Rx – All “C” 3

HYPOCALCEMIA
Comment: Hypocalcemia resulting in metabolic bone disease may be secondary
to hyperparathyroidism, pseudoparathyroidism, and chronic renal disease.
Normal serum Ca++ range is approximately 8.5-12 mg/dL. Signs and symptoms of
hypocalcemia include confusion, increased neuromuscular excitability, muscle spasms,
paresthesias, hyperphosphatemia, positive Chvostek’s sign, and positive Trousseau’s
sign. Signs and symptoms of hypercalcemia include fatigue, lethargy, decreased
concentration and attention span, frank psychosis, anorexia, nausea, vomiting,
constipation, bradycardia, heart block, shortened QT interval. Foods high in calcium
include almonds, broccoli, baked beans, salmon, sardines, buttermilk, turnip greens,
collard greens, spinach, pumpkin, rhubarb, and bran. Recommended daily calcium
intake: 1-3 years: 700 mg; 4-8 years: 1,000 mg; 9-18 years: 1,300 mg; 19-50 years:
1,000 mg: 51-70 years (males): 1,000 mg; =51 years (females): 1,200 mg; pregnancy or
nursing: 1,000-1,300 mg. Recommended daily vitamin D intake: >1 year: 600 IU; 50+
years: 800-1,000 IU. Th e American Academy of Rheumatology (AAR) recommends
the following daily doses for anyone on a chronic oral corticosteroid regimen: Calcium
1,200-1,500 mg/day and vitamin D 800-1,000 IU/day.
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H y p o c a l c e m i a ¦ 227
CALCIUM SUPPLEMENTS
Comment: Take calcium supplements aft er meals to avoid gastric upset. Dosages of
calcium over 2,000 mg/day have not been shown to have any additional benefi t. Calcium
decreases tetracycline absorption. Calcium absorption is decreased by corticosteroids.
calcitonin-salmon (C)
Miacalcin 200 units (1 spray intranasally) once daily; alternate nostrils each day
Nasal spray: 14 dose (2 ml)
Miacalcin injection 100 units/day SC or IM
Vial: 2 ml
calcium carbonate (C)(OTC)(G)
Rolaids chew 2 tabs bid; max 14 tabs/day
Tab: calcium carbonate: 550 mg
Rolaids Extra Strength chew 2 tabs bid; max 8 tabs/day
Tab: 1,000 mg
Tums chew 2 tabs bid; max 16 tabs/day
Tab: 500 mg
Tums Extra Strength chew 2 tabs bid; max 10 tabs/day
Tab: 750 mg
Tums Ultra chew 2 tabs bid; max 8 tabs/day
Tab: 1,000 mg
Os-Cal 500 (OTC) 1-2 tab bid-tid
Tab: elemental calcium carbonate 500 mg
calcium carbonate/vitamin D (C)(G)
Os-Cal 250+D (OTC) 1-2 tabs tid
Tab: elemental calcium carbonate 250 mg/vit d 125 IU
Os-Cal 500+D (OTC) 1-2 tabs bid-tid
Tab: elemental calcium carbonate 500 mg/vit d 125 IU
Viactiv (OTC) 1 tab tid
Chew tab: elemental calcium 500 mg/vit d and vit a100 IU/Vit k 40 mEq
calcium citrate
Citracal (OTC) 1-2 tabs bid
Tab: elemental calcium citrate 200 mg
calcium citrate/vitamin D (C)(G)
Citracal+D (OTC) 1-2 cplts bid
Cplt: elemental calcium citrate 315 mg/vit d 200 IU
Citracal 250+D (OTC) 1-2 tabs bid
Tab: elemental calcium citrate 250 mg/vit d 62.3 IU
VITAMIN D ANALOGS
Comment: Concurrent vitamin D supplementation is contraindicated for patients
taking calcitriol or doxercalciferol due to the risk of vitamin D toxicity. Symptoms
of hypervitaminosis D: hypercalcemia, hypercalciuria , elevated creatinine, erythema
multiforme, hyperphosphatemia. Maintain adequate daily calcium and fl uid intake. Keep
serum calcium times phosphate (Ca x P) product below 70. Monitor serum calcium (esp.
during dose titration), phosphorus, other lab values (see literature for frequency).
calcitriol (C)(G) Predialysis: initially 0.25 mcg daily; may increase to 0.5 mcg daily;
Dialysis: initially 0.25 mcg daily; may increase by 0.25 mcg/day at 4-8-week intervals;
usual maintenance 0.5-1 mcg/day; Hypoparathyroidism: initially 0.25 mcg q AM; may
increase by 0.25 mcg/day at 4-8 week intervals; usual maintenance 0.5-2 mcg/day
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Pediatric: <12 years: Predialysis: <3 years: 10-15 ng/kg per day; =3 years: initially
0.25 mcg daily; may increase to 0.5mcg daily; Dialysis: not recommended; Hypoparathyroidism:
initially 0.25 mcg daily in the AM; may increase by 0.25 mcg/day at
2-4 week intervals; usual maintenance: (1-5 years): 0.25-0.75 mcg daily; (=6 years):
0.5-2 mcg daily; Pseudohypoparathyroidism: (<6 years): insuffi cient data, see mfr
pkg insert; =12 years: Predialysis: initially 0.25 mcg daily; may increase to 0.5mcg
daily Dialysis: initially 0.25 mcg daily; may increase by 0.25 mcg daily at 4-8 week
intervals; usual maintenance: 0.5-1 mcg daily.
Rocaltrol Cap: 0.25, 0.5 mcg
Rocaltrol Solution Soln: 1 mcg/ml (15 ml, single-use dispensers)
Comment: calcitriol is indicated for the treatment of secondary hyperparathyroidism
and resultant metabolic bone disease in predialysis patients (CrCl 15-55 mL/min),
hypocalcemia and resultant metabolic bone disease in patients on chronic renal
dialysis, hypocalcemia in hypoparathyroidism, and pseudohypoparathyroidism.
doxecalciferol (C)(G) Dialysis: initially 10mcg 3 x/week at dialysis; adjust to maintain
intact parathyroid hormone (iPTH) between 150-300 pg/mL; if iPTH is not lowered
by 50% and fails to reach target range, may increase by 2.5 mcg at 8-week intervals;
max 20 mcg 3 x/week; if iPTH <100 pg/mL, suspend for 1 week, then resume at a
dose that is at least 2.5 mcg lower; Predialysis: initially 1mcg once daily; may increase
by 0.5 mcg at 2 week intervals to target iPTH levels; max 3.5 mcg/day
Pediatric: <12 years: not established; =12 years: same as adult
Hectorol Cap: 0.25, 0.5, 1, 2.5 mcg
Comment: Oral Hectorol is indicated for the treatment of secondary
hyperparathyroidism in patients with chronic kidney disease (CKD) on dialysis;
Predialysis stage 3 or 4 CKD: use oral form only.
Hectoral Injection <12 years: not recommended; =12 years: 4 mcg 3 x weekly after
dialysis; adjust dose to maintain intact parathyroid hormone (iPTH) between
150-300 pg/mL; if iPTH is not lowered by 50% and fails to reach target range,
may increase by 1-2 mcg at 8 week intervals; max 18 mcg/week; if iPTH <100 pg/
mL, suspend for 1 week, then resume at a dose that is at least 1 mcg lower
Vial: 2 mcg/ml (1, 2 ml single-dose; 2 ml multi-dose)
Comment: Hectorol Injection is indicated for the treatment of secondary
hyperparathyroidism in patients with chronic kidney disease (CKD) on dialysis.
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/dose 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; =18 years: same as adult
Zemplar Vial: 2, 5 mcg/ml soln for inj
Comment: paricalcitol is indicated for the prevention and treatment of secondary
hyperparathyroidism associated with chronic kidney disease (CKD) stage 5.
BIOENGINEERED REPLICA OF HUMAN PARATHYROID HORMONE
bioengineered replica of human parathyroid hormone (C) before starting, confi rm
25-hydroxyvitamin D stores are suffi cient; if insuffi cient, replace to suffi cient levels per
standard of care; confi rm serum calcium is above 7.5 mg/dL; the goal of treatment is to
achieve serum calcium within the lower half of the normal range; administer SC into
the thigh once daily; alternate thighs; initially, 50 mcg/day; when initiating, decrease
dose of active vitamin D by 50%, if serum calcium is above 7.5 mg/dL; monitor serum y
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H y p o k a l e m i a ¦ 229
calcium levels every 3 to 7 days aft er starting or adjusting dose and when adjusting
either active vitamin D or calcium supplements dose. Abrupt interruption or discontinuation
of Natpara can result in severe hypocalcemia. Resume treatment with, or increase
the dose of, an active form of vitamin D and calcium supplements. Monitor for
signs and symptoms of hypocalcemia and monitor serum calcium levels, In the case
of a missed dose, the next Natpara dose should be administered as soon as reasonably
feasible and additional exogenous calcium should be taken in the event of ypocalcemia.
