Rx – All “C” 2

GINGIVITIS/PERIODONTITIS
ANTI-INFECTIVE ORAL RINSES
Comment: Oral treatments should be preceded by brushing and fl ossing the teeth.
Avoid foods and liquids for 2-3 hours aft er a treatment.

• chlorhexidine gluconate (B)(G) swish 15 ml undiluted for 30 seconds bid; do not swallow; do not rinse mouth aft er treatment.
  Peridex, PerioGard Oral soln: 0.12% (480 ml)

GLAUCOMA: OPEN ANGLE
Comment: Other ophthalmic medications should not be administered within 5-10 minutes of administering an ophthalmic antiglaucoma medication. Contact lenses should be removed prior to instillation of antiglaucoma medications and may be replaced 15 minutes later. Interactions with ophthalmic anti-glaucoma agents include MAOIs, CNS depressants, beta-blockers, tricyclic antidepressants, and hypoglycemics.

OPHTHALMIC ALPHA-2-AGONISTS
Comment: Ophthalmic alpha-2-agonists are contraindicated with concomitant MAOI use. Cautious use with CNS depressants, beta-blockers (ocular and systemic), antihypertensives, cardiac glycosides, and tricyclic antidepressants.

• apraclonidine ophthalmic solution (C) 1-2 drops aff ected eye tid
  Pediatric: not recommended
  Iopidine Ophth soln: 0.5% (5 ml) (benzalkonium chloride)
• brimonidine tartrate ophthalmic solution (B) 1 drop aff ected eye q 8 hours
  Pediatric: <2 years: not recommended; =2 years: 1 drop aff ected eye q 8 hours
  Alphagan P Ophth soln: 0.1, 0.15% (5, 10, 15 ml) (purite)

OPHTHALMIC CARBONIC ANHYDRASE INHIBITORS
Comment: Ophthalmic carbonic anhydrase inhibitors are contraindicated in patients with sulfa allergy.

• brinzolamide ophthalmic suspension (C) 1 drop aff ected eye tid
  Pediatric: not recommended
  Azopt Ophth susp: 1% (2.5, 5, 10, 15 ml) (benzalkonium chloride)
• dorzolamide ophthalmic solution (C)(G) 1 drop aff ected eye tid
  Pediatric: same as adult
  Trusopt Ophth soln: 2% (10 ml) (benzalkonium chloride)

OPHTHALMIC ALPHA-2 ADRENERGIC RECEPTOR AGONIST/CARBONIC
ANHYDRASE INHIBITOR

• brimonidine/brinzolamide (C) 1 drop aff ected eye tid
  Pediatric: not recommended
  Simbrinza Ophth soln: brim 1% mg/brinz 0.2% per ml (10 ml)

OPHTHALMIC CHOLINERGICS (MIOTICS)

• carbachol/hydroxypropyl methylcellulose ophthalmic solution (C) 2 drops aff ected eye tid
  Pediatric: not recommended
  Isopto Carbachol Ophth soln: carb 0.75% or 2.25%/hydroxy 1% (15 ml); carb 1.5% or 3%/hydroxy 1% (15, 30 ml) (benzalkonium chloride)
• pilocarpine (C)(G)
  Pediatric: not recommended
  Isopto Carpine 2 drops aff ected eye tid-qid
  Ophth soln: 1, 2, 4% (15 ml) (benzalkonium chloride)
  Ocusert Pilo change ophthalmic insert once weekly
  Ophth inserts: 20 mcg/hr (8/pck)
  Pilocar Ophthalmic Solution 1-2 drops aff ected eye 1-6 times/day
  Ophth soln: 0.5, 1, 2, 3, 4, 6, 8% (15 ml)
  Pilopine HS apply 1/2 inch ribbon in lower conjunctival sac q HS
  Opth gel: 4% (4 g)

OPHTHALMIC CHOLINESTERASE INHIBITORS

• demecarium bromide ophthalmic solution (X) 1-2 drops aff ected eye q 12-48 hours
  Pediatric: not recommended
  Humorsol Ocumeter Ophth soln: 0.125, 0.25% (5 ml)
• echothiophate iodide ophthalmic solution (C) initially 1 drop of 0.03% aff ected eye bid; then increase strength as needed
  Pediatric: not recommended
  Phospholine Iodide Ophth soln: 0.03, 0.06, 0.125, 0.25% (5 ml)

OPHTHALMIC CARDIOSELECTIVE BETA-BLOCKERS
Comment: Ophthalmic beta-blockers are generally contraindicated in severe COPD, history of or current bronchial asthma, sinus bradycardia, 2nd or 3rd degree AV block.

• betaxolol ophthalmic solution (C)(G) 1-2 drops aff ected eye bid
  Pediatric: not recommended
  Betoptic Ophth soln: 0.5% (5, 10, 15 ml) (benzalkonium chloride)
  Betoptic S Ophth soln: 0.25% (2.5, 5, 10, 15 ml) (benzalkonium chloride)

OPHTHALMIC BETA-BLOCKERS (NONCARDIOSELECTIVE)
Comment: Ophthalmic beta-blockers are generally contraindicated in severe COPD, history of or current bronchial asthma, sinus bradycardia, 2nd or 3rd degree AV block.

• carteolol ophthalmic solution (C)(G) 1 drop aff ected eye bid
  Pediatric: not recommended
  Ocupress Ophth soln: 1% (5, 10, 15 ml) (benzalkonium chloride)
• levobunolol ophthalmic solution (C) 1-2 drops aff ected eye bid
  Pediatric: not recommended
  Betagan Ophth soln: 0.5% (5, 10, 15 ml) (benzalkonium chloride)
• metipranolol ophthalmic solution (C)(G) 1 drop aff ected eye bid
  Pediatric: not recommended
  OptiPranolol Ophth soln: 0.3% (5, 10 ml) (benzalkonium chloride)
• timolol ophthalmic solution and gel (C)(G)
  Pediatric: not recommended
  Betimol 1 drop aff ected eye bid
  Ophth soln: 0.25, 0.5% (5, 10, 15 ml) (benzalkonium chloride)
  Istalol 1 drop aff ected eye daily
  Ophth soln: 0.5% (2.5, 5 ml) (preservative-free)
  Timoptic 1 drop aff ected eye bid
  Ophth soln: 0.25, 0.5% (5, 10, 15 ml) (benzalkonium chloride)
  Timoptic Ocudose 1 drop bid
  Ophth soln: 0.25, 0.5% (0.2 ml/dose, 60 dose) (preservative-free)
  Timoptic-XE 1 drop aff ected eye bid
  Ophth gel: 0.25, 0.5% (2.5, 5 ml) (preservative-free)

OPHTHALMIC ALPHA-2 AGONIST/BETA-BLOCKER
(NONCARDIOSELECTIVE) COMBINATION
Comment: Generally contraindicated in severe COPD, history of or current bronchial asthma, sinus bradycardia, 2nd or 3rd degree AV block.

• brimonidine tartrate/timolol ophthalmic solution (C) 1 drop aff ected eye bid
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Combigan Ophth soln: brimo 0.2%/timo 0.5% (5, 10, 15 ml) (benzalkonium chloride)

OPHTHALMIC PROSTAMIDE ANALOGUES

• bimatropost ophthalmic solution (C)(G) 1 drop q aff ected eye HS
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Lumigan Ophth soln: 0.01, 0.03% (2.5, 5, 7.5 ml) (benzalkonium chloride)
• latanoprost ophthalmic solution (C) 1 drop aff ected eye q HS
  Pediatric: not recommended
  Xalatan Ophth soln: 0.005% (2.5 ml) (benzalkonium chloride)
• tafl uprost ophthalmic solution (C) 1 drop aff ected eye q HS
  Pediatric: not recommended
  Zioptan Ophth soln: 0.0015% (0.3 ml single-use, 30-60/carton) (preservative-free)
• travoprost ophthalmic solution (C)(G) 1 drop aff ected eye q HS
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Travatan Ophth soln: 0.004% (2.5, 5 ml) (benzalkonium chloride)
  Travatan Z Ophth soln: 0.004% (2.5, 5 ml) (boric acid, propylene glycol, sorbitol, zinc chloride)

OPHTHALMIC SYMPATHOMIMETICS
Comment: Contraindicated in narrow-angle glaucoma. Use with caution in cardiovascular disease, hypertension, hyperthyroidism, diabetes, and asthma.

• dipivefrin ophthalmic solution (B) 1 drop aff ected eye q 12 hours
  Propine Ophth soln: 0.1% (5, 10, 15 ml) (benzalkonium chloride)

OPHTHALMIC CARBONIC ANHYDRASE INHIBITOR/NONCARDIOSELECTIVE
OPHTHALMIC CARBONIC ANHYDRASE INHIBITOR/BETA-BLOCKER

• dorzolamide/timolol ophthalmic solution (C) 1 drop aff ected eye bid
  Pediatric: not recommended
  Cosopt Ophth soln: dorz 2%/tim 0.5% (10 ml) (benzalkonium chloride)
  Cosopt PF Ophth soln: dorz 2%/tim 0.5% (10 ml) (preservative-free)

OPHTHALMIC SYNTHETIC DOCOSANOID

• unoprostone isopropyl ophthalmic solution (C) 1 drop aff ected eye bid
  Pediatric: not recommended
  Rescula Ophth soln: 0.15% (5 ml) (benzalkonium chloride)

ORAL CARBONIC ANHYDRASE INHIBITORS

• acetazolamide (C) 250-1000 mg/day in divided doses or 500 mg bid sust-rel tabs; max 1 g/day
  Pediatric: not recommended
  Diamox Tab: 125*, 250*mg
  Diamox Sequels Tab: 500 mg sust-rel
• methazolamide (C)(G) 50-100 mg bid-tid times daily
  Pediatric: not recommended
  Neptazane Tab: 25, 50 mg
  Comment: Administer ophthalmic osmotic and miotic agents concomitantly.

GONORRHEA (NEISSERIA GONORRHOEAE )
Comment: Th e following treatment regimens for N. gonorrhoeae 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. Sexual abuse must be considered a cause of gonococcal infection in preadolescent children.
RECOMMENDED REGIMENS: ADULT; UNCOMPLICATED INFECTIONS OF THE CERVIX, URETHRA, AND RECTUM

Regimen 1

• ceft riaxone 250 mg IM in a single dose

plus

• azithromycin 1 g in a single dose

Regimen 2

• ceft riaxone 250 mg IM in a single dose

plus

• doxycycline 100 mg bid x 7 days

RECOMMENDED REGIMENS: ADULT; UNCOMPLICATED INFECTIONS OF THE PHARYNX

Regimen 1

• ceft riaxone 250 mg IM in a single dose

plus

• azithromycin 1 g in a single dose

Regimen 2

• ceft riaxone 250 mg IM in a single dose

plus

• doxycycline 100 mg bid x 7 days

RECOMMENDED REGIMENS: CHILDREN >45 KG, >8 YEARS; UNCOMPLICATED INFECTIONS OF THE CERVIX, URETHRA, AND RECTUM

Regimen 1

• ceft riaxone 250 mg IM in a single dose

plus

• azithromycin 1 g in a single dose

RECOMMENDED REGIMEN: CHILDREN >45 KG

Regimen 1

• ceft riaxone 250 mg IM in a single dose

RECOMMENDED REGIMEN: CHILDREN >45 KG WHO HAVE GONOCOCCAL BACTEREMIA OR ARTHRITIS

Regimen 1

• ceft riaxone 50 mg/kg IM or IV in a single dose daily x 7 days

RECOMMENDED REGIMENS: CHILDREN <45 KG, <8 YEARS; UNCOMPLICATED GONOCOCCAL VULVOVAGINITIS, CERVICITIS, URETHRITIS, PHARYNGITIS, OR PROCTITIS

Regimen 1

• ceft riaxone 250 mg IM in a single dose

RECOMMENDED REGIMEN: CHILDREN <45 KG, <8 YEARS WHO HAVE GONOCOCCAL BACTEREMIA OR ARTHRITIS

Regimen 1

• ceft riaxone 50 mg/kg (max dose 1 g) IM or IV in a single dose daily x 7 days

DRUG BRANDS AND DOSE FORMS

• azithromycin (B)
  Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
  Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
  Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
  Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
• 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
  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

ALTERNATIVE THERAPY

• azithromycin (B) 2 g x 1 dose
  Pediatric: not recommended for treatment of gonorrhea 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+)
• cefotaxime 500 mg IM x 1 dose
  Claforan Vial: 500 mg; 1, 2 g
• cefotetan 1 g IM x 1 dose
  Pediatric: not recommended
  Cefotan Vial: 1, 2 g
• cefoxitin (B) 2 g IM x 1 dose
  Pediatric: <3 months: not recommended
  Mefoxin Vial: 1, 2 g

plus

• probenecid (B)(G)
  Benemid 1 g 30 minutes before cefoxitin
  Pediatric: <2 years: not recommended; 2-14 years: 25 mg/kg 30 minutes before cefoxitin; >14 years: same as adult
  Tab: 500*mg; Cap: 500 mg
• cefpodoxime proxetil (B) 200 mg x 1 dose
  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)
  Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 mg) (lemon creme)
• ceft izoxime (B) 1 g IM x 1 dose
  Pediatric: <6 months: not recommended
  Cefi zox Vial: 500 mg; 1, 2, 10 g
• cefuroxime axetil (B)(G) 1000 mg x 1 dose
  Pediatric: 30 mg/kg/day in 2 divided doses x 10 days
  Ceft in Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 100 ml) (tutti-frutti)
• demeclocycline (X) 600 mg initially, followed by 300 mg q 12 hours x 4 days (total 3 g)
  Pediatric: <8 years: not recommended
  Declomycin Tab: 300 mg
  Comment: demeclocycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side eff ect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• enoxacin (C) 400 mg x 1 dose
  Pediatric: <18 years: not recommended
  Penetrex Tab: 200, 400 mg
• imipramine (C) 400 mg x 1 dose
  Pediatric: <18 years: not recommended
  Maxaquin Tab: 400 mg
• norfl oxacin (C) 800 mg x 1 dose
  Pediatric: <18 years: not recommended
  Noroxin Tab: 400 mg
• spectinomycin (B) 2 g IM x 1 dose
  Pediatric: 40 mg/kg IM x 1 dose
  Trobicin Vial: 2 g

GOUT

Pseudogout see Pseudogout page 364
Acetaminophen for IV Infusion see 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

PEGYLATED URIC ACID SPECIFIC ENZYME

• pegloticase (C) premedicate with antihistamine and corticosteroid; 8 mg once every 2 weeks; administer IV infusion aft er dilution over at least 2 hours; observe at least 1 hour post-infusion
  Pediatric: <18 years: not recommended
  Krystexxa Vial: 8 mg/ml (1 ml) single-use pwdr for IV infusion aft er dilution
  Comment: Slow rate, or stop and restart at lower rate, if infusion reaction occurs (e.g., Krystexxa is contraindicated with G6PD defi ciency; screen patients of African or Mediterranean descent). Krystexxa is not for the treatment of asymptomatic hyperuricemia.
• PROPHYLAXIS
  allopurinol (C)(G) initially 100 mg daily; increase by 100 mg weekly; max 800 mg/day and 300 mg/dose; usual range for mild symptoms 200-300 mg/day; for severe symptoms 400-600 mg/day; take with food
  Pediatric: not recommended
  Zyloprim Tab: 100*, 300*mg
  Comment: Do not take concurrent with colchicine.
• colchicine (C)(G) 0.6-1.2 mg at fi rst sign of attack; then 0.6 mg every hour or 1.2 mg every 2 hours until pain relief; then consider 0.6 mg/day or every other day for maintenance
  Pediatric: not recommended
  Colcrys Tab: 0.6 mg
  Mitigare Cap: 0.6 mg
  Comment: Do not take concurrent with allopurinol.
• febuxostat (C) initially 40 mg daily; aft er 2 weeks, may increase to 80 mg daily.
  Pediatric: <18 years: not recommended
  Uloric Tab: 40, 80 mg
  Comment: Gout fl are prophylaxis with colchicine or NSAID is recommended on initiation of febuxostat and up to 6 months.

URICOSURIC AGENT

• probenecid (C)(G) 250 mg bid x 1 week; maintenance 500 mg bid
  Pediatric: not recommended
  Tab: 500*mg; Cap: 500 mg
  Comment: Avoid concomitant use of probenecid and salicylates.

URICOSURIC/ANTI-INFLAMMATORY COMBINATIONS

• probenecid/colchicine (NE)(G) 1 tab once daily x 1 week; then, 1 tab bid thereaft er
  Pediatric: not recommended
  Tab: prob 500 mg/colch 0.5 mg
  Comment: probenecid/colchicine is contraindicated in the treatment of acute gout attack, patients with blood dyscrasias, and patients with uric acid kidney stones.
  Concomitant salicylates antagonize the uricosuric eff ects.
• sulfi npyrazone (C) initially 200-400 mg bid; may gradually increase to 800 mg bid
  Anturane Cap: 100, 200 mg
  Comment: Goal is serum uric acid <6.5 mg/dL.

XANTHINE OXIDASE INHIBITOR

• febuxostat (C) 40 mg once daily x 2 weeks; if serum uric acid is not <6 mg/dL, may increase to 80 mg once daily
  Pediatric: <18 years: not established
  Uloric Tab: 40, 80 mg

SELECTIVE URIC ACID REABSORPTION INHIBITOR (SURI)

• lesinurad (C) 200 mg once daily in combination with a xanthine oxidase inhibitor (XOI)
  Pediatric: <18 years: not established
  Zurampic Tab: 200 mg
  Comment: Zurampic inhibits URATI, a urate transporter, which is responsible for the majority of renal absorption of uric acid and (OAT) 4, organic anion transporter, a uric acid transporter involved in diuretic-induced hyperuricemia. Do not use as monotherapy. Use in combination with an XOI, such as allopurinol or febuxostat, (to reduce the production of uric acid). Do not initiate if CrCl <45 mL/min, ESRD, dialysis, or kidney transplant.

GOUTY ARTHRITIS
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

TOPICAL ANALGESICS

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

ORAL SALICYLATE

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

NSAID PLUS PPI

• esomeprazole/naproxen (C; not for use in 3rd)(G) 1 tab bid; use lowest eff ective dose for the shortest duration; swallow whole; take at least 30 minutes before a meal
  Pediatric: <18 years: not recommended
  Vimovo Tab: nap 375 mg/eso 20 mg ext-rel; nap 500 mg/eso 20 mg ext-rel

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) 100-400 mg 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

GRANULOMA INGUINALE (DONOVANOSIS)
Comment: Th e following treatment regimens are published in the 2015 CDC Sexually
Transmitted Diseases Treatment Guidelines. Treatment regimens are for adults only; consult a specialist for treatment of patients less than 18 years-of-age. Treatment regimens are presented by generic drug name fi rst, followed by information about brands and dose forms. Persons who have sexual contact with a patient who has had granuloma inguinale within the past 60 days before onset of the patient’s symptoms should be examined and off ered therapy. Patients who are HIV-positive should receive the same treatment as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered.

RECOMMENDED REGIMEN

• doxycycline 100 mg bid x at least 3 weeks and until all lesions have completely healed

ALTERNATE REGIMENS

• azithromycin 1 g once weekly for at least 3 weeks and until all lesions have completely healed
• ciprofl oxacin 750 mg bid x at least 3 weeks and until all lesions have completely healed
• erythromycin base 500 mg qid x 14 days or erythromycin ethylsuccinate 400 mg qid x 14 days
• trimethoprim/sulfamethoxazole 1 double-strength (160/800) dose bid x at least 3 weeks and until all lesions have completely healed

DRUG BRANDS AND DOSE FORMS

• azithromycin (B)
  Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
  Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
  Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
  Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
• ciprofl oxacin (C)
  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: ciprofl oxacin is contraindicated <18 years-of-age, and during pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
• doxycycline (D)(G)
  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)
  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.
• trimethoprim/sulfamethoxazole (C)(G)
  Bactrim, Septra
  Tab: trim 80 mg/sulfa 400 mg*
  Bactrim DS, Septra DS
  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

GROWTH FAILURE
Comment: Administer growth hormones by SC injection into thigh, buttocks, or abdomen. Rotate sites with each dose. Contraindicated in children with fused epiphyses or evidence of neoplasia.
mecasermin (recombinant human insulin-like growth factor-1 [rhIGF-1])

• Increlex (B) see mfr pkg insert
  Vial: 10 mg/ml (benzyl alcohol)
  Comment: Increlex is indicated for growth failure in children with severe primary IGF-1 defi ciency (primary IGFD) or in those with growth hormone (GH) gene deletion who have developed neutralizing antibodies to GH.
• somatropin (rDNA origin)
  Genotropin (B) initially not more than 0.04 mg/kg/week divided into 6-7 doses; may increase at 4-8 week intervals; max 0.08 mg/kg/week divided into 6-7 doses
  Pediatric: usually 0.16-0.024 mg/kg/week divided into 6-7 doses
  Intra-Mix Device: 1.5 mg (1.3 mg/ml aft er reconstitution), 5.8 mg (5 mg/ml aft er reconstitution) (two-chamber cartridge w. diluent); Pen or Intra-Mix
  Device: 5.8 mg (5 mg/ml aft er reconstitution), 13.8 mg (512 mg/ml aft er reconstitution) (two-chamber cartridge w. diluent)
  Genotropin Miniquick (B) initially not more than 0.04 mg/kg/week divided into 6-7 doses; may increase at 4-8-week intervals; max 0.08 mg/kg/week divided into 6-7 doses
  Pediatric: usually 0.16-0.024 mg/kg/week divided into 6-7 doses
  MiniQuick: 0.2, 0.4, 0.6, 0.8, 1, 1.2, 1.4, 1.6, 1.8, 2 mg/0.25 ml (pwdr for SC injection aft er reconstitution) (2-chamber cartridge w. diluent)
  Humatrope (C)
  Pediatric: initially 0.18 mg/kg/week IM or SC divided into equal doses given either on 3 alternate days or 6 x/week; max 0.3 mg/kg/week
  Vial: 5 mg w. 5 ml diluent
  Norditropin (C)
  Pediatric: 0.024-0.034 mg/kg 6 to 7 times/week SC
  Vial: 4 mg (12 IU), 8 mg (24 IU); Cartridge for inj: 5, 10, 15 mg/1.5 ml; Flex-
  Pro prefi lled pen: 5, 10, 15 mg/1.5 ml
  NordiFlex prefi lled pen: 5, 10, 15 mg/1.5 ml; 30 mg/3 ml
  Nutropin (C)
  Pediatric: 0.7 mg/kg/week SC in divided daily doses
  Vial: 5, 10 mg/vial w. diluent
  Nutropin AQ (C) <35 years: initially not more than 0.006 mg/kg SC daily; may increase to max 0.025 mg/kg SC daily; =35 years: initially not more than 0.006 mg/kg SC daily; may increase to max 0.0125 mg/kg SC daily
  Pediatric: Prepubertal: up to 0.043 mg/kg SC daily; Pubertal: up to 0.1 mg/kg SC daily; Turner Syndrome: up to 0.0375 mg/kg/week divided into equal doses 3-7 times/week
  Vial: 5 mg/ml (2 ml)
  Nutropin Depot (C) 1.5 mg/kg SC monthly on same day each month; max 22.5 mg/inj; divide injection if >22.5 mg
  Pediatric: same as adult
  Vial: 13.5, 18, 22.5 mg/vial (pwdr for injection aft er reconstitution; single-use w. diluent and needle)
  Omnitrope (B) 0.16-0.24 mg/kg/week SC divided 3-7 times/week
  Vial: 5.8 mg
  Omnitrope Pen 5 (B) 0.16-0.24 mg/kg/week SC divided 3-7 times/week
  Cartridge for inj: 5 mg/1.5 ml
  Omnitrope Pen 10 (B) 0.16-0.24 mg/kg/week SC divided 3-7 times/week
  Cartridge for inj: 10 mg/1.5 ml
  Saizen (B) 0.18 mg/kg/week IM or SC divided 3-7 times/week
  Vial: 5 mg (pwdr for SC injection w. diluent)
  Serostem (B) 0.1 mg/kg SC once daily at HS; max 6 mg
  Vial: 5, 4, 6, 8.8 mg (pwdr for SC injection w. diluent) (benzyl alcohol)

HEADACHE: MIGRAINE/CLUSTER
ERGOTAMINE AGENTS
Comment: Do not use an ergotamine-type drug within 24 hours of any triptan or other 5-HT agonist.

