Rx – All 3

ULCER: DIABETIC, NEUROPATHIC (LOWER EXTREMITY) ULCER: VENOUS INSUFFICIENCY (LOWER EXTREMITY)

NUTRITIONAL SUPPLEMENT

• L-methylfolate calcium (as metafolin)/pyridoxyl 5-phosphate/methylcobalamin (NE) take 1 cap daily
  Pediatric: not recommended
  Metanx Cap: metafo 3 mg/pyrid 35 mg/methyl 2 mg (gluten-free, yeast-free, lactose-free)
  Comment: Metanx is indicated as adjunct treatment of endothelial dysfunction and/or hyperhomocysteinemia in patients who have lower extremity ulceration.

DEBRIDING/CAPILLARY STIMULANT AGENT

• trypsin/balsam peru/castor oil (NE) apply at least twice daily; may cover with a wet bandage
  Granulex Aerosol liq: tryp 0.12 mg/bal peru 87 mg/cast 788 mg per 0.82 ml

GROWTH FACTOR

• becaplermin (C) apply once daily with a cotton swab or tongue depressor; then cover with saline moistened gauze dressing; rinse aft er 12 hours; then re-cover with a clean saline dressing
  Regranex Gel: 0.01% (2, 7.5, 15 g) (parabens)
  Comment: Store in refrigerator; do not freeze. Not for use in wounds that close by primary intention.

ULCER: DECUBITUS/PRESSURE
DEBRIDING/CAPILLARY STIMULANT AGENT

• Granulex (trypsin 0.1 mg/balsam peru 72.5 mg/castor oil 650 mg per 0.82 ml) apply at least twice daily; may cover with a wet bandage
  Aerosol liq: (2, 4 oz)

GROWTH FACTOR

• becaplermin (C) apply once daily with a cotton swab or tongue depressor; then cover with saline moistened gauze dressing; rinse aft er 12 hours; then recover with a clean saline dressing
  Regranex Gel: 0.01% (2, 7.5, 15 g) (parabens)
  Comment: Store in refrigerator; do not freeze. Not for use in wounds that close by primary intention.

ULCERATIVE COLITIS
Comment: Standard treatment regimen is anti-infective, anti-spasmodic, and bowel rest; progressing to clear liquids; then to high fi ber.
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509

• budesonide micronized (C)(G) 9 mg once daily in the AM for up to 8 weeks; may repeat an 8-week course; Maintenance of remission: 6 mg once daily for up yo 3 months; taper other systemic steroids when transferring to bunesonide
  Pediatric: not recommended
  Entocort EC Cap: 3 mg ent-coat granules
  Uceris Tab: 9 mg ext-rel

RECTAL CORTICOSTEROIDS

• hydrocortisone rectal (C)
  Pediatric: not recommended
  Anusol-HC Suppositories 1 supp rectally 3 times daily or 2 supp rectally twice daily for 2 weeks; max 8 weeks
  Rectal supp: 25 mg (12, 24/pck)
  Cortenema 1 enema q HS x 21 days or until symptoms controlled
  Enema: 100 mg/60 ml (1, 7/pck)
  Cortifoam 1 applicator full once daily-bid x 2-3 weeks and every 2nd day thereafter until symptoms are controlled
  Aerosol: 80 mg/applicator (14 application/container)
  Proctocort 1 supp rectally in AM and PM x 2 weeks; for more severe cases, may increase to 1 supp rectally 3 times daily or 2 supp rectally twice daily; max 4-8 weeks
  Rectal supp: 30 mg (12, 24/pck)
  Comment: Use hydrocortisone foam as adjunctive therapy in the distal portion of the rectum when hydrocortisone enemas cannot be retained.

RECTAL CORTICOSTEROID/ANESTHETIC

• Hydrocortisone/Pramoxine
  Proctofoam HC apply to anal/rectal area 3-4 times daily; max 4-8 weeks
  Rectal foam: hydrocort 1%/pram 1% (10 g w. applicator)

SALICYLATES

• balsalazide disodium (B)
  Colazal 2.25 g 3 times daily x 8 weeks; max 12 weeks; swallow whole or sprinkle contents into apple sauce
  Pediatric: <5 years: not recommended; =5 years: 2.25 g 3 times daily or 750 mg once daily x 8 weeks; swallow whole or sprinkle contents into apple sauce
  Cap: 750 mg
  Comment: balsalazide 6.75 g provides 2.4 g of mesalazine to the colon.
  Giazo take 3 tabs bid; max 8 weeks
  Tab: 1.1 g (sodium 126 mg/tab) fi lm-coat
• mesalamine (B)
  Pediatric: not recommended
  Apriso take 1.5 g once daily in the AM for maintenance of remission
  Cap: 0.375 g ext-rel (phenylalanine 0.56 mg/cap)
  Asacol HD 1600 mg tid x 6 weeks; maintenance 1.6 g/day in divided doses; swallow whole; do not crush or chew
  Tab: 800 mg del-rel
  Canasa 1 g qid for up to 8 weeks
  Rectal supp: 1 g del-rel (30, 42/pck)
  Delzicol 800 mg tid x 6 weeks; maintenance once daily for up to 8 weeks;
  Maintenance: 1.6 g/day in 2-4 divided doses once daily; swallow whole; do not crush or chew
  Cap: 400 mg del-rel
  Lialda 2.4-4.8 g once daily for up to 8 weeks; maintenance 2.4 g once daily; swallow whole; do not crush or chew
  Tab: 1.2 g del-rel
  Pentasa 1 g qid for up to 8 weeks
  Cap: 250, 500 mg cont-rel
  Rowasa Suppository 1 supp rectally bid x 3-6 weeks; retain for 1-3 hours or longer
  Rectal supp: 500 mg (12, 24/pck)
  Sulfite-Free Rowasa Rectal Suspension 4 g rectally by enema q HS; retain for 8 hours x 3-6 weeks
  Enema: 4 g/60 ml (7, 14, 28/pck; kit, 7, 14, 28/pck w. wipes)
• olsalazine (C) 1 g/day in 2 divided doses
  Dipentum Cap: 250 mg
• sulfasalazine (B; D in 2nd, 3rd)(G)
  Pediatric: <2 years: not recommended; 2-16 years: initially 40-60 mg/kg/day in 3 to 6 divided doses; max 30 mg/kg/day in 4 divided doses; max 2 g/day; >16 years: same as adult
  Azulfi dine initially 1-2 g/day; increase to 3-4 g/day in divided doses pc until clinical symptoms controlled; maintenance 2 g/day; max 4 g/day
  Tab: 500*mg
  Azulfi dine EN-Tabs initially 500 mg in the PM x 7 days; then 500 mg bid x 7 days; then 500 mg in the AM and 1 g in the PM x 7 days; then 1 g bid; max 4 g/day
  Tab: 500 mg ent-coat

TUMOR NECROSIS FACTOR (TNF) BLOCKER

• adalimumab (B) initially 180 mg SC (as 4 injections in 1 day or divided over 2 days) on week 0; then 80 mg at week 2; start 40 mg every other week maintenance at week 4; only continue if evidence of clinical remission by 8 weeks; administer in abdomen or thigh; rotate sites
  Pediatric: <18 years not recommended
  Humira Prefi lled syringe: 20 mg/0.4 ml; 40 mg/0.8 ml single-dose (2/pck; 2, 6/starter pck) (preservative-free)
• infliximab (B) administer by IV infusion over 2 hours; 5 mg/kg weeks 0, 2, 6; then once every 8 weeks
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Vial: 100 mg pwdr for reconstitution for IV infusion (preservative-free)
• vedolizumab (B) administer by IV infusion over 30 minutes; 300 mg at weeks 0, 2, 6; then once every 8 weeks
  Pediatric: not established
  Entyvio
  Vial: 300 mg (20 ml) single dose, pwdr for IV infusion aft er reconstitution (preservative-free)

ANTI-DIARRHEAL AGENTS

• difenoxin/atropine (C) 2 tabs; then 1 tab aft er each loose stool or 1 tab q 3-4 hours; max 8 tabs/day x 2 days
  Motofen Tab: dif 1 mg/atro 0.025 mg
• diphenoxylate/atropine (C)(G) 2 tabs or 10 ml qid
  Lomotil Tab: diphen 2.5 mg/atro 0.025 mg; Liq: diphen 2.5 mg/atro 0.025 mg/5 ml (2 oz w. dropper)
• loperamide (B)(G)
  Imodium (OTC) 4 mg initially; then 2 mg aft er each loose stool; max 16 mg/day
  Cap: 2 mg
  Imodium A-D (OTC) 4 mg initially; then 2 mg aft er each loose stool; usual max 8 mg/day x 2 days
  Cplt: 2 mg; Liq: 1 mg/5 ml (2, 4 oz)
  Imodium Advanced (OTC) 2 tabs chewed aft er fi rst loose stool; then 1 after the next loose stool; max 4 tabs/day
  Chew tab: loperamide 2 mg/simethicone 125 mg

RETHRITIS: NONGONOCOCCAL (NGU)
Comment: Th e following treatment regimens for NGU are published in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines. Treatment regimens are for adults only; consult a specialist for treatment of patients less than 18 years-of-age. Treatment regimens are presented by generic drug name fi rst, followed by information about brands and dose forms. All persons who have confi rmed or suspected urethritis should be tested for gonorrhea and chlamydia. Men treated for NGU should be instructed to abstain from sexual intercourse for 7 days aft er a single-dose regimen or until completion of a 7-day regimen.

RECOMMENDED REGIMEN: UNCOMPLICATED NGU

• azithromycin 1 g in a single dose or 100 mg orally bid x 7 days

plus

• doxycycline 100 mg bid x 7 days

PERSISTENT/RECURRENT NGU
Men Initially Treated With Azithromycin+Doxycycline

• azithromycin 1 g PO in a single dose

Men Who Fail a Regimen of Azithromycin

• moxifloxacin 400 mg PO once daily x 7 days
  Heterosexual Men Who Live in Areas Where T. Vaginalis is Highly Prevalent
• metronidazole 2 g PO in a single dose

or

• tinidazole 2 g PO in a single dose

ALTERNATIVE REGIMENS

• erythromycin base 500 mg PO qid x 7 days

or

• erythromycin ethylsuccinate 800 mg PO qid x 7 days

or

• levofloxacin 500 mg once daily x 7 days

or

• ofloxacin 300 mg PO bid x 7 days

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+)
• 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) (sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
  Vibra-Tab Tab: 100 mg fi lm-coat
  Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side eff ect 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)
  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)
  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)
  Comment: erythromycin may increase INR with concomitant warfarin, as well as increase serum level of digoxin, benzodiazepines and statins.
• levofloxacin (C)
  Levaquin Tab: 250, 500, 750 mg; Oral soln: 25 mg/ml (480 ml) (benzyl alcohol);
  Inj conc: 25 mg/ml for IV infusion aft er 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.
• 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 aft er therapy due to a possible disulfi ram-like reaction (nausea, vomiting, fl ushing, headache).
• moxifloxacin (C)(G)
  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)
  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.
• 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 aft er therapy due to a possible disulfi ram-like reaction (nausea, vomiting, flushing, headache).

URINARY RETENTION: UNOBSTRUCTIVE

• bethanechol (C) 10-30 mg tid
  Urecholine Tab: 5, 10, 25, 50 mg
  Comment: Contraindicated in presence of urinary obstruction. atropine 0.4 mg administered SC reverses bethanechol toxicity.

URINARY TRACT INFECTION (UTI, CYSTITIS: ACUTE)
URINARY TRACT ANALGESIA

• phenazopyridine (B)(G) 95-200 mg q 6 hours prn; max 2 days
  Pediatric: not recommended
  AZO Standard, Prodium, Uristat (OTC) Tab: 95 mg
  AZO Standard Maximum Strength (OTC) Tab: 97.5 mg
  Pyridium, Urogesic Tab: 100, 200 mg

ANTI-INFECTIVES: THERAPY IN ADULT FEMALE WITH UNCOMPLICATED UTI

• 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
• ciprofloxacin (C)
  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.
• fosfomycin (B) 1 pkt in 3-4 oz cold water x 1 dose
  Monurol Single-dose pkts: 1-3 g (mandarin orange; sucrose)
• levofloxacin (C) 250 mg once daily x 3 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 aft er 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.
• norfloxacin (C) 400 mg once daily x 3 days
  Pediatric: <18 years: not recommended
  Noroxin Tab: 400 mg
  Comment: norfloxacin 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) 200 mg q 12 hours x 3 days
  Pediatric: <18 years: not recommended
  Floxin Tab: 200, 300, 400 mg
  Floxin UroPak Tab: 200 mg (6/pck)
  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.
• trimethoprim (C)(G)
  Primsol 100 mg q 12 hours or 200 mg once daily x 10 days
  Pediatric: <6 months: not recommended; =6 months: 10 mg/kg/day in 2 divided doses x 10 days
  Oral soln: 50 mg/5 ml (bubble gum; dye-free, alcohol-free)
  Proloprim 100 mg q 12 hours or 200 mg once daily x 10 days
  Pediatric: not recommended
  Tab: 100, 200 mg
  Trimpex 100 mg q 12 hours or 200 mg once daily x 10 days
  Pediatric: not recommended
  Tab: 100 mg
• 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

ANTI-INFECTIVES: STANDARD REGIMEN FOR UTI

• acetyl sulfi soxazole (C)(G)
  Gantrisin initially 2-4 g in a single or divided doses; then 4-8 g/day in 4-6 divided doses x 7 days
  Tab: 500 mg
  Gantrisin
  Pediatric: <2 months: not recommended; =2 months: initial dose 75 mg/kg/day; then 150 mg/kg/day in 4-6 divided doses x 7 days; max 6 g/day
  Oral susp: 500 mg/5 ml (4, 16 oz); Syr: 500 mg/5 ml (16 oz)
• amoxicillin (B)(G) 500-875 mg bid or 250-500 mg tid x 7 days
  Pediatric: <40 kg (88 lb): 20-40 mg/kg/day in 3 divided doses x 7 days or 25-45 mg/kg/day in 2 divided doses x 7 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
• ampicillin (B) 500 mg qid x 7-14 days
  Pediatric: 50-100 mg/kg/day in 4 divided doses x 7-14 days; see page 558 for dose by weight
  Omnipen, Principen Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (100, 150, 200 ml) (fruit)
• carbenicillin (B) 1-2 tabs qid x 7-14 days
  Pediatric: not recommended
  Geocillin Tab: 382 mg
• 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) 1-2 g in a single or 2 divided doses 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)
• 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) 100 mg bid x 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 7 days: >12 years: same as adult; 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)
• cefuroxime axetil (B)(G) 125-250 mg bid x 7-10 days
  Pediatric: <3 months: not recommended; 3 months-12 years: 20-30 mg/kg/day in 2 divided doses x 7-10 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 7-10 days
  Pediatric: 25-50 mg/kg/day in 4 divided doses x 7-10 days; see page 568 for dose by weight
  Kefl ex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml) (strawberry)
• ciprofloxacin (C) 500 mg bid or 1000 mg XR once daily x 3-14 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.
• doxycycline (D)(G) 100 mg bid x 7-10 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/day in a single or 2 divided doses 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) (sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
  Vibra-Tab Tab: 100 mg fi lm-coat
  Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side eff ect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• enoxacin (C) 200 mg q 12 hours x 7 days
  Pediatric: <18 years: not recommended
  Penetrex Tab: 200, 400 mg
  Comment: enoxacin 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) 250 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 aft er 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.
• lomefloxacin (C) 400 mg once daily x 10 days
  Pediatric: <18 years: not recommended
  Maxaquin Tab: 400 mg
  Comment: lomefloxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• minocycline (D)(G) 100 mg q 12 hours x 10 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 eff ect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• nalidixic acid (B) 1 g qid x 7-14 days
  Pediatric: <3 months: not recommended; >3 months: 25 mg/lb/day in 4 divided doses x 7-14 days
  NegGram Tab: 250, 500 mg; 1 g; Cap: 250, 500 mg; Oral susp: 250 mg/5 ml
• nitrofurantoin (B)(G)
  Furadantin 50-100 mg qid x 7-10 days
  Pediatric: <1 month: not recommended; =1 month: 5-7 mg/kg/day in 4 divided doses x 7-10 days; see page 582 for dose by weight
  Oral susp: 25 mg/5 ml (60 ml)
  Macrobid 100 mg q 12 hours x 7-10 days
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Cap: 100 mg
  Macrodantin 50-100 mg qid x 5-7 days; long-term use 50-100 mg q HS
  Cap: 25, 50, 100 mg
• norfloxacin (C) 400 mg x 7-10 days
  Pediatric: <18 years: not recommended
  Noroxin Tab: 400 mg
  Comment: norfloxacin 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) 200 mg q 12 hours x 7-10 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.
• trimethoprim (C)(G)
  Primsol 100 mg q 12 hours or 200 mg once daily x 10 days
  Pediatric: <6 months: not recommended; =6 months: 10 mg/kg/day in 2 divided doses divided q 12 hours x 10 days
  Oral soln: 50 mg/5 ml (bubble gum; dye-free, alcohol-free)
  Proloprim 100 mg q 12 hours or 200 mg once daily x 10 days
  Pediatric: not recommended
  Tab: 100, 200 mg
  Trimpex 100 mg q 12 hours or 200 mg once daily x 10 days
  Pediatric: not recommended
  Tab: 100 mg
• 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

PARENTERAL THERAPY

• ertapenem (B) 1 g once daily; CrCl <30 mL/min: 500 mg once daily; treat x 10-14 days; may switch to an oral antibiotic aft er 3 days if warranted; IV infusion: administer over 30 minutes; IM injection: reconstitute with lidocaine only
  Pediatric: <18 years: not recommended
  Ivanz Vial: 1 g pwdr for reconstitution

LONG-TERM PROPHYLACTIC/SUPPRESSION THERAPY

• methenamine hippurate (C) 1 tab bid
  Pediatric: <6 years: not recommended; =6-12 years: 1/2 tab bid
  Hiprex, Urex Tab: 1 g