Natpara Soln for inj: 25, 50, 75, 100 mcg (2/pkg) multiple dose, dual-chamber
glass cartridge containing a sterile powder and diluent
Comment: Natpara is indicated as an adjunct to calcium and vitamin D in
patients with hypoparathyroidism. Because of a potential risk of osteosarcoma,
use Natpara only in patients who cannot be well-controlled on calcium and
active forms of vitamin D alone and for whom the potential benefi ts are
considered to outweigh the potential risk. Avoid use of Natpara in patients who
are at increased baseline risk for osteosarcoma, such as patients with Paget’s
disease of bone or unexplained elevations of alkaline phosphatase, pediatric and
young adult patients with open epiphyses, patients with hereditary disorders
predisposing to osteosarcoma or patients with a prior history of external beam
or implant radiation therapy involving the skeleton. Because of the risk of
osteosarcoma, Natpara is available only through a restricted program under a
Risk Evaluation and Mitigation Strategy (REMS) (www.natparaREMS.com).
HYPOKALEMIA
Comment: Normal serum K+ range is approximately 3.5-5.5 mEq/L. Signs and
symptoms of hypokalemia include neuromuscular weakness, muscle twitching
and cramping, hyporefl exia, postural hypotension, anorexia, nausea and vomiting,
depressed ST segments, fl attened T waves, and cardiac tachyarrhythmias. Signs
and symptoms of hyperkalemia include peaked T waves, elevated ST segment, and
widened QRS complexes.
PROPHYLAXIS
Comment: Usual dose range is 8-10 mEq/day.
TREATMENT OF HYPOKALEMIA: NONEMERGENCY (K+ <2.5 mEq/L)
Comment: Usual dose range 40-120 mEq/day in divided doses. Solutions are preferred;
potentially serious GI side eff ects may occur with tablet formulations or when taken
on an empty stomach.
POTASSIUM SUPPLEMENTS
Comment: Potassium supplements should be taken with food. Solutions are
the preferred form. Extended-release and sustained-release forms should be
swallowed whole; do not crush or chew. Potassium supplementation is indicated for
hypokalemia including that caused by diuretic use, and digitalis intoxication without
atrioventricular (AV) block.
potassium (C)(G)
Pediatric: not established
KCL Solution Oral soln: 10% (30 ml unit dose, 50/case)
K-Dur (as chloride) Tab: 10, 20* mEq sust-rel
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230 ¦ Hypokalemia
K-Lor for Oral Solution (as chloride) Pkts for reconstitution: 20 mEq/pkt (fruit)
Klor-Con/25 (as chloride) Pkts for reconstitution: 25 mEq/pkt
Klor-Con/EF 25 (as bicarbonate) Pkts for reconstitution: 25 mEq/pkt
( eff ervescent) (fruit)
Klor-Con Extended-Release (as chloride) Tab: 8, 10 mEq ext-rel
Klor-Con M (as chloride) Tab: 10, 15*, 20* mEq ext-rel
Klor-Con Powder (as chloride) 20, 25 mEq Pkts for reconstitution: (30/carton)
(fruit)
Klorvess (as bicarbonate and citrate) Tab: 20 mEq eff ervescent for solution;
Granules: 20 mEq/pkt eff ervescent for solution; Oral liq: 20 mEq/15 ml (16 oz)
Klotrix (as chloride) Tab: 10 mEq sust-rel
K-Lyte (as bicarbonate and citrate) Tab: 25 mEq eff ervescent for solution (lime,
orange)
K-Lyte/CL (as chloride) Tab: 25 mEq eff ervescent for solution (citrus, fruit)
K-Lyte/CL 50 (as chloride) Tab: 50 mEq eff ervescent for solution (citrus, fruit)
K-Lyte/DS (as bicarbonate and citrate) Tab: 50 mEq eff ervescent for solution
(lime, orange)
K-Tab (as chloride) Tab: 10 mEq sust-rel
Micro-K (as chloride) Cap: 8, 10 mEq sust-rel
Potassium Chloride Extended Release Caps Cap: 8, 10 mEq ext-rel
Potassium Chloride Sust-Rel Tabs Tab/Cap: 10 mEq sust-rel
Potassium Chloride ER Tab: 8mEq (600 mg), 10 mEq (750 mg)
HYPOMAGNESEMIA
Comment: Normal serum Mg++ range is approximately 1.2-2.6 mEq/L. Signs and
symptoms of hypomagnesemia include confusion, disorientation, hallucinations,
hyperrefl exia, tetany, convulsions, tachyarrhythmia, positive Chvostek’s sign,
and positive Trousseau’s sign. Signs and symptoms of hypermagnesemia include
drowsiness, lethargy, muscle weakness, hypoactive refl exes, slurred speech,
bradycardia, hypotension, convulsions, and cardiac arrhythmias.
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
HYPOPARATHYROIDISM
VITAMIN D ANALOGS
Comment: Concurrent vitamin D supplementation is contraindicated for patients
taking calcitrol or doxecalciferol owing to the risk of vitamin D toxicity.
calcitrol (C) initially 0.25 mcg q AM; may increase by 0.25 mcg/day at 4-8-week
intervals; usual maintenance 0.5-2 mcg/day
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Hypophospha t a s i a ( O s t e o m a l a c i a , R i c k e t s ) ¦ 231
Pediatric: initially 0.25 mcg daily; may increase by 0.25 mcg/day at 2-4-week intervals;
usual maintenance (1-5 years) 0.25-0.75 mcg/day, (>6 years) 0.5-2 mcg/day
Rocaltrol Cap: 0.25, 0.5 mcg
Rocaltrol Solution Soln: 1 mcg/ml (15 ml, single-use dispensers)
doxecalciferol (C) initially 0.25 mcg q AM; may increase by 0.25 mcg/day at 4-8-
week intervals; usual maintenance 0.5-2 mcg/day
Pediatric: initially 0.25 mcg daily; may increase by 0.25 mcg/day at 2-4-week
intervals; usual maintenance (1-5 years) 0.25-0.75 mcg/day, (>6 years) 0.5-2
mcg/day
Hectorol Cap: 0.25, 0.5 mcg
HUMAN PARATHYROID HORMONE
teriparatide (C) 20 mcg SC daily in the thigh or abdomen; may treat for up to 2 years
Pediatric: not recommended
Forteo Multidose Pen Multi-dose pen: 250 mcg/ml (3 ml)
Comment: Forteo is indicated for the treatment of postmenopausal osteoporosis
in women who are at high risk for fracture and to increase bone mass in men
with primary or hypogonadal osteoporosis who are at high risk for fracture.
BIOENGINEERED REPLICA OF HUMAN PARATHYROID HORMONE
bioengineered replica of human parathyroid hormone (C) initially inject mg IM into
the thigh once daily; when initiating, decrease dose of active vitamin D by 50% if
serum calcium is above 7.5 mg/dL; monitor serum calcium levels every 3-7 days after
starting or adjusting dose and when adjusting either active vitamin D or calcium
supplements dose
Natpara Soln for inj: 25, 50, 75, 100 mcg (2/pkg) multiple dose, dual-chamber
glass cartridge containing a sterile powder and diluent
Comment: Natpara is indicated as an adjunct to calcium and vitamin D in
patients with parathyroidism.
HYPOPHOSPHATASIA (OSTEOMALACIA, RICKETS)
Comment: Hypophosphatasia (HPP) is an inborn error of metabolism marked by
abnormally low serum alkaline phosphatase activity and phosphoethanolamine in the
urine. It is manifested by osteomalacia in adults and rickets in infants and children. It
is most severe in infants under 6 months-of-age. With congenital absence of alkaline
phosphatase, an enzyme essential to the calcifi cation of bone tissue, complications
include vomiting, growth retardation, and oft en death in infancy. Surviving children
have numerous skeletal abnormalities and dwarfi sm.
asfotase alfa (NE) 6 mg/kg/week SC, administered as 2 mg/kg or 1 mg/kg 6 x/week;
max 9 mg/kg/week SC administered as 3 mg/kg 3 x/week
Pediatric: same as adult
Strensiq Vial: 18 mg/0.45 ml, 28 mg/0.7 ml, 40 mg/ml, 80 mg/0.8 ml for SC inj,
single-use (1, 12/carton) (preservative-free)
Comment: Strensiq is the fi rst FDA-approved (2015) treatment for perinatal,
infantile, and juvenile onset HPP. Prior to the availability of Strensiq, there was
no eff ective treatment and patient prognosis was very poor.
