CANDIDIASIS: ABDOMEN, BLADDER,
ESOPHAGUS, KIDNEY
voriconazole (D)(G) PO: <40 kg: 100 mg q 12 hours; may increase to150 mg q 12
hours if inadequate response; =40 kg: 200 mg q 12 hours; may increase to 300 mg q
12 hours if inadequate; IV: 6 mg/kg q 12 hours x 2 doses; then 4 mg/kg q 12 hour;
max rate 3 mg/kg/hour over 1-2 hours; response
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)
CANDIDIASIS: ORAL (THRUSH)
ORAL ANTIFUNGALS
clotrimazole (C) Prophylaxis: 1 troche dissolved in mouth tid; Treatment: 1 troche
dissolved in mouth 5 times/day x 10-14 days
Pediatric: <3 years: not recommended; =3 years: same as adult
Mycelex Troches Troches: 10 mg
fluconazole (C) 200 mg x 1 dose fi rst day; then 100 mg once daily x 13 days
Pediatric: >2 weeks: 6 mg/kg x 1 day; then 3 mg/kg/day for at least 3 weeks; see page
577 for dose by weight
Diflucan Tab: 50, 100, 150, 200 mg; Oral susp: 10, 40 mg/ml (35 ml) (orange)
gentian violet (NE)(G) apply to oral mucosa with a cotton swab tid x 3 days
itraconazole (C) 200 mg daily x 7-14 days
Pediatric: 5 mg/kg daily x 7-14 days; max 200 mg/day; see page 570 for dose by weight
Sporanox Oral soln: 10 mg/ml (150 ml) (cherry-caramel)
miconazole (C) One buccal tab once daily x 14 days; apply to upper gum region; hold
in place 30 seconds; do not crush, chew, or swallow
Pediatric: <16 years: not recommended; =16 years: same as adult
Oravig Buccal tab: 50 mg (14/pck)
nystatin (C)(G)
Mycostatin 1-2 pastilles dissolved slowly in mouth 4-5 times/day x 10-14 days;
max 14 days
Pediatric: same as adult
Pastille: 200,000 units/pastille (30 pastilles/pck)
Mycostatin Suspension 4-6 ml qid swish and swallow
Pediatric: Infants: 1 ml in each cheek qid aft er feedings; Older children: same
as adult
Oral susp: 100,000 units/ml (60 ml w. dropper)
INVASIVE INFECTION
posaconazole (D) take with food; 100 mg bid on day one; then 100 mg once daily x
13 days; refractory, 400 mg bid
Pediatric: <13 years: not recommended; =13 years: same as adult
Noxafi l Oral susp: 40 mg/ml (105 ml) (cherry)
Comment: Noxafi l 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.
CANDIDIASIS: SKIN
TOPICAL ANTIFUNGALS
butenafi ne (B) apply bid x 1 week or once daily x 4 weeks
Pediatric: <12 years: not recommended; =12 years: same as adult
Lotrimin Ultra (C)(OTC) Crm: 1% (12, 24 g)
Mentax Crm: 1% (15, 30 g)
Comment: butenafi ne is a benzylamine, not an azole. Fungicidal activity continues for
at least 5 weeks aft er the last application.
ciclopirox (B)
Loprox Cream apply bid; max 4 weeks
Pediatric: <10 years: not recommended; =10 years: same as adult
Crm: 0.77% (15, 30, 90 g)
Loprox Lotion apply bid; max 4 weeks
Pediatric: <10 years: not recommended; =10 years: same as adult
Lotn: 0.77% (30, 60 ml)
Loprox Gel apply bid; max 4 weeks
Pediatric: <16 years: not recommended; =16 years: same as adult
Gel: 0.77% (30, 45 g)
clotrimazole (B) apply bid x 7 days
Pediatric: same as adult
Lotrimin Crm: 1% (15, 30, 45 g)
Lotrimin AF (OTC) Crm: 1% (12 g); Lotn: 1% (10 ml); Soln: 1% (10 ml)
econazole (C) apply bid x 14 days
Spectazole Crm: 1% (15, 30, 85 g)
ketoconazole (C) apply once daily x 14 days
Nizoral Cream Crm: 2% (15, 30, 60 g)
miconazole 2% (C) apply once daily x 2 weeks
Pediatric: same as adult
Lotrimin AF Spray Liquid (OTC) Spray liq: 2% (113 g) (alcohol 17%)
Lotrimin AF Spray Powder (OTC) Spray pwdr: 2% (90 g) (alcohol 10%)
Monistat-Derm Crm: 2% (1, 3 oz); Spray liq: 2% (3.5 oz); Spray pwdr: 2%
(3 oz)
nystatin (C)
Nystop Powder dust affected skin freely bid-tid
Pwdr: nystatin 100,000 U/g (15 g)
ORAL ANTIFUNGALS
amphotericin b (B) apply tid-qid x 7-14 days
Fungizone Oral susp: 100 mg/ml (24 ml w. dropper)
ketoconazole (C) 400 mg once daily x 1-2 weeks
Pediatric: <2 years: not recommended; =2 years: 3.3-6.6 mg/kg once daily
Nizoral Tab: 200 mg
INVASIVE INFECTION
posaconazole (D) take with food; 100 mg bid on day one; then 100 mg once daily x
13 days; refractory, 400 mg bid x 13 days
Pediatric: <13 years: not recommended; =13 years: same as adult
Noxafi l Oral susp: 40 mg/ml (105 ml) (cherry)
Comment: Noxafi l 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.
CANDIDIASIS: VULVOVAGINAL (MONILIASIS)
PROPHYLAXIS
acetic acid/oxyquinolone (C) one full applicator intravaginally bid for up to 30 days
Pediatric: not recommended
Relagard Gel: acetic acid 0.9%/oxyquin 0.025% (50 g tube w. applicator)
Comment: Th e following treatment regimens for vulvovaginal candidiasis (VVC) are
published in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines.
Treatment regimens are presented by generic drug name fi rst, followed by information
about brands and dose forms. Complicated VVC (recurrent, severe, non-albicans, or
women with uncontrolled diabetes, debilitation, or immunosuppression) may require
more intensive treatment and/or longer duration of treatment. VVC frequently occurs
during pregnancy. Only topical azole therapies, applied for 7 days, are recommended
during pregnancy.
ORAL Rx AGENT
fluconazole 150 mg in a single dose; complicated VVC, 150 mg x 3 doses on days 1,
4, 7 or weekly x 6 months
Rx INTRAVAGINAL AGENTS
Regimen 1
butoconazole 2% cream (bioadhesive product) 5 g intravaginally in a single dose
Regimen 2
nystatin 100,000-unit vaginal tablet once daily x 14 days
Regimen 3
terconazole 0.4% cream 5 g intravaginally once daily x 7 days
Regimen 4
terconazole 0.8% cream 5 g intravaginally once daily x 3 days
Regimen 5
terconazole 80 mg vaginal suppository intravaginally once daily x 3 days
OTC INTRAVAGINAL AGENTS
Regimen 1
butoconazole 2% cream 5 g intravaginally once daily x 3 days
Regimen 2
clotrimazole 1% cream intravaginally once daily x 7-14 days
t
y y y y y y y y y
70 ¦ C a n d i d i a s i s : Vu l v o v a g i n a l ( M o n i l i a s i s )
Regimen 3
clotrimazole 2% cream intravaginally once daily x 3 days
Regimen 4
miconazole 2% cream intravaginally once daily x 7 days
Regimen 5
miconazole 4% cream intravaginally once daily x 3 days
Regimen 6
miconazole 100 mg vaginal suppository intravaginally once daily x 7 days
Regimen 7
miconazole 200 mg vaginal suppository intravaginally once daily x 3 days
Regimen 8
miconazole 1,200 mg vaginal suppository intravaginally in a single application
Regimen 9
tioconazole 6.5% ointment 5 g intravaginally in a single application
DRUG BRANDS AND DOSE FORMS
butoconazole cream 2% (C)
Gynazole-12% Vaginal Cream Prefi lled vag applicator: 5 g
Femstat-3 Vaginal Cream (OTC) Vag crm: 2% (20 g w. 3 applicators); Prefi lled
vag applicator: 5 g (3/pck)
clotrimazole (B)(OTC)
Gyne-Lotrimin Vaginal Cream (OTC) Vag crm: 1% (45 g w. applicator)
Gyne-Lotrimin Vaginal Suppository (OTC) Vag supp: 100 mg (7/pck)
Gyne-Lotrimin 3 Vaginal Suppository (OTC) Vag supp: 200 mg (3/pck)
Gyne-Lotrimin Combination Pack (OTC) Combination pck: 7-100 mg supp
with 7 g 1% cream
Gyne-Lotrimin 3 Combination Pack (OTC) Combination pck: 200 mg supp (7/
pck) plus 1% cream (7 g)
Mycelex-G Vaginal Cream Vag crm: 1% (45, 90 g w. applicator)
Mycelex-G Vaginal Tab 1 Tab: 500 mg (1/pck)
Mycelex Twin Pack Twin pck: 500 mg tab (7/pck) with 1% crm (7 g)
Mycelex-7 Vaginal Cream (OTC) Vag crm: 1% (45 g w. applicator)
Mycelex-7 Vaginal Inserts (OTC) Vag insert: 100 mg insert (7/pck)
Mycelex-7 Combination Pack (OTC) Combination pck: 100 mg inserts (7/pck)
plus 1% crm (7 g)
fluconazole (C)
Diflucan Tab: 50, 100, 150, 200 mg; Oral susp: 10, 40 mg/ml (35 ml) (orange)
miconazole (B)
Monistat-3 Combination Pack (OTC) Combination pck: 200 mg supp (3/pck)
plus 2% crm (9 g)
y y y y y y y y y y y
Cat S c r a t c h Fe v e r ( B a r t o n e l l a I n f e c t i o n ) ¦ 71
Monistat-7 Combination Pack (OTC) Combination pck: 100 mg supp (7/pck)
plus 2% crm (9 g)
Monistat-7 Vaginal Cream (OTC) Vag crm: 2% (45 g w. applicator)
Monistat-7 Vaginal Suppositories (OTC) Vag supp: 100 mg supp (7/pck)
Monistat-3 Vaginal Suppositories (OTC) Vag supp: 200 mg supp (3/pck)
nystatin (C)
Mycostatin Vag tab: 100,000 U (1/pck)
terconazole (C)
Terazol-3 Vaginal Cream Vag crm: 0.8% (20 g w. applicator)
Terazol-3 Vaginal Suppositories Vag supp: 80 mg supp (3/pck)
Terazol-7 Vaginal Cream Vag crm: 0.4% (45 g w. applicator)
tioconazole (C)
1-Day (OTC) Vag oint: 6.5% (prefi lled applicator x 1)
Monistat 1 Vaginal Ointment (OTC) Vag oint: 6.5% (prefi lled applicator x 1)
Vagistat-1 Vaginal Ointment (OTC) Vag oint: 6.5% (prefi lled applicator x 1)
INVASIVE INFECTION
posaconazole (D) take with food; 100 mg bid on day 1; then 100 mg once daily x 13
days; refractory, 400 mg bid
Pediatric: <13 years: not recommended; =13 years: same as adult
Noxafi l Oral susp: 40 mg/ml (105 ml) (cherry)
Comment: Noxafi l 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.
CARPAL TUNNEL SYNDROME (CTS)
Acetaminophen for IV Infusion see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Topical/Transdermal NSAIDs see Pain page 307
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Topical Analgesic and Anesthetic Agents see page 499
CAT SCRATCH FEVER (BARTONELLA INFECTION)
Comment: Cat scratch fever is usually self-limited. Treatment should be limited to
severe or debilitating cases.
ANTI-INFECTIVES
azithromycin (B)(G) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500
mg daily x 3 days or Zmax 2 g in a single dose
Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
y y y y
t
t
y
72 ¦ Cat S c r a t c h Fe v e r ( B a r t o n e l l a I n f e c t i o n )
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
doxycycline (D)(G) 100 mg daily bid
Pediatric: <8 years: not recommended >8 years, <100 lb: 2 mg/lb on fi rst day in
2 divided doses, followed by 1 mg/lb/day in 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)
(sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
Vibra-Tab Tab: 100 mg fi lm-coat
Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and
lactation (discolors developing tooth enamel). A side eff ect may be photosensitivity
(photophobia). Do not give with antacids, calcium supplements, milk or
other dairy, or within two hours of taking another drug.
erythromycin base (B)(G) 500-1000 mg qid x 4 weeks
Pediatric: <45 kg: 30-50 mg in 2-4 divided doses x 4 weeks; =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 4 weeks
Pediatric: 30-50 mg/kg/day in 4 divided doses x 4 weeks; may double dose with
severe infection; max 100 mg/kg/day; see page 575 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.
trimethoprim/sulfamethoxazole (D)(G) bid x 10 days
Pediatric: <2 months: not recommended; =2 months: 40 mg/kg/day of sulfamethoxazole
in 2 divided doses bid x 10 days; see page 587 for dose by weight
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg*
Bactrim Pediatric Suspension, Septra Pediatric Suspension
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy
or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended
CELLULITIS
Comment: Duration of treatment should be 10-30 days. Obtain culture from site.
Consider blood cultures.
ANTI-INFECTIVES
- amoxicillin (B)(G)500-875 mg bid or 250-500 mg tid x 10 days
Pediatric: <40 kg (88 lb): 20-40 mg/kg/day in 3 divided doses x 10 days or 25-45 mg/kg/day in 2 divided doses x 10 days; =40 kg: same as adult; see page 554 for dose by weight
Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg (cherry-banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml (80, 100, 150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble gum);
Oral drops: 50 mg/ml (30 ml) (bubble gum)
Moxatag Tab: 775 mg ext-rel
Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80, 100, 150 ml) (raspberry-strawberry) - amoxicillin/clavulanate (B)(G)500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200, 400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana), 250 mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml) (orange) (phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided bid x 10 days see page 556 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml) (strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel - azithromycin (B)(G)500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500 mg daily x 3 days or Zmax 2 g in a single dose
Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
cefaclor (B)(G) 250-500 mg q 8 hours x 10 days; max 2 g/day
Pediatric: <1 month: not recommended; 20-40 mg/kg bid or q 12 hours x 10 days;
max 1 g/day; see page 560 for dose by weight
Tab: 500 mg; Cap: 250, 500 mg; Susp: 125 mg/5 ml (75, 150 ml) (strawberry); 187
mg/5 ml (50, 100 ml) (strawberry); 250 mg/5 ml (75, 150 ml) (strawberry); 375
mg/5 ml (50, 100 ml) (strawberry)
CefaclorRExtended Release
Pediatric: <16 years: ext-rel not recommended; =16years: same as adult
Tab: 375, 500 mg ext-rel
cefpodoxime proxetil (B) 400 mg bid x 7-14 days
Pediatric: <2 months: not recommended; =2 months-12 years: 10 mg/kg/day (max
400 mg/dose) or 5 mg/kg/day bid (max 200 mg/dose) x 7-14 days; >12 years: same
as adult; see page 564 for dose by weight
Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 mg) (lemon cream)
cefprozil (B) 500 mg q 12 hours x 10 days
Pediatric: <2 years: not recommended; 2-12 years: 15 mg/kg q 12 hours x 10 days;
>12 years: same as adult; see page 565 for dose by weight
Cefzil Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 75, 100 ml) (bubble
gum) (phenylalanine)
ceft aroline fosamil (B) administer 600 mg once every 12 hours, by IV infusion over
5-60 minutes, x 5-14 days
Pediatric: <18 years: not established
Teflaro Vial: 400, 600 mg pwdr for reconstitution, single-use (10/carton)
Comment: Teflaro is indicated for the treatment of adults with acute bacterial
skin and skin structures infection (ABSSSI).
ceft riaxone (B)(G) 1-2 g daily x 5-14 days IM; max 4 g daily
Pediatric: 50-75 mg/kg IM in 1-2 divided doses x 5-14 days; max 2 g/day
Rocephin Vial: 250, 500 mg; 1, 2 g
cefuroxime axetil (B)(G) 250-500 mg bid x 10 days
Pediatric: <3 months: not recommended; =3 months: 30 mg/kg/day in 2 divided
doses x 10 days; see page 567 for dose by weight
Ceft in Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 100 ml) (tutti-frutti)
cephalexin (B)(G) 500 mg bid x 10 days
Pediatric: 25-50 mg/kg/day in 4 divided doses x 10 days; see page 568 for dose by weight
Keflex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml)
(strawberry)
clarithromycin (C)(G) 500 mg q 12 hours or 500 mg ext-rel once daily x 10 days
Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg bid x 10 days; see
page 569 for dose by weight
Biaxin Tab: 250, 500 mg
Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit-punch)
Biaxin XL Tab: 500 mg ext-rel
dalbavancin (C) 1000 mg administered once as a single dose via IV infusion over
30 minutes or initially 1,000 mg once, followed by 500 mg 1 week later; infuse over
30 minutes; CrCl <30 mL/min: not receiving dialysis: initially 750 mg, followed by
375 mg 1 week later
Pediatric: <18 years: not established
Dalvance Vial: 500 mg pwdr for reconstitution, single-use (preservative-free)
Comment: Dalvance is indicated for the treatment of adults with acute bacterial
skin and skin structures infection (ABSSSI) caused by gram positive bacteria.
dicloxacillin (B)(G) 500 mg q 6 hours x 10 days
Pediatric: 12.5-25 mg/kg/day in 4 divided doses x 10 days; see page 571 for dose by weight
Dynapen Cap: 125, 250, 500 mg; Oral susp: 62.5 mg/5 ml (80, 100, 200 ml)
dirithromycin (C)(G) 500 mg once daily x 5-7 days
Pediatric: <12 years: not recommended; =12 years: same as adult
Dynabac Tab: 250 mg
erythromycin base (B)(G) 250 mg qid or 333 mg tid or 500 mg bid x 7-10 days; then
taper to lowest eff ective 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.
linezolid (C)(G) 600 mg q 12 hours x 10-14 days
Pediatric: <5 years: 10 mg/kg q 8 hours x 10-14 days; 5-11 years: 10 mg/kg q 12
hours x 10-14 days; >11years: same as adult
Zyvox Tab: 400, 600 mg; Oral susp: 100 mg/5 ml (150 ml) (orange)
(phenylalanine)
Comment: linezolid is indicated to treat susceptible vancomycin-resistant E.
faecium infections of skin and skin structures, including diabetic foot without
osteomyelitis.
loracarbef (B) 200 mg bid x 10 days
Pediatric: 15 mg/kg/day in 2 divided doses x 10 days; see page 581 for dose by weight
Lorabid Pulvule: 200, 400 mg; Oral susp: 100 mg/5 ml (50, 100 ml);
200 mg/5 ml (50, 75, 100 ml) (strawberry bubble gum)
moxifloxacin (C)(G) 400 mg once daily x 5 days
Pediatric: <18 years: recommended
Avelox Tab: 400 mg; IV soln: 400 mg/250 mg (latex-free, presservative-free)
Comment: moxifloxacin is contraindicated <18 years of age and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
oritavancin (C) administer 1,200 mg as a single dose by IV infusion over 3 hours
Pediatric: <18 years: not established
Orbactiv Vial: 400 mg pwdr for reconstitution, single-use (10/carton) (mannitol;
preservative-free)
Comment: Orbactiv is indicated for the treatment of adults with acute bacterial
skin and skin structures infection (ABSSSI).
penicillin V potassium (B) 250-500 mg q 6 hours x 5-7 days
Pediatric: >12 years: same as adult; see page 583 for dose by weight
Pen-Vee K Tab: 250, 500 mg; Oral soln: 125 mg/5 ml (100, 200 ml); 250 mg/5 ml
(100, 150, 200 ml)
tedizolid phosphate (C) administer 200 mg once daily x 6 days, via PO or IV infusion
over 1 hour
Pediatric: <18 years: not established
Sivextro Tab: 200 mg (6/blister pck)
Comment: Sivextro is indicated for the treatment of adults with acute bacterial
skin and skin structures infection (ABSSSI).
tigecycline (D)(G) 100 mg as a single dose; then 50 mg q 12 hours x 5-14 days; with severe
hepatic impaitment (Child Pugh C), 100 mg as a single dose; then 25 mg q 12 hours
Pediatric: <18 years: not recommended
Tygacil Vial: 50 mg pwdr for reconstitution and IV infusion (preservative-free)
CERUMEN IMPACTION
OTIC ANALGESIC
- antipyrine/benzocaine/zinc acetate dihydrate otic (C)fill ear canal with solution; then moisten cotton plug with solution and insert into meatus; may repeat every 1-2 hours prn
Pediatric: same as adult
Otozin Otic soln: antipyr 5.4%/benz 1%/zinc1% per ml (10 ml w. dropper)
CERUMINOLYTICS
- triethanolamine (NE)(OTC)(G)fill ear canal and insert cotton plug for 15-30 minutes before irrigating with warm water
Cerumenex Soln: 10% (6, 12 ml) - carbamide peroxide (NE)(OTC)(G)instill 5-10 drops in ear canal; keep drops in ear several minutes; then irrigate with warm water; repeat bid for up to 4 days
Debrox Soln: 15, 30 ml squeeze bottle w. applicator
CHANCROID
ANTI-INFECTIVES
azithromycin (B)(G) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or
500 mg daily x 3 days or Zmax 2 g in a single dose
Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by
weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml);
200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution
(cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
ceft riaxone (B)(G) 250 mg IM in a single dose
Pediatric: <45 kg: 125 mg IM in a single dose; =45 kg: same as adult
Rocephin Vial: 250, 500 mg; 1, 2 g
ciprofloxacin (C) 500 mg bid x 3 days
Pediatric: <18 years: not recommended
Cipro 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.
y
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y y y
C h i c k e n p o x ( Va r i c e l l a ) ¦ 77
erythromycin base (B)(G) 500 mg qid x 7 days
Pediatric: 30-50 mg/kg/day divided bid-qid; max 100 mg/kg/day
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
erythromycin ethylsuccinate (B)(G) 400 mg qid x 7 days
Pediatric: 30-50 mg/kg/day in 4 divided doses x 7 days; may double dose with
severe infection; max 100 mg/kg/day; see page 574 for dose by weight
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100,
200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab:
200 mg wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
E.E.S. 400 Tablets Tab: 400 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
CHICKENPOX (VARICELLA)
PROPHYLAXIS
Varicella virus vaccine, live, attenuated (C)
Varivax 0.5 ml SC; repeat 4-8 weeks later
Pediatric: <12 months: not recommended; 12 months-12 years: 1 dose of
0.5 ml SC; repeat 4-6 weeks later
Vial: 1350 PFU/0.5 ml single-dose w. diluent (preservative-free)
Comment: Administer Varivax SC in the deltoid for adults and children.
TREATMENT
Antipyretics see Fever page 143
ORAL ANTIPRURITICS
diphenhydramine (B)(OTC)(G) 25-50 mg q 6-8 hours; max 100 mg/day
Pediatric: <2 years: not recommended; 2-6 years: 6.25 mg q 4-6 hours; max
37.5 mg/day; >6-12 years: 12.5-25 mg q 4-6 hours; max 150 mg/day; >12 years:
same as adult
Benadryl (OTC) Chew tab: 12.5 mg (grape; phenylalanine); Liq: 12.5 mg/5 ml
(4, 8 oz); Cap: 25 mg; Tab: 25 mg; dye-free soft gel: 25 mg; Dye-free liq:
12.5 mg/5 ml (4, 8 oz)
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
AtaraxR Tab: 10, 25, 50, 100 mg; Syr: 10 mg/5 ml (alcohol 0.5%)
VistarilR Cap: 25, 50, 100 mg; Oral susp: 25 mg/5 ml (4 oz) (lemon)
ANTIVIRALS
acyclovir (B)(G) 800 mg qid x 5 days
Pediatric: <2 years: not recommended; =2 years, <40 kg: 20 mg/kg qid x 5 days;
=2 years, >40 kg: 800 mg qid x 5 days; see page 552 for dose by weight
y y
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y y y y
78 ¦ C h i c k e n p o x ( Va r i c e l l a )
Zovirax Cap: 200 mg; Tab: 400, 800 mg
Zovirax Oral Suspension Oral susp: 200 mg/5 ml (banana)
CHLAMYDIA TRACHOMATIS
Comment: Th e following treatment regimens for C. trachomatis are published in the
2015 CDC Sexually Transmitted Diseases Treatment Guidelines. Treatment regimens
are presented by generic drug name fi rst, followed by information about brands and
dose forms. Treat all sexual contacts. Patients who are HIV-positive should receive
the same treatment as those who are HIV-negative. Sexual abuse must be considered
a cause of chlamydial infection in preadolescent children, although perinatally
transmitted C. trachomatis infections of the nasopharynx, urogenital tract, and rectum
may persist for >1 year.
RECOMMENDED REGIMENS: ADOLESCENT AND ADULT, NON-PREGNANT
Regimen 1
azithromycin 1 g in a single dose
Regimen 2
doxycycline 100 mg bid x 7 days
ALTERNATIVE REGIMENS: ADOLESCENT AND ADULT, NON-PREGNANT
Regimen 1
erythromycin base 500 mg qid x 7 days
Regimen 2
erythromycin ethylsuccinate 800 mg qid x 7 days
Regimen 3
levofloxacin 500 mg once daily x 7 days
Regimen 4
ofloxacin 300 mg bid x 7 days
RECOMMENDED REGIMENS: PREGNANCY
Regimen 1
azithromycin 1 g in a single dose
Regimen 2
amoxicillin 500 mg tid x 7 days
t
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C h l a m y d i a Trachomat i s ¦ 79
ALTERNATE REGIMENS: PREGNANCY
Regimen 1
erythromycin base 500 mg qid x 7 days
Regimen 2
erythromycin base 250 mg qid x 14 days
Regimen 3
erythromycin ethylsuccinate 800 mg qid x 7 days
Regimen 4
erythromycin ethylsuccinate 400 mg qid x 14 days
ALTERNATE REGIMENS: CHILDREN (>8 YEARS)
Regimen 1
azithromycin 1 g in a single dose
Regimen 2
doxycycline 100 mg bid x 7 days
ALTERNATE REGIMEN: CHILDREN (>45 KG; <8 YEARS)
Regimen 1
azithromycin 1 g in a single dose
ALTERNATE REGIMENS: INFANTS
Regimen 1
erythromycin base 50 mg/kg/day in divided doses qid x 14 days
Regimen 2
erythromycin ethylsuccinate 50 mg/kg/day divided qid x 14 days
DRUG BRANDS AND DOSE FORMS
azithromycin (B)(G) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500
mg daily x 3 days or Zmax 2 g in a single dose
Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
doxycycline (D)(G)
Actilate Tab: 75, 150**mg
Adoxa Tab: 50, 75, 100, 150 mg ent-coat
y y y y y y y y y y y
80 ¦ C h l a m y d i a Trachomat i s
Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
Monodox Cap: 50, 75, 100 mg
Oracea Cap: 40 mg del-rel
Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple)
(sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
Vibra-Tab Tab: 100 mg fi lm-coat
Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and
lactation (discolors developing tooth enamel). A side eff ect may be photosensitivity
(photophobia). Do not give with antacids, calcium supplements, milk or
other dairy, or within two hours of taking another drug.
erythromycin base (B)(G)
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
erythromycin ethylsuccinate (B)(G)
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100, 200
ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab: 200 mg
wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
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.
levofloxacin (C)
Levaquin Tab: 250, 500, 750 mg
Comment: levofloxacin is contraindicated <18 years-of-age, and during pregnancy and
lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
ofloxacin (C)(G)
Floxin Tab: 200, 300, 400 mg
Comment: ofloxacin is contraindicated <18 years-of-age, and during pregnancy and
lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
CHOLELITHIASIS
ursodiol (B) 8-10 mg/kg/day in 2-3 divided doses
Pediatric: not recommended
Actigall Cap: 300 mg
Comment: Actigall is indicated for the dissolution of radiolucent, noncalciferous,
gallstones <20 mm in diameter and for prevention of gallstones during rapid
weight loss.