• dihydroxyergotamine mesylate (X)
  DHE 45 1 mg SC, IM, or IV; may repeat at 1 hour intervals; max 3 mg/day SC or
  IM/day; max 2 mg IV/day; max 6 mg/week
  Pediatric: not recommended
  Amp: 1 mg/ml (1 ml)
  Migranal 1 spray in each nostril; may repeat 15 minutes later; max 6 sprays/day and 8 sprays/week
  Pediatric: not recommended
  Nasal spray: 4 mg/ml; 0.5 mg/spray (caff eine)
• ergotamine (X)(G) 1 tab SL at onset of attack; then q 30 minutes as needed; max 3 tabs/day and 5 tabs/week
  Tab: 2 mg
• ergotamine/caff eine (X)(G)
  Cafergot 2 tabs at onset of attack; then 1 tab every 1/2 hour if needed; max 6 tabs/attack and 10 tabs/week
  Pediatric: not recommended
  Tab: ergot 1 mg/caf 100 mg
  Cafergot Suppository 1 suppository rectally at onset of headache; may repeat x 1 aft er 1 hour; max 2/attack, 5/week
  Rectal supp: ergot 2 mg/caf 100 mg

5-HT RECEPTOR AGONISTS
Comment: Contraindications to 5-HT receptor agonists include cardiovascular disease, ischemic heart disease, cerebral vascular syndromes, peripheral vascular disease, uncontrolled hypertension, hemiplegic or basilar migraine. Do not use any triptan within 24 hours of ergot-type drugs or other 5-HT1A agonists, or within 2 weeks of taking an MAOI.

• almotriptan (C)(G) 6.25 or 12.5 mg; may repeat once aft er 2 hours; max 2 doses/day
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Axert Tab: 6.25 mg (6/card), 12.5 mg (12/card)
  Comment: almotriptan is indicated for patients 12-17 years-of-age with PMHx migraine headache lasting =4 hours untreated.
• eletriptan (C) 20 or 40 mg; may repeat once aft er 2 hours; max 80 mg/day
  Pediatric: <18 years: not recommended
  Relpax Tab: 20, 40 mg
• frovatriptan (C)(G) 2.5 mg with fl uids; may repeat once aft er 2 hours; max 7.5 mg/day
  Pediatric: <18 years: not recommended
  Frova Tab: 2.5 mg
• naratriptan (C) 1 or 2.5 mg with fl uids; may repeat once aft er 4 hours; max 5 mg/day
  Pediatric: <18 years: not recommended
  Amerge Tab: 1, 2.5 mg
• rizatriptan (C) initially 5 or 10 mg; may repeat in 2 hours if needed; max 30 mg/day
  Pediatric: <18 years: not recommended
  Maxalt Tab: 5, 10 mg
  Maxalt-MLT ODT: 5, 10 mg (peppermint) (phenylalanine)
• sumatriptan (C)(G)
  Pediatric: <18 years: not recommended
  Alsuma 6 mg SC to the upper arm or lateral thigh only; may repeat aft er 1 hour if needed; max 2 doses/day
  Prefi lled syringe: 6 mg/0.5 ml (2/pck with auto injector)
  Imitrex Injectable 4-6 mg SC; may repeat aft er 1 hour if needed; max 2 doses/day
  Prefi lled syringe: 4, 6 mg/0.5 ml (2/pck with or without autoinjector)
  Imitrex Nasal Spray (G) 5-20 mg intranasally; may repeat once aft er 2 hours if needed; max 40 mg/day
  Nasal spray: 5, 20 mg/spray (single-dose)
  Imitrex Tab 25-200 mg x 1 dose; may be repeated at intervals of at least 2 hours if needed; max 200 mg/day
  Tab: 25, 50, 100 mg rapid-rel
  Imitrex STATdose Pen 6 mg/0.5 mg SC; may repeat once aft er 2 hours if needed; max 2 doses/day
  Prefi lled needle-free autoinjector delivery system: 6 mg/0.5 ml (6/pck)
  Onzetra Xsail each disposable white nosepiece contains half a dose of medication (11 mg of sumatriptan). A full dose is 22 mg. Do not use more than 2 nosepieces per dose; attach the mouthpiece and one nasal piece; then press the white button on the delivery device to pierce the capsule in the nasal piece, then insert the nasal piece into one nostril and blow into the mouth piece to deliver the nasal powder in the contents of one capsule (11 mg); repeat in the opposite nostril for a total single 22 mg dose
  Cap: 11 mg nasal pwdr; Kit: nosepieces (2), capsules (2), reusable breath powered delivery device (1)
  Sumavel DosePro 6 mg SC to the upper arm or lateral thigh only; may repeat aft er 1 hour if needed; max 2 doses/day
  Prefilled needle-free delivery system: 6 mg/0.5 ml (6/pck)
  Zembrace SymTouch administer 3 mg SC at onset of headache; may repeat hourly; max 12 mg/24 hours
  Pediatric: <18 years: not recommended
  Autoinjector: 3 mg/0.5 ml (prefi lled single-dose disposable autoinjector)
• zolmitriptan (C)(G) initially 2.5 mg; may repeat aft er 2 hours if needed; max 10 mg/day
  Pediatric: <18 years: not recommended
  Zomig Tab: 2.5*, 5 mg
  Zomig Nasal Spray Nasal spray: 5 mg/spray (6 single dose/carton)
  Zomig-ZMT ODT: 2.5 mg (6 tabs), 5*mg (3 tabs) (orange) (phenylalanine)
  Comment: Do not use any triptan within 24 hours of ergotamine-type drugs or other 5-HT agonists, or within 2 weeks of taking an MAOI.

5-HT IB/ID RECEPTOR AGONIST/NSAID COMBINATION

• sumatriptan/naproxen (C; D in 3rd)
  Pediatric: <18 years: not recommended
  Treximet initially 1 tab; may repeat aft er 2 hours; max 2 doses/day
  Tab: suma 85 mg/naprox 500 mg (9/blister card)
  Comment: Do not use sumatriptan within 24 hours of ergot-type drugs or other 5-HT agonists, or within 2 weeks of taking an MAOI.

OTHER ANALGESICS

• acetaminophen/aspirin/caffeine (D)(G)
  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.
  Excedrin Migraine (OTC) 2 tabs q 6 hours prn; max 8 tabs/day x 2 days
  Pediatric: not recommended
  Tab: acet 250 mg/asp 250 mg/caf 65 mg
• diclofenac potassium powder for oral solution (C; D =30 weeks)(G) empty the contents of one pkt into a cup containing 1-2 oz or 2-4 tbsp (30-60 ml) of water, mix well, and drink immediately; water only, no other liquids; take on an empty stomach; use the losest eff ective dose for the shortest duration of time; safety and eff ectiveness of a 2nd dose has not been established
  Pediatric: <18 years: not established; =18 years: same as adult
  Cambia Pwdr for oral soln: 50 mg/pkt (3 pkts/set, conjoined with a perforated border
  Comment: Cambia is not indicated for migraine prophylaxis. May not be bioequivalent with other diclofenac forms (e.g., diclofenac sodium ent-coat tabs, diclofenac sodium ext-rel tabs, diclofenac potassium immed-rel tabs) even of the mg strength is the same, therefore, it is not possible to convert dosing from any other diclofenac formulation to Cambia. Cambia is contraindicated in the setting of coronary artery bypass graft . Use of Cambia should not be considered with hepatic impairment, gastric/duodenal ulcer, starting at 30 weeks gestation (risk of premature closure of the ductus arteriosus in the fetus), concomitant NSAIDs, SSRIs, anticoagulants/antiplatelets, any risk factor for potential bleeding.
• isometheptene mucate/dichloralphenazone/acetaminophen (C)(IV)
  Midrin 2 caps initially; then 1 cap q 1 hour until relieved; max 5 caps/12 hours
  Pediatric: not recommended
  Cap: iso 65 mg/dichlor 100 mg/acet 325 mg

PROPHYLAXIS

• topiramate (D)(G) initially 25 mg daily in the PM and titrate up daily as tolerated; then 25 mg bid; then, 25 mg in the AM and 50 mg in the PM; then, 50 mg bid
  Pediatric: <12 years: not recommended
  Topamax Tab: 25, 50, 100, 200 mg
  Topamax Sprinkle Caps Cap: 15, 25 mg

BETA-BLOCKERS

• atenolol (D)(G) initially 25 mg bid; max 150 mg/day in divided doses
  Pediatric: not recommended
  Tenormin Tab: 25, 50, 100 mg
• metoprolol succinate (C)
  Pediatric: not recommended
  ToprolR-XL initially 25-100 mg in a single dose daily; increase weekly if needed; max 400 mg/day
  Tab: 25*, 50*, 100*, 200*mg ext-rel
• metoprolol tartrate (C)
  Pediatric: not recommended
  Lopressor (G) initially 25-50 mg bid; increase weekly if needed; max 400 mg/day
  Tab: 25, 37.5, 50, 75, 100 mg
• nadolol (C)(G) initially 20 mg daily; max 240 mg/day in divided doses
  Pediatric: not recommended
  Corgard Tab: 20*, 40*, 80*, 120*, 160*mg
• propranolol (C)(G)
  Inderal initially 10 mg bid; usual range 160-320 mg/day in divided doses
  Pediatric: not recommended
  Tab: 10*, 20*, 40*, 60*, 80*mg
  Inderal LA initially 80 mg daily in a single dose; increase q 3-7 days; usual range 120-160 mg/day; max 320 mg/day in a single dose
  Pediatric: not recommended
  Cap: 60, 80, 120, 160 mg sust-rel
  InnoPran XL initially 80 mg q HS; max 120 mg/day
  Cap: 80, 120 mg ext-rel
• timolol (C)(G) initially 5 mg bid; max 60 mg/day in divided doses
  Pediatric: not recommended
  Blocadren Tab: 5, 10*, 20*mg

CALCIUM ANTAGONISTS

• diltiazem (C)(G)
  Cardizem initially 30 mg qid; may increase gradually every 1-2 days; max 360 mg/day in divided doses
  Pediatric: not recommended
  Tab: 30, 60, 90, 120 mg
  Cardizem CD initially 120-180 mg once daily; adjust at 1- to 2-week intervals; max 480 mg/day
  Pediatric: not recommended
  Cap: 120, 180, 240, 300, 360 mg ext-rel
  Cardizem LA initially 180-240 mg once daily; titrate at 2-week intervals; max 540 mg/day
  Pediatric: not recommended
  Tab: 120, 180, 240, 300, 360, 420 mg ext-rel
  Cardizem SR initially 60-120 mg bid; adjust at 2-week intervals; max 360 mg/day
  Pediatric: not recommended
  Cap: 60, 90, 120 mg sust-rel
• nifedipine (C)(G)
  Pediatric: not recommended
  Adalat initially 10 mg tid; usual range 10-20 mg tid; max 180 mg/day
  Cap: 10, 20 mg
  Procardia initially 10 mg tid; titrate over 7-14 days: max 30 mg/dose and 180 mg/day in divided doses
  Cap: 10, 20 mg
  Procardia XL initially 30-60 mg daily; titrate over 7-14 days; max 90 mg/day in divided doses
• verapamil (C)(G)
  Pediatric: not recommended
  Calan 80-120 mg tid; increase daily or weekly if needed
  Tab: 40, 80*, 120*mg
  Covera HS initially 180 mg q HS; titrate in steps to 240 mg; then to 360 mg; then to 480 mg if needed
  Tab: 180, 240 mg ext-rel
  Isoptin initially 80-120 mg tid
  Tab: 40, 80, 120 mg
  Isoptin SR initially 120-180 mg in the AM; may increase to 240 mg in the AM; then, 180 mg q 12 hours or 240 mg in the AM and 120 mg in the PM; then, 240 mg q 12 hours
  Tab: 120, 180*, 240*mg sust-rel
  Tricyclic Antidepressants (TCAs)
  Comment: Co-administration of TCAs with SSRIs requires extreme caution.
• amitriptyline (C)(G) 10-20 mg q HS
  Pediatric: not recommended
  Tab: 10, 25, 50, 75, 100, 150 mg
• doxepin (C)(G) 10-200 mg q HS
  Pediatric: not recommended
  Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
• imipramine (C)(G) 10-200 mg q HS
  Tofranil 25-50 mg; max 200 mg/day; if maintenance dose exceeds 75 mg daily, may switch to Tofranil PM
  Pediatric: <6 years: not recommended; 6-12 years: initially 25 mg; >12 years: 50 mg max 2.5 mg/kg/day
  Tab: 10, 25, 50 mg
  Tofranil PM initially 75 mg once daily 1 hour before HS; max 200 mg
  Cap: 75, 100, 125, 150 mg
• nortriptyline (D)(G) 10-150 mg q HS
  Pediatric: not recommended
  Pamelor Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml (16 oz)

SSRI ANTIDEPRESSANTS
Comment: Co-administration of SSRIs with TCAs requires extreme caution.
Concomitant use of MAOIs and SSRIs is absolutely contraindicated. Avoid other serotonergic drugs. 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, hallucinations, 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. 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 the Serotonin Discontinuation Syndrome include fl u-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.”

• fl uoxetine (C)(G)
  Prozac initially 20 mg daily; may increase aft er 1 week; doses >20 mg/day may be divided into AM and noon doses; max 80 mg/day
  Pediatric: <8 years: not recommended; 8-17 years: initially 10-20 mg/day; start lower weight children at 10 mg/day; if starting at 10 mg daily, may increase aft er 1 week to 20 mg once daily
  Cap: 10, 20, 40 mg; Tab: 30*, 60*mg; Oral soln: 20 mg/5 ml (4 oz) (mint)
  Prozac Weekly following daily fl uoxetine therapy at 20 mg/day for 13 weeks, may initiate Prozac Weekly 7 days aft er the last 20 mg fl uoxetine dose
  Pediatric: not recommended
  Cap: 90 mg ent-coat del-rel pellets

OTHER AGENTS

• divalproex sodium (D) Delayed-release: initially 250 mg bid; titrate weekly to usual max 500 mg bid; Extended-release: initially 500 mg once daily; may increase aft er one week to 1 g once daily
  Pediatric: <10 years: not recommended; =10 years: same as adult
  Depakene Cap: 250 mg del-rel; syr: 250 mg/5 ml (16 oz)
  Depakote Tab: 125, 250, 500 mg del-rel
  Depakote ER Tab: 250, 500 mg ext-rel
  Depakote Sprinkle Cap: 125 mg del-rel
• methysergide (C) 4-8 mg daily in divided doses with food; max 8 mg/day; max 6 month treatment course; wean off over last 2-3 weeks of treatment course; separate treatment courses by 3-4 week drug-free interval
  Sansert Tab: 2 mg

MAGNESIUM SUPPLEMENTS

• magnesium (B)
  Slow-Mag 2 tabs daily
  Tab: 64 mg (as chloride)/110 mg (as carbonate)
• magnesium oxide (B)
  Mag-Ox 400 1-2 tabs daily
  Tab: 400 mg

HEADACHE: TENSION
(MUSCLE CONTRACTION HEADACHE)

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

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

• amitriptyline (C)(G) 50-100 mg/day
  Pediatric: not recommended
  Tab: 10, 25, 50, 75, 100, 150 mg
• desipramine (C)(G) 50-100 mg bid
  Pediatric: not recommended
  Norpramin Tab: 10, 25, 50, 75, 100, 150 mg
• 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 dosing
  Tab: 10, 25, 50 mg
  Tofranil PM initially 75 mg once 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) 25-50 mg/day
  Pediatric: not recommended
  Pamelor Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml (16 oz)

ANALGESICS

• butalbital/acetaminophen (C)(G)
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Phrenilin 1-2 tabs q 4 hours prn; max 6 tabs/day
  Tab: but 50 mg/acet 325 mg
  Phrenilin Forte 1 tab or cap q 4 hours prn; max 6 caps/day
  Cap/Tab: but 50 mg/acet 650 mg
• butalbital/acetaminophen/caff eine (C)(G)
  Pediatric: not recommended
  Fioricet 1-2 tabs q 4 hours prn; max 6/day
  Tab: but 50 mg/acet 325 mg/caf 40 mg
  Zebutal 1 cap q 4 hours prn; max 5/day
  Cap: but 50 mg/acet 500 mg/caf 40 mg
• butalbital/acetaminophen/codeine/caff eine (C)(III)(G)
  Pediatric: <12 years: not recommended
  Fioricet with Codeine 1-2 tabs at onset q 4 hours prn; max 6 tabs/day
  Tab: but 50 mg/acet 325 mg/cod 30 mg/caf 40 mg
• butalbital/aspirin/caff eine (C)(III)(G)
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Fiorinal 1-2 tabs or caps q 4 hours prn; max 6 caps/tabs/day
  Tab/Cap: but 50 mg/asa 325 mg/caf 40 mg
• butalbital/aspirin/codeine/caff eine (C)(III)(G)
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Fiorinal with Codeine 1-2 caps q 4 hours prn; max 6 caps/day
  Cap: but 50 mg/asp 325 mg/cod 30 mg/caf 40 mg
• butorphanol tartrate (C)(IV)(G) initially 1 spray (1 mg) in one nostril and may repeat aft er 60-90 minutes (Elderly 90-120 minutes) in opposite nostril if needed or 1 spray in each nostril and may repeat q 3-4 hours prn
  Pediatric: <18 years: not recommended
  Butorphanol Nasal Spray Nasal spray: 1 mg/actuation (10 mg/ml, 2.5 ml)
  Stadol Nasal Spray Nasal spray: 10 mg/ml, 1 mg/actuation (10 mg/ml, 2.5 ml)
• 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
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Tab: 100, 200, 300 mg ext-rel
  Ultram
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Tab: 50*mg
  Ultram ER
  Pediatric: <18 years: not recommended
  Tab: 100, 200, 300 mg ext-rel
• tramadol/acetaminophen (C)(IV)(G) 2 tabs q 4-6 hours prn; max 8 tabs/day; 5 days; CrCl <30 mL/min: max 2 tabs q 12 hours; max 4 tabs/day x 5 days; Cirrhosis or other
  liver disease: contraindicated
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Ultracet Tab: tram 37.5/acet 325 mg

Other Oral Analgesics see Pain page 308

MAGNESIUM SUPPLEMENTS

• magnesium (B)
  Slow-Mag 2 tabs daily
  Tab: 64 mg (as chloride)/110 mg (as carbonate)
• magnesium oxide (B)
  Mag-Ox 400 1-2 tabs daily
  Tab: 400 mg

HEART FAILURE (HF)
ACE INHIBITORS (ACEIs)

• captopril (C; D in 2nd, 3rd)(G) initially 25 mg tid; aft er 1-2 weeks may increase to 50 mg tid; max 450 mg/day
  Pediatric: not recommended
  Capoten Tab: 12.5*, 25*, 50*, 100*mg
• enalapril (D) initially 5 mg daily; usual dosage range 10-40 mg/day; max 40 mg/day
  Pediatric: not recommended
  Epaned Oral Solution Oral soln: 1mg/ml (150 ml) (mixed berry)
  Vasotec (G) Tab: 2.5*, 5*, 10, 20 mg
• fosinopril (C; D in 2nd, 3rd) initially 10 mg daily, usual maintenance 20-40 mg/day in a single or divided doses
  Pediatric: <6 years, <50 kg: not recommended; 6-12 years, =50 kg: 5-10 mg daily; >12 years: same as adult
  Monopril Tab: 10*, 20, 40 mg
• lisinopril (D) initially 5 mg daily
  Prinivil initially 10 mg daily; usual range 20-40 mg/day
  Pediatric: not recommended
  Tab: 5*, 10*, 20*, 40 mg
  Qbrelis Oral Solution administer as a single dose once daily
  Pediatric: <6 years, GFR <30 mL/min: not recommended; =6 years, GFR >30 mL/min: initially 0.07 mg/kg, max 5 mg; adjust according to BP up to a max 0.61 mg/kg (40 mg) once daily
  Oral soln: 1 mg/ml (150 ml)
  Zestril initially 10 mg daily; usual range 20-40 mg/day
  Pediatric: not recommended
  Tab: 2.5, 5*, 10, 20, 30, 40 mg
• quinapril (C; D in 2nd, 3rd) initially 5 mg bid; increase weekly to 10-20 mg bid
  Pediatric: not recommended
  Accupril Tab: 5*, 10, 20, 40 mg
• ramipril (C; D in 2nd, 3rd) initially 2.5 mg bid; usual maintenance 5 mg bid
  Pediatric: not recommended
  Altace Tab/Cap: 1.25, 2.5, 5, 10 mg
• trandolapril (C; D in 2nd, 3rd) initially 1 mg daily; titrate to dose of 4 mg daily as tolerated
  Pediatric: not recommended
  Mavik Tab: 1*, 2, 4 mg

BETA-BLOCKERS (CARDIOSELECTIVE)

• carvedilol (C)
  Coreg initially 3.125 mg bid; may increase at 1-2 week intervals to 12.5 mg bid; usual max 50 mg bid
  Pediatric: <18 years: not recommended
  Tab: 3.125, 6.25, 12.5, 25 mg
  Coreg CR initially 10 mg once daily x 2 weeks; may double dose at 2 week intervals; max 80 mg once daily; may open caps and sprinkle on food
  Pediatric: <18 years: not recommended
  Cap: 10, 20, 40, 80 mg cont-rel
• metoprolol succinate (C)
  Pediatric: not recommended
  Toprol-XL initially 12.5-25 mg in a single dose daily; increase weekly if needed; reduce if symptomatic bradycardia occurs; max 400 mg/day
  Tab: 25*, 50*, 100*, 200*mg ext-rel
• metoprolol tartrate (C)
  Pediatric: not recommended
  Lopressor (G) initially 25-50 mg bid; increase weekly if needed; max 400 mg/day
  Tab: 25, 37.5, 50, 75, 100 mg

ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs)

• valsartan (C; D in 2nd, 3rd) initially 40 mg bid; increase to 160 mg bid as tolerated or 320 mg daily aft er 2-4 weeks; usual range 80-320 mg/day
  Pediatric: not recommended
  Diovan Tab: 40*, 80, 160, 320 mg

NEPRILYSIN INHIBITOR/ARB COMBINATION

• sacubitril/valsartan (D) initially 49/51 bid; double dose aft er 2-4 weeks; maintenance 97/103 bid; GFR <30 mL/min or moderate hepatic impairment: initially 24/26 bid; double dose every 2-4 weeks to target maintenance 97/103 bid
  Pediatric: not established
  Entresto
  Tab: Entresto 24/26: sacu 24 mg/val 26 mg
  Entresto 49/51: sacu 49 mg/val 51 mg
  Entresto 97/103: sacu 97 mg/val 103 mg

ALDOSTERONE RECEPTOR BLOCKER

• eplerenone (B) initially 25 mg once daily; titrate within 4 weeks to 50 mg once daily; adjust dose based on serum K+
  Pediatric: not recommended
  Inspra Tab: 25, 50 mg
  Comment: Inspra is contraindicated with concomitant potent CYP3A4 inhibitors. Risk of hyperkalemia with concomitant ACEI or ARB. Monitor serum potassium at baseline, 1 week, and 1 month. Caution with serum Cr >2 mg/dL (male) or >1.8 mg/dL (female) and/or CrCl <50 mL/min, and DM with proteinuria.