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232 ¦ H y p o t e n s i o n : N e u r o g e n i c , O r t h o s t a t i c
HYPOTENSION: NEUROGENIC, ORTHOSTATIC
ALPHA-1 AGONIST
midodrine (C)(G) 10 mg tid at 3-4-hour intervals; take while upright; take last dose
at least 4 hours before bedtime
Pediatric: not recommended
ProAmatine Tab: 2.5*, 5*, 10*mg
SYNTHETIC AMINO ACID PRECURSOR OF NOREPINEPHRINE
droxidopa (C) initially 100 mg, taken 3 times/day (upon arising in the morning, at
midday, and in the late aft ernoon at least 3 hours prior to bedtime (to reduce the
potential for supine hypertension during sleep); administer with or without; swallow
whole; titrate to symptomatic response, in increments of 100 mg tid every 24-48
hours; max 600 mg tid (max total 1,800 mg/day)
Pediatric: not recommended
Northera Cap: 100, 200, 300 mg
Comment: Northera is indicated for the treatment of orthostatic dizziness,
lightheadedness, or feeling about to black out in adult patients with
symptomatic neurogenic orthostatic hypotension (NOH) caused by primary
autonomic failure [Parkinson’s disease (PD), multiple system atrophy (MSA)
and pure autonomic failure], dopamine beta-hydroxylase defi ciency, and
nondiabetic autonomic neuropathy. Eff ectiveness beyond 2 weeks of treatment
has not been established. Th e continued eff ectiveness of Northera should
be assessed. Administering Northera in combination with other agents that
increase blood pressure (e.g., norepinephrine, ephedrine, midodrine, triptans)
would be expected to increase the risk for supine hypertension.
HYPOTHYROIDISM
Comment: Take thyroid replacement hormone in the morning on an empty stomach.
For the elderly, start thyroid hormone replacement at 25 mcg/day. Target TSH is 0.4-
5.5 mIU/L; target T4 is 4.5-12.5 ng/L. Signs and symptoms of thyroid toxicity include
tachycardia, palpitations, nervousness, chest pain, heat intolerance, and weight loss.
ORAL THYROID HORMONE SUPPLEMENTS
T3
liothyronine (A) initially 25 mcg daily; may increase by 25 mcg every 1-2 weeks as
needed; usual maintenance 25-75 mcg/day
Pediatric: initially 5 mcg/day; may increase by 5 mcg/day every 3-4 days; Cretinism:
maintenance dose: <1 year: 20 mcg/day; 1-3 years: 50 mcg/day; >3 years: same as adult
Cytomel Tab: 5, 25, 50 mcg
T4
levothyroxine (A)(G)
Levoxyl initially 25-100 mcg/day; increase by 25 mcg/day q 2-3 weeks as needed;
maintenance 100-200 mcg/day
Pediatric: <6 months: 8-10 mcg/kg/day; 6-12 months: 6-8 mcg/kg/day; >1-5
years: 5-6 mcg/kg/day; 6-12 years: 4-5 mcg/kg/day; >12 years: same as adult
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I m p e t i g o C o n t a g i o s a ( I n d i a n Fi r e ) ¦ 233
Tab: 25*, 50* (dye-free), 75*, 88*, 100*, 112*, 125*, 137*, 150*, 175*, 200*, 300*mcg
Synthroid initially 50 mcg/day; increase by 25 mcg/day q 2-3 weeks as needed;
max 300 mcg/day
Pediatric: <6 months: 8-10 mcg/kg/day; 6-12 months: 6-8 mcg/kg/day; >1-5
years: 5-6 mcg/kg/day; 6-12 years: 4-5 mcg/kg/day; >12 years: same as adult
Tab: 25*, 50* (dye-free), 75*, 88*, 100*, 112*, 125*, 137*, 150*, 175*, 200*, 300*mcg
Unithroid initially 50 mcg/day; increase by 25 mcg/day q 2-3 weeks as needed;
max 300 mcg/day
Pediatric: 0-3 months: 10-15 mcg/kg/day; 3-6 months: 8-10 mcg/kg/day; 6-12
months: 6-8 mcg/kg/day; 1-5 years: 5-6 mcg/kg/day; 6-12 years: 4-5 mcg/kg/
day; >12 years: 2-3 mcg/kg/day; Growth and puberty complete: same as adult
Tab: 25*, 50* (dye-free), 75*, 88*, 100*, 112*, 125*, 150*, 175*, 200*, 300*mcg
T3/T4 Combination
liothyronine/levothyroxine (A) initially 15-30 mg/day; increase by 15 mg/day q 2-3
weeks to target goal; usual maintenance 60-120 mg/day
Pediatric: <6 months: 4.6-6 mcg/kg/day; 6-12 months: 3.6-4.8 mcg/kg/day; >1-5
years: 3-3.6 mcg/kg/day; 6-12 years: 2.4-3 mcg/kg/day; >12 years: 1.2-1.8 mcg/kg/
day; Growth and puberty complete: same as adult
Armour Th yroid Tab Tab: per grain: T3 9 mcg/T4 38 mcg: 1/4, 1/2, 1, 1, 2, 3*,
4*, 5* gr; 15, 30, 60, 90, 120, 180*, 240*, 300*mg
Th yrolar Tab: per grain: T3 12.5 mcg/T4 50 mcg: 1/4, 1/5, 1, 2, 3 gr
PARENTERAL THYROID HORMONE SUPPLEMENT
levothyroxine sodium (A)(G) 1/2 oral dose by IV or IM and titrate; Myxedema Coma:
200-500 mcg IV x 1 dose; may administer 100-300 mcg (or more) IV on second day
if needed; then 50-100 mcg IV daily; switch to oral form as soon as possible
Pediatric: not recommended
T4 Vial: 100, 200, 500 mcg (pwdr for IM or IV administration aft er reconstitution)
IDIOPATHIC PULMONARY FIBROSIS (IPF)
nintedanib (D) take with food at the same time each day; take 150 mg bid, 12 hours
apart; max 300 mg/day
Pediatric: not established
Ofev Cap: 100, 150 mg
Comment: Monitor liver enzymes. If elevated LFTs (3 < AST/ALT <5 XULN)
without severe liver damage, interrupt therapy or reduce dose to 100 mg bid. When
liver enzymes return to baseline, restart at 100 mg bid and titrate up.
pirfenidone (C) take with food at the same time each day; Days 1-7: 1 cap tid; Days
8-14: 2 caps tid; Days 15 and ongoing: 3 caps tid; max 9 caps/day
Pediatric: not established
Esbriet Gelcap: 267 mg
IMPETIGO CONTAGIOSA (INDIAN FIRE)
Comment: Th e most common infectious organisms are Staphylococcus aureus and
Streptococcus pyogenes.
