553
CNS:headache,ti
ngl
ing.CV: ar
rhyt
hmias,bradycardi
a.F
andE:hyper
calcemia.GI:consti
pati
on,di
arr
hea( oral
sol
uti
ononly),
nausea,vomi t
ing.GU:cal
culi
,hypercal
ciur
ia.

I
NTERACTI
ONS
Drug- Drug: Hy per cal
cemia↑ r i
skofdi goxi ntoxicity.
Chroni cusewi thantaci
dsi nr enali
nsuf ficiencymayl ead
tomi lk-alkalisy ndrome.Cal ci
um suppl ement s, i
ncludi ng
calcium- cont ainingantacidsmay↑ r iskofhy percalcemi a;
avoidconcur r entuse.May↓ absor pti
onofor all
y
admi nisteredt etracy
cli
nes, fl
uoroquinol ones, pheny toin,
andi ronsal ts; take1hrbef oreor3hraf tercal ci
um
acetat e.Excessi veamount smay↓ ef fect sofcal ci
um
channel blocker s.↓ absor pti
onofet idronat eand
ri
sedr onat e(donott akewi thi
n2hrofcal cium acet at e).
May↓ ef fectivenessofat enol ol
.Concur rentusewi th
diuretics( t
hiazi de)mayr esultinhyper calcemi a.May↓
abili
tyofsodi um pol yst
yrenesul fonatet o↓ ser um
potassi um.
Drug-
Food:Cereal
s,spi
nach,
orr
hubar
bmay↓ absor
pti
on
ofcal
cium suppl
ements.

DOSAGE
1gr
am ofcal
cium acet
atecont
ains250mgel
ement
al

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 554
cal
cium (12.
7mEqcal
cium)
.Dosesar
eexpr
essedi
nmg
cal
cium acet
ate
PO:(Adult
s) :
Hy perphosphatemi
ainend-st
agerenal
di
sease-1334mgwi t heachmeal
,may↑ graduall
y(i
n
absenceofhy percalcemia)t
oachi
evetar
getserum
phosphatelevel
s( usualdose=2001–2668mgwi theach
meal).

AVAI
LABI
LITY
Gelcaps667mg( 169mgel
ementalCa)
;Tabl
ets667mg
(169mgel ement
alCa)
;Or
alsol
uti
on667mg( 169mg
elemental
Ca)/5mL;

PATI
ENTTEACHI
NG
Inst
ructpati
ent
sonaregul
arschedul
etot
akemissed
dosesassoonaspossibl
e,t
hengobacktoregul
ar
schedule.

Adv i
sepatienttonoti
fyheal
thcarepr
ofessi
onal
prompt l
yifsignsandsymptomsofhy per
calcemia
(consti
pation,anor
exi
a,nausea,v
omiti
ng,confusi
on,
stupor)occur.

Advisepati
enttoavoidt
aki
ngcalci
um-contai
ning
supplements,
incl
udingcal
cium-
basedantaci
ds

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 555
 dur
ingt
her
apy
.

Cal
cium car
bonat
e
I
NDI
CATI
ONS
Tr
eat mentandpreventionofhypocal
cemia.Adjuncti
nthe
pr
ev enti
onofpostmenopausal ost
eopor
osis.Reli
efofaci
d
i
ndigesti
onorheartburn.Treat
mentofhyperphosphatemi
a
i
nend- st
agerenaldisease.

ACTI
ON
Essentialfornervous,muscul ar
,andskeletalsystems.
Maintaincel lmembr aneandcapi l
l
arypermeabi li
ty.Actas
anact i
vatorinthet r
ansmi ssi
onofnerveimpul sesand
contracti
onofcar diac,skelet
al,
andsmoot hmuscl e.
Essentialforbonef ormationandbloodcoagul ati
on.
TherapeuticEf f
ects:Replacementofcalcium indef i
ciency
stat
es.Cont r
olofhy per
phosphatemiainend- stagerenal
di
seasewi thoutpromot i
ngaluminum absor pt
ion

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
cal
cemi
a;Renal
cal
cul
i
;
Vent
ri
cul
arf
ibr
il
lat
ion.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngdi
git
ali
sgl
ycosi
des;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 556
Sever
erespi
rat
oryi
nsuf
fi
ciency
;Renal
disease;
Car
diac
di
sease.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headche,ti
ngli
ng.CV:
arrhyt
hmias,br
adycardi
a.GI
:
const
ipat
ion,nausea,v
omit
ing.GU:cal
culi
,hy
percal
ciur
ia.

I
NTERACTI
ONS
Drug-Drug: Hypercalcemiaincreasest her iskofdi goxi n
toxi
city.Chronicusewi thantaci dsinr enal insufficiency
mayl eadt omi lk-
alkal
isyndrome.I ngest ionbymout h
decreasest heabsor pti
onofor al l
yadmi nistered
tetr
acycl i
nes,fl
uoroquinolones, phenyt oin,andi ronsal t
s.
Excessiv eamount smaydecr easet heef fectsofcal cium
channel blockers.Decreasesabsor pti
onofet i
dronat eand
ri
sedronat e(donott akewi t
hin2hrofcal cium
supplement s).Maydecr easet heef fectivenessofat enolol
.
Concur rentusewi thdiur
etics(thiazide)mayr esul tin
hypercalcemi a.Maydecr easet heabi l
ityofsodi um
polysty
r enesulfonatetodecr easeser um pot assium.
Drug-
Food:
Cereals,spinach,orrhubarbmaydecr easet
he
absor
pti
onofcalcium supplement s.Cal
cium acet
ate
shoul
dnotbegivenconcur rent
lywi thot
hercalci
um
suppl
ements.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 557
DOSAGE
1gram ofcal
cium car
bonat
econtai
ns400mgelement
al
cal
cium (
20mEqcal ci
um).Dosesexpr
essedi
nter
msof
el
ementalcal
cium.
PO: (
Adults):Preventi
onofhypocalcemia,t
reatmentof
deplet
ion,osteoporosi
s—1–2g/ dayin3–4di vi
deddoses.
Antacid—0.5–1.5gasneeded.Hy perphosphatemiainend-
stagerenaldisease—1gwi theachmeal ,i
ncreaseto4–7
gasneeded.
PO:(
Chi
ldr
en):Suppl
ement
ati
on—45–65mg/
kg/
dayi
n4
di
vi
deddoses.
PO:(
Inf
ants):Neonat
alhypocal
cemi
a—50–150mg/
kgi
n
4–6div
ideddoses(nott
oexceed1g/day)
.

AVAI
LABI
LITY
Tablets500mg( 200mgCa) OTC, 600mg( 240mg
Ca)OTC, 650mg( 260mgCa) OTC, 667mg( 266.8mg
Ca)OTC, 1g( 400mgCa) OTC, 1.
25g( 500mgCa) OTC,1.
5
g(600mgCa) OTC; Chewabl
et abl
et s350mg( 300mg
Ca)OTC, 420mg( 168mgCa) OTC, 450mgOTC, 500mg
(200mgCa) OTC, 750mg( 300mgCa) OTC,1g( 400mg
Ca)OTC, 1.
25g( 500mgCa) OTC; Gum t abl
ets300mg
OTC, 450mgOTC, 500mg( 200mgCa) OTC;Capsules

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 558
1.
25g( 500mgCa) OTC;Lozenges600mg(240mg
Ca)
OTC; Oral
suspensi
on1.25g( 500mgCa)/5mLOTC;
Powder6.5g(2400mgCa) /packetOTC;

PATI
ENTTEACHI
NG
I
nstr
uctpat
ientnottotakeenteri
c-coat
edt abl
ets
wi
thi
n1hrofcal ci
um carbonate;
thiswil
lresul
tin
pr
ematuredissol
uti
onoft hetabl
ets.

Donotadmi nisterconcurrent
lywi thfoodscontaini
ng
l
argeamount sofoxal icacid(spinach, r
hubarb)
,phyti
c
acid(br
ans,cereals),orphosphor us(mi l
kordair
y
product
s).Admi nist
rati
onwi t
hmi l
kpr oductsmay
l
eadt omilk-
alkalisyndrome(nausea, v omit
ing,
confusi
on,headache) .Donott akewi thin1–2hrof
othermedicati
onsi fpossibl
e.

Inst
ructpati
ent
sonaregul
arschedul
etot
akemissed
dosesassoonaspossibl
e,t
hengobacktoregul
ar
schedule.

Advisepati
entthatcalci
um car bonatemaycause
consti
pati
on.Rev i
ewmet hodsofpr event
ing
consti
pati
on(increasi
ngbul kindiet,i
ncreasi
ngflui
d
i
ntake,i
ncreasingmobi l
i
ty)andusi nglaxati
ves.
Severeconsti
pationmayi ndicatetoxi
city
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 559
 Advi
sepati
entt
oav oi
dexcessiveuseoftobaccoor
bev
eragescont
aini
ngalcoholorcaff
eine.

Cal
cium Suppl
ement:Encour
agepat
ient
stomai
ntai
n
adi
etadequateinvi
taminD

Osteopor osi
s:Advisepati
entsthatexerci
sehasbeen
foundt oarrestandrever
sebonel oss.Pati
entshoul
d
discussanyexer ci
seli
mitationswit
hhealthcare
professionalbefor
ebeginningprogram.

Cal
cium chl
ori
de
I
NDI
CATI
ONS
Treatmentandpreventi
onofhypocalcemia.Emergency
tr
eatmentofhyperkalemiaandhypermagnesemiaand
adjuncti
ncardi
acar r
estorcal
cium channelbl
ocking
agenttoxi
cit
y.

ACTI
ON
Essenti
alfornerv
ous,muscul ar
,andskel
etal
sy st
ems.
Maintai
ncellmembr aneandcapi l
l
aryper
meabi l
it
y.Actas
anactiv
atorinthetr
ansmi ssi
onofnervei
mpul sesand
contr
acti
onofcar di
ac,skelet
al,
andsmoot hmuscle.
Essenti
alforboneformationandbloodcoagulati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 560
Therapeut
icEf
fect
s:Repl
acementofcal
cium i
ndef
ici
ency
st
ates.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
cal
cemi
a;Renal
cal
cul
i
;
Vent
ri
cul
arf
ibr
il
lat
ion.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngdi
git
ali
sgl
ycosi
des;
Sever
erespi
rat
oryi
nsuf
fi
ciency
;Renal
disease;
Car
diac
di
sease.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headche,ti
ngli
ng.CV: syncope,CARDIACARREST,
arr
hyt
hmi as,
bradycardi
a.GI:consti
pati
on,nausea,
vomit
ing.GU:calcul
i,
hypercalci
uri
a.Local
:phlebi
ti
s.

I
NTERACTI
ONS
Drug-Drug: Hypercal
cemi aincreasesther iskofdigoxin
toxi
city.Chronicusewi thantacidsinrenal insuff
ici
ency
mayl eadt omi l
k-al
kalisyndrome.Ingestionbymout h
decreasest heabsor pti
onofor all
yadmi nistered
tetr
acyclines,fl
uoroquinolones,phenytoin,andironsal t
s.
Excessiveamount smaydecr easetheef fectsofcalcium
channel blockers.Decreasesabsor pt
ionofet i
dronateand
ri
sedronat e(donott akewi t
hin2hrofcal cium

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 561
supplements).Maydecreaset heef f
ecti
venessofatenol
ol.
Concurrentusewit
hdiuretics(thiazi
de)mayr esulti
n
hypercal
cemia.Maydecr easet heabili
tyofsodium
poly
styrenesulf
onat
et odecr easeser um pot
assium.
Drug-
Food:
Cereals,spinach,orrhubarbmaydecr easet
he
absor
pti
onofcalcium supplement s.Cal
cium acet
ate
shoul
dnotbegivenconcur rent
lywi thot
hercalci
um
suppl
ements.

DOSAGE
1gram ofcal
cium chl
ori
decont
ains270mgel
ement
al
cal
cium (
13.5mEqcalcium).

Hy
pocal
cemi
a
I
V:(
Adul
ts)
:—500–1000mg/
doseq6hr
.
I
V: (
Chil
dren)
:10–20mg/
kg/
dose,
repeatq4–6hras
needed.

Car
diacar
restandcal
cium ant
agoni
stt
oxi
cit
y
I
V:(
Adul
ts)
:2–4mg/
kg,
mayr
epeati
n10mi
nifneeded.
I
V:(Chi
l
dren,
Infant
s,andNeonates):
20mg/ kg,
may
r
epeati
n10mi nifneeded.I
Vinf
usion:20–50mg/kg/
hr.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 562
Tet
any
I
V:(
Adul
ts)
:1gov
er10–30mi
n,mayr
epeataf
ter6hr
.
I
V: (
Chi
ldren,Inf
ants,andNeonat
es):10mg/kgov
er5–10
min,mayr epeataf
ter6hrorconti
nuousi
nfusi
onupto
200mg/ kg/day.

AVAI
LABI
LITY
Inject
ion10%(100mg/
mL)(equi
val
entt
o27.
2mg
elementalcal
cium/
mLor1.
36mEqcalci
um/mL)
;

PATI
ENTTEACHI
NG
Cal
cium Suppl
ement:Encour
agepat
ient
stomai
ntai
n
adi
etadequateinvi
taminD

Osteopor osi
s:Advisepati
entsthatexerci
sehasbeen
foundt oarrestandrever
sebonel oss.Pati
entshoul
d
discussanyexer ci
seli
mitationswit
hhealthcare
professionalbefor
ebeginningprogram.

Cal
cium ci
tr
ate
I
NDI
CATI
ONS
Tr
eatmentandprevent
ionofhypocal
cemia.Adj
uncti
nthe
pr
event
ionofpostmenopausal
osteopor
osis.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 563
ACTI
ON
Essent i
al forner v
ous, muscular, andskel
etalsyst
ems.
Maint ai
ncel l membr aneandcapi l
l
arypermeabil
it
y.Actas
anact ivatorint hetransmissi
onofner veimpulsesand
cont r
actionofcar di
ac,skelet
al ,andsmoot hmuscle.
Essent i
al forbonef ormationandbl oodcoagulati
on.
Treatmentofhy perphosphatemi ai nend-
stagerenal
di
sease.Ther apeuti
cEf f
ects:Repl acementofcalcium i
n
defici
encyst ates.Controlofhy perphosphatemiainend-
stager enal diseasewi t
houtpr omot ingal
umi num
absor pti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
cal
cemi
a;Renal
cal
cul
i
;
Vent
ri
cul
arf
ibr
il
lat
ion.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngdi
git
ali
sgl
ycosi
des;
Sever
erespi
rat
oryi
nsuf
fi
ciency
;Renal
disease;
Car
diac
di
sease.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headche,ti
ngli
ng.CV:
arrhyt
hmias,br
adycardi
a.GI
:
const
ipat
ion,nausea,v
omit
ing.GU:cal
culi
,hy
percal
ciur
ia.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 564
Drug-Drug: Hypercalcemiaincreasest her iskofdi goxi n
toxi
city.Chronicusewi thantaci dsinr enal insufficiency
mayl eadt omi lk-
alkal
isyndrome.I ngest ionbymout h
decreasest heabsor pti
onofor al l
yadmi nistered
tetr
acycl i
nes,fl
uoroquinolones, phenyt oin,andi ronsal t
s.
Excessiv eamount smaydecr easet heef fectsofcal cium
channel blockers.Decreasesabsor pti
onofet i
dronat eand
ri
sedronat e(donott akewi t
hin2hrofcal cium
supplement s).Maydecr easet heef fectivenessofat enolol
.
Concur rentusewi thdiur
etics(thiazide)mayr esul tin
hypercalcemi a.Maydecr easet heabi l
ityofsodi um
polysty
r enesulfonatetodecr easeser um pot assium.
Drug-
Food:
Cereals,spinach,orrhubarbmaydecr easet
he
absor
pti
onofcalcium supplement s.Cal
cium acet
ate
shoul
dnotbegivenconcur rent
lywi thot
hercalci
um
suppl
ements.

DOSAGE
1gram ofcalci
um cit
rat
econtai
ns211mgelement
al
cal
cium (
10.6mEqcal ci
um).Dosesar
eexpr
essedi
n
ter
msofel ementalcal
cium.
PO:(Adul
ts):
Preventi
onofhy
pocalcemi
a,t
reatmentof
depl
eti
on,ost
eoporosi
s—1–2g/dayin3–4divi
deddoses.
PO:
(Chi
l
dren)
:Suppl
ement
ati
on—45–65mg/
kg/
dayi
n4

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 565
di
vi
deddoses.
PO:(
Inf
ants):Neonat
alhypocal
cemi
a—50–150mg/
kgi
n
4–6div
ideddoses(nott
oexceed1g/day)
.

AVAI
LABI
LITY
Tabl
ets250mgOTC( 53mgelement
alcalci
um)
,950
mgOTC( 200mgel ement
alcal
cium)
;Granul
es760
mg/teaspoonf
ul(equi
val
entt
o161mgel ement
alcal
cium
pert
easpoonful
);

PATI
ENTTEACHI
NG
Donotadmi nisterconcurrent
lywi thfoodscontaini
ng
l
argeamount sofoxal icacid(spinach, r
hubarb)
,phyti
c
acid(br
ans,cereals),orphosphor us(mi l
kordair
y
product
s).Admi nist
rati
onwi t
hmi l
kpr oductsmay
l
eadt omilk-
alkalisyndrome(nausea, v omit
ing,
confusi
on,headache) .Donott akewi thin1–2hrof
othermedicati
onsi fpossibl
e.

Inst
ructpati
ent
sonaregul
arschedul
etot
akemissed
dosesassoonaspossibl
e,t
hengobacktoregul
ar
schedule.

Advi
sepati
entt
oav oi
dexcessiveuseoftobaccoor
bev
eragescont
aini
ngalcoholorcaff
eine.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 566
 Cal
cium Suppl
ement:Encour
agepat
ient
stomai
ntai
n
adi
etadequateinvi
taminD

Osteopor osi
s:Advisepati
entsthatexerci
sehasbeen
foundt oarrestandrever
sebonel oss.Pati
entshoul
d
discussanyexer ci
seli
mitationswit
hhealthcare
professionalbefor
ebeginningprogram.

Cal
cium Di
sodi
um Edet
ate
I
ndi
cat
ions
Leadpoisoni
ng(acut
eandchr
oni
c)andl
ead
encephal
opathy
.

ACTI
ON
Remov estoxicamountsofleadorotherdi
valentor
tri
val
entcati
onsbyt hei
rdispl
acementofcalcium i
n
edetatecal
cium di
sodium.Resulti
sasolublecompl ex
thatisexcr
etedbythekidneys.Ther
apeuti
cEf fect
s:
Remov aloftoxi
camount sofleadfr
om thebloodand
otherti
ssues.

Av
ail
abi
l
ity
AMPOULE5ml
(200mg/
ml)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 567
DOSAGE
I
ntr
avenousi
nject
ion
Leadpoisoni
ngwi t
houtencephal opathy:1000mg/ m2/day
asconti
nousinfusi
onf or5day s.Leadencephalopathy:
1500mg/ m2/daybycont inousintravenousinf
usionin5%
dextr
oseor0.9%NaCl (
FinalConcent rat
ionofedentat
e<
500mg/ 100ml),st
arti
ng4haf terfir
stdoseofBALand
aft
eranadequateur i
neflowisest abli
shed.Inf
usionis
conti
nuedfor5day s.
Int
ramuscul
arinj
ecti
ont obeusedi ff
lui
doverloadi
sa
concer
n.1000mg/ m2/ daydividedintoequaldoses
spaced8to12hapar t.Lignocaineorprocaineshouldbe
addedtotheinj
ecti
ontomi ni
mi zepai
natthei nj
ect
ionsi
te.

Cont
rai
ndi
cat
ions
Anur
ia;
pati
ent
swi
thact
iver
enal
diseaseorhepat
it
is;
pr
egnancy
.

I
NTERACTI
ONS
Dr
ug-Drug:↓ dur
ati
onofact
ionofzi
nci
nsul
i
n
pr
eparati
ons.

Pr
ecaut
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 568
Ensureadequat euri
neout put,pre-existi
ngmildrenal
disease;pat
ientswithleadencephal opathyandcerebral
edemamayexper ienceal ethalincreaseinintr
acrani
al
pressurefol
lowingintr
av enousi nfusion,t
heintr
amuscular
routeispref
erredforthesepat ients.

Adv
erseEf
fect
s
Renalt
ubulartoxicitywhi chmayl eadt oacuter enalfail
ure,
fev
er,
chill
s,lacri
mat ion,increasedpr ot
hrombi ntime, pai
n
ati
ntr
amuscul arinjectionsite;hypot ension;cardiac
rhy
thm i
rregulari
ti
es; thir
st;headache; f
atigue;mal ai
se;
uri
nar
yfrequency ;glycosuria;proteinuria;microscopic
hematur
ia;histamine- l
ikereactions.

PATI
ENTTEACHI
NG
HomeCareIssues:
Discussneedf orf
oll
ow-up
appoi
ntment
stomonitorleadlev
els.Addi
ti
onal
tr
eatment
smaybenecessar y.

Consultpubli
cheal
t hdepar
tmentregar
dingpotent
ial
sour
cesofl eadpoisoni
nginthehome,wor kpl
ace,
andrecreat
ionalar
eas.

Cal
cium gl
ubi
onat
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 569
I
NDI
CATI
ONS
PO:Tr
eatmentandprevent
ionofhypocal
cemia.PO:
Adj
uncti
ntheprevent
ionofpostmenopausal
ost
eopor
osis.

ACTI
ON
Essentialfornervous,muscul ar
,andskeletal
sy st
ems.
Maintaincellmembr aneandcapi l
l
arypermeabi l
it
y.Actas
anact i
vatorinthet r
ansmi ssi
onofnerveimpul sesand
contracti
onofcar diac,skelet
al,
andsmoot hmuscle.
Essentialforbonef ormationandbloodcoagul ati
on.
TherapeuticEffects:Replacementofcalcium i
ndef i
ciency
stat
es.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
cal
cemi
a;Renal
cal
cul
i
;
Vent
ri
cul
arf
ibr
il
lat
ion.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngdi
git
ali
sgl
ycosi
des;
Sever
erespi
rat
oryi
nsuf
fi
ciency
;Renal
disease;
Car
diac
di
sease.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
headche,
tingl
i
ng.CV:
arr
hyt
hmi
as,
brady
car
dia.GI
:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 570
const
ipat
ion,
nausea,
vomi
ti
ng.GU:
cal
cul
i
,hy
per
cal
ciur
ia.

I
NTERACTI
ONS
Drug-Drug: Hypercalcemiaincreasest her iskofdi goxi n
toxi
city.Chronicusewi thantaci dsinr enal insufficiency
mayl eadt omi lk-
alkal
isyndrome.I ngest ionbymout h
decreasest heabsor pti
onofor al l
yadmi nistered
tetr
acycl i
nes,fl
uoroquinolones, phenyt oin,andi ronsal t
s.
Excessiv eamount smaydecr easet heef fectsofcal cium
channel blockers.Decreasesabsor pti
onofet i
dronat eand
ri
sedronat e(donott akewi t
hin2hrofcal cium
supplement s).Maydecr easet heef fectivenessofat enolol
.
Concur rentusewi thdiur
etics(thiazide)mayr esul tin
hypercalcemi a.Maydecr easet heabi l
ityofsodi um
polysty
r enesulfonatetodecr easeser um pot assium.
Drug-
Food:
Cereals,spinach,orrhubarbmaydecr easet
he
absor
pti
onofcalcium supplement s.Cal
cium acet
ate
shoul
dnotbegivenconcur rent
lywi thot
hercalci
um
suppl
ements.

DOSAGE
1gram ofcal
cium gl
ubionat
econt
ains64mgel
ement
al
cal
cium (
3.2mEqcalcium).
Hy
pocal
cemi
a(dosedascal
cium gl
ubi
onat
e)

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 571
PO:
(Adul
ts)
:—6–18g/dayi
ndi
vi
deddoses.
PO:(
Chi
ldr
enandI
nfant
s):
600–2000mg/
kg/
dayi
n4
di
vi
deddoses,
maxi
mum 9g/day.
PO:
(Neonat
es)
:1200mg/
kg/
dayi
n4–6di
vi
deddoses.

AVAI
LABI
LITY
Sy
rup1.
8g/
5mL(
115el
ement
alcal
cium/
5mL)
;

PATI
ENTTEACHI
NG
Cal
cium Suppl
ement:Encour
agepat
ient
stomai
ntai
n
adi
etadequateinvi
taminD(seeAppendi
xM).

Donotadmi nisterconcurrent
lywi thfoodscontaini
ng
l
argeamount sofoxal icacid(spinach, r
hubarb)
,phyti
c
acid(br
ans,cereals),orphosphor us(mi l
kordair
y
product
s).Admi nist
rati
onwi t
hmi l
kpr oductsmay
l
eadt omilk-
alkalisyndrome(nausea, v omit
ing,
confusi
on,headache) .Donott akewi thin1–2hrof
othermedicati
onsi fpossibl
e.

Inst
ructpati
ent
sonaregul
arschedul
etot
akemissed
dosesassoonaspossibl
e,t
hengobacktoregul
ar
schedule.

Advi
sepati
entt
oav oi
dexcessiveuseoftobaccoor
bev
eragescont
aini
ngalcoholorcaff
eine.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 572
 Osteopor osi
s:Advisepati
entsthatexerci
sehasbeen
foundt oarrestandrever
sebonel oss.Pati
entshoul
d
discussanyexer ci
seli
mitationswit
hhealthcare
professionalbefor
ebeginningprogram.

Cal
cium Gl
uconat
e
I
ndi
cat
ions
Hy pocal
caemictet
any;cardiopulmonaryby pass.Adjunct
i
nt hepreventi
onofpostmenopausal osteopor osi
s.I
V:
Emer gencytr
eatmentofhy perkalemiaand
hypermagnesemiaandadj unctincar di
acar restorcalcium
channel bl
ocki
ngagenttoxicit
y( cal
cium chloride,
calcium
gluconate)
.

ACTI
ON
Essentialfornervous,muscul ar
,andskeletal
sy st
ems.
Maintaincellmembr aneandcapi l
l
arypermeabi l
it
y.Actas
anact i
vatorinthet r
ansmi ssi
onofnerveimpul sesand
contracti
onofcar diac,skelet
al,
andsmoot hmuscle.
Essentialforbonef ormationandbloodcoagul ati
on.
TherapeuticEffects:Replacementofcalcium i
ndef i
ciency
stat
es

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 573
1gram ofcal
cium gl
uconat
econt
ains90mgel
ement
al
cal
cium (
4.5mEqcalcium).

Hy
pocal
cemi
a
PO:
(Adul
ts)
:0.
5–2gdai
l
yin2–4di
vi
deddoses.
PO:(
Chi
ldr
enandI
nfant
s):
500–725mg/
kg/
dayi
n3–4
di
vi
deddoses.
PO:(Neonat
es)
:500–1500mg/
kg/
dayi
n4–6di
vi
ded
doses.
I
V:(Adul
ts)
:2–15g/
dayasacont
inuousi
nfusi
onori
n
di
vi
deddoses.
IV:(
Chil
drenandI
nfant
s):
200–500mg/ kg/dayasa
conti
nuousinf
usi
onorin4di
videddoses.
I
V:(Neonat
es):
200–800mg/ kg/
dayasacont
inuous
i
nfusi
onorin4div
ideddoses.
Car
diacar
restandcal
cium ant
agoni
stt
oxi
cit
y
I
V:(
Adul
ts)
:500–800mg(
maxi
mum 3g/
dose)
.
I
V:(
Chil
dren,
Inf
ants,
andNeonat
es)
:60–100mg/
kg/
dose
(
maximum 3g/dose)
.

Tet
any
I
V:(
Adul
ts)
:1–3gmaybeadmi
nist
eredunt
ilar
esponse

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 574
occur
s.
IV:(
Chil
dren,I
nfants,
andNeonat
es):100–200
mg/kg/doseov er5–10min,
mayrepeatafter6hror
conti
nuousinf
usionupto500mg/ kg/day
.

AVAI
LABI
LITY
Tabl
ets500mg( 45mgCa) OTC,650mg(58.
5mgCa) OTC,
975mg( 87.75mgCa) OTC, 1g(90mgCa)OTC;Powder
347mg/tablespoonful
;I
njecti
on10%(
100mg/ mL=0.45
mEqcalcium/mL) ;

Cont
rai
ndi
cat
ions
Condi
tionsassoci
atedwit
hhyper
calcaemi
aand
hyper
calci
uri
a(forexampl
esomef ormsofmal
i
gnant
di
sease).

I
NTERACTI
ONS
Drug-Drug: Hypercal
cemi aincreasesther iskofdigoxin
toxi
city.Chronicusewi thantacidsinrenal insuff
ici
ency
mayl eadt omi l
k-al
kalisyndrome.Ingestionbymout h
decreasest heabsor pt
ionofor all
yadmi nistered
tetr
acyclines,fl
uoroquinolones,phenytoin,andironsal t
s.
Excessiveamount smaydecr easetheef fectsofcalcium
channel blockers.Decr
easesabsor pt
ionofet i
dronateand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 575
ri
sedronate(donottakewi t
hin2hrofcal cium
supplements).Maydecreaset heef f
ecti
venessofatenol
ol.
Concurrentusewit
hdi ur
etics(thiazi
de)mayr esulti
n
hypercal
cemia.Maydecr easet heabili
tyofsodium
poly
styrenesulf
onat
et odecr easeser um pot
assium.
Drug-
Food:
Cereals,spinach,orrhubarbmaydecr easet
he
absor
pti
onofcalcium supplement s.Cal
cium acet
ate
shoul
dnotbegivenconcur rent
lywi thot
hercalci
um
suppl
ements.

Pr
ecaut
ions
Monit
orplasmacal ci
um concentr
ati
on;renali
mpair
ment;
i
nter
acti
ons( Appendi
x6c);diar
rhoea,parat
hyr
oiddi
sease;
st
omacht roubl
e.

Adv
erseEf
fect
s
Mildgast
roi
ntesti
naldi
sturbances;bradycar
dia,
arr
hythmi
as,hypotensi
on; i
rr
it
ationatinj
ecti
onsi t
e;sof
t
ti
ssuecal
cif
icati
on;nephrocal
cinosis,r
enalcalcul
i.

PATI
ENTTEACHI
NG
Cal
cium Suppl
ement:Encour
agepat
ient
stomai
ntai
n
adi
etadequateinvi
taminD(seeAppendi
xM).

Donotadmi
nist
erconcur
rent
lywi
thf
oodscont
aini
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 576
 l
argeamount sofoxal icacid(spinach,rhubarb)
,phy
tic
acid(br
ans,cereals),orphosphor us(milkordair
y
product
s).Admi ni
strati
onwi t
hmi l
kproductsmay
l
eadt omilk-
alkali
sy ndrome(nausea, vomi t
ing,
confusi
on,headache) .Donott akewi t
hin1–2hrof
othermedicati
onsi fpossibl
e.

Inst
ructpati
ent
sonaregul
arschedul
etot
akemissed
dosesassoonaspossibl
e,t
hengobacktoregul
ar
schedule.

Advi
sepati
entt
oav oi
dexcessiveuseoftobaccoor
bev
eragescont
aini
ngalcoholorcaff
eine.

Osteopor osi
s:Advisepati
entsthatexerci
sehasbeen
foundt oarrestandrever
sebonel oss.Pati
entshoul
d
discussanyexer ci
seli
mitationswit
hhealthcare
professionalbefor
ebeginningprogram.

Cal
cium l
act
ate
I
NDI
CATI
ONS
PO:Tr
eatmentandprevent
ionofhypocal
cemia.PO:
Adj
uncti
ntheprevent
ionofpostmenopausal
ost
eopor
osis.

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 577
Essentialfornervous,muscul ar
,andskeletal
sy st
ems.
Maintaincellmembr aneandcapi l
l
arypermeabi l
it
y.Actas
anact i
vatorinthet r
ansmi ssi
onofnerveimpul sesand
contracti
onofcar diac,skelet
al,
andsmoot hmuscle.
Essentialforbonef ormationandbloodcoagul ati
on.
TherapeuticEffects:Replacementofcalcium i
ndef i
ciency
stat
es.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
cal
cemi
a;Renal
cal
cul
i
;
Vent
ri
cul
arf
ibr
il
lat
ion.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngdi
git
ali
sgl
ycosi
des;
Sever
erespi
rat
oryi
nsuf
fi
ciency
;Renal
disease;
Car
diac
di
sease.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headche,ti
ngli
ng.CV:
arrhyt
hmias,br
adycardi
a.GI
:
const
ipat
ion,nausea,v
omit
ing.GU:cal
culi
,hy
percal
ciur
ia.

I
NTERACTI
ONS
Drug-Drug:Hypercal
cemiaincr
easest heriskofdigoxi
n
toxi
city.Chr
onicusewithantacidsinrenalinsuf
fici
ency
mayl eadtomi l
k-al
kal
isyndrome.Ingesti
onbymout h
decreasestheabsorpti
onofor all
yadministered

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 578
tet
racycli
nes,fl
uoroquinolones, phenytoi
n, andi ronsalt
s.
Excessiveamount smaydecr easet heeffectsofcal cium
channelblockers.Decreasesabsor pti
onofet idronateand
ri
sedronate(donott akewi t
hin2hrofcal cium
supplements).Maydecr easet heef fect
ivenessofat enol
ol.
Concurrentusewi t
hdi ur
etics(thiazide)mayr esulti
n
hypercal
cemi a.Maydecr easet heabi l
it
yofsodi um
polyst
yrenesulfonatetodecr easeser um pot assium.
Drug-
Food:
Cereals,spinach,orrhubarbmaydecr easet
he
absor
pti
onofcalcium supplement s.Cal
cium acet
ate
shoul
dnotbegivenconcur rent
lywi thot
hercalci
um
suppl
ements.

DOSAGE
1gram ofcal
cium l
act
atecont
ains130mgel
ement
al
cal
cium (
6.5mEqcalci
um).
Hy
pocal
cemi
a(dosedascal
cium l
act
ate)
PO:
(Adul
ts)
:—1.
5–3g/
dayi
n3di
vi
deddoses.
PO:(Chil
drenandI
nfants)
:500mg/
kg/
dayi
n4di
vi
ded
doses,maximum 9g/day.
PO:(Neonat
es)
:400–500mg/
kg/
dayi
n4–6di
vi
ded
doses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 579
AVAI
LABI
LITY
Tabl
ets325mg(42.
45mgCa)
OTC,
500mgOTC,
650mg
(84.
5mgCa)OTC;

PATI
ENTTEACHI
NG
Cal
cium Suppl
ement:Encour
agepat
ient
stomai
ntai
n
adi
etadequateinvi
taminD(seeAppendi
xM).

Donotadmi nisterconcurrent
lywi thfoodscontaini
ng
l
argeamount sofoxal icacid(spinach, r
hubarb)
,phyti
c
acid(br
ans,cereals),orphosphor us(mi l
kordair
y
product
s).Admi nist
rati
onwi t
hmi l
kpr oductsmay
l
eadt omilk-
alkalisyndrome(nausea, v omit
ing,
confusi
on,headache) .Donott akewi thin1–2hrof
othermedicati
onsi fpossibl
e.

Inst
ructpati
ent
sonaregul
arschedul
etot
akemissed
dosesassoonaspossibl
e,t
hengobacktoregul
ar
schedule.

Advi
sepati
entt
oav oi
dexcessiveuseoftobaccoor
bev
eragescont
aini
ngalcoholorcaff
eine.

Osteoporosi
s:Advisepati
entst
hatexerci
sehasbeen
foundtoarrestandrever
seboneloss.Pati
entshoul
d
discussanyexerci
seli
mitati
onswit
hhealthcare

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 580
 pr
ofessi
onal
bef
orebegi
nni
ngpr
ogr
am.

Canaki
numab
I
NDI
CATI
ONS
Treat
mentofCryopyr
in-
Associ
atedPeriodi
cSyndr
omes
(CAPS)incl
udi
ngFamili
alCol
dAutoinf
lammatory
Syndrome(FCAS)anMuckle-
WellsSyndrome(MWS).

ACTI
ON
Bindsandneutral
izestheacti
vityofexcessinter
leukin
associatedwi
thCAPS.Ther apeuticEff
ects:Decreased
sympt omsofCAPS, incl
udi
ngf ever,
urti
cari
a-l
ikerash,
arthr
algi
a,myal
gia,fati
gue,
andconj uncti
vit
is.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Nonenot
ed.

UseCaut
iousl
yin:
Act
iveunt
reat
edi
nfect
ion,
hist
oryof
recur
rentinf
ecti
onsorcondi tionsi
ncreasingthe
propensi
tyofinfect
ions;OB: Useduringpregnancyonl
yif
clear
lyneeded;Lactat
ion:usecautiouslyduri
nglact
ati
on;
Pedi:Saf
etyandef f
ectivenessinchil
dren<4y rhasnot
beenestabli
shed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 581
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache, verti
go.EENT: nasophary
ngiti
s.Resp:
br
onchiti
s.GI: diarrhea,nausea, gast
roenteri
ti
s.Local
:
i
nject
ionsit
er eactions.Met ab:weightgain.MS:
musculoskeletal pain.Misc: I
ncreasedri
skofser i
ous
i
nfect
ions/reinfections,inf
luenza.

I
NTERACTI
ONS
Drug-Drug:Avoidconcurrentuseofl i
vev accines;
all
vaccinati
onsshouldbecompl etedpriortotreatment.
Concur r
entusewi thtumornecrosisfact or(
TNF)
i
nhibitor
smay↑ r iskofser i
ousinfecti
ons.Mayal ter
acti
v i
tyofdrugsmet aboli
zedbyt heCYP450enzy me
systemincludi
ngwar fari
n;caref
ulmoni tori
ngofsuch
drugswi t
hnar r
owt herapeuti
cindicesshoul dbe
undertaken.

DOSAGE
Subcut(
Adul
ts≥40kg)
:150mgev
eryei
ghtweeks.
Subcut(Adul
tsandChil
dren15–40kg):
2mg/
kg;
maybe
i
ncreasedto3mg/ kgeveryei
ghtwk.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 582
Lyophi
l
izedpowderf
orsol
uti
onf
orsubcut
aneousi
nject
ion
180mg/ vi
al;

PATI
ENTTEACHI
NG
Inst
ructpati
entt
oreadPat
ientI
nfor
mat
ionpr
iort
o
star
tingther
apy.

Maycausev ert
igo.Cauti
onpat
ienttoavoi
ddriv
ing
andotheracti
vi
tiesrequi
ri
ngal
ertnessunt
ilr
esponse
tocanaki
numabi sknown.

Advisepati
enttonot
if
yhealt
hcar
eprof
essi
onal
i
mmedi atel
yifsi
gnsofinf
ecti
on(
fev
er,
sorethr
oat
,
dyspnea)occur.

I
nform pat
ientt
oav
oidr
ecei
vi
ngl
i
vev
acci
nesdur
ing
t
herapy.

Maycausei njecti
onsiter eacti
ons(pain,
ery
thema,
swell
ing,pr
uritus,brui
sing, mass,i
nfl
ammat i
on,
dermatit
is,
edema, urt
icaria,v
esicl
es,warmth,
hemor r
hage).Notifyhealthcar epr
ofessi
onali
f
react
ionispersist
ent .

Advi
sepat
ientt
oconsulthealt
hcarepr
ofessi
onal
bef
oret
aki
ngotherRx,OTC, andher
balpr
oducts.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 583
 pr
egnancyi
spl
annedorsuspect
edori
fbr
east
feedi
ng.

Candesar
tan
I
NDI
CATI
ONS
Al
oneorwi t
hot heragentsinthemanagementof
hypert
ension.Treatmentofhear tf
ail
ure(NewYor kHear
t
Associat
ionclassI I
-I
V)inpatientswi t
hlef
tventr
icul
ar
systol
i
cdy sfuncti
on( ej
ecti
onf racti
on≤40%)(canbeused
withanACEi nhibit
orandbet a-blocker)
.

ACTI
ON
Blocksthev asoconstri
ctorandaldost er
one- secret
ing
effectsofangi otensi
nIIatv ari
ousrecept orsites,i
ncl
uding
vascularsmoot hmuscl eandt headrenal gl
ands.
Therapeut i
cEf fects:
Lower ingofBPi npat i
ent swit
h
hypertension.Reducedcar di ov
asculardeat handhear t
-
fai
lure-r
elatedhospi t
ali
zationsinpatientswi thheart
fai
lure.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Bil
ater
alr
enal
art
ery
st
enosi
s;OB:
Cancauseinj
uryordeat
hoff et
usLact
ati
on:
Appear
sinbr
eastmi
lk;
pati
entmustdisconti
nue

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 584
candesar
tanorpr
ovi
deal
ter
nat
etobr
eastmi
l
k.

UseCaut
iousl
yin:
Vol
ume-orsal
t-
depl
etedpat
ient
sor
pati
entsreceiv
inglargedosesofdi uret
ics(corr
ectdeficit
s
beforeini
ti
ati
ngtherapyori nit
iateatlowerdoses) ;
Black
pati
ents(maynotbeasef fect
ive);I
mpai redr
enalfunction
duetopr i
maryrenal diseaseorHF( maywor senrenal
functi
on);Hepati
cimpai rment;Womenofchi ldbeari
ng
potenti
al–ifpregnancyoccur s,discontinueimmediately;
Pedi:Chil
dren<18y r(safetynotestabli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,
fati
gue,headache.CV: hypotensi
on,chest
pai
n, edema.FandE: hyperkalemia.GI:abdominalpai
n,
di
arrhea, nausea.GU:impairedrenalfuncti
on.MS:
art
hralgia,backpain.Misc:ANGI OEDEMA.

I
NTERACTI
ONS
Drug-Drug: NSAI Dsandselect i
veCOX- 2i nhi bit
orsmay
bl
untt heant ihypert
ensiveeffectand↑ t her i
skofrenal
dysfunction.Addi t
ivehypotensionwithot her
anti
hyper tensiv
es.Excessivehy potensionmayoccurwi th
concur r
entuseofdi ur
eti
cs.Increasedr iskof
hyperkalemi awi t
hconcur r
entuseoft rimet hoprim(high
dose),potassium supplement s,
potassium- containi
ngsalt

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 585
substi
tutes,angiot
ensin-conver
ti
ngenzymeinhi
bit
ors,or
potassi
um- sparingdiureti
cs.↑ lev
elsandmay↑ riskof
l
ithi
um toxicity
.

DOSAGE
Hy
per
tensi
on
PO:(Adul
ts):16mgoncedail
y;maybe↑ upt o32
mg/dayin1–2divi
deddoses(i
nit
iat
etherapyatal
ower
doseinpati
entswhoar
erecei
vingdiur
eti
csorarevol
ume
depl
eted)
.
PO: (
Chil
dren6–16y
rand>50kg)
:8–16mg/day(
in1–2
di
videddoses);
maybe↑ upto32mg/day(
in1–2div
ided
doses).
PO: (
Chil
dren6–16y
rand<50kg)
:4–8mg/day(i
n1–2
di
videddoses);
maybe↑ upto16mg/day(
in1–2di
vi
ded
doses).
PO:(Chi
ldr
en1–5yr
):0.
20mg/kg/day(i
n1–2div
ided
doses)
;maybe↑ upto0.4mg/kg/day(
in1–2di
vided
doses)
.

Hepat
icI
mpai
rment
(Adul
ts):
Moder
atehepat
ici
mpai
rment
-I
nit
iat
eatl
ower
doses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 586
Hear
tFai
l
ure
PO:(Adult
s):4mgoncedail
yini
ti
all
y,dosemaybe
doubledat2-
wkint
erv
alsuptotar
getdoseof32mgonce
dai
ly.

AVAI
LABI
LITY
Tabl
ets4mg,8mg, 16mg,
32mg;
Incombi
nat
ionwi
th:
hydr
ochl
orot
hiazi
de

PATI
ENTTEACHI
NG
Emphasizet hei mportanceofcont i
nuingtotakeas
dir
ected,eveni ffeeli
ngwel l
.Takemi sseddosesas
soonasr emember edi fnotalmostti
mef ornextdose;
donotdoubl edoses.I nstructpati
enttotake
medicati
onatt hesamet i
meeachday .Warnpati
ent
nottodiscont i
nuet herapyunlessdir
ectedbyhealth
careprofessional.

Cautionpat i
enttoavoidsaltsubsti
tutescont
aini
ng
potassium orfoodscontaininghighlevel
sof
potassium orsodium unl
essdi r
ectedbyhealthcare
professional
.SeeAppendi xM.

Caut
ionpat
ientt
oav oi
dsuddenposi
ti
onchangesto
decr
easeor
thostat
ichypot
ensi
on.Useofal
cohol
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 587
 st
andingforlongperi
ods,exer
cisi
ng,andhotweat
her
mayincreaseorthost
ati
chypotensi
on.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Instr
uctpati
enttonot i
fyhealt
hcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngt akenandt oconsultheal
thcar e
professi
onalbeforetakinganyOTCcough, col
d,or
all
ergyremediesorot hermedicat
ionsorher bal
products.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Inst
ructpat
ientt
onotif
yhealt
hcareprof
essi
onali
f
swell
ingofface,
eyes,l
ips,
ortongueori
fdif
fi
cul
ty
swallowi
ngorbreat
hingoccur.

Advisewomenofchi ldbeari
ngagetouse
contracept
ionandnotifyheal
thcarepr
ofessi
onal
if
pregnancyisplannedorsuspected.

Emphasi
zethei
mpor t
anceoff
oll
ow-upexamst
o
eval
uat
eeff
ecti
venessofmedi
cati
on.

Hy
per
tensi
on:
Encour
agepat
ientt
ocompl
ywi
th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 588
 additi
onali
nter
vent
ionsforhy per t
ension(weight
reducti
on,l
ow-sodi
um diet,discontinuat
ionof
smoking,moderati
onofalcohol consumpt i
on,regul
ar
exerci
se,st
ressmanagement ).Medi cat
ioncontrol
s
butdoesnotcurehy per
tension.

I
nstr
uctpat
ientandfamil
yonpr opertechni
quefor
monit
ori
ngBP.Adv i
sethem tocheckBPatl east
weekl
yandtoreportsi
gnif
icantchanges.

Capeci
tabi
ne
I
NDI
CATI
ONS
Met astat
iccolorect
alcancer.Adjuv antt r
eatmentf or
Dukes' Ccoloncancerf ol
l
owi ngpr imar yresecti
on.
Met astat
icbreastcancerthathaswor seneddespi tepri
or
therapywithanthracycl
ine(daunor ubicin,doxorubicin,
i
darubicin)(t
obeusedi ncombi nationwi thdocet axel)
.
Met astat
icbreastcancerthatisresi st
antt obot h
paclit
axelandanant hracycl
ine(daunor ubicin,
doxor ubi
cin,
i
darubicin)orisresi
stanttopacl i
taxel andf urt
her
anthracycl
inetherapyiscontrai
ndi cated.

ACTI
ON
Conv
ert
edi
nti
ssuet
o5-
fl
uor
our
aci
l(5-
FU)
,whi
chi
nhi
bit
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 589
DNAandRNAsy nt
hesisbyprev enti
ngthymidi
ne
product
ion.Theenzy mer esponsiblefort
hef i
nalstepin
theconversionto5-FUmaybef oundinhigher
concent
rationsinsomet umor s.Therapeuti
cEffects:
Deathofrapi dl
yrepl
icati
ngcells,part
icul
arl
ymalignant
ones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocapeci
tabi
neor5-
FU;Di
hydropyri
midi
nedehy drogenasedef i
ciency(pati
ents
at↑ ri
skof5-FUtoxi
city
);Sev er
er enali
mpai r
ment( CCr
<30mL/ min)
;OB:Potenti
alforfetalharm ordeath;
Lact
ati
on:Potenti
alf
orseriousadv erseeffectsi
nnur si
ng
i
nfant
s.

UseCaut
iousl
yin:
Mil
d-moder
ater
enal
impai
rment(
↓
star
ti
ngdoset o75%inpati
entswit
hCCr30–50mL/ min)
;
Hepati
cdy sf
uncti
on;Cor
onaryar
terydi
sease;
Pedi:Saf
ety
notestabl
i
shed;Geri
:↑r i
skofseveredi
arr
heainpati
ents
≥80yr.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:f
ati
gue,headache,di
zzi
ness,
insomnia.EENT:eye
i
rr
it
ati
on,epi
staxi
s,r
hinorr
hea.CV:edema,chestpai
n.GI:
DI
ARRHEA, NECROTIZINGENTEROCOLI TI
S,abdominal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 590
pain,
anor exia,constipati
on,dysgeusia,hy per bili
rubinemia,
nausea, stomat iti
s,vomi ti
ng,dyspepsia,xer ost omia.Der m:
dermatitis,hand- and-footsyndrome,naildi sor der,
al
opeci a,erythema, r ashes.FandE: dehy drat i
on.Hemat :
anemia, leukopeni a,thrombocytopenia.MS: arthralgia,
my al
gia.Neur o:peripheralneur
opathy .Resp: cough,
dyspnea.Mi sc: f
ever.

I
NTERACTI
ONS
Drug-Drug:May↑ r i
skofbl eedingwit
hwar fari
n(f
requent
monitoringofPT/INRr ecommended) .Toxicit
y↑ by
concurrentleucovor
in.Antacidsmay↑ absor pti
on.May
↑ bloodl ev
elsandr i
skoft oxici
tyf
rom phenytoi
n( may
needt o↓ pheny t
oindose).
Drug-
Food:
Food↑ absor
pti
on,
althoughcapeci
tabi
ne
shoul
dbegivenwi
thi
n30minafterameal.

DOSAGE
PO:(Adul
ts)
:1250mg/ m2twicedai
l
yfor14days,
fol
l
owedby7-dayrestper
iod;
giveni
n3-wkcycl
es.

Renal
Impai
rment
PO:(Adul
tsCCr30-
50mL/
min)
:↓i
nit
ial
doset
o75%of
usual
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 591
AVAI
LABI
LITY
Tabl
ets150mg,
500mg;

PATI
ENTTEACHI
NG
Inst
ructpat
ienttot
akemedicati
onevery12hrwit
h
waterwithi
n30mi naf
terameal.Misseddoses
shouldbeomi t
ted;
conti
nueregul
arschedul
e.Donot
doubledose.

Infor
m pat i
entoft hemostcommonsi deef f
ects.
Instr
uctpat i
entt onot ifyheal
thcar epr ov i
der
i
mmedi atel
yi fanyoft hefoll
owi ngoccur :
diarr
hea( >4
bowel mov ement sinadayoranydi arr
heaatni ght),
vomi t
ing(mor et hanoncei n24hr ),nausea( l
ossof
appetiteandsi gnificantdecreasei ndai lyfoodintake),
stomat i
ti
s( pain,redness, swel l
ing, orsor einmout h),
hand-and-footsy ndr ome( pain, swel li
ng,orrednessof
handsand/ orfeet), f
everorinf ection( temperatureof
≥100.5°Forot hersi gnsofinf ect i
on) .

I
nstructpat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
ifhe
orsheistakingf
oli
caci
d.

I
nstructpati
enttonotif
yheal t
hcareprofessionali
f
fev
er;chil
l
s;sorethroat;
signsofinfect
ion;yell
owing
ofskinoreyes;abdominal pai
n;j
ointorfl
ankpai n;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 592
 swellingoffeetorlegs; bleedinggums; br
uisi
ng;
petechiae;orbloodi nurine,stool
,oremesisoccurs.
Cautionpat i
enttoav oi
dcr owdsandper sonswith
knowni nfecti
ons.Instructpat i
enttousesof t
toothbrushandel ectri
cr azor.Pati
ent
sshoul dbe
cautionednott odrinkalcohol i
cbeveragesortake
productscont ai
ningaspi ri
norNSAI Ds.

Advisepatienttorinsemout hwit
hclearwat
eraft
er
eati
nganddr i
nkingandt oavoidfl
ossi
ngtomini
mize
stomatiti
s.Viscouslidocai
nemaybeusedi fmouth
paininter
fereswi t
heat i
ng.Stomati
ti
spainmay
requir
et r
eatmentwi thopioi
danalgesi
cs.

Revi
ewwit
hpat
ientt
heneedf
orcont
racept
iondur
ing
ther
apy
.

Emphasizetheimport
anceofr
outi
nefol
low-
upl
ab
teststomonit
orprogr
essandtocheckf
orsi
de
effect
s.

Capr
eomy
cin
I
ndi
cat
ions
Tubercul
osis,
incombi
nat
ionwi
thot
herf
ir
stl
i
nedr
ugsf
or
tuber
culosi
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 593
Av
ail
abi
l
ity
I
NJECTI
ON0.
5,0.
75and1g/
vial
.

DOSAGE
Deepi
ntr
amuscul
ari
nject
ion
Adult-1gdail
yfor2to4months(notmorethan20mg/ kg
bodywei ght
).Then1to2g2to3t i
meseachweek, i
ncase
ofrenal i
mpair
mentreducet
hedoseinaccordancewit
h
creat
ininecl
earance.

Cont
rai
ndi
cat
ions
Notf
orpaedi
atr
icuse;
hyper
sensi
ti
vi
tyt
ocapr
eomy
cin.

Pr
ecaut
ions
Renalimpair
ment;hepat i
cimpai r
ment;audit
ory
i
mpai rment;
monit
orr enal,hepati
c,audi
toryandv est
ibul
ar
functi
onandelect
roly
t es;pregnancyandlactat
ion;
i
nteracti
ons.

Adv
erseEf
fect
s
Hyper
sensi
ti
vi
tyreact
ionsincl
udingurt
icari
aandr
ashes;
eosi
nophi
li
a;l
eucocyt
osisorleucopeni
a,rar
ely
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 594
thr
ombocy topeni
a;changesinli
verfunct
iontests;
nephrotoxi
cit
y,el
ectr
olytedi
stur
bances;hearinglosswi
th
ti
nnit
usandv erti
go;neuromuscul
arblockafterlarge
doses,painandindurat
ionatinj
ecti
onsite.

St
orage
Storepr
otect
edfr
om moi
stur
eatat
emper
atur
enot
exceedi
ng25⁰C.

Capt
opr
il
I
NDI
CATI
ONS
Aloneorwi thot heragentsinthemanagementof
hypertension.Managementofhear tfai
lur
e.Reductionof
ri
skofdeat h, heartf
ail
ure-rel
atedhospit
ali
zati
ons,and
developmentofov ertheartfai
lur
efoll
owingmy ocardial
i
nfarction.Tr eatmentofdi abeti
cnephropathyinpatient
s
withTy pe1di abetesmel l
i
tusandr et
inopathy.

ACTI
ON
Angi
otensin-
convert
ingenzyme(ACE)inhibit
orsblockthe
conv
ersionofangiotensi
nItothevasoconstri
ctor
angi
otensi
nI I
.ACEinhibi
tor
salsopreventthedegradati
on
ofbr
ady ki
ninandothervasodi
l
ator
ypr ostagl
andins.ACE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 595
i
nhibitorsalso↑ pl asmar eninlevel
sand↓ al dost erone
l
evels.Netr esultissy stemicv asodil
ati
on.Therapeut ic
Eff
ect s:LoweringofBPi npatientswithhypert
ensi on.
I
mpr ov edsurvival andr educedsy mptomsi npatientswi t
h
heartfail
ure.Impr ov edsur vi
valandreduceddev elopment
ofov ertheartfail
ur eaftermy ocardi
alinf
arcti
on.
Decreasedpr ogr essionofdi abeticnephropat
hywi t h
decreasedneedf ortransplantati
onordialysi
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hist
oryof
angioedemawi thprevi
oususeofACEi nhibi
tors;
OB: Can
causei njuryordeathoffetus–i fpr
egnancyoccur s,
discontinueimmedi at
ely;Lactat
ion:Appearsinbreastmil
k;
patientmustdi sconti
nuedr ugorprovi
deal t
ernat
et o
breastmi lk.

UseCaut
iousl
yin:
Pat
ient
swi
thcol
l
agenv
ascul
ar
disease,renal i
mpai rment,hy pov olemi a,hy ponatr
emia,
andconcur rentdiur
et i
ctherapy ;Sur gery /anesthesi
a
(hypotensionmaybeexagger ated) ;Blackpat i
ents
(monot herapyf orhyper t
ensionl essef f ecti
v e,mayrequi
re
additi
onal therapy;higherri
skofangi oedema) ;
Womenof
chil
dbear i
ngpot ent
ial;Geri
:Init
ial dose↓ r ecommended.
Exer
ciseExt
remeCaut
ioni
n:Hi
stor
yofangi
oedema.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 596
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,fati
gue,headache, i
nsomni a.Resp: cough.
CV: hy potension,chestpain,palpi
tations,tachy cardia.GI:
tastedi sturbances,abdomi nalpain,anorexi a,constipati
on,
diarrhea, nausea, v
omi ti
ng.GU: pr
oteinuria, i
mpai r
edr enal
funct i
on.Der m:ANGI OEDEMA, rash,pr ur
itis.FandE:
hyper kalemi a.Hemat :AGRANULOCYTOSI S, neut
ropenia.
Mi sc:fev er.

I
NTERACTI
ONS
Drug-Drug: Excessi vehy potensionmayoccurwi th
concurrentuseofdi ureti
cs.Addi t
ivehy potensionwith
otherantihyper tensives.↑ r i
skofhy perkalemiawith
concurrentuseof potassium suppl ement s,potassi
um-
sparingdiuretics, potassium- cont
ai ni
ngsal tsubsti
tut
es,or
angiotensinIIrecept orant agonists.NSAI Dsandsel ecti
ve
COX- 2inhibit
or smaybl untt heantihyper t
ensiveeff
ectand
↑t her i
skofr enal dysfunction.↑ l evel
sandmay↑ t he
ri
skofl i
thium t oxicit
y.
Drug-Natur
alPr
oduct:Avoi
dnatural
li
cori
ce(causes
sodium andwaterr
etent
ionandincr
easespotassi
um
l
oss) .
Drug-Food:
Foodsigni
fi
cant
ly↓ absor
pti
on.Admi
nist
er
captopri
l1hrbef
oremeals.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 597
DOSAGE
Not
e:Uselowerdoses(
1/2ofthoseli
sted)i
npati
ent
s
whoaresodi
um andwaterdepl
etedduetodiur
eti
cs.

Hy
per
tensi
on
PO:(Adul
t sandAdolescent
s):12.5–25mg2–3ti
mes
dai
l
y ,maybe↑ at1–2wki nterv
alsupto150mg3ti
mes
dai
l
y( i
nit
iatether
apywith6.25–12.5mg2–3ti
mesdail
yin
pat
ientsrecei
vingdi
ureti
cs)
.

Hear
tFai
l
ure
PO:(Adul
ts):25mg3t i
mesdail
y(6.
25–12.
5mg3t i
mes
dail
yinpat
ientswhohav ebeenvi
gor
ousl
ydiur
esed)
;
ti
tr
ateduptotargetdoseof50mg3t i
mesdail
y(max
dose=450mg/ day)
.
PO:(Chil
dren):0.3mg/kg—0.5mg/ kg/dose3ti
mesdaily
,
ti
tr
ateupt oamaxi mum of6mg/ kg/dayin2–4div
ided
doses;OlderChil
dren:
6.25–12.
5mg/ doseq12–24hr ,
ti
tr
ateupt oamaxi mum of6mg/ kg/dayin2–4div
ided
doses.
PO:(
Inf
ant
s):0.
15–0.
3mg/ kg/
dose,
tit
rat
euptoa
maxi
mum of6mg/kg/dayi
n1–4divi
deddoses.
PO:
(Neonat
es)
:0.
05–0.
1mg/
kg/
doseq8–24hr
,may↑

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 598
asneededupto0.
5mg/kgq6–24hr
;Pr
emat
ureneonat
es:
0.
01mg/ kg/
doseq8–12hr
.

Lef
tVent
ri
cul
arDy
sfunct
ionPost
-MI
PO:(
Adul
ts)
:6.
25-
mgt estdose,
fol
l
owedby12.5mg3
ti
mesdai
l
y,maybe↑ upto50mg3t i
mesdai
l
y.

Di
abet
icNephr
opat
hy
PO:
(Adul
ts)
:25mg3t
imesdai
l
y.

Renal
Impai
rment
PO:(
Adul
ts)
:Cl
Cr10–50mL/ min:
Admini
ster75%ofdose;
Cl
Cr<10mL/min:
Admini
ster50%ofdose.

AVAI
LABI
LITY
Tabl
ets12.5mg,25mg, 50mg,
100mg;
Incombi
nat
ion
wit
h:hydr
ochl
orothi
azi
de

PATI
ENTTEACHI
NG
Inst
ructpati
entt
otakecapt opr i
lasdir
ectedatthe
samet imeeachday,eveniff eel
ingwell
.Takemi ssed
dosesassoonasr emember edbutnoti fal
mosttime
fornextdose.Donotdoubledoses.War npati
entnot
todiscont
inueACEinhi
bitorther apyunl
essdir
ected
byhealthcarepr
ofessi
onal.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 599
Cautionpat i
enttoavoidsaltsubsti
tutescont
aini
ng
potassium orfoodscontaininghighlevel
sof
potassium orsodium unl
essdi r
ectedbyhealthcare
professional
.

Caut
ionpatientt
ochangeposi tionsslowlyto
mini
mi zeort
hostati
chy potension.Useofalcohol,
st
andingforlongperiods,exercising,andhotweather
mayincreaseorthost
atichy potension.

Instr
uctpati
enttonot i
fyhealt
hcar epr
of essionalof
allRxorOTCmedi cati
ons,vit
amins,orher bal
productsbeingtakenandconsul theal
thcar e
professi
onalbeforetakinganynewmedi cations,
especial
lycough,cold,oral
lergyremedies.

Maycausedizziness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

Advi
sepatientt
oinf
orm heal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort ot
reat
mentorsurgery
.

Advisepati
entt
hatmedi cat
ionmaycausei
mpai
rment
oftastet
hatgenerall
yresol
veswi
thi
n8–12wk,even
wit
hcont i
nuedtherapy.

I
nst
ructpat
ienttonoti
fyhealt
hcareprof
essional
if
r
ash;mouthsores;sor
ethroat;f
ever
;swell
i
ngof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 600
 handsorf eet;i
rr
egularheartbeat;chestpai n;dry
cough; hoarseness;swelli
ngoff ace,ey es,li
ps,or
tongue; dif
ficul
tyswall
owingorbr eat hingoccurs;ori
f
tast
ei mpai rmentorskinrashper si
st s.Persist
entdry
coughmayoccurandmaynotsubsi deunt il
medi cationisdisconti
nued.Consul thealthcare
professional i
fcoughbecomesbot her some.Al so
noti
fyheal thcareprofessionali
fnausea, vomiti
ng,or
diar
rheaoccur sandcontinues.

Advisewomenofchi ldbeari
ngagetouse
contracept
ionandnotifyheal
thcarepr
ofessi
onal
of
pregnancyisplannedorsuspected.

Emphasizetheimport
anceoff
oll
ow-
upexami
nat
ions
toev
aluateeff
ecti
venessofmedi
cat
ion.

Hy pertensi
on:Encouragepatienttocomplywi t
h
additi
onal i
nter
ventionsforhypert
ension(weight
reduction,l
owsodi um di
et,di
scontinuati
onof
smoki ng,moderationofalcoholconsumpt i
on,regul
ar
exercise,andstressmanagement )
.Medicati
on
controlsbutdoesnotcur ehypertension.

Inst
ructpatientandf amil
yoncor rectt
echni
quefor
monitori
ngBP.Adv isethem tocheckBPatleast
weeklyandt or epor
tsignif
icantchangestoheal
th
careprofessional.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 601
Car
bamazepi
ne
I
NDI
CATI
ONS
Treatmentoft oni
c-cl
oni
c,mixed,andcompl ex-part
ial
seizures.Managementofpainintrigeminal
neur al
giaor
diabeticneuropat
hy.Equet
roonly:Acutemani aandmi xed
mani a.Unlabel
edUses:Otherfor
msofneur ogeni cpain.

ACTI
ON
Decreasessynapti
ctransmissi
onintheCNSbyaffect
ing
sodi
um channelsinneurons.Ther
apeuti
cEff
ects:
Prev
ent i
onofseizur
es.Reli
efofpainint
ri
geminal
neur
algia.Decr
easedmani a.

Av
ail
abi
l
ity
TABLETS100,
200and400mgPlai
n;100mgDT;200,300
and400mgCRandSR;SyRUP100ml (
100mg/5ml).

DOSAGE
Or
al
Adult
-Init
ial
l
y100and200mg1to2timesdail
yincreased
sl
owlytousualdoseof400mgt
o1.2gdai
lyi
ndi vi
ded
doses.Insomecases1.6t
o2gmaybeneeded.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 602
Admi
nist
erl
oweri
nit
ial
doset
oel
der
ly.
Chil
d-Star
twith5-10mg/ kg/dayi
ntwot othr
eedi
vi
ded
dosesthengradual
l
yincreaseatweekl
yinter
val
stoamax.
doseof30-35mg/kg/ day.

Cont
rai
ndi
cat
ions
At
ri
ovent
ri
cul
arconduct
ionabnor
mal
i
ties;
hist
oryofbone-
marr
owdepressi
on;por
phyr
ia.

I
NTERACTI
ONS
Drug-Dr ug:Maysi gnificantl
y↓ l ev elsofnef azodone;
concur rentusecont raindicated.May↑ met abol i
sm of
andt herefore↓ l ev els/ef f
ectivenessofcor ticosteroids,
doxycy cli
ne, f
elbamat e,quinidine, war f
arin,est rogen-
containingcont r
acept i
ves,bar bi
tur ates,cyclospor ine,
benzodi azepines, theophy ll
ine, l
amot ri
gine,pheny toin,
topir
amat e,valproicaci d,bupr opion, andhal oper idol.
Danazol ↑ bloodl ev els(avoidconcur r
entusei fpossi ble)
.
Concur rentuse( within2wk)ofMAOi nhibit
or smayr esult
i
nhy per pyrexia,hyper tension,seizur es,anddeat h.
Verapami l
,dil
tiazem, it
raconazol e, ketoconazol e,
eryt
hr omy cin,clari
thr omy ci
n, SSRI s,antidepr essant s,or
cimetidinemayi nhi bitthehepat icmet abolism of
carbamazepi neand↑ l evels;maycauset oxicity.Enzy me

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 603
i
nducerssuchasr i
fampin,phenobarbi
tal
,andpheny t
oin
may↓ lev el
s.May↑ r i
skofhepatotoxi
cit
yfrom isoniazi
d.
Fel
bamate↓ car bamazepinelevel
sbut↑ levelsofact i
ve
metabol
it
e.May↓ ef fecti
venessand↑ r i
skoft oxici
ty
fr
om acetaminophen.May↑ r i
skofCNSt oxicit
yf rom
l
it
hium.May↓ dur ati
onofact i
onofnondepol ar
izing
neuromuscularbl
ockingagents.
Dr
ug-
Food:Grapef
rui
tjui
ce↑ serum l
evel
sandoral
bi
oav
ail
abi
l
ityby40%andt her
eforemay↑ eff
ect
s.

Pr
ecaut
ions
Hepaticimpairmentr enalimpai r
ment ;car
diacdisease
(seealsoContr aindi
cations);skinreacti
ons(seeAdv er
se
effect
s);hi
storyofbl ooddi sorders(bloodcountsbefore
anddur i
ngtreat ment);glaucoma; lact
ationavoi
dsudden
withdr
awal;interacti
onspr egnancy
Pat i
entsortheircaretakersshoul dbetoldhowt o
recognizesignsofbl ood, l
iverorskindisorder sand
adv i
sedtoseeki mmedi atemedi calat
tentioni fsymptoms
suchasf ever ,
sorethroat ,
rash,mout hulcers, brui
singor
bleedingdev el
op.Leukopeni awhichissev ere,progressi
ve
andassoci atedwithcl i
nicalsympt omsr equires
withdrawal (
ifnecessaryundercov erofsuitabl e
alter
nativ
e).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 604
Mayimpai
rabi
li
tyt
operform ski
ll
edtasks,forexample
oper
ati
ngmachi
nery,
dri
ving;seealsonotesabov e.

Adv
erseEf
fect
s
Dizziness, dr owsi ness, headache, at axia,blur redv i
sion,
dipl
opi a(maybeassoci at edwi thhi ghpl asmal evels);
gast rointest inal intolerancei ncludi ngnauseaandv omi t
ing,
anor exia, abdomi nal pain, dr ymout h, diarrhoeaor
const ipat i
on; commonl y ,mi ldt r
ansi entgener alized
erythemat ousr ash( wit
hdr awi fwor sensori s
accompani edbyot hersy mpt oms) ;l
eukopeni aandot her
blooddi sor der s( includingt hrombocy t
openi a,
agranul ocy tosisandapl asticanaemi a);chol estatic
j
aundi ce, hepat i
tis, acuter enal fail
ur e,Stev ens- Johnson
syndr ome( er yt
hemamul tiforme) ,toxi cepi der mal
necrol ysis, alopeci a,thromboembol ism, ar thralgia,fever,
proteinur ia, l
y mphnodeenl argement ,arrhythmi as,hear t
blockandhear tf ailure,dy skinesi a,par aest hesi a,
depr ession, impot ence, mal ei nfertil
ity,gy naecomast i
a,
galact orrhoea, aggr ession, activationofpsy chosis,
phot osensi tivi
ty ,pul monar yhy per sensi ti
v i
ty ,
hyponat raemi a, oedema, dist urbancesofbone
met abol ism wi thost eomal aci aalsor epor ted; confusion
andagi tationi nel der l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 605
PATI
ENTTEACHI
NG
Instr
uctpati
entt otakecarbamazepi nearoundt he
clock,asdir
ected.Takemi sseddosesassoonas
possiblebutnotjustbeforenextdose; donotdoubl e
doses.Notifyhealthcareprofessi
onal i
fmor ethan
onedosei smi ssed.Medicati
onshoul dbegr aduall
y
disconti
nuedtopr eventsei
zures.Instr
uctpatientto
readtheMedi cati
onGui debeforestarti
ngandwi t
h
eachRxr efi
ll
;changesmayoccur .

Maycausedi zzi
nessordr owsiness.Advisepat
ients
toavoiddri
vingorotheracti
vit
iesrequir
ingaler
tness
unti
lresponsetomedi cat
ionisknown.

Instructpat ientst hatbehav i

oral changes, skinr ash,
fever ,soret hr
oat ,mout hul cers, easybr uising,
petechi ae,unusual bleedi ng,abdomi nalpai n,chi l
ls,
rash, palest ools,dar kur i
ne, orjaundi ceshoul dbe
repor tedtoheal t
hcar epr ofessional i
mmedi ately.
Adv isepat ientandf ami lytonot ifyheal t
hcar e
prof essional i
fthought saboutsui cideordy i
ng,
attempt stocommi tsui cide;neworwor sedepr ession;
neworwor seanxi ety;feel i
ngv eryagi tat
edorr estless;
pani cat t
acks; troublesl eeping; neworwor se
i
r r
itabili
ty;actingaggr essive;bei ngangr yorv iolent;
actingondanger ousi mpul ses; anext remei ncreasei n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 606
 act
ivi
tyandt
alki
ng,
otherunusual
changesi
nbehav
ior
ormoodoccur.

Inf
orm pat
ientt
hatcoati
ngofTegr
etol
XRisnot
absorbed,
butisexcr
etedinf
ecesandmaybevi
sibl
e
i
nst ool
.

Advi
sepati
entnott
otakeal
coholorot
herCNS
depr
essant
sconcurr
entl
ywi
ththi
smedicati
on.

Cauti
onpat
ient
stousesunscr
eenandpr
otecti
ve
cl
othi
ngtoprev
entphot
osensi
ti
vi
tyr
eact
ions.

I
nform patientt
hatfr
equentmouthri
nses,
goodoral
hygi
ene, andsugarl
essgum orcandymayhel
preduce
drymout h.Sali
vasubst
it
utemaybeused.Consul
t
dent
istifdrymouthpersist
s>2wk.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advisef emal
epatientst
ouseanonhor monal f
or m of
contracepti
onwhiletaki
ngcarbamazepi
ne,toav oid
breastfeedi
ng,andtonoti
fyhealt
hcareprofessionalif
pregnancyisplannedorsuspectedori
fbreastfeeding.

Emphasi
zet
hei
mportanceoff
oll
ow-upl
abt
est
sand
ey
eexamstomoni
torforsi
deeff
ect
s.

Sei
zur
es:
Adv
isepat
ient
stocar
ryi
dent
if
icat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 607
 descr
ibi
ngdi
seaseandmedi
cat
ionr
egi
menatal
l
ti
mes.

St
orage
St
orepr
otect
edf
rom l
i
ghtandmoi
stur
e.

CARBENI
CILLI
N
I
NDI
CATI
ONS
Treat
mentofuri
naryt
racti
nfect
ionsorpr
ost
ati
ti
scaused
bysuscept
ibl
eorgani
sms.

ACTI
ON
Bindstobact er
ialcellwal lmembr ane,causi
ngcelldeath.
TherapeuticEffect
s: Bact eri
cidalagainstsuscepti
ble
bacteri
a.Spectrum isbr oadert hant hatofotherpeni
cil
l
ins.
Spectrum: Acti
veagai nst: Pseudomonasaer ugi
nosa,
Escherichi
acoli,Proteusmi rabi
li
s, Prot
eusv ul
gari
s,
Providenci
ar et
tgeri,
Mor ganellamor ganii
,Enter
obacter
,
enterococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
openi
cil
l
insor
cephal
ospor
ins.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 608
UseCaut
iousl
yin:
Sev
erer
enal
impai
rment(
ifCCr<10
mL/min,
therapeuti
cconcentr
ati
onswil
lnotbeachi
evedi
n
ur
ine)
;OB:Lactat
ion:Pedi
:Safet
ynotest
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:di
arrhea,f
lat
ulence,glossi
tis,↑l i
verfunctiontests,
nausea,tast
edisturbance,vomi t
ing.Derm: rashes,
urt
icar
ia.Hemat :
anemi a,eosinophili
a,neutropenia,
thr
ombocy topeni
a.Mi sc:hypersensiti
vit
yreact i
ons
i
ncludi
nganaphy laxi
sandser um si ckness,superinf
ecti
on.

I
NTERACTI
ONS
Drug-
Drug:Probeneci
ddecr
easesr
enal
excr
eti
onand
i
ncreasesbloodlevel
s.

DOSAGE
Ur
inar
yTr
actI
nfect
ion
PO:
(Adul
ts)
:382–764mg(
1–2t
abl
ets)ev
ery6hr
.

Pr
ost
ati
ti
s
PO:
(Adul
ts)
:764mg(
2tabl
ets)ev
ery6hr
.

Renal
Impai
rment
PO:
(Adul
ts)
:CCr10–50mL/
min-
Admi
nist
erev
ery12–24

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 609
hr
.

AVAI
LABI
LITY
Tabl
ets500mg(
cont
ains382mgcar
beni
cil
l
in)
;

PATI
ENTTEACHI
NG
Inst
ructpatienttot
akemedicationaroundtheclock
andt ofi
nishthedrugcompletel
yasdi rect
ed,ev
enif
feel
ingbetter.Advi
sepat
ientthatshari
ngofthis
medi cat
ionmaybedanger ous.

Advi
sepat
ientt
oreportthesignsofsuperinf
ect
ion
(f
urr
yover
growthonthet ongue,vagi
nali
tchi
ngor
di
schar
ge,l
ooseorfoul-
smel l
ingstool
s)andall
ergy
.

I
nst
ructthepat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
i
fsy
mpt omsdonotimprove.

Car
bimazol
e
I
ndi
cat
ions
Thy
rot
oxi
cosi
s;Gr
ave’
sdi
sease.

Av
ail
abl
e
TABLETS5and10mg.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 610
DOSAGE
Or
al
I
nit
ial
l
y15to45mgdai lyin4div
ideddosesdependi
ng
uponsev
eri
ty.Mai
ntenancedose25to50mgf or1year.

Cont
rai
ndi
cat
ions
Nodul
argoitr
e;subacut
ethy
roi
dit
is,
post
par
tum pai
nless
t
hyroi
dit
is.

Pr
ecaut
ions
Li
verdi
sor
der
s;pr
egnancyl
act
ati
on;
neut
ropeni
a.

Adv
erseEf
fect
s
Nausea,mil
dgast r
o- int
estinaldist
urbances;headache;
rashesandpruri
tus, art
hralgia;
rarel
y,my opathy,alopeci
a,
bonemar r
owsuppr ession( i
ncl
udingpancy topeniaand
agranul
ocyt
osis)
; vasculit
is;cholest
aticj
aundi ce,hepati
c
necrosi
s.

St
orage
Stor
eprotect
edfr
om l
i
ghtandmoi
stur
eatat
emper
atur
e
notexceedi
ng30⁰
C.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 611
CARBOPLATI
N
I
NDI
CATI
ONS
Advancedovari
ancar
cinoma(wit
hotheragent
s).
Pall
iat
ivet
reat
mentofovari
ancarci
nomaunresponsi
vet
o
othermodali
ti
es.

ACTI
ON
I
nhibit
sDNAsy nthesi
sbypr oduci
ngcr oss-
li
nkingof
parentDNAstr
ands( cel
l-
cyclephase–nonspeci f
ic)
.
Therapeut
icEf
fects:Deathofrapi
dlyrepli
cati
ngcells,
parti
cul
arl
ymalignantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocar
bopl
ati
n,
ci
splat
in,
ormanni
tol
;OB:
Lact
ati
on:
Pregnancyor
l
actati
on.

UseCaut
iousl
yin:
Hear
ingl
oss;
Elect
rol
yteabnor
mal
i
ties;
Renal i
mpairment(dose↓ recommendedi fCCr<60
mL/ min);Acti
vei
nfecti
ons;
Diminishedbonemar row
reserve(dose↓ recommended);Otherchroni
cdebili
tat
ing
i
llnesses;Geri
:↑r i
skofthr
ombocy topeni
a,consi
derrenal
functi
oni ndosedeter
minat
ion;Pati
entswithchil
dbeari
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 612
pot
ent
ial
;Pedi
:Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: weakness.EENT: ototoxicit
y .GI:abdomi nalpain,
nausea,vomi t
ing,constipati
on, diarrhea,hepatit
is,
stomatit
is.GU: gonadal suppressi on,nephrotoxici
t y
.Derm:
alopeci
a,rash.FandE: hypocal cemi a,hypokalemi a,
hypomagnesemi a,hyponatremi a.Hemat :ANEMI A,
LEUKOPENI A, THROMBOCYTOPENI A.Metab:
hyperuri
cemia.Neur o:peripheral neuropathy.Mi sc:
hypersensit
ivi
tyreacti
onsi ncludinganaphy l
act i
c-l
ike
reacti
ons.

I
NTERACTI
ONS
Drug-Drug:↑ nephrotoxici
tyandot otoxi
cit
ywi t
hot her
nephrotoxicandototoxicdrugs( aminogly
cosides,loop
di
uretics)
.↑ bonemar rowdepr essi
onwi thotherbone
marrow–depr essi
ngdr ugsorr adiat
iontherapy.May↓
anti
bodyr esponsetolive-v
irusvaccinesand↑ r iskof
adversereacti
ons.

DOSAGE
Ot
herdosi
ngf
ormul
asar
eused
I
V:(
Adul
ts)
:Ini
ti
alt
reat
ment
—300mg/
m2wi
th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 613
cyclophosphamideat4-wkint
erval
s.Treatmentof
refr
actorytumor
s—360mg/ m2asasi ngledose;maybe
repeatedat4-wkint
erval
s,dependi
ngonr esponse.

Renal
Impai
rment
I
V:(Adul
ts)
:CCr41–59mL/ mi
n—ini
ti
aldose250mg/
m2;
CCr16–40mL/min—i
nit
ial
dose200mg/ m2.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion10mg/
mL;

PATI
ENTTEACHI
NG
I
nstructpati
enttonotif
yheal t
hcar epr of
essional
pr
ompt lyi
ffever;
chil
ls;sorethroat;signsofinfect
ion;
l
owerbackorsi depain;diffi
cultorpainfulur
inati
on;
bl
eedinggums; brui
sing;pinpointredspotsonski n;
bl
oodi nstool
s,uri
ne,oremesi s;increasedfati
gue,
dyspnea,orort
hostat
ichy potensionoccur s.

Cautionpati
enttoav oidcr owdsandper sonswi t
h
knowni nf
ecti
ons.Instructpatientt
ousesof t
toothbr
ushandel ect
r i
cr azorandtoav oidfall
s.
Cautionpati
entsnott odr i
nkalcoholi
cbev eragesor
takemedicati
oncont ainingaspiri
norNSAI Ds
becausetheymaypr eci pit
ategastri
cbleeding.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 614
Instructpati
enttopromptl
yreportanynumbnessor
tingl
ingi nextr
emiti
esorf
ace,decreasedcoor dinat
ion,
diffi
cultywithheari
ngorr
ingi
ngint heears,unusual
swel l
ing,orweightgai
ntohealt
hcar eprofessional
.

Instr
uctpati
entnottorecei
veanyv accinat
ions
withoutadvi
ceofhealt
hcareprofessionalandt o
avoidcontactwi
thpersonswhohav erecei
v edoral
poliovacci
newithi
nthepastseveralmont hs.

Advisepati
entoftheneedf
orcont
racept
ion(i
f
pati
entisnotinf
erti
l
easaresul
tofsurgi
calor
radi
ati
ontherapy)
.

Inst
ructpati
enttoinspectoral
mucosaf orery
thema
andulcerati
on.Iful
cerati
onoccurs,
adv i
sepati
entto
noti
fyhealthcareprofessi
onal
,ri
nsemout hwith
wateraftereati
ng,andusespongebr ush.Mouthpai
n
mayr equir
etreatmentwi t
hopi
oids.

Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Car
bopr
ost

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 615
I
NDI
CATI
ONS
Induct
ionofmi d-
tr
imesterabor
ti
on.Tr
eatmentof
postpart
um hemor r
hagethathasnotr
espondedt
o
conventi
onalther
apy.

ACTI
ON
Causesuter
inecontr
acti
onsbydir
ectlysti
mulat
ingthe
myometri
um.Therapeuti
cEff
ects:Expulsi
onoffetus.
Contr
olofpostpar
tum bl
eedi
ng.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
raindi
catedin:Hypersensi
ti
vi
ty;
Acutepelvi
c
i
nfl
ammat orydisease;Acti
vepulmonar
y,renal
,orhepat
ic
di
sease.
UseCauti
ousl
yin:Uter
inescarri
ng; Ast
hma;Hy pot
ensi
on;
Hypert
ensi
on;Cardi
acdisease;Adrenaldi
sease;Anemia;
Jaundi
ce;Di
abetesmelli
tus;Epi
lepsy.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness,headache.Resp:wheezing.GI:di
arr
hea,
nausea,vomi t
ing,abdominalpai
n,cramps.GU: UTERINE
RUPTURE.Der m:flushi
ng.Misc:
fever,chi
ll
s,shiv
eri
ng.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 616
Dr
ug-
Drug:
Augment
stheef
fect
sofot
heroxy
toci
cagent
s.

DOSAGE
TestDose
I
M:(
Adul
ts)
:100mcg.

Abor
ti
faci
ent
IM:(Adult
s):250mcgev ery1.5–3.5hrdependingupon
uter
ineresponse;
maybei ncreasedto500mcgi fsever
al
dosesof250mcgpr oduceinadequat
eresponse( notto
exceed2day sofconti
nuoust her
apyortotaldoseof12
mg).

Ref
ract
oryPost
par
tum Ut
eri
neBl
eedi
ng
I
M:(Adul
ts):250mcg; mayber
epeat
edev
ery15–90mi
n
(
tot
aldosenottoexceed2mg).

AVAI
LABI
LITY
I
nject
ion250mcg/
mL;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofvagi
nal
exami
nat
ions(
toassess
fort
raumatocer
vix)
.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 617
 i
mmedi atel
yiffev
erandchi
ll
s,f
oul-smell
ingv
agi
nal
di
scharge,l
owerabdominal
pain,orincr
eased
bl
eedingoccurs.

CARGLUMI
CACI
D
I
NDI
CATI
ONS
Treatment( acute/ mai
ntenance)ofhy perammonemi adue
todef i
ciencyofhepat i
cenzy meN- acetylglutamat e
synthase( NAGS) .Duri
ngacut ehyperammonemi a,
additi
onal tr
eatment sshouldbeusedi ncludingal t
ernat
e
pathwaymedi cations,
hemodi al
ysis,andpr otei
n
restr
icti
on.

ACTI
ON
Servesasananal ogueofN- acetylgl
utamate( NAG),the
natural
activat
orofcabamoy lphosphatesynthetase1
(CPS1)i ntheli
ver.CPS1hel pstoconv er
tammoni aint
o
urea.Cargl
umicaci drepl
acesNAGi nNAGSdef i
ciency
pati
entsbyact i
vati
ngCPS1.Ther apeuti
cEffects:↓
ammoni alevel
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Lact
ati
on:
Breast
feedi
ngnot

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 618
r
ecommended.

UseCaut
iousl
yin:
OB:
Duet
ori
skofneur
ologi
c
compl
icat
ionsinNAGSpati
ent
s,car
glumi
caci
dmustbe
usedt
hroughoutpr
egnancy
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,drowsi
ness, weakness.EENT:
nasopharyngit
is.GI:
abdomi nalpai
n,diar
rhea,v
omi t
ing,
abnormal t
aste.Derm:rash.Hemat :anemia.Metab:↓
weight.Misc:i
nfecti
ons,fev
er .

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
PO: (
Adul
ts):100–250mg/kg/dayi
nit
ial
l
y,gi
v enin2–4
di
videddosesimmediat
elybef
oremeals/f
eedings,
adj
ustedtomaintai
nnormalpl
asmaammoni alevels
basedonage.Doseshouldberoundedtothenear est100
mg.
PO:(
Chi
ldr
en):100–250mg/ kg/
dayi
niti
all
y,gi
venin2–4
di
vi
deddosesi
mmedi at
elybefor
emeals/f
eedings.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 619
Tabl
ets200mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakecar
glumi
caci
dasdi
rect
ed.

Adv i
sepatientthatdur ingacut ehyper
ammonemi c
episodes,proteinrestricti
onandhy percal
ori
cint
akeis
recommendedt oblockammoni agenerat
ing
cataboli
cpat hway s.Whenpl asmaammoni al
evel
s
havenor malized,proteinintakecanusuallybe↑ wit
h
goal ofunrestri
ctedpr otei
ni nt
ake.

Advi
sefemalepat i
entstonot i
fyheal
t hcar
e
prof
essi
onalifpregnancyisplannedorsuspectedor
i
fbreast
feedingDuet ori
skofneur ologi
c
compli
cati
onsinNAGSpat ients,
carglumicaci
dmust
beusedthroughoutpregnancy .

Car
isopr
odol
I
NDI
CATI
ONS
Adj
unctt
or estandphysical
therapyint
hetreat
mentof
muscl
espasm associatedwithacutepai
nful
muscul
oskeletal
condit
ions.

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 620
Skelet
almuscler
elaxat
ion,
probabl
yduetoCNS
depressi
on.Ther
apeuti
cEffect
s:Skel
etal
muscl
e
rel
axati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocar
isopr
odol
ort
o
mepr
obamat
e;Por
phy
riaorsuspect
edpor
phy
ria.

UseCaut
iousl
yin:
Sev
erel
i
verorki
dneydi
sease;
OB:
Lact
ati
on: Pedi
:Safet
ynotestabli
shedforpr
egnant
women, breast
feedi
nginf
ants,orchi
ldr
en<16yr;Ger
i:
Poorl
ytolerat
edduetoantichol
iner
giceff
ect
s.Appear
son
Beer
slist.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness, dr
owsiness, agitati
on, ataxia,depression,
headache, i
nsomni a,i
rri
tabili
ty,syncope.Resp: asthma
att
acks.CV: hypot
ension, t
achy cardia.GI:epi gastri
c
di
stress,hiccups,nausea, vomiting.Der m: flushing,rashes.
Hemat :eosinophil
ia,l
eukopeni a.Mi sc: ANAPHYLACTI C
SHOCK, fev er,
psychologicaldependence, severe
i
diosyncraticreacti
on.

I
NTERACTI
ONS
Dr
ug-
Drug:
Addi
ti
veCNSdepr
essi
onwi
thot
herCNS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 621
depr
essant
sincl
udingalcohol,
antihi
stami
nes,
opi
oid
anal
gesi
cs,andsedat
ive/hypnoti
cs.
Drug-Natur
alProduct:
Concomitantuseofkav
a-kav
a,
val
erian,
skull
cap,chamomile,
orhopscan↑ CNS
depressi
on.

DOSAGE
PO:(
Adult
s≥16y
rs)
:250–350mg4t
imesdai
l
yforno
l
ongert
han2–3wk.

AVAI
LABI
LITY
Tablet
s250mg,350mg.I ncombi
nat
ionwi
th:
aspi
ri
n
(Somacompound)andcodei
ne.

PATI
ENTTEACHI
NG
Instructpat
ienttotakemedi
cati
onasdir
ected.
Mi sseddosesshoul dbet
akenwithi
n1hr;i
fnot,omit
andr eturnt
or egul
ardosi
ngschedul
e.Donotdouble
doses.

Encouragepati
entt
ocomplywithaddi
ti
onalt
her
api
es
prescri
bedformuscl
espasm (
rest
,physi
cal
ther
apy
,
heat,et
c.)
.

Maycausedi
zzi
nessordr
owsi
ness.Adv
isepat
ientt
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 622
 avoi
ddr i
vingorot
heract
ivi
ti
esr
equi
ri
ngal
ert
ness
unti
lresponsetodr
ugisknown.

I
nstr
uctpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Advi
sepat
ientt
oav oi
dconcur
rentuseofal
coholand
ot
herCNSdepressant
swhilet
akingthi
smedicat
ion.

Instr
uctpati
enttonot
ifyhealthcarepr
ofessi
onali
f
signsofall
ergy(r
ash,hi
v es,
swelli
ngoftongueorl
ips,
dyspnea)oridi
osyncr
aticreacti
onoccur.

Car
must
ine
I
NDI
CATI
ONS
Al
oneorwit
hot hertr
eat ment
s(sur
gery,
radi
ati
on)i
nthe
managementof:Brai
nt umors,Mul
ti
plemyel
oma,
Hodgki
n’
sdisease,Otherlymphomas.

ACTI
ON
I
nhibitsDNAandRNAsy nthesi
s(cell
-cy
cle
phase–nonspeci
fic)
.Therapeuti
cEffect
s:Deat
hofr
api
dly
repl
icati
ngcel
ls,
especial
lymalignantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 623
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pr
egnancyorl
act
ati
on.

UseCaut
iousl
yin:
Inf
ect
ions;
Depr
essedbonemar
row
reserve;Ger
i:Consideragerel
at ed↓ inbodymass,
renal/hepat
ic/car
diovascul
arfuncti
on,concurr
ent
medi cati
onsandchr oni
cill
nesses;Impair
edpulmonar
y,
hepat i
c,orr
enal f
uncti
on;Otherchronicdebi
li
tati
ng
i
llnesses;OB:Patient
swi t
hchildbeari
ngpotenti
al.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Resp:PULMONARYFI BROSIS,pul
monar yi
nfi
lt
rates.GI:
hepatot
oxicit
y,nausea,vomiti
ng,anorexia,
diarr
hea,
esophagit
is.GU:renalfai
lur
e.Derm: al
opecia.Hemat :
LEUKOPENI A,THROMBOCYTOPENI A, anemia.Local:pai
n
atIVsit
e.

I
NTERACTI
ONS
Drug-Drug: ↑ bonemar rowdepressionwi thot
her
antineoplasti
csorr adi
ati
ontherapy.Smoki ng↑ r
iskof
pulmonar ytoxicit
y.May↓ ant i
bodyresponset ol
ive-
vir
us
vaccinesand↑ r i
skofadv er
sereactions.
My elosuppressionmaybe↑ byci met i
dine.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 624
I
V:(Adul
tsandChil
dren):
150–200mg/m2si
ngl
edoseq
6–8wkor75–100mg/ m2/dayf
or2daysq6wkor40
mg/m2/dayfor5daysq6wk.
I
ntr
acavi
tary(
Adul
ts):Upt
o61.6mg( 8implant
s)pl
aced
i
ncavi
tycreat
edduri
ngsur
gical
resect
ionofbrai
ntumor
.

AVAI
LABI
LITY
I
njecti
on100mg/v
ial
;I
ntr
acav
itar
ywaf
er7.
7mgi
n
packagesof8;

PATI
ENTTEACHI
NG
Instr
uctpat i
entt onotifyheal thcarepr ofessionali
f
fever;chill
s;sor ethroat;signsofi nfection;lowerback
orsidepai n; diff
icul
torpai nf ulur
ination;bleeding
gums; bruisi
ng; petechiae;orbl oodinur ine,stool
,or
emesi soccur s.Cautionpat ienttoav oidcrowdsand
personswi thknowni nfections.Instructpat i
enttouse
softtoot hbrushandel ectri
cr azor.Pat i
entsshouldbe
cautionednott odr i
nkal cohol i
cbev eragesort otake
product scont ainingaspirinorNSAI Ds.

Inst
ructpatienttonoti
fyhealthcareprof
essi
onali
f
shortnessofbr eat
horincreasedcoughoccurs.
Encouragepat i
entnottosmoke, becausesmokers
areatgr eat
erriskforpul
monar ytoxi
cit
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 625
 Inst
ructpati
entt oinspectoralmucosaforredness
andulcerat
ion.Ifmout hsoresoccur,advi
sepatientto
usespongebr ushandr i
nsemout hwithwaterafter
eati
nganddr inking.Stomati
tismayrequir
et r
eatment
withopioi
danal gesics.

Discusswithpat
ientthepossi
bil
i
tyofhai
rloss.
Explorecopi
ngstrat
egies.

Advi
sepatientoftheneedf
orcont
racept
ionandt
o
avoi
dbreastfeedi
ngduri
ngther
apy
.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasi
zeneedf
orper
iodi
clabt
est
stomoni
torf
or
si
deeff
ects.

CARTEOLOL
I
NDI
CATI
ONS
Managementofhypert
ension.Unl
abel
edUses:
Managementofanginapectori
s.

ACTI
ON
Blockssti
mulat
ionofbet
a1(myocar
dial
)-and
beta2(pul
monary,
vascul
ar,
anduter
ine)
-adrener
gic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 626
recept
orsit
es.Al
sohasint
ri
nsicsympathomi met
icacti
vit
y
(ISA)
,whichmayreducebr
adycardi
a.Therapeut
icEff
ects:
Decreasedhear
trat
eandBP.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Uncompensat
edHF;
Pul
monar
y
edema;
Car
diogeni
cshock;
Brady
car
diaorhear
tbl
ock.

UseCaut
iousl
yin:
Renal
impai
rment(
incr
easeddosi
ng
i
nt ervalrecommended) ; Hepat i
ci mpai rment ;Ger iatri
c
pat i
ents( increasedsensi t
ivi
tyt obet abl ockers; init
ial
dosager educt i
onr ecommended) ;Pulmonar ydi sease
(i
ncl udingast hma) ;avoidusei fpossi ble;Diabet es
mel li
tus( maymasksi gnsofhy pogl y
cemi a)
;
Thy rotoxicosis(maymasksy mpt oms) ;Pat i
ent swi tha
historyofsev ereallergi
cr eactions( i
ntensi t
yofr eactions
maybei ncreased); OB: Crossespl acent aandmaycause
fetal/neonat albrady cardia,hypot ension, hypogly cemi a,or
respi r
atorydepr ession); Lactation: Pedi:Saf etynot
establ i
shed; Geri:I
ncr easedsensi tivi
tytobet abl ocker s;
i
nitialdosager educt i
onr ecommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
fatigue,
weakness,
anxi
ety
,depressi
on,di
zzi
ness,
dr
owsiness,i
nsomni
a,memoryloss,
ment al
stat
us

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 627
changes, nightmar es.EENT: blurr
edv i
si on, dryeyes,nasal
stuff
iness.Resp: br onchospasm, wheezi ng.CV:
BRADYCARDI A,HF, PULMONARYEDEMA, orthost
atic
hypot ension, peri
pher alvasoconstri
ction.GI :
constipati
on,
diarr
hea, nausea.GU: erecti
l
edy sfunction, decreased
l
ibido.Der m: itchi
ng, rashes.Endo: hyper glycemia,
hypogl ycemi a.MS: art
hralgi
a,backpai n, muscl ecramps.
Neur o:par esthesia.Mi sc:drug-i
nducedl upussy ndrome.

I
NTERACTI
ONS
Drug-Dr ug:Gener alanest het i
cs,IVpheny toi
n,and
verapami lmaycauseaddi ti
v emy ocar dialdepression.
Additivebr ady cardiamayoccurwi thdi goxin.Additiv
e
hypot ensionmayoccurwi thot herant i
hy pert
ensives,
acutei ngest ionofal cohol ,ornitrates.Concur rentusewi th
amphet ami ne, cocaine, ephedr i
ne, epinephrine,
norepi nephrine, pheny l
ephr ine,orpseudoephedr inemay
resultinunopposedal pha-adr energicst imulati
on
(excessi vehy per t
ension, brady cardia).Concur r
ent
admi nistrati
onoft hyroidpr epar ati
onsmaydecr ease
effectiveness.Mayal tertheef fectivenessofi nsuli
nsor
oralhy pogly cemi cagent s(dosageadj ustment smaybe
necessar y)
.Maydecr easet heef f
ectivenessof
adrener gicsandt heophy l
li
ne.Maydecr easet hebenef i
cial
beta-car di
ov ascul aref fectsofdopami neor dobutami ne.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 628
Usecauti
ouslywi t
hin14day sofMAOi nhi
bitortherapy
(mayresul
tinhy pert
ension).Concur
rentusewi th
cl
onidi
neincreaseshy potensi
onandbr adycardi
a.May
exagger
atewi t
hdrawal phenomenonf r
om clonidine.
Concurr
entNSAI Dsmaydecr easeanti
hypertensiveacti
on.

DOSAGE
PO:(
Adult
s):2.
5mgoncedai
l
y,maybei
ncr
easedupt
o
10mg/day.

Renal
Impai
rment
PO:(
Adul
ts)
:CCr20-
60mL/
min—incr
easedosingint
erv
al
toq48hr
;CCr<20ml
/mi
n—i
ncr
easedosingi
ntervalt
oq
72hr.

AVAI
LABI
LITY
Tabl
ets2.
5mg,
5mg.

PATI
ENTTEACHI
NG
Instructpatienttotakemedi cati
onexactlyasdirected,
att hesamet imeeachday ,eveniffeeli
ngwell;donot
skipordoubl euponmi sseddoses.I fadoseis
mi ssed,itshouldbet akenassoonaspossi bl
eupt o4
hrbef orenextdose.Abr uptwi t
hdrawalmay
precipit
atelife-t
hreat
eningar r
hythmias,hyper
tension,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 629
 ormy
ocar
dial
ischemi
a.

Advisepat ienttomakesur
eenoughmedicati
onis
avai
lablef orweekends,
holi
days,
andv
acations.A
writ
tenpr escript
ionmaybekepti
nwal
letincaseof
emer gency .

Teachpat i
entandf amil
yhowtocheckpul seandBP.
Instr
uctt hem tocheckpulsedai
lyandBPbi weekl
y.
Adv i
sepat ienttoholddoseandcontacthealt
hcare
professional i
fpul
sei s<50bpm orBPchanges
signif
icantly.

Maycausedr owsinessordizzi
ness.Cauti
onpat
ient
s
toavoiddri
vi
ngorot heract
ivi
ti
esthatrequi
re
aler
tnessunti
lresponsetothedrugisknown.

Adv i
sepatientt
ochangepositi
onsslowlyt
omi ni
mize
orthostat
ichypotensi
on,
especial
lydur
ingi
nit
iat
ionof
therapyorwhendosei sincr
eased.

Cauti
onpat
ientt
hatt
hismedi
cat
ionmayi
ncr
ease
sensi
ti
vi
tyt
ocold.

I
nstructpat i
entt
oconsultheal
thcareprofessional
beforetakinganyOTCmedi cati
ons,especial
lycold
preparati
ons,concur
rent
lywiththi
smedi cati
on.

Di
abet
icsshoul
dcl
osel
ymoni
torbl
oodgl
ucose,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 630
 especiall
yifweakness,
malai
se,i
rr
it
abi
li
ty,
orf
ati
gue
occurs.Medicati
onmaymasksomesi gnsof
hypoglycemia,butdi
zzi
nessandsweat
ingmaysti
ll
occur.

Advi
sepat i
enttonotif
yheal thcareprofessi
onali
f
sl
owpul se,di
ff
icul
tybreathing,wheezing,col
dhands
andfeet,di
zzi
ness,confusion,depression,r
ash,f
ever
,
sor
et hr
oat,unusualbl
eeding, orbrui
singoccurs.

I
nst
ructpat
ienttoi
nfor
m healt
hcareprofessi
onal
of
medi
cati
onregimenbefor
etreatmentorsurger
y.

Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Hypertension:Reinforcet heneedt oconti

nue
additi
onaltherapiesf orhy pertension(wei
ghtl
oss,
sodium restri
cti
on,st ressr educti
on, r
egul
arexerci
se,
moder ati
onofal cohol consumpt ion,andsmoking
cessation)
.Medi cationcont r
olsbutdoesnotcur e
hypertensi
on.

Angi
na:Cauti
onpatientt
oav
oidov
erexer
ti
onwi
th
decr
easeinchestpain.

Car
vedi
l
ol

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 631
I
NDI
CATI
ONS
Hyper
tension.HF(ischemicorcar diomyopat
hic)wit
h
di
goxi
n,diureti
cs,
andACEi nhibi
tors.Lef
tventri
cul
ar
dy
sfuncti
onaf t
ermy ocardi
alinfarct
ion.

ACTI
ON
Blocksst i
mul at
ionofbet a1(
my ocardial
)andbet a2
(pulmonar y,v
ascul ar ,anduteri
ne)-adrenergicreceptor
sites.Alsohasal pha1bl ocki
ngact ivi
ty,whichmayr esul
t
i
nor thost
ati
chy pot ension.Therapeut i
cEffects:
Decr easedheartr ateandBP.I mpr ovedcar di
acout put,
slowi ngofthepr ogr essionofHFanddecr easedr iskof
deat h.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hi
stor
yofser
ioushy
per
sensi
ti
vi
ty
reacti
on( Stevens-Johnsonsyndr
ome, angioedema,
anaphy laxis);Pul
monar yedema;Cardiogenicshock;
Brady cardia,heartblockorsi
cksinussy ndrome( unlessa
pacemakeri sinplace);
UncompensatedHFr equi
r i
ngI V
i
not r
opi cagent s(weanbef or
estart
ingcar v
edilol
);Severe
hepatici mpai r
ment ;Asthmaorotherbronchospast i
c
disorders.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 632
UseCaut
iousl
yin:
HF(
condi
ti
onmaydet
eri
orat
edur
ing
i
nitialtherapy);Renal i
mpairment; Hepaticimpai rment;
Diabet esmel l
it
us( maymasksi gnsofhy poglycemi a)
;
Thy rotoxi
cosis( maymasksy mpt oms) ;Peri
pher al
vascul ardisease;Historyofsevereal l
ergicreactions
(i
ntensi t
yofr eactionsmaybei ncr eased);OB: Crosses
placent aandmaycausef etal
/neonat albradycardia,
hypot ension,hypoglycemia,orrespiratorydepr essi
on);
Lact ati
on: Pedi
: Safet
ynotestablished; Geri
:↑ sensi ti
vi
ty
tobet ablockers; i
niti
aldosereduct i
onr ecommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, f
atigue, weakness, anxiety,depr ession,
drowsiness,insomni a,memor yloss,ment al status
changes, ner
v ousness, nightmar es.EENT: blurredv i
sion,
dryeyes, i
ntr
aoper ativefloppyi ri
ssy ndrome, nasal
stuf
fi
ness.Resp: bronchospasm, wheezi ng.CV:
BRADYCARDI A, HF, PULMONARYEDEMA.GI : diarrhea,
constipati
on,nausea.GU: erecti
ledy sfunction, ↓l ibido.
Derm: STEVENS- JOHNSONSYNDROME, TOXI C
EPIDERMALNECROLYSI S, i
tching,rashes, urticaria.Endo:
hyperglycemia,hypogl ycemi a.MS: ar t
hralgia,backpai n,
musclecr amps.Neur o:par esthesia.Mi sc:ANAPHYLAXI S,
ANGIOEDEMA, drug-inducedl upussy ndrome.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 633
I
NTERACTI
ONS
Drug- Dr ug: Gener alanest het ics,IVpheny toin, dilt
iazem,
andv er apami lmaycause↑ my ocardi aldepr essi on.↑
ri
skofbr ady car diawi thdi goxi n.Ami odar oneor
fl
uconazol emay↑ l ev els.↑ hy potensi onmayoccurwi t
h
otherant ihy pertensi ves, acut eingest ionofal cohol ,or
ni
trat es.Concur rentusewi thcl onidine↑ hy pot ensi onand
brady car dia.May↑ wi thdr awal phenomenonf rom
cl
oni di ne( discont inuecar vedi l
ol f
irst).Concur rent
admi nist rationoft hy r
oi dpr epar ati
onsmay↓
effect iveness.Mayal tert heef fecti
v enessofi nsul i
nsor
oral hy pogl ycemi cagent s( doseadj ust ment smaybe
necessar y ).May↓ ef fect ivenessoft heophy lli
ne.May↓
benef i
ci al bet a1-car di
ov ascul aref f
ect sofdopami neor
dobut ami ne.Usecaut iousl ywi thin14day sofMAO
i
nhi bitort her apy( mayr esul tinhy pot ensi on/ br ady cardi
a).
Cimet idinemay↑ t oxi cityf rom car vedi lol.Concur rent
NSAI Dsmay↓ ant i
hy per tensi veact ion.Ef f
ect i
venessmay
be↓ byr i
fampi n.May↑ ser um di goxi nlevel s.May↑
bl
oodl ev elsofcy clospor i
ne( moni torbl oodl ev els) .

DOSAGE
PO:(
Adul
ts):
Hy per
tensi
on—6.
25mgt wi
cedai
ly
,maybe
↑ q7–14daysupto25mgt wicedai
l
yorext
ended-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 634
rel
ease—20mgoncedai ly
, dosemaybedoubl edev ery
7–14day supt o80mgoncedai ly
; HF—3. 125mgt wice
dai
lyfor2wk; maybe↑ t o6. 25mgt wicedaily.Dosemay
bedoubledq2wkast olerated( nott oexceed25mgt wice
dai
lyinpatient
s<85kgor50mgt wi cedai l
yinpat i
ents
>85kg)orext ended-release—10mgoncedai ly, dosemay
bedoubledev ery2wkast oleratedupt o80mgoncedai ly
;
Leftvent
ri
culardysfunct i
onaf terMI —6.25mgt wi cedaily,
↑ aft
er3–10day sto12. 5t wicedai lythent otargetdose
of25mgt wicedail
y;somepat ientsmayr equirel ower
i
nit
ialdosesandsl owert itrati
onorext ended-release—20
mgoncedai l
y,dosemaybedoubl edev er
y3–10day sup
to80mgoncedai ly.

AVAI
LABI
LITY
Tabl
ets3.
125mg,
6.25mg,
12.
5mg,
25mg.
Ext
ended-
rel
easecapsul
es10mg,
20mg,
40mg,
80mg.

PATI
ENTTEACHI
NG
Instr
uctpati
enttotakemedicati
onasdirected,
atthe
samet i
meeachday ,ev
eniffeel
ingwell
.Donotskip
ordoubl euponmisseddoses.Takemi sseddosesas
soonaspossi bl
eupt o4hrbeforenextdose.Abrupt
withdrawalmayprecipi
tat
eli
fe-t
hreat
ening

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 635
 ar
rhy
thmi
as,
hyper
tensi
on,
ormy
ocar
dial
ischemi
a.

Advisepat ienttomakesur
eenoughmedicati
onis
avai
lablef orweekends,
holi
days,
andv
acations.A
writ
tenpr escript
ionmaybekepti
nwal
letincaseof
emer gency .

Teachpat i
entandf amil
yhowtocheckpul seandBP.
Instr
uctt hem tocheckpulsedai
lyandBPbi weekl
y.
Adv i
sepat ienttoholddoseandcontacthealt
hcare
professional i
fpul
sei s<50bpm orBPchanges
signif
icantly.

Maycausedr owsinessordizzi
ness.Cauti
onpat
ient
s
toavoiddri
vi
ngorot heract
ivi
ti
esthatrequi
re
aler
tnessunti
lresponsetothedrugisknown.

Adv i
sepatientt
ochangepositi
onsslowlyt
omi ni
mize
orthostat
ichypotensi
on,
especial
lydur
ingi
nit
iat
ionof
therapyorwhendosei sincr
eased.

Cauti
onpat
ientt
hatt
hismedi
cat
ionmayi
ncr
ease
sensi
ti
vi
tyt
ocold.

Instr
uctpatientt
onot i
fyheal
thcareprofessional of
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbeingtakenandt oconsultheal
thcar e
professi
onal bef
oretaki
ngotherRx, OTC,orher bal
products,especi
all
ycoldpreparati
ons,concurrently

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 636
 wi
tht
hismedi
cat
ion.

Patient
swi t
hdi abet
esshouldcl
osel
ymoni t
orblood
glucose,especial
lyi
fweakness,mal
aise,i
rr
it
abili
ty,
or
fati
gueoccur s.Medicat
ionmaymasksomesi gnsof
hypoglycemia,butdizzi
nessandsweati
ngmayst i
l
l
occur.

Advi
sepat i
enttonotif
yheal thcareprofessi
onali
f
sl
owpul se,di
ff
icul
tybreathing,wheezing,col
dhands
andfeet,di
zzi
ness,confusion,depression,r
ash,f
ever
,
sor
et hr
oat,unusualbl
eeding, orbrui
singoccurs.

I
nst
ructpat
ienttoi
nfor
m healt
hcareprofessi
onal
of
medi
cati
onregimenbefor
etreatmentorsurger
y.

Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Hypertension:Reinforcet heneedt oconti

nue
additi
onaltherapiesf orhy pertension(wei
ghtl
oss,
sodium restri
cti
on,st ressr educti
on, r
egul
arexerci
se,
moder ati
onofal cohol consumpt ion,andsmoking
cessation)
.Medi cationcont r
olsbutdoesnotcur e
hypertensi
on.

CASCARASAGRADA

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 637
I
NDI
CATI
ONS
Treat
mentofconst
ipat
ion.Par
ti
cular
lyusef
ul when
const
ipat
ioni
ssecondarytopr
olongedbedrestor
const
ipat
ingdr
ugs.

ACTI
ON
Sti
mul at
esperist
alsi
s.Altersfl
uidandelect
rol
yte
tr
ansport,pr
oducingfluidaccumulati
oninthecolon.
Therapeuti
cEffects:
Ev acuati
onofthecolon.Cascarai
s
anothernamef orcascarasagrada,whichisnat
urall
y
deri
vedfrom thebarkoft hebuckthor
nt r
ee.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Abdomi
nal
pai
n,
obstr
uction,nausea,orv omi
ti
ng,especi
all
ywhen
associat
edwi thfeverorothersi
gnsofacuteabdomen;
Aromat i
ccascarasagr adafl
uidextr
actcontai
nsalcohol
andshoul dbeav oi
dedi npati
ent
swi t
hknowni nt
olerance;
Pregnancyorlactati
on.

UseCaut
iousl
yin:
Sev
erecar
diov
ascul
ardi
sease;
Anal
or
rect
alfi
ssures;
Excessi
veorpr
olongedusemayl
eadt
o
dependence.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 638
GI:
abdominalcr
amps,nausea,
diar
rhea.GU:di
scolor
ati
on
ofuri
ne.FandE:hy
pokalemia(
withchroni
cuse).

I
NTERACTI
ONS
Drug-
Dr ug:Maydecreasetheabsorpt
ionofconcur
rent
ly
administer
edoralmedicat
ionsbecauseofincr
eased
motil
it
yanddecr easedtr
ansitt
ime.

DOSAGE
Cascar
aSagr
ada
PO:
(Adul
ts)
:300mg–1goncedai
l
y.
PO:
(Chi
l
dren2–11y
r):
150–500mgoncedai
l
y.
PO:
(Chi
l
dren<2y
r):
75–250mgoncedai
l
y.
Cascar
aSagr
adaExt
ract
PO:
(Adul
ts)
:200–400mgoncedai
l
y.
PO:
(Chi
l
dren2–11y
r):
100–200mgoncedai
l
y.
PO:
(Chi
l
dren<2y
r):
50–100mgoncedai
l
y.
Cascar
aSagr
adaFl
uidExt
ract
PO:
(Adul
ts)
:0.
5–1.
5mLoncedai
l
y.
PO:
(Chi
l
dren2–11y
r):
0.25mL–0.
75mLoncedai
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 639
PO:
(Chi
l
dren<2y
r):
0.12–0.
38mLoncedai
l
y.
Ar
omat
icCascar
aFl
uidExt
ract
PO:
(Adul
ts)
:2–6mLoncedai
l
y.
PO:
(Chi
l
dren2–11y
r):
1–3mLoncedai
l
y.
PO:
(Chi
l
dren<2y
r):
0.5–1.
5mLoncedai
l
y.

AVAI
LABI
LITY
Powder,extractt
abl
ets,
fluidextr
act
,andar
omaticflui
d
ext
ractaloneandincombi nati
onwit
hdocusat
e,aloe,mil
k
ofmagnesi a.
OTC

PATI
ENTTEACHI
NG
Advi
sepatientsthatlaxati
vesshouldbeusedonl yfor
shor
t-t
erm( notl
ongert han1wkwi t
houtappr
ov alof
heal
thcareprofessional)t
herapy.Long-
ter
mt herapy
maycauseel ect
rolyteimbalanceanddependence.

Encouragepatient
st ouseot herformsofbowel
regul
ati
onsuchasi ncr
easingbul kinthediet,
i
ncreasingflui
dintake(6–8gl assesofflui
d/day)
,and
i
ncreasingmobi l
it
y.Normal bowel habit
sar e
i
ndivi
dualizedandmayv ar
yf rom 3times/dayto3
ti
mes/wk.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 640
 Instr
uctpati
ent
swithcar
diacdi
seasetoavoi
d
strai
ningdur
ingbowelmovements(Val
sal
va
maneuv er
).

Advi
sepatient
snottouselaxati
veswhenabdomi
nal
pai
n,nausea,vomi
ti
ng,orf
ev eri
spresent
.

Caspof
ungi
n
I
NDI
CATI
ONS
I
nvasiveaspergi
ll
osisrefr
actoryto, orintoler
antof ,ot
her
t
herapies.Candi
demi aandassoci atedser iousinfecti
ons
(
intr
a-abdominalabscesses,per i
tonit
is,pleuralspace
i
nfecti
ons).Esophagealcandidiasis.Suspect edfungal
i
nfecti
onsinfebri
leneutropenicpat i
ents.

ACTI
ON
Inhi
bit
sthesynthesisofβ( 1,3)
-D-gl
ucan,
anecessar
y
componentofthef ungalcell
wall.Ther
apeut
icEf
fect
s:
Deathofsuscepti
blefungi.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentusewi
th
cy
clospor
ine.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 641
UseCaut
iousl
yin:
Moder
atehepat
ici
mpai
rment(
↓
mai
ntenancedoser
ecommended)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,chil
ls.GI:di
arrhea,↑liverenzymes,
nausea,vomiti
ng.Resp: bronchospasm.GU: ↑ creat
ini
ne.
Derm: f
lushi
ng,pruri
t i
s,r
ash.Local:venousirri
tat
ionat
i
nject
ionsite.Misc:aller
gicreacti
onsincludi
ng
anaphylaxi
s,ANGI OEDEMA, fev er
.

I
NTERACTI
ONS
Drug-Dr ug:Concurrentusewi thcy cl
ospor i
nei snot
recommendedduet o↑ riskofhepat ictoxici
t y.May↓
bloodl evelsandeffectsoftacrolimus.Bl oodl evelsand
effectivenessmaybe↓ byr if
ampi n;maintenancedose
shoul dbe↑ t o70mg( inpat i
entswi t
hnor mal li
ver
function).Bloodlevelsandef f
ect i
venessal somaybe↓
byef avirenz,nel
fi
navir,
nev i
rapine,phenytoin,
dexamet hasone,orcarbamazepi ne;an↑ i nt he
mai ntenancedoset o70mgshoul dbeconsi der edin
patientswhoar enotcli
nicall
yrespondi ng.

DOSAGE
I
V:(Adul
ts)
: 70mgini
ti
all
yfoll
owedby50mgdai l
y,
dur
ati
ondetermi
nedbycli
nicalsi
tuat
ionandr
esponse;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 642
Esophagealcandidi
asi
s—50mgdai ly
,dur
ati
ondet
ermi
ned
bycli
nical
situat
ionandresponse.
I
V:( Chi
l
dren≥3mo):70mg/ m2(max:70mg)i nit
iall
y
fol
l
owedby50mg/ m2dai ly(
max:70mg/ day)
, durati
on
determi
nedbycl
ini
calsi
tuati
onandresponse.
I
V:(
Inf
ant
s1t
o<3mo)
:25mg/
m2/
doseoncedai
l
y.

Hepat
icI
mpai
rment
IV:(Adult
s):Moderatehepati
cimpai
rment—70mginiti
all
y
fol
lowedby35mgdai ly
,durati
ondet
erminedbycl
i
nical
sit
uationandresponse.

AVAI
LABI
LITY
Powderf
ori
nject
ion50mg/
vial
,70mg/
vial
;

PATI
ENTTEACHI
NG
Expl
ainthepur
poseofcaspof
ungi
ntopat
ientand
fami
ly.

Adv isepati
enttonotifyheal
thcarepr
ofessi
onal
i
mmedi atel
yifsy mptomsofall
ergicr
eacti
ons(r
ash,
facialswell
ing,prur
it
us,sensat
ionofwarmth,
diff
icult
ybreathing)occur.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 643
Cef
acl
or
I
NDI
CATI
ONS
Treat
mentofthefol l
owinginfecti
onscausedby
suscept
ibl
eorganisms: Respi
ratorytr
acti
nfect
ions,Ski
n
andskinst
ructur
ei nfect
ions,
Ur i
narytr
acti
nfecti
ons,Oti
ti
s
media.

ACTI
ON
Bindst obact eri
alcellwallmembr ane,causi ngcell
death.
Ther apeuticEffects:Bacteri
cidalactionagai nst
suscept i
blebact eri
a.Spect r
um: Simi l
art othatoffi
rst-
gener at
ioncephal osporinsbuthasi ncreasedact i
vi
ty
againstsev eralothergram- negativepat hogensincludi
ng:
Haemophi lusinfl
uenzae, Escherichiacol i
,Klebsi
ell
a
pneumoni ae,Proteusmi rabil
is.Notact i
v eagainst
met hici
ll
in-resi
stantstaphy l
ococci orent er
ococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment
;Hi
stor
yofGI
di
sease,
especi
all
ycol
i
tis;
Pregnancyandl
act
ati
on(
has

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 644
beenusedsaf
ely
).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( veryhighdoses) .GI:
PSEUDOMEMBRANOUSCOLI TIS,diar
rhea,nausea,
vomi t
ing.Derm: r
ashes, urt
icaria.Hemat :agranulocy
tosi
s,
bleeding,eosi
nophili
a,hemol yticanemi a,neutropeni
a.
Mi sc:
allergi
creacti
onsi ncl
udi nganaphy l
axisandser um
si
ckness, superi
nfecti
on.

I
NTERACTI
ONS
Dr
ug-Drug:
Probeneci
ddecreasesexcr
eti
onandi
ncr
eases
bl
oodlevel
s.Ant
acidsdecr
easeabsorpti
on.

DOSAGE
PO:(Adult
s):250–500mgq8hror375–500mgq12hr
asextended-
rel
easetabl
ets.
PO:
( Chi
l
dren>1mo):
6.7–13.
4mg/
kgq8hror10–20
mg/kgq12hr(upto1g/day)
.

AVAI
LABI
LITY
Capsul
es250mg,500mg; Extended-rel
easetabl
ets(
CD)
375mg, 500mg;
Chewabletablet(
frui
ty)125mg,187mg,
250mg, 375mg;
Oralsuspension(
strawberr
y)125mg/ 5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 645
mL,
187mg/
5mL,
250mg/
5mL,
375mg/
5mL;

PATI
ENTTEACHI
NG
Inst
ructpatienttotakemedicati
onar oundthecl
ock
atevenlyspacedt imesandt ofi
nishthemedicati
on
completely,eveniffeel
ingbett
er.Misseddoses
shouldbet akenassoonaspossi bl
eunlessalmost
timefornextdose; donotdoubledoses.Instr
uct
pati
enttousecal ibrat
edmeasur i
ngdev i
cewith
suspension.Adv i
sepatientt
hatsharingofthi
s
medicationmaybedanger ous.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Cef
adr
oxi
l
I
NDI
CATI
ONS
Tr
eat
mentoft
hef
oll
owi
ngi
nfect
ionsduet
osuscept
ibl
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 646
organi
sms:Skinandskinstr
uctureinfect
ions(including
burnwounds),Phary
ngit
isand/
ort onsil
it
is,Ur
inaryt r
act
i
nfecti
ons.Notsuit
ablef
orthetreatmentofmeni ngit
is.

ACTI
ON
Bindtobact er
ialcellwall membr ane, causingcel ldeath.
Therapeut i
cEf fects:Bact ericidalacti
onagai nst
suscept i
blebact eri
a.Spect rum: Activeagai nstmanygr am
-posi
tivecocci including: Streptococcuspneumoni ae,
GroupAbet a-hemol yticst reptococci,Penicilli
nase-
producingst aphy l
ococci .Notact i
veagai nst: Methici
ll
i
n-
resi
stantst aphy l
ococci ,
Bact eroi
desf ragil
is,Enterococcus.
Activeagainstsomegr am- negativerodsi ncluding:
Klebsiell
apneumoni ae, Pr oteusmi rabil
is,Mor axell
a
catarrhal
is,Escher i
chiacol i
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dose↓ and/
or↑
dosi
ngint
ervalrecommendedi fCCr≤50mL/ min)
;Hist
ory
ofGIdi
sease,especial
l
ycoli
ti
s; Ger
i:Doseadj
ustmentdue
toage-
rel
ated↓ inrenalf
uncti
onmaybenecessar y;OB:
Lact
ati
on:Half
-l
ifeisshor
terandbloodlevel
slowerduri
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 647
pr
egnancy
;hasbeenusedsaf
ely
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( v
eryhighdoses) .GI :
PSEUDOMEMBRANOUSCOLI TIS,diarrhea,nausea,
vomiting,dyspepsia.Derm:STEVENS- JOHNSON
SYNDROME, rashes,pr
uri
ti
s,urticaria.Hemat :
agranulocytosis,t
hrombocytopeni a.Mi sc:
all
er gi
c
reacti
onsi ncl
udinganaphylaxisandser um sickness,
superinfecti
on.

I
NTERACTI
ONS
Drug-Drug:Pr
obeneci
d↓ excr et
ionand↑ bloodlevel
sof
renall
yexcret
edcephalospori
ns.Concurr
entuseofloop
diuret
icsoraminogl
ycosidesmay↑ t heri
skofrenal
toxi
city.

DOSAGE
PO:(Adult
s):Phar
yngi
ti
sand/ortonisi
l
iti
s—500mgev ery
12hror1gev ery24hrfor10days.Ski
nandsoftti
ssue
i
nfecti
ons—500mgev er
y12hror1gev ery24hr
.Urinary
tr
actinf
ecti
ons—500mg–1gev er
y12hror1–2gev er y24
hr.
PO:
(Chi
l
dren)
:Phar
yngi
ti
s,t
onsi
l
iti
s,ori
mpet
igo—15

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 648
mg/ kgever
y12hror30mg/ kgev er
y24hrfor10
days.Ski
nandsof
ttissuei
nfect
ions—15mg/kgever
y12
hr.
Ur i
nar
ytr
acti
nfecti
ons—15mg/ kgever
y12hr.

Renal
Impai
rment
PO:(Adul
ts):CCr25–50ml
/min—500mgev er
y12hr
;CCr
10–25mL/ min—500mgev er
y24hr;CCr0–10mL/min—
500mgev ery36hr.

AVAI
LABI
LITY
Capsul
es500mg;
Tabl
ets1g;
Oral
suspensi
on250mg/
5
mL,500mg/5mL;

PATI
ENTTEACHI
NG
Instr
uctpati
enttotakemedi cationar oundt heclock
atevenlyspacedtimesandt of inishthemedi cat
ion
compl et
elyasdir
ected,eveniff eeli
ngbet ter.Missed
dosesshouldbet akenassoonaspossi bl eunless
almosttimefornextdose; donotdoubl edoses.
Instr
uctpati
enttousecal i
bratedmeasur ingdev i
ce
withli
quidprepar
ations.Advisepat ientthatsharing
thismedicati
onmaybedanger ous.

Advi
sepati
entt
oreportsi
gnsofsuperi
nfect
ion(
fur
ry
over
growt
honthetongue,vagi
nali
tchi
ngor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 649
 di
schar
ge,
looseorf
oul
-smel
l
ingst
ool
s)andal
l
ergy
.

Inst
ructpatienttonot i
fyheal
thcareprofessi
onali
f
rash,orf
ev eranddi arr
headevelop,especi
all
yif
diarr
heacont ai
nsbl ood,mucus,orpus.Adv i
se
pati
entnott otreatdiarr
heawithoutconsulti
ngheal
th
careprofessional.

CEFAMANDOLE
I
NDI
CATI
ONS
Treatmentof :Respir
ator
ytractinfecti
ons, Skinandskin
struct
ureinfecti
ons,Boneandj ointinfecti
ons, Ur
inar
y
tr
actandgy necologicinf
ections,Septicemi a.Per
ioper
ativ
e
prophy l
axi
s.Intr
a-abdominal,gynecologic,andbili
arytr
act
i
nfections.

ACTI
ON
Bindstobact eri
alcellwallmembr ane,causi ngcell
death.
TherapeuticEffects:Bacteri
cidalactionagai nst
suscepti
blebact eri
a.Spectrum: Simi l
art othatoffi
rst-
generati
oncephal osporinsbuthasi ncreasedact i
vi
ty
againstseveralothergram- negati
v epat hogensincludi
ng:
Haemophi lusinfl
uenzae, Escheri
chi acol i
,Klebsi
ell
a
pneumoni ae,Neisseriagonor r
hoeae( i
ncluding

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 650
penici
ll
inase-
producingstrai
ns),
Proteus,Mor axel
la
catarr
hali
s.Alsohasmodestact ivi
tyagainstBacter
oides
fr
agili
s.Notact i
veagainstmethi
cil
li
n-resi
stant
staphyl
ococci orent
erococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dosage
reducti
on/
increaseddosi ngintervalrecommendedi fCCr
≤80mL/ mn; Geriat
ric,
debili
tat
ed, oremaciatedpat i
ents
(mayneedsuppl ement alvi
tami nKt opreventbleedi
ng) ;
Histor
yofGIdi sease,especial
lycol i
ti
s;Geri
atr
icpatients
(dosageadjustmentduet oage- relat
eddecreasei nrenal
functi
onmaybenecessar y
);Pregnancyandl actati
on( has
beenusedsaf ely).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( highdoses) .GI
:PSEUDOMEMBRANOUS
COLITI S,diarr
hea,nausea, vomiti
ng,cramps.Derm:rashes,
urt
icaria.Hemat :bleeding,blooddyscrasi
as,hemoly
tic
anemi a.Local:painatIM site,phl
ebiti
satIVsite.Mi
sc:
al
lergi
cr eact i
onsincludinganaphylaxi
sandser um
si
ckness, superi
nfecti
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 651
I
NTERACTI
ONS
Drug-Drug:Probeneciddecr easesexcreti
onandincreases
bloodlevels.Ifal
cohol isingestedwithin48–72hrof
cefamandol e,adisulfi
ram- li
kereacti
onmayoccur .May
potenti
atet heeffect
sofant icoagul
antsandincreasethe
ri
skofbl eedingwi t
hant iplatel
etagents,
thr
ombol y
tic
agents,
nonst eroi
dalant i
-infl
ammat oryagents(NSAIDs),
pli
camy cin,orval
proicaci d.

DOSAGE
I
M: I
V: (
Adults):Mostinf
ect
ions—0.
5–2gq4–6hr .
Uri
narytracti
nfect
ions—500mg–1gq8hr .Per
ioper
ati
ve
pr
ophy l
axis—1gwi thi
n60mi nofi
nci
sion,
thenq6hrf or
24hr.
I
M:I
V:(
Chi
l
dren>1mo):8.
3–16.7mg/
kgq4hror12.
5–25
mg/
kgq6hror16.
7–33.
3mg/ kgq8hr.

AVAI
LABI
LITY
Powderf
orinj
ect
ion1g,
2g;
Premi
xedcont
ainer
s1g/
50
mLD5W, 2g/50mLD5W;

PATI
ENTTEACHI
NG
Adv
isepat
ientt
orepor
tsi
gnsofsuper
inf
ect
ion(
fur
ry

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 652
 ov
ergrowthonthetongue,vaginal
itchi
ngor
di
scharge,
looseorfoul
-smell
ingstools)andal
l
ergy
.

Cauti
onpat ientsthatconcurr
entuseofal cohol;may
causeadi sulfi
ram-li
kereact
ion(abdomi nalcramps,
nausea,vomi ti
ng,headache,hypotension,palpi
tat
ions,
dyspnea,tachy car
dia,sweat
ing,f
lushing).Alcoholand
al
cohol-containingmedicati
onsshoul dbeav oided
duri
ngandf orseveraldaysaft
ertherapy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Cef
azol
i
n
I
NDI
CATI
ONS
Treatmentoft hef ol
l
owi nginfectionsduet osuscept i
ble
organisms: Ski
nandski nst ructurei nf
ect
ions(incl
uding
bur nwounds) ,
Pneumoni a,Uri
nar yt r
acti
nfecti
ons,Bil
iary
tracti
nfecti
ons, Genit
alinfecti
ons, Boneandjoint
i
nf ect
ions,Septicemia,Bacterialendocarditi
sprophy l
axis
fordentalandupperr espi r
atorypr ocedures.Peri
operativ
e
prophy l
axi
s.Notsui t
ablef orthet reatmentofmeni ngit
is.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 653
ACTI
ON
Bindstobact er
ialcellwal lmembr ane, causi ngcel ldeath.
Therapeuti
cEf f
ect s:Bact eri
cidalactionagai nst
susceptibl
ebact eri
a.Spect rum: Act i
veagai nstmanygr am
-posit
ivecocci i
ncl uding: Str
eptococcuspneumoni ae,
GroupAbet a-hemol yticst r
eptococci, Penicillinase-
producingst aphy l
ococci .Notact i
v eagai nst: Met hici
ll
i
n-
resi
stantstaphy lococci ,
Bact eroi
desf ragil
is, Enterococcus.
Activeagainstsomegr am- negativerodsi ncludi ng:
Proteusmi rabil
is,Escher ichiacoli
.

Av
ail
abi
l
ity
I
NJECTI
ON125,
250,
500mgand1g/
vial
.

DOSAGE
I
ntr
amuscul
arandi
ntr
avenousi
nject
ion
Adul
t-1t
o4gdai
l
yin2t
o3di
vi
deddoses.
Chi
l
d-50t
o100mg/
kgbodywei
ghtev
ery6h.

Cont
rai
ndi
cat
ions
Hyper
sensi
ti
vi
tyandcephal
ospor
in;
col
i
tis;
lact
ati
on;
pr
egnancy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 654
I
NTERACTI
ONS
Drug-
Drug:
Probeneci
d↓ excret
ionand↑ bl
oodl
evel
sof
renal
l
yexcret
edcephal
ospor
ins.

Pr
ecaut
ions
Renalfunct
ionimpair
mentov
ergr
owt
hofnon-
suscept
ibl
e
organi
sm; i
nter
acti
ons.

Adv
erseEf
fect
s
Eosi
nophi l
i
a;diarrhoea;f
ever;convul
sions; neut
ropeni
a,
anaphylaxi
s,phlebiti
s,or
alcandidi
asi
s, leucopenia;
tr
ansientri
seinSGOTandSGPTandal kali
nephosphatase.

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

Inst
ructpatienttonot i
fyheal
thcareprofessi
onali
f
rash,orf
ev eranddi arr
headevelop,especi
all
yif
diarr
heacont ai
nsbl ood,mucus,orpus.Adv i
se
pati
entnott otreatdiarr
heawithoutconsulti
ngheal
th
careprofessional.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 655
St
orage
Stor
eprotectedfrom li
ghtandmoi stur
eatatemperat
ure
notexceedi
ng30⁰ C.Theconstit
utedsoluti
onshoul
dbe
stor
edprotectedfrom l
ightandusedwi thi
n24hourswhen
stor
edatat emper at
urenotexceeding30⁰Corwit
hin4
dayswhenst oredbetween2t o8⁰C.

Cef
dini
r
I
NDI
CATI
ONS
Treat
mentoft hefol
lowinginfect
ionscausedby
susceptibl
eorganisms: Communi ty-
acqui r
edpneumoni a
(adul
tsonly),Acuteexacerbati
onsofchr oni
cbronchit
is
(adul
tsonly),Acutemaxi l
l
arysinusit
is,Pharyngit
isand
tonsi
ll
it
is,Uncompl i
catedskinandski nst r
uctur
e
i
nfecti
ons, Acutebacteri
aloti
tismedia( chil
drenonly
).

ACTI
ON
Bindstobacteri
alcellwallmembr ane,causi ngcell
death.
Therapeuti
cEf f
ects:Bacteri
cidalactionagai nst
suscepti
blebacteri
a.Spect r
um: Activeagai nstthe
foll
owinggram-positi
veor ganisms: Staphylococcus
aureus,St
reptococcuspneumoni ae,St r
eptococcus
pyogenes.Activeagainstthefoll
owi nggr am- negat
ive

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 656
organi sms: Haemophi l
usi nfl
uenzae(includingβ-
l
act amase- producingst rai
ns),
Haemophi lus
parainf l
uenzae(i
ncludingβ- l
actamase- produci ngstrains)
,
Mor axel l
acatarrhali
s(includi
ngβ- l
actamase- producing
strains).Notactiveagai nstmethici
ll
in-resistant
staphy lococciorenterococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dose↓
recommendedi fCCr<30mL/ mi n)
;Diabetes(suspension
containssucrose);Hi
stor
yofGIdi sease,especiall
ycolit
is;
Geri:Doseadjustmentduetoage- rel
ated↓ i nrenal
functi
onmaybenecessar y;
OB: Lactati
on: Pedi:Pregnancy,
l
actation,orchi
ldren<6mo( safetynotestablished).
Suspensi oncontai
nssodium benzoate,avoidusei n
neonat es.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES,headache.GI:PSEUDOMEMBRANOUS
COLI TI
S,diar
rhea,
vomi t
ing,abdominalpai
n,nausea.GU:
vaginalmonil
iasi
s,vagi
niti
s.Derm:rash,pr
uri
tus.Misc:
all
ergicreact
ionsi
ncludi
nganaphy l
axis.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 657
I
NTERACTI
ONS
Drug-
Dr ug:Ant
aci
dsandironsuppl
ements↓ absor
pti
on
(admini
steratl
east2hrbeforeor2hraf
ter
).Pr
obeneci
d
↓ excreti
onand↑ bloodlevel
s.

DOSAGE
PO:(
Adult
sandChi ldren≥13yr)
:300mgev er
y12hror
600mgever y24hr(twicedai
lydosi
ngmustbeusedfor
communit
y-acquir
edpneumoni aoruncompli
cat
edski
n
andski
nstructur
einfecti
ons)
.

Renal
Impai
rment
(Adult
sandChi
l
dren≥13y
r):
CCr<30mL/
min—300mg
every24hr
.
PO:( Chi
ldren6mo–12y r):
7mg/ kgevery12hror14
mg/ kgev ery24hr(nott
oexceed600mg/ day)
.Twice
dai
lydosi ngmustbeusedf oruncompl
icat
edskinandski
n
str
uct ur
ei nf
ecti
ons.

Renal
Impai
rment
(Chi
ldr
en6mo-
12y
r):
CCr<30mL/
min—7mg/
kgev
ery24
hr.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 658
Or
alsuspension(
str
awber
ryf
lav
or)125mg/
5mL,
250
mg/5mL; Capsul
es300mg;

PATI
ENTTEACHI
NG
Instructpati
enttotakemedi cati
onar oundt heclock
atev enlyspacedtimesandt ofi
nishthemedi cati
on
compl etelyasdi
rected,eveni ff
eeli
ngbet ter.Take
mi sseddosesassoonaspossi bleunlessal most
timef ornextdose;donotdoubl edoses.I nstruct
pat i
enttousecalibrat
edmeasur i
ngdev icewi th
suspensi on.Advi
sepatientthatsharingt his
medi cationmaybedanger ous.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

Instr
uctpat i
enttonoti
fyhealt
hcareprofessionali
f
feveranddi arr
headevelop,
especial
lyifdi
arrhea
containsblood,mucus,orpus.Adv i
sepatientnotto
treatdiarr
heawi t
houtconsul
tinghealt
hcar e
professional.

Cef
dit
oren
I
NDI
CATI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 659
Treatmentofthefol
lowinginfect
ionscausedby
suscepti
bleorgani
sms: Acuteexacerbat
ionsofchronic
bronchi
ti
s,Communi ty
-acquiredpneumonia,Phar
y ngi
ti
s
andtonsil
li
ti
s,Uncomplicat
edskinandski nstr
ucture
i
nfecti
ons.

ACTI
ON
Bindst obact eri
al cellwallmembr ane, causi ngcelldeat h.
Ther apeut i
cEf f
ect s: Bactericidal actionagai nst
suscept i
blebacter ia.Spect rum: Act i
v eagai nstthe
foll
owi nggr am-posi ti
veor gani sms: Staphy l
ococcus
aureus( met hi
cil
lin-suscept iblest rains, includingβ-
l
act amase- produci ngst r
ains), Strept ococcus
pneumoni ae(peni cill
in-
suscept iblest rainsonl y),
Streptococcuspy ogenes.Act iv eagai nstt hef oll
owing
gram- negat i
veor gani sms: Haemophi lusi nfluenzae
(i
ncludi ngβ- l
actamase- produci ngst rains), Haemophi lus
parainfluenzae(incl udingβ- lactamase- produci ngstrains),
Mor axel l
acat ar
rhal i
s(incl
udi ngβ- lactamase- producing
strains).

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushyper
sensi
ti
vi
tytopeni
cil
li
ns;Car
nit
inedefi
ciency
ori
nbornerr
orsofmetabol
i
sm resul
ti
nginsigni
fi
cant

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 660
car
nit
inedefi
ciency(producesrenalexcr
eti
onofcarnit
ine);
Mil
kprotei
nhyper sensi
ti
vit
y(contai
nssodium casei
nate).

UseCaut
iousl
yin:
Renal
impai
rment(
dosageadj
ust
ment
recommendedi fCCr<50mL/ min);
Geri:Doseadj
ust
ment
duetoage-rel
ateddecreasei
nr enalfuncti
onmaybe
necessary
;OB:Lactati
on:Pedi:Pregnancy,l
act
ati
onor
chil
dren<12yr(
safetynotestabli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( hi
ghdoses) ,headache.GI :
PSEUDOMEMBRANOUSCOLI TIS,diar
rhea,abdominalpai
n,
dyspepsia,nausea,vomiti
ng.GU: hemat uri
a, v
agi
nal
monili
asis.Hemat :bl
eeding,eosinophili
a,hemolyt
ic
anemi a,
lymphocy t
osis,
neut ropenia,t
hrombocy t
osis.
Misc:all
ergicreact
ionsincludinganaphy l
axis,
superinf
ection.

I
NTERACTI
ONS
Drug-Drug:Ant
acidsandhistamineH2r eceptor
antagonist
sdecreaseabsorption(
avoidconcurrentuse)
.
Probeneciddecreasesexcr
etionandincreasesblood
l
evels.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 661
PO: (
AdultsandChil
dren≥12y r):Acutebacterial
exacerbati
onofchronicbronchit
is,communi ty–acqui
red
pneumoni a-
400mgt wicedaily;
Phar yngi
ti
s/tonsil
li
ti
s,
uncompl i
catedski
n/skinstr
uctureinfect
ions-200mg
twicedail
y.

Renal
Impai
rment
PO:(
Adult
sandChildren≥12yr):
CCr30–49
mL/min—doseshouldnotexceed200mgtwicedai
l
y;CCr
<30mL/min—doseshouldnotexceed200mgoncedail
y.

AVAI
LABI
LITY
Tabl
ets200mg,
400mg;

PATI
ENTTEACHI
NG
Inst
ructpatienttotakemedicati
onar oundtheclock
atevenlyspacedt imesandt ofi
nishthemedi cati
on
completel
y,ev eniffeel
ingbett
er.Takemi sseddoses
assoonaspossi bleunlessi
tisalmosttimef ornext
dose;donotdoubl edoses.Adv i
sepat i
entthat
shari
ngoft hismedi cat
ionmaybedanger ous.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 662
 I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Inf
ormfemal
epati
ent
sthatcefdi
tor
encanbet
aken
concomit
ant
lywi
thor
alcont
racepti
ves.

Cef
epi
me
I
NDI
CATI
ONS
Treat
mentoft hefollowinginfect
ionscausedby
suscepti
bleor ganisms:Uncompl icatedski nandskin
str
uctureinfecti
ons, Boneandj ointinfect
ions,
Uncompl i
catedandcompl i
catedur i
nar yt
ractinf
ecti
ons,
Respir
atorytractinfecti
ons,Compl icatedintr
a-abdominal
i
nfecti
ons( withmet roni
dazole),Sept i
cemia.Empi r
ic
tr
eatmentoff ebril
eneut ropenicpatients.

ACTI
ON
Bindstot hebacterial
cellwallmembr ane,causingcel l
death.Ther apeut
icEffect
s: Bacter
ici
dalactionagainst
susceptiblebacteri
a.Spectrum: Si
milartothatofsecond-
andt hi
rd-generati
oncephal ospori
ns,butactiv
ityagainst
staphyl
ococci isless,whereasactivi
tyagainstgram-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 663
negat i
vepat hogensi sgreater ,
ev enf oror ganisms
resistanttofir
st-, second-,andt hird-gener at i
onagent s.
Not ableisincreasedact i
onagai nst:Ent erobact er,
Haemophi lusinfluenzae( includingβ- lactamase- producing
strains),Escheri
chi acoli,Klebsiellapneumoni ae, Neisseri
a,
Proteus, Provi
denci a,Pseudomonasaer ugi nosa,Serratia,
Mor axellacatarrhalis(i
ncludingβ- lactamase- producing
strains).Notactiv eagainstmet hicil
li
n- r
esi stant
staphy l
ococci orent erococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
↓ dosi
ng/
↑
dosingi nterv
al recommendedi fCCr≤60mL/ min);
Histor
y
ofGIdi sease, especial
l
ycol it
is;Pat
ient
swi t
hhepati
c
dysfunct i
onorpoornut rit
ionalstat
us(maybeat↑ r i
skof
bleeding);Geriatri
cpatients(doseadjustmentduetoage-
relat
ed↓ i nrenal f
unctionmaybenecessar y
);OB:
Lactation: Pr
egnancyandl actati
on(safet
ynot
established).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
SEI
ZURES(
highdosesi
npat
ient
swi
thr
enal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 664
i
mpai rment ),
encephalopat hy
, headache.GI :
PSEUDOMEMBRANOUSCOLI TIS,di
arrhea,nausea,
vomi t
ing.Derm: rashes,pruri
ti
s, ur
ti
caria.Hemat :bl
eedi
ng,
eosinophili
a,hemol yt
icanemi a,neutropenia,
thr
ombocy topenia.Local:
painatI M site,phl
ebiti
satIV
sit
e.Mi sc:all
ergicreact
ionsincludinganaphy laxi
s,
superinfect
ion,fever.

I
NTERACTI
ONS
Drug-
Drug:Pr
obenecid↓ excr
eti
onand↑ bloodlev
els.
Concurr
entuseofloopdiur
eti
csorami
nogly
cosidesmay
↑r i
skofnephrot
oxici
ty.

DOSAGE
IM:(Adult
s):
Mild-
to-
moderateuncompli
cat
edor
complicat
eduri
naryt
racti
nfect
ionsduetoEscher
ichi
a
col
i—0.5–1gevery12hr.
IV:(
Adults):Moder ate-
to-severepneumoni a—1–2gev er
y
12hr.Mild-t
o- moder ateuncompl icatedorcompl i
cated
uri
narytr
acti nfect
ions0. 5–1gev ery12hr .Sev er
e
uncomplicatedorcompl icatedurinarytractinfect
ions,
moderate-t
o-sev ereuncompl i
catedski nandski nstruct
ure
i
nfecti
ons,compl i
catedint r
a-abdomi nalinf
ections—2g
ever
y12hr .Empi r
ict r
eatmentoff ebri
l
eneut ropenia—2g

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 665
ev
ery8hr
.
IV:(Chi
ldren1mo–16y r)
:Uncompl i
catedandcompli
cat
ed
uri
narytractinf
ecti
ons, uncompl i
cat
edskinandskin
struct
ureinfect
ions,pneumoni a—50mg/ kgev er
y12hr
(nottoexceed2g/ dose).Febri
leneutr
openia—50mg/kg
every8hr( nottoexceed2g/ dose).
I
V:(Neonat
espost
nat
alage≥14day
s):
50mg/
kgev
ery12
hr
.
I
V:(Neonatespost
natal
age<14days)
:30mg/kgever
y12
hr
;consider50mg/kgever
y12hrf
orPseudomonas
i
nfect
ions.

Renal
Impai
rment
IM:IV:(
Adults):(
SeeManuf act
urer
'sspeci
fi
c
recommendat i
ons)CCr30–60mL/ min—0.5–1gever
y24
hror2gev ery12–24hr;CCr11–29mL/ mi
n—0.5–2g
every24hr;CCr<11mL/ min—250mg–1gev er
y24hr.

AVAI
LABI
LITY
Powderf
ori
nject
ion500mg,
1g,2g;
Premi
xedcont
ainer
s
1g/50mLD5W, 2g/100mLD5W;

PATI
ENTTEACHI
NG
Adv
isepat
ientt
orepor
tsi
gnsofsuper
inf
ect
ion(
fur
ry

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 666
 ov
ergrowthonthetongue,vaginal
itchi
ngor
di
scharge,
looseorfoul
-smell
ingstools)andal
l
ergy
.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Cef
ixi
me
I
ndi
cat
ions
Oti
tismedi a,respi
rat
orytr
actinfect
ions,uncompl
i
cat
ed
UTIs,effecti
veagainsti
nfecti
onscausedby
Ent
er obacteri
aceae,H.inf
luenzaspecies.

ACTI
ON
Bindstothebact er ialcellwal
lmembr ane,causi ngcel l
death.TherapeuticEf f
ects:Bacteri
cidalactionagai nst
suscepti
blebact eria.Spect r
um: Si
mi lartothatofsecond-
generati
oncephal ospor i
ns,butacti
vityagai nst
staphyl
ococci i
sl ess, whileacti
vit
yagai nstgr am- negati
v e
pathogensisgr eat er,evenfororganismsr esi stanttofirst
-
andsecond- gener ationagents.Notabl eisincr eased
acti
onagainst :
Ent erobacter,
Haemophi l
usi nfluenzae,
Escheri
chiacoli,Kl ebsiell
apneumoni ae, Neisser i
a,Proteus,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 667
Provi
denci
a,Ser
rat
ia,
Mor
axel
l
acat
arr
hal
i
s,Bor
rel
i
a
burgdor
fer
i.

Av
ail
abi
l
ity
TABLETS50,100,
200and400mg;
CAPSULES100and
200mg;SyRUP/SUSPENSI
ON50mg/5ml,
100mg/5ml.

DOSAGE
Adult
-200-
400mg/
dayasasi
ngl
edoseori
ntwodi
vi
ded
doses.
Chi
ld-(
mor et
han6months)8mg/
kg/
dayasasi
ngl
edose
ort
wodi v
ideddoses.
Uncompl
i
cat
edgonor
rhea:
Adul
t-400mgasasi
ngl
edose.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins.

I
NTERACTI
ONS
Drug-Drug:Pr obeneciddecreasesexcret
ionandincr
eases
serum levels.Concur r
entuseoflargedosesof
cephalospor i
nsandNSAI Dsmay↑ t heri
skofbleeding.
Concur r
entuseofl oopdiureti
csornephrot
oxicagents
i
ncludingami nogl
ycosidesmay↑ r iskofnephrot
oxicit
y.
May↑ car bamazepi nelevels.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 668
Pr
ecaut
ions
Hi
stor
yofal
l
ergyt
openi
cil
l
ins,
renal
fai
l
ureorpati
ent
sunder
goi
ngcont
inuousambul
ator
y
peri
toneal
di
aly
sis(
CAPD)andhemodi al
ysi
s(HD),gast
roi
ntest
inal
di
sease,
pregnancyl
act
ati
on,i
nter
act
ions.

Adv
erseEf
fect
s
Di
arrhoea,pseudomembr anouscoli
ti
s,l
ooseorf
requent
st
ools,abdominalpai
n,nausea,dyspepsi
a;
hypersensi
ti
vi
tyreact
ions.

PATI
ENTTEACHI
NG
Inst
ructpatienttot akemedicati
onatev enl
yspaced
timesandt of i
nisht hemedicati
oncompl et
ely
, ev
eni
f
feel
ingbet t
er.Mi sseddosesshoul dbetakenassoon
aspossi bl
eunlessal mostti
mef ornextdose;donot
doubl edoses.Adv isepati
entthatshari
ngofthis
medi cati
onmaybedanger ous.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 669
 I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

St
orage
Stor
eprotect
edfr
om l
i
ghtandmoi
stur
eatat
emper
atur
e
notexceedi
ng30⁰
C.

CEFMETAZOLE
I
NDI
CATI
ONS
Tr
eatmentof :Respirat
oryt
ractinf
ecti
ons,Ski
nandski
n
st
ruct
ureinfections,Uri
nar
ytractandgynecol
ogi
c
i
nfect
ions.Perioperati
vepr
ophy l
axi
s.

ACTI
ON
Bindstobact eri
alcellwallmembr ane,causi ngcell
death.
TherapeuticEffects:Bacteri
cidalactionagai nst
suscepti
blebact eri
a.Spectrum: Simi l
art othatoffi
rst-
generati
oncephal osporinsbuthasi ncreasedact i
vi
ty
againstseveralothergram- negati
v epat hogensincludi
ng:
Haemophi lusinfl
uenzae, Escheri
chi acol i
,Klebsi
ell
a
pneumoni ae,Neisseriagonor r
hoeae( i
ncluding

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 670
penici
ll
inase-
produci
ngst r
ains),
Prot
eus,Moraxell
a
catarr
hali
s.Notactiv
eagai nstmethi
cil
l
in-
resi
stant
staphyl
ococciorenterococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dosage
reduction/i
ncreaseddosi ngi ntervalr
ecommendedi fCCr
≤90mL/ min);
Ger i
atr
ic,debili
tated,oremaci at
edpatient
s
(mayneedsuppl emental v
itami nKt opreventbleedi
ng);
HistoryofGIdi sease,especi all
ycolit
is;Somepr oducts
containaspartameandshoul dbeav oidedinpatient
swith
pheny l
ketonuri
a; Geri
atricpat i
ents(dosageadj ustment
duet oage-rel
at eddecreasei nr enalfuncti
onmaybe
necessar y
);Pregnancyandl actation(hasbeenused
safely)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( hi
ghdoses) .GI:
PSEUDOMEMBRANOUS
COLITI S,di
arr
hea,nausea,vomiti
ng,cramps.Derm: r
ashes,
urt
icaria.Hemat:bleedi
ng,blooddyscrasi
as,hemolyti
c
anemi a.Local
:phlebit
isatI
Vsi t
e.Misc:all
ergicr
eacti
ons
i
ncludinganaphy l
axisandser um si
ckness,super
inf
ecti
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 671
I
NTERACTI
ONS
Drug-Drug:Probeneciddecr easesexcreti
onandi ncr
eases
bl
oodl evel
s.Ifalcohol i
si ngestedwithin48–72hr ,a
di
sulfi
ram-li
ker eacti
onmayoccur .Maypot enti
atethe
eff
ectsofant i
coagulant sandi ncreasetheriskofbleedi
ng
withantipl
atel
etagent s,t
hr ombolyti
c
agents,
NSAI Ds,pl
icamy cin,orv al
proi
cacid.

DOSAGE
I
V:(
Adul
ts)
:1–2gq6–12hr
.

Renal
Impai
rment
I
V:(Adult
s):CCr50–90mL/mi
n—1–2gq12hr ;
CCr
30–49mL/ min—1–2gq16hr;
CCr10–29mL/min—1–2g
q24hr;CCr<10mL/ mi
n—1–2gq48hr(af
ter
hemodial
ysi
s).

AVAI
LABI
LITY
Powderf
ori
nject
ion1g,
2g;

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 672
 Cauti
onpat ientsthatconcurr
entuseofal cohol may
causeadi sulfi
ram-li
kereact
ion(abdomi nalcramps,
nausea,vomi ti
ng,headache,hypotension,palpi
tat
ions,
dyspnea,tachy car
dia,sweat
ing,f
lushing).Alcoholand
al
cohol-containingmedicati
onsshoul dbeav oided
duri
ngandf orseveraldaysaft
ertherapy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

CEFONI
CID
I
NDI
CATI
ONS
Treatmentof :Respi
rat
orytr
actinfections,Ski
nandskin
struct
ureinfecti
ons,Boneandjointinfecti
ons,Ur
inar
y
tr
actandgy necologicinf
ect
ion,Septicemia.Peri
oper
ati
ve
prophylaxi
s.

ACTI
ON
Bindstobacter
ialcellwal
lmembr ane,causingcel
ldeath.
Therapeuti
cEffect
s:Bacteri
cidalactionagainst
suscepti
blebacter
ia.Spect
rum: Simi l
artothatoffi
rst
-
generat
ioncephalospori
nsbuthasi ncreasedacti
vi
ty

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 673
againstseveralothergram- negat i
vepat hogensi ncl
udi
ng:
Haemophi lusinfl
uenzae,Escher i
chiacol i
,Kl
ebsi el
la
pneumoni ae,Neisseri
agonor rhoeae( i
ncluding
penici
ll
inase-produci
ngst r
ai ns),Proteus,Mor axell
a
catarr
hali
s.Notact iv
eagai nstmet hi
cill
i
n-resistant
staphyl
ococci orenterococci .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dosage
reduction/i
ncreaseddosinginter
valrecommendedi fCCr
<80mL/ min;HistoryofGIdi
sease,especial
l
ycolit
is;
Geriatri
cpatients(dosageadjust
mentduet oage-rel
ated
decreaseinr enalfunct
ionmaybenecessar y);
Pregnancy
andl actat
ion(hasbeenusedsaf ely
).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( highdoses) .GI
:PSEUDOMEMBRANOUS
COLITI S,diarr
hea,nausea, vomiti
ng,cramps.Derm:rashes,
urt
icaria.Hemat :bleeding,blooddyscrasi
as,hemoly
tic
anemi a.Local:painatIM site,phl
ebiti
satIVsite.Mi
sc:
al
lergi
cr eact i
onsincludinganaphylaxi
sandser um
si
ckness, superi
nfecti
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 674
I
NTERACTI
ONS
Dr
ug-Drug:
Probeneci
ddecr
easesexcr
eti
onandi
ncr
eases
bl
oodlevel
s.

DOSAGE
IM:I
V: (
Adults):Mosti
nfecti
ons—0.
5–1gq24hr
.Sev
ere
andli
fe-t
hreateni
nginf
ecti
ons—2gq24hr.

Renal
Impai
rment
I
M: I
V:(Adul
ts):CCr60–79mL/ mi
n—10–25mg/ kgq24
hr
;CCr40–59mL/ min—8–20mg/ kgq24hr;CCr20–39
mL/min—4–15mg/ kgq24hr ;
CCr10–19mL/ min—4–15
mg/kgq48hr ;CCr5–9mL/ mi
n—4–15mg/ kgq3–5days;
CCr<5mL/ min—3–4mg/ kgq3–5days.

AVAI
LABI
LITY
Powderf
ori
nject
ion500mg,
1g,
10g;

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 675
 feveranddiarr
headevel
op,especial
lyi
fstoolcontai
ns
blood,pus,
ormucus.Adv i
sepatientnott
ot r
eat
diarr
heawithoutconsul
ti
nghealt
hcar epr
ofessional
.

Cef
oper
azone
I
NDI
CATI
ONS
Treatmentoft hef oll
owinginfecti
onscausedby
susceptibleor ganisms:Ski nandskinstr
uct ureinf
ecti
ons,
Urinar
ytr actinfections,
Gy necologi
cali
nfect i
onsincl
uding
gonorrhea, Respi r
atorytracti
nfecti
ons,I
ntra-abdominal
i
nfecti
ons, Septicemia.

ACTI
ON
Bindstot hebact er ialcellwallmembr ane, causingcel l
death.Ther apeuticEf f
ects:Bact eri
cidalact i
onagai nst
suscept i
blebact eria.Spect r
um: Si
mi lartot hatofsecond-
generationcephal ospor i
ns,butact ivi
tyagai nst
staphylococci i
sl ess, whileact i
vit
yagai nstgr am- negati
ve
pathogensi sgr eat er,evenforor ganismsr esistanttofir
st-
andsecond- gener ationagent s.Not ableisincr eased
acti
onagai nst :
Ci trobacter,Ent er
obact er,Haemophi lus
i
nf l
uenzae, Escher ichiacoli,Klebsiell
apneumoni ae,
Mor ganell
amor gani i
,Neisseriagonor rhoeae, Proteus,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 676
Prov
idenci
a,Pseudomonasaer uginosa,
Serr
ati
a.Has
someactiv
ityagainstenterococci
.Hassomeact i
vi
ty
agai
nstanaerobes,incl
udingBacteroi
desfr
agil
i
s.

I
NTERACTI
ONS
Drug-Dr ug:I
ngest
ionofalcohol wi
thin48–72hrof
cefoper azonemayr esul
tinadisulf
iram- l
i
ker eacti
on.May
potentiatetheeff
ectsofanticoagulantsand↑ r iskof
bleeding.Concurrentuseofloopdiureticsor
ami noglycosi
desmay↑ r i
skofnephr otoxici
ty.

DOSAGE
I
M:IV:(Adul
ts):
Mil
dt omoder
atei
nfect
ions—1–2gever
y
12hr.Sever
einf
ect
ions—2–4gq8hror1. 5–3gev
ery6hr.

Hepat
icI
mpai
rment
IV:(
Adult
s):I
mpairedhepat
icfuncti
on/bi
l
iar
y
obstr
ucti
on—dail
ydoseshouldnotexceed4g;combi
ned
hepati
candrenali
mpairment
—dai l
ydoseshoul
dnot
exceed1–2g.

AVAI
LABI
LITY
Powderf
orinj
ect
ion1g,
2g,
10g;
Premi
xedcont
ainer
s1
g/50mL,2g/50mL;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 677
Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
ty,
int
eract
ions

Adv
erseEf
fect
s
Anaphyl
axis,
fev
er,ski
nrashes;nephri
ti
s;
gr
anulocyt
openi
a,andhemol y
ticanaemia,
hypopr
othrombi
naemiaandbl eedi
ngdisor
der
s.

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

Cautionpatientsthatconcurrentuseofal cohol with

cefoperazonemaycauseadi sulf
ir
am- l
iker eact i
on
(abdomi nalcr
amps, nausea, vomit
ing,headache,
hypotension,palpi
tati
ons,dyspnea,tachy cardia,
sweat i
ng,fl
ushing).Alcoholandalcohol-cont aini
ng
medicationsshoul dbeav oi
deddur i
ngandf orsev er
al
daysaf t
ertherapy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 678
CEFOTETAN
I
NDI
CATI
ONS
Treatmentoft hefol
lowi
nginfecti
onscausedby
suscepti
bleorganisms:Lowerrespir
ator
ytractinf
ecti
ons,
Skinandski nstr
ucturei
nfecti
ons,Boneandjoint
i
nfecti
ons, Uri
narytr
acti
nfecti
ons,Gynecol
ogical
i
nfecti
ons, I
ntra-
abdominalinf
ecti
ons.Peri
operati
ve
prophyl
axis.

ACTI
ON
Bindstobact er i
al cellwal lmembr ane,causi ngcelldeath.
TherapeuticEf fect s:Bact eri
cidal act i
onagai nst
susceptibl
ebact er i
a.Spect r
um: Simi l
art othatoffirst-
generati
oncephal ospor insbuthasi ncreasedact ivi
ty
againstseveral ot hergr am- negat i
v epat hogensincl udi
ng:
Haemophi lusi nfluenzae( i
ncludingβ- l
actamase- producing
strai
ns),Escher ichiacol i,Klebsiellapneumoni ae,
Mor ganell
amor gani i,Nei sseri
agonor r
hoeae, Proteus,
Providenci
a, Ser ratiamar cescens, Moraxellacatarrhali
s.
Alsohasact ivityagai nstBact eroidesf ragil
is.Notact iv
e
againstmet hicil
lin-resistantst aphy lococciorent erococci
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 679
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dosage↓/
↑
dosingi nterv
al recommendedi fCCr≤30mL/ min);
Hist
ory
ofGIdi sease, especiall
ycol i
ti
s; Patientswit
hhepati
c
dysfunct i
on,poornut ri
ti
onalstat e,orcancer(maybeat↑
ri
skofbl eedi
ng) ;Geri:Dosageadj ustmentduetoage-
rel
ated↓ i nrenal functi
onmaybenecessar y
;al
somaybe
at↑ riskofbl eedi ng;OB: Lactation: Hasbeenusedsaf
ely
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( hi
ghdoses) .GI:PSEUDOMEMBRANOUS
COLI TIS,di
arrhea,nausea.Derm: rashes,
urti
cari
a.Hemat
:
bleeding,eosinophil
ia,hemolyti
canemi a,l
eukopeni
a,
thrombocy topenia.Local:pai
natI M si
te,
phlebi
ti
satIV
site.Misc:all
ergicreacti
onsincludinganaphyl
axis,
super i
nfect
ion.

I
NTERACTI
ONS
Drug-
Dr ug:Pr
obenecid↓ excret
ionand↑ bloodl evel
s.I
f
al
cohol isi
ngestedwithi
n48–72hrofcef ot
etan,a
di
sulf
iram-li
kereacti
onmayoccur .Maypotentiat
et he
ef
fectsofanticoagul
antsand↑ t her
iskofbleeding.
Concurrentuseofami nogl
ycosi
desmay↑ t her i
skof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 680
nephr
otoxi
cit
y.

DOSAGE
IM:IV:(
Adul ts):Mosti nfecti
ons—1–2gev ery12hr.
Severe/
li
fe-threateninginfecti
ons—2–3gev ery12hr.
Uri
narytractinfections—500mg–2gev er
y12hror1–2g
every24hr .Perioperati
vepr ophyl
axi
s—1–2g30–60mi n
beforei
niti
al i
ncision(one-ti
medose) .

Renal
Impai
rment
IM:I
V:(Adult
s):
CCr10–30mL/ min—Usual
adultdose
ever
y24hror½usualadultdoseever
y12hr;<CCr10
mL/min—Usualadul
tdoseevery48hror1/4usualadul
t
doseevery12hr
.

AVAI
LABI
LITY
Powderfori
nject
ion1g/
vial
,2g/
vial
,10g/
vial
;Pr
emi
xed
cont
ainer
s1g/ 50mL,2g/50mL;

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

Caut
ionpat
ient
sthatconcur
rentuseofal
cohol
and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 681
 cefotet
anmaycauseadi sulfi
ram-l
ikereact i
on
(abdomi nalcr
amps, nausea, v
omiting,headache,
hypotension,palpi
tati
ons, dyspnea,tachy car
dia,
sweat i
ng,fl
ushing).Alcohol andalcohol-containi
ng
medicationsshouldbeav oideddur i
ngandf orsever
al
daysaf t
ertherapy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Cef
otaxi
me
I
ndi
cat
ions
Inf
ecti
onsduet osensi t
iveGr am posi t
iveandGr am
negati
vebact eri
asuchasbact eraemi a,cel
lul
ites,int
ra-
abdominalinfections,gonor rhoea, boneorj ointinfecti
ons,
ski
nandski nst ructureinfections, uri
narytractinfecti
ons,
septi
caemias, surgicalprophy laxis,endomet ri
tis,l
ife
thr
eateni
ngr esistant/hospital acquiredinfections,
i
nfecti
onsini mmuno- compr omi sedpat i
ents,
Haemophilusepi glotti
ti
sandmeni ngiti
s.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 682
Bindst othebact er ialcell wal lmembr ane, causingcell
deat h.Ther apeut icEf f
ect s: Bact eri
cidal actionagainst
suscept i
blebact eria.Spect rum: Similartot hatofsecond-
gener ationcephal ospor ins, butact ivi
tyagai nst
staphy l
ococci i
sl ess, wher easact i
vit
yagai nstgram-
negat ivepat hogensi sgr eat er ,
ev enforor ganisms
resistantt of i
rst-andsecond- gener ati
onagent s.Notable
i
si ncr easedact i
onagai nst :Aci netobact er,Cit
robacter,
Enter obact er,Haemophi l
usi nfluenzae( i
ncludingβ-
l
act amase- produci ngst rains) ,Haemophi l
us
parainf l
uenzae, Escher ichiacol i
,Klebsiellapneumoni ae,
Mor ganel lamor gani i
,Nei sser iagonor rhoeaeand
meni ngi t
idis,Prot eus, Pr ov i
denci a,Ser rati
a, Moraxell
a
catar rhali
s, Borreliabur gdor feri.Hassomeact i
vit
yagainst
anaer obes, i
ncludi ngBact eroi desf r
agi l
i
s.Notact i
ve
againstmet hici
lli
n- resistantst aphy l
ococci .

Av
ail
abi
l
ity
I
NJECTI
ON125,
250,
500mg,
and1g/
vial
.

DOSAGE
Suscept
ibl
einfect
ions:1–2gbyi
.vori
.mi
nject
ion,
8–12
hourl
y.Max.-
12g/day .
Chi
l
d-50-
100mg/
kg/
day
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 683
Surgi
calprophyl
axis:1gbyi
.vori
.mi
nject
ion,
30-
90
minutesbeforeprocedur
e.
Gonor
rhoea:
0.5–1gbyi
.mi
nject
ion,
asasi
ngl
edose.
Sept
icaemi
a,meni
ngi
ti
s:
Adul
t-2gi
.v,
6- 8hourl
yfor14-
28days.Neonates-50
mg/kgdai
lyin2–4di vi
deddosesmaybeincreasedto
150–200mg/ kgdail
yinsever
einf
ecti
ons.
Chi
l
d-100–150mg/kgdai
lyi
n2–4divi
deddoses
i
ncr
easedupto200mg/kgdail
yinv
erysev
ereinf
ect
ions

Cont
rai
ndi
cat
ions
Renal
diseasehy
per
sensi
ti
vi
tyt
ocephal
ospor
ins.

I
NTERACTI
ONS
Drug-Drug:
Probenecid↓ excret
ionandincr
easesser
um
l
evels.Concurrentuseofaminogly
cosi
desmay↑ r i
skof
nephrotoxi
cit
y.

Pr
ecaut
ions
Impair
edki
dneyorl
i
verdi
sease,col
it
is;
hist
oryofpeni
cil
l
in
all
ergy
;pr
egnancyl
act
ati
on;di
abetes.

Adv
erseEf
fect
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 684
Localinflammat ionorpai natinjecti
onsi t
e;
thr
ombocy t
openia,eosinophil
ia,leukopenia;
pseudomembr anouscol i
ti
s,moni li
asis,di
ar r
hoea,
candi
di asis,decreasedurinati
on; seizur
es, headache,
nauseaandv omiti
ng;jaundice;Steven’sJohnson
syndrome.

PATI
ENT TEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

St
orage
Storepr
otect
edf
rom l
i
ghtatat
emper
atur
enotexceedi
ng
30⁰C.

CEFOXI
TIN
I
NDI
CATI
ONS
Tr
eat
mentoft
hef
oll
owi
ngi
nfect
ionscausedby

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 685
susceptibl
eorgani sms:Lowerrespir
atoryt
ractinf
ect
ions,
Skinandski nstructurei
nfecti
ons,Boneandjoint
i
nfections,Uri
naryt r
acti
nfecti
ons,Gynecol
ogical
i
nfections,I
ntra-
abdomi nalinf
ecti
ons,Sept
icemia.
Perioperat
iveprophy l
axi
s.

ACTI
ON
Bindstobact eri
alcel lwallmembr ane,causi ngcelldeath.
Therapeut i
cEf fects:Bact eri
cidalactionagai nst
suscept i
blebact eria.Spect r
um: Simi l
art othatoff i
rst-
generationcephal ospor insbuthasi ncreasedact i
vi
ty
againstsev eralothergr am- negativepat hogensi ncludi
ng:
Haemophi l
usi nfl
uenzae, Escherichiacol i
,Klebsiel
la
pneumoni ae, Mor ganel l
amor ganii
,Neisser i
agonor rhoeae
(i
ncludingpeni cil
li
nase- producingst rai
ns) ,Proteus,
Providencia,Mor axel l
acat arr
halis.Alsoact iveagainst
Bacteroidesf ragil
is.Notact iveagainstmet hici
lli
n-
resi
stantst aphy l
ococci orent erococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dose↓/
↑ dosi
ng
i
nter
val
recommendedi
fCCr≤50mL/
min;
Hist
oryofGI

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 686
di
sease,especi
all
ycol
iti
s;Geri
:Doseadj
ust
mentduet
o
age-
rel
ated↓ inrenal
functi
onmaybenecessar
y;OB:
Lact
ati
on:Hasbeenusedsaf el
y.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( hi
ghdoses) .GI:PSEUDOMEMBRANOUS
COLITIS,diar
rhea,nausea, vomi t
ing.Derm:rashes,
urt
icari
a.Hemat :bleeding,eosinophili
a,hemolyt
icanemi
a,
l
eukopeni a,t
hrombocy topenia.Local :
painatIM sit
e,
phl
ebiti
satI Vsit
e.Mi sc:all
er gi
cr eact
ionsi
ncluding
anaphylaxis,
superinfecti
on.

I
NTERACTI
ONS
Drug-Drug:Pr
obeneci
d↓ excret
ionand↑ bloodl
evels.
Concurrentuseofaminogl
ycosi
desmay↑ r i
skof
nephrotoxi
cit
y.Mayenhancetheant
icoagul
antef
fectof
warfari
n.

DOSAGE
I
M: IV: (Adult
s) :Mosti nfecti
ons—1gev er
y6–8hr .Severe
i
nfections—1gev ery4hror2gev ery6–8hr.Lif
e-
thr
eat eninginfecti
ons—2gev er
y4hror3gev er
y6
hr.
Per ioperat
ivepr ophylaxis—2g30–60mi nbeforeini
tial
i
ncision, t
hen2gev ery6hrf orupto24hr.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 687
I
M: I
V:(Chil
drenandInfants>1mo) :Mil
dtomoderate
i
nfect
ions—180–100mg/ kg/daydiv
idedever
y6hr.Sever
e
i
nfect
ions—100–160mg/ kg/daydiv
idedever
y4–6hr s
(
maximum: 12g/day)Peri
operati
veprophy
laxi
s—30–40
mg/kgwi t
hin60mi nofinci
sion,t
hen30–40mg/ kgevery
6hrforupto24hr .
I
M:I
V:(
Neonat
es)
:90–100mg/
kg/
daydi
vi
dedev
ery8hr
.

Renal
Impai
rment
I
M: I
V:(
Adul
ts):CCr30–50mL/ min—Admi nisterev
ery
8–12hr
;CCr10–29mL/ min—Admi ni
sterevery12–24hr;
CCr<10mL/min—Admi ni
sterev
ery24–48hr .

AVAI
LABI
LITY
Powderfori
nject
ion1g/
vial
,2g/vi
al,
10g/
vial
;Pr
emi
xed
cont
ainer
s1g/ 50mLD5W, 2g/50mLD5W;

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst r
uctpati
enttonot
ifyhealthcareprofessi
onali
f
feveranddiar
rheadevelop,especial
lyi
fstoolcont
ains
blood,pus,
ormucus.Adv isepatientnottotr
eat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 688
 di
arr
heawi
thoutconsul
ti
ngheal
thcar
epr
ofessi
onal
.

CEFPODOXI
ME
I
NDI
CATI
ONS
Treat
mentoft hefollowinginfecti
onscausedby
suscept
ibleorganisms:Skinandski nstr
uctur
einfecti
ons,
Uncomplicateduri
nar yt
ractinfecti
ons,
Uncomplicated
gynecol
ogicalinf
ectionsincludi
nggonorrhea,
Respirator
y
tr
actinf
ections,Otit
ismedia.

ACTI
ON
Bindst othebact eri
al cellwallmembr ane, causi ngcel l
deat h.Ther apeuticEffect s:Bacteri
cidalact ionagai nst
suscept i
blebacteria.Spect rum: Similartot hatofsecond-
gener ationcephal ospor ins,butactivi
tyagai nst
staphy l
ococci i
sless, wher easact i
vit
yagai nstgr am-
negat ivepat hogensi sgr eater,
ev enforor gani sms
resistantt ofir
st-andsecond- gener ati
onagent s.Not abl
e
i
si ncr easedact i
onagai nst:Haemophi l
usi nf l
uenzae
(i
ncl udingβ- l
actamase- producingst r
ains),Escher i
chi acol
i
,
Klebsi ell
apneumoni ae, Neisseriagonor r
hoeae, Proteus.
Notact iveagainstmet hicil
l
in-r
esistantstaphy l
ococci or
enter ococci.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 689
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins;
Lact
ati
on:
Lact
ati
on.

UseCaut
iousl
yin:
Renal
impai
rment(
↑ dosi
ngi
nter
val
recommendedifCCr<30mL/ mi n)
;Histor
yofGIdisease,
especial
l
ycoli
ti
s;Ger
i:Doseadjustmentduetoage-rel
ated
↓i nrenalf
uncti
onmaybenecessar y;OB:Pedi
:
Pregnancyandinf
ant
s<2mo( safetynotest
abl
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( veryhighdoses) ,
headache.GI :
PSEUDOMEMBRANOUSCOLI TIS,di
arrhea,abdomi nalpain,
nausea, vomi ti
ng.Derm: rashes,urt
icari
a.GU:vaginal
monili
asi s.Hemat :bleeding,bl
ooddy scrasi
as,hemol yti
c
anemi a.Mi sc:all
ergi
cr eacti
onsincludi
nganaphy laxis,
superinfection.

I
NTERACTI
ONS
Drug-Drug:Probenecid↓ excreti
onandincr
easesblood
l
evels.Concurr entuseofloopdiur
eti
csornephrot
oxic
agentsincl
udingami nogly
cosi
desmay↑ r i
skof
nephrotoxi
city.Antacidsorhi
stamineH2receptor
antagonist
s↓ absor pti
onofcefpodoxi
me(take2hr
beforeorafter).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 690
DOSAGE
PO:(Adul
tsandChi
ldren≥12yr):Mostinf
ections—200mg
ever
y12hr;Ski
nandskinstruct
ureinfect
ions—400mg
ever
y12hr;Uri
nar
ytracti
nfecti
ons/phary
ngitis—100mg
ever
y12hr;Gonor
rhea—200mgsi ngl
edose.
PO:(Chil
dren2mo–12y r)
:Phar
yngi
ti
s/tonsi
l
li
tis/
oti
ti
s
media/acutemaxi
l
larysi
nusi
ti
s—5mg/ kgevery12hr(not
toexceed200mg/ dose)
.

Renal
Impai
rment
PO:(Adul
ts)
:CCr<30mL/
min—I
ncr
easedosi
ngi
nter
val
to
ever
y24hr.

AVAI
LABI
LITY
Tablet
s100mg,200mg;Oralsuspensi
on(
lemoncr
eme
fl
avor)50mg/
5mL, 100mg/5mL;

PATI
ENTTEACHI
NG
I
nstructpat
ienttotakemedicati
onatevenl
yspaced
ti
mesandt of i
nishthemedicati
oncomplet
ely,
eveni
f
feel
i
ngbet t
er.Takemi sseddosesassoonas
possibl
eunlessalmostt i
mefornextdose;
donot
doubledoses.Instr
uctpati
enttousecal
ibr
ated
measuringdevicewithsuspensi
on.Advi
sepati
ent

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 691
 t
hatshar
ingoft
hismedi
cat
ionmaybedanger
ous.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

CEFPROZI
L
I
NDI
CATI
ONS
Treat
mentoft hef
oll
owinginf
ecti
onscausedby
suscept
ibleor
gani
sms: Respi
rat
orytr
acti
nfect
ions,
Uncomplicat
edskinandskinstr
uctur
einf
ecti
ons,Oti
ti
s
media.

ACTI
ON
Bindstobacteri
alcellwallmembr ane, causingcel
l death.
Therapeuti
cEffects:Bacteri
cidalactionagai nst
suscepti
blebacteri
a.Spect r
um: Simi l
art othatoffi
rst-
generati
oncephalosporinsbuthasi ncreasedact i
vi
t y
againstsever
alothergram- negati
v epat hogensincluding:
Haemophi l
usinfl
uenzae( incl
udingβ- lactamase-producing

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 692
st
rains)
,Proteus,Moraxell
acatarr
hali
s(includingβ-
l
actamase-producingstrai
ns).Notact
iveagai nst
methici
l
li
n-resi
stantstaphyl
ococciorenterococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dosager
educt
ion
recommendedi fCCr<30mL/ min);Hist
oryofGIdi sease,
especi all
ycoli
ti
s;Suspensioncontai
nsaspar t
ameand
shoul dbeav oi
dedi npati
entswit
hpheny lket
onuria;
Geriatricpati
ents(dosageadjust
mentduet oage-relat
ed
decreasei nrenalfunct
ionmaybenecessar y)
;Pregnancy
andl actati
on(hasbeenusedsaf ely).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( veryhighdoses) ,
dizziness.GI:
PSEUDOMEMBRANOUSCOLI TIS,abdomi nalpain,di
arr
hea,
nausea,v omiti
ng.Der m:rashes,urt
icari
a.GU: vagini
ti
s.
Hemat :eosinophil
ia,hemolyti
canemi a, l
eukopenia.Misc:
al
ler
gicr eacti
onsincludinganaphy l
axis,superi
nfecti
on.

I
NTERACTI
ONS
Dr
ug-
Drug:
Probeneci
ddecr
easesexcr
eti
onandi
ncr
eases

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 693
bl
oodl ev
els.Concurr
entuseofami
nogl
ycosi
desmay
i
ncreaseriskofnephrot
oxici
ty.

DOSAGE
PO:(Adult
sandChil
dren≥13yr)
:Most
i
nfecti
ons—250–500mgev er
y12hror500mgev
ery24hr
.
PO:(Chi
ldr
en6mo–12y r)
: Oti
ti
smedi a—15mg/ kgever
y
12hr;Acut
esinusit
is—7.
5–15mg/ kgevery12hr( hi
gher
dosetobeusedf ormoderate-
to-sev
ereinfect
ions).
PO:(Chi
l
dren2–12yr
):Phar
yngi
tis/
tonsi
l
li
ti
s—7.5mg/
kg
ever
y12hr;Ski
nandskinst
ruct
ureinf
ecti
ons—20mg/kg
ever
y24hr.

Renal
Impai
rment
(Adul
tsandChi
ldr
en≥6mo) :CCr<30mL/
min-
½ofusual
doseatnormal
dosingi
nter
val.

AVAI
LABI
LITY
Tablet
s250mg,500mg;Or
alsuspensi
on(
bubbl
egum
fl
avor)125mg/
5mL,250mg/5mL;

PATI
ENTTEACHI
NG
Inst
ructpati
enttot
akemedi
cat
ionar
oundt
heclock
atevenlyspacedti
mesandt
ofi
nisht
hemedicat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 694
 completely,eveniffeel
i
ngbet t
er.Misseddoses
shouldbet akenassoonaspossi bl
eunlessalmost
ti
mef ornextdose; donotdoubledoses.Instr
uct
pati
enttousecal ibr
atedmeasur i
ngdev i
cewith
suspension.Adv i
sepatientt
hatsharingofthi
s
medicati
onmaybedanger ous.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

CEFTAROLI
NE
I
NDI
CATI
ONS
Treat
mentofacutebact
eri
alski
n/ski
nst
ruct
urei
nfect
ions
andcommunity-
acqui
redpneumonia.

ACTI
ON
Bindstobacter
ialcellwal
lmembr ane,causi
ngcell
death.
Therapeuti
cEffect
s:Bacteri
cidalacti
onagainst
suscepti
blebacter
ia.Spect
rum: Treatmentofskin/ski
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 695
struct
ureinfecti
ons—Act iv
eagai nstSt aphyl
ococcus
aureus( i
ncl
udingmet hi
cil
l
in-
suscept ibleand–r esistant
strai
ns),Str
eptococcuspy ogenes, Streptococcus
agalacti
ae,Escher i
chiacoli
,Klebsiell
apneumoni ae, and
Klebsiel
laoxytoca; Tr
eatmentofcommuni tyacqui red
pneumoni a—Streptococcuspneumoni ae(i
ncludi
ng
pneumoni awi t
hbact eremia)
,Staphy lococcus
aureus(methici
ll
in-suscepti
blestrainsonly),Haemophi lus
i
nf l
uenzae,Klebsiell
apneumoni ae, Kl
ebsiell
aoxy toca, and
Escher i
chi
acol i
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Knownser
ioushy
per
sensi
ti
vi
tyt
o
cephal
ospor
ins.

UseCaut
iousl
yin:
Knownhy
per
sensi
ti
vi
tyt
oot
herbet
a-
l
actams; Renali
mpai r
ment( dosage↓ r equi
redf orCCr
≤50mL/ min);Geri
:Doseadj ustmentmaybenecessar yfor
age-r
elat
ed↓ i nrenalfunct
ion;OB: Useonlyifpotenti
al
benefi
toutweighspotential
r i
sktofetus;Lactat
ion:Use
cauti
ouslyifbr
east-f
eeding;Pedi:Safet
yandef fecti
veness
notestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI
:PSEUDOMEMBRANOUSCOLI
TIS,
diar
rhea,
nausea.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 696
Derm:rash.Hemat:hemolyt
icanemia.Local
:phlebit
isat
i
nject
ionsite.Mi
sc:
hy per
sensi
ti
vit
yreacti
onsincludi
ng
anaphyl
axis.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
IV:(
Adul
ts18yr)
:Ski
n/ski
nstruct
urei
nfect
ions—600mg
ever
y12hrfor5–14days;Community-
acquired
pneumoni
ā—600mgev ery12hrfor5–7day s.

Renal
Impai
rment
IV:
(Adult
s>18y r
):CCr>30to≤50mL/
min—400mgever
y
12hr;CCr≥15to≤30mL/ min—300mgever
y12hr
;CCr
<15mL/ min—200mgev er
y12hr.

AVAI
LABI
LITY
Powderf
orinj
ect
ion(
requi
resr
econst
it
uti
on)400mg/
vial
,
600mg/vi
al;

PATI
ENT TEACHI
NG
Expl
aint
hepurposeofcef
tar
oli
net
opatient.
Emphasi
zetheimport
anceofcompl
eti
ngt her
apy
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 697
 ev
eni
ffeel
i
ngbet
ter
.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Cef
tazi
dime
I
NDI
CATI
ONS
Treat
mentoft hef oll
owinginfecti
onscausedby
suscepti
bleorgani sms:Skinandski nstructureinfecti
ons,
Boneandj ointinfecti
ons,Urinarytractinfecti
ons,
Gynecologi
cal infecti
ons,Lowerr espir
at orytract
i
nfecti
ons,Intra-abdominalinfecti
ons, Septicemia, Febr
il
e
neutr
openia,Meni ngi
ti
s.

ACTI
ON
Bindstothebacter i
alcellwallmembr ane,causingcell
death.Therapeut
icEf fects:Bacteri
cidalacti
onagai nst
suscepti
blebacteria.Spectrum: Si
mi lartothatofsecond-
generati
oncephal osporins,butacti
vityagainst
staphyl
ococciisless,whi l
eact i
vit
yagai nstgram-negati
ve
pathogens(parti
cularl
yPseudomonasaer uginosa)is
greater
,evenforor ganismsr esi
stantt ofir
st-andsecond-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 698
gener at
ionagent s.Not ableisincreasedact i
onagai nst:
Cit
robact er
,Ent erobact er,Haemophi l
us
i
nfluenzae(includi ngβ-lactamase- producingstrai
ns) ,
Escher i
chiacoli,Kl ebsi
ellapneumoni ae,Neisseri
a
meni ngit
idi
s,Pr ot eus,Providencia,Pseudomonas
aeruginosa,Ser rat i
a,Mor axel
lacat arr
hali
s.Notact i
v e
againstmet hicil
lin-resi
stantstaphy lococciorenterococci.

Av
ail
abi
l
ity
I
NJECTI
ON250,
500mg,
1gand2gv
ial
.

DOSAGE
Deepi
ntr
amuscul
arandi
ntr
avenousi
nject
ionandi
nfusi
on
Adul
t-1gev
ery8hor2gev
ery12h.
Sever
einfect
ions:2gevery12hor3gev
ery12h(
1gsi
ngl
e
dosebyintr
avenousroute).
I
mmunocompr omisedormeningi
ti
spat
ient
s:150mg/kg
bodywei
ghtdail
yin3divi
deddoses(max6gdail
y)gi
ven
byi
.vr
out
eonl
y.
El
der
ly-Usual
maxdoseof3gdai
l
y.
Chi
ld-Upt
o2mont hs;
25t
o60g/kgbodywei
ghti
ntwo
di
vi
deddoses.Ov
er2months:
30to100mg/kgbody

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 699
wei
ghti
n2t
o3di
vi
deddoses.

Cont
rai
ndi
cat
ions
Cephal
ospor
inhy
per
sensi
ti
vi
ty;
por
phy
ria.

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Pr
ecaut
ions
Penicil
l
insensi
ti
vity;
renali
mpai r
ment ;l
actati
onfalse
positi
veuri
naryglucose(i
ftestedforreducingsubstances)
andf al
seposit
iveCoombs’ test;i
nter
acti
onspr egnancy
fal
li
npr ot
hrombinact i
vi
ty,
coliti
s.

Adv
erseEf
fect
s
Diarr
hoea,nausea,v omi ti
ng,abdominaldiscomfort,
headache;rarel
y,antibioti
cassociat
edcoliti
s(parti
cular
ly
withhigherdoses);allergi
creacti
onsincludingrashes,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 700
pruri
tus,urti
caria, ser um sickness- li
ker eact i
on, feverand
arthr
algiaandanaphy laxis;erythemamul tif
orme, toxi
c
epidermal necrolysi sr eported;transi enthepat it
is,
cholestati
cjaundi ce; eosinophiliaandbl ooddi sor ders
(i
ncludingthrombocy topenia,leukopeni a,agranul ocyt
osi
s,
aplasti
canaemi aandhaemol yticanaemi a);reversible
i
nt er
sti
tialnephritis; nervousness, sleepdi sturbances,
confusion,hyper toni aanddi zziness; phlebiti
s,
angioedema, my ocl onia,candi diasis, t
ransientel evati
onof
bloodur eaandser um cr eatini
ne.

St
orage
Storei
nster
il
econtai
nersseal
edsoastoexcl
udemi cr
o-
organi
smsprotect
edfrom moi
stur
eatatemperat
urenot
exceedi
ng30⁰C.

CEFTI
BUTEN
I
NDI
CATI
ONS
Treatmentoft
hefol
lowi
nginfect
ionscausedby
suscepti
bleor
gani
sms:Acuteexacerbat
ionsofchroni
c
bronchi
ti
s,Oti
ti
smedia,
Pharyngi
tisandtonsi
ll
i
tis.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 701
Bindst ot hebact er i
al cellwallmembr ane, causi ngcel l
deat h.Ther apeut i
cEf fect s:Bacteri
cidalact ionagai nst
suscept iblebact eria.Spect rum: Similartot hatofsecond-
gener ati
oncephal ospor i
ns, butactivi
tyagai nst
staphy l
ococci i
sl ess, wher easact i
vit
yagai nstgr am-
negat iv
epat hogensi sgr eater,
ev enforor gani sms
resistanttof ir
st-andsecond- gener ati
onagent s.Not able
i
si ncreasedact ionagai nst:Haemophi l
usi nf l
uenzae
(i
ncl udi
ngβ- l
actamase- pr oducingst r
ains),Escher ichiacoli
,
Klebsiell
apneumoni ae, Proteus,Prov i
denci a,Mor axell
a
catar r
halis(includingβ- lactamase- produci ngst r
ains) .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
↓ dosi
ng
recommendedi fCCr<50mL/ mi
n; Di
abetes( suspension
containssucr
ose);Hi
stor
yofGIdisease,especiall
ycol i
ti
s;
Geri:Doseadj
ustmentduetoage-rel
ated↓ i nrenal
functi
onmaybenecessar y;
OB:Lactati
on:Pedi :Pregnancy,
l
actation,
andinfant
s<6mo( saf
etynotest abli
shed) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
SEI
ZURES(
ver
yhi
ghdosesi
npat
ient
swi
thr
enal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 702
i
mpai rment),dizziness,headache.GI :
PSEUDOMEMBRANOUSCOLI TIS,abdomi nal pai
n,di
arr
hea,
dyspepsia,nausea, vomi ti
ng.Der m: STEVENS- JOHNSON
SYNDROME, r ashes, urt
icar
ia.Hemat :bleeding,
eosinophil
i
a, hemol yticanemi a,l
eukopeni a,
thrombocytopeni a,thrombocy tosis.Mi sc:al
lergic
reacti
onsincludinganaphy l
axisand, super i
nfecti
on.

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

DOSAGE
PO:(Adul
tsandChi
l
dren≥12y
r):
400mgoncedai
l
yfor10
day
s.
PO:(Chi
l
dren6mo–12yr)
:9mg/
kgoncedai
l
yfor10day
s
(maxdail
ydose=400mg).

Renal
Impai
rment
PO:(Adul
ts):CCr30–49mL/mi
n—200mgor4.
5mg/kg
ever
y24hr;CCr5–29mL/min—100mgor2.
25mg/
kg
ever
y24hr.

AVAI
LABI
LITY
Capsul
es400mg;
Oral
suspensi
on(
cher
ryf
lav
or)90mg/
5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 703
mL,
180mg/
5mL;

PATI
ENTTEACHI
NG
Inst
ructpatienttot akemedicati
onatev enl
yspaced
timesandt of i
nisht hemedicati
oncompl et
ely,eveni
f
feel
ingbetter.Mi sseddosesshoul dbetakenassoon
aspossibleunlessal mostti
mef ornextdose;donot
doubledoses.I nstructpati
enttousecalibr
ated
measur i
ngdev icewi thsuspensi
on.Adv i
sepatient
thatshari
ngoft hismedicati
onmaybedanger ous.

Advi
sepatientt
oreportsignsofsuper inf
ecti
on( f
urr
y
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools),
rash,and
al
ler
gy.

I
nfor
m diabet
icpati
entsthator
alsuspensi
oncont
ains
1gsucroseperteaspoonofsuspension.

Instr
uctpat i
enttonoti
fyheal
thcareprofessionali
f
rash,orfeveranddiarr
headevelop,especi
allyifst
ool
containsblood,pus,ormucus.Advisepatientnotto
treatdiarr
heawithoutconsul
ti
nghealthcar e
professional
.

CEFTI
ZOXI
ME
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 704
I
NDI
CATI
ONS
Treatmentoft hefoll
owinginfectionscausedby
susceptibl
eorganisms: Skinandski nstr
uctureinf
ections,
Boneandj ointinf
ections,Uri
naryt r
acti
nfecti
ons,
Gy necol
ogicalinf
ecti
onsincludinggonorhhea, Lower
respirat
orytr
actinfecti
ons,Int
ra-abdominalinfect
ions,
Sept i
cemia,Meningiti
s.

ACTI
ON
Bindst othebact er ial cellwal l membr ane,causi ngcel l
deat h.Ther apeut i
cEf fect s: Bacteri
cidal actionagai nst
suscept i
blebact eria.Spect rum: Similartot hatofsecond-
gener ationcephal ospor ins, butactivityagai nst
staphy l
ococci i
sl ess, wher easact i
vityagai nstgr am-
negat ivepat hogensi sgr eat er,evenf ororgani sms
resistantt ofir
st-andsecond- generationagent s.Notable
i
si ncr easedact ionagai nst :Enterobact er,Haemophi lus
i
nf l
uenzae, Escher ichi acol i,Klebsiell
apneumoni ae,
Neisser ia,Proteus, Pr ov idenci a,Serratia,Mor axel l
a
catar rhali
s,Mor ganel l
amor ganii
.Hassomeact i
v i
ty
againstanaer obes, includi ngBact eroidesf ragil
is.Not
activeagai nstmet hi cill
in-resistantst aphylococci or
enter ococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 705
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
↓
dosing/i
ncreaseddosingintervalrecommendedi fCCr≤80
mL/ min)
;HistoryofGIdisease, especial
lycoli
ti
s;Geriat
ri
c
pati
ents(doseadjustmentduet oage-relat
ed↓ i nrenal
functi
onmaybenecessar y)
; Pr
egnancy ,
lactat
ion,and
chil
dren<6mo( safet
ynotest ablished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( highdoses) .GI:PSEUDOMEMBRANOUS
COLITI S,diarr
hea,nausea, vomi t
ing.Derm: pruri
ti
s,rashes,
urt
icaria.Hemat :bleeding,eosinophili
a,hemol yt
icanemi a,
l
eukopeni a, neutr
openia, t
hrombocy topenia,
thr
ombocy tosis.Local:painatIM site,phl
ebitisatIVsite.
Misc:al l
ergicreactionsincludi
nganaphy l
axis,
superinfection,f
ever .

I
NTERACTI
ONS
Drug-
Dr ug:Probeneciddecr easesexcret
ionandi
ncr
eases
bl
oodl evels.Concurrentuseofl oopdiur
eti
csor
nephrotoxicagentsincludingami nogl
ycosi
desmay
i
ncreaset heriskofnephr otoxi
city.

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 706
IM:IV:(Adult
s):Sever
einf ecti
ons—1–2gev ery8–12hr.
Lif
e-thr
eateningi
nfect
ions—3–4gev er
y8hr.
Uncompl i
cateduri
narytractinfecti
ons—500mgev er
y12
hr.
Gonococcal ur
ethri
ti
s/cer v
icit
is-
1gIM( si
ngl
edose).
IM:IV:(
Chi
ldr
en≥6mo):50mg/
kgev
ery6–8hr(
nott
o
exceed200mg/kg/
day
).

Renal
Impai
rment
I
M: I
V:(Adul
ts)
:CCr50–79mL/min—500mg–1.5gev er
y
8hr;CCr5–49mL/min—250mg–1gev ery12hr
;CCr0–4
mL/min—500mg–1gev ery48hror250–500mgever
y24
hr
.

AVAI
LABI
LITY
Powderf
orinj
ect
ion1g,
2g,
10g;
Premi
xedcont
ainer
s1
g/50mL,2g/50mL;

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst r
uctpati
enttonot
ifyhealthcareprofessi
onali
f
feveranddiar
rheadevelop,especial
lyi
fstoolcont
ains
blood,pus,
ormucus.Adv isepatientnottotr
eat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 707
 di
arr
heawi
thoutconsul
ti
ngheal
thcar
epr
ofessi
onal
.

Cef
tri
axone
I
NDI
CATI
ONS
Seri
ousinf
ecti
onsduet osensitivebacteria,Treatmentof:
Ski
nandski nst
ruct urei nf
ecti
ons, Boneandj oint
i
nfecti
ons,
Compl icat edanduncompl icatedurinarytr
act
i
nfecti
ons,
Uncompl icatedgynecol ogi
cal inf
ections
i
ncludi
nggonorrhea, Lowerr espirator
yt r
actinfecti
ons,
I
ntra-
abdominalinfect i
ons,Septicemia,Meni ngiti
s,Oti
ti
s
media.Per
ioper
at i
vepr ophyl
axis.

ACTI
ON
Bindstothebact er ialcellwall membr ane,causi ngcel l
death.TherapeuticEf fects:Bacteri
cidalactionagai nst
suscepti
blebact eria.Spect rum: Similartothatofsecond-
generati
oncephal ospor ins,butactivi
tyagai nst
staphyl
ococci i
sl ess, whi l
eact i
vit
yagai nstgr am- negati
ve
pathogensisgr eat er,evenf ororganismsr esi stanttofir
st-
andsecond- gener ationagent s.Not ableisincr eased
acti
onagainst :
Aci net obacter,Enterobacter, Haemophi lus
i
nf l
uenzae(incl
udi ngβ- l
actamase- producingst r
ains),
Haemophi l
uspar ainfluenzae, Escherichi
acol i,Klebsiel
la

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 708
pneumoniae, Mor ganell
amor gani
i,Neisseria,Pr
oteus,
Provi
denci
a, Serratia,
Mor axell
acatarr
halis.Hassome
acti
vi
tyagainstanaer obes,incl
udingBacteroidesfragi
l
is.
Notacti
veagai nstmet hici
ll
in-r
esi
stantstaphy l
ococcior
enter
ococci
.

Av
ail
abi
l
ity
I
NJECTI
ON125,
250,
500mg,
1gand2gv
ial
.

DOSAGE
I
ntr
amuscul
arandi
ntr
avenousi
nject
ionori
nfusi
on
Adul
t-Uri
narytractinfecti
on,
pneumonia,pelv
ic
i
nfl
ammat orydisease, pr
ophyl
axi
sofsurgicali
nfect
ions
andmeningit
is:4gi ni
tial
l
yoncedail
yfor10day sorupto
72hafterfeverdisappears.

Ty
phoi
d:4gdai
l
yfort
woday
sfol
l
owedby2gdai
l
yfor
nextt
wodays.1t
o2gdai
l
yisusedf
oranyot
hert
ypeof
condi
ti
on.

Chi
l
d-Meni
ngi
ti
s:75t
o100mg/
kgbodywei
ghtf
or7t
o
9day
s.

Ty
phoi
d:5mg/
kgbodywei
ghtf
or7day
s.50t
o75mg/
kg
bodyweighti
susedi
ncaseofanyot
hercondi
ti
on(
max
2g/day
).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 709
Cont
rai
ndi
cat
ions
Cephalospori
nhyper
sensit
ivi
ty;porphyr
ia;
neonateswi
th
j
aundice,hypoal
buminaemia,acidosi
sorimpair
edbil
ir
ubi
n
bi
nding.

I
NTERACTI
ONS
Drug-
Dr ug:Shoul
dnotbeadminist
eredconcomi
tant
lywi
th
anycalcium-cont
aini
ngsol
uti
ons.

Pr
ecaut
ions
Penici
ll
insensi ti
v i
ty;sev erer enalimpai rment ; hepat i
c
i
mpai rmenti faccompani edbyr enalimpai rment
prematur eneonat es; maydi splacebilirubinfr om ser um
al
bumi n; t
reatmentl ongert han14day s,renal f ai
lure,
dehydrationorconcomi tantt otalparent eralnut r
iti
on-ri
sk
ofceftri
axonepr ecipitati
oni ngal l
bladder ;lactat i
on( but
appropriatetouse, seepr egnancyf alseposi tiv eurinary
gl
ucose( i
ftestedf orr educingsubst ances)andf al
se
positi
veCoombs’ test; i
nteract i
onsphr ophy lact i
c
i
ndication,patientswi thi mpai redvitKsy nthesi s,
moni t
oringofpr othr ombi nt i
mei srecommended.

Adv
erseEf
fect
s
Di
arr
hoea,
nauseaandv
omi
ti
ng,
abdomi
nal
discomf
ort
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 710
headache; ant i
biot i
c-associ atedcol iti
s( par ti
cularlywi th
higherdoses) ;allergicreact ionsi ncludingr ashes, pr uri
tus,
urti
car i
a, ser um si ckness- l
iker eactions, fev erand
arthr algiaandanaphy l
axis;er ythemamul tiforme, toxi c
epider mal necr oly sisrepor ted; t
ransienthepat i
tisand
chol est aticjaundi ce;elevationofSGOTandSGPT;
eosi nophi liaandbl ooddi sor ders( i
ncludi ng
thrombocy topeni a, l
eukopeni a,agranul ocy tosis,apl astic
anaemi aandhaemol yti
canaemi a);rever sibleinterst it
ial
nephr it
is,hy per act i
vity
,ner vousness, sleepdi sturbances,
conf usi on, hy pertoni aanddi zziness; calcium cef triaxone
preci pitatesi nur ine( particular l
yinv eryy oung, dehy drated,
ort hosewhoar ei mmobi l
ized)ori ngal lbladder -
consi der
discont inuat i
oni fsy mpt omat ic;rarely,prolongat ionof
prot hrombi nt ime, pancreatitis;local r
eact ion,
hyper sensi ti
v i
ty.

PATI
ENTTEACHI
NG
Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

Instr
uctpatienttonoti
fyhealt
hcareprofessionali
f
feveranddi ar
rheadevelop,
especial
lyifdi
arrhea
containsblood,mucus,orpus.Adv i
sepatientnotto
treatdiar
rheawithoutconsul
tinghealt
hcar e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 711
 pr
ofessi
onal
.

St
orage
Storepr
otect
edf
rom l
i
ghtatat
emper
atur
enotexceedi
ng
30⁰C.

CEFUROXI
ME
I
NDI
CATI
ONS
Treatmentof :Respir
atorytractinfecti
ons, Ski
nandskin
str
uct ur
einfecti
ons,Boneandj ointinfect
ions(IV)
,Uri
nary
tr
actinfecti
ons,Gy necologicalinf
ections,Septi
cemia(I
V),
Otit
ismedi a(PO),Meni ngit
is(IV),Lymedi sease(PO).
Perioperat
iveprophy l
axis(I
V) .

ACTI
ON
Bindst obacteri
alcel lwallmembr ane, causingcell death.
Therapeut i
cEffects:Bact erici
dal actionagai nst
suscept i
blebacteri
a.Spect rum: Simi l
art othatoff i
rst-
generationcephalospor insbuthasi ncreasedact ivi
t y
againstsev er
alothergr am- negat i
v epat hogensi ncluding:
Haemophi l
usinfl
uenzae( includingβ- lactamase- producing
strai
ns),Haemophi luspar ainfluenzae, Escheri
chiacol i,
Klebsiell
apneumoni ae,Nei sseri
a, Proteus,Mor axel l
a

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 712
cat
arr
hali
s,Bor
reli
aburgdor
fer
i.Notacti
veagainst
methi
cil
l
in-
resi
stantst
aphyl
ococciorent
erococci.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dose
reducti
on/increaseddosingintervalrecommendedi fCCr
≤20mL/ min);Hist
oryofGIdi sease,especi
all
ycol
iti
s;
Geriat
ri
cpat ients(doseadjustmentmayber equi
reddue
toage-rel
ated↓ i nrenalfunction)
;Pregnancyand
l
actati
on( hasbeenusedsaf ely).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( hi
ghdoses) .GI:PSEUDOMEMBRANOUS
COLITIS,diarr
hea,nausea,vomi t
ing,cramps.Der m:rashes,
urt
icari
a,diaperdermatit
is.Hemat :bleedi
ng,eosinophil
ia,
hemol y
ticanemia,leukopenia.Local:painatIM si
te,
phl
ebiti
satI Vsit
e.Mi sc:al
lergi
cr eacti
onsincl
uding
anaphylaxi
s,superinf
ecti
on.

I
NTERACTI
ONS
Dr
ug-Drug:
Probeneci
ddecreasesexcr
eti
onandincr
eases
bl
oodlevel
s.Aminogl
ycosi
desandloopdiur
eti
csmay

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 713
i
ncr
easet
her
iskofnephr
otoxi
cit
y.

DOSAGE
Note:
Cefuroxi
meoralt
abl
etsandoralsuspensi
onar
enot
bi
oequiv
alentandar
enotsubst
it
utabl
eonamg/ mgbasi
s
PO:(AdultsandChildren>12y r
):Pharyngit
is/t
onsi
ll
i
tis,
maxil
larysinusi
ti
s,uncompl i
cateduri
narytract
i
nfecti
ons—250mgev ery12hr.Bronchit
is,uncompli
cated
ski
n/skinstruct
ureinfecti
ons—250–500mgev er
y12hr .
Gonorrhea—1gsi ngledose.Lymedisease-500mgev ery
12hrfor20day s.
PO:(Children3mo–12y r):Oti
ti
smedia,
acutebact
eri
al
maxill
arysi nusit
is,i
mpet i
go—15mg/ kgever
y12hrasor al
suspension( nott oexceed1g/ day
)or250mgev ery12hr
astablets.Phar yngi
ti
s/tonsil
l
iti
s—10mg/kgevery12hras
oralsuspensi on,nottoexceed500mg/ day.
IM: I
V: (
Adults) :Uncompl i
catedur i
nar ytr
actinfecti
ons,
skin/skinstructureinfecti
ons,dissemi natedgonococcal
i
nfect i
ons,uncompl icat
edpneumoni a-750mgev ery8hr.
Bone/ j
ointinfections,severeorcompl i
cated
i
nfect i
ons—1. 5gev ery8hr.Lif
e-threateni
ngi nfect
ions-
1.5
gev ery6hr.Meni ngiti
s-3gevery8hr .Perioper
ativ
e
prophy l
axi
s-1.5gI V30–60mi nbeforei ni
tiali
ncisi
on;750
mgI M/ IVev ery8hrcanbegi venwhenpr ocedur e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 714
prolonged.Pr
ophylaxi
sduringopen-
heartsur
ger
y-1.
5gIV
atinducti
onofanesthesiaandthenevery12hrf
or3
additi
onaldoses.
Gonorrhea—1.5gIM( 750mgintwosi
tes)
with1gpr obeneci
dPO.
I
M: I
V:(Chil
drenandI
nfants>3mo) :Most
i
nfect
ions—50–100mg/ kg/daydi
vi
dedev er
y6–8hr
(
maximum dose6g/ day).Boneandjoi
ntinf
ect
ions—150
mg/kg/daydivi
dedever
y8hr( maximum dose6g/ day
).

Renal
Impai
rment
I
M: I
V:(Adul
ts)
:CCr10–20mL/min—750mgev
ery12hr
;
CCr<10mL/min—750mgevery24hr.

AVAI
LABI
LITY
Tabl
ets250mg, 500mg; Or
alsuspension(
tutt
i-
fr
utt
i)125
mg/5mL, 250mg/ 5mL;Powderforinject
ion750mg, 1.
5
g,7.
5g;Premixedcont
ainer
s750mg/ 50mL, 1.
5g/50mL;

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakemedicati
onar oundthecl
ock
atevenlyspacedtimesandtof i
nishthemedicat
ion
completel
y,eveniffeel
i
ngbetter.Misseddoses
shouldbetakenassoonaspossi bl
eunlessalmost
timefornextdose;donotdoubledoses.Adv i
se

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 715
 pati
entthatshar
ingofthi
smedi cat
ionmaybe
dangerous.Pedi
:Tell
parentsorcargei
ver
stouse
cal
ibrat
edmeasur i
ngdevicewithli
quidpr
epar
ati
ons.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

CELECOXI
B
I
NDI
CATI
ONS
Reli
efofsi
gnsandsymptomsofosteoart
hri
ti
s,
rheumatoi
dart
hri
ti
s,anky
losi
ngspondyl
it
isandjuv
enile
rheumatoi
dart
hri
ti
s.Managementofacutepai
nincludi
ng
pri
marydysmenorr
hea.

ACTI
ON
Inhibi
tst
heenzy meCOX-2.Thi
senzymeisrequiredfort
he
synthesi
sofpr ost
agl
andi
ns.Hasanal
gesic,
anti-
i
nf l
ammat or
y,andanti
pyr
eti
cproper
ti
es.Therapeuti
c
Effect
s:Decreasedpai
nandinfl
ammationcausedby

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 716
ar
thr
it
isorspondy
li
ti
s.Decr
easedpai
n.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
mayexi stwithot herNSAI Ds, includingaspir
in;Histor
yof
all
ergic-typereact i
onst osul fonami des;Hist
oryofast hma,
urti
caria,orallergic-t
yper eact i
onst oaspiri
norot her
NSAI Ds, i
ncludingt heaspi ri
nt ri
ad( asthma,nasal pol
yps,
andsev erehyper sensiti
vityreact i
onst oaspir
in);Advanced
renaldisease; Sev erehepat i
cdy sfuncti
on;Peri-
operati
ve
painfrom cor onar yarteryby passgr aft(CABG)sur gery;
OB:
Shouldnotbeusedi nlatepr egnancy( maycause
premat ureclosur eoft heduct usar t
eri
osus).

UseCaut
iousl
yin:
Car
diov
ascul
ardi
seaseorr
iskf
act
ors
forcar diov asculardisease( may↑ r i
skofser ious
cardiov ascul arthrombot i
cev ents,my ocardial inf
arct
ion,
andst roke, especiall
ywi thpr ol
ongeduse) ;Pr e-exi
sti
ng
renal disease, hear tfail
ure,li
verdy sfuncti
on, concur r
ent
diureticorACEi nhibitortherapy( ↑r iskofr enal
i
mpai rment );
Hy pertensionorf luidretenti
on; Renal
i
nsuf ficiency( maypr ecipit
ateacut er enalfailure);
Serious
dehy drat i
on( correctdef ici
tsbef oreadmi nister i
ng);
Patient swhoar eknownorsuspect edt obepoorCYP2C9
met abol izers(↓i ni t
ialdoseby50%) ;Pre-existingasthma;
Pedi :Saf etynotest abl i
shedi nchildren<2y rsorf orl
onger

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 717
than6mo; Geri
:Concurr
enttherapywi t
hcor t
icoster
oidsor
anti
coagulants,l
ongdurati
onofNSAI Dt herapy,hist
oryof
smoking,alcoholi
sm,geri
atr
icpat i
ents,orpoorgeneral
healt
hstatus( ↑riskofGIbleeding)
;Lactati
on: Lact
ation.
Exer
ciseExt
remeCaut
ioni
n:Hi
stor
yoful
cerdi
seaseorGI
bl
eeding.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zzi
ness,headache,i
nsomnia.CV:MYOCARDI AL
I
NFARCTI ON,STROKE, THROMBOSI S,edema.GI:GI
BLEEDING,abdomi nal
pain,di
arr
hea,dyspepsi
a,fl
atulence,
nausea.Derm:EXFOLIATIVEDERMATI TIS,STEVENS-
JOHNSONSYNDROME, TOXICEPIDERMALNECROLYSI S,
rash.

I
NTERACTI
ONS
Drug-Drug:CYP2C9inhibit
orsmay↑ l evels.May↓
effecti
venessofACEinhibit
ors,thiazidedi uretics,and
furosemide.Fl
uconazole↑ levels( usel owest
recommendeddosage) .May↑ r iskofbl eedingwi th
war f
ari
nandaspiri
n.May↑ ser um l i
thium lev els.Does
notinhibi
tthecar
dioprotecti
veeff ectofl ow-doseaspi ri
n.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 718
PO:(Adults):Osteoart
hri
ti
s—200mgoncedai l
yor100mg
twi
cedaily.Rheumat oi
darthr
it
is—100–200mgt wicedail
y.
Ankyl
osingspondy li
ti
s—200mgoncedai l
yor100mg
twi
cedaily;dosemaybe↑ af t
er6wkt o400mgdaily.
Acut
epai n,i
ncludingdysmenorrhea—400mgi ni
ti
all
y,t
hen
a200-mgdosei fneededonthef i
rstday;
then200mg
twi
cedailyasneeded.

Hepat
icI
mpai
rment
PO:(
Adult
s):Moder
atehepat
ici
mpai
rment(
Chi
l
d-Pugh
Cl
assB)—↓ doseby50%.
PO:(
Childr
en≥2y
rs,≥10kg–≤25kg)
:Juv
eni
l
erheumat
oid
ar
thr
it
is—50mgtwicedai
ly.
PO:(
Childr
en≥2y
rs,
≥25kg)
:Juv
eni
l
erheumat
oid
ar
thr
it
is—100mgtwi
cedai
ly
.

AVAI
LABI
LITY
Capsul
es50mg,
100mg,
200mg,
400mg

PATI
ENTTEACHI
NG
I
nstructpatientt
otakecelecoxibexactl
yasdi r
ected.
Donott akemor ethanprescri
beddose.Increasing
dosesdoesnotappeart oincreaseeffect
iveness.Use
l
owestef fecti
vedoseforshortestperi
odoft i
me.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 719
 Adv i
sepat i
enttonot i
fyhealt
hcar epr of
essi onal
prompt lyifsignorsy mptom ofGIt oxicit
y( abdomi nal
pain,blackst ools),
skinrash,unexplainedwei ghtgain,
edema, orchestpai noccurs.Patientsshoul d
discontinuecel ecoxibandnotifyhealthcare
professional i
fsignsandsy mpt omsofhepat otoxi
city
(nausea, fati
gue, l
ethar
gy,pruri
tus,jaundice, upper
ri
ghtquadr anttenderness,fl
u-l
ikesy mptoms)occur .

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed.

Cent
chr
oman
I
ndi
cat
ions
Cont
racept
ion.

Av
ail
abi
l
ity
TABLET30mg.

DOSAGE
Or
al
30mgtabl
ets.Asi
ngl
etabl
etshoul
dbetakent
wi cea
week(
onasundayandawednesday)f
orthefi
rstthr
ee

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 720
mont
hsandt
henweekl
y(ev
erysunday
)ther
eaf
ter
.

Cont
rai
ndi
cat
ions
Medi
calhist
oryofli
verdi
sease,j
aundice;ov
ari
andisease
(
poly
cysti
cov ar
ies)
;cer
vical
hyperpl
asia;
cervi
cit
is;
chroni
c
r
enaldi
sorders.

Pr
ecaut
ions
Prolongati
onofmenst rual cycl
esmaybeexper iencedby
somei ndiv
idual
s.Delay edmenst ruati
onis
i
nconsequent i
alifdosageshav enotbeenmi ssed.Incase
ofdelayexceeding15day s,pregnancyshoul
dber uledout
withrouti
neinvesti
gations.Admi nist
rati
onshoul dbe
di
scont i
nuedimmedi atelyifpregnancyisconfir
med.

Adv
erseEf
fect
s
Wat
err
etent
ion;
tenderbr
east
s;acne;
heav
ymenst
ruat
ion.

CEPHALEXI
N
I
NDI
CATI
ONS
Treat
mentoft hefollowingi
nfecti
onscausedby
suscepti
bleorganisms:Skinandskinstr
uctur
einf
ecti
ons,
Respir
atorytr
actinfecti
ons,Oti
ti
smedia,Uri
naryt
ract

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 721
i
nfect
ions,
Bonei
nfect
ions.

ACTI
ON
Bi ndst obact er i
al cellwal lmembr ane, causi ngcell deat
h.
Ther apeut i
cEf fects: Bact erici
dal actionagai nst
suscept i
blebact eria.Spect rum: Act i
veagai nstmanygr am
-posi tivecocci includi ng: Streptococcuspneumoni ae,
Gr oupAbet a-hemol yticst r
ept ococci, Staphy l
ococci
(includi ngpeni cil
linase- produci ngst rains).Act iveagainst
thef ol l
owi nggr am- negat i
veor gani sms: Escher i
chiacoli,
Haemophi l
usi nfluenzae, Klebsiell
apneumoni ae,
Mor axel l
acat arrhalis,Pr oteus.Notact i
v eagai nst
met hicill
i
n-resistantst aphy l
ococci orent erococci :
Ent er ococcus.Notact i
veagai nstanaer obes.

Av
ail
abi
l
ity
CAPSULES/TABLETS125,
250and500mg; 125mgKi
d
tabl
ets;
250mgDT; DRySyRUP125and250mg/5ml.

DOSAGE
Tobegi
venpr
efer
abl
yonempt
yst
omach.
Adult
-250mgever
y6hor500mgev
ery8to12h,
i
ncreasedt
o1to1.
5gev
ery6to8hf
orsev
erei
nfect
ions.
Pr
ophy
laxi
sofsev
ereur
inar
ytr
acti
nfect
ion:
125mgat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 722
ni
ght
.
Chil
d-25mg/ kgbodywei ghtdail
yindi
videddoses
doubledforsever
einfecti
ons(max.100mg/ kgbody
weightdail
y);
Under1y ear
:125mgev ery12h; 1t
o5year
s:
125mgev er
y8h; 5to12y ears:
250mgev er
y8h.

Cont
rai
ndi
cat
ions
Cephal
ospor
inhy
per
sensi
ti
vi
ty.

I
NTERACTI
ONS
Drug-Drug:Pr
obeneci
d↓ excr et
ionand↑ bloodlev
elsof
renall
yexcret
edcephalospori
ns.Concurr
entuseofloop
diuret
icsoraminogl
ycosidesmay↑ r i
skofrenal
toxici
ty.

Pr
ecaut
ions
Sensit
ivi
tytobeta-l
actam ant ibacteri
als(av
oidifhi
st or
yof
i
mmedi atehypersensiti
vit
yr eaction,renali
mpairment ;
l
actati
on;fal
sepositiv
eur inarygl ucose(ift
estedfor
reduci
ngsubstances)andf alseposi t
iveCoombs' test;
poornutri
ti
onalstate;pregnancy .

Adv
erseEf
fect
s
Diar
rhoeaandr ar
ely
,ant
ibi
oti
c-associ
atedcoli
ti
s(more
l
ikel
ywithhigherdoses)
,nauseaandv omit
ing,abdomi
nal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 723
discomf ort,headache; allergicr eactionsi ncludingr ashes,
pruritus,urticaria, serum si ckness- li
ker eact i
onswi th
rashes, feverandar t
hr algiaandanaphy laxi s;
Stev ensJohnsonsy ndr ome, toxicepi dermal necrol ysis
repor ted;disturbancesi nl i
v erenzy mes, transi enthepat i
ti
s
andchol estaticj aundi ce; ot hersi de-effect srepor ted
i
ncl udeeosi nophi liaandbl ooddi sor ders( including
thrombocy topeni a,leucopeni a,agranul ocy tosis,apl astic
anaemi aandhaemol yticanaemi a);rever sibleinter sti
tial
nephr iti
s,hy peract i
vit
y ,ner vousness, sleepdi sturbances,
hallucinations, conf usi on, hy pertoniaanddi zziness;
dyspnoea, coliti
s, i
ncr easedbl oodur ea, creat i
nine, alkali
ne
phosphat ase, bili
r ubin,LDH.

PATI
ENTTEACHI
NG
Instr
uctpat i
entt
ot akemedi cationar oundtheclockat
evenlyspacedt i
mesandt of i
nishthemedi cation
compl etelyasdi
rected,eveniff eel
i
ngbet ter.Takemi ssed
dosesassoonaspossi bleunl essalmostt imef ornext
dose; donotdoubledoses.Adv isepat i
entthatshari
ngt hi
s
medi cati
onmaybedanger ous.Pedi:Tellparentsor
caregiverstousecalibr
atedmeasur ingdev i
cewi t
hliquid
preparations.
Advi
sepati
entt
oreportsi
gnsofsuperi
nfect
ion(fur
ry
over
growt
honthetongue,vagi
nali
tchi
ngordischarge,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 724
l
ooseorf
oul
-smel
l
ingst
ool
s)andal
l
ergy
.
Inst
ructpati
enttonoti
fyhealthcareprofessional
iff
ev er
anddiarrheadevel
op,especial
lyifdi
arrheacontai
nsblood,
mucus, orpus.Advi
sepatientnottotreatdiarr
heawithout
consult
inghealt
hcareprofessional.

St
orage
Stor
eprotect
edfr
om l
i
ghtandmoi
stur
eatat
emper
atur
e
notexceedi
ng30⁰
C.

CEPHAPI
RIN
I
NDI
CATI
ONS
Treatmentof :
Skinandski nstructureinfect
ions(i
ncludi
ng
burnwounds) ,Pneumoni a,Oti
ti
smedi a,Uri
narytr
act
i
nfections,Boneandjointinfecti
ons, Septi
cemia(incl
udi
ng
endocar di
ti
s)causedbysuscept ibleorganisms.
Perioperat
iveprophyl
axis.Notsuitableforthetreatment
ofmeni ngit
is.

ACTI
ON
Bindstobacter
ialcellwal
lmembr ane,causingcel
ldeat
h.
Therapeuti
cEffect
s:Bacteri
cidalacti
onagai nst
suscepti
blebacter
ia.Spect
rum: Activeagainstmanygram

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 725
-posi
ti
v ecocci i
ncludi
ng: Str
eptococcuspneumoni ae,
GroupAbet a-hemol yt
icst r
eptococci ,Penicill
inase-
producingstaphy l
ococci.Notact iveagai nst:Met hicil
l
in-
resi
stantstaphy l
ococci,
Bact eroidesfr agil
is,Enterococcus.
Limit
edact i
v i
tyagainstsomegr am- negat i
v erods
i
ncluding:Klebsiel
lapneumoni ae, Proteusmi rabil
is,
Escherichi
acol i
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Contr
aindi
cat
edin:
Hy per
sensi
ti
vi
tytocephal
ospor
ins;
Ser
ioushyper
sensi
ti
vi
tytopeni
cil
li
ns.
UseCaut i
ousl yin:Renalimpairment(dosagereduct i
on
and/orincreaseddosi nginterval
recommendedi fserum
ceratmi
ne>5mg/ dL;HistoryofGIdisease,especiall
y
coli
ti
s;Ger i
atri
cpat i
ents(dosageadjustmentduet oage-
rel
ateddecr easeinrenal f
unctionmaybenecessar y);
Pregnancyorl actati
on(half-l
i
feisshorterandbloodl evel
s
l
owerdur ingpr egnancy;hasbeenusedsaf el
y).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( hi
ghdoses).GI:PSEUDOMEMBRANOUS
COLITIS,diarrhea,nausea,
vomi t
ing,cramps.GU:
i
ntersti
ti
alnephr iti
s.Derm:r
ashes, ur
ticari
a.Hemat :
blood
dyscrasi
as, hemol yti
canemia.Local:painatIM si
te,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 726
phl
ebit
isatI
Vsit
e.Misc:
aller
gicr
eacti
onsincludi
ng
anaphyl
axi
sandser
um sickness,
superi
nfect
ion.

I
NTERACTI
ONS
Drug-Drug:Probeneciddecreasesexcreti
onandincreases
bloodlevel
sofr enall
yexcretedcephalospori
ns.
Concur r
entuseofl oopdi
ureticsmayincreasether
iskof
renaltoxi
cit
y.

DOSAGE
I
M:I
V:(
Adul
ts)
:Mosti
nfect
ions—0.
5–1gq4–6hr
.
I
M:IV:
(Chi
l
dren>3mo)
:Mosti
nfect
ions—10–20mg/
kgq
6hr
.

Renal
Impai
rment
I
M: I
V:(Adul
ts):Ser
um creat
mi ne>5mg/dL—7.
5–15
mg/kgq12hr ;di
aly
sispati
ents—7.5–15mgbef
ore
di
aly
sisandthenq12hr .

AVAI
LABI
LITY
Powderf
ori
nject
ion500mg,
1g,
2g,
4g,
20g;

PATI
ENTTEACHI
NG
Adv
isepat
ientt
orepor
tsi
gnsofsuper
inf
ect
ion(
fur
ry

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 727
 ov
ergrowthonthetongue,vaginal
itchi
ngor
di
scharge,
looseorfoul
-smell
ingstools)andal
l
ergy
.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

CEPHRADI
NE
I
NDI
CATI
ONS
Treatmentoft hef ol
l
owinginfecti
onscausedby
susceptibleorganisms:Ski
nandski nstructur
ei nf
ecti
ons
(i
ncludi
ngbur nwounds),Pneumoni a,
Otiti
smedi a,Uri
nary
tr
actinfections,Boneandjointinf
ecti
ons,Septicemia.Not
suit
ablef orthetreat
mentofmeni ngit
is.

ACTI
ON
Bindstobact er
ialcellwal lmembr ane, causi ngcel ldeath.
Therapeuti
cEf f
ect s:Bact eri
cidalactionagai nst
susceptibl
ebact eri
a.Spect rum: Act i
veagai nstmanygr am
-posi
ti
vecocci i
ncl uding: Str
eptococcuspneumoni ae,
GroupAbet a-hemol yticst r
eptococci, Penicillinase-
producingstaphy l
ococci .Notact i
v eagai nst: Met hici
ll
i
n-
resi
stantstaphylococci ,
Bact eroi
desf ragil
is, Enterococcus.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 728
Li
mi t
edact i
v i
tyagainstsomegr
am-negati
ver
ods
i
ncluding:Klebsiel
l
apneumoniae,Pr
oteusmir
abi
l
is,
Escherichi
acol i
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocephal
ospor
ins;
Ser
ioushy
per
sensi
ti
vi
tyt
openi
cil
l
ins.

UseCaut
iousl
yin:
Renal
impai
rment(
dosageadj
ust
ment
recommendedi fCCr≤50mL/ mi n)
;HistoryofGIdi
sease,
especi
all
ycolit
is;Geri
atri
cpat ients(dosageadjust
ment
duetoage-rel
ateddecr easeinr enalfuncti
onmaybe
necessary)
;Pregnancyorl actati
on( half
-l
if
eisshort
erand
bloodlevel
slowerduringpr egnancy ;hasbeenused
safel
y).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES( ver
yhighdoses).GI :
PSEUDOMEMBRANOUSCOLI TIS,diarr
hea, nausea,
vomi t
ing,cramps.Der m:rashes,pruri
tis,urti
caria.Hemat
:
eosinophili
a,leukopeni
a,neutropenia.Mi sc:all
ergic
reacti
onsi ncl
udinganaphy l
axisandser um sickness,
superinfecti
on.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 729
Dr
ug-Drug:
Probeneci
ddecreasesexcr
eti
onandincr
eases
bl
oodlevel
sofrenal
lyexcr
etedcephal
ospor
ins.

DOSAGE
PO:
(Adul
ts)
:Mosti
nfect
ions—250–500mgev
ery6–12hr
.
PO:(Chi
ldr
en≥9mo) :Mosti
nfect
ions—6.
25–12.5mg/kgq
6hr.
Otit
ismedi
a-75–100mg/kg/dayindi
videddoses
ever
y6or12hr(maxdai l
ydose=4000mg) .

Renal
Impai
rment
PO:(Adul
ts)
:CCr10–50mL/ min—Decr
easedoseby50%;
CCr<10mL/min—Decreasedoseby75%.

AVAI
LABI
LITY
Capsul
es250mg;
Oral
suspensi
on(
frui
tfl
avor
ed)250
mg/5mL;

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakemedicati
onar oundtheclock
atevenlyspacedtimesandtof i
nishthemedi cat
ion
completelyasdi
rected,
eveniffeeli
ngbetter.Missed
dosesshouldbet akenassoonaspossi bleunless
almosttimefornextdose;donotdoubl edoses.
Inst
ructpati
enttousecali
bratedmeasur i
ngdev i
ce

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 730
 wi
thli
qui
dprepar
ati
ons.Adv
isepat
ientt
hatshar
ing
t
hismedi
cat
ionmaybedangerous.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools)andall
ergy.

Instr
uctpat i
enttonoti
fyhealt
hcareprofessionali
f
feveranddi arr
headevelop,
especial
lyifdi
arrhea
containsblood,mucus,orpus.Adv i
sepatientnotto
treatdiarr
heawi t
houtconsul
tinghealt
hcar e
professional.

CERI
VASTATI
N
I
NDI
CATI
ONS
Adjuncttodi
etar
yther
apyi
nthemanagementofpr
imar
y
hyperchol
est
erol
emiaandmixeddy
sli
pidemi
as.

ACTI
ON
Inhibit
sanenzy me,3-hydroxy-
3-methylgl
utar
yl-
coenzyme
A( HMG- CoA)reductase,whichisresponsibl
efor
catalyzinganear l
ystepint hesynthesisofchol
esterol
.
Ther apeuticEff
ects:Lower i
ngoftotalandLDLchol ester
ol.
Sli
ghti ncreaseinHDLanddecr easeinVLDLchol esterol
andt ri
glyceri
des.Slowingoft heprogressi
onofcor onary

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 731
art
erydiseasewit
hresul
tantdecr
easeinmyocar
dial
i
nfarct
ion/str
okeandneedformyocardi
al
rev
asculari
zati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
amongagentsmayoccur ;Acti
veliverdi
sease;Concur
rent
useofazol
eantif
ungals(t
empor ail
ydiscont
inue
cer
ivast
ati
n);
Pregnancyorlact
ation.

UseCaut
iousl
yin:
Hist
oryofl
i
verdi
sease;
Alcohol
i
sm;
Renalimpairment(dosagereducti
onr ecommendedi fCCr
<60mL/ min);Severeacutei
nfecti
on;Hy potension;
Major
surgery
;Trauma; Severemetaboli
c,endocrine,or
el
ectrol
yteproblems;Uncontrol
ledseizures;Visual
dist
urbances;My opathy;
Womenofchi l
dbear i
ngage;
Chil
dren<18y r(safet
ynotestabli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, headache, i
nsomni a,weakness.EENT:
rhi
niti
s.Resp: bronchiti
s.GI:abdomi nalcramps,
constipati
on,diar r
hea,fl
atus,hear
t burn,alt
eredtast
e,dr
ug
-i
nducedhepat i
tis,dyspepsi
a,elevatedliverenzymes,
nausea, pancreatiti
s.GU:erecti
ledy sf
unct i
on.Derm:
rashes,pruri
tus.MS: RHABDOMYOLYSI S,arthr
algi
a,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 732
arthr
it
is,myal
gia,
myosi
ti
s.Mi
sc:
hyper
sensi
ti
vi
ty
reacti
ons.

I
NTERACTI
ONS
Drug-Drug: Chol esterol-lower i
ngef fectmaybeaddi tive
withbileaci dsequest rant s( cholestyramine,col
est i
pol).
Bioavailabilitymaybedecr easedbybi leacidsequest rants.
Riskofmy opat hyi sincr easedbyconcur r
entcyclosporine,
gemf i
br ozil,
cl ofi
brate,ery thromy cin, l
argedosesofni acin,
andazol eant i
fungal agent s(combi nedusewi th
cl
of i
brate,gemf i
brozilnotr ecommended) .Atorvastatin
mayi ncr easel evelsofor al contracept i
ves.Mayi ncrease
effect
sofwar fari
n.Lev elsmaybesi gnif
icantl
yincreased
byazol eant ifungal agent s(tempor ari
lydisconti
nueHMG-
CoAr educt asei nhibitor).Lev el
sar eincreasedby
erythr
omy ci n.
Dr
ug-
Food:
Foodenhancesbl
oodl
evel
sofl
ovast
ati
n.

DOSAGE
PO:
(Adul
ts)
:0.
3mgoncedai
l
yint
heev
eni
ng.

Renal
Impai
rment
PO:(Adul
ts)
:CCr<60mL/
min—0.
2mgoncedai
l
yint
he
eveni
ng.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 733
AVAI
LABI
LITY
Tabl
ets0.
2mg,
0.3mg;

PATI
ENTTEACHI
NG
Instr
uctpatientt
otakemedicati
onexactl
yasdirect
ed,
nottoski pdosesordoubleuponmisseddoses.
Medi cat
ionhelpscontr
olbutdoesnotcureel
evated
serum cholester
oll
evel
s.

Adv i
sepat ientthatthi
smedicationshoul
dbeusedin
conjunct i
onwi t
hdi etr
estr
ict
ions(fat
,chol
est
erol
,
carbohy drates,
alcohol)
,exer
cise,andcessat
ionof
smoki ng.

I
nstructpati
enttonotif
yhealt
hcar eprof
essi
onalif
unexplai
nedmuscl epain,
tenderness,
orweakness
occurs,especi
all
yifaccompaniedbyfeverormalai
se.

Advi
sepati
enttowearsunscreenandprotect
ive
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eacti
ons(rar
e).

Inst
ructfemalepati
entstonotif
yheal
thcare
prof
essionalpromptl
yifpregnancyi
splannedor
suspected.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 734
 Emphasizet
heimportanceoffol
l
ow-
upexamsto
deter
mineef
fect
ivenessandtomoni
torf
orsi
de
eff
ects.

CERTOLI
ZUMABPEGOL
I
NDI
CATI
ONS
Moderat
ely
-to-
sever
elyact
iveCrohn'
sdiseasewhen
r
esponsetoconventi
onalt
herapyhasbeeni nadequat
e.
Moderat
ely
-to-
sever
elyact
iverheumatoi
darthrit
is.

ACTI
ON
Neutral
izestumornecr osisfactor(TNF)
,apri
memedi at
or
ofinfl
ammat ion;pegylat
ionprov i
desalongdurati
onof
acti
on.TherapeuticEffects:
Decr easedsi
gns/symptoms
ofCrohn'sdisease.Decreasedpai nandswell
ing,
decreasedrateofjointdestruct
ionandimprovedphy si
cal
functi
oninrheumat oidarthr
iti
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Act
ivei
nfect
ion(
incl
udi
ngl
ocal
i
zed)
;
Concur
rentuseofanaki
nra.

UseCaut
iousl
yin:
Hist
oryofchr
oni
corr
ecur
rent
i
nfect
ionorunder
lyi
ngi
l
lness/
treat
mentpr
edi
sposi
ngt
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 735
i
nf ection; Historyofexposur et otuberculosis; Historyof
oppor tuni sti
cinf ection;Pat i
ent sresidi
ng, orwhohav e
resided, wher et uber culosis, hist
oplasmosi s,
cocci dioidomy coses, orblast omycosisisendemi c;Hist
ory
ofdemy elinat
ingdi sorders( mayexacer bate);Hist or
yof
hear tfailure;Ger i:May↑ r iskofi nfecti
ons; OB: Usei n
pregnancyonl yifcl earlyneeded; avoidbreast feeding;Pedi
:
Saf etynotest ablished; ↑r iskofl ymphoma( including
hepat ospl enicT- celllymphoma[ HSTCL]i npat i
ent swith
Crohn' sdi sease) ,leukemi a, andot hermal ignanci es.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Der m:psor i
asi s,skinreacti
ons( rarel
ysevere).Hemat :
hemat ologicr eact i
ons.MS: arthral
gia.Misc:all
ergic
reacti
onsi ncludi nganaphy laxis, I
NFECTIONS( i
ncluding
reacti
vationt uber culosisandot heropportuni
sti
c
i
nf ect
ionsduet obact eri
al,
inv asivefungal,vi
ral
,
my cobact er
ial, andpar asi
ti
cpat hogens),
MALI GNANCY( includinglymphoma, HSTCL, l
eukemi a,and
skincancer ),lupus- l
ikesyndr ome.

I
NTERACTI
ONS
Drug-Drug:Concurr
entusewithanaki
nra↑ ri
skofser
ious
i
nfections(cont
rai
ndicat
ed)
.Concurrentusewit
h
azathi
oprineand/ormethot
rexatemay↑ r i
skofHSTCL.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 736
May↓ ant
ibodyr
esponsetoor↑ r
iskofadver
se
r
eact
ionst
olivev
acci
nes(cont
rai
ndicat
ed)
.

DOSAGE
Cr
ohn'
sDi
sease
Subcut(
Adult
s):
400mginit
ial
ly
,repeat2and4wkl
ater
;
maybefoll
owedbymai
ntenancedoseof400mgevery4
wk.

Rheumat
oidAr
thr
it
is
Subcut(
Adult
s):400mginiti
all
y,r
epeat2and4wklat
er;
thenmaint
enancedoseof200mgev ery2wk(400mg
every4wkmaybeusedal t
ernati
vel
y).

AVAI
LABI
LITY
Lyophil
i
zedpowderf orsubcut
aneousi
nject
ion(
requi
res
reconst
itut
ion)200mg/vial
;Pr
efi
ll
edsyr
inge200mg/ mL;

PATI
ENTTEACHI
NG
Advi
sepatientofpotenti
albenefit
sandri
sksof
cer
tol
izumab.Advisepatientt
or eadtheMedi
cat
ion
Gui
depr i
ortostar
tingtherapy.

I
nfor
m pat
ientofr
iskofi
nfect
ion.Advi
sepat
ientt
o
not
if
yheal
thcareprof
essi
onalifsympt
omsof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 737
 i
nfect
ion(f
ever,cough,f
lu-
li
kesymptoms, oropen
cut
sorsores),
includi
ngTBorr eact
ivat
ionofHBV
i
nfect
ion,
occur.

Counsel
patientaboutpossi
bleri
skofl
ymphomaand
ot
hermalignanci
eswhi l
erecei
vi
ngcert
oli
zumab.

Advisepatienttonotif
yhealthcareprofessionali
f
si
gnsofhy persensiti
vityr
eacti
ons( r
ash,swol l
enface,
di
fficul
tybreathi
ng),orneworwor seningmedi cal
conditi
onssuchashear torneurol
ogicaldiseaseor
autoimmunedi sordersoccurandt oreportsignsof
bonemar rowdepr ession(br
uisi
ng,bleeding,or
persist
entfail
ure.

Instr
uctpatienttonotifyheal
thcareprofessionalof
allRxorOTCmedi cat
ions,vi
tamins,orherbal
productsbeingt akenandt oconsultheal
thcar e
professi
onal pr
iortotakinganyRx, OTC,vitamins,or
herbalproducts.

Advi
sepati
entt
onotif
yhealt
hcarepr
ofessi
onalif
pr
egnancyi
splannedorsuspect
edori
fbreast
feeding.

CETI
RIZI
NE
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 738
Reli
efofall
ergi
csymptomscausedbyhi
staminerel
ease
i
ncludi
ng:Seasonalandper
enni
alal
l
ergi
crhi
niti
s,Chr
oni
c
urt
icar
ia.