CHOLERA (VIBRIO CHOLERAE )
Comment: June 10, 2016, the FDA approved the fi rst vaccine for the prevention
of cholera caused by serogroup O1 (the most predominant cause of cholera
globally [WHO]) in adults age 18-64 years traveling to cholera-affected
y y y y
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C h o l e r a ¦ 81
areas. https://www.drugs.com/newdrugs/fda-approves-vaxchora-cholera-vaccinelive-
oral-prevent-cholera-travelers-4396.html. Vaxchora (R) is the only FDA approved
vaccine for the prevention of cholera. Th e bacterium Vibrio cholerae is acquired
by ingesting contaminated water or food and causes nausea, vomiting, and watery
diarrhea that may be mild to severe. Profuse fluid loss may cause life-threatening
dehydration if antibiotics and fluid replacement are not initiated promptly.
VACCINE PROPHYLAXIS
Vibrio cholerae vaccine
Vaxchora reconstitute the buff er component in 100 ml purifi ed bottled water;
then add the active component (lyophilized V. cholerae CVD 103-HgR); total
dose aft er reconstitution is 100 ml; instruct the patient to avoid eating or drinking
fluids for 60 minutes before and aft er ingestion of the dose
Comment: Vaxchora is a live, attenuated vaccine that is taken as a single oral dose at
least 10 days before travel to a cholera-affected area and at least 10 days before starting
antimalarial prophylaxis. Diminished immune response when taken concomitantly with
chloroquine. Avoid concomitant administration with systemic antibiotics since these
agents may be active against the vaccine strain. Do not administer to patients who have
received an oral or parental antibiotic within 14 days prior to vaccination. Vaxchora may
be shed in the stool of recipients for at least 7 days. Th ere is potential for transmission
of the vaccine strain to non-vaccinated and immunocompromised close contacts. Th e
Centers for Disease Control and Prevention and several health professional organizations
state that vaccines given to a nursing mother do not affect the safety of breastfeeding for
mothers or infants and that breastfeeding is not a contraindication to cholera vaccine.
Vaxchora is not absorbed systemically, and maternal use is not expected to result in fetal
exposure to the drug. Th e Vaxchora pregnancy exposure registry for reporting adverse
events is 800-533-5899. Th ere are 0 disease interactions, but at least 165 drug-drug
interactions with Vaxchora (see mfr pkg insert).
TREATMENT
Comment: Th e fi rst line treatment for V. cholerae is oral rehydration therapy (ORT)
and intravenous fluid replacement as indicated. Antibiotic therapy may shorten the
duration and severity of symptoms, but is optional in other than severe cases. Although
doxycycline is contraindicated in pregnancy and in children under 7 years-of-age, the
benefi ts may outweigh the risks (WHO, CDC, UNICEF). Although ciprofloxacin is
contraindicated in children under 18 years-of-age, the benefi ts may outweigh the risks
(WHO, CDC, UNICEF). Cholera is not transmitted from person to person, but rather
the fecal-oral route. Th erefore, chemoprophylaxis is not usually required with strict
hand hygiene and sanitation measures, and avoidance of contaminated food and water.
Drugs and dosages for chemoprophylaxis are the same as for treatment.
ADULTS 15 YEARS AND OLDER, NON-PREGNANT WOMEN
Regimen 1
doxycycline (D)(G) 300 mg in a single dose
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
y y
82 ¦ C h o l e r a
Oracea Cap: 40 mg del-rel
Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/ml (raspberry-apple)
(sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
Vibra-Tab Tab: 100 mg fi lm-coat
Regimen 2
azithromycin (B) 1000 mg in a single dose
Zithromax Tab: 250, 500, 600 mg
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
or
ciprofloxacin (C)(G) 1000 mg in a single dose
Cipro Tab: 250, 500, 750 mg;
Cipro XR Tab: 500, 1000 mg ext-rel
ProQuin XR Tab: 500 mg ext-rel
PREGNANT WOMEN, 15 YEARS AND OLDER
azithromycin (B) 1000 mg in a single dose
Zithromax Tab: 250, 500, 600 mg
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
or
erythromycin (B)(G) 500 mg q 6 hours x 3 days
E.E.S. 400 Tablets Tab: 400 mg
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
CHILDREN 3-15 YEARS WHO CAN SWALLOW TABLETS
Regimen 1
erythromycin (B)(G) 12.5 mg/kg q 6 hours x 3 days
E.E.S. 400 Tablets Tab: 400 mg
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
or
azithromycin (B) 20 mg/kg in a single dose; max 1 g
Zithromax Tab: 250, 500, 600 mg
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
Regimen 2
ciprofloxacin (D)(G) 20 mg/kg in a single dose
Cipro Tab: 250, 500, 750 mg;
Cipro XR Tab: 500, 1000 mg ext-rel
ProQuin XR Tab: 500 mg ext-rel
or
doxycycline (D)(G) 2-4 mg/kg in a single dose
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
y y y y y y y y
Common Cold ¦ 83
Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/ml (raspberry-apple)
(sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
Vibra-Tab Tab: 100 mg fi lm-coat
CHILDREN UNDER 3 YEARS
Regimen 1
erythromycin ethylsuccinate (B)(G) 12.5 mg/kg q 6 hours x 3 days; use suspension
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, fruit); Chew tab:
200 mg wafer (fruit)
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)
or
azithromycin (B) 20 mg/kg in a single dose; max 1 g; use suspension
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry)
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
Regimen 2
ciprofloxacin (C)(G) 20 mg/kg in a single dose; use suspension
Cipro Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry)
or
doxycycline (D)(G) 2-4 mg/kg in a single dose; use suspension or syrup
Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple)
(sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
COLIC: INFANTILE
hyoscyamine (C)(G)
Levsin Drops
Pediatric: 3-4 kg: 4 drops q 4 hours prn; max 24 drops/day; 5 kg: 5 drops
q 4 hours prn; max 30 drops/day; 7 kg: 6 drops q 4 hours prn; max 36 drops/
day; 10 kg: 8 drops q 4 hours prn; max 40 drops/day; Oral drops: 0.125 mg/ml
(15 ml) (orange) (alcohol 5%)
simethicone (C) 0.3 ml qid pc and HS
Mylicon Drops (OTC) Oral drops: 40 mg/0.6 ml (30 ml)
COMMON COLD (VIRAL UPPER RESPIRATORY
INFECTION [URI])
Oral Drugs for Allergy, Cough, and Cold see page 535
Oral Decongestants see page 535 y
Oral Expectorants see page 535
Oral Antitussives see page 535
Oral Antipyretic-Analgesics see Fever page 143
NASAL SALINE DROPS/SPRAYS
Comment: Homemade saline nose drops: 1/4 tsp salt added to 8 oz boiled water, then cool water.
saline nasal spray (NE)(G)
Afrin Saline Mist w. Eucalyptol and Menthol (OTC) 2-6 sprays in each nostril
prn
Pediatric: 1 month-2 years: 1-2 sprays in each nostril prn; >2-12 years: 1-4
sprays in each nostril prn; >12 years: same as adult
Squeeze bottle: 45 ml
Afrin Moisturizing Saline Mist (OTC) 2-6 sprays in each nostril prn
Pediatric: 1 month-2 years: 1-2 sprays in each nostril prn; 2-12 years: 1-4
sprays in each nostril prn; >12 years: same as adult
Squeeze bottle: 45 ml
Ocean Mist (OTC) 2-6 sprays in each nostril prn
Pediatric: 1 month-2 years: 1-2 sprays in each nostril prn; >2-12 years: 1-4
sprays in each nostril prn; >12 years: same as adult
Squeeze bottle: saline 0.65% (45 ml) (alcohol-free)
Pediamist (OTC) 2-6 sprays in each nostril prn
Pediatric: 1 month-2 years: 1-2 sprays in each nostril prn; >2-12 years: 1-4
sprays in each nostril prn; >12 years: same as adult
Squeeze bottle: saline 0.5% (15 ml) (alcohol-free)
NASAL SYMPATHOMIMETICS
oxymetazoline (C)(OTC) 2-3 drops or sprays in each nostril q 10-12 hours prn; max
2 doses/day; max duration 5 days
Pediatric: <6 years: not recommended; =6 years: same as adult
4-hour formulation: 2-3 drops or sprays q 4 hours prn; max duration 5 days
Pediatric: not recommended
Afrin 12-Hour Extra Moisturizing Nasal Spray
Afrin 12-Hour Nasal spray Pump Mist
Afrin 12-Hour Original Nasal spray
Afrin 12-Hour Original Nose Drops
Afrin 12-Hour Severe Congestion Nasal Spray
Afrin 12-Hour Sinus Nasal Spray
Nasal spray: 0.05% (45 ml); Nasal drops: 0.05% (45 ml)
Afrin 4-Hour Nasal Spray
Neo-Synephrine 12 Hour Nasal Spray
Neo-Synephrine 12 Hour Extra Moisturizing Nasal Spray
Nasal spray: 0.05% (15 ml)
phenylephrine (C)
Afrin Allergy Nasal Spray (OTC) 2-3 sprays in each nostril q 4 hours prn; max
duration 5 days
Pediatric: <12 years: not recommended; =12 years: same as adult
Nasal spray: 0.5% (15 ml)
Afrin Nasal Decongestant Childrens Pump Mist (OTC)
Pediatric: <6 years: not recommended; =6 years: 2-3 sprays in each nostril
q 4 hours prn; max duration 5 days
Nasal spray: 0.25% (15 ml)
Neo-Synephrine Extra Strength (OTC) 2-3 sprays or drops in each nostril
q 4 hours prn; max duration 5 days
Pediatric: <12 years: not recommended; =12 years: same as adult
Nasal spray: 0.1% (15 ml); Nasal drops: 0.1% (15 ml)
Neo-Synephrine Mild Formula (OTC) 2-3 sprays or drops in each nostril
q 4 hours prn; max duration 5 days
Pediatric: <6 years: not recommended; =6 years: same as adult
Nasal spray: 0.25% (15 ml)
Neo-Synephrine Regular Strength (OTC) 2-3 sprays or drops in each nostril q 4
hours prn; max duration 5 days
Pediatric: <12 years: not recommended; =12 years: same as adult
Nasal spray: 0.5% (15 ml); Nasal drops: 0.5% (15 ml)
tetrahydrozoline (C)
Tyzine 2-4 drops or 3-4 sprays in each nostril q 3-8 hours prn; max duration
5 days
Pediatric: <6 years: not recommended; =6 years: same as adult
Nasal spray: 0.1% (15 ml); Nasal drops: 0.1% (30 ml)
Tyzine Pediatric Nasal Drops 2-3 sprays or drops in each nostril q 3-6 hours prn
Nasal drops: 0.05% (15 ml)
CONJUNCTIVITIS: ALLERGIC
Oral Prescription Drugs for the Management of Allergy, Cough, and Cold Symptoms
page 535
OPHTHALMIC CORTICOSTEROIDS
Comment: Concomitant contact lens wear is contraindicated during therapy. Ophthalmic
steroids are contraindicated with ocular, fungal, mycobacterial, viral (except herpes
zoster), and untreated bacterial infection. Ophthalmic steroids may mask or exacerbate
infection, and may increase intraocular pressure, optic nerve damage, cataract formation,
or corneal perforation. Limit ophthalmic steroid use to 2-3 days if possible; usual max 2
weeks. With prolonged or frequent use, there is risk of corneal and scleral thinning and
cataract formation.
dexamethasone (C) initially 1-2 drops hourly during the day and q 2 hours at night;
then prolong dosing interval to 4-6 hours as condition improves
Pediatric: not recommended
Maxidex Ophth susp: 0.1% (5, 15 ml) (benzalkonium chloride)
dexamethasone phosphate (C) initially 1-2 drops hourly during the day and q 2 hours
at night; then 1 drop q 4-8 hours or more as condition improves
Pediatric: not recommended
Decadron Ophth soln: 0.1% (5 ml) (sulfi tes) y
fluorometholone (C) 1 drop bid-qid or 1/2 inch of ointment once daily-tid; may increase
dose frequency during initial 24-48 hours
Pediatric: <2 years: not recommended; =2 years: same as adult
FML Ophth susp: 0.1% (5, 10, 15 ml) (benzalkonium chloride)
FML Forte Ophth susp: 0.25% (5, 10, 15 ml) (benzalkonium chloride)
FML S.O.P. Ointment Ophth oint: 0.1% (3.5 g)
fluorometholone acetate (C) initially 2 drops q 2 hours during the fi rst 24-48 hours;
then 1-2 drops qid as condition improves
Pediatric: not recommended
Flarex Ophth susp: 0.1% (2.5, 5 10 ml) (benzalkonium chloride)
loteprednol etabonate (C)
Pediatric: not recommended
Alrex 1 drop qid
Ophth susp: 0.2% (5, 10 ml) (benzalkonium chloride)
Lotemax 1-2 drops qid
Ophth susp: 0.5% (5, 10, 15 ml) (benzalkonium chloride)
medrysone (C) 1 drop up to q 4 hours
Pediatric: not recommended
HMS Ophth susp: 1% (5, 10 ml) (benzalkonium chloride)
rimexolone (C) initially 1-2 drops hourly while awake x 1 week; then 1 drop q 2 hours
while awake x 1 week; then taper as condition improves
Pediatric: not recommended
Vexol Ophth susp: 0.1% (5, 10 ml) (benzalkonium chloride)
prednisolone acetate (C)
Pediatric: not recommended
Econopred 2 drops qid
Ophth susp: 0.125% (5, 10 ml)
Econopred Plus 2 drops qid
Ophth susp: 1% (5, 10 ml)
Pred Forte initially 2 drops hourly x 24-48 hours; then 1-2 drops bid-qid
Ophth susp: 1% (1, 5, 10, 15 ml) (benzalkonium chloride, sulfi tes)
Pred Mild initially 2 drops hourly x 24-48 hours; then 1-2 drops bid-qid
Ophth susp: 0.12% (5, 10 ml) (benzalkonium chloride)
prednisolone sodium phosphate (C) initially 1-2 drops hourly during the day
and q 2 hours at night; then 1 drop q 4 hours; then 1 drop tid-qid as condition
improves
Pediatric: not recommended
Inflamase Forte Ophth soln: 1% (5, 10, 15 ml) (benzalkonium chloride)
Inflamase Mild Ophth soln: 1/8% (5, 10 ml) (benzalkonium chloride)
OPHTHALMIC H1 ANTAGONISTS (ANTIHISTAMINES)
Comment: May insert contact lens 10 minutes aft er administration of ophthalmic
antihistamine.
emedastine (C) 1 drop qid prn
Pediatric: <3 years: not recommended; =3 years: same as adult
Emadine Ophth soln: 0.05% (5 ml) (benzalkonium chloride)
levocabastine (C) 1 drop qid prn
Pediatric: not recommended
Livostin Ophth susp: 0.05% (2.5, 5, 10 ml) (benzalkonium chloride)
OPHTHALMIC MAST CELL STABILIZERS
Comment: Concomitant contact lens wear is contraindicated during treatment.
cromolyn sodium (B) 1-2 drops 4-6 x/day at regular intervals
Pediatric: <4 years: not recommended; =4 years: same as adult
Crolom Ophth soln: 4% (10 ml) (benzalkonium chloride)
lodoxamide tromethamine (B) 1-2 drops qid up to 3 months
Pediatric: <2 years: not recommended; =2 years: same as adult
Alomide Ophth soln: 1% (10 ml) (benzalkonium chloride)
nedocromil (B) 1-2 drops bid
Pediatric: <3 years: not recommended; =3 years: same as adult
Alocril Ophth soln: 2% (5 ml) (benzalkonium chloride)
pemirolast potassium (C) 1-2 drops qid
Pediatric: <3 years: not recommended; =3 years: same as adult
Alamast Ophth soln: 0.1% (10 ml) (lauralkonium chloride)
OPHTHALMIC ANTIHISTAMINE/MAST CELL STABILIZER COMBINATIONS
alcaft adine (B) 1 drop each eye daily
Pediatric: <2 years: not recommended; =2 years: same as adult
Lastacaft Ophth soln: 0.25% (6 ml) (benzalkonium chloride)
Comment: May insert contact lens 10 minutes aft er ophthalmic administration.
azelastine (C) 1 drop each eye bid
Pediatric: <3 years: not recommended; =3 years: same as adult
Optivar Ophth soln: 0.05% (6 ml) (benzalkonium chloride)
Comment: May insert contact lens 10 minutes aft er ophthalmic administration.
bepotasti ne besilate (C) 1 drop each eye bid
Pediatric: <2 years: not recommended; =2 years: same as adult
Bepreve Ophth soln: 1.5% (10 ml) (benzalkonium chloride)
Comment: May insert contact lens 10 minutes aft er ophthalmic administration.
epinastine (C)(G) 1 drop each eye bid
Pediatric: <3 years: not recommended; =3 years: same as adult
Elestat Ophth soln: 0.05% (5 ml) (benzalkonium chloride)
ketotifen fumarate (C) 1 drop each eye q 8-12 hours
Pediatric: <3 years: not recommended; =3 years: same as adult
Alaway (OTC) Ophth soln: 0.025% (10 ml) (benzalkonium chloride)
Claritin Eye (OTC) Ophth soln: 0.025% (5 ml) (benzalkonium chloride)
Refresh Eye Itch Relief (OTC) Ophth soln: 0.025% (5 ml) (benzalkonium
chloride)
Zaditor (OTC) Ophth soln: 0.025% (5 ml)(benzalkonium chloride)
Zyrtec Itchy Eye (OTC) Ophth soln: 0.025% (5 ml) (benzalkonium chloride)
olopatadine (C) 1 drop each eye bid
Pediatric: <3 years: not recommended; =3 years: same as adult
Pataday (G) Ophth soln: 0.2% (2.5 ml) (benzalkonium chloride)
Patanol Ophth soln: 0.1% (5 ml) (benzalkonium chloride)
Pazeo Ophth soln: 0.7% (2.5 ml) (benzalkonium chloride)
Comment: May insert contact lens 10 minutes aft er administration.
OPHTHALMIC VASOCONSTRICTORS
Comment: Concomitant contact lens wear is contraindicated during treatment.
naphazoline (C) 1-2 drops each eye qid prn
Pediatric: not recommended
Vasocon-A Ophth soln: 0.1% (15 ml) (benzalkonium chloride)
oxymetazoline (NE)(OTC) 1-2 drops each eye qid prn
Pediatric: <6 years: not recommended; =6 years: same as adult
Visine L-R Ophth soln: 0.025% (15, 30 ml)
tetrahydrozoline (NE)(OTC)(G) 1-2 drops each eye qid prn
Pediatric: <6 years: not recommended; =6 years: same as adult
Visine Ophth soln: 0.05% (15, 22.5, 30 ml)
OPHTHALMIC VASOCONSTRICTOR/MOISTURIZER COMBINATION
Comment: Concomitant contact lens wear is contraindicated during treatment.
tetrahydrozoline/polyethylene glycol 400/povidone/dextran 70 (NE)(OTC) 1-2
drops each eye qid prn
Pediatric: <6 years: not recommended; =6 years: same as adult
Advanced Relief Visine Ophth soln: tetra 0.025%/poly 1%/pov 1%/dex 0.1% (15,
30 ml)
OPHTHALMIC VASOCONSTRICTOR/ASTRINGENT COMBINATION
Comment: Concomitant contact lens wear is contraindicated during treatment.
tetrahydrozoline/zinc sulfate (NE)(OTC) 1-2 drops each eye qid prn
Pediatric: <6 years: not recommended; =6 years: same as adult
Visine AC Ophth soln: tetra 0.025%/zinc 0.05% (15, 30 ml)
OPHTHALMIC VASOCONSTRICTOR/ANTI-HISTAMINE COMBINATIONS
Comment: Concomitant contact lens wear is contraindicated during treatment.
naphazoline/pheniramine (C) 1-2 drops each eye qid
Pediatric: <6 years: not recommended; =6 years: same as adult
Naphcon-A (OTC) Ophth soln: naph 0.025%/phen 0.3% (15 ml) (benzalkonium
chloride)
OPHTHALMIC NSAIDs
Comment: Concomitant contact lens wear is contraindicated during treatment.
diclofenac (B) 1 drop affected eye(s) qid
Pediatric: not recommended
Voltaren Ophthalmic Solution Ophth soln: 0.1% (2.5, 5 ml)
ketorolac tromethamine (C) 1 drop affected eye(s) qid; max x 4 days
Pediatric: <3 years: not recommended; =3 years: same as adult
Acular Ophth soln: 0.5% (3, 5, 10 ml) (benzalkonium chloride)
Acular LS Ophth soln: 0.4% (5 ml) (benzalkonium chloride)
Acular PF Ophth soln: 0.5% (0.4 ml; 12 single-use vials/carton) (preservative-
free)
nepafenac (C) 1 drop affected eye(s) tid
Pediatric: <10 years: not recommended; =10 years: same as adult
Nevanac Ophthalmic Suspension Ophth susp: 0.1% (3 ml) (benzalkonium
chloride)
CONJUNCTIVITIS/BLEPHAROCONJUNCTIVITIS:
BACTERIAL
OPHTHALMIC ANTI-INFECTIVES
azithromycin ophthalmic solution (B)(G) 1 drop to affected eye(s) bid x 2 days; then
1 drop once daily for the next 5 days
Pediatric: <1 year: not recommended; =1 year: same as adult
AzaSite Ophthalmic Solution Ophth susp: 1% (2.5 ml) (benzalkonium
chloride)
bacitracin ophthalmic ointment (C)(G) apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) 1-3 x daily x 7 days
Pediatric: same as adult
Bacitracin Ophthalmic Ointment Ophth oint: 500 units/g (3.5 g)
besifloxacin ophthalmic solution (C) 1 drop to affected eye(s) tid x 7 days
Pediatric: <1 year: not recommended; =1 year: same as adult
Besivance Ophthalmic Solution Ophth susp: 0.6% (5 ml) (benzalkonium chloride)
ciprofloxacin ophthalmic ointment (C) apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) tid x 2 days; then bid x 5 days
Pediatric: <2 years: not recommended; =2 years: same as adult
Ciloxan Ophthalmic Ointment Ophth oint: 0.3% (3.5 g)
ciprofloxacin ophthalmic solution (C) 1-2 drops to affected eye(s) q 2 hours while
awake x 2 days; then, q 4 hours while awake x 5 days
Pediatric: <1 years: not recommended; =1 year: same as adult
Ciloxan Ophthalmic Solution Ophth soln: 0.3% (2.5, 5, 10 ml) (benzalkonium
chloride)
erythromycin ophthalmic ointment (B) apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) up to 6 x/day
Pediatric: same as adult
Ilotycin Ophthalmic Ointment Ophth oint: 5 mg/g (1/8 oz)
gatifloxacin ophthalmic solution (C)
Pediatric: <1 years: not recommended; =1 year: same as adult
Zymar Ophthalmic Solution initially 1 drop to affected eye(s) q 2 hours while
awake up to 8 times/day for 2 days; then 1 drop qid while awake x 5 more days
Ophth soln: 0.3% (5 ml) (benzalkonium chloride)
Zymaxid Ophthalmic Solution (G) initially 1 drop to affected eye(s) q 2 hours while
awake up to 8 times/day on day 1; then 1 drop bid-qid while awake on days 2-7
Ophth soln: 0.5% (2.5 ml) (benzalkonium chloride)
gentamicin sulfate ophthalmic ointment (C)(G) apply 1/2 inch ribbon to the lower
conjunctival sac of affected eye(s) bid-tid
Pediatric: same as adult
Garamycin Ophthalmic Ointment Ophth oint: 3 mg/g (3.5 g) (preservative-free
formulation available)
Genoptic Ophthalmic Ointment Ophth oint: 3 mg/g (3.5 g)
Gentacidin Ophthalmic Ointment Ophth oint: 3 mg/g (3.5 g)
gentamicin sulfate ophthalmic solution (C)(G) 1-2 drops to affected eye(s) q 4 hours
x 7-14 days; max 2 drops q 1 h
Pediatric: same as adult
Garamycin Ophthalmic Solution Ophth soln: 0.3% (5 ml) (benzalkonium chloride)
Genoptic Ophthalmic Solution Ophth soln: 0.3% (3, 5 ml)
levofloxacin ophthalmic solution (C) 1-2 drops to affected eye(s) q 2 hours while
awake on days 1 and 2 (max 8 times/day); then 1-2 drops q 4 hours while awake on
days 3-7; max 4 x/day
Pediatric: <1 years: not recommended; =1 years: same as adult
Quixin Ophthalmic Solution Ophth soln: 0.5% (2.5, 5 ml) (benzalkonium
chloride)
moxifloxacin ophthalmic solution (C) 1 drop to affected eye(s) tid x 7 days
Pediatric: <1 years: not recommended; =1 year: same as adult
Moxeza Ophthalmic Solution (G) Ophth soln: 0.5% (3 ml)
Vigamox Ophthalmic Solution Ophth soln: 0.5% (3 ml)
ofloxacin ophthalmic solution (C) 1-2 drops to affected eye(s) q 2-4 hours x 2 days;
then qid x 5 days
Pediatric: <1 years: not recommended; =1 year: same as adult
Ocuflox Ophthalmic Solution Ophth soln: 0.3% (5, 10 ml) (benzalkonium
chloride)
sulfacetamide ophthalmic solution and ointment (C)
Bleph-10 Ophthalmic Solution 1-2 drops to affected eye(s) q 2-3 hours x 7-10 days
Pediatric: <2 months: not recommended; =2 months: 1-2 drops q 2-3 hours
during the day x 7-10 days
Ophth soln: 10% (2.5, 5, 15 ml) (benzalkonium chloride)
Bleph-10 Ophthalmic Ointment apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) q 3-4 hours and HS x 7-10 days
Pediatric: <2 years: not recommended; =2 years: same as adult
Ophth oint: 10% (3.5 g) (phenylmercuric acetate)
Cetamide Ophthalmic Solution initially 1-2 drops to affected eye(s) q 2-3
hours; then increase dosing interval as condition improves
Pediatric: <2 years: not recommended; =2 years: same as adult
Ophth soln: 15% (5, 15 ml)
Isopto Cetamide Ophthalmic Ointment initially 1/2 inch ribbon in lower
conjunctival sac of affected eye(s) q 3-4 hours; then increase dosing interval as
condition improves
Pediatric: <2 years: not recommended; =2 years: same as adult
Ophth oint: 10% (3.5 g)
Isopto Cetamide Ophthalmic Solution initially 1-2 drops to affected eye(s)
q 2-3 hours; then increase dosing interval as condition improves
Pediatric: <2 years: not recommended; =2 years: same as adult
Ophth soln: 15% (5, 15 ml)
tobramycin (B)
Tobrex Ophthalmic Solution 1-2 drops to affected eye(s) q 4 hours
Pediatric: same as adult
Ophth soln: 0.3% (5 ml) (benzalkonium chloride)
Tobrex Ophthalmic Ointment apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) bid-tid
Pediatric: same as adult
Ophth oint: 0.3% (3.5 g) (chlorobutanol)
OPHTHALMIC ANTI-INFECTIVE COMBINATIONS
polymyxin B sulfate/bacitracin ophthalmic ointment (C) apply 1/2 inch ribbon to the
lower conjunctival sac of affected eye(s) q 3-4 hours x 7-10 days
Pediatric: same as adult
Polysporin Ophthalmic Ointment Ophth oint: poly b 10,000 U/bac 500 U
(3.75 g)
polymyxin B sulfate/bacitracin zinc/neomycin sulfate ophthalmic ointment (C) apply
1/2 inch ribbon to the lower conjunctival sac of affected eye(s) q 3-4 hours x 7-10 days
Pediatric: same as adult
Neosporin Ophthalmic Ointment Ophth oint: poly b 10,000 U/bac 400 U/neo
3.5 mg/g (3.75 g)
polymyxin B sulfate/gramicidin/neomycin ophthalmic solution (C) 1-2 drops to
affected eye(s) q 1 hour x 2-3 doses; then 1-2 drops bid-qid x 7-10 days
Pediatric: not recommended
Neosporin Ophthalmic Solution Ophth soln: poly b 10,000 U/gram 0.025 mg/
neo 1.7 mg/g (10 ml)
trimethoprim/polymyxin B sulfate ophthalmic solution (C) 1 drop to affected eye(s)
q 3 hours x 7-10 days; max 6 doses/day
Pediatric: <2 years: not recommended; =2 years: same as adult
Polytrim Ophth soln: trim 1 mg/poly b 10,000 U/ml (10 ml) (benzalkonium
chloride)
OPHTHALMIC ANTI-INFECTIVE/STEROID COMBINATIONS
Comment: Ophthalmic corticosteroids are contraindicated aft er removal of a corneal
foreign body, epithelial herpes simplex keratitis, varicella, other viral infections of the
cornea or conjunctiva, fungal ocular infections, and mycobacterial ocular infections.