THIAZIDE DIURETICS
Comment: Monitor hydration status, blood pressure, urine output, serum K+.

• chlorothiazide (C)(G) 0.5-1 g/day in single or divided doses; max 2g/day
  Pediatric: <6 months: up to 15 mg/lb/day in 2 divided doses; =6 months: 10 mg/lb/day in 2 divided doses
  Diuril Tab: 250*, 500*mg; Oral susp: 250 mg/5 ml (237 ml)
• hydrochlorothiazide (B)(G)
  Pediatric: not recommended
  Esidrix 25-100 mg once daily
  Tab: 25, 50, 100 mg
  Microzide 12.5 mg daily; usual max 50 mg/day
  Cap: 12.5 mg
• methyclothiazide/deserpidine (B) initially 2.5 mg once daily; max 5 mg once 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) 2-4 mg once daily
  Pediatric: not recommended
  Renese Tab: 1, 2, 4 mg

POTASSIUM-SPARING DIURETICS
Comment: Monitor hydration status, blood pressure, urine output, serum K+.

• amiloride (B) initially 5 mg once daily; may increase to 10 mg; max 20 mg
  Pediatric: not recommended
  Midamor Tab: 5 mg
• spironolactone (D)(G) initially 50-100 mg in a single or divided doses; titrate at 2 week intervals
  Pediatric: not established
  Aldactone Tab: 25, 50*, 100*mg

LOOP DIURETICS
Comment: Monitor hydration status, blood pressure, urine output, serum K+.

• bumetanide (C)(G) 0.5-2 mg as a single dose; may repeat at 4-5 hour intervals; max 10 mg/day
  Pediatric: <18 years: not recommended
  Bumex Tab: 0.5*, 1*, 2*mg
  Comment: bumetanide is contraindicated with sulfa drug allergy.
• ethacrynic acid (B)(G) initially 50-200 mg once daily
  Pediatric: infants: not recommended; >1 month: initially 25 mg/day; then adjust dose in 25 mg increments
  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 40 mg bid
  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 once daily; may increase to 10 mg daily
  Pediatric: not recommended
  Demadex Tab: 5*, 10*, 20*, 100*mg

OTHER DIURETICS
Comment: Monitor hydration status, blood pressure, urine output, serum K+.

• indapamide (B) initially 1.25 mg once daily; may titrate dosage upward every 4 weeks if needed; max 5 mg/day
  Lozol Tab: 1.25, 2.5 mg
  Comment: indapamide is contraindicated with sulfa drug allergy.
• metolazone (B) 2.5-5 mg once daily
  Pediatric: not recommended
  Zaroxolyn Tab: 2.5, 5, 10 mg
  Comment: metolazone is contraindicated with sulfa drug allergy.

DIURETIC COMBINATIONS
Comment: Monitor hydration status, blood pressure, urine output, serum K+.

• amiloride/hydrochlorothiazide (B)(G) initially 1 tab once 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)
  Pediatric: not recommended
  Aldactazide 25 usual maintenance 50-100 mg in a single or divided doses
  Tab: spiro 25 mg/hydro 25 mg
  Aldactazide 50 usual maintenance 50-100 mg in a single or divided doses
  Tab: spiro 50 mg/hydro 50 mg
• triamterene/hydrochlorothiazide (C)(G)
  Pediatric: not recommended
  Dyazide 1-2 caps 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*

NITRATE/PERIPHERAL VASODILATOR COMBINATION

• isosorbide dinitrate/hydralazine (C) initially 1 tab tid; may reduce to 1/2 tab tid if not tolerated; titrate as tolerated aft er 3-5 days; max 2 tabs tid
  Pediatric: not recommended
  BiDil Tab: isosor 20 mg/hydral 37.5 mg
  Comment: BiDil is an adjunct to standard therapy in self-identifi ed black persons to improve survival, to prolong time to hospitalization for heart failure, and to improve patient-reported functional status.

CARDIAC GLYCOSIDES
Comment: Th erapeutic serum level of is 0.8-2 mcg/ml.

• digoxin (C)(G) 1-1.5 mg IM, IV, or PO in divided doses over 1-3 days as a loading dose; usual maintenance 0.125-0.5 mg/day
  Pediatric: Total oral pediatric digitalizing dose (in 24 hours): <2 years: 40-50 mcg/kg; 2-10 years: 30-40 mcg/kg; >10 years: 0.75-1.5 mg; Daily oral pediatric maintenance
  dose (single-dose): <2 years: 10-12 mcg/kg; 2-10 years: 8-10 mcg/kg; >10 years: 0.125–0.5 mg
  Comment: For more information on the use of digoxin in pediatric heart failure, see Jain, S. & Vaidyanathan B. Ann Pediatr Cardiol. 2009 Jul-Dec; 2(2): 149–152.
  Lanoxicaps
  Pediatric: <10 years: use elixir or parenteral form
  Cap: 0.05, 0.1, 0.2 mg soln-fi lled (alcohol)
  Lanoxin
  Pediatric: <10 years: use elixir or parenteral form
  Tab: 0.0625, 0.125*, 0.1875, 0.25*mg; Elix: 0.05 mg/ml (2 oz w. dropper) (lime) (alcohol 10%)
  Lanoxin Injection Amp: 0.25 mg/ml (2 ml)
  Lanoxin Injection Pediatric Amp: 0.1 mg/ml (1 ml)

OTHER

• ivabradine (D) initially 5 mg bid with food; assess aft er 2 weeks and adjust dose to achieve a resting heart rate 50-60 bpm; thereaft er, adjust dose as needed based on resting heart rate and tolerability; max 7.5 mg bid; in patients with a history of conduction defects, or for whom bradycardia could lead to hemodynamic compromise, initiate at 2.5 mg bid before increasing the dose based on heart rate
  Pediatric: <18 years: not established
  Corlanor Tab: 5, 7.5 mg
  Comment: Corlanor is indicated to reduce the risk of hospitalization for worsening heart failure inpatients with stable, symptomatic, chronic heart failure with left ventricular ejection fraction (LVEF) =35%, who are in sinus rhythm with resting heart rate =70 bpm and either are on maximally tolerated doses of beta-blockers or have a contraindication to beta-blocker use. Corlanor is contraindicated with acute decompensated heart failure, BP <90/50, sick sinus syndrome (SSS), sinoatrial block, and 3rd degree AV block (unless patient has a functioning demand pacemaker). Corlanor may cause fetal toxicity when administered pregnant women based on embryo-fetal toxicity and cardiac teratogenic to eff ects observed in animal studies. Th erefore, females should be
  advised to use eff ective contraception when taking this drug.

HELICOBACTER PYLORI (H. PYLORI ) INFECTION
ERADICATION REGIMENS
Comment: Th ere are many H2 receptor blocker-based and PPI-based treatment regimens suggested in the professional literature for the eradication of the H. pylori organism and subsequent ulcer healing. Generally, regimens range from 10-14 days for eradication and 2-6 more weeks of continued gastric acid suppression. A three- or four-antibiotic combination may increase treatment eff ectiveness and decrease the likelihood of resistant strain emergence. Empirical treatment is not recommended. Diagnosis should be confi rmed before treatment is started. Antibiotic choices include doxycycline, tetracycline, amoxicillin, amoxicillin/clavulanate, clarithromycin, clindamycin, and metronidazole.
Follow-up visits are recommended at 2 and 6 weeks to evaluate treatment outcomes.

• Regimen 1: Helidac Th erapy (D) bismuth subsalicylate 525 mg qid + tetracycline 500 mg qid + metronidazole 250 mg qid x 14 days
  Pediatric: not recommended
  Pack: bismuth subsalicylate chew tab: 262.4 mg (112/pck); tetracycline cap: 500 mg (56/pck); metronidazole Tab: 250 mg (56/pck)
• Regimen 2: PrevPac (D)(G) amoxicillin 500 mg 2 caps bid + lansoprazole 30 mg bid + clarithromycin 500 mg bid x 14 days (one card per day)
  Pediatric: not recommended
  Kit: lansoprazole cap: 30 mg (2/card); amoxicillin cap: 500 mg (4/card); clarithromycin tab: 500 mg (2/card) (14 daily cards/carton)
• Regimen 3: Pylera (D) take 3 caps qid aft er meals and at bedtime x 10 days; take with 8 oz water plus omeprazole 20 mg bid, with breakfast and dinner, for 10 days
  Pediatric: not recommended
  Cap: bismuth subsalicylate 140 mg/tetracycline 125 mg/metronidazole 125 mg (120 caps)
  Comment: omeprazole not included with Pylera.
• Regimen 4: Omeclamox-Pak (C) omeprazole 20 mg bid + amoxicillin 1000 bid + clarithromycin 500 mg bid x 10 days
  Kit: omeprazole cap: 20 mg (2/pck); amoxicillin cap: 500 mg (4/pck); clarithromycin tab: 500 mg (2/pck) (10 pcks/carton)
• Regimen 5: (C) omeprazole 40 mg daily + clarithromycin 500 mg tid x 2 weeks; then continue omeprazole 10-40 mg daily x 6 more weeks
• Regimen 6: (B) lansoprazole 30 mg tid + amoxicillin 1 g tid x 10 days; then continue lansoprazole 15-30 mg daily x 6 more weeks
• Regimen 7: (C) omeprazole 40 mg daily + amoxicillin 1 g bid + clarithromycin 500 mg bid x 10 days; then continue omeprazole 10-40 mg daily x 6 more weeks
• Regimen 8: (D) bismuth subsalicylate 525 mg qid + metronidazole 250 mg qid + tetracycline 500 mg qid + H2 receptor agonist x 2 weeks; then continue H2 receptor agonist x 6 more weeks
• Regimen 9: (not for use in 1st; B in 2nd, 3rd) bismuth subsalicylate 525 mg qid + metronidazole 250 mg qid + amoxicillin 500 mg qid + H2 receptor agonist x 2 weeks; then continue H2 receptor agonist x 6 more weeks receptor agonist x 2 weeks; then continue H2 receptor agonist x 6 more weeks
• Regimen 10: (C) ranitidine bismuth citrate 400 mg bid + clarithromycin 500 mg bid x 2 weeks; then continue ranitidine bismuth citrate 400 mg bid x 2 more weeks
• Regimen 11: (D) omeprazole 20 mg or lansoprazole 30 mg q AM + bismuth subsalicylate 524 mg qid + metronidazole 500 mg tid + tetracycline 500 mg qid x 2 weeks; then continue omeprazole 20 mg or lansoprazole 30 mg q AM for 6 more weeks

HEMORRHOIDS

• dibucaine (C)(OTC)(G) 1 applicatorful or suppository bid and aft er each stool; max 6/day
  Pediatric: not recommended
  Nupercainal (OTC) Rectal oint: 1% (30, 60 g); Rectal supp: 1% (12, 14/pck)
• hydrocortisone (C)(OTC)(G)
  Pediatric: not recommended
  Anusol-HC 1 suppository rectally bid-tid or 2 suppositories bid x 2 weeks
  Rectal supp: 25 mg (12, 24/pck)
  Anusol-HC Cream 2.5% apply bid-qid prn
  Rectal crm: 2.5% (30 g)
  Anusol HC-1 apply tid-qid prn; max 7 days
  Rectal crm: 1% (0.7 oz)
  Hydrocortisone Rectal Cream
  Rectal crm: 1, 2.5% (30 g)
  Nupercainal apply tid-qid prn
  Rectal crm: 1% (30 g)
  Proctocort 1 suppository rectally bid-tid prn or 2 suppositories bid x 2 weeks
  Rectal supp: 30 mg (12/pck)
  Proctocream HC 2.5% apply rectally bid-qid prn
  Rectal crm: 2.5% (30 g)
  Proctofoam HC 1% apply rectally tid-qid prn
  Rectal foam: 1% (14 applications/10 g)
• hydrocortisone/pramoxine (C) 1 applicatorful tid-qid and aft er each stool; max 2 weeks
  Pediatric: not recommended
  Procort Rectal crm: hydro 1.85%/pramox 1.15% (30 g)
• hydrocortisone/lidocaine (B) apply bid-tid prn
  Pediatric: not recommended
  AnaMantle HC, LidaMantle HC Crm/Lotn: hydrocort 5%/lido 3% (1 oz)
• petrolatum/mineral oil/shark liver oil/phenylephrine (C)(OTC)(G)
  Preparation H Ointment apply up to qid prn
  Rectal oint: 1, 2 oz
• petrolatum/glycerin/shark liver oil/phenylephrine (C)(OTC)(G)
  Preparation H Cream apply up to qid prn
  Rectal crm: 0.9, 1.8 oz
• phenylephrine/cocoa butter/shark liver oil (C)(OTC)(G)
  Preparation H Suppositories 1 suppository or 1 application of rectal ointment or cream, up to qid
  Rectal supp: phenyle 0.25%/cocoa 85.5%/shark 3% (12, 24, 45/pck); Rectal oint: phenyle 0.25%/petro 1.9%/mineral oil 14%/shark liv 3% (1, 2 oz); Rectal crm: phenyle 0.25%/petro 18%/gly 12%/shark liv 3% (0.9, 1.8 oz) witch hazel topical solution/gel (NE)(OTC)
  Tucks apply up to 6 x/day; leave on x 5-15 minutes
  Pad: 12, 40, 100/pck; Gel: 19.8 g
• lidocaine 3% cream (B) apply bid-tid prn
  Pediatric: reduce dosage commensurate with age, body weight, and physical condition
  LidaMantle Crm: 3% (1 oz)
  Bulk-forming Agents, Stool Soft eners, and Stimulant Laxatives see Constipation page 97

HEPATITIS A (HAV)
Comment: Administer a 2-dose series. Schedule fi rst immunization at least 2 weeks before expected exposure. Booster dose recommended 6-12 months later. Under 1 year-of-age administer in the vastus lateralis; over 1 year-of-age administer in deltoid.

PROPHYLAXIS (HEPATITIS A)

• hepatitis A vaccine, inactivated (C)
  Havrix 1,440 El.U IM; repeat in 6-12 months
  Pediatric: <2 years: not recommended; 2-18 years: 720 El.U IM; repeat in 6-12 months or 360 El.U IM; repeat in 1 month
  Vaqta 25 U (1 ml) IM; repeat in 6 months
  Pediatric: <2 years: not recommended; 2-18 years: 0.5 ml IM; repeat in 6-18 months
  Vial: 25 U/ml single-dose (preservative-free); Prefi lled syringe: 25 U/ml, (0.5, 1 ml single-dose)

PROPHYLAXIS (HEPATITIS A AND B COMBINATION)

• hepatitis A inactivated/hepatitis B surface antigen (recombinant vaccine) (C)
  Pediatric: <18 years: not recommended
  Twinrix 1 ml IM in deltoid; repeat in 1 month and 6 months
  Vial (soln): hepatitis A inactivated 720 IU/hepatitis B surface antigen (recombinant) 20 mcg/ml (1, 10 ml); Prefi lled syringe: hepatitis A inactivated 720 IU/ hepatitis B surface antigen (recombinant) 20 mcg/ml

HEPATITIS B (HBV)
PROPHYLAXIS (HEPATITIS B)
Comment: Administer IM; under 1 year-of-age, administer in vastus lateralis. Over 1 year-of-age, administer in the deltoid. Administer a 3-dose series; First dose: newborn (or now); Second dose: 1-2 months aft er fi rst dose; Th ird dose: 6 months aft er fi rst dose.

• hepatitis B recombinant vaccine (C)
  Engerix-B Adult 20 mcg (1 ml) IM; repeat in 1 and 6 months
  Pediatric: infant-19 years: 10 mcg (1/2 ml) IM; repeat in 1 and 6 months
  Vial: 20 mcg/ml single-dose (preservative-free, thimerosal); Prefi lled syringe: 20 mcg/ml
  Engerix-B Pediatric/Adolescent
  Pediatric: infant-19 years: 10 mcg IM; repeat in 1 and 6 months; Vial: 10 mcg/0.5 ml single-dose (preservative-free, thimerosal)
  Prefi lled syringe: 10 mcg/0.5 ml
  Recombivax HB Adult 10 mcg (1 ml) IM in deltoid; repeat in 1 and 6 months
  Vial: 10 mcg/ml single-dose; Vial: 10 mcg/3 ml multi-dose
  Recombivax HB Pediatric/Adolescent 5 mcg (0.5 ml) IM; repeat in 1 and 6 months
  Pediatric: birth-19 years: 5 mcg (0.5 ml) IM; repeat in 1 and 6 months; >19 years: use adult formulation or 10 mcg (1 ml) pediatric/adolescent formulation
  Vial: 5 mcg/0.5 ml single-dose

PROPHYLAXIS (HEPATITIS A AND B COMBINATION)
Comment: Administer IM; under 1 year-of-age, administer in vastus lateralis. Over 1 year-of-age, administer in the deltoid. Administer a 3-dose series; First dose: newborn (or now); Second dose: 1-2 months aft er fi rst dose; Th ird dose: 6 months aft er fi rst dose.

• hepatitis A inactivated/hepatitis B surface antigen (recombinant) vaccine (C)
  Pediatric: <18 years: not recommended
  Twinrix 1 ml IM in deltoid; repeat in 1 months and 6 months
  Vial (soln): hepatitis A inactivated 720 IU/hepatitis B surface antigen (recombinant) 20 mcg/ml (1, 10 ml); Prefi lled syringe: hepatitis A inactivated 720 IU/
  hepatitis B surface antigen (recombinant) 20 mcg/ml

CHRONIC HBV INFECTION TREATMENT

Nucleoside Analogs (Reverse Transcriptase Inhibitors and HBV Polymerase Inhibitors)
Comment: Nucleoside analogs are indicated for chronic hepatitis infection with viral replication and either elevated ALT/AST or histologically active disease.

• adefovir dipivoxil (C)(G) 10 mg daily; CrCl 20-49 mL/min: 10 mg q 48 hours; CrCl 10-19 mL/min: 10 mg q 72 hours
  Pediatric: not recommended
  Hepsera Tab: 10 mg
• entecavir (C)(G) take on an empty stomach
  Nucleoside naïve: 0.5 mg daily; Nucleoside naïve, CrCl 30-49 mL/min: 0.25 mg daily; Nucleoside naïve, CrCl 10-29 mL/min: 0.15 mg daily; Nucleoside naïve, CrCl <10 mL/min: 0.05 mg daily; lamivudine-refractory: 1 mg daily; lamivudine-refractory, renal impairment: see mfr pkg insert
  Pediatric: <16 years: not recommended
  Baraclude Tab: 0.5, 1 mg; Oral Soln: 0.05 mg/ml (orange; parabens)
• lamivudine (C)(G) 100 mg daily; CrCl <5 mL/min: 35 mg for 1st dose, then 10 mg once daily; CrCl 5-14 mL/min: 35 mg for 1st dose, then 15 mg once daily; CrCl 15-29 mL/min: 100 mg for 1st dose, then 25 mg once daily; CrCl 30-49 mL/min: 100 mg for 1st dose, then 50 mg once daily
  Pediatric: <2 years: not recommended; 2-17 years: 3 mg/kg (max 100 mg) once daily
  Epivir-HBV Tab: 100 mg
  Epivir-HBV Oral Solution Oral Soln: 5 mg/ml (240 ml) (strawberry-banana)
• telbivudine (C) 600 mg daily; CrCl <40 mL/min: 600 mg q 72 hours; CrCl 30-49 mL/min: 600 mg q 48 hours
  Pediatric: <16 years: not recommended
  Tyzeka Tab: 600 mg
• tenofovir alafenamide (TAF) (C) take with food; take 1 tab once daily with concomitant carbamazepine 2 tablets
  Pediatric: <18 years: not established
  Vemlidy Tab: 25 mg
  Comment: No dosage adjustment of Vemlidy is required in patients with mild hepatic impairment (Child-Pugh A). Th e safety and effi cacy of Vemlidy in patients with decompensated cirrhosis (Child-Pugh B or C) have not been established; therefore Vemlidy is not recommended in patients with decompensated (Child-Pugh B or C) hepatic impairment, Healthcare providers are encouraged to register patients by calling the Antiretroviral Pregnancy Registry (APR) at 1-800-258-4263.