ACTI
ON
Ant agonizestheeffectsofhi stami neatH1-r
ecept orsit
es;
doesnotbi ndtoori nacti
vatehi st
ami ne.Ant
icholi
nergic
effectsar eminimal andsedat ionisdoser el
ated.
Ther apeuticEff
ects: Decreasedsy mpt omsofhi st
ami ne
excess( sneezing,rhinorr
hea, ocularteari
ngandr edness,
pruritus)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocet
ir
izi
ne,
hy
droxy
zineoranycomponent
;Lact
ati
on:
Excr
etedi
n
br
eastmil
k;notr
ecommendedforuse.

UseCaut
iousl
yin:
Pat
ient
swi
thhepat
icorr
enal
i
mpai r
ment( dose↓ recommendedifCCr≤31mL/minor
hepati
cf unct
ioni
si mpair
ed)
;OB:Pedi
:Saf
etynot
establ
ishedforpregnantwomenorchi
ldr
en<6mo; Ger
i:
Ini
ti
ateatlowerdoses.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
dizzi
ness,
drowsi
ness(
signi
fi
cantwi
thdoses>10

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 739
mg/
day
),f
ati
gue.EENT:
phar
yngi
ti
s.GI
:dr
ymout
h.

I
NTERACTI
ONS
Drug-
Drug: Addi
ti
veCNSdepr essi
onmayoccurwi t
h
al
cohol,opioi
danalgesics,orsedat
ive/
hypnoti
cs.
Theophyll
inemay↓ cl earanceand↑ toxici
ty.

DOSAGE
PO:(
Adult
sandchil
dren≥6y
r):
5–10mggi
venonceor
di
vi
dedtwicedai
l
y.
PO:(
Chi
l
dren2–5yr
):2.
5mgoncedai
l
yinit
ial
l
y,maybe↑
to5mgoncedai
l
yor2.5mgev
ery12hr.
PO:
(Chi
ldr
en1–2y
r):
2.5mgoncedai
l
y;maybe↑ t
o2.
5
mgever
y12hr.
PO:
(Chi
l
dren6–12mo)
:2.
5oncedai
l
y.
Hepat
ic/
Renal
Impai
rment
PO:
(Adul
tsandChi
ldr
en≥12yr)
:CCr≤31mL/mi
n,hepat
ic
i
mpair
mentorhemodi
aly
sis—5mgoncedai
ly
.
Hepat
ic/
Renal
Impai
rment
PO:
(Chi
l
dren6–11y
r):
star
tther
apyat<2.
5mg/
day
.

Hepat
ic/
Renal
Impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 740
PO:
(Chi
l
dren<6y
r):
usenotr
ecommended.

AVAI
LABI
LITY
Tablets5mgOTC, 10mgOTC; Capsul
es5mgOTC, 10
mgOTC; Chewabletablet
s( gr
ape)5mgOTC, 10mgOTC;
Orall
ydisintegr
ati
ngtablets10mg; Syr
up(banana-grape
andbubbl egum fl
avors)1mg/ mLOTC; I
ncombi nation
with:pseudoephedri
ne

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakemedi
cat
ionasdi
rect
ed.

Maycausedi zzi
nessanddr owsiness.Caut
ionpati
ent
toavoiddri
vingorotheracti
vi
tiesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

Advi
sepati
entt
oavoidt
akingal
coholorot
herCNS
depr
essant
sconcur
rent
lywit
hthi
sdrug.

Advi
sepat
ientthatgoodor al
hy giene,
frequentri
nsi
ng
ofmout
hwi thwater,andsugarlessgum orcandy
maymini
mi zedrymout h.Pat
ientshouldnot i
fydent
ist
i
fdrymout
hper sist
s>2wk.

I
nstr
uctpat
ienttocontactheal
thcar
eprofessi
onal
if
di
zzi
nessoccursorifsymptomspersist
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 741
CETUXI
MAB
I
NDI
CATI
ONS
Local lyorregionall
yadv ancedsquamouscel lcarci
noma
oftheheadandneckwi thradiati
on.Recur r
entor
met ast ati
csquamouscel lcarci
nomaoft heheadandneck
progr essingafterplatinum- basedtherapy .Epidermal
growt hf actorreceptor(EGFR)expr essingmet astati
c
colorect alcancerinpat i
ent swhohav enotr espondedto
i
rinotecanandoxal iplati
n.Met astat
iccol orectalcancer
(withi ri
notecan)whent umor sexpresst heEGFRandhav e
notr espondedorar ei nt
oleranttoiri
notecanal one.

ACTI
ON
Bi
ndsspeci fi
call
ytoEGFR, ther ebyprevent i
ngthebindi
ng
ofendogenousepi dermalgrowt hfactor(EGF).This
preventscellgr
owt handdif
f erenti
ationpr ocesses.
Combi nati
onwithirinot
ecanenhancesant it
umoref f
ect
s
ofir
inotecan.Therapeuti
cEff ects:Decreasedt umor
growthandspr ead.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocet
uxi
mabor
mur
ine(
mouse)pr
otei
ns;
Pat
ient
swhoset
umor
shav
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 742
KRASmutati
onsincodon12or13(notef
fect
ive)
;OB:
Lact
ati
on:
Pregnancyorl
act
ati
on.

UseCaut
iousl
yin:
Exposur
etosunl
i
ght(
mayexacer
bat
e
der
mat
ologi
ctoxi
cit
y);
Pedi
:Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Mostadverser
eact
ionsr
efl
ectcombi
nat
iont
her
apywi
th
i
ri
notecan
CNS: mal aise,depr ession,headache, i
nsomni a.EENT:
conjunctiviti
s.Resp: dy spnea, ↑ cough, int
ersti
ti
al l
ung
disease.CV: PULMONARYEMBOLI SM.GI :abdominalpain,
constipation,diarrhea, nausea, vomi ti
ng, anorexi
a,
stomat i
tis.GU: renal fail
ure.Der m: acnef orm dermatit
is,
hypertri
chosi s,naildisorder, pruri
tus, skindesquamat i
on,
skininfection.FandE: dehy drati
on, hy pomagnesemi a,
peripheraledema.Hemat :anemi a,l
eukopeni a.MS: back
pain.Met ab: weightl oss.Mi sc: I
NFUSI ONREACTI ONS,
fever,desquamat i
onofmucosal epitheli
um.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
Head&NeckCancerwi
thRadi
ati
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 743
I
V: (
Adults):400mg/ m2admi nister
ed1wkpr i
orto
i
niti
ati
onofr adiationtherapy,f
ollowedbyweekl y
maintenancedosesof250mg/ m2f ort
hedurati
onof
radi
ati
ont herapy.Compl eteinfusion1hrpriort
or adi
ati
on
ther
apy;dosemodi f
icati
onrecommendedf or
dermatologictoxicit
y .

HeadandNeckCancerMonot
her
apy
I
V: (Adult
s):400mg/m2i ni
ti
alloadi
ngdose,f
oll
owedby
weeklymai nt
enancedosesof250mg/ m2unt
ildi
sease
progressi
onorunacceptabl
etoxici
ty;
dosemodifi
cati
on
recommendedf ordermatol
ogictoxi
cit
y.

Col
orect
alCancer
I
V:(Adult
s):400mg/m2i ni
ti
all
oadingdose,f
ollowedby
weekl
ymai nt
enancedosesof250mg/ m2;dose
modif
icat
ionrecommendedfordermatol
ogictoxici
ty.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion2mg/
mL;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofcet
uxi
mabandpot
ent
ial
side
eff
ect
stopati
ent
.

Adv
isepat
ientt
orepor
tder
mat
ologi
cchangesand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 744
 si
gnsandsy mptomsofinf
usi
onreact
ions(
fev
er,
chi
ll
s,orbr
eathi
ngprobl
ems)promptl
y.

Cauti
onpati
enttowearsunscreenandhat
sandl
i
mit
sunexposureduri
ngther
apyduringandf
or2mo
fol
l
owinglastdoseofcetuxi
mab.

Advisebothfemal eandmalepati
ent
stouse
adequatecontracepti
onduri
ngandfor6mofol
lowi
ng
ther
apyandt oav oidbr
east
feedi
ngduri
ngandf
or2
mof oll
owingtherapy.

CEVI
MELI
NE
I
NDI
CATI
ONS
Tr
eat
mentofthesympt
omsofdr
ymout
hassoci
atedwi
th
Sj
ögr
en'
ssyndrome.

ACTI
ON
Directchol
inergic(muscar
ini
c)eff
ectsresultonincreased
secreti
onofexocr i
negl
andsincl
udingsali
varyandsweat
glands,andincreasedsmoothmuscl etoneinthe
gastroi
ntestinalanduri
nar
ytract
s.Therapeuti
cEf f
ects:
Impr ov
edsy mpt omsofdrymouthinpat i
entswith
Sjögren'
ssy ndrome.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 745
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Whenmi
osi
sis
undesi
rabl
e(acuteir
it
is,
angl
e-cl
osur
egl
aucoma)
;
Lactat
ion:
Discont
inueorbot
tl
efeed.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
seasei
ncl
udi
ng
anginapect ori
sorhistor
yofMI ;Pul
monar ydisease
i
ncludingast hma,chroni
cbr onchiti
s,orchronic
obstructi
vepulmonar ydisease;Nephroli
thi
asisor
choleli
thi
asis;Geri
:Maybemor esensit
ivetotoxici
ty;
OB:
Useonl yifpotenti
albenefitj
ustif
iespotenti
alri
sktothe
fet
us; Pedi:Safet
ynotest abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: coughing.EENT:rhi
nit
is,
visualdist
urbances.GI
:
nausea,diarr
hea,excessi
vesali
vation.Derm:excessi
ve
sweating,hotfl
ashes.

I
NTERACTI
ONS
Drug-Drug:Concurr
entbetabl ockertherapymay↑ t he
ri
skofcar di
acconduct i
ondisturbances.Additi
ve
parasympat het
icandmuscar ini
cef f
ectsmayoccurwi th
drugsthathav eparasy
mpat heticormuscar i
nicproper
ti
es.
Drugst hati
nhibi
tCYP2D6andCYP3A3/ 4li
verenzymes
mayi nhibi
tthemetabolism ofcevimelineand↑ its

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 746
ef
fect
sandr
iskoft
oxi
cit
y.
Drug-NaturalProduct:
St .John'
swortmay↑ the
metabolism ofcev i
melineand↓ it
slevel
s.Angel
'
s
tr
umpet ,ji
msonweed, andscopoli
amayantagonize
choli
nergiceffects.

DOSAGE
PO:
(Adul
ts)
:30mg3t
imesdai
l
y.

AVAI
LABI
LITY
Capsul
es30mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakecev
imel
i
neasdi
rect
ed.

Maycausevi
sualdist
urbances,especi
all
yatni
ght
,
t
hatcoul
dimpairabil
i
tytodrivesafel
y.

Advisepat
ientt
odri
nkextr
awaterifsweat
ing
excessi
vel
y.Maycausedehydr
ati
on.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 747
 Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

CHLORALHYDRATE
I
NDI
CATI
ONS
Shor
t-t
erm sedativ
eandhy pnoti
c(eff
ecti
veness
decr
easesafter2wkofuse) .Sedati
onorr educt
ionof
anxi
etypr
eoper ati
vely(
anesthet
icadj
unct)orpri
orto
di
agnosti
cpr ocedures.

ACTI
ON
Convert
edt otrichl
oroet
hanol,
whichistheacti
vedrug.
Hasgener al
izedCNSdepr essantproper
ti
es.Ther
apeuti
c
Ef
fects:Sedationorinduct
ionofsleep.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erecar
diac
di
sease; Sever
er enalimpair
ment(ClCr<50mL/ min);
Comaorpr e-
existingCNSdepression;Uncontr
olledsever
e
pain;OB:Crossespl acent
a;chr
onicusedur i
ngpr egnancy
maycausewi t
hdr awalsymptomsint heneonate;
Lactati
on:Excretedinhumanmi lk,
usebynur singmot her
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 748
maycausesedat ioni
nt heinfant;Esophagit
is,
gastr
it
is,
or
ulcerdisease;Pr
octit
is(rectaluse);Tar
trazi
ne
hypersensiti
vi
ty(somer ectalproducts)
;Impaired
respir
atoryfunct
ion;Sleepapnea.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Hist
oryof
sui
cideatt
emptorsubst
anceabuse; Obstr
uct
ivesl
eep
apnea;Pedi:
Maycausedir
ecthyper
bili
rubi
nemiain
neonates;
Geri:
Pedi
:Dosagereduct
ionrecommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: excesssedat i
on,disori
entati
on, di
zziness, hangover,
headache, incoordinati
on,irr
it
abili
ty,
paradoxi cal exci
tat
ion
(chil
dren).Resp: respi
ratorydepression.GI:diarrhea,
nausea, v
omi t
ing,fl
atul
ence.Der m: r
ashes.Mi sc:
toler
ance, physicaldependence, psychological
dependence.

I
NTERACTI
ONS
Drug-Drug:Addi t
iveCNSdepr essionwi thotherCNS
depressants,includingalcohol,antihist
amines,
anti
depressant s,sedat i
ve/hy
pnot i
cs, andopioid
analgesics.Maypot enti
atewarf ar
in.Whengi venwi t
hin24
hrofIVf urosemide, maycausedi aphor esi
s,changesinBP,
andf l
ushing.Mayi ncreasemet abolism anddecrease

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 749
eff
ect
sofphenytoi
n.Mayi
ncr
easet
oxi
cit
yofi
fosf
ami
de
andcycl
ophoshamide.
Drug-Natur
alProduct:
Concomitantuseofkava-kav
a,
val
erian,
skull
cap,chamomile,
orhopscani ncr
easeCNS
depressi
on.

DOSAGE
PO: (
Adult
s):Hypnoti
c—500–1000mg15–30mi nbef
ore
bedti
me.Preoperat
ivesedat
ion—500mg–1000mg30mi n
beforesur
gery.Day
timesedati
on—250mg3t i
mesdail
y.
Singl
edose/dail
ydoseshouldnot>2g.
PO:(Ger
iat
ri
cPat
ient
s):
Hypnot
ic—250mg15–30mi
n
bef
orebedti
me.
Rect(Adul
ts)
:Sedat
ion—325mg3t i
mesdail
y.
Hypnoti
c—500–1000mg.Singl
edose/dai
l
ydoseshoul
d
not>2g.
PO:Rect( Childr
en>1mo) :Pre-
electroencephalogram
sedation—20–25mg/ kg30–60mi nprior.Sedationpri
ort
o
dental/medicalprocedures—50–75mg/ kg30–60mi n
pri
or;mayr epeatwi t
hin30mi nifneeded; si
ngledose
shouldnotexceed1gt otalf
orinfantsor2gt otalfor
chi
ldren.Hy pnoti
c—50mg/ kg;maxi mum 2g/ day.
Sedation/anxiet
y:25–50mg/ kg/daydi vi
dedq6–8hr ;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 750
maxi
mum 500mg/
dose.
PO:
Rect(
Neonat
es)
:25mg/
kg/
dosepr
iort
oapr
ocedur
e.

AVAI
LABI
LITY
Capsul
es500mg;
Syr
up500mg/
5mL;
Supposi
tor
ies325
mg,500mg;

PATI
ENTTEACHI
NG
Instructpat
ienttot akechl
oralhydrateexactlyas
directed.Misseddosesshoul dbeomi t
ted;donot
doubl edoses.Ifusedf or2wkorl onger,abrupt
withdrawalmayr esul ti
nCNSexci tement,tr
emor ,
anxiety,hal
luci
nations,anddeli
ri
um.

Chlor
alhy
dr atecausesdrowsi
nessanddizzi
ness.
Cauti
onpatienttoavoi
ddr i
vi
ngorotheract
ivi
ti
es
requi
ri
ngalert
nessuntilr
esponsetomedicat
ionis
known.

Cautionpat i
entthatconcurrentalcohol usemay
createanaddi t
iveeffectthatresult
sint achycardi
a,
vasodilat
ion,fl
ushing,headache,hypot ensi
on, and
pronouncedCNSdepr essi
on.Alcohol andotherCNS
depressantsshoul dbeav oidedwhiletakingchl or
al
hydrate.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 751
 Advi
sepat ienttodiscont
inueuseandnot i
fyhealt
h
car
epr ofessional
ifskinrash,di
zzi
ness,i
rr
itabi
li
ty,
i
mpairedt houghtprocesses,headache,
ormot or
i
ncoordinationoccurs.

Teachsl
eephy gi
enetechni
ques(
darkroom,qui
et,
bedti
meritual
,l
imi
tdayti
menapping,
avoidni
coti
ne
andcaff
eine).

Chl
orambuci
l
I
ndi
cat
ions
Chr
oni
clymphocyt
icl
eukaemia;somenonHodgki n’
s
l
ymphomas;Hodgki
n’
sdisease,
ov ar
iancancerand
Wal
denst
rom (
pri
mary)macrogl
obuli
naemia.

ACTI
ON
Analkyl
ati
ngagentt hati
nter
fereswit
hcel l
ularprotei
n
sy
nthesis(cel
l-
cyclephase–nonspeci
fi
c).Ther apeuti
c
Ef
fects:
Deat hofrapidl
yrepl
icati
ngcel
ls,parti
cularl
y
mali
gnantones.

Av
ail
abi
l
ty
TABLETS2and5mg.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 752
DOSAGE
Adult-Chroni
clymphocy t
icleukaemia:i
nit
ial
ly150µg/ kg
bodywei ghtdail
yuntil
leucocytecountsuffi
cientl
y
reduced.Maintenance(star
ted4weeksaf terf i
rstcour
se)
100µg/ kgbodywei ght.
Waldar
str
om’smacr
oglobul
inaemi
a:6t
o12mgdai
lyunt
il
l
eucopeni
aoccur
s,t
henreduceto2to8mgdai
l
y.
Chi
l
d-Notr
ecommended.

Cont
rai
ndi
cat
ions
Seenot
esaboveandconsultl
it
erat
ure;
hyper
sensi
ti
vi
ty;
por
phyr
ia;
pregnancyandl
actat
ion.

I
NTERACTI
ONS
Drug-
Drug:Addit
ivebonemar r
owdepr essionwit
hot her
bonemarrowdepr essant
s( anti
neopl
astics)or
i
mmunosuppr essantagents.May↓ ant ibodyresponseto
l
ive-
vir
usvacci
nesand↑ t her iskofadversereacti
ons.
Drug-Natur
alPr
oduct
:Concomi
tantusewi
thast
ragal
us,
echinacea,
andmelat
oni
nmayinterf
erewi
th
i
mmunosuppr essi
on.

Pr
ecaut
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 753
Seenotesaboveandconsul
tli
ter
atur
e;r
enal
impai
rment
;
hepat
icimpai
rment.

Adv
erseEf
fect
s
Seenotesabov
eandconsul
tli
teratur
e.Hepatot
oxi
cit
y;
peri
pheral
neur
opat
hy;
cysti
ti
s;seizur
es;pul
monary
fi
brosi
s.

PATI
ENTTEACHI
NG
Instructpati
entt otakemedi cat
ionexactlyasdirected,
eveni fnauseaorv omi t
ingisapr oblem.Consult
healthcarepr ofessional i
fvomitingoccursshor t
ly
afterdoseist aken.Ifadosei smi ssedandt he
medi cati
onisor dereddai ly,
takewhenr emember ed
l
at erthatday.Iforder edmor efrequentl
y,takeas
soonaspossi bleunl essalmostt imefornextdose.
Donotdoubl edoses.

Instructpat ienttoreportunusualbl
eedingorbr ui
sing.
Adv isepat i
entofthrombocy t
openiaprecauti
ons(use
sof ttoot hbrush,el
ectri
crazor,andavoidfal
ls;donot
drinkal cohol i
cbev er
agesort akemedicati
on
cont ainingaspi r
inorNSAI Dsbecauset heymay
preci pi
tat egastri
cbleeding)
.

Caut
ionpat
ientt
oav
oidcr
owdsandper
sonswi
th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 754
 knowninfecti
ons.Heal t
hcareprofessi
onalshoul
dbe
i
nformedimmedi atel
yifsymptomsofinfecti
on(fev
er,
sorethr
oat,chil
ls,cough,hoar
seness,l
owerbackor
si
depain,diff
icultorpainf
ulur
inat
ion)orrashoccurs.

Inst
ructpati
entt oinspectoralmucosaforredness
andulcerat
ion.Ifmout hsoresoccur,advi
sepatientto
usespongebr ushandr i
nsemout hwithwaterafter
eati
nganddr inking.Stomati
tismayrequir
et r
eatment
withopioi
danal gesics.

Advisepatientsonlong-
termt her
apytonoti
fyheal
th
careprofessional
immedi at
elyifcough,
short
nessof
breath,
andf everoccur.

I
nstructpat
ientt
oinfor
m heal t
hcareprof
essionalif
nauseaandv omit
ingpersi
st.Anti
emeti
csmaybe
used,alt
houghthesesi
deef fect
susual
lylastless
than1dayandt endtodecreasewithconti
nued
ther
apy.

Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

Thisdrugmaycausei rr
ever
sibl
egonadalsuppression;
howev er
,pati
entshoul
dstil
lusebirt
hcontr
ol.I
nstruct
pati
enttoinfor
m healt
hcareprofessi
onal
if
pregnancyissuspect
ed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 755
 I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

CHLORAMPHENI
COL
I
ndi
cat
ions
Severelif
e-threateninginfecti
ons, parti
cularl
ythose
causedbyHaemophi l
usi nf
luenzaeandt yphoidfever;
cerebralabscess; mast oidi
ti
s;relapsingfever;gangrene;
granulomai nguinale;l
isteri
osis;severemel ioi
dosis;pl
ague;
psit
tacosis;tular
aemi a;Whi pple’
sdi sease;septi
caemi a;
empi r
icaltr
eat mentofmeni ngiti
s;ocularinfecti
on.

ACTI
ON
I
nhi bit
sproteinsynthesisinsuscept i
blebacteriaatthe
l
ev elofthe50Sr i
bosome.Ther apeuticEf f
ects:
Bact er
iostat
icaction.Spectrum: Wi dev ari
etyofgr am-
positiveaerobicorganismsi ncluding:Streptococcus
pneumoni aeandot herstr
ept ococci,Someent erococci
(especiall
yv ancomy ci
n-r
esistant).Gram- negative
pathogens: Haemophi lusinfl
uenzae, Nei sseri
a

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 756
meningit
idis,Sal
monella,Shigel
l
a.Anaerobes:Bact
eroi
des
f
ragil
is,
Pr evotel
l
amel aninogeni
ca.Otherorgani
sms
i
nhibi
ted:Rickett
sia,
Chl amydia,Mycopl
asma.

Av
ail
abi
l
ity
CAPSULES250and500mg;
SyRUP125mg/
5ml
;
I
NJECTION250and500mg/vi
al.

DOSAGE
Or
al
i
ntr
amuscul
arori
ntr
avenousi
nject
ionori
nfusi
on
Adult-50mg/kgbodyweightinfourdi
v i
deddoses(
canbe
doubledinv
erysever
einfect
ions,sept
icaemia,
meningi
ti
s,
reduceassoonascli
nical
lyi
ndicated)
.
Chil
d-Haemophi l
usepigl
oti
ti
sandpyrogeni
cmeningi
tis:
50to100mg/ kgbodywei ghtdai
lyi
ndivi
deddoses(can
bedoubledinsevereinf
ecti
ons,r
educeassoonas
cl
ini
cal
lyindi
cated).

Cont
rai
ndi
cat
ions
Pregnancyporphyr
ia;
blooddy scrasi
as,
preexi
sti
ngbone
marrowdepressi
on;hypersensit
ivi
ty;
pati
entsr
eceiv
ing
radi
ati
onther
apy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 757
I
NTERACTI
ONS
Drug- Dr
ug: May↑ ef f
ectsofthefol
lowingdrugs: or
al
hypogl y
cemi cagents,warf
arin,
andpheny t
oin.
Phenobar bit
alorri
fampinmay↓ chl orampheni colblood
l
ev els.Maydel ayr
esponset ovit
aminBorf oli
caci d
therapy.Bonemar rowdepr essi
onmaybeaddi t
ivewi th
bonemar row-depr
essingagents(anti
neoplast
ics).

Pr
ecaut
ions
Avoidrepeat
edcour sesandprolongeduse;reducedosei n
hepati
cimpairmentandsev ererenalimpair
ment ;blood
countsrequi
redbef or
eandduringtreatment;monitor
pl
asmaconcent rati
onsinneonates(seebelow);lactati
on
i
nteracti
onsregularbl
oodcount;overgrowthofnon-
suscept
ibl
eor
gani
sm mayoccur
;sei
zur
edi
sor
der
s.

Adv
erseEf
fect
s
Bonemar
rowdepr
essi
on-
rev
ersi
bleand
i
rreversi
bl eapl asti
canaemi a(wit
hr eport
sof
l
eukaemi a),anaemi a,l
eukopeniaand
thrombocy topenia;noctur
nalhaemogl obinur
ia;
peripheral neurit
isandopt i
cneurit
is;nausea,
vomi t
ing, diarr
hoea, dr
ymout h,st
omat it
is,gl
ossit
is;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 758
headache, depression;hy persensi ti
vityreactions
i
ncluding,rashes,fever,angi oedemaandr arely,
anaphy l
axis;greybabysy ndrome( v omi t
ing,greenish
di
arrhoea,abdomi naldistensi on,hypot hermia, pal
li
d
cyanosis,i
rregularrespiration, cir
culatorycol l
apse)
mayf oll
owexcessi vedosesi nneonat eswi th
i
mmat urehepat i
cmet abol ism; al
sor epor t
edi n
i
nfantsbor nt omot herstreat edi nlatepr egnancy ;
ocularir
rit
ation,angioneur eti
cedema.

St
orage
Capsule:
Storepr
otect
edfr
om moist
ure.Sy
rupand
I
nject
ion:St
oreprot
ectedf
rom l
i
ghtandmoist
ure.

CHLORDI
AZEPOXI
DE
I
NDI
CATI
ONS
Adj
unctmanagementofanxi
ety.Tr
eat
mentofalcohol
wit
hdr
awal.Adj
unctmanagementofanxi
etyassoci
ated
wit
hacut
emy ocar
dial
inf
arct
ion.

ACTI
ON
Act
satmanyl
evel
soft
heCNSt
opr
oduceanxi
oly
tic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 759
eff
ect.DepressestheCNS, pr
obabl
ybypotent
iat
ingGABA,
aninhibi
tor
yneur ot
ransmit
ter
.Ther
apeut
icEff
ects:
Sedati
on.Reliefofanxi
ety
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Somepr
oduct
s
containtartrazineandshoul dbeav oi
dedinpat i
ent
swi th
knowni ntolerance; Cross-
sensitiv
itywithother
benzodiazepi nesmayoccur ;Comat osepat i
entsorthose
wit
hpr e-existingCNSdepr ession;Uncontrol
ledsevere
pai
n; Pulmonar ydisease;Angle-cl
osureglaucoma;
Porphyria;OB: Lactat
ion:MaycauseCNSdepr essi
on,
fl
accidit
y ,f
eedi ngdi f
fi
cult
ies,andwei ghtl
ossininfants;
Pedi:Children≤6y r.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Sev
erer
enal
i
mpai r
ment;Hist
or yofsuicideattemptorsubst ance
abuse;Geri
:Long-acti
ngbenzodi azepinescause
prol
ongedsedationintheel derl
y.AppearsonBeer sli
st
andisassociat
edwi thincreasedr i
skoffalls(↓ dose
requi
redorconsidershor t
-acti
ngbenzodi azepi
ne);
Debil
it
atedpati
ents(ini
tialdose↓ r equir
ed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
dizzi
ness,
drowsi
ness,
hangov
er,
headache,
ment
al

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 760
depression, paradoxicalexci
tation,sedation.EENT:
bl
urredv ision.GI:consti
pat i
on,diarrhea,nausea,vomit
ing,
weightgai n.Der m:rashes.Mi sc:phy si
caldependence,
psychological dependence, t
olerance.

I
NTERACTI
ONS
Drug-Drug: Alcohol,anti
depressants,anti
histami nes,and
opioidanalgesi cs—concurrentuser esul
tsinaddi t
iveCNS
depression.Ci metidine,
oralcontracepti
ves, disulf
iram,
fl
uoxetine,isoniazid,ket
oconazole,met oprolol,
propranolol,orv al
proicacidmayenhanceef fects.May↓
effi
cacyofl ev odopa.Rifampinorbar bit
uratesmay↓
effecti
venessofchl ordi
azepoxide.Sedativeef fectsmay
be↓ byt heophy ll
i
ne.
Drug-
Natur
alPr
oduct:Concomi
tantuseofkav
a-kava,
val
eri
an,
chamomile,
orhopscan↑ CNSdepr essi
on.

DOSAGE
PO:(Adult
s):Alcohol
withdr
awal—50–100mg, r
epeat
ed
unt
ilagi
tati
oniscontr
oll
ed(upto400mg/ day
).
Anxi
ety—5–25mg3–4t i
mesdaily.
PO:
(Ger
iatr
icPat
ientsorDebi
li
tat
edPat
ient
s):Anxi
ety
—5
mg2–4timesdai
lyinit
ial
l
y,i
ncr
easedasneeded.
PO:
(Chi
l
dren>6y
r):
Anxi
ety
—5mg2–4t
imesdai
l
y,upt
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 761
10mg2–3t
imesdai
l
y.

AVAI
LABI
LITY
Capsules5mg,10mg,25mg;Incombinati
onwit
h:
amit
ripty
li
ne(
Limbi
tr
ol,
Limbi
tr
olDS),
clidi
nium

PATI
ENTTEACHI
NG
Inst
ructpatienttot akechlordiazepoxideasdirected.
Ifmedicati
oni slessef f
ectiveaf t
eraf ewweeks,
checkwi t
hheal thcar eprofessional
;donoti ncrease
dose.Medi cati
onshoul dbet aperedatthecompl etion
oflong-t
ermt herapy .Suddencessat ionofmedi cati
on
mayl eadtowi thdrawal (
insomni a,i
rri
tabi
li
ty,
nervousness,tremor s).

Adv
isepat
ientnott
oshar
emedi
cat
ionwi
thot
her
s;
maybedangerous.

Maycausedr owsi
nessordizziness.Cauti
onpati
ent
toavoiddri
vingorotheracti
vi
tiesrequir
ingal
ert
ness
unti
lresponsetomedi cat
ionisknown.

Adv
isepati
enttoav
oidtheuseofal
cohol
andot
her
CNSdepressant
sconcurr
ent
lywi
ththi
smedi
cat
ion.

Instr
uctpat
ientt
onotifyheal
thcar
eprofessional
of
allRxorOTCmedi cat
ions,vi
tami
ns,orherbal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 762
 productsbeingtakenandtoconsul
theal
thcar
e
professi
onalpri
ortotaki
nganyRx,OTC,vi
tami
ns,
or
herbalproduct
s.

I
nstr
uctpat
ientt
onoti
fyhealt
hcareprofessi
onal
if
pr
egnancyi
splannedorsuspect
ed,orif
br
eastf
eedi
ng.

CHLORHEXI
DINE
I
ndi
cat
ions
Ant
isept
ic;
disi
nfect
ionofcl
eani
nst
rument
s;gi
ngi
vi
ti
s.

Av
ail
abi
l
ity
SOLUTION100ml
(2%and4%w/
v);
MOUTHWASH100
ml(0.
2%,w/v)
.

DOSAGE
Anti
septi
c(pre-operat
iveskindisi
nfect
ionandhand
washing)
:usesol ut
ioninalcohol(70%).Ant
isept
ic
(wounds,burnsandot herski
ndamage) :
apply0.
05%
aqueoussoluti
on.
Di
sinfect
ionofcl
eaninst
ruments:i
mmerseforatleast30
mi
ni n0.05%solut
ioncontai
ningSodi
um ni
tr
it
e0.1%( t
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 763
i
nhi
bitmet
alcor
rosi
on)
.Emer
gencydi
sinf
ect
ionofcl
ean
i
nst
rument
s:immersef
or2mini
n0.5%solut
ioni
nalcohol
(
70%).

Cont
rai
ndi
cat
ions
Meni
ngi
ti
s;mi
ddl
eearsur
ger
y;sensi
ti
vet
issues.

Pr
ecaut
ions
Aqueoussol uti
ons-suscept i
blet omi crobialcontami nati
on
-usest eri
li
zedpr eparationorf reshlypreparedsol uti
onand
av oidcont aminat i
ondur i
ngst orageordi lut
ion;
i
nst rument swi thcement edgl asscomponent s(avoid
pr epar
at i
onscont ai
ningsur faceact i
veagent s);i
rri
tant-
av oidcont actwi t
hmi ddleear ; eyes;brainandmeni nges;
notf orusei nbodycav i
ties;al coholicsoluti
onsnot
sui t
ablebef oredi at
her my ;syringesandneedl estreated
wi thchlorhexidine(rinset hor oughl ywithsterilewateror
sal i
nebef oreuse) ;i
nact ivatedbycor k( useglass; pl
asti
c
orr ubbercl osures);alcohol basedsol utionsar e
flammabl e; pregnancy .

Adv
erseEf
fect
s
Occasionalski
nsensi
ti
vi
tyandi
rr
it
ati
on;
Upperr
espi
rat
ory
t
ractinfect
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 764
St
orage
St
orepr
otect
edf
rom l
i
ght
.

CHLOROQUI
NE
I
ndi
cat
ions
Treatmentofacut emalari
acausedbyP.mal ari
ae
andsuscept ibleP.fal
ciparum; P.v i
vaxandP.ov al
e
(foll
owedbypr i
maqui netoeli
mi nateintrahepati
c
forms);prophy l
axisofmalariaforpr egnantwomen
andnoni mmunei ndiv
idual
satr isk;rheumat i
c
disorders.Treatmentofext r
aintesti
nal amebiasis.
UnlabeledUses: Treatmentofsev ererheumat oi
d
arthri
ti
s.Treatmentofsy st
emi clupuser ythematosus.

ACTI
ON
Inhibi
tspr ot
einsynthesi
sinsuscept i
bleorganisms
byinhibiti
ngDNAandRNApol ymerase.Therapeuti
c
Effect
s: Deathofpl asmodi
ar esponsibl
eforcausing
mal ar
ia.Deathofamoebar esponsibleforcausing
amebi asis.I
mpr ovementininfl
ammat i
onin
rheumat oidarthri
ti
sandsy st
emi clupus

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 765
er
ythemat
osus.

Av
ail
abi
l
ity
TABLETS250and500mg;I
NJECTI
ON10and30ml
(40mg/ml)
;SUSPENSI
ON50mg/ml.

DOSAGE
Or
al
Adult
-Immedi
atel
y600mg,aft
er6h300mg
fol
l
owedby300mgdai l
yfor2days.
Chil
d-10mg/ kgbodywei
ghtf
oll
owedby5mg/kg
bodyweightaft
er6h,t
her
eaft
eronceadayf
or2
days.
I
ntr
amuscul
ari
nject
ion
Adul
t-10mlfol
l
owedby5ml
aft
er6h.Ther
eaf
ter5
mldail
yfort
wodays.
Chil
d-5mg/
kgbodyweightadmi
nist
eredev
ery12h
fol
l
owedbyoral
ther
apy
.

Cont
rai
ndi
cat
ions
Sev
erehaemat
ologi
cdi
str
essorgast
roi
ntest
inal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 766
di
str
ess;
eyedy
sfunct
ion;
li
verdi
sease.

I
NTERACTI
ONS
Drug- Dr ug: Ant acidsmay↓ absor pti
on( separ ate
admi ni strationoft heseagent sbyatl east4hr ).
Bloodl ev elsmaybe↑ by
cimet idine, f
luconazol e,ketoconazol e,clarithromy cin,
erythromy cin,fluoxet i
ne, nef azodone, par oxet i
ne,pr ote
asei nhi bitors, quinidine, r
itonav ir
,andv erapami l
(concur rentusewi thci met idine,shoul dbeav oided) .
May↓ absor ptionofampi cil
lin(separ at e
admi ni strationoft heseagent sbyatl east2hr ).May
↑ bl oodl evel sof
cyclospor ine, fl
uoxet ine, l
idocai ne,mirtazapi ne,nef azo
done, par oxet i
ne, r
isper idone, ri
tonav i
r,thioridazine, t
ric
ycli
cant i
depr essant s, andv enlafaxine.Bl oodl ev els
maybe↓ by
carbamazepi ne, nev i
rapi ne,phenobar bital,
pheny toin,
andr ifampi n.May↑ t her iskofhepat otoxi ci
tywhen
admi ni steredwi thot herhepat otoxicagent s.Ur inar y
acidifiersmay↑ r enal excr eti
onand↓
effectiv eness.Concur rentusewi t
hmef l
oqui nemay
↑r i
skofsei zur es.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 767
Drug-
Food:Foodsthataci
dif
yur
inemay↑ excr
eti
on
and↓ eff
ecti
veness.

Pr
ecaut
ions
Ifpat i
entcont i
nuest odet eriorateaf terchl oroquine-
suspectr esi
st anceandadmi ni sterquinine
i
nt ravenousl yasemer gencymeasur e;hepat ic
i
mpai rment ;
r enal i
mpai rmentpr egnancy( buti n
mal aria, benef itconsideredt oout weighr isk;
l
act ationmayexacer batepsor iasis;neur ological
disorder s(avoi dforpr ophylaxisi fhistoryof
epilepsy ); mayaggr avatemy ast heniagr avis;severe
gast rointestinal disor
der s;G- 6-PDdef i
ciency ;avoid
concur rentther apywi thhepat otoxicdr ugs;
i
nt eract i
ons.

Adv
erseEf
fect
s
Headache, gastr
ointestinaldi
sturbances;also
convul
sions; v
isualdisturbances( r
eti
nopathy
associ
atedwi thlong-term, hi
ghdoset herapyor
i
nappropri
at eselfmedicat i
on);depigmentationor
l
ossofhai r;r
ashes;pr urit
us-maybecomei ntoler
able;
bone-marrowsuppr ession; hypersensi
ti
vi
tyr eact
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 768
suchasur t
icar
iaandangioedema;atr
iov
entr
icul
ar
block(mayber esul
tofinappr
opri
atesel
f-
medication);porphy
riaandpsori
asi
sinsuscepti
ble
i
ndividuals.

PATI
ENTTEACHI
NG
Instructpati
enttot akemedi cati
onexactlyas
directedandcont inuefullcourseoftherapy,
eveni ffeel
ingbetter.Misseddosesshoul dbe
takenassoonasr emember ed,exceptwit
h
regimensr equiri
ngdosesmor ethanonceaday ,
forwhi chmi sseddosesshoul dbetakenwithi
n1
hroromi t
ted.Donotdoubl edoses.
Reviewmet hodsofmi nimizingexposur eto
mosqui toeswithpati
entsreceivingchloroqui
ne
prophylacti
call
y(useinsectrepellent
,wearlong-
sl
eev edshirtandlongtrousers,usescreenor
nett
ing).
Advisepati
entstoavoi
duseofal
cohol
whi
l
e
taki
ngchloroqui
ne.
Caut
ionpat
ientt
okeepchl
oroqui
neoutoft
he

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 769
 r
eachofchi
ldr
en;f
atal
i
tieshav
eoccur
redwi
th
i
ngest
ionof3or4tabl
ets.
Explai
nneedforper i
odicophthal
micexamsf or
pati
entsonprolongedhigh-dosetherapy.Advise
pati
entthatt
her i
skofocul ardamagemaybe
decreasedbytheuseofdar kgl
assesinbright
l
ight.Prot
ect
iveclothi
ngandsunscr eenshould
alsobeusedtor educeriskofdermatoses.
Adv isepat i
entt onotifyhealthcarepr ofessi
onal
prompt l
yifsor ethroat,f
ev er
,unusual bleeding
orbr uising,blurr
edv isi
on, di
ffi
cultyreading,
visual changes, ri
ngingint heears, di
ffi
culty
hear ing,ment alchanges, ormuscl eweakness
occur sorifdiarr
hea, anorexi
a, nausea,stomach
pain, vomi t
ing,orrashbecomespr onouncedor
bot hersome.Mostadv ersereactionsar edose
related.
Advisef
emalepat
ientt
onoti
fyhealt
hcare
prof
essi
onalofpr
egnancyi
splannedor
suspect
ed,ori
fbr
eastf
eedi
ng.
Rheumat
oidAr
thr
it
is/
Syst
emi
cLupus

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 770
 Eryt
hematosus:I
nst
ructpatienttocontact
healt
hcareprof
essi
onalifnoi mprovementis
noti
cedwithi
nafewday s.Treatmentmay
requi
reupto6mof orfullbenefi
t.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

CHLOROTHI
AZI
DE
I
NDI
CATI
ONS
Managementofmi ldtomoderat
ehy per
tensi
on.
Treatmentofedemaassoci
atedwith:HF,Renal
dysfuncti
on,
Cirr
hosis,
Cor
ti
coster
oidtherapy,
Estr
ogen
therapy.

ACTI
ON
Incr
easesexcreti
onofsodium andwat erbyinhibi
ti
ng
sodium r
eabsorpti
oninthedistal
tubule.Promotes
excret
ionofsodium,chlori
de,pot
assium, magnesium,
phosphate,water
,andbicarbonat
e.Maypr oducear t
eri
olar
dil
ati
on.Therapeuti
cEffect
s:Loweri
ngofBPi n
hypert
ensiv
epat i
entsanddiuresi
swithmobi l
izati
onof
edema.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 771
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty(
cross-
sensi
ti
vi
ty
withotherthi
azi
desorsulfonami
desmayexi
st);Some
productscontai
ntart
razi
neandshoul
dbeavoidedin
pati
entswithknownintol
erance;
Anur
ia;
Lact
ation:
Disconti
nueorbottl
efeed.

UseCaut
iousl
yin:
Renal
orhepat
ici
mpai
rment
;OB:
May
causejaundiceort
hrombocyt
openiai
nnewborn;Pedi
:
Maycausej aundi
ceorthr
ombocytopeni
ainnewborn;
Ger
i:
Mayhav e↑ r i
skofsi
deeff
ectsduetoage-
rel
ated↓ i
n
renal
functi
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, drowsiness, l
ethargy, weakness.CV:
hy potension.GI :anorexia,crampi ng, hepat i
ti
s,nausea,
vomi ting,pancreat i
ti
s.Der m: photosensi tivi
ty,rashes.
Endo: hypergly
cemi a.FandE: hypokal emi a,dehy drati
on,
hy percalcemia, hypochloremi calkalosi s,
hy pomagnesemi a,hyponat remia,hy pophosphat emi a,
hy povolemia.Hemat :blooddy scrasias( rare),
thrombocy t
openi a.Met ab: hyperuricemi a,
hy percholesterolemia.MS: muscl ecr amps.Mi sc: blur
red
vision.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 772
I
NTERACTI
ONS
Drug-
Dr ug: Additivehypotensionwi thot her
anti
hyper tensives,acuteingestionofal coholornit
rates.
Addit
ivehy pokalemiawi thcorticosteroids,amphot er
icinB,
l
oopdi ur eti
cs,piperaci
ll
in,orticarci
lli
n.↓ excr eti
onof
l
it
hium.Chol estyramineor col
est i
pol ↓ absor pti
on.
Hypokal emi a↑ r i
skofdi goxi
nt oxicit
y .NSAI Dsmay↓
eff
ecti
v eness.

DOSAGE
Whenusedasadi
uret
icinadul
ts,
gener
all
ygi
vendai
l
y,but
maybegiv
enever
yotherdayor2–3days/
wk
PO:(
Adul
ts):125mg–2g/
dayasasi
ngl
edoseori
n2
di
vi
deddoses.
PO:
(Childr
en>6mo) :20mg/kg/
dayasasi
ngl
edoseori
n
2di
videddoses.Maxi
mum dose:1g/
day
.
PO:(Neonat
esupto6mo):20–40mg/kg/
dayi
n2di
vi
ded
doses.Maxi
mum dose:
375mg/ day
.
I
V:(Adul
ts):Di
uret
ic—100–500mg/
dayasasi
ngl
edose
or2divi
deddoses.
I
V:(Chi
ldr
en>6mo):4mg/kg/
dayi
n1–2di
vi
deddoses.
Maximum dose:
20mg/
kg/
day.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 773
I
V: (
Neonatesupto6mo) :
2–8mg/kg/
dayi
n2di
vi
ded
doses.Maximum dose:
20mg/kg/
day.

AVAI
LABI
LITY
Tabl
ets250mg, 500mg;Or
alsuspensi
on250mg/
5mL;
Powderfori
nject
ion500mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakethi
smedicati
onatthesame
ti
meeachday .Takemisseddosesassoonas
remember edbutnotjustbef
orenextdoseisdue.Do
notdoubledoses.

I
nstr
uctpati
enttomonit
orweightbiweeklyandnot
if
y
heal
thcar
eprofessi
onalofsi
gnif
icantchanges.

Cautionpati
entt
ochangeposit
ionssl
owl
yto
minimizeort
hostat
ichypot
ensi
on.Thi
smaybe
potenti
atedbyal
cohol.

Advi
sepati
enttousesunscreenandprot
ectiv
e
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

I
nstructpat
ientt
odi
scussdi
etar
ypotassi
um
requi
rementswit
hheal
thcar
eprofessi
onal(
see
AppendixM) .

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 774
 medi
cat
ionr
egi
menbef
oret
reat
mentorsur
ger
y.

Advisepati
enttorepor
tmuscl
eweakness,
cramps,
nausea,vomit
ing,
diarr
hea,
ordi
zzi
nesstoheal
thcar
e
prof
essional
.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

Hypert
ensi
on:Advisepat i
ent
st oconti
nuetaki
ngt
he
medicat
ioneveniffeeli
ngbetter.Medi
cati
oncont
rol
s
butdoesnotcurehy per
tensi
on.

Encouragepat ientt
ocompl ywithadditi
onal
i
nterv
entionsf orhypertension(weightreducti
on,l
ow-
sodi
um di et
,regularexercise,smokingcessat i
on,
moderationofal coholconsumpt ion,andstress
management ).

I
nst
ructpat
ientandf
amil
yincor
rectt
echni
quef
or
moni
tori
ngweeklyBP.

Advisepat i
enttoconsulthealt
hcar eprofessi
onal
beforetakingotherRx,OTC, orherbalproduct
s,
especiall
ycoughorcoldpr eparati
ons,concurrent
ly
wit
ht histherapy.

Chl
oroxy
lenol

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 775
I
ndi
cat
ions
Ant
isept
ic;
disi
nfect
ionofi
nst
rument
sandsur
faces.

Av
ail
abi
l
ity
SOLUTI
ONS50,
100,
200,
500ml
,1and5l
i
tres.

DOSAGE
Ant
isept
ic(woundsandot
herski
ndamage) :
applya1in
20dil
uti
onof5%concentr
atei
nwater.Di
sinf
ect
ionof
i
nstr
ument s:
usea1in20dil
uti
onof5%concentrat
ein
al
cohol(70%).

Cont
rai
ndi
cat
ions
Meni
ngi
ti
s;eari
nfect
ion.

Pr
ecaut
ions
Aqueoussoluti
onsshouldbefreshlyprepar
ed;
appropr
iat
e
measuresrequir
edtopreventcontaminati
onduri
ng
st
orageordilut
ion;
pregnancylact
ation.

Adv
erseEf
fect
s
Ski
nsensi
ti
vi
ty,
repor
teddr
yness.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 776
Chl
orpheni
rami
ne
I
ndi
cat
ions
Symptomaticreli
efofall
ergy,al
l
ergicrhi
nit
is(hayfev
er)
;
conj
uncti
vi
tis;
urticar
ia;
insectsti
ngsandpr ur
itusof
al
ler
gicori
gin;adj
unctintheemer gencytr
eatmentof
anaphyl
acti
cshockandsev er
eangioedema.

ACTI
ON
Antagonizest heeffectsofhist
amineatH2-receptorsi
tes;
doesnotbi ndt oorinacti
vatehist
amine.Therapeuti
c
Effect
s:Decreasedsy mptomsofhi st
amineexcess
(sneezi
ng, r
hinorrhea,nasalandocularpr
uri
tus,ocular
teari
ng,andr edness).

Av
ail
abi
l
ity
TABLETS2,
4and6mg;I
NJECTI
ONS10mg/10ml,
CAPSULE8mg;Sy
RUP10mg/50ml
,100mg/100ml.

DOSAGE
Or
al
Adul
t-Al
l
ergi
creact
ions:
4mgev
ery4t
o6h(
max.24mg
dai
ly
).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 777
Chil
d-1t
o2years:
1mgtwicedail
y.2to5year
s:1mg
ever
y4to6h(max.12mgdail
y).6to12year
s:2mgever
y
4to6h(max.12mgdai
ly
)

I
ntr
amuscul
arori
ntr
avenousi
nject
ion
Adul
t-All
ergi
creact
ions:
10t
o20mg,
repeat
edi
frequi
red
(max.40mgi n24h).

Subcut
aneousi
nject
ion
Chi
l
d-Al
l
ergi
creact
ions:
87.
5µg/
kg,
repeat
edi
fnecessar
y
upt
o4ti
mesdaily.

I
ntr
avenousi
nject
ion(
over1mi
n).

Adul
t-Anaphy
laxi
s(adj
unct
):10t
o20mg.
Chi
ld-Anaphyl
axi
s(adj
unct
)-under1year
:250µg/
kg.1t
o
5years:2.
5to5mg.6t o12years:5t
o10mg.

Cont
rai
ndi
cat
ions
Pr
ostaticenl
argement ,ur
inar
yretent
ion;
ileusor
pyl
oroduodenalobstructi
on;ast
hma; chi
l
dunder1y ear
;
hyper
sensiti
vi
ty,nar
rowangl egl
aucoma, pregnancy
l
actati
on

I
NTERACTI
ONS
Dr
ug-
Drug:
↑ CNSdepr
essi
onwi
thot
herCNSdepr
essant
s,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 778
i
ncl udingal cohol
,opioidanal gesics,and
sedat i
v e/hypnoti
cs.MAOi nhibitorsintensi
fyandpr ol
ong
antichol i
nergiceffect
sofant ihistamines.↑
antichol i
nergiceffect
swi t
hot herdrugspossessi ng
antichol i
nergicpropert
ies,includingant i
depressant
s,
atropine, haloper
idol,
phenot hiazines,quini
dine,and
disopy ramide.

Pr
ecaut
ions
Performingworksrequi
ri
ngutmostalert
nesssuchas
vehicl
edr i
vi
ng,oper
ati
ngmachinesetcwi t
hin24hof
takingthedrugshoul
dbeavoided.
Lactati
onr enal
and
hepaticimpair
mentepil
epsy
;int
eract
ionsatropicgast
ri
ti
s,
elderl
y.

Adv
erseEf
fect
s
Drowsiness( r
arely,paradoxi calstimulationwi thhi gh
doses,ori nchildrenorel der l
y )
,hypotensi on,headache,
palpi
tations,psy chomot ori mpai rment,urinaryret ent
ion,
drymout h,bl
urredv isi
on, gast r
ointesti
nal disturbances;
l
iverdysf uncti
on; blooddisor ders; al
sorashand
photosensi ti
vi
tyr eacti
ons, hy persensit
ivityreactions
(i
ncludingbr onchospasm, angioedema, anaphy laxis)
;
sweatingandt remor ,i
nject i
onsmaybei rrit
ant ;
flatul
ence,
di
ar r
hoea.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 779
PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakechl
orpheni
rami
neasdi
rect
ed.

Caut
ionpar
entst
oavoidOTCcoughandcold
pr
oductswhi
lebr
east
feedi
ngort
ochil
dren<4yr
s.

Geri
:Teachpati
entandfamilyaboutanti
choli
ner
gic
ef
fectsandtocontactheal
thcareprof
essionali
f
ef
fectsper
sist
.

Maycausedr owsiness.Caut
ionpati
entt
oavoid
driv
ingorotheracti
vi
ti
esrequir
ingal
ert
nessunt
il
responsetodrugisknown.

Caut
ionpat
ientt
oavoidusi
ngalcoholorot
herCNS
depr
essant
sconcur
rentl
ywit
hthisdrug.

Advi
sepat
ientt
hatgoodoralhygiene,
frequentr
insi
ng
ofmout
hwi t
hwater,andsugar
lessgum orcandy
mayhel
preli
evedry
nessofmout h.

Inst
ructpat
ientt
ocont
actheal
thcar
epr
ofessi
onal
if
symptomsper si
st.

St
orage
St
orepr
otect
edf
rom l
i
ghtandmoi
stur
e.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 780
Chl
orpr
omazi
ne
I
ndi
cat
ions
Schizophr
eni
aandot herpsychoti
cdisorders,
mania,
psychomotoragi
tati
onandv iol
entbehaviour;
adj
unctin
severeanxi
ety
;psychosis,
mani a,
hiccups.
Unl
abel
edUses:
Vascul
arheadache.Bi
pol
ardi
sor
der
.

ACTI
ON
Alt
erstheef fectsofdopami nei
nt heCNS.Hassi gnif
icant
anti
choli
ner gi
c/ al
pha-adr
energi
cbl ocki
ngacti
vi
ty.
TherapeuticEffects:Dimi
nishedsigns/symptomsof
psychosis.Reliefofnausea/vomiti
ng/ i
ntr
act
ablehiccups.
Decreasedsy mpt omsofpor phyr
ia.

Av
ail
abi
l
ity
TABLETS25,
50and100mg;Sy
RUP60ml
(25mg/
5ml
);
I
NJECTION2mlampoule(
25mg/ml
).

DOSAGE
Or
al
Adul
t-Schi
zophr
eni
aandot
herpsy
choses,
mani
a,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 781
psychomotoragitation,vi
olentbehav
iourandsevere
anxiet
y(adj
uv ant
):initi
all
y25mg3t i
mesdaily(or75mg
atnight
)adjustedtor esponsetousualmaintenancedose
of100-300mgdai l
y( butupto1.2gdail
ymayber equi
red
i
npsy chosi
s).
Elder
lyordebil
it
ated-Schizophr
eniaandot herpsychoses,
mania,psychomotoragitati
on,vi
olentbehaviourand
severeanxiet
y(adjunct
):one-t
hir
dt oone-hal
fadultdose.
Chil
d-Schi zophreniaandot herpsychoses, mani
a,
psychomot oragit
ation,
violentbehaviourandsever
e
anxiety(adjunct)
;(forchi
ldhoodschi zophreni
aandauti
sm)
1to5y ears:500µg/ kgev ery4-6h(max.40mgdai ly)
.6to
12y ears:one-thi
rdtoone- halfadul
tdose( max.75mg
dail
y).
Deepi
ntr
amuscul
ari
nject
ion
Adul
t-Rel
i
efofacut
esy
mpt
oms:
25t
o50mgev
ery6t
o8
h.
Chi
ld-Rel
iefofacut
esympt
oms:500µg/kgever
y6to8h
(1t
o5y ears:max.40mgdai
ly
.6to12years:
max.75mg
dai
l
y )
.

Cont
rai
ndi
cat
ions
I
mpai
redconsci
ousnessduet
oCNSdepr
essi
on;
bone-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 782
marrowdepressi
on;
pheochromocy t
oma; epil
epsy
,nar
row
angl
eglaucoma,Par
kinson’
sdisease;depressedl
evel
of
consci
ousness.

I
NTERACTI
ONS
Drug-Dr ug: Pimozi de↑ t her iskofpot ential l
yser i
ous
cardiovascul arreactions; concur rentusecont raindi cat ed.
Mayal t
erser um pheny toi nlev els.↓ pr essoref fectof
norepinephr i
neandel i
mi natesbr adycar dia.Ant agoni zes
peripheral vasoconst ri
ct ionf rom epi nephr ineandmay
reversesomeofi tsact i
ons.May↓ el i
mi nat ionand↑
effectsofv alproicaci d.May↓ t hephar macol ogi cef fects
ofamphet ami neandr el atedcompounds.May↓ t he
effectiv
enessofbr omocr iptine.May↑ bl oodl ev elsand
effectsoft ri
cyclicant idepr essant s.Ant acidsoradsor bent
antidi
arr healsmay↓ adsor ption; admi nister1hrbef or eor
2hraf terchl or promazi ne.↑ r iskofant ichol inergi cef f
ect s
withant ihistami nes, t
ricy cli
cant idepressant s,qui nidi ne, or
disopy r
ami de.Pr emedi cat i
onwi thchl orpr omazi ne↑ t he
ri
skofneur omuscul arexci t
at ionandhy pot ensionwhen
foll
owedbybar biturateanest hesi a.Barbitur atesmay↑
met abolism and↓ ef fect i
veness.Chl or promazi nemay↓
barbituratel evels.Addi ti
v ehy pot ensionwi th
antihyper t
ensi ves.Addi tiveCNSdepr essi onwi thal cohol ,
antidepressant s,antihist ami nes, MAOi nhi bitors, opi oid

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 783
analgesics,sedat i
ve/hypnotics,orgeneralanestheti
cs.
Concur r
entusewi thli
thium maypr oducedi sor
ientat
ion,
unconsci ousness, orextrapyramidalsymptoms.
Concur r
entusewi thmeper i
dinemaypr oduceexcessi v
e
sedationandhy potension.Concur r
entusewi th
propranolol↑ bl oodlevelsofbot hdrugs.
Drug-
NaturalProduct:Concomitantuseofkava-
kava,
val
eri
an,chamomi le,
orhopscan↑ CNSdepr ession.↑
anti
chol
i
ner gi
ceffectswithangel’
strumpet,
ji
msonweed,
andscopoli
a.

Pr
ecaut
ions
Cardiovascul arandcer ebrov ascul ardisor der s,respiratory
disease,par kinsoni sm, epil
epsy ,acut einfect i
ons,
pregnancyl act ationrenal andhepat icimpai rment( avoid
i
fsev ere;histor yofj aundice, l
eukopeni a( bl oodcount si f
unexplainedf ev erorinfection);hy pothyroidi sm,
my astheniagr av i
s,prostatichyper trophy, angl e-closure
glaucoma; el der ly(part
icularl
yinv eryhotorv erycol d
weat her)
;av oidabr uptwi t
hdr awal ;pati
ent sshoul dr emai n
supineandt hebl oodpr essur emoni tor
edf or30mi naf ter
i
nt r
amuscul ari njecti
on;interactionsext remeheat ,
alcohol
withdrawal, pept i
culcer.Mayi mpai rabili
tyt oper form
skil
ledtasks, forexampl eoper atingmachi ner y
,dr i
ving.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 784
Adv
erseEf
fect
s
Extrapy rami dal sympt omsandonpr olonged
admi ni str ation, occasi onal l
ypot ent iallyi r
rev ersiblet ar di
ve
dyski nesi as( seenot esabov e);hy pot her mi a(occasi onally
pyrexi a), dr owsi ness, apat hy ,pallor ,ni ghtmar es, dizziness,
excitement ,insomni a, headache, conf usion, depr essi on;
mor er arel y,agi t
at i
on; EEGchanges; conv ulsions; nasal
congest i
on; ant i
chol iner gicsy mpt omsi ncl udingdr ymout h,
const ipat ion; bl
ur redv ision, dif
ficul tyi nmi cturit
ion;
hypot ensi on, tachy car diaandar r hy thmi as; ECGchanges;
respir ator ydepr essi on; menst r
ual dist urbances,
galact or rhoea, gy naecomast ia,i
mpot ence, weightgai n;
sensi tivityr eact ionssuchasagr anul ocy tosi s,l
eukopeni a,
l
eukocy tosi s, haemol y ticanaemi a, phot osensi ti
zat ion,
cont actsensi ti
zationandr ashes, jaundi ceandal terat i
ons
i
nl i
v erf unct ion; neur ol epticmal ignantsy ndr ome; lupus
erythemat osusl i
kesy ndr ome; withpr ol ongedhi ghdosage,
corneal andl ensopaci t i
es,andpur plishpi gment ationof
theski n, cor neaandr et i
na; i
nt r
amuscul ari njectionmaybe
painf ul andcausehy pot ensi onandt achy car dia( see
Precaut ions)andnodul ef ormat ion; sei zur es,temper ature
disorder ,hy per prolact inemi a,ocul arcompl i
cation.

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 785
Adv i
sepat i
entt
ot akemedicationasdi rectedandnot
toskipdosesordoubl euponmi sseddoses.Ifadose
i
smi ssed, t
akewithin1hroromi tdoseandr etur
nto
regularschedul
e.Abr uptwit
hdrawal mayl eadto
gastrit
is,
nausea,vomi ti
ng,
dizziness,headache,
tachycardi
a,andinsomni a.

Infor
m pat i
entofpossibi
l
ityofextrapyramidal
sympt omsandt ardiv
edyskinesia.Inst
ructpati
entt
o
reportthesesympt omsimmedi atel
yt ohealt
hcare
professional
.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

Maycausedr owsiness.Cautionpati
entt
oavoid
driv
ingorotheracti
vi
tiesrequir
ingal
ert
nessunt
il
responsetothemedi cat
ionisknown.

Caut
ionpat
ientt
oavoidtaki
ngal
coholorotherCNS
depr
essant
sconcur
rentl
ywitht
hismedicat
ion.

Advisepat ienttousesunscr eenandpr ot

ecti
ve
clot
hingwhenexposedt othesun.Exposedsur faces
maydev elopat empor arypigmentchange( rangi
ng
from yell
ow- brownt ogr ay
ishpur ple).Ext
remesof
temper ature(exercise,hotweat her,hotbathsor
shower s)shoul dalsobeav oided,becausethisdrug

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 786
 i
mpai
rsbodyt
emper
atur
eregul
ati
on.

I
nstr
uctpati
entt ousefr
equentmouthrinses,good
or
alhygi
ene, andsugarl
essgum orcandytomi ni
mize
dr
ymout h.Consultheal
thcar
eprofessi
onal i
fdry
mouthcontinuesfor2wk.

Advi
sepati
entnottotakechlor
promazi
newi
thi
n2hr
ofant
aci
dsorantidi
arrheal
medicati
on.

I
nfor
m pati
entt
hatthi
smedi
cat
ionmayt
urnur
inea
pi
nk-
to-
reddi
sh-
browncol
or.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

I
nstructpati
enttonoti
fyhealt
hcarepr ofessi
onal
promptlyi
fsorethroat,
fever
,unusual bl
eedingor
brui
sing,r
ash,weakness,t
remor s,
visualdistur
bances,
dark-
color
edurine,orcl
ay-
coloredstoolsoccur.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Emphasi zethei mport

anceofrouti
nef ol
low-
upexams
tomoni t
orr esponsetomedicati
onanddet ectsi
de
eff
ects.Encour ageconti
nuedparti
cipati
onin
psychotherapyasi ndi
cat
ed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 787
 Tr
eatmentisnotacur
e; sy
mptomsmayr
ecuraf
ter
di
scont
inuat
ionofmedicati
on.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

CHLORPROPAMI
DE
I
NDI
CATI
ONS
Contr
olofbloodsugari
ntype2diabetesmell
it
uswhen
di
ettherapyfai
l
s.Requi
ressomepancr eat
icf
unct
ion.
Unl
abeledUses:Managementofneurogenicdi
abetes
i
nsipi
dus.

ACTI
ON
Lower sbloodsugarbyst imulatingt her
eleaseofinsuli
n
fr
om t hepancr easandi ncreasingt hesensit
ivi
tytoinsul
in
atreceptorsites.Mayal sodecr easehepat i
cglucose
production.Ther apeut
icEffects: Loweri
ngofbl oodsugar
i
ndi abeticpatients

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
wi
thsul
fonami
des(
incl
udi
ngt
hiazi
dedi
uret
ics)mayoccur
;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 788
Type1di abet
es;Diabeti
ccomaorket oacidosi
s;Severe
renalorhepat
icdisease;Uncontr
oll
edinfecti
on,ser
ious
burns,ortr
auma;Lactati
on:Discont
inuedr ugorbot
tle
feed.

UseCaut
iousl
yin:
Sev
erecar
diov
ascul
ardi
sease;
Glucose6- phosphatedehy drogenasedef i
ciency( ↑riskof
hemol y t
icanemi a);Hepaticorrenal impairment( ↑r i
skof
hypogl ycemi a)
;Infecti
on,str
ess, orchangesi ndi etmay
alt
err equirement sforcontrolofbl oodsugar ;Impair
ed
thyroid,pit
uitary
, oradrenalfunction;Malnut r
iti
on,hi
gh
fever,prolongednausea, orvomi ti
ng;OB: Safetynot
established; i
nsulinrecommendeddur ingpregnancy ;
Geri:
Prolongedhal f
-l
ifemaycausehy poglycemia; dose↓ may
ber equired.Appear sonBeer slist.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: anor exia,dizziness,headache.GI :consti
pati
on,
diarrhea, drug- i
nducedhepat i
ti
s,↑ appet it
e,nausea,
vomi ting.Der m: photosensit
ivi
ty,
rash, pruri
ti
s,urt
icar
ia.
Endo: hy pogl ycemi a,syndromeofi nappr opri
ate
antidiur etichor mone( SIADH)secretion.FandE:
hyponat remi a.Hemat :APLASTICANEMI A,
agranul ocy t
osi s,eosinophili
a,hemolyticanemi a,
l
eukopeni a, pancy topenia,t
hrombocy topenia.Misc:
disulfi
r am- l
iker eacti
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 789
I
NTERACTI
ONS
Drug- Dr ug: I
ngest ionofal cohol mayr esul tindi sulfir
am-
l
iker eact i
on.Ef fectivenessmaybe↓ byconcur rentuseof
diuretics, calcium channel blocker s,corticost eroids,
phenot hiazines, hormonal cont raceptives, est r
ogens,
thyroidagent s,pheny toi n, nicotinicacid, adrener gics, and
i
soni azi d.Alcohol ,
andr ogens( testosterone) ,
chlorampheni col, f
luor oqui nol ones, MAO
i
nhibi t
or s,mi conazol e,NSAI Ds) ,probeneci d, salicylates,
sulfonami des, andwar farinmay↑ t her iskof
hypogl y cemi a.Concur rentusewi thwar far i
nmayal t
erthe
responset obot hagent s( may↑ ef f
ectsofbot h;close
moni tor ingrecommendeddur i
nganychangesi ndose) .
Betabl ocker smayal tert her esponset oor al hypogl ycemic
agent s( ↑ or↓ r equirement s; nonselect i
veagent smay
causepr olongedhy pogl ycemi a).
Dr
ug-
Natur
al Pr
oduct:Gl
ucosami
nemaywor sen
hy
pogl
ycemia.Fenugr
eek,
chromi
um,andcoenzymeQ-
10
maypr
oduceadditi
vehypogl
ycemi
ceffect
s.

DOSAGE
PO:(Adul
ts)
:250mgoncedail
y,i
niti
all
y;may↑ doseby
50–125mg/dayat3–5dayi
nter
vals.Maximum dai
lydose
i
s750mg. Ol
der,
debi
li
tat
edormalnouri
shed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 790
pati
ent
s—ini
ti
atether
apywit
h100–125mgoncedai l
y;
may↑ doseby50–125mg/ dayat3–5dayint
erv
als.
Maximum dai
lydoseis750mg.
Anti
diur
eti
c
dose—100–250mg/ day
.
Hepat
icI
mpai
rment
PO:
(Adul
ts)
:Ini
ti
atet
her
apywi
th100–125mg/
day
.
Renal
Impai
rment
PO:(Adul
tsCCr≥50mL/mi
n):
Ini
ti
atet
her
apywi
th
100–125mgoncedai
ly.

Renal
Impai
rment
PO:
(Adul
tsCCr<50mL/
min)
:Av
oiduse.

AVAI
LABI
LITY
Tabl
ets100mg,
250mg;

PATI
ENTTEACHI
NG
I
nstructpat
ienttotakemedicati
onatsameti
meeach
day.Takemi sseddosesassoonasr emember
ed
unl
essalmostt imefornextdose.Donott
akei
f
unabletoeat.

Explai
ntopat
ientt
hatt
hismedi
cat
ioncontrol
s
hypergl
ycemi
abutdoesnotcur
edi
abetes.Therapyi
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 791
 l
ong-
ter
m.

Reviewsi gnsofhy pogl

y cemiaandhyperglycemia
withpatient.I
fhypoglycemi aoccur
s,advisepati
entto
takeagl assoforangej uiceor2–3tspofsugar ,
honey ,
orcor nsyrupdissolvedinwaterandt onoti
fy
healthcareprofessional.

Encouragepatientt
ofoll
owpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.Caut
ion
pati
enttoav oi
dskippi
ngmeal s.

Inst
ructpat
ientinpropertest
ingofserum glucose
andurineketones.Thesetestsshoul
dbecl osely
monitoredduringperi
odsofst r
essoril
lnessand
healt
hcarepr ofessi
onalnoti
fi
edifsi
gnifi
cant
changesoccur .

Concurrentuseofal
coholmaycauseadi sul
fi
ram-
li
ke
react
ion(abdominalcr
amps,nausea,
flushi
ng,
headaches,andhypogl
ycemi
a).

Mayoccasi onal
l
ycausedi zziness.Caut
ionpatientt
o
avoi
ddr i
vingorotheracti
vit
iesrequir
ingaler
tness
unti
lresponsetomedi cat
ioni sknown.

Caut
ionpat
ienttoavoi
dothermedicati
ons,
especial
l
y
aspi
ri
nandalcohol
,whil
eont hi
stherapywi
thout

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 792
 consul
ti
ngheal
thcar
epr
ofessi
onal
.

Insul
i
ni sthepreferredmet hodofcontroll
ingblood
sugarduringpregnancy .Counselfemalepatientsto
useaf orm ofcontracepti
onot herthanoral
contr
acept i
vesandt onot i
fyhealt
hcar eprofessi
onal
promptlyifpregnancyisplannedorsuspect ed.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Advi
sepatientt
oinf
orm heal
thcar
eprofessionalof
medicat
ionregi
menbeforetr
eatmentorsurgery.

Advisepatienttocarr
yaform ofsugar(sugarpacket
s,
candy)andi denti
fi
cati
ondescri
bingdi
seaseprocess
andmedi cationregi
menatallti
mes.

Adv i
sepatientt
onot i
fyhealthcareprof
essional
promptlyifunusualweightgain,weakness,sore
throat
,rash,orunusualbleedingorbrui
singoccurs.

Emphasi
zetheimpor
tanceofr
out
inef
oll
ow-
up
exami
nati
ons.

Chl
ort
hal
i
done
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 793
Managementofmi ldtomoder at
ehy pertensi
on.
Treatmentofedemaassociatedwi t
h:HF, Renal
dysfuncti
on,
Cirr
hosis,
Glucocort
icoidtherapy,Est
rogen
therapy.

ACTI
ON
Increasesexcreti
onofsodi um andwat erbyinhibi
ti
ng
sodium reabsorpti
oni nthedi
stal t
ubule.Promotes
excretionofchlor
ide,potassi
um, magnesi um,and
bicarbonate.Maypr oducearter
iolardi
lati
on.Therapeut
ic
Effects:Loweri
ngofBPi nhypertensi
vepat i
entsand
diuresiswithmobili
zationofedema.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty(
cross-
sensi
ti
vi
ty
withotherthi
azi
desorsulfonami
desmayexi
st);Some
productscontai
ntar
trazi
neandshoul
dbeavoidedin
pati
entswithknownintol
erance;
Anur
ia;
Lact
ation:
Lactat
ion.

UseCaut
iousl
yin:
Renal
orhepat
ici
mpai
rment
;OB:
May
causej
aundi
ceort
hrombocy
topeni
ainnewbor
n.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
dizzi
ness,
drowsi
ness,
let
har
gy,
weakness.CV:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 794
hypot
ension.GI :anorexia,cramping, hepati
ti
s,nausea,
vomit
ing.Der m: phot
osensi tiv
ity,rash.Endo:
hyper
glycemi a.FandE: hypokalemi a, dehydrat
ion,
hyper
calcemi a,hypochloremi calkalosi s,
hypomagnesemi a,hyponat r
emi a,hy pophosphat emi
a,
hypovol
emi a.Hemat :blooddy scrasias.Met ab:
hyper
uricemia, hyper
chol esterol
emi a.MS: musclecramps.
Misc:pancreatiti
s.

I
NTERACTI
ONS
Drug- Drug:Addit
ivehypot ensi
onwi thother
antihy pert
ensi
veagent s,acuteingesti
onofal cohol
ornitrates.Addi
ti
vehy pokalemiawi thcorti
costeroi
ds,
amphot eri
cinB,pi
peracill
in,orti
carcil
li
n.↓ theexcret
ion
oflithium.Cholestyr
ami neorcol esti
pol↓ absorpti
on.
Hypokal emia↑ ri
skofdi goxintoxici
ty.NSAIDsmay↓
effectiveness.

DOSAGE
Whenusedasadi
uret
icinadul
ts,
gener
all
ygi
vendai
l
y,but
maybegiv
enever
yotherdayor2–3days/
week
PO:(Adult
s):12.5–100mgoncedail
y(dosesabove25
mgar eassoci
atedwithgr
eat
erl
ikel
i
hoodofelectr
oly
te
abnormali
ti
es).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 795
AVAI
LABI
LITY
Tablets15mg,25mg, 50mg; I
ncombinat
ionwit
h:
atenol
ol(Tenor
eti
c),
azil
sar
tan(Edar
bycl
or)
,andcloni
dine
(Clor
pres)

PATI
ENTTEACHI
NG
I
nstructpati
enttotakethismedicat
ionatt
hesame
ti
meeachday .I
fadosei smissed,t
akeassoonas
remember edbutnotjustbefor
enextdoseisdue.Do
notdoubledoses.

I
nstr
uctpati
enttomonit
orweightbiweeklyandnot
if
y
heal
thcar
eprofessi
onalofsi
gnif
icantchanges.

Cautionpati
entt
ochangeposit
ionssl
owl
yto
minimizeort
hostat
ichypot
ensi
on.Thi
smaybe
potenti
atedbyal
cohol.

Advi
sepati
enttousesunscreenandprot
ectiv
e
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

I
nst
ructpat
ientt
odi
scussdi
etar
ypotassi
um
r
equi
rementswit
hheal
thcar
eprofessi
onal

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Adv
isepat
ientt
orepor
tmuscl
eweakness,
cramps,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 796
 nausea,
vomit
ing,
diar
rhea,
ordi
zzi
nesst
oheal
thcar
e
prof
essi
onal
.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

Hypert
ensi
on:Advisepat i
ent
st oconti
nuetaki
ngt
he
medicat
ioneveniffeeli
ngbetter.Medi
cati
oncont
rol
s
butdoesnotcurehy per
tensi
on.

Encouragepat ientt
ocompl ywithadditi
onal
i
nterv
entionsf orhypertension(weightreducti
on,l
ow-
sodi
um di et
,regularexercise,smokingcessat i
on,
moderationofal coholconsumpt ion,andstress
management ).

I
nst
ructpat
ientandf
amil
yincor
rectt
echni
quef
or
moni
tori
ngweeklyBP.

Advi
sepati
enttoconsulthealt
hcar epr
ofessional
bef
oretaki
ngOTCmedi cat i
on,especi
all
ycoughor
col
dpreparat
ions,
concurrentl
ywiththi
stherapy

Chl
orzoxazone
I
NDI
CATI
ONS
Adj
unctt
orestandphysical
therapyint
hetreat
mentof
muscl
espasm associ
atedwithacutepai
nful

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 797
muscul
oskel
etal
condi
ti
ons.

ACTI
ON
Skelet
almusclerel
axati
on,probabl
yduetoCNS
depressi
on.Ther
apeuticEf
fects:Skel
etal
muscl
e
rel
axati
onwithdecreaseddiscomfort
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Por
phy
ria.

UseCaut
iousl
yin:
Under
lyi
ngcar
diov
ascul
ardi
sease;
I
mpai redrenalorhepati
cfuncti
on;OB:Lact
ati
on:Pedi
:
Safetynotestabl
ished;Geri
:AppearsonBeersl
ist
.Poorl
y
tol
eratedduet oanti
choli
nergi
ceffect
s.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness,dr
owsi ness.GI:GIBLEEDING,const
ipat
ion,
di
arrhea,heartbur
n, nausea,vomiti
ng.Derm:al
ler
gic
dermatit
is.Hemat :AGRANULOCYTOSI S,anemia.Misc:
al
lergi
creactionsincludingangioedema.

I
NTERACTI
ONS
Drug-Drug:↑r i
skofCNSdepr essi
onwi thotherCNS
depressants,
incl
udingalcohol
,anti
hist
amines,
anti
depressants,sedat
ive/
hypnoti
cs,oropioi
danalgesi
cs.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 798
Drug-Natur
alProduct:
Concomitantuseofkav
a-kav
a,
val
erian,
skull
cap,chamomile,
orhopscan↑ CNS
depressi
on.

DOSAGE
PO:
(Adul
ts)
:250–750mg3–4t
imesdai
l
y.
PO:(
Chi
ldr
en):20mg/
kgor600mg/
m2/
dayi
n3–4
di
vi
deddoses.

AVAI
LABI
LITY
Tabl
ets250mg,
500mg;

PATI
ENTTEACHI
NG
Inst
ructpatientt
otakemedi cat
ionasdirect
ed;donot
takemor ethantheprescr
ibedamount .Misseddoses
shouldbet akenwit
hin1hroft i
meor dered;ot
her
wise,
omitandr eturnt
onormal doseschedule.Donot
doubledoses.

Medicati
onmaycausedrowsinessanddizzi
ness.
Cauti
onpatientt
oavoi
ddr i
vi
ngorotheracti
vi
ti
es
requi
ri
ngalert
nessunt
ilr
esponsetodrugisknown.

Advi
sepat
ientt
oav oi
dconcurr
entuseofalcohol
or
ot
herCNSdepressant
swiththi
smedicati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 799
 Ifconsti
pati
onbecomesapr obl
em, advi
sepati
ent
thatincr
easi
ngfl
uidint
akeandbulki ndi
etandstool
softener
smayallevi
atethi
scondit
ion.

CHOLECALCI
FEROL
I
NDI
CATI
ONS
Tr
eat
mentorpr
event
ionofv
itami
nDdef
ici
ency
.

ACTI
ON
Requiresact i
vat
ionint
heli
verandki dney
st ocreatethe
acti
vef orm ofvit
aminD3(calci
tr
iol)
.Promotest he
i
ntesti
nal absorpti
onofdi
etarycalci
um.Ther apeut
ic
Eff
ects: Treat
mentandpreventi
onofdef i
ciencystates,
part
icularl
ybonemani f
est
ations

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
cal
cemi
a;
Vit
aminDt oxi
city
;Concurr
entuseofmagnesi
um-
contai
ningantaci
dsorothervi
tami
nDsupplement
s;
Malabsorpt
ionprobl
ems.

UseCaut
iousl
yin:
OB:
Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 800
Seenprimaril
yasmani
fest
ati
onsoft
oxi
cit
y
(hy
percalcemia)
CNS: headache, i
rri
tabi
li
ty,somnolence, weakness.EENT:
conjuncti
v i
ti
s, photophobia.CV:arrhythmias,hypert
ensi
on.
GI:anorexia,const i
pati
on, dr
ymout h,↑l i
verenzymes,
met al
li
ct aste,nausea,PANCREATI TI
S, polydi
psia,
vomi t
ing,wei ghtloss.GU: al
buminuri
a, azotemia,pol
yur
ia.
Derm: prurit
us.FandE: hypercal
cemi a.MS: bonepain,
muscl epain.

I
NTERACTI
ONS
Drug-Dr ug:Cholestyr
amine,colesti
pol,ormi neraloil↓
absor pti
onofv it
ami nDanal ogues.Usewi ththiazide
diureti
csmayr esulti
nhyper cal
cemi a.Corti
costeroids↓
effectiv
enessofv i
taminDanal ogues.Concur rentuseof
magnesi um-contai
ningdrugsmayl eadto
hypermagnesemi a.Calci
um- contai
ningdr ugsmay↑ r isk
ofhy percalcemia.Concurrentuseofot herv i
taminD
supplement s(↑r i
skofhy percal
cemi a).
Drug-
Food:
Ingest
ionoffoodshi
ghincal
cium cont
ent(
see
Appendi
xM)mayl eadtohyper
cal
cemia.

DOSAGE
PO:
(Adul
ts)
:400–1000I
Udai
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 801
PO:(I
nfant
s):
Excl
usi
vel
yorpar
ti
all
y-
breastf
ed-400I
U
dai
l
y.

AVAI
LABI
LITY
Tabl
ets400I
UOTC,1000IUOTC;Oralsol
uti
on400
I
U/dropOTC;
Incombi
nati
onwith:al
endronat
e

PATI
ENTTEACHI
NG
Advisepat
ienttotakemedicationasdir
ected.Take
misseddosesassoonasr emember edthatday,
unl
essalmostt i
mef ornextdose;donotdoubleupon
doses.Advi
separ ent
stousecal i
brat
edmeasur i
ng
devi
ceordr opperwit
horalsoluti
on.

Rev
iewdietmodi
fi
cati
onswi t
hpat
ient
.SeeAppendi
x
Mforfoodshi
ghincal
cium andvi
tami
nD.

Encouragepatienttocompl ywi
thdietar
y
recommendat ionsofhealthcar
epr of
essional
.Explai
n
thatthebestsour ceofvi
taminsisawell-
balanced
dietwithfoodsfrom the4basicfoodgroupsandt he
i
mpor tanceofsunl i
ghtexposur
e.SeeAppendi xM for
foodshighinv i
taminD.

Pati
ent
ssel
f-
medicat
ingwit
hvi
taminsuppl
ement
s
shoul
dbecaut
ionednott
oexceedRDA.The

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 802
 ef
fecti
venessofmegadosesfort
reat
mentofvar
ious
medicalcondi
ti
onsi
sunprovedandmaycauseside
ef
fects.

Advi
sepati
entt
oavoidconcur
rentuseofant
aci
ds
cont
aini
ngmagnesi
um.

Rev
iewsymptomsofover
dosageandinstr
uctpati
ent
tor
epor
tthesepr
omptl
ytohealt
hcareprofessi
onal
.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
eval
uat
eprogr
ess.

CHOLESTYRAMI
NE
I
NDI
CATI
ONS
Managementofpr i
mar yhyperchol
ester
olemia.Pruri
tus
associ
atedwithel
evatedlevel
sofbileacids.Unlabel
ed
Uses:Di
arrheaassoci
atedwi t
hexcessbileacids.

ACTI
ON
BindbileacidsintheGIt r
act,
forminganinsol
uble
compl ex.Resulti
si ncreasedclear
anceofcholester
ol.
TherapeuticEffects:Decreasedplasmacholesterol
and
l
ow- densit
ylipoproteins(LDLs).Decr
easedprurit
us.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 803
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Compl
etebi
l
iar
y
obstr
uct
ion;
Someproductscont
ainaspart
ameand
shoul
dbeav oi
dedi
npati
entswit
hphenylket
onur
ia.

UseCaut
iousl
yin:
Hist
oryofconst
ipat
ion.

Exerci
seExtremeCauti
oni
n:Chi
l
dren(maycause
i
ntesti
nalobstr
uct
ion;
deat
hshaveoccur
red)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:irr
it
ationoft hetongue.GI: abdominaldiscomfort
,
const
ipati
on, nausea,fecali
mpact i
on,fl
atul
ence,
hemorrhoids,perianali
rri
tat
ion,steatorr
hea,vomiti
ng.
Derm:ir
rit
ation,rashes.FandE: hyperchl
oremicacidosi
s.
Metab:vit
ami nA, D,andKdef ici
ency .

I
NTERACTI
ONS
Drug-Dr ug: Maydecr easeabsor pti
on/ effectsofor al
ly
admi nisteredacet ami nophen, amiodar one, cl
indamy ci
n,
clof
ibrat e,digoxin, diuretics,gemfi
brozi l
,gli
pizide,
cort
icost eroids,imi prami ne, mycophenol ate,met hot
rexat
e,
methy ldopa, niacin, NSAI Ds, peni
cil
li
n, pheny t
oin,
phosphat es,propr anol ol,tet
racycl
ines, t
olbutami de,
thyr
oi dpr eparations, ur sodiol,
warfari
n, andf at-
soluble

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 804
vi
tamins(
A,D,E,andK)
.Maydecreaseabsor
pti
onofot
her
or
all
yadmini
ster
edmedicat
ions.

DOSAGE
PO:(Adult
s):
4g1–2t imesdai
l
y(i
nit
ial
l
y,maybe
i
ncreasedasneeded/
tol
erat
edupt
o24g/ dayi
n6di
vi
ded
doses).
PO:
(Chil
dren)
:240mg/
kg/
dayi
n2–3di
vi
deddoses(
not
>8g/day)
.

AVAI
LABI
LITY
Powderf orsuspensi onwi t
haspar tame(st
rawber r
yflavor
[LoCHOLEST] ,unflavored[Prevali
te,Questr
anLight])4g
cholest
yrami ne/packetorscoop; Powderfor
suspension(strawberryflavor[LoCHOLEST] ,unf
lavored
[Questr
an,gener i
c])4gchol esty
ramine/packetorscoop;

PATI
ENTTEACHI
NG
I
nstr
uctpat
ientt
otakemedicat
ionexactl
yasdirect
ed;
donotski
pdosesordoubl
euponmi sseddoses.

Inst
ructpati
enttot akemedicati
onbeforemeal s.Mix
cholest
yraminewi t
h4–6ozwat er,
mi l
k,f
ruitjui
ce,or
othernoncarbonatedbeverages.Shakevigorously.
Slowlysti
rinalargeglass.Rinsegl
asswi thsmal l

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 805
 amountofaddi t
ionalbeveragetoensureal
l
medi cati
oni staken.Mayal somi xwit
hhighlyfluid
soups, cereals,orpulpyfrui
ts(appl
esauce,crushed
pineapple).Allowpowdert osi
tonflui
dandhy drate
for1–2mi nbef oremi xi
ng.Donottakedry.Var i
ati
ons
i
nt hecol orofchol est
y r
aminedonotalterstabili
ty.

Adv i
sepat ientthatthismedicat ionshoul
dbeusedin
conjunct i
onwi t
hdi etaryrest
ricti
ons(fat,
chol
ester
ol,
carbohy drates,
alcohol),exercise,andcessat
ionof
smoki ng.

Explainthatconstipati
onmayoccur .I
ncreaseinflui
ds
andbul kindiet,
exer ci
se,st
oolsofteners,and
l
axat i
vesmayber equiredtominimizethe
constipati
ngeffects.Inst
ructpati
enttonot i
fyhealth
carepr of
essionalifconsti
pati
on,nausea, fl
atul
ence,
andhear tburnpersistori
fstoolsbecomef r
othyand
foulsmel l
ing.

Advisepatienttonoti
fyhealt
hcar epr of
essionali
f
unusualbleedingorbrui
sing;petechiae;orblack,
tar
ry
stoolsoccur.Treat
mentwi t
hv i
tami nKmaybe
necessary.

Chol
i
neandmagnesi
um sal
i
cyl
ates

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 806
I
NDI
CATI
ONS
I
nfl
ammatorydi
sorder
sincl
udi
ng:
Rheumat oi
dar
thr
it
is,
Ost
eoar
thr
it
is.Mi
ldtomoderat
epain.Fev
er.

ACTI
ON
Produceanal gesi
aandr educei
nflammati
onandf everby
i
nhi bi
tingtheproduct
ionofprost
aglandi
ns.Therapeut
ic
Effects:Analgesi
a.Reducti
onofinfl
ammation.Reducti
on
offever .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oaspi
ri
norot
her
sal
icy
lat
es;
Cross-
sensi
ti
vi
tywithotherNSAI
Dsmayexi
st
(l
esswit
hnonaspi
ri
nsali
cyl
ates).

UseCaut
iousl
yin:
Hist
oryofGIbl
eedi
ngorul
cerdi
sease;
Chronical cohol use/abuse; Sev ererenal di
sease
(magnesi um t oxici
tymayoccur ) ;
Sev erehepat i
cdisease;
OB:Salicylatesmayhav eadv erseef fectsonf etusand
mother; shoul dbeav oideddur ingpr egnancy ,
especi ally
duri
ngt he3r dtri
mest er;Lactation:Safetynotest ablished;
Pedi:Mayi ncreasether iskofRey e’
ssy ndromei nchildren
oradolescent srecoveringfrom chi ckenpoxorf lu
symptoms; Geri
: ↑r i
skofadv erser eacti
onsespeci allyGI

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 807
bl
eedi
ng;
mor
esensi
ti
vet
otoxi
clev
els.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT: t
innit
us.GI:GIBLEEDING,dyspepsia,epi
gast
ri
c
dist
ress,nausea,abdominal
pain,anorexia,
hepatot
oxi
cit
y,
vomiti
ng.Mi sc:al
ler
gicr
eacti
onsincludinganaphyl
axi
s
andlaryngealedema.

I
NTERACTI
ONS
Drug-Drug: May↑ act i
vityofpeni cill
i
ns,phenytoi
n,
met hotrexat e,val
proi
caci d,or
al hypogl y
cemicagents, and
sulfonami des.May↓ benef ici
al effectsofprobenecid.
Urinaryaci difi
cati
on↑ r eabsorptionandmay↑ ser um
salicyl
atelev els.Al
kali
nizati
onoft heur i
neortheingestion
oflargeamount sofantacids↑ excr eti
onand↓ ser um
salicyl
atelev els.Maybluntthet her apeuticr
esponset o
diureti
csorot heranti
hyper t
ensives.↑ r iskofGIi
rri
tati
on
withNSAI Ds.Mayi ncreasehy popr othrombinemiceffect
ofwar fari
n.
Drug-
Food:
Foodscapabl
eofacidi
fyi
ngtheur
ine(
see
Appendi
xM)may↑ serum sal
i
cy l
atel
evel
s.

DOSAGE
5mLofl
i
qui
dequi
val
entt
o500mgsal
i
cyl
ateor650mg

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 808
ofaspi
rin.Tabl
etstr
engthexpr
essedinmgofsalicy
lat
e:
500-mgt abl
etequi
valentt
o650mgofaspi r
in,
750-mg
tabl
etequival
entto975mgofaspiri
n,1000-
mgt abl
et
equi
valentto1.3gofaspiri
n
PO: (
Adult
s):Anal
gesi
c/ant
ipyret
ic—2–3gof
sali
cyl
ate/
dayin2–3divi
deddoses.Anti
-i
nfl
ammat
ory
—3
g/dayatbedt
imeorin2–3di v
ideddoses.
PO:(Chi
ldr
en)
:30–60mg/
kg/
daygi
veni
n3–4di
vi
ded
doses.

AVAI
LABI
LITY
Tabl
ets500mg,
750mg,
1000mg;
Liqui
d500mg/
5mL;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakesal
icy
lat
eswithaful
lglassof
waterandtor emaininanupri
ghtposi
ti
onfor15–30
minafteradmi ni
str
ati
on.

Advi
sepatientt
or epor
tti
nni
tus;
unusualbl
eedi
ngof
gums;brui
sing;
black,t
arr
ystool
s;orf
everl
asti
ng
l
ongerthan3day s.

Cauti
onpati
enttoavoidconcurr
entuseofalcohol
wit
hthismedicat
iontomi ni
mizepossibl
egastr
ic
i
rri
tat
ion;
3ormor eglassesofalcohol
perdaymay

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 809
 i
ncreaset her
iskofGIbleedi
ng.Cautionpati
entto
avoi
dt aki
ngconcurrent
lywit
hacet aminophenor
NSAIDsf ormorethanaf ewdays,unlessdir
ect
edby
heal
thcar eprof
essi
onaltopreventanalgesi
c
nephropathy.

Tabl
etswithanacet
ic(
vinegar
-l
ike)odorshoul
dbe
di
scarded.

Advi
sepatientsonlong-
termt her
apytoinf
orm heal
th
car
eprofessionalofmedicat
ionregi
menbef ore
sur
gery
.Sal i
cylat
esmayneedt obewit
hheldfor1wk
bef
oresurgery.

Ci
clesoni
de
I
NDI
CATI
ONS
Sympt omat
icmanagementofseasonal
/per
enni
alal
l
ergi
c
rhi
nit
is.

ACTI
ON
Actsasapot
ent,local
l
yact ingant
i-
infl
ammator
yand
i
mmunemodi fi
er.TherapeuticEf
fects:
Decr
eased
symptomsofal
lergicr
hinit
is.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 810
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Concur
rentket
oconazol
e;OB:
/Lactati
on:Safeusei
npregnancyorl
actat
ionnot
establi
shed;Pedi
:Saf
euseinchil
dren<6yrnot
establi
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache.EENT:earpain,epi
staxi
s,l
ocalst
ingi
ng,
nasophary
ngit
is.Endo:
adrenalsuppressi
on(hi
gh-dose,
l
ongt er
mt her
apyonly)
.

I
NTERACTI
ONS
Dr
ug-
Drug:
Ket
oconazol
e↑ bl
oodl
evel
s;usecaut
iousl
y.

DOSAGE
I
ntranasal:
(Adul
tsandChi
ldren≥6y
r):2spr
aysi
neach
nostri
loncedail
y(nott
oexceed2spraysi
neach
nostri
l
/day).

AVAI
LABI
LITY
Aqueoussuspensi
onspr
ayfornasaluse50
mcg/act
uati
onin12.5gr
am bott
les;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 811
 Advisepat i
enttotakemedicati
onasdir
ect
ed.Take
misseddosesassoonasr ememberedunl
essalmost
ti
mef ornextdose.Medicati
onshoul
dbeusedat
regularint
erval
sforbesteffect
.

Caut
ionpat
ientnott
oexceedmaxi
mal
dai
l
ydose.

Instructpati
entincorrecttechniqueforadminist
eri
ng
nasal spray(seeAppendixD) .Mostnasal sprays
i
ncl udedirecti
onswithpictures.Inst
ructpati
entto
readpat i
entinformat
ionsheetpr i
ortouse.Shakewell
bef oreuse.War npat
ientthattempor arynasal
stingingmayoccur .

Advi
sepat i
ent
soni mmunosuppressi
vedosesof
cor
ti
osteroi
dstoavoidexposuret
ochickenpoxor
measles.I
fexposed,cont
actheal
thcareprof
essi
onal
.

Instr
uctpati
enttonoti
fyheal
thcareprofessionali
f
sympt omsdonoti mprovewit
hin1–2wksf or
seasonalall
ergi
crhini
ti
sor5wksi nperennialall
ergi
c
rhini
ti
sorifnasaldi
schargebecomespur ul
ent.

CI
DOFOVI
R
I
NDI
CATI
ONS
Managementofcy
tomegal
ovi
rus(
CMV)r
eti
nit
isi
nHI
V-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 812
i
nfect
edpat
ient
s(wi
thpr
obeneci
d).

ACTI
ON
Suppressesrepli
cati
onofCMVbyi nhi
bit
ingv i
ralDNA
synthesi
s.Therapeuti
cEffect
s:Sl
owsprogressionofCMV
ret
init
is;
maynotbecur at
ive.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oci
dof
ovi
r,
probenecid,orsul
fonami des;Serum Cr>1.5mg/ dL,CCr
≤55mL/ mi n,orur
ineprotein≥100mg/ dL(≥2+protei
nur
ia)
;
Concurrentuseoff oscarnet,amphoteri
cinB,
aminoglycosideanti-
inf
ectives,NSAI
Ds, orIVpentamidi
ne.

UseCaut
iousl
yin:
Pregnancyorchi
l
dren(
saf
etynot
est
abli
shed)
;br
east
feedi
ngi
snotr
ecommendedi
nHI
V-
posi
ti
vepati
ent
s.
ExerciseExtremeCauti
onin:Anycondi
ti
onormedi
cat
ion
thatincreasesther
iskofdehydr
ati
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,weakness.EENT: decreasedintraocular
pr
essur e,hear
ingloss,i
ri
ti
s,ocul
arhy potony,
uv eit
is.Resp:
dyspnea,pneumoni a.GI
:HEPATICDYSFUNCTI ON,
PANCREATI TI
S,abdominalpain,
nausea, vomiti
ng,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 813
anorexi
a, di
arrhea.GU:RENALFAI LURE,protei
nur
ia.Derm:
al
opecia, r
ash.FandE: decreasedserum bicar
bonate.
Hemat :neutr
openi a,
anemi a.Metab:METABOLI C
ACIDOSI S.Misc:chil
ls,
fever,inf
ecti
on.

I
NTERACTI
ONS
Drug-Drug:↑r iskofnephr otoxici
tywithami nogly cosides,
amphot eri
cinB, f
oscarnet,andpent amidi neandshoul dbe
avoided;wait7day saftergivingothernephr otoxicagent s.
Probenecid,whichisrequiredconcur rently,mayi nteract
withacetaminophen, acyclovir,
ACEi nhibitors,bar bit
urates,
benzodiazepines,bumet anide,methotrexat e,famot idine,
fur
osemi de,NSAI Ds,
theophy lli
ne,andzi dov udine.

DOSAGE
I
V:(
Adul
ts)
:5mg/
kgonceweeklyf
or2wk,f
oll
owedby5
mg/
kgever
y2wk(mustbegi
venwit
hpr
obeneci
d).
Renal
Impai
rment
IV:(Adult
s) :
Increaseinser
um creatinineof0.3–0.4
mg/ dL—decr easedoseto3mg/ kg; discont
inueifserum
creati
nineincreases≥0.5mg/dLov erbaseline.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion75mg/
mLi
n5-
mLampul
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 814
PATI
ENTTEACHI
NG
I
nform pat
ientthatcidofov
iri
snotacur
eforCMV
ret
ini
ti
sandt hatret
init
ismayconti
nuet
oprogr
ess
duri
ngandaf tert
herapy.

Inf
orm pat
ientthatconcurrentant i
ret
rovi
ralther
apy
maybecont inued.However ,zidovudi
netherapy
shoul
dbet empor ar
il
ydiscont inuedordecreasedby
50%ont heday sofcidof
ov i
rt herapybecauseofthe
eff
ectsofprobenici
donzi dov udine.

Adv i
sepatientofthepossibi
li
tyofrenal
toxi
cit
yf r
om
cidofovi
r.Emphasizetheimportanceofrout
inelab
teststomoni t
orrenalfuncti
on.

Inf
or m pat
ientthatci
dofov
irmayhavet erat
ogenic
effects.Womenshoul dusecontr
aceptionduringand
for1moaf tert
herapy.Menshoul
dusebar r
ier
contracept
iondur i
ngandfor3moaf tertherapy.

Discusswithpat
ientthepossi
bil
i
tyofhai
rloss.
Explorecopi
ngstrat
egies.

Advi
sepati
ent
stohaverouti
neopht
hal
mol
ogi
c
examsaft
erci
dof
ovirt
herapy.

Ci
l
ost
azol
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 815
I
NDI
CATI
ONS
Reduct
ionoft
hesymptomsofint
ermit
tentcl
audi
cat
ionas
measuredbyi
ncr
easedwal
kingdist
ance.

ACTI
ON
Inhibit
stheenzymecy clicadenosinemonophosphat e
(cAMP)phosphodi esteraseIII(PDEIII
),whichresultsin
i
ncr easedcAMPi nplateletsandbl oodvessels,producing
i
nhi bit
ionofpl
atel
etaggr egationandv asodil
ati
on.
Ther apeut
icEf
fects:Reducedsy mptomsofi ntermittent
claudicati
onwit
himpr ov edwal ki
ngdistance.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
HF;
OB:
Pot
ent
ial
for
congenit
aldef
ect
s,stil
l
bir
th,andlowbir
thweight
;
Lactat
ion:Pot
ent
ial
risktonursi
nginf
ants;
discont
inueor
bott
lefeed.

UseCaut
iousl
yin:
Pedi
:Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache,
dizzi
ness.CV:
pal
pit
ati
ons,
tachy
car
dia.GI
:
di
arr
hea.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 816
Drug-Drug:Concur rentadmi ni
str
ati
onofket oconazole,
i
traconazole,erythromy ci
n,dil
ti
azem, fl
uconazole,
miconazole, f
luvoxami ne,f
luoxeti
ne,nefazodone,
sertr
ali
ne,oromepr azoledecreasesmet aboli
sm and
i
ncreasesl evelsandact iv
ityofcil
ostazol(uselower
doses).Concur rentusewi thaspir
inhasaddi t
iveeff
ects
onplateletfunction.
Drug-
Food:Grapef
rui
tjui
ceinhi
bit
smetabol
i
sm and
i
ncreasesef
fects;
concurr
entuseshoul
dbeavoi
ded.

DOSAGE
PO: (
Adult
s):100mgtwicedail
y(50mgt wi
cedai
l
yif
recei
vingi
nhi
bitor
sofci
l
ostazolmetabol
i
sm).

AVAI
LABI
LITY
Tabl
ets50mg,
100mg;

PATI
ENTTEACHI
NG
Inst
ructpat
ienttot
akecil
ostazol
onanempt
y
stomach,exactl
yasdi
rected.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 817
 Advi
sepati
entt
oav
oidsmoki
ng;
nicot
ineconst
ri
cts
bl
oodvessel
s.

Ci
met
idi
ne
I
NDI
CATI
ONS
Short
-ter
mt reat
mentofact i
v eduodenal ulcersandbenign
gastr
iculcers.Mai nt enancet herapyforduodenal ulcer
s
aft
erhealingofact iv eulcer(
s) .Managementof
gastr
oesophageal ref l
uxdisease( GERD) .Treatmentof
heart
burn, acidi
ndi gest i
on,andsourst omach( OTCuse) .
Managementofgast ri
chy persecretorystates(Zoll
i
nger-
El
li
sonsy ndr ome).Unl abel
edUses: ManagementofGI
symptomsassoci at edwi ththeuseofNSAI Ds.
Managementofur ticaria.

ACTI
ON
Inhibi
tstheactionofhist
amineatt heH2-recept orsit
e
l
ocat edprimari
lyingastr
icpariet
alcel
ls,result
ingin
i
nhi bi
tionofgastri
cacidsecreti
on.TherapeuticEf f
ects:
Heal i
ngandpr eventi
onofulcers.Decr
easedsy mpt omsof
gast r
oesophageal r
efl
ux.Decreasedsecretionofgast ri
c
acid.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 818
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Oral
li
qui
dcont
ains
al
coholandshoul
dbeav
oidedi
npat
ient
swi
thknown
i
ntol
erance.

UseCaut
iousl
yin:
Renal
impai
rment(
mor
esuscept
ibl
e
toadv er
seCNSr eacti
ons;↑ doseint
ervalrecommended
i
fr enali
mpairmentissever
e);OB:Lact
ation:Safet
ynot
establi
shed;Ger
i:AppearsonBeersli
st.Geriat
ri
cpatient
s
aremor esuscepti
bletoadverseCNSreactions(dose↓
recommended) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: conf
usion, dizzi
ness,drowsiness,hal
lucinati
ons,
headache.CV: ARRHYTHMI AS.GI:consti
pation,di
arrhea,
drug-
inducedhepat i
ti
s,nausea.GU: ↓ sperm count,
erect
iledysf
unct ion.Endo:gynecomast i
a.Hemat :
AGRANULOCYTOSI S,APLASTICANEMI A,anemi a,
neutr
openia,thrombocy topenia.Misc:hypersensit
ivi
ty
react
ions.

I
NTERACTI
ONS
Drug-Drug:Ci
metidi
neinhi
bitsdrug-
metaboli
zingenzymes
i
nt heli
ver;mayleadto↑ bloodlevel
sandt oxici
tywi
th
thefoll
owing—somebenzodi azepi
nes(especiall
y
chlor
diazepoxi
de,di
azepam, andmidazolam),somebeta

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 819
blockers(labetalol,metoprol ol,
pr opranolol),caffeine,
calci
um channel blockers,car bamazepi ne, chloroqui ne,
l
idocaine,met ronidazole,pent oxifyl
li
ne, pheny toin,
propafenone, quinidi
ne, qui
ni ne,met formin, sulfony l
ureas,
theophy l
li
ne, t
ri
amt erene,tricycli
cant idepressant s,and
war f
arin.May↑ t heef f
ectsofsucci ny l
choline, f
lecainide,
procainami de,carmust i
ne, andf luorouracil
.↓ absor pti
on
ofketoconazol e.Ant aci
dsandsucr alfate↓ absor pti
on.
Drug-Natur
alProduct
: ↑ caf
fei
nelevel
sandsideeff
ects
withcaff
eine-
contai
ningherbs(col
anut,guar
ana,mate,
tea,cof
fee).

DOSAGE
PO: (
Adul t
s) :
Short-t
ermt reatmentofacti
veulcers—300
mg4t i
mesdai l
yor800mgatbedt i
meor400–600mg
twicedaily(nottoexceed2. 4g/ day
).Duodenalulcer
prophylaxis—300mgt wicedailyor400mgatbedt i
me.
GERD—800–1600mg/ dayi ndivi
deddoses.Gastric
hypersecretorycondit
ions—300–600mgq6hr( upto12
g/dayhav ebeenused) .OTCuse—upt o200mgmaybe
takentwicedai l
y(fornomor ethan2wk).
PO:(
Chi
ldr
en):
Short
-t
ermtreat
mentofacti
ve
ul
cer
s—20–40mg/kg/dayi
n4divi
deddoses.
Renal
Impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 820
PO:
(Adul
ts)
:300mgq8–12hr ;
fur
theradj
ust
mentmay
ber
equi
redf
orconcur
renthepat
ici
mpairment
.
PO:(
Chi
ldr
en)
:10–15mg/
kg/
daygi
veni
ndi
vi
deddosesq
8–12hr
.

AVAI
LABI
LITY
Tabl
ets100mgOTC,200mgOTC, 300mg,400mg,600
mg,800mg;Oral
li
quid(
mint
-peach)300mg/5mL,
200
mg/5mLOTC;

PATI
ENTTEACHI
NG
Instructpat
ienttotakemedicati
onasdirectedfort
he
fullcourseoftherapy,
eveniffeel
ingbet
ter.Take
mi sseddosesassoonasr emember edbutnotif
almostt imefornextdose.Donotdoubledoses.

Advisepati
entstakingOTCci metidi
nepr epar
ati
ons
nottotakethemaxi mum dosecont inuouslyf
ormor e
than2wkwi t
houtconsul ti
nghealt
hcar eprof
essi
onal.
Notifyheal
thcarepr ofessi
onali
fdiff
icul
tyswall
owing
occursorabdomi nal pai
npersi
sts.

Inf
orm pat
ientthatsmoki ngi
nter
fer
eswiththeact
ion
ofhist
amineant agoni
sts.Encour
agepati
enttoqui
t
smokingoratleastnott osmokeafterl
astdoseof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 821
 t
heday
.

Maycausedr owsi
nessordizzi
ness.Cauti
onpati
ent
toavoiddri
vingorotheract
ivi
ti
esrequir
ingal
ert
ness
unti
lresponsetothedrugisknown.

Advisepat
ientt
oav oi
dalcohol,
product
scont
aini
ng
aspi
r i
norNSAIDs,andfoodsthatmaycausean
i
ncreaseinGIir
ri
tati
on.

Inf
orm pat
ientt
hati
ncreasedflui
dandf i
beri
ntake
andexerci
semaymi ni
mi zeconsti
pat
ion.

Advisepatienttorepor
tonsetofbl
ack, t
arr
ystools;
fev
er ;
soret hroat
;di
arr
hea;di
zzi
ness;rash;confusi
on;
orhalluci
nationstoheal
thcarepr
ofessionalpromptl
y.

Ci
nacal
cet
I
NDI
CATI
ONS
Secondar yhyperpar
athyr
oidism inpat i
entswithchroni
c
ki
dneydi sease(CKD)ondi alysis.Hypercalcemiacaused
byparathy r
oidcarci
noma.Sev erehypercalcemiain
pati
entswi thpri
mar yhy
perpar athyr
oidism inpati
entswho
areunablet oundergoparathyroidectomy .

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 822
Increasessensi t
ivi
tyofcalcium-sensi
ngreceptor
sl ocated
ont hesur f
aceofchi efcel
lsofpar at
hyroi
dglandtol evel
s
ofext racel
lul
arcalcium.Thisdecreasesparathyr
oid
hormonepr oducti
onwi thresult
antdecreaseinserum
calcium.Ther apeuti
cEffects:Decreasedboneturnov er
andf ibrosi
s.Decreasedser um calci
um.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hypocal
cemi
a;
Lact
ati
on:
Discont
inuedr
ugorbot
tl
e-f
eed.

UseCaut
iousl
yin:
Hist
oryofsei
zur
edi
sor
der(
↑ri
skof
sei
zur eswi thhypocalcemia);Chronickidneydisease
patientswhoar enotbeingdi al
yzed(↑r i
skof
hypocal cemia);I
ntactparathyroi
dhor mone( i
PTH)l evel
<150pg/ mL( dose↓ ordi scontinuat
ionmaybe
warr anted);Moderatetosev erehepaticimpai
rment ;OB:
Useonl yifbenefi
tsjusti
fyri
skst ofetus;Pedi
:Safetynot
established.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: seizur
es.GI
:nausea,
vomi
ting.FandE:
hypocalcemia.Metab:
adynami
cbonedi sease.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 823
Drug-Drug: I
nhibi
tsCYP2D6andmay↑ l evel
sofflecainide,
vi
nblastine,thior
idazi
ne,met oprol
ol,
carv
edil
ol,
andmost
tr
icycl
icant i
depressants;doseadjustmentsmaybe
necessar y.Bloodlevel
sare↑ byst rongCYP3A4inhibitors
i
ncludingket oconazole,i
traconazol
e,andery
thromycin;
moni t
oringanddoseadj ustmentmaybenecessar y.

DOSAGE
PO: (Adult s):Secondar yhyper
parathyr
oidi
sm inCKD
patientsondi al
y sis—30mgoncedai l
y;may↑ doseev ery
2–4wk( doser ange30–180mgoncedai l
y)basedon
i
PTHl evels;Parat hyr
oidcar
cinomaorpr imary
hyper parathyroidism—30mgt wicedaily
;mayt i
trateev
ery
2–4wkupt o90mg3–4t i
mesdai l
ybasedonser um
calcium lev el
s.

AVAI
LABI
LITY
Tabl
ets30mg,
60mg,
90mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakeci
nacal
cetasdi
rect
ed.

Advisepat
ientt
orepor
tsignsandsymptomsof
hypocal
cemiatoheal
thcareprof
essi
onalpr
omptl
y.

Emphasi
zet
hei
mpor
tanceoff
oll
ow-
upl
abt
est
sto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 824
 moni
torsaf
elyandef
fi
cacy
.

Ci
prof
loxaci
n
I
ndi
cat
ions
Gast roenterit
is-i
ncludingchol era,shigellosi
s,travell
ers’
diarrhoea, campy lobact erandsal monel laenterit
is;t
yphoid;
gonor rhoea; chancroid; legi
onnai res’disease; meningiti
s
(i
ncludi ngmeni ngococcal meni ngit
ispr ophylaxis);
respiratory-t
ractinfectionsincl udingpseudomonal
i
nf ectionsincy sti
cf i
br osis,butnotpneumococcal
pneumoni a;urinary-t
racti nfections;boneandj oint
i
nf ections;septicaemi a; anthrax;skininf ect
ions;
prophy l
axi
si nsurgery .

ACTI
ON
Inhi
bitsbact eri
al DNAsy nthesisbyi nhibi
t i
ngDNAgy r
ase
enzy me.Ther apeut icEffect s:Deat hofsuscept ible
bacteria.Spectrum: Activeagai nstgr am- positi
ve
pathogens, incl
udi ng: Staphy lococcusaur eus,
Staphy l
ococcusepi dermi di
s, Staphy lococcus
saprophy ti
cus,St reptococcuspy ogenes, Streptococcus
pneumoni ae,Enter ococcusf aecal i
s, Bacill
usant hraci
s
(anthrax).Gram- negat iv
espect r um not ableforact i
vit
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 825
against:Escherichiacoli,Kl
ebsiell
apneumoni ae,
Enterobactercloacae, Salmonellatyphi,Shigel
laspp,
Proteusmi rabil
i
s, Proteusv ul
gari
s,Pr ovi
denciastuart
ii
,
Providenciarett
ger i
, Morganell
amor ganii
,Pseudomonas
aeruginosa,Serratiamar cescens,Haemophi l
usinfl
uenzae,
Mor axel
lacat ar
rhalis,Campy l
obacterj ej
uni.

Av
ail
abi
l
ity
TABLETS100,
250,500and750mg;
INFUSI
ON50,
100
and200ml(2mg/ml).
Adult
-Uri
narytr
actinfecti
on,r
espir
atorytr
actinfect
ion:
250to500mg, twicedaily
.Severerespi
rat
or ytr
act
i
nfecti
ons:upto750mgt wicedail
y(howev eri
nacute
uncompli
catedcysti
ti
si nwomen100mgt wicedail
yfor
thr
eedays).
Chroni
cprost
ati
ti
s:500mgtwi
cedail
yfor28day
s.
Gonorr
hoea:500mgasasingl
edose.
Chi
l
d-Notr
ecommended.
I
ntr
avenousi
nfusi
on(
30t
o60mi
n)
Adult
-Urinaryt
ractinf
ecti
on,ENTi nfection,ski
n,soft
ti
ssueandbonei nfect
ion,j
ointinf
ection, gast
roi
ntest
inal
tr
actinf
ection,
severesystemicinfecti
on, gonorr
hea,
surgi
calprophyl
axisandsepticaemia; 100t o200mgt wice

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 826
dai
l
ybysl
owi
ntr
avenousi
nject
ionori
nfusi
on.

Cont
rai
ndi
cat
ions
Hist
oryoftendondi sor
dersrel
atedtoquinoloneuse;
exposuretostrongsunli
ght,hyper
sensi
ti
vitytoquinol
ones
deri
vati
ves;t
izanidi
netherapy.

I
NTERACTI
ONS
Drug- Drug: Concur r entusewi t
ht heophy l
li
nemayr esulti
n
↑t heophy llineconcent r
at i
onsandt her eforeser iousand
potent i
al l
yf atalreact i
onsduet ot heophy l
li
net oxicity
;if
concur rentusecannotbeav oi
dedser um t heophy l
li
ne
l
ev elsshoul dbemoni tored.Admi nistrationwi thant acids,
i
ronsal ts,bismut hsubsal icyl
ate,sucr al fate,andzi ncsalts
↓ absor ption.Mayal t
ert heeffect sofwar far i
n.May↓
l
ev elsandef fect
ivenessofpheny toin.Ser um l ev elsmay
be↓ byant ineoplast i
cs.Ci met i
dinemayi nt erferewi t
h
eli
mi nat i
on.Benef icialeffectsmaybeant agoni zedby
nit
rof urantoi n.Probeneci d↓ r enal eli
mi nat i
on.May↑ r i
sk
ofnephr otoxi ci
tyfrom cy clospor i
ne.Concur rentusewi th
foscar netmay↑ r iskofsei zures.Concur rentt her apywith
corticost er
oi dsmay↑ r iskoft endonr uptur e.May↓
met abol ism oft i
zani dine,usecont raindi cated.
Dr
ug-
Nat
ural
Product
:Fennel
↓ bi
oav
ail
abi
l
ity
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 827
Drug-
Food:Absorpt
ionisimpai r
edbyconcurrentent
eral
feedi
ng(becauseofmet alcati
ons)
.Absorpti
onis↓ by
foodand/ordair
yproducts(take1hrbeforeor2hrafter
).

Pr
ecaut
ions
Historyofepi l
epsyorcondi tionst hatpr edisposet o
seizures, G-6-PDdef iciency ,my astheniagr avis(ri
skof
exacer bation),pr egnancyl act ation,childr
enor
adolescent s( seebel ow) ;av oidexposur etoexcessi ve
sunlight( discont i
nuei fphot osensi t
ivi
tyoccur s);r
arely
,
tendondamage- di scont i
nueatf i
rstsignofpai nor
i
nf l
ammat i
onandr estaf fect edl imb; hepaticimpai r
ment;
renal fai
lureav oidexcessi veal kalinit
yofur ineandensur e
adequat ef luidint akeast her eisr iskofcr y
st al
luri
a;
i
nter acti
onscer ebr al arterioscler osis,anxiety,paranoi
a,
erythema, bli
stering.
UseI nChi l
dren.Ciprofl
oxaci ncausesar thropathyint he
weight-beari
ngj oint
sofi mmat ureanimal sandi stherefore
generallynotrecommendedi nchi l
drenandgr owing
adolescents.Howev er
, thesignifi
canceoft hiseffectin
humansi suncer t
ainandi nsomespeci ficcircumst ances
short-
term useofci profloxacininchildrenmaybej ust i
fi
ed.
Ciprofl
oxacinisusedf orpseudomonal infectionsincy sti
c
fi
brosis( f
orchildrenov er5y ears)andf ortreatmentand
prophylaxisofant hr
ax.Mayi mpai rabil
i
t ytoper f
orm

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 828
ski
l
ledt
asks,
forexampl
eoper
ati
ngmachi
ner
y,dr
ivi
ng.

Adv
erseEf
fect
s
Nausea, v
omi ting, dy spepsi a, abdomi nal pain, fl
at ul ence,
diar r
hoea( rarely,ant i
biotic-associ at edcol iti
s) ,dy sphagi a,
tremor ,hy per glycaemi a, headache, dizzi ness, sleep
disor der s,rash( rar ely,erythemamul t
ifor me( Stev ens-
Johnsonsy ndr ome)andt oxi cepi der mal necr oly sis)and
prur i
tus; vascul it
is, erythemanodosum, pet echi ae,
haemor rhagi cbul l
ae; l
essf requent l
yanor exia, i
ncr easein
bloodur eaandcr eat i
nine; dr owsiness, rest lessness,
ast heni a,depr essi on, conf usi on,halluci nat i
ons,
conv ul sions, paraest hesia; phot osensi tiv i
ty,
hy persensi tivit
yr eact i
onsi ncl udingf ev er ,urticar ia,
angi oedema, arthr algia,my algiaandanaphy l
axi s; blood
disor der s( i
ncl udingeosi nophi l
ia,leukopeni a,
thrombocy topeni a) ,alteredpr othrombi nt ime;
distur bancesi nv ision, taste, hear i
ngandsmel l,tinni tus;
tenosy nov itis;tachy cardia, oedema, sy ncope, hotf lushes
andsweat ing; ifpsy chiatri
c, neur ologi cal or
hy persensi tivit
yr eact i
ons( incl udingsev erer ash)occur
discont inue; arthral gia.

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakemedi
cat
ionasdi
rect
edat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 829
 evenl
yspacedt imesandtof i
nishdrugcomplet
ely
,
eveniffeelingbett
er.Takemisseddosesassoonas
possi
ble, unlessal
mostt i
mef ornextdose.Donot
doubledoses.Adv isepati
entthatshari
ngofthi
s
medicationmaybedanger ous.

Adv
isepati
entstonot
ifyhealt
hcareprofessi
onal
i
mmediatel
yiftheyar
et aki
ngtheophy
ll
ine.

Encour
agepat
ientt
omaintai
naflui
dint
akeofatl
east
1500–2000mL/daytopr
eventcr
yst
all
uri
a.

Advi
sepat i
entthatant
acidsormedicati
ons
cont
aini
ngcal ci
um, magnesi
um,aluminum,i
ron,
or
zi
ncwi l
ldecreaseabsorpt
ionandshouldnotbetaken
wit
hin4hrbef oreand2hraftert
akingthi
s
medicati
on.

Maycausedi zzi
nessanddr owsiness.Caut
ionpati
ent
toavoiddri
vingorotheracti
vi
tiesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

Cauti
onpat i
enttousesunscreenandpr otecti
ve
clot
hingtopreventphot
otoxicityreact
ionsduringand
for5daysafterther
apy.Noti
f yhealthcare
prof
essionali
fasunburn-l
iker eacti
onorski nerupt
ion
occurs.

I
nst
ructpat
ient
sbei
ngt
reat
edf
orgonor
rheat
hat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 830
 par
tner
sal
somustbet
reat
ed.

Instr
uctpatientt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbeingtakenandt oconsultheal
thcar e
professi
onal bef
oretaki
nganyot herRx,OTC, or
herbalproducts.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(
fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools).

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Instructpatientt onot i
fyheal thcar epr ofessional
i
mmedi at
elyi frash, j
aundice, signsofhy persensit
ivi
ty,
ort endon(shoul der,hand,Achi lles, andot her)pain,
swel li
ng,orinf l
ammat ionoccur .Iftendonsy mpt oms
occur ,avoi
dexer ci
seanduseoft heaf fectedarea.
Increasedr i
ski n>65y r
sold, kidney , heartandl ung
transplantreci pients,andpat ient staki ng
cort i
coster
oi dsconcur rent
ly.Ther apyshoul dbe
discont i
nued

St
orage
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 831
EyedropsandTablet:St
oreprotect
edf r
om l
ight.I
nject
ion:
Storepr
otect
edfrom l
ightatatemper at
urenotexceeding
30⁰C.Thecontai
nershouldnotbeallowedtofreeze.

CI
SAPRI
DE
I
NDI
CATI
ONS
Managementofnoct urnalsymptoms(hear
tbur
n)
associatedwithGERD.Unlabel
edUses:Managementof
gastroparesi
sduetodiabetes,
pseudo-
obstr
uct
ion,
or
othercauses.

ACTI
ON
Enhancest hereleaseofacetyl
choli
neatthemy enteri
c
plexus.I
ncreasest hestr
engthofesophagealperistal
sis
andi ncr
easesloweresophageal sphinct
erpr
essur e.Al
so
actsasaser otonin-4agoni
st.Therapeut
icEf
fects:
Reducednoct urnalsymptomsofGERD.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sit
uat
ionsi
nwhi
ch
i
ncr
easedGImoti
li
tymaybeharmful(GIhemor
rhage,
mechani
cal
obst
ructi
on,
orper
forat
ion).

UseCaut
iousl
yin:
Pregnancyorl
act
ati
on(
saf
etynot

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 832
est
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness,fatigue,headache.Resp: pharyngi
ti
s,
rhini
ti
s.CV: chestpain.GI: abdominalpain,consti
pat
ion,
diarr
hea,dyspepsi a,fl
atul
ence, v
omi t
ing.FandE:
dehydrati
on.MS: backpai n,myalgi
a.

I
NTERACTI
ONS
Drug-Dr ug: Antichol inergicsmaydecr easet heef fectsof
cisapride.Mayaccel eratet hesedat iveef fectsof
benzodi azepi nesoral cohol.Mayi ncr easet heef fectsof
war f
ar i
n.Mayal tertheef fect sofdr ugswi thnarrow
therapeut i
cmar gins( digoxi n,ant i
conv ulsants;bloodl evel
moni toringr ecommended) .Ci met idinei ncreasespl asma
l
ev elsofci sapride.GIabsor ptionofci metidineand
ranit
idinei saccel erated.Del avirdine, ketoconazol e,
i
traconazol e, mi conazol e,fl
uconazol e, t
roleandomy cin
(TAO) ,erythromy cin, dir
ithromy cin, andcl arit
hromy ci
n
decreasemet abol ism andi ncr easel evelsofci sapride;
mayr esultinser i
ousar rhy t
hmi as( av oidconcur rentuse) .

DOSAGE
PO:(
Adults)
:Tr
eat
ment—5–10mg3–4ti
mesdail
y.
Pr
event
ion—10mgtwi
cedail
yor20mgoncedai
l
yat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 833
bedt
ime.
PO:
(Chi
l
dren)
:0.
15–0.
3mg/
kg3–4t
imesdai
l
y.

AVAI
LABI
LITY
Tabl
ets5mg,
10mg,
20mg;
Oral
suspensi
on1mg/
mL;

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakeci
sapri
deasdi r
ected,
eveni
f
feel
i
ngbet t
er.I
fadoseismissed,t
akeassoonas
possibl
eunlessal
mostti
mef ornextdose.

Cisapri
demaycausedr owsiness;cauti
onpat
ientt
o
avoiddri
vingorot
heracti
vit
iesrequiri
ngal
ert
ness
unti
lresponsetomedicat
ionisknown.

Advi
sepat
ientt
oconsul
thealt
hcar
eprof
essi
onal
bef
oret
aki
ngOTCmedi cat
ionswhi
let
aki
ngcisapr
ide.

Advisepati
enttoavoidalcoholorot
herdepressant
s
whil
et aki
ngcisapri
de;ci
sapridemayenhancethe
sedati
v eef
fectsoftheseproduct
s.

CI
SATRACURI
UM
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 834
I
nduct i
onofskeletalmuscl
eparal
ysi
sandf acil
i
tat
ionof
i
ntubationafteri
nducti
onofanest
hesiai
nsur gi
cal
procedures.Faci
li
tat
ionofcompli
anceduri
ngmechani cal
venti
lat
ion.

ACTI
ON
Preventneur
omusculart
ransmissionbyblockingthe
eff
ectofacetyl
chol
ineatthemy oneur
aljunct
ion.Hav eno
anal
gesicoranxiol
yti
cproper
ti
es.Therapeuti
cEf f
ects:
Skel
etalmuscleparal
ysi
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
bromides(pancur
onium,vecur
oni
um onl
y);
Pedi:
Product
s
contai
ningbenzyl
alcohol
shouldbeavoi
dedinneonat
es.

UseCaut
iousl
yin:
Pat
ient
swi
thunder
lyi
ng
cardiovasculardisease( ↑r i
skofar r
hythmi as;lesswith
atracuri
um orv ecuronium) ;Dehy dr
ationorel ectrol
yte
abnor mali
ti
es( shouldbecor rected);Situationsinwhi ch
histaminereleasewoul dbepr oblemat i
c( worsewi th
atracuri
um; l
esswi t
hci satr
acur ium andv ecuronium);
Fracturesormuscl espasm; Ger i
atri
cpat ientsorpat i
ents
withimpai r
edr enalfunction( sloweronsett ocompl ete
paralysiswit
hci satracurium;↓ el i
minationof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 835
pancur onium) ;Hy per t
her mia( ↑ dur at
ion/ i
ntensi tyof
paralysis);Pat i
entswi thsignifi
canthepat i
ci mpai rment( ↓
met abolism ofv ecuroni um, alt
er edresponset oot hers);
Shock; Extensi vebur ns( maybemor er esi
stantt oeffects
ofcisat r
acur i
um) ;Lowpl asmapseudochol inest erase
l
ev els(maybeseeni nassoci ationwi t
hanemi a,
dehy drati
on, chol i
nest erasei nhibit
ors/insecticides, severe
l
iverdisease, pregnancy ,orher edit
arypr edisposi ti
on);
Obesepat ients; OB: Lact at
ion: Pedi:Saf et
ynotest ablished
forsomeagent s; mostagent shav ebeenusedsaf elyin
pregnantwomenunder goingcesar eansect ion; selected
agent shav ebeenusedsaf el
yi nchildren.
Exer
ciseExt
remeCauti
onin:Pat
ientswit
hneuromuscul
ar
di
seasessuchasmyastheni
agravis(smal
ltestdosemay
beusedtoassessr
esponse)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Resp:bronchospasm.CV: at
racur i
um—hypotension,
pancuroni
um—hy pertension,at
r acuri
um,
pancuroni
um—t achycardia.GI:pancuroni
um—excessi v
e
sali
vat
ion.Derm:rash,atracuri
um—ski nfl
ushing.Misc:
al
lergi
creacti
onsincludinganaphy laxi
s.

I
NTERACTI
ONS
Dr
ug-
Drug:
Int
ensi
tyanddur
ati
onofpar
aly
sismaybe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 836
prolongedbypr etreatmentwi thsucci nylcholine,gener al
anesthesi a( i
nhal ati
on),ami nogl ycosi des, vancomy cin,
tetr
acy clines,poly myxinB, col i
st in,clindamy cin,lidocaine,
andot herlocal anesthetics, l
ithium, qui nidi
ne,
procainami de,bet a-
adrener gicbl ocki ngagent s,pot assium
-l
osingdi ur eti
cs,ormagnesi um.Ef fect sofci sat racurium
maybeenhancedbyconcur r
entenf luraneori soflurane
(dosager equirement smaybedecr easedby30–40%;
smal l
erbol usesandl oweri nfusi onr at esmaybe
necessar y)
.Hi gherinfusionr at esmayber equi r
edand
durationofact ionmaybeshor tenedi npat ientsr eceiving
l
ong- term car bamazepi neorpheny toin.Rocur onium
associ atedwi thQTci nt
er val prol ongat ionwhen
admi nisteredwi t
hgener alanest hesia.

DOSAGE
At
racur
ium
IV:(AdultsandChi ldren>2y r
):0.4–0.5mg/ kginit
ial
ly
(0.
25–0. 35mg/ kgifadmi ni
steredaftersteady-
state
anesthesiawithenf luraneori soflur
aneor0. 3–0.4mg/ kg
fol
lowingsucci nylcholine)thenmayr epeat0.08–0.1
mg/ kg20–45mi nafteriniti
aldoseasneeded, orby
continuousinfusionat0. 4–0.8mg/ kg/hr.
I
V:(
Neonat
es,
Inf
ant
s,andChi
l
drenupt
o2y
r):
0.3–0.
4

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 837
mg/kgini
ti
all
yfol
l
owedbymai
ntenancedosesof0.
3–0.
4
mg/kgasneededor0.
6–1.
2mg/ kg/
hrvi
aconti
nuous
i
nfusi
on.

Ci
sat
racur
ium
I
V: (
AdultsandChi
ldren>12y r)
:Ini
ti
alintubating
dose—0.15–0.2mg/ kg,
addit
ionalmai ntenancedosesof
0.
03mg/ kgmaybeused40–65mi nlater;conti
nuous
i
nfusion—1–3mcg/ kg/min.
IV:(Chil
dren2–12yr)
:Ini
ti
ali
ntubati
ngdose—0.
1mg/kg
fol
lowedbyamai ntenancedoseof0.03mg/kgasneeded;
continuousinf
usi
on—1–4mcg/ kg/
min.

Pancur
oni
um
I
V: (
Adult
sandChil
dren>12yr)
:0.
15mg/kgini
ti
all
y;r
epeat
dosesmaybegivenq30–60mi ntomai
ntai
nparal
ysis.
Conti
nuousi
nfusi
on—0.02–0.
04mg/kg/
hr.
I
V:(Chil
dren1–12y r
):0.
15mg/ kgi
niti
all
y;repeatdoses
maybegi venq30–60mi ntomaint
ainpar aly
sis.
Conti
nuousinf
usion—0.03–0.
1mg/ kg/hr.
I
V: (NeonatesandInf
antsupto1yr
):0.
1mg/kgini
ti
all
y;
repeatdosesmaybegi venq30–60mintomai
ntai
n
paraly
sis.Conti
nuousinf
usi
on—0.
02–0.04mg/
kg/hr.

Rocur
oni
um

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 838
I
V:(Adul
ts)
:Rapidsequencetr
acheali
ntubat
ion—0. 6–1.
2
mg/kg;mai
ntenancedosi
ng—0.1–0.
2mg/ kg;continuous
i
nfusi
on—10–12mcg/ kg/min(r
ange4–16mcg/ kg/ mi
n).
I
V:(Chi
ldr
en≥3mo) :I
ntubati
ondose—0.
6mg/ kg;
maint
enancedose—0.075–0.125mg/kg;cont
inuous
i
nfusi
on—12mcg/ kg/
mi n.

Vecur
oni
um
IV:(
Adul t
sandChi ldren>10y r)
:Int
ubati
on—80–100
mcg/ kgforintubati
on( 60–85mcg/ kgifgivenaf t
erst eady
-st
ateanesthesiaachi evedor40–60mcg/ kgaf t
er
succinyl
choline-
assistedintubationandanest hesia;wait
fordisappearanceofsucci nylcholi
neeffects;or50–60
mcg/ kgduringbalancedanest hesi
a).Upt o150–280
mcg/ kghavebeenusedi nsomepat i
ents;
maintenance—10–15mcg/ kg25–40mi naf terini
tialdose,
thenq12–15mi nasneededorasacont i
nuousi nfusion
at1.5–2mcg/ kg/min.
IV:(
Chil
dren>1yr
):100mcg/kgq1hrasneededorasa
conti
nuousinf
usi
onof1.5–2.
5mcg/kg/
min.
IV:
(Inf
ant
s>7wk–1y r):
100mcg/kgq1hrasneededor
asaconti
nuousi
nfusi
onof1–1.
5mcg/kg/
min.
I
V:(Neonates)
:100mcg/kgini
ti
all
ythen30–150
mcg/kg/doseq1–2hrasneeded.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 839
AVAI
LABI
LITY
At
racur
ium
I
nject
ion10mg/
mli
n5-
mlampul
esand10-
mlv
ial
s;

Ci
sat
racur
ium
Sol
uti
onf
orinject
ion2mg/mlin5-
mlsingl
e-usevi
alsor
10-
mlmult
iple-
dosevi
als(
wit
hbenzyl
alcohol)
,10mg/ ml
i
n20-mlv
ialsRx;

Pancur
oni
um
Inj
ect
ion1mg/
mli
n10-
mlv
ial
s,2mg/
mli
n2-and5-
ml
ampules;

Rocur
oni
um
I
nject
ion10mg/
mli
n5-
mlv
ial
s;

Vecur
oni
um
Powderf
ori
nject
ion10mgand20mgv
ial
s;

PATI
ENTTEACHI
NG
Expl
ainallprocedurestopati
entrecei
ving
neuromuscularblockerther
apywithoutgener
al
anesthesi
a,becauseconsciousnessisnotaff
ect
edby
neuromuscularblocki
ngagentsalone.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 840
 Reassur
epati
entt
hatcommunicat
ionabi
l
iti
eswi
l
l
ret
urnasthemedi
cati
onwear
sof f
.

Ci
spl
ati
n
I
ndi
cat
ions
Met
ast
ati
ctest
icul
art
umour
s,met
ast
ati
cov
ari
ant
umour
s,
Advancedbl
addercancer
.Headandneckcancer
.Cer
vical
cancer
.Lungcancer
.Othert
umors.

ACTI
ON
I
nhibit
sDNAsy nthesi
sbypr oduci
ngcr oss-
li
nkingof
parentDNAstr
ands( cel
l-
cyclephase–nonspeci f
ic)
.
Therapeut
icEf
fects:Deathofrapi
dlyrepli
cati
ngcells,
parti
cul
arl
ymalignantones.

Av
ail
abi
l
ity
I
NJECTI
ON10ml
(10mg)and50ml
(50mg)v
ial
s.

DOSAGE
Int
rav
enousi
nject
ion(
usesy
ringesdev
oidofal
umi
nium
component
)
Ov
ari
ant
umor
:50mg/
m2ofbodysur
facear
eaonceev
ery

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 841
t
hreeweeks.Bl
addercancer
:50to70mg/
m2onceever
y
3to4weeks.Test
iculart
umor:
20mg/m2for5day
sever
y
3weeksfor3courses.

Cont
rai
ndi
cat
ions
Seenotesabov
eandconsul
tli
ter
atur
e;hyper
sensi
ti
vi
ty;
renal
impai
rmentpr
egnancyandlact
ati
on.

I
NTERACTI
ONS
Drug-Drug:↑r iskofnephrotoxicityandot ot
oxici
tywi th
othernephr ot
oxicandot ot
oxicdr ugs( aminogl
ycosides,
l
oopdi ur
etics)
.↑ riskofhypokal emiaand
hypomagnesemi awithloopdiureti
csandamphot eri
cinB.
May↓ pheny toinl
evels.↑ bonemar rowdepr essionwi t
h
otherantineoplast
icsorradiati
ont herapy.May↓ ant i
body
responset oli
ve-vi
rusvaccinesand↑ adv er
sereactions.

Pr
ecaut
ions
Seenotesaboveandconsul
tli
ter
atur
e;hyper
uraemi
a;
hypomagnesaemia;
hypocal
caemia;i
nter
acti
ons.

Adv
erseEf
fect
s
Seenot
esabov
eandconsul
tli
ter
atur
e.Ti
nni
tus;
neur
opat
hy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 842
St
orage
St
orepr
otect
edf
rom l
i
ght
.

Ci
tal
opr
am
I
NDI
CATI
ONS
Depressi on.UnlabeledUses:Premenst rualdysphori
c
disorder( PMDD) .Obsessiv
e-compul sivediscor
der(OCD).
Panicdi sorder.General
izedanxietydisorder(GAD).Post-
traumat i
cst r
essdi sor
der(PTSD) .Socialanxiet
ydisorder
(soci
al phobia).

ACTI
ON
Sel
ecti
vel
yinhi
bitsthereuptakeofserot
oninint
heCNS.
Ther
apeuti
cEffects:Anti
depressantact
ion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentMAO
i
nhibi
tororpi
mozi
det
her
apy
;Congeni
tal
longQT
sy
ndrome.

UseCaut
iousl
yin:
Hist
oryofmani
a;Hi
stor
yofsui
cide
att
empt/
ideat
ion(↑ri
skduri
ngear
lyt
herapyandduring
doseadj
ustment)
;Hi
stor
yofsei
zur
edisor
der;I
ll
nessesor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 843
condi t
ionst hatar elikelyt or esulti
nal t
er edmet abol i
sm or
hemody nami cr esponses; Sev ererenal orhepat ic
i
mpai r
ment ;Hy pokal emi aorhy pomagnesemi a( correct
priortoi nit
iatingt herapy ); Poormet abol i
zer sofCYP2C19
(↑r iskofQTi nt er
val prol ongat i
on);Concur r
entuseof
CYP2C19i nhibit or
s( ↑r iskofQTi nterval prol
ongat ion);
OB: Usedur ingt hirdt ri
mest ermayr esultinneonat al
serotoninsy ndr omer equi ringpr olongedhospi tali
zation,
respiratoryandnut ri
tional suppor t
;Lactat i
on:Pr esentin
breastmi l
kandmayr esul ti nlethargywi th↓ f eedingi n
i
nf ants;wei ghr isk/benef it
s; Pedi:May↑ r iskofsui cide
attempt /ideationespeci allydur ingear l
yt reatmentordose
adjustmenti nchi l
dren/ adol escent s( unlabeledf or
pediatricuse) ; Geri:↓ dosesr ecommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, SUICIDAL
THOUGHTS, apathy ,confusion,drowsi ness,insomni a,
weakness, agitat
ion, amnesi a,anxiet
y ,↓l ibido,dizziness,
fat
igue,impai r
edconcent r
ation,↑ depr ession, migraine
headache.EENT: abnor malaccommodat ion.Resp: cough.
CV: TORSADEDEPOI NTES, posturalhy potension,QT
i
ntervalprolongation, tachycardia.GI
: abdomi nalpain,
anorexi
a, di
arrhea, drymout h,dyspepsi a,f
latulence, ↑
sal
iva,nausea, al
ter edt ast
e, ↑ appetite,vomi ti
ng.GU:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 844
amenor rhea,dysmenorrhea,ejacul
atorydel
ay ,erect
il
e
dysfunction,pol
yuri
a.Derm: sweati
ng, phot
osensi ti
vi
ty,
pruri
tus,rash.Metab:weightloss,weightgain.FandE:
hyponatremi a.MS:art
hralgi
a,my al
gia.Neuro:tremor ,
paresthesia.Misc:SEROTONI NSYNDROME, fever,
yawning.

I
NTERACTI
ONS
Drug- Drug: Maycauseser i
ous, pot ent i
allyfat alreact ions
whenusedwi thMAOi nhibitors;allowatl east14day s
bet weenci talopram andMAOi nhibitors.Concur rentuse
withpi mozi demayr esul tinpr olongat i
onoft heQTc
i
nt erval andi scont raindicated.QTi nterv alpr olonging
drugsmay↑ t her iskofQTi nter val prolongat i
onand
torsadedepoi ntes; ECGmoni t
or i
ngr ecommended.
CYP2C19i nhibitorsmay↑ l evelsandt her iskoft oxicity.
Drugst hataf f
ectser otoner gicneur otransmi ttersy stems,
i
ncl udingl inezolid, tramadol ,andt riptans↑ r iskof
ser otoninsy ndrome.Usecaut iouslywi t
hot hercent r
al l
y
act i
ngdr ugs( includi ngal cohol ,antihistami nes, opioid
anal gesics, andsedat ive/hypnot ics; concur rentusewi th
alcohol isnotr ecommended) .Ci met idinemay↑ l ev els.
Ser otoner gicef fectsmaybe↑ byl i
thium ( concur rentuse
shoul dbecar efullymoni tored) .Ket oconazol e,
i
traconazol e, erythromy cin,andomepr azol emay↑ l ev el
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 845
Carbamazepinemay↓ bl oodlevel
s.May↑ l evel
sof
metoprol
ol.Usecauti
ouslywitht
r i
cycli
canti
depressants
duetounpredict
ableeffect
sonser otoni
nand
nor
epinephri
nereuptake.↑ ri
skofbleedingwit
haspi r
in,
NSAIDs,cl
opidogrel
,orwarfar
in.
Drug-Natur
alProduct
:↑r i
skofserot
onergi
csi
deeffect
s
i
ncludingserot
oninsyndr
omewi t
hSt.John’
swortand
SAMe.

DOSAGE
PO:(Adul
ts):
20mgoncedai l
yini
ti
all
y,maybe↑ i none
weekto40mg/ day(
maximum dose);Poormetaboli
zerof
CYP2C19orconcurr
entuseofCYP2C19i nhi
bit
or—Donot
exceeddoseof20mg/day.
PO:
(Ger
iat
ri
cPatients):20mgoncedail
yini
ti
all
y,maybe
↑to40mg/ dayonlyinnonr
espondi
ngpati
ents.
Hepat
icI
mpai
rment
PO:
(Adult
s):20mgoncedailyi
nit
iall
y,maybe↑ t
o40
mg/dayonl
yinnonr
espondi
ngpatients.

AVAI
LABI
LITY
Tabl
ets10mg,
20mg,
40mg.
sol
uti
on(
pepper
mintf
lav
or)10mg/
5mL.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 846
PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakeci
tal
opr
am asdi
rect
ed.

Maycausedr owsi
ness,di
zzi
ness, i
mpair
ed
concentrati
on,andbl
urredvi
sion.Cauti
onpati
entto
avoi
ddr i
v i
ngandotheracti
vi
ti
esr equi
ri
ngaler
tness
unti
lresponsetothedrugisknown.

Instr
uctpatientt
onot ifyheal
thcareprof essionalof
allRxorOTCmedi cations,vi
tamins,orher bal
productsbeingtakenandt oconsulthealthcar e
professi
onal bef
oretakinganyot herRx,OTC, or
herbalproducts,especial
lyal
cohol orotherCNS
depressants.

Caut
ionpat
ienttochangeposi
ti
onssl
owl
yto
mini
mizedi
zziness.

Advisepati
ent,fami l
y ,andcar egiverstolookfor
sui
cidali
ty,
especi all
ydur ingear l
ytherapyordose
changes.Notifyhealthcar eprofessionalimmediatel
y
i
fthoughtsaboutsui cideordy ing,attemptsto
commi tsuici
de, neworwor sedepr essi
onoranxi et
y,
agit
ati
onorr estlessness, panicattacks,insomnia,
neworwor seirritabi
lity,aggressiveness,acti
ngon
dangerousimpul ses, mani a,orotherchangesi n
moodorbehav iorori fsy mptomsofser otoni
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 847
 sy
ndr
omeoccur
.

Advi
sepati
enttousesunscreenandwearprotect
ive
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

Inf
orm patientthatfr
equentmouthrinses,goodoral
hygiene,andsugar l
essgum orcandymaymi ni
mize
drymout h.Ifdr
ymout hpersist
sformor ethan2wk,
consulthealthcareprof
essionalr
egardinguseof
sali
vasubst i
tut
e.

Instructfemal
epat i
entstoinf
orm healt
hcare
professionali
fpr egnancyisplannedorsuspected,
or
i
ft heyplantobr eastfeed.I
fusedduringpregnancy
shoul dbetapereddur ingthi
rdtri
mestertoavoid
neont alser
oti
ninsy ndrome.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
moni
torprogr
ess.

Cl
adr
ibi
ne
I
NDI
CATI
ONS
Managementofactivehairycel
lleukemiamani fest
edas
anemia,l
eukopeni
a,thr
ombocy t
openi a,orcl
ini
cal
symptoms.Unlabel
edUses: chr
onicly mphocyti
cleukemi
a,
chroni
cmy el
ogenousleukemia,non-Hodgkin's

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 848
l
ymphomas,
progr
essi
vemul
ti
plescl
erosi
s.

ACTI
ON
I
nhi
bit
sDNAsy nt
hesi
s.Ther
apeuti
cEff
ects:Deat
hof
r
api
dlyrepl
i
cat
ingcel
l
s,part
icul
arl
ymal
ignantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Dil
uentcont
ains
benzy
lalcoholandshoul
dbeavoi
dedinpati
entswith
knownintol
erance;
OB:Lact
ati
on:
Pregnancyorlact
ati
on.

UseCaut
iousl
yin:
Act
ivei
nfect
ion;
↓ bonemar
row
reser
ve;Hepat
icorrenali
mpair
ment;OB:Pat
ient
swith
chil
dbear
ingpotent
ial
;Pedi
:Saf
etynotest
abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: f
at i
gue,headache, dizziness, i
nsomni a, malaise,
weakness.EENT: epi
staxis.Resp: abnor mal breathsounds,
cough, dyspnea.CV: edema, t
achy cardia.GI:anorexia,
di
arrhea, nausea,v omiti
ng, abdomi nalpain,constipati
on.
Derm: rash,eryt
hema, petechi ae,pruri
tis,sweat i
ng.Hemat :
NEUTROPENI A,anemi a,thrombocy topenia.Local :
i
njecti
onsi tereactions,phl ebiti
s,thrombosi s.MS:
art
hralgia,my al
gia.Misc: chills,f
ev er,
infecti
on, tr
unkpain.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 849
I
NTERACTI
ONS
Dr
ug-
Drug:Addi
ti
vebonemarrowdepressi
onmayoccur
wi
thot
heranti
neopl
ast
icsorr
adiat
ionther
apy
.

DOSAGE
I
V:(Adul
ts)
:Hai
rycel
ll
eukemi
a–0.
09mg/
kg/
dayf
or7
day
s.

AVAI
LABI
LITY
I
nject
ion1mg/
mL;

PATI
ENTTEACHI
NG
Instructpat i
entt onotifyheal thcar eprof essional
prompt l
yi ntheev entoff ever;sor ethroat ;signsof
i
nf ection;bleedinggums; bruising; petechi ae;bloodin
urine, stool,
oremesi s; unusual swelli
ng; jointpain;
shor tnessofbr eath;orconf usi on.Caut ionpat i
entto
avoidcr owdsandper sonswi thknowni nfections.
Instructpat i
entt ousesof tt
oot hbr ushandel ectric
razorandt obeespeci all
ycar eful t
oav oidf all
s.
Pat i
ent sshouldal sobecaut ionednott odr i
nk
alcohol i
cbev eragesort otakepr oductscont aining
aspirinorNSAI Dsbecauset hesemaypr ecipit
ateGI
hemor rhage.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 850
 Advi
sepat i
enttousenonhormonalcontracepti
ve
measuresduringandforatl
east4moaf ter
completi
onoft her
apyandtoavoi
dbr eastfeedi
ng.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Cl
ari
thr
omy
cin
I
NDI
CATI
ONS
Forthet r
eatmentofbacteri
alinfections
(pharyngit
is/
tonsi
ll
it
is,
sinusi
ti
s,br onchiti
s,pneumonia,
uncompl i
catedskinandskinstructur ei
nfecti
ons)caused
byH.i nfl
uenzae,M.catar
rhal
is,M.pneumoni ae,S.
pneumoni ae,C.pneumoniae,S.aur eus,S.pyogenes,
My cobacteri
um avi
um andMy cobact er
ium i
ntracel
l
ular
e.

ACTI
ON
I
nhibitsprotei
nsy nthesisatt heleveloft he50Sbacterial
ri
bosome.Ther apeuticEffects:Bacteriostati
cacti
on.
Spectrum: Acti
v eagainstthesegr am- positi
veaerobi
c
bacteri
a:Staphy l
ococcusaur eus,Staphy l
ococcus
pneumoni ae,S.py ogenes( groupAst rep) .Acti
veagai
nst
thesegram- negativeaerobicbact eri
a: Haemophi l
us
i
nfluenzae,Mor axell
acat arrhal
is.Alsoact iveagai
nst:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 851
My
copl
asma,
Legi
onel
l
a,H.py
lor
i,M.av
ium.

Av
ail
abi
l
ity
TABLETS250and500mg;
125mgDT.SUSPENSI
ON125
mg/5ml.

DOSAGE
Or
al
Adult
-250mgto500mgt wiceadayf
or7to14days
i
ncreasei
nsev
ereinf
ect
ionsto500mgevery12hupto
14days.
Chi
ld-Bodyweightunder8kg:
7.5mg/kgbodywei
ght
twi
cedail
y;8to11kg: 62.
5mgt wi
cedai
ly
;30to40kg:
250mgt wicedai
ly.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
tyt
ocl
ari
thr
omy
cin;
cephal
ospor
in.

I
NTERACTI
ONS
Drug-
Drug: Clar
it
hromyci
nisaninhibi
toroft
heCYP3A
enzymesy stem.Concurr
entusewi t
hotheragents
metaboli
zedbyt hissy
stem can↑ level
sandriskof
toxi
cit
y.Maypr olongt
heQTi nt
ervaland↑ ri
skof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 852
arrhy thmi aswi thpimozi de; concur rentusei s
cont raindi cated.May↑ l ev elsofer got ami neand
dihy droer got ami neandr i
skf oracut eer gott oxi ci
t y;
concur rentusecont raindi cat ed.May↑ ser um l ev elsand
ther iskoft oxi cit
yf rom car bamazepi ne, some
benzodi azepi nes( mi dazol am, triazol am, alpr azol am) ,
cy clospor ine, disopy rami de, qui nidine, ergotal kaloids,
felodi pine, omepr azol e, tacr oli
mus, digoxi n, ort heophy ll
ine.
May↑ l ev elsandef fect sofomepr azol e.Ri tonav ir↑ bl
ood
l
ev el
s( ↓ cl ar it
hromy cindosei npat ient swi thCCr<60
mL/ mi n) .↑ l ev elsofHMG- CoAr educt asei nhi bit
or sand
may↑ r iskofr habdomy olysis.May↑ or↓ ef fectsof
zidov udi ne.Bl oodl ev el sar e↑ bydel av ir
di neand
fl
uconazol e.Bl oodl ev elsmaybe↓ byr i
fampi n,rifabuti
n,
efav ir
enz, andnev irapi ne.May↑ l ev elsandr iskoft oxi
city
from col chi cine; ↓ col chi cinedosei npat ient swi thnor mal
renal andhepat icfunct i
on; concur rentusei s
cont raindi catedi npat ient swi t
hr enal orhepat ic
i
mpai r ment .May↑ v er apami ll
ev elsandt her iskf or
hy potensi on, br adycar di a, andl act icaci dosi s.May↑
war f
ar i
nl ev elsandt her i
skf orbl eedi ng.May↑ bl ood
l
ev el
sandef fectsofsi ldenaf il
,tadal af il
, andv ardenaf il
;
concur rentusenotr ecommended.May↑ l ev elsof
tolterodi ne.Concur r entusewi that azanav irmay↑
clar i
thromy cinandat azanav irlevel s; ↓ cl ar ithromy cin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 853
doseby50%.Concurr
entusewi t
hitr
aconazol
emay↑
cl
ari
thromyci
nandit
raconazol
elevel
s.Concurr
entuse
wit
hsaquinavi
rmay↑ clari
thr
omy ci
nandsaquinavi
r
l
evels.

Pr
ecaut
ions
Neonat eunder2weeks( riskofhy pertr
ophicpylor
ic
stenosi s);predisposit
iont oQTi ntervalpr
olongati
on
(i
ncl udingel ectrol
ytedisturbances,concomi t
antuseof
drugst hatpr ol
ongQTi nt
er val
);avoidinporphyri
a;hepat
ic
i
mpai rment ;renalimpairment ;pregnancy(notknownt obe
har mful)l actati
on( onlysmal lamount sinmilk)
;
i
nt eractionsmy astheniagrav i
s.

Adv
erseEf
fect
s
Nausea, vomi ting,abdomi naldi
scomf ort,di
ar rhoea
(anti
bioti
c-associ atedcol it
isreported)
;lessf requent l
y
urti
caria,r
ashesandot herall
ergicreacti
ons; rev ersible
heari
ngl ossr epor t
edaf t
erlargedoses; cholest atic
j
aundice, pancr eati
tis,cardiaceffects(i
ncludi ngchestpai n
andar rhythmi as),my asthenia-l
i
kesy ndrome, Stev ens-
Johnsonsy ndr ome, toxicepidermal necrolysisal so
report
ed, dy spepsia,toot handt onguediscol ourat i
on,
smellandt astedistur bances,stomat i
ti
s,glossi ti
sand
headache; l
esscommonl yhepat i
ti
s,art
hralgiaandmy al
gia;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 854
rar
ely,t
innit
us; ver
yr arel
y,pancreati
ti
s,di
zziness,
i
nsomni a,nightmar es,anxi
ety,confusi
on,psychosi
s,
paraesthesi
a, convulsi
ons, hypogly
caemia,renalf
ailur
e,
l
eucopeni aandt hrombocy topenia;onint
ravenousinfusi
on,
l
ocal t
enderness, phlebit
is.

PATI
ENTTEACHI
NG
Inst
ructpat i
enttotakemedi cationaroundtheclock
andt ofini
shthedrugcompl etel
yasdi rect
ed,ev
enif
feel
ingbet t
er.Takemi sseddosesassoonas
possible,unl
essalmostt imef ornextdose.Donot
doubl edoses.Advi
sepat ientthatshari
ngofthis
medi cati
onmaybedanger ous.

Advisepati
enttorepor
tthesi
gnsofsuperinfect
ion
(bl
ack,fur
ryovergr
owthonthetongue;vaginali
tchi
ng
ordischar
ge;l
ooseorfoul-
smell
ingstool
s).

Instr
uctpat i
enttonoti
fyheal
thcareprofessionali
f
rash,orfeveranddiarr
headevelop,especi
allyifst
ool
containsblood,pus,ormucus.Advisepatientnotto
treatdiarr
heawithoutconsul
ti
nghealthcar e
professional
.

Caut
ionpati
ent
staki
ngzi
dovudi
nethatcl
ari
thr
omyci
n
andzidov
udi
nemustbetakenatl
east4hrapart
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 855
 Advi
sepati
entt
onotif
yhealt
hcarepr
ofessi
onalif
pr
egnancyi
splannedorsuspect
edori
fbreast
feeding.

I
nst
ructthepat
ientt
onoti
fyhealt
hcar
eprof
essi
onal
i
fsy
mpt omsdonotimprovewithi
nafewdays.

St
orage
St
orepr
otect
edf
rom moi
stur
e.

Cl
emast
ine
I
NDI
CATI
ONS
Rel
i
efofal
ler
gicsymptomscausedbyhi
stami
ner
elease
i
ncl
udi
ng:All
ergi
crhi
nit
is,
Urt
icar
ia.

ACTI
ON
Antagonizest heeffectsofhist
amineatH-receptorsit
es;
doesnotbi ndt oorinacti
vatehist
amine.Therapeuti
c
Effect
s:Decreasedsy mptomsofhi st
amineexcess
(sneezi
ng, r
hinorrhea,nasalandocularpr
urit
us,ocular
teari
ng,andr edness).

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Angl
e-cl
osur
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 856
gl
aucoma; Lactat
ion(av
oiduse)
;Knownal
cohol
i
ntol
erance(li
quidfor
m) .

UseCaut
iousl
yin:
Acut
east
hmaat
tacks;
Liv
erdi
sease;
Prostati
chyperplasia;
Hyperthyr
oidism;Hy
pertension;
Geriatr
icpat
ients(mor esuscepti
bletoadver
ser eacti
ons)
;
Pregnancyorchildren<6y r(
safetynotest
abli
shed) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dr owsiness,confusion, di
zziness, paradoxi
cal
excit
ation( chil
dren).EENT: blurr
edv ision.CV:
hypertension,arrhythmias,hy potension, pal
pitat
ions,
tachycar di
a.GI:drymout h, constipat
ion, nausea,
obstruct i
on,vomi t
ing.GU: uri
naryr et
ent ion.Derm: r
ash.
Resp: thickmucus.

I
NTERACTI
ONS
Drug-Drug:Addit
iveCNSdepressionwit
hotherCNS
depressants,i
ncludi
ngal
cohol,opioi
danal
gesics,
and
sedativ
e/hypnoti
cs.Mayantagonizeeff
ect
sofchol i
ner
gic
agonists(e.
g.donepezi
l)
.
Drug-Natur
alProduct:
Concomitantuseofkava-kav
a,
val
erian,
skull
cap,chamomile,
orhopscani ncr
easeCNS
depressi
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 857
DOSAGE
PO:(Adul
ts):
OTCl abel
i
ng—1.
34mg( 1mgbase)twice
dai
l
y .Rxl
abel
ing—1.34mg(1mgbase)twi
cedai
ly;may
i
ncreaseupto2.68mg( 2mgbase)3t
imesdai
ly
.
PO:(Chi
l
dren6–12y
r):0.
67–1.34mg(0.
5–1mgbase)
twi
cedail
y.(
nott
oexceed4.02mg/day(
3mg/daybase)
.

AVAI
LABI
LITY
Tabl
ets1mgOTC, 1.
34mg( 1mgbase)
OTC, 2.
68mg( 2
mgbase) ;
Syrup(
citr
usfl
avor
)0.
67mg/5mLRx( 0.67mg
cl
emastinefumarate=0.
5mgbase)(cont
ains5.5%
al
cohol)
;

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakemedi
cati
onasdir
ected.Donot
takemor et
hanrecommendedamount .Misseddoses
shouldbetakenassoonaspossibl
eunlessalmost
timefornextdose.Donotdoubl
edoses.

Maycausedr owsiness.Caut
ionpati
entt
oavoid
driv
ingorotheracti
vi
ti
esrequir
ingal
ert
nessunt
il
responsetodrugisknown.

Caut
ionpat
ientt
oavoidusi
ngalcoholorot
herCNS
depr
essant
sconcur
rentl
ywit
hthisdrug.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 858
 Advi
sepatientt
hatgoodoralhygiene,
frequentr
insi
ng
ofmouthwi t
hwater,
andsugarlessgum orcandy
mayhelpreli
evedrymouth.Pat
ientshouldnotif
y
dent
isti
fdrymouthpersi
stsfor>2wk.

Geri
atr
icpati
entsareatr
iskf
oror
thost
ati
c
hypot
ension.Advi
sepati
entt
ochangeposi
ti
ons
sl
owly.

Instructpat ientt ocont acthealthcareprofessionalif

sympt omsper si
stori fdiffi
cult
ywithurinati
on;
changesi nv ision;conf usion;severedrymout h,nose,
andt hr oat;ordi zzi
nessoccur s.Maybemor e
commoni nger i
atr
icpat i
ents.Parentsshouldnot if
y
heal t
hcar epr ofessional i
ftheirchi
ldhasdi ff
icul
ty
sleeping, becomesunusual lyexci
tedorirri
table,or
dev elopsshor tnessofbr eathorfacial
flushing.

Cl
evi
dipi
ne
I
NDI
CATI
ONS
ReductionofBPwhenor
alt
her
apyi
snot
feasi
ble/desi
rabl
e.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 859
Inhi
bit
scalcium tr
anspor tintovascularsmoot hmuscle,
resul
tingi
ni nhi
bit
ionofexci tat
ion-contr
acti
oncoupl i
ng
andsubsequentcont raction.Decreasessystemi cvascul
ar
resi
stance;doesnotr educecar di
acf i
ll
ingpressure(pre-
l
oad).Hasnoef f
ectonv enouscapaci t
ancev essel
s.
Therapeuti
cEf f
ects:DecreasesBP.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
All
ergyt
osoy
beans
oreggs/eggproducts;
Defectiv
eli
pidmetabol
i
sm
i
ncludi
ngpathologi
chy per
li
pidemi
a, l
i
poi
dnephrosi
sor
acutepancr
eatit
is;
Severeaorti
cstenosi
s.

UseCaut
iousl
yin:
Ger
i:Ti
tr
atedosecaut
iousl
y,i
nit
iat
e
ther
apyatl owendofdoser ange;considerage-r
elated°i
n
hepatic,r
enal orcardi
acfuncti
on,concomi t
antdiseases,
orotherdr ugtherapy;OB:Useonlyifmat er
nalbenefit
outweighspot enti
alri
sktofetus;Lactat
ion:Consider
possibleinfantexposure;
Pedi:Safetynotestabl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache.CV:HF,hypotension,rebound
hypertensi
on,ref
lext
achycardia.GI:nausea,v
omi
ti
ng.MS:
ar
thralgia.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 860
Drug-Dr
ug:↑r i
skofexcesshypotensi
onwi t
hother
anti
hypert
ensi
ves.Doesnotprot
ectagainsteff
ectsof
abruptbet
ablockerwit
hdrawal
.

DOSAGE
IV:(
Adul ts):I
nit
ialdose—1–2mg/ hr;Dose
ti
tr
ation—Doubl edoseev ery90seci nit
ial
l
y ;
asBP
approachesgoal ,↑ dosebyl essthandoubl i
ngand
l
engthent hetimebet weendoseadj ustment stoevery
5–10mi n.Usualdoser equiredis4–6mg/ hour.Sever
e
hypertensivepati
entsmayr equirehigherdoseswi t
ha
maximum of16mg/ hrorl ess.Dosesupt o32mg/ hrhave
beenused, butgener al
lyshoul dnotexceed21mg/ hrina
24hrper iodduet oli
pidload.

AVAI
LABI
LITY
Emul
sionf
ori
nject
ion0.
5mg/
mL50mL/
vial
,100mL/
vial
;

PATI
ENTTEACHI
NG
I
nfor
m pat
ientoft
her
ati
onal
eforuseofcl
evi
dipi
ne.

Advi
sepat i
entst
ocontactaheal
thcareprofessi
onal
i
mmedi atel
yifsi
gnsofanewhy per
tensi
ve
emergency(neur
ologi
calsy
mptoms, vi
sualchanges,
evi
denceofHF)occur.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 861
 Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Encour agepatientswi
thunder
lyi
nghy per
tensionto
continuefollow-upcar
eandtocont i
nuetakingthei
r
oralantihypert
ensivemedi
cati
on(s)asdir
ect ed.

Cl
i
ndamy
cin
I
NDI
CATI
ONS
PO:IM: I
V:Treatmentof :Skinandski nstructureinfecti
ons,
Respir
atorytr
actinfections, Septi
cemi a,I
ntra-abdomi nal
i
nfecti
ons,Gynecologi cinfecti
ons, Osteomy eli
ti
s,
Endocardit
isprophylaxis.Topi cal
:Severeacne.Vag
Bacter
ialvagi
nosis.Unl abeledUses: PO: I
M: I
V: Treat
ment
ofPneumocy sti
scar ini
i pneumoni a,CNSt oxopl asmosis,
andbabesiosis.

ACTI
ON
Inhibit
sproteinsy nt
hesisinsuscept i
blebacteri
aatt
he
l
ev elofthe50Sr i
bosome.Ther apeut
icEffects:
Bact er
ici
dalorbact eri
ostati
c,dependingonsusceptibi
l
ity
andconcent ration.Spectrum: Acti
veagainstmostgram-
positiveaer
obi ccocci,i
ncluding:Staphyl
ococci,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 862
Str
ept ococcuspneumoni ae,otherstreptococci,butnot
enterococci.Hasgoodact i
vityagainstthoseanaer obic
bacteriathatcausebacteri
alv agi
nosis,i
ncluding
Bacteroidesf r
agil
i
s,Gardner
el l
av agi
nali
s, Mobiluncusspp,
Mycopl asmahomi ni
s,andCor ynebacter
ium.Al soactiv
e
againstP.jiroveci
iandToxoplasmagondi i.

Av
ail
abi
l
ity
TABLETS/CAPSULES150&300mg;SyRUP4ml(
150
mg/ml);I
NJECTION2ml(150mg/ml)
;
CREAM/ GEL/
OINTMENT10g(1%w/
w);LOTI
ON25ml
(1%w/v)
.

DOSAGE
Or
al
Ser
iousanaer
obi
cinf
ect
ions
Adul
t:150-
300mg6ev
eryhr
;formor
esev
erei
nfect
ion:
300to450mgever
y6hr.
Chi
l
d:2-4mg/kgever
y6hr;
formor
esever
einf
ect
ion:
3-6
mg/kgever
y6hr;10kg:
37.
5mgevery8hr
.
Pr
ophylaxi
sofendocar
dit
is600mg1hrbef
oredent
al
pr
ocedure.
I
ntr
avenous/
Int
ramuscul
arSer
iousanaer
obi
cinf
ect
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 863
Adult:
0.6-
2.7g/dayin3-
4di
vi
deddoses,
upt
o4.
8g/
day
forsever
einfect
ions.
Chi
l
d:20-
40mg/
kgdai
l
yin3-
4di
vi
deddose.
Neonat
e:15-
20mg/
kgdai
l
yin3-
4di
vi
deddose.
Toxi
cshocksy
ndr
ome
Adult
:900mgev er
y8hralongwit
hpenici
ll
i
nGor
ceft
ri
axone.Pelv
icinf
lammator
ydiseaseAdul
t:900mg
ever
y8hral ongwithgent
amici
n.
Vagi
nalBacter
ial
vagi
nosi
sAspessaryor2%cr
eam:
100
mgonceni ght
lyf
or3-
7days.Topi
cal
AcneAs1%
pr
eparat
ion:Appl
ytwi
cedail
y.

Cont
rai
ndi
cat
ions
Hyper
sensit
ivi
ty,
meningi
ti
sasithasl
esspenet
rat
ioni
nto
CNS,pseudomembranouscol
it
is.

I
NTERACTI
ONS
Drug-Drug:Kaoli
n/pecti
nmay↓ GIabsor pti
on.May
enhancet heneuromuscularblocki
ngacti
onofother
neuromuscularblockingagents.Topi
cal
:Concurr
entuse
withir
ri
tants,abr
asives,ordesquamati
ngagentsmay
resul
tinadditi
veirr
it
at i
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 864
Pr
ecaut
ions
Hepati
candrenali
mpairment,pr
egnancyandlactat
ion,
GI
di
sease,el
der
ly,at
opicpati
ent
s,regul
armonit
oringof
bl
oodcounts,i
nconjucti
onwit
hant i
biot
ict
herapy,
pr
egnancyint
eract
ions.

Adv
erseEf
fect
s
Urti
caria,r
ashes, contactdermat itis,
exfoliati
veand
vesicul
ousder matit
is,l
ocalirr
itati
onabdomi nalpain,
oesophagi t
is,nausea,vomi t
ing, diarr
hoea, jaundiceand
l
iverabnor maliti
es,eosinophil
ia,er yt
hemamul t
if
or me,
thr
ombophl oebiti
s,gaspingsy ndrome( premat ur
ei nf
ants
andneonat es)duet opr eservativebenzoy l al
cohol i
n
parenteralformulati
on,pseudomembr anouscol i
tis,
azotemi a,
ol i
guri
a,proteinur
ia.

PATI
ENTTEACHI
NG
Instructpati
enttotakemedicat
ionaroundtheclock
atev enlyspacedti
mesandt ofi
nishthedrug
compl etel
yasdirected,
eveniff
eeli
ngbet t
er.Take
mi sseddosesassoonaspossi bleunlessalmost
timef ornextdose.Donotdoubledoses.Adv i
se
pat i
entthatshari
ngofthismedicat
ionmaybe
danger ous.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 865
Instructpatientt
onot i
fyhealt
hcar eprofessi
onal
i
mmedi atelyifdi
arrhea,abdominalcramping,fev
er,
or
bloodyst oolsoccurandnott otreatwith
antidiar
rhealswithoutconsult
inghealthcare
professional.

Advi
sepatientt
oreportsi
gnsofsuperi
nfecti
on(f
urr
y
over
growthonthetongue,vagi
naloranali
tchi
ngor
di
scharge)
.

Noti
fyheal
thcar
eprof
essi
onal
ifnoi
mpr
ovement
wi
thinafewdays.

Pati
entswithahi stor
yofrheumati
cheartdiseaseor
val
vereplacementneedt obetaughtt
heimpor tance
ofanti
microbialprophyl
axi
sbefor
einvasiv
emedi cal
ordental
pr ocedures.

IV:
Inform pat
ientt
hatbit
tert
ast
eoccurr
ingwi
thI
V
administ
rati
onisnotcl
ini
call
ysi
gni
fi
cant.

 Vag: I
nstr
uctpat i
entonpr operuseofv aginal
applicator
.Inserthighintovaginaatbedt i
me.Inst
ruct
patienttoremainr ecumbentf oratleast30min
foll
owi ngi
nsertion.Advisepatienttousesanitar
y
napkint opreventstaini
ngofcl othi
ngorbedding.
Cont i
nuetherapydur ingmenst rual
period.

Adv
isepat
ientt
oref
rai
nfr
om v
agi
nal
sexual

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 866
 i
nter
cour
sedur
ingt
reat
ment
.

Cauti
onpat i
entthatminer
aloili
ncli
ndamycincream
mayweakenl atexorrubbercontr
acepti
vedevi
ces.
Suchproductsshouldnotbeusedwi thi
n72hrof
vagi
nalcream.

Topical
:Cauti
onpat
ientappl
yingtopi
calcl
indamyci
n
thatsol
utioni
sfl
ammabl e(v
ehicl
eisisopr
opyl
alcohol
).Avoi
dappl
i
cationwhilesmokingornearheat
orflame.

Advisepat
ientt
onoti
fyheal
thcarepr
ofessi
onal
if
excessi
vedryi
ngofski
noccurs.

Advi
sepat
ientt
owait30minaft
erwashi
ngor
shav
ingar
eabefor
eapply
ing.

St
orage
St
orepr
otect
edf
rom moi
stur
e

Cl
obazam
I
ndi
cat
ions
Add-onforrefract
orypart
ial
,complexandgeneral
i
zed
sei
zures,add-oninWestsy ndr
ome, LGS,
my ocl
oni
c
epi
lepsy,absenceseizur
es,tocov
ershortperi
odof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 867
i
ncreasedseizuresuscepti
bil
it
yaddit
ionofnewAED
examinati
onsov er
nighttr
avelcatameni
alepi
lepsy
,
i
ntermit
tentprophyl
axisinfebri
l
eseizur
es.

ACTI
ON
Facil
i
tatesneurot
ransmi ssi
onmedi at
edbygamma- ami
no
butyr
icacid(GABA)bybi ndingtothebenzodi azepinesi
te
oftheGABAAr eceptor.Therapeut
icEffects:Decreased
i
ncidenceandsev er
ityofseizuresassociatedwi t
hLennox
-Gest
autsy ndr
ome.

Av
ail
abi
l
ity
TABLETS5,
10and20mg.

DOSAGE
Or
al
0.
3-2.
9mg/kg/
day,(
aver
age1mg/
kg/
day
)si
ngl
eatbed
ti
meortwi
cedail
ydose.

CONTRAI
NDI
CATI
ON
None

I
NTERACTI
ONS
Dr
ug-
Drug:
Alcohol
↑ bl
oodl
evel
sby50%.↑ r
iskofCNS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 868
depressionwithalcohol,someant i
depressants,
anti
histamines,opioidanalgesi
csandsedat i
ve/ hy
pnoti
cs.
Concurrentuseofst rong/moderateinhibi
torsoft he
CYP2C19enzy mesy stem incl
udingfluconazole,
fl
uvoxami ne,t
icl
opidineandomepr azole↑ levelsand
eff
ectsofN- desmet hyl
clobazam; l
owerdosesof
cl
obazam maybenecessar y.

Pr
ecaut
ions
Pr
egnancyi
nter
act
ions.

Adv
erseEf
fect
s
Sedati
on,dizziness,
hyper
acti
vi
ty,
behav
iour
alprobl
em,
i
rri
tabi
li
ty,
dr ooli
ng,wei
ghtgai
n,sl
eepdi
stur
bance,bl
urr
ing,
di
plopi
a.

PATI
ENTTEACHI
NG
Instructpatienttot akecl obazam ar oundt heclock,as
directed.Donotst opt akingcl obazam wi t
hout
consul ti
ngheal t
hcar epr ofessional.Medi cation
shoul dbegr aduallydi scont i
nuedt opr event
withdr awalsympt oms( seizur es,psy chosis,
hallucinati
ons,behav i
oral disorder,tremor ,anxi
ety)
.
Adv isepatienttoreadt heMedi cationGui debef or
e
startingtherapyandwi theachRxr ef il
li
ncaseof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 869
 changes.

Maycausedr owsi ness, dizziness,ataxia,and

i
ncoor di
nation.Caut ionpat ienttoav oiddrivi
ngor
otheractiv
iti
esrequi ringal ertnessuntilresponset
o
medi cat
ionisknown.Tel lpat i
entnott oresume
dri
vinguntilphysiciangi vescl earancebasedon
controlofseizuredi sorder .

Infor
m pat ientsandf ami l
i
esofr iskofsui ci
dal
thought sandbehav iorandadv i
set hatbehav i
oral
changes, emer gencyorwor seningsi gnsand
sympt omsofdepr essi on,unusual changesinmood,
oremer genceofsui ci dalthoughts, behavi
or,or
thought sofsel f
-harm shoul dber eportedtohealt
h
carepr ofessionalimmedi ately
.

Instr
uctpatienttonoti
fyhealt
hcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,
orher bal
productsbeingtakenandconsulthealt
hcar e
professi
onal bef
oretaki
nganynewmedi cations.
Adv i
sepatienttoavoidtaki
ngotherCNSdepr essant
s
oralcohol.

Instr
uctfemalepati
enttouseanonhormonal method
ofcontracepti
onduri
ngandf or28daysaft
er
clobazam use.Adv
isefemalepati
entstonoti
fyhealt
h
careprofessi
onali
fpregnancyispl
annedor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 870
 suspect
edori
fbr
eastf
eedi
ng.

Cl
obet
asol
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandi
nfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofdermat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroi
dorcomponent sofvehi
cles(oi
ntmentor
cream base,preser
vat
ive,
alcohol
);Untr
eatedbacter
ial
or
vi
rali
nfecti
ons.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cataracts,gl
aucoma, ortuberculosis(useoflarge
amount sofhi gh-
potencyagent smaywor sencondi t
ion);
Patientswithpre-exi
sti
ngskinat rophy;OB:Lact at
ion:Pedi:
Pregnancy ,l
actat
ion,orchil
dren( chroni
chigh-doseuse
mayr esultinadrenalsuppressioninmot her,growth

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 871
suppressi
oninchil
dren;
chil
drenmaybemor esuscept
ibl
e
toadrenalandgrowthsuppr
ession)
;Notr
ecommended
foruseinchil
dren<12yr.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topi
cal
: (
AdultsandChil
dren)
:Appl
ytoaf
fect
edarea(
s)
1–3ti
mesdai ly(
dependsonprepar
ati
onandcondi
ti
on
bei
ngtreated)
.

AVAI
LABI
LITY
Cr
eam 0.05%;
Emol l
i
entcream 0.
05%;Foam 005%;Gel
0.
05%;Loti
on0.05%;Oi
ntment0.05%;Scal
psolut
ion
0.
05%;Shampoo0.05%;Spray0.05%;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 872
PATI
ENTTEACHI
NG
Inst
ructpati
entoncorrecttechni
queofmedicati
on
administr
ati
on.Emphasizeimpor t
anceofavoi
dingthe
eyes.Ifadoseismissed,itshouldbeappl
iedassoon
asremember edunl
essal mostt i
meforthenextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.

Caut i
onwoment hatmedicati
onshouldnotbeused
extensiv
ely,
inl
argeamount s,
orforprot
ract
ed
periodsift
heyarepregnantorpl
anningtobecome
pregnant.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

I
nst
ructpat
ientt
oinf
orm heal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 873
 sy
mptomsofunderl
yi
ngdiseaser
etur
norwor
senor
i
fsympt
omsofinfect
iondevel
op.

Cl
ocor
tol
one
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandi
nfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofdermat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroi
dsorcomponent sofvehi
cles(oi
ntmentor
cream base,preser
vat
ive,
alcohol)
;Untr
eatedbacter
ial
or
vi
rali
nfecti
ons.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cat
aracts,gl
aucoma, ortuberculosi
s(useoflarge
amountsofhigh-potencyagent smaywor sencondit
ion);
Pat
ientswithpre-
existi
ngskinat rophy;Pr
egnancy,
l
actat
ion,orchil
dren(chronichigh-doseusagemayr esul
t

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 874
i
nadr enalsuppressi
oni
nmot
her
,growthsuppr
essionin
chil
dren;chi
ldrenmaybemor
esuscept
ibl
etoadrenaland
growthsuppr essi
on)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topi
cal:
(Adul
tsandChi
l
dren≥12y
r):
Appl
ytoaf
fect
ed
ar
ea(s)3ti
mesdail
y.

AVAI
LABI
LITY
Cr
eam 0.
1%;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientoncor
rectt
echni
queofmedi
cat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 875
 admini
str
ati
on.Emphasizei
mportanceofavoi
dingthe
eyes.I
fadoseismissed,i
tshoul
dbeappliedassoon
asrememberedunl
essal mostt
imeforthenextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.

Caut i
onwoment hatmedicati
onshouldnotbeused
extensiv
ely,
inl
argeamount s,
orforprot
ract
ed
periodsift
heyarepregnantorpl
anningtobecome
pregnant.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onali
f
symptomsofunder l
yingdiseaser
etur
norwor senor
i
fsympt omsofinfect
iondev el
op.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 876
Cl
ofar
abi
ne
I
NDI
CATI
ONS
Ref
ract
ory
/rel
apsedacut
ely
mphobl
ast
icl
eukemi
ain
chi
l
dren1–21yr.

ACTI
ON
Convertedintracellul
arlytotheactive5'-
tr
iphosphat e
metabolitewhi chact sasapur i
nenucl eoside
anti
met aboli
te; netresulti
sinhibi
ti
onofDNAsy nthesis.
Producesar api dreductionofperipherall
eukemi acells.
TherapeuticEff ect
s: Deathofrapi
dlyrepli
catingcells,
part
icul
arlymal i
gnantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:None;
OB:
Lact
ati
on:
Pregnancyor
l
act
ati
on.

UseCaut
iousl
yin:
Hepat
icorr
enal
impai
rment
;
Concur
rentuseofnephr
otoxi
corhepat
otoxi
cdr
ugs.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: f
ati
gue.Resp:
phar
yngi
ti
s.CV:
peri
car
dialeffusi
on,
tachy
cardi
a,edema.GI
:HEPATOTOXICI
TY,di
arrhea,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 877
nausea,
abdomi nalpain,
const i
pation,mucositi
s,vomit
ing.
FandE: dehydr
ation.Hemat: NEUTROPENI A,anemia,
thr
ombocy t
openia.Local:i
njecti
onsi t
epain.Misc:
SYSTEMI CINFLAMMATORYRESPONSESYNDROME,
TUMORLYSI SSYNDROME, i
nf ect
ions,fev
er ,
chil
ls.

I
NTERACTI
ONS
Dr
ug-Drug:Concurr
entuseofhepato-ornephr
otoxi
c
dr
ugs↑ r i
skofhepato-andnephrot
oxici
tyandshoul
dbe
av
oidedforthe5-daytr
eatmentperi
od.

DOSAGE
I
V:(
Chil
dren1–21yr
):52mg/
m2dai
l
yfor5day
s;cy
cle
mayberepeat
edev
ery2–6wk.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion20mg/
20mLv
ial
s;

PATI
ENTTEACHI
NG
Advisepati
enttoconsultheal
thcar
eprof
essi
onali
f
di
zziness,
fainti
ngspel
ls,ordecr
easedur
ineout
put
occurduri
ngt her
apy.

Instr
uctpat
ientt
onotifyheal
thcar
eprofessional
of
allRxorOTCmedi cat
ions,vi
tami
ns,orherbal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 878
 productsbeingtakenandtoconsultheal
thcare
professi
onalbeforetaki
nganyotherRx,OTC,or
herbalproduct
s.

Cl
ofazi
mine
I
ndi
cat
ions
MBl
epr
osy
;ty
pe2l
epr
areact
ions.

Av
ail
abi
l
ity
TABLETS25,
50,
100mg;
CAPSULES50and100mg.

DOSAGE
Or
al
Adult
-300mgspreadoveraweek.Sulf
oner esist
ant
cases:600mgweekl
yprefer
abl
yaftermeal.Lepra
react
ion:200mgdai
l
yfor3weeksorasr equired.
Chi
l
d-1to2mg/kgbodywei
ghtdai
l
yor4t
o6mg/
kgbody
wei
ghtonceamont
h.

Cont
rai
ndi
cat
ions
Pr
egnancyl
act
ati
on,
renal
andhepat
ici
mpai
rment
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 879
Pr
ecaut
ions
Pre-
existi
nggastroi
nt esti
nalsy mptoms( r
educedose,
i
ncreasedosei nt
erval ordisconti
nueifsymptomsdevelop
duri
ngt r
eatment);l
iverandr enalimpairment;
may
di
scoloursoftcontactlenses; paediat
ri
cs,el
derl
y,
i
nteracti
ons.

Adv
erseEf
fect
s
Reversibl
ediscol our ati
onofski n,hair
, cor nea,conjunct
iva,
tear
s, sweat,sput um, faecesandur i
ne; dose- rel
ated
gastroint
esti
nal sy mpt omsi ncludi
ngpai n, nausea,
vomi t
inganddi arrhoea; severemucosal andsubmucosal
oedema, withpr olongedt reatmentwi thhi ghdoses- may
besev ereenought ocausesubacut esmal l-bowel
obstructi
on( seeal soPr ecautions);pruritus, i
chthyosi
s,
elev
at edbloodsugar ,
diminishedv i
sion, dizziness,
eosinophil
li
cent er opathy.

St
orage
St
orepr
otect
edf
rom moi
stur
e.

CLOMI
PHENE
I
NDI
CATI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 880
Inducesov ulati
oninanovul
atorywomenwhodesi r
e
pregnancy.Requi r
esint
actanteri
orpi
tui
tar
y,t
hyroi
d,and
adrenalfunction.Unl
abel
edUses: Mal
einfer
ti
li
tydueto
oli
gospermi a.

ACTI
ON
Sti
mulatesrel
easeofpit
uit
arygonadotropi
ns,foll
icl
e-
st
imulati
nghormone,andlutei
nizi
nghor mone,resul
ti
ngi
n
ovul
ationandthedevel
opmentoft hecorpusluteum.
Therapeut
icEff
ects:
Induct
ionofov ul
ati
on.

Av
ail
abi
l
ity
TABLETS25,
50and100mg.

DOSAGE
Or
al
Adult
-Anovulat
oryinfer
ti
li
ty:
50mgdai lyfor5days,
star
ti
ngwi t
hin5day sofonsetofmenstruati
on,
preferabl
y
onthesecondday ,
oratanyt i
mei fcy
cleshaveceased; a
secondcourseof100mgdai l
yfor5day smaybegiv enin
theabsenceofovulati
on.

Cont
rai
ndi
cat
ions
Hepat
ici
mpai
rmentov
ari
ancy
sts;
hor
monedependent

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 881
tumoursoruter
inebl
eedingofundet
erminedcause;
pregnancyhy
perprol
act
inaemia;
depressi
on.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

Pr
ecaut
ions
Visual di
stur
bances(di
scont
inueandi
nit
iat
eeye
exami nati
on)andovari
anhyperst
imul
ati
onsyndr
ome
(disconti
nuetreat
ment
i
mmedi atel
y);polycy
sti
cov ar
ysy ndrome(cystsmay
enlar
geduringt r
eatment)
;uteri
nef i
broi
ds,ect
opic
pregnancy,
incidenceofmul t
ipl
ebirthsi
ncreased
(consi
derultr
asoundmoni tori
ng);l
actat
ion.

Adv
erseEf
fect
s
Visualdisturbances; ovari
anhy perstimulati
on;hotflushes;
abdomi nal di
scomf ort;occasionalnauseaandv omi ti
ng;
depression; i
nsomni a;breasttenderness; headache;
i
ntermenst rualspotting;menor rhagia;endomet r
iosis;
convulsions;weightgai n;rashes;dizzinessandhai rloss.

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakecl
omi
pheneexact
lyas

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 882
 dir
ectedatthesamet i
meeachday .Misseddoses
shoul
dbet akenassoonasr emember edandthe
dosedoubledifnotrememberedunti
l t
heti
meoft he
nextdose.Noti
fyhealt
hcareprof
essionali
fmore
thanonedoseismi ssed.

Advi
sepatientt hatconcepti
onshouldbeatt
empted
wit
hinter
cour seev er
yotherdayst ar
ti
ng48hrpr
iort
o
ovul
ati
on.Ov ulati
onusuallyoccurs7days(r
ange
5–10)aft
erlastdoseofcl omi phene.

I
nstructpati
enti
nthecor r
ectmet hodformeasur i
ng
basalbodytemperature.Arecor
doft hedai l
ybasal
bodytemperatureshouldbemai ntai
nedpr i
ortoand
thr
oughoutcourseoft her
apy.Emphasi zethe
i
mpor tanceofcompliancewithallaspectsofther
apy.

Pri
ort
otherapy
,pati
entshouldbei
nfor
medoft
he
pot
enti
alf
ormulti
plebi
rths.

Medicati
onmaycausev isualdi
stur
bancesor
dizzi
ness.Caut
ionpati
enttoavoiddri
vi
ngunt
ilt
he
responsetothemedicat
ionisknown.

Inst
ructpat
ientt
onot i
fyhealt
hcarepr ofessi
onal
i
mmedi atel
yifpregnancyissuspected;clomi
phene
shouldnotbetakendur i
ngpregnancy.

Adv
isepat
ientt
hatopht
hal
mol
ogi
cexamsshoul
dbe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 883
 per
for
medt oevaluatethepossi
bil
i
tyofocul
art
oxi
cit
y
i
ftr
eatmentiscontinuedformorethan1yr.

Advisepati
enttonot ifyhealt
hcareprofessional
promptl
yifbloating,stomachorpel vi
cpai n,bl
urr
ed
vi
sion,j
aundice,persistenthotf
lashes,breast
di
scomf or
t,headache, diarr
hea,weightgain,or
nauseaandv omi ti
ngoccur .

Emphasizethei
mportanceofcl
osemonit
ori
ngby
heal
thcareprof
essi
onalthr
oughoutt
her
apy.

Cl
omi
prami
ne
I
ndi
cat
ions
Phobicandobsessi
onalst
ates;pani
cattacks;
blocki
ng
repl
acement,
catapl
exy,
chronicdiar
rhoea.
Unl
abel
edUses:
Depr
essi
on,
neur
opat
hicpai
n/chr
oni
c
pai
n.

ACTI
ON
Potent
iatestheeffectofser
otoni
n(ant
iobsessi
onaleff
ect
)
andnorepinephri
neint heCNS.Hasmoderate
anti
choli
nergicef
fects.Ther
apeuti
cEff
ects:Dimi
nished
obsessiv
e-compulsivebehavi
or.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 884
Av
ail
abi
l
ity
TABLETS10,
25,
50and75mg;
CAPSULES10and25mg.

DOSAGE
Or
al
Adult
-I
nit
ial
l
y25mgdail
y,usual
l
yatbedt
imei
ncr
eased
over2weeksto100t
o150mgdai l
y.
El
der
ly-I
nit
ial
l
y10mgdail
y,usual
l
yatbedt
imei
ncr
eased
ov
er2weekst o100t
o150mgdai l
y.
Chi
l
d-Notusual
l
yrecommended.

Cont
rai
ndi
cat
ions
Recentmy ocar di
ali
nfar
cti
on,arrhythmias(especial
l
y
heartbl
ock); manicphaseinbipolardisorders;
severel
i
ver
di
sease; chi
ldren;por
phyri
a;narr
owangl eglaucoma,
uri
naryretenti
on.

I
NTERACTI
ONS
Drug-Dr
ug:Maycausehy pot
ensionandtachy
cardi
awhen
usedwithMAOi nhi
bit
ors(concurr
entusenot
recommended).Wait2wkbef orei
nit
iat
ingcl
omiprami
ne
afterMAOinhi
bitor
sarestopped.Wait2wkbefore

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 885
i
nitiati
ngMAOi nhi bitor
saf terclomi prami neisst opped.
Maypr ev entt het herapeut i
cr esponset oant i
hy per t
ensiv
es.
Usewi thcl onidinemayr esultinhy per tensivecr isis(avoid
concur r entuse) .↑ CNSdepr essionwi thot herCNS
depr essant si ncludingal cohol,antihistami nes, opi oi
ds,and
sedat i
v e/ hypnot i
cs.Adr energicandant i
chol i
ner gicside
effectsmaybe↑ wi thot heragent shav ing
adrener gic/anticholinergicpr operties.Ef fectsandt oxici
ty
maybe↑ byconcur rentusewi t
hSSRIant i
depr essant s
(waitsev eralweeksaf terstoppingSSRI st ostar t
clomi pirami ne;upt o5weeksf orf l
uoxet i
ne) ,
phenot hiazines, cimet i
dine,oror al cont r
acept i
v es.
Nicot i
nemay↑ met abol i
sm and↓ ef fect i
veness.
Transi entdel iri
um mayoccurwi thdi sulfi
ram.
Drug-Natur
alPr oduct
:↑r iskofserot
onergi
csi
deeffect
s
i
ncludingserotoninsyndromewi t
hSt.John’
swortand
SAMe.Kav a,valeri
an,orchamomi l
ecan↑ CNS
depressi
on.
Dr
ug-
Food:
Grapef
rui
tjui
ce↑ ser
um l
evel
sandef
fect
.

Pr
ecaut
ions
Cardi
acdisease(seeCont r
aindi
cat
ionsabove)
,hi
storyof
epi
lepsy;
lact
ati
onpr egnancyelder
ly;hepat
ici
mpairment
thy
roiddi
sease;pheochromocy t
oma; hi
stor
yofmania,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 886
psychoses( mayaggr avatepsychot i
csy mptoms) ;angle-
closureglaucoma, historyofurinaryretent
ion;concur r
ent
electr
oconv ul
sivetherapy ;av
oidabr uptwithdrawal;
anaesthesia(increasedr i
skofar rhythmiasand
hypotension);i
nteractionsdecr easedur i
neout put,
breathi
ngpr oblem.Mayi mpairabili
tytoperform skil
led
tasks,forexampl eoper ati
ngmachi nery,dri
ving.

Adv
erseEf
fect
s
Sedat ion; drymout h;blurredv ision( di sturbanceof
accommodat ion, i
ncreasedi nt ra-ocul arpr essure) ;
const i
pat ion;nausea; diffi
cult yinmi cturition;
cardiov ascularadv erseef fect spar ti
cul arlywi thhi gh
dosagei ncludingECGchanges, arrhy thmi as, post ural
hypot ensi on,tachy cardia,sy ncope; sweat ing,tremor ,rash
andhy per sensitivi
tyreact ions( urticar i
a, phot osensi ti
vity)
;
behav iour aldisturbances; hypomani aormani a, conf usion
(parti
cul arlyinel derly
),interfer encewi thsexual function,
bloodsugarchanges; increasedappet it
eandwei ghtgai n
(occasi onal wei ghtloss) ;endocr ineadv erseef fect ssuch
ast esticularenl argement ,gy naecomast iaand
galactor rhoea; conv ulsions,mov ementdi sordersand
dyskinesi as, f
ev er,agranul ocy tosi s,leukopeni a,
eosinophi l
ia,pur pura,thrombocy t
openi a, hyponat r
aemi a
(maybeduet oi nappr opriateant i
diur eti
chor mone

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 887
secreti
on)
;abnor
mall
iv
erfuncti
ont est
;ext
rapyr
amidal
syndrome,bonemar
rowdepression,hyper
tensi
on,
stroke.

PATI
ENTTEACHI
NG
Inst
ructpatienttotakemedi
cati
onexactl
yasdi r
ected.
Abruptdiscontinuat
ionmaycausenausea,headache,
andmal aise.

Maycausedr owsinessandbl
ur r
edv i
sion.Cauti
on
pat
ienttoavoiddriv
ingandotheracti
viti
esrequi
ring
al
ertnessunt
ilresponsetodr
ugi sknown.

Ort
hostatichypotensi
on,sedati
on,andconf
usi
onare
commondur i
ngear l
ytherapy,
especial
l
yinger
iat
ri
c
pati
ents.Prot
ectpat i
entf
rom fal
lsandadvi
sepati
ent
tochangeposi t
ionsslowl
y .

Advi
sepati
enttoav oi
dalcoholorotherCNS
depr
essantdrugsduri
ngcourseoft her
apyandf
or
3–7daysaftercessat
ionoftherapy
.

Advisepati
ent,famil
y ,
andcaregiverstolookfor
sui
cidali
ty,
especiall
yduri
ngear l
ytherapyordose
changes.Notifyheal
thcareprofessionalimmediat
ely
i
fthoughtsaboutsui ci
deordying,attemptsto
commi tsuici
de,neworwor sedepr essi
onoranxiet
y,
agit
ati
onorr estl
essness,
panicattacks,insomni
a,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 888
 neworworseir
ri
tabil
it
y,aggressi
veness,
acti
ngon
danger
ousimpulses,
mani a,
orotherchangesin
moodorbehavi
oroccur .

Instructpatienttonot i
fyheal t
hcar eprofessionali
f
drymout horconst ipati
onper sist
sori furi
nar y
retention,uncontroll
edmov ement s,orri
gidit
yoccur s.
Sugar l
esscandyorgum maydi minishdrymout h,and
ani ncreasei nfl
uidintakeorbul kmaypr event
const i
pation.Ifthesesy mptomsper sist
,dosage
reduct i
onordi scontinuati
onmaybenecessar y.
Consul thealthcar eprofessionali
fdr ymout hpersists
formor ethan2wk.

Advisepati
entt
oinf
orm healt
hcareprof
essi
onalif
sexualdysf
unct
ionoccur
s.Infor
m malepati
entsthat
sexualdysf
unct
ioni
scommonwi tht
hismedicati
on.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

I
nform pat
ientofneedt omoni
tordi
etar
yint
ake
becausepossibl
eincreasei
nappeti
temayleadto
undesi
redweightgain.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Emphasi
zet
hei
mpor
tanceoff
oll
ow-
upexamst
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 889
 moni
toref
fect
ivenessandsi
deef
fect
sandt
o
i
mprovecopi
ngskill
s.

I
nfor
m pat
ient
stakinghi
ghdoses( 250–300mg/
day
)
t
hatri
skofsei
zuresisi
ncreased.

St
orage
St
orepr
otect
edf
rom l
i
ghtandmoi
stur
e.

Cl
onazepam
I
ndi
cat
ions
Absencesei zures,my ocl
onicsei
zures,aki
neti
cseizur
es,
panicdisor
der ,subcorti
calmyoclonus,adj
uvanttr
eatment
ofrefr
actoryepi l
epsy.Unlabel
edUses: Uncontr
oll
edleg
mov ementsdur ingsleep.Neural
gias.I
nfanti
l
espasms.
Sedati
on.Adj unctmanagementofacut emania,acute
psychosis,
ori nsomni a.

ACTI
ON
Anti
conv ul
santeffectsmaybeduet opresy
napti
c
i
nhibi
tion.Producessedati
veef f
ectsintheCNS,probably
bysti
mul ati
nginhibit
oryGABAr eceptor
s.Ther
apeuti
c
Eff
ects:Preventi
onofseizures.Decreasedmanif
estati
ons
ofpanicdisorder
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 890
Av
ail
abi
l
ity
TABLETS0.
25,
0.5,
1and2mg.

DOSAGE
Adul
t-0.5-5mgt hri
cedai
l
y,i
nit
ial
doseshoul
dnotexceed
1.
5mg/ day,sl
owt i
tr
ati
oni
srecommendedMai nt
enance
dose4-8mgdai l
y,Maxi
mum dose20mgdai l
y.
Inf
antsandchil
d: I
nit
ialdose0.
01-0.03mg/kg/day(nott
o
exceed0.05mg/ kg/day)giv
enin2-3divi
deddoses.
Maintenancedose0.1-0.2mg/kg/dayin3div
ideddoses.
Panicdi
sorder
:Adul
t-I
nit
ial
dose0.
25mgtwi
cedail
y,
usualmaint
enancedose1mg/day,
maxi
mum dose4
mg/day.

Cont
rai
ndi
cat
ions
Hyper
sensit
ivi
tytobenzodi
azepi
nes,acut
epul
monar
y
i
nsuff
ici
ency,acut
enarrowanglegl
aucoma.

I
NTERACTI
ONS
Drug-
Drug:Alcohol,antidepressant
s, anti
histamines,ot
her
benzodi
azepines,andopi oidanalgesics;concurrentuse
resul
tsi
n↑ CNSdepr ession.Cimetidine,hormonal
contr
acept
ives,disulf
iram, f
luoxeti
ne, i
soniazid,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 891
ketoconazol e,metopr
olol,pr
opoxyphene, propranolol
,or
valproicacidmay↓ met aboli
sm and↑ t oxicit
yof
clonazepam.May↓ ef ficacyoflevodopa.Ri f
ampi nor
barbituratesmay↑ met abolism and↓ ef fecti
veness.
Sedat i
veef fect
smaybe↓ byt heophy ll
i
ne.May↑ ser um
pheny toinlevel
s.Phenyt
oinmay↓ l evel
s.
Drug-
Natur
alPr
oduct
:Concomi
tantuseofkava-
kav
a,
val
eri
an,
orchamomil
ecan↑ CNSdepr essi
on.

Pr
ecaut
ions
Neonat
es,chr
onicpul
monaryinsuf
fici
ency
,hepat
icand
r
enaldysf
uncti
on,por
phyr
ia,
elderl
y,pr
egnancyl
actat
ion
i
nter
act
ionsavoidsuddenwit
hdrawal.

Adv
erseEf
fect
s
Sedat
ion,dul
lness,CNSdepr
essi
on,
ataxi
a,br
onchi
al
hyper
secreti
on,abnormal
eyemovement,
blood
dyscr
asias.

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakemedi cati
onexactl
yasdirect
ed.
Takemi sseddoseswi thi
n1hroromi t
;donotdouble
doses.Abruptwithdrawalofclonazepam maycause
stat
usepi l
ept
icus,tr
emor s,
nausea, v
omiti
ng,and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 892
 abdominal
andmuscl ecr
amps.Instructpat
ientt
o
readt
heMedi cat
ionGui
debeforestarti
ngandwith
eachRxrefi
ll
,changesmayoccur.

Advisepati
entthatcl
onazepam i
susual
lypr
escr
ibed
forshort
-t
erm useanddoesnotcureunderl
yi
ng
problems.

Adv
isepat
ientt
onotshar
emedi
cat
ionwi
thot
her
s.

Maycausedr owsinessordizzi
ness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heractiv
iti
esrequir
ingal
ert
ness
unti
lresponsetodrugisknown.

Instr
uctpatienttonot i
fyhealthcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orher bal
productsbeingt akenandt oconsulthealthcar e
professi
onal beforetaki
nganyot herRx,OTC, or
herbalproducts.Caut i
onpatienttoavoidtaking
alcoholorotherCNSdepr essantsconcur r
entlywith
thismedication.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

I
nst r
uctpatientandfamilytonot i
fyhealthcare
professi
onal ofunusualti
redness,bleedi
ng,sore
throat,
fever,cl
ay-col
oredstools,yel
lowingofskin,
or
behav i
oralchanges.Advisepatientandfami l
yto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 893
 noti
fyhealthcar eprofessional i
fthought sabout
sui
cideordy ing,attempt stocommi tsuicide;newor
worsedepr ession;neworwor seanxiety;feel
ingv er
y
agit
atedorr estl
ess; panicattacks;troublesleeping;
neworwor seirri
tabili
ty;
actingaggr essive;being
angryorviolent;actingondanger ousimpul ses;an
extr
emei ncreasei nact i
vit
yandt alking,otherunusual
changesinbehav i
orormoodoccur .

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

CLONI
DINE
I
NDI
CATI
ONS
PO:Transdermal:Mildtomoder atehypertension.PO:
Att
enti
on-defi
cithyperacti
vi
tydisorder(
ADHD)( as
monotherapyorasadj uncti
vetost i
mulants)(Kapv ayonl
y).
Epi
dural:
Managementofcancerpai nunresponsivet o
opi
oidsalone.UnlabeledUses:Managementofopi oid
wit
hdrawal.Adjuncti
vetreatmentofneuropat hicpain.

ACTI
ON
St
imul
atesal
pha-
adr
ener
gicr
ecept
orsi
ntheCNS,
whi
ch

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 894
resultsindecr easedsympatheti
cout f
lowinhi
biti
ng
cardioaccelerationandvasoconstri
cti
oncenters.Pr
ev ents
painsi gnalt
ransmi ssi
ontotheCNSbyst imulat
ingalpha-
adrener gi
crecept or
sinthespinalcord.Ther
apeutic
Effects:DecreasedBP.Decr easedpain.Improvementi n
ADHDsy mptoms.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Epi
dur
al—i
nject
ion
si
tei
nfect
ion,
ant
icoagul
antt
her
apy
,orbl
eedi
ngpr
obl
ems.

UseCaut
iousl
yin:
Ser
iouscar
diacorcer
ebr
ovascul
ar
disease;Renal insuffi
ciency;Pedi
:Safetyandef fi
cacynot
establi
shedf orADHDi nchil
dren<6yr;eval
uationf or
cardiacdiseaseshoul dprecedeini
ti
ationoftherapyf or
ADHDi nchil
dr en;Geri:AppearonBeer sli
stduet o↑ r isk
ofor t
hostati
chy potensionandadverseCNSef fectsin
geriatr
icpati
ent s( ↓ doserecommended) ;OB: Lact at
ion:
Safetynotest ablished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness,depression,dizzi
ness,nerv
ousness,
ni
ghtmar es.EENT: dryey es.CV: br
adycardi
a,hypotensi
on
(↑ withepidural
),pal
pi t
ations.GI:drymouth,constipat
ion,
nausea, v
omi t
ing.GU: erecti
ledysfuncti
on.Derm: r
ash,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 895
sweati
ng.FandE:sodi
um retent
ion.Metab:
weightgai
n.
Neuro:par
est
hesi
a.Misc:
wi t
hdrawalphenomenon.

I
NTERACTI
ONS
Drug-Drug: Additi
vesedat i
onwi thCNSdepr essants,
i
ncludingal cohol,anti
hist
ami nes,opi oi
danal gesics,and
sedative/hypnot i
cs.Additivehy potensionwi t
hot her
anti
hyper t
ensi vesandni t
rates.Addi tivebr adycardiawit
h
betablocker s,dil
ti
azem, verapami l
,ordi goxin.MAO
i
nhibit
or s,amphet amines, ort r
icycli
cant idepressantsmay
↓ antihyper t
ensiveeffect.Wi thdrawal phenomenonmay
be↑ bydi scont i
nuati
onofbet abl ockers.Epi dural
cl
onidinepr olongst heeffectsofepi durall
yadmi nister
ed
l
ocalanest hetics.May↓ ef fectivenessofl evodopa.

DOSAGE
0.17mgdai lyofextended-rel
easetabl
ets/
suspensi
onis
equiv
alentto0.1mgt wicedail
yofimmediate-
rel
ease
tabl
ets;0.26mgdai l
yofext ended-
rel
ease
tabl
ets/suspensionisequival
entto0.15mgdai l
yof
i
mmedi ate-rel
easetablets
PO:(Adult
sandAdol escent
s≥12yrs)
:Hy
pert
ensi
on
(i
mmedi at
e–rel
ease)-100mcg(0.
1mg)BID,↑ by
100–200mcg( 0.1–0.2mg)/dayq2–4days;
usual

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 896
maintenancedosei s200–600mcg( 0.2–0.6mg)/ dayin
2–3di vi
deddoses( upto2. 4mg/ day).Urgenttr
eat mentof
hypert
ensi on(i
mmedi ate-
release)-200mcg( 0.
2mg)
l
oadingdose, then100mcg( 0.1mg)qhrunt il
BPi s
contr
olledor800mcg( 0.8mg)t otalhasbeen
administered;
foll
owwi thmai ntenancedosi ng.
Hypertension(NexiclonXR) -0.17mgoncedai l
yatbedt i
me;
may↑ by0. 09mg/ dayever yweek, asneeded( donot
exceed0. 52mg/ day )
;Opioidwi thdrawal (
immedi ate-
rel
ease)-300mcg( 0.3mg) –1. 2mg/ day ,
maybe↓ by
50%/dayf or3day s, t
hendi scontinuedor↓ by100–200
mcg( 0.1–0.2mg) /day .
PO:(Ger
iatr
icPati
ent
s) :
Hyper
tensi
on
(i
mmediate–rel
ease)
-100mcg(0.1mg)atbedt
imei
nit
ial
l
y,
↑ asneeded.
PO:(Chi
ldren) :Hypert
ension( i
mmedi at
e-r
elease)-
Ini
ti
al
5–10mcg/ kg/ daydivi
dedBI D-TID,then↑ gr adual
lyto
5–25mcg/ kg/ dayindivi
deddosesq6hr ;maxi mum dose:
0.
9mg/ day .ADHD( Kapvay )(chil
dren>6y r)
—0. 1mgonce
dail
yatbedt i
me; aft
er1wk, ↑ doset o0.1mgi nAM and
atbedti
me; after1wk, ↑ doset o0.1mgi nAM and0. 2mg
atbedti
me; after1wk, ↑ doset o0.2mgi nAM andat
bedti
me( maxdose=0. 4mg/ day).Neuropathicpain
(i
mmedi at
e- r
elease)-
2mcg/ kg/doseq4–6hrt hen↑

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 897
gr
adual
l
yov
erday
supt
o4mcg/
kg/
doseq4–6hr
.
Transdermal:(
Adults):
Hy per
tension—Transdermal
system deli
ver
ing100–300mcg( 0.1–0.
3mg) /24hr
appliedevery7days.I
nit
iatewit
h100mcg( 0.1mg)/24hr
system;dosageincrementsmaybemadeq1–2wkwhen
system i
schanged.
Transdermal
:(Chi
ldren):Oncestabl
eor aldoseisreached,
chil
drenmaybeswi tchedtoat r
ansdermal syst
em
equival
entcl
osesttothetotaldai
lyoraldose.
Epidur
al:
(Adul
ts)
:30mcg/
hri
nit
ial
l
y;t
it
rat
edaccor
dingt
o
need.
Epidural:
(Chi
ldr
en):
0.5mcg/
kg/hrini
ti
all
y;t
it
rat
ed
accordingtoneedupto2mcg/kg/
hr.

AVAI
LABI
LITY
Tablets25mcg( 0.025mg) ,100mcg( 0.1mg) ,200mcg
(0.
2mg) ,
300mcg( 0.
3mg) .Extended- r
eleaset ablets
(Nexicl
onXR)0.17mg, 0.26mg; Extended- releaset ablets
(Kapvay)0.1mg, 0.
2mg; Extended- r
eleaseor al
suspension(Nexicl
onXR)0. 09mg/ mL; Transder mal
systemsCat apr
es-TTS1, releases0. 1mg/ 24hr ,Catapres-
TTS2, rel
eases0.2mg/ 24hr ,Catapres-TTS3, releases
0.3mg/ 24hrSoluti
onf orepi durali
njection( Dur aclon)100

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 898
mcg/mL,500mcg/
mL;
Incombi
nat
ionwi
th:
chl
ort
hal
i
done

PATI
ENTTEACHI
NG
Instructpatientt otakecl oni di
neatt hesamet i
me
eachday ,eveni ffeelingwel l.Takemi sseddosedas
soonasr emember ed.Ifdoseofext ended-rel
ease
producti smi ssed; omi tdoseandt akenextdoseas
schedul ed.Donott akemor et hanthepr escri
beddai
ly
dosei nany24hr .Ifmor et han1or aldosei narowis
mi ssedori ftransder mal sy stem islateinbeing
changedby3ormor eday s, consulthealthcare
professional.All routesofcl onidi
neshoul dbe
graduallydiscont inuedov er2–4day st oprevent
reboundhy pertension.

Advisepat ienttomakesur
eenoughmedicati
onis
avai
lablef orweekends,
holi
days,
andv
acations.A
writ
tenpr escript
ionmaybekepti
nwal
letincaseof
emer gency .

Maycausedr owsiness,whichusuall
ydi
minisheswith
conti
nueduse.Adv i
sepatientt
oav oi
ddriv
ingorother
acti
vi
ti
esrequir
ingalert
nessuntilr
esponseto
medicati
onisknown.

Caut
ionpat
ientt
oav
oidsuddenchangesi
nposi
ti
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 899
 todecr easeorthost
atichypotension.Useofal
cohol
,
standingf orl
ongperiods,exercisi
ng,andhotweat
her
mayi ncreaseor t
hostati
chypot ensi
on.

Ifdrymout hoccur
s,fr
equentmout hr
inses,goodor
al
hygiene,andsugarl
essgum orcandymaydecr ease
effect
.Ifdrymouthcontinuesformor
et han2wk,
consulthealt
hcareprofessional
.

Caut
ionpat
ienttoav oi
dconcur
rentuseofalcohol
or
ot
herCNSdepr essantswi
ththi
smedi cat
ion.

Instr
uctpatientt
onot ifyheal
thcarepr ofessionalof
allRxorOTCmedi cations,vi
tamins,orher bal
productsbeingtakenandt oconsulthealthcar e
professi
onal bef
oretakinganyot herRx,OTC, or
herbalproducts,especial
lycough,cold,orallergy
remedies.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Adv i
sepatienttonot i
fyhealt
hcar eprof
essionalif
i
tchingorr ednessofskin(wi t
htransdermalpatch),
ment aldepressi
on, swel
li
ngoff eetandlowerlegs,
palenessorcol dfeeli
nginfingert
ipsortoes,orvivi
d
dreamsorni ght
mar esoccur.Mayr equi
re
di
scont i
nuationoftherapy,especial
lywit
hdepr essi
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 900
 Hy pertension:Encouragepat i
enttocompl ywi t
h
additi
onal inter
ventionsforhyper t
ension(weight
reduction,low-sodium di
et,discontinuati
onof
smoki ng, moderationofalcohol consumpt i
on,regular
exercise,andst ressmanagement ).Medicati
onhel ps
control butdoesnotcur ehy pert
ensi on.

Inst
ructpati
entandf ami
lyonpropert
echni
queforBP
monitori
ng.Advisethem t
ocheckBPatleastweekl
y
andreportsi
gnifi
cantchanges.

Transder
mal:I
nstructpat
ientonproperappli
cat
ionof
tr
ansdermal
system.Donotcutort r
im uni
t.
Transder
malsystem canremaininplaceduri
ng
bathi
ngorswimmi ng.

Adv i
sepatientref
erredforMRItesttodiscusspat
ch
withref
erri
ngheal t
hcarepr of
essional
andMRIf aci
li
ty
todeter
mi neifremov al
ofpatchisnecessarypri
orto
testandfordirect
ionsforrepl
acingpatch.

Pedi
:Advi
separ
ent
stonot
if
yschool
nur
seof
medi
cati
onregi
men.

Cl
opi
dogr
el
I
ndi
cat
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 901
Pr
ophylaxi
sinthromboembol i
cdisordersi
ncludi
ng
myocardi
ali
nfarcti
on,per
ipher
alarteri
aldi
seaseand
st
roke,
acutecoronarysyndrome.

ACTI
ON
I
nhibit
splat
eletaggregat
ionbyirrev ersi
blyinhi
bit
ingthe
bi
ndingofATPt oplatel
etreceptors.Ther apeut
icEffect
s:
Decreasedoccurr
enceofat her
oscl eroti
cev ent
sin
pat
ientsatri
sk.

Av
ail
abi
l
ity
TABLETS75mg,
150mgand300mg

DOSAGE
Adul
t-75mgoncedai
l
y.
Non-STsegmentelev
ati
onmyocar
dial
inf
arcti
on:
loadi
ng
dose300mgf ol
lowedby75mgoncedaily.

Cont
rai
ndi
cat
ions
Hypersensi
ti
vi
ty,
acti
vepathol
ogi
calbl
eedi
ngsuchas
pept
iculcerori
ntr
acrani
alhemor
rhage,
coagul
ati
on
di
sorders,l
act
ati
on.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 902
Drug-Drug:Concur rentabciximab,ept i
fi
batide, t
ir
ofiban,
aspiri
n,NSAI Ds, hepar i
n,LMWHs, thrombol yti
cagent s,
ti
clopidi
ne,orwar farinmay↑ r iskofbl eeding.May↓
met aboli
sm and↑ ef fectsofpheny toi
n,tolbutami de,
tamoxi f
en,torsemi de,fl
uvastat
in,andmanyNSAI Ds.
Concur r
entuseofst rongormoder ateCYP2C19i nhibit
ors
(e.
g.omepr azol e, esomepr azol
e,cimet i
dine, f
luconazol e,
ketoconazole,v oriconazole,etr
aviri
ne,felbamat e,
fl
uoxet i
ne,orfluv oxami ne)may↓ ant i
plateleteffects
(concurrentuseshoul dbeav oi
ded) .
Drug-NaturalPr
oduct:↑ bleedingr
iskwithani
se,ar
nica,
chamomi le,cl
ove,f
enugreek,fever
few,garl
i
c,gi
nger,
ginkgo,Panaxginseng,andothers.

Pr
ecaut
ions
Patientwit
hincreasedri
skofbleedingfrom t
rauma,
surgeryorotherpathol
ogical
conditi
ons,ul
cers,r
enal
i
mpai rment,hepati
cimpairment
,histor
yofbleedi
ngor
haemost at
icdisorder
,pr
egnancyint er
acti
ons.

Adv
erseEf
fect
s
Bleedi
ng,neutr
openia,thr
ombocy t
openia,otherbone
mar r
owtoxici
ty,di
arrhoea,epi
gast
ricpain,r
ashes,
paraest
hesia,
verti
go.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 903
PATI
ENTTEACHI
NG
Inst
ructpatienttotakemedi cati
onexact l
yasdi r
ected.
Takemi sseddosesassoonaspossi bl
eunless
almosttimef ornextdose; donotdoubl edoses.Do
notdisconti
nuecl opidogrelwi
thoutconsulti
ngheal t
h
careprofessional
; mayincreaseriskofcardiovascular
events.AdvisepatienttoreadtheMedi cati
onGui de
beforestart
ingclopidogrelandwit heachRxr efi
lli
n
caseofchanges.

Advi
sepat
ienttonot
if
yheal t
hcareprof
essi
onal
pr
omptlyi
ffever,
chi
l
ls,sorethr
oat,
orunusual
bl
eedi
ngorbruisi
ngoccurs.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Instr
uctpatienttonot i
fyhealt
hcareprof essionalof
allRxorOTCmedi cati
ons,vit
amins,orher bal
productsbeingt akenandt oconsulthealthcar e
professi
onal beforetaki
nganyot herRx, OTC, or
herbalproducts,especial
lythosecontainingaspirinor
NSAI Dsorpr otonpumpi nhibit
ors.

Advi
sefemalepati
enttonot
if
yhealthcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
ed,
or
i
fbreast
feedi
ng.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 904
Cl
orazepat
e
I
NDI
CATI
ONS
Managementofsi
mplepar
ti
alseizur
es.Anxi
etydi
sor
der
,
sy
mptomsofanxiety
.Acut
ealcoholwit
hdrawl
.

ACTI
ON
Actsatmanyl evelsint heCNSt opr oduceanxi ol
yticeff
ect
andCNSdepr essi
on( byst i
mulati
ngi nhibi
toryGABA
recept ors)
.Producesskel et
almuscl erelaxation(by
i
nhibi ti
ngspinalpoly
sy napticaff
erentpat hway s)
.Alsohas
anticonv ul
santeff
ect( enhancespr esynapticinhi
biti
on).
Ther apeuticEff
ects:Rel i
efofanxiety.Sedation.Prevent
ion
ofsei zures.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
wit
hot herbenzodiazepinesmayoccur ;Pr
e-exi
stingCNS
depression;Sever
euncont rol
l
edpai n;Angle-cl
osure
gl
aucoma; OB:Lactat
ion:MaycauseCNSdepr ession,
fl
accidit
y,feedi
ngdiffi
culti
es,andseizuresininfant.I
n
l
actationdisconti
nuedrugorbot tl
e-feed.

UseCaut
iousl
yin:
All
pat
ient
s(may↑ r
iskofsui
cidal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 905
thought s/behavi
ors);Pre-existi
nghepat i
cdy sfuncti
on;
Patientswhomaybesui cidalorhav ebeenaddi ctedto
drugsi nthepast ;Debil
it
atedpat i
ents(dosager educti
on
required);Severepulmonar ydisease;Geri
:Long- act
ing
benzodi azepinescausepr ol ongedsedationint heelder
ly.
Appear sonBeer sli
standi sassoci atedwithincreased
ri
skoff alls(↓ doser equiredorconsi dershort-acti
ng
benzodi azepine)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SUICIDALTHOUGHTS, dizziness,drowsiness,
l
ethargy,hangov er
,headache, ment aldepression,slurred
speech,ataxia, par
adoxicalexcitation.EENT: blurr
edv isi
on.
Resp:respiratorydepression.GI: constipat
ion,diarrhea,
nausea,vomi ting,weightgain(unusual ).Derm: rashes.
Misc:physical dependence, psychol ogi
caldependence,
tol
erance.

I
NTERACTI
ONS
Drug- Drug: Alcohol,antidepressants,anti
hist
amines,and
opioidanal gesi cs—concur rentuser esult
sin↑ CNS
depr ession.Ci metidine,hormonal cont r
acepti
ves,
di
sul fir
am, fluoxetine,isoniazi
d,ketoconazole,metoprol
ol,
propr anolol,orv al
proicacidmay↓met aboli
sm of
cl
or azepat e,↑i t
sact i
ons.May↓ ef f
icacyoflevodopa.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 906
Ri
fampinorbarbi
tur
atesmay↓ met abol
ism and↓
ef
fecti
venessofcl
orazepat
e.Sedat
iveef
fect
smaybe↓
bytheophyl
li
ne.
Drug-
Natur
alPr
oduct
:Concomi
tantuseofkav
a-kav
a,
val
eri
an,
orchamomil
e↑ CNSdepr essi
on.

DOSAGE
Prescr
ibelar
gestdoseatbedt
imetoavoiddayt
ime
sedati
on.Canbeusedonpr nbasi
sforanxi
ety
PO:(Adult
s):Anxiety—7.5–15mg2–4t i
mesdai l
yor15
mgatbedt i
mei ni
tial
l
y .Al
cohol
withdr
awal—30mgi nit
ial
l
y,
then15mg2–4t i
mesdai l
yon1stday,t
hengradual
ly↓
oversubsequentdays.
PO:(Adul
tsandChi
ldr
en>12yr)
:Ant
iconv
ulsant—7.
5mg3
ti
mesdail
y;may↑ bynomorethan7.5mg/ dayatweekl
y
i
nter
vals(
dail
ydosenott
oexceed90mg) .
PO:(
Geriat
ri
cPat
ient
sorDebi
l
itat
edPati
ent
s):
Anxi
ety
—7.5mg1–2t i
mesdai
ly;maybe↑.
PO:(Chil
dren9–12y
r):
Anti
convul
sant
—7.5mgtwi
cedail
y
i
nit
ial
ly,may↑ bynomorethan7.
5mg/ wk(
nott
oexceed
60mg/ day).

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 907
Tabl
ets3.
75mg,
7.5mg,
15mg;

PATI
ENTTEACHI
NG
Instr
uctpat
ienttotakemedicationasdirected,
notto
skipordoubleuponmi sseddoses.Abr upt
withdrawal
maycausest at
usepi l
epti
cus,tr
emor s,
nausea,vomiti
ng,andabdomi nalandmuscl ecramps.
Instr
uctpat
ienttoreadtheMedi cati
onGuidebef or
e
start
ingandwitheachRxr efi
l
l,changesmayoccur .

Maycausedr owsinessordizzi
ness.Adv i
sepati
entto
avoi
ddr i
vingorotheract
ivi
ti
esrequir
ingalert
ness
unti
lresponsetodrugisknown.Geri:Inst
ructpat
ient
andfami l
yhowt oreducefal
lsri
skathome.

Cautionpat
ientt
oavoidalcoholorotherCNS
depressant
sconcurr
entl
ywi tht
hismedi cat
ion.Advi
se
pati
enttoconsul
thealt
hcar epr
ofessionalpri
orto
taki
ngOTCorher balpr
oducts.

Instructpatientandf amilytonot i
fyhealthcare
professional ofunusual ti
redness, bl
eeding,sore
throat,fever,cl
ay -
coloredstools,yell
owingofski n,or
behav ioralchanges.Adv isepatientandf amilyto
notifyhealthcar eprofessionalifthoughtsabout
suicideordy i
ng,attemptst ocommi tsui
cide;newor
wor sedepr ession;neworwor seanxi et
y;feeli
ngv ery

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 908
 agit
atedorrest
less;panicat
tacks;
troublesleeping;
neworwor seir
ritabi
li
ty;
acti
ngaggressive;being
angryorvi
olent
; acti
ngondangerousimpul ses;an
extr
emeincreasei nacti
vi
tyandtal
king,otherunusual
changesinbehav i
orormoodoccur .

Inst
ructpatienttocontacthealthcarepr of
essi
onal
i
mmedi atel
yifpregnancyisplannedorsuspect edori
f
breastfeedi
ng.Encouragepr egnantpatientst
oenrol
l
i
nNor t
hAmer i
canAnt i
epi
lepti
cDr ug(NAAED)
PregnancyRegi str
ytocollectinf
ormat i
onabout
safetyofantiepil
epti
cdrugsdur i
ngpr egnancy.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Emphasizet
heimportanceoffol
l
ow-upexamst
o
det
ermineef
fect
ivenessofthemedi
cati
on.

Sei
zures:Pati
entsonant
iconvul
santt
her
apyshoul
d
car
ryidenti
fi
cati
ondescr
ibi
ngdiseasepr
ocessand
medicati
onregimenatal
ltimes

Cl
otr
imazol
e
I
ndi
cat
ions
Vul
vo-
vagi
nal
candi
diasi
s,t
ri
chomoni
asi
s,v
agi
nit
is,
non-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 909
specifi
cvagini
ti
s,mi xedvaginalinfect
ion,Gr
am- posi
ti
ve
andGr am-negati
vebact er
ialinf
ect i
on,inf
ect
ive
l
eucor r
hoeas;preventionofathletesfootandri
ngwor m
diseaseofskinfol
ds.

ACTI
ON
Aff
ectstheper
meabi l
it
yofthefungalcel
lwall
,al
lowi
ng
l
eakageofcell
ularcont
ent
s.Therapeuti
cEffect
s:
Decreasei
nsympt omsoffungalinf
ecti
on

Av
ail
abi
l
ity
PESSARI
ES/
VAGI
NALTABLETS100and200mg;
CREAM
1%w/ w;
POWDER75g;
LOTI
ON50ml .

DOSAGE
Adult
-Pessari
es/vagi
naltablet
s:100mgpessar y
/v agi
nal
tabl
ettobeinser
tedint
ov aginaatnightbef
oregoingto
bedasdeepaspossi bl
ef orconsecuti
ve6to7day sor
200mgf or3consecutiv
eni ghtbefor
egoingtobedor500
mgsi ngl
edose.
Chil
d-Pessari
es/vaginalt
ablet
s:notrecommended.
Cream:Rubonaf fectedarea2to3t i
mesbyapplyi
ngin
thi
nlayerandrubbing,conti
nuefor14daysaf
terheal
ing.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 910
Cont
rai
ndi
cat
ions
Opht
hal
micuse;
hyper
sensi
ti
vi
ty.

I
NTERACTI
ONS
Or
al
Drug-Drug:May↓ met abol i
sm and↑ r iskoftoxici
tyf
rom
CYP3A4subst rates,i
ncludingcycl
ospor i
ne,HMG- CoA
reductasei
nhibit
ors,somebenzodi azepines(al
prazol
am,
midazolam,tr
iazolam),calcium channel bl
ocker
s,
colchi
cine,
fentanyl,
tacroli
mus, andwar fari
n.

Pr
ecaut
ions
Av
oidcont
actwi
they
es,
pregnancyandl
act
ati
on.

Adv
erseEf
fect
s
Locali
rr
it
ati
on,bur
ningsensat
ionandit
ching,
abnor
mal
l
iverf
uncti
on,unpl
easantmouthsensat
ion.

PATI
ENTTEACHI
NG
Inst
ructpati
entt
otakecl
otr
imazol
easdi
rect
ed.Al
l
ow
eachtrochetosl
owlydi
ssol
veinmout
h.

St
orage

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 911
Stor
eprotect
edf
rom l
i
ghtandmoi
stur
e.Donotcr
ush
pessar
ies.

Cl
oxaci
l
li
n
I
NDI
CATI
ONS
Tr
eatmentofthef
oll
owinginf
ecti
onsduet openi
cill
i
nase-
pr
oduci
ngstaphyl
ococci
:Respi
rat
orytracti
nfect
ions,
Si
nusi
ti
s,Ski
nandskinstr
ucturei
nfect
ions.

ACTI
ON
Bindtobact eri
al cell
wal l
,l
eadingtocel l
deat h.Not
i
nact i
vat
edbypeni ci
ll
inaseenzymes.Ther apeuticEffect
s:
Bacteri
cidalaction.Spect r
um: Acti
v eagainstmostgr am-
positi
veaerobiccocci .Spectrum isnotableforactivi
ty
against:
Peni ci
ll
inase-producingstrainsofStaphy l
ococcus
aureus,Staphylococcusepi dermidis.Notactiveagainst
met hi
cil
l
in-r
esistantbact eri
a.

Av
ail
abi
l
ity
CAPSULES250and500mg;
INJECTI
ON250and500
mg/vi
al;
DRySyRUP125mg/5ml.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 912
Or
al
Adult
-250-500mgev er
y6hatleast30mi n.bef
orefood.
Osteomyeli
ti
s;upto8gdailyi
n2to3di v
ideddoses.
Surgi
calprophyl
axis;
1t o2gati
nducti
ont her
eaft
erupto4
fur
therdoseseachof500mgmaybegi venevery6h.

Sl
owi
ntr
avenousi
nject
ionori
nfusi
on.
Adul
t-Sur
gical
prophy
laxi
s;1to2gati
nduct
iont
her
eaft
er
upto4furt
herdoseseachof500mgmaybegi v
enever
y6
h.
Chil
d-Hi
ghr
iskpr
ocedur
es;Under2year
s;quar
teradul
t
dose.2t
o10year
s;hal
fadul
tdose.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
tyt
openi
cil
l
ins(
seenot
esabov
e).

I
NTERACTI
ONS
Drug-Drug:Cloxaci
ll
inmay↓ ef fectiv
enessofor al
contracepti
veagent s.Probenecid↓ r enalexcretionand↑
bloodlevelsofcloxacil
li
n( t
herapymaybecombi nedfor
thispurpose).Neomy cinmay↓ absor pt
ionofcloxacill
i
n.
Concur r
entusewi thmet hotr
exate↓ met hotrexate
eli
minationand↑ r iskofserioust oxi
city.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 913
Pr
ecaut
ions
Hi
stor
yofal
ler
gy(seenotesabove)
;renalandhepat
ic
i
mpair
mentheartf
ail
ure;
lact
ati
onpregnancy.

Adv
erseEf
fect
s
Nauseaandv omi t
ing,diar
rhoea; hypersensiti
vityreacti
ons
i
ncludi ngur ticaria,fever,j
ointpai n,rashes,angi oedema,
anaphy l
axis, serum sickness- li
ker eactions,haemol yti
c
anaemi a,interstiti
alnephriti
s( seeal sonot esabov e);
neut r
openi a, thr
ombocy t
openi a,coagul ati
ondi sorders;
antibioticassoci atedcol i
ti
s; hepat i
ti
sandchol estati
c
j
aundi ce- maybedel ayedinonset ;electrol
ytedi st
urbances;
pain,inflammat ion, phlebi
ti
sort hrombophl ebitisat
i
njectionsi tes.

PATI
ENTTEACHI
NG
Inst
ructpatienttotakemedicati
onar oundt heclock
andt ofi
nishthedr ugcompletel
yasdi rected,ev
enif
feel
ingbetter.Misseddosesshoul dbet akenassoon
asremember ed.Advisepati
entthatshar i
ngofthis
medi cat
ionmaybedanger ous.

Advisepati
entt
orepor
tsignsofsuperi
nfect
ion(
black,
fur
ryovergr
owthonthetongue;v
aginali
tchi
ngor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 914
 di
schar
ge;
looseorf
oul
-smel
l
ingst
ool
s)andal
l
ergy
.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Inst
ructpat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
if
symptomsdonoti mpr
ove.

St
orage
Storepr
otect
edfr
om moi
stur
eatat
emper
atur
enot
exceedi
ng30⁰C.

CLOZAPI
NE
I
NDI
CATI
ONS
Schi
zophreni
aunr esponsivetoori
ntolerantofstandar
d
ther
apywithotherantipsychot
ics(
treatmentrefract
ory)
.
Toreducerecurr
entsui ci
dalbehav
iorinschizophreni
c
pati
ent
s.

ACTI
ON
Bindstodopaminer
ecept
orsintheCNS.Al
sohas
anti
choli
ner
gicandal
pha-
adrenergi
cbl
ocki
ngact
ivi
ty.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 915
Producesf ewerextrapyr
amidalreacti
onsandl esstardi
ve
dyskinesi
at hanstandardant
ipsychoti
csbutcar ri
eshigh
ri
skofhemat ol
ogicabnormali
ties.TherapeuticEffects:
Diminishedschizophreni
cbehav i
or.Diminishedsui ci
dal
behav i
or.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Bonemar
row
depressi
on;Sev
er eCNSdepr
essi
on/coma;
Uncontr
olled
epi
lepsy;Gr
anulocyt
openi
a;
Lact
ati
on:Di
scont
inuedrugor
bott
le-f
eed.

UseCaut
iousl
yin:
LongQTsy
ndr
ome;
Riskf
act
orsf
orQT
i
nt erval prolongat ionorv ent ricul
arar r
hythmi as( i.
er ecent
my ocar dial infarcti
on,hear tf ail
ure,
arrhythmi as);Concur r
entuseofCYP1A2, CYP2D6, or
CYP3A4i nhi bitorsorQT- inter valprol
onging
drugs;Hy pokal emi aorhy pomagenesemi a; Pr
ost atic
enlargement ;Angle-cl
osur egl aucoma; Mal nour i
shed
pat i
ent sorpat i
entswithcar diovascular,hepat i
c, orrenal
disease( usel owerinit
ialdose, t
it
ratemor esl owl y)
;Risk
factorsf orst roke( ↑riskofst r
okei npatientswi th
dement ia);Diabet es;
Seizur edi sorder;
OB: Neonat esat↑
ri
skf orext rapy ramidalsympt omsandwi thdrawal after
deliverywhenexposeddur ingt he3r dtri
mest er;useonl yi
f
benef itout wei ghsr i
skt of etus;Pedi:Chil
dr en<16y r

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 916
(saf
etynotestabl
ished)
;Ger
i:↑riskofmort
ali
tyi
nel
der
ly
pati
entstr
eatedfordementi
a-rel
atedpsy
chosi
s.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, SEIZURES,
dizzi
ness,sedation.EENT: v
isualdi st
urbances.CV:
CARDI ACARREST, MYOCARDI TI
S, TORSADEDEPOI NTES,
VENTRI CULARARRHYTHMI AS,hypot ensi
on,tachycar
dia,
ECGchanges, hypertensi
on, QTint ervalprol
ongati
on.GI:
consti
pation,abdomi naldiscomf ort,drymout h,↑
sali
vati
on, nausea,vomi t
ing,weightgai n.Derm: r
ash,
sweating.Endo: hypergly
cemi a.Hemat :
AGRANULOCYTOSI S,LEUKOPENI A.Neur o:extr
apyramidal
react
ions.Mi sc:fever.

I
NTERACTI
ONS
Drug-Dr ug: ↑ ant icholi
ner giceffect swi t
hot heragents
havingant icholinergicpr operti
es, includingant i
hist
amines,
quinidine, disopy ramide, andant idepr essants.Concur r
ent
usewi thSSRIant i
depressant s( especi al
lyf l
uvoxamine),
carbamazepi ne, f
lecainide,propaf enone, qui
nidine,
ci
met idine,ciprofloxacin, ander ythromy cin↑ bl oodlevel
s
andr iskoft oxicit
y .↑ CNSdepr essionwi thalcohol
,
antidepr essant s,antihistamines, opi oidanalgesics,or
sedat i
v e/hy pnotics.↑ hy potensionwi t
hni tr
ates,acute

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 917
i
ngest i
onofalcohol, oranti
hyper t
ensives.↑ r
iskofbone
mar rowsuppr essionwi thantihypert
ensivesorradi
ati
on
therapy .Usewithlit
hi um ↑ ri
skofadv erseCNSr eact
ions,
i
ncludi ngseizures.Pheny t
oin,nicoti
ne,andrif
ampinmay
↓l ev elsandleadt o↓ ef f
icacy.↑ riskofQTi nt
erval
prolongat i
onwithot heragentscausi ngQTi nt
erval
prolongat i
on.
Drug-Natur
alPr
oduct
: Caf
fei
ne-cont
ainingherbs(col
anut
,
tea,cof
fee)may↑ serum l
evel
sandsi deeffect
s.St.
John’swortmay↓ bloodlevel
sandef fi
cacy.

DOSAGE
PO:(Adults):
25mg1–2t i
mesdailyinit
iall
y;↑ by25–50
mg/dayov eraper i
odof2wkupt otargetdoseof
300–450mg/ day.May↑ byupt o100mg/ dayonceor
twi
cef ur
ther(nottoexceed900mg/ day ).Treat
ment
shouldbecont i
nuedforatleast2yrinpat i
entswit
h
sui
cidalbehavior
.

AVAI
LABI
LITY
Tabl
ets25mg,100mg;
Oral
l
y-di
sint
egr
ati
ngt
abl
ets(
mint
)
25mg, 100mg;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 918
I
nstructpati
enttotakemedicat
ionasdi
rected.
Pat
ientsonlong-ter
mt her
apymayneedt o
di
scontinuegradual
lyover1–2wk.

Expl
ainpur
poseandpr
ocedur
esforCl
ozar
ilPat
ient
ManagementSyst
em t
opati
ent.

Inf
orm pati
entofpossi
bil
it
yofext
rapyr
amidal
symptoms.Instr
uctpat
ienttor
eportt
hesesympt
oms
i
mmedi atel
y.

Infor
m pat
ientt hatci
garet
tesmokingcandecrease
clozapi
nel
ev els.Riskf
orrelapsei
ncr
easesifpati
ent
beginsori
ncr easessmoking.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

Maycausesei
zuresanddr owsiness.Cauti
onpati
ent
t
oavoiddri
vi
ngorot heracti
vi
ti
esr equi
ri
ngaler
tness
whi
let
akingcl
ozapine.

Instr
uctpatienttonot i
fyheal
thcarepr ofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orher bal
productsbeingt akenandt oconsulthealthcar e
professi
onal beforetaki
nganyot herRx,OTC, or
herbalproducts.Caut i
onpati
enttoav oidconcur rent
useofalcohol andot herCNSdepr essants.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 919
 I
nstr
uctpati
enttousef
requentmouthrinses,
good
or
alhygi
ene,andsugar
lessgum orcandytomi ni
mize
dr
ymout h.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Inst
ructpatientt
onot i
fyhealthcareprofessional
promptlyifunexplai
nedf at
igue,dy
spnea, tachypnea,
chestpain,palpi
tati
ons,sorethr
oat,fever,l
ethargy,
weakness, malai
se,orflu-l
i
kesy mptomsoccur .

Advi
sefemalepati
entstonoti
fyhealt
hcar e
pr
ofessi
onali
fpregnancyispl
annedorsuspect
ed,
or
i
fbreast
-f
eedi
ngorpl anni
ngtobreast-
feed.

Adv
isepati
entofneedforconti
nuedmedi
calfol
low-
upforpsy
chother
apy,eyeexams,andl
abor
atorytest
s.

Coal
tar
I
ndi
cat
ions
Chroni
cpsor
iasi
s,ei
theral
oneorincombi
nat
ionwi
th
exposur
etoult
ravi
oletl
i
ght;eczema.

Av
ail
abi
l
ity
CREAM 20g(
1-6%w/
w);
LOTI
ON50ml
(1-6%w/
v).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 920
DOSAGE
Psor
iasi
s:apply1to4ti
mesdai
l
y,pr
efer
abl
yst
art
ingwi
th
l
owerstrengt
hprepar
ati
on.
Coaltarbath;use100mlinbathoftepi
dwaterandsoak
for10to20mi n;
useoncedail
ytoonceevery3daysforat
l
east10bat hs;oft
enal
ter
natedwit
hul t
rav
iol
et(UV)r
ays,
all
owingatleast24hbetweenexposureandtreat
ment
withcoaltar.

Cont
rai
ndi
cat
ions
I
nfl
amed,
brokenori
nfect
edski
n.

Pr
ecaut
ions
Skinprotect
ionpossi
blyrequi
redtoreduce
photosensit
ivi
tyr
eact
ions;avoidcont
actwithey
es;
pregnancy.

Adv
erseEf
fect
s
Ir
ri
tati
on;phot
osensit
ivi
tyreact
ions;
rarel
y,hy
per
sensi
ti
vi
ty,
skin;
hairandfabr
icsdiscol
oured;st
ingi
ng.

CODEI
NE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 921
I
ndi
cat
ions
Mil
dtomoder atepain;
diar
rhoea;
coughsuppr
essant
;
i
rr
it
ablebowel syndr
ome.Antit
ussi
v e(i
nsmal
l
erdoses)
.
Unl
abeledUses:Managementofdi arr
hea.

ACTI
ON
Bindstoopiatereceptor
sint heCNS.Al t
ersthepercepti
on
ofandr esponsetopainfulstimul
i whi
l
epr oduci
ng
general
izedCNSdepr ession.Decreasescoughr efl
ex.
DecreasesGImot il
it
y.Ther apeut
icEff
ects:Decreased
severi
tyofpain.Suppressionofthecoughr efl
ex.Reli
efof
diar
rhea.

Av
ail
abi
l
ity
TABLET10mg;
SyRUP15mg/
5ml
.

DOSAGE
Or
al
Adul
t-30t
o60mgev
ery4h.(
max.240mg/day
).
Chi
l
d-1y
eart
o12y
ear
:3mg/
kgdai
l
yindi
vi
deddoses.