URINARY TRACT ANALGESIC/ANTISPASMODICS

• hyoscyamine (C)(G)
  Anaspaz 1-2 tabs q 4 hours prn; max 12 tabs/day
  Pediatric: <2 years: not recommended; =2-12 years: 0.0625-0,125 mg q4 hours prn; max 0.75 mg/day; >12 years: same as adult
  Tab: 0.125*mg
  Levbid 1-2 tabs q 12 hours prn; max 4 tabs/day
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Tab: 0.375*mg ext-rel
  Levsin 1-2 tabs q 4 hours prn; max 12 tabs/day
  Pediatric: <6 years: not recommended; 6-12 years: 1 tab q 4 hours prn; =12 years: same as adult
  Tab: 0.125*mg
  Levsin Drops 1-2 ml q 4 hours prn; max 60 ml/day
  Pediatric: 3.4 kg: 4 drops q 4 hours prn; max 24 drops/day; 5 kg: 5 drops q 4 hours prn; max 30 drops/day; 7 kg: 6 drops q 4 hours prn; max 36 drops/day; 10 kg: 8 drops q 4 hours prn; max 40 drops/day
  Oral drops: 0.125 mg/ml (15 ml) (orange) (alcohol 5%)
  Levsin Elixir 5-10 ml q 4 hours prn
  Pediatric: <10 kg: use drops; 10-19 kg: 1.25 ml q 4 hours prn; 20-39 kg: 2.5 ml q 4 hours prn; 40-49 kg: 3.75 ml q 4 hours prn; >50 kg: 5 ml q 4 hours prn
  Elix: 0.125 mg/5 ml (16 oz) (orange) (alcohol 20%)
  Levsinex SL 1-2 tabs q 4 hours SL or PO; max 12 tabs/day
  Pediatric: 2-12 years: 1 tab q 4 hours; max 6 tabs/day; >12 years: same as adult
  Tab: 0.125 mg sublingual
  Levsinex Timecaps 1-2 caps q 12 hours; may adjust to 1 cap q 8 hours
  Pediatric: 2-12 years: 1 cap q 12 hours; max 2 caps/day; >12 years: same as adult
  Cap: 0.375 mg time-rel
  NuLev dissolve 1-2 tabs on tongue, with or without water, q 4 hours prn; max 12 tabs/day
  Pediatric: <2 years: not recommended; 2-12 years: dissolve 1 tab on tongue, with or without water, q 4 hours prn; max 6 tabs/day
  ODT: 0.125 mg (mint) (phenylalanine)
• methenamine/phenyl salicylate/methylene blue/benzoic acid/atropine sulfate/hyoscyamine (C)(G) 2 tabs qid prn
  Pediatric: <6 years: not recommended
  Urised Tab: meth 40.8 mg/phenyl salic 18.1 mg/meth blue 5.4 mg/benz acid 4.5 mg/atro sulf 0.03 mg/hyoscy 0.03 mg
  Comment: Urised imparts a blue-green color to urine which may stain fabrics.
• methenamine/phenyl salicylate/methylene blue/na phosphate onobasic/hyoscyamine (C) 1 cap qid prn
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Uribel Cap: meth 118 mg/phenyl salic 36 mg/meth blue 10 mg/naphos mono 40.8 mg/hyoscy 0.12 mg
• methenamine/phenyl salicylate/methylene blue/na biphosphate/hyoscyamine (C) 1 tab qid prn
  Pediatric: <6 years: not recommended; =6 years: same as adult
  Urelle Cap: meth 81 mg/phenyl salic 32.4 mg/meth blue 10.8 mg/na biphos 40.8 mg/hyoscy 0.12 mg
• phenazopyridine (B)(G) 95-200 mg q 6 hours prn; max 2 days
  Pediatric: not recommended
  AZO Standard, Prodium, Uristat (OTC) Tab: 95 mg
  AZO Standard Maximum Strength (OTC) Tab: 97.5 mg
  Pyridium, Urogesic Tab: 100, 200 mg
  Comment: phenazopyridine imparts an orange-red color to urine which may stain fabrics.

PROPHYLACTIC/SUPPRESSION THERAPY

• methenamine hippurate (C) 1 g bid
  Pediatric: <6 years: 0.25 g/30 lb qid; 6-12 years: 25-50 mg/kg/day in 2 divided doses or 0.5-1 g bid; >12 years: same as adult
  Hiprex Tab: 1 g; Oral susp: 500 mg/5 ml (480 ml)

UROLITHIASIS (RENAL CALCULI, KIDNEY STONES)

Acetaminophen for IV Infusion see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Opioids and Other Analgesics see page 308

ANTISPASMOTIC

• flavoxate (B)(G)
  Urispaz 100-200 mg tid-qid

PARENTERAL NARCOTICS
Aid to Stone Passage: Alpha-1A Blockers

• alfuzosin (B)(G) 10 mg once daily taken immediately aft er the same meal eachday
  UroXatral Tab: 10 mg ext-rel
• tamsulosin (B)(G) initially 0.4 mg once daily; may increase to 0.8 mg once daily after 2-4 weeks if needed
  Flomax Cap: 0.4 mg
  Comment: May take Flomax 0.4 mg with Avodart 0.5 mg once daily as combination therapy.
• buprenorphine (C)
  Buprenex administer 1-2 mg IM/IV q 3-4 hours prn; may repeat once (up to 0.3 mg) if required, 30 to 60 minutes aft er initial dose
  Pediatric: 2-12 years: 2-6 mcg/kg IM/IV q 4-6 hours prn
  Amp: 0.3 mg/ml (1 ml)
  Comment: Buprenex is approximately equivalent to 10 mg morphine sulfate in analgesic and respiratory depressant eff ects.
• meperidine (B; D in 2nd, 3rd)(II)(G) 50-100 mg IM q 3-4 hours prn
  Demerol Tubex: 25, 50, 75, 100 mg/ml (2 ml); Vial: 25 mg/ml (1 ml); 50 mg/ml (1, 30 ml); 75 mg/ml; (1 ml); 100 mg/ml (1, 20 ml) Amp: 25, 50, 75, 100 mg/ml (1 ml)
• morphine sulfate (C)(II)(G) 10-15 mg q 3-4 hours prn
  Vial: 1 mg/ml (1, 60 ml); 5 mg/ml (1 ml); 8 mg/ml (1 ml); 10 mg/ml (1, 2, 10 ml); 15 mg (1, 20 ml); Amp: 8 mg/ml (1 ml); 10 mg/ml (1 ml); 15 mg/ml (1 ml)

PREVENTION OF CALCIUM STONES

• chlorothiazide (B)(G) 50 mg bid
  Diuril Tab: 250*, 500*mg; Oral susp: 250 mg/5 ml (237 ml)
• hydrochlorothiazide (B)(G) 50 mg bid
  Esidrix Tab: 25, 50mg
  Microzide Cap: 12.5 mg

PREVENTION OF CYSTINE STONES

• penicillamine (D) 1-4 g/day
  Pediatric: not recommended
  Cuprimine Cap: 125, 250 mg
  Depen Titratable tab: 250 mg potassium citrate (C)(G) 30 mEq qid
  Umetozolvrocit-K Tab: 5, 10, 15 mEq ext-rel
  Comment: potassium citrate is contraindicated in hyperkalemia.

PREVENTION OF URIC ACID STONES

• allopurinol (C)(G) 200-300 mg in 1-3 doses; max 800 mg/day
  Zyloprim Tab: 100*, 300*mg
• potassium citrate (C)(G) 30 mEq qid
  Urocit-K Tab: 5, 10, 15 mEq ext-rel
  Comment: potassium citrate is contraindicated in hyperkalemia. Encourage patients to limit salt intake and maintain liberal hydration (urine volume should be at least 2 liters/day). Target urine pH is 6.0-7.0 and urine citrate at least 320 mg/day and close to the normal mean of 640 mg/day. Take with food.

URTICARIA: CHRONIC IDIOPATHIC (CIU)

• hydroxyzine (C)(G) 25 mg tid prn; max 600 mg/day
  Pediatric: <6 years: 50 mg/day divided qid prn; =6 years: 50-100 mg/day divided qid prn; max 600 mg/day
  AtaraxR Tab: 10, 25, 50, 100 mg; Syr: 10 mg/5 ml (alcohol 0.5%)
  VistarilR Cap: 25, 50, 100 mg; Oral susp: 25 mg/5 ml (4 oz) (lemon)
  Oral Drugs for Allergy, Cough, and Cold Symptoms see page 535

URTICARIA: ACUTE (HIVES)

MILD/MODERATE URTICARIA
Oral Drugs for Allergy, Cough, and Cold Symptoms see page 535
Topical Corticosteroids see page 506
Oral Corticosteroids see page 509

SEVERE URTICARIA

Parenteral Antihistamines

• diphenhydramine (C)(G) 25-50 mg IM immediately; then q 6 hours
  Pediatric: 1.25 mg/kg up to 25 mg IM x 1 dose; then q 6 hours
  Benadryl Injectable Vial: 50 mg/ml (1 ml single-use); 50 mg/ml (10 ml multidose);
  Amp: 10 mg/ml (1 ml); Prefi lled syringe: 50 mg/ml (1 ml)
  Parenteral Corticosteroids see page 511
• epinephrine (C) 1:1000 0.01 ml/kg SC; max 0.3 ml
  Pediatric: 0.01 mg/kg SC

VAGINAL IRRITATION: EXTERNAL

• Replens Vaginal Moisturizer (NE)(OTC) apply as needed; for external use only
  Bottle: 2 oz
  Vagisil Intimate Moisturizer (NE)(OTC) apply as needed; for external use only
  Bottle: 2 oz
  Comment: Vagisil has no eff ect on condom integrity.

VERTIGO

• meclizine (B)(G) 25-100 mg/day in divided doses
  Pediatric: not recommended
  Antivert Tab: 12.5, 25, 50*mg
  Bonine (OTC) Cap: 15, 25, 30 mg; Tab: 12.5, 25, 50 mg; Chew tab/Film-coat tab: 25 mg
  Dramamine II (OTC) Tab: 25*mg
  Zentrip Strip: 25 mg orally-disint

VITILIGO
REPIGMENTATION ENHANCEMENT

• methoxsalen (C) Apply to well-defi ned area of vitiligo; then expose area to source of UVA (ultraviolet A) or sunlight; initial exposure no more than 1/2 predicted minimal erythemal dose; repeat weekly
  Pediatric: <12 years: not recommended
• Oxsoralen Lotn: 1% (30 ml)
  Comment: methoxsalen may only be applied by a health care provider. Do not dispense to patient.
• trioxsalen (C) 10 mg daily, taken 2-4 hours before ultraviolet light exposure; max 14 days and 28 tabs
  Pediatric: <12 years: not recommended
  Trisoralen Tab: 5 mg
  Depigmenting Agents see Hyperpigmentation page 206

WART: COMMON (VERRUCA VULGARIS)

• salicylic acid (NE)(G)
  Duo Film (OTC) apply daily-bid; max 12 weeks; Liq: 17% (1/2 oz w. applicator)
  Duo Film Patch for Kids (OTC) apply 1 patch q 48 hours; max 12 weeks
  Patch: 40% (18/pck)
  Occlusal HP (OTC) apply daily-bid; max 12 weeks
  Liq: 17% (10 ml w. applicator)
  Wart-Off (OTC) apply one drop at a time to suffi ciently cover wart, let dry; repeat 1-2 times daily; max 12 weeks
  Liq: 17% (0.45 oz)

WART: PLANTAR (VERRUCA PLANTARIS)

• salicylic acid (NE)(G)
  Duo Plant Gel (OTC) apply daily bid; max 12 weeks
  Gel: 17% (1/2 oz)
  Mediplast cut to size of wart and apply; remove q 1-2 days, peel keratin, and reapply; repeat as long as needed
  Occlusal-HP (OTC) apply once daily-bid; max 12 weeks
  Liq: 17% (10 ml w. applicator)
  Wart-Off (OTC) apply one drop at a time to suffi ciently cover wart, let dry; repeat 1-2 times daily; max 12 weeks
  Liq: 17% (0.45 oz)
• trichloroacetic acid (NE) apply aft er wart is pared and repeat weekly

WART: VENEREAL, HUMAN PAPILLOMAVIRUS (HPV),
CONDYLOMA ACUMINATA
Comment: This section contains treatment regimens for genital warts published in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines as well as other treatment options. Due to the increased risk of cervical cancer with HPV, Pap smears should be done q 3 months during active disease and then q 3-6 months for the next 2 years.

PATIENT-APPLIED AGENTS

Regimen 1

• imiquimod (C)
  Pediatric: not recommended
  Aldara (G) rub into lesions before bedtime and remove with soap and water 6-10 hours later; treat 3 times per week; max 16 weeks
  Crm: 5% (12 single-use pkts/carton)
  Zyclara rub into lesions before bedtime and remove with soap and water 8 hours later; treat 3 times per week; max 1 packet per treatment; max 8 weeks
  Crm: 3.75% (28 single-use pkts/carton) (parabens)

Regimen 2

• podofi lox 0.5% cream (C) apply bid (q 12 hours) x 3 days; then discontinue for 4 days; may repeat if needed; max 4 treatment cycles
  Condylox Soln: 0.5% (3.5 ml); Gel: 0.5% (3.5 g)

Regimen 3

• sinecatechins 15% ointment (C) apply to each lesion tid for up to 16 weeks
  Veregen Oint: 15% (15, 30 g)

PROVIDER-ADMINISTERED AGENTS

Regimen 1

• Cryotherapy with liquid nitrogen or cryoprobe; repeat applications every 1-2 weeks as needed

Regimen 2

• trichloroacetic acid (TCA) 80-90% (C) apply to warts; repeat weekly if needed
  Comment: TCA is the preferred treatment during pregnancy. Immediate application of sodium bicarbonate paste following treatment decreases pain.

Regimen 3

• podofilox 0.5% cream (C) apply bid (q 12 hours) x 3 days; then discontinue for 4 days; may repeat if needed; max 4 treatment cycles
  Condylox Soln: 0.5% (3.5 ml); Gel: 0.5% (3.5 g)

Regimen 4

• interferon alfa-n3 (C) 0.05 ml injected into base of wart twice weekly for up to 8 weeks; max 0.5 ml/session (20 warts/session)
  Alferon N Vial: 5 million units/ml (1 ml)

Regimen 5

• interferon alfa-2b (C) 0.1 ml injected into base of wart three times weekly for up to 3 weeks; max 0.5 ml/session (5 warts/session)
  Intron A Vial: 1 million units/0.1 ml (0.5, 1 ml)

Regimen 6

• Surgical removal either by tangential scissor excision, tangential shave excision, curettage, or electrosurgery

WHIPWORM (TRICHURIASIS)
ANTHELMINTICS

• albendazole (C) 400 mg as a single dose; may repeat in 3 weeks; take with a meal
  Pediatric: <2 years: 200 mg daily x 3 days; may repeat in 3 weeks; 2-12 years: 400 mg 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; 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
  Antiminth (OTC) Cap: 180 mg; Liq: 50 mg/ml (30 ml); 144 mg/ml (30 ml); Oral susp: 50 mg/ml (60 ml)
  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: 2 doses/day 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.

WOUND: INFECTED, NONSURGICAL, MINOR
TETANUS PROPHYLAXIS

Previously Immunized (within previous 5 years)

• tetanus toxoid vaccine (C) 0.5 ml IM x 1 dose
  Vial: 5 Lf units/0.5 ml (0.5, 5 ml); Prefi lled syringe: 5 Lf units/0.5 ml (0.5 ml)
  Not Previously Immunized
  see Tetanus page 408

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)

ORAL ANTI-INFECTIVES

• azithromycin (B) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500 mg daily x 3 days or Zmax 2 g in a single dose
  Pediatric: 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+)
• 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
  Cefaclor Extended Release Tab: 375, 500 mg ext-rel
• cefadroxil 1 g/day in 1-2 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 or 600 mg daily 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)
• cefpodoxime proxetil (B) 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 cream)
  Pediatric: see page 564 for dose by weight
• cefprozil (B) 250-500 mg q 12 hours or 500 mg daily x 10 days
  Pediatric: <2 years: not recommended; 2-12 years: 7.5 mg/kg-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)
• cephalexin (B)(G) 2 g 1 hour before procedure
  Pediatric: 50 mg/kg/day in 4 divided doses x 10 days; see page 568 for dose by weight
  Kefl ex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml) (strawberry)
  Pediatric: see page 568 for dose by weight
• clarithromycin (C)(G) 500 mg or 500 mg ext-rel for 7-10 days
  Pediatric: 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) (fruitpunch)
  Biaxin XL Tab: 500 mg ext-rel
• dirithromycin (C)(G) 500 mg daily x 7 days
  Pediatric: <12 years: not recommended
  Dynabac Tab: 250 mg
• erythromycin base (B)(G) 500 mg qid x 14 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.
• gemifloxacin (C)(G) 320 mg 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 daily x 7 days; Complicated: 750 mg daily x 7 days
  Pediatric: <18 years: not recommended
  Levaquin Tab: 250, 500, 750 mg
  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) 200-400 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)
• 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.

WRINKLES: FACIAL (CROW’S FEET, FROWN LINES, SMILE LINES)
TOPICAL RETINOIDS

Comment: Wash the aff ected area with a soap-free cleanser; pat dry and wait 20 to 30 minutes; then apply topical retinoid sparingly to aff ected area. Use only once daily in
the PM. Avoid eyes, ears, nostrils, and mouth.

• adapalene (C)(G)
  Pediatric: <12 years: not recommended
  Differin Crm: 0.1% (15, 45 g); Gel: 0.1% (15, 45 g); Pad: 0.1% (30/pk; alcohol 30%)
  Differin Solution Soln: 0.1% (30 ml; alcohol 30%)
• tazarotene (X) apply daily at HS
  Pediatric: not recommended
  Avage Cream Crm: 0.1% (5, 30 g)
  Tazorac Cream Crm: 0.05, 0.1% (15, 30, 60 g)
  Tazorac Gel Gel: 0.05, 0.1% (30, 100 g)
• tretinoin (C) apply daily at HS
  Pediatric: <12 years: not recommended
  Atralin Gel Gel: 0.05% (45 g)
  Avita Crm: 0.025% (20, 45 g); Gel: 0.025% (20, 45 g) Renova Crm: 0.02% (40 g); 0.05% (40, 60 g)
  Retin-A Cream Crm: 0.025, 0.05, 0.1% (20, 45 g)
  Retin-A Gel Gel: 0.01, 0.025% (15, 45 g; alcohol 90%)
  Retin-A Liquid Soln: 0.05% (alcohol 55%)
  Retin-A Micro Gel Gel: 0.04, 0.08, 0.1% (20, 45 g)
  Tretin-X Cream Crm: 0.075% (35 g) (parabens-free, alcohol-free, propylene glycol-free)
  Retin-A Micro Microspheres: 0.04, 0.1% (20, 45 g)
  Comment: Eff ective for mitigation of fi ne wrinkles, mottled hyperpigmentation, and tactile roughness of skin. No mitigating eff ect on deep wrinkles, skin yellowing, lentigines, telangiectasia, skin laxity, keratinocytic atypia, melanocytic atypia, or dermal elastosis. Avoid sun exposure. Cautious use of concomitant astringents, alcohol-based products, sulfur-containing products, salicylic acid-containing products, soap, and other topical agents.