Interferon Alpha

• interferon alfa-2b (C) 5 million IU SC or IM daily or 10 million IU SC or IM 3 times/week x 16 weeks; reduce dose by half or interrupt dose if WBCs, granulocyte count, or platelet count decreases
  Pediatric: <1 year: not recommended; >1 year: 3 million IU/m2 3 times/week x 1 week; then increase to 6 million IU/m2 3 times/week to 16-24 weeks; max 10 million IU/dose; reduce dose by half or interrupt dose if WBCs, granulocyte count, or platelet count decreases
  Intron A Vial (pwdr): 5, 10, 18, 25, 50 million IU/vial (pwdr + diluent; single-dose) (benzoyl alcohol); Vial (soln): 3, 5, 10 million IU/vial (single-dose);
  Multi-dose vials (soln): 18, 25 million IU/vial soln; Multi-dose pens (soln): 3, 5, 10 million IU/0.2 ml (6 doses/pen)

HEPATITIS C (HCV)
CHRONIC HCV INFECTION TREATMENT

Nucleoside Analogs (Reverse Transcriptase Inhibitors)
Comment: Nucleoside analogs are indicated for patients with compensated liver disease previously untreated with alpha interferon or who have relapsed aft er alpha interferon therapy. Primary toxicity is hemolytic anemia. Contraindicated in male partners of pregnant women; use 2 forms of contraception during therapy and for 6 months aft er discontinuation.

• ribavirin (X)(G) take with food in 2 divided doses; Genotype 2, 3: 800 mg/day x 24 weeks; Genotype 1, 4, <75 kg: 1 gm/day x 48 weeks; =75 km 1.2 gm/day x 48 weeks; HIV co-infection: 800 mg/day x 48 weeks; CrCl 30-50 mL/min: alternate 200 mg and 400 mg every other day; CrCl <30 mL/min or hemodialysis: reduce dose or discontinue if hematologic abnormalities occur
  Pediatric: <5 years: not established; =5-<18 years: 23-33 kg: 400 mg/day; 34-46 kg: 600 mg/day; 47-59 kg: 800 mg/day; 60-75 kg: 1 gm/day; 1.2 gm/day; =75 kg:
  Genotype 2, 3: treat for 24 weeks; Genotype 1, 4: treat for 48 weeks; reduce dose or discontinue if hematologic abnormalities occur; =18 years: same as adult
  Copegus Tab: 200 mg
  Rebetol Cap: 200mg
  Rebetol Oral Solution Oral soln: 40 mg/ml (120 ml) (bubble gum)
  Ribashere RibaPak 600 mg Tab: 600 mg (14/pck)

Interferon Alpha

• interferon alfacon-1 (C)
  Pediatric: <18 years: not recommended
  Infergen 9 mcg SC 3 times/week x 24 weeks, then 15 mcg SC 3 times/week x 6 months; allow at least 48 hours between doses
  Vial (soln): 9, 15 mcg/vial soln (6-single dose/pck; preservative-free)
• interferon alfa-2b (C)
  Intron A Vial (pwdr): 5, 10, 18, 25, 50 million IU/vial (pwdr w. diluent; single-dose) (benzoyl alcohol); Vial (soln): 3, 5, 10 million IU/vial (single-dose); Multi-dose vials (soln): 18, 25 million IU/vial; Multi-dose pens (soln): 3, 5, 10 million IU/0.2 ml (6 doses/pen)
• peginterferon alfa-2a (C) administer 180 mcg SC once weekly (on the same day of the week); treat for 48 weeks; consider discontinuing if adequate response aft er 12-24 weeks
  Pediatric: <18 years: not recommended
  PEGasys Vial: 180 mcg/ml (single-dose); Monthly pck (vials): 180 mcg/ml (1 ml, 4/pck)
• peginterferon alfa-2b (C) administer SC once weekly (on the same day of the week); treat for 1 year; consider discontinuing if inadequate response aft er 24 weeks; 37-45 kg: 40 mcg (100 mg/ml, 0.4 ml); 46-56 kg: 50 mcg (100 mg/ml, 0.5 ml); 57-72 kg: 64 mcg (160 mg/ml, 0.4 ml); 73-88 kg: 80 mcg (160 mg/ml, 0.5 ml); 89-106 kg: 96 mcg (240 mg/ml, 0.4 ml); 107-136 kg: 120 mcg (240 mg/ml, 0.5 ml); 137-160 kg: 150 mcg (300 mg/ml, 0.5 ml)
  Pediatric: <18 years: not recommended
  PEG-Intron Vial: 50, 80, 120, 150 mcg/ml (single-dose)
  PEG-Intron Redipen Pen: 50, 80, 120, 150 mcg/ml (disposable pens)
  HCV NS5A Inhibitor
• daclatasvir (X) 60 mg once daily for 12 weeks (with sofosbuvir); if sofosbuvir is discontinued, daclatasvir should also be discontinued; with concomitant CY3P inhibitors, reduce dose to 30 mg once daily; with concomitant CY3P inducers, increase dose to 90 mg once daily
  Daklinza Tab: 30, 60 mg
  Comment: Daklinza is indicated in combination with sofosbuvir with or without ribavirin, for the treatment of HCV genotypes 1 and 3, and in patients with co-morbid HIV-1 infection, advanced cirrhosis, or post-liver transplant recurrence of HCV.

HCV NS5A Inhibitor/HCV NS3/4A Protease Inhibitor Combinations

• elbasvir/grazoprevir (NE) 1 tab as a single dose once daily; see mfr pkg insert for length of treatment
  Pediatric: <18 years: not recommended
  Zepatier Tab: elba 50 mg/grazo 100/mg
  Comment: Zepatier is contraindicated with moderate or severe hepatic impairment, concomitant azanavir, carbamazepine, cyclosporine, darunavir, efavirenz, lopinavir, phenatoin, rifampin, saquinavir, St. John’s wort, tipranavir. When co-administered with ribavirin, pregnancy category (X)

HCV NS5A Inhibitor/HCV NS3/4A Protease Inhibitor/CYP3A Inhibitor Combinations

• ombitasvir/paritaprevir/ritonavir (B) take 2 tabs once daily in the AM x 12 weeks
  Pediatric: <18 years: not established
  Technivie Tab: omvi 25 mg/pari 75 mg/rito 50 mg (4 x 7 daily dose pcks/carton)
  Comment: Technivie is indicated for use in chronic HCV genotype 4 without cirrhosis. Technivie is not for use with moderate hepatic impairment.

HCV NS3/4A Protease Inhibitor Combinations

• boceprevir (C) 800 mg 3 times/day; take with food (not low-fat); not for monotherapy; start aft er 4 weeks therapy with peginterferon and discontinue if HCV-RNA levels indicate futility ribavirin; Without cirrhosis: continue as indicated by HCV-RNA levels at weeks 8, 12, and 24; With cirrhosis: continue for 44 weeks; do not reduce dose
  Pediatric: <18 years: not recommended
  Victrelis Cap: 200 mg
• simeprevir (C) 150 mg once daily; swallow whole; take with food, not for monotherapy; do not reduce dose or interrupt therapy; if discontinued, do not reinitiate; discontinue if HCV-RNA levels indicate futility; discontinue if peginterferon, ribavirin, or sofobuvir is permanently discontinued; Treatment naïve, treatment relapses, with or without cirrhosis: treat x 12 weeks (simeprevir + peginterferon + ribavirin) followed by additional 12 weeks peginterferon + ribavirin (total = 24 weeks). Partial and non-responders, with or without cirrhosis: treat x 12 weeks (simeprevir + peginterferon + ribavirin) followed by additional 36 weeks peginterferon + ribavirin (total = 48 weeks); Treatment naïve or treatment experienced without cirrhosis: treat x 12 weeks (simeprevir + sofobuvir); Treatment naïve or treatment experienced with cirrhosis: treat x 24 weeks (simeprevir + sofobuvir)
  Olysio Cap: 150 mg

HCV NS5A Inhibitor/HCV NS5B Polymerase Inhibitor Combinations

• ledipasvir/sofosbuvir (NE) Treatment naïve, without cirrhosis, with pretreatment HCV RNA <6 million IU/ml: 1 tab daily x 8 weeks; Treatment naïve with or without cirrhosis or treatment-experienced without cirrhosis: 1 tab daily x 12 weeks; Treatment-experienced with cirrhosis: 1 tab daily x 24 weeks; In combination with ribavirin: 1 tab daily x 12 weeks
  Pediatric: <18 years: not established
  Harvoni Tab: ledi 90 mg/sofo 400 mg
  Comment: Harvoni is indicated for patients with advanced liver disease, genotytpe 1, 4, 5, or 6 infection: chronic HCV genotype 1- or 4-infected liver transplant recipients with or without cirrhosis or with compensated cirrhosis (Child-Pugh A), and for HCV genotype 1-infected patients with decompensated cirrhosis (Child-Pugh B/C), including those who have undergone liver transplantation. No adequate human data are available to establish whether or not Harvoni poses a risk to pregnancy outcomes; the background risk of major birth defects and miscarriage for the indicated population is unknown. If Harvoni is administered with ribavirin, the combination regimen is contraindicated (X) in pregnant women and in men whose female partners are pregnant. It is not known whether Harvoni and its metabolites are present in human breast milk, aff ect human milk production or have eff ects on the breastfed infant. If Harvoni is administered with ribavirin, the nursing mother’s information for ribavirin also applies to this combination regimen.
• sofosbuvir/velpatasvir (NE) Without cirrhosis or compensated cirrhosis (Child-Pug A): 1 tablet daily x 12 weeks; Decompensated cirrhosis (Child Pugh B or C): 1 tablet daily plus ribavirin (RBV)
  Pediatric: <18 years: not established
  Epclusa Tab: sofo 400 mg/velpa 100 mg
  Comment: Epclusa is indicated for patients with chronic HCV with genotytpe 1, 2, 3, 4, 5, or 6 infection.

HCV NS5A Inhibitor/HCV NS3/4A Protease Inhibitor/CYP3A Inhibitor Combination

• sofosbuvir/velpatasvir (B) 1 tab daily
  Pediatric: not established
  Viekira XR Tab: dasa 200 mg/omvi 8.33 mg/pari 50 mg/rito 33.33 mg ext-rel (4 weekly cartons, each containing 7 daily dose packs/carton)
  Comment: Viekira XR is indicated for HCV genotype 1 with mild liver dysfunction (Child-Pugh A). Viekira XR is contraindicated for moderate (Child-Pugh B) to severe (Child-Pugh C) liver dysfunction. No adjustment is recommended with mild, moderate, or severe renal dysfunction.

HCV NS5A Inhibitor/HCV NS3/4A Protease Inhibitor/CYP3A Inhibitor PLUS HCV NS5B Polymerase Inhibitor Combination

• ombitasvir/paritaprevir/ritonavir plus dasabuvir (B)
  Pediatric: not established
  Viekira Pak ombitasvir/paritaprevir/ritonavir fi xed-dose combination tablet: 2 tablets orally once a day (in the morning); dasabuvir: 250 mg orally twice a day (morning and evening)
  Tab: omvi 12.5 mg/pari 75 mg/rito 50 mg plus Tab: dasa 250 mg (28 day supply/pck)
  Comment: Viekira Pak is indicated for mild liver dysfunction (Child-Pugh A).
  Viekira Pak is contraindicated for moderate (Child-Pugh B) to severe (Child-Pugh C) liver dysfunction. No adjustment is recommended with mild, moderate, or severe renal dysfunction.

HERPANGINA ANALGESICS

acetaminophen (B) see Fever page 143

• 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 <40 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 <40 mL/min: max 100 mg q 12 hours; Cirrhosis: max 50 mg q 12 hours
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Tab: 50*mg
  Ultram ER initially 100 mg once daily; may increase by 100 mg every 5 days; max 300 mg/day; CrCl <40 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; 5 days; CrCl <40 mL/min: max 2 tabs q 12 hours; max 4 tabs/day x 5 days
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Ultracet Tab: tram 37.5/acet 325 mg
  Other Oral Analgesics see Pain page 308

TOPICAL ANESTHETICS

• lidocaine viscous soln (B) 15 ml gargle or mouthwash; repeat aft er 3 hours; max 8 doses/day
  Pediatric: <4 years: apply 1.25 ml to aff ected area with cotton-tipped applicator; may repeat aft er 3 hours; max 8 doses/day
  Xylocaine 2% Viscous Solution Viscous soln: 2% (20, 100, 450 ml)
  Antipyretics see Fever page 143

HERPES GENITALIS (HSV TYPE II)
Comment: Th e following treatment regimens are published in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines. Treatment regimens are for adults only; consult a specialist for treatment of patients less than 18 years-of-age. Treatment regimens are presented in alphabetical order by generic drug name, followed by brands and dose forms.

RECOMMENDED REGIMENS: FIRST CLINICAL EPISODE

Regimen 1

• acyclovir 400 mg tid x 7-10 days or 200 mg 5 times/day x 10 days or until clinically resolved

Regimen 2

• acyclovir cream apply q 3 hours 6 x/day x 7 days

Regimen 3

• famciclovir 250 mg tid x 7-10 days or until clinically resolved

Regimen 4

• valacyclovir 1 g bid x 10 days or until clinically resolved

RECOMMENDED RECURRENT/EPISODIC REGIMENS
Comment: Initiate treatment of recurrent episodes within 1 day of onset of lesions.

Regimen 1

• acyclovir 200 mg 5 times/day x 5 days

Regimen 2

• famciclovir 125 mg bid x 5 days

Regimen 3

• valacyclovir 500 mg bid x 3-5 days or until clinically resolved

SUPPRESSION THERAPY REGIMENS

Regimen 1

• acyclovir 400 mg bid x 1 year

Regimen 2

• famciclovir 250 mg bid x 1 year

Regimen 3

• valacyclovir 500 mg daily x 1 year (for =9 recurrences/year) or 1 g daily x 1 year (for =10 recurrences/year)

DAILY SUPPRESSIVE REGIMENS FOR PERSONS WITH HIV

Regimen 1

• acyclovir 400-800 mg bid-tid

Regimen 2

• famciclovir 500 mg bid

Regimen 3

• valacyclovir 500 mg bid

RECURRENT/EPISODIC REGIMENS FOR PERSONS WITH HIV

Regimen 1

• acyclovir 400 mg tid x 5-10 days

Regimen 2

• famciclovir 500 mg bid x 5-10 days

Regimen 3

• valacyclovir 1 g bid x 5-10 days

DRUG BRANDS AND DOSE FORMS

• acyclovir (B)(G)
  Zovirax Cap: 200 mg; Tab: 400, 800 mg
  Zovirax Oral Suspension Oral susp: 200 mg/5 ml (banana)
  Zovirax Cream Crm: 5% (3, 15 g); Oint: 5% (3, 15 g)
• famciclovir (B)
  Famvir Tab: 125, 250, 500 mg
• valacyclovir (B)
  Valtrex Cplt: 500, 1,000 mg

HERPES LABIALIS/HERPES FACIALIS (HERPES SIMPLEX VIRUS TYPE I, COLD SORE, FEVER BLISTER)
PRIMARY INFECTION

• acyclovir (B)(G) do not chew, crush, or swallow the buccal tab; apply within 1 hour of symptom onset and before appearance of lesion; apply a single buccal tab to the upper gum region on the aff ected side and hold in place for 30 seconds
  Pediatric: not established
  Sitavig Buccal tab: 50 mg
  Pediatric: see page 552 for dose by weight
  Comment: Sitavig is contraindicated with allergy to milk protein concentrate.
• valacyclovir (B) 2 g q 12 hours x 1 day
  Valtrex Cplt: 500, 1,000 mg

SUPPRESSION THERAPY (FOR 6 OR MORE OUTBREAKS/YEAR)

• acyclovir (B)(G) 200 mg 2-5 x/day x 1 year
  Pediatric: <2 years: not recommended; >2 years, <40 kg: 20 mg/kg 2-5 times/day x 1 year; >2 years, >40 kg: 200 mg 2-5 times/day x 1 year; see page 552 for dose by weight
  Zovirax Cap: 200 mg; Tab: 400, 800 mg
  Zovirax Oral Suspension Oral susp: 200 mg/5 ml (banana)

TOPICAL ANTIVIRAL THERAPY

• acyclovir (B)(G) apply q 3 hours 6 times/day x 7 days
  Pediatric: <2 years: not recommended; =2 years: same as adult
  Zovirax Cream Crm: 5% (3, 15 g); Oint: 5% (3, 15 g)
• docosanol (B) apply and gently rub in 5 times daily until healed
  Pediatric: not recommended
  Abreva (OTC) Crm: 10% (2 g)
• penciclovir (B) apply q 2 hours while awake x 4 days
  Pediatric: not recommended
  Denavir Crm: 1% (2 g)

TOPICAL ANTIVIRAL/CORTICOSTEROID THERAPY

• acyclovir/hydrocortisone (B)(G) cream apply to aff ected area 5 x/day x 5 days
  Pediatric: <12 years: not recommended; =12 years: same as adult
  Crm: 1% (2, 5 g)

HERPES ZOSTER (SHINGLES)
ORAL ANTIVIRALS

• famciclovir (B) 500 mg tid x 7 days
  Pediatric: <18 years: not recommended
  Famvir Tab: 125, 250, 500 mg
• valacyclovir (B) 1 g tid x 7 days
  Pediatric: not recommended
  Valtrex Cplt: 500, 1,000 mg
• acyclovir (B)(G) 800 mg 5 x/day x 7-10 days
  Pediatric: <2 years: not recommended; =2 years, <40 kg: 20 mg/kg 5 x/day x 7-10 days; >2 years, >40 kg: 800 mg 5 x/day x 7-10 days; see page 552 for dose by weight
  Zovirax Cap: 200 mg; Tab: 400, 800 mg
  Zovirax Oral Suspension Oral susp: 200 mg/5 ml (banana)

PROPHYLAXIS AGAINST SECONDARY INFECTION

• silver sulfadiazine (B) apply qid
  Pediatric: not recommended
  Silvadene Crm: 1% (20, 50, 85, 400, 1,000 g jar; 20 g tube)

ANALGESICS

• acetaminophen (B) 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 <40 mL/min: max 100 mg q 12 hours; Cirrhosis: max 50 mg q 12 hours
  Pediatric: <16 years: not recommended: =16 years: same as adult
  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 <40 mL/min: max 2 tabs q 12 hours; max 4 tabs/day x 5 days
  Pediatric: <16 years: not recommended; =16 years: same as adult
  Ultracet Tab: tram 37.5/acet 325 mg
  Other Oral Analgesics see Pain page 308
  Postherpetic Neuralgia see page 351

SECONDARY INFECTION PROPHYLAXIS

• silver sulfadiazine (B) apply qid
  Pediatric: not recommended
  Silvadene Crm: 1% (20, 50, 85, 400, 1,000 g/jar; 20 g tube)

HICCUPS: INTRACTABLE

• chlorpromazine (C) 25-50 mg tid-qid
  Pediatric: <6 months: not recommended; =6 months: 0.25 mg/lb orally q 4-6 hours prn or 0.5 mg/lb rectally q 6-8 hours prn
  Th orazine Tab: 10, 25, 50, 100, 200 mg; Spansule: 30, 75, 150 mg sust-rel; Syr: 10 mg/5 ml (4 oz; orange custard); Oral conc: 30 mg/ml (4 oz); 100 mg/ml (2, 8 oz); Supp: 25, 100 mg

HIDRADENITIS SUPPURATIVA
ORAL ANTI-INFECTIVES

• doxycycline (D)(G) 100 mg bid x 7-14 days
  Pediatric: <8 years: not recommended; =8 years, <100 lb: 2 mg/lb on fi rst day in 2 divided doses, followed by 1 mg/lb/day in 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) 1-1.5 g divided qid x 7-14 days
  Pediatric: <45 kg: 30-50 mg in 2-4 divided doses x 7-14 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) 1200-1600 mg divided qid x 7-14 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.
• minocycline (D)(G) 100 mg bid x 7-14 days
  Pediatric: <8 years: not recommended, =8 years: same as adult
  Dynacin Cap: 50, 100 mg
  Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (sulfi tes, alcohol 5%)
  Comment: minocycline is contraindicated <8 years-of-age, in pregnancy, and lactation (discolors developing tooth enamel). A side eff ect may be photosensitivity (photophobia). Do not give with antacids, calcium supplements, milk or other dairy, or within two hours of taking another drug.
• tetracycline (D)(G) 250 mg qid or 500 mg tid x 7-14 days
  Pediatric: <8 years: not recommended; =8 years, <100 lb: 25-50 mg/kg/day in 2-4 divided doses x 7-14 days; =8 years, =100 lb: same as adult; see page 585 for dose by weight
  Achromycin V Cap: 250, 500 mg
  Sumycin Tab: 250, 500 mg; Cap: 250, 500 mg; Oral susp: 125 mg/5 ml (100, 200 ml) (fruit, sulfi tes)
  Comment: tetracycline 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.

