Rx – All 2 edited good

RETINITIS: CYTOMEGALOVIRUS (CMV)

Comment: cidofovir and valganciclovir are nucleoside analogues and prodrugs of ganciclovir indicated for the treatment of AIDS-related cytomegalovirus (CMV) retinitis and prevention of CMV disease in adult kidney, heart, and kidney-pancreas transplant patients at high risk, and for prevention of CMV disease in pediatric kidney and heart transplant patients at high risk.

• cidofovir (C) administer via IV infusion over 1 hour; pre-treat with oral probenecid (2 g, 3 hours prior to starting the cidofovir infusion and 1 g, 2 and 8 hours after the infusion is ended) and 1 liter  of IV NaCl should be infused immediately before each dose of cidofovir (a 2nd liter of NaCl should also be infused either during or after each dose of cidofovir if a fluid load is tolerable); Induction: 5 mg/kg once weekly for 2 consecutive weeks; Maintenance: 5 mg/kg once every 2 weeks; reduce to 3 mg/kg if serum Cr increases 0.3-0.4 mg/dL above baseline; discontinue if serum Cr increases to >0.5 mg/dL above baseline or if >3+ proteinuria develops
  Pediatric: not recommended
  Vistide Vial: 75 mg/ml (5 ml) (preservative-free)
  Comment: cidofovir is a nucleoside analogue indicated for treatment of AIDS related cytomegalovirus (CMV) retinitis.
• valganciclovir (C)(G) take with food; Induction: 900 mg bid x 21 days; Maintenance: 900 mg daily; CrCl <60 mL/min: reduce dose (see mfr pkg insert; hemodialysis or CrCl <10 mL/min not recommended (use ganciclovir)
  Pediatric: <4 months: not recommended; 4 months-16 years: see mfr pkg insert for dosing calculation equation
  Valcyte Tab: 450 mg (preservative-free); Oral pwdr for reconstitution: 50 mg/ml (tutti-frutti)

RHEUMATOID ARTHRITIS (RA)

Injectable Acetaminophen see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Topical/Transdermal NSAIDs see Pain page 307
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Topical Analgesic and Anesthetic Agents see page 499

TOPICAL ANALGESICS

• capsaicin (B)(G) apply tid-qid prn to intact skin
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Axsain Crm: 0.075% (1, 2 oz)
  Capsin Lotn: 0.025, 0.075% (59 ml)
  Capzasin-P (OTC) Crm: 0.025% (1.5 oz); Lotn: 0.025% (2 oz)
  Dolorac Crm: 0.025% (28 g)
  Double Cap (OTC) Crm: 0.05% (2 oz)
  R-Gel Gel: 0.025% (15, 30 g)
  Zostrix (OTC) Crm: 0.025% (0.7, 1.5, 3 oz)
  Zostrix HP (OTC) Emol crm: 0.075% (1, 2 oz)
• trolamine salicylate (NE)
  Mobisyl apply tid-qid
  Crm: 10%
  Comment: Provides some relief by 1-2 weeks; optimal benefit may take 4-6 weeks.

ORAL SALICYLATE

• indomethacin (C) initially 25 mg bid-tid, increase as needed at weekly intervals by 25-50 mg/day; max 200 mg/day
  Pediatric: <14 years: usually not recommended; >2 years, if risk warranted: 1-2 mg/kg/day in divided doses; max 3-4 mg/kg/day (or 150-200 mg/day, whichever is less; <14 years, ER cap not recommended
  Cap: 25, 50 mg; Susp; 25 mg/5 ml (pineapple-coconut, mint; alcohol 1%); Supp: 50 mg; ER Cap: 75 mg ext-rel
  Comment: indomethacin is indicated only for acute painful fl ares. Administer with food and/or antacids. Use lowest effective dose for shortest duration.

NSAID
See more Oral NSAIDs page 511

• diclofenac sodium (C)(G)
  Voltaren 50 mg bid-qid or 75 mg bid or 25 mg qid with an additional 25 mg at HS if necessary
  Tab: 25, 50, 75 mg ent-coat
  Voltaren XR 100 mg once daily; rarely, 100 mg bid may be used
  Tab: 100 mg ext-rel

NSAID PLUS PPI

• esomeprazole/naproxen (C)(G) 1 tab bid; use lowest effective dose for the shortest duration swallow whole; take at least 30 minutes before a meal
  Pediatric: <18 years: not recommended
  Vimovo Tab: nap 375 mg/eso 20 mg ext-rel; nap 500 mg/eso 20 mg ext-rel
  Comment: Vimovo is indicated to improve signs/symptoms, and risk of gastric ulcer in patients at risk of developing NSAID-associated gastric ulcer.

COX-2 INHIBITORS
Comment: Cox-2 inhibitors are contraindicated with history of asthma, urticaria, and allergic-type reactions to aspirin, other NSAIDs, and sulfonamides, 3rd trimester of pregnancy, and coronary artery bypass graft (CABG) surgery.

• celecoxib (C)(G) 50-400 mg once daily-bid; max 800 mg/day
  Pediatric: <18 years: not recommended
  Celebrex Cap: 50, 100, 200, 400 mg
• meloxicam (C)(G) initially 7.5 mg once daily; max 15 mg once daily
  Pediatric: <2 years: not recommended; =2 years: 0.125 mg/kg; max 7.5 mg once daily
  Mobic Tab: 7.5, 15 mg; Oral susp: 7.5 mg/5 ml (100 ml) (raspberry)
  Vivlodex Cap: 5, 10 mg

JANUS KINASE (JAK) INHIBITOR

• tofacitinib (C) 5 mg twice daily; reduce to 5 mg once daily for moderate-to-severe renal impairment or moderate hepatic impairment, concomitant potent CYP3A4 inhibitors, or drugs that result in both CYP3A4 and potent CYP2C19 inhibition
  Pediatric: not established
  Xeljanz Tab: 5 mg
  Xeljanz XR Tab: 11 mg ext-rel
  Comment: Xeljanz is indicated for moderate-to-severe RA as monotherapy in patients who have inadequate response or intolerance to methotrexate (MTX) and/or in combination with other non-biologic DMARDs.

DISEASE MODIFYING ANTI-RHEUMATIC DRUGS (DMARDs)
Comment: DMARDs are fi rst-line treatment options for RA. DMARDs include penicillamine, gold salts (auranofin, aurothio-glucose), immunosuppressants, and hydroxychloroquine. Th e DMARDs reduce ESR, reduce RF, and favorably affect the outcome of RA. Immunosuppressants may require 6 weeks to affect benefits and 6 months for full improvement.

• auranofin (gold salt) (C) 3 mg bid or 6 mg once daily; if inadequate response after 6 months, increase to 3 mg tid
  Pediatric: not recommended
  Ridaura Vial: 100 mg/20 ml
• azathioprine (D) 1 mg/kg/day in a single or divided doses; may increase by 0.5 mg/kg/day q 4 weeks; max 2.5 mg/kg/day; minimum trial to ascertain effectiveness is 12 weeks
  Pediatric: not recommended
  Azasan Tab 75*, 100*mg
  Imuran Tab 50*mg
• cyclosporine (immunosuppressant) (C) 1.25 mg/kg bid; may increase after 4 weeks by 0.5 mg/kg/day; then adjust at 2 week intervals; max 4 mg/kg/day; administer with meals
  Pediatric: not recommended
  Neoral Cap: 25, 100 mg (alcohol)
  Neoral Oral Solution Oral soln: 100 mg/ml (50 ml) may dilute in room temperature apple juice or orange juice (alcohol)
  Comment: Neoral is indicated for RA unresponsive to methotrexate (MTX).
• hydroxychloroquine (C) 400-600 mg/day
  Pediatric: not recommended
  Plaquenil Tab: 200 mg
  Comment: May require several weeks to achieve beneficial effects. If no improvement in 6 months, discontinue.
• leflunomide (X)(G) initially 100 mg once daily x 3 days; maintenance dose 20 mg once daily; max 20 mg daily
  Pediatric: <18 years: not recommended
  Arava Tab: 10, 20, 100 mg
  Comment: Arava is contraindicated with breastfeeding.
• methotrexate (X) 7.5 mg x 1 dose per week or 2.5 mg x 3 at 12 hour intervals once a week; max 20 mg/week; therapeutic response begins in 3-6 weeks; administer methotrexate injection SC only into the abdomen or thigh
  Pediatric: <2 years: not recommended; =2 years: 10 mg/m2 once weekly; max 20 mg/m2
  Rasuvo Autoinjector: 7.5 mg/0.15 ml, 10 mg/0.20 ml, 12.5 mg/0.25 ml, 15 mg/0.30 ml, 17.5 mg/0.35 ml, 20 mg/0.40 ml, 22.5 mg/0.45 ml, 25 mg/0.50 ml, 27.5 mg/0.55 ml, 30 mg/0.60 ml (solution concentration for SC injection is 50 mg/ml)
  Rheumatrex Tab: 2.5*mg (5, 7.5, 10, 12.5, 15 mg/week, 4/card unit-of-use dose pack)
  Trexall Tab: 5*, 7.5*, 10*, 15*mg (5, 7.5, 10, 12.5, 15 mg/week, 4/card unit-of use dose pack)
  Comment: methotrexate (MTX) is contraindicated with immunodeficiency, blood dyscrasias, alcoholism, and chronic liver disease.
• penicillamine (D) 125-250 mg once daily initially; may increase by 125-250 mg/day q 1-3 months; max 1.5 g/day
  Pediatric: not recommended
  Cuprimine Cap: 125, 250 mg
  Depen Tab: 250 mg
• sulfasalazine (C; D in 2nd, 3rd)(G) initially 0.5 g once daily bid; gradually increase every 4 days; usual maintenance 2-3 g/day in equally divided doses at regular intervals; max 4 g/day
  Pediatric: <6 years: not recommended; 6-16 years: initially 1/4 to 1/3 of maintenance dose; increase weekly; maintenance 30-50 mg/kg/day in 2 divided doses at regular intervals; max 2 g/day
  Azulfidine Tab: 500 mg
  Azulfidine EN Tab: 500 mg ent-coat

TUMOR NECROSIS FACTOR (TNF) BLOCKERS

• adalimumab (B) 40 mg SC once every other week; may increase to once weekly without methotrexate (MTX); administer in abdomen or thigh; rotate sites; 2-17 years, supervise fi rst dose
  Pediatric: <2 years, <10 kg: not recommended; 10-<15 kg: 10 mg every other week; 15-<30 kg: 20 mg every other week; =30 kg: 40 mg every other week
  Humira Prefilled syringe: 20 mg/0.4 ml; 40 mg/0.8 ml single-dose (2/pck; 2, 6/ starter pck) (preservative-free)
  Comment: Humira may use with methotrexate (MTX), DMARDs, corticosteroids, salicylates, NSAIDs, or analgesics.
• certolizumab pegol (B) 400 mg SC on day 1, at week 2, and at week 4; then 200 mg every other week; rotate sites
  Pediatric: not recommended
  Cimzia Vial: 200 mg single-dose w. supplies (2/pck, 2, 6/starter pck); Prefilled syringe: 200 mg single-dose w. supplies (2/pck, 2, 6/starter pck) (preservative-free)
• etanercept (B) 25 mg SC twice weekly, 72-96 hours apart or 50 mg SC weekly; rotate sites
  Pediatric: <4 years: not recommended; 4-17 years: 0.4 mg/kg SC twice weekly, 72-96 hours apart (max 25 mg/dose) or 0.8 mg/kg SC weekly (max 50 mg/dose)
  Enbrel Vial: 25 mg pwdr for SC injection after reconstitution (4/carton w. supplies) (preservative-free; diluent contains benzyl alcohol); Prefilled syringe: 50 mg/ml (preservative-free); SureClick autoinjector: 50 mg/ml (preservative-free)
  Comment: etanercept reduces pain, morning stiff ness, and swelling. May be administered in combination with methotrexate. Live vaccines should not be administered concurrently. Do not administer with active infection.
• golimumab (B) administer SC or IV infusion (in combination with methotrexate [MTX])
  Pediatric: <18 years: not established
  Simponi 50 mg SC once monthly; rotate sites
  Prefilled syringe, SmartJect autoinjector: 50 mg/0.5 ml, single-use ( preservative-free)
  Simponi Aria 2 mg/kg IV infusion week 0 and week 4; then every 8 weeks thereafter
  Vial: 50 mg/4 ml, single-use, soln for IV infusion after dilution (latex-free, preservative-free)
  Comment: corticosteroids, non-biologic DMARDs, and/or NSAIDs may be continued during treatment with golimumab.
• infliximab (B) administer SC or IV infusion (in combination with methotrexate [MTX]) administer by IV infusion over at least 2 hours; 3 mg/kg once weekly at weeks 0, 2, 6, and then every 8 weeks; may increase to 10 mg/kg or administer every 4 weeks
  Pediatric: <18 years: not established
  Remicade Vial: 100 mg pwdr for reconstitution and dilution; (preservative-free)
  Comment: Use infliximab concomitantly with methotrexate when there has been insufficient response to methotrexate alone.

Interleukin-1 Receptor Antagonist

• anakinra (interleukin-1 receptor antagonist) (B) 100 mg SC once daily; discard any unused portion
  Pediatric: not recommended
  Kineret Prefilled syringe: 100 mg/single-dose syringe (7, 28/pk) (preservative-free)

Interleukin-6 Receptor Antagonist

• tocilizumab (B) administer as an IV infusion over 60 minutes once every 4 weeks; initially 4 mg/kg; may increase to 8 mg/kg based on clinical response
  Pediatric: not recommended
  Actemra Vial: 80 mg/4 ml, 200 mg/10 ml, 400 mg/20 ml for IV infusion after dilution

Selective Costimulation Modulator

• abatacept (C) administer as an IV infusion over 30 minutes at weeks 0, 2, and 4; then every 4 weeks thereafter; <60 kg, administer 500 mg/ dose; 60-100 kg, administer 750 mg/dose; >100 kg, administer 1 g/dose; 60-100 kg, administer 750 mg/ dose; >100 kg, administer 1 g/dose
  Pediatric: <6 years: not recommended; 6-17 years: administer as an IV infusion over 30 minutes at weeks 0, 2, and 4; then every 4 weeks thereafter; <75 kg, administer 10 mg/kg; same as adult (max 1 g)
  Orencia Vial: 250 mg pwdr for IV infusion after reconstitution (silicone-free) (preservative-free); Prefilled syringe: 125 mg/ml soln for SC injection ( preservative-free); ClickJect Autoinjector: 125 mg/ml soln for SC injection

CD20 ANTIBODY

• rituximab (C) administer corticosteroid 30 minutes prior to each infusion; concomitant methotrexate therapy, administer a 1000 mg IV infusion at 0 and 2 weeks; then every 24 weeks or based on response, but not sooner than every 16 weeks.
  Pediatric: <6 years: not recommended; >6 years: same as adult
  Rituxan Vial: 10 mg/ml (10, 50 ml) (preservative-free)

INTRA-ARTICULAR INJECTION

• sodium hyaluronate 20 mg as intra-articular injection weekly x 5 weeks
  Pediatric: not recommended
  Hyalgan Prefilled syringe: 20 mg/2 ml
  Comment: Remove joint effusion and inject with lidocaine if possible before injecting Hyalgan.

RHINITIS/SINUSITIS: ALLERGIC

Oral Prescription Drugs for the Management of Allergy, Cough, and Cold Symptoms see page 535
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509

ALLERGEN EXTRACTS
Comment: Allergen extracts (Grastek, Oralair, Ragwitek) are not for immediate relief of allergic symptoms. Contraindicated with severe, unstable, and uncontrolled asthma, history of eosinophilic esophagitis, and severe local or systemic reaction. First dose under supervision HCP and observe =30 minutes. Subsequent doses may be taken at home.

• short ragweed pollen allergen extract (C) one SL tab once daily
  Pediatric: <18 years: not established
  Ragwitek SL tab: Amerosia artemisiifolia 12 amb a 1-unit (30, 90/blister pck)
  Comment: Initiate Ragwitek at least 12 weeks before onset of ragweed pollen season and continue throughout season.
• sweet vernal, orchard, perennial rye, timothy, Kentucky blue grass mixed pollen allergen extract (C) 300 IR once daily
  Pediatric: <10 years: not established; 10-17 years: Day 1: 100 IR; Day 2: 200 IR; Day 3 and thereafter: 300 IR once daily
  Oralair SL tab: 100, 300 IR (index of reactivity) (30/blister pck)
  Comment: Oralair is indicated for grass pollen-induced allergic rhinitis with or without conjunctivitis confirmed by positive skin test. Initiate Orlair at least 4 months before onset of grass pollen season and continue throughout season.
• timothy grass pollen allergen extract (C) one SL tab once daily
  Pediatric: <5 years: not established; =5 years: same as adult
  Grastek SL tab: 2800 bioequivalent allergy units (BAUS) (30/blister pck)
  Comment: Grastek is indicated for grass pollen-induced allergic rhinitis with or without conjunctivitis confirmed by positive skin test. Initiate Grastek at least 12 weeks before onset of grass pollen season and continue throughout season.

NASAL DECONGESTANT

• tetrahydrozoline (C)
  Tyzine 2-4 drops or 3-4 sprays in each nostril q 3-8 hours prn
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Nasal spray: 0.1% (15 ml); Nasal drops: 0.1% (30 ml)
  Tyzine Pediatric Nasal Drops 2-3 sprays or drops in each nostril q 3-6 hours prn
  Nasal drops: 0.05% (15 ml)

LEUKOTRIENE RECEPTOR ANTAGONISTS
Comment: For prophylaxis and chronic treatment only. Not for primary (rescue) treatment of acute asthma attack.

• montelukast (B)(G) 10 mg once daily in the PM; for EIB, take at least 2 hours before exercise; max 1 dose/day
  Pediatric: <12 months: not recommended; 12-23 months: one 4 mg granule pkt daily; 2-5 years: one 4 mg chew tab or granule pkt daily; 6-14 years: one 5 mg chew tab daily daily; >15 years: same as adult
  Singulair Tab: 10 mg
  Singulair Chewable Chew tab: 4, 5 mg (cherry, phenylalanine)
  Singulair Oral Granules: 4 mg/pkt; take within 15 minutes of opening pkt; may mix with applesauce, carrots, rice, or ice cream
• zafirlukast (B)(G) 20 mg bid, 1 hour ac or 2 hours pc
  Pediatric: <7 years: not recommended; 7-11 years: 10 mg bid 1 hour ac or 2 hours pc; >11 years: same as adult
  Accolate Tab: 10, 20 mg
• zileuton (C) 1 tab qid
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Zyflo Tab: 600 mg

NASAL CORTICOSTEROIDS

• beclomethasone dipropionate (C)
  Beconase 1 spray in each nostril bid-qid
  Pediatric: <6 years: not recommended; 6-12 years: 1 spray in each nostril tid; >12 years: same as adult
  Nasal spray: 42 mcg/actuation (6.7 g, 80 sprays; 16.8 g, 200 sprays)
  Beconase AQ 1-2 sprays in each nostril bid
  Pediatric: <6: not recommended; =6 years: same as adult
  Nasal spray: 42 mcg/actuation (25 g, 180 sprays)
  Beconase Inhalation Aerosol 1-2 sprays in each nostril bid to qid
  Pediatric: <6: not recommended; 6-12 years: 1 spray in each nostril tid; >12 years: same as adult
  Nasal spray: 42 mcg/actuation (6.7 g, 80 sprays; 16.8 g, 200 sprays)
  Vancenase AQ 1-2 sprays in each nostril bid
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Nasal spray: 84 mcg/actuation (25 g, 200 sprays)
  Vancenase AQ DS 1-2 sprays in each nostril once daily
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Nasal spray: 84, 168 mcg/actuation (19 g, 120 sprays)
  Vancenase Pockethaler 1 spray in each nostril bid or qid
  Pediatric: <6: not recommended; =6 years: 1 spray in each nostril tid
  Pockethaler: 42 mcg/actuation (7 g, 200 sprays)
  QNASL Nasal Aerosol 2 sprays, 80 mcg/spray, in each nostril once daily
  Pediatric: <12 years: 2 sprays, 40 mcg/spray, in each nostril once daily; =12 years: same as adult
  Nasal spray: 40 mcg/actuation (4.9 g, 60 sprays); 80 mcg/actuation (8.7 g, 120 sprays)
• budesonide (C)
  Rhinocort initially 2 sprays in each nostril bid in the AM and PM, or 4 sprays in each nostril in the AM; max 4 sprays each nostril/day; use lowest effective dose
  Pediatric: <6 years: not recommended; >6 years: same as adult
  Nasal spray: 32 mcg/actuation (7 g, 200 sprays)
  Rhinocort Aqua Nasal Spray initially 1 spray in each nostril once daily; max 4 sprays in each nostril once daily
  Pediatric: <6 years: not recommended; =6-12 years: initially 1 spray in each nostril once daily; max 2 sprays in each nostril once daily
  Nasal spray: 32 mcg/actuation (10 ml, 60 sprays)
• ciclesonide (C)
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Omnaris 2 sprays in each nostril once daily
  Nasal spray: 50 mcg/actuation (12.5 g, 120 sprays)
  Zetonna 1-2 sprays in each nostril once daily
  Nasal spray: 37 mcg/actuation (6.1 g, 60 sprays) (HFA)
• dexamethasone (C) 2 sprays in each nostril bid-tid; max 12 sprays/day; maintain at lowest effective dose
  Pediatric: <6 years: not recommended; =6-12 years: 1-2 sprays in each nostril bid; max 8 sprays/day; maintain at lowest effective dose; >12 years: same as adult
  Dexacort Turbinaire Nasal spray: 84 mcg/actuation (12.6 g, 170 sprays)
• fluticasone furoate (C) 2 sprays in each nostril once daily; may reduce to 1 spray each nostril once daily
  Pediatric: <2 years: not recommended; =2-11 years: 1 spray in each nostril once daily; =12 years: same as adult
  Veramyst Nasal spray: 27.5 mcg/actuation (10 g, 120 sprays) (alcohol-free)
• fluticasone propionate (C)(OTC)(G) initially 2 sprays in each nostril once daily or 1 spray bid; maintenance 1 spray once daily
  Pediatric: <4 years: not recommended; >4 years: initially 1 spray in each nostril once daily; may increase to 2 sprays in each nostril once daily; maintenance 1 spray in each nostril once daily; max 2 sprays in each nostril/day
  Flonase Nasal spray: 50 mcg/actuation (16 g, 120 sprays)
• flunisolide (C) 2 sprays in each nostril bid; may increase to 2 sprays in each nostril tid; max 8 sprays/nostril/day
  Pediatric: <6 years: not recommended; 6-14 years: initially 1 spray in each nostril tid or 2 sprays in each nostril bid; max 4 sprays/nostril/day; >14 years: same as adult
  Nasalide Nasal spray: 25 mcg/actuation (25 ml, 200 sprays)
  Nasarel Nasal spray: 25 mcg/actuation (25 ml, 200 sprays)
• mometasone furoate (C)(G) 2 sprays in each nostril once daily
  Pediatric: <2 years: not recommended; 2-11 years: 1 spray in each nostril once daily; max 2 sprays in each nostril once daily; >11 years: same as adult
  Nasonex Nasal spray: 50 mcg/actuation (17 g, 120 sprays)
• olopatadine (C) 2 sprays in each nostril bid
  Pediatric: <6 years: not recommended; 6-11 years: 1 spray each nostril bid; >11 years: same as adult
  Patanase Nasal spray: 0.6%; 665 mcg/actuation (30.5 g, 240 sprays) (benzalkonium chloride)
• triamcinolone acetonide (C)(G) initially 2 sprays in each nostril once daily; max 4 sprays in each nostril once daily or 2 sprays in each nostril bid or 1 spray in each nostril qid; maintain at lowest effective dose
  Pediatric: <6 years: not recommended; =6 years: 1 spray in each nostril once daily; max 2 sprays in each nostril once daily
  Nasacort Allergy 24HR (OTC) Nasal spray: 55 mcg/actuation (10 g, 120 sprays)
  Tri-Nasal Nasal spray: 50 mcg/actuation (15 ml, 120 sprays)

NASAL MAST CELL STABILIZERS

• cromolyn sodium (B)(OTC) 1 spray in each nostril tid-qid; max 6 sprays in each nostril/day
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Children’s NasalCrom, NasalCrom Nasal spray: 5.2 mg/spray (13 ml, 100 sprays; 26 ml, 200 sprays)
  Comment: Begin 1-2 weeks before exposure to known allergen. May take 2-4 weeks to achieve maximum effect.