XEROSIS

MOISTURIZING AGENTS

• Aquaphor Healing Ointment (OTC) Oint: 1.75, 3.5, 14 oz (alcohol)
  Eucerin Daily Sun Defense (OTC) Lotn: 6 oz (fragrance-free)
  Comment: Eucerin Daily Sun Defense is a moisturizer with SPF 15 sunscreen.
  Eucerin Facial Lotion (OTC) Lotn: 4 oz
  Eucerin Light Lotion (OTC) Lotn: 8 oz
  Eucerin Lotion (OTC) Lotn: 8, 16 oz
  Eucerin Original Creme (OTC) Crm: 2, 4, 16 oz (alcohol)
  Eucerin Plus Creme (OTC) Crm: 4 oz
  Eucerin Plus Lotion (OTC) Lotn: 6, 12 oz
  Eucerin Protective Lotion (OTC) Lotn: 4 oz (alcohol)
  Comment: Eucerin Protective is a moisturizer with SPF 25 sunscreen.
  Lac-Hydrin Cream (OTC) Crm: 280, 385 g
  Lac-Hydrin Lotion (OTC) Lotn: 225, 400 g
  Lubriderm Dry Skin Scented (OTC) Lotn: 6, 10, 16, 32 oz
  Lubriderm Dry Skin Unscented (OTC) Lotn: 3.3, 6, 10, 16 oz (fragrance-free)
  Lubriderm Sensitive Skin Lotion (OTC) Lotn: 3.3, 6, 10, 16 oz (lanolin-free)
  Lubriderm Dry Skin (OTC) Lotn: 2.5, 6, 10, 16 oz (scented); 1, 2.5, 6, 10, 16 oz (fragrance-free)
  Lubriderm Bath & Shower Oil (OTC) 1-2 capfuls in bath or rub onto wet skin as needed, then rinse
  Oil: 8 oz
  Moisturel apply as needed
  Crm: 4, 16 oz; Lotn: 8, 12 oz; Clnsr: 8.75 oz

Topical Oil

• fluocinolone acetamide 0.01% topical oil (C)
  Pediatric: <6 years: not recommended; =6 years: apply sparingly bid for up to 4 weeks
  Derma-Smoothe/FS Topical Oil apply sparingly tid
  Topical oil: 0.01% (4 oz; peanut oil)

ZOLLINGER-ELLISON SYNDROME

PROTON PUMP INHIBITORS
Comment: If hepatic impairment, or if patient is Asian, consider reducing the PPI dose.

• dexlansoprazole (B)(G) 30-60 mg daily for up to 4 weeks
  Pediatric: <18 years: not recommended
  Dexilant Cap: 30, 60 mg ent-coat del-rel granules; may open and sprinkle on applesauce; do not crush or chew granules
  Dexilant SoluTab Tab: 30 mg del-rel orally-disint
• esomeprazole (B)(OTC)(G) 20-40 mg daily; max 8 weeks; take 1 hour before food; swallow whole or mix granules with food or juice and take immediately; do not crush or chew granules
  Pediatric: <1 year: not recommended; 1-11 years, <20 kg: 10 mg; >20 kg: 10-20 mg once daily; 12-17 years: 20-40 mg once daily; max 8 weeks
  Nexium Cap: 20, 40 mg ent-coat del-rel pellets
  Nexium for Oral Suspension Oral susp: 10, 20, 40 mg ent-coat del-rel granules/pkt; mix in 2 tblsp water and drink immediately; 30 pkt/carton
• esomeprazole/aspirin (D) take one dose daily; max 8 weeks; take 1 hour before food
  Yosprala
  Tab: Yosprala 40/81 esom 40 mg/asa 81 mg del-rel
  Yosprala 40/325 esom 40 mg/asa 325 mg del-rel
• lansoprazole (B)(OTC)(G) 15-30 mg daily for up to 8 weeks; may repeat course; take before eating
  Pediatric: <1 year: not recommended; 1-11 years, <30 kg: 15 mg once daily; >11 years: same as adult
  Prevacid Cap: 15, 30 mg ent-coat del-rel granules; swallow whole or mix granules with food or juice and take immediately; do not crush or chew granules; follow with water
  Prevacid for Oral Suspension Oral susp: 15, 30 mg ent-coat del- rel granules/pkt; mix in 2 tblsp water and drink immediately; 30 pkt/carton (strawberry)
  Prevacid SoluTab ODT: 15, 30 mg (strawberry; phenylalanine)
  Prevacid 24HR Oral granules: 15 mg ent-coat del-rel granules; swallow whole or mix granules with food or juice and take immediately; do not crush or chew granules; follow with water
• omeprazole (C)(OTC)(G) 20-40 mg daily; take before eating; swallow whole or mix granules with applesauce and take immediately; do not crush or chew; follow with water
  Pediatric: <1 year: not recommended; 5-<10 kg: 5 mg daily; 10-<20 kg: 10 mg daily; =20 kg: same as adult
  Prilosec Cap: 10, 20, 40 mg ent-coat del-rel granules
  Pediatric: <18 years: not recommended
  Prilosec Tab: 20 mg del-rel (regular, wild berry)
• pantoprazole (B) initially 40 mg bid
  Pediatric: not recommended
  Protonix (G) Tab: 40 mg ent-coat del-rel
  Protonix for Oral Suspension Oral susp: 40 mg ent-coat del-rel granules/pkt; mix in 1 tsp apple juice for 5 seconds or sprinkle on 1 tsp apple sauce, and swallow immediately; do not mix in water or any other liquid or food; take approximately 30 minutes prior to a meal; 30 pkt/carton any other liquid or food; take approximately 30 minutes prior to a meal; 30 pkt/carton
• rabeprazole (B)(OTC)(G) initially 20 mg daily; then titrate; may take 100 mg daily in divided doses or 60 mg bid
  Pediatric: <12 years: not recommended; =12 years: 20 mg once daily; max 8 weeks
  AcipHex Tab: 20 mg ent-coat del-rel

SECTION II
APPENDICES
APPENDIX A: FDA PREGNANCY CATEGORIES

Category Description

• A Controlled studies in women have failed to demonstrate risk to the fetus in the fi rst trimester of pregnancy and there is no evidence of risk in later trimesters.
• B Animal reproduction studies have not demonstrated risk to the fetus, but there are no controlled studies in pregnant women, or animal studies have demonstrated an adverse eff ect, but controlled studies in pregnant women have not documented risk to the fetus in the first trimester of pregnancy and there is no evidence of risk in later trimesters.
• C Risk to the fetus cannot be ruled out. Animal reproduction studies have demonstrated adverse eff ects on the fetus (i.e., teratogenic or embryocidal eff ects or other) but there are no controlled studies in pregnant women or controlled studies in women and animals are not available.
• D Th ere is positive evidence of human fetal risk, but benefi ts from use by pregnant women may be acceptable despite the potential risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineff ective.
• X Studies in animals or humans have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, or both, and the risk of using the drug in pregnant women clearly outweighs any possible benefi t. Th e drug is contraindicated in women who are pregnant or who may become pregnant.

APPENDIX B: U.S. SCHEDULE OF
CONTROLLED SUBSTANCES

Schedule Description

I High potential for abuse and of no currently accepted medical use. Not obtainable by prescription, but may be legally procured for research, study, or instructional use. (Examples: heroin, LSD, marijuana, mescaline, peyote)

II High abuse potential and high liability for severe psychological or physical dependence potential. Prescription required and cannot be refi lled. Prescription must be written in ink or typed and signed. A verbal prescription may be allowed in an emergency by the dispensing pharmacist, but must be followed by a written prescription within 72 hours. Includes opium derivatives, other opioids, and short-acting barbiturates.

III Potential for abuse is less than that for drugs in schedules I and II. Moderate to low physical dependence and high psychological dependence potential. Prescription required. May be refi lled up to 5 times in 6 months. Prescription may be verbal (telephone) or written. Includes certain stimulants and depressants not included in the above schedules, and prepararations containing limited quantities of certain opioids.

IV Lower potential for abuse than Schedule III drugs. Prescription required. May be refi lled up to 5 times in 6 months. Prescription may be verbal (telephone) or written.

V Abuse potential less than that for Schedule IV drugs. Preparations contain limited quantities of certain narcotic drugs. Generally intended for antitussive and anti-diarrheal purposes and may be distributed without a prescription provided that
• such distribution is made only by a pharmacist;
• not more than 240 ml or not more than 48 solid dosage units of any substance containing opium, nor more than 120 ml or not more than 24 solid dosage units of any other controlled substance may be distributed at retail to the same purchaser in any given 48-hour period without a valid prescription order;
• the purchaser is at least 18 years old;
• the pharmacist knows the purchaser or requests suitable identifi cation;
• the pharmacist keeps an offi cial written record of: name and address of purchaser, name, and quantity of controlled substance purchased, date of sale, initials of dispensing pharmacist. Th is record is to be made available for inspection and copying by the U.S. officers authorized by the Attorney General;
• other federal, state, or local law does not reuire a prescription order. Under jurisdiction of the Federal Controlled Substances Act.

Refi llable up to 5 times within 6 months.

