Rx – All “A”

Dec 6, 2019 admin DƯỢC KHOA 0

ACETAMINOPHEN OVERDOSE

ANTIDOTE/CHELATING AGENT

  • acetylcysteine (B)(G) Loading Dose: 150 mg/kg administered over 15 minutes; Maintenance: 50 mg/kg administered over 4 hours; then 100 mg/kg administered over 16 hours
    Pediatric: same as adult
    Acetadote Vial: soln for IV infusion after dilution: 200 mg/ml (30 ml; dilute in D5W (preservative-free)
    Comment: acetaminophen overdose is a medical emergency due to the risk of irreversible hepatic injury. An IV infusion of acetylcysteine should be started as soon as possible and within 24 hours if the exact time of ingestion is unknown.
    Use a serum acetaminophen nomogram to determine need for treatment. Extreme caution is needed if used with concomitant hepatotoxic drugs.

ACNE ROSACEA

Comment: All acne rosacea products should be applied sparingly to clean, dry skin as directed. Avoid use of topical corticosteroids.

  • ivermectin (C) apply bid
    Soolantra Crm: 1% (30 g)
    Comment: Soolantra is a macrocyclic lactone. Exactly how it works to treat rosacea is unknown.

TOPICAL ALPHA-2 AGONIST

  • brimonidine (B) apply once daily
    Pediatric: <18 years: not recommended
    Mirvaso apply to affected area once daily
    Gel: 0.33% (30, 45 g tube; 30 g pump)
    Comment: For persistent erythema; constricts dilated facial blood vessels to reduce redness.

TOPICAL ANTIMICROBIALS

  • azelaic acid (B) apply bid
    Azelex Crm: 20% (30, 50 g)
    Finacea Gel: 15% (30 g); Foam: 15% (50 g)
  • metronidazole (B) apply to clean dry skin
    MetroCream apply bid
    Emol crm: 0.75% (45 g)
    MetroGel apply once daily
    Gel: 1% (60 g tube; 55 g pump)
    MetroLotion apply bid
    Lotn: 0.75% (2 oz)
  • sodium sulfacetamide (C)(G) apply 1-3 x daily
    Klaron Lotn: 10% (2 oz)
  • sodium sulfacetamide/sulfur (C)
    Clenia Emollient Cream apply 1-3 x daily
    Wash: sod sulfa 10%/sulfur 5% (10 oz)
    Clenia Foaming Wash wash affected area once or twice daily
    Wash: sod sulfa 10%/sulfur 5% (6, 12 oz)
    Rosula Gel apply 1-3 x daily
    Gel: sod sulfa 10%/sulfur 5% (45 ml)
    Rosula Lotion apply tid
    Lotn: sod sulfa 10%/sulfur 5% (45 ml) (alcohol-free)
    Rosula Wash wash bid
    Clnsr: sod sulfa 10%/sulfur 5% (335 ml)

ORAL ANTIMICROBIALS

  • doxycycline (D)(G) 40-100 mg bid
    Pediatric: <8 years: not recommended; =8 years, <100 lb: 2 mg/lb on first day in 2 divided doses, followed by 1 mg/lb/day in 1-2 divided doses; =8 years, =100 lb: same as adult; see page 572 for dose by weight
    Actilate Tab: 75, 150** mg
    Adoxa Tab: 50, 75, 100, 150 mg ent-coat
    Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
    Monodox Cap: 50, 75, 100 mg
    Oracea Cap: 40 mg del-rel
    Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple)
    (sulfites); Oral susp: 25 mg/5 ml (raspberry)
    Vibra-Tab Tab: 100 mg film-coat
    Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
  • minocycline (D)(G) 200 mg on first day; then 100 mg q 12 hours x 9 more days
    Pediatric: <8 years: not recommended; =8 years, <100 lb: 2 mg/lb on first day in 2 divided doses, followed by 1 mg/lb q 12 hours x 9 more days; =8 years, =100 lb: same as adult
    Dynacin Cap: 50, 100 mg
    Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (sulfites, alcohol 5%)
    Comment: minocycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.

ACNE VULGARIS

ANTIBACTERIAL SOAPS

Dial (OTC) wash affected area bid
Lever 2000 Antibacterial (OTC) wash affected area bid

TOPICAL ANTIMICROBIALS
Comment: All topical antimicrobials should be applied sparingly to clean, dry skin.

  • azelaic acid (B) apply bid
    Azelex Crm: 20% (30, 50 g)
    Finacea Gel: 15% (30 g); Foam: 15% (50g)
  • benzoyl peroxide (C)(G)
    Comment: benzoyl peroxide may discolor clothing and linens.
    Benzac-W initially apply to affected area once daily; increase to bid-tid as tolerated
    Gel: 2.5, 5, 10% (60 g)
    Benzac-W Wash wash affected area bid
    Wash: 5% (4, 8 oz); 10% (8 oz)
    Benzagel apply to affected area one or more times/day
    Gel: 5, 10% (1.5, 3 oz) (alcohol 14%)
    Benzagel Wash wash affected area bid
    Gel: 10% (6 oz)
    Desquam X5 wash affected area bid
    Wash: 5% (5 oz)
    Desquam X10 wash affected area bid
    Wash: 10% (5 oz)
    Triaz apply to affected area daily bid
    Lotn: 3, 6, 9% (bottle), 3% (tube); Pads: 3, 6, 9% (jar)
    ZoDerm apply once or twice daily
    Gel: 4.5, 6.5, 8.5% (125 ml); Crm: 4.5, 6.5, 8.5% (125 ml); Clnsr: 4.5, 6.5, 8.5% (400 ml)
  • clindamycin topical (B) apply bid
    Pediatric: not recommended
    Cleocin T Pad: 1% (60/pck; alcohol 50%); Lotn: 1% (60 ml); Gel: 1% (30, 60 g);
    Soln w. applicator: 1% (30, 60 ml) (alcohol 50%)
    Clindagel Gel: 1% (42, 77 g)
    Evoclin Foam: 1% (50, 100 g) (alcohol)
  • clindamycin/benzoyl peroxide topical (C) apply sparingly to clean dry skin once daily
    Pediatric: <12 years: not recommended; =12 years: same as adult
    Acanya (G) apply once daily-bid
    Gel: clin 1.2%/benz 2.5% (50 g)
    BenzaClin (G) apply bid
    Gel: clin 1%/benz 5% (25, 50 g)
    Duac apply daily in the evening
    Gel: clin 1%/benz 5% (45 g)
    Onexton Gel apply once daily
    Gel: clin 1.2%/benz 3.75% (50 g pump) (alcohol-free) (preservative-free)
  • dapsone topical (C) apply bid
    Pediatric: <12 years: not recommended; =12 years: same as adult
    Aczone Gel: 5, 7.5% (30, 60, 90 g pump)
  • erythromycin/benzoyl peroxide (C) initially apply once daily; increase to bid as tolerated
    Benzamycin Topical Gel Gel: eryth 3%/benz 5% (46.6 g/jar)
  • sodium sulfacetamide (C)(G) apply tid
    Klaron Lotn: 10% (2 oz)

ORAL ANTIMICROBIALS

  • doxycycline (D)(G) 100 mg bid
    Pediatric: <8 years: not recommended; =8 years, <100 lb: 2 mg/lb on first day in 2
    divided doses, followed by 1 mg/lb/day in 1-2 divided doses; =8 years, =100 lb: same
    as adult; see page 572 for dose by weight
    Actilate Tab: 75, 150**mg
    Adoxa Tab: 50, 75, 100, 150 mg ent-coat
    Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
    Monodox Cap: 50, 75, 100 mg
    Oracea Cap: 40 mg del-rel
    Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple)
    (sulfites); Oral susp: 25 mg/5 ml (raspberry)
    Vibra-Tab Tab: 100 mg film coat
    Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
  • erythromycin base (B)(G) 250 mg qid, 333 mg tid or 500 mg bid x 7-10 days; then taper to lowest effective dose
    Pediatric: <45 kg: 30-50 mg in 2-4 divided doses x 7-10 days; =45 kg: same as adult
    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 7-10 days
    Pediatric: 30-50 mg/kg/day in 4 divided doses x 7-10 days; may double dose with severe infection; max 100 mg/kg/day; see page 574 for dose by weight
    EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100, 200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab:
    200 mg wafer (fruit)
    E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
    E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
    E.E.S. 400 Tablets Tab: 400 mg
    Comment: erythromycin may increase INR with concomitant warfarin, as well as
    increase serum level of digoxin, benzodiazepines and statins.
  • minocycline (D)(G) initially 50-200 mg/day in 2 divided doses; reduce dose after
    improvement
    Pediatric: <8 years: not recommended; =8 years: same as adult
    Dynacin Cap: 50, 100 mg
    Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (sulfites,
    alcohol 5%)
    Comment: minocycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
  • tetracycline (D)(G) initially 1 g/day in 2-4 divided doses; after improvement, 125-
    500 mg daily
    Pediatric: <8 years: not recommended; =8 years, <100 lb: 25-50 mg/kg/day in 2-4
    divided doses; =8 years, =100 lb: same as adult; see page 585 for dose by weight
    Achromycin V Cap: 250, 500 mg
    Sumycin Tab: 250, 500 mg; Cap: 250, 500 mg; Oral susp: 125 mg/5 ml (100,
    200 ml) (fruit) (sulfites)
    Comment: tetracycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photo-sensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.

TOPICAL RETINOIDS

Comment: Wash affected area with a soap-free cleanser; pat dry and wait 20 to 30 minutes; then apply sparingly to affected area; use only once daily in the evening.
Avoid applying to eyes, ears, nostrils, and mouth.
Pediatric: <8 years: not recommended; =8 years: same as adult

  • adapalene (C) apply once daily at HS
    Differin Crm: 0.1% (45 g); Gel: 0.1. 0.3% (45 g) (alcohol-free); Pad: 0.1%
    (30/pck) (alcohol 30%); Ltn: 0.1% (2, 4 oz)
  • tazarotene (X) apply once daily at HS
    Pediatric: not recommended
    Avage Cream Crm: 0.1% (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 once daily at HS
    Pediatric: <12 years: not recommended; =12 years: same as adult
    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)

TOPICAL RETINOID/ANTIMICROBIAL COMBINATIONS

Comment: Wash affected area with a soap-free cleanser; pat dry and wait 20-30 minutes; then apply sparingly to affected area; use only once daily in the evening.
Avoid eyes, ears, nostrils, and mouth.

  • adapalene/benzoyl peroxide (C) apply a thin film once daily
    Pediatric: <18 years: not recommended
    Epiduo Gel Gel: adap 0.1%/benz 2.5% (45 g)
  • tretinoin/clindamycin (C) apply a thin film once daily
    Pediatric: <18 years: not recommended
    Ziana Gel: tret 0.025%/clin 1.2% (30, 60 g)

ORAL RETINOID

Comment: Oral retinoids are indicated only for severe recalcitrant nodular acne unresponsive to conventional therapy including systemic antibiotics.

  • isotretinoin (X) initially 0.5-1 mg/kg/day in 2 divided doses; maintenance 0.5-2 mg/
    kg/day in 2 divided doses x 4-5 months; repeat only if necessary 2 months following
    cessation of first treatment course
    Pediatric: not recommended
    Accutane Cap: 10, 20, 40 mg (parabens)
    Amnesteem Cap: 10, 20, 40 mg (soy)
    Comment: isotretinoin is highly teratogenic and, therefore, female patients should be counseled prior to initiation of treatment as follows: Two negative pregnancy tests are required prior to initiation of treatment and monthly thereafter. Not for use in females who are or who may become pregnant or who are breastfeeding.
    Two effective methods of contraception should be used for 1 month prior to, during, and continuing for 1 month following completion of treatment. Low-dose progestin (mini-pill) may be an inadequate form of contraception. No refills; a new prescription is required every 30 days and prescriptions must be filled within 7 days.
    Serum lipids should be monitored until response is established (usually initially and again after 4 weeks). Bone growth, serum glucose, ESR, RBCs, WBCs, and liver enzymes should be monitored. Blood should not be donated during, or for 1 month after, completion of treatment. Avoid the sun and artificial UV light. Isotretinoin should be discontinued if any of the following occurs: visual disturbances, tinnitus, hearing impairment, rectal bleeding, pancreatitis, hepatitis, significant decrease in CBC, hyperlipidemia (particularly hypertriglyceridemia).

ORAL CONTRACEPTIVES

see Combined Oral Contraceptives page 487
see Progesterone-only Contraceptives (Mini-Pill) page 496

ACROMEGALY

GROWTH HORMONE RECEPTOR ANTAGONIST

  • pegvisomant (B) Loading dose: 40 mg SC; Maintenance: 10 mg SC daily; titrate by 5 mg (increments or decrements, based on IGF-1 levels) every 4 to 6 weeks; max 30 mg/day
    Pediatric: not recommended
    Somavert Inj: 10, 15, 20 mg
    Comment: Prior to initiation of pegvisomant, patients should have baseline fasting serum glucose, HgbA1c, serum potassium and magnesium, liver function tests (LFTs), EKG, and gallbladder ultrasound.