Limit ophthalmic steroid use to 2-3 days if possible; usual max 2 weeks. With
prolonged or frequent use, there is risk of corneal and scleral thinning and cataract
formation.
gentamicin sulfate/prednisolone acetate ophthalmic suspension (C)
Pediatric: not recommended
Pred-G Ophthalmic Suspension 1 drop to affected eye(s) bid-qid; max 20 ml/
therapeutic course
Ophth susp: gent 0.3%/pred 1%/ml (2, 5, 10 ml) (benzalkonium chloride)
Pred-G Ophthalmic Ointment apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) once daily-tid; max 8 g/therapeutic course
Ophth oint: gent 0.3%/pred 0.6%/g (3.5 g)
neomycin sulfate/polymyxin B sulfate/dexamethasone ophthalmic suspension (C)
Pediatric: not recommended
Maxitrol Ophthalmic Suspension 1-2 drops to affected eye(s) q 1 hour (severe
infection) or qid (mild to moderate infection)
Ophth susp: neo 0.35%/poly b 10,000 U/dexa 1%/ml (5 ml) (benzalkonium
chloride)
Maxitrol Ophthalmic Ointment apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) q 1 hour (severe infection) or qid (mild to moderate infection)
Ophth oint: neo 0.35%/poly b 10,000 U/dexa 0.1%/g (3.5 g)
neomycin sulfate/polymyxin B sulfate/prednisolone acetate ophthalmic suspension (C)
Pediatric: not recommended
Poly-Pred Ophthalmic Suspension 1-2 drops to affected eye(s) q 3-4 hours;
more oft en as necessary; max 20 ml/therapeutic course.
Ophth susp: neo 0.35%/poly b 10,000 U/pred 0.5%/ml (10 ml)
polymyxin B sulfate/neomycin sulfate/hydrocortisone ophthalmic suspension (C)
Pediatric: not recommended
Cortisporin Ophthalmic Suspension 1-2 drops to affected eye(s) tid-qid; more
oft en if necessary; max 20 ml/therapeutic course
Ophth susp: poly b 10,000 U/neo 0.35%/hydro 1%/ml (7.5 ml) (thimerosal)
polymyxin B sulfate/neomycin sulfate/bacitracin zinc/hydrocortisone ophthalmic
ointment (C)
Pediatric: not recommended
Cortisporin Ophthalmic Ointment apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) tid-qid; more oft en if necessary; max 8 g/therapeutic
course
Ophth oint: poly b 10,000 U/neo 0.35%/bac 400 U/hydro 1%/g (3.5 g)
sulfacetamide sodium/fluorometholone suspension (C) 1 drop to affected eye(s) qid;
max 20 ml/ therapeutic course
Pediatric: not recommended
FML-S Ophth susp: sulfa 10%/fluoro 0.1%/ml (5, 10, 15 ml) (benzalkonium
chloride)
sulfacetamide sodium/prednisolone acetate ophthalmic suspension and ointment (C)
Pediatric: <6 years: not recommended; =6 years: same as adult
Blephamide Liquifi lm 2 drops to affected eye(s) qid and HS
Ophth susp: sulfa10%/pred 0.2%/ml (5, 10 ml) (benzalkonium chloride)
Blephamide S.O.P. Ophthalmic Ointment apply 1/2 inch ribbon to the lower
conjunctival sac of affected eye(s) tid-qid
Ophth oint: sulfa 10%/pred 0.2%/g (3.5 g) (benzalkonium chloride)
sulfacetamide sodium/prednisolone sodium phosphate ophthalmic solution (C) 2 drops
to affected eye(s) q 4 hours
Pediatric: <6 years: not recommended; =6 years: same as adult
Vasocidin Ophthalmic Solution Ophth soln: sulfa 10%/pred 0.25%/ml (5, 10 ml)
tobramycin/dexamethasone ophthalmic solution and ointment (C)
TobraDex Ophthalmic Solution 1-2 drops to affected eye(s) q 2-6 hours x 24-48
hours; then 4-6 hours; reduce frequency of dose as condition improves; max 20
ml per therapeutic course
Pediatric: >2 years: not recommended; >2 years: 1-2 drops q 4-6 hours; may
start with 1-2 drops q 2 hours fi rst 1-2 days
Ophth susp: tobra 0.3%/dexa 0.1%/ml (2.5, 5 ml) (benzalkonium chloride)
TobraDex Ophthalmic Ointment apply 1/2 inch ribbon to the lower conjunctival
sac of affected eye(s) tid-qid; may use at HS in conjunction with daytime
drops; max 8 g/therapeutic course
Pediatric: <2 years: not recommended; >2 years: apply 1/2 inch ribbon to
lower conjunctival sac tid-qid
Ophth oint: tobra 0.3%/dexa 0.1%/g (3.5 g) (chlorobutanol chloride)
TobraDex ST 1-2 drops to affected eye(s) q 2-6 hours x 24-48 hours; then 4-6
hours; reduce frequency of dose as condition improves; max 20 ml per therapeutic
course
Pediatric: not recommended
Ophth susp: tobra 0.3%/dexa 0.05%/ml (2.5, 5, 10 ml) (benzalkonium chloride)
tobramycin/loteprednol etabonate ophthalmic suspension (C)
Pediatric: not recommended
Zylet 1-2 drops to affected eye(s) q 1-2 hours fi rst 24-48 hours; reduce frequency
of dose to q 4-6 hours as condition improves; max 20 ml per therapeutic course
Ophth susp: tobra 0.3%/lote etab 0.5%/ml (2.5, 5, 10 ml) (benzalkonium
chloride)
y y y y y y
C o n j u n c t i v i t i s : C h l a m y d i a l ¦ 93
CONJUNCTIVITIS: CHLAMYDIAL
Comment: A chlamydial etiology should be considered for all infants aged =30 days that
have conjunctivitis, especially if the mother has a history of chlamydia infection. Topical
antibiotic therapy alone is inadequate for treatment for ophthalmia neonatorum caused
by chlamydia and is unnecessary when systemic treatment is administered.
ANTI-INFECTIVES
amoxicillin (B)(G) 500 mg tid x 7 days
Pediatric: <40 kg (88 lb): 20-40 mg/kg/day in 3 divided doses x 7 days >40 kg: same
as adult; see page 554 for dose by weight
Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg (cherry-
banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml (80, 100,
150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble gum); Oral
drops: 50 mg/ml (30 ml) (bubble gum)
RECOMMENDED 1ST LINE REGIMEN
erythromycin base (B)(G) 250 mg qid x 14 days or 500 mg qid x 7 days
Pediatric: <45 kg: 50 mg/kg/day in 4 divided doses x 14 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 14 days or 800 mg qid x 7 days
Pediatric: 50 mg/kg/day in 4 divided doses x 7 days; 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.
ALTERNATE REGIMEN
azithromycin (B) 500 mg x 1 dose on day 1; then 250 mg once daily on days; 2-5 or
500 mg daily x 3 days or 2 g in a single dose
Pediatric: 20 mg/kg in a single dose once daily x 3 days
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
t
y y y y
94 ¦ C o n j u n c t i v i t i s : F u n g a l
CONJUNCTIVITIS: FUNGAL
natamycin ophthalmic suspension (C) 1 drop q 1-2 hours x 3-4 days; then 1 drop
every 6 hours; treat for 14-21 days; withdraw dose gradually at 4- to -7-day intervals
Pediatric: <1 year: not recommended; =1 year: same as adult
Natacyn Ophthalmic Suspension Ophth susp: 0.5% (15 ml) (benzalkonium
chloride)
CONJUNCTIVITIS: GONOCOCCAL
RECOMMENDED REGIMENS
Regimen 1
ceft riaxone (B)(G) 250 mg IM x 1 dose
Pediatric: <45 kg: 50 mg/kg IM x 1 dose; max 125 mg IM
Rocephin Vial: 250, 500 mg; 1, 2 g
Regimen 2
erythromycin base (B)(G) 250 mg qid x 10-14 days
Pediatric: <45 kg: 50 mg/kg/day in 4 divided doses x 10-14 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 14 days or 800 mg qid x 7 days
Pediatric: 50 mg/kg/day in 4 divided doses x 7 days; 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.
ALTERNATE REGIMEN
azithromycin (B) 500 mg x 1 dose on day 1; then 250 mg once daily on days; 2-5 or
500 mg daily x 3 days or 2 g in a single dose
Pediatric: not recommended for bronchitis in children
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
t
y
t
y y y y
C o n s t i p a t i o n ¦ 95
CONJUNCTIVITIS: VIRAL
Comment: For prevention of secondary bacterial infection, see agents listed under
bacterial conjunctivitis. Ophthalmic corticosteroids are contraindicated with herpes
simplex, keratitis, Varicella, and other viral infections of the cornea.
trifluridine ophthalmic suspension (C) 1 drop q 2 hours while awake; max 9 drops/
day; aft er re-epithelialization, 1 drop q 4 h x 7 days (at least 5 drops/day); max 21
days of therapy
Pediatric: <6 years: not recommended; =6 years: same as adult
Viroptic Ophthalmic Solution Ophth soln: 1% (7.5 ml) (thimerosal)
CONSTIPATION
CHRONIC IDIOPATHIC CONSTIPATION (CIC)
lubiprostone (chloride channel activator [GI motility enhancer]) (C) 1 cap bid with
food
Pediatric: not recommended
Amitiza Cap: 24 mcg
linaclotide (guanylate cyclase-c agonist) (C) 290 mcg once daily; take on an empty
stomach at least 30 minutes before the fi rst meal of the day; swallow whole
Pediatric: <6 years: not recommended; 6-17 years: avoid
Linzess Cap: 145, 290 mcg
BULK-FORMING AGENTS
calcium polycarbophil (C)
FiberCon (OTC) 2 tabs once daily to qid
Pediatric: <6 years: not recommended; 6-12 years: 1 tab daily to qid
Cplt: 625 mg
Konsyl Fiber Tablets (OTC) Tab: 625 mg
methylcellulose
Citrucel 1 heaping tbsp in 8 oz cold water tid
Pediatric: <6 years: not recommended; 6-12 years: 1/2 adult dose
Oral pwdr: 16, 24, 30 oz and single-dose pkts (orange)
Citrucel Sugar-Free 1 heaping tblsp in 8 oz cold water tid
Pediatric: <6 years: not recommended; 6-12 years: 1/2 adult dose
Oral pwdr: 16, 24, 30 oz and single-dose pkts (orange) (sugar-free, phenylalanine)
psyllium husk (B)
Pediatric: <6 years: not recommended; 6-12 years: 1/2 adult dose in 8 oz liquid tid
Metamucil (OTC) wafer or cap or 1 pkt or 1 rounded tsp (1 rounded tblsp for
sugar-containing form) in 8 oz liquid tid
Cap: psyllium husk 5.2 g (100, 150/carton); Wafer: psyllium husk 3.4 g/rounded
tsp (24/carton) (apple crisp, cinnamon spice); Plain and flavored pwdr: 3.4
g/rounded tsp (15, 20, 24, 29, 30, 36, 44, 48 oz); Efferv sugar-free flav pkts: 3.4
g/pkt (30/pkt) (phenylalanine)
psyllium hydrophilic mucilloid (B) 2 rounded tsp in 8 oz water qid
Pediatric: <6 years: not recommended; 6-12 years: 1 rounded tsp in 8 oz liquid tid
Konsyl (OTC) Pwdr: 6 g/rounded tsp (10.6, 15.9 oz); Pwdr pkt: 6 g/rounded tsp
(30/carton)
Konsyl-D (OTC) Pwdr: 3.4 g/rounded tsp (11.5, 17.59 oz); Pwdr pkt: 3.4 g/
rounded tsp (30/carton)
Konsyl Easy Mix Formula (OTC) Pwdr: 3.4 g/rounded tsp (8 oz) (sugar-free,
low sodium)
Konsyl Orange (OTC) Pwdr: 3.4 g/rounded tsp (19 oz); Pwdr pkt: 3.4 g/rounded
tsp (30/carton)
Konsyl Orange SF (OTC) Pwdr: 3.5 g/rounded tsp (15 oz) (phenylalanine);
Pwdr pkt: 3.5 g/rounded tsp (30/carton) (phenylalanine)
STOOL SOFTENERS
docusate sodium (OTC) 50-200 mg/day
Pediatric: <3 years: 10-40 mg/day; 3-6 years: 20-60 mg/day; >6 years: 40-120 mg/day
Cap: 50, 100 mg; Liq: 10 mg/ml (30 ml w. dropper); Syr: 20 mg/5 ml (8 oz)
(alcohol =1%)
Dialose 1 tab q HS
Pediatric: <6 years: not recommended; =6 years: same as adult
Tab: 100 mg
Surfak (OTC) 240 mg/day
Pediatric: not recommended
Cap: 240 mg
OSMOTIC LAXATIVES
lactulose (B)(G) take 10-20 g dissolved in 4 oz water once daily prn; max 40 g/day
Pediatric: not recommended
Kristalose Crystals for oral soln: 10, 20 g single-dose pkts (30/carton)
magnesium citrate (B)(G) 1 full bottle (120-300 ml) once daily prn
Pediatric: <2 years: not recommended; 2-6 years: 4-12 ml once daily prn; =6-12
years: 50-100 ml once daily prn
Citrate of Magnesia (OTC) Oral soln: 300 ml
magnesium hydroxide (B) 30-60 ml/day in a single or divided doses prn
Pediatric: 2-5 years: 5-15 ml/day in a single or divided doses; 6-11 years: 15-30 ml/
day in a single or divided doses; =12 years: same as adult
Milk of Magnesia Liq: 390 mg/5 ml (10, 15, 20, 30, 100, 120, 180, 360, 720 ml)
polyethylene glycol (PEG) (C)(OTC)(G) 1 tblsp (17 g) dissolved in 4-8 oz water per
day for up to max 7 days; may need 2-4 days for results
Pediatric: =17: not recommended
GlycoLax Powder for Oral Solution Oral pwdr: 7, 14, 30, and 45 dose bottles
w. 17 g dosing cup (gluten-free, sugar-free); 17 g single-dose pkts (20/carton)
MiraLAX Powder for Oral Solution Oral pwdr: 7, 14, 30, and 45 dose bottles
w. 17 g dosing cup (gluten-free, sugar-free)
Polyethylene Glycol 3350 Powder for Oral Solution (G) Oral pwdr: 3350 g w.
dosing cup; 17 g/scoop
Comment: PEG is an osmotic indicated for occasional constipation without affecting
glucose and electrolyte levels. Contraindicated with suspected or known bowel obstruction.
STIMULANTS
bisacodyl (B) 2-3 tabs or 1 suppository bid prn
Dulcolax, Gentlax Tab: 5 mg; Rectal supp: 10 mg
Pediatric: <12 years: 1/2 suppository once daily prn; 6-12 years: 1 tablet or
1/2 suppository once daily prn; >12 years: same as adult
Senokot (OTC) initially 2-4 tabs or 1 level tsp at HS prn; max 4 tabs or 2 tsp bid
Pediatric: <2 years: not recommended; 2-6 years: 1/4 tab or 1/2 tsp once daily
prn; max 1 tab or 1/2 tsp bid; 6-12 years: 1 tab or 1/2 tsp once daily prn; max
2 tabs or 1 tsp once daily
Tab: 8.6*mg; Granules: 15 mg/tsp (2, 6, 12 oz) (cocoa)
Senokot Syrup (OTC) initially 10-15 ml at HS prn; max 15 ml bid
Pediatric: use Childrens Syrup
Syr: 8.8 mg/5 ml (2, 8 oz) (chocolate) (alcohol-free)
Senokot Childrens Syrup (OTC)
Pediatric: <2 years: not recommended; 2-6 years: 2.5-3.75 ml once daily prn;
max 3.75 ml bid prn; =6-12 years: 5-7.5 ml once daily prn; max 7.5 ml bid
Syr: 8.8 mg/5 ml (2.5 oz) (chocolate) (alcohol-free)
Senokot Xtra (OTC) 1 tab at HS prn; max 2 tabs bid
Pediatric: <2 years: not recommended; 2-6 years: use Childrens Syrup; 6-12
years: 1/2 tab once daily at HS; max 1 tab bid
Tab: 17*mg
BULK FORMING AGENT/STIMULANT COMBINATIONS
psyllium/senna (B)
Perdiem (OTC) 1-2 rounded tsp swallowed with 8 oz cool liquid daily bid
Pediatric: <7 years: not recommended; 7-11 years: 1 rounded tsp swallowed
with 8 oz cool liquid once daily-bid; =12 years: same as adult
Canister: 8.8, 14 oz; Individual pkt: 6 g (6/pck)
SennaPrompt (OTC) initially 2-5 caps bid
Pediatric: not recommended
Cap: psyl 500 mg/senna 9 mg
STOOL SOFTENER/STIMULANT COMBINATIONS
docusate/casanthranol (C)
Doxidan (OTC) 1-3 caps/day; max 1 week
Pediatric: <2 years: not recommended; =2 years: 1 cap/day
Cap: doc 60 mg/cas 30 mg
Peri-Colace (OTC) 1-2 caps or 15-30 ml q HS; max 2 caps or 30 ml bid or 3 caps
q HS
Pediatric: 5-15 ml q HS
Cap: doc 100 mg/cas 30 mg; Syr: doc 60 mg/cas 30 mg per 15 ml (8, 16 oz)
docusate/senna concentrate (C)
Senokot S (OTC) 2 tabs q HS; max 4 tabs bid
Pediatric: <2 years: not recommended; 2-6 years: 1/2 tab daily; max 1 tab bid;
>6-12 years: 1 tab daily; max 2 tabs bid
Tab: doc 50 mg/senna 8.6 mg
ENEMAS AND OTHER AGENTS
sodium biphosphate/sodium phosphate enema (C)(OTC)
Fleets Adult 59-118 ml rectally
Pediatric: <2 years: not recommended; =2-12 years: 59 ml rectally
Enema: Na biphos 19 g/Na phos 7 g (59, 118 ml w. applicator)
Fleets Pediatric 59 ml
Pediatric: rectally
Enema: na biphos 19 g/na phos 7 g (59 ml w. applicator)
glycerin suppositories (C)(OTC)
Pediatric: <6 years: 1 pediatric suppository; =6 years: 1 adult suppository
CORNEAL EDEMA
sodium chloride (NE)(G)
Pediatric: same as adult
Various (OTC) 1-2 drops or 1 inch ribbon q 3-4 hours prn; reduce frequency as
edema subsides
Ophth soln: 2, 5% (15, 30 ml); Ophth oint: 5% (3.5 g)
CORNEAL ULCERATION
ANTIBACTERIAL OPHTHALMIC SOLUTION/OINTMENT
see Conjunctivitis/Blepharoconjunctivitis: Bacterial page 89
COSTOCHONDRITIS (CHEST WALL SYNDROME)
Acetaminophen for IV Infusion see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Topical/Transdermal NSAIDs see Pain page 307
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Topical Analgesic and Anesthetic Agents see page 499
CRAMPS: ABDOMINAL, INTESTINAL
ANTISPASMODIC/ANTICHOLINERGIC COMBINATIONS
dicyclomine (B)(G) initially 20 mg bid-qid; may increase to 40 mg qid PO; usual IM
dose 80 mg/day divided qid; do not use IM route for more than 1-2 days
Pediatric: not recommended
Bentyl Tab: 20 mg; Cap: 10 mg; Syr: 10 mg/5 ml (16 oz); Vial: 10 mg/ml (10 ml);
Amp: 10 mg/ml (2 ml)
methscopolamine bromide (B) 1 tab q 6 hours prn
Pediatric: not recommended
Pamine Tab: 2.5 mg
Pamine Forte Tab: 5 mg
ANTICHOLINERGICS
hyoscyamine (C)(G)
Anaspaz 1-2 tabs q 4 hours prn; max 12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: 0.0625-0.125 mg q 4 hours
prn; max 0.75 mg/day; =12 years: same as adult
Tab: 0.125*mg
Levbid 1-2 tabs q 12 hours prn; max 4 tabs/day
Pediatric: <12 years: not recommended; =12 years: same as adult
Tab: 0.375*mg ext-rel
Levsin 1-2 tabs q 4 hours prn; max 12 tabs/day
Pediatric: <6 years: not recommended; =6-12 years: 1 tab q 4 hours prn
Tab: 0.125*mg
Levsinex SL 1-2 tabs q 4 hours SL or PO; max 12 tabs/day
Pediatric: 2-12 years: 1 tab SL or PO q 4 hours; max 6 tabs/day
Tab: 0.125 mg sublingual
Levsinex Timecaps 1-2 caps q 12 hours; may adjust to 1 cap q 8 hours
Pediatric: 2-12 years: 1 cap q 12 hours; max 2 caps/day
Cap: 0.375 mg time-rel
NuLev dissolve 1-2 tabs on tongue, with or without water, q 4 hours prn; max
12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: dissolve 1 tab on tongue,
with or without water, q 4 hours prn; max 6 tabs/day; >12 years: same as adult
ODT: 0.125 mg (mint) (phenylalanine)
simethicone (C)(G) 0.3 ml qid pc and HS
Mylicon Drops (OTC) Oral drops: 40 mg/0.6 ml (30 ml)
phenobarbital/hyoscyamine/atropine/scopolamine (C)(IV)(G)
Donnatal 1-2 tabs ac and HS
Pediatric: not recommended
Tab: pheno 16.2 mg/hyo 0.1037 mg/atro 0.0194 mg/scop 0.0065 mg
Donnatal Elixir 1-2 tsp ac and HS
Pediatric: 20 lb: 1 ml q 4 hours or 1.5 ml q 6 hours; 30 lb: 1.5 ml q 4 hours or
2 ml q 6 hours; 50 lb: 1/2 tsp q 4 hours or 3/4 tsp q 6 hours; 75 lb: 3/4 tsp q 4
hours or 1 tsp q 6 hours; 100 lb: 1 tsp q 4 hours or 1 tsp q 6 hours
Elix: pheno 16.2 mg/hyo 0.1037 mg/atro 0.0194 mg/scop
0.0065 mg per 5 ml (4, 16 oz)
Donnatal Extentabs 1 tab q 12 hours
Pediatric: not recommended
Tab: pheno 48.6 mg/hyo 0.3111 mg/atro 0.0582 mg/scop
0.0195 mg ext-rel
ANTICHOLINERGIC/SEDATIVE COMBINATION
chlordiazepoxide/clidinium (D)(IV) 1-2 caps ac and HS; max 8 caps/day
Pediatric: not recommended
Librax Cap: chlor 5 mg/clid 2.5 mg
CROHN’S DISEASE
Comment: Standard treatment regimen for active disease (flare) is: antibiotic,
antispasmodic, and bowel rest; progress to clear liquids; then progress to high-fi ber diet.
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100 ¦ C r o h n ’ s D i s e a s e
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
azathioprine (D)(G)
Imuran Tab: 50*mg; Injectable: 100 mg
Comment: Imuran is usually administered on a daily basis. Th e initial
dose should be approximately 1.0 mg/kg (50 to 100 mg) as a single dose or
divided bid. Dose may be increased beginning at 6-8 weeks, and thereaft er
at 4-week intervals, if there are no serious toxicities and if initial response is
unsatisfactory. Dose increments should be 0.5 mg/kg/day, up to max 2.5 mg/kg
per day. Th erapeutic response usually occurs aft er 6-8 weeks of treatment. An
adequate trial should be a minimum of 12 weeks. Patients not improved aft er
12 weeks can be considered refractory. Imuran may be continued long-term
in patients with clinical response, but patients should be monitored carefully,
and gradual dosage reduction should be attempted to reduce risk of toxicities.
Maintenance therapy should be at the lowest eff ective dose, and the dose given
can be lowered decrementally with changes of 0.5 mg/kg or approximately 25
mg daily every 4 weeks while other therapy is kept constant. Th e optimum
duration of maintenance Imuran has not been determined. Imuran can be
discontinued abruptly, but delayed eff ects are possible.
infliximab (tumor necrosis factor-alpha blocker) (B) administer 5 mg/kg/dose by IV
infusion over at least 2 h; Fistulizing disease: initial dose; repeat dose at 2 weeks and
6 weeks (total 3 doses); then repeat dose every 8 weeks; Maintenance: usually 5 mg/
kg/dose every 8 weeks; may increase to 10 mg/kg/dose
Pediatric: not recommended
Remicade Vial: 100 mg pwdr for IV infusion single-use (preservative-free)
mesalamine (B)
Asacol 800 mg tid x 6 weeks; maintenance 1.6 g/day in divided doses; swallow
whole, do not crush or chew
Pediatric: not recommended
Tab: 400 mg del-rel
Comment: 2 Asacol 400 mg tabs are not bioequivalent to 1 Asacol HD 800 mg tab.
Asacol HD 1600 mg tid x 6 weeks; swallow whole, do not crush or chew
Pediatric: not recommended
Tab: 800 mg del-rel
Comment: 1 Asacol HD 800 mg tab is not bioequivalent to 2 Asacol 400 mg
tabs
Canasa 1 g qid for up to 8 weeks
Rectal supp: 1 g del-rel (30, 42/pck)
Delzicol Treatment: 800 mg tid x 6 weeks; maintenance 1.6 g/day in 2-4 divided
doses daily; swallow whole; do not crush or chew
Pediatric: <5 years: not established; > years: same as adult
Cap: 400 mg del-rel
Comment: 2 Delzicol 400 mg caps are not bioequivalent to 1 mesalamine
800 mg del-rel tab
Lialda 2.4-4.8 g daily in a single dose for up to 8 weeks; swallow whole, do not
crush or chew
Pediatric: <18 years: not recommended
Tab: 1.2 g del-rel
Pentasa 1 g qid for up to 8 weeks; swallow whole, do not crush or chew
Pediatric: not recommended
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Cap: 250 mg cont-rel
Rowasa Enema 4 g rectally by enema q HS; retain for 8 hours x 3-6 weeks
Enema: 4 g/60 ml (7, 14, 28/pck; kit, 7, 14, 28/pck w. wipes)
Rowasa Suppository 1 suppository rectally bid x 3-6 weeks; retain for 1-3 hours
or longer
Rectal supp: 500 mg
Sulfi te-Free Rowasa Rectal Suspension 4 g rectally by enema q HS; retain for
8 hours x 3-6 weeks
Enema: 4 g/60 ml (7, 14, 28/pck; kit, 7, 14, 28/pck w. wipes)
olsalazine (C)
Dipentum 1 g/day in 2 divided doses; max 2 g/day
Cap: 250 mg
Comment: Indicated in persons who cannot tolerate sulfasalazine.
sulfasalazine (B)(G)
Azulfi dine initially 1-2 g/day; increase to 3-4 g/day in divided doses pc until
clinical symptoms controlled; maintenance 2 g/day; max 4 g/day
Tab: 500*mg
Pediatric: <2 years: not recommended; 2-16 years: initially 40-60 mg/kg/day
in 3-6 divided doses; max 2 g/day
Azulfi dine EN initially 500 mg in the PM x 7 days; then 500 mg bid x 7 days;
then 500 mg in the AM and 1 g in the PM x 7 days; then 1 g bid; max 4 g/day
Pediatric: not recommended
Tab: 500 mg ent-coat
Comment: sulfasalazine
vedolizumab (B) administer by IV infusion over 30 minutes; 300 mg at weeks 0, 2, 6;
then once every 8 weeks
Pediatric: not established
Entyvio
Vial: 300 mg (20 ml) single dose, pwdr for IV infusion aft er reconstitution
(preservative-free)
budesonide micronized (C) (G)
Pediatric: not recommended
Entocort EC Treatment 9 mg once daily in the AM for up to 8 weeks; may repeat
an 8-week course; Maintenance of remission: 6 mg once daily for up to 3 months
Cap: 3 mg ent-coat ext-rel granules
Comment: Taper other systemic steroids when transferring to Entocort EC. When
corticosteroids are used chronically, systemic eff ects such as hypercorticism and
adrenal suppression may occur. Corticosteroids can reduce the response of the
hypothalamus-pituitary-adrenal (HPA) axis to stress. In situations where patients
are subject to surgery or other stress situations, supplementation with a systemic
corticosteroid is recommended. General precautions concerning corticosteroids
should be followed.