APPENDIX C: JNC-8* AND ASH**
HYPERTENSION EVALUATION AND TREATMENT
RECOMMENDATIONS

APPENDIX C.1: BLOOD PRESSURE CLASSIFICATION
Classifi cation SBP mmHg DBP mmHg
Normal <120 and <80
Prehypertension 120-139 or 80-89
Classifi cation SBP mmHg DBP mmHg
Hypertension, Stage 1 140-159 or 90-99
Hypertension, Stage 2 =160 or =100
¶ Adapted from: PL Detail-Document, Treatment of Hypertension: JNC 8 and More. Pharmacist’s
Letter/Prescriber’s Letter, February 2014.
APPENDIX C.2: BLOOD PRESSURE RCOMMENDATIONS
Classifi cation SBP mmHg DBP mmHg
Optimal <120 <80
Normal <130 <85
High normal 130-139 85-89
APPENDIX C.3: IDENTIFIABLE CAUSES OF HYPERTENSION (JNC-8)
• Obstructive sleep apnea
• Chronic kidney disease
• Primary aldosteronism
• Renovascular disease
• Excess sodium ingestion
• Herbal supplements
• Coarctation of the aorta
• Pheochromocytoma
• Th yroid disease
• Parathyroid disease
• Cushing’s syndrome
• Prescription Drugs: oral contraceptives,
sympathomimetics, venlafaxine, bupropion,
clozapine, buspirone, bromocriptine,
carbamazepine, metoclopramide
• Illicit, Over-the-Counter Drugs, and Herbal
Products: excess alcohol consumption, alcohol
withdrawal, anabolic steroids, cocaine, cocaine
withdrawal, phenylpropanolamine analogs,
ephedra alkalois, ergotcontaining herbal
products, St. John’s wart, nicotine withdrawal
APPENDIX C.4: CVD RISK FACTORS (JNC-8)
• Hypertension
• Obesity (BMI =30 kg/m2)
• Dyslipidemia
• Diabetes mellitus
• Cigarette smoking
• Physical inactivity
• Microalbuminuria, GFR <60 mL/min
• Age (men >55 yrs, women >65 yrs)
• Family History of premature CVD (men <55
yrs, women <65 yrs)
APPENDIX C.5: DIAGNOSTIC WORKUP OF HYPERTENSION (JNC-8)
• Assess risk factors and comorbidities
• Reveal identifi able causes of hypertension
• Assess for presence of target organ damage
• History and physical examination
(continued)
(continued)
474 ¦ Ap p e n d i x C : J N C – 8 * a n d ASH**
• Urinalysis, blood glucose, hematocrit, lipid panel, potassium, creatinine, calcium,
(optional urine albumin/Cr ratio), EKG
APPENDIX C.6: BLOOD PRESSURE MEASUREMENT
RECOMMENDATIONS (JNC-8)
• Blood pressure should be measured aft er the patient has emptied their bladder
and has been seated for 5 minutes with back supported and legs resting on the
ground (not crossed)
• Arm used for measurement should rest on a table, at heart level.
• Use a sphygmomanometer/stethoscope or automated electronic device
(preferred) with the correct size arm cuff
• Take two readings one to two minutes apart, and average the readings (preferred)
• Measure blood pressure in both arms at initial valuation; use the higher
reading for measurements thereaft er
• Confi rm the diagnosis of HTN at a subsequent visit one to four weeks aft er the fi rst
• If blood pressure is very high (e.g., systolic 180 mmHg or higher), or timely
follow-up unrealistic, treatment can be started aft er just one set of measurements
APPENDIX C.7: PATIENT-SPECIFIC FACTORS TO CONSIDER WHEN
SELECTING DRUG THERAPY(IES) (JNC-8* AND ASH**)
JNC-8:
• Nonblack, including those with diabetes: thiazide, CCB, ACEI, or ARB
• African American, including those with diabetes: thiazide or CCB
• CKD; regimen should include an ACEI or ARB (including African
Americans)
• Can initiate with two agents, especially if systolic >20 mmHg above goal or
diastolic >10 mmHg above goal
• If goal not reached: stress adherence to medication and lifestyle, increase dose
or add a second or third agent from one of the recommended classes
• Choose a drug outside of the classes recommended above only if these options
have been exhausted. Consider specialist referral
ASH:
• Nonblack <60 years of age: First-line: ACEI or ARB; Second-line (add-on):
CCB or thiazide; Th ird-line: CCB plus ACEI or ARB plus thiazide
• Nonblack 60 years of age and older: First-line: CCB or thiazide preferred,
ACEI, or ARB; Second-line (add-on): CCB, thiazide, ACEI, or ARB (don’t use
ACEI plus ARB); Th ird-line: CCB plus ACEI or ARB plus thiazide
• African American: First-line: CCB or thiazide; Second-line (add-on): ACEI or
ARB. Th ird-line: CCB plus ACEI or ARB plus thiazide
(continued)
(continued)
Ap p e n d i x C : J N C – 8 * a n d A S H * * ¦ 475
Comorbidities (ASH):
• Diabetes: First-line: ACEI or ARB (can start with CCB or thiazide in African
Americans); Second-line: add CCB or thiazide (can add ACEI or ARB in
African Americans); Th ird-line: CCB plus ACEI or ARB plus thiazide
• CKD: First-line: ARB or ACEI (ACEI for African Americans) Second-line (addon):
CCB or thiazide; Th ird-line: CCB plus ACEI or ARB plus thiazide
• CAD: First-line: BB plus ARB or ACEI; Second-line (add-on): CCB or thiazide;
Th ird-line: BB plus ARB or ACEI plus CCB plus thiazide
• Stroke history: First-line: ACEI or ARB; Second-line: add CCB or thiazide;
Th ird-line: CCB plus ACEI or ARB plus thiazide
• Heart failure: ACEI or ARB plus BB plus diuretic plus aldosterone antagonist.
Amlodipine can be added for additional BP control (Start with ACEI, BB,
diuretic. Can add BB even before ACE-I optimized. Use diuretic to manage
fl uid.)
• In patients 60 years of age or older who do not have diabetes or chronic kidney
disease, the goal blood pressure level is now <150/90 mmHg
• In patients 18 to 59 years of age without major comorbidities, and in patients
60 years of age or older who have diabetes, chronic kidney disease, or both
conditions, the new goal blood pressure level is <140/90 mmHg
APPENDIX C.8: BLOOD PRESSURE MANAGEMENT CHANGES FROM
JNC VII TO JNC-8¶
• First-line and later-line treatments should now be limited to 4 classes of medications:
thiazide-type diuretics, calcium channel blockers (CCBs), ACEIs, and
ARBs
• Second- and third-line alternatives included higher doses or combinations of
ACEIs, ARBs, thiazide type diuretics, and CCBs
• Several medications are now designated as later-line alternatives, including the
following:
• Beta-blockers
• Alpha-blockers
• Alpha1/beta-blockers (e.g., carvedilol)
• Vasodilating beta-blockers (e.g., nebivolol)
• Central alpha2-adrenergic agonists (e.g, clonidine)
• Direct vasodilators (e.g., hydralazine)
• Loop diuretics (e.g., furosemide)
• Aldosterone antagonists (e.g., spironolactone)
• Peripherally acting adrenergic antagonists (e.g., reserpine)
• When initiating therapy, patients of African descent without chronic kidney
disease should use CCBs and thiazides instead of ACEIs.
• Use of ACEIs and ARBs is recommended in all patients with chronic kidney disease
regardless of ethnic background, either as fi rst-line therapy or in addition to
fi rst-line therapy.
(continued)
(continued)
476 ¦ Ap p e n d i x C : J N C – 8 * a n d ASH**
• ACEIs and ARBs should not be used in the same patient simultaneously.
• CCBs and thiazide-type diuretics should be used instead of ACEIs and ARBs
in patients over the age of 75 with impaired kidney function due to the risk of
hyperkalemia, increased creatinine, and further renal impairment.
¶ Adapted from: PL Detail-Document, Treatment of Hypertension: JNC 8 and More. Pharmacist’s
Letter/Prescriber’s Letter, February 2014.
APPENDIX D: ATP-IV TARGET LIPID
RECOMMENDATIONS¶
APPENDIX D.1: TARGET TC, TG, HDL-C, NON-HDL-C
Total cholesterol <200 mg/dL
Triglyceride <150 mg/dL
High-density lipoprotein (HDL) >40 mg/dL (male)
>50 mg/dL (female)
Non-high-density lipoprotein
(Non-HDL-C)
<130 mg/dL; 30 mg/dL above the LDL-C
treatment target
¶Adapted from the National Cholesterol Education Program Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel IV, 2012)
APPENDIX D.2: TARGET LDL-C†
Risk Assessment†† LDL Target Initiate TLC††† Initiate Drug Th erapy
0-1 <160 mg/dL =160 mg/dL =190 mg/dL (optional
at 160-189 mg/dL)
2 or more plus
10-year risk <10%
<130 mg/dL =130 mg/dL =160 mg/dL
2 or more plus
10-year risk <20%
<130 mg/dL
<100 mg/dL
optional
=130 mg/dL =130 mg/dL
CHD or CHD risk
equivalents
10-year risk >20%
<100 mg/dL
<70 mg/dL
optional
=100 mg/dL =100 mg/dL
†Treatment decisions based on LDL cholesterol.
††Risk factors include age (men =45 years and women =55 years).
†††Th erapeutic lifestyle changes (e.g., exercise, weight loss, low fat diet).
t
(continued)
Ap p e n d i x E : E f f e c t s o f S e l e c t e d D r u g s o n I n s u l i n A c t i v i t y ¦ 477
APPENDIX D.3: NON-HDL-C¶
Desirable <130 mg/dL Non-HDL-C is calculated as total
cholesterol minus HDL-C. Th e addition
of non-HDL-C to the Lipid Panel refl ects
the recognition of this calculated value
as a predictive factor in cardiovascular
disease based on the National
Cholesterol Education III studies. Th e
reference ranges for non-HDL-C are
based on National Cholesterol Education
III guidelines: Non-HDL-C is thought
to be a better predictor of CVD than
LDL-C; treatment goal for non-HDL-C
is usually 30 mg/dL above the LDL-C
treatment target. For example, if the
LDL-C treatment goal is <70 mg/dL, the
non-HDL-C treatment target would be
<100 mg/dL.
Borderline high 139-159 mg/dL
High 160-189 mg/dL
Very high =190 mg/dL
¶Adapted from the National Cholesterol Education Program Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel IV, 2012).
APPENDIX E: EFFECTS OF SELECTED DRUGS ON
INSULIN ACTIVITY
Hyper- and Hypo-glycemic Drug Eff ects
Drugs Th at May Cause Hyperglycemia Drugs Th at May Cause Hypoglycemia
Calcium channel blockers Alcohol
Th iazide diuretics Beta-blockers
Corticosteroids MAO inhibitors
Nicotinic acid Salicylates
Oral contraceptives NSAIDs
Phenytoin Warfarin
Sympathomimetics diazoxide Phenylbutazone
t
478 ¦ Ap p e n d i x F : G l y c o s y l a t e d H e m o g l o b i n ( H b A 1 c )
APPENDIX F: GLYCOSYLATED HEMOGLOBIN (HBA1c)
AND AVERAGE BLOOD GLUCOSE EQUIVALENT
HbA1c and Average Blood Glucose Equivalent
HbA1c GLU HbA1c GLU
4% 60 mg/dL 14% 360 mg/dL
5% 90 mg/dL 15% 390 mg/dL
6% 120 mg/dL 16% 420 mg/dL
7% 150 mg/dL 17% 450 mg/dL
8% 180 mg/dL 18% 480 mg/dL
9% 210 mg/dL 19% 510 mg/dL
10% 240 mg/dL 20% 540 mg/dL
11% 270 mg/dL 21% 570 mg/dL
12% 300 mg/dL 22% 600 mg/dL
13% 330 mg/dL 23% 630 mg/dL
APPENDIX G: ROUTINE IMMUNIZATION
RECOMMENDATIONS¶
• Prior to 1 year-of-age, administer IM vaccinations in the vastus lateralis muscle
• Aft er 1 year-of-age, administer vaccinations in the posterolateral upper arm
• Infl uenza vaccine should be administered annually for all ages =6 months of age
• Inactivated vaccines (e.g., pneumococcal, meningococcal, and inactivated infl uenza
vaccines), are generally acceptable and live vaccines are generally avoided, in
persons with immune defi ciencies or immuneocompromising conditions
• Additional information about routine vaccinations, unknown vaccination status,
travel vaccinations, vaccinations in pregnancy, and other vaccines, is available at:
www.cdc.gov/vaccines/hcp/acip-recs/index.html
www.cdc.gov/mmwr/preview/mmwrhtml rr6002a1/htm
wwwnc.cdc.gov/travel/destinations/list
www.cdc.gov/vaccines/adult/rec-vac/pregnant.html
www.cdc.gov/fl u/protect/vaccine/vaccines/htm
• DTaP (diphtheria-tetanus-toxoid, acellular pertussis); minimum age 6 wks
• DTaP should not be administered at or aft er the 7th birthday
• Th e 4th dose of DTaP vaccine can be administered as early as age 12 months, provided
that the interval between doses 3 and 4 is at least 6 months
• DTaP and IPV should be administered at or before school entry
• HAV (hepatitis A vaccine) is recommended for all children at 1 year (12-23
months) of age
t
t
(continued)
Ap p e n d i x G : R o u t i n e I m m u n i z a tion Recommenda t i o n s ¦ 479
• HAV 2-dose series should be administered at least 6 months apart
• HBV (hepatitis B vaccine) is a 3-dose series initiated at birth; administer 2nd dose
at 1-2 months; administer the 3rd dose at age 6 months (not before =24 weeks)
• HBV should be off ered to all children who have not received the full series
• Infants born to HVsAG-positive mothers should be tested for HBsAG and antibody
to HBsAg aft er completion of the HBV series (at age 9-18 months)
• Hib (hemophilus infl uenzae type b conjugate vaccine) minimum age 6 months
• Hib is not recommended if age >5 years
• HPV (human papillovirus vaccine) vaccine should be administered anytime between
11 and 12 years-of-age
• HPV is a 3-series vaccine administered months 0, 1, 6; females may recive HPV/4
or HPV/2; males should receive HPV/2
• HPV if not previously received at 11 or 12 years-of-age, may be iniitiated at any
time between 13 and 26 years-of-age
• IIV (inactivated infl uenza vaccine) can be administered >6 months (use age-appropriate
formulation), pregnant women, and persons with hives-only allergy to eggs
• IHD (infl uenza high dose) (Fluzone High Dose) may be recommended to persons
=65 years of age
• IPV (inactivated poliovirus vaccine) minimum age 4 weeks
• An all-IPV schedule is recommended to eliminate the risk of vaccine-associated
paralytic polio (VAPP) associated with OPV (oral poliovirus vaccine)
• LAIV (live attenuated infl uenza vaccine) may be administered intranasally (FluMist)
• Men (meningococcal vaccine) should be administered to all children at the 11-12 year old
visit as well as to unvaccinated adolescents 15 years-of-age (usually at high school entry)
• Men should be administered to all college freshmen living in dormitories\
• Use MPSV4 for children aged 2-10 years and MCV4 for older children, although
MPSV4 is an acceptable alternative for prophylaxis in men
• MMR (mumps-measles-rubella) should be administered at age 12 months in highrisk
areas; if indicated, tuberculin testing can be done at the same visit
• MMR should be administered at age 11-12 years unless 2 doses were given aft er the
fi rst birthday; the interval between doses should be at least 4 weeks
• MMR adults born <1957 are generally considered immune to measles and mumps;
all adults born =1957 should have documentation of at least I dose of MMR vaccine
unless there is a medical contraindication or laboratory evidence of immunity
to each of the 3 disease components; documentation of provider-diagnosed disease
is not acceptable evidence of immunity to any of the 3 disease components
• PCV-13 (pneumococcal vaccine) does not replace 23-valent pneumococcal polysaccharide
in children age =24 months
• PCV-13 when PCV-13 and PCV-23 are indicated, administer PCV-13 fi rst; do not
administer PCV-13 and PCV-23 in the same visit
• PCV-13 adults =65 years-of-age, who have not received PCV-13 or PCV-23, should
receive PCV-13 followed by PCV-23 6-12 months later
• PCV-23 (pneumococcal vaccine 23 trivalent) minimum age 6 weeks
• PCV-23 adults =65 years of age, who have received PCV-23, but not received PCV-
13, should receive. PCV-13 at least I year later; adults =65 years of age, who have
not received PCV-23, should receive
(continued)
(continued)
480 ¦ Ap p e n d i x G : R o u t i n e I m m u n i z a tion Recommenda t i o n s
• PCV-13 followed by PCV-23 6-12 months later
• RIV (recombinant infl uenza vaccine; FluBlok) may be administered to any adult
>18 years-of-age, including pregnant women
• RIV does not contain any egg protein; can be administered to anyone with egg
allergy at any severity
• Older infants and children previously vaccinated with PCV should receive 3 doses
(if age 7-11 months), 2 doses (if age 12-23 months) or 1 dose (if age >24 months)
• Rot (rotavirus vaccine) is a live attenuated oral vaccine for infants age >6 weeks or
<32 weeks only; administer the 1st dose at 6-12 weeks-of-age; administer 2nd and
3rd doses at 4-10-week intervals for a total of 3 doses
• Rot If an incomplete dose is administered, do not administer a replacement dose,
but continue with the remaining doses in the recommended series
• Td (tetanus-diphtheria vaccine) should be repeated every 10 years throughout life
(or if at-risk injury =5 years aft er previous dose)
• Td should not be administered until minimum age =7 years
• TdaP (tetanus-diphtheria-acellular pertussis) administer 1 dose to pregnant women
during each pregnancy, preferably during 27-36 weeks gestation, regardless of
interval since prior Td or TdaP
• TdaP persons =11 years of age who have not received Tdap vaccine or for whom
vaccine status is unknown, should receive 1 dose of TdaP followed by a Td booster
every 10 years
• Var should be administered to children at age 11-12 years who have not had
chicken-pox or who report having had chickenpox but do not have laboratory
documentation of immunity
• Var If not received between age 11 and 12 years, administer 2 doses at least 4 weeks
apart anytime aft er 12 years-of-age or a 2nd dose if previously only received 1 dose
• VarZ (herpes zoster vaccine) should be administered in a single dose once at =60
years-of-age, whether or not the person reports a prior episode of active herpes
zoster infection
• VarZ is contraindicated in pregnancy and immune defi ciency
• DTaP and IPV can be initiated as early as 4 weeks in areas of high endemicity or
outbreak.
¶Adapted from DHHS CDC 2015.
APPENDIX G.1: CONTRAINDICATIONS TO VACCINES¶
All vaccines Previous anaphylactic reaction to the vaccine
Moderate or severe illness with or without fever
TDaP/DTaP, Td Encephalopathy within 7 days of administration of previous dose
Hib Previous anaphylactic reaction to the vaccine
Moderate or severe illness with or without fever
HBV Anaphylactic reaction to baker’s yeast
(continued)
(continued)
Ap p e n d i x G : R o u t i n e I m m u n i z a tion Recommenda t i o n s ¦ 481
HAV Previous anaphylactic reaction to the vaccine
Moderate or severe illness with or without fever
Infl uenza Allergy to eggs (except FluBlok which does not contain any egg
protein)
IPV Anaphylactic reaction to neomycin or streptomycin
Pneumococcal Hypersensitivity to diphtheria toxoid
MMR Pregnancy, immunodefi ciency, anaphylactic reaction to eggs or
neomycin
Meningococcal Encephalopathy within 7 days of administration of previous dose
Rotavirus <6 months or >32 months
HPV Pregnancy; pregnancy testing is not required; however, if
administered, defer the remaining dose(s) until completion or
termination of pregnancy
Varicella Pregnancy
Herpes zoster Pregnancy
¶ Adapted from DHHS CDC 2015.
APPENDIX G.2: ROUTE OF ADMINISTRATION AND DOSE OF VACCINES¶
Vaccine Route Dose
Single Vaccines
Diphtheria-Tetanus-Pertussis (DTaP, Dtap, DT) IM 0.5 ml
Haemophilus infl uenza type b (Hib) IM 0.5 ml
Hepatitis A vaccine (HAV) IM 0.5 ml: age <18 yrs
1.0 ml: age =19 yrs
Hepatitis B vaccine (HBV) IM 0.5 ml: age <18 yrs
1.0 ml: age =19 yrs
Human Papillomavirus (HPV) IM 0.5 ml
Infl uenza (Fluzone Intradermal) ID 0.5 ml
Infl uenza, inactivated (IIV), recombinant (RIV) IM 0.25 ml: age 6-35
months
0.5 ml: age =3 yrs
Infl uenza, live attenuated (LAIV) NS 0.2 ml;
0.1 ml in each nostril
Meningococcal conjugate IM 0.5 ml
(continued)
(continued)
482 ¦ Ap p e n d i x G : R o u t i n e I m m u n i z a tion Recommenda t i o n s
Vaccine Route Dose
Meningococcal polysaccharide (MPSV) SC 0.5 ml
Meningococcal sero group B (Men B) IM 0.5 ml
Mumps-Measles-Rubella (MMR) SC 0.5 ml
Pneumococcal conjugate (PCV) IM 0.5 ml
Pneumococcal polysaccharide (PPSV) IM/SC 0.5 ml
Polio, Inactivated (IPV) IM/SC 0.5 ml
Rotavirus (Rotarix) PO 1 ml
Rotavirus (Rotateq) PO 2 ml
Tetanus (Td) IM 0.5 ml
Varicella SC 0.5 ml
Herpes Zoster SC 0.65 ml: age =60 yrs
Combination Vaccines
MMR-Var (ProQuad) SC 0.5 ml: age =12 yrs
HBV-HAV (Twinrix) IM 1 ml: >18 yrs
DTaP-HBV-IPV (Pediarix) IM 0.5 ml
DTaP-IPV-Hib (Pentacel) IM 0.5 ml
DTaP-IPV (Kinrix, Quadracel) IM 0.5 ml
Hib-HBV (Comvax) IM 0.5 ml
Hib-MenCY (MenHibrix) IM 0.5 ml
¶ Adapted from DHHS CDC 2015.
APPENDIX G.3: ADVERSE REACTIONS TO VACCINES¶
Vaccine Signs and Symptoms Treatment
Inactivated antigens: DTP,