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234 ¦ I m p e t i g o C o n t a g i o s a ( I n d i a n Fi r e )
TOPICAL ANTI-INFECTIVES
mupirocin (B)(G) apply to lesions bid; apply to walls of nares bid
Pediatric: same as adult
Bactroban Oint: 2% (22 g); Crm: 2% (15, 30 g)
Centany Oint: 2% (15, 30 g)
ORAL ANTI-INFECTIVES
amoxicillin (B)(G) 500-875 mg bid or 250-500 mg tid x 10 days
Pediatric: <40 kg (88 lb): 20-40 mg/kg/day in 3 divided doses x 10 days or 25-45 mg/kg/
day in 2 divided doses x 10 days; >40 kg: same as adult; see page 554 for dose by weight
Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg (cherry-
banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml (80, 100,
150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble gum); Oral
drops: 50 mg/ml (30 ml) (bubble gum)
Moxatag Tab: 775 mg ext-rel
Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80,
100, 150 ml) (raspberry-strawberry)
amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200,
400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana), 250
mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml) (orange)
(phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided
bid x 10 days see page 556 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml)
(strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day
in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
azithromycin (B) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500 mg
daily x 3 days or 2 g in a single dose
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
cefaclor (B)(G) 250-500 mg q 8 hours x 10 days; max 2 g/day
Pediatric: <1 month: not recommended; 20-40 mg/kg bid or q 12 hours x 10 days;
max 1 g/day; see page 560 for dose by weight
Tab: 500 mg; Cap: 250, 500 mg; Susp: 125 mg/5 ml (75, 150 ml) (strawberry); 187
mg/5 ml (50, 100 ml) (strawberry); 250 mg/5 ml (75, 150 ml) (strawberry); 375
mg/5 ml (50, 100 ml) (strawberry)
Pediatric: <16 years: ext-rel not recommended; =16 years: same as adult
Cefaclor Extended Release Tab: 375, 500 mg ext-rel
cefadroxil (B) 1-2 g in 1-2 divided doses x 10 days
Pediatric: 30 mg/kg/day in 2 divided doses x 10 days; see page 561 for dose by
weight
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I m p e t i g o C o n t a g i o s a ( I n d i a n Fi r e ) ¦ 235
Duricef Cap: 500 mg; Tab: 1 g; Oral susp: 250 mg/5 ml (100 ml); 500 mg/5 ml
(75, 100 ml) (orange-pineapple)
cefpodoxime proxetil (B) 200 mg bid x 10 days
Pediatric: <2 months: not recommended; 2 months-12 years: 10 mg/kg/day (max
400 mg/dose) or 5 mg/kg/day bid (max 200 mg/dose) x 10 days; see page 564 for
dose by weight
Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 mg) (lemon
creme)
cefprozil (B) 500 mg bid x 10 days
Pediatric: =6 months: not recommended; 6 months-12 years: see page 565 for dose
by weight
Cefzil Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 75, 100 ml) (bubble
gum) (phenylalanine)
ceft aroline fosamil (B) administer by IV infusion aft er reconstitution every 12 hours
x 5-14 days; CrCl >50 mL/min: 600 mg; CrCl >30-<50 mL/min: 400 mg; CrCl >1
5-<30 mL/min: 300 mg; ESRD: 200 mg
Tefl aro Vial: 400, 600 mg
cefuroxime axetil (B) (G) 250-500 mg bid x 10 days
Pediatric: 15 mg/kg bid x 10 days; see page 567 for dose by weight
Ceft in Tab: 250, 500 mg; Oral susp: 12, 250 mg/5 ml (50, 100 ml) (tutti-frutti)
cephalexin (B) (G) 250-500 mg qid or 500 mg bid x 10 days
Pediatric: 25-50 mg/kg/day in 4 divided doses x 10 days; see page 568 for dose by
weight
Kefl ex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml)
(strawberry)
clarithromycin (C)(G) 500 mg or 500 mg ext-rel daily x 7 days
Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg bid x 7 days; see page
569 for dose by weight
Biaxin Tab: 250, 500 mg
Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit punch)
Biaxin XL Tab: 500 mg ext-rel
dicloxacillin (B) (G) 500 mg q 6 hours x 10 days
Pediatric: 12.5-25 mg/kg/day in 4 divided doses x 10 days; see page 571 for dose by
weight
Dynapen Cap: 125, 250, 500 mg; Oral susp: 62.5 mg/5 ml (80, 100, 200 ml)
erythromycin base (B)(G) 250 mg qid, or 333 mg tid, or 500 mg bid x 7-10 days
Pediatric: =45 kg: 30-50 mg in 2-4 divided doses x 7-10 days; =45 kg: same as adult
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
erythromycin ethylsuccinate (B)(G) 400 mg tid x 7-10 days
Pediatric: 30-50 mg/kg/day in 4 divided doses x 7-10 days; may double dose with
severe infection; max 100 mg/kg/day; see page 574 for dose by weight
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100,
200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab:
200 mg wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
E.E.S. 400 Tablets Tab: 400 mg
y y y y y y y y y
236 ¦ I m p e t i g o C o n t a g i o s a ( I n d i a n Fi r e )
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
loracarbef (B) 200 mg bid x 10 days
Pediatric: 15 mg/kg/day in 2 divided doses x 10 days; see page 581 for dose by weight
Pediatric: 30 mg/kg/day in 2 divided doses x 7 days
Lorabid Pulvule: 200, 400 mg; Oral susp: 100 mg/5 ml (50, 100 ml); 200 mg/5
ml (50, 75, 100 ml) (strawberry bubble gum)
penicillin G (benzathine) (B) 1.2 million units IM x 1 dose
Pediatric: <60 lb: 300,000-600,000 units IM x 1 dose; =60 lb: 900,000 units x 1 dose
Bicillin L-A Cartridge-needle unit: 600,000 units (1 ml); 1.2 million units (2 ml)
penicillin G (benzathine/procaine) (B) (G) 2.4 million units IM x 1 dose
Pediatric: <30 lb: 600,000 units IM x 1 dose; 30-60 lb: 900,000-1.2 million units IM
x 1 dose
Bicillin C-R Cartridge-needle unit: 600,000 units (1 ml); 1.2 million units (2 ml);
2.4 million units (4 ml)
penicillin V potassium (B) 250-500 mg q 6 hours x 10 days
Pediatric: 50 mg/kg/day in 4 divided doses x 3 days; =12 years: same as adult; see page
583 for dose by weight
Pen-Vee K Tab: 250, 500 mg; Oral soln: 125 mg/5 ml (100, 200 ml); 250 mg/5 ml
(100, 150, 200 ml)
INCONTINENCE: FECAL
Comment: Treatment of fecal incontinence in patients who have failed conservative
therapy (e.g., diet, fi ber therapy, antimotility agents).
dextranomer microspheres/sodium hyaluronate (NE)
Pediatric: =18 years: not recommended
Pretreatment: bowel preparation using enema (required) and prophylactic
antibiotics (recommended) prior to injection
Treatment: inject slowly into the deep submucosal layer in the proximal part of
the high pressure zone of the anal canal about 5 mm above the dentate line; four
1-ml injections in the following order: posterior, left lateral, anterior, right lateral;
keep needle in place 15-30 seconds to minimize leakage; use a new needle for
each syringe and injection site
Posttreatment: avoid hot baths and physical activity during fi rst 24 hours; avoid
antidiarrheal drugs, sexual intercourse, and strenuous activity for 1 week; avoid
anal manipulation for 1 month
Retreatment: may repeat if needed with max 4 ml, no sooner than 4 weeks aft er
the fi rst injection; point of injection should be made in between initial injection
sites (i.e., shift ed 1/8 of a turn)
Solesta dex micro 50 mg/sod hyal 15 mg per ml
Syringe: 1 ml (4 w. needles)
INCONTINENCE: URINARY (OVERACTIVE BLADDER/
STRESS INCONTINENCE/URGE INCONTINENCE)
See Enuresis page 138
estrogen replacement (X) see Menopause page 264
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I n c o n t i n e n c e : U r i n a r y ¦ 237
pseudoephedrine (C)(G) 30-60 mg tid
Sudafed (OTC) Tab: 30 mg; Liq: 15 mg/5 ml (1, 4 oz)
VASOPRESSIN
desmopressin acetate (DDAVP) (B)(G)
DDAVP usual dosage 0.1-1.2 mg/day in 2-3 divided doses; 0.2 mg q HS prn for
nocturnal enuresis
Pediatric: <6 years: not recommended; =6 years: 0.5 mg daily or q HS prn
Tab: 0.1*, 0.2*mg
DDAVP Rhinal Tube
Pediatric: <6 years: not recommended; =6 years: 10 mcg or 0.1 ml of soln each
nostril (20 mcg total dose) q HS prn; max 40 mcg total dose
Rhinal tube: 0.1 mg/ml (2.5 ml)
BETA-3 ADRENERGIC AGONIST
mirabegron (C) initially 25 mg once daily; max 50 mg once daily; severe renal impairment,
25 mg once daily
Myrbetriq Tab: 25, 50 mg ext-rel
MUSCARINIC RECEPTOR ANTAGONISTS