Cyclohexapeptide Somatostatin

  • pasireotide (C) administer SC in the thigh or abdomen; initial dose is 0.6 mg or 0.9 mg bid. Titrate dose based on response and tolerability; for patients with moderate hepatic impairment (Child-Pugh B), the recommended initial dosage is 0.3 mg twice daily and max dose 0.6 mg twice daily; avoid use in patients with severe hepatic impairment (Child-Pugh C)
    Pediatric: not recommended
    Signifor LAR Amp: 0.3, 0.6, 0.9 mg/ml, single-dose, long-act rel (LAR) susp for inj

ACTINIC KERATOSIS

Comment: pasireotide is also indicated for destroying superficial basal cell carcinoma (sBCC) lesions.

  • diclofenac sodium 3% (C; D =30 wks)(G) apply to lesions bid x 60-90 days
    Pediatric: not recommended
    Solaraze Gel Gel: 3% (50 g) (benzyl alcohol)
    Comment: Contraindicated with aspirin allergy. As with other NSAIDs,
    Solaraze Gel should be avoided in late pregnancy (=30 weeks) because it may cause premature closure of the ductus arteriosus.
  • fluorouracil (X)(G) apply to lesion(s) daily-bid until erosion occurs, usually 2-4 weeks
    Pediatric: not recommended
    Carac Crm: 0.5% (30 g)
    Efudex (G) Crm: 5% (25 g); Soln: 2, 5% (10 ml w. dropper)
    Fluoroplex Crm: 1% (30 g); Soln: 1% (30 ml w. dropper)
  • imiquimod (B)
    Pediatric: <18 years: not recommended
    Aldara (G) rub into lesions before bedtime and remove with soap and water 8 hours later; treat 2 times per week; max 16 weeks
    Crm: 5% (single-use pkts/carton)
    Zyclara rub into lesions before bedtime and remove with soap and water 8 hours later; treat for 2-week cycles separated by a 2-week no-treatment cycle; max 2 packs per application; max one treatment course per area
    Crm: 3.75% (single-use pkts; 28/carton) (parabens)
  • ingenol mebutate (C) limit application to one contiguous skin area of about 25 cm2 using one unit dose tube; allow treated area to dry for 15 minutes; wash hands immediately after application; may remove with soapy water after 6 hours; Face and Scalp: apply 0.015% gel to lesions daily x 3 days; Trunk and Extremities: apply 0.05% gel to lesions daily x 2 days
    Pediatric: <18 years: not recommended
    Picato Gel: 0.015% (3 single-use tubes), 0.05% (2 single-use tubes)

ALCOHOL DEPENDENCE/ALCOHOL WITHDRAWAL SYNDROME
ALCOHOL WITHDRAWAL SYNDROME

Comment: Total length of time of a given detoxification regimen and/or length of time of treatment at any dose reduction level may be extended based on patient specific factors, including potential or actual seizure, hallucinosis, increased sympathetic nervous system activity (severe anxiety, unwanted elevation in vital signs). If any of these symptoms are anticipated or occur, revert to an earlier step in the dosing regimen to stabilize the patient, extend the detoxification timeline and consider appropriate adjunctive drug treatments (e.g., anti-convulsants, antipsychotic agents, antihypertensive agents, sedative hypnotics agents).

  • clorazepate (D)(IV)(G) in the following dosage schedule: Day 1: 30 mg initially, followed by 30-60 mg in divided doses; Day 2: 45-90 mg in divided doses; Day 3: 22.5-45 mg in divided doses; Day 4: 15-30 mg in divided doses; Thereafter, gradually reduce the daily dose to 7.5-15 mg; then discontinue when patient’s condition is stable; max dose 90 mg/day
    Tranxene Tab: 3.75, 7.5, 15 mg
    Tranxene T-Tab Tab: 3.75*, 7.5*, 15*mg
  • chlordiazepoxide (D)(IV)(G)
    Librium 50-100 mg q 6 hours x 24-72 hours; then q 8 hours x 24-72 hours; then q 12 hours x 24-72 hours; then daily x 24-72 hours
    Cap: 5, 10, 25 mg
    Librium Injectable 50-100 mg IM or IV; then 25-50 mg IM tid-qid prn; max 300 mg/day
    Inj: 100 mg
  • diazepam (D)(IV)(G) 2-10 mg q 6 hours x 24-72 hours; then q 8 hours x 24-72 hours; then q 12 hours x 24-72 hours; then daily x 24-72 hours
    Diastat Rectal gel delivery system: 2.5 mg
    Diastat Acu Dial Rectal gel delivery system: 10, 20 mg
    Valium Tab: 2*, 5*, 10*mg
    Valium Injectable Vial: 5 mg/ml (10 ml); Amp: 5 mg/ml (2 ml); Prefilled syringe: 5 mg/ml (5 ml)
    Valium Intensol Oral Solution Conc oral soln: 5 mg/ml (30 ml w. dropper) (alcohol 19%)
    Valium Oral Solution Oral soln: 5 mg/5 ml (500 ml) (wintergreen-spice)
  • oxazepam (C) 10-15 mg tid-qid x 24-72 hours; decrease dose and/or frequency every 24-72 hours; total length of therapy 5-14 days; max 120 mg/day
    Cap: 10, 15, 30 mg

ABSTINENCE THERAPY

GABA Taurine Analogue

  • acamprosate (C)(G) 666 mg tid; begin therapy during abstinence; continue during relapse; CrCl 30-50-mL/min: max 333 mg tid; CrCl <30 mL/min: contraindicated
    Campral Tab: 333 mg ext-rel
    Comment: Campral does not eliminate or diminish alcohol withdrawal symptoms.

AVERSION THERAPY

  • disulfiram (X)(G)
    Antabuse 500 mg once daily x 1-2 weeks; then 250 mg once daily
    Tab: 250, 500 mg; Chew tab: 200, 500 mg
    Comment: disulfiram use requires informed consent. Contraindications: severe cardiac disease, psychosis, concomitant use of isoniazid, phenytoin, paraldehyde, and topical and systemic alcohol-containing products. Approximately 20% remains in the system for 1 week after discontinuation.

Nutritional Support

  • thiamine (A)(G) injectable 50-100 mg IM/IV daily (or tid if severely deficient)
    Vial: 100 mg/1 ml (1 ml)

ALLERGIC REACTION: GENERAL

PARENTERAL ANTIHISTAMINE

  • diphenhydramine (C)(G) 25-50 mg IM immediately; then q 6 hours prn
    Pediatric: 1.25 mg/kg up to 25 mg IM x 1 dose; then q 6 hours prn
    Benadryl Injectable Vial: 50 mg/ml (1 ml single-use); 50 mg/ml (10 ml multidose);
    Amp: 10 mg/ml (1 ml); Prefilled syringe: 50 mg/ml (1 ml)
  • Oral Drugs for Allergy, Cough, and Cold see page 535
    Topical Corticosteroids see page 506
    Parenteral Corticosteroids see page 511
    Oral Corticosteroids see page 509

ALZHEIMER’S DISEASE

NUTRITIONAL SUPPLEMENT

  • L-methylfolate calcium (as metafolin)/methylcobalamin/N-acetyl cysteine (NE) take 1 cap once daily
    Cerefolin Cap: metafo 5.6 mg/methyl 2 mg/N-ace 600 mg (gluten-free, yeastfree, lactose-free)
    Comment: Cerefolin is indicated in the dietary management of patients treated for early memory loss, with emphasis on those at risk for neurovascular oxidative stress, hyperhomocysteinemia, mild to moderate cognitive impairment with or without vitamin B-12 deficiency, vascular dementia, or Alzheimer’s disease.

REVERSIBLE ANTICHOLINESTERASE INHIBITORS (RAIs)

Comment: The RAI drugs do not halt disease progression. Th ey are indicated for early-stage disease; not effective for severe dementia. If treatment is stopped for more than several days, re-titrate from lowest dose. Side effects include nausea, anorexia, dyspepsia, diarrhea, headache, and dizziness. Side effects tend to resolve with continued treatment. Peak cognitive improvements are seen 12 weeks into therapy (increased spontaneity, reduced apathy, lessened confusion, and improved attention, conversational language, and performance of daily routines).

  • donepezil (C)(G) initially 5 mg q HS, increase to 10 mg after 4-6 weeks as needed; max 23 mg/day
    Aricept Tab: 5, 10, 23 mg
    Aricept ODT ODT tab: 5, 10 mg orally-disint
  • galantamine (B) initially 4 mg bid x at least 4 weeks; usual maintenance 8 mg bid; max 16 mg bid
    Razadyne Tab: 4, 8, 12 mg
    Razadyne ER Tab: 8, 16, 24 mg ext-rel
    Razadyne Oral Solution Oral soln: 4 mg/ml (100 ml w. calib pipette)
  • rivastigmine (B)(G)
    Exelon initially 1.5 mg bid, increase every 2 weeks as needed; max 12 mg/day; take with food
    Cap: 1.5, 3, 4.5, 6 mg
    Excelon Oral Solution initially 1.5 mg bid; may increase by 1.5 mg bid at intervals of at least 2 weeks; usual range 6-12 mg/day; max 12 mg/day; if stopped, restart at lowest dose and re-titrate; may take directly from syringe or mix with water, fruit juice, or cola
    Oral soln: 2 mg/ml (120 ml w. dose syringe)
    Excelon Patch initially apply 4.6 mg/24 hours patch; if tolerated, may increase to 9.5mg/24 hours patch after 4 weeks; max 13.3 mg/24 hours; change patch daily; apply to clean, dry, hairless, intact skin; rotate application site; allow 14 days before applying new patch to same site
    Patch: 4.6, 9.5, 13.3 mg/24 hours trans-sys (30/carton)
  • tacrine (C) initially 10 mg qid, increase 40 mg/day q 4 weeks as needed; max 160 mg/day
    Cognex Cap: 10, 20, 30, 40 mg
    Comment: Transaminase levels should be checked every 3 months.

N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONIST

  • memantine (B)
    Namenda (G) initially 5 mg once daily; titrate weekly in 5 mg/day increments;
    Week 2: 5 mg bid; Week 3: 5 mg AM and 10 mg PM; Week 4: 10 mg bid; CrCl 5-29 mL/min: max 5 mg bid
    Tab: 5, 10 mg
    Namenda Oral Solution (G) initially 5 mg once daily; titrate weekly in 5 mg increments administered bid
    Oral soln: 2 mg/ml (360 ml) (peppermint) (sugar-free, alcohol-free)
    Namenda Titration Pak
    Cap: 7 x 7 mg, 7 x 14 mg, 7 x 21 mg, 7 x 28 mg/pck
    Namenda XR (G) initially 7 mg once daily; titrate in 7 mg increments weekly; max 28 mg once daily; do not divide doses
    Cap: 7, 14, 21, 28 mg ext-rel
    Comment: memantine does not halt disease progression. It is indicated for moderate to severe dementia.

N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONIST/ACETYLCHOLIN-ESTERASE INHIBITOR COMBINATION

  • memantine/donepezil (C) initiate one 28/10 dose daily in the evening after stabilized on memantine and donepezil separately; start the day after the last dose of memantine and donepezil taken separately; swallow whole or open cap and sprinkle on applesauce; CrCl 5-29 mL/min: take one 14/10 dose once daily in the evening
    Namzaric
    Cap: Namzaric 7/10: mem 7 mg/done 10mg
    Namzaric 14/10: mem 14 mg/done 10 mg
    Namzaric 21/10: mem 21 mg/done 10mg
    Namzaric 28/10: mem 28 mg/done 10 mg

ERGOT ALKALOID (DOPAMINE AGONIST)

  • ergoloid mesylate (C) 1 mg tid
    Hydergine Tab: 1 mg
    Hydergine LC Cap: 1 mg
    Hydergine Liquid Liq: 1 mg/ml (100 ml w. calib dropper) (alcohol 28.5%)

AMEBIASIS

AMEBIASIS (INTESTINAL)

  • diiodohydroxyquin (iodoquinol) (C)(G) 650 mg tid pc x 20 days
    Pediatric: <6 years: 40 mg/kg/day in 3 divided doses pc x 20 days; max 1.95 g; 6-12 years: 420 mg tid pc x 20 days
    Tab: 210, 650 mg
  • metronidazole (not for use in 1st; B in 2nd, 3rd)(G) 750 mg tid x 5-10 days
    Pediatric: 35-50 mg/kg/day in 3 divided doses x 10 days
    Flagyl Tab: 250*, 500*mg
    Flagyl 375 Cap: 375 mg
    Flagyl ER Tab: 750 mg ext-rel
    Comment: Alcohol is contraindicated during treatment with oral metronidazole and for 72 hours after therapy due to a possible disulfiram-like reaction (nausea, vomiting, flushing, headache).
  • tinidazole (not for use in 1st; B in 2nd, 3rd) 2 g daily x 3 days; take with food
    Pediatric: <3 years: not recommended; =3 years: 50 mg/kg daily x 3 days; take with food; max 2 g/day
    Tindamax Tab: 250*, 500*mg
    Comment: Alcohol is contraindicated during treatment with oral tinidazole and for 72 hours after therapy due to a possible disulfiram-like reaction (nausea, vomiting, flushing, headache).
  • paromomycin 25-35 mg/kg/day in 3 divided doses x 5-10 days
    Pediatric: same as adult
    Humatin Cap: 250 mg

AMEBIASIS (EXTRAINTESTINAL)

  • chloroquine phosphate (C)(G) 1 g PO daily x 2 days; then 500 mg daily x 2 to 3 weeks or 200-250 mg IM daily x 10-12 days (when oral therapy is impossible); use with intestinal amebicide
    Pediatric: see mfr pkg insert
    Aralen Tab: 500 mg; Amp: 50 mg/ml (5 ml)

AMEBIC LIVER ABSCESS

ANTI-INFECTIVES

  • metronidazole (not for use in 1st; B in 2nd, 3rd)(G) 250 mg tid or 500 mg bid or 750 mg daily x 7 days
    Pediatric: not recommended
    Flagyl Tab: 250*, 500*mg
    Flagyl 375 Cap: 375 mg
    Flagyl ER Tab: 750 mg ext-rel
    Comment: Alcohol is contraindicated during treatment with oral metronidazole and for 72 hours after therapy due to a possible disulfiram-like reaction (nausea, vomiting, flushing, headache).
  • tinidazole (not for use in 1st; B in 2nd, 3rd) 2 g once daily x 3-5 days; take with food
    Pediatric: <3 years: not recommended; =3 years: 50 mg/kg once daily x 3-5 days;  take with food; max 2 g/day
    Tindamax Tab: 250*, 500*mg
    Comment: Alcohol is contraindicated during treatment with oral tinidazole and for 72 hours after therapy due to a possible disulfiram-like reaction (nausea, vomiting, flushing, headache).