ORAL ANTI-INFECTIVES
metronidazole (not for use in 1st; B in 2nd, 3rd)(G) 500 mg tid or 750 mg bid; max
8 weeks
Pediatric: 35-50 mg/kg/day in 3 divided doses x 10 days
Flagyl Tab: 250*, 500*mg
Flagyl 375 Cap: 375 mg
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Flagyl ER Tab: 750 mg ext-rel
Comment: Alcohol is contraindicated during treatment with oral metronidazole
and for 72 hours aft er therapy due to a possible disulfi ram-like reaction (nausea,
vomiting, flushing, headache).
TUMOR NECROSIS FACTOR (TNF) BLOCKER
adalimumab (B) 40 mg SC once every other week; may increase to once weekly without
MTX; administer in abdomen or thigh; rotate sites
Pediatric: <2 years, <10 kg: not recommended; 10-<15 kg: 10 mg every other week;
15-<30 kg: 20 mg every other week; =30 kg: 40 mg every other week; 2-17 years,
supervise fi rst dose
Humira Prefi lled syringe: 20 mg/0.4 ml; 40 mg/0.8 ml single-dose (2/pck; 2, 6/
starter pck) (preservative-free)
Comment: May use with methotrexate (MTX), DMARDS, corticosteroids, salicylates,
NSAIDs, or analgesics.
certolzumab (B) 400 mg SC (2 x 200 mg inj at two diff erent sites on day 1); then,
400 mg SC at weeks 2 and 4; maintenance 400 mg SC every 4 weeks; administer in
abdomen or thigh; rotate sites
Pediatric: not recommended
Cimzia Vial: 200 mg (2/pck); Prefi lled syringe: 200 mg/ml single-dose (2/pck; 2,
6/starter pck) (preservative-free)
infliximab (B) administer by IV infusion over 2 hours; 5 mg/kg weeks 0, 2, 6; then
once every 8 weeks
Pediatric: <6 years: not recommended; =6 years: same as adult
Remicade
Vial: 100 mg pwdr for reconstitution for IV infusion (preservative-free)
vedolizumab (B) administer by IV infusion over 30 minutes; 300 mg at weeks 0, 2, 6;
then 300 mg once every 8 weeks
Pediatric: not established
Entyvio
Vial: 300 mg (20 ml) single dose, pwdr for IV infusion aft er reconstitution
(preservative-free)
INTEGRIN RECEPTOR ANTAGONIST (IMMUNOMODULATOR)
natalzumab (C) administer by IV infusion over 1 hour; monitor during and for 1
hour postinfusion; 300 mg every 4 weeks; discontinue aft er 12 weeks if no therapeutic
response, or if unable to taper off chronic concomitant steroids within 6 months;
may continue aminosalicylates
Pediatric: not established
Tysarbi
Vial: 300 mg single-dose, soln aft er dilution for IV infusion
(preservative-free)
CRYPTOSPORIDIUM PARVUM
nitazoxanide (B) 500 mg by mouth q 12 hours x 3 days
Pediatric: 12-47 months: 5 ml q 12 hours x 3 days; 4-11 years: 10 ml q 12 hours x 3
days; =12 years: same as adult
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D e m e n t i a ¦ 103
Alinia Oral susp: 100 mg/5 ml (60 ml)
Comment: Alinia is an antiprotozoal for the treatment of diarrhea due to G.
lamblia or C. parvum.
CYSTIC FIBROSIS
acetylcysteine (B)(G) administer via face mask, mouth piece, tracheostomy T-piece,
mist tent, or croupette; routine tracheostomy care, 1 to 2 ml of a 10% to 20% solution
may be administered by direct instillation into the tracheostomy every 1 to 4 hours
Pediatric: same as adult
Mucomyst Vial: 10, 20% (4, 10, 30 ml) soln for inhalation
Comment: Mucomyst is a mucolytic. For inhalation, the 10% concentration
may be used undiluted; the 20% concentration should be diluted with sterile
water or normal saline (either for injection or inhalation).
lumacaft or/ivacaft or (B) 2 tabs q 12 hours; reduce dose with moderate to severe hepatic
impairment
Pediatric: <12 years: not established
Orkambi Tab: luma 200 mg/iva 125 mg fi lm-coat
DEEP VEIN THROMBOSIS (DVT)
Anticoagulation Th erapy see page 527
DEHYDRATION
ORAL REHYDRATION AND ELECTROLYTE REPLACEMENT THERAPY
oral electrolyte replacement (NE)(OTC)(G)
KaoLectrolyte 1 pkt dissolved in 8 oz water q 3-4 hours
Pediatric: not indicated <2 years Pkt: sod 12 mEq/pot 5 mEq/chlor 10 mEq/
citrate 7 mEq/dextrose 5 g/calories 22 per 6.2 g
Pedialyte
Pediatric: <2 years: as desired and as tolerated; >2 years: 1-2 liters/day
Oral soln: dextrose 20 g/fructose 5 g/sodium 25 mEq/potassium 20 mEq/chloride
35 mEq/citrate 30 mEq/calories 100 per liter (8 oz, 1 L)
Pedialyte Freezer Pops
Pediatric: as desired and as tolerated
Pops: dextrose 1.6 g/sodium 2.8 mEq/potassium 1.25 mEq/chloride 2.2 mEq/
citrate 1.88 mEq/calories 6.25 per 62.5 ml (2.1 floz) pop
DEMENTIA
Comment: Underlying cause should be explored, accurately diagnosed, and addressed.
All antipsychotic agents are associated with increased risk of mortality in elderly
patients with dementia-related psychosis (Black Box Warning.) APA recommends
that non-emergency antipsychotic medication should only be used for the treatment
of agitation or psychosis in patients with dementia when symptoms are severe, are
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104 ¦ Dementia
dangerous and/or cause signifi cant distress to the patient. APA recommends that
before nonemergency treatment with an antipsychotic is initiated in patients with
dementia, the potential risks and benefi ts are discussed with the patient and the
patient’s surrogate decision maker with input from family or others involved with the
patient.
Alzheimer’s Disease see page 11
Antidepressants see Depression page 105
Hypnotics/Sedatives see Insomnia page 242
ANTIPSYCHOTICS
haloperidol (C)(G) 0.5-1 mg q HS
Haldol Tab: 0.5, 1, 2, 5, 10, 20 mg
mesoridazine (C) initially 25 mg tid; max 300 mg/day
Serentil Tab: 10, 25, 50, 100 mg; Conc: 25 mg/ml (118 ml)
olanzapine (C) initially 2.5-10 mg daily; increase to 10 mg/day within a few days;
then by 5 mg/day at weekly intervals; max 20 mg/day
Zyprexa Tab: 2.5, 5, 7.5, 10 mg
Zyprexa Zydis ODT: 5, 10, 15, 20 mg (phenylalanine)
quetiapine fumarate (C)
SeroQUEL initially 25 mg bid, titrate q 2nd or 3rd day in increments of
25-50 mg bid-tid; usual maintenance 400-600 mg/day in 2-3 divided doses
Tab: 25, 50, 100, 200, 300, 400 mg
SeroQUEL XR administer once daily in the PM; Day 1: 50 mg; Day 2: 100 mg;
Day 3: 200 mg; Day 4: 300 mg; usual range 400-600 mg/day
Tab: 50, 150, 200, 300, 400 mg ext-rel
risperidone (C) 0.5 mg bid x 1 day; adjust in increments of 0.5 mg bid; usual range
0.5-5 mg/day
Risperdal Tab: 1, 2, 3, 4 mg; Oral soln: 1 mg/ml (100 ml)
Risperdal M-Tab Tab: 0.5, 1, 2 mg
thioridazine (C)(G) 10-25 mg bid
Mellaril Tab: 10, 15, 25, 50, 100, 150, 200 mg; Oral susp: 25 mg/5 ml, 100 mg/5 ml;
Oral conc: 30 mg/ml, 100 mg/ml (4 oz)
DENTAL ABSCESS
amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200,
400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana), 250
mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml) (orange)
(phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided
bid x 10 days see page 556 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml)
(strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day
in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
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D e p r e s s i o n , M a j o r D e p r e s s i v e D i s o r d e r ( M D D ) ¦ 105
clindamycin (B) (administer with fluoroquinolone in adults and TMP-SMX in
children) 300 mg qid x 10 days
Pediatric: 8-16 mg/kg/day in 3-4 divided doses x 10 days
Cleocin (G) Cap: 75 (tartrazine), 150 (tartrazine), 300 mg
Cleocin Pediatric Granules (G) Oral susp: 75 mg/5 ml (100 ml) (cherry)
erythromycin base (B)(G) 500 mg q 6 hours x 10 days
Pediatric: 30-40 mg/kg/day in 4 divided doses x 10 days
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
erythromycin ethylsuccinate (B)(G) 400 mg qid x 7 days
Pediatric: 30-50 mg/kg/day in 4 divided doses x 7 days; may double dose with severe
infection; max 100 mg/kg/day; see page 574 for dose by weight
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100,
200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab: 200
mg wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
E.E.S. 400 Tablets Tab: 400 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
penicillin V potassium (B) 250-500 mg q 6 hours x 5-7 days
Pediatric: 25-50 mg/kg/day divided q 6 hours x 5-7 days; >12 years: same as adult;
see page 583 for dose by weight
Pen-Vee K Tab: 250, 500 mg; Oral soln: 125 mg/5 ml (100, 200 ml); 250 mg/5 ml
(100, 150, 200 ml)
DENTURE IRRITATION
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
Pediatric: with adult supervision only
Gly-Oxide Liq: 10% (15, 60 ml, squeeze bottle w. applicator)
DEPRESSION, MAJOR DEPRESSIVE DISORDER (MDD)
Comment: Abrupt withdrawal or interruption of treatment with an antidepressant
medication is sometimes associated with an antidepressant discontinuation syndrome
which may be mediated by gradually tapering the drug over a period of two weeks or
longer, depending on the dose strength and length of treatment. Common symptoms
of antidepressant withdrawal include flu-like symptoms, insomnia, nausea, imbalance,
sensory disturbances, and hyperarousal. Th ese medications include SSRIs, TCAs,
MAOIs, and atypical agents such as venlafaxine (Eff exor), mirtazapine (Remeron), y
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106 ¦ D e p r e s s i o n , M a j o r D e p r e s s i v e D i s o r d e r ( M D D )
trazodone (Desyrel), and duloxetine (Cymbalta). Common symptoms of the serotonin
discontinuation syndrome include flu-like symptoms (nausea, vomiting, diarrhea,
headaches, sweating), sleep disturbances (insomnia, nightmares, constant sleepiness),
mood disturbances (dysphoria, anxiety, agitation), cognitive disturbances (mental
confusion, hyperarousal), sensory and movement disturbances (imbalance, tremors,
vertigo, dizziness, electric-shock-like sensations in the brain, oft en described by
suff erers as “brain zaps.”
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 which 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, sweating), sleep disturbances (insomnia, nightmares, constant
sleepiness), mood disturbances (dysphoria, anxiety, agitation), cognitive disturbances
(mental confusion, hyperarousal, hallucinations), sensory and movement disturbances
(imbalance, tremors, vertigo, dizziness, electric-shock-like sensations in the brain,
oft en described by suff erers as “brain zaps.”
citalopram (C)(G) initially 20 mg daily; may increase aft er one week to 40 mg; max
40 mg
Pediatric: not recommended
Celexa Tab: 10, 20, 40mg; Oral soln: 10 mg/5 ml (120 ml) (pepper mint)
(sugar-free, alcohol-free, parabens)
escitalopram (C)(G) initially 10 mg daily; may increase to 20 mg daily aft er 1 week;
elderly or hepatic impairment, 10 mg once daily
Pediatric: <12 years: not recommended; 12-17 years: initially 10 mg daily; may
increase to 20 mg daily aft er 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 aft er 1 week; doses >20 mg/day
should be divided into AM and noon doses; max 80 mg/day
Pediatric: <8 years: not recommended; 8-17 years: initially 10 mg/day; may
increase aft er 1 week to 20 mg/day; range 20-60 mg/day; range for lower
weight children, 20-30 mg/day
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 for 13 weeks,
may initiate Prozac Weekly 7 days aft er the last 20 mg fluoxetine dose
Pediatric: not recommended
Cap: 90 mg ent-coat del-rel pellets
levomilnacipran (C) swallow whole; initially 20 mg once daily for 2 days; then increase
to 40 mg once daily; may increase dose in 40 mg increments at intervals of =2
days; max 120 mg once daily; CrCl 30-59 mL/min: max 80 mg once daily; CrCl 15-29
mL/min: max 40 mg once daily y
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D e p r e s s i o n , M a j o r D e p r e s s i v e D i s o r d e r ( M D D ) ¦ 107
Fetzima
Pediatric: not recommended
Cap: 20, 40, 80, 120 mg ext-rel
paroxetine maleate (D)(G)
Pediatric: not recommended
Paxil initially 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 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 cont-rel ent-coat
Paxil Suspension initially 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)(G) initially 50 mg daily; increase at 1 week intervals if needed; max 200
mg daily; dilute oral concentrate immediately prior to administration in 4 oz water,
ginger ale, lemon/lime soda, lemonade, or orange juice
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: 25*, 50*, 100*mg; Oral conc: 20 mg per ml (60 ml) (alcohol 12%)
SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)
desvenlafaxine (C)(G) swallow whole; initially 50 mg once daily; max 120 mg/day
Pediatric: not recommended
Pristiq Tab: 50, 100 mg ext-rel
duloxetine (C)(G) swallow whole; initially 30 mg once daily x 1 week; then, increase
to 60 mg once daily; max 120 mg/day
Pediatric: not recommended
Cymbalta Cap: 20, 30, 40, 60 mg del-rel
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
vortioxetine (C) initially 10 mg once daily; max 30 mg/day
Pediatric: <18 years: not restablished
Brintellix Tab: 5, 10, 15, 20 mg
SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI)/5-HT-14 RECEPTOR
PARTIAL AGONIST COMBINATION
vilazodone (C) take with food; initially 10 mg once daily x 7 days; then, 20 mg once
daily x 7 days; then, 40 mg once daily
Pediatric: <18 years: not restablished
Viibryd Tab: 10, 20, 40 mg
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108 ¦ D e p r e s s i o n , M a j o r D e p r e s s i v e D i s o r d e r ( M D D )
THIENOBENZODIAZEPINE/SSRI COMBINATION
olanzapine/fluoxetine (C) initially one 6/25 cap in the PM; titrate; max one 18/75 cap
once daily in the PM
Pediatric: <10 years: not established; <10 years: same as adult
Symbyax
Cap: Symbyax 3/25: olan 3 mg/fluo 25 mg
Symbyax 6/25: olan 6 mg/fluo 25 mg
Symbyax 6/50: olan 6 mg/fluo 50 mg
Symbyax 12/25: olan 12 mg/fluo 25 mg
Symbyax 12/50: olan 12 mg/fluo 50 mg
Comment: Symbyax is a thienobenzodiazepine-SSRI indicated for the treatment
of depressive episodes associated with bipolar depression disorder and
treatment resistant depression (TRD).
TRICYCLIC ANTIDEPRESSANTS (TCAs)
Comment: Co-administration of TCAs with SSRIs requires extreme caution.
amitriptyline (C)(G) initially 75 mg/day in divided doses or 50-100 mg in a single
dose at HS; max 300 mg/day
Pediatric: not recommended
Tab: 10, 25, 50, 75, 100, 150 mg
amoxapine (C) initially 50 mg bid-tid; aft er 1 week may increase to 100 mg bidtid;
usual eff ective dose 200-300 mg/day; if total dose exceeds 300 mg/day, give in
divided doses (max 400 mg/day); may give as a single bedtime dose (max 300 mg
q HS)
Pediatric: not recommended
Tab: 25, 50, 100, 150 mg
desipramine (C)(G) 100-200 mg/day in single or divided doses; max 300 mg/day
Pediatric: not recommended
Norpramin Tab: 10, 25, 50, 75, 100, 150 mg
doxepin (C)(G) 75 mg/day; max 150 mg/day
Pediatric: not recommended
Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
imipramine (C)(G)
Pediatric: not recommended
Tofranil initially 75 mg daily (max 200 mg); adolescents initially 30-40 mg
daily (max 100 mg/day); if maintenance dose exceeds 75 mg daily, may switch
to Tofranil PM for divided or bedtime dose
Tab: 10, 25, 50 mg
Tofranil PM initially 75 mg daily 1 hour before HS; max 200 mg
Cap: 75, 100, 125, 150 mg
Tofranil Injection 50 mg IM; lower dose for adolescents; switch to oral form as
soon as possible
Amp: 25 mg/2 ml (2 ml)
nortriptyline (D)(G) initially 25 mg tid-qid; max 150 mg/day
Pediatric: not recommended
Pamelor Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml (16 oz)
protriptyline (C) initially 5 mg tid; usual dose 15-40 mg/day in 3-4 divided doses;
max 60 mg/day
Pediatric: <12 years: not recommended
y y y y y y y y
D e p r e s s i o n , M a j o r D e p r e s s i v e D i s o r d e r ( M D D ) ¦ 109
Vivactyl Tab: 5, 10 mg
trimipramine (C) initially 75 mg/day in divided doses; max 200 mg/day
Pediatric: not recommended
Surmontil Cap: 25, 50, 100 mg
AMINOKETONES
bupropion HBr (C)(G)
Pediatric: not established
Aplenzin initially 100 mg bid for at least 3 days; may increase to 375 or 400
mg/day aft er several weeks; then aft er at least 3 more days, 450 mg in 4 divided
doses; max 450 mg/day, 174 mg/single-dose
Tab: 174, 348, 522 mg
Forfi vo XL do not use for initial treatment; use immediate-release bupropion
forms for initial titration; switch to Forfi vo XL 450 mg once daily when total
dose/day reaches 450 mg; may switch to Forfi vo XL when total dose/day reaches
300 mg for 2 weeks and patient needs 450 mg/day to reach therapeutic target;
swallow whole, do not crush or chew
Tab: 450 mg ext-rel
bupropion HCl (C)(G)
Pediatric: <18 years: not recommended
Wellbutrin initially 100 mg bid for at least 3 days; may increase to 375 or 400
mg/day aft er several weeks; then aft er 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; 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 450 mg/day
Tab: 150, 300 mg sust-rel
MONOAMINE OXIDASE INHIBITORS (MAOIs)
Comment: Many drug and food interactions with this class of drugs, use cautiously.
Should be reserved for refractory depression that has not responded to other classes of
antidepressants. Concomitant use of MAOIs and SSRIs is an absolute contraindication.
See mfr pkg insert for drug and food interactions.
isocarcatronazid (C)(G) initially 10 mg bid; increase by 10 mg every 2-4 days up to
40 mg/day; may increase by 20 mg/week to max 60 mg/day divided bid-qid
Marplan
Pediatric: <16 years: not recommended; =16 years: same as adult
Tab: 10 mg
phenelzine (C)(G) initially 15 mg tid; max 90 mg/day
Nardil
Pediatric: <16 years: not recommended; =16 years: same as adult
Tab: 15 mg
selegiline (C) initially 10 mg tid; max 60 mg/day
Emsam Transdermal patch: 6 mg/24 h, 9 mg/24 h, 12 mg/24 h
Comment: With the Emsam transdermal patch 6 mg/24 h dose, the dietary
restrictions commonly required when using nonselective MAOIs are not necessary.
y y y y y y
110 ¦ D e p r e s s i o n , M a j o r D e p r e s s i v e D i s o r d e r ( M D D )
tranylcypromine (C) initially 10 mg tid; may increase in 10 mg/day every 1-3 weeks;
max 60 mg/day
Parnate Tab: 10 mg
TETRACYCLICS
maprotiline (B)(G) initially 75 mg/day for 2 weeks then change gradually as needed
in 25 mg increments; max 225 mg/day
Pediatric: <18 years: not recommended
Ludiomil Tab: 25, 50, 75 mg
mirtazapine (C) initially 15 mg q HS; increase at intervals of 1-2 weeks; usual range
15-45 mg/day; max 45 mg/day
Pediatric: not recommended
Remeron Tab: 15*, 30*, 45*mg
Remeron SolTab ODT: 15, 30, 45 mg (orange) (phenylalanine)
chlordiazepoxide/amitriptyline (C)(IV)
Pediatric: not recommended
Limbitrol 3-4 tabs in divided doses
Tab: chlor 5 mg/amit 12.5 mg
Limbitrol DS 3-4 tabs in divided doses; max 6 tabs/day
Tab: chlor 10 mg/amit 25 mg
trazodone (C)(G) initially 150 mg/day in divided doses with food; increase by 50 mg/
day q 3-4 days; max 400 mg/day in divided doses
Pediatric: <18 years: not recommended
Oleptro Tab: 50, 100*, 150*, 200, 250, 300 mg
ATYPICAL ANTIPSYCHOTICS
aripiprazole (C)(G) initially 15 mg daily; may increase to max 30 mg/day
Pediatric: <10 years: not recommended; 10-17 years: initially 2 mg/day for 2 days;
then, increase to 5 mg/day for 2 days; then, increase to target dose of 10 mg/day;
may increase by 5 mg/day at 1 week intervals as needed to max 30 mg/day
Abilify Tab: 2, 5, 10, 15, 20, 30 mg
Abilify Discmelt Tab: 15 mg orally disintegrating (vanilla) (phenylalanine)
Abilify Maintena Vial: 300, 400 mg ext-rel pwdr for IM injection aft er reconstitution;
300, 400 mg single-dose prefi lled dual-chamber syringes w. supplies
Comment: Abilify is indicated for acute and maintenance treatment of manic
or mixed episodes in bipolar I disorder, as monotherapy or as an adjunct to
lithium or valproate, as adjunct to antidepressants for major depressive disorder
(MDD), and for irritability associated with autistic disorder.
brexpiprazole (C) initially 0.5 or 1 mg once daily; titrate weekly up to target 2 mg/
day; max 3 mg/day; Moderate-severe hepatic impairment, renal impairment, or
ESRD, max 2 mg/day
Pediatric: not established
Rexulti Tab: 0.25, 0.5, 1, 2, 3, 4 mg
DERMATITIS: ATOPIC (ECZEMA)
Oral Antihistamines: see Oral Drugs for Allergy, Cough, and Cold see page 535
Parenteral Corticosteroids see page 511
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Dermat i t i s : A t o p i c ( E c z e m a ) ¦ 111
Oral Corticosteroids see page 509
TOPICAL STEROIDS
(For other topical steroids, see Topical Corticosteroids page 506)
Comment: Topical steroids should be applied sparingly and for the shortest time
necessary. Do not use in the diaper area. Do not use an occlusive dressing. Systemic
absorption of topical corticosteroids can induce reversible hypothalamic-pituitaryadrenal
(HPA) axis suppression with the potential for clinical corticosteroids
insuffi ciency.
desonide 0.05% topical gel (C) apply sparingly bid-tid; max 4 weeks
Pediatric: <3 months: not recommended; =3 months: same as adult
Desonate Gel: 0.05% (60 g) (89% purifi ed water; fragrance-free, surfactant-free,
alcohol-free)
PHOSPHODIESTERASE 4 INHIBITOR
crisaborole 2% (C) apply sparingly bid; max 4 weeks
Pediatric: <2 years: not recommended; =2 years: same as adult
Eucrisa Oint: 2% (60 g)
MOISTURIZING AGENTS
Aquaphor Healing Ointment (OTC) Oint: 1.75, 3.5, 14 oz (alcohol)
Eucerin Daily Sun Defense (OTC) Lotn: 6 oz (fragrance-free)
Comment: Eucerin Daily Sun Defense is a moisturizer with SPF-15 sunscreen.
Eucerin Facial Lotion (OTC) Lotn: 4 oz
Eucerin Light Lotion (OTC) Lotn: 8 oz
Eucerin Lotion (OTC) Lotn: 8, 16 oz
Eucerin Original Creme (OTC) Crm: 2, 4, 16 oz (alcohol)
Eucerin Plus Creme (OTC) Crm: 4 oz
Eucerin Plus Lotion (OTC) Lotn: 6, 12 oz
Eucerin Protective Lotion (OTC) Lotn: 4 oz (alcohol)
Comment: Eucerin Protective Lotion is a moisturizer with SPF-25 sunscreen.
Lac-Hydrin Cream (OTC) Crm: 280, 385 g
Lac-Hydrin Lotion (OTC) Lotn: 25, 400 g
Lubriderm Dry Skin Scented (OTC) Lotn: 6, 10, 16, 32 oz
Lubriderm Dry Skin Unscented (OTC) Lotn: 3.3, 6, 10, 16 oz (fragrance-free)
Lubriderm Sensitive Skin Lotion (OTC) Lotn: 3.3, 6, 10, 16 oz (lanolin-free)
Lubriderm Dry Skin (OTC) Lotn (scented): 2.5, 6, 10, 16 oz;
Lotn (fragrance-free): 1, 2.5, 6, 10, 16 oz
Lubriderm Bath 1-2 capfuls in bath or rub onto wet skin as needed, then rinse
Oil: 8 oz
Moisturel apply as needed
Crm: 4, 16 oz; Lotn: 8, 12 oz; Clnsr: 8.75 oz
OATMEAL COLLOIDS
Aveeno (OTC) add to bath as needed
Regular: 1.5 oz (8/pck); Moisturizing: 0.75 oz (8/pck)
Aveeno Oil (OTC) add to bath as needed
Oil: 8 oz
y y
112 ¦ Dermat i t i s : A t o p i c (Eczema)
Aveeno Moisturizing (OTC) apply as needed
Lotn: 2.5, 8, 12 oz; Crm: 4 oz
Aveeno Cleansing Bar (OTC) Bar: 3 oz
Aveeno Gentle Skin Cleanser (OTC) Liq clnsr: 6 oz
TOPICAL OIL
fluocinolone acetamide 0.01% topical oil (C)
Pediatric: <6 years: not recommended; =6 years: apply sparingly bid for up to 4 weeks
Derma-Smoothe/FS Topical Oil apply sparingly tid
Topical oil: 0.01% (4 oz) (peanut oil)
TOPICAL ANALGESICS
capsaicin cream (B)(G) apply tid-qid prn
Pediatric: <2 years: not recommended; =2 years: apply sparingly tid-qid prn
Axsain Crm: 0.075% (1, 2 oz)
Capsin (OTC) Lotn: 0.025, 0,075% (59 ml)
Capzasin-P (OTC) Crm: 0.025% (1.5 oz); Lotn: 0.025% (2 oz)
Capzasin-HP (OTC) Crm: 0.075% (1.5 oz); Lotn: 0.075% (2 oz)
Dolorac Crm: 0.025% (28 g)
Double Cap (OTC) Crm: 0.05% (2 oz)
R-Gel Gel: 0.025% (15, 30 g)
Zostrix (OTC) Crm: 0.025% (0.7, 1.5, 3 oz)
Zostrix HP (OTC) Emol crm: 0.075% (1, 2 oz)
Comment: Provides some relief by 1-2 weeks; optimal benefi t may take 4-6 weeks.
Avoid contact with mucous membranes.
doxepin (B) cream apply to affected area qid at intervals of at least 3-4 hours;
max 8 days
Pediatric: not recommended
Prudoxin Crm: 5% (45 g)
Zonalon Crm: 5% (30, 45 g)
pimecrolimus 1% cream (C) apply to affected area bid; do not occlude
Pediatric: <2 years: not recommended; =2 years: same as adult
Elidel Crm: 1% (30, 60, 100 g)
Comment: pimecrolimus is indicated for short-term and intermittent long-term
use. Discontinue use when resolution occurs. Contraindicated if the patient is
immunosuppressed. Change to the 0.1% preparation or if secondary bacterial
infection is present.
tacrolimus (C) apply to affected area bid; do not occlude or apply to wet skin; continue
for 1 week aft er clearing
Pediatric: <2 years: not recommended; 2-15 years: use 0.03% strength; apply to
affected area bid; continue for 1 week aft er clearing; >15 years: same as adult
Protopic Oint: 0.03, 0.1% (30, 60, 100 g)
TOPICAL ANESTHETIC
lidocaine (B) apply to affected area bid-tid prn
Pediatric: reduce dosage commensurate with age, body weight, and physical condition
Lidoderm Crm: 3% (85 g)
y y y y y y
Dermat i t i s : S e b o r r h e i c ¦ 113
DERMATITIS: CONTACT
PROPHYLAXIS
bentoquatam (NE) apply as a wet fi lm to exposed skin at least 15 minutes prior to
possible contact; reapply at least q 4 hours; remove with soap and water
Pediatric: <6 years: not recommended; =6 years: same as adult
IvyBlock (OTC) Soln: 120 ml
Comment: Provides protection against genus rhus (poison ivy, oak, and sumac).