Cont
rai
ndi
cat
ions
Respi
rat
orydepr
essi
on;
obst
ruct
iveai
rway
sdi
sease;
acut
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 922
asthmaat t
ack;
wherer
iskofpar
aly
tici
l
eus;
hypersensi
ti
vi
ty;
headi
njur
y;i
ncr
easedint
racr
ani
al
pressure.

I
NTERACTI
ONS
Drug- Dr ug:Usewi t
hext remecaut ioni npat i
entsr ecei
v i
ng
MAOi nhi bit
ors( ↓initi
aldoset o25%ofusual dose).
Addi ti
v eCNSdepr essionwi t
halcohol ,ant i
depressant s,
antihistami nes,andsedat i
ve/hypnot ics.Admi nistrati
onof
partial antagonist
s( buprenorphine,but orphanol,
nalbuphi ne,orpentazocine)maypr ecipit
ateopi oid
withdr awal inphysicall
ydependentpat i
ents.Nal buphine
orpent azocinemay↓ anal gesia.
Drug-Natur
alProduct:
Concomitantuseofkav
a-kav
a,
val
erian,
skull
cap,chamomile,
orhopscan↑ CNS
depressi
on.

Pr
ecaut
ions
Hepatici
mpairmentandrenalimpai
rment
;opi
oids
dependence;l
act
ati
on;pregnancyi
nter
act
ions
hypothyr
oidi
sm;shock.

Adv
erseEf
fect
s
Const
ipat
ionpar
ti
cul
arl
ytr
oubl
esomei
nlong-
ter
m use,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 923
dizziness, nausea, vomiti
ng;difficultywithmi ct
ur i
ti
on;
uretericorbi l
iaryspasm; drymout h;headaches; sweating;
facialflushing;intherapeuticdoses, codeineismuchl ess
l
iablet hanmor phinet oproducet oler
ance, dependence,
euphor ia,sedationorot heradv erseef fects;ort
host at
ic
hypot ension;respiratorydepressi on;rhabdomy olysis;
conv ulsions(especi al
lyinchil
dr en) .

PATI
ENTTEACHI
NG
I
nstr
uctpat
ientonhowandwhent
oaskf
orandt
ake
pai
nmedicati
on.

Maycausedr owsinessordizzi
ness.Adv i
sepatientt
o
cal
lforassi
stancewhenambul at
ingorsmoki ng.
Cauti
onambul ator
ypatienttoavoiddriv
ingorother
act
ivi
ti
esrequiri
ngalert
nessunt i
lresponseto
medicati
onisknown.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

Caut
ionpat
ienttoav oi
dconcur
rentuseofalcohol
or
ot
herCNSdepr essantswi
ththi
smedi cat
ion.

Encour
agepat
ienttoturn,cough,
andbr
eat
hedeepl
y
ever
y2hrtopreventatel
ectasi
s.

Adv
isepat
ientt
hatgoodor
alhy
giene,
frequentmout
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 924
 r
inses,
andsugar
lessgum orcandymaydecr
easedr
y
mouth.

Col
chi
cine
I
NDI
CATI
ONS
Pr
ophylaxi
sandtreatmentofacut eat
tacksofgout
y
ar
thr
it
is.Fami
li
alMedi t
erraneanfever
.Unlabel
edUses:
Tr
eatmentofhepaticci
rrhosis.

ACTI
ON
Int
er f
ereswiththefuncti
onsofWBCsi ninit
iat
ingand
perpetuati
ngtheinflammat oryresponset omonosodium
uratecryst
als.Therapeut
icEf f
ects:Decreasedpainand
i
nflammat ioninacuteattacksofgout .Reducednumberof
attacksofgoutandf ami
l
ial Mediter
raneanf ev
er.

Av
ail
abi
l
ity
TABLET0.
5mg.

DOSAGE
Or
al
Acut
egout
:1-
2tabl
ets(
0.5mgeach)canbegi
venev
ery6-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 925
8hoursoverseveral
dayswit
hsubsequenttaperi
ng.The
dr
ugmustbest oppedpromptl
yatthefi
rstsignofloose
st
oolsandsympt omati
ctr
eatmentmustbegi venfor
di
arr
hoea.
Pr
ophy
laxi
s:0.
5mgonceort
wicedai
l
y.

Cont
rai
ndi
cat
ions
Pr
egnancy
.

Pr
ecaut
ions
El
derl
y;gast
roi
ntest
inaldi
sease;car
diacimpairment
;
hepat
icimpai
rment;renal
impair
ment ;l
actat
ion.

Adv
erseEf
fect
s
Nausea; vomiti
ng;abdominalpai
n;excessi vedosesmay
causesev erediar
rhoea;gast
roi
ntestinalhaemor r
hage;
rash;renalandhepaticdamage;rarely,peri
pheralneur
iti
s;
my opathy;al
opecia;i
nhibi
ti
onofsper mat ogenesi
swi t
h
prolongedtreat
ment ;bl
ooddisor
der s.

I
NTERACTI
ONS
Drug-Drug:Concurr
entuseofst r
ongCYP3A4i nhibi
tor
s,
i
ncludingatazanavi
r,cl
ari
thromycin,darunav
ir/
rit
onavi
r,
i
ndinavir,
itr
aconazol
e,ketoconazole,l
opinavi
r/r
it
onavir
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 926
nefazodone, nelfi
navir,r
itonav ir,saqui nav i
r,telithromy cin,
ortipranav ir/rit
onav i
r,may↑ l ev elsandr i
skoft oxicity;↓
colchicinedosei npat i
entswi thnor mal renal orhepat ic
funct i
on; concur rentusei npat ient swithr enal orhepat i
c
i
mpai rmenti scont r
aindicat ed.Concur r
entuseofP-
glycopr oteini nhi
bitors,includi ngcy cl
ospor i
neor
ranolazinemay↑ l evelsandr iskoft oxicity
; ↓ col chicine
dosei npat ientswithnor mal renal orhepat icf unct i
on;
concur rentusei npat i
ent swi t hr enal orhepat i
c
i
mpai rmenti scont r
aindicat ed.Moder ateCYP3A4
i
nhi bit
or s,includingapr epitant , dilti
azem, erythromy cin,
fl
uconazol e, fosampr enav ir
, orv erapami l may↑ l evels
andr iskoft oxicit
y;↓ col chici nedose.Addi t
ivebone
mar rowdepr essionmayoccurwi t
hbonemar row
depr essant sorr adiationt her apy .↑ r iskof
rhabdomy olysiswithHMG- CoAr educt asei nhi bitors,
gemf i
brozi l
, f
enof i
brate,ordi goxi n.Addi tiveadv erseGI
effectswi thNSAI Ds.Maycauser eversi
bl emal absor pti
on
ofv it
ami nB12.
Drug-
Food: Gr
apef
ruitj
uicemay↑ l
evel
sandr
iskof
toxi
cit
y;↓ col
chi
cinedose.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 927
COLESEVELAM
I
NDI
CATI
ONS
Adjunctivetherapytodi etandexer cisef orthereducti
onof
LDLchol esterolinpati
ent swithprimar y
hypercholesterol
emi a;maybeusedal oneori n
combi nati
onwi thstati
ns.Adj uncti
vet her apytodietand
exerci
sef orther educti
onofLDLchol est er
olinchil
dren
10–17y r
swi thheterozygousf amilial
hypercholesterol
emi aifdi ettherapyf ails(LDLcholesterol
remains≥190mg/ dLorr emai ns≥160mg/ dL[withfamily
hist
oryofpr emat urecar diovasculardi seaseor≥2r isk
factor
sf orcardiovasculardi sease]);maybeusedal oneor
i
ncombi nati
onwi t
hstatin.Adj unctivet herapytodietand
exerci
set oimpr oveglycemi ccontrol inpat i
entswithtype
2diabetes.

ACTI
ON
Bindsbi l
eacidsi
ntheGItract
.Resultinincreased
cl
ear anceofchol
ester
ol.Mechani
sm f orloweringbl
ood
glucoseunknown.Therapeuti
cEffects:Decreased
cholesterol
andbloodglucose

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 928
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Bowel
obst
ruct
ion;
Tr
igl
yceri
des>500mg/dL;
Hist
oryofpancr
eat
it
isduet
o
hy
pertr
igl
ycer
idemi
a.

UseCaut
iousl
yin:
Tri
gly
cer
ides>300mg/
dL;
Dysphagi
a,
swall
owingdisorders,sev
er eGImoti
li
tydi
sor
ders,or
majorGItractsurgery
;OB: Lact
ati
on:Pedi
:Pr
egnancy,
l
actat
ion,orchil
dren<10y r(saf
etynotest
abl
ished)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI
:const
ipat
ion,
dyspepsi
a.

I
NTERACTI
ONS
Drug-
Dr ug:May↓ absorpti
onofglyburide, lev
othyroxi
ne,
phenytoin,
cy cl
ospori
ne,
estr
ogen-containingor al
contr
aceptives(giv
e≥4hrbeforecolesev elam).

DOSAGE
Hy
per
li
pidemi
a
PO:
(Adul
ts)
:3t
abl
etst
wicedai
l
yor6t
abl
etsoncedai
l
y.
PO:(Adul
tsandChi
ldr
en10–17yr)
:Suspensi
on—one
3.
75–gpacketoncedail
yorone1.
875–gpacket
stwice
dai
ly
.

Ty
pe2Di
abet
es

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 929
PO:(Adul
ts):
3tabletst
wicedai
lyor6tabl
etsoncedai
l
y;
Suspensi
on—one3.75–gpacketoncedail
yorone
1.
875–gpacketstwicedai
ly
.

AVAI
LABI
LITY
Tablet
s625mg;Granul
esforor
alsuspensi
on1.
875
g/packet
,3.
75g/
packet;

PATI
ENTTEACHI
NG
Inst
ructpat
ientt
otakemedi
cationasdir
ect
ed;
donot
skipdosesordoubl
euponmi sseddoses.

Instr
uctpati
entt onot i
fyhealthcarepr ofessionalof
allRxorOTCmedi cati
ons,vit
ami ns,orher bal
productsbeingt akenandconsul thealthcar e
professi
onal beforetaki
ngot herRx,OTC, orherbal
products.Adv i
sepat i
entstakingoral v
itami n
supplementat i
onoror alcontracepti
vest ot akethei
r
vit
ami nsatleast4hour spriortocolesev elam.

Inst
ructpatienttoconsumeadi etthatpr
omot es
bowel r
egularit
y.Patientsshoul
dbei nstr
uctedto
promptlydiscontinuecolesevel
am andnot i
fyheal
th
careprofessionalifsevereabdominalpainorsever
e
consti
pationorsy mpt omsofacut epancreati
ti
s
(sever
eabdomi nalpainwithorwithoutnauseaand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 930
 v
omi
ti
ng)occur
.

Hy percholest
erol
emia:Advi
sepat i
entt
hatthis
medi cati
onshoul dbeusedinconjunct
ionwithdi
et
restri
cti
ons( f
at,chol
est
erol
,carbohydr
ates,al
cohol
),
exercise,andcessati
onofsmoki ng.

Diabetes:
Explaintopat
ientt
hatt
hismedi
cati
on
control
shy per
glycemi
abutdoesnotcur
ediabet
es.
Therapyislongterm.

Revi
ewsi gnsofhy pogl
ycemiaandhy perglycemia
wit
hpat i
ent.I
fhypoglycemiaoccurs,advisepati
entto
dri
nkagl assoforangejuiceoringest2–3t spof
sugar,honey,
orcor nsyrupdissol
vedinwat eroran
appropri
atenumberofgl ucosetablet
sandnot if
y
heal
thcar epr
ofessional
.

Encouragepatientt
ofol
lowpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.

Inst
ructpati
enti
npropertesti
ngofser um gl
ucose
andketones.Thesetestsshouldbeclosel
ymoni t
ored
duri
ngper i
odsofstr
essorill
nessandheal thcar
e
prof
essionalnot
if
iedifsi
gnif
icantchangesoccur.

I
nsul
ini
stherecommendedmethodofcont
rol
li
ng
bl
oodsugardur
ingpr
egnancy
.Counsel
female

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 931
 pati
entstouseaf or
m ofcontr
acepti
onot hert
han
oralcontr
acept
ivesandtonoti
fyhealt
hcar e
prof
essionalpr
omptlyi
fpregnancyisplannedor
suspected.

Advisepatienttocarr
yaform ofsugar(sugarpacket
s,
candy)andi denti
fi
cati
ondescri
bingdi
seaseprocess
andmedi cationregi
menatallti
mes.

Col
est
ipol
I
NDI
CATI
ONS
Managementofpr i
mar yhyperchol
ester
olemia.Pruri
tus
associ
atedwithel
evatedlevel
sofbileacids.Unlabel
ed
Uses:Di
arrheaassoci
atedwi t
hexcessbileacids.

ACTI
ON
Bindsbil
eacidsintheGIt r
act,
formingani
nsoluble
complex.Resul
tisincreasedclear
anceofcholest
erol
.
Therapeut
icEffect
s:Decreasedplasmacholester
oland
LDL.Decreasedpruri
tus.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Compl
etebi
l
iar
y
obst
ruct
ion;
Somepr
oduct
scont
ainaspar
tameand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 932
shoul
dbeav
oidedi
npat
ient
swi
thpheny
lket
onur
ia.

UseCaut
iousl
yin:
Hist
oryofconst
ipat
ion.

Exerci
seExt r
emeCaut i
onin:Pedi:
Maycausepot
ent
ial
l
y
fat
al i
ntest
inalobst
ruct
ioninchi
ldren.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:irr
it
ationoft hetongue.GI: abdominaldiscomfort
,
const
ipati
on, nausea,fecali
mpact i
on,fl
atul
ence,
hemorrhoids,perianali
rri
tat
ion,steatorr
hea,vomiti
ng.
Derm:ir
rit
ation,rashes.FandE: hyperchl
oremicacidosi
s.
Metab:vit
ami nA, D,andKdef ici
ency .

I
NTERACTI
ONS
Drug- Dr ug: Maydecr easeabsor pti
on/effectsofor al
ly
admi nisteredacet ami nophen, amiodarone, cl
indamy ci
n,
clofibrat e,digoxin, diuretics,gemf i
brozil
,gli
pizide,
cor t
icost eroids,imi prami ne, my cophenolate,met hot
rexat
e,
met hy ldopa, niacin, NSAI Ds, penici
lli
n,pheny t
oin,
phosphat es,propr anol ol,tet
racy cl
i
nes, t
olbutami de,
thy r
oi dpr eparations, ur sodiol,warfari
n,andf at-
soluble
vitami ns( A, D,E, andK) .Maydecr easeabsor ptionofother
orallyadmi nisteredmedi cations.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 933
PO:(Adul
ts):Gr
anul
es—5g1–2t i
mesdaily
,maybe
i
ncreasedq1–2moupt o30g/dayin1–2doses.
Tablet
s—2g1–2t i
mesdail
y,maybeincr
easedq1–2mo
upto16g/ dayi
n1–2doses.

AVAI
LABI
LITY
Granulesf
orsuspension(unfl
avored)5g/packetorscoop;
Fl
avoredgranulesforsuspensionwithaspar
tame(orange
fl
avor)5g/packetorscoop;Tablets1g;

PATI
ENTTEACHI
NG
I
nstr
uctpat
ientt
otakemedicat
ionexactl
yasdirect
ed;
donotski
pdosesordoubl
euponmi sseddoses.

Instr
uctpat i
enttotakemedi cati
onbef oremeal s.
Colesti
pol canbemi xedwi thwat er,j
uice, or
carbonatedbev er
ages.Sl owl ysti
rinal argeglass.
Rinseglasswi t
hsmal lamountofaddi tional bev er
age
toensureal lmedicat i
onist aken.Mayal somi xwi th
highl
yf l
uidsoups, cereals,orpul pyfr
uits( applesauce,
crushedpineapple).Al l
owpowdert ositonf l
uidand
hydratefor1–2mi nbef oremi xi
ng.Donott akedr y.

Adv i
sepatientthatthi
smedicationshoul
dbeusedin
conjuncti
onwi t
hdi etr
estr
ict
ions(fat
,chol
est
erol
,
carbohydrates,
alcohol)
,exer
cise,andcessat
ionof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 934
 smoki
ng.

Explainthatconstipati
onmayoccur .I
ncreaseinflui
ds
andbul kindiet,
exer ci
se,st
oolsofteners,and
l
axat i
vesmayber equiredtominimizethe
constipati
ngeffects.Inst
ructpati
enttonot i
fyhealth
carepr of
essionalifconsti
pati
on,nausea, fl
atul
ence,
andhear tburnpersistori
fstoolsbecomef r
othyand
foulsmel l
ing.

Advisepatienttonoti
fyhealt
hcar epr of
essionali
f
unusualbleedingorbrui
sing;petechiae;orblack,
tar
ry
stoolsoccur.Treat
mentwi t
hv i
tami nKmaybe
necessary.

COLFOSCERI
LPALMI
TATE
I
NDI
CATI
ONS
Tr
eatmentandprophyl
axi
sofr
espir
atorydist
ress
sy
ndrome(RDS,hyali
nemembranedisease)i
npremat
ure
i
nfant
s.

ACTI
ON
Repl
acesendogenouspulmonarysurf
actanti
npremature
i
nfant
s,al
lowingnormalsurf
aceacti
vit
yinalv
eoli
.Cety
l
al
coholi
nf or
mulati
onspreadscol
fosceri
lonair
-f
lui
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 935
sur
face,whereastyl
oxapol
,asurfact
ant,di
sperses
col
fosceril
andcetylal
cohol
.Therapeut
icEffects:
Decreasedinci
dence,mort
ali
ty,
andcompl i
cationsfr
om
RDSi nprematur
einfant
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Noknowncont
rai
ndi
cat
ions.

UseCaut
iousl
yin:
Noknowncaut
ions.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Resp:apnea,
pulmonaryhemor r
hage.CV:brady
cardia,
hypot
ension,
vasoconstr
ict
ion.Misc:
incr
easedriskof
sepsi
saftert
reat
ment.

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

DOSAGE
Endotr
acheal(I
nfants,Premature):
Pr ophyl
acti
c
tr
eatment—5mL/ kggi venas2half-dosesof2.5mL/ kgas
soonaspossibleafterbir
th;r
epeat12and24hrl aterif
sti
ll
mechanicall
yventil
ated.Rescuetreatment—5mL/ kg
gi
venas2hal f
-dosesof2. 5mL/ kgassoonasdi agnosis
ofRDSismade; givea2nddose12hrl at
erifst
il
l

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 936
mechani
cal
l
yvent
il
ated.

AVAI
LABI
LITY
Powderforendotr
achealadmini
str
ati
on(
requi
res
reconst
it
uti
on)108mg/ v
ial;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofmedi
cat
iont
opar
ent
s.

Col
l
agenasecl
ost
ri
dium hi
stol
yti
cum
I
NDI
CATI
ONS
Tr
eat
mentofDupuy
tren’
scont
ract
urewi
thapal
pabl
ecor
d
i
nadul
ts.

ACTI
ON
Lysisofcoll
agendeposit
spresenti
nDupuyt
ren’
scord.
Therapeuti
cEffect
s:Enzymati
cdisr
upt
ionofDupuy
tren’
s
cord.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Noneknown.

UseCaut
iousl
yin:
Abnor
mal
coagul
ati
on,
incl
udi
ng
concur
rentant
icoagul
ant
sot
hert
hanl
ow-
doseaspi
ri
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 937
wit
hin7daysoftreatment.OB:Useonlyi
fcl
earl
yneeded;
Lact
ati
on:Usecautiousl
y;Pedi
:Safet
yandeff
ecti
veness
notest
abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV: vasov agal syncope.MS: li
gamenti njury,complex
regi
onal painsy ndr ome( CRPS),sensor yabnor mali
tyof
hand, tendonr upt ure.Local:contusion,hemor rhage,
i
njectionsi t
er eact ion,pain,
pruri
tus, swell
ing.Misc:
all
ergicr eacti
onsi ncludi
nganaphy laxis,axil
larypai
n,
l
y mphadenopat hy.

I
NTERACTI
ONS
Drug-Dr
ug:Concur
rentuseofant
icoagul
ant
smay↑ r
isk
oflocal
bleedi
ng.

DOSAGE
Int
ral
esi
onal(Adul
ts):0.
58mgintoapalpabl
ecordwitha
contr
act
ureofamet acar
pophal
angeal
(MP)jointora
proxi
malint
erphal
angeal(PI
P)j
oint
.

AVAI
LABI
LITY
Ly
ophy
li
zedpowderfori
nject
ion(r
equi
resr
econst
it
uti
on)
0.
9mg/vi
al(
del
iver
s0.58mg/ dose)
;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 938
PATI
ENTTEACHI
NG
I
nstructpati
enttor
eturntoheal
thcarepr
ofessi
onal
’s
off
icethenextdayforanexaminati
onoftheinj
ect
ed
handandf orpossi
blef
ingerext
ensi
onproceduret
o
di
sruptthecord.

I
nst
ructpat
ientnottof
lexf
inger
sofinj
ectedhandto
r
educeextr
avasati
onofmedicat
ionoutofthecor
d.

Adv
isepati
entnott
odi
srupti
nject
edcor
dby
manipul
ati
on.

I
nstr
uctpati
entt
oel
evat
ehandasmuchaspossi
ble
unt
ilbedt
ime.

Advisepati
entthati
nject
ionisli
kelytoresul
tin
swelli
ng,br
uisi
ng,bl
eeding,and/orpainofthe
i
njectedsit
eandsurroundingti
ssue.

Advisepati
entt opromptl
ynotifyhealt
hcare
prof
essionalifsignsofi
nfecti
on(fever,chi
l
ls,
i
ncreasingrednessorswel l
i
ng),sensorychangesin
thetreat
edfinger,tr
oubl
ebendingt hefi
ngerafter
swelli
nggoesdownoccur .

Comf
rey

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 939
I
NDI
CATI
ON
Topical
:Appl
i
edtoperi
-woundareas,
ski
nul
cer
s,f
ract
ures,
brui
sesandsprai
nst
ost i
mulat
eheali
ng

ACTI
ON
Topical
:Comfrey’
st opicalheali
ngandant i
-infl
ammat or
y
act
ionscomef rom theal l
antoinandrosmar icacid
components.Somepy rrol
izi
dinealkal
oidshav eanti-
i
nfl
ammat oryactiv
ity.Comf reycontai
nshepat otoxi
cand
car
cinogenicpyrr
oli
zidinealkaloi
dsiftakenor al
ly.
Therapeut
icEff
ects: Decreasedinfl
ammat ion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Contrai
ndicatedin:Or aluse.Ascites,hepat ospl
enomegaly,
j
aundice,hepaticcirrhosisandnecr osisandDEATHcan
resul
tfrom veno-occlusivedisease.Or aluseofcomf r
ey
forasli
ttl
eas5- 7day sinachildand19- 45day sinadult
s
haveresultedinsev erehepaticdiseaseanddeat h;
Pregnancyandl actation;All
ergytocomf rey;Useon
brokenskin;Donotuset opi
calcomf reyf ormoret han4-6
wkpery earor>100mcg/ day(seedosi ng).
UseCaut
iousl
yin:
Liv
erdi
sease.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 940
Toxi
cit
iesassoci
atedwi
thor
aluse:
Misc:
Ext
endedtopi
caluseorhighconcent
rat
ionscan
l
eadtosyst
emicabsor
ptionandcausetoxi
cit
y.

I
NTERACTI
ONS
Natur
alPr
oduct-
Drug:Phenobar
bitalandot
herhepat
otoxi
c
agent
scan↑ theriskofhepat
otoxicit
y.
NaturalProduct-NaturalProduct :
Donotusewi thot her
pyrr
olizi
dinealkaloi
d-containingherbs, i
ncluding: alkanna,
borae,Crotolar
iaspp, gravelroot,Heli
otropium spp, hemp
agri
mony ,Heneciospp, hound’stongue, petasites, colt
’s
foot,
andSeneci ospeci espl ants:dustymiller
, alpine
ragwor t
,groundsel,
gol denragwor t,andtansyr agwor t.

ROUTEANDCOMMONLYUSEDDOSES
Topical:(
Adults):Applyasneededt oaffect
edarea.Do
notapplyonbr okenski n.Dail
y-
appli
eddosageof
pyrr
olizi
dinealkal
oidsshoul dnotexceed100mcg, but
productsaregener al
l
ynotl abeledwit
hthisinf
ormati
on.
Donotusef ormoret han4–6wkpery ear.

AVAI
LABI
LITY
Cr
eam OTC;
Oint
mentOTC;
PowderOTC;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 941
PATI
ENTTEACHI
NG
War npati
ent
sthatoralconsumpt
ionhasbeen
associat
edwithl
iverdamageandisnot
recommended.

Topical
:Useonanopenwoundisnotr
ecommended
becauseabsor
pti
onisi
ncr
easedwit
htheri
skofl
iv
er
toxi
cit
y.

Instructpatientt
hati
fsignsofr edness,tender
ness,
swel l
ing,painorwounddr ainagedev el
opto
discont i
ueuseoft hi
sherbal supplementandseek
attentionfrom ahealt
hcar eprovider.

Advisepat
ient
sthattr
aditi
onalwoundheali
ng
ther
apieshaveshowntobeef fecti
veandencourage
useofFDAappr ovedproduct
sf orwoundheali
ng.

Cauti
onpatientsthatuseoft
hisher
balsuppl
ement
shoul
dnotext endbeyond4-6wkatonetimeorfora
tot
alcumulati
v et
imeof4-6wkwi t
hint
hesame12
moper i
od.

Warnwomenofchildbear
ingagenott
ouset
his
agenti
fpr
egnantorbr
eastfeedi
ng.

Coni
vapt
an
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 942
I
NDI
CATI
ONS
Toincr
easeser
um sodi
um i
nhospital
i
zedpat
ient
swi
th
euv
olemicorhy
per
v ol
emichyponat
remia.

ACTI
ON
Antagonizesvasopr essinatV2receptorsi
tesi
nrenal
col
lecti
ngduct s,result
inginexcr
etionoffr
eewater.
TherapeuticEffects:I
ncreasedserum sodi
um
concentr
at i
ons.Impr ovedfl
uidstatus.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hypov
olemi
c
hyponat
remia;Concurr
entuseofket
onconazol
e,
i
tr
aconazole,cl
ari
thr
omy ci
n,r
it
onavi
rori
ndinav
ir.

UseCaut
iousl
yin:
Impai
redhepat
icorr
enal
funct
ion(
not
recommendedifCCr<30mL/ min)
;OB:Lactat
ion:
Saf
ety
notest
abl
ished;Pedi
:Saf
etynotestabl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,conf
usion,insomni a.CV:hyper
tensi
on,
hypotension.GI:
diar
rhea.GU: polyuri
a.FandE:
dehydrati
on,hypokal
emi a,
hy pomagnesemi a,
hyponatremia.Local
:inf
usionr eacti
ons.Misc:f
ever,
thi
rst
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 943
I
NTERACTI
ONS
Drug-Drug:Bloodlevel
sandef fectsare↑ byketoconazol
e,
i
traconazole,cl
arit
hromycin,r
itonavi
r,ori
ndi
navir;
concurrentuseiscontrai
ndicated.↑ bloodl
evel
sandmay
↑ effectsofmi dazol
am, si
mv astati
n,l
ovast
ati
n,
amlodipine,andotherdrugsmet aboli
zedbyCYP3A4;
carefulmonitori
ngrecommended.May↑ di goxinlevel
s.

DOSAGE
IV:(Adul
ts):
20mgl oadingdoseiniti
all
y,foll
owedby20
mg/ dayasacontinuousi nf
usi
on.Followi nit
ial
dayof
treatmentwi
thanaddi t
ional1–3day sinacont inuous
i
nf usi
onof20mg/ day.Mayt it
rat
econi vaptanupt o40
mg/ dayasacontinuousi nf
usi
oni fserum sodium isnot
ri
singatdesi
redrate.Totaldurat
ionoft herapyshouldnot
exceed4day s.

Renal
Impai
rment
(Adult
s) :
CCr30–60mL/ min-
10mgl oadingdosei ni
ti
all
y,
foll
owedby10mg/ dayasacontinuousinfusi
onf or2days;
mayt i
trat
eupt o20mg/ dayasacont i
nuousinfusionif
serum sodium i
snotri
singatdesir
edrate;tot
aldurati
on
oftherapyshouldnotexceed4days;CCr<30mL/ min-Not
recommended.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 944
Hepat
icI
mpai
rment
(Adul
ts):Moder atehepat
icimpai
rment-10mgl oadi
ng
doseinit
ial
ly
,foll
owedby10mg/ dayasacont i
nuous
i
nfusionfor2day s;maytit
rat
eupt o20mg/ dayasa
conti
nuousinfusionifser
um sodi
um isnotrisi
ngat
desir
edrate;tot
al dur
ati
onoftherapyshoul
dnotexceed4
days.

AVAI
LABI
LITY
Pr
emi
xedi
nfusi
on20mg/
100mLD5W;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofmedi
cat
iont
opat
ient
.

I
nstr
uctpati
entt
onotif
yheal
thcar
eprof
essi
onal
if
pai
norrednessoccur
satinf
usi
onsit
e.

CORTI
COTROPI
N
I
NDI
CATI
ONS
Acuteexacer
bat
ionsofmul
ti
plescl
erosi
s.I
nfant
il
e
spasms.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 945
Nor mallypr oducedbyt hepi tuitary,stimulatestheadr enal
glandt opr oducebot hcor t
icost eroids( hydrocorti
sone)
andmi neralocorti
coi ds( aldost erone) .Actionrequires
i
nt actadr enalresponsi veness.Act ionsr esemblet hoseof
cor t
icosteroidadmi nistrati
onandi ncludesuppr essionof
thenor mal i
mmuner esponseandi nflammat i
on.
Addi ti
onal numer ousi ntensemet aboliceffects.Potent
mi neralocorti
coid( sodi um r etention).Suppr essesadr enal
funct i
onwi thchroni cuse.Mechani sm ofant i
conv ulsant
actionisunknown.Ther apeut i
cEf f
ect s:Reductionin
frequencyofmul t
iplescl er
osi sexacer bati
ons.
Suppr essionofspasm.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
opor
kpr
otei
ns;
Seri
ousinfecti
ons;Scleroder ma;
Recentsurger
y;Hist
ory
orpresenceofpept i
cul cer;Hear
tfai
l
ure;Uncontr
oll
ed
hypert
ension;Pri
mar yadr enocor
ti
cali
nsuff
ici
ency;Useof
l
iveorliv
eat t
enuatedv accines.

UseCaut
iousl
yin:
Diabet
es;
Myast
heni
agr
avi
s;Chr
oni
c
tr
eatmentmayr esul
tinadr enalsuppr
essi
on;Donot
disconti
nueabruptly;
Usel owestpossibl
edosefor
shortestperi
odoft i
me; OB: Lact
ati
on:Saf
etynot
establi
shed;Pedi:Chroni
cusemayl eadtogrowt
h
suppression.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 946
ADVERSEREACTI
ONSANDSI
DEEFFECTS
(
wit
hchr
oni
cuse)
CNS: depr essi on,euphor ia,psy choses.EENT: cataracts,↑
i
nt r
aocul arpr essur e.CV: HF, THROMBOEMBOLI SM,
edema, hy per tension.GI :nausea, ↑ appetite,pept ic
ulceration, vomi ting, wei
ghtgai n.Derm: ↓ woundheal i
ng,
petechi ae, acne, ecchy moses, fragil
it
y,hirsutism.Endo:
ADRENALSUPPRESSI ON, ↓ gr owt hinchildren,
hypergly cemi a,menst r
ual i
rregul ar
iti
es.FandE:
hypokal emi a,sodi um retention, hypocalcemi a, met aboli
c
alkal
osi s.Local :atrophyatI M si tes(repositorydosage
forms) .MS: avascul arnecrosi sofj oi
nts,my opathy ,
osteopor osis, weakness.Mi sc: cushingoidappear ance
(moonf ace, buffalohump) ,↑ suscept i
bil
ityt oinfect i
ons,
pancr eatitis.

I
NTERACTI
ONS
Drug-Drug:Concurrentuseofl ivevacci
nesorl i
v e
att
enuat edvacci
nesi scontraindicat
ed.Additi
ve
hypokalemiawi t
hamphot eri
cinB, pi
peraci
ll
in,t
icar ci
l
li
n,or
potassi
um- l
osingdiureti
cs.Hy pokalemiamay↑ t heri
sk
ofdigoxintoxi
city
.May↑ r equirementsforinsulinsororal
hypoglycemicagent s.Phenytoin,phenobarbit
al,and
ri
fampinst i
mulatemet aboli
sm, may↓ ef f
ectiveness.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 947
Hor
monal
cont
racept
ivesmay↓ met
abol
i
sm.
Dr
ug-
Nat
ural
Product
:Addi
ti
vehy
pokal
emi
awi
thl
i
cor
ice.

DOSAGE
Mul
ti
pleScl
erosi
s
I
M:Subcut(
Adul
ts)
:80–120uni
ts/
dayf
or2–3wk.
I
nfant
il
eSpasms
I
M:(Chi
ldr
en<2y
r):
75uni
ts/
m2t
wicedai
l
yfor2wk,
then
t
aperov
er2wk.

AVAI
LABI
LITY
Reposi
tor
ycor
ti
cot
ropi
ninj
ect
ion80uni
ts/
mL;

PATI
ENTTEACHI
NG
Instructpati
entand/orparentoncor recttechni que
foradmi nist
rati
onandt oconti
nuemedi cationas
directed.Mustbest oppedgradually.I
fmedi cationis
stoppedpat ientappearsweak,l
oseswei ghtorhasa
decr easeinappetit
e,appearsti
redorl ackingener gy,
appear spale,hasstomachpain, appearssi ckorhasa
fevernot i
fyhealt
hcareprofessi
onal i
mmedi ately.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 948
 si
gnsandsy mptomsofGIbleeding(stomachpain,
vomiti
ngbl ood,bl
oodyorbl
ackst ool
s)orinf
ect
ion,or
opencut sandsoresoccurandtoav oi
dcrowdsand
peoplethathaveanactiv
einfect
ionduet o↑
suscepti
bil
ity.

Cauti
onpati
entandpar
entst
oavoi
d.vacci
nati
ons
wit
houtconsul
ti
ngheal
thcar
epr
ofessi
onal.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Cor
ti
sone
I
NDI
CATI
ONS
Managementofadr enocor t
ical
insuff
ici
ency;
chr oni
cuse
i
nothersituati
onsisli
mitedbecauseofmi neralocort
icoi
d
act
ivi
ty.Replacementtherapyinadrenali
nsuff
iciency.

ACTI
ON
I
nphar macologicdoses,suppressesinfl
ammationandthe
normalimmuner esponse.Hasnumer ousint
ense
metaboliceff
ects( seeAdver
seReact i
onsandSide
Eff
ects).Suppressesadrenalf
unctionatchroni
cdosesof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 949
20mg/ day.Repl
acesendogenouscor ti
solindefici
ency
states.Alsohaspotentmineral
ocort
icoid(sodium-
retai
ning)acti
vit
y.Ther
apeuticEff
ects:Suppressionof
i
nf l
ammat i
onandmodi f
icat
ionofthenor malimmune
response.Replacementtherapyi
nadr enali
nsuf f
ici
ency
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Act
iveunt
reat
edi
nfect
ions(
maybe
usedinpat
ient
sbei
ngt
reat
edfort
uber
cul
ousmeni
ngi
ti
s);
Lact
ati
on:Avoi
dchr
oni
cuse.

UseCaut
iousl
yin:
Chr
oni
ctr
eat
ment(
wil
ll
eadt
oadr
enal
suppr ession;usel owestpossibledosef orshor t
estper iod
ofti
me) ,unlessbei ngusedt otr
eatadr enalinsuff
iciency ;
Str
ess( surgery,i
nf ecti
ons)
;supplement aldosesmaybe
needed; Hypothyroidism;Ci
rrhosis;Ulcerat
ivecoli
tis;
Potent i
al i
nfecti
onsmaymasksi gns( fever
,infl
ammat ion);
OB: Safet ynotestabl i
shed;Pedi:Chronicusewi l
lresulti n
↓ gr owt h;uselowestpossi bledosef orshortestper i
odof
ti
me.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Adver
sereact
ions/
sideef
fect
saremuchmor
ecommon
wit
hhigh-
dose/l
ong-t
ermther
apy
CNS:
depr
essi
on,
euphor
ia,
headache,
↑int
racr
ani
al

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 950
pressur e(chil
drenonl y),personalit
ychanges, psy choses,
rest l
essness.EENT: cat aracts,↑i nt r
aocul arpressur e.CV:
hy pertension.GI :PEPTI CULCERATI ON, anor exia,nausea,
vomi ting.Der m: acne, ↓ woundheal i
ng, ecchy moses,
fragili
ty, hi
rsuti
sm, petechi ae.Endo: adrenal suppr ession,
hy perglycemi a.FandE: f
luidretention(long- ter
m hi gh
doses) ,hypokalemia, hypokal emical kalosis.Hemat :
THROMBOEMBOLI SM, t
hrombophl ebiti
s.Met ab:wei ght
gai n,wei ghtloss.MS: avascularnecr osisofj oints,muscle
wast ing, osteoporosis, musclepai n.Mi sc: cushingoi d
appear ance( moonf ace, buf f
alohump) ,↑ suscept ibil
i
tyto
i
nf ection.

I
NTERACTI
ONS
Drug-Drug: Addit
ivehypokal emiawiththi
azideorl oop
diureti
cs,oramphot eri
cinB.Hy pokal
emi amay↑ r iskof
digoxintoxicit
y.May↑ r equir
ementf ori
nsulinsoror al
hypoglycemi cagents.Pheny t
oin,
phenobarbit
al, and
ri
fampi nstimulatemet abolism; may↓ ef f
ectiveness.Oral
cont r
aceptivesmay↓ met aboli
sm.↑ r i
skofadv erseGI
effectswithNSAI Ds(includingaspiri
n).Atchroni cdoses
thatsuppressadr enalfunct i
on,may↓ ant ibodyr esponse
toand↑ t heriskofadv ersereacti
onsf r
om live-vir
us
vaccines.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 951
DOSAGE
PO:(Adul
ts)
:25–300mg/
dayi
ndi
vi
deddosesev
ery
12–24hr.
PO:(Childr
en) :
Adrenocor
ti
calinsuf
fici
ency—0.
7
mg/kg/ day(20–25mg/ m2/day)indivi
deddosesev
ery8
hr
.Otheruses—2. 5–10mg/ kg/
day( 75–300mg/m2/day
)
i
ndivideddosesev ery6–8hr.

AVAI
LABI
LITY
Tabl
ets25mg;

PATI
ENTTEACHI
NG
Instructpati
entoncor recttechni queofmedi cation
admi nistr
ati
on.Adv i
sepat i
entt ot akemedi cat i
onas
directed.Takemi sseddosesassoonasr emember ed
unlessal mostt i
mef ornextdose.Donotdoubl e
doses.St oppingt hemedi cationsuddenl ymayr esult
i
nadr enali
nsuf f
iciency(anorexi a,nausea, weakness,
fatigue,dyspnea, hypotension, hypoglycemi a).I
ft hese
signsappear ,
notifyhealthcar epr ofessional
i
mmedi at
ely.Thiscanbel i
fet hreatening.

Gl
ucocor
ti
coidscauseimmunosuppressi
onandmay
masksymptomsofinfect
ion.I
nst
ructpat
ientt
oav
oid

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 952
 peopl
ewithknowncont
agi
ousil
lnessesandt
orepor
t
possi
blei
nfect
ionsi
mmedi
atel
y.

Cauti
onpat
ienttoav
oidvacci
nati
onswi
thoutf
ir
st
consul
ti
nghealt
hcarepr
ofessi
onal.

Revi
ewsi deef f
ectswithpati
ent.Instr
uctpat i
entto
i
nform healthcareprofessi
onalprompt l
yifsev er
e
abdominal pai
nort ar
rystool
soccurPat i
entshould
al
sorepor tunusualswelli
ng,weightgain,ti
redness,
bonepain, br
uisi
ng,nonheali
ngsor es,vi
sual
di
stur
bances, orbehaviorchanges.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Discusspossi
bleef
fect
sonbodyi
mage.Expl
ore
copingmechanisms.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onalif
symptomsofunder l
yingdiseaser
etur
norwor sen.

Advisepat
ientt
ocarr
yidenti
fi
cati
ondescribi
ng
di
seaseprocessandmedicati
onr egi
menintheevent
ofemergencyinwhi
chpatientcannotrel
atemedi
cal
hi
story.

Explai
nneedforconti
nuedmedicalf
oll
ow-
upto
assesseff
ect
ivenessandpossi
blesi
deeff
ect
sof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 953
 medicat
ion.Per
iodi
clabt
est
sandey
eexamsmaybe
needed.

Long-
ter
m Therapy:Encour
agepatienttoeatadi
et
hi
ghinprot
ein,
calcium,andpotassium,andlowi
n
sodi
um andcarbohydrat
es.Al
cohol shoul
dbe
avoi
dedduri
ngtherapy.

Cosy
ntr
opi
n
I
NDI
CATI
ONS
Adr
enocor
ti
cal
insuf
fi
ciency
.

ACTI
ON
Asy nthet i
cform ofcort
icotr
opin(ACTH) ;st
imulatesthe
adrenal glandtoprimaril
yproducecor ti
coster
oids
(hy
dr ocor t
isone)andasmal lamountof
mineralocor ti
coi
ds(aldoster
one).Act i
onrequir
esintact
adrenal responsiv
eness.TherapeuticEffect
s:Production
ofadr enal st
eroi
dsafteradministr
ation.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
OB:
Lact
ati
on:
Pregnancyorl
act
ati
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 954
(
saf
etynotest
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Mi
sc:
hyper
sensi
ti
vi
tyr
eact
ionsi
ncl
udi
nganaphy
laxi
s.

I
NTERACTI
ONS
Dr
ug-Drug:Corti
coster
oids,
est
rogens,
andspi
ronol
act
one
al
tert
her esul
tsoftest
ing.

DOSAGE
I
M:I
V:(
Adul
tsandChi
l
dren>2y
r):
0.25mg.
I
M:I
V:(
Chi
l
dren<2y
r):
0.125mg.

AVAI
LABI
LITY
Powderf
ori
nject
ion0.
25mg/
vial
;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofcosy
ntr
opi
nandneedf
orl
abt
est
s.

CRI
ZOTI
NIB
I
NDI
CATI
ONS
Local
l
yadv
anced/
met
ast
ati
cnon-
smal
lcel
ll
ungcancer

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 955
(
NSCLC)t
hati
sposi
ti
vef
oranapl
ast
icl
ymphomaki
nase
(
ALK)
.

ACTI
ON
.Ther
apeut
icEf
fect
s:Decr
easedspr
eadofl
ungcancer
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Concur
rentuseofst
rong
i
nhibit
ors/i
nducersoftheCYP3Aenzy
mesy st
em;
Congenitall
ongQTsy ndrome;OB:
Maycausefet
alhar
m;
Lactat
ion:Breastf
eedingshoul
dbeavoi
ded.

UseCaut
iousl
yin:
HF,
brady
arr
hyt
hmi
as,
elect
rol
yte
abnormalit
ies,concurrentmedicati
onst hatprolongQT
i
nterval(
increasedriskofar r
hythmias);
Bloodl evel
sare
i
ncreasedinpat i
entswi thAsianethnici
ty;Hepatic
i
mpai rment;Severerenal i
mpairment;Patient
swi thchi
ld-
beari
ngpot enti
al;Pedi:Safeandeffecti
veusei nchil
dren
hasnotbeenest abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: f
atigue,headache,insomnia.EENT: v
isual
dist
urbances.Resp: PNEUMONI TIS.CV:QTCpr ol
ongati
on,
edema, chestpain.GI:consti
pation,di
arrhea,nausea,
vomiti
ng, abdominalpain,dysgeusia,↓ appetit
e,↑l i
ver

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 956
enzymes,
stomat
it
is.Der
m:r
ash.Neur
o:neur
opat
hy.Mi
sc:
fever
.

I
NTERACTI
ONS
Dr ug-Drug:Concur r
entuseofst r
ongCYP3A
i
nhi bit
orsincludingat azanav i
r,clarit
hromycin,i
ndinavi
r,
i
traconazol e,ket oconazol e,nef azodone,nelfi
navi
r,
ri
tonav ir
,saqui navir
, tel
ithromy cin,
troleandomy ci nandv ori
conazol emay↑ bl oodlevelsand
shoul dbeav oi ded.Concur rentuseofst r
onginducersof
theCYP3Asy stem includingcar bamazepine,
phenobar bital,pheny toin,ri
fabut inandri
fampinmay↓
bloodl evelsandef fecti
v enessandshoul dbeav oided.
Dr
ug-Nat
ural
Product:Concur
rentuseofSt.John'
s
wort
may↓ bloodlev
elsandeffecti
venessandshoul
dbe
av
oided.
Drug-
Food:Grapef
rui
torgrapef
rui
tjui
cemay↑ bl
ood
l
evelsandshouldbeavoi
ded.

DOSAGE
PO:(Adult
s):250mgtwicedail
y;doseadj
ust
edaccor
ding
tot
olerance,
toxi
cit
yoradver
seeffect
s.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 957
Capsul
es200mg,
250mg;

PATI
ENT TEACHI
NG
Inst
ructpatienttotakecr i
zoti
nibasdi rected;donot
changedoseorst opt aki
ngwi thoutconsul t
inghealt
h
careprofessional.Takemi sseddosesassoonas
remember edunl ess<6hr suntilnextdose.I f<6hrto
nextdose,skipdoseandr et
urntor egularschedule;
donotdoubl edoses.Adv i
sepat i
entt oreadt he
Pati
entInformat i
onleaf l
etbeforestarti
ngandwi t
h
eachRxr efi
llincaseofchanges.

Advi
sepati
enttoavoi
deatinggr
apef
rui
tordr
inki
ng
gr
apefr
uitj
uicedur
ingther
apy.

Cauti
onpat i
entthatdizzinessandv isualdisorders
mayoccur .Advi
sepat ienttoav oiddr i
vingorot her
acti
vi
ti
esrequiri
ngal ertnessunt i
lresponset o
medicat
ionisknown.Vi sual disturbancesgener al
l
y
star
twit
hin2wksoft herapy.Inst r
uctpat ienttonotif
y
heal
thcareprofessional iffl
ashesofl ightornewor
worsevit
reousfloatersoccur ;
opht halmol ogical
eval
uati
onshouldbeconsi dered.

Inf
orm pat
ientt
hatnausea,diar
rhea,
vomiti
ng,and
const
ipati
onarecommonsi deeff
ect
s.Standar
danti
-
emeti
c,anti
diar
rheal
,andlaxati
vemedicati
onsare

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 958
 usual
l
yef
fect
ive.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Inst
ructwomenofchi l
dbeari
ngageandthei
rpart
ners
touseef f
ecti
vecontracepti
onduri
ngandforatl
east
90day sfol
lowingdisconti
nuati
onoft
herapyandto
avoi
dbr eastf
eedingduringther
apy

Cr
omol
yn†
I
NDI
CATI
ONS
Inhaln:
Prophy laxis(l
ong-t
erm control
)ofbronchi
al
asthma.Pr event i
onofexercise-
inducedbronchospasm.
Intr
anasal:Prev enti
onandt r
eatmentofseasonal and
perennial
al l
ergicrhini
ti
s.PO: Mastocyt
osi
s.Treatmentof
foodaller
gy .Treatmentofinflammat or
ybowel di
sease
(IBD).

ACTI
ON
Preventstherel
easeofhistami
neandslow-reacti
ng
substanceofanaphyl
axis(SRS-
A)from sensi
tizedmast
cell
s.Therapeut
icEff
ects:Decr
easedfr
equencyand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 959
i
ntensi
tyofast
hmat
icepi
sodesoral
l
ergi
creact
ions.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Acut
eat
tacksof
ast
hma(
inhal
ati
on)
.

UseCaut
iousl
yin:
Renal
orhepat
icdy
sfunct
ion;
Bronchospasm—Willnotreli
eveandmaywor senacute
at
tacks(inhal
ati
on)
;OB: Lactat
ion:Saf
etynotest
abl
ished;
Pedi:Saf
etynotest
abli
shedi nchil
dren<2yr.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,headache.Derm: rash,urticar
ia,
angi oedema.EENT: i
ntr
anasal—nasal i
rri
tati
on,nasal
congest i
on,sneezi
ng.Resp:inhalati
on—i rri
tat
ionofthe
throatandt r
achea,cough,wheezing, bronchospasm.GI:
nausea, unpl
easanttaste.Mi
sc: all
ergicreactions
i
ncl udinganaphy l
axisorworseningofcondi ti
onsbeing
treated.

I
NTERACTI
ONS
Dr
ug-
Drug:
Notknown.

DOSAGE
I
nhal
n:(
Adul
tsandChi
l
dren≥2y
r):
Nebul
i
zedsol
uti
on:
One

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 960
ampul e(20-mg)ofthenebul
izersol
uti
on4timesdai
ly.For
preventi
onofbronchospasm, useonenebul
izedampule
(20mg)10–15mi nbeforeexposuretoknown
precipi
tati
ngsit
uati
on.
I
ntr
anasal
:(Adul
tsandChi
ldren≥2yr
):1spr
ay(5.
2
mg/spr
ay)i
ntoeachnostr
il3–4ti
mesdail
y(upto6t
imes
dai
l
y).
PO:
(Adul
tsandChi
l
dren>12y
r):
200mg4t
imesaday
.
PO:(Chi
ldr
en2–12yr
):100mg4t
imesaday
;nott
o
exceed40mg/kg/
day.

AVAI
LABI
LITY
Solut
ionfornebuli
zati
on10mg/ mL;Nasalsolut
ion40
mg/ mL(5.2mg/ spray
)in13-mL(≥100spray
s)or26-mL
(≥200sprays)contai
nersOTC;Or
alsol
uti
on100mg/ 5mL;

PATI
ENTTEACHI
NG
Instr
uctpatientoncorrectuseofmedi cati
on.
Medi cat
ionmustbeusedr out
inel
yandnotmor e
frequent
lythanpr escr
ibed.Takemi sseddosesas
soonasr emember edandspaceot herdosesat
regulari
ntervals.Donotdoubledoses.Donot
disconti
nuet herapywithoutconsul
tingheal
thcar
e
professi
onal,orexacerbationofsympt omsmayoccur
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 961
 Inst
ructpati
entnottodisconti
nueconcurr
ent
cort
icoster
oidorbronchodil
atorther
apywit
hout
consult
inghealt
hcarepr of
essional.

Ifcr
omol y
nisprescr
ibedbeforecontactwit
hknown
all
ergenorexercise,
explainthati
tshouldbe
admi nist
ered10–15mi n,andnoearli
erthan60min,
i
nadv ance.

I
nhaln:Cauti
onpat i
entt
onoti
fyheal
thcar
e
pr
ofessionali
fasthmati
csymptomsdonotimpr
ove
wi
thin4wk, worsen,orr
ecur
.

I
ntr
anasal
:Instr
uctpati
entt
oclearnasalpassages
bef
oreadminist
rat
ionandtoinhal
ethroughnose
dur
ingadminist
rat
ion.

Inst
ructpat
ienttostar
tusingproductupto1wk
beforecomingintocontactwi
thall
ergenandt
ouse
everydaywhileincont
actwithall
ergen.

Cy
anocobal
ami
n
I
NDI
CATI
ONS
Vit
aminB12def i
ciency(parenter
alproduct
sornasalspr
ay
shoul
dbeusedwhendef i
ciencyi
sduet omalabsor
pti
on).
Perni
ciousanemia(parenteralpr
oductsshoul
dbeused

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 962
foriniti
altherapy ;
nasal ororalpr
oductsarenotindi
cat
ed
untilpati
entshav eachi evedhemat ol
ogicremissi
on
fol
lowi ngpar enteraltherapyandhav enosi gnsofCNS
i
nv olvement ).Partoft heSchi l
l
ingtest(
vit
ami nB12
absor pti
ont est)(diagnost i
c).

ACTI
ON
Necessarycoenzy meformet aboli
cpr ocesses, i
ncludi
ng
fatandcarbohydratemet abolism andpr otei
nsy nthesis.
Requiredforcel
lreproduct i
onandhemat opoi
esis.
Therapeuti
cEffects:Corr
ect smani festat
ionsof
perni
ciousanemi a(megal oblast
icindices,GIlesions,and
neurol
ogicdamage) .Correctsv i
tami nB12def ici
ency .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pedi
:Av
oidusi
ng
pr
eparat
ionscontai
ningbenzy
l al
cohol
inprematur
e
i
nfant
s(associ
atedwi t
hfat
al“gaspi
ngsyndrome”)
.

UseCaut
iousl
yin:
Her
edi
tar
yopt
icner
veat
rophy
(acceler
atesnervedamage);Renaldysfunction(when
usingaluminum-contai
ningproduct
s);Uremi a,f
olicaci
d
defici
ency,concur
renti
nfect
ion,i
rondef i
ciency(response
tov i
taminB12wi l
lbeimpair
ed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 963
CNS: headache.CV: hear
tfailur
e.GI:di
arrhea.Derm:
i
tching,swell
ingofthebody .FandE: hypokalemia.Hemat
:
thr
ombocy tosis.Resp:pul
monar yedema.Local :pai
nat
IM si
te.Misc:hypersensi
ti
vityreact
ionsincludi
ng
anaphylaxi
s.

I
NTERACTI
ONS
Drug-
Drug:Chlor
amphenicol andanti
neoplasti
csmay↓
hematologi
cresponsetov i
taminB12.Colchici
ne,
aminosali
cyl
icaci
d,orexcessiveint
akeofalcohol,or
vi
taminCmay↓ absor ption/eff
ecti
venessofv i
taminB12.

DOSAGE
Oralproduct
sar eusual
lynotr
ecommendedduet opoor
absorpti
onandshoul dbeusedonlyifpati
entref
usesthe
i
ntramuscular,
deepsubcutaneous,orint
ranasalr
out
eof
administr
ati
on.
Vi
tami
nB12Def
ici
ency
PO:(
Adul
tsandChil
dren)
:Amountdependsondef
ici
ency
(upt
o1000mcg/dayhavebeenused).
I
M: Subcut(
Adul
ts)
:30mcg/
dayf
or5–10day
s,t
hen
100–200mcg/month.
I
M:Subcut(
Chi
l
dren)
:0.
2mcg/
kgf
or2day
s,t
hen1000

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 964
mcg/
dayf
or2–7day
s,t
hen100mcg/
weekf
or1mo.
I
ntranasal
:(Adul
ts)
:500mcg(
onespr
ay)i
nonenost
ri
l
onceweekly.
Per
nici
ousAnemi
a
IM: Subcut(Adult
s): 100mcg/ dayfor6–7day s;i
f
i
mpr ovement,gi
vesamedoseev eryotherdayfor7doses,
thenev ery3–4day sfor2–3wk; oncehemat ol
ogicval
ues
returntonormal (
remi ssion),cangivemai nt
enancedose
of100mcg/ mont h(dosesupt o1000mcghav ebeen
usedf ormaintenance)( couldalter
nativel
yuseoralor
i
ntranasal f
ormulati
onsbel owf ormaintenanceat
speci f
ieddoses).
PO:(
Adult
s):
Forhemat
ologi
cremi
ssi
ononl
y-
1000–2000
mcg/day
.
I
ntr
anasal
:(Adult
s):
Forhematol
ogi
cremi
ssiononl
y–500
mcg(onespray)i
nonenost
ri
lonceweekl
y.
I
M: Subcut(Chi
ldr
en): 30–50mcg/dayfor2ormore
weeks( t
oat ot
aldoseof1000–5000mcg) ,t
hengi
ve
maintenancedoseof100mcg/ month(dosesupto1000
mcghav ebeenusedf ormaint
enance)
.
Schi
l
li
ngTest
I
M:Subcut(
Adul
ts)
:Fl
ushi
ngdosei
s1000mcg.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 965
AVAI
LABI
LITY
Tablets50mcgOTC, 100mcgOTC, 250mcgOTC, 500
mcgOTC, 1000mcgOTC, 5000mcgOTC;Extended-rel
ease
tabl
ets1000mcgOTC, 1500mcgOTC;Sublingualtabl
ets
2500mcgOTC; Lozenges100mcgOTC, 250mcgOTC, 500
mcgOTC; Nasalspray500mcg/ 0.
1mLact uation(8
sprays/bott
le)
;Inj
ecti
on1000mcg/ mLin1–, 10-and30-
mLv ial
s;

PATI
ENT TEACHI
NG
Encouragepati
enttocompl ywi
thdi
et
recommendat i
onsofhealthcar
eprofessi
onal.Expl
ain
thatthebestsourceofvi
taminsi
sawel l-
bal
anced
dietwit
hfoodsfrom thef
ourbasicfoodgroups.

Foodshi
ghinv i
tami
nB12i ncl
udemeat
s,seaf
ood,
eggyol
k,andferment
edcheeses;f
ewvit
aminsare
l
ostwit
hordinar
ycooking.

Pati
ent
sself-
medicati
ngwithvi
taminsuppl
ements
shoul
dbecautionednottoexceedRDA.Eff
ecti
veness
ofmegadosesfortr
eatmentofvari
ousmedical
condi
ti
onsisunprovedandmaycausesideeffect
s.

I
nform pat
ient
swithpernici
ousanemi
aoft
hel
i
fel
ong
needforvi
taminB12replacement.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 966
 Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
eval
uat
eprogr
ess.

Intr
anasal:Instr
uctpat i
enti npr operadmi nistr
ati
on
techni
que.Rev i
ewPat ientInformat ionSheetand
demonst rateuseofact uator.Unitmustbepr i
med
with3st r
okesuponusi ngfort hefirstti
me.Uni tmust
bepr i
medwi th1st r
okebef oreeachoft her emai
ning
doses.Adv isepatienttoclearnose, thenplacet i
p
approximat el
y1i nchint onostrilandpr esspump
once,fi
rml yandqui ckl
y .Afterdose, remov eunitfrom
noseandmassagedosednost ril
gent l
yforaf ew
seconds.Vi aldeli
vers8doses.Uni tshouldbest ored
atroom temper atureandpr otectedf r
om light.

Cy
clobenzapr
ine
I
NDI
CATI
ONS
Managementofacutepai
nful
musculoskel
etal
condi
ti
ons
associ
atedwi
thmusclespasm.Unl
abeledUses:
Managementoffi
bromyal
gia.

ACTI
ON
Reducestoni
csomaticmuscl
eacti
vi
tyatthelev
el oft
he
brai
nstem.St
ruct
ural
l
ysimil
artot
ri
cycl
icanti
depressant
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 967
Therapeuti
cEff
ects:Reduct
ioninmusclespasm and
hyperact
ivi
tywi
thoutlossoffunct
ion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Shoul
dnotbeused
wit
hin14daysofMAOi nhibi
torther
apy;I
mmedi at
eperiod
af
terMI;Sev
ereorsymptomat i
ccardiov
asculardisease;
Cardi
acconduct
iondi
sturbances;Hyper
thyr
oidism.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease;
Ger
i:Appear
s
onBeersli
st.Poorl
yt ol
erat
edduet oanti
chol
iner
gic
eff
ects;
OB:Lact at
ion:Pedi
:Pregnancy,
lact
ati
on,and
chi
ldr
en<15y r(safetynotest
abli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,dr
owsiness,confusi
on,f
ati
gue,headache,
nervousness.EENT:drymout h,bl
urr
edvisi
on.CV:
arr
hy t
hmi as.GI
:const
ipati
on,dyspepsi
a,nausea,
unpleasanttast
e.GU:urinar
yr et
enti
on.

I
NTERACTI
ONS
Drug-Drug:Addit
iveCNSdepr essionwithotherCNS
depressants,i
ncludingalcohol,anti
hist
amines,opi
oid
analgesics,
andsedat iv
e/ hy
pnot i
cs.Addit
ive
anti
choliner
giceffectswithdrugspossessing

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 968
anti
choli
nergicproper t
ies,
incl
udingantihi
stamines,
anti
depressants,at
r opine,
disopyramide,hal
operidol
,and
phenothi
azines.Avoi dusewi t
hin14day sofMAO
i
nhibi
tors(hyperpyreticcri
sis,
seizur
es,anddeat hmay
occur)
.
Drug-
Natur
alPr
oduct:Concomi
tantuseofkav
a-kava,
val
eri
an,
chamomile,
orhopscan↑ CNSdepr essi
on.

DOSAGE
PO:(Adult
s) :Acutepainfulmuscul oskelet
al
condi
ti
ons—I mmedi ate–release:10mg3t imesdail
y
(r
ange20–40mg/ dayin2–4di v
ideddoses; nott
oexceed
60mg/ day);Extended-r
elease:15–30mgoncedai l
y.
Fi
bromy al
gia—5–40mgatbedt i
me( unlabel
ed).

AVAI
LABI
LITY
Tabl
ets5mg,10mg.Ext
ended-
rel
easecapsul
es(
Amr
ix)
15mg, 30mg.

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakemedi cati
onasdirected;donot
takemor et
hantheprescri
bedamount .Takenmi ssed
doseswithi
n1hroft imeordered;ot
herwise,ret
urnto
normaldoseschedule.Donotdoubledoses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 969
 Medicati
onmaycausedr owsiness,
dizzi
ness,and
bl
urr
edv isi
on.Cauti
onpati
enttoavoiddri
vi
ngor
ot
heractivi
ti
esrequi
ringal
ert
nessuntilr
esponseto
dr
ugi sknown.

Advi
sepat
ientt
oav oi
dconcurr
entuseofalcohol
or
ot
herCNSdepressant
swiththi
smedicati
on.

Ifconsti
pati
onbecomesapr obl
em, advi
sepati
ent
thatincr
easi
ngfl
uidint
akeandbulki ndi
etandstool
softener
smayallevi
atethi
scondit
ion.

Advisepat
ienttonot i
fyheal
thcareprofessi
onali
f
symptomsofur i
naryret
enti
on(dist
endedabdomen,
feel
i
ngoffullness,overf
lowinconti
nence,voi
ding
smallamount s)occur.

I
nform pat
ientt
hatgoodoralhygi
ene,
frequentmouth
ri
nses,andsugarl
essgum orcandymayhelprel
iev
e
drymouth.

Cy
clophosphami
de
I
ndi
cat
ions
Mal
ignantl
ymphomasincl
udingNonHodgkin’
s
l
ymphomas, l
ymphocy
ticl
ymphoma,Burkit
t’
slymphoma;
mul
tipl
emy el
oma;l
eukaemias,
mycosi
sf ungoi
des;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 970
neurobl
ast
oma;
adenocarci
nomaoft
heov
ary
;
ret
inobl
ast
oma;
breastcancer
.
Unl
abel
edUses:Sever
eactiv
erheumat
oidar
thr
it
isor
Wegener
’sgr
anulomatosi
s.

ACTI
ON
I
nt er
fer
eswithDNAr epli
cat i
onandRNAt r
anscri
pti
on,
ult
imatelydi
srupti
ngpr oteinsynthesis(cel
l-cy
cle
phase–nonspecifi
c).Ther apeut
icEff ect
s:Deathofrapi
dly
repli
cat
ingcell
s,parti
cularlymali
gnantones.Al sohas
i
mmunosuppr essantactioninsmal lerdoses.

Av
ail
abi
l
ity
TABLET50mg;INJECTION15ml (
200mg)
,30ml(500
mg)and50ml (
1g)vial
s;dr
ypowdert
ober
econst
it
uted
bef
oreadmi
nist
rat
ion.

DOSAGE
I
ntr
avenousi
nject
ion
Malignancy:40t
o50mg/ kgbodyweighti
ndivideddoses
over2t o5days.Al
ter
nati
vel
y10to15mg/ kgbodywei ght
ev
er y7t o10daysor3to5mg/ kgbodyweighttwicea
week.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 971
Or
al
1to5mg/kgbodywei
ght.Mi
nimal
changenephr
oti
c
sy
ndrome:2.
5to3mg/kgbodywei
ght.

Cont
rai
ndi
cat
ions
Seenotesaboveandconsultl
it
eratur
e;bl
adder
haemorrhage;
thr
ombocytopeni
a; sev
erebonemar
row
depr
ession;pr
egnancyandlactat
ion.

I
NTERACTI
ONS
Drug- Drug: Phenobarbital orrif
ampi nmay↑ t oxici
tyof
cyclophosphami de.Concur rental l
opurinol or
thi
azi dedi ureti
csmayexagger atebonemar rowdepr ession.
Maypr olongneur omuscul arblockadef rom
succiny lchol i
ne.Cardiotoxi cit
ymaybeaddi tiv
ewi t
hot her
cardiotoxi cagent s(e.g.,cy tar
abi ne,daunor ubicin,
doxor ubi cin).May↓ ser um di goxinlevel s.Additivebone
mar rowdepr essi
onwi t
hot herant i
neopl asticsorr adiati
on
therapy .Maypot entiatet heef fectsofwar fari
n.May↓
anti
bodyr esponset ol i
ve- vi
rusv accinesand↑ r iskof
adver ser eact i
ons.Pr ol
ongst heef fectsofcocai ne.

Pr
ecaut
ions
Seenot
esabov
eandconsul
tli
ter
atur
e;r
enal
impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 972
andhepat
ici
mpai
rmenti
nter
act
ions

Adv
erseEf
fect
s
Seenotesabov eandconsultli
ter
ature.Haemor
rhagi
c
cyst
it
is;col
i
tis;
cardiactoxi
cit
y;anorexi
a;
thr
ombocy t
openia;dermati
ti
s.

PATI
ENTTEACHI
NG
Instructpati
enttotakedoseinearlymorning.
Emphasi zeneedf oradequat
ef l
uidint
akef or72hr
aftertherapy.Pati
entshoul
dv oi
df r
equentlyto
decr easebladderir
ri
tat
ionfr
om met abol
itesexcreted
byt hekidneys.Reporthematuri
aimmedi atel
y.Ifa
dosei smi ssed,cont
actheal
thcareprofessional.

Instructpat ienttonot if
yhealthcar eprof essional
prompt l
yi ffever;sorethroat;si
gnsofi nfect i
on; l
ower
backorsi depai n; dif
fi
cultorpainfulurinat i
on; soresi
n
themout horont helips;yel
lowdi scolorationofski n
orey es; bleedinggums; brui
sing;petechi ae; bl
oodi n
urine, st
ool ,oremesi s;unusual swelli
ng; jointpain;
shor tnessofbr eath;orconfusionoccur s.Caut ion
pat i
entt oav oidcr owdsandper sonswi thknown
i
nf ections.Instructpat i
enttousesof ttoot hbrushand
electricrazorandt oavoidfall
s.Pat i
entshoul dalso

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 973
 becautionednottodri
nkalcoholi
cbev
eragesort
o
takeproductscont
aini
ngaspiri
norNSAIDs;may
preci
pit
ateGIhemor r
hage.

Advi
sepat i
entthatt hi
smedi cati
onmaycausest er
il
it
y
andmenst ruali
rregulari
ti
esorcessat ionofmenses.
Thi
sdr ugi salsot erat
ogenic, andcontracept
ive
measur esshoul dcont i
nuef oratleast4moaf t
er
complet i
onoft her apy.

Discusswit
hpat i
entthepossi
bil
i
tyofhairl
oss.
Exploremethodsofcoping.Mayalsocausedar
keni
ng
ofskinandfinger
nail
s.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

St
orage
Inj
ecti
on:Storei
nr efr
igerat
or(2to8⁰C).Avoi
dlong
exposuretotemper at
ureabov e30⁰
C.Thesolutionshould
beusedi mmediatelyafterpr
eparat
ionasitdeteri
orat
es
onstorage.Tabl
et: St
oreatat emperat
urenotexceeding
30⁰C.

Cy
closer
ine
I
ndi
cat
ions
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 974
Tuber
cul
osi
sresi
stantt
ofi
rst
-l
inedr
ugs.

Av
ail
abi
l
ity
CAPSULE/
TABLET250mg.

DOSAGE
Or
al
Adult-I
nit
ial
ly250mgev ery12hfor2weeks,i
ncr
ease
accordi
ngt obloodconcentr
ati
onandr
esponseto500mg
every2h.
Chi
ld-I
nit
ial
l
y10mg/kgbodyweightdai
l
yadj
ust
edt
o
bl
oodconcentr
ati
onandr
esponse.

Cont
rai
ndi
cat
ions
Sever
erenali
mpai r
ment;
epil
epsy;depr
essi
on,
sev
ere
anxi
ety,
psychoti
cstat
es,al
cohol
dependence;
por
phyr
ia;
hyper
sensi
ti
vit
y.

Pr
ecaut
ions
Reducedosei nrenalimpair
ment( avoidifsever
e); moni
tor
haemat ologi
cal
,renalandhepati
cf uncti
on; l
act
ation;
di
scontinueorreducedosei fal
l
ergi cski
nr eact
ionsor
CNSt oxicit
yoccur,pr
egnancy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 975
Adv
erseEf
fect
s
Mainlyneur ological
,incl
udi ngheadache,dizzi
ness, vert
igo,
drowsiness, tr
emor ,conv ulsi
ons,conf
usion,psychosi s,
depression( disconti
nueorr educedoseifsympt omsof
CNSt oxicit
y);rashes, al
lergicdermati
ti
s(discontinueor
reducedose) ;megaloblasticanaemia;changesinl iv
er
functi
ont ests; hear
tfail
ur eathighdosesreported.

St
orage
St
oreatat
emperat
urenotexceeding30⁰
C(t
abl
ets)
.St
ore
pr
otect
edf
rom moi
stur
e(capsules).

Cy
clospor
ine
I
ndi
cat
ions
Rejecti
oninkidney,l
iver,
heartorbonemar
row
transpl
antat
ion;graf
t-
v er
sushostdi
sease;
insev
ere
recalci
tr
antatopicdermatit
is.
Unlabel
edUses: Managementofr ecal
citr
antulcerati
ve
coli
ti
s.Treatmentofster
oidresi
stantnephroticsyndrome.
Treatmentofseverester
oidresi
stantautoimmune
di
sease.Pr ev
enti
onandt r
eatmentofgr aftvs.host
di
seaseinbonemar r
owt r
ansplantpati
ents.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 976
ACTI
ON
Inhibit
snor mal immuner esponses( cel
lul
arandhumor al
)
byi nhibi
ti
ngi nterleuki
n-2,afactornecessaryfori
nit
iat
ion
ofT- cell
activit
y .Therapeuti
cEffects:Prevent
ionof
rejecti
onr eacti
ons.Sl owedpr ogressionofrheumatoid
arthrit
isorpsor iasis.

Av
ail
abi
l
ity
CAPSULES10,
25,50and100mg;
INFUSI
ON50and100
ml(100mg/ml
);I
NJECTI
ON1and5ml ampoul
e(250
mg/ml).

DOSAGE
Or
alandi
ntr
avenousi
nfusi
on
Adultandchildover3months-I
nit
ial
l
y5mg/kgb. i
.d.for2
weeks;canber educedto1.
5to3mg/ kg/
dayaccordingto
pati
entsresponse.Ifnor
esponseaft
er2weeks,increase
dose7mg/ kg/day.
Organtransplant:10to15mg/ kgbodyweight2t o4h
beforetranspl
antati
on,fol
lowedby10to15mg/ kgbody
weightfor1t o2weekspostoper ati
vel
y.Decrease
thereaf
tergraduall
yto2t o6mg/ kgbodywei ghtfor
maintenance( adj
ustaccordi
ngtobloodcyclospor i
ne

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 977
concentrati
onandr enalf
uncti
on)
,ifr
equir
ed1/3r
d
correspondingoraldosecanbeadminist
eredby
i
ntravenousi nf
usionover2to6h.

I
ntr
avenousi
nfusi
on
Bonemar rowtr
anspl
ant
ati
on;3to5mg/kgbodywei
ght
byint
ravenousi
nfusi
onover2to4hfr
om daybef
ore
tr
ansplant
ati
on.

Cont
rai
ndi
cat
ions
Pat
ient
saf
fect
edbypsor
iasi
s.

I
NTERACTI
ONS
Drug- Drug:↑ bl oodl evelsand/ orr iskoft oxicitywit h
azithromy ci
n,clar it
homy cin, amphot er icinB,
ami noglycosides, ami odar one, anabol icst er
oi ds,some
calcium channel bl ockers, cimet idine, col chi
ci ne,danazol ,
erythromy cin,fl
uconazol e, fluoroqui nol ones, ketoconazol e,
i
traconazol e,vor iconazol e, met oclopr ami de,
met hot r
exate,mi conazol e, nef azodoneNSAI Ds, mel phalan,
proteasei nhibit
or squi nupr i
st i
n/ dalfopr istin,orhor monal
cont r
acept i
ves.↑ nephr ot oxicitywi t hacy cl
ov ir
,
amphot eri
cinB, ami nogly cosides, NSAI Ds, t
rimet hoprim,
ci
pr ofloxaci
n, andv ancomy cin.↑ i mmunosuppr ession
withot herimmunosuppr essant s( cy clophosphami de,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 978
azat hiopri
ne, corticosteroids).Bar bitur
ates,pheny toi
n,
ri
fampi n,rif
abut i
n, carbamazepi ne, oxcar bazepineor
sulfonami desmay↓ l evelsandef fect.↑ r i
skof
hyper kalemi awi thpot assium- spar ingdi uret
ics, potassi
um
suppl ement s,orACEi nhibit
ors.↑ ser um levels/riskof
toxicityfrom di goxin( ↓ digoxindoseby50%) .Pr olongs
theact i
onofneur omuscul arbl ocki ngagent s.↑ r i
skof
seizureswi thimipenem/ cilastat i
n.May↓ ant ibody
responset ol i
ve-virusv accinesand↑ r i
skofadv erse
react i
ons.↑ r iskofr habdomy olysi swi t
hHMG- CoA
reduct asei nhibit
or s.May↑ l ev elsandr i
skoft oxicit
yfr
om
etoposi de.Concur rentusewi tht acr oli
musshoul dbe
avoided.Or li
stat↓ absor ption; av oidconcur rentuse.May
↑l ev elsandt heriskofhy pogly cemi afrom repagl ini
de.
Drug-
Nat uralPr
oduct:Concomitantusewi
thechinacea
andmel atoninmayinterf
erewithimmunosuppressi
on.
UsewithSt .John’
swor tmaycause↓ serum level
sand
organrejecti
onfortr
ansplantpati
ents.
Drug-
Food:Concurrenti
ngest
ionofgrapefr
uitorgr
apef
rui
t
j
uice↑ absor
ptionandshouldbeav oi
ded.Food↓
absor
pti
onofmi croemulsi
onproducts(Neoral
).

Pr
ecaut
ions
Moni
torki
dneyf
unct
ion(
dosedependenti
ncr
easei
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 979
ser um creatinineandur eadur i
ngf i
rstf ewweeksmay
necessi t
atedoser eduction, excluder ejectioni fkidney
transplant),moni torli
verf unct i
onmoni torbloodpr essure
(disconti
nuei fhy per t
ensi oncannotbecont r
olledby
ant i
hypertensi ves) ;moni torserum pot assium, particul
arl
y
i
fmar kedr enal impai rment( ri
skofhy per kalaemi a);
moni torser um magnesi um; hyperuricaemi a; measur e
bloodl i
pidsbef oreanddur ingt r
eatment ;av oidin
por phyri
a;v acci nationinef f
ect i
ve;moni torser um
creatini
nel ev els;pat i
entsaf f
ectedwi thpsor iasis;lactat
ion
i
nt eracti
onspr egnancy .

Adv
erseEf
fect
s
Dose- relatedandr ever sibl
ei ncreasesi nser um creati
nine
andur eaunr el
at edt ot i
ssuer eject ion;bur ningsensationin
handsandf eetdur i
ngi niti
al ther apy ;electrolyt
e
disturbancesi ncl udinghy perkal aemi a,hy pomagnesaemi a;
hepat icdy sfunct ion; hyper uri
caemi a;
hyper cholest erolaemi a;hy pergly caemi a,hyper t
ension
(especi all
yi nhear ttranspl antpat ients); i
ncreased
i
nci denceofmal ignanci esandl y mphopr oli
ferati
ve
disorder s;increasedsuscept ibili
t yt oinfectionsduet o
i
mmunosuppr essi on; gastrointest inal disturbances;
gingival hyper plasia; hirsutism; fat igue; all
ergicreacti
ons;
thrombocy topeni a(somet imeswi t hhaemol yti
cur aemic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 980
syndrome) ,alsomi l
danaemi a;tremors;conv
ulsions,
neuropathy;dy smenor r
hoeaoramenor r
hoea;pancreati
ti
s,
my opathyormuscl eweakness; cramps,gout,oedema;
headache; gingivalhypert
rophy;renal
dysfuncti
on;
hypertri
chosis; par
esthesia;
renal t
oxi
cit
y ;
gastroi
ntest
inal
sympt oms.

PATI
ENT TEACHI
NG
Inst
ructpati
enttot
akemedicationatthesamet i
me
eachdaywi t
hmeal s,
asdir
ected.Donotskipdoses
ordoubleuponmi sseddoses.Takemi sseddosesas
soonasr ememberedwithi
n12hr .Donotdisconti
nue
medicati
onwi t
houtadvi
ceofhealthcareprof
essional
.

Reinforcetheneedf orl
i
felongtherapytoprevent
transplantrej
ect
ion.Revi
ewsy mptomsofr ejecti
on
fortransplant
edorgan,andstressneedt onotif
y
healthcareprofessi
onalimmedi at
elyift
heyoccur.

Inst
ructpati
ent
sand/ orpar
entst
onot i
fyheal
thcare
prof
essionali
fdiarr
headevel
ops;decr
eases
absorpti
onofcyclospori
neandcanresulti
nrej
ecti
on.

I
nst
ructpat
ienttoavoi
dgrapef
rui
tandgrapef
rui
tjui
ce
t
opreventi
nteract
ionwi
thcycl
ospor
ine.

Adv
isepat
ientofcommonsi
deef
fect
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 981
 (nephrot
oxici
ty,
incr
easedBP, handtremors,
i
ncreasedfacialandbodyhai r
,gi
ngiv
alhyper
plasi
a).
Advisepati
entsthatifhairgr
owthisexcessi
ve,
depil
ator
ies,orwaxing,canbeused.

Teachpat ientthecorr
ectmethodformoni t
ori
ngBP.
Instr
uctpat i
enttonoti
fyheal
thcarepr ofessi
onalof
signif
icantchangesinBPori fhematuria,i
ncreased
frequency,cloudyuri
ne,decr
easedurineout put,
fever
,
sorethroat,ti
redness,
orunusualbrui
singoccur s.

Instr
uctpat
ientonproperor
alhygiene.Meti
culous
oralhygi
eneanddentalexaminati
onsforteet
h
cleani
ngandplaquecontrol
ev er
y3mowi l
lhel
p
decreasegi
ngivali
nfl
ammat i
onandhy per
plasi
a.

Instr
uctpati
enttonot i
fyhealthcareprofessional of
allRxorOTCmedi cati
ons,vi
tami ns,orherbal
productsbei
ngt akenandconsul thealthcare
professi
onalbeforetaki
ngot herRx,OTC, orher bal
productsorreceiv
inganyv accinati
onswhi letaking
thismedicat
ion.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed,
orif
br
eastf
eedi
ng.

Emphasi
zet
hei
mpor
tanceoff
oll
ow-
upexamsand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 982
 l
abt
est
s.

St
orage
St
orei
nawel
lcl
osedcont
ainerbel
ow25⁰
C.

Cy
prohept
adi
ne
I
NDI
CATI
ONS
Reli
efofall
ergi
csymptomscausedbyhist
aminer el
ease
i
ncludi
ng:Seasonalandper
enni
alal
ler
gicr
hini
tis,
Chroni
c
urt
icar
ia,
Coldurti
cari
a.Unl
abel
edUses:St
imulati
onof
appeti
te.

ACTI
ON
Ant agonizestheeffect
sofhi stamineatH- receptorsi
tes;
doesnotbi ndtoorinactivat
ehi st
ami ne.Alsoblocksthe
effectsofser ot
onin,whichmayr esul ti
nincreased
appet it
e.Therapeuti
cEffects:Decr easedsy mptomsof
hi
st ami neexcess(sneezing,rhi
nor rhea,nasal andocular
pruritus,ocul
arteari
ngandr edness) .Decreasedcold
urti
car i
a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Acut
eat
tacksof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 983
ast
hma;
Lact
ati
on;
Knownal
cohol
int
oler
ance(
syr
uponl
y).

UseCaut
iousl
yin:
Ger
i:Appear
sonBeer
sli
st.Ger
iat
ri
c
pat
ientsaresensiti
vetoantichol
inergiceff
ectsandhave
i
ncreasedriskforsideeff
ects;Angle-cl
osureglaucoma;
Li
verdisease;Pregnancy(safet
ynotest abl
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dr
owsiness,excit
ation(i
ncreasedinchil
dren)
.EENT:
bl
urredvisi
on.CV: ar
rhythmias,hypotensi
on,pal
pit
ati
ons.
GI:drymouth,consti
pation.GU:hesit
ancy ,
ret
enti
on.Derm:
photosensi
ti
vit
y,rashes.Misc:weightgain.

I
NTERACTI
ONS
Drug-Drug:Additi
veCNSdepr essionwithotherCNS
depressants,i
ncludingalcohol,opioi
danalgesics,and
sedativ
e/hypnotics.MAOi nhi
bitorsmayintensif
yand
prol
ongt heanticholi
nergiceffectsofanti
histamines.

DOSAGE
PO:(Adult
s):4mgq8hr(r
ange4–20mg/
dayi
n3di
vi
ded
doses;upto0.5mg/
kg/
day)
.
PO:(
Chil
dren6–14y
r):
2–4mgq8–12hr(
nott
oexceed
16mg/day).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 984
PO:
(Chil
dren2–6y
r):
2mgq8–12hr(
nott
oexceed12
mg/day
).

AVAI
LABI
LITY
Tabl
ets4mg,
4mgOTC;
Syr
up2mg/
5mL,
2mg/
5mLOTC;

PATI
ENTTEACHI
NG
Instructpati
enttot akecypr
oheptadineexact
lyas
directed.Misseddoseshoul dbet akenassoonas
remember ed.Donotdoubl edoses.Syrupshouldbe
accur atel
ymeasur edusingcali
bratedmedicati
oncup
ormeasur i
ngdevice.

Medicati
onmaycausedrowsiness.Advi
sepati
entto
avoi
ddr i
vingorot
heract
ivi
ti
esrequi
ri
ngaler
tness
unti
lresponsetot
hedrugisknown.

Advi
sepati
enttousesunscr
eenandprot
ecti
ve
cl
othi
ngtoprev
entaphotosensi
ti
vi
tyr
eacti
on.

Caut
ionpati
entt
oavoidconcur
rentuseofal
cohol
andotherCNSdepr
essants.

Advisepat i
entt
hatfrequentmouthri
nses,goodoral
hygiene,andsugarl
essgum orcandymaydecr ease
drymout h.Pati
entshouldnoti
fydent
isti
fdrymouth
persist
sf or>2wk.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 985
 Geri
:Teachpati
entandfamil
yaboutant
ichol
i
nergic
ef
fectsandtocontactaheal
thcar
eprovi
derifsuch
ef
fectsper
sist
.

Cy
steami
ne
I
NDI
CATI
ONS
Managementofnephr
opat
hiccy
sti
nosi
s.

ACTI
ON
Prevent stheaccumul at
ionofi nt
racell
ularcyst
ineby
favoringconv er
siontocy stei
neandcy st
einecompounds
thatar eabl etoleavetheint r
acell
ularspace.Therapeut
ic
Effects:Pr eventi
onofdamaget oorgansandt i
ssues
(especiallykidneys)inpat i
entswithnephr opat
hic
cystinosis.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ocy
steami
neor
peni
cil
l
ami
ne;
Lact
ati
on.

UseCaut
iousl
yin:
Pregnancy(
saf
etynotest
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 986
CNS: SEIZURES, lethargy ,ataxia,conf usion,depression,
encephalopathy ,
headache, hallucinations,nightmares,
somnol ence.CV: hy pertension.EENT: heari
ngl oss.GI:
anorexia,diar
rhea, vomit i
ng, abdomi nalpain,abnormal
l
iverfunctionstudies, badbr eath,const ipat
ion,dyspepsia.
Derm: r
ash, urt
icaria.FandE: dehy drat i
on.Hemat :anemi a,
l
eukopeni a.MS: tremor .Mi sc: f
ev er.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
PO:(AdultsandChildren>12yrand>110l b)
:Ini
ti
aldose—
1/4–1/6oft hemaintenancedoseindi
videddoses
i
ncreasedgradual
lyov er4–6wkt omaintenancedose.
Maintenancedose—500mg4t i
mesdaily.
PO:(Childr
en<12yr
):Ini
ti
aldose—1/ 4–1/6ofthe
maintenancedosei
ndi vi
deddosesincreasedgradual
l
y
over4–6wkt omaintenancedose.Maintenancedose—1.
3
g/m2/ dayor60mg/kg/dayin4divi
deddoses.

AVAI
LABI
LITY
Capsul
es50mg,
150mg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 987
PATI
ENTTEACHI
NG
Inst
ructpat
ientorpar
entstotakecy st
eamineexact
ly
asdirect
ed.Ifadoseismissed,takeassoonas
possibl
eunlessalmostt
imef ornextdose.

I
nst
ructpat
ientt
oremai
nwel
l
-hy
drat
ed(
2–3L/
day
).

Maycausedr owsiness.Cautionpati
entt
oavoid
driv
ingorotheracti
vi
tiesrequir
ingal
ert
nessunt
il
responsetomedicationisknown.

Advisepatientt
onotif
yhealt
hcareprof
essi
onali
f
drowsiness,fev
er,
incr
easedthi
rst
,nauseaor
vomiti
ng,rash,sor
ethroat
,tr
embli
ng,orsei
zur
es
occur.

Emphasi
zetheimpor
tanceofrouti
nel
abt
est
sto
moni
torprogr
essandsideef
fects.

Cy
tar
abi
ne
I
NDI
CATI
ONS
I
V:Usedmai nl
yincombinat
ionchemotherapeut
ic
r
egimensf ort
hetr
eatmentofleukemi
asandnon-
Hodgkin’
slymphomas.I
TTreatmentoflymphomat ous
meningit
is.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 988
ACTI
ON
Inhi
bit
sDNAsy nthesi
sbyinhibi
tingDNApol ymer
ase(cel
l
-
cycl
eS-phase–specif
ic)
.TherapeuticEf
fect
s:Deat
hof
rapi
dlyrepl
i
cati
ngcells,
part
icul
ar l
ymali
gnantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pregnancyorl
act
ati
on;
Act
ivemeni
ngeal
inf
ect
ion(
IT
only)
.

UseCaut
iousl
yin:
Act
ivei
nfect
ions;
↓ bonemar
row
reser
ve;Renal/
hepati
cimpai
rment;
Otherchroni
c
debil
it
ati
ngil
lnesses;
OB:Pat
ient
swithchil
dbeari
ng
potenti
al.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: CNSdy sf unction( highdose) ,confusion, drowsiness,
headache.EENT: corneal toxicit
y(highdose) ,hemor rhagic
conjunctivi
tis( hi
ghdose) ,vi
sual di
sturbances( i
ncluding
bl
indness) .Resp: PULMONARYEDEMA( hi
ghdose) .CV:
edema.GI :nausea, vomi ti
ng, hepatotoxicit
y,severeGI
ul
cer at
ion( highdose) ,stomat i
ti
s.GU: urinaryincont i
nence.
Derm: alopeci a,rash.Endo: steril
it
y.Hemat :(
lesswi t
hI T
use)—anemi a, l
eukopeni a,thrombocy topenia.Met ab:
hyperuricemi a.Neur o:Int r
at hecalonly—CHEMI CAL

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 989
ARACHNOIDI
TIS,abnor
mal
gai
t.Mi
sc:
cyt
arabi
ne
syndr
ome,
fever.

I
NTERACTI
ONS
Drug-Dr ug:↑ bonemar r
owdepr essionwi thot her
anti
neopl asti
csorr adiat
iont her
apy .↑ r i
skof
cardiomy opathywhenusedi nhigh-doser egimenswi t
h
cyclophosphami de.May↓ ant i
bodyr esponset oliv
e-vi
rus
vaccinesand↑ r i
skofadv ersereactions.May↓
absor pti
onofdi goxi ntablets.May↓ t heef f
icacyof
gentami cinwhenusedt ot r
eatKl ebsiell
apneumoni ae
i
nfect i
ons.Recentt reatmentwi thaspar aginasemay↑
ri
skofpancr eati
tis.↑ neur otoxicit
ywi thconcur rentl
y
admi nister
edI Tant ineoplasti
cs( I
Tonl y).

DOSAGE
Doser
egi
mensv
arywi
del
y
IV:(
Adults)
: I
nduct
iondose—200mg/ m2/ dayfor5daysq
2wkasasi ngleagentor2–6mg/ kg/day(100–200
mg/m2/ day)asasingledail
ydoseori n2–3divided
dosesfor5–10daysorunt ilr
emi ssionoccursaspartof
combinati
onchemot herapy
.Mai ntenance—70–200
mg/m2/ dayfor2–5day smont hl
y .Refr
actory
l
eukemias/lymphomas—3g/ m2q12hrf orupto12doses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 990
Subcut(
Adul
ts)
:Mai
ntenance—1–1.
5mg/
kgq1–4wk.
IT(Adul ts): DepoCy tI
nduction—50mg( i
ntraventri
cularor
l
umbarpunct ur
e)q14day sfor2doses( weeks1and3) ;
consol idati
on—50mg( i
ntraventricularorlumbarpunct ur
e)
q14day sfor3doses( weeks5, 7, and9) ,fol
lowedbyone
additional doseatweek13; mai ntenance—50mg
(i
ntrav entri
cularorlumbarpunct ure)q28day sfor4doses
(weeks17, 21,25,and29).Ifdrug- relat
edneur otoxi
city
occur s,doseshoul dber educedt o25mgordi scontinued
(dexamet hasone4mgPO/ I
Vt wicedai lyfor5day sshould
best artedconcur rentl
ywithITcy tarabi
ne) .

AVAI
LABI
LITY
Powderfori
njecti
on100mg, 500mg,1g, 2g;Sol
uti
onf
or
i
nject
ion20mg/ mL, 100mg/mL;Sust
ained-
rel
ease
l
iposomeinj
ectionforITuse10mg/mL;

PATI
ENTTEACHI
NG
Cauti
onpati
enttoavoidcr owdsandper sonswith
knowninf
ecti
ons.Reportsy mptomsofi nfect
ion
(f
ever,
chi
ll
s,cough,hoarseness,sorethroat,
lower
backorsi
depain,painf
ul ordi
ffi
cultur
inati
on)
i
mmedi at
ely
.

I
nst
ructpat
ientt
orepor
tunusual
bleedi
ng.Adv
ise

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 991
 patientofthr
ombocytopeniaprecauti
ons( usesoft
toothbrushandelect
ri
cr azor
,avoidfal
ls,donotdr i
nk
alcoholi
cbeveragesortakemedi cat
ioncont ai
ning
aspiri
norNSAI Ds;maypr eci
pit
ategastri
cbleeding).

Inst
ructpati
entt oinspectoralmucosaforredness
andulcerat
ion.Ifmout hsoresoccur,advi
sepatientto
usespongebr ushandr i
nsemout hwithwaterafter
eati
nganddr inking.Stomati
tismayrequir
et r
eatment
withopioi
danal gesics.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Advisepati
entthatthi
smedicati
onmayhav e
ter
atogenicef
fects.Contr
acept
ionshoul
dbeused
duri
ngt her
apyandf oratl
east4moaf t
erther
apyi
s
concluded.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

ITInfor
m patientabouttheexpectedsideef
fect
s
(headache,nausea,vomiti
ng,fever
)andaboutearl
y
signsofneurotoxici
ty.I
nstr
uctpatientt
onoti
fyheal
th
careprofessi
onal i
fthesesignsoccur.

Emphasizet
heimport
anceoft
aki
ngdexamet
hasone
wi
thlyposomal
cytar
abine.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 992
Cy
tomegal
ovi
rusi
mmunegl
obul
i
n
I
NDI
CATI
ONS
Preventionofcy t
omegalovir
us( CMV)diseaseassoci
ated
withtransplant
ationofki
dney ,
lung,l
iv
er,pancr
eas,or
heart(iftr
ansplantisot
herthankidneyfrom CMV-posi
tiv
e
donorst oCMV- negati
vereci
pient,t
henconcurrent
ganciclovi
rshouldbeconsidered).

ACTI
ON
ConsistsofIgGantibodi
escapableofprovi
dingpassive
i
mmuni tyagainstCMVdi sease.Ther
apeuti
cEffects:
Prev
ent i
onofserioussequelaeofCMVdi seasein
tr
ansplantpati
ents.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oimmunegl
obul
i
ns
oral
bumi
n;Sel
ect
iveI
gAdef
ici
ency
.

UseCaut
iousl
yin:
OB:
Lact
ati
on:
Pregnancyorl
act
ati
on
(safetynotest
abl
i
shed);
Renali
nsuff
ici
encyor
predisposi
ti
ontoacut
erenal
fai
lur
e.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 993
CNS: headache, t
remor ,
anxi ety,seizures.Hemat :
pancytopenia, hemolysis, l
eukopeni a.Resp:wheezi ng,
dyspnea, pulmonar yedema.CV: hypot ensi
on,
thr
omboembol ism.GI :
nausea, vomi ti
ng,hepati
c
dysfunction.Der m:fl
ushi ng,rash.GU: ol
igur
ia,anuria,
acuterenal fail
ure.MS: backpai n, muscl ecramps.Mi sc:
all
ergi
cr eactionsincludingchi l
ls,fever,ANAPHYLAXI S.

I
NTERACTI
ONS
Drug-
Drug:Mayint
erferewit
himmuneresponsetosome
l
ive-
vir
usvacci
nesincludi
ngmeasl
es,mumps, andrubel
la
(MMR; donotadmini
sterwit
hin3moofimmunegl obuli
n)

DOSAGE
Ki
dneyTr
anspl
ant
IV:(Adul
ts)
:150mg/kgwithin72hroftr
anspl
ant
ati
on,
fol
lowedby100mg/kgat2, 4,6,and8wk,t
hen50mg/kg
at12and16wkpost-tr
ansplantati
on.

Li
ver
,Pancr
eas,
Lung,
orHear
tTr
anspl
ant
IV:
(Adul
ts):150mg/kgwit
hin72hroft
ransplant
ati
on,
andat2,4,6,and8wk,t
hen100mg/kgafterat12and16
wkpost-
transpl
ant
ati
on.
I
V:(
Chi
l
dren)
:Saf
etyandef
fi
cacyhasnotbeen

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 994
establ
i
shedinpedi
atr
ics,
howev
eradul
tdoseshav
ebeen
usedinchi
ldr
en.

AVAI
LABI
LITY
Powderf
ori
nject
ion1000-
mgv
ial
,2500-
mgv
ial
;

PATI
ENTTEACHI
NG
Inst
ructpati
enttonoti
fyheal
thcar
epr
ofessi
onal
if
anyadv er
sereacti
onsoccur.

I
flivevi
rusv
acci
neswer eadminist
eredwit
hin14
daysofimmuneglobul
in,vacci
nati
onshouldbe
repeat
ed3moaf t
erthelastdoseofimmunegl obul
i
n.

DABI
GATRAN
I
NDI
CATI
ONS
Toreducetheri
skofstr
oke/sy
stemicembol i
zat
ion
associ
atedwit
hnon-val
vul
aratr
ial
fibr
il
lat
ion.

ACTI
ON
Actsasadi recti
nhibi
torofthrombin.Therapeut
icEff
ect
s:
Loweredriskofthrombot i
csequelae(str
okeandsy st
emic
embolizat
ion)ofnon-valv
ularatr
ialfi
bri
l
lat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 995
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Act
ivepat
hol
ogi
cal
bl
eedi
ng;Concur
rentuseofP—gl
ycopr
otei
n(P-
gp)
i
nducer
s.

UseCaut
iousl
yin:
Concur
rentmedi
cat
ions/
pre-
exi
sti
ng
conditi
onst hat↑ bleedi
ng r isk( ot
herant icoagulants,
anti
platel
etagents, ant
if
ibrinolyti
cs,hepar i
ns, chroni
c
NSAI Duse, l
aboranddel i
v ery);Surgicalprocedur es
(di
scont i
nue1–2day spriorifCCr≥50mL/ minor3–4
dayspriorifCCr<50mL/ mi n; Geri:
↑r i
skofbl eedi
ng;
Lactati
on: Usecautiousl
ydur ingbr eastfeeding; Pedi
:
Safetyandef fect
ivenessnotest abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI
:abdominalpai
n,diar
rhea,dy
spepsi
a,gastr
it
is,nausea.
Hemat:BLEEDING.Misc:hyper
sensi
ti
vi
tyreact
ions
i
ncl
udinganaphyl
axis.

I
NTERACTI
ONS
Drug-
Drug: Concurrentuseofotheranticoagulant
s,
anti
plat
eletagents,anti
fi
bri
nolyti
cs,hepari
ns,prasugr
el,
cl
opidogrel,orchr
onicuseofNSAI Ds↑ r i
skofbleedi
ng.
ConcurrentuseofP- gpinducersincl
udingrif
ampin↓
l
evelsandef fect
iveness;avoi
dconcur r
entuse.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 996
Dr
onedar
onemay↑ l
evel
sandt
her
iskofbl
eedi
ng.

DOSAGE
PO:
(Adul
ts)
:150mgt
wicedai
l
y.
Renal
Impai
rment
PO:(
Adul
ts)
:CCr15–30mL/min—75mgt
wicedai
l
y;CCr
<15mL/mi
n—Notrecommended.

AVAI
LABI
LITY
Capsul
es75mg,
110mg,
150mg;

PATI
ENTTEACHI
NG
Instructpatienttotakedabi gat r
anasdi r
ected.Take
mi sseddosesassoonasr emember edwi t
hin6hrs.I
f
<6hrunt i
lnextdose, ski
pdoseandt akenextdose
whenschedul ed; donotdoubl edoses.Donot
discontinuewi thoutconsultingheal thcare
professional,Iftemporaril
ydi scontinued,restar
tas
soonaspossi bl
e.Storedabi gatranatr oom
temper ature.Afteropeningbot t
le,usewi t
hin4mo;
discardunuseddabi gatr
anaf ter4mo.

I
nfor
m pat
ientt
hattheymaybleedmor
eeasi
lyor
l
ongert
hanusual.Advi
sepat
ientt
onot
if
yhealt
hcar
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 997
 professional i
mmedi atelyifsignsofbl eeding
(unusual bruisi
ng,pinkorbr ownur ine,redorblack,
tarr
yst ools,coughingupbl ood, vomitingblood,pai
n
orswel li
ngi najoint,headache, di
zziness,weakness,
recurri
ngnosebl eeds,unusual bleedingfrom gums,
heav i
erthannor mal menst rualbleeding,dyspepsi
a,
abdomi nal pain,
epigastricpain)occur s.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Advi
sefemalepati
enttonot
if
yhealthcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Dacar
bazi
ne
I
NDI
CATI
ONS
Treatmentofmet ast
ati
cmal i
gnantmelanoma(si
ngle
agent).TreatmentofHodgkin’sdi
seaseassecond-l
i
ne
therapy(withotheragents)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 998
ACTI
ON
Disr
uptsDNAandRNAsy nthesi
s(cell
-cycl
e
phase–nonspeci
fi
c).Therapeuti
cEffects:Deat
hofr
api
dly
growingt
issuecel
ls,especi
allymali
gnantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pr
egnancyorl
act
ati
on.

UseCaut
iousl
yin:
Act
ivei
nfect
ions;
Bonemar
row
depr
essi
on;Pedi
:Chi
ldr
en( saf
etynotest
abl
i
shed)
;Renal
dysf
unct
ion;
Hepati
cdysfuncti
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:HEPATI CNECROSI S,anorexia,nausea,vomiti
ng,
diar
rhea, hepati
cv eint hrombosi s.Derm: al
opecia,facial
fl
ushing, photosensitivit
y,rash.Endo: gonadalsuppr ession.
Hemat :anemi a,leukopeni a,thrombocy topeni
a.Local :pain
atIVsi t
e, phl
ebit
isatI Vsi te,ti
ssuenecr osi
s.MS: my algia.
Neuro: facial
parest hesia.Mi sc:ANAPHYLAXI S, fev
er ,fl
u-
l
ikesy ndrome, mal aise.

I
NTERACTI
ONS
Dr
ug-
Drug:
Addi
ti
vebonemar
rowdepr
essi
onwi
thot
her

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 999
antineoplast i
cs.Car bamazepi ne,
phenobarbi
tal
,rif
ampi n,
andami nogl utethi
mi demay↑ met abol
i
sm anddecr ease
effectiveness.Bl oodl evel
smaybe↑ wi t
hami odarone,
ciprofloxacin,fluvoxami ne,ket
oconazol
e,nor
floxacin,
ofloxacin,isoni azi
d,ormi conazol
e.May↓ ant i
body
responset ol i
ve-vi
rusv acci
nesand↑ r i
skofadv erse
reactions.

DOSAGE
Ot
herr
egi
mensar
eused
IV:
(Adul
ts):Malignantmel anoma—2–4.5mg/ kg/dayfor
10daysadministeredever y4wkor250mg/ m2/ dayfor5
daysadmini
steredev er
y3wk.Hodgki n’
sdisease—150
mg/m2/dayfor5day s(incombinati
onwit
hot heragents)
admini
ster
edev ery4wkor375mg/ m2(i
ncombi nati
on
wit
hotheragents)admi nister
edever
y15day s.

AVAI
LABI
LITY
Powderf
ori
nject
ion200mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttonotif
yhealthcareprofessi
onalif
fev
er;chil
l
s;sorethroat;
signsofinfecti
on;bl
eeding
gums; br
uisi
ng;petechi
ae;abdomi nalpai
n;yel
lowing

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1000
 ofey es;orbloodi nur i
ne,stool
,oremesisoccurs.
Cautionpat i
entt oav oi
dcr owdsandper sonswith
knowni nfections.Instructpati
enttousesoft
toothbrushandel ectri
crazor.Pati
ent
sshoul dbe
cautionednott odr inkalcoholi
cbeveragesortake
productscont aini
ngaspi r
inorNSAIDs;mayi ncr
ease
GIirri
tati
on.

Maycausephotosensit
ivi
ty.I
nstructpat
ientt
oav
oid
sunl
ightorwearpr
otecti
veclothinganduse
sunscreenf
or2daysaftertherapy.

Instr
uctpatienttoinf
orm healt
hcareprofessi
onalif
flu-
li
kesyndr omeoccurs.Sympt omsincl
udef ev
er,
my al
gia,andgener al
malaise.Mayoccuraf t
ersever
al
coursesoft herapy
.Usuallyoccurs1wkaf t
er
admi ni
strat
ion.Maypersistfor1–3wk.
Acetaminophenmaybeusedf orrel
iefofsymptoms.

Discusswithpat
ientthepossi
bil
i
tyofhai
rloss.
Explorecopi
ngstrat
egies.

Advi
sepatientoft
heneedf
oranonhor
monal
met
hod
ofcont
racepti
on.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1001
DACLI
ZUMAB
I
NDI
CATI
ONS
Prev
enti
onofacuteorganrej
ect
iondur
ingrenal
tr
anspl
antat
ion(
withcycl
ospori
neandcort
icost
eroi
ds)
.

ACTI
ON
Bindsspecif
icall
ytoi nter
leukin-2(IL-
2)receptorsi
teson
acti
vatedlymphocy tes,acti
ngasanI L-2receptor
antagoni
st.Thisprev entsfurt
heract i
vati
onof
l
ymphocy tesandal l
ogr aftr
ejection.Therapeuti
cEffect
s:
Preventi
onofr enalallograf
trejecti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Ger
iat
ri
cpat
ient
s;Pr
egnancy
,lact
ati
on,
orchi
ldren(hasbeenusedinchil
dren;
incr
easedr
iskof
hyper
tensionanddehydrat
ion)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:di
zzi
ness,f
atigue,headache,i
nsomnia.Resp:
PULMONARYEDEMA, coughi
ng,dyspnea.CV:chestpai
n,
edema,
hypert
ension(↑i nchildr
en),hy
potensi
on,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1002
tachy cardia.GI:abdomi naldiscomf ort,constipation,
diar r
hea( ↑i nchildren), dyspepsi a, epigast ri
cpain, nausea,
pyr osis,vomi t
ing(↑i nchi l
dren) .GU: dy suri
a,oli
gur i
a,
renal tubularnecrosi s.Derm: acne, impai redwound
heal i
ng, pruri
tus(↑i nchi l
dren) .Hemat :thrombosi s.MS:
arthralgia,backpai n, muscul oskel etal pain.Neur o:tremor.
Mi sc:Allergicreactionsi ncludinganaphy l
axis,f
ev er(↑i n
children),post -
operat i
vepai n( ↑i nchi ldren),ur
inaryand
respi r
atorytractinfect i
on(↑i nchi ldren) .

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.
Drug-Natur
alPr
oduct
:Concomi
tantusewi
thast
ragal
us,
echinacea,
andmelat
oni
nmayinterf
erewi
th
i
mmunosuppr essi
on.

DOSAGE
I
V:(Adult
sandChil
dren)
:1mg/ kg,wit
h1stdosegi
venno
morethan24hrbeforet
ranspl
antat
ion,t
henq2wkf ora
t
otalof5doses.

AVAI
LABI
LITY
Concentr
atef
ori
nject
ion(
mustbedi
l
uted)25mg/
5mLi
n
5-
mLv ial
s;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1003
PATI
ENTTEACHI
NG
Expl
aint
hatpati
entwill
needtoresumeli
felong
ther
apywithot
herimmunosuppressi
vedrugsafter
complet
ionofdacl
izumabcourse.

Maycausedi zziness.Cauti
onpatientt
oavoiddrivi
ng
orotheract
ivi
tiesrequir
ingaler
tnessunti
lresponseis
known.

Inst
ructpati
enttocont
inuetoavoidcr
owdsand
personswithknowninf
ections;t
hisdr
ugal
so
suppressesthei
mmunesy stem.

Inst
ructpatientnott
or ecei
veanyv acci
nati
onsandto
avoidcontactwithpersonsreceiv
ingoralpol
io
vaccinewithoutadvi
ceofheal t
hcar epr
ofessi
onal
.

DACTI
NOMYCI
N
I
NDI
CATI
ONS
Aloneorwit
hot hert
reat
mentmodal i
ti
esinthe
managementof :Wil
ms’tumor ,Rhabdomyosarcoma,
Ewing’
ssarcoma, Tr
ophoblasti
cneoplasms,Testi
cul
ar
carci
noma,Metastati
cnonsemi nomatoustest
icul
ar
cancer,
Gestat
ionaltr
ophoblasti
cneoplasi
a.Asa

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1004
componentofregi
onalper
fusi
onf
ort
reat
mentofl
ocal
l
y
recur
rentsol
i
dmalignanci
es.

ACTI
ON
I
nhibit
sRNAsy nt
hesisbyformingacompl exwithDNA
(cel
l-
cycl
ephase–nonspecif
ic)
.Therapeut
icEffect
s:Deat
h
ofrapi
dlyrepl
i
cat
ingcell
s,part
icul
arl
ymalignantones.
Alsohasimmunosuppressiv
epr oper
ti
es.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pregnancyorlact
ati
on;
Pati
entswi
thconcur
rentorrecent
chickenpoxorher
peszost
erinf
ect
ion;
Pedi:
Childr
en<6
mo.

UseCaut
iousl
yin:
Act
ivei
nfect
ions;
Immunosupr
essed
pati
ent
s;Concur
rentradi
ati
onther
apy;Hepati
c
dysf
uncti
on;Pat
ient
swi t
hchil
dbear
ingpotent
ial
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: l
et hargy,malai
se.GI:anorexia,nausea,stomati
tis,
vomiting,abdomi nalpai
n,ascites,diar
rhea,dysphagia,
esophagi ti
s,hepatotoxi
cit
y,ulcerat
ion.Derm: acne,
alopecia,eryt
hema( especiall
yofpr evi
ouslyirr
adiat
ed
skin)
,hy perpi
gment ati
on(especiallyofprevi
ously

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1005
i
rradiat
edski n)
,skinerupti
ons,photosensiti
vit
y,rash.
EENT: pharyngi
tis.Endo:hypocal
cemi a,gonadal
suppression.Hemat :anemia,l
eukopeni a,
thrombocy t
openia,febri
leneutr
openia,neutropenia.Local
:
phlebit
isatIVsite.MS: myalgi
a.Resp: pneumonitis.Misc:
fever.

I
NTERACTI
ONS
Drug-Drug:↑ bonemar rowdepr essionwit
hother
anti
neoplasti
csorr adi
ationtherapy.May↓ anti
body
responsetoli
v e-
vir
usv accinesand↑ r i
skofadver
se
reacti
ons(avoidconcurrentuse).

DOSAGE
Doseinobeseoredemat
ouspat
ient
sshoul
dbebasedon
bodysur
facearea
Wi
l
ms'
Tumor
,Rhabdomy
osar
coma,
Ewi
ng'
sSar
coma
IV:
(Adul
tsandChi
l
dren>6mo):15mcg/kg/
dayfor5day
s
admini
ster
edi
nvari
ouscombi
nati
onsandschedul
es.
Met
ast
ati
cNonsemi
nomat
ousTest
icul
arCancer
I
V:(Adul
ts):1000mcg/
m2assi
ngl
edosei
ncombi
nat
ion
wi
thotheragents.
Gest
ati
onal
Trophobl
ast
icNeopl
asms

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1006
IV:(
Adults)
:12mcg/
kg/dayfor5daysasasi
ngleagent
or500mcg/ dayf
or2daysincombinat
ionwi
thother
agents.
Regi
onal
Per
fusi
oni
nLocal
l
yRecur
rentSol
i
dMal
i
gnanci
es
Regi
onalper
fusi
on(Adul
ts)
:Lowerext
remi
ty/
pel
vi
s—50
mcg/kg;
uppperext
remit
y—35mcg/kg.

AVAI
LABI
LITY
Powderf
ori
nject
ion0.
5mg/
vial
;

PATI
ENTTEACHI
NG
Instr
uctpat i
enttonotifyhealt
hcar epr ofessionalif
fever;chill
s;sorethroat;si
gnsofi nfection;bleeding
gums; bruisi
ng;petechiae;orbloodinur ine,stool,or
emesi soccur s.Cautionpat i
enttoav oidcr owdsand
personswi thknowni nfecti
ons.Instructpat i
enttouse
softtoot hbrushandel ectr
icrazor.Caut ionpatientnot
todrinkal coholi
cbev eragesort akepr oducts
containingaspi r
inorNSAI Ds; mayincr easeGI
i
r r
it
ation.

Inst
ructpat
ienttoinspector
almucosaf oreryt
hema
andulcerat
ion.Iful
cerat
ionoccur
s,advisepati
entto
usespongebr ushandr i
nsemouthwi t
hwat eraft
er
eati
nganddr inki
ng.Stomati
ti
smayr equir
etreatment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1007
 wi
thopi
oidanal
gesi
cs.

I
nf orm patientthatthi
smedicat i
onmaycause
i
rreversiblegonadal suppr
ession.Advisepat
ientt
hat
thi
smedi cationmayhav eteratogeni
ceffect
s.A
nonhor monal methodofcontracepti
onshouldbe
useddur i
ngt herapyandforatleast4moaf ter
therapyisconcl uded.

Discusswithpat
ientthepossi
bil
i
tyofhai
rloss,
whi
ch
usuall
yoccurs7–10day saft
eradmini
str
ati
on.
Explorecopi
ngstrat
egies.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

I
nf orm patientthatthi
smedicat i
onmaycause
i
rreversiblegonadal suppr
ession.Advisepat
ientt
hat
thi
smedi cationmayhav eteratogeni
ceffect
s.A
nonhor monal methodofcontracepti
onshouldbe
useddur i
ngt herapyandforatleast4moaf ter
therapyisconcl uded.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Dal
fampr
idi
ne

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1008
I
NDI
CATI
ONS
Tr
eat
mentofmut
ipl
escl
erosi
s,t
oimpr
ovewal
ki
ngspeed.

ACTI
ON
Actsasapot assium channelbl
ocker
,whichmayi ncr
ease
conduct i
onofactionpotent
ial
s.Ther
apeuti
cEf f
ects:
Increasedwalki
ngspeedi npati
entswit
hmul t
ipl
e
sclerosi
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hi
stor
yofsei
zur
es;
Moder
ate/
sev
ere
r
enal
impai
rment(
↑ri
skofsei
zur
es)
;Lact
ati
on:
Avoi
duse.

UseCaut
iousl
yin:
Ger
i:Consi
derage-
rel
ated↓ i
nrenal
functi
on;OB:Useonlyifpotent
ialbenefi
tjust
if
iespot
ent
ial
ri
sktof et
us.Pedi
:Safetyandeffecti
venessnot
establ
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, di
zziness,headache,insomnia,weakness.
EENT: nasopharyngiti
s,pharyngolar
yngealpai
n.GI:
consti
pation,dyspepsia,nausea.GU: uri
nar
ytractinfecti
on.
MS: backpain.Neur o:balancedisor
der ,
multi
plesclerosi
s
rel
apse,paresthesia.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1009
I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
PO:
(Adul
ts)
:10mgt
wicedai
l
y.

AVAI
LABI
LITY
Ext
ended-
rel
easet
abl
ets10mg;

PATI
ENTTEACHI
NG
Instructpatienttotakedalfampr i
dineasdi r
ected,wit
h
appr oxi
mat ely12hr sbetweent abl
et s.I
fadosei s
mi ssed,omi tandtakenextschedul eddoseont ime;
donotdoubl edoses.Mayi ncreaser i
skofseizures.
Adv isepati
entt oreadMedi cationGui depri
orto
beginningther apyandwi theachRxr efi
ll
;new
i
nf ormationmaybeav ai
l
abl e.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

I
faseizur
eoccur
s,advi
sepati
entt
onoti
fyheal
thcar
e
pr
ofessi
onal
immediat
ely,
todi
sconti
nue

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1010
 dal
fampri
dine,andt
orepor
ttheev
entt
oAcor
da
(manuf
acturer
)

Advi
sefemalepati
enttonot
if
yhealthcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Dal
tepar
in
I
NDI
CATI
ONS
Prevent
ionofvenousthromboembol ism (
deepv ei
n
thr
ombosis(DVT)and/ orpulmonar yembol i
sm (PE))in
surgi
calormedicalpati
ents.Extendedt r
eatmentof
symptomaticDVTand/ orPEi npat i
entswithcancer.
Prevent
ionofi
schemi ccompl i
cations(withaspi
r i
n)in
pati
entswit
h:unstabl
eangi na,non–Q- waveMI.

ACTI
ON
Pot enti
atestheinhibi
tor
yeffectofanti
thr
ombinonFactor
Xaandt hrombin.Therapeuti
cEffect
s:Prevent
ionof
thrombusf or
mat i
on.Decreasedinci
denceofdeathor
recurrentMI .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odal
tepar
in,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1011
hepari
n,orporkpr
oducts;Act
ivemajorbl
eedi
ng;
Thrombocytopeni
arel
atedtoprevi
ousdalt
epar
inther
apy
.

UseCaut
iousl
yin:
Pat
ient
swi
thsev
erer
enal
orhepat
ic
i
mpai rment;Reti
nopat hy(hypert
ensiveordiabeti
c);
Spinal
orepiduralanesthesia;Geri
:Riskofbleedingmaybe↑,
considerage-rel
ated↓ i nrenalfunct
ionandbodywei ght;
OB:Lactati
on: Pedi:Safetynotestabl
ished;product
s
containi
ngbenzy lalcoholshouldnotbeusedi nneonates.
ExerciseExt remeCaut ionin:Spi nal/
epidur alanest
hesiaor
spinalpunct ure(↑r i
skofspi nal/epi
dur alhemat omat hat
mayl eadt olong-term orper manentpar al
y si
s);Severe
uncont r
oll
edhy pert
ension;Bact erialendocarditi
s,bleedi
ng
disorders;GIbleeding/ulceration/pathology ;
Hemor rhagic
stroke;RecentCNSoropht hal mologicsurger y;Acti
veGI
bleeding/ulcerati
on;Historyoft hrombocy topeni ar
elated
tohepar i
n.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:di
zzi
ness.GI
:rev
ersi
ble↑ i
nli
verenzy
mes.Hemat
:
BLEEDI
NG,thr
ombocytopeni
a.

I
NTERACTI
ONS
Drug-
Drug:
Riskofbleedi
ng↑ byconcurr
entuseof
thr
ombolyt
ics,
ant
icoagul
ant
s,oragentsthataf
fect

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1012
pl
ateletf
uncti
onincl
udingNSAI
DS,
ticl
opi
dine,
clopi
dogr
el,
ti
rof
iban,orept
if
ibat
ide.

DOSAGE
DVTPr
ophy
laxi
s
Subcut(Adults):Abdomi nalsurger y—2500I U1–2hr
beforesurgery,
thenoncedai l
yfor5–10day s;High-ri
sk
pati
entsundergoingabdomi nalsur gery—5000I Uev ening
beforesurgery,
thenoncedai l
yfor5–10day sor2500I U
1–2hrbef oresurgery,
anot her2500I U12hourl at
er,then
5000I Udail
yfor5–10day s;Hipr eplacement
surgery—2500IUwi thi
n2hrbef oresur gery,another2500
IUeveningofthedayofsur gery≥6hraf terfi
rstdose, then
5000I Udail
yfor5–10day s( i
fsur geryisintheev ening
omitseconddosedayofsur gery)or5000I Uev ening
beforesurgery,
then5000I Udai lyf or5–10day s.Medi cal
pati
entswi t
hsev er
elyrestri
ctedmobi li
ty:5000IUf or12t o
14day s.
Ext
endedTr
eat
mentofSy
mpt
omat
icVTEi
nPat
ient
swi
th
Cancer
Subcut(Adult
s):200IU/kgoncedai
ly(nott
oexceed
18,000IU/day
)forfir
st30days,t
hen150IU/kgoncedai
l
y
(nottoexceed18,000IU/day
)formont
hs2–6.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1013
Angi
na/
Non–Q-
wav
eMI
Subcut(
Adul
ts):120IU/kg(nott
oexceed10,
000I
U)q12
hrwit
hconcur
rentaspir
in.
Renal
Impai
rment
Subcut(
Adult
s):Cancerpat
ient
sr ecei
vingext
ended
tr
eatmentofsymptomati
cVTEwi thCCr<30
mL/min—Monitorant
i-
Xalevel
s(target0.5–1.
5IU/mL)
.

AVAI
LABI
LITY
Solut
ionforinjecti
on(prefi
l
ledsyri
nges)2500IU/ 0.
2mL,
5000IU/0.2mL, 7500IU/0.
3mL, 10,000IU/0.
4mL, 10,000
I
U/mL, 12,500I U/0.
5mL, 15,000I
U/ 0.
6mL, 18,
000
I
U/0.72mL; Soluti
onforinj
ecti
on(mul t
idosevi
als)10,000
I
U/mLi n9. 5-mLv i
als,
25,000IU/mLi n3.8–mLv i
als;

PATI
ENTTEACHI
NG
Advi
sepat i
enttorepor
tanysy mpt omsofunusual
bl
eedingorbruisi
ng,di
zziness,
itching,
rash,
fev
er,
swell
ing,ordi
ff
icul
tybreathi
ngtoheal t
hcare
prof
essionali
mmedi at
ely.

Inst
ructpat
ientnottot
akeaspi
rinorNSAI
Dswi
thout
consult
inghealt
hcareprof
essi
onalwhi
leon
dalt
eparint
herapy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1014
DANAPAROI
D
I
NDI
CATI
ONS
Preventionofthromboembol icphenomenai ncludi
ngdeep
veinthrombosisandpul monar yemboliaft
ersur gi
cal
procedur esknownt oincreaset her
iskofsuch
compl i
cat i
ons(knee/hipreplacement,abdomi nalsur
ger
y).
UnlabeledUses: Managementofunst ableangina.

ACTI
ON
Potenti
atestheinhi
bit
oryeff
ectofant
it
hrombinonfact
or
Xaandt hrombin.Danaparoi
disahepari
noi
d.Ther
apeuti
c
Eff
ects:Prevent
ionofthrombusfor
mation.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odanapar
oid,
por
k
pr
oduct
s,orsul
fi
tes;
Uncont
rol
l
edbl
eedi
ng.

UseCaut
iousl
yin:
Sev
erel
i
verorki
dneydi
sease;
Retinopathy(hypert
ensiveordi abeti
c);Untreat
ed
hyper t
ension;Recenthist
oryoful cerdisease;
Spinal/epi
duralanesthesia;Histor
yofcongeni tal
or
acqui r
edbleedingdisorder;
Ger iat
ri
cpat i
ents(enoxapar
in
el
imi nati
onprolonged);Malignancy;Historyof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1015
thr
ombocy topeniarel
atedtohepari
n(hasbeenused
successful
ly)
;Pregnancy,l
act
ation,
orchil
dren(
safet
ynot
establ
ished).
Exerci
seExt r
emeCaut i
onin:Severeuncontroll
ed
hypert
ension;Bact
eri
alendocardit
is,bl
eedingdisorder
s;GI
bl
eeding/ulcer
ati
on/pathol
ogy;Hemor rhagi
cstroke;
RecentCNSoropht halmologi
csur gery
; Act
iveGI
bl
eeding/ulcer
ati
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, headache, i
nsomni a.CV: edema.GI :
constipati
on, nausea, r
ev ersibleincreasei nli
verenzymes,
vomiting.GU: ur i
nar yretention.Der m: ecchy moses,
pruri
tus,rash, urti
car i
a.Hemat :BLEEDI NG, anemia,
thrombocy topeni a.Local :erythemaati nj
ect i
onsite,
hemat oma, ir
ritation,pain.Mi sc:fever.

I
NTERACTI
ONS
Drug-Drug: Riskofbleedingmaybei ncreasedby
concurrentuseofwar farinordrugst hataff
ectpl
atel
et
functi
on,includingaspirin,NSAIDs,di
pyri
damole,some
penici
ll
ins,clopidogr
el,
ticlopi
dine,anddextran.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1016
Subcut(Adul
ts)
:750ant
i-f
act
orXaIUq12hrstar
ti
ng1–4
hrpreopandatl
east2hrpost
opfor7–10day
sorunti
l
ambulator
y(upto14days)
.

AVAI
LABI
LITY
Soluti
onfori
nject
ion750anti
-f
act
orXaI
U/0.
6mLi
n
prefi
l
ledsyri
ngesandampules;

PATI
ENTTEACHI
NG
Advi
sepat i
enttorepor
tanysy mpt omsofunusual
bl
eedingorbruisi
ng,di
zziness,
itching,
rash,
fev
er,
swell
ing,ordi
ff
icul
tybreathi
ngtoheal t
hcare
prof
essionali
mmedi at
ely.

I
nstr
uctpat
ientnottotakeaspir
in,napr
oxen,
or
i
buprof
enwithoutconsult
inghealt
hcareprof
essi
onal
whi
leondanaparoidther
apy.

DANAZOL
I
ndi
cat
ions
Endomet ri
osis,f
ibrocyst
icmasti
ti
s,heredit
ary
angioedema, menor r
hagia,
gynaecomastia,pr
ecoci
ous
puberty.
Pall
iati
vetherapyoffi
brocyst
icbreastdi
sease.
Prophylaxi
sofher edit
aryangi
oedema.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1017
ACTI
ON
Inhi
bitspitui
taryoutputofgonadot ropi
ns,resul
ti
ngin
suppressionofov arianfuncti
on.Hasweakandr ogenic-
anabolicacti
v i
ty.Therapeuti
cEffects:Atr
ophyofect opi
c
endomet ri
altissueinendomet ri
osis.Decreasedpainand
nodulari
tyinfibrocysti
cbreastdisease.Correct
ionof
biochemicalabnor malit
iesinhereditar
yangioedema.

Av
ail
abi
l
ity
TABLETS/
CAPSULES50,
100and200mg.

DOSAGE
Endometri
osis:Adul
t-200to600mgdail
yin2di
vi
ded
doses.Fi
brocysti
cmastit
is:
Adult
-100t
o400mgdail
yin2
di
videddoses.
Heredi
tar
yangioedema: Adul
t-200mgt
wiceort
hri
cedail
y.
Gynaecomast
ia:Adult-I
nit
ial
l
y400mgdail
yin4div
ided
dosesfor6mont hs.
Chi
l
d-I
nit
ial
l
y200mgdai l
y,mayincr
easet
o400mgaf
ter
2mont
hs.Menor
rhagi
a:Adul
t-200mgoncedai
l
y.

Cont
rai
ndi
cat
ions
Hepat
icdy
sfunct
ion;
undi
agnosedv
agi
nal
bleedi
ng;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1018
porphyri
a;t
hromboembol
i
ccompl
i
cat
ion;
hyper
sensi
ti
vi
ty;
pregnancyl
actat
ion.

I
NTERACTI
ONS
Drug-Drug:Maypotenti
atewarfar
in,oralhypogly
cemic
agents,insul
i
ns,orcort
icost
eroi
ds.May↑ cy cl
ospori
neor
carbamazepinelevel
sandr i
skoftoxicit
y.May↑ t he
requir
ementf ori
nsul
ininpati
entswithdiabetes.

Pr
ecaut
ions
Usewithcautioninpatientswit
hmi graine,headache,
heart
,li
verorkidneydisease.Hi
storyofsei zures;
abnormalbleeding;pr
ev i
ousstr
okes; severehy per
tensi
on;
di
abetesmel l
it
us, pol
ycythaemi
a;interacti
ons.

Adv
erseEf
fect
s
Androgenli
keeff
ectsincl
udingweightgain,acne,
deepeningofvoi
ce;
sebor r
hoea;edema; hai
rloss;
amenor r
hoea;
hir
suti
sm; benigni
ntracr
anialhyper
tensi
on;
di
zziness.

PATI
ENTTEACHI
NG
Gener
al:I
nstr
uctpati
entt
otakemedicat
ionexact
lyas
di
rect
ed.Takemisseddosesassoonasr emembered,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1019
 i
fnotal
mostt
imef
ornextdose;
donotdoubl
edoses.

Advisepati
entt
onot i
fyheal
thcarepr
ofessi
onali
f
masculi
nizi
ngeffect
soccur(abnormalgr
owthof
faci
alhai
rorotherbodyhair
,deepeni
ngofthevoi
ce)
.

Advi
sepati
enttousesunscreenandprot
ectiv
e
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

Adv i
sepat i
entt ouseanonhor monal form of
cont r
aceptionduringtherapy.Inform pati
entthat
amenor rheaisexpect edwithhi gherdoses.Instr
uct
patienttonotifyhealthcareprof essi
onalifregul
ar
menst ruati
ondoesnotoccurwi thin60–90day saft
er
discontinuati
onoft herapyorifpr egnancyis
suspect ed.

Emphasi
zetheimport
anceofrout
inevi
sit
stoheal
th
car
eprof
essional
tocheckpr
ogressduri
ngther
apy.

Fibrocysti
cBreastDisease:Teachpati
entthecorrect
techniqueformont hlybr
eastself
-exam.I
nstruct
patienttoreporti
ncreaseinsizeofnodul
estoheal t
h
carepr of
essionalpromptl
y.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1020
Dant
rol
ene
I
NDI
CATI
ONS
PO:Treatmentofspasti
cit
yassociatedwi t
h:Spinalcor
d
i
njury,
Str
oke,Cerebral
palsy,
Multi
plesclerosis.
Prophyl
axisofmali
gnanthypert
hermi a.I
V: Emergency
tr
eatmentofmalignanthyper
ther
mi a.UnlabeledUses:
Managementofneur ol
epti
cmal i
gnantsy ndrome.

ACTI
ON
Actsdirectl
yonskeletal muscle,
causingr el
axati
onby
decreasingcalci
um releasefrom sarcoplasmicret
icul
um
i
nmuscl ecell
s.Preventsint
ensecat aboli
cprocess
associatedwithmalignanthyperthermia.Therapeuti
c
Eff
ects:Reduct i
onofmuscl espasticit
y.Preventi
onof
malignanthyperther
mi a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Nocont
rai
ndi
cat
ionst
oIVf
ormi
n
tr
eatmentofhypert
hermia;OB:Lact
ation:
Pregnancyand
l
actati
on;Si
tuat
ionsinwhichspasti
cit
yisusedtomaintai
n
postur
eorbalance.

UseCaut
iousl
yin:
Car
diac,
pul
monar
y,orpr
evi
ousl
i
ver

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1021
di
sease;
Women,
pat
ient
s>35y
r(↑r
iskofhepat
otoxi
cit
y).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dr owsiness,muscleweakness, confusi
on,dizziness,
headache, i
nsomnia,mal aise, nerv ousness.EENT:
excessi velacri
mation,visual disturbances.Resp: pleur
al
effusions.CV: changesinBP, tachy cardia.GI:
HEPATOTOXI CITY,diarr
hea, anorexi a,cramps,dy sphagia,
GIbleedi ng,vomiti
ng.GU: crystalluria,dysuri
a,fr
equency ,
erecti
ledy sfuncti
on,incont i
nence, noct uri
a.Derm: pruri
tus,
sweat ing,urti
cari
a.Hemat :eosi nophi li
a.Local:i
rri
tati
onat
IVsite, phl
ebiti
s.MS: my algia.Mi sc: chill
s,dr
ooling,fever.

I
NTERACTI
ONS
Drug-Drug:Addi ti
veCNSdepr essionwi thCNS
depressants,includingalcohol,anti
histami nes,opioi
d
analgesics,sedative/hy
pnot i
cs,andpar enteral
magnesi um sul f
ate.↑ ri
skofhepat otoxicit
ywi thother
hepatotoxicagent sorest r
ogens.↑ r iskofar rhythmias
withverapami l.↑ neuromuscul arblocki ngeffectsof
vecuronium.
Drug-
Natur
alPr
oduct:Concomi
tantuseofkav
a-kav
a,
val
eri
an,
chamomile,
orhopscani ncr
easeCNSdepressi
on.

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1022
PO: (
Adul t
s):Spastici
ty—25mg/ dayinit
ial
ly;
↑ by25
mg/ dayq4–7day sunt i
ldesir
edr esponseort otalof100
mg4t imesdail
yisr eached.Preventionofmal i
gnant
hyperthermia—4–8mg/ kg/dayin3–4di v i
deddosesf or
1–2day sbefor
epr ocedure,l
astdose3–4hrpr eop.Post
-
hyperthermiccri
sisfoll
ow-up—4–8mg/ kg/dayin3–4
di
videddosesf or1–3day safterIVtreatment.
PO: (
Children>5y r)
:Spastici
ty—0.5mg/ kgt wicedaily;↑
by0.5mg/ kg/dayq4–7day sunt i
ldesir
edr esponseis
obtai
nedordosageof3mg/ kg4t i
mesdai l
yisr eached
(nottoexceed400mg/ day).Preventi
onofmal i
gnant
hyperthermia—4–8mg/ kg/dayi n3–4divideddosesf or
1–2day sbeforeprocedure,lastdose3–4hrpr eop.Post-
hyperthermiccrisi
sfoll
ow-up—4–8mg/ kg/dayin3–4
divi
deddosesf or1–3day saf t
erIVtreatment.
IV:(
Adult
sandChi ldren):Treatmentofmalignant
hypert
hermia—atleast1mg/ kg(upto3mg/ kg),
conti
nueduntilsymptomsdecr easeoracumul ati
vedose
of10mg/ kghasbeengi ven.Ifsymptomsreappear ,
dose
mayber epeated.Preventionofmal i
gnant
hypert
hermia—2.5mg/ kgbeforeanesthesi
a.

AVAI
LABI
LITY
Capsul
es25mg,
50mg,
100mg;
Powderf
ori
nject
ion20

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1023
mg/
vial
;

PATI
ENTTEACHI
NG
Advisepat
ientnott otakemoremedicati
onthanthe
amountprescribed,tomini
mizeri
skofhepatotoxi
cit
y
andothersideeffects.I
fadosei
smi ssed,donot
takeunl
essr emember edwit
hin1hr.Donotdouble
doses.

Maycausedi zziness,drowsiness, visualdisturbances,

andmuscleweakness.Adv i
sepat ientt oavoiddr i
ving
andotheractivi
tiesrequir
ingalertnessunt ilresponse
todrugisknown.Af terIVdosef orsur ger
y ,pati
ents
mayexperiencedecr easedgr ipstrengt h,
leg
weakness,li
ght-headedness, anddi ffi
cult
yswal l
owing
forupto48hr .Cautionpat i
entst oav oidact i
vi
ties
requi
ri
ngalertnessandt ousecaut ionwhenwal ki
ng
downstair
sandeat ingduringt hi
sper iod.

Advi
sepati
entt
oavoidt
akingal
cohol
orotherCNS
depr
essant
sconcur
rent
lywit
hthi
smedicat
ion.

Instr
uctpat i
enttonoti
fyheal
thcar epr of
essionali
f
rash;it
ching;yel
loweyesorskin; darkuri
ne;orclay-
colored,bloody,
orblack,t
arr
yst oolsoccurori f
nausea, weakness,malai
se,f
atigue, ordi
arrhea
persist
s.Mayr equir
ediscont
inuat i
onoft herapy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1024
 Advi
sepati
enttowearsunscreenandprotect
ive
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eacti
ons.

Emphasi
zethei
mport
anceoffol
low-
upexamst
o
checkpr
ogr
essinl
ong-
termther
apyandbl
oodt
est
s
tomonit
orf
orsi
deeff
ects.

Mali
gnantHypert
hermi
a: Pati
entswit
hmal i
gnant
hy
perthemiashoul
dcarryidenti
fi
cat
iondescri
bing
di
seaseprocessatal
lti
mes.

DAPSONE
I
ndi
cat
ions
PBandMBl eprosy
;acnevulgar
is,
dermat i
tis,
pneumocyst
icpneumonia.
Unlabel
edUses: Prevent
ion(as
monother
apy)andtreat
mentofPneumocy sti
sji
rov
ecii
pneumoni
a(withtr
imethopr
im orotheragents).

ACTI
ON
I
nterfer
eswi t
hfolatesynthesisinsusceptibl
eorgani
sms.
Therapeuti
cEffects:Bact
eriostati
caction.Spect
rum:
Acti
veagainst:My cobact
erium leprae,
Pneumocy sti
s
j
ir
ovecii.

Av
ail
abi
l
ity
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1025
TABLETS25,
50and100mg;
GEL5%w/
w.

DOSAGE
Or
al
Adult
-Lepr osy:50to100mgdai l
ydependi nguponbody
weight.Der mat
iti
sherpet
if
ormis:star
twith50mgdai l
y
andincr easeupto400mgt il
lful
lresponsei sobtai
ned;
doser educedtomi ni
mum maintenancelev elassoonas
possible.
Chi
ld-1to2mg/ kgbodyweightasmini
mum doset
ost
art
wit
h,increasedweekl
ysothatattheendof7t
hweek
pat
ientisreceiv
ingmax.dose.

Cont
rai
ndi
cat
ions
Hy
per
sensi
ti
vi
tyt
osul
fones;
sev
ereanaemi
a;por
phy
ria.

I
NTERACTI
ONS
Drug-Dr ug: Concurrentadmi nistrat
ionwi t
hdi danosi
neor
antacidsmay↓ absor pti
onofdapsone( separate
admini str
at i
ont imesby2hr ).Bloodl evel
smaybe↑
byamiodar one,fl
uconazol e,
ketoconazol e,
it
raconazole,
cl
ari
t
hromy cin,ery t
hromy cin,quini
dine,verapamil,ordil
ti
azem.
Bloodl evelsmaybe↓ by ri
fampi n,
pheny t
oin,
phenobar bi tal
,orcar bamazepi ne.Coadmi nistr
ati
onwith

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1026
tr
imethoprimresul
tsi
n↑ l
evel
sofbothagents.
Concurrentusewit
hagent
scausi
ngblooddyscrasi
asor
hemolyticanemiamay↑ t
heri
skoftheseadver
seef f
ect
s.
Drug-
Natural
Product
:St
.John'
swor
tmay↓ bl
oodl
evel
s
ofdapsone.

Pr
ecaut
ions
Anaemia(tr
eatsev
ereanaemi
abefor
etherapyand
monit
orbloodcountsdur
ingt
reat
ment)
;suscept
ibi
l
ityt
o
haemoly
sisincl
udi
ng
G-6-PDdef i
ciency( includingl actati
onaf fectedinfants)
;
l
act at
ionpor phy r
ia; i
nteractionshy perbi
li
rubinemia,
met haemoglobi nemi a; r
enal i
mpai r
mentpr egnancy .
On
l
ong- t
ermt r
eat mentpat ientsandt heircaretakersshould
bet ol
dhowt or ecogni zeblooddi sordersandadv i
sedto
seeki mmediat emedi cal at
tentioni fsympt omssuchas
fever,sor
ethr oat,rash, mout hul cers,purpura,bruisi
ngor
bleedingdevelop.

Adv
erseEf
fect
s
Haemol
ysi
sandmet
haemogl
obi
naemi
a;
al
l
ergi
cder
mat
it
is(
rar
ely
,incl
udi
ngt
oxi
c
epi
der
mal
necr
oly
sisandt
heSt
evens-
Johnsonsy
ndr
ome)
;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1027
rarel
y,hepatit
isandagr anulocytosis;‘
dapsonesy ndrome’
resemblingmononucl eosis-rarehypersensiti
vit
yreacti
on
withsympt omsi ncludingr ash,fever,j
aundiceand
eosinophil
ia;gastroint
est i
nal i
rri
tat
ion;tachycardi
a,
headache, nervousness, i
nsomni a,bl
urredvisi
on,
paraesthesia,r
ev ersi
bleper i
pher alneur
opat hyand
psychosesrepor
ted;i
ncreaseinret
icul
ocyt
es,ver
ti
go;
pancreat
it
is;r
enalpapi
ll
arynecrosi
s;anor
exia.

PATI
ENTTEACHI
NG
Instructpat
ienttotakedapsoneasdirect
edf ort
he
fullcourseoftherapy,eveni
ffeel
i
ngwel l
.Doses
shoul dbetakenatt hesametimeeachday .Take
mi sseddosesassoonaspossi bl
eifnotti
mef ornext
dose; donotdoubl edoses.

Emphasizetheimpor tanceofr egularf

oll
ow-upand
bl
oodwor ktocheckpr ogress.Advisepati
enttonot
if
y
heal
thcareprofessional i
fnoi mprovementisseeni
n
2–3moi npat i
entswithl eprosy,1wkinpatient
swit
h
Pneumocystisji
roveciipneumoni a,orwit
hinafew
daysi
npat i
entswithder mat it
isherpet
if
ormis.

I
nstr
uctpati
entt
oconsul
thealt
hcareprofessi
onal
bef
oretaki
nganyRX,OTC,orherbal
products.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1028
 I
nstr
uctpat ienttonotif
yhealthcareprofessi
onal
i
mmedi at
elyifrash,soret
hroat,fever,
chil
ls,
per
sistentfatigue,y
ell
owey es/skin,br
uisi
ng,or
bl
eedingoccur .

Advi
sepati
entt
onot i
fyheal
thcareprofessi
onal
is
pr
egnancyi
splannedorsuspected.Avoid
br
eastf
eedi
ngduringther
apy.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

DAPTOMYCI
N
I
NDI
CATI
ONS
Compl
icat
edskinandski
nstruct
urei
nfect
ionscausedby
aer
obi
cGram-posi
ti
vebacter
ia.

ACTI
ON
Causesr apiddepolari
zat
ionofmembr anepotential
fol
lowingbi ndi
ngtobacterial membr ane;thi
sr esultsi
n
i
nhibit
ionofpr otei
n,DNA, andRNAsy nthesi
s.Ther apeut
ic
Eff
ects: Deathofbacteri
awi t
hresolutionofinfection.
Spectrum: Acti
veagainstSt aphyl
ococcusaur eus
(i
ncludingmet hi
cil
li
n-r
esistantstr
ains) ,St
reptococcus

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1029
pyogenes,S.pyogenesagal
acti
ae,someS.dy sgalacti
ae,
andEnterococcusfaecal
is(
vancomy ci
n-susceptible
str
ains)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
CCr<30mL/
min(
dose↓ r
equi
red)
;
Moder at
e-t
o-severer
enali
mpair ment( mayhav e↓ cl
ini
cal
response);
Geri:Mayhave↓ clinicalresponsewi t
h↑ ri
sk
ofadversereacti
ons;OB:Useonl yifclearl
yneeded;
Lactati
on:Lactat
ion;
Pedi
: Saf
etynotest abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness.Resp:EOSINOPHI LI
CPNEUMONI A,
dyspnea.CV: hyper
tension,hypot ension.GI:
PSEUDOMEMBRANOUSCOLI TIS,const i
pation,diarr
hea,
nausea, vomi t
ing,↑liverenzymes.GU: renalfai
lure.Der
m:
pruri
tus,rash.Hemat :anemi a.Local :i
njecti
onsi t
e
react
ions.MS: ↑ CPK.Mi sc: f
ev er.

I
NTERACTI
ONS
Drug-
Drug:
Tobr
amycin↑ bl
oodl
evel
s.Concur
rentHMG-
CoAreduct
asei
nhi
bit
orsmay↑ t
heriskofmyopathy
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1030
DOSAGE
I
V:(
Adul
ts)
:4mg/
kgev
ery24hr
.
Renal
Impai
rment
I
V:(
Adul
ts)
:CCr<30mL/
min—4mg/
kgev
ery48hr
.

AVAI
LABI
LITY
Powderf
ori
nject
ion500mg/
vial
;

PATI
ENTTEACHI
NG
I
nfor
m pat
ientofpur
poseofmedi
cat
ion.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advisepati
entt
onot i
fyheal
thcar
epr
ofessi
onal
i
mmedi atel
yofsignsandsymptomsofeosi
nophi
li
c
pneumoniaoccur.

Dar
bepoet
in
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1031
I
NDI
CATI
ONS
Anemi
aassoci atedwit
hchroni
ckidneydi
sease(CKD).
Chemother
apy -
inducedanemiai
npatient
swithnon-
myel
oidmalignancies.

ACTI
ON
Sti
mulateserythropoiesi
s(producti
onofredbloodcel
ls)
.
Therapeut
icEffects:Maintai
nsandmayel evateredbl
ood
cel
lcounts,decreasingtheneedf ortr
ansf
usions.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Uncont
rol
l
ed
hypertensi
on;Pati
ent
sreceiv
ingchemot
her
apywhen
anti
cipatedoutcomeiscure.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
seaseorst
roke;
Underlyi
nghemat ol
ogicdiseases, i
ncludinghemolyt
ic
anemia,sickl
e-cel
lanemia,thalassemi aandporphyr
ia
(safet
ynotestabli
shed);
OB: Lactat
ion: Pedi
:Saf
etynot
establ
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:SEI
ZURES,di
zziness,f
ati
gue,headache,weakness.
Resp:
cough,
dyspnea,bronchi
ti
s.CV:HF, MI,
STROKE,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1032
THROMBOEMBOLI CEVENTS( especi al
lywit
hhemogl obin
>11g/ dL) ,edema, hypert
ension, hypotensi
on, chestpain.
GI:abdomi nalpai
n,nausea,diarrhea, vomit
ing,
consti
pat ion.Derm: prur
it
us.Hemat :pureredcel lapl
asia.
MS: myal gia,art
hral
gia,backpain, li
mbpai n.Mi sc:f
ever,
al
lergi
cr eact i
ons,fl
u-l
ikesyndrome, sepsi
s,↑ mor t
ali
ty
and↑ t umorgr owth(withhemogl obin≥12g/ dL).

I
NTERACTI
ONS
Dr
ug-
Drug:
Noner
epor
ted.

DOSAGE
Anemi
aduet
oChr
oni
cRenal
Fai
l
ure
(
Donoti
nit
iat
eifhemogl
obi
n≥10g/
dL)
IV:Subcut(Adults):Startingtr
eatmentwi thdarbepoeti
n
(nopr evi
ousepoet i
n)—0. 45mcg/ kgonceweekl y( may
startwith0.75mcg/ kgq2wki npatientsnotondi al
ysi
s);
usel owestdosesuf fi
cientto↓ theneedf orr
edbl oodcell
transfusi
ons( donotexceedhemogl obinof10g/ dL
[pati
entsondi al
y si
s]or11g/ dL[patientsnotondi al
ysi
s])
;
i
fHgb↑ by>1. 0g/dLin2wk, ↓ doseby25%; ifHgb↑ by
<1.0g/ dLafter4wkoft herapy(wit
hadequat eironstor
es),
↑ doseby25%; donot↑ dosemor efrequent
lythanq4
wk.Conv ersionfrom epoet i
ntodarbepoet i
n—weekl y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1033
epoeti
ndose<2500uni t
s=6. 25mcg/ weekdarbepoeti
n,
weeklyepoeti
ndose2500–4999uni ts=12.5mcg/ week
darbepoet
in,
weekl yepoeti
ndose5000–10, 999units=25
mcg/ weekdarbepoetin,
weeklyepoetindose
11,
000–17,999uni t
s=40mcg/ weekdar bepoeti
n,weekl
y
epoeti
ndose18, 000–33,999unit
s=60mcg/ week
darbepoet
in,
weekl yepoeti
ndose34, 000–89,999unit
s=
100mcg/ weekdar bepoeti
n,weeklyepoeti
ndose>90,000
uni
ts=200mcg/ weekdar bepoet
in.
Anemi
aduet
oChemot
her
apy
(Useonl yforchemot
her
apy -
rel
atedanemiaand
disconti
nuewhenchemot herapycoursei
scomplet
ed;
do
notinit
iateifhemogl
obi
n≥10g/ dL.)
Subcut(Adults)
:2.
25mcg/ kgweekl yor500mcgq3wk;
targetHgbshouldnotexceed12g/ dL.I
fHgb↑ by>1.0
g/dLin2wkororr eachesalevelneededtoavoi
dred
bloodcellt
ransf
usi
ons,↓ doseby40%; i
fHgb↑ by<1.
0
g/dLaf t
er6wkoft her
apy,↑ doseto4.5mcg/kgweekly.

AVAI
LABI
LITY
Albumi
nsolut
ionforinj
ect
ion25mcg/mL1-mLv i
al,
40
mcg/mL1- mLvial
,60mcg/ mL1-
mLvial
,100mcg/ mL1-
mLv i
al,
150mcg/ mL0.75-mLvi
al,
200mcg/mL1- mLv i
al,
300mcg/ mL1-mLv i
al,
500mcg/mL1-mLv i
al;
Pre-f
il
led

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1034
syr
inges25mcg/ 0.
42mL,40mcg/
0.4mL,60mcg/0.
3mL,
100mcg/ 0.
5mL, 150mcg/0.
3mL,200mcg/
0.4mL,300
mcg/0.6mL, 500mcg/1mL;

PATI
ENTTEACHI
NG
ExplainESAAPPRI SEOncol ogyPr ogr am andt he
rati
onaleforconcur rentirontherapy( i
ncreasedr ed
bloodcel l
product i
onr equiresir
on) .Instr
uctpat i
entto
readt heMedi cati
onGui depr i
ortobegi nningt herapy.
I
nf orm pati
entsofr i
sksandbenef itsofdar bepoet i
n.
I
nf orm pati
entswi t
hcancert hattheymustsi gnthe
patient-
healt
hcar eprov i
deracknowl edgmentf orm
beforethest artofeacht reatmentcour se.

Discusspossibl
ereturnofmensesandf er
til
i
tyin
womenofchi l
dbeari
ngage.Pat
ientshoulddiscuss
contracept
iveopti
onswithheal
thcareprofessional
.

Discusswaysofprevent
ingsel
f-
inj
ur yi
npatient
sat
ri
skforsei
zures.Dri
vi
ngandactivi
ti
esr equi
ri
ng
conti
nuousalert
nessshoul
dbeav oided.

Inf
orm pati
entthatuseofdar bepoetinmayresul
tin
short
enedov er
allsurvi
v al
and/ or↓ ti
met ot
umor
progr
ession.Mayal socauseMIorst r
oke.Advi
se
pati
enttonotif
yheal t
hcar eprofessi
onali
mmedi at
ely
i
fchestpain;tr
oublebr eat
hingorshor t
nessofbreat
h;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1035
 paininlegs,withorwi thoutswel l
ing;acool orpale
arm orleg;suddenconf usion,troublespeaki ng,or
tr
oubleunder standingot hers’speech; sudden
numbnessorweaknessi nf ace,arm, orleg,especi
all
y
ononesi deofbody ;suddent r
oubl eseeing;sudden
tr
oublewal ki
ng, dizziness, l
ossofbal anceor
coordinati
on;lossofconsci ousness( fai
nting);or
hemodi al
ysisv ascularaccessst opswor king.

Anemi aofChr onicKidneyDi sease—St ress

i
mpor tanceofcompl i
ancewi t
hdi etaryr estri
cti
ons,
medications,anddi al
ysis.Foodshi ghini ronandlow
i
npot assium includeli
ver ,
pork,v eal,beef ,mustar
d
andturnipgreens, peas,eggs, broccol i
,kale,
bl
ackber ri
es,
st rawberri
es, applejuice,wat ermelon,
oatmeal,andenr i
chedbr ead.Dar bepoet inwillr
esult
i
nincreasedsenseofwel l-
being, butitdoesnotcur e
underlyi
ngdisease.

HomeCar eIssues:Homedi alysi

spat i
ents
determinedt obeablet osafel
yandef fecti
vely
admi ni
sterdarbepoetinshouldbetaughtpr operdose,
admi ni
strat
iontechniquewithsyri
nge, auto-
inj
ectoror
IVuse,anddi sposalofequipment.Informationfor
Patient
sandCar egi
versshouldbepr ovidedtopat i
ent
alongwi t
hmedi cati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1036
Dar
if
enaci
n
I
NDI
CATI
ONS
Over
act
ivebladderwit
hsy
mpt
oms(
urgei
ncont
inence,
ur
gency
,frequency)
.

ACTI
ON
Actsasamuscar i
nic(choli
nergi
c)recept
orantagonist
;
antagoni
zesbl
addersmoot hmusclecontr
acti
on.
Therapeut
icEf
fect
s: Decreasedsymptomsofov eracti
ve
bl
adder.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Uri
nar
yret
ent
ion;
Gastr
icr
etent
ion;
Uncont
rol
ledangl
e-cl
osur
egl
aucoma;
Sever
ehepati
cimpai
rment.

UseCaut
iousl
yin:
Concur
rentuseofCYP3A4i
nhi
bit
ors
(uselowerdose/ cl
i
nical moni t
oringmaybenecessar y);
Moder atehepati
cimpai rment( l
owerdoser ecommended) ;
Bladderoutfl
owobst ruction;GIobst r
ucti
vedi sor
ders,↓
GImot il
it
y,sever
econst ipationorulcerat
ivecol i
ti
s;
My astheni
agravis;Angle-closureglaucoma; Lactati
on:
Pedi:Safetynotestabli
shed; OB: Useonlyifmat ernal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1037
benef
itout
wei
ghsf
etal
risk.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
dizzi
ness.EENT:blur
redv
isi
on.GI:
constipat
ion,
dry
mout
h,dyspepsi
a,nausea.Met
ab:heati
ntol
erance.Misc:
ANGI
OEDEMA.

I
NTERACTI
ONS
Drug-Dr ug:Bloodl evelsandriskoft oxicityare↑ by
concur rentuseofst rongCYP3A4i nhibitorsincl
uding
ketoconazol e,i
traconazol e,
rit
onav ir
,nel f
inavir
,
cl
arithromy cin,andnef azodone;dai l
ydoseshoul dnot
exceed7. 5mg.Concur rentuseofmoder ateinhibit
orsof
CYP3A4, especiallythosewi t
hnar rowt her apeuti
cindices,
i
ncludingf lecai
nide, thi
ori
dazine,andt ricycli
c
antidepressants, shouldbeunder takenwi thcaution.

DOSAGE
PO:
(Adul
ts)
:7.
5mgoncedai
l
y,maybe↑ af
ter2wkt
o15
mgoncedai
l
y.

AVAI
LABI
LITY
Ext
ended-
rel
easet
abl
ets7.
5mg,
15mg;

PATI
ENTTEACHI
NG
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1038
 I
nstructpati
enttotakedar i
fenaci
nasdirected.Advi
se
pati
enttoreadthePatientInformati
onbef or
estart
ing
ther
apyandwi theachpr escri
pti
onrefi
l
l.Ifadoseis
missed,ski
pdoseandt akenextday;donott ake2
dosesinsameday .

Donotshar
edar
if
enaci
nwi
thot
her
s;maybe
danger
ous.

I
nf or
m pati
entofpotent
ialanti
chol
inergi
csideeffect
s
(consti
pat
ion,ur
inar
yretenti
on,bl
urredvi
sion,heat
prostr
ati
oninahotenv i
ronment).

Maycausedi zzi
nessandbl ur
redvi
sion.Cauti
on
pati
enttoavoiddri
vi
ngandot heracti
vit
iesthat
requi
realer
tnessunti
lresponsetomedi cat
ioni
s
known.

Advisepati
entt
oconsul
theal
thcarepr
ofessi
onal
pri
ortotaki
ngRx,OTC,orher
balpr
oductswit
h
dari
fenaci
n.

DARUNAVI
R
I
NDI
CATI
ONS
HIVinf
ecti
on(mustbeusedwi
thr
it
onav
irandwi
thot
her
ant
ir
etrov
iral
s).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1039
ACTI
ON
I
nhibitsHIV-1protease,selecti
v el
yinhibiti
ngt hecleavage
ofHIV-encodedspeci fi
cpol yprotei
nsini nfectedcel l
s.Thi
s
preventstheformationofmat ureviruspar ti
cles.
TherapeuticEff
ects:IncreasedCD4cel lcount sand
decreasedv i
rall
oadwi thsubsequentsl owedpr ogressi
on
ofHIVi nf
ecti
onandi t
ssequel ae.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Concur
rental
fuzosi
n,si
l
denaf
il
(Revatio)
,ergotderi
vati
ves,
mi dazol
am (PO),pi
mozide,
tri
azolam,lovastat
in,
simvastati
n,ri
fampin,
orSt.John'
s
wort;Lactati
on:HIVmaybet ransmittedi
nhumanmi l
k;
Pedi:Chil
dren<3y r.

UseCaut
iousl
yin:
Hepat
ici
mpai
rment
;Sul
faal
l
ergy
;Ger
i:
Considerage-r
elat
edi mpair
menti nhepati
cfuncti
on,
concurrentchr
onicdiseasestatesanddrugtherapy;OB:
Useonlyi fmater
nalbenefi
tout weighsf
etalr
isk;Pedi
:
Chil
dren3–6y r(saf
etynotest abl
ished)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Basedonconcur
rentusewi
thr
it
onav
ir

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1040
GI:HEPATOTOXI CITY,constipat
ion,
diarr
hea,nausea,
vomiti
ng.Endo:hyperglycemia.Metab:bodyfat
redi
str
ibut
ion.Derm: r
ash, STEVENS-JOHNSON
SYNDROME, TOXICEPI DERMALNECROLYSI S.

I
NTERACTI
ONS
Dr ug-Drug: Dar unav irandr it
onav irar ebot hinhi bitorsof
CYP3Aandar emet abol i
zedbyCYP3A.Mul ti
pledr ug-drug
i
nt eractionscanbeexpect edwi thdr ugst hatshar e,inhibit
,
ori nducet hesepat hway s.Consul tpr oducti nf ormat ionf or
mor especi f
icdet ail
s.↑ bl oodl ev elsandr i
skoft oxi cit
y
from er gotder ivati
ves( dihydroer gotami ne, ergonov ine,
ergot ami ne,met hylergonov i
ne) , sildenaf il (
Rev atio) ,
alfuzosin, pi
mozi de,lovastati
n, si mv ast at i
n, midazol am
(oral),andt riazol am; concurrentusei scont raindicat ed.
Rifampi n↑ met abolism andmay↓ ant i
r etr
ov ir
al
effect i
veness, concur rentusei scont raindi cated.
Concur r
entusewi thindinavirmay↑ dar unav i
rand
i
ndi nav i
rlevel s.↑ l evelsandr i
skofmy opat hyf rom
ator vastati
n, rosuv ast ati
n,orpr av astatin( usel owestdose
oft heseagent sorconsi derfluv ast atin).Concur r
entuse
wi thefav i
renzr esultsi n↓ dar unav irlevel sand↑
efav i
renzl evel s;usecombi nat i
oncaut i
ousl y.
Lopi vavir/r
itonav i
rmay↓ l ev els; althoughconcur r entuse

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1041
i
snotr ecommended, addi t
ional rit
onav i
rmayber equi r
ed.
Saqui nav irmay↓ l ev el s; concur rentusei snot
recommended.↑ l ev elsofl i
docai ne, qui ni
dine,
propaf enone, flecai nide, andami odar one; usecaut iously
andwi thav ailablebl oodl evel moni tor ing.↑ di goxi nlevels;
bloodl ev el moni tor i
ngr ecommended.May↑
carbamazepi nel ev els; bl oodl ev elmoni toring
recommended.May↓ pheny toi norphenobar bital l
evels;
bloodl ev el moni tor i
ngr ecommended.↓ l evelsofwar far
in;
moni torI NR.↑ l ev elsoft razodoneanddesi prami ne;use
cautiousl yand↓ dosei fnecessar y .↑ l evelsof
clari
thromy cin; ↓ doseofcl arithromy cini fCCr≤60
mL/ mi n.Ket oconazol eandi traconazol emayl ev els.↑
l
ev elsofket oconazol eandi t r
aconazol e; dailydoseof
i
traconazol eorket oconazol eshoul dnotbe>200mg.↓
l
ev elsofv or i
conazol e; concur rentusenotr ecommended.
Concur rentusewi thr ifabut i
n↑ r if
abut i
nl evelsand↓
darunav irl ev els;(maybeduet or it
onav ir
) ;
↓r i
fabut in
doset o150mgev eryot herday .↑ l ev elsofbet a-blockers;
mayneedt o↓ dose.↑ l ev elsoff elodi pine, ni
fedi pine,or
nicardipine; moni torcl ini cal responsecar efully.
Dexamet hasone↓ l ev els.May↑ l ev elsofi nhaled
fl
uticasone; chooseal ter nativ einhal edcor ticoster oid.↑
l
ev elsofcy clospor ine, tacr olimus, orsi rol i
mus; bloodl evel
moni toringr ecommended.↓ l ev el
sofmet hadone.↑

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1042
ri
sper idoneandt hioridazi nelev els;mayneedt o↓ dose.
May↑ l ev elsofsi l
denaf il
,vardenaf ilort adal afil
;may
resultinhy pot ensi on, sy ncope, visual changes, and
prolongeder ect i
on( ↓ doseofsi l
denaf ilto25mgq48hr ,
vardenaf ilto2. 5mgq72hr ,andt adalafilto10mgq72hr
recommended) .↓ l ev elsofser trali
neandpar oxetine;
adjustdosebycl i
ni cal response.May↓ l ev elsand
cont racept iveef ficacyofsomeest rogen- basedhor monal
cont racept ivesi ncludi nget hinyl estradiol (al t
ernativeor
additional met hodsofcont racept ionr ecommended) .May
↑r iskofadv erseef f
ect swi thsal met erol;concur rentuse
notr ecommended.May↑ bosent anl evels; init
iate
bosent anat62. 5mgoncedai lyorev eryot herday ;if
patiental readyr ecei vingbosent an,discont inuebosent an
atleast36hrbef orei nitiati
onofdar unav irandt henr estart
bosent anatl east10day slaterat62. 5mgoncedai lyor
everyot herday .May↑ t adalafil (
Adci rca)l ev el
s;init
iate
tadalaf il(Adci r
ca)at20mgoncedai l
y;ifpat i
entalready
receiv i
ngt adalfil(Adci rca) ,
discont i
nuet adal afi
l (
Adci r
ca)
atleast24hrbef orei nitiati
onofdar unav irandt henr estart
tadalaf il(Adci r
ca)atl east7day sl aterat20mgoncedai l
y.
May↑ col chicinel ev els; ↓ doseofcol chi cine;donot
admi nist ercol chicinei fpatientshav er enal orhepat i
c
i
mpai rment .Concur r
entusewi thr altegrav irmay↑ r iskof
rash.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1043
Drug-
Nat uralProduct
:St.John'
swort↑ metaboli
sm and
may↓ ant i
retr
ovir
aleff
ecti
veness;
concur
rentuseis
contr
aindicated.

DOSAGE
Genot ypictest
ingofthebaselinev i
rusisr ecommended
priortoiniti
ati
ngtreatmenti
nt herapy-experienced
pat i
ents.Thistest
ingisperf
ormedt oscreenf ordarunavir
resistanceassociatedsubsti
tuti
ons, whichmaybehel pful
i
ndet ermini
ngwhet hertheHIVv i
ruswi llbesusceptibl
eto
dar unavir
.
PO:(Adult
s):Ther apy-
naiv
e—800mgwi thri
tonavi
r100
mgoncedai ly
;Ther apy-
experi
enced(wit
hnodar unavir
resi
stanceassociatedsubsti
tuti
on)—800mgwi thrit
onavir
100mgoncedai l
y Ther
apy-experi
enced(wit
h≥1dar unavi
r
resi
stanceassociatedsubsti
tuti
onorifgenoty
pictesti
ng
notperfor
med) —600mgwi thri
tonavi
r100mgt wicedaily
.
PO:(Chi
l
dren≥6y r
):20–29kg—375mgwi thri
tonavi
r50
mgtwicedail
y;30–39kg—450mgwi t
hri
tonavi
r60mg
twi
cedail
y;≥40kg—600mgwi thri
tonavi
r100mgt wice
dai
ly
.

AVAI
LABI
LITY
Tabl
ets75mg,
150mg,
400mg,
600mg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1044
PATI
ENTTEACHI
NG
Emphasi zetheimpor tanceoft aki
ngdar unav i
rwi t
h
ri
tonavirexactl
yasdi rected,atevenl yspacedt i
mes
throughoutday.Donott akemor et hanpr escr i
bed
amountanddonotst opt akingwithoutconsul ti
ng
healthcareprofessional.Ifadoseofdar unav iror
ri
tonavirismissedbymor ethan6hr ,waitandt ake
nextdoseatr egularl
yschedul edtime.I fmi ssedby
l
esst han6hr ,t
akedar unavi
randr itonav i
r
i
mmedi atel
yandt hent akenextdoseatr egul arl
y
scheduledtime.Ifadosei sskipped, donotdoubl e
doses.Adv i
sepat i
entt oreadt hePat ientInf ormation
sheetbef or
estarti
ngt herapyandwi theachRx
renewal i
ncasechangeshav ebeenmade.

I
nst
ructpat
ientt
hatdar
unav
irshoul
dnotbeshar
ed
wi
thother
s.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

I
nform patientthatdarunav
irdoesnotcur
eAI DSor
pr
ev entassociatedoropportuni
sti
cinf
ect
ions.
Darunavirdoesnotr educetheri
skoftr
ansmissionof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1045
 HIVtoot hersthroughsexual cont actorblood
contamination.Cautionpatientt ouseacondom
duri
ngsexual cont
actandt oav oi
dshar i
ngneedl esor
donatingbloodt opreventspr eadingtheAI DSvirusto
others.Advisepatientthatthelong- t
erm effect
sof
darunavirareunknownatt histime.

I
nf orm pat i
entt hatdarunav i
rmaycause
hyper gl
y cemia, hepatotoxici
ty ,
andsev ereskin
react i
ons.Adv isepat i
entt onot i
fyhealthcare
professional prompt l
yi fsignsofhy perglycemia
(i
ncr easedt hir
storhunger ;unexplai
nedwei ghtloss;
i
ncr easedur ination;fati
gue; ordry,i
tchyskin),
hepat otoxici
ty( unexplainedf ati
gue,anorexia,nausea,
j
aundi ce, abdomi nalpainordar kuri
ne),orrashoccur .

Advisepatientstaki
ngoralcontr
acepti
vestousea
nonhormonal methodofbi
rthcontr
olduri
ngdarunav
ir
therapy.Advisefemalepat
ientstoavoi
d
breastf
eedingdur i
ngther
apywi t
hdarunavi
r.

Inf
orm pat i
entthatr
edi st
ribut
ionandaccumul at
ionof
bodyf atmayoccur ,causingcentralobesi
ty,
dorsocer v
ical
fatenlargement( buff
alohump),
peri
pher alwasti
ng,breastenlargement,and
cushingoidappearance.Thecauseandl ong-t
erm
eff
ectsar enotknown.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1046
 Emphasizetheimport
anceofregul
arfol
l
ow-upexams
andbloodcountstodeter
mineprogr
essandmonitor
forsi
deeffect
s.

DASATI
NIB
I
NDI
CATI
ONS
Chronic, accel
erated,ormy el
oidorl ymphoidblastphase
Phil
adel phiachromosomeposi tive(Ph+)chronicmyeloi
d
l
eukemi a( CML)r esist
ant/i
ntoleranttopri
ortherapy
(i
ncludingi mati
nib).Newlydiagnosedchr onicphasePh+
CML.Ph+acut elymphoblasticleukemia(ALL)
resi
stant /i
ntol
eranttopriortherapy.

ACTI
ON
Inhi
bit
styr
osinekinasesresult
ingininhi
bit
ionofl
eukemi
c
cell
li
nes,i
ncludingthoseresi
stanttoimati
nib.
Therapeut
icEffects:Decr
easedprogressi
onofleukemi
as.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:OB:
Lact
ati
on:
Pregnancyorl
act
ati
on.

UseCautiousl
yin:↑r i
skofQTcpr ol
ongati
onincludi
ng
hypokal
emia,hypomagnesemia,congenit
alpr
olongedQT
syndrome,concur
rentant
iar
rhyt
hmi cdrugsorotherdrugs

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1047
thatprol
ongQTi ntervalincludingcumul at
ivehigh-dose
anthracycl
inetherapy( correctelectrol
yteabnormal i
ti
es
pri
ort ouse);Concurrentuseofant i
coagulant
soragent s
thati
nhibitpl
ateletfunction; Pedi:Safet
ynotest abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEI ZURES, alt
eredaf fect, anxiety ,conf usion,
depr essi on, drowsi ness, headache, insomni a,mal ai se,
sy ncope, v er
tigo.EENT: conj unct i
v i
ti
s, dryey e,ti
nni tus.
Resp: PULMONARYEDEMA, PULMONARY
HYPERTENSI ON, asthma, pneumoni tis.CV: HF, MI , QTC
PROLONGATI ON, hyper tensi on, hypot ensi on, palpitations.
GI :abdomi nalpai n,alteredappet it
e,dy sgeusi a,dy spepsi a,
i
leus, mucosi tis,nausea, vomi ting.GU: RENALFAI LURE,
urinar yf r
equency .Derm: acne, al opeci a,dr yskin, flushing,
nai ldisor der,phot osensi tivi
ty ,pigmentdi sor der,rash,
sweat ing, urti
car i
a.Endo: gy necomast i
a.FandE: fluid
retent i
on, hypocal cemi a.Hemat :BLEEDI NGEVENTS,
anemi a, neut r
openi a, pancy topeni a,thrombocy topeni a.
Met ab: hy perur i
cemi a.MS: muscl e
i
nf lammat ion/weakness, muscul oskel etal pain.Neur o:
tremor .Mi sc: INFECTI ONS, PALMAR- PLANTAR
ERYTHRODYSESTHESI A, TUMORLYSI SSYNDROME.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1048
Drug-Dr ug: Thef ollowi ngdr ugsmay↑ dasat i
nibl evels
andr iskoft oxicitybyi nhi bitingCYP3A4: ket oconazol e,
i
traconazol e, cl
ar i
thromy cin, ritonav i
r,atazanav i
r,indinav i
r,
nefazodone, nelfinavir, saqui nav i
r,telit
hromy cin,and
voriconazol e; concur rentuseshoul dbeav oided.I f
concur rentusei sr equi r ed, ↓ doseofdasat inibmaybe
required.Thef oll
owi ngdr ugsmay↓ dasat iniblev elsby
i
nduci ngCYP3A4: dexamet hasone, pheny toin,
carbamazepi ne, ri
fampi n, r i
fabut in,andphenobar bital;
concur rentuseshoul dbeav oi ded.I fconcur rentusei s
required, ↑ doseofdasat inibmayber equired.Ant acids
mayal terabsor ption; simul taneoususeshoul dbeav oided
(doseatl east2hour spr i
ort oor2hour saf terdasat ini
b).
H2bl ocker sandpr otonpumpi nhibitorsmayal so↓
absor ptionandshoul dbeav oi ded; considerant aci dsas
anal ternative.Al fentani l
, cycl ospor ine,fentany l,pimozi de,
quinidine, siroli
mus, tacr olimus, orer gotalkal oids
(ergotami ne, di
hy droer got ami ne)shoul dbeadmi nistered
withcaut i
onbecauseoft heirnar r
owt herapeut ici ndices
andt heunpr edictabilityofenzy mei nduction/ i
nhi biti
on.
Dr
ug-NaturalProduct:
St.John'
swortmay↓ l
evel
sand
ef
fect
iveness;avoidconcur
rentuse.
Drug-
Food:Grapef
rui
tjui
cemay ↑l
evel
sandr
iskof
toxi
cit
y;av
oidconcur
rentuse.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1049
DOSAGE
Accel
erat
ed,
ormy
eloi
dorl
ymphoi
dbl
astphaseCMLor
Ph+ALL
PO:( Adults)
:140mgoncedai l
y;may↑ t o180mgonce
dail
yi fhematol
ogicorcyt
ogeneti
cresponseisnot
achiev ed;
Concurr
entstr
ongCYP3A4i nhi
bit
or—Ini
ti
ateat
40mgoncedai ly
.
Chr
oni
cphaseCML
PO:(Adult
s) :100mgdai l
y;may↑ t o140mgoncedail
yif
hematologicorcy t
ogenet
icresponsei
snotachi
eved;
Concurr
entstr ongCYP3A4inhibit
or—I
nit
iat
eat20mg
oncedaily
.

AVAI
LABI
LITY
Tabl
ets20mg,
50mg,
70mg,
80mg,
100mg,
140mg;

PATI
ENTTEACHI
NG
Explai
npurposeofdasat i
nib.Instr
uctpati
enttotake
dasati
nibatthesamet i
meeachday .Donotstopor
changedosewi t
houtconsul t
inghealthcare
prof
essional
.Ifadoseismi ssed, omitandtakenext
scheduleddoseatregularti
me; donotdoubledoses.
Advisepati
enttoreadthePat ientInf
ormati
onsheet

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1050
 pri
ortostar
ti
ngt
her
apyandwi
theachRxr
efi
l
lincase
ofchanges.

Advisepat i
entt onotif
yheal t
hcareprofessi
onal
i
mmedi atelyiffever
,bleedingoreasybruisi
ng,
swelli
ng,wei ghtgain,orincreasi
ngshortnessof
breathorsi gnsandsy mptomsofpul monaryart
eri
al
hypertension( short
nessofbr eat
h,fat
igue,and
swelli
ng( anklesandl egs)occur.

Maycausedi zzi
ness.Cauti
onpati
entstoavoi
d
driv
ingorotheract
ivi
ti
esrequi
ri
ngalert
nessunti
l
responsetomedicati
onisknown.

Advisepat ienttonot i
fyheal t
hcareprofessi
onal
beforet aki
nganyRx, OTC, orher
balproduct
sori f
l
actosei nt
olerant.Advisepat i
ent
stoav oidt
aking
medi cinesthatr educest omachacidtoi mprove
absor pti
on.Medi ci
nest hatneutr
ali
zestomachaci d,
suchasant acids, maybeusedupt o2hr sbeforeor2
hrsaf terdasatinibdose.

Inf
orm pat
ientt
hatheadacheandmusculoskel
etal
painmayoccur;not
if
yhealthcar
epr
ofessi
onalif
sever
e.

Mayhaveterat
ogeni
ceffect
s.Adv
isepati
enttouse
ef
fect
ivecontr
acept
ionandtonot
ifyheal
thcare

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1051
 professi
onalifpr
egnancyispl
annedorsuspected,or
i
fbr east
feedi
ng.Womenwhoar epregnantormay
becomepr egnantshouldavoi
dhandli
ngcrushedor
brokentablet
s.Menr ecei
vi
ngdasati
nibshouldbe
advisedtowearacondom t oavoi
dpregnancyinthei
r
partner.

DAUNORUBI
CINCI
TRATELI
POSOME
I
NDI
CATI
ONS
Managementofadv
ancedKaposi
’
ssar
comai
nHI
V-
i
nfect
edpati
ent
s.

ACTI
ON
Formsacompl exwi t
hDNA, whichsubsequent l
yinhibit
s
DNAandRNAsy nthesis(cel
l
-cyclephase–nonspecific)
.
Encapsulati
oni nal i
posomei ncreasesuptakebyt umor
anddecr easessy stemictoxi
cit
y.TherapeuticEff
ects:
Deathofr apidl
yrepl i
cati
ngcell
s,parti
cular
lymalignant
ones.Alsohasi mmunosuppr essiveproper
ties.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odaunor
ubuci
nor
anyothercomponent
sint
hef
ormul
ati
on;
Pregnantor
l
actat
ingwomen.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1052
UseCaut
iousl
yin:
Act
ivei
nfect
ionsordecr
easedbone
mar rowr eser v
e;Geriatricpat i
entsorpatientswithot her
chronicdebi li
tati
ngillnesses; Mayr eacti
vateskinlesions
producedbypr evi
ousr adi ationtherapy;Hepaticorr enal
i
mpai rment( dosager educt i
onr ecommendedi fserum
creatinine>3mg/ dLorser um bili
rubin>1.2mg/ dL);
Patientswhohav ereceiv edpr ev i
ousanthracycli
net herapy
orwhohav eunder l
yingcar diovasculardisease(increased
ri
skofcar diotoxi
cit
y )
; Pat i
ent swithchil
dbear i
ngpot ential
;
Children( safetynotest ablishedf orDaunoXome) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: fati
gue, headache, depression,dizziness, insomni a,
mal aise.EENT: r hinitis,abnormal v
ision,sinusi ti
s.CV:
CARDI OTOXI CI TY, chestpai n,edema.GI :abdomi nal pain,
anor exia, const ipat ion,diarrhea,nausea, st omat itis,
tenesmus, vomi ting.GU: redur i
ne, gonadal suppr ession.
Derm: alopeci a, incr easedsweat ing,pruritus.Hemat :
anemi a,leukopeni a, t
hrombocy topenia.Local :phlebitisat
IVsite.Met ab: hy per uri
cemi a.MS: backpai n, arthralgia,
my algia.Neur o: neur opat hy.Misc:DaunoXome—al l
ergic
reactions, chills, fev er,backpai n,fl
ushi ng,chestt ightness,
i
nf l
uenza- li
kesy mpt oms.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1053
Drug-Drug:Addi
ti
vemy elosuppressionwithother
anti
neoplasti
cs.Maydecr easeantibodyresponset ol
ive-
vi
rusv acci
nesandincreaser i
skofadv er
ser eacti
ons.
Cyclophosphamideincreasestheriskofcardiotoxi
cit
y.

DOSAGE
Otherdoseregimensar
eused.I
nadul
ts,
cumulati
vedose
shouldnotexceed550mg/m2(450mg/m2ifprevi
ous
chestradi
ati
on)
I
V:(
Adul
ts)
:40mg/
m2q2wk.
Renal
Impai
rment
I
V:(Adul
ts)
:Ser
um cr
eat
ini
ne>3mg/
dL—r
educedoseby
50%.
Hepat
icI
mpai
rment
I
V:(Adul
ts)
: Ser
um bi
l
irubi
n1.2–3mg/ dL—r
educedoseby
25%;ser
um bil
ir
ubi
n>3mg/ dL—reducedoseby50%.

AVAI
LABI
LITY
Li
posomal
disper
sionf
ori
nject
ion2mg/
mLi
n25-
mLv
ial
;

PATI
ENTTEACHI
NG
I
nstr
uctpati
enttonoti
fyheal
thcareprofessi
onal
if
f
ever;chi
l
ls;
sorethr
oat;si
gnsofinfect
ion;bl
eedi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1054
 gums; bruisi
ng;petechiae;orbloodinur i
ne,stool,
or
emesi soccurs.Cautionpat i
enttoav oidcrowdsand
personswi thknowni nfecti
ons.Instructpati
enttouse
softtoothbrushandel ectri
crazor.Patientshouldbe
cauti
onednott odri
nkal coholi
cbev eragesortake
productscont ai
ningaspirinorNSAI Ds.

Instructpati
enttoinspectoralmucosaf oreryt
hema
andul cerat
ion.Iful
cerat
ionoccurs,advisepati
entto
usespongebr ushandr i
nsemout hwi t
hwat eraft
er
eatinganddr inki
ng.Stomatit
ispainmayr equir
e
managementwi thopi
oidanalgesi
cs.Per i
odof
highestriskis3–7day safteradminist
rati
onofdose.

I
nstr
uctpat
ienttonoti
fyheal
thcareprofessi
onal
i
mmediatel
yifir
regul
arheart
beat,
shortnessofbreat
h,
orswel
li
ngoflowerextremi
ti
esoccurs.

Di
scusswithpati
entpossibi
l
ityofhairloss.Expl
ore
methodsofcopi
ng.Regrowthofhai rusuall
ybegins
wi
thin5wkafterdiscont
inui
ngtherapy.

Inf
orm pat
ientt
hatmedicat
ionmayturnur
iner
eddi
sh
colorf
or1–2day saf
teradmini
str
ati
on.

I
nfor
m patientthatt
hismedi
cati
onmaycause
i
rr
eversi
blegonadalsuppr
essi
on.Advi
sepat
ientt
hat
t
hismedicationmayhaveter
atogeni
ceff
ect
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1055
 Cont
racept
ionshoul
dbeusedduri
ngther
apyandf
or
atl
east4moaf t
erther
apyi
sconcl
uded.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Daunor
ubi
cinhy
drochl
ori
de
I
NDI
CATI
ONS
I
ncombinat
ionwi
thot
herant
ineopl
ast
icsi
nthet
reat
ment
ofl
eukemi
as.

ACTI
ON
Formsacompl exwi t
hDNA, whichsubsequentl
yinhibi
ts
DNAandRNAsy nt
hesis(
cell
-cycl
ephase-nonspeci
fic)
.
Therapeuti
cEff
ects:Deathofrapi
dlyrepl
i
catingcel
ls,
parti
cul
arlymal
ignantones.Alsohasimmunosuppr essi
ve
propert
ies.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odaunor
ubuci
nor
anyot
hercomponent
sint
hef
ormul
ati
on;
Sympt
omat
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1056
HF/
arr
hyt
hmi
as;
Pregnantorl
act
ati
ngwomen.

UseCaut
iousl
yin:
Act
ivei
nfect
ionsordecr
easedbone
mar rowreser v
e; Geri
atri
cpat i
entsorpat i
entswithother
chronicdebilit
atingil
lnesses(dosager educti
on
recommendedf orpatients≥60y r
);Mayr eacti
vateskin
l
esionspr oducedbypr eviousradiat
iontherapy;Hepati
cor
renal i
mpairment( dosager educti
onr ecommendedi f
serum creatini
ne>3mg/ dLorserum bi l
ir
ubin>1.2mg/ dL);
Patientswhohav ereceivedpreviousant hr
acycli
netherapy
orwhohav eunder ly
ingcar di
ovasculardisease(incr
eased
ri
skofcar diotoxici
ty)
; Pati
entswithchildbeari
ngpotential
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:rhini
tis,abnormalvisi
on,si
nusitis.CV:
CARDIOTOXI CITY,
arrhyt
hmias.GI:nausea, vomi t
ing,
esophagiti
s,hepatoxici
ty,
stomatit
is.GU: redurine,
gonadalsuppr essi
on.Derm: al
opecia.Hemat :anemi a,
l
eukopenia,thrombocy t
openia.Local:phlebi
tisatIVsite.
Metab:hyper uri
cemia.Misc:chi
ll
s,fever.

I
NTERACTI
ONS
Drug-
Drug:Addi
ti
vemyelosuppressionwithother
anti
neopl
asti
cs.Maydecreaseantibodyresponsetoli
ve-
vi
rusvacci
nesandincr
easer i
skofadv er
ser eact
ions.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1057
Cy cl
ophosphamidei
ncreasesther
iskofcar
diot
oxicit
y.
Increasedri
skofhepat
ictoxi
cit
ywithot
herhepatotoxi
c
agent s.

DOSAGE
Otherdoseregimensar
eused.I
nadul
ts,
cumulati
vedose
shouldnotexceed550mg/m2(450mg/m2ifprevi
ous
chestradi
ati
on)
IV:(
Adul t
s<60yr
):45mg/m2/ dayf
or3daysi
nfir
st
course,thenf
or2daysofsecondcour
se(aspar
tof
combi nati
onr
egi
men).
IV:(
Adul t
s≥60yr
):30mg/m2/ dayf
or3daysi
nfir
st
course,thenf
or2daysofsecondcour
se(aspar
tof
combi nati
onr
egi
men).
IV:(
Chil
dren>2yr)
:25mg/ m2onceweekl
y(aspartof
combinati
onregi
men).I
nchil
dren<2y
rorBSA<0.5m2,
dosageshouldbedet
erminedonamg/kgbasis.

AVAI
LABI
LITY
Powderf
ori
nject
ion20mg/v
ial
;Sol
uti
onf
ori
nject
ion5
mg/mLin4-
mLv ial
s(20mg)
;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1058
Instr
uctpat i
enttonotifyheal t
hcar epr ofessionalif
fever;chill
s;sorethroat;signsofi nfection;bleeding
gums; bruisi
ng;petechiae;orbl oodinur ine,stool,or
emesi soccur s.Cautionpat ienttoav oidcrowdsand
personswi thknowni nfections.Instructpatienttouse
softtoot hbrushandel ectri
cr azor.Patientshoul dbe
cautionednott odri
nkal cohol i
cbev eragesort ake
product scont ai
ningaspirinorNSAI Ds.

Instructpati
enttoinspectoralmucosaf oreryt
hema
andul cerat
ion.Iful
cerat
ionoccurs,advisepati
entto
usespongebr ushandr i
nsemout hwi t
hwat eraft
er
eatinganddr inki
ng.Stomatit
ispainmayr equir
e
managementwi thopi
oidanalgesi
cs.Per i
odof
highestriskis3–7day safteradminist
rati
onofdose.

I
nstr
uctpat
ienttonoti
fyheal
thcareprofessi
onal
i
mmediatel
yifir
regul
arheart
beat,
shortnessofbreat
h,
orswel
li
ngoflowerextremi
ti
esoccurs.

Di
scusswithpati
entpossibi
l
ityofhairloss.Expl
ore
methodsofcopi
ng.Regrowthofhai rusuall
ybegins
wi
thin5wkafterdiscont
inui
ngtherapy.

Inf
orm pat
ientt
hatmedicat
ionmayturnur
iner
eddi
sh
colorf
or1–2day saf
teradmini
str
ati
on.

I
nfor
m pat
ientt
hatt
hismedi
cat
ionmaycause

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1059
 i
rreversi
blegonadalsuppr
ession.Advisepatientt
hat
thi
smedi cati
onmayhav eteratogeni
cef f
ects.
Contracepti
onshouldbeuseddur ingtherapyandfor
atleast4moaf tert
herapyisconcluded.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Deci
tabi
ne
I
NDI
CATI
ONS
Tr
eat
mentofv
ari
ousmy
elody
spl
ast
icsy
ndr
omes(
MDS)
.

ACTI
ON
I
nhibi
tsDNAmet hy
ltr
ansferase,causingapoptosi
s.Has
moreeff
ectonrapi
dlyrepl
icatingcell
s.Therapeuti
c
Eff
ect
s:Impr
ovedhemat ologicandclini
calmanifestat
ions
ofMDS.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Pregnancyor
l
act
ati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1060
UseCaut
iousl
yin:
Pat
ient
swi
thchi
l
d-bear
ingpot
ent
ial
(mal
esandfemales)
;Impai
redhepat
ic/r
enal
funct
ion;
Ger
i:
Maybemor esensi
ti
vetoef
fect
s;Pedi:
Safet
ynot
est
abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: confusion, fati
gue, insomni a,depressi on,lethar gy
.
EENT: blurr
edv ision.Resp: cough.CV: at ri
al fi
bril
lation,
pulmonar yedema, t
achy cardia.GI:abdomi nalpai n,
constipati
on,diarr hea, st
omat iti
s,vomiting, ↑l i
v er
enzymes.Der m: pet echiae,rash.FandE: edema,
hypokalemia, hypomagnesemi a,ascit
es.Hemat :
BLEEDI NG,anemi a, neutropenia,thrombocy topeni a.Local
:
i
njecti
onsi teirr
itation.Met ab: hypergl
ycemi a.MS:
art
hralgia,myalgia.Mi sc:INFECTI ON,fev er,
l
ymphadenopat hy .

I
NTERACTI
ONS
Drug-
Dr ug:↑r i
skofmyel
osuppressi
onwi t
hother
anti
neoplasti
cs,i
mmunosuppressants,orr
adi
ati
on
ther
apy.May↓ ant i
bodyresponsetoand↑ ri
skof
adversereacti
onsfr
om l
iv
ev ir
usvaccines.

DOSAGE
I
V:(
Adul
ts)
:15mg/
m2asacont
inuousi
nfusi
onov
er3hr

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1061
repeatedq8hrf or3days;cycl
eshouldberepeat
edq6
wkf orami nimum of4cy cl
es.or20mg/ m2asa
continuousinfusionov
er1hrr epeat
eddail
yfor5days;
cycleshouldber epeat
edq4wkf oraminimum of4cycl
es.

AVAI
LABI
LITY
Lyophi
l
izedpowderf
ori
nject
ion(
requi
resr
econst
it
uti
on)
50mg/ vi
al;

PATI
ENTTEACHI
NG
Cauti
onpati
enttoavoidcr owdsandper sonswith
knowninf
ecti
ons.Reportsy mptomsofi nfect
ion
(f
ever,
chi
ll
s,cough,hoarseness,sorethroat,
lower
backorsi
depain,painf
ul ordi
ffi
cultur
inati
on)
i
mmedi at
ely
.

Instructpati
entt
oreportunusualbleeding.Adv i
se
patientofthrombocy
topeniaprecautions(usesof t
toothbrushandelect
ri
cr azor
,avoidfall
s,donotdr i
nk
alcoholicbever
agesortakemedi cati
oncont aini
ng
aspirinorNSAIDs;maypr eci
pit
ategast r
icbleeding).

Infor
m pat i
entthatthismedicati
onmayhav e
terat
ogeniceffects.Adv i
sewoment ouseef f
ecti
ve
contracepti
onandav oidbecomingpregnantduri
ng
treat
ment .Advisemennott ofat
herachil
ddur i
ngor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1062
 f
or2moaf
tert
reat
ment
.

Def
erasi
rox
I
NDI
CATI
ONS
Chr
oni
cir
onov
erl
oadduet
obl
oodt
ransf
usi
ons.

ACTI
ON
Select
ivel
ychelatesi
ronandeliminatesiti
nfeces.
Therapeuti
cEffects:
Decreasedironwithdecreased
sequelaeofir
onexcess(hemosi derosi
s).

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
CCr<40ml
/mi
nor
serum creat
ini
ne>2xt heupperli
mitofnormal;Poor
performancestatusandhigh-r
iskmyelodyspl
asti
c
syndromesoradv ancedmal i
gnanci
es;Platel
etcount
<50,000/mm3; Sever
ehepaticimpair
ment .

UseCaut
iousl
yin:
Renal
impai
rment(
↑ri
skof
wor seningrenalfuncti
on);Mi l
dormoder atehepati
c
i
mpai r
ment ;Geri
:↑r iskofr enal
/hepaticimpairmentand
GIhemor rhage;Pedi:
Chi l
dren<2y r(safetynot
established);↑r i
skofGIhemor rhageinchi l
dren;
OB:Use
caut i
ouslyduringlact
ation,useinpr egnancyonlyifcl
ear
ly

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1063
needed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, di
zzi
ness.EENT: heari
ngloss,ocular
disturbances.Resp: cough.GI:GIBLEEDING/ ULCERATION,
HEPATI CFAI LURE,diar
rhea,nausea,vomi t
ing,abdominal
pain,drug-inducedhepatiti
s,↑l i
verenzymes.GU: ↑
ser um creati
nine,r
enalfail
ure.Derm:rash.MS: art
hral
gia.
Mi sc:fever.

I
NTERACTI
ONS
Drug-Drug: Alumi num- containingant aci dsmay↓
effecti
veness.Chol estyrami ne, ri
fampi n,pheny toi
n,
phenobar bital,andr i
tonav i
rmay↓ ef fecti
v eness; avoid
concurrentuseor↑ def erasiroxdose.Av oidconcur r
ent
usewi thot herironchel ators.↑ r iskofGIbl eeding
ulcerat
ionwi t
hNSAI Ds, corticosteroids, bisphosphonat es,
orant i
coagul ant s.May↓ l ev elsofCYP3A4subst r
ates.
May↑ l ev elsofandr iskofhy pogl y
cemi awi t
hr epagli
nide;
↓ doseofr epagl i
nide.May↑ l evel
sandr iskoft oxi
cityof
theophyll
ine; av oidconcur rentuseor↓ t heophy ll
inedose.
May↑ l ev elsofCYP1A2subst rates,includi ng
cyclobenzapr ine, imiprami ne, haloperidol ,
f l
uv oxamine,
mexi l
eti
ne, olanzapi ne, ti
zani dine,zil
eut on, and
zolmitri
ptan.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1064
DOSAGE
PO:(
Adult
sandChi l
dren≥2y
r):
20mg/ kg/
day
;adj
ust
edby
5–10mg/kgev er
y3–6moont hebasi
sofser
um f
err
it
in
l
evel
s(nottoexceed30mg/kg/day
).

Hepat
icI
mpai
rment
(
Adult
sandChildr
en≥2):Moderat
ehepat
ici
mpai
rment
(
Chi
ld-PughB)
—↓ i ni
ti
aldoseby50%.

AVAI
LABI
LITY
Tabl
etsf
oror
alsuspensi
on125mg,
250mg,
500mg;

PATI
ENTTEACHI
NG
Inst
ructpat
ientt
otakedef
erasi
roxasdi
rect
edat
samet i
meeachday .

Advi
sepati
entnott
otakealumi
num-
cont
aini
ng
ant
acidswi
thdefer
asi
rox.

Maycausedizziness.Advi
sepat
ientt
oavoi
ddrivi
ng
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

Advi
sepati
enttomai
ntai
nadequat
ehy
drat
ioni
f
vomi
tingordi
arr
heaoccur
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1065
 Adv i
sepati
enttonot
if
yhealt
hcareprofessi
onalif
rash,stomachpai
n,bl
eedi
ng,orchangesinvisi
onor
hearingoccur
.

Instr
uctpatientt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbeingtakenandt oconsultheal
thcar e
professi
onal bef
oretaki
nganyot herRx,OTC, or
herbalproducts.

DEFERI
PRONE
I
NDI
CATI
ONS
Treat
mentoftransf
usi
onalir
onoverl
oadduet
o
thal
assemiawhenotherchel
ati
onregi
mensar
e
i
nadequate.

ACTI
ON
Bondswithferr
icionstofor
m neutr
alcomplexeswhich
ar
etheneliminated.Ther
apeuti
cEff
ects:Decreasei
nir
on
over
loadasreflectedi
ndecreasedf
erri
ti
nlevels.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Pregnancy
shoul
dbeav
oided;
Lact
ati
on:
Breastf
eedi
ngnot

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1066
r
ecommended.

UseCaut
iousl
yin:
Renal
/hepat
ici
mpai
rment(
saf
etyand
effecti
venessnotestabli
shed)
;Anyr i
sk/histor
yofQT
prolongati
onincludi
ngHF, br
adycardi
a,diureti
cuse,
cardiachypertr
ophy,hypokal
emia,hypomagnesemi a;Pedi
:
Safeandef fect
iveuseinchil
drenhasnotbeen
establi
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache.CV:TORSADESDEPOI NTES.GI :
abdomi nalpai
n,nausea,changei nappet
ite,
vomiting,↑
l
iverenzymes.GU: chromaturi
a.Hemat :
AGRANULOCYTOSI S, neut
ropenia.MS:arthr
algi
a,
art
hropathy,backpain,ext
remitypain.Misc:↓ zi
ncl ev
els.

I
NTERACTI
ONS
Drug-
Drug:Concurr
entuseofot herdrugst hatcause
neutr
openi
a/agranulocytosi
smay↑ r iskof
neutr
openi
a/agranulocytosi
s.Mayal sochel ateother
concurr
entl
yadminist er
edpolyvalentcati
onsi nmi ner
al
suppl
ementsandant aci
ds,i
ncludingiron,aluminum and
zi
nc;wait4hrbetweenadmi ni
strati
on.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1067
PO:(Adult
s):25mg/ kgthr
eeti
mesdai
ly,
maybeadjusted
upto33mg/ kgthreeti
mesdail
y(r
ange75–99mg/kg/day
i
ndivideddoses)
.Doseshouldber
oundedtot
henearest
250mg( 1/2tabl
et).

AVAI
LABI
LITY
Tabl
ets500mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakedef
eri
prone3times/day.Take
misseddosesassoonasr emember ed,butnotjust
beforenextdose.Donotdoubledoses.

Advi
sepat ienttost
opt herapyandnot i
fyhealt
hcar
e
pr
ofessional i
mmedi atelyifsignsandsy mptomsof
i
nfecti
on(fev er
,sor
et hr oat)orifpal
pit
ati
ons,
di
zziness,syncope,orsei zuresoccur.

Inf
orm pat
ientt
hatr
eddish/br
ownur
inemayoccur
;
commonandnothar mful.

Advi
sefemalepati
entstousecontracepti
onand
avoi
dbreast
feedi
ngduringther
apy.Ifpregnancyis
pl
annedorsuspected,
notif
yhealt
hcar eprofessi
onal
pr
omptly.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1068
Def
eroxami
ne
I
NDI
CATI
ONS
Acutetoxi
cir
oningesti
on.Secondaryi
ronoverl
oad
syndromesassoci
atedwithmulti
pletr
ansf
usionther
apy
.

ACTI
ON
Chel
atesunboundiron,
formingawat er
-sol
ublecomplex
(f
err
ioxamine)inpl
asmathatiseasi
lyexcretedbythe
ki
dneys.Therapeut
icEf
fect
s: Remov
al ofexcessir
on.Al
so
chel
atesaluminum.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Sev
erer
enal
disease;
Anur
ia;
OB:
Ear
lypr
egnancyorchildbearingpotent
ial
(however,
may
beusedsaf
elyinpregnantpat i
entswit
hmoder at
e-t
o-
sev
ereacut
eironintoxicat
ion).

UseCaut
iousl
yin:
Pedi
:Chi
l
dren<3y
r(saf
etynot
est
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:bl
urr
edvisi
on,cat
aracts,
otot
oxi
cit
y.CV:
hypot
ensi
on,t
achycardi
a.GI:
abdominalpai
n,di
arr
hea.GU:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1069
reduri
ne.Derm: er
ythema,fl
ushing,urti
cari
a.Local
:
i
ndurati
onatinject
ionsit
e,painatinjecti
onsit
e.MS: l
eg
cramps.Misc:all
ergi
creacti
ons,fever,shockaft
errapi
dIV
admini
strat
ion.

I
NTERACTI
ONS
Drug-
Drug:
Ascorbi
caci
dmay↑ effect
ivenessof
defer
oxaminebutmayal
so↑ car
diaci
ront oxi
cit
y.

DOSAGE
Acut
eIr
onI
ngest
ion
I
M: IV:
(Adult
sandChi l
dren≥3yr)
:1g,
then500mgq4hr
for2doses.Addit
ional
dosesof500mgq4–12hrmaybe
needed(nottoexceed6g/ 24hr
).

Chr
oni
cIr
onOv
erl
oad
IM:IV:(AdultsandChil
dren≥3yr)
:500mg–1gdai l
yIM;
additi
onaldosesof2gshoul dbegivenIVforeachunitof
bloodtransfused(nott
oexceed1g/ dayinabsenceof
tr
ansfusions;6g/dayifpati
entr
ecei
vestransf
usions)
.
Subcut(Adul
tsandChi
ldr
en≥3yr
):1–2g/
day(
20–40
mg/kg/day)i
nfusedov
er8–24hr
.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1070
Powderf
ori
nject
ion500mg/
vial
,2g/
vial
;

PATI
ENTTEACHI
NG
Reinf
orceneedt okeepir
onprepar
ati
ons,al
l
medicati
ons,andhazardoussubst
ancesoutoft
he
reachofchi
ldren.

Reassur
epati
entthatr
edcolorat
ionofur
ineis
expect
edandref
lectsexcr
eti
onofexcessir
on.

Maycausedi zzinessorimpair
mentofv isi
onor
heari
ng.Cautionpatienttoav
oiddr i
vi
ngorother
acti
vi
ti
esrequi r
ingalert
nessunti
lresponsefr
om
medicati
onisknown.

Advisepat
ientnott
ot akev i
tami
nCpr eparati
ons
wit
houtconsulti
nghealthcarepr
ofessional,
because
ti
ssuetoxi
cit
ymayi ncrease.

Encour
agepati
ent
srequi
ringchr
onict
herapyt
okeep
fol
low-
upappoi
ntmentsforl
abtest
s.Eyeandhear
ing
examsmaybemoni t
oredevery3mo.

DEGARELI
X
I
NDI
CATI
ONS
Managementofadv
ancedpr
ost
atecancer
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1071
ACTI
ON
Reversi
blybr
ingstoGnRHr eceptor
sinthepi
tui
tarygl
and,
causi
ngadecr easeintherel
easeofgonadot
ropinsand
test
oster
one.Therapeuti
cEffect
s:Decr
easedspreadof
prost
atecancer.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Pr
evi
oushy
per
sensi
ti
vi
ty;
OB:
Pregnancy(maycausef
etal
har
m)orpotent
ial
forchi
l
d-
beari
ng;Lact
ati
on:Notr
ecommendedf
oruseinwoman.

UseCaut
iousl
yin:
Sev
erehepat
ic/
renal
impai
rment
;
Previ
oushi st
or yofcardi
ovasculardi
seasei ncl
uding
congenital
longQTsy ndrome,electr
oly
t eabnormalit
ies,
HF,concurrentusofcl assIAorclassIIIanti
arrhyt
hmi cs
(may↑ t heriskofQTpr olongati
on;Geri:Maybemor e
sensi
ti
v etodr ugeffect
s;Pedi:Safet
yandef fecti
veness
notestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zzi
ness, headache, i
nsomnia,weakness.GI :
↑l i
ver
enzymes,diarr
hea, nausea.GU: er
ecti
ledy sf
uncti
on,
test
icul
aratrophy.Endo: gynecomastia,pi
tui
tar
ygonadal
suppressi
on.Local: i
njecti
onsiter
eact i
ons.Metab:hot
fl
ashes,weightgain,↓ bonedensi ty
.Mi sc:f
ever,sweat
ing.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1072
I
NTERACTI
ONS
Drug-Drug:Concurrentusewi
thcl assIAanti
arrhyt
hmi
cs,
i
ncludingprocainamideandquinidineorcl
assI
II
anti
arrhythmicsincl
udingamiodaroneorsotalolmay↑
ri
skofQTpr olongati
onandseriousar r
hyt
hmias.

DOSAGE
Subcut(
Adul
ts):
240mgini
ti
all
y(givenastwoinj
ect
ions
of120mgeach,fol
l
owedbymaintenancedoseof80mg
ever
y28days.

AVAI
LABI
LITY
Powderforsubcut
aneousinj
ect
ion(r
equi
res
reconst
it
uti
on80mg/ vi
al,
120mg/ v
ial
;

PATI
ENTTEACHI
NG
Explai
npurposeofmedicati
ont opati
ent.I
nstr
uct
pati
enttonoti
fyheal
thcareprofessi
onalifan
i
njecti
onismissed.Adv
isepatienttoreadPati
ent
Labeli
ngcareful
l
y.

Inf or
m patientofpossi
blesideeffect
s(hotf
lashes,
flushing,i
ncreasedweight,decr
easedsexdr i
ve,
er ecti
ledysfunct
ion)Advi
sepatientthatr
edness,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1073
 swel
li
ng,anditchi
ngatinject
ionsit
eisusual
l
ymi
l
d,
sel
f-
li
mit
ing,anddecreaseswi t
hin3days.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Advi
sefemal
epatientt
hatwomenwhoar epregnant
orwhoplant
obecomepr egnantorbr
east
feedshoul
d
nott
akedegar
eli
x.

Del
avi
rdi
ne
I
NDI
CATI
ONS
TreatmentofHI
Vinf
ect
ioni
ncombi
nat
ionwi
thot
her
anti
retr
ovi
ral
s.

ACTI
ON
Bi
ndst orever
setr
anscri
ptase,inhi
bit
ingvir
alDNA
sy
nthesis.Ther
apeut
icEffects:Decr
easedv i
ral
loadand
i
ncreasedCD4cellcount
.Slowedpr ogressi
onofHIV
i
nfecti
onanddecreasedsev eri
tyofi
tssequelae

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1074
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentuseof
astemizole,benzodiazepi
nesandant i
arrhy
thmics,
dihydr
opy ri
dine,cal
cium channelbl
ockers(ni
fedi
pine)
,
ergotalkaloi
ds,amphet amines,andsi
ldenafi
l
.

UseCaut
iousl
yin:
Impai
redhepat
icf
unct
ion;
Achlor
hydri
a(requi
resacidicenvi
ronmentforabsorpt
ion)
;
OB:Lactat
ion:
Pedi:Safetynotestabl
ished;
HIV-i
nfect
ed
pat
ientsshoul
dnotbr eastf
ed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: f
ati
gue,headache.GI:di
arr
hea,↑ amyl
ase,↑li
ver
enzymes,nausea,vomiti
ng.Derm:rash,
prur
it
us.Mi
sc:f
at
redi
str
ibut
ion.

I
NTERACTI
ONS
Drug-Dr ug: Del
avir
dineinhibit
st hehepat icdr ug-
met abolizingenzymeCYPP3A4and↑ bl oodl evelsof
sedat i
ve/ hypnoti
csantiarr
hy t
hmi cs,calcium channel
blockers, ergotal
kaloids,sil
denaf i
l,andpi mozi de; t
hismay
resultinpot enti
all
ylif
e-threateningadv ersereact ions
(avoidconcur r
entuse).Concur rentadmi nist
rationof
clari
thromy ci
nsignif
icantly↑ l evelsofbot hagent s.
Concur rentadmi nist
rationwit hdi danosine↓ l ev elsof
bothagent s(separatedosesby1hr ).Fluoxet i
ne

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1075
andketoconazole↑ delavirdinelevels.Ant acids↓
absorpti
on(donotusewi thin1hrofeachot her)
.
Histamineblockers↓ absor ption(av oidchr oni
cuse).
Levelsare↓ byr if
abuti
n,rifampi n,pheny t
oin,
phenobarbit
al,andcarbamazepi ne( avoidconcur r
entuse)
.
↑l evel
sofampr enavi
r,i
ndinav ir
,andsaqui navi
r(dosage
reducti
onsmaybenecessar y).Concur rentusewi th
saquinavi
rmay↑ r i
skofliverdy sfunction.
Drug-Nat ur
alProduct:
UsewithSt.John’
swortmay↓
l
ev elsandef f
ecti
veness,
incl
udi
ngdev el
opmentofdr
ug
resistance.

DOSAGE
PO:
(Adul
ts)
:400mg3t
imesdai
l
y.

AVAI
LABI
LITY
Tabl
ets100mg,
200mg;

PATI
ENTTEACHI
NG
Emphasi zet heimportanceoftaki
ngdelavir
dineas
di
r ected,atevenlyspacedt i
mesthroughoutday.Do
nott akemor ethanprescribedamountanddonot
stopt aki
ngwi thoutconsulti
ngheal
thcare
professional.Takemi sseddosesassoonas

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1076
 r
emember
ed;
donotdoubl
edoses.

I
nst
ructpat
ientt
hatdel
avi
rdi
neshoul
dnotbeshar
ed
wi
thother
s.

Advi
sepati
entt
oavoidtaki
ngothermedicat
ions,
pr
escri
pti
onorOTC,wit
houtconsult
ingheal
thcare
pr
ofessi
onal
.

Infor
m pat i
entthatdelavir
dinedoesnotcur eAI DSor
preventassociatedoroppor tunistici
nfections.
Delavi
rdinedoesnotr educether iskoftransmi ssion
ofHIVt ootherst hr
oughsexual contactorbl ood
contami nat
ion.Cautionpatienttouseacondom and
avoidshar i
ngneedlesordonat i
ngbl oodt opr event
spreadingtheAI DSv i
rustoot hers.Advisepat ientthat
thelong-ter
m effectsofdelav i
rdineareunknownat
thi
st i
me.

Inf
orm pat i
entthatr
edi st
ribut
ionandaccumul at
ionof
bodyf atmayoccur ,causingcentralobesi
ty,
dorsocer v
ical
fatenlargement( buff
alohump),
peri
pher alwasti
ng,breastenlargement,and
cushingoidappearance.Thecauseandl ong-t
erm
eff
ectsar enotknown.

Emphasi
zethei
mport
anceofregul
arfol
l
ow-upexams
andbl
oodcount
stodeter
mineprogr
essandmonitor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1077
 f
orsi
deef
fect
s.

Deni
l
euki
ndi
ft
it
ox
I
NDI
CATI
ONS
Persistentorr
ecurr
entcutaneousT-
cel
ll
ymphomawhose
malignantcell
sexpresstheCD25componentoft
he
i
nterleukin-
2(I
L-2)r
eceptor.

ACTI
ON
Af usi
onproteint hatcontainspartsofdi
phtheri
atoxin
fusedtoIL-2.Directscy t
ocidalacti
onofdipht
heriatoxi
nto
cellswi
thIL-2recept ors.Therapeuti
cEff
ects:Regressi
on
ofcutaneousT- celll
y mphoma.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odeni
l
euki
n,
di
pht
her
iat
oxi
n,ori
nter
leuki
n-2;
Lact
ati
on.

UseCaut
iousl
yin:
Ger
iat
ri
cpat
ient
s(i
ncr
easedr
iskof
adversereacti
ons);
Pre-existi
ngcardi
ovasculardi
sease
(i
ncreasedriskofvascularleaksyndr
ome) ;OB:Pedi
:
Pregnancyorchildr
en(safet ynotest
abl
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1078
CNS: dizziness, headache, confusion, insomni a,
ner vousness, weakness.EENT: l
ossofv isual acuity,loss
ofcol orv isi
on.Resp: cough, dyspnea, phar y ngitis,rhini
tis.
CV: chestpai n, edema, hypotension, tachy car dia,
arrhy thmi a,
hy pot ension, t
hrombot i
cev ent s.Der m: rash,
prur i
tis, sweat i
ng.GI :anorexia,diarrhea, nausea, v
omi t
ing,
const ipation,dy spepsi a,dysphagi a,incr eased
transami nases.GU: albumi nuria,hemat ur i
a.FandE:
hy pocal cemi a, dehy dration,hypokal emi a.Hemat :anemi a,
l
eukopeni a,t
hr ombocy topenia.Local : i
nject ionsi t
e
react ions.Met ab: hy
poal bumi nemi a,wei ghtl oss.MS:
my algia, art
hral gi
a.Neur o:paresthesi a.Mi sc: ACUTE
HYPERSENSI TIVI TYREACTI ONS, chill
s, fev er,flu-l
ike
sy ndr ome, i
nfect ion.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
IV:(
Adul
ts)
:9or18mcg/
kg/
dayf
or5consecut
iveday
s
ever
y21days.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion(
frozen)150mcg/
mL;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1079
PATI
ENTTEACHI
NG
Adv i
sepat ienttonot i
fyheal thcar epr of
essi onal i
f
fever;chil
ls;dyspnea; di
arrhea; rash;persi
st entcough;
sorethr oat;si
gnsofi nfection; edema; f
lu-
like
sympt oms; bl
eedinggums; br uising;petechiae; or
bloodi nurine,stool,oremesi soccur .Cautionpat i
ent
toavoi dcrowdsandper sonswi thknowni nf ecti
ons.
Instr
uctpat ienttousesof ttoot hbrushandel ect
ri
c
razor.Caut i
onpat ientnott odr inkalcoholicbev er
ages
ortakepr oduct scont ai
ningaspi ri
norNSAI Ds.

DENOSUMAB
I
NDI
CATI
ONS
Pr olia:Treat mentof :Osteoporosisinpost menopausal
womenwhoar eathi ghriskforf r
actureort hosewhohav e
failed/ areintolerantofconv entionalost eoporosi
st herapy,
Menr eceivingandr ogendepr ivati
ont her apyfor
nonmet astaticprostatecancerwhoar eathi ghriskfor
fract ure,Womenr eceivi
ngadj uvantar omat aseinhibit
or
ther apyf orbr eastcancerwhoar eathi ghr i
skforfracture.
Xgev a: Prevent i
onofskel etal
-r
elatedev entsinpati
ents
wi thbonemet astasesfrom solidtumor s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1080
ACTI
ON
Amonocl onal anti
bodyt hatbindsspecificall
yt othe
humanr ecept oractivatorofnuclearfactorkappa- B-ligand
(RANKL),whi chi srequiredforformation, f
unct i
onand
survi
valofost eoclasts.Bindinginhi
bitsost eoclast
formati
on, funct i
onandsur vival
.Therapeut icEffects: ↓
boneresorpt i
onwi t
h↓ occur r
enceoff ractures( v
ertebral
,
nonvert
ebr al,hip)orotherskeletal
-r
elatedev ents(e.g.
radi
ati
ont herapyt obone, surgerytobone, spinalcord
compression) .↑ bonemass.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
pocal
cemi
a(cor
rectbef
ore
admini
steri
ng);adequat
esupplement
alcal
cium and
vi
taminDr equir
ed;Lact
ati
on:Avoi
duse;↓ mammar y
gl
anddev elopmentandlact
ati
on.

UseCaut
iousl
yin:
Condi
ti
onsassoci
atedwi
th
hypocalcemiai ncl
udinghy popar athyroidism,previous
thyr
oid/parathyroi
dsur gery,mal absor pti
onsy ndromes,
hist
oryofsmal li
ntesti
nal excisi
on, renal
i
mpai rment/hemodi alysis(CCr<30mL/ min);monitor
ing
ofcalci
um andot hermi neralsrecommended; Concurrent
useofi mmunosuppr essant sordiseasesr esult
ingin
i
mmunosuppr ession(↑r i
skofi nfection);Geri
:Maybe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1081
moresensi
ti
vet odrugeff
ects;OB:Useonl
ywhen
pot
enti
albenefi
tjusti
fi
espotenti
alr
iskt
ofet
us;
Pedi
:
Saf
etyandeffecti
venessnotestabl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache.GI:PANCREATI TIS,
diarr
hea,nausea.GU:
cyst
iti
s.Der m:dermatiti
s,eczema, r
ashes.FandE:
hypocalcemia,hypophosphat emia.Metab:
hypercholester
olemia.MS: backpain,extr
emitypain,
muscul oskel
etalpai
n, ost
eonecrosisofthejaw,
suppressionofbonet urnover.Resp:dyspnea,cough.Misc:
i
nfection.

I
NTERACTI
ONS
Drug-
Drug:Concur
rentuseofi
mmunosuppr
essant
s↑ r
isk
ofinf
ecti
on.

DOSAGE
Pr
oli
a
Subcut(
Adul
ts)
:60mgev
ery6mo.

Xgev
a
Subcut(
Adul
ts)
:120mgev
ery4weeks.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1082
AVAI
LABI
LITY
Injecti
on(Prol
ia)60mg/ 1mLinpr
efi
ll
edsyr
ingesand
single-
usev i
als.I
nject
ion(
Xgev
a)120mg/1.7mLinsingl
e
-usev i
als.

PATI
ENTTEACHI
NG
Expl
aint hepur poseofdenosumabt opat
ient.I
fa
doseismi ssed,admini
steri
njecti
onassoonas
possible;scheduleinj
ect
ionsev er
y6mof rom dat
eof
l
astinjection.

Advisepati
enttoeatabal anceddietandconsult
heal
t hcar
eprofessionalabouttheneedf or
supplementalcal
cium andv i
taminD( seeAppendi
x
M).

Adv isepati
entt onot ifyheal t
hcar epr ofessi
onal
i
mmedi atel
yifsi gnsofhy pocalcemi a(spasms,
twitches,orcrampsi nmuscl es; numbnessort ingling
i
nf ingers,t
oes, orar oundmout h) ,i
nf ect
ion(fever ,
chill
s,skinthatisr ed,swol len,hot ,ortendertot ouch;
sev ereabdomi nalpai n,frequentorur gentneedt o
urinateorburningdur ingur i
nation), orskinreactions
(redness,it
ching, r
ash, dr
yorl eat heryfeeli
ng,blisters
thatoozeorbecomecr usty,peeling)occur .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1083
 Encouragepatientt
opart
ici
pateinr
egul
arexer
cise
andtomodi fybehavi
orst
hat↑ theri
skof
osteoporosi
s(stopsmoki
ng,reduceal
cohol
consumpt i
on).

Adv i
sepati
enttotakegoodcareofteethandgums
(brushandfl
ossregular
ly)andtoi
nform heal
thcar
e
professi
onaloft
herapypriort
odentalsurger
y.

Advisefemalepati
entstonot i
f yheal
thcare
professi
onali
fpregnancyi splannedorsuspect
edor
i
fbr east
feedi
ng.Encouragewomenwhobecome
pregnantduri
ngXgev atreatmentt oenrol
li
nAmgen’s
PregnancySurvei
ll
ancePr ogram.Pat i
entsort
heir
healthcarepr
ofessi
onal

Desf
err
ioxami
neMesy
lat
e
I
ndi
cat
ions
Acut
ei r
onpoisoni
ng;chr
onici
ronover
load;
alumi
nium
over
load;pr
imaryhemochromatosi
s.

Av
ail
abi
l
ity
I
NJECTI
ON5ml
and10ml
vial
(500mg/
vial
).

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1084
Cont
inuousi
ntr
avenousi
nfusi
on
AdultandChi ld-Begi nwith5mg/ kg/h,i
ncr easingover15
minut esift
oleratedt o15mg/ kg/h,tomi ni
mi zetheriskof
hypotension.Af t
er1t o2hr educet o3-4mg/ kg/hforthe
next22- 23hrs( maxdosei s100mg/ kgov er24hr s).
Patientswithcar diovascul
arcol l
apse:5mg/kg/ h(upto
max.of80mg/ kgi n24h. )Chronicironov erl
oad:
I
ntramuscul ar500t o1000mgdai ly,i
naddi ti
on2gby
i
ntravenousi nfusionwi t
heachuni tofbloodt ransf
used.

Cont
rai
ndi
cat
ions
Sev
erer
enal
disease;
pregnancy

Pr
ecaut
ions
Renal i
mpairment ;ey
eandearexami nati
onsbefor
eandat
3-mont hi
ntervalsduri
ngtreatment;alumini
um
encephalopathy( mayexacerbateneurologi
cal
dysfuncti
on);chil
drenunder3y ears(mayr et
ardgr
owth)
;
l
actation;i
nteracti
ons.

Desi
prami
ne
I
NDI
CATI
ONS
Depr
essi
on.Unl
abel
edUses:
Chr
oni
cpai
nsy
ndr
omes.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1085
Anxi
ety
.Insomni
a.

ACTI
ON
Potenti
atestheeffectofserotoni
nandnor epinephr
inein
theCNS.Hassi gnifi
cantanti
choliner
gicproperti
es.
Therapeuti
cEffects:Ant
idepressantacti
on(maydev el
op
onlyoverseveralweeks).

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Angl
e-cl
osur
egl
aucoma;
RecentMI
,
hear
tfai
l
ure,
knownhi
stor
yofQTcpr
olongat
ion.

UseCaut
iousl
yin:
Pat
ient
swi
thpr
e-exi
sti
ng
car diovascul ardisease; Familyhistor yofsuddendeat h,
car diacar rhythmias, orconduct i
ondi stur bances; Prostati
c
hy perplasia( ↑ suscept ibil
it
ytour inar yret ention);Histor
y
ofsei zures( t
hresholdmaybe↓; sei zur esmaypr ecede
thedev elopmentofcar diacarrhythmi asordeat h);May↑
ri
skofsui cideattempt /
ideati
onespeci all
ydur i
ngear ly
treat mentordoseadj ust ment;ri
skmaybegr eaterin
chi l
drenoradol escent s;OB: Usedur ingpr egnancyonl yif
pot ent i
almat ernal benefitoutweighsr iskst of etus;use
dur inglact ati
onmayr esulti
nneonat al sedat ion;Pedi :
Chi ldren<12y r(safetynotest abli
shed) ; Ger i
:↑ sensi ti
vi
ty
toef f
ects.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1086
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness, f
atigue.EENT: bl
ur r
edv i
sion,dryeyes,
drymout h.CV: ARRHYTHMI AS,hypotension,ECGchanges.
GI:consti
pation, dr
ug-inducedhepat it
is,
par al
yti
cileus,
↑
appetit
e,weightgai n.GU: uri
naryretenti
on, ↓libi
do.Derm:
photosensit
iv i
ty.Endo: changesinbloodgl ucose,
gynecomast ia.Hemat :bl
ooddy scrasi
as.

I
NTERACTI
ONS
Drug-Dr ug: Desi prami nei smet abolizedi nthel iverbyt he
cytochromeP4502D6enzy meandi t
sact i
onmaybe
affectedbydr ugswhi chcompet eformet abol ism byor
alt
ert heact i
vityoft hisenzy mei ncludingot her
antidepressant s, phenot hiazi
nes, carbamazepi ne, class1C
antiarrt
hy thmi cs( pr opaf enoneorf l
ecai nide,); whenused
concur rent l
ydose↓ ofoneort heot herorbot hmaybe
necessar y.Concur r entuseofot herdr ugst hati nhibitthe
activi
tyoft heenzy me, includingci met i
dine, qui nidine,
ami odar one, andr itonav i
r,mayr esultin↑ ef fect s.May
causehy pot ensi on, tachy cardia,andpot enti
al lyf atal
reactionswhenusedwi thMAOi nhibit
or s(av oid
concur rentuse—di scont i
nue2wkpr i
ort o).Concur rent
usewi t
hSSRIant idepr essant smayr esul ti
n↑ t oxicityand
shouldbeav oided( fl
uoxet ineshoul dbest opped5wk

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1087
bef ore) .Concur r entusewi thcl onidinemayr esul tin
hyper tensi vecr isisandshoul dbeav oided.Pheny t oi
nmay
↓l evel sandef fectiv eness; ↑ dosesofdesi pr ami nemay
ber equi r
edt otreatdepr ession.Concur rentusewi th
l
ev odopamayr esul tindel ayed/ ↓ absor pti
onofl evodopa
orhy per t
ensi on.Bl oodl evel sandef fectsmaybe↓ by
ri
fampi n, car bamazepi ne,andbar biturates.Concur r
ent
usewi t
hmoxi fl
oxaci n↑ r iskofadv er secar diov ascul ar
react ions.↑ CNSdepr essi onwi thot herCNSdepr essants
i
ncl udi ngal cohol ,ant ihistami nes, cl
oni dine,opi oid
anal gesi cs, andsedat i
v e/hy pnot ics.Bar bituratesmayal t
er
bloodl ev el
sandef fect s.Adr ener gicandant ichol inergic
sideef fectsmaybe↑ wi t
hot heragent shav ingt hese
proper ti
es.Hor monal cont racept ives↑ l evelsandmay
causet oxicity.Cigar ettesmoki ngmay↑ met abol ism and
alteref fect s.
Drug-
NaturalProduct
:Concomit
antuseofkava-
kav
a,
val
eri
an,orchamomi l
ecan↑ CNSdepr essi
on.↑
anti
chol
i
ner gi
ceffect
swithji
msonweedandscopoli
a.

DOSAGE
PO:(
Adul
ts):100–200mg/
dayasasi
ngl
edoseori
n
di
vi
deddoses(upto300mg/day
).
PO:
(Ger
iat
ri
cPat
ient
s):
25–50mg/
dayi
ndi
vi
deddoses

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1088
(
upt
o150mg/
day
).
PO:(Chi
l
dren>12yr
):25–50mg/ dayi
ndi
vi
deddoses,
may
↑ asneededupto100mg/ day
.
PO:(
Chi
ldr
en6–12y
r):
10–30mg/
day(
1–5mg/
kg/
day
)in
di
vi
deddoses.

AVAI
LABI
LITY
Tabl
ets10mg,
25mg,
50mg,
75mg,
100mg,
150mg;

PATI
ENTTEACHI
NG
Instructpat i
enttotakemedi cationasdi rected.Take
mi sseddosesassoonaspossi bleunlessal most
timef ornextdose; ifregimeni sasi ngledoseat
bedt i
me, donott akeint hemor ningbecauseofsi de
effects.Adv i
sepat i
entt hatdrugef f
ectsmaynotbe
not i
cedf oratleast2wk.Abr uptdi scontinuati
onmay
causenausea; vomi ti
ng; di
arrhea; headache; t
rouble
sleeping,wi t
hv i
viddreams; andi r
rit
abil
ity.I
nstruct
pat i
enttor eadtheMedi cati
onGui depriortostarti
ng
andwi t
heachRxr efil
lincaseofchanges.

Maycausedr owsinessandbl
ur r
edv i
sion.Cauti
on
pat
ienttoavoiddriv
ingandotheracti
viti
esrequi
ring
al
ertnessunt
ilresponsetodr
ugi sknown.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1089
Orthostat
ichy potensi
on,sedation,andconfusionare
commondur i
ngear l
ytherapy,especial
lyi
nt heelder
ly.
Protectpatientfr
om fall
s.Insti
tutefall
precauti
ons.
Adv i
sepatienttomakeposi t
ionchangessl owly.

Advisepati
enttoav
oidal
cohol orot
herCNS
depressantdr
ugsduri
ngandf or3–7daysaf
ter
ther
apyhasbeendiscont
inued.

Advisepati
ent,fami l
y ,andcar egiverstolookfor
sui
cidali
ty,
especi all
ydur ingear l
ytherapyordose
changes.Notifyhealthcar eprofessionalimmediatel
y
i
fthoughtsaboutsui cideordy ing,attemptsto
commi tsuici
de, neworwor sedepr essi
onoranxi et
y,
agit
ati
onorr estlessness, panicattacks,insomnia,
neworwor seirritabi
lit
y ,aggressiveness,acti
ngon
dangerousimpul ses, mani a,orotherchangesi n
moodorbehav ioroccur .

Instructpatientt onot i
fyheal
thcareprofessionalif
urinaryretention, drymouth,orconsti
pationpersists.
Sugar l
esscandyorgum maydi minishdrymout h, and
ani ncreasei nfluidsorbulkmaypr eventconst i
pation.
Ifsy mptomsper sist
,dosereduct
ionor
discont i
nuationmaybenecessar y
.Consul thealt
h
carepr ofessional ifdrymouthpersist
sformor ethan
2wk.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1090
 Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

I
nform pat
ientofneedt
omonitordi
etar
yint
ake.
I
ncreaseinappeti
temayleadt
oundesir
edweight
gai
n.

Al
ertpat
ientt
hatmedi
cat
ionmayt
urnur
inebl
ue-
gr
eenincolor
.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Advi
sefemal
epatient
stonot
ifyheal
thcar
e
pr
ofessi
onal
ifpr
egnancyi
splannedorsuspect
ed.

Ther
apyfordepressionisusuall
yprolonged.
Emphasi
zetheimpor tanceoffoll
ow-upexamsto
monit
oreff
ecti
venessandsi deeffectsandto
i
mprovecopingskil
ls.

Desi
rudi
n
I
NDI
CATI
ONS
Prevent
ionofdeep-
vei
nthr
ombosi
s(DVT)af
terhi
p-
repl
acementsurger
y.

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1091
Select i
velyinhi
bitsfr
eeandcl ot
-boundt hrombin.Inhi
bit
ion
ofthr ombi npreventsacti
vat
ionoffactor sV,VII
I,andXII;
conv ersionoff i
bri
nogent of
ibri
n;plat
eletadhesionand
aggr egation.Therapeuti
cEff
ects:Decreasedi nci
denceof
DVTandsubsequentpul monar yembolism afterhip-
replacementsur ger
y.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
onat
ural
or
recombi
nanthi
rudi
ns;
Act
ivebl
eedi
ng;
Coagul
ati
on
disor
der
s.

UseCaut
iousl
yin:
Renal
impai
rment(
dosagechange
recommendedi fCCr≤60mL/ min);Geri
atr
icpati
ent
s(due
toage-rel
atedrenali
mpairment)
;Hepatici
mpairment;
Pregnancy(useonlyifbenef
it
stomot heroutwei
ghfetal
ri
sk);Lact
ation,chi
l
dren(saf
etynotestabl
i
shed).
Exerci
seExtremeCaut ionin:Spinal
/epi
dural
anesthesi
a
(i
ncreasedriskofspinal/
epiduralhematomasandt hei
r
sequelae,
especiall
ywhenusedwi t
hNSAIDs,pl
atel
et
i
nhibit
ors,orotheranti
coagulants).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI
:nausea.Hemat:BLEEDING,anemi
a.Local
:i
nject
ion
si
ter
eacti
ons,woundsecreti
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1092
I
NTERACTI
ONS
Drug- Drug:Dext ran40, sy
stemiccor ticosteroids,
thrombol y t
ics,andot heranti
coagul ants↑ r iskofbl eedi
ng
(discont i
nuei fpossible;i
fnot,moni torlabor atoryand
cli
nical statusclosely).Agentsalteri
ngpl ateletf uncti
on
i
ncl udingsal i
cylates,NSAIDs,clopidogr el
,ticlopidine,
dipy r
idamol e,andgl ycoprot
einIIb/I
IIaant agoni stsalso↑
ri
skofbl eeding.

DOSAGE
Subcut(Adul
ts):
15mgev er
y12hr,st
art5–15mi npr
ior
tosurger
y,butaf
terr
egi
onalbl
ock(
ifused)
,forupto12
days.

Renal
Impai
rment
Subcut(Adul
ts):CCr31–60mL/mi
n—star
twith5mg
every12hr;f
urt
herdosesdet
ermi
nedbydail
yaPTT;CCr
<31mL/ min—st
artwith1.
7mgevery12hr
;furt
herdoses
determi
nedbydailyaPTT.

AVAI
LABI
LITY
Ly
ophi l
i
zedpowderf ori
nject
ion(r
equi
resr
econst
it
uti
on
wi
t hspecif
icdil
uent
)15.75mg/ vi
alwi
th0.
6mLampul eof
di
luent(contai
nsmannit
ol,deli
ver
s15mgdose);

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1093
PATI
ENTTEACHI
NG
Advi
sepati
entt
or epor
tsympt
omsofunusual
bl
eedi
ngorbrui
singtoheal
thcar
epr
ofessi
onal
i
mmediatel
y.

Inst
ructpatientnott
otakeaspi
ri
n,NSAIDs,
orher
bal
productsdur i
ngther
apywit
houtconsul
ti
ngheal
th
careprofessional
.

Desl
orat
adi
ne
I
NDI
CATI
ONS
Symptomsofall
ergi
cr hi
nit
is(
seasonal
andper
enni
al)
.
Chroni
cidi
opat
hicur
ticari
a.

ACTI
ON
Blocksper i
pheraleff
ectsofhistami nereleasedduri
ng
al
lergicreacti
ons.TherapeuticEffects:Decreased
sympt omsofal ler
gicreact
ions( nasalstuffi
ness,r
ed
swolleney es)
.Decreasedpr uri
tus,reductioninnumber
andsi zeofhivesinchronicidiopathicurt
icari
a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Lact
ati
on:
Lact
ati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1094
UseCaut
iousl
yin:
Hepat
icorr
enal
impai
rment(
↓ dose
to5mgev eryotherday)
;Geri:Dosingfortheelder
ly
shouldconsider↓ hepati
c,renal,
orcardiacfuncti
on,
concomi t
antdiseases,
otherdrugtherapyand↑ r i
skof
adversereacti
ons;Pedi:
Chil
dren<6mo( saf
etynot
establi
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:drowsiness(r
are).EENT:phar
yngi
ti
s.GI:dr
ymout
h.
Misc:
aller
gicreact
ionsincl
udi
nganaphyl
axis.

I
NTERACTI
ONS
Drug-
Dr ug:Thef oll
owinginteracti
onsmayoccur ,butar
e
l
esslikelytooccurwi thdeslorati
dinethanwithmor e
sedati
ngant ihi
stamines.MAOi nhibit
orsmay↑ and
prol
ongef fectsofantihist
ami nes.↑ CNSdepr essi
onmay
occurwi t
hot herCNSdepr essantsincl
udi
ngalcohol,
anti
depressant s,opi
oids,andsedat iv
e/hypnot
ics.

DOSAGE
PO:
(Adul
tsandChi
l
dren≥12y
r):
5mgoncedai
l
y.
Hepat
icI
mpai
rment
Renal
Impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1095
PO:
(Adul
tsandChi
l
dren≥12y
r):
5mgev
eryot
herday
.
PO:
(Chi
l
dren6–11y
r):
2.5mgoncedai
l
y.
PO:
(Chi
l
dren12mo–5y
r):
1.25mgoncedai
l
y.
PO:
(Chi
l
dren6–12mo)
:1mgoncedai
l
y.

AVAI
LABI
LITY
Tabl
ets5mg; Oral
l
y-di
sint
egrati
ngtabl
ets(
Redi
Tabs)(
tut
ti
fr
utt
i)2.
5mg, 5mg; Sy
rup(bubbl
egum)0.5mg/mL;In
combinat
ionwit
h:pseudoephedri
ne

PATI
ENTTEACHI
NG
Instr
uctpatient
stot
akedeslorat
idineasdirect
ed.Do
notincreasedoseorfr
equency;doesnotincrease
effect
ivenessandmayincreasesideeff
ects.

Mayr arel
ycausedrowsiness.Caut
ionpatientt
oavoi
d
driv
ingorotheract
ivi
ti
esrequiri
ngaler
tnessunti
l
responsetomedicati
onisknown.

Advi
sepati
entt
oavoidt
akingal
coholorot
herCNS
depr
essant
sconcur
rent
lywit
hthi
sdrug.

Advi
sepat
ientthatgoodoral
hy giene,
frequentri
nsi
ng
ofmout
hwi thwater,
andsugarlessgum orcandy
maymini
mi zedrymouth.Pat
ientshouldnot i
fydent
ist

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1096
 i
fdr
ymout
hper
sist
s>2wk.

Desmopr
essi
n
I
NDI
CATI
ONS
PO: Subcut:I
V: I
ntranasal:Treat
mentofcent raldi
abetes
i
nsipiduscausedbyadef i
ciencyofvasopressin.I
V:
I
ntranasal:Controlsbleedi
ngi ncer
taintypesof
hemophi l
iaandv onWi l
l
ebrand’sdi
sease.PO: Pr
imary
nocturnalenuresis.

ACTI
ON
Ananal ogueofnat urallyoccurri
ngv asopressi
n
(anti
diuret
ichormone) .Pri
mar yactionisenhanced
reabsorpti
onofwat erinthekidney s.Therapeut
icEffect
s:
Preventionofnoctur nalenuresis.Maintenanceof
appropriat
ebodywat ercontentindiabetesinsi
pidus.
Controlofbleedingincer tai
nt ypesofhemophi l
iaorv on
Will
ebrand’sdisease.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
chlorobut
anol
;Pati
entswit
hsever
etypeI
,ty
peII
Bor
platel
et-
type(
pseudo)vonWil
l
ebrand’
sdi
sease,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1097
hemophi
l
iaAwithf
act
orVI
IIl
evels<5%orhemophi
li
aB;
Renal
impai
rment(
CCr<50mL/ min)
;Hyponat
remi
a.

UseCaut
iousl
yin:
Angi
napect
ori
s;Hy
per
tensi
on;
Pat
ient
satriskf
orhy
ponat
remi
a;OB:
Lact
ati
on:
Saf
etynot
est
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, drowsiness, headache,li
stlessness.EENT:
i
ntranasal—nasal congest i
on, r
hini
ti
s.Resp: dy spnea.CV:
hypertension,hypotension,tachycardia(l
argeI Vdoses
only)
.GI :mildabdomi nalcramps, nausea.GU: vulv
al pai
n.
Derm: fl
ushing.FandE: wateri nt
oxicati
on/hy ponatremia.
Local:phlebiti
satIVsi t
e.

I
NTERACTI
ONS
Drug-Dr
ug:Chlor
propami de,clofibrate,
chlor
promazine,
l
amot ri
gine, SSRIsorcar bamazepinemay
enhancetheanti
diureti
cr esponset odesmopr essi
n.
Demeclocycli
ne,l
it
hium, ornor epinephri
nemaydi mini
sh
theanti
diur
eti
cresponset odesmopr essin.Largedoses
mayenhancet heeffectsofv asopr essors.

DOSAGE
Pr
imar
yNoct
urnal
Enur
esi
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1098
PO: (
Adult
sandChi
l
dren≥6yr)
:0.
2mgatbedt i
me;maybe
ti
trat
edupt o0.
6mgatbedt
imetoachi
evedesi
red
response.

Di
abet
esI
nsi
pidus
PO:(Adult
sandChildren)
:0.
05mgt wi
cedail
y;adj
ust
edas
needed(usual
range:0.1–1.
2mg/dayforadul
tsor0.
1–0.
8
mg/dayforchil
drenin2–3divi
deddoses)
.
I
ntr
anasal
:(Adult
sandChi
l
dren≥12y r
):DDAVP–5–40
mcg(0.
0.05–0.4mL)i
n1–3div
ideddoses.
I
ntranasal
:(Chi
l
dren3mo–12y r
):DDAVP–5–30mcg
(
0.05–0.3mL)in1–2div
ideddoses.
SubcutI
V:(Adul
tsandChi
l
dren≥12y
r):
2–4mcg/
dayi
n2
di
videddoses.
SubcutI
V:(Chi
ldr
en<12y
r):
0.1–1mcg/
dayi
n1–2
di
videddoses.

Hemophi
l
iaA/
vonWi
l
lebr
and'
sdi
sease
I
ntr
anasal
:(Adul
tsandChi
ldr
en>50kg)
:St
imat
e—1spr
ay
(
150mcg)ineachnostr
il
.
I
ntr
anasal
:(Adul
tsandChi
l
dren≤50kg)
:St
imat
e—1spr
ay
(
150mcg)inonenostri
l
.
I
V:(
Adul
tsandChi
l
dren>3mo)
:0.
3mcg/
kg,
repeat
edas

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1099
needed.

AVAI
LABI
LITY
Tablets0.1mg, 0.2mg; Nasal
spray(DDAVP)10
mcg/ spray—5-mLbot t
le(0.
1mg/ mL)contai
ns50doses) ;
Nasal spray(
Stimate)150mcg/ spray
;Rhi
naltubedeli
ver
y
syst
em- nasalsoluti
on2.5-mLvial
swithappl
icatort
ubes
(0.
1mg/ mL);I
njecti
on4mcg/ mL;

PATI
ENTTEACHI
NG
Adv i
sepat i
enttonotifyheal
thcareprof
essi onalif
bleedingisnotcont r
oll
edorifheadache,dy spnea,
heartburn,nausea,abdominalcramps,vul
v alpain,or
severenasal congesti
onorirri
tati
onoccurs.

Cauti
onpat
ienttoavoidconcur
rentuseofal
cohol
wit
hthismedicat
ion.

DiabetesInsipidus:Instr
uctpatientoni ntr
anasal
administr
ation.Medi cati
oni ssuppl i
edwi t
haf lexible
cali
bratedcat heter(rhi
nyl
e).Drawsol utionintorhinyle.
Inser
toneendoft ubeintonostril,bl
owont heot her
endtodeposi tsolut
iondeepi ntonasal cavity
.Anai r
-
fil
l
edsy ri
ngemaybeat tachedtot heplast i
ccathet er
forchil
dren,infants,orobtundedpat ients.Tube
shouldber i
nsedunderwat eraftereachuse.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1100
 Ifnasalsprayi
sused, primepumppr i
ortofir
stuseby
pressingdown4t imes.Caut i
onpatientthatnasal
sprayshouldnotbeusedbey ondthel abel
ednumber
ofsprays;subsequentspr ay
smaynotdel i
ver
accuratedose.Donotat tempttotransferremaini
ng
soluti
ontoanotherbot t
le.

I
nstructpati
entt
ot akemisseddosesassoonas
remember edbutnotifi
tisalmostt
imefort
henext
dose.Donotdoubledoses.

Advisepati
entthatr
hini
ti
sorupperr espi
rat
ory
i
nfecti
onmaydecr easeeffect
ivenessofthi
sther
apy
.
Ifi
ncreaseduri
neoutputoccurs,pati
entshoul
d
contactheal
thcareprof
essionalfordosage
adj
ustment .

Pati
ent
swi t
hdiabet
esinsi
pidusshoul
dcarr
y
i
denti
fi
cati
onatallt
imesdescri
bingdi
seasepr
ocess
andmedicati
onregi
men.

Desoni
de
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1101
ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroi
dsorcomponent sofvehi
cles(oi
ntmentor
cream base,preser
vat
ive,
alcohol)
;Untr
eatedbacter
ial
or
vi
rali
nfecti
ons.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cataracts, gl
aucoma, ortuberculosi
s(useoflarge
amount sofhi gh-potencyagent smaywor sencondi ti
on);
Patientswi thpr e-
existi
ngskinat rophy;Pr
egnancy ,
l
actation, orchi l
dren(chronichigh-doseusagemayr esul
t
i
nadr enal suppr essioninmot her,growthsuppressionin
chil
dren; chil
dr enmaybemor esusceptibl
etoadr enaland
growt hsuppr ession).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergi
ccont actdermati
tis,atr
ophy ,burni
ng,
dr
y ness,edema, fol
li
culi
ti
s,hypersensit
ivityreact
ions,
hypertri
chosis,hypopigmentat
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,
secondar yinfecti
on,stri
ae.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1102
Misc:
adrenal
suppressi
on(
useofoccl
usi
vedr
essi
ngs,
l
ong-t
ermtherapy
).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topical:(
Adult
sandChi l
dren≥12yr
):Applytoaff
ect
ed
area(s)2–4timesdail
y(dependsonpreparat
ionand
conditi
onbeingtr
eated).
Topi
cal
:(Chi
l
dren≥3mo)
:Appl
ytoaf
fect
edar
ea(
s)once
dai
ly
.