AMENORRHEA: SECONDARY

  • estrogen/progesterone (X)
    Premarin (estrogen) 0.625 mg daily x 25 days; then 5 days off ; repeat monthly
    Provera (progesterone) 5-10 mg last 10 days of cycle; repeat monthly
  • estrogen replacement (X) see Menopause page 264
  • human chorionic gonadotropin 5,000-10,000 units IM x 1 dose following last dose of menotropins
    Pregnyl Vial: 10,000 units (10 ml) w. diluent (10 ml)
  • medroxyprogesterone (X) Monthly: 5-10 mg last 5-10 days of cycle; begin on the 16th or 21st day of cycle; repeat monthly; One-time only: 10 mg once daily x 10 days
    Amen Tab: 10 mg
    Provera Tab: 2.5, 5, 10 mg
  • norethindrone (X) 2.5-10 mg daily x 5-10 days
    Aygestin Tab: 5 mg
  • progesterone, micronized (X)(G) 400 mg q HS x 10 days
    Prometrium Cap: 100, 200 mg
    Comment: Administration of progesterone induces optimum secretory transformation of the estrogen-primed endometrium. Administration of progesterone is contraindicated with breast cancer, undiagnosed vaginal bleeding, genital cancer, severe liver dysfunction or disease, missed abortion, thrombophlebitis, thromboembolic disorders, cerebral apoplexy, and pregnancy.

ANAPHYLAXIS

  • epinephrine (C)(G) 0.3-0.5 mg (0.3-0.5 ml of a 1:1000 soln) SC q 20-30 minutes as needed up to 3 doses
    Pediatric: <2 years: 0.05-0.1 ml; 2-6 years: 0.1 ml; =6-12 years: 0.2 ml; All: q 20-30 minutes as needed up to 3 doses; >12 years: same as adult
  • Parenteral Corticosteroids see page 511
    Oral Corticosteroids see page 509

ANAPHYLAXIS EMERGENCY TREATMENT KITS

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

ANEMIA OF CHRONIC KIDNEY DISEASE (CKD) AND CHRONIC RENAL FAILURE (CRF)

ERYTHROPOIESIS STIMULATING AGENTS (ESAs)

  • darbepoetin alpha (erythropoiesis stimulating protein) (C) administer IV or SC q 1-2 weeks; do not increase more frequently than once per month; Not currently receiving epoetin alpha: initially 0.75 mcg/kg once weekly; adjust based on Hgb levels (target not to exceed 12 g/dL); reduce dose if Hgb increases more than 1 g/dL in any 2-week period; suspend therapy if polycythemia occurs; Converting from epoetin alpha and for dose titration: see mfr pkg insert
    Pediatric: not recommended
    Aranesp Vial: 25, 40, 60, 100, 150, 200, 300, 500 mcg/ml (single-dose) for IV or SC administration (preservative-free, albumin [human] or polysorbate 80)
    Aranesp Singleject, Aranesp Sureclick Singleject Prefilled syringe: 25, 40, 60, 100, 150, 200, 300, 500 mcg (single-dose) for IV or SC administration (preservative-free, albumin [human] or polysorbate 80)
  • peginesatide (C) use lowest effective dose; initiate when Hgb <10 g/dL; do not increase dose more often than every 4 weeks; if Hgb rises rapidly (i.e., >1 g/dL in 2 weeks or >2 g/dL in 4 weeks), reduce dose by 25% or more; if Hgb approaches or exceeds 11 g/dL, reduce or interrupt dose and then when Hgb decreases, resume dose at approximately 25% below previous dose; if Hgb does not increase by >1 g/dL after 4 weeks, increase dose by 25%; if response inadequate after a 12-week escalation period, use lowest dose that will maintain Hgb sufficient to reduce need for RBC transfusion; discontinue if response does not improve; Not currently on ESA: initially 0.04 mg/kg as a single IV or SC dose once monthly; Converting from epoetin alfa: administer first dose 1 week after last epoetin alfa; Converting from darbepoetin alfa: administer first dose at next scheduled dose of darbepoetin alfa
    Pediatric: not established
    Omontys Vial, single-use: 2, 3, 4, 5, 6 mg (0.5 ml) (preservative-free); Vial, multi-use: 10, 20 mg (2 ml) (preservatives); Prefilled syringe: 2, 3, 4, 5, 6 mg (0.5 ml) (preservative-free)

ERYTHROPOIETIN HUMAN, RECOMBINANT

  • epoetin alpha (C) individualize; initially 50-100 units/kg 3 x/week; IV (dialysis or nondialysis) or SC (nondialysis); usual max 200 units/kg 3 x/week (dialysis) or 150 units/kg 3 x/week (non-dialysis); target Hct 30-36%
    Pediatric: <1 month: not recommended; =1 month: individualize; Dialysis: initially 50 units/kg 3 x/week IV or SC; target Hct 30-36%
    Epogen Vial: 2,000, 3,000, 4,000, 10,000, 40,000 units/ml (1 ml) single-use for IV or SC administration (albumin [human]; preservative-free)
    Epogen Multidose Vial: 10,000 units/ml (2 ml); 20,000 units/ml, (1 ml) for IV or SC administration (albumin [human]; benzoyl alcohol)
    Procrit Vial: 2,000, 3,000, 4,000, 10,000, 40,000 units/ml (1 ml) single-use for
    IV or SC administration (albumin [human]) (preservative-free)
    Procrit Multidose Vial: 10,000 units/ml (2 ml); 20,000 units/ml, (1 ml) for IV or SC administration (albumin [human]; benzoyl alcohol)

ANEMIA: FOLIC ACID DEFICIENCY

  • folic acid (A)(OTC) 0.4-1 mg once daily
    Comment: folic acid (vitamin B-9) 400 mcg daily is recommended during pregnancy to prevent neural tube defects. Women who have had a baby with a neural tube defect should take 400 mcg every day, even when not planning to become pregnant, and if planning to become pregnant should take 4 mg daily during the month before becoming pregnant until at least the 12th week of pregnancy.

ANEMIA: IRON DEFICIENCY

Comment: Hemochromatosis and hemosiderosis are contraindications to iron therapy. Iron supplements are best absorbed when taken between meals and with vitamin C-rich foods. Excessive iron may be extremely hazardous to infants and young children. All vitamin and mineral supplements should be kept out of the reach of children.

IRON PREPARATIONS

  • ferrous gluconate (A)(G) 1 tab once daily
    Fergon (OTC)
    Pediatric: not recommended
    Tab: iron 27 mg (240 mg as gluconate)
  • ferrous sulfate (A)(G)
    Feosol Tablets (OTC) 1 tab tid-qid pc and HS
    Pediatric: <6 years: use elixir; =6-12 years: 1 tab tid pc
    Tab: iron 65 mg (200 mg as sulfate)
    Feosol Capsules (OTC) 1-2 caps daily
    Pediatric: not recommended
    Cap: iron 50 mg (169 mg as sulfate) sust-rel
    Feosol Elixir (OTC) 5-10 ml tid
    Pediatric: >1 year: 2.5-5 ml tid between meals
    Elix: iron 44 mg (220 mg as sulfate) per 5 ml
    Fer-In-Sol (OTC) 5 ml daily
    Pediatric: <4 years, use drops; =4 years: 5 ml once daily
    Syr: iron 18 mg (90 mg as sulfate) per 5 ml (480 ml)
    Fer-In-Sol Drops (OTC)
    Pediatric: <4 years: 0.6 ml daily; =4 years: use syrup
    Oral drops: iron 15 mg (75 mg as sulfate) per 5 ml (50 ml)

ANEMIA: MEGALOBLASTIC/ANEMIA: PERNICIOUS

Comment: Signs of vitamin B-12 deficiency include megaloblastic anemia, glossitis, paresthesias, ataxia, spastic motor weakness, and reduced mentation.

  • vitamin B-12 (cyanocobalamin) (A)(G) 500 mcg intranasally once a week; may increase dose if serum B-12 levels decline; adjust dose in 500 mcg increments

Nascobal Nasal Spray

Intranasal gel: 500 mcg/0.1 ml (1.3 ml, 4 doses) (citric acid, benzalkonium chloride)
Comment: Nascobal Nasal Spray is indicated for maintenance of hematologic remission following IM B-12 therapy without nervous system involvement. Must be primed before each use.

ANGINA PECTORIS: STABLE

  • aspirin (D) 325 mg (range 75-325 mg) once daily
    Comment: Daily ASA dose is contingent upon whether the patient is also taking an anticoagulant or antiplatelet agent.

CALCIUM ANTAGONISTS
Comment: Calcium antagonists are contraindicated with history of ventricular arrhythmias, sick sinus syndrome, 2nd or 3rd degree heart block, cardiogenic shock, acute myocardial infarction, and pulmonary congestion.

  • amlodipine (C)(G) 5-10 mg daily
    Pediatric: not recommended
    Norvasc Tab: 2.5, 5, 10 mg
  • diltiazem (C)(G)
    Cardizem initially 30 mg qid; may increase gradually every 1-2 days; max 360 mg/day in divided doses
    Pediatric: not recommended
    Tab: 30, 60, 90, 120 mg
    Cardizem CD initially 120-180 mg daily; adjust at 1- to 2-week intervals; max 480 mg/day
    Pediatric: not recommended
    Cap: 120, 180, 240, 300, 360 mg ext-rel
    Cardizem LA initially 180-240 mg daily; titrate at 2 week intervals; max 540 mg/day
    Pediatric: not recommended
    Tab: 120, 180, 240, 300, 360, 420 mg ext-rel
    Cartia XT initially 180 mg or 240 mg once daily; max 540 mg once daily
    Cap: 120, 180, 240, 300 mg ext-rel
    Dilacor XR initially 180 mg or 240 mg once daily; max 540 mg once daily
    Cap: 180, 240 mg ext-rel
    Tiazac initially 120-180 mg daily; max 540 mg/day
    Cap: 120, 180, 240, 300, 360, 420 mg ext-rel
  • nicardipine (C)(G) initially 20 mg tid; adjust q 3 days; max 120 mg/day
    Pediatric: not recommended
    Cardene Cap: 20, 30 mg
  • nifedipine (C)(G)
    Pediatric: not recommended
    Adalat CC initially 30 mg once daily; usual range 30-60 mg tid; max 90 mg/day
    Tab: 30, 60, 90 mg ext-rel
    Procardia initially 10 mg tid; titrate over 7-14 days: max 30 mg/dose and 180 mg/day in divided doses
    Cap: 10, 20 mg
    Procardia XL initially 30-60 mg daily; titrate over 7-14 days; max dose 90 mg/day
    Tab: 30, 60, 90 mg ext-rel
  • verapamil (C)(G)
    Pediatric: not recommended
    Calan 80-120 mg tid; increase daily or weekly if needed
    Tab: 40, 80*, 120*mg
    Calan SR initially 120 mg once daily; increase weekly if needed
    Tab: 120, 180, 240 mg
    Covera HS initially 180 mg q HS; titrate in steps to 240 mg; then to 360 mg; then to 480 mg if needed
    Tab: 180, 240 mg ext-rel
    Isoptin SR initially 120-180 mg in the AM; may increase to 240 mg in the AM; then 180 mg q 12 hours or 240 mg in the AM and 120 mg in the PM; then 240 mg q 12 hours
    Tab: 120, 180*, 240*mg sust-rel

BETA-BLOCKERS
Comment: Beta-blockers are contraindicated with history of sick sinus syndrome (SSS), 2nd or 3rd degree heart block, cardiogenic shock, pulmonary congestion, asthma, moderate to severe COPD with FEV1 <50% predicted, patients with chronic bronchodilator treatment.