TOPICAL ANTI-INFECTIVES

• clindamycin (B) topical apply bid x 7-14 days
  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%)

HOOKWORM (UNCINARIASIS, CUTANEOUS LARVAE MIGRANS)
ANTHELMINTICS

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

HUMAN IMMUNODEFICIENCY VIRUS (HIV)
EXPOSURE, ANTIRETROVIRAL PEP/nPEP

Antiretroviral drug brand names and dose forms (see Anti-HIV Drugs page 523)
Comment: Antiretroviral prophylactic treatment regimens for occupational HIV exposure (PEP) and nonoccupational exposure (nPEP) are referenced from the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines, MMWR, and NIH available at: www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm and www.aidsinfo.nih.gov/guidelines/default_db2.asp?id=50.
In this section, the 2015 CDC-recommended highly active antiretroviral treatment (HAART) regimens are followed by a listing of the single and combination drugs with dosing regimens and dose forms. Appendix S is an alphabetical listing of the HIV drugs and dose forms. For more information on the management of HIV infection in adults and adolescents, see Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: https://aidsinfo.nih.gov/contentfi les/lvguidelines/adultandadolescentgl.pdf. For specifi c dosing information in the management of HIV infection in children, see Guidelines for Use of Antiretroviral Agents in Pediatric HIV Infection: https://www.aidsinfo.nih.gov/contentfi les/lvguidelines/pediatricguidelines.pdf. Providers should consult, and/refer HIV-infected patients to, a specialist and/or specialty community services for age-appropriate dosing regimens and other patientspecific needs.
Initiation of PEP/nPEP with ART as soon as possible increases the likelihood of prophylactic benefi t. Treatment regimens must be initiated =72 hours following exposure. A 28-day course of ART is recommended for persons with substantial risk for HIV exposure (i.e., exposure of vagina, rectum, eye, mouth, or other mucous membrane, non-intact skin, or percutaneous contact with blood, semen, vaginal secretions, breast milk, or any body fl uid that is visibly contaminated with blood, when the source is known to be infected with HIV). ART is not recommended for persons with negligible risk for HIV exposure (i.e., exposure of vagina, rectum, eye, mouth, or other mucus membrane, intact or non-intact skin, or percutaneous contact with urine, nasal secretions, saliva, sweat, or tears, if not visibly contaminated with blood, regardless of the known or suspected HIV status of the source). Th ere is no evidence indicating any specifi c antiretroviral medication, or combination of medications is optimal for suppressing local viral replication. Th ere is no evidence to indicate that a 3-drug ART regimen is any more benefi cial than a 2-drug regimen. When the source person is available for interview and testing, his or her history of retroviral medication use and most recent/current viral load measurement should be considered when selecting an ART treatment regimen (e.g., to help avoid prescribing an antiretroviral medication to which the source virus is likely to be resistant). Register pregnant patients exposed to antiretroviral agents to the Antiretroviral Pregnancy Registry (APR) at 800-258-4263. Th e Centers for Disease Control and Prevention recommend that HIV-infected mothers not breastfeed their infants to avoid risking postnatal transmission of HIV infection.

REGIMENS

Nonnucleoside Reverse Transcriptase Inhibitor (NNRTI)-Based Regimen

• efavirenz plus (lamivudine or emtricitabine) plus (zidovudine or tenofovir)

Protease Inhibitor (PI)-Based Regimens

• lopinavir/ritonavir (co-formulated as Kaletra) plus (lamivudine or emtricitabine) plus zidovudine
• darunavir/cobicistat (co-formulated as Prezcobix) plus other retroviral agents

ALTERNATIVE REGIMENS
NNRTI-Based Regimen

efavirenz plus (lamivudine or emtricitabine) plus (abacavir or didanosine or stavudine)
Comment: efavirenz should be avoided in pregnant women and women of childbearing potential.

Protease Inhibitor-Based Regimens

Regimen 1

• atazanavir plus (lamivudine or emtricitabine) plus (zidovudine or stavudine or abacavir or didanosine) or (tenofovir plus ritonavir (100 mg/day)

Regimen 2

• fosamprenavir plus (lamivudine or emtricitabine) plus (zidovudine or stavudine) or (abacavir or tenofovir or didanosine)

Regimen 3

• fosamprenavir/ritonavir plus (lamivudine or emtricitabine) plus (zidovudine or stavudine or abacavir or tenofovir or didanosine)

Regimen 4

• indinavir/ritonavir plus (lamivudine or emtricitabine) plus (zidovudine or stavudine or abacavir or tenofovir or didanosine)
  Comment: Using ritonavir with indinavir may increase risk for renal adverse events.

Regimen 5

• lopinavir/ritonavir (co-formulated as Kaletra) plus (lamivudine or emtricitabine) plus (stavudine or abacavir or tenofovir or didanosine)

Regimen 6

• nelfi navir plus (lamivudine or emtricitabine) plus (zidovudine or stavudine or abacavir or tenofovir or didanosine)

Regimen 7

• saquinavir/ritonavir plus (lamivudine or emtricitabine) plus (zidovudine or stavudine or abacavir or tenofovir or didanosine)

Triple Nucleoside Reverse Transcriptase Inhibitor (NRTI)-Based Regimen

• abacavir plus lamivudine plus zidovudine
  Comment: Triple NRTI therapy should be used only when an NNRTI- or PI-based regimen cannot or should not be used.

BRAND NAMES, DOSING AND DOSE FORMS: SINGLE AGENTS

Integrase Strand Transfer Inhibitor (INSTI)

• dolutegravir (C) Treatment naïve or treatment experienced but INSTI naïve: 50 mg once daily; Treatment experienced or naïve and co-administered with efavirenz, FPV/r, TPV/r, or rifampin: 50 mg bid; INSTI experienced with certain INSTI- associated resistance substitutions: 50 mg bid
  Pediatric: <12 years, <40 kg: not established; =12 years, =40 kg: same as adult
  Tivicay Tab: 10, 25, 50 mg
• raltegravir (as potassium) (C) 400 mg (one fi lm-coat tab) bid; take with concomitant rifampin 800 mg bid; swallow whole; do not crush or chew
  Pediatric: =4 weeks, 3-11 kg [oral suspension] 3-<4 kg: 20 mg bid; 4-<6 kg: 30 mg bid; 6-<8 kg: 40 mg bid; 8-<11 kg: 60 mg bid; =11-<25 kg [oral suspension/chewable
  tab]; 6 mg/kg/dose bid; see mfr pkg insert for dose by weight table; =25 kg and unable to swallow tablet use chewable tab; 25-<28 kg: 150 mg bid; 28-<40 kg: 200 mg bid; =40 kg: 300 mg bid; 6 years, =25 kg, and able to swallow tablets use fi lm-coat tab; 400 mg bid
  Isentress Tab: 400 mg fi lm-coat; Chew tab: 25, 100*mg (orange banana) ( phenylalanine)
  Isentress Oral Suspension Oral susp: 100 mg/pkt pwdr for oral susp (banana)
  Comment: Oral suspension, chewable tablets and fi lm-coated raltegravir tablets are not bioequivalent. Maximum dose for chewable tablets is 300 mg twice daily.
  Maximum dose for fi lm-coated tabletsis 400 mg twice daily

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

• abacavir sulfate (C)(G) 600 mg once daily or 300 mg bid; Mild hepatic impairment: use oral solution for titration
  Pediatric: 3 months-16 years: [tablet/oral solution] 16 mg/kg qd or 8 mg/kg bid; max 300 mg bid; >14 kg: see mfr pkg insert for tablet dosing by weight band
  Ziagen (as sulfate) Tab: 300*mg
  Ziagen Oral Solution Oral soln: 20 mg/ml (240 ml) (strawberry-banana) ( parabens, propylene glycol)
• didanosine (C)
  Videx EC take once daily on an empty stomach; swallow whole; <20 kg: use oral solution; 20-<25 kg: 200 mg; 25-<60 kg: 250 mg; =60 kg: 400 mg; CrCl 30-59 mL/min: <60 kg: 125 mg; =60 kg: 200 mg; CrCl 10-29 mL/min: 125 mg; CrCl<10 mL/min or dialysis:<60 kg: use oral solution =60 kg: 125 mg
  Pediatric: same as adult
  Cap: 125, 200, 250, 400 mg ent-coat del-rel; Chew tab: 25, 50, 100, 150, 200 mg (mandarin orange) (buff ered with calcium carbonate and magnesium hydroxide, phenylalanine)
  Videx Pediatric Pwdr for Solution <60 kg: 125 mg bid; =60 kg: 200 mg bid; If once daily dosing required: <60 kg: 250 mg once daily; =60 kg: 400 mg once daily; CrCl 30-59 mL/min: <60 kg: 150 mg once daily or 75 mg bid; =60 kg: 200 mg once daily or 100 mg bid; CrCl 10-29 mL/min: <60 kg: 100 mg once daily; =60 kg: 150 mg once daily; CrCl <10 mL/min or dialysis: <60 kg: 75 mg once daily; =60 kg: 100 mg once daily; take on an empty stomach
  Pediatric: <2 weeks: not recommended; 2 weeks-8 months: 100 mg/m2 bid; >8 months: 120 mg/m2 bid; Renal impairment: consider reducing dose or increasing dosing interval; take on an empty stomach
  Pwdr for oral soln: 2, 4 g (120, 240 ml)
  Comment: didanosine is contraindicated with concomitant allopurinal or ribavirin.
• emtricitabine (B) 200 mg once daily; CrCl 30-49 mL/min: 200 mg q 48 hours; CrCl 15-29 mL/min: 200 mg q 72 hours; CrCl <15 mL/min or dialysis: 200 mg q 96 hours
  Pediatric: <3 months: 3 mg/kg oral soln once daily; 3 months-17 years, 6 mg/kg once daily; =33 kg: use oral soln, max 240 mg (24 ml); >33 kg: 200 mg cap once daily; max 240 mg/day; =18 years: same as adult
  Emtriva Cap: 200 mg
  Emtriva Oral Solution Oral soln: 10 mg/ml (170 ml) (cotton candy)
• lamivudine (C)(G) CrCl =50 mL/min: 300 mg qd or 150 mg bid; CrCl >30-50 mL/min: 150 mg qd; CrCl 15-29: fi rst dose 150 mg, then 100 mg once daily; CrCl 5-14 mL/min: fi rst dose 150 mg, then 50 mg qd; CrCl <5 mL/min: fi rst dose 50 mg, the 25 mg once daily; max 8mg/kg once daily or 150 mg bid
  Pediatric: <3 months: not established; 3 months-16 years: 4 mg/kg oral soln or tab bid; [tab] 14-<20 kg: 150 mg once daily or 75 mg bid; =20-<25 kg: 225 mg once daily or 75 mg in the AM and 150 mg in the PM; =25 kg: 300 mg once daily or 150 mg bid; max 8 mg/kg once daily or 150 mg bid or 300 mg once daily
  Epivir Tab: 150*, 300 mg
  Epivir Oral Solution Oral soln: 10 mg/ml (240 ml) (strawberry-banana) (sucrose 3 g/15 ml)
  Comment: With renal impairment reduce lamivudine dose or extend dosing interval.
• stavudine (C)(G) =60 kg: 40 mg q 12 hours; =60 kg: 30 mg q 12 hours; If peripheral neuropathy develops: discontinue; Aft er resolution, =60 kg: may re-start at 20 mg q 12 hours; Aft er resolution, =60 kg: may restart at 15 mg q 12 hours; if neuropathy returns: consider permanent discontinuation; CrCl 10-50 mL/min, =60 kg: 20 mg q 12 hours; CrCl 10-50 mL/min, =60 kg: 15 mg q 12 hours; Hemodialysis, =60 kg: 20 mg q 24 hours; Hemodialysis, =60 kg: 15 mg q 24 hours; administer at the same time of day; Hemodialysis: administer at the end of dialysis
  Pediatric: birth-13 days: [tablet/oral solution] 0.5 mg/kg q 12 hours; >14 days, <30 kg: [tablet/oral solution] 1 mg/kg q 12 hours; =30-<60 kg: 30 mg q 12 hours; =60 kg: 40 mg q 12 hours
  Zerit Cap: 15, 20, 30, 40 mg
  Zerit for Oral Solution Oral soln: 1 mg/ml pwdr for reconstitution (fruit) (dye-free)
  Comment: Withdraw stavudine if peripheral neuropathy occurs. Aft er complete resolution, may restart at half the recommended dose. If peripheral neuropathy recurs consider permanent discontinuation.
• tenofovir disoproxil fumarate (C) 300 mg once daily; CrCl 30-49 mL/min: 300 mg q 48 hours; CrCl 10-29: 300 mg q 72-96 hours; Hemodialysis: 300 mg once every 7 days or aft er a total of 12 hours of dialysis; CrCl <10 mL/min: not recommended
  Pediatric: <2 years: not established; 2-12 years: 8 mg/kg once daily; >12 years, 35 kg: 300 mg once daily; mix oral pwdr with 2-4 oz soft food
  Viread Tab: 150, 200, 250, 300 mg; Oral pwdr: 40 mg/g (60 g w. dosing scoop)
• zidovudine (C)(G) 600 mg daily divided bid-tid; ESRD/dialysis: 100 mg q 6-8 hours;
  Vertical transmission, severe anemia, or neutropenia: see mfr pkg insert
  Pediatric: Treatment of HIV-1 infection: 4-<9kg: 24 mg/kg/day divided bid or tid; =9-<30 kg: 18 mg/kg/day divided bid or tid; =30 kg: 600 mg/day divided bid or tid;
  Prevention of maternal-fetal neonatal transmission: <12 hours aft er birth until 6 weeks of age: [Solution] 2 mg/kg q 6 hours until 6 weeks-of-age; [IV] 1.5 mg/kg infused
  over 30 minutes q 6 hours until 6 weeks-of-age; max 200 mg q 8 hours
  Retrovir Tablets Tab: 300 mg
  Retrovir Capsules Cap: 100 mg
  Retrovir Syrup Syrup: 50 mg/5 ml (strawberry)
  Retrovir IV Vial: 10 mg/ml aft er dilution (20 ml) (preservative-free)

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• delavirdine mesylate (C) 400 mg (4 x 100-mg or 2 x 200 mg) tablets tid in combination with other antiretroviral agents
  Pediatric: <16 years: not established; =16 years: same as adult
  Rescriptor Tab: 100, 200 mg
  Comment: Th e 100 mg Rescriptor tablets may be dispersed in water prior to consumption. To prepare a dispersion, add four 100 mg Rescriptor tablets to at least 3 ounces of water, allow to stand for a few minutes, and then stir until a uniform dispersion occurs. Th e dispersion should be consumed promptly. Th e glass should be rinsed with water and the rinse swallowed to insure the entire dose is consumed. Th e 200 mg tablets should be taken as intact tablets, because they are not readily dispersed in water.
• efavirenz (D) 600 mg once daily
  Pediatric: >3 months, 3.5 kg: [tablet/capsule] 3.5-< 5 kg: 100 mg once daily 5-<7.5 kg: 150 mg once daily; 7.5-<15 kg: 200 mg once daily; 15-<20 kg: 250 mg once daily; 20-<25 kg: 300 mg once daily; 25-<32.5 kg: 350 once daily; 32.5-<40 kg: 400 mg once daily; >40 kg: 600 mg once daily; max 600 mg once daily
  Comment: For children who cannot swallow capsules, the capsule contents can be administered with a small amount of food or infant formula using the capsule sprinkle method of administration. See mfr pkg insert for instructions. Tablets should not be crushed or chewed. Administer at bedtime to limit CNS eff ects.
  Sustiva Tab: 75, 150, 600, 800 mg; Cap: 50, 200 mg
• etravirine (B) 200 mg (1 x 200 mg tablet or 2 x 100 mg tablets) bid following a meal
  Pediatric: <3 year: not recommended; =3 years, >16 kg: 16-< 20 kg: 100 mg bid; 20- <25 kg: 125 mg bid; 25-<30 kg: 150 mg bid; =30 kg: 200 mg bid; max 200 mg bid; take following a mail
  Intelence Tab: 25*, 100, 200 mg
• nevirapine (B)(G) initiatially one 200 mg tablet of immediate-release Viramune once daily for the fi rst 14 days in combination with other antiretroviral agents; then, one 400 mg tablet of Viramune XR once daily
  Comment: Th e 14-day lead-in period has been found to lessen the frequency of rash.
  Pediatric: <6 years: not recommended; 6-<18 years: BSA 0.58-0.83 kg/m2: 200 mg once daily; BSA 0.84-1.16 kg/m2: 300 mg once daily; BSA =1.17 kg/m2: 400 mg; once daily; max 400 mg once daily
  Comment: Children must initiate therapy with immediate-release Viramune for the fi rst 14 days; =15 days: [oral suspension/tablet]: 150 mg/m2 once daily for 14 days, then 150 mg/m2 bid
  Viramune Tab: 200*mg
  Viramune Oral Suspension Oral susp: 50 mg/5 ml (240 ml)
  Viramune XR Tab: 100, 400mg ext-rel
• rilpivirine (D) 25 mg once daily; If concomitant rifabutin: 50 mg once daily: If concomitant rifabutin stopped: 25 mg once daily Pediatric: <12 years: not recommended; =12 years, >35 kg: same adult
  Edurant Tab: 25 mg

Nucleoside and Nonnucleoside Reverse Transcriptase Inhibitor (NRTI/NNRTI) Combinations

• Atripla (B) efavirenz/emtricitabine/tenofovir disoproxil fumarate 1 tab once daily preferably at HS; take on an empty stomach; Concomitant rifabutin: >50 kg: take additional efavirenz 200 mg/day
  Pediatric: <12 years: not recommended; =12 years, 40 kg: same as adult
  Tab: efa 600 mg/emtri 200 mg/teno dis fum 300 mg
  Complera (B) emtricitabine/tenofovir disoproxil fumarate/rilpivirine 1 tab once daily; CrCl <50 mL/min: not recommended; Concomitant rifabutin: take additional ribavirin 25 mg qd
  Pediatric: <12 years, <35 kg: not established; =12 years, =35 kg: same as adult
  Tab: emtri 200 mg/teno dis 300 mg/rilpiv 25 mg

Protease Inhibitors (PIs)

• atazanavir (B) Treatment naiive: Recommended regimen: 300 mg plus ritonavir 100 mg once daily; Unable to tolerate ritonavir: 400 mg once daily; Incombination with efavirenz: 400 mg plus ritonavir 100 mg once daily; Treatment experienced: Recommended regimen: 300 mg plus ritonavir 100 mg once daily; In combination with both an H2-blocker or PPI and tenofovir: 400 mg plus ritonavir 100 mg once daily; take with food
  Pediatric: <3 months: not recommended; =3 mos, 5 kg: [oral powder] 5-<15 kg: 200 mg (4 packets) plus ritonavir 80 mg once daily; 15-<25 kg: 250 mg (5 packets) plus ritonavir 80 mg once daily; =25 kg, unable to swallow capsules: 300 mg (6 packets) plus rotinovir once daily; 6 yrs, <15 kg: [capsule] 15-<20 kg: 150 mg plus ritonavir 100 mg once daily; 20-<40 kg: 200 mg plus ritonavir 100 mg once daily; =40kg: 300 mg plus ritonavir 100 mg once daily; [capsule]15-<20 kg: 150 mg plus ritonavir 100 mg once daily; 20-<40 kg: 200 mg plus ritonavir 100 mg once daily; =40kg: 300 mg plus ritonavir 100 mg once daily; max dose 400 mg once daily; take with food
  Reyataz Cap: 100, 150, 200, 300 mg; Oral pwdr: 50 mg/pkt (30/carton) ( phenylalanine)
  Comment: Administration of atazanavir with rotinavir is preferred. Dose for treatment-naïve children =13 years of age and =40 kg unable to tolerate rotinavir, administer 400 mg once daily. See mfr pkg insert for special dosing considerations when combining altazanavir with other retrovirals.
• darunavir (C)(G) Treatment naïve and treatment experienced with no darunavir resistamce associated substitutions: 800 mg once daily with ritonavir 100 mg once daily; Treatment-experienced with at least one darunavir resistamce associated substitution: 600 mg bid with ritonavir 100 mg bid; Severe hepatic impairment: not recommended
  Pediatric: =3 yrs, 10 kg [oral solution/tablet/capsule] Treatment naïve or experienced without darunavir-associated substitutions: 10-<15 kg: 35 mg/kg once daily plus ritonavir 7mg/kg once daily; 15-<30 kg: 600 mg plus ritonavir 100 mg once oaily; 30- <40 kg: 675 mg plus ritonavir 100 mg once daily; >40 kg: 800 mg plus ritonavir 100 mg once daily; Treatment experienced with =1 darunavir-associated substitution(s): 10-15 kg: 20 mg/kg bid plus ritonavir 3 mg/kg bid; 15-<30 kg: 375 mg plus ritonavir 48 mg bid; 30-<40 kg: 450 mg plus ritonavir 60 mg bid; >40 kg: 600 mg plus ritonavir 100 mg bid
  Prezista Tab: 75, 150, 600, 800 mg fi lm-coat
  Prezista Oral Suspension Susp: 100 mg/ml (strawberry cream)
  Comment: Prezista is FDA approved for treatment of HIV-1-infected pregnant women and for the treatment of children >3 years-of-age in combination with ritonavir and other antiretrovirals.
• fosamprenavir (C)(G) Treatment-naïve: 1,400 mg bid or 1,400 mg once daily plus ritonavir 200 mg once daily or 1,400 mg once daily plus ritonavir 100 mg once daily or 700 mg bid plus ritonavir 100 mg bid; Protease inhibitor-experienced: 700 mg bid plus ritonavir 100 mg bid
  Pediatric: <4 weeks: not recommended; Protease inhibitor-naïve, =4 weeks or protease inhibitor-experienced: =6 Months, <11 kg: 45 mg/kg plus ritonavir 7 mg/kg bid; 11- <15 kg: 30 mg/kg plus ritonavir 3 mg/kg bid; 15 kg-<20 kg: 23 mg/kg plus ritonavir 3 mg/kg bid; =20 kg: 18 mg/kg plus ritonavir 3 mg/kg bid; Protease-inhibitor naïve, =2 years: 30 mg/kg bid without ritonavir: max dose 700 mg plus ritonavir 100 mg bid Lexiva: Tab: 700 mg fi lm-coat
  Lexiva Oral Suspension Oral usp: 50 mg/ml (225 ml) (grape-bubble gumpeppermint)
  Comment: fosamprenavir 1 ml is equivalent to approximately 43 mg of amprenavir 1 ml.
• indinavir sulfate (C) 800 mg q 8 hours; Concomitant rifabutin: 1 g q 8 hours and reduce rifabutin dose by half; Hepatic insuffi ciency or concomitant ketoconazole, itraconazole, or delavirdine: 600 mg q 8 hours; take with water on an empty stomach or with a light meal
  Pediatric: not established (3-18 years, doses of 500 mg/m2 every 8 hours have been used; see mfr pkg insert)
  Crixivan Cap: 100, 200, 333, 400 mg
• nelfi navir mesylate (B) 1250 mg (5 x 250 mg tablets or 2 x 625 mg tablets) bid or 750 mg (3 x 250 mg tablets) tid; take with a meal; may dissolve tablets in a small amount of water; max 2500 mg/day
  Pediatric: <2 years: not established; 2-13 years: 45-55 mg/kg bid or 25-35 mg/kg tid; take with a meal; max 2500 mg/day; =13 years: same as adult
  Viracept Tab: 250, 625 mg
  Viracept Oral Powder Oral pwdr: 50 mg/g (144 g) (phenylalanine)
  Comment: Th e 250 mg Viracept tabs are interchangeable with oral powder, the 625 mg tabs are not.
• raltegravir (as potassium) (B) 400 mg bid
  Pediatric: =4 weeks, 3-11 kg: [oral suspension] 3-<4 kg: 20 mg bid; 4-<6 kg: 30 mg bid; 6-<8 kg: 40 mg bid; 8-<11 kg: 60 mg bid; =11-<25 kg: [oral suspension/chewable tablet] 6 mg/kg/dose bid; see mfr pkg insert for dosage by weight; =25 kg and unable to swallow tablet: [chewable tablet] 25-<28 kg: 150 mg bid; 28-<40 kg: 200 mg bid; =40 kg: 300 mg bid; =6 years, =25 kg, able to swallow tablets: 400 mg fi lm-coat tablet bid
  Comment: Oral suspension, chewable tablets, and fi lm-coated tablets are not bioequivalent. Chewable tablet max dose 300 mg bid. Film-coated tablets max dose 400 mg bid. Oral suspension max dose 100 mg bid
  Isentress Tab: 400 mg fi lm-coat; Chew tab: 25, 100*mg (orange-banana) ( phenylalanine)
  Isentress Oral Suspension Oral susp: 100 mg/pkt pwdr for oral susp (banana)
• ritonavir (B) initially 300 mg bid; increase at 2-3 day intervals by 100 mg bid; max 600 mg bid
  Pediatric: <1 month: not recommended; =1 month: 350-400 mg/m2 bid; initiate at 250 mg/m2 bid and titrate upward every 2-3 days by 50 mg/m2 bid; max dose 600
  mg bid
  Comment: Lower doses of ritonavir have been used to boost other protease inhibitors but the ritonavir doses used for boosting have not been specifi cally approved in children.
  Norvir Tab: 100 mg fi lm-coat; Gel cap: 100 mg (alcohol)
  Norvir Oral Solution Oral soln: 80 mg/ml, 600 mg/7.5 ml (8 oz) (peppermintcaramel) (alcohol)
  Comment: Norvir tablets should be swallowed whole. Take Norvir with meals. Patients may improve the taste of Norvir Oral Solution by mixing with chocolate milk, Ensure, o r Advera within one hour of dosing. Dose reduction of Norvir is necessary when used with other protease inhibitors (atazanavir, darunavir, fosamprenavir, saquinavir, and tipranavir. Patients who take the 600 mg gel cap bid may experience more gastrointestinal side eff ects such as nausea, vomiting, abdominal pain or diarrhea when switching from the gel cap to the tablet because of greater maximum plasma concentration (Cmax) achieved with the tablet. Th ese adverse events (gastrointestinal or paresthesias) may diminish as treatment is continued.
• saquinavir mesylate (B)
  Pediatric: <16 years: not established; >16 years: same as adult
  Fortovase Tab/Cap: 200 mg
  Invirase Tab: 500 mg; Cap: 200 mg
• tipranavir (C) 500 mg bid plus ritonavir 200 mg bid
  Pediatric: <2 years: not recommended; 2-18 yrs: [capsule/oral solution] 14 mg/kg plus ritonavir 6 mg/kg bid or 375 mg/m2 plus ritonavir 150 mg/m2 bid; max 500 mg plus ritonavir 200 mg bid
  Aptivus Gel cap: 250 mg (alcohol)
  Aptivus Oral Solution Oral soln: 100 mg/ml (buttermint-butter toff ee) (Vit E 116 IU/ml)