NASAL ANTIHISTAMINES

• azelastine (C) 1 spray in each nostril bid
  Pediatric: <5 years: not recommended; =5-12 years: 1 spray in each nostril once daily bid; >12 years: same as adult
  Astelin Ready Spray 2 sprays in each nostril bid
  Nasal spray: 137 mcg/actuation (30 ml, 200sprays) (benzalkonium chloride)
  Astepro 0.15% Nasal Spray 1 or 2 sprays each nostril once daily bid
  Pediatric: not recommended
  Nasal spray: 205.5 mcg/actuation (17 ml, 106 sprays; 30 ml, 200 sprays) (benzalkonium chloride)

NASAL ANTIHISTAMINE/CORTICOSTEROID COMBINATION

• azelastine/fluticasone (C) 1 spray in each nostril bid
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Dymista Nasal spray: azel 137 mcg/fl utic 50 mcg per actuation (23 g, 120 sprays) (benzalkonium chloride)

NASAL ANTICHOLINERGICS

• ipratropium bromide (B)(G)
  Atrovent Nasal Spray 0.03% 2 sprays in each nostril bid-tid
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Nasal spray: 21 mcg/actuation (30 ml, 345 sprays)
  Atrovent Nasal Spray 0.06% 2 sprays in each nostril tid-qid; max 5-7 days
  Pediatric: <5 years: not recommended; =5-11 years: 2 sprays in each nostril tid; >11 years: same as adult
  Nasal spray: 42 mcg/actuation (15 ml, 165 sprays)
  Comment: Avoid use with narrow-angle glaucoma, prostate hyperplasia, and bladder neck obstruction.

RHINITIS MEDICAMENTOSA

Comment: Th e nasal/oral regimen selected should be instituted with concurrent weaning from the nasal decongestant.
Oral Prescription Drugs for the Management of Allergy, Cough, and Cold Symptoms see page 535
Nasal Corticosteroids see Allergic Rhinitis page 382
Oral Corticosteroids see page 509
Parenteral Corticosteroids see page 511

NASAL ANTICHOLINERGICS

• ipratropium bromide (B)(G)
  Atrovent Nasal Spray 0.03% stop nasal decongestant; 2 sprays in each nostril bid-tid with progressive weaning as tolerated
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Nasal spray: 21 mcg/actuation (30 ml, 345 sprays)
  Atrovent Nasal Spray 0.06% stop nasal decongestant; 2 sprays in each nostril tid-qid with progressive weaning as tolerated
  Pediatric: <5 years: not recommended; =5-11 years: 2 sprays in each nostril tid; =11 years: same as adult
  Nasal spray: 42 mcg/actuation (15 ml, 165 sprays)
  Comment: Avoid use with narrow-angle glaucoma, prostate hyperplasia, and bladder neck obstruction

NASAL ANTIHISTAMINE

• azelastine (C) 2 sprays in each nostril bid
  Pediatric: <5 years: not recommended; =5-12 years: 1 spray in each nostril bid
  Astelin Ready Spray
  Nasal spray: 137 mcg/actuation (30 ml, 200 sprays)

RHINITIS: VASOMOTOR

NASAL ANTICHOLINERGICS

• ipratropium bromide (B)(G)
  Atrovent Nasal Spray 0.03% stop nasal decongestant; 2 sprays in each nostril bid-tid with progressive weaning as tolerated
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Nasal spray: 21 mcg/actuation (30 ml, 345 sprays)
  Atrovent Nasal Spray 0.06% stop nasal decongestant; 2 sprays in each nostril tid-qid with progressive weaning as tolerated
  Pediatric: <5 years: not recommended; =5-11 years: 2 sprays in each nostril tid; >11 years: same as adult
  Nasal spray: 42 mcg/actuation (15 ml, 165 sprays)
  Comment: Avoid use with narrow-angle glaucoma, prostate hyperplasia, and bladder neck obstruction

ROSEOLA (EXANTHEM SUBITUM)

Antipyretics see Fever page 143

ROCKY MOUNTAIN SPOTTED FEVER (RICKETTSIA RICKETTSII )

ANTI-INFECTIVES

• doxycycline (D)(G) 200 mg on fi rst day; then 100 mg bid x 7-10 days
  Pediatric: <8 years: not recommended; =8 years, <100 lb: 2-2.5 mg/kg q 12 hours x 7-10 days; =8 years, >100 lb: same as adult
  Actilate Tab: 75, 150**mg
  Adoxa Tab: 50, 75, 100, 150 mg ent-coat
  Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
  Monodox Cap: 50, 75, 100 mg
  Oracea Cap: 40 mg del-rel
  Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple) (sulfites); Oral susp: 25 mg/5 ml (raspberry)
  Vibra-Tab Tab: 100 mg film-coat
  Comment: doxycycline contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photo-sensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• tetracycline (D)(G) 500 mg q 6 hours x 7-10 days
  Pediatric: <8 years: not recommended; =8 years, <100 lb: 10 mg/kg/day q 6 hours x 7-10 days; =8 years, >100 lb: same as adult
  Achromycin V Cap: 250, 500 mg
  Sumycin Tab: 250, 500 mg; Cap: 250, 500 mg; Oral susp: 125 mg/5 ml (100, 200 ml) (fruit) (sulfites)
  Comment: tetracycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photo-sensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.

ROTAVIRUS GASTROENTERITIS

PROPHYLAXIS
Comment: RotaTeq targets the most common strains of rotavirus (G1, G2, G3, G4), which are responsible for more than 90% of rotavirus disease in the United States.

• rotavirus vaccine, live not recommended for adults
  Pediatric: <6 weeks or >32 weeks: not recommended; >6 weeks and <32 weeks: administer 1st dose at 6-12 weeks of age; administer 2nd and 3rd doses at 4-10- week intervals for a total of 3 doses; if an incomplete dose is administered, do not administer a replacement dose, but continue with the remaining doses in the recommended series
  RotaTeq Oral susp: 2 ml single-use tube (fetal bovine serum [trace], preservativefree, thimerosal-free)

ROUNDWORM (ASCARIASIS)

ANTHELMINTICS

• albendazole (C) 400 mg once daily x 7 days; take with a meal
  Pediatric: <2 years: 200 mg once daily x 3 days; may repeat in 3 weeks; =2-12 years: 400 mg once daily x 3 days; may repeat in 3 weeks
  Albenza Tab: 200 mg
• mebendazole (C) chew, swallow, or mix with food; 100 mg bid x 3 days; may repeat in 3 weeks if needed; take with a meal
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Emverm Chew tab: 100 mg
  Vermox (G) Chew tab: 100 mg
• pyrantel pamoate (C) 11 mg/kg once daily x 3 days; max 1 g/dose; take with a meal
  Pediatric: 25-37 lb: 1/2 tsp x 1 dose; 38-62 lb: 1 tsp x 1 dose; 63-87 lb: 1 tsp x 1 dose; 88-112 lb: 2 tsp x 1 dose; 113-137 lb: 2 tsp x 1 dose; 138-162 lb: 3 tsp x 1 dose; 163-187 lb: 3 tsp x 1 dose; >187 lb: 4 tsp x 1 dose
  Pin-X (OTC) Cap: 180 mg; Liq: 50 mg/ml (30 ml); 144 mg/ml (30 ml); Oral susp: 50 mg/ml (30 ml)
• thiabendazole (C) 25 mg/kg bid x 7 days; max 1.5 g/dose; max 3000 mg/day; take with a meal
  Pediatric: same as adult
  Mintezol Chew tab: 500*mg (orange); Oral susp: 500 mg/5 ml (120 ml) (orange)
  Comment: thiabendazole is not for prophylaxis. May impair mental alertness.

RUBELLA (GERMAN MEASLES)

PROPHYLAXIS

• rubella virus, live, attenuated/neomycin vaccine (C)
  Pediatric: <12 months: not recommended (if vaccinated <12 months, revaccinate at 12 months); =12 months: 25 mcg SC
  Meruvax II 25 mcg SC
• measles, mumps, rubella, live, attenuated, neomycin vaccine (C)
  MMR II 25 mcg SC (preservative-free)
  Comment: Contraindications: hypersensitivity to neomycin or eggs, primary or acquired immune deficiency, immunosuppressant therapy, bone marrow or lymphatic malignancy, and pregnancy (within 3 months following vaccination). see Childhood Immunizations page 478

TREATMENT

• immune globulin (Ig) 0.25 ml/kg IM (0.5 mg/kg in immunocompromised children)
  Antipyretics see Fever page 143

RUBEOLA (RED MEASLES)

PROPHYLAXIS

• measles, mumps, rubella, live, attenuated, neomycin vaccine (C)
  MMR II 25 mcg SC (preservative-free)
  Comment: Contraindications: hypersensitivity to neomycin or eggs, primary or acquired immune deficiency, immunosuppressant therapy, bone marrow or lymphatic malignancy, and pregnancy (within 3 months following vaccination). see Childhood Immunizations page 478

TREATMENT

• immune globulin (Ig) 0.25 ml/kg IM (0.5 mg/kg in immunocompromised children)
  Antipyretics see Fever page 143

SALMONELLOSIS

• ciprofloxacin (C) 500 mg bid x 3-5 days
  Pediatric: <18 years: not recommended
  Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry)
  Cipro XR Tab: 500, 1000 mg ext-rel
  ProQuin XR Tab: 500 mg ext-rel
  Comment: ciprofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• trimethoprim/sulfamethoxazole (D)(G)
  Pediatric: <2 months: not recommended; =2 months: 40 mg/kg/day of sulfamethoxazole in 2 divided doses bid x 10 days; see page 587 for dose by weight
  Bactrim, Septra 2 tabs bid x 10 days
  Tab: trim 80 mg/sulfa 400 mg*
  Bactrim DS, Septra DS 1 tab bid x 10 days
  Tab: trim 160 mg/sulfa 800 mg*
  Bactrim Pediatric Suspension, Septra Pediatric Suspension
  Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
  Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not recommended

SCABIES (SARCOPTES SCABIEI )

Comment: Th is section presents treatment regimens for scabies infestation published in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines, as well as other available treatments.

RECOMMENDED REGIMEN

• permethrin (B)(G) massage into skin from head to soles of feet; leave on x 8-14 hours, then rinse off
  Pediatric: <2 months: not recommended; =2 months: same as adult
  Acticin, Elimite Crm: 5% (60 g)

ALTERNATIVE REGIMEN

• lindane (B)(G) 1 oz of lotion or 30 g of cream apply to all skin surfaces from neck down to the soles of the feet; leave on x 8 hours, then wash off thoroughly; may repeat if needed in 14 days
  Pediatric: <2 months: not recommended; =2 months: same as adult
  Kwell Lotn: 1% (60, 473 ml); Crm: 1% (60 g); Shampoo: 1% (60, 473 ml)

OTHER TOPICAL TREATMENTS

• crotamiton (C) massage into skin from chin down; repeat in 24 hours
  Pediatric: not recommended
  Eurax Lotn: 10% (60 g); Crm: 10% (60 g)

SCARLET FEVER (SCARLATINA)

Comment: Microorganism responsible for scarlet fever is Group A beta-hemolytic Streptococcus (GABHS). Strep cultures and screens will be positive.

• azithromycin (B) 500 mg x 1 dose on day 1, then 250 mg once daily on days 2-5 or 500 mg once daily x 3 days
  Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
  Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
  Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
  Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
  Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
• cefadroxil (B)
  Pediatric: 15-30 mg/kg/day in 2 divided doses x 10 days; see page 561 for dose by weight
  Duricef Cap: 500 mg; Tab: 1 g; Oral susp: 250 mg/5 ml (100 ml); 500 mg/5 ml (75, 100 ml) (orange-pineapple)
• cephalexin (B)(G)
  Pediatric: 25-50 mg/kg/day in 2 divided doses x 10 days; see page 568 for dose by weight
  Keflex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml) (strawberry)
• clarithromycin (C)(G) 250 mg bid or 500 mg ext-rel once daily x 10 days
  Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg bid x 10 days; see page 569 for dose by weight
  Biaxin Tab: 250, 500 mg
  Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit punch)
  Biaxin XL Tab: 500 mg ext-rel
• clindamycin (B)(G) 150-300 mg q 6 hours x 10 days
  Pediatric: 8-16 mg/kg/day in 3-4 divided doses x 10 days
  Cleocin Cap: 75 (tartrazine), 150 (tartrazine), 300 mg
  Cleocin Pediatric Granules Oral susp: 75 mg/5 ml (100 ml) (cherry)
• erythromycin estolate (B)(G) 250 mg q 6 hours x 10 days
  Pediatric: 20-50 mg/kg q 6 hours x 10 days; see page 573 for dose by weight
  Ilosone Pulvule: 250 mg; Tab: 500 mg; Liq: 125, 250 mg/5 ml (100 ml)
  Comment: erythromycin may increase INR with concomitant warfarin, as well as increase serum level of digoxin, benzodiazepines and statins.
• erythromycin ethylsuccinate (B)(G) 400 mg qid or 800 mg bid x 10 days
  Pediatric: 30-50 mg/kg/day in 4 divided doses x 10 days; may double dose with severe infection; max 100 mg/kg/day; see page 574 for dose by weight
  EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100, 200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab: 200 mg wafer (fruit)
  E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
  E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
  E.E.S. 400 Tablets Tab: 400 mg
  Comment: erythromycin may increase INR with concomitant warfarin, as well as increase serum level of digoxin, benzodiazepines and statins.
• penicillin G (benzathine and procaine) (B)(G) 2.4 million units IM x 1 dose
  Pediatric: <30 lb: 600,000 units IM x 1 dose; 30-60 lb: 900,000-1.2 million units IM x 1 dose
  Bicillin C-R Cartridge-needle unit: 600,000 units (1 ml); 1.2 million units; (2 ml); 2.4 million units (4 ml)
• penicillin V potassium (B) 250 mg tid x 10 days
  Pediatric: 25-50 mg/kg day in 4 divided doses x 10 days; =12 years: same as adult; see page 583 for dose by weight
  Pen-Vee K Tab: 250, 500 mg; Oral soln: 125 mg/5 ml (100, 200 ml); 250 mg/5 ml (100, 150, 200 ml)

SEIZURE DISORDER

Status Epilepticus see Status Epilepticus page 402
Anticonvulsant Drugs see page 520

SEXUAL ASSAULT (STD/STI/VD EXPOSURE)

Comment: Th e following treatment regimens for victims of sexual assault are published in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines.

RECOMMENDED PROPHYLAXIS REGIMEN

• ceftriaxone 250 mg IM in a single dose plus metronidazole 2 g in a single dose plus
  azithromycin 1 g in a single dose

ALTERNATE PROPHYLAXIS REGIMENS

Regimen 1

• ceftriaxone 250 mg IM in a single dose plus metronidazole 2 g in a single dose plus doxycycline 100 mg bid x 7 days

Regimen 2

• cefixime 400 mg in a single dose plus metronidazole 2 g in a single dose plus azithromycin 1 g in a single dose

Regimen 3

• cefixime 400 mg in a single dose plus metronidazole 2 g in a single dose plus doxycycline 100 mg bid x 7 days

Regimen 4

• azithromycin (B) 1 g as a single dose plus metronidazole 2 g in a single dose

DRUG BRANDS AND DOSE FORMS

• azithromycin (B)
  Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
  Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
  Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
  Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
• cefixime (B)
  Suprax Tab: 400 mg; Cap: 400 mg; Oral susp: 100, 200 mg/5 ml (50, 75, 100 ml) (strawberry)
• ceftriaxone (B)(G)
  Rocephin Vial: 250, 500 mg; 1, 2 g
• doxycycline (D)(G)
  Actilate Tab: 75, 150**mg
  Adoxa Tab: 50, 75, 100, 150 mg ent-coat
  Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
  Monodox Cap: 50, 75, 100 mg
  Oracea Cap: 40 mg del-rel
  Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple) (sulfites); Oral susp: 25 mg/5 ml (raspberry)
  Vibra-Tab Tab: 100 mg film-coat
  Comment: Doxycycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• metronidazole (not for use in 1st; B in 2nd, 3rd)(G)
  Flagyl Tab: 250*, 500*mg
  Flagyl 375 Cap: 375 mg
  Flagyl ER Tab: 750 mg ext-rel
  Comment: Alcohol is contraindicated during treatment with oral metronidazole and for 72 hours after therapy due to a possible disulfi ram-like reaction (nausea, vomiting, flushing, headache).

SHIGELLOSIS

ANTI-INFECTIVES

• azithromycin (B) 500 mg x 1 dose on day 1, then 250 mg once daily on days 2-5 or 500 mg once daily x 3 days or Zmax 2 g in a single dose
  Pediatric: <6 months: not recommended; >6 months: 10 mg/kg x 1 dose on day 1; then 5 mg/kg/day on days 2-5; max 500 mg/day; see page 559 for dose by weight
  Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
  Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
  Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
  Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
• ciprofloxacin (C) 500 mg bid x 3 days
  Pediatric: <18 years: not recommended
  Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry)
  Cipro XR Tab: 500, 1000 mg ext-rel
  ProQuin XR Tab: 500 mg ext-rel
  Comment: ciprofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• ofloxacin (C)(G) 400 mg bid x 3 days
  Pediatric: <18 years: not recommended
  Floxin Tab: 200, 300, 400 mg
  Comment: ofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• tetracycline (D)(G) 250-500 mg qid x 5 days
  Pediatric: <8 years: not recommended; =8 years, <100 lb: 25-50 mg/kg/day in 4 divided doses x 5 days; =8 years, >100 lb: same as adult; see page 585 for dose by weight
  Achromycin V Cap: 250, 500 mg
  Sumycin Tab: 250, 500 mg; Cap: 250, 500 mg; Oral susp: 125 mg/5 ml (100, 200 ml) (fruit) (sulfites)
  Comment: tetracycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photo-sensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• trimethoprim/sulfamethoxazole (D)(G)
  Bactrim, Septra 2 tabs bid x 10 days
  Tab: trim 80 mg/sulfa 400 mg*
  Bactrim DS, Septra DS 1 tab bid x 10 days
  Tab: trim 160 mg/sulfa 800 mg*
  Bactrim Pediatric Suspension, Septra Pediatric Suspension 20 ml bid x 10 days
  Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
  Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not recommended

SINUSITIS/RHINOSINUSITIS: ACUTE BACTERIAL (ABRS)

ANTI-INFECTIVES

• amoxicillin (B)(G) 500-875 mg bid or 250-500 mg tid x 10 days
  Pediatric: <40 kg (88 lb): 20-40 mg/kg/day in 3 divided doses x 10 days or 25-45 mg/kg/day in 2 divided doses x 10 days; see page 554 for dose by weight
  Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg (cherry-banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml (80, 100, 150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble gum); Oral drops: 50 mg/ml (30 ml) (bubble gum)
  Moxatag Tab: 775 mg ext-rel
  Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80, 100, 150 ml) (raspberry-strawberry)
• amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
  Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200, 400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana), 250 mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml) (orange) (phenylalanine)
  Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided bid x 10 days see pages 556-557 for dose by weight
  Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml) (strawberry cream) (phenylalanine) every 12 hours
  Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day in 2 divided doses; =40 kg: not recommended
  Augmentin XR 2 tabs q 12 hours x 7-10 days
  Pediatric: <16 years: use other forms; =16 years: same as adult
  Tab: 1000*mg ext-rel
• cefaclor (B)(G) 250-500 mg q 8 hours x 10 days; max 2 g/day
  Pediatric: <1 month: not recommended; 20-40 mg/kg bid or q 12 hours x 10 days; max 1 g/day; see page 560 for dose by weight
  Tab: 500 mg; Cap: 250, 500 mg; Susp: 125 mg/5 ml (75, 150 ml) (strawberry); 187 mg/5 ml (50, 100 ml) (strawberry); 250 mg/5 ml (75, 150 ml) (strawberry); 375 mg/5 ml (50, 100 ml) (strawberry)
  Pediatric: <16 years: ext-rel not recommended; =16 years: same as adult
  Cefaclor Extended Release Tab: 375, 500 mg ext-rel
• cefdinir (B) 300 mg bid or 600 mg once daily x 10 days
  Pediatric: <6 months: not recommended; 6 months-12 years: 14 mg/kg/day in a single or 2 divided doses x 10 days; 12 years: same as adult; see page 562 for dose by weight
  Omnicef Cap: 300 mg; Oral susp: 125 mg/5 ml (60, 100 ml) (strawberry)
• cefixime (B) 400 mg once daily x 10 days
  Pediatric: <6 months: not recommended; 6 months-12 years, <50 kg: 8 mg/kg/day in 1-2 divided doses x 10 days; >12 years, >50 kg: same as adult; see page 563 for dose by weight
  Suprax Tab: 400 mg; Cap: 400 mg; Oral susp: 100, 200 mg/5 ml (50, 75, 100 ml) (strawberry)
• cefpodoxime proxetil 200 mg bid x 10 days
  Pediatric: <2 months: not recommended; 2 months-12 years: 10 mg/kg/day (max 400 mg/dose) or 5 mg/kg/day bid (max 200 mg/dose) x 10 days; see page 564 for dose by weight
  Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 mg) (lemon creme)
• cefprozil (B) 250-500 mg bid x 10 days
  Pediatric: <6 months: not recommended; 6 months-12 years: Mild: 7.5 mg/kg bid x 10 days; Moderate/Severe: 15 mg/kg q 12 hours x 10 days; >12 years: same as adult; see page 565 for dose by weight
  Cefzil Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 75, 100 ml) (bubble gum) (phenylalanine)
• ceftibuten (B) 400 mg once daily x 10 days
  Pediatric: 9 mg/kg once daily x 10 days; max 400 mg/day; see page 566 for dose by weight
  Cedax Cap: 400 mg; Oral susp: 90 mg/5 ml (30, 60, 90, 120 ml); 180 mg/5 ml (30, 60, 120 ml) (cherry)
• cefuroxime axetil (B)(G) 250 mg bid x 10 days
  Pediatric: <3 months: not recommended; 3 months-12 years: 20-30 mg/kg/day in 2 divided doses x 10 days; >12 years: same as adult; see page 567 for dose by weight
  Ceftin Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 100 ml) (tutti-frutti)
• ciprofloxacin (C) 500 mg bid x 10 days
  Pediatric: <18 years: not recommended
  Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry)
  Cipro XR Tab: 500, 1000 mg ext-rel
  ProQuin XR Tab: 500 mg ext-rel
  Comment: ciprofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• clarithromycin (C)(G) 500 mg bid or 1000 mg ext-rel once daily x 10 days
  Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg bid x 10 days; see page 569 for dose by weight
  Biaxin Tab: 250, 500 mg
  Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit punch)
  Biaxin XL Tab: 500 mg ext-rel
• levofloxacin (C) Uncomplicated: 500 mg once daily x 10-14 days; Complicated: 750 mg once daily x 10-14 days
  Pediatric: <18 years: not recommended
  Levaquin Tab: 250, 500, 750 mg; Oral soln: 25 mg/ml (480 ml) (benzyl alcohol); Inj conc: 25 mg/ml for IV infusion after dilution (20, 30 ml single-use vial) (preservative-free); Premix soln: 5 mg/ml for IV infusion (50, 100, 150 ml) (preservative-free)
  Comment: levofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• loracarbef (B) 400 mg bid x 10 days
  Pediatric: 15 mg/kg/day in 2 divided doses x 10 days; see page 581 for dose by weight
  Lorabid Pulvule: 200, 400 mg; Oral susp: 100 mg/5 ml (50, 100 ml); 200 mg/5 ml (50, 75, 100 ml) (strawberry bubble gum)
• moxifloxacin (C)(G) 400 mg once daily x 10 days
  Pediatric: <18 years: not recommended
  Avelox Tab: 400 mg
  Comment: moxifloxacin is contraindicated <18 years of age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• trimethoprim/sulfamethoxazole (D)(G)
  Pediatric: <2 months: not recommended; =2 months: 40 mg/kg/day of sulfamethoxazole in 2 divided doses bid x 10 days; see page 587 for dose by weight
  Bactrim, Septra 2 tabs bid x 10 days
  Tab: trim 80 mg/sulfa 400 mg*
  Bactrim DS, Septra DS 1 tab bid x 10 days
  Tab: trim 160 mg/sulfa 800 mg*
  Bactrim Pediatric Suspension, Septra Pediatric Suspension
  Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
  Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not recommended