fesoterodine (C)(G) 4 mg daily; max 8 mg/day
Pediatric: not recommended
Toviaz Tab: 4, 8 mg ext-rel
tolterodine tartrate (C)(G)
Pediatric: not recommended
Detrol 2 mg bid; may decrease to 1 mg bid
Tab: 1, 2 mg
Detrol LA 2-4 mg once daily
Cap: 2, 4 mg ext-rel
ANTISPASMODIC/ANTICHOLINERGICS
darifenacin (C) 7.5-15 mg daily with liquid; max 15 mg/day
Pediatric: not recommended
Enablex 7.5-15 mg daily with liquid; max 15 mg/day
Tab: 7.5, 15 mg ext-rel
dicyclomine (B)(G) 10-20 mg qid
Pediatric: not recommended
Bentyl Tab: 20 mg; Cap: 10 mg; Syr: 10 mg/5 ml (16 oz)
fl avoxate (B) 100-200 mg tid-qid
Pediatric: not recommended
Urispas Tab: 100 mg
hyoscyamine (C)(G)
Anaspaz 1-2 tabs q 4 hours prn; max 12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: 0.0625-0.125 mg q 4 hours
prn; max 0.75 mg/day
Tab: 0.125*mg
Levbid 1-2 tabs q 12 hours prn; max 4 tabs/day
Pediatric: <12 years: not recommended; =12 years: same as adult
y y y y y y y y y
238 ¦ I n c o n t i n e n c e : U r i n a r y
Tab: 0.375*mg ext-rel
Levsin 1-2 tabs q 4 hours prn; max 12 tabs/day
Pediatric: <6 years: not recommended; 6-12 years: 1 tab q 4 hours prn
Tab: 0.125*mg
Levsin Drops 1-2 ml q 4 hours prn; max 60 ml/day
Pediatric: 3.4 kg: 4 drops q 4 hours prn; max 24 drops/day; 5 kg: 5 drops q 4
hours prn; max 30 drops/day; 7 kg: 6 drops q 4 hours prn; max 36 drops/day;
10 kg: 8 drops q 4 hours prn; max 40 drops/day
Oral drops: 0.125 mg/ml (15 ml) (orange) (alcohol 5%)
Levsin Elixir 5-10 ml q 4 hours prn
Pediatric: <10 kg: use drops; 10-19 kg: 1.25 ml q 4 hours prn; 20-39 kg: 2.5
ml q 4 hours prn; 40-49 kg: 3.75 ml q 4 hours prn; =50 kg: 5 ml q 4 hours prn
Elix: 0.125 mg/5 ml (16 oz) (orange) (alcohol 20%)
Levsinex SL 1-2 tabs q 4 hours SL or PO; max 12 tabs/day
Pediatric: 2-12 years: 1 tab q 4 hours; max 6 tabs/day; >12 years: same as adult
Tab: 0.125 mg sublingual
Levsinex Timecaps 1-2 caps q 12 hours; may adjust to 1 cap q 8 hours
Pediatric: 2-12 years: 1 cap q 12 hours; max 2 caps/day; >12 years: same as
adult
Cap: 0.375 mg time-rel
NuLev dissolve 1-2 tabs on tongue, with or without water, q 4 hours prn; max
12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: dissolve 1 tab on tongue,
with or without water, q 4 hours prn; max 6 tabs/day; =12 years: same as adult
ODT: 0.125 mg (mint; phenylalanine)
oxybutynin chloride (B)
Ditropan 5 mg bid-tid; max 20 mg/day
Pediatric: <5 years: not recommended; 5-12 years: 5 mg bid; max 15 mg/day;
=16 years: same as adult
Tab: 5*mg; Syr: 5 mg/5 ml
Ditropan XL initially 5 mg daily; may increase weekly in 5-mg increments as
needed; max 30 mg/day
Pediatric: <6 years: not recommended; =6 years: initially 5 mg once daily; may
increase weekly in 5-mg increments as needed; max 20 mg/day
Tab: 5, 10, 15 mg ext-rel
GelniQUE 3 mg Pump: apply 3 pumps (84 mg) once daily to clean dry intact
skin on the abdomen, upper arm, shoulders, or thighs; rotate sites; wash hands;
avoid washing application site for 1 hour aft er application
Pediatric: not recommended
Gel: 3% (92 g, metered pump dispenser) (alcohol)
GelniQUE 1 g Sachet: apply 1 g gel (1 sachet) once daily to dry intact skin on
abdomen, upper arms/shoulders, or thighs; rotate sites; wash hands; avoid
washing application site for 1 hour aft er application
Pediatric: not recommended
Gel: 10%, 1 g/sachet (30/carton) (alcohol)
Oxytrol Transdermal Patch (OTC): apply patch to clean dry area of the abdomen,
hip, or buttock; one patch twice weekly; rotate sites
Pediatric: not recommended
Transdermal patch: 3.9 mg/day
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I n f l u e n z a ( F l u ) ¦ 239
propantheline (C) 15-30 mg tid
Pediatric: not recommended
Pro-Banthine Tab: 7.5, 15 mg
solifenacin (C)(G) 5-10 mg daily
Pediatric: not recommended
VESIcare Tab: 5, 10 mg
trospium chloride (C)(G)
Pediatric: not recommended
Sanctura 20 mg twice daily; =75 years: CrCl =30 mL/min: 20 mg once daily
Tab: 20 mg
Sanctura XR 60 mg daily in the morning
Cap: 60 mg ext-rel
Comment: Take trospium chloride on an empty stomach.
OVERFLOW INCONTINENCE/ATONIC BLADDER
bethanechol (C) 10-30 mg tid
Urecholine Tab: 5, 10, 25, 50 mg
OVERFLOW INCONTINENCE/PROSTATIC ENLARGEMENT
Alpha-1 Blockers
Comment: Educate the patient regarding the potential side eff ect of hypotension when
taking an alpha-1 blocker, especially with fi rst dose. Start at lowest dose and titrate
upward.
terazosin (C) initially 1 mg q HS; titrate to 10 mg q HS; max 20 mg/day
Hytrin Cap: 1, 2, 5, 10 mg
doxazosin (C) initially 1 mg q HS; may double dose every 1-2 weeks; max 8 mg/day
Cardura Tab: 1*, 2*, 4*, 8*mg
Cardura XL Tab: 4, 8 mg
prazosin (C)(G) 1-15 mg q HS; max 15 mg/day
Minipress Tab: 1, 2, 5 mg
tamsulosin (C) initially 0.4 mg daily; may increase to 0.8 mg daily aft er 2-4 weeks if
needed
Flomax Cap: 0.4 mg
5-ALPHA REDUCTASE INHIBITOR
fi nasteride (X)(G) 5 mg daily
Proscar Tab: 5 mg
ALPHA 1A-BLOCKER
silodosin (B) take 8 mg with food once daily; CrCl 30-50 mL/min: take 4 mg
Rapafl o Cap: 4, 8 mg
INFLUENZA (FLU)
Comment: With the exception of Flucelvax, fl u vaccine is contraindicated
with allergy to egg or chicken proteins, or egg products. All fl u vaccines are
contraindicated with allergy to latex, active infection, acute respiratory disease,
y y y y y y y y y y
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240 ¦ I n f l u e n z a ( F l u )
active neurological disorder; history of Guillain-Barre syndrome. Have epinephrine
1:1,000 on hand. Flu vaccine is contraindicated for children under 18 years of age
who are taking aspirin and/or an aspirin-containing product due to the risk of
developing Reye’s syndrome. Under 1 year of age, administer fl u vaccine in the
vastus lateralis. Over 1 year of age, administer fl u vaccine in the deltoid. Flu vaccine
formulations change annually. Administer fl u vaccine 1 month before fl u season.
Spray may be administered earlier. Th e infl uenza vaccine reduces hospitalization by
about 70% and mortality by about 80% in the elderly.
PROPHYLAXIS (NASAL SPRAY)
trivalent, live attenuated infl uenza vaccine, types A and B (C) 1 spray each nostril;
=50 years not recommended
Pediatric: =5 years: not recommended; =5 years: same as adult
Never vaccinated with FluMist: 5-8 years: 2 divided doses 46-74 days apart.
Previously vaccinated with FluMist: 5-8 years: same as adult
FluMist Nasal Spray 0.5 ml spray annually
Nasal spray: 0.5 ml (0.25 ml/spray) (10/carton) (preservative-free)
PROPHYLAXIS (INJECTABLE)
quadrivalent inactivated infl uenza subvirion vaccine, types A and B (C)
Fluad 0.5 ml IM annually
Comment: Fluad is the fi rst seasonal infl uenza vaccine with adjuvant, indicated
for persona =65 years-of-age. Adjuvants are incorporated into some vaccine
formulations to enhance or direct the immune response.
Fluarix Quadrivalent 0.5 ml IM annually
Pediatric: <3 years: not recommended; =3 years: same as adult
Prefi lled syringes: 0.5 ml (10/carton; preservative-free, latex-free)
trivalent inactivated infl uenza subvirion vaccine, types A and B
Fluarix (B) 0.5 ml IM annually
Pediatric: <3 years: not recommended; 3-9 years (previously unvaccinated or
vaccinated for the fi rst time last season with one dose of fl u vaccine): 2 doses
per season at least 1 month apart; 3-9 years (previously vaccinated with two
doses of fl u vaccine); and >9 years: 1 dose per season
Prefi lled syringe: 0.5 ml single-dose (5/carton) (may contain trace amounts of
hydrocortisone, gentamicin; preservative-free)
Flublok 0.5 ml IM annually; =49 years, not recommended
Pediatric: <18 years: not recommended
Vial: 0.5 ml single-dose (10/carton) (preservative-free, egg protein-free, antibiotic-
free, latex-free)
Comment: Flublok is a cell culture-derived vaccine and, therefore, is an alternative
to the traditional egg-based vaccines. Contains 3 times the amount of active
ingredient in traditional fl u vaccines Flucelvax 0.5 ml IM annually
Pediatric: <18 years: not recommended
Prefi lled syringes: 0.5 ml (10/carton; preservative-free, latex-free)
Comment: Flucelvax is a cell culture-derived vaccine and, therefore, is an alternative
to the traditional egg-based vaccines.