  • atenolol (D)(G) initially 25-50 mg daily; increase weekly if needed; max 200 mg daily
    Pediatric: not recommended
    Tenormin Tab: 25, 50, 100 mg
  • metoprolol succinate (C)
    Pediatric: not recommended
    Toprol-XL initially 100 mg in a single dose once daily; increase weekly if needed; max 400 mg/day
    Tab: 25*, 50*, 100*, 200*mg ext-rel
  • metoprolol tartrate (C)
    Pediatric: not recommended
    Lopressor (G) initially 25-50 mg bid; increase weekly if needed; max 400 mg/day
    Tab: 25, 37.5, 50, 75, 100 mg
  • nadolol (C)(G) initially 40 mg daily; increase q 3-7 days; max 240 mg/day
    Pediatric: not recommended
    Corgard Tab: 20*, 40*, 80*, 120*, 160*mg
  • propranolol (C)(G)
    Pediatric: not recommended
    Inderal LA initially 80 mg daily in a single dose; increase q 3-7 days; usual range 120-160 mg/day; max 320 mg/day in a single dose
    Cap: 60, 80, 120, 160 mg sust-rel
    InnoPran XL initially 80 mg q HS; max 120 mg/day
    Cap: 80, 120 mg ext-rel

NITRATES
Comment: Use a daily nitrate dosing schedule that provides a dose-free period of 14 hours or more to prevent tolerance. aspirin and acetaminophen may relieve nitrate-induced headache. Isosorbide is not recommended for use in MI and/or CHF. Nitrate use is a contraindication for using phosphodiesterase type 5 inhibitors: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra).

  • isosorbide dinitrate (C)
    Pediatric: not recommended
    Dilatrate-SR 40 mg once daily; max 160 mg/day
    Cap: 40 mg sust-rel
    Isordil Titradose initially 5-20 mg q 6 hours; maintenance 10-40 mg q 6 hours
    Tab: 5, 10, 20, 30, 40 mg
  • isosorbide mononitrate (C)
    Pediatric: not recommended
    Imdur initially 30-60 mg q AM; may increase to 120 mg daily; max 240 mg/day
    Tab: 30*, 60*, 120 mg ext-rel
    Ismo 20 mg upon awakening; then 20 mg 7 hours later
    Tab: 20*mg
  • nitroglycerin (C)(G)
    Pediatric: not recommended
    Nitro-Bid Ointment initially 1/2 inch q 8 hours; titrate in 1/2 inch increments
    Oint: 2% (20, 60 g)
    Nitrodisc initially one 0.2-0.4 mg/hour patch for 12-14 hours/day
    Transdermal disc: 0.2, 0.3, 0.4 mg/hour (30, 100/carton)
    Nitro-Dur initially 0.2-0.4 mg/hour patch for 12-14 hours/day
    Transdermal patch: 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hour
    Nitrolingual Pump Spray 1-2 sprays on or under tongue; max 3 sprays/15 minutes
    Spray: 0.4 mg/dose (14.5 g, 200 doses)
    Nitromist 1-2 sprays at onset of attack, on or under the tongue while sitting; may repeat q 5 minutes as needed; max 3 sprays/15 minutes; may use prophylactically 5-10 minutes prior to exertion; do not inhale spray; do not rinse mouth for 5-10 minutes after use
    Lingual aerosol spray: 0.4 mg/actuation (230 metered sprays)
    Nitrostat 1 tab SL; may repeat q 5 minutes x 3
    SL tab: 0.3 (1/100 gr), 0.4 (1/150 gr), 0.6 (1/4 gr) mg
    Transderm-Nitro initially one 0.2 mg/hour or 0.4 mg/hour patch for 12-14 hours/day
    Transdermal patch: 0.1, 0.2, 0.4, 0.6, 0.8 mg/hour

NON-NITRATE PERIPHERAL VASODILATOR

  • hydralazine (C)(G) initially 10 mg qid x 2-4 days; then increase to 25 mg qid for remainder of first week; then increase to 50 mg qid; max 300 mg/day
    Tab: 10, 25, 50, 100 mg

NITRATE/PERIPHERAL VASODILATOR COMBINATION

  • isosorbide/hydralazine HCl (C) initially 1 tab tid; max 2 tabs tid
    Bidil Tab: isosorb 20 mg/hydral 37.5 mg

NON-NITRATE ANTI-ANGINAL

  • ranolazine (C) initially 500 mg bid; may increase to max 1 g bid
    Ranexa Tab: 500, 1000 mg ext-rel
    Comment: Ranexa is indicated for the treatment chronic angina that is inadequately controlled with other antianginals. Use with amlodipine, beta-blocker, or nitrate.

ANOREXIA/CACHEXIA

APPETITE STIMULANTS

  • cyproheptadine (B)(G) initially 4 mg tid prn; then adjust as needed; usual range 12-16 mg/day; max 32 mg/day
    Pediatric: <2 years: not recommended; =2-6 years: 2 mg bid-tid prn; max 12 mg/day; 7-14 years: 4 mg bid-tid prn; max 16 mg/day; >14 years: same as adult
    Periactin Tab: cypro 4*mg; Syr: cypro 2 mg/5 ml
  • dronabinol (cannabinoid) (B)(III) initially 2.5 mg bid before lunch and dinner; may reduce to 2.5 mg q HS or increase to 2.5 mg before lunch and 5 mg before dinner; max 20 mg/day in divided doses
    Pediatric: not recommended
    Marinol Cap: 2.5, 5, 10 mg (sesame oil)
  • megestrol (progestin) (X)(G) 40 mg qid
    Pediatric: not recommended
    Megace Tab: 20*, 40*mg
    Megace ES Oral susp (concentrate): 125 mg/ml; 625 mg/5 ml (5 oz) (lemon-lime)
    Megace Oral Suspension Oral susp: 40 mg/ml (8 oz); 820 mg/20 ml) (lemon-lime)
    Megestrol Acetate Oral Suspension (G) 125 mg/ml
    Comment: megestrol is indicated for the treatment of anorexia, cachexia, or an unexplained, significant weight loss in patients with a diagnosis of AIDS.

ANTHRAX (BACILLUS ANTHRACIS) POSTEXPOSURE PROPHYLAXIS OF INHALATIONAL ANTHRAX AND TREATMENT OF INHALED AND CUTANEOUS ANTHRAX INFECTION

Immune globulin

  • bacillus athracis immune globulin intravenous (human) (NE) administer via IV infusion at a maximum rate of 2 ml/min; dose is weight-based as follows, but may doubled in severe cases if weight >5 kg:
    Pediatric: <16 years: not established; 5-<10 kg: 1 vial; 10-<18 kg: 2 vials; 18-<25 kg: 3 vials; 25-<35 kg: 4 vials; 35-<50 kg: 5 vials; 50-<60 kg: 6 vials; =60 kg: 7 vials
    Anthrasil Vial: (60 units) sterile solution of purifi ed human immune globulin G (IgG) containing polyclonal antibodies that target the anthrax toxins of Bacillus anthracis for IV infusion
    Comment: Anthrasil is indicated for the emergent treatment of inhaled anthrax in combination with appropriate antibacterial agents
  • ciprofloxacin (C) 500 mg (or 10-15 mg/kg/day) q 12 hours for 60 days (start as soon as possible after exposure)
    Pediatric: <18 years: usually 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 daily bid
    Pediatric: <8 years: not recommended =8 years, <100 lb: 2 mg/lb on first day in 2 divided doses, followed by 1 mg/lb/day in a single or divided doses; =8 years, =100 lb: same as adult; see page 572 for dose by weight
    Actilate Tab: 75, 150**mg
    Adoxa Tab: 50, 75, 100, 150 mg ent-coat
    Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
    Monodox Cap: 50, 75, 100 mg
    Oracea Cap: 40 mg del-rel
    Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple) (sulfites); Oral susp: 25 mg/5 ml (raspberry)
    Vibra-Tab Tab: 100 mg film-coat
    Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
  • minocycline (D)(G) 100 mg q 12 hours
    Pediatric: <8 years: not recommended; =8 years, <100 lb: 2 mg/lb on first day in 2 divided doses, followed by 1 mg/lb q 12 hours x 9 more days; =8 years, =100 lb: same as adult
    Dynacin Cap: 50, 100 mg
    Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (sulfites, alcohol 5%)
    Comment: minocycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.

TREATMENT OF INHALATIONAL, GI, AND OROPHARYNGEAL ANTHRAX

  • ciprofloxacin (C) 400 mg IV q 12 hours (start as soon as possible); then, switch to 500 mg PO q 12 hours for total 60 days
    Pediatric: <18 years: usually not recommended; 10-15 mg/kg IV q 12 hours (start as soon as possible); then switch to 10-15 mg/kg PO q 12 hours for 60 days
    Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry); IV conc: 10 mg/ml after dilution (20, 40 ml); IV premix: 2 mg/ml (100, 200 ml)
    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. Infuse IV ciprofloxacin over 60 minutes.
  • doxycycline (D)(G) 100 mg daily bid
    Pediatric: <8 years: not recommended =8 years, <100 lb: 2 mg/lb on first day in 2 divided doses, followed by 1 mg/lb/day in a single or divided doses; =8 years, =100 lb: same as adult; see page 572 for dose by weight
    Actilate Tab: 75, 150**mg
    Adoxa Tab: 50, 75, 100, 150 mg ent-coat
    Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
    Monodox Cap: 50, 75, 100 mg
    Oracea Cap: 40 mg del-rel
    Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple) (sulfites); Oral susp: 25 mg/5 ml (raspberry)
    Vibra-Tab Tab: 100 mg film-coat
    Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
  • minocycline (D)(G) 100 mg q 12 hours
    Pediatric: <8 years: not recommended; =8 years, <100 lb: 2 mg/lb on first day in 2 divided divided doses, followed by 1 mg/lb q 12 hours x 9 more days; =8 years, =100 lb: same as adult
    Dynacin Cap: 50, 100 mg
    Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (sulfites, alcohol 5%)
    Comment: minocycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.

ANXIETY DISORDER: GENERALIZED (GAD)/ANXIETY DISORDER: SOCIAL (SAD)

1ST GENERATION ANTIHISTAMINE

  • hydroxyzine (C)(G) 50-100 mg qid; max 600 mg/day
    Pediatric: <6 years: 50 mg/day divided qid; =6 years: 50-100 mg/day divided qid
    Atarax Tab: 10, 25, 50, 100 mg; Syr: 10 mg/5 ml (alcohol 0.5%)
    Vistaril Cap: 25, 50, 100 mg; Oral susp: 25 mg/5 ml (4 oz) (lemon)

AZASPIRONES

  • buspirone (B) initially 7.5 mg bid; may increase by 5 mg/day q 2-3 days; max 60 mg/day
    Pediatric: <6 years: not recommended; 6-17 years: same as adult
    BuSpar Tab: 5, 10, 15*, 30* mg

BENZODIAZEPINES
Comment: If possible when considering a benzodiazepine to treat anxiety, a shortacting benzodiazepines should be used only prn to avert intense anxiety and panic for the least time necessary while a different non-addictive antianxiety regimen (e.g., SSRI, SNRI, TCA, buspirone, beta-blocker) is established and effective treatment goals achieved. Benzodiazepines have a high addiction potential when they are chronically used and are common drugs of abuse. Benzodiazepine withdrawal syndrome may include restlessness, agitation, anxiety, insomnia, tachycardia, tachypnea, diaphoresis, and may be potentially life threatening depending on the benzodiazepine and the length of use. Symptoms of withdrawal from short-acting benzodiazepines, such as alprazolam (Xanax), oxazepam, lorazepam (Ativan), triazolam (Halcion), usually appear within 6-8 hours after the last dose and may continue 10-14 days. Symptoms of withdrawal from long-acting benzodiazepines, such as diazepam (Valium), clonazepam (Klonopin), chlordiazepam (Librium), usually appear within 24-96 hours after the last dose and may continue from 3-4 weeks to 3 months. People who are heavily dependent on benzodiazepines may experience protracted withdrawal syndrome (PAWS), random periods of sharp withdrawal symptoms months after quitting. A closely monitored medical detoxification regimen may be required for a safe withdrawal and to prevent PAWS. Detoxification includes gradual tapering of the benzodiazepine along with other medications to manage the withdrawal symptoms.