SJOGRENS, SYNDROME (CHRONIC DRY MOUTH)

CHOLINERGIC/MUSCARINIC AGONIST COMBINATION

• cevimeline (C)(G) 30 mg tid
  Evoxac Cap: 30 mg
  Comment: cevimeline is contraindicated in acute iritis, narrow angle glaucoma, and uncontrolled asthma.
• pilocarpine (C)(G) 5 mg qid or 7.5 mg tid
  Salagen Tab: 5, 7.5 mg

ORAL ENZYME RINSE

• xylitol/solazyme/selectobac (NE) swish 5 ml for 30 seconds bid-tid
  Orazyme Dry Mouth Rinse Oral soln: 1.5, 16 oz

SKIN: CALLOUSED

KERATOLYTICS

• salicylic acid (C)(OTC) apply lotion, cream or gel to affected area once daily-bid; apply patch to affected area and leave on x 48 hours with max 5 applications/14 days
  Pediatric: <12 years: not recommended; =12 years: same as adult
• urea (C)
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Carmol 40 apply to affected area with applicator stick provided once daily-tid; smooth over until cream is absorbed; protect surrounding tissue; may cover with adhesive bandage or gauze secured with adhesive tape
  Crm/Gel: 40% (30 g)
  Keratol 40 apply to affected area with applicator stick provided once daily-tid; smooth over until cream is absorbed; protect surrounding tissue; may cover with adhesive bandage or gauze secured with adhesive tape
  Crm: 40% (1, 3, 7 oz); Gel: 40% (15 ml); Lotn: 40% (8 oz)
  Comment: Th e moisturizing effect of Carmol 40 and Keratol 40 is enhanced by applying while the skin is still moist (after washing or bathing).

SKIN INFECTION: BACTERIAL (CARBUNCLE, FOLLICULITIS, FURUNCLE)

Comment: Abscesses usually require surgical incision and drainage.

ANTIBACTERIAL SKIN CLEANSERS

Dial soap (OTC) bid
Lever 2000 Antibacterial soap (OTC) bid

• hexachlorophene (C)
  pHisoHex dispense 5 ml into wet hand, work up into lather; then apply to area to be cleansed; rinse thoroughly
  Liq clnsr: 5, 16 oz

TOPICAL ANTI-INFECTIVES

• mupirocin (B)(G) apply to lesions bid
  Pediatric: same as adult
  Bactroban Oint: 2% (22 g); Crm: 2% (15, 30 g)
  Centany Oint: 2% (15, 30 g)
• polymyxin B/neomycin (C) oint apply once daily-tid
  Neosporin (OTC) Oint: 15 g

ORAL ANTI-INFECTIVES

• amoxicillin (B)(G) 500-875 mg bid or 250-500 mg tid x 10 days
  Pediatric: <40 kg (88 lb): 20-40 mg/kg/day in 3 divided doses x 10 days or 25-45 mg/kg/day in 2 divided doses x 10 days; see page 554 for dose by weight
  Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg (cherry-banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml (80, 100, 150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble gum); Oral drops: 50 mg/ml (30 ml) (bubble gum)
  Moxatag Tab: 775 mg ext-rel
  Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80, 100, 150 ml) (raspberry-strawberry)
• azithromycin (B) 500 mg x 1 dose on day 1, then 250 mg once daily on days 2-5 or 500 mg once daily x 3 days or Zmax 2 g in a single dose
  Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
  Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
  Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
  Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
  Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
• cefaclor (B)(G) 250-500 mg q 8 hours x 10 days; max 2 g/day
  Pediatric: <1 month: not recommended; 20-40 mg/kg bid or q 12 hours x 10 days; max 1 g/day; see page 560 for dose by weight
  Tab: 500 mg; Cap: 250, 500 mg; Susp: 125 mg/5 ml (75, 150 ml) (strawberry); 187 mg/5 ml (50, 100 ml) (strawberry); 250 mg/5 ml (75, 150 ml) (strawberry); 375 mg/5 ml (50, 100 ml) (strawberry)
  Cefaclor Extended Release
  Pediatric: <16 years: ext-rel not recommended
  Tab: 375, 500 mg ext-rel
• cefadroxil (B) 1-2 g in a single or 2 divided doses x 10 days
  Pediatric: 15-30 mg/kg/day in 2 divided doses x 10 days; see page 561 for dose by weight
  Duricef Cap: 500 mg; Tab: 1 g; Oral susp: 250 mg/5 ml (100 ml); 500 mg/5 ml (75, 100 ml) (orange-pineapple)
• cefdinir (B) 300 mg bid x 10 days
  Pediatric: <6 months: not recommended; 6 months-12 years: 14 mg/kg/day in 1-2 divided doses x 10 days; see page 562 for dose by weight
  Omnicef Cap: 300 mg; Oral susp: 125 mg/5 ml (60, 100 ml) (strawberry)
• cefditoren pivoxil (B) 200 mg bid x 10 days
  Pediatric: not recommended
  Spectracef Tab: 200 mg
  Comment: Contraindicated with milk protein allergy or carnitine deficiency.
• cefpodoxime (B) proxetil 400 mg bid x 7-14 days
  Pediatric: <2 months: not recommended; 2 months-12 years: 10 mg/kg/day (max 400 mg/dose) or 5 mg/kg/day bid (max 200 mg/dose) x 7-14 days; see page 564 for dose by weight
  Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 mg) (lemon creme)
• cefprozil (B) 250-500 mg bid or 500 mg once daily x 10 days
  Pediatric: 2-12 years: 7.5 mg/kg bid x 10 days; >12 years: same as adult; see page 565 for dose by weight
  Cefzil Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 75, 100 ml) (bubble gum) (phenylalanine)
• ceftriaxone (B)(G) 1-2 g IM once daily; max 4 g/day
  Rocephin
  Pediatric: 50-75 mg/kg IM in 1-2 divided doses; max 2 g/day
  Vial: 250, 500 mg; 1, 2 g
• cefuroxime axetil (B)(G) 250-500 mg bid x 10 days
  Pediatric: <3 months: not recommended; 3 months-12 years: 20-30 mg/kg/day in 2 divided doses x 10 days; >12 years: same as adult; see page 567 for dose by weight
  Ceftin Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 100 ml) (tutti-frutti)
• cephalexin (B)(G) 500 mg bid x 10 days
  Pediatric: 25-50 mg/kg/day in 4 divided doses x 10 days; see page 568 for dose by weight
  Keflex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml)(strawberry)
• clarithromycin (C)(G) 250-500 mg bid or 500-1000 mg ext-rel once daily x 7-14 days
  Pediatric: <6 months: not recommended; >6 months: 7.5 mg/kg bid x 7-14 days; see page 569 for dose by weight
  Biaxin Tab: 250, 500 mg
  Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit punch)
  Biaxin XL Tab: 500 mg ext-rel
• dicloxacillin (B) 500 mg qid x 10 days
  Pediatric: 12.5-25 mg/kg/day in 4 divided doses x 10 days; see page 571 for dose by weight
  Dynapen Cap: 125, 250, 500 mg; Oral susp: 62.5 mg/5 ml (80, 100, 200 ml)
• dirithromycin (C)(G) 500 mg once daily x 5-7 days
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Dynabac Tab: 250 mg
• doxycycline (D)(G) 100mg bid x 9 days
  Pediatric: <8 years: not recommended; =8 years, <100 lb: 1 mg/lb in a single dose once daily x 9 days x 9 days; =8 years, >100 lb: same as adult; see page 572 for dose by weight
  Actilate Tab: 75, 150**mg
  Adoxa Tab: 50, 75, 100, 150 mg ent-coat
  Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
  Monodox Cap: 50, 75, 100 mg
  Oracea Cap: 40 mg del-rel
  Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple) (sulfites); Oral susp: 25 mg/5 ml (raspberry)
  Vibra-Tab Tab: 100 mg film-coat
  Comment: Doxycycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• erythromycin base (B)(G) 250-500 mg tid x 10 days
  Pediatric: 30-50 mg/kg/day in 2-4 divided doses x 10 days
  Ery-Tab Tab: 250, 333, 500 mg ent-coat
  PCE Tab: 333, 500 mg
  Comment: erythromycin may increase INR with concomitant warfarin, as well as increase serum level of digoxin, benzodiazepines and statins.
• erythromycin estolate (B)(G) 250-500 mg q 6 hours x 10 days
  Pediatric: 20-50 mg/kg q 6 hours x 10 days; see page 573 for dose by weight
  Ilosone Pulvule: 250 mg; Tab: 500 mg; Liq: 125, 250 mg/5 ml (100 ml)
  Comment: erythromycin may increase INR with concomitant warfarin, as well as increase serum level of digoxin, benzodiazepines and statins.
• erythromycin ethylsuccinate (B)(G) 400 mg qid x 10 days
  Pediatric: 30-50 mg/kg/day in 4 divided doses x 10 days; may double dose with severe infection; max 100 mg/kg/day; see page 574 for dose by weight
  EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100, 200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab: 200 mg wafer (fruit)
  E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
  E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
  E.E.S. 400 Tablets Tab: 400 mg
  Comment: erythromycin may increase INR with concomitant warfarin, as well as increase serum level of digoxin, benzodiazepines and statins.
• gemifloxacin (C)(G) 320 mg once daily x 5-7 days
  Pediatric: <18 years: not recommended
  Factive Tab: 320*mg
  Comment: gemifloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• levofloxacin (C) Uncomplicated: 500 mg once daily x 7-10 days; Complicated: 750 mg once daily x 7-10 days
  Pediatric: <18 years: not recommended
  Levaquin Tab: 250, 500, 750 mg; Oral soln: 25 mg/ml (480 ml) (benzyl alcohol);
  Inj conc: 25 mg/ml for IV infusion after dilution (20, 30 ml single-use vial) (preservative-free); Premix soln: 5 mg/ml for IV infusion (50, 100, 150 ml) (preservative-free)
  Comment: levofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• linezolid (C)(G) 400-600 mg q 12 hours x 10-14 days
  Pediatric: <5 years: 10 mg/kg q 8 hours x 10-14 days; 5-11 years: 10 mg/kg q 12 hours x 10-14 days; >11 years: same as adult
  Zyvox Tab: 400, 600 mg; Oral susp: 100 mg/5 ml (150 ml) (orange) (phenylalanine)
  Comment: linezolid is indicated to treat susceptible vancomycin-resistant E. faecium infections.
• loracarbef (B) 200 mg bid x 7 days
  Pediatric: 15 mg/kg/day in 2 divided doses x 7 days; see page 581 for dose by weight
  Lorabid Pulvule: 200, 400 mg; Oral susp: 100 mg/5 ml (50, 100 ml); 200 mg/5 ml (50, 75, 100 ml) (strawberry bubble gum)
• minocycline (D)(G) 200 mg on fi rst day; then 100 mg q 12 hours x 9 more days
  Pediatric: <8 years: not recommended; =8 years, <100 lb: 2 mg/lb on fi rst day in 2 divided doses, followed by 1 mg/lb q 12 hours x 9 more days; =8 years, >100 lb: same as adult
  Dynacin Cap: 50, 100 mg
  Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (sulfites, alcohol 5%)
  Comment: minocycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• moxifloxacin (C)(G) 400 mg once daily x 10 days
  Pediatric: <18 years: not recommended
  Avelox Tab: 400 mg
  Comment: moxifloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• ofloxacin (C)(G) 400 mg bid x 10 days
  Pediatric: <18 years: not recommended
  Floxin Tab: 200, 300, 400 mg
  Comment: ofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• tetracycline (D)(G) 500 mg qid x 10 days
  Pediatric: <8 years: not recommended; =8 years, <100 lb: 25-50 mg/kg/day in 4 divided doses x 10 days; =8 years, >100 lb: same as adult; see page 585 for dose by weight
  Achromycin V Cap: 250, 500 mg
  Sumycin Tab: 250, 500 mg; Cap: 250, 500 mg; Oral susp: 125 mg/5 ml (100, 200 ml) (fruit) (sulfites)
  Comment: tetracycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.

SLEEP APNEA (HYPOPNEA SYNDROME)

ANTI-NARCOLEPTIC AGENTS

• armodafi nil (C)(IV)(G) OSAHS: 150-250 mg once daily in the AM; SWSD: 150 mg 1 hour before starting shift ; reduce dose with severe hepatic impairment
  Pediatric: <17 years: not recommended
  Nuvigil Tab: 50, 150, 200, 250 mg
• modafinil (C)(IV) 100-200 mg q AM; max 400 mg/day
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Provigil Tab: 100, 200*mg
  Comment: modafi nil promotes wakefulness in patients with excessive sleepiness due to obstructive sleep apnea/hypopnea syndrome.

SLEEPINESS: EXCESSIVE/SHIFT WORK SLEEP DISORDER (SWSD)

ANTI-NARCOLEPTIC AGENT

• armodafinil (C)(IV)(G) OSAHS: 150-250 mg once daily in the AM; SWSD: 150 mg 1 hour before starting shift ; reduce dose with severe hepatic impairment
  Pediatric: <17 years: not recommended
  Nuvigil Tab: 50, 150, 200, 250 mg
• modafinil (C)(IV) 100-200 mg q AM; max 400 mg/day
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Provigil Tab: 100, 200*mg
  Comment: Provigil promotes wakefulness in patients with narcolepsy, shift work sleep disorder, and excessive sleepiness due to obstructive sleep apnea/hypopnea syndrome.

SMALLPOX (VARIOLA MAJOR)

PROPHYLAXIS

• vaccina virus vaccine (dried, calf lymph type) (C)
  Pediatric: <12 months: not recommended; 12 months-18 years, non-emergency: not recommended
  DRYvax
  Kit: vial dried smallpox vaccine (1), 0.25 ml diluent in syringe (1), vented needle (1), 100 individually wrapped bifurcated needles (5 needles/strip, 20 strips) (polymyxin B sulfate, dihydrostreptomycin sulfate, chlortetracycline HCL, neomycin sulfate, glycerin, phenol)
  Comment: DRYvax is a dried live vaccine with approximately 100 million Infectious vaccina viruses (pock-forming units [pfu] per ml). Contact with immunosuppressed individuals should be avoided until the scab has separated from the skin (2 to 3 weeks) and/or a protective occlusive dressing covers the inoculation site. Scarifi cation only. Do not inject IV, IM, or SC. Revaccination is
  recommended every 10 years.

SPRAIN

Comment: RICE: Rest; Ice; Compression; Elevation.
Injectable Acetaminophen see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Topical/Transdermal NSAIDs see Pain page 307
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Topical Analgesic and Anesthetic Agents see page 499

STATUS ASTHMATICUS

Inhaled Beta-Agonists (Bronchodilators) see Asthma page 32
Oral Beta-Agonists (Bronchodilators) see Asthma page 35
Inhaled Anticholinergics see Asthma page 29
Inhaled Anticholinergic/Beta-Agonist Combination see Asthma page 33
Methylxanthines see Asthma page 36
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509

EPINEPHRINE

• epinephrine (C)(G) 0.3-0.5 mg (0.3-0.5 ml of a 1:1000 soln) SC q 20-30 minutes as needed up to 3 doses
  Pediatric: <2 years: 0.05-0.1 ml; 2-6 years: 0.1 ml; 6-12 years: 0.2 ml; All: q 20-30 minutes as needed up to 3 doses; >12 years: same as adult

ANAPHYLAXIS EMERGENCY TREATMENT KITS

• epinephrine (C) 0.3 ml IM or SC in thigh; may repeat if needed
  Pediatric: 0.01 mg/kg SC or IM in thigh; may repeat if needed; <15 kg: not recommended; 15-30 kg: 0.15 mg; >30 kg: same as adult
  AdrenaClick Auto-injector: 0.15, 0.3 mg (1 mg/ml; 2/carton) (sulfites)
  Auvi-Q Auto-injector: 0.15, 0.3 mg (1 mg/ml; 2/carton w. 1 nonactive training device) (sulfites)
  EpiPen Autoinjector 0.3 mg (epi 1:1000, 0.3 ml (2/carton) (sulfites)
  EpiPen Jr Autoinjector 0.15 mg (epi 1:2000, 0.3 ml (2/carton) (sulfites)
  Twinject Autoinjector: 0.15, 0.3 mg (epi 1:1000, 2/carton) (sulfites)
• epinephrine/chlorpheniramine (C) epinephrine 0.3 ml SC or IM plus 4 tabs chlorpheniramine by mouth
  Pediatric: infants-2 years: 0.05-0.1 ml SC or IM; 2-6 years: 0.15 ml SC or IM plus 1 tab chlor; 6-12 years: 0.2 ml SC or IM plus 2 tabs chlor; >12 years: same as adult
  Ana-Kit: 0.3 ml syringes of epi 1:1000 (2/carton) for self-injection plus chlor 2 mg chewable tabs x 4

STATUS EPILEPTICUS

Anticonvulsant Drugs see page 520

• diazepam injectable (D)(IV) initially 5-10 mg IV in large vein; may repeat q 10-15 minutes; max 30 mg; may repeat in 2-4 hours if needed; do not dilute; may give IM if IV not accessible
  Pediatric: 1 month-5 years: 0.2-0.5 mg IV q 2-5 minutes; max 5 mg; >5 years: 1 mg IV q 2-5 minutes; max 10 mg; may repeat in 2-4 hours if needed
  Diastat Rectal gel delivery system: 2.5 mg
  Diastat AcuDial Rectal gel delivery system: 10, 20 mg
  Valium Injectable Vial: 5 mg/ml (10 ml); Amp: 5 mg/ml (2 ml); Prefilled syringe: 5 mg/ml (5 ml)
  Valium Intensol Oral Solution Conc oral soln: 5 mg/ml (30 ml w. dropper) (alcohol 19%)
  Valium Oral Solution Oral soln: 5 mg/5 ml (500 ml) (wintergreen-spice)
• lorazepam injectable (D)(IV) 4 mg IV over 2 minutes (dilute fi rst); may repeat in 10-15 minutes; may give IM if needed (undiluted)
  Pediatric: <18 years: not recommended
  Ativan Injectable Vial: 2 mg/ml (1, 10 ml); Tubex: 2 mg/ml (0.5 ml); Cartridge: 2, 4 mg/ml (1 ml)
• phenytoin (injectable) (D)(G) 10-15 mg/kg IV, not to exceed 50 mg/minute; follow with 100 mg orally or IV q 6-8 hours; do not dilute in IV fluid
  Pediatric: 15-20 mg/kg IV, not to exceed 1-2 mg/kg/minute
  Dilantin Vial: 50 mg/ml (2, 5 ml); Amp: 50 mg/ml (2 ml)
  Comment: Monitor phenytoin serum levels. Therapeutic serum level: 10-20 g/ml.
  Side effects include gingival hyperplasia.