FUSION INHIBITORS—CCR5 CO-RECEPTOR ANTAGONISTS

• enfuvirtide (B) 90 mg (1 ml) SC bid; administer in upper arm, abdomen, or anterior thigh; rotate injection sites
  Pediatric: <6 years: not established; 6-16 years: administer 2 mg/kg SC bid; max 90 mg SC bid; rotate injection sites
  Fuzeon Vial: 90 mg/ml pwdr for SC inj aft er reconstitution (1 ml, 60 vials/kit) (preservative-free)
• maraviroc (B) must be administered concomitant with other retrovirals; Concomitant potent CYP3A inhibitors (with or without a potent CYP3A inducer) including protease inhibitors (except tipranavir/ritonavir), delavirdine, ketoconazole, itraconazole, clarithromycin, other potent CYP3A inhibitors (e.g., nefazodone, telithromycin): CrCl =30 mL/min: 150 mg bid; <30 mL/min, dialysis: not recommended; Potent CYP3A inducers (without a potent CYP3A inhibitor) including efavirenz, rifampin, etravirine, carbamazepine, phenobarbital, and phenytoin: 300 mg bid; CrCl =30 mL/min: 600 mg bid; <30 mL/min: not recommended; Other concomitant agents, including tipranavir/ritonavir, nevirapine, raltegravir, all NRTIs, and enfuvirtide: 300 mg bid
  Pediatric: <16 years: not established; =16 years: same as adult
  Selzentry Tab: 150, 300 mg fi lm-coat

BRAND NAMES, DOSING, AND DOSE FORMS: COMBINATION AGENTS

• Atripla (B) efavirenz/emtricitabine/tenofovir disoproxil fumarate 1 tablet once daily on an empty stomach; bedtime dosing may improve the tolerability of nervous system symptoms; CrCl <50 mL/min: not recommended
  Pediatric: <12 years: not established; =12 years, =40 kg: same as adult
  Tab: efa 600 mg/emtri 200 mg/teno dis fum 300 mg fi lm-coat
  Combivir (C)(G) lamivudine/zidovudine
  Pediatric: <12 years: not recommended; =12 years, =30 kg: 1 tablet bid with food
  Tab: lami 150 mg/zido 300 mg
  Complera (B) emtricitabine/tenofovir disoproxil fumarate/rilpivirine 1 tablet once daily; CrCl <50 mL/min: not recommended
  Pediatric: <12 years, <40 kg: not recommended; =12 years, =40 kg: same as adult
  Tab: emtri 200 mg/teno dis 300 mg/rilpiv 25 mg
  Descovy (D) emtricitabine/tenofovir alafenamide 1 tablet once daily with or without food; CrCl <30 mL/min: not recommended
  Pediatric: <12 years, <35 kg: not recommended; =12 years, =35 kg: same as adult
  Tab: emtri 200 mg/teno ala 25 mg
  Comment: Patients with HIV-1 should be tested for the presence of chronic hepatitis B virus (HBV) before initiating antiretroviral therapy. Descovy is not approved for the treatment of chronic HBV infection, and the safety and effi cacy of Descovy have not been established in patients co-infected with HIV-1 and HBV.
  Epzicom (B) abacavir sulfate/lamivudine 1 tab daily; Mild hepatic impairment or CrCl<50 mL/min: not recommended
  Pediatric: <25 kg: use individual componends; =25 kg: one tablet once daily; Mild hepatic impairment or CrCl<50 mL/min: not recommended
  Tab: aba 600 mg/lami 300 mg
  Evotaz (B) atazanavir/cobicistat 1 tab once daily
  Pediatric: not established
  Tab: ataz 600 mg/cobi 300 mg
  Genvoya (B) elvitegravir/cobicistat/emtricitabine/tenefovir alafenamide 1 tab once daily; Severe hepatic impairment or CrCl <30 mL/min: not recommended; take with food
  Pediatric: <12 years: not established; =12 years, =35 kg: same as adult
  Tab: elvi 150 mg/cobi 150 mg/emtri 200 mg/teno 10 mg
  Kaletra, Kaletra Oral Solution (C) lopinavir/ritonavir 800 mg/200 mg (4 tablets or 10 ml) once daily or 400 mg/100 mg (2 tablets or 5 ml) bid; May administer once daily or bid: patients with <3 lopinavir resistance-associated substitutions; May dose bid only: patients with =3 resistance-associated substitutions; Dose must be increased: when administered in combination with efavirenz, nevirapine, or nelfi navir (500 mg/125 mg (2 x 200 mg/50 mg tablet plus 1 x 100 mg/25 mg tablet) bid or 520 mg/130 mg (6.5 ml) bid; Once daily dosing regimen not recommended: in combination with =3 lopinavir resistance-associated substitutions or in combination with: carbamazepine, phenobarbital, or phenytoin; Patients receiving nevirapine or efavirenz with Kaletra should have their Kaletra dose increased; swallow whole with or without food
  Pediatric: dose calculation is based on the lopinavir component; 14 days-6months: 16 mg/kg bid; 6 months-12 years: [tablet/capsule/solution] 7-<15 kg: 12 mg/kg bid (13 mg/kg plus nevirapine); 15-40 kg: 10 mg/kg bid (11 mg/kg plus nevirapine), >40 kg, >12 years: lopinavir 400 mg bid (533 mg plus nevirapine); max lopinavir 400 mg bid for patients who are not receiving nevirapine or efavirenz; Kaletra should not be used in combination with NNRTIs in children <6 months-of-age; see mfr pkg insert for BSA-based dosing
  Tab: Kaletra 100/25 lopin 100 mg/riton 25 mg
  Kaletra 200/50 lopin 200 mg/riton 50 mg
  Oral soln: lopin 80 mg/riton 20 mg per ml, lopin 400 mg/riton 500 mg per 5 ml (160 ml) (cotton candy) (alcohol 42.4%)
  Odefsey (D) emtricitabine/rilpivirine/tenofovir alafenamide 1 tab once daily with food; CrCl <30 mL/min: not recommended
  Pediatric: <12 years, <35 kg: not established; =12 years: same as adult
  Tab: emtri 200 mg/rilpi 25 mg/teno alafen 25 mg
  Prezcobix (C) darunavir/cobicistat 1 tab once daily; Treatment naïve and treatment experienced with no darunavir resistance-associated substitution: 800 mg once daily plus ritonavir 100 mg once daily; Treatment experienced with at least one darunavir resistance associated substitution: 600 mg bid plus ritonavir 100 mg bid; take with food; CrCl <70 mL/min: not recommended
  Pediatric: not recommended
  Tab: darun 800 mg/cobi 150 mg
  Stribild (B) elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate 1 tab once daily; CrCl <70 mL/min: not recommended; if CrCl declines to <50 mL/min during treatment: discontinue; Severe hepatic impairment: not recommended
  Pediatric: not established
  Tab: elvi 150 mg/cobi 150 mg/emtri 200 mg/teno dis fum 300 mg
  Triumeq (C)(G) abacavir sulfate/dolutegravir/lamivudine 1 tab once daily
  Pediatric: not established
  Tab: aba 600 mg/dolu 50 mg/lami 300 mg
  Trizivir (C)(G) abacavir sulfate/lamivudine/zidovudine 1 tab bid
  Pediatric: <40 kg: not recommended; =40 kg: same as adult
  Tab: aba 300 mg/lami 150 mg/zido 300 mg
  Truvada (B) emtricitabine/tenofovir disoproxil fumarate
  Pediatric: <17 kg: not established; 17-<22 kg: 100/150 once daily; 22-<28 kg: 133/200 once daily; 28-35 kg: 167/250 once daily; =35 kg: 200/300 once daily
  Tab: Truvada 100/150 emt 100 mg/teno 150 mg
  Truvada 133/200 emt 133 mg/teno 200 mg
  Truvada 167/250 emt 167 mg/teno 250 mg
  Truvada 200/300 emt 200 mg/teno 300 mg
  Comment: Truvada is indicated for treatment of HIV-1 infection and pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 in high risk adults in combination with safe sex practices.

HUMAN PAPILLOMAVIRUS (HPV, VENEREAL WART) PROPHYLAXIS
Comment: Administer IM in deltoid. Administer a 3-dose series; First dose females (10-25 years of age) and males (9-15 years of age); Second dose: 1-2 months aft er fi rst dose; Th ird dose: 6 months aft er fi rst dose. HPV vaccination is indicated for the prevention of cervical, vulvar, vaginal, and anal cancers. Register pregnant patients exposed to Gardasil by calling 800-986-8999.
bivalent human papillomavirus types 16 and 18 vaccine, aluminum adsorbed (B)
Pediatric: <10 years: not recommended
Cervarix administer in the deltoid; 1st dose 0.5 ml IM on elected date; then, 2nd dose 0.5 ml IM 1 month later; then, 3rd dose 0.5 ml IM 6 months aft er the fi rst dose
Vial: susp for IM inj (single-dose; prefi lled syringe) (preservative-free) quadrivalent human papillomavirus types 6, 11, 16, and 18 vaccine, recombinant, aluminum adsorbed (B)
Pediatric: >9 years: not recommended
Gardasil administer in the deltoid or upper thigh; 1st dose 0.5 ml IM on elected date; then, 2nd dose 0.5 ml IM 2 months later; then, 3rd dose 0.5 ml IM 6 months aft er the fi rst dose
Vial: susp for IM inj (single-dose; prefi lled syringe w. needles or tip caps) (preservative- free) quadrivalent human papillomavirus types 6, 11, 16, 18, 31, 33, 45, 52, and 58 vaccine, recombinant, aluminum adsorbed (B)
Gardasil 9 Adults and Children: 9-26 Years-of-Age: administer IM in the deltoid or thigh; administer the 1st dose; administer the 2nd dose 2 months aft er the 1st dose; administer the 3rd dose 6 months aft er the 1st dose (4 months aft er the 2nd dose).
Vial: susp for IM inj (0.5 ml single-dose; prefi lled syringe w. needles or tip caps) (preservative-free)

TREATMENT
see Wart: Venereal page 460

HYPERHIDROSIS (PERSPIRATION, EXCESSIVE)

• aluminum chloride (NE) 20% solution apply q HS; wash treated area the following morning; aft er 1-2 treatments, may reduce frequency to 1-2 times/week
  Drysol Soln: 35, 60 ml (alcohol 93%) cont-rel
  Comment: Apply to clean dry skin (e.g., underarms). Do not apply to broken, irritated, or recently shaved skin.

HYPERHOMOCYSTEINEMIA
Comment: Elevated homocysteine is associated with cognitive impairment, vascular dementia, and dementia of the Alzheimer’s type.

HOMOCYSTEINE-LOWERING NUTRITIONAL SUPPLEMENTS

• L-methylfolate calcium (as metafolin)/pyridoxyl 5-phosphate/methyl-cobalamin (NE) take 1 cap daily
  Pediatric: not recommended
  Metanx Cap: metafo 3 mg/pyrid 35 mg/methyl 2 mg (gluten-free, yeast-free, lactose-free)
  Comment: Metanx is indicated as adjunct treatment of endothelial dysfunction and/or hyperhomocysteinemia in patients who have lower extremity ulceration.
• L-methylfolate calcium (as metafolin)/methylcobalamin/N-acetylcysteine (NE) take 1 cap daily
  Pediatric: not recommended
  Cerefolin Cap: metafo 5.6 mg/methyl 2 mg/N-ace 600 mg (gluten-free, yeastfree, lactose-free)
  Comment: Cerefolin is indicated in the dietary management of patients treated for early memory loss, with emphasis on those at risk for neurovascular oxidative stress, hyperhomocysteinemia, mild to moderate cognitive impairment with or without vitamin B-12 defi ciency, vascular dementia, or Alzheimer’s disease.

HYPERKALEMIA (POTASSIUM EXCESS) HYPERKALEMIA CATION EXCHANGE RESINS
Comment: Normal serum K+ range is approximately 3.5-5.5 mEq/L. Hyperkalemia is associated with cardiac dysrhythmias and metabolic acidosis. Risk factors include kidney disease, heart failure, and drugs that inhibit the renin-angiotensinaldosterone system (RAAS) including ACEIs, ARBs, direct renin inhibitors, and aldosterone antagonists. Cation exchange resins are not for emergency treatment of life-threatening hyperkalemia, severe constipation, bowel obstruction or impaction. May cause GI irritability, ulceration, necrosis, sodium retention, hypocalcemia, hypomagnesemia, fecal impaction, ischemic colitis. Avoid non-absorbable cationdonating antacids and laxatives (e.g., magnesium hydroxide, aluminum hydroxide). Concomitant sorbitol should be avoided because it may cause intestinal necrosis.

• patiromer sorbitex calcium (B) initially 8.4 gm once daily; adjust dosage as prescribed based on potassium concentration and target range; may increase dosage at 1-week (or longer) intervals in increments of 8.4 gm; max dose 25.2 gm once daily; prepare immediately prior to administration; do not take in dry form; administer with food; measure 1/3 cup of water and pour half into a glass; then add Veltassa and stir; add the remaining water and stir well; the powder will not dissolve and the mixture will look cloudy; add more water as needed for desired consistency; do not heat or mix with heated food or fl uids
  Veltassa Pkt: 8,4, 16.8, 25.2 gm pwdr for oral susp, 30 single-use pkts/carton
  Comment: Take Veltassa at least 3 hours before or 3 hours aft er any other medicine taken by mouth. Store packets in the refrigerator. It stored at room temperature, product must be used within 3 months.
• sodium polystyrene sulfonate (C)(G)
  Pediatrics: Use 1 gm/1 mEq of K+ as basis of calculation; see mfr literature
  Kayexalate Susp: 15 gm 1-4 times daily; Rectal Enema: 30-50 gm in 100 ml every 6 hours

HYPERPARATHYROIDISM

• calcifediol (C)(G) 1 cap daily
  Pediatric: <18 years: not established
  Rayaldee Cap: 30 mcg ext-rel
  Comment: Rayaldee is indicated for the prevention and treatment of secondary hyperparathyroidism associated with chronic kidney disease (CKD), stage 3 or 4 and serum total 25-hydroxyvitamin D levels <30 mg/mL.
• paricalcitol (C)(G) administer 0.04-1 mcg/kg (2.8-7 mcg) IV bolus, during dialysis, no more than every other day; may be increased by 2-4 mcg every 2-4 weeks; monitor serum calcium and phosphorus during dose adjustment periods; if Ca x P >75, immediately reduce dose or discontinue until these levels normalize; discard unused portion of single-use vials immediately
  Pediatric: <18 years: not established
  Zemplar Vial: 2, 5 mcg/ml soln for inj
  Comment: Zemplar is indicated for the prevention and treatment of secondary hyperparathyroidism associated with chronic kidney disease (CKD), stage 5.

HYPERPHOSPHATEMIA PHOSPHATE BINDERS
Comment: Monitor for development of hypercalcemia. Normal serum PO4- is 2.5-4.5 mg/dL and normal serum calcium is 8.5-10.5 mg/dL.

• calcium acetate (C)(G) initially 2 tabs or caps with each meal; then titrate gradually to keep serum phosphate at <6 mg/dL; usual maintenance is 3-4 tabs or caps with each meal
  Pediatric: not recommended
  PhosLo Tab: 667 mg; Cap: 667 mg
• lanthanum carbonate (C) initially 750 mg to 1.5 g per day in divided doses; take with meals; titrate at 2-3-week intervals in increments of 750 mg/day based on serum phosphate; usual range 1.5-3 g/day; usual max 3,750 mg/day
  Pediatric: not recommended
  Fosrenol Chew tab: 250, 500, 750 mg; 1 g
• sevelamer (C) for patients not taking a phosphate binder, take tid with meals; swallow whole; titrate by 1 tab per meal at 1-week intervals to keep serum phosphorus 3.5-5.5 mg/dL; switching from calcium acetate to sevelamer, see mfr pkg insert. Serum phosphorus >5.5 to >7.5 mg/dL: 800 mg tid; Serum phosphorus 7.5-9: 1.2-1.6 g tid
  Pediatric: not recommended
  Renagel Tab: 400, 800 mg
  Renvela Tab: 800 mg

HYPERPIGMENTATION
Comment: Depigmenting agents may be used for hyperpigmented skin conditions including chloasma, melasma, freckles, senile lentigenes. Limit treatments to small areas at one time. Sunscreen =30 SPF recommended.

• hydroquinone (C)(G) apply sparingly to aff ected area and rub in bid
  Lustra Crm: 4% (1, 2 oz) (sulfi tes)
  Lustra AF Crm: 4% (1, 2 oz) (sunscreen, sulfi tes)
• monobenzone (C) apply sparingly to aff ected area and rub in bid-tid; depigmentation occurs in 1-4 months
  Benoquin Crm: 20% (1.25 oz)
• tazarotene (X)(G) 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 daily at HS
  Pediatric: <12 years: not recommended; =12 years: same as adult
  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)

COMBINATION AGENTS

• hydroquinone/fl uocinolone/tretinoin (C) apply sparingly to aff ected area and rub in daily at HS
  Pediatric: not recommended
  Tri-Luma Crm: hydro 4%/fl uo 0.01%/tretin 0.05% (30 g) (parabens, sulfi tes)
• hydroquinone/padimate O/oxybenzone/octyl methoxycinnamate (C) apply sparingly to aff ected area and rub in bid
  Pediatric: <12 years: not recommended; =16 years: same as adult
  Glyquin Crm: 4% (1 oz jar)
• hydroquinone/ethyl dihydroxypropyl PABA/dioxybenzone/oxybenzone (C) apply sparingly to aff ected area and rub in bid; max 2 months
  Pediatric: not recommended
  Solaquin Crm: hydro 2%/PABA 5%/dioxy 3%/oxy 2% (1 oz) (sulfi tes)
• hydroquinone/padimate/dioxybenzone/oxybenzone (C) apply sparingly to aff ected area and rub in bid; max 2 months
  Pediatric: not recommended
  Solaquin Forte Crm: hydro 4%/pad 0.5%/dioxy 3%/oxy 2% (1oz) (sunscreen, sulfi tes)
• hydroquinone/padimate/dioxybenzone (C) apply sparingly to aff ected area and rub in bid; max 2 months
  Pediatric: not recommended
  Solaquin Forte Gel: hydro 4%/pad 0.5%/dioxy 3% (1 oz) (alcohol, sulfi tes)

HYPERPROLACTINEMIA DOPAMINE RECEPTOR AGONIST

• dostinex (B)(G) initial therapy is 0.25 mg twice a week; may increase by 0.25 mg twice weekly up to 1 mg twice a week according to the patient’s serum prolactin level; dose increases should not occur more than every 4 weeks; aft er a normal serum prolactin level has been maintained for 6 months, may be discontinued, with periodic monitoring of serum prolactin level to determine if/when treatment should be reinstituted
  Pediatric: not established
  Cabergoline Tab: 0.5 mg
  Comment: Cabergoline is indicated to treat hyperprolactinemia disorders due to idiopathic or pituitary adenoma.

HYPERTENSION: PRIMARY
see JNC-8 Recommendations page 472

BETA-BLOCKERS: CARDIOSELECTIVE
Comment: Cardioselective beta-blockers are less likely to cause bronchospasm, peripheral vasoconstriction, or hypoglycemia than noncardioselective beta-blockers.