TREATMENT
Oatmeal Colloids
Aveeno (OTC) add to bath as needed
Regular: 1.5 oz (8/pck); Moisturizing: 0.75 oz (8/pck)
Aveeno Oil (OTC) add to bath as needed
Oil: 8 oz
Aveeno Moisturizing (OTC) apply as needed
Lotn: 2.5, 8, 12 oz; Crm: 4 oz
Aveeno Cleansing Bar (OTC) Bar: 3 oz
Aveeno Gentle Skin Cleanser (OTC) Liq clnsr: 6 oz
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
DERMATITIS: SEBORRHEIC
ANTIFUNGAL SHAMPOOS AND TOPICAL AGENTS
chloroxine shampoo (C) massage onto wet scalp; wait 3 minutes, rinse, repeat, and
rinse thoroughly; use twice weekly
Pediatric: not recommended
Capitrol Shampoo Shampoo: 2% (4 oz)
ciclopirox (B) apply gel once daily or apply cream or lotion twice daily, x 4 weeks
or shampoo twice weekly; massage shampoo onto wet scalp; wait 3 minutes, rinse,
repeat, and rinse thoroughly; shampoo twice weekly
Loprox Cream
Pediatric: <10 years: not recommended; =10 years: same as adult
Crm: 0.77% (15, 30, 90 g)
Loprox Gel
Pediatric: <16 years: not recommended; =16 years: same as adult
Gel: 0.77% (30, 45 g)
Loprox Lotion
Pediatric: <10 years: not recommended; =10 years: same as adult
Lotn: 0.77% (30, 60 ml)
Loprox Shampoo Shampoo: 1% (120 ml)
coal tar (C)(G)
Pediatric: same as adult
Scytera (OTC) apply once daily-qid; use lowest eff ective dose
t
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y y y
114 ¦ Dermat i t i s : S e b o r r h e i c
Foam: 2%
T/Gel Shampoo Extra Strength (OTC) use every other day; max 4 x/week;
massage into wet scalp for 5 minutes; rinse; repeat Shampoo: 1%
T/Gel Shampoo Original Formula (OTC) use every other day; max 7 x/week;
massage into wet scalp for 5 minutes; rinse; repeat
Shampoo: 0.5%
T/Gel Shampoo Stubborn Itch Control (OTC) use every other day; max 7 x/
week; massage into wet scalp for 5 minutes; rinse; repeat
Shampoo: 0.5%
fluocinolone acetamide (C)
Derma-Smoothe/FS Shampoo apply up to 1 oz to scalp daily, lather, and leave
on x 5 minutes, then rinse twice
Pediatric: not recommended
Shampoo: 0.01% (4 oz)
Derma-Smoothe/FS Topical Oil fluocinolone acetamide 0.01% topical oil (C)
apply sparingly tid; for scalp psoriasis wet or dampen hair or scalp, then apply a
thin fi lm, massage well, cover with a shower cap and leave on for at least 4 hours
or overnight, then wash hair with regular shampoo and rinse
Pediatric: <6 years: not recommended; =6 years: apply sparingly bid for up
to 4 weeks
Topical oil: 0.01% (4 oz) (peanut oil)
ketoconazole (C) apply cream or gel once daily x 4 week or apply up to 1 oz shampoo
to scalp daily, lather, leave on x 5 minutes, then rinse twice
Pediatric: not recommended
Nizoral Cream Crm: 2% (15, 30, 60 g)
Nizoral Shampoo Shampoo: 2% (4 oz)
Xolegel Gel: 2% (45 g)
Xolegel Duo Kit: Xolegel Gel: 2% (45 g) + Xolex Shampoo: 2% (4 oz)
selenium sulfi de (C) massage cream into scalp twice weekly x 2 weeks or massage
into wet scalp, wait 2-3 minutes, rinse; repeat twice weekly x 2 weeks; may continue
treatment with lotion of shampoo 1-2 x weekly as needed
Pediatric: not recommended
Exsel Shampoo Shampoo: 2.5% (4 oz)
Selsun Rx Lotn: 2.5% (4 oz)
Selsun Shampoo Shampoo: 1% (120, 210, 240, 330 ml); 2.5% (120 ml)
sodium sulfacetamide/sulfur (C)
Clinia Emollient Cream apply daily tid
Emol crm: sod sulfa 10%/sulfur 5% (10 oz)
Clinia Foaming Wash wash 1-2 x/daily
Wash: sod sulfa 10%/sulfur 5% (6, 12 oz)
Rosula Gel apply daily tid
Gel: sod sulfa 10%/sulfur 5% (45 ml)
Rosula Lotion apply daily tid
Lotn: sod sulfa 10%/sulfur 5% (45 ml) (alcohol-free)
Rosula Wash wash bid
Clnsr: sod sulfa 10%/sulfur 5% (335 ml)
TOPICAL STEROID
betamethasone valerate 0.12% foam (C)(G) apply twice daily in AM and PM; invert
can and dispense a small amount of foam onto a clean saucer or other cool surface
y y y y y
D i a b e t i c Pe r i p h e r a l N e u r o p a t h y ¦ 115
(do not apply directly to hand) and massage a small amount into affected area until
foam disappears
Pediatric: not recommended
Luxiq Foam: 100 g
Other Topical Corticosteroids see page 506
DIABETIC PERIPHERAL NEUROPATHY
NUTRITIONAL SUPPLEMENT
L-methylfolate calcium (as metafolin)/pyridoxyl 5-phosphate/methyl-cobalamin
(NE) 1 cap twice daily or 2 caps once daily
Pediatric: not recommended
Metanx Cap: meta 3 mg/pyr 35 mg/methyl 2 mg
Comment: Metanx is indicated as adjunct treatment for patients with
endothelial cell dysfunction, who have loss of protective sensation and
neuropathic pain associated with diabetic peripheral neuropathy.
Acetaminophen for IV Infusion see Pain page 306
ORAL ANALGESICS
acetaminophen (B)(G) see Fever page 143
aspirin (D)(G) see Fever page 144
Comment: aspirin-containing medications are contraindicated with history of
allergic-type reaction to aspirin, children and adolescents with Varicella or other
viral illness, and 3rd trimester pregnancy.
tramadol (C)(IV)(G)
Rybix ODT initially 100 mg once daily; may increase by 100 mg every 5 days;
max 300 mg/day; CrCl <30 mL/min or severe hepatic impairment: not recommended;
Cirrhosis: max 50 mg q 12 hours
Pediatric: <17 years: not recommended
ODT: 50 mg (mint) (phenylalanine)
Ryzolt initially 100 mg once daily; may increase by 100 mg every 5 days; max
300 mg/day; CrCl <30 mL/min or severe hepatic impairment: not recommended
Pediatric: <16 years: not recommended; =16 years: same as adult
Tab: 100, 200, 300 mg ext-rel
Ultram 50-100 mg q 4-6 hours prn; max 400 mg/day; CrCl <30 mL/min, max
100 mg q 12 hours; cirrhosis, max 50 mg q 12 hours
Pediatric: <16 years: not recommended
Tab: 50*mg
Ultram ER initially 100 mg once daily; may increase by 100 mg every 5 days;
max 300 mg/day; CrCl <30 mL/min or severe hepatic impairment: not recommended
Pediatric: <18 years: not recommended
Tab: 100, 200, 300 mg ext-rel
tramadol/acetaminophen (C)(IV)(G) 2 tabs q 4-6 hours; max 8 tabs/day x 5 days;
CrCl <30 mL/min: max 2 tabs q 12 hours; max 4 tabs/day x 5 days
Pediatric: <16 years: not recommended
Ultracet Tab: tram 37.5/acet 325 mg
Other Oral Analgesics see Pain page 306
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116 ¦ D i a b e t i c Pe r i p h e r a l N e u r o p a t h y
TOPICAL ANALGESICS
capsaicin cream (B)(G) apply tid-qid aft er lesions have healed
Pediatric: <2 years: not recommended; =2 years: same as adult
Axsain Crm: 0.075% (1, 2 oz)
Capsin Lotn: 0.025, 0.075% (59 ml)
Capsaicin-P (OTC) Crm: 0.025% (1.5 oz); Lotn: 0.025% (2 oz)
Capsaicin-HP (OTC) Crm: 0.075% (1.5 oz); Lotn: 0.075% (2 oz); Crm: 0.025%
(45, 90 g)
Dolorac Crm: 0.025% (28 g)
Double Cap (OTC) Crm: 0.05% (2 oz)
R-Gel Gel: 0.025% (15, 30 g)
Zostrix (OTC) Crm: 0.025% (0.7, 1.5, 3 oz)
Zostrix HP Emol crm: 0.075% (1, 2 oz)
capsaicin 8% patch (B) apply up to 4 patches for one 60-minute application to
clean dry skin; may prep area with topical anesthetic; wear nonlatex gloves; patches
may be cut to size/shape; treatment may be repeated every 3 months
Pediatric: <18 years: not recommended
Qutenza Patch: 8% 1640 mcg/cm (179 mg) (1 or 2 patches w. 1-50 g tube
cleansing gel/carton)
lidocaine 5% patch (B)(G) apply up to 3 patches at one time for up to 12 hours/24-
hour period (12 hours on/12 hours off ); patches may be cut into smaller sizes before
removal of the release liner; do not re-use
Pediatric: not recommended
Lidoderm Patch: 5% 10×14 cm (30 patches/carton)
ANTICONVULSANTS
Gamma Aminobutyric Acid Analog
gabapentin (C)
Pediatric: <3 years: not recommended; 3-12 years: initially 10-15 mg/kg/day in
3 divided doses; max 12 hours between doses; titrate over 3 days; 3-4 years: titrate
to 40 mg/kg/day; 5-12 years: titrate to 25-35 mg/kg/day; max 50 mg/kg/day
Gralise (C) initially 300 mg on Day 1; then 600 mg on Day 2; then 900 mg on
Days 3-6; then 1200 mg on Days 7-10; then 1500 mg on Days 11-14; titrate up
to 1800 mg on Day 15; take entire dose once daily with the evening meal; do not
crush, split, or chew
Tab: 300, 600 mg
Neurontin (G) Tab: 600*, 800* mg; Cap: 100, 300, 400 mg; Oral soln: 250 mg/5 ml
(480 ml) (strawberry-anise)
gabapentin enacarbil (C) 600 mg once daily at about 5:00 PM; if dose not taken at
recommended time, next dose should be taken the following day; swallow whole;
take with food; CrCl 30-59 mL/min: 600 mg on Day 1, Day 3, and every day thereafter;
CrCl <30 mL/min: or on hemodialysis: not recommended
Pediatric: not recommended
Horizant Tab: 300, 600 mg ext-rel
Comment: Avoid abrupt cessation of gabapentin and gabapentin enacarbil. To
discontinue, withdraw gradually over 1 week or longer.
pregabalin (GABA analog) (C)(V) initially 50 mg tid; may titrate to 100 mg tid within
one week; max 600 mg divided tid; discontinue over 1 week
Pediatric: <18 years: not recommended y
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D i a p e r R a s h ¦ 117
Lyrica Cap: 25, 50, 75, 100, 150, 200, 225, 300 mg; Oral soln: 20 mg/ml
TRICYCLIC ANTIDEPRESSANTS (TCAs)
Comment: Co-administration of TCAs with SSRIs requires extreme caution.
amitriptyline (C)(G) titrate to achieve pain relief; max 300 mg/day
Pediatric: not recommended
Tab: 10, 25, 50, 75, 100, 150 mg
amoxapine (C) titrate to achieve pain relief; if total dose exceeds 300 mg/day, give
in divided doses; max 400 mg/day
Pediatric: not recommended
Tab: 25, 50, 100, 150 mg
desipramine (C)(G) titrate to achieve pain relief; max 300 mg/day
Pediatric: not recommended
Norpramin Tab: 10, 25, 50, 75, 100, 150 mg
doxepin (C)(G) titrate to achieve pain relief; max 150 mg/day
Pediatric: not recommended
Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
imipramine (C)(G)
Pediatric: not recommended
Tofranil titrate to achieve pain relief; max 200 mg/day; adolescents max 100 mg/
day; if maintenance dose exceeds 75 mg/day, may switch to Tofranil PM at bedtime
Tab: 10, 25, 50 mg
Tofranil PM titrate to achieve pain relief; initially 75 mg at HS; max 200 mg at HS
Cap: 75, 100, 125, 150 mg
Tofranil Injection 50 mg IM; lower dose for adolescents; switch to oral form as
soon as possible
Amp: 25 mg/2 ml (2 ml)
nortriptyline (D)(G) titrate to achieve pain relief; initially 10-25 mg tid-qid; max
150 mg/day; lower doses for elderly and adolescents
Pediatric: not recommended
Pamelor titrate to achieve pain relief; max 150 mg/day
Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml (16 oz)
protriptyline (C) titrate to achieve pain relief; initially 5 mg tid; max 60 mg/day
Pediatric: <12 years: not recommended
Vivactyl Tab: 5, 10 mg
trimipramine (C) titrate to achieve pain relief; max 200 mg/day
Pediatric: not recommended
Surmontil Cap: 25, 50, 100 mg
DIAPER RASH
Topical Corticosteroids see page 506
Comment: Low to intermediate potency topical corticosteroids are indicated if
inflammation is present.
PROTECTIVE BARRIERS
aloe/vitamin E/zinc oxide (NE) ointment apply at each diaper change aft er thoroughly
cleansing skin
Balmex Oint: 2, 4 oz tube; 16 oz jar
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vitamin A&D (NE) (G) ointment apply at each diaper change aft er thoroughly
cleansing skin
A&D Ointment Oint: 1.5, 4 oz
zinc oxide (NE)(G) cream and ointment apply at each diaper change aft er thoroughly
cleansing the skin
A&D Ointment with Zinc Oxide Oint: 10% (1.5, 4 oz)
Desitin Oint: 40% (1, 2, 4, 9 oz)
Desitin Cream Crm: 10% (2, 4 oz)
TOPICAL ANTIFUNGALS
Comment: Use if caused by Candida albicans.
butenafi ne (B)(G) apply bid x 1 week or once daily x 4 weeks
Pediatric: <12 years: not recommended
Lotrimin Ultra (C)(OTC) Crm: 1% (12, 24 g)
Mentax Crm: 1% (15, 30 g)
Comment: butenafi ne is a benzylamine, not an azole. Fungicidal activity continues
for at least 5 weeks aft er last application.
clotrimazole (B) apply to affected area bid x 7 days
Pediatric: same as adult
Lotrimin (OTC) Crm: 1% (15, 30, 45 g)
Lotrimin AF (OTC) Crm: 1% (12 g); Lotn: 1% (10 ml); Soln: 1% (10 ml)
econazole (C) apply bid x 7 days
Spectazole Crm: 1% (15, 30, 85 g)
ketoconazole (C)(G)
Nizoral Cream Crm: 2% (15, 30, 60 g)
miconazole 2% (C)(G) apply bid x 7 days
Pediatric: same as adult
Lotrimin AF Spray Liquid (OTC) Spray liq: 2% (113 g) (alcohol 17%)
Lotrimin AF Spray Powder (OTC) Spray pwdr: 2% (90 g) (alcohol 10%)
Monistat-Derm Crm: 2% (1, 3 oz); Spray liq: 2% (3.5 oz); Spray pwdr: 2%
(3 oz)
nystatin (C)(G) apply bid x 7 days
Mycostatin Crm: 100,000 U/g (15, 30 g)
COMBINATION AGENT
clotrimazole/betamethasone (C)(G) cream apply bid x 7 days
Lotrisone Crm: 15, 45 g
DIARRHEA: ACUTE
attapulgite (C)
Donnagel (OTC) 30 ml aft er each loose stool; max 7 doses/day x 2 days
Pediatric: <3 years: not recommended; 3-6 years: 7.5 ml; >6-12 years: 15 ml;
>12 years: same as adult
Liq: 600 mg/15 ml (120, 240 ml)
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D i a r r h e a : A c u t e ¦ 119
Donnagel Chewable Tab (OTC) 2 tabs aft er each loose stool; max 14 tabs/day
Pediatric: <3 years: not recommended; 3-6 years: 1/2 tab aft er each loose
stool; max 7 doses/day; >6-12 years: 1 tab aft er each loose stool; max 7 tabs/
day
Chew tab: 600 mg
Kaopectate (OTC) 30 ml aft er each loose stool; max 7 doses/day x 2 days
Pediatric: <3 years: not recommended; 3-6 years: 7.5 ml aft er each loose
stool; >6-12 years: 15 ml aft er each loose stool; >12 years: same as adult
Liq: 600 mg/15 ml (120, 240 ml)
bismuth subsalicylate (C; D in 3rd)(G)
Pepto-Bismol (OTC) 2 tabs or 30 ml q 30-60 minutes as needed; max 8 doses/day
Pediatric: <3 years (14-18 lb): 2.5 ml q 4 hours; max 6 doses/day; <3 years
(18-28 lb): 5 ml q 4 hours; max 6 doses/day; 3-6 years: 1/3 tab or 5 ml q 30-60
minutes; max 8 doses/day; >6-9 years: 2/3 tab or 10 ml q 30-60 minutes; max
8 doses/day; >9-12 years: 1 tab or 15 ml q 30-60 minutes; max 8 doses/day
Chew tab: 262 mg; Liq: 262 mg/15 ml (4, 8, 12, 16 oz)
Pepto-Bismol Maximum Strength (OTC) 30 ml q 60 minutes; max 4 doses/day
Pediatric: <3 years: not recommended; 3-6 years: 5 ml q 60 minutes; max 4
doses/day; >6-9 years: 10 ml q 60 minutes; max 4 doses/day; >9-12 years:
15 ml q 60 minutes; max 4 doses/day
Liq: 525 mg/15 ml (4, 8, 12, 16 oz)
Comment: aspirin-containing medications are contraindicated with history of allergictype
reaction to aspirin, children and adolescents with Varicella or other viral illness,
and 3rd trimester pregnancy.
calcium polycarbophil (C)
Pediatric: <6 years: not recommended; 6-12 years: 1 tab daily qid; >12 years: same
as adult
Fibercon (OTC) 2 tabs daily qid
Cplt: 625 mg
crofelemer (C) 2 tabs once daily; swallow whole with or without food; do not crush
or chew
Pediatric: not established
Mytesi
Tab: 125 mg del-rel
Comment: crofelemer is indicated for the symptomatic relief of non-infectious
diarrhea in adult patients with HIV/AIDS on antiretroviral therapy.
difenoxin/atropine (C)
Pediatric: <2 years: not recommended; =2 years: same as adult
Motofen 2 tabs, then 1 tab aft er each loose stool or 1 tab q 3-4 hours as needed;
max 8 tab/day x 2 days
Tab: dif 1 mg/atro 0.025 mg
diphenoxylate/atropine (C)(V)(G)
Pediatric: <2 years: not recommended; 2-12 years: initially 0.3-0.4 mg/kg/day in
4 divided doses; >12 years: same as adult
Lomotil 2 tabs or 10 ml qid until diarrhea is controlled
Tab: diphen 2.5 mg/atrop 0.025 mg; Liq: diphen 2.5 mg/atrop 0.025 mg per
5 ml (2 oz)
loperamide (B)(OTC)(G)
Imodium 4 mg initially, then 2 mg aft er each loose stool; max 16 mg/day x 2 days y
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120 ¦ D i a r r h e a : A c u t e
Pediatric: <5 years: not recommended; =5 years: same as adult
Cap: 2 mg
Imodium A-D 4 mg initially, then 2 mg aft er each loose stool; usual max 8 mg/
day x 2 days
Pediatric: <2 years: not recommended; 2-5 years (24-47 lb): 1 mg up to tid
x 2 days; 6-8 years (48-59 lb): 2 mg initially, then 1 mg aft er aft er each loose
stool; max 4 mg/day x 2 days; 9-11 years (60-95 lb): 2 mg initially, then 1 mg
aft er each loose stool; max 6 mg/day x 2 days
Cplt: 2 mg; Liq: 1 mg/5 ml (2, 4 oz) (cherry-mint) (alcohol 0.5%)
loperamide/simethicone (B)(OTC)(G)
Imodium Advanced 2 tabs chewed aft er loose stool, then 1 aft er the next loose
stool; max 4 tabs/day
Pediatric: 6-8 years: chew 1 tab aft er loose stool, then chew 1/2 tab aft er next
loose stool; 9-11 years: chew 1 tab aft er loose stool, then chew 1/2 tab aft er
next loose stool; max 3 tabs/day; =12 years: same as adult
Chew tab: loper 2 mg/simeth 125 mg (vanilla-mint)
ORAL REHYDRATION AND ELECTROLYTE REPLACEMENT THERAPY
oral electrolyte replacement (NE)(OTC)
CeraLyte 50 dissolve in 8 oz water
Pediatric: <4 years: not indicated; =4 years, same as adult
Pkt: sodium 50 mEq/potassium 20 mEq/chloride 40 mEq/citrate 30 mEq/rice
syrup solids 40 g/calories 190 per liter (mixed berry) (gluten-free)
CeraLyte 70 dissolved in 8 oz water
Pediatric: <4 years: not indicated; =4 years: same as adult
Pkt: sodium 70 mEq/potassium 20 mEq/chloride 60 mEq/citrate 30 mEq/rice
syrup solids 40 g/calories 165 per liter (natural or lemon) (gluten-free)
KaoLectrolyte 1 pkt dissolved in 8 oz water q 3-4 hours
Pediatric: <2 years: not indicated; =2 years: same as adult
Pkt: sod 12 mEq/pot 5 mEq/chlor 10 mEq/citrate 7 mEq/dextrose 5 g/calories
22 per 6.2 g
Pedialyte
Pediatric: <2 years: as desired and as tolerated; =2 years: 1-2 L/day
Oral soln: dextrose 20 g/fructose 5 g/sodium 25 mEq/potassium 20 mEq/chloride
35 mEq/citrate 30 mEq/calories 100 per liter (8 oz, 1 L)
Pedialyte Freezer Pops
Pediatric: as desired and as tolerated
Pops: dextrose 1.6 g/sodium 2.8 mEq/potassium 1.25 mEq/chloride 2.2 mEq/
citrate 1.88 mEq/calories 6.25 per 6.25 ml pop (8 oz, 1 L)
DIARRHEA: CHRONIC
cholestyramine (C)
Questran Powder for Oral Suspension initially 1 pkt or scoop daily; usual
maintenance 2-4 pkts or scoops daily in 2 doses; max 6 pkts or scoops daily
Oral pwdr: 9 g pkts; 9 g equal 4 g anhydrous cholestyramine resin (60/pck);
Bulk can: 378 g w. scoop
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D i a r r h e a : C h r o n i c ¦ 121
Questran Light initially 1 pkt or scoop daily; usual maintenance 2-4 pkts or
scoops daily in 2 doses
Light: 5 g pkts; 5 g equals 4 g anhydrous cholestyramine resin (60/pck); Bulk
can: 210 g w. scoop
Comment: Use cholestyramine only if diarrhea is due to bile salt malabsorption.
crofelemer (C) 2 tabs once daily; swallow whole with or without food; do not crush
or chew
Pediatric: not established
Mytesi
Tab: 125 mg del-rel
Comment: crofelemer is indicated for the symptomatic relief of non-infectious
diarrhea in adult patients with HIV/AIDS on antiretroviral therapy.
difenoxin/atropine (C)
Pediatric: <2 years: not recommended; =2 years: same as adult
Motofen 2 tabs, then 1 tab aft er each loose stool or 1 tab q 3-4 hours prn; max 8
tab/day x 2 days
Tab: dif 1 mg/atrop 0.025 mg
diphenoxylate/atropine (B)(V)(G)
Pediatric: <2 years: not recommended; 2-12 years: initially 0.3-0.4 mg/kg/day in 4
divided doses; >12 years: same as adult
Lomotil 5-20 mg/day in divided doses
Tab: diphen 2.5 mg/atrop 0.025 mg; Liq: diphen 2.5 mg/atrop 0.025 mg per
5 ml (2 oz w. dropper)
attapulgite (C)(G)
Donnagel (OTC) 30 ml aft er each loose stool; max 7 doses/day
Pediatric: <2 years: not recommended; 2-6 years: 7.5 ml aft er each loose
stool; >6 years: same as adult
Liq: 600 mg/15 ml (120, 240 ml)
Donnagel Chewable Tab 2 tabs aft er each loose stool; max 14 tabs/day
Pediatric: <3 years: not recommended; 3-6 years: 1/2 tab aft er each stool;
max 7 doses/day; >6-12 years: 1 tab aft er each loose stool; max 7 tabs/day;
>12 years: same as adult
loperamide (B)(OTC)(G)
Imodium (OTC) 4-16 mg/day in divided doses
Pediatric: <5 years: not recommended; =5 years: same as adult
Cap: 2 mg
Imodium A-D (OTC) 4-16 mg/day in divided doses
Pediatric: <2 years: not recommended; 2-5 years (24-47 lb): 1 mg up to
tid x 2 days; 6-8 years (48-59 lb): 2 mg initially, then 1 mg aft er aft er each
loose stool; max 4 mg/day x 2 days; 9-11 years (60-95 lb): 2 mg initially,
then 1 mg aft er each loose stool; max 6 mg/day x 2 days; =12 years: same
as adult
Cplt: 2 mg; Liq: 1 mg/5 ml (2, 4 oz)
loperamide/simethicone (B)(OTC)(G)
Imodium Advanced 2 tabs chewed aft er loose stool, then 1 aft er the next loose
stool; max 4 tabs/day
Pediatric: 6-8 years: chew 1 tab aft er loose stool, then chew 1/2 tab aft er next
loose stool; 9-11 years: chew 1 tab aft er loose stool, then chew 1/2 tab aft er
next loose stool; max 3 tabs/day
Chew tab: loper 2 mg/simeth 125 mg
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DIARRHEA: TRAVELERS
ciprofloxacin (C) 500 mg bid x 3 days
Pediatric: <18 years: not recommended
Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry)
Cipro XR Tab: 500, 1000 mg ext-rel
ProQuin XR Tab: 500 mg ext-rel
Comment: ciprofloxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
rifaximin (C) 200 mg tid x 3 days; discontinue if diarrhea worsens or persists more
than 24 hours; not for use if diarrhea is accompanied by fever or blood in the stool or
if causative organism other than E. coli is suspected.
Pediatric: <12 years: not recommended; =12 years: same as adult
Xifaxan Tab: 200 mg
trimethoprim/sulfamethoxazole (C)(G) bid x 10 days
Pediatric: <2 months: not recommended; >2 months: 40 mg/kg/day of sulfamethoxazole
in 2 divided doses x 10 days; see page 587 for dose by weight
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg*
Bactrim Pediatric Suspension, Septra Pediatric Suspension
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy or
lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not recommended
DIGITALIS TOXICITY
Comment: Th e digitalis therapeutic index is narrow, 0.8-1.2 ng/mL. Whether acute
or chronic toxicity, the patient should be treated in the emergency department and/
or admitted to in-patient service for continued monitoring and care. Signs and
symptoms of digitalis toxicity include: loss of appetite, nausea, vomiting, abdominal
pain, diarrhea, visiual disturbances (diplopia, blurred, or yellow vision, yellow-green
halos around lights and other visual images, spots, blind spots), decreased urine
output, generalized edema, orthopnea, confusion, delerium, decreased consciousness,
potentially lethal cardiac arrhythmias (ranging from ventricular tachycardia
(VT) and ventricular fi brillation (VF) to sino-atrial heart block AVB). Treatment
measures include repeated doses of charcoal via NG tube administered aft er gastric
lavage for acute ingestion (methods to induce vomiting are usually discouraged
because vomiting can worsen bradyarrhythmias), digitalis binders. Monitoring
includes: serial ECGs, serum digitalis level, chemistries, potassium (hyperkalemia),
magnesium (hypomagnesemia), BUN and creatinine.
DIGOXIN BINDER
digoxin (immune fab [ovine])(B)
Digibind contents of one vial of Digibind neutralizes 0.5 mg digoxin; dose
based on amount of digoxin or digitoxin to be neutralized; see mfr pkg insert
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Pediatric: see mfr pkg insert
Vial: 38 mg
Digifab dose is based on amount of digoxin or digitoxin to be neutralized (see
mfr pkg insert for dosage; contents of 1 vial neutralizes 0.5 mg digoxin.