STYE (HORDEOLUM)

OPHTHALMIC ANTI-INFECTIVES

• erythromycin ophthalmic ointment (B) 1 cm up to 6 times/day
  Pediatric: same as adult
  Ilotycin Ophthalmic Ointment Ophth oint: 5 mg/g (1/8 oz)
• erythromycin ophthalmic solution (B) initially 1-2 drops q 1-2 hours; may then increase dose interval
  Pediatric: same as adult
  Isopto Cetamide Ophthalmic Solution Ophth soln: 15% (15 ml)
• gentamicin ophthalmic ointment (C) 1 cm bid-tid
  Pediatric: same as adult
  Garamycin Ophthalmic Ointment Ophth oint: 3 mg/g (3.5 g)
  Genoptic Ophthalmic Ointment Ophth oint: 3 mg/g (3.5 g)
  Gentacidin Ophthalmic Ointment Ophth oint: 3 mg/g (3.5 g)
• polymyxin B/bacitracin ophthalmic ointment (C) apply 1/2 inch q 3-4 hours
  Pediatric: same as adult
  Polysporin Ophth oint: poly 10,000 U/bac 500 units per g (3.75 g)
• polymyxin B/bacitracin/neomycin ophthalmic ointment (C)(G) apply 1/2 inch q 3-4 hours
  Pediatric: same as adult
  Neosporin Ophthalmic Ointment Ophth oint: poly B 10,000 U/bac 400 U/neo 3.5 mg/g (3.75 g)
• polymyxin B/neomycin/gramicidin ophthalmic solution (C) 1-2 drops 2-3 times q 1 hour; then 1-2 drops bid-qid x 7-10 days
  Pediatric: same as adult
  Neosporin Ophthalmic Solution
  Ophth soln: poly 10,000 U/neo 1.75 mg/gram 0.025 mg/ml (10 ml)
• sodium sulfacetamide ophthalmic solution and ointment (C)
  Bleph-10 Ophthalmic Solution 2 drops q 4 hour x 7-14 days
  Pediatric: <2 years: not recommended; =2 years: 1-2 drops q 2-3 hours during the day
  Ophth soln: 10% (2.5, 5, 15 ml; benzalkonium chloride)
  Bleph-10 Ophthalmic Ointment apply 1/2 inch qid and HS
  Pediatric: <2 years: not recommended; =2 years: apply 1/4-1/3 inch qid and HS
  Ophth oint: 10% (3.5 g) (phenylmercuric acetate)

SUNBURN

• prednisone (C)(G) 10 mg qid x 4-6 days if severe and extensive
• silver sulfadiazine (C)(G) apply topically to burn once daily-bid
  Pediatric: not recommended
  Silvadene Crm: 1% (20, 50, 85, 400, 1000 g jar; 20 g tube)

SYPHILIS (TREPONEMA PALLIDUM )

Comment: Th e following treatment regimens for T. pallidum are published in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines. Treat all sexual contacts. Consider testing for other STDs. Penicillin G, administered parenterally, is the preferred drug for treating all stages of syphilis. Th e preparation used (i.e., benzathine, aqueous procaine, or aqueous crystalline), the dosage, and the length of treatment depend on the stage and clinical manifestations of the disease. Combinations of benzathine penicillin, procaine penicillin, and oral penicillin preparations are not appropriate (e.g., Bicillin C-R). All women should be screened serologically for syphilis early in pregnancy. Th ere are no proven alternatives to penicillin for the treatment of syphilis during pregnancy. Pregnant patients who are allergic to penicillin should be desensitized and treated with penicillin. Sexual transmission of T. pallidum is thought to occur only when mucotaneous syphilis at any stage should be evaluated clinically and serologically and treated with a recommended regimen according to CDC guidelines.

PRIMARY, SECONDARY, AND EARLY LATENT (<1 YEAR) SYPHILIS

Regimen 1

• penicillin G (benzathine) 2.4 million units IM in a single dose

LATE LATENT, LATENT SYPHILIS OF UNKNOWN DURATION, AND TERTIARY SYPHILIS

Regimen 1

• penicillin G (benzathine) 7.2 million units total administered in 3 divided doses of 2.4 million units each IM at 1 week intervals

REGIMEN: ADULT, NEUROSYPHILIS

Regimen 1

• aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units IV every 4 hours or continuous IV infusion, for 10-14 days

ALTERNATIVE REGIMEN: ADULT, NEUROSYPHILIS

Regimen 1

• penicillin G (procaine) 2.4 million units IM once daily x 10-14 days plus probenecid 500 mg qid x 10-14 days

PRIMARY AND SECONDARY SYPHILIS IN HIV-INFECTED PERSONS

Regimen 1

• penicillin G (benzathine) 2.4 million units IM in a single dose

LATENT SYPHILIS AMONG HIV-INFECTED PERSONS
Comment: Treatment is the same as for HIV-negative persons.

CONGENITAL SYPHILIS

Regimen 1

• aqueous crystalline penicillin G 100,000-150,000 units/kg/day, administered as 50,000 units IV every 12 hours during the fi rst 7 days of life and every 8 hours thereafter for a total of 10 days

ALTERNATE REGIMEN

Regimen 1

• penicillin G (benzathine) 50,000 units/kg IM in a single dose

Regimen 2

• penicillin G (procaine) 50,000 units/kg/dose IM, administered in a single daily dose x 10 days

OLDER INFANTS AND CHILDREN

Regimen 1

• aqueous crystalline penicillin G 200,000-300,000 units/kg/day, administered as 50,000 units IV every 12 hours during the fi rst 7 days of life and every 4-6 hours thereafter for a total of 10 days

DRUG BRANDS AND DOSE FORMS

• aqueous crystalline penicillin G (B)(G)
• penicillin G (benzathine) (B)(G)
  Bicillin L-A Cartridge-needle unit: 600,000 million units (1 ml); 1.2 million units (2 ml); 2.4 million units (4 ml)
• penicillin G (procaine) (B)(G)
  Bicillin C-R Cartridge-needle unit: 600,000 units (1 ml); 1.2 mill- ion units; (2 ml); 2.4 million units (4 ml)
• probenecid (B)(G)
  Benemid Tab: 500*mg; Cap: 500 mg

TAPEWORM (CESTODE)

• albendazole (C)(G) <2 years: 200 mg once daily x 3 days; may repeat in 3 weeks; =2-12 years: 400 mg once daily x 3 days; may repeat in 3 weeks; =12 years: 400 mg bid x 7 days; take after a meal
  Albenza Tab: 200 mg
  Comment: albendazole is a broad-spectrum benzimidazole carbamate anthelmintic.
• praziquantel (B) <4 years: not established; =4 years: 5-10 mg/kg as a single dose
  Biltricide Tab: 600 mg film-coat (scored for half or quarter dose)
  Comment: Therapeutically effective levels of Biltricide may not be achieved when administered concomitantly with strong P450 inducers, such as rifampin. Females should not breastfeed on the day of Biltricide treatment and during the subsequent 72 hours. Use caution with hepatosplenic patients who have moderate to severe liver impairment (Child-Pugh class B and C).
• nitazoxanide (B) <12 months: not recommended; =12 months: treat q 12 hours x 3 days; <11 years: [suspension]12-47 months: 5 ml; 4-11 years: 10 ml; =11 years: [tab/suspension] 500 mg
  Alinia Tab: 500 mg; Oral susp: 100 mg/5 ml (60 ml)

TEMPORAL ARTERITIS

Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509

TEMPOROMANDIBULAR JOINT (TMJ) DISORDER

Injectable Acetaminophen see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Topical/Transdermal NSAIDs see Pain page 307
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Topical Analgesic and Anesthetic Agents see page 499

TESTOSTERONE DEFICIENCY, HYPOTESTOSTERONEMIA, HYPOGONADISM

Comment: testosterone is contraindicated in male breast cancer and prostate cancer. testosterone replacement therapy is indicated in males with primary hypogonadism (congenital or acquired due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, or orchidectomy), or hypogonadotropic hypogonadism (congenital or acquired), and delayed puberty not secondary to a pathological disorder (x-ray of the hand and wrist to determine bone age should be obtained every 6 months to assess the effect of treatment on the epiphyseal centers).

ORAL ANDROGENS

• fluoxymesterone (X)(III) Hypogonadism: 5-20 mg once daily; Delayed puberty: use low dose and limit duration to 4-6 months
  Pediatric: use by specialist only
  Halotestin Tab: 2*, 5*, 10*mg (tartrazine)
• methyltestosterone (X)(III) usually 10-50 mg once daily; for delayed puberty, use low dose and limit duration to 4-6 months
  Android Cap: 10 mg
  Methitest Tab: 10*mg
  Testred Cap: 10 mg
• testosterone (X)(III) 30 mg q 12 hours to gum region, just above the incisor tooth on either side of the mouth; hold system in place for 30 seconds; rotate sites with each application
  Striant Buccal tab: 30 mg (6 blister pks; 10 buccal systems/blister pck)
  Comment: Serum total testosterone concentrations may be checked 4 to 12 weeks after initiating treatment with Striant. To capture the maximum serum concentration, an early morning sample (just prior to applying the AM dose) is recommended.

TOPICAL ANDROGENS
Comment: Wash hands after application. Allow solution to dry before it touches clothing. Do not wash site for at least 2 hours after application. Pregnant and nursing women, and children, must avoid skin contact with application sites on men. If there is contact, wash the area as soon as possible with soap and water.

• testosterone (X)(III)
  Pediatric: <18 years: not recommended
  AndroGel 1% initially apply 5 g once daily in the AM to clean, dry, intact skin of the shoulders, upper arms, and/or abdomen; do not apply to scrotum; may increase to 7.5 g/day and then to 10 g/day if needed
  Gel: 2.5, 5 g (30 pkts); 75 g (60 metered 1.25 g doses)
  AndroGel 1.62% initially apply 2.5 g (2 pump actuations) once daily in the AM to clean, dry, skin of the shoulders and upper arms intact skin of the upper arms; do not apply to abdomen or genitals; may adjust dose between 1 and 4 pump actuations based on the pre-dose morning serum testosterone concentration at approximately 14 and 28 days after starting treatment or adjusting dose
  Gel: 2.25 mg pump actuation (75 g, 60 metered 1.25 g doses)
  Axiron apply to clean dry intact skin of the axillae; do not apply to the scrotum, penis, abdomen, shoulders, or upper arms; initially apply 60 mg (30 mg/axilla) once daily in the AM; adjust dose based on serum testosterone concentration 2 to 8 hours after applying and at least 14 days after starting therapy or following dose adjustment; may increase dose in 30 mg increments if serum testosterone <300 ng/dL up to 120 mg; reduce dose to 30 mg if levels >1050 ng/dL; discontinue if serum testosterone remains at >1050 ng/dL
  Soln: 30 mg/1.5 ml pump actuation (90 ml; 60 metered actuations) (alcohol, latex-free)
  Fortesta (G) initially 40 mg of testosterone (4 pump actuations) applied to the thighs once daily in the AM; may adjust between 10 mg minimum and 70 mg maximum.
  Gel: 10 mg/0.5 g pump actuation (120 actuations)
  Comment: Th e Fortesta dose should be based on the serum testosterone concentration 2 hours after applying Fortesta and at approximately 14 days and 35 days after starting treatment or  following dose adjustment. Dose adjustment criteria: =500 ng/dL, increase daily dose by 10 mg; 500-=1250 ng/dL, no change; 1250-=2500 ng/dL, decrease daily dose by 10 mg; =2500 ng/dL, decrease daily dose by 20 mg.
  Gel: 10 mg (0.5 g)/pump actuation (60 g; 120 metered dose actuations) (ethanol)
  Testim (G) initially apply 5 g once daily in the AM to clean, dry, intact skin of the shoulders and/or upper arms; do not apply to the genitals or abdomen; may increase to 10 g after 2 weeks
  Gel: 1%, clear, hydroalcoholic (5 mg/5 g, 5 g single-use tube)
  Vogelxo Gel (G) 1% initially apply 5 g once daily in the AM to clean, dry, intact skin of the shoulders, upper arms, and/or abdomen; do not apply to scrotum; may increase to 7.5 g/day and then to 10 g/day if needed
  Gel: 5 g/pkt (30 pkts); 5 g/tube (30 tubes); metered dose pumps (2 x 75 g, 1.25 g actuation)

INTRANASAL ANDROGENS

• testosterone (nasal gel) (X)(III) initially one pump actuation each nostril (33 mg) 3x/day, at least 6-8 hours apart, at the same times each day max: 6 pump actuation/day
  Pediatric: <18 years: not established
  Natesto
  Gel: 5.5 mg/actuation, metered dose pump (11 g, 60 actuations)

TRANSDERMAL ANDROGEN

• testosterone (X)(III)
  Androderm initially apply 4 mg nightly at approximately 10 PM to clean, dry area of the arm, back, or upper buttocks; leave on x 24 hours; may increase to 7.5 mg or decrease to 2.5 mg based on confirmed AM serum testosterone concentrations
  Pediatric: <15 years: not recommended
  Transdermal patch: 2, 4 mg/24hr

TETANUS (CLOSTRIDIUM TETANI ) PROPHYLAXIS

see Childhood Immunizations page 578

POSTEXPOSURE PROPHYLAXIS IN PREVIOUSLY NONIMMUNIZED PERSONS

• tetanus immune globulin, human (C) 250 mg deep IM in a single dose
  Pediatric: >7 years: same as adult
  BayTET, Hyper-TET
  Vial: 250 units single dose; Prefilled syringe: 250 units
• tetanus toxoid vaccine (C) 0.5 ml IM x 3 dose series
  Vial: 5 Lf units/0.5 ml (0.5, 5 ml); Prefilled syringe: 5 Lf units/0.5 ml (0.5 ml)
  Comment: Dose of BayTET/HyperTET S/D is calculated as 4 units/kg. However, it may be advisable to administer the entire contents of the syringe of BayTET/HyperTET S/D (250 units) regardless of the child’s size, since theoretically the same amount of toxin will be produced in the child’s body by the infecting tetanus organism as it will in an adult’s body. At the same time but in a diff erent extremity and with a diff erent syringe, administer Diphtheria and Tetanus Toxoids and Pertussis Vaccine Adsorbed (DTP) or Diphtheria and Tetanus Toxoids Adsorbed (For Pediatric Use) (DT), if pertussis vaccine is contraindicated, should be administered per mfr pkg insert. Tetanus immune globulin may interact with live viral vaccines such as measles, mumps, rubella, and polio. It is also unknown if BayTET/HyperTET can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Th e single injection of tetanus toxoid only initiates the series for producing active immunity in the recipient. Impress upon the patient the need for further toxoid injections in 1 month and 1 year, otherwise the active immunization series is incomplete. If a contraindication to using tetanus toxoid-containing preparations exists for a person who has not completed a primary series of tetanus toxoid immunization, and that person has a wound that is neither clean nor minor, only passive immunization should be given using tetanus immune globulin.

THREADWORM (STRONGYLOIDIDES STERCORALIS)

ANTHELMINTICS

• albendazole (C) 400 mg bid x 7 days; take with a meal
  Pediatric: <2 years: 200 mg once daily x 3 days; may repeat in 3 weeks; =2-12 years: 400 mg once daily x 3 days; may repeat in 3 weeks; >12 years: same as adult
  Albenza Tab: 200 mg
• ivermectin (C) take with water; 200 mcg/kg as a single dose; may re-treat in 3 weeks
  Pediatric: <15 kg: not recommended; =15 kg: same as adult
  Stromectol Tab: 3, 6*mg
• mebendazole (C) chew, swallow, or mix with food; 100 mg bid x 3 days; may repeat in 3 weeks if needed; take with a meal
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Emverm Chew tab: 100 mg
  Vermox (G) Chew tab: 100 mg
• pyrantel pamoate (C) 11 mg/kg x 1 dose; max 1 g/dose; take with a meal
  Pediatric: 25-37 lb: 1/2 tsp x 1 dose; 38-62 lb: 1 tsp x 1 dose; 63-87 lb: 1 tsp x 1 dose; 88-112 lb: 2 tsp x 1 dose; 113-137 lb: 2 tsp x 1 dose; 138-162 lb: 3 tsp x 1 dose; 163-187 lb: 3 tsp x 1 dose; >187 lb: 4 tsp x 1 dose
  Pin-X (OTC) Cap: 180 mg; Liq: 50 mg/ml (30 ml); 144 mg/ml (30 ml); Oral susp: 50 mg/ml (30 ml)
• thiabendazole (C) 25 mg/kg dosed bid x 7 days; max 1.5 g/dose; take with meals
  Pediatric: same as adult; <30 lb: consult mfr pkg insert; >30 lb: 25 mg/kg/dose bid with meals; 30-50 lb: 250 mg bid with meals; >50 lb: 10 mg/lb/dose bid with meals; max 3g/day Mintezol Chew tab: 500*mg (orange); Oral susp: 500 mg/5 ml (120 ml) (orange)
  Comment: thiabendazole is not for prophylaxis. May impair mental alertness.

TINEA CAPITIS

Comment: Tinea capitis must be treated with an oral anti-fungal.

FOR SEVERE KERION PRURITUS

• prednisone (C) 1 mg/kg/day for 7-14 days
  see Oral Corticosteroids page 509

SYSTEMIC ANTI-FUNGALS

• griseofulvin, microsize (C)(G) 500 mg once daily x 4-6 weeks or longer; max 1 g/day
  Pediatric: <30 lb: 5 mg/lb/day; 30-50 lb: 125-250 mg/day; >50 lb: 250-500 mg/day; 5 mg/lb/day x 4-6 weeks or longer; see page 579 for dose by weight
  Grifulvin V Tab: 250, 500 mg; Oral susp: 125 mg/5 ml (120 ml; alcohol 0.02%)
• griseofulvin, ultramicrosize (C)(G) 375 mg/day in a single or divided doses x 4-6 weeks or longer
  Pediatric: <2 years: not recommended; =2 years: 3.3 mg/lb/day in a single or divided doses x 4-6 weeks or longer
  Gris-PEG Tab: 125, 250 mg
  Comment: griseofulvin should be taken with fatty foods (e.g., milk, ice cream).
  Liver enzymes should be monitored.
• ketoconazole (C)(G) initially 200 mg once daily; max 400 mg/day x 4 weeks
  Pediatric: <2 years: not recommended; =2 years: 3.3-6.6 mg/kg once daily x 4 weeks
  Nizoral Tab: 200 mg
  Comment: Caution with ketoconazole due to concerns about potential for hepatotoxicity.

TINEA CORPORIS (RINGWORM)

TOPICAL ANTI-FUNGALS

• butenafine (C)(G) apply bid x 1 week or once daily x 4 weeks
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Lotrimin Ultra (OTC) Crm: 1% (12, 24 g)
  Mentax Crm: 1% (15, 30 g)
  Comment: butenafine is a benzylamine, not an azole. Fungicidal activity continues for at least 5 weeks after last application.
• ciclopirox (B)
  Loprox Cream apply bid; max 4 weeks
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Crm: 0.77% (15, 30, 90 g)
  Loprox Lotion apply bid; max 4 weeks
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Lotn: 0.77% (30, 60 ml)
  Loprox Gel apply bid; max 4 weeks
  Pediatric: <16 years: not recommended
  Gel: 0.77% (30, 45 g)
• clotrimazole (B)(G) apply to affected area bid x 7 days
  Pediatric: same as adult
  Lotrimin Crm: 1% (15, 30, 45 g)
  Lotrimin AF (OTC) Crm: 1% (12 g); Lotn: 1% (10 ml); Soln: 1% (10 ml)
• econazole (C) apply once daily x 14 days
  Pediatric: same as adult
  Spectazole Crm: 1% (15, 30, 85 g)
• ketoconazole (C) apply once daily x 14 days
  Pediatric: not recommended
  Nizoral Cream Crm: 2% (15, 30, 60 g)
• miconazole 2% (C) apply once daily-bid x 2 weeks
  Pediatric: same as adult
  Lotrimin AF Spray Liquid (OTC) Spray liq: 2% (113 g) (alcohol 17%)
  Lotrimin AF Spray Powder (OTC) Spray pwdr: 2% (90 g) (alcohol 10%)
  Monistat-Derm Crm: 2% (1, 3 oz); Spray liq: 2% (3.5 oz); Spray pwdr: 2% (3 oz)
• naftifine (B)(G)
  Pediatric: not recommended
  Naftin Cream apply once daily x 14 days
  Crm: 1% (15, 30, 60 g)
  Naftin Gel apply bid x 14 days
  Gel: 1% (20, 40, 60 g)
• oxiconazole nitrate (B)(G) apply once daily-bid x 2 weeks
  Pediatric: same as adult
  Oxistat Crm: 1% (15, 30, 60 g); Lotn: 1% (30 ml)
• sulconazole (C) apply once daily-bid x 3 weeks
  Pediatric: not recommended
  Exelderm Crm: 1% (15, 30, 60 g); Lotn: 1% (30 mg)
• terbinafine (B)(G)
  Pediatric: <12 years: not recommended
  Lamisil Cream (OTC) apply to affected and surrounding area once daily-bid x 1-4 weeks until significantly improved
  Crm: 1% (15, 30 g)
  Lamisil AT Cream (OTC) apply to affected and surrounding area once daily-bid x 1-4 weeks until significantly improved
  Crm: 1% (15, 30 g)
  Lamisil Solution (OTC) apply to affected and surrounding area once daily x 1 week
  Soln: 1% (30 ml spray bottle)

TOPICAL ANTIFUNGAL/STEROID COMBINATION

• clotrimazole/betamethasone (C)(G) apply bid x 2 weeks; max 4 weeks
  Pediatric: <12 years: not recommended; >12 years: same as adult
  Lotrisone Crm: clotrim 1 mg/beta 0.5 mg (15, 45 g); Lotn: clotrim 1 mg/beta 0.5 mg (30 ml)

SYSTEMIC ANTIFUNGALS

• griseofulvin, microsize (C)(G) 500 mg/day x 2-4 weeks; max 1 g/day
  Pediatric: <30 lb: 5 mg/lb/day; 30-50 lb: 125-250 mg/day; >50 lb: 250-500 mg/day; see page 579 for dose by weight
  Grifulvin V Tab: 250, 500 mg; Oral susp: 125 mg/5 ml (120 ml) (alcohol 0.02%)
• griseofulvin, ultramicrosize (C)(G) 375 mg/day in a single or divided doses x 2-4 weeks
  Pediatric: <2 years: not recommended; =2 years: 3.3 mg/lb/day in a single or divided doses
  Gris-PEG Tab: 125, 250
  Comment: griseofulvin should be taken with fatty foods (e.g., milk, ice cream). Liver enzymes should be monitored.
• ketoconazole (C) initially 200 mg once daily; max 400 mg/day x 4 weeks
  Pediatric: <2 years: not recommended; >2 years: 3.3-6.6 mg/kg/day x 4 weeks
  Nizoral Tab: 200 mg
  Comment: Caution with ketoconazole due to concerns about potential for hepatotoxicity.