Dtap, DTaP, Td, IPV, infl uenza
inactiveted (IIV) recombinant
(RIV)
Live attenuated viruses: MMR,
Meningococcal, rotavirus,
varicella, herpes zoster
Local tenderness
Erythema
Swelling
Low-grade fever
Drowsiness
Fretfulness
Decreased appetite
Prolonged crying
Unusual cry
acetaminophen
or ibuprofen for
age and/or weight;
aspirin and
aspirin-containing
products are
contraindicated
¶ Adapted from DHHS CDC 2015.
(continued)
Ap p e n d i x G : R o u t i n e I m m u n i z a tion Recommenda t i o n s ¦ 483
APPENDIX G.4: MINIMUM INTERVALS BETWEEN VACCINE DOSES¶
Type #1 to #2 #2 to #3 #3 to #4 #4 to #5
HBV 4 weeks 5 months
HAV 6 months
DTaP 4 weeks 4 weeks 6 months 6 months
IPV 4 weeks 4 weeks 4 weeks
MMR 4 weeks
Var 4 weeks
Rotavirus 4 weeks 4 weeks; do not
administer >32
weeks of age
PCV-13 4 weeks (if #1 at
age <12 months
and current age
<24 months);
8 weeks (as last
dose if #1 at age
>12 months or
current age 24-59
months);
No more doses
needed if healthy
and #1 at age =24
months
4 weeks if age <12
months;
8 weeks (as last
dose if age =12
months); No more
doses needed
if healthy and
previous dose at age
=24 months
8 weeks
(as last
dose; only
necessary
for age 12
months to
5 years who
received 3
doses before
age 12
months)
Hib 4 weeks (if #1 at
age <12 months);
8 weeks (as last
dose if #1 at age
12-14 months);
No more doses
needed if healthy
and #1 at age =15
months
4 weeks if age 12
months;
8 weeks (as last
dose if age =12
months);
No more doses
needed if previous
dose at age =15
months
8 weeks
(as last
dose; only
necessary
for age 12
months to
2 years who
received 3
doses before
age 12
months)
HPV 4 weeks 20 weeks (24 weeks
aft er #1
¶ Adapted from DHHS CDC 2015.
484 ¦ Ap p e n d i x G : R o u t i n e I m m u n i z a tion Recommenda t i o n s
APPENDIX G.5: RECOMMENDED CHILDHOOD IMMUNIZATION SCHEDULE¶
Type
Birth
1
month
2
months
4
months
6
months
6-18
months
12-15
months
15-18
months
4-6
years
11-12
years
HBV ? ? ?
DTaP ? ? ? ? ?
IPV ? ? ? ?
Hib ? ? ? ?
Rotavirus ? ? ?
MMR ? ?
TDaP ?
Varicella ? ?
PVC-13 ? ? ? ?
HAV ? ?
Meningitis ?
HPV? ???
¶Adapted from DHHS CDC 2015.
?Shaded box=immunization due.
???HPV 3-dose series, months 0, 1, 6.
Ap p e n d i x G : R o u t i n e I m m u n i z a tion Recommenda t i o n s ¦ 485
APPENDIX G.6: RECOMMENDEND CHILDHOOD IMMUNIZATION CATCH-UP
SCHEDULE¶
Vaccine Minimum Interval Between Doses
#1 to #2 #2 to #3 #3 to #4 #4 to #5
HBV 4 weeks 8 weeks (16 weeks
aft er #1)
DTaP 4 weeks 4 weeks 6 months 6 months
IPV 4 weeks 4 weeks 4 weeks
MMR 4 weeks
Var 4 weeks
Rotavirus 4 weeks 4 weeks; do not
administer >32 weeks
of age
PCV 2 months 2 months 2 months 6-15 months
HPV 4 weeks 20 weeks (24 weeks
aft er #1
¶Adapted from DHHS CDC 2015.
APPENDIX G.7: RECOMMENDED ADULT IMMUNIZATION SCHEDULE¶
Type 19-21 yrs 22-26 yrs 27-49 yrs 50-59 yrs 60-65 yrs =65 yrs
Infl uenza 1 dose annually
HBV 3 dose series: months 0, 1, 6
Td/TdaP Substitute Tdap for Td one time; then continue Td once every
10 years
MMR* Born >1957: 2 doses
Varicella* Without evidence of immunity: 2 doses, 4 weeks apart
Herpes
zoster*
1 time dose
PVC-13/
PVC-23
1 time dose
HAV Single Antigen, 2 doses: months 0, 6-12 (Havrix); 0, 6-18 (Vaqta)
Meningitis 1 or more doses
(continued)
486 ¦ Ap p e n d i x G : R o u t i n e I m m u n i z a tion Recommenda t i o n s
Type 19-21 yrs 22-26 yrs 27-49 yrs 50-59 yrs 60-65 yrs =65 yrs
HPV
(female)*ß
3 doses; months 0, 1, 6
HPV
(male)ß
3 doses; months 0, 1, 6
¶Adapted from DHHS CDC 2015.
*Contraindicated in pregnancy.
ßOnly if not previously vaccinated between 11-12 years-of-age.
APPENDIX H: CONTRACEPTIVES:
CONTRAINDICATIONS AND RECOMMENDATIONS
• All contraceptives are pregnancy category X
• No non-barrier contraceptives protect against STDs
• Absolute Contraindication:
• HTN >35 years-of-age
• DM >35 years-of-age
• LDL-C >160 or TG >250
• Known or suspected pregnancy
• Known or suspected carcinoma of the breast
• Known or suspected carcinoma of the endometrium
• Known or suspected estrogen-dependent neoplasia
• Undiagnosed abnormal genital bleeding
• Cerebral vascular or coronary artery disease
• Cholestatic jaundice of pregnancy or jaundice with prior use
• Hepatic adenoma or carcinoma or benign liver tumor
• Active or past history of thrombophlebitis or thromboembolic disorder
• Relative Contraindications
• Lactation
• Asthma
• Ulcerative colitis
• Migraine or vascular headache
• Cardiac or renal dysfunction
• Gestational diabetes, prediabetes, diabetes mellitus
• Diastolic BP 90 mmHg or greater or hypertension by any other criteria
• Psychic depression
• Varicose veins
• Smoker >35 years-of-age
• Sickle-cell or sickle-hemoglobin C disease
• Cholestatic jaundice during pregnancy, active gallbladder disease
• Hepatitis or mononucleosis during the preceding year
t
(continued)
(continued)
Ap p e n d i x H : C o n t r a c e p t i v e s ¦ 487
• First-order family history of fatal or nonfatal rheumatic CVD or diabetes prior to
age 50 years
• Drug(s) with known interaction(s)
• Elective surgery or immobilization within 4 weeks
• Age >50 years
• Recommendations
• Start the fi rst pill on the fi rst Sunday aft er menses begins. Th ereaft er, each new pill
pack will be started on a Sunday.
• Take each daily pill in the same 3-hour window (e.g., 9A-12N, 12N-3P; a 4-hour
window prior to bedtime is not recommended).
• If 1 pill is missed, take it as soon as possible and the next pill at the regular time.
• If 2 pills are missed, take both pills as soon as possible and then two pills the
following day. A barrier method should be used for the remainder of the pill pack.
• If 3 pills are missed before 10th cycle day, resume taking OCs on a regular
schedule and take precautions.
• If 3 pills are missed aft er the 10th cycle day, discard the current pill pack and
begin a new one 7 days aft er the last pill was taken.
• If very low-dose OCs are used or if combination OCs are begun aft er the th day of
the menstrual cycle, an additional method of birth control should be used for the
fi rst 7 days of OC use.
• If nausea occurs as a side eff ect, select an OC with lower estrogen content.
• If breakthrough bleeding occurs during the fi rst half of the cycle, select an OC
with higher progesterone content.
• Symptoms of a serious nature include loss of vision, diplopia, unilateral
numbness, weakness, or tingling, severe chest pain, severe pain in left arm or
neck, severe leg pain, slurring of speech, and abdominal tenderness or mass.
APPENDIX H.1: 28-DAY ORAL CONTRACEPTIVES
Comment: Beyaz, Loryna, Syeda, Safyral, Yasmin, and Yaz are contraindicated with renal
and adrenal insuffi ciency. Monitor k+ level during the fi rst cycle if the patient is at risk for
hyperkalemia for any reason. If the patient is taking drugs that increase potassium (e.g.,
ACEIs, ARBS, NSAIDs, K+ sparing diuretics), the patient is at risk for hyperkalemia.
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
Alesse-21, Alesse-28 (X)(G)
ethinyl estradiol/levonorgestrel
20 0.1
Altavera (X)
ethinyl estradiol/levonorgestrel
30 0.15
Apri (X)(G)
ethinyl estradiol/desogestrel
30 0.15
Aranelle (X)(G)
ethinyl estradiol/norethindrone
35 0.5
1
0.5
(continued)
(continued)
488 ¦ Ap p e n d i x H : C o n t r a c e p t i v e s
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
Aviane (X)(G)
ethinyl estradiol/levonorgestrel
20 0.1
Balziva (X)(G)
ethinyl estradiol/norethindrone
35 0.4
Beyaz (X)(G)
ethinyl estradiol/drospirenone
plus levomefolate calcium 0.451 mcg (28 tabs)
20 3
Blisovi 24Fe (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg (4 tabs)
20 1
Brevicon-21, Brevicon-28 (X)(G)
ethinyl estradiol/norethindrone
35 0.5
Camrese (X)
ethinyl estradiol/levonorgestrel
30
10
0.15
Camrese Lo (X)
ethinyl estradiol/levonorgestrel
20
10
0.1
Cesia (X)(G)
ethinyl estradiol/desogestrel
25
25
25
0.1
0.125
0.15
Cryselle (X)(G)
ethinyl estradiol/norgestrel
30 0.3
Cyclessa (X)(G)
ethinyl estradiol/desogestrel
25
25
25
0.1
0.125
0.15
Demulen 1/35-21, Demulen 1/35-28 (X)
(G)
ethinyl estradiol/ethynodiol diacetate
35 1
Demulen 1/50-21, Demulen 1/50-28 (X)
(G)
ethinyl estradiol/ethynodiol diacetate
50 1
Desogen (X)(G)
ethinyl estradiol/desogestrel diacetate
30 0.15
Enpresse (X)(G)
ethinyl estradiol/levonorgestrel
30
40
30
0.05
0.075
0.125
(continued)
(continued)
Ap p e n d i x H : C o n t r a c e p t i v e s ¦ 489
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
Estrostep Fe (X)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
20
30
35
111
Femcon Fe (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
35 0.4
Generess Fe Chew tab (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
25 0.8
Genora (X)(G)
ethinyl estradiol/norethindrone
35
35
35
0.5
1
0.5
Gianvi (X)(G)
ethinyl estradiol/drospirenone
20 3
Gildess 1.5/30 (X)(G)
ethinyl estradiol/norethindrone
30 1.5
Introvale (X)
ethinyl estradiol/levonorgestrel
30 0.15
Jenest-28 (X)
ethinyl estradiol/norethindrone
35
35
0.5
1
Jolessa (X)(G)
ethinyl estradiol/levonorgestrel
30 0.15
Junel 1/20 (X)(G)
ethinyl estradiol/norethindrone
20 1
Junel 1.5/30 (X)(G)
ethinyl estradiol/norethindrone
30 1.5
Junel Fe 1/20 (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
20 1
Junel Fe 1.5/30 (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
30 1.5
Kaitlib Fe Chew Tab (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
25 0.8
(continued)
(continued)
490 ¦ Ap p e n d i x H : C o n t r a c e p t i v e s
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
Kariva (X)(G)
ethinyl estradiol/desogestrel
20
10
0.15
0.15
Kelnor 1/35 (X)(G)
ethinyl estradiol/ethynodiol diacetate
35 1
Leena (X)
ethinyl estradiol/norethindrone
35
35
35
0.5
1
0.5
Lessina 28 (X)(G)
ethinyl estradiol/levonorgestrel
20 0.1
Levlen 21, Levlen 28 (X)(G)
ethinyl estradiol/levonorgestrel
30 0.15
Levlite 28 (X)(G)
ethinyl estradiol/levonorgestrel
20 0.1
Levora-21, Levora-28 (X)(G)
ethinyl estradiol/levonorgestrel
30 0.15
Loestrin 21 1/20 (X)(G)
ethinyl estradiol/norethindrone
20 1
Loestrin 21 1.5/30 (X)(G)
ethinyl estradiol/norethindrone
30 1.5
Loestrin Fe 1/20 (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
20 1
Loestrin Fe 1.5/30 (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg (4 tabs)
30 1.5
Loestrin 24 Fe (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg (4 tabs)
20 1
Lo Loestrin Fe (X)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg (2 tabs)
10 1
Lomedia 24 Fe (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
20 1
Lo/Ovral-21, Lo/Ovral-28 (X)(G)
ethinyl estradiol/norgestrel
30 0.3
(continued)
(continued)
Ap p e n d i x H : C o n t r a c e p t i v e s ¦ 491
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
Loryna (X)
ethinyl estradiol/drospirenone
20 3
Low-Ogestrel-21,
Low-Ogestrel-28 (X)(G)
ethinyl estradiol/norgestrel
30 0.3
Lutera (X)(G)
ethinyl estradiol/levonorgestrel
20 0.1
Lybrel (X)
ethinyl estradiol/levonorgestrel
20 0.09
Mibelas 24 FE (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
20 1
Microgestin 1/20 (X)(G)
ethinyl estradiol/norethindrone
20 1
Microgestin Fe 1/20 (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
20 1
Microgestin 1.5/30 (X)(G)
ethinyl estradiol/norethindrone
30 1.5
Microgestin Fe 1.5/30 (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
30 1.5
Mircette (X)(G)
ethinyl estradiol/desogestrel diacetate
20
10
0.15
Minastrin 24 FE (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg
20 1
Modicon 0.5/35-28 (X)(G)
ethinyl estradiol/norethindrone
35 0.5
MonoNessa (X)(G)
ethinyl estradiol/norgestimate
35 0.25
Natazia (X)(G)
estradiol valerate/dienogest
30
20
20
10
—23—
(continued)
(continued)
492 ¦ Ap p e n d i x H : C o n t r a c e p t i v e s
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
Necon 0.5/35-21, Necon 0.5/35-28 (X)(G)
ethinyl estradiol/norethindrone
35 0.5
Necon 1/35-21, Necon 1/35-28 (X)(G)
ethinyl estradiol/norethindrone
35 0.5
Necon 10/11-21, Necon 10/11-28 (X)(G)
ethinyl estradiol/norethindrone
35
35
0.5
1
Necon 1/50-21, Necon 1/50-28 (X)(G)
mestranol/norethindrone
50 1
Nelova 0.5/35-21, Nelova 0.5/35-28 (X)(G)
ethinyl estradiol/norethindrone
35 0.5
Nelova 1/35-21, Nelova 1/35-28 (X)(G)
ethinyl estradiol/norethindrone
35 1
Nelova 10/11-21, Nelova 10/11-28 (X)(G)
ethinyl estradiol/norethindrone
35
35
0.5
1
Nelova 1/50-21, Nelova 1/50-28 (X)(G)
mestranol/norethindrone
50 1
Neocon 7/7/7 (X)(G)
ethinyl estradiol/norethindrone
35
35
35
0.5
0.75
1
Nordette-21, Nordette-28 (X)(G)
ethinyl estradiol/levonorgestrel
30 0.15
Norinyl 1+35-21, Norinyl 1+35-28 (X)(G)
ethinyl estradiol/norethindrone
35 1
Norinyl 1+50-21, Norinyl 1+50-28 (X)(G)
mestranol/norethindrone
50 1
Nortrel 0.5/35 (X)(G)
ethinyl estradiol/norethindrone
35 0.5
Nortrel 1/35-21, Nortrel 1/35-28 (X)(G)
ethinyl estradiol/norethindrone
35 1
Nortrel 7/7/7-28 (X)(G)
ethinyl estradiol/norethindrone
35
35
35
0.5
0.75
1
Ocella (X)(G)
ethinyl estradiol/drospirenone
30 3
(continued)
(continued)
Ap p e n d i x H : C o n t r a c e p t i v e s ¦ 493
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
Ortho-Cept 28 (X)(G)
ethinyl estradiol/desogestrel
30 0.15
Ortho-Cyclen 28 (X)(G)
ethinyl estradiol/norgestimate
35 0.25
Ortho-Novum 1/35-21, Ortho-Novum
1/35-28 (X)(G)
ethinyl estradiol/norethindrone
35 1
Ortho-Novum 1/50-21, Ortho-Novum
1/50-28 (X)(G)
mestranol/norethindrone
50 1
Ortho-Novum 7/7/7-28 (X)(G)
ethinyl estradiol/norethindrone
35
35
35
0.5
0.75
1
Ortho-Novum 10/11-28 (X)
ethinyl estradiol/norethindrone
35
35
0.5
1
Ortho Tri-Cyclen 21, Ortho
Tri-Cyclen 28 (X)(G)
ethinyl estradiol/norgestimate
35
35
35
0.18
0.215
0.25
Ortho Tri-Cyclen Lo (X)(G)
ethinyl estradiol/norgestimate
25
25
25
0.18
0.215
0.25
Ovcon 35 Fe (X)(G)
ethinyl estradiol/norethindrone plus ferrous
fumarate 75 mg (4 tabs)
35 0.4
Ovcon 50-28, Ovcon 50-28 (X)(G)
ethinyl estradiol/norethindrone
50 1
Ovral-21, Ovral-28 (X)(G)
ethinyl estradiol/norgestrel
50 0.5
Portia (X)(G)
ethinyl estradiol/levonorgestrel
30 0.15
Previfem (X)
ethinyl estradiol/norgestimate
35 0.25
Quasense (X)
ethinyl estradiol/levonorgestrel
30 0.15
(continued)
(continued)
494 ¦ Ap p e n d i x H : C o n t r a c e p t i v e s
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
Reclipsen (X)(G)
ethinyl estradiol/desogestrel
plus ferrous fumarate 75 mg (4 tabs)
30 0.15
Safyral (X)
ethinyl estradiol/drospirenone
plus levomefolate calcium 0.451 mg
30 3
Sprintec 28 (X)(G)
ethinyl estradiol/norgestimate
35 0.25
Syeda (X)
ethinyl estradiol/drospirenone
30 3
Tarina Fe 1/20 (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg (7 tabs)
20 1
Taytulla Fe 1/20 (X)(G) (Soft gel caps)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg (4 Soft gel caps)
20 1
Tilia Fe (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg (7 tabs)
20
30
35
111
Tri-Legest 21 (X)(G)
ethinyl estradiol/norethindrone
20
30
35
111
TriLegest Fe (X)(G)
ethinyl estradiol/norethindrone
plus ferrous fumarate 75 mg (7 tabs)
20
30
35
111
Tri-Levlen 21, Tri-Levlen 28 (X)(G)
ethinyl estradiol/levonorgestrel
30
40
30
0.05
0.075
0.125
Tri-Lo-Estarylla (X)(G)
ethinyl estradiol/norgestimate
25
25
25
0.18
0.215
0.25
Tri-Lo-Sprintec (X)(G)
ethinyl estradiol/norgestimate
25
25
25
0.18
0.215
0.25
(continued)
(continued)
Ap p e n d i x H : C o n t r a c e p t i v e s ¦ 495
Combined Oral Contraceptive Estrogen (mcg) Progesterone (mg)
TriNessa (X)(G)
ethinyl estradiol/norgestimate
35
35
35
0.18
0.215
0.25
Tri-Norinyl 21, Tri-Norinyl 28 (X)(G)
ethinyl estradiol/norethindrone
35
35
35
0.5
1
0.5
Triphasil-21, Triphasil-28 (X)(G)
ethinyl estradiol/levonorgestrel
30
40
30
0.050
0.075
0.125
Tri-Previfem (X)(G)
ethinyl estradiol/norgestimate
35
35
35
0.18
0.215
0.25
Tri-Sprintec (X)(G)
ethinyl estradiol/norgestimate
35
35
35
0.18
0.215
0.25
Trivora (X)(G)
ethinyl estradiol/levonorgestrel
30
40
30
0.05
0.075
0.125
Velivet (X)(G)
ethinyl estradiol/desogestrel
25
25
25
0.1
0.125
0.15
Yasmin (X)(G)
ethinyl estradiol/drospirenone
30 3
Yaz (X)(G)
ethinyl estradiol/drospirenone
20 3
Zovia 1/35E-28 (X)(G)
ethinyl estradiol/ethynodiol diacetate
35 1
Zovia 1/50E-28 (X)(G)
ethinyl estradiol/ethynodiol diacetate
50 1
APPENDIX H.2: EXTENDED-CYCLE ORAL CONTRACEPTIVES
91 Day
ethinyl estradiol/levonorgestrel (X) 1 tab daily x 91 days; repeat (no tablet-free days)
Ashlyna (G) Tab: levnorgest 15 mcg/eth est 30 mcg (84) + eth est 10 mcg (7)
(91 tabs/pck)
Jolessa (G) Tab: levonorgest 15 mcg/eth est 30 mcg (84) + inert tabs (7m91 tabs/pck)
LoSeasonique Tab: levnorgest 0.1 mcg/eth est 20 mcg (84) + eth est 10 mcg (7)
(91 tabs/pck)
y
(continued)
(continued)
496 ¦ Ap p e n d i x H : C o n t r a c e p t i v e s
Quartette (G) Tab: levonorgest 15 mcg/eth est 30 mcg (84) + eth est 10 mcg (7)
(91 tabs/pck)
Quasense (G) Tab: levonorgest 15 mcg/eth est 30 mcg (84) + inert tabs (7) (91
tabs/pck)
Seasonale (G) Tab: levonorgest 15 mcg/eth est 30 mcg (84) + inert tabs (7) (91
tabs/pck)
Seasonique (G) Tab: levnorgest 15 mcg/eth est 30 mcg (84) + eth est 10 mcg (7)
(91 tabs/pck)
365 Day
ethinyl estradiol/levonorgestrel (X) 1 tab daily x 28 days; repeat (no tablet-free days)
Lybrel Tab: levnorgest 0.09 mcg/eth est 20 mcg (28 tabs/pck)
APPENDIX H.3: PROGESTERONE-ONLY ORAL CONTRACEPTIVES
(“MINI-PILL”)
Brand Progesterone Mcg
Comment: Take progestin-only pills at the same time each day (within a 3-hour
time window). If a pill is missed, another method of contraception should be used
for the remainder of the pill pack.
Camila norethindrone (X)(G) 35
Errin norethindrone (X)(G) 35
Jolivette norethindrone (X)(G) 35
Micronor norethindrone (X)(G) 35
Nora-BE norethindrone (X)(G) 35
Nor-QD norethindrone (X)(G) 35
Ovrette norgestrel (X) 7.5
APPENDIX H.4: INJECTABLE CONTRACEPTIVES
H.4.1: Injectable Progesterone
90 Days
Comment: Administer fi rst dose within 5 days of onset of normal menses, within
5 days postpartum if not breastfeeding, or at 6 weeks postpartum if breastfeeding
exclusively. Do not use for >2 years unless other methods are inadequate.
medroxyprogesterone (X)(G)
Depo-Provera 150 mg deep IM q 3 months
Vial: 150 mg/ml (1 ml); Prefi lled syringe: 150 mg/ml
Depo-SubQ 104 mg SC q 3 months
Prefi lled syringe: 104 mg/ml (0.65 ml) (parabens) y
y
(continued)
Ap p e n d i x H : C o n t r a c e p t i v e s ¦ 497
APPENDIX H.5: TRANSDERMAL CONTRACEPTIVE
Ethinyl Estradiol/Norelgestromin
Comment: Apply the transdermal patch to the abdomen, buttock, upper-outer arm,
or upper torso. Do not apply the transdermal patch to the breast. Rotate the site
(however, may use the same anatomical area).
ethinyl estradio/norelgestromin (X)(G) apply one patch once weekly x 3 weeks;
then 1 patch-free week; then repeat sequence
Ortho Evra
Transdermal patch: eth est 20 mcg/norel 150 mcg per day (1, 3/pck)
APPENDIX H.6: CONTRACEPTIVE VAGINAL RINGS
Ethinyl Estradiol/Etonogestrel
Comment: Th e vaginal ring should be inserted prior to, or on 5th day, of the
menstrual cycle. Use of a backup method is recommended during the fi rst week.
When switching from oral contraceptives, the vaginal ring should be inserted
anytime within 7 days aft er the last active tablet and no later than the day a new
pill pack would have been started (no back up method is needed). If the ring is
accidently expelled for less than 3 hours, it should be rinsed with cool to lukewarm
water and reinserted promptly. If ring removal lasts for more than 3 hours, an
additional contraceptive method should be used. If the ring is lost, a new ring
should be inserted and the regimen continued without alteration.
etonogestrel/ethinyl estradiol (X) insert 1 ring vaginally and leave in place for
3 weeks; then remove for 1 ring-free week; then repeat
NuvaRing
Vag ring: eth est 15 mcg/eton 120 mcg per day (1, 3/pck)