AVAI
LABI
LITY
Cream 0.05%;
Gel
0.05%;
Oint
ment0.
05%;
Lot
ion0.
05%;
Foam 0.05%;

PATI
ENTTEACHI
NG
Inst
ructpati
entoncorrecttechni
queofmedicati
on
administr
ati
on.Emphasizeimpor t
anceofavoi
dingthe
eyes.Ifadoseismissed,itshouldbeappl
iedassoon
asremember edunl
essal mostt i
meforthenextdose.

Caut
ionpat
ientt
ouseonl
yasdi
rect
ed.Av
oidusi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1103
 cosmeti
cs,bandages,dressings,
orotherskin
product
soverthet r
eat
edar eaunlessdir
ectedby
healt
hcareprofessi
onal
.

Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.

Advi
separent
sthatdesoni
deshoul
dnotbeusedt
o
tr
eatdi
aperdermat
it
is.

Caut i
onwoment hatmedicati
onshouldnotbeused
extensiv
ely,
inl
argeamount s,
orforprot
ract
ed
periodsift
heyarepregnantorpl
anningtobecome
pregnant.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onali
f
symptomsofunder l
yingdiseaser
etur
norwor senor
i
fsympt omsofinfect
iondev el
op.

Desoxi
met
asone

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1104
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroi
dsorcomponent sofvehi
cles(oi
ntmentor
cream base,preser
vat
ive,
alcohol)
;Untr
eatedbacter
ial
or
vi
rali
nfecti
ons.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cataracts,glaucoma, ortuberculosi
s( useofl arge
amount sofhi gh-
potencyagent smaywor sencondi ti
on);
Patientswi t
hpr e-
existi
ngski natrophy;OB: Lact at
ion:
Chronichi gh-doseusagemayr esultinadr enal
suppressioni nmot her,growthsuppr essioninchi ldr
en;
Pedi:Children<10y r(safetynotest abli
shed); chil
drenmay
bemor esuscept i
bletoadr enalandgr owt hsuppr ession.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1105
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topi
cal
:(Adul
ts)
:Appl
ytoaf
fect
edar
ea(
s)t
wicedai
l
y.
Topi
cal
:(Chi
l
dren≥10y
r):
Appl
ytoaf
fect
edar
ea(
s)once
dai
ly
.

AVAI
LABI
LITY
Cr
eam 0.
25%,
0.05%;
Gel
0.05%;
Oint
ment0.
25%;

PATI
ENTTEACHI
NG
 Inst
ructpati
entoncorrecttechni
queofmedicati
on
administr
ati
on.Emphasizeimpor t
anceofavoi
dingthe
eyes.Ifadoseismissed,itshouldbeappl
iedassoon
asremember edunl
essal mostt i
meforthenextdose.
 Caut
ionpat
ientt
ouseonl
yasdi
rect
ed.Av
oidusi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1106
 cosmeti
cs,bandages,dressings,
orotherskin
product
soverthet r
eat
edar eaunlessdir
ectedby
healt
hcareprofessi
onal
.
 Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.
 Caut i
onwoment hatmedicati
onshouldnotbeused
extensiv
ely,
inl
argeamount s,
orforprot
ract
ed
periodsift
heyarepregnantorpl
anningtobecome
pregnant.
 Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onali
f
symptomsofunder l
yingdiseaser
etur
norwor senor
i
fsympt omsofinfect
iondev el
op.

Desv
enl
afaxi
ne
I
NDI
CATI
ONS
Maj
ordepr
essi
vedi
sor
der
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1107
ACTI
ON
Inhi
bit
sserot
oni nandnorepi
nephr
inereuptakeintheCNS.
Therapeut
icEffect
s:Decr
easeindepressive
symptomatology,wit
hfewerrel
apses/recur
rences.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ovenl
afaxi
neor
desvenl
afaxi
ne;Concur
rentMAOi nhibit
orsorwithi
n14
daysofstoppi
nganMAOi nhibi
tor
;afterdesvenl
afaxi
neis
stoppedwait7daysunti
lstarti
nganMAOi nhibi
tor
;Shoul
d
notbeusedconcurrent
lywithvenl
afaxine.

UseCaut
iousl
yin:
Unt
reat
edcer
ebr
ovascul
aror
cardiovascul ardisease, i
ncludi ngunt r
eat edhy per
tension
(control BPbef oreiniti
ati
ngt herapy )
;Bipol ardi
sorder
(mayact iv
atemani a/hypomani a);Historyof↑ i ntr
aocular
pressur e/angle-closureglaucoma; Renal impairment
(considermodi fi
cat i
ons,doseshoul dnotexceed50
mg/ day ,especiallyinmoder atet osev erer enal
i
mpai rment )
;Hist or
yofsei zur esorneur ologicimpair
ment ;
Hepat i
ci mpai rment( doseshoul dnotexceed100mg/ day);
Ger i
:Consi derage- rel
ated↓ i nrenal funct i
on,↓ body
mass, concur r
entdi seasest ates, andmedi cati
ons;OB:
Lactation: Useonl yifmat ernal benef i
tout weighs
fetal
/infantr i
sk; Pedi:↑r iskofsui ci
dal thinki
ngand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1108
behavi
or(suici
dal
it
y)inchil
drenandadolescentswi
th
majordepressi
vedisorderandotherpsy
chiatr
icdi
sorder
s.
Observecl
oselyforsui
cidali
tyandbehavi
orchanges.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, SEIZURES,
SUICIDALTHOUGHTS, anxiety ,di
zzi
ness,drowsiness,
i
nsomni a,headache,v ert
igo.EENT: ↑i ntr
aocularpressur
e,
my dr
iasi
s.Resp: eosinophi l
icpneumoni a,
inter
sti
tiall
ung
di
sease.CV: hypertension.GI : ↓ appet
ite,consti
pati
on,
nausea.GU: malesexual dy sfuncti
on.Derm: ERYTHEMA
MULTI FORME, STEVENS- JOHNSONSYNDROME, TOXIC
EPIDERMALNECROLYSI S, sweat i
ng.FandE:
hyponatremia.Hemat : ↑r iskofbl eedi
ng.Met ab:
hypercholest
erol
ema, hyper li
pidemia.
Mi
sc:
SEROTONI
NSYNDROME.

I
NTERACTI
ONS
Drug-Dr
ug: Concur r
entusewi thMAOi nhi bit
orsmayr esul
t
i
nser i
ous,potentiall
yf atalreacti
ons( wai tatleast2wk
aft
erstoppingMAOi nhibit
orbef oreiniti
ating
desvenl
afaxine;wai tatleast1wkaf terst opping
desvenl
afaxinebef orest ar
t i
nganMAOi nhibi
tor).↑ r
iskof
bl
eedingwi thotherdr ugst hat↑ bleedi ngr i
skincludi
ng
anti
coagulants,antithrombot ics,pl
ateletaggr egati
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1109
i
nhibit
ors,andNSAI Ds.Usecautiouslywithot herCNS-
acti
vedrugs,incl
udingalcoholorsedative/hy pnoti
cs;
eff
ectsofcombi nationareunknown.Dr ugst hataf f
ect
serot
onergicneurotransmitt
ersystems,includingl i
nezol
i
d,
tr
amadol ,
andt ri
ptans↑ riskofserotoninsy ndrome.
Ketoconazolemay↑ t heeff
ectsofdesv enlafaxine.

DOSAGE
PO:
(Adul
ts)
:50mgoncedai
l
y.
Renal
Impai
rment
PO:
(Adul
ts)
:CCr30–50mL/ mi
n—50mg/
day
;CCr<30
mL/mi
n—50mgev er
yotherday
.

AVAI
LABI
LITY
Ext
ended-
rel
easet
abl
ets50mg,
100mg;

PATI
ENTTEACHI
NG
Instr
uctpati
enttotakemedi cati
onexact lyasdi
rected
atthesamet imeeachday .Takemi sseddosesas
soonaspossi bl
eunlessal mostt i
mef ornextdose.
Donotdoubl edosesordi scont i
nueabrupt l
y;
gradual
lydecreasebef or
edi sconti
nuationt opr
event
dizzi
ness,nausea,headache, ir
ri
tabi
li
ty,insomnia,
diarr
hea,anxi
ety,f
atigue,abnor maldreams, and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1110
 hy
per
hidr
osi
s.

Adv i
sepat i
ent,fami l
yandcar egiverst olookf or
suicidal i
ty,
especi all
ydur i
ngear l
ytherapyordose
changes.Not ifyhealthcar epr ofessional immediatel
y
i
fthought saboutsui cideordy ing,attempt sto
commi tsuici
de, neworwor sedepr essionoranxi et
y,
agitationorr estlessness, panicattacks, insomnia,
neworwor seirritabi
lity,
aggressi veness, acti
ngon
danger ousimpul ses, mania,orot herchangesi n
moodorbehav iorori fsympt omsofser otoni
n
syndr omeoccur .

Maycausedr owsi
nessordizzi
ness.Cauti
onpati
ent
toavoiddri
vingorotheract
ivi
ti
esrequir
ingal
ert
ness
unti
lresponsetothedrugisknown.

Cautionpati
enttoav oidtakingalcoholorotherCNS-
depressantdrugsduringther apyandofincreasedr isk
ofbleedingwithconcomi tantuseofNSAI Ds, aspiri
n,
orotherdrugsthataffectcoagul at
ionorbleeding.
Instr
uctpati
enttonot i
fyheal thcar
eprofessional of
allRxorOTCmedi cati
ons, vi
tamins,orherbal
productsbeingtakenandt oconsultheal
thcar e
professi
onalbeforetakingot herRx,OTC,orher bal
products.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1111
 si
gnsofall
ergy(
rash,
hiv
es,
swel
l
ing,
dif
fi
cul
ty
br
eathi
ng)occur
.

I
nstructfemalepati
entstoinf
orm heal
thcare
pr
ofessionali
fpregnancyisplannedorsuspect
edor
i
fbreastfeedi
ng.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
moni
torprogr
ess.

Dexamet
hasone
I
ndi
cat
ions
Adjuncti
nt heemer gencytreatmentofanaphy l
axis;shor
t-
ter
m suppressionofinflammat i
oni nallergi
cdisorders;
adrenocort
icalinsuf
fi
ciency,ocul
arinf l
ammat ion,
autoi
mmunedi sorders,r
heumat i
cdi sorder,
cerebral
oedema, unresponsiveshock,bacterialmeningit
isalong
wit
hant i
bioti
cs.

Unl
abel
edUses:Shor
t-
ter
m admi
nist
rat
iont
ohi
gh-
ri
sk
mot her
sbeforedeli
verytopreventrespirat
orydistr
ess
syndromeinthenewbor n.Adjunctiv
emanagementof
nauseaandv omiti
ngfrom chemot herapy.Treatmentof
ai
rwayedemapr iortoextubati
on.Usedi nneonat eswit
h
bronchopul
monar ydysplasi
atof aci
li
tateventi
lator

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1112
weani
ng.

ACTI
ON
I
nphar macologi cdoses, suppr essesi nfl
ammat i
onandt he
normal i
mmuner esponse.Hasnumer ousint
ense
metabol i
ceffects( seeAdv erseReact ionsandSide
Eff
ects).Suppressesadr enal f
unctionatchr oni
cdosesof
0.
75mg/ day.Hasnegl igi
blemi neralocorti
coidacti
vi
ty.
TherapeuticEffects: Suppressionofi nfl
ammat i
onand
modificati
onoft henor malimmuner esponse.

Av
ail
abi
l
ity
TABLETS0.
5mg;INJECTI
ON2ml
vial
(4mg/ml
);CREAM
5and15g(0.1%w/w).

DOSAGE
Or
al
Adult
-0.5to10mgdai
l
yindi
vi
deddoses,
repeati
f
necessar
y.
Chi
ld-0.
02t
o0.
3mg/
kgi
nthr
eeorf
ourdi
vi
deddoses
dai
l
y .

I
ntr
avenousi
nject
ion
4t
o10mgev
ery6h.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1113
Cont
rai
ndi
cat
ions
Unt r
eatedsystemici
nfect i
on( unlessconditionli
fe-
threateni
ng)
;admi ni
strat
ionofl ivevirusvaccines;r
enal
fai
lure,di
abetesmelli
tus,psy chosis,osteoporosis,
pregnancyCHF, t
uberculosis,fungalinfect
ionsoft heey
e.

I
NTERACTI
ONS
Drug- Drug: ↑r i
skofhy pokal emi awi t
ht hiazideandl oop
diuretics, amphot er
icinB, piper acill
in,ort i
carcil
li
n.
Hy pokal emi amay↑ r iskofdi goxi nt oxicity
.May↑
requirementf orinsulinoror al hy poglycemi cagent s.May
↓l ev elsof pheny toi
nandi soni azi d.Lev elsmaybe↑ wi th
oralcont r
acept ives.↑ r i
skofadv erseGIef fectswi t
h
NSAI Ds( i
ncl udingaspi rin),alcohol andcaf feine.Atchr oni
c
dosest hatsuppr essadr enal f
unct i
on, may↓ t heantibody
responset oand↑ r iskofadv er ser eactionsf r
om live-
vir
usv acci nes.May↑ or↓ t heef fectsofwar far
in.Lev el
s
maybe↓ whenusedwi thpheny toin,phenobar bit
al,or
ri
fampi n.May↑r iskoft endonr upturewhenusedwi th
fl
uor oqui nolones.

Pr
ecaut
ions
Incr
easedsuscepti
bil
it
ytoandsev
eri
tyofi
nfect
ion;
acti
vat
ionorexacerbat
ionoft
uber
cul
osis,
amoebiasi
s,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1114
strongyloidi
asis;riskofseverechickenpoxi nnon-immune
pat i
ent(varicel
la-zosteri
mmunogl obulinrequiredif
exposedt ochickenpox) ;
avoidexposur etomeasl es
(normal immunogl obuli
npossibl
yr equiredifexposed);
diabetesmel l
it
us; pepti
culcer
;hyper t
ension;precauti
ons
relati
ngt olong-term useofcorti
cost er
oids;glaucoma,
epilepsy;drugshoul dnotbeabruptlywithdrawn;
i
nt eract
ionsl actation.

Adv
erseEf
fect
s
Nausea, dyspepsia,mal aise, hi
ccups;hy persensitivi
ty
reactionsincludinganaphy l
axis;peri
neal i
rri
tationaf t
er
i
ntravenousadmi ni
stration; adverseeffectsassoci ated
withlong- t
erm cor t
icosteroi dtreatment;hyper glycaemia,
abdomi naldist
ension, angi oedema, bradycardia, acne,
erythema, Cushing’ssy ndr ome, or
opharangeal candidi
asi
s,
hypothal amicpituit
aryadr enalaxissuppr ession.

PATI
ENTTEACHI
NG
Instructpati
entoncor recttechniqueofmedication
admi nistr
ati
on.Adv i
sepat i
enttot akemedicati
onas
directed.Takemi sseddosesassoonasr emember ed
unlessal mostti
mef ornextdose.Donotdoubl e
doses.St oppi
ngt hemedi cationsuddenlymayr esul
t
i
nadr enali
nsuff
iciency(anorexia,nausea,weakness,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1115
 fati
gue,dyspnea,
hypotension,
hypoglycemia)
.Ift
hese
signsappear,not
if
yhealthcareprofessi
onal
i
mmedi ately;
maybel i
fe-t
hreat
ening.

Cort
icoster
oi dscauseimmunosuppr essi
onandmay
masksy mpt omsofi nf
ecti
on.Instr
uctpati
enttoavoi
d
peoplewithknowncont agi
ousi l
lnessesandtorepor
t
possibl
einfectionsi
mmedi at
ely.

Cauti
onpat
ienttoav
oidvacci
nati
onswi
thoutf
ir
st
consul
ti
nghealt
hcarepr
ofessi
onal.

Revi
ewsi deef f
ectswithpati
ent.Instr
uctpati
entto
i
nform healthcareprofessi
onalprompt l
yifsever
e
abdominal pai
nort ar
rystool
soccur .Pati
entshould
al
sorepor tunusualswelli
ng,weightgain,t
ir
edness,
bonepain, br
uisi
ng,nonheali
ngsor es,vi
sual
di
stur
bances, orbehaviorchanges.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Discusspossi
bleef
fect
sonbodyi
mage.Expl
ore
copingmechanisms.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onalif
symptomsofunder l
yingdiseaser
etur
norwor sen.

Adv
isepat
ientt
ocar
ryi
dent
if
icat
iondescr
ibi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1116
 di
seaseprocessandmedi
cati
onr egi
menintheevent
ofemergencyinwhi
chpat
ientcannotrel
atemedi
cal
hi
stor
y.

Explainneedforconti
nuedmedicalf
oll
ow-upto
assessef f
ecti
venessandpossi
blesi
deef f
ect
sof
medi cat
ion.Per
iodi
clabtest
sandey eexamsmaybe
needed.

St
orage
Storepr
otect
edf
rom l
i
ghtatat
emper
atur
enotexceedi
ng
30⁰C.

Dexl
ansopr
azol
e
I
NDI
CATI
ONS
Healingoferosi
veesophagiti
s(EE).Maintenanceof
healedEEandr eli
efofheart
burn.Treatmentofheartbur
n
from non-
erosiv
egastroesopahagealrefl
uxdisease
(GERD).

ACTI
ON
Bindstoanenzymeint hepresenceofacidicgast
ri
cpH,
preventi
ngthefi
nalt
ransportofhydrogenionsint
othe
gastri
clumen.Ther
apeuticEffect
s:Dimini
shed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1117
accumul
ati
onofaci
dint
hegast
ri
clumen,
wit
hlessened
aci
drefl
ux.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erehepat
ic
i
mpai
rment
;Lact
ati
on:
Lact
ati
on.

UseCaut
iousl
yin:
Moder
atehepat
ici
mpai
rment(
dai
l
y
doseshouldnotexceed30mg);Pat
ientsusi
nghigh-doses
for>1year(↑riskofhi
p,wr
ist
,orspinefr
act
ures);
Pedi :
Safet
ynotestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:
abdominalpai
n,di
arr
hea,fl
atul
ence,nausea,
vomi
ti
ng.
FandE: hy
pomagnesemia(especi
all
yiftr
eatment
durat
ion≥3mo).MS:bonefract
ure.

I
NTERACTI
ONS
Drug- Dr
ug: ↓l evelsofatazanav i
r;donotadmi ni
ster
concur r
ently.May↓ absor pti
onofdr ugsrequiri
ngacidpH
forabsor pti
on, i
ncludi
ngami pcill
in,i
ronsalt
s,and
ketoconazol e.Mayi ncr
easeef fectofwarfari
n.May↓ t he
antiplat
eleteffectsofclopidogrel.May↑ tacroli
mus
l
ev els.Hypomagnesemi a↑ r i
skofdi goxi
ntoxicit
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1118
DOSAGE
PO:(
Adul
ts)
:Heali
ngofEE—60mgoncedai
lyf
orupto8
wk;
Maint
enanceofheal
edEE—30mgoncedai
lyf
orupt
o
6mo;GERD—30mgoncedailyf
or4wk.
Hepat
icI
mpai
rment
PO:(Adul
ts)
:Moderat
ehepat
ici
mpai
rment
—dai
l
ydose
shoul
dnotexceed30mg.

AVAI
LABI
LITY
Del
ayedr
eleasecapsul
es30mg,
60mg;

PATI
ENTTEACHI
NG
I
nstructpat
ienttotakemedicati
onasdi r
ectedfort
he
f
ullcourseoftherapy,
eveniffeel
ingbetter
.Take
misseddosesassoonasr emember ed.Brandname
wasf or
merlyKapidex.

Advisepat
ientt
oav oi
dalcohol,
product
scont
aini
ng
aspi
r i
norNSAIDs,andfoodsthatmaycausean
i
ncreaseinGIir
ri
tati
on.

Advi
sepati
enttoreportonsetofbl
ack,t
arryst
ool
s;
di
arr
hea;orabdominalpaintoheal
thcare
pr
ofessi
onalpromptl
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1119
 Instr
uctpati
entt
onot i
fyheal
thcarepr of
essional
of
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultwithhealt
hcare
professi
onalbef
oretaki
ngothermedi cati
ons.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Dexmedet
omi
dine
I
NDI
CATI
ONS
Sedati
onofinit
ial
lyi
ntubat
edandmechani call
yventil
ated
pati
entsduri
ngt r
eat
mentinanintensi
v ecar
esetting;
shouldnotbeusedfor>24hr.Sedati
onofnon- i
ntubated
pati
entsbefor
eand/orduri
ngsurgicalandother
procedur
es.

ACTI
ON
Actsasarel
ati
velysel
ecti
veal
pha-
adrenergi
cagoni
stwi
th
sedat
ivepr
opert
ies.Ther
apeut
icEf
fects:
Sedati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1120
UseCaut
iousl
yin:
Hepat
ici
mpai
rment(
lowerdosesmay
ber equir
ed);Adv
ancedhear
tbl ock;Sever
el eftvent
ri
cul
ar
dysfunction;
Geri
:↑r i
skofbrady cardi
aandhy pot
ensi
on
(considerdose↓) ;
OB:Lact
ation: Pedi
:Safetynot
establi
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Resp:hypoxi
a.CV:BRADYCARDI A,SI
NUSARREST,
hypot
ension,t
ransi
enthyper
tensi
on.GI:
drymout
h,nausea,
vomit
ing.Hemat:anemia.Misc:f
ever
.

I
NTERACTI
ONS
Drug-
Drug:Sedat
ionisenhancedbyanesthet
ics,
other
sedat
ive/
hypnoti
cs,andopioi
danalgesi
cs.
Drug-Natural
Pr oduct:
Concomi
tantuseofkava-
kava,val
eri
an,skull
cap,
chamomi
le,orhopscan↑ CNS
depression.

DOSAGE
I
CUSedat
ion
I
V:(Adult
s):Loadi
nginfusion—1mcg/kgover10min
f
oll
owedbymai ntenanceinfusi
onof0.
2–0.7mcg/kg/
hr
f
ormaximum of24hr ;rat
ei sadj
ust
edtoachi
evedesi
red
l
evelofsedat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1121
Pr
ocedur
alSedat
ion
IV:(Adults):Loadinginfusion—1mcg/ kg( 0.5mcg/ kgfor
ophthalmi csurgeryorpatients>65y r
)ov er10mi n
foll
owedbymai nt
enancei nfusi
onof0. 6mcg/ kg/hr;r
ate
i
sadj ustedtoachi evedesiredlevelofsedat i
on( usual
range0.2–1mcg/ kg/ hr
)(mai nt
enancei nfusionof0. 7
mcg/ kg/hrrecommendedf orfi
beropti
ci ntubati
onunt i
l
endotracheal t
ubesecur ed).

AVAI
LABI
LITY
I
nject
ion100mcg/
mL;

PATI
ENTTEACHI
NG
Expl
aintopati
entandf
ami
l
ythepur
poseoft
he
medicat
ion.

Dexmet
hyl
pheni
dat
e
I
NDI
CATI
ONS
Adj
unct
ivet
reat
mentofADHD.

ACTI
ON
Pr
oducesCNSandr
espi
rat
oryst
imul
ati
onwi
thweak

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1122
sy
mpat homi
meti
cact
ivi
ty.Ther
apeut
icEf
fect
s:I
ncr
eased
at
tent
ionspani
nADHD.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
exci
tabl
e
states( markedanxiety,agit
ation, ort
ension);
Hy pert
hy r
oidism;Psychot i
cper sonali
ties,sui
cidalor
homi cidaltendenci
es;Glaucoma; Mot ortics,
familyhi
stor
y
ordiagnosi sofTourette'
ssy ndrome; Concur rentuseof
MAOi nhibit
ors;Shoul
dnotbeusedt ot r
eatdepressi
onor
prevent /
treatnormalfatigue;Psy choses( mayexacerbate
sympt oms) .

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease(
suddendeat
h
hasoccur redi nchil
drenwi thstructuralcar di
ac
abnormalitiesorot herserioushear tproblems) ;
Hyperthyroidism;Hy pertension;Diabetesmel l
it
us;Geri
:
Geriat
ric/
debi li
tat
edpat ients;Continual use( mayresul
tin
psychological orphysicaldependence) ; Seizuredi
sorder
s
(maylowersei zurethreshold);OB: Lactati
on: Pedi
:
Pregnancy ,lactat
ion,orchildren<6y r(saf etynot
establ
ished; useinpr egnancyonl yifclearlyneeded).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
behav
ior
aldi
stur
bances,
hal
l
uci
nat
ions,
insomni
a,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1123
mania,nervousness,thoughtdi
sorder.EENT:v i
sual
dist
urbances.CV:SUDDENDEATH, tachycar
dia.GI:
abdomi nalpai
n,anorexia,
nausea.Met ab:gr
owt h
suppression,wei
ghtloss(mayoccurwi t
hprolongeduse)
.
Neuro:twitchi
ng.Misc:fever
.

I
NTERACTI
ONS
Drug-Drug: Concurrentusewithorusewi t
hin14day s
fol
lowingdi sconti
nuationofMAOi nhibitorsmayr esulti
n
hypertensivecrisi
sandi scontr
aindicated.May↓ ef fect
s
ofantihypertensives.May↑ effectsofv asopressors.May
↑ effectsofwar f
arin,
phenobarbit
al,pheny t
oin,some
anti
depr essants;doseadjustmentsmaybenecessar y.

DOSAGE
Tabl
ets
PO:(Adul
tsandChildr
en≥6y r
):Pati
entsnotprevi
ousl
y
taki
ngmethylpheni
dat
e—2.5mgt wicedai l
y,maybe↑
weeklyasneededupto10mgt wicedaily
;Pati
ent
s
curr
entl
ytaki
ngmet hy
lpheni
date—star
tingdoseis1/2of
themethyl
phenidat
edose,upto10mgt wicedail
y.

Ext
ended-
rel
easecapsul
es
PO:
(Adul
ts)
:Pat
ient
snotpr
evi
ousl
ytaki
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1124
methyl
phenidate—10mgoncedai l
y,maybe↑ by10mg
upto40mg/ day ;
Patientscurr
entl
ytaki
ng
methyl
phenidate—st art
ingdoseis1/2ofthe
methyl
phenidatedose, upto40mg/ daygi
venasasi
ngl
e
dail
ydose;Patientscurrentl
ytaki
ng
dexmethyl
pheni date—givesamedai l
ydoseasasi
ngl
e
dose.
PO:(Childr
en≥6y r
):Patientsnotprevi
ouslytaking
methylphenidat
e—5mgoncedai ly
,maybe↑ by5mg
weeklyupt o30mg/ day; Pati
entscurr
entl
ytaking
methylphenidat
e—st art
ingdosei s1/2ofthe
methylphenidat
edose, upt o30mg/ day,
givenasasi ngl
e
dail
ydose; Pati
entscurrent l
ytaki
ng
dexmet hyl
phenidate—giv esamedai l
ydoseasasi ngl
e
dose.

AVAI
LABI
LITY
Tabl
ets2.
5mg, 5mg,10mg;Ext
ended-
releasecapsul
es5
mg,10mg, 15mg,20mg,25mg,30mg, 35mg, 40mg;

PATI
ENTTEACHI
NG
Inst
ructpatienttotakemedicati
onasdirected.I
f
moret hanpr escr
ibedamountistaken,
not i
fyhealt
h
careprofessionalimmedi
ately.I
fadosei smissed,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1125
 taketheremainingdosesf orthatdayatregularl
y
spacedinterv
als; donotdoubl edoses.Taket helast
dosebefore6pm t omi ni
mizet heri
skofinsomni a.
Inst
ructpati
entnott oal t
erdosewi thoutconsult
ing
healt
hcar eprofessional.Abruptcessati
onwi thhigh
dosesmaycauseext remef ati
gueandment al
depressi
on.Adv isepat i
entandpar entstoreadthe
Medicati
onGui depr iortostart
ingtherapyandwi th
eachRxr efi
ll
.

I
nform pat
ientt
hatshar
ingt
hismedi
cat
ionmaybe
danger
ous.

Advisepat
ienttocheckweight2–3ti
mesweeklyand
reportwei
ghtlosstoheal
thcareprof
essi
onal
.

Instr
uctpati
entt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultheal
thcar e
professi
onalbef
oretaki
ngotherRx, OTC,orherbal
products.

Mayr arelycausedizzi
nessordrowsiness.Caut
ion
pat
ientt oavoiddriv
ingoract
ivi
ti
esrequiri
ng
al
ertnessunt i
lresponsetomedicat
ionisknown.

Advi
sepatienttonotif
yhealt
hcareprof
essionali
f
ner
vousness,rest
lessness,
insomni
a,di
zziness,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1126
 anorexi
a,ordrymouthbecomessev er
e.Pedi:
If
reducedappeti
teandweightlossareaproblem,
adviseparent
stoprovi
dehi ghcalor
iemealswhen
druglevel
sarelow(atbreakfastandorbedti
me).

Advi
sepati
entand/orparentstonot
ifyheal
thcar
e
pr
ofessi
onalofbehavi
oralchanges.

Inf
orm pat
ientt
hathealt
hcareprof
essi
onal
mayor der
peri
odi
chol i
daysf
rom thedrugt
oassessprogr
ess
andtodecreasedependence.

Cautionpati
entst
oinfor
m heal
thcareprof
essionali
f
theyhaveeverabusedorbeendependentonalcohol
ordrugs,ori
ftheyarenowabusingordependenton
alcoholordr
ugs.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed,
orif
br
eastf
eedi
ng.

Emphasi
zetheimport
anceofr
out
inef
oll
ow-
upexams
tomonit
orprogr
ess.

HomeCareI
ssues:Advi
separ
ent
stonot
if
yschool
nur
seofmedi
cati
onregi
men.

Dexr
azoxane
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1127
I
NDI
CATI
ONS
Reducinginci
denceandsev eri
tyofcardiomyopathyfrom
doxorubici
ninwomenwi t
hmet astati
cbreastcancerwho
havealreadyrecei
vedacumul ati
vedoseofdoxor ubicin
>300mg/ m2.Treatmentofextravasati
onresult
ingfrom
I
Vant hracycl
i
nechemot herapy.

ACTI
ON
Actsasanintr
acel
lul
archelati
ngagent .Ther
apeuti
c
Eff
ects:Di
mini
shesthecardiotoxiceff
ectsofdoxorubi
cin.
Decreaseddamagefrom extr
av asat
ionofanthr
acycli
nes.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Anyot
hert
ypeofchemot
her
apy
exceptot
herant
hracy
cli
nes(
doxor
ubi
cin-
li
keagent
s).

UseCaut
iousl
yin:
CCr<40mL/
min(
doser
educt
ion
requir
ed);OB:Pr
egnancy
,lact
ati
on,
orchi
l
dren(
saf
etynot
establ
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Hemat
:my
elosuppr
essi
on.Local
:pai
nati
nject
ionsi
te.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1128
Drug-
Drug: Myel
osuppr essi
onmaybe↑ by
anti
neoplasti
csorradiati
onther
apy
.Ant
it
umoref fectsof
concurr
entcombi nat
ionchemother
apywithfl
uorouraci
l
andcyclophosphamidemaybe↓ bydexr azoxane.

DOSAGE
Car
diopr
otect
ive
I
V:(
Adul
ts)
:10mgofdexr
azoxane/
1mgdoxor
ubi
cin.
Renal
Impai
rment
I
V:(
Adul
ts)
:decr
easedoseby50%.

Ext
rav
asat
ionpr
otect
ion
I
V:(Adul
ts)
:1000mg/m2(maxi
mum 2000mg)giv
enon
days1and2,andf
oll
owedbyadoseof500mg/
m2
(maxi
mum 1000mg)onday3.
Renal
Impai
rment
I
V:(
Adul
tsCCr<40mL/
min)
:decr
easedoseby50%.

AVAI
LABI
LITY
I
nject
ion(Zinecar
d)250-
mgv
ial
,500-
mgv
ial
;I
nject
ion
(
Totect)500-mgv i
al;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1129
 Expl
aint
hepur
poseoft
hemedi
cat
iont
othepat
ient
.

Emphasi
zetheneedf
orcont
inuedmoni
tor
ingof
car
diacf
uncti
on.

Advi
sepatienttonot
ifyheal
thcareprofessi
onalif
pr
egnancyissuspectedorplanned.Dexrazoxanemay
beter
atogenic.

Dext
ran40
I
ndi
cat
ions
Plasmav ol
umeexpansi onduri
nghypovol
emicshock
whenbloodnotav ai
labl
e,Prophyl
axisoft
hromboembol
i
c
disor
derstoimprovelocalci
rcul
ati
oninperi
pher
al
vascul
arocclusi
on.

Av
ail
abi
l
ity
INFUSION10%dext
ran40+5%dext
roseor0.
9%sodi
um
chlor
ide.

DOSAGE
I
ntr
avenous
Toimprov
elocal
cir
cul
ati
oni
nper
ipher
alv
ascul
ar
occl
usi
on:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1130
Adult
-500- 1000ml (1020ml /
kg)inf i
rst24hour s;
ther
eafter500ml every1-2daysforupt o2weeks.
Thromboembol i
sm pr ophyl
axi
s:Adult-5001000ml (10-20
ml/kg)ondayofsur gery,t
hen500ml dail
yfor2-3day s,
then500ml everysecondort hir
dday ,forupto2weeks.
Shock:Adult-i
niti
all
y500- 1000ml (10-20ml /kg)infused
asrapidlyasneeded; mayf oll
owwi th500ml (10ml /kg)
duri
ngt hesame24hourper i
od;thereafter500ml (10
ml/kg)mayber epeateddailyforupt o5day s.

Cont
rai
ndi
cat
ions
Hypersensi
ti
vi
ty,
cardi
acdecompensation,ol
iguri
aor
anuri
a,hemostat
icdefect
s,t
hrombocytopeni
a, bl
ood
coagulat
iondi
sorder
,pulmonaryoedema,neonates.

Pr
ecaut
ions
Renal
andhepat i
cimpairment,pregnancylactai
on,
di
abetes,
cardiacpat
ients,el
derl
y,monitoruri
neoutput
,
monit
orforsignsofcir
culator
yov er
load,i
nter
acti
ons.

Adv
erseEf
fect
s
Nausea,vomit
ing,l
ocali
njecti
onsit
er eact
ion,
hyper
sensit
ivi
tyandanaphylact
oidreacti
ons,i
ncr
eased

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1131
ser
um SGOTandSGPTconcent
rat
ions,
osmot
icnephr
osi
s.

St
orage
Storepr
otect
edf
rom l
i
ghtatat
emper
atur
enotexceedi
ng
30⁰C.

Dext
roamphet
ami
ne
I
NDI
CATI
ONS
AdjunctmanagementofADHD.Nar
col
epsy
.Unl
abel
ed
Uses:Exogenousobesi
ty.

ACTI
ON
ProducesCNSst i
mul ati
onbyr eleasingnor epinephrine
from ner v
eendi ngs.Phar macologiceffects: CNSand
respiratorystimul at
ion,Vasoconst r
icti
on,My dri
asis
(pupill
arydilati
on) ,Contracti
onoft heur i
nar ybladder
sphincter.Ther apeuticEf f
ects:I
ncreasedmot oractivi
ty
andment al al
ertnessanddecr easedf ati
guei nnar colept
ic
patients.Increasedat tenti
onspani nADHD.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:OB:
Lact
ati
on:
Pregnancyorl
act
ati
on;
Hy
per
exci
tabl
est
ates,
incl
udi
nghy
per
thy
roi
dism;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1132
Psychoti
cpersonal
i
ties;Sui
cidalorhomici
dal
tendenci
es;
Glaucoma;Someproduct scontai
ntartr
azi
ne;
avoidin
pati
entswit
hknownhy per
sensiti
vi
ty.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease(
suddendeat
h
hasoccur redi nchildrenwi thstr
uctural cardiac
abnormal i
tiesorot herser iousheartpr oblems) ;
Hypertension; Diabetesmel l
it
us;Historyofsubst ance
abuse;Debi li
tatedpat ients;Conti
nual use( maypr oduce
psychological dependenceorphy sical addiction)
;Geri
:
AppearsonBeer sli
st.El derl
yareat↑ r i
skf or
cardi
ov ascularsideef fects.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: hy per act i
vit
y,insomni a,restlessness, tremor ,
behav ior al disturbances, depression, dizziness,
hallucinat ions, headache, i
rri
tabil
ity,mani a,thought
disorder .CV: SUDDENDEATH, palpit
at i
ons, tachy cardi
a,
arrhythmi as, hy pert
ension.GI :anor exia,const ipation,
cramps, diarrhea, drymout h, met all
ictaste, nausea,
vomi ting.GU: erectil
edy sfunction, ↑l ibi
do.Der m:
urti
car ia.Mi sc: physicaldependence, psy chol ogical
dependence.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1133
Drug-Drug:↑ adrenergiceffectswi thotheradr ener gi
cs.
Usewi thMAOi nhibi
torscanr esultinhypertensiv ecrisi
s.
Alkali
nizi
ngtheurine(sodium bi carbonate,acet azolamide)
prolongseffect
.Acidif
icati
onofur ine(ammoni um chl ori
de,
l
ar gedosesofascor bicacid)↓ ef fect.Phenot hiazines
may↓ ef f
ectofdextroamphet amine.Mayant agoni zethe
responsetoantihypertensi
v es.↑ r i
skofcar diov ascular
sideeffectswit
hbet ablocker sort ri
cycl
icantidepr essants.
Drug-
Nat uralPr
oduct :St.John'
swor tmay↑ ser
iousside
eff
ects,concurrentusei snotrecommended.Usewi t
h
caff
eine-contai
ningher bs(guarana,
tea,
cof
fee)↑
sti
mulantef f
ect.St.John'swor tmay↑ ser
iousside
eff
ects,concurrentusei snotrecommended.

DOSAGE
At
tent
ion-
Def
ici
tHy
per
act
ivi
tyDi
sor
der
PO:(Adul
ts):5–40mg/ dayi
ndi
videddoses.Sust
ained-
rel
easecapsulesshoul
dnotbeusedasini
tialt
her
apy .
PO:(Chi
ldr
en≥6yr):
5mg1–2t imesdai
ly,
↑ by5mgdai l
y
atweekl
yinter
val
s(maximum:40mg/day).Sustai
ned-
rel
easecapsul
esshoul
dnotbeusedasini
tialt
herapy.
PO:(Chi
ldren3–5yr)
:2.
5mg/day
,↑ by2.5mgdai
l
yat
weeklyi
nterval
s(maxi
mum:40mg/day)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1134
Nar
col
epsy
PO:(Adult
s) :
5–60mg/ daysi
ngl
edoseorindi
vi
ded
doses.Sustai
ned-
rel
easecapsul
esshoul
dnotbeusedas
i
nit
ialther
apy.
PO: (
Children≥12yr
):10mg/ day
,↑ by10mg/ dayat
weeklyinterval
sunt
ilr
esponseisobt
ainedor60mgis
reached.
PO: (
Children6–12yr)
:5mg/ day,
↑ by5mg/ dayat
weeklyinterval
sunt
ilr
esponseisobt
ainedor60mgis
reached.

Exogenousobesi
ty
PO:(Adul
tsandChi
l
dren>12yr)
:5–30mg/dayi
ndivi
ded
dosesof5–10mggiven30–60minbef
oremeals.

AVAI
LABI
LITY
Tabl
ets5mg,
10mg;
Sust
ained-
rel
easecapsul
es5mg,
10
mg,15mg;

PATI
ENTTEACHI
NG
I
nstructpat
ienttot
akemedicati
onatl east6hrbefor
e
bedti
met oavoidsl
eepdi
sturbances.Takemi ssed
dosesassoonasr ememberedupt o6hrbef ore
bedti
me.Donotdoubledoses.Adv i
sepat i
entand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1135
 parentstoreadt heMedicati
onGuidepriort
ost ar
ti
ng
therapyandwi theachRxr ef
il
l.I
nstr
uctpati
entnotto
alt
erdosewi thoutconsult
inghealt
hcareprofessi
onal
.
Abruptcessationofhighdosesmaycauseext r
eme
fati
gueandment aldepr
ession.

I
nform pat
ientt
hatshar
ingt
hismedi
cat
ionmaybe
danger
ous.

I
nform pat
ientthatt
heeffect
sofdrug-
induceddr
y
mouthcanbemi ni
mizedbyrinsi
ngfr
equentl
ywit
h
waterorchewingsugarl
essgum orcandies.

Advi
sepati
entt
oav
oidt
hei
ntakeofl
argeamount
sof
caf
fei
ne.

Medicati
onmayi mpai
rjudgment.Advi
sepati
entsto
usecauti
onwhendr i
vi
ngorduringotheract
ivi
ti
es
requi
ri
ngaler
tness.

Advisepatienttonotif
yhealthcareprofessional i
f
nervousness,rest
lessness,i
nsomnia,dizziness,
anorexi
a,ordr ymouthbecomessev ere.Pedi :I
f
reducedappet i
teandwei ghtl
ossareapr oblem,
adviseparentstoprovidehighcalor
iemeal swhen
druglevel
sar elow(atbreakfastand/orbedt ime).

Advi
sepati
entand/orparentstonot
ifyheal
thcar
e
pr
ofessi
onalofbehavi
oralchanges.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1136
 I
nform pati
entt
hatperi
odi
choli
dayfr
om thedr
ugmay
beorderedtoassesspr
ogressanddecr
ease
dependence.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed,
orif
br
eastf
eedi
ng.

Cautionpati
entst
oinfor
m heal
thcareprof
essionali
f
theyhaveeverabusedorbeendependentonalcohol
ordrugs,ori
ftheyarenowabusingordependenton
alcoholordr
ugs.

Emphasi
zetheimport
anceofr
out
inef
oll
ow-
upexams
tomonit
orprogr
ess.

HomeCareI
ssues:Advi
separ
ent
stonot
if
yschool
nur
seofmedi
cati
onregi
men.

Dext
romet
hor
phan
I
NDI
CATI
ONS
Sympt omaticrel
iefofcoughscausedbymi norvi
ral
upper
respirator
yt r
actinfect
ionsorinhaledi
rr
it
ants.Most
effectiveforchronicnonproducti
vecough.Acommon
i
ngr edientinnonprescript
ioncoughandcoldprepar
ati
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1137
ACTI
ON
Suppressest hecoughr ef
lexbyadi recteffectonthe
coughcent erinthemedul l
a.Relatedtoopi oids
str
uct
ur al
lybuthasnoanal gesi
cpr opert
ies.Therapeut
ic
Eff
ects:Reliefofir
ri
tat
ingnonpr oductiv
ecough.

Av
ail
abi
l
ity
TABLET10mg;
SyRUP15mg/
5ml
and30mg/
5ml
.

DOSAGE
Or
al
Adul
t-10–20mgev
ery4houror30mgev
ery6–8hour
s.
Chil
d-6–12years:5–10mgevery4hour
sor15mg
ever
y6–8hour s.2–6year
s:2.
5–5mgev er
y4hour
sor
7.
5mgev er
y6–8hour s.

Cont
rai
ndi
cat
ions
Pati
entsatri
skofdevelopi
ngr espi
rat
oryf
ail
ure;
per
sist
ent
orchroni
ccough;pat
ientsreceivi
ngmonoamineoxi
dase
i
nhibi
tors(wi
thorwit
hin2weeks) .

I
NTERACTI
ONS
Dr
ug-
Drug:
Usewi
thMAOi
nhi
bit
orsmayr
esul
tin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1138
serotoni nsy ndrome( nausea,conf
usion, changesinBP);
concur rentuseshoul dbeav oi
ded.↑ CNSdepr essi
onwi t
h
antihistami nes,alcohol
,anti
depressants,
sedat iv
e/ hypnot i
cs,oropioi
ds.Amiodar one,fl
uoxeti
ne,or
quinidinemay↑ bl oodlevel
sandadv erser eacti
onsfrom
dextromet horphan.

Pr
ecaut
ions
Moder at
e/ sever
erenali
mpair
ment;l
i
verdisease,at
opic
chi
ldren;patient
sconfi
nedtosupi
neposi
tion;debil
i
tat
ed
pati
ents;thirdtr
imest
erofpr
egnancyasthma;
i
nteracti
ons

Adv
erseEf
fect
s
Dependency;di
zzi
ness;rest
lessness;ment
alconf
usi
on;
exci
tat
ion;gast
roi
ntest
inaldist
urbance.

PATI
ENTTEACHI
NG
I
nst
ructpati
entt
ocougheff
ecti
vel
y:Si
tupri
ghtand
t
akeseveral
deepbr
eathsbefor
eatt
emptingtocough.

Advisepat i
entt
omi ni
mi zecoughbyav oi
dingir
ri
tant
s,
suchasci garet
tesmoke, fumes,anddust.
Humi di
ficati
onofenvir
onment al
air,
frequentsi
psof
water,andsugarlesshardcandymayal sodecrease

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1139
 t
hef
requencyofdr
y,i
rr
it
ati
ngcough.

Caut ionpati
enttoavoidtakingmor ethanthe
recommendeddoseort akingalcoholorotherCNS
depr essantsconcurr
entlywiththi
smedi cati
on;
fatali
tieshaveoccurred.Cauti
onpar entstoavoi
dOTC
coughandcol dproductswhi l
ebreastfeedi
ngorto
children<4y r
s.

Mayoccasi onal
l
ycausedizziness.Cauti
onpatientt
o
avoi
ddr i
vingorotheract
ivi
ti
esr equi
ri
ngaler
tness
unti
lresponsetothemedicationisknown.

Advisepat
ientt
hatanycoughlasti
ngover1wkor
accompaniedbyfever
,chestpain,
per
sist
ent
headache,
orskinrashwarrant
smedicalatt
ent
ion.

Dext
rose
I
NDI
CATI
ONS
I
V: Lower-concentrati
on( 2.5–11.5%)injecti
onpr ovides
hydrati
onandcal ories.Higherconcent rati
ons(upt o70%)
tr
eathy pogly
cemi aandi ncombi nati
onwi thaminoaci ds
providecalor
iesforpar enteralnutri
ti
on.50%—t reatmentof
hypoglycemia(hy peri
nsulinemiaori nsuli
nshock) .PO:
Correctshypoglycemi ainconsci ouspat i
ents.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1140
ACTI
ON
Provi
descalori
es.Ther
apeuti
cEf
fect
s:Provi
sionof
calor
ies.Pr
eventi
onandtreat
mentofhypogl
ycemia.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Al
l
ergyt
ocor
norcor
npr
oduct
s;
Hypert
oni
csoluti
on(>5%)shoul
dnotbegi
ventopat
ient
s
wit
hCNSbl eedi
ngoranuri
aorwhoareatr
iskof
dehydr
ati
on.

UseCaut
iousl
yin:
Knowndi
abet
icpat
ient
s(f
requentl
ab
assessmentnecessar ytoquantitateappropri
atedoses);
Neonates(excess/rapidi
nfusi
onofsol ut
ions>10%may↑
ri
skofintr
acer ebr
alhemorrhage); Chr
onicalcoholi
csor
severel
ymal nouri
shedpati
ents( administ
rati
onr equi
res
i
niti
alpret
reatmentwi t
hthiamine) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Endo:inappropri
atei
nsuli
nsecreti
on( l
ong-t
erm use).F
andE: fl
uidoverl
oad,hypokal
emia,hypomagnesemi a,
hypophosphatemia.Local:l
ocalpain/
irr
it
ati
onatI Vsit
e
(hyper
tonicsolut
ion)
.Met ab:gl
ycosuri
a,hyper
glycemia.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1141
Dr
ug-
Drug:Wil
lal
terrequi
rementsf
orinsul
inoror
al
hy
pogl
ycemicagentsindi
abeti
cpati
ents.

DOSAGE
Hy
drat
ion(
as5%sol
uti
on)
I
V:(
Adul
tsandChi
l
dren)
:0.
5–0.
8g/
kg/
hr.

Hy
pogl
ycemi
a
PO:(
AdultsandChi
l
dren)
:Consci
ouspat
ient
s—10–20g,
mayrepeati
n10–20min.
I
V:(
Adul
ts)
:20–50mLof50%sol
uti
oni
nfusedsl
owl
y(3
mL/
min)
.
I
V:(
Inf
ant
s>6moandChi ldr
en)
:0.
5–1g/kg/dose
(
maximum of25g/
dose)(
as25%dext
rose)
.
I
V:(
Inf
ant
s≤6moandNeonat es)
:0.
25–0.50g/
kg/
dose
(
maximum of25g/
dose)(
as25%dextr
ose).

AVAI
LABI
LITY
Oralgel
40%i n15-g, 30-g,and45–gt ubesOTC;Chewable
tabl
ets4g,5gOTC; Solutionforinj
ecti
on2.5%,5%,10%,
20%,25%,30%, 40%, 50%, 60%,70%; I
ncombinati
onwith:
sodi
um chlor
ide,otherel ect
roly
tes,andaminoacids.

PATI
ENTTEACHI
NG
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1142
 Expl
ainthepur
poseofdext
roseadmi
nist
rat
iont
o
pati
ent.

Inst
ructdi
abeticpat
ientonthecor
rectmet
hodf
or
self
–bloodglucosemonitor
ing.

Advi
sepati
entonwhenandhowt oadmi
nist
er
dext
rosepr
oductsf
orhypogl
ycemia.

DEZOCI
NE
I
NDI
CATI
ONS
Shor
t-
ter
m managementofmoder
atet
osev
erepai
n.

ACTI
ON
Bindstoopiatereceptorsint heCNS.Al t
ersthepercept
ion
ofandt heresponsetopai nfulst
imuli,
whi l
ecausing
generali
zedCNSdepr ession.Haspar tialant
agonist
properti
es,whichmayr esultinopioi
dwi thdrawalin
physical
lydependentpatients.TherapeuticEffect
s:Rel
i
ef
ofmoder atetoseverepain.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odezoci
neor
bi
sul
fi
tes.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1143
UseCaut
iousl
yin:
Headt
rauma;
Incr
easedi
ntr
acr
ani
al
pressure;Sev erer enal ,hepati
c,orpul monar ydisease
(dosager educt ionr ecommended) ;Undi agnosed
abdomi nalpai n; Geriatri
cordebi l
it
atedpat i
ents(ini
tial
dosager educt ionr ecommended) ;
Pat i
entswhoar e
physicall
ydependentonopi oi
danal gesicagoni sts(may
precipi
tatewi thdr awal )orwhohav er ecentl
yreceived
systemicopi oids; Pr egnancy ,
labor,lactati
on,orchildren
<18y r(safet
ynotest abli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: sedation,anxiet
y,conf usion,crying,dizzi
ness,
sl
urredspeech.EENT: blurredv isi
on,doubl ev i
sion,miosi
s.
Resp: respi
ratorydepression.CV: orthost ati
chy pot
ension.
GI:abdomi nalpain,consti
pat i
on, drymout h,nausea,
vomiting.GU: hesit
ancy,retention,uri
nar yf r
equency.Derm:
fl
ushingorr ednessofski n.Mi sc:phy sicaldependence,
psychol ogi
caldependence, tolerance.

I
NTERACTI
ONS
Drug-
Dr ug:Usewithcauti
oni npatientsreceivingMAO
i
nhibi
tors(mayr esul
tinunpredictablereactions).Addi
ti
ve
CNSdepr essionwithal
cohol,antihist
ami nes,and
sedat
ive/hypnoti
cs.Maypr ecipi
tatewithdrawal i
npati
ents
whoar edependentonopioidanal gesicagoni sts.May

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1144
di
mini
sht
heanal
gesi
cef
fect
sofot
heropi
oidanal
gesi
cs.

DOSAGE
IM:(
Adult
s):10mginit
ial
l
yever
y3–6hr(r
ange5–20mg)
asneeded(nott
oexceed120mg/day
).
IV:
(Adul
ts)
:5mgini
ti
all
yever
y2–4hr(r
ange2.
5–10mg)
asneeded(
nott
oexceed120mg/day
).

AVAI
LABI
LITY
I
nject
ion5mg/
mL,
10mg/
mL,
15mg/
mL;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientonhowandwhent
oaskf
orpai
n
medi
cati
on.

Dezocinemaycausedrowsi nessordi
zzi
ness.Advi
se
pati
enttocallf
orassi
stancewhenambul ati
ngandto
avoi
ddr i
vingorot
heracti
vit
iesrequi
ri
ngalert
ness
unti
lresponsetot
hemedi cati
onisknown.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Advi
sepati
entt
hatfr
equentmouthri
nses,
goodoral
hygi
ene,
andsugarl
essgum orcandymaydecr
ease
dr
ymout h.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1145
 Encour
agepat
ienttoturn,cough,
andbr
eat
hedeepl
y
ever
y2hrtopreventatel
ectasi
s.

Advi
sepat
ientt
oav oi
dconcurr
entuseofalcohol
or
ot
herCNSdepressant
swiththi
smedicati
on.

Di
azepam
I
ndi
cat
ions
Statusepil
epti
cus;emer gencymanagementofr ecurr
ent
seizures;f
ebri
leconvulsi
ons; seizur
esassociatedwi t
h
poisoningandmedi ci
newi thdrawal;adj
unctinacut e
al
cohol wi
thdr
awal;premedi cati
on;anxi
etydisorders;
psy chosomati
cbehav i
ourdi sorder;
spasti
cit
y.

Unl
abel
edUses:Anxi
etyassoci
atedwi
thacut
e
my
ocar
dial
inf
arct
ion,
insomni
a.

ACTI
ON
Depressest heCNS, probablybypot enti
ati
ngGABA, an
i
nhibitoryneurotransmi t
ter.Producesskeletalmuscle
rel
axat i
onbyi nhibit
ingspinalpolysynapti
caf f
erent
pathway s.Hasant iconvulsantproperti
esduet oenhanced
presynapticinhibit
ion.TherapeuticEffect
s:Reli
efof
anxiet
y .Sedation.Amnesi a.Skeletalmusclerelaxat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1146
Decr
easedsei
zur
eact
ivi
ty.

Av
ail
abi
l
ity
TABLETS2,5and10mg;
CAPSULE10mg;SUSPENSI
ON
2mg/ml;I
NJECTION2mlampoul
e(5mg/
ml)

DOSAGE
I
ntr
avenousi
nject
ion
Adult-
Treatmentofstat
usepi
lept
icusandconv
ulsi
onsdue
topoisoning:10mgattherat
eof1ml /min(5mg)
repeatedifnecessar
yaft
er10min.
Chi
ld-Under12year
s:300t
o400µg/
kg,
repeat
edaf
ter10
minifnecessar
y.

Cont
rai
ndi
cat
ions
Respir
atorydepressi
on;acutepulmonaryinsuffi
ciency;
sl
eepapnoea; severehepati
cimpairment;my astheni
a
gravi
s;avoidi
njecti
onscontaini
ngbenzylalcohol i
n
neonates,nar
rowangleglaucoma; hyper
sensi t
ivi
tyto
benzodiazepi
ne.

I
NTERACTI
ONS
Dr
ug-
Drug:
Alcohol
,ant
idepr
essant
s,ant
ihi
stami
nes,
and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1147
opioidanal gesics—concur rentuser esultsinadditi
veCNS
depressi on.Cimet idine,hormonal contracepti
ves,
disulf
ir
am, fl
uoxet ine,isoniazid,ketoconazole,metoprol
ol,
propoxy phene, propr anolol,orv al
proicacidmay↓ t he
met abolism ofdi azepam, enhanci ngitsactions.May↓
theefficacyofl ev odopa.Ri fampi norbar bit
uratesmay↑
themet abolism and↓ ef fectivenessofdi azepam.
Sedativeef fectsmaybe↓ byt heophy l
li
ne.Concurrent
useofr itonav i
risnotr ecommended.
Drug-
Natur
alPr
oduct
:Concomi
tantuseofkava-
kav
a,
val
eri
an,
orchamomil
ecan↑ CNSdepr essi
on.

Pr
ecaut
ions
Respi r
atorydisease, muscl eweakness, historyofal cohol
ordr ugabuse, markedper sonali
tydisor
der ;
pregnancy
l
act ati
onreducedosei nelderl
yordebi l
i
t atedpat ientsand
i
nhepat i
cimpai r
mentr enal i
mpairment; avoidpr olonged
useandabr uptwithdr awal;whengi v
eni ntravenousl y,
facil
iti
esforreversingr espirat
orydepressi onwi t
h
mechani calventil
ationmustbeathand( seebel ow) ;
porphy r
ia;i
nteracti
onsbl oodcountt estonpr olonged
treatment.
I
ntr
avenousinf
usionofdiazepam i
spotent
ial
l
yhazardous
(
especi
all
yifpr
olonged)call
ingf
orcloseandconst
ant

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1148
observ
ati
onandbestcarri
edoutinaspeci al
i
tycentr
ewith
i
ntensi
vecar
ef aci
l
iti
es.Pr
olongedi
ntravenousinf
usion
mayleadtoaccumulati
onanddelayrecovery.
Mayimpai
rabi
li
tyt
operform ski
ll
edtasks,forexample
oper
ati
ngmachi
nery,
dri
ving;seealsonotesabov e.

Adv
erseEf
fect
s
Drowsi nessandl i
ght headednesst henextday ;conf usi
on
andat axi a(
especiall
yi ntheel derly
);amnesi a;dependence;
paradoxi cali
ncr
easei naggr ession;muscl eweakness;
occasi onall
yheadache, ver
tigo, sal
ivat
ionchanges,
gast r
ointesti
naldisturbances, skinreacti
ons, visual
disturbances,dysarthria,tr
emor s,i
ncontinence, ur
inary
retention;bl
ooddi sordersandj aundice;hypotensionand
apnoea, pai
nandt hrombophl ebiti
s(withinjecti
on) ;
i
ncr easedappet i
te;wei ghtgai n.

PATI
ENTTEACHI
NG
Inst
ructpatientt otakemedi cati
onasdi rectedand
nottot akemor et hanpr escribedorincreasedoseif
l
essef fecti
veaf teraf ewweekswi thoutcheckingwith
healt
hcar eprof essional.Rev i
ewpackagei nser
tfor
Diastatrect
al gel wit
hpat ient/car
egiverpriorto
administrat
ion.Abr uptwi thdrawalofdiazepam may

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1149
 causeinsomnia,unusual
irri
tabil
it
yornervousness,
andseizures.Advi
sepati
entt hatshar
ingofthis
medicati
onmaybedanger ous.

Medicati
onmaycausedr owsi ness,cl
umsi ness,or
unsteadi
ness.Adv i
sepatienttoav oi
ddr i
vi
ngorot her
acti
vit
iesrequi
ringaler
tnessunt i
lresponset o
medicationisknown.Ger i
:Adv i
seger i
atr
icpatient
sof
i
ncreasedr i
skforCNSef fectsandpot enti
al f
orfal
ls.

Caut
ionpat
ientt
oavoidtaki
ngal
coholorotherCNS
depr
essant
sconcur
rentl
ywitht
hismedicat
ion.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed.

Emphasi
zethei
mportanceoff
oll
ow-
upexaminat
ions
todet
ermi
neeff
ect
ivenessoft
hemedicat
ion.

Sei
zures:Pati
entsonant
iconvul
santt
her
apyshoul
d
car
ryidenti
fi
cati
ondescr
ibi
ngdiseasepr
ocessand
medicati
onregimenatal
ltimes.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Di
azoxi
de
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1150
I
NDI
CATI
ONS
I
V: Tr
eatmentofhyper
tensi
veemer gency.PO:Treatment
ofhypogl
ycemiaassoci
atedwithhyperi
nsuli
nism dueto
i
sletcel
lcar
cinomaorothercauses.

ACTI
ON
Dir
ect l
yrelaxesv ascularsmoot hmusclei nperi
pheral
art
erioles.Produces↓ i nBP, refl
extachycardi
aand
i
ncreasedcar di
acout put.I
nhibit
sinsuli
nr el
easefrom the
pancreasanddecr easesper i
pheraluti
li
zationofglucose.
Therapeut i
cEf f
ects:LoweringofBP.I ncreasedblood
gl
ucose.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
bi
sulf
ites(I
Vonly)
.Cross-
sensit
ivi
tywit
hsul
fonami
des
mayoccur ;
Hypert
ensionassoci
atedwith
pheochromocyt
omaoraor ti
cdissect
ion.

UseCaut
iousl
yin:
Diabet
ics(
hyper
gly
cemi
a
accompaniesuse);
Cardiovasculardi
sease;Renal
or
hepat
icimpairment
;OB: Lactat
ion:Pr
egnancyand
l
actat
ion(safet
ynotestabli
shed; mayinhi
bitl
abor
).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1151
CNS: dizzi
ness,headache.CV: hypotension,tachycardi
a,
angina,edema, fl
ushi
ng.Der m:hirsuti
sm.Endo:
hyperglycemia,hyper
uricemia.FandE: sodium andwat er
ret
ention.GI:nausea,vomiti
ng,constipation.Local:
phlebi
tisatIVsite.MS: weakness.

I
NTERACTI
ONS
Drug-Drug:Concur r
entdiuret
ictherapymaypot enti
ate
hypergl
y cemic,hyperur
icemic,andhy potensi
veeffects.
May↑ met abolism and↓ effecti
v enessofphenytoin.
Corti
cost er
oidsmay↑ hy per
glycemi a.May↑ effectsof
warfari
n.Mayal tertheeffect
sofi nsuli
nsororal
hypoglycemicagent s.
Dr
ug-
Nat ur
alProduct:
Glucosaminemayworsen
hy
pergl
ycemia.Fenugreek,
chromium,
andcoenzymeQ-
10
mayproduceaddit
ivehypogly
cemicef
fect
s.

DOSAGE
Hy
per
tensi
on
IV:(
AdultsandChil
dren):1–3mg/ kg(nottoexceed150
mg/dose) ;
mayrepeatdosei n5–15mi nuntil
BPis
l
ower edtodesi
redlevel
;repeatadmini
strat
ionevery4–24
hrmaybeusedt omai nt
ainBPunt il
oralanti
hypert
ensi
ves
arestart
ed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1152
Hy
per
insul
i
nemi
cHy
pogl
ycemi
a
PO:(AdultsandChi
l
dren)
:1mg/ kgq8hri niti
all
y,fur
ther
adj
ustment smadeonthebasi
sofr esponse.Usual
maintenancedosei
s3–8mg/ kg/daygivenindivided
dosesev er
y8–12hr.
PO:(Inf
antsandNewborns)
:2.
7mg/ kgq8hrinit
ial
l
y,
fur
theradjust
mentsmadeonthebasisofr
esponse.Usual
maintenancedoseis8–15mg/kg/
dayindi
videddoses
every8–12hr.

AVAI
LABI
LITY
Capsul
es100mg; Oralsuspensi
on50mg/
mL(
cont
ains
7.
5%alcohol
);I
nject
ion15mg/ mL;

PATI
ENTTEACHI
NG
Hypogl
ycemia:
Inst
ructpat
ientt
otakemedi
cat
ionas
di
rect
ed,att
hesamet i
meeachday .

Encouragepatientt
ofol
lowpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.

Revi
ewsignsofhy
pogl
ycemi
aandhy
per
gly
cemi
a
wit
hpat
ient.

Adv
isepat
ientnott
oswi
tchf
rom capsul
etoor
al

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1153
 suspensionf
orm withoutconsul
ti
ngheal
thcar
e
prof
essional
,becauseoralsuspensi
onpr
oduces
hi
gherbloodconcentrati
ons.

Advi
sepatientt
oinf
orm heal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort ot
reat
mentorsurgery
.

Hyper
tensi
on:I
nst
ructpat
ienttochangeposi
ti
ons
sl
owlytomini
mizeort
hostati
chypotensi
on.

Cauti
onpatientt
oav oidtaki
ngotherRx,OTC,or
her
balproducts,especi
all
ycoldproductsandNSAI
Ds,
wit
houtconsulti
nghealthcareprofessi
onal
.

Emphasizet
heimpor
tanceofr
outi
nefol
low-upexams,
especi
all
ydur
ingt
hefi
rstfewweeksoft
herapy.

DI
BUCAI
NE
I
NDI
CATI
ONS
Topical:Rel i
efofpruritusorpainassoci atedwi thminor
skindisor dersincl
udingbur ns,abrasions, bruises,
insect
sti
ngs/ bites,dermati
tis,hemor r
hoi ds,orot herformsof
skinir
ritation.Mucosal :Provi
del ocalanest hesiato
mucosal surfacesbefor ei
nstrument ation, minor
procedur es,orendoscopy .Decr easeirritati
oncausedby
minormout handthroatcondi t
ionsi ncludingsor ethroat
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1154
gingi
vi
ti
s,st
omati
tis,
orteet
hing.Al
sousedtosuppr
ess
thegagrefl
exdur
ingendoscopyorint
ubat
ion.

ACTI
ON
I
nhibiti
nit
iat
ionandconductionofsensorynerv
eimpul
ses.
Therapeuti
cEffect
s:Localanest
hesiawit
hsubsequent
l
ossofsensat i
onorreli
efofpainand/orprur
it
us.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.Cr
oss-
sensi
ti
vi
ty
mayoccuramongr elatedagent s(ami detypes—dibucaine;
estertypes—benzocaine,t etr
acaine);Hypersensiti
vi
tyt o
anycomponent sofpr epar ati
onsi ncludi
ngst abi
li
zers,
colorants,
orbases;Active, untr
eat edinf
ectionofaf fect
ed
area;Nottobeusedi nt heey e;Somepr oduct scontain
al
cohol andshouldbeav oidedinpat i
entswithknown
al
cohol int
oler
ance;Pedi :Topicalbenzocainepr oduct s
shouldnotbeusedi nchi ldren<2y r.

UseCaut
iousl
yin:
Debi
l
itat
edpat
ient
s;Lar
georsev
erel
y
abradedar easofskinormucousmembr ane;Pr
olonged
use(notr ecommended) ;Pedi
:↑r i
skofsy stemictoxi
cit
y,
safetynotestabli
shedforsomepr oducts;usesmal l
er
dosesduet opotent
ialf
ormet hemoglobinemia;Geri
:↑
ri
skoft oxici
ty;
usesmal l
erdoses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1155
ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:mucosal use—↓ orabsentgagref
lex.Der
m: topi
cal
use—burning,edema,irr
it
ati
on,st
ingi
ng,t
enderness,
urt
icar
ia.Misc:all
ergi
creact
ionsincl
udi
nganaphy l
axis.

I
NTERACTI
ONS
Drug-
Drug:Toxi
cit
yofest
er-t
ypeagent
smaybei ncr
eased
byconcurr
entuseofchol
inest
erasei
nhi
bit
ors.

DOSAGE
Topical
:(Adult
sandChi
l
dren):
Applyasneeded(nott
o
exceed30g/ dayi
nadul
tsor7.5g/
dayinchil
dren)
.Canbe
used3–4t i
mesdaily
.

AVAI
LABI
LITY
Topi
cal
oint
ment1%OTC;

PATI
ENTTEACHI
NG
I
nstr
uctpat
ientoncorrectappli
cati
ontechni
que.High
Al
ert
:Inf
orm pat
ientofpotenti
alharmfrom over
use.
Emphasi
zeneedt oavoidcontactwit
hey es.

Caut
ionpat
ientt
hattheseagentsshouldnotbe
appl
i
edforprol
ongedperiodsortolar
geareas,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1156
 especi
allyi
fskinisabr
adedorbroken, wi t
hout
consult
inghealt
hcareprof
essional.Patientshoul
d
alsoconsul
thealthcar
eprofessi
onal beforeusing
theseagentsforcondi
ti
onsotherthani ndicat
ed.

Advisepat i
entt odisconti
nueuseandnot ifyhealt
h
carepr ofessionalifer y
thema, r
ash,ori
rr
itati
onatsit
e
ofadmi nist
rationoccur s;ar
eabecomesi nfected;
medi cationisswal lowed; orcondi
ti
onwor sensor
doesnoti mpr ovewi thi
n7day s.

Caut
ionpati
enttor eadl
istofacti
vei ngredi
ent
son
OTCproducts.Brandnamesf requentlychangeand
maybemi sl
eadingast oactualcontents.

Advi
seadul
tsusi
ngli
quidfor
m ar
oundt
hemout
hto
avoi
dsmoki
nguntil
solut
ioni
sdry.

TeethingGel :I
nstructpati
entstonotifyhealthcar
e
professionali
fpaini sexcessiv
eorpr olonged.Advi
se
parentst oavoidfeedingimmedi at
elyaf t
erappli
cat
ion
toprev entchokingfrom dimini
shedgagr ef
lex.

Lozenge:Instructpati
enttosuckonl ozengeand
al
lowi tt
osl owlydissol
ve.Consulthealt
hcare
prof
essional i
fthroatpai
npersist
smor ethan2day
s.
Avoidusei nyoungchi l
drenbecauseofdangerof
choking.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1157
DI
CHLORPHENAMI
DE
I
NDI
CATI
ONS
Loweri
ngofi
ntr
aocul
arpr
essur
eint
het
reat
mentof
gl
aucoma.

ACTI
ON
Inhi
bit
ionofcarboni canhydraseintheey eresultsin
decreasedsecretionofaqueoushumor .Inhibi
tsrenal
carbonicanhydrase,resul
ti
ngi nself
-li
miti
ngur i
nary
excreti
onofsodi um, pot
assium,bicarbonate,andwat er
.
Therapeuti
cEffect s:
Loweringofintraocularpressure.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorcr
oss-
sensi
ti
vi
ty
withsul
fonamides;Concurrentuseoforalandopht
hal
mic
carboni
canhydraseinhibi
tors(dor
zolamide)i
snot
recommended; Fi
rsttr
imesterofpregnancy.

UseCaut
iousl
yin:
Chr
oni
crespi
rat
orydi
sease;
El
ectrolyt
eabnormali
ti
es;Renalorhepat
icdi
sease;
Diabetesmell
it
us;Secondorthi
rdtri
mesterofpr
egnancy
orlact
ation(
safet
ynotestabli
shed).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1158
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: depression, ti
redness,weakness, drowsi ness.EENT:
transientnear sightedness.GI:anor exi
a, met all
ictaste,
nausea, vomi ting.GU: cryst
all
uria,renal calculi
.Derm:
rashes.Endo: hy pergl
ycemia.FandE: hy perchloremic
aci dosi
s,hypokal emia.Hemat :APLASTI CANEMI A,
HEMOLYTI CANEMI A,LEUKOPENI A.Met ab:wei ghtl
oss,
hy peruri
cemi a.Neur o:paresthesias.Mi sc: al
lergic
react i
ons.

I
NTERACTI
ONS
Drug-Drug:Excret
ionofbarbi
tur
ates,aspiri
n,andlit
hium i
s
decreasedandmayl eadt
odecreasedef fecti
veness.
Excreti
onofamphet amine,
quini
dine,procainamide,and
possibl
yt r
icycl
i
cant i
depr
essantsisdecreasedandmay
l
eadt otoxici
ty.

DOSAGE
PO:(Adult
s):
100–200mgf oll
owedby100mgq12hr
i
nit
ial
ly,
thenmai
ntenancedoseof25–50mg1–3t
imes
dai
ly.

AVAI
LABI
LITY
Tabl
ets25mg,
50mg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1159
PATI
ENTTEACHI
NG
I
nstructpati
entt
otakeexact
lyasdir
ect
ed.Ifadosei
s
missed,takeassoonaspossibl
eunl
essalmostti
me
f
ornextdose.Donotdoubledoses.

Advi
sepatientoftheneedforper
iodic
opht
hal
mol ogicexams;lossofvi
sionmaybegr
adual
andpai
nless.

Adv i
sepat ienttorepor tnumbnessort i
nglingof
extremities,weakness, rash,sor
et hr
oat,unusual
bleedingorbr uisi
ng,orf evertohealt
hcar e
professional.Ifhemat opoieti
creacti
ons,fever
,rash,
orrenalpr oblemsoccur ,car
bonicanhydraseinhibi
tor
therapyshoul dbedi scont i
nued.

Mayoccasionallycausedr owsi
ness.Cauti
onpati
ent
toavoiddri
vi
ngandot heracti
vi
ti
esthatrequi
re
aler
tnessunti
lresponset othedrugisknown.

Cauti
onpat
ienttousesunscreenandwearprotect
ive
cl
othi
ngtopreventphot
osensit
ivi
tyr
eact
ions.

Di
clof
enac
I
ndi
cat
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1160
Acut
emusculo-skel
etalpai
n;art
hri
ti
s;gout
;spondy
li
ti
s;
migr
aine;
post
-operat
ivepain.

ACTI
ON
Inhibit
sprostaglandi
nsy nthesis.Therapeut
icEff
ects:
Suppr essi
onofpai nandi nfl
ammat i
on.Reli
efofacute
mi grai
neattacks.Topical(Solaraze)
—Cl ear
anceofacti
nic
keratosisl
esions.

Av
ail
abi
l
ity
TABLETS25and50mgPlain;
75and100mgSR;
CAPSULES100mg,100mgCR; I
NJECTION3mlampoul
e
(25mg/ml)
;EyE/
EARDROPS0.1%w/v;SUPPOSI
TORI
ES
25,50and100mg;GEL1%w/w.

DOSAGE
Or
al
100to150mgdai l
yin2to3di
vi
deddoses,
(max150
mg/day)mai
ntenanceby50t
o100mgi ndi
videddoses.

I
ntr
amuscul
ari
nject
ion75mg,2t
o3t
imesdai
l
y.

Topi
cal
l
yAdul
t-Appl
y1%w/
wgel
ont
oaf
fect
edar
ea3t
o
4t
imesdai
l
y.
I
nst
il
ltoey
ePost
-oper
ati
veocul
ari
nfl
ammat
ion:
Adul
t-as

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1161
sodium (
1%w/v)
,4t
imesdai
l
yst
art
ing24haf
tersur
ger
y
forupto28day
s.

Rect
al
Post-
operati
vepain.Adult
-75t o150mgdailyi
ndiv
ided
doses(max.150mg/ day,i
nclusiv
eofdi
clof
enac
admini
steredthr
oughot herroutes).
Chi
ld-6t
o12y ear
:1t
o2mg/
kg/
dayi
ndi
vi
deddosesf
or
max.of4day
s.

Cont
rai
ndi
cat
ions
Porphy
ria;
av oidinj
ect
ionscont
aini
ngbenzylal
coholi
n
neonat
es;historyofgastr
icul
cer
s,bleedi
ngorperf
orat
ion.
Addit
ionalcont r
aindicati
onsi ncludeconcomi tantNSAID
oranti
coagul antuse( i
ncludingl ow- dosehepar i
n);hi
story
ofhaemor rhagicdiathesis;hist
or yofconf ir
medor
suspectedcer ebrovascularbleedi ng;operati
onswi thhigh
ri
skofhaemor rhage;hist
or yofast hma;moder ateor
sever
er enalimpai r
ment ;hypov olaemi a;dehydrat
ion.

I
NTERACTI
ONS
Pr
imar
il
ynot
edf
oror
aladmi
nist
rat
ion
Dr
ug-
Drug:↑ adverseGIef f
ect
swithaspi
ri
n,other
NSAI
Ds,orcor
ticoster
oids.May↓ eff
ecti
venessof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1162
diureticsorant i
hy pert
ensi v
es.May↑ l evels/riskof
toxicit
yf rom cyclospor i
ne,li
t hi
um, ormethot rexate.↑ risk
ofbl eedingwi t
hsomecephal osporins,t
hrombol y
tic
agent s,antipl
ateletagent s,orwar fari
n.CYP2C9i nhibi
tors,
i
ncl udingv ori
conazol emay↑ l evel
s/ri
skoft oxicit
y.
CYP2C9i nducers,incl
udingr i
fampinmay↓
l
ev els/effecti
vness.Concur rentuseofor alNSAI Dsdur ing
topical di
clofenact herapyshoul dbemi ni
mi zed.
Drug-NaturalPr
oduct:↑ bl
eedingri
skwitharni
ca,
chamomi le,cl
ove,dongquai
,fever
few,garl
i
c,ginger
,
ginkgo,Panaxginseng,andot
hers.

Pr
ecaut
ions
NSAIDsshoul dbeusedwi t
hcaut i
onintheelderl
y( r
iskof
ser
iousside-eff
ect
sandf atal
it
ies)
;int
eract
ionspr egnancy
pat
ient
swi thcoagulat
iondisor
ders;hepati
c,renaland
car
diacimpai r
ment;hi
storyofgastroi
ntest
inall
esions.

Adv
erseEf
fect
s
I
nject
ionsit
ereacti
ons;t
ransi
entepigastr
icpai
n,r
iskof
t
hromboticevents;
toxi
cepider
mal necrol
ysi
s;Abnormal
it
y
i
nkidneyfuncti
on.

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1163
Cauti
onpatienttoavoi
dconcurr
entuseofalcohol
,
aspi
ri
n,acetaminophen,ot
herNSAIDs,orot
herOTC
medicat
ionswithoutconsul
ti
nghealt
hcare
prof
essi
onal.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Maycauseser ioussi deef fect s:CV( MIorst roke) ,GI

(ulcers, bleeding) ,skin( exf oliati
veder matitis, St evens
-JohnsonSy ndrome, toxicepi dermal necroly sis)and
hyper sensi tivi
ty(anaphy laxi s).Mayoccurwi thout
war ningsy mpt oms.Adv isepat i
enttost opmedi cation
andnot ifyheal thcar epr ofessi onal i
mmedi atel yi f
sympt omsofCVsi deef f ects( chestpai n,shor tness
ofbr eat h,weakness, slur ri
ngofspeech) ,GIsi de
effect s(epi gast r
icpai n,dy spepsi a,mel ana,
hemat emesi s),skinsi deef fect s(skinr ash,bl ister s,
fever, i
tchi ng)orhy persensi ti
v i
tyreact i
ons( difficul ty
breat hingorswel li
ngoff aceort hroat)occur .I nf orm
pat i
entt hatr iskf orhear tat tackorst roket hatcan
l
eadt odeat hi ncreaseswi thl ongeruseofNSAI D
medi cat ionsandi npeopl ewhohav ehear tdi sease
andt hatr i
skoful ceri ncreaseswi thconcur rentuseof
cor t
icost eroidsandant icoagul ants,longeruse,
smoki ng, drinkingal cohol ,
ol derage, andhav ingpoor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1164
 heal
th.

Adv i
sepat i
enttonotif
yhealt
hcarepr of
essional
prompt lyi
funexplai
nedweightgain,swell
ingofar ms
andl egsorhandsandf eet,
nausea,fati
gue, l
ethargy,
rash,pruri
ti
s,yel
lowingofskinoreyes,i
tching,
stomachpai n,vomit
ingblood,bl
oodyort arrystools,
orflu-l
ikesymptomsoccur .

I
nstr
uctfemalepat i
entstoinfor
m healt
hcare
pr
ofessi
onaliftheyplanorsuspectpregnancy.
Caut
ionfemalepat i
enttoav oi
duseofdiclof
enaci
n
l
asttr
imesterofpregnancyandt onoti
fyhealt
hcar
e
pr
ofessi
onalifbreastf
eeding.

PO: Inst
ructpatienttotakediclof
enacwi thaful
lglass
ofwat erandtor emai ni
nanupr i
ghtpositi
onfor
15–30mi nafteradmi ni
strat
ion.Takemi sseddoses
assoonaspossi bl
ewi t
hin1–2hri ft
akingonceor
twiceadayorunl essalmostt i
mef ornextdoseif
takingmor ethant wiceaday .Donotdoubl edoses.

Maycausedr owsi
nessordizziness.Cauti
onpati
ent
toavoiddri
vingorotheracti
vi
tiesrequir
ingal
ert
ness
unti
lresponsetomedi cat
ionisknown.

Cauti
onpat
ienttowearsunscr
eenandpr
otecti
ve
cl
othi
ngtopreventphot
osensi
ti
vi
tyr
eact
ions.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1165
Topi
cal:Advisepatienttominimizeuseofconcurr
ent
NSAIDsduringt opi
calther
apy.Instr
uctpati
entt
or ead
Medicat
ionGui debeforestart
ingtherapyandwit
h
eachRxr ef
il
lincasechangeshav ebeenmade.

Inst
ructpat
ienttoavoi
dcoveri
nglesi
onwith
occlusi
vedressi
ngandt oav
oidapply
ingsunscr
eenor
cosmeticst
ot heaff
ectedar
ea.

Advi
sepati
entthati
tmaytakeupt
o1mofor
complet
eheal
ingofthel
esiont
ooccur
.

Transdermal:I
nstructpat i
entoncorrectappl
icati
on
procedureforpatch.Appl ypatchtomostpainf ularea.
Changepat chevery12hr .Removepatchifir
ritat
ion
occurs.Fol
dusedpat chessoadhesi vesti
ckst oitsel
f
anddiscardwher echildrenandpetscannotgett hem.
Encouragepatienttor eadtheNSAI DMedication
Guidethataccompani est heprescri
pti
on.

Inst
ructpat
ient
sifpatchbegi
nstopeelofft
otapethe
edges.Donotwearpat chdur
ingbat
hingorshower
ing.
Bathi
ngshouldtakeplacebet
weenscheduledpat
ch
removalandappli
cati
on.

Advi
sepatientr
efer
redforMRItestt
odiscusspat
ch
wit
hrefer
ri
nghealthcar
eprofessi
onalandMRIfaci
li
ty
todet
ermineifremoval
ofpatchisnecessar
ypri
orto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1166
 t
estandf
ordi
rect
ionsf
orr
epl
aci
ngpat
ch.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Di
cloxaci
l
li
n
I
NDI
CATI
ONS
Tr
eatmentofthef
oll
owingi nf
ecti
onsduet openi
cill
inase-
pr
oduci
ngstaphyl
ococci:Respi
rat
orytr
actinfect
ions,
Si
nusi
ti
s,Osteomyel
i
tis,
Skinandskinstructur
einfections.

ACTI
ON
Bindtobact eri
al cell
wal l
,l
eadingtocel l
deat h.Not
i
nact i
vat
edbypeni ci
ll
inaseenzymes.Ther apeuticEffect
s:
Bacteri
cidalaction.Spect r
um: Acti
v eagainstmostgr am-
positi
veaerobiccocci .Spectrum isnotableforactivi
ty
against:
Peni ci
ll
inase-producingstrainsofStaphy l
ococcus
aureus,Staphylococcusepi dermidis.Notactiveagainst
met hi
cil
l
in-r
esistantbact eri
a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Pr
evi
oushy
per
sensi
ti
vi
tyt
o
peni
cil
l
ins(
cross-
sensi
ti
vi
tyexi
stswi
thcephal
ospor
ins

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1167
andot
herbet
a-l
act
am ant
ibi
oti
cs)
.

UseCaut
iousl
yin:
Sev
erer
enal
orhepat
ici
mpai
rment
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES.GI:PSEUDOMEMBRANOUSCOLI TI
S,
di
arrhea,epi
gastri
cdistr
ess,nausea,vomiti
ng,↑l iv
er
enzymes.GU: i
ntersti
ti
alnephri
ti
s.Derm:rash,urti
cari
a.
Hemat :eosi
nophili
a,l
eukopenia.Misc:al
l
ergicreacti
ons
i
ncludinganaphylaxi
sandser um si
ckness,superi
nfecti
on.

I
NTERACTI
ONS
Drug-Drug:May↓ ef f
ectivenessofor alcontraceptive
agents.Probenecid↓ renal excreti
onand↑ bl oodl ev el
s
(t
herapymaybecombi nedfort hispur
pose) .Neomy ci
n
may↓ absor pt
ion.Concurrentusewi thmet hotrexate↓
methotrexateeli
minati
onand↑ r i
skofserioust oxicit
y .

DOSAGE
PO:(
Adult
sandChi
l
dren≥40kg)
:125–250mgq6hr(
up
to2g/day
).
PO: (
Chi
ldr
en<40kg) :
25–50mg/ kg/
daydi
vi
dedq6hr;
(upto50–100mg/ kg/daydi
vi
dedq6hrhasbeenusedf
or
osteomyel
i
tis)
,maximum: 2g/day
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1168
AVAI
LABI
LITY
Capsul
es250mg,
500mg;

PATI
ENTTEACHI
NG
Inst
ructpatienttotakemedicati
onar oundt heclock
andt ofi
nishthedr ugcompletel
yasdi rected,ev
enif
feel
ingbetter.Misseddosesshoul dbet akenassoon
asremember ed.Advisepati
entthatshar i
ngofthis
medi cat
ionmaybedanger ous.

Adv i
sepati
entt
oreportsignsofsuperinfect
ion(black,
furryov
ergr
owthonthet ongue;v
aginal i
tchi
ngor
dischar
ge;l
ooseorfoul-
smelli
ngstools)andal l
ergy.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Inst
ructpat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
if
symptomsdonoti mpr
ove.

Di
cycl
omi
ne
I
ndi
cat
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1169
I
nfant
il
ecol
i
c,gast
roi
ntest
inal
tractspasm.
Managementofir
ri
tabl
ebowel sy
ndromeinpati
ent
swho
donotrespondt
ousualint
erv
entions(
sedat
ion/
changei
n
di
et)
.

ACTI
ON
Mayhav eadi
rectandlocal
effectonGIsmoothmuscle,
reduci
ngmoti
li
tyandtone.Therapeut
icEf
fect
s:Decr
eased
GImotil
it
y.

Av
ail
abi
l
ity
TABLETS10and20mg.DROPS10mg/
ml;
INJECTI
ON10
mg/ml.

DOSAGE
Or
al
Adul
t-10-
20mgt
hreet
imesaday
.
Par
ent
eral
IMi
nject
ion:
80mgdai
l
yin4di
vi
deddoses.

Cont
rai
ndi
cat
ions
Gl
aucoma,ref
luxoesophagi
tis,
myast
heni
agr
avi
s,
l
act
ati
on,i
ntesti
nalobst
ruct
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1170
I
NTERACTI
ONS
Drug-Drug:Additi
v eanti
cholinergi
cef f
ectswi t
hot her
anticholi
nergi
cs,incl
udingant i
hist
ami nes,quini
dine, and
disopyramide.Mayal tertheabsorptionofot herorally
admi ni
stereddrugsbysl owingmot ili
tyoftheGIt ract.
Antacidsoradsor bentant i
diar
rheals↓ theabsor pt i
onof
anticholi
nergi
cs.May↑ GImucosal l
esionsinpat ients
takingoralpotassium chlori
detablets.

Pr
ecaut
ions
Patientswithmentaldepressionandment aldi
stur
bances,
hepaticorkidneydisease,angleclosureglaucoma,
hyperthyr
oidism,CHF, el
derl
y,pregnancy,mayi mpairt
he
abil
itytodri
v eoroperatemachi ner
y;int
eracti
ons
pregnancy.

Adv
erseEf
fect
s
Drymout h;nausea;vomit
ing;consti
pation;tasteloss;
anorexia;
dizzi
ness;dyski
nesia;l
ethargy,respirat
oryarr
est;
drowsiness;photophobi
a,blur
redv i
sion;i
ncr easedocular
pressure;t
achycardi
a;uri
naryretent
ion.

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakedi
cycl
omi
neexact
lyas

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1171
 dir
ect
edandnott otakemorethantheprescr
ibed
amount.Misseddosesshoul
dbet akenassoonas
rememberedifnotj
ustbefor
enextdose.

Medicati
onmaycausedrowsinessandblur
redvisi
on.
Cauti
onpatientt
oavoi
ddr i
vi
ngorotheract
ivi
ti
es
requi
ri
ngalert
nessunt
ilr
esponsetothemedicati
onis
known.

I
nf or
m pat
ientthatfrequentoralr
inses,
sugarless
gum orcandy,andgoodor alhygi
enemayhel preli
eve
drymouth.Consulthealthcareprofessi
onalregardi
ng
useofsali
vasubst i
tuteifdrymouthpersist
sf ormore
than2wk.

Advisepat
ientrecei
vi
ngdicy
clominetomakeposi
ti
on
changessl
owl ytomini
mizetheeffect
sofdr
ug-
i
nducedorthostati
chypot
ension.

Caut
ionpat
ientt
oav oi
dextr
emesoft emperat
ure.
Thi
smedicati
ondecreasest
heabil
it
yt osweatand
mayincr
easetheri
skofheatst
roke.

Instr
uctpati
entt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultheal
thcar e
professi
onalbef
oretaki
ngotherRx, OTC,orherbal
products.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1172
 Advisepatienttonotif
yhealthcareprofessional
i
mmedi at
elyifeyepainorincreasedsensitivi
tyt
oli
ght
occurs.Emphasi zetheimportanceofroutineeye
examst hroughouttherapy
.

St
orage
I
njecti
on:Stor
eprotectedf r
om l
ight,
insi
ngledoseor
multi
pledosecontainers.Tabl
ets:St
oreprot
ectedf
rom
l
ight.

Di
danosi
ne
I
ndi
cat
ions
HIVinf
ecti
onincombinat
ionwi
that
leastt
woot
her
ant
ir
etrov
iral
drugs.

ACTI
ON
Inhibi
tsvir
alrepl i
cati
onbyi nterf
eringwithv i
ral
RNA-
directedDNApol ymerase(rev er
set r
anscri
ptase).
Conv ert
edintracellul
arl
ybyt hephosphor yl
ationpr ocess
toitsactiv
ef orm.Ther apeuticEffects:
IncreaseinCD4cel l
count sanddecr easedv i
ralload,withdecreasedi ncidence
ofoppor t
unisticinfect
ionsandsl owedpr ogressioni nHIV-
i
nf ectedpati
ent s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1173
Av
ail
abi
l
ity
TABLETS100,
250mgand400mg;
CAPSULES250and
400mg.

DOSAGE
Or
al
Adul
t-Under60kg:250mgdail
yin1to2div
ideddoses.
60kgandov er
:400mgdail
yin1to2divi
deddoses,30
minbefor
emeal sor2haf
termeals.
Chi
l
d-2week-8mont
hs:100mg/m2t
wicedai
l
y.>8
months:
120mg/m2t
wicedai
ly
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Lact
ati
on:
Lact
ati
on;
Concur
rentuseofr
ibav
iri
noral
l
opur
inol
.

UseCaut
iousl
yin:
Hist
oryofgout
;Renal
impai
rment
(dosagemodi f
icat
ionrequi
redi
fCCr<60mL/mi
n;↑r i
sk
ofpancreati
ti
s);Hi
stor
yofseizur
es;
Diabet
esmel
li
tus;
Pedi:↑r i
skofpancreati
ti
s.

I
NTERACTI
ONS
Dr
ug-
Drug:
Ribav
iri
nandal
l
opur
inol
↑lev
elsandr
iskof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1174
toxicity(concur rentusenotr ecommended) .Lev elsare↑
byt enof ovir(doser educt i
onr ecommended) .Concur rent
usewi thganci cl ovir↑ l ev els( doseadj ustment smaybe
necessar y)
.Met hadone↓ l ev elsofdi danosi ne( dose
adjust ment smaybenecessar y).Buffersindi danosi ne↑
absor ptionofket oconazol e, i
traconazol e,dapsone,
tetr
acy clines, andf luoroqui nol ones( donotadmi nister
within2hrofdi danosi ne).↑ r iskofper i
pher al neuropathy
withi soniazid, pheny toin,st avudi ne,ethambut ol,and
chlorampheni col (usecaut i
ousl y) .↑ ri
skofpancr eati
ti
s
withot heral cohol ,thiazidedi ur etics,I
Vpent ami dine,
tetr
acy clines( usewi thext remecaut i
on).↑ r i
skofbone
mar rowdepr essi onwi thot herdr ugscausingbonemar row
depr ession.Concur rentusewi thst avudinedur ing
pregnancy↑ t her iskoff etal l
act icacidosis.
Dr
ug-
Food:
Admi
nist
rat
ionwi
thf
ood↓ absor
pti
onby50%.

Adv
erseEf
fect
s
Pancreati
ti
s( seealsounderPr ecaut
ions); peripheral
neuropathyespeciall
yinadv ancedHIVi nfection-suspend
(r
educeddosemaybet ol
eratedwhensy mpt omsr esol
ve)
;
hyperuri
caemi a(suspendtreatmentifsignificant
el
evation);
diarrhoea(occasionall
yseri
ous) ;alsor eport
ed,
nausea,vomit i
ng,drymouth, ast
henia,headache,
hypersensi
tiv
ityreacti
ons;reti
nalandopt icner vechanges

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1175
(especi
all
yinchi
ldr
en)
;diabetesmell
it
us,rai
sedli
ver
enzymes( seeal
sounderPrecaut
ions)
;li
verfai
l
ure.

PATI
ENTTEACHI
NG
I
nstructpat
ientontheimpor t
anceoftaki
ng
di
danosineexactl
yasdirected,eveni
ffeel
ingbet
ter
.
Cautionpati
entnottoshareortradet
hismedicat
ion
wit
hot her
s.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Inf
orm patientthatdidanosinemaycause
hypergly
cemi a.Adv i
sepatienttonotif
yheal
thcare
professi
onal i
fincreasedthirstorhunger
;unexpl
ained
weightloss;increaseduri
nat i
on;fat
igue;
ordry,i
tchy
skinoccurs.

Inst
ructpat i
enttonot i
fyhealt
hcar epr of
essi onal
i
mmedi atel
yifsympt omsofl acti
caci dosis( t
iredness
orweakness, unusual musclepai n,tr
oublebr eat hi
ng,
stomachpai nwi t
hnauseaandv omi t
ing,cold
especiall
yinar msorl egs,
dizzi
ness, fastori rr
egular
heartbeat)orifsi
gnsofhepat otoxicity(yell
owski nor
whitesofey es,darkur i
ne,
li
ght-coloredst ools,lackof
appetit
ef orseveraldaysorlonger ,nausea, abdomi nal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1176
 pain)occur
.Thesesymptomsmayoccurmor e
fr
equentlyi
npati
entsthataref
emale,
obese,orhave
beentakingmedicat
ionsli
kedi
danosi
neforalong
ti
me.

Instr
uctpati
entt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultheal
thcar e
professi
onalbef
oretaki
ngotherRx, OTC,orherbal
products.

Cauti
onpati
enttoav
oidcr
owdsandper
sonswi
th
knowninf
ecti
ons.

Advisepat i
enttonot
if
yhealt
hcarepr
ofessi
onal
i
mmedi atelyi
fnumbnessorti
ngl
i
ngofthehandsor
feet
, occurs.

Cauti
onpati
entt
ouseacondom t
oprevent
tr
ansmissi
onofHIVandnott
oshareneedl
eswi
th
anyone.

Inf
orm pat i
entthatr
edi st
ribut
ionandaccumul at
ionof
bodyf atmayoccur ,causingcentralobesi
ty,
dorsocer v
ical
fatenlargement( buff
alohump),
peri
pher alwasti
ng,breastenlargement,and
cushingoidappearance.Thecauseandl ong-t
erm
eff
ectsar enotknown.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1177
 Chi
l
drenshoul
dhav
edilat
edret
inal
examsev er
y3–6
moorift
herei
sachangeinv
isi
onthroughoutt
her
apy.

Emphasi
zet
heimport
anceofr
egul
arexamst
o
moni
torf
orsi
deeff
ects.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

DI
ENESTROL
I
NDI
CATI
ONS
Symptomat
icmanagementofat
rophi
cvagi
nit
isi
n
post
menopausal
women.

ACTI
ON
Estr
ogenspr omotethegrowthanddev elopmentoff emal
e
sexorgansandt hemai ntenanceofsecondar ysex
characteri
sti
csinwomen.Met abol
iceffectsincl
ude:
Reducedbl oodcholester
ol,Prot
einsynthesis,Sodi
um and
waterretenti
on.Therapeuti
cEf f
ects:
Rest orat
ionof
i
ntegrit
yoft hevaginalmucosainpostmenopausal women.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1178
Cont
rai
ndi
cat
edi
n:Thr
omboembol
i
cdi
sease;
Undi
agnosedvaginal
bleeding;Pregnancy(
usemayr
esul
t
i
nharmtot hef
etus);Lact
ation.

UseCaut
iousl
yin:
Pat
ient
swi
thser
iouscar
diac,
hepat
ic,
orr
enaldi
sease;
Mayi
ncr
easet
her
iskofendomet
ri
al
car
cinoma.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: depression,dizziness, headache.CV: edema,
hypertension.GI:abdomi nalcramps,bl oating,jaundice,
nausea, vomiti
ng.GU: breakthroughbl eeding, cysti
ti
s,
dysmenor rhea,vaginal candidiasi
s.Der m: pigment ation,
rashes.Endo: hyperglycemi a.FandE: hy percalcemia,
sodium andwat erretention.Hemat :thromboembol i
sm.
Misc:breastenlargement ,breasttender ness, changei n
l
ibido.

I
NTERACTI
ONS
Drug-Dr
ug:Mayalt
err equir
ement sforwarfari
n,or
al
hypogly
cemicagent
s, orinsul
ins.Mayi nt
erfer
ewiththe
desir
edeff
ectsofbromocr ipt
ine.Mayincreaseblood
l
evelsandri
skoftoxicit
yf r
om cyclospori
ne.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1179
Vag(Adult
s):1appl
icat
orf
ul1–2timesdail
yfor1–2wk,
then½dosefor1–2wk.Mai nt
enancedoseof1
appli
cat
orf
ul1–3ti
mes/ wkfor3wk,then1wkof f
.

AVAI
LABI
LITY
Vagi
nal
cream 0.
01%;

PATI
ENTTEACHI
NG
Instructpati
entinthecorr
ectuseofvaginalappl
icator
.
Pat i
entshouldremai nr
ecumbentforatleast30mi n
afteradmi ni
str
ation.Mayusesani
tarynapkinto
protectclothi
ng,butdonotusetampons.

Explai
ndosagescheduleandmai ntenancerouti
ne.I
f
adosei smissed,
omi tandret
urntor egul
ardosi
ng
schedule.Di
scont
inui
ngmedi cat
ionsuddenlymay
causewi t
hdrawalbl
eeding.

Adv i
sepat ienttoreportsignsandsy mptomsoff l
uid
retenti
on( swelli
ngofankl esandf eet,weightgai n),
thromboembol icdisorders( pain,swel li
ng, t
enderness
i
next remities,headache, chestpai n,blurr
edv isi
on),
ment aldepr essi
on, unusual vaginal bleeding,or
hepaticdy sfuncti
on( yel
lowedski norey es,pruri
tus,
darkur i
ne, l
ight-
coloredst ools)toheal t
hcar e
professional.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1180
 I
nstr
uctpati
enttost
optaki
ngmedicat
ionandnoti
fy
heal
thcar
eprofessi
onal
ifpr
egnancyi
ssuspect
ed.

Cauti
onpatientt
hatci
garettesmokingduri
ng
estr
ogentherapymayincreaseri
skofseri
oussi
de
eff
ects,
especial
lyf
orwomenov er35yr.

Emphasi
zethei
mportanceofrouti
nefol
low-
up
phy
sical
exams,i
ncl
udingBP;breast,
abdomen,and
pel
vi
cexams;andPAPsmear severy6–12mo.

Di
ethy
lcar
bamazi
ne
I
ndi
cat
ions
Treat
mentofloi
asi
s;prophyl
axisofl
oiasi
sint
empor ar
y
resi
dent
sinendemicareas;ti
ssuenematodei
nfect
ions;
l
y mphat
icf
il
ari
asi
s;toxocar
iasi
s.

Av
ail
abi
l
ity
TABLETS50and100mg;
SyRUP5mg/
mland120mg/
5
ml.

DOSAGE
Or
al
Adul
tandchi
l
d-11mg/
kgbodywei
ghtdai
l
yint
hree

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1181
divi
deddosesont hefi
rstday.Thereafteri ncrease
graduall
yto6mg/ kgbodywei ghtgivenaf terf ooddail
yfor
twotot hr
eedays.Hookwor minfecti
on: treatf or21days.
Fil
ari
asis:2mg/kgbodywei ghtisgivent hr eetimesaday
for3to4weeks.1mg/ kgbodywei ghtf oranadul tof50
kg.Treatmentmayber epeatedonceaf ter6mont hs.

Cont
rai
ndi
cat
ions
Pr
egnancy(delaytreat
mentunt ilaf
terdeli
ver
y);
infant
s,
el
der
ly,debi
li
tated(usual
lyexcludedf r
om masstreatment
pr
ogrammes; seealsoPr ecaut
ions);cardi
acdi
sease,
hy
persensit
ivi
ty,i
mpairedrenalfuncti
on.

Pr
ecaut
ions
Renal i
mpai r
ment;cardi
acdisor
ders;othersever
eacut e
diseases-
delaydiethy
lcar
bamazinetreatmentunti
l af
ter
recovery;
riskofmeningoencephal
iti
sinsev er
einfect
ion
(seenotesabov e).

Adv
erseEf
fect
s
Headache,dizzi
ness,drowsiness,nauseaandv omiting;
i
mmunol ogicalr
eactions,wit
hinaf ewhouroft hefi
rst
dose,subsi
dingbyf i
fthdayoftreatmentandi ncl
uding
fev
er,headache,j
ointpain,di
zziness,anor
exia,malaise,
nauseaandv omiti
ng, ur
ti
cari
aandast hmainasthmat ics

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1182
(si
milartoMazzottir
eacti
on)
,inducedbydisi
ntegrati
ng
microfi
lar
iae;
microencephal
it
is(wit
hheavy
microfi
lar
aemia,seenotesabove);r
ever
sibl
eproteinuri
a;
enl
argementofly mphnodes.

St
orage
St
orepr
otect
edf
rom moi
stur
e.

DI
ETHYLSTI
LBESTROL
I
NDI
CATI
ONS
Pal
li
ativ
einadvanced,i
noperabl
emet astat
icprost
ate
car
cinomaandpost menopausalbreastcar
cinoma
(St
il
phostr
olusedforpr
ostatecarci
nomaonl y).

ACTI
ON
Promotest hegrowt handdev elopmentoff emal esex
organsandt hemai ntenanceofsecondar ysex
charact
eristi
csinwomen.Met aboli
cef fect
sinclude
reducedbloodchol esterol
,prot ei
nsy nthesi
s,andsodium
andwat erretenti
on.Compet esf orandrogenbi ndi
ngsit
es
i
npr ost
atecancer .Therapeut i
cEf fects:Decreasedtumor
spreadinandr ogen-sensit
ivetumor s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1183
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Thr
omboembol
i
cdi
sease;
Undi
agnosedvaginal
bleeding;Pregnancy(
usemayr
esul
t
i
nharmtot hef
etus);Lact
ation.

UseCaut
iousl
yin:
Under
lyi
ngcar
diov
ascul
ardi
sease;
Sever
ehepat
icorrenal
disease;
Mayi
ncr
easet
her
iskof
endomet
ri
alcar
cinoma.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, dizzi ness, l
et hargy.EENT: intolerancet o
contactlenses, wor seni ngofmy opiaorast i
gmat ism.CV:
MYOCARDI ALINFARCTI ON, THROMBOEMBOLI SM, edema,
hypertension.GI :nausea, anor exia,increasedappet i
te,
j
aundice, vomi t
ing.GU: women—amenor rhea,
breakthroughbl eedi ng, dy smenor rhea, cervi
cal erosions,
l
ossofl ibido,vagi nal candi diasis; men—er ectil
e
dysfunction,testicul arat rophy .Der m: acne, oi
lyski n,
photosensi t
ivi
ty,pi gment ation, urti
car i
a.Endo:
gynecomast i
a( men) , hyper gly cemi a.FandE:
hypercalcemia, sodi um andwat err etenti
on.Met ab: weight
changes.MS: legcr amps.Mi sc: breastt enderness.

I
NTERACTI
ONS
Dr
ug-
Drug:
Mayal
terr
equi
rementf
orwar
far
in,
oral

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1184
hypogl
ycemicagent
s, orinsul
ins.Barbi
turat
esorri
fampi
n
maydecreaseeff
ectiveness.Mayi nter
fer
ewi t
hthe
desi
redeff
ectsofbromocr ipt
ine.Mayincreasebl
ood
l
evelsandri
skoftoxicit
yf r
om cyclospori
ne.

DOSAGE
Post
menopausal
BreastCar
cinoma
PO:
(Adul
ts)
:15mg/
day
.
Pr
ost
ateCar
cinoma
PO:(Adul
ts):Di
ethylst
il
best
rol—1–3mg/ dayi
nit
ial
l
y,t
hen
decr
easeto1mg/ day.
Diet
hylst
il
best
rol
di
phosphate—50–200mg3t imesdail
y.
I
V:(Adult
s):500mg—1g/dayi
nit
ial
l
yunti
lresponseis
obt
ained(5ormoreday
s),
then250–500mg1–2t i
mes
weekly
.

AVAI
LABI
LITY
Tabl
ets1mg,
5mg;
Tabl
ets(
ent
eri
c-coat
ed)1mg,
5mg;
Di
ethy
lst
il
best
rol
Diphosphat
e
Tabl
ets50mg,
83mg;
Inj
ect
ion50mg/
mL;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1185
I
nstructpati
enttotakeoralmedi
cati
onasdirect
ed.I
f
adosei smissed,takeassoonasrememberedas
l
ongasi tisnotjustbef
orenextdose.Donotdoubl
e
doses.

Ifnauseabecomesaprobl
em,advi
sepat
ientt
hat
eati
ngsoli
df oodof
tenpr
ovi
desrel
i
ef.

Advisepat ienttor epor tsignsandsy mpt omsoff l

uid
ret
ent i
on( swellingofankl esandf eet,wei ghtgai n),
thr
omboembol icdi sorders( pain,swel li
ng, t
ender ness
i
next remities,headache, chestpai n,blurredvision),
ment aldepr ession, orhepat i
cdy sf unction(yellowed
ski
norey es, pruri
tus, darkur i
ne,li
ght -coloredst ools)
toheal t
hcar epr ofessi onal.

Instr
uctpati
enttostoptakingmedi cationandnot i
fy
healthcar
eprofessionali
fpr egnancyissuspected.
Cautionpati
entoftheincreasei ncerv
ical andvagi
nal
carci
nomai nfemaleof f
spri
ngandi ntesticul
ar
tumor si
nmal eoff
springifthisdrugist akenduri
ng
pregnancy.

Cauti
onpatientt
hatci
garettesmokingdur
ing
estr
ogentherapymayincreaseri
skofseri
oussi
de
eff
ects,
especial
lyf
orwomenov erage35.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1186
 medi
cat
ionr
egi
menbef
oret
reat
mentorsur
ger
y.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Emphasi
zethei
mportanceofroutinefoll
ow-
up
phy
sical
examsincl
udingBP;breast,abdomen,
and
pel
vi
cexams;andPAPsmear sev ery6–12mo.

Di
fl
orasone
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroi
dsorcomponent sofvehi
cles(oi
ntmentor
cream base,preser
vat
ive,
alcohol)
;Untr
eatedbacter
ial
or
vi
rali
nfecti
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1187
UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cataracts,gl
aucoma, ortuber
culosi
s( useofl arge
amount sofhi gh-
potencyagentsmaywor senconditi
on);
Patientswithpre-
existi
ngskinatrophy;OB: Lactati
on:Pedi:
Chronichigh-doseusagemayr esul
tinadr enal
suppressioninmot her,growt
hsuppr essioninchildr
en;
chi
ldrenmaybemor esuscepti
bletoadr enal andgrowth
suppression.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topical
:(Adul
ts)
:Applytoaff
ect
edarea(s)1–4t
imes
dai
ly(dependsoncondit
ionbei
ngtr
eated).
Topi
cal
:(Chi
l
dren)
:Appl
ytoaf
fect
edar
ea(
s)oncedai
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1188
AVAI
LABI
LITY
Cr
eam 0.
05%;
Oint
ment0.
05%;

PATI
ENTTEACHI
NG
Inst
ructpati
entoncorrecttechni
queofmedicati
on
administr
ati
on.Emphasizeimpor t
anceofavoi
dingthe
eyes.Ifadoseismissed,itshouldbeappl
iedassoon
asremember edunl
essal mostt i
meforthenextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onali
f
symptomsofunder l
yingdiseaser
etur
norwor senor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1189
 i
fsy
mpt
omsofi
nfect
iondev
elop.

Caut i
onwoment hatmedicati
onshouldnotbeused
extensiv
ely,
inl
argeamount s,
orforprot
ract
ed
periodsift
heyarepregnantorpl
anningtobecome
pregnant.

Di
fl
uni
sal
I
NDI
CATI
ONS
I
nfl
ammatorydisorder
sincl
udi
ng:
Rheumatoi
dart
hri
ti
s,
Ost
eoar
thr
it
is.Treatmentofmi
ldt
omoderatepai
n.

ACTI
ON
Inhi
bit
sprostagl
andinsynthesi
s.Difl
uni
sali
sanNSAI
D
chemicall
yrel
atedtoaspiri
n.Therapeut
icEf
fect
s:
Suppressi
onofpainandi nfl
ammat i
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
mayexi stwi
thotherNSAIDsandaspi r
in;Act
iveGI
bl
eedingorulcerdisease;
Pati
entswithrecenthi
stor
yof
coronaryart
erybypasssurger
y;Pregnancy(3rdt
ri
mester
);
Lactat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1190
UseCaut
iousl
yin:
Sev
erer
enal
orhepat
icdi
sease;
Hist
oryofcar diovasculardisease; Hist
oryofulcerdisease;
Adolescents(mayi ncreaset heriskofRey e’ssyndromei f
useddur i
ngv i
rali
llness);Alcohol use;El
derly(i
ncreased
ri
skofadv erseeffects);Pregnancy( 1stand2nd
tr
imesters);
Chi l
dren<12y r(safet ynotestabl
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness, drowsi ness,headache.EENT: ti
nnit
us.CV:
arrhy
thmi as, ↑i nBP, chestpain, edema.GI :
GIBLEEDI NG,
abdomi nal discomf ort
,nausea, const i
pati
on,diar
rhea,
dyspepsia, vomi t
ing.GU: renalfail
ure.Derm: r
ash.Hemat :
blooddy scrasias, prol
ongedbl eedingt i
me.Mi sc:al
ler
gic
react
ionsi ncludinganaphy l
axi
s, chil
ls.

I
NTERACTI
ONS
Drug- Drug:Concur rentusewi thaspi rinmaydecr ease
effectiveness.Addi ti
veadv erseGIef fectswithaspi ri
n,
otherNSAI Ds,colchicine, corti
cost eroids,oralcohol .
Chr onicusewi t
hacet ami nophenmayi ncreaset her i
skof
adv erserenal andhepat icreactions( increases
acet aminophenbl oodl evelsby50%) .Maydecr easet he
effectivenessofdi ureticsorant ihy pertensives;but
i
ncr easesl evelsofhy dr ochlorothiazide.Mayi ncr easethe
hypogl ycemicef fectsofsul f
ony lureas.Pr obeneci d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1191
i
ncreasesr i
skoft oxicit
yf r
om di fl
unisal.I
ncr easedriskof
bl
eedi ngwi thsomecephal osporinsorant icoagulants.
Mayi ncreasel evelsandi ncreaset heriskoft oxici
tyfrom
cycl
ospor i
ne,digoxin,l
it
hium, ormet hotrexate.Increased
ri
skofadv ersehemat ol
ogi creactionswi thant i
neoplast
ics
orradiationtherapy .Admi nist
rationwithant acids
decreasesabsor pti
onofdi fl
unisal.Mayi ncreaset heri
sk
ofadv erserenal reacti
onswhenusedwi t
hgol d
compounds.
Dr
ug-Natural
Product:Incr
easedbl
eedi
ngriskwithani
se,
ar
nica,
chamomi le,cl
ove,fev
erf
ew,gar
li
c,ginger
,gi
nkgo,
gi
nseng,andothers.

DOSAGE
PO:(Adult
s):Ant
i-
inf
lammatory—250–500mgtwicedai
l
y
(maximum dai
lydose=1.5g).Anal
gesi
c—500mg–1g
i
nit
ial
ly,
then250–500mgq8–12hr( maximum dai
l
ydose
=1.5g).

AVAI
LABI
LITY
Tabl
ets250mg,
500mg;

PATI
ENTTEACHI
NG
Adv
isepat
ientt
otakedi
fl
uni
sal
wit
haf
ull
glassof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1192
 waterandtoremaininanupr
ightposi
ti
onf
or15–30
minafteradmini
str
ati
on.

I
nstr
uctpati
enttotakedif
luni
salexactl
yasdirect
ed.
I
fadoseismi ssed,i
tshouldbetakenassoonas
rememberedbutnotifal
mostt i
mef orthenextdose.
Donotdoubledoses.

Maycausedr owsi
nessordizziness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heract
ivi
ti
esr equir
ingal
ert
ness
unti
lresponsetot
hemedicationisknown.

Cauti
onpatienttoavoi
dconcur r
entuseofalcohol
,
aspi
ri
n,otherNSAIDs,acetaminophen,orot
herOTC
medicat
ionswithoutconsult
inghealt
hcare
prof
essi
onal.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Adv i
sepati
enttoconsulthealt
hcareprofessi
onali
f
rash,i
tchi
ng,vi
sualdi
sturbances,t
inni
tus,wei
ghtgai
n,
edema, bl
ackstool
s,persist
entheadache,or
i
nf l
uenza-
li
kesyndrome( chi
ll
s,fev
er,muscleaches,
pain)occur
s.

Cent
ersforDiseaseControlandPr event
ionwarn
agai
nstgiv
ingaspiri
norsalicyl
atestochildr
enor
adol
escentswithvari
cel
l
a( chickenpox)orinf
luenza-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1193
 l
ikeorvi
rali
l
lnessesbecauseofapossi
ble
associ
ati
onwithReye’
ssy ndr
ome.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed.

DI
GITOXI
N
I
NDI
CATI
ONS
TreatmentofHF.Tachy
ar r
hyt
hmias:At
rial
fibr
il
lati
onand
atri
alfl
utt
er(sl
owsvent
ricul
arrat
e),
Paroxysmal at
rial
tachycar
dia.

ACTI
ON
Increasesthef or
ceofmy ocardi
alcontr
acti
on.Pr olongs
refract
oryperiodoftheAVnode.Decr easesconduct ion
throughtheSAandAVnode.Ther apeuti
cEf f
ects:
Increasedcardiacoutput(posi
ti
veinotr
opiceffect)and
slowingoft heheartr
ate(negati
vechronotropiceffect)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Uncont
rol
l
ed
vent
ricul
ararrhy
thmias;
AVbl ock;I
diopat
hichy
per
trophi
c
subaorti
cstenosis;
Constr
ict
iveperi
cardi
ti
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1194
UseCaut
iousl
yin:
Elect
rol
yteabnor
mal
i
ties
(hypokal emi a,hyper
calcemi a, andhy pomagnesemi amay
predi sposet otoxici
ty)
; Geriatri
cpat i
ents(verysensi
ti
veto
toxicef fects);
My ocardialinfarcti
on; Renal
impai r
ment
(dosager educt i
onofdi gi
toxi nrequired)
;Pregnancyand
l
act at i
on( al
thoughsaf etyhasnotbeenest abli
shed,
digitoxinhasbeenuseddur ingpr egnancywithoutadver
se
effect sont hef et
us).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: f
ati
gue, headache,weakness.EENT:blurr
edv i
sion,
yel
lowv i
sion.CV: ARRHYTHMI AS,brady
cardia,ECG
changes.GI:anorexia,
nausea,vomiti
ng,di
arrhea.Endo:
gynecomast i
a.Hemat :thr
ombocy t
openia.

I
NTERACTI
ONS
Drug- Drug:Concur rentusewi thphenobar bital,phenyt oi
n,
orr i
fampi nmayr esultindecr easedeffectivenessof
digitoxin.Useofdi gitoxinwi thsucci
nylchol inemay
i
ncr easecar di
aci rri
tabil
ity.Amphot eri
cinB,
cor t
icosteroi
ds, diureti
cs(loop) ,
mezlocill
in, piperacil
lin,
thiazide,andticarcill
inwhi chcausehy pokal emia,may
i
ncr easet heri
skoft oxicit
y .Amiodarone,cy closporine,
diclofenac,dil
tiazem, propaf enone,qui
nidi ne, and
verapami l
incr
easeser um l evel
sandmayl eadt ot oxicit
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1195
(serum levelmonitori
ng/dosager educt i
onrecommended) .
Addi t
ivebradycardi
amayoccurwi thbet a-
adrenergi
c
blockingagent sandotherant i
arr
hy thmics( di
sopyramide,
quinidine)
.Absorptionisdecreasedbyconcur rent
antacids,cholest
yramine,colesti
pol, orkaoli
n/pecti
n.
Thyroidhor monesmaydecr easet herapeuticeff
ects.
Drug-Food:
Concurr
enti
ngest
ionofahi
gh-
fi
bermeal
may
decreaseabsor
pti
on.

DOSAGE
Forrapidef
fect,
alargeri niti
all
oading/
digi
tal
izi
ngdose
shouldbegiveninsev eraldivi
deddosesov er12–24hr.Al
l
dosingmustbeev aluatedbyi ndivi
dualr
esponse.In
general
,dosesrequiredf oratri
alar
rhyt
hmiasarehigher
thanthosefori
notropicef fect
PO:(AdultsandChildr
en>12y r)
:Rapiddigit
ali
zati
on—600
mcg( 0.6mg) ,t
hen400mcg( 0.4mg)4–6hrl at
er,then
200mcg( 0.2mg)4–6hraf t
erthat
,foll
owedby
maintenancedose.Slowdigit
ali
zat
ion—200mcg( 0.2mg)
twi
cedai l
yf or4days,
fol
lowedbymai ntenance
dose.
Mai ntenancedose—50–300mcg( 0.05–0.3mg) /
day
.
PO:(Chi
l
dren>2yr)
:Digi
tal
izi
ngdose—0.03mg/ kg(0.
75
mg/m2)giveni
n3–4di v
ideddosesatleast6hrapart
,
fol
l
owedbymai nt
enancedose.Maint
enancedose—10%

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1196
oft
hedi
git
ali
zi
ngdose.
PO:(Chil
dren1–2y r
):Digi
tal
izi
ngdose—0.04mg/kggi
ven
i
n3–4di videddosesatleast6hrapart
,fol
lowedby
maintenancedose.Maintenancedose—10%ofthe
di
git
alizi
ngdose.
PO:(Chil
dren<1yr):
Digit
alizi
ngdose—0.045mg/kggi
ven
i
n3–4di videddosesatleast6hrapart
,foll
owedby
maintenancedose.Maintenancedose—10%ofthe
di
git
alizi
ngdose.

PATI
ENTTEACHI
NG
Instr
uctpatientt otakemedi cationexactl
yasdi rect
ed,
atthesamet i
meeachday .Misseddosesshoul dbe
takenwithin12hrofschedul eddoseornott akenat
all
.Donotdoubl edoses.Consul thealt
hcar e
professi
onal i
fdosesf or2ormor eday saremissed.
Donotdi scontinuemedi cati
onwi thoutconsult
ing
healthcareprof essional
.

Teachpati
enttotakepulseandtocont
actheal
thcare
prof
essi
onalbeforetaki
ngmedicat
ioni
fpulser
ateis
<60or>100.

Revi
ewsi gnsandsymptomsofdigi
tal
istoxi
cit
ywit
h
pat
ientandfamil
y.Advi
sepat
ienttonoti
fyhealt
hcare

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1197
 prof
essionali
mmedi at
elyi
ftheseorsy
mptomsofHF
occur.I
nform pati
entt
hatthesesympt
omsmaybe
mistakenforthoseofcol
dsorf l
u.

Advisepati
entt
hatshar
ingoft
hismedi
cat
ioncanbe
dangerous.

Cauti
onpat i
entt oavoidconcurr
entuseofOTC
medicati
onswi thoutconsult
inghealt
hcare
prof
essional.Advisepati
enttoavoidtaki
ngant
aci
ds
oranti
diarr
healswi t
hin2hrofdigit
oxin.

Advisepatienttonoti
fyheal
thcar
eprof
essi
onal
of
thi
smedi cationregi
menbeforetr
eat
ment.

Pati
entstaki
ngdigi
toxi
nshouldcar
ryident
if
icat
ion
descri
bingdi
seaseprocessandmedicati
onregi
men
atall
times.

Emphasi
zethei
mportanceofrout
inef
ollow-upexams
todet
ermi
neeff
ect
ivenessandtomonitorfortoxi
cit
y.

Di
goxi
n
I
ndi
cat
ions
Supr
aventr
icul
arar
rhyt
hmias,
parti
cul
arl
yatri
alf
ibr
il
lat
ion;
hear
tfai
lur
eandatri
alfl
utt
er(
slowsventr
icul
arr
ate).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1198
Par
oxy
smal
atr
ial
tachy
car
dia.

ACTI
ON
Increasesthef or
ceofmy ocardi
alcontr
acti
on.Pr olongs
refract
oryperiodoftheAVnode.Decr easesconduct ion
throughtheSAandAVnodes.Ther apeuti
cEffects:
Increasedcardiacoutput(posi
ti
veinotr
opiceffect)and
slowingoft heheartr
ate(negati
vechronotropi
cef fect)
.

Av
ail
abi
l
ity
TABLET0.
25mg; I
NJECTION2ml(0.
5mg/2ml
);ELI
XIR
0.
05mg/ml (
paedi
atr
icuse)
;Sy
RUP1.5mg/
30ml.

DOSAGE
Or
al
Adult-Atr
ialf
ibr
il
lati
onandhear tfai
lure:
1to1. 5mgin
divi
deddosesov er24hf orr
apiddigit
ali
zat
ionor250µg1
to2t i
mesdai l
yifdigit
ali
zati
onlessurgent;
mai nt
enance
62.5to500µgdai l
y(higherdosemaybedi vided)
,
accordingtorenalfuncti
onandhear trat
eresponse;usual
range125t o250µgdai l
y.
El
der
ly-Lowerdosemor
eappr
opr
iat
e.
I
ntr
avenousi
nfusi
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1199
Emer
gencycont
rol
ofat
ri
alf
ibr
il
lat
ion,
overatl
east2h:
0.
75to1mg.
Emer
gencyl
oadi
ngdosef
orhear
tfai
l
ure,
overatl
east2h:
0.
75to1mg.

Cont
rai
ndi
cat
ions
Hypertr
ophi cobstructivecardiomy opathy(unlessalso
atr
ialfi
bril
lat
ionandhear tfai
lure);ventr
icul
artachycardi
a;
hypokalaemi a;
digitali
stoxici
ty;arrhythmias;Wolff
-
Parki
nson- Whitesy ndromeorot heraccessorypathway ,
parti
cularl
yifaccompani edbyat ri
al f
ibr
ill
ati
on;
i
ntermittentcompl eteheartblock; seconddegree
atr
ioventri
cularblock.

I
NTERACTI
ONS
Drug-Drug: Thiazideandl oopdi uretics, piperacilli
n,
ti
carcil
li
n,amphot er i
cinB,cort
icost eroids, andexcessi ve
useofl axativesmaycausehy pokal emi awhi chmay↑ r i
sk
oftoxicit
y.Ami odarone,somebenzodi azepi nes,
cyclosporine,diphenoxy l
ate,i
ndomet haci n,itraconazol
e,
propafenone, quinidine,quini
ne, spironol actone, and
verapami lmay↑ l evelsandleadt ot oxicity( serum l
evel
moni t
oring/dose↓ mayber equi r
ed) .Lev elsmaybe↓ by
someant i
neopl astics(bleomycin, car must ine,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1200
cyclophosphami de,cy tarabi ne, doxor ubi cin,met hotr
exate,
procar bazi
ne, vincr i
stine), activatedchar coal,
cholest yr
ami ne, colestipol ,kaol i
n/pect i
n, met oclopramide,
penicill
ami ne, rifampi n, orsul fasalazi ne.I nasmal l
percent age( 10%)ofpat ient sgutbact eriamet aboli
ze
digoxint oinact iv ecompounds; macr olideant i-i
nfecti
ves
(erythromy cin, azi t
hromy ci n,clari
thromy cin)and
tetr
acy cli
nes, byki ll
ingt hesebact eria, willcause↑ l evels
andt oxicit
y ;dosemayneedt obe↓ f orupt o9weeks.
Addi ti
vebr ady car diamayoccurwi thbet ablocker s,
dil
ti
azem, ver apami l,cloni dine,andot herant iarr
hy t
hmics
(quinidine,disopy rami de) .Concur rentuseof
sympat homimet icsmay↑ r iskofar rthy thmias.
Thyroidhor monesmay↓ t herapeut icef fects.
Drug-NaturalProduct:
Licori
ceandst i
mulantnat
ural
products(aloe)may↑ r iskofpotassi
um depl
eti
on.St.
John’swor tmay↓ l evel
sandef f
ect.
Dr
ug-Food:Concurr
entingest
ionofahi
gh-
fi
bermealmay
↓ absorpt
ion.Admini
sterdi
goxi
n1hourbefor
eor2hour
s
af
tersuchameal .

Pr
ecaut
ions
Recentmyocardi
ali
nfar
cti
on;
sicksi
nussyndr
ome; sev
ere
pul
monarydisease;
thyr
oiddi
sease;
congest
ivecar
diac

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1201
myopathy;
hypercal
caemia; aor t
icval
vedisease,hear t
bl
ock,car
diacdysrr
ythmias; elderl
y(r
educedose) ;renal
i
mpairmentavoi
dhy pokalaemi a;avoi
drapidintr
av enous
admini
str
ati
on(nauseaandr iskofarrhy
thmias);lactati
on;
i
nter
acti
onspregnancy.

Adv
erseEf
fect
s
Usual l
yassoci atedwi thexcessi vedosageandi nclude
anor exia,nausea,vomi ti
ng, diarr
hoea, abdomi nal pain;
visual dist
urbances, headache, f
atigue,drowsiness,
conf usion,deli
ri
um, hal l
ucinations,depression;
arrhythmi as,heartblock;rarely,rash,int
estinalischaemi a;
gy naecomast iaonl ong-term use; thrombocy topenia
repor t
ed; si
nusbr ady car
dia; apathy;psychosis;mal aise.

PATI
ENTTEACHI
NG
Instructpatienttot akemedi cationasdi r
ected,atthe
samet i
meeachday .Teachpar ent sorcaregiversof
i
nf antsandchi ldrenhowt oaccuratelymeasur e
medi cation.Takemi sseddoseswi thi
n12hrof
schedul eddoseoromi t
.Donotdoubl edoses.
Consul thealthcar epr ofessi
onal ifdosesf or2or
mor eday saremi ssed.Donotdi scont i
nuemedi cation
withoutconsul tingheal thcarepr ofessional.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1202
Teachpati
enttotakepulseandtocont
actheal
thcare
prof
essi
onalbeforetaki
ngmedicat
ioni
fpulser
ateis
<60or>100.

Pedi:Teachparentsorcar egiverst hatchangesi n

heartrat
e,especiall
ybr adycardia,areamongt hef i
rst
signsofdigoxintoxici
tyininfant sandchi l
dren.
Instr
uctparentsorcar egiv
ersi napicalheartrate
assessmentandaskt hem t onot if
yaheal thcar e
professi
onalifheartrateisout sideofrangesetby
healthcareprofessi
onal beforeadmi ni
steri
ngt he
nextscheduleddose.

Revi
ewsi gnsandsy mptomsofdi gi
tal
istoxi
cit
ywit
h
pati
entandf amil
y.Advi
sepatienttonoti
fyhealt
hcare
prof
essionalimmediat
elyift
heseorsy mptomsofHF
occur.I
nform pati
entt
hatthesesy mptomsmaybe
mistakenforthoseofcoldsorflu.

Instr
uctpat i
enttokeepdigoxintabletsi
ntheiror
igi
nal
containerandnott omixi
npi llboxeswithother
medi cati
ons;theymaylooksimi lartoandmaybe
mi st
akenf orothermedi
cations.

Advisepati
entt
hatshar
ingoft
hismedi
cat
ioncanbe
dangerous.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1203
 al
l RxorOTCmedi cati
ons,vi
tamins,orherbal
productsbeingtakenandt oconsultheal
thcare
professi
onalbeforetaki
ngotherRx, OTC,orherbal
products.Advi
sepat i
enttoavoidtakingantaci
dsor
antidi
arr
healswithi
n2hrofdi goxin.

Advisepatienttonoti
fyheal
thcar
eprof
essi
onal
of
thi
smedi cationregi
menbeforetr
eat
ment.

Pati
entstaki
ngdigoxi
nshouldcar
ryi
dent
ifi
cat
ion
descri
bingdi
seaseprocessandmedi
cati
onregimen
atall
times.

Geri
:Revi
ewfallpr
eventi
onst
rat
egi
eswi
thol
der
adul
tsandthei
rfamil
ies.

Emphasi
zethei
mportanceofrout
inef
ollow-upexams
todet
ermi
neeff
ect
ivenessandtomonitorfortoxi
cit
y.

St
orage
Tablet
:Stor
epr otect
edf r
om l
ight
.Inj
ect
ion:St
ore
prot
ectedfrom li
ghtinasingl
edosecontainer
.Solut
ion:
stor
eprotectedfrom l
ightatatemperat
urenotexceeding
30⁰C.

Di
goxi
nimmuneFab

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1204
I
NDI
CATI
ONS
Ser
iousl
i
fe-
thr
eat
eni
ngov
erdosagewi
thdi
goxi
n.

ACTI
ON
Anantibodyproducedinsheepthatbi
ndsant i
genical
lyt
o
unbounddigoxininser
um.Therapeuti
cEffects:Bi
nding
andsubsequentremovalofdigoxi
n,pr
eventingtoxic
eff
ectsinoverdose.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Noknowncont
rai
ndi
cat
ions.

UseCaut
iousl
yin:
Knownhy
per
sensi
ti
vi
tyt
osheep
prot
einsorproducts;Chi
ldr
en,
pregnancy
,orl
act
ati
on
(saf
etynotestabl
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:r
e-emer
genceofat
ri
alf
ibr
il
lat
ion,
re-
emer
genceofHF.
FandE:HYPOKALEMIA.

I
NTERACTI
ONS
Dr
ug-
Drug:
Prev
ent
sther
apeut
icr
esponset
odi
goxi
n.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1205
Digi
bind—38mgofdi goxinimmuneFabwillbind0.5mg
ofdigoxi
n.Eachvial
contains38mgofdigoxinimmune
Fab;Digi
Fab—40mgofdi goxinimmuneFabwi l
lbi
nd0.
5
mgofdi goxi
n.Eachvial
contains40mgofdi goxin
i
mmuneFab
KnownAmountofDi
goxi
nIngest
ed(
Admi
nist
ered)
I
V:(AdultsandChildren):Fordigi
tal
isgl
ycosidetoxi
cit
y
duetodigoxintabl
ets,oral sol
uti
on,orI
M digoxi
n—doseof
di
goxiningested(mg)×0. 8/1000×38.Fordigit
ali
s
gl
ycosidetoxi
cityduet odigoxincapsul
es,I
V
di
goxin—doseofdi goxiningested(mg)/0.
5×38.
KnownSer
um Di
goxi
nConcent
rat
ions(
SDCs)
I
V: (Adult
sandChil
dren):
Digibi
nd—Dose(mg) =SDC
(nanograms/mL)×bodywei ght(kg)
/100×38;
Digi
Fab—SDC( nanograms/mL)×bodywei ght(kg)
/100×
40.
UnknownAmountI
ngest
ed/
SDCsUnav
ail
abl
e
I
V:(Adult
sandChi
ldr
en):Di
gibi
nd—760mg(
20v
ial
s);
Di
giFab—800mg(20vial
s).
Toxi
cit
ydur
ingchr
oni
cdi
goxi
nther
apy
I
V:(Adult
sandChi
l
dren):Di
gibi
nd—228mg(
6vi
als)
;
Di
giFab—240mg(6vial
s).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1206
AVAI
LABI
LITY
Powderf
ori
nject
ion,
lyophi
l
ized(
Digi
bind)38mg/
vial
;
Powderf
ori
nject
ion,
lyophi
l
ized(
Digi
Fab)40mg/vi
al;

PATI
ENTTEACHI
NG
Explai
nthepr
ocedur
eandpur
poseoft
het
reat
ment
tothepati
ent
.

I
nstr
uctpatienttonoti
fyhealt
hcareprov
ider
i
mmedi atel
yifsignsofdel
ayedall
ergi
creacti
on(rash,
pr
uri
tus,urt
icari
a)occuraft
erhospi
taldi
scharge.

Di
hydr
oer
got
ami
ne
I
ndi
cat
ions
Acut
etr
eat
mentofmigr
aineheadacheswithorwit
hout
aur
aandacut
etr
eat
mentofclusterheadacheepi
sodes.

ACTI
ON
Vasoconstri
ctionofdil
atedbl oodv esselsbystimulati
ng
alpha-
adrenergicandserotoner gi
c( 5-HT)recept
ors.
Largerdosesmaypr oduceal pha-adr energi
cblockadeand
vasodil
ati
on.Therapeuti
cEf fects:Const ri
cti
onofdilat
ed
caroti
darter
ybedwi thresolutionofv ascul
arheadache.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1207
Av
ail
abi
l
ity
TABLET1mg;
INJECTI
ON1ml
Ampoul
e(1mg/
ml)
.

DOSAGE
Usual
l
yincombi
nat
ionwi
thot
heranal
gesi
cse.
g.caf
fei
ne.
Adultandchi
l
dover12year
s-1to2tabl
etsatonset(max.
4tablet
sin24h)
,nott
oberepeatedati
nter
val
sofless
than4days.

I
ntr
avenousi
nfusi
on
Terminat
ionofanacut
eat
tackofcl
ust
erheadache,
migrai
ne:Adul
t-0.
5to1mg,1dose(Max:3mg/ dayor6
mg/week) .

Cont
rai
ndi
cat
ions
Peri
pher alvasculardisease,cor
onaryheartdi
sease,
obli
terati
vev asculardiseaseandRaynaud’ssyndrome,
tempor alar
terit
is;hepaticimpai
rment,r
enal i
mpairment,
sepsis;severeori nadequatel
ycontr
oll
edhy pert
ension,
hyperthyroi
dism, pregnancylact
ati
on;porphyri
a,i
schaemic
heartdisease;angi napectori
s.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1208
Drug-Drug: ConcurrentuseofCYP3A4enzy mei nhi
bitors
(macr oli
deant i
-i
nfecti
v esandpr ot easei nhibitors)may
produceser i
ous,li
fe-t
hr eateningper ipher alischemi aand
i
scont r
aindicat
ed.Concur rentusewi t hbet abl ockers,oral
cont r
acept i
ves,ornicotine( heavysmoki ng)may↑ r iskof
peripheralvasoconst r
iction.Di hydroer gotami ne
antagonizest heant i
angi naleffectsofni trat
es.Concur r
ent
usewi thv asoconstri
ctor smayhav e↑ ef fects( avoid
concur r
entuse) .Concur rentusewi t
hsumat ri
pt anmay
resultinprolongedv asoconst ri
ction( all
ow24hrbet ween
use).

Pr
ecaut
ions
Riskofper i
pheralvasospasm; elderl
y;i
tshoul
dnotbe
usedf ormigrai
nepr ophyl
axis;i
nt er
acti
onsWar npati
ent
tostopt r
eatmenti mmediatelyifnumbnessortingl
ingof
extr
emi ti
esdevelopsandt ocont actdoctor
,compromised
cir
culati
on;hypertensi
on.

Adv
erseEf
fect
s
Nausea,vomi t
ing,ver
tigo,abdominalpain,
diarrhoea,
musclecrampsandoccasi onall
yheadachepr ov oked
(
usuall
ybecauseofpr olongedexcessivedosageorabr upt
wit
hdrawal)
; precardi
alpain,myocardi
alandintest i
nal
i
schaemia,rarely,myocardiali
nfar
cti
on;repeatedhi gh

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1209
dosagemaycauseer goti
sm wi t
hgangr eneandconf
usi
on;
pleur
al,peri
tonealandheart-
valvefi
brosismayoccurwit
h
excessiveuse;coronar
yarteryvasospasm; vent
ri
cul
ar
tachycardi
a;alt
eredsenseoft ast
e;rhi
niti
s.

PATI
ENTTEACHI
NG
Inst
ructpat
ientt
ousedi hydr
oer
got
amineatt
hefir
st
signofanimpendingheadacheandnott
oexceedthe
maximum dosepr escr
ibed.

Encour
agepati
enttor
esti
naqui
et,
dar
kroom af
ter
taki
ngergot
amine.

Reviewsymptomsoftoxi
cit
y.I
nst
ructpat
ientt
o
reportt
heseprompt
ly.

Cauti
onpat i
entnottosmokeandtoavoidexposur
e
tocold;
thesev asoconst
ri
ctor
smayf
urtheri
mpair
peri
pheralci
rculat
ion.

Maycausedizzi
ness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
iti
esrequi
ri
ngal
ert
nessunt
ilr
esponse
tot
hedrugisknown.

Advisepatientt
oav oi
dal
cohol
,whi
chmaypr
eci
pit
ate
vascularheadaches.

I
nst
ructf
emal
epat
ient
stoi
nfor
m heal
thcar
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1210
 pr
ofessi
onalift
heyplanorsuspectpregnancy.
Di
hydroer
gotamineshoul
dnotbet akenduring
pr
egnancy.

IM: Subcut
:Inj
ectatt hef
ir
stsignofaheadacheand
repeatat1-hri
ntervalsupto3doses.Oncemi ni
mal
effecti
vedoseisdet ermi
ned,adj
ustdosefor
subsequentattacks.

Int
ranasal:I
nstr
uctpatienti
nproperuseofnasal
spray.Pri
menasal sprayer4ti
mesbef oredose.
Admi ni
ster1spraytoeachnost ri
lfoll
owedi n15mi n
byanaddi ti
onalspr
ayi neachnostr i
lforatotalof4
sprays.Donottil
theadorsni f
ffoll
owi ngspray.Do
notusemor ethanamounti nstructed.Discar
dampul e
withi
n8hrofopeni ng.Donotr efri
gerate.Assembly
maybeusedf or4treatments;t
hendi scard.

Advisepati
entnottouseMi granal
topr
eventa
headacheifther
ear enosympt omsori
fheadachei
s
di
fferentf
rom ty
picalmigr
aine.

Instructpati
entt onot i
fyhealt
hcarepr ofessional
if
numbnessort inglinginfinger
sort oes;pain,
tightness,ordiscomf ortinchest;
muscl epai nor
cr ampsinar msorl egs;weaknessinlegs; temporar
y
speedi ngorslowi ngofhear tr
ate;orswel l
ingor
i
t chingoccurs.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1211
St
orage
St
orepr
otect
edf
rom l
i
ght
.

Di
l
l
COMMONUSES
PO:
GI,
kidney
,andur
inar
ytr
actdi
seases
i
nsomni
a

ACTI
ON
Dil
lseedhasant i
bact
eri
al,
sedat
ive,anddiur
eti
ceffects.
Dil
lseedoilhasspasmolyt
icef
fectsonsmoot hmuscle.
Therapeut
icEffect
s:I
mprovedsleep.Rel
i
efofintest
inal
di
scomf or
t.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Al
l
ergyt
odi
l
loral
l
ergyt
ocar
rot
famil
yplant
s,i
ncludi
ngasaf
oet
ida,
car
away
,cel
ery
,
cori
anderandfennel
.

UseCaut
iousl
yin:
OB:
Pregnancyandl
act
ati
on:
avoi
d
amount
sgr
eat
ert
hanseasoni
ngquant
it
ies.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1212
Der
m:cont
actder
mat
it
is.

I
NTERACTI
ONS
Nat
ural
Product
-Dr
ug:
May↑ l
i
thi
um l
evel
s.
Nat
ural
Product
-Nat
ural
Product
:Noneknown.

DOSAGE
PO:(Adul
ts)
:Dr
iedseeds—1–4gPOTI
D;Oi
l
—2–6dr
ops
dai
l
y.

AVAI
LABI
LITY
Bul
kdr
iedseedsOTC;
Dil
loi
lOTC;

PATI
ENTTEACHI
NG
I
nfor
m pat
ientst
hatt
herear
enoappr
ovedusesf
or
t
hisher
balsuppl
ement.

Advisepati
entthatdil
lcontai
nsahi ghsodium
contentandpatientsonarestri
ctedsodium di
et
shouldnottakethisherbal
supplementwi t
hout
consult
inghealt
hcar eprof
essional
.

Warnpat
ient
sthatski
ncont
actwit
hthisher
bal
suppl
ementmaycauseski
nirr
it
ati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1213
Di
l
oxani
deFur
oat
e
I
ndi
cat
ions
Amoebiasis(asymptomati
ccarri
ersi
nnonendemicar
eas;
er
adicati
onofr esi
duall
uminalamoebaeaf
tertr
eat
mentof
i
nvasivediseasewithot
herdrugs)
.

Av
ail
abi
l
ity
TABLET500mg.

DOSAGE
Or
al
Adul
t-500mgev
ery8hf
or10day
s.
Chil
d-20mg/kgbodywei
ghtdai
l
yint
hreedi
vi
deddoses
for10day
s.

Cont
rai
ndi
cat
ions
Lact
ati
onsy
stemi
camoebi
asi
s.

Pr
ecaut
ions
Pr
egnancy(
def
ert
reat
mentunt
ilaf
terf
ir
stt
ri
mest
er)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1214
Adv
erseEf
fect
s
Flat
ulence;
occasi
onal
l
yvomi
ti
ng,
prur
it
usandur
ti
car
ia;
furr
edtongue.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Di
l
tiazem
I
NDI
CATI
ONS
Hypert
ension.Angi
napectori
sandv asospastic
(Pr
inzmetal’
s)angi
na.Supr
aventri
culartachy
arrhythmias
andrapi
dv entr
icul
arr
atesinatr
ialf
lutterorf
ibri
ll
ation.

ACTI
ON
Inhi
bitstr
anspor tofcal ci
um int
omy ocardialandv ascular
smoot hmuscl ecells,result
ingininhibit
ionofexcitation-
contracti
oncoupl i
ngandsubsequentcont raction.
TherapeuticEffects:Systemi cvasodilat
ionresulti
ngi n
decreasedBP.Cor onaryv asodi
lati
onr esul
tingin
decreasedf r
equencyandsev er
ityofat t
acksofangi na.
Reductionofv entr
icularrateinatri
alfibri
ll
ationorf l
utter
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1215
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sicksi
nus
syndr
ome;2nd-or3rd-
degreeAVblock(unl
essanar t
if
ici
al
pacemakeri
sinplace)
;Systol
i
cBP<90mm Hg; RecentMI
orpul
monarycongesti
on;Concur
rentuseofri
fampin.

UseCaut
iousl
yin:
Sev
erehepat
ici
mpai
rment(
↓ dose
recommended) ;
Ger i
:↓ dose;slowerIVinfusionrate
recommended; ↑r i
skofhy potensi
on;considerage-
rel
ateddecr easeinbodymass, ↓ hepati
c/renal/
cardiac
function,concur
rentdrugtherapyandot herdisease
states);Severer
enalimpairment;Seri
ousv entri
cular
arrhythmiasorHF; OB:Lactati
on:Pedi:Safetynot
established.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: abnor mal dreams, anxi ety
,confusi on, dizzi
ness,
drowsi ness, headache, nervousness, psy chiatri
c
di
st urbances, weakness.EENT: bl
urredv i
sion, disturbed
equili
br i
um, epist axi
s,ti
nnitus.Resp: cough, dyspnea.CV:
ARRHYTHMI AS, HF,peripher aledema, brady cardia,chest
pain,hy pot ension, palpi
tati
ons, syncope, tachy cardia.GI:
↑l iverenzy mes, anorexia,const i
pati
on, diarrhea, dr
y
mout h, dy sgeusi a,dyspepsi a,nausea, vomi t
ing.GU:
dysur i
a, noct ur
ia, polyuri
a,sexual dysf unct i
on, urinary
fr
equency .Derm: STEVENS- JOHNSONSYNDROME,
dermat itis,erythemamul ti
for me,fl
ushi ng, sweat ing,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1216
photosensit
ivi
ty,
pr ur
itus/ur
ticari
a,r
ash.Endo:
gynecomast i
a,hyperglycemia.Hemat :anemia, l
eukopenia,
thr
ombocy topenia.Met ab:weightgain.MS: j
ointsti
ffness,
musclecramps.Neur o:paresthesi
a,tremor.Misc:gingival
hyperpl
asia.

I
NTERACTI
ONS
Drug-Drug: ↑ hy pot ensionmayoccurwhenusedwi th
fentanyl,otherant ihy per
tensives,nitrates, acut eingestion
ofalcohol ,orqui nidine.Antihypertensi veef fectsmaybe
↓ byNSAI Ds.May↑ di goxinlevels.May↑ l evelsofand
ri
skofmy opat hyfrom si mvastatinandl ov astat i
n.
Concur rentusewi thbet ablocker s,cloni di
ne, digoxi n,
disopyrami de, orpheny t
oinmayr esul tinbr ady cardia,
conduct iondef ects, orHF.Phenobar bitalandpheny toi
n
may↑ met aboli
sm and↓ ef f
ectiveness.May
↓met abol i
sm ofand↑ r iskoftoxi cityfrom cy closporine,
quinidi
ne, orcar bamazepi ne.Cimet idineandr anitidi
ne↑
l
ev el
sandef fects.May↑ or↓ t heef fectsofl ithium or
theophy ll
ine.
Dr
ug-
Food:
Grapef
rui
tjui
ce↑ l
evel
sandef
fect
.

DOSAGE
PO:
(Adul
ts)
:30–120mg3–4t
imesdai
l
yor60–120mg

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1217
twicedail
yasSRcapsulesor180–240mgoncedai lyas
CDorXRcapsul esorLAt ablet
s(upto360mg/ day);
Concurrentsi
mvast
atintherapy—Dil
ti
azem doseshould
notexceed240mg/ dayandsi mvastat
indoseshouldnot
exceed10mg/ day.
I
V:(Adul
ts):0.
25mg/kg;mayrepeatin15mi nwi
thadose
of0.
35mg/ kg.Mayf
oll
owwi t
hcontinuousinf
usi
onat10
mg/hr(r
ange5–15mg/ hr
)forupto24hr .

AVAI
LABI
LITY
Tablet
s30mg, 60mg, 90mg, 120mg.Sust ai
ned-rel
ease
capsules60mg, 90mg, 120mg.Extended-r
eleasetabl
ets
(Car
dizem LA)120mg, 180mg, 240mg, 300mg, 360mg,
420mg.

PATI
ENTTEACHI
NG
Adv i
sepatientt
otakemedicationasdi
rect
edatthe
samet i
meeachday ,
eveniffeeli
ngwel
l.Takemissed
dosesassoonaspossi bleunlessal
mosttimefor
nextdose;donotdoubledoses.Mayneedt obe
discont
inuedgradual
ly.

Advi
sepati
enttoavoi
dlargeamounts(
6–8gl
assesof
gr
apefr
uitj
uice/
day
)duringther
apy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1218
I
nst r
uctpat i
entoncorr
ecttechniquef
ormonit
ori
ng
pulse.Instr
uctpati
enttocontactheal
thcar
e
professionali
fheartr
ateis<50bpm.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Maycausedr owsi
nessordizziness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heract
ivi
ti
esr equir
ingal
ert
ness
unti
lresponsetot
hemedicationisknown.

Instr
uctpat i
entonimpor t
anceofmai ntai
ninggood
dentalhygieneandseei ngdenti
stfrequentl
yforteet
h
cleani
ngt opr ev
enttenderness,bl
eeding,andgingi
val
hyperpl
asia( gum enl
argement )
.

Instr
uctpati
enttonot ifyheal
thcareprofessionalof
allRxorOTCmedi cations,vi
tamins,orherbal
productsbeingtakenandt oavoidconcurrentuseof
alcoholorOTCmedi cationsandherbalproducts,
especial
lycoldpreparations,wi
thoutconsulti
ng
healthcareprof
essional .

Adv i
sepat i
enttonot i
fyheal
thcareprofessionali
f
rash,ir
regularheartbeat
s,dyspnea,swell
ingofhands
andf eet,pronounceddizzi
ness,nausea,consti
pati
on,
orhypot ensionoccursorifheadacheissev er
eor
persist
ent .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1219
Cauti
onpat
ienttowearprotect
ivecl
othinganduse
sunscr
eent
opr eventphot
osensit
ivi
tyreact
ions.

Angi
na:Instructpat
ientonconcurrentni
tr
ateorbet a-
bl
ockertherapytocontinuet
akingbot hmedicat
ions
asdi
rectedandt ouseSLni t
rogly
cer i
nasneededf or
angi
nalattacks.

Advisepati
enttocont acthealt
hcareprof
essionali
f
chestpaindoesnoti mprove,worsensaft
ertherapy
,
oroccurswithdiaphoresis;i
fshort
nessofbreath
occurs;
orifsevere,persist
entheadacheoccurs.

Caut
ionpati
enttodi
scussexerci
serestr
ict
ionswi
th
heal
thcar
eprofessi
onalbef
oreexer
tion.

Hypertension:Encouragepat i
enttocompl ywithother
i
nterventionsforhypertensi
on( weightreduct
ion,
low-
sodium diet,smokingcessation,moder ati
onof
al
cohol consumpt i
on, r
egularexercise,
andstress
management ).Medicationcontrol
sbutdoesnotcur e
hypertension.

I
nstructpati
entandf amil
yinpropertechni
quef
or
moni t
ori
ngBP.Adv isepati
enttotakeBPweeklyand
toreportsi
gnif
icantchangestohealthcare
professi
onal
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1220
Di
menhy
dri
nat
e
I
NDI
CATI
ONS
Nausea,
vomi t
ing,
dizzi
ness,
andv
ert
igoaccompany
ing
moti
onsickness.

ACTI
ON
Inhi
bit
sv esti
bul
arstimulati
on.Hassi gnif
icantCNS
depressant,ant
icholi
nergi
c,anti
hist
ami ni
c, andanti
emet
ic
propert
ies.Therapeuti
cEffects:
Decreasedv est
ibul
ar
sti
mulation,whi
chmaypr eventmotionsickness.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Somepr
oduct
s
cont
ainalcohol
ort
art
razi
ne;
inpat
ient
swi
thknown
i
ntol
erance.

UseCaut
iousl
yin:
Angl
e-cl
osur
egl
aucoma;
Sei
zur
e
di
sor
der
s;Pr
ost
ati
chy
per
plasi
a.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness,dizzi
ness,headache,paradoxical
exci
tati
on( chil
dren).EENT:blurr
edv i
sion,
tinni
tus.CV:
hypotension,pal
pitati
ons.GI:anorexi
a,consti
pat i
on,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1221
di
arr
hea,dr
ymout h.GU:dy
sur
ia,f
requency
.Der
m:
phot
osensi
ti
vi
ty.Local
:pai
natIM si
te.

I
NTERACTI
ONS
Drug-Drug: ↑ CNSdepr essi
onwi thotherant i
histamines,
alcohol,opioidanalgesics,andsedat ive/hypnotics.May
masksi gnsorsy mpt omsofot otoxici
tyinpatients
receivi
ngot otoxi
cdr ugs( aminoglycosides,ethacryni
cacid
).↑ ant icholi
nergi
cpr operti
eswi t
ht r
icycli
c
antidepressants,quinidi
ne,ordisopy r
ami de.MAO
i
nhibitorsintensi
fyandpr ol
ongtheant icholi
nergiceffect
s
ofant i
histamines.

DOSAGE
PO:
(Adult
s):
50–100mgq4hr(
nott
oexceed400
mg/day
).
PO:(
Chi
l
dren6–12y
r):
25–50mgq6–8hr(
nott
oexceed
300mg/
day).
Rect(
Adul
ts)
:50–100mgq6–8hr
.
Rect(
Chi
l
dren8–12y
r):
25–50mgq8–12hr
.
Rect(
Chi
l
dren6–8y
r):
12.
5–25mgq8–12hr
.
I
M:I
V:(
Adul
ts)
:50mgq4hrasneeded.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1222
I
M: IV:
(Chil
dren):1.
25mg/kg(
37.
5mg/
m2)q6hras
needed(nottoexceed300mg/
day)
.

AVAI
LABI
LITY
Tabl
ets50mgOTC; Chewabletabl
ets(or
angefl
avor)50
mgOTC;Capsules50mgOTC; Extended-
rel
easecapsules
25mgOTC;Eli
xir(cher
ryfl
avor)12.5mg/ 5mLOTC, 15
mg/5mLOTC; Liquid12.
5mg/ 4mLOTC; Supposi
tori
es50
mgOTC,100mgOTC; Inj
ecti
on50mg/ mL;

PATI
ENTTEACHI
NG
Maycausedr owsiness.Caut
ionpati
entt
oavoid
driv
ingorotheracti
vi
ti
esrequir
ingal
ert
nessunt
il
responsetothedrugisknown.

Inf
orm pati
entthatthi
smedicat
ionmaycausedr y
mouth.Frequentoralr
inses,
goodoralhygi
ene,and
sugar
lessgum orcandymaymi ni
mizethi
seffect
.

Caut
ionpat
ientt
oavoidalcoholandot
herCNS
depr
essant
sconcur
rentl
ywi t
hthismedi
cati
on.

Advi
sepati
enttousesunscreenandprot
ectiv
e
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

Di
mer
capr
ol
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1223
I
ndi
cat
ions
Acut
epoi soningbyanti
mony ,ar
seni
c,bismut
h,copper
gol
d, mercur
yandpossi bl
ythall
i
um;adjunct(
wit
hsodium
cal
cium edetate)i
nleadpoisoni
ng.

ACTI
ON
Bindsheav ymet alsinarever
sibl
ecompl exsot
hatthey
cannotbi ndtotissuesandcauseor gandamage.
Ther apeuti
cEffects:Pr
eventi
onofor gandamagefr
om
mer cury,gol
d,arsenic,
orleadpoisoning.

Av
ail
abi
l
ity
OI
LyI
NJECTI
ON2ml
ampoul
e(50mg/
ml)
.

DOSAGE
I
ntr
amusculari
njecti
onTobeadmi ni
ster
dbydeep
i
ntr
amusculari
njecti
ononlyLeadpoisoning:
Adul
ts-
4
mg/kgever
y4hf or5days.Chi
ld-75mg/ m2ever
y5hfor
5days.
Arseni
cpoisoni
ng:3mg/kgevery4hf or48handthen
twiceadayfor7-
10days.Mercurypoi
soning:
5mg/ kg
fol
lowedby2.5mg/kgevery12-24hforupto10days

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1224
Cont
rai
ndi
cat
ions
Notindicatedfori
ron,sel
enium orcadmium poi
soning;
severehepat i
cimpairment(unl
essduet oar
senic
poisoni
ng) ;hy
pert
ension;t
ellur
ium poi
soni
ng,peanut
al
lergy,
G- 6-PDdefi
ciency.

I
NTERACTI
ONS
Drug-Drug:For
msat oxi
ccomplexwithi
ron,cadmium,
seleni
um, orur
anium.Nephr
otoxi
cit
ydecreasedbyagent
s
thatalkal
ini
zetheuri
ne.
Dr
ug-Food:Nephr
otoxi
cit
ydecr
easedbyf
oodst
hat
al
kal
i
nizetheuri
ne.

Pr
ecaut
ions
Hypertension;r
enal impairment(discontinueorusewit
h
extr
emecaut i
oni frenalfai
lur
eoccur sdur i
ngtreat
ment)
;
anyabnor mal r
eact i
onsuchashy perpyrexiashoul
dbe
assessed; el
derl
y ;pregnancylact
ation,alkal
ini
zeuri
neto
pHof7. 5-8.0usingsodi um bi
carbonate.

Adv
erseEf
fect
s
Hyper
tensi
on,
tachy
cardia;
malaise,
nausea,v
omiti
ng,
abdominal
pai
n,sal
ivat
ion,
lacr
imati
on,sweati
ng,
burni
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1225
sensati
oni nt
hemouth,thr
oatandey es;f
eeli
ngof
constr
ict
ioninthr
oatandchest;
headache, muscle
spasms, t
ingl
ingoft
heextremi
ti
es;feverinchil
dren;l
ocal
painandabscessatinj
ecti
onsit
e,i
ront oxi
cit
ypot ent
iat
ion.

PATI
ENTTEACHI
NG
Expl
ainpur
poseoft
her
apyt
opat
ientorpar
ent
s.

Inf
orm pati
entthatinj
ect
ionispai
nfulandmaycause
anunpleasantgarl
ic-l
i
kebreathodor.

I
nstructpati
enttonot
if
yheal
thcareprofessi
onal
if
headache,burni
ngofli
ps,
sweati
ng,orteari
ngoccur
s.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Di
nopr
ost
one
I
NDI
CATI
ONS
Endocervical
Gel,VaginalInsert:
Usedt o"ri
pen"thecervi
x
i
npr egnancyatorneart erm wheni nducti
onoflaboris
i
ndicated.VaginalSuppository:I
nducti
onofmi dtri
mester
aborti
on,Managementofmi ssedabor t
ionupto28wk,
Managementofnonmet astati
cgest at
ionalt
rophoblast
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1226
di
sease(
beni
gnhy
dat
idi
for
m mol
e).

ACTI
ON
Producescontracti
onssi mi l
artot hoseoccurr
ingdur ing
l
aboratt er
m byst i
mul ati
ngt hemy ometri
um (
oxy t
oci c
eff
ect).I
nit
iat
essof t
eni ng,effacement ,
anddil
ationoft he
cervi
x("r
ipeni
ng").Alsost i
mul atesGIsmoot hmuscl e.
Therapeuti
cEffects:Init
iat
ionofl abor.Expul
sionoff etus.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
opr
ost
agl
andi
nsor
addi
ti
vesi nthegel orsuppository;Thegel /
insertshould
beavoidedinsit uat
ionsi
nwhi chprolongedut eri
ne
cont
ractionsshoul dbeavoided, i
ncluding;Presenceof
acut
epel vi
cinflammat or
ydi seaseorr upturedmembr anes;
Concurrentoxytocicther
apy( waitfor30mi nafter
removi
ngi nsertbeforeusingoxy t
ocin).

UseCaut
iousl
yin:
Uter
inescar
ri
ng;
Ast
hma;
Hypot
ensi
on;
Cardiacdisease;Adrenal di
sorders;
Anemi a;Jaundi
ce;
Diabetesmel l
it
us;Epilepsy;Glaucoma;Pulmonary,renal
,
orhepaticdisease;Mul t
ipar
ity(upto5pr evi
ousterm
pregnancies);Women>30y r,
thosewithcompl i
cati
ons
duri
ngpr egnancy,andt hosewi thagestati
onalage>40wk
(↑r i
skofdi sseminatedintravascul
arcoagulati
on).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1227
ADVERSEREACTI
ONSANDSI
DEEFFECTS
Endocer
vical
Gel
,Vagi
nal
Inser
t
GU: uter
inecont
ract
il
eabnor
mal
i
ties,
warmfeel
i
ngi
n
vagina.MS:backpain.Mi
sc:
AMNIOTICFLUI
DEMBOLI
SM,
fever.
Supposi
tor
y
CNS: headache,drowsiness, syncope.Resp:coughing,
dyspnea, wheezing.CV: hy potensi
on, hy
pert
ension.GI:
diarrhea,nausea, v
omi ti
ng.GU: UTERI NERUPTURE,
urinarytracti
nfection,uter
inehy perst
imulat
ion,
vaginal/uteri
nepain.Mi sc:all
ergicreacti
onsincl
uding
anaphy laxi
s,chil
ls,fev
er .

I
NTERACTI
ONS
Dr
ug-
Drug:
Augment
stheef
fect
sofot
heroxy
toci
cs.

DOSAGE
Cer
vical
Ripeni
ng
Vag( Adul
ts,
Cer v
ical)
:Endocer
vical
gel—0.
5mg; if
responseisunfavorabl
e,mayrepeatin6hr(nottoexceed
1.5mg/ 24hr)
.Vaginal i
nser
t—one10-mginsert
.

Abor
ti
faci
ent

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1228
Vag(Adult
s):One20-
mgsuppositor
y,r
epeatq3–5hr(
not
toexceed240mgtotalorl
ongert
han48hr).

AVAI
LABI
LITY
Endocervi
calgel(
Prepi
dil)0.5mgdi noprostonein3gof
gelvehi
cleinaprefi
l
ledsy r
ingewithcatheters;Vagi
nal
i
nsert(Cerv
idi
l)10mg; Vaginalsupposit
ory( Pr
osti
nE
Vaginal
)20mg;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofmedi
cat
ionandv
agi
nal
exams.

Abort
ifaci
ent :I
nstructpatienttonoti
fyhealt
hcare
pr
ofessional i
mmedi at
elyiffeverandchil
l
s,foul
-
smell
ingv aginaldischarge,lowerabdominalpai
n,or
i
ncreasedbl eedingoccur s.

Pr
ovi
deemot
ional
suppor
tthr
oughoutt
her
apy
.

Cervi
calRipeni
ng:I
nfor
m pat
ientt
hatshemay
exper
ienceawar mfeel
ingi
nhervaginadur
ing
administ
rati
on.

Advi
sepatientt
onot
if
yhealt
hcarepr
ofessi
onal
if
cont
ract
ionsbecomeprol
onged.

Di
phenhy
drami
ne
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1229
I
NDI
CATI
ONS
Reli
efofallergicsymptomscausedbyhi stami nerelease
i
ncluding:
Anaphy l
axis,
Seasonalandperenni alal
lergi
c
rhi
niti
s,Al
lergicdermatoses.Par
kinson'
sdi seaseand
dystonicr
eact i
onsf r
om medicat
ions.Mildnight t
ime
sedati
on.Pr eventi
onofmot i
onsickness.Ant i
tussiv
e
(syr
uponly )
.

ACTI
ON
Antagonizestheeffectsofhistami neatH1- r
eceptorsit
es;
doesnotbi ndtoorinactivat
ehi st
ami ne.Signi
fi
cantCNS
depressantandant i
choli
nergicproper ti
es.Ther
apeut i
c
Effect
s:Decreasedsy mptomsofhi st
amineexcess
(sneezi
ng, r
hinor
rhea,nasalandocul arprur
it
us,ocular
teari
ngandr edness,urti
cari
a).Reliefofacutedystonic
reacti
ons.Preventi
onofmot i
onsi ckness.Suppressionof
cough.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Acut
eat
tacksof
asthma;
Lactat
ion:
Lactat
ion;
Knownal
cohol
int
oler
ance
(someli
qui
dproducts)
.

UseCaut
iousl
yin:
Sev
erel
i
verdi
sease;
Angl
e-cl
osur
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1230
glaucoma; Sei zur
edi sorders;Prostatichy perpl
asia;Peptic
ulcer;Maycausepar adoxicalexcitati
oni ny oungchi l
dren;
Hy perthyr
oidism; OB: Safetynotest abli
shed; Geri:Appears
onBeer sl
ist.Geriatri
cpat i
entsar emor esuscept i
bleto
adv ersedrugr eactionsandant icholinergi
cef fects
(delir
ium,acut econf usi
on, di
zziness, drymout h,blurred
vision,uri
naryr et
ent i
on,constipation,tachycardia);dose
↓ ornon- anticholinergi
cant i
histami nerecommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dr
owsi ness, di
zzi
ness,headache, paradoxical
excit
ati
on( i
ncr easedinchil
dren).EENT: blurr
edv i
sion,
ti
nnit
us.CV: hy potensi
on,palpi
tati
ons.GI :anorexi
a,dry
mout h,
const ipati
on,nausea.GU: dysuri
a, f
requency,
uri
naryret
ent ion.Derm:photosensitiv
ity.Resp:chest
ti
ghtness,
t hickenedbronchialsecreti
ons, wheezing.Local
:
painatIM site.

I
NTERACTI
ONS
Drug-
Dr ug: ↑r i
skofCNSdepr essi
onwi t
hot her
anti
histami nes,alcohol,
opi
oidanalgesi
cs,and
sedative/hypnotics.↑ anti
choli
nergi
ceffectswit
htr
icy
cli
c
anti
depr essants,quinidi
ne,
ordisopyramide.MAO
i
nhibi
t orsintensifyandprol
ongt heanti
choli
nergi
cef
fects
ofantihistamines.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1231
Drug-
Natur
alPr
oduct
:Concomi
tantuseofkava-
kav
a,
val
eri
an,
orchamomil
ecan↑ CNSdepr essi
on.

DOSAGE
PO:(AdultsandChildren>12y r
):
Anti
hist
ami nic/
anti
emet i
c/anti
ver
ti
gini
c—25–50mgq4–6
hr,
nottoexceed300mg/ day.Ant
it
ussive—25mgq4hr
asneeded, nottoexceed150mg/ day .
Anti
dyskineti
c—25–50mgq4hr( nottoexceed400
mg/day).Sedative/
hypnotic—50mg20–30mi nbef
ore
bedti
me.
PO:(Children6–12y r)
:
Anti
hist
ami ni
c/antiemeti
c/ant i
vert
igi
nic—12.5–25mgq
4–6hr( nott oexceed150mg/ day).Anti
dyski
neti
c—1–1.5
mg/kgq6–8hrasneeded( nott oexceed300mg/ day).
Anti
tussive—12. 5mgq4hr( nottoexceed75mg/ day
).
Sedati
ve/ hypnotic—1mg/ kg/ dose20–30mi nbef
ore
bedti
me( nottoexceed50mg) .
PO:(Children2–6y r):
Anti
hist
ami ni
c/anti
emeti
c/ant i
vert
igi
nic—6.25–12.5mgq
4–6hr( nott oexceed37.
5mg/ day).Antidy
skinet
ic—1–1.5
mg/kgq4–6hrasneeded( nott oexceed300mg/ day)
.
Anti
tussive—6.25mgq4hr( nottoexceed37. 5mg/ 24hr)
.
Sedati
ve/ hypnoti
c—1mg/ kg/ dose20–30mi nbefore

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1232
bedt
ime(
nott
oexceed50mg)
.
I
M:I
V:(Adul
ts)
:25–50mgq4hrasneeded(mayneedup
t
o100-
mgdose,nottoexceed400mg/
day
).
I
M:IV:(
Childr
en):
1.25mg/kg(
37.
5mg/
m2)4t
imesdai
l
y
(
nottoexceed300mg/day
).
Topi
cal
:(Adul
tsandChi
l
dren≥2y
r):
Appl
ytoaf
fect
edar
ea
upto3–4timesdai
ly
.

AVAI
LABI
LITY
Capsul es25mgRx, OTC, 50mgRx, OTC; Tabl ets25mgRx,
OTC, 50mgRx, OTC; Chewabl et ablets(grapef lavor)25
mgRx, OTC; Orallydisintegr atingst ri
ps(cher r
yandgr ape
fl
avor)12. 5mgRx, OTC, 25mgOTC; Orall
ydi sintegrati
ng
tabl
ets12. 5mgOTC, 25mgOTC, 50mgRx, OTC;
Eli
xir
(cher ryandot herf lav ors)12. 5mg/ 5mLRx, OTC;
Syrup(cher ryandr aspber ryflavor)12. 5mg/ 5mLRx, OTC;
Cream 1%Rx, OTC, 2%Rx, OTC; Topical gel2%OTC; Topical
spray2%OTC; Topical stick2%OTC; Inj
ect i
on50mg/ mL; In
combi nationwi th:anal gesi cs,decongest ant s,and
expectorant s,i
nOTCpai n, sl
eep, cough, andcol d
preparations.

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakemedi
cat
ionasdi
rect
ed;
donot

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1233
 exceedrecommendedamount .Caut
ionpat
ientnotto
useoralOTCdiphenhydramineproduct
swithany
otherpr
oductcontai
ningdiphenhydr
amine,
includi
ng
product
susedtopical
ly.

Maycausedr owsiness.Caut
ionpati
entt
oavoid
driv
ingorotheracti
vi
ti
esrequir
ingal
ert
nessunt
il
responsetodrugisknown.

Maycausedr ymout h.I

nform patientthatfr
equent
oralr
inses,goodor alhygi
ene,andsugar l
essgum or
candymaymi nimizethi
seffect .Noti
fyhealthcar
e
prof
essionalifdrymout hpersistsformor ethan2wk.

Teachsl
eephygi
enet echni
ques(darkroom, qui
et,
bedti
merit
ual
,l
imitdayti
menapping,avoidanceof
ni
coti
neandcaff
eine)topati
entstaki
ng
di
phenhydr
aminetoaidsleep.

Advi
sepati
enttousesunscreenandprot
ectiv
e
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

Caut
ionpat
ientt
oavoiduseofal
cohol
andotherCNS
depr
essant
sconcur
rentl
ywit
hthi
smedicat
ion.

Pedi:Cancauseexci tati
oni nchil
dren.Cauti
on
parentsorcaregiversaboutpr operdosecalculat
ion;
overdose,especiall
yininfantsandchildren,
cancause
hall
ucinat
ions,seizures,ordeath.Cautionparent
st o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1234
 av
oidOTCcoughandcoldproductswhi
l
e
br
east
feedi
ngort
ochil
dren<4y r
.

Geri:I
nstructolderadultstoav oi
dOTCpr oductsthat
contai
ndi phenhy dramineduet oincr
easedsensiti
vi
ty
toanticholi
nergicef f
ectsandpot ent
ial
foradverse
reacti
onsr el
atedt otheseeffects.

Advi
sepatient
staki
ngdiphenhydr
ami neinOTC
pr
eparat
ionstonoti
fyheal
thcareprofessi
onal
if
symptomswor senorper
sistf
ormor ethan7days

Di
pyr
idamol
e
I
NDI
CATI
ONS
PO: Preventi
onoft hromboembol ism i
npat ient
swi t
h
prostheti
chear tvalves( wit
hwar far
in)
.Mai ntainspat ency
aftersurgi
calgr aft
ingpr ocedures,i
ncludingcor onary
arterybypass(wi thaspirin)
.IV:Asanal ternati
vet o
exerciseinmy ocar dial
per f
usionscint
igraphy( cardi
ac
stresstesti
ngwi t
hr adi
ot r
acerimaging).

ACTI
ON
PO:Decreasesplat
eletaggregat
ionbyinhi
bit
ingthe
enzymephosphodiesterase.I
V:Producescoronary
vasodi
l
ationbyinhi
biti
ngadenosineuptake.Therapeut
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1235
Effects:
PO:Inhibi
ti
onofpl at
eletaggr egati
onand
subsequentthromboembol icevent s.IV:I
ndiagnosti
c
thall
ium i
maging,dipy
ridamoledilat esnormalcoronar
y
arteri
es,r
educingfl
owt ovesselst hatarenarrowedand
causingabnormal t
hall
ium dist
ri
but ion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Hypot
ensi
vepat
ient
s;Ger
i:Appear
s
onBeer sli
st.Ger i
atri
cpat i
entsmaybemor esuscepti
ble
toorthost
atichy potension;Patientswithplat
eletdef
ects;
Pregnancy(althoughsaf etynotest abli
shed,hasbeen
usedwi t
houthar m duringpr egnancy )
;Lact
ationor
chil
dren<12y r(safetynotest ablished)

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,headache,syncope,
IVonly—transient
cerebral i
schemi a,weakness.Resp:
IV
onl
y —br onchospasm.CV: I
Vonly—MI,hypotension,
arr
hy t
hmi as,flushi
ng.GI:nausea,di
arr
hea,GIupset ,
vomiting.Der m: r
ash.

I
NTERACTI
ONS
Dr
ug-
Drug:
Addi
ti
veef
fect
swi
thaspi
ri
nonpl
atel
et

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1236
aggregation.Ri
skofbl eedingmaybe↑ whenusedwi t
h
anti
coagul ant
s,thrombolyticagents,NSAIDs,
cefoperazone,cefotetan,
orv al
proicacid.↑ r
iskof
hypotensionwithal cohol
.Theophy l
li
nemaynegat ethe
eff
ectsofdi pyr
idamol eduringdiagnosti
cthal
lium i
maging.

DOSAGE
PO:
(Adul
ts)
:225–400mg/
dayi
n3–4di
vi
deddoses.
I
V:(
Adul
ts)
:570mcg/
kg;
maxi
mum dose60mg.

AVAI
LABI
LITY
Tabl
ets25mg,
50mg, 75mg,100mg; I
njecti
on5mg/mL
i
n2-mLand10-
mlvi
als;I
ncombinat
ionwi t
h:aspi
ri
n

PATI
ENTTEACHI
NG
PO:Inst
ructpat
ientt
ot akemedi cati
onatev enl
y
spacedinter
val
sasdirected.Takemi sseddosesas
soonasr ememberedunlessthenextschedul eddose
i
swi t
hin4hr.Donotdoubl edoses.Benef i
tof
medicati
onmaynotbeappar enttopatient
;encourage
pati
enttoconti
nuetaki
ngmedi cati
onasdi r
ected.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1237
 Advisepati
enttoavoidtheuseofal
cohol,asi
tmay
potenti
atethehypotensi
veeff
ect
s.Tobaccoproduct
s
shouldalsobeavoidedbecauseni
coti
necauses
vasoconstr
icti
on.

Advisepat i
enttoconsulthealthcarepr
ofessional
beforetakingOTCmedi cati
onsconcurr
ent l
ywiththis
medi cat
ion.Aspiri
nshouldbet akenonlyifdir
ected
andonl yindosepr escr
ibed.Adv i
sepat
ienttodiscuss
al
ternativ
esf orpai
nr el
ieforfever.

I
nstructpati
enttonoti
fyhealt
hcarepr ofessi
onal i
f
unusualbleedi
ngorbruisi
ngoccurs.Concur rentuse
ofaspir
inorwar f
ari
nmayi ncr
easeriskofbl eeding
butiscommonl yusedwi t
hspeci
fi
ci ndicati
ons.

Advi
sepatienttonoti
fyheal
thcareprof
essi
onalof
medicat
ionregimenandwhet herusi
ngconcur
rent
aspi
ri
norwar far
inther
apy.

I
V:I
nst
ructpati
enttonoti
fyhealt
hcarepr
ofessi
onal
i
mmediat
elyifdyspneaorchestpai
noccur
s.

Di
ri
thr
omy
cin
I
NDI
CATI
ONS
Tr
eat
mentoft
hef
oll
owi
ngi
nfect
ions:
Acut
ebact
eri
al

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1238
exacerbati
onsofchr onicbr onchiti
sduet oHaemophi l
is
i
nfluenzae,Moraxell
acat arrhali
s,orStreptococcus
pneumoni ae,Secondarybact eriali
nfecti
onsofacut e
bronchit
isduet oMor axell
acat arrhal
isorSt r
eptococcus
pneumoni ae,Communi t
y -
acquiredpneumoni aduet o
Legionel
lapneumophi l
a,My coplasmapneumoni ae,orS.
pneumoni ae,Pharyngit
is/tonsil
lit
isduet oStreptococcus
pyogenes, Uncompl i
catedski n/ski
nstructureinfecti
ons
duet omet hi
cil
li
n-susceptiblestrai
nsofSt aphylococcus
aureusorS.py ogenes.

ACTI
ON
Suppressespr ot
einsynthesisatthelev elofthe50S
bacteri
alribosome.Ther apeuticEffects:Bacteriost
ati
c
acti
onagai nstsuscept i
blebacteri
a.Spect r
um: Acti
ve
againstgram- posit
iveaerobesincluding: S.aureus
(methici
ll
in-suscepti
ble),S.pneumoni aeandS.py ogenes.
Activeagainstgram- negati
veaerobes, including:H.
i
nfluenzae, L.pneumophi l
a,M.cat arr
hal i
s.Alsoactive
againstM.pneumoni ae.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odi
ri
thr
omy
cin,
eryt
hromyci
n,orothermacr
oli
deant
i-
infect
ives;Known,
suspect
ed,orpotent
ial
bact
eremi
a(serum level
sare

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1239
i
nadequat
e).

UseCaut
iousl
yin:
Moder
ateorsev
erehepat
ic
i
mpair
ment;Pr
egnancy,l
act
ati
on,
orchi
l
dren<12y
r
(
saf
etynotest
abl
ished)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness/v er
tigo,headache,i
nsomnia,
weakness.
Resp: dyspnea,increasedcough.GI:
PSEUDOMEMBRANOUSCOLI TI
S,abdominal
pain,
diarr
hea,
dyspepsia,flat
ulence,nausea, v
omiti
ng.GU:vagi
nit
is.
Derm: pruri
tus/urti
caria,r
ash.

I
NTERACTI
ONS
Drug-Drug:Absorpt
ionsl i
ghtly↑ whenusedwi thantacids
orH2–r eceptorant
agoni st
s.May↑ bl oodl evelsof
tr
iazolam,di
goxin,
warfarin,
ergotami ne,
cyclosporine,
carba
mazepi ne,
alf
entani
l,
disopyrami de,phenyt
oin,bromocripti
ne,
valpr
oicacid,
lovast
ati
n, andsi mv astat
in.
Dr
ug-
Food:
Foodi
ncr
easesabsor
pti
on.

DOSAGE
PO:(Adult
sandChil
dren>12yr)
:500mg/ dayasasi
ngl
e
dosefor5–14days(dur
ati
ondependsuponthe
i
ndicat
ion).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1240
AVAI
LABI
LITY
Tabl
ets250mg;

PATI
ENTTEACHI
NG
I
nstructpatientstotakemedicationexactl
yas
dir
ect edandtof i
nishthedrugcompl et
ely
,eveni
f
feel
ingbet t
er.Advisepati
entsthatshari
ngofthi
s
medi cati
onmaybedanger ous.

Advisepati
enttorepor
tthesi
gnsofsuperinfect
ion
(bl
ack,fur
ryovergr
owthonthetongue;vaginali
tchi
ng
ordischar
ge;l
ooseorfoul-
smell
ingstool
s).

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed.

I
nst
ructthepat
ientt
onoti
fyhealt
hcar
eprof
essi
onal
i
fsy
mpt omsdonotimprovewithi
nafewdays.

Di
sopy
rami
de

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1241
I
NDI
CATI
ONS
Treat
mentofventr
icul
art
achycar
dia.Unl
abel
edUses:
Treat
ment/
prevent
ionofsupr
aventri
cul
ar
tachy
arr
hyt
hmias.

ACTI
ON
Decreasesmy ocar
dialexcitabil
it
yandconduct i
onveloci
ty.
Hasant i
chol
inergi
cproper t
ies.Lit
tl
eeffectonheartr
ate
buthasadi r
ectnegati
vei notropi
ceffect.Ther
apeuti
c
Eff
ects:Suppressi
onofv ent r
icul
ararr
hythmias.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Car
diogeni
cshock;
2nd-or3r
d-degr
eehear
tbl
ock;
Sicksi
nussy
ndr
ome
(wi
thoutapacemaker)
.

UseCaut
iousl
yin:
HForl
eftv
ent
ri
cul
ardy
sfunct
ion
(dose↓ recommended) ;Hepat i
corr enali
nsuffi
ciency
(dose↓ recommendedi fCCr≤40mL/ min);Prost
atic
enlargement;My astheni
agr avis;Glaucoma; Geri
:Appears
onBeer sli
st.Mayi nducehear tfail
ureinelderl
ypat i
ents;
OB: Lact
ati
on: Pedi:Safetynotest abli
shed.
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
dizzi
ness,
fat
igue,
headache.EENT:
blur
redv
isi
on,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1242
dryeyes,drythroat.CV: HF, ar
rhythmias,AVblock,
dyspnea,edema, hy potension.GI:consti
pati
on,drymouth,
abdominal pai
n, f
latulence,nausea.GU: uri
naryhesi
tancy
,
uri
naryretenti
on.Endo: hypoglycemia.Misc:i
mpaired
temperatureregulation.

I
NTERACTI
ONS
Drug- Drug: Maypot entiateanti
coagul antef f
ectofwar f
arin.
Rifampi n,phenobar bital,andpheny toinmay↓ bl ood
l
ev elsandef fectiveness.Ci metidineor erythromy cinmay
↓ met abolism and↑ bl oodlevels.Mayhav eaddi ti
ve
toxiccar diacef fectswhenusedwi thot herantiarrhyt
hmi cs
(prolongedconduct ionand↓ car di
acout put),especial
ly
verapami l
—av oidusi ngdi sopyrami def or48hrbef oreor
24hraf ter.Anticholinergicsideef fectsmaybeaddi t
ive
withot herdr ugshav ingant i
cholinergicpr operties,
i
ncl udingant ihistami nesandt r
icy cli
cant idepressants.↑
ri
skofar rhythmi aswi t
hpi mozide.
Drug-
Nat
ural
Product
:↑ ant
ichol
i
nergi
ceffect
swi
th
angel
'
str
umpet,j
imsonweed,andscopol
i
a.

DOSAGE
PO:(Adul
ts>50kg)
:150mgq6hr(
asimmediat
e-rel
ease
capsul
es)or300mgq12hr(
asCRdosagef
orm; notto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1243
exceed800mg/
day
).
PO:(Adul
ts<50kgorPat
ient
swithPoorLef
tVentri
cul
ar
Functi
on)
:100mgq6–8hr( asimmediat
e-r
elease
capsul
es)or200mgq12hr( asCRdosageform).
PO:(Chi
l
dren12–18y
r):
6–15mg/
kgdai
l
y,i
ndi
vi
ded
dosesq6hr.
PO:(Chi
l
dren4–12y
r):
10–15mg/
kgdai
l
yindi
vi
ded
dosesq6hr.
PO:
(Chil
dren1–4y
r):
10–20mg/
kgdai
l
yindi
vi
deddoses
q6hr.
PO:
(Chi
l
dren<1y
r):
10–30mg/
kgdai
l
yindi
vi
deddosesq
6hr
.

Renal
Impai
rment
PO:(Adul
ts):
CCr>40mL/
mi norpati
entswithhepat
ic
i
mpairment—100mgq6hr;CCr30–40mL/ mi n—100mg
q8hr ;
CCr15–30mL/mi
n—100mgq12hr ;CCr<15
mL/min—100mgq24hrasi mmediate-
rel
easedosage
for
m.

AVAI
LABI
LITY
Capsul
es100mg,
150mg;
Ext
ended-
rel
easecapsul
es100
mg,150mg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1244
PATI
ENTTEACHI
NG
Advisepatientt
otakemedicati
onar oundtheclock,as
di
rected.Donotdiscont
inuemedicat i
onwithout
consult
inghealthcar
eprofessi
onal.Ifadoseis
missed,takeassoonasr emember edunlesswithi
n4
hrofnextdose.Donotdoubl edoses.

Medicati
onmaycausedi zzi
ness.Cauti
onpat
ient
sto
avoi
ddr i
vingorot
heracti
vit
iesrequi
ri
ngal
ert
ness
unti
lresponsetomedicat
ionisknown.

I
nstr
uctpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Advi
sepati
entt
hatfr
equentmouthri
nses,
goodor
al
hygi
ene,
andsugarl
essgum orcandymayhel
prel
i
eve
dr
ymout h.

Cautionpati
enttoavoidext
remesoftemper at
ure,
becausethismedicati
onmaycausei mpairmentof
bodyt emperat
ureregul
ati
on.Pat
ientshoulduse
sunscreenandprotecti
vecl
othi
ngtopr ev
ent
photosensi
tivi
tyr
eacti
ons.

Instr
uctpati
entt
onotifyheal
thcareprofessionalof
allRxorOTCmedi cat
ions,vi
tamins,orherbal
productsbei
ngtakenandt oconsultheal
thcar e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1245
 pr
ofessi
onalbefor
etaki
ngot
herRx,
OTC,
her
bal
pr
oducts,oral
cohol.

Ifconsti
pati
onbecomesapr obl
em, advi
sepati
ent
thatincr
easi
ngbulkandfl
uidsinthedietand
exercisi
ngmaymi ni
mizeconsti
pati
on.

I
nstructpatientt
onotifyheal
thcar
eprofessi
onali
f
dr
ymout h,dif
fi
cultur
inat
ion,
const
ipat
ion,orbl
urr
ed
vi
sionper si
sts.

Di
sul
fi
ram
I
NDI
CATI
ONS
Managementofchroni
calcoholi
sm i
npatientswho
requir
eordesir
eanenfor
cedstateofsobri
ety,whichmay
allowforaddi
ti
onal
support
iveandpsychotherapeut
ic
treat
ment.

ACTI
ON
I
nhibit
stheenzymeal dehydedehy drogenase, t
hisresult
s
i
nt oxi
caccumulati
onofacet aldehydeoneoft heiniti
al
breakdownproductsofalcohol.Theal cohol-
disulf
iram
reacti
onisunpl
easantanddi scouragesal coholingesti
on.
Therapeuti
cEff
ects:Alcoholabstinence.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1246
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odi
sul
fi
ram or
otherthi ur
ams( includingthoseusedi nrubber
vulcanizationandpest i
cides);Si
gnifi
cantcardi
ovascular
disease; Psychosis;Concur rentorrecentuseof
met ronidazole,paraldehyde, al
coholoralcohol
-cont
aining
product s;Lactati
on: Lactati
on.

UseCaut
iousl
yin:
Diabet
es;
Hyper
thy
roi
dism;
Epi
l
epsy
;
Cerebraldamage;Hepati
correnali
mpai
rment
;OB:
Pedi
:
Pregnancyorchil
dren(saf
etynotest
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness,fati
gue,
headache,psychoses.EENT:
opti
cneur i
ti
s.GI: HEPATOTOXI CI
TY,metall
ic/gar
li
c-l
ike
tast
e.GI :
erecti
ledy sf
unct
ion.Derm:acneif
orm erupt
ions,
all
ergicdermatit
is.Neuro:per
ipher
alneuri
ti
s/neuropathy,
polyneuri
ti
s.

I
NTERACTI
ONS
Drug-Dr ug:Theal cohol-
disulf
iram i
nteract
ionisthe
mai nstayoft herapy;concurrentuseresult
si nsever
e
al
cohol int
oleranceresulti
ngi nfl
ushing,↑r espir
ati
on,
pulseandcar diacoutput.Concur r
entusewi thisoni
azi
d
mayr esulti
nunst eadygai tandbehav i
orchanges( ↓

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1247
disulfir
am doseordi scont i
nue) .Concur r
entusewi t
h
met ronidazol
e↑ r iskofpsy chosesorconf usi
on( oneor
bothdr ugsmayneedt obedi scontinued).↓ met aboli
sm
andmay↑ CNSdepr essionf rom somebenzodi azepines;
uset hosewhi char emet abolizedbyot herpathway s
(t
emazepam, oxazepam, l
orazepam) .↓ met aboli
sm and
may↑ CNSdepr essionfrom chl orzoxazone( dose↓ may
benecessar y
).May↑ CNSandcar di
acst i
mul at
ionfrom
caffeine.May↑ r iskofadv er secar di
acr eacti
onsf r
om
cocai ne.May↑ l evelsandr iskoft oxicit
yfrom pheny t
oin
andt heophy l
li
ne;moni tori
ngi sr ecommended.May↑
l
ev elsandr i
skofor ganicbr ainsy ndromef rom tri
cycli
c
antidepressants.

DOSAGE
PO:(
Adul
ts)
:500mg/dayf
or1–2wk,
then250mg/
day
(upt
o500mg/day
).

AVAI
LABI
LITY
Tabl
ets250mg,
500mg;

PATI
ENTTEACHI
NG
Inf
orm pati
entofpur
poseofdisul
fir
am andthe
consequencesofdri
nki
ngalcoholduri
ngther
apy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1248
 Maycausedrowsiness.Cauti
onpati
enttoavoi
d
driv
ingandot
heracti
v i
ti
esrequi
ri
ngaler
tnessunt
il
responset
omedicationisknown.

Cautionpat ientnott otakeal cohol oranymedi cation

containingal cohol duri
ngt herapyorf or14day s
foll
owingt her apy;maycauseadi sulfi
r am- reacti
on
(bl
urredv i
sion, chestpai n,confusion, dizzinessor
fai
nting,fastorpoundi nghear tbeat,fl
ushedor
rednessoff ace,increasesweat i
ng, nausea, vomi t
ing,
throbbingheadache, t
roublebr eathi
ng, severe
weakness, sei zures,unconsci ousness, heartattack
death).React ionmayper si
stfrom 30mi ntosev er
al
hours.Adv isepat ienttocheckal l
medi cationsf orthe
presenceofal cohol .

Advi
sepati
entt
oconsul
theal
thcareprof
essi
onal
pr
iort
otaki
ngotherCNSdepr
essants.

Advi
sepati
enttonotif
yhealthcareprof
essi
onalof
si
gnsofhepatotoxi
cit
y(yel
loweyesorskin,dar
keni
ng
orur
ine,
li
ght-
graycoloredstool
s,sev
erestomach
pai
n.

Di
thr
anol
I
ndi
cat
ions
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1249
Moder
atel
ysev
erepsor
iasi
s.

Av
ail
abi
l
ity
OI
NTMENT30g(
0.25,
0.5and1%w/
w).

DOSAGE
Psoriasi
s:ini
tiateundermedicalsupervi
sionstart
ingwi t
h
0.
1%, careful
l
yappl ytolesi
onsonly,leav
ei ncontactfor30
min,thenwashof fthor
oughly;r
epeatapplicat
iondai l
y,
graduall
yincreasingstr
engthto2%andcont actti
met o60
minatweekl yi nt
erval
s;washhandst horoughl
yaf teruse.

Cont
rai
ndi
cat
ions
Hypersensi
ti
vi
ty;av
oiduseonf
ace;
acut
eer
upt
ions;
excessi
velyi
nfl
amedareas.

Pr
ecaut
ions
I
rri
tant
-av
oidcont
actwit
hey esandheal
thyski
n;nott
obe
usedinacut
epsori
asi
s;pregnancy
.

Adv
erseEf
fect
s
Localir
ri
tati
on;di
sconti
nueusei fexcessi
veery t
hemaor
spreadoflesi
ons;conj
unctiv
iti
sfoll
owingcont actwit
h
eyes;st
aini
ngofskin;hai
r;andfabrics;st
ainsskin.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1250
St
orage
St
orepr
otect
edf
rom l
i
ght
.

DI
VALPROEXSODI
UM
I
NDI
CATI
ONS
Monot herapyandadjunct i
vet herapyf orsimpleand
compl exabsenceseizures.Monot herapyandadjuncti
ve
therapyforcomplexpartial seizures.Adjunctiv
etherapy
forpatientswit
hmul t
ipl
esei zurety pes,i
ncludi
ngabsence
seizures.Div
alpr
oexsodi um onl y:Mani cepisodes
associatedwithbipol
ardi sorder,Pr event
ionofmi gr
aine
headache.

ACTI
ON
Incr
easelevelsofGABA,aninhibit
oryneurotr
ansmi t
teri
n
theCNS.Ther apeut
icEf
fect
s: Suppressi
onofseizure
acti
vit
y.Decreasedmanicepisodes.Decreasedfrequency
ofmigrai
neheadaches.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hepat
ici
mpai
rment
;
Known/
suspect
edur
eacy
cledi
sor
der
s(mayr
esul
tinf
atal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1251
hy
per
ammonemi
cencephal
opat
hy)
.

UseCaut
iousl
yin:
All
pat
ient
s(may↑ r
iskofsui
cidal
thought s/behav iors) ;Bleedingdisorder s;Historyofl iv
er
disease; Organi cbr aindi sease;Bonemar r
owdepr essi on;
Renal impai rment ;Womenofchi ldbear i
ngpot ent i
al;Geri:
↑r i
skofadv erseef fects; OB:Usedur i
ngpr egnancyi s
l
inkedt ocongeni tal anomal i
es,neural tubedef ects,
clotti
ngabnor mal i
ties, andhepat icdy sfunctionint he
neonat easwel lasi mpai redcogni t
ivedev elopmentast he
childmat ur es.Usewi t
hext r
emecaut i
on.Lact ation: Pass
i
nt obr eastmi l
k.Consi derdiscontinuingnur singwhen
valproatesar eadmi nisteredtothenur singmot her ;Pedi:
Children,especi all
y<2y r(at↑ riskf orpot enti
all
yf atal
hepat otoxicity).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SUICIDALTHOUGHTS, agit
at i
on, dizzi
ness,headache,
i
nsomni a,sedation,confusion,depr ession.CV: peri
pheral
edema.EENT: vi
sual di
sturbances.GI :HEPATOTOXI CITY,
PANCREATI TIS,abdominal pain,anor exia,diar
rhea,
i
ndigesti
on, nausea,vomi t
ing,const ipati
on, ↑ appeti
te.
Derm: al
opecia,rashes.Endo: weightgai n.Hemat :
l
eukopeni a,t
hrombocy topenia.Met ab:
HYPERAMMONEMI A.Neur o: HYPOTHERMI A,tr
emor,
ataxi
a.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1252
I
NTERACTI
ONS
Drug- Drug: ↑r iskofbl eedingwi thwar farin.Bloodl ev el
s
andt oxici
tymaybe↑ byaspi ri
n,car bamazepi ne,
chlor promazi ne, cimet i
dine,erythromy cin,orf elbamat e.↑
CNSdepr essi onwi t
hot herCNSdepr essant s,i
ncl uding
alcohol ,antihistami nes, anti
depressant s,opi oid
anal gesics, MAOi nhi bitors,andsedat ive/hy pnot i
cs.MAO
i
nhi bitorsandot herant i
depressant smay↓ sei zure
threshol dand↓ ef fectivenessofv alproat e.
Car bamazepi ne, mer openem, phenobar bital,pheny toin,
or
ri
fampi nmay↓ v alpr oatebloodl evel s.Val proat emay↑
toxicityofcar bamazepi ne,diazepam,
ami triptyl
ine,nor tr
iptyline,ethosuximi de, lamot r i
gine,
phenobar bital,pheny toin,topir
amat e,orzi dov udine.
Concur rentusewi tht opiramatemay↑ r iskof
hypot her mia.Er tapenem, imipenem, ormer openem may
↓v alproat ebl oodl ev els.

DOSAGE
Regul
ar-
rel
easeanddelay
ed-
rel
easeformulati
onsusual
l
y
giv
enin2–4divi
deddosesdail
y;ext
ended-r
elease
for
mulat
ion(Depakot
eER)usuall
ygivenoncedail
y

Ant
iconv
ulsant

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1253
PO: (Adul t
sandChi ldren>10y r
):Single-
agentt herapy
(compl expar ti
alsei zures)—Init
ialdoseof10–15
mg/ kg/ dayi n1–4di vi
deddoses; ↑ by5–10mg/ kg/day
weekl yunt i
l t
herapeut i
cr esponseachi ev ed(nottoexceed
60mg/ kg/ day);whendai lydoseexceeds250mg, givei
n
divi
deddoses.Pol ytherapy( complexpar ti
al
seizures)—I nit
ialdoseof10–15mg/ kg/ day;↑ by5–10
mg/ kg/ dayweekl yunt iltherapeuti
cr esponseachi eved
(nottoexceed60mg/ kg/ day);
whendai lydosageexceeds
250mg, gi
v eindivideddoses.
PO: (Adult
sandChildr
en>2y r[
>10yrforDepakot eERand
Stavzor]
):Simpl
eandcompl exabsenceseizures—Ini
ti
al
doseof15mg/ kg/dayin1–4di vi
deddoses; ↑ by5–10
mg/ kg/dayweeklyuntilt
herapeut
icresponseachieved
(nottoexceed60mg/ kg/day);
whendai l
ydoseexceeds
250mg, gi
veindivi
deddoses.
IV:
(Adult
sandChildr
en)
:Givesamedail
ydoseandat
samefrequencyaswasgiv
enor al
ly
;swi
tcht
ooral
for
mulati
onassoonaspossible.
Rect(
Adult
sandChi l
dren):Dil
utesy
rup1:
1wit
hwaterf
or
useasaretent
ionenema.Gi ve17–20mg/kgl
oad,
maint
enance10–15mg/ kg/doseq8hr.

MoodSt
abi
l
izer

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1254
PO: (Adul
ts) :
DepakoteandSt avzor—Ini
ti
aldoseof750
mg/ dayindivideddosesinit
ial
ly,t
it
rat
edr api
dlytodesired
cli
nicalef
fectort r
oughplasmal evel
sof50–125mcg/ mL
(nottoexceed60mg/ kg/day).DepakoteER—Initi
aldose
of25mg/ kgoncedai l
y;t
it
ratedrapidl
ytodesiredcli
nical
effectoftroughplasmalevelsof85–125mcg/ mL( notto
exceed60mg/ kg/
day).

Mi
grai
nePr
event
ion
PO:(Adult
sandChil
dren≥16yr)
:Depakot
eand
St
avzor—250mgt wi
cedaily(
upto1000mg/ day
).
DepakoteER—500mgoncedai l
yfor1wk,then↑ t
o1000
mgoncedai l
y.

AVAI
LABI
LITY
Val
proi
cAci
d
Capsul
es250mg,500mg;Del
ayed-
rel
easecapsul
es125
mg,250mg,500mg;Syr
up250mg/ 5mL;

Val
proat
eSodi
um
I
nject
ion100mg/
mL
Delayed-
rel
easetablets(Depakot
e)125mg,250mg,500
mg; Capsul
es-spr
inkle125mg; Ext
ended-
rel
easet
abl
ets
(DepakoteER)250mg, 500mg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1255
PATI
ENTTEACHI
NG
Inst
ructpati
enttotakemedi cationasdirect ed.Ifa
doseismi ssedonaonce- a-
dayschedule, takeas
soonasr emember edt hatday.I
fonamul tiple-dose
schedule,t
akeitwithin6hroft heschedul edt i
me,
thenspacer emaini
ngdosest hr
oughoutt he
remainderoftheday .Abruptwithdr
awal mayl eadto
stat
usepilepti
cus.

Maycausedr owsinessordizziness.Cauti
onpat i
ent
toavoiddri
vingorot heracti
vi
t i
esrequir
ingalert
ness
unti
leffect
sofmedi cat
ionareknown.Tel lpati
entnot
toresumedr i
v i
ngunt i
lphysi
ciangivesclearance
basedoncont r
olofseizuredisorder.

Cautionpatienttoav
oidtakingalcohol
,CNS
depressants,OTCmedi cat
ionsorherbalproduct
s
concurrentl
ywi t
hval
proateswithoutconsult
ingheal
th
careprofessional
.

Adv isepatientandf amilytonot if

yhealthcare
prof essi
onal i
fthoughtsaboutsui ci
deordy i
ng,
attempt stocommi tsuicide;neworwor sedepressi
on;
neworwor seanxiety;f
eel i
ngv eryagit
atedorrestl
ess;
pani cattacks;t
roublesleeping; neworwor se
i
rri
t abil
it
y;acti
ngaggr essive;beingangr yorvi
olent;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1256
 act
ingondangerousi
mpulses;anextr
emeincr
easein
act
ivi
tyandt
alki
ng,ot
herunusualchangesi
nbehavi
or
ormoodoccur.

I
nst
ructpat
ienttonot
if
yheal
thcarepr
ofessi
onalof
medi
cati
onregimenpri
ortot
reat
mentorsurgery
.

Advisepat i
enttonot if
yheal t
hcarepr of
essionalif
anorexi
a, abdomi nalpain,severenauseaandv omit
ing,
yell
owski norey es,fever,sorethr
oat,malaise,
weakness, faci
al edema, l
ethargy,unusualbleedi
ngor
brui
sing,pregnancy ,orlossofseizurecontroloccurs.
Chil
dren<2y rofagear eespeci al
l
yatr i
skforf at
al
hepatotoxici
ty.

Maycauset erat
ogeniceffect
s.Instr
uctfemal
e
pati
entstonotif
yhealthcareprofessi
onal
i
mmedi atel
yifpregnancyisplannedorsuspect
edori
f
breast
feedi
ng.

Advisepati
entt
ocar r
yident
if
icat
ionatal
lti
mes
descri
bingmedicat
ionregi
men.

Emphasi
zetheimpor
tanceofr
out
ineexamst
o
moni
torprogr
ess.

Dobut
ami
ne

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1257
I
ndi
cat
ions
Acuteheartfai
lur
e;acutemyocardi
ali
nfarct
ion;
cardi
ogenicshockfoll
owingcardi
acsurgery
; speci
fi
c
shock;acutedecompensati
onofchronicCHF.

ACTI
ON
Sti
mul atesbeta1(myocar di
al)
-adr
energi
creceptorswit
h
rel
ativ
elymi noreff
ectonhear trateorperi
pheralbl
ood
vessels.Therapeuti
cEf f
ects:Incr
easedcardi
acout put
withoutsignif
icant
lyincreasedheartrat
e.

Av
ail
abi
l
ity
INJECTION250mg/ 20ml ,40mg/ml,
12.5mg/
ml,
5ml
ampoule( 50mg/ml)
,vial
250mg/ 20ml,
50mg/4ml;
250
mgdr ysteri
lel
yophi
l
isedpowder.

DOSAGE
2.
5to10µg/kg/minwhi
chcanbeti
tr
atedt
o40µg/
kg/
min
aspert
hei
ndivi
dualr
equi
rement
.

Cont
rai
ndi
cat
ions
Hyper
sensi
ti
vi
ty;
idi
opat
hichy
per
trophi
csubaor
ti
c
st
enosi
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1258
I
NTERACTI
ONS
Drug-Drug: Usewi t
hnit
ropr ussidemayhav easy ner
gist
ic
eff
ecton↑ car diacoutput.Bet abl ockersmaynegat ethe
eff
ectofdobut amine.↑ riskofar rhyt
hmi asor
hypertensionwi t
hsomeanest hetics(cyclopropane,
halothane),MAOi nhibi
tors,oxy tocics,ortri
cycli
c
antidepressants.

Pr
ecaut
ions
Int
eracti
onspr egnancymoni t
orheartrateandrhythm;
art
erialBPandi nfusi
onratecl
osely;
cor r
ecthypovolemi
a
pri
ort otreatment;el
der
ly;
neonates;r
iskofrapid
ventr
icularresponseinpati
entswit
hat r
ialf
ibr
il
lat
ion;
chil
dren.

Adv
erseEf
fect
s
Tachycardiaandmar kedincr
easeinsyst
oli
cblood
pressur
ei ndi
cateoverdosage;phl
ebi
ti
s;r
arel
y,
thrombocy t
openia.

PATI
ENTTEACHI
NG
Expl
aintopati
entt
herati
onal
eforinst
it
uti
ngthi
s
medicat
ionandtheneedforf
requentmonit
ori
ng.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1259
 Advi
sepatienttoi
nfor
m nurseimmediat
elyifchest
pai
n;dy
spnea; ornumbness,t
ingl
i
ng,orburningof
ext
remi
tiesoccurs.

I
nstr
uctpati
enttonoti
fynur
seimmediat
elyofpai
nor
di
scomfortatt
hesiteofadmini
str
ati
on.

HomeCar
eIssues:
Inst
ructcar
egi
veronpr
opercar
e
ofI
Vequi
pment.

I
nst r
uctcaregiv
ert oreportsignsofworseni
ngHF
(shortnessofbreath,orthopnea,decr
easedexer
cise
toler
ance),abdominal pain,andnauseaorvomit
ingto
healthcareprofessionalpromptly.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

DOCETAXEL
I
NDI
CATI
ONS
Breastcancer(l
ocal
lyadvanced/ met ast
aticbreastcancer
orwithdoxorubi
cinandcy clophosphami deasadj uvant
tr
eatmentofnode-posit
ivedi sease).Non–smal l
-cel
l l
ung
cancer(l
ocall
yadvanced/met ast
ati
c)afterfail
ureon
plat
inum regi
menorwi t
hpl atinum asini
tialther
apy).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1260
Advancedmet astati
chormone- r
efractorypr
ost
atecancer
(wi
thprednisone).Squamouscel lcarcinomaofthehead
andneck(locall
yadv anced)withcisplati
nandfl
uorouraci
l.
Gastr
icadenocarcinoma( local
l
yadv anced)wit
hcisplati
n
andfl
uorouracil
.

ACTI
ON
I
nterf
ereswit
hnor malcel
lul
armicrot
ubulefuncti
on
requi
redfori
nter
phaseandmi t
osis.Ther
apeuticEff
ect
s:
Deathofrapi
dlyr
epli
cati
ngcell
s,parti
cul
arl
ymal i
gnant
ones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
poly
sorbate80;Knownalcohol
int
oler
ance;Neutrophi
l
count<1500/mm3; Li
veri
mpairment(
serum bil
ir
ubin>
upperli
mitofnormal,
ALTand/orAST>1. 5ti
mesupper
l
imitofnormal,
withalkal
i
nephosphatase>2.5ti
mes
upperli
mitofnormal)
;OB:Lact
ati
on:Pregnancyor
l
actati
on.

UseCaut
iousl
yin:
OB:
Pat
ient
swi
thchi
l
dbear
ing
pot
ent
ial
;Pedi
:Ef
fi
cacynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1261
CNS: f
at i
gue, weakness.Resp: bronchospasm.CV:
ASCITES, CARDI ACTAMPONADE, PERI CARDI AL
EFFUSI ON, PULMONARYEDEMA, per i
pher aledema.GI :
di
arrhea, nausea, stomat it
is,vomi t
ing.Der m: al
opecia,
edema, rash, dermat it
is,desquamat ion, eryt
hema, nail
di
sorder s.Hemat :anemi a,leukopeni a,thr ombocy t
openia,
l
eukemi a.Local :i
njecti
onsi tereactions.MS: myalgi
a,
art
hralgia.Neur o:neur osensor ydeficits, per
ipheral
neuropat hy.Mi sc:hypersensi t
ivi
tyreact ions,incl
uding
anaphy l
axi s.

I
NTERACTI
ONS
Drug-Drug:↑ bonemar r
owdepr essionmayoccurwi t
h
otherantineoplasti
csorr adiat
iont herapy .Strong
i
nhibitor
sofCYP3A4, i
ncludingat azanav i
r ,
clari
thr
omyci
n,
i
ndinav i
r,i
traconazole,ketoconazol e,nefazodone,
nelf
inavir
, r
itonavi
r,saquinavir
,teli
thromy cin,or
vori
conazol e↑ levelsandt heriskoft oxi
city;avoi
d
concomi tantuse(ifneedt ouse, ↓ docet axel doseby
50%) .

DOSAGE
I
V:(Adul
ts):Br
eastcancer—60–100mg/ m2ev ery3wk;
Br
eastcanceradj
uvantther
apy—75mg/ m2ev ery3wkfor
6cycl
es(wit
hdoxorubici
nandcy cl
ophosphamide);

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1262
Non–smal l-
cel
ll
ungcancer —75mg/ m2ev ery3wk( al
one
orwi thplati
num);Prostatecancer—75mg/ m2ev ery3wk
(withoral pr
edni
sone) ;Squamouscellheadandneck
cancer —75mg/ m2ev ery3wkf or3–4cycles(wit
h
cisplati
nandf l
uorouracil
);Gastr
icadenocarci
noma-75
mg/ m2ev ery3wk( withcispl
ati
nandf l
uorouraci
l
).

AVAI
LABI
LITY
Inj
ecti
onconcent
rat
e10mg/ mL, 20mg/
mL, 40mg/
mL;
Lyophi
li
zedpowderfori
nject
ion20mg/vi
al,
80mg/vi
al;

PATI
ENTTEACHI
NG
Inst
ructpatienttoreportsymptomsof
hypersensit
ivi
tyreactions(t
roubl
ebr eathi
ng;sudden
swell
ingoff ace,l
ips,tongue,t
hroat;tr
ouble
swallowing;hiv
es;rash; r
ednessalloverbody)to
healt
hcar eprofessionalimmediatel
y.

Adv i
sepatienttonoti
f yhealthcarepr of
essionalif
fever>101°F;chil
l
s;sor et hr
oat;si
gnsofi nf
ect i
on;
bleedinggums; brui
sing; petechi
ae;orbloodi nuri
ne,
stool,oremesisoccur .Cautionpati
entt oav oi
d
crowdsandper sonswi thknowni nfecti
ons.Instr
uct
patienttousesofttoot hbrushandel ect
ricrazor.

Pat
ientshoul
dbecaut
ionednott
odr
inkal
cohol
i
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1263
 bev
eragesort
akepr
oduct
scont
aini
ngaspi
ri
nor
NSAIDs.

Fat
igueisaf
requentsideeffectofdocet
axel
.Adv
ise
pat
ientt
hatf
requentrestperiodsandpaci
ngof
act
ivi
ti
esmaymi ni
mizef at
igue.

Instructpat
ienttonoti
fyhealthcareprofessionalif
signsoff l
uidret
enti
on( peri
pheraledemai nthelower
extremiti
es,weightgai
n, dyspnea)
,abdomi nalpain,
yell
owski n,weakness,paresthesi
a,gaitdi
sturbances,
swel l
ingofthefeet,
orjointormuscl eachesoccur .

Inst
ructpat
ienttoinspectoral
mucosaforredness
andulcerat
ion.Ifmouthsoresoccur
,advi
sepatientto
usespongebr ushandr i
nsemouthwithwaterafter
eati
nganddr inki
ng.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Discusswi t
hpatientthepossibil
i
tyofhai
rloss.
Compl etehairl
ossusuallybeginsaft
er1or2
treatmentsandisr ev
ersi
bleafterdi
scont
inuati
onof
therapy.Expl
orecopingstrat
egies.

I
nst
ructpat
ientnott
orecei
veanyv
acci
nat
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1264
 wi
thoutadv
iceofheal
thcar
epr
ofessi
onal
.

Advisefemalepat
ient
stouseeffect
ivecontracepti
on
duri
ngt her
apyandtonoti
fyheal
thcareprofessionalif
pregnancyispl
annedorsuspect
edorifbreastfeeding.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Docosanol
I
NDI
CATI
ONS
Treatmentofr
ecur
rentor
al-
faci
alher
pessi
mpl
ex(
col
d
sores,f
everbl
i
ster
s).

ACTI
ON
Preventsherpessi mplexvirusfrom enter
ingcell
sby
preventi
ngviralpar t
icl
esfrom fusi
ngwi thcel
lmembr anes.
Therapeuti
cEf f
ect s:Reducedhealingtime.Decreased
durati
onofsy mpt oms( pain,burni
ng,it
ching,
tingl
ing)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odocosanol
orany
ot
hercomponentsoft
hefor
mul at
ion(benzy
lal
cohol
,
miner
aloi
l
,propy
lenegl
ycol
,orsucrose)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1265
UseCaut
iousl
yin:
Chi
l
dren<12y
r(saf
etynot
est
abl
i
shed)
;Pr
egnancy(
useonl
yifcl
ear
lyneeded)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Al
ll
ocal
react
ionsoccur
edatsi
teofappl
i
cat
ion
Local
:acne,
ski
n,i
tchi
ng,
rash.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topi
cal
:(Adul
tsandChi
ldr
en≥12yr
):Appl
ysmallamount
5ti
mesdailyt
osoresonli
psorf
aceunti
lheal
ed.

AVAI
LABI
LITY
Cr
eam 10%cr
eam i
n2gt
ubesOTC;

PATI
ENTTEACHI
NG
I
nstructpati
entoncor rectt
echniqueforapplicati
onof
docosanol.Cream shouldonlybeappliedtolipsand
face.Avoi
dappl icat
ioninorneareyes.Emphasi ze
handwashingf oll
owingappli
cati
on,ortouching
l
esionstoprev entspreadtoothersortootherar eas
ofthebody .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1266
 Advisepat
ientt
obeginappl
icat
ionofdocosanolat
thefir
stsi
gnofasoreorbli
ster
,evenduring
prodromalst
age(f
eel
ingofburning,
itchi
ng,t
ingl
i
ng,
ornumbness).

I
nf orm pati
entthatdocosanol reducesdur ationof
herpessi mplexvir
usepisodesbutdoesnotcur evir
us.
Viralreacti
vati
onmaybet r
igger edbyultraviolet
radiat
ionorsunexposur e,stress,fati
gue, chill
ing,and
windbur n.Otherpossi
bletr
igger sincl
udef ev er,inj
ury,
menst ruati
on,dentalwork,andi nfect
iousdi seases
(cold,fl
u).

Advi
sepati
entt
onoti
fyheal
thcar
eprofessional
if
l
esi
onsdonotheali
n14day sori
ffev
er,rash,or
swol
lenl
ymphnodesoccur.

Docusat
esodi
um
I
NDI
CATI
ONS
PO: Treatmentofconsti
pationassoci
atedwit
hdry,har
d
stoolsanddecreasedintesti
nalmotil
i
ty.Pr
event
ionof
opioid-i
nducedconsti
pation.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1267
Senna'smetaboli
teact sasalocali
rri
tantonthecol
on
st
imulati
ngperist
alsis.Docusatepromotesincor
por
ati
on
ofwaterintost
ool,result
inginsoft
erfecalmass.
Therapeuti
cEff
ects: Soft
eningandpassageofstool
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Abdomi
nal
pai
n,
nausea,orvomi
ti
ng,
especi
all
ywhenassoci
atedwi t
hfev
er
orothersi
gnsofanacut
eabdomen;Concomitantuseof
mineraloi
l.

UseCaut
iousl
yin:
Excessi
veorpr
olongedusemayl
ead
t
odependence,fl
uidandelect
rol
ytei
mbal
ance,
and
v
itami
nandmi neraldef
ici
enci
es.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
FandE: el
ectrol
yteimbal
ances,dehydrati
on.GI:
abdomi nalcramps,nausea,vomit
ing,diar
rhea.Der
m:
rashes.GU: uri
nediscol
orat
ion.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
PO:
(Adul
tsandChi
l
dren>12y
r):
2tabl
etsoncedai
l
yat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1268
bedt
ime;
maxi
mum 4t
abl
etst
wicedai
l
y.
PO:(
Chi
l
dren6–12yr
):1tabl
etoncedai
l
yatbedt
ime;
maxi
mum:2tabl
etst
wicedail
y.
PO:(
Chi
l
dren2–6yr
):1/
2tabl
etoncedai
l
yatbedt
ime;
maxi
mum:1tabl
ett
wicedai
ly
.

AVAI
LABI
LITY
Tabl
etsDocusat
esodi
um 50mgandsennosi
des8.
6
mgOTC;

PATI
ENTTEACHI
NG
Advi
sepati
entsthatlaxat
ivesshouldbeusedonl
yfor
shor
t-
ter
mt her
apy .Long-
termtherapymaycause
el
ectr
oly
tei
mbal anceanddependence.

Encouragepat ient
st ouseot herf
ormsofbowel
regul
ati
on, suchasi ncreasi
ngbulkinthediet
,
i
ncreasingf l
uidintake(6–8f ul
lgl
asses/day)
,and
i
ncreasingmobi l
it
y.Normal bowelhabit
sarev ar
iabl
e
andmayv aryfrom 3t i
mes/dayt o3ti
mes/ wk.

Instr
uctpati
ent
swithcar
diacdi
seaset
oavoid
strai
ningdur
ingbowelmovementsVal
sal
va
maneuv er
).

Adv
isepat
ientnott
ousel
axat
iveswhenabdomi
nal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1269
 pai
n,nausea,
vomi
ti
ng,
orf
everi
spr
esent
.

Advi
sepati
entnott
otakewi
thi
n2hrofot
her
l
axat
ives.

Dof
eti
l
ide
I
NDI
CATI
ONS
Maint enanceofnormal sinusrhythm (delayint
imeto
recurrenceofatri
alf
ibril
lation/
atri
alfl
utter[AF/
AFl]
)in
patientswithAF/AFllastingmor ethanoneweek, andwho
havebeenconv er
tedtonor malsi
nusr hythm.Conversi
on
ofAFandAFl tonormal si nusrhyt
hm.

ACTI
ON
Blockscardiacionchannelsresponsiblefort
ransportof
potassium.Increasesmonophasi cactionpotent
ial
duration.I
ncreaseseff
ecti
ver ef
ractoryperi
od.
TherapeuticEffect
s:Prev
entionofrecur r
entAF/AFl.
Conv ersi
onofAF/ AFlt
onor mal si
nusr hyt
hm.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Congeni
tal
or
acqui
redpr
olongedQTsyndr
omes;Baseli
neQTintervalor
QTcof>440msec( 500msecinpat
ient
swi t
hvent
ricular

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1270
conducti
onabnor mali
ties);Creati
nineclearance<20
mL/ min;Concurrentuseofv erapamil,
cimet i
dine,
ketoconazole,i
traconazole,tri
met hopr
im, megestrol,
prochlor
perazine,hydrochlorothi
azide,orotherQT-inter
val
prolongi
ngdr ugs;Lactati
on: Avoiduse.

UseCaut
iousl
yin:
Under
lyi
ngel
ect
rol
yteabnor
mal
i
ties
(↑r i
skofseriousarrhythmias; correctpri
ort
o
administr
ati
on);Cr
eat i
nineclear ance20–60mL/ min
(dose↓ recommended) ;Severehepat i
cimpair
ment;OB:
Useonl ywhenpotentialbenefitt opati
entoutweighs
potent
ialri
sktofetus;Pedi:Safet ynotestabl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:di
zziness,headache.CV:VENTRI
CULAR
ARRHYTHMI AS(incl
udingtor
sadedepoint
es)
,chestpai
n,
QTint
ervalprol
ongation.

I
NTERACTI
ONS
Drug-Dr ug:Hy drochl
orot hi
azide,verapamil,ci
met i
dine,
ketoconazol e,it
raconazol e,t
rimethoprim,megest rol,
and
prochlor perazine↑ dof eti
li
delevelsandt heriskofQT
i
nterval prolongat ionwi tharr
hy t
hmi as;concurrentuseis
contraindicat ed.QTi ntervalprol
ongi ngdrugsmay↑ t he
ri
skofQTi nter v
al pr
olongat i
onwi tharrhythmias;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1271
concur rentusecont r
aindi cat ed.Ami l
or ide, metformin,and
triamt erenemayal so↑ dof eti
li
delev els; usewi thcaution.
Inhi bit
or soft hecy t ochr omeP450sy st em ( CYP4503A4
i
soenzy me)i ncl udi ngmacr ol i
deant i
-infect i
v es,azole
ant ifungal s,prot easei nhi bit
orant i
retrov irals,SSRI
ant idepr essant s, ami odar one, dil
ti
azem, nefazodone,
qui nine, andzaf irl
ukastmayal so↑ bl oodl ev el
sandt he
riskofar rhy t
hmi asandconcur rentuseshoul dbe
under takenwi t
hcaut ion.Shoul dnotbeusedconcur r
ent l
y
wi thot hercl assIorI IIant iarrhythmicsduet o↑ r i
skof
ar rhythmi as.Hy pokal emi aorhy pomagnesemi afrom
pot assi um- deplet ingdi uretics↑ t her iskofar rhythmias;
cor rectabnor mal i
tiespr iort oadmi nistrat i
on.Concur rent
useofdi goxinmay↑ t her iskofar rhythmi as.
Drug-
Food:
Grapef
rui
tjui
cemay↑ l
evel
s;av
oidconcur
rent
use.

DOSAGE
Dosingshoul
dbeadj
ustedaccor
dingt
orenal
funct
ionand
assessmentofQTi
nter
val
PO:(Adults)
:Star
ti
ngdose—500mcgtwicedail
y;
maintenancedose—250mcgtwicedai
l
y(nottoexceed
500mcgt wi
cedail
y).
Renal
Impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1272
PO:(Adults):
CCr40–60mL/ minStar
ti
ngdose—250mcg
twi
cedai l
y;maint
enancedose—125mcgtwicedai
ly
;CCr
20–40mL/ minStar
ti
ngdose—125mcgt wi
cedail
y;
maintenancedose—125mcgoncedai l
y.

AVAI
LABI
LITY
Capsul
es125mcg,
250mcg,
500mcg;

PATI
ENT TEACHI
NG
I
nstructpat
ientt
otakemedicati
onasdirect
ed,ev
enif
feel
i
ngwel l
.Ifadosei
smi ssed,donotdoubl
enext
dose.Takenextdoseatusualti
me.

Patientshoul
dreadt hepati
entpackagei nsertpriort
o
i
niti
ationofther
apyandr ereaditeacht i
met herapyis
renewed.Emphasi zetheneedf orcompliancewi th
therapy,t
hepotentialf
ordruginteract
ions,andt he
needf orperi
odi
cmoni tor
ingtomi nimizetheriskof
seri
ousar r
hythmias.

I
nstr
uctpati
entorfami
lymemberonhowt ot
ake
pul
se.Advi
sepati
enttoreportchangesi
npul
ser
ate
orr
hythm t
ohealthcar
eprofessional
.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1273
 medi
cat
ioni
sknown.

Advi
sepatientt
oinf
orm heal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort ot
reat
mentorsurgery
.

Instr
uctpati
entt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultheal
thcar e
professi
onalbef
oretaki
ngotherRx, OTC,orherbal
products.

Advisepat i
enttoconsul thealthcarepr ofessi onal
i
mmedi atel
yiftheyfai
nt ,becomedi zzy,orhav efast
heartbeats.I
fhealthcarepr ofessional i
sunav ail
able
i
nstructpat i
enttogotonear esthospi t
al emer gency
department ,t
akeremai ningdof eti
li
decapsul es,and
showt hem tot hedoctorornur se.Ifsy mptoms
associatedwi t
halter
edel ectrolyt
ebal ancesuchas
excessiveorpr ol
ongeddi arrhea,sweat i
ng, or
vomi t
ingorlossofappet i
teort hir
stoccurheal thcare
professionalshoul
dalsobenot if
iedimmedi ately.

Emphasi
zetheimport
anceofr
out
inef
oll
ow-
upexams
tomonit
orprogr
ess.

Dol
aset
ron

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1274
I
NDI
CATI
ONS
PO:Preventi
onofnauseaandv omiti
ngassociat
edwi
th
emetogenicchemother
apy.PO: I
V:Prevent
ionof
post
operati
venausea/vomit
ing.Treat
mentof
post
operati
venausea/vomit
ing.

ACTI
ON
Blockstheef fectsofser otoni
natreceptorsi
tes(select
ive
antagonist)l
ocat edinv agalnervet
erminalsandinthe
chemor eceptortriggerzonei ntheCNS.Therapeutic
Effect
s: Decreasedi ncidenceandseverit
yof
nausea/ vomitingassoci at
edwi t
hemet ogeni
c
chemot herapyorsur gery.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Prev
ent
ionof
nauseaandv omiti
ngassoci
atedwit
hemetogeni
c
chemotherapy(forI
Vonly)(
may↑ riskofQTint
erv
al
prol
ongati
on);Congenit
all
ongQTsy ndr
ome;Complet
e
heartbl
ock(unlesspacemakerpr
esent)
.

UseCaut
iousl
yin:
Pat
ient
swi
thr
iskf
act
orsf
orcar
diac
conduct
ionabnormal
it
ies(
under
lyi
ngstruct
ural
hear
t
di
sease,si
cksinussy
ndrome,at
ri
alfi
bri
l
lati
onandsl
ow

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1275
ventri
cularrate,my ocardi
alischemia,concur r
entβ-blocker,
verapami l
,dil
tiazem, orant
iarrhyt
hmict herapy);
Hy pokalemia,hy pomagenesemi a,concurrenttherapywi t
h
diuret
ics,orhistoryofcumul ativ
ehigh-doseant hracycl
ine
therapy;Geri:
↑r i
skforcardiacconductionabnor malit
ies;
OB: Lactati
on: Safetynotestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache(increasedincancerpat i
ents),dizzi
ness,
fati
gue, sy
ncope.CV: CARDIACARREST, TORSADEDE
POINTES, VENTRI CULARARRHYTHMI AS, bradycardi
a,
heartblock,hy
pertension,hypot
ension,PRi nterval
prol
ongat i
on,QRSi nterv
alprol
ongation,QTi nter
v al
prol
ongat i
on,t
achy cardi
a.GI:di
arr
hea, dyspepsia.GU:
oli
guria.Derm:pruri
tus.Misc:chi
ll
s,fever,pain.

I
NTERACTI
ONS
Drug-Drug:Concur rentdiureti
corant i
arrhythmicther
apy
orcumul ati
vehigh-doseant hr
acy cl
inet herapymay↑ r i
sk
ofconduct i
onabnor malit
ies.Bloodl evelsandef f
ectsof
hydrodolast
eronar e↑ byat enololandci meti
dine.Blood
l
evelsandef fectsofhy drodolaset r
onar e↓ byr i
fampin.
↑r i
skofQTi ntervalprolongationwi thot heragents
causingQTi ntervalprolongation.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1276
DOSAGE
Pr
event
ionofChemot
her
apy
-InducedNausea/
Vomi
ti
ng
PO:(Adul
ts):
100mggi
venwi
thi
n1hrbef
ore
chemother
apy.
PO:(Chi
ldr
en2–16yr):
1.8mg/kggi
venwi
thi
n1hrbef
ore
chemother
apy(nott
oexceed100mg).
Pr
event
ion/
Treat
mentofPost
oper
ati
veNausea/
Vomi
ti
ng
PO:(Adul
ts)
:Pr
event
ion-
100mggi
venwi
thi
n2hrbef
ore
sur
gery.
PO:
(Childr
en2–16yr):
Prev
ent
ion-
1.2mg/ kg(
upt
o100
mg/dose)giv
enwit
hin2hrbef
oresurger
y.
IV:(
Adult
s):Preventi
onortr
eatment-
12.5mggiven15
minbeforecessati
onofanesthesi
a(prev
ent
ion)oras
soonasnauseaorv omit
ingbegins(t
reat
ment).
IV:(
Childr
en2–16y r):Pr
ev ent
ionort
reatment
-0.35
mg/kg( upto12.5mg)gi ven15mi nbefor
ecessationof
anesthesi
a(prev
ention)orassoonasnauseaorv omit
ing
begins(tr
eat
ment )
.

AVAI
LABI
LITY
Tabl
ets50mg,
100mg;
Inj
ect
ion12.
5mg/
0.625mL(
in

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1277
si
ngl
e-usev
ial
sandCar
puj
ect
s),
20mg/
mL;

PATI
ENTTEACHI
NG
Advisepat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
if
nauseaorvomiti
ngoccur
s.

Advisepat
ientt
onot i
fyheal
thcareprof
essional
symptomsofabnor malheartrat
eorrhyt
hm (raci
ng
heartbeat
,shor
tnessofbreath,di
zzi
ness,f
ainti
ng)
occur.

Donepezi
l
I
ndi
cat
ions
Fort
het
reat
mentofmi
l
dtomoder
ateAl
zhei
mer
’sdi
sease.

ACTI
ON
Inhi
bit
sacetylchol
i
nest
erasethusi mprov i
ngcholiner
gic
functi
onbymaki ngmoreacetylcholi
neav ai
labl
e.
Therapeuti
cEf f
ect
s:Maytempor ari
lylessensomeoft he
dement i
aassociat
edwit
hAl zheimer’sdisease.Enhances
cognit
ion.Doesnotcur
et hedisease.

Av
ail
abi
l
ity

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1278
TABLETand5mg,
10mg23mgPl
ain.

DOSAGE
Or
al
Adult
-Ini
ti
all
y5mgdai
lyi
ntheev
ening.I
fnecessar
y
i
ncreaseupto10mgoncedai
l
yafter4-
6wee
Ext
endedr
eleaset
abl
et-oncedai
l
y(23mg/day
).once
dai
ly(
23mg/day )
.
Maxi
mum dose-10mgdai
l
y.

Cont
rai
ndi
cat
ions
Hyper
sensi
ti
vi
ty,
severehepat
icandr
enalimpair
ment ,
pr
egnancyl
actat
ion,
notrecommendedforchi
ldren.

I
NTERACTI
ONS
Drug-Drug:Exagger atesmuscl er elaxati
onf r
om
succinyl
chol i
ne.Inter
fereswi ththeact ionof
antichol
inergics.↑ cholinergiceffectsofbet hanechol
.
May↑ r i
skofGIbl eedingf rom NSAI Ds.Quinidi
neand
ketoconazole↓ met abolism ofdonepezi l.Rifampin,
carbamazepi ne,dexamet hasone, phenobarbital
,and
pheny t
oininducet heenzy mesthatmet aboli
zedonepezil
andmay↓ i tsef f
ects.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1279
Drug-Nat
ural
Product:
Jimsonweedandscopol
i
amay
antagoni
zechol
iner
giceff
ect
s.

Pr
ecaut
ions
Mechani calint
est i
nalobstructi
onorper i
toni
tis,Recent
i
nt est
inalorbladdersur gery,br
onchialasthmaorCOPD,
arrhyt
hmi as,bradycardia,r
ecentMIandhy potension,
vagotonia,epil
epsy ,hypert
hyroidi
sm, par
kinsonism,
moder aterenal orhepaticimpairmentorpept icul
cer,si
ck
sinussy ndrome.

Adv
erseEf
fect
s
Nausea,
vomi ti
ng,diarrhoea,fati
gue,insomni a,muscle
cramps,
bradycardia,conv ul
sions,gastroint
estinal
,
haemorr
hage, hepati
tis,uri
naryincontinence,infl
uenza,
prur
it
us,i
ncreasedlivertransami nases.

PATI
ENTTEACHI
NG
Emphasizetheimpor t
anceoft aki
ngdonepezildai
l
y,
asdir
ected.Misseddosesshoul dbeskippedand
regul
arscheduleretur
nedt othefol
lowi
ngday .Donot
takemorethanpr escr
ibed;hi
gherdosesdonot
i
ncreaseeffect
sbutmayi ncr
easesideeffect
s.

I
nfor
m pat
ient
/fami
l
ythati
tmayt
akeweeksbef
ore

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1280
 i
mpr
ovementi
nbasel
i
nebehav
iori
sobser
ved.

Cauti
onpat
ientandcar
egi
vert
hatdonepezi
lmay
causedi
zzi
ness.

Advi
sepat i
entandcaregivertonotif
yhealt
hcare
pr
ofessionali
fnausea,vomiting,di
arr
hea,orchanges
i
ncolorofstooloccurorifnewsy mptomsoccuror
pr
eviouslynot
edsy mptomsi ncreaseinsever
it
y.

Instr
uctpati
entt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultheal
thcar e
professi
onalbef
oretaki
ngotherRx, OTC,orherbal
products.

Advi
sepat i
entandcar
egivertonot
if
yheal
thcar
e
prof
essionalofmedi
cati
onr egi
menbef
oretr
eat
ment
orsurgery
.

Emphasi
zetheimportanceoffoll
ow-upexamsto
monit
orprogr
ess;at
ypicalanti
psychoti
csmaybe
usedasanadjunctt
oimpr ovebehavior
.

St
orage
Storepr
otect
edfr
om moi
stur
e,atat
emper
atur
enot
exceedi
ng25⁰C.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1281
Dopami
ne
I
ndi
cat
ions
Car
diogenicshocki
nmy ocardi
ali
nfar
cti
onorcar
diac
sur
gery;acut
eheartf
ail
ure.

ACTI
ON
Smal l
doses( 0.
5–3mcg/ kg/ min)stimul atedopami nergi
c
receptors,pr oducingrenal vasodilat
ion.Lar gerdoses
(2–10mcg/ kg/mi n)sti
mul atedopami nergicandbet a1-
adrenergicr eceptors,producingcar diacst i
mul at
ionand
renalvasodi lati
on.Dosesgr eaterthan10mcg/ kg/mi n
sti
mul at
eal pha- adrenergicrecept or
sandmaycauser enal
vasoconst r
ict i
on.Ther apeuticEffects:Increasedcar di
ac
output,i
ncr easedBP, andi mprov edrenal bloodflow.

Av
ail
abi
l
ity
I
NJECTI
ON5ml v
ial
(40mg/
ml)
,5and10ml
ampoul
e
(
200mg/5ml
).

DOSGE
I
ntr
avenousi
nfusi
on
Adul
t-Car
diogeni
cshock:
int
olar
gev
ein,
ini
ti
all
y2t
o5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1282
µg/kg/mi n;
gr aduall
yi ncreasedby5t o10µg/kg/mi n
accordingtobl oodpr essure,cardi
acoutputandurine
output;seri
ouslyillpatientsupto20t o50µg/ kg/min.By
i
ntravenousr outeinit
ially1t o5µg/kg/mincanbe
i
ncreasedgr aduallyto5t o10µg/ kg/
min.max20t o50
µg/kg/mi ni
nser iouspat ients.

Cont
rai
ndi
cat
ions
Hypersensi
ti
v i
ty;
tachyarr
hyt
hmias,v
ent
ri
cul
arf
ibr
il
lat
ion,
i
schaemi cheartdisease;
pheochr
omocyt
oma;
hyper
thyroi
dism.

I
NTERACTI
ONS
Drug-Drug:Usewi thMAOi nhibi
t or
s,ergotal
kaloi
ds
(er
gotami ne),doxapr am, orsomeant i
depressantsr
esul
ts
i
nsev erehy pertension.Usewi t
hI Vphenytoinmaycause
hypotensionandbr ady cardia.Usewi thgeneral
anestheti
csmayr esultinar rhythmias.Betablocker
smay
antagonizecar diacef f
ects.

Pr
ecaut
ions
Corr
ecthypovol
aemiabefor
eandmaint
ainbloodvolume
duri
ngtr
eatment;cor
recthy
poxi
a;hy
percapni
aand
metabol
icaci
dosisbefor
eoratsameti
measst art
ing
tr
eatment;
lowdoseinshockduetomyocardi
alinf
arct
ion;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1283
hi
storyofper i
pher alvasculardisease(i
ncreasedriskof
i
schaemiaofext remities)
;elderly
;int
eract
ionshistor
yof
ather
osclerosis;Raynaud’sdi sease;di
abeti
cendocar di
ti
s;
di
spropotionateincreasei ndiastoli
cpressure;pr
egnancy
l
actati
on;paedi at
r i
cs.Dopami nemustbedi l
utedbeforei.
v.
administ
ration.

Adv
erseEf
fect
s
Nauseaandv omi t
ing; peri
pheralvasoconstr
ict
ion;
hypotensi
onwi t
hdi zziness;f
ainti
ng;fl
ushing;t
achycar
dia;
ectopicbeat
s;palpitati
ons;anginalpain;
headache;
dyspnoea;hypert
ensi onparti
cularl
yinov er
dosage.

PATI
ENTTEACHI
NG
Expl
aintopati
entt
herati
onal
eforinst
it
uti
ngthi
s
medicat
ionandtheneedforf
requentmonit
ori
ng.

Advi
sepatienttoi
nfor
m nurseimmediat
elyi
fchest
pai
n;dy
spnea; numbness,
tingl
i
ng,orbur
ningof
ext
remi
tiesoccurs.

I
nstr
uctpati
enttoi
nfor
m nur
seimmediat
elyofpai
nor
di
scomfortatt
hesit
eofadmini
str
ati
on.

St
orage
St
orei
nanai
rt
ightcont
ainerpr
otect
edf
rom l
i
ght
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1284
Dor
ipenem
I
NDI
CATI
ONS
Inf
ect
ionscausedbysuscepti
bleorgani
smsincluding:
compli
catedi
ntra-
abdominali
nfect
ions,
complicated
uri
nar
ytracti
nfect
ions,
incl
udi
ngpy el
onephr
it
is.

ACTI
ON
Inhibitsbact eri
al cellwall for
mat ion.Therapeut i
cEffect
s:
Bact erici
dal acti
onagai nstsuscept i
blebact eri
a.Spectr
um:
Act iv
eagai nstt hef oll
owi nggr am- negativ
eor ganisms:
Aci netobacterbaumani i,Escherichiacoli,Klebsi
ell
a
pneumoni ae, Proteusmi rabil
is,andPseudomonas
aer uginosa.Al soact iveagai nstthef oll
owi nggram-
posi t
iveor ganisms: Streptococcusconst ellat
usandS.
i
nt ermedi us.Anaer obicspect rum includesBact eroi
des
caccae, B.fr
agi l
is,B.thet aiotaomi cr
on, B.
uni f
ormis,B.
vulgatus, andPept ostrept ococcusmi cr
os.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odor
ipenem,
other
car
bapenems,
orbet
a-l
act
ams.

UseCaut
iousl
yin:
Ger
i:Consi
derage-
rel
ated↓ i
nrenal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1285
funct
ionwhenchoosi
ngdose;Lactati
on:Usecaut
iousl
y
duri
nglact
ati
on;Pedi
:Saf
etynotestabl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:headache.GI :PSEUDOMEMBRANOUSCOLI TIS,
di
arrhea,nausea,↑l i
verenzymes.Hemat :anemi a.Local
:
phl
ebiti
s.Misc: al
l
ergicreact
ionsincl
udinganaphy l
axis,
i
nfecti
onwi t
hr esi
stantorganisms,superi
nfect
ion.

I
NTERACTI
ONS
Drug-Drug:
May↓ ser
um v
alpr
oat
elev
els(
↑ri
skof
seizur
es).
Drug-
NaturalProduct
:May↓ bloodlevelsofvalpr
oicaci
d;
thi
smayr esulti
nlossofsei
zur
econt r
ol.Probeneci
d↓
renal
clear
anceand↑ bl oodl
evels.

DOSAGE
I
V:(
Adul
ts)
:500mgev
ery8hr
.
Renal
Impai
rment
I
V:(Adul
ts)
:CCr30–50mL/
mi n—250mgev
ery8hr
;CCr
>10–<30mL/min—250mgevery12hr
.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1286
Powderf
ori
nject
ion(
requi
resr
econst
it
uti
on)500mg/
vial
;

PATI
ENTTEACHI
NG
Adv i
sepat ienttoreportthesignsofsuperinfecti
on
(black,furryovergr
owt hont hetongue;vaginali
tchi
ng
ordi scharge;l
ooseorf oul-smell
ingstool
s)and
aller
gy .Consulthealt
hcar eprofessi
onalbef or
e
treatingwithantidi
arrheals.

Caut i
onpat ienttonoti
fyheal
thcareprofessi
onalif
rash,orf everanddiarr
heaoccur,especi
allyi
fstool
containsbl ood,pus,ormucus.Advisepati
entnotto
treatdiarrheawithoutconsul
ti
nghealthcare
professional.Mayoccurupt oseveralweeksafter
discontinuationofmedicati
on.

Dor
naseal
fa
I
NDI
CATI
ONS
Adjunctmanagement(
wit
hst
andar
dther
apy
)ofcy
sti
c
fi
brosis.

ACTI
ON
Breaksdownexcessiv
eamount
sofDNAfoundinthe
respi
rat
oryt
ractofpati
ent
swi
thcy
sti
cfi
brosi
s.Excessi
ve

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1287
DNAcont r
ibutestoincr
easedsputum viscosityandriskof
i
nfecti
on.Therapeuti
cEffect
s:Decreasedinfectionrates
andrequi
rementf orpar
enteral
anti
-inf
ectives.Improved
pul
monar yfuncti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odor
naseal
faor
Chi
neseHamst
erOv
arycel
lpr
oduct
s.