Short Acting

  • alprazolam (D)(IV)(G)
    Pediatric: <18 years: not recommended
    Niravam initially 0.25-0.5 mg tid; may titrate every 3-4 days; max 4 mg/day
    Tab: 0.25*, 0.5*, 1*, 2*mg orally-disint
    Xanax initially 0.25-0.5 mg tid; may titrate every 3-4 days; max 4 mg/day
    Tab: 0.25*, 0.5*, 1*, 2*mg
    Xanax XR initially 0.5-1 mg once daily, preferably in the AM; increase at intervals of at least 3-4 days by up to 1 mg/day. Taper no faster than 0.5 mg every 3 days; max 10 mg/day. When switching from immediate-release alprazolam, give total daily dose of immediate-release once daily.
    Tab: 0.5, 1, 2, 3 mg ext-rel
  • oxazepam (C)(IV)(G) 10-15 mg tid-qid for moderate symptoms; 15-30 mg tid-qid for severe symptoms
    Pediatric: not recommended
    Cap: 10, 15, 30 mg
    Intermediate Acting
  • lorazepam (D)(IV)(G) 1-10 mg/day in 2-3 divided doses
    Pediatric: not recommended
    Ativan Tab: 0.5, 1*, 2*mg
    Lorazepam Intensol Oral conc: 2 mg/ml (30 ml w. graduated dropper)

Long Acting

  • chlordiazepoxide (D)(IV)(G)
    Pediatric: <6 years: not recommended; =6 years: 5 mg bid-qid; increase to 10 mg bid-tid
    Librium 5-10 mg tid-qid for moderate symptoms; 20-25 mg tid-qid for severe symptoms
    Cap: 5, 10, 25 mg
    Librium Injectable 50-100 mg IM or IV; then 25-50 mg IM tid-qid prn; max 300 mg/day
    Inj: 100 mg
  • chlordiazepoxide/clidinium (D)(IV) 1-2 caps tid-qid: max 8 caps/day
    Pediatric: not recommended
    Librax Cap: chlor 5 mg/clid 2.5 mg
  • clonazepam (D)(IV)(G) initially 0.25 mg bid; increase to 1 mg/day after 3 days
    Pediatric: <18 years: not recommended
    Klonopin Tab: 0.5*, 1, 2 mg
    Klonopin Wafers dissolve in mouth with or without water
    Wafer: 0.125, 0.25, 0.5, 1, 2 mg orally-disint
  • clorazepate (D)(IV)(G) 30 mg/day in divided doses; max 60 mg/day
    Pediatric: <9 years: not recommended; =9 years: same as adult
    Tranxene Tab: 3.75, 7.5, 15 mg
    Tranxene SD do not use for initial therapy
    Tab: 22.5 mg ext-rel
    Tranxene SD Half Strength do not use for initial therapy
    Tab: 11.25 mg ext-rel
    Tranxene T-Tab Tab: 3.75*, 7.5*, 15*mg
  • diazepam (D)(IV)(G) 2-10 mg bid to qid
    Pediatric: not recommended
    Diastat Rectal gel delivery system: 2.5 mg
    Diastat AcuDial Rectal gel delivery system: 10, 20 mg
    Valium Tab: 2*, 5*, 10*mg
    Valium Injectable Vial: 5 mg/ml (10 ml); Amp: 5 mg/ml (2 ml); Prefilled syringe: 5 mg/ml (5 ml)
    Valium Intensol Oral Solution Conc oral soln: 5 mg/ml (30 ml w. dropper) (alcohol 19%)
    Valium Oral Solution Oral soln: 5 mg/5 ml (500 ml) (wintergreen spice)

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

  • doxepin (C)(G) usual optimum dose 75-150 mg/day; elderly lower initial dose and therapeutic dose; max single dose 150 mg; max 300 mg/day in divided doses Sinequan
    Pediatric: not recommended
    Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
    Comment: Glaucoma, urinary retention, and bipolar disorder are contraindications to doxepin. Separate from MAOIs by at least 14 days. Separate from fluoxetine by at least 5 weeks. Avoid abrupt cessation. doxepin is potentiated by CYP2D6 inhibitors (e.g., cimetidine, SSRIs, phenothiazines, type 1C antiarrhythmics).

PHENOTHIAZINES

  • prochlorperazine (C)(G)
    Compazine 5 mg tid-qid
    Pediatric: not recommended
    Tab: 5 mg; Syr: 5 mg/5 ml (4 oz) (fruit); Rectal supp: 2.5, 5, 25 mg
    Compazine Spansule 15 mg q AM or 10 mg q 12 hours
    Pediatric: not recommended
    Spansule: 10, 15 mg sust-rel
  • trifluoperazine (C)(G) 1-2 mg bid; max 6 mg/day; max 12 weeks
    Pediatric: not recommended
    Stelazine Tab: 1, 2, 5, 10 mg

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Comment: Co-administration of SSRIs with TCAs requires extreme caution.
Concomitant use of MAOIs and SSRIs is absolutely contraindicated. Avoid St. John’s wort and other serotonergic agents. A potentially fatal adverse event is serotonin syndrome, caused by serotonin excess. Milder symptoms require HCP intervention to avert severe symptoms that can be rapidly fatal without urgent/emergent medical care. Symptoms include restlessness, agitation, confusion, tachycardia, hypertension, dilated pupils, muscle twitching, muscle rigidity, loss of muscle coordination, diaphoresis, diarrhea, headache, shivering, piloerection, hyperpyrexia, cardiac arrhythmias, seizures, loss of consciousness, coma, death. Common symptoms of the serotonin discontinuation syndrome include flu-like symptoms (nausea, vomiting, diarrhea, headaches, diaphoresis); sleep disturbances (insomnia, nightmares, constant sleepiness); mood disturbances (dysphoria, anxiety, agitation); cognitive disturbances (mental confusion, hyperarousal); and sensory and movement disturbances (imbalance, tremors, vertigo, dizziness, electric-shock-like sensations in the brain often described by sufferers as “brain zaps”).

  • escitalopram (C)(G) initially 10 mg daily; may increase to 20 mg daily after 1 week;
    Elderly or hepatic impairment, 10 mg once daily
    Pediatric: <12 years: not recommended; 12-17 years: initially 10 mg once daily; may increase to 20 mg once daily after 3 weeks
    Lexapro Tab: 5, 10*, 20*mg
    Lexapro Oral Solution Oral soln: 1 mg/ml (240 ml) (peppermint) (parabens)
  • fluoxetine (C)(G)
    Prozac initially 20 mg daily; may increase after 1 week; doses >20 mg/day may be divided into AM and noon doses; max 80 mg/day
    Pediatric: <8 years: not recommended; 8-17 years: initially 10-20 mg once daily; start lower weight children at 10 mg once daily; if starting at 10 mg once daily, may increase after 1 week to 20 mg once daily
    Cap: 10, 20, 40 mg; Tab: 30*, 60*mg; Oral soln: 20 mg/5 ml (4 oz) (mint)
    Prozac Weekly following daily fluoxetine therapy at 20 mg/day x 13 weeks, may initiate Prozac Weekly 7 days after the last 20 mg fluoxetine dose
    Pediatric: not recommended
    Cap: 90 mg ent-coat del-rel pellets
  • paroxetine maleate (D)(G)
    Pediatric: not recommended
    Paxil initially 10-20 mg daily in AM; may increase by 10 mg/day at weekly intervals as needed; max 60 mg/day
    Tab: 10*, 20*, 30, 40 mg
    Paxil CR initially 12.5-25 mg daily in AM; may increase by 12.5 mg at weekly intervals as needed; max 62.5 mg/day
    Tab: 12.5, 25, 37.5 mg ent-coat cont-rel
    Paxil Suspension initially 10-20 mg daily in AM; may increase by 10 mg/day at weekly intervals as needed; max 60 mg/day
    Oral susp: 10 mg/5 ml (250 ml) (orange)
  • sertraline (C) initially 50 mg daily; increase at 1 week intervals if needed; max 200 mg daily
    Pediatric: <6 years: not recommended; 6-12 years: initially 25 mg daily; max 200 mg/day; 13-17 years: initially 50 mg daily; max 200 mg/day
    Zoloft Tab: 15*, 50*, 100*mg; Oral conc: 20 mg per ml (60 ml [dilute just before administering in 4 oz water, ginger ale, lemon-lime soda, lemonade, or orange juice]) (alcohol 12%)

SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)

  • venlafaxine (C)(G)
    Eff exor initially 75 mg/day in 2-3 divided doses; may increase at 4 day intervals in 75 mg increments to 150 mg/day; max 225 mg/day
    Pediatric: <18 years: not recommended
    Tab: 37.5, 75, 150, 225 mg
    Eff exor XR initially 75 mg q AM; may start at 37.5 mg daily x 4-7 days; then increase by increments of up to 75 mg/day at intervals of at least 4 days; usual max 375 mg/day
    Pediatric: not recommended
    Tab: Cap: 37.5, 75, 150 mg ext-rel

COMBINATION AGENTS

  • chlordiazepoxide/amitriptyline (D)(G)
    Pediatric: not recommended
    Limbitrol 3-4 tabs/day in divided doses
    Tab: chlor 5 mg/amit 12.5 mg
    Limbitrol DS 3-4 tabs/day in divided doses; max 6 tabs/day
    Tab: chlor 10 mg/amit 25 mg
  • perphenazine/amitriptyline (C)(G) 1 tab bid-qid
    Pediatric: not recommended
    Tab: Etrafon 2-10: perph 2 mg/amit 10 mg
    Etrafon 2-25: perph 2 mg/amit 25 mg
    Etrafon 4-25: perph 4 mg/amit 25 mg

APHTHOUS STOMATITIS (MOUTH ULCER, CANKER SORE)

ANTI-INFLAMMATORY AGENTS

  • dexamethasone elixir (B) 5 ml swish and spit q 12 hours
    Pediatric: not recommended
    Elix: 0.5 mg/ml
  • triamcinolone acetonide 0.1% dental paste (NE)(G) press (do not rub) thin film onto lesion at bedtime and, if needed, 2-3 x daily after meals; re-evaluate if no improvement in 7 days
    Oralone Dental paste: 0.1% (5 g)
  • triamcinolone 1% in Orabase (B) apply 1/4 inch to each ulcer bid-qid until ulcer heals
    Pediatric: not recommended
    Kenalog in Orabase Crm: 1% (15, 60, 80 g)

TOPICAL ANESTHETICS

  • benzocaine topical gel (C)(G) apply tid-qid
  • benzocaine topical spray (C)(G) 1 spray to painful area every 2 hours as needed; retain for 15 seconds, then spit
    Cepocal Spray (OTC), Chloraseptic Spray (OTC)
  • lidocaine viscous soln (B)(G) 15 ml gargle or swish, then spit; repeat after 3 hours; max 8 doses/day
    Pediatric: <3 years: 1.25 ml; apply with cotton-tipped applicator; may repeat after 3 hours; max 8 doses/day
    Xylocaine Viscous Solution Viscous soln: 2% (20, 100, 450 ml)
  • triamcinolone (Kenalog) in Orabase (C) apply with swab

DEBRIDING AGENT/CLEANSER

  • carbamide peroxide 10% (NE)(OTC) apply 10 drops to affected area; swish x 2-3 minutes, then spit; do not rinse; repeat treatment qid
    Gly-Oxide Liq: 10% (50, 60 ml squeeze bottle w. applicator)

ANTI-INFECTIVES

  • minocycline (D)(G) swish and spit 10 ml susp (50 mg/5 ml) or 1 x 100 mg cap or 2 x 50 mg caps dissolved in 180 ml water, bid x 4-5 days
    Pediatric: <8 years: not recommended; =8 years: same as adult
    Dynacin Cap: 50, 100 mg
    Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (sulfites, alcohol 5%)
    Comment: minocycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
  • tetracycline (D) swish and spit 10 ml susp (125 mg/5 ml) or one 250 mg tab/cap dissolved in 180 ml water qid x 4-5 days
    Pediatric: <8 years: not recommended; =8 years: same as adult; see page 585 for dose by weight
    Achromycin V Cap: 250, 500 mg
    Sumycin Tab: 250, 500 mg; Cap: 250, 500 mg; Oral susp: 125 mg/5 ml (100, 200 ml) (fruit) (sulfites)
    Comment: tetracycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side effect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.

ASPERGILLOSIS (SCEDOSPORIUM APIOSPERMUM, FUSARIUM SPP.)

INVASIVE INFECTION

isavuconazonium (C) swallow cap whole; Loading dose: 372 mg q 8 hours x 6 doses (48 hours); Maintenance: 372 mg once daily starting 12-24 hours after last loading dose
Pediatric: <18 years: not established
Cresemba Cap: 186 mg; Vial: 372 mg pwdr for reconstitution (7/blister pck) (preservative-free)
Comment: Cresemba is indicated for the treatment of invasive aspergillus and mucormycosis in patients >18-years-old who are at high risk due to being severely compromised.

posaconazole (D) take with food; swallow tab whole; Day 1: 300 mg bid; then 300 mg once daily for duration of treatment (e.g., resolution of neutropenia or immunosuppression)
Pediatric: <13 years: not recommended; =13 years: same as adult
Noxafil Tab: 100 mg del-rel; Oral susp: 40 mg/ml (105 oz w. dosing spoon) (cherry)
Comment: Noxafil is indicated as prophylaxis for invasive aspergillus and candida infections in patients >13-years-old who are at high risk due to being severely compromised.

voriconazole (D)(G) PO: <40 kg: 100 mg q 12 hours; may increase to 150 mg q 12 hours if inadequate response; >40 kg: 200 mg q 12 hours; may increase to 300 mg q 12 hours if inadequate response; IV: 6 mg/kg q 12 hours x 2 doses; then 4 mg/kg q
12 hours; max rate 3 mg/kg/hour over 1-2 hours
Pediatric: not recommended
Vfend Tab: 50, 200 mg
Vfend I.V. for Injection Vial: 200 mg pwdr for reconstitution (preservative-free)
Vfend Oral susp: 40 mg/ml pwdr for reconstitution (75 ml) (orange)

ASTHMA

Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509

LEUKOTRIENE RECEPTOR ANTAGONISTS (LRAs)
Comment: Th e LRAs are indicated for prophylaxis and chronic treatment, only. Not for primary (rescue) treatment of acute asthma attack.