APPENDIX H.7: SUBDERMAL CONTRACEPTIVES
Comment: Implants must be inserted within 7 days of the onset of menses.
A complete physical examination is required annually. Remove if pregnancy, thromboembolic disorder including thrombophlebitis, jaundice, visual disturbances. Not for use by patients with hypertension, diabetes, hyperlipidemia, impaired liver function, epilepsy, asthma, migraine, depression, cardiac or renal insufficiency, thromboembolic disorder including thrombophlebitis, prolonged immobilization, or who are smokers.

• etonogestrel (X) implant rod subdermally in the upper inner non-dominant arm; remove and replace at the end of 3 years
  Implanon, Nexplanon
  Implantable rod: 68 mg implant for subdermal insertion (w. insertion device; latex-free)
• levonorgestrel (X) implant rods subdermally in the upper inner nondominant arm; remove and replace at the end of 5 years
  Norplant
  Implantable rods: 6-36 mg implants (total 216 mg) for subdermal insertion (1 kit w. sterile supplies)

APPENDIX H.8: INTRAUTERINE CONTRACEPTIVES
Comment: Indicated in women who have had at least one child and who are in a stable, mutually monogamous relationship. Reexamine aft er menses within 3 months (recommend 4-6 weeks) to check placement.

• levonorgestrel (X)
  Kyleena IUD: 19.5 mg (replace at least every 5 years)
  Liletta IUD: 52 mg (replace at least every 3 years)
  Mirena IUD: 52 mg (replace at least every 5 years)
  Skyla IUD: 13.5 mg (replace at least every 3 years)

APPENDIX H.9: EMERGENCY CONTRACEPTION
Comment: Emergency contraception must be started within 72 hours aft er unprotected intercourse following a negative urine hCG pregnancy test. If vomiting occurs within 1 hour of taking a dose, repeat the dose.

ethinyl estradiol/levonorgestrel (X) 2 tabs as soon as possible aft er unprotected intercourse or contraceptive failure, then 2 more 12 hours aft er fi rst dose
Pediatric: premenarchal: not applicable
Preven
Tab: eth est 50 mcg/lev 250 mcg (4/pck) + Pregnancy test: 1 hCG home pregnancy test
Yuzpe Regimen
Tab: eth est 50 mcg/lev 250 mcg (4/pck)

levonorgestrel (X)(OTC)(G)
Comment: <17 years of age (prescription required; =17 years of age (OTC)
Pediatric: premenarchal: not applicable
My Way take 1 tab as soon as possible, within 72 hours, aft er unprotected sex or suspected contraceptive failure
Tab: 1.5 mg
Plan B One Step take 1 tab as soon as possible, within 72 hours, aft er unprotected sex or suspectedcontraceptive failure
Tab: 1.5 mg
EContra EZ take 1 tab within 72 hours aft er unprotected sex or suspected contraceptive failure
Tab: 1.5 mg

ulipristal (X)
Pediatric: premenarchal: not applicable
ella 1 tab as soon as possible within 120 hours (5 days) aft er unprotected intercourse or contraceptive failure; may repeat dose if vomiting occurs within 3 hours
Tab: 30 mg