• acebutolol (B)(G) initially 400 mg in 1-2 divided doses; usual range 200-800 mg/day; max 1.2 g/day in 2 divided doses
  Pediatric: not recommended
  Sectral Cap: 200, 400 mg
• atenolol (D)(G) initially 50 mg daily; may increase aft er 1-2 weeks to 100 mg daily; max 100 mg/day
  Pediatric: not recommended
  Tenormin Tab: 25, 50, 100 mg
• betaxolol (C) initially 10 mg daily; may increase to 20 mg/day aft er 7-14 days; usual max 20 mg/day
  Pediatric: not recommended
  Kerlone Tab: 10*, 20 mg
• bisoprolol (C) 5 mg daily; max 20 mg daily
  Pediatric: not recommended
  Zebeta Tab: 5*, 10 mg
• metoprolol succinate (C)
  Pediatric: not recommended
  Toprol-XL initially 25-100 mg in a single dose once daily; increase weekly if needed; max 400 mg/day; as monotherapy or with a diuretic
  Tab: 25*, 50*, 100*, 200*mg ext-rel
• metoprolol tartrate (C)
  Pediatric: not recommended
  Lopressor (G) initially 25-50 mg bid; increase weekly if needed; max 400 mg/day; as monotherapy or with a diuretic
  Tab: 25, 37.5, 50, 75, 100 mg
• nebivolol (C)(G)
  Pediatric: not recommended
  Bystolic initially 5 mg daily; may increase at 2 week intervals; max 40 mg/day
  Tab: 2.5, 5, 10, 20 mg

BETA-BLOCKERS: NONCARDIOSELECTIVE
Comment: Noncardioselective beta-blockers are more likely to cause bronchospasm, peripheral vasoconstriction, and/or hypoglycemia than cardioselective beta-blockers.

• nadolol (C)(G) initially 40 mg daily; usual maintenance 40-80 mg daily; max 320 mg/day
  Pediatric: not recommended
  Corgard Tab: 20*, 40*, 80*, 120*, 160*mg
• penbutolol (C) 20 mg daily
  Pediatric: not recommended
  Levatol Tab: 20*mg
• pindolol (B)(G) initially 5 mg bid; may increase aft er 3-4 weeks in 10 mg increments; max 60 mg/day
  Pediatric: not recommended
  Pindolol Tab: 5, 10 mg
  Visken Tab: 5, 10 mg
• propranolol (C)(G)
  Inderal initially 40 mg bid; usual maintenance 120-240 mg/day; max 640 mg/day
  Pediatric: initially 1 mg/kg/day; usual range 2-4 mg/kg/day in 2 divided doses; max 16 mg/kg/day
  Tab: 10*, 20*, 40*, 60*, 80*mg
  Inderal LA initially 80 mg daily in a single dose; increase q 3-7 days; usual range 120-160 mg/day; max 320 mg/day in a single dose
  Pediatric: not recommended
  Cap: 60, 80, 120, 160 mg sust-rel
  InnoPran XL initially 80 mg q HS; max 120 mg/day
  Pediatric: not recommended
  Cap: 80, 120 mg ext-rel
• timolol (C)(G) initially 10 mg bid, increase weekly if needed; usual maintenance 20-40 mg/day; max 60 mg/day in 2 divided doses
  Pediatric: not recommended
  Blocadren Tab: 5, 10*, 20*mg

BETA-BLOCKER: (NONCARDIOSELECTIVE)/ALPHA-1 BLOCKER COMBINATIONS

• carvedilol (C)
  Pediatric: <18 years: not recommended
  Coreg initially 6.25 mg bid; may increase at 1-2-week intervals to 12.5 mg bid; max 25 mg bid
  Tab: 3.125, 6.25, 12.5, 25 mg
  Coreg CR initially 20 mg once daily for 2 weeks; may increase at 1-2-week intervals; max 80 mg once daily
  Tab: 10, 20, 40, 80 mg cont-rel
• carteolol (C)
  Pediatric: not recommended
  Cartrol initially 2.5 mg daily, gradually increase to 5 or 10 mg daily; usual maintenance 2.5-5 mg daily
  Tab: 2.5, 5 mg
• labetalol (C)(G) initially 100 mg bid; increase aft er 2-3 days if needed; usual maintenance 200-400 mg bid; max 2.4 g/day
  Pediatric: not recommended
  Normodyne Tab: 100*, 200*, 300 mg
  Trandate Tab: 100*, 200*, 300*mg

DIURETICS

Thiazide Diuretics

• chlorthalidone (B)(G) initially 15 mg daily; may increase to 30 mg once daily based on clinical response; max 45-60 mg/day
  Pediatric: not established
  Chlorthalidone Tab: 25, 50 mg
  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
  Diuril Tab: 250*, 500*mg; Oral susp: 250 mg/5 ml (237 ml)
• hydrochlorothiazide (B)(G)
  Pediatric: not recommended
  Esidrix 25-100 mg once daily
  Tab: 25, 50, 100 mg
  Hydrochlorothiazide Tab: 25*, 50*mg
  Microzide 12.5 mg once daily; usual max 50 mg/day
  Cap: 12.5 mg
• methyclothiazide (B) initially 2.5 mg daily; max 10 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) 2-4 mg once daily
  Pediatric: not recommended
  Renese Tab: 1, 2, 4 mg
  Potassium-Sparing Diuretics
• amiloride (B)(C) initially 5 mg; may increase to 10 mg; max 20 mg
  Pediatric: not recommended
  Midamor Tab: 5 mg
• spironolactone (D)(G) initially 50-100 mg in a single or divided doses; titrate at 2-week intervals
  Pediatric: not established
  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; 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 50-200 mg/day
  Pediatric: infant: not recommended; =1 month: initially 25 mg/day; then adjust dose in 25-mg increments
  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 40 mg bid
  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 once daily; may increase to 10 mg once daily
  Pediatric: not recommended
  Demadex Tab: 5*, 10*, 20*, 100*mg

Other Diuretics

• indapamide (B) initially 1.25 mg daily; may titrate dosage upward q 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
  Zaroxolyn 2.5- 5 mg 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*
• deserpidine/methylchlothiazide (C) titrate methylchlothiazide 2.5-10 mg daily
  Pediatric: not recommended
  Enduronyl
  Tab: Enduronyl 0.25/5 deser 0.25 mg/methylclo 5 mg*
  Enduronyl 0.5/5 deser 0.5 mg/methylclo 5 mg*
• spironolactone/hydrochlorothiazide (D)(G)
  Pediatric: not recommended
  Aldactazide 25 usual maintenance 50-100 mg in a single or divided doses
  Tab: spiro 25 mg/hctz 25 mg
  Aldactazide 50 usual maintenance 50-100 mg in a single or divided doses
  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/hctz 25 mg
  Maxzide 1 tab once daily
  Tab: triam 75 mg/hctz 50 mg*
  Maxzide-25 1-2 tabs once daily
  Tab: triam 37.5 mg/hctz 25 mg*

ANGIOTENSIN CONVERTING ENZYME INHIBITORS (ACEIs)
Comment: Black patients receiving ACEI monotherapy have been reported to have a higher incidence of angioedema compared to non-Blacks. Non-Blacks have a greater decrease in BP when ACEIs are used compared to Black patients.

• benazepril (D)(G) initially 10 mg daily; usual maintenance 20-40 mg/day in 1-2 divided doses; usual max 80 mg/day
  Pediatric: not recommended
  Lotensin Tab: 5, 10, 20, 40 mg
• captopril (D)(G) initially 25 mg bid-tid; aft er 1-2 weeks increase to 50 mg bid-tid
  Pediatric: not recommended
  Capoten Tab: 12.5*, 25*, 50*, 100*mg
• enalapril (D) initially 5 mg daily; usual dosage range 10-40 mg/day; max 40 mg/day
  Pediatric: not recommended
  Epaned Oral Solution Oral soln: 1mg/ml (150 ml) (mixed berry)
  Vasotec (G) Tab: 2.5*, 5*, 10, 20 mg
• fosinopril (D) initially 10 mg daily; usual maintenance 20-40 mg/day in a single or divided doses; max 80 mg/day
  Pediatric: <6 years, <50 kg: not recommended; =6-12 years, >50 kg: 5-10 mg once daily
  Monopril Tab: 10*, 20, 40 mg
• lisinopril (D)
  Prinivil initially 10 mg daily; usual range 20-40 mg/day
  Pediatric: not recommended
  Tab: 5*, 10*, 20*, 40 mg
  Qbrelis Oral Solution administer as a single dose once daily
  Pediatric: <6 years, GFR <30 mL/min: not recommended; =6 years, GFR >30 mL/min: initially 0.07 mg/kg, max 5 mg; adjust according to BP up to a max 0.61 mg/kg (40 mg) once daily
  Oral soln: 1 mg/ml (150 ml)
  Zestril initially 10 mg daily; usual range 20-40 mg/day
  Pediatric: not recommended
  Tab: 2.5, 5*, 10, 20, 30, 40 mg
• moexipril (D) initially 7.5 mg daily; usual range 15-30 mg/day in 1-2 divided doses; max 30 mg/day
  Pediatric: not recommended
  Univasc Tab: 7.5*, 15*mg
• perindopril (D) 2-8 mg daily-bid; max 16 mg/day
  Pediatric: not recommended
  Aceon Tab: 2*, 4*, 8*mg
• quinapril (D) initially 10 mg once daily; usual maintenance 20-80 mg daily in 1-2 divided doses
  Pediatric: not recommended
  Accupril Tab: 5*, 10, 20, 40 mg
• ramipril (D)(G) initially 2.5 mg bid; usual maintenance 2.5-20 mg in 1-2 divided doses
  Pediatric: not established
  Altace Tab/Cap: 1.25, 2.5, 5, 10 mg
• trandolapril (C; D in 2nd, 3rd) initially 1-2 mg once daily; adjust at 1-week intervals; usual range 2-4 mg in 1-2 divided doses; max 8 mg/day
  Pediatric: not recommended
  Mavik Tab: 1*, 2, 4 mg

ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs)

• azilsartan medoxomil (D) Monotherapy, not volume depleted: 80 mg once daily; Volume-depleted (concomitant high-dose diuretic): initially 40 mg once daily
  Pediatric: not recommended
  Edarbi Tab: 40, 80 mg
• candesartan (D)(G) initially 16 mg daily; range 8-32 mg in 1-2 divided doses
  Pediatric: not recommended
  Atacand Tab: 4, 8, 16, 32 mg
• eprosartan (D)(G) initially 400 mg bid or 600 mg once daily; max 800 mg/day
  Pediatric: not established
  Teveten Tab: 400, 600 mg
• irbesartan (D)(G) initially 150 mg daily; titrate up to 300 mg
  Pediatric: not recommended
  Avapro Tab: 75, 150, 300 mg
• losartan (D)(G) initially 50 mg daily; max 100 mg/day
  Pediatric: not recommended
  Cozaar Tab: 25, 50, 100 mg
• olmesartan medoxomil (D) initially 20 mg once daily; aft er 2 weeks, may increase to 40 mg daily
  Pediatric: <6 years: not recommended; =6-16 years: 20-35 kg: initially 10 mg once daily; aft er 2 weeks, may increase to max 20 mg once daily; =6-16 years: >35 kg: initially 20 mg once daily; aft er 2 weeks, may increase to max 40 mg once daily
  Benicar Tab: 5, 20, 40 mg
• telmisartan (D)(G) initially 40 mg once daily; usual dose 20-80 mg
  Pediatric: not recommended
  Micardis Tab: 20, 40, 80 mg
• valsartan (D)(G) initially 80 mg once daily; may increase to 160 or 320 mg once daily aft er 2-4 weeks; usual range 80-320 mg/day
  Pediatric: not recommended
  Diovan Tab: 40*, 80, 160, 320 mg

CALCIUM CHANNEL BLOCKERS (CCBs)

Benzothiazepines

• diltiazem (C)(G)
  Pediatric: not established
  Cardizem initially 30 mg qid; may increase gradually every 1-2 days; max 360 mg/day in divided doses
  Tab: 30, 60, 90, 120 mg
  Cardizem CD initially 120-180 mg daily; adjust at 1-2-week intervals; max 480 mg/day
  Cap: 120, 180, 240, 300, 360 mg ext-rel
  Cardizem LA initially 180-240 mg daily; titrate at 2-week intervals; max 540 mg/day
  Tab: 120, 180, 240, 300, 360, 420 mg ext-rel
  Cardizem SR initially 60-120 mg bid; adjust at 2-week intervals; max 360 mg/day
  Cap: 60, 90, 120 mg sust-rel
  Cartia XT initially 180 or 240 mg once daily; max 540 mg once daily
  Cap: 120, 180, 240, 300 mg ext-rel
  Dilacor XR initially 180 or 240 mg in AM; usual range 180-480 mg/day; max 540 mg/day
  Cap: 120, 180, 240 mg ext-rel
  Tiazac (G) initially 120-240 mg daily; adjust at 2-week intervals; usual max 540 mg/day
  Cap: 120, 180, 240, 300, 360, 420 mg ext-rel
• diltiazem maleate (C) initially 120-180 mg daily; adjust at 2-week intervals; usual range 120-480 mg daily
  Pediatric: not recommended
  Tiamate Cap: 120, 180, 240 mg ext-rel
  Dihydropyridines
• amlodipine (C) initially 5 mg once daily; max 10 mg/day
  Pediatric: not recommended
  Norvasc Tab: 2.5, 5, 10 mg
• clevidipine butyrate (C) administer by IV infusion; initially 1-2 mg/hour; double dose at 90-second intervals until BP approaches goal; then titrate slower; adjust at 5-10-minute intervals; maintenance 4-6 mg/hour; usual max, 16-32 mg/hour; do not exceed 1,000 ml (21 mg/hour for 24 hours) due to lipid load
  Pediatric: <18 years: not recommended
  Cleviprex Vial: 0.5 mg/ml soln for IV infusion (single use, 50, 100 ml) (lipids)
  Comment: Cleviprex is indicated to reduce blood pressure when oral therapy is not feasible or desirable. Cleviprex is contraindicated with egg or soy allergy.
• felodipine (C)(G) initially 5 mg daily; usual range 2.5-10 mg daily; adjust at 2-week intervals; max 10 mg/day
  Pediatric: not recommended
  Plendil Tab: 2.5, 5, 10 mg ext-rel
• isradipine (C)
  Pediatric: not recommended
  DynaCirc initially 2.5 mg bid; adjust in increments of 5 mg/day at 2-4-week intervals; max 20 mg/day
  Cap: 2.5, 5 mg
  DynaCirc CR initially 5 mg daily; adjust in increments of 5 mg/day at 2-4-week intervals; max 20 mg/day
  Tab: 5, 10 mg cont-rel
• nicardipine (C)(G)
  Pediatric: <18 years: not recommended
  Cardene initially 20 mg tid; adjust at intervals of at least 3 days; max 120 mg/day
  Cap: 20, 30 mg
  Cardene SR 30-60 mg bid
  Cap: 30, 45, 60 mg sust-rel
• nifedipine (C)(G)
  Pediatric: not recommended
  Adalat initially 10 mg tid; usual range 10-20 mg tid; max 180 mg/day
  Cap: 10, 20 mg
  Adalat CC initially 10 mg tid; usual range 10-20 mg tid; max 180 mg/day
  Cap: 30, 60, 90 mg ext-rel
  Afeditab CR initially 30 mg once daily; titrate over 7-14 days; max 90 mg/day
  Cap: 30, 60 mg ext-rel
  Procardia initially 10 mg tid; titrate over 7-14 days: max 30 mg/dose and 180 mg/day in divided doses
  Cap: 10, 20 mg
  Procardia XL initially 30-60 mg daily; titrate over 7-14 days; max dose 90 mg/day
  Tab: 30, 60, 90 mg ext-rel
• nisoldipine (C)
  Pediatric: not recommended
  Sular initially 20 mg daily; may increase by 10 mg weekly; usual maintenance 20-40 mg/day; max 60 mg/day
  Tab: 10, 20, 30, 40 mg ext-rel

Diphenylalkylamines

• verapamil (C)(G)
  Pediatric: not recommended
  Calan 80-120 mg tid; may titrate up; usual max 360 mg in divided doses
  Tab: 40, 80*, 120*mg
  Calan SR initially 120 mg in the AM; may titrate up; max 480 mg/day in divided doses
  Cplt: 120, 180*, 240*mg sust-rel
  Covera HS initially 180 mg q HS; titrate to 240 mg; then to 360 mg; then to 480 mg if needed
  Tab: 180, 240 mg ext-rel
  Isoptin initially 80-120 mg tid
  Tab: 40, 80, 120 mg
  Isoptin SR initially 120-180 mg in the AM; may increase to 240 mg in the AM; then 180 mg q 12 hours or 240 mg in the AM and 120 mg in the PM; then 240 mg q 12 hours
  Tab: 120, 180*, 240*mg sust-rel
  Verelan initially 240 mg once daily; adjust in 120 mg increments; max 480 mg/day
  Cap: 120, 180, 240, 360 mg sust-rel
  Verelan PM initially 200 mg q HS; may titrate upward to 300 mg; then 400 mg if needed
  Cap: 100, 200, 300 mg ext-rel

ALPHA-1 ANTAGONISTS
Comment: Educate the patient regarding potential side eff ects of hypotension when taking an alpha-1 antagonist, especially with fi rst dose (“fi rst dose eff ect”). Start at lowest dose and titrate upward.

• doxazosin (C)(G) initially 1 mg once daily at HS; increase dose slowly every 2 weeks if needed; max 16 mg/day
  Pediatric: not recommended
  Cardura Tab: 1*, 2*, 4*, 8*mg
  Cardura XL Tab: 4, 8 mg
• prazosin (C)(G) fi rst dose at HS, 1 mg bid-tid; increase dose slowly; usual range 6-15 mg/day in divided doses; max 20-40 mg/day
  Pediatric: not recommended
  Minipress Cap: 1, 2, 5 mg
• terazosin (C) 1 mg q HS, then increase dose slowly; usual range 1-5 mg q HS; max 20 mg/day
  Pediatric: not recommended
  Hytrin Cap: 1, 2, 5, 10 mg

CENTRAL ALPHA-AGONISTS

• clonidine (C)
  Pediatric: <12 years: not recommended
  Catapres initially 0.1 mg bid; usual range 0.2-0.6 mg/day in divided doses; max 2.4 mg/day; Tab: 0.1*, 0.2*, 0.3*mg
  Catapres-TTS initially 0.1 mg patch weekly; increase aft er 1-2 weeks if needed; max 0.6 mg/day
  Patch: 0.1, 0.2 mg/day (12/carton); 0.3 mg/day (4/carton)
  Kapvay (G) initially 0.1 mg bid; usual range 0.2-0.6 mg/day in divided doses; max 2.4 mg/day; Tab: 0.1, 0.2 mg
  Nexiclon XR initially 0.18 mg (2 ml) suspension or 0.17 mg tab once daily; usual max 0.52 mg (6 ml suspension) once daily
  Tab: 0.17, 0.26 mg ext-rel; Oral susp: 0.09 mg/ml ext-rel (4 oz)
• guanabenz (C)(G) initially 4 mg bid; may increase by 4-8 mg/day every 1-2 weeks; max 32 mg/day
  Pediatric: not recommended
  Tab: 4, 8 mg
• guanfacine (B)(G) initially 1 mg/day q HS; may increase to 2 mg/day q HS; usual max 3 mg/day
  Pediatric: not recommended
  Tenex Tab: 1, 2 mg
• methyldopa (B)(G) initially 250 mg bid-tid; titrate at 2-day intervals; usual maintenance 500 mg/day to 2 g/day; max 3 g/day
  Pediatric: initially 10 mg/kg/day in 2-4 divided doses; max 65 mg/kg/day or 3 g/day, whichever is less
  Aldomet Tab: 125, 250, 500 mg; Oral susp: 250 mg/5 ml (473 ml)

ALDOSTERONE RECEPTOR BLOCKER

• eplerenone (B) initially 25-50 mg daily; may increase to 50 mg bid; max 100 mg/day
  Pediatric: not recommended
  Inspra Tab: 25, 50 mg
  Comment: Contraindicated with concomitant potent CYP3A4 inhibitors. Risk of hyperkalemia with concomitant ACE-I or ARB. Monitor serum potassium at baseline, 1 week, and 1 month. Caution with serum Cr >2 mg/dL (male) or >1.8 mg/dL (female) and/or CrCl <50 mL/min, and DM with proteinuria.