FluLaval (C) 0.5 ml IM annually
Pediatric: <6 months: not recommended; =6 years: same as adult
Vial: (5 ml) y
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I n s e c t B i t e / S t i n g ¦ 241
FluShield 0.5 ml IM annually
Pediatric: <6 months: not recommended; Never vaccinated: <9 years: 2 doses
at least 4 weeks apart; 9-12 years: same as adult; Previously vaccinated: 6-35
months: 0.25 ml IM x 1 dose; 3-8 years: same as adult
Fluzone 0.5 ml IM annually
Vial: 5 ml (thimerosal)
Fluzone Preservative-Free: Adult Dose 0.5 ml IM annually
Pediatric: <6 months: not recommended; Not previously vaccinated:
6 months-8 years: 0.25 ml IM; repeat in 1 month; Previously vaccinated:
6-35 months: 0.25 ml IM x 1 dose; >3 years: same as adult
Prefi lled syringe: 0.5 ml (10/carton) (preservative-free, trace thimerosal)
Fluzone Preservative-Free: Pediatric Dose
Pediatric: <6 months: not recommended; Not previously vaccinated: 6
months-8 years: 0.25 ml IM; repeat in 1 month; Previously vaccinated: 6-35
months: 0.25 ml IM x 1 dose; =3 years: 0.5 ml IM (use Fluzone for Adult)
Prefi lled syringe: 0.5 ml (10/carton; preservative-free; trace thimerosal)
PROPHYLAXIS AND TREATMENT
Neuraminidase Inhibitors
Comment: Eff ective for infl uenza type A and B. Indicated for treatment of
uncomplicated acute illness in patients who have been symptomatic for no more than
2 days; therefore, start within 2 days of symptom onset or exposure. Indicated for
infl uenza prophylaxis in patients =3 months of age.
oseltamivir phosphate (C)(G)
Treatment: 75 mg bid x 5 days; initiate treatment only if symptomatic <2 days
Pediatric: <1 year: not recommended; 1-12 years: <15 kg: 30 mg bid x 5 days;
16-23 kg: 45 mg bid x 5 days; 24-40 kg: 60 mg bid x 5 days; >40 kg: same as adult
Prophylaxis: 75 mg daily for at least 7 days and up to 6 weeks for community
outbreak
Pediatric: <1 year: not recommended; 1-12 years: <15 kg: 30 mg once daily x
10 days; 16-23 kg: 45 mg once daily x 10 days; 24-40 kg: 60 mg once daily x 10
days; >40 kg: same as adult
Tamifl u Cap: 30, 45, 75 mg; Oral susp: 6 mg/ml pwdr for reconstitution (60 ml w.
oral dispenser) (tutti-frutti)
Comment: Tamifl u is eff ective for infl uenza type A and B.
zanamivir (C) 2 inhalations (10 mg) bid x 5 days
Pediatric: <7 years: not recommended; =7 years: same as adult
Relenza Inhaler Inhaler: 5 mg/inh blister; 4 blisters/Rotadisk (5 Rotadisks/carton
w. 1 inhaler)
Comment: Relenza Inhaler is eff ective for infl uenza type A and B. Use caution
with asthma and COPD.
Antipyretics see Fever page 143
INSECT BITE/STING
TOPICAL ANESTHETIC
lidocaine 3% cream (B) apply bid-tid prn
Pediatric: reduce dosage commensurate with age, body weight, and physical condition
y y
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242 ¦ I n s e c t B i t e / S t i n g
LidaMantle Crm: 3% (1 oz)
Oral Drugs for Allergy, Cough, and Cold see page 535
Topical Corticosteroids see page 506
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
OTHER AGENTS
epinephrine (C)(G) 1:1,000 0.3-0.5 ml SC
Pediatric: 0.01 ml/kg SC
TETANUS PROPHYLAXIS
tetanus toxoid vaccine (C)(G) 0.5 ml IM x 1 dose if previously immunized
Vial: 5 Lf units/0.5 ml (0.5, 5 ml); Prefi lled syringe: 5 Lf units/0.5 ml (0.5 ml) (For
patients not previously immunized see Tetanus page 408)
INSOMNIA
MELATONIN RECEPTOR AGONIST
ramelteon (C)(IV) 8 mg within 30 minutes of bedtime; delayed eff ect if taken with
a meal
Pediatric: not recommended
Rozerem Tab: 8 mg
NONBENZODIAZEPINES
eszopiclone (C)(IV)(G) (pyrrolopyrazine) 1-3 mg; max 3 mg/day x 1 month; do not
take if unable to sleep for at least 8 hours before required to be active again; delayed
eff ect if taken with a meal
Pediatric: <18 years: not recommended
Lunesta Tab: 1, 2, 3 mg
zaleplon (C)(IV) (imidazopyridine) 5-10 mg at HS or aft er going to bed if unable to
sleep; do not take if unable to sleep for at least 4 hours before required to be active
again; max 20 mg/day x 1 month; delayed eff ect if taken with a meal
Pediatric: not recommended
Sonata Cap: 5, 10 mg (tartrazine)
Comment: Sonata is indicated for the treatment of insomnia when a middle-ofthe-
night awakening is followed by diffi culty returning to sleep.
zolpidem oral solution spray (C)(IV) (imidazopyridine hypnotic) 2 actuations (10
mg) immediately before bedtime; Elderly, debilitated, or hepatic impairment: 2 actuations
(5 mg); max 2 actuations (10 mg)
Pediatric: not recommended
ZolpiMist Oral soln spray: 5 mg/actuation (60 metered actuations) (cherry)
Comment: Th e lowest dose of zolpidem in all forms is recommended for women as
drug elimination is slower than in men.
zolpidem tabs (B)(IV)(G) (pyrazolopyrimidine hypnotic) 5-10 mg or 6.25-12.5 extrel
q HS prn; max 12.5 mg/day x 1 month; do not take if unable to sleep for at least
8 hours before required to be active again; delayed eff ect if taken with a meal
Pediatric: =18 years: not recommended
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I n s o m n i a ¦ 243
Ambien Tab: 5, 10 mg
Ambien CR Tab: 6.25, 12.5 mg ext-rel
Comment: Th e lowest dose of zolpidem in all forms is recommended for women as
drug elimination is slower than in men.
zolpidem sublingual tabs (C)(IV)(G) (imidazopyridine hypnotic) dissolve 1 tab under
the tongue; allow to disintegrate completely before swallowing; take only once
per night and only if at least 4 hours of bedtime remain before planned time for
awakening
Edluar SL Tab: 5, 10 mg
Intermezzo SL Tab: 1.75, 3.5 mg
Comment: Intermezzo is indicated for the treatment of insomnia when a middle-
of-the-night awakening is followed by diffi culty returning to sleep. Th e lowest
dose of zolpidem in all forms is recommended for women as drug elimination is
slower than in men.
OREXIN RECEPTOR ANTAGONIST
suvorexant (C)(IV) use lowest eff ective dose; take 30 minutes before bedtime; do not
take if unable to sleep for =7 hours, max 20 mg
Pediatric: not recommended
Belsomra Tab: 5, 10, 15, 20 mg (30/blister pck)
BENZODIAZEPINES
estazolam (X)(IV)(G) initially 1 mg q HS prn; may increase to 2 mg q HS
Pediatric: =18 years: not recommended
ProSom Tab: 1*, 2*mg
fl urazepam (X)(IV)(G) 30 mg q HS prn; elderly or debilitated, 15 mg
Pediatric: <15 years: not recommended; =15 years: same as adult
Dalmane Cap: 15, 30 mg
temazepam (X)(IV)(G) 7.5-30 mg q HS prn; short term, 7-10 days; max 30 mg; max
1 month
Pediatric: <18 years: not recommended
Restoril Cap: 7.5, 15, 22.5, 30 mg
triazolam (X)(IV) 0.125-0.25 mg q HS prn; short term, 7-10 days; max 0.5 mg; max
1 month
Pediatric: <18 years: not recommended
Halcion Tab: 0.125, 0.25*mg
Barbiturates
pentobarbital (D)(II)(G)
Nembutal 100 mg q HS prn
Cap: 50, 100 mg
Nembutal Suppository 120 or 200 mg suppository rectally q HS prn
Pediatric: 2-12 months (10-20 lb): 30 mg supp; 1-4 years (21-40 lb): 30 or 60 mg
supp; 5-12 years (41-80 lb): 60 mg supp; 12-14 years (81-110 lb): 60 or 120 mg sup
Rectal supp: 30, 60, 120, 200 mg
ORAL H1 RECEPTOR AGONIST (1ST GENERATION ANTIHISTAMINE)
doxepin (C)
Silenor 3-6 mg q HS prn; Elderly, hepatic impairment, tendency to urinary
retention: initially 3 mg
y y y y y y y y
244 ¦ I n s o m n i a
Tab: 3, 6 mg
Other Oral 1st Generation Antihistamines see page 535
ANALGESIC/1ST GENERATION ANTIHISTAMINE COMBINATIONS
acetaminophen/diphenhydramine (B)
Excedrin PM (OTC) 2 tabs q HS prn
Pediatric: <12 years: not recommended; =12 years: same as adult
Tab/Geltab: acet 500 mg/diphen 38 mg
Tylenol PM (OTC) 2 caps q HS prn
Pediatric: <12 years: not recommended; =12 years: same as adult
Tab/Cap/Gel cap: acet 500 mg/diphen 25 mg
Tricyclic Antidepressants see Depression page 108
INTERSTITIAL CYSTITIS
Comment: Avoid peppers and spicy food, citrus, vinegar, caff eine (e.g., coff ee, tea,
colas), alcohol, carbonated beverages, and other GU tract irritants.