UseCaut
iousl
yin:
Chi
l
dren(
inci
denceofcough,
rhi
nit
is,
andrashisi
ncr
eased)
;Pr
egnancyorl
act
ati
on(
saf
etynot
est
abli
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT: sorethroat,
v oi
ceal
ter
ati
on,conj
uncti
vit
is,
hoarseness,rhini
ti
s.Resp:
cough,dyspnea.CV:chestpai
n.
Derm: rash.Misc:fever
.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
I
nhal
n:(
Adul
tsandChi
l
dren)
:2.
5mg1–2t
imesdai
l
y.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1288
Sol
uti
onf
ori
nhal
ati
on1mg/
mLi
n2.
5-mLsi
ngl
e-use
ampul
es;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakedornasealf
aexact l
yas
di
rected,atthesametimeeachday .I
fadosei s
missed,takeassoonaspossi bl
e;ifalmostti
mef or
nextdose,skipmisseddoseandr eturnt
or egul
ar
dosingschedule.

Emphasizetheimportanceofcont
inui
ngother
medicat
ionsforcyst
icfibr
osi
sduri
ngdornasealf
a
ther
apy.

Instructpatientinpr opert echniquefordor nasealfa

admi nistr
ati
on.Washhandsbef oreassembl ing
nebul i
zerandaddi ngmedi cati
on.Useacl eansur f
ace
toassembl enebul izer,andkeepnebul i
zerpar tscl
ean
accor dingtomanuf acturer’
sdirecti
ons.Openampul e
andempt yintonebul izercup;useal lofmedi cati
onin
ampul e.Admi ni
steraccor di
ngt omanuf acturer’
s
directi
ons.Cl eannebul izerfol
l
owi nguse.

Doxapr
am
I
NDI
CATI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1289
Usedincarefull
yselectedshort -
term si
tuati
onswi t
hot her
support
ivemeasur estotreatpost operati
vepat i
entswi th
respi
rat
orydepressionsecondar yt oanesthesia.
Prevent
ionofacut ehypercapneadur i
ngadmi nist
rationof
oxygentopatientswithacut erespirat
oryinsuffi
ciencydue
toCOPD( short-
term only
—l essthan2hr )
.Treatmentof
mild-
to-
moder aterespi
ratoryandCNSdepr essionduet o
drugoverdosage.

ACTI
ON
Inlowdoses, stimulatesbreathingbyact iv
at i
ngcaroti
d
receptors.Largerdosesdi r
ectlystimulatether espi
rat
ory
centerinmedul laaswel lasproducegener ali
zedCNS
sti
mul ati
on.Ther apeuti
cEffects:Transientincreasein
ti
dal vol
ume, smal li
ncreaseinr espi
rat
or yrate.
Oxy genati
onisnoti ncreased.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pat
ient
son
mechanicalventil
ation;Headtrauma; Sei
zures;Flai
lchest
;
Pul
monar yembol ism; Pneumothorax;Pulmonar yfi
brosi
s;
Acuteasthma; Extremedy spnea;Cardiovascul
aror
cer
ebrovasculardisease;Pedi:Newbor ns(containsbenzyl
al
cohol)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1290
UseCaut
iousl
yin:
Pat
ient
swi
thahi
stor
yofast
hmaor
arr
hythmi
as;Hy perthyr
oidi
sm; Pheochromocytoma;
Seri
ousuncorrectedmet abol
icdisorder
s;Hepati
correnal
i
mpai r
ment;OB: Lactat
ion:Pedi:Pr
egnancy,l
actat
ion,
or
chi
ldr
en<12y r(safetynotestabli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, apprehensi on, disorientati
on, di
zziness,
headache.EENT: gagging, my dr i
asis.Resp:
LARYNGOSPASM, bronchospasm, cough, dyspnea,
hiccups,reboundhy pov entil
at i
on, t
achy pnea.CV:
arrhyt
hmi as,changesi nhear tr ate,chestpai n,
hypertension,T-wav einv ersion.GI :diarrhea, nausea,
vomi t
ing.GU: albumi nuria,per i
neal/ genitalbur ni
ng
sensat i
on,spont aneousv oiding,urinaryr etent i
on.Der m:
fl
ushing, prur
it
us, sweat ing.Hemat : hemol ysis.Local :
phlebiti
s.MS: involuntarymov ement ,muscl espast ici
ty,
skeletalmusclehy peractivi
ty.Neur o:gener alizedclonus,
paresthesia,positivebilateralBabi nski’ssign.Mi sc:fever
.

I
NTERACTI
ONS
Drug-Drug:Pr essoreff
ect
smaybe↑ byconcur r
entuseof
adrenergicami nes(sympathomimet i
cs)orMAOinhi
bitor
s.
Maymaskr esidualeff
ect
sofskeletalmuscl
erel
axants.
Ini
ti
alreleaseofepi nephr
inecausedbydoxapram may

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1291
causeadv er
sereacti
onswhengi venconcur r
entlywi
th
anest heti
csknownt osensit
izethemy ocardium t ot
he
effectsofcathecholamines(wait10mi nutesf ol
lowi
ng
discont i
nuati
onofanthestheti
ctoadmi nisterdoxapram)
.
Concur rentusewithaminophy l
li
neortheophy lli
nemay
wor senskeletal
muscl ehyperacti
vi
ty.

DOSAGE
Respi
rat
oryDepr
essi
onf
oll
owi
ngAnest
hesi
a
IV:(Adult
s):I
nt er
mitt
entinjecti
on–0.5–1mg/ kg( nott
o
exceed1. 5mg/ kg)i
nit
ial
ly;mayr epeatevery5mint oa
totalof2mg/ kg.Inf
usion—Init
iateat5mg/ mi
nunt i
l
responseisobt ai
ned;t
hendecr easeinfusionrat
et o1–3
mg/ mi n(
tot
al dosebyinfusionmet hodshouldnotexceed
4mg/ kg)
.

Dr
ug-
InducedCNSDepr
essi
on
IV:(Adults):Int ermit
tenti
nj ecti
on–Gi vepri
mi ngdoseof
1–2mg/ kg; repeati n5mi n.Mayr epeatat1–2–hr
i
nter val
sunt i
l sustainedconsci ousnessort ot
alof3g/ 24
hrgi v
en.I nf
usi on—Gi veprimi ngdoseof1–2mg/ kgby
directinj
ection; repeatin5mi n.I
fnor esponse,conti
nue
suppor ti
vemeasur esfor1–2hrandr epeatprimingdose.
Ifsomer espiratorystimulationoccurs,ini
ti
ateinfusi
onat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1292
1–3mg/ min.Disconti
nueinfusi
onifpat
ientbegi
nsto
awakenorafter2hr.Infusi
onmayber estart
ed(al
ongwit
h
pri
mingdose)af t
errestint
erval
of30–120mi n.Donot
exceed3g/24hr .
Acut
eHy
per
capneaSecondar
ytoCOPD
I
V:(Adul
ts)
:Inf
usi
on–1–2mg/ mi
n(upto3mg/
min)
.
Shoul
dnotbeusedformor
ethan2hr.

AVAI
LABI
LITY
I
nject
ion20mg/
mL;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
onotifyheal
thcar
epr
ofessi
onal
i
mmediatel
yifshor
tnessofbreat
hworsens.

Doxazosi
n
I
NDI
CATI
ONS
Hypert
ensi
on( al
oneorwi
thotheragents)(i
mmedi
ate-
r
eleaseonl
y).Symptomat
icbenignprostat
ichy
per
plasi
a
(
BPH) .

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1293
Dil
atesbothart
eriesandv einsbyblocki
ngpostsynapt
ic
al
pha1- adr
ener
gicreceptors.Ther
apeuti
cEffects:
LoweringofBP.Increasedur i
nefl
owanddecr eased
symptomsofBPH.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Gast
roi
ntest
inal
nar
rowing(XLonly)
;Geri:AppearsonBeer sli
st.Geri
atr
ic
pat
ient
sareat↑ riskforhypotension;OB:Lactati
on:Pedi
:
Saf
etynotestabl
i
shed; Pati
entsundergoingcataract
sur
gery(↑r i
skofint
raoperati
vefloppyir
issyndrome) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,headache, depr ession,drowsiness, fati
gue,
nervousness, weakness.EENT: abnor mal vi
sion,blur red
vi
sion,conj uncti
vit
is,epistaxis,i
ntraoperativ
ef l
oppyi r
is
syndrome.Resp: dy spnea.CV: fir
st-doseor t
host atic
hypotension, arr
hythmi as,chestpai n,edema, palpit ati
ons.
GI:abdomi naldi
scomf or
t,const i
pation,diar
rhea, dr y
mout h,fl
at ul
ence,nausea, v
omi ti
ng.GU: ↓l i
bido, sexual
dysfunction.Derm: f l
ushing,rash,ur t
icar
ia.MS: art hralgi
a,
art
hriti
s,gout ,myalgia.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1294
Drug-Drug:↑riskofhypotensionwithsil
denafil
,tadalaf
il
,
vardenafi
l,
otherant
ihyper
tensives,ni
tr
ates,oracut e
i
ngest i
onofalcohol
.NSAIDs, sympathomimet i
cs, or
estrogensmay↓ effectsofant i
hypert
ensiv
et herapy.

DOSAGE
Hy
per
tensi
on
PO:(Adults):—1mgoncedai ly,maybegr adual
ly↑ at2-
wkintervalst
o2–16mg/ day;
incidenceofpostural
hypotensiongreat
ly↑ atdoses>4mg/ day.BPH—1mg
oncedaily,maybegraduall
yincreasedto8mg/ day
.

Beni
gnPr
ost
ati
cHy
per
plasi
a
PO:(Adul
ts):
Immediater
elease—1mgoncedaily,
maybe
↑ ever
y1–2wkupt o8mg/ day;
Ext
endedr
elease—4mg
oncedail
y(wi
thbr
eakfast
),maybe↑ in3–4wkt o8
mg/day.

AVAI
LABI
LITY
Tabl
ets1mg,2mg,
4mg,
8mg;
Ext
ended-
rel
easet
abl
ets
4mg, 8mg;

PATI
ENTTEACHI
NG
Emphasi
zet
hei
mpor
tanceofcont
inui
ngt
otaket
his

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1295
 medicati
on,eveniffeel
i
ngwell
.Inst
ructpati
entt
o
t
akemedi cati
onatthesamet i
meeachday .Take
misseddosesassoonasr emember edunlessal
most
t
imef ornextdose.Donotdoubledoses.

Maycausedr owsi
nessordizziness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heracti
vit
iesrequir
ingal
ert
ness
unti
lresponsetomedicat
ionisknown.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
decr
easeor
thostat
ichy
pot
ensi
on.

Instr
uctpati
enttonot ifyhealthcareprofessional of
allRxorOTCmedi cations,vit
ami ns,orherbal
productsbeingtakenandt oav oidconcurrentuseof
alcoholorOTCmedi cationsandher balproduct s,
especial
lycoldpreparations,withoutconsul t
ing
healthcareprof
essional ,especial
lycough, cold,or
all
ergyremedies.

Emphasizet
heimportanceoffol
low-
upv
isi
tst
o
det
ermineef
fect
ivenessofther
apy.

Hy per
tension:
Instr
uctpati
entandfami l
yonpr oper
techni
quef orBPmoni t
ori
ng.Adv i
sethem tocheck
BPatl eastweeklyandreportsi
gnif
icantchanges.

Encouragepat
ientt
ocomplywi
thaddit
ional
i
nterv
entionsf
orhyper
tensi
on(
weightr
educti
on,
low-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1296
 sodi
um diet
,smoki
ngcessat
ion,moderat
ionof
al
coholconsumpti
on,
regul
arexerci
se,
andstress
management).

Doxepi
n
I
NDI
CATI
ONS
PO:Managementof :Depr
essi
on,Insomnia.Topi
cal
:Short
-
ter
m contr
olofprur
it
usassociat
edwi t
h:Eczematous
dermati
ti
s,Li
chensimplexchr
onicus.Unl
abeledUses:PO:
Managementof:Chronicpai
nsyndromes, Pr
uri
tus,
Dermati
ti
s,Anxi
ety.

ACTI
ON
PO:Pr eventsthereupt akeofnor epi nephri
neandser otoni
n
bypresy napti
cneur ons; r
esul t
antaccumul ati
onof
neurotransmitter
spot entiatesthei racti
vi
ty.Also
possessessi gnif
icantant i
chol i
nergicproper t
ies.Topi
cal:
Anti
prur i
ti
cactionduet oant i
histami ni
cproper t
ies.
Therapeut i
cEffects:PO: Reliefofdepr ession.Decreased
anxi
ety .Sedati
onandi mpr ovedsl eepmai ntenance.
Topical:Decreasedpr urit
us.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1297
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentuseof
MAOi nhibit
ors;Somepr oductscontainbisul
fit
esand
shouldbeav oidedinpati
entswi t
hknowni nt
olerance;
Unt r
eat edangle-cl
osur
egl aucoma;Sev er
eur i
nary
retention;Peri
odi mmediatelyaft
ermy ocardi
al i
nfarct
ion;
historyofQTcpr ol
ongati
on, hear
tfai
lure,car
diac
arrhythmi a.

UseCaut
iousl
yin:
Ger
i:Pr
e-exi
sti
ngcar
diov
ascul
ar
disease( ↑r i
skofadv erser eact ions);Prost atic
enlargement( mor esuscept i
blet our inaryr etention);
Seizur es;OB:Useonl yifpot ent i
al mat ernal benef i
t
outwei ghsr i
skst ofetus; Lact ation:Usedur i
ngl actat
ion
mayr esultinneonat alsedat ion.Recommenddi scontinue
drugorbot tl
e-feed;Pedi :May↑ r i
skofsui cide
attempt /ideati
onespeci all
ydur i
ngdoseear l
yt r
eat mentor
doseadj ustment ;
riskmaybegr eaterinchi ldrenor
adolescent s;safetynotest ablished; Ger i
: Appear son
Beer sl i
standisassoci atedwi t
h↑ f allsrisksecondar yto
antichol i
nergi
candsedat iv
eef fects.Ger iatri
cpat i
ents
shoul dhav einiti
aldosage↓.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:fat
igue,sedation,
agi
tat
ion,
conf
usion,hall
uci
nat
ions.
EENT:bl
ur r
edv i
sion,↑int
raocul
arpr
essure.CV:
hypot
ension,ar
rhy t
hmias,
ECGabnormalit
ies.GI
:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1298
consti
pati
on, drymouth,↑ appeti
te,hepati
tis,nausea,
paral
yti
cileus,weightgain.GU:↓libido,ur
inaryretent
ion.
Derm:phot osensi
tiv
ity
,rash.Hemat:blooddy scrasi
as.
Misc:hypersensit
ivi
tyreacti
ons.

I
NTERACTI
ONS
Appl
ytobot
htopi
cal
andor
aluse
Drug-Dr ug: Doxepi nismet abolizedi nt hel i
verbyt he
cytochr omeP4502D6enzy meandi tsact i
onmaybe
affectedbydr ugst hatcompet ef ormet abolism byt his
enzy mei ncl udingot herant i
depr essant s, phenot hiazines,
carbamazepi ne, propafenone, fl
ecai ni
de; whenused
concur rent l
y ,
dosage↓ ofoneort heot herorbot hmaybe
necessar y.Concur rentuseofot herdr ugst hati nhi bitthe
activi
tyoft heenzy me, includingci metidine, qui nidine,
ami odar one, andr i
tonav i
r,mayr esultin↑ ef f
ect sof
doxepi n.Maycausehy pot ension, tachy cardia, and
potent i
allyf atal r
eact i
onswhenusedwi thMAOi nhibitors
(avoidconcur rentuse—di scont i
nue2wkpr i
ort odoxepi n).
Concur rentusewi t
hSSRI antidepr essant smayr esultin↑
serotoni nsy ndr omeandshoul dbeav oided( fluoxet i
ne
shoul dbest opped5wkbef ore).Concur r
entusewi th
clonidinemayr esultinhy pertensiv ecr i
sisandshoul dbe
avoided.Concur r
entusewi t
hl evodopamayr esul tin
delayed/ ↓ absor pti
onofl evodopaorhy pertensi on.Bl ood

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1299
l
evelsandef fect smaybe↓ byr i
famycins.↑ CNS
depressionwi thot herCNSdepr essantsincludingalcohol,
anti
histami nes, clonidi
ne,opioi
danalgesics, and
sedativ
e/ hypnot ics.Barbit
uratesmayal terbloodlev el
s
andef f
ect s.Adr ener gi
candant i
choli
nergi csideeffect
s
maybe↑ wi t
hot heragentshavingthesepr operti
es.
Phenothiazinesorhor monalcontracepti
v es↑ levelsand
maycauset oxicity.Smokingmay↑ met abolism andalter
eff
ects.
Drug-
NaturalProduct
:Concomit
antuseofkava-
kav
a,
val
eri
an,orchamomi l
ecan↑ CNSdepr essi
on.↑
anti
chol
i
ner gi
ceffect
swithji
msonweedandscopoli
a.

DOSAGE
PO: (
Adults):Antidepressant/
antianxiet
y—25mg3t imes
dail
y,maybe↑ asneeded( upto150mg/ dayin
outpati
entsor300mg/ dayininpati
ents;somepat ients
mayr equi
reonl y25–50mg/ day).Oncest abil
ized,
entir
e
dail
ydosemaybegi venatbedt i
me.Ant ipruri
ti
c—10mgat
bedti
mei nit
ial
ly,maybe↑ upt o25mg.I nsomnia—6mg
atbedtime(shouldnotexceed3mg/ dayifconcurrentl
y
taki
ngcimet i
dine).
PO:(Geri
atr
icPat
ient
s):
Ant
idepressant
—25–50mg/day
i
nit
ial
ly
,maybe↑ asneeded.Insomnia—3mgatbedti
me,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1300
maybe↑ asneededto6mgatbedtime(
shoul
dnot
exceed3mg/
dayifconcur
rent
lyt
aki
ngci
meti
dine)
.
Topi
cal
:(Adul
ts)
:Apply4ti
mesdai
ly(wai
t3–4hr
bet
weenappli
cat
ions)f
orupto8days.

AVAI
LABI
LITY
Capsul
es10mg, 25mg,50mg,
75mg, 100mg,150mg;
Tabl
ets(Sil
enor)3mg,6mg;Or
alconcent
rat
e10mg/mL;
Topi
calcream 5%;

PATI
ENTTEACHI
NG
I
nfor
m pati
entt
hatsyst
emi
csi
deef
fect
smayoccur
wi
thoralort
opi
caluse.

Maycausedr owsinessandblurr
edvisi
on.Cauti
on
pat
ienttoavoiddriv
ingandotheracti
vi
ti
esrequir
ing
al
ertnessunt
ilresponsetot
hemedi cati
onisknown.

Orthostati
chy pot
ensi
on, sedati
on,andconf usi
onare
commondur i
ngearl
yther apy
,especial
l
yi ngeri
atr
ic
patient
s.Pr ot
ectpati
entfrom fal
ls.I
nsti
tutefal
l
precautions.Advi
sepatienttochangeposi t
ions
sl
owl y.

Advi
sepati
enttoav
oidal
coholorot
herCNS
depr
essantdr
ugsduri
ngandforatl
east3–7day
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1301
 af
tert
her
apyhasbeendi
scont
inued.

Inform patientthatdoxepinmycauseget ti
ngupout
ofbedwhi lenotbei ngfull
yawakeanddoanact i
vit
y
thatpat i
entsdoesnotknowt heyaredoing.Thenext
mor ning,theymaynotr emembert hattheydid
any t
hingdur ingthenight.Mayoccurmor efrequent
ly
withal coholorot hersedati
ves.Advisepati
entto
notif
yheal thcar eprofessi
onalift
hisoccurs.

Instructpatienttonot i
fyheal t
hcar eprofessi
onalif
urinaryretenti
onoccur sori fdrymout hor
const i
pati
onper si
sts.Sugar l
esscandyorgum may
diminishdr ymout h,andani ncreaseinflui
dintakeor
bulkmaypr ev entconstipati
on.I fsymptomsper si
st,
doser eductionordi scontinuationmaybenecessar y.
Consul thealthcarepr ofessional i
fdrymout hpersi
sts
formor ethan2wk.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

PO:Instructpati
enttotakemedi cati
onasdi rect
ed.
Takemi sseddosesassoonaspossi bleunless
al
mostt i
mef ornextdose;ifregimeni sasi
ngledose
atbedtime, donottakeinthemor ni
ngbecauseof
si
deef fects.Advi
sepatientthatdrugef f
ect
smaynot
benoticedf oratl
east2wk.Abr uptdiscont
inuat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1302
 maycausenausea, vomi ti
ng, di
arrhea, headache,
tr
oublesl eepingwi t
hv ivi
ddr eams, and
i
rri
tabil
ity.
Adv i
sepatient,
fami ly
,andcar egiversto
l
ookf orsui cidal
it
y,especiall
ydur ingear lytherapyor
dosechanges.Not i
fyhealthcar epr ofessional
i
mmedi atelyifthoughtsaboutsui cideordy ing,
att
empt st ocommi tsuici
de, neworwor sedepr essi
on
oranxiety,agi t
ati
onorr estl
essness, panicat t
acks,
i
nsomni a, neworwor seirr
itabil
it
y ,aggressiveness,
acti
ngondanger ousi mpulses,mani a,orother
changesi nmoodorbehav i
orori fsy mpt omsof
serot
oni nsy ndromeoccur .

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

I
nfor
m pat
ientt
hatur
inemayt
urnbl
ue-
greeni
ncol
or.

I
nform pat
ientofneedtomonitordi
etar
yi nt
ake.
I
ncreaseinappeti
teispossi
bleandmayl eadto
undesi
redweightgain.

Ther
apyfordepressi
onisusuall
yprolonged.
Emphasi
zetheimportanceoffoll
ow-upexamsto
monit
oreff
ecti
venessandsideeffects.

Topi
cal
:Inst
ructpat
ientt
oappl
yathi
nfi
lm of
medi
cati
onexactlyasdir
ect
ed;
donotusemore

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1303
 medicati
onthandi
rected,
appl
ytoalar
gerareathan
dir
ected,
usemoreof t
enthandi
rect
ed,orusel
onger
than8day s.

I
nform patientthattopi
cal
prepar ati
onmaycause
burni
ng, st
ingi
ng, swell
i
ng,i
ncreasedi t
chi
ng,or
worseningofeczema.Not if
yheal thcarepr
ofessi
onal
i
fthesesy mpt omsbecomebot hersome.

Cauti
onpati
entnott
ouseocclusi
vedr
essi
ngs;
may
i
ncreasesy
stemicabsor
pti
on.

Advisepati
enttonot if
yhealt
hcar eprofessi
onalif
excessiv
edr owsinessoccurswi t
htopicalappli
cati
on.
Numberofappl icati
onsperday ,amountofcr eam
appli
ed,orareaofappl i
cat
ionmayber educed.May
requir
edisconti
nuationoftherapy.

Doxer
cal
cif
erol
I
NDI
CATI
ONS
Treat
mentofsecondar yhy perparat
hyroi
dism i
npat i
ents
undergoingchronicrenal di
alysis(I
VandPO) .Treatment
ofsecondaryhy perparathyr
oidism i
npatient
swi thStage3
or4chr oni
ckidneydi sease(POonl y).

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1304
Requiresacti
vat i
oni nthel i
vertocr eat
etheact ivef
orm of
vi
tami nD2.Promot estheabsor ptionofcal cium and
decreasesparat hyroi
dhor moneconcent rations.
Therapeuti
cEff ects:Treatmentandpr event i
onof
defi
ciencystat
es, par t
icularl
ybonemani festat i
ons.
I
mpr ovedcalcium andphosphor oushomeost asisi
n
pati
entswithchr onicki dneydisease.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
cal
cemi
a;
Vit
aminDtoxicit
y ;
Lactat
ion:Lact
ati
on;Concur
rentuseof
magnesi
um- containi
ngantaci
dsorothervi
taminD
suppl
ements.

UseCaut
iousl
yin:
Pat
ient
srecei
vi
ngdi
goxi
n;OB:
Saf
ety
notest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Seenprimaril
yasmani
fest
ati
onsoft
oxi
cit
y
(hy
percalcemia)
CNS:dizzi
ness,headache,mal ai
se, somnol ence,
weakness.EENT: conjunct
ivi
ti
s,phot ophobia, r
hinor
rhea.
Resp:dyspnea.CV: edema,arrhythmias, br
ady cardi
a,
hyper
tension.GI:nausea,v
omi ti
ng,anor exi
a, consti
pati
on,
drymouth, ↑liv
erenzy mes,met all
i
ct aste,PANCREATI TIS,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1305
polydi
psia, weightl
oss.GU: albuminuri
a,azot
emia, ↓
l
ibi
do, nocturia,pol
yuri
a.Der m:pruri
tus.FandE:
hypercalcemi a.Metab:hyperther
mia.MS: art
hral
gia,bone
pain,met astati
ccalci
fi
cation,musclepain.

I
NTERACTI
ONS
Drug- Drug: Cholestyrami ne,colestipol,ormi neraloi l↓
absor ptionofv i
tami nDanal ogues.Usewi ththiazide
diureticsmayr esultinhy percalcemi a.Cor t
icost eroids↓
effectivenessofv it
ami nDanal ogues.Usewi t
hdi goxi n↑
ri
skofar rhythmi as.Concur rentuseofmagnesi um-
cont ainingdr ugsmayl eadt ohy permagnesemi a.Cal cium-
cont ainingdr ugsmay↑ r i
skofhy percalcemi a.Concur rent
useofot herVi taminDsuppl ement s(↑r i
skof
hyper calcemi a).Agent sthatinducel i
verenzy mes
(phenobar bit
al,ri
fampi n)andagent st hatinhibi
tl i
v er
enzy mes( atazanav i
r,clari
thromy cin,erythromy cin,
i
ndi nav i
r,itraconazol e,ketoconazol e,nefazodone,
nelfinavir,r i
tonav i
r,saquinavir,
v erapami l
, vori
conazol e)
mayal terr equirement sf ordoxer calci
ferol( moni t
or i
ngof
calcium andphosphor usr ecommended) .

DOSAGE7
PO:(Adul
ts):
Dial
ysi
spat
ient
s—10mcg3ti
mesweekl
y(at
di
aly
sis);
dosemaybeadjust
edby2.
5mcgat8-
wk

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1306
i
nter
valsbasedoni
ntactPTHconcentr
ati
ons(maximum
dose=20mcg3t imesweekly)
.Non-di
aly
sispat
ient
s—1
mcg/day;dosemaybeadjust
edby0.5mcgat2–wk
i
nter
valsbasedoni
ntactPTHconcentr
ati
ons(maximum
dose=3.5mcg/day)
.
I
V: (
Adults):
4mcg3t imesweekl
yattheendofdial
ysi
s;
dosemaybeadj ust
edby1–2mcgat8- wkint
erv
alsbased
onintactPTHconcent
rat
ions(
maximum dose=6mcg3
ti
mesweekl y)
.

AVAI
LABI
LITY
Capsul
es0.
5mcg,
1mcg,
2.5mcg;
Inj
ect
ion2mcg/
mL;

PATI
ENTTEACHI
NG
Advisepati
entt
hatmedi
cat
ionmaybegi
vendur
ing
thei
rdial
ysi
ssessi
on.

Reviewdietmodi ficat
ionswithpati
ent.forfoodshigh
i
ncal ci
um andv i
taminD.Renal pat
ientsmuststil
l
considerrenalfail
uredieti
nfoodsel ecti
on.Healt
h
careprofessionalmayor derconcurrentcal
cium
supplement .

Encour
agepati
entt
ocompl ywi
thdi
etar
y
recommendat
ionsofheal
thcar
eprof
essional
.Expl
ain

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1307
 thatthebestsourceofvi
taminsisawell-
bal
anced
dietwithfoodsf
rom the4basicfoodgroupsandthe
i
mpor tanceofsunli
ghtexposur
e.forf
oodshighin
vit
ami nD.

Pati
entsself
-medi
cati
ngwi t
hv i
taminsuppl
ement
s
shoul
dbecaut i
onednottoexceedRDA.The
eff
ecti
venessofmegadosesf ortr
eatmentofv
ari
ous
medicalcondi
ti
onsisunprovedandmaycauseside
eff
ects.

Advi
sepati
entt
oavoidconcur
rentuseofant
aci
ds
cont
aini
ngmagnesi
um.

Reviewsymptomsofover
doseandinstr
uctpati
entt
o
reportt
heseprompt
lyt
oheal
thcar
epr ofessi
onal
.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
eval
uat
eprogr
ess.

Doxor
ubi
cin
I
ndi
cat
ions
Softti
ssueandbonesarcomas, acuteleukemi a,mali
gnant
l
ymphoma, Hodgki
n'
sdisease,non-Hodgkin'sdisease,
breastcarci
noma,small
-cel
lcarci
nomaofl ungs,
AIDSrel
atedKaposi’
ssarcoma,multipl
emy el
oma, gastr
o-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1308
i
ntesti
nal
tractcarcinoma,bl
addercancer,ov
ari
an
carci
noma,acutemy el
obl
ast
icleukemia,
thyroi
d
carci
noma,neuroblastoma.

ACTI
ON
I
nhibi
tsDNAandRNAsy nthesisbyfor mi
ngacompl ex
wit
hDNA; act
ioni scell
-cycleS-phase–specifi
c.Alsohas
i
mmunosuppr essiveproper t
ies.Therapeuti
cEffects:
Deathofr
apidlyrepli
catingcells,par
ticul
arl
ymal i
gnant
ones.

Av
ail
abi
l
ity
LI
POSOMALinj
ecti
on10ml vi
al(
2mg/
ml)
.INJECTI
ON10
&50mglyophi
l
izedpowder
/vi
al,
2mg/
mlsolut
io

DOSAGE
I
ntrav
enous50-
75mg/ m2bodysur
facear
eabysl
owi
.v
i
nject
ionev
ery3weeks.
AIDS-r
elat
edKaposi
'
ssarcoma:Adul
t:Aspegyl
ated
l
iposome:20mg/ m2bodysur
facear
eainfusedover1hr
onceevery3weeks
Ovar
iancar
cinoma:Adult
:Aspegy
lat
edli
posome:
50
mg/m2BSAi nfusedov
er1hronceever
y4weeks.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1309
Cont
rai
ndi
cat
ions
Knownhypersensi
ti
vi
ty,
car
diacdi
sease,
pregnancy
l
actat
ion,
neonates.

I
NTERACTI
ONS
Drug-Drug: ↑ bonemar rowdepr essi onwi thot her
anti
neopl asti
csorr adiationt her apy.Pedi at ri
cpat i
ent s
whohav erecei vedconcur rentdoxor ubicinand
dactinomy cinhav ean↑ r iskofr ecallpneumoni ti
sat
vari
ablet i
mesf oll
owi ngl ocal r
adi at
iont her apy.May↑
skinreactionsatpr eviousr adiat ionther apysi tes.If
paclit
axel i
sadmi nisteredf irst, clearanceofdoxor ubi
cinis
↓ andt hei ncidenceandsev eri
t yofneut ropeni aand
stomat i
tisare↑ ( problem i sdi mi ni
shedi fdoxor ubicinis
admi ni
steredf ir
st).Hemat ologi ct oxicit
yi s↑ and
prolongedbyconcur rentuseofcy clospor ine;riskofcoma
andsei zuresisal so↑.I nci denceandsev erityof
neutropeniaandt hrombocy topeni aar e↑ byconcur r
ent
progesterone.Phenobar bital may↑ cl ear anceand
decreaseef fectsofdoxor ubi cin.Doxor ubicinmay↓
met aboli
sm and↑ ef fectsofpheny toi
n.St r
ept ozocinmay
↑t hehal f-
lif
eofdoxor ubici n(dosage↓ ofdoxor ubicin
recommended) .May↑ r iskofhemor r
hagi ccy stit
isfrom
cyclophosphami deorhepat i
tisf rom mer capt opurine.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1310
Cardi
actoxi
cit
ymaybe↑ byr adiat
ionther
apyor
cycl
ophosphamide.May↓ ant
ibodyresponset
oli
ve-
vir
us
vacci
nesand↑ r i
skofadv
ersereacti
ons.

Pr
ecaut
ions
Av oi
dextr
avasati
on,moni torECGchanges, ar
rhyt
hmias,
bloodcounts,hy
potensionorcongest i
veheartfai
lur
e,
hepatici
mpairment,i
nteractionLi
posomal andnon-
l
iposomal pr
eparat
ionsar enotint
erchangeable.

Adv
erseEf
fect
s
Infusionr eacti
ons,cardi
otoxi
city,
bonemar row
suppr ession, l
i
verimpair
ment ,nauseaandv omi t
ing,
reversiblealopecia,st
omat i
ti
s,conjunct
ivi
ti
s,keratit
is,
mucosi t
is,discol
ourati
onofbodyf lui
ds,l
ocal ski
n
reactionsandt i
ssuedamage, secondaryleukemi as.

PATI
ENTTEACHI
NG
Instructpati
entt onot if
yhealthcar eprofessi
onal
prompt lyi
ffev er;
sor et hr
oat;signsofinfecti
on;
bleedinggums; bruising;pet
echi ae;bl
oodi nstool
s,
urine,oremesi s;increasedfatigue; dy
spnea;or
orthostati
chy potensionoccur s.Caut i
onpat i
entto
avoidcr owdsandper sonswithknowni nfect
ions.
Instructpati
entt ousesof tt
oothbr ushandelectri
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1311
 razorandtoavoidfal
ls.Caut
ionpati
entnottodrink
alcoholi
cbever
agesort akemedicat
ioncontai
ning
aspiri
norNSAIDs,becausethesemaypr eci
pit
ate
gastri
cbleedi
ng.

I
nst
ructpat
ientt
orepor
tpai
nati
nject
ionsi
te
i
mmediatel
y.

Instructpatienttoinspector almucosaf oreryt

hema
andul cerat
ion.I
fulcerati
onoccur s,adv
isepati
entto
usespongebr ush,ri
nsemout hwi thwateraft
ereating
anddr inki
ng,andconf erwi t
hheal thcar
epr of
essional
i
fmout hpaininter
fereswi theating.Pai
nmayr equi
re
treatmentwi t
hopioidanal gesics.Theriskof
dev elopingstomatiti
si sgreatest5–10day saftera
dose; theusualdurati
oni s3–7day s.

Inst
ructpatienttonot i
fyheal
thcareprofessi
onal
i
mmedi at
elyifirr
egularheart
beat,short
nessofbreat
h,
swell
ingofl owerext r
emiti
es,orskinir
ri
tati
on
(swell
ing,pain,orrednessoffeetorhands)occur
s.

Discussthepossibi
li
tyofhai
rlosswit
hpati
ent
.
Exploremethodsofcoping.Regrowt
husual
lyoccur
s
2–3moaf t
erdiscont
inuat
ionofther
apy.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1312
 Inf
orm pati
entthatmedi
cat
ionmaycauseur
inet
o
appearredfor1–2days.

Instr
uctpati
entt
onoti
fyheal
thcar
eprof
essi
onal
if
skinirr
it
ati
onoccur
satsit
eofprev
iousr
adi
ati
on
therapy.

Advisefamil
yand/orcar
egiver
stot
akepr
ecaut
ions
(i
.e.
,lat
exgloves)i
nhandl
ingbodyf
lui
dsf
oratl
east5
daysposttr
eatment.

Adv i
sepat i
entthatthi
smedi cati
onmayhav e
teratogenicef f
ects.Contracept
ionshoul dbeused
duringandf oratleast4moaf t
ertherapyis
concl uded.Inform pati
entbeforeini
tiati
ngther
apy
thatthismedi cationmaycausei r
reversi
blegonadal
suppr ession.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

St
orage
Storepr otectedfrom l
ight,
inwellclosedcont ainersat
temper aturebet ween(1530⁰C);
Storeint actvial
sof
soluti
onunderr efri
gerat
ionat2-8⁰C.Uset hesolut
ion
preparedusi ngtheli
quidstat
edont hel abel i
mmedi at
ely
afterprepar ati
onbut,inanycase,withint heperiod

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1313
recommendedbyt hemanufact
urerwhenpr eparedand
storedstr
ict
lyinaccor
dancewiththei
nstructi
onsoft he
manuf act
urer.Li
posomalfor
mulati
ons:Refri
gerateat2-
8⁰C.Donotf r
eeze.

Doxy
cycl
i
ne
I
ndi
cat
ions
Respi ratory -
tracti nfections, i
ncl udingpneumoni aand
chroni cbr onchi tis;ur i
nary-tracti nf
ect i
ons; syphilis;
chlamy dia, my copl asmaandr ickett
sia; prostatit
is;
l
y mphogr anul omav ener eum; pelvi
ci nfl
ammat orydisease
(withmet r
oni dazol e);Lymedi sease; brucellosis(wi t
h
ri
fampi cin);lept ospirosis,scr ubt yphusandt r
av eller
s’
diarrhoea; psittacosi s;chol er a; meli
oidosi s;plague;
anthr ax; Qf ever ;Treatmentofacut emal ari
acausedbyP.
mal ariaeandsuscept i
bleP.f alciparum; P.vivaxandP.
ovale( followedbypr imaqui net oeliminat eintrahepatic
forms) ; prophy laxisofmal ar i
af orpregnantwomenand
non- i
mmunei ndi vi
dual satr isk.

ACTI
ON
I
nhibit
sbacteri
alpr
otei
nsy nt
hesisatt
helev
eloft
he30S
bacter
ial
ribosome.Low-doseproduct
susedint
he

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1314
managementofper iodontit
isinhibitcol l
agenase.
Ther apeut icEf f
ect s:Bacteriostaticact i
onagai nst
suscept i
blebact eri
a.Spect rum: Includesact ivi
tyagai nst
somegr am- posi ti
vepat hogens: Baci ll
us
anthr acis(anthrax) ,Clostri
dium per f
ringens, Clostridium
tetani ,
Listeriamonocy togenes, Nocar dia,
Propi onibact eri
um acnes, Actinomy cesi sraeli
i.Act ive
agai nstsomegr am- negat i
vepat hogens: Haemophi lus
i
nf l
uenzae, Legi onellapneumophi l
a,Yer siniaent erocol i
tica,
Yer siniapest is,Neisser i
agonor rhoeae, Nei sseri
a
meni ngiti
dis.Alsoact iveagainstsev eralotherpat hogens,
i
ncl uding: My copl asma, Treponemapal l
idum, Chlamy dia,
Ricket tsi
a, Bor r
eliabur gdorferi
.

Av
ail
abi
l
ity
TABLET/
CAPSULES100and200mg.Sy
RUPSy
RUP25
mg/5ml.

DOSAGE
Or
al
Sever
einfecti
onsincludi
ngr ef
ract
oryur i
nar
ytract
i
nfecti
on:
200mgdai l
y.Earl
ysyphil
is:100mgt wicedai
ly
for14days.Latentsyphil
i
s:200mgt wcedail
yf or28days.
Uncompli
catedgeni t
alChlamydia,nongonococcal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1315
ur
ethr
it
is:
100mgt
wicedai
l
yfor7day
s.
Chi
l
dOnlyifal
ternat
eant
ibact
eri
alcannotbegi
ven5
mg/kgbodyweighti
ntwodivi
deddoses.

Cont
rai
ndi
cat
ions
Pr
egnancychi
l
dren(seenot
esabove);
por
phyri
a;syst
emi
c
l
upuseryt
hematosus;
hyper
sensi
ti
vi
tytot
etr
acycl
ine.

I
NTERACTI
ONS
Drug-Drug:May↑ ef fectofwar fari
n.May↓ ef f
ecti
veness
ofestrogen-containingor alcontr
acepti
ves.Ant aci
ds,
calci
um, ir
on,andmagnesi um forminsolublecompounds
(chel
ates)and↓ absor pti
onoft etr
acycl
ines;thiseff
ectis
l
eastwi thdoxycycline.Chol estyr
amineorcol esti
pol↓
absorpti
onoft etracy cli
nes.Adsor bentantidi
arrheal
smay
↓ absor pt
ion.Barbitur ates,carbamazepine,orpheny t
oin
may↓ ef f
ectiv
eness.
Drug-
Food:Cal
cium i
nfoodsordair
ypr
oduct
s↓
absor
pt i
onbyf
orminginsol
ubl
ecompounds(chel
ates)
;
thi
seffecti
sminimalwit
hdoxycy
cli
ne.

Pr
ecaut
ions
Avoidexposur
etosunl
ightorsunl
ampsphot
osensi
ti
vi
ty
repor
ted;r
enali
mpair
ment ;
hepati
cimpai
rmentl
act
ati
on;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1316
i
nter
actionsint
eract
ions(Appendi
x6a,
6b,
6c6d)
;
pr
edisposit
iontocandidi
asi
s.

Adv
erseEf
fect
s
Gast r
oi ntesti
nal disturbances; anor exia,erythema
(discont i
nuet reat ment ) ;
phot osensi t
ivit
y; hyper sensitivi
ty
reactions; headacheandv isual disturbances;
hepat otoxicit
y ,blooddi sor ders,pancr eatitisandant ibioti
c-
associ atedcol iti
sr eported; staini
ngofgr owi ngt eethand
occasi onal dent al hypopl asia;er y
t hemat ousr ashes,
nasophr yngit
is,si nusitis,increasedbl oodgl ucosel ev el
s,
haemol yti
canaemi a,neut ropenia.

PATI
ENTTEACHI
NG
Inst
ructpatienttotakemedi cati
onar oundtheclock
andt ofini
shthedrugcompl etel
yasdi rect
ed,eveni
f
feel
ingbet t
er.Takemi sseddosesassoonas
possibleunlessiti
salmostt i
mef ornextdose;donot
doubl edoses.Advi
sepat ientthatshari
ngofthis
medi cati
onmaybedanger ous.

Advi
sepatientt oavoidt
aki
ngantaci
ds,cal
cium,
magnesium-cont ai
ningmedi
cat
ions,sodi
um
bi
carbonat
e, andi r
onsuppl
ementswithi
n1–3hrof
or
aldoxycycline.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1317
Instructpatienttonotifyheal
thcareprof
essional
i
mmedi atelyifrash,diarr
hea,abdominal
cramping,
fever,orbloodyst oolsoccurandnott ot
reatwith
antidiar
rhealswi t
houtconsultingheal
thcare
professionals.

Advisef
emalepati
enttouseanonhormonal
method
ofcontr
acept
ionwhil
etaki
ngtet
racy
cli
nesandunt
il
nextmenstr
ualper
iod.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Advisepatienttoreportt
hesignsofsuperinfect
ion
(bl
ack,furryovergr
owthont hetongue,vaginali
tchi
ng
ordischarge,l
ooseorf oul
-smell
ingstool
s).Skinrash,
prur
itus,andurti
cariashouldal
sober eport
ed.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Inst
ructpat
ientt
onotif
yheal
thcar
eprofessi
onali
f
symptomsdonoti mprovewi
thi
naf ewdaysfor
systemicpr
eparati
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1318
 Caut
ionpati
entt
odiscar
dout dat
edordecomposed
doxy
cycl
ine;t
heymaybet oxi
c.

MalariaPr ophylaxis:Advisepat ientt oav oidbei ng

bit
tenbymosqui toesbyusi ngpr otectivemeasur es,
especiallyfr
om duskt odawn( e.g., st
ay ingi n
wellscreenedar eas, usi
ngmosqui tonet s, covering
thebodywi thclothing,andusi nganef fectiveinsect
repell
ant )
.Doxy cycli
nepr ophylaxi sshoul dbegin1- 2
daysbef oret r
avel tothemal ariousar ea, conti
nued
dail
ywhi l
einthemal ari
ousar eaandaf t
erl eavi
ngt he
malariousar ea,shoul dbecont inuedf or4mor e
weekst oavoiddev elopmentofmal aria.Donot
exceed4mo.

St
orage
Stor
eprotect
edfr
om l
i
ghtandmoi
stur
eatat
emper
atur
e
notexceedi
ng30⁰
C.

Dr
onabi
nol
I
NDI
CATI
ONS
Prevent
ionofser
iousnauseaandvomiti
ngfrom cancer
chemotherapywhenothermoreconvent
ionalagent
shave
fai
led.Managementofanorexi
aassoci
atedwithweight

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1319
l
ossi
npat
ient
swi
thAI
DS.

ACTI
ON
Acti
veingredientinmari
juana.Hasawi dev ar
iet
yofCNS
eff
ects,i
ncludinginhi
bit
ionoft hevomitingcontr
ol
mechanism int hemedullaoblongata.Therapeuti
cEff
ects:
Suppressi
onofnauseaandv omiti
ng.Increasedappet
itein
pati
entswithAI DS

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
odr
onabi
nol
,
mari
j
uana,orsesameoil
;Nauseaandv
omi
ti
ngduet
oany
ot
hercauses;
Lactat
ion:
Lact
ation.

UseCaut
iousl
yin:
Pat
ient
swi
thhi
stor
yofsubst
ance
abuse;Cardiovasculardisease(duet opotentialadverse
eff
ects);
Mani a, depr
ession,orschizophrenia(usemay
worsenthesecondi t
ions);Pat
ientstaki
ngsedat i
ves,
hypnoti
cs,orot herpsychoactivedrugs(i
ncr easedr i
skof
adverseeffects);Geri
:↑r iskofadv er
seef f
ect s;OB:Pedi:
Safet
yandef f
icacynotest abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
anxiety,
concent
rat
iondiff
icul
ty,
confusi
on,di
zzi
ness,
dr
owsiness,
moodchange, abnormalthi
nki
ng,depr
essi
on,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1320
di
sor i
entation,hall
ucinations, headache, impaired
j
udgment ,memor ylapse, paranoi a.EENT: drymout h.CV:
pal
pitati
ons, syncope, tachy cardia.GI:abdomi nalpain,
nausea, vomi t
ing.Derm: faci alfl
ushing.Neur o:ataxia,
paresthesia.Mi sc:physical dependence, psy chol
ogical
dependence( highdosesorpr olongedt herapy).

I
NTERACTI
ONS
Drug-Drug: Addit
iveCNSdepr essionwi t
halcohol ,
anti
histami nes,
bar bitur
at es,benzodiazepines, at
ropi
ne,
scopolami ne,l
it
hium, buspi r
one, musclerelaxants,opi
oid
analgesics,tri
cyclicantidepressant s,and
sedative/hypnotics.Incr easedr i
skoft achycardiawith
amphet ami ne,atropine, scopolami ne,cocaine,
sympat homi metics, antihist
ami nes,and
tri
cycl
icantidepressant s.Mayi ncreasebloodl evel
sof
theophy l
li
ne.
Drug-
Nat uralProduct:Increasedr i
skoftachy
cardi
awith
caff
eine-contai
ningher bs( cola
nut,
guarana,mat e,
tea,
cof f
ee) .Concomit
antuseof
kava,
valerian,
skull
cap,chamomi le,
orhopscanincr
ease
CNSdepr essi
on.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1321
PO:(Adul ts):Anti
emet i
c—5mg/ m21–3hrpr iorto
chemot herapy ;
mayr epeatevery2–4hraf ter
chemot herapyt oatotalof4–6doses/ day.If5mg/ m2
doseisi neffect
iveandnosi gnif
icantadversereacti
ons
haveoccur red,dosagemaybei ncreasedby2. 5mg/ m2to
amaxi mum of15mg/ m2/dose.Appetit
est i
mul ant
—2.5
mgt wicedai lyi
niti
all
y;maybegr aduall
yincreasedas
needed( upt o20mg/ day)
.Reducedoset o2.5mg/ dayin
theeveni ngoratbedt i
mei funabletotol
erate5mg/ day
dose.

AVAI
LABI
LITY
Gel
ati
ncapsul
es2.
5mg,
5mg,
10mg;

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakedronabi
nolexactl
yasdirect
ed.
Takemi sseddosesassoonaspossi blebutnotif
almosttimefornextdose;donotdoubledoses.Signs
ofoverdose(moodchanges, conf
usion,hal
luci
nati
ons,
depressi
on,nerv
ousness,fastorpoundingheart
beat)
mayoccurwi thi
ncreaseddoses.

Advisepati
enttocal
lforassi
stancewhenambul ati
ng,
becausethisdrugmaycausedi zzi
ness,dr
owsiness,
andimpairedjudgmentandcoor di
nati
on.Avoi
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1322
 driv
ingorotheract
ivi
ti
esrequi
ri
ngal
ert
nessunt
il
responsetothedrugisknown.

I
nstr
uctpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Caut
ionpat
ientt
oavoidtaki
ngalcoholorot
herCNS
depr
essant
sduri
ngdronabinol
therapy
.

Advi
sepat i
entandfamilytousegeneralmeasur est
o
decreasenausea(begi
nwi t
hsipsofliquidsandsmall,
nongreasymeals;pr
ovideoralhy
giene;remov e
noxi
ousst i
mulifr
om envir
onment).

Dr
onedar
one
I
NDI
CATI
ONS
Reducest heriskofhospital
i
zationinpati
entswith
paroxysmal orpersi
stentatr
ialfi
bri
ll
ati
on(AF)oratri
al
fl
utter(AFL)
, whohav ehadar ecentepi
sodeofAF/ AFL
andhav eothercardiovascul
arriskfact
orsandare
current
lyinsinusrhythm orplantobecardiover
ted.

ACTI
ON
Hassever
alanti
arr
hyt
hmicpropert
ies;pr
olongsPRand
QTcint
erv
als.Ther
apeut
icEf
fects:Suppr
essionofAF/
AFL.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1323
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Cl
assI
Vhear
tfai
l
ureorCl
assI
I–I
II
hear tfail
ur ewithrecentdecompensat ionrequiring
hospi tali
zation;Per manentAF; Second-ort hir
d-degree
atrioventricular(AV)bl ockorsi cksi nussy ndrome( unless
apacemakeri spresent )
;Heartr ate<50bpm; Concur r
ent
useofst rongCYP3Ai nhibit
orsordr ugs/her balproducts
thatpr olongt heQTi nterval
;QTci nt erval≥500ms;
Concur r
entuseofCl assIorI I
Iant iarr
hy t
hmi csincludi
ng
ami odar one, fl
ecainide,propafenone, qui
nidine,
disopy rami de,dofetili
deandsot alol;mustbedi sconti
nued
priortot reatment ;Sev er
ehepat i
ci mpai r
ment ;OB: May
causef etalharm; Lact at
ion:Avoi duse.

UseCaut
iousl
yin:
New/
wor
seni
nghear
tfai
l
ure;
Hypokalemiaorhy pomagnesemia(may↑ r iskof
ar
rhythmias);Mi
ldormoder atehepatici
mpai r
ment;OB:
Womenwi thchi
ldbeari
ngpotenti
al;cont
racepti
onshould
beused; Pedi
:Safeyandeffecti
venessnotestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: weakness.CV:HF,QTcpr ol
ongation.GI:
HEPATOTOXI CI
TY,abdominalpain,
diarrhea,nausea,
tast
e
abnormalit
y,vomit
ing.GU:↑ serum creati
nine.Derm:
photosensi
tiv
ity
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1324
I
NTERACTI
ONS
Drug- Drug: Dr onedar onei smet abol izedbyCYP3Aandi sa
moder atei nhi bi torofCYP3AandCYP2D6enzy me
syst ems; int eract i
onsmayoccurwi thot herdr ugst hatar e
subst ratesf ororar emet abol izedbyt hesessy stems.
Dronedar oneal soi nhi bitsP- gp, whi chcanr esultin↑
absor ptionofcer taindr ugs.Concur rentuseofst rong
CYP3Ai nhibi tor si ncl udingket oconazol e, itr
aconazol e,
vor i
conazol e, cy clospor i
ne, telithromy ci
n, clari
thromy cin,
nef azodone, andr i
t onav irordr ugst hatpr olongt heQT
i
nt ervalincl udi ngphenot hiazineant ipsychot i
cs,tricyclic
ant i
depr essant s, someor almacr ol i
deant ibiot
icsand
otherCl assIandI IIant iarrhy t
hmi cs↑ r i
skofser ious
adv ersecar diov ascul arr eact i
onsandshoul dbeav oided.
Concur r
entuseofCYP3A4i nducer sincludi ngrifampi n,
phenobar bit al,car bamazepi ne, orpheny toin↓ bl ood
l
ev elsandef fect ivenessandshoul dbeav oided.↑ di goxin
l
ev elsandt her iskoft oxicity( discont inueor↓ doseby
50%bef oret reat mentandmoni torcar efully).May↑
dabi gatranandwar farinlev elsandt her i
skofbl eedi ng.
Av oidconcur rentuseofot herant iarrhythmi cs,includi ng
ami odar one, flecai nide, propaf enone, quinidine,
disopy rami de, dof et i
li
de, andsot alol duet o↑ r iskof
adv ersecar diov ascul arr eact i
ons; discont inuepr iort o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1325
dronedar onet her apy( concurr
entusei scont r
aindicated).
Concur rentuseofcal cium channel blocker s↑ r iskof
adv ersecar diovascul arr eacti
ons( initiateatlowerdose
andi ncreaseonl yaf terECGev aluation) .Concur r
entuseof
betabl ocker s↑ r iskofbr adycardia( init
iateatlowerdose
andi ncreaseonl yaf terECGev aluation) .Mayal so↑ l evel
s
andef f
ect softricycli
cant i
depressant s,andsel ecti
v e
serotoni nreupt akei nhi bi
tors(SSRIs) .May↑ l evelsand
ri
skoft oxicit
yofsomeHMG- CoAr educt aseinhibitors
(stati
ns) ,seer ecommendat i
onsf orspeci fi
cagent s.
Concur rentusewi thCYP3Asubst ratesi ncluding
sir
ol i
musandt acr oli
musmay↑ r iskofser iousadv erse
reactions; moni torandadj ustdosagecar ef
ull
y.
Dr
ug-
Natural
Product:St
.John’
swor t↓ bl
oodl
evel
sand
may↓ ef
fecti
veness;
avoidconcur
rentuse.
Drug-
Food:Grapef
rui
tjui
cemay↑ level
sandt
her
iskof
toxi
cit
y;av
oidconcur
renti
ngest
ion.

DOSAGE
PO:
(Adul
ts)
:400mgt
wicedai
l
y.

AVAI
LABI
LITY
Tabl
ets400mg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1326
PATI
ENTTEACHI
NG
Instr
uctpat i
enttotakedr onedaroneasdi rected.Do
notstoptakingdr onedar one,eveniffeeli
ngbet t
er
withoutconsul t
ingheal thcareprofessi
onal .I
fadose
i
smi ssed, omitandt akenextdoseatr egul ar
ly
scheduledt i
me; donotdoubl edose.Adv isepat i
entt
o
readMedi cati
onGui debef or
estarti
ngt herapyand
witheachRxr efi
ll
;ther emaybenewi nformat ion.

Adv
isepat
ientt
oav
oidgr
apef
rui
tjui
cedur
ingt
her
apy
.

Advisepati
entt
onotif
yhealt
hcareprof
essionali
f
si
gnsandsy mptomsofheartfai
l
ure(weightgai
n,
dependentedema,i
ncreasi
ngshort
nessofbreath)or
hepati
cinj
uryoccur
.

Instr
uctpati
entt
onot i
fyheal
thcarepr of
essional
of
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultwithhealt
hcare
professi
onalbef
oretaki
ngothermedi cati
ons,
especial
lySt
.John'swort.

Maybet eratogeni
c.Cauti
onfemalepat i
entsof
chil
dbeari
ngaget ouseeffecti
vecontr
acept i
onduri
ng
therapyandtonot i
fyheal
thcareprof
essionalif
pregnancyisplannedorsuspectedorifbreastf
eedi
ng.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1327
Dr
oper
idol
I
NDI
CATI
ONS
Usedt oproducetr
anquil
izat
ionandasanadj
unctto
generalandregi
onalanesthesi
a.Unl
abel
edUses:Usef
uli
n
decreasi
ngpostoperat
iveorpostpr
ocedur
enauseaand
vomiti
ng.

ACTI
ON
Simil
art
ohaloperidol
—alt
erstheacti
onofdopami neint
he
CNS.Therapeuti
cEf f
ect
s:Tranqui
l
izat
ion.Suppr
essionof
nauseaandv omit
inginsel
ectedsi
tuati
ons.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Knowni
ntol
erance;
Angle-cl
osuregl
aucoma; Bonemarrowdepr essi
on;
CNS
depression;
Severel
iverorcar
diacdisease;
Knownor
suspectedQTpr ol
ongati
on.

UseCaut
iousl
yin:
Ger
iat
ri
c,debi
l
itat
ed,
orsev
erel
yil
l
pati
ents(smal l
erdosesshoul dbeused) ;Di
abeticpat
ients;
Respir
atoryinsuffi
ciency;Prost
ati
chy per
plasi
a;CNS
tumors;Int
estinalobstructi
on;Sei
zures(maylowersei zure
thr
eshold);Severeli
v erdi
sease;Pregnancy,l
actati
on,
and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1328
chi
ldren<2y r(alt
houghsaf etynotestabli
shed,droper
idol
hasbeenuseddur ingcesareansectionwi t
houtrespir
ator
y
depressioninthenewbor n);Age>65y r,concurr
ent
benzodiazepines,volat
il
eanestheti
cs, I
Vopioids(may
i
ncreaser i
skofser iousarr
hythmias);uselowerinit
ial
doses.
ExerciseExtr
emeCaut i
onin:
Patientswi thri
skfactor
sfor
prolongedQTsy ndr
ome( HF,br
ady cardia,di
uret
icuse,
cardiachypert
rophy
,hypokal
emia,hy pomagnesema)or
otherdrugsknownt oprol
ongQTi nterval.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, extrapyramidal r
eactions, abnor malEEG,
anxiety,
confusion, di
zziness, excessivesedat i
on,
hall
ucinati
ons,hy peractiv
ity,
ment aldepr essi on,
nightmares,r
est l
essness, tardivedy skinesia.CV:
ARRHYTHMI AS( includingtorsadesdepoi nt es),QT
prolongati
on.EENT: blurr
edv ision,dryey es.Resp:
bronchospasm, laryngospasm.CV: hy potensi on,
tachycardi
a.GI:const i
pat i
on,dr ymout h.Mi sc: chi
l
ls,
faci
al
sweat i
ng,shi
vering.

I
NTERACTI
ONS
Dr
ug-Drug:Addi
ti
vehy
potensi
onwit
hant
ihy
per
tensi
vesor
ni
tr
ates.Addi
ti
veCNSdepressi
onwit
hot
herCNS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1329
depressants,
includi
ngalcohol,anti
hist
amines,
anti
depressants,opioi
danalgesics,andothersedat
ives.
Concurrentuseofdr ugsknownt opr ol
ongQTi nt
erval(↑
ri
skofpot ent
iall
ylif
e-t
hreat
eningarrhythmias)
.
Drug-
Natur
alPr
oduct:Concomi
tantuseofkav
a-kava,
val
eri
an,
chamomile,
orhopscan↑ CNSdepr essi
on.

DOSAGE
Pr
emedicati
on/
UseWi
thoutPr
emedi
cat
ioni
nDi
agnost
ic
Pr
ocedures
I
V: I
M: (
Adults):2.
5–init
ial
ly
,30–60minpri
ortoinduct
ion
ofanesthesi
a;addit
ionaldosesof1.
25mgI Vmaybe
needed,butshouldbeunder t
akenwi
thcaut
ion.
I
M:I
V:(
Chi
l
dren2–12y
r):
0.1mg/
kgmaxi
mum i
nit
ial
dose.

Adj
unctt
oGener
alAnest
hesi
a
I
V:(Adul
ts):2.
5mgaddi
ti
onaldosesof1.25mgIVmay
beneeded,
butshoul
dbeunder
takenwit
hcauti
on.
I
M:I
V:(
Chi
l
dren2–12y
r):
0.1mg/
kgmaxi
mum i
nit
ial
dose.

Adj
uncti
nRegi
onal
Anest
hesi
a
I
M:I
V:(
Adul
ts)
:2.
5mg.
Ant
iemet
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1330
I
V:(
Adul
ts)
:0.
5–1.
25mgq4hrasneeded(
unl
abel
ed)
.

AVAI
LABI
LITY
I
nject
ion2.
5mg/
mL;

PATI
ENTTEACHI
NG
Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Medi
cati
oncausesdrowsi
ness.Advi
sepati
enttocal
l
f
orassi
stancedur
ingambulat
ionandtr
ansfer
.

Dr
otr
ecogi
n
I
NDI
CATI
ONS
Tor
educemor
tal
i
tyi
nadul
tpat
ient
swi
thsepsi
s.

ACTI
ON
Probabl
yactsbysuppressi
ngwidespr
eadi
nfl
ammat i
on
associ
atedwit
hsepsis.Ther
apeuti
cEff
ect
s:Decr
ease
mortal
it
yduetosepsis.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pat
ient
swi
thahi
gh

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1331
ri
skofbleeding, i
ncl udi
ngt hosewi t
h;Patientsnot
expectedtosur vi
v eduet opr e-exi
stingmedi cal
condit
ion(s);HIV-positi
vepat ientswi t
hCD- 4cellcount
s
≤50/mm3; Chronicdi al
ysi
spat i
ents;Patientswhohav e
undergonebonemar r
ow,lung, li
ver,pancreasorsmal l
bowel t
ransplantation;OB: Lactation.

UseCaut
iousl
yin:
Concur
rentt
her
apeut
ichepar
in
therapy( ≥15uni ts/kg/hr),r
ecent( wi t
hin3day s)
thrombol y t
icther apy ,r
ecent( within7day s)oral
ant i
coagul antsorgl ycoproteinIIb/II
Iainhibit
ors, r
ecent
(within7day s)aspi rintherapy>650mg/ dayorot her
plateletinhibitors;Plateletcount<30, 000x106/ L;
Prot hrombi ntime—I NR>3. 0;Recent( wit
hin6wk)GI
bleeding; Recent( withi
n3mos)i schemi cst r
oke;
Intracranialarteriovenousmal format ionoraneur ysm;
Knownbl eedingdi athesis;Chr onicsev erehepat i
cdi sease;
Anyot herser i
ousbl eedingrisk;Sur gi
cal procedures
(discontinue2hrbef or
e; r
esume12hraf terifhemost asis
i
sachi eved) ;
OB: Pregnancy( useonl yifclearl
yneeded) ;
Pedi :Children( safetynotest ablished) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Hemat
:BLEEDI
NG.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1332
Drug-Drug:Ri
skofseri
ousbl eedi
ngmaybe↑ by
anti
plat
eletagents,
ant
icoagulants,
thrombol
yti
cagent
s,or
otheragentsthatmayaffectcoagulat
ion.
Drug-NaturalPr
oduct:Riskofbl
eedi
ngmaybe↑ byarni
ca,
chamomi le,cl
ove,dongquai,f
ever
few,
gar
li
c,gi
nger
,
gingko,Panaxginseng,andother
s.

DOSAGE
I
V:(
Adul
ts)
:24mcg/
kg/
hrf
or96hr
.

AVAI
LABI
LITY
Powderfori
ntr
avenousi
nfusi
on(
requi
resr
econst
it
uti
on)5
-
mgv i
al,
20-mgv i
al;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofmedi
cat
iont
opat
ient
.

Dut
ast
eri
de
I
NDI
CATI
ONS
Managementoft hesymptomsofbeni
gnprostat
ic
hyper
plasi
a(BPH)inmenwi thanenl
argedpr
ostategl
and
(al
oneorwithtamsulosi
n).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1333
ACTI
ON
I
nhi bit
stheenzy me5- alpha-reduct ase,
whi chi s
responsibleforconv ertingtest osteronetoi tspot ent
met abolit
e5-al
pha- dihy dr
otest osteroneint hepr ostat
e
glandandot hertissues.5- Alpha- dihydr
otest osteroneis
partlyresponsi
bleforpr ostatichy perpl
asia.Ther apeuti
c
Effects:Reducedpr ost atesizewi thassoci ateddecr ease
i
nur i
narysymptoms.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
wit
hother5-al
pha-
reduct
asei
nhi
bit
orsmayoccur
;Women;
Pedi
:Chil
dren.

UseCaut
iousl
yin:
Hepat
ici
mpai
rment
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GU: PROSTATECANCER( hi
gh-grade)
,↓libi
do,
ejacul
ati
on
disorder
s,erect
il
edysfunct
ion.Endo:gy
necomasti
a.Derm:
rash,urt
icar
ia.Misc:
ALLERGICREACTI ONS,
ANGI OEDEMA.

I
NTERACTI
ONS
Dr
ug-
Drug:
Bloodl
evel
sandef
fect
smaybe↑ byr
it
onav
ir,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1334
ket
oconazol
e,verapamil
,di
lt
iazem,
cimeti
dine,
ci
prof
loxaci
n,orotherCYP3A4enzymeinhi
bitor
s.

DOSAGE
PO:(Adul
ts)
:0.
5mgoncedai
l
y(wi
thorwi
thout
tamsul
osi
n).

AVAI
LABI
LITY
Softgelat
incapsul
es0.
5mg;
Incombi
nat
ionwi
th:
tamsulosi
n

PATI
ENTTEACHI
NG
Inst
ructpati
entt otakedutaster
ideatthesameti
me
eachdayasdi rected,evenifsymptomsi mpr
oveor
areunchanged.Takemi sseddosesassoonas
remember edlaterinthedayoromi tdose.Donot
makeupbyt akingdoubledosest henextday.

Cauti
onpatientt
hatshar
ingofdut
ast
eri
demaybe
dangerous.

I
nfor
m pati
entthatthevolumeofejacul
atemaybe
decr
easedduri
ngt her
apybutthatthi
swillnot
i
nter
fer
ewithnormal sexualf
uncti
on.

Adv
isepat
ientt
oav
oiddonat
ingbl
oodf
oratl
east6

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1335
 moafterlastdoseofdutast
eri
detopreventa
pr
egnantf emal
efrom r
eceivi
ngdutast
eri
dethrougha
bl
oodtransfusi
on.

I
nfor
m pat
ientofpot
ent
ial
incr
easer
iski
nhi
gh-
grade
pr
ostat
ecancer.

Cautionpati
entthatdutasteri
deposesapot enti
alri
sk
toamal efetus.Womenwhoar epregnantormay
becomepr egnantshouldav oi
dexposur etosemenof
apartnertaki
ngdutasterideandshouldnothandl e
dutaster
idebecauseoft hepotenti
alforabsorpt
ion.

Emphasizet
heimpor
tanceofper
iodicf
oll
ow-up
examstodeter
minewhetheracl
i
nicalr
esponsehas
occur
red.

D-
Peni
cil
l
ami
ne
I
ndi
cat
ions
Poi
soni
ngbyheavymetal
s,par
ti
cul
arl
yleadandcopper
;
Wil
son’
sdi
sease;
sever
erheumatoi
darthri
ti
s.

Av
ail
abi
l
ity
CAPSULE/
TABLET250mg.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1336
DOSAGE
Or
al(
giv
enbef
oref
ood)
Adul
t-1to2gdail
yint
hreedivi
deddosesstar
ti
ngwith250
mgODandgr adual
lyi
ncreasi
ngtoful
ldoseover2-
3
weeks.
Child20mg/ kg/
dayadmi ni
steredin3-4div
ideddoses,
i
niti
ati
ngt r
eatmentat25%oft hisdoseandgr aduall
y
i
ncreasingtoful
ldoseover2-3weekst omi ni
mi zeadver
se
reacti
ons.Conti
nueti
llbl
oodleadl ev
els<45µg/ dl.

Cont
rai
ndi
cat
ions
Hy per
sensiti
vi
ty;
lupuser y
thematosus;
goldoranti
malar
ial
drug;penici
ll
amineinducedagranul
ocyt
osis;
aplast
ic
anaemi a;t
hrombocy t
openia,pr
egnancy,l
act
ati
on(for
rheumat oi
darthr
it
is).

Pr
ecaut
ions
Monitort
hroughouttreatmentincl
udi
ngbl
oodcountsand
uri
netest
s; r
enalimpairment;i
mmunosuppressi
ve
tr
eatment;avoi
dor al
ironwithi
n2hofadose; hepat
ic
i
mpairment;pregnancy
I
nWi l
son’
sdi
sease,
consi
derwi
thdrawali
fpl
atel
etcount
f
all
sbelow120000/mm3orwhitebloodcel
l
sbelow

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1337
2500/ mm3orif3successi
vefal
lswit
hinreferencerange
(canrestar
tatr
educeddosewhencount sreturnto
refer
encerangebutper
manentwithdrawalnecessaryif
neutropeni
aorthr
ombocy t
openi
arecur).
I
nWi lson’sdi
seasewar npati
enttotel
ldoct
orimmediat
ely
i
fsoret hroat
,fever,
inf
ect
ion,non-
speci
fi
cil
lness,
unexplainedbleedi
ngandbruisi
ng,pur
pura,mouthul
cer
s
orrashesdev elop.

Adv
erseEf
fect
s
Initial
lynausea( lessofapr oblem i ftakenwi thf oodand
onr eti
ring), anorexia, fev er;tastel oss( miner al
suppl ement snotr ecommended) ;blooddi sor ders
i
ncl udingt hrombocy topeni a, neutropenia, agr anul ocytosis
andapl ast icanaemi a; pr oteinuria,rarely
,haemat uria
(wi thdrawi mmedi ately );haemol yti
canaemi a, nephr otic
sy ndrome, l
upuser ythemat osuslikesy ndrome,
my astheni agr avis-l
ikesy ndrome, polymy osit i
s( rarely,
wi thcar diaci nvol v
ement ),der mat omy ositis,mout hulcers,
stomat iti
s, alopecia, br onchi oli
ti
sandpneumoni tis,
pemphi gus, Goodpast uresy ndromeandSt ev ens- Johnson
sy ndromeal sor epor ted; mal eandf emalebr east
enl argementr eported; rashear l
yint r
eatment( usually
allergic-mayneedt empor arywi thdrawal )
, l
at er ashes
(reducedoseorwi thdr awt reatment ).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1338
Ecal
l
ant
ide
I
NDI
CATI
ONS
Treat
mentofacuteat
tacksofher
edi
tar
yangi
oedema
(HAE)inpat
ient
s≥16y r
.

ACTI
ON
Actsasasel ecti
ve,rev
ersibl
einhi
bitorofkal l
ikrein,
therebyinhi
bit
ingit
sactioninini
ti
atingbr adykinin
production,
partofthecascadeofev entsinher edit
ary
angioedema( HAE).Therapeuti
cEffect s:Decreased
severit
yofattackofHAE.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Ger
i:Consi
derage-
rel
ated↓ i
n
hepati
c,renal
,orcar
diacfunct
ion,concomitantdi
seases
orotherdrugther
apy;loweri
nit
ial
dosemaybeconsi der
ed;
Lactat
ion:Usecauti
ously;
OB:Useonl yifcl
earl
yneeded.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,
fat
igue.EENT:nasophar
yngi
ti
s.GI
:
nausea,abdominalpai
n,diar
rhea.Der
m:prur
it
us,r
ash,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1339
urti
cari
a.Local
:inj
ect
ionsi
tereactions.Mi
sc:
hypersensi
ti
vit
yreact
ionsi
ncludinganaphyl
axi
s,al
l
ergi
c
reacti
onsincl
udinganaphy
laxis,
fever.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
Subcut(Adult
s≥16yr)
:30mggi venast
hree10mg
i
njecti
ons;anaddi
ti
onaldoseof30mgmaybegi v
en
withi
n24hr .

AVAI
LABI
LITY
I
nject
ionf
orsubcut
aneoususe10mg/
mL;

PATI
ENTTEACHI
NG
Inst
ructpatientinthepur
poseforecall
anti
deandthe
needf oradmi ni
str
ati
onbyhealthcar
epr of
essi
onal
.
Advisepat i
enttoreadMedicat
ionGuidepriort
o
admi ni
strat
ion.

Cauti
onpati
entoftheriskforanaphy l
act
icr eact
ion
usual
lywi
thi
n1hrofi njecti
on.Adv i
sepatienttonoti
fy
heal
thcar
eprofessionali
mmedi atelyi
fsignsand
symptomsofanaphy l
acticreact
ionsoccur .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1340
 I
nfor
m pati
entt
hati
njecti
onsit
ereacti
ons(local
pr
uri
tus,
eryt
hema,pain,
irr
it
ati
on,
urit
icar
ia,
br ui
sing)
mayoccur.

Instr
uctpati
entt
onot i
fyheal
thcarepr of
essional
of
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultwithhealt
hcare
professi
onalbef
oretaki
ngothermedi cati
ons.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Econazol
e
I
NDI
CATI
ONS
Treatmentofav ari
etyofcut
aneousf ungali
nfect
ions,
i
ncludingcutaneouscandi di
asis,
tineapedi
s(athl
ete’s
foot)
,tineacruri
s( j
ockit
ch),t
ineacorpori
s(ri
ngworm) ,
andtineav er
sicolor.

ACTI
ON
Aff
ectstheper
meabi l
it
yofthefungalcel
lwall
,al
lowi
ng
l
eakageofcell
ularcont
ent
s.Therapeuti
cEffect
s:
Decreasei
nsympt omsoffungalinf
ecti
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1341
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oact
ivei
ngr
edi
ent
s,
addi
ti
ves,
preser
vat
ives,
orbases.

UseCaut
iousl
yin:
Nai
landscal
pinf
ect
ions(
mayr
equi
re
additi
onalsy
stemi
cther
apy
);OB:
Lact
ati
on:
Saf
etynot
establ
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Local:burni
ng,i
tchi
ng,
local
hyper
sensi
ti
vi
tyr
eact
ions,
redness,sti
ngi
ng.

I
NTERACTI
ONS
Dr
ug-
Drug:
Notknown.

DOSAGE
Topi
cal:(
AdultsandChil
dren):Appl
yoncedailyi
npat i
ent
s
wit
htineapedis(for1mo),t
ineacrur
is(f
or2wk) ,
tinea
cor
poris(for2wk),andt
ineaversi
color(
for2wk).Apply
twi
cedailyinpat
ientswi
thcutaneouscandidi
asi
s(for2
wk).

AVAI
LABI
LITY
Cr
eam 1%;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1342
PATI
ENTTEACHI
NG
I
nstructpat
ienttoapplymedicationasdirect
edf or
ful
lcourseoftherapy
,eveniffeelingbet
ter.
Emphasizetheimportanceofav oidingt
heey es.

Cauti
onpati
entthatsomepr oductsmayst ai
nfabri
c,
ski
n,orhai
r.Checklabelinf
ormat i
on.Fabr
icsst
ained
fr
om cream canusuall
ybecl eanedbyhandwashing
wit
hsoapandwar m wat er.

Pati
entswi
thathlet
e’sf
ootshoul
dbetaughttowear
well
-f
it
ti
ng,vent
il
atedshoes,
towashaff
ectedareas
thor
oughl
y,andtochangeshoesandsocksatleast
onceaday.

Advi
sepatientt
oreportincr
easedski
nir
ri
tat
ionor
l
ackofresponsetotherapytoheal
thcar
e
pr
ofessi
onal.

Adv i
sepat i
entthatearl
yrel
iefofsymptomsmaybe
seeni n2–3day s.ForCandida,t
ineacr
uri
s,t
inea
corpor i
s,andti
neav er
sicol
or,2wkareneeded,and
fortineapedis,
therapeuti
cresponsemaytake4wk.
Recur rentf
ungalinf
ecti
onsmaybeasi gnofsy st
emic
i
llness.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1343
Ecul
i
zumab
I
NDI
CATI
ONS
Toreducehemol ysi
sinpati
entswi t
hpar oxy
smal
noctur
nalhemoglobinur
ia(PNH) .Toinhi
bitcompl
ement
-
mediatedthr
ombot i
cmicroangiopathyinpati
ent
swit
h
aty
picalhemoly
ticuremicsyndrome( aHUS).

ACTI
ON
Ecul
izumabi samonocl onal anti
bodythatbindst o
complementpr ot
einC5.Thisbindinginhi
bit
scompl ement
acti
vati
on, anecessarystepintheinit
iati
onofhemol y
sis
duetoPNHandt hedevelopmentoft hrombot i
c
microangiopathyinaHUS.Ther apeuti
cEffects:Decreased
hemolysisassociatedwithPNH.Reducedcompl ement -
mediatedt hr
ombot i
cmi croangi
opathyinaHUS.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Unr
esol
vedser
iousNei
sser
ia
meninigi
ti
disi
nf ect
ion; Pati
entsnotvaccinatedagainst
Neisseri
ameni nigi
ti
dis( unl
essri
skofdel ayi
ngtreatment
outweighsri
sksofdev elopingameni ngococcali
nfecti
on)
(v
accinateatleast2wkpr i
ortofi
rstdose).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1344
UseCaut
iousl
yin:
Syst
emi
cinf
ect
ion;
Discont
inuat
ion
requir
esmonitor
ingforint
ravascularhemolysi
s;OB: Use
onlyifmater
nalbenefi
toutweighsf et
alri
sk;
Lactati
on:
Lactati
on;
Pedi:Safet
yandeff ect
ivenessnotestabl
ished
fortr
eatmentofPNH.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, i
nsomni a, f
atigue.CV: hyper t
ension,
tachy cardia,peripheraledema.EENT: nasophar yngit
is,
sinusitis,vert
igo.Resp: cough.GI :di
arrhea, nausea,
vomi ting,const i
pat i
on.MS: backpain, extremi t
ypain,
my algia.Hemat :anemi a,leukpenia.Mi sc:↑ RI SKOF
MENI NGOCOCCALI NFECTI ONS, f
ever,Haemophi lus
i
nf l
uenzaei nfection,herpessi mplexinfection,infl
uenza-
l
ikeillness, Streptococcuspneumoni aei nfection.

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

DOSAGE
Par
oxy
smal
Noct
urnal
Hemogl
obi
nur
ia
I
V:(
Adul
ts)
:600mgev ery7day
sf or4doses,
then900
mg7daysl
ater
,then900mgevery14days.
At
ypi
cal
Hemol
yti
cUr
emi
cSy
ndr
ome

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1345
I
V:(
Adul
ts)
:900mgev ery7day
sfor4doses,
then1200
mg7daysl
ater
,then1200mgever
y14days.
I
V: (
Chil
dren<18y
rand≥40kg)
:900mgev er
y7daysfor4
doses,t
hen1200mg7dayslat
er,
then1200mgevery14
days.
I
V: (
Chil
dren<18yrand30–<40kg)
:600mgev er
y7day
s
for2doses,t
hen900mg7day slat
er,
then900mgever
y
14days.
I
V: (
Chil
dren<18yrand20–<30kg)
:600mgev er
y7day
s
for2doses,t
hen600mg7day slat
er,
then600mgever
y
14days.
I
V:(Chi
l
dren<18yrand10–<20kg)
:600mg,
then300mg
7daysl
ater
,then300mgevery14days.
I
V:(Chi
l
dren<18y rand5–<10kg)
:300mg,
then300mg7
day
slater
,then300mgev er
y21days.

AVAI
LABI
LITY
Sol
uti
onf
orI
Vadmi
nist
rat
ion(
requi
resf
urt
herdi
l
uti
on)10
mg/mL;

PATI
ENTTEACHI
NG
Expl
aintheri
sksandbenefi
tsofecul
i
zumabto
pati
ent.I
nst
ructpat
ientt
oreadtheMedi
cat
ionGui
de

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1346
 befor
estart
ingt
her
apyandwi
theachdosei
ncaseof
changes.

Instr
uctpat i
enttoobt ai
nr equiredmeni ngococcal
vaccinationatl east2wkspr iortotherapyand
revaccinat i
onaccor dingtogui deli
nes.Cautionpat i
ent
torepor tsympt omsofmeni ngococcal i
nfection
(moder atet osev ereheadachewi t
hnauseaor
vomi t
ing, headache, fever
,orst i
ffneckorst i
f fback;
feverof103° For39. 4°Corhi gher;fev
erandar ash;
confusion; orsev eremuscl eacheswi thflu-
like
sympt oms; andey essensiti
v etolight)
.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed.

Inf
orm pati
entt
ocarrySoli
ri
sPat i
entSafetyCar
d
descr
ibingsymptomswhich,ifexper
ienced,pat
ient
shoul
dseekmedi cal
evaluati
on,atallt
imes.

Advisepat i
entofpotentialf
orserioushemol ysi
sif
ecul
izumabi sdiscontinuedandofneedf or
moni t
oringbyhealthcar eprof
essionalforatleast8
wksf ol
lowingdiscontinuati
on.Cautionpatientto
noti
fyheal t
hcareprofessionali
mmedi at
elyifalarge
dropinr edbloodcellcountcausinganemi a,
confusion,chestpai
n, ki
dneyproblems, andblood
cl
otsoccur .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1347
Edet
atecal
cium di
sodi
um
I
NDI
CATI
ONS
Managementofacuteandchr
oni
cleadpoisoni
ng,
i
ncl
udingencephal
opat
hyandnephropat
hy.

ACTI
ON
Remov estoxicamountsofleadorotherdi
valentor
tri
val
entcati
onsbyt hei
rdispl
acementofcalcium i
n
edetatecal
cium di
sodium.Resulti
sasolublecompl ex
thatisexcr
etedbythekidneys.Ther
apeuti
cEf fect
s:
Remov aloftoxi
camount sofleadfr
om thebloodand
otherti
ssues.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Anur
ia;
Act
ivehepat
it
is.

UseCaut i
ouslyin:Underlyi
ngr enaldi
sease( dose
reducti
onrequiredifserum creati
nine>2mg/ dL);
Cardiac
arrhyt
hmias;OB: Lactat
ion:Pregnancyorl actat
ion(safet
y
notestabl
ished);Leadencephal opathy(shouldbeused
withconcurrentdimercaprol)
;Ger i
:Geri
atri
cpat i
ents(dose
reducti
onmaybenecessar ybecauseofage- rel
ated
decreaseinrenalfuncti
on).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1348
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache.EENT: l
acrimati
on,nasal congestion,
sneezing.CV: arr
hy thmia,ECGchanges( i
nv er
tedTwav es),
hypotension.GI:anor exi
a,nausea, v
omi ti
ng.GU:
nephrotoxicit
y,gl
y cosuria,prot
einur
ia.FandE:
hypercalcemia,zincdef i
ciency.Hemat :anemi a.Local:
painatI M si
te,phlebiti
satI Vsit
e.MS: arthral
gia,my al
gia.
Neuro: numbness, t
ingli
ng,tremor.Misc:chill
s,excessive
thi
rst
, f
ev er.

I
NTERACTI
ONS
Dr
ug-Drug:↓ dur
ati
onofact
ionofzi
nci
nsul
i
n
pr
eparati
ons.

DOSAGE
Var
iousot
herr
egi
mensar
eused
I
M: IV:(
AdultsandChil
dren)
:1000mg/ m2/
dayf or5day
s
(nottoexceed2g/day).Mayberepeat
edafter2–4day
restper
iod.Maybegivenasaninfusi
onover8–12hrorin
divi
deddosesIM ever
y8–12hr .

Renal
Impai
rment
IM:I
V:(
Adul
ts):Thefol
lowingr
egi
mensmayber epeat
ed
atmont
hlyi
nter
valsunt
ill
eadexcr
eti
oni
sreducedtoward

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1349
nor
mal.
Serum cr
eati
nine2–3mg/dL—500mg/m2/
dayfor
5days.
Ser
um creat
ini
ne3–4mg/ dL-
500mg/m2ever
y48
hrf
or3doses.
Serum creat
ini
ne>4mg/dL-
500
mg/m2/week.

AVAI
LABI
LITY
I
nject
ion200mg/
mL;

PATI
ENTTEACHI
NG
HomeCareIssues:
Discussneedf orf
oll
ow-up
appoi
ntment
stomonitorleadlev
els.Addi
ti
onal
tr
eatment
smaybenecessar y.

Consultpubli
cheal
t hdepar
tmentregar
dingpotent
ial
sour
cesofl eadpoisoni
nginthehome,wor kpl
ace,
andrecreat
ionalar
eas.

Edr
ophoni
um
I
NDI
CATI
ONS
Diagnosisofmy astheniagravi
s.Assessmentofadequacy
ofantichol
inesteraset her
apyinmy astheni
agrav
is.
Diff
erenti
atingmy asthenicfrom chol
inergi
ccr
isi
s.
Reversalofmuscl epar aly
sisfr
om nondepolar
izi
ng
neuromuscul arblockingagents.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1350
ACTI
ON
Inhibitsthebr eakdownofacet yl
choli
nesot hatit
accumul atesandhasapr olongedef fect.Effect
si ncl
ude
mi osis; i
ncreasedi ntestinal andskel etalmuscl etone;
bronchi alconst r
icti
on; brady cardia;
increasedsal i
v at
ion,
l
acr i
mat i
on, andsweat i
ng.Ther apeuti
cEf fects:Short-
li
ved
i
mpr ov ementi nmuscul arf unct i
oninpat ientswith
my ast heniagr avis.Rev er sal ofnondepol arizi
ng
neur omuscul arbl ockingagent s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Mechani
cal
obst
ructi
onoft heGIorGUt ract;
Hy persensi
ti
vi
tyto
bi
sulf
it
es; OB: Maycauseut eri
neirr
itabil
i
tyaft
erIV
admini
strationnearterm;newbor nsmaydi spl
aymuscl
e
weakness; Lactat
ion:Lact
ation.

UseCaut
iousl
yin:
Hist
oryofast
hma;
Car
diov
ascul
ar
disease;Becausesomepatientsmaybeextremel
y
sensiti
vetotheeffect
sofantichol
i
nest
erases,
atr
opi
ne
shouldbeav ai
labl
eincaseofexcessi
vedosage.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:SEIZURES,di
zzi
ness,dysphasi
a,dysphoni
a,
weakness.EENT:di
plopi
a,l
acri
mat i
on,miosi
s.Resp:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1351
bronchospasm, excesssecr etions.CV:brady
cardia,
hypotension.GI:abdomi nalcramps, di
arr
hea,dysphagi
a,
excesssal i
vat
ion, vomit
ing,nausea.GU: i
nconti
nence,
uri
naryfrequency .Derm: sweating,r
ashes.MS:
fasci
culati
on.

I
NTERACTI
ONS
Drug-Drug:Act i
onmaybeant agonizedbydr ugs
possessingant icholi
nergi
cpr operti
es,including
anti
histamines, anti
depressants,atropine,haloper
idol
,
phenothiazines,quini
dine,anddi sopyrami de.Prol
ongs
acti
onofdepol ari
zingmuscl e-rel
axingagent s
(succi
ny l
choline,decamet honium).Mayl eadt o↑
bradycardiainpat i
entsreceivi
ngdi goxin.
Drug-
Natur
alPr
oduct:Angel
'
strumpet,
ji
msonweed,
and
scopol
iamayantagoni
zecholi
ner
gicef
fect
s.

DOSAGE
Di
agnosi
sofMy
ast
heni
aGr
avi
s
IV:(Adults):2mg;ifnoresponse,administ
eranadditi
onal
8mgaf ter45sec;mayr epeatt
estin30mi n.Ifchol
i
nergi
c
responseoccur saft
erinit
ial2mgdose, administ
er
atropine0.4–0.5mgI V.Pati
ent
s>50y rshouldbe
pretreat
edwi that
ropinetoprevent

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1352
br
ady
car
dia/
hypot
ensi
on.
I
V:(
Chil
dren>34kg)
:2mg;i
fnoresponseaf
ter45sec,
mayadmini
ster1mgev
ery30–45sectoatotalof10mg.
I
V:(
Chil
dren<34kg)
:1mg;i
fnoresponseaf
ter45sec,
mayadmini
ster1mgev
ery45sectoatotal
of5mg.
I
V:(
Inf
ant
s):
0.5mg.
IM: (
Adult
s):10mg.Ifcholi
nergi
cresponseoccur s,may
repeat2-mgdosein30mi ntoruleoutfalse-negat
ive
reacti
on.Pat
ients>50yrshoul
dbepr etreatedwith
atropi
netopreventbr
adycardi
a/hypotension.
I
M:(
Chi
l
dren>34kg)
:5mg.
I
M:(
Chi
l
dren<34kg)
:2mg.
AssessmentofAnt
ichol
i
nest
eraseTher
apy
I
V: (
Adul
ts)
:1–2mg1hraf
teror
alant
ichol
i
nest
erase
dose.
Di
ff
erent
iat
ionofChol
i
ner
gicf
rom My
ast
heni
cCr
isi
s
I
V:(
Adul
ts)
:1mg;
maygi
veaddi
ti
onal
1mg1mi
nlat
er.
Rever
sal
ofNondepol
ari
zi
ngNeur
omuscul
arBl
ocki
ng
Agent
s
I
V:(
Adul
ts)
:10mg;
mayr
epeatasneeded(
nott
oexceed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1353
40mg)
.Dosesof0.
5–1mg/
kghav
ebeenused.

AVAI
LABI
LITY
I
nject
ion10mg/
mL;
Incombi
nat
ionwi
th:
atr
opi
ne(
Enl
on-
Pl
us).

PATI
ENTTEACHI
NG
I
nfor
m pat
ientt
hatt
heef
fect
soft
hismedi
cat
ionl
ast
upto30min.

EFALI
ZUMAB
I
NDI
CATI
ONS
Moderat
etosevereplaquepsor
iasi
sinadul
tswhoar
e
candi
dat
esforsystemicther
apyorphot
other
apy.

ACTI
ON
I
nhibit
sf usionofleukocyt
estoothercel
lty
pesresult
ingi
n
decreasedmi gr
ati
onofleukocyt
estopsori
ati
careas.
TherapeuticEf f
ect
s:Decreasedareaandsever
it
yof
pl
aquepsor iasi
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Act
ivei
nfect
ion;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1354
Concurrenti
mmunosuppr
essant
s;OB:
Lact
ati
on:
Pregnancy,l
act
ati
on.

UseCaut
iousl
yin:
Chr
oni
c/r
ecur
renti
nfect
ions;
High
ri
sk/hi
stor
yofmal
ignancy
;Geri:Maybemor
esensi
ti
vet
o
eff
ects;
Pedi:
Saf
etynotestabl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: PROGRESSI VEMULTI FOCAL
LEUKOENCEPHALOPATHY, headache.Der m:
photosensi t
ivi
ty,toxi
cepider mal necr
olysi
s,worseningof
psoriasis.Hemat :hemol y
ticanemi a,thr
ombocy topeni
a.
MS: arthral
gia,arthri
ti
s,pain.Misc: MALIGNANCI ES,
SERIOUSI NFECTI ONS,fever,fir
stdoser eact
ions,
hypersensiti
vit
yr eacti
ons,inflammat ory
/ i
mmune
mediat edreactions.

I
NTERACTI
ONS
Drug-
Drug:↑r i
skofi nf
ecti
onswi t
hother
i
mmunosuppr essants.May↓ ant i
bodyresponsetoand
↑r i
skofadversereacti
onsfr om v
acci
nati
ons;acell
ular
,
l
iv
eandl i
ve-
attenuat
edv accinesshoul
dbeav oided.

DOSAGE
Subcut(
Adul
ts)
:0.
7mg/
kgcondi
ti
oni
ngdosef
oll
owedby

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1355
1mg/kgonceweekl
y(nosi
ngl
edoseshoul
dexceed200
mg)
.

AVAI
LABI
LITY
Lyophi
l
izedpowderf
ori
nject
ion(
requi
resr
econst
it
uti
on)
125mg/ vi
al;

PATI
ENTTEACHI
NG
Instr
uctpati
entt
oadmi nisterasdirect
ed.Pat
ient
shouldreadthePati
entInformationhandoutbefor
e
fir
stdoseandwitheachr efil
l
.Donotst oporchange
therapywit
houtconsul
tingwi thhealt
hcare
professi
onal
.

Inst
ructpati
entorcaregi
veronpropertechni
quefor
subcutaneousinj
ecti
onanddisposalofsyri
ngesand
needles.Caut
ionpati
entsnottoreusesyri
ngesor
needles.

Inf
orm pat
ientt
hatheadache,chil
l
s,f
ever,
nausea,
andmuscleachesareusual dur
ing48hrafter
i
nject
ionandoftendecreasewithi
nfi
rstf
ewweeksof
use.

Advi
sepati
entt
onoti
fyheal
thcar
epr of
essi
onalif
si
gnsofthr
ombocyt
openia(
easybleedi
ngfrom gums,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1356
 br
uisi
ng,
pet
echi
ae)occur
.

Infor
m pati
entt
hatimmunosuppr essi
veeffectof
efali
zumabmayi ncreaseri
skofi
nfecti
onor
mal i
gnancy
.Noti
fyheal t
hcarepr
ofessionalpr
omptl
y
i
finfecti
onormalignancyaredi
agnosed.

Advi
sepati
enttonot
if
yheal
thcar
epr of
essional
if
psor
iasi
sworsensori
fnewrashappears.

Advi
sepati
ent
snott
orecei
vevaccinati
onswi
thout
di
scussi
ngwit
hheal
thcar
eprofessional
.

Advisefemalepatientstonot
ifyhealt
hcare
professi
onalifpr
egnancyisplannedorsuspected
duri
ngorwi thi
n6wksoft her
apyorifbreastf
eedi
ng.
Advisepregnantpatient
stoenrolli
nRaptiva
PregnancyRegistr
y .

Advi
sepat
ientt
oconsulthealt
hcar
eprofessi
onal
bef
oret
aki
ngotherRx/OTC/ her
bal
products.

Cautionpat
ienttousesunscreen,
wearprot
ect
ive
cl
othingandav oi
dphotother
apytopr
event
photosensi
ti
vit
yreact
ions.

Ef
avi
renz

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1357
I
ndi
cat
ions
HIVinf
ecti
onincombinat
ionwi
thatl
eastt
woot
her
ant
ir
etrov
iral
drugs.

ACTI
ON
Inhi
bitsHIVreversetranscr
ipt
ase, whi
chresul
tsin
disr
uptionofDNAsy nthesi
s.Therapeuti
cEff
ects:Sl
owed
progressi
onofHI Vinfecti
onanddecr easedoccurr
enceof
sequelae.I
ncreasesCD4cel lcountsanddecreasesvir
al
l
oad.

Av
ail
abi
l
ity
TABLET/
CAPSULES200,
400and600mg.

DOSAGE
Or
al
Adul
t-
600mgonceaday
.
Chi
ldOver3years13to14kgbodywei
ght:200mgoncea
day
.15to19kgbodywei ght
:250mgonceaday;25t
o
32.
5kgbodywei ght
:400mgonceaday;ov
er40kgbody
wei
ght:
adultdose.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1358
Cont
rai
ndi
cat
ions
Pr
egnancy(seenotesaboveandsubsti
tutenevi
rapi
nef
or
ef
avir
enzinpregnantwomenorwomenf orwhom
ef
fect
ivecontr
acepti
oncannotbeassur
ed) ;
hy
persensi
ti
vit
y.

I
NTERACTI
ONS
Drug- Dr ug: ↑l ev elsofpi mozi de, mi dazol am, tri
azolam, or
ergotal kal oidswhenusedconcur rent l
y ;mayr esultin
potent iall
yser iousadv er sereact i
onsi ncl uding
arrhy t
hmi as, CNS, andr espiratorydepr essi on( concur r
ent
usecont raindicat ed).Induces( stimul at es)t hehepat i
c
cytochr omeP4503A4enzy mesy stem andwoul dbe
expect edt oinf luencet heef fectsofot herdr ugst hatar e
met abol izedbyt hissy st em; efavirenzi tselfi salso
met abol izedbyt hissy st em.↑ r i
skofCNSdepr ession
withot herCNSdepr essant s,includingal cohol ,
antidepr essant s, antihistami nes,andopi oidanal gesics.
Concur rentusewi t
hr itonav i
r↑ l ev elsofbot hagent sand
thelikel i
hoodofadv erser eact i
ons, especi ally
hepat ot oxicity.May↓ t heef fecti
v enessofpr ogestin-
cont aininghor monal cont racept i
ves( e.g.et onogest rel
,
norelgest romi n, l
ev onor gestrel).Usewi t hv oriconazol e
signifi
cant ly↓ v oriconazol el evelsand↑ ef av i
renzl evels;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1359
concur rentusewi thst andarddosesofv or
iconazoleis
contraindicated;ifusedt ogether,↑ doseofv ori
conazol e
to400mgq12hrand↓ doseofef avi
renzto300mgdai ly.
May↓ posaconazol elevels(avoidconcurrentuse).↓
i
ndinav irlevel
s( i
ndinav i
rdose↑ r ecommended) .↓
saqui nav i
rlevel
s( av
oi dusingsaqui navi
rastheonl y
proteasei nhibit
orwi thefavir
enz).↓ mar avir
oclevels
(mar avirocdose↑ r ecommended) .Mayal t
ertheef f
ects
ofwar f
ar i
n.May↓ l ev el
sofcy clospori
ne,tacrol
imus, and
sir
olimus.May↓ l evelsofbupr opionandser t
rali
ne.
Drug-Natur
alProduct:UsewithSt.John’
swortmaycause
↓l evel
sandef fect
iveness,
incl
udingdevel
opmentofdr
ug
resi
stance(concurr
entusecontraindi
cat
ed).
Drug-
Food:
Ingest
ionf
oll
owi
ngahi
gh-
fatmeal
↑
absor
pti
onby50%.

Pr
ecaut
ions
Hepat i
cimpairment(avoi
di fsevere;severerenal
i
mpai rment;l
actat
ion(seenot esabov e);el
derl
y;historyof
ment ali
ll
nessorsubstanceabuse; i
nteract
ionspsy chiat
ri
c
sympt oms.Rash,usuall
yint hefi
rst2weeks, i
st hemost
commonadv erseeff
ect;disconti
nuei fsevererashwi th
bli
steri
ng,desquamat i
on,mucosal invol
v ementorf ever;i
f
rashmi l
dormoder ate,maycont i
nuewi thoutinterrupt
ion-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1360
r
ashusual
l
yresol
veswi
thi
n1mont
h.

Adv
erseEf
fect
s
Rashi ncludingSt evens- Johnsonsy ndr ome( seeal so
above) ;
dizziness, headache, i
nsomni a, somnol ence,
abnormal dreams, f
ati
gue, i
mpai redconcent ration
(administrationatbedt imeespeci al
lyint hefirst2- 4weeks
reducesCNSef f
ect s);nausea; lessf requent l
yv omi t
ing,
diarr
hoea, hepat itis,depr essi
on, anxiet y,psychosi s,
amnesi a,ataxi a,stupor ,verti
go; alsor eportedr aised
serum chol est er
ol ,el
ev atedliverenzy mes( especi all
yi f
seropositivef orhepat itisBorC) ,pancr eatit
is.

PATI
ENTTEACHI
NG
Emphasi zetheimportanceoftaki
ngef avi
renzas
di
rected.Itmustalway sbeusedincombi nationwith
otherantir
etrov
iral
drugs.Donott akemoret han
prescri
bedamount ,anddonotst optakingwi thout
consult
inghealthcareprofessi
onal.Takemi ssed
dosesassoonasr emember ed;donotdoubl edoses.

I
nst
ructpat
ientt
hatef
avi
renzshoul
dnotbeshar
ed
wi
thother
s.

Maycausedizziness,i
mpairedconcent
rati
on,
or
dr
owsiness.Cautionpati
enttoavoi
ddrivi
ngorot
her

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1361
 act
ivi
ti
esrequi
ringal
ert
nessunt
ilr
esponset
o
medicat
ionisknown.

I
nst
ructpat
ienttonoti
fyhealt
hcar
epr
ofessi
onal
i
mmediatel
yifrashoccurs.

Infor
m pat ientthatefavir
enzdoesnotcur eAI DSor
preventassoci atedoroppor t
unistici
nfecti
ons.
Efavir
enzdoesnotr educetheriskoftransmi ssi
onof
HIVt oot hersthroughsexualcont actorblood
contami nation.Cautionpati
entt ouseacondom and
toavoidshar i
ngneedl esordonat i
ngbloodt oprevent
spreadingt heAI DSv i
rustoothers.Advisepat i
entthat
thelong-term effectsofefavi
renzar eunknownatt hi
s
time.

Inf
orm pat i
entthatr
edi st
ribut
ionandaccumul at
ionof
bodyf atmayoccur ,causingcentralobesi
ty,
dorsocer v
ical
fatenlargement( buff
alohump),
peri
pher alwasti
ng,breastenlargement,and
cushingoidappearance.Thecauseandl ong-t
erm
eff
ectsar enotknown.

Instr
uctpati
entt
onot i
fyheal
thcarepr of
essional
of
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultwithhealt
hcare
professi
onalbef
oretaki
ngothermedi cati
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1362
 Adv i
sepatientstakingoral
contraceptivestousea
nonhormonal methodofbirt
hcont rolduri
ngef avi
renz
therapyandf oratleast12wkf ol
lowing
disconti
nuationandt onoti
fyhealthcarepr ofessi
onal
i
ft heybecomepr egnantwhil
etakingefav i
renz.
Encouragepat ientswhobecomepr egnantdur i
ng
therapy

Emphasizetheimport
anceofregul
arfol
l
ow-upexams
andbloodcountstodeter
mineprogr
essandmonitor
forsi
deeffect
s.

St
orage
St
orepr
otect
edf
rom l
i
ght
.

Ef
lor
nit
hinet
opi
cal
I
NDI
CATI
ONS
Reduct
ionofunwant
edf
aci
alhai
rinwomen.

ACTI
ON
I
nhibi
tstheenzy meornithi
nedecarboxylase(ODC)inski
n,
whichdecreasessynthesisofpol
yami nes.Ther
apeuti
c
Ef
fects:
Decr easedhairgrowthi
nar easofappli
cati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1363
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Pregnancy
,lact
ati
onorchi
l
dren<12y
r
(
saf
etynotest
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Local
:bur
ning,
rash,
sti
ngi
ng,
tingl
i
ng.

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

DOSAGE
Topi
cal
:(Adult
s):Appl
yathinl
ayertoaff
ectedareasof
thef
aceandadjacenti
nvol
vedareasunderthechinand
rubi
nthoroughl
y.Donotwashfor4hrfoll
owing
appl
i
cati
on.Usetwicedai
lyatl
east8hrapart.

AVAI
LABI
LITY
13.
9%cr
eam 30-
gtube;

PATI
ENTTEACHI
NG
Inst
ructpat
ienti
nthecorr
ectt
echni
quef
or
appli
cati
onofefl
orni
thi
ne.I
fadoseismi
ssed,
donot

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1364
 tr
yt omakei tup;retur ntonormal application
schedule.Adv i
sepat ientthatmedicationdoesnot
permantlyremov ehai rorcur eunwant edf aci
al hai
r.I
t
i
snotadepi l
atory.Cur renthairr
emov al technique
shouldcontinue.Eflornithi
nehelpsmanagecondi t
ion
andi mproveappear ance.Hai rwil
lreturnt o
pretr
eatmentcondi tioni nabout8wkaf t
er
discont
inuation.

Advi
sepati
entthatnor
mal cosmet
icsorsunscreen
maybeusedaf t
erefl
orni
thi
neappl
icat
ion.Waitafew
minut
estoall
owt r
eatmenttobeabsorbedbefore
appl
yi
ngthem.

I
nf orm pati
entthatefl
onit
hinemaycauset empor ar
y
redness, r
ash,burni
ng,sti
nging,orti
ngl
i
ng,especial
ly
whent heski nisdamaged.Folli
culi
ti
sorhairbumps
mayal sooccur .I
fir
ri
tati
oncontinuesorcondit
ion
wor sens,stopmedicati
onandnot if
yhealt
hcar e
professional.

Advisepati
entt
onoti
fyheal
thcar
eprofessi
onal
beforet
akinganyRXorOTCmedicat
ionsorusingany
faci
alorskincr
eams.

Advisepati
enttoi
nfor
m healt
hcarepr
ofessi
onal
if
pregnancyi
splannedorsuspect
edori
fbreast
feedingani
nfant.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1365
El
etr
ipt
an
I
NDI
CATI
ONS
Acut
etr
eat
mentofmi
grai
neheadache.

ACTI
ON
Actsasanagonistatspecif
ic5-hydroxy-t
rypt
ami ne
recept
orsit
esinintr
acr
anialbloodv essel
sandsensor y
tri
geminal
nerves.Ther
apeuticEffects:Cr
anialv
essel
vasoconst
ri
cti
onwi t
hresult
antdecr easeinmigraine
headache.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hemi
plegi
cor
basilarmigraine; I
schemi chear tdiseaseorsi gnsand
sympt omsofi schemi cheartdisease, Pri
nzmet al'
sangina,
oruncont r
olledhy pert
ension;Strokeort r
ansientischemic
attack;Peri
pher al vascul
ardisease( i
ncluding,butnot
l
imi t
edt o,
ischemi cbowel disease) ;Severehepat ic
i
mpai r
ment; Shoul dnotbeusedwi thin24hrofot her5-
HT1agoni stsorer got-t
ypecompounds
(di
hy droer
got ami ne);Shouldnotbeusedwi t
hin72hrof
potentCYP3A4i nhibit
orsincludingket oconazol e,
i
traconazole, nefazodone, cl
ar i
thromy cin,r
itonav i
r,and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1366
nel
fi
nav
ir.

UseCaut
iousl
yin:
OB:
Useonl
yifpot
ent
ial
benef
it
s
j
ustif
ypotent
ialr
isktofet
us;Lactat
ion:
Dosesupt o80mg
dail
ynotexpect
edt ocauseadverseeff
ectsinbreast
fed
i
nfants>2mo( NIH);Pedi
:Safet
ynotestabli
shed;Geri
:↑
ri
skof↑ BP.
Exerci
seExt remeCaut i
oni n:Cardiovascul
arriskfact
ors
(hyper
tension, hypercholester
olemi a,ci
garet
tesmoki ng,
obesit
y,diabet es,st
rongf amilyhistory,
menopausal
womenormen>40y r
);useonlyifcar di
ovascularst
atus
hasbeenev aluatedanddet er
minedt obesaf eand1st
doseisadmi nister
edundersuper visi
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zzi
ness, dr
owsi ness,weakness.CV: MI ,
angi na,
chestti
ghtness/pressure,coronaryvasospasm, ECG
changes,t
ransienthyper t
ension.GI:abdomi nalpain,dr
y
mouth,dysphagia,nausea.Neur o:paresthesia.

I
NTERACTI
ONS
Drug-Drug:Bloodlev
elsandr i
skofadv erser eact
ionsare
↑ bypot entCYP3A4i nhi
bit
ors( i
ncludingket oconazol
e,
i
traconazole,nef
azodone,clar
ithr
omy cin,r
itonavi
r,and
nelf
inavir
);usewithi
n72hriscont raindicated.Concurrent

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1367
use(within24hrofeachot her
)withergot-
containi
ng
drugs(dihydroergotami
ne)mayresul
tinprolonged
vasospasticreacti
onsandshouldbeav oi
ded.↑ serotoni
n
l
ev el
sandser otoninsyndr
omemayoccurwhenused
concurr
ent l
ywi t
hSSRIandSNRIant i
depressants.

DOSAGE
PO: (
Adult
s):20or40mg; mayberepeat
edi
n2hrifi
nit
ial
responsei
sinadequat
e(nott
oexceed80mg/24hror
treat
mentof3headaches/mo).

AVAI
LABI
LITY
Tabl
ets20mg,
40mg;

PATI
ENTTEACHI
NG
I
nst ructpati
entthateletr
iptanshouldonl
ybeused
duringami grai
neat tack.El
et r
iptani
susedfor
treatmentofami grai
neat t
ack, notf
orpr
event
ion.
Adv i
sepat i
enttor eadthePat i
entSummar yof
I
nf ormationbeforestarti
ngt herapyandwit
heachRx
refil
lincaseofchanges.

Instructpat
ientt
otakeel
etr
iptanatt
hefir
stsi
gnofa
mi grai
ne,butmaybeadminister
edatanyti
meduri
ng
attack.All
owatleast2hrbetweendosesanddonot

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1368
 usemor
ethan80mg/
dayor3at
tacks/
mo.

Caut
ionpati
entnottotakeel
etri
ptanwit
hin24hrof
ot
hervascul
arheadachesuppressant
s.

Advisepati
entt
hatl
yi
ngdowninadarkenedroom
aft
erelet
ri
ptanadmi
nist
rat
ionmayf
urtherhel
prel
iev
e
headache.

Advi
sepati
enttonot
ifyheal
thcareprofessionali
fshe
pl
ansorsuspectspr
egnancy,ori
fbreastfeeding.

Adv i
sepat i
enttonot i
fyheal t
hcarepr ofessional
beforenextdoseofel et
riptanifpainort i
ghtnessin
thechestoccur s.Ifchestpai ni
ssev ereordoesnot
subside,notif
yheal t
hcar eprofessi
onal immedi at
ely
.
Iffeel
ingsoft i
ngli
ng,heat ,
f l
ushi
ng, heaviness,
pressure,drowsiness,dizzi
ness, t
ir
edness, or
sicknessdev el
op,discusswi thhealthcar eprovi
derat
nextv i
sit
.

Maycausedr owsi
nessordizziness.Cauti
onpati
ent
toavoiddri
vingorotheracti
vi
tiesrequir
ingal
ert
ness
unti
lresponsetomedi cat
ionisknown.

Instr
uctpati
entt
onot i
fyheal
thcarepr of
essional
of
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultwithhealt
hcare
professi
onalbef
oretaki
ngothermedi cati
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1369
 Advisepati
entt
oavoidalcohol
,whi
chaggr
avat
es
headaches,dur
ingt
herapy.

Instructpat ientt onot i

fyhealthcar
epr ofessionali
f
signsofser otoninsy ndrome( mental statuschanges:
agitation, hallucinati
ons,coma; autonomi cinstabi
l
ity
:
tachy car di
a, labi
leBP, hyperther
mia; neur omuscular
aber rations: hyperrefl
exia,i
ncoordi
nat ion; and/or
gast rointestinalsy mptoms: nausea,v omi ti
ng,
diarrhea)occur .

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed,
orif
br
eastf
eedi
ng.

El
tr
ombopag
I
NDI
CATI
ONS
Treatmentofchr onici
mmune( i
diopathi
c)
thrombocy t
openicpurpur
ainpati
entswhohav ehadan
i
nadequat eresponsetocorti
cost
eroids,i
mmunoglobul
ins
orsplenectomy( shoul
donlybeusedi npati
ent
swithan↑
ri
skofbl eedi
ng).

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1370
Increasesplatel
etproducti
onbyi ni
ti
atingproli
fer
ati
onand
diff
erentiat
ionofmegakar yocytesfrom bonemar row
progenitorcell
s.Therapeut
icEff ect
s:Increasedplat
elet
countwi threducedriskofbleeding.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Lact
ati
on:
Lact
ati
on.

UseCaut
iousl
yin:
Myel
ody
spl
ast
icsy
ndr
omes(
may↑
ri
skofhemat ologi
cmal i
gnancy);Hepati
cimpairment
(l
oweri nit
ial
doser equired);Pat
ientsofEastAsian
ancest r
y(mayr equirelowerdoses) ;
Geri:Maybemor e
sensi t
ivet
odr ugeffects;↑ dosecaut i
ously
,considerage-
related↓ inrenalandhepat icfuncti
on,concurr
ent
diseasestatesanddr ugtherapy;OB:Useonlywhen
pot enti
almaternalbenefitoutweighspotenti
alr
isktofetus.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:dev
elopment/wor
seni
ngofcat
aract
s.CV:
THROMBOEMBOLI SM.GI:HEPATOTOXICI
TY.Hemat
:
bonemarrowchanges.

I
NTERACTI
ONS
Dr
ug-
Drug:
↓ avai
labi
li
tyandabsor
pti
onofi
ron,cal
cium,
al
umi
num,magnesium,sel
eni
umandzincbychelat
ion;
do

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1371
notadmini
sterwi
thi
n4hrofmedi
cat
ionscont
aini
ngt
hese
andotherpoly
val
entcat
ions.
Drug-Food:↓ avail
abil
i
tyandabsorpt
ionofir
on,calcium,
al
umi num,magnesi um,sel
eni
um, andzi
ncbychel at
ion;do
notadmi ni
sterwit
hin4hroffoodscontai
ningtheseand
otherpolyv
alentcati
ons.

DOSAGE
PO: (
Adults):50mgoncedai l
y, maybe↑ t oachi ev ea
plat
eletcountof≥50x109/ L(nott oexceed75mg/ day);
Pati
ent sofEastAsianancestryormi ld,moder ate, or
severehepaticimpairment(ChildPughCl assA, B, C) —25
mgoncedai l
yinit
ial
ly,maybe↑ t oachi eveapl atel et
countof≥50x109/ L( nott
oexceed75mg/ day )
; Pat i
ents
ofEastAsianancest rywithmild,moder ate,
orsev er e
hepaticimpairment(ChildPughCl assA, B,C)—25mg
everyotherdayiniti
all
y,maybe↑ t oachieveapl at elet
countof≥50x109/ L( nott
oexceed75mg/ day )
.

AVAI
LABI
LITY
Tabl
ets25mg,
50mg,
75mg;

PATI
ENTTEACHI
NG
Expl
ainpur
pose,
risksandbenef
it
soft
her
apyt
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1372
 pat
ient
.Ri
sksorl
ongt
ermt
her
apyar
eunknown.

Inst
ructpati
enttoav oi
dtakingelt
rombopagwit
hin4
hroffoods,mineralsupplements,andant
aci
ds
contai
ningir
on,calci
um, aluminum,magnesi
um,zinc,
andselenium.

Advi
sepati
entstoav
oidact
ivi
ti
est
hatmayi
ncr
ease
ri
skofbl
eeding.

Instr
uctpati
enttonotif
yhealthcar epr
ofessi
onalif
sympt omsofli
verproblems( yell
owingofski
nor
whitesofeyes,unusualdarkeningofuri
ne,unusual
tir
edness,pai
ninrightupperstomach)occur.

Advisefemalepat i
entstonotifyhealt
hcare
professi
onalprompt l
yifpregnancyisplannedor
suspectedorifbreastfeedi
ng.Apr egnancyregi
str
y
hasbeenestabl i
shedtocol l
ectinfor
mat i
onabout
el
trombopagef fectsduringpregnancy.

Emphasizet
heimportanceofr
out
inel
abtestst
o
det
ermineef
fect
ivenessandmoni
torf
orsideef
fect
s.

Emt
ri
cit
abi
ne
I
ndi
cat
ions

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1373
HI
Vinf
ect
ion.

ACTI
ON
Phosphoryl
atedi nt
racell
ular
lywhereitinhi
bitsHIVr ev
erse
tr
anscri
ptase,r
esul t
inginv i
ral
DNAchai nterminat
ion.
Therapeut
icEffects:Slowedpr ogr
essionofHI Vinfect
ion
anddecreasedoccur renceofsequelae.IncreasesCD4cel l
countsanddecr easesv i
rall
oad.

Av
ail
abi
l
ity
CAPSULE200mg.

DOSAGE
Or
al
Adul
tandchi
l
dov
er33kg-200mgonceaday
.
Chi
l
dUnder33kg:
6mg/
kgbodywei
ghtonceaday
.

Cont
rai
ndi
cat
ions
Lact
ati
on;
hyper
sensi
ti
vi
ty.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1374
Pr
ecaut
ions
Monitorpati
entswithhepat
it
isB(ri
skofexacerbat
ionof
hepati
ti
s);obesi
ty,
lact
icaci
dosis,
sev er
ehepat
omegaly,
coi
nfecti
onwi t
hhepatit
isBvir
us;pregnancy

Adv
erseEf
fect
s
Gastro-
intesti
nal disturbances( suchasnausea, vomiti
ng,
abdomi nalpain,flatulenceanddi arrhoea);anorexia;
pancreati
tis;l
i
v erdamage( seealsoLact icAcidosis,
above);dyspnoea; cough, headache; i
nsomni a;di
zziness;
fat
igue;blooddi sor ders(i
ncludinganaemi a,
neutropenia
andthrombocy topeni a);
my algi
a, ar
thralgi
a,rash,urt
icar
ia
andfever.Lipody strophy ,abnormal dreams, prur
it
usand
hyperpi
gment at i
on.

PATI
ENTTEACHI
NG
Emphasi zetheimportanceoftakingemtri
cit
abineas
dir
ected.Itmustalway sbeusedi ncombinat
ionwith
otherantir
etrovi
ral
drugs.Donott akemorethan
prescri
bedamountanddonotst optaki
ngwithout
consult
ingheal t
hcareprofessi
onal.Takemissed
dosesassoonasr emember ed,butnotifal
mostt i
me
fornextdose; donotdoubledoses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1375
Inst
ructpati
entthatemt
ri
cit
abi
neshoul
dnotbe
sharedwithothers.

Inform pati
entthatemt ricit
abinedoesnotcur eAI DS
orpr eventassoci
atedoroppor tunistici
nfect
ions.
Emt rici
tabi
nedoesnotr educet heriskof
transmi ssi
onofHIVt oot hersthroughsexual contact
orbloodcont amination.Caut ionpat i
enttousea
condom andt oavoidshar i
ngneedl esordonating
bloodt opreventspreadingt heAI DSv ir
ustoothers.
Adv i
sepat i
entthatthelong- term ef fect
sof
emt ri
citabi
neareunknownatt histime.

Instr
uctpat i
enttonot i
fyheal t
hcarepr of
essi onal
i
mmedi atel
yifsympt omsofl act
icacidosis( ti
redness
orweakness, unusual muscl epain,tr
oublebr eat hi
ng,
stomachpai nwi t
hnauseaandv omi t
ing,cold
especiall
yinar msorl egs,dizzi
ness,fastori rr
egular
heartbeat)orifsi
gnsofhepat otoxi
city(yell
owski nor
whi t
esofey es,darkur i
ne,li
ghtcoloredst ools,lackof
appetiteforseveralday sorlonger,nausea, abdomi nal
pain)occur.Thesesy mpt omsmayoccurmor e
frequentl
yinpat i
entst hatarefemale,obese, orhav e
beent aki
ngmedi cationsl i
keemt ri
cit
abinef oral ong
time.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1376
 si
gnsandsy mptomsofsi
gnsofImmune
Reconsti
tut
ionSyndr
ome(si
gnsandsy
mptomsofan
i
nfecti
on)occur
.

Infor
m pat i
entt hatredist
ributi
onofbodyf at(
centr
al
obesity,dorsocervicalfatenlargementorbuff
alo
hump, per
ipheralandf acialwast i
ng,br
east
enlargement ,cushingoidappear ance)andski
n
discolorat
ion( hyperpi
gment at
iononpalmsandsol es)
mayoccur .

Advi
sepati
enttonot
ifyheal
thcareprofessionali
fshe
pl
ansorsuspectspr
egnancyorisbreastfeeding.

Emphasizetheimport
anceofregul
arfol
l
ow-upexams
andbloodcountstodeter
mineprogr
essandmonitor
forsi
deeffect
s.

St
orage
St
orepr
otect
edf
rom moi
stur
e.

Enal
apr
il
I
NDI
CATI
ONS
Al
oneorwit
hotheragent
sinthemanagementof
hy
pert
ensi
on.Managementofsympt
omatichear
tfai
l
ure.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1377
Sl
owedpr ogr
essi
onofasy mptomaticl
eftvent
ri
cular
dysf
unct
iontoovertheartf
ail
ure.Unl
abeledUses:
Tr
eatmentofprot
einuri
ainsteroi
d-r
esi
stantnephr
oti
c
sy
ndromepat i
ent
s.

ACTI
ON
Angi otensin-conv ertingenzy me( ACE)inhibit
orsbl ockthe
conv ersionofangi otensi nItot hevasoconstri
ctor
angi otensinII.ACEi nhibitor
sal sopreventthedegr adati
on
ofbr ady ki
ninandot herv asodil
atoryprostagl
andi ns.ACE
i
nhi bit
or salso↑ pl asmar eninlevel
sand↓ al dost erone
l
ev els.Netr esultissy stemicv asodil
ati
on.Ther apeutic
Effects: Lower i
ngofBPi npatientswithhypertension.
Increasedsur viv
al andr educti
onofsy mpt omsi npat i
ents
withsy mptomat ichear tfail
ure.Decreaseddev elopmentof
over theartfailure.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hist
oryof
angioedema( ei
theri
diopathi
corwi t
hprevi
oususeofACE
i
nhibit
ors);
OB: Cancausei nj
uryordeathoffetus–i f
pregnancyoccurs,di
scontinueimmediatel
y.Lactat
ion:
Appearsinbreastmilk;pati
entmustdisconti
nueenalapri
l
orprovideal
ternatet
obr eastmilk.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1378
UseCaut
iousl
yin:
Pat
ient
swi
thr
enal
impai
rment
,
hypov ol
emi a,hy ponatremia,andconcur r
entdiureti
c
therapy;Blackpat ients(monot herapyofhypertensionless
effecti
ve,mayr equireadditi
onal t
herapy;hi
gherr i
skof
angioedema) ;
Sur gery/anesthesia(hypot
ensionmaybe
exagger at
ed) ;Womenofchi l
dbearingpotent
ial;Pedi:
Inj
ectablepr oductcont ainsbenzy lal
coholwhichis
associatedwi thgaspi ngsy ndromei nneonates;Geri:
Ini
tialdose↓ r ecommended.
Exer
ciseExt
remeCaut
ioni
n:Fami
l
yhi
stor
yof
angi
oedema.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,fati
gue, headache,vert
igo,weakness.
Resp: cough.CV: hypotension,chestpain.GI:abdominal
pain,
di arr
hea,nausea,v omiti
ng.GU: protei
nuria,i
mpaired
renalfuncti
on.Der m:rashes.FandE: hyperkalemia.Resp:
dyspnea.Mi sc:ANGI OEDEMA.

I
NTERACTI
ONS
Drug-Drug:Excessiv
ehy potensionmayoccurwi th
concurrentuseofdiuretics.Addit
ivehypotensi
onwith
otherantihy
pertensi
ves.↑ r i
skofhy perkal
emiawith
concurrentuseofpot assium supplements,pot
assi
um-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1379
sparingdiureti
cs,pot assium-cont
ainingsaltsubst
it
utes,or
angiotensi
nI Ireceptorant agoni
sts.NSAIDsandsel ecti
ve
COX- 2inhibi
torsmaybl unttheantihypert
ensiveef
fectand
↑t her i
skofr enal dysfuncti
on.↑ levelsandmay↑ t he
ri
skofl i
thi
um t oxicit
y.
Drug-Natur
alPr
oduct:Avoi
dnatur
all
icori
ce;causes
sodium andwaterr
etent
ionand↑ potassi
um loss.

DOSAGE
Hy
per
tensi
on
PO:(Adul
ts):2.
5–5mgoncedai ly,↑ asrequi
redupto40
mg/dayin1–2divideddoses(i
nit
iatether
apyat2.5mg
oncedail
yinpati
entsrecei
vi
ngdiureti
cs).
PO: (
Chi
ldr
enandNeonates)
:0.
1mg/kg/
dayq12–24hr
(onceadayinneonat
es)
;maybesl
owlyti
tr
atedupt
oa
maximum of0.5mg/kg/
day.
I
V:(Adult
s):0.
625–1.25mg(0.
625mgifr
ecei
vi
ng
di
uret
ics)ev
ery6hr;canbet
it
rat
edupt
o5mgev er
y6hr
.
I
V:(Chi
l
drenandNeonat
es)
:5–10mcg/
kg/
dosegi
venq
8–24hr.
Renal
Impai
rment
PO:
IV:
(Adul
ts)
:CCr10–50mL/
min—75%ofdose;
CCr

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1380
<10mL/
min-
50%ofdose.
Renal
Impai
rment
PO:
IV:
(Chi
l
drenandNeonat
es)
:CCr<30mL/
min-
Cont
rai
ndi
cat
ed.
Hear
tFai
l
ure
PO:(Adul
ts):2.5mg1–2t i
mesdaily,
tit
rat
edupt ot ar
get
doseof10mgt wi
cedail
y;i
nit
iat
etherapyat2.5mgonce
dai
lyinpat
ientswit
hhyponatr
emia(serum sodium <130
mEq/L).
Asy
mpt
omat
icLef
tVent
ri
cul
arDy
sfunct
ion
PO:(Adul
ts)
:2.5mgt
wicedai
l
y,ti
tr
atedupwar
dtoa
tar
getdoseof10mgt
wicedai
ly.

AVAI
LABI
LITY
Tabl
ets2.
5mg, 5mg,10mg,
20mg;
Incombi
nat
ionwi
th:
hydr
ochl
orot
hiazi
de
I
nject
ion1.
25mg/
mL;

PATI
ENTTEACHI
NG
Emphasi
zet
heimportanceofcont
inui
ngtotake
medi
cati
onasdi
rect
edatt hesametimeeachday,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1381
 eveniff
eelingwell
.Takemisseddosesassoonas
remember edbutnoti
falmostt i
mef ornextdose.Do
notdoubledoses.Warnpatientnottodiscont
inue
ACEinhibi
torther
apyunlessdirect
edbyheal t
hcare
prof
essi
onal .

Cautionpat i
enttoavoidsaltsubsti
tutescont
aini
ng
potassium orfoodscontaininghighlevel
sof
potassium orsodium unl
essdi r
ectedbyhealthcare
professional
.

Caut
ionpatientt
ochangeposi tionsslowlyto
mini
mi zeort
hostati
chy potension.Useofalcohol,
st
andingforlongperiods,exercising,andhotweather
mayincreaseorthost
atichy potension.

Instr
uctpati
enttonot i
fyhealt
hcar epr
of essionalof
allRxorOTCmedi cati
ons,vit
amins,orher bal
productsbeingtakenandconsul theal
thcar e
professi
onalbeforetakinganynewmedi cations,
especial
lycough,cold,oral
lergyremedies.

Maycausedizziness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

Advi
sepatientt
oinf
orm heal
thcar
eprofessionalof
medicat
ionregi
menbeforetr
eatmentorsurgery.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1382
Inst
ructpat ienttonot i
fyheal thcarepr ofessionali
f
rash;mout hsor es;sorethr oat; f
ever;swellingof
handsorf eet;i
rregularhear tbeat;chestpai n;dry
cough; hoarseness; swelli
ngoff ace, eyes,li
ps,or
tongue; orifdiff
icul
tyswal lowi ngorbr eathingoccurs.
Persist
entdr ycoughmayoccurandmaynotsubsi de
unti
l medicat i
oni sdiscontinued.Consul thealt
hcare
professional i
fcoughbecomesbot hersome.Al so
notif
yheal thcarepr ofessional ifnausea, vomiti
ng,or
diarr
heaoccur sandcont inues.

Adv i
sewomenofchi ldbearingaget ouse
contracepti
onandnotifyhealthcareprofessi
onal
of
pregnancyisplannedorsuspect ed.I
fpregnancyi
s
detected,di
sconti
nuemedi cati
onassoonaspossi bl
e.

Emphasizetheimport
anceoff
oll
ow-
upexami
nat
ions
toev
aluateeff
ecti
venessofmedi
cat
ion.

Hy pertensi
on:Encouragepatienttocomplywi t
h
additi
onal i
nter
ventionsforhypert
ension(weight
reduction,l
owsodi um di
et,di
scontinuati
onof
smoki ng,moderationofalcoholconsumpt i
on,regul
ar
exercise,andstressmanagement )
.Medicati
on
controlsbutdoesnotcur ehypertension.

I
nst
ructpat
ientandf
ami
l
yoncor
rectt
echni
quef
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1383
 monit
ori
ngBP.Adv isethem tocheckBPatleast
weekl
yandt orepor
tsignif
icantchangest
ohealt
h
car
eprofessi
onal.

Enf
uvi
rt
ide
I
NDI
CATI
ONS
ManagementofHIVinf
ecti
onincombinati
onwithot
her
ant
ir
etr
ovi
ralsi
npati
entswit
hev i
denceofprogr
essi
veHI
V
-1r
epli
cat
iondespi
teongoi
ngtreatment
.

ACTI
ON
Prev ent sentr
yofHI V-
1i ntocel l
sbyinter
feri
ngwiththe
fusionoft heviruswit
hcel l
ularmembranes.Therapeuti
c
Effect s:DecreasedreplicationoftheHIVv i
rus.Sl
owed
progr essionofHI Vinfectionwi t
hdecreasedoccurrenceof
sequel ae.I
mpr ovedCD4cel lcount.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Lact
ati
on:
Breast
f
eedi
ngnotr
ecommendedf
orHI
V-i
nfect
edmot
her
s.

UseCaut
iousl
yin:
OB:
Useonl
yifcl
ear
lyi
ndi
cat
ed;
Pedi
:
Saf
etynotest
abl
i
shedi
nchi
l
dren<6y
r.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1384
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: fati
gue.EENT: conj
uncti
viti
s.Resp: cough,
pneumoni a,si
nusi
tis.GI:di
arr
hea, nausea, abdominalpai
n,
anorexia,dr
ymout h,pancreat
it
is, weightloss.Local:
i
njecti
onsi t
ereacti
ons.MS: my algia,l
imbpai n.Misc:
hypersensit
ivi
tyr
eact i
ons,her
pessi mplex.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
Subcut(
Adul
ts)
:90mgt
wicedai
l
y.
Subcut(
Chi
ldr
en6–16yr
):2mg/
kgt
wicedai
l
y(nott
o
exceed90mg/dose)
.

AVAI
LABI
LITY
Lyophi
l
izedpowderforsubcutadminist
rati
on108mg/
vial
(t
odeli
vera90mg/ 1mLconcent r
ation);

PATI
ENTTEACHI
NG
Inst
ructpat
ientonthecorr
ecttechni
quefor
administ
eri
ngenfuvir
ti
de.Revi
ewpatienti
nformati
on
sheet,pr
eparat
ionofdose,admini
str
ati
onsitesand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1385
 technique,anddi sposal ofequipmenti
ntoapunct ur
e-
resi
stantcont ainer.Fi
rstinj
ecti
onshouldbe
admi nister
edundersuper vi
sionofahealthcare
professionalandt echniqueshouldbere-ev al
uated
periodicall
y.I
nst r
uctpatienttocontact
www. FUZEON. com or1- 877-4-
FUZEON( 1-877-438-
9366)f ormor einformat i
on.

Emphasi zet heimpor t

anceofadmi nisteri
ng
enfuvir
tideexact l
yasdi rected.Itmustal waysbeused
i
ncombi nationwithot herantiretr
ov i
rals.Donott ake
mor ethanpr escri
bedamountanddonotst opt aking
withoutconsul t
ingheal t
hcar epr ofessional.Ifadose
i
smi ssed, takeassoonasr emember edt henr eturnto
regularschedule.Ifcloset otimef ort henextdose,
waitandadmi nist
ernextdoseasr egul arl
yschedul ed;
donotadmi nist
ert wodosesatsamet i
me.I ftoo
muchi sadmi ni
stered,notif
yheal thcar eprofessi onal
prompt l
y .

I
nst
ructpat
ientt
hatenf
uvi
rt
ideshoul
dnotbeshar
ed
wi
thother
s.

I
nf orm pati
entthatenfuvir
tidedoesnotcur eAIDSor
preventopportunist
icinfections.Enf
uvir
tidedoesnot
reducet heri
skoft r
ansmi ssionofHIVt oothers
throughsexual contactorbloodcont aminati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1386
 Cauti
onpati
enttouseacondom andtoavoidshar
ing
needl
esordonati
ngblood.Advi
sepati
entthatt
he
l
ong-t
erm ef
fect
sofenfuvir
ti
deareunknownatthi
s
ti
me.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advi
sepati
enttonot
ifyheal
thcarepr
ofessi
onal
ifshe
pl
ansorsuspectspr
egnancyorifbr
eastf
eedi
ng.

Instr
uctpati
enttonotif
yheal t
hcareprof
essionali
f
signsofinj
ecti
onsiteinfect
ion(oozi
ng,i
ncreasing
heat,swell
i
ng,redness,orpain),
pneumonia,or
hypersensi
ti
vit
yoccur.

Emphasizetheimport
anceofregul
arfol
l
ow-upexams
andbloodcountstodeter
mineprogr
essandmonitor
forsi
deeffect
s.

ENOXACI
N
I
NDI
CATI
ONS
Tr
eatmentof:
Uri
naryt
ractandgynecol
ogicinf
ect
ions,
Gonor
rhea(maynotbeconsider
edafir
st-
li
neagent).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1387
ACTI
ON
Inhibitsbacter i
alDNAsy nthesisbyi nhibitingDNAgy rase.
Ther apeut i
cEf f
ect s:Deathofsuscept i
blebact eri
a.
Spect rum: Gram- negat i
vespect rum not abl ef oract i
v i
ty
agai nst:Escherichiacoli,Klebsiell
aspp, Ent erobacter,
Sal monel l
a,Shigel l
a,Proteusv ulgaris,Pr ov idenciast uarti
i
,
Pr ovidenciarettgeri,Morganellamor gani i,Pseudomonas
aer uginosa,Ser r
at i
a,Haemophi l
usspp, Aci netobact er,
Nei sseriagonor rhoeaeandNei sser iameni ngi ti
dis,
Mor axel
lacat arr
hal i
s,Yersini
a,Vi bri
o, Brucel l
a,
Campy l
obacter,Aer omonasspp.Addi t
ional spect r
um
i
ncl udes: Chlamy diapneumoni aeandChl amy dia
trachomat i
s,Legi onell
apneumoni ae,My cobact er
ium
tuber culosi
s, Mycopl asmapneumoni ae,Ur eaur ealy
t i
cum.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.Cr
oss-
sensi
ti
vi
ty
amongagent
smayoccur( i
ncl
udi
ngcinoxaci
nand
nal
i
dixi
caci
d);OB:
Pregnancy;
Pedi
:Chil
dren<18yr
.

UseCaut
iousl
yin:
Under
lyi
ngCNSpat
hol
ogy
;Renal
i
mpai r
ment(dosager educti
onrecommendedi fCCr≤30
mL/mi n)
;Cir
rhosis;Geri
:Geri
atr
icpatient
s,di
aly
sis
pati
ents(i
ncreasedr i
skofadversereacti
ons)
;Lactat
ion
(saf
etynotestabli
shed).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1388
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, di
zzi ness,drowsiness, headache,
i
nsomni a,acutepsy choses, agitat
ion, conf usion,
hall
ucinati
ons, increasedi ntr
acranial pressur e, l
ight-
headedness, tremor s.GI :PSEUDOMEMBRANOUSCOLI TI
S,
abdomi nalpain, di
ar r
hea, nausea,alteredt ast e.GU:
i
nterstit
ialcysti
tis,vaginiti
s.Derm: phot osensi t
ivit
y,rash.
Endo: hypergly
cemi a,hypoglycemi a.MS: tendi niti
s,t
endon
rupt
ure.Mi sc:hy persensitivi
tyreacti
onsi ncludi ng
anaphy l
axisandSt ev ens-Johnsonsy ndrome.

I
NTERACTI
ONS
Dr ug-Drug: I
ncr easesser um t heophy ll
inelevelsandmay
l
eadt otoxicity.Admi nistrationwi thant acids,ironsalts,
bismut hsubsal icylate,sucralfate,andzi ncsal t
s↓
absor pti
onoff l
uor oqui nol
ones.May↑ t heef fectsof
war fari
n.Ser um l ev el
smaybe↓ byant ineoplasti
cagent s.
Cimet idinemayi nterferewi thel i
mi nation.Pr obenecid↓
renal eli
minat ionoff l
uor oqui nolones.May↑ ser um
digoxinl evels.May↑ t heriskofnephr otoxicit
y
fromcy clospor ine.Concur rentt herapywi t
hcor ti
costeroi
d
may↑ t heriskoft endonr upt ure.May↑ r i
skof
hy poglycemi awhenusedwi thant i
di abetic
agent sespeci allyinsul i
nandgl y
bur ide.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1389
Drug-
Food:Absorpt
ioni
simpair
edbyconcur
rentt
ube
feedi
ng(becauseofmetal
cati
ons)
.

DOSAGE
PO:
(Adul
ts)
:Complicateduri
narytr
actinfecti
ons—400
mgq12hr.Uncomplicatedur
inar
ytracti
nf ect
ions—200
mgq12hr.Gonor
rhea—400mgsi ngledose.
Renal
Impai
rment
PO:(Adul
ts)
:CCr≤30mL/
min—50%oft
her
ecommended
doseq12hr.

AVAI
LABI
LITY
Tabl
ets200mg,
400mg;

PATI
ENTTEACHI
NG
Instr
uctpati
enttotakemedi cationasdi rectedat
evenlyspacedti
mesandt ofinishdr ugcompl etel
y,
eveniffeel
ingbett
er.Misseddosesshoul dbet aken
assoonaspossi bl
e, unl
essal mostt imef ornextdose.
Donotdoubl edoses.Advisepat ientthatsharingof
thismedicati
onmaybedanger ous.

Adv
isepati
entstonot
ifyhealt
hcareprofessi
onal
i
mmediatel
yiftheyar
et aki
ngtheophy
ll
ine.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1390
Encour
agepat
ientt
omaintai
naflui
dint
akeofatl
east
1500–2000mL/daytopr
eventcr
yst
all
uri
a.

Advisepati
entthatant
aci
dsormedicat
ions
contai
ningi
ronorzincwil
ldecr
easeabsorpt
ionand
shouldnotbetakenwithi
n8hrbefor
eand2hraf ter
taki
ngthismedicati
on.

Maycausedi zzi
nessanddr owsiness.Caut
ionpati
ent
toavoiddri
vingorotheracti
vi
tiesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

Cauti
onpati
enttousesunscreenandprotect
ive
clot
hingt
opreventphot
otoxi
cityr
eact
ionsduringand
for5daysaf
terther
apy.

Advi
sepati
entt
hatfr
equentmouthri
nses,
goodoral
hygi
ene,
andsugarl
essgum orcandymaymini
mize
dr
ymout h.

I
nstr
uctpati
ent
sbei
ngtr
eatedf
orgonor
rheat
hat
par
tner
salsomustbet
reat
ed.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(
fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools).

I
nstr
uctpat
ienttonot
ifyhealt
hcar
epr of
essi
onali
f
f
everanddi
arrheadevelop,
especi
all
yifst
oolcont
ains

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1391
 bl
ood,pus,
ormucus.Adv i
sepat
ientnott
otreat
di
arr
heawithoutconsul
ti
ngheal
thcarepr
ofessi
onal
.

I
nstructpatienttonot
if
yhealthcareprof
essi
onal
i
mmedi at
elyifrashort
endonpainorinfl
ammation
occur.Therapyshouldbedisconti
nued.

Enoxapar
in
I
NDI
CATI
ONS
Prevent i
onofv enousthromboembol ism (VTE)(deepv ei
n
thrombosi s( DVT)and/ orpulmonar yembol ism (PE))in
surgicalormedi calpati
ents.Tr eat
mentofDVTwi thor
withoutPE( withwar f
arin)
.Pr eventi
onofi schemi c
compl icati
ons( withaspiri
n)f rom unstabl
eangi naandnon
-ST-segment -
elevati
onMI .Treat mentofacut eST-
segment -
elevationMI( wit
ht hrombol yt
icsorper cutaneous
coronar yinterv
ent i
on).

ACTI
ON
Potent
iatestheinhibi
tor
yeffectofanti
thr
ombinonfact
or
Xaandt hrombin.Therapeut
icEffect
s:Prevent
ionof
thr
ombusf or
mat i
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1392
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
benzylal
cohol(mult
idosevial
);Posi
ti
veinvit
rotestfor
anti
plat
eletant
ibodyinthepresenceofenoxapari
n;Acti
ve,
majorbleedi
ng.

UseCaut
iousl
yin:
Sev
erehepat
icorr
enal
disease
(adjustdosei fCCr<30mL/ min)
;Retinopathy
(hypertensiveordi abet ic);Uncontr
olledhypert
ension;
Recenthi storyoful cerdi sease;Historyofcongenitalor
acqui r
edbl eedingdi sor der;Women<45kgandmen<57
kg( ↑ exposur etoenoxapar inwith↑ r i
skofbleeding;
weight -
adjusteddosi ngr ecommended) ;Mali
gnancy ;
Ger i
:
Mayhav e↑ r iskofbl eedingduet oage-rel
ated↓ inr enal
funct i
on;OB: Lactation: Pedi:Safetynotestabli
shed;
shoul dnotbeusedi npr egnantpat i
entswithprosthetic
hear tval
veswi t
houtcar efulmonitoring.
Exerci
seExt remeCaut i
oni n:Sev ereuncont rolled
hypertensi
on; Bact
eri
al endocar dit
is;Bleedingdi sorders;
GIbleeding/ulcer
ati
on/ pat
hol ogy;Hemor rhagicst r
oke;
RecentCNSoropht halmol ogicsur gery;Historyof
thr
ombocy t
openiarelatedt ohepar in;Spinal/epidural
anesthesiaorspinalpunctur e(↑r iskofspi nal/ epi
dural
hemat omat hatmayl eadtol ong-ter m orpermanent
paraly
sis).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1393
CNS: dizzi
ness,headache, i
nsomni a.CV: edema.GI :
constipati
on,↑l i
verenzy mes, nausea,vomi t
ing.GU:
uri
naryr et
enti
on.Der m: ecchy moses, pruri
tus,rash,
urt
icaria.FandE: hyperkalemi a.Hemat :bleeding,anemi
a,
thr
ombocy t
openia.Local :eryt
hemaati njecti
onsi t
e,
hemat oma, i
rr
it
ation,pain.Mi sc:fever.

I
NTERACTI
ONS
Drug-Drug:Riskofbl eedingmaybe↑ byconcur r
entuse
ofdrugst hataffectplateletfuncti
onandcoagulati
on,
i
ncludingwar far
in,aspirin,thrombolyt
icagents,
NSAI Ds,
dipyri
damol e,somepeni cil
li
ns,cl
opi
dogrel,
abciximab,eptif
ibati
de, ti
rofiban,
ticl
opidi
ne,anddextr
an.

DOSAGE
VTEPr
ophy
laxi
s
Subcut(Adul
ts):Kneer epl
acementsur gery
—30mgq12
hrstar
ti
ng12–24hraf t
ersurgeryfor7–10day s;Hip
repl
acement—30mgq12hrst ar
ti
ng12–24hrpost opor
40mgoncedai l
ystart
ing12hrbef oresur gery( ei
therdose
maybecont i
nuedf or7–14day s;continuedpr ophy l
axi
s
with40mgoncedai l
ymaybecont inuedf orupt o3wk) ;
Abdominalsurgery
—40mgoncedai l
yst ar
ti
ng2hrbef ore
surger
yandthencont i
nuedf or7–12day sorunt i
l

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1394
ambulat
ory(
upt
o14days)
;Medical
pati
ent
swi
thacut
e
i
ll
ness—40mgoncedai
l
yfor6–14days.
Subcut(I
nfant
sandChi
l
dren≥2mo—18y
r):
0.5
mg/kg/doseever
y12hr.
Subcut(
Inf
ant
s1–2mo)
:0.
75mg/
kg/
doseev
ery12hr
.

Tr
eat
mentofDVT/
PE
Subcut( Adults):Outpatient—1mg/ kgevery12hr.
War far
inshoul dbest artedwi t
hin72hr ;
enoxapari
nmay
becont i
nuedf orami nimum of5day sanduntil
therapeuti
cant icoagulationwithwar f
ari
nisachieved(I
NR
>2f or2consecut iv
eday s)
;Inpatient—1mg/ kgevery12hr
or1.5mg/ kgev ery24hr .War f
arinshoul dbestart
ed
within72hr ;enoxapar i
nmaybecont i
nuedforami ni
mum
of5day sorunt i
ltherapeuticanticoagulati
onwithwarfari
n
i
sachi eved(INR>2f ortwoconsecut i
vedays).
Subcut(I
nfant
sandChi
l
dren≥2mo—18y
r):
1
mg/kg/doseever
y12hr.
Subcut(
Inf
ant
s1–2mo)
:1.
5mg/
kg/
doseev
ery12hr
.
Unst
abl
eAngi
na/
Non–ST-
Segment
-El
evat
ionMI
Subcut(
Adul
ts)
:1mg/
kgq12hrf
or2–8day
s(wi
th
aspi
ri
n).
ST-
Segment
-El
evat
ionMI

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1395
IV:Subcut(Adults<75y r
):Admi ni
stersingl
eIVbolusof30
mgpl us1mg/ kgsubcutdose( maxi mum of100mgf or
fir
st2dosesonl y),f
oll
owedby1mg/ kgsubcutq12hr .
Theusual durati
onoft r
eatmenti s2–8day s.Inpat
ients
undergoingpercutaneouscor onaryinter
venti
on,i
flast
subcutdosewas<8hrbef or
ebal looninfl
ati
on,no
additi
onaldosingneeded; i
flastsubcutdosewas≥8hr
beforeball
ooni nf
lat
ion,administersingl
eIVbolusof0.3
mg/ kg.
Subcut(
Adult
s≥75y r)
:0.75mg/kgever
y12hr( noIV
bol
usneeded)(maximum of75mgf orf
irst2dosesonl
y;
noini
ti
albol
us).Theusualdur
ati
onoftr
eatmentis2–8
days.
Renal
Impai
rment
Subcut(Adult
sCCr<30mL/ min):VTEpr ophylaxi
sfor
abdominalorknee/hipreplacementsur gery—30mgonce
dai
ly.Treat
mentofDVT/ PE—1mg/ kgoncedai l
y.Unstabl
e
angi
na/non-ST-segment-elevationMI —1mg/ kgoncedai l
y.
AcuteST-segment -
elev
ationMI( pati
ents<75y r
)—Single
IVbolusof30mgpl us1mg/ kgsubcutdose, foll
owedby
1mg/ kgsubcutoncedai ly.Acut eST-segment -el
evati
on
MI(pati
ents≥75y r)
—1mg/ kgoncedai ly(noiniti
albolus)
.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1396
Sol
uti
onfori
njecti
on(pr
efi
ll
edsy
ringes)30mg/ 0.
3mL, 40
mg/0.
4mL, 60mg/ 0.
6mL, 80mg/0.8mL,100mg/ 1mL,
120mg/0.8mL, 150mg/1mL;Soluti
onfori
njecti
on
(mul
ti
dosevial
s)300mg/ 3mL;

PATI
ENTTEACHI
NG
Advi
sepat i
enttorepor
tanysy mpt omsofunusual
bl
eedingorbruisi
ng,di
zziness,
itching,
rash,
fev
er,
swell
ing,ordi
ff
icul
tybreathi
ngtoheal t
hcare
prof
essionali
mmedi at
ely.

I
nstr
uctpat
ientnottotakeaspir
in,napr
oxen,
or
i
buprof
enwithoutconsult
inghealt
hcareprof
essi
onal
whi
leonenoxapari
ntherapy.

Ent
acapone
I
NDI
CATI
ONS
Wi t
hlevodopa/carbi
dopatotreatidi
opat
hicPar ki
nson’
s
diseasewhensi gnsandsympt omsofend- of
-dose
"wearing-
off
"(so-cal
l
edfluct
uat i
ngpati
ents)occur.

ACTI
ON
Act
sasaselecti
veandr
eversi
blei
nhi
bit
oroftheenzyme
cat
echol
O-methyl
tr
ansf
erase(COMT).I
nhi
bit
ionofthi
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1397
enzymepr eventsthebreakdownofl evodopa,incr
easi
ng
avail
abil
i
tytotheCNS.Ther apeut
icEffects:Pr
olongs
durati
onofresponset olevodopawithend- of-
dosemotor
fl
uctuati
ons.Decreasedsignsandsy mptomsof
Parki
nson’sdisease.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rent
nonsel
ect
iveMAOi
nhi
bit
ort
her
apy
.

UseCaut
iousl
yin:
Hepat
ici
mpai
rment
;Concur
rentuse
ofdrugst
hataremetaboli
zedbyCOMT; OB:Lact
ati
on:
Safet
ynotest
abli
shed;Pedi:
Noident
if
ieduseinchi
ldr
en.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, dizzi
ness,
hal
luci nations,syncope, urges(gambl ing, sexual).Resp:
pulmonar yinfi
ltr
ates,pleuraleff
usion, pleuralthickening.
CV: hy potension.Derm: mel anoma.GI :abdomi nal pain,
col
itis, di
arrhea,nausea( duringinit
iati
on) ,retr
oper it
oneal
fi
brosi s.GU: brownish-orangediscol orationofur ine.MS:
RHABDOMYOLYSI S.Neur o:dyskinesia.

I
NTERACTI
ONS
Dr
ug-
Drug:
Concur
rentusewi
thsel
ect
iveMAOi
nhi
bit
orsi
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1398
notr ecommended; bothagentsinhibitthemet abol ic
pathway sofcat echolamines.Concur rentuseofdr ugs
thatar emet abolizedbyCOMTsuchasi soproter enol ,
epinephr i
ne, norepinephri
ne,dopami ne, dobutami ne, and
met hyldopamay↑ r i
skoftachycardia,↑ BP, and
arrhythmi as.Probeneci d,
cholesty
rami ne, er
ythr omy cin,
ri
fampi n, ampicill
in,andchlor
ampheni colmayi nter f
er e
withbi l
iaryeliminationofentacapone; useconcur rent l
y
withcaut ion.

DOSAGE
PO:(Adul
ts):200mgwit
heachdoseof
l
evodopa/car
bidopaupt
oamaximum of8t
imesdai
l
y.

AVAI
LABI
LITY
Tabl
ets200mg;
Incombi
nat
ionwi
th:
lev
odopa/
car
bidopa

PATI
ENTTEACHI
NG
Encouragepatientt
ot akeent
acaponeasdir
ect
ed.
Takemi sseddosesassoonaspossi bl
e,upto2hr
befor
et henextdose.Tapergradual
l
ywhen
di
scontinuingorawithdrawalr
eacti
onmayoccur.

Maycausedizzi
nessorhall
ucinat
ions.Advi
sepat
ient
t
oavoiddri
vi
ngorot heract
ivi
ti
esthatrequi
re

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1399
 al
ert
nessunt
ilr
esponset
othedr
ugi
sknown.

I
nform pati
entt
hatnauseamayoccur ,especiall
yat
i
niti
ati
onoftherapyanddi arr
hea.Adv i
sepat ientwit
h
di
arrheatodri
nkf l
uidstomai ntai
nadequat e
hydrat
ionandmoni torforweightloss.Ifdiarr
heais
pr
olonged,mayr esolvewithdisconti
nuation.Therapy
maycausechangei nurinecolortobrowni shorange.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto
mini
mizeor
thostat
ichy
pot
ensi
on.

Advisepati
enttonot
if
yheal thcareprof
essionalif
suspici
ousorunusualskinchanges,hal
luci
nations,or
newori ncr
easedgambling,sexual,
orotherint
ense
urgesoccur.

I
nstr
uctpat
ientt
onoti
fyhealt
hcareprofessi
onal
if
pr
egnancyi
splannedorsuspect
ed,orif
br
eastf
eedi
ng.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

Ent
ecav
ir
I
NDI
CATI
ONS
Chr
oni
chepat
it
isBi
nfect
ionwi
thev
idenceofact
ive

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1400
di
sease.

ACTI
ON
Phosphoryl
atedint
racel
lul
arl
ytoactiveform whichact
sas
ananalogueofguanosine,i
nter
fer
ingwi thvi
ralDNA
synt
hesis.Ther
apeuticEff
ects:
Decr easedhepatic
damageduet ochronichepati
ti
sBi nfecti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Lact
ati
on:
Pot
ent
ial
f
orser
iousadv
erseef
fect
sini
nfant
.

UseCaut
iousl
yin:
Renal
impai
rment(
doser
educt
ion
recommendedifCCr<50mL/ min; Li
vert r
ansplant
reci
pients(
car
efulmonitori
ngofr enalfunct i
on
recommended);Pati
entsco-infectedwi thHI V(unl
ess
recei
vinghi
ghl
yactiv
eant ir
etrovir
al t
her apy;at↑ ri
skfor
resi
stance)
;OB:Useonlyifclearlyneeded, consi
der
ing
benefit
sandri
sks;Pedi:Safetynotest ablishedinchil
dren
<16yr;Geri
:↑riskoftoxici
tyduet oage- r
elated↓ inrenal
funct
ion.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:di
zzi
ness,
fati
gue,headache.GI:
HEPATOMEGALY
(WI
THSTEATOSI S)
,dyspepsi
a,nausea.FandE:
LACTI
C

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1401
ACI
DOSI
S.Der
m:al
opeci
a,r
ash.

I
NTERACTI
ONS
Drug-
Drug:Concur
rentuseofdrugswhi
chmayi mpair
renal
funct
ionmay↑ bl oodl
evelsandr
iskoft
oxici
ty.

DOSAGE
PO:(
Adult
sandChi
ldren>16y
r):
0.5mgoncedai
l
y;hi
stor
y
ofl
amiv
udiner
esi
stance—1mgoncedai
l
y.
Renal
Impai
rment
PO: (
AdultsandChi l
dren>16y r):CCr30–50mL/ min—0.25
mgoncedai l
y,hist
oryofl
ami vudineresist
ance—0.5mg
oncedaily;CCr10–<30mL/ mi n—0.15mgoncedai l
y,
hist
oryoflamivudineresi
stance—0. 3mgoncedai ly;
CCr
<10mL/ min—0. 05mgoncedai ly
, hi
stor
yoflamivudi
ne
resi
stance—0.1mgoncedai l
y.

AVAI
LABI
LITY
Tabl
ets0.
5mg,
1mg;
Oral
sol
uti
on(
orange)0.
05mg/
mL;

PATI
ENTTEACHI
NG
Inst
ructpati
enttoreadthePati
entInf
ormat
ionwith
eachrefi
llandtotakeentecav
irasdir
ect
ed.Take

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1402
 mi sseddosesassoonaspossi bleunlessalmost
ti
mef ornextdose.Donotr unoutofent ecavi
r,get
mor ewhensuppl yrunslow.Donotdoubl edoses.
Emphasi zethei mpor t
anceofcompl iancewi t
hf ul
l
cour seoft herapy,nottakingmor ethant he
prescribedamount ,andnotdi scont
inuingwi t
hout
consul t
ingheal thcarepr ofessional
.Inform pati
ent
thathepat iti
sexacer bati
onmayoccurupon
discontinuationoft herapy.Caut i
onpat i
entnott o
shar emedi cationwi t
hot hers.

Inform pat i
entthatentecav i
rdoesnotcur eHBV
disease, butmayl owertheamountofHBVi nthe
body ,lowertheabi l
i
tyofHBVt omul ti
plyandi nf
ect
newl ivercells,andmayi mprovet heconditi
onoft he
l
iv er
.Ent ecavirdoesnotr educet heriskof
transmi ssionofHBVt oot hersthroughsexual contact
orbloodcont ami nati
on.Caut i
onpat i
enttousea
condom dur i
ngsexual contactandav oi
dshar i
ng
needl esordonat ingbloodt oprev entspreadingHBV
toot hers.

Advisepati
enttonot
if
yhealthcareprofessional
promptlyi
fsignsofl
acti
cacidosis(weaknessor
ti
redness;
unusualmusclepain;
troubl
ebr eathi
ng;
stomachpainwithnauseaandv omiti
ng;feeli
ngcol
d,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1403
 especial
l
yinarmsorlegs;dizzi
ness,fastori
rr
egul
ar
heart
beat)orhepat
otoxi
city(j
aundice,dar
kuri
ne,l
ight
-col
oredbowelmov ements,anorexi
a,nausea,
lower
stomachpain)occur.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advi
sepati
entt
oconsulthealt
hcareprofessi
onal
bef
oret
akingot
herRx,OTC, orher
balproduct
swith
ent
ecav
ir.

Discussthepossi
bil
i
tyofhai
rlosswi
thpat
ient
.
Exploremethodsofcopi
ng.

Advi
sepati
entt
onotif
yhealt
hcarepr
ofessi
onalif
pr
egnancyi
splannedorsuspect
edori
fbreast
feeding.

Emphasizetheimpor
tanceofr
egul
arfol
low-
upexams
andbloodtest
stodetermi
neprogr
essandmonit
or
forsi
deeffect
s.

Epi
rubi
cin
I
NDI
CATI
ONS
Acomponentofadj
uvantt
her
apyf
orev
idenceofaxi
l
lar
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1404
tumorinv
olv
ementf
oll
owi
ngr
esect
ionofpr
imar
ybr
east
cancer
.

ACTI
ON
Inhi
bit
sDNAandRNAsy nthesi
sbyformi
ngacompl
ex
withDNA.Therapeut
icEff
ects:Deat
hofr
api
dlyr
epl
i
cat
ing
cell
s,par
ti
cul
arlymal
ignantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oepi
rubi
cin,
other
anthracycl
ines,orrelat
edcompounds; Baselineneutrophil
count<1500cel ls/mm3; Severemy ocardiali
nsuf f
ici
ency
orrecentMI ;Pr
ev i
ousant hr
acycli
nesupt othemaxi mum
cumul at
ivedose; Severehepati
cdy sfuncti
on; Concurr
ent
ci
met idi
net her
apy ;OB:Lactat
ion:Signif
icantriskforfet
al
orinfantharm.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease,
pri
oror
concomi t
antradiat i
ontherapyt omedi asti
nalorpericardial
area,previ
ousther apywithant hracycli
nes,orconcomi tant
useofcar di
otoxicdr ugs(↑r iskofcar diot
oxici
ty)
;Sev ere
renalimpair
ment( serum creati
nine>5mg/ dL);
consi der↓
dose;Hepat i
cimpai rment(dose↓ r ecommendedf or
bil
ir
ubin>1.2mg/ dLorAST>2–4t i
mesupperl imitof
normal);Depressedbonemar rowr eserve;
OB: Warn

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1405
patientswit
hchildbeari
ngpot ent
ial
toavoidpregnancy
duringtreat
ment ;Pedi:
Safetynotestabl
i
shed;↑r iskof
acut ecardi
otoxi
cityandchronicHF;Geri
:↑r i
skoft oxi
cit
y
i
nf emal epati
ents≥70y r.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: l
ethargy .CV: CARDI OTOXI CITY( dose-related).GI:
nausea,vomi ting, anor exi
a,diarrhea,mucosi ti
s.Der m:
alopeci
a,flushing, itching,photosensitivi
ty,
r adiati
on- r
ecal
l
reacti
on,rash, skin/ nailhyper
pi gment at
ion.Endo: gonadal
suppressi
on.Hemat :LEUKOPENI A,anemia,
thrombocy topeni a,treatment-related
l
eukemi a/my elody spl asti
csyndr omes.Local :
injectionsit
e
reacti
ons,phlebi tisatI Vsite,
tissuenecr osis.Met ab: hot
fl
ashes,hy peruricemi a.Mi sc:ANAPHYLAXI S,INFECTI ON.

I
NTERACTI
ONS
Drug-Dr ug: Cimetidi
ne↑ bl oodlevelsandr i
skofser ious
toxi
city;av oidconcur rentuse.Addi ti
vehemat ol
ogicand
gastrointest i
nal t
oxici
tywi thotherantineoplasticsor
radiati
ont her apy.Usewi t
hot hercardiot
oxicdr ugsmay↑
ri
skofcar diotoxicit
y;avoidconcur rentuse.May↓
anti
bodyr esponset olive-
virusvaccinesand↑ r i
skof
adverser eact ions.Trastuzumabmay↑ r iskof
cardiotoxicity;avoidepirubicinfor≥24wkaf terstopping

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1406
t
rast
uzumabt
her
apy
.

DOSAGE
IV:(Adults):100–120mg/ m2r epeat
edin3–4wkcy cl
es
(totaldosemaybegi v
enonday1orspl i
tandgivenin
equal l
ydivi
deddosesonday1andday8ofeachcy cle
(combi nati
onregimensmayempl oyconcur
rent5-
fluorouraci
landcyclophosphamide).
Hepat
icI
mpai
rment
I
V: (
Adults):
Bil
ir
ubi
n1.2–3mg/dLorAST2–4times
upperli
mitofnormal
—use50%ofrecommendedstart
ing
dose;bi
li
rubi
n>3mg/ dLorAST>4ti
mesupperli
mitof
normal—use25%ofrecommendedstar
ti
ngdose.

AVAI
LABI
LITY
Powderf
ori
nject
ion50mg/
vial
;Sol
uti
onf
ori
nject
ion(
red)
2mg/mL;

PATI
ENTTEACHI
NG
I
nstructpati
entt onot if
yhealt
hcar eprof
essi
onal
pr
ompt lyi
ffev er;
sor et hr
oat;
si gnsofinf
ecti
on;
bl
eedinggums; bruising;pet
echi ae;bl
oodinstool
s,
ur
ine,oremesi s;increasedfatigue;dyspnea;
or
or
thostati
chy potensionoccur s.Caut i
onpati
entto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1407
 avoidcrowdsandper sonswi thknowninfect
ions.
Instr
uctpatienttousesof ttoothbr
ushandelect r
ic
razorandt oavoidfall
s.Patientshoul
dbecaut ioned
nottodr i
nkalcoholi
cbev eragesortakemedi cati
on
containi
ngaspi r
inorNSAI Ds,becausethesemay
precipi
tat
egast ri
cbleeding.

I
nst
ructpat
ientt
orepor
tpai
nati
nject
ionsi
te
i
mmediatel
y.

Instr
uctpatienttoinspectoral mucosaf oreryt
hema
andul cerat
ion.I
fulcerati
onoccur s,advisepati
entt o
usespongebr ush,ri
nsemout hwithwat eraft
ereating
anddr inki
ng,andconf erwit
hheal thcarepr of
essional
i
fmout hpaininter
fereswitheat i
ng.Painmayr equir
e
treat
mentwi t
hopioidanalgesics.Patientsusually
recoverbyt hethir
dweekoft herapy.

Adv i
sepat i
entthatthi
smedi cati
onmayhav e
teratogenicef f
ects.Contracept
ionshoul dbeused
duringandf oratleast4moaf t
ertherapyis
concl uded.Inform pati
entbeforeini
tiati
ngther
apy
thatthismedi cationmaycausei r
reversi
blegonadal
suppr ession.

Instr
uctpati
entt
onotifyheal
thcarepr
ofessional
of
allRxorOTCmedi cat
ions,vi
tami
ns,orherbal
productsbei
ngtakenandt oavoi
dconcurr
entuseof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1408
 al
coholorOTCmedicati
onsandher bal
products,
especi
all
ycol
dpreparat
ions,wit
houtconsulti
ng
heal
thcarepr
ofessi
onal,especi
all
ycimeti
dine.

I
nstructpatienttonoti
fyhealt
hcar eprof
essional
i
mmedi atel
yifvomiti
ng,dehydrat
ion,f
ever,evidence
ofinfecti
on,symptomsofHF, orpainati
njecti
onsi t
e
occurs.Patient
sshouldbei nf
ormedoft her i
skof
i
rreversi
blecardiacdamageandt reatment-
related
l
eukemi a.

Discussthepossibi
li
tyofhai
rlosswit
hpati
ent
.
Exploremethodsofcoping.Regrowt
husual
lyoccur
s
2–3moaf t
erdiscont
inuat
ionofther
apy.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Inf
orm pati
entthatmedi
cat
ionmaycauseur
inet
o
appearredfor1–2days.

Instr
uctpati
enttonoti
fyheal
thcareprofessional
if
skinirr
it
ati
onoccursatsit
eofprevi
ousradiat i
on
therapy.Maycausehyperpi
gmentati
onoft heskin
andnai l
s.Advi
sepati
enttousesunscreenand
protecti
veclot
hingt
opreventphot
osensitivi
ty
reacti
ons.

Adv
isepat
ientt
hatt
hismedi
cat
ionmayhav
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1409
 teratogenicef f
ects.Contracept
ionshoul dbeused
duringandf oratleast4moaf t
ertherapyis
concl uded.Inform pati
entbeforeini
tiati
ngther
apy
thatthismedi cationmaycausei r
reversi
blegonadal
suppr ession.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Epl
erenone
I
NDI
CATI
ONS
Hyper
tensi
on(al
one,orwi
thot
heragent
s).LVsy
stol
i
c
dy
sfuncti
onandevi
denceofHFpost-
MI.

ACTI
ON
Blockstheeffect
sofaldoster
onebyat t
achingto
mineralocor
ti
coidreceptor
s.Therapeut
icEffect
s:
Lower i
ngofBP.Impr ovessur
vivali
npatient
swi t
h
evidenceofHFpost -
MI .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Ser
um pot
assi
um >5.
5mEq/
L;Ty
pe
2di
abet
eswithmicroal
bumi
nur
ia(forpati
ent
swi
thHTN;
↑ri
skofhyperkal
emia)
;Ser
um cr
eatini
ne>2mg/
dLin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1410
malesor>1. 8mg/ dLi nfemal es(forpatient swithHTN);
CCr≤30mL/ mi n(forallpatients)
;CCr<50mL/ min(for
pati
entswithHTN) ;Concur rentuseofpot assium
supplementsorpot assium-spar i
ngdiuretics( forpati
ent
s
wit
hHTN) ;Concurrentuseofst ronginhibitorsoft he
CYP3A4enzy mesy stem (ketoconazole,i
t raconazole,
nefazodone,clari
thromy cin,ri
tonavir
,ornel f
inavir
);
Lactati
on:Lactati
on.

UseCaut
iousl
yin:
Sev
erehepat
ici
mpai
rment
;OB:
Use
onl
yifcl
ear
lyneeded;
Pedi
:Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness, f
atigue.GI:
abnor mall
iverfuncti
ontests,
abdominal pain,diarr
hea.GU:albuminuria.Endo:abnormal
vagi
nalbleedi ng,gynecomasti
a.FandE: HYPERKALEMI A.
Metab:hyper cholesterol
emia,
hy per
tri
glyceri
demia.Misc:
fl
u-l
i
kesy mpt oms.

I
NTERACTI
ONS
Drug-Dr ug:Concurrentuseofstr
ongi nhi
bitor softhe
CYP3A4enzy mesy stem (
ket
oconazol e,
itraconazole,
nefazodone, clar
it
hr omyci
n,r
it
onav i
r,ornel f
inavi
r)
si
gnificantly↑ effectsofepl
enerone;concur rentuse
contraindicat
ed.Concur r
entuseofweaki nhibit
orsofthe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1411
CYP3A4enzy mesy stem (
erythromy ci
n,saquinavi
r,
fl
uconazole,verapami l
)may↑ ef fectsofeplerenone;
i
niti
aldoseofepl erenoneshoul dbe↓ by50%.NSAI Ds
may↓ ant ihypert
ensiveeffects.ConcurrentuseofACE
i
nhibit
orsorAngi otensinI
Ireceptorblockersmay↑ r i
sk
ofhyperkalemia.

DOSAGE
Hy
per
tensi
on
PO:(Adults):50mgdailyini
ti
all
y;maybe↑ t o50mg
twi
cedaily;Pati
entsr
eceivi
ngconcur r
entmoderate
CYP3A4i nhibi
tor
s(er
ythromycin,saqui
navi
r,v
erapami
l
,
fl
uconazole)—25mgoncedai lyini
ti
all
y.
HFPost
-MI
PO:(Adult
s):25mgdai l
yini
ti
all
y;↑in4wkt o50mgdai
l
y;
subsequentdoseadjust
mentsmayneedt obemade
basedonserum potassi
um concent
rat
ions.

AVAI
LABI
LITY
Tabl
ets25mg,
50mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakemedi
cat
ionasdi
rect
edatt
he

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1412
 samet
imeeachday
,ev
eni
ffeel
i
ngwel
l
.

Encouragepat ienttocomplywithaddit
ional
i
nterventionsforhypertensi
on(weightreduct
ion,
di
scont i
nuat i
onofsmoki ng,moderati
onofalcohol
consumpt i
on,regul
arexerci
se,st
ressmanagement ).
Medicationcont rol
s,butdoesnotcure,hyper
tensi
on.

Instr
uctpatientandfamil
yoncorr
ectt
echni
quefor
moni t
oringBP.Adv i
sethem t
omonit
orBPatleast
weekly ,
andnot i
fyheal
thcar
eprof
essi
onalof
signi
ficantchanges.

Inf
orm pat
ientnottousepotassi
um supplements,
sal
tsubsti
tutescontai
ningpot
assium,orotherRx,
OTC,orherbalproduct
swi t
houtconsul
ti
nghealth
carepr
ofessional
.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advisepatienttonot
ifyhealt
hcareprofessi
onal
if
di
zziness,diarr
hea,v
omi t
ing,rapi
dorir
regul
ar
heartbeat
,lowerextr
emityedema, ordi
ffi
cul
ty
breathi
ngoccur .

Advi
sepat
ienttoi
nfor
m heal
thcar
eprof
essi
onalof
tr
eat
mentregimenpri
ort
ot r
eat
mentorsur
gery
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1413
 Advi
sepatienttonotif
yhealt
hcar eprof
essi
onalif
pr
egnancyispl annedorsuspected.Advi
sepat
ientto
avoi
dbreastfeedingduri
ngtherapy.

Emphasizetheimpor
tanceoff
oll
ow-
upexamst
o
checkserum pot
assi
um.

Epoet
in
I
NDI
CATI
ONS
Anemi aassociatedwi t
hchr onicki
dneydisease(CKD).
Anemi asecondar ytozidovudine(AZT)therapyinHIV-
i
nfectedpatients.Anemi afrom chemotherapyinpati
ents
withnonmy eloi
dmal i
gnancies.Reducti
onofneedf or
al
logeneicredbl oodcelltr
ansfusionsinpatient
s
undergoingelective,
noncardiac,nonvascul
arsurgery.

ACTI
ON
Sti
mul at
esery
thropoi
esi
s(product
ionofr
edbloodcel
l
s).
Therapeuti
cEff
ects:Mai
ntai
nsandmayel ev
ateRBCs,
decreasi
ngtheneedfortr
ansfusi
ons.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oal
bumi
nor
mammal
i
ancel
l
-der
ivedpr
oduct
s;Uncont
rol
l
ed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1414
hypertensi
on;Pati
entswi t
herythr
opoieti
nlevel
s>200
mUnits/ mL;Pati
ent
sr ecei
vingchemot her
apywhen
anti
cipatedoutcomeiscur e;Neut
ropeniainnewborns.

UseCaut
iousl
yin:
Hist
oryofsei
zur
esorst
roke;
Cardiovasculardisease;Hist
oryofporphyri
a;OB: Evi
dence
offetalharmi nanimal st
udies—useonlyifpotential
benefitoutweighspot ent
ialr
isktofet
us;OB: Lactati
on:
Li
ttl
epubl i
shedi nformati
on,however,ery
thropoetinalf
ais
anor malconst i
tuentofbreastmil
k;Pedi:
Mul ti
-dosevial
s
containbenzy lal
cohol,whichcancausepot ential
lyf
atal
gaspingsy ndromei nneonates.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, headache.CV:CHF,MI,STROKE,
THROMBOEMBOLI CEVENTS( especi
all
ywithhemoglobi
n
>11g/ dL),hypertensi
on.Derm:tr
ansientr
ashes.Endo:
rest
oredf er
ti
li
ty,resumptionofmenses.Misc:↑ mortal
i
ty
and↑ t umorgr owth(withhemoglobi
n≥12g/ dL).

I
NTERACTI
ONS
Drug-
Drug:
May↑ r equi
rementf
orhepar
inant
icoagul
ati
on
duri
nghemodi
aly
sis.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1415
Anemi
aofCKD
(
Donoti
nit
iat
eifhemogl
obi
n≥10g/
dL)
SubcutIV:(Adult
s):50–100uni t
s/kg3t i
mesweekl y
i
niti
all
y;uselowestdosesuf fi
cientto↓ theneedf orr
ed
bl
oodcel lt
ransfusi
ons( donotexceedhemogl obi
nof10
g/dL[pati
entsondialysis]or11g/ dL[pat
ientsnoton
di
alysi
s]);i
fHgb↑ by>1. 0g/dLin2wk, ↓ doseby25%; i
f
Hgb↑ by<1. 0g/dLafter4wkoft her
apy( wi
thadequate
i
ronstores),↑ doseby25%; donot↑ dosemor e
fr
equentlythanq4wk.
SubcutIV:(Children1mo- 16yr):50uni
ts/kg3times
weeklyinit
iall
y;usel owestdosesuf f
ici
entto↓ t heneed
forr
edbl oodcel ltransf
usions(donotexceedhemogl obi
n
of10g/ dL[ pat
ientsondi aly
sis]or11g/dL[patientsnot
ondialysi
s]));i
fHgb↑ by>1. 0g/ dLin2wk, ↓ doseby
25%;ifHgb↑ by<1. 0g/dLaf t
er4wkoft herapy( wit
h
adequateironst ores),↑ doseby25%; donot↑ dose
moref r
equent l
yt hanq4wk.

Anemi
aSecondar
ytoAZTTher
apy
SubcutIV:(
Adult
s):100uni
ts/
kg3timesweeklyfor8wk;
i
finadequater
esponse,may↑ by50–100uni
ts/kgever
y
4–8wk( max:300units/
kg3ti
mesweekly)
.
SubcutI
V:(
Chi
l
dren8mo-
17y
r):
50–400uni
ts/
kg2–3

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1416
t
imesweekl
y.

Anemi
afr
om Chemot
her
apy
(Useonl yforchemot
her
apy -
rel
atedanemiaand
disconti
nuewhenchemot herapycour
seiscomplet
ed;
do
notinit
iateifhemogl
obi
n≥10g/ dL)
Subcut( Adults) :150uni
ts/kg3t imesweeklyor40, 000
unitsweekly ;adjustdosetomai ntai
nlowesthemogl obin
l
ev elsuffi
cienttoav oi
dbloodt ransf
usions(donotexceed
hemogl obinof12g/ dL);
ifHgb↑ by>1. 0g/dLin2wkor
reachesal evel neededtoav oidredbloodcell
transfusions,
↓ doseby25%; i
fHgb↑ by<1. 0g/dL(andremai ns<10
g/dL)afteriniti
al 4wkoft herapy(wit
hadequat ei
r on
stores),
↑ doset o300units/kg3t i
mesweekl yor60, 000
unitsweekly .
IV: (
Children5—18y r
):600units/kgweekl y;adjustdoseto
mai ntainlowesthemoglobinlevel suffi
cienttoav oi
dblood
transfusions(donotexceedhemogl obinof12g/ dL);
if
Hgb↑ by>1. 0g/ dLi
n2wkorr eachesal evelneededt o
av oi
dr edbloodcellt
ransfusi
ons, ↓ doseby25%; i
fHgb↑
by<1. 0g/ dL(andremains<10g/ dL)af terini
ti
al 4wkof
therapy( wit
hadequateironstores) ,↑ doset o900
uni t
s/kg( maximum =60,000uni ts)weekl y.
Sur
ger
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1417
Subcut(Adul
ts):300unit
s/kg/dayfor10day sbef
ore
sur
gery,dayofsurger
y,and4day safteror600unit
s/kg
21,14,and7daysbeforesurgeryandondayofsur gery
.

AVAI
LABI
LITY
I
nject
ion2000uni
ts/
mL,3000uni
ts/mL,4000unit
s/mL,
10,
000units/
mL,20,
000uni
ts/
mL, 40,
000uni
ts/mL;

PATI
ENTTEACHI
NG
Advisepatienttoreadt
heMedi cati
onGui depri
orto
i
niti
at i
ngtherapyandwit
heachRxr ef
il
lincaseof
changes.Pat i
entmustsignthepati
ent-healt
hcar
e
provideracknowledgmentform bef
oreeachcour seof
ther
apy .

Expl
ainr
ati
onal
eforconcur
renti
ront
her
apy
(i
ncr
easedredbl
oodcellpr
oduct
ionr
equi
resi
ron)
.

Discusswaysofprevent
ingsel
f-
inj
ur yi
npatient
sat
ri
skforsei
zures.Dri
vi
ngandactivi
ti
esr equi
ri
ng
conti
nuousalert
nessshoul
dbeav oided.

Inf
orm pati
entthatuseofepoeti
nmayresul
tin
short
enedov er
allsur
viv
aland/or↓ t
imetotumor
progr
ession.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1418
 i
mmedi atelyi fsi gnsofbl oodcl ots( chestpai n,
tr
oublebr eat hingorshor tnessofbr eath,paininthe
l
egs, withorwi thoutswel li
ng;acool orpalear m orl
eg,
suddenconf usi on, t
roublespeaki ngort r
ouble
understandi ngot hers’speech, suddennumbnessor
weaknessi nt hef ace, arm, orl
eg, especiallyonone
si
deoft hebody , suddent roubleseei ng,sudden
tr
oublewal king, dizziness,lossofbal anceor
coordinati
on, lossofconsci ousnessorf ainti
ng,
hemodi alysisv ascul araccessst opswor king)occur.

Advi
sepatienttoi
nform heal
thcar
eprofessi
onal
of
medicat
ionpriort
otreat
mentorsurgery
.

Discusspossibl
ereturnofmensesandf er
til
i
tyin
womenofchi l
dbeari
ngage.Pat
ientshoulddiscuss
contracept
iveopti
onswithheal
thcareprofessional
.

Anemi aofChr oni

cRenal Failure:Stressimpor t
ance
ofcompl iancewi t
hdi etaryrestri
ctions,medi cations,
anddi al
ysis.Foodshi ghinironandl owi npot assium
i
ncl udeli
ver ,
pork,veal,beef,must ardandt ur ni
p
greens,peas, eggs,broccoli,kale,blackberr
ies,
strawberries,appl
ej ui
ce,wat ermel on,oatmeal ,and
enrichedbr ead.Epoetinwi l
lresultinincreasedsense
ofwel l
-being,butitdoesnotcur eunder lyi
ngdi sease.

HomeCar
eIssues:
Homedi
aly
sispat
ient
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1419
 deter
mi nedt obeablet osafelyandeff
ectivel
y
administerepoetinshouldbet aughtproperdosage,
administrat
iontechnique,anddisposalofequipment.
Inf
ormat i
onf orHomeDi al
ysisPati
entsshouldbe
provi
dedt opat i
entalongwithmedi cat
ion.

Epopr
ost
enol
I
NDI
CATI
ONS
Pul
monar
yar
ter
ial
hyper
tensi
on(
WHOGr
oup1)
.

ACTI
ON
Aprostaglandi
nthatdir
ectl
ydil
atespul
monar yand
syst
emi carter
ial
vascul
atur
e.Alsoinhi
bit
splatel
et
aggregati
on.Therapeut
icEff
ect
s: I
mprovedexerci
se
capacit
y.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oepopr
ost
enol
or
si
milarcompounds;HFduet osever
elef
tvent
ri
cul
ar
syst
oli
cdysfunct
ion;Pati
entswhodevel
oppul
monary
edemaduringdoseinit
iat
ion.

UseCaut
iousl
yin:
Ger
i:Doseadj
ust
ment
smaybe
necessar
y;OB:
Lact
ati
on:
Pedi
:Saf
etynotest
abl
i
shed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1420
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: anxiety
,headache, di
zziness.Resp: dyspnea,
pulmonar yedema.CV: t
achy cardia,chestpain,
hypotension,bradycar
dia.GI: nausea, vomit
ing,abdominal
pain,
di arr
hea.Derm: f
lushing, r
ash.MS: myalgi
a, j
awpain.
Hemat : bl
eeding,t
hrombocy topeni a.Neuro:
hypesthesia/hyperest
hesia/par esthesi
a.Misc:flu-
li
ke
sympt oms, i
nject
ionsitereact i
ons, sweati
ng.

I
NTERACTI
ONS
Drug-
Drug:Additi
vehypotensionmayoccurwi th
anti
hyper
tensiv
es,diur
eti
cs, orot
hervasodil
ator
s.
Alt
houghconcur r
entuseiscommonandaccept ed,
riskof
bl
eedingmaybe↑ byant icoagul
antsorotheragents
aff
ecti
ngplatel
etfunct
ion.May↑ l evel
sofdigoxin.

DOSAGE
IV:(
Adults):I
nitiateat2ng/ kg/min;may↑ by2
ng/kg/minever y15mi norlongerunt i
ldose-l
imiti
ng
adverseeff
ects( e.g.nausea, vomiti
ng,headache,
abdominalpain, fl
ushing,ordy spnea)orat ol
erancetothe
eff
ectsofthedr ugar enot ed.Ifdose-l
i
mi t
ingadv er
se
eff
ectsoccur,infusionr at
emaybe↓ i ndecrement sof2
ng/kg/minatint er
v al
sofatl east15mi n.Changesi n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1421
i
nf usi
onr at
eshouldbebaseduponper si
stance,
recurr
ence, orworseni
ngofsymptomsand/ oremer
gence
ofadv ersereact
ions.Abr
uptwit
hdrawalorlar
ge
reductionsininf
usionrat
eshoul
dbeav oided.

AVAI
LABI
LITY
Powderf
ori
nject
ion0.
5mg/
vial
,1.
5mg/
vial
;

PATI
ENTTEACHI
NG
HomeCar eIssues:I
nst
ructpat
ientonr
econsti
tut
ion,
admini
str
ati
on, andcar
eofthepermanentcent
ral
venouscat
heter.

Adv i
sepat i
entoft heimpor tanceofcont inuous
therapy.Inform pat i
entt hatev enbriefint errupti
onsof
theinfusionmaycausesy mpt omsofr ebound
pulmonar yhy pertension( dyspnea,dizziness,
asthenia).Prov i
depat i
entwi t
haccesst oabackup
i
nfusionpumpandi nt r
av enousi nf
usionset st o
preventpot entiali
nter r
upt ionsindrugdel ivery.Al
so
i
nfor m pati
ent sthatt herapymaybepr ol onged,
possiblylasti
ngy ear s.

Epr
osar
tan

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1422
I
NDI
CATI
ONS
Al
oneorwit
hotheragent
sint
hemanagementof
hy
pert
ensi
on.

ACTI
ON
Blocksthevasoconstri
ctorandaldosterone-secret
ing
effect
sofangiotensi
nIIatv ar
iousreceptorsites,i
ncl
udi
ng
vascularsmoothmuscl eandtheadr enalglands.
Therapeuti
cEffects:
Lower i
ngofBPi npati
entswi t
h
hypertensi
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pr
egnancyorl
act
ati
on.

UseCaut
iousl
yin:
Vol
ume-orsal
t-
depl
etedpat
ient
sor
patient
srecei
vinglargedosesofdi ureti
cs( cor
rectdefici
ts
beforeini
ti
ati
ngtherapy )
;Blackpati
ent s(maynotbeas
effecti
ve)
;Impair
edr enalfuncti
oncausedbypr i
mar yrenal
diseaseorheartfai
lure(maywor senr enalfuncti
on);
Womenofchi l
dbearingpot ent
ial
;Pedi:Safetynot
establi
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1423
CNS:depressi
on,fati
gue.CV:hypotensi
on.EENT:
phar
yngit
is,r
hini
ti
s.FandE: hyperkal
emia.GI:
abdomi
nal
pai
n.GU:impairedrenalf
uncti
on.MS: pai
n.Misc:
ANGIOEDEMA.

I
NTERACTI
ONS
Drug- Drug:Addi
tivehypot ensi
onwi thother
antihyper t
ensi
ves.Excessi vehypot ensi
onmayoccurwi th
concur r
entuseofdiuret
ics.↑ r iskofhy perkalemiawit
h
concur r
entuseofpotassi um suppl ement s,
potassi
um-
cont aini
ngsaltsubsti
tutes,angiotensin-converti
ngenzyme
i
nhi bit
or s,
orpotassi
um- spar i
ngdi ureti
cs.NSAI Dsand
selectiveCOX-2inhibi
torsmaybl unttheant i
hypert
ensi
ve
eff
ectand↑ t heriskofr enaldysf uncti
on.

DOSAGE
PO:(
Adults):
600mgoncedail
ywhenusedas
monother
apyinpat
ient
swhoarenotvol
umedeplet
ed;
maybe↑ t o800mg/day(
in1–2div
ideddoses)
.
Renal
Impai
rment
PO:
(Adult
s):
CCr<60mL/
min—Donotexceed600
mg/day
.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1424
Tabl
ets400mg, 600mg;
Incombi
nat
ionwi
th:
hydr
ochl
orot
hiazide

PATI
ENTTEACHI
NG
Emphasizet hei mportanceofcont i
nuingtotakeas
dir
ected,eveni ffeeli
ngwel l
.Takemi sseddosesas
soonasr emember edi fnotalmostti
mef ornextdose;
donotdoubl edoses.I nstructpati
enttotake
medicati
onatt hesamet i
meeachday .Warnpati
ent
nottodiscont i
nuet herapyunlessdir
ectedbyhealth
careprofessional.

Cautionpat i
enttoavoidsaltsubsti
tutescont
aini
ng
potassium orfoodscontaininghighlevel
sof
potassium orsodium unl
essdi r
ectedbyhealthcare
professional
.

Encour agepatientt
ocompl ywithadditi
onal
i
nterventionsforhypertension(weightreduct
ion,l
ow-
sodium diet,di
scontinuati
onofsmoki ng, moderat
ion
ofalcohol consumption, r
egularexer
cise,st
ress
management ).Medicationcontrol
sbutdoesnotcur e
hypertension.

I
nstr
uctpat
ientandfamil
yonpr opertechni
quefor
monit
ori
ngBP.Adv i
sethem tocheckBPatl east
weekl
yandtoreportsi
gnif
icantchanges.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1425
Cautionpat ienttoavoidsuddenchangesi nposit
ion
todecr easeor thost
atichypotension.Useofal
cohol,
standingf orlongperiods,exercisi
ng,andhotweather
mayi ncreaseor t
hostati
chypot ensi
on.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Instr
uctpati
enttonot i
fyhealt
hcar epr
of essionalof
allRxorOTCmedi cati
ons,vit
amins,orher bal
productsbeingtakenandconsul theal
thcar e
professi
onalbeforetakinganynewmedi cations,
especial
lycough,cold,oral
lergyremedies.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Inst
ructpat
ientt
onotif
yhealt
hcareprof
essi
onali
f
swell
ingofface,
eyes,l
ips,
ortongueori
fdif
fi
cul
ty
swallowi
ngorbreat
hingoccur.

Advisewomenofchi l
dbeari
ngaget ouse
contracepti
onandnot i
fyheal
thcarepr ofessi
onalif
pregnancyissuspectedorplanned,orif
breastfeedi
ng.I
fpregnancyisdetected,discont
inue
medi cati
onassoonaspossi bl
e.

Emphasi
zet
hei
mpor
tanceoff
oll
ow-
upexamst
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1426
 ev
aluat
eef
fect
ivenessofmedi
cat
ion.

Ept
if
ibat
ide
I
NDI
CATI
ONS
Acut ecor onarysy ndrome( unstableangi
na/non–Q-wave
MI ),
includingpat i
ent swhowi llbemanagedmedi cal
lyand
thosewhowi llundergoper cutaneouscoronary
i
nt erventi
on( PCI)t hatmayconsi stofpercut
aneous
transluminal angioplasty(PCTA)orat her
ectomy .
Treatmentofpat i
ent sundergoingPCI.Usuall
yused
concur rentl
ywi thaspi r
inandhepar in.

ACTI
ON
Decreasesplateletaggregati
onbyr ev ersibl
yantagonizi
ng
thebindingoffibri
nogent otheglycopr oteinII
b/I
II
a
bindi
ngsi t
eonpl atel
etsurfaces.Ther apeuticEff
ects:
I
nhibiti
onofplateletaggregati
onr esulti
ngi ndecreased
i
ncidenceofnewMI ,deat
h,orrefractoryischemia,
reducingtheneedf orrepeaturgentcar diacinter
venti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Act
ivei
nter
nal
bl
eedi
ngorhi
stor
yofbl
eedi
ngwi
thi
npr
evi
ous30day
s;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1427
Sev er
euncont rolledhy pertension(systolicBP>200mm
Hgand/ ordi
ast olicBP>110mm Hg) ;Maj orsur gical
procedur ewit
hin6wk; Historyofhemor rhagicst rokeor
otherstrokewi t
hi n30day s;Concurrentuseofot her
glycoprotei
nIIb/ I
IIareceptorant agonists;Plateletcount
<100,000/ mm3; Severerenal insuff
ici
ency( ser um
creati
nine≥4mg/ dL)ordependencyonr enaldi al
y si
s.

UseCaut
iousl
yin:
Ger
i:↑r
iskofbl
eedi
ng;
Renal
i
nsuff
ici
ency(↓i nf
usionrateifCCr<50mL/ min);OB:
Pedi
:Pregnancy,
lactat
ion,orchi
ldr
en(safet
ynot
est
abli
shed;useinpregnancyonlyi
fclear
lyneeded).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Not
edforpati
ent
srecei
vi
nghepar
inandaspi
ri
ninaddi
ti
on
t
oepti
fi
bati
de
CV: hy
potension.Hemat:BLEEDI
NG(incl
udi
ngGIand
i
ntracrani
albleeding,
hematur
ia,
andhematomas)
,
thr
ombocy topenia.

I
NTERACTI
ONS
Drug-
Drug:↑r i
skofbleedingwi thotherdrugsthataff
ect
hemostasi
s(hepar
ins,war f
arin,NSAI Ds,t
hrombolyt
ic
agent
s,abci
ximab,dipyr
idamol e,ti
clopidi
ne,cl
opi
dogrel,
somecephalospor
ins,valproates).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1428
Drug-NaturalPr
oduct
:↑ bleedingri
skwitharni
ca,
chamomi le,cl
ove,
dongquai,fever
few,garl
i
c,ginger
,
ginkgo,andPanaxginseng.

DOSAGE
Acut
eCor
onar
ySy
ndr
ome
IV:
( Adul
ts≤121kg):180mcg/
kgasabol usdose,
fol
l
owedby2mcg/ kg/mi
nunt
ilhospi
tal
dischar
geor
surgical
int
ervent
ion(upt
o72hr).

Per
cut
aneousCor
onar
yInt
erv
ent
ion
I
V:( Adul
ts):180mcg/ kgasabolusdose,i
mmedi atel
y
beforePCI,f
ollowedby2mcg/ kg/mi
ninfusi
on; asecond
bol
usof180mcg/ kgisgi
ven10minafterfi
rstbolus;
i
nfusionshouldcontinuef
or18–24orhospitaldischarge
(minimum of12hr ).
Renal
Impai
rment
(AdultsCCr<50mL/ min)
:180mcg/kgbolusfol
lowedby1
mcg/ kg/mi
ninfusi
on;secondbol
usof180mcg/ kgis
given10mi naf
terfi
rstbol
usforpat
ient
sundergoi
ngPCI.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion20mg/
10mL,
75mg/
100mL,
200
mg/100mL;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1429
PATI
ENTTEACHI
NG
I
nfor
m pat
ientoft
hepur
poseofept
if
ibat
ide.

I
nst
ructpat
ientt
onoti
fyheal
thcareprof
essi
onal
i
mmediatel
yifanybl
eedi
ngisnoted.

Er
gocal
cif
erol
I
NDI
CATI
ONS
Treat
mentoffamili
alhypophosphat
emia.Tr
eatmentof
hypoparat
hyr
oidi
sm.Treatmentofvit
aminD-r
esist
ant
ri
ckets.

ACTI
ON
Requiresact iv
ati
oni nthel
iverandkidneystocreatet
he
activ
ef orm ofv i
taminD2.Promot estheabsorpti
onof
calci
um anddecr easesparathyr
oidhormone
concent rati
ons.Therapeut
icEffects:Tr
eatmentand
preventionofdef ici
encyst
ates,parti
cul
arl
ybone
mani f
est ati
ons.Improvedcalci
um andphosphor ous
homeost asi
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
cal
cemi
a;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1430
Vit
aminDt oxicit
y ;Lactat
ion:Lactati
on;Concur
rentuseof
magnesium- containingantacidsorothervi
taminD
suppl
ement s;Mal absorpti
onpr oblems;Pati
ent
swi t
h
knownintol
er ancet otart
razine.

UseCaut
iousl
yin:
OB:
Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Seenprimaril
yasmani
fest
ati
onsoft
oxi
cit
y
(hy
percalcemia)
CNS: dizziness,headache, mal aise,somnol ence,
weakness.EENT: conjunct iv
itis,photophobi a,rhinorr
hea.
Resp: dyspnea.CV: arr
hy thmi as,edema, hy per t
ension.GI:
anorexia,const i
pation,drymout h, ↑l i
verenzy mes,
metallictaste,nausea, PANCREATI TIS,polydi psia,
vomiting,wei ghtloss.GU: albumi nuri
a,azot emi a,↓l i
bido,
nocturia,polyuri
a.Der m: prur i
tus.FandE: hy percalcemia.
Metab: hyper t
hermi a.MS: bonepai n,met ast ati
c
cal
cifi
cat i
on, musclepai n.

I
NTERACTI
ONS
Drug-
Drug:Cholestyr
amine,
colesti
pol,
ormi neraloil↓
absor
ptionofvit
ami nDanalogues.Usewiththiazide
di
uret
icsmayr esulti
nhypercal
cemia.Cort
icosteroids↓
eff
ecti
venessofv i
taminDanalogues.Concurrentuseof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1431
magnesium-containi
ngdrugsmayl eadto
hyper
magnesemi a.Calci
um- contai
ningdrugsmay↑ r
isk
ofhyper
calcemia.Concurrentuseofot hervi
tami
nD
suppl
ement s↑ riskofhypercalcemia.
Drug-
Food:
Ingest
ionoffoodshi
ghincal
cium cont
ent(
see
Appendi
xM)mayl eadtohyper
cal
cemia.

DOSAGE
Fami
l
ial
Hypophosphat
emi
a
PO:(Adul
tsandChi
l
dren):
10,
000–80,
000I
U/day(
wit
h
phosphor
us1–2g/day)
.

Hy
popar
athy
roi
dism
PO:(Adult
sandChi l
dren):
50,000–200,
000I
U/day(
tobe
usedwithcal
cium supplements).

Vi
tami
nD-
Resi
stantRi
cket
s
PO:(Adul
ts)
:12,
000–500,
000I
U/day(
tobeusedwi
th
phosphat
esuppl
ements)
.
PO:(Chil
dren):40,
000–80,
000I
U/day(
tobeusedwi
th
phosphatesupplement
s).
Adequat
eInt
ake
PO:
(Inf
ant
s):
Excl
usi
vel
yorpar
ti
all
y-
breastf
ed-400I
U

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1432
dai
l
y.

AVAI
LABI
LITY
Liqui
d8000I
U/mLOTC;
Capsul
es50,
000I
U;Tabl
ets400
IU;

PATI
ENTTEACHI
NG
Advisepat
ientt
otakemedicati
onasdir
ected.Take
misseddosesassoonasr ememberedthatday,
unl
essalmosttimefornextdose;
donotdoubleupon
doses.

Reviewdietmodi ficat
ionswithpati
ent.forfoodshigh
i
ncal ci
um andv i
taminD.Renal pat
ientsmuststil
l
considerrenalfail
uredieti
nfoodsel ecti
on.Healt
h
careprofessionalmayor derconcurrentcal
cium
supplement .

Encouragepatienttocompl ywi
thdietar
y
recommendat ionsofhealthcar
epr of
essional
.Explai
n
thatthebestsour ceofvi
taminsisawell-
balanced
dietwithfoodsfrom the4basicfoodgroupsandt he
i
mpor tanceofsunl i
ghtexposur
e.forfoodshighin
vit
ami nD

Pat
ient
ssel
f-
medi
cat
ingwi
thv
itami
nsuppl
ement
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1433
 shoul
dbecaut i
onednottoexceedRDA.The
eff
ecti
venessofmegadosesfortr
eatmentofv
ari
ous
medicalcondi
ti
onsisunprov
edandmaycauseside
eff
ects.

Advi
sepati
entt
oavoidconcur
rentuseofant
aci
ds
cont
aini
ngmagnesi
um.

Reviewsymptomsofover
doseandinstr
uctpati
entt
o
reportt
heseprompt
lyt
oheal
thcar
epr ofessi
onal
.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
eval
uat
eprogr
ess.

Er
gonov
ine
I
NDI
CATI
ONS
Prev
enti
onandtreat
mentofpost
part
um orpostabor
ti
on
hemorr
hagecausedbyuter
ineat
onyori
nvolut
ion.

ACTI
ON
Dir
ectlyst
imul
atesuter
ineandvascul
arsmoot
hmuscl
e.
Therapeut
icEf
fects:
Uteri
necontr
acti
on.
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Avoi
dchr
oni
cuse;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1434
Shoul
dnotbeusedt
oinducel
abor
.

UseCaut
iousl
yin:
Hyper
tensi
veorecl
ampt
icpat
ient
s
(i
ncreasedsuscepti
bil
i
tyt ohyper
tensi
veand
arr
hythmogenicsideeffects)
;Sever
ehepati
corr
enal
di
sease; Sepsi
s;Thi
rdstageoflabor.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness,headache.EENT:t
innit
us.Resp:dyspnea.
CV:arrhyt
hmi as,chestpai
n,hyper
tensi
on,palpi
tat
ions.GI
:
nausea,vomi t
ing.Derm:sweati
ng.Misc:al
ler
gicreacti
ons.

I
NTERACTI
ONS
Drug-
Drug:Excessiv
ev asoconstr
ict
ionmayresultwhen
usedwithothervasopressors,
suchasdopami neor
ni
coti
ne.May↑ t heriskofadv er
sereact
ionswit
h
bromocri
pti
ne.

DOSAGE
Oxy
toci
c
PO:SL:(
Adul
ts)
:0.
2–0.
4mgq6–12hr(
usual
cour
sei
s
48hr)
.
I
M: I
V:(Adul
ts)
:200mcg(
0.2mg)q2–4hrf
orupt
o5
doses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1435
AVAI
LABI
LITY
Tabl
ets0.
2mg;
Inj
ect
ion0.
25mg/
mL;

PATI
ENTTEACHI
NG
Revi
ewsy mpt
omsoftoxici
tywi
thpat
ient
.Instr
uctthe
pat
ientt
orepor
toccur
renceoft
heseimmedi at
ely
.

Inf
orm pat
ientt
hatuter
inecr
ampi
ngdemonst
rat
es
eff
ecti
venessofther
apy.

Expl
ainneedforpadcounttodet
erminedegreeof
bl
eeding.I
nstr
uctpati
entt
orepor
timmediatelyan
i
ncreaseindegreeofbl
eedi
ngorpassageofclots.

I
nst
ructpat
ientt
orepor
tbr
east
feedi
ngdi
ff
icul
ti
es.

Caut
ionpat
ientnottosmokewhil
er ecei
ving
er
gonovi
ne;nicot
inei
salsoavasoconstr
ictor
.

Er
got
ami
ne
I
NDI
CATI
ONS
Treat
mentofvascularheadachesincl
udi
ng:
Migr
ainewi
th
orwit
houtaur
a,Clusterheadaches.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1436
Vasoconstri
ctionofdil
atedbl oodv esselsbystimulati
ng
alpha-
adrenergicandserotoner gi
c( 5-HT)recept
ors.
Largerdosesmaypr oduceal pha-adr energi
cblockadeand
vasodil
ati
on.Therapeuti
cEf fects:Const ri
cti
onofdilat
ed
caroti
darter
ybedwi thresolutionofv ascul
arheadache.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Per
ipher
alv
ascul
ardi
sease;
I
schemicheartdi
sease;
Uncont
rol
l
edhypert
ension;
Sev
ere
r
enalorl
iverdi
sease;Mal
nut
ri
ti
on;OB:
Pregnancy;

UseCaut
iousl
yin:
Ill
nessesassoci
atedwi
thper
ipher
al
vascularpat
hol
ogysuchasdiabetesmell
it
us;Concur
rent
administr
ati
onofotherv
asoconst
r i
cti
ngagent
s;Pedi
:
Chil
dren<6y r(
saf
etynotest
abli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness.CV: MYOCARDI ALINFARCTION,
hypertension,anginapect or
is,
ar t
eri
alspasm, i
nter
mitt
ent
cl
audicat i
on.GI :abdominalpain,nausea,vomiti
ng,
di
arrhea, polydipsi
a.MS: ext
remi t
ystif
fness,musclepai
n,
st
iffneck, sti
ffshoulder
s.Neur o:legweakness,numbness
orti
ngl i
ngi nfingersort
oes.Mi sc: f
ati
gue.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1437
Drug-Drug: Concur rentusewi t
hbet abl ocker s,oral
contraceptives,macr oli
deanti
-i
nfectives(eryt hr
omy cin
,tr
oleandomy cin),ornicoti
ne(heav ysmoki ng)may↑ r i
sk
ofper i
pheral vasoconst ri
cti
on.Dihy droergotami ne
antagonizest heant ianginaleff
ectsofni trates.Concur r
ent
usewi thvasoconst ri
ctorsmayhav eaddi ti
veef fects
(avoi
dconcur rentuse) .Concurrentusewi thal motri
ptan,
naratri
ptan,rizatr
iptan, sumatri
ptan, orzolmi tri
ptanmay
resul
tinpr olongedv asoconstri
ction( al
low24hrbet ween
use).

DOSAGE
SL:(Adul
ts):1–2mgi ni
ti
all
y,t
hen1–2mgq30mi nunti
l
att
acksubsidesoratotalof6mghasbeengi ven.Shoul
d
notbeusedmor ethantwiceweekl
y,wit
hatleast5day s
betweencourses;
1–2mgPOatbedt i
medai l
yf or10–14
dayshavebeenusedt otermi
nateser
iesofcl
ust er
headaches.

AVAI
LABI
LITY
Subli
ngualt
ablet
s2mg; Incombinati
onwi
th:
caf
fei
nei
n
prepar
ati
onsforvascul
arheadaches.

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakeer
got
ami
neatt
hef
ir
stsi
gnof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1438
 ani
mpendi
ngheadacheandnott
oexceedt
he
maxi
mum dosepr
escri
bed.

Encour
agepati
enttor
esti
naqui
et,
dar
kroom af
ter
taki
ngergot
amine.

Reviewsymptomsoftoxi
cit
y.I
nst
ructpat
ientt
o
reportt
heseprompt
ly.

Cauti
onpat i
entnottosmokeandtoavoidexposur
e
tocold;
thesev asoconst
ri
ctor
smayf
urtheri
mpair
peri
pheralci
rculat
ion.

Maycausedizzi
ness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
iti
esrequi
ri
ngal
ert
nessunt
ilr
esponse
tot
hedrugisknown.

Advisepatientt
oav oi
dal
cohol
,whi
chmaypr
eci
pit
ate
vascularheadaches.

I
nstr
uctfemalepati
entst
oinform healt
hcare
pr
ofessi
onali
ftheyplanorsuspectpregnancy.
Er
gotamineshouldnotbetakenduringpregnancy

ERI
BULI
N
I
NDI
CATI
ONS
Met
ast
ati
cbr
eastcancert
hathaspr
ogr
esseddespi
teat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1439
l
easttwoprev
iousr
egimenswhi
chincludedan
ant
hracy
cli
neandataxanei
neit
herregimen.

ACTI
ON
I
nhibit
sintracell
ularmicrotubul
egrowthphase, causi
ng
G2/M cell
-cycleblockresulti
nginapoptot
iccelldeath.
Therapeut
icEf fects:
Deat hofrapi
dlyr
epli
catingcell
s,
part
icul
arl
ymal i
gnantones.↓ spreadofbr eastcancer.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Sev
erehepat
ici
mpai
rment
;Sev
ere
renali
mpairment(CCr<30mL/ min)
;Congenitall
ongQT
syndrome;OB:Pregnancy;
maycausef etalharm;
Lactati
on:
Av oi
dbreastf
eeding.

UseCaut
iousl
yin:
HF,
brady
arr
hyt
hmi
as,
concur
rent
useofdr ugsknownt opr ol
ongt heQTi nterval(i
ncl uding
ClassIaandI I
Ianti
arrhyt
hmi cs),el
ectrol
y t
eabnor mal i
ti
es
(↑r i
skofar r
hythmias);Moder aterenalimpai r
ment ;l
ower
i
niti
aldoserecommendedf orCCr30–50mL/ min;Mi ldto
moder at
ehepat i
cimpai r
ment ;lowerinit
ialdose
recommended; OB: Womenwi thchi l
dbearingpot ential;
Pedi:Safeandef f
ecti
v euseinchi l
dren<18y rhasnot
beenestabli
shed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1440
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: f
at i
gue, weakness, depression,dizzi
ness, headache,
i
nsomni a.EENT: ↑l acri
mat i
on.CV: QTCPROLONGATI ON,
per ipher aledema.Resp: cough, dyspnea, upperrespirat
ory
tracti nfection.GI :anorexia,const i
pation,nausea,
abdomi nalpain, abnor mal t
aste, drymout h,dyspepsia,
mucusi t
is,diarrhea, vomiti
ng.Der m:alopecia,rash.Fand
E: hy pokalemi a.Hemat :ANEMI A, NEUTROPENI A.MS:
arthr algia,my algia.Neuro: peri
pher alneuropathy .Mi
sc:
fev er,urinaryt r
acti nfect
ion.

I
NTERACTI
ONS
Drug-
Drug: ↑riskofbonemar rowdepressi
onwithother
anti
neoplast
icsorradi
ati
ont herapy
.↓ anti
bodyresponse
and↑ riskofadv er
sereact
ionswi t
hli
vevir
usvaccines.

DOSAGE
I
V: (
Adul
ts):1.
4mg/ m2onday s1and8ofa21daycy cl
e;
dosemodif
icat
ionsrequi
redforhepat i
cimpair
ment
,
moderat
erenalimpair
ment,neutropenia,
thr
ombocyt
openia,orper
ipheralneuropathy
.
Renal
Impai
rment
I
V:(
Adul
ts)
:Mi
l
dhepat
ici
mpai
rment(
Chi
l
d-PughA)—1.
1

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1441
mg/m2ondays1and8ofa21daycy cl
eModer
ate
hepat
ici
mpai
rment(Chil
d-PughB)—0.
7mg/m2onday
s1
and8ofa21daycycle.
Renal
Impai
rment
I
V:(
Adul
ts)
:Moder
ater
enal
impai
rment(
CCr30–50
mL/
min)
—1.1mg/m2ondays1and8ofa21daycycl
e.

AVAI
LABI
LITY
Sol
uti
onf
orI
Vadmi
nist
rat
ion0.
5mg/
mLi
n2-
mLv
ial
s;

PATI
ENTTEACHI
NG
Adv i
sepatienttonoti
fyhealthcarepr
ofessi
onali
f
feverof≥100.5°Forot hersignsorsy
mpt omsof
i
nfection(chil
l
s,cough, bur
ningorpai
nonur i
nat
ion)
occur.

Advisefemalepati
enttouseeffect
ivecontr
acepti
on
duri
ngtherapyandt onoti
fyheal
thcareprof
essional
i
mmedi atel
yifpregnancyispl
annedorsuspectedorif
breast
feedi
ng.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1442
 Advisepati
entnott
or ecei
vev accinat
ionswi
thout
consult
ingheal
thcareprofessional.

Er
lot
ini
b
I
NDI
CATI
ONS
Locallyadv anced/ metastat
icnon-smal lcelll
ungcancer ,
whichhasnotr espondedt oprevi
ouschemot herapy
.
Maint enancet reat
mentofl ocall
yadv anced/ metastati
c
non-smal l
celllungcancerwhendi seasehasnot
progressedaf terfourcy cl
esofplat i
num- basedf i
rst
-l
ine
chemot herapy.Fir
st-
li
net her
apyforl ocallyadvanced,
surgicallyunresectabl
e, ormetastaticpancreaticcancer
(wit
hgemci t
abine).

ACTI
ON
I
nhibit
stheenzy met yr
osinekinase,whichi
sassociat
ed
wit
hhumanepi der malgrowthf act
orreceptor(
EGFR);
bl
ocksgr owthstimulat
ionsignalsincancercel
ls.
Therapeuti
cEffects:
Decreasedspr eadoflungor
pancreat
iccancerwithincreasedsurviv
al.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:OB:
Lact
ati
on:
Pregnancyorl
act
ati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1443
UseCaut
iousl
yin:
Hepat
ici
mpai
rment
;Pr
evi
ous
chemot herapy/r
adiati
on,pr
e-exist
ingl
ungdisease,
met ast
aticlungdisease(may↑ r i
skofinter
stit
ial
lung
disease);Pati
entswithchil
d-beari
ngpotenti
al;
Pedi:Saf
ety
notestablished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: CEREBROVASCULARACCI DENT( pancr eaticcancer
patient
s),fatigue.CV: MYOCARDI AL
INFARCTI ON/ I
SCHEMI A( pancreaticcancerpat ients).
EENT: conjunct i
viti
s,corneal perforati
on,corneal
ulcerat
ion.Resp: I
NTERSTI TIALLUNGDI SEASE, dyspnea,
cough.GI :HEPATOTOXI CI TY,GIPERFORATI ON, di
ar r
hea,
abdomi nalpai n,anorexia,nausea, stomatiti
s, v
omi ting,↑
l
iverenzymes.Der m: BULLOUSANDEXFOLI ATIVESKI N
DISORDERS, rash, dryskin, pr
uri
tus.GU: RENALFAI LURE.
Hemat :micr oangiopat hi
chemol yti
canemi awi th
thrombocy topeni a(pancreat i
ccancerpat ients).

I
NTERACTI
ONS
Drug-Drug:Stronginhibitor
sofCYP3A4, i
ncluding
atazanavir
,clari
thromy cin,
indi
nav i
r,i
traconazol e,
ketoconazole,nefazodone, nel
finavi
r,ri
tonav i
r,saquinav
ir,
tel
ithr
omy ci
n, orvori
conazol e↑ levelsandt her iskof
toxi
city
;considerdoser educti
on.Strongi nducer sof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1444
CYP3A4, i
ncludingr i
fampi n,ri
fabut i
n,r
if
apentine,
pheny toin,carbamazepi ne,orphenobar bit
al↓l evelsand
may↓ r esponse; alter
nativetherapyor↑ doseshoul dbe
consi dered.Cipr ofloxacinmay↑ l evel
sandt heri
skof
toxicity
.Smoki ngmay↓ l evel
sandmay↓ r esponse;may
consi der↑ dosei fsmoki ngcont inues.May↓ mi dazolam
l
ev els.May↑ r iskofbl eedingwi t
hwar f
ari
n.↓ levelswi t
h
protonpumpi nhi bitorsandH2bl ockers;avoidconcurrent
use.
Drug-
Natur
alProduct:
St .John'
swor tmay↓ lev
elsand
may↓ response;al
ternati
vetherapyor↑ doseshoul
dbe
consi
der
ed.

DOSAGE
PO: (Adults):Non-
smal lcel
ll
ungcancer –150mgdail
y
takenatl east1hrbeforeor2hraf terf
ood;Pancr
eat
ic
cancer —100mgdai lytakenatleast1hrbef or
eor2hr
afterfood.

AVAI
LABI
LITY
Tabl
ets25mg,
100mg,
150mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakeer
lot
ini
basdi
rect
ed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1445
 Advisepati
enttonotif
yheal
thcarepr ofessional
if
severeorpersi
stentdi
arr
hea,nausea,anor exi
a,
vomiti
ng,onsetorworseni
ngofskinr ash,
unexplai
neddyspneaorcough,orey eirri
tati
onoccur
.

Advi
sepati
entt
owearsunscreenandpr
otect
ive
cl
othi
ngtodecr
easeski
nreacti
ons.

Cautionpat
ienttousecontraceptiveduringandforat
l
east2wkaf t
ercompleti
onoft herapy.Adv i
sefemale
pati
entstonotifyheal
thcareprofessi
onal if
pregnancyi
spl annedorsuspectedori fbreast
feedi
ng.

I
nst
ructpat
ientt
odiscontinuesmoki
ngdur
ing
t
her
apy;smokingdecreasesbloodl
evel
sofer
lot
ini
b.

Er
tapenem
I
NDI
CATI
ONS
Moder atetosev ere: compli
catedi ntra-abdominal
i
nfecti
ons, compl icatedskinandski nst r
uctureinfecti
ons,
communi tyacqui redpneumoni a,compl i
catedurinarytract
i
nfecti
ons( includingpy el
onephr i
ti
s) ,acutepelvi
c
i
nfecti
onsi ncludingpost part
um endomy omet ri
ti
s, sept
ic
abort
ion, andpostsur gi
calgynecol ogicinfecti
ons.
Prophylaxisofsur gicalsi
teinfecti
onf oll
owingel ecti
ve

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1446
col
orect
alsur
ger
y.

ACTI
ON
Ther apeut i
cEf fect s:Bact er i
cidal actionagai nst
suscept iblebact eri
a.Spect rum: Activeagai nstt he
foll
owi ngaer obi cgr am- posi tiveor ganisms
Staphy lococcusaur eus( met hicillin-
suscept iblest r
ains
only),Staphy lococcusepi dermi di s,Streptococcus
agalact i
ae, S.pneumoni ae( peni cilli
n-suscept iblestrai
ns
only),andS.py ogenes.Al soact iveagai nstt hef ol
lowing
gram- negat iv
eaer obi cor gani smsEscher i
chi acoli,
Haemophi l
usi nf l
uenzae( beta- l
act amasenegat i
vest r
ains)
,
Klebsiellapneumoni a,andMor axel l
acat arrhalis,
Prov i
denci aret tgeri.Addi tionanaer obicspect rum incl
udes
Bacter oidesf ragi l
i
s, B.di stasoni s, B.ov atus, B.
thetaiotami cron, B.uni for mis, B.v ul
gat i
s,Clost ri
dium
clostri
of orme, Eubact erium l ent um, Peptostrept ococcus,
Porphy romonasasacchar olytica, andPr ev otellabivia.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
mayoccurwit
hpenicil
li
ns,cephalospor
insandot
her
car
bapenems;Hypersensi
tiv
itytoli
docai
ne(maybeused
asadil
uentf
orIM admi ni
str
ation)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1447
UseCaut
iousl
yin:
Hist
oryofmul
ti
plehy
per
sensi
ti
vi
ty
reacti
ons;Seizur
edi sor
ders;Renal i
mpairment;OB:Usein
pregnancyonl yi
fclearl
yneeded; Lactat
ion:Notexpected
tocauseadv erseeffect
si nbreast-
fedinfant
s(NIH);Pedi
:
Safetynotestabli
shed;Ger i
:↑ sensiti
vi
tyduetoage-
rel
ated↓ inrenal f
unction.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEI
ZURES, headache.GI:PSEUDOMEMBRANOUS
COLITIS,di
arr
hea, nausea,
vomi t
ing.GU:vaginit
is.Local
:
phlebi
ti
satIVsi t
e,painatIM si
te.Misc:
hy persensit
ivi
ty
reacti
onincl
udinganaphy l
axi
s.

I
NTERACTI
ONS
Dr
ug-
Drug:Pr
obenecid↓ excret
ionand↑ bloodlevel
s.
May↓ ser
um val
proatel
evels(↑r i
skofsei
zures).

DOSAGE
I
V:I
M:(Adul
tsandChi
ldr
en13yr
sorol
der
):1goncedai
l
y
f
orupt
o14day s(I
V)or7day
s(I
M).
I
V:I
M: (
Chi
ldr
en3mo–12y r
s):
15mg/
kgtwi
cedail
y(not
t
oexceed1g/day
)forupt
o14day
s(I
V)or7day
s(IM).
Renal
Impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1448
I
M: I
V:(
Adul
ts)
:CCr≤30mL/
min/
1.73m2—500mgonce
dai
l
y.

AVAI
LABI
LITY
Powderf
ori
nject
ion1g/
vial
;

PATI
ENTTEACHI
NG
Advisepati
enttorepor
tthesi
gnsofsuperinfect
ion
(bl
ack,fur
ryovergr
owthonthetongue;vaginali
tchi
ng
ordischar
ge;l
ooseorfoul-
smell
ingstool
s)and
all
ergy.

Cautionpatienttonoti
fyhealthcar eprofessionalif
feveranddiarrheaoccur,especiall
yifstoolcont ai
ns
blood,pus,ormucus.Adv i
sepatientnott otreat
diarr
heawi t
houtconsultinghealthcarepr ofessional
.
Mayoccurupt osev er
alweeksaf t
erdiscontinuation
ofmedi cati
on.Consulthealthcareprof essi
onal
beforetreat
ingwi t
hantidiar
rheals.

ERYTHROMYCI
N
I
NDI
CATI
ONS
I
V:PO:I
nfect
ionscausedbysuscepti
bleorganisms
i
ncl
udi
ng:Upperandlowerrespi
rat
orytracti
nfecti
ons,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1449
Otiti
smedi a(wit
hsul fonami des),Skinandski nstr
uct ur
e
i
nfect i
ons,Pert
ussi s, Di
phther i
a,Erythr
asma, Int
estinal
amebi asi
s,Pelvi
ci nflammat or ydisease, Nongonococcal
urethri
ti
s,Syphi
lis,Legi onnaires’disease,Rheumat i
cf ever
.
Usef ulwhenpeni ci
lli
ni sthemostappr opri
atedrugbut
cannotbeusedbecauseofhy per
sensitivi
ty,i
ncl
uding:
Streptococcali
nfect ions,Treat mentofsy phil
isor
gonor r
hea.Topical: Treatmentofacne.

ACTI
ON
Suppressespr oteinsynthesisatthelev el ofthe50S
bacteri
alribosome.Ther apeuticEffects: Bacteri
ostati
c
acti
onagai nstsuscept i
blebacteri
a.Spect rum:Active
againstmanygr am-positi
vecocci,including: St
reptococci
,
Staphylococci.Gram-positiv
ebaci l
l
i,including:Clostr
idi
um,
Corynebact er
ium.Sev eralgram-negat i
vepat hogens,
notably:Neisseri
a,Legionell
apneumophi la.Mycoplasma
andChl amy diaarealsousual l
ysuscept ible.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentuseof
pimozide,ergotamine,ordi
hy droer
gotamine;Known
alcoholi
ntolerance(mosttopicals)
;Tartr
azinesensit
ivi
ty
(somepr oductscontaintar
trazine—FDCy el
lowdy e#5);
Productscontainingbenzylalcoholshoul
dbeav oidedin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1450
neonat
es.

UseCaut
iousl
yin:
Liv
er/
renal
disease;
OB:
Maybeused
i
npregnancyt otr
eatchlamy di
ali
nfecti
onsorsyphi
li
s;
Myastheniagravi
s( mayworsensympt oms);
Geri:↑risk
ofot
otoxicit
yifparent
eraldose>4g/ day,
↑r i
skofQTc
i
nter
valprolongati
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: seizures(rare).EENT: ototoxi
city.CV:TORSADEDE
POINTES, VENTRI CULARARRHYTHMI AS,QTi nt
erval
prol
ongat i
on.GI :PSEUDOMEMBRANOUSCOLI TIS,nausea,
vomiting,abdomi nal pai
n,crampi ng,diarr
hea,hepat i
ti
s,
i
nfantilehy pert
rophicpy l
ori
cst enosis,pancreati
tis(r
are).
GU:interstiti
alnephriti
s.Derm: rash.Local:phlebit
isatIV
si
te.Mi sc:aller
gicreactions,superinfecti
on.

I
NTERACTI
ONS
Drug-Drug:Concur rentusewi thpimozi demay↑ l evels
andt heri
skf orser i
ousar rhythmias( concur r
entuse
contrai
ndicated);simil
aref fectsmayoccurwi t
hdilt
iazem,
verapamil,ketoconazol e,i
traconazol e,nefazodone,and
proteaseinhibit
ors;avoi dconcur rentuse.May↑ l evelsof
ergotamineanddi hydroergotami neandr i
skf oracute
ergottoxici
ty;concurrentusecont r
aindicated.May↑

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1451
ver apami llevelsandt her i
skf orhy potensi on, br adycar dia,
andl acticaci dosis.↑ bl oodl ev el
sandef fect sofsi ldenaf il
,
tadal afilandv ardenafil
;usel owerdoses.Concur r
ent
ri
fabut i
norr if
ampi nmay↓ ef fectofer y thromy cinand↑
ri
skofadv erseGIr eact i
ons.↑ l evelsandr iskoft oxi cit
y
from al f
ent anil,
alprazolam, br omocr iptine, car bamazepi ne,
cy clospor ine, ci
lostazoldiazepamdi sopy rami de, ergot
alkal oids, f
elodipine,met hyl
pr edni solone, mi dazol am,
qui nidine, ri
fabut i
n,tacrolimus, tri
azol am, orv inblastine.
May↑ l ev elsofl ovastatin,andsi mv ast atinand↑ t her isk
ofmy opat hy/rhabdomy ol y
sis.May↑ ser um di goxinl evels.
Theophy l
linemay↓ bl oodl ev els.May↑ col chicinel evel s
andt her iskf ortoxicit
y;usel owerst ar t
ingandmaxi mum
doseofcol chicine.May↑ t heophy ll
inel ev elsandt her isk
fort oxicity; ↓t heophy l
linedose.May↑ war farinlev els
andt her iskf orbleeding.

DOSAGE
250mgofery
thromycinbaseorst
ear
ate=400mgof
ery
thr
omy
cinethyl
succinat
e

MostI
nfect
ions
PO:(Adul
ts)
:Base,
stearat
e—250mgq6hr ,
or333mgq8
hr,
or500mgq12hr .Ethyl
succi
nat
e—400mgq6hror
800mgq12hr .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1452
PO:(Chil
dren>1mo) :
Baseandet hyl
succi
nate—30–50
mg/kg/daydivi
dedq6–8hr( maximum 2g/ dayasbaseor
3.
2g/ dayasethyl
succinat
e).Stearat
e—30–50mg/ kg/day
di
vi
dedq6hr( maximum 2g/ day).
PO:(
Neonat
es)
:Ethy
lsucci
nat
e—20–50mg/
kg/
day
di
vi
dedq6–12hr.
I
V:(
Adul
ts)
:250–500mg(
upt
o1g)q6hr
.
I
V:(Chi
ldr
en>1mo):
15–50mg/
kg/
daydi
vi
dedq6hr
,
maximum 4g/
day
.

Acne
Topi
cal:
(Adul
tsandChi
l
dren>12yr
):2%oi
ntment
,gel
,
sol
uti
on,orpl
edget
stwi
cedai
ly.

AVAI
LABI
LITY
Er
ythr
omy
cinBase
Enteri
c-coatedtabl
ets250mg, 333mg; Tabl
etswith
polymer-coatedpart
icles333mg, 500mg; Fi
lm-coated
tabl
ets500mg; Del
ay ed-r
eleasecapsul
es250mg;
Er
ythr
omy
cinEt
hyl
succi
nat
e
Chewabl
etablet
s(fr
uitfl
avor)200mg;Tabl
ets400mg,
600mg;Oralsuspension(f
rui
tfl
avor
,cher
ry)200mg/
5mL;
Oral
suspensi
on(orange,bananafl
avor
s)400mg/5mL;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1453
Dr
ops(
frui
tfl
avor
)100mg/
2.5mL;
Er
ythr
omy
cinLact
obi
onat
e
Powderf
ori
nject
ion500mg,
1g;
Er
ythr
omy
cinSt
ear
ate
Fi
l
m-coat
edt
abl
ets250mg,
500mg;
Topi
cal
Prepar
ati
ons
Ointment2%;Gel2%; Solut
ion2%;Pledget
s2%;I
n
combinati
onwith:sul
fisoxazol
e(generi
conly
)andbenzoy
l
peroxi
de(Benzamy ci
n).

PATI
ENTTEACHI
NG
Instr
uctpatienttotakemedi cat
ionaroundt heclock
andt ofi
nishthedr ugcompl et
elyasdirected,evenif
feeli
ngbetter.Takemi sseddosesassoonas
remember ed, wit
hr emai ni
ngdosesev enlyspaced
throughoutday .Adv i
sepat i
entthatshari
ngoft his
medi cat
ionmaybedanger ous.

Maycausenausea, vomiting,di
arrhea, orstomach
cr
amps; noti
fyhealt
hcar eprofessional i
fthese
ef
fectspersi
storifsevereabdomi nal pain,yell
ow
di
scolorat
ionoftheskinorey es,darkenedur i
ne,pal
e
st
ools,orunusualti
rednessdev el
ops.Maycause

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1454
 i
nfant
il
ehyper
trophi
cpyl
ori
cst
enosi
sini
nfant
s;not
if
y
heal
thcar
eprofessi
onal
ifv
omit
ingandi
rr
it
abil
i
ty
occur
.

Cautionpatienttonot
ifyhealthcareprofessionalif
feveranddiarrheaoccur,especi
all
yifstoolcont ai
ns
blood,pus,ormucus.Adv isepati
entnott otreat
diarr
heawithoutconsulti
ngheal t
hcarepr ofessional
.
Mayoccurupt oseveralweeksaf t
erdiscontinuation
ofmedi cat
ion.

Adv i
sepati
entt
oreportsignsofsuperinfect
ion(
black,
furryov
ergr
owthonthet ongue;v
aginal i
tchi
ngor
dischar
ge;l
ooseorfoul-
smelli
ngstools).

Inst
ructpat
ientt
onoti
fyheal
thcar
epr
ofessi
onal
if
symptomsdonoti mpr
ove.

Esci
tal
opr
am
I
NDI
CATI
ONS
Majordepressivedisorder.Generali
zedanxietydisorder
(GAD).UnlabeledUses: Panicdisorder.Obsessive-
compulsivedisorder(OCD) .Post-
traumaticstressdisor
der
(PTSD).Socialanxiet
ydiscor der(
socialphobia).
Premenstrualdysphoricdisorder(PMDD) .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1455
ACTI
ON
Sel
ecti
vel
yinhi
bitsthereuptakeofserot
oninint
heCNS.
Ther
apeuti
cEffects:Anti
depressantact
ion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentMAO
i
nhibit
ororpi
mozi
det
her
apy
;Concur
rentuseof
ci
talopr
am.

UseCaut
iousl
yin:
Hist
oryofmani
a(mayact
ivat
e
mani a/hypomani a);Historyofsei zures;Pati
entsatr iskf
or
suicide;Hepaticimpair ment( dose↓ recommended) ;
Sev ererenalimpairment ;OB: Neonatesexposedt oSSRIs
i
nt he3r dtrimestermaydev elopdr ugdisconti
nuat i
on
syndr omemani f
estedbyr espi r
atorydistr
ess,feeding
dif
ficulty,
andi r
ri
tabili
ty;Lact ati
on: Maycauseadv erse
eff
ect sininfant;considerrisk/ benefi
t;Pedi:May↑ r i
skof
suicideattempt /
ideationespeci al
lyduringearlytr
eat ment
ordoseadj ust
ment ;safetynotest abli
shedinchi l
dren<12
yr;Ger i
:↓ dosesr ecommendedduet o↓ dr ugclearance
i
nol derpat i
ents.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:NEUROLEPTI
CMALI GNANTSYNDROME, SUICIDAL
THOUGHTS,i
nsomnia,
dizzi
ness,
drowsi
ness,
fat
igue.GI
:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1456
di
ar r
hea, nausea,abdominal pai
n, consti
pati
on,drymouth,
i
ndigest i
on.GU: anorgasmia,↓l ibido,ej
acul
atorydelay
,
erecti
ledy sf
unction.Derm: sweating.Endo:syndromeon
i
nappr opriat
esecr eti
onofant i
diureti
chormone( SIADH).F
andE: hyponat r
emi a.Metab:SEROTONI NSYNDROME, ↑
appetite.

I
NTERACTI
ONS
Dr ug-Drug: Maycauseser ious, potent iallyfatal r
eact ions
whenusedwi thMAOi nhibit
or s;all
owatl east14day s
bet weenesci tal
opr am andMAOi nhi bitors.Concur rentuse
wi thpimozi demayr esultinpr olongat ionoft heQTc
i
nt ervalandi scont raindicated.Usecaut iouslywi thot her
cent ral
lyact i
ngdr ugs( i
ncludingal cohol ,antihistami nes,
opi oi
danal gesics, andsedat i
v e/hypnot ics;concur r
entuse
wi thalcohol isnotr ecommended) .Dr ugst hataf fect
ser otonergicneur otransmi tt
ersy stems, includingl inezoli
d,
tramadol ,andt ri
pt ans↑ r i
skofser ot oni nsy ndrome.
Cimet i
dinemay↑ l evels.Ser otoner gicef fectsmaybe↑
byl it
hium ( concur rentuseshoul dbecar efullymoni tored).
Car bamazepi nemay↓ l evels.May↑ l evelsofmet oprolol
.
Usecaut iouslywi tht ricycli
cant idepr essant sduet o
unpr edictableef fect sonser ot oninandnor epinephr ine
reupt ake.↑ r iskofbl eedingwi t
haspi rin,NSAI Ds,
clopidogr el,orwar fari
n.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1457
Dr
ug-Nat
ural
Product
:↑ri
skofser
otoni
nsy
ndr
omewi
th
St
.John'
swortandSAMe.

DOSAGE
PO:
(Adul
ts)
:Depr
essi
onandGAD–10mgoncedai
l
y,may
be↑ t
o20mgoncedailyaf
ter1wk.
Hepat
icI
mpai
rment
PO:
(Adul
ts)
:10mgoncedai
l
y.
PO:
(Ger
iat
ri
cPat
ient
s):
10mgoncedai
l
y.
PO:
(Chil
dren≥12y
r):
Depressi
on—10mgoncedai
l
y,may
be↑ t
o20mgoncedai l
yafter3wk.

AVAI
LABI
LITY
Tabl
ets5mg,
10mg,
20mg.
Or
alsol
uti
on(
pepper
mintf
lav
or)1mg/
mL.

PATI
ENTTEACHI
NG
I
nst ructpati
enttot akeescital
opram asdirect
ed.Take
mi sseddosesont hesamedayassoonas
remember edandconsul thealthcareprofessi
onal
.
Resumer egulardosingschedul enextday.Donot
doubl edoses.Donotst opabruptly
,shouldbe
discontinuedgradual l
y.Inst
ructpati
enttoread

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1458
 Medi
cati
onGuidebeforest
art
ingandwi
theachRx
r
efi
ll
incaseofchanges.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Adv i
sepat i
ent,fami l
y ,andcar egiverstolookfor
suicidal i
ty,
especi all
ydur ingear l
ytherapyordose
changes.Not ifyhealthcar eprofessionalimmediatel
y
i
fthought saboutsui cideordy ing,attemptsto
commi tsuici
de, neworwor sedepr essi
onoranxi et
y,
agitationorr estlessness, panicattacks,insomnia,
neworwor seirritabi
lity,aggressiveness,acti
ngon
danger ousimpul ses, mani a,orotherchangesi n
moodorbehav iorori frashorsy mpt omsofser otonin
syndr omeoccur .

Instr
uctpatientt
onot ifyheal
thcareprof essionalof
allRxorOTCmedi cations,vi
tamins,orher bal
productsbeingtakenandt oconsulthealthcar e
professi
onal bef
oretakinganyot herRx,OTC, or
herbalproducts,especial
lyal
cohol orotherCNS
depressants.

I
nstructfemal
epat i
entstonotif
yhealt
hcar e
pr
ofessionali
fpregnancyisplannedorsuspectedor
i
ftheyplantobreastfeed.I
fusedduri
ngpr egnancy
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1459
 shoul
dbetaperedduri
ng3r
dtr
imest
ert
oav
oid
neont
alser
oti
ninsyndr
ome.

Emphasizei
mpor
tanceoff
oll
ow-
upexamst
omoni
tor
pr
ogress.

Esmol
ol
I
NDI
CATI
ONS
Managementofsi
nust
achy
car
diaandsupr
avent
ri
cul
ar
ar
rhyt
hmias.

ACTI
ON
Blockssti
mulat
ionofbeta1(myocar
dial
)-adr
energi
c
recept
ors.Doesnotusuall
yaff
ectbeta2(pul
monar y,
vascular
,orut
erine)
-r
ecept
orsit
es.TherapeuticEf
fects:
Decreasedheartrat
e.Decr
easedAVconduct ion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Uncompensat
edHF;
Pul
monar
y
edema;
Car di
ogenicshock;
Brady
car
diaorhear
tbl
ock;
Knownalcoholi
ntoler
ance.

UseCaut
iousl
yin:
Ger
i:↑ sensi
ti
vi
tyt
otheef
fect
sof
bet
abl
ocker
s;Thy
rot
oxi
cosi
s(maymasksy
mpt
oms)
;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1460
Diabetesmel l
it
us( maymasksy mpt omsofhy poglycemia)
;
Patientswithahistoryofsevereallergi
creacti
ons
(i
ntensityofreacti
onsmaybei ncreased);OB:Lactati
on:
Pedi:Safetynotestabli
shed;neonat albr
adycardi
a,
hypotension,hypogly
cemia,andr espirat
orydepression
mayoccurr ar
ely.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: fat
igue,
agit
ati
on,conf
usion,di
zzi
ness, dr
owsiness,
weakness.CV: hy
potensi
on,peri
pheral
ischemia.GI:
nausea,vomiti
ng.Derm:sweati
ng.Local:i
nject
ionsit
e
react
ions.

I
NTERACTI
ONS
Drug-Dr ug:Gener alanest hesi a,I
Vpheny t
oin,and
verapami l maycauseaddi tivemy ocardialdepr ession.
Additivebr ady cardiamayoccurwi thdigoxin.Addi tive
hypot ensionmayoccurwi thot herantihypertensives,
acutei ngest i
onofal cohol ,ornitrates.Concur r
entusewi th
amphet ami ne, cocaine, ephedr i
ne, epi
nephr i
ne,
norepi nephrine, pheny lephrine,orpseudoephedr inemay
resultinunopposedal pha- adrenergicstimulation
(excessi vehy per t
ensi on,br adycardia)
.Concur rentt hyr
oid
hormoneadmi nistrati
onmay↓ ef fecti
veness.Mayal t
er
theef fecti
venessofi nsulinsoror al hypoglycemi cagent s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1461
(doseadj ust
mentsmaybenecessar y
) .May↓
effecti
venessoftheophy l
l
ine.May↓ beneficialbet
a
cardiovascul
areffectsofdopamineordobut amine.Use
cautiouslywit
hin14day sofMAOi nhibit
ortherapy(may
resulti
nhy pert
ension).

DOSAGE
IV:(Adults) :Ant iarrhythmi c—500- mcg/ kgl oadingdose
over1mi ninitially,foll
owedby50- mcg/ kg/mi ninfusion
for4mi n; i
fnor esponsewi thin5mi n,give2ndl oading
doseof500mcg/ kgov er1mi n,then↑ i nfusiont o100
mcg/ kg/mi nf or4mi n.I fnor esponse, r
epeatl oadi ngdose
of500mcg/ kgov er1mi nand↑ i nfusionr ateby50-
mcg/ kg/mi ni ncr ement s( nott oexceed200mcg/ kg/ min
for48hr ).Ast her apeut i
cendpoi ntisachi eved, eli
mi nate
l
oadi ngdosesanddecr easedosei ncrement st o25
mg/ kg/mi n.Int raoper ative
anti
hy pertensiv e/ anti
arr hythmi c—250–500- mcg/ kg
l
oadi ngdoseov er1mi ni nit
ially,
followedby50-
mcg/ kg/mi ni nfusi onf or4mi n;i
fnor esponsewi thin5
min, gi
ve2ndl oadi ngdoseof250–500mcg/ kgov er1mi n,
then↑ i nfusiont o100mcg/ kg/mi nfor4mi n.Ifno
response, repeatl oadingdoseof250–500mcg/ kgov er1
minand↑ i nfusi onr ateby50- mcg/ kg/mi nincrement s
(nottoexceed200mcg/ kg/mi nfor48hr ).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1462
I
V:(
Chi
l
dren)
:Ant
iar
rhy
thmi
c—50mcg/
kg/
min,
maybe↑
q10mi
nupto300mcg/kg/
min.

AVAI
LABI
LITY
Sol
uti
onforinj
ecti
on(predi
lut
edforuseasl
oadi
ngdose)
10mg/mL, 20mg/ mL;Premixedi
nfusi
on2000mg/
100
mL,2500mg/ 250mL;

PATI
ENTTEACHI
NG
Maycausedrowsiness.Caut
ionpati
ent
srecei
ving
esmol
oltocall
forassist
anceduri
ngambulati
onor
tr
ansf
er.

Advi
sepati
entst
ochangeposi
ti
onssl
owl
yto
mini
mizeort
host
ati
chypot
ensi
on.

Patient
swi t
hdi abet
esshouldclosel
ymoni t
orblood
glucose,especial
lyi
fweakness,malaise,
irr
it
abi
lit
y,or
fati
gueoccur s.Medicat
iondoesnotblockdizzi
ness
orsweat i
ngassi gnsofhypogly
cemia.

Est
azol
am
I
NDI
CATI
ONS
Shor
t-
ter
m managementofi
nsomni
a.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1463
ACTI
ON
DepressestheCNS, pr
obablybypotent
iat
ingGABA,an
i
nhibit
oryneurot
ransmitt
er.Ther
apeuti
cEffect
s:Rel
i
efof
i
nsomni a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oest
azol
am or
ot
herbenzodi
azepi
nes;
OB:
Lact
ati
on:
Pedi
:Pr
egnancy
,
l
actat
ion,
orchi
ldr
en.

UseCaut
iousl
yin:
Hepat
icorr
enal
dysf
unct
ion;
Ger
i:
Geri
atri
cordebili
tat
edpati
ent
s(ini
ti
aldose↓ maybe
necessary
);Hist
oryofdepr
essi
on;Hist
oryofdr
ugabuse
orsuici
deattempt.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness, headache, weakness,abnor mal dreams,
abnormal thi
nking, behav iorchanges,conf usion,
depression,dizzi
ness, hall
ucinati
ons,hangov er ,malai
se,
nervousness, sl
eep—dr ivi
ng.Resp: col
dsy mpt oms,
pharyngiti
s.CV: chestpai n.GI :abdominalpai n,dyspepsi
a,
nausea.MS: backpai n, l
owerext remit
ypai n,st i
ff
ness.
Neuro:abnor mal coor dinati
on, hypoki
nesia.Mi sc:
ANAPHYLACTI CREACTI ONS, bodypain,phy sical
dependence, psychol ogical dependence.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1464
I
NTERACTI
ONS
Drug-Drug:Additi
veCNSdepr essionwi t
hal cohol
,
anti
histamines,anti
depr essant s,MAOi nhibit
ors,ot
her
sedative/hypnoti
cs(incl
udi ngbenzodi azepines),
oropi oid
analgesics.Cimeti
dineorhor monal contracepti
vesmay↓
met aboli
sm and↑ ef fectsofest azolam.May↓ ef ficacy
oflevodopa.Ri f
ampinorci gar ettesmoki ng↑ met abolism
and↓ ef fecti
veness.Theophy ll
inemayant agoni
zethe
eff
ect i
venessofestazolam.
Drug-NaturalProduct:Concomit
antuseofkav a,v
aleri
an,
chamomi le,orhopscan↑ CNSdepr essi
on.Seesedat i
ve
i
nteracti
ons.St .John'
swor tmayaff
ectestazolam l
evels
andef f
ectiveness;avoi
duse.