TINEA CRURIS (JOCK ITCH)

TOPICAL ANTIFUNGALS

• butenafine (B)(G) apply bid x 1 week or once daily x 4 weeks
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Lotrimin Ultra (C)(OTC) Crm: 1% (12, 24 g)
  Mentax Crm: 1% (15, 30 g)
  Comment: butenafine is a benzylamine, not an azole. Fungicidal activity continues for at least 5 weeks after last application.
• ciclopirox (B)
  Loprox Cream apply bid; max 4 weeks
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Crm: 0.77% (15, 30, 90 g)
  Loprox Lotion apply bid; max 4 weeks
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Lotn: 0.77% (30, 60 ml)
  Loprox Gel apply bid; max 4 weeks
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Gel: 0.77% (30, 45 g)
• clotrimazole (B)(G) apply to affected area bid x 7 days
  Pediatric: same as adult
  Lotrimin Crm: 1% (15, 30, 45 g)
  Lotrimin AF (OTC) Crm: 1% (12 g); Lotn: 1% (10 ml); Soln: 1% (10 ml)
• econazole (C) apply once daily x 2 weeks
  Pediatric: same as adult
  Spectazole Crm: 1% (15, 30, 85 g)
• ketoconazole (C)(G) apply bid x 4 weeks
  Pediatric: not recommended
  Nizoral Cream Crm: 2% (15, 30, 60 g)
• miconazole 2% (C)(G) apply once daily-bid x 2 weeks
  Pediatric: same as adult
  Lotrimin AF Spray Liquid (OTC) Spray liq: 2% (113 g) (alcohol 17%)
  Lotrimin AF Spray Powder (OTC) Spray pwdr: 2% (90 g) (alcohol 10%)
  Monistat-Derm Crm: 2% (1, 3 oz); Spray liq: 2% (3.5 oz); Spray pwdr: 2% (3 oz)
• naftifine (B)(G)
  Pediatric: not recommended
  Naftin Cream apply once daily x 2 weeks
  Crm: 1% (15, 30, 60 g)
  Naftin Gel apply bid x 2 weeks
  Gel: 1% (20, 40, 60 g)
• oxiconazole nitrate (B)(G) apply once daily-bid x 2 weeks
  Pediatric: same as adult
  Oxistat Crm: 1% (15, 30, 60 g); Lotn: 1% (30 ml)
• sulconazole (C) apply once daily-bid x 3 weeks
  Pediatric: not recommended
  Exelderm Crm: 1% (15, 30, 60 g); Lotn: 1% (30 mg)
• terbinafine (B)(G)
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Lamisil Cream (OTC) apply bid x 1-4 weeks
  Crm: 1% (15, 30 g)
  Lamisil AT Cream (OTC) apply to affected and surrounding area once daily-bid x 1-4 weeks until significantly improved
  Crm: 1% (15, 30 g)
  Lamisil Solution (OTC) apply to affected and surrounding area once daily x 1 week
  Soln: 1% (30 ml spray bottle)
• tolnaftate (C)(OTC)(G) apply sparingly bid x 2-4 weeks
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Tinactin Crm: 1% (15, 30 g); Pwdr: 1% (45, 90 g); Soln: 1% (10 ml); Aerosol liq: 1% (4 oz); Aerosol pwdr: 1% (3.5, 5 oz)
• undecylenate acid (NE) apply bid x 4 weeks
  Pediatric: same as adult
  Desenex (OTC) Pwdr: 25% (1.5, 3 oz); Spray pwdr: 25% (2.7 oz); Oint: 25% (0.5, 1 oz)

TOPICAL ANTIFUNGAL/ANTI-INFLAMMATORY AGENTS

• clotrimazole/betamethasone (C)(G) apply bid x 4 weeks; max 4 weeks
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Crm: clotrim 10 mg/beta 0.5 mg (15, 45 g); Lotn: clotrim 10 mg/beta 0.5 mg (30 ml)

SYSTEMIC ANTIFUNGALS

• griseofulvin, microsize (C)(G) 1 g once daily x 2 weeks
  Pediatric: <30 lb: 5 mg/lb/day; 30-50 lb: 125-250 mg/day; >50 lb: 250-500 mg/day; 5 mg/lb/day x 4-6 weeks or longer; see page 579 for dose by weight
  Grifulvin V Tab: 250, 500 mg; Oral susp: 125 mg/5 ml (120 ml) (alcohol 0.02%)
• griseofulvin, ultramicrosize (C) 375 mg/day in a single or divided doses x 2 weeks
  Pediatric: <2 years: not recommended; =2 years: 3.3 mg/lb/day in a single or divided doses
  Gris-PEG Tab: 125, 250 mg
  Comment: griseofulvin should be taken with fatty foods (e.g., milk, ice cream). Liver enzymes should be monitored.
• ketoconazole (C) initially 200 mg once daily; max 400 mg once daily x 4 weeks
  Pediatric: <2 years: not recommended; =2 years: 3.3-6.6 mg/kg/day
  Nizoral Tab: 200 mg
  Comment: Caution with ketoconazole due to concerns about potential for hepatotoxicity.

TINEA PEDIS (ATHLETE’S FOOT)

TOPICAL ANTIFUNGALS

• butenafine (B)(G) apply bid x 1 week or once daily x 4 weeks
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Lotrimin Ultra (C)(OTC) Crm: 1% (12, 24 g)
  Mentax Crm: 1% (15, 30 g)
  Comment: butenafine is a benzylamine, not an azole. Fungicidal activity continues for at least 5 weeks after last application.
  Burrows solution (NE) wet dressings
• ciclopirox (B)
  Loprox Cream apply bid; max 4 weeks
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Crm: 0.77% (15, 30, 90 g)
  Loprox Lotion apply bid; max 4 weeks
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Lotn: 0.77% (30, 60 ml)
  Loprox Gel apply bid; max 4 weeks
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Gel: 0.77% (30, 45 g)
• clotrimazole (C)(G) apply bid to affected area x 4 weeks
  Pediatric: same as adult
  Desenex Crm: 1% (0.5 oz)
  Lotrimin Crm: 1% (15, 30, 45, 90 g); Lotn: 1% (30 ml); Soln: 1% (10, 30 ml)
  Lotrimin AF (OTC) Crm: 1% (15, 30, 45, 90 g); Lotn: 1% (20 ml); Soln: 1% (20 ml)
• econazole (C) apply once daily x 4 weeks
  Pediatric: same as adult
  Spectazole Crm: 1% (15, 30, 85 g)
• ketoconazole (C) apply once daily x 6 weeks
  Pediatric: not recommended
  Nizoral Cream Crm: 2% (15, 30, 60 g)
• miconazole 2% (C)(G) apply bid x 4 weeks
  Pediatric: same as adult
  Lotrimin AF Spray Liquid (OTC) Spray liq: 2% (113 g) (alcohol 17%)
  Lotrimin AF Spray Powder (OTC) Spray pwdr: 2% (90 g; alcohol 10%)
  Monistat-Derm Crm: 2% (1, 3 oz); Spray liq: 2% (3.5 oz); Spray pwdr: 2% (3 oz)
• naftifine (B)(G)
  Pediatric: not recommended
  Naftin Cream apply once daily x 4 weeks
  Crm: 1% (15, 30, 60 g)
  Naftin Gel apply bid x 4 weeks
  Gel: 1% (20, 40, 60 g)
• oxiconazole nitrate (B)(G) apply once daily-bid x 4 weeks
  Pediatric: same as adult
  Oxistat Crm: 1% (15, 30, 60 g); Lotn: 1% (30 ml)
• sertaconazole (C) apply once daily-bid x 4 weeks
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Ertaczo Crm: 2% (15, 30 g)
• sulconazole (C) apply once daily-bid x 4 weeks
  Pediatric: not recommended
  Exelderm Crm: 1% (15, 30, 60 g); Lotn: 1% (30 mg)
• terbinafine (B)(G)
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Lamisil Cream (OTC) apply bid x 1-4 weeks
  Crm: 1% (15, 30 g)
  Lamisil AT Cream (OTC) apply to affected and surrounding area once daily-bid x 1-4 weeks until significantly improved
  Crm: 1% (15, 30 g)
  Lamisil Solution (OTC) apply to affected and surrounding area bid x 1 week
  Soln: 1% (30 ml spray bottle)
• tolnaftate (C)(OTC)(G) apply sparingly bid x 2-4 weeks
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Tinactin Crm: 1% (15, 30 g); Pwdr: 1% (45, 90 g); Soln: 1% (10 ml); Aerosol liq: 1% (4 oz); Aerosol pwdr: 1% (3.5, 5 oz)

TOPICAL ANTIFUNGAL/ANTI-INFLAMMATORY COMBINATION

• clotrimazole/betamethasone (C)(G) apply bid x 4 weeks; max 4 weeks
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Lotrisone Crm: clotrim 1 mg/beta 0.5 mg (15, 45 g); Lotn: clotrim 1 mg/beta 0.5 mg (30 ml)

SYSTEMIC ANTIFUNGALS

• griseofulvin, microsize (C)(G) 1 g once daily x 4-8 weeks
  Pediatric: <30 lb: 5 mg/lb/day; 30-50 lb: 125-250 mg/day; >50 lb: 250-500 mg/day; 5 mg/lb/day x 4-6 weeks or longer; see page 579 for dose by weight
  Grifulvin V Tab: 250, 500 mg; Oral susp: 125 mg/5 ml (120 ml) (alcohol 0.02%)
• griseofulvin, ultramicrosize (C) 750 mg/day in a single or divided doses x 4-6 weeks
  Pediatric: <2 years: not recommended; =2 years: 3.3 mg/lb/day in a single or divided doses
  Gris-PEG Tab: 125, 250
  Comment: griseofulvin should be taken with fatty foods (e.g., milk, ice cream).
  Liver enzymes should be monitored.
• ketoconazole (C) initially 200 mg once daily; max 400 mg/day x 4 weeks
  Pediatric: <2 years: not recommended; =2 years: 3.3-6.6 mg/kg once daily x 4 weeks
  Nizoral Tab: 200 mg
  Comment: Caution with ketoconazole due to concerns about potential for hepatotoxicity.

TINEA VERSICOLOR

Comment: Resolution may take 3-6 months.

TOPICAL ANTIFUNGALS

• butenafine (G) apply once daily x 2 weeks
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Lotrimin Ultra (C)(OTC) Crm: 1% (12, 24 g)
  Mentax (B) Crm: 1% (15, 30 g)
  Comment: butenafine is a benzylamine, not an azole. Fungicidal activity continues for at least 5 weeks after last application.
• ciclopirox (B)
  Loprox Cream apply bid; max 4 weeks
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Crm: 0.77% (15, 30, 90 g)
  Loprox Lotion apply bid; max 4 weeks
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Lotn: 0.77% (30, 60 ml)
  Loprox Gel apply bid; max 4 weeks
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Gel: 0.77% (30, 45 g)
• clotrimazole (B)(G) apply bid x 7 days
  Pediatric: same as adult
  Lotrimin Crm: 1% (15, 30, 45 g)
  Lotrimin AF (OTC) Crm: 1% (12 g); Lotn: 1% (10 ml); Soln: 1% (10 ml)
• econazole (C) apply once daily x 2 weeks
  Pediatric: same as adult
  Spectazole Crm: 1% (15, 30, 85 g)
• miconazole 2% (C)(G) apply once daily x 2 weeks
  Pediatric: same as adult
  Lotrimin AF Spray Liquid (OTC) Spray liq: 2% (113 g) (alcohol 17%)
  Lotrimin AF Spray Powder (OTC) Spray pwdr: 2% (90 g) alcohol 10%)
  Monistat-Derm Crm: 2% (1, 3 oz); Spray liq: 2% (3.5 oz); Spray pwdr: 2% (3 oz)
• ketoconazole (C)(G)
  Pediatric: not recommended
  Nizoral Cream apply once daily x 2 weeks
  Crm: 2% (15, 30, 60 g)
  Nizoral Shampoo lather into area and leave on 5 minutes x 1 application
  Shampoo: 2% (4 oz)
• oxiconazole nitrate (B)(G) apply once daily x 2 weeks
  Pediatric: same as adult
  Oxistat Crm: 1% (15, 30, 60 g); Lotn: 1% (30 ml)
• selenium sulfi de shampoo (C)(G) apply after shower, allow to dry, leave on overnight; then scrub off vigorously in AM; repeat in 1 week and again q 3 months until resolution occurs
  Pediatric: same as adult
  Selsun Blue Shampoo: 1% (120, 210, 240, 330 ml); 2.5% (120 ml)
• sulconazole (C) apply once daily-bid x 3 weeks
  Pediatric: not recommended
  Exelderm Crm: 1% (15, 30, 60 g); Lotn: 1% (30 mg)
• terbinafine (B) apply bid to affected and surrounding area x 1 week
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Lamisil Solution (OTC) Soln: 1% (30 ml spray bottle)

ORAL ANTI-FUNGALS

• ketoconazole (C) initially 200 mg once daily; max 400 mg/day x 4 weeks
  Pediatric: <2 years: not recommended; =2 years: 3.3-6.6 mg/kg once daily x 4 weeks
  Nizoral Tab: 200 mg

TOBACCO DEPENDENCE/NICOTINE WITHDRAWAL SYNDROME

NON-NICOTINE PRODUCTS

Alpha4-Beta2 Nicotinic Acetylcholine Receptor Partial Agonist

• varenicline (C)
  Pediatric: <18 years: not recommended
  Chantix set target quit date; begin therapy 1 week prior to target quit date; take after eating with a full glass of water; initially 0.5 mg once daily for 3 days; then 0.5 mg bid x 4 days; then 1 mg bid; treat x 12 weeks; may continue treatment for 12 more weeks
  Tab: 0.5, 1 mg; Starting Month Pak: 0.5 mg x 11 tabs + 1 mg x 42 tabs; Continuing
  Month Pak: 1 mg x 56 tabs
  Comment: Caution with Chantix due to potential risk for anxiety or suicidal ideation.

AMINOKETONES

• bupropion HBr (C)(G)
  Pediatric: <18 years: not recommended
  Aplenzin initially 100 mg bid for at least 3 days; may increase to 375 or 400 mg/day after several weeks; then after at least 3 more days, 450 mg in 4 divided doses; max 450 mg/day, 174 mg/single dose
  Tab: 174, 348, 522 mg
• bupropion HCl (B)(G)
  Pediatric: <18 years: not recommended
  Wellbutrin initially 100 mg bid for at least 3 days; may increase to 375 or 400 mg/day after several weeks; then after at least 3 more days, 450 mg in 4 divided doses; max 450 mg/day, 150 mg/single dose
  Tab: 75, 100 mg
  Wellbutrin SR initially 150 mg in AM for at least 3 days; may increase to 150 mg bid if well tolerated; usual dose 300 mg/day; max 400 mg/day
  Tab: 100, 150 mg sust-rel
  Wellbutrin XL initially 150 mg in AM for at least 3 days; increase to 150 mg bid if well tolerated; usual dose 300 mg/day; max 400 mg/day
  Tab: 150, 300 mg sust-rel
  Zyban 150 mg once daily x 3 days; then 150 mg bid x 7-12 weeks; max 300 mg/day
  Pediatric: <18 years: not recommended
  Tab: 150 mg sust-rel
  Comment: Contraindications to bupropion include seizure disorder, eating disorder, concurrent MAOI and alcohol use. Smoking should be discontinued after the 7th day of therapy with bupropion. Avoid bedtime dose.

TRANSDERMAL NICOTINE SYSTEMS (D)

• Habitrol (OTC) initially one 21 mg/24 hour patch/day x 4-6 weeks; then one 14 mg/24 hour patch/day x 2-4 weeks; then one 7 mg/24 hour patch/day x 2-4 weeks; then discontinue
  Pediatric: not recommended
  Transdermal patch: 7, 14, 21 mg/24 hour
• Nicoderm CQ (OTC) initially one 21 mg/24 hour patch/day x 6 weeks, then one 14 mg/24 hour patch/day x 2 weeks; then one 7 mg/24 hour patch/day x 2 weeks
  Pediatric: not recommended
  Transdermal patch: 7, 14, 21 mg/24 hour
  Comment: Nicoderm CQ is available as a clear patch.
• Nicotrol Step-down Patch (OTC) 1 patch/day x 6 weeks
  Pediatric: not recommended
  Transdermal patch: 5, 10, 15 mg/16 hour (7/pck)
• Nicotrol Transdermal (OTC) 1 patch/day x 6 weeks
  Pediatric: not recommended
  Transdermal patch: 15 mg/16 hour (7/pck)
  Prostep initially one 22 mg/24 hour patch/day x 4-8 weeks; then discontinue or one 11 mg/24 hour patch/day x 2-4 additional weeks
  Pediatric: not recommended
  Transdermal patch: 11, 22 mg/24 hour (7/pck)

NICOTINE GUM

• nicotine polacrilex (D) chew one piece of gum slowly and intermittently over 30 minutes q 1-2 hours x 6 weeks; then q 2-4 hours x 3 weeks; then q 4-8 hours x 3 weeks; max 24 pieces/day; 2 mg if smoked <25 cigarettes/day; 4 mg if smoked >24 cigarettes/day
  Pediatric: not recommended
  Nicorette (OTC) Gum squares: 2, 4 mg (108 piece starter kit and 48 piece refi ll) (orange, mint, or original, sugar-free)

NICOTINE LOZENGE

• nicotine polacrilex (X)(OTC)(G) dissolve over 20-30 minutes; minimize swallowing; do not eat or drink for 15 min before and during use; Use 2 mg lozenge if fi rst cigarette smoked >30 minutes after waking; Use 4 mg lozenge if fi rst cigarette smoked within 30 min of waking; 1 lozenge q 1-2 hours (at lest 9/day) x 6 weeks; then q 2-4 hours x 3 weeks; then q 4-8 hours x 3 weeks; then stop; max 5 lozenges/6 hours and 20 lozenges/day
  Pediatric: <18 years: not recommended
  Commit Lozenge Loz: 2, 4 mg (72/pck) (phenylalanine)
  Nicorette Mini Lozenge (G) Loz: 2, 4 mg (72/pck) (mint; phenylalanine)

NICOTINE INHALATION PRODUCTS

• nicotine 0.5 mg aqueous nasal spray (D)
  Pediatric: not recommended
  Nicotrol NS 1-2 doses/hour nasally; max 5 doses/hour or 40 doses/day; usual max 3 months
  Nasal spray: 0.5 mg/spray; 10 mg/ml (10 ml, 200 doses)
• nicotine 10 mg inhalation system (D)
  Pediatric: not recommended
  Nicotrol Inhaler individualize therapy; at least 6 cartridges/day x 3-6 weeks; max 16 cartridges/day x fi rst 12 weeks; then reduce gradually over 12 more weeks
  Inhaler: 10 mg/cartridge, 4 mg delivered (42 cartridge/pck) (menthol)
  Comment: Nicotrol Inhaler is a smoking replacement; to be used with decreasing frequency. Smoking should be discontinued before starting therapy. Side effects include cough, nausea, mouth, or throat irritation. Th is system delivers nicotine, but no tars or carcinogens. Each cartridge lasts about 20 minutes with frequent continuous puffi ng and provides nicotine equivalent to 2 cigarettes.

TONSILLITIS: ACUTE

• amoxicillin (B)(G) 500-875 mg bid or 250-500 mg tid x 10 days
  Pediatric: <40 kg (88 lb): 20-40 mg/kg/day in 3 divided doses x 10 days or 25-45 mg/kg/day in 2 divided doses x 10 days; see page 554 for dose by weight
  Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg (cherry-banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml (80, 100, 150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble gum);
  Oral drops: 50 mg/ml (30 ml) (bubble gum)
  Moxatag Tab: 775 mg ext-rel
  Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80, 100, 150 ml) (raspberry-strawberry)
• azithromycin (B) 500 mg x 1 dose on day 1, then 250 mg once daily on days 2-5 or 500 mg once daily x 3 days or Zmax 2 g in a single dose
  Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
  Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
  Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
  Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
  Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
• cefaclor (B)(G) 250-500 mg q 8 hours x 10 days; max 2 g/day
  Pediatric: <1 month: not recommended; 20-40 mg/kg bid or q 12 hours x 10 days; max 1 g/day; see page 560 for dose by weight
  Tab: 500 mg; Cap: 250, 500 mg; Susp: 125 mg/5 ml (75, 150 ml) (strawberry); 187 mg/5 ml (50, 100 ml) (strawberry); 250 mg/5 ml (75, 150 ml) (strawberry); 375 mg/5 ml (50, 100 ml) (strawberry)
  Pediatric: <16 years: ext-rel not recommended; =16 years; same as adult
  Cefaclor Extended Release Tab: 375, 500 mg ext-rel
• cefadroxil (B) 1 g once daily or divided bid x 10 days
  Pediatric: 30 mg/kg/day in 2 divided doses x 10 days; see page 561 for dose by weight
  Duricef Cap: 500 mg; Tab: 1 g; Oral susp: 250 mg/5 ml (100 ml); 500 mg/5 ml (75, 100 ml) (orange-pineapple)
• cefdinir (B) 300 mg bid x 5-10 days or 600 mg once daily x 10 days
  Pediatric: <6 months: not recommended; 6 months-12 years: 14 mg/kg/day in a single or 2 divided doses x 10 days; >12 years: same as adult; see page 562 for dose by weight
  Omnicef Cap: 300 mg; Oral susp: 125 mg/5 ml (60, 100 ml) (strawberry)
• cefditoren pivoxil (B) 200 mg bid x 10 days
  Pediatric: <12 years: not recommended
  Spectracef Tab: 200 mg
  Comment: Contraindicated with milk protein allergy or carnitine deficiency.
• ceftibuten (B) 200 mg once daily x 10 days
  Pediatric: 9 mg/kg once daily x 10 days; max 400 mg/day; see page 566 for dose by weight
  Cedax Cap: 400 mg; Oral susp: 90 mg/5 ml (30, 60, 90, 120 ml); 180 mg/5 ml (30, 60, 120 ml) (cherry)
• cefixime (B) 400 mg once daily x 10 days
  Pediatric: <6 months: not recommended; 6 months-12 years, <50 kg: 8 mg/kg/day in a single or 2 divided doses x 10 days; >12 years, >50 kg: same as adult; see page 563 for dose by weight
  Suprax Tab: 400 mg; Cap: 400 mg; Oral susp: 100, 200 mg/5 ml (50, 75, 100 ml) (strawberry)
• cefpodoxime proxetil (B) 200 mg bid x 5-7 days
  Pediatric: <2 months: not recommended; 2 months-12 years: 10 mg/kg/day (max 400 mg/dose) or 5 mg/kg/day bid (max 200 mg/dose) x 5-7 days; see page 564 for dose by weight
  Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 mg) (lemon creme)
• cefprozil (B) 500 mg once daily x 10 days
  Pediatric: 2-12 years: 7.5 mg/kg bid x 10 days; >12 years: same as adult; see page 565 for dose by weight
  Cefzil Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 75, 100 ml) (bubble gum) (phenylalanine)
• cephalexin (B)(G) 250 mg tid x 10 days
  Pediatric: 25-50 mg/kg/day in 4 divided doses x 10 days; see page 568 for dose by weight
  Keflex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml) (strawberry)
• clarithromycin (C)(G) 250 mg bid or 500 mg ext-rel once daily 10 days
  Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg bid x 10 days; see page 569 for dose by weight
  Biaxin Tab: 250, 500 mg
  Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit punch)
  Biaxin XL Tab: 500 mg ext-rel
• dirithromycin (C)(G) 500 mg once daily x 10 days
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Dynabac Tab: 250 mg
• erythromycin base (B)(G) 300-400 mg tid x 10 days
  Pediatric: 30-50 mg/kg/day in 2-4 divided doses x 10 days
  Ery-Tab Tab: 250, 333, 500 mg ent-coat
  PCE Tab: 333, 500 mg
  Comment: erythromycin may increase INR with concomitant warfarin, as well as increase serum level of digoxin, benzodiazepines and statins.
• erythromycin ethylsuccinate (B)(G) 400 mg qid x 7 days
  Pediatric: 30-50 mg/kg/day in 4 divided doses x 7 days; may double dose with severe infection; max 100 mg/kg/day; see page 574 for dose by weight
  EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100, 200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab: 200 mg wafer (fruit)
  E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
  E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
  E.E.S. 400 Tablets Tab: 400 mg
  Comment: erythromycin may increase INR with concomitant warfarin, as well as increase serum level of digoxin, benzodiazepines and statins.
• loracarbef (B) 200 mg bid x 10 days
  Pediatric: 15 mg/kg/day in 2 divided doses x 10 days; see page 581 for dose by weight
  Lorabid Pulvule: 200, 400 mg; Oral susp: 100 mg/5 ml (50, 100 ml); 200 mg/5 ml (50, 75, 100 ml) (strawberry bubble gum)
• penicillin V potassium (B)(G) 250 mg tid x 10 days
  Pediatric: 25-50 mg/kg day in 4 divided doses x 10 days; =12 years: same as adult; see page 583 for dose by weight
  Pen-Vee K Tab: 250, 500 mg; Oral soln: 125 mg/5 ml (100, 200 ml); 250 mg/5 ml (100, 150, 200 ml)

TRICHINOSIS (TRICHINELLA SPIRALIS )

Comment: Trichinosis is caused by eating raw or undercooked pork or wild game infected with the larvae of a parasitic worm, Trichinella spiralis. Th e initial symptoms are abdominal discomfort, nausea, vomiting, diarrhea, fatigue, and fever beginning one to two days following ingestion. Th ese parasites then invade other organs (e.g., muscles) causing muscle aches, itching, fever, chills, and joint pains that begins about two to eight weeks after ingestion. Th e treatment is oral anthelmintics which may cause abdominal pain, diarrhea, and (rarely) hypersensitivity reactions, convulsions, neutropenia, agranulocytosis, and hepatitis.