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

IGE BLOCKER (IGG1K MONOCLONAL ANTIBODY)

  • omalizumab (B) 150-375 mg SC every 2-4 weeks based on body weight and pre-treatment serum total IgE level; max 150 mg/injection site
    Pediatric: <12 years: not recommended; 30-90 kg + IgE >30-100 IU/ml 150 mg q 4 weeks; 90-150 kg + IgE >30-100 IU/ml or 30-90 kg + IgE >100-200 IU/ml or 30-60 kg + IgE >200-300 IU/ml 300 mg q 4 hours; >90-150 kg + IgE >100-200 IU/ml or >60-90 kg + IgE >200-300 IU/ml or 30-70 kg + IgE >300-400 IU/ml 225 mg q 2 weeks; >90-150 kg + IgE >200-300 IU/ml or >70-90 kg + IgE >300-400 IU/ml or 30-70 kg + IgE >400-500 IU/ml or 30-60 kg + IgE >500-600 IU/ml or 30-60 kg + IgE >600-700 IU/ml 375 mg q 2 weeks
    Xolair Vial: 150 mg pwdr for SC injection after reconstitution (preservative-free)

INHALED ANTICHOLINERGICS

  • ipratropium bromide (C)(G)
    Atrovent 2 inhalations qid; additional inhalations as required; max 12 inhalations/day
    Pediatric: not recommended
    Inhaler: 18 mcg/actuation (14 g, 200 inh)
    Atrovent Inhalation Solution 500 mcg tid-qid prn by nebulizer
    Pediatric: not recommended
    Inhal soln: 0.02% (500 mcg in 2.5 ml; 25/carton)

INHALED CORTICOSTEROIDS
Comment: Instruct patient to rinse mouth after using an inhaled steroid to reduce risk of oral candidiasis. Not for primary (rescue) treatment of acute asthma attack.

  • beclomethasone dipropionate (C)(G) Previously using only bronchodilators: initiate 40-80 mcg bid; max 320 mcg bid; Previously using inhaled corticosteroid: initiate 40-160 mcg bid; max 320 mcg/day; Previously taking a systemic corticosteroid: attempt to to wean off the systemic drug after approximately 1 week after initiating; rinse mouth after use
    Pediatric: not recommended
    Qvar
    Inhal aerosol: 40, 80 mcg/metered dose actuation (8.7 g, 120 inh) metered dose inhaler (chlorofluorocarbon [CFC]-free)
  • budesonide (B)
    Pulmicort Flexhaler initially 180-360 mcg bid; max 360 mcg bid; rinse mouth after use
    Pediatric: <6 years: not recommended; =6 years: 1-2 inhalations bid
    Flexhaler: 90 mcg/actuation (60 inh); 180 mcg/actuation (120 inh)
    Pulmicort Respules (G) adult use flexhaler
    Pediatric: <12 months: not recommended; 12 months-8 years: Previously using only bronchodilators: initiate 0.5 mg/day once daily or in 2 divided doses; may start at 0.25 mg daily; Previously using inhaled corticosteroids: initiate 0.5 mg once daily or in 2 divided doses; max 1 mg/day; Previously taking oral corticosteroids: initiate 1 mg/day daily or in 2 divided doses; >8 years: use flexhaler; rinse mouth after use
    Inhal susp: 0.25, 0.5, 1 mg/2 ml (30/carton)
  • ciclesonide (C) initially 80 mcg bid; max 320 mcg/day; rinse mouth after use; Previously on inhaled corticosteroid: initially 80 mcg bid; Previously on oral steroid: 320 mg bid
    Pediatric: <12 years: not recommended; =12 years: same as adult
    Alvesco
    Inhal aerosol: 80, 160 mcg/actuation (6.1 g, 60 inh)
  • flunisolide (C) rinse mouth after use
    AeroBid, AeroBid-M initially 2 inhalations bid; max 8 inhalations/day; rinse mouth after use
    Pediatric: <6 years: not recommended; 6-15 years: 2 inhalations bid; =15 years: same as adult
    Inhaler: 250 mcg/actuation (7 g, 100 inh)
    Aerospan HFA initially 160 mcg bid; max 320 mcg bid
    Pediatric: <6 years: not recommended; 6-11 years: 80 mcg bid; max 160 mcg bid; =12 years: same as adult
    Inhaler: 80 mcg (5.1 g, 60 doses; 80 mcg, 120 doses)
  • fluticasone furoate (C) currently not on inhaled corticosteroid: usually initiate at 100 mcg once daily at the same time each day; may increase to 200 mcg once daily if inadequate response after 2 weeks; max 200 mcg/day; rinse mouth after use
    Pediatric: not established
    Arnuity Ellipta Inhal: 100, 200 mcg/dry pwdr per inhalation (30 doses)
    Comment: Arnuity Ellipta is not for primary treatment of status asthmaticus or acute asthma episodes. Arnuity Ellipta is contraindicated with severe hypersensitivity to milk proteins.
  • fluticasone propionate (C)
    Flovent, Flovent HFA initially 88 mcg bid; Previously using an inhaled corticosteroid: initially 88-220 mcg bid; Previously taking an oral corticosteroid: 880 mcg bid; rinse mouth after use
    Pediatric: use Flovent Diskus
    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)
    Flovent Diskus initially 100 mcg bid; max 500 mcg bid; Previously using an inhaled corticosteroid: initially 100-250 mcg bid; max 500 mcg bid; Previously taking an oral corticosteroid: 1000 mcg bid
    Pediatric: <4 years: not recommended; 4-11 years: initially 50 mcg bid; max 100 mcg bid; rinse mouth after use; =12 years: same as adult
    Diskus: 50, 100, 250 mcg/inh dry pwdr (60 blisters w. diskus)
  • mometasone furoate (C) 220-440 mcg once daily or bid; max 880 mcg/day; rinse mouth after use
    Asmanex HFA Inhaler: 100, 200 mcg/actuation (13 g, 120 inh)
    Pediatric: not established
    Asmanex Twisthaler Inhaler: 110 mcg/actuation (30 inh), 220 mcg/actuation (30, 60, 120 inh)
    Pediatric: <4 years: not recommended; 4-11 years: 110 mcg once daily in the
    PM; rinse mouth after use
  • triamcinolone (C)
    Azmacort 2 inhalations tid-qid or 4 inhalations bid; rinse mouth after use
    Pediatric: <6 years: not recommended; 6-12 years: 1-2 inhalations tid or 2-4 inhalations bid; >12 years: same as adult
    Inhaler: 100 mcg/actuation (20 g, 240 inh)

INHALED MAST CELL STABILIZERS (PROPHYLAXIS)
Comment: IMCSs are for prophylaxis and chronic treatment, only. Not for primary (rescue) treatment of acute asthma attack.

  • cromolyn sodium (B)(G)
    Intal 2 inhalations qid; 2 inhalations up to 10-60 minutes before precipitant as prophylaxis; rinse mouth after use
    Pediatric: <2 years: not recommended; 2-5 years: use inhal soln via nebulizer; >5 years: 2 inhalations qid via inhaler
    Inhaler: 0.8 mg/actuation (8.1, 14.2 g; 112, 200 inh)
    Intal Inhalation Solution 20 mg by nebulizer qid; 20 mg up to 10-60 minutes before precipitant as prophylaxis
    Pediatric: <2 years: not recommended; =2 years: same as adult
    Inhal soln: 20 mg/2 ml (60, 120/carton)
  • nedocromil sodium (B)
    Tilade 2 sprays qid; rinse mouth after use
    Pediatric: <6 years: not recommended; =6 years: 2 sprays qid
    Inhaler: 1.75 mg/spray (16.2 g; 104 sprays)
    Tilade Nebulizer Solution 0.5% 1 amp qid by nebulizer
    Pediatric: <2 years: not recommended; =2 years: initially 1 amp qid by nebulizer; 2-5 years: initially 1 amp tid by nebulizer; =5 years: same as adult
    Inhal soln: 11 mg/2.2 ml (2 ml; 60, 120/carton)

INHALED BETA AGONISTS (BRONCHODILATORS)

  • albuterol sulfate (C)(G)
    AccuNeb Inhalation Solution 1 unit-dose vial tid-qid prn by nebulizer; ages 2-12 years only; not for adult
    Pediatric: <2 years: not recommended; 2-12 years: initially 0.63 mg or 1.25 mg tid-qid; 6-12 years: with severe asthma, or >40 kg, or 11-12 years: initially 1.25 mg tid-qid
    Inhal soln: 0.63, 1.25 mg/3ml (3 ml, 25/carton) (preservative-free)
    Albuterol Inhalation Solution (G) not recommended
    Pediatric: <2 years: not recommended; =2 years: 1 vial via nebulizer over 5-15 minutes
    Inhal soln: 0.63 mg/3 ml (0.021%); 1.25 mg/3 ml (0.042%) (25/carton)
    Albuterol Inhalation Solution 0.5% (G) not recommended
    Pediatric: <4 years: not recommended; =4 years: same as adult
    Inhal soln: 0.083% (25/carton)
    Albuterol Nebules (G) 2.5 mg (0.5 ml of 5% diluted to 3 ml with sterile NS or 3 ml of 0.083%) tid-qid
    Pediatric: use other forms
    Inhal soln: 0.083% (25/carton)
    Proair HFA Inhaler 1-2 inhalations q 4-6 hours prn; 2 inhalations 15 minutes before exercise as prophylaxis for exercise-induced asthma (EIA)
    Pediatric: <4 years: not established; =4 years: same as adult
    Inhaler: 90 mcg/actuation (0.65 g, 200 inh) (CFC-free)
    Proair RespiClick 1-2 inhalations q 4-6 hours prn; 2 inhalations 15-30 minutes before exercise as prophylaxis for exercise-induced asthma (EIA)
    Pediatric: not established
    Inhaler: 90 mcg/actuation (8.5 g, 200 inh)
    Proventil HFA Inhaler 1-2 inhalations q 4-6 hours prn; 2 inhalations 15 minutes before exercise as prophylaxis for exercise-induced asthma (EIA)
    Pediatric: <4 years: use syrup; =4 years: same as adult
    Inhaler: 90 mcg/actuation with a dose counter (6.7 g, 200 inh)
    Proventil Inhalation Solution 2.5 mg diluted to 3 ml with normal saline tid-qid prn by nebulizer
    Pediatric: use syrup
    Inhal soln: 0.5% (20 ml w. dropper); 0.083% (3 ml; 25/carton)
    Ventolin Inhaler 2 inhalations q 4-6 hours prn; 2 inhalations 15 minutes before exercise as prophylaxis for exercise-induced asthma
    Pediatric: <2 years: not recommended; 2-4 years: use syrup; >4 years: same as adult
    Inhaler: 90 mcg/actuation (17 g, 220 inh)
    Ventolin Rotacaps 1-2 cap inhalations q 4-6 hours prn; 2 inhalations 15 minutes before exercise as prophylaxis for exercise-induced asthma (EIA)
    Pediatric: <4 years: not recommended; =4 years 1-2 caps q 4-6 hours prn
    Rotacaps: 200 mcg/Rotacaps (100 doses/Rotacaps)
    Ventolin 0.5% Inhalation Solution
    Pediatric: <2 years: not recommended; =2 years: initially 0.1-0.15 mg/kg/dose tid-qid prn; 10-15 kg: 0.25 ml diluted to 3 ml with normal saline by nebulizer tid-qid prn; >15 kg: 0.5 ml diluted to 3 ml with normal saline by nebulizer tid-qid prn
    Inhal soln: 20 ml w. dropper
    Ventolin Nebules
    Pediatric: <2 years: not recommended; =2 years: initially 0.1-0.15 mg/kg/dose tid-qid prn; 10-15 kg: 1.25 mg or 1/2 nebule tid-qid prn; >15 kg: 2.5 mg or 1 nebule tid-qid prn
    Inhal soln: 0.083% (3 ml; 25/carton)
  • isoproterenol (B) Rescue: 1 inhalation prn; repeat if no relief in 2-5 minutes; Maintenance: 1-2 inhalations q 4-6 hours
    Pediatric: <12 years: not recommended; =12 years: same as adult
    Medihaler-1SO Inhaler: 80 mcg/actuation (15 ml, 30 inh)
  • levalbuterol tartrate (C)(G) initially 0.63 mg tid q 6-8 hours prn by nebulizer; may increase to 1.25 mg tid at 6-8 hour intervals as needed
    Pediatric: not recommended
    Xopenex Inhal soln: 0.31, 0.63, 1.25 mg/3 ml (24/carton) (preservative-free)
    Xopenex HFA Inh: 45 mg (15 g, 200 inh) (preservative-free)
    Xopenex Concentrate Vial: 1.25 mg/0.5 ml (30/carton) (preservative-free)
  • metaproterenol (C)(G)
    Alupent 2-3 inhalations tid-qid prn; max 12 inhalations/day
    Pediatric: <6 years: use syrup; =6 years: via nebulizer 0.1-0.2 ml diluted with normal saline to 3 ml, up to q 4 hours prn
    Inhaler: 0.65 mg/actuation (14 g, 200 doses)
    Alupent Inhalation Solution 5-15 inhalations tid-qid prn; q 4 hours prn for acute attack
    Pediatric: <6 years: use syrup =6 years: via nebulizer 0.1-0.2 ml diluted with normal saline to 3 ml, up to q 4 hours prn
    Inhal soln: 5% (10, 30 ml w. dropper)
  • pirbuterol (C) 1-2 inhalations q 4-6 hours prn; max 12 inhalations/day
    Maxair
    Pediatric: <12 years: not recommended
    Autohaler: 200 mcg/actuation (14 g, 400 inh); Inhaler: 200 mcg/actuation (25.6 g, 300 inh)
  • terbutaline (B) 2 inhalations q 4-6 hours prn
    Pediatric: not recommended
    Inhaler: 0.2 mg/actuation (10.5 g, 300 inh)

INHALED RACEPINEPHRINE (BRONCHODILATOR)

  • racepinephrine (C)(OTC)(G) 1-3 inhalations not more than every 3 hours; max 12 inhalations/24 hours
    Pediatric: <4 years: not recommended; =4 years: same as adult
    Asthmanephrin Inhaler Starter kit: 10 x 0.5 ml vials 2.25% solution for atomized inhalation w. EZ Breathe Atomizer; Refills: 30 x 0.5 ml vials 2.25% solution for atomized inhalation
    Comment: Inhalational epinephrine is only recommended for use during pregnancy when there are no alternatives and benefi t outweighs risk.