APPENDIX I: ANESTHETIC AGENTS
FOR LOCAL INFILTRATION AND
DERMAL/MUCOSAL MEMBRANE APPLICATION
Agents and Indications
Brand/generic Indication(s)
AnaMantle HC
lidocaine 3%/hydrocortisone 0.5%
Local anesthetic/steroid; for
hemorrhoids, pruritus ani, anal fi ssure
Decadron Phosphate with Xylocaine
dexamethasone 4 mg/lidocaine 10 mg/
ml (5 ml)
Local anesthetic/steroid; infi ltration by
injection
Dyclone
dyclonine 0.5%, 0.1%
Local anesthetic; infi ltration by
injection
Duranest (B)
etidocaine 1% (30 ml)
Duranest (B) w. Epinephrine
Inj: etido 1.5%/epi 1:200,000 (30 ml)
Dental Cartridge: etido 1.5%/epi
1:200,000 (1.8 ml)
Nerve block and local anesthetic;
mouth, pharynx, larynx, trachea,
esophagus, anogenital area, urethra
Local anesthetic: dental procedures
Ela-Max 4% Cream (B)
lidocaine 4%
Ela-Max 5% Cream (B)
lidocaine 5%
Local dermal anesthetic and for
anorectal irritation and pain
Emla Cream (B) (5, 30 g) Emla
Anesthetic Disc (B) (2 discs/box)
lidocaine 2.5%/prilocaine 2.5%
Local dermal anesthetic; preparation
for phlebotomy, PIV starts, injections
Flector Patch (C/D) (30/box)
diclofenac epolamine 180 mg
Local dermal NSAID analgesic
Exparel (B) Vial: 13.3 mg/ml (20 ml)
bupivacaine liposome 1.3% susp for inj
Surgical site injection for postop pain
management
y
t
(continued)
(continued)
500 ¦ Ap p e n d i x I : A n e s t h e t i c A g e n t s
Agents and Indications
Brand/generic Indication(s)
LidaMantle (B) cream (1, 2 oz)
LidaMantle (B) lotion (177 ml)
Lidoderm cream (B) (85 g)
lidocaine 3%
Lidoderm (B)(G) adhesive patch (10 cm
x14 cm; 30/box)
lidocaine 5%
Local dermal anesthetic lotion, cream,
and adhesive patch
Ophthaine (B) (15 ml)
proparacaine 0.5% ophthalmic solution
Ophthalmic anesthetic for examination/
removal of foreign body (eye)
Pliaglis Cream (B) (30 g)
lidocaine 7%/tetracaine 7%
Local dermal anesthetic for superfi cial
dermatological procedures
Qutenza (B) (1, 2 patches, each with 50 g
tube of cleansing gel)
capsaicin 8% patch
Local dermal NSAID analgesic for
postherpetic neuralgia
Synera Topical Patch (B) (2, 10/pck)
lidocaine 70 mg/tetracaine 70 mg
Local dermal anesthetic for venous
access or skin lesion removal
Tetracaine Ophthalmic Solution (B) (15
ml)
proparacaine 0.5% ophthalmic solution
Ophthalmic anesthetic for
examination/removal of foreign body
(eye)
Xylocaine Jelly (B) (5, 10, 20, 30 ml)
lidocaine 2% aqueous
For procedures of the urethra, painful
urethritis, and endotracheal intubation
Xylocaine Ointment (B) (3.5, 35 g)
lidocaine 5% water miscible
For procedures of the urethra, painful
urethritis, and endotracheal intubation
Xylocaine Topical Solution (B) (100 ml)
lidocaine 2% solution
Xylocaine Viscous (B) (50 ml)
lidocaine 2% viscous solution
Anesthetic for the nasal and
oropharyngeal mucosa and the
proximal portions of the GI tract
Zingo
lidocaine monohydrate 0.5 mg
Hand-held, needle-free device,
helium-powered delivery system
that numbs site in 1-3 minutes
delivers 0.5 mg sterile lidocaine HCL
monohydrate sterile lidocaine HCL
pwdr for intradermal injection for the
management of venous access pain
(continued)
(continued)
Ap p e n d i x J : O r a l P r e s c r i p t i o n N S A I D s ¦ 501
Agents and Indications
Brand/generic Indication(s)
Zostrix (B) (0.7, 1.5, 3 oz)
capsaicin 0.025% cream
Zostrix HP (B) (1, 2 oz)
capsaicin 0.075% emollient cream
Local dermal NSAID analgesic
APPENDIX J: ORAL PRESCRIPTION NSAIDs
Comment: NSAIDs should be taken with food to decrease gastric upset. Dosing
of NSAIDs should be scheduled rather than PRN for maximal benefi t. NSAIDs
are contraindicated with sulfonamide or aspirin allergy, 3rd trimester pregnancy
(causes premature closure of the ductus arteriosus), and coronary artery bypass
graft (CABG) surgery. Concomitant use of misoprostol (Cytotec) with NSAIDs
reduces gastric upset and potential for ulceration; however, misoprostol is pregnancy
category X. Administration of misoprostol in pregnancy can cause spontaneous
abortion, premature birth, birth defects, and uterine rupture (beyond the 8th week
of pregnancy). NSAIDs and warfarin (Coumadin) are synergistic. With all patients,
use the lowest eff ective dose for the shortest time necessary. NSAIDs should be taken
with food to reduce the risk of gastrointestinal adverse side eff ects (GIASE).
GI ADVERSE SIDE EFFECTS:
(+) MILD; (++) FREQUENT; (+++) MORE FREQUENT/SEVERE
celecoxib (C/D)(G)(+) 100 mg twice daily or 200 mg once daily or 200 mg twice
daily or 400 mg once daily; <50 kg, start at lowest dose
Pediatric: <2 years: not recommended; =2 years, >10<25 kg: 50 mg twice daily;
=25 kg: 100 mg once daily
Celebrex
Cap: 50, 100, 200, 400 mg
diclofenac sodium (D)(+++)
Pediatric: not recommended
Dyloject administer 37.5 mg IV bolus over 15 seconds q 6 hours; max
150 mg/day
Vial: 37.5 mg/ml (25/box)
Pennsaid 1% in 10 drop increments, dispense and rub into front, side, and
back of knee: usually 40 drops (40 mg) qid
Topical soln: 1.5% (150 ml)
Pennsaid 2% apply 2 pump actuations (40 mg) and rub into front, side, and
back of knee bid
Topical soln: 2% (20 mg/pump actuation; 112 g)
Solaraze Gel apply to aff ected areas bid
Gel: 3% (30 mg (100 g)
Voltaren 50 mg bid or 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
Zorvolex 35 mg tid
Gelcap: 18, 35 mg ext-rel
diclofenac potassium (C/D)(G)(+++) 50 mg tid or qid or 25 mg tid or qid and may
add 25 mg at HS
Pediatric: not recommended
Catafl am
Tab: 50 mg
Zipsor
Gel cap: 25 mg
diclofenac sodium plus misoprostol (X)(++)
Pediatric: not recommended
Arthrotec
Tab: 50, 75 mg
difl unisal (C/D)(G)(+++) initially 1 g as a single dose followed by 500 mg q 8-12
hours or 500 mg as a single dose followed by 250 mg q 8-12 hours
Pediatric: <12 years: not recommended
Dolobid
Tab: 500*mg
etodolac (C/D)(G)(+)
Pediatric: not recommended
Lodine initially 600 mg to 1 g/day in 2-3 divided doses; usual max 1 g/day in
divided doses; may increase to 1.2 g/day when needed
Tab: 400, 500 mg; Cap: 200, 300 mg
Lodine XL 400 mg to 1 g once daily; max 1.2 g/day
Tab: 400, 500, 600 mg ext-rel
fenoprofen (B/D)(++) 300-600 mg tid-qid; max 3.2 g/day
Pediatric: not recommended
Nalfon
Tab: 200 mg
fl urbiprofen (B/D)(G)(++) 200-300 mg/day in 2-4 divided doses; max single dose
100 mg; reduce dosage for renal impairment
Pediatric: not recommended
Ansaid
Tab: 50, 100 mg
ibuprofen/famotidine (B/D)(++) 1 tab 3 times daily; swallow whole; use lowest
eff ective dose for the shortest duration
Pediatric: not recommended
Duexis
Tab: ibu 800 mg/fam 26.6 mg
indomethecin (B/D)(G)(+++) 75-100 mg daily in 3-4 divided doses; max
200 mg/day
Pediatric: <14 years: not recommended
Indocin
Cap: 25, 50 mg; Rectal supp: 50 mg; Oral susp: 25 mg/5 ml; Vial: 1 mg pwdr
for reconstitution and IV infusion
Indocin SR
Cap: 75 mg ext-rel
Tivorbex
Cap: 20, 40 mg
ketoprofen (C/D)(G)(++) 75 mg tid or 50 mg qid; max 300 mg/day
Pediatric: <18 years: not recommended
Orudis
Cap: 50, 75 mg
Oruvail
Cap: 100, 150, 200 mg ext-rel
ketorolac tromethamine (C/D)(G)(+++)
Pediatric: <17 years: not recommended
Sprix 17-64 years: 1 spray each nostril (total dose 31,5 mg) every 6-8 hours
prn; max 4 doses/24 hours (total daily dose 126 mg); =65 years, renal impairment
or <50 kg: 1 spray in one nostril (total dose 15.75 mg) every 6-8 hours;
max 4 doses/24 hours (63 mg); discard used bottle aft er 24 hours
Nasal spray: 15.75 mg/100 mcl nasal spray (8 sprays, 1.7 g)
Toradol 60 mg as a single IM dose; max 30 mg as a single IV dose; may
administer 30 mg IV and 30 mg IM as a single dose; oral dosing is indicated
only as continuation therapy to IM or IV dosing; oral formulation
should never be administered as an initial dose; initiate oral dosing at 20
mg followed by 10 mg q 4-6 hours prn; max oral dosing 40 mg/day; >65
years, initiate oral dosing at 10 mg followed by 10 mg q 4-6 hours prn;
max 40 mg/day; the combined duration of IV/IM/PO dosing is not to
exceed 5 days
Tab: 10 mg; Inj 15, 30, 60 mg/ml
magnesium chol salicylate (C/D)(G)(+)
Pediatric:
Trilisate
Tab: 10 mg
meclofenamate sodium (B/D)(G)(++) 50-100 mg q 4-6 hours or 300-400 mg/day
in 3-4 equal doses; max 400 mg/day
Pediatric: <14 years: not recommended
Meclofen
Cap: 50, 100 mg
mefenamic acid (C)(G)(++) 500 mg once; then, 250 mg q 6 hours
Pediatric: <14 years: not recommended
Ponstel
Cap: 250 mg
meloxicam (C/D)(G)(+) 7.5 mg once daily; max 15 mg/day; hemodialysis max
7.5 mg/day
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)
Relafen
Tab: 500, 750 mg
nabumetone (C/D)(G)(+) 1-2 g/day in a single dose or 2 divided doses; max 2 g/
day; <50 kg, max 1 g/day
Pediatric: not recommended
naproxen (B)(G)(++) 275-550 mg twice daily or 275 mg every 6-8 hours; max 1.375
g fi rst day; then, max 1.1 g/day; acute gout: 825 mg once, then 275 mg every 8 hours
Pediatric: <2 years: not recommended; =2 years: 5 mg/kg bid; max 15 mg/kg/day
has been used; use suspension
Naprosyn
Tab: 250, 375, 500 mg
Naprosyn Suspension
Oral susp: 125 mg/5 ml
naproxen/esomeprazole (as magnesium trihydrate) (C/D)(++)(G) one 375/20
or one 500/20 tab twice daily; take at least 30 minutes before meals; take lowest
eff ective dose
Pediatric: <18 years: not recommended
Vimovo 375/20
Tab: nap 375 mg/eso 20 mg
Vimovo 500/20
Tab: nap 500 mg/eso 20 mg
oxaprozin (C/D)(++) 1.2 g once daily; max 1.8 g or 26 mg/kg daily, whichever is
less, in divided doses; low body weight, milder disease, or on dialysis: initially 600
mg once daily; max 1.2 g daily
Pediatric: <6 years: not recommended; 6-16 years, 21-31 kg: 600 mg once daily;
32-54 kg: 900 mg once daily; =55 kg: 1.2 g once daily
Daypro Tab: 600*
piroxicam (C/D)(G)(+++) 20 mg once daily
Pediatric: not recommended
Feldene
Cap: 10, 20 mg
Comment: Because of the long half-life, steady state blood levels of piroxicam are
not reached for 7-12 days. Th erefore, there is a progressive response over several
weeks.
salsalate (C/D)(G)(+) 1.5 g bid or 1 g tid
Pediatric: not recommended
Disalcid
Tab: 500*, 750*mg; Cap: 500 mg
sulindac (B/D)(G)(+++) 150-200 mg bid; max 400 mg/day; usually x 7-14 days
Pediatric: not recommended
Clinoril
Tab: 150*, 200*mg
Tolectin DS
Cap: 400 mg
Tolectin 600
Tab: 600 mg fi lm-coat
tolmetin (C/D)(G)(+++) initially 400 mg tid; usual range 600 mg to 1.8 g/day in
divided doses; max 1,800 mg/day
Pediatric: <2 years: not recommended; =2 years: 20 mg/kg divided tid to qid;
usual range 15-30 mg/kg/day divided tid to qud: max 30 mg/kg/day
Tolectin Tab: 200*mg
nabumetone (C/D)(G)(+) 1-2 g/day in a single dose or 2 divided doses; max 2 g/
day; <50 kg, max 1 g/day
Pediatric: not recommended
naproxen (B)(G)(++) 275-550 mg bid or 275 mg q 6-8 hours; max 1.375 g fi rst day,
then, max 1.1 g/day; Acute gout attack: 825 mg once, then 275 mg every 8 hours
Pediatric: <2 years: not recommended; =2 years: 5 mg/kg bid; max 15 mg/kg/day
has been used; use suspension
Naprosyn
Tab: 250, 375, 500 mg
Naprosyn Suspension
Oral susp: 125 mg/5 ml
naproxen/esomeprazole (as magnesium trihydrate) (C/D)(++)(G) 1 x 375/20 or 1
x 500/20 tab bid; take at least 30 minutes before meals; take lowest eff ective dose
Pediatric: <18 years: not recommended
Vimovo 375/20
Tab: nap 375 mg/eso 20 mg
Vimovo 500/20
Tab: nap 500 mg/eso 20 mg
oxaprozin (C/D)(++) 1.2 g once daily; max 1.8 g or 26 mg/kg daily, whichever is
less, in divided doses; Low body weight, milder disease, or on dialysis: initially 600
mg once daily; max 1.2 g daily
Pediatric: <6 years: not recommended; 6-16 years, 21-31 kg: 600 mg once daily;
32-54 kg: 900 mg once daily; =55 kg: 1.2 g once daily
Daypro
Tab: 600* y
y
y
y
y
y
y
(continued)
(continued)
506 ¦ Ap p e n d i x J : O r a l P r e s c r i p t i o n N S A I D s
piroxicam (C/D)(G)(+++) 20 mg once daily
Pediatric: not recommended
Feldene
Cap: 10, 20 mg
Comment: Because of the long half-life, steady state blood levels of piroxicam are
not reached for 7-12 days. Th erefore, there is a progressive response over several
weeks.
salsalate (C/D)(G)(+) 1.5 g bid or 1 g tid
Pediatric: not recommended
Disalcid
Tab: 500*, 750*mg; Cap: 500 mg
Tolectin 600
Tab: 600 mg fi lm-coat
APPENDIX K: TOPICAL CORTICOSTEROIDS
BY POTENCY
Comment: All topical, oral, and parenteral corticosteroids are pregnancy category
C. Use with caution in infants and children. Steroids should be applied sparingly
and for the shortest time necessary. Do not use in the diaper area. Do not use an
occlusive dressing. Systemic absorption of topical corticosteroids can induce reversible
hypothalamic-pituitary-adrenal (HPA) axis suppression with the potential for clinical
glucocorticoid insuffi ciency.
Potency guide:
• Face: Low potency
• Ears/scalp margin: Intermediate potency
• Eyelids: Hydrocortisone in ophthalmic ointment base 1%
• Chest/back: Intermediate potency
• Skin folds: Low potency
Generic Brand/Formulation/
Frequency
Strength/Volume
Low Potency
alclometasone
dipropionate (C)
Aclovate Crm bid-tid
Aclovate Oint bid-tid
0.05% (15,45, 60 g)
0.05% (15,45, 60 g)
fl uocinolone acetonide (C) Synalar Crm bid-qid 0.025% (15, 60 g)
hydrocortisone base or
acetate (C)(G)
Anusol-HC Crm bid-qid
Hytone Crm bid-qid
Hytone Oint bid-qid
Hytone Lotn bid-qid
2.5% (30 g)
1% (1, 2 oz)
1% (1 oz)
1% (2 oz)
Generic Brand/Formulation/
Frequency
Strength/Volume
Hytone Crm bid-qid
Hytone Oint bid-qid
Hytone Lotn bid-qid
U-cort Crm bid-qid
2.5% (1, 2 oz)
2.5% (1 oz)
2.5% (1 oz)
1% (7, 28, 35 g)
triamcinolone acetonide
(C)(G)
Kenalog Crm bid-qid
Kenalog Lotn bid-qid
Kenalog Oint bid-qid
0.025% (15, 80 g)
0.025% (60 ml)
0.025% (15, 60, 80 g)
Intermediate Potency
betamethasone valerate
(C)(G)
Luxiq Foam bid 0.12% (100 g)
clocortolone pivalate (C) Cloderm Crm bid
desonide (C)(G) Desonate Gel/Formulation
bid-tid
DesOwen Crm bid-tid
DesOwen Lotn bid-tid
DesOwen Oint bid-tid
Tridesilon Crm bid-qid
Tridesilon Oint bid-qid
Verdeso Foam
0.05% (15, 60 g)
0.05% (15, 60 g)
0.05% (2, 4 fl oz)
0.05% (15, 60 g)
0.05% (15, 60 g)
0.05% (15, 60 g)
desoximetasone (C)(G) Topicort-LP Emol Crm bid 0.05% (15, 60 g, 4 oz)
fl uocinolone acetonide
(C)(G)
Capex Shampoo
Derma-Smoothe/FS Oil tid
Derma-Smoothe/FS
Shampoo
Synalar Crm bid-qid
Synalar Oint bid-qid
0.01% (4 oz)
0.01% (4 oz)
0.01% (4 oz)
0.025% (15, 30, 60 g)
0.025% (15, 60 g)
fl urandrenolide (C) Cordran-SP Crm bid to tid
Cordran Oint bid-tid
Cordran-SP Crm bid-tid
Cordran Lotn bid-tid
Cordran Oint bid-tid
0.025% (30, 60 g)
0.025% (30, 60 g)
0.05% (15, 30, 60 g)
0.05% (15, 60 ml)
0.05% (15, 30, 60 g)
fl uticasone propionate
(C)(G)
Cutivate Oint bid
Cutivate Crm qd-bid
Cutivate Lotn qd-bid
0.005% (15, 30, 60 g)
0.05% (15, 30, 60 g)
0.05%
(continued)
(continued)
508 ¦ Ap p e n d i x K : To p i c a l C o r t i c o s t e r o i d s b y Po t e n cy
Generic Brand/Formulation/
Frequency
Strength/Volume
hydrocortisone probutate
(C)
Pandel Crm qd-bid 0.1% (15, 45 g)
hydrocortisone butyrate
(C)(G)
Locoid Crm bid-tid
Locoid Oint bid-tid
Locoid Soln bid-tid
0.1% (15, 45 g)
0.1% (15, 45 g)
0.1% (30, 60 ml)
hydrocortisone valerate
(C)(G)
Westcort Crm bid-tid
Westcort Oint bid-tid
0.2% (15, 45, 60, 120 g)
0.2% (15, 45, 60 g)
mometasone furoate (C) Elocon Crm qd
Elocon Lotn qd
Elocon Oint qd
0.1% (15, 45 g)
0.1% (30, 60 ml)
0.1% (15, 45 g)
prednicarbate Dermatop Emol Crm bid
Dermatop Oint bid
0.1% (15, 60 g)
triamcinolone acetonide
(C)(G)
Kenalog Crm bid-tid
Kenalog Lotn bid-tid
Kenalog Emul Spray bid-tid
0.1% (15, 60, 80 g)
0.1% (60 ml)
0.2% (63, 100 g)
High Potency
amcinonide (C)(G) Crm bid-tid
Lotn bid
Oint bid
0.1% (15, 30, 60 g)
0.1% (20, 60 ml)
0.1% (15, 30, 60 g)
Betamethasone
dipropionate (C)
Sernivo Spray Emul Spray
bid
0.05% (60, 120 ml)
betamethasone
dipropionate, augmented
(C)
Diprolene AF Emol Crm
qd-bid
Diprolene Lotn qd-bid
0.05% (15, 50 g)
0.05% (30, 60 ml)
desoximetasone (C)(G) Topicort Gel bid
Topicort Emol Crm bid
Topicort Oint bid
0.05% (15, 60 g)
0.25% (15, 60 g)
0.25% (15, 60 g)
diflorasone diacetate (C) Psorcon e Emol Crm bid
Psorcon e Emol Oint qd-tid
0.05% (15, 30, 60 g)
0.05% (15, 30, 60 g)
fl uocinonide (C) Lidex Crm bid-qid
Lidex Gel bid-qid
Lidex Oint bid-qid
Lidex Soln bid-qid
Lidex-E Emol Crm bid-qid
0.05% (15, 30, 60, 120 g)
0.05% (15, 30, 60 g)
0.05% (15, 30, 60, 120 g)
0.05% (20, 60 ml)
0.05% (15, 30, 60 g)
(continued)
(continued)
Ap p e n d i x L : O r a l C o r t i c o s t e r o i d s ¦ 509
Generic Brand/Formulation/
Frequency
Strength/Volume
Flurandrenolide (C) Cordan Oint bid-tid
Cordan Crm bid-tid
0.05% (15, 30, 60 g)
0.025% (30, 60, 120 g)
0.05% (15, 30, 60, 120 g)
halcinonide (C) Halog Crm bid-tid
Halog Oint bid-tid
Halog Soln bid-tid
Halog-E Emol Crm qd-tid
0.1% (15, 30, 60, 240 g)
0.1% (15, 30, 60, 120 g)
0.1% (20, 60 ml)
0.1% (15, 30, 60 g)
triamcinolone acetonide
(C)(G)
Kenalog Crm bid-tid 0.5% (20 g)
Super High Potency
betamethasone
dipropionate, augmented
(C)
Diprolene Oint qd-bid
Diprolene Gel qd-bid
0.05% (15, 50 g)
0.05% (15, 50 g)
clobetasol propionate
(C)(G)
Clobex Shampoo daily
Clobex Spray bid
Cormax Oint bid
Cormax Scalp App
Olux Foam
Olux E Foam
Temovate Crm bid
Temovate Gel bid
Temovate Oint bid
Temovate Scalp App bid
Temovate-E Emol Crm bid
0.05% (4 oz)
0.05% (2, 4.5 oz)
0.05% (15, 45 g)
0.05% (15, 45 g)
0.05% (50, 100 g)
0.05% (50, 100 g)
0.05% (15, 30, 45, 60 g)
0.05% (15, 30, 60 g)
0.05% (15, 30, 45, 60 g)
0.05% (25, 50 ml)
0.05% (15, 30, 60 g)
fl uocinonide (C) Vanos Oint qd-tid 0.1% (30, 60, 120 g)
fl urandrenolide (C) Cordran Tape q 12 hours 4 mcg/sq cm
(roll of 3?x 80?)
halobetasol
propionate (C)
Ultravate Crm qd-bid
Ultravate Oint qd to bid
0.05% (15, 45 g)
0.05% (15, 45 g)
t APPENDIX L: ORAL CORTICOSTEROIDS
(continued)
Comment: Systemic corticosteroids increase glucose intolerance, reduce the action
of insulin and oral hypoglycemic agents, reduce adrenal cortex activity, decrease
immunity, mask signs of infection, impair wound healing, suppress growth in
(continued)
510 ¦ Ap p e n d i x L : O r a l C o r t i c o s t e r o i d s
children, and promote osteoporosis, fl uid retention, and weight gain. Use systemic
steroids with caution, using the lowest possible dose to aff ect clinical response, and
withdraw (wean) gradually in tapering doses to avoid adrenal insuffi ciency. Th e
American Academy of Rheumatology (AAR) recommends the following daily doses
for anyone on a chronic systemic corticosteroid regimen: Calcium 1,200-1,500 mg/
day and vitamin D 800-1,000 IU/day.
betamethasone (C)(G) initially 0.6-7.2 mg daily
Pediatric: same as adult
Celestone Tab: 0.6 mg; Syr: 0.6 mg/5 ml (120 ml)