DOSAGE
PO:(Adult
s):1mgatbedt i
me; somepati
entsmayrequi
re
2mg( range0.
5–2mg) .Debil
i
tatedorsmallel
der
ly
pat
ients—mayini
ti
ateat0.5mg, ↑ asneeded.

AVAI
LABI
LITY
Tabl
ets1mg,
2mg;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1465
 Adv i
sepatientt otakemedi cationasdir
ected.
Discussthei mpor tanceofpr epari
ngenvir
onmentf or
sleep(darkr oom, quiet,
av oidanceofnicotineand
caffei
ne).Gradual discontinuat i
onmayber equired
foll
owingpr olongedt herapy .Maycausedi sturbed
sleepforthef ir
st2ni ghtsf oll
owingdiscontinuation.

Maycauseday t
imedr owsiness.Cautionpatientto
avoiddrivi
ngandotheract i
viti
esrequiri
ngalertness
unti
lresponsetomedi cati
oni sknown.Inform patient
tonotifyheal
thcar
epr ofessionali
fsleep-r
elated
behaviors,(
mayincludesleep-dri
ving—dr i
vingwhi le
notfull
yawakeaf t
eringestionofasedat iv
e-hypnot i
c
product,wit
hnomemor yoft heevent)occur.

Caut
ionpat
ient
stoavoi
dtaki
ngalcohol
orotherCNS
depr
essant
sconcur
rent
lywit
hthi
smedicat
ion.

I
nst
ructpat
ientt
onoti
fyheal
thcarepr
ofessi
onal
i
mmediatel
yifpr
egnancyi
splannedorsuspect
ed.

ESTRADI
OL
I
NDI
CATI
ONS
PO:IM:Topi
cal
:Tr
ansder
mal:Repl
acementofest
rogen
(HRT)t
odimini
shmoderat
etoseverevasomot
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1466
sympt omsofmenopauseandofv ariousestrogen
def i
ciencystat esincluding:Femalehy pogonadism,
Ov ari
ect omy, Pri
mar yov ari
anfail
ur e.Treatmentand
prevent ionofpost menopausal osteopor osi
s( notvaginal
dosef orms).PO: Inoperablemet ast ati
cpostmenopausal
breastorpr ost atecarcinoma.VagManagementof
atrophi cvaginiti
sthatmayoccurwi thmenopause( l
ow
dose) ,bothersomesy stemi csympt omsofmenopause
(higherdose) .Concur rentuseofpr ogestini
s
recommendeddur ingcy cl
icalt
herapyt odecreaset heri
sk
ofendomet rialcarcinomai npat i
ent swithani ntactuter
us.

ACTI
ON
Estrogenspromot egrowthanddev elopmentoff emal
e
sexor gansandt hemai ntenanceofsecondar ysex
characteri
sti
csi nwomen.Met aboliceff ectsinclude
reducedbloodchol est
erol,pr
otei
nsy nthesis,andsodium
andwat erretention.Therapeuti
cEf fects:Rest orati
onof
hormonal balancei nvari
ousdef i
ciencyst at
es, i
ncludi
ng
menopause.Tr eatmentofhor mone- sensi ti
vetumor s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Thr
omboembol
i
cdi
sease;
Undiagnosedv
agi
nal
bleedi
ng;
OB:
Posi
ti
veev
idenceof
fet
alrisk.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1467
UseCaut
iousl
yin:
Under
lyi
ngcar
diov
ascul
ardi
sease;
Sever
ehepaticorrenaldisease;May↑ theri
skof
endometri
alcar
cinoma; Histor
yofporphyr
ia;
Lact
ati
on:
Usual
lycompatibl
ewi t
hbr eastfeedi
ng(AAP).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, di
zziness, lethargy.EENT: i
ntol
er anceto
cont actlenses, wor seningofmy opiaorasti
gmat i
sm.CV:
MI ,THROMBOEMBOLI SM, edema, hypert
ension.GI :
nausea, weightchanges, anorexia,↑ appeti
te,jaundice,
vomi ting.GU: women—amenor r
hea,dysmenor rhea,
breakt hroughbl eeding, cervicalerosions,l
ossofl ibi
do,
vaginal candidiasis; men—er ecti
ledy sf
uncti
on,t esti
cul
ar
atrophy .Derm: oi l
yskin, acne, pigmentati
on,urticari
a.
Endo: gynecomast i
a( men) , hypergl
ycemia.FandE:
hyper calcemia, sodium andwat erretenti
on.MS: l
eg
cramps.Mi sc:br easttender ness.

I
NTERACTI
ONS
Drug-
Dr ug:Mayalterrequir
ementf orwarfar
in,
oral
hypoglycemicagents,orinsuli
ns.Barbi
tur
atesorrif
ampi
n
may↓ ef f
ect
iveness.Smoki ng↑ riskofadverseCV
react
ions.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1468
Estrogensshoul
dbeusedinthelowestdosesforthe
shortestper
iodoft
imeconsi
stentwit
hdesiredtherapeut
ic
outcome
Sy
mpt omsofMenopause,
Atrophi
cVaginit
is,Femal
e
Hypogonadi
sm,
Ovari
anFail
ure/Ost
eoporosis
PO:
(Adul
ts)
:0.
45–2mgdai
l
yori
nacy
cle.
I
M: (
Adul
ts)
:1–5mgmont hly(
estr
adiol
cypi
onat
e)or
10–20mg(est
radi
olv
aler
ate)monthl
y.
Topical
:Emulsi
on(
Est
rasor
b)(Adul
ts)
:Appl
ytwo1.
74g
pouches(4.
35mgestr
adiol
)dail
y.
Gel(
Adult
s) :
Applycont
entsofonepacket(Div
igel
)orone
act
uati
onfrom pump(Estr
oGel,
Elest
ri
n)dai
l
y .
Spr
ayEvaMist(
Adul
ts)
:1spr
aydai
l
y,maybe↑ t
o2–3
spr
aysdai
ly
.
Transder mal:(Adul
ts):
Al or
a—25–50–mcg/ 24-
hr
tr
ansder mal patchappl
iedtwi ceweekl y.
Estraderm—50–mcg/ 24-hrtr
ansder malpatchapplied
twiceweekl y.Cli
mara—25- mcg/ 24-hrpatchappliedweekly
.
Vivell
e-Dot—25–50–mcg/ 24-hrtransdermal pat
chappl i
ed
twiceweekl y.Menostar—14-mcg/ 24-hrpat
chappl i
edq7
days.Pr ogesti
nmaybeadmi ni steredfor10–14day sof
eachmont h.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1469
Vag( Adults): Cream—2–4g( 0.2–0.4mgest radiol)dail
y
for1–2wk, then↓ t o1–2g/ dayf or1–2wk; then
maintenancedoseof1g1–3t i
mesweekl yf or3wk, t
hen
offfor1wk; thenr epeatcy cleoncev aginalmucosahas
beenr estored; Vaginalri
ng( Estring)—2-
mg( releases7. 5
mcgest r
adiol/24hr )q3mo; Vaginalri
ng( Femr ing)—12.4
mg( releases50mcgest radi ol/
24hr )q3moor24. 8mg
(rel
eases100mcgest radiol/24hr )q3mo( Femr i
ng
requir
esconcur r
entprogest erone)Vaginal tablet—1t abl
et
oncedai lyfor2wk, thentwi ceweekl y.
Post
menopausal
BreastCar
cinoma
PO:
(Adul
ts)
:10mg3t
imesdai
l
y.
Pr
ost
ateCar
cinoma
PO:
(Adul
ts)
:1–2mg3t
imesdai
l
y.
I
M:(
Adul
ts)
:30mgq1–2wk(
est
radi
olv
aler
ate)
.

AVAI
LABI
LITY
Tablets0.45mg, 0.5mg, 0.
9mg, 1mg,1.8mg, 2mg;
I
njecti
on( val
erat
ei noi
l)10mg/mL, 20mg/ mL, 40mg/ mL;
I
njecti
on( cypi
onateinoil
)5mg/ mL;Topicalemulsion
4.
35mg/ 1.74gpouchi nboxesof14pouchesi na1-
mont hsupplycartonof56pouches;Topicalgelpacket
0.
25mg/ packet,
0. 5mg/packet
,1mg/ packet;Topi
calgel

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1470
pump( 0.
06%)0. 52mg/ actuation,0.75mg/ act uati
on;
Transdermal Spray1. 53mg/ spray;Transder mal system
14mcg/ 24-hrreleaser ate,25mcg/ 24-hrreleaser ate,37.5
mcg/ 24-hrreleaser ate,50mcg/ 24-hrreleaser ate,60
mcg/ 24-hrreleaser ate,75mcg/ 24-hrreleaser ate,100
mcg/ 24-hrreleaser ate;Vaginal cream 100mcg/ g;Vaginal
ri
ng( Estr
ing)2mg( releases7. 5mcg/ dayov er90day s)
;
Vaginal r
ing(Femr ing)12. 4mg( releases50mcg/ dayov er
90day s),24.8mg( releases100mcg/ dayov er90day s)
;
Vaginal t
ablet10mcg;

PATI
ENTTEACHI
NG
Instructpatientoncorrectmethodofadmi nist
rat
ion.
Instructpatienttot
akemedi cati
onasdirected.Take
mi sseddosesassoonasr emember edaslongasi ti
s
notj ustbeforenextdose.IfadoseofEv aMistis
mi ssed,appl yi
fmorethan12hrbef orenextdose; i
f
l
esst han12hr ,omitdoseandr et
urntoregular
schedul e.Donotdoubl edoses.

Explai
ndoseschedul eandmaintenancer
outi
ne.
Discont
inui
ngmedi cati
onsuddenlymaycause
withdr
awalbleedi
ng.

Ifnauseabecomesaprobl
em,advi
sepat
ientt
hat
eati
ngsoli
df oodof
tenpr
ovi
desrel
i
ef.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1471
Advisepat ienttor epor tsignsandsy mpt omsoff l
uid
ret
ent i
on( swellingofankl esandf eet,wei ghtgai n),
thr
omboembol icdi sorders( pain,swel li
ng, t
ender ness
i
next remities,headache, chestpai n,blurredvision),
ment aldepr ession, orhepat i
cdy sf unction(yellowed
ski
norey es, pruri
tus, darkur i
ne,li
ght -coloredst ools)
toheal t
hcar epr ofessi onal.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Cauti
onpatientthatci
garet
tesmokingduring
est
rogentherapymaycausei ncr
easedriskofser
ious
si
deeffect
s, especi
all
yforwomenov erage35.

Cauti
onpat
ienttousesunscr
eenandprot
ect
ive
cl
othi
ngtopreventi
ncr
easedpigment
ati
on.

Advi
sepatientt
reatedf orosteoporosisthatexerci
se
hasbeenfoundt oar r
estandr everseboneloss.
Pati
entshoulddiscussanyexer ciseli
mi t
ati
onswi t
h
heal
thcareprofessionalbeforebeginningprogram.

I
nf or
m pati
entthatestr
ogensshouldnotbeusedto
decreaseri
skofcardiovascul
ardi
sease.Est
rogens
mayi ncr
easeriskofcardi
ovascul
ardi
seaseand
breastcancer
.

I
nst
ructpat
ientt
ost
opt
aki
ngmedi
cat
ionandnot
if
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1472
 heal
thcarepr
ofessi
onal
ifpr
egnancyi
spl
annedor
suspect
ed.

Emphasi zetheimportanceofr outi

nef ol
low- up
phy si
cal exams,incl
udingBP; breast,abdomen, and
pelvicexami nati
ons;Papani colaousmear sev er
y
6–12mo; andmammogr am ev ery12mooras
directed.Healthcareprof essionalwillevaluate
possibilit
yofdisconti
nui ngmedi cationev ery3–6mo.
Ifoncont i
nuous(notcy cli
cal)therapyorwi t
hout
concur rentprogesti
ns,endomet ri
albiopsymaybe
recommended, i
futerusisintact.

 Vag:Instructpatienti
nthecorr
ectuseofappl i
cat
or.
Pat i
entshoul dremainrecumbentforatleast30min
afteradmi nistr
ati
on.Mayusesanitarynapkinto
protectclothing,butdonotusetampon.I fadoseis
missed, donotuset hemisseddose,butretur
nto
regulardosingschedul e.

Inst
ructpat
ienttouseapplicat
orprov
idedwit
h
vagi
nal t
abl
et.Insertashi
ghupi nt
hev agi
naas
comf or
tabl
e,withoutusi
ngf or
ce.

VaginalRing:I
nst
ructpati
enttopressr ingintoanoval
andinsertint
otheupperthirdoft
hev aginalvaul
t.
Exactpositi
onisnotcri
ti
cal.Onceringi sinsert
ed,
pati
entshouldnotfeelanyt
hing.I
fdi scomf orti
sfel
t,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1473
 ri
ngi sprobablynoti nfarenough;gentl
ypushf arther
i
ntov agina.Leaveinpl aceconti
nuouslyfor90day s.
Ringdoesnoti nterferewithsexualint
ercourse.If
strai
ningatdef ecati
onmakesr i
ngmov et olower
vagina,pushupwi t
hf i
nger.I
fexpelledtotal
ly,
rinse
ri
ngwi thlukewar m waterandreinsert
.Tor emov e,
hookaf ingerthrought heri
ngandpul litout.

Transdermal: I
nstructpat i
enttowashanddr yhands
fi
rst.Applydisct ointactskinonhairl
esspor t
ionof
abdomen( donotappl ytobreastsorwaistl
i
ne) .Press
di
scf or10sect oensur econtactwithskin(especiall
y
aroundedges) .Av oidareaswher eclot
hingmayr ub
di
scl oose.Changesi tewitheachadmi ni
str
at i
ont o
preventskinirr
itati
on.Donotr eusesit
efor1wk; disc
mayber eappli
edi fitfal
lsoff.

Adv i
sepatientref
erredforMRItesttodiscusspat
ch
withref
erri
ngheal t
hcarepr of
essional
andMRIf aci
li
ty
todeter
mi neifremov al
ofpatchisnecessarypri
orto
testandfordirect
ionsforrepl
acingpatch.

Evamist
:Cauti
onpati
enttomakesur echi
l
dr enare
notexposedtoEvamistanddonotcomeintocont act
withanyski
nareawherethedrugwasapplied.
Womenwhocannotav oi
dcontactwit
hchil
dr en
shouldwearagarmentwithl
ongsleevest
ocov ert
he

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1474
 appl
i
cat
ionsi
te.

Est
ramust
ine
I
NDI
CATI
ONS
Pall
iat
ivet
reat
mentofadv
ancedmet
ast
ati
cpr
ost
ate
cancer.

ACTI
ON
Consi stsofcombi nati
onofmechl orethami ne,an
alkyl
at i
ngagent ,
andest r
adiol,
anest rogeniccompound.
Ant i
neoplasti
cact i
vit
ymaybeduet oeithercomponentor
thecombi nation.Alsodecreasesser um testoster
one
l
ev el
s.Ther apeuti
cEf f
ects:Decreasedspr eadofpr ost
ate
cancer .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Act
ivet
hrombophl
ebi
ti
sor
thr
omboemboli
cdisor
der
;Knownhy
per
sensi
ti
vi
tyt
o
estr
adi
olormechl
oret
hamine.

UseCaut
iousl
yin:
Hist
oryoft
hrombophl
ebi
ti
sor
thr
omboembol i
cdisorder
s;Hy percal
cemi a;
Renal or
hepati
cimpai
rment;Coronaryarterydisease;Hypertension;
Heartfai
l
ure;
Diabetesmelli
tus;Cerebrovasculardisease;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1475
Migrai
neheadaches;
Met abol
i
cbonedi
sease;
Epi
l
epsy
;
Pati
entswi
thchil
dbeari
ngpotent
ial
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: insomnia.CV: THROMBOEMBOLI SM, edema,
hypertensi
on.GI :diarrhea,nausea, anorexia,fl
atulence,
vomiting.Derm: bruising,dryskin,pruri
tis,rashes.Endo:
decreasedlibi
do, gy necomast i
a, gonadal suppression
(azoospermia),hy perglycemia.Hemat :
leukopeni a,
thrombocy t
openi a.MS: l
egcramps.Resp: dyspnea.Mi sc:
ANGI OEDEMA, al l
ergicr eact
ions.

I
NTERACTI
ONS
Drug-
Drug:
Calci
um supplementsfor
m aninsol
ubl
e
complexwit
hestr
amustinethatcannotbeabsor
bed.
Drug-
Food:
Calci
um i
ndair
yfoodsformsani nsol
uble
complexwi
thest
ramust
inethatcannotbeabsorbed.

DOSAGE
PO:(Adul
ts):14mg/kg/
dayi
n3–4di
vi
deddoses(
range
10–16mg/ kg/day
).

AVAI
LABI
LITY
Capsul
es140mg;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1476
PATI
ENTTEACHI
NG
I
nstructpati
enttotakeestramusti
neexactl
yas
di
rected.Ifadoseismissed, omi
t;donottakeatall.
Donotdoubl edoses.Notif
yhealthcarepr
ofessional
i
fvomi ti
ngoccursshortl
yaf t
eradoseistaken.Donot
di
scontinuewithoutconsul
tinghealt
hcare
pr
ofessional.

I
nstructpati
enttostorecapsulesi
ntherefr
igerator
,
butcapsulesmaybekeptatr oom temperaturefor
24–48hrwi thoutl
osingpotency.

Advi
sepati
entandpartneroft
heneedfor
cont
racept
iont
hroughoutther
apy
,assperm cel
l
smay
beal
tered.

Adv i
sepat ientt
or epor
tsignsandsy mptomsoff l
uid
retenti
on( swell
ingofanklesandf eet
,weightgai
n)
andt hromboembol i
cdisorder
s( painorswelli
ngin
l
egs, tendernessinextremiti
es,shor t
nessofbreat
h;
headache; chestpain;blur
redvision)tohealt
hcare
professional.

Est
ropi
pat
e
I
NDI
CATI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1477
PO: Aspar tofHRTi nt het
reatmentofv asomot or
sympt omsofmenopause.Tr eat
mentofv ar
iousest rogen
def i
ciencyst ates,i
ncludi
ng:Femal ehypogonadi sm,
Ov ari
ect omy ,Pri
mar yovari
anfail
ure.Adjuncti
v etherapyof
post menopausal osteoporosi
s.VagManagementof
atrophi cvaginiti
s.Concurr
entuseofpr ogestinis
recommendeddur i
ngcy cl
icalt
herapytodecr easet herisk
ofendomet r
ialcarci
nomai npatientswithani ntactuter
us.

ACTI
ON
Estrogenspromot ethegrowthanddev elopmentoff emale
sexor gansandt hemaintenanceofsecondar ysex
characteri
sti
csinwomen.Met aboliceffectsinclude
reducedbloodchol est
erol,pr
otei
nsy nt
hesis, andsodium
andwat erretenti
on.Therapeuti
cEf fect
s: Rest or
ati
onof
hormonal balanceinvari
ousdef i
ciencyst ates.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Thr
omboembol
i
cdi
sease;
Undi
agnosedvaginal
bleedi
ng;
OB:Knowntocausef
etal
har
m; Lact
ati
on:Decr
easesquant
it
yandqual
it
yofbr
east
mil
k.

UseCaut
iousl
yin:
Under
lyi
ngcar
diov
ascul
ardi
sease;
Sev
erehepat
icorr
enal
disease;
Mayi
ncr
easet
her
iskof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1478
endomet
ri
alcar
cinoma.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
(
syst
emi
cuse)
CNS: headache, dizziness,lethar gy, ment al depression.
EENT: intolerancet ocont actl enses, wor seningofmy opia
orast igmat ism.CV: MI ,THROMBOEMBOLI SM, edema,
hyper tension.GI :nausea, wei ghtchanges, anorexia,
i
ncr easedappet it
e,jaundice, vomi t
ing.GU: women—
amenor r
hea, breakthroughbl eedi ng,dy smenor rhea,
cervical erosion, l
ossofl i
bido, vaginal candi diasis,men—
erectiledy sfunct i
on, t
esticularat rophy .Der m: acne, oi
ly
skin,pi gment ation,urti
car i
a.Endo: gynecomast ia( men),
hyper glycemi a.FandE: hyper calcemi a, sodi um andwat er
retention.MS: legcr amps.Mi sc: breastt enderness.

I
NTERACTI
ONS
Drug-
Drug:Mayal t
errequir
ementf orwarf
arin,
oral
hypogl
ycemicagents,orinsuli
ns.Barbi
tur
atesorri
fampi
n
may↓ ef f
ecti
veness.Smoki ng↑ theri
skofadv er
se
cardi
ovascul
arreacti
ons.

DOSAGE
Vasomot
orSy
mpt
omsofMenopause/
Atr
ophi
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1479
Vagi
nit
is/
Ost
eopor
osi
s
PO:
(Adul
ts)
:0.
75–6mgdai
l
yori
nacy
cle.
Vag(Adul
ts)
:3–6mg(2–4gof0. 15%cream)dai
l
yfor3
wk,t
henofff
or1wk,
thenrepeatcycl
e.
Femal
eHy
pogonadi
sm/
Ovar
ianFai
l
ure
PO:
(Adul
ts)
:1.
5–9mgdai
l
yori
nacy
cle.

AVAI
LABI
LITY
Tabl
ets0.75mg,1.
5mg,
3mg,
6mgest
ropi
pat
e;Vagi
nal
cr
eam 1.5mg/g;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakeoralmedi
cati
onasdirect
ed.I
f
adosei smissed,takeassoonasrememberedas
l
ongasi tisnotjustbef
orenextdose.Donotdoubl
e
doses.

Expl
ainmedi cati
onschedul
etowomenon21- day
cycl
efollowedby7day sofnottaki
ngmedicat
ion.
Encouragepatientt
otakemedicati
onatt
hesame
ti
meeachday .

Ifnauseabecomesaprobl
em,advi
sepat
ientt
hat
eati
ngsoli
df oodof
tenpr
ovi
desrel
i
ef.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1480
Adv i
sepatienttor eportsignsandsy mpt omsoff l
uid
retenti
on(swel l
ingofankl esandf eet,weightgai n),
thromboembol i
cdi sorders( pai
n,swel l
ing,or
tendernessinext r
emities;headache; chestpai n;
blurredvi
sion),ment aldepr essi
on, hepatic
dysfuncti
on( yellowedski norey es,prurit
us, darkurine,
l
ight-col
oredst ools),orabnor malv aginalbleedingt o
healthcareprof essional.

I
nstr
uctpati
enttost
optaki
ngmedicat
ionandnoti
fy
heal
thcar
eprofessi
onal
ifpr
egnancyi
ssuspect
ed.

Cauti
onpatientt
hatci
garettesmokingdur
ing
estr
ogentherapymayincreaseri
skofseri
oussi
de
eff
ects,
especial
lyf
orwomenov erage35.

Cauti
onpat
ienttousesunscr
eenandprot
ect
ive
cl
othi
ngtopreventi
ncr
easedpigment
ati
on.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Advisepati
enttreat
edf orosteoporosisthatexerci
se
hasbeenf oundtoar r
estandr everseboneloss.The
pati
entshoulddiscussanyexer ciseli
mi t
ati
onswi t
h
heal
t hcar
epr of
essionalbeforebeginningprogram.

Emphasi
zethei
mportanceofrouti
nefol
low-
up
phy
sical
exams,i
ncl
udingBP;breast,
abdomen,and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1481
 pelvicexami nati
ons;Papani colaousmear sev er
y
6–12mo; andmammogr am ev ery12mooras
directed.Healthcareprofessi onalwillev
aluate
possibilit
yofdisconti
nuingmedi cationevery3–6mo.
Ifoncont i
nuous(notcyclical)therapyorwi t
hout
concur rentprogest
ins,endomet ri
albiopsymaybe
recommended, i
futer
usi sintact.

 Vag:Instructpatienti
nthecorr
ectuseofappl i
cat
or.
Pat i
entshoul dremainrecumbentforatleast30min
afteradmi nistr
ati
on.Mayusesanitarynapkinto
protectclothing,butdonotusetampon.I fadoseis
missed, donotuset hemisseddose,butretur
nto
regulardosingschedul e.

Eszopi
clone
I
NDI
CATI
ONS
I
nsomni
a.

ACTI
ON
I
nteractswithGABA- r
ecept
orcomplexes;nota
benzodiazepi
ne.Therapeut
icEff
ect
s:Impr ovedsl
eepwith
decreasedlatencyandincr
easedmaintenanceofsleep.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1482
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Debi
l
itat
edpat
ient
smayhav
e↓
met abolism ori
ncreasedsensiti
vity;
useloweri niti
aldose;
Condi t
ionsthatmayal termetabolicorhemody nami c
functi
on; Severehepati
ci mpai
rment( useloweri nit
ial
dose);OB: Pedi:Safet
ynotestablished;Lactati
on:
Occasional usewhilebreastf
eedinganol derinfantshould
posel i
ttl
er i
sk(NIH);Geri
:Mayimpai rmot orand/ or
cogniti
v eperfor
mance; seedosinggui del
ines.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: abnormalthi
nki
ng,behavi
orchanges,depression,
hall
ucinat
ions,
headache,sl
eep-dri
vi
ng.CV:chestpai n,
peri
pheraledema.GI:dr
ymout h,unpl
easanttaste.Derm:
rash.

I
NTERACTI
ONS
Drug-Drug:↑r iskofCNSdepr essionwi thotherCNS
depressantsincludingant i
histami nes,anti
depr essants,
opioi
ds, sedati
ve/hy pnot
icsandant i
psychotics.↑ level
s
andriskofCNSdepr essi
onwi thdr ugsthatinhibitthe
CYP3A4enzy mesy stem,includingket oconazol e,
i
traconazole,cl
arithromycin,nef azodone, r
it
onav i
rand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1483
nelf
inav i
r.Level
sandeff
ecti
venessmaybe↓ bydrugs
thatinducet heCYP3A4enzymesy st
em,
incl
udi
ng
ri
fampi n.

DOSAGE
PO: (
Adults):2mgi mmedi atelybeforebedti
me, maybe↑
to3mgi fneeded( 3mgdosei smor eeff
ectiv
ef orsleep
maintenance);Geri
atr
icpat ients—1mgi mmedi atel
y
beforebedtimeforpatientswi thdiff
icul
tyfall
ingasleep,2
mgf orpatient
swhodi fficultystayi
ngasleep;Concur rent
useofCYP3A4i nhi
bit
or s—1mgi mmediatelybefore
bedti
me, maybe↑ t o2mgi fneeded.
Hepat
icI
mpai
rment
PO:
(Adul
ts):Severehepati
cimpai
rment
—1mg
i
mmediat
elybeforebedti
me.

AVAI
LABI
LITY
Tabl
ets1mg,
2mg,
3mg;

PATI
ENTTEACHI
NG
Inst
ructpatienttotakeeszopi cl
onei
mmedi atel
y
beforegoingt obed,asdirected.Mayresultinshort-
term memor yimpairment ,
halluci
nat
ions,i
mpai red
coordinat
ion,anddizziness.Donotincreasedoseor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1484
 di
sconti
nuewi t
houtnot i
fyi
nghealthcarepr
ofessi
onal
.
Dosemayneedt obedecr easedgradual
lyt
omi ni
mize
wit
hdrawalsympt oms.Reboundi nsomniamayoccur
upondiscont
inuationandusuallyresol
veswit
hin1–2
ni
ghts.

Maycauseday ti
medrowsi ness.Caut
ionpati
entt
o
avoi
ddr i
vingorot
heracti
viti
esrequir
ingal
ert
ness
unti
lresponsetomedicat
ionisknown.

Instr
uctpatientt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbeingtakenandt oconsultheal
thcar e
professi
onal bef
oretaki
nganyot herRx,OTC, or
herbalproducts.

Caut
ionpat
ienttoav oi
dconcur
rentuseofal
cohol
or
ot
herCNSdepr essants.

Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onal
if
pr
egnancyi
splannedorsuspect
ed.

Et
aner
cept
I
NDI
CATI
ONS
Todecreasepr
ogression,si
gnsandsympt
omsof
rheumatoi
dart
hri
ti
s,juvenil
ear
thr
it
is,
anky
losi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1485
spondyli
ti
s,psor
iat
icar
thri
ti
sorplaquepsori
asiswhen
responsehasbeeninadequatet
oot herdi
sease-
modif
ying
agents.Maybeusedwi t
hotheragents.

ACTI
ON
Bi
ndst otumornecrosisfact
or(TNF),makingitinact
ive.
TNFisamedi at
orofinfl
ammat or
yresponse.Therapeut i
c
Eff
ects:Decreasedinfl
ammationandslowedpr ogression
ofart
hrit
is,
spondy l
i
tisorpsor
iasi
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Act
ivei
nfect
ion
(i
ncl
udinglocal
i
zed);Lact
ati
on:Lactati
on;Unt
reat
ed
i
nfecti
ons;Wegener’
sgranulomatosi
s( r
ecei
vi
ng
i
mmunosuppr essi
veagents);Concurr
ent
cycl
ophosphamideoranakinra.

UseCaut
iousl
yin:
Hist
oryofchr
oni
corr
ecur
rent
i
nf ecti
onorunder l
yi
ngillness/ tr
eat mentpredisposingto
i
nf ecti
on(includingadvancedorpoor l
ycontroll
ed
diabetes);Historyofexposur et ot ubercul
osis;Hist
oryof
oppor t
unisti
ci nfect
ion;Patientsr esidi
ng,orwhohav e
resided,wher etubercul
osis, histoplasmosis,
coccidioi
domy coses,orblast omy cosisisendemi c;Pre-
existi
ngorr ecentdemy el i
natingdi sorders(multi
ple

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1486
sclerosis, my eli
ti
s,opti
cneur i
tis);Latexal lergy(needle
cov erofdi luentsyringecontainsl atex);Ger i:Mayhav e↑
ri
skofi nfection;Pedi:Chi
ldrenwi t
hsi gnificantexposure
tov aricel
lav irus(t
empor ari
lydi scontinueet anercept
;
consi derv ari
cellazosterimmunegl obulin);↑r i
skof
l
y mphoma( i
ncludinghepatospl enicT- celllymphoma
[HSTCL] )
,leukemi a,andothermal ignanci es; OB:Useonly
i
fneeded.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, dizzi
ness, weakness.EENT: r
hinitis,
pharyngi ti
s.Resp:upperr espirator
yt r
acti nfection, cough,
respi
r atorydisor
der.GI:abdomi nalpain,dy spepsi a.Derm:
psoriasis,rash.Hemat :pancyt openia.Local :i
nject i
onsi t
e
reactions.Mi sc:I
NFECTI ONS( incl
udingr eactivati
on
tuberculosisandot heroppor tunisti
cinfect i
onsduet o
bacter i
al,i
nvasivefungal,vir
al,my cobacter i
al,and
parasiti
cpat hogens),MALI GNANCY( i
ncludingl ymphoma,
HSTCL, leukemia,andskincancer ).

I
NTERACTI
ONS
Drug-
Drug: Concurrentusewithanaki
nra↑ ri
skofseri
ous
i
nfecti
ons( notrecommended) .Concurr
entuseof
cycl
ophosphami demay↑ r i
skofmal i
gnanci
es.
Concurrentusewi t
hazat hi
opri
neand/ormethotr
exat
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1487
may↑ r i
skofHSTCL.May↓ antibodyresponset
oli
ve-
vi
rusvaccineand↑ ri
skofadv
ersereacti
ons(donot
admini
sterconcur
rent
ly)
.

DOSAGE
Subcut(Adult
s) :
Adultrheumatoi
darthr
it
is,
anky
losing
spondyl
iti
s,psori
ati
carthri
ti
s—50mgonceweekl y;adul
t
plaquepsori
asis—50mgt wi
ceweeklyfor3mos,then50
mgonceweekl y,
mayal sobegivenas25–50mgonce
weeklyasani ni
ti
aldose.
Subcut(
Chil
dren4–17y r):
>63kg—0.8mg/kg/wk(upt
o
50mg)asasi ngl
einject
ion;31–62kg—0.
8mg/ kg/
wk
ei
therastwoinj
ecti
onsont hesamedayordivi
dedand
gi
venontwosepar at
eday s3–4daysapart
;<31kg—0.
8
mg/kg/wkasasingleinj
ection.

AVAI
LABI
LITY
Pr
e-f
il
ledsy
ringes50mg/
mL;
Powderf
ori
nject
ion25
mg/vi
al;

PATI
ENTTEACHI
NG
Inst
ructpat
ientonself-
administr
ati
ontechnique,
stor
age,anddisposalofequipment.Fi
rstinject
ion
shouldbeadmi ni
ster
edundert hesuperv
isionof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1488
 heal
thcar
epr of
essi
onal.Provi
depati
entwi
tha
punct
ure-
proofcont
ainerforusedequi
pment.

Adv i
sepat i
entnottoreceivelivevacci
nesdur i
ng
therapy.Parentsshoul
dbeadv isedthatchi
ldren
shouldcompl eteimmunizationst odatebefore
i
niti
ationofetanercept
.Pat i
entswi t
hsignif
icant
exposur etovari
cell
avir
us( chickenpox)should
tempor ari
l
ydisconti
nuet herapyandv ari
cel
laimmune
globuli
nshoul dbeconsidered.

Advi
sepat i
entthatmet
hotr
exat
e,anal
gesi
cs,NSAIDs,
cor
ticoster
oids,
andsal
icy
lat
esmaybecontinued
dur
ingt her
apy.

I
nstructpat
ienttonotifyhealthcarepr
ofessionalif
upperrespi
rator
yorot herinfect
ionsoccur.Therapy
mayneedt obedi scontinuedifseri
ousinf
ection
occurs.

Advisepatientofriskofmalignanciessuchas
hepatosplenicT-cell
lymphoma.i nstr
uctpat i
entto
reportsi
gnsandsy mptoms( splenomegal y,
hepatomegal y,
abdomi nalpain,
per si
stentfever
,night
sweat s,
weightloss)tohealthcarepr ofessi
onal
prompt l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1489
Et
hacr
yni
caci
d
I
NDI
CATI
ONS
Edemaduet oheartfai
lur
e,hepati
cimpai
rmentorrenal
disease.Short-
ter
m managementofascitesdueto
mal i
gnancy,i
diopathi
cedema, andly
mphedema.
Alternat
ivediur
eti
cinpati
entswi t
hanall
ergyt
o
sulfonamides.

ACTI
ON
Inhibit
st hereabsorpti
onofsodi um andchl or
idefrom the
l
oopofHenl eanddi st
alr
enal t
ubule.Increasesrenal
excretionofwat er,sodi
um, chl
or i
de,magnesi um,
hydr ogen,andcalcium.Effecti
venessper si
stsinimpaired
renal funct
ion.Therapeuti
cEf f
ects:Diuresi
sand
subsequentmobi li
zati
onofexcessf luid(edema, pleur
al
effusions).

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hepat
iccomaor
anur
ia.

UseCaut
iousl
yin:
Sev
erel
i
verdi
sease(
maypr
eci
pit
ate
hepat
iccoma;
concur
rentusewi
thpot
assi
um-
spar
ing

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1490
di
ureticsmaybenecessar y);El
ectrol
y t
edeplet
ion;
Diabetesmell
it
us; I
ncreasi
ngazot emia;OB:Lactati
on:
Safetynotest
ablished;Geri
:Possibleincr
easedriskof
si
deef fect
satusual doses,especial
lyhypot
ensionand
el
ectrolyt
eimbalance.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: conf usi
on, fatigue, headache,nervousness, vert
igo.
EENT: hear i
ngl oss, ti
nnitus.CV: hypotension.GI :
abdomi nal pai
n, anor exia,diarr
hea,drymout h,dy sphagia,
nausea, vomi t
ing.GU: excessi veuri
nation,hemat uri
a.
Der m: rash.Endo: hy perglycemia,hyperuri
cemi a.FandE:
dehy dration,hy pocal cemi a,hypochlor
emi a,hy pokalemia,
hypomagnesemi a, hyponat r
emia,hypovolemi a,met abolic
alkalosis.Hemat : AGRANULOCYTOSI S,neutropeni a,
thrombocy t
openi a.Mi sc: fever
,incr
easedBUN.

I
NTERACTI
ONS
Drug-Drug: ↑ hy pot
ensionwi t
hant i
hyper t
ensiv es,ni
trat
es,
oracut eingest ionofalcohol .↑ riskofhy pokal emiawi t
h
otherdiuret i
cs, amphot eri
cinB, st
imul antlaxatives,and
corti
coster oids.Hy pokalemi amay↑ r iskofdi goxin
toxi
cityand↑ r iskofarrhythmiainpat i
entstaki ngdrugs
thatprolongt heQTi nterval.↓ li
thium excr et
ion, may
causel i
thium t oxici
ty.↑ riskofot otoxici
tywi th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1491
aminogl
ycosi
des.May↑ theeff
ect
ivenessofwar
far
in,
NSAIDS↓ eff
ectsofet
hacryni
caci
d.

DOSAGE
PO: (
Adult
s):50–100mg/dayi
n1–2div
ideddoses;may
i
ncreasedoseby25–50mgev er
yfewdaysunt
ildesi
red
response(maxi
mum dose=400mg/day).
PO:(
Chil
dren>1mo):1mg/kg/
doseoncedai
l
y;maybe
i
ncr
easedevery2–3day
stoamaximum of3mg/kg/
day.
I
V:(
Adul
ts):
0.5–1mg/ kg/
dose(maxi
mum =100
mg/
dose)
;mayrepeatdoseever
y8–12hri
fneeded.
I
V:(
Chil
dren>1mo)
:1mg/
kg/
dose,
mayr
epeatdosei
f
i
ndi
cat
edq8–12hr.

AVAI
LABI
LITY
Tabl
et25mgRX;
Inj
ect
ion50mg/
vial
;

PATI
ENTTEACHI
NG
I
nstructpati
enttot
akeethacr
yni
caci
dasdir
ect
ed.
Takemi sseddosesassoonaspossi
ble;
donot
doubledoses.

Caut
ionpat
ientt
ochangeposi
ti
onssl
owlyto
mini
mizeor
thostat
ichy
pot
ensi
on.Caut
ionpati
ent

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1492
 thattheuseofalcohol
,exer
ciseduri
nghotweat
her
,
orstandi
ngf orl
ongperi
odsdur i
ngther
apymay
enhanceorthost
atichy
potension.

I
nst
ructpat
ientt
oconsul
theal
thcar
eprof
essional
r
egardi
ngadiethi
ghinpot
assi
um.SeeAppendixM.

Advisepati
enttoobtai
nwei ghtatt hesamet i
meeach
day(prefer
ablyi
nthemor ningaf t
eruri
nating)andt
o
keepadai l
ylogoftheresults.Advi
sepat i
entto
contacthealt
hcareprofessi
onal ofweightgainmore
than3lbsinoneday .

Advisepat
ientt
oconsul
thealt
hcareprofessional
beforet
aki
ngOTCmedi cati
onorherbalproducts
concurr
ent
lywitht
hist
herapy.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advi
sepatientt
ocontactheal
thcar
eprofessional
i
mmediatelyifmuscl
eweakness,cr
amps, nausea,
di
zzi
ness,numbness,orti
ngli
ngofext
remiti
esoccurs.

Advi
sepat
ient
swit
hdiabetestomonit
orblood
gl
ucosecl
osel
y;maycauseincr
easedbloodgl
ucose
l
evel
s.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
up

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1493
 exami
nat
ions.

Ger
i:Cautionol
derpatient
sorthei
rcaregi
versabout
i
ncreasedr i
skf
orfal
ls.Suggestst
rat
egiesforf
all
pr
evention.

Et
hambut
ol
I
NDI
CATI
ONS
Act
ivetuber
culosi
sorothermy
cobact
eri
aldi
seases(
wit
h
atl
eastoneotherdrug)
.

ACTI
ON
I
nhibi
tst
hegrowthofmy cobacteri
a.Ther
apeuti
cEff
ect
s:
Tuber
cul
ost
aticef
fectagainstsuscept
ibl
eorgani
sms.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Opt
icneur
it
is.

UseCaut
iousl
yin:
Renal
andsev
erehepat
ici
mpai
rment
(dosagereduct
ionrequir
ed);OB:Alt
houghsafet
ynot
establ
ished,
ethambutolhasbeenusedwi thi
soniazidi
n
pregnantwomenwi thoutfetal
adverseef
fect
s;Lactati
on:
Usuall
ycompat i
blewithbreastf
eedi
ng(AAP).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1494
CNS:conf usi
on, di
zziness,hallucinat
ions,headache,
malai
se.EENT: opti
cneur it
is.GI:HEPATI TIS,abdominal
pai
n,anorexia,nausea, vomiting.Metab: hyperuri
cemia.
MS: j
ointpain.Neuro: peri
pher alneur
iti
s.Resp: pul
monary
i
nfi
ltr
ates.Mi sc:anaphy l
actoidreacti
ons, f
ever.

I
NTERACTI
ONS
Drug-Drug:Neurot
oxi
cit
ymaybe↑ wit
hotherneurotoxi
c
agents.Aluminum hy
droxi
demaydecr
easeabsorpti
on
(spacedoses4hrapar t
).

DOSAGE
PO:(Adult
sandChil
dren>13yr
):15–25mg/kg/
day
(maximum 2.
5g/day)or50mg/kg(upto2.
5g)twi
ce
weeklyor25–30mg/kg(upto2.5g)3ti
mesweekl
y.
PO: (Chil
dren1mo—13y r)
: HIVnegat ive–15-20
mg/ kg/dayoncedai l
y(maximum: 1g/day )or50
mg/ kg/doset wiceweekly(maxi mum: 2.5g/ dose)HI V-
exposed/ -
infected–15-25mg/ kg/ dayoncedai l
y
(maxi mum: 2.5g/ day)MAC, secondar yprophy l
axis,or
tr
eat mentinHI V-exposed/-
infected–15- 25mg/ kg/ day
oncedai l
y( maximum: 2.
5g/ day)wi thclari
thromycin( or
azi
t hromycin)wi t
horwi t
houtr i
fabut i
nNont uberculous
my cobacteriali
nfecti
on–15-25mg/ kg/dayoncedai l
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1495
(
maxi
mum:
2.5g/
day
).

AVAI
LABI
LITY
Tabl
ets100mg,
400mg;

PATI
ENTTEACHI
NG
I
nst r
uctpati
enttotakemedicati
onasdi r
ected.Take
misseddosesassoonaspossi bleunl
essalmost
ti
mef ornextdose;donotdoubleuponmi sseddoses.
Af ul
lcourseoftherapymaytakemont hstoy r.Donot
di
scont i
nuewithoutconsul
ti
nghealthcare
professi
onal,
eventhoughsympt omsmaydi sappear
.

Advi
sepati
entt
onoti
fyheal
thcar
epr
ofessi
onal
if
pr
egnancyi
ssuspect
ed.

I
nstr
uctpati
enttonotifyheal
thcareprofessi
onalifno
i
mprovementisseenin2–3wk.Heal thcare
pr
ofessi
onalshoul
dal sobenotif
iedifunexpected
wei
ghtgainordecreasedur i
neoutputoccurs.

Emphasi
zetheimportanceofr
outi
neexamst o
eval
uat
eprogressandophthal
micexaminat
ionsi
f
si
gnsofopti
cneurit
isoccur
.

Et
hosuxi
mide
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1496
I
NDI
CATI
ONS
Absencesei
zur
es(
pet
itmal
).

ACTI
ON
Elevatest heseizurethreshold.Suppressesabnor
mal
wav eandspi keacti
vityassociatedwithabsence(pet
itmal
)
seizures.Ther apeuti
cEf f
ects:Preventi
onofabsence(pet
it
mal )seizures.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pedi
:Chi
l
dren<3y
r
(
saf
etynotest
abl
i
shed)
.

UseCaut
iousl
yin:
All
pat
ient
s(may↑ r
iskofsui
cidal
thoughts/behav
ior
s);Hepaticorr
enaldisease;Mixed
seizur
edisorders(
may↑ r iskofgrandmal seizures)
;
Bonemar rowsuppression;
OB: Lactat
ion:Safetynot
establ
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: ↑ FREQUENCYOFTONI C-CLONIC(GRANDMAL)
SEIZURES, SUICI
DALTHOUGHTS, at
axi
a,di
zzi
ness,
drowsiness,euphor
ia,
fati
gue,headache,hy
peracti
vit
y,
i
rri
tabi
lit
y,psychi
atr
icdist
urbances.EENT:myopia.GI:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1497
abdomi nal pain,anorexi
a,crampi ng,diarrhea,nausea,
vomi ti
ng,wei ghtloss,hi
ccups.GU: pink/brown
discolorati
onofur i
ne,vagi
nal bleeding.Der m: STEVENS-
JOHNSONSYNDROME, hi
rsuti
sm, rashes, urt
icaria.Hemat:
agranulocy tosi
s,eosinophili
a,leukopenia, pancytopenia.
Neur o:ataxia.Misc:systemiclupuser yt
hemat osus.

I
NTERACTI
ONS
Drug-Drug:Sei
zuret hreshol dmaybel oweredby
phenothiazi
nes,antidepr essants, orMAOinhibi
tors.
Additi
veCNSdepr essionwi t
hot herCNSdepr essants,
i
ncludingalcohol,
ant i
hist amines, ant
idepr
essants,opi
oid
analgesics,
andsedat ive/ hypnotics.May↑ pheny toi
n
l
evels.May↓ phenobar bitalorprimidonelevel
s.Blood
l
evelsmaybe↑ or↓ byv al
proi
caci d.
Drug-Nat
uralProduct:Seesedati
veinter
acti
ons.St .John'
s
wortmayaf f
ectethosuximidelev
elsandef fect
iveness;
avoiduse.Concomitantuseofkav a,
valeri
an,skull
cap,
chamomi l
e,orhopscan↑ CNSdepr ession.

DOSAGE
PO: (
Adult
sandChi ldr
en>6yr):
250mgbi dini
ti
all
y;may↑
by250mg/ dayevery4–7daysunt
ilcont
rol
achieved
(usualmaintenancedose20–40mg/ kg/
dayin2divi
ded

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1498
doses)
.
PO: (
Chi
ldr
en3–6y r
):250mgoncedail
yini
ti
all
y;may↑
by250mg/ dayever
y4–7daysunti
lcont
rolachi
eved
(opti
maldoseformostchi
l
dreni
s20mg/ kg/dayin2
divi
deddoses)
.

AVAI
LABI
LITY
Capsul
es250mg;
Syr
up250mg/
5mL;

PATI
ENTTEACHI
NG
I
nstructpatienttot akemedi cati
onasdi rected.I
fa
dosei smissed, takeassoonasr emember edwithi
n4
hr,t
hencont inueondoseschedul e.Donotdoubl e
doses.Donotdi scontinuemedi cati
onwi thoutadvi
ce
ofhealthcarepr ofessional
.Suddenwi t
hdr awalmay
preci
pitateseizures.Instr
uctpat i
enttoreadt he
MedicationGui debef orestart
ingandwi theachRx
refi
ll
,changesmayoccur .

Medicati
onmaycausedi zziness,dr
owsiness,or
bl
urredvisi
on.Cauti
onpatienttoavoiddri
vingor
otheracti
vi
ti
esrequi
ringal
er t
nessuntil
responseto
medicati
onisknown.Donotr esumedrivi
nguntil
physici
angivescl
earancebasedoncont rolofsei
zur
e
di
sorder.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1499
Advi
sepatientt
oav
oidal
cohol
whi
l
etaki
ngt
his
medicat
ion.

Advisepatientt
oconsul
theal
thcareprof
essional
beforetaki
nganyOTCmedi cat
ionsconcurr
entl
ywith
thi
sdr ug.

Instructpat ientt onot i

fyheal t
hcar epr ofessional i
f
skinr ash, j
oi ntpai n,soret hroat, f
ev er,unusual
bleedingorbr uising, swollengl ands, orpi nk/brown
urine,occur s.Adv isepat ientandf ami l
yt onot ify
healthcar epr ofessional ifthought saboutsui cideor
dying, at
tempt st ocommi tsui cide;neworwor se
depr ession; neworwor seanxi ety;feelingv er
y
agitatedorr estless; panicat tacks; troublesl eeping;
neworwor sei r
ritabilit
y;actingaggr essive; being
angr yorv iolent; actingondanger ousi mpul ses;an
extremei ncr easei nact ivi
tyandt alking,ot herunusual
changesi nbehav iorormoodoccur .

I
nstr
uctpat
ientt
onoti
fyhealt
hcarepr
ofessi
onal
if
pr
egnancyi
splannedorsuspect
ed.

Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Emphasi
zetheimpor
tanceoffol
l
ow-upexamst
o
moni
torprogr
essandsideef
fect
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1500
Et
idr
onat
e
I
NDI
CATI
ONS
TreatmentofPaget’
sdiseaseofbone.Treat
mentand
prophyl
axisofhet
erotopi
ccalci
fi
cati
onassociat
edwi
th
total
hiprepl
acementorspinalcor
dinjur
y.

ACTI
ON
Bl
ocksthegrowthofcalcium hydroxy apati
tecrystal
sby
bi
ndi
ngt ocal
cium phosphate.Ther apeuti
cEffects:
Decr
easedboner esor
pti
onandt urnov er
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Over
tost
eomal
aci
a;
Abnor
mali
ti
esoftheesophaguswhi
chdel
ayesophageal
empty
ing(
i.
e.st
ri
ctur
es,achal
asi
a).

UseCaut
iousl
yin:
Hist
oryofupperGIdi
sor
der
s;
Hypocalcemi a;Hypov i
taminosi
sD; Renal i
mpai r
ment
(dosager educti
onmaybeneeded) ;Invasivedent al
procedures,cancer,receivi
ngchemot herapyor
corti
costeroids,poororalhygei
ne,periodontaldisease,
dentaldi
sease, anemi a,coagul
opathy,inf
ection,orpoorl
y-
fi
tti
ngdent ures(may↑ r i
skofjawost eonecrosis);
OB:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1501
Lact
ati
on:
Pedi
:Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:di
arr
hea,nausea, esophagiti
s,esophagealcancer
,
esophagealulcer.MS: musculoskelet
alpai
n,
microf
ractur
es, ost
eonecrosis(pri
mar i
lyofj
aw) .

I
NTERACTI
ONS
Drug-Drug:Ant
aci
ds,mi neralsuppl
ement s,
orbuffers(as
i
ndi danosi
ne)contai
ningcalcium,aluminum,ir
on,or
magnesi um may↓ absor pti
onofetidr
onate.
Hypocalcemiceff
ectmaybeaddi ti
vewithcalci
tonin.
Dr
ug-Food:Foodscont
aini
nglargeamount
sofcal
cium,
al
uminum,iron,
ormagnesium may↓ absor
pti
onof
et
idr
onate.

DOSAGE
Paget
’sDi
sease
PO:(Adul
ts)
:5–10mg/ kg/
daysi
ngledosef
orupt
o6mo
or11–20mg/kg/dayf
ornotmorethan3mo.
Het
erot
opi
cOssi
fi
cat
ion(
HipRepl
acement
)
PO:(Adult
s):20mg/
kg/
dayf
or1mobef
oreand3mo
af
tersurgery
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1502
Het
erot
opi
cOssi
fi
cat
ion(
Spi
nal
Cor
dInj
ury
)
PO:(
Adult
s) :
20mg/ kg/
dayf
or2wk,
thendecr
easedt
o
10mg/kg/dayfor10wk.

AVAI
LABI
LITY
Tabl
ets200mg,
400mg;

PATI
ENTTEACHI
NG
Adv i
sepati
entt
otakeasdir
ected.Takemisseddoses
assoonasr ememberedunlessal
mosttimefornext
dose.Donotdoubleupondoses.Doseshouldnotbe
takenwithi
n2hrofeati
ng(especi
all
yproductshi
ghin
calci
um)ortaki
ngvit
aminsorantaci
ds,because
absorpt
ionwil
lbeimpai
red.

Inst
ructpati
enttonotif
yheal t
hcareprofessi
onali
f
swallowi
ngdiffi
cul
ti
es, chestpai
n,neworwor seni
ng
heartbur
n,ortr
oubleorpai nwhenswallowingoccurs;
maybesi gnsofproblemsoft heesophagus.

I
nstructpat
ienttonot
ifyheal
thcareprofessional
if
diar
rheaoccurs.Heal
thcareprof
essionalmaydi vi
de
thedosethroughoutt
hedayt ocontr
ol di
arrhea.

Encour
agepati
entstocomplywi
thdi
et
recommendat
ions.Di
etshoul
dcont
ainadequat
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1503
 amount
sofcal
cium andv
itami
nD(
seeAppendi
xM)
.

Infor
m patientthatseveremusculoskel
et alpainmay
occurwithinday s,months,
oryrafterstarti
ng
etidr
onate.Sy mptomsmyr esolvecompl etelyaft
er
discont
inuationorsloworincompl et
eresol uti
onmay
occur.Notifyhealt
hcareprofessi
onal i
fsev erepain
occurs.

Emphasi zeneedforkeepingfol
low-
upappoi
ntment
s
tomonitorprogress,evenaft
ermedicat
ioni
s
discont
inued,todetectrel
apse.

Advi
sepati
enttoi
nform heal
thcareprof
essi
onal
of
et
idr
onat
etherapypri
ortodentalsur
gery.

Et
odol
ac
I
NDI
CATI
ONS
Ost
eoar
thri
ti
s.Rheumat
oidar
thr
it
is.Mi
l
dtomoder
atepai
n
(
notXLtabl
ets)
.

ACTI
ON
Inhi
bit
sprostagl
andinsynthesi
s.Alsohasur
icosur
ic
acti
on.Therapeut
icEff
ects:Suppressi
onofi
nflammati
on.
Decreasedseveri
tyofpain.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1504
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Act
iveGIbl
eedi
ng
orulcerdisease;Cross-
sensi
ti
vit
ymayexistwithother
NSAI Ds,
includi
ngaspi r
in;
OB:Useduringsecondhalfof
pregnancycanr esulti
nprematurecl
osureofductus
arter
iosi
s.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
seaseorr
iskf
act
ors
forcardiovasculardisease(may↑ r i
skofser i
ous
cardiovascularthromboticev ent
s,my ocardiali
nfar
cti
on,
andst r
oke, especial
lywithpr ol
ongeduse) Renalorhepat
ic
disease;Historyofulcerdisease;Lactati
on: Li
mited
i
nf or
mat ionavailabl
e;useot hersaferNSAI D;Pedi:
Safet
y
notestabl i
shed;Geri:↑r i
skofGIbl eeding.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: depression,dizzi
ness, drowsi ness, insomnia,
malaise,nervousness, syncope, weakness.EENT: blurr
ed
vi
sion,photophobi a,ti
nnitus.Resp: asthma.CV: CHF,
edema, hypertension,palpit
ations.GI : GIBLEEDI NG,
dyspepsia,abdomi nalpain, const i
pation, di
arrhea, dr
ug-
i
nducedhepat i
tis,drymout h,flatulence, gastri
ti
s, nausea,
stomatit
is,thi
rst,vomiting.GU: dysuria,renalfail
ur e,
uri
naryfrequency .Derm: EXFOLI ATIVEDERMATI TIS,
STEVENS- JOHNSONSYNDROME, TOXI CEPI DERMAL

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1505
NECROLYSIS,ecchymoses,fl
ushi
ng,hyper pi
gment at
ion,
pr
uri
tus,r
ashes,sweati
ng.Hemat :
anemi a,prol
onged
bl
eedingt
ime,thrombocyt
openia.Misc:all
ergicreact
ions
i
ncl
udinganaphylaxi
s,ANGIOEDEMA, chil
ls,f
ev er
.

I
NTERACTI
ONS
Drug-Drug: Concurrentusewi thaspi ri
nmay↓
effecti
veness.↑ adv erseGIef fect swi thaspi ri
n,other
NSAI Ds,potassium supplement s, corti
costeroids,
antipl
ateletagents,oralcohol.Chr onicusewi th
acetami nophenmay↑ r iskofadv erserenal reacti
ons.
May↓ ef fecti
venessofdi uret
icorant i
hyper t
ensive
therapy.May↑ ser um li
thium lev elsand↑ r iskoft oxicit
y.
↑r i
skoft oxi
cityfr
om met hot
rexat e.↑ riskofbl eeding
withcefot et
an,cefoperazone, valpr oicacid, t
hrombol y t
ics,
antipl
ateletagents,oranticoagul ant s.↑ riskofadv er se
hemat ologicreacti
onswi thantineopl asti
csorr adiation
therapy.May↑ t heriskofnephr otoxicit
yf rom
cyclosporine.
Drug-
Nat
uralPr
oduct
:↑riskofbleedingwi
tharni
ca,
chamomil
e,cl
ove,
dongquai,
feverfew,gar
li
c,gi
nko,
and
Panaxgi
nseng.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1506
PO:(Adul
ts):Analgesi
a—200–400mgq6–8hr( notto
exceed1200mg/ day).Osteoar
thri
ti
s/r
heumatoi
d
art
hri
ti
s—300mg2–3t imesdail
y,400mgtwicedaily
,or
500mgt wicedail
y;mayal sobegivenas400–1200mg
oncedail
yasXLt ablets.

AVAI
LABI
LITY
Capsul
es200mg,300mg;Tabl
ets400mg,500mg;
Ext
ended-
rel
easet
abl
ets(
XL)400mg, 500mg,600mg;

PATI
ENTTEACHI
NG
Advisepati
ent
stotakeetodol
acwithaful
lgl
assof
waterandtoremaininanupri
ghtposi
ti
onfor15–30
minafteradmini
str
ati
on.

I
nstructpati
enttotakemedi cati
onasdirect
ed.Take
misseddosesassoonaspossi bl
ewithi
n1–2hri f
t
akingtwice/day,orunlessalmostti
mef ornextdose
i
ftakingmor ethantwice/day.Donotdoubledoses.

Etodolacmayoccasionall
ycausedrowsinessor
dizzi
ness.Advisepat
ientt
oav oi
ddrivi
ngorother
activ
iti
esrequi
ringal
ert
nessunti
lresponsetothe
medi cat
ionisknown.

Caut
ionpat
ientt
oav
oidt
heconcur
rentuseofal
cohol
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1507
 aspi
ri
n,acetami
nophen,NSAIDs,orot
herOTC
medicat
ionswit
houtconsul
tati
onwithheal
thcar
e
prof
essi
onal.

Advi
sepatientt
oinf
orm heal
thcar
eprofessionalof
medicat
ionregi
menbeforetr
eatmentorsurgery.

Adv i
sepati
enttoconsulthealt
hcareprofessi
onali
f
rash,i
tchi
ng,vi
sualdi
sturbances,t
inni
tus,wei
ghtgai
n,
edema, bl
ackstool
s,persist
entheadache,or
i
nf l
uenza-
li
kesyndrome( chi
ll
s,fev
er,muscleaches,
pain)occur
s.

Et
omi
dat
e
I
NDI
CATI
ONS
I
nduct
ionofgeneral
anesthesia.Supplemental
anesthesi
a
wi
thotheragent
s(ni
trousoxide)forshortpr
ocedures.

ACTI
ON
HypnoticCNSdepressantwit
houtanalgesi
cacti
vi
ty.
Therapeuti
cEf
fect
s: I
nduct
ion/suppl
ementati
onofgener
al
anesthesi
a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1508
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Prol
ongedi
nfusi
on
notrecommended( suppressescort
isol
product
ion);OB:
Pregnancy
,labor
,deli
very(incl
udi
ngcesareansecti
on).

UseCaut
iousl
yin:
Pat
ient
sunder
goi
ngsev
erest
ress
(mayrequi
resupplementalcor
ticost
eroi
ds);Ger
i:Ger
iatr
ic
pat
ient
s;Lactat
ion:Safet
ynotestabl
ished;
Pedi:Chil
dren
<10yr(saf
etynotestabli
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:arr
hy t
hmias,hy per
tension,hypotensi
on.Resp: APNEA,
LARYNGOSPASM, hyperventi
lat
ion,hypoventi
lat
ion.GI:
post
operativ
enausea/ vomi ti
ng.Local:tr
ansientinj
ecti
on
si
tepain.MS: t
ransientskeletalmusclemov ement s.

I
NTERACTI
ONS
Drug-Drug:↑ CNSdepr essionwithotherCNSdepr essant
s
i
ncludingant i
hist
ami nes,anti
depressants,
sedative/hypnoti
cs,antipsychot
icsandopi oi
ds;↓ dosage
ofotherCNSdepr essant si
fnecessary.Verapamilmay↑
anestheticeffect
,whichmay↑ r iskofrespir
ator
y
depressionandapnea.

DOSAGE
I
V:(
Adul
tsandChi
l
dren>10y
r):
0.2–0.
6mg/
kg(
usual

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1509
dosei
s0.3mg/kg)fori
nducti
on.Smal
lerincr
ement
smay
beuseddur
ingshor
tprocedur
estosupplementot
her
agent
s.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion2mg/
mL;

PATI
ENTTEACHI
NG
I
nfor
m pat
ientoft
hepur
poseofmedi
cat
ion.

Maycausedr owsinessordizzi
ness.Advisepat i
entto
requestassi
stancepri
ortoambulationandt ransfer
andtoav oi
ddr i
vi
ngorotheracti
vit
iesrequir
ing
aler
tnessfor24hrfoll
owingadministr
ati
on.

Advi
sepat i
enttoavoi
dal
coholorot
herCNS
depressant
swithoutt
headvi
ceofaheathcare
prof
essionalf
or24hrfol
l
owingadmini
str
ati
on.

Et
onnogest
rel
I
NDI
CATI
ONS
Prev
enti
onofpregnancy.Regul
ati
onofmenstrual
cycl
e.
Emergencycont
racepti
on(someproduct
s).Tr
eatmentof
heavymenstr
ualbleedi
nginwomenwhochooset ouse

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1510
i
nt r
auteri
necont racept
ionast heirmet
hodof
cont r
acepti
on( Mirena)
.Treatmentofpr emenstrual
dysphoricdisorder(Beyaz,Yaz,Yasmin).Managementof
acnei nwomen>14y rwhodesi recont
racepti
on, haveno
healthproblems, andhavefail
edt opi
caltr
eatment .
Increasefolatelevel
sinwomenwhodesi r
eor al
cont r
acepti
ont oreducether i
skofneuraltubedef ectsi
na
pregnancyt hatoccurswhiletakingorshortl
yafter
disconti
nuingt heproduct.

ACTI
ON
Monophasi cOr alCont racept ives: Pr ovideaf i
xeddosage
ofestrogen/pr ogest i
nov era21- daycy cl
e.Ov ulati
oni s
i
nhibitedbysuppr essi onoff olli
cle-st i
mul ati
nghor mone
(FSH)andl uteinizinghor mone( LH) .Mayal tercer vical
mucusandt heendomet rialenv ironment ,prev ent i
ng
penetrati
onbysper m andi mpl ant ationoft heegg.
BiphasicOral Cont racept i
v es: Ov ulationisinhi bitedby
suppressionofFSHandLH.Mayal t
ercer vical mucusand
theendomet rial environment , prevent i
ngpenet rationby
sperm andi mpl antationoft heegg.I naddi ti
on, smal l
er
doseofpr ogest ininphase1al l
owsf orproliferationof
endomet ri
um.Lar geramounti nphase2al lowsf or
adequatesecr et orydev elopment .Tr iphasicOr al
Contracepti
ves: Ovulat i
oni si nhibitedbysuppr essionof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1511
FSHandLH.Mayal tercer v
ical mucusandt heendomet ri
al
env i
ronment ,prev ent ingpenet rat i
onbysper m and
i
mpl ant ationoft heegg.Var y i
ngdosesof
est r
ogen/ progest i
nmaymor ecl osel ymi mi cnat ural
hor monal fluctuat ions.Four phasi cOr al Cont racept i
ves:
Ov ulat i
oni sinhi bitedbysuppr essi onofFSHandLH.May
altercer vical mucusandt heendomet rial env ir
onment ,
prev ent i
ngpenet rationbysper m andi mpl ant ationoft he
egg.Dosesofest rogendecr easewhi l
edosesofpr ogest i
n
i
ncr easeov erthe28–daycy cle.Ext ended- cycle: Prov i
des
cont inuousest rogen/ progest i
nf or84day s( 365day sfor
Ly brel),thenof ffor7day s(l
ow- doseest rogen- onlyt ablet
takendur ingt hese7day swi thLoSeasoni queand
Seasoni que) ,resul tingi n4menst rualper iods/ year(no
per i
ods/ yearf orLy brel).Progr essi veEst rogen: Cont ai
ns
const antamountofpr ogestinwi th3pr ogr essi vedosesof
est r
ogen.Pr ogest in-Onl yCont r acept ives/ Cont racept ive
Impl ant /Intraut erine
Lev onor gest rel/Medr oxy progest eroneI nject ion:
Mechani sm notcl ear lyknown.Mayal tercer vical mucus
andt heendomet rial env i
ronment ,prevent ingpenet r
ation
bysper m andi mpl ant ationoft heegg.Ov ul ationmayal so
besuppr essed.Emer gencyCont racept i
v ePi ll
s( ECPs) :
Inhibitov ulat i
on/ fer ti
li
zat i
on; mayal soal tert ubal
transpor tofsper m/ eggandpr ev enti mpl ant ation.Vagi nal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1512
Ring,Transder mal Patch:inhibi
tsov ulati
on, decreases
sperm ent ryintouterus,anddecr easesl ikel
ihoodof
i
mpl antation.Ant i
-acneeffect:Combi nat i
onof
estrogen/ progestinmayi ncreasesexhor monebi nding
globulin(SHBG)r esult
ingindecreasedunbound
testosterone, whichmaybeacauseofacne.Ther apeutic
Effects:Prev ent
ionofpr egnancy .Decr easedsev eri
tyof
acne.Decr easeinmenst rualbloodl oss.Decr easein
premenst rual di
sphor i
cdisorder.Increasei nfolatelevel
s
andpr event i
onofneur al t
ubedef ects.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:OB:
Pregnancy
;Hi
stor
yofci
gar
ett
e
smokingorage>35y r(↑r i
skofcar diovascul aror
thromboembol icphenomenon) ;Historyof
thromboembol icdisease( e.g.,DVT, PE, MI ,stroke) ;
Thrombophi li
cdi sorders;Val vul
arhear tdi sease; Maj or
surgerywi thext endedper i
odsofi mmobi l
ity; Diabet eswi t
h
vascularinv olvement ;Headachewi t
hf ocal neur ological
symptoms; Uncont rol
ledhy per t
ension; Histor yofbr east,
endomet r
ial,orest r
ogen- dependentcancer ; Abnor mal
genit
al bleeding; Li
v erdisease; Hyper sensitivityt o
parabens( injectableonl y);Drosperinone- cont aining
productsonl y—Renal impai rment ,
liverdisease, oradr enal
i
nsuffi
ci ency( ↑r i
skofhy perkalemia) ;I
ntraut erine

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1513
l
evonor gestrel only—Intrauterineanomal y,postpart
um
endomet ri
osis,mul ti
plesexual par
tners,pelvi
c
i
nflammat orydi sease,li
v erdisease,genitalacti
nomy cosi
s,
i
mmunosuppr ession,IVdr ugabuse, untreated
genitourinaryinfection,historyofectopicpr egnancy;
Somepr oduct scont aintartrazineandshoul dbeav oided
i
npat ientswi thknownhy persensiti
vi
tyintolerance;
Lactation:Av oiduse.

UseCaut
iousl
yin:
Presenceofot
hercar
diov
ascul
arr
isk
factors(
obesity
,hypergl
y cemi a,hypert
ension);Hist
oryor
familyhi
storyofhypertr
iglyceridemia(↑r iskof
pancreati
ti
s);Hi
storyofdi abetesmel l
itus,bl
eeding
disorder
s,concurr
entant i
coagul anttherapyorheadaches;
Pedi:Avoidusebeforemenar che.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: depr ession,headache.EENT: cont actlens
i
ntol erance, opticneur i
ti
s, r
etinalthrombosi s.CV:
THROMBOEMBOLI SM( riskisgr eatestdur i
ngf i
rst6moof
therapy ),edema, hyper tension,Ray naud’ sphenomenon,
thrombophl ebitis.FandE: Drosper inone-contai
ning
product sonl y—hy perkalemi a.GI :
PANCREATI TIS,
abdomi nal cramps, bloating,cholest at
icjaundice,
gallbladderdi sease, l
ivertumor s, nausea, vomiti
ng.GU:
amenor rhea, breakthr oughbl eeding, dysmenor rhea,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1514
spott
ing,I
ntrauteri
nelevonorgestr
elonly—ut
erine
i
mbedment /ut er
ineruptur
e.Derm: melasma,rash.Endo:
hypergl
ycemi a.MS: I
nject
ablemedr oxy
progester
one
only
—bonel oss.Mi sc:weightchange.

I
NTERACTI
ONS
Drug- Drug: Or al cont racept iv eef ficacymaybe↓ by
penici l
li
ns, chl orampheni col ,bar biturat es, chroni cal cohol
use, car bamazepi ne, oxcar bazepi ne, felbamat e, systemi c
corti
cost eroi ds, pheny toin, topiramat e,pr imi done,
modaf inil
, rifampi n,rifabut in, somepr oteasei nhi bitors
(i
ncludi ngr itonav i
r)
, non- nucl eosi der ev er set ranscr ipt ase
i
nhibi tors.ort etracycl i
nes.May↑ ef fect s/ r
iskoft oxi city
ofsomebenzodi azepi nes, bet abl ocker s, cor t
icost eroi ds,
cyclospor ine, andt heophy lline.↑ r i
skofhepat i
ct oxi city
withdant rol ene( estrogenonl y).Indi nav ir, it
raconazol e,
ketoconazol e, f
luconazol e, vor i
conazol e, rosuv astat i
n, and
atorvast atinmay↑ ef fects/ riskoft oxi cit y.Smoki ng↑
ri
skoft hr omboembol icphenomena( est r ogenonl y )
.May
↓l ev elsofacet ami nophen, temazepam, lamot rigi
ne,
l
orazepam, oxazepam, ormor phi ne.Dr osper inone-
contai ningpr oduct sonl y—concur r entusewi thNSAI Ds,
potassi um- spar i
ngdi uretics, pot asssi um suppl ement s,
ACEi nhibit ors, aldost eroner ecept orant agoni st s,or
angiot ensi nI Ir ecept orant agoni stsmayr esul tin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1515
hy
per
kal
emi
a.
Dr
ug-Natur
alPr
oduct :Concomitantusewi
thSt.John’
s
wortmay↓ contracepti
veeff
icacyandcause
br
eakthr
oughbleedingandirr
egularmenses.
Dr
ug-
Food:
Grapef
rui
tjui
cemay↑ ef
fect
s/r
iskoft
oxi
cit
y.

DOSAGE
Monophasi
cOr
alCont
racept
ives
PO:(Adul
ts):On21-dayregimen, takefi
rsttabl
etonfir
st
Sundayaft
ermensesbegi ns( t
akeonSundayi fmenses
begi
nsonSunday )for21day s,thenskip7day sandbegin
agai
n.Regimenmayal sobest artedonf i
rstdayof
menses,cont
inuefor21day s,thenskip7day sandbegin
agai
n.Somer egi
menscont ain7pl acebotablets,
sothat1
tabl
eti
stakeneverydayfor28day s.
Bi
phasi
cOr
alCont
racept
ives
PO: (Adults): Gi
venin2phases.Fi r
stphaseis10day sof
smal l
eramountofpr ogestin.Secondphaseislarger
amountofpr ogest
in.Amountofest rogenremains
const antforsamel engthoft i
me( t
otalof21day s),
then
skip7day sandbegi nagain.Somer egimenscont ai
n7
placebot abletsfor28-dayregimen.
Tr
iphasi
cOr
alCont
racept
ives

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1516
PO:(Adult
s):Pr
ogesti
namountvari
esthroughout21-day
cycl
e.Estr
ogencomponentst
aysthesameormayv ary.
Somer egi
menscontai
n7placebotabl
etsfor28-day
regi
men.
Four
phasi
cOr
alCont
racept
ives
PO: (Adul
ts):
Givenin4phases.Firstphasecont ains
higheramountofestrogenandnopr ogestin.Secondand
thir
dphasescontainsloweramountofest rogen, and
i
ncr easi
ngamountsofpr ogesti
n.Fourthphasecont ai
ns
l
owdoseofest r
ogenonly .Al
socontains2pl acebotabl
ets
tocompl et
e28–dayr egi
men.
Ext
ended-
Cycl
eCont
racept
ive
PO:(Adults) :LoSeasoni que,SeasonaleandSeasoni que.
Star
ttakingf i
r stactivepi l
lonfir
stSundayaf termenses
begi
ns( i
ff i
rstdayi sSunday ,beginthen),conti
nuefor84
daysofact ivepi l
l,
followedby7day sofpl acebotablets
(l
ow-doseest rogent abletsforLoSeasoniqueand
Seasonique), thenr esume84/ 7cycleagain.ForLybrel,
begi
nt akingt hef i
rstpillduri
ngt hefi
rstdayoft he
menstrual cycleandst artthenextpackt hedayaf t
erthe
prev
iouspackends.
Pr
ogest
in-
Onl
yOr
alCont
racept
ives
PO:
(Adul
ts)
:St
artonf
ir
stdayofmenses.Takendai
l
yand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1517
cont
inuousl
y.
Pr
ogr
essi
veEst
rogenOr
alCont
racept
ives
PO:(Adul
ts):Estr
ogenamountincr
easesq7days
thr
oughout21-daycycl
e.Pr
ogesti
ncomponentst
ayst
he
same.Somer egimenscont
ain7placebot
abl
etsf
or28-
dayregi
men.
Emer
gencyCont
racept
ive
PO: (AdultsandAdol escents) :PlanB—1t abletwithin72hr
ofunpr ot
ectedi ntercour sefollowedby1mor etablet12hr
l
ater ;Lo/Ov r
al—4whi tetabletswi thi
n72hrofunpr otected
i
nter coursef oll
owedby4mor ewhi t
et ablets12hrl ater
;
Levlen, Nordet t
e—4l i
ghtor anget abl
etswi t
hin72hrof
unpr otectedintercour sef ol
lowedby4mor elightor ange
tablets12hrl ater
; Triphasil
, Tri
-Lev l
en—4y ellowtabl ets
within72hrofunpr otectedintercour sef oll
owedby4mor e
yell
owt ablet
s12hrl ater;Uli
pristal—1t abletassoonas
possi blewithin120hour s(5day s)afterunpr otected
i
nter courseorknown/ suspectedcont raceptivefailure.
I
nject
abl
eCont
racept
ive
medr
oxy
progest
erone(
Depo-
Prov
era)
I
M: (
Adult
s) :150mgwithi
nfirst5daysofmensesor
wi
thi
n5day spostpar
tum,ifnotbreast
feedi
ng.I
f
br
eastf
eeding,gi
ve6wkpost part
um; r
epeatq3mo.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1518
medr
oxy
progest
erone(
Depo-
SubQPr
over
a104)
Subcut(Adult
s):104mgwithinf
irst5daysofmensesor
withi
n5day spostpar
tum,
ifnotbreast
feedi
ng.I
f
breast
feedi
ng,gi
ve6wkpost par
tum; r
epeatq12–14wk.
I
ntr
aut
eri
neCont
racept
ive
Int
rauter
ine(Adul
ts):
Inser
tonedevi
ceint
out eri
necavit
y
withi
n7day sofmensesorimmediat
elyafter1sttr
imester
aborti
on;rel
eases20mcglevonor
gestr
el/
dayov er5yr.
Vagi
nal
RingCont
racept
ive
Vag(Adult
s):Oner
inginsert
edonorpri
ortoday5of
menstrual
cycl
e.Ri
ngislefti
nplacef
or3wk,then
removedfor1wk,t
henanewr i
ngisi
nser
ted.
Tr
ansder
mal
Pat
ch
Tr
ansdermal:(Adult
s):Patchisappl
iedonday1of
menst
rualcycle(orconvenientdayi
nfir
stweek),changed
weekl
ythereaft
erfor3weeks.Week4i spat
ch-f
ree.Cycle
i
sthenrepeated.

Acne
PO:(
Adult
s):Ort
hoTr
i-
Cycl
enonl
y,t
akendai
l
yfor21day
s,
of
ffor7days.

AVAI
LABI
LITY
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1519
Combinati
onEst
rogen/
Progest
inOr
alCont
racept
ives
(gener
icavai
l
abl
e)
Oralcontracept
ivetabletsUsuall
yinmonthlypackswit
h
enough( 21)acti
v et
abletstocompletea28-daycycl
e.
Somecont ai
n7i ner
ttabletstocomplet
ethecy cl
ewit
hor
withoutsupplementaliron,BeyazandSafyr
al—contain
0.451mgofl ev
omef ol
at ecalci
um/tabl
et

Ext
ended-
Cycl
eCont
racept
ive
Tabl et
sLoSeasoni que—activetabletscont ai
ning0. 02mg
ethinylestradiol,0.
1mgl evonor gestrel,and7t abl
et s
cont ai
ning0. 01mget hi
nylestradiol,
Seasonal e—84act i
ve
tabletscont aining0.
03mget hinylest r
adiol and0. 15mg
l
ev onorgest reland7inactiv
et ablets,Seasoni que—act i
ve
tabletscont aining0.
03mget hinylest r
adiol ,
0.15mg
l
ev onorgest rel,
and7t abl
etscont aining0. 01mget hi
nyl
estradiol,
Ly brel—28activetabletscont aining0. 09mg
l
ev onorgest reland0.02mget hinylestradiol.
Lev
onor
gest
rel
Emergencycontracept i
ves2tablet
scontai
ning0.
75mg
l
evonorgestr
el(PlanB) ;I
mplantRodcontai
ns68mg
et
onogestrel
;Int
r auter
inesy
stem contai
ns52mg
l
evonorgestr
el(releases20mcg/ day)
;

Ul
i
pri
stal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1520
Tabl
ets30mg;
Medr
oxy
progest
erone(
gener
icav
ail
abl
e)
I
njectabl
eIM 150mg/mL; I
nject
abl
eSubcut
aneous104
mg/ 0.
65mL( inpr
e-f
il
ledsyr
inges)
;

Vagi
nal
RingCont
racept
ive
Ri
ngdeli
vers0.015mget
hiny
lest
radi
oland0.
120mg
et
onogest
rel/
day .

Tr
ansder
mal
Pat
ch
Pat
chcontains0.
75mget hi
nyl
est
radioland6mgof
nor
elgest
romin;r
eleases20mgethiny
l est
radi
ol/
150mg
nor
elgest
rominper24hr .

PATI
ENTTEACHI
NG
I
nstructpati
enttot
akeoralmedi
cat
ionasdi r
ectedat
thesamet i
meeachday .Pi
l
lsshoul
dbet akenin
propersequenceandkepti
ntheori
ginal
container
.
Advisepati
entnottoski
ppil
lsev
enifnothavingsex
veryoft
en.

Ifsi
ngledail
ydosei smissed:Takeassoonas
remembered; i
fnotuntil
nextday,take2tabl
etsand
conti
nueonr egulardosi
ngschedule.If2day
sina
rowaremi ssed:Take2t abl
etsadayf ort
henext2

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1521
 daysandcont inueonr egulardosingschedul e,usi
nga
secondmet hodofbi rthcont rol f
ortheremai ni
ng
cycl
e.If3day sinar owar emi ssed:Disconti
nue
medicat i
onanduseanot herform ofbirthcontrolunt
il
peri
odbegi nsorpr egnancyi sr ul
edout ;t
henbegi na
newcy cleoft ablet
s.For28- daydosi ngschedule:If
scheduleisf oll
owedf orfir
st21day sand1dosei s
missedoft hel ast7t ablets,iti
si mportanttotakethe
1sttabletofnextmont h’scycleont heregularl
y
scheduledday .

Adv i
sepat i
entt akingJol
essa,Quasense,Seasonale,
Sesoni que, orLoSeasoniqueextended-cyclet
ablet
s
thatwi thdrawal bleedi
ngshouldoccurdur i
ngthe7
daysf ollowingdi sconti
nuat
ionoftheact i
vetabl
ets.I
f
withdrawal bleedingdoesnotoccur,notif
yhealt
hcare
professi onal.Adv i
sepati
enttaki
ngLy brelt
hatno
withdrawal bleedingshoul
doccur.

Forinit
ialuseofJol essa,Quasense,Seasonale,
Seasoni que,orLoSeasoniqueextendedcy cletablet
s,
cauti
onpat i
entt ouseanonhor monalmet hodof
contraceptionunt i
lshehastakenthefirst7day sof
acti
vet ablets.Each91-daycycleshouldstartont he
samedayoft heweek.Ifstart
edlaterthanthepr oper
dayor2ormor edaysaremissed,asecond

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1522
 nonhor monal methodofcontracept
ionshoul dbe
usedunt ilshehastakenthepinktabletfor7day s.
Transientspotti
ngorbleedingmayoccur .I
fbleedi
ng
i
sper sistentorprol
onged,noti
fyhealthcare
professional.

Advisepati
enttaki
ngextendedcycl
et abl
etsthat
spotti
ngorli
ghtbleedi
ngmayoccur ,especi
all
yduri
ng
fi
rst3mo.Cont i
nuemedi cat
ion;
noti
fyhealthcar
e
professi
onali
fbleedi
nglasts>7days.

Advi
sepat i
entoftheneedtouseanot
herfor
m of
contr
acepti
onforthefi
rst3wkwhenbeginni
ngtouse
oral
contracept
ives.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
nganynewmedi cations.

Adv isepat ientthatasecondmet hodofbi rthcont rol

shoul dalsobeuseddur ingeachcy cl
einwhi chanyof
thef oll
owi ngar eused: Oralcont raceptives—ampi cil
l
in,
cor ti
costeroids,antiret
rovir
alpr oteasei nhibitor
s,
bar bit
urates, carbamazepine, chlorampheni col,
dihy dr
oergot ami ne,cort
icosteroids( systemi c),
mi neraloil,oralneomy cin,oxcar bazapine, penicil
li
nV,
pheny lbutazone, pri
mi done,ri
fampi n,sulfonami des,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1523
 t
etr
acy
cli
nes,
topi
ramat
e,orv
alpr
oicaci
d.

Explai
ndoseschedul eandmaintenancer
outi
ne.
Discont
inui
ngmedi cati
onsuddenlymaycause
withdr
awalbleedi
ng.

Ifnauseabecomesapr oblem, advi

sepati
entthat
eati
ngsoli
df oodoftenprov i
desr el
i
ef.I
fnausea
persi
stsorvomi t
ingordiarrheaoccur,usea
nonhormonal methodofcont racepti
onandnot i
fy
healt
hcarepr of
essional.

Adv i
sepatienttor epor tsignsandsy mpt omsoff l
uid
retenti
on(swel l
ingofankl esandf eet,weightgai n),
thromboembol i
cdi sorder s(pain,swel l
ing, t
enderness
i
next remiti
es,headache, chestpai n,blur
redv isi
on),
ment aldepression, hepat i
cdy sfunction(y el
lowedski n
orey es,pr
urit
us, dar kurine,li
ght-coloredst ools)
, or
abnor malvaginal bleeding.Womenwi thast rong
fami l
yhist
oryofbr eastcancer ,fibrocysticbreast
disease,abnormal mammogr ams, orcervical
dysplasiashouldbemoni tor
edf orbr eastcancerat
l
easty earl
y.

I
nstr
uctpati
enttost
optaki
ngmedicat
ionandnoti
fy
heal
thcar
eprofessi
onal
ifpr
egnancyi
ssuspect
ed.

Caut
ionpat
ientt
hatci
gar
ett
esmoki
ngdur
ing

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1524
 estr
ogenther
apymayi ncr
easer
iskofser
ioussi
de
eff
ects,
especi
all
yforwomenoverage35.

Cauti
onpat
ient
stousesunscreenandprot
ect
ive
cl
othi
ngtoprev
enti
ncreasedpigment
ati
on.

Cauti
onpati
entthathor
monal cont
racept
ivesdonot
pr
otectagai
nstHIVorothersexual
lytr
ansmitt
ed
di
seases.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Emphasizethei
mpor tanceofrouti
nef ol
l
ow-
up
physi
calexamsincludingBP;breast,
abdomen,and
pel
vicexaminat
ions;andPapanicolaousmearsever
y
6–12mo.

Emer gencyCont r
aception:I
nstructpatienttot ake
emer gencycontracepti
v easdirected.Advisepat ient
thattheyshouldnott akeemer gencycont racept i
vesif
theyknoworsuspectt heyarepr egnant;emer gency
contracept
ivesarenotf oruset oendanexi sti
ng
pregnancy.Adv i
sepat i
enttocont acthealt
hcar e
professi
onal i
ftheyvomi twit
hin3hr saft
ert aking
uli
prist
al.

Inf
orm pat
ientt
hatuli
pri
stalmayr educethe
eff
ecti
venessofhormonal cont
racepti
ves.Adv
ise

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1525
 pati
entt
ouseanon-hor
monal
cont
racept
ivedur
ing
thatmenst
rual
cycl
e.

Advisepatienttonotifyheal
thcar
eprofessi
onaland
considerthepossi bi
l
ityofpr
egnancyofthei
rperi
odis
del
ay edbymor ethan1wkbey ondtheexpecteddat
e
aft
ert aki
ngulipri
stal
.

I
nform pati
entthatemergencycont
racepti
vesarenot
tobeusedasar outi
nefor
m ofcontr
acepti
onort obe
usedrepeatedl
ywi t
hint
hesamemenst r
ualcycl
e.

Advisepatientt
onoti
fyhealt
hcareprof
essional
if
severelowerabdominalpai
noccurs3–5wksaf ter
taki
ngul i
pri
stal
tobeevaluat
edforanectopic
pregnancy.

Advisef
emalepati
ent
stoav
oidbr
east
feedi
ngi
f
taki
nguli
pri
stal
.

IM:Subcut
:Advisepat
ientt
omaintai
nadequate
amountsofdiet
arycal
cium andv
itami
nDt ohel
p
prev
entboneloss.

Transdermal:
Instr
uctpatientonappli
cationofpatch.
Fi
rstpatchshouldbeappl i
edwi t
hin24hrof
menstrualperi
od.Ifappl
iedafterDay1ofmenst rual
peri
od,anonhor monalmet hodofcontracept
ion
shouldbeusedf orthenext7day s.Dayofappli
cation

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1526
 becomesPatchChangeDay.Pat
chesarewornfor1
wkandchangedont hesamedayofeachwkfor3wk.
Week4i spatch-
fr
ee.Wi
thdr
awalbl
eedi
ngisexpect
ed
duri
ngthist
ime.

Applypat chtoclean, dry,i

ntact,healthyskinon
buttock,abdomen, upperout erarm, oruppertorsoin
aplacewher eitwon’ tber ubbedbyt ightcl
othing.Do
notplaceonski nt hatisred, i
rri
tated,orcut,anddo
notplaceonbr east s.Donotappl ymake- up,creams,
l
oti
ons, powder s,orot hertopicalproductstoar eaof
patchappl i
cati
on.

Toappl ypatchopenf oilpouchbyt ear i

ngal ongedge
usi
ngf ingers.Peel pouchapar tandopenf lat.Graspa
cornerofthepat chf irmlyandr emov egentlyf r
om f oi
l
pouch.Usef i
ngernailtol i
ftonecor neroft hepat ch
andpeel patchandt hepl asti
clinerof fthefoilli
ner.
Donotr emov eclearl ineraspat chisr emov ed.Peel
awayhal fofthecl earl i
nerwithoutt ouchingst i
cky
surface.Applythest ickysur f
aceandr emov ether est
oftheliner.Pressdownf i
rmlywi t
hpal m ofhandf or
10seconds; makesur etheedgesst ickwel l.

OnPatchChangeDayremov epatchandapplynew
oneimmediat
ely
.Usedpatchsti
llcontai
nssome
act
ivehor
mones;fol
dinhalfsoitsti
ckstoi
tsel
fand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1527
 throwaway.Applynewpat
chest
oanewspotto
preventski
nirr
it
ati
on;
maybeappl
iedi
nsame
anatomicarea.

Fol
lowi
ngpat
ch-f
reeweek,applyanewpatchon
Pat
chChangeDay,t
hedayaf t
erDay28,nomatt
er
whenthemenst
rualcy
clebegins.

Ifpat
chbecomespar ti
all
yorcompl etel
ydetachedf or
l
esst han1day ,reapplypatchorappl ynewpat ch.I
f
patchisdetachedf ormor ethan1day ,
applyanew
patchimmedi atelyanduseanonhor monal f
or m of
contr
aceptionfort henext7day s.Cyclewillnowstart
overwithanewPat chChangeDay .Ifpatchisno
l
ongerst i
cky,applyanewpat ch;donotuset apeor
wrapst okeeppat chinplace.

IfpatchisnotchangedonPat chChangeDayi nthe

fir
stweekoft hecy cl
e,applynewpat chimmedi atel
y
uponr emember i
nganduseanonhor monal methodof
cont r
acepti
onfornext7day s.Ifpat
chchangei s
mi ssedinfor1or2day sduringWeek2or3, apply
newpat chimmedi atel
yandappl ynextpatchonusual
Pat chChangeDay .Nobackupcont racepti
oni s
needed.Ifpatchchangei smi ssedformor et han2
day sduri
ngWeek2or3, st
opt hecycleandst ar
ta
new4- wkcont r
aceptivecyclebyappl yingnewpat ch

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1528
 i
mmedi atel
yandusi
nganonhormonalmet hodof
contr
acepti
onfort
henext7days.I
fpatchisnot
removedonPatchChangeDayinWeek4, removeas
soonasrememberedandstar
tnextcycleonusual
PatchChangeDay.Noaddi
ti
onalcont
raceptioni
s
needed.

Adv i
sepatientref
erredforMRItesttodiscusspat
ch
withref
erri
ngheal t
hcarepr of
essional
andMRIf aci
li
ty
todeter
mi neifremov al
ofpatchisnecessarypri
orto
testandfordirect
ionsforrepl
acingpatch.

Nuv aRing: Ifahor monal contr acept i

vewasnotused
i
nt hepastmont h,i
nsertNuv aRi ngbetweenDay s1
and5oft hemenst rualcy cl
e( Day1=f ir
stdayof
menst r
ual per i
od),eveni fbleedi nghasnotf inished.
Useanonhor monal met hodofbi r
thcontrolotherthan
adi aphragm dur i
ngt hef i
rst7day sofr i
nguse.I f
switchingf rom acombi nationest rogen/progest er
one
oral contr
acept i
ve,insertNuv aRi nganyt i
medur ing
fi
rst7day saf terlasttabletandnol at
erthant hedaya
newpi l
lcycl ewoul dhav est art ed.Noext rabirth
cont roli
sneeded.I fswi tchingf rom ami ni-
pil
l,start
usingNuv aRi ngonanydayoft hemont h;donotski p
daysbet weenl astpi l
landf irstdayofNuv aRinguse.I f
switchingf rom ani mpl ant ,
st ar tusingNuv aRingon

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1529
 samedayi mpl anti sremov ed.Ifswi t
chingf rom an
i
njectabl econt racept i
ve,startusingNuv aRingont he
daywhennexti njecti
onisdue.I fswitchingf rom a
progestin-cont ainingIUD, startusingNuv aRingont he
samedayasI UDi sremov ed.Anonhor monal met
hod
ofcont racept i
on, otherthant hedi aphragm, shoul
dbe
usedf ort hef i
rst7day sofNuv aRingusewhen
switchingf rom t hemi ni-
pill
,impl ant
,injectable
contracept i
v e,orI UD.

Nuv aRingcomesi nar eclosablefoilpouch.I nstruct

patientt owashhands, t
henr emov eNuv aRingf rom
pouch; keeppouchf orr ingdisposal.Usi ngaposi ti
on
ofcomf ort(l
yingdown, squatting,orst andingwi th
onel egup) ,holdNuv aRingbet weent humbandi ndex
fi
ngerandpr essopposi tesidesoft her ingtoget her .
Gent lypushf oldedringi ntovagina.Exactposi t
ioni s
noti mpor t
antf orfunctionofNuv aRing.Mostwomen
donotf eelNuv aRingoncei ti
si nplace.I fdiscomf ort
i
sf elt,NuvaRingmaynotbei nsertedf arenoughi nto
vagina; usefingertopushf urtherintov agina.Ther eis
nodangerofNuv aRingbei ngpushedi nt oof aror
gettinglost.Oncei nser t
ed, l
eav eNuv aRingi npl ace
for3wk.

Remov
eri
ng3wkaf
teri
nser
ti
ononsamedayand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1530
 ti
meofi nser t
ion.Remov ebyhooki ngfingerunder
for
war drim orbyhol dingr i
ngbetweeni ndexand
middlefingerandpul li
ngout .Placer i
nginf oil
pouch
anddispose; donott hrowi ntoil
et.Menst r
ual peri
od
wil
lusuallystart2–3day safterri
ngi sremov edand
maynothav ef i
nishedbef orenextringisinserted.To
conti
nuecont raceptiveprotecti
on, newr i
ngmustbe
i
nserted1wkaf t
erlastonewasr emov ed, evenif
menst r
ual peri
odhasnotst opped.

IfNuv aRingsli
psoutofv agi
naandhasbeenoutl ess
than3hr ,cont
racepti
veprot
ectionisstil
linplace.
Nuv aRingcanber i
nsedi
ncool totepi
dwat erand
shouldber ei
nsert
edassoonaspossi ble.Ifri
ngis
l
ost, i
nser tanewr i
ngandcontinuesameschedul eas
l
ostr i
ng.I fNuvaRinghasbeenoutofv aginaformore
than3hr ,anonhormonalmethodofcont racepti
on,
othert hanadiaphragm,shouldbeusedf orthenext7
days.

IfNuv aRinghasbeenl efti

nforanext r
awkorl ess(4
wkt otal orless),remov eandinsertanewr i
ngaf t
era
1-wkr ing-fr
eebr eak.IfNuv aRinghasbeenleftin
placef ormor et han4wk, womanshoul dcheckt obe
sureshei snotpr egnant.Anonhor monal
met hodof
contracept i
on, othert
hanadi aphragm,mustbeused

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1531
 f
ort
henext7day
s.

Int
rauter inesy stem: Advisepat i
enttonot i
fyhealt
h
carepr of essionalifpelv
icpai norpai nduringsex,
unusual vaginaldischargeorgeni talsor
es,
unexplai nedf ever,exposur etosexual l
ytransmitt
ed
i
nfections, verysevereormi grai
neheadaches,
yel
lowingofski norwhi tesoft heey es,verysever
e
vaginal bleedingorbl eedingt hatlastsalongt i
me
occurs, ifamenst rualperiodismi ssed,orifMirena'
s
thr
eadscannotbef el
t.

Et
oposi
de
I
NDI
CATI
ONS
Refractoryt esti
cularneoplasms( I
Vonl y
)(usedin
combi nationwi thotherchemot herapeuti
cagentsin
pati
ent swhohav ealr
eadyr eceivedchemot her
apy ,sur
gery,
orradiation).Smal lcell
lungcar cinoma( POandI V)(fi
rst
-
l
inet herapy ;usedincombi nationwi thother
chemot her apeuticagents).UnlabeledUses: Ly
mphomas
andsomel eukemi as.Ut
erinecancer .Br
aintumors.

ACTI
ON
DamagesDNAbef
oremi
tosi
s(cy
cle-
dependentandphase

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1532
-speci
fi
c).Therapeut
icEff
ects:Deat
hofr
api
dlyr
epl
i
cat
ing
cell
s,par
ticul
arlymali
gnantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pregnancy
;
Lactat
ion;
Knownint
olerancet
oet
hyl
alcohol
or
poly
sorbate80(
IVonly)
.

UseCaut
iousl
yin:
Pat
ient
swi
thchi
l
dbear
ingpot
ent
ial
;
Acti
vei nfecti
ons;Decreasedbonemar rowr eserv
e;
Renal/hepat i
cimpairment(dosagemodi fi
cationmaybe
necessary )
;Hy poal
buminemi a;
Elder
ly(maybeat
i
ncreasedr iskofadv er
seef f
ects)
;Chil
dren(safetyand
eff
ecti
v enessnotest abl
ished);
Otherchronicdebili
tat
ing
i
ll
nesses.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsi ness,fatigue.CV: hypotension(IV).GI:
anorexia, diarrhea,nausea, vomiting,abdomi nalpain,
stomatitis.Der m: alopeci a,pruri
tis,r
ash, ur
ticari
a.Endo:
ster
il
ity.Hemat :anemi a,leukopeni a,thr
ombocy t
openia.
Local:phl ebiti
satI Vsi te.Neur o:peripheralneuropathy.
Misc:aller gicreactionsi ncludinganaphy laxis,f
ever.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1533
Drug-Drug:↑ bonemar rowdepr essionwit
hother
anti
neoplasti
csorr adi
ationtherapy.Mayalt
erimmune
responsetoli
v e-
vir
usv accinesand↑ r i
skofadver
se
reacti
ons.

DOSAGE
Ot
herr
egi
mensar
eused

Test
icul
arNeopl
asms
IV:(
Adul
ts):
Dosagerangesf
rom 50–100mg/m2dailyf
or
5daysupto100mg/ m2dail
yondays1,3,and5;
repeat
at3–4wkinter
val
s.

Smal
l
-Cel
lCar
cinomaoft
heLung
PO:(Adults)
:Dosagerangesfr
om 70mg/ m2dailyf
or4
daysupt o100mg/ m2dail
yfor5days(rounddosetot
he
nearest50mg);r
epeatat3–4wkinterv
als.
I
V: (
Adults):
Dosager
angesfr
om 35mg/ m2dailyf
or4
daysupt o50mg/m2dail
yfor5days;
repeatat3–4wk
i
nterval
s.

AVAI
LABI
LITY
Capsul
es50mg;
Inj
ect
ion20mg/
mLi
n5–ml
,25–ml
,and
50–mlvial
s;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1534
PATI
ENTTEACHI
NG
Inst
ructpatientt
otakeetoposi
deexactlyasdi
rect
ed,
evenifnauseaorv omiti
ngoccurs.I
fvomiti
ngoccurs
shortl
yafterdoseistaken,
consultphy
sici
an.I
fa
doseismi ssed,donottakeatal
l.

Adv i
sepat ienttonot ifyhealthcarepr of
essionalif
fever;chil
ls;sorethroatorot hersignsofinfecti
on;
bleedinggums; bruising; petechi
ae;orbloodinur i
ne,
stool,oremesi soccur s.Caut i
onpat i
enttoav oi
d
crowdsandper sonswi thknowni nfecti
ons.Instr
uct
patienttousesof ttoot hbrushandel ect
ricrazor.
Caut i
onpat ientnott odr inkalcoholi
cbev er
agesor
takepr oductscont ainingaspi ri
norNSAI Ds.

I
nstructpati
enttonotif
yhealthcareprofessionali
f
rapi
dheartbeat,di
ff
icul
tybreathi
ng,abdomi nalpai
n,
yell
owskin/eyes,weakness,parest
hesia,orgait
dist
urbancesoccur.

Inst
ructpati
entt oinspector almucosaforr edness
andulcerati
on.Ifmout hsor esoccur,advi
sepat ientto
usespongebr ushandr insemout hwithwat erafter
eati
nganddr inking.Viscousl i
docai
neswi shesmay
beusedi fpai
ni nterf
ereswi theati
ng.Stomat it
ispain
mayr equir
etreatmentwi t
hopi oi
danalgesics.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1535
 Discusswithpat
ientthepossi
bil
i
tyofhai
rloss.
Explorecopi
ngstrat
egies.

Adv
isepat
ientt
ousecont
racept
ion.

I
nstr
uctpat
ientnott
oreceiv
eanyv
acci
nat
ions
wi
thoutadv
iceofphysi
cian.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Et
rav
iri
ne
I
NDI
CATI
ONS
HIV-1inf ecti
on( wit
hot heranti
retr
ov i
ral
s)i
ntreatment
-
experiencedpat ientswhohav eev i
denceofv i
ral
repli
cationandHI V-1strai
nsresistanttoanon-nucl
osi
de
reverset ranscri
ptaseinhibi
tor(NNRTI )andot
her
antir
etrov ir
als.

ACTI
ON
Bi
ndst otheenzymereversetranscri
ptase,whichresul
ts
i
ndisruptedvi
ral
DNAsy nthesis.Therapeuti
cEf f
ects:
Evi
denceofdecreasedvir
al r
eplicat
ionandr educedvir
al
l
oadwi thsl
owedprogressionofHI Vandi t
ssequelae.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1536
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Concur
rentusewi
thot
herNNRTI
s,
r
if
ampi
n,r
if
apent
ine,
St.John'
swor
t.

UseCaut
iousl
yin:
Concur
rentuseofant
iar
rhy
thmi
cs,
ant i
conv ul
sants,anti
fungals,clar
ithyromy ci
n, r
if
abuti
n,
diazepam, dexamethasone, HMGCoAr eductaseinhi
bit
ors
(stati
ns), i
mmunusuppr essants;Geri:Considerage-rel
ated
↓i norganf uncti
onandbodymass, concurrentdisease
statesandmedi cati
ons; Pedi:OB: Lactati
on:Saf et
ynot
established,breast-
feedingnotr ecommendedi nHIV-
i
nf ectedwomen.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEI ZURES, anxiety, confusion, fatigue,headache,
i
nsomni a, sleepdi sorders.EENT: blur redvision, ver
tigo.
CV: MYOCARDI ALI NFARCTI ON, angi napect or is,at
rial
fi
bril
lati
on, hyper tension.GI :HEPATI CFAI LURE, nausea,
abdomi nal pain, anor exi
a, drymout h, hepatit
is, stomatit
is,
vomit i
ng.GU: renal fail
ure.Endo: gynecomast ia,
hyperglycemi a, hy perli
pidemi a.Hemat :anemi a, hemolyt
ic
anemi a.Der m: ERYTHEMAMULTI FORME, STEVENS
JOHNSONSYNDROME, TOXI CEPI DERMALNECROLYSI S,
rash.Met ab: fatr edistri
but i
on.Neur o: peri
pher al
neuropat hy .MS: hemar throsis.Mi sc: all
ergicreact i
ons

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1537
i
ncl
udi
ng,
IMMUNERECONSTI
TUTI
ONSYNDROME.

I
NTERACTI
ONS
Drug- Drug: Etraviri
nei sasubst rateoft heCYP3A4,
CYP2C9, andCYP2C19enzy mesy stems; other
medi cat i
onst hatinduceori nhi bitthesesy stemsmaybe
expect edt oal terther esponset oet rav iri
ne.Et rav i
ri
nei s
ani nducerofCYP3A4andani nhi bitorofCYP2C9and
CYP2C19.Theef fect sofmedi cat i
onst hatar esubst rates
oft heseenzy mesy stemsmaybeal teredbyconcur rent
use.Concur rentusewi thot herNNRTI si ncl udi ngef av i
renz,
nev ir
apine, anddel av i
rdinemayl eadt o↓ ef fect iveness
andshoul dbeav oided.Concur rentusewi thpr ot ease
i
nhi bit
or s(PI s)incl uding, nel f
inav irandi ndi nav irmayl ead
toal t
eredpl asmal ev elsandshoul dbeunt ertakenwi th
concur rentl owdoser i
tonav ir.Concur rentusewi thhi gher
doser i
tonav ir,combi nationt ipranav i
r /ri
tonav ir,
fosampr enav ir/r
itonav ir,atazanav ir/ritonav i
ral terl ev el
s
andef f
ect i
v enessofet ravir
ineandshoul dbeav oided.
Concur rentusewi thl opinav ir/ri
t onav irmay↓ l ev el
s.
Concur rentuseoft hecombi nat ionsaqui nav ir/ritonav i
r
shoul dbeunder takecaut iousl y.↓ bl oodl ev elsand
effectivenessofant i
arrhy t
hmi csi ncludi ngami odar one,
disopy rami de, fl
ecai nide,li
docai ne, mexi letine, qui nidine,
propaf enone, andqui nidine; bloodl ev elmoni t oring

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1538
recommended.Bl oodl evelsandef fect
smaybe↓ by
ant i
conv ulsant sincludingcar bamazepi ne,phenobar bi
tal,
andpheny toin.Concur rentusewi th
vor i
conazol ev oriconazol emay↑ l ev el
sofbot hdr ugs;↓
l
ev elsofi traconazol eandket oconazole( dose
adjustment smaybenecessar y)
.Concur rentusewi th
fl
uconazol emay↑ l evels.Mayal terlevelsandr esponse
tocl ar
ithromy cin;otheragent sshoul dbeconsi dered.
Rifampi nandr i
fapent i
ne↓ bl oodl evel
sandef f
ect i
veness
andshoul dbeav oided; ri
fabut i
nshoul donl ybeused
withoutapr oteasei nhibitor/ri
tonav i
rcombi nat i
on.May↑
bloodl ev elsandsedat i
onf rom diazepam, moni torfor
effects.Lev el
sandef f
ect ivenessmaybe↓ by
dexamet hasoneusecaut i
ousl yandconsi deral ter
nat i
ves.
Mayal t
erbl oodl evelsandef fectsoff l
uvast ati
n, l
ovastati
n,
andsi mv astatin(doseadj ustment smaybenecessar y.
Mayal t
erbl oodl evelsandef fectsofcy cl
ospor i
ne,
siroli
mus, andt acr oli
mus; carefulmoni t
or i
ngr equired.
May↓ t heant iplateletef f
ect sofclopidogrel .May↓
bupr enor phinel evels.
Drug-
Nat ur
alProduct:St
.John'
swortmay↓ bl
oodl
evel
s
andeffecti
veness;av
oidconcurr
entuse.

DOSAGE
PO:
(Adul
ts)
:200mgt
wicedai
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1539
AVAI
LABI
LITY
Tabl
ets100mg,
200mg;

PATI
ENTTEACHI
NG
Emphasi zetheimpor tanceoftakinget r
avir
ineas
direct
ed,atthesamet imeeachday .I
tmustal ways
beusedi ncombi nati
onwi thotherant i
retr
oviraldrugs.
Donott akemor ethanpr escri
bedamountanddonot
stoptakingwithoutconsul t
inghealthcare
professi
onal.Takemi sseddosesf oll
owingameal if
remember edwi t
hin6hroft heti
mei t
susual l
yt aken,
thenreturntoregularschedule.Ifmor ethan6hrf rom
ti
medosei susuall
yt aken,omitdoseandr esume
dosingschedule;donotdoubl edoses.

I
nst
ructpat
ientt
hatet
rav
iri
neshoul
dnotbeshar
ed
wi
thother
s.

Infor
m pat ientthatetravi
ri
nedoesnotcur eAIDSor
preventassoci atedoroppor t
unistici
nfecti
ons.
Etravi
ri
nedoesnotr educetheriskoft r
ansmi ssi
onof
HIVt oot hersthroughsexualcont actorblood
contami nation.Cautionpati
enttouseacondom and
toavoidshar i
ngneedl esordonatingbloodt oprevent
spreadingt heAI DSv i
rustoothers.Advisepat i
entthat

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1540
 t
helong-
ter
m ef
fect
sofet
rav
iri
near
eunknownatt
his
t
ime.

Maycausedi zzi
ness,i
mpairedconcentrati
on,or
drowsi
ness.Cautionpati
enttoavoiddri
v i
ngorother
acti
vi
ti
esrequiri
ngaler
tnessunti
lresponset o
medicat
ionisknown.

Instr
uctpat ienttonot i
fyhealthcar epr ofessional
i
mmedi at elyifrash, signsofhy persensi tiv
ity( f
ever,
gener al
lyi l
lfeeling,ext r
emet iredness, muscl eorj oi
nt
aches, bli
st ers,orallesions,eyei nf l
ammat i
on, faci
al
swelling),signsandsy mpt omsofl i
v erproblems
(yel
lowi ngofski norwhi tesofey es, darkort ea
coloredur i
ne, palecol oredstool s/bowel mov ements,
nausea, v
omi ti
ng, l
ossofappet i
te, orpai n,achingor
sensitivi
tyonr ightsidebel owr ibs) ,orsignsof
ImmuneReconst i
tutionSy ndrome( signsand
sympt omsofani nfect i
on)occur .

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations,
especial
lySt
.John'swor t.

I
nfor
m pat
ientt
hatchangesinbodyfat(i
ncr
easedfat
i
nupperbackandneck,breast
,andaroundback,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1541
 chest
,andstomacharea,
lossoff
atf
rom l
egs,
arms,
andface)mayoccur
.

Adv i
sepati
entstaki
ngoralcontraceptivestousea
nonhormonal methodofbi
rthcont r
ol duri
ngetravi
ri
ne
therapyandtonotif
yheal
thcar eprofessionali
fthey
becomepr egnantorpl
antobr eastfeedwhi l
etaki
ng
etravi
ri
ne.

Emphasizetheimport
anceofregul
arfol
l
ow-upexams
andbloodcountstodeter
mineprogr
essandmonitor
forsi
deeffect
s.

Ev
erol
i
mus
I
NDI
CATI
ONS
Af i
nit
or:Adv ancedr enal cellcarcinomawhi chhasf ai
led
treatmentwi thsuni ti
niborsor af enib,Subependy malgiant
cellastrocytoma( SEGA)associ at edwithtuber ous
sclerosis(TS)i npat ientswhoar enotcandi datesf or
curativesurgi calresection, Progr essiv
eneur oendocr i
ne
tumor sofpancr eat i
cor i
gi n(PNET)i npatient
swi th
unresect able,locallyadv ancedormet astati
cdi sease.
Zor t
ress—Pr eventionofor ganrej ecti
oninpat ientswho
hav ereceivedaki dneyt ransplantandar eatl ow- t
o-
moder atei mmunol ogicr isk.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1542
ACTI
ON
Actsasaki naseinhibi
tor
,decr easingcellprol
i
fer
ati
on.
I
nhibitsacti
vati
onandpr oli
ferati
onofTandB
l
y mphocytes.Therapeuti
cEf f
ect s:Decreasedspr
eadof
renalcel
lcarci
noma.Decr easedv olumeofSEGAl esi
ons.
Preventi
onofkidneyt r
ansplantr ej
ection.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oev
erol
i
musor
otherrapamyci
ns;Severehepaticimpair
ment( Chil
d-Pugh
cl
assC) ;OB:Avoi
dusedur ingpregnancy(Afi
nitor)
;use
onlyifbenef
itt
omot heroutweighsri
sktof et
us( Zort
ress)
;
Lactati
on:Avoi
dbreastfeeding.

UseCaut
iousl
yin:
Moder
atehepat
ici
mpai
rment(
Chi
l
d-
PughclassB);dose↓ required;Exposur
et osunl
ight
/UV
l
ight(may↑ riskofmalignantskinchanges);Ger
i:Maybe
moresensiti
vetodrugeffects;consi
derage-r
elat
ed↓ in
hepati
cfuncti
on,concur
rentdiseasestatesanddrug
ther
apy;Pedi
:Safetynotestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:fat
igue,
weakness,headache.CV: peri
pheral
edema.
Resp:
PNEUMONI TIS,
cough,dyspnea,pulmonary
emboli
sm.GI:anorexi
a,const
ipati
on,diar
rhea,mucosi
ti
s,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1543
mout hul cers, nausea, stomat it
is,vomi ting, dysgeusia.GU:
acut erenal fail
ur e,i
nferti
li
ty,proteinuria.Der m:delayed
woundheal i
ng, dr yskin,pruri
tus,rash.Hemat :
HEMOLYTI CUREMI CSYNDROME, THROMBOTI C
MI CROANGI OPATHY, THROMBOTI C
THROMBOCYTOPENI CPURPURA, anemi a,leukopenia,
thrombocy topeni a.Met ab:hyper l
ipidemi a, hyperglycemia,
hyper t
rigl
y ceridemi a.MS: extremi typai n.Mi sc:
ANGI OEDEMA, fever,hypersensi t
ivit
yr eact i
onsi ncludi
ng
anaphy laxis,infect i
on( i
ncludingact ivationofl atentv i
ral
i
nf ecti
onssuchasBKv i
rus-associ atednephr opathy )
,
kidneyar terial
/ venoust hrombosi s( Zor tress),↑r iskof
l
y mphoma/ skincancer( Zortr
ess) .

I
NTERACTI
ONS
Drug-Dr ug:StrongCYP3A4i nhibitor s, i
ncl udingat azanav i
r,
clar
it
hr omy cin,indinavi
r,i
traconazol e, ket oconazol e,
nefazodone, nel fi
navir,
rit
onav i
r, saqui nav ir
,telit
hr omy cin,
orvoriconazol e↑ l evelsandt her iskoft oxicity;av oi
d
concurr entuse.Moder ateinhibitor sofCYP3A4, including
aprepitant,dil
tiazem, eryt
hromy cin, fluconazol e,
fosampr enavir
, andv er
apami l,↑l ev elsandt her iskof
toxi
city; ↓ doseofev erol
imus( Af ini t
or ).Av oidconcur rent
usewi thCYP3A4i nducersi ncl
udi ngcar bamazepi ne,
dexamet hasone, phenobarbi t
al,pheny toin,rifabutinand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1544
ri
fampi n;↑ doseofev er
olimusmayber equired.
Cyclospor i
ne, apr
epit
ant,dilt
iazem, verapami l,fl
uconazole,
fosampr enav i
rmay↑ l evels.↑ riskofnephr ot oxici
tywit
h
aminogl ycosides,amphot eri
cinB, ci
splatin,or
cyclospor i
ne.ACEi nhi
bitorsmay↑ r iskofangi oedema.
May↓ ant ibodyformat i
onand↑ r i
skofadv erse
reacti
onsf rom liv
ev i
rusv accines.
Dr
ug-Nat
ural
Product
:St.John'
swor
tmay↓ l
evel
sand
ef
fi
cacy;
avoi
dconcurr
entuse.
Dr
ug-Food:↑ bl
oodlev
elsandri
skoftoxi
cit
ywi
th
gr
apefr
uitj
uice;
avoi
dconcurr
entuse.

DOSAGE
Adv
ancedRenal
Cel
lCar
cinomaandPNET
PO:(Adults)
:10mgoncedai l
y;Concur
rentuseof
moderateinhi
bit
orsofCYP3A4—↓ doset o2.5mgdai
l
y;
Concurr
entuseofstrongi
nducersofCYP3A4—↑ dosein
5mgi ncrementsupto20mg/ dai
ly
.
Hepat
icI
mpai
rment
PO:(
Adul
ts)
:Moder
atehepat
ici
mpai
rment(
Chi
l
d–Pugh
Cl
assB)-
5mgoncedail
y.
SEGA

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1545
PO: (
Adults):BSA0.5–1.2m2—2. 5mgoncedai ly
;BSA
1.3–2.1m2—5mgoncedai ly
; BSA≥2. 2m2—7. 5mgonce
dail
y.Tit
rate,
asneeded, at2–wki ntervalstoachi
eve
recommendedwhol ebloodtroughconcent r
ati
on
Concurrentuseofmoder ateinhibi
torsofCYP3A4—↓
doseby50%; Concurr
entuseofst rongi nducer
sof
CYP3A4—doubl edose.

Ki
dneyTr
anspl
ant
ati
on
PO:(Adult
s):
0.75mgt wicedail
y(withr
educed-
dose
cycl
ospori
ne)
;ti
tr
atetoachiev
er ecommendedwhole
bl
oodt r
oughconcent
rati
on.
Hepat
icI
mpai
rment
PO:(Adul
ts)
:Moder
atehepat
ici
mpai
rment
—↓ dai
l
ydose
by50%.

AVAI
LABI
LITY
Tabl
ets(
Afini
tor
)2.
5mg,5mg,
10mg;
Tabl
ets(
Zor
tress)
0.
25mg, 0.
5mg, 0.
75mg;

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakeeverol
imusatt
hesamet ime
eachdayasdi r
ected.Takemisseddosesassoonas
remember edupto6hraf tert
imeofnormaldose.I
f

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1546
 mor ethan6hraf t
ernormaldose, omitdosef orthat
dayandt akenextdosenextday ;donott ake2doses
tomakeupmi sseddose.Donoteatgr apefr
uitor
drinkgrapefr
uitjui
ceduringtherapy.Advisepatientt
o
readPat i
entInformati
onLeafletpriort
obegi nning
therapyandwi theachRxr ef
illi
ncaseofnew
i
nf ormati
on.

Advisepat i
enttoreportwor seni
ngr espir
atory
sympt omsorsi gnsofinfection(neworwor sening
cough, short
nessofbr eath,chestpain,dif
ficul
ty
breathingorwheezing, f
ev er
,chil
ls,ski
nrash, j
oint
painandi nfl
ammat i
on, t
iredness,lossofappet it
e,
nausea, pal
estoolordar kurine,yell
owingoft heskin,
paininupperr i
ghtside)toheal t
hcar eprofessional
prompt ly
.

I
nf or
m pati
entthatmouthsoresmayoccur.Consul
t
healthcar
epr of
essi
onalfort
reat
mentifpai
n,
discomfort
,oropensoresinmouthoccur.May
requir
especialmouthwashorgel.

Inst
ructpat
ientt
oavoi
duseofl
ivevacci
nesandclose
contactwit
hthosewhohav
erecei
vedliv
evacci
nes.

Instr
uctpati
entt
onotifyheal
thcareprofessional
of
allRxorOTCmedi cat
ions,vi
tamins,orherbal
productsbei
ngtakenandt oconsultwit
hheal t
hcare

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1547
 pr
ofessi
onal
bef
oret
aki
ngot
hermedi
cat
ions.

Mayhav et eratogeniceff
ectsanddecr easemal
eand
femalef ertil
i
ty .Advi
sefemal epati
entstouse
effecti
vecont racepti
onduringandforupt o8wks
fol
lowingt her apyandt onotif
yhealthcare
professional ifpregnancyisplannedorsuspect
edor
i
fbr eastfeeding.

Emphasizet
heimportanceofr
out
inebl
oodt
est
sto
det
ermineef
fect
ivenessandsi
deeff
ect
s.

Exenat
ide
I
NDI
CATI
ONS
Managementoft
ype2di
abet
esasanadj
unctt
odi
etand
exer
cise.

ACTI
ON
Mimicst
heact ionofincret
inwhichpr omot
esendogenous
i
nsul
insecret
ionandpr omot esothermechani
smsof
gl
ucose-
lowering.Therapeuti
cEffects:I
mprov
edcontrol
ofbl
oodglucose.

CONTRAI
NDI
CATI
ONANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1548
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Type1di
abet
esor
di
abet i
cketoacidosis; Sever
er enali
mpairmentorend-
stagerenaldisease( CCr<30mL/ mi
n);Severe
gastroi
ntest
inaldisease; OB:Hascausedf etal phy
sical
defectsandneonat al deathinanimal st
udies;Lactat
ion:
Excreti
onintobreastmi lkunknown.

UseCaut
iousl
yin:
Hist
oryofpancr
eat
it
is;
Pedi
:Saf
ety
notest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:dizziness,headache,ji
tt
eri
ness,weakness.GI:
PANCREATI TIS,di
arrhea,
nausea, v
omiti
ng,dyspepsi
a,
gastr
oinestinalref
lux.GU:acut
er enal
fai
lure.Der
m:
hyperhydrosis.Metab:↓ appeti
te,wei
ghtloss.

I
NTERACTI
ONS
Drug-Drug:Concurrentusewi t
hsul fony l
ureasmay↑ r i
sk
ofhypogl y
cemia( ↓ doseofsul fonylureaifhy pogly
cemi a
occurs).Concurrentusewithinsulinmay↑ r i
skof
hypoglycemia(↓ doseofi nsulinifhy poglycemi aoccurs)
.
Concurrentusewi thnategl
ini
deorr epaglinidemay↑ r isk
ofhypogl y
cemia.Duet oslowedgast ricempt ying,may↓
absorptionoforall
yadmi ni
steredmedi cations,especi
ally
thoserequiri
ngrapidGIabsor ptionorr equireaspeci f
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1549
l
evelforef
fi
cacy;t
akeoral
anti
-i
nfect
ivesandoral
cont
racept
ivesatl
east1hrbef
oreinj
ectingexenat
ide)
.

DOSAGE
Subcut(
Adul
ts):5mcgwi thi
n60minbef
oremor
ningand
eveni
ngmeal;
after1mo, dosemaybe↑ t
o10mcg
dependi
ngonresponse.
Renal
Impai
rment
Subcut(Adul
ts)
:CCr30–50mL/
min-
Usecaut
ionwhen↑
dosefrom 5mcgto10mcg.

AVAI
LABI
LITY
Soluti
onforsubcutaneousinj
ect
ion250mcg/mLi n
prefi
l
ledpen-i
njectort
hatdeli
ver
seit
her5mcg/ dose(1.
2-
mLpen)or10mcg/ dose(2.
4-mLpen)for60doses(30
daysoftwicedailydosing)
;

PATI
ENTTEACHI
NG
Instructpati
enttot
akeexenat
ideasdirectedwit
hin
60mi nbeforeameal.Donott
akeafterameal .I
fa
dosei smi ssed,
ski
pthedoseandtaket henextdose
att heprescri
bedti
me.Donottakeanext r
adoseor
i
ncr easetheamountofthenextdosetomakeupf or
mi sseddose.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1550
Instructpatientinpropertechniquef oradmi nistr
ati
on,
timingofdoseandconcur r
entor almedi cat
ions,
storageofmedi cati
onanddi sposal ofusedneedl es.
Pat i
entsshoul dreadtheI nformat i
onf orPatienti
nsert
priortoinit
iationoftherapyandwi theachRxr efi
ll
.
Adv i
sepat i
entt hatNewPenSet upshoul dbedone
onlywi theachnewpen, notwitheachdose.

I
nform pat
ientt
hatpenneedlesarenotincl
udedwit
h
penandmustbepur chasedseparat
ely
.Adv i
se
pati
entwhichneedl
elengthandgaugeshouldbe
used.Caut
ionpati
entnottosharepenandneedles.

Explai
ntopati
entt
hatexenat
idehelpscontrol
hypergl
ycemi
abutdoesnotcurediabetes.Therapyi
s
usuall
ylongt
erm.

Encouragepati
enttofol
lowpr escr
ibeddiet,
medicati
on,andexerci
ser egi
ment oprevent
hyper
glycemicorhypoglycemicepisodes.

Reviewsi gnsofhy pogly cemiaandhyperglycemia

withpatient.I
fhypogl ycemi aoccur
s,advisepatientto
takeagl assoforangej uiceor2–3tspofsugar ,
honey ,
orcor nsyrupdi ssolvedinwater
,andnot ify
healthcareprofessional .Riskofhy
poglycemi ais
i
ncreasedi fsulf
onur easar etakenconcurrentl
ywi t
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1551
 exenat
ide.

Advisepatienttonoti
fyhealt
hcar eprofessi
onal
i
mmedi at
elyifsymptomsofpancr eatit
is(unexpl
ained,
persist
ent,severeabdominalpainwhichmayormay
notbeaccompani edbyvomiting)occur.

Inf
orm patientthatther
apymayr esul
tinreduct
ionof
appetit
e,foodintake,and/orbodywei ght
.Dose
modi f
icat
ionisnotnecessar y.Nauseaismor e
commonati nit
iati
onoft her
apyandusual ly
decreasesov erti
me.

Instr
uctpat ienttonot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei ngt akenandt oconsulthealt
hcar e
professional beforetaki
nganyot herRx,OTC, or
herbalproduct s.Exenatidedelay
sst omachempt y
ing.
Somemedi cations(suchasant i
-i
nfecti
vesandor al
contraceptives)mayneedt obet aken1hrbef ore
exenatideinject i
on.

Instr
uctpatientinpropertestingofbloodglucoseand
urineket
ones.Theset estsshouldbemoni t
or ed
closel
ydur i
ngper i
odsofst ressoril
lnessandhealth
careprofessionalnoti
fiedifsigni
fi
cantchangesoccur.

Adv
isepat
ientt
oinf
orm heal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1552
 medi
cat
ionr
egi
menbef
oret
reat
mentorsur
ger
y.

Advi
sepati
entt
onoti
fyheal
thcareprof
essi
onal
if
pr
egnancyi
ssuspect
edorplanned.

Advisepatienttocarr
yaform ofsugar(sugarpacket
s,
candy)andi denti
fi
cati
ondescri
bingdi
seaseprocess
andmedi cationregi
menatallti
mes.

Emphasi
zethei
mportanceofrout
inef
oll
ow-upexams
andr
egulart
est
ingofbl
oodglucoseandgly
cosyl
ated
hemogl
obin.

Ezet
imi
be
I
NDI
CATI
ONS
Al
oneorwi thotheragents(HMG-CoAreductaseinhi
bit
ors)
i
nt hemanagementofdy sl
i
pidemiasi
ncl
udingprimary
hyperchol
ester
olemia,homozygousfamil
i
al
hyperchol
ester
olemiaandhomozy goussi
toster
olemia.

ACTI
ON
I
nhibit
sabsorpti
onofcholester
oli
nthesmallint
est
ine.
Therapeut
icEff
ects:Loweri
ngofcholest
erol
,aknownrisk
fact
orforather
oscler
osis.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1553
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Acut
eli
verdi
sease
orunexplai
nedl aboratoryev i
denceofliverdi
sease( when
usedwi t
hHMG- CoAr eductasei nhi
bit
or);Moderateor
severehepati
ci mpairment ;Concurrentuseoff i
brates;OB:
Maycausef etal harm byinterf
eringwithcholesterol
synthesi
sand, possibly,
biologicall
yacti
vesubst ances
deri
v edf
rom chol est
erol;Lactati
on:Potenti
alforadv er
se
eff
ect si
nnursingi nf
ant.

UseCaut
iousl
yin:
Pedi
:Chi
l
dren<10y
r(saf
etynot
est
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:
chol
ecyst
it
is,chol
eli
thi
asi
s,↑li
verenzymes(with
HMG-CoAreductasei
nhibi
tor
s),
nausea,pancr
eat
it
is.
Derm:r
ash.Misc:ANGIOEDEMA.

I
NTERACTI
ONS
Drug-Dr
ug:Eff
ectsmaybe↓ bychol est
yramineorother
bi
leacidsequestrant
s.Concurrentuseoff i
bratesmay↑
l
evelsandtheriskofcholel
it
hiasis.Cycl
osporinemay↑
l
evels.May↑ riskofrhabdomy olysi
swhenusedwi t
h
HMGCoA- reductaseinhi
bit
ors.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1554
DOSAGE
PO:
(Adul
ts)
:10mgoncedai
l
y.

AVAI
LABI
LITY
Tabl
ets10mg.

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakemedi cati
onasdirected,att
he
samet i
meeachday ,eveniffeel
ingwell
.Takemi ssed
dosesassoonasr emember ed,butdonott akemore
than1dose/ day.Medicati
onhelpscontrolbutdoes
notcureelevatedserum cholest
eroll
evel
s.

Adv i
sepat ientthatthi
smedicationshouldbeusedi n
conjunct i
onwi t
hdi etr
estr
ict
ions(fat
,cholester
ol,
carbohy drates,al
cohol)
,exer
cise,andcessationof
smoki ng.Ezet i
mibedoesnotassi stwit
hwei ghtloss.

I
nstructpatienttonot
if
yhealt
hcareprofessi
onal
if
unexplainedmusclepain,
tender
ness,
orweakness
occur.Riskmayi ncr
easewhenusedwi t
hHMGCoA
reductaseinhibi
tor
s.

Instr
uctpati
entt
onotifyheal
thcareprofessionalof
allRxorOTCmedi cat
ions,vi
tamins,orherbal
productsbei
ngtakenandt oconsultheal
thcar e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1555
 professi
onalbefor
etaki
nganyot
herRx,
OTC,
or
herbalproduct
s.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Inst
ructfemal epatientstonotif
yhealt
hcare
prof
essionalpr ompt l
yifpregnancyispl
annedor
suspectedori fbreastfeeding.I
fregi
menincl
udes
HMG- CoAr eductasei nhi
bitor
s,theyar
e
contrai
ndicatedinpr egnancy.

Emphasizet
heimportanceoffol
l
ow-
upexamsto
deter
mineef
fect
ivenessandtomoni
torf
orsi
de
eff
ects.

EZOGABI
NEa
I
NDI
CATI
ONS
Adj
unct
ivet
reat
mentofpar
ti
al-
onsetsei
zur
es.

ACTI
ON
Enhancestransmembr anepot assium curr
ents(enhances
KCNQchannel s),
stabil
izesresti
ngmembr anepotent
ial
anddecreasesexcitabi
lit
y.Mayal soincreaseGABA-
mediatedcurrent
s.TherapeuticEffects:Decreased

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1556
occur
renceofpar
ti
al-
onsetsei
zur
es.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Lact
ati
on:
Breast
feedi
ngnot
r
ecommended.

UseCaut
iousl
yin:
Hist
oryofpr
olongedQTi
nter
val
,
concurr entuseofmedi cati
onsknowt opr ol
ongQT
i
nterval, hist
oryofHF, v entr
icularhypertr
ophy,
hypokal emi aorhy pomagnesemi a(↑r i
skofar r
hythmias)
;
Historyofdepr ession,suici
dal thoughtsorideati
on;Geri
:
Lowerdosesr ecommended; Renal i
mpai r
ment( dose↓
recommendedf orCCr<50mL/ mi n;OB:Useonlyif
potential benefitj
ustif
iespot entialr
isktothefetus;Pedi
:
Safetyandef fecti
venessusenotest abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,drowsi
ness, aphasia,confusion,dysart
hri
a,
fati
gue, hall
ucinat
ions,i
mpai redat t
enti
on, i
mpai r
ed
memor y,psychoses,sui
cidal thoughts/i
deation.EENT:
blurredv i
sion,di
plopi
a.Neuro: abnormalcoordinati
on,
balancedi sorder,
gaitdi
sturbance, tr
emor .GU: ur
inary
retention.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1557
Drug-Drug:Bl
oodl ev
elsandeffecti
venessmaybe↓ by
carbamazepineorpheny t
oin;l
argerdosesmayber equi
red.
Onemet abol
i
temay↓ excr eti
onofdi goxi
n;moni
tori
ngis
recommended.Concur rentuseofalcohol↑ bl
oodlevel
s
andr i
skofadv er
sereacti
ons.

DOSAGE
PO:(Adul
ts)
:100mgt hreeti
mesdai lyforoneweek,t
hen
↑ by150mg/ dayatweekl
yinterv
alstomai nt
enancedose
of200–400mgt hr
eeti
mesdai ly(nottoexceed1200
mg/day).
PO:(Geri
atr
icPati
ent
s):50mgt hr
eeti
mesdai
l
yini
tial
l
y,
then↑ by150mg/ dayatweekl
yint
erv
alst
omaint
enance
dosenottoexceed750mg/ day
.
Renal
Impai
rment
PO:(Adults)
:CCr<50mL/min—50mgthreeti
mesdail
y
i
nit
ial
ly,t
hen↑ by150mg/dayatweekl
yinter
val
sto
maintenancedosenott
oexceed600mg/day.
Hepat
icI
mpai
rment
PO:(Adults)
:Chil
d-Pugh>7–9—50mgt hreeti
mesdai ly
i
nit
ial
ly,t
hen↑ by150mg/ dayatweekl
yinter
valsto
maintenancedosenottoexceed750mg/ day;Chil
d-Pugh
>950mgt hr
eetimesdail
yinit
ial
l
y,t
hen↑ by150mg/ day

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1558
atweekl
yint
erv
alst
omai
ntenancedosenott
oexceed600
mg/day.

AVAI
LABI
LITY
Tabl
ets50mg,
200mg,
300mg,
400mg;

PATI
ENTTEACHI
NG
Instr
uctpatientt
ot akeezogabinearoundtheclock,
asdirected.Medicati
onshouldbegr aduall
y
disconti
nuedt opreventsei
zures.Advisepati
entto
readtheMedi cati
onGui depri
ortotakingezogabine
andwi t
heachRxr efi
lli
ncaseofchanges.

Maycausedi zzi
nessanddr owsiness.Caut
ionpati
ent
toavoiddri
vingorotheracti
vi
tiesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

Infor
m pat ientsandf ami l
i
esofr iskofsui ci
dal
thought sandbehav iorandadv i
set hatbehav i
oral
changes, emer gencyorwor seningsi gnsand
sympt omsofdepr essi on,unusual changesinmood,
oremer genceofsui ci dalthoughts, behavi
or,or
thought sofsel f
-harm shoul dber eportedtohealt
h
carepr ofessionalimmedi ately
.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1559
 al
l RxorOTCmedi cati
ons,vi
tamins,
orherbal
productsbeingtakenandconsulthealt
hcare
professi
onal bef
oretaki
nganynewmedi cat
ions.
Adv i
sepatienttoavoidtaki
ngotherCNSdepr essant
s
oralcohol.

Advi
sefemal epati
entstonoti
fyhealt
hcare
pr
ofessionali
fpregnancyispl
annedorsuspectedor
i
fbreastfeedi
ng.Encouragepregnantpat
ient
s

Famci
clov
ir
I
NDI
CATI
ONS
Acuteherpeszosterinf
ections( shingl
es).
Treatment/
suppressionofr ecurrentherpesgenital
i
si n
i
mmunocompet entpatients.Treat mentofrecurr
ent
herpeslabi
ali
s(coldsores)inimmunocompet entpati
ents.
Treatmentofrecurr
entmucocut aneousher pessimplex
vi
rus(HSV)infecti
oninHI V-inf
ect edpati
ents.

ACTI
ON
I
nhibit
sv i
ralDNAsy nthesisinherpes-
infectedcell
sonl
y.
Therapeuti
cEffect
s: Decreaseddurati
onofher peszost
er
i
nfecti
onwi t
hdecreaseddur at
ionofviralsheddi
ng.
Decreasedtimetoheal i
ngf orcol
dsores.Decr eased

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1560
l
esionfor
mat
ionandi
mpr
ovedheal
i
ngi
nrecur
rentHSV
i
nfecti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Pat
ient
swi
thi
mpai
redr
enal
funct
ion
(↑ dosei nter
v al/
↓ doser ecommendedi fCCr<40–60
mL/ mi n)
;OB: Lactation: Li
mitedinf
ormati
on; useonlyif
mat ernalbenef i
tclearlyoutweighspotent
ial r
iskstofet
us
orinfant;Pedi:Safetynotest abli
shedinchildren<18y r
;
Geri:Considerage- related↓ inrenalf
unctionwhen
prescribi
ng.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache,
dizzi
ness,
fat
igue.GI
:di
arr
hea,
nausea,
vomi
ting.

I
NTERACTI
ONS
Drug-
Drug:Probeneci
d↑ pl
asmaconcent
rat
ionsof
penci
clov
ir.

DOSAGE
Her
pesZost
er

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1561
PO:
(Adul
ts)
:500mgq8hrf
or7day
s.
Renal
Impai
rment
PO:(Adul
ts)
:CCr40–59mL/mi
n—500mgq12hr ;CCr
20–39mL/min—500mgq24hr;CCr<20mL/min—250mg
q24hr;Hemodial
ysi
s—250mgaft
ereachdi
aly
sis.
Recur
rentGeni
tal
Her
pesSi
mpl
exI
nfect
ions
PO:
(Adul
ts)
:1000mgt
wicedai
l
yforoneday
.
Renal
Impai
rment
PO:(
Adults):CCr40–59mL/ min—500mgtwicedai
lyf
or
1day;CCr20–39mL/ min—500mgasasi ngl
edose;CCr
<20mL/mi n—250mgasasi ngledose;
Hemodial
ysi
s—250
mgasasi ngledoseaf
terdi
alysi
s.

Suppr
essi
onofRecur
rentHer
pesSi
mpl
exI
nfect
ions
PO:
(Adul
ts)
:250mgq12hrf
orupt
o1y
r.
Renal
Impai
rment
PO:(Adult
s):CCr20–39mL/mi n—125mgq12hrfor5
day
s; CCr<20mL/min—125mgq24hrf or5day
s;
Hemodialysi
s—125mgaftereachdial
ysi
s.

Recur
rentHer
pesLabi
ali
sInf
ect
ions(
col
dsor
es)
PO:
(Adul
ts)
:1500mgasasi
ngl
edose.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1562
Renal
Impai
rment
PO:(Adul
ts):CCr40–59mL/ min—750mgasasingle
dose;CCr20–39mL/ min—500mgasasi ngl
edose;CCr
<20mL/ min—250mgasasi ngledose;
Hemodial
ysi
s—250
mgasasi ngledoseaft
erdi
alysi
s.
Her
pesSi
mpl
exi
nHI
V-I
nfect
edPat
ient
s
PO:
(Adul
ts)
:500mgq12hrf
or7day
s.
Renal
Impai
rment
PO:(Adult
s):CCr20–39mL/mi n—500mgq24hrfor7
day
s; CCr<20mL/min—250mgq24hrf or7day
s;
Hemodialysi
s—250mgaftereachdial
ysi
s.

AVAI
LABI
LITY
Tabl
ets125mg,
250mg,
500mg;

PATI
ENTTEACHI
NG
I
nstr
uctpati
enttotakefamciclov
irasdi
rect
edfort
he
f
ull
courseoftherapy.Takemisseddosesassoonas
r
emember ed,i
fnotjustbefor
enextdose.

Infor
m pati
entthatf
amcicl
ov i
rdoesnotpreventthe
spreadofinfect
iontoot
hers.Unti
lal
llesi
onshave
crusted,
precauti
onsshoul
dbet akenaroundothers

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1563
 whohavenothadchi
ckenpoxorvari
cel
l
avacci
neor
peopl
ewhoareimmunosuppressed.

Advisepati
entthatcondomsshouldbeuseddur
ing
sexualcontactandthatnosexual
cont
actshoul
dbe
madewhi lelesi
onsarepresent
.

Maycausedizziness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

I
nstructwomenwithgeni
talherpestohav
eyear
ly
Papanicol
aousmearsbecausethesewomenmaybe
morelikel
ytodev
elopcervi
calcancer.

Famot
idi
ne
I
NDI
CATI
ONS
Short
-ter
mt reat
mentofact iveduodenal ulcersandbeni gn
gastr
iculcers.Maintenancet herapyforduodenal ulcers
aft
erhealingofact i
veul cer(s).Managementof
gastr
oesophageal r
efluxdisease( GERD) .Tr eatmentof
heart
burn, acidi
ndigesti
on, andsourst omach( OTCuse) .
Managementofgast r
ichy persecretoryst ates(Zoll
inger-
El
li
sonsy ndr ome).Preventionandt reatmentofst ress-
i
nducedupperGIbl eedingi ncr i
ti
call
yillpat i
ents.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1564
UnlabeledUses:ManagementofGIsy mpt omsassociat
ed
wit
ht heuseofNSAI Ds.Pr ev
enti
onofstressulcer
ati
onor
aspir
ationpneumoni t
is.Prev
enti
onofacidinacti
vati
onof
supplementalpancreati
cenzy mesi
npatientswith
pancreati
cinsuff
ici
ency .Managementofurti
cari
a.

ACTI
ON
Inhibi
tstheactionofhist
amineatt heH2-recept orsit
e
l
ocat edprimari
lyingastr
icpariet
alcel
ls,result
ingin
i
nhi bi
tionofgastri
cacidsecreti
on.TherapeuticEf f
ects:
Heal i
ngandpr eventi
onofulcers.Decr
easedsy mpt omsof
gast r
oesophageal r
efl
ux.Decreasedsecretionofgast ri
c
acid.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pheny
lket
onur
ia
(chewablet
abl
etsonly
);OB:Crossesplacent
a;no
adequatehumanstudi
es;Lact
ation:Di
sconti
nue
breastf
eedi
ngtoavoi
dexposureofinfanttoseri
oussi
de
effect
s.

UseCaut
iousl
yin:
Renal
impai
rment(
mor
esuscept
ibl
e
toadverseCNSr eact
ions;
↑ dosageint
erval
recommendedi fCCr<10mL/min);Pedi
:Inj
ecti
oncont
ains
benzylalcohol
whichhasbeenassociat
edwithgaspi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1565
sy
ndr
omeinneonat
es;
Geri
:Mor
esuscept
ibl
etoadv
erse
CNSr
eact
ions;
dose↓ r
ecommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: conf
usion,dizzi
ness,drowsiness,hall
ucinations,
headache.CV: ARRHYTHMI AS.GI:consti
pation,diarrhea,
nausea.GU: ↓ sperm count,er
ectil
edy sf
unct i
on.Endo:
gynecomastia.Hemat :AGRANULOCYTOSI S,APLASTI C
ANEMI A,anemia,neutropenia,
thrombocy t
openi a.Local:
painatIM si
te.Misc:hypersensiv
ityreact
ions.

I
NTERACTI
ONS
Drug-
Drug:
May↓ absorpti
onofketoconazol
e,
i
tr
aconazol
e,at
azanav
ir,
delav
irdi
ne,andgeft
ini
b.

DOSAGE
PO: (
Adults):Shor t-
ter
mt r
eatmentofact iveulcers—40
mg/ dayatbedt imeor20mgt wicedail
yforupt o8
wk.Duodenal ulcerprophyl
axis—20mgoncedai lyat
bedtime.GERD—20mgt wi
cedai l
yforupto6wk; upto40
mgt wicedailyforupt o12wkf oresophagiti
swi th
erosions,
ulcerations,andcont i
nuingsymptoms.Gast r
ic
hypersecret
orycondi ti
ons—20mgq6hri nitial
ly
,upt o160
mgq6hr .OTCuse—10mgf orr el
iefofsympt oms;for
preventi
on—10mg60mi nbef oreeati
ngort ake10mgas

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1566
chewablet
ablet15minut
esbefor
ehear
tbur
n-i
nduci
ng
foodsorbeverages(
nott
oexceed20mg/24hrforupto2
wk).
PO:IV:(
Childr
en1–12y r
):Pepticul
cer
—0.5mg/ kg/
dayas
asingl
ebedt i
medoseorindiv i
deddosestwicedai
l
y
(maximum: 40mgdaily
);GERD—1mg/ kg/dayi
ndivi
ded
dosestwicedail
y(maxi
mum: 80mgdai l
y).
PO:(I
nfant
s>3mo—1y
r):
GERD—0.
5mg/
kg/
doset
wice
dai
l
y.
PO:
( I
nfant
sandneonates<3mo)
:GERD—0.
5
mg/kg/doseoncedai
l
y.
I
V:(
Adul
ts)
:20mgq12hr
.
Renal
Impai
rment
PO:(Adul
ts)
:CCr10–50mL/min-admi
nist
ernor
maldose
q24hror50%doseatnormaldosingi
nter
val
CCr<10
mL/min—20mgatbedti
me;int
ervalmayneedtobe↑ t
o
ever
y36–48hr.

AVAI
LABI
LITY
Tabl
ets10mgOTC, 20mgRx, OTC,40mg; Gelcaps10
mgOTC;Oralsuspensi
on(cher
ry-
banana-
mintf l
avor
)40
mg/5mL; Pr
emixedinfusi
on20mg/ 50mL0. 9%NaCl ;
Sol
uti
onfori
njecti
on10mg/ mL;Incombinati
onwi t
h:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1567
Ant
aci
ds(
Pepci
dCompl
ete)
,ibupr
ofen(
Duexi
s).

PATI
ENTTEACHI
NG
Instructpat
ienttotakemedicati
onasdirectedfort
he
fullcourseoftherapy,
eveniffeel
ingbet
ter.Take
mi sseddosesassoonasr emember edbutnotif
almostt imefornextdose.Donotdoubledoses.

Adv i
sepatient
st akingOTCpr eparati
onsnott otake
themaxi mum dosecont inuouslyformor ethan2wk
withoutconsult
ingheal t
hcarepr ofessi
onal.Not
ify
healthcareprofessionali
fdif
ficult
yswallowing
occursorabdomi nalpai
npersists.

Inf
orm pat
ientthatsmoki ngi
nter
fer
eswiththeact
ion
ofhist
amineant agoni
sts.Encour
agepati
enttoqui
t
smokingoratleastnott osmokeafterl
astdoseof
theday.

Maycausedr owsi
nessordizzi
ness.Cauti
onpati
ent
toavoiddri
vingorotheract
ivi
ti
esrequir
ingal
ert
ness
unti
lresponsetothedrugisknown.

Advisepat
ientt
oav oi
dalcohol,
product
scont
aini
ng
aspi
r i
norNSAIDs,andfoodsthatmaycausean
i
ncreaseinGIir
ri
tati
on.

I
nfor
m pat
ientt
hati
ncr
easedf
lui
dandf
iberi
ntake

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1568
 andexer
cisemaymi
nimi
zeconst
ipat
ion.

Advisepatienttorepor
tonsetofbl
ack, t
arr
ystools;
fev
er ;
soret hroat
;di
arr
hea;di
zzi
ness;rash;confusi
on;
orhalluci
nationstoheal
thcarepr
ofessionalpromptl
y.

Fatemul
sion
I
NDI
CATI
ONS
Prov i
sionofnonprot
eincal
oriestopati
entswhoset ot
al
calori
cneedscannotbemetbycar bohydrates(gl
ucose)
alone,usuallyaspar
tofparenteral
nutr
it
ion.Treatment
andpr eventi
onofessenti
alfatt
yaciddefi
ciencyin
patientsreceiv
ingl
ong-t
erm parent
eral
nut r
iti
on(provi
des
l
inoleicacid).

ACTI
ON
Actsasanonpr ot
eincal
ori
esour
ce.Ther
apeut
icEff
ects:
Provi
sionofessenti
alf
att
yaci
dsandnonprot
eincal
ori
es.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
li
pidemi
as;
Lipoi
dnephr
osi
s;
Pancr
eatiti
saccompani edbyli
pemia;Hy
persensi
ti
vi
tyt
o
eggproducts(emulsif
ieriseggyol
kphosphol
ipi
d),
l
egumes, soybeans,orfatemulsi
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1569
UseCaut
iousl
yin:
Thr
omboembol
i
cdi
sor
der
s;Sev
ere
l
iverorpul
monarydi
sease;Anemiaorbleedi
ngdi
sor
der
s;
Pati
entswhoareatr
iskforfatembol
ism.
Exer
ciseExt
remeCaut
ioni
n:Pr
eter
minf
ant
s(↓ abi
l
ityt
o
cl
earfatemulsi
on)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Seenonl
ywi
thl
ong-
ter
m use.
†
CV: chestpain.Resp:INTRAVASCULARFAT
ACCUMULATI ON(pret
ermi nfantsonl
y).GI:
hepatomegal y†,j
aundice†,nausea,pancreati
ti
s,vomit
ing.
Local:phlebi
tisatIVsite.Endo:hypert
ri
glycer
idemia.Misc:
fever,i
nfecti
on,chil
ls,
hy persensi
ti
vit
yreacti
ons.

I
NTERACTI
ONS
Dr
ug-
Drug:Concur
rentusewi
thpr
opof
olmay↑ r
iskof
hy
per
tri
gly
ceri
demia.

DOSAGE
Tot
alPar
ent
eral
Nut
ri
ti
on
I
V: (
Adults):
Ini
ti
aldose:
1g/kg/
day,
incr
easeby0.
5–1
g/kg/daytoamaximum of2.
5g/kg/
day.
I
V:(
Chi
l
dren≥1mo)
:Ini
ti
aldose:
0.5–1g/
kg/
day
,incr
ease

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1570
by0.
5g/
kg/
dayt
oamaxi
mum of3g/
kg/
day
.
I
V: (
Neonatespremat
ure)
:Ini
ti
aldose:
0.25–0.
5g/kg/
day
,
i
ncreaseby0.25–0.
5g/kg/daytoamaximum of3
g/kg/day
.

Essent
ial
Fat
tyAci
dDef
ici
ency
IV:
(Adult
sandChil
dren)
:Pr
ovi
de8–10%ofcal
ori
cint
ake
asfat
,inf
useonceortwi
ceweekl
y.

AVAI
LABI
LITY
Emul
sionf
orI
VUse10%,
20%,
30%;

PATI
ENTTEACHI
NG
Expl
ainthepur
poseoffatemul
siont
othepat
ient
pri
ortoadmini
str
ati
on.

Febuxost
at
I
NDI
CATI
ONS
Chr
onicmanagementofhy
per
uri
cemi
ainpat
ient
swi
tha
hi
stor
yofgout
.

ACTI
ON
Decr
easespr
oduct
ionofur
icaci
dbyi
nhi
bit
ingxant
hine

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1571
oxi
dase.Ther
apeuti
cEffect
s:Loweri
ngofserum ur
icaci
d
l
evel
swi t
hresul
tantdecr
easeingoutyat
tacks.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Concur
rentazat
hiopr
ineor
mer
capt
opur
ine.

UseCaut
iousl
yin:
Sev
erer
enal
impai
rment(
CCr<30
mL/ min)
;Severehepaticimpair
ment ;
OB: Useonlywhen
potent
ialmaternalbenefi
toutweighspotenti
alf
etalr
isk;
Lactat
ion:Unknowni fexcret
edintobreastmil
k;use
cauti
onwhenbr east
feeding;
Pedi:Safet
yinchil
dren<18yr
notestabl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:↑liv
erfuncti
ont
est
s,nausea.Der
m:r
ash.MS:
gout
fl
are,
arthr
algi
a.

I
NTERACTI
ONS
Drug-
Drug:Si
gnifi
cantl
y↑ level
sofandr iskofseri
ous
toxi
cit
yfr
om azathiopr
ineandmer capt
opurine;
concurrent
useiscontr
aindi
cated.May↑ levelsoftheophyl
li
ne;use
cauti
ousl
ytogether.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1572
PO:(Adul
ts)
:40mgoncedail
yini
ti
all
y;i
fser
um ur
icaci
d
doesnot↓ t
o<6mg/dL,doseshoul
dbe↑ to80mgonce
dai
ly.

AVAI
LABI
LITY
Tabl
ets40mg,
80mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakef ebuxostatasdir
ect
ed.Ifa
goutflar
eoccurs,continuefebuxostatandconsul
t
heal
thcar epr
ofessional;medicati
onstomanagegout
fl
aremaybeadded.

Adv i
sepatienttonoti
fyhealt
hcareprofessionali
f
rash,chestpain,shor
tnessofbreath,
orst r
oke
sympt oms( weakness,headache,
confusion,sl
urr
ed
speech)occurori fsi
deeffectsar
epersistentor
bothersome.

Instr
uctpatientt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbeingtakenandt oconsultheal
thcar e
professi
onal bef
oretaki
nganyot herRx,OTC, or
herbalproducts.

Adv
isef
emal
epat
ientt
onot
if
yheal
thcar
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1573
 pr
ofessi
onali
fpregnancyi
spl
annedorsuspect
edor
i
fbreast
feedi
ng.

Emphasi
zet
hei
mpor
tanceoff
oll
ow-
upl
abt
est
sto
moni
tort
her
apy
.

Fel
bamat
e
I
NDI
CATI
ONS
Usedal one( monot herapy)orasadj unctiv
et herapywi t
h
otheranticonv ulsantsint reatmentofpar t
ialseizures.
Adjunctivether apywi thotherant iconvulsantsinchi l
dren
(2–14y r)whohav epar t
ial orgenerali
zedsei zures
associatedwi thLennox- Gast autsyndrome.Becauseof
deathsduet oapl asticanemi aandacut eliverfail
ure,
fel
bamat eshoul dnev erbeusedasaf i
rst-l
inetherapy,but
shouldber eser vedf orpat ientswhoseepi l
epsyi sso
severethatt heser isksar econsi deredaccept ablegiven
thedrug'sbenef i
t.

ACTI
ON
Probablyactsbyr ai
singsei
zur
et hreshol
dandprevent
ing
seizur
espr ead.Therapeut
icEf
fects:Decreasedi
nci
dence
ofseizures.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1574
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofel
bamat
eor
ot
hercar
bamates(e.
g.meprobamate)
;Hist
oryofhepat
ic
dy
sfunct
ion;
Hist
oryofbl
ooddy scr
asi
as.

UseCaut
iousl
yin:
All
pat
ient
s(may↑ r
iskofsui
cidal
t
hought
s/behav
ior
s);
Renal
dysf
unct
ion.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:SUICIDALTHOUGHTS, di
zziness,drowsiness, fat
igue,
headache,i
nsomni a,anxiety,psychological di
sturbances.
EENT:dipl
opia,pharyngit
is,rhini
tis,si
nusitis.GI:ACUTE
LIVERFAILURE, anor
exia, consti
pat i
on,dy spepsia,nausea,
vomiti
ng,alt
eredtaste,diarrhea,hiccups.Der m: acne,rash.
Hemat :
APLASTI CANEMI A.MS: my algi
a.Neur o: at
axia.
Misc:fl
u-l
i
kesy ndrome, weightloss.

I
NTERACTI
ONS
Drug-Drug:↑ bl oodlev elsandri
skoft oxicit
yf r
om
pheny t
oin,
valproicacid, andphenobarbi t
al.↓
carbamazepi nebl oodlev el
sbut↑ lev elsof
carbamazepi neepoxi de, anact
ivemet abol i
te.Becauseof
potenti
al i
nteracti
ons, dosesofcarbamazepi ne, pheny
toi
n,
andv alpr
oicaci d,andphenobar bi
talshouldbe↓ by
20–33%wheni niti
ati
ngf el
bamatether apy.Further

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1575
reducti
onsmayber equi
red.Concur
rentuseofot
her
hepatotoxi
cagent
sordr ugswhichmaycauseaplast
ic
anemiamay↑ t heriskoftheseser
iousadver
ser
eactions.
Drug-
NaturalProduct:
Seesedati
vei
nteracti
ons.St.John'
s
wortmayaf f
ectfelbamat
elevel
sandef f
ecti
veness;avoid
use.Concomitantuseofkava-
kava,
valeri
an,skul
lcap,
chamomi l
e,orhopscan↑ CNSdepr ession.

DOSAGE
PO: (
Adul t
sandChi l
dren>14y r):I
fusedal one,startwit
h
1200mg/ dayi n3–4di vi
deddoses.Maybe↑ by600
mg/ dayat2- wki nterval
supt oat otalof3600mg.I f
convert
ingf rom ot heragents,startwith1200mg/ dayin
3–4di v
ideddosesand↓ ot herant i
conv ul
santsby1/ 3.At
week2, ↑f elbamat eto2400mg/ dayin3–4di vi
ded
dosesand↓ ot herant i
convulsantsbyupt o1/3oft hei
r
ori
ginaldosage.Atweek3, ↑f el
bamat eto3600mg/ day
i
n3–4di videddoseswhi lecont i
nuingto↓ dosesofot her
anti
convul sants.Ifusingasadj unctiv
et herapy(wit
hot her
agents),startwith1200mg/ dayin3–4di v
ideddoses, ↓
dosesofot heranticonvulsantsby20%.↑ doseatweekl y
i
nterval
sby1200mg/ dayto3600mg/ day.↓ dosesof
otheranticonv ul
sant sasnecessar y.
PO:
(Chi
l
dren)
:Asadj
unct
ivet
her
apy
,st
artat15

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1576
mg/ kg/
dayi n3–4divideddoses,
↓t hedoseofother
anti
convulsant
sby20%.↑ dosageby15mg/ kg/
day(not
toexceed3600mg/ day)atweekl
yinterv
alst
o45
mg/ kg/
day .↓ dosesofotherant
iconvul
sant
sas
necessary
.

AVAI
LABI
LITY
Tabl
ets400mg,
600mg;
Oral
suspensi
on600mg/
5mL;

PATI
ENTTEACHI
NG
Instructpat i
enttotakefelbamateasdi r
ected.Take
mi sseddosesassoonaspossi blebutnotj ustbefor
e
nextdose; donotdoubl edoses.Notifyhealthcare
professi onali
fmor ethan1dosei smi ssed.
Medi cat
ionshouldbegr aduall
ydiscontinuedto
prev entseizuresandstatusepil
epticus.Instr
uct
pat i
entt oreadtheMedi cati
onGuidebef orestart
ing
andwi theachRxr efi
ll
,changesmayoccur .

Maycausedi zzi
nessanddr owsiness.Advi
sepati
ents
toavoiddri
vingorotheracti
vi
tiesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

I
nstr
uctpat i
entthatf
ever
,sor
ethroat,mouthulcer
s,
pet
echiae,unusualbl
eedi
ngorbruisi
ng,abdominal
pai
n,chil
ls,pal
estool
s,dar
kuri
ne,orjaundiceshoul
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1577
 ber epor tedtoheal t
hcar epr of
essi onalimmedi ately.
Adv isepat ientandf amilytonot ifyhealthcare
prof essional i
fthoughtsaboutsui cideordy i
ng,
attempt st ocommi tsuicide;neworwor sedepr essi
on;
neworwor seanxiety;f
eel i
ngv eryagi t
atedorr estl
ess;
pani cattacks; tr
oublesleeping; neworwor se
i
rri
t abili
ty;acti
ngaggr essive;bei ngangr yorviolent;
actingondanger ousimpul ses; anext r
emei ncreasei n
activ i
tyandt alki
ng;otherunusual changesinbehav ior
ormoodoccur .

Instr
uctpat ienttonot i
fyhealt
hcareprofessionalof
allRxorOTCmedi cati
ons,vit
amins,orherbal
product sbeingt akenandt oconsulthealt
hcar e
professional beforetaki
nganyot herRx,OTC, or
herbal products.Adv i
sepatientnottotakealcoholor
otherCNSdepr essantsconcurrent
lywiththi
s
medi cation.

I
nst
ructpat
ienttonot
if
yheal
thcarepr
ofessi
onalof
medi
cati
onregimenpri
ortot
reat
mentorsurgery
.

Advi
sepati
enttouseanonhormonalf
orm of
cont
racept
ionwhi
letaki
ngf
elbamate.

Advi
sepati
entt
ocarryident
if
icat
iondescr
ibi
ng
di
seaseandmedicat
ionregi
menatal lt
imes.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1578
Fel
odi
pine
I
NDI
CATI
ONS
Managementofhyper
tension,angi
napect
ori
s,and
vasospast
ic(
Pri
nzmetal
’s)angina.

ACTI
ON
Inhi
bitsthetr
anspor tofcal
cium int
omy ocardialand
vascularsmoothmuscl ecells,r
esulti
ngi ninhi
biti
onof
excit
ation-
contract
ioncoupli
ngandsubsequent
contracti
on.Therapeuti
cEffects:Systemicv asodil
ati
on
resul
tingindecreasedBP.Cor onaryvasodi l
ati
onr esul
ti
ng
i
ndecr easedfrequencyandsev erit
yofat tacksofangina.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty(
cross-
sensi
ti
vi
ty
mayoccur)
;Si
cksi
nussyndr
ome;2nd-or3r
d-degreeAV
bl
ock(unl
essanar
ti
fi
cial
pacemakeri
sinpl
ace);Syst
oli
c
BP<90mm Hg.

UseCaut
iousl
yin:
Sev
erehepat
ici
mpai
rment(
dose↓
recommended);Geri
:Dose↓ recommended; ↑ri
skof
hypotensi
on;
Severerenal
impairment;
Histor
yofseri
ous
ventr
icul
arar
rhy
thmiasorHF;OB: Lact
ati
on:Pedi
:Safet
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1579
notest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, abnor mal dr eams, anxi ety ,
conf usion,
dizziness, drowsi ness, ner vousness, psy chiat ric
disturbances, weakness.EENT: bl
ur redv i
sion, disturbed
equilibrium, epi staxi s, t
innitus.Resp: cough, dy spnea.CV:
ARRHYTHMI AS, HF, peripher al edema, chestpai n,
hypot ensi on, palpi tations, sy ncope, tachy car dia.GI :
anor exia, const ipat ion, diarrhea, drymout h,dy sgeusi a,
dyspepsi a, ↑l iverenzy mes, nausea, v omi ti
ng.GU: dysuri
a,
noct uria,pol yuria, sexual dysf unct i
on, urinaryf r equency .
Der m: der mat iti
s, er ythemamul tif
or me, fl
ushi ng, ↑
sweat i
ng, phot osensi t
ivity,pr uri
tus/ urticar i
a, rash.Endo:
gynecomast i
a, hy per glycemi a.Hemat : anemi a, leukopenia,
thrombocy topeni a.Met ab: wei ghtgai n.MS: j
oi ntst if
fness,
muscl ecr amps.Neur o: parest hesia, tremor .Mi sc:
STEVENS- JOHNSONSYNDROME, gingi val hy per plasia.

I
NTERACTI
ONS
Drug-Drug:Additiv
ehy potensionmayoccurwhenused
concurrentl
ywit hfentanyl
,otherantihy
per t
ensives,
ni
trates,acuteingesti
onofal cohol,orquinidi
ne.
Antihypert
ensiveef f
ectsmaybe↓ byconcur rentuseof
NSAI Ds.Ketoconazole,it
raconazole,propranololand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1580
ery
thromyci
n↓ metabol
ism,↑ bloodlev
elsandt
her
isk
oftoxi
cit
y(dose↓ maybenecessary)
.
Dr
ug-
Food:
Grapef
rui
tjui
ce↑ ser
um l
evel
sandef
fect
.

DOSAGE
PO:(
Adult
s):
5mg/ day(
2.5mg/dayinger
iat
ri
cpat
ient
s);
may↑ q2wk( r
ange5–10mg/day;nott
oexceed10
mg/day
).

AVAI
LABI
LITY
Ext
ended-
rel
easet
abl
ets2.
5mg,
5mg,
10mg;

PATI
ENTTEACHI
NG
Advisepati
enttotakemedicati
onasdirect
ed,
eveni
f
feel
i
ngwel l
.Ifadoseismissed,takeassoonas
possibl
eunlessal
mosttimef ornextdose;
donot
doubledoses.Mayneedtobedi sconti
nuedgr
adual
l
y.

I
nst r
uctpat i
entoncorr
ecttechniquef
ormonit
ori
ng
pulse.Instr
uctpati
enttocontactheal
thcar
e
professionali
fheartr
ateis<50bpm.

Advi
sepat
ienttoav
oidgr
apef
rui
torgr
apef
rui
tjui
ce
dur
ingt
her
apy .

Caut
ionpat
ientt
ochangeposi
ti
onssl
owl
yto

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1581
 mi
nimi
zeor
thost
ati
chy
pot
ensi
on.

Maycausedr owsi
nessordizziness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heract
ivi
ti
esr equir
ingal
ert
ness
unti
lresponsetot
hemedicationisknown.

Instr
uctpat i
entonimpor t
anceofmai ntai
ninggood
dentalhygieneandseei ngdenti
stfrequentl
yforteet
h
cleani
ngt opr ev
enttenderness,bl
eeding,andgingi
val
hyperpl
asia( gum enl
argement )
.

Instr
uctpati
enttonot ifyheal
thcareprofessionalof
allRxorOTCmedi cations,vi
tamins,orherbal
productsbeingtakenandt oavoidconcurrentuseof
alcoholorOTCmedi cationsandherbalproducts,
especial
lycoldpreparations,wi
thoutconsulti
ng
healthcareprof
essional .

Adv i
sepat ientt onoti
fyhealt
hcareprofessi
onal i
f
rash,irr
egul arheartbeat
,dyspnea,swell
ingofhands
andf eet,pronounceddi zzi
ness,nausea,consti
pati
on,
rash,orhy pot ensi
onoccursorifheadachei ssevere
orper si
stent .

Cauti
onpat
ienttowearprotect
ivecl
othingandtouse
sunscr
eent
opr eventphot
osensit
ivi
tyreact
ions.

Advi
sepatientt
oinf
orm heal
thcar
eprofessionalof
medicat
ionregi
menbeforetr
eatmentorsurgery.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1582
Angi
na:Instructpat
ientonconcurrentni
tr
ateorbet a-
bl
ockertherapytocontinuet
akingbot hmedicat
ions
asdi
rectedandt ouseSLni t
rogly
cer i
nasneededf or
angi
nalattacks.

Advisepati
enttocontactheal
thcareprofessionalif
chestpaindoesnotimproveorwor sensaftertherapy,
occurswithdi
aphoresisorshort
nessofbr eath,orif
severe,
persi
stentheadacheoccurs.

Caut
ionpati
enttodi
scussexerci
serestr
ict
ionswi
th
heal
thcar
eprofessi
onalbef
oreexer
tion.

Hypertension:Encouragepat i
enttocompl ywithother
i
nterventionsforhypertensi
on( weightreduct
ion,
low-
sodium diet,smokingcessation,moder ati
onof
al
cohol consumpt i
on, r
egularexercise,
andstress
management ).Medicationcontrol
sbutdoesnotcur e
hypertension.

I
nst
ructpati
entandf amil
yinpropertechni
quef
or
moni
tori
ngBP.Adv isepati
enttotakeBPweeklyand
t
oreportsi
gnif
icantchanges.

Fenof
ibr
ate
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1583
Withdietarytherapyt odecr easeLDLchol est
erol,
total
cholester
ol ,
tri
glyceri
des, andapol ipoproteinBi nadult
patient
swi thhyper cholesterolemiaormi xeddy sl
i
pidemia.
Withdietarymanagementi nt hetreatmentof
hypertr
igl
y ceri
demi a( t
ypesI VandVhy perli
pidemia)in
patient
swhoar eatr iskforpancr eatit
isanddonot
respondt onondr ugt herapy.

ACTI
ON
Fenofibr
icaci
dpr i
mari
lyi
nhibi
tstr
igl
ycer
idesynt
hesi
s.
Therapeuti
cEffect
s:Loweri
ngofcholest
eroland
tr
igl
yceri
deswithsubsequentdecr
easedriskof
pancreati
ti
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hepat
ici
mpai
rment
(i
ncludingpri
mar ybil
iar
ycirr
hosis);Pr
e-exi
sti
ng
gall
bladderdisease;Severer
enal i
mpai r
ment; Concurr
ent
useofHMG- CoAr eductasei
nhibit
ors;Lact
ation:Potenti
al
fortumorigenici
tynotedinanimalstudies;
discontinue
breastf
eeding.

UseCaut
iousl
yin:
Concur
rentwar
far
inorHMG-
CoA
r
eductaseinhi
bit
orther
apy
;OB:Embr
yoci
daland
t
erat
ogenicinanimalst
udi
es;
useonl
yifpot
enti
albenef
it
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1584
out
weighriskstot
hefetus;
Pedi:
Safet
ynotestabli
shed;
Ger
i:Age-
relat
ed↓ inrenalf
unct
ionmaymakeol der
pat
ient
smor esuscept
ibl
etoadverser
eact
ions.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: f
atigue/weakness, headache.CV: PULMONARY
EMBOLI SM, arrhyt
hmi as,deepv ei
nthrombosi s.GI
:
cholel
it
hiasis,pancreati
ti
s.Der m:rash,urti
cari
a.MS:
rhabdomy olysi
s.Misc: hypersensi
tiv
ityreacti
ons.

I
NTERACTI
ONS
Drug-Drug:↑ anticoagulanteffectsofwar f
ari
n.HMG- CoA
reductaseinhi
bit
or s↑ r i
skofrhabdomy ol
ysis(concur r
ent
useshoul dbeav oided).Absorptionis↓ bybi l
eaci d
sequestrants(f
enof i
brateshouldbegi ven1hrbef oreor
4–6hraf ter)
.↑ riskofnephr otoxici
tywithcyclosporine.

DOSAGE
Pr
imar
yhy
per
chol
est
erol
emi
a/mi
xeddy
sli
pidemi
a
PO:(Adults):Antar
a—130mg/dayinit
ial
ly;Fenogl
i
de—120
mg/ day;Lof
ibra—200mg/dayi
niti
all
y;Tri
cor—145mg/day
i
nit
iall
y;Tri
gli
de—160mg/ dayi
nit
ial
ly;
Lipofen—50mg
dai
ly.

Hy
per
tri
gly
cer
idemi
a

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1585
PO:(Adults):Antara—43–130mg/ day;
Fenogli
de—40–120mg/ day
;Lofi
bra—67–200mg/day
i
niti
all
y;Tri
cor—48–145mg/ dayi
niti
all
y;Tr
igl
i
de—50–160
mg/ dayini
ti
all
y;Lipofen—50mgdai l
y.

Renal
impai
rment
/Ger
iat
ri
cpat
ient
s
PO:
(Adult
s):Antar
a—43mg/day;Fenogl
i
de—st
artat40
mg/day
;Lofi
bra—67mg/day
;Tri
cor—48mg/day
.

AVAI
LABI
LITY
Tabl
ets(
Fenogl
i
de)40mg,
120mg
Tabl
ets(
Tri
gli
de)50mg,
160mg.
Mi
croni
zedt
abl
ets(
Lof
ibr
a)54mg,
100mg,
160mg.
Capsul
es(
Lipof
en)50mg,
150mg.
Mi
croni
zedcapsul
es(
Lof
ibr
a)67mg,
134mg,
200mg.

PATI
ENTTEACHI
NG
Instr
uctpatientt
otakemedicat
ionasdir
ected,
notto
skipdosesordoubl euponmisseddoses.Medicat
ion
helpscontrolbutdoesnotcur
eelevat
edserum
tri
glycer
idelevel
s.

Advi
sepati
entt
hatthi
smedicat
ionshoul
dbeusedin
conj
unct
ionwit
hdietr
est
ri
cti
ons(fat
,chol
est
erol
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1586
 car
bohydr
ates,
alcohol
),exer
cise,
andcessat
ionof
smoki
ng.

I
nstructpati
enttonotif
yhealt
hcar eprof
essi
onalif
unexplai
nedmuscl epain,
tenderness,
orweakness
occurs,especi
all
yifaccompaniedbyfeverormalai
se.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Inst
ructfemalepati
entstonotif
yheal
thcare
prof
essionalpromptl
yifpregnancyi
splannedor
suspected.

Emphasizet
heimportanceoffol
l
ow-
upexamsto
deter
mineef
fect
ivenessandtomoni
torf
orsi
de
eff
ects.

Fenof
ibr
icaci
d
I
NDI
CATI
ONS
Withast ati
ntor educet r
igly
cerides( TG)andi ncreasehigh
densityli
poprotein-C(HDL-C)inpat i
entswi thmi xed
dysl
ipidemiasandCHDoraCHDr iskequi valentwhoar e
onstat i
ntherapyt oachievetheirlow- densityli
popr ot
ein-
C
(LDL-C)goal(TriLipixonly)
.Asmonot herapyt oreduceTG
i
npat ientswithsev erehypertr
igly
cer i
demi a.As

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1587
monother
apyt oreduceelev atedLDL-C,
tot
al chol
esterol
(Tot
al-
C),
TGandapol i
popr oteinB(ApoB),andincrease
HDL-Cinpati
entswithpri
mar yhyperl
ipi
demiaormi xed
dysl
ipi
demia.Partofacompr ehensiv
eprogram to
decr
easecardiov
ascularriskf act
ors.

ACTI
ON
Activat
est heperoxisomepr ol
if
erat oracti
vatedr eceptorα
(PPARα) ,r
esulti
ngi nincr
easedlipolysisandel iminati
onof
tri
gly
ceridesfrom plasma.ActivationofPPARαal so
i
ncreasespr oduct i
onofHDL.Ther apeuti
cEf f
ect s:
Improvementi nlipidprof
il
ewithl oweredtrigl
y ceri
desand
LDLchol ester
ol,andincreasedHDLchol esterol.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofenof
ibr
icaci
d,
chol
inefenofi
brat
eorfenofi
brate;
Severerenal
impair
ment
(CCr<30mL/ min)
;Act
iveliv
erorgall
bladderdi
sease;
Lact
ation:Av
oiduseduringbreast
feeding.

UseCaut
iousl
yin:
Mil
d/moder
ater
enal
impai
rment
(
dose↓ r equiredforCCr30–80mL/ min);
Concurr
entuse
wi
thstati
nsi nelderl
ypati
ents,pat
ientswithdi
abet
es,
r
enalfai
lure,orhypothyr
oidi
sm (↑r i
skof
myopathy/rhabdomy ol
ysi
s);Geri
:Considerage-
rel
ated↓

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1588
i
nr enalfunct
ion,concurr
entil
lnessesanddr ugther
apy
;
OB: Useonlyifthepotenti
albenefi
tjust
if
iest hepot
ent
ial
ri
skt othefet
us.Pedi:Safetyandeffect
ivenessnot
establi
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache.GI
:diar
rhea,
nausea,
choleli
thi
asi
s,↑l i
ver
enzy
mes, pancr
eat
it
is.GU:↑ ser
um creat
ini
ne.MS:
MYOPATHY/ RHABDOMYOLYSI S,myalgi
a,backpain.

I
NTERACTI
ONS
Drug-
Dr ug:↑ effectsandr i
skofbleedingwithwar f
arin;
monitorprothrombint i
me/ I
NR.Bi l
eacidsequestrantsmay
↓ absor pt
ionandef fecti
veness;administ
eratleast1hr
befor
eor4–6hraf t
erabi l
eacidsequest r
ant.Concurrent
usewi t
hnephr otoxi
cdr ugsincl
udingcy cl
ospori
nemay
i
mpai rrenalfuncti
onandexcr eti
on, ↑riskofadverse
react
ions.

DOSAGE
Mi
xedDy
sli
pidemi
a
PO:(Adul
ts):
TriLi
pix—135mgoncedai
l
y;
Hypert
ri
gly
ceri
demia—45–135mgoncedai
ly
.

Hy
per
tri
gly
cer
idemi
a

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1589
PO:(
Adults):
Fibr
icor
—35–105mgoncedai
l
y;
Tr
iLi
pix—45–135mgoncedail
y.
Renal
Impai
rment
Pr
imar
yHy
per
chol
est
erol
emi
aorMi
xedDy
sli
pidemi
a
PO:
(Adul
ts)
:Fi
bri
cor
—105mgoncedai
l
y;Tr
iLi
pix—135
mgoncedai
l
y.
Renal
Impai
rment
PO:(
Adult
s):CCr30–80mL/ min—Fibri
cor:I
nit
iat
ewith35
mgoncedail
y;maytitr
atecauti
ously;Tri
Lipi
x:I
nit
iat
ewith
45mgoncedaily;maytit
rat
ecautiously
;CCr<30
mL/min—Contr
aindi
cated.

AVAI
LABI
LITY
Del
ayed-
rel
easecapsul
es(
Fibri
cor)35mg,105mg;
Del
ayed-
rel
easecapsul
es(
TriLi
pix)45mg,
135mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakemedicationasdir
ected.Take
misseddosesassoonasr emember ed;i
ftimefor
nextdose,ski
pdoseandt akenextdoseatr egular
ti
me.Donotdoubl edoses.Medi cat
ionhelpscontr
ol
butdoesnotcureel ev
atedserum tr
igl
yceri
delevel
s.
Advisepati
enttoreadMedicationGuidebefore

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1590
 st
art
ingandwit
heachRxr
efi
l
l,newi
nfor
mat
ionmay
beavai
labl
e.

Adv i
sepat ientthatthi
smedicationshoul
dbeusedin
conjunct i
onwi t
hdi etr
estr
ict
ions(fat
,chol
est
erol
,
carbohy drates,
alcohol)
,exer
cise,andcessat
ionof
smoki ng.

I
nstructpatienttonot
if
yhealt
hcar eprofessi
onalif
unexplai
nedmuscl epain,
tenderness,weakness,
ti
redness,fever,
nausea,v
omiting,orabdominalpain
occurs,especial
lyi
faccompaniedbyf everormalai
se.

Inst
ructfemalepati
entstonotif
yheal
thcare
prof
essionalpromptl
yifpregnancyi
splannedor
suspected.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Emphasizet
heimportanceoffol
l
ow-
upexamsto
deter
mineef
fect
ivenessandtomoni
torf
orsi
de
eff
ects.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1591
Fenol
dopam
I
NDI
CATI
ONS
Short
-t
erm(<48hr),
in-
hospi
talmanagementof
hyper
tensi
veemergenci
es,i
ncl
udingmalignant
hyper
tensi
onwit
hend-organdeter
ior
ati
on.

ACTI
ON
Actsasanagonistatdopamined1-l
iker
ecept
ors.Also
bi
ndst oal
pha-
adrenergi
crecept
ors.Act
sasav asodil
ator
.
Therapeut
icEf
fects:
Rapidlower
ingofBP.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofenol
dopam or
sul
fit
es;Concurr
entbet
abl
ockert
her
apy(
wil
lpr
event
ref
lextachy
cardi
a).

UseCaut
iousl
yin:
Glaucomaori
ntr
aocul
arhy
per
tensi
on;
OB:
Pedi
:Lact
ati
on:
Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,nervousness/anxi
ety
,dizzi
ness.CV:
hypotensi
on,tachycardia,
ECGchanges, peri
pheraledema.
GI
: nausea,abdominal pai
n,consti
pati
on,di
arrhea,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1592
vomit
ing.Derm:f
lushi
ng,sweati
ng.FandE:hy
pokal
emi
a.
Local
:inj
ecti
onsi
tereact
ions.MS:backpai
n.

I
NTERACTI
ONS
Drug-Drug:Concur
rentusewithbetablocker
smayr
esul
t
i
nexcessi vehypot
ension(concur
rentuseshoul
dbe
avoided).

DOSAGE
I
V:(
Adul
ts)
:0.
01–1.
6mcg/
kg/
min.

AVAI
LABI
LITY
Concent
rat
efori
nject
ion10mg/mLi n1–and2-
mLsi
ngl
e
-
useampules(wi
thsodium met
a-bi
sulf
it
e);

PATI
ENTTEACHI
NG
Expl
ainpur
poseofmedi
cat
iont
opat
ient
.

Advisepat
ientt
orepor
theadacheorpai
natt
he
i
njecti
onsi
te.

Fenopr
ofen
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1593
Rheumat
oidar
thr
it
is.Ost
eoar
thr
it
is.Mi
l
dtomoder
atepai
n.

ACTI
ON
I
nhibi
tspr
ost
agl
andinsy
nthesi
s.Therapeut
icEf
fect
s:
Suppr
essi
onofpai
nandinfl
ammat i
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofenopr
ofen,
aspiri
n,orot
herNSAIDS;ActiveGIbl
eedingorulcer
disease;Sev
ererenal
dysfuncti
on;Peri
operat
ivepai
nin
setti
ngofcoronaryar
ter
yby passsurger
y.

UseCaut
iousl
yin:
Car
diov
ascul
ar,
renal
,orhepat
ic
disease;Histor
yofulcerdi
sease;
OB:Notrecommended
forusedur i
ngt hi
rdtr
imest
er;Ger
i:↑ri
skofadver
se
events;Lactati
on:Pedi:
Saf
etynotest
abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: conf usion,dizzi
ness,drowsiness,headache.EENT:
blurr
edv ision,hear i
ngloss,ti
nni
tus.CV: edema,
palpit
ations.GI :GIBLEEDI NG,HEPATI TIS,dyspepsia,
abdomi nal pain,consti
pation,di
arrhea,discomf or
t,nausea,
vomi t
ing.GU: cyst
iti
s,dysuri
a,hemat uri
a, r
enalfai
lure.
Derm: pruriti
s, r
ashes,sweat i
ng.Hemat :prolonged
bleedingtime.Neur o:t
remor .Misc:all
ergicreacti
ons

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1594
i
ncl
udi
nganaphy
laxi
s.

I
NTERACTI
ONS
Drug-Drug: Concur r
entusewi thaspiri
norant acidsmay↓
effecti
veness.Addi ti
v eadv erseGIef f
ect swi thaspi ri
n,
otherNSAI Ds, pot assium suppl ement s,corticosteroids,or
alcohol.May↓ t heef fect
ivenessofdi ureti
csor
antihypert
ensi ves.May↑ ser um li
thium l evelsand↑ t he
ri
skoft oxicit
y .↑ t heriskoft oxici
tyfrom met hot r
exate.↑
ri
skofbl eedingwi thcef otetan,heparin,thrombol y
t i
c
agents,antiplateletagent s,orwar fari
n.↑ r iskofadv erse
hemat ologicreact ionswi thant i
neoplast i
csorr adiati
on
therapy.Phenobar bital may↑ met abol i
sm and↓
effecti
venessoff enopr of
en.May↑ t her i
skof
nephrotoxicit
ywi t hcyclospor i
ne.
Drug-Nat
uralPr
oduct
:↑ bl
eedi
ngriskwit
hanise,
arnica,
chamomi l
e,cl
ove,
fev
erf
ew,gar
li
c,ginger
,gi
nkgo,Panax
ginseng,
andother
s.

DOSAGE
Rheumat
oidAr
thr
it
is/
Ost
eoar
thr
it
is
PO:(
Adul
ts):
400–600mg3–4t
imesdai
l
y(nott
oexceed
3.
2g/day
).

Mi
l
d-t
o-Moder
atePai
n
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1595
PO:
(Adul
ts)
:200mgq4–6hr
.

AVAI
LABI
LITY
Capsul
es200mg,
400mg;
Tabl
ets600mg;

PATI
ENTTEACHI
NG
Advi
sepatienttotakethismedicati
onwithaf
ull
glass
ofwaterandtor emaininanuprightposi
ti
onf
or
15–30mi nafteradmini
strat
ion.

Instructpat
ientt
ot akemedicat
ionasdi
rect
ed.Take
mi sseddosesassoonasr emembered,
butnotif
almostt i
mef ornextdose.Donotdoubl
edoses.

Maycausedr owsi
nessordizziness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heract
ivi
ti
esr equir
ingal
ert
ness
unti
lresponsetot
hemedicationisknown.

Cauti
onpat i
entt oavoidconcurr
entuseofal cohol
,
aspi
ri
n, acetaminophen,otherNSAIDs,orotherOTC
orherbalproductswithoutconsult
inghealt
hcar e
prof
essional.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Adv i
sepati
enttoconsultheal
thcareprofessi
onali
f
rash,i
tchi
ng,vi
sualdi
sturbances,
tinni
tus,wei
ghtgai
n,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1596
 edema, bl
ackst
ool
s,per
sist
entheadache,or
i
nfluenza-
li
kesy
ndr
ome( chi
ll
s,f
ever,muscleaches,
pai
n)occurs.

Fer
umoxy
tol
I
NDI
CATI
ONS
Treatmentofi
rondefi
ciencyanemi
ainadul
tpat
ient
swi
th
chroni
ckidneydi
sease(CKD).

ACTI
ON
Consi stsofasuper par amagnet i
ci ronoxidecoat edwitha
car bohy drat eshell;
whent heiron-carbohy dratecompl ex
ent ersther eticul
oendot heli
alsystem ( RES),ironis
releasedf rom t heiron-carbohydratecompl exwi thi
n
macr ophages.Thi si r
oncanei t
herent erthei ntracel
lul
ar
stor agei ronpool orbet ransfer
redt oer yt
hroi dprecursor
cellsf orincor por
ati
oni ntohemogl obin.Ther apeutic
Effect s:Impr ovementi nanemi ainpat ientswi thchronic
kidneydi sease.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Evi
denceofi
ron
ov
erl
oad;
Anemi
anotduet
oir
ondef
ici
ency
;Lact
ati
on:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1597
Av
oiduse.

UseCaut
iousl
yin:
MRI
;Ger
i:Consi
derage-
rel
ated↓ i
n
hepati
c,r
enal,orcardi
acf uncti
on,andconcur r
ent
di
seasesorotherdrugt herapy;dosecautiousl
y;OB:
Use
onlyi
fpotenti
albenefi
tjustif
iespotenti
alriskt
othefet
us.
Pedi:
Safetyandeffecti
venessnotest abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:dizziness.CV:HYPOTENSI ON,hypert
ension,
per
ipheraledema.GI :const
ipati
on,diar
rhea,nausea.
Hemat:ironov er
load.Misc:hypersensi
ti
vit
yreactions
i
ncl
udinganaphy l
axisandanaphy l
actoi
dreactions.

I
NTERACTI
ONS
Drug-
Drug:May↓ absor
pti
onofconcur
rent
ly
admini
ster
edoral
ironpr
eparat
ions.

DOSAGE
I
V: (Adul
ts≥18yr):
510mgini
ti
all
y,f
oll
owedbyasecond
510-mgI Vi
nject
ion3to8day
slater
.Coursemaybe
repeatedaf
ter1mo.

AVAI
LABI
LITY
Aqueouscol
l
oidf
ori
ntr
avenousi
nject
ion510-
mg

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1598
el
ement
ali
ron/
17mL(
30mg/
mL)v
ial
s;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofi
ront
her
apyt
opat
ient
.

Adv
isepat
ient
stoavoi
dMRIstudi
esdur
ingandf
or3
mofoll
owi
ngferumoxy
tol
ther
apy.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advisepatienttoreportsi
gnsandsy mptomsof
hypersensi
tivi
tyreacti
ons(rash,
itchi
ng,di
zzi
ness,
swelli
ng,andbr eat
hingproblems)tohealt
hcare
prof
essional i
mmedi atel
y.

Fesot
erodi
ne
I
NDI
CATI
ONS
Tr
eatmentofover
acti
vebl
adderfuncti
onthatresul
tsi
n
ur
inar
yfr
equency,ur
gency
,orurgeincont
inence.

ACTI
ON
Actsasacompeti
tiv
emuscarini
cr ecept
orant
agonist
resul
ti
ngi
ninhi
bit
ionofchol
i
nergicall
ymediat
edbladder

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1599
cont
racti
on.Ther
apeut
icEff
ects:Decreasedur
inar
y
fr
equency,ur
gency,
andurgeinconti
nence.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Uri
nar
yret
ent
ion;
Gastr
icret
enti
on;Sev
erehepat
ici
mpai
rment
;Uncont
rol
l
ed
nar
row-angl
eglaucoma.

UseCaut
iousl
yin:
Signi
fi
cantbl
adderout
letobst
ruct
ion
(↑r i
skofr etent i
on);Severerenal i
nsuf f
ici
ency(dose
adjust
mentr equired);↓ GImot il
i
t yincl
udingsevere
consti
pation; Treatednarrow-anglegl aucoma( useonlyif
benefi
tsout wei ghr i
sks)
;My astheniagr avi
s;Severerenal
i
mpai r
ment( doseshoul dnotexceed4mg/ day);Geri
:↑
ri
skofant icholinergicsi
deef f
ectsi npat i
ents>75y r
;OB:
Lactat
ion:Av oidusi ngunlesspot entialbenefi
tsoutweighs
potent
ialriskt ofetus/neonate;Pedi: Safet
ynot
establ
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:tachycar
dia(doserelated).GI:
drymouth,const
ipat
ion,
nausea,upperabdominal pain.GU:dysur
ia,
uri
nary
ret
enti
on.MS: backpain.Mi sc:ANGIOEDEMA.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1600
Drug-Drug:Concur rentuseofpot entCYP3A4enzy me
i
nhibit
orsincludingket oconazole, i
tr
aconazole,and
cl
arit
hromy cin↑ bl oodlevelsandr i
skoftoxicit
y;dail
y
doseshoul dnotexceed4mg.Usel esspotentinhibi
tors
ofCYP3A4( suchaser yt
hromy cin)withcauti
on; escalat
e
dosecar ef
ully.Anticholi
nergi
cef fectsmayal tertheGI
absorpti
onofot herdrugs.

DOSAGE
PO:
(Adults)
:4mgoncedailyini
ti
all
ymaybe↑ t o8
mg/dai
ly;
Concurr
entpot
entCYP3A4i nhibi
tor
sorCCr<30
mL/min—doseshoul
dnotexceed4mg/ day.

AVAI
LABI
LITY
Ext
ended-
rel
easet
abl
ets4mg,
8mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakefesot
erodineasdi
rected.Ifa
doseismi ssed,omitandbegintaki
ngagai
nt henext
day;donott ake2dosesthesameday .Advisepatient
toreadthePat i
entInf
ormati
onsheetpri
ortoi ni
ti
ation
oftherapyandwi t
heachRxr efi
l
l.

Maycausedrowsi
nessandblur
redvi
sion.Cauti
on
pat
ientt
oavoiddr
ivi
ngorot
heracti
vi
ti
esr equi
ri
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1601
 al
ert
nessunt
ilr
esponset
omedi
cat
ioni
sknown.

Advi
sepatientt
oav
oidal
cohol
;mayi
ncr
ease
dr
owsiness.

Advi
sepati
entt
ousecauti
oninhotenv
ironments;
maycausedecr
easedsweati
ngandsevereheat
i
ll
ness.

Instr
uctpati
entt
onot i
fyheal
thcarepr of
essional
of
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbei
ngtakenandt oconsultwithhealt
hcare
professi
onalbef
oretaki
ngothermedi cati
ons.

Advisepatienttostopmedicat
ionandnot
if
yheal
th
careprofessional
ifsignsandsymptomsof
angioedemaoccur .

Advi
sepati
entt
onotif
yhealt
hcarepr
ofessi
onalif
pr
egnancyi
splannedorsuspect
edori
fbreast
feeding.

Fexof
enadi
ne
I
NDI
CATI
ONS
Rel
i
efofsymptomsofseasonalall
ergi
crhini
ti
s.
Managementofchr
oni
cidi
opathicurti
car
ia.

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1602
Antagonizestheeff ect
sofhi stamineatper ipheral
hi
stamine–1( H1)r eceptors,i
ncludingpr ur
itusand
urt
icari
a.Alsohasadr yi
ngef fectont henasal mucosa.
TherapeuticEffect
s: Decreasedsneezi ng,rhinor
rhea,i
tchy
eyes,nose,andt hr
oatassoci atedwi t
hseasonal al
ler
gies.
Decreasedur t
icari
a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Impai
redr
enal
funct
ion(
↑ dosi
ng
i
ntervalrecommended) ;OB:useonl yi
fmaternalbenef
it
outweighspotent
ialrisktofetus;Lact
ati
on:Usuall
y
compat i
blewit
hbr eastfeedi
ng( AAP).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:drowsiness,
fat
igue.GI
:dy
spepsi
a.Endo:
dysmenorr
hea.

I
NTERACTI
ONS
Dr
ug-Drug:Magnesi
um andalumi
num-containi
ngant
aci
ds
↓ absorpt
ionandmaydecreaseef
fect
iveness.
Drug-
Food:
Appl
e,or
ange,andgrapef
ruitj
uice↓
absor
pti
onandmaydecreaseef
fecti
veness.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1603
DOSAGE
PO:
(Adul
tsandChi
l
dren≥12y
r):
60mgt
wicedai
l
y,or180
mgoncedai
ly.
PO:
(Chi
l
dren2–11y
r):
30mgt
wicedai
l
y.
PO:
(Chi
l
dren6mo–2y
r):
15mgt
wicedai
l
y.
Renal
Impai
rment
PO:
(Adul
ts)
:60mgoncedai
l
yasast
art
ingdose.
PO:(Chi
l
dren6–11y
r):
30mgoncedai
l
yasast
art
ing
dose.

AVAI
LABI
LITY
Tablet
s30mgOTC, 60mgOTC,120mgOTC, 180mgOTC;
Oral
lydisi
ntegr
ati
ngtabl
ets30mgOTC; Suspensi
on(
ber
ry
fl
avor)30mg/ 5mLOTC;Incombinat
ionwith:
pseudoephedri
ne

PATI
ENTTEACHI
NG
I
nstructpati
enttot
akemedi
cat
ionasdi
rected.Take
misseddosesassoonasrememberedunlessalmost
t
imef ornextdose.

I
nfor
m pat
ientt
hatdr
ugmaycausedr
owsi
ness,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1604
 alt
houghi ti
slesslikel
ytooccurthanwi t
hot her
anti
histamines.Avoiddri
vingorotheracti
vit
ies
requi
ringalert
nessuntilr
esponset odrugisknown.

Inst
ructpat
ientt
ocont
actheal
thcar
epr
ofessi
onal
if
symptomsper si
st.

Fi
daxomi
cin
I
NDI
CATI
ONS
Tr
eat
mentofdi
arr
heaassoci
atedwi
thCl
ost
ri
dium di
ff
ici
l
e.

ACTI
ON
Bacteri
cial
acti
onmost lyagai
nstclostr
idi
a;i
nhibi
tsRNA
synthesi
s.Act
slocall
yint heGItr
acttoelimi
nate
Clostr
idi
um di
ffi
cil
e.Therapeut
icEffects:
Eli
minati
onof
di
arrheacausedbyCl ostr
idi
um dif
fici
l
e.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Nonenot
ed.

UseCaut
iousl
yin:
OB:
Lact
ati
on:
Usedur
ingpr
egnancy
onl
yifcl
earl
yneeded,usecauti
ousl
yduri
nglact
ati
on;Pedi
:
Saf
eandef f
ect
iveuseinchil
dren<18yrhasnotbeen
est
abli
shed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1605
ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:GIHEMORRHAGE, nausea,
abdomi
nal
pai
n.Hemat
:
anemia,neut
ropeni
a.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nosi
gni
fi
canti
nter
act
ionsnot
ed.

DOSAGE
PO:
(Adul
ts>18y
r):
200mgt
wicedai
l
yfor10day
s.

AVAI
LABI
LITY
Tabl
ets200mg;

PATI
ENTTEACHI
NG
I
nst ructpati
entt ot akefidamoxi cinasdir
ectedforthe
fullcourseoft herapy ,
eveni ffeelingbet
ter.Ski
pping
dosesornotcompl eti
ngf ul
lcour seoftherapymay
decr easeeffecti
v enessoft herapyandi ncr
easer i
sk
thatbact er
iawi l
l developresistanceandnotbe
treatableinthef uture.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1606
Fi
l
grast
im
I
NDI
CATI
ONS
Preventionoff ebril
eneut ropeni aandassoci atedinf ecti
on
i
npat i
ent swhohav ereceivedbonemar row–depr essi ng
anti
neopl asticsf orthet r
eat mentofnonmy eloid
malignanci es.Reduct ionoft i
mef orneut rophi lr
ecov ery
anddur at ionoff everinpat ientsunder goi ngi nductionand
consolidat ionchemot herapyf oracut emy elogenous
l
eukemi a.Reduct i
onoft imet oneut r
ophi lrecov eryand
sequelaeofneut ropeniainpat i
entswi thnonmy eloi
d
malignanci esunder goingmy eloablati
v echemot her apy
fol
lowedbybonemar r
owt r
anspl antation.Mobi l
izationof
hemat opoi et
icpr ogeni t
orcel lsintoper ipheral bl
oodf or
coll
ectionbyl eukapher esis.Managementofsev ere
chronicneut ropeni a.Unlabel edUses: Neut ropeni a
associat edwi thHI Vinfection.Neonat al neutropenia.

ACTI
ON
Aglycoprot
ein, fi
l
grast
im bindstoandst i
mulates
i
mmat ur
eneut rophi
lst
odi videanddi
fferenti
ate.Also
acti
vatesmat ureneutr
ophils.Ther
apeuticEffects:
Decreasedincidenceofinfectioni
npatientswhoar e
neutr
openicfrom chemot herapyorothercauses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1607
I
mpr ov
edhar
vestofpr
ogeni
torcel
l
sforbonemar
row
t
ranspl
ant
ati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofi
l
grast
im or
Escher
ichi
acol
i
-der
ivedpr
otei
ns.

UseCaut
iousl
yin:
Mal
i
gnancywi
thmy
eloi
d
char
acteri
sti
cs;Pre-
exi
stingcardi
acdisease;OB:Useonl
y
i
fpotenti
albenefi
tjust
if
iespotent
ialri
sktofetus;
Lact
ati
on:Unlikel
ytoadv er
sel
yaffectbreast
fedinf
ant
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Hemat:excessi
vel
eukocyt
osi
s.Local
:pai
n,r
ednessat
subcutsi
te.MS:medul
lar
ybonepain.

I
NTERACTI
ONS
Drug-
Drug:Simultaneoususewithanti
neoplasticsmay
haveadverseeffectsonrapi
dlyprol
if
erati
ng
neutr
ophil
s—av oi
dusef or24hrbeforeand24hraf ter
chemotherapy.Lit
hium maypotenti
atethereleaseof
neutr
ophil
s;concurrentuseshoul
dbeunder taken
cauti
ousl
y.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1608
Af
terMy
elosuppr
essi
veChemot
her
apy
I
V: Subcut(
Adult
sandChil
dren)
:5mcg/kg/dayasasingl
e
i
njecti
ondail
yforupt
o2wk.Dosagemaybei ncr
easedby
5mcg/ kgduri
ngeachcy
cleofchemot
herapy,dependi
ng
onbloodcounts.

Af
terBoneMar
rowTr
anspl
ant
ati
on
IV:
Subcut(Adult
s):10mcg/ kg/dayasa4-or24- hrI
V
i
nfusi
onorasacont i
nuoussubcuti nfusion;i
nit
iat
eat
l
east24hrafterchemot
her apyandatl east24hrafter
bonemarrowt r
anspl
ant
ation.Subsequentdosagei s
adj
ustedaccordi
ngtobloodcount s.
Per
ipher
alBl
oodPr
ogeni
torCel
lCol
l
ect
ionandTher
apy
Subcut(Adult
s) :10mcg/ kg/
dayasabol usorconti
nuous
i
nfusi
onf oratleast4daysbef orefi
rstl
eukapheresi
sand
conti
nueduntillastl
eukapheresis;
dosagemodi f
icati
on
suggest
edi fWBC>100, 000cel l
s/mm3.

Sev
ereChr
oni
cNeut
ropeni
a
Subcut(Adul
ts):Congenit
alneutropeni
a—6mcg/kgtwi
ce
dail
y.I
diopat
hic/
cy cl
i
calneut
ropenia—5mcg/kgdail
y
(decr
easeifANCr emains>10,000/mm3) .
Neonat
alneut
ropeni
a

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1609
I
V:Subcut(
Neonat
es)
:5–10mcg/
kg/
dayoncedai
l
yfor
3–5days.

AVAI
LABI
LITY
I
nject
ion300mcg/
mLi
n1-and1.
6-mLv
ial
s;

PATI
ENTTEACHI
NG
Expl
ainpur
poseoff
il
grast
imt
opat
ient
.

HomeCar eI ssues:Instr
uctpati
entoncorrect
techniqueandpr operdisposalf
orhome
admi nist
rati
on.Caut ionpati
entnottoreuseneedl
e,
vial
,orsy r
inge.Pr ovi
depat i
entwit
hapunct ur
e-pr
oof
containerforneedl eandsy r
ingedisposal
.

Fi
nast
eri
de
I
NDI
CATI
ONS
Benignpr
ostat
ichyperpl
asi
a(BPH);
canbeusedwit
h
doxazosi
n.Androgenet
ical
opeci
a(mal
epatt
ernbal
dness)
i
nmenonl y.

ACTI
ON
I
nhi
bit
stheenzy
me5-
alpha-
reduct
ase,
whi
chi
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1610
responsi bleforconv erti
ngt estost
eronetoit
spot ent
met abol i
te5- al
pha-dihydrotestost
eroneinprostate,l
i
ver,
andski n; 5-
alpha-dihydrotestoster
oneisparti
ally
responsi bleforprostat i
chy perpl
asiaandhairloss.
Ther apeut i
cEf f
ects:Reducedpr ostat
esizewith
associ ateddecr easei nurinarysymptoms.Decr easeshai
r
l
oss; promot eshairregrowt h.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Women.

UseCaut
iousl
yin:
Pat
ient
swi
thhepat
ici
mpai
rmentor
obst
ruct
iveur
opat
hy.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Endo:gy
necomastia.GU:PROSTATECANCER( HIGH-
GRADE),↓libi
do,↓v olumeofej
acul
ate,
erect
il
e
dysf
uncti
on.Misc:
BREASTCANCER.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
PO:(
Adult
s):
BPH—5mgdai l
y(Proscar
);Andr
ogenet
ic
al
opeci
a—1mg/day(
Propeci
a).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1611
AVAI
LABI
LITY
Tabl
ets1mg(
Propeci
a),
5mg(
Proscar
);

PATI
ENTTEACHI
NG
Inst
ructpatienttotakefi
nast
eri
deasdirected, evenif
symptomsi mproveorareunchanged.Atleast6–12
mooft herapymaybenecessar ytodetermine
whetherornotani ndivi
dualwi
llr
espondtof inasteri
de.
AdvisepatienttoreadthePati
entPackageI nsertpri
or
tostart
ingtherapyandwi t
heachRxr ef
il
lincaseof
changes.

I
nform pati
entthatthev ol
umeofej acul
atemaybe
decr
easeddur i
ngt herapybutthatthi
swi l
lnot
i
nter
ferewithnormal sexualfuncti
on.Sexual
dysf
unctionsi
deef fectswil
ldimini
shov erti
me.

Advi
sepati
enttonot
if
yhealt
hcareprof
essi
onal
pr
omptlyi
fchangesi
nbreasts(
lumps,pai
n,ni
ppl
e
di
schar
ge)occur.

Cautionpati
entthatfi
nast
erideposesapot enti
alr
isk
toamal efetus.Womenwhoar epregnantormay
becomepr egnantshouldavoidexposuretosemenof
apar t
nertaki
ngfinast
eri
deandshoul dnothandle
crushedfi
nasteri
debecauseoft hepotent
ialfor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1612
 absor
pti
on.

Emphasizet
heimpor
tanceofper
iodicf
oll
ow-up
examstodeter
minewhetheracl
i
nicalr
esponsehas
occur
red.

FI
NGOLI
MOD
I
NDI
CATI
ONS
Tr
eat
mentofr
elapsi
ngf
ormsofmul
ti
plescl
erosi
s.

ACTI
ON
Conver
tedbysphi ngosineki nasetotheact i
vemet abol
it
e
fi
ngol
imod-phosphate, whichbi ndstosphingosine
1–phosphatereceptors,r
esul tingi
n↓ mi grati
onof
l
ymphocy t
esintoper i
pheral blood.Thi
smay↓
l
ymphocy t
emi grati
onintot heCNS.Ther apeuticEffect
s:
↓f r
equencyofr el
apses/ delayedaccumul ati
onof
di
sabil
i
ty.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Act
iveacut
e/chr
oni
cunt
reat
ed
i
nfect
ions;
OB: Pr
egnancy
;maycausefetalhar
m;
Lact
ati
on:Breast
feedi
ngshoul
dbeavoided.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1613
UseCaut
iousl
yin:
Concur
rentuseofcl
assI
aorcl
assI
II
antiar
rhy thmics,bet ablocker s, orcal cium channel
blockers, bradycardia,historyofsy ncope, ischemi chear t
diseaseorHF( ↑r iskofbr ady cardia/ heartbl ock);Sev ere
hepatici mpai r
ment( ↑ bloodl evelsandr iskofadv erse
reacti
ons) ; Di
abetesmel li
tus/ histor yofuv eitis(↑r iskof
macul aredema) ;Negat i
v ehi storyf orchi ckenpoxor
vaccinat i
onagai nstv ari
cellazost erv irusv accination; Geri
:
Riskofadv ersereact i
onsmaybe↑, consi derage- related
↓i ncar diac/renal/hepat i
cf unct i
on, chroni cill
nessesand
concur rentdrugt herapy; Pedi :Saf etyandef f
ectiveness
notest ablished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache.EENT: blur
redvi
sion,eyepain,
macular
edema.Resp: cough,↓ pul
monar yfuncti
on.CV:
BRADYCARDI A, HEARTBLOCK.GI :diar
rhea,↑ hepat
ic
tr
ansaminases.Hemat :l
eukopenia,l
ymphopenia.MS:
backpai
n.Mi sc:↑r i
skofinfect
ion.

I
NTERACTI
ONS
Drug-
Dr ug:Concur r
entuseofclassIaorclassII
I
anti
arrhythmicsmay↑ r iskofseri
ousarrhythmias;caref
ul
monitoringrecommended.Concur rentuseofbet a
bl
ocker sordilt
iazem may↑ riskofbradycardi
a;careful

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1614
moni tori
ngrecommended.Concur rentuseof
ketoconazolemay↑ bl oodl
evelsandofadv erse
reactions.↑ ri
skofimmunosuppr essionwith
ant i
neoplast
ics,i
mmunosuppr essantsorimmune
modul at
ingt
herapies.Liv
eatt
enuatedv acci
nes↑ ri
skof
i
nf ecti
on.

DOSAGE
PO:
(Adul
ts)
:0.
5mgoncedai
l
y.

AVAI
LABI
LITY
Har
dcapsul
es0.
5mg;

PATI
ENTTEACHI
NG
I
nstr
uctpati
enttotakefi
ngoli
modasdi r
ected.Donot
di
sconti
nuether
apywi t
houtconsul
ti
nghealthcare
pr
ofessi
onal
.Advisepati
enttoreadtheMedicati
on
Gui
depriort
ostarti
ngtherapyandwitheachRxrefi
ll
i
ncaseofchanges.

Advisepati
enttonotif
yheal thcareprofessionalif
si
gnsandsy mpt omsofl i
v erdysfunct
ion(unexplained
nausea,vomit
ing,abdomi nalpain,fat
igue,anorexi
a,
j
aundice,dar
kur i
ne),i
nfection,
newonsetofdy spnea,
orchangesinv i
siondevelop.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1615
 Instructpatientnott
oreceiveli
veattenuatedv acci
nes
dur i
ngandf or2moaf t
ertreatmentduet oriskof
i
nf ection.Pati
entswhohav enothadchi ckenpoxor
vacci nati
onshouldconsidervari
cel
lazost ervi
rus
vacci nati
onpr i
ortost
art
ingtherapy,thenpostponing
startoff i
ngolimodfor1mot oal
lowf orfullef
fectof
vacci nati
on.

Advisefemalepatient
stousecont racepti
ondur i
ng
andf oratl
east2moaf t
erdiscontinuationoft herapy
andt onoti
fyhealt
hcarepr ofessi
onal i
mmedi atelyif
pregnancyisplannedorsuspect edori fbreastfeeding.
Encouragepregnantpatientstoenr ol
linthe
pregnancy

Fl
avocoxi
d
I
NDI
CATI
ONS
Di
etarymanagementofost
eoar
thr
it
is;
consi
der
edt
obea
medical
foodproduct
.

ACTI
ON
Ant
i-i
nfl
ammatoryandanalgesicproper
ti
esrelat
edto
i
nhibi
ti
onofprost
aglandi
nsy nt
hesisbyinhi
bit
ingcycl
o-
oxy
genase(notCOX-2select
ive)andothermediator
sof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1616
i
nfl
ammat i
on.Therapeut
icEffect
s:Decreased
pai
n/i
nfl
ammat i
onassociatedwithosteoart
hri
ti
s,wi
th
i
mprovedmobili
ty.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pedi
:
Notr
ecommended.

UseCaut
iousl
yin:
Hist
oryofGIbl
eedi
ng.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:↑ BP,↑i
nvar
icosev
eins.GI
:GIupset
.Der
m:
psor
iasi
s.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
PO:(
Adul
ts)
:250mgev er
y12hr(
upt
o250mgt
hree
ti
mesdai
l
yhasbeenused).

AVAI
LABI
LITY
Capsul
es250mg;

PATI
ENTTEACHI
NG
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1617
 I
nstructpati
entt
otakeflav
ocoxidasdi
rect
ed.Donot
i
ncreasedoeswithoutconsul
ti
nghealt
hcare
pr
ofessional
.

Fl
ecai
nide
I
NDI
CATI
ONS
Life-t
hreateningv entr
iculararrhythmi as,incl
uding
vent r
iculart
achy cardi
a.Supr avent ri
culartachyarrhythmias
i
ncl uding:Paroxysmal supraventriculartachycardia(PSVT),
Par oxysmal atr
ialfibr
il
lati
on/flutter(PAF) .UnlabeledUses:
Singledoset reatmentofat ri
al f
ibril
lati
on.

ACTI
ON
Sl
owsconductionincardi
actissuebyal
teri
ngtr
anspor
tof
i
onsacrosscellmembranes.Therapeut
icEff
ect
s:
Suppr
essionofarr
hythmias.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Car
diogeni
cshock.

UseCaut
iousl
yin:
HF(
dosage↓ mayber
equi
red)
;Pr
e-
exist
ingsinusnodedy sf
uncti
onor2nd-or3rd-
degree
heartblock(withoutapacemaker
);Renali
mpair
ment
(dosage↓ r equir
edifCCr<35mL/mi n)
;OB:Ter
atogeni
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1618
i
nani mal studi
es;useonlyifpot
enti
albenef
itj
ust
ifi
es
potenti
alrisktofetus;Lact
ati
on:Usual
lycompati
blewi
th
breastfeeding(AAP) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,anxiety,f
ati
gue,headache,ment al
depression.EENT: blur
redvisi
on,vi
sual di
stur
bances.CV:
ARRHYTHMI AS, CHESTPAI N,HF.GI :anor
exia,
constipati
on,dr
ug-inducedhepat i
ti
s,nausea,stomach
pai
n, vomiti
ng.Derm: r
ash.Neuro:tr
emor .

I
NTERACTI
ONS
Drug- Drug: ↑r iskofar r
hy thmi aswithot her
antiarrhythmi cs,includingcal ci
um channel blockers.
Disopy rami de,bet ablocker s,orverapami lmayhav e↑
my ocar dialdepr essantef f ects;combinat i
onuseshoul dbe
under takencaut iously.Ami odaronedoubl esser um
fl
ecai nidelevels( ↓f l
ecai nidedoseby50%) .↑ serum
di
goxi nlevelsbyasmal l amount( 15–25%) .Concur r
ent
betabl ockert her apymaycause↑ l evelsofbet ablocker
andf lecainide.Al kali
nizingagent spromot er eabsorpt
ion,
↑ bl oodl evels,andmaycauset oxici
ty.Acidifyi
ngagent s
↑r enal eli
minat ionandmay↓ ef f
ectivenessoff l
ecaini
de
(i
fur inepH<5) .
Dr
ug-
Food:
Foodst
hat↑ ur
inepHt
o>7r
esul
tin↑ l
evel
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1619
(st
ri
ctvegetar
iandiet)
.Foodsorbev
eragesthat↓ uri
ne
pHto<5↑ r enaleli
minati
onandmay↓ ef f
ecti
venessof
fl
ecai
nide(aci
dicjui
ces).

DOSAGE
Vent
ri
cul
arTachy
car
dia
PO:(Adul
ts):100mgq12hri ni
ti
all
y,↑ by50mgt wi
ce
dai
lyunti
lresponseisobtainedormaximum tot
aldai
ly
doseof400mgi sreached.Somepat i
entsmayrequi
req8
hrdosi
ng.
Renal
Impai
rment
PO:(
Adult
s) :
CCr<35mL/ min—100mgonceadayor50
mgq12hri ni
tial
l
y;f
urt
herdosi
ngonthebasi
soff
requent
bl
oodlev
elmoni t
ori
ng.
PSVT/
PAF
PO:(Adul
ts):50mgq12hri ni
ti
all
y,↑ by50mgt wice
dai
lyunti
lresponseisobtainedormaximum tot
aldail
y
doseof300mgi sreached.Somepat i
entsmayrequir
eq8
hrdosi
ng.
At
ri
alFi
bri
l
lat
ion(
unl
abel
ed)
PO:
(Adul
ts)
:200mgor300mgsi
ngl
edose.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1620
AVAI
LABI
LITY
Tabl
ets50mg,
100mg,
150mg;

PATI
ENTTEACHI
NG
Instr
uctpatienttotakemedicat
ionaroundtheclock
asdi r
ectedatev enl
yspacedint
erval
s,eveniff
eeling
better.Takemisseddosesassoonasr emember edif
within6hr ;
omi tifr
ememberedlater
.Gradualdose
reductionmaybenecessar y.

Maycausedi zzi
nessorvisualdi
stur
bances.Cauti
on
pat
ienttoavoiddriv
ingandotheracti
vi
ti
esrequir
ing
al
ertnessunt
ilresponsetomedicati
onisknown.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Inst
ructpati
entt
onoti
fyhealt
hcareprof
essionali
f
chestpain,
short
nessofbreat
h,ordi
aphoresisoccur
s.

Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
moni
torprogr
ess.

Fl
oxur
idi
ne
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1621
I
NDI
CATI
ONS
Treat
mentofhepat
icmet
ast
asesofgast
roi
ntest
inal
carci
noma.

ACTI
ON
I
nhibitsDNAandRNAsy nthesisbypr
eventingthymidi
ne
pr
oduct i
on(cell
-cy
cleSphase–specifi
c).Therapeut
ic
Ef
fects:Deathofrapidl
yrepl
icati
ngcel
ls,part
icul
arl
y
malignantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pregnancyor
l
act
ati
on.

UseCaut
iousl
yin:
Pat
ient
swi
thchi
l
dbear
ingpot
ent
ial
;
Hepaticorrenaldysf
unct
ion;Hist
oryofhigh-
dosepel
vic
i
rr
adiationorprevi
oususeofalkylat
ingagent
s;Inf
ect
ions;
Depressedbonemar rowreserv
e.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,fati
gue.GI:bleeding,di
arrhea,gastri
ti
s,
nausea,stomat i
ti
s,vomiti
ng,anor exi
a,ulcer.Derm:
al
opecia,erythema,macul opapularrash.Endo: gonadal
suppression.Hemat :anemia,leukopenia,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1622
t
hrombocy
topeni
a.Mi
sc:
fev
er.

I
NTERACTI
ONS
Drug-Drug:Addit
ivebonemar r
owdepr essi
onwi t
hother
bonemar rowdepr essants(other
anti
neoplastics,and
radi
ationther
apy )
.Concomi tantuseofpentost at
inmay
causef at
alpulmonaryt oxi
cit
y(avoi
dconcur rentuse).May
decreaseantibodyresponset oli
ve-
vir
usv accinesand
i
ncreaser i
skofadv ersereacti
ons.

DOSAGE
I
ntra-
art
eri
al(
Adult
s):0.
1–0.6mg/kg/dayasacont i
nuous
i
nfusi
onfor14days,f
oll
owedbya2-wkr est(onl
y
hepar
ini
zedsali
neadmini
ster
edduri
ngthisrestper
iod)
.

AVAI
LABI
LITY
Powderf
ori
nject
ion500mgi
n5-or10-
mLv
ial
s;

PATI
ENTTEACHI
NG
Instr
uctpat i
enttonotif
yhealthcarepr ofessionalif
fever,chills,
sorethroat
, si
gnsofinfection,bleedi
ng
gums, bruisi
ng,petechi
ae,bloodinur i
neorst ool
,
j
aundi ce, abdominalpain,l
ocalir
rit
ationatt hesiteof
arter
ial cannulat
ion,oremesi soccurs.Caut i
onpat i
ent

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1623
 toav oi
dcrowdsandpersonswithknowni nf
ecti
ons.
Instr
uctpatientt
ousesoftt
oothbrushandelect
ric
razor.Pati
entshoul
dbecauti
onednott odri
nk
alcoholi
cbev er
agesort
akeproductscontai
ning
aspiri
norNSAI Ds.

Advisepatienttori
nsemout hwit
hclearwat
eraft
er
eati
nganddr i
nkingandtoav oidfl
ossi
ngtomini
mize
stomatit
is.Healthcareprofessi
onalmayorder
vi
scousl i
docaineorotherlocalagentsi
fmouthpain
i
nterfer
eswi theati
ng.Stomat i
ti
spainmayrequi
re
tr
eatmentwi thopioi
danal gesi
cs.

Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

Revi
ewwit
hpat
ientt
heneedf
orcont
racept
iondur
ing
ther
apy
.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasizetheimport
anceofr
outi
nefol
low-
upl
ab
teststomonit
orprogr
essandtocheckf
orsi
de
effect
s.

Fl
uconazol
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1624
I
NDI
CATI
ONS
PO: IV: Fungal i
nfectionscausedbysuscept i
bleorganisms,
i
ncl uding: Orophar yngeal oresophageal candidiasis,
Ser i
oussy stemi ccandi dali
nfections,Uri
nar ytr
act
i
nf ecti
ons, Peritonit
is,Cryptococcalmeni ngiti
s.Preventi
on
ofcandi di
asisi npat ientswhohav eundergonebone
mar rowt r
anspl antation.PO: Single-
doseor altr
eatmentof
vaginal candi diasis.UnlabeledUses: Preventionof
recurrentv agi nalyeasti nf
ections.

ACTI
ON
Inhi
bitssynthesisoffungalster
ols,anecessary
componentoft hecel
l membr ane.Therapeuti
cEffect
s:
Fungistat
icactionagainstsuscepti
bleorganisms.Maybe
fungi
cidalinhigherconcentrati
ons.Spectrum:
Crypt
ococcusneof or
mans.Candi daspp.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofl
uconazol
eor
otherazol
eant
if
ungal
s;Concur
rentusewi
thpi
mozi
deor
vori
conazol
e.

UseCaut
iousl
yin:
Renal
impai
rment(
dose↓ r
equi
redi
f
CCr<50mL/
min)
;Under
lyi
ngl
i
verdi
sease;
OB:
Saf
etynot

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1625
establi
shed;congenit
aldefectshav eoccur
redwithuseof
high-
dosef l
uconazole(400–800mg/ day);
Lactat
ion:
Usuallycompatibl
ewi t
hbr eastfeeding;Geri
:↑r i
skof
adversereacti
ons(rash,vomi t
ing, di
arr
hea,sei
zures)
;
considerage-r
elat
ed↓ i nrenal functi
onindetermini
ng
dose.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
I
nci
denceofadv
erser
eact
ionsi
sincr
easedi
nHI
Vpat
ient
s
CNS: headache,dizzi
ness, seizures.GI: HEPATOTOXI CITY,
abdomi naldi
scomf ort
,diarrhea,nausea, vomiti
ng.Derm:
exfoli
ati
veskindisordersincludingst ev ens-j
ohnson
syndrome.Endo: hypokalemi a,hy per
triglycer
idemia.Misc:
all
ergicreact
ions,
incl
udinganaphy l
axis.

I
NTERACTI
ONS
Drug-Drug: ↑ act ivi
tyofwar f
arin.Rifampi n,ri
fabutin,and
i
soni azi
d↓ l evels.Fluconazoleatdoses>200mg/ day
mayi nhi bi
ttheCYP3A4enzy mesy st em andef fectthe
activi
tyofdr ugsmet abol i
zedbyt hissy stem.↑
hypogl ycemicef fectsoft olbutami de, gl
yburi
de, or
gli
pizide.↑ l evelsandr i
skoft oxicit
yf rom cyclospor i
ne,
ri
fabut i
n, t
acrolimus, theophy l
l
ine, zidovudine,alfentani
l,
andpheny toin.↑ level sandef fectsofbenzodi azepines,
zolpidem, bispirone,nisoldipi
ne, tri
cy cli
cantidepressants,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1626
andlosart
an.May↑ riskofbl
eedingwit
hwarf
ari
n.May
ant
agonizeeff
ectsofamphoteri
cinB.May↑ vor
iconazol
e
l
evel
s; av
oidconcur
rentuse.

DOSAGE
Or
ophar
yngeal
Candi
diasi
s
PO:I
V:(
Adult
s):
200mgi
nit
ial
l
y,t
hen100mgdai
l
yforat
l
east2wk.
PO:
IV:(Chi
l
dren>14days)
:6mg/
kgi
nit
ial
l
y,t
hen3
mg/kg/
dayforatl
east2wk.
PO:IV:
( Neonat
es<14days,30–36weeksgestat
ion)
:
samedoseasol derchi
l
drenexceptf
requencyi
sq48hr;
Prematureneonat
es<29weeksgestati
on:5–6
mg/kg/doseq48–72hr .

Esophageal
Candi
diasi
s
PO: I
V: (
Adult
s):
200mgini
ti
all
y,then100mgoncedai
l
y
foratleast3wk(upt
o400mg/ day).
PO:
IV:(Chi
l
dren>14days)
:6mg/
kgi
nit
ial
l
y,t
hen3–12
mg/kg/
dayforatl
east3wk.
PO:IV:
( Neonat
es<14days,30–36weeksgestat
ion)
:
samedoseasol derchi
l
drenexceptf
requencyi
sq48hr;
Prematureneonat
es<29weeksgestati
on:5–6

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1627
mg/
kg/
doseq48–72hr
.

Vagi
nal
Candi
diasi
s
PO: (
Adult
s):150-
mgsingl
edose;
prev
ent
ionof
recur
rence(unl
abel
ed)
—150mgdailyf
or3dayst
hen
weeklyfor6mo.

Sy
stemi
cCandi
diasi
s
PO:
IV:(Adult
s):400mg/
dayi
nit
ial
l
y,t
hen200–800
mg/dayfor28days.
PO:
IV:
(Chi
l
dren>14day
s):
6–12mg/
kg/
dayf
or28day
s.
PO:IV:
( Neonat
es<14days,30–36weeksgestat
ion)
:
samedoseasol derchi
l
drenexceptf
requencyi
sq48hr;
Prematureneonat
es<29weeksgestati
on:5–6
mg/kg/doseq48–72hr .

Cr
ypt
ococcal
Meni
ngi
ti
s
PO: IV:(
Adults) :
Tr eat
ment—400mgoncedai l
yunti
l
favorabl
eclinicalresponse,t
hen200–800mgoncedai l
y
foratleast10–12wkaf t
erclear
ingofCSF;changetooral
therapyassoonaspossi ble.Suppressi
vet
herapy—200
mgoncedai ly
.
PO:I
V:(
Chil
dren>14day
s):12mg/kg/
dayini
ti
all
y,then
6–12mg/kg/
dayforatl
east10–12wkaf
tercl
earingof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1628
CSF;changet
ooral
ther
apyassoonaspossi
ble.
Suppressi
vet
her
apy—6mg/kg/
day.
PO:IV:
( Neonat
es<14days,30–36weeksgestat
ion)
:
samedoseasol derchi
l
drenexceptf
requencyi
sq48hr;
Prematureneonat
es<29weeksgestati
on:5–6
mg/kg/doseq48–72hr .
Pr
event
ionofCandi
diasi
saf
terBoneMar
rowTr
anspl
ant
PO: I
V:(Adult
s):400mgoncedaily
;begi
nseveraldays
beforeprocedur
eifsever
eneut
ropeni
aisexpected,
and
conti
nuef or7daysaft
erANC>1000/mm3.
PO:IV:(
Chil
dren>14day
s):
10–12mg/
kg/
day
,nott
o
exceed600mg/ day
.
Renal
Impai
rment
PO:IV:(
Adul
ts)
:CCr11–50mL/
min—50%oft
heusual
dose.

AVAI
LABI
LITY
Tablet
s50mg, 100mg, 150mg,200mg.
suspension(
orangeflav
or)10mg/ mL,40mg/mL.
Premixedinf
usion2mg/ mLin100-or200-
mL
bott
les/cont
ainers;

PATI
ENTTEACHI
NG
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1629
 I
nstructpatienttotakemedicat
ionasdir
ected,
evenif
feel
i
ngbet ter.Dosesshouldbetakenatthesame
ti
meeachday .Takemisseddosesassoonas
remember ed, butnoti
falmostti
mefornextdose.Do
notdoubledoses.

Instr
uctpat ienttonotifyhealt
hcar eprof essionali
f
skinrash, abdomi nalpain,fev
er,ordiarrheabecomes
pronounced, i
fsignsandsy mptomsofl iver
dysfunction( unusualfati
gue,anorexia,nausea,
vomi t
ing,jaundice,darkurine,orpalest ools)occur,i
f
unusual bruisingorbleedingoccur, orifno
i
mpr ov ementi sseenwi thi
naf ewday soft herapy.

Fl
ucy
tosi
ne
I
NDI
CATI
ONS
Treat
mentofseriousfungali
nfect
ionsi
ncludi
ng:
Endocardi
ti
s,Meningit
is,
Septi
cemia,Ur
inaryt
ract
i
nfecti
ons,Pul
monar yinf
ect
ions.

ACTI
ON
Foll
owingpenetrat
ionint
ofungi,
conver
tedtofl
uorouraci
l,
whichint
erfer
eswithfungalDNAandRNAsy nt
hesis.
Synergi
sti
cactionwithamphoteri
cinBagai
nstsomef ungi
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1630
Therapeuti
cEffect
s:Fungi
cidalacti
onagainstsuscept
ibl
e
organi
sms.Spect r
um:Activ
eagai nstonl
yasmal lnumber
offungi,
mai nl
y:Candi
da,Crypt
ococcus.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pr
egnancyorl
act
ati
on.

UseCaut
iousl
yin:
Bonemar
rowdepr
essi
on(
especi
all
y
f
oll
owi
ngr
adi
ati
ont
her
apyorant
ineopl
ast
ics)
.
Exerci
seExtr
emeCaut ionin:Renal
impai
rment(
blood
l
ev elmoni
tor
ing,↓ dose,and↑ dosagei
nter
val
recommendedi fCCr<40mL/ min).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, at
axia,confusi
on, dizziness, drowsiness,
fati
gue,headache.CV: chestpai n.EENT: hearingloss.GI:
diar
rhea,nausea, v
omi t
ing,abdomi nal pain, dr
ymout h.
Derm: photosensit
ivi
ty,
prurit
is,rash,urt i
caria.Endo:
hypoglycemia.FandE: hy pokalemia.GU: azot emia.
Hemat :APLASTI CANEMI A,eosinophilia,leukopenia,
pancytopenia,anemia,thrombocy topeni a.Neur o:
peri
pheralneuropathy.Resp: dyspnea.Mi sc: f
ever.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1631
Drug-
Drug: Addi
ti
vebonemar r
owdepr essionwithother
bonemar r
owdepr essantdrugs,i
ncludinganti
neoplasti
cs
andradi
ationtherapy .Amphoteri
cinBmay↑ t oxici
tyof
fl
ucyt
osinebutmayal soi
ncreaseit
sant if
ungalacti
vit
y.
Cytar
abinemay↓ i tsanti
fungalacti
vit
y .

DOSAGE
PO:
(Adul
ts)
:12.
5–37.
5mg/
kgev
ery6hr
.
PO:
(Chi
l
dren)
:12.
5–37.
5mg/
kgev
ery6hr
.
Renal
Impai
rment
PO:(
Adult
s):CCr20–40mL/min—12.5mg/
kgev er
y12hr
;
CCr10–20mL/min—12.5mg/kgever
y24hr;CCr<10
mL/min—12.
5mg/ kgev
ery24–48hr.

AVAI
LABI
LITY
Capsul
es250mg,
500mg;

PATI
ENTTEACHI
NG
Advisepati
enttotakemedicat
ionasdi
rect
ed,evenif
feel
i
ngbet t
er.Misseddosesshoul
dbetakenassoon
asremember ed,i
fnotalmostti
mefornextdose;do
notdoubledoses.

Maycausedi
zzi
nessordr
owsi
ness.Caut
ionpat
ient

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1632
 toavoiddri
vingandot
heract
ivi
ti
esrequi
ri
ngal
ert
ness
unti
lresponsetomedi
cati
onisknown.

Cauti
onpat
ienttousesunscreenandwearprotect
ive
cl
othi
ngtopreventphot
osensit
ivi
tyr
eact
ions.

I
nstructpati
enttonotifyheal
thcar eprofessi
onal
promptlyi
fr ash,f
ever
, sor
ethr oat
,yel
l
owi ngofskin
oreyes,changesincolorofst oolorur
ine,diar
rhea,
unusualbleedingorbruisi
ng,unusualtir
edness,or
weaknessoccur s.

Emphasizet
heimportanceoffol
low-
upexamst
o
det
ermineef
fect
ivenessoftr
eatment.

I
nst
ructpat
ientt
onoti
fyheal
thcar
eprofessi
onal
i
mmediatel
yifpl
anni
ngtobecomepregnant.

Fl
udar
abi
ne
I
NDI
CATI
ONS
B-
cel
lchroniclymphocyt
icl
eukemi
aunr
esponsiv
eto
st
andar
dt herapy.Unl
abel
edUses:
Non-
Hodgkin'
s
l
ymphoma.

ACTI
ON
Conv
ert
edi
ntr
acel
l
ular
lyt
oanact
ivephosphor
ylat
ed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1633
metabol
itet
hati
nhibi
tsDNAsynt
hesi
s.Ther
apeuti
c
Ef
fects:
Deathofrapi
dlyr
epl
i
cati
ngcel
ls,
part
icul
arl
y
mali
gnantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofl
udar
abi
ne,
mannit
ol,
orsodium hydr
oxide;Patient
stakingpentost
ati
n;
OB:Lact
ati
on:Pregnancyorlactat
ion;Severerenal
i
mpairment(CCr<30mL/ min)(forintr
avenous).

UseCaut
iousl
yin:
Moder
ater
enal
impai
rment(
↓ dosei
f
CCr<70mL/mi
n);
OB: Pat
ientswit
hchil
dbear
ingpotent
ial
;
Bonemarr
owdepressi
on;Pedi:
Safet
ynotest
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROTOXI CITY, fati
gue, agitation,coma, conf usion,
headache, malaise, weakness.EENT: hear i
ngl oss, visual
disturbances.Resp: PULMONARYHYPERSENSI TI VITY,
cough, pneumoni a,dy spnea, sinusitis.CV: edema.GI :GI
BLEEDI NG, di
arrhea, nausea, anor exia, esophagitis,
mucosi tis,stomat it
is, v
omi ti
ng.GU: dysuria,hemat uria,
urinarytractinfection.Der m: rashes.Endo: gonadal
suppr ession.Hemat :PANCYTOPENI A, anemi a,l
eukopeni a,
thrombocy topenia,hemol yti
canemi a.MS: my algia.Neur o:
per i
pheral neuropat hy.Mi sc:fever,tumorl ysi
ssy ndrome.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1634
I
NTERACTI
ONS
Drug-Dr
ug: ↑ bonemar rowsuppressionwit
hother
anti
neoplasti
csorradiati
ontherapy.Concomit
antusewi t
h
pentost
atin↑ riskofpotent
ial
lyfat
al pul
monarytoxi
cit
y
(concur
rentusenotr ecommended) .

DOSAGE
PO:(Adul
ts)
:40mg/
m2dai
l
yfor5day
s;r
epeatcour
se
ever
y28days.
IV:(
Adul
ts)
:25mg/
m2dai
l
yfor5day
s;r
epeatcour
se
ever
y28days.
Renal
Impai
rment
PO:
IV:
(Adul
ts)
:CCr30–70mL/
min—↓ doseby20%.
Renal
Impai
rment
PO:
(Adul
ts)
:CCr<30mL/
min—↓ doseby50%.

AVAI
LABI
LITY
Tabl
ets10mg; Powderf
ori
nject
ion50mg/
vial
;Sol
uti
on
fori
nject
ion25mg/mL;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakef
ludar
abi
neasdi
rect
ed.Av
oid

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1635
 handli
ngtabl
ets;
washhandswithsoapandwat
eri
f
touchi
ngtabl
etorpowderfr
om t
ablet
s.Not
if
yheal
th
careprof
essi
onalifadosei
smissed.

Cauti
onpat i
enttoavoi
dcrowdsandper sonswith
knowninfecti
ons.Healt
hcareprofessi
onalshoul
dbe
i
nformedimmedi atel
yifsy
mpt omsofinfecti
on(chi
l
ls,
cough,orburni
ngpainonur i
nati
on)occur.

Instructpatienttoreportunusual bleeding.Adv i
se
patientoft hrombocytopeni aprecautions( usesoft
toothbr ushandel ect
ricrazor;avoidcont actsports
andot hersi t
uati
onsi nwhi chinjur
ymi ghtoccur).Do
notdr inkalcoholi
cbev eragesort akemedi cat
ion
cont ai
ni ngaspir
inorNSAI Ds; maypr ecipit
ategast r
ic
bleeding.

Instructpat
ienttoinspectoralmucosaf orredness
andul cerat
ion.Ifmouthsoresoccur,adv i
sepat i
entto
usespongebr ushandr i
nsemout hwithwat erafter
eatinganddr inki
ng.Consultheal
thcarepr ofessi
onal
i
fpai ninter
fereswi t
heati
ng.Stomatit
ispai n
treatmentmayr equi
reopioi
danalgesics.

Advisepati
entthatthi
smedicati
onmayhav e
ter
atogenicef
fects.Contr
acept
ionshoul
dbeused
duri
ngt her
apyandf oratl
east6moaf t
erther
apyi
s
concluded.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1636
 Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

Fl
udr
ocor
ti
sone
I
NDI
CATI
ONS
Sodium l
ossandhy pot ensi
onassoci atedwi t
h
adrenocorti
cali
nsuffi
ciency(givenwi t
hhy drocorti
soneor
cor
t i
sone).Managementofsodi um lossduet ocongeni t
al
adrenogenit
alsyndrome( congenitaladrenalhy per
plasi
a).
Unlabel
edUses: Idi
opat hi
corthostati
chy potension(wit
h
i
ncreasedsodium intake).TypeIVr enaltubularacidosi
s.

ACTI
ON
Causessodi um r
eabsorption,hy dr
ogenandpot assi
um
excreti
on,andwat err
etentionbyi t
sef f
ectsonthedist
al
renaltubul
e.Therapeuti
cEf fects:Maintenanceofsodi
um
balanceandBPi npatientswi thadrenocorti
cal
i
nsuf f
ici
ency.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
HF;
Addi
son’
sdi
sease(
pat
ient
smay
hav
eexagger
atedr
esponse)
;OB:
Lact
ati
on:
Pedi
:Saf
ety

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1637
notest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,headache.CV: HF,arrhyt
hmias, edema,
hypertensi
on.GI:anor exi
a,nausea.Endo: adrenal
suppression,weightgain.FandE: hypokalemia,
hypokalemicalkalosis.MS: art
hralgi
a, muscularweakness,
tendoncont r
actures.Neuro: ascendi
ngpar alysi
s.Misc:
hypersensit
ivi
tyreactions.

I
NTERACTI
ONS
Drug-Drug: Usewi ththi
azideorloopdi uret
ics,
piper
aci
ll
in,
oramphot ericinBmay↑ r i
skofhy pokalemia.
Hypokal emiamay↑ r i
skofdigoxintoxicit
y.Mayproduce
prolongedneur omuscularblockadefollowingtheuseof
nondepol ari
zi ngneuromuscularblockingagents.
Phenobar bital orr
if
ampi nmay↑ met aboli
sm and↓
effecti
veness.
Drug-Food:Largeamount
sofsal
torsodium-cont
aini
ng
foodsmaycauseexcessivesodi
um r
etenti
onand
potassium l
oss.

DOSAGE
PO:
(Adul
ts)
:Adr
enocor
ti
cal
insuf
fi
ciency
—100mcg/
day

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1638
(range100mcg3t i
mesweekl y—200mcgdai l
y).Dosesas
smal las50mcgdai l
ymayber equir
edbysomepat i
ents.
Usewi th10–37.5mgcor ti
sonedailyor10–30mg
hy dr
ocorti
sonedail
y.Adrenogenit
alsyndr
ome—100–200
mcg/ day.I
diopat
hichypotensi
on—50–200mcg/ day
(unlabel
ed).
PO:
(Chi
l
dren)
:50–100mcg/
day
.

AVAI
LABI
LITY
Tabl
ets100mcg(
0.1mg)
;

PATI
ENTTEACHI
NG
Instructpati
enttotakemedi cati
onasdi r
ected.Take
mi sseddosesassoonasr emember edbutnotj ust
bef orenextdoseisdue.Expl ainthatli
fel
ongt herapy
maybenecessar yandt hatabruptdiscont
inuation
mayl eadtoAddisonianCr isi
s.Pati
entshouldkeepan
adequat esupplyavailableatallti
mes.

Advisepati
entt ofoll
owdiet
arymodi fi
cati
on
prescr
ibedbyheal thcarepr
ofessional.I
nstruct
pati
enttofollowadi ethi
ghinpotassium (see
AppendixM) .Amountofsodi um all
owedi ndietvar
ies
withpathophy si
ology.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1639
 I
nstructpati
enttoinf
orm healt
hcareprof
essi
onali
f
weightgainoredema, muscleweakness,
cramps,
nausea,anorexi
a,ordi
zzi
nessoccurs.

Advisepati
enttocarr
yident
if
icat
ionatal
lti
mes
descri
bingdiseasepr
ocessandmedicati
onregi
men.

Fl
umazeni
l
I
NDI
CATI
ONS
Complete/
parti
alrev
ersalofeff
ectsofbenzodiazepi
nes
usedasgeneralanesthet
ics,
orduringdiagnost
icor
ther
apeuti
cprocedures.Managementofi nt
enti
onalor
acci
dentalov
erdoseofbenzodiazepines.

ACTI
ON
Fl
umazeni lisabenzodiazepineder ivati
vethat
antagonizestheCNSdepr essantef f
ectsof
benzodiazepinecompounds.I thasnoef fectonCNS
depressionfrom othercauses,includingopioids,al
cohol
,
barbit
urates,orgeneralanestheti
cs.Ther apeuti
cEffect
s:
Reversalofbenzodiazepineef f
ects.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofl
umazeni
lor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1640
benzodiazepines;
Pat i
entsreceivi
ngbenzodiazepinesf
or
l
ife-
thr
eateningmedi calproblems,incl
udi
ngst at
us
epil
epti
cusor↑ i ntr
acranialpressure;
Ser
iouscy cli
c
anti
depressantoverdosage.

UseCaut
iousl
yin:
MixedCNSdepr
essantov
erdose
(eff
ectsofotheragent smayemer gewhen
benzodiazepi
neef fecti
sr emov ed) ;Hi
st oryofseizur
es
(sei
zuresaremor el i
kel
yt ooccuri npat ientswhoar e
experi
encingsedat i
ve/hypnoticwi thdrawal ,
whohav e
recent
lyreceivedr epeateddosesofbenzodi azepi
nes,or
whohav eapr evioushi storyofsei zureact i
vity)
;Head
i
njury(may↑ i ntracranialpressureandr i
skofseizures)
;
Severehepaticimpai rment ;OB: Lactation:Safetynot
establ
ished;Pedi:Chi l
dren<1y r(safetynotest abli
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, dizziness, agi
tation,confusion,
drowsiness, emotional labil
it
y,fati
gue,headache, sleep
di
sor ders.EENT: abnormal hearing,abnormal visi
on,
bl
urredv isi
on.CV: arrhy thmias,chestpain, hypert
ension.
GI:nausea, vomiti
ng, hiccups.Der m: fl
ushing,sweat i
ng.
Local:pain/inj
ecti
on- si
ter eacti
ons, phl
ebiti
s.Neur o:
paresthesia.Misc:rigors, shi
vering.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1641
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Rev
ersal
ofConsci
ousSedat
ionorGener
alAnest
hesi
a
I
V:(Adult
s):0.
2mg.Addi t
ionaldosesmaybegi v
enat1-
minint
erval
sunti
ldesi
redresult
sareobt ai
ned,uptoa
t
otaldoseof1mg.Ifresedati
onoccurs,regimenmaybe
r
epeatedat20-
mininterv
als,nottoexceed3mg/ hr
.
IV:(Chil
dren) :
0.01mg/ kg(upt o0.2mg) ;i
fthedesi
red
l
ev elofconsciousnessisnotobt ai
nedaf t
erwaiti
ngan
additi
onal 45sec,furt
herinject
ionsof0.01mg/ kg(upto
0.2mg)canbeadmi nist
eredandr epeatedat60-sec
i
ntervalswhennecessar y(upt oamaxi mum of4
additi
onal ti
mes)toamaxi mum totaldoseof0.05mg/kg
or1mg, whicheverislower.Thedoseshoul dbe
i
ndi vi
duali
zedbasedont hepatient
’sresponse.
Suspect
edBenzodi
azepi
neOv
erdose
IV:(Adults):0.2mg.Addi ti
onal0.3mgmaybegi ven30
seclater.Furtherdosesof0. 5mgmaybegi venat1- min
i
ntervals,ifnecessar
y ,
toat otaldoseof3mg.Usual dose
requir
edi s1–3mg.I fresedati
onoccurs,addi
ti
onal doses
of0.5mg/ minf or2minmaybegi v
enat20-mininterval
s
(gi
vennomor ethan1mgatat i
me, nott
oexceed3mg

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1642
perhr
).
IV:(
Chil
dren):Unl
abel
ed—0. 01mg/kg(maximum dose0.2
mg)wi t
hrepeatdoseseveryminut
eupt oacumul at
ive
doseof1mg.Asanal t
ernati
vetorepeatdoses,
conti
nuousinf
usionsof0.005–0.
01mg/ kg/hrhavebeen
used.