ANTHELMINTICS

• albendazole (C) 400 mg as bid x 15 days; take with a meal
  Pediatric: <2 years: 200 mg once daily x 3 days; may repeat in 3 weeks; 2-12 years: 400 mg once daily x 3 days; may repeat in 3 weeks; >12 years: same as adult
  Albenza Tab: 200 mg
• mebendazole (C) chew, swallow, or mix with food; 200-400 mg tid x 3 days; then 400-500 mg tid x 10 days; take with a meal
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Emverm Chew tab: 100 mg
  Vermox (G) Chew tab: 100 mg
• pyrantel pamoate (C) 11 mg/kg x 1 dose; max 1 g/dose; take with a meal
  Pediatric: 25-37 lb: 1/2 tsp x 1 dose; 38-62 lb: 1 tsp x 1 dose; 63-87 lb: 1 tsp x 1 dose; 88-112 lb: 2 tsp x 1 dose; 113-137 lb: 2 tsp x 1 dose; 138-162 lb: 3 tsp x 1 dose; 163-187 lb: 3 tsp x 1 dose; >187 lb: 4 tsp x 1 dose
  Pin-X (OTC) Cap: 180 mg; Liq: 50 mg/ml (30 ml); 144 mg/ml (30 ml); Oral susp: 50 mg/ml (30 ml)
• thiabendazole (C) 25 mg/kg bid x 7 days; max 1.5 g/dose; take with a meal
  Pediatric: same as adult; <30 lb: consult mfr pkg insert; =30 lb: 25 mg/kg in 2 divided doses/day with meals; 30-50 lbs: 250 mg bid with meals; >50 lb: 10 mg/lb/dose
  bid with meals; max 3g/day
  Mintezol Chew tab: 500*mg (orange); Oral susp: 500 mg/5 ml (120 ml) (orange)
  Comment: thiabendazole is not for prophylaxis. May impair mental alertness.

TRICHOMONIASIS (TRICHOMONAS VAGINALIS )

Comment: Th e following treatment regimens for Trichomoniasis are published in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines. Treat all sexual contacts. A multi-dose treatment regimen should be considered in HIV-positive women.

RECOMMENDED REGIMENS (NON-PREGNANT)

Regimen 1

• metronidazole 2 g once in a single dose

Regimen 2

• tinidazole 2 g once in a single dose

RECOMMENDED ALTERNATE REGIMEN

Regimen 1

• metronidazole 500 mg bid x 7 days

DRUG BRANDS AND DOSE FORMS

• metronidazole (not for use in 1st; B in 2nd, 3rd)(G)
  Flagyl Tab: 250*, 500*mg
  Flagyl 375 Cap: 375 mg
  Flagyl ER Tab: 750 mg ext-rel
  Comment: Alcohol is contraindicated during treatment with oral metronidazole and for 72 hours after therapy due to a possible disulfi ram-like reaction (nausea, vomiting, flushing, headache).
• tinidazole (not for use in 1st; B in 2nd, 3rd)
  Tindamax Tab: 250*, 500*mg
  Comment: Alcohol is contraindicated during treatment with oral tinidazole and for 72 hours after therapy due to a possible disulfi ram-like reaction (nausea, vomiting, flushing, headache).

RECOMMENDED REGIMENS: PREGNANCY/LACTATION
Comment: All pregnant women should be considered for treatment. Women can be treated with 2 g metronidazole in a single dose at any stage of pregnancy. Lactating women who are administered metronidazole should be instructed to interrupt breastfeeding for 12-24 hours after receiving the 2 g dose of metronidazole.

TRIGEMINAL NEURALGIA (TIC DOULOUREUX)

• baclofen (C)(G) initially 5-10 mg tid with food; usual dose 10-80 mg/day
  Pediatric: not recommended
  Lioresal Tab: 10*, 20*mg
  Tab: 10, 20 mg
  Comment: Potential for seizures or hallucinations on abrupt withdrawal of baclofen.
• carbamazepine (C)
  Carbatrol initially 200 mg bid; may increase weekly as needed by 200 mg/day; usual maintenance 800 mg-1.2 g/day
  Pediatric: <12 years: max <35 mg/kg/day; use ext-rel form above 400 mg/day; 12-15 years: max 1 g/day in 2 divided doses; >15 years: usual maintenance 1.2 g/day in 2 divided doses
  Cap: 200, 300 mg ext-rel
  Tegretol (G) initially 100 mg bid or 1/2 tsp susp qid; may increase dose by 100 mg q 12 hours or by 1/2 tsp susp q 6 hours; usual maintenance 400-800 mg/day; max 1200 mg/day
  Pediatric: <6 years: initially 10-20 mg/kg/day in 2 divided doses; increase weekly as needed in 3-4 divided doses; max 35 mg/kg/day in 3-4 divided doses; =6 years: initially 100 mg bid; increase weekly as needed by 100 mg/day in 3-4 divided doses; max 1 g/day in 3-4 divided doses
  Tab: 200*mg; Chew tab: 100*mg; Oral susp: 100 mg/5 ml (450 ml) (citrus-vanilla)
  Tegretol XR (G) initially 200 mg bid; may increase weekly by 200 mg/day in 2 divided doses
  Pediatric: <6 years: use other forms; =6 years: initially 100 mg bid; may increase weekly by 100 mg/day in 2 divided doses; max 1 g/day
  Tab: 100, 200, 400 mg ext-rel
• clonazepam (D)(IV)(G) initially 0.25 mg bid; increase to 1 mg/day after 3 days
  Pediatric: <10 years, <30 kg: initially 0.1-0.3 mg/kg/day; may increase up to 0.05 mg/kg/day bid-tid; usual maintenance 0.1-0.2 mg/kg/day tid
  Klonopin Tab: 0.5*, 1, 2 mg
  Klonopin Wafers dissolve in mouth with or without water
  Wafer: 0.125, 0.25, 0.5, 1, 2 mg orally-disint
• divalproex sodium (D) initially 250 mg bid; gradually increase to max 1000 mg/day if needed
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Depakene Cap: 250 mg; Syr: 250 mg/5 ml
  Depakote Tab: 125, 250 mg
  Depakote ER Tab: 250, 500 mg ext-rel
  Depakote Sprinkle Cap: 125 mg
• phenytoin (D) 400 mg/day in divided doses
  Dilantin Cap: 30, 100 mg; Oral susp: 125 mg/5 ml (8 oz); Infatab: 50 mg
  Comment: Monitor phenytoin serum levels. Therapeutic serum level: 10-20 g/ml.
  Side effects include gingival hyperplasia.
• valproic acid (D) initially 15 mg/kg/day; may increase weekly by 5-10 mg/kg/day; max 60 mg/kg/day or 250 mg/day
  Depakene Cap: 250 mg; Syr: 250 mg/5 ml

TRICYCLIC ANTIDEPRESSANTS (TCAs)
Comment: Co-administration of TCAs with SSRIs requires extreme caution.

• amitriptyline (C)(G) titrate to achieve pain relief; max 300 mg/day
  Pediatric: not recommended
  Tab: 10, 25, 50, 75, 100, 150 mg
• amoxapine (C) titrate to achieve pain relief; if total dose exceeds 300 mg/day, give in divided doses; max 400 mg/day
  Pediatric: not recommended
  Tab: 25, 50, 100, 150 mg
• desipramine (C)(G) titrate to achieve pain relief; max 300 mg/day
  Pediatric: not recommended
  Norpramin Tab: 10, 25, 50, 75, 100, 150 mg
• doxepin (C)(G) titrate to achieve pain relief; max 150 mg/day
  Pediatric: not recommended
  Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
• imipramine (C)(G)
  Pediatric: not recommended
  Tofranil titrate to achieve pain relief; max 200 mg/day; adolescents max 100 mg/day; if maintenance dose exceeds 75 mg/day, may switch to Tofranil PM at bedtime
  Tab: 10, 25, 50 mg
  Tofranil PM titrate to achieve pain relief; initially 75 mg at HS; max 200 mg at HS
  Cap: 75, 100, 125, 150 mg
  Tofranil Injection 50 mg IM; lower dose for adolescents; switch to oral form as soon as possible
  Amp: 25 mg/2 ml (2 ml)
• nortriptyline (D)(G) titrate to achieve pain relief; initially 10-25 mg tid-qid; max 150 mg/day; lower doses for elderly and adolescents
  Pediatric: not recommended
  Pamelor titrate to achieve pain relief; max 150 mg/day
  Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml (16 oz)
• protriptyline (C) titrate to achieve pain relief; initially 5 mg tid; max 60 mg/day
  Pediatric: <12 years: not recommended
  Vivactyl Tab: 5, 10 mg
• trimipramine (C) titrate to achieve pain relief; max 200 mg/day
  Pediatric: not recommended
  Surmontil Cap: 25, 50, 100 mg

PULMONARY TUBERCULOSIS (TB) (MYCOBACTERIUM TUBERCULOSIS)

SCREENING

• purifi ed protein derivative (PPD) (C) 0.1 ml intradermally; examine inoculation site for induration at 48 to 72 hours.
  Pediatric: same as adult
  Aplisol, Tubersol Soln: 5 US units/0.1 ml (1, 5 ml)

ANTI-TUBERCULAR AGENTS
Comment: Avoid streptomycin in pregnancy. pyridoxine (vitamin B-6) 25 mg once daily x 6 months should be administered concomitantly with INH for prevention of side effects. rifapentine produces red-orange discoloration of body tissues and body fluids and may stain contact lenses.

• bedaquiline (B)(G)
  Sirturo Tab: 100 mg
  Comment: bedaquiline is a diarylquinoline antimycobacterial ATP synthase for the treatment of pulmonary multi-drug resistant TB (MDR-TB).
• ethambutol (EMB) (B)(G)
  Myambutol Tab: 100, 400*mg
• isoniazid (INH) (C) Tab: 300*mg
• pyrazinamide (PZA) (C) Tab: 500*mg
• rifampin (RIF) (C)(G)
  Rifadin, Rimactane Cap: 150, 300 mg
• rifapentine (C)
  Priftin Tab: 150 mg (24, 32 ct pck)
  Comment: Th e 32-count packs of Priftin are intended for patients with active tuberculosis infection (TB). Th e 24-count packs are are intended for patients with latent tuberculosis infection (LTBI) who are at high risk for progression to tuberculosis disease. Priftin for active TB is indicated for patients =12 years-of-age.
  Priftin for LTBI is indicated for patients =2 years-of-age.
• rilipivirine (C) Tab: 25 mg
  Rifabutin Cap: 150 mg
• streptomycin (SM) (C)(G) Amp: 1 g/2.5 ml or 400 mg/ml (2.5 ml)

COMBINATION AGENTS

• rifampin/isoniazid (C)
  Rifamate Cap: rif 300 mg/iso 150 mg
• rifampin/isoniazid/pyrazinamide (C)
  Rifater Tab: rif 120 mg/iso 50 mg/pyr 300 mg

PROPHYLAXIS AFTER EXPOSURE TO TUBERCULOSIS, WITH NEGATIVE PPD

• isoniazid (C) 300 mg once daily in a single dose x at least 6 months
  Pediatric: 10-20 mg/kg/day x 9 months

PROPHYLAXIS AFTER EXPOSURE, WITH NEW PPD CONVERSION

• isoniazid (C) 300 mg once daily in a single dose x 12 months
  Pediatric: 10-20 mg/kg/day x 9 months
  Tab: 100, 300*mg; Syr: 50 mg/5 ml; Inj: 100 mg/ml
• rifampin (C) 600 mg once daily + isoniazid (C) 300 mg once daily x 4 months
  Pediatric: rifampin (C) 10-20 mg/kg + isoniazid (C) 10-20 mg/kg once daily x 4 months
• rifapentine (C) 600 mg once weekly + isoniazid (C) 300 mg once weekly x 12 weeks
  Pediatric: =12 years: Treat x 12 weeks; 10-14 kg: rifapentine (C) 300 mg once weekly + isoniazid (C) 25 mg/kg (max 900 mg) once weekly; 14.1-25 kg: rifapentine (C) 450 mg once weekly + isoniazid (C) 25 mg/kg (max 900 mg) once weekly; 25.1-32 kg: rifapentine (C) 600 mg once weekly + isoniazid (C) 25 mg/kg (max 900 mg) once weekly; 32.1-50 kg: rifapentine (C) 750 mg once weekly + isoniazid (C) 25 mg/kg (max 900 mg) once weekly; >50 kg: rifapentine (C) 900 mg once weekly + isoniazid (C) 25 mg/kg (max 900 mg) once weekly; >12 years: same as adult

ADULT TREATMENT REGIMENS (>12 YEARS)

Regimen 1

• rifampin (C) 600 mg + isoniazid (C) 300 mg + pyrazinamide (C) 2 g + ethambutol (C) 15-25 mg/kg or streptomycin (C) 1 g once daily x 8 weeks; then isoniazid (C) 300 mg + rifampin (C) 600 mg once daily x 16 weeks or isoniazid 900 mg + rifampin (C) 600 mg 2-3 times/week x 16 weeks

Regimen 2

• rifampin 600 mg + isoniazid 300 mg + pyrazinamide 2 g + ethambutol 15-25 mg/kg or streptomycin 1 g once daily x 2 weeks; then rifampin 600 mg + isoniazid 900 mg + pyrazinamide 4 g + ethambutol 50 mg/kg or streptomycin 1.5 g 2 times/week x 6 weeks; then isoniazid 300 mg + rifampin 600 mg once daily x 16 weeks or 2 times/week x 16 weeks rifampin 600 mg once daily x 16 weeks or 2 times/week x 16 weeks

Regimen 3

• rifampin 600 mg + isoniazid 900 mg + pyrazinamide 3 g + ethambutol 25-30 mg/kg or streptomycin 1.5 g 3 times/week x 6 months

Regimen 4 (for smear and culture negative for pulmonary TB in adult)

• Options 1, 2, or 3 x 8 weeks; then isoniazid 300 mg + rifampin 600 mg once daily x 16 weeks; then rifampin 600 mg + isoniazid 300 mg + pyrazinamide 2 g + ethambutol 15-25 mg/kg or streptomycin 1 g once daily x 8 weeks or 2-3 times/week x 8 weeks

Regimen 5 (for smear and culture negative for pulmonary TB in adult)

• rifanpentine 600 mg twice weekly x 2 months (at least 72 hours between doses) + once daily isoniazid 300 mg, ethambutol 15-25 mg/kg + pyrazinamide 2 g; then rifanpentine 600 mg once weekly x 4 months + once daily isoniazid 300 mg + another appropriate anti-tuberculosis agent for susceptible organisms

Regimen 6 (when pyrazinamide is contraindicated)

• rifampin 600 mg + isoniazid 300 mg + ethambutol 15-25 mg/kg + streptomycin 1 g once daily x 4-8 weeks; then isoniazid 300 mg + rifampin 600 mg once daily x 24 weeks or 2 x/week x 24  weeks

PEDIATRIC TREATMENT REGIMENS

Regimen 1

• rifampin 10-20 mg/kg + isoniazid 10-20 mg/kg + pyrazinamide 15-20 mg/kg + ethambutol 15-25 mg/kg or streptomycin 20-40 mg/kg once daily x 8 weeks; then isoniazid 10-20 mg/kg + rifampin 10-20 mg/kg once daily x 16 weeks or isoniazid 20-40 mg/kg + rifampin 10-20 mg/kg 2-3 times/week x 16 weeks

Regimen 2

• rifampin 10-20 mg/kg + isoniazid 10-20 mg/kg + pyrazinamide 15-30 mg/kg + ethambutol 15-25 mg/kg or streptomycin 20-40 mg/kg once daily x 2 weeks; then rifampin 10-20 mg/kg + isoniazid 20-40 mg/kg + pyrazinamide 50-70 mg/kg + ethambutol 50 mg/kg or streptomycin 25-30 mg/kg 2 times/week x 6 weeks; then isoniazid 10-20 mg/kg + rifampin 10-20 mg/kg once daily x 16 weeks or rifampin 10-20 mg/kg + isoniazid 20-40 mg/kg 2 times/week x 16 weeks

Regimen 3

• rifampin 10-20 mg/kg + isoniazid 20-40 mg/kg + pyrazinamide 50-70 mg/kg + ethambutol 25-30 mg/kg or streptomycin 25-30 mg/kg 3 times/week x 6 months

Regimen 4 (when pyrazinamide is contraindicated)

• rifampin 10-20 mg/kg + isoniazid 10-20 mg/kg + ethambutol 15-25 mg/kg + streptomycin 20-40 mg/kg once daily x 4-8 weeks; then isoniazid 10-20 mg/kg + rifampin 10-20 mg/kg once daily x 24 weeks or rifampin 10-20 mg/kg + isoniazid 20-40 mg/kg 2 x/week x 24 weeks

TYPE 1 DIABETES MELLITUS

Comment: Target glycosylated hemoglobin (HbA1c) is <7%. Addition of daily ACE-I and/or ARB therapy is strongly recommended for renal protection. Insulin may be indicated in the management of Type 2 diabetes with or without concomitant oral anti-diabetic agents.

TREATMENT FOR ACUTE HYPOGLYCEMIA

• glucagon (recombinant) (B) administer SC, IM, or IV; if patient does not respond in 15 minutes, may administer a single dose or 2 divided doses; <20 kg: 0.5 mg or 20-30 mg/kg; =20 kg: 1 mg
  Pediatric: same as adult

INHALED INSULIN
Rapid-Acting Inhalation Powder Insulin

• insulin human (inhaled) (C) one inhaler may be used for up to 15 days, then discard; dose at meal times as follows: Insulin naïve: initially 4 units at each meal; adjust according to blood glucose monitoring
  Conversion from SC to inhaled mealtime insulin:
  SC 1-4 units: inhal 4 units
  SC 5-8 units: inhal 8 units
  SC 9-12 units: inhal 12 units
  SC 13-16 units: inhal 16 units
  SC 17-20 units: inhal 20 units
  SC 21-24 units: inhal 24 units
  Pediatric: <18 years: not established
  Afrezza Inhalation Powder administer at the beginning of the meal; Mealtime
  insulin naïve: initially 4 units at each meal; Using SC prandial insulin: convert dose to Afrezza using a conversion table (see mfr pkg insert); Using SC pre-mixed: divide 1/2 of total daily injected pre-mixed insulin equally among 3 meals of the day; administer 1/2 total injected pre-mixed dose as once daily injected basal insulin dose
  Inhal: 4, 8, 12 unit single-inhalation color-coded cartridges (30, 60, 90/pkg w. 2 disposable inhalers)
  Comment: Afrezza is not a substitute for long-acting insulin. Afrezza must be used in combination with long-acting insulin in patients with T1DM. Afrezza is not recommended for the treatment of diabetic ketoacidosis. Afrezza is contraindicated with chronic lung disease because of the risk of acute bronchospasm. Th e use of Afrezza is not recommended in patients who smoke or who have recently stopped smoking. Each card contains 5 blister strips with 3 cartridges each (total 15 cartridges). Th e doses are color-coded. Afrezza is contraindicated with chronic respiratory disease (e.g., asthma, COPD) and patients prone to episodes of hypoglycaemia.

INJECTABLE INSULINS
Rapid-Acting Insulins

• insulin aspart (recombinant) (B) onset <15 minutes; peak 1-3 hours; duration 3-5 hours; administer 5-10 minutes prior to a meal; SC or infusion pump or IV infusion
  Pediatric: <3 years: not recommended; =3 years: same as adult
  NovoLog Vial: 100 U/ml (10 ml); PenFill cartridge: 100 U/ml (3 ml, 5/pk) (zinc, m-cresol)
• insulin glulisine (rDNA origin) (C) onset <15 minutes; peak 1 hour; duration 2-4 hours; administer up to 15 minutes before, or within 20 minutes after starting a meal; use with an intermediate or long-acting insulin; SC only; may administer via insulin pump; do not dilute or mix with other insulin in pump
  Pediatric: <4 years: not recommended; =4 years: same as adult
  Apidra Vial: 100 U/ml (10 ml); Cartridge: 100 U/ml (3 ml, 5/pck; m-cresol)
• insulin lispro (recombinant) (B) onset <15 minutes; peak 1 hour; duration 3.5-4.5 hours; administer up to 15 minutes before, or immediately after, a meal; SC or IV infusion pump only
  Pediatric: <3 years: not recommended; =3 years: same as adult
  Humalog
  Vial: 100 U/ml (10 ml); Prefilled disposable KwikPen: 100 U/ml (3 ml, 5/pck) (zinc, m-cresol); HumaPen Memoir and HumaPen Luxura HD inj device for Humulog cartridges (100 U/ml, 3 ml 5/pck) (zinc, m-cresol)
• insulin regular (B)
  Humulin R U-100 (human, recombinant) (OTC) onset 30 minutes; peak 2-4 hours; duration up to 6-8 hours; SC or IV or IM
  Vial: 100 U/ml (10 ml)
  Humulin R U-500 (human, recombinant) onset 30 minutes; peak 1.75-4 hours; duration up to 24 hours; SC only; for in-hospital use only
  Vial: 500 U/ml (20 ml); KwikPen: 3 ml (2, 5/carton)
  Comment: Humulin R U-500 formulation is 5 times more concentrated than standard U-100 concentration, indicated for adults and children who require =200 units of insulin/day, allowing patients to inject 80% less liquid to receive the desired dose. Recommend using U-500 syringe (BD, Eli Lilly). Th e U-500 syringe (0.5 ml, 6 mm x 31 gauge) is marked in 5 unit increments and allows for dosing up to 250 units.
  Iletin II Regular (pork) (OTC) onset 30 minutes; peak 2-4 hours; duration 6-8 hours; SC, IV or IM
  Vial: 100 U/ml (10 ml)
  Novolin R (human) (OTC) onset 30 minutes; peak 2.5-5 hours; duration 8 hours; SC, IV, or IM
  Vial: 100 U/ml (10 ml); PenFill cartridge: 100 U/ml (1.5 ml, 5/pck); Prefilled syringe: 100 U/ml (1.5 ml, 5/pck)
• pramlintide (amylin analogue/amylinomimetic) (C) administer immediately before major meals (=250 kcal or =30 g carbohydrates); initially 15 mcg; titrate in 15 mcg increments for 3 days if no significant nausea occurs; if nausea occurs at 45 or 60 mcg, reduce to 30 mcg; if not tolerated, consider discontinuing therapy; Maintenance: 60 mcg (30 mcg only if 60 mcg not tolerated)
  Symlin Vial: 0.6 mg/ml (5 ml) (m-cresol, mannitol)
  Comment: Symlin is indicated as adjunct to mealtime insulin with or without a sulfonylurea and/or metformin when blood glucose control is suboptimal despite optimal insulin therapy. Do not mix with insulin. When initiating Symlin, reduce preprandial short/rapid-acting insulin dose by 50% and monitor pre- and post-prandial and bedtime blood glucose. Do not use in patients with poor compliance, HgbA1c is >9%, recurrent hypoglycemia requiring assistance in the previous 6 months, or if taking a prokinetic drug. With Type 2 DM, initial therapy is 60 mcg/dose and max is 120 mcg/dose.