INHALED LONG-ACTING ANTICHOLINERGIC

  • tiotropium (as bromide monohydrate) (C) 2 inhalations once daily using inhalation device; do not swallow caps
    Pediatric: <12 years: not recommended; =12 years: same as adult
    Spiriva HandiHaler Inhal device: 18 mcg/cap pwdr for inhalation (5, 30, 90 caps w. inhalation device)
    Spiriva Respimat Inhal device: 1.25, 2.5 mcg/actuation cartridge w. inhalation device (4 g, 60 metered actuations) (benzylkonian chloride)
    Comment: tiotropium is for prophylaxis and chronic treatment, only. Not for primary (rescue) treatment of acute attack. Avoid getting powder in eyes. Caution with narrow-angle glaucoma, BPH, bladder neck obstruction, and pregnancy.
    Contraindicated with allergy to atropine or its derivatives (e.g., ipratropium).

INHALED ANTICHOLINERGIC/BETA AGONIST

  • ipratropium bromide/albuterol sulfate (C) 2 inhalations qid
    Combivent 2 inhalations qid; additional inhalations as required; max 12 inhalations/day
    Pediatric: not recommended
    Inhaler: ipra 18 mcg/albu 90 mcg/actuation (14.7 g, 200 inh)
    Duoneb 1 vial via nebulizer 4-6 times daily prn
    Pediatric: <18 years: not recommended
    Inhal soln: ipra 0.5 mg (0.017%)/albu 2.5 mg (0.083%) per 3 ml (23/carton)

INHALED BETA AGONIST (LONG-ACTING) (LABA)

  • arformoterol (C) 15 mcg bid via nebulizer
    Pediatric: not recommended
    Brovana Inhal soln: 15 mcg/2 ml (2 ml; 30/carton)
    Comment: arformoterol is indicated for the treatment of COPD but is used off -label for the treatment of asthma. It is used for prophylaxis and chronic treatment, only. Not for primary (rescue) treatment of acute attack.
  • formoterol fumarate (C)
    Foradil Aerolizer 12 mcg q 12 hours
    Pediatric: <5 years: not recommended; =5 years: same as adult
    Inhaler: 12 mcg/cap (12, 60 caps w. device)
    Perforomist 20 mcg q 12 hours
    Pediatric: not recommended
    Inhal soln: 20 mcg/2 ml (60/carton)
    Comment: formoterol is for prophylaxis and chronic treatment, only. Not for primary (rescue) treatment of acute attack. Do not mix formoterol with other drugs. formoterol off -label for asthma.
  • olodaterol (C)
    Pediatric: not established
    Striverdi Respimat 12 mcg q 12 hours
    Inhal soln: 2.5 mcg/cartridge (metered actuation) (40 g, 60 metered actuations) (benzalkonium chloride)
    Comment: Striverdi Respimat is contraindicated in persons with asthma without use of long-term control medication.
  • salmeterol (C)(G) 2 inhalations q 12 hours prn; 2 inhalations at least 30-60 minutes before exercise as prophylaxis for exercise-induced asthma; do not use extra doses for exercise-induced bronchospasm if already using regular dose
    Serevent Diskus
    Pediatric: <4 years: not recommended; =4 years: 1 inhalation q 12 hours prn; 1 inhalation at least 30-60 minutes before exercise as prophylaxis for exercise-induced asthma; do not use extra doses for exercise-induced bronchospasm if already using regular dose
    Diskus (pwdr): 50 mcg/actuation (60 doses/disk)

CORTICOSTEROID/INHALED LONG-ACTING BETA AGONIST (LABA)

  • budesonide/formoterol (C) 1 inhalation bid; rinse mouth after use
    Pediatric: <12 years: not recommended; =12 years: same as adult
    Symbicort 80/4.5
    Inhaler: bud 80 mcg/for 4.5 mcg
    Symbicort 160/4.5
    Inhaler: bud 160 mcg/for 4.5 mcg
  • fluticasone propionate/salmeterol (C)
    Advair HFA Not previously using inhaled steroid: start with 2 inh 45/21 or 115/21 bid; if insufficient response after 2 weeks, use next higher strength; max 2 inh 230/50 bid; Already using inhaled steroid; see mfr pkg insert; rinse mouth after use
    Advair HFA 45/21
    Pediatric: not recommended
    Inhaler: flu pro 45 mcg/sal 21 mcg/actuation (CFC-free)
    Advair HFA 115/21
    Pediatric: not recommended
    Inhaler: flu pro 115 mcg/sal 21 mcg/actuation (CFC-free)
    Advair HFA 230/21
    Pediatric: not recommended
    Inhaler: flu pro 230 mcg/sal 21 mcg/actuation (CFC-free)
    Advair Diskus Not previously using inhaled steroid: start with 1 inh 100/50 bid;
    Already using inhaled steroid: see mfr pkg insert; rinse mouth after use
    Advair Diskus 100/50
    Pediatric: <4 years: not recommended; 4-11 years: 1 inhalation bid; >11 years: 1 inhalation bid
    Diskus: flu pro 100 mcg/sal 50 mcg/actuation (60 blisters)
    Advair Diskus 250/50 1 inhalation bid; rinse mouth after use
    Pediatric: 4-12 years: use 100/50 strength; >12 years: same as adult
    Diskus: flu pro 250 mcg/sal 50 mcg/actuation (60 blisters)
    Advair Diskus 500/50
    Pediatric: 4-12 years: use 100/50 strength; >12 years: same as adult
    Diskus: fluticasone propionate 500 mcg/salmeterol 50 mcg/actuation (60 blisters)
    Comment: Advair Diskus is not a rescue inhaler. Allow 12 hours between doses.
  • fluticasone furoate/vilanterol (C) 1 inhalation 100/25 once daily at the same time each day
    Pediatric: <17 years: not established
    Breo Ellipta 100/25 Inhal pwdr: flu 100 mcg/vil 25 mcg dry pwdr per inhal (30 doses)
    Breo Ellipta 200/25 Inhal pwdr: flu 200 mcg/vil 25 mcg dry pwdr per inhal (30 doses)
    Comment: Breo Ellipta is contraindicated with severe hypersensitivity to milk proteins.
  • mometasone furoate/formoterol fumarate (C) 2 inhalations bid; rinse mouth after use
    Pediatric: not established
    Dulera 100/5 Inhaler: mom 100 mcg/for 5 mcg (HFA)
    Dulera 200/5 Inhaler: mom 200 mcg/for 5 mcg (HFA)
    Comment: Dulera is not a rescue inhaler.

ANTICHOLINERGIC/INHALED LONG-ACTING BETA AGONIST (LABA)

  • glycopyrrolate/formoterol fumarate (C) 2 inhalations bid (AM & PM)
    Pediatric: <18 years: not established
    Bevespi Aerosphere Metered dose inhaler: 9/4.8 Inhal pwdr: gly 9 mcg/for 4.8 mcg per inhal (10.7 g, 120 inh)

ORAL BETA2-AGONISTS (BRONCHODILATORS)

  • albuterol (C)
    Albuterol Syrup (G) Adults: 2-4 mg tid-qid; may increase gradually; max 8 mg qid; Elderly: initially 2-3 mg tid-qid; may increase gradually; max 8 mg qid
    Pediatric: <2 years: not recommended; =2-6 years: 0.1 mg/kg tid; initially max 2 mg tid; may increase gradually to 0.2 mg/kg tid; max 4 mg tid; >6-12 years: 2 mg tid-qid; may increase gradually; max 6 mg qid; =12 years: same as adult
    Syr: 2 mg/5 ml
    Proventil 2-4 mg tid-qid prn
    Pediatric: <6 years: not recommended; =6 years: same as adult
    Tab: 2, 4 mg
    Proventil Repetabs 4-8 mg q 12 hours prn
    Pediatric: use syrup
    Repetab: 4 mg sust-rel
    Proventil Syrup 5-10 ml tid-qid prn; may increase gradually; max 20 ml qid prn
    Pediatric: <2 years: not recommended; =2-6 years: 0.1 mg/kg tid prn; max initially 5 ml tid prn; may increase gradually to 0.2 mg/kg tid prn; max 10 ml tid; >6-14 years: 5 ml tid-qid prn; may increase gradually; max 60 ml/day in divided doses; >14 years: same as adult
    Syr: 2 mg/5 ml
    Ventolin 2-4 mg tid-qid prn; may increase gradually; max 8 mg qid
    Pediatric: <2 years: not recommended; =2-6 years: 0.1 mg/kg tid prn; max initially 2 mg tid prn; may increase gradually to 0.2 mg/kg tid; max 4 mg tid; >6-14 years: 2 mg tid-qid prn; may increase gradually; max 6 mg tid
    Tab: 2, 4 mg; Syr: 2 mg/5 ml (strawberry)
    VoSpire ER 4-8 mg q 12 hours prn; max 32 mg/day divided q 12 hours; swallow whole
    Pediatric: <6 years: not recommended; =6-12 years: 4 mg q 12 hours; max 24
    mg/day q 12 hours; >12 years: same as adult
    Tab: 4, 8 mg ext-rel
  • metaproterenol (C)
    Alupent 20 mg tid-qid prn
    Pediatric: <6 years: not recommended (doses of 1.3-2.6 mg/kg/day have been used); =6-9 years (<60 lb): 10 mg tid-qid prn; >9-12 years (>60 lb): 20 mg tidqid prn; >12 years: same as adult
    Tab: 10, 20 mg; Syr: 10 mg/5 ml

METHYLXANTHINES
Comment: Check serum theophylline level just before 5th dose is administered.
Therapeutic theophylline level: 10-20 mcg/ml.

  • theophylline (C)(G)
    Theo-24 initially 300-400 mg once daily at HS; after 3 days, increase to 400-600 mg once daily at HS; max 600 mg/day
    Pediatric: <45 kg: initially 12-14 mg/kg/day; max 300 mg/day; increase after 3 days to 16 mg/kg/day to max 400 mg; after 3 more days increase to 30 mg/kg/day to max 600 mg/day; =45 kg: same as adult
    Cap: 100, 200, 300, 400 mg ext-rel
    Theo-Dur initially 150 mg bid; increase to 200 mg bid after 3 days; then to 300 mg bid after 3 more days
    Pediatric: <6 years: not recommended; 6-15 years: initially 12-14 mg/kg/day in 2 divided doses; max 300 mg/day; then increase to 16 mg/kg in 2 divided doses; max 400 mg/day; then to 20 mg/kg/day in 2 divided doses; max 600 mg/day; =15 years: same as adult
    Tab: 100, 200, 300 mg ext-rel
    Theolair-SR
    Pediatric: not recommended
    Tab: 200, 250, 300, 500 mg sust-rel
    Uniphyl 400-600 mg daily with meals
    Pediatric: not recommended
    Tab: 400*, 600*mg cont-rel

METHYLXANTHINE/EXPECTORANT

  • dyphylline/guaifenesin (C) 1 tab qid
    Lufyllin GG Tab: dyphy 200 mg/guaif 200 mg; Elix: dyphy 100 mg/guaif 100 mg per 15 ml

HUMANIZED INTERLEUKIN-5 ANTAGONIST MONOCLONAL ANTIBODY

mepolizumab (NE) 100 mg SC once every 4 weeks in upper arm, abdomen, or thigh
Pediatric: <12 years: not recommended; =12 years: same as adult
Nucala Vial: 100 mg pwdr for reconstitution, single-use (preservative-free)
Comment: Nucala is an add-on maintenance treatment for severe asthma. Th ere is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Nucala during pregnancy. Healthcare providers can enroll patients or encourage patients to enroll themselves by calling 1-877-311-8972 or visiting www.mothertobaby.org/asthma.