AVAI
LABI
LITY
I
nject
ion0.
1mg/
mL;

PATI
ENTTEACHI
NG
Flumazenildoesnotconsi stentl
yr everset he
amnest i
ceffect sofbenzodi azepines.Pr ovidepat i
ent
andf amil
ywi thwr i
t t
eni nstr
uctionsf orpost procedure
care.Inf
ormf ami l
yt hatpat i
entmayappearal ertat
thetimeofdi schar gebutt hesedat i
veef fectsofthe
benzodiazepinemayr ecur.Instr
uctpat ientt oavoid
driv
ingorotheract i
vit
iesr equiri
ngal er
t nessf orat
l
east24hraf t erdischar ge.

I
nstructpati
entnottot
akeanyalcoholor
nonprescr
ipti
ondrugsforatl
east18–24hraf
ter
di
scharge.

Resumpt
ionofusual
act
ivi
ti
esshoul
doccuronl
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1643
 whennoresi
dual
eff
ect
soft
hebenzodi
azepi
ne
r
emain.

Fl
uni
sol
i
de
I
NDI
CATI
ONS
Maint
enancetreat
mentofasthmaaspr ophy
lact
ict
her
apy
.
Maydecreaserequir
ementfororeli
minat
euseof
sy
stemiccort
icoster
oidsi
npatient
swithast
hma.

ACTI
ON
Pot
ent,l
ocal
lyacti
nganti-i
nflammatoryandimmune
modif
ier
.Therapeut
icEffects:Decr
easedfrequencyand
sev
eri
tyofasthmaattacks.Improvesasthmasy mptoms.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Acut
eat
tackof
ast
hma/
stat
usast
hmat
icus.

UseCaut
iousl
yin:
Act
iveunt
reat
edi
nfect
ions;
Diabet
es
orglaucoma; Underl
yingi mmunosuppr ession(dueto
diseaseorconcurrentt herapy)
;Sy st
emi ccorti
costeroi
d
therapy(shoul
dnotbeabr upt
lydiscontinuedwheni nhaled
therapyi
sst ar
ted;additionalcort
icosteroidsneededi n
stressortrauma);OB: Lactati
on:Pedi: Pregnancy,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1644
l
actati
on,orchil
dren<6yr(
safet
ynotestabl
i
shed;
prol
ongedorhigh-doset
herapymayleadto
complicat
ions)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, dizziness,irr
it
abil
ity,ner vousness.CV:
pal
pitations.EENT: hoar seness,nasal congest ion,
pharyngi t
is,dysphoni a,oropharyngeal fungal infecti
ons,
rhi
niti
s, si
nusi t
is.Resp: bronchospasm, cough, wheezing.
Derm: rash.GI :diarrhea,nausea, t
ast edi stur
bances,
vomi t
ing,abdomi nal pai
n, anorexi
a, drymout h.GU:
menst rual dist
urbances.Endo: adrenal suppr ession(high-
dose,long- termt herapyonl y),
↓ gr owt h( chi
ldren).Misc:
fl
u-l
ikesy ndr ome.

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

DOSAGE
I
nhaln:(Adul
tsandChi
ldren≥12yr):160mcg(2
i
nhalati
ons)twi
cedai
ly(nottoexceed4inhal
ati
onst
wice
dai
l
y) .
I
nhaln:(Chi
ldr
en6–11yr)
:80mcg( 1inhal
ati
on)t
wice
dai
l
y( nottoexceed2i
nhalat
ionst
wicedail
y).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1645
AVAI
LABI
LITY
Inhalati
onaer
osol80mcg/meteredinhal
ati
onin5.
1-g
canisters(
del
iver
s60meteredinhal
ati
ons)orin8.
9-g
canisters(
del
iver
s120meteredinhal
ati
ons);

PATI
ENTTEACHI
NG
Advisepat i
enttotakemedi cati
onasdi r
ect
ed.Take
misseddosesassoonasr emember edunl
essalmost
ti
mef ornextdose.Advisepatientnottodi
scont
inue
medi cati
onwi t
houtconsultinghealt
hcare
prof
essi onal
;gradualdecreaseisrequir
ed.

Advisepatientsusinginhal
ati
oncorticoster
oidsand
bronchodil
atortousebr onchodi
lat
orf i
rstandtoall
ow
5mi ntoelapsebef oreadminist
eri
ngt he
corti
costeroi
d,unlessotherwi
sedirectedbyhealth
careprofessional
.

Advisepat
ientt
hatinhalat
ioncorti
cost
eroidsshoul
d
notbeusedt ot
reatanacut easthmaattackbut
shouldbeconti
nuedev enifotheri
nhal
ationagents
areused.

Patient
susinginhalat
ioncorti
cost
eroidstocontr
ol
asthmamayr equi
resystemiccort
icoster
oidsfor
acuteattacks.Advi
sepatientt
ouser egul
arpeakflow

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1646
 moni
tor
ingt
odet
ermi
ner
espi
rat
oryst
atus.

Caut
ionpati
enttoavoi
dsmoking,
knownal
l
ergens,
andotherr
espi
rator
yir
ri
tant
s.

Adv
isepati
entt
onot
if
yphy
sici
ani
fsor
ethr
oator
mouthoccur
s.

Instr
uctpat i
entwhosesy st
emi ccorti
cost
eroidshave
beenr ecentl
yreducedorwi thdr
awnt ocarryawar ni
ng
cardindicati
ngtheneedf orsupplementalsystemic
corti
costeroidsi
ntheev entofstressorsevere
asthmaat tackunresponsivetobronchodi
lators.

Met ered-DoseI nhaler:

Inst r
uctpat i
entint heproper
useoft hemet ered-doseinhal er.Mosti nhaler
s
requireprimingpr iortofirstuse.Exhal ecompl et
ely
andt hencl osel i
psfir
ml yar oundmout hpiece.Whil
e
breathingindeepl yandsl owl y ,
pr essdownon
canister.Holdbr eathforasl ongaspossi bl
etoensure
deepi nstil
l
ationofmedi cation.Remov einhalerf
rom
mout handbr eatheoutgent ly.Allow1–2mi n
betweeni nhal ati
ons.Rinsemout hwi thwat eror
mout hwashaf tereachuset omi nimizef ungal
i
nfect i
ons, drymout h,andhoar seness.Wash
i
nhal ati
onassembl yev eryfewday sinwar mrunni
ng
water

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1647
Fl
uoci
nol
one
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroi
dsorcomponent sofvehi
cles(oi
ntmentor
cream base,preser
vat
ive,
alcohol)
;Untr
eatedbacter
ial
or
vi
rali
nfecti
ons.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cat
aracts, gl
aucoma, ortuberculosi
s(useoflarge
amountsofhi gh-potencyagent smaywor sencondi ti
on);
Pat
ientswi thpre-
existi
ngskinat rophy;Pr
egnancy ,
l
actat
ion, orchil
dren(chronichigh-doseusagemayr esul
t
i
nadrenal suppressioninmot her,growthsuppressionin
chi
l
dren; chil
drenmaybemor esusceptibl
etoadr enaland

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1648
gr
owt
hsuppr
essi
on)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topical
:(Adul
ts)
:Applyt
oaffect
edarea(
s)2–5times
dai
ly(dependsonprepar
ati
onandcondit
ionbei
ngtreat
ed)
.
Topical:
(Chi
ldren≥2y r
):Appl
ytoaf
fect
edarea(s)1–2
ti
mesdai ly(
dependsonpr oduct
,pr
epar
ati
on,and
conditi
onbeingtreat
ed).

AVAI
LABI
LITY
Cream 0.
01%,0.
025%;Oint
ment0.
025%;
Sol
uti
on0.
01%;
Shampoo0.01%;Oil
0.01%;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1649
PATI
ENTTEACHI
NG
Inst
ructpati
entoncorrecttechni
queofmedicati
on
administr
ati
on.Emphasizeimpor t
anceofavoi
dingthe
eyes.Ifadoseismissed,itshouldbeappl
iedassoon
asremember edunl
essal mostt i
meforthenextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Caut i
onwoment hatmedicati
onshouldnotbeused
extensiv
ely,
inl
argeamount s,
orforprot
ract
ed
periodsift
heyarepregnantorpl
anningtobecome
pregnant.

I
nst
ructpat
ientt
oinf
orm heal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1650
 sy
mptomsofunderl
yi
ngdiseaser
etur
norwor
senor
i
fsympt
omsofinfect
iondevel
op.

Fl
uoci
noni
de
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandi
nfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofdermat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroidorcomponent sofvehicl
es(oi
ntmentor
cream base,preservat
ive,al
cohol
);Localunt
reat
ed
bacter
ialorvirali
nfect
ions.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cat
aracts,gl
aucoma, ortuberculosi
s(useoflarge
amountsofhigh-potencyagent smaywor sencondit
ion);
Pat
ientswithpre-
existi
ngskinat rophy;Pr
egnancy,
l
actat
ion,orchil
dren(chronichigh-doseusagemayr esul
t

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1651
i
nadr enalsuppressi
oni
nmot
her
,growthsuppr
essionin
chil
dren;chi
ldrenmaybemor
esuscept
ibl
etoadrenaland
growthsuppr essi
on)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topical
:(Adul
ts)
:Applytoaf
fect
edarea(s)2–4t
imes
dai
ly(dependsonproduct
,pr
eparat
ion,
andcondit
ion
bei
ngt r
eated)
.
Topi
cal
:(Chi
l
dren)
:Appl
ytoaf
fect
edar
ea(
s)oncedai
l
y.

AVAI
LABI
LITY
Cr
eam 0.
05%,
0.1%;Gel0.
05%;Oi
ntment0.
05%;Sol
uti
on
0.
05%;I
ncombinat
ionwit
h:v
ari
ousothert
opi
cal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1652
pr
epar
ati
ons.

PATI
ENTTEACHI
NG
Inst
ructpati
entoncorrecttechni
queofmedicati
on
administr
ati
on.Emphasizeimpor t
anceofavoi
dingthe
eyes.Ifadoseismissed,itshouldbeappl
iedassoon
asremember edunl
essal mostt i
meforthenextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onali
f
symptomsofunder l
yingdiseaser
etur
norwor senor
i
fsympt omsofinfect
iondev el
op.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1653
Fl
uor
our
aci
l
I
NDI
CATI
ONS
IV:Usedal oneandincombi nat ionwithothermodal i
ties
(surgery,
radiat
iontherapy,otherantineoplasti
cs)inthe
treatmentof:Coloncancer ,
Br eastcancer,Rectalcancer,
Gast r
iccancer,Pancreati
ccar cinoma.Topi cal
:
Managementofmul t
ipleacti
ni c(sol
ar)keratosesand
superfici
albasalcel
lcarcinomas.

ACTI
ON
I
nhibitsDNAandRNAsy nthesisbypr
eventingthymidi
ne
pr
oduct i
on(cell
-cy
cleS-phase–specifi
c).Therapeut
ic
Ef
fects:Deathofrapidl
yr epl
icati
ngcel
ls,part
icul
arl
y
malignantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Dihy
dropy
rimi
dine
dehydrogenasedefi
ciency(pat
ient
sat↑ r
iskof5–FU
toxi
cit
y);OB:Lact
ati
on: Pr
egnancyorl
act
ation.

UseCaut
iousl
yin:
Inf
ect
ions;
Depr
essedbonemar
row
reserve;Otherchroni
cdebi
li
tat
ingi
l
lnesses;Obese
patients,
patient
swi t
hedemaorascit
es( doseshoul
dbe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1654
basedoni
deal
bodywei
ght
).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Morel
i
kel
ytooccurwi
thsy
stemi
cuset
hanwi
tht
opi
cal
use

CNS: acutecer ebel l

ardysfunct
ion.GI: di
arrhea,nausea,
stomat iti
s, vomi t
ing.Derm: al
opecia,macul opapularrash,
l
ocal i
nflammat oryreacti
ons( t
opicalonl y)
,melanosisof
nails,nailloss, palmar-pl
antareryt
hrody sesthesi
a,
phot otoxicit
y .Endo: st
eri
li
ty.Hemat :anemi a,l
eukopenia,
thrombocy topeni a.Local
:thrombophl ebit
is.Misc:fever.

I
NTERACTI
ONS
Drug-Drug:Combinationchemot herapywi thi
rinotecan
maypr oduceunaccept abl
et oxicit
y( dehydrat
ion,
neutropeni
a,sepsi
s).Addi t
ivebonemar rowdepr ession
withotherbonemar rowdepr essant s, i
ncludi
ngot her
anti
neoplasti
csandr adiati
ont herapy .May↓ ant ibody
responsetoliv
e-vi
rusv acci
nesand↑ r iskofadv erse
reacti
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1655
DOSAGE
Dosesmayvar
ygreat
ly,dependi
ngont
umor
,pat
ient
condi
ti
on,
andprot
ocolused

Adv
ancedCol
orect
alCancer
I
V:(Adul
ts):370mg/m2precededbyleucov
or i
nor425
mg/m2pr ecededbyl
eucov
ori
ndail
yfor5day s.Maybe
r
epeatedq4–5wk.
Ot
herTumor
s
I
V: (Adult
s) :I
nit
ialdose—12mg/ kg/dayfor4day s,then1
dayofr est,t
hen6mg/ kgev eryotherdayfor4–5dosesor
7–12mg/ kg/dayfor4day sf ol
lowedby3- dayrest,t
hen
7–10mg/ kgq3–4day sf or3doses.Mai ntenance—7–12
mg/ kgq7–10day sor300–500mg/ m2/dayfor4–5day s,
repeatedmont hly(nosi ngledai lydoseshouldexceed800
mg) .Poor-Ri
skPatients: 3–6mg/ kg/dayonday s1–3, 3
mg/ kg/dayonday s5, 7, 9( nottoexceed400mg/ dose).
Dosesof370–425mg/ m2/ dayf or5day shavebeenused
i
ncombi nati
onwi t
hl eucov or i
n.
Act
ini
c(Sol
ar)Ker
atoses
Topi
cal:
(Adults):Carac—Apply0.5%cr
eam t
olesi
ons
oncedai
lyforupt o4wk; Ef
udex—Apply2%or5%solut
ion
orcr
eam tolesionstwicedai
lyfor2–4wk;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1656
Fl
uor
opl
ex—Appl
y1%cr
eam t
olesi
onst
wicedai
l
yfor2–6
wk.
Super
fi
cial
Basal
Cel
lCar
cinomas
Topical
:(Adul
ts)
:Ef
udex—Appl
y5%sol
uti
onorcr
eam t
o
l
esionstwicedai
l
yfor3–6wk(upt
o12wk).

AVAI
LABI
LITY
I
nject
ion50mg/
mL;
Cream 0.
5%,
1%,
5%;
Sol
uti
on2%,
5%;
NURSI
NGI
MPLI
CATI
ONS

PATI
ENTTEACHI
NG
Instr
uctpat i
enttonot i
fyheal thcarepr ofessionali
f
fever;chi
ll
s;sorethroat; si
gnsofi nfection;yell
owing
ofskinorey es;abdomi nal pain;j
ointorf l
ankpai n;
swellingoffeetorlegs; bleedinggums; brui
sing;
petechiae;orbloodi nurine,stool
,oremesi soccurs.
Cautionpat i
enttoav oi
dcr owdsandper sonswi th
knowni nfecti
ons.Instructpat i
enttousesof t
toothbrushandel ectri
cr azor.Pati
entsshoul dbe
cautionednott odrinkalcohol i
cbev eragesort ake
productscont ai
ningaspi ri
norNSAI Ds.

Advisepat
ienttori
nsemout
hwithcl
earwat
eraf
ter
eat
inganddr i
nkingandt
oavoi
dfl
ossi
ngtomini
mize

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1657
 stomati
ti
s.Viscousli
docai
nemaybeusedifmout
h
paini
nter
fereswitheati
ng.St
omati
ti
spai
nmay
requi
retr
eatmentwithopioi
danal
gesi
cs.

Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

Revi
ewwit
hpat
ientt
heneedf
orcont
racept
iondur
ing
ther
apy
.

Cauti
onpat
ienttousesunscreenandprotect
ive
cl
othi
ngtopreventphot
otoxi
cityr
eact
ions.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasizetheimport
anceofr
outi
nefol
low-
upl
ab
teststomonit
orprogr
essandtocheckf
orsi
de
effect
s.

Topi cal:Inst
ructpati
entincorrectappli
cat i
onof
solutionorcr eam.Emphasi zeimpor t
anceofav oiding
theey es;cauti
onshouldalsobeusedwhenappl ying
medi cat i
onnearmout handnose.I fpatientuses
cleanf i
ngertoself-
admi ni
ster
,emphasi zeimpor tance
ofwashi nghandst horoughlyaft
erapplicati
on.
Explai nthaterythema,scali
ng,andblisteri
ngwi th
pruritusandbur ningsensationareexpect ed.Advise
patientt oavoidsunli
ghtorul t
ravi
oletli
ght( t
anning

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1658
 boot hs)asmuchaspossi bl
e;mayincr
easeside
effects.Ther
apyisdisconti
nuedwhenerosi
on,
ulcerati
on,andnecrosi
soccurin2–6wk( 10–12wk
forbasal cel
lcar
cinomas).Ski
nheals4–8wkl at
er.

FLUOXETI
NE
I
NDI
CATI
ONS
Maj ordepr essi
v edisor der.Obsessi vecompul siv
edi sor
der
(OCD) .Bul i
mianer vosa.Pani cdi sorder.Depr essive
episodesassoci at
edwi t
hbi polarIdi sorder( whenused
withol anzapine).Treat ment -r
esi stantdepr ession(when
usedwi t
hol anzapine) .Sarafem: Premenst rualdysphori
c
disorder( PMDD) .Unl abeledUses: Anorexi anervosa:
ADHD, Diabeticneur opat hy,Fibromy al
gia, Obesity,
Ray naud’sphenomenon, Social anxietydi sorder(social
phobi a),Post-t
raumat i
cst ressdi sorder( PTSD) .

ACTI
ON
Sel
ectivelyinhi
bitsthereuptakeofserotoninintheCNS.
TherapeuticEffects:Anti
depressantaction.Decreased
behaviorsassociatedwith:panicdisorder,bul
imia.
Decreasedmoodal t
erat
ionsassociatedwi thPMDD.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1659
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentuseor
usewi thin14day sofdisconti
nuingMAOi nhibi
tor
s
(f
luoxetineshouldbedi sconti
nuedatl east5wkbef ore
MAOt herapyisi
niti
ated);Concurrentuseofpi mozide;
Concur rentuseofthior
idazine(fl
uoxetineshouldbe
di
scont inuedatleast5wkbef or
et hi
oridazi
netherapyis
i
niti
ated) .

UseCaut
iousl
yin:
Hist
oryofsei
zur
es;
Debi
l
itat
ed
pati
ents( ↑r i
skofsei zur es);Di abetesmel litus;Pat ient s
withconcur r
entchr oni cillnessormul t
ipl
edr ugt her apy
(doseadjustment smaybenecessar y )
;Hepat ic
i
mpai rment( ↓ doses/ ↑ dosi ngi ntervalmaybe
necessary);May↑ r iskofsui cideat tempt/ ideat i
on
especiall
ydur i
ngear lyt reatmentordoseadj ustment ;
Patientswith↑ i ntr
aocul arpr essur eoratr iskf oracut e
narrow-angleglaucoma; OB: Usedur ingfirstt ri
mest ermay
↑r iskofcardiov ascul armal for mat ionsini nf ant.Use
duri
ngt hir
dt r
imest ermayr esul tinneonat al serot onin
syndromer equi r
ingpr olongedhospi tali
zation, respir atory
andnut ri
ti
onal suppor t.Maycausesedat ioni ninfant .Use
onlyifpotenti
al benef itj
ust if
iespot entialriskt of etus;
Lactati
on: Maycausesedat ioni ni nfant;discont inuedr ug
orbot t
le-
feed;Pedi :Riskofsui cideideat i
onorat tempt
maybegr eaterinchi ldrenoradol escent s(saf eusei n
chil
dren<8y rnotest ablished) ; Geri:Appear sonBeer sli
st.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1660
Geri
atr
icpat
ientsar
eat↑ ri
skforexcessi
veCNS
st
imulati
on,
sleepdi
stur
bances,
andagitat
ion.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, SEIZURES,
SUI CIDALTHOUGHTS, anxiety,drowsiness, headache,
i
nsomni a,ner vousness, abnormal dr
eams, dizziness,
fatigue, hypomani a, mani a,weakness.EENT: my dri
asis,
stuf fynose, v i
sual disturbances.Resp: cough.CV: chest
pai n,pal pitations.GI :diarrhea, abdomi nal pain, abnormal
tast e,anor exi a,const i
pat i
on, drymout h, dyspepsi a,
nausea, vomi t
ing,wei ghtl oss.GU: sexual dysf unction,
urinar yf requency .Der m: ↑ sweat ing,pr urit
us, er yt
hema
nodusum, flushing, rashes.Endo: dysmenor rhea.FandE:
hy ponat remi a.MS: art
hr algi
a, backpai n, my algia.Neur o:
tremor .Mi sc: SEROTONI NSYNDROME, all
ergicr eactions,
fev er,flu-li
kesy ndrome, hotf l
ashes, sensi ti
vityr eacti
on.

I
NTERACTI
ONS
Drug-Drug:Discont i
nueuseofMAOi nhibit
orsfor14days
beforefluoxeti
net her apy;combi nedt herapymayr esul
tin
confusion,agitati
on, seizures, hy
pert
ensi on,and
hyperpyrexia(serotoni nsyndr ome).Fluoxetineshouldbe
disconti
nuedf oratl east5wkbef or
eMAOi nhibit
or
therapyisinit
iated.Concur rentusewi thpimozi demay↑

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1661
ri
skofQTi nter v al prolongat i
on.↑ l ev el soft hi or i
dazine
may↑ r iskofQTi nterval prolongat ion( concur rentuse
cont rai ndicat ed; fl
uoxet i
neshoul dbedi scont inuedf orat
l
east5wkbef or et hioridazi nei si nit
iat ed) .Inhibi tsthe
activ i
tyofcy tochr omeP4502D6enzy mei nt hel i
verand
↑ ef fect sofdr ugsmet abol i
zedbyt hisenzy mesy stem.
Medi cat ionst hati nhi bittheP450enzy mesy st em
(i
ncl udi ngr itonav ir,saqui nav ir
, andef av irenz)may↑ r isk
ofdev elopingt heser otoni nsy ndr ome) .Forconcur r
ent
usewi thr i
tonav i
r↓ f luoxet i
nedoseby70%; ifi niti
ating
fl
uoxet i
ne, star twi th10mg/ daydose.↓ met abol i
sm and
↑ ef fect sofal pr azol am ( decr easeal pr azol am doseby
50%) .Dr ugst hataf fectser otoner gicneur otransmi tter
syst ems, i
ncl udi ngl inezol id, tr
amadol , andt r
ipt ans,↑r isk
ofser ot oninsy ndr ome.↑ CNSdepr essi onwi thal cohol ,
ant i
hi stami nes, otherant idepr essant s, opi oidanal gesics,
orsedat ive/hy pnot i
cs.↑ r i
skofsi deef fectsandadv erse
react ionswi thot herant idepr essant s, risper idone, or
phenot hiazines.May↑ ef fectiveness/ r i
skoft oxi cit
yf rom
car bamazepi ne, cl ozapi ne, digoxi n,hal oper i
dol , pheny t
oin,
l
ithium, orwar far in.May↓ t heef fectsofbuspi rone.
Cy prohept adi nemay↓ orr ev erseef fect soff l
uoxet i
ne.
May↑ sensi tiv ityt oadr ener gi csandi ncr easet her i
skof
serot oni nsy ndr ome.Mayal tert heact i
v ityofot herdr ugs
thatar ehi ghl yboundt opl asmapr otei ns.↑ r iskof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1662
serotoninsy
ndr
omewit
h5HT1agoni
sts.↑ ri
skof
bleedingwit
hNSAI
DS,
aspi
ri
n,cl
opi
dogrel
,orwarf
ari
n.
Dr
ug-Nat
ural
Product
:↑ri
skofser
otoni
nsy
ndr
omewi
th
St
.John’
swortandSAMe.

DOSAGE
PO: (Adul ts): Depr ession, OCD—20mg/ dayinthemor ning.
Aftersev er alweeks, may↑ by20mg/ dayatweekl y
i
nt ervals.Dosesgr eatert han20mg/ dayshoul dbegi v
en
i
n2di vi
deddoses, i
nt hemor ningandatnoon( notto
exceed80mg/ day ).Pat i
ent swhohav ebeenstabili
zedon
the20mg/ daydosemaybeswi tchedov ertodelayed-
releasecapsul es( ProzacWeekl y)atdoseof90mgweekl y,
i
nitiated7day saf t
erthel ast20–mgdose.Pani c
disor der—10mg/ dayi ni
tial
ly ,
may↑ af t
er1weekt o20
mg/ day( usual dosei s20mg, butmaybe↑ as
needed/ toleratedupt o60mg/ day).Bulimianervosa—60
mg/ day( mayneedt ot i
tr
ateupt odosageov ersev er
al
day s).PMDD—20mg/ day( nott oexceed80mg/ day)or20
mg/ dayst arting14day spr i
ort oexpect edonseton
menses, cont inuedt hroughf i
rstfulldayofmenst r
uati
on,
repeat edwi t
heachcy cle.Depr essiveepisodesassociated
withbi polarIdi sorder-20mg/ daywi tholanzapi
ne5
mg/ day( bothgi veninev eni ng);may↑ f l
uoxeti
nedoseup
to50mg/ dayandol anzapinedoseupt o12.5mg/ day;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1663
Treatment-resi
stantdepressi
on-
20mg/ daywith
olanzapine5mg/ day(bothgi
venineveni
ng);may↑
fl
uoxetinedoseupt o50mg/ dayandolanzapi
nedoseup
to20mg/ day.
PO:
(Geri
atr
icPati
ent
s):
Depressi
on—10mg/ dayi
nthe
mor
ningi
nit
ial
ly
,maybe↑ (nottoexceed60mg/day)
.
PO:(Chil
dren7–17y r
):Adolescentsandhigherweight
chi
ldren—10mg/ daymaybe↑ af ter2wkt o20mg/ day;
additi
onali
ncreasesmaybemadeaf t
erseveral
mor e
weeks( r
ange20–60mg/ day);Lower-
weightchi
ldr
en—10
mg/ dayini
ti
all
y,maybe↑ af tersever
almor eweeks
(r
ange20–30mg/ day)
.

AVAI
LABI
LITY
Tabl
ets10mg,
15mg,
20mg.
Del
ayed-
rel
easecapsul
es(
ProzacWeekl
y)90mg.
Or
alsol
uti
on(
mintf
lav
or)20mg/
5mL.

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakefl
uoxet i
neasdirected.Ifa
doseismi ssed,
omi tandr et
urntoregularschedule.
Donotdoubl edosesordi sconti
nuewithout
consult
inghealt
hcar eprofessi
onal;di
scontinuat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1664
 maycauseanxi
ety
,insomni
a,ner
vousness.

Maycausedrowsiness,di
zziness,i
mpairedjudgment,
andbl
urr
edv i
sion.Cauti
onpat i
enttoavoiddri
ving
andot
heracti
viti
esrequir
ingalert
nessuntil
response
tot
hedrugisknown.

Adv i
sepat i
ent,fami l
yandcar egiverst olookf or
suicidal i
ty,
especi all
ydur i
ngear l
ytherapyordose
changes.Not ifyhealthcar epr ofessional immediatel
y
i
fthought saboutsui cideordy ing,attempt sto
commi tsuici
de, neworwor sedepr essionoranxi et
y,
agitationorr estlessness, panicattacks, insomnia,
neworwor seirritabi
lity,
aggressi veness, acti
ngon
danger ousimpul ses, mania,orot herchangesi n
moodorbehav iorori fsympt omsofser otoni
n
syndr omeoccur .

Advisepatientt oavoidalcohol orotherCNS

depressantdr ugsdur ingt
her apyandt oconsul
theal
th
careprofessional beforetaki
ngot hermedicati
onsor
natural
/herbal productswi t
hf l
uoxetine.

Caut
ionpat
ienttochangeposi
ti
onssl
owl
yto
mini
mizedi
zziness.

I
nform pat
ientt
hatfr
equentmouthri
nses,
goodoral
hygi
ene,andsugarl
essgum orcandymaymini
mize

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1665
 drymouth.I
fdrymouthpersist
sformorethan2wk,
consul
theal
thcarepr
ofessionalr
egar
dinguseof
sali
vasubst
it
ute.

Cauti
onpat
ienttowearprotect
ivecl
othinganduse
sunscr
eent
opr eventphot
osensit
ivi
tyreact
ions.

I
nfor
m pat
ientt
hatmedi
cat
ionmaycausedecr
eased
l
i
bido.

Advisepati
enttonotif
yhealthcar
eprofessionali
f
symptomsofsensi ti
vi
tyreacti
onoccurorifheadache,
nausea,anorexi
a,anxi
ety
, ori
nsomniapersist
s.

I
nstructfemalepati
entstoinf
orm heal
thcare
pr
ofessionali
fpregnancyisplannedorsuspect
ed,
or
i
fbreastfeedi
ng.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
moni
torprogr
ess.

Fl
uphenazi
ne
I
NDI
CATI
ONS
Acut
eandchr
oni
cpsy
choses.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1666
Alt
erstheeffectsofdopamineintheCNS.Has
anti
choli
nergi
candal pha-
adrener
gicbl
ocki
ngact
ivi
ty.
Therapeut
icEffects:
Dim

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
withotherphenot hiazinesmayexi st
;Subcor ti
calbrai
n
damage; SevereCNSdepr ession;Coma; Bonemar row
depression;Liverdi
sease; Hy persensiti
vi
tyt osesameoil
(decanoat esalt
);Somepr oductscont ai
nal coholor
tart
razineandshoul dbeav oi
dedi npat i
entswi thknown
i
ntolerance;Concur rentuseofdr ugst hatprolongtheQT
i
nterval;Pedi:Chil
dren<6mo( safetynotest abl
ished)
.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease;
Par
kinson'
s
disease; Angle-cl
osureglaucoma; My astheniagr avis;
Prost at
ichy pertr
ophy;Seizuredisor
ders; OB: Useonl yif
pot enti
albenefitjust
if
iespot enti
alr
isktof etus;Lact at
ion:
Ent ersbreastmi l
k,notrecommended; Ger i
: I
nit
ialdose↓
maybenecessar yingeriatri
cordebi l
it
atedpat ients;↑
ri
skofmor tal
it
yinelderl
ypat ient
streatedf ordement i
a-
relatedpsy chosis.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
NEUROLEPTI
CMALI
GNANTSYNDROME,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1667
extr
apy r
ami dalreactions,sedati
on, t
ardivedy ski
nesi
a.
EENT: bl
ur r
edv isi
on, dryeyes.CV: hypertensi
on,
hypotension,tachycar di
a.GI:anorexia,consti
pation,
drug-
i
nducedhepat it
is,drymout h,i
leus,nausea, weightgai
n.
GU: ur
inaryretenti
on.Der m: photosensiti
v i
ty,
pigment
changes, r
ashes.Endo: galact
orrhea.Hemat :
AGRANULOCYTOSI S,leukopenia,t
hrombocy topeni
a.Misc:
all
ergi
cr eacti
ons.

I
NTERACTI
ONS
Drug- Drug: Concur rentusewi thdr ugst hatpr ol ongt heQT
i
nt erval
, includingant iar
rhy t
hmi cs, pimozi de, er y t
hromy ci
n,
clari
thromy cin,fluoroquinolones, met hadone, andt ri
cy cli
c
ant i
depr essant smay↑ t her iskf orar r
hy thmi as;
concur rentuseshoul dbeav oi ded.Addi t
ivehy pot ension
withant ihy pertensives.Addi tiveCNSdepr essi onwi t
h
otherCNSdepr essant s,i
ncludi ngal cohol, ant idepr essant s,
ant i
histami nes, opioids,sedat iv e/hy pnotics, orgener al
anest hetics.Ef fectsmaybe↓ byphenobar bital.May↑
ther i
skofl it
hium t oxici
ty.Or al absor pti
onmaybe↓ by
alumi num- cont ainingant aci
ds.May↓ ant i
-Par kinson
act i
vi
tyofl evodopaandbr omocr i
pt i
ne.May↓ t he
vasopr essorr esponset oepi nephr ineandnor epi nephrine.
Effectsmaybe↑ bybet abl ocker s, chlorpr omazi ne,
chloroqui ne, delavirdi
ne,fluoxet ine, paroxet ine, quini
dine,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1668
quini
ne,ri
tonav ir
,andropinirol
e.↑ riskofant i
chol
inergi
c
eff
ectswithot heragent shav i
ngantichol
inergicpr
oper t
ies,
i
ncludi
ngant ihistamines,tri
cycli
canti
depressants,
di
sopy r
ami de,orquinidine.Metoclopramidemay↑ t he
ri
skofextrapy r
ami dalreacti
ons.

DOSAGE
Fl
uphenazi
neDecanoat
e
I
M: (
Adult
s):
12.5–25mginiti
all
y;mayber
epeatedq3wk.
Dosemaybeslowly↑ asneeded(nott
oexceed100
mg/dose)
.
Fl
uphenazi
neHy
drochl
ori
de
PO:(Adul
ts):0.
5–10mg/
dayindi
vi
deddosesq6–8hr
(maximum dose=40mg/day
).
PO:(Ger
iat
ri
cPatientsorDebil
i
tatedPat
ient
s):
1–2.
5
mg/dayini
ti
all
y;↑ doseevery4–7daysby1–2.5mg/day
asneeded(maxdose=20mg/ day)
.
I
M:(
Adul
ts)
:1.
25–2.
5mgq6–8hr
.

AVAI
LABI
LITY
Fl
uphenazi
nedecanoatei
njecti
on25mg/ mL,100mg/mL;
Fl
uphenazi
nehydrochl
ori
detablet
s1mg, 2.5mg,5mg,10
mg;Fl
uphenazi
nehy dr
ochl
orideel
ixi
r(
orangef
lav
or)2.
5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1669
mg/
5mL;Fl
uphenazinehy
drochlori
deconcentr
ate5
mg/
mL;
Fluphenazi
nehydrochl
orideinj
ect
ion2.
5mg/ mL;

PATI
ENTTEACHI
NG
Adv i
sepat ientt
ot akemedicati
onasdi rect
edandnot
toski pdosesordoubl euponmi sseddoses.I fadose
i
smi ssed,takewithin1hrorskipdoseandr eturnto
regularscheduleiftaki
ngmor ethan1dose/ day;take
assoonaspossi bleunlessalmostt i
mef ornextdose
i
ft aking1dose/ day.Abruptwit
hdr awalmayl eadto
gastriti
s,nausea,vomiti
ng,di
zziness,headache,
tachy car
dia,andinsomnia.

Infor
m pat i
entofpossibi
l
ityofextrapyr
amidal
sympt omsandt ardiv
edyskinesia.Cauti
onpati
entt
o
reportthesesympt omsimmedi atel
ytohealt
hcare
professional
.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

Medicati
onmaycausedr owsiness.Caut
ionpati
entt
o
avoi
ddr i
vingorot
heracti
vit
iesrequi
ri
ngaler
tness
unti
lresponsetomedicat
ionisknown.

Caut
ionpat
ientt
oavoidtaki
ngal
coholorotherCNS
depr
essant
sconcur
rentl
ywitht
hismedicat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1670
Advisepat i
enttousesunscreenandpr ot
ecti
v e
clot
hingwhenexposedt othesun.Exposedsur f
aces
maydev el
opabl ue-
graypigmentat
ion,whichmay
fadeafterdisconti
nuati
onofthemedi cat
ion.
Extremesoft emperatur
eshouldalsobeav oided
becauset hi
sdr ugimpair
sbodytemper at
ure
regulat
ion.

Advisepat
ientt
hatgoodoralhygiene,fr
equentri
nsing
ofmouthwi t
hwater,andsugar
lessgum orcandy
mayhelpreli
evedrymouth.Healt
hcar eprofessi
onal
shouldbenoti
fi
edifdrymouthper si
stsbeyond2wk.

I
nstructpati
enttonoti
fyhealt
hcarepr ofessi
onal
promptlyi
fsorethroat,
fever
,unusual bl
eedingor
brui
sing,r
ash,weakness,t
remor s,
visualdistur
bances,
dark-
color
edurine,orcl
ay-
coloredstoolsoccur.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Emphasizet
hei mpor t
anceofrout
inefol
low-upexams,
i
ncludi
ngocularexams, wi
thlong-
ter
mt herapyand
conti
nuedpar
t i
cipat
ioninpsychot
herapy.

Fl
urandr
enol
i
de

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1671
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocor
ticosteroi
dsorcomponentsofvehi
cles(oi
ntmentor
base,
pr eserv
ati
ve,al
cohol
);Unt
reat
edbacteri
alorvi
ral
i
nfect
ions.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cataracts, gl
aucoma, ortuberculosi
s(useoflarge
amount sofhi gh-potencyagent smaywor sencondi ti
on);
Patientswi thpr e-
existi
ngskinat rophy;Pr
egnancy ,
l
actation, orchi l
dren(chronichigh-doseusagemayr esul
t
i
nadr enal suppr essioninmot her,growthsuppressionin
chil
dren; chil
dr enmaybemor esusceptibl
etoadr enaland
growt hsuppr ession).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1672
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topical
:(Adul
ts)
:Applytoaf
fect
edarea(s)2–3t
imes
dai
ly(dependsonproduct
,pr
eparat
ion,
andcondit
ion
bei
ngt r
eated)
.
Topical
:(Chi
ldr
en):
Applytoaff
ectedarea(
s)1–2ti
mes
dai
ly(dependsonproduct
,pr
eparati
on,
andcondit
ion
bei
ngt r
eated).

AVAI
LABI
LITY
Lot
ion0.
05%;
Tape4mcg/
cm2;

PATI
ENTTEACHI
NG
Inst
ructpat
ientoncorr
ecttechni
queofmedicat
ion
administ
rat
ion.Emphasizei
mportanceofav
oidi
ngthe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1673
 eyes.I
fadoseismi
ssed,
itshoul
dbeappl
iedassoon
asrememberedunl
essal
mosttimef
orthenextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.

Caut i
onwoment hatmedi
cati
onshouldnotbeused
extensiv
ely,
inlar
geamounts,
orforprot
racted
periodsinpati
ent
swhoarepregnantorplanni
ngt
o
becomepr egnant.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onali
f
symptomsofunder l
yingdiseaser
etur
norwor senor
i
fsympt omsofinfect
iondev el
op.

Fl
urazepam
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1674
I
NDI
CATI
ONS
Shor
t-
ter
m managementofi
nsomni
a(<4wk)
.

ACTI
ON
DepressestheCNS, pr
obablybypotent
iat
ingGABA,an
i
nhibit
oryneurot
ransmitt
er.Ther
apeuti
cEffect
s:Rel
i
efof
i
nsomni a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:I
mpai
redr
espi
rat
oryf
unct
ion;
Impai r
edr espiratoryfunct ion;Sleepapnea;
Hy persensiti
vit
y ;Cross-sensi ti
vit
ywi thother
benzodi azepinesmayexi st; Pr
e-existi
ngCNSdepr essi
on;
Sev ereuncont r
olledpai n; Angle-closureglaucoma;OB:
Chr onicusedur ingpr egnancymaycausewi t
hdrawal
effectsinneonat es;Lactat ion:Entersbreastmilk;
discont i
nueorbot tl
e-feed.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion(
doser
educt
ion
maybenecessar y
);Hist
oryofsuicideattemptordrug
dependence;Debi
li
tat
edpatients(i
niti
aldosereducti
on
maybenecessar y
);Pedi
:Safetynotestabli
shedinchil
dren
<15yr;Geri
:AppearsonBeer'sli
standisassociatedwit
h
i
ncreasedfall
sri
skingeriat
ri
cpatients.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1675
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: abnor mal t
hinki ng, behaviorchanges, confusion,
dayti
medr owsi ness, decr easedconcent rat
ion,dizziness,
hal
lucinations, headache, let
hargy,ment aldepression,
paradoxical excitation, sleep—dr i
ving.EENT: blurr
edv isi
on.
GI:constipation, diarrhea, nausea,v omit
ing.Der m: rashes.
Neuro: at
axia.Mi sc: phy sicaldependence, psychologi cal
dependence, tolerance.

I
NTERACTI
ONS
Drug- Drug:Concurrentusewi thalcohol,anti
depr essants,
antihistamines,andopi oidsmayr esultinadditi
veCNS
depr ession.Cimetidine, hormonal contr
aceptives,
di
sul fir
am, fl
uoxeti
ne, isoni azi
d, ketoconazol
e, met oprol
ol,
propr anolol
,orvalproicaci dmay↓ met abol
ism of
fl
urazepam, enhanci ngitsact ions.May↓ ef ficacyof
l
ev odopa.Ri fampinorbar bit
uratesmay↑ met abolism
anddecr ease↓ ef fectivenessoff lur
azepam.Sedat iv
e
effectsmaybe↓ byt heophy l
line.
Drug-
Natur
alPr
oduct:Concomi
tantuseofkav
a-kava,
val
eri
an,
chamomile,
orhopscan↑ CNSdepr essi
on.

DOSAGE
PO:
(Adul
ts)
:15–30mgatbedt
ime.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1676
PO:(Geri
atr
icPati
entsorDebi
l
itat
edPat
ient
s):
15mg
i
nit
ial
ly
,maybei ncreased.

AVAI
LABI
LITY
Capsul
es15mg,
30mg;
Tabl
ets15mg,
30mg;

PATI
ENTTEACHI
NG
Adv
isepat
ientt
otakemedi
cat
ionasdi
rect
ed.

Teachsleephygi
enet echni
ques(
darkroom, qui
et,
bedti
mer i
tual
,l
imitdayti
menapping,
avoidanceof
ni
ctoti
neandcaffeine).

Maximum hypnoti
cpr opert
iesar
eapparent2–3
ni
ghtsaft
erini
ti
atingtherapyandmaylast1–2night
s
af
terther
apyisdisconti
nued.

Medicati
onmaycauseday t
imedrowsiness.Caut
ion
pat
ienttoavoi
ddriv
ingandotheracti
vi
ti
esrequir
ing
al
ertnessunt
ilr
esponsetomedicati
onisknown.

Caut
ionpat
ientt
oavoidtaki
ngal
coholorotherCNS
depr
essant
sconcur
rentl
ywitht
hismedicat
ion.

Referf
orpsy
chother
apyifi
neff
ect
ivecopi
ngi
sbasi
s
forsl
eeppat
ter
ndist
urbance.

I
nst
ructpat
ientt
ocont
actheal
thcar
epr
ofessi
onal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1677
 i
mmediatel
yifpr
egnancyi
spl
annedorsuspect
ed,
or
i
fbr
eastf
eeding.

Fl
utami
de
I
NDI
CATI
ONS
Treatmentofprost
atecarcinomai
nconj
unct
ionwi
th
l
uteini
zinghormone–rel
easinghor
mone(LHRH)
analoguessuchasleupr
olide.

ACTI
ON
Antagoni zestheeffectsofandrogen(test
oster
one)att
he
cell
ularlevel.Ther
apeut i
cEffect
s:Decreasedgrowt
hof
prostatecarcinoma, anandrogen-sensi
ti
vetumor.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erehepat
ic
i
mpai
rment
.

UseCaut
iousl
yin:
Sev
erecar
diov
ascul
ardi
sease.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Si
deef
fect
spr
imar
il
ycausedbyLHRHant
agoni
st
CNS:
anxi
ety
,conf
usi
on,
drowsi
ness,
ment
aldepr
essi
on,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1678
nerv
ousness.CV:edema, hypert
ension.GI
:
HEPATOTOXI CI
TY,diar
rhea,nausea, vomi
ti
ng.GU:erect
il
e
dysf
uncti
on,l
ossoflibi
do.Der m: phot
osensi
ti
vi
ty,
rash.
Endo:gy
necomastia.Misc:hotflashes.

I
NTERACTI
ONS
Drug-
Drug:
Actssy
ner
gist
ical
l
ywi
thLHRHanal
ogues
(l
eupr
oli
de).

DOSAGE
PO:(
Adult
s):
250mgq8hr
;gi
venconcur
rent
lywi
th
l
eupr
oli
de.

AVAI
LABI
LITY
Capsul
es125mg,
250mg;

PATI
ENTTEACHI
NG
Explainthatfl
ut ami demustbet akeninconjunct
ion
withleuprol
ide.I nstructpat
ientt
ot akefl
utamide
exactlyasdirect ed.Ifadosei smissed,t
akeassoon
aspossi bl
eunl essal mosttimef ornextdose.Donot
doubledoses.

Warnpat
ientt
hatsi
deeffectssuchashotfl
ashes,
l
ossofsexdri
ve,er
ect
il
edy sfunct
ion,
andbreast

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1679
 enlar
gementmaybecausedbyt heLHRHagonist
.
Thepr i
mar ysi
deef f
ectoff
lut
ami deal
oneisdi
arr
hea,
butthecombi nat
ionofdrugsisnecessar
ytoachi
eve
thetherapeuti
ceffect.

Advisepat ienttonotifyhealt
hcarepr ofessional
i
mmedi atelyifdarkurine,i
tchi
ng,lossofappet i
te,
nausea, v
omi t
ing,paininri
ghtside, oryel
lowey esor
ski
noccur s.Hepat ot
oxici
tyusuall
yr esolveswhen
fl
utamidei sdi sconti
nued,butitmaybepr ogressive
andf at
al;requi r
esimmedi atemedi calatt
ent i
on.

Fl
uti
casone
I
NDI
CATI
ONS
Maintenanceandprophylact
ict
reat
mentofast
hma.May
decreaserequi
rementfororavoi
duseofsyst
emic
cort
icoster
oidsanddel
aypul monar
ydamagethatoccur
s
fr
om chronicasthma.

ACTI
ON
Pot
ent,l
ocal
lyacti
nganti-i
nflammatoryandimmune
modif
ier
.Therapeut
icEffects:Decr
easesfr
equencyand
sev
eri
tyofasthmaattacks.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1680
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty(
cont
ains
pr
opel
l
ant
s);
Acut
eat
tackofast
hma/
stat
usast
hmat
icus.

UseCaut
iousl
yin:
Act
iveunt
reat
edi
nfect
ions;
Diabet
es
orgl aucoma; Under l
yingimmunosuppr essi on(duet o
diseaseorconcur renttherapy )
;Systemi ccor ti
cost eroid
therapy( shoul dnotbeabr uptlydiscont i
nuedwhen
i
nhal ablet herapyi sstart
ed;addi t
ional cor ti
costeroids
neededi nst r
essort r
auma) ;Hepat i
cdy sfunction;Sev ere
mi l
kpr oteinal l
ergy(powderf ororalinhal ati
oncont ai
ns
l
act ose) ;
OB: Lact ati
on:Pedi :Pregnancy , l
actation,or
chil
dr en<4y r(safetynotest abli
shed; pr olongedorhi gh-
doset herapymayl eadt ocompl icati
ons) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, dizziness.EENT: dysphonia, hoarseness,
orophar yngeal fungal infections,nasal st
uffiness,
rhinorrhea,sinusi tis.Resp: br onchospasm, cough, upper
respiratorytracti nf ect
ion, wheezi ng.GI:diarrhea.Endo:
adr enalsuppr essi on( high-dose, l
ong- t
ermt her apyonly)
,
↓ bonemi neral densi ty,↓ gr owth( i
nchi l
dren) ,Cushi
ng's
syndr ome.MS: muscl epai n.Mi sc:hypersensi t
ivit
y
react i
onsincludi nganaphy laxis,laryngealedema,
urticari
a,andbr onchospasm, CHURG- STRAUSS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1681
SYNDROME,
fev
er.

I
NTERACTI
ONS
Drug- Drug:StrongCYP3A4i nhibit
ors,includi
ngr i
tonavir
,
atazanav ir
,clari
thromyci
n,indi
nav i
r,i
traconazole,
ketoconazol e,nefazodone,nel
finavi
r,saquinavir
,and
tel
ithromy ci
n↓ met aboli
sm and↑ l evels;concurrentuse
notr ecommended.

DOSAGE
Aer
osol
foror
ali
nhal
ati
on
Inhal
n:(Adul
tsandChi l
dren≥12y r)
: Pati
entswhose
previ
ousasthmat herapyincludedbr onchodil
ators
alone—88mcgt wicedai l
yiniti
all
y,maybe↑ upt o440
mcgt wicedail
y;Pati
entswhosepr ev i
oustherapyincluded
otheri
nhaledcorti
costeroi
ds—88–220mcgt wicedaily
i
niti
all
y,maybe↑ upt o440mcgt wicedaily;
Patients
whosepr evi
oustherapyincludedor alcorti
coster
oids—440
mcgt wicedail
yini
ti
ally,
maybe↑ upt o880mcgt wice
dail
y.
Inhal
n:(
Chi
l
dren4–11yr
):88mcgt
wicedai
l
y(nott
o
exceed88mcgtwi
cedai
ly).

Powderf
oror
ali
nhal
ati
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1682
Inhal
n: (
Adult
sandChi l
dren≥12y r
): Pati
entswhose
previ
ousasthmat herapyincludedbr onchodil
ators
alone—100mcgt wi
cedai l
yiniti
all
y,maybe↑ upt o500
mcgt wicedail
y;Pati
entswhosepr ev i
oustherapyincl
uded
otherinhal
edcorti
coster
oids—100–250mcgt wicedaily
i
niti
all
y ,
maybe↑ upt o500mcgt wicedaily;
Patients
whosepr evi
oustherapyincludedor al
corti
coster
oids—500–1000mcgt wicedai l
y.
Inhaln:
(Children4–11y r)
:Pat i
ent
swhosepr evi
ous
asthmat herapyi ncl
udedbronchodil
atorsalone-50mcg
twicedail
yi nit
iall
y,maybe↑ upt o100mcgt wicedail
y;
Patient
swhosepr evi
oustherapyi
ncludedot herinhal
ed
corti
costeroids-50mcgt wicedail
yini
tial
ly
,maybe↑ upt o
100mcgt wi cedaily
.

AVAI
LABI
LITY
Inhalati
onaerosol (Fl
oventHFA)44mcg/ metered
i
nhal ati
onin10.6-gcani sters(120met er
edinhalations)
,
110mcg/ met er
edi nhal
at ionin12-gcani
sters(120
met eredinhalat
ions),220mcg/ meteredinhal
ationin12- g
canisters(120met eredi nhalati
ons);
Powderf orinhalat
ion
(FloventDiskus)50mcg, 100mcg, 250mcg; In
combi nati
onwi th:salmet erol

PATI
ENTTEACHI
NG
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1683
Adv i
sepatienttotakemedi cati
onasdi rected.Ifa
dosei smissed,takeassoonasr emember edunl ess
al
mostt imef ornextdose.Instr
uctpat i
entt oreadt he
PatientI
nformat i
onandI nstr
ucti
onsf orUsebef ore
usingandwi theachRxr efil
l,
incaseofnew
i
nfor mati
on.Adv i
sepatientnottodiscont i
nue
medi cat
ionwi t
houtconsulti
ngheal t
hcar e
professi
onal;gradualdecreaseisrequir
ed.

Advisepatientsusinginhal
ati
oncorticoster
oidsand
bronchodil
atortousebr onchodi
lat
orf i
rstandtoall
ow
5mi ntoelapsebef oreadminist
eri
ngt he
corti
costeroi
d,unlessotherwi
sedirectedbyhealth
careprofessional
.

Advisepat
ientt
hatinhalat
ioncorti
cost
eroidsshoul
d
notbeusedt ot
reatanacut easthmaattackbut
shouldbeconti
nuedev enifotheri
nhal
ationagents
areused.

Patientsusi
nginhalat
ioncorti
coster
oidst ocontr
ol
asthmamayr equir
esystemiccorti
costeroidsfor
acuteat t
acks.Advi
sepatientt
ouser egularpeakflow
moni tor
ingtodetermi
ner espi
rat
orystatus.

Advi
sepati
entt
ostopusi
ngmedi
cati
onandnoti
fy
heal
thcar
eprof
essi
onali
mmedi
atel
yifsi
gnsand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1684
 sy
mpt
omsofhy
per
sensi
ti
vi
tyr
eact
ionsoccur
.

Caut
ionpati
enttoavoi
dsmoking,
knownal
l
ergens,
andotherr
espi
rator
yir
ri
tant
s.

Advi
sepat
ientt
onoti
fyhealt
hcar
epr
ofessi
onal
if
sor
ethr
oatormouthoccurs.

Instr
uctpati
entt
onot i
fyheal
thcar
eprofessionalof
allRxorOTCmedi cati
ons,vi
tami
ns,orherbal
productsbei
ngtakenandconsultheal
thcare
professi
onalbef
oretaki
ngotherRx,OTC,orherbal
products.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Instr
uctpat i
entwhosesy st
emi ccorti
cost
eroidshave
beenr ecentl
yreducedorwi thdr
awnt ocarryawar ni
ng
cardindicati
ngtheneedf orsupplementalsystemic
corti
costeroidsi
ntheev entofstressorsevere
asthmaat tackunresponsivetobronchodi
lators.

Aerosolf
orInhalati
on: Instr
uctpati
entintheproper
useofthemet ered-dosei nhal
er.I
nhal
ershouldbe
pri
medbef oreusingf orfir
stti
mebyr eleasi
ng4
spraysi
ntoair,awayf rom face.Wheninhalerhasnot
beenusedf ormor ethan7day s,r
epri
meuni tby

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1685
 rel
easing1spr ayi ntoai rawayf rom face.Shake
i
nhalerwell.Exhal ecompl etel
yandt henclosel i
ps
fi
rmlyaroundmout hpiece.Whi lebreathi
ngi ndeeply
andslowly,pressdownoncani ster.Holdbr eat
hfor
aslongaspossi bletoensur edeepi nsti
ll
ationof
medicati
on.Remov erinhal erfr
om mout handbr eat he
outgently
.Allow1–2mi nbet weeni nhal
ations.Rinse
mout hwithwat erormout hwashaf tereachuset o
minimizefungal infections, dr
ymout hand
hoarseness.Washi nhal ati
onassembl yatleastonce
weeklyinwar mr unni ngwat er

Powderf orInhalati
on:Donotusewi t
haspacer .
Exhalecompl etelyandt hencl osel ipsfir
ml yar ound
mout hpiece.Whi lebreathingi ndeepl yandsl owl y,
pressdownoncani st
er.Hol dbr eathf orasl ongas
possiblet oensur edeepi nsti
llationofmedi cation.
Remov eri nhalerfrom mout handbr eatheoutgent ly.
All
ow1–2mi nbet weeni nhalations.Af t
eri nhalat i
on,
ri
nsemout hwithwat erandspi tout ,Nev erwasht he
mout hpieceoranypar toft heDi skusinhaler .Di scard
Diskusinhal erdev i
ce6wks( 50-mcgst rengt h)or2
mo( 100- mcgand250- mcgst rengths)af t
err emov al
fr
om pr otectivefoiloverwrappouchoraf teral l
bl
istershav ebeenused( whichev ercomesf ir
st).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1686
Fl
uvast
ati
n
I
NDI
CATI
ONS
Adjunctivemanagementofpr i
mar yhypercholest
erolemia
andmi xeddy sl
ipi
demi a.Secondarypreventi
onofcor onary
revasculari
zati
oninpat i
entswithcli
nicall
yevi
dent
coronaryheartdisease.Slowsthepr ogressi
onofcor onary
atheroscler
osisinpati
entswi t
hcor onaryart
erydisease.

ACTI
ON
Inhibits3-hy dr
oxy -
3-methy l
glutaryl
-coenzymeA( HMG- CoA)
reduct ase, anenzy mewhi chi sresponsibleforcat alyzi
ng
anear lystepint hesynthesisofchol esterol
.Therapeut ic
Effect s:Loweringoft ot
al andLDLchol esteroland
tri
glycer i
des.Slightl
yincreasesHDLchol ester
ol.Sl owsthe
progr essionofcor onaryat herosclerosi
swi thresultant
decr easei nincidenceofcor onar yheartdisease-related
event s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pregnancyandl
actati
on;
Acti
veli
verdi
seaseor
unexplai
nedper
sist
entel
evat
ionsi
nASTandALT.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1687
UseCaut
iousl
yin:
Hist
oryofl
i
verdi
sease;
Alcohol
i
sm;
Renal
impai
rment
;Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,dizziness,insomni a,fati
gue.Resp:
bronchiti
s,cough,phary ngi
tis,r
hiniti
s,sinusiti
s.CV:chest
pain,peri
pheraledema.GI :nausea, v
omi ting,abdominal
pain/cramps,const i
pation,fl
atul
ence, dy spepsia,↑li
ver
enzymes.Der m: photosensi t
ivi
ty,r
ash/ prurit
us.MS:
RHABDOMYOLYSI S, ar
thrit
is,my opathy,backpai n,
arthr
opathy.Misc: al
lergicreacti
onsi ncludinganaphylaxi
s.

I
NTERACTI
ONS
Drug-Dr ug:Fluv ast at i
ni smet abol i
zedbyt heCYP2C9
met abolicpat hway .Concur rentusewi thgemf ibrozil
,
erythromy cin,cycl ospor i
ne, azol eantifungal agents,or
niacin(nicotinicaci d)may↑ r iskofmy opathy( concurr
ent
usewi t
hgemf i
br ozi lshoul dbeav oided, t
empor ari
ly↓
doseordi scont inuei fsy stemi cazol eantifungalsar e
required).Concur r enti ngest i
onwi t
hchol estyrami ne
orcolestipol↓ absor ptionoff l
uv astat i
n.Bloodl evelsare
↑ byci met idine,rani tidine,omepr azole,andconcur rent
i
ngest ionofal cohol .Concur rentusewi t
hr i
fampi n↓
bloodl evels.Maysl i
ght l
y↑ ser um di goxinlevels.May↑
ri
skofbl eedingwi thwar fari
n.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1688
Drug-Food:Grapefr
uitj
uice↑ bl
oodl
evel
sandt
her
iskof
rhabdomy ol
ysis.

DOSAGE
PO:(Adult
s):20–40mg(i
mmediate-
rel
ease)oncedai
lyat
bedti
me.Maybe↑ t o40mgtwicedail
y(i
mmedi at
e-
rel
ease)or80mgoncedail
y(ext
ended-
rel
ease).

AVAI
LABI
LITY
Capsul
es20mg,
40mg;
Ext
ended-
rel
easet
abl
ets80mg;

PATI
ENTTEACHI
NG
I
nstructpati
entt otakemedi cati
onasdi rect ed.Take
misseddosesassoonasr emember ed;i
fmor ethan
12hrsincelastdose, waitandt akethenextdoseat
theregul
artime.Donotdoubl edoses.Adv isepat i
ent
toreadPatientInformat i
onsheetpr i
ortot herapyand
witheachRxr efil
l.Fl
uv astati
nhel pscontrol butdoes
notcureelevatedser um chol est
er ol
lev
els.

Adv i
sepat ientthatfl
uvast
ati
nshouldbeusedin
conjunct i
onwi t
hdi etr
estr
ict
ions(f
at,
chol
est
erol
,
carbohy drates,
alcohol)
,exer
cise,
andcessat
ionof
smoki ng.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1689
 unexplai
nedmuscl epain,t
enderness,
orweakness
occurs,especi
all
yifaccompaniedbyfever,
malaise,
nausea,vomiti
ng,ti
redness,dar
k-col
oreduri
ne,
yellow
ski
norey es,orstomachpain.

Advi
sepati
enttousesunscreenandwearprotect
ive
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Inst
ructfemalepatient
st onotifyheal
thcar
e
prof
essionalimmedi at
elyifpregnancyispl
annedor
suspected,orifbr
eastfeeding.

Emphasizet
heimportanceoffol
l
ow-
upexamsto
deter
mineef
fect
ivenessandtomoni
torf
orsi
de
eff
ects.

Fl
uvoxami
ne
I
NDI
CATI
ONS
Obsessiv
e-compulsi
vedisor
der(OCD).Unlabel
edUses:
Depressi
on.General
i
zedanxietydi
sor
der(GAD) .Social
anxi
etydisor
der(SAD).Post
-t
raumati
cstressdisorder
(PTSD).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1690
ACTI
ON
I
nhibi
tst
hereupt
akeofserot
onini
ntheCNS.Ther
apeuti
c
Ef
fect
s:Decr
easeinobsessi
ve-
compul
siv
ebehavi
ors.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ofl
uvoxami
neor
otherSSRIs;Concurr
entuseofMAOIs(orwit
hin14day
s
ofdisconti
nuingfl
uvoxamine)
,al
oset
ron,
pimozide,
thi
oridazi
ne,orti
zani
dine.

UseCaut
iousl
yin:
Impai
redhepat
icf
unct
ion;
Riskof
suici de(may↑ r i
skofsui cideat tempt / i
deationespeci all
y
dur i
ngear l
yt reatmentordoseadj ustment );OB: Neonat es
exposedt oSSRIi nt hir
dt ri
mest ermaydev el
opdr ug
discont inuationsy ndromei ncludi ngr espiratorydistress,
feedi ngdi f
fi
cul ty,andirrit
abili
ty; Lact ati
on: Disconti
nue
drugorbot t
le-feed; Pedi:May↑ r iskofsui ci
de
attempt /i
deat ionespeci al
lydur ingear lytreatmentordose
adjust ment ;maybegr eaterinchi ldrenandadol escent s
(saf etynotest abl
ishedinchi ldr en<18y r
[cont rol
led–r elease]and<8y r[ immedi ate-release])
;Pedi :
Saf etynotest abli
shedi nchi l
dr en<8y r(forimmedi at e-
release) ;Geri:Mayhav e↑ sensi ti
v i
ty;recommendl ower
i
nitial doseandsl owerdosaget it
rat i
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1691
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, SUICIDAL
THOUGHTS, sedat i
on, dizziness, dr owsi ness, headache,
i
nsomni a, ner vousness, weakness, agitation, anxiety,
apathy ,emot ional l
abili
ty ,mani cr eact i
ons, ment al
depressi on, psy chot i
creact ions, sy ncope.EENT: si
nusit
is.
Resp: cough, dy spnea.CV: edema, hyper tension,
palpi
tations, post uralhy potension, tachy cardia,
vasodilation.GI :const i
pat i
on, diarr hea,dr ymout h,
dyspepsi a, nausea, anor exia,dysphagi a, ↑l i
verenzy mes,
fl
atulence, vomi ting.GU: ↓l ibi
do/ sexual dysfunct i
on.
Derm: ↑ sweat i
ng.Met ab: weightgai n, wei ghtloss.MS:
hypertoni a, my oclonus/ twitching.Neur o:
hypokinesi a/ hy perkinesia,tremor .Mi sc: SEROTONI N
SYNDROME, allergicreact i
ons, chi lls,
flu-likesy mptoms,
toothdisor der/car i
es, yawni ng.

I
NTERACTI
ONS
Drug-Drug:Ser i
ous,potenti
all
yfat
al r
eactions(serot
oni
n
syndrome)mayoccurwi thMAOi nhibit
ors.Smokingmay
↓ effectiv
enessoff l
uvoxamine.Concurrentusewi t
h
tr
icycl
icantidepressantsmay↑ pl asmal evelsof
fl
uvoxami ne.Dr ugsthataff
ectserotonergic
neurotransmi t
tersystems,incl
udi
ngl i
nezolid,t
ramadol
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1692
andt ri
ptans, ↑r i
skofser otoninsy ndr
ome.↓ met abol
ism
andmay↑ ef fectsofsomebet ablocker
s(pr opranolol
),
alosetron(av oidconcur r
entuse) ,somebenzodi azepines
(avoidconcur rentdi azepam) ,carbamazepine, methadone,
l
ithium, t
heophy ll
i
ne( ↓ doset o33%ofusual dose) ,
ramel t
eon( av oidconcur rentuse), war
far
in,andl -
tryptophan.↑ r i
skofbl eedingwi thNSAIDS, aspiri
n,
clopidogrel
, orwar farin.↑ bloodl evel
sandr iskoft oxi
cit
y
from clozapine( dosageadj ustment smaybenecessar y).

DOSAGE
PO:(Adults):Immedi at
erelease–50mgdai l
yatbedti
me;
↑ by50mgq4–7day sunti
l desi
redeffecti
sachi
eved.I
f
dai
lydose>100mg, givei
nt woequal l
ydivi
deddosesor
gi
veal argerdoseatbedt i
me( nottoexceed300mg/ day
);
Contr
olledrelease–100mgatbedt i
me; ↑ by50mgq7
daysunt i
ldesir
edeffectisachi ev
ed,nottoexceed300
mg/day .
PO: (
Chi
ldren8–17yr
):I
mmedi at
erel
ease–25mgat
bedti
me,may↑ by25mg/ dayq4–7day s(
nottoexceed
200mg/ day;dai
l
ydoses>50mgshoul dbegiv
enin
di
videddoseswithal
argerdoseatbedti
me).
Hepat
icI
mpai
rment
PO:
(Adul
ts)
:Immedi
ater
elease–25mgdai
l
yatbedt
ime

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1693
i
nit
ial
l
y,sl
owert
it
rat
ionandl
ongerdosi
ngi
nter
val
sshoul
d
beused.

AVAI
LABI
LITY
Tablet
s25mg,50mg,100mg;
Cont
rol
l
ed-
rel
ease
capsul
es100mg,150mg;

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakefl
uvoxamineasdi rect
ed.Do
notskipordoubl
euponmi sseddoses.Improvement
i
nsy mptomsmaybenot icedin2–3wk, but
medicati
onshouldbecontinuedasdirected.

Maycausedr owsi
nessanddizzi
ness.Cauti
onpati
ent
toavoiddri
vingandotheract
ivi
ti
esrequir
ingal
ert
ness
unti
lresponsetomedicati
onisknown.

Advisepati
ent,fami l
y ,andcar egiverstolookfor
sui
cidali
ty,
especi all
ydur ingear l
ytherapyordose
changes.Notifyhealthcar eprofessionalimmediatel
y
i
fthoughtsaboutsui cideordy ing,attemptsto
commi tsuici
de, neworwor sedepr essi
onoranxi et
y,
agit
ati
onorr estlessness, panicattacks,insomnia,
neworwor seirritabi
lity,aggressiveness,acti
ngon
dangerousimpul ses, mani a,orotherchangesi n
moodorbehav iorori fsy mptomsofser otoni
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1694
 sy
ndr
omeoccur
.

Advisepati
enttoavoidal
coholorot
herCNS
depressant
sduringther
apyandtoconsultheal
thcar
e
prof
essionalbef
oretaki
ngothermedicat
ionswit
h
fl
uvoxamine.

I
nstr
uctfemal
epat i
entstonoti
fyhealt
hcare
pr
ofessi
onali
fbreastf
eedingorifpr
egnancyi
s
pl
annedorsuspected.

Advisepatientt
onoti
fyhealt
hcareprofessi
onali
f
rashorhivesoccurori
fheadache,nausea,anor
exi
a,
anxiet
y,orinsomni
apersist
s.

Advi
sepat
ientt
oav
oiduseofcaf
fei
ne(
chocol
ate,
tea,
col
a).

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
moni
torprogr
ess.

Fol
i
caci
d
I
NDI
CATI
ONS
Preventi
onandt r
eatmentofmegal
obl
asti
cand
macr ocy
ticanemias.Gi
vendur
ingpr
egnancyt
opr
omot
e
normal f
etaldev
elopment.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1695
ACTI
ON
Requi
redforprot
einsynthesi
sandr edbloodcellfunct
ion.
Sti
mulat
estheproductionofredbloodcel ls,whit
eblood
cel
ls,
andplatel
ets.Necessar
yf ornormal fetal
devel
opment.Therapeuti
cEffects:Restorati
onand
maint
enanceofnor malhemat opoi
esis.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Uncor
rect
edper
nici
ous,
apl
ast
ic,
or
normocyticanemi as(neur
ologi
cdamagewi l
lprogress
despit
ecor rect
ionofhemat ol
ogicabnormali
ti
es);Pedi:
Preparat
ionscont ai
ningbenzylal
coholshoul
dnotbeused
i
nnewbor ns.

UseCaut
iousl
yin:
Undi
agnosedanemi
as.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Der
m:r
ash.
CNS:ir
ri
tabi
li
ty,
dif
fi
cul
tysl
eepi
ng,
mal
aise,
conf
usi
on.
Misc:
fever.

I
NTERACTI
ONS
Drug-
Drug:Pyri
methamine,met
hotrexat
e,t
ri
methopr
im,
andtr
iamterenepr
eventtheact
ivat
ionoffol
icaci
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1696
(l
eucov orinshoul dbeusedi nsteadt otreatoverdosesof
thesedr ugs).Absor pt
ionoff oli
caci dis↓ by
sulfonami des( i
ncludi
ngsul f
asal azi
ne),antaci
ds,and
cholestyramine.Fol i
cacidrequir ementsar e↑ by
estrogens, phenytoin,phenobarbi t
al,
primidone,
carbamazepi ne,orcorti
costeroids.May↓ pheny toi
n
l
ev els.

DOSAGE
Ther
apeut
icDose(
Fol
i
caci
ddef
ici
ency
)
PO:IM:IV:Subcut(Adul
tsandChi
l
dren>11yr)
:1mg/
day
i
nit
ialdosethen0.5mg/daymaint
enancedose.
PO:IM:I
V:Subcut(
Chi
ldr
en>1y r)
:1mg/dayi
nit
ial
dose
then0.
1–0.
4mg/ daymai
ntenancedose.
PO:I
M: I
V:Subcut(
Inf
ant
s):
15mcg/
kg/
dosedai
l
yor50
mcg/day.
RecommendedDai
l
yAl
l
owance
PO:
(Adul
tsandChi
l
dren>15y
r):
0.2mg/
day
.
PO:
(Adult
s):
Femal
esofchi
l
dbear
ingpot
ent
ial
–0.
4–0.
8
mg/day
.
PO:
(Chi
l
dren11–14y
r):
0.15mg/
day
.
PO:
(Chi
l
dren7–10y
r):
0.1mg/
day
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1697
PO:
(Chi
l
dren4–6y
r):
0.075mg/
day
.
PO:
(Inf
ant
s6mo–3y
r):
0.05mg/
day
.

AVAI
LABI
LITY
Tabl
ets0.4mg, 0.
8mg, 1mg,5mg;Inj
ect
ion5mg/mL;I
n
combinati
onwith:ot
hervi
tami
nsandmineral
sasmul
ti
ple
vi
taminsRx,OTC.

PATI
ENTTEACHI
NG
Encouragepat i
enttocompl ywit
hdi et
recommendat i
onsofheal thcareprofessi
onal.Expl
ain
thatthebestsour ceofvi
t aminsisawel l-
bal
anced
dietwit
hf oodsfrom thefourbasicf oodgroups.A
dietl
owi nv i
taminBandf olat
ewillbeusedt o
diagnosef ol
i
caciddef i
ciencywi t
houtconcealing
pernici
ousanemi a.

Foli
cacidi
nearl
ypregnancyi
snecessar
ytopr
event
neural
tubedef
ects.

Foodshi
ghinfol
icacidincludevegetabl
es,fr
uit
s,and
organmeat
s;heatdestr
oy sfol
icacidinfoods.

Pati
entsself
-medi
cat
ingwit
hv i
taminsuppl
ement
s
shoul
dbecaut i
onednott
oexceedRDA.The
eff
ecti
venessofmegadosesfortr
eatmentofv
ari
ous

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1698
 medicalcondi
ti
onsi
sunpr
ovenandmaycausesi
de
ef
fects.

Explai
nthatf
oli
caci
dmaymakeur
inemor
eint
ensel
y
yel
low.

I
nst
ructpati
entt
onot
if
yhealthcar
epr
ofessi
onal i
f
r
ashoccurs,whi
chmayindi
catehy
per
sensit
ivi
ty.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
eval
uat
eprogr
ess.

Fol
l
itr
opi
nal
fa
I
NDI
CATI
ONS
Inductionofov ulati
oni nanovulatorypatientswhose
i
nf ert
il
ityi
snotduet opri
mar yovarianfailure(Gonal-
Fand
Gonal -
FRFF) .Stimul at
ionofmul ti
pleoocy t
esinov ul
ator
y
pat i
entsundergoi ngassistedreproductiont echnol
ogy
(ART)( Gonal-FandGonal -
FRFF) .Inductionof
sper matogenesisi nmenwi t
hpr i
mar yandsecondar y
hypogonadot ropichy pogonadism whosei nfert
il
it
yisnot
duet opr i
maryt esticul
arfail
ure(Gonal-Fonl y).

ACTI
ON
St
imul
atesf
oll
i
cler
ecr
uit
ment
,gr
owt
handmat
urat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1699
I
nducesspermatogenesi
s.Therapeuti
cEf
fect
s: Ov
ulat
ion.
I
mpr ovedpr
oducti
on/har
vestofoocy t
esi
npatient
s
undergoi
ngART.Spermatogenesis.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pri
mar
yov
ari
anor
test
icularfai
lure;
Uncontr
olledthyroi
doradrenal
dysfuncti
on; Abnormalut
erinebleedi
ng;I
ntr
acranial
or
hormone- dependenttumors;Ovari
ancyst/
enlargement
notduet opol y
cysti
covari
ansy ndrome.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, headache.EENT: phar y
ngiti
s,r
hinit
is.GI:
constipati
on,diarrhea,dyspepsi
a,flatul
ence.GU: OVARI AN
HYPERSTI MULATI ONSYNDROME, abdomi nal/pelv
icpain,
dysmenor rhea,irr
egularbleedi
ng,ov ari
anenlargement .
Derm: acne.Endo: br
eastpain.Resp: cough.Local:
i
njecti
onsi tereactions.Misc:fl
u-l
i
kesy mptoms, multi
ple
bi
rths.

I
NTERACTI
ONS
Dr
ug-
Drug:
Unknown.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1700
Femal
einf
ert
il
it
y
Subcut(Adul
ts):75IU/dayf
or14days,t
henincr
easedby
37.
5IUatweekl yint
erv
alsasneededbyassessment(
up
to300IU/day)
;foll
owedbyhCG.

Assi
stedRepr
oduct
ionTechnol
ogi
es
Subcut(Adult
s):150IU/daystart
ingonday2or3ofcy
cle
unti
lfol
li
clesdevel
opsuffi
cient
ly;
ifneededmaybe
i
ncreasedby75–150I U/dayevery3–5day s(
nott
o
exceed10day sor450IU/day);f
ollowedbyhCG.
Mal
ePati
ent
swit
hHy
pogonadot
ropi
cHy
pogonadi
sm
(
Gonal
-Fonl
y)
Subcut(Adult
s):Aft
ernormal ser
um t
estosteronel
evel
s
areachievedwit
hhCG, Gonal–Fcanbeinit
iatedat150I
U
3timesweekl y(
mustbegi venwit
hhCG).Ifazoospermi
a
persi
sts,dosecanbeincreasedupto300IU3t i
mes
weekly;maybegivenforupt o18mo.

AVAI
LABI
LITY
Powderfori
nject
ion75IU/vi
al(Gonal
-FRFF),450IU/v
ial
(mul
ti
-dosevi
al)(Gonal
-F)
;Pre-
fi
ll
edmultidosepen(Gonal
-
FRFFPen)300I U/pen,
450IU/pen,900IU/pen;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1701
 Pri
ortoi
nit
iati
onoft her
apydiscusswithpatientt
he
dur
ati
onoft herapy,
requir
edmoni t
ori
ng,potenti
al
adver
sereactions,
andriskofmulti
plebir
ths.

Encouragecoupl
et ohav einter
coursedail
y,begi
nni
ng
ont hedaypri
ort
oadmi nistr
ati
onofhCGunt i
l
ovulati
onbecomesappar entbasedoni ndicesto
determinepr
ogestati
onal acti
vi
ty.Careshouldbe
takentoensurei
nsemi nation.

Fol
l
itr
opi
nbet
a
I
NDI
CATI
ONS
Induct ionofov ul
ationandpr egnancyi nanov ulatory
i
nf ertilewomenwhosei nfertil
it
yi snotduet opr i
mar y
ov arianf ail
ure.Stimulat
ionofmul ti
pleoocy t
esi n
ov ulator ywomenunder goi ngassi stedreproduct i
on
technol ogy(ART) .Pregnancyi nnormal ovulatorywomen
under goingcont rol
ledov arianst i
mul at
ionaspar tofanin
vitrof ertil
i
zation(IVF)orint racytoplasmicsper mi nj
ecti
on
(ICSI )cy cl
e(Fol l
i
stim AQcar tri
dgeonl y)
.Induct i
onof
sper mat ogenesisinmenwi thprimar yandsecondar y
hy pogonadot ropichypogonadi sm (HH)whosei nf er
ti
li
tyi
s
notduet opr i
mar ytesti
cularf ail
ure.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1702
ACTI
ON
Sti
mul at
esfol
li
clerecruit
ment,growt
h, andmaturat
ion(
in
women)andsper mat ogenesis(i
nmen) .Ther
apeuti
c
Eff
ects:Ovul
ati
on.Impr ovedproduct
ion/harv
estof
oocytesinpat
ientsundergoingART.Pregnancy.
Spermatogenesi
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oFSHorant
ibi
oti
cs,
str
ept omy cinorneomy ci
n( maycont aintr
acesoft hese
anti
biot i
cs); Abnormal vaginalbleedi
ng; Ri
skf act
or sfor
thr
omboembol i
sm; Uncontrol
ledadrenal,thyroi
d,or
pit
uitarydy sfunction;Intr
acranialorhormone- dependent
tumor s;Ov ariancy st/
enlargementnotduet opoly cysti
c
ovarysy ndr ome; Primaryov ar
ianort esti
cularfai
lure;OB:
Lactation:Pr egnancyorl actati
on.

UseCaut
iousl
yin:
Nonenot
ed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,headache.CV: THROMBOEMBOLI SM,
tachy
car di
a.GI :
nausea,fl
atulence,const
ipat
ion.GU:
OVARI ANHYPERSTI MULATI ONSYNDROME,
abdomi nal
/ pel
vicpai
n,dysmenor rhea,i
rr
egul
arbleeding,
ovari
anenl argement,ovar
ianneopl asm,ovar
iantorsi
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1703
Endo: br
eastpain/enl
argement .MS:backpai n.Resp:
ACUTERESPI RATORYDI STRESSSYNDROME, dyspnea,
tachypnea,upperrespi
ratorytr
actinf
ection.Derm: acne,
rash.Local
: i
njecti
onsi
ter eact
ions.Misc:fl
u-li
ke
sympt oms,mul t
ipl
ebir
ths.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Ov
ulat
ionandPregnancyInduct
ioninAnov
ulat
oryI
nfer
ti
le
Women(Foll
i
sti
m AQSi ngle-
UseVial
)
SubcutI
M:(Adul
ts):75IU/
dayforupto7days,
then↑ by
25–50IUatweekl
yinter
val
sasneededbyassessment
(300IU/
daymaximum) ;
fol
lowedbyhCG.
Ov
ari
anandPregnancyI
nductioni
nAnov
ulat
oryI
nfer
ti
le
Women(Fol
l
ist
im AQCartr
idge)
Subcut(Adults):
50I U/dayf orupto7days,t
hen↑ by
25–50IUatweekl yinterval
sasneededbyassessment
(250IU/daymaximum) ;f
ollowedbyhCG.Al oweri
nit
ial
doseshoul dbegivenifpreviousdoseswereadmini
ster
ed
usingFoll
isti
m AQsingle-usev i
als.
Assi
stedRepr
oduct
ionTechnol
ogi
es(
Fol
l
ist
im AQSi
ngl
e-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1704
UseVi
al)
SubcutI
M: (Adult
s):150–225IU/dayforatleastt
hefir
st
4daysoftreatment;dosemaybet henadjustedbased
uponovari
anr esponse(600I
U/daymaxi mum) ;f
oll
owed
byhCG.
Pr
egnancyinNormal
Ov ul
ator
yWomenUnder
goi
ngI
VFor
I
CSI(Fol
li
sti
m AQCart
ri
dge)
Subcut(Adult
s):200IUdail
yforatleastthef
ir
st7daysof
treat
ment;dosemaybet henadjustedbaseduponovar
ian
response(500IU/daymaximum) ;
foll
owedbyhCG.
Sper
mat ogenesi
sInduct
ion(
Fol
l
ist
im AQSi
ngl
e-UseVi
al
orCart
ri
dge)
Subcut(Adul
ts):
Pretr
eatwithhCGpr i
ortouseofFol
l
ist
im
AQ;oncenormalserum t
estost
eronelevel
sachi
eved,
give
450IU/week(as225IUtwiceweeklyor150IU3t i
mes
weekly
)withhCG;conti
nueforatleast3–4mo.

AVAI
LABI
LITY
I
njecti
on( si
ngl
e-usev i
al)75I
U/vi
al,
150IU/vi
al;
Inj
ection
(
mul t
i-
dosecar t
ridge)175IU/v
ial
(deli
ver
s150IU),350
I
U/ v
ial(deli
ver
s300I U),650I
U/vi
al(del
iv
ers600IU),975
I
U/ v
ial(deli
ver
s900I U

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1705
PATI
ENTTEACHI
NG
Pri
ortoi
nit
iati
onoft her
apydiscusswithpatientt
he
dur
ati
onoft herapy,
requir
edmoni t
ori
ng,potenti
al
adver
sereactions,
andriskofmulti
plebir
ths.

Encouragecoupl
et ohav einter
coursedail
y,begi
nni
ng
ont hedaypri
ort
oadmi nistr
ati
onofhCGunt i
l
ovulati
onbecomesappar entbasedoni ndicesto
determinepr
ogestati
onal acti
vi
ty.Careshouldbe
takentoensurei
nsemi nation.

Advisepati
enttonot
ifyheal
thcareprofessi
onali
f
worseningorstr
ongabdomi nal
painoccursorifany
si
deef f
ectthati
spersist
entorbother
someoccur s.

Advi
sefemal
epatient
stonot
if
yheal
thcar
e
pr
ofessi
onal
ifbr
eastf
eedi
ng.

FOMI
VIRSEN
I
NDI
CATI
ONS
Localtr
eatmentofcyt
omegal ovir
us( CMV)ret
ini
ti
sin
pati
entswithAIDSwhoar eint
olerantoforhave
contr
aindi
cati
onstootherformsoft reat
ment.

ACTI
ON
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1706
Bindst ot
argetmRNAwhi chinhi
bit
sprotei
nsynthesi
sand
subsequentv i
ral
repl
icati
on.Therapeut
icEff
ects:
Decreasedv i
sualdet
erior
ationasaconsequenceofCMV
reti
nit
is.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Recent(
wit
hin2–4
wk)I
Vori
ntr
avi
trealci
dof
ovi
r(i
ncr
easedr
iskofocul
ar
i
nfl
ammat
ion)
;Lactati
on.

UseCaut
iousl
yin:
Pregnancyorchi
l
dren(
saf
etynot
est
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:i
ncr
easedint
raocul
arpr
essur
e,ocul
ari
nfl
ammat
ion
(i
ncl
udi
ngir
it
isandvit
ri
ti
s).

I
NTERACTI
ONS
Drug-Dr
ug:Recentuseofci
dof
ovi
rincr
easest
her
iskof
oculari
nfl
ammat i
on.

DOSAGE
I
ntravi
tr
eal(
Adults)
:Induct
ionphase—330mcgev er
y
otherweekfort
wodoses; maint
enancephase—330mcg
onceevery4weeks.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1707
AVAI
LABI
LITY
Sol
utionf
ori
ntr
avi
tr
eal
inj
ect
ion6.
6mg/
mLi
n0.
25-
mL
vi
als;

PATI
ENTTEACHI
NG
Inf
orm pat
ientthatfomiv ersenisnotacur eforCMV
ret
ini
ti
sandt hatreti
nit
ismaycont i
nuetoprogress
duri
ngandaf tert
herapy.Fomi v ersentr
eatsonlythe
eyethatwasi nj
ected;systemicdi seaseorinf
ectionof
theopposi
teey emayal sodev elop.

Inf
orm pati
entt
hatcurrentant
ir
etr
ovi
ral
ther
apy
shouldbeconti
nued,unlessadvi
sedbyheal
thcar
e
professi
onal
.

Advi
sepati
ent
stohav
erout
ineopht
hal
mol
ogi
c
examsfol
l
owingfomi
ver
senther
apy
.

Fondapar
inux
I
NDI
CATI
ONS
Prevent
ionandtr
eatmentofdeepv ei
nthrombosi
sand
pulmonaryemboli
sm.Unlabel
edUses: Sy
stemic
anti
coagulat
ionf
orotherdi
agnoses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1708
ACTI
ON
Bindsselecti
v el
ytoanti
thr
ombi nIII(ATI I
I)
.Thi
sbinding
potenti
atestheneut r
ali
zat
ion(inactivati
on)ofacti
ve
factorX( Xa)
.Therapeuti
cEf f
ects:Interr
upti
onofthe
coagulati
oncascader esul
tingininhibiti
onofthrombus
formation.Prevent
ionofthrombusf ormati
ondecreases
theriskofpulmonar yemboli.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erer
enal
i
mpair
ment( CCr<30mL/ min;↑r i
skofbleeding);Body
wei
ght<50kg( forpr
ophyl
axis)(
mar kedl
y↑ r i
skof
bl
eedi
ng);
Act i
vemajorbl
eeding;Bacteri
alendocardit
is;
Thr
ombocytopeniaduetofondapari
nuxant i
bodies.

UseCaut
iousl
yin:
Mil
d-t
o-moder
ater
enal
impai
rment
(CCr30–50mL/ mi
n);Untr
eatedhypertension;Recent
hist
oryofulcerdisease;Bodyweight<50kg( fortreatment
ofDVTorPE)( may↑ r i
skofbleeding);Geri:Patients>65
yr(↑r i
skofbl eedi
ng);Mali
gnancy;Historyofhepar in-
i
nducedt hrombocy t
openia;OB:Lactat
ion:Pedi :Safetynot
establ
ished;useduringpregnancyonlyifclearlyneeded.
Exerci
seExtremeCauti
oni
n:Hi
stor
yofcongeni
tal
or
acquir
edbleedingdi
sor
der
;Sev
ereuncont
rol
l
ed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1709
hyper tension; Hemorrhagicstr
oke;RecentCNSor
opht halmol ogicsurgery;Act
iveGIbleeding/ulcerat
ion;
Retinopat hy( hyper
tensiveordiabeti
c);
Spi nal
/ epi
dural
anest hesiaorspi nalpuncture(↑r i
skofspi nal/epi
dural
hemat omat hatmayl eadtolong-t
erm orper manent
paralysis).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: conf
usi on,dizziness,headache,i
nsomni a.CV:
edema, hypotension.GI :consti
pati
on,diarr
hea,dy spepsi
a,
↑l iverenzymes, nausea, vomiti
ng.GU: ur
inar
yr etenti
on.
Derm: bul
l
ouser upt ion,hemat oma,purpura,r
ash.Hemat :
bleeding,thrombocy topenia.FandE:hy pokal
emi a.Misc:
fever,↑ wounddr ai
nage.

I
NTERACTI
ONS
Drug-Drug:Ri
skofbleedi
ngmaybe↑ byconcur rentuse
ofwar f
arinordr
ugsthataffectplat
eletfuncti
on, i
ncl udi
ng
aspir
in,NSAIDs,di
pyri
damole, somecephal osporins,
valpr
oates,cl
opi
dogrel,t
icl
opidine,
abciximab, epti
fibati
de,
ti
rofi
ban,anddextr
an.
Drug-NaturalPr
oduct:↑r i
skofbleedi
ngwithar
nica,
chamomi le,cl
ove,dongquai,
feverf
ew,gar
li
c,gi
nger,
gingko,Panaxginseng,andother
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1710
DOSAGE
Tr
eat
mentofDVT/
PE
Subcut(Adul t
s) :<50kg—5mgoncedai l
yforatleast5
daysuntilt
her apeuticanti
coagul
ationwi thwarfari
ni s
achieved(I
NR>2f or2consecuti
veday s);
warfari
nmaybe
star
tedwi t
hin72hroff ondapari
nux( hasbeenusedf orup
to26day s);50–100kg—7. 5mgoncedai l
yforatleast5
daysuntilt
her apeuticanti
coagul
ationwi thwarfari
ni s
achieved(I
NR>2f or2consecuti
veday s);
>100kg—10mg
oncedailyforatl east5day sunt
ilt
her apeuti
c
anti
coagulationwi thwarfari
nisachiev ed(I
NR>2f or2
consecuti
veday s);warf
arinmaybest art
edwi t
hin72hrof
fondapari
nux.

Pr
event
ionofDVT/
PE
Subcut(Adul
ts) :2.
5mgoncedai l
y,star
ti
ng6–8hrafter
surger
y,conti
nuingfor5–9day s(
upto11days)fol
l
owi ng
abdominalsurgeryorknee/hi
prepl
acementorcont
inuing
for24daysfollowinghi
pfract
uresurger
y(upto32day s)
.

AVAI
LABI
LITY
Sol
ut i
onforsubcuti
nject
ion2.5mg/0.5mLi npr
efil
led
syr
inges,5mg/ 0.
4mLi nprefi
ll
edsy
ringes,7.
5mg/ 0.6mL
i
npr efi
ll
edsyri
nges,
10mg/ 0.
8mLinpr ef
il
ledsy
ringes;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1711
PATI
ENTTEACHI
NG
Advi
sepat i
enttorepor
tanysy mpt omsofunusual
bl
eedingorbruisi
ng,di
zziness,
itching,
rash,
fev
er,
swell
ing,ordi
ff
icul
tybreathi
ngtoheal t
hcare
prof
essionali
mmedi at
ely.

Inst
ructpat
ientnott
otakeaspi
rinorNSAIDswithout
consult
inghealt
hcarepr
ofessi
onaldur
ingther
apy.

For
mot
erol
I
NDI
CATI
ONS
Asconcomi tanttherapyforthet reatmentofast hmaand
thepr ev
ent i
onofbr onchospasm i npat ientswhoar e
currentl
ytakingbutar einadequat elycont r
olledonal ong-
term asthma- contr
ol medicati
on( e.g.inhaled
corti
costeroid)(Foradil
only).Prev ent
ionofexer ci
se-
i
nducedbr onchospasm ( Foradi
l only)
.Mai ntenance
treatmenttopr eventbronchospasm i nchroni cobstr
ucti
ve
pulmonar ydisease( COPD)i ncl
udi ngchr onicbronchit
is
andemphy sema.

ACTI
ON
Pr
oducesaccumul
ati
onofcy
cli
cadenosi
ne

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1712
monophosphat e(cAMP)atbeta-adrenergi
crecept
ors,
result
ingi
nr el
axati
onofair
waysmoot hmuscle.Rel
ati
vel
y
specifi
cforbeta2(pul
monary)receptors.Ther
apeut
ic
Effect
s:Bronchodil
ati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Acut
eat
tackof
asthma( onsetofacti
onisdel
ayed);Pati
entsnotrecei
ving
along-t
erm asthma-contr
olmedicati
on(e.g.i
nhal
ed
corti
costeroi
d);
Patient
swhoseast hmaiscurrent
ly
control
ledonlow-ormedi um-
dosei nhal
edcorti
coster
oid
therapy
.

UseCaut
iousl
yin:
Car
diov
ascul
ardi
sease(
incl
udi
ng
angi
naandhy pertension)
;Diabetes;Glaucoma;
Hyperthyroidi
sm; Pheochr omocy toma; Excessi v
euse
(mayleadt ot oler
anceandpar adoxical br
onchospasm) ;
OB:Lactat i
on: Pedi:Pregnancy,l
actation,orchi l
dren<5y r
(mayinhibitcont r
act i
onsduringlabor;useonl yifpotenti
al
benefi
tsout wei ghrisks;i
nchildr
en,af ixed-dose
combinationpr oductcont ai
ningformot erol andani nhaled
cort
icosteroidshoul dbest r
onglyconsi deredt oensur e
adherence).

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1713
CNS: dizzi
ness, fati
gue,headache, insomni a,malaise,
nervousness.Resp: ASTHMA- RELATEDDEATH,
PARADOXI CALBRONCHOSPASM.CV: angina,arrhythmias,
hypertension, hypotensi
on,pal pi
tati
ons,tachycardia.GI:
drymout h, nausea.FandE: hy pokalemia.Metab:
hyperglycemi a,met abol
icacidosis.MS: muscl ecramps.
Neuro: tr
emor .Misc:all
ergi
cr eacti
onsincluding
anaphy l
axis.

I
NTERACTI
ONS
Drug-Drug: Concur r
entusewi t
hMAOi nhibit
ors,tr
icycl
i
c
anti
depr essants,orotheragent sthatmaypr ol
ongt heQTc
i
ntervalmayr esulti
nser i
ousar r
hy t
hmi asandshoul dbe
undertakenwi thext r
emecaut ion.↑ r i
skofhy pokalemia
withtheophy l
line,cort
icoster
oids,potassium- l
osing
di
uretics.Betabl ockersmay↓ t herapeuticeffect
s.↑
adrenergiceffectsmayoccurwi thconcur rentuseof
adrenergics.

DOSAGE
Ast
hma
Inhal
n:(
Adult
sandChi
l
dren≥5yr
):1capsul
e(12mcg)
every12hrusi
ngt
heAerol
i
zerI
nhal
er.
Pr
event
ionofExer
cise-
InducedBr
onchospasm

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1714
I
nhaln:(
Adult
sandChildren≥5yr)
:1capsul
e(12mcg)at
l
east15minbeforeexerciseonanoccasi
onalas-
needed
basi
s;addi
ti
onaldosesshouldnotbeusedforatl
east12
hr.

COPD
I
nhaln:
(Adul
ts):Foradil
-1capsule(12mcg)ev
ery12hr
usi
ngtheAerol
i
zerI nhal
er;Perf
oromist-
20mcg/2mL-uni
t-
dosevi
altwi
cedailyviajetnebul
izer.

AVAI
LABI
LITY
CapsuleforAerol
izeruse(Foradil
)12mcg;Inhal
ati
on
sol
uti
onf ornebul
izati
on(Perf
or omist
)20mcg/ 2mL;I
n
combinati
onwi t
h:budesonide(Symbicor
t)and
momet asone(Dulera)
;

PATI
ENTTEACHI
NG
Instructpatienttot akef omot erolasdir
ected.Donot
discontinuet herapywi thoutdi scussi
ngwithhealth
carepr ofessional,eveni ffeeli
ngbet t
er.I
fona
schedul eddosi ngregimen, takeami sseddoseas
soonasr emember ed,spaci ngr emaini
ngdosesat
regularintervals.Donotdoubl edoses.Usear apid-
actingbr onchodi l
atorifsy mpt omsoccurbef orenext
dosei sdue.Caut i
onpat ientnottousemor ethan2

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1715
 ti
mesadayorl esst
han12hrapar t;maycause
adverseeffects,par
adoxicalbr
onchospasm, orl
oss
ofeffect
ivenessofmedi cati
onInst
ructpati
entto
revi
ewmedi cati
onguidewi t
heachRxr ef
il
l.

Advi
sepatientt
ohavear api
d-act
ingbronchodi
lator
avai
l
abl
ef oruseatall
timesforsymptomat i
creli
efof
acut
easthmaat t
acks.

I
nst
ructpatientt
ocont acthealt
hcar eprofessi
onal
i
mmediatelyifshort
nessofbr eathisnotreliev
edby
medi
cati
onornausea, vomit
ing,shakiness,headache,
f
astorir
regularheart
beat,orsleepl
essnessoccur .

Inst
ructpati
enttonotifyheal
thcarepr of
essionalif
ther
ei snoresponsetot heusualdoseori fcontents
ofonecanisterareusedi nl
essthan2wk.Ast hma
andtreatmentregimenshouldber e-eval
uatedand
cort
icoster
oidsshouldbeconsidered.Needf or
i
ncreaseduset otreatsymptomsi ndicat
esdecr ease
i
nast hmacont r
olandneedt oreevaluatepatient’
s
ther
apy .

Advi
sepati
enttoconsul
thealt
hcar epr ofessi
onal
bef
oret
akinganyRx,OTC,orherbal productsor
al
cohol
concurrent
lywit
hthi
stherapy .Caut i
onpati
ent
al
sotoavoidsmokingandotherrespiratoryir
ri
tant
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1716
Advi
sepati
entt
onotif
yhealt
hcareprof
essi
onali
f
pr
egnancyi
splannedorsuspect
ed,
orifnur
sing.

Inhal
er:I
nstr
uctpat ientoncor recttechniqueforuse
ofAeroli
zerInhaler.Advisepatientalway stousenew
Aerol
izerI
nhalert hatcomeswi theachr efi
ll
.Take
sti
ckerwith"useby "datewr i
ttenbyphar macistfr
om
theoutsi
deoft heboxandpl acei tont heAeroli
zer
Inhal
ercover.Ifthedatei sblank,count4mof r
om the
dateofpurchaseandwr itedateonst i
cker.Usenew
i
nhalerandbl i
sterpackf oll
owingt he"useby "date.

I
nform pat
ientthatf
ormot
erol
mayi
ncr
easet
her
isk
ofast
hma- rel
ateddeat
h.

Inf orm pati

entthati nrar
ecasescapsul emightbr eak
i
nt osmal lpi
eces.Thesepi ecesshouldber etainedby
thescr eeninthei nhal
er,howeverinrar
einstances
tinypi ecesmayr eachmout horthroataft
erinhalati
on.
Shat ter i
ngofcapsul eisl
essl i
kel
ytohappeni f
st orageconditionsar estri
ctl
yfol
lowed,capsules
remov edf r
om blisteri
mmedi atel
ybeforeuse, and
capsul esareonlypi er
cedonce.

Fosampr
enav
ir
I
NDI
CATI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1717
Withotherant
ir
etr
ovi
ral
sint
hemanagementofHI
V
i
nfect
ion.

ACTI
ON
Inhibi
tstheacti
onofHIVpr ot
easeandpr ev
entsthe
cleavageofvir
alpoly
prot
eins.Ther
apeuticEff
ects:
IncreasedCD4cellcount
sanddecr easedvir
alloadwi
th
subsequentslowedprogressi
onofHI Vanditssequel
ae.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty,
sul
fonami
de/
sul
fa
hypersensi
ti
vi
ty;Sev er
ehepaticimpai rment;Concurrent
useoff l
ecai
nide,propafenone,r
ifampi n,er
gotder i
vati
ves,
St.John'swort,
lovastati
n,si
mv astatin,pi
mozi de,
delavi
rdi
ne,si
ldenafil(
Revati
o),alfuzosin,midazol
am or
tr
iazolam.

UseCaut
iousl
yin:
Ger
i:Consi
derage-
rel
ated↓ i
nbody
mass, cardiac/hepatic/r
enal i
mpairment ,
concur r
ent
i
ll
nessandmedi cati
ons; Hepaticimpairment;Concurrent
useofmedi cati
onshandl edbyoraf fecti
ngt heCYP3A4
enzymesy stem (mayr equireserum l
evel monitor
ing,dose
ordosingi nterv
alalterat
ions);OB:Lactati
on: Pedi
:
Pregnancy ,lact
ati
on, chi
ldren<2y r(
safetynotest abl
i
shed;
breastfeedingnotr ecommendedi nHI V-i
nfectedpati
ents).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1718
ADVERSEREACTI
ONSANDSI
DEEFFECTS
Ref
lect
susewi
thot
herant
ir
etr
ovi
ral
s
CNS: headache, fati
gue, mooddisor ders.CV:
MYOCARDI ALI NFARCTI ON.GI:diarrhea,nausea, vomit
ing,
abdomi nalpain,↑l i
verenzymes.Der m: rash.Endo:
glucoseintolerance.GU: nephrol
ithi
asi s.Hemat :
neutropenia.Met ab:↑ cholesterol,
fatr edistr
ibut
ion,↑
tr
iglycer
ides.Mi sc:all
ergicreact
ionsi ncludingstevens-
j
ohnsonsy ndrome, ANGI OEDEMA, i
nf l
ammat oryresponse
tooppor t
unisti
ci nfecti
on.

I
NTERACTI
ONS
Drug-Dr ug: Ampr enavir
, t
heact ivemoi etyof
fosampr enav i
ri smet abolizedbyCYP3A4; italsoi nhibit
s
andi nducest hisenzy mesy st em.Theact ionofanyot her
medi cationt hati salsohandl edbyoraf fectst hissy stem
maybeal teredbyconcur r
entuse.↑ bl oodl evelsandr i
sk
oftoxicityf rom f l
ecainide,propaf enone, rif
ampi n,ergot
derivati
v es( di
hy droergotami ne, ergotami ne, ergonov i
ne,
met hylergonov i
ne) ,l
ovastatin, simv astatin,pimozi de,
delavir
di ne,sildenaf i
l(Revat i
o) ,alfuzosin, midazol am, or
tri
azolam; concur r
entusecont raindicated.Bl oodl evels
are↓ byef avirenz( addit
ional r
itonav i
rmayber equired
whenusedt oget her),
nev i
rapi ne, l
opinav i
r/rit
onav ir,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1719
saqui nav ir
, car bamazepi ne, phenobar bi tal,pheny toin,
dexamet hasone, hist ami neH2- recept orant agoni sts,and
proton- pumpi nhibitor s; moni torf or↓ ant i
ret roviral
activit
y.Concur r
entusewi thr altegr av irmay↓ l evelsof
ampr enav irandr altegr av i
r .Lev el sar e↑ byi ndinav i
rand
nelfi
nav i
r.May↓ met hadoneandpar oxet i
nel evels.↑
l
ev elsandr iskoft oxi cityf rom ami odar one, lidocai ne,
quinidine( moni t
orbl oodl ev els), ket oconazol e,and
i
traconazol e( doseofi t
raconazol eorket oconazol eshould
notexceed200mg/ daywhenf osampr enav irisusedwi t
h
ri
tonav iror400mg/ daywhenusedwi thout ), ri
fabut in
(moni torf orneut ropeni a, ↓r i
f abut indoseby50%when
usedwi thf osampr enav irorby75%whenusedwi t
h
fosampr enav irwithr itonav ir),at or v
ast atinand
rosuv ast atin( dosenott oexceed20mg/ dayorconsi der
otherHMG- CoAr educt asei nhi bitor s), cyclospor i
neor
tacrolimus( moni torbl oodl evel sofi mmunosuppr essants)
,
calcium channel blocker s( cl i
nical moni t
oring
recommended) ,
somebenzodi azepi nes( alprazol am,
clorazepat e, diazepam, flur azepam; dose↓ of
benzodi azepi nemaybeneeded) , si
ldenaf i
l,tadal afil
,and
vardenaf il
( usecaut iousl y ;↓ doseofsi ldenaf i
lto25mg
every48hr , fortadal af i
l singl edoseshoul dnotexceed10
mgi nany72hrper iod, doseofv ardenaf ilshoul dnot
exceed2. 5mgev er y24hri fusedwi t
houtr itonav i
ror2.5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1720
mgev ery72hrwi thr it
onav irwi thmoni toringf ortoxicit
y )
andt ricycli
cant idepr essant s(bl oodl ev elmoni toring
recommended) .Mayal tertheef fect sofwar fari
n( moni tor
INR)orhor monal cont racept iv
es( useal t
ernat i
vemet hod
ofcont r
acept i
on) .May↑ f l
ut i
casonel evels;concur rent
usenotr ecommended.May↑ r iskofadv erseef fectswi t
h
salmet erol;concur rentusenotr ecommended.May↑
bosent anl evels;ini
tiatebosent anat62. 5mgoncedai l
yor
ever yotherday ;i
fpat ientalreadyr ecei vingbosent an,
discont i
nuebosent anatl east36hrbef oreiniti
ationof
fosampr enav i
randt henr est artbosent anatl east10day s
l
at erat62. 5mgoncedai l
yorev er yot herday .May↑
tadalaf i
l(Adcirca)lev els;init
iatet adal afil(Adcirca)at20
mgoncedai l
y;ifpat i
ental readyr ecei v i
ngt adal f
il(Adcirca),
discont i
nuet adal af
il (Adcirca)atl east24hrbef ore
i
nitiati
onoff osampr enav i
randt henr est arttadalafil
(Adci r
ca)atl east7day slaterat20mgoncedai l
y.May↑
colchicinel evels;↓ doseofcol chi cine; donotadmi nister
colchicinei fpatientshav erenal orhepat icimpai rment .
Drug-NaturalProduct
:Concurr
entuseofSt.John'
swor
tis
contrai
ndicated;↓ bl
oodlevel
sandmayl eadto↓
vi
rologi
cr esponse.

DOSAGE
PO:
(Adul
ts)
:Tr
eat
ment
-nai
vepat
ient
swi
thout

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1721
ri
tonavir—1400mgt wicedail
y;Treatment -naiv
epatients
withri
tonavir—1400mgoncedai l
ywi t
hr i
tonav i
r100or
200mgoncedai l
y,or700mgt wicedailywi thri
tonavi
r100
mgt wicedaily.Pr
oteaseinhibi
tor–exper i
enced
pati
ents—700mgt wi cedai
lywithr i
tonavir100mgt wice
dail
y.I
fef avi
renzisaddedt oaoncedai l
yr egimenusing
bothfosampr enavi
randr i
tonavir,anadditional100mgof
ri
tonavir(t
otalof300mg)shoul dbegi ven.
PO:(Chil
dren2–5yr
):Tr
eat
ment
-nai
ve—30mg/
kgt
wice
dai
l
y, nott
oexceed1400mgtwi
cedail
y.
PO: (Chi l
dren≥6y r)
: Treatment -
naive—30mg/ kgtwice
daily,nottoexceed1400mgt wicedai l
y,or18mg/ kg
twicedai ly(nottoexceed700mgt wi cedail
y)with
ri
tonav ir3mg/ kgt wicedai l
y(nott oexceed100mgt wice
daily)
; Proteaseinhibit
or-experienced—18mg/ kgtwice
daily(nott oexceed700mgt wicedai ly
)withri
tonavi
r3
mg/ kgt wicedaily(nott oexceed100mgt wicedail
y).
Whenusedwi t
houtr i
tonav i
rinchildren≥47kg, mayuse
adultr egimenof1400mgt wicedai l
y.
Hepat
icI
mpai
rment
PO: (
Adults):Mi l
dhepati
cimpair
ment–700mgt wicedai
ly
withoutri
tonavir(t
her
apy-nai
ve)or700mgtwicedail
ywith
ri
tonavir100mgoncedai l
y(t
herapy-
nai
veorprot
ease
i
nhibit
orexperienced);
Moderatehepati
cimpai
rment-700

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1722
mgt wicedailywithoutri
tonavi
r(therapy-
naive)or450mg
twi
cedai l
ywi t
hr i
tonavi
r100mgoncedai ly(t
herapy-nai
ve
orproteaseinhibi
torexperi
enced);Sev er
ehepat i
c
i
mpai r
ment —350mgt wicedail
ywi thoutrit
onav i
r(t
herapy-
nai
ve)or300mgt wicedail
ywithr i
tonavir100mgonce
dai
ly(therapy-
naiveorproteaseinhibit
orexperienced).

AVAI
LABI
LITY
Tabl
ets700mg;
Oral
suspensi
on50mg/
mL;

PATI
ENTTEACHI
NG
Emphasi zethei mpor t
anceoft akingf osamprenav i
r
asdi r
ect ed.Adv isepati
entt or eadt hePat i
ent
Informat i
ont hatcomeswi tht hepr escripti
onpr i
orto
i
nitiat
ionoft her apyandwi t heachpr escri
pti
onr efi
l
l,i
n
caseofchanges.Fosampr enav i
rmustal waysbe
usedi ncombi nat i
onwithot herant i
retrovir
aldrugs.
Donott akemor et hanprescr i
bedamountanddonot
stopt akingwi thoutconsult i
ngheal thcar e
professional.Takemi sseddosesassoonas
remember edi fwi t
hin4hr sofschedul eddose.I f
mor et han4hr s,skipdose, thenretur ntoregular
schedul e.Ifadosei sski
pped, donotdoubl ethenext
doses.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1723
Inst
ructpati
entthatfosampr
enav
irshoul
dnotbe
sharedwithothers.

Inform pati
entthatfosampr enav i
rdoesnotcur eAIDS
orpr ev
entassociatedoroppor tunisticinf
ect
ions.
Fosampr enavirdoesnotr educet her i
skof
transmissionofHIVt oot hersthroughsexual contact
orbloodcont amination.Cautionpat i
enttousea
condom andt oavoidshar i
ngneedl esordonating
bloodtopr eventspreadingtheAI DSv ir
ustoothers.
Adv i
sepat i
entthatthelong-term ef fectsof
fosampr enavirar
eunknownatt hist i
me.

Emphasizet heimpor tanceofpr ovi

dinghealthcare
prof
essional wit
haccur atecurrentdrughistoryand
noti
fyi
ngheal thcar epr ofessi
onalbeforetakingany
Rx,OTC, orherbal product sbecauseofpot ential
l
y
seri
ousdr uginteractions.

I
nstructpat
ienttonoti
fyheal
thcareprof
essi
onal
if
nausea,vomiti
ng,di
arr
hea,orrashoccur
s.

Inf
orm pat i
entthatr
edi st
ribut
ionandaccumul at
ionof
bodyf atmayoccur ,causingcentralobesi
ty,
dorsocer v
ical
fatenlargement( buff
alohump),
peri
pher alwasti
ng,breastenlargement,and
cushingoidappearance.Thecauseandl ong-t
erm

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1724
 ef
fect
sar
enotknown.

Maydecreaseef f
ecti
venessofhormonal
contr
acept
ives;advi
sepatienttouseanonhor
monal
for
m ofcontracepti
onduringther
apy.

Emphasizetheimport
anceofregul
arfol
l
ow-upexams
andbloodcountstodeter
mineprogr
essandmonitor
forsi
deeffect
s.

Foscar
net
I
NDI
CATI
ONS
Treat
mentofcy tomegal
ovi
rus(CMV)r et
ini
tisi
nHI V-
i
nfectedpati
ents(al
oneorwithganci
clovir
).Treatmentof
acycl
ovir
-r
esist
antmucocutaneousherpessimpl exvi
rus
(HSV)inf
ecti
onsi ni
mmunocompr omisedpat i
ents.

ACTI
ON
Prevent
sv i
ralr
epl
icat
ionbyinhibi
tingvi
ralDNA-
poly
mer aseandrever
setranscri
ptase.Therapeuti
cEff
ect
s:
Vir
ustat
icacti
onagainstsuscepti
blevir
usesincludi
ng
CMV.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1725
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Renal
impai
rment(
dose↓ r
equi
redi
f
CCr≤1.4–1.6mL/min/
kg;seeproducti
nfor
mation)
;
Histor
yofseizur
es;
OB:Lactat
ion:Pedi
:Saf
etynot
establ
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, headache, anxi ety,conf usion,dizziness,
fati
gue, mal aise, ment al depr ession, weakness.EENT:
conjunct ivi
tis, ey epai n, v i
sionabnor mal i
ti
es.Resp:
coughi ng, dy spnea.CV: chestpai n, ECGabnor maliti
es,
edema, palpi tations.GI : diar rhea, nausea, vomiti
ng,
abdomi nal pai n, abnor mal tast esensat i
on, anorexia,
const ipati
on, dy spepsi a.GU: renal failur
e, albuminur i
a,
dysur i
a, noct uria, pol yur i
a, urinar yretent i
on.Der m: ↑
sweat ing,pr ur i
tus, r ash, ski nul cerat i
on.FandE:
hypocal cemi a, hy pokal emi a, hypomagnesemi a,
hyper phosphat emi a, hy pophosphat emi a.Hemat : anemi a,
granul ocytopeni a, l
eukopeni a.Local : pain/infl
ammat ionat
i
nject i
onsi te.MS: ar t
hr algia, my algia, backpai n,
i
nv oluntarymuscl econt raction.Neur o:ataxia,
hypoest hesi a, neur opat hy ,par esthesi a,tremor .Mi sc:fever
,
chil
ls, fl
u-l
ikesy ndr ome, lymphoma, sarcoma.

I
NTERACTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1726
Drug-
Drug:Concurrentusewit
hpar ent
eralpentami di
ne
mayresultinsever
e, l
i
fe-
thr
eateninghypocal
cemi a.Risk
ofnephrot
oxici
tymaybe↑ byconcur r
entuseofot her
nephrot
oxicagents(amphoter
icinB,aminoglycosides).

DOSAGE
I
V: (
Adul t
s):CMVr eti
nit
is—60mg/kgq8hror90mg/ kgq
12hrf or2–3wk, t
hen90–120mg/ kg/
dayasasi ngle
dose.Dose↓ r equi
redforanydegr
eeofrenali
mpairment
;
HSV—40mg/ kgq8–12hrf or2–3wkorunti
lheali
ng
occurs.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion24mg/
mL;

PATI
ENTTEACHI
NG
I
nf orm pat
ientt hatf
oscarnetisnotacureforCMV
reti
nit
is.Progressionofretini
ti
smaycont i
nuein
i
mmunocompr omisedpatientsdur
ingandafter
therapy.Advisepat i
ent
st ohav er
egular
ophthalmologicexams.

Advi
sepati
enttonot
if
yhealthcarepr
ofessi
onal
i
mmediatel
yifper
ior
alti
ngl
ingornumbnessinthe
ext
remi
ti
esorparest
hesiaoccursdur
ingoraft
er

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1727
 i
nfusion.I
fthesesi
gnsofelect
roly
teimbal
anceoccur
duri
ngadmi ni
str
ati
on,inf
usi
onshouldbestoppedand
l
absampl esforserum el
ect
rol
yteconcent
rat
ions
obtai
nedimmedi at
ely
.

Emphasi
zet
heimport
anceoffr
equentfol
low-up
examstomoni
torr
enalf
unct
ionandelect
roly
tes.

Fosf
omy
cin
I
NDI
CATI
ONS
Uncomplicat
edur
inar
ytr
acti
nfect
ionsi
nwomen(
acut
e
cyst
it
is)
.

ACTI
ON
Inacti
vatesanenzy mecr ucialforbacteri
alcel
lwal l
synthesis.Decreasesadher enceofbact er
iato
uroepit
helialcell
s.TherapeuticEff
ects:Bacteri
cidalact
ion
againstsuscept i
blebacteri
a.Spect r
um: Acti
veagainst:
Enterococcusf aecal
isandEscher ichiacol
i.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pyel
onephr
it
is;
Lact
ati
on:
Lact
ati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1728
UseCaut
iousl
yin:
OB:
Pedi
:Pr
egnancyorchi
l
dren<12y
r
(
saf
etynotest
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zzi
ness,headache,
weakness.GI:
PSEUDOMEMBRANOUSCOLI TIS,
diarr
hea,dy
spepsi
a,
nausea.GU:vagini
ti
s.

I
NTERACTI
ONS
Drug-Drug:
Uri
nar
yexcreti
onandbl
oodl
evel
sar
e
decreasedbymetocl
opramide.

DOSAGE
PO:
(Adul
tsandChi
l
dren≥18y
r):
3gsi
ngl
edose.

AVAI
LABI
LITY
Sachet3g;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientoncor
rectpr
epar
ati
onofsachet
.

Instructpatientt
onot i
fyhealt
hcar eprofessi
onal
i
mmedi atelyifdi
arrhea,abdominalcramping,fev
er,
or
bloodyst oolsoccurandnott otreatwith
antidiar
rhealswithoutconsult
inghealthcare

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1729
 pr
ofessi
onal
s.

Advi
sepati
entt
onotifyheal
thcar
eprofessi
onalif
symptomshavenotimprovedorper
sistmorethan
2–3daysaft
ertr
eatment.

Fosi
nopr
il
I
NDI
CATI
ONS
Al
oneorwit
hotheragent
sinthemanagementof
hy
pert
ensi
on.Managementofhear
tfai
lur
e.

ACTI
ON
Angiotensin-convertingenzy me( ACE)inhibitorsblockthe
conver si
onofangi otensi nItot hevasoconst r
ictor
angiotensinII.ACEi nhibitor
sal sopreventthedegr adati
on
ofbrady ki
ninandot herv asodil
atoryprostaglandins.ACE
i
nhibitorsalso↑ pl asmar eninlevel
sand↓ al dosterone
l
evels.Netr esulti
ssy stemicv asodil
ati
on.Ther apeutic
Eff
ect s:Lower i
ngofBPi npatientswithhyper t
ension.
Decreasedaf t
erl
oadandsy mpt omsi npatientswi t
hheart
fai
lure.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Bil
ater
alr
enal
art
ery

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1730
st
enosis;Historyofangioedemawi t
hprevi
oususeofACE
i
nhibit
ors;OB: Cancauseinjur
yordeathoffetus–if
pregnancyoccur s,
disconti
nueimmediatel
y.
Lactat
ion:
Appearsinbreastmi lk;
pati
entmustdisconti
nuefosinopr
il
orprovi
deal t
ernatetobreastmilk.

UseCaut
iousl
yin:
Pat
ient
swi
thr
enal
impai
rment
,
hypov olemia, hyponatremia,
andconcur r
entdiureti
c
therapy; Bl
ackpat i
ents(monot her
apyforhypert
ension
l
essef f
ective, mayrequireadditi
onalt
herapy;hi
gherr i
sk
ofangi oedema) ;Surgery
/anesthesi
a(hypotensi
onmaybe
exagger ated);Womenofchi ldbeari
ngpotenti
al;Pedi:
Children<6y r(safetynotestabli
shed)
;Geri
: I
nit
ialdose↓
recommended.
Exer
ciseExt
remeCaut
ioni
n:Fami
l
yhi
stor
yof
angi
oedema.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,fatigue, headache,insomnia,weakness.
Resp: cough.CV: hy potension,chestpai
n, edema.GI:
abdomi nal pain,
di arrhea,nausea, vomit
ing.GU: er
ecti
l
e
dysfunction, i
mpai redr enalfuncti
on.Derm: rash.FandE:
hyperkalemi a.MS: muscl ecramps.Resp: dyspnea.Misc:
ANGI OEDEMA.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1731
I
NTERACTI
ONS
Drug-Drug: Excessivehy potensionmayoccurwi th
concur r
entuseofdi ureti
cs.Addi ti
vehy potensionwith
otherant i
hyper t
ensiveagent s.↑ r i
skofhy perkalemiawith
concur r
entuseofpot assium suppl ement s,potassi
um-
sparingdiuretics,potassium- contai
ningsal tsubsti
tut
es,or
angiotensinIIreceptorant agonists.NSAI Dsandsel ect
ive
COX- 2inhibit
or smaybl untt heant i
hypertensiveeff
ectand
↑t her i
skofr enal dysfunction.Absor pti
onmaybe↓ by
antacids(separ ateadmi nist
r at
ionby1–2hr )
.↑ level
sand
may↑ t her i
skofl i
thium toxicit
y.

DOSAGE
PO:(Adults)
:Hypert
ension—10mgoncedai l
y,maybe↑
asrequir
edupt o80mg/ day.Hear
tfai
lur
e—10mgonce
dai
ly(5mgoncedai lyi
npatient
swhohav ebeen
vi
gorouslydi
uresed)
,maybe↑ ov ersever
alweeksupt
o
40mg/ day.
PO:(Chi
l
dren≥6y
rand>50kg)
:Hy
per
tensi
on—5–10mg
oncedai
ly.

AVAI
LABI
LITY
Tabl
ets10mg, 20mg,40mg;
Incombi
nat
ionwi
th:
hydr
ochl
orot
hiazi
de.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1732
PATI
ENTTEACHI
NG
Inst
ructpati
entt
otakemedi cati
onasdirect
edatt he
samet imeeachday,eveniffeel
ingwel
l
.Takemi ssed
dosesassoonasr emember edbutnotifalmosttime
fornextdose.Donotdoubledose.Warnpat i
entnot
todiscont
inueACEinhi
bitorther
apyunl
essdi r
ected
byhealthcarepr
ofessi
onal.

Cautionpat i
enttoavoidsaltsubsti
tutescont
aini
ng
potassium orfoodscontaininghighlevel
sof
potassium orsodium unl
essdi r
ectedbyhealthcare
professional

Caut
ionpatientt
ochangeposi tionsslowlyto
mini
mi zeort
hostati
chy potension.Useofalcohol,
st
andingforlongperiods,exercising,andhotweather
mayincreaseorthost
atichy potension.

Advisepatientt
oconsul
thealt
hcareprofessional
beforetaki
nganyOTCcough, col
d,orall
ergy
remedies,orothermedi
cat
ionsorherbalproducts.

Maycausedizziness.Cauti
onpat
ientt
oavoi
ddriv
ing
andot
heractiv
itiesrequi
ri
ngal
ert
nessunt
ilr
esponse
tomedi
cati
oni sknown.

Adv
isepat
ientt
oinf
orm heal
thcar
epr
ofessi
onal
of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1733
 medi
cat
ionr
egi
menbef
oret
reat
mentorsur
ger
y.

Inst
ructpat ienttonot i
fyheal thcarepr ofessionali
f
rash;mout hsor es;sorethr oat; f
ever;swellingof
handsorf eet;i
rregularhear tbeat;chestpai n;dry
cough; hoarseness; swelli
ngoff ace, eyes,li
ps,or
tongue; orifdiff
icul
tyswal lowi ngorbr eathingoccurs.
Persist
entdr ycoughmayoccurandmaynotsubsi de
unti
l medicat i
oni sdiscontinued.Consul thealt
hcare
professional i
fcoughbecomesbot hersome.Al so
notif
yheal thcarepr ofessional ifnausea, vomiti
ng,or
diarr
heaoccur sandcont inues.

Advisewomenofchi ldbeari
ngagetouse
contracept
ionandnotifyheal
thcarepr
ofessi
onal
of
pregnancyisplannedorsuspected.

Emphasizetheimport
anceoff
oll
ow-
upexami
nat
ions
toev
aluateeff
ecti
venessofmedi
cat
ion.

Hy pertensi
on:Encouragepatienttocomplywi t
h
additi
onal i
nter
ventionsforhypert
ension(weight
reduction,l
owsodi um di
et,di
scontinuati
onof
smoki ng,moderationofalcoholconsumpt i
on,regul
ar
exercise,andstressmanagement )
.Medicati
on
controlsbutdoesnotcur ehypertension.

I
nst
ructpat
ientandf
ami
l
yoncor
rectt
echni
quef
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1734
 monit
ori
ngBP.Adv isethem tocheckBPatleast
weekl
yandt orepor
tsignif
icantchangest
ohealt
h
car
eprofessi
onal.

Fospheny
toi
n
I
NDI
CATI
ONS
Short-term(<5day)parenteral
managementof
gener ali
zed,
convulsi
vestatusepil
epti
cuswhenuseof
pheny toini
snotfeasibl
e.Treatmentandprev
ent
ionof
seizuresduringneurosur
gerywhenuseofphenytoi
nisnot
feasible.

ACTI
ON
Limitsseizurepropagati
onbyal ter
ingiontransport.May
alsodecr easesynapti
ctransmission.Fosphenytoinis
rapidlyconvertedt
opheny toin,
whichisresponsiblefori
ts
phar macologiceff
ects.Therapeuti
cEffects:Dimini
shed
seizureactivi
ty.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sinusbr
ady
car
dia,
si
noat
ri
alblock,
2nd-or3r
d-degr
eeAVhear
tbl
ockor
Adams-St
okessyndrome.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1735
UseCaut
iousl
yin:
Hepat
icorr
enal
disease(
↑ri
skof
adverser eact
ions;dosereducti
onrecommendedf or
hepaticimpairment )
;OB:Safetynotest
abli
shed;may
resul
tinf etal
hy dant
oinsyndromeifusedchroni
call
yor
hemor rhageint henewbornifusedatter
m; Lact
ati
on:
Safet
ynotest abli
shed.
Exerci
seExtremeCaut ionin:
Pati
entsposit
iveforHLA-
B*1502all
ele( unl
essexcepti
onalci
rcumstancesexist
wherebenefi
t sclear
lyoutweight
herisks)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,drowsi ness,ny stagmus, agitati
on,brain
edema, headache, stupor,vertigo.EENT: ambl yopia,
deafness, dipl
opia,tinnit
us.CV: hypotension( withrapi
dI V
admi ni
st r
ation)
,tachy cardia.GI :
dr ymout h,nausea, t
aste
perversion,tonguedi sorder ,
vomi ting.Derm: pruri
tus,rash,
STEVENS- JOHNSONSYMDROME.MS: backpai n.Neuro:
ataxi
a, dysarthr
ia,ext r
apyrami dal syndrome, hypesthesia,
i
ncoor dinati
on,par esthesia,tremor .Misc: pelv
icpain.

I
NTERACTI
ONS
Drug-Dr
ug:Disul
fi
ram,acuteingesti
onofalcohol
,
amiodarone,
ethosuxi
mi de,i
soniazi
d,chl
orampheni
col,
sulf
onamides,fl
uoxet
ine,gabapenti
n,H2antagoni
sts,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1736
benzodi azepi nes, omepr azol e, ket oconazol e, fluconazole,
estrogens, succi nami des, hal ot hane, met hy lpheni dat e,
phenot hiazi nes, salicy lates, ticlopi di ne, tolbut ami de,
topiramat e, trazodone, f elbamat e, andci met idi nemay↑
pheny toinbl oodl ev els.Bar bitur at es, car bamazepi ne,
reserpine, andchr onici ngest i
onofal cohol may↓
pheny toinbl oodl ev els.Pheny t oinmay↓ t heef f
ectsof
ami odarone, benzodi azepi nes, car bamazepi ne,
chlorampheni col ,cor ti
cost eroi ds, di sopy r ami de, warfari
n,
fel
bamat e, doxy cycline, l
amot r i
gi ne, or al cont racept i
ves,
paroxet i
ne, pr opaf enone, rifampi n, ri
tonav ir,qui nidine,
tacroli
mus, theophy ll
ine, topiramat e, tri
cy cl i
c
antidepressant s,zoni sami de, met hadone, cy clospor ine,
andest r
ogens.I Vpheny toinanddopami nemaycause
additiv
ehy pot ension.Addi ti
veCNSdepr essi onwi t
hot her
CNSdepr essant s, i
ncl udi ngal cohol , antihi stami nes,
antidepressant s,opi oids, andsedat i
v e/hy pnot ics.
Antacidsmay↓ absor pt i
onofor al l
yadmi nister ed
pheny toin.↑ sy stemi ccl ear anceofant il
eukemi cdr ugs
teniposideandmet hot r exat ewhi chhasbeenassoci ated
withawor seev ent -fr
eesur vi
v al, pheny toinusei snot
recommendedi nchi ldrenunder goi ngchemot her apyf or
acut el
y mphocy ti
cl eukemi a.Cal cium andsucr al f
ate↓
pheny toinabsor ption.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1737
DOSAGE
Note:Dosesoffosphenyt
oinar
eexpr
essedaspheny
toi
n
sodium equi
val
ents[PE]

St
atusEpi
l
ept
icus
I
V:(
Adul
ts)
:15–20mgPE/
kg.

Nonemer
gentandMai
ntenanceDosi
ng
I
V:I
M:(
Adult
sandChildr
en>16y r
):Loadi
ngdose—10–20
mgPE/
kg.Maint
enancedose—4–6mgPE/ kg/day
.
I
V:I
M:(
Chi
l
dren10–16y
r):
6–7mgPE/
kg/
day
.
I
V:I
M:(
Chi
l
dren7–9y
r):
7–8mgPE/
kg/
day
.
I
V:I
M:(
Chi
l
dren4–6y
r):
7.5–9mgPE/
kg/
day
.
I
V:I
M:(
Chi
l
dren0.
5–3y
r):
8–10mgPEkg/
day
.
I
V:I
M:(
Inf
ant
s):
5mgPEkg/
day
.
I
V:I
M:(
Neonat
es)
:5–8mgPE/
kg/
day
.

AVAI
LABI
LITY
I
nject
ion50mgPE/
mL;

PATI
ENTTEACHI
NG
Maycausedr
owsi
nessordi
zzi
ness.Caut
ionpat
ient

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1738
 toavoiddrivi
ngorot heract i
vi
tiesrequi
ri
ngal
ert
ness
unti
lresponset omedi cationisknown.Donotresume
dri
vi
ngunt ilphysi
ciangi vesclear
ancebasedon
contr
ol ofseizur
edi sor der.

Instructpat ient st hatbehav i

oral changes, skinr ash,
fever ,sor et hroat ,mout hul cers, easybr uising,
petechi ae,unusual bleeding, abdomi nal pain,chi l
ls,
palest ools, dar kur i
ne, j
aundi ce, sev er
enauseaor
vomi t
ing, dr owsi ness, slurredspeech, unsteadygai t
.
swol lengl ands, orper sistentheadacheshoul dbe
repor tedt oheal thcar epr of essional immedi ately.
Adv isepat ientandf ami l
ytonot ifyheal t
hcar e
prof essi onal ifthought saboutsui cideordy i
ng,
attempt st ocommi tsuicide; neworwor sedepr ession;
neworwor seanxi ety;feeli
ngv eryagi tatedorr estless;
pani cat tacks; tr
oubl esl eeping; neworwor se
i
r r
itability;act i
ngaggr essi ve;bei ngangr yorv iolent;
actingondanger ousimpul ses; anext remei ncreasei n
activ i
tyandt alking, otherunusual changesi nbehav ior
ormoodoccur .

Advi
sef emalepatientstouseanaddi t
ional
nonhormonal methodofcont r
acepti
ondur i
ngtherapy
anduntilnextmenst r
ualperi
od.I
nstructpati
entto
noti
fyhealthcar
epr ofessi
onali
fpregnancyisplanned

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1739
 orsuspect
ed.Encour
agepat
ient
swhobecome
pregnantt
oenrol
lint
heNort
hAmericanAnt
iepi
l
ept
ic

Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Emphasizetheimpor t
anceofr outi
neexamsto
monitorpr
ogress.Patientshouldhaverout
ine
physi
calexams,especi al
l
ymoni tor
ingski
nandly
mph
nodes,andEEGt est
ing.

Fospr
opof
ol
I
NDI
CATI
ONS
Monit
oredanesthesi
acar
e( MAC)inadul
tsunder
goi
ng
di
agnosit
ic/
ther
apeuti
cprocedur
es.

ACTI
ON
Mechanism ofact
ionisnotknown.Ther
apeut
icEf
fect
s:
I
nducti
onandmai ntenanceofanest
hesi
a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Nonenot
ed.

UseCaut
iousl
yin:
Compr
omi
sedcar
diacf
unct
ion,
r
educedv
ascul
art
oneorr
educedi
ntr
avascul
arv
olume(
↑

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1740
ri
skofhy potension);
Hepat icimpairment ;Renal
i
mpai rment(safetynotest abli
shedf orCCr<30mL/ min)
;
Geri:Pat
ients≥65y rort hosewithsev eresystemic
disease(dose↓ r equired);OB:Lactation:Not
recommendedf orusedur i
nglabor,deliver
yorlact
ation
(maycauseneonat alrespirat
oryandcar di
ovascul
ar
depressi
on);Pedi :
Children<18y r(safetynotestabl
ished,
usenotrecommended) .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Resp:RESPIRATORYDEPRESSI ON, cough,hy
poxemia.CV:
hypot
ension.Derm:pr
uri
tus.Neuro:parest
hesia.Mi
sc:
l
ossofpur posef
ulr
esponsiveness.

I
NTERACTI
ONS
Drug-Drug:
May↑ r iskofcardio-
respir
atorydepr essi
on
whenusedwi thothercardi
o-respi
ratorydepressant s
i
ncludingbenzodi
azepinesandopi oidanalgesics.

DOSAGE
Pat
ient
swei ghi
ng>90kgshoul
dbedosedasi
ftheyar
e
90kg;pat
ientswei
ghi
ng<60kgshoul
dbedosedasift
hey
ar
e60kg.
I
V:(
Adul
ts)
:6.
5mg/
kg(
nott
oexceed16.
5mL)i
nit
ial
l
y,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1741
fol
lowedbysuppl
emental
dosesof1.
6mg/ kg(
nott
o
exceed4mLormor ef
requent
lyt
hatever
y4min)as
needed.
I
V:(Geri
atr
icPat
ients≥65yrort
hosewi
thsev
eresy
stemi
c
di
sease)
:75%ofst andar
ddose.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion1050mg/
30mL;

PATI
ENTTEACHI
NG
I
nfor
m pati
entthatt
hismedicat
ionwi
l
ldecr
ease
mental
recal
loftheprocedur
e.

Inform patientt
hatparest
hesias(burni
ng,ti
ngl
ing,
stingi
ng)andpr uri
tusintheperi
nealregionmayoccur
uponi njecti
onoffospropofol
;usuall
ymildto
moder ateintensi
ty,l
astashortti
me, andrequi
reno
treatment .

Maycausedr owsinessordizzi
ness.Advisepat i
entto
requestassi
stancepri
ortoambulationandt ransfer
andtoav oi
ddr i
vi
ngorotheracti
vit
iesrequir
ing
aler
tnessfor24hrfoll
owingadministr
ati
on.

Advi
sepati
entt
oav oi
dal
coholorot
herCNS
depr
essant
swithoutt
headvi
ceofahealt
hcar
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1742
 pr
ofessi
onal
for24hrf
oll
owi
ngadmi
nist
rat
ion.

Fr
ovat
ri
ptan
I
NDI
CATI
ONS
Acut
etr
eat
mentofmi
grai
neheadache.

ACTI
ON
Actsasanagoni statspeci fi
c5-HTreceptorsi
tesin
i
ntracranialbl
oodv esselsandsensorytri
geminalnerv
es.
Therapeut i
cEffects: Crani
alvesselv
asoconstr
ict
ionwith
associateddecreasei nrel
easeofneuropepti
desand
resul
tantdecreasei nmi gr
aineheadache.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hist
ory
,sy
mpt
oms
orfindingsconsistentwi t
h; Cerebrovascul
arsyndromes
i
ncluding; Uncontr
oll
edhy pertensi
on; Hemipl
egicorbasil
ar
migraine;Peripher
al v
ascul ardisease, i
ncl
udi
ngi schemic
bowel disease;Shouldnotbeusedwi t
hin24hrofany
other5- HTagonistorer got-typecompounds( e.g.
di
hy droergotamine,ergotami ne);Pedi:Chi
ldr
en<18y r
.

UseCaut
iousl
yin:
Concur
rentuseofSSRI
sorSNRI
s(↑
r
iskofser
otoni
nsy
ndr
ome)
;Ger
i:Maybemor
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1743
suscepti
bletoadver
secardi
ovascul
aref
fect
s;OB:
Lactat
ion:Safet
ynotest
abli
shed.
Exerci
seExt remeCaut i
oni n:Cardiovascul
arriskfact
ors
(hyper
tension, hypercholester
olemi a,ci
garet
tesmoki ng,
obesit
y,diabet es,st
rongf amilyhistory,
menopausal
womenormen>40y r
);useonlyifcar di
ovascularst
atus
hasbeenev aluatedanddet er
minedt obesaf eandf i
rst
doseisadmi nister
edundersuper visi
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:dizzi
ness,dr
owsiness,fat
igue.CV: CORONARY
ARTERYVASOSPASM, MI,
VENTRI CULARFI BRILLATION,
VENTRICULARTACHYCARDI A,chestpain,my ocar
dial
i
schemia.GI:drymouth,dyspepsia,nausea.Derm:
fl
ushi
ng.MS: skel
etal
pain.Neur o:parest
hesia.Misc:pai
n.

I
NTERACTI
ONS
Drug-Dr ug:Hormonal contr
acept ivesorpropranolol
may
↑l evels.↑ r i
skofser i
ousv asospast i
creacti
onswi t
h
di
hy droergotami neorergotami ne(concurr
entuse
contraindicated).↑ ri
skofser otoninsyndromewhenused
withfluoxetine,paroxeti
ne,sertral
ine,fl
uvoxamine,
ci
talopram, escital
opram, v
enlaf axine,
orduloxeti
ne.

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1744
PO:(Adult
s) :2.
5mg;ift
herehasbeenini
ti
alr
eli
ef,a
secondtabletmaybetakenaft
eratl
east2hr(dai
lydose
shouldnotexceed3tabl
etsandshouldnotbeusedto
tr
eatmor ethan4att
acks/30dayperi
od).

AVAI
LABI
LITY
Tabl
ets2.
5mg;

PATI
ENTTEACHI
NG
I
nfor m pati
entthatfr
ovatr
ipt
anshoul
dbeusedonly
duringami grai
neat t
ack.I
tismeantt
obeusedt o
rel
ievemi grai
neattackbutnott
opreventorr
educe
thenumberofat t
acks.

Inst
ructpat
ientt
oadmi ni
sterfr
ovat
ri
ptanassoonas
symptomsappear ,buti
tmaybeadmi nist
eredany
timeduri
nganat t
ack.Ifmi
grainesy
mpt omsr et
urn,a
seconddosemaybeused.Al l
owatleast2hr
betweendoses,anddonotusemor ethan3t ablet
sin
any24-hrperi
od.

I
fdosedoesnotreli
eveheadache,
addi
ti
onal
fr
ovatr
ipt
andosesarenotli
kel
ytobeeff
ecti
ve;
not
if
y
heal
thcarepr
ofessi
onal
.

Adv
isepat
ientt
hatl
yi
ngdowni
nadar
kenedr
oom

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1745
 f
oll
owingfr
ovatri
ptanadmi
nist
rat
ionmayf
urt
herhel
p
r
eli
eveheadache.

Cautionpati
entnottousefrovat
ri
ptanifshei
s
pregnant,
suspectssheispregnant
,planstobecome
pregnant,
orisbreast
feedi
ng.Adequatecontr
acepti
on
shouldbeuseddur i
ngther
apy .

Maycausedi zzi
nessordr owsiness.Cauti
onpati
ent
toavoiddri
vingorotheracti
vit
iesrequir
ingal
ert
ness
unti
lresponsetomedi cat
ionisknown.

Advisepat i
enttonot if
yheal t
hcar epr ofessionalprior
tonextdoseoff rovatr
iptanifpainort ightnessi nthe
chestoccur sdur inguse.I fpainissev ereordoesnot
subside, notifyheal t
hcar epr of
essi onal i
mmedi ately.
Ifwheezi ng;hear tthrobbing; swelli
ngofey eli
ds,face,
orli
ps; skinr ash; skinlumps; orhi v
esoccur ,noti
fy
healthcar epr ofessional i
mmedi atelyanddonott ake
moref rov atr
iptanwi t
houtappr ov alofheal t
hcar e
prof
essi onal.Iff eeli
ngsoft ingli
ng, heat,fl
ushing,
heaviness, pressur e,drowsiness, dizziness,tir
edness,
orsicknessdev el op,discusswi t
hheal thcare
prof
essi onal atnextv i
sit.

Advisepati
entt
oavoidalcohol
,whi
chaggr
avat
es
headaches,dur
ingf
rovat
ript
anuse.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1746
Ful
vest
rant
I
NDI
CATI
ONS
Treatmentofhormonereceptor
-posi
ti
vemet ast
ati
cbr east
cancerinpostmenopausalwomenwi t
hprogressiv
e
diseasethathasnotr
espondedtoantiest
rogentherapy.

ACTI
ON
Competit
ivel
ybindstoestr
ogenr eceptors.Bindi
ngr esul
ts
i
ndown- r
egulat
ionofestr
ogenr eceptorproteinin
cancer
ousbreastti
ssue.TherapeuticEffect
s: Decreased
progr
essi
onofhor monereceptor-posi
tiv
ebr eastcancer.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:OB:
Lact
ati
on:
Pregnancyorl
act
ati
on;
Pedi:
Chi
ldr
en;Hy
persensi
ti
vit
y;Bl
eedingdi
sor
ders,
thr
ombocyt
openi
a,concur
rentant
icoagul
antt
her
apy.

UseCaut
iousl
yin:
Moder
atet
osev
erehepat
ic
i
mpai
rment
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache,
weakness,anxi
ety
,depressi
on,dizzi
ness,
i
nsomnia.EENT:phar
yngi
ti
s.Resp:cough,dyspnea.CV:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1747
vasodilati
on( hotflushes) ,chestpai n,edema.GI :
abdomi nal pain,constipation,diarrhea,nausea, vomit
ing,
anorexia.GU: pelvicpai n,uri
nar ytractinfect
ion.Derm:
rash,sweat ing.Local:pai n/i
nflammat i
onati njecti
onsit
e.
Hemat : anemi a.MS: backpai n, bonepai n,arthri
ti
s.Neuro:
paresthesia.Mi sc:fever ,
flusyndr ome.

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

DOSAGE
I
M:(Adult
s):500mgondays1, 15,
and29,
andt
henonce
monthl
y(giv
enastwoi
nject
ionsof250mg(5mL)each)
.
Hepat
icI
mpai
rment
IM: (
Adul
ts):Moderat
ehepati
cimpai
rment—250mgon
days1,15,and29,andthenoncemonthl
y(gi
venasa
singl
einj
ecti
on)
.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion50mg/
mLi
n5–ml
pref
il
ledsy
ringes;

PATI
ENTTEACHI
NG
I
nfor
m pat
ientt
hatf
ulv
est
rantmaycausemi
l
dpai
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1748
 andi
nfl
ammat
ionati
nject
ionsi
te.

Advisepat i
entt
ousecontr
acepti
onduri
ngtreat
ment
wit
hf ulvest
rant
.Maycauseter
atogeni
ceff
ectsand
fet
al death.

Inf
or m pat
ientofpot
ent
ial
foradver
sereact
ionsand
advisehertonotif
yheal
thcarepr
ofessi
onal
.

Advi
sepat
ientt
oreportanincr
easeinpainso
tr
eat
mentwithanal
gesicscanbeini
ti
ated.

Fur
osemi
de
I
NDI
CATI
ONS
Edemaduetoheartfai
l
ure,
hepat
ici
mpai
rmentorr
enal
di
sease.Hy
per
tension.

ACTI
ON
Inhibi
tsthereabsorpt i
onofsodium andchl ori
def rom the
l
oopofHenl eanddi stalrenalt
ubule.Increasesr enal
excreti
onofwat er,sodium, chl
oride,magnesi um,
potassium,andcal ci
um.Ef f
ecti
venessper sistsin
i
mpai redrenalfunction.TherapeuticEffects:Diuresisand
subsequentmobi li
zat i
onofexcessf l
uid(edema, pleur
al
effusi
ons).DecreasedBP.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1749
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
wit
hthiazidesandsul
fonamidesmayoccur;
Hepaticcoma
oranuri
a;Somel i
qui
dproductsmaycontai
nalcohol
,avoi
d
i
npatientswithal
coholi
ntol
erance.

UseCaut
iousl
yin:
Sev
erel
i
verdi
sease(
maypr
eci
pit
ate
hepat iccoma; concurr
entusewi thpot assium- sparing
diureticsmaybenecessar y )
; El
ectrolytedepl etion;
Diabet esmel l
it
us;Hypoproteinemia( ↑r iskofot ot
oxi
cit
y);
Sev erer enali
mpairment(↑r i
skofot otoxicit
y); OB:
Lact ati
on: Saf
etynotestabli
shed; Pedi :↑r i
skf orrenal
calculi andpatentductusarteri
osisi npr emat ureneonates;
Geri: Mayhav e↑ riskofsideef f
ect s,especi all
y
hypot ensionandelectrol
yteimbalance, atusual doses.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: blurr
edv i
sion,di
zziness, headache, vert
igo.EENT:
heari
ngl oss,ti
nnit
us.CV: hypot ension.GI:anor exi
a,
constipati
on,diarr
hea,drymout h,dyspepsi a,
↑l iv
er
enzymes, nausea,pancreatit
is, vomiting.GU:↑ BUN,
excessiveuri
nat i
on,nephrocalcinosis.Der m:STEVENS-
JOHNSONSYNDROME, TOXI CEPI DERMALNECROLYSI S,
photosensiti
vit
y,pruri
ti
s,rash.Endo: hypercholesterol
emia,
hyperglycemia,hypert
ri
glyceridemi a,hyperuri
cemi a.Fand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1750
E:dehydrati
on,hy pocalcemia,hypochl
oremia,
hypokalemia,hy pomagnesemi a, hy
ponatr
emia,
hypovolemia,met aboli
calkalosis.Hemat:APLASTI
C
ANEMI A,AGRANULOCYTOSI S,hemolyt
icanemia,
l
eukopenia,thrombocy t
openia.MS: musclecr
amps.Neur
o:
parest
hesia.Mi sc:fever.

I
NTERACTI
ONS
Drug- Dr ug: ↑r iskofhy pot ensionwi t
hant ihy pert
ensives,
nitr
at es, oracut eingest ionofal cohol .↑ riskof
hypokal emi awi thot herdi uretics, amphot ericinB,
stimul antl axat i
ves,andcor t
icost eroids.Hy pokalemi amay
↑r i
skofdi goxint oxici
tyand↑ r i
skofar r
hy thmiai n
patient st akingdr ugst hatpr olongt heQTi nterval.↓
l
ithium excr etion,maycausel ithium t oxicit
y.↑ r iskof
ototoxi citywi thami nogl ycosi desorci spl
atin.↑ r iskof
nephr ot oxicitywi t
hci splatin.NSAI DS↓ ef fect sof
furosemi de.May↑ r i
skofmet hot rexatetoxi cit
y.↓
effect soff ur osemi dewhengi venatsamet imeas
sucr alfate,chol estyrami ne,orcol est i
pol.↑ r iskof
salicylatet oxicity(wi t
huseofhi gh- dosesal icylate
therapy ).Concur rentusewi thcy clospor i
nemay↑ r iskof
gout yar thriti
s.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1751
Edema
PO: (Adult
s) :20–80mg/ dayasasi ngl
edosei ni
ti
all
y,may
repeatin6–8hr ;may↑ doseby20–40mgq6–8hrunt il
desiredresponse.Mai nt
enancedosesmaybegi venonce
ortwi cedail
y( dosesupt o2.5g/dayhav ebeenusedi n
patientswithHForr enaldi
sease).Hypertensi
on—40t wice
dail
yi ni
ti
all
y(whenaddedt oregi
men, ↓ doseofother
anti
hy pert
ensiv esby50%) ;adj
ustfurt
herdosingbasedon
response;Hy per cal
cemia—120mg/ dayi
n1–3doses.
PO:(Chi
l
dren>1mo):
2mg/kgasasi
ngl
edose;
maybe
↑ by1–2mg/kgq6–8hr(
maxi
mum dose=6mg/kg)
.
PO:
(Neonat
es)
:1–4mg/
kg/
dose1–2t
imes/
day
.
I
M: I
V:(Adult
s):20–40mg, mayrepeatin1–2hrand↑ by
20mgev ery1–2hrunti
l r
esponseisobtai
ned,
maint
enancedosemaybegi v
enq6–12hr ; Continuous
i
nfusi
on—Bolus0.1mg/ kgfol
lowedby0.1mg/ kg/hr,
doubl
eq2hrt oamaxi mum of0.4mg/ kg/hr.
I
M: I
V:(Chi
l
dren)
:1–2mg/ kg/
doseq6–12hrCont
inuous
i
nfusi
on—0.05mg/kg/
hr,
tit
rat
etocl
i
nical
eff
ect
.
I
M:I
V:(
Neonat
es)
:1–2mg/
kg/
doseq12–24hr
.

Hy
per
tensi
on
PO:
(Adul
ts)
:40t
wicedai
l
yini
ti
all
y(whenaddedt
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1752
regimen,↓ doseofotherant
ihy
pert
ensiv
esby50%)
;
adjustf
urt
herdosingbasedonresponse.

AVAI
LABI
LITY
Tablet
s20mg,40mg,80mg,
500mg.Sol
uti
onf
or
i
njecti
on10mg/mL;

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakef
urosemideasdi
rect
ed.Take
misseddosesassoonaspossible;
donotdoubl
e
doses.

Cautionpat
ientt ochangeposi tionsslowlyto
minimizeorthostati
chy potension.Cautionpati
ent
thattheuseofal cohol
,exer ci
sedur i
nghotweat her
,
orstandi
ngf orlongperiodsdur ingtherapymay
enhanceorthostatichypotension.

I
nst
ructpat
ientt
oconsul
theal
thcarepr
ofessi
onal
r
egardi
ngadiethi
ghinpot
assi
um (seeAppendi
xM).

Adv
isepat
ientt
ocont
acthealt
hcar
eprof
essi
onal
of
wei
ghtgai
nmor et
han3lbsin1day.

Instr
uctpati
entt
onotifyheal
thcareprofessionalof
allRxorOTCmedi cat
ions,vi
tamins,orherbal
productsbei
ngtakenandt oconsultheal
thcar e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1753
 prof
essi
onalbef
oret
akinganyOTCmedi
cat
ions
concur
rent
lywit
hthi
stherapy
.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Advisepatienttocontactheal
thcareprof
essi
onal
i
mmedi atelyifrash,muscleweakness,cr
amps,
nausea,dizziness,numbness,
ortingl
ingof
ext
remiti
esoccur s.

Advi
sediabet
icpat
ient
st omonit
orbl
oodglucose
cl
osel
y;maycauseincreasedbl
oodgl
ucoselevel
s.

Emphasi
zetheimpor
tanceofr
out
inef
oll
ow-
up
exami
nati
ons.

Ger
i:Cautionol
derpatient
sorthei
rcaregi
versabout
i
ncreasedr i
skf
orfal
ls.Suggestst
rat
egiesforf
all
pr
evention.

Hy per
tension:Advi
sepati
ent
sonant i
hyper
tensiv
e
regiment oconti
nuetaki
ngmedicati
oneveniffeeli
ng
better
.Furosemidecontr
olsbutdoesnotcure
hypertension.

Rei
nfor
cet
heneedt
ocont
inueaddi
ti
onal
ther
api
es

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1754
 forhypertension(weightl
oss,exerci
se, r
estr
icted
sodium i
nt ake,str
essreducti
on,regularexer
cise,
moder at
ionofal coholconsumption,cessati
onof
smoking).

Gabapent
in
I
NDI
CATI
ONS
Parti
alseizures(adjuncttr
eatment)(immedi ate-r
elease
only)
.Post -
herpeti
cneur al
gia(i
mmedi at e-
releaseand
Grali
seonl y
).Restlesslegssyndrome( Hor i
zantonl y)
.
Unlabel
edUses: Neuropathicpai
n.Prev enti
onofmi grai
ne
headache.Bipolardisorder.Anxi
ety.Diabeticperipheral
neuropathy.

ACTI
ON
Mechanism ofacti
onisnotknown.Mayaf f
ectt
ransport
ofaminoacidsacrossandstabi
li
zeneuronalmembranes.
Ther
apeuti
cEf f
ects:Decr
easedinci
denceofsei
zures.
Decr
easedpost -
herpet
icpai
n.Decreasedl
egrestl
essness.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
All
pat
ient
s(may↑ r
iskofsui
cidal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1755
thoughts/behaviors)
;Renal i
nsuff
iciency(↓ doseand/ or
↑ dosingi nt
ervalifCCr≤60mL/ min);OB: Pregnancy
;Pedi:
Childr
en<18y r(sust
ained-/ext
ended-release)or<3yr
(i
mmedi ate-r
elease)(safetynotestablished);Lact
ati
on:
Disconti
nuedr ugorbot tl
e-f
eed;Geri:Maybemor e
susceptibl
etot oxici
tyduet oage-r
elated↓ i nrenal
functi
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SUICIDALTHOUGHTS, confusion,depression,
drowsi ness, sedat ion,anxi
et y,concentrati
ondifficult
ies
(chil
dr en),dizzi
ness, emotional l
abilit
y(chil
dren),hostil
it
y,
hyper kinesia(chi l
dr en)
,mal aise,verti
go,weakness.EENT:
abnor mal v i
sion, nystagmus.CV: hy pert
ension.GI :weight
gain,anor exia,flatulence,gingivit
is.MS: art
hralgia.Neuro:
ataxia, al
teredr eflexes,hyperkinesia,paresthesia.Misc:
MULTI -ORGANHYPERSENSI TIVITYREACTI ONS, faci
al
edema.

I
NTERACTI
ONS
Drug-Drug:Antacidsmay↓ absor pti
onofgabapent i
n.↑
ri
skofCNSdepr essionwi thotherCNSdepr essants,
i
ncludingalcohol,anti
histamines,opi
oids,
and
sedative/
hypnotics.Mor phine↑ gabapenti
nl ev
elsand
may↑ r i
skoftoxicit
y,dosageadj ust
mentsmaybe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1756
r
equi
red.
Drug-
Nat
ural
Product:Kav
a-kav
a,v
aler
ian,
orchamomi
l
e
can↑ CNSdepressi
on.

DOSAGE
Thesustai
ned/ext
ended-
rel
easeformul
ati
onsshoul
dnot
beint
erchangedwit
htheimmediate-
rel
easepr
oduct
s

Epi
l
epsy
PO:(Adult
sandChildr
en>12y r)
:300mg3t i
mesdail
y
i
nit
ial
ly.Ti
tr
ati
onmaybecont inuedunt
ildesi
red(
rangei
s
900–1800mg/ dayin3divi
deddoses;dosesshoul
dnotbe
morethan12hrapar t
).Dosesupto2400–3600mg/ day
havebeenwelltol
erat
ed.
PO:( Chil
dren≥5–12y r
):10–15mg/ kg/dayin3divi
ded
dosesi ni
ti
all
ytit
ratedupwardover3day sto25–35
mg/ kg/dayin3di v
ideddoses;dosageinter
valshoul
dnot
exceed12hr( dosesupt o50mg/ kg/dayhav ebeenused)
.
PO:( Chil
dren3–4yrs)
:10–15mg/ kg/dayin3divi
ded
dosesi ni
ti
all
yti
tr
atedupwardover3day sto40
mg/ kg/dayin3divi
deddoses;dosageinter
valshoul
dnot
exceed12hr( dosesupto50mg/ kg/dayhav ebeenused)
.
Renal
Impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1757
PO:
(Adul
tsandChi
ldren>12yr)
:CCr30–59
mL/mi
n—200–700mgt wicedai
ly;CCr15–29
mL/mi
n—200–700mgoncedai ly
;CCr15
mL/mi
n—100–300mgoncedai ly
;CCr<15
mL/mi
n—Reducedail
ydoseinproport
iontoCCr
.

Post
-Her
pet
icNeur
algi
a
PO: (Adults):I
mmediate-
release–300mgoncedai lyon
fi
rstday ,then300mg2t i
mesdai lyonsecondday ,then
300mg3t i
mes/dayonday3, mayt henbet i
trat
edupwar d
asneededupt o600mg3t imes/ day;Sust
ained-r
elease
(Grali
se) —300mgoncedai l
yonf irstday,t
hen600mg
oncedai lyonsecondday,then900mgoncedai lyonday s
3–6, then1200mgoncedai lyonday s7–10, t
hen1500
mgoncedai l
yondays11–14, then1800mgoncedai ly
thereafter.
Renal
Impai
rment
PO: (
Adults) :CCr30–59mL/ min—200–700mgt wice
dail
y( i
mmedi ate-r
elease);600–1800mgoncedai ly
(sustai
ned-release[Gral
ise])
;CCr15–29
mL/ min—200–700mgoncedai l
y(immediat
e-r
elease);
Sustainedrelease[Grali
se]notrecommended;CCr15
mL/ min—100–300mgoncedai l
y(immediat
e-r
elease);
Sustainedrelease[Grali
se]notrecommended;CCr<15
mL/ min—↓ dai lydoseinpr opor
ti
ontoCCr(immedi ate

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1758
r
elease)
;Sust
ainedr
elease[
Gral
i
se]notr
ecommended.

Rest
lessLegsSy
ndr
ome
PO:(Adul
ts)
:Ext
ended-
rel
ease(
Hor
izant
)—600mgonce
dai
l
yat5pm.
Renal
Impai
rment
(Adul
ts):CCr30–59mL/min—600mgat5pm onDay1
andDay3, then600mgdail
yat5pm (
ext
ended-
rel
ease
[Hori
zant
];CCr<30mL/min—Notr
ecommended.

Neur
opat
hicPai
n(unl
abel
eduse)
PO:(Adul
ts):100mg3t i
mesdai
lyi
nit
ial
l
y.Tit
rat
eweekl
y
by300mg/ dayupto900–2400mg/day(maxi
mum:3600
mg/day).
PO:(
Childr
en):5mg/kg/
doseatbedti
mei ni
ti
all
ythen↑
to5mg/ kgBI
Donday2and5mg/ kgTIDonday3.Ti t
rat
e
toef
fectupto8–35mg/kg/dayi
n3divideddoses.

AVAI
LABI
LITY
Capsul
es100mg,
300mg,
400mg.
Tabl
ets600mg,
800mg.
Ext
ended-
rel
easet
abl
ets(
Hor
izant
)600mg;
Sust
ained-
rel
easet
abl
ets(
Gral
i
se)300mg,
600mg;
Oral

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1759
sol
uti
on(
cool
str
awber
ryani
sef
lav
or)250mg/
5mL.

PATI
ENTTEACHI
NG
Adv isepat ientandf amilytonot ifyhealthcare
prof essional i
fthoughtsaboutsui cideordy i
ng,
attempt st ocommi tsuicide;neworwor sedepr essi
on;
neworwor seanxiety;f
eel i
ngv eryagi t
atedorr estl
ess;
pani cattacks; tr
oublesleeping; neworwor se
i
rri
t abili
ty;acti
ngaggr essive;bei ngangr yorviolent;
actingondanger ousimpul ses; anext r
emei ncreasei n
activ i
tyandt alki
ng,otherunusual changesinbehav ior
ormoodoccur .

Advi
sefemalepati
enttonot
if
yhealthcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advi
sepat
ientt
ocarr
yident
if
icat
iondescr
ibi
ng
di
seasepr
ocessandmedicat
ionregi
menatallt
imes.

Gal
ant
ami
ne
I
NDI
CATI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1760
Mi
l
dtomoder
atedement
iaoft
heAl
zhei
mer
’st
ype.

ACTI
ON
Enhancescholi
nergicfunct
ionbyrever
sibleinhi
bit
ionof
chol
inester
ase.Therapeuti
cEff
ects:Decreaseddementi
a
(t
empor ary
)associat
edwi t
hAlzhei
mer ’
sdisease.
Cognit
iveenhancer.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erehepat
icor
r
enal
impai
rment
;Pedi
:Lact
ati
on:
Chi
l
drenorl
act
ati
on.

UseCaut
iousl
yin:
Pat
ient
swi
thsupr
avent
ri
cul
arcar
diac
conduct i
ondef ectsorconcurrentuseofdr ugst hatmay
sl
owhear tr at
e( ↑r i
skofbrady cardia)
; Historyofulcer
disease/GIbl eeding/concur
rentNSAI Duse; Severe
asthmaorobst ructi
vepulmonar ydisease; Mi l
dto
moder ater enal i
mpairment(av oidusei fCCr<9mL/ mi
n);
Mi l
dt omoder atehepati
cimpai rment( cautiousdose
ti
trati
onr ecommended) ;May↑ r i
skofcar diovascul
ar
mor tali
ty;OB: Useonl yi
fpotentialbenef i
tout weighs
potentialri
skt of et
us.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
fat
igue,
dizzi
ness,
headache,
syncope.CV:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1761
brady
cardi
a, chestpai
n.GI:anorexi
a,di
arr
hea,dyspepsi
a,
fl
atul
ence,nausea,vomiti
ng.GU: bl
adderout
flow
obstr
ucti
on,inconti
nence.Neuro:tr
emor.Misc:weight
l
oss.

I
NTERACTI
ONS
Drug-Drug: Wil
l ↑ neuromuscul arblockadef rom
succi
ny lcholi
ne-typeneuromuscul arbl ocki
ngagent s.May
↑ effectsofot hercholinesteraseinhibit
orsorot her
choli
nergicagoni sts,i
ncludingbethanechol .May↓
eff
ectivenessofant i
choli
ner gi
cmedi cations.Bloodlevel
s
andef f
ect smaybe↑ byket oconazole,paroxet
ine,
amitr
ipty l
ine,
fluvoxamine, orquinidi
ne.

DOSAGE
PO:(Adul t
s) :
Immedi ate-rel
easetablets4mgt wicedail
y
i
nit
iall
y,dosei ncrementsof4mgshoul dbemadeat4wk
i
nterval
s, upto12mgt wi cedail
y.Dosesupt o16mgt wice
dai
lyhav ebeenused( r
ange16–32mg/ day
;Extended-
rel
easecapsul es—8mg/ dayasasi ngledoseinthe
morning,maybe↑ t o16mg/ dayafter4wk, t
henupt o24
mg/ dayaf t
er4wk, incr
ement sbasedon
benefit
/toler
abili
ty.
Renal
Impai
rment

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1762
PO:(Adul
ts)
:Moderat
erenal
impai
rment
—Dai
l
ydose
shoul
dnotexceed16mg.
Hepat
icI
mpai
rment
PO:(Adul
ts)
:Moderat
ehepat
ici
mpai
rment
—Dai
l
ydose
shoul
dnotexceed16mg.

AVAI
LABI
LITY
I
mmedi at
e-rel
easet
abl
ets4mg,
8mg,12mg;
Extended-
r
eleasecapsules8mg,
16mg,24mg;
Oral
sol
uti
on4
mg/mL;

PATI
ENTTEACHI
NG
Emphasi zetheimpor t
anceoft akinggalantami ne
daily ,
asdirected.Instructpat i
entand/ orcaregi v
eri
n
cor rectuseofpi petteifusingor al sol
uti
on.Ski p
mi sseddosesandr eturntor egularschedulet he
followingday ;donotdoubl edoses.Donot
discont i
nueabr uptly;alt
houghnoi ncr
easei n
frequencyofadv erseev entsmayoccur ,benefici
al
affect sofgalantami nearel ostwhent hedrugi s
discont i
nued.

Cauti
onpat
ientandcar
egi
vert
hatgal
ant
ami
nemay
causedi
zzi
ness.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1763
 Advi
sepati
entandcaregi
vertonot
if
yhealthcare
prof
essi
onali
fnauseaorvomiti
ngpersi
stsbeyond7
daysori
fnewsy mptomsoccurorprevi
ouslynot
ed
symptomsincr
easeinsever
it
y.

Advi
sepat i
entandcar
egivertonot
if
yheal
thcare
prof
essionalofmedi
cati
onr egi
menpri
ort
otreat
ment
orsurgery
.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
moni
torprogr
ess.

Teachpati
entandcar
egi
verst
hati
mprovementsi
n
cogni
tivef
unct
ioni
ngmaytakeweekst
omont hst
o
stabi
l
ize.

Caut
iont
hatdi
seaseisnotcur
edanddegener
ati
ve
pr
ocessi
snotrever
sed.

Gal
l
ium Ni
tr
ate
I
NDI
CATI
ONS
Managementofcancer-
rel
atedhyper
cal
cemi
a,i
ncl
udi
ng
hy
percal
emiaresi
stantt
ohy dr
ati
on.

ACTI
ON
I
nhi
bit
scal
cium r
esor
pti
onf
rom bone.Ther
apeut
icEf
fect
s:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1764
Lower
ingofser
um cal
cium l
evel
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Sev
erer
enal
impai
rment(
ser
um
cr
eat
ini
ne>2.
5mg/
dL)
.

UseCaut
iousl
yin:
Renal
impai
rment
;Ger
i:Consi
derage-
r
elateddecreaseinrenal
functi
on;OB:Pedi
:Pregnancy
,
l
actati
on,orchil
dren(saf
etynotestabl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
EENT:heari
ngloss,
opti
cneurit
is,
visual
impair
ment.GU:
renal
toxi
cit
y.FandE:hypophosphatemia,
hypocal
cemia.

I
NTERACTI
ONS
Drug-
Drug:I
ncreasedriskofnephrot
oxicit
ywi
thot
her
nephrot
oxi
cagent s,
includingamphot
erici
nBand
aminogl
ycosi
des( di
scont i
nuegal
li
um).

DOSAGE
I
V:(Adul
ts)
:100–200mg/m2dail
yfor5days;
2–4wkr
est
r
ecommendedbetweencour
sesofther
apy.

AVAI
LABI
LITY
I
nject
ion25mg/
mLi
n20-
mLv
ial
s;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1765
PATI
ENTTEACHI
NG
Encouragepatienttocompl ywit
hphy si
cian’sdiet
ary
recommendat ions.Foodshighincal ci
um t hatshoul
d
beavoidedincludedairyproduct
s, cannedsal mon
andsardines,broccoli
,bokchoy,tofu,mol asses,and
cream soups

Emphasi zeneedforkeepingfol
low-
upappoi
ntment
s
tomonitorprogress,evenaft
ermedicat
ioni
s
discont
inued,todetectrel
apse.

Gal
sul
fase
I
NDI
CATI
ONS
Mucopol
ysacchar
ri
dosi
sVI(
MPSI
V).

ACTI
ON
Replacesadefi
cientenzymei nMPSI V.Wi t
hout
repl
acement,gl
ycoami noglycansaccumulateresul
tingin
cell
,organandti
ssuedy sfuncti
on.Therapeuti
cEffects:
Improvedwalki
ngandst aircli
mbing.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:None.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1766
UseCaut
iousl
yin:
Febr
il
eorr
espi
rat
oryi
l
lness;
Pedi
:
Chi
l
dren<5yr(saf
etynotestabl
ished)
;OB:
Pregnancyor
l
act
ati
on(saf
etybeingeval
uated).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:mal ai
se.EENT: conj
unct
ivi
tis,cor
nel
aopacif
icat
ion,
earpain.Resp:dyspnea.CV:chestpain,
↑ BP.Derm:
faci
aledema.GI :gastr
oent
eri
tis,abdominal
pai
n.MS:
aref
lexi
a.Misc:INFUSIONREACTI ONS,r
igor
s.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
I
V:(
Adul
tsandChi
l
dren>5y
r):
1mg/
kgonceweekl
y.

AVAI
LABI
LITY
Sol
uti
onf
orI
Vadmini
str
ati
on(
dil
utedpr
iort
ouse)5mg/
5
mLin5mLvial
s;

PATI
ENTTEACHI
NG
I
nform pat
ientt
hataCl i
nicalSur
vei
ll
anceProgram
hasbeenestabl
ishedtobet t
erunder
standthe
var
iabi
li
tyandprogressi
onofMPSVIandt oevaluat
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1767
 l
ongt erm ef
fect
sofgalsulf
ase.Encouragepat
ient
sto
part
icipat
e;part
ici
pat
ionisvol
untaryandmaybel ong
ter
m.

Ganci
clov
ir
I
NDI
CATI
ONS
IV:Treatmentofcy tomegalovir
us( CMV)r et
ini
ti
sin
i
mmunocompr omi sedpat
ients,incl
udingHIV-i
nfected
pat i
ents(maybeusedwi t
hf oscarnet).Pr
eventi
onofCMV
i
nf ecti
onintransplantpat
ientsatr i
sk.Congenit
al CMV
i
nf ecti
oninneonat es.PO:Maintenancet r
eatmentof
stableCMVr etinit
isinimmunocompr omisedpatients
afterini
ti
alI
Vt reatmentandpr eventi
onofCMVr et i
nit
isi
n
pat i
entswit
hadv ancedHIVi nfecti
on.

ACTI
ON
CMVconv er
tsganciclovi
rtoit
sact i
veform(ganciclovi
r
phosphate)insi
dethehostcel l
,whereitinhi
bit
sviralDNA
poly
mer ase.Therapeuti
cEffects:Ant
ivi
ralef
fectdirect
ed
pref
erenti
all
yagainstCMV- i
nfectedcell
s.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oganci
clov
iror

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1768
acyclovi
r;Bonemarrowdepressi
onor
i
mmunosuppr essi
onorthr
ombocy topeni
a(donot
admi ni
steri
fANC<500/mm3orpl atel
etcount
<25,000/mm3) .

UseCaut
iousl
yin:
Renal
impai
rment(
dose↓ r
equi
redi
f
CCr<80mL/
min)
;Ger
i:Dose↓ r
ecommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEI ZURES, abnor mal dreams, coma, confusi on,
dizzi
ness, drowsi ness, headache, mal aise,nervousness.
EENT: retinal det achment , i
ntravi
trealonly—↓ v i
sual acuit
y,
vi
t r
eoushemor rhage, hy phema, i
ntraocularpressur e
spikes, lensopaci ti
es, macul arabnormal it
ies,opticner ve
changes, uveitis.Resp: dy spnea.CV: ar r
hythmi as,edema,
hyper tensi on, hypot ensi on.GI :GIBLEEDI NG, abdomi nal
pain,↑l iv erenzy mes, nausea, vomi t
ing.GU: gonadal
suppr essi on, hemat uria, r
enal toxi
city.Derm: alopeci a,
photosensi t
ivity,prurit
us, rash,urt
icaria.Endo:
hypogl ycemi a.Hemat :neut r
openia,thrombocy topeni a,
anemi a,eosi nophi l
ia.Local :
pain/phlebiti
satI Vsi te.Neuro:
ataxia, t
remor .Mi sc:fev er.

I
NTERACTI
ONS
Dr
ug-
Drug:
↑ri
skofbonemar
rowdepr
essi
onwi
th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1769
antineoplasti
cs,radiati
ontherapy,orzi
dovudine.Toxi
cit
y
maybe↑ bypr obeneci d.↑ r
iskofseizur
eswi th
i
mi penem/ cil
astatin.Concurr
entuseofot hernephrot
oxic
drugs, cycl
osporine,oramphot er
icinB↑ riskof
nephr otoxi
cit
y.

DOSAGE
I
V:(Adult
sandChi l
dren>3mo) :I
nduction—5mg/ kgq12
hrf
or14–21day s.Mai ntenancer
egimen—5mg/ kg/dayor
6mg/ kgfor5daysofeachweek.I fprogressi
onoccur s,
↑
toq12hrr egi
men.Pr eventi
on—5mg/ kgq12hrf or7–14
days,
then5mg/ kg/dayor6mg/ kgf or5day sofeach
week.
I
V:(Neonat
es)
:Congeni
tal
CMVi
nfect
ion-
12mg/
kg/
day
di
vi
dedq12hrx6weeks.
PO:(Adult
s):Maint
enancer
egi
men—1000mg3t imes
dai
l
y( wi
thfood)or500mg6t i
mesdai l
y;Pr
event
ionof
CMVr et
ini
tisi
nadvancedHI
Vinfect
ion—1000mg3t imes
dai
l
y.
I
ntr
avi
tr
eal
(Adul
ts)
:4.
5mgi
mpl
ant
.
I
V:
Renal
Impai
rment
(
Adul
tsandChi
l
dren)
:Induct
ion—CCr50–69ml
/mi
n:2.
5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1770
mg/kg/doseq12hr ;CCr25–49ml /
min:2.5mg/ kg/
dose
q24hr ;CCr10–24ml /
mi n:1.25mg/ kg/doseq24hr ;CCr
<10ml /
mi n:1.
25mg/kg3t imes/ weekaf t
erhemodialysi
s;
Maint
enance—CCr50–69ml /min:2.5mg/ kg/
doseq24hr ;
CCr25–49ml /
min:1.
25mg/ kg/doseq24hr ;
CCr10–24
ml/min:0.625mg/kg/doseq24hr ;CCr<10ml /min:0.
625
mg/kg3t imes/weekafterhemodi al
ysis.

AVAI
LABI
LITY
Capsules250mg, 500mg; Powderf
ori
nject
ion500
mg/vial;
Int
rav
itr
ealinser
t4.5mg;

PATI
ENTTEACHI
NG
I
nstructpat
ientt
otakeganci
clov
irwi
thf
ood,
as
di
rected.

Inform pati
entt hatganciclovi
risnotacureforCMV
reti
nit
is.Progressi onofretini
ti
smaycont i
nuei n
i
mmunocompr omi sedpatientsduri
ngandaf ter
therapy.Advisepat i
entstohav er
egularophthal
mic
examsatl eastev ery6wk.Dur ati
onoftherapyfor
CMVpr eventi
oni sbasedont hedurati
onanddegr ee
ofimmunosuppr ession.

Advisepat
ientt
onoti
fyheal
thcar
eprof
essional
if
fev
er ;
chi
ll
s;sor
ethr
oat;ot
hersi
gnsofi
nfecti
on;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1771
 bl
eedi nggums;brui
sing; petechi
ae;orbloodinur i
ne,
stool,oremesi
soccur s.Caut i
onpatienttoav oi
d
crowdsandper sonswi thknowni nfecti
ons.Instr
uct
pati
entt ousesoftt
oot hbrushandel ect
ricrazor.
Patientshoul
dbecaut ionednott odrinkalcoholi
c
beveragesortakeproduct scontaini
ngaspi r
inor
NSAI Ds.

Adv i
sepatientt
hatganci
clovi
rmayhav eterat
ogenic
effects.Anonhormonalmethodofcontracepti
on
shouldbeuseddur i
ngandf oratl
east90day saft
er
therapy.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Emphasi
zet
heimportanceoffr
equentf
oll
ow-
up
examstomoni
torbl
oodcounts.

Gani
rel
i
x
I
NDI
CATI
ONS
Asacomponentofi nferti
l
ityr
egimens(wi t
hrecombi nant
fol
li
clesti
mulati
nghor mone[ FSH],andhumanchor ionic
gonadotropi
n)toinhibitprematurel
utei
nizi
nghor mone
(LH)surgesinpati
ent sundergoingcont
roll
edov ari
an

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1772
hy
per
sti
mul
ati
on.

ACTI
ON
I
nducesar api
d,reversibl
esuppr essionofgonadotropin
(FSHandLH)secr etion,whichsuppr essessurgesinLH.
Ganirel
i
xi sagonadot r
opin-r
eleasinghormoneant agonist
.
TherapeuticEff
ects: SuppressionofLHsur gesincreases
thei
mpl antati
onandpr egnancyr atesinpat
ients
undergoinginvit
rof erti
li
zati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ogani
rel
i
x,
gonadot
ropi
nrel
easi
nghormoneoranyofi
tsanal
ogs;
OB:
Knownorsuspect
edpregnancy
.

UseCaut
iousl
yin:
Nonenot
ed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:OVARI ANHYPERSTI MULATI
ONSYNDROME,
abdomi nalpai
n,nausea.GU:
pelv
icpai
n,vaginalbl
eedi
ng.
Local
: HYPERSENSI TI
VITYREACTIONS,i
njecti
onsit
e
react
ions.

I
NTERACTI
ONS
Dr
ug-
Drug:
Unknown.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1773
DOSAGE
Subcut(Adults):250mcgoncedai l
yduringthemid-t
o-l
ate
foll
i
cularphaseofmenst rual
cycl
eafteri
niti
ati
ngFSHon
day2or3ofcy cle.Treat
mentwit
hganireli
xshouldbe
continuedai
lyunt i
ldayofadmini
str
ati
onofhuman
chorioni
cgonadot ropin(
whenadequatefoll
i
cular
responseachieved) .

AVAI
LABI
LITY
I
nject
ion250mcg/
0.5mLi
npr
efi
l
ledsy
ringes;

PATI
ENTTEACHI
NG
Inst
ructpati
entoncorrectt
echni
quefor
subcutaneousinj
ect
ion.Mostconveni
entsi
tesarein
theabdomenar oundthenavelandint
heupperthigh.

Gat
if
loxaci
n
I
NDI
CATI
ONS
Treat
mentoft hefollowingbact eri
alinfect
ions:Uri
nary
tr
actinfect
ions,i
ncludingcy sti
ti
s,pyelonephri
ti
s,and
gonorrhea,Respi
rat
or ytractinf
ectionsincludi
ngacute
si
nusiti
s,acuteexacerbat i
onsofchr onicbronchit
is,
and

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1774
communit
y-acqui
redpneumoni
a,Uncompl
i
cat
edSki
nand
ski
nst
ruct
ur ei
nfect
ions.

ACTI
ON
Inhi bitsbacteri
alDNAsy nthesisbyi nhibiti
ngDNAgy rase
enzy me.Ther apeut icEffects:Deathofsuscept i
ble
bact eri
a.Spectrum: Acti
v eagainstgr am- posit
ive
pat hogens, incl
udi ng:Staphy l
ococcusaur eus,
St reptococcuspy ogenes, Streptococcuspneumoni ae
(incl udingmul t
i-
dr ugresistantstrains).Gr am-negativ
e
spect rum notablef oractivi
tyagainst :Escherichiacoli
,
Kl ebsiellapneumoni ae,Haemophi lusinfluenzae,
Mor axel l
acatarr
hal is,Neisseri
agonor rhea,Proteus
mi rabi l
is.Al
soact iveagai nstthef oll
owi ngaddi t
ional
pat hogens: Chlamy dophy l
iapneumoni ae, Legionel
la
pneumophi l
iaandMy coplasmapneumoni ae.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty(
cross-
sensi
ti
vi
ty
wit
hincl
assmayexist
);Di
abet
icpat
ient
s;Pedi
:Chi
l
dren
<18yr;
OB:Pr
egnancy.

UseCaut
iousl
yin:
Knownorsuspect
edCNSdi
sor
der
;
Renali
mpairment(
dosereduct
ionifCCr≤40mL/min)
;
Concur
rentuseofClassI
Aanti
arrhyt
hmics(di
sopy
ramide,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1775
quinidine, procainami de)orClassI IIanti
arrhyt
hmics
(ami odarone, sot al
ol),eryt
hromy i
n, somephenot hiazi
nes
andt ricyclicantidepressant s(
increasedr iskofQTc
prolongat ionandr esultantarr
hythmi as);Congenit
al l
ong
QTsy ndrome; Ger i
:Ger i
atri
cpatients( i
ncreasedri
skof
adver ser eactions);OB: Lactat
ion( safetynotestabli
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, dizzi
ness,drowsi ness,headache,
i
nsomni a, agit
at i
on,confusion.CV: QTcpr olongat
ion,
ARRHYTHMI AS.GI :PSEUDOMEMBRANOUSCOLI TIS,
abdomi nal pain,di
ar r
hea,nausea.GU: vagi
niti
s.Derm:
photosensi ti
vi
t y
,rash.Endo: hyperglycemia,hypogly
cemia.
Local:phlebiti
satI Vsi t
e.MS: tendoniti
s,tendonruptur
e.
Misc:hy persensiti
v i
tyreact
ionsi ncl
udinganaphy l
axis.

I
NTERACTI
ONS
Drug- Drug: ↑r i
skofser i
ousadv ersereact i
ons(QTc
prolongat i
on&r esultantarrhythmi as)withconcurrentuse
ofCl assI AandCl assIIIanti
ar r
hy t
hmi cs,some
phenot hiazinesandt ri
cycli
cant i
depr essants;concurr
ent
usei scont raindicated.Eryt
hr omy cin,orpentamidinemay
hav esimi l
aref fects.Concur r
entuseofNSAI Dsmay↑
ri
skofadv erseCNSr eacti
ons.May↑ ser um digoxin
l
ev els.Probeneci d↑ bl oodl evels.Admi nistr
ati
onwi t
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1776
ant
aci ds, i
ronsalts,bismut hsubsali
cylat
e,sucralfate,and
zi
ncsal t
s↓ absor ption( gati
fl
oxacinshouldbe
admini stered4hrbef oret heseagents).May↑ ef fectsof
warfarin.Serum lev elsmaybe↓ byant i
neopl
ast ics.May
↑r i
skofnephr otoxicit
yf rom cycl
ospor i
ne.Concur rent
cor
ticost eroi
dt herapymay↑ r i
skoft endonrupt ure.
Concomi tantusewi t
hgl ucose-alt
eri
ngmedi cationsmay
adverselyef fectbloodsugarl evel
s.
Drug-Food:
Absorpti
onis↓ byconcur
rentent
eral
feedi
ng
(becauseofmetalcati
ons)
.

DOSAGE
PO:IV: (
Adult
s):Mosti nfect
ions—400mgq24hr( for
5–14day s,dependingont heinfect
ion) ;uncompl i
cated
uri
narytracti
nfect
ions( cyst
it
is)—400mgsi ngledoseor
200mgq24hrf or3day s;uncompl icatedur et
hral
gonorrheainmenorendocer vical
/rectal gonorr
heain
women—400mgsi ngledose.
Renal
Impai
rment
PO:I
V:(
Adul
ts)
:CCr<40mL/
min—400mgi
nit
ial
l
y,t
hen
200mgq24hr.

AVAI
LABI
LITY
Tabl
ets200mg,
400mg;
Oral
suspensi
on(
frui
t)200mg/
5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1777
mLin1,2,
3and4–gunitofusebott
les;
Inj
ecti
on200
mg/20mLv i
al,
400mg/ 20mLv i
al;
Premixedbagsf
orI
V
use200mg/100mL,400mg/ 100mL;

PATI
ENTTEACHI
NG
I
nst ructpati
enttotakemedicationasdirect
edandto
fi
nishdr ugcompletely
,eveniffeeli
ngbetter
.Take
misseddosesassoonaspossi ble,unl
essalmost
ti
mef ornextdose.Donotdoubl edoses.Advise
patientthatshar
ingthismedicationmaybe
danger ous.

Encour
agepat
ientt
omaintai
naflui
dint
akeofatl
east
1500–2000mL/daytopr
eventcr
yst
all
uri
a.

Advi
sepat i
entthatant
acidsormedicati
ons
cont
aini
ngcal ci
um, magnesi
um,aluminum,i
ron,
or
zi
ncwi l
ldecreaseabsorpt
ionandshouldnotbetaken
wit
hin4hrbef oreand2hraftert
akingthi
s
medicati
on.

Maycausedi zzi
nessanddr owsiness.Caut
ionpati
ent
toavoiddri
vingorotheracti
vi
tiesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

Cauti
onpat
ienttousesunscreenandprotect
ive
cl
othi
ngtopreventphot
otoxi
cityr
eact
ionsduringand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1778
 f
or5day
sfol
l
owi
ngt
her
apy
.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(
fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools).

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

I
nstructpatienttonot
if
yhealthcar
epr of
essi
onal
i
mmedi at
elyifrashortendonpai
norinfl
ammation
occurs.Therapyshouldbediscont
inued.

Gef
it
ini
b
I
NDI
CATI
ONS
Pati
entswhoarecurrent
lybenef
it
ingfr
om orhav
e
benefi
tedfr
om gef
it
inibi
nthepastfortr
eat
mentofnon-
smallcel
ll
ungcancer.

ACTI
ON
Inhi
bitsacti
vati
onofki nasesfoundint
ransmembr anecell
surfacerecept
or s,
incl
udingepider
malgrowt hfact
or
receptor(EGFR-TK).Therapeuti
cEff
ect
s: Deathofrapi
dly

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1779
r
epl
i
cat
ingcel
l
s,par
ti
cul
arl
ymal
i
gnantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pedi
:
Pr
egnancy
,lact
ati
on,
chi
l
dren.

UseCaut
iousl
yin:
Idi
opat
hicpul
monar
yfi
brosi
s(↑r
isk
ofpulmonar
ytoxi
cit
y);
Concur
rentuseofstr
onginhi
bit
ors
oftheCYP3A4enzymesystem (
may↑ riskoft
oxici
ty)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: weakness.EENT: aber r
anteyelash, conjunct
ivi
tis,
cornealerosi
on/ulcer
,ey epain,↓v ision.CV: peri
pher al
edema.Resp: PULMONARYTOXI CITY, dyspnea.GI:
di
arrhea,nausea,vomiting,anorexi
a, hepatotoxici
ty,mout h
ul
cerati
on.Derm: acne, dryski
n,rash, pruri
tus.Metab:
weightloss.Misc:all
ergicreact
ionsi ncludingangioedema.

I
NTERACTI
ONS
Drug-Drug:St rongi
nducersoft heCYP3A4enzy mesy st
em,
i
ncludingr i
fampi nandpheny t
oin↓ bl oodlevel
sand
eff
ects( consider↑ doseofgef i
ti
nibto500mg/ day).
Str
ongi nhibitorsoftheCYP3A4enzy mesy stem,
i
ncludingketoconazol eanditr
aconazol e↑ bloodlevels
andef f
ects( usewi t
hcaution).Absorptionandefficacy

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1780
maybe↓ bydr ugsthat↑ gastr
icpHincl
udi
ngcimeti
dine
andrani
ti
dine.May↑ theri
skofbleedi
ngwithwarf
ari
n.
Concurr
entusewithvi
norel
binemay↑ r i
sk/
sever
it
yof
neut
ropeni
a.

DOSAGE
PO:
(Adul
ts)
:250mgoncedai
l
y.

AVAI
LABI
LITY
Tabl
ets250mg;

PATI
ENTTEACHI
NG
I
nstructpati
enttot
akegef
iti
nibasdir
ected.Adv
ise
pati
enttoreadtheI
nstr
uct
ionSheetwitheachRx
ref
il
l;newinfor
mati
onmaybeav ail
abl
e.

Advisepati
enttonotif
yheal t
hcareprofessi
onal
promptl
yifseverepersist
entdiar
rhea,nausea,
vomiti
ng,oranorexi
aoccur ;i
fshort
nessofbr eathor
coughoccurorwor sen;orifeyei
rri
tat
ionorot hernew
symptomsdev elop.

I
nstr
uctpat
ientt
onoti
fyhealt
hcarepr
ofessi
onali
f
pr
egnancyi
splannedorsuspect
edori
fbreastf
eedi
ng.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1781
Gemci
tabi
ne
I
NDI
CATI
ONS
Pancreat
iccancer(locall
yadv ancedormet astati
c).
I
noperablelocal
lyadv anced/met astat
icnon-smallcell
l
ungcancer( wit
hcispl at
in)
.Met astati
cbreastcancer
(wi
thpaclit
axel)
.Adv ancedov ari
ancancert hathas
rel
apsed6moaf tercompl et
ionofpl ati
num-basedt herapy
(wi
thcarboplati
n).

ACTI
ON
I
nterfer
eswithDNAsy nthesi
s(cel
l-
cycl
ephase–speci
fic)
.
Therapeut
icEff
ects:Deathofrapi
dlyr
epli
cat
ingcel
ls,
part
icul
arl
ymalignantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Cancausef
etal
malformati
on;
Lactat
ion:Canexposeinf
anttoser
ious
adverseeff
ect
s.Bott
lefeedi
fgemcitabi
nether
apyis
necessary
.

UseCaut
iousl
yin:
Hist
oryofcar
diov
ascul
ardi
sease;
I
mpai r
edhepat
icorrenalf
uncti
on(↑r i
skoftoxi
cit
y);
Otherchr
oni
cdebil
it
atingi
ll
ness;OB:
Patient
swith

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1782
chi
l
dbear
ingpot
ent
ial
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Resp:PULMONARYTOXI CITY, dyspnea,bronchospasm.
CV: ARRHYTHMI AS, CEREBROVASCULARACCI DENT, MI,
edema, hypert
ensi on.GI :HEPATOTOXI CITY,di
arrhea,
nausea,stomat it
is,transient↑ ofl iverenzymes,v omit
ing.
GU: HEMOLYTI CUREMI CSYNDROME, hematuri
a,
protei
nuri
a.Der m: alopecia, r
ash.Hemat :anemia,
l
eukopenia,thrombocy topeni a.Local:inj
ecti
onsite
reacti
ons.Neur o:par esthesias.Mi sc:fl
u-l
ikesympt oms,
fever,
anaphy l
actoidr eactions.

I
NTERACTI
ONS
Drug-Drug:↑ bonemarrowdepressionwit
hother
anti
neoplasti
csorradi
ati
ontherapy.May↓ anti
body
responsetoli
v evi
rusv
accinesand↑ r i
skofadver
se
reacti
ons.

DOSAGE
Ot
herr
egi
mensar
eused

Pancr
eat
icCancer
I
V:(Adul
ts)
:1000mg/m2onceweekl
yfor7wk,f
oll
owed
byaweekofrest
.Maybef
oll
owedbycycl
esofonce-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1783
weekl
yadmi
nist
rat
ionf
or3wkf
oll
owedbyaweekofr
est
.
Non-
Smal
lCel
lLungCancer(
wit
hCi
spl
ati
n)
I
V:(Adul
ts):
1000mg/ m2ondays1,8,and15ofeach28-
daycycl
e(ci
spl
ati
nisal
sogivenonday1)or1250mg/m2
ondays1and8ofeach21-daycycl
e(ci
splat
ini
sal
so
gi
venonday1).

Br
eastCancer
IV:(
Adult
s):1250mg/m2onday
s1and8ofeach21-
day
cycl
e(pacl
it
axeli
sal
sogi
venonday1)
.

Ov
ari
anCancer
IV:(
Adul
ts)
:1000mg/
m2onday
s1and8ofeach21-
day
cycl
e.

AVAI
LABI
LITY
Powderf
ori
nject
ion200mg/
vial
,1g/
vial
,2g/
vial
;

PATI
ENTTEACHI
NG
Instr
uctpat i
enttonotif
yheal t
hcar epr ofessionali
f
fever;chi
ll
s;sorethroat;
signsofi nfection;bleedi
ng
gums; br
uisi
ng;petechi
ae;orbl oodinur ine,stool
,or
emesi soccurs.Cautionpatienttoav oidcrowdsand
personswi thknowni nf
ections.Instructpatienttouse

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1784
 softtoothbr
ushandelectri
crazor
.Pati
entshoul
dbe
cauti
onednott odri
nkalcoholi
cbever
agesortake
productscontai
ningaspi
rinorNSAIDs.

Inst
ructpat
ienttoinspector
almucosaforeryt
hema
andulcerat
ion.Iful
cerat
ionoccur
s,advi
sepati
entto
usespongebr ushandr i
nsemouthwithwateraft
er
eati
nganddr inki
ng.Stomati
ti
spainmayrequir
e
managementwi thopi
oidanal
gesi
cs.

Instr
uctpati
entt onoti
fyhealt
hcareprofessi
onali
ffl
u
-l
ikesymptoms( f
ever,
anorexia,
headache,cough,
chil
ls,myal
gia)
, swell
i
ngoft hefeetorl
egs,or
shortnessofbreathoccurs.

Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

Advisepat
ientthatthi
smedicati
onmayhave
ter
atogeni
ceffects.Cont
racept
ionshoul
dbeused
duri
ngtherapy.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1785
Gemf
ibr
ozi
l
I
NDI
CATI
ONS
Managementoft ypeII-bhyperl
ipidemi a(decr
easedHDL,
i
ncr easedLDL,increasedtri
glycerides)inpati
entswhodo
noty ethavecl
inicalcoronaryarterydiseaseandhav e
fai
ledt her
apywithdiet,exerci
se, weightloss,
orother
agent s(ni
aci
n,bileacidsequestrants).

ACTI
ON
I
nhi bi
tsperi
pherall
ipolysis.Decreasest r
igl
yceri
de
productionbytheli
ver .Decreasespr oducti
onoft he
tr
iglycer
idecarr
ierprotein.IncreasesHDL.Ther apeuti
c
Effects:
Decreasedpl asmat r
igly
ceri
desandi ncreased
HDL.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pri
mar
ybi
l
iar
y
ci
rr
hosi
s;Concur
rentuseofHMG-
CoAr
educt
asei
nhi
bit
ors
orr
epagl
ini
de.

UseCaut
iousl
yin:
Gal
l
bladderdi
sease;
Liv
erdi
sease;
Sever
erenali
mpai
rment
;OB:
Lact
ati
on:
Pedi
:Saf
etynot
est
abli
shed.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1786
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness,headache.EENT:blurr
edvisi
on.GI:
abdomi nalpai
n,diarr
hea,epi
gastr
icpain,f
lat
ulence,
gall
stones,heartbur
n,nausea,v
omi ti
ng.Derm:alopecia,
rashes,urt
icar
ia.Hemat :
anemia,l
eukopenia.MS: my osi
ti
s.

I
NTERACTI
ONS
Drug-Drug:Repagli
nidemay↑ t heriskofsev ere
hypoglycemia;concurrentusecont r
aindicated.May↑ the
eff
ectsofwar f
ari
norsul fonylureaoral hypoglycemic
agents.Concur r
entusewi t
hHMG- CoAr eductase
i
nhibit
orsmay↑ t heriskofr habdomy olysi
s(av oi
d
concurrentuse).May↓ t heef fectofcy closporine.
Cholestyramineandcol esti
pol may↓ absor ption;
separateadmi ni
strat
ionby≥2hr .

DOSAGE
PO:(
Adult
s):600mgt
wicedai
l
y30mi
nbef
orebr
eakf
ast
anddi
nner.

AVAI
LABI
LITY
Tabl
ets600mg;
Capsul
es300mg;

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1787
 Instructpati
enttot
akemedicat
ionasdir
ected,
nott
o
skipdosesordoubl euponmisseddoses.Take
mi sseddosesassoonasr ememberedunlessal
most
timef ornextdose.

Adv i
sepat ientthatthismedicat ionshoul
dbeusedin
conjunct i
onwi t
hdi etaryrest
ricti
ons(fat,
chol
ester
ol,
carbohy drates,
alcohol),exercise,andcessat
ionof
smoki ng.

Instr
uctpat ienttonotif
yhealthcarepr
ofessi
onal
prompt lyifanyoft hefoll
owingsymptomsoccur:
severest omachpai nswit
hnauseaandv omiti
ng,
fever,chil
ls,sorethroat
,rash,di
arr
hea,muscle
crampi ng,generalabdomi naldi
scomfort
,or
persistentfl
at ul
ence.

Gemi
fl
oxaci
n
I
NDI
CATI
ONS
Treat
mentoft hefoll
owingbacter
ial
respi
ratoryi
nfect
ions:
Acutebact
erialexacerbat
ionsofchr
onicbronchi
ti
s,
Communi t
y-acquir
edpneumoni a.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1788
Inhibitsbact eri
alDNSsy nthesisbyi nhi
bit
ingDNAgy rase
enzy me.Ther apeuticEffects:Deathofsuscept i
ble
bact eriaresulti
ngi nresoluti
onofi nfecti
on.Spectr
um:
Activ eagainstgr am- posi
tivepathogensi ncl
uding:
Strept ococcuspneumoni ae.Gram- negati
vespectrum
notabl efor:Klebsiell
apneumoni ae, Haemophil
us
i
nf l
uenzae, Haemophi l
uspar ai
nfl
uenzae, Moraxell
a
catar rhal
is.Additionalspectrum includes:Chl
amy dophyl
ia
pnaumoni ae, Mycopl asmapneumoni ae.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty(
cross-
sensi
ti
vi
ty
withincl assmayexi st )
;Historyofmy astheni agravis(may
wor sensy mpt omsi ncludingmuscl eweaknessand
breat hi
ngpr oblems); QTci nt
er v
al prolongat i
on;
Uncor r
ect edhy pokalemi aorhy pomagnesemi a;
Concur rentuseofCl assI Aant i
arr
hy thmics( disopyramide,
quinidine, procainami de)orCl assI I
Iant i
arrhythmics
(ami odar one,sot al
ol)(↑r i
skofQTci ntervalprolongati
on
andt or sadedepoi ntes);OB: Lactation:Pedi :Safetynot
establ i
shed.

UseCaut
iousl
yin:
Knownorsuspect
edCNSdi
sor
der
;
Renali
mpairment(↓ dosei
fCCr≤40mL/ min);Concur
rent
useoferyt
hromyci
n,anti
psy
choti
cs,
andtricycl
ic
ant
idepr
essants(
↑r i
skofQTcint
erval
prolongati
onand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1789
t
orsadedepointes);
Concurr
entuseofcor t
icost
eroids(↑
ri
skoftendi
nit
is/t
endonrupt
ure);Kidney,heart
,orlung
t
ranspl
antpati
ents(↑riskoftendinit
is/
tendonr uptur
e);
Geri
:↑r i
skofadv er
sereact
ions.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: ELEVATEDI NTRACRANI ALPRESSURE( i
ncluding
pseudot umorcer ebri
),SEIZURES, agi t
ati
on,anxiety,
confusion, depr
ession,dizziness,drowsiness,
hall
ucinations,headache, insomnia, ni
ghtmares, paranoi
a,
tr
emor .CV: TORSADEDEPOI NTES, QTinter
val
prol
ongat ion.GI:PSEUDOMEMBRANOUSCOLI TI S,
di
arrhea, abdominal pain,nausea,v omiti
ng.Derm:
STEVENS- JOHNSONSYNDROME, photosensit
ivity
,rash.
MS: tendiniti
s,t
endonr uptur e.

I
NTERACTI
ONS
Drug-Drug: Concur rentuseof amiodar one, disopy r
amide,
eryt
hromy cin, procainami de, dof
etil
ide, quinidine,some
anti
psy chotics,sot al
ol,ort r
icycl
icant i
depr essant s↑ risk
oftorsadedepoi ntesinsuscept ibleindi v
idual s(avoi
d
concurrentuse) .Admi nistr
at i
onwi t
hmagnesi um and
aluminum- cont ainingant acids,i
ronsal ts,bismut h
subsali
cy l
ate, sucralfate,didanosine( chewabl e/buff
ered
tabl
etsorpedi atricpowderf ororalsol uti
on) ,zincsalt
s,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1790
andothermetal
s↓ absorpti
on.Concurr
entuseof
cort
icost
eroi
dsmay↑ ther i
skoftendonruptur
e.May↑
theri
skofnephr
otoxi
cit
yfrom cycl
ospori
ne.Level
sar
e↑
byprobeneci
d.

DOSAGE
Acut
ebact
eri
alexacer
bat
ionofchr
oni
cbr
onchi
ti
s(ABECB)
PO:
(Adul
ts)
:320mgoncedai
l
yfor5day
s.
Communi
ty-
acqui
red-
pneumoni
a(CAP)
PO:
(Adul
ts)
:320mgoncedai
l
yfor7day
s.
Renal
Impai
rment
PO:(Adult
s):CCr≤40mL/
minAECB:160mgoncedai
l
y
for5days;CAP:160mgoncedai
l
yfor7day
s.

AVAI
LABI
LITY
Tabl
ets320mg;

PATI
ENTTEACHI
NG
I
nst r
uctpati
enttotakemedicat
ionasdir ectedandt o
f
inishdrugcompletely
,eveniff
eeli
ngbet ter.Take
misseddosesassoonasr emember ed,unlessalmost
t
imef ornextdose.Donotdoubledosesort akemor e
t
han1dose/ day
.Adv i
sepati
entthatshar i
ngoft hi
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1791
 medicati
onmaybedanger ous.Cauti
onpati
entsthat
gemifl
oxaci
nshouldonlybeusedt otr
eatbact
eri
al
i
nfecti
ons;i
tisnotef
fecti
veagainstvi
ral
inf
ecti
ons,
suchasthecommoncol d.

Encour
agepat
ientt
omaintai
naflui
dint
akeofatl
east
1500–2000mL/daytopr
eventcr
yst
all
uri
a.

Advi
sepat i
entthatant
acidsormedications
cont
aini
ngcal ci
um, magnesium,al
uminum, ir
on,
or
zi
ncwi l
ldecreaseabsorpt
ionandshouldnotbet aken
wit
hin4hrbef oreor2hraftergemif
loxacin.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Adv i
sepat ienttonot i
fyhealt
hcareprofessional of
anyper sonal orfami l
yhist
oryofQTcpr olongationor
proarrhythmi cconditi
onssuchasr ecenthy pokalemia,
signi
ficantbr adycardi
a,orrecentmyocardialischemia
oriffainti
ngspel lsorpalpit
ati
onsoccur.Pat i
entswi t
h
thishistoryshouldnotr ecei
vegemi f
loxacin.

Cauti
onpati
enttousesunscreenandpr otecti
ve
cl
othi
ngtopreventphot
osensiti
vit
yreacti
onsdur ing
andfor5daysaftert
her
apy.Not i
fyhealt
hcar e
prof
essi
onali
fasunburn-l
i
ker eacti
onorski nerupti
on

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1792
 occur
s.

Advi
sepatientt
oreportsignsofsuper inf
ect
ion(
fur
ry
over
growthonthetongue, vaginal
itchi
ngor
di
scharge,
looseorfoul-
smel l
ingstools).

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

I
nst r
uctpati
enttonoti
fyhealthcareprofessionalif
feveranddiarr
headevelop,especial
lyi
fstool contai
ns
blood,pus,
ormucus.Adv i
sepatientnottotreat
diarr
heawithoutconsul
tinghealt
hcar eprofessional
.

Instructpatientt onot i
fyheal thcar epr ofessional
i
mmedi at
elyi frash, j
aundice, signsofhy persensit
ivi
ty,
ort endon(shoul der,hand,Achi lles, andot her)pain,
swel li
ng,orinf l
ammat ionoccur .Iftendonsy mpt oms
occur ,avoi
dexer ci
seanduseoft heaf fectedarea.
Increasedr i
ski n>65y r
sold, kidney , heartandl ung
transplantreci pients,andpat ient staki ng
cort i
coster
oi dsconcur rent
ly.Ther apyshoul dbe
discont i
nued.

Gl
ati
ramer
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1793
I
NDI
CATI
ONS
Reducti
onoffrequencyofrelapsesinrel
apsi
ng-
remitt
ing
multi
plescl
erosi
s(MS) ,i
ncludingpat
ient
swhohav e
exper
iencedafir
stcli
nicalepisodeandMRIfeat
ures
consi
stentwit
hMS.

ACTI
ON
Appearstomodifythei
mmunepr ocessthoughttobe
responsi
blef
orMS.Therapeuti
cEffect
s:Decreased
i
ncidenceofrel
apsesinr
elapsi
ng-
remitt
ingMS.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ogl
ati
rameror
manni
tol
.

UseCaut
iousl
yin:
OB:
Lact
ati
on:
Pedi
:Saf
etynot
est
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: anxiety
,weakness,confusi
on,migraine,verti
go.CV:
chestpain,palpi
tat
ions,edema,syncope,tachycardia,
vasodilat
ion.Derm:pruri
ti
s,r
ashes,sweating,erythema.
EENT: rhi
niti
s,nyst
agmus.GI :di
arr
hea,nausea, anorexi
a,
vomiting.GU: ur
gency.Local
:inj
ecti
onsitereactions.MS:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1794
art
hral
gia,backpain,hypertoni
a.Neuro:tr
emor.Resp:
dyspnea.Misc:f
lu-l
ikesympt oms,l
ymphadenopat hy
, f
ever
,
i
mmedi ateposti
njecti
onr eacti
on,i
nfect
ion,pai
n,weight
gain.

I
NTERACTI
ONS
Dr
ug-
Drug:
Unknown.

DOSAGE
Subcut(
Adul
ts)
:20mg/
day
.

AVAI
LABI
LITY
I
nject
ion20mg/
mLi
npr
efi
l
ledsy
ringes;

PATI
ENTTEACHI
NG
I
nstructpati
enttoadmini
stermedicat
ionexact
lyas
dir
ected.Misseddosesshouldbetakenassoonas
remember edbutomitt
edifnotremembereduntil
next
day;donotdoubledoses.

Advisepati
entnottodiscont
inuemedicati
onor
changedoseordosingschedul ewi
thoutconsul
ti
ng
heal
t hcar
eprofessi
onal.

I
nfor
m pat
ientofpot
ent
ial
post
-i
nject
ionr
eact
ions.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1795
 Advisepat
ientt
ocontactheal
thcar
epr
ofessi
onal
if
chestpai
nisunusal
l
ysev ere.

HomeCar eIssues: Instr

uctpati
entinthecorr
ect
techniqueforsel f
-i
njecti
on,stor
age,andproper
disposalofequi pment .Prov
ideanddiscusspati
ent
packagei nsert
.Caut ionpati
entnottoreusesyri
nge.
Providepatientwi t
hapunct ure-
proofcontai
nerfor
needleandsy r
ingedi sposal
.

Gl
i
mepi
ri
de
I
NDI
CATI
ONS
PO: Controlofbloodsugari
ntype2di
abet
esmell
it
us
whendi ettherapyfai
l
s.Requir
essomepancr
eat
ic
functi
on.

ACTI
ON
Lowersbl oodsugarbystimulatingt herel
easeofi nsuli
n
fr
om thepancr easandincreasingt hesensiti
vi
tytoi nsul
in
atreceptorsit
es.Mayalsodecr easehepat icglucose
producti
on.Maybeusedconcur rentlywit
hmet formi n
whent hecombi nati
onofdiet,exercise,andeitherdrug
al
onef ai
lstopr oducegl
ycemi ccont rol
.Therapeutic
Effect
s:Lower i
ngofbloodsugari ndiabeti
cpat i
ents.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1796
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
sulfonamides( cr
oss-
sensit
ivi
tymayoccur )
;Type1
diabetes;Diabeti
ccomaorket oacidosis;
Sev er
erenal
,
hepat i
c,t
hyroid,orot
herendocrinedisease;Uncontr
oll
ed
i
nf ecti
on,seri
ousburns,ortr
auma.

UseCaut
iousl
yin:
Sev
erecar
diov
ascul
arorhepat
ic
disease; Glucose6-phosphat edehy drogenasedef ici
ency
(↑r iskofhemol yt
icanemi a) ;Geri
:↑ sensi ti
vity;dose
reduct i
onmayber equired; Sev er
er enaldisease( ↑r i
skof
hypogl ycemia);I
nfecti
on, stress,orchangesi ndi etmay
alterrequirementsforcont rol ofbloodsugar ;
Impai r
ed
thyroid,pit
uitar
y,oradrenal function;Mal nutri
tion,high
fever,prolongednausea, orvomi ti
ng; OB: Lactation:Safety
notest abli
shed;insul
inr ecommendeddur ingpr egnancy .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,drowsiness,headache, weakness.GI:
constipati
on,cramps, diar
rhea,drug-i
nducedhepatit
is,
dyspepsia,↑ appet i
te,nausea,vomiti
ng.Derm:
photosensiti
vit
y,rashes.Endo:hy pogly
cemia.FandE:
hyponat r
emia.Hemat :hemolyt
icanemi a.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1797
Drug- Drug: I
ngest ionofal cohol mayr esultindi sulfi
ram-
l
iker eaction.Ef fect i
v enessmaybe↓ byconcur rentuseof
diuretics,corti
cost eroids, phenot hiazines, oral
cont r
acept ives,est rogens, thyroidpr eparations,
pheny toin,nicotinicaci d,sy mpat homi metics, and
i
soni azid.Alcohol , andr ogens( testost erone),
chlorampheni col,clar i
thromy cin,disopy rami de,
fl
uor oquinolones, fluoxet ineMAOi nhi bitors,NSAI Ds
(exceptdi clofenac) ,salicylates,sulfonami des, andwar far
in
may↑ r i
skofhy pogl ycemi a.Concur rentusewi t
hwar far
in
mayal terther esponset obot hagent s( ↑ ef fectsofbot h
i
nitiall
y ,t
hen↓ act ivity);closemoni tor i
ngr ecommended
duringanychangesi ndose.Bet a-adr energicbl ockersmay
maskt hesi gnsandsy mpt omsofhy pogl ycemi a.May↑
cyclospor inelevel s.

DOSAGE
PO:
(Adul
ts):1–2mgoncedailyi
nit
ial
ly;
may↑ q1–2wk
upt
o8mg/ day(usual
range1–4mg/ day)
.

AVAI
LABI
LITY
Tabl
ets1mg, 2mg,4mg; I
ncombi nat
ionwi
th:
pi
ogl
itazone(
Duet
act)
,rosi
gli
tazone

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1798
I
nstructpat
ienttotakemedicati
onatsameti
meeach
day.Takemi sseddosesassoonasr emember
ed
unl
essalmostt imefornextdose.Donott
akei
f
unabletoeat.

Explai
ntopat
ientt
hatt
hismedi
cat
ioncontrol
s
hypergl
ycemi
abutdoesnotcur
edi
abetes.Therapyi
s
l
ongt er
m.

Revi
ewsi gnsofhy pogl
ycemiaandhy perglycemia
wit
hpat i
ent.I
fhypoglycemiaoccurs,advisepati
entto
dri
nkagl assoforangejuiceoringest2–3t spof
sugar,honey,
orcor nsyrupdissol
vedinwat eroran
appropri
atenumberofgl ucosetablet
sandnot if
y
heal
thcar epr
ofessional
.

Encouragepatientt
ofol
lowpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.

Inst
ructpati
enti
npropertesti
ngofser um gl
ucose
andketones.Thesetestsshouldbeclosel
ymoni t
ored
duri
ngper i
odsofstr
essorill
nessandheal thcar
e
prof
essionalnot
if
iedifsi
gnif
icantchangesoccur.

Concurrentuseofal
coholmaycauseadi sul
fi
ram-
li
ke
react
ion(abdominalcr
amps,nausea,
flushi
ng,
headaches,andhypogl
ycemi
a).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1799
Mayoccasi
onall
ycausedizzi
nessordrowsiness.
Cauti
onpat
ientt
oavoiddrivi
ngorotheract
ivi
ti
es
requi
ri
ngal
ert
nessunti
lresponset
omedi cati
onis
known.

Cauti
onpatienttoavoi
dothermedicati
ons,
especial
l
y
aspi
rinandalcohol
,whil
eont hi
stherapywi
thout
consult
inghealt
hcareprof
essional
.

Insulinistherecommendedmet hodofcont r
oll
ing
bloodsugardur ingpregnancy.Counsel female
patientstouseaf or
m ofcontracepti
onot herthan
oral contr
aceptiv
esandt onotifyhealt
hcar e
professionalpromptlyi
fpregnancyi splannedor
suspect ed.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Advi
sepatientt
oinf
orm heal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort ot
reat
mentorsurgery
.

Advi
sepatienttonotif
yhealthcareprofessional
pr
ompt l
yifunusual wei
ghtgain,swell
ingofankl es,
dr
owsiness,shortnessofbreath,musclecramps,
weakness,sorethroat
,rash,orunusualbleedingor
br
uisi
ngoccur s.

Adv
isepat
ientt
ocar
ryaf
orm ofsugar(
sugarpacket
s,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1800
 candy
)andident
if
icat
iondescr
ibi
ngdi
seasepr
ocess
andmedicat
ionr
egimenatallt
imes.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

Gl
i
pizi
de
I
NDI
CATI
ONS
PO: Control
sofbloodsugarintype2di
abet
esmell
it
us
whendi etther
apyfai
ls.Requi
ressomepancr
eat
ic
functi
on.

ACTI
ON
Lower sbloodsugarbyst imulatingt her
eleaseofinsuli
n
fr
om t hepancr easandi ncreasingt hesensit
ivi
tytoinsul
in
atreceptorsites.Mayal sodecr easehepat i
cglucose
production.Ther apeut
icEffects: Loweri
ngofbl oodsugar
i
ndi abeticpatients

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
sul
fonamides(cr
oss-
sensit
ivi
tymayoccur
);I
nsul
in-
dependentdi
abeti
cs;
Diabeti
ccomaorketoaci
dosis.

UseCaut
iousl
yin:
Sev
erecar
diov
ascul
arorhepat
ic

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1801
disease; Glucose6-phosphat edehy dr
ogenasedef ici
ency
(↑r iskofhemol yt
icanemi a);Geri
:↑ sensiti
vity;dosage
↓ mayber equir
ed; Severerenaldisease(↑r iskof
hypogl ycemia);I
nfection,str
ess,orchangesi ndi etmay
alterrequirementsforcont rolofbloodsugar ;
Impai r
ed
thyroid,pit
uitar
y,oradr enalfunct
ion;Malnutri
tion,high
fever,prolongednausea, orvomiti
ng;OB: Lactation:Safety
notest abli
shed;insuli
nr ecommendeddur ingpr egnancy .

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, drowsiness,headache, weakness.GI:
constipati
on, cramps, diar
rhea,
dr ug-i
nducedhepatit
is,
dyspepsia,↑ appet i
te,nausea,
v omiti
ng.Derm:
photosensitivit
y ,rashes.Endo:hy pogly
cemia.FandE:
hyponat r
emi a.Hemat :APLASTICANEMI A,
agranulocytosis, hemol yti
canemi a,l
eukopenia,
pancytopenia, thrombocy t
openia.

I
NTERACTI
ONS
Drug- Drug:Ingestionofal coholmayr esultindisulfi
ram-
l
iker eaction.Effectivenessmaybe↓ byconcur rentuseof
diuretics,corti
coster oids,
phenothi
azines, oral
cont racepti
ves,est rogens,thyr
oidprepar ati
ons,pheny t
oin,
nicotinicacid,sympat homimetics,
andi soniazid.Alcohol,
andr ogens( test
ost erone),chl
orampheni col,cl
ofibrate,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1802
clari
thromy cin,fl
uoroquinolones,MAOi nhibit
ors,NSAI Ds
(exceptdi cl
ofenac),sali
cy l
ates,fl
uconazol esulf
onami des,
andwar fari
nmay↑ r iskofhy poglycemi a.Concurrentuse
withwar f
ari
nmayal tertheresponset obot hagents(↑
effectsofbot hiniti
all
y,then↓ act i
v i
ty)
;closemoni toring
recommendeddur i
nganychangesi ndose.Bet a-
adrener gicblockersmaymaskt hesignsandsy mpt omsof
hypogly cemia.May↑cy cl
osporinelevels.

DOSAGE
PO: (Adul
ts) :
5mg/ dayini
tial
l
y,↑ asneeded(
range
2.5–40mg/ day)
;XLdosef ormisgiv
enoncedail
y.Doses
>15mg/ daymaybegi v
enas2di vi
deddosesofregul
ar-
releaseproduct(notXL).
PO:
(Ger
iat
ri
cPat
ient
s):
2.5mg/
dayi
nit
ial
l
y.

AVAI
LABI
LITY
Tabl
ets5mg,10mg;Extended-
rel
easetabl
ets2.
5mg,
5
mg,10mg;I
ncombinati
onwi t
h:metfor
min

PATI
ENTTEACHI
NG
I
nstr
uctpat
ienttotakemedicati
onatsameti
meeach
day
.Takemi sseddosesassoonasr emember
ed
unl
essal
mostt imefornextdose.Donott
akei
f

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1803
 unabl
etoeat
.

Explai
ntopat
ientt
hatt
hismedi
cat
ioncontrol
s
hypergl
ycemi
abutdoesnotcur
edi
abetes.Therapyi
s
l
ongt er
m.

Revi
ewsi gnsofhy pogl
ycemiaandhy perglycemia
wit
hpat i
ent.I
fhypoglycemiaoccurs,advisepati
entto
dri
nkagl assoforangejuiceoringest2–3t spof
sugar,honey,
orcor nsyrupdissol
vedinwat eroran
appropri
atenumberofgl ucosetablet
sandnot if
y
heal
thcar epr
ofessional
.

Encouragepatientt
ofol
lowpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.

Concurrentuseofal
coholmaycauseadi sul
fi
ram-
li
ke
react
ion(abdominalcr
amps,nausea,
flushi
ng,
headaches,andhypogl
ycemi
a).

Inst
ructpati
enti
npropertesti
ngofser um gl
ucose
andketones.Thesetestsshouldbeclosel
ymoni t
ored
duri
ngper i
odsofstr
essorill
nessandheal thcar
e
prof
essionalnot
if
iedifsi
gnif
icantchangesoccur.

Mayoccasi
onall
ycausedizzi
nessordrowsiness.
Cauti
onpat
ientt
oavoiddrivi
ngorotheract
ivi
ti
es
requi
ri
ngal
ert
nessunti
lresponset
omedi cati
onis

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1804
 known.

Cauti
onpatienttoavoi
dothermedicati
ons,
especial
l
y
aspi
rinandalcohol
,whil
eont hi
stherapywi
thout
consult
inghealt
hcareprof
essional
.

Insulinistherecommendedmet hodofcont r
oll
ing
bloodsugardur ingpregnancy.Counsel female
patientstouseaf or
m ofcontracepti
onot herthan
oral contr
aceptiv
esandt onotifyhealt
hcar e
professionalpromptlyi
fpregnancyi splannedor
suspect ed.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Advi
sepatientt
oinf
orm heal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort ot
reat
mentorsurgery
.

Advisepatienttocarr
yaform ofsugar(sugarpacket
s,
candy)andi denti
fi
cati
ondescri
bingdi
seaseprocess
andmedi cationregi
menatallti
mes.

Advi
sepatienttonotif
yhealthcareprofessional
pr
ompt l
yifunusual wei
ghtgain,swell
ingofankl es,
dr
owsiness,shortnessofbreath,musclecramps,
weakness,sorethroat
,rash,orunusualbleedingor
br
uisi
ngoccur s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1805
 Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

Gl
ucagon
I
NDI
CATI
ONS
Acutemanagementofseverehypoglycemiawhen
admini
str
ati
onofgl
ucoseisnotf easi
ble.Faci
li
tati
onof
radi
ogr
aphicexami
nati
onoft heGItract.Unl
abeledUses:
Anti
dot
eto:Betabl
ockers,
Cal ci
um channelbl
ockers.

ACTI
ON
Stimulateshepaticpr oducti
onofglucosefrom gl ycogen
stores(glycogenolysis).Rel
axesthemuscul atureoft heGI
tract(stomach,duodenum, smallbowel,
andcol on),
tempor ari
lyinhi
bit
ingmov ement.Haspositi
v einotropic
andchr onotropi
cef fects.Ther
apeuti
cEffects: I
ncreasein
bloodgl ucose.RelaxationofGImusculatur
e, facil
itat
ing
radiographicexami nati
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Pheochr
omocy
toma;
Someproductscontaingl
yceri
nandphenol
—avoidusei
n
pat
ient
swithhypersensi
ti
vi
tiestot
hesei
ngredi
ents.

UseCaut
iousl
yin:
Hist
orysuggest
iveofi
nsul
i
nomaor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1806
pheochr omocy t
oma; Prol
ongedfasti
ng, star
vati
on, adr
enal
i
nsuf fi
ciencyorchronichypogl
ycemia( l
owl evelsof
releasableglucose)
; WhenusedtoinhibitGImot il
i
ty,use
caut i
ouslyingeri
atr
icpati
entwithcardiacdiseaseor
diabetics;OB:Shouldbeuseddur i
ngpr egnancyonl yif
clearl
yneeded; Lactati
on:Saf
etynotest abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CV:hypot
ensi
on.GI:nausea,v
omiti
ng.Misc:
hyper
sensi
ti
vi
tyreact
ionsincl
udi
nganaphylaxi
s.

I
NTERACTI
ONS
Drug-Drug:Largedosesmayenhancet heef f
ectof
war f
ari
n.Negat estheresponset oinsuli
noror al
hypoglycemicagent s.Pheny t
oininhi
bitsthestimulant
ef
f ectofglucagononi nsuli
nr el
ease.Hy per
glycemic
ef
f ecti
si nt
ensifi
edandpr olongedbyepi nephrine.
Pat i
entsonconcur r
entbet ablockertherapymayhav ea
greaterincr
easei nheartrateandBP.

DOSAGE
Hy
pogl
ycemi
a
I
V:I
M: Subcut(
Adul
tsandChil
dren≥20kg)
:1mg;
maybe
r
epeat
edin15mi ni
fnecessar
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1807
I
V:I
M:Subcut(
Chil
dren<20kg)
:0.
5mgor0. 02–0.
03
mg/
kg;mayberepeatedi
n15mini
fnecessary
.

Radi
ogr
aphi
cExami
nat
ionoft
heGITr
act
I
M: IV:(Adul
ts):0.25–2mg; dependi
ngonlocat
ionand
durati
onofexami nati
on( 0.
5mgI Vor2mgI Mfor
rel
axati
onofst omach, f
orexaminati
onoft
hecolon2mg
I
M 10mi nbeforeprocedure)
.

Ant
idot
e(unl
abel
ed)
IV:(Adul
ts):Tobet
ablockers—50–150mcg( 0.
05–0. 15
mg) /kg,
foll
owedby1–5mg/ hrinf
usion.Tocal
cium
channelblocker
s—2mg; addit
ionaldosesdeter
mi nedby
response.

AVAI
LABI
LITY
Powderfori
nject
ion1-
mg(equi
val
entto1unit
)vial
sasan
emergencyki
tforlowbl
oodgl
ucoseandadiagnosti
cki
t;

PATI
ENTTEACHI
NG
Teachpat i
entandf amil
ysignsandsy mptomsof
hypoglycemia.Instr
uctpat
ienttot
akeor algl
ucoseas
soonassy mptomsofhy pogly
cemi aoccur—gl
ucagon
i
sr eser
v edforepisodeswhenpatienti
sunableto
swallowbecauseofdecr easedlev
el of

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1808
 consci
ousness.

HomeCar eIssues:Instr
uctfamilyoncorr
ect
t
echniquet oprepare, dr
awup, andadmini
ster
i
njecti
on.Heal t
hcar eprofessi
onalmustbecontact
ed
i
mmedi atelyaftereachdosef ororder
sregardi
ng
f
urthertherapyoradj ustmentofinsul
i
ndoseordiet.

Advi
sef
amilyt
hatpati
entshoul
drecei
veor
algl
ucose
whenal
ert
nessret
urns.

Inst
ructfamilyt oposit
ionpat
ientonsideunti
lful
l
y
aler
t.Explai
nt hatglucagonmaycausenauseaand
vomiti
ng.Aspi rati
onmayoccuri fpat
ientvomit
swhil
e
l
y i
ngonback.

I
nst
ructpat
ientt
ocheckexpi
rat
iondat
emont hl
yand
t
orepl
aceoutdatedmedi
cati
onimmediat
ely
.

Revi
ewhy pogl
ycemi
cmedi
cat
ionr
egi
men,
diet
,and
exer
ciseprogr
ams.

Pati
entswi
t hdi
abet
esmel li
tusshoul
dcarryasour
ce
ofsugar(
suchasapacketofsugarorcandy )and
i
denti
fi
cati
ondescri
bingdiseaseprocessand
tr
eatmentregi
menatallti
mes.

Gl
ybur
ide
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1809
I
NDI
CATI
ONS
PO: Controlofbloodsugari
ntype2di
abet
esmell
it
us
whendi ettherapyfai
l
s.Requir
essomepancr
eat
ic
functi
on.

ACTI
ON
Lower sbloodsugarbyst imulatingt her
eleaseofinsuli
n
fr
om t hepancr easandi ncreasingt hesensit
ivi
tytoinsul
in
atreceptorsites.Mayal sodecr easehepat i
cglucose
production.Ther apeut
icEffects: Loweri
ngofbl oodsugar
i
ndi abeticpatients

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
sulfonamides(cr
oss-
sensi
ti
vi
tymayoccur)
;Type1
diabetes;
Diabeti
ccomaorketoaci
dosi
s;Concur
rentuse
ofbosentan.

UseCaut
iousl
yin:
Sev
erecar
diov
ascul
arorhepat
ic
disease; Gl
ucose6- phosphatedehy drogenasedef i
ciency
(↑r iskofhemol yticanemia);Geri
:↑ sensi ti
vit
y;dose
reductionmayber equired;
Sev er
er enaldisease(↑r iskof
hypogl ycemia)
;Infecti
on,str
ess,orchangesi ndietmay
alterrequir
ement sforcontrolofbloodsugar ;Impair
ed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1810
thy
roid,pi
tui
tary
,oradrenalf
unct
ion;
Malnutri
ti
on,high
fev
er,prol
ongednausea, orv
omiti
ng;OB:Lact
ation:Saf
ety
notestabl
ished;i
nsul
inrecommendedduringpregnancy.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, drowsiness,headache, weakness.GI:
constipati
on, cramps, diar
rhea,
dr ug-i
nducedhepatit
is,
dyspepsia,↑ appet i
te,nausea,
v omiti
ng.Derm:
photosensitivit
y ,rashes.Endo:hy pogly
cemia.FandE:
hyponat r
emi a.Hemat :APLASTICANEMI A,
agranulocytosis, hemol yti
canemi a,l
eukopenia,
pancytopenia, thrombocy t
openia.

I
NTERACTI
ONS
Drug-Drug: ↑r i
skofel ev at edliv
erenzy meswhenused
withbosent an( avoidconcur rentuse) .Ingest ionofal cohol
mayr esul ti
ndi sul f
iram- likereact ion.Ef fect ivenessmay
be↓ byconcur rentuseofdi uretics,cor ticost er
oids,
phenothiazi nes,oralcont racept i
ves, est rogens, t
hy r
oid
preparations, pheny toin, nicotini
caci d,sy mpat homi met i
cs,
ri
fampi n,andi soni azid.Al cohol ,andr ogens( testosterone),
chlorampheni col,ACEi nhi bit
ors,di sopy rami de,fl
uoxet i
ne,
clari
thr
omy cin,f l
uoroqui nol ones,MAOi nhi bitors,NSAI Ds
(exceptdi cl
of enac) ,salicy l
ates, sul f
onami des,
andwar farinmay↑ t her i
skofhy pogl ycemi a.Concur rent

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1811
usewithwarfari
nmayal tertheresponsetobothagents
(↑ ef
fectsofbothini
tial
ly,
then↓ activi
ty)
;cl
ose
monitor
ingrecommendeddur i
nganychangesi ndose.
Beta-
adrenergi
cblockersmaymaskt hesignsand
symptomsofhy poglycemia.May↑cy cl
ospori
nelev
els.

DOSAGE
Thenonmi croni
zedformul
ati
on(
Diabet
a)cannotbeused
i
nterchangeablywi
ththemicr
oni
zedfor
mulati
on(Gly
nase
PresTab)
PO: (
Adults):Di
aBeta(nonmicr
onized)—2.5–5mgonce
dai
lyinit
ial
ly(r
ange1.25–20mg/ day).GlynasePresTab
(microni
zed)—1.5–3mg/ dayi
nit
ial
ly(range0.75–12
mg/ day;doses>6mg/ dayshoul
dbegi v
enasdi vi
ded
doses).I
ncrementsshouldnotexceed1. 5mg/ wk.
PO: (
Geriat
ri
cPati
ents):Di
aBeta
(nonmicroni
zed)
—1.25–2.5mg/dayi
nit
ial
l
y;maybe↑ by
2.5mg/ dayweekl
y.Gly
nasePresTab
(microni
zed)—0.
75–3mg/ day;
maybe↑ by1.5mg/day
weekly.

AVAI
LABI
LITY
Tabl
ets1.
25mg,2.
5mg, 5mg; Mi
cronizedtabl
ets1.
5mg,
3mg, 6mg;I
ncombinat
ionwi
th:metformin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1812
PATI
ENTTEACHI
NG
I
nstructpat
ienttotakemedicati
onatsameti
meeach
day.Takemi sseddosesassoonasr emember
ed
unl
essalmostt imefornextdose.Donott
akei
f
unabletoeat.

Explai
ntopat
ientt
hatt
hismedi
cat
ioncontrol
s
hypergl
ycemi
abutdoesnotcur
edi
abetes.Therapyi
s
l
ongt er
m.

Revi
ewsi gnsofhy pogl
ycemiaandhy perglycemia
wit
hpat i
ent.I
fhypoglycemiaoccurs,advisepati
entto
dri
nkagl assoforangejuiceoringest2–3t spof
sugar,honey,
orcor nsyrupdissol
vedinwat eroran
appropri
atenumberofgl ucosetablet
sandnot if
y
heal
thcar epr
ofessional
.

Concurrentuseofal
coholmaycauseadi sul
fi
ram-
li
ke
react
ion(abdominalcr
amps,nausea,
flushi
ng,
headaches,andhypogl
ycemi
a).

Encouragepatientt
ofol
lowpr escr
ibeddiet,
medication,
andexerci
ser egi
ment oprevent
hypogl
y cemicorhyper
glycemicepisodes.

Inst
ructpat
ienti
npropertest
ingofserum gl
ucose
andketones.Thesetest
sshouldbeclosel
ymoni t
ored

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1813
 duri
ngperi
odsofstr
essoril
lnessandhealt
hcare
prof
essi
onalnot
if
iedifsi
gni
fi
cantchangesoccur
.

Mayoccasi
onall
ycausedizzi
nessordrowsiness.
Cauti
onpat
ientt
oavoiddrivi
ngorotheract
ivi
ti
es
requi
ri
ngal
ert
nessunti
lresponset
omedi cati
onis
known.

Cauti
onpatienttoavoi
dothermedicati
ons,
especial
l
y
aspi
rinandalcohol
,whil
eont hi
stherapywi
thout
consult
inghealt
hcareprof
essional
.

Insulinistherecommendedmet hodofcont r
oll
ing
bloodsugardur ingpregnancy.Counsel female
patientstouseaf or
m ofcontracepti
onot herthan
oral contr
aceptiv
esandt onotifyhealt
hcar e
professionalpromptlyi
fpregnancyi splannedor
suspect ed.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Advi
sepatientt
oinf
orm heal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort ot
reat
mentorsurgery
.

Advisepatienttocarr
yaform ofsugar(sugarpacket
s,
candy)andi denti
fi
cati
ondescri
bingdi
seaseprocess
andmedi cationregi
menatallti
mes.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1814
 Advi
sepatienttonotif
yhealthcareprofessional
pr
ompt l
yifunusual wei
ghtgain,swell
ingofankl es,
dr
owsiness,shortnessofbreath,musclecramps,
weakness,sorethroat
,rash,orunusualbleedingor
br
uisi
ngoccur s.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

Gl
ycer
in
I
NDI
CATI
ONS
RectTreatmentofconst
ipat
ion.Opht
hReduct
ionof
cornealedema.

ACTI
ON
Drawswaterintothelumenoft hecol
on.Osmot i
cal
ly
drawswaterfrom extrav
ascul
arspaces,incl
udingtheey
e,
i
ntointr
avascularcompar t
ment.Ther
apeuticEffect
s:
Reli
efofconsti
pation.Reduct
ionofcornealedema.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Sev
eredehy
drat
ion;
Ger
iat
ri
cpat
ient
s
(
incr
easedr
iskofdehy
drat
ion)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1815
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:confusi
on,
headache.GI:
diarr
hea,crampi
ng,
nausea,
vomi
ting.FandE:dehy
drati
on.Misc:t
hirst.

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

DOSAGE
Laxat
ive
Rect(
Adult
sandChildr
en>6yr
):1adul
tsupposi
tor
y1–2
ti
mes/dayasneededor5–15mLasanenema.
Rect(
Chil
dren<6y
r):
1inf
antsupposi
tor
y1–2t
imes/
day
asneededor2–5mLasanenema.

Reduct
ionofCor
neal
Edema
Ophth(Adul
tsandChi
l
dren)
:1–2dropsiney
e(s)pr
iort
o
examinat
ionor1–2dr
opsineye(
s)ever
y3–4hrfor
l
ubri
canteffect
.

AVAI
LABI
LITY
Supposit
ori
esAdul
tOTC,pedi
atr
icOTC;
Liqui
dforrect
al
pediat
ri
cuse4-mLappli
cator
sOTC;Ophthal
micsolut
ion
15-mLcontai
ner
sOTC;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1816
PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakegl
ycer
inasdirect
ed.Donot
t
akemor et
hantheamountprescr
ibed.

Laxat
ive:Advi
sepati
entthatl
axat
ivesshouldbeused
onlyf
orshort-
ter
mt her
apy.Long-
termtherapymay
causeelect
rol
ytei
mbalanceanddependence.

Caut
ionpatient
snottousel
axat
iveswhenabdomi
nal
pai
n,nausea,vomi
ti
ng,orf
everi
spresent
.

Gl
ycopy
rrol
ate
I
NDI
CATI
ONS
Inhibitssalivat
ionandexcessi ver espiratorysecreti
ons
whengi venpr eoperatively.Reversessomeoft he
secr etoryandv agalactionsofchol inesteraseinhibi
tors
usedt otreatnondepol ar i
zingneur omuscul arblockade
(chol i
nergicadj unct)
.Adj uncti
vemanagementofpept ic
ulcerdi sease.Or alsolution:Reducechr onicsevere
drool i
ngi nchildrenwithneur ologiccondi ti
onsassoci at
ed
withdr ooling.

ACTI
ON
I
nhi
bit
stheact
ionofacet
ylchol
i
neatpost
gangl
i
oni
csi
tes

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1817
l
ocatedinsmoot hmuscl e, secretoryglands,andt heCNS
(anti
muscar ini
cacti
v it
y ).Lowdosesdecr easesweat i
ng,
sali
vati
on, andrespirator ysecr etions.Int
ermediatedoses
resul
tinincreasedhear tr ate.Largerdosesdecr easeGI
andGUt ractmot il
it
y.Ther apeut i
cEf f
ects:DecreasedGI
andrespiratorysecreti
ons.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Angl
e-cl
osur
e
glaucoma; Acutehemor rhage;Tachy cardi
asecondar yto
cardiacinsuff
ici
encyort hyr
otoxicosis;Sever
eulcerativ
e
coli
ti
s; Toxicmegacolon; Myastheniagravis;
Obstructiv
e
uropathy ;
Paraly
t i
cil
eus;Concur r
entuseofor alpotassium
chlori
dedosagef orms(oralsoluti
ononl y)
;Pedi
:Injecti
on
containsbenzy lal
coholandshoul dnotbegi vento
neonat es.

UseCaut
iousl
yin:
Pat
ient
swhomayhav
eint
ra-
abdomi nalinfecti
ons; Prost ati
chy perpl
asia;Chroni
cr enal
,
hepatic,pulmonar y,orcar diacdisease; Hypert
hyroi
dism;
Downsy ndromeandchi ldr enwi t
hspast icparal
ysisor
braindamage( maybehy per sensit
ivetoantimuscarinic
effects);OB:Lactati
on: Saf etynotest abli
shed;Pedi:
↑
sensitiv
itytoanticholi
ner gicef f
ectsandadv er
sereact i
ons;
Ger i
:↑ sensitivi
tytoant i
chol i
nergi
cef f
ectsandadv erse
reacti
ons.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1818
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, confusion,drowsiness.EENT:nasal
congestion, bl
urr
edv isi
on,cyclopl
egia,dryeyes,mydriasi
s.
CV:tachy cardi
a,orthostati
chy pot
ension,pal
pitat
ions.GI:
drymout h, vomit
ing,constipati
on.GU: uri
nar
yhesitancy,
uri
naryret enti
on.Derm: fl
ushing.

I
NTERACTI
ONS
Drug- Drug:May↑ GImucosal lesionsi npat i
ent st aking
oral potassium chl ori
detablets; concur r
entusewi thor al
glycopy rrol
atesol uti
oncont raindicated.Addi tive
antichol i
nergi
cef fectswi t
hot herant icholi
ner gics,
i
ncl udingant i
histami nes,phenot hiazines,meper idine,
amant adine,t
ri
cy clicanti
depr essant s,quinidine, and
disopy ramide.Mayal tertheabsor pti
onofot heror all
y
admi nistereddrugsbysl owingmot il
it
yoft heGIt r
act.May
↑ GIt r
ansitti
meofor aldigoxinand↑ di goxi nl evels.
Antaci dsoradsor bentantidi
arrheal agents↓ absor pti
on
ofant icholi
nergics.May↑ GImucosal l
esionsi npat i
ents
takingor alpotassi um chlori
det abl et
s.May↑ at enolol
andmet f
orminl evels.May↓ l evelsofhal oper i
dol and
l
ev odopa.Concur rentusemay↓ absor pti
onof
ketoconazol e(admi nist
er2hraf terketoconazol e).

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1819
Cont
rol
ofSecr
eti
onsdur
ingSur
ger
y
I
M: (
Adul
ts)
:4.
4mcg/
kg30–60mi
npr
eop(
nott
oexceed
0.
1mg).
I
M:(
Chi
l
dren>2y
r):
4.4mcg/
kg30–60mi
npr
eop.
I
M:(
Chi
l
dren<2y
r):
4.4–8.
8mcg/
kg30–60mi
npr
eop.

Cont
rol
ofSecr
eti
ons(
chr
oni
c)
I
M:I
V:(
Chi
l
dren)
:4–10mcg/
kg/
doseq3–4hr
.
PO:
(Chi
l
dren)
:40–100mcg/
kg/
dose3–4t
imes/
day
.

Chol
i
ner
gicAdj
unct
I
V: (
Adult
sandChil
dren)
:200mcgf oreach1mgof
neosti
gmineor5mgofpy r
idost
igminegiv
enatt
hesame
ti
me.

Ant
iar
rhy
thmi
c
I
V:(
Adul
ts)
:100mcg,
mayber
epeat
edq2–3mi
n.
I
V:(Chil
dren)
:4.
4mcg/kg(
upt
o100mcg)
;maybe
r
epeatedq2–3mi n.

Pept
icUl
cer
PO: (
Adults):
1–2mg2–3t i
mesdai
l
y.Anaddi
ti
onal2mg
maybegi venatbedt
ime;
maybe↓ to1mgtwicedai
ly
(nottoexceed8mg/day)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1820
I
M:I
V:(
Adul
ts)
:100–200mcgq4hrupt
o4t
imesdai
l
y.

Chr
oni
cSev
ereDr
ool
i
ng
PO: (
Chil
dren3–16yr
):Oralsol
uti
on-
0.02mg/kg3ti
mes
dail
y;may↑ by0.02mg/ kg3ti
mesdai l
yev
ery5–7day
s
(nottoexceed0.
1mg/ kg3timesdai
lyor1.
5–3mg/dose)
.

AVAI
LABI
LITY
Tabl
ets1mg,2mg; I
nject
ion200mcg(
0.2mg)
/mL;
Oral
sol
uti
on(
cher
ry-
fl
avor
)1mg/ 5mL;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakegly
copy r
rol
ateasdi
rectedand
nottotakemor ethantheprescri
bedamount.Take
misseddosesassoonasr emember edi
fnotjust
beforenextdose.