PERIPHERAL ADRENERGIC BLOCKER

• guanethidine (C) initially 10 mg daily; may adjust dose at 5-7 day intervals; usual range 25-50 mg/day
  Pediatric: not recommended
  Ismelin Tab: 10, 25 mg

DIRECT RENIN INHIBITOR

• aliskiren (D) initially 150 mg once daily; max 300 mg/day
  Pediatric: <18 years: not recommended
  Tekturna Tab: 150, 300 mg

PERIPHERAL VASODILATORS

• hydralazine (C)(G) initially 10 mg qid x 2-4 days; then increase to 25 mg qid for remainder of 1st week; then increase to 50 mg qid; max 300 mg/day
  Pediatric: initially 0.75 mg/kg/day in 4 divided doses; increase gradually over 3-4 weeks; max 7.5 mg/kg/day or 2,000 mg/day
  Tab: 10, 25, 50, 100 mg
• minoxidil (C) initially 5 mg daily; may increase at 3-day intervals to 10 mg/day, then 20 mg/day, then 40 mg/day; usual range 10-40 mg/day; max 100 mg/day
  Pediatric: initially 0.2 mg/kg daily; may increase in 50%-100% increments every 3 days; usual range 0.25-1 g/kg/day; max 50 mg/day
  Loniten Tab: 2.5*, 10*mg

ACEI/DIURETIC COMBINATIONS

• benazepril/hydrochlorothiazide (D)
  Lotensin HCT 1 tab once daily; titrate individual components
  Pediatric: not recommended
  Tab: Lotensin HCT 5/6.25 benaz 5 mg/hctz 6.25 mg*
  Lotensin HCT 10/12.5 benaz 10 mg/hctz 12.5 mg*
  Lotensin HCT 20/12.5 benaz 20 mg/hctz 12.5 mg*
  Lotensin HCT 20/25 benaz 20 mg/hctz 25 mg*
• captopril/hydrochlorothiazide (D)(G)
  Pediatric: not recommended
  Capozide 1 tab once daily; titrate individual components
  Tab: Capozide 25/15 capt 25 mg/hctz 15 mg*
  Capozide 25/25 capt 25 mg/hctz 25 mg*
  Capozide 50/15 capt 50 mg/hctz 15 mg*
  Capozide 50/25 capt 50 mg/hctz 25 mg*
• enalapril/hydrochlorothiazide (D)
  Pediatric: not recommended
  Vaseretic 1 tab once daily; titrate individual components
  Tab: Vaseretic 5/12.5 enal 5 mg/hctz 12.5 mg
  Vaseretic 10/25 enal 10 mg/hctz 25 mg
• lisinopril/hydrochlorothiazide (D)
  Pediatric: not recommended
  Prinzide 1 tab once daily; titrate individual components
  Tab: Prinzide 10/12.5 lis 10 mg/hctz 12.5 mg
  Prinzide 20/12.5 lis 20 mg/hctz 12.5 mg
  Prinzide 20/25 lis 20 mg/hctz 25 mg
  Zestoretic 1 tab once daily; titrate individual components; CrCl <40 mL/min: not recommended
  Tab: Zestoretic 10/12.5 lis 10 mg/hctz 12.5 mg
  Zestoretic 20/12.5 lis 20 mg/hctz 12.5 mg*
  Zestoretic 20/25 lis 20 mg/hctz 25 mg
• moexipril/hydrochlorothiazide (D)
  Pediatric: not recommended
  Uniretic 1 tab once daily; titrate individual components
  Tab: Uniretic 7.5/12.5 moex 7.5 mg/hctz 12.5 mg*
  Uniretic 15/12.5 moex 15 mg/hctz 12.5 mg*
  Uniretic 15/25 moex 15 mg/hctz 25 mg*
• quinapril/hydrochlorothiazide (D)
  Pediatric: not recommended
  Accuretic 1 tab once daily; titrate individual components
  Tab: Accuretic 10/12.5 quin 10 mg/hctz 12.5 mg*
  Accuretic 20/12.5 quin 20 mg/hctz 12.5 mg*
  Accuretic 20/25 quin 20 mg/hctz 25 mg*

ARB/DIURETIC COMBINATIONS

• azilsartan/chlorthalidone (D)
  Pediatric: <18 years: not recommended
  Edarbyclor 1 tab once daily; titrate individual components
  Tab: Edarbyclor 40/12.5 azil 40 mg/chlor 12.5 mg
  Edarbyclor 40/25 azil 40 mg/chlor 25 mg
• candesartan/hydrochlorothiazide (D) 1 tab once daily; titrate individual components
  Pediatric: not recommended
  Atacand HCT
  Tab: Atacand HCT 16/12.5 cande 16 mg/hctz 12.5 mg
  Atacand HCT 32/12.5 cande 32 mg/hctz 12.5 mg
• eprosartan/hydrochlorothiazide (D)
  Pediatric: not recommended
  Teveten HCT 1 tab once daily; titrate individual components
  Tab: Teveten HCT 600/12.5 epro 600 mg/hctz 12.5 mg
  Teveten HCT 600/25 epro 600 mg/hctz 25 mg
• irbesartan/hydrochlorothiazide (D)
  Pediatric: not recommended
  Avalide 1 tab once daily; titrate individual components
  Tab: Avalide 150/12.5 irbes 150 mg/hctz 12.5 mg
  Avalide 300/12.5 irbes 300 mg/hctz 12.5 mg
• losartan/hydrochlorothiazide (D)(G)
  Pediatric: not recommended
  Hyzaar 1 tab once daily; titrate individual components
  Tab: Hyzaar 50/12.5 losar 50 mg/hctz 12.5 mg
  Hyzaar 100/12.5 losar 100 mg/hctz 12.5 mg
  Hyzaar 100/25 losar 100 mg/hctz 25 mg
• olmesartan medoxomil/hydrochlorothiazide (D)(G)
  Pediatric: not recommended
  Benicar HCT 1 tab once daily; titrate individual components
  Tab: Benicar HCT 20/12.5 olmi 20 mg/hctz 12.5 mg
  Benicar HCT 40/12.5 olmi 40 mg/hctz 12.5 mg
  Benicar HCT 40/25 olmi 40 mg/hctz 25 mg
• telmisartan/hydrochlorothiazide (D)(G)
  Pediatric: not recommended
  Micardis HCT 1 tab once daily; titrate individual components
  Tab: Micardis HCT 40/12.5 telmi 40 mg/hctz 12.5 mg
  Micardis HCT 80/12.5 telmi 80 mg/hctz 12.5 mg
  Micardis HCT 80/25 telmi 80 mg/hctz 25 mg
• valsartan/hydrochlorothiazide (D)
  Pediatric: not recommended
  Diovan HCT 1 tab once daily; titrate individual components
  Tab: Diovan HCT 80/12.5 vals 80 mg/hctz 12.5 mg
  Diovan HCT 160/12.5 vals 160 mg/hctz 12.5 mg
  Diovan HCT 160/25 vals 160 mg/hctz 25 mg
  Diovan HCT 320/12.5 vals 320 mg/hctz 12.5 mg
  Diovan HCT 320/25 vals 320 mg/hctz 25 mg

CENTRAL ALPHA-AGONIST/DIURETIC COMBINATIONS

• clonidine/chlorthalidone (C)
  Pediatric: not recommended
  Combipres 1 tab daily-bid
  Tab: Combipres 0.1 clon 0.1 mg/chlorthal 15 mg*
  Combipres 0.2 clon 0.2 mg/chlorthal 15 mg*
  Combipres 0.3 clon 0.3 mg/chlorthal 15 mg*
• methyldopa/hydrochlorothiazide (C)(G)
  Pediatric: not recommended
  Aldoril initially Aldoril 15 bid-tid or Aldoril 25 bid; titrate individual components
  Tab: Aldoril 15 meth 250 mg/hctz 15 mg
  Aldoril 25 meth 250 mg/hctz 25 mg
  Aldoril D30 meth 500 mg/hctz 30 mg
  Aldoril D50 meth 500 mg/hctz 50 mg

BETA-BLOCKER (CARDIOSELECTIVE)/DIURETIC COMBINATIONS

• atenolol/chlorthalidone (D)(G)
  Pediatric: not recommended
  Tenoretic initially tenoretic 50 mg once daily; may increase to tenoretic 100 mg once daily
  Tab: Tenoretic 50/25 aten 50 mg/chlor 25 mg*
  Tenoretic 100/25 aten 100 mg/chlor 25 mg
• bisoprolol/hydrochlorothiazide (C)
  Pediatric: not recommended
  Ziac initially one 2.5/6.25 mg tab daily; adjust at 2 week intervals; max two 10/6.25 mg tabs daily
  Tab: Ziac 2.5 biso 2.5 mg/hctz 6.25 mg
  Ziac 5 biso 5 mg/hctz 6.25 mg
  Ziac 10 biso 10 mg/hctz 6.25 mg
• metoprolol succinate/hydrochlorothiazide (C)
  Pediatric: not recommendxed
  Lopressor HCT titrate individual components
  Tab: Lopressor HCT 50/25 meto succ 50 mg/hctz 25mg*
  Lopressor HCT 100/25 meto succ 100 mg/hctz 25mg*
  Lopressor HCT 100/50 meto succ 100 mg/hctz 50mg*
• metoprolol succinate/ext-rel hydrochlorothiazide (C)
  Pediatric: not established
  Dutoprol titrate individual components; may titrate to max 200/25 mg once daily
  Tab: Dutoprol 25/12.5 meto succ 25 mg/ext-rel hctz 12.5 mg
  Dutoprol 50/12.5 meto succ 50 mg/ext-rel hctz 12.5 mg
  Dutoprol 100/12.5 meto succ 100 mg/ext-rel hctz 12.5 mg

BETA-BLOCKER (NONCARDIOSELECTIVE)/DIURETIC COMBINATIONS

• nadolol/bendrofl umethiazide (C)
  Pediatric: not recommended
  Corzide titrate individual components
  Tab: Corzide 40/5 nado 40 mg/bend 5 mg*
  Corzide 80/5 nado 80 mg/bend 5 mg*
• propranolol/hydrochlorothiazide (C)(G)
  Pediatric: not recommended
  Inderide titrate individual components
  Tab: Inderide 40/25 prop 40 mg/hctz 25 mg*
  Inderide 80/25 prop 80 mg/hctz 25 mg*
  Inderide LA titrate individual components
  Cap: Inderide LA 80/50 prop 80 mg/hctz 50 mg sust-rel
  Inderide LA 120/50 prop 120 mg/hctz 50 mg sust-rel
  Inderide LA 160/50 prop 160 mg/hctz 50 mg sust-rel
• timolol/hydrochlorothiazide (C)
  Pediatric: not recommended
  Timolide usual maintenance 2 tabs/day in a single or 2 divided doses
  Tab: timo 10 mg/hctz 25 mg

BETA-BLOCKER (CARDIOSELECTIVE)/ARB COMBINATION

• nebivolol/valsartan (X) 1 tab daily; may initiate when inadequately controlled on nebivolol 10 mg or valsartan 80 mg
  Pediatric: not established
  Byvalson Tab: nebi 5 mg/val 80 mg

ALPHA-1 ANTAGONIST/DIURETIC COMBINATIONS

• prazosin/polythiazide (C)
  Pediatric: not recommended
  Minizide titrate individual components
  Cap: Minizide 1 praz 1 mg/poly 0.5 mg
  Minizide 2 praz 2 mg/poly 0.5 mg
  Minizide 5 praz 5 mg/poly 0.5 mg

PERIPHERAL ADRENERGIC BLOCKER/HCTZ COMBINATIONS

• guanethidine/hydrochlorothiazide (C)
  Pediatric: not recommended
  Esmil titrate individual components
  Tab: Esmil 10/25 guan 1 mg/hctz 25 mg

ACEI/CCB COMBINATIONS

• amlodipine/benazepril (D)
  Pediatric: not recommended
  Lotrel titrate individual components
  Cap: Lotrel 2.5/10 amlo 2.5 mg/benaz 10 mg
  Lotrel 5/10 amlo 5 mg/benaz 10 mg
  Lotrel 5/20 amlo 5 mg/benaz 20 mg
  Lotrel 10/20 amlo 10 mg/benaz 20 mg
  Lotrel 5/40 amlo 5 mg/benaz 40 mg
  Lotrel 10/40 amlo 10 mg/benaz 40 mg
• amlodipine/perindopril (D)
  Pediatric: not recommended
  Prolastin titrate individual components
  Cap: Prolastin 2.5/3.5 amlo 2.5 mg/peri 3.5 mg
  Prolastin 5/7 amlo 5 mg/peri 7 mg
  Prolastin 5/14 amlo 5 mg/peri 14 mg
• enalapril/diltiazem (D)
  Pediatric: not recommended
  Teczem titrate individual components
  Tab: enal 5 mg/dil 180 mg ext-rel
• enalapril/felodipine (D)
  Pediatric: <18 years: not recommended
  Lexxel initially 1 tab daily; aft er 1-2 weeks may increase to 2 tabs/day; titrate individual components
  Tab: Lexxel 5/2.5 enal 5 mg/felo 2.5 mg ext-rel
  Lexxel 5/5 enal 5 mg/felo 5 mg ext-rel
• perindopril/amlodipine (D)
  Pediatric: not established
  Prestalia titrate individual components; max 14/10 once daily
  Tab: Prestalia 3.5/2.5 peri 3.5 mg/amlo 2.5 mg
  Prestalia 7/5 peri 7 mg/amlo 5 mg
  Prestalia 14/10 peri 14 mg/amlo 10 mg
• trandolapril/verapamil (D)
  Pediatric: not established
  Tarka titrate individual components
  Tab: Tarka 1/240 tran 1 mg/ver 240 mg ext-rel
  Tarka 2/180 tran 2 mg/ver 180 mg ext-rel
  Tarka 2/240 tran 2 mg/ver 240 mg ext-rel
  Tarka 4/240 tran 4 mg/ver 240 mg ext-rel

DRI/HCTZ COMBINATIONS

• aliskiren/hydrochlorothiazide (D) initially aliskiren150 mg once daily; max aliskiren 300 mg/day
  Pediatric: <18 years: not recommended
  Tekturna HCT
  Tab: Tekturna HCT 150/12.5 alisk 150 mg/hctz 12.5 mg
  Tekturna HCT 150/25 alisk 150 mg/hctz 25 mg
  Tekturna HCT 300/12.5 alisk 300 mg/hctz 12.5 mg
  Tekturna HCT 300/25 alisk 300 mg/hctz 25 mg

DRI/ARB COMBINATIONS

• aliskiren/valsartan (D)
  Pediatric: not recommended
  Valturna initially 150/160 once daily; may increase to max 300/320 once daily
  Tab: Valturna 150/160 alisk 150 mg/vals 160 mg
  Valturna 300/320 alisk 300 mg/vals 320 mg

DRI/CCB COMBINATIONS

• aliskiren/amlodipine (D)
  Pediatric: not recommended
  Tekamlo initially 150/5 once daily; may increase to max 300/10 once daily
  Tab: Tekamlo 150/5 alisk 150 mg/amlo 5 mg
  Tekamlo 150/10 alisk 150 mg/amlo 10 mg
  Tekamlo 300/5 alisk 300 mg/amlo 5 mg
  Tekamlo 300/10 alisk 300 mg/amlo 10 mg

DRI/CCB/HCTZ COMBINATIONS

• aliskiren/amlodipine/hydrochlorothiazide (D)
  Pediatric: not established
  Amturnide initially 150/5/12.5 once daily; may increase to max 300/10/25 once daily
  Tab: Amturnide 150/5/12.5 alisk 150 mg/amlo 5 mg/hctz 12.5 mg
  Amturnide 300/5/12.5 alisk 300 mg/amlo 5 mg/hctz 12.5 mg
  Amturnide 300/5/25 alisk 300 mg/amlo 5 mg/hctz 25 mg
  Amturnide 300/10/25 alisk 300 mg/amlo 10 mg/hctz 25 mg

HYPERTENSION ARB/CCB COMBINATIONS

• amlodipine/valsartan medoxomil (D)(G)
  Pediatric: not recommended
  Exforge 1 tab daily; titrate individual components at 1-week intervals; max 10/320 daily
  Tab: Exforge 5/160 amlo 5 mg/vals 160 mg
  Exforge 5/320 amlo 5 mg/vals 320 mg
  Exforge 10/160 amlo 10 mg/vals 160 mg
  Exforge 10/320 amlo 10 mg/vals 320 mg
• amlodipine/olmesartan (D)
  Pediatric: not established
  Azor titrate individual components
  Tab: Azor 5/20 amlo 5 mg/olme 20 mg
  Azor 10/20 amlo 10 mg/olme 20 mg
  Azor 5/40 amlo 5 mg/olme 40 mg
  Azor 10/40 amlo 10 mg/olme 40 mg
• telmisartan/amlodipine (D)
  Pediatric: not established
  Twynsta initially 40/5 once daily; titrate at 1 week intervals; max 80/10 once daily
  Tab: Twynsta 40/5 telmi 40 mg/amlo 5 mg
  Twynsta 40/10 telmi 40 mg/amlo 10 mg
  Twynsta 80/5 telmi 80 mg/amlo 5 mg
  Twynsta 80/10 telmi 80 mg/amlo 10 mg

ARB/CCB/HCTZ COMBINATIONS

• amlodipine/valsartan medoxomil/hydrochlorothiazide (D)(G)
  Pediatric: not recommended
  Exforge HCT: initially 5/160/12.5 once daily; may titrate at 1-week intervals to max 10/320/25 once daily
  Tab: Exforge HCT 5/160/12.5 amlo 5 mg/vals 160 mg/hctz 12.5 mg
  Exforge HCT 5/160/25 amlo 5 mg/vals 160 mg/hctz 25 mg
  Exforge HCT 10/160/12.5 amlo 10 mg/vals 160 mg/hctz 12.5 mg
  Exforge HCT 10/160/25 amlo 10 mg/vals 160 mg/hctz 25 mg
  Exforge HCT 10/320/25 amlo 10 mg/vals 320 mg/hctz 25 mg
• olmesartan medoxomil/amlodipine/hydrochlorothiazide (D)
  Pediatric: not recommended
  Tribenzor: initially 40/5/12.5 once daily; may titrate at 1-week intervals to max 40/10/25 daily
  Tab: Tribenzor 40/5/12.5 olme 40 mg/amlo 5 mg/hctz 12.5 mg
  Tribenzor 40/5/25 olme 40 mg/amlo 5 mg/hctz 25 mg
  Tribenzor 40/10/12.5 olme 40 mg/amlo 10 mg/hctz 12.5 mg
  Tribenzor 40/10/25 olme 40 mg/amlo 10 mg/hctz 25 mg

OTHER COMBINATION AGENTS

• clonidine/chlorthalidone (C)
  Pediatric: not recommended
  Clorpres initially 0.1/15 once daily; may titrate to max 0.3/15 bid
  Tab: Clorpres 0.1/15 clon 0.1 mg/chlor 15 mg
  Clorpres 0.2/15 clon 0.2 mg/chlor 15 mg
  Clorpres 0.3/15 clon 0.3 mg/chlor 15 mg
• reserpine/hydrofl umethiazide (C)
  Pediatric: not recommended
  Salutensin initially 1.25/25 once daily; may titrate to 1.25/25 bid or 1.25/50 once daily
  Tab: Salutensin 1.25/25 enal 1.25 mg/hydro 25 mg
  Salutensin 1.25/50: enal 1.25 mg/hydro 50 mg

ANTIHYPERTENSION/ANTILIPID COMBINATIONS

CCB/Statin Combinations

• amlodipine/atorvastatin (X)
  Pediatric: <10 years: not established; =10 years (female postmenarche): same as adult
  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
  Tab: Caduet 2.5/10 amlo 2.5 mg/ator 10 mg
  Caduet 2.5/20 amlo 2.5 mg/ator 20 mg
  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
• HYPERTHYROIDISM
  methimazole (D) initially 15-60 mg/day in 3 divided doses; maintenance 5-15 mg/day
  Pediatric: initially 0.4 mg/kg/day in 3 divided doses; maintenance 0.2 mg/kg/day or 1/2 initial dose
  Tapazole Tab: 5*, 10*mg
  Comment: methimazole potentiates anticoagulants. Contraindicated in nursing mothers.
• propylthiouracil (ptu) (D)(G)
  Propyl-Th yracil initially 100-900 mg/day in 3 divided doses; maintenance usually 50-600 mg/day in 2 divided doses
  Pediatric: <6 years: not recommended; =6-10 years: initially 50-150 mg/day or 5-7 mg/kg/day in 3 divided doses; >10 years: initially 150-300 mg/day or 5-7 mg/kg/day in 3 divided doses; maintenance: 0.2 mg/kg/day or 1/2-2/3 of initial dose
  Tab: 50* mg
  Comment: Preferred agent in pregnancy. Side eff ects include dermatitis, nausea, agranulocytosis, and hypothyroidism. Should be taken regularly for 2 years. Do not discontinue abruptly.

BETA-ADRENERGIC BLOCKER

• propranolol (C)(G) 40-240 mg daily
  Pediatric: not recommended
  Inderal Tab: 10*, 20*, 40*, 60*, 80*mg
  Inderal LA initially 80 mg daily in a single dose; increase q 3-7 days; usual range 120-160 mg/day; max 320 mg/day in a single dose
  Cap: 60, 80, 120, 160 mg sust-rel
  InnoPran XL initially 80 mg q HS; max 120 mg/day
  Cap: 80, 120 mg ext-rel

HYPERTRIGLYCERIDEMIA
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 daily; swallow whole, do not crush or chew
  Pediatric: <18 years: not recommended
  Lovaza Gelcap: 1 g (a-tocopherol 4 mg/cap) omega 3-carcartonyl acids (C) take 2-4 gel aps (2-4 g) daily without regard to meals
  Epanova Gelcap: 1 g

ISOBUTYRIC ACID DERIVATIVE

• gemfi brozil (C)(G)
  Pediatric: not recommended
  Lopid 600 mg bid 30 minutes before AM and PM meals
  Tab: 600*mg

FIBRATES (FIBRIC ACID DERIVATIVES)

• fenofi brate (C) take with meals; adjust at 4-8-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 once daily; max 130 mg/day
  Cap: 43, 87, 130 mg
  FibriCor 30-105 mg once daily; max 105 mg/day
  Tab: 30, 105 mg
  TriCor (G) 48-145 mg once daily; max 145 mg/day
  Tab: 48, 145 mg
  TriLipix (G) 45-135 mg once daily; max 135 mg/day
  Cap: 45, 135 mg del-rel
  Lipofen (G) 50-150 mg once 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: Contraindicated in liver disease. 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 or as indicated by manufacturer, LFT, glucose, and uric acid. Signifi cant side eff ect of transient skin fl ushing. Take with food and take aspirin 325 mg 30 minutes before dose to decrease fl ushing.

• niacin (C)
  Niaspan 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 1-3 g/day
  Tab: 500, 750, 1,000 mg ext-rel
  Slo-Niacin 250 mg or 500 mg or 750 mg q AM or HS
  Tab: 250, 500, 750 mg cont-rel

HMG-COA REDUCTASE INHIBITORS

• atorvastatin (X)(G) initially 10 mg daily; usual range 10-80 mg daily
  Pediatric: <10 years: not recommended; =10 years (female postmenarche): same as adult
  Lipitor Tab: 10, 20, 40, 80 mg
• fl uvastatin (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) initially 20 mg daily at evening meal; may increase at 4 week intervals; max 80 mg/day in a single or divided doses; Concomitant fi brates, niacin, or CrCl <40 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; Concomitant fi brates, niacin, or CrCl <40 mL/min: usual max 20 mg/day
  Mevacor Tab: 10, 20, 40 mg
• pravastatin (X)(G) initially 10-20 mg q HS; usual range 10-80 mg/day; may start at 40 mg/day
  Pediatric: <8 years: not recommended; 8-13 years: 20 mg q HS; 14-17 years: 40 mg q HS
  Pravachol Tab: 10, 20, 40, 80 mg
• rosuvastatin (X) initially 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 q HS; max 20 mg q HS
  Crestor Tab: 5, 10, 20, 40 mg
• simvastatin (X)(G) initially 20 mg q HS; usual range 5-80 mg/day; adjust at 4 week intervals
  Pediatric: <10 years: not recommended; 10-17 years: initially 10 mg q HS; may increase at 4 week intervals; max 40 mg q HS
  Zocor Tab: 5, 10, 20, 40, 80 mg

NICOTINIC ACID DERIVATIVE/HMG-COA REDUCTASE INHIBITOR

• niacin/lovastatin (X)
  Advicor
  Pediatric: <18 years: not recommended
  Tab: Advicor 500 mg/20 mg niac 500 mg ext-rel/lova 20 mg
  Advicor 750 mg/20 mg niac 750 mg ext-rel/lova 20 mg
  Advicor 1,000 mg/20 mg niac 1,000 mg ext-rel/lova 20 mg