MANAGEMENT OF PAIN AND URINARY URGENCY
Acetaminophen for IV Infusion see Pain page 306
Oral Prescription NSAIDs see page 501
phenazopyridine (B)(G) 95-200 mg q 6 hours prn; max 2 days
Pediatric: not recommended
AZO Standard, Prodium, Uristat (OTC) Tab: 95 mg
AZO Standard Maximum Strength (OTC) Tab: 97.5 mg
Pyridium, Urogesic Tab: 100, 200 mg phenazopyridine (B)(G) 190-200 mg tid;
max 2 days
Pediatric: not recommended
Azo Standard (OTC) Tab: 95 mg
Azo Standard Maximum Strength (OTC) Tab: 97.5 mg
Pyridium Tab: 100, 200 mg ent-coat
Uristat (OTC) Tab: 95 mg
Urogesic Tab: 100, 200 mg
hyoscyamine (C)(G)
Anaspaz 1-2 tabs q 4 hours prn; max 12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: 0.0625-0.125 mg q 4 hours
prn; max 0.75 mg/day; =12 years: same as adult
Tab: 0.125*mg
Levbid 1-2 tabs q 12 hours prn; max 4 tabs/day
Pediatric: <12 years: not recommended; =12 years: same as adult
Tab: 0.375*mg ext-rel
Levsin 1-2 tabs q 4 hours prn; max 12 tabs/day
Pediatric: <6 years: not recommended; 6-12 years: 1 tab q 4 hours prn; =12
years: same as adult
Tab: 0.125*mg
Levsin Drops 1-2 ml q 4 hours prn; max 60 ml/day
Pediatric: 3.4 kg: 4 drops q 4 hours prn; max 24 drops/day; 5 kg: 5 drops q 4
hours prn; max 30 drops/day; 7 kg: 6 drops q 4 hours prn; max 36 drops/day;
10 kg: 8 drops q 4 hours prn; max 40 drops/day y
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I n t e r s t i t i a l C y s t i t i s ¦ 245
Oral drops: 0.125 mg/ml (15 ml) (orange) (alcohol 5%)
Levsin Elixir 5-10 ml q 4 hours prn
Pediatric: <10 kg: use drops; 10-19 kg: 1.25 ml q 4 hours prn; 20-39 kg: 2.5 ml
q 4 hours prn; 40-49 kg: 3.75 ml q 4 hours prn; =50 kg: 5 ml q 4 hours prn; Elix:
0.125 mg/5 ml (16 oz) (orange) (alcohol 20%)
Levsinex SL 1-2 tabs q 4 hours SL or PO; max 12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: 1 tab q 4 hours; max 6 tabs/
day; =12 years: same as adult
SL tab: 0.125 mg
Levsinex Timecaps 1-2 caps q 12 hours; may adjust to 1 cap q 8 hours
Pediatric: <2 years: not recommended; 2-12 years: 1 cap q 12 hours; max 2
caps/day; =12 years: same as adult
Cap: 0.375 mg time-rel
NuLev dissolve 1-2 tabs on tongue, with or without water, q 4 hours prn; max
12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: dissolve 1 tab on tongue,
with or without water, q 4 hours prn; max 6 tabs/day; =12 years: same as
adult
ODT: 0.125 mg (mint; phenylalanine)
methenamine/na phosphate monobasic/phenyl salicylate/methylene blue/hyoscyamine
sulfate (C) 1 cap qid
Pediatric: <6 years: not recommended; =6 years: individualize dose
Uribel Cap: meth 118 mg/na phos 40.8 mg/phenyl sal 36 mg/meth blue 10 mg/
hyoscy 0.12 mg
methenamine/phenyl salicylate/methylene blue/benzoic acid/atropine sulfate/hyoscyamine
sulfate (C)(G) 2 tabs qid
Pediatric: <6 years: not recommended; =6 years: same as adult
Urised Tab: meth 40.8 mg/phenyl sal 18.1 mg/meth blue 5.4 mg/benz acid 4.5
mg/atro sul 0.03 mg/hyoscy 0.03 mg
Comment: Urised imparts a blue-green color to urine which may stain fabrics.
oxybutynin chloride (B)
Ditropan 5 mg bid-tid; max 20 mg/day
Pediatric: <5 years: not recommended; 5-12 years: 5 mg bid; max 15 mg/day;
=12 years: same as adult
Tab: 5*mg; Syr: 5 mg/5 ml
Ditropan XL initially 5 mg daily; may increase weekly in 5-mg increments as
needed; max 30 mg/day
Tab: 5, 10, 15 mg ext-rel
pentosan (B) 100 mg tid; reevaluate at 3 and 6 months
Pediatric: <16 years: not recommended; =16 years: same as adult
Elmiron Cap: 100 mg
URINARY TRACT ANALGESIA
phenazopyridine (B)(G) 95-200 mg q 6 hours prn; max 2 days
Pediatric: not recommended
AZO Standard, Prodium, Uristat (OTC) Tab: 95 mg
AZO Standard Maximum Strength (OTC) Tab: 97.5 mg
Pyridium, Urogesic Tab: 100, 200 mg
Pediatric: not recommended
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246 ¦ I n t e r s t i t i a l C y s t i t i s
Azo Standard (OTC) Tab: 95 mg
Azo Standard Maximum Strength (OTC) Tab: 97.5 mg
Pyridium Tab: 100, 200 mg ent-coat
Uristat (OTC) Tab: 95 mg
Urogesic Tab: 100, 200 mg
Comment: Phenazopyridine imparts an orange-red color to urine which may stain
fabrics.
propantheline (C) 15-30 mg tid
Pro-Banthine Tab: 7.5, 15 mg
tolterodine tartrate (C)(G) 2 mg bid; may decrease to 1 mg bid
Detrol 2 mg bid; may decrease to 1 mg bid
Tab: 1, 2 mg
Detrol XL 2-4 mg daily
Cap: 2, 4 mg ext-rel
ANTICHOLINERGIC/SEDATIVE COMBINATION
chlordiazepoxide/clidinium (D)(IV) 1-2 caps ac and HS; max 8 caps/day
Pediatric: not recommended
Librax Cap: chlor 5 mg/clid 2.5 mg
TRICYCLIC ANTIDEPRESSANTS (TCAS)
amitriptyline (C)(G) 25-50 mg q HS
Pediatric: not recommended
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 dose
Tab: 10, 25, 50 mg
Tofranil PM initially 75 mg daily 1 hour before HS; max 200 mg
Cap: 75, 100, 125, 150
INTERTRIGO
Comment: Intertrigo is an irritation and rash secondary to adjacent skin surfaces
rubbing together. Treatment is dependent on symptoms and presence of infection.
Topical Corticosteroids see page 506
Topical Antifungals see Tinea Corporis page 410
Topical Anti-infectives see Skin Infection: Bacterial page 396
IRITIS: ACUTE
loteprednol etabonate (C) 1-2 drops qid; may increase to 1 drop hourly as needed
Pediatric: not recommended
Lotemax Ophthalmic Solution Ophth soln: 0.3% (2.5, 5, 10, 15 ml)
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I r r i t a b l e B o wel Syndrome W i t h C o n s t i p a t i o n ( I B S – C ) ¦ 247
prednisone acetate (C) 1 drop q 1 hour x 24-48 hours, then 1 drop q 2 hours while
awake x 24-48 hours, then 1 drop bid-qid until resolved
Pediatric: not recommended
Pred Forte Ophth soln: 1% (1, 5, 10, 15 ml)
IRON OVERLOAD
IRON CHELATING AGENTS
deferasirox (tridentate ligand) (C)(G) initially 20 mg/kg/day; titrate; may increase
5-10 mg/kg q 3-6 months based on serum ferritin trends; max 30 mg/kg/day
Pediatric: <2 years: not recommended; =2 years: same as adult
Exjade Tab for oral soln: 125, 250, 500 mg
Jadenu Tab: 90, 180, 360 mg fi lm-coat
Comment: deferasirox is an orally active chelator selective for iron. It is indicated
for the treatment of chronic iron overload due to blood transfusions (transfusional
hemosiderosis). Monitor serum ferritin monthly. Consider interrupting therapy
if serum ferritin falls below 500 mcg/L. Take deferasirox (Jadenu, Exjade) on an
empty stomach. Completely disperse tablet(s) for oral solution in 3.5 oz liquid if
dose is =1 g or 7 oz liquid if dose is =1 g.