Pediatric: see mfr pkg insert
Vial: 40 mg for IV injection aft er reconstitution (preservative-free)
DIPHTHERIA
Prophylaxis see Childhood Immunizations page 478
POSTEXPOSURE PROPHYLAXIS FOR NON-IMMUNIZED PERSONS
erythromycin base (B)(G) 500 mg qid x 14 days
Pediatric: <45 kg: 50 mg/kg/day in 4 divided doses x 14 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 14 days
Pediatric: 30-50 mg/kg/day in 4 divided doses x 14 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.
Immunization Series
see Childhood Immunizations page 478
POSTEXPOSURE PROPHYLAXIS FOR IMMUNIZED PERSONS
Diphtheria immunization booster
DIVERTICULITIS
amoxicillin (B)(G) 500 mg q 8 hours or 875 mg q 12 hours x 7 days
Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg
(cherry-banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml
(80, 100, 150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble
gum); Oral drops: 50 mg/ml (30 ml) (bubble gum)
Moxatag Tab: 775 mg ext-rel
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Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80,
100, 150 ml) (raspberry-strawberry)
amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200,
400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana),
250 mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml)
(orange) (phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided
bid x 10 days see pages 556-557 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml)
(strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day
in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
ciprofloxacin (C) 500 mg bid x 7 days
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.
metronidazole (not for use in 1st; B in 2nd, 3rd)(G) 250-500 mg q 8 hours or 750
mg q 12 hours x 7 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 aft er therapy due to a possible disulfi ram-like reaction (nausea,
vomiting, flushing, headache).
trimethoprim/sulfamethoxazole (D)(G) bid x 7 days
Bactrim, Septra 2 tabs bid x 7 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 7 days
Tab: trim 160 mg/sulfa 800 mg*
Bactrim Pediatric Suspension, Septra Pediatric Suspension 20 ml bid x 7 days
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy
or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended
DIVERTICULOSIS
BULK-PRODUCING AGENTS
see Constipation page 95
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DRY EYE SYNDROME
OPHTHALMIC IMMUNOMODULATOR/ANTI-INFLAMMATORY
cyclosporine (C) 1 drop q 12 hours
Pediatric: <16 years: not recommended
Restasis Ophth emul: 0.05% (0.4 ml) (preservative-free)
Comment: Ophthalmic Immunomodulators are contraindicated with active ocular
infection. Allow at least 15 minutes between doses of artifi cial tears. May re-insert
contact lenses 15 minutes aft er treatment.
OCULAR LUBRICANTS
Comment: Remove contact lens prior to using an ocular lubricant.
dextran 70/hypromellose (NE) 1-2 drops prn
Pediatric: same as adult
Bion Tears (OTC) Ophth soln: single-use containers (28/pck) (preservative-free)
hydroxypropyl cellulose (NE) apply 1/2 inch ribbon or 1 insert in each inferior culde-
sac 1-2 times/day prn
Pediatric: same as adult
Lacrisert Ophth inserts: 5 mg (60/pck) (preservative-free)
Hypotears Ophthalmic Ointment (OTC) Ophth oint: 1% (3.5 g)
(preservative-free)
Comment: Place insert in the inferior cul-de-sac of the eye, beneath the base of the tarsus,
not in apposition to the cornea nor beneath the eyelid at the level of the tarsal plate.
hydroxypropyl methylcellulose (NE) 1-2 drops prn
Pediatric: same as adult
GenTeal Mild, GenTeal Moderate (OTC) Ophth soln: (15 ml) (perborate)
GenTeal Severe (OTC) Ophth soln: (15 ml) (carbopol 980, perborate)
petrolatum/mineral oil (NE) apply 1/2 inch ribbon prn
Pediatric: same as adult
Hypotears Ophthalmic Ointment (OTC) Ophth oint: 1% (3.5 g) (benzalkonium
chloride, alcohol 1%)
Hypotears PF Ophthalmic Ointment (OTC) Ophth oint: 1% (3.5 g) (preservative-
free, alcohol 1%)
Lacri-Lube (OTC) Ophth oint: 1% (3.5, 7 g)
Lacri-Lube NP (OTC) Ophth oint: 1% (0.7 g, 24/pck) (preservative-free)
petrolatum/lanolin/mineral oil (NE) apply 1/4 inch ribbon prn
Pediatric: same as adult
Duratears Naturale (OTC) Ophth oint: 3.5 g (preservative-free)
polyethylene glycol/glycerin/hydroxypropyl methylcellulose (NE) 1-2 drops prn
Pediatric: same as adult
Visine Tears (OTC) Ophth soln: 1% (15, 30 ml)
polyethylene glycol 400 0.4%/propylene glycol 0.3% (NE) 1-2 drops prn
Pediatric: same as adult
Systane (OTC) Ophth soln: (15, 30, 40 ml) (polyquaternium-1, zinc chloride);
Vial: 0.01 oz (28) (preservative-free)
Systane Ultra (OTC) Ophth soln: (10, 20 ml) (aminomethylpropanol, polyquaternium-
1, sorbitol (zinc chloride); Vial: 0.01 oz (24) (preservative-free)
polyvinyl alcohol (NE) 1-2 drops prn
Pediatric: same as adult
t
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126 ¦ Dr y Eye Syndrome
Hypotears (OTC) Ophth soln: 1% (15, 30 ml)
Hypotears PF (OTC) 1-2 drops q 3-4 hours prn
Ophth soln: 1% (0.02 oz single-use containers, 30/pck) (preservative-free)
propylene glycol 0.6% (NE) 1-2 drops prn
Pediatric: same as adult
Systane Balance (OTC) Ophth soln: (10 ml) (polyquaternium-1)
DYSHIDROSIS
Topical Corticosteroids see page 506
Comment: Intermediate to high potency ophthalmic steroid treatment is indicated for
dyshidrosis.
DYSFUNCTIONAL UTERINE BLEEDING (DUB)
medroxyprogesterone acetate (X) 10 mg daily x 10-13 days
Provera Tab: 2.5, 5, 10 mg
Oral contraceptives (X) with 35 mcg estrogen equivalent
see Combined Oral Contraceptives page 486
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
DYSLIPIDEMIA (HYPERCHOLESTEROLEMIA,
HYPERLIPIDEMIA, MIXED DYSLIPIDEMIA)
OMEGA 3-FATTY ACID ETHYL ESTERS
Comment: Vascepa, Lovaza, and Epanova are indicated for the treatment of TG =500
mg/dL.
icosapent ethyl (omega 3-fatty acid ethyl ester of EPA) (C) 2 caps bid with food; max
4 g/day; swallow whole, do not crush or chew
Pediatric: <18 years: not recommended
Vascepa sgc: 0.5, 1 g (a-tocopherol 4 mg/cap)
omega 3-fatty acid ethyl esters (C)(G) 2 g bid or 4 g once daily; swallow whole, do
not crush or chew
Pediatric: <18 years: not recommended
Lovaza Soft gelcap: 1 g (a-tocopherol 4 mg/cap) omega 3-carcartonyl acids (C)
take 2-4 gel caps (2-4 g) daily without regard to meals
Epanova Gelcap: 1 g
MICROSOMAL TRIGLYCERIDE-TRANSFER PROTEIN (MTP) INHIBITOR
lomitapide mesylate (X) 10 mg daily
Pediatric: not established
Juxtapid Cap: 5, 10, 20 mg
Comment: Juxtapid is an adjunct to low-fat diet and other lipid-lowering
treatments, including LDL apheresis where available, to reduce LDL-C, total
cholesterol, apoB, and non-HDL-C in patients with homozygous familial
hypercholesterolemia (HoFH); not for patients with hypercholesterolemia who
do not have HoFH. y
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D y s l i p i d e m i a ¦ 127
OLIGONUCLEOTIDE INHIBITOR OF APO B-100 SYNTHESIS
mipomersen (B) administer 200 mg SC once weekly, on the same day, in the upper arm,
abdomen, or thigh; administer 1st injection under appropriate professional supervision
Pediatric: not established
Kynamro Vial/Prefi lled syringe: 200 mg mg/ml soln for SC inj single-use vial
(preservative-free)
Comment: Kynamro is an adjunct to low-fat diet and other lipid-lowering
treatments, to reduce LDL-C, apo-B, total cholesterol (TC), non-HDL-C in
patients with homozygous familial hypercholesterolemia (HoFH).
CHOLESTEROL ABSORPTION INHIBITOR
ezetimibe (C)(G) 10 mg daily
Pediatric: <10 years: not recommended; =10 years: same as adult
Zetia Tab: 10 mg
Comment: ezetimibe is contraindicated with concomitant statins in liver disease,
persistent elevations in serum transaminase, pregnancy, and nursing mothers.
Concomitant fi brates are not recommended. Potentiated by fenofi brate, gemfi brozil,
and possibly cyclosporine. Separate dosing of bile acid sequestrants is required; take
ezetimibe at least 2 hours before or 4 hours aft er.
PROPROTEIN CONVERTASE SUBTILISIN KEXIN TYPE 9 (PCSK9) INHIBITOR
Comment: PCSK9 inhibitors are an adjunct to maximally tolerated statin therapy in
persons who require additional lowering of LDL-C.
alirocumab (NE)
Pediatric: not established
Praluent administer SC in the upper outer arm, abdomen, or thigh; initially
75 mg SC once every 2 weeks; measure LDL 4-8 weeks aft er initiation or titration;
if inadequate response, may increase to 150 mg SC every 2 weeks
Soln for SC inj: 75, 150 mg/ml single-use prefi lled syringe (preservative-free)
Comment: Although Praluent, does not have an assigned pregnancy category, it
is contraindicated in the 2nd and 3rd trimester of pregnancy.
evolocumab (NE)
Pediatric: HeFH, primary hyperlipidemia: not established; HoFH: <13 years: not
established; >13 years: same as adult
Repatha administer SC in the upper outer arm, elbow, or thigh; measure LDL
4-8 weeks aft er initiation; HeFH or primary hyperlipidemia: 140 mg SC once
every 2 weeks or 420 mg once monthly; HoFH: 420 mg once monthly
Soln for SC inj: single-use prefi lled syringe; 140 mg/syringe; single-use prefi
lled SureClick autoinjector (140 mg/syringe preservative-free)
Comment: To administer 420 mg of Repatha, administer 150 mg SC x 3 within
30 minutes. Although Repatha, does not have an assigned pregnancy category,
it is contraindicated in pregnancy.
HMG-COA REDUCTASE INHIBITORS (STATINS)
Comment: Th e statins decrease total cholesterol, LDL-C, TG, and apo-B, and increase
HDL-C. Before initiating and at 4-6 weeks, 3 months, and 6 months of therapy,
check fasting lipid profi le and LFTs. Side eff ects include myopathy and increased
liver enzymes. Relative contraindications include concomitant use of cyclosporine,
y y y y
128 ¦ D y s l i p i d e m i a
a macrolide antibiotic, various oral antifungal agents, and CYP-450 inhibitors. An
absolute contraindication is active or chronic liver disease.
atorvastatin (X)(G) initially 10 mg daily; usual range 10-80 mg/day
Pediatric: <10 years: not recommended; =10 years (female post-menarche): same
as adult
Lipitor Tab: 10, 20, 40, 80 mg
fluvastatin (X)(G) initially 20-40 mg q HS; usual range 20-80 mg/day
Pediatric: <18 years: not recommended
Lescol Cap: 20, 40 mg
Lescol XL Tab: 80 mg ext-rel
lovastatin (X)
Mevacor initially 20 mg daily at evening meal; may increase at 4-week intervals;
max 80 mg/day in single or divided doses; if concomitant fi brates, niacin, or
CrCl <30 mL/min, usual max 20 mg/day
Pediatric: <10 years: not recommended; 10-17 years: initially 10-20 mg daily
at evening meal; may increase at 4-week intervals; max 40 mg daily
Tab: 10, 20, 40 mg
Altoprev initially 20 mg daily at evening meal; may increase at 4-week intervals;
max 60 mg/day; if concomitant fi brates, or niacin; >1 g/day, usual max
40 mg/day; if concomitant cyclosporine, amiodarone, or verapamil, or CrCl
<30 mL/min, usual max 20 mg/day
Pediatric: <20 years: not recommended
Tab: 10, 20, 40, 60 mg ext-rel
pitavastatin (X) initially 2 mg q HS; may increase to 4 mg aft er 4 weeks; max 4 mg/
day; if concomitant erythromycin or CrCl <60 ml/min; 1 mg/day with usual max
2 mg/day; if concomitant rifampin, max 2 mg once daily
Pediatric: not established
Livalo Tab: 1, 2, 4 mg
pravastatin (X) initially 10-20 mg q HS; usual range 10-40 mg/day; may start at
40 mg/day
Pediatric: <8 years: not recommended; 8-13 years: 20 mg daily; 14-18 years: 40 mg daily
Pravachol Tab: 10, 20, 40, 80 mg
rosuvastatin (X)(G) initially 10-20 mg q HS; usual range 5-40 mg/day; adjust at 4-week
intervals
Pediatric: <10 years: not recommended; 10-17 years: 5-20 mg/day; max 20 mg/day
Crestor Tab: 5, 10, 20, 40 mg
simvastatin (X) initially 20 mg q PM; usual range 5-80 mg/day; adjust at 4-week
intervals
Pediatric: <10 years: not recommended; =10 years (female postmenarche): same as adult
Zocor Tab: 5, 10, 20, 40, 80 mg
CHOLESTEROL ABSORPTION INHIBITOR/HMG-COA REDUCTASE
INHIBITOR COMBINATION
ezetimibe/simvastatin (X)(G) Take once daily in the PM; may start at 10/40; swallow
whole
Pediatric: <17 years: not recommended
Tab: Vytorin 10/10 ezet 10 mg/simva 10 mg
Vytorin 10/20 ezet 10 mg/simva 20 mg
Vytorin 10/40 ezet 10 mg/simva 40 mg
Vytorin 10/80 ezet 10 mg/simva 80 mg y
y
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D y s l i p i d e m i a ¦ 129
ISOBUTYRIC ACID DERIVATIVES AND FIBRATE
Comment: Th ese agents decrease total cholesterol, LDL-C, and TG; increase HDL-C.
Th ey are indicated when the primary problem is very high TG level. Side eff ects
include epigastric discomfort, dyspepsia, abdominal pain, cholelithiasis, myopathy,
and neutropenia. Before initiating, and at 4-6 weeks, 3 months, and 6 months of
therapy, check fasting CBC, lipid profi le, LFT, and serum creatinine. Absolute
contraindications include severe renal disease and severe hepatic disease.
ISOBUTYRIC ACID DERIVATIVES
gemfi brozil (C)(G) 600 mg bid 30 minutes before AM and PM meal
Pediatric: not recommended
Lopid Tab: 600*mg
FIBRATES (FIBRIC ACID DERIVATIVES)
fenofi brate (C)(G) take with meals; adjust at 4- to 8-week intervals; discontinue if
inadequate response aft er 2 months; lowest dose or contraindicated with renal impairment
and the elderly
Pediatric: not recommended
Antara 43-130 mg daily; max 130 mg/day
Cap: 43, 87, 130 mg
Fenoglide 40-120 mg daily; max 120 mg/day
Tab: 40, 120 mg
FibriCor 30-105 mg daily; max 105 mg/day
Tab: 30, 105 mg
TriCor 48-145 mg daily; max 145 mg/day
Tab: 48, 145 mg
TriLipix 45-135 mg daily; max 135 mg/day
Cap: 45, 135 mg del-rel
Lipofen 50-150 mg daily; max 150 mg/day
Cap: 50, 150 mg
Lofi bra 67-200 mg daily; max 200 mg/day
Tab: 67, 134, 200 mg
NICOTINIC ACID DERIVATIVES
Comment: Nicotinic acid derivatives decrease total cholesterol, LDL-C, and TG;
increase HDL-C. Before initiating and at 4-6 weeks, 3 months, and 6 months of
therapy, check fasting lipid profi le, LFT, glucose, and uric acid. Side eff ects include
hyperglycemia, upper GI distress, hyperuricemia, hepatotoxicity, and signifi cant
transient skin flushing. Take with food and take aspirin 325 mg 30 minutes before dose
to decrease flushing. Relative contraindications include diabetes, hyperuricemia (gout),
and PUD and absolute contraindications include severe gout and chronic liver disease.
niacin (C)
Niaspan (G) 375 mg daily for 1st week, then 500 mg daily for 2nd week, then
750 mg daily for 3rd week, then 1 g daily for weeks 4-7; may increase by 500 mg
q 4 weeks; usual range 1-2 g/day; max 2 g/day
Pediatric: <21 years: not recommended
Tab: 500, 750, 1000 mg ext-rel
Slo-Niacin one 250 or 500 mg tab q AM or HS or one-half 750 mg tab q AM or HS
y y y
130 ¦ D y s l i p i d e m i a
Pediatric: not recommended
Tab: 250, 500, 750 mg cont-rel
BILE ACID SEQUESTRANTS
Comment: Bile acid sequestrants decrease total cholesterol, LDL-C, and increase
HDL-C, but have no eff ect on triglycerides. A relative contraindication is TG =200
mg/dL and an absolute contraindication is TG =400 mg/dL. Before initiating and at
4-6 weeks, 3 months, and 6 months of therapy, check fasting lipid profi le. Side eff ects
include sandy taste in mouth, abdominal gas, abdominal cramping, and constipation.
Th ese agents decrease the absorption of many other drugs.
cholestyramine (C)
Pediatric: see mfr pkg insert
Questran Powder for Oral Suspension initially 1 pkt or scoop daily; usual maintenance
2-4 pkts or scoops daily in 2 divided doses; max 6 pkts or scoops daily
Pwdr: 9 g pkts; 9 g equals 4 g anhydrous cholestyramine resin for reconstitution
(60/pck); Bulk can: 378 g w. scoop
Questran Light initially 1 pkt or scoop daily; usual maintenance 2-4 pkts or
scoops daily in 2 doses
Light: 5 g pkts; 5 g equals 4 g anhydrous cholestyramine resin (60/pck): Bulk
can: 210 g w. scoop
colesevelam (B)
Monotherapy: 3 tabs bid or 6 tabs once daily or one 1.875 g pkt bid or one
3.75 g pkt once daily
Pediatric: not recommended
WelChol Tab: 625 mg; Pwdr for oral susp: 1.875 g pwdr pkts (60/carton); 3.75 g
pwdr pkts (30/carton) (citrus) (phenylalanine)
Comment: WelChol is indicated as adjunctive therapy to improve glycemic
control in adults with type 2 diabetes. It can be added to metformin,
sulfonylureas, or insulin alone or in combination with other antidiabetic agents
colestipol (C)
Pediatric: not recommended
Colestid tabs: 2-16 g daily in a single or divided doses; granules: 5-30 g daily in
a single or divided dose
Tabs: 1 g (120); Granules: unflavored: 5 g pkt (30, 90/carton); unflavored
bulk: 300, 500 g w. scoop; orange-flavored: 7.5 g pkt (60/carton) (aspartame);
orange-flavored bulk: 450 g w. scoop (aspartame) flavored: 7.5 g pkt; flavored
bulk: 450 g w. scoop
Colestid Tab initially 2 g bid; increase by 2 g bid at 1-2-month intervals; usual
maintenance 2-16 g/day
Tab: 1 g
Comment: colestipol lowers LDL and total cholesterol.
ANTILIPID COMBINATIONS
Nicotinic Acid Derivative/HMG-CoA Reductase Inhibitors
niacin/lovastatin (X)
Pediatric: <18 years: not recommended
Advicor swallow whole at bedtime with a low-fat snack; may pretreat with
aspirin; start at lowest niacin dose; may titrate niacin by no more than 500 mg/
day every 4 weeks; max 2000/40 daily
y y y y
Dysmenorrhea: P r i m a r y ¦ 131
Tab: Advicor 500/20 nia 500 mg ext-rel/lova 20 mg
Advicor 750/20 nia 750 mg ext-rel/lova 20 mg
Advicor 1000/20 nia 1000 mg ext-rel/lova 20 mg
Advicor 1000/40 nia 1000 mg ext-rel/lova 40 mg
niacin/simvastatin (X)
Pediatric: <18 years: not recommended
Simcor swallow whole at bedtime with a low-fat snack; may pretreat with
aspirin; start at lowest niacin dose; may titrate niacin by no more than 500 mg/
day every 4 weeks; max 2000/40 daily
Tab: Simcor 500/20 nia 500 mg ext-rel/simva 20 mg
Simcor 750/20 nia 750 mg ext-rel/simva 20 mg
Simcor 1000/20 nia 1000 mg ext-rel/simva 20 mg
Simcor 500/40 nia 500 mg ext-rel/simva 40 mg
Simcor 1000/40 nia 1000 mg ext-rel/simva 40 mg
ANTIHYPERTENSIVE/ANTILIPID COMBINATIONS
Calcium Channel Blocker/HMG-CoA Reductase Inhibitor (Statin) Combinations
amlodipine/atorvastatin (X)(G)
Caduet select according to blood pressure and lipid values; titrate amlodipine
over 7-14 days; titrate atorvastatin according to monitored lipid values;
max amlodipine 10 mg/day and max atorvastatin 80 mg/day; refer to
contraindications and precautions for CCB and statin therapy
Pediatric: <10 years: not recommended; =10 years (female, post-menarche):
same as adult
Tab: Caduet 5/10 amlo 5 mg/ator 10 mg
Caduet 5/20 amlo 5 mg/ator 20 mg
Caduet 5/40 amlo 5 mg/ator 40 mg
Caduet 5/80 amlo 5 mg/ator 80 mg
Caduet 10/10 amlo 10 mg/ator 10 mg
Caduet 10/20 amlo 10 mg/ator 20 mg
Caduet 10/40 amlo 10 mg/ator 40 mg
Caduet 10/80 amlo 10 mg/ator 80 mg
DYSMENORRHEA: PRIMARY
Acetaminophen for IV Infusion see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
BENZENEACETIC ACID DERIVATIVE
diclofenac (C) 50-100 mg once; then 50 tid
Pediatric: <14 years: not recommended; =14 years: same as adult
Cataflam Tab: 50 mg
Voltaren Tab: 25, 50, 75 mg ent-coat
Voltaren-XR Tab: 100 mg ext-rel
Comment: diclofenac is contraindicated with aspirin allergy and late (=30 weeks)
pregnancy.
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132 ¦ Dysmenorrhea: P r i m a r y
FENAMATE
mefenamic acid (C) 500 mg once; then 250 mg q 6 hours for up to 2-3 days; take with food
Pediatric: <14 years: not recommended
Ponstel Cap: 250 mg
Comment: Avoid aspirin with a fenamate.
COX-2 INHIBITORS
Comment: Cox-2 inhibitors are contraindicated with history of asthma, urticaria, and
allergic-type reactions to aspirin, other NSAIDs, and sulfonamides, 3rd trimester of
pregnancy, and coronary artery bypass graft (CABG) surgery.
celecoxib (C)(G) 400 mg x 1 dose; then 200 mg more on 1st day if needed; then
400 mg daily-bid; max 800 mg/day
Pediatric: <18 years: not recommended
Celebrex Cap: 50, 100, 200, 400 mg
meloxicam (C)(G) initially 7.5 mg once daily; max 15 mg once daily
Pediatric: <2 years: not recommended; =2 years: 0.125 mg/kg; max 7.5 mg once daily
Mobic Tab: 7.5, 15 mg; Oral susp: 7.5 mg/5 ml (100 ml) (raspberry)
Vivlodex Cap: 5, 10 mg
Combined Oral Contraceptives see page 486
DYSPAREUNIA, POSTMENOPAUSAL/
PAINFUL INTERCOURSE
Comment: Vulvar and vaginal atrophy due to menopause can cause painful intercourse.
Oral Hormonal and Transdermal Th erapy see Menopause page 264
NONHORMONAL THERAPY
ospemifene
Osphena Tab: 60 mg
VAGINAL PREPARATIONS (WITHOUT UTERUS)
Comment: Vaginal preparations provide relief from vaginal and urinary symptoms
only (i.e., atrophic vaginitis, dyspareunia, dysuria, and urinary frequency).
estradiol (X)(G)
Vagifem Tabs insert one 10 mcg or 25 mcg vaginal tablet once daily x 2 weeks;
then twice weekly x 2 weeks (e.g., tues/fri); consider the addition of a progestin
Vag tab: 10, 25 mcg (8, 18/blister pck with applicator)
Yuvafem Vaginal Tablet insert one 10 mcg or 25 mcg vaginal tablet once daily
x 2 weeks; then twice weekly x 2 weeks (e.g., tues/fri); consider the addition of
a progestin
Vag tab: 10, 25 mcg (8, 18/blister pck with applicator)
prasterone (dehydroepiandrosterone [DHEA]) (X) 1 tab intravaginally daily
Intrarosa Tabs Vag tab: 10, 25 mcg (8, 18/blister pck with applicator)
Comment: prosterone is an active endogenous steroid converted into active
androgens and/or estrogens.
Vag tab: 6.5 mg (7 tabs, 4 blister packs)
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Edema ¦ 133
EDEMA
THIAZIDE DIURETICS
chlorthalidone (B)(G) initially 30-60 mg daily or 60 mg on alternate days; max
90-120 mg/day
Th alitone Tab: 15 mg
chlorothiazide (B)(G) 0.5-1 g/day in a single or divided doses; max 2 g/day
Pediatric: <6 months: up to 15 mg/lb/day in 2 divided doses; =6 months: 10 mg/lb/
day in 2 divided doses; max 375 mg/day
Diuril Tab: 250*, 500*mg; Oral susp: 250 mg/5 ml (237 ml)
hydrochlorothiazide (B)(G)
Pediatric: not recommended
Esidrix 25-200 mg daily
Tab: 25, 50, 100 mg
Microzide 12.5 mg daily; usual max 50 mg/day
Cap: 12.5 mg
hydroflumethiazide (B) 50-200 mg/day in a single or 2 divided doses
Pediatric: not recommended
Saluron Tab: 50 mg
methyclothiazide/deserpidine (B) initially 2.5 mg daily; max 5 mg daily
Pediatric: not recommended
Enduronyl Tab: methy 5 mg/deser 0.25 mg*
Enduronyl Forte Tab: methy 5 mg/deser 0.5 mg*
polythiazide (C) 1-4 mg daily
Pediatric: not recommended
Renese Tab: 1, 2, 4 mg
POTASSIUM-SPARING DIURETICS
amiloride (B)(G) initially 5 mg; may increase to 10 mg; max 20 mg
Pediatric: not recommended
Tab: 5 mg
spironolactone (D)(G) initially 25-200 mg in a single or divided doses; titrate at
2-week intervals
Pediatric: not recommended
Aldactone Tab: 25, 50*, 100*mg
triamterene (B) 100 mg bid; max 300 mg
Pediatric: not recommended
Dyrenium Cap: 50, 100 mg
LOOP DIURETICS
bumetanide (C)(G) 0.5-2 mg daily; Tab: 5 mg; may repeat at 4-5 hour intervals; max
10 mg/day
Pediatric: <18 years: not recommended
Tab: 1* mg
Comment: bumetanide is contraindicated with sulfa drug allergy.
ethacrynic acid (B)(G) initially 50-100 mg once daily-bid; max 400 mg/day
Pediatric: Infants: not recommended; =1 month: initially 25 mg/day; then adjust
dose in 25 mg increments
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134 ¦ Edema
Edecrin Tab: 25, 50 mg
ethacrynate sodium (B)(G) for IV injection
Sodium Edecrin Vial: 50 mg single-dose
Comment: Sodium Edecrin is more potent than more commonly used loop and
thiazide diuretics.
furosemide (C)(G) initially 20-80 mg as a single dose
Pediatric: not recommended
Lasix Tab: 20, 40*, 80 mg; Oral soln: 10 mg/ml (2, 4 oz w. dropper)
Comment: furosemide is contraindicated with sulfa drug allergy.
torsemide (B) 5 mg daily; may increase to 10 mg daily
Pediatric: not recommended
Demadex Tab: 5*, 10*, 20*, 100*mg
OTHER DIURETICS
indapamide (B) initially 1.25 mg daily; may titrate every 4 weeks if needed; max
5 mg/day
Pediatric: not recommended
Lozol Tab: 1.25, 2.5 mg
Comment: indapamide is contraindicated with sulfa drug allergy.
metolazone (B)
Pediatric: not recommended
Mykrox initially 0.5 mg q AM; max 1 mg/day
Tab: 0.5 mg
Zaroxolyn 2.5-5 mg once daily
Tab: 2.5, 5, 10 mg
Comment: metolazone is contraindicated with sulfa drug allergy.