ATROPHIC VAGINITIS

Oral Estrogens see Menopause page 264

VAGINAL ESTROGEN PREPARATIONS

  • estradiol (X)(G)
    Vagifem Vaginal Tablet 1 tab intravaginally daily x 2 weeks; then 1 tab intravaginally twice weekly
    Vag tab: 10 mcg (15 tabs w. applicators)
    Yuvafem Vaginal Tablet 1 tab intravaginally daily x 2 weeks; then 1 tab intravaginally twice weekly
    Vag tab: 10 mcg (15 tabs w. applicators)
  • estradiol (X)
    Estrace Vaginal Cream 2-4 g daily x 1-2 weeks; then gradually reduce to 1/2 initial dose x 1-2 weeks; then maintenance dose of 1 g 1-3 times/week
    Vag crm: 0.01% (1 oz tube w. calib applicator)
  • estrogens, conjugated (X)
    Premarin Cream 2 g/day intravaginally
    Vag crm: 1.5 oz w. applicator marked in 1/2 g increments to max 2 g
  • estropipate (X)
    Ogen Cream 2-4 g intravaginally daily x 3 weeks; discontinue 4th week; continue in this cyclical pattern
    Vag crm: 1.5 mg/g (42.5 g w. calib applicator)

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)

  • atomoxetine (C) take one dose daily in the morning or in two divided doses in the morning and late afternoon or early evening; initially 40 mg/kg; increase after at least 3 days to 80 mg/kg; then after 2-4 weeks may increase to max 100 mg/day
    Pediatric: <6 years: not recommended; =6 years, <70 kg: initially 0.5 mg/kg/day: increase after at least 3 days to 1.2 mg/kg/day; max 1.4 mg/kg/day or 100 mg/day (whichever is less); =6 years, >70 kg: same as adult
    Strattera Cap: 10, 18, 25, 40, 60, 80, 100 mg
    Comment: Not associated with stimulant or euphoric effects. May discontinue without tapering.

STIMULANTS

  • amphetamine sulfate (C)(II)
    Adzenys XT-ODT take with or without food; individualize the dosage according to the therapeutic needs and response; initially 6.3 mg once daily in the morning; increase in increments of 3.1 mg or 6.3 mg at weekly intervals; max recommended dose 18.8 mg once daily (6-12 years-of-age) and 12.5 mg once daily (13-17 years-of-age);
    Pediatric: <6 years: not recommended; =6 years: same as adult
    Comment: Patients taking Adderall XR may be switched to Adzenys XR-ODT at the equivalent dose taken once daily; switching from any other amphetamine products (e.g., Adderall immediate-release), discontinue that treatment, and titrate with Adzenys XR-ODT using the titration schedule (see mfr pkg insert)
    ODT: 3.1, 6.3, 9.4, 12.5, 15.7, 18.8 mg orally-disint (orange) (fructose)
    Dyanavel XR Oral Suspension initially 2.5 mg or 5 mg once daily in the morning; may increase in increments of 2.5 mg to 5 mg per day every 4-7 days; max 20 mg per day; shake bottle prior to administration
    Pediatric: <6 years: not recommended; =6 years: same as adult
    Oral susp: 2.5 mg/ml (464 ml)
    Evekeo initially 5 mg once or twice daily at the same time(s) each day; may increase by 5 mg/day at weekly intervals; max 40 mg/day
    Pediatric: <3 years: not recommended; =3-5 years: initially 2.5 mg once or twice daily at the same time(s) each day; may increase by 2.5 mg/day at weekly intervals; max 40 mg/day; =6 years: same as adult
    Tab: 5, 10 mg
  • dextroamphetamine sulfate (C)(II)(G) initially start with 10 mg daily; increase by 10 mg at weekly intervals if needed; may switch to daily dose with sust-rel spansules when titrated
    Pediatric: <3 years: not recommended; =3-5 years: 2.5 mg daily; may increase by 2.5 mg daily at weekly intervals if needed; 6-12 years: initially 5 mg daily or bid; may increase by 5 mg/day at weekly intervals; usual max 40 mg/day; >12 years: initially 10 mg daily; may increase by 10 mg/day at weekly intervals; max 40 mg/day
    Dexedrine Tab: 5*mg (tartrazine)
    Dexedrine Spansule Cap: 5, 10, 15 mg ext-rel
    Dextrostat Tab: 5, 10 mg (tartrazine)
  • dextroamphetamine saccharate/dextroamphetamine sulfate/amphetamine aspartate/amphetamine sulfate (C)(II)(G) not indicated for adults
    Adderall initially 10 mg daily; may increase weekly by 10 mg/day; usual max 60 mg/day in 2-3 divided doses; first dose on awakening; then q 4-6 hours prn
    Pediatric: <6 years: not indicated; =6-12 years: initially 5 mg daily; may increase by 5 mg/day at weekly intervals; >12 years: same as adult
    Tab: 5**, 7.5**, 10**, 12.5**, 15**mg, 3.75 mg, 20**, 30**mg
    Adderall XR 20 mg by mouth once daily in AM; may increase by 10 mg/day at weekly intervals; max: 60 mg/day
    Pediatric: <6 years: not recommended; =6 years: initially 10 mg daily in the AM; may increase by 10 mg/day at weekly intervals; max 30 mg/day; 13-17 years: 10-20 mg by mouth daily in the AM; may increase by 10 mg/day at weekly intervals; max 40 mg/day; Do not chew; may sprinkle on apple sauce
    Cap: 5, 10, 15, 20, 25, 30 mg ext-rel
  • dexmethylphenidate (C)(II)(G) not indicated for adults
    Pediatric: <6 years: not recommended; =6 years: initially 2.5 mg bid; allow at least 4 hours between doses; may increase at 1 week intervals; max 20 mg/day
    Focalin Tab: 2.5, 5, 10*mg (dye-free)
    Focalin XR Cap: 5, 10, 15, 20, 25, 30, 35, 40 mg ext-rel
  • lisdexamphetamine dimesylate (C)(II) 30 mg once daily in the AM; may increase by 10-20 mg/day at weekly intervals; max 70 mg/day
    Pediatric: <6 years: not recommended; =6 years: same as adult
    Vyvanse Cap: 20, 30, 40, 50, 60, 70 mg
    Comment: May dissolve Vyvanse capsule contents in water; take immediately.
  • methamphetamine (C)(II)(G) initially 5 mg once daily to bid; may increase by 5 mg/day at weekly intervals; usual effective dose 20-25 mg/day
    Desoxyn Granumets
    Pediatric: <6 years: not recommended; =6 years: same as adult
    Tab: 5, 10, 15 mg sust-rel
  • methylphenidate (regular-acting) (C)(II)(G)
    Methylin, Methylin Chewable, Methylin Oral Solution usual dose 20-30 mg/day in 2-3 divided doses 30-45 minutes before a meal; max 60 mg/day
    Pediatric: <6 years: not recommended; =6 years: initially 5 mg bid ac (breakfast and lunch); may increase 5-10 mg/day at weekly intervals; max 60 mg/day
    Tab: 5, 10*, 20*mg; Chew tab: 2.5, 5, 10 mg; (grape; phenylalanine); Oral soln: 5, 10 mg/5 ml (grape)
    Ritalin 10-60 mg/day in 2-3 divided doses 30-45 minutes ac; max 60 mg/day
    Pediatric: <6 years: not recommended; =6 years: initially 5 mg bid ac (breakfast and lunch); may increase by 5-10 mg at weekly intervals as needed; max 60 mg/day
    Tab: 5, 10*, 20*mg
  • methylphenidate (long-acting) (C)(II)
    Concerta initially 18 mg q AM; may increase in 18 mg increments as needed; max 54 mg/day; do not crush or chew
    Pediatric: <6 years: not recommended; =6-12 years: initially 18 mg daily; max 54 mg/day; =13-17 years: initially 18 mg daily; max 72 mg/day or 2 mg/kg, whichever is less
    Tab: 18, 27, 36, 54 mg sust-rel
    Metadate CD (G) 1 cap daily in the AM; may sprinkle on food; do not crush or chew
    Pediatric: <6 years: not recommended; =6 years: initially 20 mg daily; may gradually increase by 20 mg/day at weekly intervals as needed; max 60 mg/day
    Cap: 10, 20, 30, 40, 50, 60 mg immed- and ext-rel beads
    Metadate ER 1 tab daily in the AM; do not crush or chew
    Pediatric: <6 years: not recommended; >6 years: use in place of regular-acting methylpheni- date when the 8-hour dose of Metadate-ER corresponds to the titrated 8-hour dose of regular-acting methylphenidate
    Tab: 10, 20 mg ext-rel (dye-free)
    QuilliChew ER initially 1 x 10 mg chew tab once daily in the AM
    Pediatric: <6 years: not recommended; initially 10 mg daily; may gradually increase by 20 mg/day at weekly intervals as needed; max 60 mg/day
    Chew tab: 20*, 30*, 40 mg ext-rel
    Quillivant XR initially 20 mg once daily in the AM, with or without food; may be titrated in increments of 10-20 mg/day at weekly intervals; daily doses above 60 mg have not been studied and are not recommended; shake the bottle vigorously for at least 10 seconds to ensure that the correct dose is administered
    Pediatric: <6 years: not recommended; =6 years: same as adult
    Bottle: 5 mg/ml, 25 mg/5 ml pwdr for reconstitution; 300 mg (60 ml), 600 mg (120 ml), 750 mg (150 ml), 900 mg (180 ml)
    Comment: Quillivant XR must be reconstituted by a pharmacist, not by the patient or caregiver.
    Ritalin LA (G) 1 cap daily in the AM
    Pediatric: <6 years: not recommended; =6 years: use in place of regular-acting methylphenidate when the 8-hour dose of Ritalin LA corresponds to the titrated 8-hour dose of regular-acting methylphenidate; max 60 mg/day
    Cap: 10, 20, 30, 40 mg ext-rel (immed- and ext-rel beads)
    Ritalin SR 1 cap daily in the AM
    Pediatric: <6 years: not recommended; =6 years: use in place of regular-acting methylphenidate when the 8-hour dose of Ritalin SR corresponds to the titrated 8-hour dose of regular-acting methylphenidate; max 60 mg/day
    Tab: 20 mg sust-rel (dye-free)
  • methylphenidate (transdermal patch) (C)(II)(G) not applicable >17 years
    Pediatric: <6 years: not recommended; =6-17 years: initially 10 mg patch applied to hip 2 hours before desired effect daily in the AM; may increase by 5-10 mg at weekly intervals; max 60 mg/day
    Daytrana Transdermal patch: 10, 15, 20, 30 mg
  • pemoline (B)(IV) 18.75-112.5 mg/day; usually start with 37.5 mg in AM; may increase 18.75 mg/day at weekly intervals; max 112.5 g/day
    Pediatric: <6 years: not recommended; =6 years: same as adult
    Cylert Tab: 18.75*, 37.5*, 75*mg
    Cylert Chewable Chew tab: 37.5*mg
    Comment: Check baseline serum ALT and monitor every 2 weeks thereafter.

CENTRAL ALPHA2A-AGONIST

  • guanfacine (B)(G) not applicable >17 years
    Pediatric: <6 years: not recommended; =6-17 years: initially 1 mg once daily; may increase by 1 mg/day at weekly intervals; usual max 4 mg/day
    Intuniv Tab: 1, 2, 3, 4 mg ext-rel
    Comment: Take Intuniv with water, milk, or other liquid. Do not take with a high-fat meal. Withdraw gradually by 1 mg every 3-7 days.

TRICYCLIC ANTIDEPRESSANTS (TCAs)
see Depression page 105

OTHER AGENTS

  • clonidine (C)(G)
    Catapres 4-5 mcg/kg/day
    Pediatric: <12 years: not recommended; =12 years: same as adult
    Tab: 0.1*, 0.2*, 0.3*mg
    Kapvay not indicated for adults
    Pediatric: <6 years: not recommended; =6-12 years: initially 0.1 mg at bedtime x 1 week; then 0.1 mg bid x 1 week; then 0.1 mg AM and 0.2 mg PM x 1 week; then 0.2 mg bid; withdraw gradually by 0.1 mg/day at 3-7 day intervals
    Tab: 0.1, 0.2 mg ext-rel

AMINOKETONES (FOR THE TREATMENT OF ADHD)

  • bupropion HCl (B)(G)
    Pediatric: <18 years: not recommended
    Wellbutrin initially 100 mg bid for at least 3 days; may increase to 375 or 400 mg/day after several weeks; then after at least 3 more days, 450 mg in 4 divided doses; max 450 mg/day, 150 mg/single dose
    Tab: 75, 100 mg
    Wellbutrin SR initially 150 mg in AM for at least 3 days; may increase to 150 mg bid if well tolerated; usual dose 300 mg/day; max 400 mg/day
    Tab: 100, 150 mg sust-rel
    Wellbutrin XL initially 150 mg in AM for at least 3 days; increase to 150 mg bid if well tolerated; usual dose 300 mg/day; max 400 mg/day
    Tab: 150, 300 mg sust-rel

 

BÀI LIÊN QUAN