Medicati
onmaycausedrowsinessandblur
redvisi
on.
Cauti
onpatientt
oavoi
ddr i
vi
ngorotheract
ivi
ti
es
requi
ri
ngalert
nessunt
ilr
esponsetothemedicati
onis
known.

I
nform pat
ientthatfrequentoralr
inses,
sugarless
gum orcandy,andgoodor alhygi
enemayhel preli
eve
drymouth.Consulthealthcareprofessi
onalregardi
ng
useofsali
vasubst i
tuteifdrymouthpersist
sf ormore

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1821
 t
han2wk.

Advisepati
entt
ochangepositi
onsslowl
ytomini
mize
theeffect
sofdrug-
inducedor
thost
ati
chypot
ensi
on.

Caut
ionpat
ientt
oav oi
dextr
emesoft emperat
ure.
Thi
smedicati
ondecreasest
heabil
it
yt osweatand
mayincr
easetheri
skofheatst
roke.

Advisepatienttonotif
yhealthcareprofessional
i
mmedi at
elyifeyepainorincreasedsensitivi
tyt
oli
ght
occurs.Emphasi zetheimportanceofroutineeye
examst hroughouttherapy
.

Advisepati
entt
oconsul
theal
thcareprof
essional
beforetaki
nganyOTCmedicat
ionsconcurr
entl
ywith
thi
st her
apy.

Geri
:Advisegeri
atri
cpati
entsabouti
ncreased
suscept
ibil
i
tytosideeff
ectsandtocall
healthcar
e
prof
essi
onal i
mmedi at
elyi
ftheyoccur
.

Pedi
:Inst
ructpar
entstouseacalibr
atedmeasur
ing
devi
cewithsolut
ionforaccur
atedosi
ng.

Adviseparentstostopglycopy
rrolat
eandnot i
fy
heal
t hcar
epr of
essi
onalifconsti
pation;signsof
uri
naryretent
ion(i
nabil
i
tyt our
inate,drydiaper
sor
undergarments,i
rr
it
abil
it
yorcry i
ng)orr ash,hi
vesor

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1822
 anal
l
ergi
creact
ionoccur
s.

Glycopyr
rol
atereducessweati
ng.Adviseparentst
o
avoidexposur
eoft hepat
ienttohotorverywarm
envir
onmentaltemperat
urestoavoidoverheati
ngand
heatexhausti
onorheatstroke

Gol
i
mumab
I
NDI
CATI
ONS
Treatmentofmoderatelyt
osev erel
yacti
verheumatoi
d
arthr
iti
s(wi
thmethotrexat
e).Treatmentofacti
vepsor
iati
c
arthr
iti
s(al
oneorwit
hmet hotrexate)
.Treat
mentofactiv
e
ankylosi
ngspondyl
i
tis.

ACTI
ON
Inhibit
sbi ndi
ngofTNFαt orecept
orsi nhi
bit
ingacti
vit
yand
resultinginanti-i
fl
ammat oryandantiprol
if
erat
iveacti
vit
y.
Ther apeuticEffects:
Decreasedpainandswel li
ngwith
decr easedjointdestruct
ioninpat
ientswi t
hrheumatoid
arthrit
is,psori
aticart
hrit
isandankylosingspondyl
it
is.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Act
ivei
nfect
ion(
incl
udi
ngl
ocal
i
zed)
;
Concur
rentuseofabat
aceptoranaki
nra(
↑ri
skof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1823
i
nfect
ions)
;Lact
ati
on:
Avoi
ddur
ingbr
east
feedi
ng.

UseCaut
iousl
yin:
Hist
oryofchr
oni
corr
ecur
rent
i
nf ecti
onorunder lyi
ngi llness/ treat mentpr edisposi ngto
i
nf ecti
on; Historyofexposur etot uber culosis;Hi storyof
oppor t
uni st
icinf ection; Patientsr esi di
ng, orwhohav e
resided, wheret uber culosis, histopl asmosi s,
coccidioidomy coses, orblast omy cosisisendemi c;Hist
ory
ofHF( maywor sen); Historyofcent ralnervoussy stem
demy elinati
ngdi sorder s( maywor sen); Historyof
cytopeni as(maywor sen) ;
Hi storyofpsor iasis( may
exacer bate);Hepat itisBv i
ruscar riers(ri
skofr eact i
vati
on)
;
Ger i
:Usecaut i
ousl yi nel derlypat ientsduet o↑ r i
skof
i
nf ecti
on; OB: Usedur i
ngpr egnancyonl yifcl earlyneeded;
Pedi :
Saf etynotest abl i
shed; ↑r iskofl ymphoma
(i
ncludi nghepat osplenicT- cel ll
y mphoma[ HSTCL] ),
l
eukemi a,andot hermal ignanci es.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:CENTRALNERVOUSSYSTEM DEMYELI NATI NG
DISORDERS.EENT: nasophar yngiti
s.Resp: upper
respi
ratorytr
actinfect
ion.CV: HF, hypert
ensi on.GI: ↑l i
ver
enzymes.Der m:psor i
asi
s.Hemat :aplasticanemi a,
l
eukopeni a,
neutropenia,pancy t
openia,thrombocy topenia.
Local
: i
nject
ionsitereactions.Neur o:paresthesia.Mi sc:
ANAPHYLAXI S,HYPERSENSI TIVITYREACTI ONS,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1824
INFECTIONS( i
ncludingreacti
vat
iontuberculosisandother
opportuni
sti
cinfecti
onsduet obacterial
,i
nvasi v
efungal,
vir
al,
my cobacteri
al,
andpar asi
ti
cpat hogens),
MALIGNANCY( i
ncludinglymphoma, HSTCL, leukemi
a,and
skincancer)
,fever.

I
NTERACTI
ONS
Drug- Drug:Abat acept
,anaki nra,corti
costeroidsor
met hot r
exate↑ r i
skofser i
ousi nfecti
ons;concur r
entuse
withanaki nraorabat acepti snotr ecommended.↓
antibodyr esponseand↑ r i
skofadv ersereactionswith
l
ivev irusvaccines.Concur r
entusewi t
hazat hiopri
ne
and/ ormet hotrexatemay↑ r iskofHSTCL.Maynor mali
ze
previouslysuppr essedlev elsofCYP450enzy mes,
fol
lowi nginit
iati
onordi scont i
nuationofgol imumab,
effectsofsubst r at
esofthi ssy st
em maybeal ter
edand
shoul dbemoni tored,i
ncludingwar f
ari
n, t
heophy ll
ine,
and
cyclospor i
ne.

DOSAGE
Subcut(
Adul
ts)
:50mgoncemont
hly
.

AVAI
LABI
LITY
Sol
uti
onforsubcutaneousinj
ect
ion50mg/0.5mLin
si
ngl
e-dosepref
il
ledsyri
ngesandSmart
jectaut
oinj
ect
ors;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1825
PATI
ENTTEACHI
NG
Instructpat i
entoncor recttechniquef or
admi nistr
at i
on.Rev iewpat i
entinformat i
onsheet ,
prepar ati
onofdose, admi ni
strati
onsi t
esand
technique, anddi sposal ofequi pmenti ntoapunct ur
e-
resistantcont ainer.Adv i
sepat ientofrisksand
benef it
sofgol i
mumabt herapy.Injectmi sseddoses
assoonasr emember ed, t
henr eturntoregular
schedul e.Instructpat i
entt oreadMedi cati
onGui de
bef orestarti
ngt herapyandwi theachRxr efi
l
l;new
i
nf ormat i
onmaybeav ailable.

Cauti
onpatientnottoshar
ethi
smedicat
ionwi
th
other
s,evenwiththesamesymptoms;maybe
harmful
.

I
nform pat
ientofincr
easedri
skofinf
ecti
ons,
mali
gnancies,car
diacandnervoussy
stem di
sor
der
s
dur
ingther
apy .

Cautionpat ienttonotif
yheal t
hcarepr ofessional
prompt lyifanysignsofi nfect
ion,i
ncludingTB,
i
nv asi
v efungal i
nfecti
ons( fev
er,malaise,wei ghtl
oss,
sweat s,cough, dypsnea,pulmonaryinfil
trates,ser
ious
systemi cill
nesswi t
horwi thoutconcomi tantshock),
reacti
v ati
onofHBV, hypersensit
ivi
tyreactions,or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1826
 nerv
oussyst
em probl
ems(vi
sionchanges,weakness
i
nar msorl
egs,numbnessort
ingl
inginanypartof
thebody
)devel
op.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

I
nfor
m pati
enttoav
oidr
ecei
vi
ngli
vev
acci
nat
ions;
ot
hervacci
nati
onsmaybegi
ven.

Advi
sepati
entt
onotif
yhealt
hcarepr
ofessi
onalof
pr
egnancyi
splannedorsuspect
edori
fbreast
feedi
ng.

Gonador
eli
nacet
ate
I
NDI
CATI
ONS
Usedtopr
oduceovul
ati
oni
npat
ient
swi
thpr
imar
y
hypot
hal
amicamenorr
hea.

ACTI
ON
Causestherel
easeofluteinizi
nghormoneand,toa
small
erextent
,fol
li
cle-
stimulati
nghormonefrom the
pi
tui
tar
y.Whenadmi nisteredinapulsat
il
emanner ,
i
nducesovulat
ion.I
fov ulati
onandpregnancyoccur,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1827
gonadorel
inhelpst omaint
aint
hecorpuslut
eum.
Therapeut
icEffects:I
nduct
ionofov
ulati
on.Mai
ntenance
ofthecorpusluteum.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentusewi
th
ovar
iansimulators;
Condit
ionsthatwouldbeexacerbat
ed
bypregnancy
; Ovari
ancysts,hor
monallysensi
ti
vetumors,
orot
herconditionsworsenedbyreproducti
vehormones.

UseCaut
iousl
yin:
Pat
ient
s<18y
r(saf
etynot
est
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Endo:mult
ipl
epr
egnanci
es,ov
ari
anhyper
sti
mulat
ion.
Local
:i
nfl
ammation,
inf
ecti
on,mi
ldphl
ebi
ti
s,hematomas
atIVsi
te.

I
NTERACTI
ONS
Dr
ug-Drug:Avoi
dconcur
rentusewi
thot
herov
ari
an
st
imulat
ors.

DOSAGE
I
V:(Adul
ts):5mcgq90mi n(range1–20mcg)f
or21
day
s.Ifovul
ati
onoccur
s,cont
inuefor2wkt
omaintai
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1828
cor
pusl
uteum.

AVAI
LABI
LITY
I
nject
ion0.
8-,
3.2-
mgv
ial
sforusewi
tht
heLut
repul
se
pump;

PATI
ENTTEACHI
NG
I
nstructpat
ientr
egar
dingpr
operreconsti
tut
ionof
gonadorel
inacet
ateanduseofLutrepul
sepump.

Advi
sepat
ientt
orepor
tanyr
ednessori
nfl
ammat
ion
atI
Vsit
e.

Counsel
pat i
entr
egar
dingtheneedforfol
l
ow-
upif
pr
egnancyoccursandofthepossi
bil
it
yofmul
tipl
e
pr
egnancies.

Gonador
eli
nHy
drochl
ori
de
I
NDI
CATI
ONS
Usedtoassessthegonadot
ropi
n-pr
oduci
ngcapaci
tyof
theant
eri
orpit
uit
ary
.

ACTI
ON
Causest
her
eleaseofgonadot
ropi
n(l
utei
nizi
nghor
mone)

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1829
f
rom thepi
tui
tar
y.Ther
apeut
icEf
fect
s:I
ncr
easedl
evel
sof
l
utei
nizi
nghormone(LH).

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ogonador
eli
nor
benzy
lal
cohol
.

UseCaut
iousl
yin:
Pregnancy
,lact
ati
on,
orchi
l
dren
(
saf
etynotest
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Local:
hypersensi
ti
vi
tyr
eact
ions(mult
ipl
e-doseuse)
i
ncludi
nganaphy l
axi
sandanti
bodyformation(l
arge
multi
pledoses).

I
NTERACTI
ONS
Drug-Drug: Concurr
entuseofandr ogens, estrogens,
progestins,orcort
icosteroi
dsmayal terproduct i
onof
gonadot ropins.Di
goxinandhor monal contracepti
v esmay
decreasegonadot ropinlevel
s.Levodopa
andspironolactonemayi ncreasegonadot ropinlevels.
Responset ogonadoreli
nmaybedecr easedby
phenothiazinesanddopami neantagonists.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1830
SubcutI
V:(
Adul
tsandChi
l
dren≥12y
r):
100mcg.

AVAI
LABI
LITY
Powderf
ori
nject
ion100mcg/
vial
,500mcg/
vial
;

PATI
ENTTEACHI
NG
I
nfor
m pat
ientoft
hepur
poseoft
hismedi
cat
ion.

Inst
ructpati
entt
oreportt
hesymptomsof
anaphylaxi
simmediat
ely(
dif
fi
cul
tbreat
hing,
persi
stentfl
ushi
ng,
hives)
.

Goser
eli
n
I
NDI
CATI
ONS
Prostatecanceri npati
entswhocannott olerate
orchiectomyorest rogentherapy( pal
liati
ve).Wi th
fl
utami deandr adiat
iontherapyint het r
eatmentofl ocal
ly
confinedst ageT2b–T4( stageB2–C)pr ostatecancer .
Advancedbr eastcancerinperi-andpost menopausal
women( palli
ati
ve).Endomet r
iosis.Producest hinni
ngof
theendomet ri
um beforeendomet r
ialablati
onf or
dysfunctionaluteri
nebleeding.

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1831
Act sasasy ntheticform oflut einizi
nghor mone–r el
easi
ng
hor mone( LHRH, GnRH) .Inhibitsthepr oductionof
gonadot ropinsbyt hepituit
arygl and.I niti
all
y,lev
elsof
l
ut einizinghor mone( LH),foll
icle-sti
mul ati
nghor mone
(FSH) ,andt estosteroneincrease.Cont inued
admi nistrati
onl eadst odecreasedpr oduct i
onof
test osteroneandest r
adiol.Ther apeuticEf fects:
Decr easedspr eadofcanceroft hepr ost at
eorbr east
.
Regr essionofendomet r
iosiswi thdecr easedpai n.
Thi nningoft heendomet ri
um.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Undi
agnosed
v
agi
nal
bleedi
ng;
OB:
Lact
ati
on:
Pregnancyorl
act
ati
on.

UseCaut
iousl
yin:
Pedi
:Saf
etynotest
abl
i
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: STROKE, headache, anxi
ety,depr essi on,dizziness,
fatigue,insomni a,weakness.Resp: dyspnea.CV:
MYOCARDI ALINFARCTI ON, vasodilati
on, chestpai n,
hyper tension,palpi
tati
ons.GI :anorexia, const i
pation,
diarrhea, nausea,ulcer
, vomiti
ng.GU: r enal insuffi
ciency,
urinaryobst ructi
on.Der m: sweati
ng, r
ash.Endo: ↓l i
bido,
erectil
edy sfunct
ion,breastswel l
ing,br eastt enderness,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1832
i
nferti
li
ty,ovar
iancysts,ovar
ianhyperst
imulati
on
syndrome( withgonadotropi
ns).FandE: peri
pheraledema.
Hemat :anemia.Met ab:gout
,hypergl
ycemia, ↑lipi
ds.MS:
↑ bonepai n,art
hral
gia,↓ bonedensity
.Mi sc:hotfl
ashes,
chil
l
s, f
ever,weightgain.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Subcut(Adult
s) :3.6mgever
y4wkor10. 8mgq12wk.
Endometri
althinning—1or2depotsgi
ven4wkapar t
;if1
depotused,surgeryisper
for
medat4wk; if2depot
sused,
surger
yisperformed2–4wkaf ter2nddepot.

AVAI
LABI
LITY
I
mpl
ant3.
6mg,
10.
8mg;

PATI
ENTTEACHI
NG
Advisepat
ientthatbonepainmayi ncr
easeat
i
nit
iati
onoftherapy.Thi
swi l
lresol
vewitht
ime.
Pat
ientshoulddiscussuseofanalgesi
cstocont
rol
pai
nwi t
hhealthcareprofessi
onal.

Adv
isef
emal
epat
ient
stonot
if
yheal
thcar
e

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1833
 pr
ofessi
onal
ifr
egul
armenst
ruat
ionper
sist
s.

I
nform diabet
icpati
ent
sofpotent
ial
for
hyper
glycemia.Encour
agecl
osemoni t
ori
ngofser
um
gl
ucose.

Advisepati
entthatmedi cati
onmaycausehotf l
ashes.
Notifyheal
thcareprofessionali
fthesebecome
bothersome.Hor moner epl
acementt herapymaybe
addedt odecreasevasomot orsymptomsandv aginal
dry
nesswi thoutcompr omisingbenefici
aleff
ect.

I
nstr
uctpatienttonoti
fyheal
thcareprofessional
pr
omptlyifdiff
icul
tyuri
nat
ingorifsymptomsof
myocar
dialinfarct
ionorst
roke(chestpain,dif
fi
cul
ty
br
eathi
ng,weakness, l
ossofconsciousness)occur.

Advi
sepremenopausalwoment onoti
fyheal
thcare
prof
essi
onali
fpregnancyi
splannedorsuspectedof
i
fbreast
feedi
ng.Eff
ecti
vecontr
acepti
onshouldbe
usedduri
ngandfor12wkaf t
ertreat
mentends.

Emphasizet
hei
mportanceofadher
ingt
othe
schedul
eofmont
hlyorever
y-3-
monthadmini
str
ati
on.

Gr
iseof
ulv
in
I
NDI
CATI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1834
Treatmentofvari
oustineainf
ect
ions.Shoul
dnotbeused
forsuperf
ici
ali
nfect
ionsthatmayrespondtotopi
cal
anti
fungal
s.

ACTI
ON
I
nhi bi
tsmitosi
soffungalcell
s.Deposi
tsinprecur
sorcell
s
ofhair,ski
n,andnail
s,makingthem r
esist
anttofungal
i
nv asi
on.Therapeuti
cEff
ects:Growthofnewcel l
sthatar
e
resist
anttoinvasi
onbyfungi.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erel
i
verdi
sease
orpor
phy
ria.

UseCaut
iousl
yin:
OB:
Lact
ati
on:
Saf
etynotest
abl
i
shed;
Possi
blecr
oss-
sensi
ti
vi
tywi
thpeni
cil
l
in.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache,dizzi
ness.EENT: hear
ingloss.GI:
HEPATOTOXI CITY,diar
rhea,epigastri
cdistr
ess,extr
eme
thi
rst
, f
latul
ence,nausea, vomiti
ng.Derm: ERYTHEMA
MULTI FORME, STEVENS- JOHNSONSYNDROME, TOXIC
EPIDERMALNECROLYSI S,photosensit
ivi
ty,
rashes.Hemat
:
l
eukopeni a.Misc:hyper
sensi t
ivi
tyreacti
onsincl
uding
serum sickness,l
upus-l
ikesy ndrome.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1835
I
NTERACTI
ONS
Drug-
Dr ug:Tachycardi
a,f
lushi
ng,and↑ CNSdepr essi
on
mayr esulti
ftakenconcurrent
lywit
hal
cohol
.
Phenobar bi
tal↓ bl
oodlevelsandmay↓ effect
iveness.
May↓ t heef f
ecti
venessofwar f
ari
norhor
monal
contr
acept i
veagents.
Dr
ug-
Food:
Absor
pti
oni
s↑ byf
att
yfoods.

DOSAGE
Mi
crosi
ze
PO:(
Adul
ts):
Tineapedi
s,onychomycosi
s—500mgq12
hr
.Ti
neacapi
ti
s,cor
pori
s,orcrur
is—250mgq12hror500
mgoncedai
ly.
PO:
(Chi
ldr
en>23kg)
:125–250mgq12hror250–500
mgoncedail
y.
PO:
(Chi
ldr
en14–23kg)
:62.
5–125mgq12hr
or125–250
mgoncedail
y.

Ul
tr
ami
crosi
ze
PO: (
Adul
ts):
Tineapedi
s,onychomycosi
s—375mgq12
hr.Ti
neacapi
ti
s,cor
pori
s,orcrur
is—187.
5mgq12hror
375mgoncedai l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1836
PO:
(Chi
l
dren>27kg)
:187.
5–375mgoncedai
l
y.
PO:
(Chi
l
dren16–27kg)
:125–187.
5mgoncedai
l
y.

AVAI
LABI
LITY
Micr
osi
zet
abl
ets500mg;Oral
suspensi
on(
mi cr
osi
ze)
125mg/5mL;
Ultr
amicr
osi
zetabl
ets125mg,250mg;

PATI
ENTTEACHI
NG
Inst
ructpatientt
ocompl et
efullcour
seoftherapy
;
severalweeksoft herapymaybenecessar y.I
fadose
i
smi ssed,takeassoonasr emember ed,
butdonot
takeifal
mostt imef ornextdose.

I
nstructpat
ientonhy gi
enet
ocont
rol
sour
cesof
i
nfecti
onorr ei
nfect
ion.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

Advi
sepati
enttowearsunscreenandprotect
ive
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eacti
on.

Caut
ionpat
ientnott
odr
inkal
cohol
whi
l
etaki
ngt
his
medi
cati
on.

Adv
isepat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1837
 r
ash,
sor
et hr
oat,
fever
, di
arr
hea,
orsor
enessof
mout
hortongueoccurs.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

Advi
sef emalepatient
stakingoral
contracepti
vesto
useanaddi t
ionalnonhor
monal for
m ofcontracepti
on
duri
ngtherapyandunt i
lnextmenstrualperi
odandt o
noti
fyhealt
hcar eprof
essionali
fpregnancyisplanned
orsuspected.

Emphasi
zeimport
anceoffol
low-
upexami
nat
ionst
o
moni
torprogr
essofther
apy.

Guai
fenesi
n
I
NDI
CATI
ONS
Coughsassoci
atedwi
thv
iral
upperr
espi
rat
oryt
ract
i
nfect
ions.

ACTI
ON
Reducesviscosit
yoft enacioussecr
etionsbyi
ncreasing
respi
rat
orytractfl
uid.Therapeuti
cEffects:
Mobil
i
zation

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1838
andsubsequentexpect
orat
ionofmucus.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Somepr
oduct
s
cont
ainalcohol
;av
oidinpati
entswi
thknownint
oler
ance;
Somepr oduct
scontai
naspartameandshoul
dbeav oi
ded
i
npatientswit
hphenyl
ketonur
ia.

UseCaut
iousl
yin:
Coughl
ast
ing>1wkoraccompani
ed
byf ever
,rash,orheadache; Patient
sr ecei
vingdisul
fi
ram
(l
iquidproductsmaycont ai
nalcohol
); Di
abeti
cpat i
ents
(somepr oduct smaycont ai
nsugar);OB: Al
thoughsafety
hasnotbeenest abli
shed,guaif
enesinhasbeenused
withoutadv er
seef f
ects;Pedi:
OTCcoughandcol d
productscont ainingthismedicati
onshoul dbeav oi
dedin
chil
dren<4y r
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:dizzi
ness,headache.GI
:nausea,
diar
rhea,
stomach
pai
n,vomiti
ng.Derm: r
ash,ur
ti
cari
a.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1839
PO:(Adult
s):200–400mgq4hror600–1200mgq12hr
asextended-
rel
easeproduct(
nott
oexceed2400mg/
day
).
PO:(Chi
l
dren6–12yr)
:100–200mgq4hror600mgq12
hrasext
ended-
rel
easeproduct(
nott
oexceed1200
mg/day)
.
PO:(
Chi
l
dren4–6y
r):
50–100mgq4hr(
nott
oexceed
600mg/
day).

AVAI
LABI
LITY
Syr
up100mg/5mLOTC;
Oral
sol
uti
on100mg/
5mLRx,
OTC,200mg/
5mLOTC;
Capsul
es200mgOTC;
Tabl
ets100mgOTC,
200mgRx,
OTC,
1200mg;
Extended-rel
easetablets(Mucinex)600mg, 1200mg;In
combi nat
ionwith:analgesi
cs/anti
pyret
ics,ant
ihi
stami
nes,
decongestants,andcoughsuppr essantsRx,OTC.

PATI
ENTTEACHI
NG
Instructpat
ienttocougheffect
ivel
y.Pat
ientshoul
dsi
t
uprightandt akesever
aldeepbreathsbefor
e
attempt i
ngtocough.

Caut
ionpar
ent
stoav
oidOTCcoughandcol
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1840
 productswhi
l
ebreast
feedi
ngoradmi
nist
eri
ngt
o
chil
dren<4yr
s.

Infor
m pati
entthatdrugmayoccasi
onall
ycause
dizzi
ness.Avoi
ddr i
vi
ngorotheract
ivi
ti
esrequi
ri
ng
alert
nessunti
lresponset
odrugisknown.

Adv i
sepatientt
olimi
ttal
ki
ng,stopsmoki ng,mai
ntai
n
moi st
ureinenvir
onmentalai
r,andtakesome
sugarlessgum orhar
dcandyt ohel
pal l
eviat
ethe
discomf or
tcausedbyachronicnonproducti
vecough.

Instr
uctpati
enttocontactheal
thcar
eprofessionali
f
coughper si
stsl
ongerthan1wkori saccompani edby
fever,r
ash,orper
sist
entheadacheorsorethroat.

Guanabenz
I
NDI
CATI
ONS
Managementofhy
per
tensi
on.

ACTI
ON
Stimul atesCNSal pha2-
adrener
gicr
eceptors,produci
nga
decr easei nsy mpatheti
coutfl
owtoheart,ki
dney s,
and
bloodv essels.Resulti
sdecreasedBPandper ipheral
resistance, aslightdecr
easeinheartr
ate,andnochange

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1841
i
ncar
diacout
put
.Ther
apeut
icEf
fect
s:Lower
ingofBP.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Ser
iouscar
diacorcer
ebr
ovascul
ar
disease,
renal
orhepaticinsuf
fi
ciency;
Geri
atr
icpati
ents
(mor epr
onetoadversereacti
ons);Pr
egnancy
,lact
ati
on,or
chil
dren<12yr(saf
etynotestabl
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness, dr
owsi ness,weakness, headache,
i
rri
tabili
ty,nervousness.EENT: blur
redv i
sion,dr yeyes,
miosis,nasal congest i
on.Resp: dyspnea.CV: arrhyt
hmi as,
bradycardia,chestpai n,edema, hypotension,pal pi
tations.
GI:drymout h,abdomi nal pai
n, abnormal taste,anor exia,
constipation,diarr
hea, nausea, vomiting.GU: erectil
e
dysfunction,urinaryfr
equency .Derm: pr
urit
us, rashes,
sweating.Endo: gynecomast ia.MS: backache, painful
extr
emi ti
es.Mi sc: wi
thdr awalphenomenon.

I
NTERACTI
ONS
Drug-Drug:Addit
ivesedationwit
hCNSdepr essant
s,
i
ncludingalcohol
,anti
histamines,opi
oids,
and
sedative/
hypnoti
cs.Tricy
cl i
cant
idepr
essantsandNSAIDs

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1842
maydecr easeantihypertensi
veeff
ects.MAOi nhi
bit
or s
decreaseeffect
iveness.Additi
vehypotensionwit
hot her
anti
hypertensi
ves,nit
rates,andacuteingesti
onofalcohol.

DOSAGE
PO:(
Adult
s):4mgbid;
mayi
ncr
easeq1–2wki n4–8-
mg
i
ncr
ements(r
ange8–16mg/
day;nott
oexceed32
mg/day
).

AVAI
LABI
LITY
Tabl
ets4mg,
8mg;

PATI
ENTTEACHI
NG
Emphasi zet hei mpor tanceofcont inuingt otaket hi
s
medi cati
onasdi r
ected, eveniffeeli
ngwel l
.
Medi cati
oncont rolsbutdoesnotcur ehy pertensi
on.
Instructpatientt otakemedi cati
onatt hesamet i
me
eachday .I
fadosei smi ssed, t
akeassoonas
remember ed; donotdoubl edoses.I nstructpat i
entto
i
nf orm healthcar epr ofessionalifmor ethanone
consecut iv
edosei smi ssed.Donotdi scontinue
abr uptl
y;maycausesy mpat heti
cov ersti
mul ati
on
(ner v
ousness, anxi
ety ,r
eboundhy pertension).

Adv
isepat
ientt
omakesur
eenoughmedi
cat
ioni
s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1843
 avai
lablef orweekends,
hol
i
days,
andv
acati
ons.A
writ
tenpr escri
pti
onmaybekepti
nwal
leti
ncaseof
emer gency .

Encouragepatienttocomplywi thaddit
ional
i
nterv
ent i
onsforhy per
tensi
on( weightreduct
ion,
low-
sodi
um di et
,smokingcessation,moder ati
onof
al
cohol consumption,r
egularexercise,
andstress
management ).

Inst
ructpati
entandf ami
lyonpropert
echni
queforBP
monitori
ng.Advisethem t
ocheckBPatleastweekl
y
andreportsi
gnifi
cantchanges.

Pati
entsshouldweighthemselvestwi
ceweekl
yand
assessfeetandanklesforf
lui
dr et
ent
ion.

Maycausedr owsi
nessordi zziness.Cauti
onpatient
toavoiddri
vingorotheractivi
tiesrequir
ingal
ertness
unti
lresponsetothemedi cationisknown.
Drowsinessusuall
ydecreaseswi thconti
nuedtherapy.

Advi
sepatientt
oconsultheal
thcareprofessi
onal
bef
oretaki
nganyOTCmedi cat
ions,especi
all
ycough,
col
d,orall
ergyr
emedies.

Caut
ionpat
ientt
oavoi
dalcohol
andotherCNS
depr
essant
swhilet
aki
ngguanabenz.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1844
 Frequentmout hri
nses,
goodor alhygi
ene,and
sugarlessgum orcandymaymi nimizedrymouth.I
f
drymout hpersist
sformorethan2wk, consul
tdenti
st
regardinguseofsali
vasubst
itute.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advisepatienttonot i
fyheal
thcareprofessi
onalif
fr
equentdizzinessorweakness, i
rri
tabil
it
yor
nervousness,slowhear trat
e,pi
npointpupil
s,unusual
ti
redness,orper si
stentdrymouthoccurs.

Emphasi
zethei
mpor t
anceoff
oll
ow-upexamst
o
eval
uat
eeff
ecti
venessofmedi
cati
on.

Guanadr
el
I
NDI
CATI
ONS
Moderat
etosev
erehypert
ensi
on(
wit
hatl
eastoneot
her
agent
,usual
l
yadiur
eti
c).

ACTI
ON
Prevent
sthereleaseofnorepinephri
nefrom adrener
gic
nerv
eendingsandt headrenal medull
ainresponseto
sympathet
ic(adrener
gic)sti
mul at
ion.Depl
etes

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1845
norepi
nephri
nefrom nerv
eendings.Resul
tisdecreased
sympatheti
cal
lymediatedvasoconst
ri
cti
on.Therapeuti
c
Eff
ects:Loweri
ngofBP.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
HF;
Pheochr
omocy
toma;
Lact
ati
on.

UseCaut
iousl
yin:
Ast
hma;
Car
diov
ascul
aror
cerebrovascul
arinsuffi
ciency;Pept i
cul
cerdisease;
Patientswithrenalfai
l
ure( i
ncreaseddosi ngi
nterval
recommendedi fCCr<60mL/ mi n);Ger
i:AppearsonBeers
l
ist.Geriat
ri
cpat i
entsareatincr easedri
skfororthost
ati
c
hypotension.Pregnancy,lact
ation,orchil
dren<18y r
(safetynotestabli
shed).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: conf usion,dizziness, drowsiness, fainting,fatigue,
headaches, anxiet
y ,depressi on,sl
eepdi sturbances.EENT:
nasal stuffi
ness, v
isual disturbances.Resp: cough,
shortnessofbr eath.CV: chestpai n, edema, or t
host ati
c
hypotension, palpi
t ati
ons.GI :anorexia,const ipation,
diar
rhea, drymout h, gaspai n,indi
gest i
on, abdomi nalpain,
nausea.GU: ejaculationdi sturbances, erecti
ledy sfuncti
on,
nocturia,uri
nar yfrequency .MS: achingl i
mbs, l
egcr amps.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1846
Neur
o:par
est
hesi
a.

I
NTERACTI
ONS
Drug- Drug: Concur rentusewi t
hbet ablocker sor
vasodi l
at orsincreasest her i
skofexcessi v eort
hostati
c
hypot ensi on(concur rentusewi thv asodi l
atorsisnot
recommended) .Ant i
hypertensiveef f
ectsmaybe
decr easedbyconcur rentuseofphenot hiazinesor
sympat homi met ics.Effectsofdirect-acting
sympat homi met icsmaybei ncreasedbyguanadr el.
Tricycli
cant idepressant smaydi minisht he
antihyper tensiveef f
ectsofguanadr el.Abr uptwithdrawal
oft r
icyclicantidepressant smayenhancet heeffectof
guanadr el.NSAI Dsmaydecr easetheant i
hy per
tensive
effectsofguanadr el.

DOSAGE
PO:(Adul
ts):
5mgbi d,
increasedweekl
yormonthlyas
needed(r
ange20–75mg/ dayin2–4divi
deddoses).
Renal
Impai
rment
PO:(Adul
ts)
:CCr30—60mL/ mi n—5mgq24hri nit
ial
ly,
dosagemaybeadjust
edat7dayi nter
val
s;CCr<30
mL/mm—5mgq48hri ni
ti
all
y,dosagemaybeadjustedat
14dayint
erv
als.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1847
AVAI
LABI
LITY
Tabl
ets10mg,
25mg;

PATI
ENTTEACHI
NG
Emphasizet hei
mpor t
anceofconti
nuingtotaket
his
medicati
onasdi r
ected,eveni
ffeel
i
ngwel l
.
Medicati
oncont r
olsbutdoesnotcurehypert
ensi
on.
Inst
ructpati
enttotakemedicati
onatthesamet i
me
eachday .I
fadosei smissed,
takeassoonas
remember ed;donotdoubledoses.

Encouragepatienttocomplywi thaddit
ional
i
nterv
ent i
onsforhy per
tensi
on( weightreduct
ion,
low-
sodi
um di et
,smokingcessation,moder ati
onof
al
cohol consumption,r
egularexercise,
andstress
management ).

Inst
ructpati
entandf ami
lyonpropert
echni
queforBP
monitori
ng.Advisethem t
ocheckBPatleastweekl
y
andreportsi
gnifi
cantchanges.

Pati
entsshouldweighthemselvestwi
ceweekl
yand
assessfeetandanklesforf
lui
dr et
ent
ion.

I
nfor
m pat
ientthatseveri
tyofsi
deeff
ect
sisusual
l
y
r
educedaf
tertheinit
ial8wkofther
apy.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1848
Maycausedr owsi
nessordizziness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heract
ivi
ti
esr equir
ingal
ert
ness
unti
lresponsetot
hemedicationisknown.

Cautionpat i
enttoavoidsuddenchangesi nposit
ion,
especiall
yuponr isi
nginthemor ning,tomi ni
mize
ort
host ati
chy pot
ension.Alcoholandot herCNS
depressants,standi
ngf orl
ongper iods,hotshowers,
andexer ci
singinhotweat hershouldbeav oi
ded
becauseofenhancedor thostat
icef f
ects.

Advi
sepatientt
oconsultheal
thcareprofessi
onal
bef
oretaki
nganyOTCmedi cat
ions,especi
all
ycough,
col
d,orall
ergyr
emedies.

Caut
ionpat
ientt
oavoi
dalcohol
andotherCNS
depr
essant
swhilet
aki
ngguanadrel
.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advisepat i
entt onot i
fyhealt
hcareprofessi
onalif
severediarrhea,frequentdizzi
nessorfainti
ng,f
ever,
orswelli
ngoff eetorlowerlegsoccurs.Dosage
reducti
onmayber equir
edforexcessi
veor t
hostat
ic
hypotension,sev erediarr
hea,ornormalsupineBP.

Emphasi
zethei
mpor t
anceoff
oll
ow-upexamst
o
eval
uat
eeff
ecti
venessofmedi
cati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1849
Guanet
hidi
ne
I
NDI
CATI
ONS
Moderat
etosev
erehy
per
tensi
on(
wit
honeot
heragent
,
usual
l
yadiur
eti
c).

ACTI
ON
Preventstherel
easeofnor epinephri
nefrom adrenergi
c
nerv
eendi ngsinresponset osympat het
icsti
mul at
ion.
Depletesnorepi
nephrinefrom nerveendings.Resulti
s
decreasedsy mpatheti
call
ymedi at
edv asoconstri
cti
on.
TherapeuticEff
ects:Gradualandprolongedf al
li
nBP.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
HF;
Pheochr
omocy
toma.

UseCaut
iousl
yin:
Ast
hma;
Car
diov
ascul
aror
cerebrovascularinsuf fi
ciency;Pepti
culcerdisease;
Impairedrenal f
unct i
on( dosagereducti
onrequir ed);
Geri
:
Appear sonBeer sl ist.Maycauseor t
hostat
ichy potensi
on
i
nol deradults;Fev er;Pregnancy,lact
ati
on,orchi ldr
en
(safet
ynotest ablished) .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1850
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: confusion,dizziness,drowsi ness,faint
ing, fati
gue,
headaches, anxiety,mental depression, sl
eep
distur
bances.EENT: nasal stuffi
ness, vi
sual di
st urbances.
Resp: cough,shor t
nessofbr eath.CV: chestpai n, edema,
orthostat
ichy potension,palpit
at i
ons.GI :anorexia,
constipati
on,diarrhea,drymout h,gaspai n,i
ndi gestion,
abdomi nalpain,nausea.GU: ejaculati
ondi sturbances,
erecti
ledysfunction,nocturia,urinaryfrequency .MS:
achinglimbs, l
egcr amps.

I
NTERACTI
ONS
Drug-Drug: Hy potensiv
eef fectsmaybedecr easedby
haloperi
dol ,met hyl
pheni dat e,
MAOi nhi
bi t
ors(di sconti
nue
1wkbef or eguanet hi
dine) ,phenothi
azines,adr energic
agents( sympat homimet ics) ,
andtri
cycli
cantidepr essant
s.
Profoundhy potensionmayoccurwi thmi noxidil.
Guanethi dinemaypot ent i
atet heeff
ectsofdi rect-acti
ng
adrenergics( sympat homi met i
cs)
.NSAI Dsmaydecr ease
theantihy pertensiv
eef fectsofguanet hidine.

DOSAGE
PO:(Adult
s):
Ambulat
orypati
ents—10or12.
5mg/day
i
nit
ial
ly;
maybeincr
easedevery5–7daysby10or12.
5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1851
mg/day.Usualmaintenancedoseis25–50mg/dayasa
si
ngledose.Hospit
alizedpat
ient
s—Ini
ti
aldosemaybe
25–50mg, i
ncreasedby25–50mgdai l
yorever
yotherday
asneeded.
PO:(Chi
ldr
en)
:0.2mg/ kg/
day(6mg/ m2/day
)asasingl
e
dose;maybei
ncreasedevery7–10daysby0.2mg/
kg( 6
mg/m2)asneeded(upt o3mg/ kg/
day)
.

AVAI
LABI
LITY
Tabl
ets10mg, 25mg;
Incombi
nat
ionwi
th:
hydr
ochl
orot
hiazi
de

PATI
ENTTEACHI
NG
Emphasi zet heimpor t
anceofcont inuingtotaket hi
s
medi cati
on, eveniffeel
ingwell.I
nst r
uctpatientto
takemedi cat i
onatthesamet i
meeachday .Ifadose
i
smi ssed,takeassoonasr emember ed;donot
doubl edoses.I f2dosesi narowar emi ssed, consul
t
healthcarepr ofessi
onal.Guanethidinecontrolsbut
doesnotcur ehy per
tension.Donotdi sconti
nue
medi cati
onwi thoutconsulti
ngheal thcare
professional.

Encouragepat
ientt
ocomplywi
thaddit
ional
i
nterv
entionsf
orhyper
tensi
on(
weightr
educti
on,
low-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1852
 sodi
um diet
,smoki
ngcessat
ion,moderat
ionof
al
coholconsumpti
on,
regul
arexerci
se,
andstress
management).

Inst
ructpati
entandf ami
lyonpropert
echni
queforBP
monitori
ng.Advisethem t
ocheckBPatleastweekl
y
andreportsi
gnifi
cantchanges.

Pati
entsshouldweighthemselvestwi
ceweekl
yand
assessfeetandanklesforf
lui
dr et
ent
ion.

Maycausedrowsi
ness.Adv
isepatientt
oav oi
ddrivi
ng
orot
heract
ivi
ti
esrequi
ri
ngaler
tnessunti
lresponseto
medi
cati
onisknown.

Cautionpatienttoav oidsuddenchangesi nposi ti

on
tomi ni
mizeor t
host ati
chy pot
ensi
on, especiall
yupon
ari
singinthemor ning.Usingal
cohol orotherCNS
depressants,standingf orl
ongperiods,taki
nghot
showers,andexer ci
singinhotweat hershouldbe
avoi
dedbecauseofenhancedor t
host at
iceffects.

Ifdrymout hoccurs,fr
equentmouthrinses,
goodor al
hygiene,andsugarlessgum orcandymaydecr ease
effect
.Ifdrymouthper sist
sformorethan2wk,
consultdenti
stregardinguseofsal
ivasubsti
tute.

Advi
sepat
ientt
oconsul
theal
thcareprofessi
onal
bef
oret
aki
nganyOTCmedi cat
ions,especi
all
ycough,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1853
 col
d,oral
l
ergyr
emedi
es.

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advisepat
ienttonoti
fyheal
thcar
eprofessi
onalif
severedi
arrhea,
fever
,fr
equentdi
zzi
ness,orfai
nti
ng
occurs.

Emphasi
zethei
mpor t
anceoff
oll
ow-upexamst
o
eval
uat
eeff
ecti
venessofmedi
cati
on.

guanf
aci
ne
I
NDI
CATI
ONS
Hy pert
ension(
withthiazi
de-ty
pediur
etics)(i
mmedi ate-
release)
.Treat
mentofat tenti
on-
defi
cithyperacti
vi
ty
disorder(ADHD)asmonot her
apyorasadj uncti
vetherapy
tost i
mulants(
extended-r
elease)
.

ACTI
ON
Stimul atesCNSal pha2-
adrener
gicr
eceptors,producinga
decr easei nsy mpatheti
coutfl
owtoheart,ki
dney s,and
bloodv essels.Resulti
sdecreasedBPandper ipheral
resistance, aslightdecr
easeinheartrat
e,andnochange
i
ncar diacout put.Mechani
sm ofactioni
nADHDi s

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1854
unknown.Ther
apeuticEf
fects:
Loweri
ngofBPin
hypert
ensi
on.I
ncreasedatt
enti
onspaninADHD.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Sev
erecor
onar
yar
ter
ydi
seaseor
recentmy ocardi
al i
nfarction;Geri:Mayhav e↑ sensi ti
vi
ty,
especiall
ythosewi thhepat ic,
car diac,orrenal dysfunct
ion;
Cerebrovasculardisease; Severer enalorliverdisease;
Historyofhypotension, heartblock, br
ady cardia,or
cardiovascul
ardisease; OB: Lactation:Pedi: Pregnancy,
l
actat i
on,orchil
dren<6y r(safetynotest ablished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsi ness,headache, weakness, depression,
di
zziness, fati
gue,insomni a,ir
ri
tabi
li
ty.EENT: tinni
tus.
Resp: dyspnea.CV: br
ady cardi
a,chestpain,hy potensi
on,
palpi
tations,reboundhy per t
ension,syncope.GI :
constipati
on, drymout h,abdomi nalpain,nausea.GU:
erect
iledy sfuncti
on.

I
NTERACTI
ONS
Dr
ug-Drug:↑ hypot
ensi
onwithot
heranti
hyper
tensi
ves,
ni
tr
ates,andacutei
ngest
ionofal
cohol
.↑ CNS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1855
depr essionmayoccurwi thotherCNSdepr essants,
i
ncl udingal cohol,antihist
ami nes,opi
oidanalgesi
cs,
tr
icy cl
icant i
depressant s,andsedat i
ve/hypnoti
cs.NSAIDs
may↓ ef fecti
veness.Adr energi
csmay↓ ef f
ecti
veness.
↑r iskofhy potensionandbr ady car
diawithstr
ong
CYP3A4i nhibi
tors,includingketoconazole.Str
ong
CYP3A4i nducers,includingr i
fampinmay↓ ef fects(an↑
i
ndoseofguanf acinemaybeneeded) .May↑ levelsof
valproicaci d.

DOSAGE
I
mmediate-
rel
easeandext
ended-
rel
easet
abl
etsshoul
d
notbei
nter
changed

Hy
per
tensi
on
PO:(Adul
ts)
:1mgdailygivenatbedt
ime,
maybe↑ i
f
necessar
yat3–4wkinter
valsupto2mg/day
;mayal
so
begiveni
n2divi
deddoses.

ADHD
PO:(
Adul
tsandChi
ldr
en≥6y r
):1mgdail
yinmorni
ng;
may
be↑ by1mg/dayatweekl
yint
erv
alst
oachiev
edoseof
1–4mg/day
.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1856
I
mmedi ate-
rel
easetabl
ets(
Tenex)1mg,2mg;Ext
ended-
r
eleasetabl
ets(I
ntuni
v)1mg,2mg, 3mg,4mg;

PATI
ENTTEACHI
NG
Adv i
sepati
enttonot i
fyhealthcar
eprofessionalofal
l
RxorOTCmedi cations,vi
tamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetakingothermedi
cations,
especial
lycough,cold,orall
ergyr
emedies.

Caut
ionpat
ientt
oavoi
dalcoholandotherCNS
depr
essant
swhilet
aki
ngguanfacine.

Advisepati
enttonotifyhealt
hcarepr ofessi
onalifdr
y
mout horconst
ipati
onper si
sts.Frequentmout h
ri
nses,goodoralhygiene,andsugar l
essgum or
candymaymi nimizedr ymouth.Increaseinfl
uidand
fi
berint
akeandexer cisemaydecr easeconst i
pati
on.

I
nst
ructpat
ienttonot
if
yheal
thcarepr
ofessi
onalof
medi
cati
onregimenpri
ortot
reat
mentorsurgery
.

Adv i
sepatienttonoti
fyhealthcarepr of
essionali
f
di
zziness,prolongeddrowsiness,fati
gue,weakness,
depressi
on, headache,sexualdysfuncti
on,mental
depressi
on, orsleeppatt
erndistur
banceoccur s.
Disconti
nuationmayber equi
redifdrug-r
elated

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1857
 ment
aldepr
essi
onoccur
s.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

Emphasi
zethei
mpor t
anceoff
oll
ow-upexamst
o
eval
uat
eeff
ecti
venessofmedi
cati
on.

Hy per t
ensi on:Emphasi zet heimpor t
anceof
cont inuingt otakemedi cat i
onasdi rected, eveni f
feeli
ngwel l
.Medi cat i
oncont r
olsbutdoesnotcur e
hyper tension.I nstructpatienttot akemedi cati
onat
thesamet imeeachday .Takemi sseddosesassoon
asr emember ed; donotdoubl edoses.I f2ormor e
dosesar emi ssed, consultheal t
hcar epr ofessional.
Donotdi scont i
nueabr upt l
y ;
maycausesy mpat heti
c
over sti
mul ation( nervousness, anxi ety,rebound
hyper tension, chestpai n,tachycar dia,increased
salivation,nausea, tr
embl ing,stomachcr amps,
sweat i
ng, dif
ficultysleeping).Theseef f ectsmay
occur2–7day saf terdiscont i
nuation, although
reboundhy pertensioni srareandmor el ikelytooccur
withhi ghdoses.

Advisepatienttomakesur
eenoughmedicati
onis
avai
labl
ef orweekends,
holi
days,
andv
acations.A
writ
tenprescript
ionmaybekepti
nwal
letincaseof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1858
 emer
gency
.

Encouragepatienttocomplywi thaddit
ional
i
nterv
ent i
onsforhy per
tensi
on( weightreduct
ion,
low-
sodi
um di et
,smokingcessation,moder ati
onof
al
cohol consumption,r
egularexercise,
andstress
management ).

Inst
ructpat i
entandf amilyonpropert
echni
queforBP
monitoring.Adv i
sethem tocheckBPatleastweekl
y
andtor eportsignif
icantchanges.

Maycausedr owsi
nessordizziness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heract
ivi
ti
esr equir
ingal
ert
ness
unti
lresponsetot
hemedicationisknown.

ADHD: I
nst r
uctpati
entt
otakemedicationasdirect
ed.
Takemi sseddosesassoonaspossi ble,
butshould
nottakemor ethanthet
otaldai
lyamounti nany24-hr
peri
od.Adv i
sepati
entandparentst
or eadthe
MedicationGuidepri
ort
ostarti
ngtherapyandwi t
h
eachRxr efi
ll
.

I
nform pat
ientt
hatshar
ingt
hismedi
cat
ionmaybe
danger
ous.

Pedi
:Advi
separ
ent
stonot
if
yschool
nur
seof
medi
cati
onregi
men.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1859
Hal
azepam
I
NDI
CATI
ONS
Adj
uncti
nthemanagementofanxi
ety
.

ACTI
ON
DepressestheCNS, pr
obablybypotenti
ati
nggamma-
aminobutyr
icaci
d( GABA),aninhi
bit
oryneurot
ransmi
tt
er.
Therapeut
icEff
ects:Reli
efofanxi
ety.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
withotherbenzodiazepinesmayoccur ;
Comat osepati
ent
s;
Pre-exi
sti
ngCNSdepr ession;Uncont
rol
ledseverepai
n;
Angle-cl
osureglaucoma; Pregnancyorl
actati
on.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Sev
erer
enal
i
mpai r
ment ;Historyofsuicideat t
emptordr ugabuse; Geri
:
Long—act i
ngbenzodi azepinescausepr olongedsedat i
on
i
ntheel derl
y.Appear sonBeer sl i
standisassoci at
edwith
i
ncreasedr i
skoff all
s(↓ doser equi r
edorconsidershor t
-
acti
ngbenzodi azepine.
);Debili
tatedpati
ents( i
niti
al
dosager educt
ionr equi
red);Children<18y r(safetynot
est
ablished).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1860
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness, dr
owsi ness,
lethargy,hangover,headache,
ment aldepr ession, paradoxi
cal excit
ati
on.EENT: blur
red
vision.Resp: respiratorydepression.GI:consti
pation,
diarrhea, drymout h, nausea,vomi t
ing.Derm:rashes.Misc:
phy sicaldependence, psychologicaldependence,
tolerance.

I
NTERACTI
ONS
Drug- Drug:Addi ti
veCNSdepr essionwi thot herCNS
depr essants, including
alcohol ,
anti
hi stami nes, anti
depr essants,opioi ds,andot her
sedat ive/hypnot i
cs(incl udi
ngot herbenzodi azepines).
Cimet idine,
oral contracept i
ves,
disulfi
ram, f
luoxet i
ne,isoniazid,ketoconazol e,met oprolol,
pr
opoxy phene, pr opranol ol,orvalproicaci dmaydecr ease
met abol i
sm andi ncreaseCNSdepr ession.Maydecr ease
theef fi
cacyofl evodopa.Ri f
ampi norbar bi
tur atesmay
i
ncr easemet abol ism anddecr easeef fecti
v eness.

DOSAGE
PO:
(Adul
ts)
:20–40mg3–4t
imesdai
l
y.
PO:(
Geri
atr
icPat
ient
s,Debi
l
itat
edPat
ient
s):
20mg1–2
ti
mesdai
lyi
nit
ial
l
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1861
AVAI
LABI
LITY
Tabl
ets20mg,
40mg;

PATI
ENTTEACHI
NG
Instructpat i
entt otakemedicati
onexact l
yasdirected;
donotski pordoubl euponmi sseddoses.Ifadosei s
mi ssed,i
tcanbet akenwithin1hr;otherwi
se,skipthe
doseandr eturntot her
egularschedule.I
fmedication
i
sl essef fectiveafterafewweeks, checkwithhealth
car eprofessi onal
;donotincreasedose.Abrupt
withdrawal ofhalazepam maycausesweat i
ng,
vomi ti
ng, muscl ecramps,tremors,andconv ul
sions.

Halazepam maycausedr owsinessordizzi

ness.
Cautionpatientt
oav oi
ddrivi
ngandotheracti
vit
ies
requi
ringalert
nessunti
lresponsetot
hemedi cationi
s
known.Ger i:I
nst
ructpati
entandfamil
yhowt oreduce
fal
lsriskathome.

Advi
sepat i
enttoavoidtheuseofal coholorother
CNSdepr essant
sconcur r
entlywit
ht hi
smedi cati
on.
I
nstr
uctpat i
enttoconsulthealt
hcarepr of
essional
bef
oretakingOTCmedi cationsconcurrentl
ywi t
hthi
s
medicat
ion.

I
nfor
m pat
ientt
hatf
requentmout
hri
nses,
goodor
al

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1862
 hy
giene,
andsugar
lessgum orcandymaymi
nimi
ze
dr
ymout h.

Hal
cinoni
de
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
candimmunol
ogi
cski
nprobl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroi
dsorcomponent sofvehi
cles(oi
ntmentor
cream base,preser
vat
ive,
alcohol)
;Untr
eatedbacter
ial
or
vi
rali
nfecti
ons.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cat
aracts,gl
aucoma, ortuberculosi
s(useoflarge
amountsofhigh-potencyagent smaywor sencondit
ion);
Pat
ientswithpre-
existi
ngskinat rophy;Pr
egnancy,
l
actat
ion,orchil
dren(chronichigh-doseusagemayr esul
t

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1863
i
nadrenalsuppressioninmot
herand,growthsuppr
essi
on
i
nchil
dren;chi
ldrenmaybemor esuscepti
bletoadr
enal
andgrowthsuppr essi
on).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topical
:(Adul
ts)
:Applytoaf
fect
edarea(s)1–3t
imes
dai
ly(dependsonproduct
,pr
eparat
ion,
andcondit
ion
bei
ngt r
eated)
.
Topi
cal
:(Chi
l
dren)
:Appl
ytoaf
fect
edar
ea(
s)oncedai
l
y.

AVAI
LABI
LITY
Cr
eam 0.
025%,
0.1%;
Oint
ment0.
1%;

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1864
PATI
ENTTEACHI
NG
Inst
ructpati
entoncorrecttechni
queofmedicati
on
administr
ati
on.Emphasizeimpor t
anceofavoi
dingthe
eyes.Ifadoseismissed,itshouldbeappl
iedassoon
asremember edunl
essal mostt i
meforthenextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Adviseparentsofpedi
atri
cpati
ent
snottoappl
yti
ght-
fi
tti
ngdiapersorplast
icpant
sonachildtr
eat
edinthe
di
aperar ea;
thesegarmentsworkl
ikeanoccl
usi
ve
dressi
ngandmaycausemor eofthedrugtobe
absorbed.

Caut i
onwoment hatmedicati
onshouldnotbeused
extensiv
ely,
inl
argeamount s,
orforprot
ract
ed
periodsift
heyarepregnantorpl
anningtobecome
pregnant.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

I
nst
ructpat
ientt
oinf
orm heal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1865
 sy
mptomsofunderl
yi
ngdiseaser
etur
norwor
senor
i
fsympt
omsofinfect
iondevel
op.

Hal
obet
asol
I
NDI
CATI
ONS
Managementofi
nfl
ammati
onandpr
uri
ti
sassoci
atedwi
th
var
iousal
l
ergi
c/i
mmunol
ogicski
npr
obl
ems.

ACTI
ON
Suppressesnor
malimmuneresponseandinfl
ammat
ion.
Therapeuti
cEff
ect
s:Suppr
essi
onofder mat
ologi
c
i
nfl
ammat i
onandi
mmunepr ocesses.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyorknowni
ntol
erance
tocort
icosteroi
dsorcomponent sofvehi
cles(oi
ntmentor
cream base,preser
vat
ive,
alcohol)
;Untr
eatedbacter
ial
or
vi
rali
nfecti
ons.

UseCaut
iousl
yin:
Hepat
icdy
sfunct
ion;
Diabet
esmel
l
itus,
cat
aracts,gl
aucoma, ortuberculosi
s(useoflarge
amountsofhigh-potencyagent smaywor sencondit
ion);
Pat
ientswithpre-
existi
ngskinat rophy;Pr
egnancy,
l
actat
ion,orchil
dren(chronichigh-doseusagemayr esul
t

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1866
i
nadr enalsuppressi
oni
nmot
her
,growthsuppr
essionin
chil
dren;chi
ldrenmaybemor
esuscept
ibl
etoadrenaland
growthsuppr essi
on)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Derm: all
ergiccontactdermat i
tis,atr
ophy ,burning,
dr
y ness,edema, fol
licul
i
tis,
hy persensit
ivityreactions,
hypertri
chosis,hypopigment at
ion, i
rr
it
ation,macer at
ion,
mili
aria,peri
oraldermatit
is,secondar yinfecti
on, stri
ae.
Misc:adr enalsuppressi
on( useofoccl usivedr essings,
l
ong- t
ermt herapy).

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
Topi
cal
:(Adul
ts)
:Appl
ytoaf
fect
edar
ea(
s)1–2t
imes
dai
ly
.

AVAI
LABI
LITY
Cr
eam 0.
05%;
Oint
ment0.
05%;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientoncor
rectt
echni
queofmedi
cat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1867
 admini
str
ati
on.Emphasizei
mportanceofavoi
dingthe
eyes.I
fadoseismissed,i
tshoul
dbeappliedassoon
asrememberedunl
essal mostt
imeforthenextdose.

Cautionpati
entt ouseonlyasdi r
ected.Av oi
dusi
ng
cosmet i
cs,bandages,dressings,
orot herskin
productsoverthet r
eat
edar eaunlessdi r
ectedby
healt
hcar eprofessi
onal
.

Caut i
onwoment hatmedi
cati
onshouldnotbeused
extensiv
ely,
inlar
geamounts,
orforprot
racted
periodsinpati
ent
swhoarepregnantorplanni
ngt
o
becomepr egnant.

Advisepati
entt
oconsul
thealt
hcareprof
essional
bef
or eusi
ngmedici
neforcondi
ti
onotherthan
i
ndicated.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onali
f
symptomsofunder l
yingdiseaser
etur
norwor senor
i
fsympt omsofinfect
iondev el
op.

Hal
ofant
ri
ne
I
NDI
CATI
ONS
Tr
eat
mentofmi
l
dtomoder
atemal
ari
a.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1868
ACTI
ON
Actsont heeryt
hrocyti
cphaseofpar asit
el i
fecycleby
formingacompl exthatistoxi
ctothepar asitecel
l
membr ane,causingcelll
ysisanddeath.Doesnotaf fect
otherstagesofparasit
elif
ecy cl
e.TherapeuticEff
ects:
Deathofsusceptiblepl
asmodi aintheerythrocyt
icphase.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Fami
l
yhi
stor
yof
congeni
tal
QTcpr
olongat
ion.

UseCaut
iousl
yin:
AVconduct
iondi
sor
der
s,unexpl
ained
syncope,ventri
culararr
hythmias,t
hiaminedef i
ciency
(i
ncreasedr i
skofar r
hythmias);
Life-
thr
eateningmal ar
ial
i
nfecti
ons; Pregnancy,l
actati
on,orchil
dren(safetynot
establ
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: di
zziness.Resp:cough.CV:prol
ongedQTci nt
erv
al.
GI:abdomi nalpai
n,di
arrhea,
nausea,vomit
ing.Derm:
i
tching.Hemat :ACUTEINTRAVASCULARHEMOLYSI S.
Misc:chil
l
s.

I
NTERACTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1869
Drug-Dr
ug:Incr
easedr
iskofar
rhyt
hmi
aswithmefloqui
ne
orother
drugsknowntoprol
ongtheQTci
nterv
al.
Drug-Food:Foodgreatl
yenhancesabsorpt
ion;
foodhi
ghi
n
fatcontenti
ncreasesabsor
pti
onby6- f
old.

DOSAGE
Subsequenttr
eat
mentwithanot
herant
imalar
ial(
an8-
aminoquinol
i
ne)i
srequi
redtoel
imi
nateexoeryt
hrocy
tic
parasi
tes
PO:(Adult
s):Non-
immunepat
ient
s—500mgq6hrfor3
doses,r
epeatin7day
s;semi
-i
mmunepati
ent
s—500mgq
6hrfor3doses.

AVAI
LABI
LITY
Tabl
ets250mg;

PATI
ENTTEACHI
NG
Inst
ructpatienttotakehal
ofant
ri
neonanempty
stomach, exactl
yasdirect
edforful
lcour
seoft
her
apy
,
eveniffeeli
ngbet t
er.

Maycausedizziness.Cauti
onpatientt
oavoiddrivi
ng
orot
heract
ivi
tiesrequir
ingaler
tnessunti
lresponseto
medi
cati
onisknown.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1870
Hal
oper
idol
I
NDI
CATI
ONS
Acuteandchr onicpsy chot i
cdi sor dersincluding:
schizophr eni a,mani cst ates,dr ug-inducedpsy choses.
Schizophr eni cpat ientswhor equi relong-term par enter
al
(I
M)ant ipsy chotict herapy .Al sousef uli
nmanagi ng
aggressi veoragi tatedpat ients.Tour et
te’
ssy ndr ome.
Sever ebehav ioralpr oblemsi nchi l
drenwhi chmaybe
accompani edby :unpr ov oked, combat i
ve,explosi ve
hyper excitabili
ty,hy per activi
tyaccompani edbyconduct
disorder s(shor t-t
er m usewhenot hermodal iti
eshav e
fail
ed) .Consi deredsecond- l
inet reatmentaf terfailur
ewi t
h
atypical antipsychot i
c.Unl abel edUses: Nauseaand
vomi tingfrom sur ger yorchemot her apy.

ACTI
ON
Alt
erstheeffectsofdopamineint heCNS.Al sohas
anti
choli
nergicandalpha-
adrenergicblocki
ngactiv
ity
.
Therapeuti
cEf f
ects:
Dimini
shedsi gnsandsy mptomsof
psychoses.Improvedbehaviori
nchi l
drenwithTourett
e’s
syndromeorot herbehavi
oralpr
obl ems.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1871
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Angl
e-cl
osur
e
glaucoma; Bonemar rowdepr ession;CNSdepr essi
on;
Par kinsoni smSev er
eliverorcardi
ov asculardi
sease(QT
i
nt erval prolongingconditi
ons);Somepr oduct
scontain
tartrazine, sesameoi l
,orbenzylalcohol andshouldbe
avoi dedi npat i
entswithknowni ntoleranceor
hyper sensi ti
vit
y.

UseCaut
iousl
yin:
Debi
l
itat
edpat
ient
s(dose↓ r
equi
red)
;
Cardiacdi sease( ri
skofQTpr olongat i
onwi thhighdoses) ;
Diabet es;Respiratoryinsuffici
ency ; Pr
ostatichyper pl
asi
a;
CNSt umor s;I
ntest i
nal obstruction;Seizures;OB:
Neonat esat↑ r i
skf orext r
apy rami dalsympt omsand
withdrawal afterdeliverywhenexposeddur ingt he3rd
tri
mest er
;useonl yifbenef itoutwei ghsrisktof etus;
Lactation:Discont i
nuedr ugorbot t
le-f
eed; Geri
: Dose↓
requiredduet o↑ sensi t
ivi
ty;↑r i
skofmor tali
tyinelder
ly
patientst r
eatedf ordement ia-
relatedpsy chosis.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, extrapyramidalreacti
ons, conf usion,
drowsi ness,restlessness,tar
divedy skinesia.EENT:
blurredv i
sion,dryey es.Resp: r
espir
at orydepressi on.CV:
hypot ension,tachycardia,ECGchanges( QTpr olongati
on,
torsadedepoi ntes),ventri
cul
arar r
hy t
hmi as.GI :
const i
pation,drymout h,anorexi
a,drug-inducedhepat i
ti
s,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1872
i
leus,weightgain.GU: i
mpot ence,uri
naryretenti
on.Der
m:
diaphoresis,
photosensit
ivi
ty,rashes.Endo:amenor r
hea,
galactorr
hea,gynecomast i
a.Hemat :AGRANULOCYTOSI S,
anemi a,l
eukopenia,neutr
openi a.Metab:hyperpyr
exi
a.
Mi sc:
NEUROLEPTI CMALI GNANTSYNDROME,
hypersensiti
vi
tyreacti
ons.

I
NTERACTI
ONS
Drug-Dr ug:Mayenhancet heQTc- prol
ongi ngef fectofQTc
-pr
olongi ngagent s↑ hy potensi onwi thant ihypertensiv
es,
nit
rates, oracutei ngest i
onofal cohol.↑ ant i
cholinergi
c
eff
ect swi thdrugshav ingant i
chol iner
gi cpr oper ti
es,
i
ncludingant i
histami nes, antidepr essant s, atropine,
phenot hiazines,qui ni
dine, anddi sopyrami de.↑ CNS
depressi onwi t
hot herCNSdepr essants, incl udi
ngal cohol,
anti
hist amines, opioidanal gesi cs, andsedat i
ve/hy pnot
ics.
Concur rentusewi thepi nephr inemayr esul tinsev ere
hypotensi onandt achycar dia.May↓ t her apeut icef f
ects
oflevodopa.Acut eencephal opat hicsy ndr omemayoccur
whenusedwi t
hl i
thium.Dement iamayoccurwi th
met hyldopa.
Drug-
Nat
ural
Product:Kav
a-kav
a,v
aler
ian,
orchamomi
l
e
can↑ CNSdepressi
on.

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1873
PO:(Adul
ts)
:0.
5–5mg2–3ti
mesdai
l
y.Pat
ientswit
h
sev
eresymptomsmayr
equi
reupt
o100mg/ day.
PO:(Ger
iat
ri
cPatient
sorDebil
it
atedPati
ent
s):0.
5–2mg
twi
cedail
yini
ti
all
y;maybegraduall
y↑ asneeded.
PO: (Children3–12y ror15–40kg)
:0.
25-0.5mg/daygiv
en
i
n2- 3di videddoses;incr
easeby0.
25-
0.5mgev ery5-
7
days; maxi mum dose: 0.
15mg/kg/
day(upt o0.
75
mg/ kg/ dayforTourette’
ssyndr
omeor0.15–mg/ kg/
day
forpsy choses).
I
M:(
Adul
ts)
:2–5mgq1–8hr(
nott
oexceed100mg/
day
).
I
M:(Chi
l
dren6–12y
r):
1-3mg/ doseev
ery4-
8hour
stoa
maxi
mum of0.
15mg/kg/day
I
V:(
Adul
ts):0.
5–5mg,
mayber
epeat
edq30mi
n
(
unl
abel
ed)
.
Hal
oper
idol
Decanoat
e
IM:(Adul
ts):10–15t
imestheprevi
ousdail
yPOdosebut
nottoexceed100mgi ni
ti
all
y,gi
venmonthl
y(nott
o
exceed300mg/ mo).

AVAI
LABI
LITY
Tablet
s0.5mg,1mg,
2mg, 5mg,10mg, 20mg; Or
al
concentr
ate2mg/
mL;Hal
oper
idoll
act
ateinj
ect
ion5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1874
mg/
mL;
Hal
oper
idol
decanoat
einj
ect
ion50mg/
mL,
100
mg/
mL;

PATI
ENTTEACHI
NG
Adv i
sepat i
enttotakemedi cationasdi r
ected.Take
misseddosesassoonasr emember ed, wit
h
remainingdosesev enlyspacedt hroughoutt heday.
Mayr equireseveral weekst oobt ai
ndesi r
edef f
ects.
Donoti ncreasedoseordi scont i
nuemedi cation
withoutconsulti
ngheal thcar eprofessional.Abrupt
withdrawal maycausedi zzi ness;nausea;vomi t
ing;GI
upset;trembli
ng;oruncont roll
edmov ement sof
mout h,tongue,orjaw.

Inf
orm pati
entofpossibil
i
tyofextrapyr
amidal
sympt oms,t
ardi
vedy ski
nesia,andneurol
epti
c
malignantsyndr
ome.Caut ionpati
enttorepor
t
sympt omsimmediately.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

Maycausedr owsiness.Cautionpati
entt
oavoid
driv
ingorotheracti
vi
tiesrequir
ingal
ert
nessunt
il
responsetomedicationisknown.

Caut
ionpat
ientt
oav
oidt
aki
ngal
cohol
orot
herCNS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1875
 depr
essant
sconcur
rent
lywi
tht
hismedi
cat
ion.

Advisepati
enttousesunscreenandpr
otecti
ve
clot
hingwhenexposedt othesuntopr
ev ent
photosensi
ti
vi
tyreacti
ons.Ext
remesoftemperat
ure
shouldalsobeavoided;dr
ugimpair
sbody
temperatur
eregulat
ion.

I
nstr
uctpati
enttousef
requentmouthrinses,
good
or
alhygi
ene,andsugar
lessgum orcandytomi ni
mize
dr
ymout h.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

I
nst r
uctpati
enttonoti
fyhealt
hcareprofessional
prompt l
yifweakness,
tremors,vi
sual
disturbances,
dark-col
oreduri
neorclay-
color
edstools,sorethr
oat,
fever,menstr
ualabnor
mal i
ti
es,gal
act
or r
heaorsexual
dysfuncti
onoccur.

Emphasi
zethei
mport
anceofrouti
nef
oll
ow-upexams
tomonit
orr
esponset
omedicati
onanddetectsi
de
eff
ect
s.

Hepar
in
I
NDI
CATI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1876
Prophy l
axi
sandt reatmentofv ar
iousthromboembol ic
disordersincl
uding: Venousthromboembol i
sm,
Pulmonar yembol i,Atri
alf
ibr
il
lati
onwi t
hembol izati
on,
Acut eandchr onicconsumpt i
vecoagul opat
hies,
Peripheralart
erialthromboembol i
sm.Usedi nv eryl
ow
doses( 10–100uni t
s)tomaintainpatencyofIVcat heter
s
(heparinfl
ush) .

ACTI
ON
Potentiatesthei nhibi
t or
yeffectofant i
thrombinonf actor
Xaandt hrombi n.Inlowdoses, preventst heconv ersionof
prothrombi ntot hrombi nbyitseffectsonf actorXa.
Higherdosesneut ral
izethrombin,preventingthe
conv ersi
onoff ibri
nogent ofi
bri
n.Ther apeuticEffects:
Prevent i
onoft hrombusf ormation.Preventionof
extensionofexi stingt hr
ombi (f
ulldose) .

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Uncont
rol
l
ed
bl
eeding;Severethr
ombocytopeni
a;Openwounds(f
ull
dose)
; Av
oiduseofpr oduct
scontai
ningbenzy
lal
coholi
n
prematur
ei nf
ants.

UseCaut
iousl
yin:
Sev
erel
i
verorki
dneydi
sease;
Ret
inopat
hy(
hyper
tensi
veordi
abet
ic)
;Unt
reat
ed

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1877
hypertension;Ul
cerdisease;Spinalcordorbr ai
ni nj
ury;
Histor
yofcongeni taloracquir
edbl eedingdisorder;
Malignancy ;OB:
Maybeuseddur ingpregnancy, butuse
withcaut i
onduringthelasttri
mest erandinthei mmedi at
e
postpartum peri
od;Geri:Women>60y rhave↑ r iskof
bl
eeding.
Exerci
seExt r
emeCaut i
oni n:Severeuncont r
oll
ed
hypert
ension;Bact
eri
al endocardit
is,bl
eedingdisorder
s;GI
bleedi
ng/ulcer
ati
on/pathology;Hemor rhagicstr
oke;
RecentCNSoropht halmol ogi
csur gery
; Acti
veGI
bleedi
ng/ulcer
ati
on;Historyofthrombocy topeni
arelat
ed
tohepari
n.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:drug-i
nducedhepatit
is.Derm: alopecia(l
ong-term use)
,
rashes,urt
icar
ia.Hemat :BLEEDING, HEPARI N-I
NDUCED
THROMBOCYTOPENI A( HIT)(WITHORWI THOUT
THROMBOSI S),anemia.Local:painatinject
ionsite.MS:
osteoporosis(l
ong-t
erm use).Misc: fev
er,hypersensit
ivi
ty.

I
NTERACTI
ONS
Hepari
nisf r
equent
lyusedconcurrentl
yorsequenti
all
y
wit
hotheragentsaffecti
ngcoagul
ation.Theri
skof
pot
ential
lyseri
ousi
nt er
acti
onsisgreatestwi
thful
l
ant
icoagulat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1878
Drug- Dr ug: Riskofbl eedingmaybe↑ byconcur rentuse
ofdr ugst hataf fectplateletf unction,includingaspi ri
n,
NSAI Ds, clopidogr el
,dipyridamol e,somepeni cil
lins,
ti
clopidi ne, abciximab, eptifibit
ide, t
ir
of i
ban, anddext ran.
Riskofbl eedingmaybe↑ byconcur rentuseofdr ugst hat
causehy popr othrombi nemi a, i
ncl udi
ngqui nidine,
cefoper azone, cefotetan, andv alproi
caci d.Concur r
ent
useoft hr ombol y t
ics↑ r i
skofbl eeding.Hepar insaf f
ect
thepr ot hrombi nt i
meusedi nassessi ngt her esponset o
war farin.Di goxin,tetracyclines, nicoti
ne, and
antihistami nesmay↓ ant i
coagul anteffectofhepar i
n.
Streptoki nasemaybef ollowedbyr elati
ver esistancet o
hepar in.
Drug-
Nat
uralPr
oduct
:↑riskofbleedingwi
tharni
ca,anise,
chamomil
e,cl
ove,
dongquai,
feverfew,gar
li
c,gi
nger
, and
Panaxgi
nseng.

DOSAGE
Ther
apeut
icAnt
icoagul
ati
on
I
V: (
Adult
s) :I
nter
mittentbolus—10,
000units,f
oll
owedby
5000–10,000unitsq4–6hr .Conti
nuousinfusi
on—5000
uni
ts(35–70uni t
s/kg),f
oll
owedby20, 000–40,
000unit
s
i
nfusedov er24hr(approx.1000unit
s/hror15–18
uni
ts/kg/
hr )
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1879
I
V:(Chi
ldr
en>1y r
):I
ntermit
tentbol
us—50–100uni
ts/
kg,
fol
l
owedby50–100uni t
s/kgq4hr .Conti
nuous
i
nfusi
on—Loadi
ngdose75uni ts/
kg,fol
l
owedby20
uni
ts/
kg/hr,
adj
usttomaintainaPTTof60–85sec.
I
V:(Neonat
esandInfant
s<1yr):
Continuous
i
nfusi
on—Loadi
ngdose75units/kg,
foll
owedby28
uni
ts/
kg/hr
,adj
usttomaint
ainaPTTof60–85sec.
Subcut(
Adult
s):5000unit
sIV,fol
lowedbyi
nit
ial
subcut
doseof10,
000–20,000uni
ts,t
hen8000–10,
000unit
sq8
hror15,
000–20,
000unitsq12hr .

Pr
ophy
laxi
sofThr
omboembol
i
sm
Subcut(
Adul
ts):5000uni
tsq8–12hr(
maybest
art
ed2
hrpri
ort
osurger
y )
.

Car
diov
ascul
arSur
ger
y
I
V:(Adul
ts)
:Atl
east150uni
ts/kg(300unit
s/kgi
f
pr
ocedur
e<60min;400uni
ts/kgif>60min).
I
ntr
a-art
eri
al(
Neonat
es,Inf
ant
s,andChi
ldr
en):100–150
uni
ts/kgvi
aanart
erypr
iort
ocardi
accat
heter
izati
on.

Li
neFl
ushi
ng
I
V:(
Adult
sandChi
ldr
en)
:10–100unit
s/mL(10unit
s/mL
f
ori
nfant
s<10kg,
100unit
s/mLforal
lother
s)sol
uti
ont
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1880
f
il
lhepar
inl
ocksett
oneedl
ehub;
repl
aceaf
tereachuse.
Tot
alPar
ent
eral
Nut
ri
ti
on
IV:(
Adult
sandChil
dren):
05–1uni
ts/
mL( f
inal
sol
uti
on
concent
rati
on)t
omaintai
nli
nepat
ency.
Ar
ter
ial
LinePat
ency
I
ntr
a-ar
ter
ial
(Neonat
es)
:0.
5–2uni
ts/
mL.

AVAI
LABI
LITY
Hepar
inSodi
um
Soluti
onforinj
ection10units/mL,100units/
mL, 1000
uni
ts/mL, 5000units/mL,7500units/
mL, 10,
000units/mL,
20,
000uni ts/
mL, 40,000unit
s/mL; Pr
emixedsoluti
on
1000units/500mL, 2000uni t
s/1000mL, 12,
500units/
250
mL, 25,
000uni t
sin250and500mL;

PATI
ENTTEACHI
NG
Advi
sepati
entt
or epor
tanysymptomsofunusual
bl
eedi
ngorbrui
singtoheal
thcar
epr of
essi
onal
i
mmediatel
y.

Inst
ructpat
ientnott
otakemedicati
onscont
aini
ng
aspir
inorNSAIDswhileonhepari
nther
apy.

Caut
ionpat
ientt
oav
oidI
Minj
ect
ionsandact
ivi
ti
es

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1881
 l
eadi
ngtoinj
uryandtouseasof
ttoot
hbr
ushand
el
ect
ri
crazordur
inghepar
int
her
apy.

Advi
sepatientt
oinf
orm heal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort ot
reat
mentorsurgery
.

Pat
ient
sonanticoagul
antther
apyshoul
dcar
ryan
i
denti
fi
cat
ioncardwiththi
sinf
ormati
onatal
lti
mes.

Hepat
it
isBi
mmunegl
obul
i
n
I
NDI
CATI
ONS
Preventshepat
it
isBinf
ectioninpati
ent
swhoar eknown
tohavebeenexposed,includi
ngneonatesbor
ntoHBsAg-
posi
tivewomen, bypr
ov i
dingpassi
veimmunit
y.

ACTI
ON
Animmunegamma- gl
obul
infracti
oncont ai
ninghighti
ter
s
ofant
ibodi
estothehepati
ti
sBsur faceant i
gen.Confer
s
passi
veimmunitytohepat
it
isBi nf
ection.Therapeut
ic
Eff
ects:
Prevent
ionofhepat
iti
sBi nfecti
on.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oimmunegl
obul
i
ns,
gl
yci
ne,
ort
himer
osal
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1882
UseCaut
iousl
yin:
Thr
ombocy
topeni
a;I
gAdef
ici
ency
;
Lact
ati
on:
Lact
ati
on;
OB:
Hasbeenuseddur
ingpr
egnancy
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,fai
nt ness,malaise,weakness.Derm:
pruri
tus,rashes,ur
ticaria.Local
: er
ythemaatIM sit
e,pai
n,
swell
ing, t
enderness.MS: j
ointpain.Misc:al
l
ergi
c
react
ionsi ncl
udinganaphy l
acti
cshockandangi oedema.

I
NTERACTI
ONS
Drug-
Drug:
Mayi
nter
fer
ewi
tht
hei
mmuner
esponset
oli
ve
-
vacci
nes.

DOSAGE
I
M: (
Adul
ts):
0.06mL/ kg(usual
dose3–5mL)withi
n7
day
sofexposure,
repeated28–30day
saft
erexposure.
I
M:(
Neonat
es)
:0.
5mLwi
thi
n12hrofbi
rt
h.

AVAI
LABI
LITY
I
nject
ion0.
5-mLpr
efi
l
ledsy
ringes,
1-,
4-,
5-mLv
ial
s;

PATI
ENTTEACHI
NG
Expl
aint
opatienttheuseandpurposeofhepat
it
isB
i
mmunegl obuli
ntherapy
.Discussmethodsof

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1883
 t
ransmi
ssi
onandv
acci
nat
ionf
orpr
ophy
laxi
s.

Adv
isepati
entt
orepor
tsy
mpt
omsofanaphy
laxi
s
i
mmediatel
y.

Inf
orm pat
ientthatpai
n,t
ender
ness,
swell
i
ng,and
eryt
hemaatt heinj
ecti
onsit
emayoccuraft
erI
M
i
njecti
ons.

Het
ast
arch
I
NDI
CATI
ONS
Adj
unctforf
lui
drepl
acementandv olumeexpansioninthe
ear
lymanagementofshockori mpendingshockcaused
by:
Burns,Hemorr
hage,Surger
y,Sepsis,Tr
auma.Adjunct
i
nleukapher
esi
s(improvescol
lect
ionofgranulocy
tes)
.

ACTI
ON
Asynthet
icmolecul
ethatactsasacoll
oidalosmotic
agentsi
milart
oalbumin.Ther
apeut
icEff
ects:Plasma
vol
umeexpansion.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Sev
erebl
eedi
ng
di
sor
der
s;HF;
Pul
monar
yedema;
Oli
gur
icoranur
icr
enal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1884
f
ail
ure;
OB:
Ear
lypr
egnancy
.

UseCaut
iousl
yin:
Thr
ombocy
topeni
a;Sev
erer
enal
i
mpairment(ifCCr<10mL/ min,i
nit
ialdosemaybet he
same;subsequentdosesshouldbe↓ t o25–50%ofusual
dose)
;Geri
:Geriat
ri
cpati
ents;Lact
ation:Pedi
:Saf
etynot
est
abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache.CV: HF, pulmonaryedema.GI :v
omi ti
ng.
Derm: prur
itus,urt
icaria.FandE: fl
uidov er
load,
peripheral
edemaoft helowerext r
emi ti
es.Hemat :↓ hemat ocri
t,↓
platel
etfunction.MS: my algia.Misc: hy
persensi
ti
v i
ty
reacti
onsincludinganaphy lactoi
dr eacti
ons,chi
ll
s,fever
,
paroti
dandsubmaxi l
laryglandenl argement .

I
NTERACTI
ONS
Dr
ug-
Drug:
Noknowni
nter
act
ions.

DOSAGE
IV:(Adult
s):Plasmavolumeexpansi on–30–60g
(500–1000mLof6%sol ut
ion),
mayber epeated;nott
o
exceed90g( 1500mL/ day).Inacutehemor rhagi
cshock,
upto20mL/ kg/hrmaybeused; l
eukapheresis—250–700
mLi nfusedataconstantfi
xedr at
ioof1:8t o1:13to

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1885
v
enouswhol
ebl
ood.

AVAI
LABI
LITY
Inj
ecti
on6g/100mLin0.9%sal
i
ne;
Incombi
nat
ionwi
th:
Lactat
edRi
nger'
s(Hext
end)
.

PATI
ENTTEACHI
NG
Expl
aint
opat
ientt
her
ati
onal
eforuseoft
hissol
uti
on.

I
nstructpati
entt
onotif
yheal
thcarepr
ofessi
onal
if
dyspnea,i
tchi
ng,orf
lu-
li
kesy
mpt omsoccur.

Hy
dral
azi
ne
I
NDI
CATI
ONS
Moderatet
oseverehypert
ension(wi
thadiur
etic)
.
Unl
abeledUses:
HFunr esponsiv
etoconv
entionalther
apy
wit
hdigoxi
nanddiuret
ics.

ACTI
ON
Dir
ect-act
ingper
ipher
alart
eri
olarvasodi
lat
or.Therapeut
ic
Eff
ects:Loweri
ngofBPi nhypert
ensivepat
ientsand
decreasedaft
erl
oadinpati
entswithHF.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1886
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Somepr
oduct
s
cont
aintart
razi
neandshoul
dbeav
oidedi
npat
ient
swi
th
knownintol
erance.

UseCaut
iousl
yin:
Car
diov
ascul
arorcer
ebr
ovascul
ar
di
sease;Sever
erenalandhepati
cdisease(dose
modif
icati
onmaybenecessary);OB:Lactat
ion:
Hasbeen
usedsafel
yduri
ngpregnancy.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,drowsiness,headache.CV: t
achy cardi
a,
angina, arrhythmias,edema, ort
host ati
chy potension.GI:
diarrhea, nausea,v omit
ing.Derm: rash.FandE: sodium
retention.MS: ar
thralgi
as,art
hrit
is.Neuro: per
ipher al
neuropat hy .Misc:drug-i
nducedlupussy ndrome.

I
NTERACTI
ONS
Drug-Drug: ↑ hypot ensionwi t
hacut eingestionofal cohol
,
otherant i
hypert
ensi ves, ornit
rates.MAOi nhibitorsmay
exagger atehypotensi on.May↓ pr essorresponset o
epinephr i
ne.NSAI Dsmay↓ ant ihypert
ensiver esponse.
Betablocker s↓ t achy cardi
af r
om hy dral
azine( ther
apy
maybecombi nedf ort hisreason).Metoprolol and
propranolol↑ hy dralazinelevels.↑ bloodlev elsof
met oprololandpr opranol ol
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1887
DOSAGE
PO: (
Adult
s):Hyper
tension—10mg4t i
mesdailyi
niti
all
y.
Aft
er2–4day smay↑ t o25mg4t imesdail
yfortherest
ofthe1stweek;maythen↑ t o50mg4t i
mesdaily(upto
300mg/ day)
.Oncemai ntenancedosei
sestabli
shed,
twi
ce-dai
lydosi
ngmaybeused.HF—25–37. 5mg4t i
mes
dai
ly;maybe↑ upt o300mg/ dayi
n3–4di v
ideddoses.
PO: (
Chil
dren>1mo) :I
niti
al—0.75–1mg/ kg/dayin2–4
divi
deddoses,nottoexceed25mg/ dose;may↑
gradual
lyto5mg/ kg/
dayini nf
antsand7.5mg/ kg/
dayin
chil
dren(nott
oexceed200mg/ day)in2–4di v
ideddoses.
IM:IV:(
Adults)
:Hyper
tensi
on—5–40mgr epeatedas
needed.Ecl
ampsia—5mgq15–20mi n;i
fnoresponse
aft
eratotalof20mg,consi
deranal
ternat
iveagent
.
I
M:I
V: (
Chi
ldren>1mo):
Ini
ti
al—0.
1–0.
2mg/kg/
dose(
not
t
oexceed20mg)q4–6hrasneeded,up1.
7–3.
5
mg/
kg/dayin4–6di
vi
deddoses.

AVAI
LABI
LITY
Tabl
ets10mg,25mg,50mg, 100mg; I
njecti
on20mg/
mL;
I
ncombinat
ionwit
h:i
sosor
bidedini
tr
ate(BiDil
).

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1888
Emphasi zetheimpor tanceofcont inuingt
ot aket hi
s
medicat i
on,eveniffeeli
ngwel l.I
nst r
uctpatientto
takemedi cati
onatt hesamet imeeachday ;lastdose
ofthedayshoul dbet akenatbedt i
me.Takemi ssed
dosesassoonasr emember ed; donotdoubl edoses.
Ifmor ethan2dosesi nar owar emi ssed,
consul t
healt
hcar eprofessional.Mustbedi scont
inued
graduallytoavoidsuddeni ncreasei nBP.Hy dralazi
ne
controlsbutdoesnotcur ehypertension.

Encour agepat i
enttocompl ywi thadditional
i
nt er
ventionsforhy pertension( weightreducti
on,low-
sodium diet,smoki ngcessat ion,moder at i
onof
alcohol i
ntake,regularexercise,andst ress
management )
.Instructpatientandf ami lyonproper
techniquef orBPmoni tori
ng.Adv isethem t ocheck
BPatl eastweekl yandr eportsignif
icantchanges.

Pati
entsshouldweighthemselvestwi
ceweekl
yand
assessfeetandanklesforf
lui
dr et
ent
ion.

Mayoccasi onal
l
ycausedr owsiness.Adv
isepatientt
o
avoi
ddr i
vingorotheracti
vit
iesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

Caut
ionpati
entt
oavoi
dsuddenchangesi
nposi
ti
on
tomini
mizeort
host
ati
chy
potensi
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1889
 Adv i
sepati
enttonot i
fyhealthcar
eprofessionalofal
l
RxorOTCmedi cations,vi
tamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetakingothermedi
cations,
especial
lycough,cold,orall
ergyr
emedies.

I
nst
ructpat
ienttonoti
fyheal
thcareprofessi
onal
of
medi
cati
onpriortotr
eatmentorsurgery
.

Adv i
sepatienttonot i
fyhealt
hcar eprofessi
onal
i
mmedi at
elyifgeneral t
ir
edness;fever;muscleorj
oint
aching;chestpain;skinrash;sor
et hroat;or
numbness, ti
ngli
ng, pain,orweaknessofhandsand
feetoccurs.Vit
ami nB6( pyri
doxine)maybeusedt o
treatperi
pheralneurit
is.

Emphasi
zethei
mpor t
anceoff
oll
ow-upexamst
o
eval
uat
eeff
ecti
venessofmedi
cati
on.

Hi
str
eli
n
I
NDI
CATI
ONS
Pal
li
ati
vetr
eatmentofadv
ancedprost
atecancer(
Vant
as)
.
Cent
ralpr
ecoci
ouspubert
y(Suppr
eli
nLA).

ACTI
ON

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1890
Conti
nuousadmi nist
rati
ondecreasesproducti
onof
gonadotr
opins.Therapeuti
cEffects:
Suppressi
onof
test
oster
onepr oducti
on.Prev
ent i
onofdisease
progr
ession.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oanycomponentof
t
hepr
oduct
,GnRH,
orGnRHagoni
stanal
ogs;
Women.

UseCaut
iousl
yin:
Pat
ient
swi
thmet
ast
ati
cver
tebr
al
l
esi
onsoruri
naryt
ractobstr
ucti
on(i
nit
ial
transi
ent↑ i
n
t
est
oster
onemaywor sensy mpt
oms);Pedi:Chi
l
dren<2yr
(
saf
etynotest
abli
shed)(Suppr
eli
nLA).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: STROKE, headache, anxi ety,depr ession, dizziness,
i
nsomni a,ir
ritabil
it
y, l
ethar gy, malaise, seizures.EENT:
visualdisturbances.Resp: dy spnea.CV: MYOCARDI AL
INFARCTI ON, vasodi l
ation, edema, palpitations,
tachycardia.GI :HEPATOTOXI CITY,abdomi nal discomf or
t,
const i
pation, nausea, vomi ting.GU: dysur i
a, hemat uri
a,
polyuria,uri
nar yretention.Der m: acne, ↑ sweat i
ng,
prurit
is,rash.Endo: breastdi schar ge, breastpai n,genital
prurit
is,↑ br eastsize.Hemat :anemi a.Local :
itching,
erythema, andswel li
ngati mpl antationsi te.Met ab:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1891
hypercal
cemia, hyper
glycemia,hyperli
pidemi
a.MS:
arthr
algi
a,bonepai n,j
ointsti
ff
ness, musclecr
amps,
musclestiff
ness, myalgi
a.Neuro:tremor .Mi
sc:al
ler
gic
reacti
onsincludingangioedema,hotf l
ashes,↑ appeti
te,
↑ pain.

I
NTERACTI
ONS
Dr
ug-
Drug:
Unknown.

DOSAGE
Pr
ost
ateCancer
Subcut(
Adul
ts)
:50mgi
mpl
anti
nser
tedev
ery12mo.

Cent
ral
Precoci
ousPuber
ty
Subcut(
Chi
l
dren≥2y
r):
50mgi
mpl
anti
nser
tedev
ery12
mo.

AVAI
LABI
LITY
I
nject
ion50mg/
impl
ant
;

PATI
ENTTEACHI
NG
Inst
ructpat
ientt
onottogetar
m wetfor24hrsandt
o
avoi
dst r
enuousli
ft
ingf
or7daysaf
terinser
ti
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1892
 I
nfor
m pat
ientandfami
lyt
hati
fimpl
ant
sar
enot
gi
venyear
ly,
diseasemaypr
ogr
ess.

Advisepatientandfami l
ythatduri
ngi
nit
ialagoni
stic
phase( 1–3wk)t hepatientmayhavetr
ansient
symptom wor seningoronsetofnewsympt oms,
i
ncludingbonepai n,neuropat
hy,hemat
uria,orur
inary
tr
actobst r
uction.

Inf
orm pat
ientandfami l
ythatrednessorswelli
ng
mayoccuratt heimplantati
onsite,
especial
lyaft
er
i
niti
ali
mplantati
onorimpl antremoval
.Not i
fyheal
th
carepr
ofessionali
fthisreacti
onissevereordoesnot
goaway .

Inst
ructpati
entandfamil
ytocontactheal
thcare
prof
essionalatt
hefir
stsignofski
nrash,urt
icari
a,
rapi
dheartbeat,
dif
fi
cult
yswallowi
ngorbreathing,or
anyswelli
ngthatmaysuggestangioedema.

Hy
dral
azi
ne
I
NDI
CATI
ONS
Moderatet
oseverehypert
ension(wi
thadiur
etic)
.
Unl
abeledUses:
HFunr esponsiv
etoconv
entionalther
apy
wit
hdigoxi
nanddiuret
ics.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1893
ACTI
ON
Dir
ect-act
ingper
ipher
alart
eri
olarvasodi
lat
or.Therapeut
ic
Eff
ects:Loweri
ngofBPi nhypert
ensivepat
ientsand
decreasedaft
erl
oadinpati
entswithHF.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Somepr
oduct
s
cont
aintart
razi
neandshoul
dbeav
oidedi
npat
ient
swi
th
knownintol
erance.

UseCaut
iousl
yin:
Car
diov
ascul
arorcer
ebr
ovascul
ar
di
sease;Sever
erenalandhepati
cdisease(dose
modif
icati
onmaybenecessary);OB:Lactat
ion:
Hasbeen
usedsafel
yduri
ngpregnancy.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizziness,drowsiness,headache.CV: t
achy cardi
a,
angina, arrhythmias,edema, ort
host ati
chy potension.GI:
diarrhea, nausea,v omit
ing.Derm: rash.FandE: sodium
retention.MS: ar
thralgi
as,art
hrit
is.Neuro: per
ipher al
neuropat hy .Misc:drug-i
nducedlupussy ndrome.

I
NTERACTI
ONS
Dr
ug-
Drug:
↑ hy
pot
ensi
onwi
thacut
eingest
ionofal
cohol
,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1894
otherant i
hypert
ensives, ornit
rates.MAOi nhibi
torsmay
exagger atehypotension.May↓ pr essorresponseto
epinephr i
ne.NSAIDsmay↓ ant ihypert
ensiveresponse.
Betablocker s↓ tachy cardi
af r
om hy dral
azine(ther
apy
maybecombi nedfort hisreason).Metoprololand
propranolol↑ hydralazinelevels.↑ bloodlevelsof
met oprololandpropranol ol
.

DOSAGE
PO: (
Adult
s):Hyper
tension—10mg4t i
mesdailyi
niti
all
y.
Aft
er2–4day smay↑ t o25mg4t imesdail
yfortherest
ofthe1stweek;maythen↑ t o50mg4t i
mesdaily(upto
300mg/ day)
.Oncemai ntenancedosei
sestabli
shed,
twi
ce-dai
lydosi
ngmaybeused.HF—25–37. 5mg4t i
mes
dai
ly;maybe↑ upt o300mg/ dayi
n3–4di v
ideddoses.
PO: (
Chil
dren>1mo) :I
niti
al—0.75–1mg/ kg/dayin2–4
divi
deddoses,nottoexceed25mg/ dose;may↑
gradual
lyto5mg/ kg/
dayini nf
antsand7.5mg/ kg/
dayin
chil
dren(nott
oexceed200mg/ day)in2–4di v
ideddoses.
IM:IV:(
Adults)
:Hyper
tensi
on—5–40mgr epeatedas
needed.Ecl
ampsia—5mgq15–20mi n;i
fnoresponse
aft
eratotalof20mg,consi
deranal
ternat
iveagent
.
I
M:I
V: (
Chi
ldr
en>1mo):I
nit
ial
—0.
1–0.2mg/
kg/
dose(
not
t
oexceed20mg)q4–6hrasneeded,
up1.
7–3.
5

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1895
mg/
kg/
dayi
n4–6di
vi
deddoses.

AVAI
LABI
LITY
Tabl
ets10mg,25mg,50mg, 100mg; I
nject
ion20mg/
mL;
I
ncombinat
ionwit
h:i
sosor
bidedini
tr
ate

PATI
ENTTEACHI
NG
Emphasi zetheimpor tanceofcont inuingt
ot aket hi
s
medicat i
on,eveniffeeli
ngwel l.I
nst r
uctpatientto
takemedi cati
onatt hesamet imeeachday ;lastdose
ofthedayshoul dbet akenatbedt i
me.Takemi ssed
dosesassoonasr emember ed; donotdoubl edoses.
Ifmor ethan2dosesi nar owar emi ssed,
consul t
healt
hcar eprofessional.Mustbedi scont
inued
graduallytoavoidsuddeni ncreasei nBP.Hy dralazi
ne
controlsbutdoesnotcur ehypertension.

Encour agepat i
enttocompl ywi thadditional
i
nt er
ventionsforhy pertension( weightreducti
on,low-
sodium diet,smoki ngcessat ion,moder at i
onof
alcohol i
ntake,regularexercise,andst ress
management )
.Instructpatientandf ami lyonproper
techniquef orBPmoni tori
ng.Adv isethem t ocheck
BPatl eastweekl yandr eportsignif
icantchanges.

Pat
ient
sshoul
dwei
ght
hemsel
vest
wiceweekl
yand

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1896
 assessf
eetandankl
esf
orf
lui
dret
ent
ion.

Mayoccasi onal
l
ycausedr owsiness.Adv
isepatientt
o
avoi
ddr i
vingorotheracti
vit
iesrequi
ri
ngaler
tness
unti
lresponsetomedi cat
ionisknown.

Caut
ionpati
entt
oavoi
dsuddenchangesi
nposi
ti
on
tomini
mizeort
host
ati
chy
potensi
on.

Adv i
sepati
enttonot i
fyhealthcar
eprofessionalofal
l
RxorOTCmedi cations,vi
tamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetakingothermedi
cations,
especial
lycough,cold,orall
ergyr
emedies.

I
nst
ructpat
ienttonoti
fyheal
thcareprofessi
onal
of
medi
cati
onpriortotr
eatmentorsurgery
.

Adv i
sepatienttonot i
fyhealt
hcar eprofessi
onal
i
mmedi at
elyifgeneral t
ir
edness;fever;muscleorj
oint
aching;chestpain;skinrash;sor
et hroat;or
numbness, ti
ngli
ng, pain,orweaknessofhandsand
feetoccurs.Vit
ami nB6( pyri
doxine)maybeusedt o
treatperi
pheralneurit
is.

Emphasi
zethei
mpor t
anceoff
oll
ow-upexamst
o
eval
uat
eeff
ecti
venessofmedi
cati
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1897
Hy
drochl
orot
hiazi
de
I
NDI
CATI
ONS
Managementofmi ldtomoder at
ehy pertensi
on.
Treatmentofedemaassociatedwi t
h:HF, Renal
dysfuncti
on,
Cirr
hosis,
Glucocort
icoidtherapy,Est
rogen
therapy.

ACTI
ON
Increasesexcretionofsodi um andwat erbyinhibi
ti
ng
sodium reabsorpt i
oninthedi stal
tubule.Pr
omot es
excreti
onofchl oride,potassium,hydrogen,magnesium,
phosphat e,cal
cium andbi carbonate.Mayproduce
arteri
olardi
lati
on.Ther apeuticEff
ects:LoweringofBPin
hypertensiv
epat ientsanddi uresi
swi t
hmobi l
izati
onof
edema.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty(
cross-
sensi
ti
vi
ty
withotherthi
azi
desorsulfonami
desmayexi
st);Some
productscontai
ntar
trazi
neandshoul
dbeavoidedin
pati
entswithknownintol
erance;
Anur
ia;
Lact
ation:
Lactat
ion.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1898
UseCaut
iousl
yin:
Renal
orhepat
ici
mpai
rment
;OB:
Jaundi
ceort
hrombocy
topeni
amaybeseeni
nthe
newborn.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness, drowsi ness, lethar gy,weakness.CV:
hypotension.GI :anor exia,crampi ng,hepat iti
s, nausea,
vomi t
ing.Der m: STEVENSJOHNSONSYNDROME,
photosensitivi
ty,rash.EENT: acut eangl e-closur e
glaucoma, acut emy opia.Endo: hy perglycemi a.FandE:
hypokalemi a,dehy dration,hy percal cemi a,hy pochloremic
alkal
osis,hy pomagnesemi a, hyponat remia,
hypophosphat emia, hypov olemi a.Hemat :blood
dyscrasias.Met ab: hyper uri
cemi a,hy percholest er
olemia.
MS: muscl ecr amps.Mi sc: pancr eat i
tis.

I
NTERACTI
ONS
Drug-Drug:Additiv
ehy potensionwithot her
anti
hypertensiv
es, acut eingesti
onofal cohol,ornit
rates.
Additi
vehy pokalemi awi t
hcor ti
coster
oids,amphot eri
cinB,
pi
peracill
in,ort
icar ci
lli
n.↓ theexcretionoflithi
um.
Cholestyr
ami neor colesti
pol ↓ absorpti
on.Hy pokalemia
↑r i
skofdi goxintoxi ci
ty.NSAI Dsmay↓ ef fect
iveness.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1899
Whenusedasadi
uret
icinadul
ts,
gener
all
ygi
vendai
l
y,but
maybegiv
enever
yotherdayor2–3days/
week
PO:(
Adult
s):12.5–100mg/ dayin1–2doses( upto200
mg/day
;nottoexceed50mg/ dayf
orhypert
ension;doses
abov
e25mgar eassoci
atedwi t
hgreat
erl
ikel
ihoodof
el
ect
rol
yteabnormali
ti
es)
.
PO:(Chi
ldr
en>6mo):2mg/
kgi
n2di
vi
deddoses(
nott
o
exceed200mg/day
).
PO:(Chil
dren<6mo) :
Upto2–4mg/kg/
dayi
n2di
vi
ded
doses(nottoexceed37.
5mg/day
).

AVAI
LABI
LITY
Tabl
ets25mg,
50mg,
100mg.
Capsul
es12.
5mg.

PATI
ENTTEACHI
NG
I
nstructpati
enttotakethi
smedicati
onatthesame
ti
meeachday .Takemisseddosesassoonas
remember edbutnotjustbef
orenextdoseisdue.Do
notdoubledoses.

I
nstr
uctpati
enttomonit
orweightbiweeklyandnot
if
y
heal
thcar
eprofessi
onalofsi
gnif
icantchanges.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1900
Cautionpati
entt
ochangeposit
ionssl
owl
yto
minimizeort
hostat
ichypot
ensi
on.Thi
smaybe
potenti
atedbyal
cohol.

Advi
sepati
enttousesunscreenandprot
ectiv
e
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eact
ions.

I
nst
ructpat
ientt
odi
scussdi
etar
ypotassi
um
r
equi
rementswit
hheal
thcar
eprofessi
onal

I
nst
ructpat
ienttonot
if
yheal
thcar
eprofessionalof
medi
cati
onregimenbefor
etr
eatmentorsurgery.

Advisepat i
enttorepor
trash,muscl
eweakness,
cramps, nausea,vomit
ing,di
arr
hea,
ordi
zzi
nessto
healthcareprofessi
onal.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
upexams.

Hypert
ensi
on:Advisepat i
ent
st oconti
nuetaki
ngt
he
medicat
ioneveniffeeli
ngbetter.Medi
cati
oncont
rol
s
butdoesnotcurehy per
tensi
on.

Encouragepat ientt
ocompl ywithadditi
onal
i
nterv
entionsf orhypertension(weightreducti
on,l
ow-
sodi
um di et
,regularexercise,smokingcessat i
on,
moderationofal coholconsumpt ion,andstress
management ).

I
nst
ructpat
ientandf
ami
l
yincor
rectt
echni
quef
or

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1901
 moni
tor
ingweekl
yBP.

Instr
uctpatientt
onot i
fyheal
thcareprofessionalof
allRxorOTCmedi cati
ons,vi
tamins,orherbal
productsbeingtakenandt oconsultheal
thcar e
professi
onal bef
oretaki
ngotherRx, OTC,orherbal
products,especi
all
ycoughorcoldpr eparati
ons.

Hy
drocodone
I
NDI
CATI
ONS
Usedmai nl
yincombinat
ionwit
hnonopioidanal
gesi
cs
(acet
aminophen/i
buprof
en)i
nthemanagementof
moderatetosever
epain.Ant
it
ussiv
e(usuall
yin
combinati
onproduct
swi t
hdecongest
ants).

ACTI
ON
Bindt oopiat
ereceptorsintheCNS.Al t
erthepercepti
onof
andr esponsetopainfulsti
muliwhi
leproducing
gener al
i
zedCNSdepr essi
on:Suppressthecoughr efl
ex
viaadi r
ectcentr
alaction.Ther
apeuticEff
ects:Decrease
i
nsev er
it
yofmoder atepain.Suppr
essionoft hecough
refl
ex.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1902
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
ohy
drocodone
(cross-sensi t
ivitymayexi sttoot heropi oids);
Hy persensitivi
tyt oacet ami nophen/ i
bupr ofen(for
combi nationpr oduct s)
; I
bupr ofen-cont ainingpr oducts
shoul dbeav oidedi npat ientswi t
hbl eedingdi sordersor
thrombocy topeni a;Acet aminophen- cont ainingpr oducts
shoul dbeav oidedi npat ientswi t
hsev er ehepat icorr enal
disease; I
bupr of en-containingpr oduct sshoul dbeav oided
i
npat i
entsunder goingcor onaryar teryby passgr aft
surger y
;OB: Lact ati
on: Av oi
dchr onicuse; Product s
cont ai
ningal cohol ,aspar tame, sacchar in, sugar,or
tartr
azine( FDCy el
lowdy e#5)shoul dbeav oidedi n
patientswhohav ehy persensi t
ivi
tyori nt olerancet othese
compounds.

UseCaut
iousl
yin:
Headt
rauma;
↑int
racr
ani
alpr
essur
e;
Severer enal,hepat i
c,orpulmonar ydisease;
Cardiovascul ardisease(ibuprofen-containi
ngproducts
only)
; Historyofpept icul
cerdi sease( i
buprofen-
contai
ning
productsonl y )
;Alcoholi
sm; Ger i
:Geriatr
icordebil
it
ated
pati
ent s(init
ialdosage↓ r equi r
ed; morepronetoCNS
depression, constipati
on);Patientswithundiagnosed
abdomi nal pain;Prostati
chy perplasi
a;

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Not
edf
orhy
drocodoneonl
y;see

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1903
acet
ami
nophen/i
buprofenmonographsf
orspeci
fi
c
i
nfor
mat
iononindiv
idualcomponents
CNS: confusion, di
zziness,sedation,euphori
a,
hal l
ucinations,headache, unusual dreams.EENT: blur
red
vision,diplopia,miosis.Resp:respiratorydepressi
on.CV:
hy potension, bradycardi
a.GI:const i
pati
on,dyspepsia,
nausea, v omi ti
ng.GU: uri
naryretenti
on.Der m: sweati
ng.
Mi sc:phy sicaldependence, psychologicaldependence,
tolerance.

I
NTERACTI
ONS
Drug-Dr ug:Usewi thextremecaut ioni npat i
ent srecei
ving
MAOi nhibitors(
maypr oducesev ere,unpredi ctable
reactions—donotusewi thi
n14day sofeachot her).
AdditiveCNSdepr essi
onwi thalcohol ,antihistamines,and
sedat i
ve/ hypnot
ics.Admi nistr
ationofpar tialantagonist
opioids( buprenorphine,butorphanol ,nalbuphi ne,or
pentazoci ne)may↓ anal gesiaorpr ecipi
tateopi oid
withdrawal inphy sical
l
ydependentpat ients.
Drug-Natur
alProduct:
Concomitantuseofkav
a-kav
a,
val
erian,
skull
cap,chamomile,
orhopscan↑ CNS
depressi
on.

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1904
PO: (Adults):Anal
gesi
c—2. 5–10mgq3–6hrasneeded;i
f
usingcombi nat
ionpr
oduct s,
acetaminophendosage
shoul dnotexceed4g/ dayandshoul dnotexceed5
tablets/dayofibupr
ofen-contai
ningproduct
s;
Antitussive—5mgq4–6hrasneeded.
PO: (
Childr
en):
Analgesi
c( 1–13yr)—0.
1–0.2mg/kgq3–4
hr.Anti
tussi
ve—0.6mg/ kg/daydiv
idedq6–8hr;
(maximum doses<2y r
:1.25mg/ dose;2-
12yr
:5mg/dose;
>12y r:10mg/dose).

AVAI
LABI
LITY
Hydrocodonetabl
ets5mg; Hy dr
ocodonesyrup5mg/mL)
;
Incombinati
onwith:chl
orphenir
amine(Tussi
onex)
,
chl
orphenir
amineandpseudoephedr i
neZutri
pro

PATI
ENTTEACHI
NG
Adv i
sepati
enttotakemedi cati
onasdirectedandnot
totakemor ethantherecommendedamount .Sever
e
andper manentli
verdamagemayr esul
tfrom
prolongeduseorhighdosesofacet aminophen.Renal
damagemayoccurwi thpr olongeduseof
acetaminophenoribuprofen.Dosesofnonopi oi
d
agentsshouldnotexceedt hemaxi mum
recommendeddai lydose.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1905
 I
nstr
uctpat
ientonhowandwhent
oaskf
orandt
ake
pai
nmedicati
on.

Maycausedr owsinessordizzi
ness.Advisepati
entt
o
callf
orassi
stancewhenambul at
ingorsmoking.
Cautionpat
ienttoavoi
ddr i
vingorotheracti
vi
ti
es
requi
ringal
ert
nessuntilr
esponset othemedicati
onis
known.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

Caut
ionpat
ienttoav oi
dconcur
rentuseofalcohol
or
ot
herCNSdepr essantswi
ththi
smedi cat
ion.

Encour
agepat
ienttoturn,cough,
andbr
eat
hedeepl
y
ever
y2hrtopreventatel
ectasi
s.

Advisepati
entt
hatgoodoralhygi
ene,
frequentmout
h
ri
nses,andsugarl
essgum orcandymaydecreasedr
y
mout h.

Hy
drocor
ti
sone
I
NDI
CATI
ONS
Managementofadr
enocor
ti
cali
nsuff
ici
ency
;chroni
cuse
i
nothersi
tuat
ionsi
sli
mit
edbecauseofmineral
ocor
ticoi
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1906
activ
ity.Usedsy stemical
lyandlocall
yinawi devari
etyof
disordersincl
uding:Infl
ammat ory,
Aller
gic,Hematologi
c,
Neopl asti
c,Autoimmunedi sorder
s,Septicshock.

ACTI
ON
Inphar macologicdoses, suppr essesi nfl
ammat i
onandthe
normal immuner esponse.Hasnumer ousintense
met aboliceff
ects( seeAdv erseReact i
onsandSi de
Effects).Suppressesadr enal functi
onatchr onicdosesof
20mg/ day.Replacesendogenouscor ti
solindefici
ency
states.Alsohaspot entminer alocort
icoid(sodium-
retai
ning)activi
ty.Therapeut icEffects:Replacement
therapyi nadrenalinsuff
iciency .Suppressionof
i
nf l
ammat i
onandmodi f
icationoft henor mal i
mmune
response.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Act
iveunt
reat
edi
nfect
ions(
maybe
usedinpat i
entsbeingtreatedfortubercul
ousmeningi
ti
s
orsepti
cshock) ;Lactat
ion:Avoidchronicuse;Known
al
cohol,bisulf
it
e,ortart
razi
nehy persensit
ivi
tyor
i
ntol
erance( somepr oductscontaintheseandshouldbe
avoi
dedi nsusceptibl
epat i
ents).

UseCaut
iousl
yin:
Chr
oni
ctr
eat
ment(
wil
ll
eadt
oadr
enal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1907
suppr ession; uselowestpossibledosef orshortestper
iod
oft i
me) ;Pedi :Chroni
cusewi llr
esultin↓ gr owth;use
l
owestpossi bledosef orshort
estper i
odoft ime;
Hy pothyroidism; Cir
rhosis;
Ulcerati
vecoliti
s;Str
ess
(surgery,infections);
supplement aldosesmaybeneeded;
Pot enti
alinfect i
onsmaymasksi gns(fever
,infl
ammat i
on);
OB: Saf
etynotest abl
ished.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
Adver
sereact
ions/
sideef
fect
saremuchmor
ecommon
wit
hhigh-
dose/l
ong-t
ermther
apy
CNS: depressi on, euphor ia, headache, ↑i ntracranial
pressur e(chi l
dr enonl y),per sonal i
tychanges, psy choses,
rest l
essness.EENT: cataract s,↑i nt r
aocularpr essure.CV:
hy pertension.GI :PEPTI CULCERATI ON, anorexia,nausea,
vomi ting.Der m: acne, ↓ woundheal i
ng,ecchy moses,
fragili
ty,hirsutism, petechi ae.Endo: adrenal suppression,
hy perglycemi a.FandE: flui dretention(long-term high
doses) ,
hy pokal emi a,hypokal emical kal
osis.Hemat :
THROMBOEMBOLI SM, t
hr ombophl ebiti
s.Met ab: weight
gai n,weightl oss.MS: muscl ewast ing,osteopor osis,
av ascularnecr osi sofj oints, muscl epain.Mi sc:
hy persensi t
ivit
yr eact i
onsi ncludinganaphy l
axis,
cushi ngoidappear ance( moonf ace, buff
alohump) ,↑
suscept ibili
tytoi nfection.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1908
I
NTERACTI
ONS
Drug- Drug:Additi
v ehypokalemiawi ththiazideandl oop
diuretics,oramphot eri
cinB.Hy pokal emiamay↑ t herisk
ofdi goxintoxici
ty.May↑ r equirementf ori nsuli
nororal
hypogl ycemi cagents.Pheny t
oin,phenobarbi t
al,and
ri
fampi n↑ met aboli
sm; may↓ ef fecti
veness.Or al
cont racepti
vesmay↓ met aboli
sm.↑ r i
skofadv erseGI
effect swithNSAI Ds(incl
udingaspi r
in).Atchr onicdoses
thatsuppr essadr enalfuncti
on,may↓ ant i
bodyr esponse
toand↑ r i
skofadv ersereacti
onsf r
om live-vi
rusvaccines.

DOSAGE
PO:(
Adul
tsandChi
l
dren>12y
r):
20–240mg/
dayi
n1–4
di
vi
deddoses.
PO:(Chi
ldr
en):Physi
ologi
creplacement—0.5–0.
75
mg/kg/dayor20–25mg/ m2/daydi vi
dedq6hr .
Anti
-
i
nfl
ammat oryori
mmunosuppr essive—2.
5–10mg/ kg/day
or75–300mg/ m2/dayin3–4divideddoses.
PO:
(Neonates)
:Congeni
tal
adr
enal
hyper
plasi
a—10–20
mg/m2/dayin3di
vi
deddoses.
PO:
IV:(Neonat
es):
Refr
act
oryhypogl
ycemia—5
mg/kg/
daydivi
dedq8–12hror1–2mg/ kg/doseq6hr
.
Rect(
Adul
ts)
:Ret
ent
ionenema—100mgni
ght
lyf
or21

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1909
day
sorunt
ilr
emi
ssi
onoccur
s.
I
M:I
V:(
Adul
ts)
:100–500mgq2–6hr(
range100–8000
mg/
day
).
I
M: IV: (
ChildrenandI nfants)
:Adr enocorti
cal
i
nsuf fi
ciency—1–2mg/ kg/dosebol us,t
hen25–250
mg/ dayi ndivideddosesq6–8hr .Anti-
infl
ammator
yor
i
mmunosuppr essi v
e—1–5mg/ kg/dayor30–150
mg/ m2/ daydi videdq12–24hr ;Phy si
ologi
c
replacement —0. 25–0.35mg/ kg/dayor12–15mg/ m2/
day
oncedai ly;
Shock—50mg/ kgbolust hen50mg/ kgasa24
hrinfusion.
I
V: (
Neonates): Br
onchopulmonarydy spl
asiaprev
enti
onin
pret
erm neonateswithprenat
al i
nfl
ammat oryexposur
e-1
mg/ kg/
daydividedq12hrdur i
ngt hefir
st2weeksoflife;
Refract
oryhypotensi
on—3mg/ kg/daydivi
dedq8hrx5
days.

AVAI
LABI
LITY
Tabl
ets5mg, 10mg, 20mg;Enema100mg/ 60mL;
Powderfori
nject
ion(sodi
um succi
nat
e)100mg/v
ial
,250
mg/vi
al,
500mg/ v i
al,
1g/vi
al;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientoncor
rectt
echni
queofmedi
cat
ion

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1910
 admi nistr
ati
on.Adv i
sepat i
entt ot akemedi cati
onas
directed.Takemi sseddosesassoonasr emember ed
unlessal mostt i
mef ornextdose.Donotdoubl e
doses.St oppingt hemedi cationsuddenl ymayr esult
i
nadr enali
nsuf f
iciency(anorexi a,nausea, weakness,
fatigue,dyspnea, hypotension, hypoglycemi a)
.Ifthese
signsappear ,
notifyhealthcar epr ofessi
onal
i
mmedi at
ely.Thiscanbel i
fe-threatening.

Cort
icoster
oi dscauseimmunosuppr essi
onandmay
masksy mpt omsofi nf
ecti
on.Instr
uctpati
enttoavoi
d
peoplewithknowncont agi
ousi l
lnessesandtorepor
t
possibl
einfectionsi
mmedi at
ely.

Cauti
onpat
ienttoav
oidvacci
nati
onswi
thoutf
ir
st
consul
ti
nghealt
hcarepr
ofessi
onal.

Revi
ewsi deef f
ectswithpati
ent.Instr
uctpati
entto
i
nform healthcareprofessi
onalprompt l
yifsever
e
abdominal pai
nort ar
rystool
soccur .Pati
entshould
al
sorepor tunusualswelli
ng,weightgain,t
ir
edness,
bonepain, br
uisi
ng,nonheali
ngsor es,vi
sual
di
stur
bances, orbehaviorchanges.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

Di
scusspossi
bleef
fect
sonbodyi
mage.Expl
ore

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1911
 copi
ngmechani
sms.

Inst
ructpat
ientt
oinform healt
hcarepr
ofessi
onalif
symptomsofunder l
yingdiseaser
etur
norwor sen.

Advisepat
ientt
ocarr
yidenti
fi
cati
ondescribi
ng
di
seaseprocessandmedicati
onr egi
menintheevent
ofemergencyinwhi
chpatientcannotrel
atemedi
cal
hi
story.

Explainneedforconti
nuedmedicalf
oll
ow-upto
assessef f
ecti
venessandpossi
blesi
deef f
ect
sof
medi cat
ion.Per
iodi
clabtest
sandey eexamsmaybe
needed.

Long-
ter
m Therapy:Encouragepatientt
oeatadiet
hi
ghinprot
ein,cal
cium,andpot assium,andl
owin
sodi
um andcarbohydrates(seeAppendixM).Al
cohol
shoul
dbeavoideddur i
ngtherapy.

I
frect
aldoseused>21days,decr
easetoever
yot
her
ni
ghtfor2–3weekstodecreasegr
adual
ly

HYDROMORPHONE
I
NDI
CATI
ONS
Moder
atet
osev
erepai
n(al
oneandi
ncombi
nat
ionwi
th

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1912
nonopioidanalgesi
cs);
extendedrel
easeproductf
oropi
oid
-t
oler
antpatientsrequi
ri
ngaround-t
he-cl
ockmanagement
ofpersist
entpain.Anti
tussi
ve(l
owerdoses).

ACTI
ON
Bindstoopiat
ereceptorsintheCNS.Al t
ersthepercepti
on
ofandresponsetopai nf
ulsti
muliwhileproduci
ng
general
izedCNSdepr essi
on.Suppressesthecoughr efl
ex
vi
aadi r
ectcentr
alaction.Ther
apeuticEff
ects:Decrease
i
nmoder at
etoseverepain.Suppr
essionofcough.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Somepr
oduct
s
cont ai
nbisulfit
esandshoul dbeav oidedinpati
entswit
h
knownhy persensit
ivi
ty;
Sev ererespir
ator
ydepression(i
n
absenceofr esusci
tati
veequi pment);Par
alyt
ici
leus
(extended-releaseonly
);Pri
orGIsur geryornarr
owingofGI
tract(ext
ended- rel
easeonly);Opioi
dnon-tol
erantpati
ents
(extended-releaseonly
);OB: Lactat
ion:Avoi
dchronicuse
duringpregnancyorl actat
ion.

UseCaut
iousl
yin:
Headt
rauma;
↑int
racr
ani
alpr
essur
e;
Sev er
erenal
, hepati
c, orpulmonar
ydisease;
Hy pothy
roi
dism; Seizuredisor
der;
Adrenalinsuf
fici
ency
;
Alcoholi
sm;Undi agnosedabdomi nal
pain;Prostati
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1913
hypert
rophy;Bil
iar
yt r
actdisease(
incl
udi
ngpancr
eat
it
is)
;
Geri
:Geriat
ri
canddebi li
tat
edpati
entsmaybemore
suscepti
blesideeffects;dose↓ r
ecommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: confusion,sedation,dizziness,dysphor i
a,euphoria,
fl
oatingfeeli
ng,hallucinati
ons, headache, unusual dr
eams.
EENT: blur
redv i
sion,diplopia,mi osi
s.Resp: respir
atory
depression.CV: hypotension, bradycardia.GI:consti
pation,
drymout h,nausea, vomi t
ing.GU: ur
inaryretenti
on.Derm:
fl
ushing,sweat i
ng.Mi sc:phy sicaldependence,
psychologicaldependence, t
olerance.

I
NTERACTI
ONS
Drug- Dr ug:Exerciseext remecaut ionwi thMAOi nhi bi
tors
(maypr oducesev er e,unpr edictabler eactions—r educe
i
nitialdoseofhy dromor phonet o25%ofusual dose,
discont inueMAOi nhibitors2wkpr i
ort ohy dromor phone).
↑r iskofCNSdepr essionwi thalcohol ,antidepressant s,
antihistami nes,andsedat i
v e/hypnot icsincluding
benzodi azepinesandphenot hiazines.Admi nistr
ationof
partial antagonists( bupr enor phine,but orphanol,
nalbuphi ne,orpent azocine)maypr ecipit
ateopi oid
withdr awal inphy sicall
ydependentpat i
ents.Nal buphine
orpent azocinemay↓ anal gesia.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1914
Drug-
Natur
alPr
oduct:Concomi
tantuseofkav
a-kava,
val
eri
an,
chamomile,
orhopscan↑ CNSdepr essi
on.

DOSAGE
Dosesdependonl
evelofpainandt
oler
ance.Lar
gerdoses
mayberequir
eddur
ingchronict
her
apy

Anal
gesi
c
PO: (
Adults≥50kg) :I
mmediate-r
elease–4–8mgq3–4hr
i
nit
iall
y(somepat ient
smayr espondt odosesassmallas
2mgi niti
all
y);
oronce24-hropioi
dr equi
rementi
s
deter
mi ned,convertt
oExtended-r
eleasebyadmini
ster
ing
tot
aldailyoraldoseoncedail
y-.
PO:(Adult
sandChi l
dren<50kg)
:0.
06mg/kgq3–4hr
i
nit
iall
y,y
oungerchil
drenmayrequi
resmal
l
eri
nit
ial
doses
of0.03mg/ kg.Maxi
mum dose5mg.
I
V:IM:Subcut(
Adul
ts≥50kg)
:1.
5mgq3–4hrasneeded
i
nit
ial
l
y;maybe↑.
I
V:I
M:Subcut(
Adul
tsandChildr
en<50kg)
:0.
015mg/
kg
mgq3–4hrasneededini
ti
all
y;maybe↑.
IV:(
Adults):Conti
nuousi nf
usion(unl
abeled)
—0.2–30
mg/ hrdependi
ngonpr evi
ousopioiduse.Anini
ti
albol
us
oftwicethehourlyrateinmgmaybegi venwith
subsequentbreakthroughbolusesof50–100%oft he

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1915
hour
lyr
atei
nmg.
Rect(
Adul
ts)
:3mgq6–8hri
nit
ial
l
yasneeded.

Ant
it
ussi
ve
PO:
(Adul
tsandChi
l
dren>12y
r):
1mgq3–4hr
.
PO:
(Chi
l
dren6–12y
r):
0.5mgq3–4hr
.

AVAI
LABI
LITY
I
mmedi ate-r
eleasetabl
ets2mg,3mg, 4mg,8mg;
Ext
ended-rel
easet abl
ets4mg,8mg, 12mg,16mg,32mg,
64mg;Or alsoluti
on5mg/ 5mL;I
njecti
on1mg/mL,2
mg/mL, 4mg/ mL,10mg/ mL;
Supposit
ori
es3mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientonhowandwhent
oaskf
orpai
n
medi
cati
on.

Maycausedr owsinessordizzi
ness.Advisepatientt
o
callf
orassi
stancewhenambul at
ingorsmoki ng.
Cautionpat
ienttoavoi
ddr i
vingorotheractiv
iti
es
requi
ringal
ert
nessuntilr
esponset omedi cat
ionis
known.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1916
 I
nstr
uctpat
ienttoav oi
dconcur
rentuseofal
cohol
or
ot
herCNSdepr essants.

Encour
agepat
ienttoturn,cough,
andbr
eat
hedeepl
y
ever
y2hrtopreventatel
ectasi
s.

HomeCar eIssues:Explaintopati
entandfami lyhow
andwhent oadmi ni
sterhy dr
omorphone,discusssafe
storageofthemedi cati
on, andhowtocar efor
i
nf usi
onequipmentpr oper l
y.Pedi
:Teachpar entsor
caregiver
showt oaccur atelymeasureli
quid
medi cati
onandt ouseonl ythemeasuringdev ice
dispensedwi t
hthemedi cati
on.

Emphasizet
heimpor
tanceofaggressi
veprevent
ion
ofconst
ipat
ionwi
tht
heuseofhy dromorphone.

Hy
droxocobal
ami
n
I
NDI
CATI
ONS
Vit
ami nB12defici
ency.Per
nici
ousanemia.Par
tofthe
Schil
l
ingtest(vi
taminB12absorpti
ontest
)(di
agnosti
c).
Cyanidepoisoni
ng(Cyanoki
tonly)
.

ACTI
ON
Necessar
ycoenzy
mef
ormet
abol
i
cpr
ocesses,
incl
udi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1917
fatandcarbohydratemet abol i
sm andpr otei
nsy nthesis.
Requiredforcel
l r
eproduct i
onandhemat opoi
esis.
Therapeuti
cEffects:Corr
ect smani festat
ionsof
perni
ciousanemi a(megal oblasti
cindices,GIlesions,and
neurologi
cdamage) .Correctsv it
ami nB12def ici
ency.
Reversessympt omsofcy ani detoxi
city.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
IMi
nject
ion—Ur
emi
a,f
oli
caci
d
def
ici
ency ,
concurr
entinfect
ion,i
rondefi
ciency(r
esponse
tovi
taminB12wi ll
beimpai r
ed);Pedi
:Cyanokit—Saf
ety
andeffecti
venessnotestabl
ished;OB:Cyanokit
—Useonly
i
fpotential
benefi
tjust
ifi
espotenti
alri
sktof et
us.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
I
Minj
ect
ion
GI:di
arr
hea.Der
m: it
chi
ng.FandE: hy
pokalemia.Local:
pai
natIM sit
e.Misc:hy
persensi
ti
vi
tyreact
ionsincl
uding
anaphyl
axi
s.
Cy
anoki
t
CNS: di
zziness,
headache,memoryi
mpairment,
rest
lessness.CV:hyper
tensi
on,
chestpai
n,edema,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1918
tachycardia.EENT: drythroat,eyeredness,eyeswelling.
Resp: dyspnea.GI :
abdomi naldi
scomf or
t,diar
rhea,
dyspepsia, dysphagia,hemat ochezi
a,nausea,vomiting.
GU: r
edur ine.Derm: erythema, r
ash,pruri
ti
s,urt
icar
ia.
Local:inj
ect i
onsitereaction.

I
NTERACTI
ONS
ForI
Minj
ect
iononl
y
Drug-
Drug:Chlor
amphenicol andanti
neoplasti
csmay↓
hematologi
cresponsetov i
taminB12.Colchici
ne,
aminosali
cyl
icaci
d,orexcessiveint
akeofalcohol,or
vi
taminCmay↓ absor ption/eff
ecti
venessofv i
taminB12.

DOSAGE
Vi
tami
nB12Def
ici
ency(
IM onl
y)
I
M:(Adul
ts):30mcg/
dayf
or5–10day
s,t
hen100–200
mcg/month.
IM:(
Chil
dren):100mcg/dayf
or2ormoreweeks(t
o
achi
evetotal
doseof1000–5000mcg)
,then30–50
mcg/month.

Per
nici
ousAnemi
a(I
M onl
y)
I
M: (
Adul
ts)
:100mcg/dayfor6–7days;i
fimprov
ement,
gi
vesamedoseev
eryotherdayfor7doses,t
henever
y

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1919
3–4daysfor2–3wk;oncehematol
ogi
cvaluesr
etur
nto
nor
mal(remissi
on)
,gi
vemaint
enancedoseof100
mcg/month.
IM:(
Chil
dren):30–50mcg/dayf
or2ormoreweeks(
to
achi
evetotal
doseof1000–5000mcg)
,then100
mcg/month.
Schi
l
li
ngTest
I
M:Subcut(
Adul
ts)
:Fl
ushi
ngdosei
s1000mcg.

Cy
ani
dePoi
soni
ng(
Cyanoki
tonl
y)
I
V:(Adult
s):5gov er15min;anot
her5gdosemaybe
i
nfusedover15–120mi ndependi
nguponsev
erit
yof
poi
soning(maxi
mum cumul ati
vedose=10g).

AVAI
LABI
LITY
I
nject
ion(
generi
cavai
labl
e)1000mcg/
mL;
Powderf
or
i
nject
ion(
Cyanoki
t)5g/vi
al;

PATI
ENTTEACHI
NG
Encouragepati
enttocompl ywi
thdi
et
recommendat i
onsofhealthcar
eprofessi
onal.Expl
ain
thatthebestsourceofvi
taminsi
sawel l-
bal
anced
dietwit
hfoodsfrom thef
ourbasicfoodgroups.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1920
Foodshi
ghinv i
tami
nB12i ncl
udemeat
s,seaf
ood,
eggyol
k,andferment
edcheeses;f
ewvit
aminsare
l
ostwit
hordinar
ycooking.

Pati
ent
sself-
medicati
ngwithvi
taminsuppl
ements
shoul
dbecautionednottoexceedRDA.Eff
ecti
veness
ofmegadosesfortr
eatmentofvari
ousmedical
condi
ti
onsisunprovedandmaycausesideeffect
s.

I
nform pat
ient
swithpernici
ousanemi
aoft
hel
i
fel
ong
needforvi
taminB12replacement.

Emphasi
zetheimpor
tanceoff
oll
ow-
upexamst
o
eval
uat
eprogr
ess.

Int
er mi tt
entI nfusion:Adv isepat ientt hatskinr edness
mayl astupt o2wkandt hatt heirurinemayr emai n
redf orupt o5wkaf t
erdr ugadmi nistrati
on.Inst r
uct
patientt oav oi dsunexposur ewhi letheirskini sred.
Adv i
sepat ientt ocontactheal thcar epr ofessional i
f
ski
norur i
ner ednessper sistaf tertheset imeper iods.
Adv i
sepat ientt hatarashmaydev elopf r
om 7–28
daysaf terdrugadmi nistration.Itwi llusuall
yr esolve
withoutt r
eatmentwi thinaf ewweeks.Adv i
sepat i
ent
tocont actheal thcarepr of essional ifrashper sists
aft
ert histi
meper i
od.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1921
Hy
droxy
chl
oroqui
ne
I
NDI
CATI
ONS
Suppression/chemoprophyl
axi
sofmalar
ia.Tr
eat
mentof
sever
er heumat oi
dart
hrit
is/
syst
emi
clupus
ery
themat osus.

ACTI
ON
I
nhibi
tsprotei
nsynthesi
sinsusceptibl
eorgani
smsby
i
nhibi
ti
ngDNAandRNApol ymerase.Ther
apeuti
cEffects:
Deathofplasmodi
ar esponsi
bleforcausi
ngmalari
a.Also
hasanti
-i
nflammatoryproper
ti
es.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
o
hydr
oxy
chlor
oquineorchloroquine;
Prev
iousvi
sual
damagefr
om hydroxy
chloroquineorchl
oroqui
ne.

UseCaut
iousl
yin:
Concur
rentuseofhepat
otoxi
cdr
ugs;
Hist
oryofliverdi
seaseoral coholi
sm orr enali
mpai r
ment ;
Severeneurologi
cal di
sorders;
Sev ereblooddisorders;
Reti
nalorv i
sualf
ieldchanges; G6PDdef ici
ency;Psoriasi
s;
Bonemar rowdepr essi
on; Obesit
y( det
erminedoseby
i
dealbodywei ght)
; OB:Lactati
on:Av oi
duseunl ess

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1922
tr
eat
ing/pr
event
ingmalar
iaortr
eati
ngamebicabscess;
Pedi
:Long-t
erm usemayincr
easesensi
ti
vi
tytoef
fects.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, aggr essiveness, anxiety,apathy ,
confusion,fatigue, headache, i
rrit
abil
ity,personal i
ty
changes, psychoses.EENT: keratopathy ,otot
oxi ci
ty,
reti
nopathy,tinni tus,v i
sual disturbances.CV: ECG
changes, hypot ensi on.GI :abdomi nalcramps, anorexi
a,
diarr
hea,epigast ri
cdi scomf ort
, nausea, vomiting,hepati
c
fail
ure.Derm: bl eachi ngofhai r
, al
opecia,
hyperpigment at i
on, phot osensi ti
vity,
Stev ens-Johnson
syndrome.Hemat :AGRANULOCYTOSI S, APLASTI C
ANEMI A,l
eukopeni a, thrombocy topenia.Neur o:
neuromy opathy , peripher alneur i
ti
s.

I
NTERACTI
ONS
Drug-Drug:May↑ t her i
skofhepatotoxi
citywhen
administeredwi thhepat otoxi
cdrugs.May↑ t heriskof
hemat ol
ogi ctoxici
tywhenadmi nist
eredwi thpenicil
lami
ne.
May↑ r i
skofder mat i
tiswhenadmi nist
eredwi t
hot her
agentshav ingder mat ologi
ctoxi
city
.Maydecr easeserum
ti
ter
sofr abi esantibodywhengi venconcur rentl
ywi t
h
humandi ploi dcellrabiesvacci
ne.Urinaryacidif
ier
smay
↑r enalexcr eti
on.May↑ ser um level
sofdi goxin.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1923
DOSAGE
Anti
mal ari
aldosesexpressedasmgofbase;
anti
rheumat i
candlupusdosesexpr essedasmgof
hydroxychl
oroquinesulf
ate(200mghy dr
oxy
chl
oroqui
ne
sulf
ate=155mgofhy droxychl
oroqui
nebase)

Mal
ari
a
PO:(Adul
ts):Suppressi
onorchemopr ophy l
axis—310mg
onceweekly;
start1–2wkpr i
ortoenteringmal ari
ousarea;
conti
nuefor4wkaf terl
eavi
ngarea.Treatment —620mg,
then310mgat6hr ,24hr,
and48hraf terini
tialdose.
PO:(Chil
dren):
Suppr essionorchemoprophylaxi
s—5
mg/kgonceweekl y;start1–2wkpriort
oent eri
ng
malari
ousarea;conti
nuef or4wkaf t
erl
eavingarea.
Tr
eatment —10mg/ kginiti
all
y,t
hen5mg/ kgat6–8hr ,
24
hr
,and48hraf teri
niti
aldose.

Rheumat
oidAr
thr
it
is
PO:
(Adults)
:400–600mgoncedail
yini
ti
all
y,
mai
ntenance200–400mg/
daydiv
ided1–2t i
mes/
day
.
PO:
(Chi
ldr
en):
3–5mg/kg/
daydivi
ded1–2t
imes/dayto
amaxi
mum of400mg/
day;nott
oexceed7mg/kg/day
.

Sy
stemi
cLupusEr
ythemat
osus

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1924
PO:(Adul
ts)
:400mgonceort
wicedai
l
y,mai
ntenance
200–400mg/day.
PO:
(Chi
ldr
en):
3–5mg/kg/
daydivi
ded1–2t
imes/dayto
amaxi
mum of400mg/
day;nott
oexceed7mg/kg/day
.

AVAI
LABI
LITY
Tabl
ets200mg(
155-
mgbase)
;

PATI
ENTTEACHI
NG
Inst
ructpati
enttotakemedicat
ionexactl
yasdi r
ect
ed
andcontinueful
lcourseoft
herapyev eni
ffeeli
ng
bett
er.Misseddosesshouldbet akenassoonas
remember edunl
essi ti
sal
mostt imefornextdose.
Donotdoubl edoses.

Advi
sepat
ient
stoavoi
duseofal
cohol
whi
l
etaki
ng
hydr
oxy
chl
oroqui
ne.

Cauti
onpati
enttokeephydroxychl
oroquineoutof
reachofchi
l
dren;f
atal
i
tieshaveoccurredwith
i
ngesti
onof3or4t abl
ets.

Expl
ainneedforperiodi
cophthal
micexamsf or
pati
entsonprolongedhigh-
dosether
apy.Advise
pati
entthatt
her i
skofoculardamagemaybe
decreasedbytheuseofdar kgl
assesi
nbrightli
ght
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1925
 Prot
ecti
veclot
hingandsunscreenshoul
dal
sobe
usedtoreduceri
skofdermatoses.

Adv i
sepatienttonot i
fyhealthcareprofessi
onal
prompt l
yifsorethroat,fever,
unusual bl
eedi
ngor
bruisi
ng,blur
redv i
sion,visualchanges,ri
ngi
nginthe
ears,di
ffi
cultyheari
ng, ormuscl eweaknessoccurs.

MalariaProphyl
axi
s:Revi
ewmet hodsofmi ni
mizing
exposuretomosquitoeswit
hpatientsreceivi
ng
hydroxychl
oroqui
neprophyl
acti
call
y(userepellent,
wearlong-sl
eevedshir
tandlongtrousers,usescreen
ornetti
ng).

Advisepat
ientt
onoti
fyhealt
hcar
eprofessi
onal
if
fev
erdevel
opswhilet
r av
eli
ngorwi
thi
n2moof
l
eavinganendemicarea.

RheumatoidArt
hrit
is:Instructpati
enttocont
act
heal
thcareprof
essional ifnoimpr ov
ementisnot
iced
wit
hinafewday s.Treatmentf orrheumatoi
dart
hri
tis
mayrequir
eupt o6mof orfullbenef
it
.

Hy
droxy
progest
erone
I
NDI
CATI
ONS
Tr
eat
mentofamenor
rheaandf
unct
ional
uter
inebl
eedi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1926
associ
atedwithhormonal
imbalance.Product
ionof
secret
oryendometri
um.Diagnost
icagentforendogenous
estr
ogenproducti
on.

ACTI
ON
Asy ntheti
canalogofpr ogesterone.Pr oducessecretory
changesi ntheendomet ri
um.I ncreasesbasal temper at
ure.
Produceschangesi nthev aginalepitheli
um.Rel axes
uteri
nesmoot hmuscle.Stimulatesmammar yalveol
ar
growth.Inhibi
tspit
uit
aryfunction.Pr oduceswithdrawal
bleedi
ng( requir
esestr
ogen) .Therapeut i
cEffects:
Restorati
onofnor malhor monal balance.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Hyper
sensi
ti
vi
tyt
o
castoroil
,sesameoi l
,orbenzy lal
cohol;
Thromboembol
i
c
disorder
s;Sev erel
iverdisease; Br
eastcarci
noma;
Undiagnosedv agi
nalbleeding;Missedaborti
on;
Pregnancy,lactati
on,orchildren.

UseCaut
iousl
yin:
Car
diacdi
sease;
Renal
dysf
unct
ion;
Ast
hma;
Sei
zur
es;
Migr
aineheadaches;
Diabet
esmel
l
itus.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
CEREBRALTHROMBOSI
S,depr
essi
on.Resp:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1927
coughing, dyspnea.CV:PULMONARYEMBOLI SM, edema,
thrombophl ebit
is.GI
:cholestat
icj
aundice.GU:
breakthroughbl eedi
ng,amenorrhea,cerv
ical
changes.
Der m:increasedpigmentation,
rashes.Misc:all
ergic
reacti
ons, weightchanges.

I
NTERACTI
ONS
Drug-Drug:
Int
erf
ereswitht
heeff
ectsofbr
omocr
ipt
ine
(causesamenorrheaorgal
act
orr
hea).

DOSAGE
Amenor
rhea,
Dysf
unct
ional
Uter
ineBl
eedi
ng,
Met
ror
rhagi
a
I
M:(
Adul
ts)
:375mg.
Pr
oduct
ionofSecr
etor
yEndomet
ri
um
IM:(Adult
s):125–250mggivenonthe10t
hdayofthe
cycle,r
epeat
edq7day sunt
ilsuppr
essi
oni
snolonger
requir
ed.

AVAI
LABI
LITY
I
nject
ion125mg/
mL,
250mg/
mL;

PATI
ENTTEACHI
NG
Adv
isepat
ientt
orepor
tsi
gnsandsy
mpt
omsoff
lui
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1928
 ret
ention(swelli
ngofankl esandf eet,weightgain),
thr
omboembol icdisorders(pain,swel l
ing,t
ender ness
i
next r
emi ti
es,headache, chestpai n,bl
urredv i
sion),
depression,orhepaticdysfunction( yel
lowedski nor
eyes,pruri
tus,darkurine,l
ight-
color edstools)to
healt
hcar eprofessional.

Inst
ructpat
ienttonoti
fyheal
thcarepr
ofessi
onali
f
changeinvaginalbl
eedingpat
ter
norspotti
ngoccurs.

I
nstr
uctpati
enttost
optaki
ngmedicat
ionandnoti
fy
heal
thcar
eprofessi
onal
ifpr
egnancyi
ssuspect
ed.

Cauti
onpat
ienttousesunscr
eenandprot
ect
ive
cl
othi
ngtopreventi
ncr
easedpigment
ati
on.

I
nst
ructpatientt
opr acti
cegoodor al
hygiene,
hav
e
t
eethcleanedregularl
y,andnotif
ydenti
stif
t
enderness,swell
i
ng, orbleedi
nggumsoccur .

Adv i
sepati
entswithdiabet
estomoni t
orserum
glucosecaref
ull
yandr epor
tanyabnormalit
iest
o
healthcar
eprofessional
;maydecreaseglucose
toler
ance.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Emphasi
zet
hei
mpor
tanceofr
out
inef
oll
ow-
up

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1929
 physi
calexams,i
ncludi
ngBP;ophthalmi
c,br
east
,
abdominal,
andpelv
icexaminat
ions;andPAPsmear
s.

Amenor rheaorFunct i
onalUter
ineBleedi
ng: Expl
ain
28-daycy cl
icdosageschedule.Cycl
ictherapybegins
after4day sofdesquamationfrom i
niti
aldoseor21
day saft
erinject
ionifbl
eedingdidnotoccur.Explai
n
thatseveralmont hsofest
rogentherapymaybe
requir
edbef oremenst r
uat
ionoccurs.

Hy
droxy
urea
I
NDI
CATI
ONS
Headandneckcar ci
noma.Ov ari
ancar
cinoma.Resi stant
chroni
cmy el
ogenousleukemi a.Mel
anoma.Reduct ionof
painf
ulcri
sesinsi
cklecellanemiaanddecreasedneedf or
tr
ansfusi
onsinadultpati
ent swit
hahist
oryofr ecurrent
moderatetosever
ecr i
ses( atl
east3intheprecedingy r)
.

ACTI
ON
I
nterfer
eswithDNAsy nt
hesis(cell-
cycleS-
phase–speci
fic).Mayaltercharacteri
sticsofRBCs.
Therapeut
icEffects:
Deat hofrapidlyrepli
cati
ngcell
s,
part
icul
arl
ymal i
gnantones.Decr easedf requencyof
pai
nfulcri
sesanddecr easedneedf ortr
ansfusionsi
n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1930
si
ckl
ecel
lanemi
a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pregnancyorl
act
ati
on;Someproduct
scontai
ntar
trazi
ne
(FDCy el
l
owdye#5)andshouldbeavoidedi
npati
ents
withknownhyper
sensi
ti
vit
y.

UseCaut
iousl
yin:
Pat
ient
swi
thchi
l
dbear
ingpot
ent
ial
;
Renal i
mpai r
ment( closemoni toringofhemat ol
ogi c
par amet ersrecommended, dosage↓ maybenecessar y);
Hepat icimpai rment( closemoni t
oringofhemat ologic
par amet ersrecommended) ; My eloprol
if
erativ
edi sorders
(may↑ r i
skofv ascul i
ti
cul cerat i
onsandgangr ene) ;Acti
ve
i
nf ections;↓ bonemar rowr eser ve;Otherchroni c
debi l
itati
ngill
ness; HIVpat ient sreceivi
ngdi danosi neand
stav udine(↑r i
skofpancr eat i
tisandhepat otoxicity)
; Ger
i:
Maybemor esensi ti
vet oef fects,lowerdosesmaybe
requi r
ed; Obesepat ientsorpat ientswithedema( dose
shoul dbedet er
mi nedusi ngi deal bodywei ght).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dr
owsiness(largedoses).GI :
anor exia,di
arr
hea,
nausea,vomit
ing,consti
pati
on, hepatit
is, st
omat i
ti
s.GU:
dysuri
a,i
nfer
til
it
y,renalt
ubulardy sfunction.Derm:

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1931
alopecia,
exacer bati
onofpost-r
adi
ationery
thema,
erythema, prur
it
us, r
ashes.Hemat:l
eukopenia,anemia,
thrombocy topenia.Metab:hy
perur
icemia.Misc:chi
ll
s,
fever,malaise.

I
NTERACTI
ONS
Drug-Drug: Addit
ivebonemar r
owdepr essi
onwi t
hagents
thatdepressbonemar row,includi
ngr adi
ati
ontherapy.
May↓ t heant ibodyresponset oandi ncr
easetheriskof
adverser eacti
onst ol
ive-
vir
usv accines.↑ r
iskof
pancreatiti
sandhepat otoxi
citywhenusedwi t
hdidanosi
ne
andst avudine;avoidconcurrentuse.

DOSAGE
HeadandNeckCancer
,Ov
ari
anCancer
,Mal
i
gnant
Melanoma
PO:(Adult
s):60–80mg/kg(2–3g/m2)asasi ngledai
l
y
doseq3day sor20–30mg/kg/dayasasingledose.
Ther
apyshouldbeini
ti
ated7dayspri
ort
or adi
ationand
cont
inued.
Resi
stantChr
oni
cMy
elogenousLeukemi
a
PO:
(Adul
ts)
:20–30mg/
kg/
dayi
n1–2di
vi
deddoses.
Si
ckl
eCel
lAnemi
a

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1932
PO:(
Adul
tsandChi
l
dren)
:15mg/
kg/
dayasasingl
edose,
may↑ by5mg/kg/
dayq12wkupto35mg/kg/day
.

AVAI
LABI
LITY
Capsul
es200mg,
300mg,
400mg,
500mg;

PATI
ENTTEACHI
NG
Instr
uctpati
entt otakemedicati
onasdi r
ected,
evenif
nausea,vomiting,ordiarr
heaisaproblem.Consult
healthcarepr
of essionali
fvomiti
ngoccursshortl
y
afterdoseistaken.Takemi sseddosesassoonas
remember edunl essjustbef
orenextdose.Donot
takedoubledoses.Consul theal
thcareprof
essionali
f
mor ethanonedosei smissed.

Instructpati
entt onot ifyhealthcar epr ofessionalif
fever;chil
ls;sorethr oat;signsofi nfection;lossof
appet it
e;nausea; vomi ti
ng; diarr
hea; bleedinggums;
bruising;pet
echi ae;orbl oodi nurine, stool
,oremesi s
occur s.Cautionpat i
entt oav oidcr owdsandper sons
withknowni nfections.Inst r
uctpat ienttousesof t
toothbrushandel ectricrazor.Pat i
ent sshoul dbe
cautionednott odr i
nkal cohol i
cbev eragesort ot ake
product scont ai
ningaspi rinorNSAI Ds.

I
nfor
m pat
ientt
hatl
ong-
ter
m usemayi
ncr
easet
he

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1933
 r
iskofdev
elopi
ngcancer
.

Inst
ructpati
enttoinspectoralmucosaforeryt
hema
andulcerati
on.Iful
cerat
ionoccurs,advi
sepati
entto
usespongebr ushandr i
nsemout hwithwateraft
er
eati
nganddr inki
ng.Consultheal
thcareprof
essional
i
fmout hpaini nt
erf
ereswitheati
ng.Stomati
ti
spain
mayr equir
etreatmentwithopioi
danalgesi
cs.

Discusspossi
bil
it
yofdrowsinesswithpati
ents
recei
vingl
argedoses.Advisepat
ienttoavoi
ddriv
ing
orotheract
ivi
ti
esunti
lresponsetodrugisknown.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

Revi
ewwithpat
ienttheneedforcontr
acepti
onduri
ng
ther
apy
.Womenneedt ousecontr
acepti
onev eni
f
amenorr
heaoccurs.Maycauseinfer
ti
li
ty.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

Emphasi
zeneedforl
abtest
sandfol
low-upv
isi
tst
o
moni
torprogr
essanddet
ectsi
deeff
ects.

Leukemi
a:Encour
agef
lui
dint
akeof2000–3000

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1934
 mL/day
.All
opur
inolandalkal
i
nizat
ionoft
heuri
ne
maybeusedtohelpprev
enturatestonef
ormat
ion.

Hy
droxy
zine
I
NDI
CATI
ONS
Treatmentofanxi
ety
.Pr
eoperat
ivesedat
ion.Anti
emeti
c.
Antipr
uri
ti
c.Maybecombinedwithopioi
danalgesi
cs.

ACTI
ON
ActsasaCNSdepr essantatthesubcor ti
call
evelofthe
CNS.Hasant i
cholinergic,anti
hist
ami ni
c,andanti
emet i
c
properti
es.Blockshi stamine1r eceptor
s.Therapeuti
c
Effect
s: Sedati
on.Rel i
efofanxiety.Decreasednauseaand
vomi t
ing.Decreasedal ler
gicsympt omsassociatedwi t
h
rel
easeofhi stamine, i
ncludingpruri
tus.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Pot
ent
ial
for
congeni
taldef
ect
s(oralcl
eft
sandhypoplasi
aofcer
ebr
al
hemispher
e;Lact
ati
on:Safet
ynotest
abli
shed.

UseCaut
iousl
yin:
Sev
erehepat
icdy
sfunct
ion;
OB:
Has
beenusedsafel
yduri
ngl
abor;Pedi
:Inj
ecti
oncontai
ns
benzy
lalcohol
,whi
chcancausepotenti
all
yfat
algaspi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1935
syndromeinneonat
es;Geri
:AppearsonBeersl
ist.
Geriat
ri
cpati
entsar
emor esuscepti
blet
oadverse
reacti
onsduetoant
ichol
i
nergiceff
ects;
dosagereduct
ion
recommended.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsiness,agit
ati
on,ataxia,dizzi
ness, headache,
weakness.Resp: wheezing.GI:drymout h,bit
tertaste,
constipat
ion,nausea.GU: ur
inaryretenti
on.Der m: fl
ushing.
Local:pai
natI M sit
e,abscessesatI M sites.Misc:chest
ti
ghtness.

I
NTERACTI
ONS
Drug-Drug:AdditiveCNSdepr essionwi thot herCNS
depressants,i
ncludi ngal cohol,antidepr essant s,
anti
histamines,opioi danal gesics,andsedat i
v e/
hypnot
ics.
Additi
veant i
cholinergicef fectswi t
hot herdr ugs
possessingantichol i
ner gicproper t
ies,includi ng
anti
histamines,antidepr essant s,atropine, haloperi
dol
,
phenothiazi
nes,qui nidine,anddi sopy rami de.Can
antagonizethev asopr essoref fectsofepi nephr i
ne.
Drug-
NaturalProduct:Concomitantuseofkava-kava,
val
eri
an,orchamomi l
ecanincreaseCNSdepr ession.
I
ncreasedantichol
inergi
ceffect
swi t
hangel’
strumpet ,
j
imsonweed, andscopol i
a.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1936
DOSAGE
PO:(Adul
ts):Anti
anxiety—25–100mg4t i
mes/day,
nott
o
exceed600mg/ day.Pr eoper
ati
vesedat
ion—50–100mg
si
ngledose.Anti
pruri
tic—25mg3–4t i
mesdaily
.
PO:
(Chi
l
dren)
:—2mg/
kg/
daydi
vi
dedq6–8hr
.
I
M: (Adul
ts)
:Pr
eoper
ati
vesedat
ion—25–100mgsingle
dose.Ant
iemet
ic,
adj
unctt
oopioidanal
gesi
cs—25–100
mgq4–6hrasneeded.
I
M:(
Chi
l
dren)
:—0.
5–1mg/
kg/
doseq4–6hrasneeded.

AVAI
LABI
LITY
Tabl
ets10mg,25mg, 50mg,100mg;Capsules10mg, 25
mg,50mg,100mg; Sy
r up10mg/5mL;Oralsuspensi
on
25mg/ 5mL;
Inj
ect
ion25mg/ mL,50mg/mL;

PATI
ENTTEACHI
NG
I
nstructpati
entt
otakemedicat
ionexactl
yasdi r
ect
ed.
Misseddosesshouldbetakenassoonas
remember edunl
essiti
salmostti
mef ornextdose;
do
notdoubledoses.

Maycausedrowsi
nessordizzi
ness.Cauti
onpat
ient
t
oavoiddri
vi
ngandotheractiv
iti
esrequi
ri
ngal
ertness

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1937
 unt
ilresponsetomedicati
onisknown.Geri
:War
n
pat
ientsorcaregiv
ersthatol
deradult
sareat
i
ncreasedriskforCNSef f
ect
sandf al
ls.

Advi
sepat
ientt
oav oi
dconcurr
entuseofalcohol
or
ot
herCNSdepressant
swiththi
smedicati
on.

I
nf or
m pati
entthatfrequentmout hri
nses,goodor al
hygiene,
andsugar l
essgum orcandymayhel p
decreasedrymout h.Ifdrymout hper
sist
sf ormore
than2wk, consul
tdent istaboutsal
iv
asubst i
tute.

I
fusedforanxi
ety
,adv i
sepat
ientt
hatpsychot
herapy
i
sbenef
icial
inaddressi
ngsourcesofanxi
etyand
i
mprovi
ngcopingskill
s.

Teachothermethodstodecreaseanxi
ety
,suchas
i
ncreasedexer
cise,suppor
tgroups,
andrelaxat
ion
techni
ques.

Hy
oscy
ami
ne
I
NDI
CATI
ONS
Control
ofgastri
csecreti
on,vi
scer alspasm, hypermot
il
it
y
i
nspast i
ccol
iti
s,spasti
cbladder ,
pylorospasm, and
rel
atedabdominalcramps.Decr easessy mptomsof
var
iousfunct
ionali
ntesti
naldisordersincludi
ngmi l
d

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1938
dysent eries,diver ti
cul i
ti
s,infantcolic,bil
iar yandr enal
coli
c.Adj unctivet her apyinpept iculcerdi sease, ir
ri
table
bowel syndrome, neur ogenicbowel disturbances.
Decr easespai nandhy persecr et
ionassoci atedwi th
pancr eatiti
s.Rel i
efofsy mpt omsofacut er hi
nit
is.
Decr easesr igidityandt remor sassoci atedwi t
h
parkinsoni sm andcont r
olsr el
atedsi alorr
heaand
hyper hidrosis.Mayal sobeusedt omanage
antichol i
nesterasepoi soning.Managementofcy stit
isor
renal coli
c.Managementofsomef ormsofhear tblock
duet ov agal act i
v i
ty.I M:IV: Subcut:Facili
t ati
onof
diagnost ichy potoni cduodenogr aphy ;
mayal soi ncrease
radiologicv i
sibi l
i
t yoft heki dneys.Pr eoper ati
ve
admi nistrati
ondecr easessecr et
ionsandbl ocks
brady cardiaassoci atedwi thsomef ormsofanest hesia
andr elatedsur gical agents.

ACTI
ON
Inhibit
st hemuscarini
cef f
ectofacetylcholi
nei nsmoot h
muscl e,secretor
yglandsandt heCNS.Smal ldoses
decr easesali
varyandbr onchi
alsecreti
onsanddecr ease
sweat ing;i
ntermedi
atedosesdi l
atethepupi l
,inhibi
t
accommodat i
on,i
ncreaseheartrat
e( vagolyt
icact i
on);
l
ar gedosesdecr easeGIandGUmot il
i
ty,furt
herincrease
i
ndosedecr easesgast r
icacidsecreti
on.Ther apeuti
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1939
Ef
fect
s:Decr
easedsecret
ionswi
thdecr
easedGIandGU
sy
mptomatology
.Incr
easedhear
trat
e.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Angl
e-cl
osur
e
glaucoma; Tachy cardiaorunst abl
ecardiovascularst
atus;
GIobst ructivedisease, paral
yticil
eus,i
ntesti
nalatony,
sev ereul cerativecolit
is;Obstructi
veuropathy;My ast
henia
grav is;Lactation:Lact ati
on;Pedi:Productscontaini
ng
benzy lalcohol shouldnotbeusedi nnewbor nori mmature
i
nf ant s;Somepr oduct scontainalcohol,sul
fi
tes,or
tartrazineandshoul dbeav oidedinpatientswithknown
i
nt olerance/ hyper sensit
ivi
ty.

UseCaut
iousl
yin:
Hist
oryofcar
diov
ascul
ardi
sease
i
ncludingHF, ar
rhythmi as,hypertension, t
achycardia,or
coronaryar t
erydisease; Renal orhepat icimpairment ;
Prostatichyperplasia;Earlyi
leusorr efluxesophagi ti
s;
Automoni cneur opathy; Hypert
hy roi
dism; Geri:Appearson
Beersl i
st;↑ sensiti
v i
tytoant i
chol i
nergics;Pedi:Inf
ants,
small chil
dren,Down’ ssy ndrome, braindamage, orspasti
c
paral
y si
s( ↑ sensiti
v i
ty);OB:Maycausef etalt
achy cardi
a;
safet
ynotest abli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1940
CNS: conf usion/ excitement( especi al
lyinger iatr
ic
pat i
ent s),dizziness, fl
ushi ng, headache, i
nsomni a,
l
ight headedness( I
M, IV,subcut ),ner vousness.EENT:
blurredv ision, cycloplegia, ↑i ntraocul arpressur e,
my dr i
asis, phot ophobi a.CV: palpit at
ions, t
achy car di
a.GI:
drymout h,alteredt asteper cept i
on, bloatedf eeling,
const ipation, nausea, par alyti
ci leus, vomi t
ing.GU: erect
il
e
dysf unction, urinaryhesi tancy / r
et enti
on.Der m: ↓
sweat ing, urti
car ia.Local :local i
r ri
tati
on( IM, I
V, subcut )
.
Mi sc:al l
ergicr eactionsi ncludi nganaphy l
axis, f
ev er
(especi allyinchi ldren),suppr essi onofl actat
ion.

I
NTERACTI
ONS
Drug-Dr ug:Concurrentadministr
ationwi thamantadi
ne↑
anticholinergi
csideeffects(mayr equi r
edose↓) .↑
effectsofat enol
ol.Concurrentusewi thphenothi
azi
nes
mayr esultin↓ eff
ectofphenot hiazineand↑
anticholinergi
csideeffects(doser eductionmaybe
necessar y).↑ anti
choliner
gicsideef fectswit
h
tr
icyclicanti
depressants.

DOSAGE
PO:SL:
(Adul
ts)
:0.
125–0.25mg3–4t i
mesdailyor
0.
375–0.75mgassust
ainedr
eleasef
orm ev
ery12hr.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1941
PO:(Chi
ldr
en34–36kg)
:125–187mcgev
ery4hras
needed.
PO:(Chi
ldr
en22.
7–33kg)
:94–125mcgev
ery4hras
needed.
PO:
(Chi
l
dren13.
6–22.
6kg)
:63mcgev
ery4hrasneeded.
PO:
(Chi
l
dren9.
1–13.
5kg)
:31.
3mcgev
ery4hrasneeded.
PO:
(Chi
l
dren6.
8–9kg)
:25mcgev
ery4hrasneeded.
PO:
(Chi
l
dren4.
5–6.
7kg)
:18.
8mcgev
ery4hrasneeded.
PO:
(Chi
l
dren3.
4–4.
4kg)
:15.
6mcgev
ery4hrasneeded.
PO:
(Chi
l
dren2.
3–3.
3kg)
:12.
5mcgev
ery4hrasneeded.
IM:IV:Subcut( Adul ts):Gast
rointesti
nal
anti
cholinergic—0. 25–0.5mg3–4t i
mesdail
yasneeded;
preoperativ
epr ophy laxi
sofsecr eti
ons—0.5mgor0.005
mg/ kg30–60mi nbef oreanesthesia;
anti
arrhythmi c—0.125mgI Vrepeat edasneeded;
choli
nergicadj unct( cur
ari
form block)—0.
2mgf oreach1
mgofneost igmi ne.
IM:I
V:Subcut(Chi
l
dren≥2yr
):Pr
eoper
ativ
eprophylaxi
sof
secr
eti
ons—0.005mg/kg30–60minbeforeanest
hesia.

AVAI
LABI
LITY

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1942
Tablets0.125mg; Sublingual
tablets0.125mg; Orall
y-
disi
ntegrati
ngtablets(mint
)0.125mg; Ext
ended-
release
tabl
ets0.375mg; Soluti
on(dr
ops) (or
ange)0.125mg/ mL;
Eli
xi
r(orange)0.125mg/ 5mL; I
njecti
on0.5mg/ mL;

PATI
ENTTEACHI
NG
I
nstructpati
enttotakeexact
lyasdi
rected.Take
misseddosesassoonasr ememberedunlessalmost
t
imef ornextdose.Donotdoubledoses.

Maycausedr owsiness.Cautionpati
ent
stoavoi
d
driv
ingorotheracti
vi
tiesrequir
ingal
ert
nessunt
il
responsetomedicationisknown.

Inst
ructpat
ientthator
alri
nses,
sugar
lessgum or
candy ,
andfrequentor
alhygi
enemayhelprel
i
ev edr
y
mout h.

Cauti
onpatientsthathyoscyami
neimpai
rsheat
regul
ati
on.Strenuousacti
vit
yinahotenv
ironment
maycauseheatst roke.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

I
nfor
m mal
epat
ient
swi
thbeni
gnpr
ost
ati
c

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1943
 hyperpl
asi
athathyoscyaminemaycauseur i
nary
hesi
tancyandretent
ion.Changesinuri
nar
ystream
shoul
dber epor
tedtohealthcareprof
essi
onal.

I
bandr
onat
e
I
NDI
CATI
ONS
Tr
eat
ment
/pr
event
ionofpost
menopausal
ost
eopor
osi
s.

ACTI
ON
I
nhibit
sresorpt
ionofbonebyi nhibi
tingosteoclastact
ivi
ty.
Therapeut
icEffect
s:Reversal
/preventi
onofpr ogressi
on
ofosteoporosi
swithdecreasedf r
actures.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Abnor
mal
i
tiesoft
he
esophaguswhi chdelayesophageal
emptying(
i.
e.
str
ictur
es,achalasi
a);Uncor
rect
edhypocal
cemia;I
nabi
li
ty
tostand/si
tuprightforatl
east60min;CCr<30mL/min.

UseCaut
iousl
yin:
Hist
oryofupperGIdi
sor
der
s;
ConcurrentuseofNSAI Dsoraspiri
n;Invasiv
edental
procedures,cancer,
receivi
ngchemotherapyor
corti
costeroi
ds,poororalhygei
ne,peri
odontaldi
sease,
dentaldisease,anemia,coagul
opathy
, i
nfecti
on,
orpoorl
y-

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1944
fi
ttingdentures(may↑ r i
skofj awost eonecrosi
s);OB:
Useonl yifpotenti
albenefi
tout weighsriskstomot herand
fetus;Lactati
on:Lactat
ion;Pedi:Chil
dren<18y r(safety
notest abl
ished);
Geri:Considerager el
ated↓ inbody
mass, renalandhepat i
cfunction,concurrentdi
sease
statesanddr ugtherapy.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
GI:diar
rhea,dyspepsia,dysphagia,
esophageal cancer
,
esophagitis,
esophageal /
gastri
culcer.MS:
muscul oskel
etalpain,pai
ninarms/ legs,f
emurf r
actur
es,
osteonecrosis(pri
mar i
lyofjaw).Misc:inj
ect
ionsite
reacti
ons.

I
NTERACTI
ONS
Drug-Drug:Calci
um-,al
uminum-,magnesium-,andiron-
containingproduct
s,i
ncl
udingantaci
ds↓ absor pt
ion
(i
bandr onat
eshouldbetaken60mi nbefore)
.Concur r
ent
useofNSAI Dsincl
udi
ngaspir
in,
may↑ r iskofgastric
i
rri
tati
on.
Dr
ug-
Food:
Mil
kandot
herf
oods↓ absor
pti
on.

DOSAGE
PO:
(Adul
ts)
:2.
5mgoncedai
l
yor150mgoncemont
hly
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1945
I
V:(
Adul
ts)
:3mgev
ery3mo.

AVAI
LABI
LITY
Tabl
ets2.5mg,150mg;
Inj
ect
ion3mg/
3mLi
npr
efi
l
led
si
ngl
e-usesyr
inge;

PATI
ENTTEACHI
NG
Advisepati
enttoeatabal anceddi etandconsult
heal
t hcar
eprof essionalabouttheneedf or
supplementalcal ci
um andv i
taminD.Wai tatleast60
minaf t
eradmini str
ati
onbef oretakingsuppl
ement al
cal
cium andvitami nD.

Encouragepatientt
opart
ici
pateinr
egularexer
cise
andtomodi fybehavi
orst
hatincr
easetheriskof
osteoporosi
s(stopsmoki
ng,reduceal
cohol
consumpt i
on).

I
nform patientthatsev
eremusculoskel
etalpainmay
occurwi t
hinday s,
months,
ory raft
erstar
ti
ng
i
bandr onate.Symptomsmyr esolvecompletel
yaft
er
di
scont i
nuationorslowori
ncompl eter
esoluti
onmay
occur.Notifyhealt
hcarepr
ofessionali
fseverepai
n
occurs.

I
nst
ructpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1946
 swal
lowi
ngdif
ficul
ti
es,chestpai
n,neworworseni
ng
hear
tbur
n,ort
roubleorpainwhenswall
owingoccurs;
maybesignsofproblemsoftheesophagus.

Advi
sepati
enttoinfor
m heal
thcarepr
ofessi
onal
of
i
bandronat
etherapypri
ortodent
alsur
gery.

Advi
sefemalepati
enttonot
if
yhealthcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ng.

PO: Instructpat ientont hei mpor tanceoft akingas

dir
ect ed,firstthingi nthemor ning, 60mi nbef or e
othermedi cations, bever ages,orf ood.Ibandr onat e
shoul dbet akenwi t
h6–8ozpl ainwat er( mi neral
water ,orangej uice, coffee,andot herbev erages
decreaseabsor ption).Donotcheworsuckont ablet.
Ifadosei smi ssed, ski
pdoseandr esumet henext
mor ning; donotdoubl edosesort akel aterint heday .
Ifaonce- mont hlydosei smi ssedandt henext
schedul eddosei s>7day saway ,
takei nt hemor ning
fol
lowi ngt hedat eitisremember ed.Resumeor igi
nal
schedul et hef oll
owi ngmont h.Ifthenextdosei s<7
daysaway ,omi tdoseandt akenextschedul eddose.
Donotdi scont inuewi t
houtconsul ti
ngheal thcar e
professional .

Caut
ionpat
ientt
oremai
nupr
ightf
or60mi
nfol
l
owi
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1947
 dosetofaci
l
itat
epassagetost
omachandmi
nimi
ze
ri
skofesophageal
irr
it
ati
on.

IV:Advisepat i
entthatIVdosesshoul dnotbe
administeredsoonert hatev ery3mo.Ifadoseis
missed, havehealthcarepr ofessi
onaladmi
nist
eras
soonaspossi bl
e;nextinjectionshoul
dbescheduled
3mof rom l asti
njecti
on.

I
bupr
ofen
I
ndi
cat
ions
Painandinfl
ammat i
oninr heumaticdiseaseandot her
musculoskelet
aldisordersincludi
ngjuvenil
earthri
ti
s;mil
d
tomoderatepainincludingdy smenorrhoealpain,
headache;paininchil
dren; acutemigr
aineattack.

ACTI
ON
I
nhibit
sprostagl
andi
nsy
nthesi
s.Ther
apeut
icEf
fect
s:
Decreasedpainandi

Av
ail
abi
l
ity
TABLET200,
400and600mg;
CAPSULES400mgPl
ain,
300mgSRSUSPENSION100mg/
5ml .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1948
DOSAGE
Adult
-andChildover12years-ini
ti
all
y300to400mg3t o
4ti
mesdai ly
,incr
easeifnecessary(max.2.
4gdai
l
y),
maintenancedoseof0.6to1. 2gdail
ymaybeadequat
e.
I
nfantorChil
dover3months-5-
10mg/kg3to4
t
imes/day,Maxi
mum dai
lydose:40mg/kg/
day
.
Intr
avenousi
njecti
onandi nfusionNeonate-i
nit
ial
l
yby
i
ntravenousi
njecti
on(overat l
east5mi n)25-
100µg/kg
thenbyconti
nuousi nt
ravenousi nf
usion5-40µg/kg/h.
adjust
edaccordingtoresponse.
Child1-
6mont hs: i
nit
iall
ybyintravenousinject
ion(over
atl
east5mi n)100-200µg/ kgthenbycont i
nousinfusi
on
10-30µg/h.adjustedaccor di
ngt oresponse.6mont hs-12
years:i
nit
ial
lybyintr
av enousinjecti
on(overatl
east5mi n)
100-200µg/kg, adj
ustedaccor dingtoresponse.Juvenil
e
rheumatoidarthri
ti
s:20t o40mg/kg/ dayin3t o4divided
doses.

Cont
rai
ndi
cat
ions
Hyper sensi
ti
vity(
includingasthma;angioedema;urt
icari
a
orrhiniti
s)t
oacet ylsal
icyl
icacidoranyotherNSAID;acti
ve
pepti
cul cer
ation;fortreat
mentofpr e-
operati
vepaininthe
sett
ingofcor onaryar t
erybypassgraftsurger
y;neonates

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1949
wi
thcongeni
tal
hear
tdi
sease.

I
NTERACTI
ONS
Drug- Drug: Mayl i
mi tt hecar diopr otectiveef f
ect sofl ow-
doseaspi r
in.Concur rentusewi thaspi rinmay↓
effectivenessofi bupr ofen.Addi ti
veadv er seGIsi de
effectswi t
haspi r
in,or al pot assi um, otherNSAI Ds,
corticost eroids, oral cohol .Chr oni cusewi th
acetami nophenmay↑ r iskofadv erser enal r
eact i
ons.
May↓ ef f
ect i
v enessofdi uretics, ACEi nhibitors, orot her
antihyper tensiv es.May↑ hy pogl ycemi cef f
ect sofi nsul i
n
oror alhy pogl ycemi cagent s.May↑ ser um lithium l evels
andr iskoft oxici t
y.↑ r i
skoft oxi ci
tyf rom met hot rexat e.
Probeneci d↑ r iskoft oxi cityfrom i bupr of en.↑ r i
skof
bleedingwi thcef otet an, cef oper azone, cor t
icost eroids,
valproicaci d, thrombol y
t ics, war fari
n, anddr ugsaf fecting
plateletf unctioni ncl udingcl opi dogr el
, ticlopidine,
abciximab, ept ifi
bat i
de, ort i
r ofi
ban.↑ r iskofadv erse
hemat ologicr eact ionswi thant ineopl ast icsorr adi ation
therapy .↑ r iskofnephr ot oxicitywi thcy clospor ine.
Drug-
Natural
Product
:↑ bleedingr
iskwith,
arni
ca,
chamomile,f
ever
few,gar
li
c,ginger
,ginkgo,
Panaxginseng,
andother
s.

Pr
ecaut
ions
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1950
Renalandhepaticimpairmentprefer
abl
yav oidifhi
stor
yof
pepti
culcer
ati
on; cardi
acdisease;el
der
ly;pregnancy
l
actati
oncoagulationdefect
s;all
ergi
cdisorders;
i
nteract
ions

Adv
erseEf
fect
s
Gast r
oint estinal disturbancesi ncl udingnausea, diarrhoea,
dyspepsi a,gast rointestinal haemor rhage; hy persensi ti
vity
reactionsi ncl udi ngr ash, angioedema; bronchospasm;
headache; dizzi ness; nerv ousness; depr essi on;
drowsi ness; insomni a; verti
go; tinnitus; phot osensi ti
vity
;
haemat ur i
a;r enal f
ailure; f
luidret ention( rar ely,
precipitatingcongest ivehear tfai l
urei nel der ly)
,r aised
bloodpr essur e; r
arely,hepat i
cdamage; alv eolit
is,
pulmonar yeosi nophi l
ia;pancr eat iti
s;v i
sual distur bances;
erythemamul t i
for me( St evensJohnsonsy ndr ome) ;toxi
c
dermal necr oly sis( Lyell
'ssy ndr ome) ;coli
tis; asept i
c
meni ngitis.Ski nr eactionsl ikeder mat it
is.

PATI
ENTTEACHI
NG
Advisepati
ent
stotakeibupr
ofenwit
haf ul
lgl
assof
waterandtoremaininanupri
ghtposi
ti
onfor15–30
minafteradmini
str
ati
on.

I
nst
ructpat
ientt
otakemedi
cat
ionasdi
rect
ed.Take

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1951
 misseddosesassoonasr emember edbutnotif
al
mosttimefornextdose.Donotdoubl edoses.Pedi
:
Teachparent
sandcar egi
ver
stocalculateand
measuredosesaccuratel
yandtousemeasur ing
devi
cesuppli
edwithproduct
.

Maycausedr owsi
nessordizziness.Advi
sepati
entt
o
avoi
ddr i
vingorot
heracti
vit
iesrequir
ingal
ert
ness
unti
lresponsetomedicat
ionisknown.

Cautionpati
enttoavoi
dt heconcurr
entuseofal
cohol
,
aspir
in,acet
aminophen,andotherOTCorherbal
productswit
houtconsul
tinghealt
hcareprof
essi
onal.

Advi
sepatientt
oinf
orm heal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort ot
reat
mentorsurgery
.

I
nstructpati
entsnottotakeOTCi buprof
en
preparat
ionsformorethan10day sforpainormore
than3day sforfever
,andtoconsul thealt
hcare
professi
onalifsymptomspersistorwor sen.Many
OTCpr oductscontai
nibuprof
en; avoiddupli
cat
ion.

Caut
ionpati
entthatuseofibupr
ofenwith3ormor e
gl
assesofalcoholperdaymayincreasether
iskofGI
bl
eeding.

Adv i
sepati
enttoconsultheal
thcareprofessi
onali
f
rash,i
tchi
ng,vi
sualdi
sturbances,
tinni
tus,wei
ghtgai
n,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1952
 edema,epi
gast
r i
cpai n,dyspepsi
a,bl
ackst ool
s,
hematemasi
s,persistentheadache,orinf
luenza-
li
ke
syndr
ome(chil
ls,fever,muscleaches,pai
n)occurs.

Pedi:Advi
separentsorcaregi
ver
snottoadmi ni
ster
i
buprofentochil
drenwhomaybedehy dr
ated(can
occurwithvomiti
ng,di
arr
hea,orpoorfl
uidi
ntake);
dehydrat
ionincr
easesri
skofrenaldysf
unti
on.

Advi
sefemal
epatient
stonot
ifyheal
thcar
e
pr
ofessi
onal
ifpr
egnancyi
splannedorsuspect
ed

St
orage
St
orepr
otect
edf
rom l
i
ghtandmoi
stur
e.

I
but
il
ide
I
NDI
CATI
ONS
Rapidconversi
onofrecent-onsetatr
ialfl
utt
erorf
ibr
il
lat
ion
tonormalsinusrhyt
hm, i
ncludingmanagementofat r
ial
fl
utt
erorfibri
ll
ati
onoccurr
ingwi t
hin1wkofcor onar
y
art
erybypassorcardiacvalvesurger
y .

ACTI
ON
Act
ivat
essl
owi
nwar
dcur
rentofsodi
um i
ncar
diact
issue,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1953
resul
ti
ngindelayedrepol
ari
zat
ion, pr
olongedacti
on
potent
ialdur
ati
on,andincr
easedr efr
actori
ness.Mil
dly
slowssinusrat
eandAVconduct i
on.Therapeuti
cEffect
s:
Conversi
ontonor malsi
nusrhythm.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
HForl
eftv
ent
ri
cul
ardy
sfunct
ion(
↑
ri
skofmor eseri
ousar r
hyt
hmi asduri
ngi
nfusi
on)
;OB:
Lactat
ion:
Pedi:Pregnancy
,lactat
ion,
orchi
ldr
en<18y
r
(saf
etynotestabl
ished)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:
headache.CV:
arr
hyt
hmi
as.GI
:nausea.

I
NTERACTI
ONS
Drug-Dr ug:Amiodar one, di
sopyramide,procainami de,
quinidine,andsot alolshouldnotbegi venconcur rentlyor
within4hrbecauseofaddi tiv
eef f
ectsonr efractoriness.
Proarr hyt
hmi ceffectsmaybe↑ byphenot hiazines,
tr
icyclicandt et
racy cl
icanti
depressants,some
antihistamines,andhi stamineH2-receptorblocking
agent s;concurrentuseshoul dbeav oided.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1954
DOSAGE
At
ri
alFi
bri
l
lat
ion/
Flut
ter
IV:(
Adul
ts≥60kg):1mginfusi
on;
mayber
epeat
ed10mi
n
aft
erendoffi
rsti
nfusi
on.
I
V:(
Adult
s<60kg):0.
01mg/ kginf
usi
on;
mayber
epeat
ed
10minaf
terendoffi
rsti
nfusion.
At
ri
alFi
bri
l
lat
ion/
Flut
terAf
terCar
diacSur
ger
y
I
V:(
Adul
ts≥60kg)
:0.
5mgi
nfusi
on,
mayber
epeat
edonce.
I
V:(Adul
ts<60kg)
:0.
005mg/
kgi
nfusi
on,
maybe
r
epeatedonce.

AVAI
LABI
LITY
Sol
uti
onf
ori
nject
ion0.
1mg/
mL;

PATI
ENTTEACHI
NG
I
nfor
m pat
ientoft
hepur
poseofi
but
il
ide.

I
DARUBI
CIN
I
NDI
CATI
ONS
Acut
emy
elogenousl
eukemi
ainadul
ts(
wit
hot
heragent
s).

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1955
ACTI
ON
I
nhi
bit
snuclei
cacidsy
nthesis.Ther
apeut
icEff
ects:
Death
ofr
api
dlyr
epli
cat
ingcell
s,parti
cul
arl
ymali
gnantones.
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS

Cont
rai
ndi
cat
edi
n:OB:
Lact
ati
on:
Pregnancyorl
act
ati
on.

UseCaut
iousl
yin:
Pat
ient
swi
thchi
l
dbear
ingpot
ent
ial
;
Activeinfecti
on;↓ bonemar r
owr eserve;Otherchroni
c
debili
tati
ngill
nesses; Hepati
cimpairment( dose↓ maybe
required;avoi
difbili
rubin≥5mg/ dL);Renal i
mpairment;
Pre-exist
ingcardiacdisease;Previ
ousdaunor ubici
nor
doxorubicintherapy;Pedi:Saf
etynotest abl
ished;Geri
:↑
i
ncidenceofsi deef f
ectsandadv ersereactions.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: headache, ment alstatuschanges.Resp:
pul
monar yt oxi
city,
pul monar yal l
ergicreactions.CV:
ARRHYTHMI AS,CARDI OTOXI CITY, CHF.GI :
abdomi nal cramps, diarrhea,mucosi ti
s,nausea,
vomiting.Der m: al
opeci a,phot osensi t
ivi
ty,r
ashes.
Endo: gonadal suppr ession.Hemat : BLEEDING,
anemi a,leukopenia, t
hrombocy t
openi a.Local:
phl
ebit i
satI Vsi t
e.Met ab: hyperuricemi a.Neuro:
peri
pher alneur opathy.Mi sc:fever.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1956
I
NTERACTI
ONS
Drug-Drug:↑ myel
osuppr essi
onwithother
anti
neoplasti
csorradiat
iontherapy
.May↓ ant ibody
responsetoandincreaser i
skofadver
ser eact
ionsfr
om
l
ive-vi
rusvacci
nes.

DOSAGE
I
V:(Adult
s) :
12mg/
m2dai
l
yfor3day
sincombi
nat
ion
wi
thcytarabi
ne.

AVAI
LABI
LITY
Powderfori
nject
ion5mg/
vial
,10mg/
vial
;Sol
uti
onf
or
i
nject
ion1mg/ mL;

PATI
ENTTEACHI
NG
Instructpati
entt onot if
yheal thcar epr ofessi
onal
prompt lyi
ffev er ;
sor et hroat;signsofi nfecti
on;
bleedinggums; bruising; pet
echi ae;bloodi nstool
s,
urine,oremesi s; increasedf atigue; dyspnea;or
orthostati
chy pot ensionoccur s.Caut i
onpat i
entto
avoidcr owdsandper sonswi thknowni nfect
ions.
Instructpati
entt ousesof tt
oothbr ushandel ectri
c
razorandt oav oi df al
ls.Caut i
onpat ientnottodr i
nk
alcoholicbever agesort akemedi cati
oncont aini
ng

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1957
 aspiri
norNSAI
Ds,
ast
hesemaypr
eci
pit
ategast
ri
c
bleedi
ng.

I
nst
ructpat
ientt
orepor
tpai
nati
nject
ionsi
te
i
mmediatel
y.

Instr
uctpat i
enttoinspectoralmucosaf orerythema
andul ceration.I
fulcerati
onoccur s,advisepat i
entto
usespongebr ush,ri
nsemout hwi thwat eraftereating
anddr inking,andconf erwit
hheal thcarepr ofessional
i
fmout hpai ninter
fereswitheating.Furthercour ses
ofidarubi ci
nshouldbewi t
hheldunt i
lrecov er
yf r
om
mucosi tis,andsubsequentdosesshoul dbe
decreasedby25%.St omat i
ti
spai nmayr equi
re
treat
mentwi t
hopioidanalgesics.

I
nstr
uctpat
ienttonoti
fyheal
thcareprofessi
onal
i
mmediatel
yifir
regul
arheart
beat,
shortnessofbreat
h,
orswel
li
ngoflowerextremi
ti
esoccurs.

Advi
sepati
enttowearsunscreenandprotect
ive
cl
othi
ngtoprev
entphotosensit
ivi
tyr
eacti
ons.

Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

I
nstr
uctpat
ientnott
orecei
veanyvacci
nat
ions
wi
thoutadv
iceofhealt
hcar
eprofessi
onal
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1958
 I
nfor
m pat
ientt
hatur
inemayt
urnar
eddi
shcol
or.

Adv i
sepati
entthatthi
smedi cat
ionmayhave
terat
ogenicef
fects.Cont
raceptionshoul
dbe
practi
cedduri
ngandf oratleast4moaf t
ert
her
apyi
s
concluded.

Emphasi
zetheneedf
orper
iodi
clabt
est
stomoni
tor
forsi
deef
fect
s.

I
dur
sul
fase
I
NDI
CATI
ONS
Tr
eat
mentofMucopol
ysacchar
idosi
sII(
MPSI
I,
Hunt
er
sy
ndr
ome).

ACTI
ON
Replacesanenzy menotpresenti
nHunt ersyndrome.
Absenceoft heenzymeresult
sincell
ularaccumulati
onof
aminoglycans,or
ganomegalyandorgandy sfuncti
on.
Therapeuti
cEffects:
Impr
ov edwalki
ngcapaci t
y.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Noknowncont
rai
ndi
cat
ions.

UseCaut
iousl
yin:
Compr
omi
sedr
espi
rat
ory

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1959
funct
ion/acuterespi
ratorydi
sease( i
ncreasedriskof
i
nfusionreacti
ons);OB: Useinpregnancyonlyifclear
ly
needed;OB: Usecautiouslyi
nlactat
ion;Pedi:Safeusein
chil
dren<5y rnotestabli
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:headache,malaise.CV:hypert
ension.GI
:dyspepsi
a.
Der
m: cutaneousreacti
ons.Local:
infusi
onsit
eswel l
i
ng.
MS:arthr
algi
a.Misc:ANAPHYLACTOI DREACTI ONS,fev
er.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonenot
ed.

DOSAGE
I
V:(
Adul
ts)
:0.
5mg/
kgweekl
y.

AVAI
LABI
LITY
Sol
utionf
orI
Vinf
usi
on(
requi
resdi
l
uti
on2mg/
mLi
n3mL
vi
als;

PATI
ENTTEACHI
NG
Inf
orm pati
entthataHunterOutcomeSur
veywas
establ
i
shedt oevaluat
elongter
mt r
eat
ments.For
i
nformation,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1960
I
fosf
ami
de
I
NDI
CATI
ONS
Germ cel
ltesti
cularcar
cinoma(wit
hot heragent
s).Used
wit
hmesna, whichprev
entsif
osfamide-i
nduced
hemorrhagiccysti
ti
s.

ACTI
ON
Foll
owingconversiontoact i
vecompounds, i
nter
fer
eswith
DNAr epli
cat
ionandRNAt ranscri
pti
on,ult
imatel
y
disr
upti
ngproteinsynthesis(cel
l-
cycle
phase–nonspecifi
c).Therapeuti
cEffects:
Deathofrapi
dly
repl
icat
ingcell
s,parti
cul
arlymalignantones.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Lact
ati
on:
Pr
egnancyorl
act
ati
on.

UseCaut
iousl
yin:
Pat
ient
swi
thchi
l
dbear
ingpot
ent
ial
;
Act
iveinf
ecti
ons;Decreasedbonemar rowreserve;
Ger
i:
Ger
iatr
icpati
ent
s;Otherchronicdebil
it
ati
ngil
lness;
I
mpairedrenalf
uncti
on; Pedi
:Chil
dren.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1961
CNS: CNSt oxicity( somnol ence, confusion,hall
ucinations,
coma) ,cranial nerv edy sfunction,disori
entati
on, dizzi
ness.
CV: cardiotoxicity.GI :
nausea, vomi t
ing,anorexia,
constipation,diar r
hea, hepat otoxicit
y.GU: hemor rhagic
cystit
is,dysuria, steril
it
y ,
renal toxici
ty.Derm: al
opeci a.
Hemat :anemi a, l
eukopeni a,t
hr ombocy topenia.Local:
phlebiti
s.Mi sc: all
er gi
cr eactions.

I
NTERACTI
ONS
Drug-
Drug: ↑ myel
osuppressionwit
hot her
anti
neoplasti
csorradi
ati
ont her
apy.Toxici
tymaybe↑ by
al
lopuri
nolorphenobarbit
al.May↓ antibodyresponseto
and↑ riskofadversereacti
onsfrom l
ive-v
irusvacci
nes.

DOSAGE
Ot
herRegi
mensar
eUsed
I
V:(Adul
ts)
:1.2g/m2/dayf
or5day
s;coadmi
nist
erwi
th
mesna.Mayrepeatcy
cleq3wk.

AVAI
LABI
LITY
I
nject
ion1g/
vial
,3g/
vial
;I
ncombi
nat
ionwi
th:
Inaki
twi
th
mesna.

PATI
ENTTEACHI
NG

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1962
Emphasi zeneedforadequatefl
uidintakethroughout
therapy.Pati
entshouldvoi
dfrequentl
yt odecrease
bladderirr
it
ati
onfrom metaboli
tesexcretedbythe
kidneys.Notif
yhealthcar
eprofessi
onal i
mmedi atel
y
i
fhemat ur
iaisnoted.

I
nst
ructpati
enttodr
inkatl
east8gl
assesof
wat
er/dayduri
ngandfor3daysaft
ercompl
eti
onof
t
her
apy .

Instr
uctpat i
enttonot if
yheal t
hcareprofessional
prompt l
yiffever;chil
ls;cough; hoarseness;sore
throat;
signsofi nfect
ion; lowerbackorsi depain;
painfulordiffi
culturi
nation; bl
eedinggums; bruisi
ng;
petechiae;bloodinur i
ne, stool,oremesis;or
confusionoccur s.

Caut i
onpat i
enttoav oi
dcr owdsandper sonswi t
h
knowni nfecti
ons.Instructpati
enttousesof t
toothbrushandel ect
r i
crazorandtoav oidfal
ls.
Patientsshouldalsobecaut i
onednottodr i
nk
alcoholi
cbev er
agesort otakeproductscontaini
ng
aspiri
norNSAI Ds, asthesemaypr eci
pit
ateGI
hemor rhage.

Revi
ewwit
hpat
ientt
heneedf
orcont
racept
iondur
ing
ther
apy
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1963
 Discusswit
hpatientt
hepossi
bil
i
tyofhai
rloss.
Exploremethodsofcopi
ng.

Advi
sepat
ientt
oconsul
theal
thcar
eprof
essi
onal
bef
oret
aki
nganyRx,OTC,orher
balpr
oduct
s.

I
nstructpati
entnottorecei
veanyv accinations
wit
houtadv i
ceofhealt
hcar eprofessional;i
fosfami
de
maydecr easeanti
bodyresponset oandi ncreaseri
sk
ofadversereact
ionsfr
om li
v e-
vir
usv accines.

I
loper
idone
I
NDI
CATI
ONS
Schi
zophr
eni
a.

ACTI
ON
Mayactbyantagoni
zingdopamineandser
otoni
nint
he
CNS.Ther
apeuti
cEffects:
Decreasedsy
mptomsof
schi
zophr
eni
a.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Concur
rentuseof
dr
ugsknowntoprolongQTcint
erval
;Br
adycardi
a,recent
MIoruncompensat
edheartf
ail
ure(↑riskofseri
ous

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1964
arr
hythmias);Congenit
allongQTsy ndrome, QTcinterval
>500msecorhi storyofcardiacar
rhyt
hmi as;Hepatic
i
mpai r
ment ;Geri
:Elder
lypatient
swithdement ia-
rel
ated
psychoses(↑r iskofdeath,CVAorTI A);
Lact ati
on:
Breastf
eedingshouldbeav oided.

UseCaut
iousl
yin:
Knowncar
diov
ascul
ardi
sease
i
ncludi nghear tfailure,hi storyofMI /ischemi a, conduct i
on
abnor mal iti
es, cerebr ovascul ardisease, orot her
condi ti
onsknownt opr edi sposet ohy potensioni ncluding
dehy drat ion, hypov olemi a, concur rentant ihyper tensi ve
therapy( ↑r iskofor thost ati
chy pot ensi on);Elect rolyte
abnor mal iti
es, especi all
yhy pomagnesemi aor
hypokal emi a( correctpr i
ort other apy );Concur rentuseof
CYP3A4orCYP2D6i nhi bitors;
Known↓ WBCorhi storyof
drug-inducedl eukopeni a/ neutropeni a; Cir
cumst ancest hat
mayr esul tin↑ bodyt emper at
ur e, i
ncl udingst renuous
exercise, exposur et oext remeheat ,concur rent
antichol inergi cact i
v i
ty,ordehy dration( mayi mpai r
thermor egul ation); Patient satriskf oraspi r
ation; Ger i
:May
have↑ sensi tivi
tyandr i
skofadv erser eactions; OB:
Neonat esat↑ r iskf orext rapyrami dal sympt omsand
withdr awal af t
erdel iverywhenexposeddur ingt he3r d
tri
mest er; useonl yifpot ent i
almat ernal benef i
tj ustifi
es
potent ial fetalrisk; Pedi: Safetyandef fectiv
enessnot
established.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1965
ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: NEUROLEPTI CMALI GNANTSYNDROME, SUI CIDAL
THOUGHTS, di zzi
ness, drowsi ness, fatigue, agitati
on,
delusion, restlessness, extrapy ramidal disorders.EENT:
nasal congest ion.CV: orthost ati
chy pot ensi on,
tachy cardia,pal pi
tati
ons, QTci nterval prolongat ion.GI:dr
y
mout h, nausea, abdomi nal discomf or t,diarrhea.GU:
priapism, urinar yincontinence.Endo: hy perglycemi a,
hyper prolactinemi a.Neur o: t
ar divedy skinesi a.Met ab:
wei ghtgai n,wei ghtloss.MS: ↓ bonedensi ty ,
muscul oskelet alsti
ffness.

I
NTERACTI
ONS
Drug- Drug: Avoiduseofdr ugsknownt oprolongQTc
i
ncl udingt heant i
arrhy thmicsquinidi
ne,procainamide,
ami odar one,andsot alol;anti
psychoticsincludi
ng
chlorpromazi neandt hiori
dazine,the
antibioti
cmoxi fl
oxaci n, oranyot hermedi cati
onsknownt o
prolongt heQTci nter valincl
udingpent amidine,
l
ev omet hady l,
andmet hadone; concurrentusemayr esul
t
i
nser i
ous, li
fe-
threat eningar r
hy t
hmias.Concur rentuseof
strongCYP2D6i nhi bitorsincl
udingfluoxetineand
paroxet i
ne↑ l ev elsandt heriskoftoxici
ty;dose↓ i s
required.Concur rentuseofst rongCYP3A4i nhibi
tors

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1966
i
ncludi
ngketoconazol eandclarithromycin↑ lev
el sand
theri
skoftoxi
city;dosage↓ i srequired.Concurrentuse
ofanti
hyper
tensivesincludi
ngdi ureti
csmay↑ r iskof
ort
hostat
ichypotension.Concur r
entant i
choli
nergicsmay
↑r i
skofimpairedt hermoregulation.

DOSAGE
PO:(Adults):Init
iatet
reatmentwith1mgt wi
cedailyon
thefir
stday ,
then2mgt wicedail
ythesecondday ,then↑
by2mg/ dayev erydayuntil
atargetdoseof12–24
mg/ daygivenint wodivi
deddosesi sr eached;Concurr
ent
str
ongCYP2D6orCYP3A4i nhibi
tors—↓ doseby50%, if
i
nhibitori
swi t
hdr awn↑ doset opreviousamount .Re-
ti
tr
ationisrequiredifi
loperi
doneisdiscont i
nued>3day s;
Poormet aboli
zer s-
↓ doseby50%.

AVAI
LABI
LITY
Tabl
ets1mg,
2mg,
4mg,
6mg,
8mg,
10mg,
12mg;

PATI
ENTTEACHI
NG
I
nstr
uctpat
ienttotakemedi cat
ionexactl
yasdi
rect
ed.
Advi
sepati
entthatappearanceoftablet
sinst
oolis
nor
malandnotofconcer n.

I
nfor
m pat
ientoft
hepossi
bil
i
tyofext
rapy
rami
dal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1967
 sy
mpt
oms.Inst
ructpat
ientt
orepor
tthesesy
mpt
oms
i
mmedi
atel
ytohealt
hcareprof
essi
onal.

Advi
sepati
entt
ochangeposi
ti
onssl
owl
ytomi
nimi
ze
or
thost
ati
chypotensi
on.

Maycausedr owsiness.Cautionpati
entt
oavoid
driv
ingorotheracti
vi
tiesrequir
ingal
ert
nessunt
il
responsetomedicationisknown.

Extr
emesintemper
atur
eshouldalsobeav oi
ded;
thi
s
drugimpai
rsbodyt
emperat
ureregulat
ion.

I
nstructpat i
enttonotifyhealt
hcareprof essi
onal
pr
ompt lyifsorethroat,fever
,unusualbleedingor
br
uising,rash,tr
emor s,palpi
tat
ions,f
ainting,
menst r
ual abnormali
ties,gal
actorr
heaorsexual
dysf
unct i
onoccur .

Adv isepat ientandf amilytonot ifyhealthcare

prof essional i
fthoughtsaboutsui cideordy i
ng,
attempt st ocommi tsuicide;neworwor sedepr essi
on;
neworwor seanxiety;f
eel i
ngv eryagi t
atedorr estl
ess;
pani cattacks; tr
oublesleeping; neworwor se
i
rri
t abili
ty;acti
ngaggr essive;bei ngangr yorviolent;
actingondanger ousimpul ses; anext r
emei ncreasei n
activ i
tyandt alki
ng;otherunusual changesinbehav ior
ormoodoccur .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1968
 Caut
ionpati
entt
oavoidconcur
rentuseofal
cohol
andotherCNSdepr
essants.

Adv i
sepati
enttonot i
fyhealt
hcareprofessionalofal
l
RxorOTCmedi cations,
vitamins,
orherbalproducts
beingtakenandt oconsultwithheal
thcare
professi
onalbeforetaki
ngot hermedi
cations.

Advi
sepatientt
onot
if
yhealt
hcareprof
essi
onalof
medicat
ionregi
menbefor
etreat
mentorsur
gery
.

Advi
sefemalepati
entstonot
ifyheal
thcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
edor
i
fbreast
feedi
ngorplanni
ngtobreast
feed.

Emphasizetheneedf
orconti
nuedfol
low-
upf
or
psy
chotherapyandmoni
tori
ngforsi
deeff
ect
s.

I
lopr
ost
I
NDI
CATI
ONS
Pul
monar
yar
ter
ial
hyper
tensi
on(
WHOGr
oup1)
.

ACTI
ON
Di
lat
espulmonar
yandar t
eri
alvasculat
ure.Ther
apeut
ic
Ef
fect
s:I
mprovedexer
cisecapacity
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1969
CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Syst
oli
cBP<85mm
Hg;
Lact
ati
on:
Lact
ati
on.

UseCaut
iousl
yin:
Concur
rentuseofdr
ugsorcoexi
sti
ng
medi calcondit
ionsthatmay↑ riskofsy ncope;COPD,
asthma, oracutepulmonaryinf
ecti
on( may↑ r i
skof
bronchospasm) ;Hepatici
mpairment( mayneedt o↑
dosinginterval
);Pedi:
Safet
ynotestablished;OB:Useonl
y
i
fmat er
nalbenefitoutwei
ghsfetal
risk.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: dizzi
ness,fai nti
ng, headache, insomnia.EENT:
epist
axis.Resp: cough, bronchospasm, dyspnea,
hemopt ysis,wheezi ng.CV: HF, vasodi l
ati
on,chestpai
n,
hypotension,peripher aledema, supr aventr
icular
tachycardia.GI
:di arrhea, gi
ngivalbleeding,nausea,
vomiting.GU: r
enal f
ailure.Derm: facialfl
ushing.MS:back
pain,
jaw- musclespasm, muscl ecr amps.

I
NTERACTI
ONS
Dr
ug-Drug:↑riskofhypot
ensi
onwi
thothervasodi
lat
orsor
di
uret
ics.Ri
skofbleedi
ngmaybe↑ byanti
coagulant
s.

DOSAGE
ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1970
I
nhal
n:(
Adult
s):2.
5mcgini
ti
all
y,t
hen5mcg/
dose6–9
t
imesdai
ly
;notmoret
hanever
y2hr .
Hepat
icI
mpai
rment
I
nhaln:
(Adul
ts)
:Chi
l
dPughClassBorC-
Consi
der↑
dosi
ngint
erv
alt
oevery3–4hr
.

AVAI
LABI
LITY
Sol
uti
onf
ori
nhal
ati
on10mcg/
mLampul
es,
20mcg/
mL
ampul
es;

PATI
ENTTEACHI
NG
Instr
uctpatientinuseofilopr
ostandPr odoseADD
System orI-nebADDsy st
em, f
requency,ampule
dispensing,andcleaningofequipment.See
manuf acturer'
sinst
ructi
ons.Advisepati
entthat
i
nhalationinterval
sshouldnotbel esst
han2hr ,but
acutebenef it
sofmedi cati
onmaynotl ast2hr.

Maycausedizzi
nessandfai
nti
ngduetohypotensi
on.
Caut
ionpat
ienttochangeposi
ti
onssl
owlyto
mini
mizeor
thostat
ichypot
ensi
on.

I
mat
ini
b

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1971
I
NDI
CATI
ONS
Newl ydi agnosedPhi l
adel phi aposi tive( Ph+)chr onic
my eloidl eukemi a( CML) .CMLi nbl astcr i
sis, accel erated
phase, orinchr oni cphaseaf terf ai
lur eofi nt erfer on-
al pha
treat ment .Kit( CD117)posi t
ivemet astat i
c/ unr esectabl e
mal i
gnantgast rointest i
nal stomal tumor s( GI ST) .Adj uvant
treat mentf ollowi ngr esect ionofKi t( CD117)posi ti
veGI ST.
Pedi atri
cpat ient swi thPh+CMLaf t erfai l
ureofbone
mar rowt ranspl antorr esi stancet oi nter feron- alpha.Adul t
pat ient swi thr elapsedorr efract oryPh+acut e
l
y mphobl ast i
cl eukemi a(ALL) .
My elody spl ast i
c/my elyprol if
er ativedi sease( MDS/ MPD)
associ atedwi t hplatel et-
der i
vedgr owt hf actorr ecept or
(PDGFR)gener e-ar r
angement s.Aggr essi v
esy stemic
mast ocytosi s( ASM)wi thoutt heD816Vc- Kitmut ati
onor
wi thc- Kitmut ati
onal statusunknown.Hy per eosi nophi li
c
sy ndr omeand/ orchr oniceosi nophi li
cl eukemi a
(HES/ CEL) .Unr esect abl e, recur rent, ormet ast at i
c
der mat ofibrosar comapr otuber ans( DFSP) .

ACTI
ON
Inhi
bit
skinaseswhi chmaybepr oducedbymal i
gnantcel
l
l
ines.Therapeuti
cEf f
ects:
Inhi
bit
sproducti
onofmal i
gnant
cell
li
neswi thdecreasedprol
if
erat
ionofleukemiccel
lsin

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1972
CML,
HES/CEL,andALLandmal
i
gnantcel
l
sinGI
ST,
MDS/MPD,ASM,andDFSP.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
OB:
Pot
ent
ial
for
fetalhar
m;Lact
ation:Potenti
alf
orseri
ousadverse
reacti
onsinnur
singinfants;
breast
-f
eedingshouldbe
avoided.

UseCaut
iousl
yin:
Hepat
ici
mpai
rment(
dose↓
recommendedi fbil
i
rubin>3timesnormalorli
ver
transami nases>5t i
mesnor mal);Car
diacdi
sease(sever
e
HFandl eftventri
culardysf
uncti
onmayoccur )
;Pedi:
Children<3y r(safetynotestabl
i
shed);Geri
:↑riskof
edema.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: fat
igue,headache, weakness.Resp: cough, dyspnea,
epistaxis,nasophar yngitis,pneumoni a.GI:
HEPATOTOXI CITY, abdomi nalpain,anor exia,consti
pati
on,
diarrhea,dyspepsia, nausea, v
omi ti
ng.Der m: petechiae,
pruritus,ski
nr ash.FandE: edema( i
ncl udingpleural
effusion,pericardi
al infusion,anasar ca,superf i
cial
edema
andf luidretenti
on),hy pokal emia.Endo: ↓ growt h(i
n
children),hypothyroidism.Hemat : BLEEDI NG,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1973
NEUTROPENI A,THROMBOCYTOPENI
A.Met ab:weight
gai
n.MS: ar
thral
gia,
muscl
ecr
amps,musculoskeletal
pai
n,
myalgia.Mi
sc:TUMORLYSISSYNDROME,fever,night
sweats.

I
NTERACTI
ONS
Drug-Drug: Bloodl ev elsandef fectsar e↑ byconcur r
ent
useofpot entCYP3A4i nhibi t
ors(e.g.ketoconazol e,
i
traconazole, clarit
hr omy ci n,atazanav i
r,i
ndi navi
r,
nefazodone, nel f
inav ir,r
itonav ir,
saqui navor, t
eli
thromy ci
n,
orv ori
conazol e).Bl oodl ev elsandef fectsmaybe↓ by
potentCYP3A4i nducer s( e.g.,dexamet hasone, pheny t
oin,
carbamazepi ne, rifampi n, rif
abut i
n,andphenobar bit
al;
if
usedconcur r
ent ly,↑ doseofi mat ini
bby50%.↑ bl ood
l
ev elsofsimv ast atin.Imat inibinhibit
st hef oll
owi ng
enzy mesy stems: CYP2C9, CYP2D6, CYP3A4/ 5andmay
beexpect edt oal tert heef fectsofot herdr ugs
met aboli
zedbyt hesesy stems.
Drug-
Food:Bl
oodlevel
sandef
fect
sare↑ bygr
apef
rui
t
j
uice;
concurr
entuseshoul
dbeavoi
ded.

DOSAGE
Chr
oni
cMy
eloi
dLeukemi
a
PO:
(Adul
ts)
:Chr
oni
cphase—400mgoncedai
l
y,maybe

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1974
↑t o600mgoncedai l
y;accel
eratedphaseorbl
ast
cr
isi
s—600mgoncedai ly;maybe↑ t o800mg/daygi
ven
as400mgt wi
cedai
l
ybasedonr esponseand
ci
rcumstances.
PO:(Chil
dren):NewlydiagnosedPh+CML- 340
mg/m2/ day(nottoexceed600mg) ;CMLr ecur
rentaf
ter
fai
l
ureofbonemar r
owt ranspl
antorr
esi
stanceto
i
nterf
eron-al
pha—260mg/ m2/day.

Gast
roi
ntest
inal
Str
omal
Tumor
s
PO: (
Adult
s) :Metastat
icorunresect
able—400mg/ day
;
maybe↑ t o400mgt wicedai
l
yi fwell
tol
eratedand
responseinsuff
ici
ent;Adjuv
anttreat
mentafter
resect
ion—400mg/ day.
Ph+Acut
eLy
mphobl
ast
icLeukemi
a
PO:
(Adul
ts)
:600mg/
day
.
My
elody
spl
ast
ic/
Myel
opr
oli
fer
ati
veDi
seases
PO:
(Adul
ts)
:400mg/
day
.
Aggr
essi
veSy
stemi
cMast
ocy
tosi
s
PO:(Adul
ts):
400mg/ day.Forpati
ent
swit
h
eosi
nophi
li
a—100mg/ day;↑t o400mg/dayi
fwel
l
tol
erat
edandresponseinsuf
fi
cient
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1975
Hypereosi
nophi
l
icSy
ndr
omeand/
orChr
oni
cEosi
nophi
l
ic
Leukemia
PO:(
Adult
s):400mg/ day
.Forpat
ient
swi t
h
FI
P1L1–PDGFRafusi
onkinase100mg/ day
;incr
easeto
400mg/dayi
fwellt
olerat
edandresponseinsuf
fici
ent
.
Der
mat
ofi
brosar
comaPr
otuber
ans
PO:
(Adul
ts)
:800mg/
day
.
Hepat
icI
mpai
rment
PO:
(Adul
ts)
:↓ doseby25%i
nsev
erehepat
ici
mpai
rment
.
Renal
Impai
rment
PO:(Adult
s):CCr40–59mL/mi
n—Donotexceeddoseof
600mg/ day;CCr20–39mL/
min—↓ i
nit
ial
doseby50%;
↑ astoler
ated.

AVAI
LABI
LITY
Tabl
ets100mg,
400mg;

PATI
ENTTEACHI
NG
Expl
ainpur
poseofi
mat
ini
btopat
ient
.

Advi
sepat
ienttoav
oidgr
apef
rui
tandgr
apef
rui
tjui
ce
dur
ingt
her
apy .

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1976
 Advi
sefemalepati
enttonot
if
yhealthcar
e
pr
ofessi
onali
fpregnancyi
splannedorsuspect
ed;
avoi
dbreast
feedi
ng.

I
migl
ucer
ase
I
NDI
CATI
ONS
Tr
eat
mentofsy
mpt
omat
ict
ype1Gaucher
’sdi
sease.

ACTI
ON
Preventstheaccumul ati
onofgl ucocerebr
osidesincel
l
s.
Replacesglucocerebrosidasesthataredefici
entint
ype1
Gaucher’sdisease.Therapeut i
cEffect
s:Improvementi
n
sympt omsofGaucher ’
sdisease(anemi a,
thr
ombocy t
openia,bonedi sease,spl
enomegaly,and
hepatomegal y)
.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty.

UseCaut
iousl
yin:
Pregnancyorl
act
ati
on(
saf
etynot
est
abl
i
shed)
.

ADVERSEREACTI
ONSANDSI
DEEFFECTS

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1977
CNS:dizzi
ness,headache.CV:mildhypotensi
on.GI:
abdominaldi
scomf ort
,nausea.GU:decreaseduri
nary
fr
equency.Derm: pr
uri
tus,r
ash.Misc:anti
bodyproducti
on,
hyper
sensit
ivi
tyreacti
ons,f
ever.

I
NTERACTI
ONS
Dr
ug-
Drug:
Nonesi
gni
fi
cant
.

DOSAGE
IV:(
Adul
tsandChil
dren):Range2.
5uni
ts/kg3t
imes
weeklyt
o15–60units/kgq1–2wk.Evaluat
edosage
ever
y6mof orpossi
blereducti
on.

AVAI
LABI
LITY
I
nject
ion200uni
ts/
vial
;

PATI
ENTTEACHI
NG
I
nf or
m patientoft
hepur poseoft hi
smedicat
ionand
theimportanceoftreatmentatleastever
y4wk.
I
mi gl
ucerasehelpscontrolthesympt omsbutdoes
notcureGaucher ’
sdisease.Lif
elongther
apymaybe
requi
red.

Emphasi
zethei
mpor
tanceoff
oll
ow-
upexami
nat
ions
andl
abtest
s.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1978
I
mipenem/
cil
ast
ati
n
I
NDI
CATI
ONS
Treat
mentof :
Lowerrespir
atorytr
actinf
ections,
Urinar
y
tr
actinf
ect
ions,Abdominalinf
ecti
ons,Gynecologic
i
nfecti
ons,
Skinandskinstructur
einfect
ions,Boneand
j
ointi
nfect
ions,Bact
eremia,Endocar
diti
s,Polymicr
obic
i
nfecti
ons.

ACTI
ON
Imipenem bi ndst ot hebact eri
al cell wal l
,resultingincell
deat h.Combi nationwi thci lastatinpr ev entsrenal
i
nact ivati
onofi mi penem, r
esultingi nhi ghur i
nar y
concent r
ations.Imi penem r esistst heact i
onsofmany
enzy mest hatdegr ademostot herpeni cill
insandpeni cil
li
n
-l
ikeant i-
infectives.Ther apeuticEf f
ect s:Bact ericidal
actionagai nstsuscept i
bl ebact eria.Spect rum: Spect r
um
i
sbr oad.Act iveagai nstmostgr am- posi t
iveaer obi ccocci
:
Streptococcuspneumoni ae,GroupAbet a-hemol yti
c
streptococci ,Enter ococcus, Staphy lococcusaur eus.
Act i
veagai nstmanygr am- negat ivebaci l
laryor ganisms:
Escher ichiacol i
,Kl ebsi ella,Acinet obact er,Prot eus,
Ser r
atia,Pseudomonasaer ugi
nosa.Al sodi splay sacti
vit
y
against :Salmonel l
a, Shigella,Nei sser i
agonor rhoeae,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1979
Numer
ousanaer
obes.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
mayoccurwi
thpeni
cil
l
insandcephal
ospor
ins.

UseCaut
iousl
yin:
Prev
ioushi
stor
yofmul
ti
ple
hypersensiti
vit
yreacti
ons;Sei
zuredisorder
s;Renal
i
mpai rment( dose↓ requir
edifCCr≤70mL/ min/
1.73m2)
;
OB: Lactat
ion:Pedi:Safet
ynotestabli
shed;Ger
i:Maybeat
↑r iskfortoxicreacti
onsduetoage-relat
ed↑ inrenal
functi
on.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: SEIZURES, di
zziness,somnolence.CV: hypotensi
on.
GI:PSEUDOMEMBRANOUSCOLI TI
S,diarrhea, nausea,
vomi t
ing.Derm: r
ash,pruri
tus,sweating,urti
car i
a.Hemat:
eosinophili
a.Local:
phlebit
isatIVsite.Mi sc:aller
gic
reacti
oni ncl
udinganaphy l
axis,f
ever
, superinfecti
on.

I
NTERACTI
ONS
Drug-
Drug:Donotadmixwithami nogly
cosides
(i
nacti
vat
ionmayoccur).Pr
obenecid↓ r enalexcreti
on
and↑ bloodlev
els.↑ r
iskofseizureswithganciclovi
ror
cycl
ospori
ne(avoi
dconcurrentuseofganciclovi
r).May↓

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1980
ser
um v
alpr
oat
elev
els(
↑ri
skofsei
zur
es)
.

DOSAGE
I
V:(Adul
ts):Mil
dinfect
ions—250–500mgq6hr
.
Moderat
einfect
ions—500mgq6–8hror1gq8hr .
Ser
iousi
nfecti
ons—500mgq6hrt o1gq6–8hr.
IV:(
Chi
ldr
en≥3mo[ non-
CNSinfect
ions]
):15–25mg/kgq
6hr;hi
gherdoseshavebeenusedinolderchil
drenwi
th
cyst
icf
ibrosi
s.
I
V:(
Chi
l
dren4wk–3mo)
:25mg/
kgq6hr
.
I
V:(
Chi
l
dren1–4wk)
:25mg/
kgq8hr
.
I
V:(
Chi
l
dren<1wk)
:25mg/
kgq12hr
.
I
M:(
Adul
ts)
:500–750mgq12hr
.
I
M:(
Chi
l
dren)
:10–15mg/
kgq6hr
.
Renal
Impai
rment
I
V: (Adult
s):Ifdosefornormalrenalfunct
ionis1g/day—
CCr41–70mL/ min—125–250mgq6–8hr ,CCr21–40
mL/ min—125–250mgq8–12hr ,CCr6–20
mL/ min—125–250mgq12hr ;i
fdosef ornormalrenal
functi
onis1.5g/ day—CCr41–70mL/ min—125–250mgq
6–8hr ,CCr21–40mL/ min—125–250mgq8–12hr ,CCr
6–20mL/ min—125–250mgq12hr ;ifdosefornormal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1981
renalfuncti
onis2g/ day—CCr41–70mL/ min—125–500
mgq6–8hr ,CCr21–40mL/ min—125–250mgq8–12hr ,
CCr6–20mL/ mi
n—125–250mgq12hr ;
ifdosefor
normal renalf
uncti
onis3g/ day—CCr41–70
mL/ min—250–500mgq6–8hr , CCr21–40
mL/ min—250–500mgq6–8hr , CCr6–20
mL/ min—250–500mgq12hr ;ifdosefornormalrenal
functi
oni s4g/day—CCr41–70mL/ min—250–750mgq
6–8hr ,CCr21–40mL/ min—250–500mgq6–8hr ,CCr
6–20mL/ min—250–250mgq12hr .

AVAI
LABI
LITY
Powderf orIVinj
ect
ion250mgi mipenem/250mg
cil
astat
in,500mgi mipenem/500mgci l
ast
ati
n;Powder
forIMinject
ion500mgi mipenem/500mgci l
ast
ati
n,750
mgi mipenem/ 750mgci l
ast
ati
n;

PATI
ENTTEACHI
NG
Adv i
sepat ienttoreportthesignsofsuperinfecti
on
(black,furryovergr
owt hont hetongue;vaginali
tchi
ng
ordi scharge;l
ooseorf oul-smell
ingstool
s)and
aller
gy .Consulthealt
hcar eprofessi
onalbef or
e
treatingwithantidi
arrheals.

Caut
ionpat
ientt
onot
if
yheal
thcar
epr
ofessi
onal
if

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1982
 feveranddiarr
heaoccur,especi
all
yifstoolcontai
ns
blood,pus,ormucus.Advisepati
entnottot r
eat
diarr
heawithoutconsul
ti
nghealthcarepr of
essi
onal.
Mayoccurupt osever
alweeksafterdisconti
nuati
on
ofmedi cat
ion.

I
mipr
ami
ne
I
NDI
CATI
ONS
Variousformsofdepr essi
on.Enuresisinchi
ldren.
UnlabeledUses: Adjunctinthemanagementofchr oni
c
pain,i
ncontinence( i
nadults),
vascularheadache
prophylaxi
s,clusterheadache,insomnia.

ACTI
ON
Potentiatestheeffectofserotoni
nandnor epinephri
ne.
Hassi gnifi
cantantichol
i
nergicpropert
ies.Therapeuti
c
Eff
ects: Anti
depressantacti
ont hatdevelopsslowlyover
severalweeks.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
ty;
Cross-
sensi
ti
vi
ty
wi
thotherant
idepressant
smayoccur;Angl
e-cl
osur
e
gl
aucoma;Hypersensit
ivi
tyt
otar
trazi
neorsulf
it
es(
in

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1983
somepreparat
ions)
;RecentMI,knownhi
stor
yofQTc
i
nter
val
prolongati
on,hear
tfai
l
ur e.

UseCaut
iousl
yin:
Pre-
exi
sti
ngcar
diov
ascul
ardi
sease;
Seizur esorhi storyofseizur edisorder;May↑ r i
skof
suicideat tempt /i
deat i
onespeci al
lyduringear l
ytreatment
ordoseadj ustment ;Lactation:Drugispr esentinbr east
milk;di scontinuei miprami neorbot t
lefeed; Pedi:Suicide
ri
skmaybegr eateri
nchi ldrenoradol escents.Saf etynot
establ i
shedi nchi ldr
en<6y r
;Geri:Moresuscept ibleto
adv erser eactions.Ger i
atricmal eswithpr ostat
ic
hyper plasiaar emor esuscept i
bletour i
naryretention.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: drowsi ness,fatigue,agit
at i
on,confusion,
hal
lucinations,insomni a.EENT: blur
redv i
sion,dryeyes.
CV:ARRHYTHMI AS, hypotension, ECGchanges.GI :
constipati
on, drymout h,nausea, paral
yti
cileus,weight
gai
n.GU: uri
nar yretention,↓l i
bido.Der m: photosensi
ti
vi
ty.
Endo: gynecomast i
a.Hemat :blooddy scrasias.

I
NTERACTI
ONS
Drug-Drug:Maycausehypotension,
tachycardi
a,and
potenti
all
yfat
alreact
ionswhenusedwi thMAOi nhi
bit
ors
(avoi
dconcurrentuse—discont
inue2wkpr iort
o

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1984
i
mi pr ami ne) .Concur rentusewi thSSRIant idepr essant s
mayr esul tin↑ t oxi cityandshoul dbeav oided( fl
uoxet ine
shoul dbest opped5wkbef ore).Concur rentusewi th
cl
oni dinemayr esul tinhy per tensiv ecr i
si sandshoul dbe
avoi ded.I mi pr ami nei smet abol izedi nt hel iverbyt he
cytochr omeP4502D6enzy meandi t
sact i
onmaybe
affect edbydr ugst hatcompet ef ormet abol ism byt his
enzy mei ncl udi ngot herantidepr essant s,phenot hiazines,
carbamazepi ne, cl ass1Cant iarrhy thmi cs( pr opaf enone,
fl
ecai nide) ;whenusedconcur rent ly,doser educt i
onofone
ortheot herorbot hmaybenecessar y.Concur rentuseof
otherdr ugst hati nhi bittheact i
vityoft heenzy me,
i
ncl udi ngci met idine, quinidine, ami odar one, andr it
onav ir
,
mayr esul tin↑ ef fect sofi mi prami ne.Concur rentuse
withl ev odopamayr esultindel ay ed/ ↓ absor ptionof
l
ev odopaorhy per tensi on.Bl oodl ev elsandef fect smaybe
↓ byr i
famy cins.↑ CNSdepr essi onwi thot herCNS
depr essant si ncl udi ngal cohol ,
ant ihistami nes, clonidine,
opioi ds, andsedat ive/ hypnot ics.Bar bi
t uratesmayal ter
bloodl ev elsandef fect s.Adr ener gicandant ichol inergic
si
deef fect smaybe↑ wi thot heragent shav ingt hese
proper ti
es.Phenot hi azinesorhor monal cont racept ives↑
l
ev elsandmaycauset oxi
city .Cigar ettesmoki ng( nicoti
ne)
may↑ met abol i
sm andal teref fect s.
Dr
ug-
Nat
ural
Product
:Concomi
tantuseofkav
a-kav
a,

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1985
val
eri
an,orchamomil
ecan↑ CNSdepr
essi
on.↑
ant
ichol
i
nergicef
fect
swit
hji
msonweedandscopol
i
a.

DOSAGE
PO:(
Adult
s):25–50mg3–4ti
mesdail
y(nott
oexceed
300mg/day)
;tot
aldai
l
ydosemaybegi
venatbedt
ime.
PO:(
Ger
iat
ri
cPat
ients):
25mgatbedt
imei
nit
ial
l
y,upt
o
100mg/
dayindi
videddoses.
PO:(
Chi
ldr
en>12yr
):Ant
idepr
essant
—25–50mg/
dayi
n
di
vi
deddoses(
nott
oexceed100mg/ day
).
PO:
(Childr
en6–12y
r):
Ant
idepr
essant
—10–30mg/
dayi
n
2di
videddoses.
PO: (
Chil
dren≥6y r
):Enur
esis—25mgoncedai
ly1hr
beforebedti
me; ↑ifnecessaryby25mgatweekl
y
i
nterval
sto50mgi nchil
dren<12yr,
upt
o75mgi n
chi
ldren>12y r
.

AVAI
LABI
LITY
Tabl
ets10mg,25mg,50mg,
75mg;
Capsul
es75mg,
100
mg,125mg,150mg;

PATI
ENTTEACHI
NG
I
nst
ructpat
ientt
otakemedi
cat
ionasdi
rect
ed.Take

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1986
 misseddosesassoonaspossi bl
eunl essalmost
ti
mef ornextdose;i
fr egimeni sasi ngledoseat
bedti
me, donottakeint hemor ningbecauseofsi de
eff
ects.Advi
sepat i
entt hatdrugef f
ectsmaynotbe
noti
cedforatleast2wk.Abr uptdiscont i
nuati
onmay
causenausea,vomiting, di
arr
hea, headache,trouble
sl
eepingwithvivi
ddreams, andi r
ri
tabili
ty.

Maycausedr owsinessandbl
ur r
edv i
sion.Cauti
on
pat
ienttoavoiddriv
ingandotheracti
viti
esrequi
ring
al
ertnessunt
ilresponsetodr
ugi sknown.

I
nst r
uctpatientt
onoti
fyheal
thcareprof
essionalif
visualchangesoccur
.Inf
orm pat
ientt
hatperiodi
c
glaucomat esti
ngmaybeneededdur i
nglong-ter
m
therapy.

Caut i
onpat ienttochangeposi ti
onssl owl yto
minimi zeor thostatichy potension. Advisepat i
ent,
fami l
y, andcar egiverst olookf orsui ci
dality
,
especi allyduringear l
yt herapyordosechanges.
Not i
fyheal t
hcar eprof essional i
mmedi atelyif
thought saboutsui cideordy i
ng, attemptst ocommi t
suicide, neworwor sedepr essionoranxi ety,agi
tat
ion
orrestlessness, pani cat t
acks, insomni a,newor
wor sei rr
itabil
it
y,aggr essiveness, act i
ngon
danger ousi mpul ses, mani a,orot herchangesi n

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1987
 moodorbehavi
orori
fsy
mpt
omsofser
otoni
n
sy
ndromeoccur.

Advi
sepat i
entt oavoi
dalcoholorot
herCNS
depressantdrugsduri
ngtherapyandforatleast3–7
daysaftertherapyhasbeendiscont
inued.

Instructpatientt onotif
yheal
thcareprof
essionalif
urinaryretention,dr ymout
h,orconsti
pat
ionpersists.
Sugar l
esscandyorgum maydi minishdrymouthand
ani ncreasei nfluidint
akeorbul
kmaypr event
const i
pation.Ifsy mptomspersi
st,dosereducti
onor
discont i
nuationmaybenecessar y
.Consulthealt
h
carepr ofessional ifdr
ymouthpersist
sformor ethan
2wk.

Cauti
onpat
ienttousesunscreenandprot
ecti
ve
cl
othi
ngtopreventphot
osensit
ivi
tyr
eacti
ons.

Al
ertpat
ientt
hatur
inemayt
urnbl
ue-
greeni
ncol
or.

Inform patientofneedt omonitordietar

yint
ake,
as
possi bl
eincreasei nappeti
temayl eadtoundesi
red
wei ghtgain.Infor
m patientt
hatincreasedamountsof
ribofl
avinint hedietmayber equir
ed;consul
thealt
h
carepr ofessional
.

Advi
sepatientt
onot
if
yheal
thcarepr
ofessi
onalof
medicat
ionregi
menpri
ort
otreat
mentorsurger
y.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1988
 Ther
apyfordepressi
onisusuall
yprolonged.
Emphasi
zetheimportanceoffoll
ow-upexamsto
eval
uat
eprogressandimprovecopingskill
s.

I
nstructfemalepati
entstonot
if
yhealt
hcare
pr
ofessionali
fpregnancyispl
annedorsuspect
ed,
or
i
fbreastfeedi
ng.

Pedi:I
nform parentsthatthesideeff
ectsmostli
kel
y
tooccurincludenervousness,insomnia,
unusual
ti
redness,andmi ldnauseaandv omiti
ng.Noti
fy
healt
hcarepr ofessi
onalifthesesymptomsbecome
pronounced.

Advi
separent
st okeepmedicat
ionoutofr
eachof
chi
l
drentopreventi
nadver
tentover
dose.

I
miqui
mod
I
NDI
CATI
ONS
Externalgenit
alorperianalwart
s/condyl
omat a
(condy l
omaacumi natum) .Ty
pical
,nonhyperker
atot
ic,
nonhy pert
rophi
cactinickerat
osesont hefaceorscalp.
Biopsy -
confi
rmed,primarysuperfi
cial
basalcell
carcinoma
(Aldaraonly)
.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1989
ACTI
ON
Mayi nducet hef or
mat i
onofinterf
eronst hathave
anti
prol i
fer
ativ
eandant i
vi
ralpr
operties.Therapeut
ic
Eff
ect s:Regressionofexternalgeni
talorper i
anal
warts/ condyl
omat a,acti
nicker
atoses, orbasalcel
l
car
cinomal esions.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Noneknown.

UseCaut
iousl
yin:
Prev
ioust
reat
ment
/sur
ger
yin
aff
ect edarea(areashouldbeheal edpri
ortouse);Pre-
exi
st i
nginfl
ammat oryskinl esi
ons( maybeexacerbat ed);
Immunocompr omisedpat ients(safet
ynotestabl
ished) ;
OB: Lactat
ion:Pedi:
Pr egnancy ,
lactat
ion,
orchil
dren<12
yr(safetynotestabl
ished).

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS:dizzi
ness,fatigue,
headache.GI:di
arrhea,
nausea.
GU:dysuri
a,vulvarswelli
ng.Local
:i
rri
tat
ion,pai
n,pr
urit
us,
bur
ning,swell
ing,fungalinf
ecti
ons(women) .

I
NTERACTI
ONS
Dr
ug-
Drug:
Noneknown.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1990
DOSAGE
Ext
ernal
Geni
tal
War
ts
Topical:
(Adultsandchi l
dren≥12y r
):Aldara—Applythin
l
ayertowar tsatbedt i
meev eryotherday( 3t i
mesweekl y)
;
l
eaveonf or6–10hr ,t
henr i
nseoffwi t
hmi ldsoapand
water.Useunt i
llesi
onsar ecompletelyclearedorupt o16
wk.Zy cl
ara—Appl yt
hinlayerof3.75%cr eam t owart
sat
bedti
meev eryday;l
eaveonf or8hr ,t
henr inseoffwit
h
mil
dsoapandwat er.Useuntill
esionsar ecompletel
y
cl
earedorupt o8wk.

Act
ini
cKer
atoses
Topical:(
Adults):Al
dara—Appl ythinlayertoclean,dry
aff
ectedar eatwiceweekly;l
eav eonf or8hr, t
henr i
nseoff
withmi l
dsoapandwat er.Continuefor16wk.
Zyclar
a—Appl ythinl
ayerof2.5%or3. 75%cr eam toclean,
dryaffectedareaoncedai l
ybef orebedtime;leaveonf or8
hr,t
henr i
nseof fwit
hmi ldsoapandwat er.Continuefor2
wk,foll
owedby2wkwi thouttreatment,thenbegi n
applyi
ngcr eam agai
nforanot her2wk.
Super
fi
cial
Basal
Cel
lCar
cinoma
Topi
cal
:(Adul
ts)
:Appl
ythi
nlay
ert ocl
ean,dr
yaf f
ect
ed
ar
ea5timesperweek;
leav
eonf or8hr,t
henrinseof
fwit
h

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1991
mi
l
dsoapandwat
er.Cont
inuef
or6wk.

AVAI
LABI
LITY
Cr
eam 2.5%insingl
e-usepacket
sinboxesof28(Zyclar
a),
3.
75%insingl
e-usepacketsinboxesof28(Zy
clar
a),5%in
si
ngl
e-usepacketsi
nboxesof12( Aldar
a);

PATI
ENTTEACHI
NG
Inst
ructpatientonpr operappli
cati
ont echnique.
Emphasizet heimpor tanceofwashinghandsbef ore
andafterappl i
cati
onandav oidingcontactwi t
hey es.
Advisepatientnottousemor ecream thanwas
prescr
ibed.Mi sseddosesshoul dbeappl iedassoon
aspossible;thenreturntoregularschedule.

Advisepati
enttodel
aynextdoseforseveraldays
whenexper i
enci
ngdiscomfor
torseverereacti
ons.
Noti
f yheal
thcarepr
ofessi
onali
fsever
er eacti
ons
occur.

Advi
sepat
ientt
oav
oidshar
ingt
hismedi
cat
ionwi
th
ot
hers.

I
nstr
uctpati
enttoavoidcont
actwit
haffect
edar eas
whil
ethecream i
sont heski
n.Washcream offof
geni
talar
easbeforeengagi
nginsexualact
ivi
ti
es.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1992
 Inf
orm pat
ientt
hatoi
lsinthecr
eam weakenl
atex
contr
acept
ivedevi
ces,suchascer
vical
caps,
condoms,anddiaphr
agms.

Adv i
sepatientt
oavoi
duseofothertopical
medi cat
ionsonsametreat
mentareaunl ess
recommendedbyheal t
hcarepr
ofessional.

I
mmuneGl
obul
i
n
I
NDI
CATI
ONS
IM:Prov idespassi veimmuni t
ytoav ariet
yofi nfecti
ons
i
ncluding: Hepat i
ti
sA, Measl es( rubeol a)wheni mmune
seraar eunav ail
ableorwhent her ei sinsuffici
enttimef or
acti
vei mmuni zati
ontot akepl ace.I V:Usef ulinpatients
withimmunodef i
ciencysy ndromeswhoar eunabl et o
produceI gG-typeant i
bodi es.Prev entionofbact erial
i
nfectionsi npat i
entswithB- cellchr oniclymphocy ti
c
l
eukemi a(Gammagar dS/ Donl y).Prev enti
onofbact eri
al
i
nfectionsi nchi l
dreninfectedwi thHI V.Tr eatmentof
i
diopathict hrombocy topenicpur pur a( Cari
muneNF,
Gammagar dS/ D,andGamunex- C) .Treatmentof
Kawasaki syndrome( Iveegam ENandGammagar dSD) .
Treatmentofchr onicinflammat orydemy elinati
ng
polyneuropat hy(Gamunex—Conl y).Tr eatmentofpr i
mary

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1993
i
mmunedefici
ency(
Gamunex-Conl
y).Subcut
:Tr
eat
ment
ofpr
imar
yimmunedefi
ciency
.

ACTI
ON
Ahumanser um fracti
oncont aininggammagl obuli
n
anti
bodies( IgG).TherapeuticEf f
ects:Provisionofpassi
ve
i
mmuni tyagai nstmanyi nfect i
ons.Decr eased
consequencesofi diopat
hict hrombot ypenicpur pur
a.
Decreasedi ncidenceofcor onar yarter
ydamagei n
Kawasaki sy ndrome.Improv ementi nsympt omsof
chroni
cinflammat orydemy elinatingpolyneuropathy.

CONTRAI
NDI
CATI
ONSANDPRECAUTI
ONS
Cont
rai
ndi
cat
edi
n:Hy
per
sensi
ti
vi
tyt
oimmunegl
obul
i
ns
oraddi
tiv
es(maltose,t
himeri
sol
,gly
cine,
poly
ethy
lene
gl
ycol,
albumi
n);Select
iveI
gAdefici
ency;I
gEmediated
ant
ibodi
estoIgA.

UseCaut
iousl
yin:
Thr
ombocy
topeni
a(I
M use)
;
Cardiovasculardiseaseorhi stor
yofthromboti
cev ents(
↑
ri
skofv ascularocclusion);Renalimpair
ment,age>65y r
,
di
abet esmel l
itusvolumedepl eti
on,sepsi
s,
paraprotei
nemi aorconcucur r
entuseofnephrotoxi
c
agents(↑r iskofr enalfail
ure;usesl
owerinfusi
onr at
e);
Productscont aini
ngsucr ose(mayhav e↑ ri
skofr enal

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1994
fai
lure)
;Agammaglobulinemi
aor
hypogammagl obul
i
nemi a(↑r i
skofhypotensi
onand
anaphylaxi
sfoll
owi
ngr apidI
Vadmi ni
str
ation)
;OB:
Has
beenuseddur i
ngpregnancy,al
thoughsafetyi
snot
establi
shed.

ADVERSEREACTI
ONSANDSI
DEEFFECTS
CNS: asept icmeni ngiti
ssy ndrome, headache,
l
ightheadedness, mal ai
se.Resp: dyspnea, wheezing.CV:
THROMBOEMBOLI CEVENTS, chestpai n,vascular
occlusion.GI :nausea.GU: RENALFAI LURE, diuresi
s
(maltosecont aining-product s)
,nephr oti
csy ndrome.Der m:
cyanosi s,urti
car i
a.Local :atSubcutorI M sit
e—muscl e
sti
ffness, pain,tender ness, atIVsite—local i
nflammat i
on,
phlebit
is, ur
ticaria.MS: art
hr al
gia,backpai n,hi
ppai n.Misc:
all
ergicr eactionsi ncl
udi nganaphy l
axis,angioedema,
chil
ls,fev er
,sweat i
ng.

I
NTERACTI
ONS
Drug-
Drug: Mayinter
fer
ewiththeimmuner esponset
o
somel i
ve-
v i
rusvacci
nes,i
ncl
udingmeasles,mumps,and
rubel
l
av i
rusv acci
ne(donotadminist
erwit
hin3moof
i
mmunegl obuli
n).

DOSAGE

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1995
Pr
imar
yImmunodef
ici
encyDi
sor
der
Subcut( Adult
sandChildren):Doseisadmini
stered1wk
afterIGI
Vdose.Dosei sdet erminedbymulti
ply
ing
previousIGIVdoseby1. 37,thendivi
deint
oweekl ydoses
basedonf r
equencyofpr ev
ioust r
eatment
.Recommended
dosei s100–200mg/ kg/ wk.
I
V:(
Adul
tsandChi
l
dren)
:300–600mg(
3–6mL)
/kgq3–4
wk.
Hepat
it
isAPr
ophy
laxi
s(I
M)
I
M: (
AdultsandChildr
en)
:0.
02mL/kg(f
orpr
e-exposure
pr
ophylaxi
s,hi
gherdoses—0.
06mL/kgq4–6moar eused
i
fexposurewil
llast>3mo).
Measl
esPr
ophy
laxi
s(I
M)
I
M:(
Adult
sandChildr
en):
0.25mL/kg(
0.5mL/
kgi
f
i
mmunosuppr
essed;nott
oexceed15mL).
I
mmunogl
obul
i
nDef
ici
ency(
IM)
I
M:(Adul
tsandChi
l
dren)
:1.
3mL/
kgi
nit
ial
l
y,t
hen0.
66
mL/
kgq3–4wk.
Var
icel
l
a(I
M)
I
M:(
Adul
tsandChil
dren)
:0.6–1.
2mL/
kgi
fvar
icel
l
azost
er
i
mmunegl
obuli
nisunavai
labl
e.

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1996
Rubel
l
a(I
M)
I
M:(
Adul
tsandChi
l
dren)
:0.
55mL/
kg.
I
mmunodef
ici
ency(
IV)
I
V:(Adul
tsandChildr
en)
:200–800mg( 4–8mL)
/kg
monthl
y;i
fresponseisi
nadequat
e,maybegi
ventwi
ce
monthl
y.
I
diopat
hicThr
ombocy
topeni
cPur
pur
a
IV:(
Adult
sandChildren)
:0.
4g/ kg/dayf
or2–5day s;then
0.4g/kgsi
nglei
nfusionasneededt omaintainplat
elet
countof30,
000cells/mm3orpr ev
entbleeding;dosesup
to0.8–1.
0g/kgmaybeneeded.
I
V:(Adul
tsandChil
dren)
:Pri
vi
genandGamunex–C1g/
kg
dai
l
yfor2consecuti
vedaysforat
otal
of2g/kg.
Prev
ent
ionofBact
eri
alI
nfect
ionsi
nHI
V-I
nfect
edPat
ient
s,
orBcel
lCLL
I
V:(
Adul
tsandChi
l
dren)
:400mg/
kgq3–4wk.
Kawasaki
Syndr
ome
IV:(
Childr
en) :
400mg/kg/
dayfor4consecut
iveday
sor
1–2g/ kgsingl
edosegi
venwit
haspir
inther
apy;mustbe
star
tedwithin10day
sofonsetofsy
mpt oms.
Chr
oni
cInf
lammat
oryDemy
eli
nat
ingPol
yneur
opat
hy

ᏆᖴA2022 Dr
ugi
nHeal
thyCar
e 1997
I
V:(Adul
ts):2g/kgindi
vi
deddosesover2–4consecut
ive
daysi
nit
ial
l
y,then1g/kgadmi
nist
eredoveroneday(or
0.
5g/kgadmi ni
ster
edon2consecuti
vedays)q3wk.

AVAI
LABI
LITY
I
nject
ion(I
M)2- mL,10-mLv ial
s;Inj
ection(IV)5%sol ut
ion,
10%soluti
on,0.5-
g,1-g,
2.5-g,3-g,5-
g,6-g,10-g,
12-gv i
als;
I
nject
ion(Subcut)160mgI gG/ mLsingl eusev i