DIURETIC COMBINATIONS
amiloride/hydrochlorothiazide (B)(G) initially 1 tab daily; may increase to 2 tabs/day
in a single or divided doses
Pediatric: not recommended
Moduretic Tab: amil 5 mg/hydro 50 mg*
spironolactone/hydrochlorothiazide (D)(G) usual maintenance is 100 mg each of
spironolactone and hydrochlorothiazide daily, in a single dose or in divided doses;
range 25-200 mg of each component daily depending on the response to the initial
titration
Pediatric: not recommended
Aldactazide 25
Tab: spiro 25 mg/hydro 25 mg
Aldactazide 50
Tab: spiro 50 mg/hydro 50 mg
triamterene/hydrochlorothiazide (C)(G)
Pediatric: not recommended
Dyazide 1-2 caps once daily
Cap: triam 37.5 mg/hydro 25 mg
Maxzide 1 tab once daily
Tab: triam 75 mg/hydro 50 mg*
Maxzide-25 1-2 tabs once daily
Tab: triam 37.5 mg/hydro 25 mg*
y y y y y y y y
Emphysema ¦ 135
EMPHYSEMA
Inhaled Corticosteroids see Asthma page 34
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Inhaled Beta Agonists (Bronchodilators) see Asthma page 31
Oral Beta-Agonists (Bronchodilators) see Asthma page 35
LONG-ACTING INHALED BETA AGONIST (LABA)
indacaterol (C)
Arcapta Neohaler inhale contents of one 75 mcg cap once daily
Neohaler Device/Cap: 75 mcg (5 blister cards, 6 caps/card)
Comment: Remove cap from blister cap immediately before use. For oral
inhalation with neohaler device only. Arcapta Neohaler is indicated for the longterm
maintenance treatment of bronchoconstriction in persons with COPD. It is
not indicated for treating asthma, for primary treatment of acute symptoms, or
for acute deterioration of COPD.
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)
CORTICOSTEROID/INHALED LONG-ACTING BETA-AGONIST (LABA)
fluticasone furoate/vilanterol (C) 1 inhalation 100/25 or 200/25 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.
INHALED ANTICHOLINERGICS (ANTIMUSCARINICS)
ipratropium (B)(G)
Atrovent 2 inhalations qid; max 12 inhalations/day
Inhaler: 14 g (200 inh)
Atrovent Inhaled Solution 500 mcg by nebulizer tid to qid
Inhal soln: 0.02%; 500 mcg (2.5 ml)
INHALED LONG-ACTING ANTICHOLINERGICS (ANTIMUSCARINICS)
Comment: Inhales LAA’s are indicated 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). Avoid
other anticholinergic agents.
t
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136 ¦ Emphysema
aclidinium bromide (C) 1 inhalation twice daily using inhaler
Pediatric: not recommended
Tudorza Pressair Inhal device: 400 mcg/actuation (60 doses per inhalation device)
INHALED LONG-ACTING ANTICHOLINERGICS
glycopyrrolate (C) inhale the contents of 1 capsule 2 x/day at the same times of day,
AM and PM, using the neohaler; do not swallow caps
Pediatric: not established
Seebri Neohaler Inhal cap: 15.6 mcg (60/blister pck) dry pwdr for inhalation w.
1 Neohaler device (lactose)
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).
umeclidinium (C) one inhalation once daily at the same time each day
Pediatric: not established
Incruse Ellipta Inhal pwdr: 62.5 mcg/inhalation (30 doses) (lactose)
Comment: Incruse Ellipta is contraindicated with allergy to atropine or its derivatives.
INHALED BRONCHODILATOR/ANTICHOLINERGIC COMBINATION
ipratropium/albuterol (C)
Combivent MDI 2 inhalations qid; max 12 inhalations/day
Inhaler: 14.7 g (200 inh)
INHALED ANTICHOLINERGIC/LONG-ACTING BETA
AGONIST (LABA) COMBINATIONS
indacaterol/glycopyrrolate (C)
Utibron Neohaler inhale the contents of 1 capsule 2 x/day at the same times of
day, AM and PM, using the neohaler; do not swallow caps
Inhal cap: indac 27.5 mcg/glycop 15.6 mcg per cap (60/blister pck) dry pwdr
for inhalation w. 1 Neohaler device (lactose)
ipratropium/albuterol (C) 1 inhalation qid; max 6 inhalations/day
Combivent Respimat Inhal soln: ipra 20 mcg/alb 100 mcg per inhal (4 g, 120 inhal)
Comment: When the labeled number of metered actuations (120) has been
dispensed from the Combivent Respimat inhaler, the locking mechanism
engages and no more actuations can be dispensed. Combivent Respimat is
contraindicted with atropine allergy.
tiotropium/olodaterol (C) 2 inhalations once daily at the same time each day; max 2
inhalations/day
Stiolto Respimat Inhal soln: tio 2.5 mcg/olo 2.5 mcg per actuation (4 g, 60 inh)
(benzalkonium chloride)
Comment: Stiolto Respimat is not for treating asthma, for relief of acute
bronchospasm, or acutely deteriorating COPD. y
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E n d o m e t r i o s i s ¦ 137
umeclidinium/vilanterol (C) 1 inhalation once daily at the same time each day
Anoro Ellipta Inhal soln: ume 62.5 mcg/vila 25 mcg per inhal (30 doses)
Comment: Anoro Ellipta is contraindicated with severe hypersensitivity to milk
proteins.
METHYLXANTHINES
see Asthma page 28
METHYLXANTHINE/EXPECTORANT COMBINATION
dyphylline/guaifenesin (C)
Pediatric: not recommended
Lufyllin GG 1 tab qid
Tab: dyph 200 mg/guaif 200 mg
Lufyllin GG Elixir 30 ml qid
Elix: dyph 100 mg/guaif 100 mg per 15 ml (16 oz)
OTHER METHYLXANTHINE COMBINATION
theophylline/potassium iodide/ephedrine/phenobarbital (X)(II) 1 tab tid-qid prn; add
an additional dose q HS as needed
Pediatric: <6 years: not recommended; =6-12 years: 1/2 tab tid
Quadrinal Tab: theo 130 mg/pot iod 320 mg/ephed 24 mg/phenol 24 mg
ENCOPRESIS
INITIAL BOWEL EVACUATION
mineral oil (C) 1 oz x 1 day
bisacodyl (B)
Pediatric: <12 years: 1/2 suppository daily pen
Dulcolax Rectal supp: 10 mg
glycerin suppository
Pediatric: <6 years: 1 pediatric suppository; =6 years: 1 adult suppository
MAINTENANCE
mineral oil (C) 5-15 ml once daily
multivitamin (A) 1 daily
Comment: Mineral oil can inhibit absorption of fat-soluble vitamins.
ENDOMETRIOSIS
Acetaminophen for IV Infusion see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Contraceptives see page 486
- medroxyprogesterone (X)30 mg daily
Provera Tab: 2.5, 5, 10 mg - medroxyprogesterone acetate injectable (X)100-400 mg IM monthly
Depo-Provera Injectable: 300 mg/ml (2.5, 10 ml) - norethindrone acetate (X)initially 5 mg daily x 2 weeks; then increase by 2.5 mg/day every 2 weeks up to 15 mg/day maintenance dose; then continue for 6 to 9 months unless breakthrough bleeding is intolerable
Aygestin Tab: 5*mg
GONADOTROPIN-RELEASING HORMONE ANALOGS
- goserelin (GnRH analogue) implant (X)implant SC into upper abdominal wall; 1 SC implant q 28 days for up to 6 months; re-treatment not recommended
Pediatric: <18 years: not recommended
Zoladex SC implant in syringe: 3.6 mg - leuprolide acetate (GnRH analogue) (X)
Pediatric: <18 years: not recommended
Lupron Depot 3.75 mg 3.75 mg SC monthly for up to 6 months; may repeat one 6-month cycle
Syringe: 3.75 mg (single-dose depo susp for SC injection)
Lupron Depot-3 Month 22.5 mg SC q 3 months (84 days); max 2 injections
Syringe: 22.5 mg (single-dose depo susp for IM injection)
Comment: Do not split doses. - nafarelin acetate (X)1 spray (200 mcg) into one nostril q AM, then 1 spray (200 mcg) into the other nostril q PM x 6 months; if no response aft er 2 months, may increase to 2 sprays (400 mcg) bid
Synarel Nasal spray: 2 mg/ml (10 ml)
Comment: Start on 3rd or 4th day of menstrual period or aft er a negative pregnancy test.
OTHER AGENTS
- danazol (X)initially 400 mg bid; gradual downward titration of dosage may be considered dependent upon patient response; mild cases may respond to 100-200 mg bid
Danocrine Cap: 50, 100, 200 mg
ENURESIS: PRIMARY, NOCTURNAL
VASOPRESSIN
desmopressin acetate (B)
DDAVP usual dosage 0.1-1.2 mg/day in 2-3 divided doses; 0.2 mg q HS prn for
nocturnal enuresis
Pediatric: <6 years: not recommended
Tab: 0.1*, 0.2*mg
DDAVP Rhinal Tube
Pediatric: <6 years: not recommended; =6 years: 10 mcg or 0.1 ml of soln
each nostril (20 mcg total dose) q HS prn; max 40 mcg total dose
Nasal spray: 10 mcg/actuation (5 ml, 50 sprays); Rhinal tube: 0.1 mg/ml (2.5 ml)
TRICYCLIC ANTIDEPRESSANT(TCA)
imipramine (C)(G)
Pediatric: <6 years: not recommended; 6-12 years: 25 mg 1 hour before bedtime;
aft er 1 week, may increase to 50 mg; max 50 mg; >12 years: 25 mg 1 hour before
bedtime; aft er 1 week, may increase to 50 mg; max 75 mg; Early night bedwetters:
administer 25 mg in the aft ernoon and repeat at bedtime; max 2.5 mg/kg/day
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E p i d i d y m i t i s ¦ 139
Comment: If drug response favorable, consider gradual tapering and attempting
drug-free periods.
Tofranil initially 75 mg daily (max 200 mg); if maintenance dose exceeds 75 mg
daily, may switch to Tofranil PM for divided or bedtime dose
Tab: 10, 25, 50 mg
Tofranil PM initially 75 mg 1 hour before HS; max 200 mg
Cap: 75, 100, 125, 150 mg
EPICONDYLITIS
Acetaminophen for IV Infusion see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Topical/Transdermal NSAIDs see Pain page 307
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Topical Analgesic and Anesthetic Agents see page 499
EPIDIDYMITIS
Comment: Th e following treatment regimens for epididymitis are published in the 2015
CDC Transmitted Diseases Treatment Guidelines. Treatment regimens are presented by
generic drug name fi rst, followed by information about brands and dose forms. Empiric
treatment requires concomitant treatment of chlamydia. Treat all sexual contacts. Patients
who are HIV-positive should receive the same treatment as those who are HIV-negative.
RECOMMENDED REGIMEN
Regimen 1
ceft riaxone (B)(G) 250 mg IM in a single dose
plus
doxycycline (D)(G) 100 mg bid x 10 days
RECOMMENDED REGIMENS: LIKELY CAUSED BY ENTERIC ORGANISMS
Regimen 1
levofloxacin (C) 500 mg daily x 10 days
Regimen 2
ofloxacin (C)(G) 300 mg bid x 10 day
DRUG BRANDS AND DOSE FORMS
ceft riaxone (B)(G)
Rocephin Vial: 250, 500 mg; 1, 2 g
doxycycline (D)(G)
Actilate Tab: 75, 150**mg
Adoxa Tab: 50, 75, 100, 150 mg ent-coat
Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
Monodox Cap: 50, 75, 100 mg
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140 ¦ E p i d i d y m i t i s
Oracea Cap: 40 mg del-rel
Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple)
(sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
Vibra-Tab Tab: 100 mg fi lm-coat
Comment: doxycycline is contraindicated <8 years-of-age, in pregnancy, and
lactation (discolors developing tooth enamel). A side eff ect may be photo-sensitivity
(photophobia). Do not give with antacids, calcium supplements, milk or other dairy,
or within two hours of taking another drug.
levofloxacin (C)
Levaquin Tab: 250, 500, 750 mg; Oral soln: 25 mg/ml (480 ml) (benzyl alcohol)
Comment: levofloxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
ofloxacin (C)(G)
Floxin Tab: 200, 300, 400 mg
Comment: ofloxacin is contraindicated <18 years-of-age, and during pregnancy and
lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
ERECTILE DYSFUNCTION (ED)
Comment: Due to a degree of cardiac risk with sexual activity, consider cardiovascular
status of patient before instituting therapeutic measures for erectile dysfunction.
PHOSPHODIESTERASE TYPE 5 (PDE5) INHIBITORS, CGMP-SPECIFIC
Comment: Oral PDE5 inhibitors (Cialis, Levitra, Staxyn, Viagra) are contraindicated
in patients taking nitrates. Caution with history of recent MI, stroke, life-threatening
arrhythmia, hypotension, hypertension, cardiac failure, unstable angina, retinitis
pigmentosa, CYP3A4 inhibitors (e.g., cimetidine, the azoles, erythromycin, grapefruit
juice), protease inhibitors (e.g., ritonavir), CYP3A4 inducers (e.g., rifampin,
carbamazepine, phenytoin, phenobarbital), alcohol, antihypertensive agents. Side eff ects
include headache, flushing, nasal congestion, rhinitis, dyspepsia, and diarrhea. Use with
caution in patients with anatomical deformation of the penis (e.g., angulation, cavernosal
fi brosis, or Peyronie’s disease) or in patients who have conditions, which may predispose
them to priapism (e.g., sickle cell anemia, multiple myeloma, or leukemia). In the event
of an erection that persists longer than 4 hours, the patient should seek immediate
medical assistance. If priapism (painful erection greater than 6 hours in duration) is not
treated immediately, penile tissue damage and permanent loss of potency could result.
avanafi l (B) initially 100 mg taken 30 min prior to sexual activity; may decrease to
50 mg or increase to 200 mg based on response; max one administration/day
Stendra Tab: 50, 100, 200 mg
sildenafi l citrate (B)(G) one dose about 1 hour (range 30 min-4 hrs) before sexual
activity; usual initial dose 50 mg; may decrease to 25 mg or increase to max 100 mg/
dose based on response; max one administration/day
Viagra Tab: 25, 50, 100 mg
tadalafi l (B) initially 10 mg prior to sexual activity up to once daily; may decrease
to 5 mg or increase to 20 mg based on response; max one administration/day; eff ect
may last 36 hours
Cialis Tab: 2.5, 5, 10, 20 mg
vardenafi l (B) initially 10 mg taken 60 min prior to sexual activity; may decrease to
5 mg or increase to 20 mg based on response; max one administration/day y
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E r y s i p e l a s ¦ 141
Levitra Tab: 2.5, 5, 10, 20 mg fi lm-coat
Comment: Levitra is not interchangeable with Staxyn.
vardenafi l (as HCl) (B)(G) dissolve 1 tab on tongue 60 min prior to sexual activity,
max once daily
Staxyn Tab: 10 mg orally disintegrating (peppermint) (phenylalanine)
Comment: Staxyn is not interchangeable with Levitra.
alprostadil (X) urethral suppository initially 125 or 250 mcg inserted in the urethra
aft er urination; adjust dose in stepwise manner on separate occasions; max two
administrations/day
Muse Urethral supp: 125, 250, 500, 1000 mcg
Comment: Contraindicated with urethral stricture, balanitis, severe hypospadias
and curvature, urethritis, predisposition to venous thrombosis, hyperviscosity
syndrome. Extreme caution with anticoagulant therapy (e.g., warfarin, heparin).
Potential for hypotension and/or syncope.
alprostadil (X) injection inject over 5-10 seconds into the dorsal lateral aspect of the
proximal third of the penis; avoid visible veins; rotate injection sites and sides; if no
initial response, may give next higher dose within 1 hour; if partial response, give
next higher dose aft er 24 hours; max 60 mcg and 3 self-injections/week; allow at least
24 hours between doses; reduce dose if erection lasts >1 hour.
Caverject Vial: 5, 10, 20, 40 mcg/vial (pwdr for reconstitution w. diluent)
Caverject Impulse Cartridge: 10, 20 mcg (2 cartridge starter and refi ll pcks)
Edex Vial: 5, 10, 20, 40 mcg (6/pck); Syringe: 5, 10, 20, 40 mcg (4/pck); Cartridge:
10, 20, 40 mcg (2 cartridge starter and refi ll pcks)
Comment: Determine dose of injectable prostaglandins in the offi ce.
Contraindicated with predisposition to priapism, penile angulation, cavernosal
fi brosis, Peyronies disease, penile implant. Extreme caution with anticoagulant
therapy (e.g., warfarin, heparin).
ERYSIPELAS
Comment: Erysipelas is most commonly due to GABHS (Group A beta-hemolytic Strept).
TREATMENT OF CHOICE
penicillin V potassium (B) 250-500 mg q 6 hours x 10 days
Pediatric: 25-50 mg/kg/day divided q 6 hours x 10 days; see page 583 for dose by
weight
Pen-Vee K Tab: 250, 500 mg; Oral soln: 125 mg/5 ml (100, 200 ml); 250 mg/5 ml
(100, 150, 200 ml)
TREATMENT IF PENICILLIN ALLERGIC
erythromycin base (B)(G) 250 mg q 6 hours x 10 days
Pediatric: 30-40 mg/kg/day divided q 6 hours x 10 days; >40 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 days
Pediatric: 30-50 mg/kg/day in 4 divided doses x 7 days; may double dose with
severe infection; max 100 mg/kg/day; see page 574 for dose by weight
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142 ¦ E r y s i p e l a s
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.
ESOPHAGITIS, EROSIVE
Antacids see GERD page 151
H2 Antagonists see GERD page 153
Proton Pump Inhibitors see GERD page 154
sucralfate (B)(G) Active ulcer: 1 g qid; Maintenance: 1 g bid
Carafate Tab: 1*g; Oral susp: 1 g/10 ml (14 oz)
EYE PAIN
Acetaminophen for IV Infusion see Pain page 306
OPHTHALMIC NSAIDs
Comment: Concomitant contact lens wear is contraindicated during therapy. Etiology
of eye pain must be known prior to use of these agents
diclofenac (B) 1 drop affected eye qid
Pediatric: not recommended
Voltaren Ophthalmic Solution Ophth soln: 0.1% (2.5, 5 ml)
ketorolac tromethamine (C) 1 drop affected eye qid for up to 4 days
Pediatric: <3 years: not recommended; =3 years: same as adult
Acular Ophth soln: 0.5% (3, 5, 10 ml; benzalkonium chloride)
Acular LS Ophth soln: 0.4% (5 ml; benzalkonium chloride)
Acular PF Ophth soln: 0.5% (0.4 ml; 12 single-use vials/carton)
(preservative-free)
nepafenac (C) 1 drop affected eye tid
Pediatric: <10 years: not recommended; =10 years: same as adult
Nevanac Ophthalmic Suspension Ophth susp: 0.1% (3 ml) (benzalkonium
chloride)
OPHTHALMIC STEROIDS
Comment: Contraindications: ocular fungal, viral, or mycobacterial infections.
Eff ectiveness of treatment should be assessed aft er 2 days. Th e corticosteroid should be
tapered and treatment concluded within 14 days if possible due to risk of corneal and/
or scleral thinning with prolonged use.
difluprednate (C) 1 drop affected eye qid; Post-op Pain: beginning 24 hours aft er surgery,
1 drop affected eye qid; continue for 2 weeks post-op; then bid x 1 week; then
taper until resolved
Pediatric: not recommended
Durezol Ophthalmic Solution Ophth emul: 0.05% (5 ml)
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Fe v e r ( P y r e x i a ) ¦ 143
etabonate (C) 1 drop affected eye qid
Pediatric: not recommended
Alrex Ophthalmic Solution Ophth emul: 0.2% (5 ml) (benzylkonium chloride)
FACIAL HAIR, EXCESSIVE/UNWANTED
TOPICAL HAIR GROWTH RETARDANT
eflornithine 13.9% cream (C) apply a thin layer to affected areas of face and under the
chin bid at least 8 hours apart; rub in thoroughly; do not wash treated area for at least
4 hours following application
Pediatric: not recommended
Vaniqa Crm: 13.9% (30, 60 g)
Comment: Aft er Vaniqa dries, may apply cosmetics or sunscreen. Hair removal
techniques may be continued as needed.
FECAL ODOR
bismuth subgallate powder (B)(OTC) 1-2 tabs tid with meals
Devron Chew tab: 200 mg; Cap: 200 mg
Comment: Devron is an internal (oral) deodorant for control of odors from
ileostomy or colostomy drainage or fecal incontinence.
FEVER (PYREXIA)
ACETAMINOPHEN FOR IV INFUSION
acetaminophen injectable (B)(G) administer by IV infusion over 15 minutes; 1000
mg q 6 hours prn or 650 mg q 4 hours prn; max 4,000 mg/day
Pediatric: <2 years: not recommended; 2-13 years <50 kg: 15 mg/kg q 6 hours prn
or 12.5 mg/kg q 4 hours prn; max 750 mg single-dose; max 75 mg/kg per day
Ofi rmev Vial: 10 mg/ml (100 ml) (preservative-free)
Comment: Th e Ofi rmev vial is intended for single-use. If any portion is
withdrawn from the vial, use within 6 hours. Discard the unused portion. For
pediatric patients, withdraw the intended dose and administer via syringe
pump. Do not ad-mix Ofi rmev with any other drugs. Ofi rmev is physically
incompatable with diazepam and chlorpromazine hydrochloride.
acetaminophen (B)(G)
Children’s Tylenol (OTC) 10-20 mg/kg q 4-6 hours prn
Oral susp: 80 mg/tsp
4-11 months (12-17 lb): 1/2 tsp q 4 hours prn; 12-23 months (18-23 lb):
3/4 tsp q 4 hours prn; 2-3 years (24-35 lb): 1 tsp q 4 hours prn; 4-5 years
(36-47 lb): 1 tsp q 4 hours prn; 6-8 years (48-59 lb): 2 tsp q 4 hours
prn; 9-10 years (60-71 lb): 2 tsp q 4 hours prn; 11 years (72-95 lb): 3 tsp
q 4 hours prn; All: max 5 doses/day
Elix: 160 mg/5 ml (2, 4 oz)
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144 ¦ Fe v e r ( P y r e x i a )
Chew tab: 80 mg
2-3 years (24-35 lb): 2 tabs q 4 hours prn; 4-5 years (36-47 lb): 3 tabs q
4 hours prn; 6-8 years (48-59 lb): 4 tabs q 4 hours prn; 9-10 years (60-
71 lb): 5 tabs q 4 hours prn; 11 years (72-95 lb): 6 tabs q 4 hours prn; All:
max 5 doses/day
Junior Strength:
6-8 years: 2 tabs q 4 hours prn; 9-10 years: 2 tabs q 4 hours prn; 11 years:
3 tabs q 4 hours prn; 12 years: 4 tabs q 4 hours prn; All: max 5 doses/day
Chew tab: 160 mg
Junior cplt: 160 mg
Infant’s Drops and Suspension: 80 mg/0.8 ml (1/2, 1 oz)
<3 months: 0.4 ml q 4 hours prn; 4-11 months: 0.8 ml q 4 hours prn;
12-23 months: 1.2 ml q 4 hours prn; 2-3 years (24-35 lb): 1.6 ml q 4
hours prn; 4-5 years (36-47 lb): 2.4 ml q 4 hours prn; All: max 5 doses/
day
Extra Strength Tylenol (OTC) 1 g q 4-6 hours prn; max 4 g/day
Pediatric: not recommended
Tab/Cplt/Gel tab/Gel cap: 500 mg; Liq: 500 mg/15 ml (8 oz)
FeverAll Extra Strength Tylenol (OTC)
Pediatric: <3 months: not recommended; 3-36 months: 80 mg q 4 hours prn;
3-6 years: 120 mg q 4 hours prn; =6 years: 325 mg q 4 hours prn; Rectal supp:
80, 120, 325 mg (6/carton)
Maximum Strength Tylenol Sore Th roat (OTC) 500-1000 mg q 4-6 hours prn
Pediatric: not recommended
Liq: 1000 mg/30 ml (8 oz)
Tylenol (OTC) 650 mg q 4-6 hours; max 4 g/day
Pediatric: <6 years: not recommended; 6-11 years: 325 mg q 4-6 hours prn;
max 1.625 g/day; =12 years: same as adult
aspirin (D)(G)
Bayer (OTC) 325-650 mg q 4 hours prn; max: 5 doses/day
Pediatric: not recommended
Tab/Cplt: 325 mg ext-rel
Extra Strength Bayer (OTC) 500 mg-1 g q 4-6 hours prn; max 4 g/day
Pediatric: not recommended
Cplt: 500 mg
Extended-Release Bayer 8 Hour (OTC) 650-1300 mg q 8 hours prn
Pediatric: not recommended
Cplt: 650 mg ext-rel
Comment: aspirin-containing medications are contraindicated with history of
allergic-type reaction to aspirin, children and adolescents with Varicella or other
viral illness, and 3rd trimester pregnancy.
aspirin/caff eine (D)(G)
Anacin (OTC) 800 mg q 4 hours prn; max 4 g/day
Pediatric: <6 years: not recommended; 6-12 years: 400 mg q 4 hours prn;
max 2 g/day; =12 years: same as adult
Tab/Cplt: 400 mg
Anacin Maximum Strength (OTC) 1 g tid-qid
Pediatric: not recommended
Tab: 500 mg
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Fe v e r ( P y r e x i a ) ¦ 145
Comment: aspirin-containing medications are contraindicated with history of
allergic-type reaction to aspirin, children and adolescents with Varicella or other
viral illness, and 3rd trimester pregnancy.
aspirin/antacid (D)(G)
Extra Strength Bayer Plus (OTC) 500 mg-1 g q 4-6 hours prn; usual max 4 g/day
Pediatric: not recommended
Cplt: 500 mg aspirin with calcium carbonate
Buff erin (OTC) 650 mg q 4 hours; max 3.9 mg/day
Pediatric: not recommended
Tab: 325 mg aspirin with calcium carbonate, magnesium carbonate, and
magnesium oxide
Comment: aspirin-containing medications are contraindicated with history of
allergic-type reaction to aspirin, children and adolescents with Varicella or other
viral illness, and 3rd trimester pregnancy.
ibuprofen (B; not for use in 3rd)(G)
Comment: ibuprofen is contraindicated in children <6 months-of-age.