cortisone (D)(G) initially 25-300 mg daily or every other day
Pediatric: not recommended
Cortone Acetate Tab: 25 mg
xamethasone (C)(G) initially 0.75-9 mg/day
Pediatric: same as adult
Decadron Tab: 0.5*, 0.75*, 4*mg; Syr: 0.5 mg/5 ml (100 ml)
Decadron 5-12 Pak Tabs: 0.75*mg (12/pck)
hydrocortisone (C)(G) 20-240 mg daily
Pediatric: 2-8 mg/day
Cortef Tab: 5, 10, 20 mg; Oral susp: 10 mg/5 ml
Hydrocortone Tab: 10 mg
methylprednisolone (C)(G) 4-48 mg/day
Pediatric: same as adult
Medrol Tab: 2*, 4*, 8*, 16*, 24*, 32*mg
Medrol Dosepak Dosepak: 4*mg tabs (21/pck)
prednisolone (C)(G) initially 5-60 mg/day in 1-2 doses x 3-5 days
Pediatric: 0.14-2 mg/kg/day in 3-4 doses x 3-5 days
Flo-Pred Susp: 5, 15 mg/5 ml
Orapred Soln: 15 mg/5 ml (grape) (dye-free, alcohol 2%)
Orapred ODT Tab: 10, 15, 30 mg orally disintegrating (grape)
Pediapred Soln: 5 mg/5 ml (raspberry, sugar-, alcohol-, dye-free)
Prelone Syr: 15 mg/5 ml
Comment: Flo-Pred does not require refrigeration or shaking prior to use.
prednisone (C)(G) initially 5-60 mg/day in 1-2 doses x 3-5 days
Pediatric: 0.14-2 mg/kg/day in 3-4 doses x 3-5 days
Deltasone Tab: 2.5*, 5*, 10*, 20*, 50*mg
prednisone (delayed release) (C) initially 5-60 mg/day in 1-2 doses x 3-5 days
Pediatric: 0.14-2 mg/kg/day in 3-4 doses x 3-5 days
RAYOS Tab: 1, 2, 5 mg del-rel
triamcinolone (C)(G) initially 4-48 mg/day in 1-2 doses x 3-5 days
Pediatric: 0.14-2 mg/kg/day in 3-4 doses x 3-5 days
Aristocort Tab: 4*mg
Aristocort Forte Susp: 40 mg/ml (benzoyl alcohol)
Aristocort Aristopak Tab: 4*mg (16/pck) y
y
y
y
y
y
y
y
y
(continued)
Ap p e n d i x M : Pa r e n t e r a l C o r t i c o s t e r o i d Thera p y ¦ 511
APPENDIX M: PARENTERAL
CORTICOSTEROID THERAPY
t
Comment: Systemic glucocorticosteroids increase glucose intolerance, reduce
the action of insulin and oral hypoglycemic agents, reduce adrenal cortex activity,
decrease immunity, mask signs of infection, impair wound healing, suppress
growth in children, and promote osteoporosis, fl uid retention, and weight gain.
Use systemic steroids with caution, using the lowest possible dose to aff ect clinical
response, and withdraw (wean) gradually in tapering doses to avoid adrenal
insuffi ciency. Th e American Academy of Rheumatology (AAR) recommends the
following daily doses for anyone on a chronic systemic corticosteroid regimen:
Calcium 1,200-1,500 mg/day and vitamin D 800-1,000 IU/day.
betamethasone (C)(G)
Celestone 0.5-9 mg IM/IV x 1 dose
Vial: 3 mg/ml (10 ml)
Celestone Soluspan 0.5-9 mg IM/IV x 1 dose; usual IM dose 6 mg
Vial: 6 mg/ml (10 ml)
cortisone (D)(G) 20-300 mg IM
Pediatric: not recommended
Cortone Acetate Vial: 50 mg/ml (10 ml)
dexamethasone (C)(G) initially 0.5-9 mg IM/IV daily
Dalalone D.P. Vial: 16 mg/ml (1, 5 ml)
Decadron Vial: 4, 24 mg/ml for IM use (5 ml, sulfi tes)
Decadron-LA Vial: 8 mg/ml (1, 5 ml)
hydrocortisone (C)(G) initially 100-500 mg IM/IV daily
Pediatric: 2-8 mg/kg loading dose (max 250 mg); then 8 mg/kg/day
Hydrocortone Vial: 50 mg/ml (5 ml)
Solu-Cortef Vial: 100 mg (2 ml); 250 mg (2 ml); 500 mg (4 ml); 1 g (8 ml)
hydrocortisone phosphate (C)(G) for IM, IV, and SC injection
Hydrocortone Vial: 50 mg/ml (2 ml)
methylprednisolone (C)(G) 40-120 mg IM/week for 1-4 weeks
Depo-Medrol Vial: 20 mg/ml (5 ml); 40 mg/ml (5, 10 ml); 80 mg/ml (5 ml)
methylprednisolone sodium succinate (C)(G) 10-40 mg IV initially; then, IM or IV
Pediatric: 1-2 mg/kg loading dose; then 1.6 mg/kg/day in divided doses at least
6 hours apart
Solu-Medrol Vial: 40 mg (1 ml), 125 mg (2 ml), 500 mg (4 ml); 1 g (8 ml); 2 g (8 ml)
triamcinolone (C)(G) 40 mg IM/week
Aristocort Vial: 25 mg/ml (5 ml)
Aristocort Forte Vial: 40 mg/ml (1, 5 ml)(do not administer IV)
Aristospan Vial: 5 mg/ml (5 ml); 20 mg/ml (1, 5 ml)
TAC-3 Vial: 3 mg/ml (5 ml) for intralesional and intradermal use
Injectable Corticosteroid/Anesthetic
dexamethasone/lidocaine (C) 0.1-0.75 ml into painful area
Decadron Phosphate with Xylocaine Vial: dexa 4 mg/lido 10 mg per ml (5 ml)
Comment: Inhaled glucocorticosteroids are indicated for the long-term control of
asthma. Inhaled corticosteroids are not indicated for exercise induced asthma or for
relief of acute symptoms (i.e., “rescue”). Low doses are indicated for mild persistent
asthma, medium doses are indicated for moderate persistent asthma, and high
doses are reserved for severe cases. Titrate to lowest eff ective dose. To reduce the
potential for adverse eff ects with inhalers, the patient should use a spacer or holding
chamber and rinse the mouth and spit aft er every inhalation treatment. Linear
growth should be monitored in children. When inhaled doses exceed 1000 mcg/
day, consider supplements of calcium (1-1.5 g/day), vitamin D (400 IU/day), and
estrogen replacement therapy for postmenopausal women.
beclomethasone (C)
Beclovent 2 inhalations tid-qid or 4 inhalations bid; max 20 inhalations/day
Pediatric: <6 years: not recommended; 6-12 years: 1-2 inhalations tid-qid
or 4 inhalations bid; max 10 inhalations/day
Inhaler: 42 mcg/actuation (6.7 g, 80 inh); 16.8 g (200 inh)
Qvar Previously using only bronchodilators: initiate 40-80 mcg bid; max 320
mcg/day; Previously using an inhaled corticosteroid: initiate 40-160 mcg bid;
max 320 mcg/day; Previously taking a systemic corticosteroid: attempt to
wean off the systemic drug aft er approximately 1 week aft er initiating Qvar
Pediatric: not recommended
Inhaler: 40, 80 mcg/actuation metered-dose aerosol w. dose counter (8.7 g,
120 inh) (CFC-free)
Vanceril 2 inhalations tid to qid or 4 inhalations bid
Pediatric: <6 years: not recommended; 6-12 years: 1-2 inhalations tid to
qid
Inhaler: 42 mcg/actuation (16.8 g, 200 inh)
Vanceril Double Strength 2 inhalations bid
Pediatric: <6 years: not recommended; 6-12 years: 1-2 inhalations bid; >12
years: same as adult
Inhaler: 84 mcg/actuation (12.2 g, 120 inh)
budesonide (B)(G)
Pulmicort Respules use turbuhaler
Pediatric: <12 months: not recommended; =12 months to 8 years:
Previously using only bronchodilators: initiate 0.5 mg/day once daily or
in 2 divided doses; may start at 0.25 mg/day; Previously using inhaled
orticosteroids: initiate 0.5 mg/day daily or in 2 divided doses; max 1 mg/
day; Previously using oral orticosteroids: initiate 1 mg/day daily or in 2
divided doses
Inhal susp: 0.25 mg/2 ml (30/box)
Pulmicort Turbuhaler 1-2 inhalations bid; Previously on oral corticosteroids:
2-4 inhalations bid
Pediatric: <6 years: not recommended; =6 years: 1-2 inhalations bid
Turbuhaler: 200 mcg/actuation (200 inh)
fl unisolide (C)(G)
AeroBid, AeroBid M initially 2 inhalations bid; max 8 inhalations/day
Pediatric: <6 years: not recommended; 6-15 years: 2 inhalations bid; =16
years: same as adult
Inhaler: 250 mcg/actuation (7 g, 100 inh)
fl uticasone (C)(G)
Flovent HFA initially 88 mcg bid; if previously using an inhaled corticosteroid,
initially 88-220 mcg bid; if previously taking an oral corticosteroid,
initially 880 mcg/day
Pediatric: use Rotadisk: initially 50-88 mcg inh bid; <4 years: not recommended;
4-11 years: initially 50-88 mcg bid; >11 years: initially 100 mcg
bid; if previously using an inhaled corticosteroid, initially 100-200 mcg
bid; Previously taking an oral corticosteroid; initially 1000 mcg bid
Inhaler: 44 mcg/actuation (7.9 g, 60 inh; 13 g, 120 inh); 110 mcg/actuation
(13 g, 120 inh); 220 mcg/actuation (13 g, 120 inh)
Rotadisk 50 mcg/actuation (60 blisters/disk); 100 mcg/actuation (60 blisters/
disk); 250 mcg/actuation (60 blisters/disk)
mometasone furoate (C) Previously using a bronchodilator or inhaled corticosteroid:
220 mcg q PM or bid; max 440 mcg q PM or 220 mcg bid; Previously using an
oral corticosteroid: 440 mcg bid; max 880 mcg/day
Pediatric: <12 years: not recommended
Asmanex Twisthaler
Inhaler: 220 mcg/actuation (6.7 g, 80 inh); 16.8 g (200 inh)
APPENDIX O: ORAL ANTIARRHYTHMIA DRUGS
Antiarrhythmics by Classifi cation With Dose Forms
Brand/generic
Pregnancy Category
Class/Indication(s) Dose
Form(s)
Betapace
sotalol (B)
Class: Class II and III Antiarrhythmic
Indications: Documented life-threatening
ventricular arrhythmias
Tab: 80*,
120*, 160*,
240*mg
Betapace AF
sotalol (B)
Class: Class II and III Antiarrhythmic
Indications: Maintenance of normal sinus
rhythm in patients with highly symptomatic
atrial fi brillation or atrial fl utter who are
currently in sinus rhythm
Tab: 80*,
120*,
160*mg
Calan
verapamil (C)(G)
Class: Calcium Channel Blocker
Indications: Control (with digitalis) of ventricular
rate in patients with chronic atrial fi brillation
or atrial fl utter; prophylaxis of repetitive
paroxysmal supraventricular tachycardia
Tab:
40, 80*,
120*mg
t
(continued)
(continued)
514 ¦ Ap p e n d i x O : O r a l A n t i a r r h y t h m i a D r u g s
Antiarrhythmics by Classifi cation With Dose Forms
Brand/generic
Pregnancy Category
Class/Indication(s) Dose
Form(s)
Cordarone
amiodarone (D)(G)
Class: Class III Antiarrhythmic
Indications: Documented life threatening
recurrent refractory ventricular
fi brillation or hemodynamically unstable
ventricular tachycardia
Tab:
200*mg
Quinidex
quinidine sulfate (C)
(G)
Class: Class I Antiarrhythmic
Indications: Atrial and ventricular
arrhythmias
Tab: 300
mg ext-rel
Inderal
propranolol (C)(G)
Inderal XL
propranolol ext-rel
(C)(G)
InnoPran XL
Propranolol ext-rel
(C)
Class: Beta-Blocker
Indications: Atrial and ventricular
arrhythmias; tachyarrhythmias due to
digitalis intoxication; reduce mortality and
risk of reinfarction in stabilized patients aft er
myocardial infarction
Tab:
10*, 20*,
40*, 60*,
80*mg
Cap: 60,
80, 120,
160 mg
sust-rel
Cap: 80,
120 mg
ext-rel
Mexitil
mexiletine (C)
Class: Class IB Antiarrhythmic
Indications: Documented life-threatening
ventricular arrhythmias
Cap: 150,
200, 250
mg
Multaq
dronedarone (C)
Class: IB Antiarrhythmic
Indications: Paroxysmal or persistent atrial
fi brillation or atrial fl utter
Tab: 400
mg
Norpace
disopyramide (C)
Class: Class I Antiarrhythmic
Indications: Documented life threatening
ventricular arrhythmias
Cap: 100,
150 mg
Procanbid
procainamide (C)(G)
Class: Class IA Antiarrhythmic
Indications: Life threatening ventricular
arrhythmias
Tab: 500,
1000 mg
ext-rel
Quinaglute
quinidine gluconate
(C)(G)
Class: Class I Antiarrhythmic
Indications: Atrial and ventricular
arrhythmias
Tab: 324
mg ext-rel
(continued)
(continued)
Ap p e n d i x O : O r a l A n t i a r r h y t h m i a D r u g s ¦ 515
Antiarrhythmics by Classifi cation With Dose Forms
Brand/generic
Pregnancy Category
Class/Indication(s) Dose
Form(s)
Rythmol
propafenone (C)(G)
Class: Class IC Antiarrhythmic
Indications: Documented lifethreatening
ventricular arrhythmias; prolonged
recurrence of paroxysmal atrial fi brillation
and/or atrial fl utter or paroxysmal
supraventricular tachycardia associated with
disabling symptoms in patients without
structural heart disease
Tab: 150*,
225*,
300*mg
Cap: 225,
325, 425
mg ext-rel
Sectral
acebutolol (B)(G)
Class: Beta-Blocker
Indications: Ventricular arrhythmias
Cap: 200,
400 mg
Sotylize
sotalol (B)
Class: Class II and III Antiarrhythmic
Indications: Documented life threatening
ventricular arrhythmias, and highly
symptomatic AF/AF
Oral soln:
5 mg/ml
Tambocor
fl ecainide acetate
(C)(G)
Class: Class IC Antiarrhythmic
Indications: Documented life threatening
ventricular arrhythmias; paroxysmal atrial
fi brillation and/or
atrial fl utter or paroxysmal supraventricular
tachycardia in patients without structural
heart disease
Tab: 50,
100*,
150* mg
Tenormin
atenolol (C)(G)
Class: Beta-Blocker
Indications: Reduce mortality and in stabilized
patients aft er myocardial infarction
Tab: 25,
50, 100
mg
Inj: 5 mg/
ml (10
ml) for IV
administration
timolol maleate (C)
(G)
Class: Beta-Blocker
Indications: Reduce mortality and in stabilized
patients aft er myocardial infarction
Tab:
5, 10*,
20*mg
(continued)
(continued)
516 ¦ Ap p e n d i x O : O r a l A n t i a r r h y t h m i a D r u g s
Antiarrhythmics by Classifi cation With Dose Forms
Brand/generic
Pregnancy Category
Class/Indication(s) Dose
Form(s)
dofetilide (C)(G) Class: Class III Antiarrhythmic
Indications: Maintenance of normal sinus
rhythm in patients with atrial fi brillation or
atrial fl utter of >1 week duration who were
converted to normal sinus rhythm (only for
highly symptommatic patients); conversion to
normal sinus rhythm
Cap: 125,
250, 500
mcg
Tonocard
tocainide (C)(G)
Class: Class I Antiarrhythmic
Indications: Documented lifethreatening
ventricular arrhythmias
Tab: 400*,
600*mg
Toprol XL
metoprolol (C)(G)
Class: Beta-Blocker
Indications: Ischemic, hypertensive, or
cardiomyopathic heart failure
Tab: 25*,
50*, 100*,
200*mg
APPENDIX P: ORAL ANTINEOPLASIA DRUGS
Antineoplastics With Classifi cation With Dose Forms
Brand/generic
Pregnancy Category
Class/Indications Dose Forms
Alkeran
melphalan (D)
Alkylating Agent Tab: 2*mg
Arimidex
anastrozole (D)
Aromatase Inhibitor Tab: 1 mg
Aromasin
exemestane (D)
Aromatase Inactivator Tab: 25 mg
Arranon
nelarabine (D)
Nucleoside Analog Vial: 250 mg for IV infusion
Casodex
Bicalutamide (X)
Antiandrogen Tab: 50 mg
Cytoxan
Cyclophosphamide (D)
Alkylating Agent Tab: 25, 50 mg
t
(continued)
(continued)
Ap p e n d i x P : O r a l A n t i n e o p l a s i a D r u g s ¦ 517
Antineoplastics With Classifi cation With Dose Forms
Brand/generic
Pregnancy Category
Class/Indications Dose Forms
Eligard
leuprolide acetate (X)
GnRH Analogue Inj: 7.5 mg ext-rel per monthly
SC injection
Eulexin
fl utamide (D)
Antiandrogen Cap: 125 mg
Faslodex
fulvestrant (D)(G)
Estrogen Receptor
Antagonist
Prefi lled syringe for IM inj: 50
mg/ml (2.5, 5 ml/syringe)
Femara
letrozole (D)
Aromatase Inhibitor Tab: 2.5 mg
Gleevec
imatinib mesylate (D)
Signal Transduction
Inhibitor
Cap: 100 mg
Hydrea
hydroxyurea (D)(G)
Substituted Urea Cap: 500 mg
Iressa
gefi tinib (D)
Epidermal Growth
Factor receptor tyrosine
kinase inhibitor
Tab: 250 mg
Leukeran
chlorambucil (D)(G)
Alkylating Agent Tab: 2 mg
Leupron
leuprolide (X)
GnRH Analogue Susp for IM inj: 1 mg (daily);
7.5 mg depot (monthly); 22.5
mg depot (every 3 months);
30 mg depot (every 4 months)
Megace, Megace
Oral Suspension,
Megace ES,
megestrol acetate (D)
(G)
Progestin Tab: 20*, 40*mg; Susp: 40 mg/
ml; ES concentrate: 125 mg/
ml, 625 mg/5 ml
Nexavar
sorafenib (D)
Multikinase Inhibitor Tab: 200 mg
Nolvadex
tamoxifen citrate (D)
(G)
Antiestrogen Tab: 10, 20 mg
(continued)
(continued)
518 ¦ Ap p e n d i x P : O r a l A n t i n e o p l a s i a D r u g s
Antineoplastics With Classifi cation With Dose Forms
Brand/generic
Pregnancy Category
Class/Indications Dose Forms
Tarceva
erlotinib (D)
Kinase Inhibitor Tab: 25, 100, 150 mg
Velcade
bortezomib (D)
Proteasome Inhibitor Vial: 3.5 mg (pwdr for IV
injection aft er reconstitution)
Viadur
leuprolide acetate (X)
GnRH Analogue SC implant: 65 mg depot
(replace every 12 months)
Xeloda
capecitabine (D)
Fluoropyrimidine
(prodrug of
5-fl uorouracil)
Tab: 150, 500 mg
Zoladex
goserelin acetate (D)
GnRH Analogue SC implant: 3.6 mg depot
(28 days), 10.8 mg depot
(3-month)
Zometa
zoledronic acid (D)
Bisphosphonate Vial: 4 mg pwdr for
reconstitution for IV infusion,
single dose
APPENDIX Q: ORAL AND DEPOT
ANTIPSYCHOSIS DRUGS
ANTIPSYCHOSIS DRUGS WITH DOSE FORMS
t
(continued)
Comment: Patients receiving an antipsychosis agent should be monitored closely for
the following adverse side eff ects: neuroleptic malignant syndrome, extrapyramidal
reactions, tardive dyskinesia, blood dyscrasias, anticholinergic eff ects, drowsiness,
hypotension, photosensitivity, retinopathy, and lowered seizure threshold. Use
lower doses for elderly or debilitated patients. Prescriptions should be written
for the smallest practical amount. Foods and beverages containing alcohol are
contraindicated for patients receiving psychotropic drug therapy.
aripiprazole (C)(G)
Abilify Tab: 2, 5, 10, 15, 20, 30 mg; Oral soln: 1 mg/ml (150 ml; orange crèam;
parabens)
Abilify Discmelt Tab: 15 mg orally disintegrating (vanilla) (phenylalanine)
Abilify Maintena Vial: 300, 400 mg ext-rel pwdr for IM injection aft er
reconstitution; 300, 400 mg single dose prefi lled dual chamber syringes w.
supplies
y (
continued)
Ap p e n d i x Q : O r a l a n d D e p o t A n t i p s y c h o s i s D r u g s ¦ 519
asenapine (C)
Saphris SL tab: 2.5, 5, 10 mg
brexpizole (C)
Rexulti Tab: 0.25, 0.5, 1, 2, 3, 4 mg
bupropion (C)
Forfi vo XL Tab: 450 mg ext-rel
cariprazine (NE)
Vraylar Cap: 1.5, 3, 4.5, 6 mg
chlorpromazine (C)(G)
Th orazine Tab: 10, 25, 50, 100, 200 mg; Cap: 30, 75, 150 mg sust-rel; Syr: 10
mg/5 ml (4 oz, orange-custard); Vial/Amp: 25 mg/ml (1, 2 ml) (sulfi tes)
clozapine (B)(G)
Clozapine ODT (G) ODT: 150, 200 mg
Clozaril (G) Tab: 25*, 100* mg; ODT: 150, 200 mg
FazaClo ODT (G) ODT: 12.5, 25, 100, 150, 200 mg (phenylalanine)
Versacloz Oral susp: 50 mg/ml (100 ml)
fl uphenazine (C)(G)
Prolixin Tab: 1, 2.5, 5*, 10 mg (tartrazine); Conc: 5 mg/ml (4 oz w. calib
dropper) (alcohol 14%); Elix: 5 mg/ml (2 oz w. calib dropper) (alcohol 14%);
Vial: 25 mg/ml (10 ml)
fl uphenazine decanoate (C)(G)
Prolixin Decanoate Vial: 25 mg/ml (5 ml) (benzyl alcohol)
fl uphenazine (C)(G)
Prolixin Ethanate Vial: 25 mg (5 ml) (benzyl alcohol)
fl uphenazine decanoate (C)(G)
Prolixin Decanoate Vial: 25 mg/ml (5 ml) (benzyl alcohol)
haloperidol (B)(G)
Haldol Tab: 0.5*, 1*, 2*, 5*, 10*, 20 mg
iloperidone (C)
Fanapt Tab: 1, 2, 4, 6, 8, 10, 12 mg
loxapine (C)
Adasuve Oral inhal pwdr: 10 mg single-use disposable inhaler (5/box)
lurasidone (B)
Latuda Tab: 20, 40, 80 mg
olanzapine fumarate (C)(G)
Zyprexa Tab: 2.5, 5, 7.5, 10, 15, 20 mg
Zyprexa Zydis ODT: 5, 10, 15, 20 mg (phenylalanine)
paliperidone (C)(G)
Invega Tab: 3, 6, 9 mg ext-rel
Invega Sustenna Prefi lled syringe: 39, 78, 117, 156, 234 mg ext-rel suspension
w. needle
Invega Trinza Prefi lled syringe: 273, 410, 546, 819 mg ext-rel suspension
prochlorperazine (C)(G)
Compazine Tab: 5, 10 mg; Cap: 10, 15 mg susrel; Syr: 5 mg/5 ml (4 oz; fruit);
Supp: 2.5, 5, 25 mg
quetiapine (C)(G)
Seroquel Tab: 25, 100, 200, 300 mg
Seroquel XR Tab: 50, 150, 200, 300, 400 mg ext-rel
risperidone (C)(G)
Risperdal Tab: 0.25, 0.5, 1, 2, 3, 4 mg; Soln: 1 mg/ml (30 ml w. pipette);
Consta (Inj): 25, 37.5, 50 mg
Risperdal M-Tabs M-tab: 0.5, 1, 2, 3, 4 mg orally-disint (phenylalanine)
thioridazine (C)(G) Tab: 10, 25, 50, 100 mg
trifl uoperazine (C)(G)
Stelazine Tab: 1, 2, 5, 10 mg; Conc: 10 mg/ml; (2 oz w. calib dropper (banana-
vanilla) (sulfi tes); Vial: 2 mg/ml (10 ml)
ziprasidone (C)(G)
Geodon Cap: 20, 40, 60, 80 mg