RAPID-ACTING AND INTERMEDIATE-ACTING INSULIN

Insulin Aspart Protamine Suspension/Insulin Aspart Combinations

• insulin aspart protamine suspension 70%/insulin aspart 30% (recombinant) (B) onset 15 min; peak 2.4 hours; duration up to 24 hours; SC only
  Pediatric: not recommended
  NovoLog Mix 70/30 (OTC) Vial: 100 U/ml (10 ml)
  NovoLog Mix 70/30 FlexPen (OTC) Prefilled disposable pen: 100 U/ml (3 ml, 5/pck); PenFill cartridge: 100 U/ml (3 ml, 5/pck)

LONG-ACTING INSULINS

• insulin detemir (human) (B) administer SC once daily with evening meal or at HS as a basal insulin; may administer twice daily (AM/PM); administer in the deltoid, abdomen, or thigh; onset 1-2 hours; peak 6-8 hours; duration 24 hours; switching from another basal insulin, dose should be the same on a unit-to-unit basis; may need more insulin detemir when switching from NPH; Type 1: starting dose 1/3 of total daily insulin requirements; rapid-acting or short-acting, pre-meal insulin should be used to satisfy the remainder of daily insulin requirements; Type 2 (inadequately controlled on oral antidiabetic agents): initially 10 units or 0.1-0.2 units/kg, once daily in the evening or divided twice daily (AM/PM); do not add-mix or dilute insulin detemir with other insulins.
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Levemir Vial: 100 U/ml (10 ml); FlexPen: 100 U/ml (3 ml, 5/pck; (zinc, m-cresol)
  Comment: Do not mix or dilute insulin detemir with other insulins.
• insulin glargine (recombinant) (C)
  Basaglar administer SC once daily, at the same time each day, as a basal insulin in the deltoid, abdomen, or thigh; onset 1-1.5 hours, no pronounced peak, duration 20-24 hours; T1DM (adults and children >6 years-of-age): initially 1/3 of total daily insulin dose; administer the remainder of the total dose as short- or rapid-acting pre-prandial insulin; T2DM (adults only): initially 2 units/kilogram or up to 10 units once daily; Switching from once daily insulin glargine 300 units/ml (i.e., Toujeo) to 100 units/ml: initially 80% of the insulin glargine 300 units/ml; Switching from twice daily NPH: initially 80% of the total daily NPH dose; do not add-mix or dilute insulin glargine with other insulins.
  Pediatric: <6 years: not established; =6 years: individualize and adjust as needed
  Prefilled KwikPen (disposable), 100 U/ml (3 ml) (5/carton) (m-cresol)
  Lantus administer SC once daily at the same time each day as a basal insulin; onset 1-1.5 hours, no pronounced peak, duration 20-24 hours; initial average starting dose 10 units for insulin-naïve patients; Switching from once daily NPH or Ultralente insulin: initial dose of insulin glargine should be on a unit-for-unit basis; Switching from twice daily NPH insulin: start at 20% lower than the total daily NPH dose
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Vial: 100 U/ml (10 ml); Cartridge: 100 U/ml (3 ml, for use in the OptiPen One
  Insulin Delivery Device) (5/carton) (m-cresol); SoloStar pen (disposable): 100 U/ml (3 ml) (5/carton)
  Toujeo administer SC once daily at the same time each day as a basal insulin; in the upper arm, abdomen, or thigh; onset of action 6 hours; duration 20-24 hours; T2DM, insulin naïve: initially 0.2 units/kg; titrate every 3-4 days; T1DM, insulin naïve: initially 1/3-1/2 total daily insulin dose; remainder as short-acting insulin divided between each meal; Switch from once daily long- or intermediate-acting insulin: on a unit-for-unit basis; Switching from Lantus: a higher daily dose is expected; Switching from twice daily NPH: reduce initial dose by 20% of total daily NPH dose
  Pediatric: <18 years: not established
  Soln for SC injection: 300 units/ml Prefilled disposable SoloStar Pen (1.5 ml, 3-5/carton)
• insulin isophane suspension (NPH) (B)
  Humulin N (human, recombinant) (OTC) onset 1-2 hours; peak 6-12 hours; duration 18-24 hours; SC only
  Vial: 100 U/ml (10 ml); Prefilled disposable pen: 100 U/ml (3 ml, 5/pck)
  Novolin N (recombinant) (OTC) onset 1.5 hours; peak 4-12 hours; duration 24 hours; SC only
  Vial: 100 U/ml (10 ml); PenFill cartridge: 1.5 ml (5/pck); KwikPens: 1.5 ml (5/pck)
  Iletin II NPH (pork) (OTC) onset 1-2 hours; peak 6-12 hours; duration 18-26 hours; SC only
  Vial: 100 U/ml (10 ml)
• insulin zinc suspension (lente) (B)
  Pediatric: <18 years: not recommended
  Humulin L (human) (OTC) onset 1-3 hours; peak 6-12 hours; duration 18-24 hours; SC only
  Vial: 100 U/ml (10 ml)
  Iletin II Lente (pork) (OTC) onset 1-3 hours; peak 6-12 hours; duration 18-26 hours; SC only
  Vial: 100 U/ml (10 ml)
  Novolin L (human) (OTC) onset 2.5 hours; peak 7-15 hours; duration 22 hours; SC only
  Vial: 100 U/ml (10 ml)

Ultra Long-Acting Insulin

• insulin deglutec (insulin analog) (C) administer by SC injection once daily at any time of day, with or without food, into the upper arm, abdomen, or thigh; titrate every 3-4 days; Insulin naïve with type 1 diabetes: initially 1/3-1/2 of total daily insulin dose, usually 0.2-0.4 units/kg; administer the remainder of the total dose as short-acting insulin divided between each daily meal; Insulin naive with type 2 diabetes: initially 10 units once daily; adjust dose of concomitant oral antidiabetic agent; Already on insulin (type 1 or type 2): initiate at same unit dose as total daily long- or
  intermediate-acting insulin unit dose Pediatric: <1 year: not established; =1 year: same as adult
  Tresiba FlexTouch Pen: 100 U/ml (3 ml, 5 pens/carton), 200 U/ml (3 ml, 3 pens/carton) (zinc, m-cresol)
  Comment: Tresiba U-200 FlexTouch is the only long-acting insulin in a 160-unit pen allowing up to 160 units in a single injection. Th e U-200 dose counter always shows the desired dose (i.e., no conversion from U/100 to U-200 is required)
• insulin extended zinc suspension (Ultralente) (human) (B) onset 4-6 hours; peak 8-20 hours; duration 24-48 hours; SC only
  Pediatric: <18 years: not recommended
  Humulin U (OTC) Vial: 100 U/ml (10 ml)

Insulin Lispro Protamine/Insulin Lispro Combinations

• insulin lispro protamine75%/insulin lispro 25% (B)
  Pediatric: <18 years: not recommended
  Humalog Mix 75/25 (human) onset 15 minutes; peak 30 minutes to 1 hour; duration 24 hours; SC only
  Vial: 100 U/ml (10 ml); Prefilled disposable KwikPen: 100 U/ml (3 ml, 5/pck) (zinc, m-cresol); HumaPen Memoir and HumaPen Luxura HD inj device for Humalog cartridges (100 U/ml, 3 ml, 5/pck) (zinc, m-cresol)
• insulin lispro protamine 50%/insulin lispro 50% (B)
  Pediatric: <18 years: not recommended
  Humalog Mix 50/50 (recombinant) (B) onset 15 minutes; peak 2.3 hours; range 1-5 hours; SC only
  Vial: 100 U/ml (10 ml); Prefilled disposable KwikPen: 100 U/ml (3 ml, 5/pck) (zinc, m-cresol); HumaPen Memoir and Huma-Pen Luxura HD inj device for
  Humalog cartridges (100 U/ml, 3 ml, 5/pck) (zinc, m-cresol)

Insulin Isophane Suspension (NPH)/Insulin Regular Combinations

• NPH 70%/regular 30% (B)
  Pediatric: same as adult
  Humulin 70/30 (human, recombinant) (OTC) onset 30 minutes; peak 2-12 hours; duration up to 24 hours; SC only
  Vial: 100 U/ml (10 ml)
  Novolin 70/30 (recombinant) (OTC) onset 30 minutes; peak 2-12 hours; duration up to 24 hours; SC only
  Vial: 100 U/ml (10 ml)
  NPH 50%/regular 50% (B)
  Pediatric: <18 years: not recommended
  Humulin 50/50 (human) (OTC) onset 30 minutes; peak 3-5 hours; duration up to 24 hours; SC only
  Vial: 100 U/ml (10 ml)

Insulin Lispro Protamine/Insulin Lispro Combinations

• insulin lispro protamine 75%/insulin lispro 25% (B)
  Pediatric: <18 years: not recommended
  Humalog Mix 75/25 (recombinant) onset 15 minutes; peak 30-90 minutes; duration 24 hours; SC only
  Vial: 100 U/ml (10 ml); Prefilled disposable KwikPen: 100 U/ml (3 ml, 5/pck) (zinc, m-cresol); HumaPen Memoir and Huma-Pen Luxura HD inj device for
  Humalog cartridges (100 U/ml, 3 ml 5/pck) (zinc, m-cresol)
• insulin lispro protamine 50%/insulin lispro 50% (B)
  Pediatric: <18 years: not recommended
  Humalog Mix 50/50 (recombinant) onset 15 minutes; peak 1 hour; duration up to 16 hours; SC only
  Vial: 100 U/ml (10 ml); Prefilled disposable KwikPen: 100 U/ml (3 ml, 5/pck) (zinc, m-cresol); HumaPen Memoir and HumaPen LUXURA HD inj device for Humalog cartridges (100 U/ml, 3 ml 5/pck) (zinc, m-cresol); U/ml (3 ml, 5/pck) (zinc, m-cresol); HumaPen Memoir and HumaPen LUXURA HD inj device for Humalog cartridges (100 U/ml, 3 ml 5/pck) (zinc, m-cresol); (100 U/ml, 3 ml 5/pck (zinc, m-cresol)

Basal Insulin/GLP-1 RA Combinations

• insulin degludec (insulin analog)/liraglutide (C) for treatment of type 2 diabetes only in adults inadequately controlled on <50 units of basal insulin daily or =1.8 mg of liraglutide daily; administer by SC injection once daily, with or without food, into the upper arm, abdomen, or thigh; titrate every 3-4 days
  Pediatric: <18 years: not recommended
  Xultophy Prefilled pen: 100/3.6 U/ml (3 ml, 5 pens/carton)
• insulin glargine (insulin analog)/lixisenatide (C) for treatment of type 2 diabetes only in adults inadequately controlled on <60 units of basal insulin daily or lixisenatide; administer by SC injection once daily, with or without food, into the upper arm, abdomen, or thigh; titrate every 3-4 days
  Pediatric: <18 years: not recommended
  Soliqua Prefilled pen: 100/33 U/ml (3 ml, 5 pens/carton) covering 15-60 mg insulin glargine 100 units/ml and 15-20 mcg of lixisenatide (m-cresol)

TYPE 2 DIABETES MELLITUS

Comment: Normal fasting glucose is <100 mg/dL. Impaired glucose tolerance is a risk factor for type 2 diabetes and a marker for cardiovascular disease risk; it occurs early in the natural history of these two diseases. Impaired fasting glucose is >100 mg/dL and <125 mg/dL. Impaired glucose tolerance is OGTT, 2 hour post-load 75 g glucose >140 mg/dL and <200 mg/dL. Target pre-prandial glucose is 80 mg/dL to 120 mg/dL. Target bedtime glucose is 100mg/dL to 140 mg/dL. Target glycosylated hemoglobin (HbA1c) is <7.0%. Addition of daily ACE-I and/or ARB therapy is strongly recommended for renal protection. Consider diabetes screening at age 25 years for persons in high-risk groups (non-Caucasian, positive family history for DM, obesity). Hypertension and hyperlipidemia are common comorbid conditions. Macrovascular complications include cerebral vascular disease, coronary artery disease, and peripheral vascular disease. Microvascular complications include retinopathy, nephropathy, neuropathy, and cardiomyopathy. Oral hypoglycemics are contraindicated in pregnancy.

Insulins see Type 1 Diabetes Mellitus page 426

TREATMENT FOR ACUTE HYPOGLYCEMIA

• glucagon (recombinant) (B) administer SC, IM, or IV; if patient does not respond in 15 minutes, may administer a single or 2 divided doses
  Adults and Children: <20 kg: 0.5 mg or 20-30 mg/kg; >20 kg: 1 mg

SULFONYLUREAS
Comment: Sulfonylureas are secretagogues (i.e., stimulate pancreatic insulin secretion); therefore, the patient taking a sulfonylurea should be alerted to the risk for hypoglycemia. Action is dependent on functioning beta cells in the pancreatic islets.

1st Generation Sulfonylureas

• chlorpropamide (C)(G) initially 250 mg/day with breakfast; max 750 mg
  Pediatric: not recommended
  Diabinese Tab: 100*, 250*mg
• tolazamide (C)(G) initially 100-250 mg/day with breakfast; increase by 100-250 mg/day at weekly intervals; maintenance 100 mg 1 g/day; max 1 g/day
  Pediatric: not recommended
  Tolinase Tab: 100, 250, 500 mg
• tolbutamide (C) initially 1-2 g in divided doses; max 2 g/day
  Pediatric: not recommended
  Tab: 500 mg

2nd Generation Sulfonylureas

• glimepiride (C) initially 1-2 mg once daily with breakfast; after reaching dose of 2 mg, increase by 2 mg at 1-2 week intervals as needed; usual maintenance 1-4 mg once daily; max 8 mg/day
  Pediatric: not recommended
  Amaryl Tab: 1*, 2*, 4*mg
• glipizide (C)(G)
  Pediatric: not recommended
  Glucotrol initially 5 mg before breakfast; increase by 2.5-5 mg every few days if needed; max 15 mg/day; max 40 mg/day in divided doses
  Tab: 5*, 10* mg
  Glucotrol XL initially 5 mg with breakfast; usual range 5-10 mg/day; max 20 mg/day
  Tab: 2.5, 5, 10 mg ext-rel
• glyburide (C)(G) initially 2.5-5 mg/day with breakfast; increase by 2.5 mg at weekly intervals; maintenance 1.25-20 mg/day in a single or 2 divided doses; max 20 mg/day
  Pediatric: not recommended
  DiaBeta, Micronase Tab: 1.25*, 2.5*, 5*mg
• glyburide, micronized (B)
  Pediatric: not recommended
  Glynase PresTab initially 1.5-3 mg/day with breakfast; increase by 1.5 mg at weekly intervals if needed; usual maintenance 0.75-12 mg/day in single or divided doses; max 12 mg/day
  Tab: 1.5*, 3*, 6*mg

ALPHA-GLUCOSIDASE INHIBITORS
Comment: Alpha-glucosidase inhibitors block the enzyme that breaks down carbo-hydrates in the small intestine, delaying digestion and absorption of complex carbo-hydrates, and lowering peak post-prandial glycemic concentrations. Use as monotherapy or in combination with a sulfonylurea. Contraindicated in inflammatory bowel disease, colon ulceration, and intestinal obstruction. Side effects include flatulence, diarrhea, and abdominal pain.

• acarbose (B) initially 25 mg tid ac, increase at 4-8 week intervals; or initially 25 mg once daily, increase gradually to 25 mg tid; usual range 50-100 mg tid; max 100 mg tid
  Pediatric: not recommended
  Precose Tab: 25, 50, 100 mg
• miglitol (B) initially 25 mg tid at the start of each main meal, titrated to 50 mg tid at the start of each main meal; max 100 mg tid
  Pediatric: not recommended
  Glyset Tab: 25, 50, 100 mg

BIGUANIDE
Comment: Th e biguanides decrease gluconeogenesis by the liver in the presence of insulin. Action is dependent on the presence of circulating insulin. Lower hepatic glucose production leads to lower overnight, fasting, and pre-prandial plasma glucose levels. Common side effects include GI distress, nausea, vomiting, bloating, and flatulence which usually eventually resolve. May be used as monotherapy (in adults only) or with a sulfonylurea or insulin.

• metformin (B)(G) take with meals
  Comment: metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.
  Fortamet initially 1000 mg once daily; may increase by 500 mg/day at 1 week intervals; max 2.5 g/day
  Pediatric: <17 years: not recommended
  Tab: 500, 1000 mg ext-rel
  Glucophage initially 500 mg bid; may increase by 500 mg/day at 1 week intervals; max 1 g bid or 2.5 g in 3 divided doses; or initially 850 mg once daily in AM; may increase by 850 mg/day in divided doses at 2 week intervals; max 2000 mg/day; take with meals
  Pediatric: <10 years: not recommended; =10-16 years: use only as monotherapy; dose same as adult
  Tab: 500, 850, 1000*mg
  Glucophage XR initially 500 mg by mouth every evening; may increase by 500 mg/day at 1 week intervals; max 2 g/day
  Pediatric: <10 years: not recommended; =10-16 years: use immediate release form; >16 years: same as adult
  Tab: 500, 750 mg ext-rel
  Glumetza ER (G) initially 1000 mg once daily; may increase by 500 mg/day at week intervals; max 2 g/day
  Pediatric: <18 years: not recommended
  Tab: 500, 1000 mg ext-rel
  Riomet XR initially 500 mg once daily; may increase by 500 mg/day at 1 week intervals; max 2 g/day in divided doses; take with meals
  Pediatric: <10 years: not recommended; =10 years: monotherapy only
  Oral soln: 500 mg/ml (4 oz; cherry)

MEGLITINIDES
Comment: Meglitinides are secretagogues (i.e., stimulate pancreatic insulin secretion) in response to a meal. Action is dependent on functioning beta cells in the pancreatic islets. Use as monotherapy or in combination with metformin.

• nateglinide (C) 60-120 mg tid ac 1-30 minutes prior to start of the meal
  Pediatric: not recommended
  Starlix Tab: 60, 120 mg
• repaglinide (C)(G) initially 0.5 mg with 2-4 meals/day; take 30 minutes ac; titrate by doubling dose at intervals of at least 1 week; range 0.5-4 mg with 2-4 meals/day; max 16 mg/day
  Pediatric: not recommended
  Prandin Tab: 0.5, 1, 2 mg

THIAZOLIDINEDIONES (TZDs)
Comment: Th e TZDs decrease hepatic gluconeogenesis and reduce insulin resistance (i.e., increase glucose uptake and utilization by the muscles). Liver function tests are indicated before initiating these drugs. Do not start if ALT more than 3 times greater than normal. Recheck ALT monthly for the fi rst six months of therapy; then every two months for the remainder of the fi rst year and periodically thereafter. Liver function tests should be obtained at the fi rst symptoms suggestive of hepatic dysfunction (nausea, vomiting, fatigue, dark urine, anorexia, abdominal pain).

• pioglitazone (C)(G) initially 15-30 mg once daily; max 45 mg/day as a monotherapy; usual max 30 mg/day in combination with metformin, insulin, or a sulfonylurea
  Pediatric: <18 years: not recommended
  Actos Tab: 15, 30, 45 mg
• rosiglitazone (C)(G) initially 4 mg/day in a single or 2 divided doses; may increase after 8-12 weeks; max 8 mg/day as a monotherapy or combination therapy with metformin or a sulfonylurea; not for use with insulin
  Pediatric: <18 years: not recommended
  Avandia Tab: 2, 4, 8 mg

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR/THIAZOLIDINEDIONE COMBINATION
Comment: Th e FDA has reported that alogliptin-containing drugs may increase the risk of heart failure, especially in patients who already have cardiovascular or renal disease. Th e drug Oseni (alogliptin/pioglitazone) is in this risk group.

• alogliptin/pioglitazone (C) take 1 dose once daily with fi rst meal of the day; max: rosiglitazone 8 mg and max glimepiride per day; Same precautions as alogliptin and pioglitazone
  Pediatric: <18 years: not recommended
  Oseni
  Tab: Oseni 12.5/15: alo 12.5 mg/pio 15 mg;
  Oseni 12.5/30: alo 12.5 mg/pio 30 mg
  Oseni 12.5/45: alo 12.5 mg/pio 45 mg
  Oseni 25/15: alo 25/pio 15 mg
  Oseni 25/30: alo 25/pio 30 mg
  Oseni 25/45: alo 25 mg/pio 45 mg

2ND GENERATION SULFONYLUREA/BIGUANIDE COMBINATIONS
Comment: Metaglip and Glucovance are combination secretagogues (sulfonylureas) and insulin sensitizers (biguanides). Sulfonylurea: Action is dependent on functioning beta cells in the pancreatic islets; patient should be alerted to the risk for hypoglycemia. Common side effects of the biguanide include GI distress, nausea, vomiting, bloating, and flatulence which usually eventually resolve. Take with food. metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.

• glipizide/metformin (C) take with meals; Primary therapy: 2.5/250 once daily or if FBS is 280-320 mg/dL, may start at 2.5/250 bid; may increase by 1 tab/day every 2 weeks; max 10/2000 per day in 2 divided doses; Second Line Therapy: 2.5/500 or 5/500 bid; may increase by up to 5/500 every 2 weeks; max: 20/2000 per day; Same precautions as glipizide and metformin
  Pediatric: not recommended
  Metaglip
  Tab: Metaglip 2.5/250: glip 2.5 mg/met 250 mg
  Metaglip 2.5/500: glip 2.5 mg/met 500 mg
  Metaglip 5/500: glip 5 mg/met 500 mg
• glyburide/metformin (B) take with meals; Primary therapy (initial therapy if HgbA1c <9.0%): initially 1.25/250 once daily; max glyburide 20 mg and metformin 2000 mg per day; Primary therapy (initial therapy if HbA1c >9.0% or FBS >200): initially 1.25/250 bid; max glyburide 20 mg and metformin 2000 mg per day; Second line therapy (initial therapy if HbA1c >7.0%): initially 2.5/500 or 5/500 bid; max glyburide 20 mg and metformin 2000 mg per day; Previously treated with a sulfonylurea and metformin: dose to approximate total daily doses of glyburide and metformin already being taken; max: glyburide 20 mg and metformin 2000 mg per day; Same precautions as glyburide and metformin
  Pediatric: not recommended
  Glucovance
  Tab: Glucovance 1.25/250: glyb 1.25 mg/met 250 mg
  Glucovance 2.5/500: glyb 2.5 mg/met 500 mg
  Glucovance 5/500: glyb 5 mg/met 500 mg
  Comment: metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.