Children’s Advil (OTC), ElixSure IB (OTC), Motrin (OTC),
PediaCare (OTC), PediaProfen (OTC)
Pediatric: 5-10 mg/kg q 6-8 hours; max 40 mg/kg/day; <24 lb (<2 years):
individualize; 24-35 lb (2-3 years): 5 ml q 6-8 hours prn; 36-47 lb (4-5 years):
7.5 ml q 6-8 hours prn; 48-59 lb (6-8 years): 10 ml or 2 tabs q 6-8 hours prn;
60-71 lb (9-10 years): 12.5 ml or 2 tabs q 6-8 hours prn; 72-95 lb (11 years):
15 ml or 3 tabs q 6-8 hours prn
Oral susp: 100 mg/5 ml (2, 4 oz) (berry); Junior tabs: 100 mg
Children’s Motrin Drops (OTC), PediaCare Drops (OTC)
Pediatric: <24 lb (<2 years): individualize; 24-35 lb (2-3 years): 2.5 ml
q 6-8 hours prn; Oral drops: 50 mg/1.25 ml (15 ml; berry)
Children’s Motrin Chewables and Caplets (OTC)
Pediatric: 48-59 lb (6-8 years): 200 mg q 6-8 hours prn; 60-71 lb (9-10 years):
250 mg q 6-8 hours prn; 72-95 lb (11 years): 300 mg q 6-8 hours prn; =12
years: same as adult
Chew tab: 100*mg (citrus; phenylalanine)
Cplt: 100 mg
Motrin (OTC) 400 mg q 6 hours prn
Pediatric: <6 months: not recommended; >6 months, fever <102.5: 5 mg/kg q
6-8 hours prn; >6 months, fever >102.5: 10 mg/kg q 6-8 hours prn
All: max 40 mg/kg/day
Tab: 400 mg; Cplt: 100*mg; Chew tab: 50*, 100*mg (citrus; phenylalanine);
Oral susp: 100 mg/5 ml (4, 16 oz) (berry); Oral drops: 40 mg/ml (15 ml)
(berry)
Advil (OTC), Motrin IB (OTC), Nuprin (OTC) 200-400 mg q 4-6 hours; max
1.2 g/day
Pediatric: not recommended
Tab/Cplt/Gel cap: 200 mg
naproxen (B)(G)
Pediatric: <2 years: not recommended; =2 years: 2.5-5 mg/kg bid-tid; max:
15 mg/kg/day
Aleve (OTC) 400 mg x 1 dose; then 200 mg q 8-12 hours prn; max 10 days
Tab/Cplt/Gel cap: 200 mg y
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146 ¦ Fe v e r ( P y r e x i a )
Anaprox 550 mg x 1 dose; then 550 mg q 12 hours or 275 mg q 6-8 hours prn;
max 1.375 g fi rst day and 1.1 g/day thereaft er
Tab: 275 mg
Anaprox DS 1 tab bid
Tab: 550 mg
EC-Naprosyn 375 or 500 mg bid prn; may increase dose up to max 1500 mg/
day as tolerated
Tab: 375, 500 mg del-rel
Naprelan 1 g daily or 1.5 g daily for limited time; max 1 g/day thereaft er
Tab: 375, 500 mg
Naprosyn initially 500 mg, then 500 mg q 12 hours or 250 mg q 6-8 hours prn;
max 1.25 g fi rst day and 1 g/day thereaft er
Tab: 250, 375, 500 mg; Oral susp: 125 mg/5 ml (473 ml) (pineapple-orange)
FIBROCYSTIC BREAST DISEASE
Contraceptives see page 486
spironolactone (D(G) 10 mg bid premenstrually
Aldactone Tab: 25, 50*, 100*mg
vitamin E (A) 400-600 IU daily
vitamin B6 (A) 50-100 mg daily
danazol (X) 50-200 mg bid x 2-6 months
Danocrine Cap: 50, 100, 200 mg
Comment: Start on 3rd or 4th day of menstrual period or aft er a negative pregnancy test.
FIBROMYALGIA
Acetaminophen for IV Infusion see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Topical/Transdermal NSAIDs see Pain page 307
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Topical Analgesic and Anesthetic Agents see page 499
SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)
duloxetine (C)(G) swallow whole; initially 30 mg once daily x 1 week; then increase
to 60 mg once daily; max 120 mg/day
Pediatric: not recommended
Cymbalta
Cap: 20, 30, 60 mg ent-coat pellets
milnacipran (C)(G) Day 1: 12.5 mg once; Days 2-3: 12.5 mg bid; Days 4-7: 25 mg
bid; max 100 mg bid
Pediatric: <17 years: not recommended
Savella
Tab: 12.5, 25, 50, 100 mg
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Fibromy a l g i a ¦ 147
GAMMA-AMINOBUTYRIC ACID ANALOG
gabapentin (C)
Pediatric: not applicable
Gralise initially 300 mg on Day 1; then 600 mg on Day 2; then 900 mg on Days 3-6;
then 1200 mg on Days 7-10; then 1500 mg on Days 11-14; titrate up to 1800 mg on
Day 15; take entire dose once daily with the evening meal; do not crush, split, or chew
Tab: 300, 600 mg
Neurontin (G) 100 mg daily x 1 day; then 100 mg bid x 1 day; then 100 mg tid
continuously or 300 mg bid; max 900 mg tid
Tab: 600*, 800* mg; Cap: 100, 300, 400 mg; Oral soln: 250 mg/5 ml (480 ml)
(strawberry-anise)
gabapentin enacarbil (C) 600 mg once daily at about 5:00 PM; if dose not taken at
recommended time, next dose should be taken the following day; swallow whole;
take with food; CrCl 30-59 mL/min: 600 mg on Day 1, Day 3, and every day thereafter;
CrCl <30 mL/min: or on hemodialysis: not recommended
Pediatric: not recommended
Horizant Tab: 300, 600 mg ext-rel
Comment: Avoid abrupt cessation of gabapentin and gabapentin enacarbil. To
discontinue, withdraw gradually over 1 week or longer.
a2-DELTA LIGAND
pregabalin (GABA analog) (C)(V) initially 50 mg tid; may titrate to 100 mg tid within
one week; max 600 mg divided tid; discontinue over one week
Pediatric: <18 years: not recommended
Lyrica Cap: 25, 50, 75, 100, 150, 200, 225, 300 mg; Oral soln: 20 mg/ml
OTHER AGENTS
amitriptyline (C)(G) 20 mg q HS; may increase gradually to max 50 mg q HS
Pediatric: not recommended
Tab: 10, 25, 50, 75, 100, 150 mg
cyclobenzaprine (B)(G) 10 mg tid; usual range 20-40 mg/day in divided doses; max
60 mg/day x 2-3 weeks or 15 mg ext-rel once daily; max 30 mg ext-rel/day x 2-3 weeks
Pediatric: <15 years: not recommended
Amrix Cap: 15, 30 mg ext-rel
Fexmid Tab: 7.5 mg
Flexeril Tab: 5, 10 mg
eszopiclone (C)(IV)(G) (pyrrolopyrazine) 1-3 mg; max 3 mg/day x 1 month; do not
take if unable to sleep for at least 8 hours before required to be active again; delayed
eff ect if taken with a meal
Pediatric: <18 years: not recommended
Lunesta Tab: 1, 2, 3 mg
flurazepam (X)(IV)(G) 15 mg q HS; may increase to 30 mg q HS
Dalmane Cap: 15, 30 mg
trazodone (C)(G) 50 mg q HS
Desyrel Tab: 50, 100, 150, 300 mg
triazolam (X)(IV)(G) 0.125 mg q HS, may increase gradually to 0.5 mg
Halcion Tab: 0.125, 0.25*mg
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148 ¦ Fibromy a l g i a
zaleplon (C)(IV) (imidazopyridine) 5-10 mg at HS or aft er going to bed if unable to
sleep; do not take if unable to sleep for at least 4 hours before required to be active
again; max 20 mg/day x 1 month; delayed eff ect if taken with a meal
Pediatric: not recommended
Sonata Cap: 5, 10 mg (tartrazine)
Comment: Sonata is indicated for the treatment of insomnia when a middle-of
the-night awakening is followed by diffi culty returning to sleep.
zolpidem oral solution spray (C)(IV) (imidazopyridine hypnotic) 2 actuations (10
mg) immediately before bedtime; Elderly, debilitated, or hepatic impairment: 2 actuations
(5 mg); max 2 actuations (10 mg)
Pediatric: not recommended
ZolpiMist Oral soln spray: 5 mg/actuation (60 metered actuations) (cherry)
Comment: Th e lowest dose of zolpidem in all forms is recommended for women as
drug elimination is slower than in men.
zolpidem tabs (B)(IV)(G) (pyrazolopyrimidine hypnotic) 5-10 mg or 6.25-12.5 extrel
q HS prn; max 12.5 mg/day x 1 month; do not take if unable to sleep for at least 8
hours before required to be active again; delayed eff ect if taken with a meal
Pediatric: =18 years: not recommended
Ambien Tab: 5, 10 mg
Ambien CR Tab: 6.25, 12.5 mg ext-rel
Comment: Th e lowest dose of zolpidem in all forms is recommended for women as
drug elimination is slower than in men.
zolpidem sublingual tabs (C)(IV) (imidazopyridine hypnotic) dissolve 1 tab under
the tongue; allow to disintegrate completely before swallowing; take only once per
night and only if at least 4 hours of bedtime remain before planned time for awakening
Edluar SL Tab: 5, 10 mg
Intermezzo SL Tab: 1.75, 3.5 mg
Comment: Intermezzo is indicated for the treatment of insomnia when a
middle-of-the-night awakening is followed by diffi culty returning to sleep.
Th e lowest dose of zolpidem in all forms is recommended for women as drug
elimination is slower than in men.
FIFTH DISEASE (ERYTHEMA INFECTIOSUM)
Antipyretics see Fever page 143
FLATULENCE
simethicone (C)(G)
Gas-X (OTC) 2-4 tabs pc and HS prn
Tab: 40, 80, 125 mg; Cap: 125 mg
Mylicon (OTC) 2-4 tabs pc and HS prn
Tab: 40, 80, 125 mg; Cap: 125 mg
Phazyme-95 1-2 tabs with each meal and HS prn
Tab: 95 mg
Phazyme Infant Oral Drops
Pediatric: <2 years: 0.3 ml qid pc and HS prn; 2-12 years: 0.6 ml qid pc and
HS prn; >12 years: 1.2 ml qid pc and HS prn;
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Fo l l i c u l i t i s B a r b a e ¦ 149
Oral drops: 40 mg/0.6 ml (15, 30 ml w. calibrated dropper) (orange) (alcohol-free)
Maximum Strength Phazyme 1-2 caps with each meal and HS prn
Cap: 125 mg
FLUORIDATION, WATER, <0.6 PPM
fluoride (NE)(G)
Luride
Pediatric: Water fluoridation 0.3-0.6 ppm: <3 years: use drops; 3-6 years: 0.25 mg
daily; 7-16 years: 0.5 mg daily; Water fluoridation <0.3 ppm: <3 years: use drops;
6 months-3 years: 0.25 mg daily; 4-6 years: 0.5 mg daily; 7-16 years: 1 mg daily
Chew tab: 0.25, 0.5, 1 mg (sugar-free)
Luride Drops
Pediatric: Water fluoridation 0.3-0.6 ppm: 6 months-3 years: 0.25 ml once
daily; 4-6 years: 0.5 ml once daily; 7-16 years: 1 ml once daily; Water fluoridation
<0.3 ppm: 6 months-3 years: 0.5 ml once daily; 4-6 years: 1 ml once
daily; 7-16 years: 2 ml daily
Oral drops: 0.5 mg/ml (50 ml) (sugar-free)
COMBINATION AGENTS
fluoride/vitamin a/vitamin d/vitamin c (NE)(G)
Pediatric: Water fluoridation 0.3-0.6 ppm: <3 years: not recommended; 3-6 years:
0.25 mg fluoride/day; 7-16 years: 0.5 mg fluoride/day; Water fluoridation <0.3 ppm:
<6 months: not recommended; 6 months-3 years: 0.25 mg fluoride/day; 4-6 years:
0.5 mg fluoride/day; 7-16 years: 1 mg fluoride/day
Tri-Vi-Flor Drops
Oral drops: fluoride 0.25 mg/vit a 1500 u/vit d 400 u/vit c 35 mg per ml (50 ml)
Oral drops: fluoride 0.5 mg/vit a 1500 u/vit d 400 u/vit c 35 mg per ml (50 ml)
fluoride/vitamin a/vitamin d/vitamin c/iron (NE)
Pediatric: Water fluoridation 0.3-0.6 ppm: <3 years: not recommended; 3-6 years:
0.25 mg fluoride/day; 7-16 years: 0.5 mg fluoride/day; Water fluoridation <0.3 ppm:
<6 months: not recommended; 6 months-3 years: 0.25 mg fluoride/day; 4-6 years:
0.5 mg fluoride/day; 7-16 years: 1 mg fluoride/day
Tri-Vi-Flor w. Iron Drops
Oral drops: fluoride 0.25 mg/vit a 1500 u/vit d 400 u/vit c 35 mg/iron 10 mg
per ml (50 ml)
FOLLICULITIS BARBAE
TOPICAL AGENTS
benzoyl peroxide (B) 5% apply once daily aft er shaving
Pediatric: same as adult
see Acne Vulgaris for benzoyl peroxide preparations page 4
clindamycin topical (B) apply bid
Pediatric: same as adult
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%)
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150 ¦ Fo l l i c u l i t i s Barbae
Clindagel Gel: 1% (42, 77 g)
Clindets Pad: 1% (60/pck)
Evoclin Foam: 1% (50, 100 g) (alcohol)
clindamycin/benzoyl peroxide topical (C)
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 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% (30 g)
hydrocortisone 1% (C)(OTC)(G) apply q HS
Pediatric: same as adult
see Topical Corticosteroids page 506
tazarotene (X) apply 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 q HS
Pediatric: <12 years: not recommended
Avita Crm/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 Liq: 0.05% (28 ml) (alcohol 55%)
Retin-A Micro Microspheres: 0.04, 0.1% (20, 45 g)
FOREIGN BODY: ESOPHAGUS
glucagon (B) 0.02 mg/kg IV or IM with serial x-rays; max 1 mg
Glucagon (rDNA origin or beef/pork derived)
Vial: 1 mg/ml w. diluent
Comment: glucagon facilitates passage of foreign body from esophagus into stomach.
FOREIGN BODY: EYE
proparacaine (NE) 1-2 drops to anesthetize surface of eye; then flush with normal
saline
Ophthaine Ophth soln: 0.5% (15 ml)
Comment: proparacaine facilitates the search, location, and removal of foreign
body and examination of the cornea.
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Gastroesopha g e a l R e f l u x D i s e a s e ( G E R D ) ¦ 151
GASTRITIS
Antacids see GERD page 151
H2 Antagonists see GERD page 153
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Comment: Precipitators of gastric reflux include narcotics, benzodiazepines, calcium
antagonists, alcohol, nicotine, chocolate, and peppermint.
ANTACIDS
Comment: Antacids with aluminum hydroxide may potentiate constipation. Antacids
with magnesium hydroxide may potentiate diarrhea.
aluminum hydroxide (C)
ALTernaGEL (OTC) 5-10 ml between meals and HS prn; max 90 ml/day
Pediatric: not recommended
Liq: 500 mg/5 ml (5, 12 oz)
Amphojel (OTC) 10 ml 5-6 times/day between meals and HS prn; max 60 ml/day
Pediatric: not recommended
Oral susp: 320 mg/5 ml (12 oz)
Amphojel Tab (OTC) 600 mg 5-6 times/day between meals and HS prn; max
3.6 g/day
Pediatric: not recommended
Tab: 300, 600 mg
aluminum hydroxide/magnesium hydroxide (C)(OTC)(G)
Maalox 10-20 ml qid and HS prn
Pediatric: not recommended
Oral susp: alum 225 mg/mag 200 mg per 5 ml (5, 12, 26 oz) (mint, lemon, cherry)
Maalox Th erapeutic Concentrate 10-20 ml qid pc and HS prn
Pediatric: not recommended
Oral susp: alum 600 mg/mag 300 mg per 5 ml (12 oz) (mint)
aluminum hydroxide/magnesium hydroxide/simethicone (C)(OTC)(G)
Maalox Plus 10-20 ml qid pc and HS prn
Pediatric: not recommended
Tab: alum 200 mg/mag 200 mg/sim 25 mg
Extra Strength Maalox Plus 10-20 ml qid pc and HS prn
Pediatric: not recommended
Tab: alum 350 mg/mag 350 mg/sim 30 mg
Oral susp: alum 500 mg/mag 450 mg/sim 40 mg per 5 ml (5, 12, 26 oz)
Extra Strength Maalox Plus Tab 1-3 tabs qid pc and HS prn
Pediatric: not recommended
Tab: alum 350 mg/mag 350 mg/sim 30 mg
Mylanta 10-20 ml between meals and HS prn
Pediatric: not recommended
Liq: alum 200 mg/mag 200 mg/sim 20 mg per 5 ml (5, 12, 24 oz)
Mylanta Double Strength 10-20 ml between meals and HS prn
Pediatric: not recommended
Liq: alum 700 mg/mag 400 mg/sim 40 mg per 5 ml (5, 12, 24 oz)
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152 ¦ Gastroesopha g e a l R e f l u x D i s e a s e ( G E R D )
aluminum hydroxide/magnesium carbonate (C)(OTC)(G)
Maalox HRF 10-20 ml qid pc and HS prn
Pediatric: not recommended
Oral susp: alum 280 mg/mag 350 mg per 10 ml (10 oz)
aluminum hydroxide/magnesium trisilicate (C)(G)
Gaviscon chew 2-4 tabs qid pc and HS prn
Pediatric: not recommended
Tab: alum 80 mg/mag 20 mg
Gaviscon Liquid 15-30 ml qid pc and HS prn
Pediatric: not recommended
Liq: alum 95 mg/mag 359 mg per 15 ml (6, 12 oz)
Gaviscon Extra Strength 2-4 tabs qid pc and HS prn
Pediatric: not recommended
Tab: alum 160 mg/mag 105 mg
Gaviscon Extra Strength Liquid 10-20 ml qid prn
Pediatric: not recommended
Liq: alum 508 mg/mag 475 mg per 10 ml (12 oz)
aluminum hydroxide/magnesium hydroxide/simethicone (C)(OTC)(G)
Maalox Maximum Strength 10-20 ml qid prn; max 60 ml/day
Pediatric: not recommended
Oral susp: alum 500 mg/mag 450 mg/sim 40 mg per 5 ml (5, 12, 26 oz) (mint,
cherry)
calcium carbonate (C)(OTC)(G)
Children’s Mylanta Tab
Pediatric: <2 years: not recommended; 2-5 years (24-47 lb): 1 tab as needed
up to tid; 6-11 years (48-95 lb): 2 tabs as needed up to tid
Tab: 400 mg
Children’s Mylanta
Pediatric: <2 years: not recommended; 2-5 years (24-47 lb): 1 tab as needed
up to tid; 6-11 years (48-95 lb): 2 tabs as needed up to tid
Liq: 400 mg/5 ml (4 oz)
Maalox Tab chew 2-4 tabs prn; max 12 tabs/day
Pediatric: not recommended
Chew tab: 600 mg (wild berry, lemon, wintergreen) (phenylalanine)
Maalox Maximum Strength Tab 1-2 tabs prn; max 8 tabs/day
Pediatric: not recommended
Tab: 1 g (wild berry, lemon, wintergreen; phenylalanine)
Rolaids Extra Strength 1-2 tabs dissolved in mouth or chewed q 1 hour prn;
max 8 tabs/day
Tab: 1000 mg
Tums 1-2 tabs dissolved in mouth or chewed q 1 hour prn; max 16 tabs/day
Tab: 500 mg
Tums E-X 1-2 tabs dissolved in mouth or chewed q 1 hour prn; max 16 tabs/day
Tab: 750 mg
calcium carbonate/magnesium hydroxide (C)
Mylanta Tab 2-4 tabs between meals and HS prn
Pediatric: not recommended
Tab: calib 350 mg/mag 150 mg
Mylanta DS Tab 2-4 tabs between meals and HS prn
Pediatric: not recommended
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Gastroesopha g e a l R e f l u x D i s e a s e ( G E R D ) ¦ 153
Tab: calib 700 mg/mag 300 mg
Rolaids Sodium-Free 1-2 tabs dissolved in mouth or chewed q 1 hour as needed
Tab: calib 317 mg/mag 64 mg
calcium carbonate/magnesium carbonate (C)
Mylanta Gel Caps (OTC) 2-4 caps prn
Gel cap: calib 550 mg/mag 125 mg
dihydroxyaluminum (NE)
Rolaids (OTC) 1-2 tabs dissolved in mouth or chewed q 1 hour prn; max
24 tabs/day
Tab: 334 mg
H2 ANTAGONISTS
cimetidine (B)(OTC)(G) 800 mg bid or 400 mg qid; max 12 weeks
Pediatric: <16 years: not recommended; =16 years: same as adult
Tagamet 800 mg bid or 400 mg qid; max 12 weeks
Tab: 200, 300, 400*, 800*mg
Tagamet HB Prophylaxis: 1 tab ac; Treatment: 1 tab bid
Tab: 200 mg
Tagamet HB Oral Suspension Prophylaxis: 1-3 tsp ac; Treatment: 1 tsp bid
Oral susp: 200 mg/20 ml (12 oz)
Tagamet Liquid Liq: 300 mg/5 ml (mint-peach) (alcohol 2.8%)
famotidine (B)(OTC)(G)
Pediatric: 0.5 mg/kg/day q HS prn or in 2 divided doses; max 40 mg/day
Maximum Strength Pepcid AC 1 tab ac
Tab: 20 mg
Pepcid 20-40 mg bid; max 6 weeks
Tab: 20 mg; Tab: 40 mg; Oral susp: 40 mg/5 ml (50 ml)
Pepcid AC 1 tab ac; max 2 doses/day
Tab/Rapid dissolving tab: 10 mg
Pepcid Complete (OTC) 1 tab ac; max 2 doses/day
Tab: fam 10 mg/CaCO2 800 mg/mg hydroxide 165 mg
Pepcid RPD Tab: 20, 40 mg rapid dissolv
nizatidine (B)(OTC)(G) 150 mg bid or 300 mg once daily
Pediatric: not recommended
Axid Cap: 150, 300 mg; Oral soln: 15 mg/ml (480 ml) (bubble gum)
ranitidine (B)(OTC)(G)
Pediatric: <1 month: not recommended; 1 month to 16 years: 2-4 mg/kg/day in 2
divided doses; max 300 mg/day; Duodenal/Gastric Ulcer: 2-4 mg/kg/day divided
bid; max 300 mg/day; Erosive Esophagitis: 5-10 mg/kg/day divided bid; max 300
mg/day; 20 lb, 9 kg: 0.6 ml; 30 lb, 13.6 kg: 0.9 ml; 40 lb, 18.2 kg: 1.2 ml; 50 lb, 22.7
kg: 1.5 ml; 60 lb, 27.3 kg: 1.8 ml; 70 lb, 31.8 kg: 2.1 ml
Zantac 150 mg bid or 300 mg q HS
Tab: 150, 300 mg
Zantac 75 1 tab ac
Tab: 75 mg
Zantac EFFERdose dissolve 25 mg tab in 5 ml water and dissolve 150 mg tab in
6-8 oz water
Eff erdose: 25, 150 mg eff ervescent
Zantac Syrup Syr: 15 mg/ml (peppermint) (alcohol 7.5%)
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154 ¦ Gastroesopha g e a l R e f l u x D i s e a s e ( G E R D )
ranitidine bismuth citrate (C) 400 mg bid
Pediatric: not recommended
Tritec Tab: 400 mg
PROTON PUMP INHIBITORS
dexlansoprazole (B)(G) 30-60 mg daily for up to 4 weeks
Pediatric: <18 years: not recommended
Dexilant Cap: 30, 60 mg ent-coat del-rel granules; may open and sprinkle on
applesauce; do not crush or chew granules
Dexilant SoluTab Tab: 30 mg del-rel orally disint
esomeprazole (B)(OTC)(G) 20-40 mg once daily; max 8 weeks; take 1 hour before
food; swallow whole or mix granules with food or juice and take immediately; do not
crush or chew granules
Pediatric: <1 month: not established; 1 month-<1 year, 3-5 kg: 2.5 mg; 5-7.5 kg: 5
mg; >7.5-12 kg: 10 mg; 1-11 years, <20 kg: 10 mg; =20 kg: 10-20 mg; 12-17 years:
20 mg; max 8 weeks
Nexium Cap: 20, 40 mg ent-coat del-rel pellets
Nexium for Oral Suspension Oral susp: 10, 20, 40 mg ent-coat del-rel granules/
pkt; mix in 2 tblsp water and drink immediately; 30 pkt/carton
lansoprazole (B)(OTC)(G) 15-30 mg daily for up to 8 weeks; may repeat course; take
before eating
Pediatric: <1 year: not recommended; 1-11 years, <30 kg: 15 mg once daily;
>11 years: same as adult
Prevacid Cap: 15, 30 mg ent-coat del-rel granules; swallow whole or mix granules
with food or juice and take immediately; do not crush or chew granules;
follow with water
Prevacid for Oral Suspension Oral susp: 15, 30 mg ent-coat del-rel granules/
pkt; mix in 2 tblsp water and drink immediately; 30 pkt/carton (strawberry)
Prevacid SoluTab ODT: 15, 30 mg (strawberry) (phenylalanine)
Prevacid 24HR 15 mg ent-coat del-rel granules; swallow whole or mix granules
with food or juice and take immediately; do not crush or chew granules; follow
with water
omeprazole (C)(OTC)(G) 20-40 mg daily for 14 days; may repeat course in 4 months;
take before eating; swallow whole or mix granules with applesauce and take immediately;
do not crush or chew granules; follow with water
Pediatric: <1 year: not recommended; 5-<10 kg: 5 mg daily; 10-<20 kg: 10 mg daily;
=20 kg: same as adult
Prilosec Cap: 10, 20, 40 mg ent-coat del-rel granules
Pediatric: <1 year: not recommended; 5-<10 kg: 5 mg daily; 10-<20 kg: 10
mg daily; =20 kg: same as adult
Prilosec OTC Tab: 20 mg del-rel (regular, wildberry)
Pediatric: <18 years: not recommended
pantoprazole (B) 40 mg daily
Pediatric: not recommended
Protonix (G)
Tab: 40 mg ent-coat del-rel
Protonix for Oral Suspension Oral susp: 40 mg ent-coat del-rel granules/pkt;
mix in 1 tsp apple juice for 5 seconds or sprinkle on 1 tsp apple sauce, and
swallow immediately; do not mix in water or any other liquid or food; take
approximately 30 minutes prior to a meal; 30 pkt/carton
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G i a r d i a s i s ( G i a r d i a L a m b l i a ) ¦ 155
rabeprazole (B)(OTC)(G) Tab: 20 mg daily aft er breakfast; do not crush or chew;
Cap: open cap and sprinkle contents on a small amount of soft food or liquid
Pediatric: <1 year: not recommended; 1-11 years, <15 kg: 5 mg once daily for up to
12 weeks; =12 years, =15 kg: same as adult
AcipHex Tab: 20 mg ent-coat del-rel
AcipHex Sprinkle Cap: 5, 10 mg del-rel
PROTON PUMP INHIBITORS/SODIUM BICARBONATE COMBINATION
omeprazole/na bicarbonate (B)(G) 20 mg daily; do not crush or chew; max 8 weeks
Pediatric: <18 years: not recommended
Zegerid Cap: omep 20 mg/na bicarb 1100 mg; omep 40 mg/na bicarb 1100 mg
Zegerid OTC (OTC) Cap: omep 20 mg/na bicarb 1100 mg
Zegerid for Oral Suspension Pwdr for oral susp: omep 20 mg/na bicarb 1680
mg; omep 40 mg/na bicarb 1680 mg (30 pkt/carton)
PROMOTILITY AGENT
metoclopramide (B)(G) 10-15 mg qid 30 minutes ac and HS prn; up to 20 mg prior
to provoking situation; max 12 weeks per therapeutic course
Pediatric: <18 years: not recommended
Metozolv ODT ODT: 5, 10 mg (mint)
Reglan Tab: 5*, 10 mg; Syr: 5 mg/5 ml
Reglan ODT ODT: 5, 10 mg (orange)
Comment: metoclopropamide is contraindicated when stimulation of GI
motility may be dangerous. Observe for tardive dyskinesia and Parkinsonism.
Avoid concomitant drugs which may cause an extrapyramidal reaction (e.g.,
phenothiazines, haloperidol).
GIARDIASIS (GIARDIA LAMBLIA)
metronidazole (not for use in 1st; B in 2nd, 3rd)(G) 250 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 aft er therapy due to a possible disulfi ram-like reaction (nausea,
vomiting, flushing, headache).
tinidazole (not for use in 1st; B in 2nd, 3rd) 2 g in a single dose; take with food
Pediatric: <3 years: not recommended; =3 years: 50 mg/kg daily in a single dose;
take with food; max 2 g
Tindamax Tab: 250*, 500*mg
Comment: Alcohol is contraindicated during treatment with oral tinidazole and for
72 hours aft er therapy due to a possible disulfi ram-like reaction (nausea, vomiting,
flushing, headache).
nitazoxanide (B) 500 mg q 12 hours x 3 days; take with food
Pediatric: <1 year: not recommended; 1-3 years; 100 mg q 12 hours x 3 days; 4-11
years: 200 mg q 12 hours x 3 days; =12 years: same as adult
Alinia Tab: 500 mg; Oral susp: 100 mg/5 ml (60 ml)
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156 ¦ G i a r d i a s i s ( G i a r d i a L a m b l i a )
Comment: Alinia is an antiprotozoal for the treatment of diarrhea due to G.
lamblia or C. parvum.