THIAZOLIDINEDIONE/BIGUANIDE COMBINATION

• pioglitazone/metformin (C) take in divided doses with meals; Previously on metformin alone: initially 15mg/500mg or 15mg/850 mg once or twice daily; Previously on pioglitazone alone: initially 15mg/500mg bid; Previously on pioglitazone and metformin: switch on a mg/mg basis; may increase after 8-12 weeks; max: pioglitazone 45 mg and metformin 2000 mg per day; Same precautions as pioglitazone and metformin
  Pediatric: not recommended
  Actoplus Met, Actoplis Met R (G)
  Tab: Actoplus Met 15/500: pio 15 mg/met 500 mg
  Actoplus Met 15/850: pio 15 mg/met 850 mg
  Actoplus Met XR 15/1000: pio 15 mg/met 1000 mg
  Actoplus Met XR 30/1000: pio 30 mg/met 1000 mg
  Comment: metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.
• rosiglitazone/metformin (C) take in divided doses with meals; Previously on metformin alone: add rosiglitazone 4 mg/day; may increase after 8-12 weeks; Previously on rosiglitazone alone: add metformin 1000 mg/day; may increase after 1-2 weeks; Previously on rosiglitazone and metformin: switch on a mg/mg basis; may increase rosiglitazone by 4 mg and/or metformin by 500 mg per day; max: rosiglitazone 8 mg and metformin 2000 mg per day; Same precautions as rosiglitazone and metformin
  Pediatric: not recommended
  Avandamet
  Tab: Avandamet 2/500: rosi 2 mg/met 500 mg
  Avandamet 2/1000: rosi 2 mg/met 1000 mg
  Avandamet 4/500: rosi 4 mg/met 500 mg
  Avandamet 4/1000: rosi 4 mg/met 1000 mg
  Comment: rosiglitazone has been withdrawn from retail pharmacies. In order to enroll and receive rosiglitazone, healthcare providers and patients must enroll in the Avandia-Rosiglitazone Medicines Access Program. Th e program limits the use of rosiglitazone to patients already being treated successfully, and those whose blood sugar cannot be controlled with other antidiabetic medicines. metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.

THIAZOLIDINEDIONE/SULFONYLUREA COMBINATIONS

• pioglitazone/glimepiride (C) take 1 dose daily with fi rst meal of the day; Previously on sulfonylurea alone: initially 30mg/2mg; Previously on pioglitazone and glimepiride: switch on a mg/mg basis; max: pioglitazone 30 mg and glimepiride 4 mg per day; Same precautions as pioglitazone and glimepiride
  Pediatric: <18 years: not recommended
  Duetact
  Tab: Duetact 30/2: pio 30 mg/glim 2 mg
  Duetact 304: pio 30 mg/glim 4 mg
• rosiglitazone/glimepiride (C) take 1 dose daily with fi rst meal of the day; max: rosiglitazone 8 mg and glimepiride 4 mg per day; Same precautions as rosiglitazone and glimepiride
  Pediatric: <18 years: not recommended
  Avandaryl
  Tab: Avandaryl 4/1: rosi 4 mg/glim 1 mg
  Avandaryl 4/2: rosi 4 mg/glim 2 mg
  Avandaryl 4/4: rosi 4 mg/glim 4 mg
  Avandaryl 8/2: rosi 8 mg/glim 2 mg
  Avandaryl 8/4: rosi 8 mg/glim 4 mg

GLUCAGON-LIKE PEPTIDE-1 (GLP-1) RECEPTOR AGONISTS
Comment: GLP-1 receptor agonists act as an agonist at the GLP-1 receptors. Th ey have a longer half-life than the native protein allowing them to be dosed once daily. Th ey increase intracellular cAMP resulting in insulin release in the presence of increased serum concentration, decrease glucagon secretion, and delay gastric emptying, thus, reducing fasting, premeal, and post-prandial glucose throughout the day. GLP-1 receptor agonists are not a substitute for insulin, not for treatment of DKA, and not for post-prandial administration.

• albiglutide (C) administer by SC injection into the upper arm, abdomen, or thigh once daily; initially 30 mg once weekly on the same day; may increase to max 50 mg once weekly
  Pediatric: <18 years: not established
  Tanzeum Prefilled pen/syringe: 30, 50 mg/pen pwdr for injection after reconstitution (4/pck) (preservative-free)
• dulaglutide (C) administer by SC injection into the upper arm, abdomen, or thigh once daily; initially 0.6 mg/day for 1 week; then 1.2 mg/day; may increase to max 1.8 mg/day; if more than 3 days since last dose, restart at 0.6 mg/day and titrate as before
  Pediatric: <18 years: not established
  Trulicity Prefilled pen/syringe: 0.75, 1.5 mg/0.5 ml single-dose (4/pck)
• exenatide (C) administer by SC injection into the upper arm, abdomen, or thigh
  Pediatric: not recommended
  Bydureon administer 2 mg weekly (every 7 days); inject immediately after mixing; if changing from Byetta, discontinue and start Vial: 2 mg pwdr for reconstitution (1 vial pwdr and 1 syringe Prefilled w. diluents, vial connector, and needles, 4/pck)
  Byetta inject within 60 minutes before AM and PM meals; initially 5 mcg/dose; may increase to 10 mcg/dose after one month
  Prefilled pen: 250 mcg/ml (5, 10 mcg/dose; 60 doses, needles not included) (m-cresol, mannitol)
• liraglutide (C) administer by SC injection into the upper arm, abdomen, or thigh once daily; initially 0.6 mg/day for 1 week; then 1.2 mg/day; may increase to 1.8 mg/day
  Pediatric: <18 years: not recommended
  Victoza Prefilled pen: 6 mg/ml (3 ml; needles not included)
• lixisenatide (C) administer SC in the upper arm, abdomen, or thigh once daily; initially 10 mcg SC x 14 days; maintenance: 20 mcg beginning on day 15; administer within one hour of the fi rst meal of the day and the same meal of the day
  Pediatric: <18 years: not established
  Adlyxin Soln for SC inj; Starter Pen: 50 mcg/ml (14 doses of 10 mcg; 3 ml); Maintenance Pen: 100 mcg/ml (14 doses of 20 mcg); Starter Pack: 1 Prefilled starter pen and 1 Prefilled maintenance pen; Maintenance Pack: 2 Prefilled maintenance pens
  Comment: Adlyxin is indicated as an adjunct to diet and exercise for T2DM. Not indicated for treatment of T1DM. Do not use with Victoza, Saxenda, other GLP-1 receptor agonists, or insulin. Contraindicated with gastroparesis and GFR <15 mL/min. Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, stillbirth and delivery complications. Poorly controlled diabetes increases the fetal risk for major birth defects, still birth, and macrosomia related morbidity. Adlyxin should be used during pregnancy only if the potential benefit justifi es the potential risk to the fetus. Estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS
Comment: SGLT2 inhibitors block the SGLT2 protein involved in 90% of glucose reabsorption in the proximal renal tubule, resulting in increased renal glucose excretion (typically >2000 mg/dL), and lower blood glucose levels (low risk of hypoglycemia), modest weight loss, and mild reduction in blood pressure (probably due to sodium loss). Th ese agents probably also increase insulin sensitivity, decrease gluconeogenesis, and improve insulin release from pancreatic beta cells. SGLT2 inhibitors are contraindicated in T1DM, and are decreased or contraindicated with decreased GFR, increased SCr, renal failure, ESRD, renal dialysis, metabolic acidosis, or diabetic ketoacidosis. Th e most commen side effects are UTI, female genital mycotic infection, and increased urination. Th ese effects may be managed with adequate hydration and genital hygiene. Th e SGLT2 inhibitors are not recommended in nursing women. Th ere is potential for a hypersensitivity reaction to include angioedema and anaphylaxis. Caution with SGLT2 use due to reports of increased risk of treatment-emergent bone fractures.

• canagliflozin (C) take one tab before the fi rst meal of the day; initially 100 mg; may titrate up to max 300 mg once daily; GFR <45 mL/min: do not initiate
  Pediatric: <18 years: not established
  Invokana Tab: 100, 300 mg
  Comment: Invokana is contraindicated with GFR <45 mL/min; If GFR 45-=60 mL/min, max 100 mg once daily or consider other antihyperglycemic
• dapagliflozin (C) take one tab before the fi rst meal of the day; initially 5 mg; may increase to max 10 mg once daily
  Pediatric: <18 years: not established
  Farxiga Tab: 5, 10 mg
  Comment: Farxiga is contraindicated with GFR <60 mL/min.
• empagliflozin (C) take one tab before the fi rst meal of the day; initially 10 mg; may increase to max 25 mg once daily
  Pediatric: <18 years: not established
  Jardiance Tab: 10, 25 mg
  Comment: Jardiance is contraindicated with GFR <45 mL/min.

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITOR/BIGUANIDE COMBINATIONS
Comment: Caution with SGLT2 use due to reports of increased risk of treatmentemergent bone fractures. metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.

• canagliflozin/metformin (C) take 1 dose twice daily with meals; max daily dose 300/2000; GFR 45-=60 mL/min: canagliflozin max 100 mg once daily or consider other antihyperglycemic; GFR <45 mL/min: do not initiate
  Pediatric: <18 years: not established
  Invokamet
  Tab: Invokanamet 50/500: cana 50 mg/met 500 mg
  Invokanamet 50/1000: cana 50 mg/met 1000 mg
  Invokanamet 150/500: cana 150 mg/met 500 mg
  Invokanamet 150/1000: cana 150 mg/met 1000 mg
• dapagliflozin/metformin (C) swall whole; do not crush or chew; take once daily fi rst meal of the day; max daily dose 10/2000
  Pediatric: <18 years: not established
  Xigduo XR
  Tab: Xigduo XR 5/500: dapa 5 mg/met 500 mg ext-rel
  Xigduo XR 5/1000: dapa 5 mg/met 1000 mg ext-rel
  Xigduo XR 10/500: dapa 10 mg/met 500 mg ext-rel
  Xigduo XR 10/1000: dapa 10 mg/met 1000 mg ext-rel
  Comment: Xigduo is contraindicated with GFR <60 mL/min, SCr >1.5 (men), or SCr >1.4 (women)
• empagliflozin/metforman (C) take 1 dose twice daily with meals; max daily dose 25/2000
  Pediatric: <18 years: not established
  Synjardy
  Tab: Synjardy 5/500: empa 5 mg/met 500 mg
  Synjardy 5/1000: empa 5 mg/met 1000 mg
  Synjardy 12.5/500: empa 12.5 mg/met 500 mg
  Synjardy 12.5/1000: empa 12.5 mg/met 1000 mg
  Synjardy XR
  Tab: Synjardy XR 5/1000: empa 5 mg/met 1000 mg
  Synjardy XR 12.5/1000: empa 12.5 mg/met 1000 mg
  Synjardy XR 10/1000: empa 10 mg/met 1000 mg
  Synjardy XR 25/1000: empa 25 mg/met 1000 mg
  Comment: Synjardy is contraindicated with GFR <45 mL/min, SCr >1.5 (men), or SCr >1.4 (women).

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITOR/DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR COMBINATION
Comment: Caution with SGLT2 use due to reports of increased risk of treatmentemergent bone fractures.

• empagliflozin/linagliptin (C) initially 10/5 once daily with the fi rst meal of the day; max daily dose 25/5
  Pediatric: <18 years: not established
  Glyxambi
  Tab: Glyxambi 10/5: empa 10 mg/lina 5 mg
  Glyxambi 25/5: empa 25 mg/lina 5 mg
  Comment: Glyxambi is contraindicated with GFR <45 mL/min.

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR
Comment: DPP-4 is an enzyme that degrades incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Th us, DPP-4 inhibitors increase the concentration of active incretin hormones, stimulating the release of insulin in a glucose-dependent manner and decreasing the levels of circulating glucagon. Th e FDA has reported that saxagliptin- and alogliptin-containing drugs may increase the risk of heart failure, especially in patients who already have cardiovascular or renal disease. Drugs in this risk group include Nesina (alogliptin) and Onglyza (saxagliptin)

• algogliptin (B) take twice daily with meals; max 25 mg/day
  Pediatric: <18 years: not recommended
  Nesina Tab: 6.25, 12.5, 25 mg
• linagliptin (B) 5 mg once daily
  Pediatric: <18 years: not recommended
  Tradjenta Tab: 5 mg
• saxagliptin (B) 2.5-5 mg once daily
  Pediatric: <18 years: not recommended
  Onglyza Tab: 2.5, 5 mg
• sitagliptin (B) as monotherapy or as combination therapy with metfor- min or a TZD
  Pediatric: <18 years: not recommended
  Januvia 25-100 mg once daily
  Tab: 25, 50, 100 mg

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR/BIGUANIDE COMBINATIONS
Comment: DPP-4 inhibitor/metformin combinations are contraindicated with renal impairment (men: SCr =1.5 mg/dL; women: SCr =1.4 mg/dL) or abnormal CrCl, metabolic acidosis, ketoacidosis, or history of angioedema. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents. Avoid in the elderly, malnourished, dehydrated, or with clinical or lab evidence of hepatic disease. For other DPP-4 and/or metformin precautions, see mfr pkg insert. The FDA has reported that saxagliptin- and alogliptin-containing drugs may increase the risk of heart failure, especially in patients who already have cardiovascular or renal disease. These drugs include: Onglyza (saxagliptin), Kombiglyze XR (saxagliptin/metformin), Nesina (alogliptin), Kazano (alogliptin/metformin), and Oseni (alogliptin/pioglitazone).

• alogliptin/metformin (B) take twice daily with meals; max algogliptin 25 mg/day, max metformin 2000 mg/day
  Pediatric: <18 years: not recommended
  Kazano
  Tab: Kazano 12.5/500: algo 12.5 mg/met 500 mg
  Kazano 2.5/1000: algo 12.5 mg/met 1000 mg
• linagliptin/metformin (B)
  Pediatric: <18 years: not recommended
  Jentadueto take twice daily with meals; max linagliptin 5 mg/day, max metformin 2000 mg/day
  Tab: Jentadueto 2.5/500: lina 2.5 mg/met 500 mg film-coat
  Jentadueto 2.5/850: lina 2.5 mg/met 850 mg film-coat
  Jentadueto 2.5/1000: lina 2.5 mg/met 1000 mg film-coat
  Jentadueto XR Currently not treated with metformin: initiate Jentadueto XR 5/1000 once daily; Already treated with metformin: initiate Jentadueto XR 5 mg linagliptin total daily dose and a similar total daily dose of metformin once daily; Already treated with linagliptin and metformin or Jentadueto: switch to Jentadueto XR containing 5 mg of linagliptin total daily dose and a similar total daily dose of metformin once daily; max linagliptin 5 mg and metformin 2000 mg; take as a single dose once daily; take with food; do not crush or chew eGFR <30 mL/min: contraindicated; eGFR 30-45 mL/min: not recommended
  Tab: Jentadueto 2.5/1000: lina 2.5 mg/met 1000 mg film-coat ext-rel
  Jentadueto 5/1000: lina 5 mg/met 1000 mg film-coat ext-rel
• saxagliptin/metformin (B) take once daily with meals; max saxagliptin 5 mg/day, max metformin 2000 mg/day; do not crush or chew
  Pediatric: <18 years: not recommended
  Kombiglyze XR
  Tab: Kombiglyze XR 5/500: saxa 5 mg/met 500 mg
  Kombiglyze XR 2.5/1000: saxa 2.5 mg/met 1000 mg
  Kombiglyze XR 5/1000: saxa 5 mg/met 1000 mg
  Comment: Th e FDA has reported that saxagliptin-containing drugs may increase the risk of heart failure, especially in patients who already have cardiovascular or renal disease. Th e drug Kombiglyze XR (saxagliptin/metformin) is in this risk group. metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.
• sitagliptin/metformin (B) take twice daily with meals; max sitagliptin 100 mg/day, max metformin 2000 mg/day
  Pediatric: <18 years: not recommended
  Janumet
  Tab: Janumet 50/500: sita 50 mg/met 500 mg
  Janumet 50/1000: sita 50 mg/met 1000 mg
  Janumet XR
  Tab: Janumet XR 50/500: sita 50 mg/met 500 mg ext-rel
  Janumet XR 50/1000: sita 50 mg/met 1000 mg ext-rel
  Janumet XR 100/1000: sita 100 mg/met 1000 mg ext-rel
  Comment: metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.

MEGLITINIDE/BIGUANIDE COMBINATION

• repaglinide/metformin (C)(G) take in 2-3 divided doses within 30 minutes before food; max 4/1000 per meal and 10/2000 per day
  Pediatric: not recommended
  Prandimet
  Tab: Prandimet 1/500: repa 1 mg/met 500 mg
  Prandimet 2/500: repa 2 mg/met 500 mg
  Comment: metformin is contraindicated with renal impairment, metabolic acidosis, ketoacidosis. Suspend metformin, prior to, and for 48 hours after, surgery or receiving IV iodinated contrast agents.

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR/HMG-COA REDUCTASE INHIBITOR COMBINATION

• sitagliptin/simvastatin (B) take once daily in the PM; swallow whole; adjust dose if needed after 4 weeks; Concomitant verapamil or diltiazem: max 100/10 once daily; Concomitant amiodarone, amlodipine, or ranolazine: max 100/20 once daily; Homogenous familial hypercholesterolemia: max 100/40 once daily; Chinese patients taking lipid-modifying doses (>1 g/day niacin) of niacin-containing products: caution with 100/40 dose; increase risk of myopathy
  Pediatric: <18 years: not recommended
  Juvisync
  Tab: Juvisync 100/10: sita 100 mg/simva 10 mg
  Juvisync 100/20: sita 100 mg/simva 20 mg
  Juvisync 100/40: sita 100 mg/simva 40 mg

DOPAMINE RECEPTOR AGONIST

• bromocriptine mesylate (B) take with food in the morning within 2 hours of waking; initially 0.8 mg once daily; may increase by 0.8 mg/week; max 4.8 mg/week; Severe psychotic disorders: not recommended
  Pediatric: not recommended
  Cycloset Tab: 0.8 mg
  Comment: Cycloset is an adjunct to diet and exercise to improve glycemic control. Contraindicated with syncopal migraines, nursing mothers, and other ergot-related drugs.

Bile Acid Sequestrant

• colesevelam (B) Monotherapy: 3 tabs bid or 6 tabs once daily or one 1.875 g pkt bid or one 3.75 g pkt once daily
  Pediatric: not recommended
  WelChol Tab: 625 mg; Pwdr for oral susp: 1.875 g pwdr pkts (60/carton); 3.75 g pwdr pkts (30/carton) (citrus; phenylalanine)
  Comment: colesevelam (WelChol) is indicated as an adjunctive therapy to improve glycemic control in adults with type 2 diabetes. It can be added to metformin, sulfonylureas, or insulin alone or in combination with other antidiabetic agents

TYPHOID FEVER (SALMONELLA TYPHI)

PRE-EXPOSURE PROPHYLAXIS

• typhoid vaccine, oral, live, attenuated strain
  Vivotif Berna 1 cap every other day, 1 hour before a meal, with a lukewarm (not > body temperature) or cold drink for a total of 4 doses; do not crush or chew; complete therapy at least 1 week prior to expected exposure; re-immunization recommended every 5 years if repeated exposure
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Cap: ent-coat
• typhoid Vi polysaccharide vaccine (C)
  Typhim Vi 0.5 ml IM in deltoid; re-immunization recommended every 2 years if repeated exposure
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Vial: 20, 50 dose; Prefilled syringe: 0.5 ml
  Comment: Febrile illness may require delaying administration of the vaccine; have epinephrine 1:1000 readily available.

TREATMENT

• azithromycin (B) 8-10 mg/kg/day; Mild Illness: treat x 7 days; Severe Illness: treat x 14 days
  Pediatric: 8-10 mg/kg/day; max 500 mg/day; Mild Illness: treat x 7 days; Severe
  Illness: treat x 14 days; see page 559 for dose by weight
  Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherrybanana)
  Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
  Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
  Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
• cefixime (B) Mild Illness: 15-20 mg/kg/day x 7-14 days; Severe Illness: 20 mg/kg/day x 10-14 days
  Pediatric: <6 months: not recommended; 6 months-12 years, <50 kg: Mild Illness: 15-20 mg/kg/day x 7-14 days; Severe Illness: 20 mg/kg/day x 10-14 >50 kg: same as adult; see page 563 for dose by weight
  Suprax Tab: 400 mg; Cap: 400 mg; Oral susp: 100, 200 mg/5 ml (50, 75, 100 ml) (strawberry)
• ciprofloxacin (C) 15 mg/kg/day; Mild Illness: treat x 5-7 days; Severe Illness: treat x 10-14 days
  Pediatric: <18 years: not recommended
  Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry)
  Cipro XR Tab: 500, 1000 mg ext-rel
  ProQuin XR Tab: 500 mg ext-rel
  Comment: ciprofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• ofloxacin (C) 15 mg/kg/day; Mild Illness: treat x 5-7 days; Severe Illness: treat x 10-14 days
  Pediatric: <18 years: not recommended
  Pediatric: <18 years: not recommended
  Floxin Tab: 200, 300, 400 mg
  Comment: ofloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• cefotaxime 80 mg/kg/day IM/IV x 10-14 days; max 2 g/day
  Pediatrics: 80 mg/kg/day IM/IV x 10-14 days; max 2 g/day
  Claforan Vial: 500 mg; 1, 2 g
• ceftriaxone (B)(G) 75 mg/kg/day IM/IV x 10-14 days; max 2 g/day
  Pediatrics: 75 mg/kg/day IM/IV x 10-14 days; max 2 g/day
  Rocephin Vial: 250, 500 mg; 1, 2 g
• trimethoprim/sulfamethoxazole (D)(G) 8-40 mg/kg/day x 14 days
  Pediatric: <2 months: not recommended; =2 months: 8- 40 mg/kg/day of sulfamethoxazole in 2 divided doses bid x 10 days; see page 587 for dose by weight
  Bactrim, Septra 2 tabs bid x 10 days
  Tab: trim 80 mg/sulfa 400 mg*
  Bactrim DS, Septra DS 1 tab bid x 10 days
  Tab: trim 160 mg/sulfa 800 mg*
  Bactrim Pediatric Suspension, Septra Pediatric Suspension 20 ml bid x 10 days
  Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
  Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not recommended