Succimer (C) initially 10 mg/kg q 8 hours x 5 days; then, reduce frequency to every 12
hours x 14 more days; allow at least 14 days between courses unless blood lead levels
indicate need for prompt treatment
Pediatric: <12 months: not recommended; =12 monhs: same as adult
Chemet Cap: 100 mg
Comment: Chemet is indicated for the treatment of lead poisoning when blood
lead level 45 mcg/dL. Treatment for more than 3 consecutive weeks is not
recommended. Monitor hydration, renal, and hepatic function.
IRRITABLE BOWEL SYNDROME WITH
CONSTIPATION (IBS-C)
Bulk-Producing Agents, Laxatives, Stool Soft eners see Constipation page 95
GUANYLATE CYCLASE-C AGONIST
linaclotide (C) 290 mcg once daily; take on an empty stomach at least 30 minutes
before the fi rst meal of the day; swallow whole
Pediatric: <6 years: not recommended; 6-17 years: avoid
Linzess Cap: 145, 290 mcg
Comment: May open Linzess cap and sprinkle on applesauce or in water for
administration
lubiprostone (C) 8 mcg bid; take with food and water; Severe hepatic impairment
(Child-Pugh Class C): 8 mcg once daily
Pediatric: <18 years: not recommended
Amitiza Cap: 8, 24 mcg y
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248 ¦ I r r i t a b l e B o wel Syndrome W i t h D i a r r h e a ( I B S – D )
IRRITABLE BOWEL SYNDROME WITH
DIARRHEA (IBS-D)
Bulk-Producing Agents see Constipation page 95
CONSTIPATING AGENTS
difenoxin/atropine (C) 2 tabs, then 1 tab aft er each loose stool or 1 tab q 3-4 hours as
needed; max 8 tab/day x 2 days
Pediatric: <12 years: not recommended; =12 years: same as adult
Motofen Tab: difen 1 mg/atro 0.025 mg
diphenoxylate/atropine (C)(G) 2 tabs or 10 ml qid
Pediatric: <2 years: not recommended; 2-12 years: initially 0.3-0.4 mg/kg/day in 4
divided doses; =12 years: same as adult
Lomotil Tab: difen 2.5 mg/atro 0.025 mg; Liq: difen 2.5 mg/atro 0.025 mg per 5
ml (2 oz)
eluxadoline (NA)(IV) 100 mg bid; 75 mg bid if unable to tolerate 100 mg, or without
a gall bladder, or mild-to-moderate hepatic impairment, or receiving concomitant
OATP1B1 inhibitors
Pediatric: not established
Viberzi 4 mg initially, then 2 mg aft er each loose stool; max 16 mg/day
Tab: 75, 100 mg fi lm-coat
Comment: Eluxadoline is a mu-opioid receptor agonist. It is contraindicated with
biliary obstruction, Sphincter of Oddi disease or dysfunction, alcohol abuse or
addiction, pancreatitis, pancreatic duct obstruction, severe hepatic impairment, and
mechanical GI obstruction.
loperamide (B)(G)
Imodium (OTC) 4 mg initially, then 2 mg aft er each loose stool; max 16 mg/day
Pediatric: <5 years: not recommended; =5 years: same as adult
Cap: 2 mg
Imodium A-D (OTC) 4 mg initially, then 2 mg aft er each loose stool; usual max
8 mg/day x 2 days
Pediatric: <2 years: not recommended; 2-5 years (24-47 lb): 1 mg up to tid x 2
days; 6-8 years (48-59 lb): 2 mg initially, then 1 mg aft er each loose stool; max
4 mg/day x 2 days; 9-11 years (60-95 lb): 2 mg initially, then 1 mg aft er each
loose stool; max 6 mg/day x 2 days; =12 years: same as adult
Cplt: 2 mg; Liq: 1 mg/5 ml (2, 4 oz)
loperamide/simethicone (B)(G)
Imodium Advanced (OTC) 2 tabs chewed aft er loose stool, then 1 aft er the next
loose stool; max 4 tabs/day
Pediatric: <6 years: not recommended; 6-8 years: 1 tab chewed aft er loose stool,
then 1/2 aft er next loose stool; max 2 tabs/day; 9-11 years: 1 tab chewed aft er loose
stool, then 1/2 aft er next loose stool; max 3 tabs/day; =12 years: same as adult
Chew tab: lop 2 mg/sim 125 mg
5-HT3 RECEPTOR ANTAGONIST
alosetron (B)(G) initially 0.5 mg bid; may increase to 1 mg bid aft er 4 weeks if starting
dose is tolerated but inadequate
Pediatric: not recommended
Lotronex Tab: 0.5, 1 mg
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I r r i t a b l e B o wel Syndrome W i t h D i a r r h e a ( I B S – D ) ¦ 249
ANTISPASMODIC/ANTICHOLINERGIC COMBINATIONS
dicyclomine (B)(G) initially 20 mg bid-qid; may increase to 40 mg qid PO; usual IM
dose 80 mg/day divided qid; do not use IM route for more than 1-2 days
Pediatric: not recommended
Bentyl Tab: 20 mg; Cap: 10 mg; Syr: 10 mg/5 ml (16 oz); Vial: 10 mg/ml (10 ml);
Amp: 10 mg/ml (2 ml)
methscop olamine bromide (B) 1 tab q 6 hours prn
Pediatric: not recommended
Pamine Tab: 2.5 mg
Pamine Forte Tab: 5 mg
ANTICHOLINERGICS
hyoscyamine (C)(G)
Anaspaz 1-2 tabs q 4 hours prn; max 12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: 0.0625-0.125 mg q 4 hours
prn; max 0.75 mg/day; =12 years: same as adult
Tab: 0.125*mg
Levbid 1-2 tabs q 12 hours prn; max 4 tabs/day
Pediatric: <12 years: not recommended; =12 years: same as adult
Tab: 0.375*mg ext-rel
Levsin 1-2 tabs q 4 hours prn; max 12 tabs/day
Pediatric: <6 years: not recommended; 6-12 years: 1 tab q 4 hours prn; >12
years: same as adult
Tab: 0.125*mg
Levsinex SL 1-2 tabs q 4 hours SL or PO; max 12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: 1 tab q 4 hours; max 6 tabs/
day; >12 years: same as adult
Tab: 0.125 mg sublingual
Levsinex Timecaps 1-2 caps q 12 hours; may adjust to 1 cap q 8 hours
Pediatric: <2 years: not recommended; 2-12 years: 1 cap q 12 hours; max 2
caps/day; >12 years: same as adult
Cap: 0.375 mg time-rel
NuLev dissolve 1-2 tabs on tongue, with or without water, q 4 hours prn; max
12 tabs/day
Pediatric: <2 years: not recommended; 2-12 years: dissolve 1 tab on tongue,
with or without water, q 4 hours prn; max 6 tabs/day; >12 years: same as adult
ODT: 0.125 mg (mint; phenylalanine)
simethicone (C)(G) 0.3 ml qid pc and HS
Mylicon Drops (OTC) Oral drops: 40 mg/0.6 ml (30 ml)
phenobarbital/hyoscyamine/atropine/scopolamine (C)(IV)(G)
Donnatal 1-2 tabs ac and HS
Pediatric: not recommended
Tab: pheno 16.2 mg/hyo 0.1037 mg/atro 0.0194 mg/scop 0.0065 mg
Donnatal Elixir 1-2 tsp ac and HS
Pediatric: 20 lb: 1 ml q 4 hours or 1.5 ml q 6 hours; 30 lb: 1.5 ml q 4 hours or
2 ml q 6 hours; 50 lb: 1/2 tsp q 4 hours or 3/4 tsp q 6 hours; 75 lb: 3/4 tsp q 4
hours or 1 tsp q 6 hours; 100 lb: 1 tsp q 4 hours or 1 tsp q 6 hours
Elix: pheno 16.2 mg/hyo 0.1037 mg/atro 0.0194 mg/scop 0.0065 mg per 5 ml
(4, 16 oz)
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250 ¦ I r r i t a b l e B o wel Syndrome W i t h D i a r r h e a ( I B S – D )
Donnatal Extentabs 1 tab q 12 hours
Pediatric: not recommended
Tab: pheno 48.6 mg/hyo 0.3111 mg/atro 0.0582 mg/scop 0.0195 mg ext-rel
ANTICHOLINERGIC/SEDATIVE COMBINATION
chlordiazepoxide/clidinium (D)(IV) 1-2 caps ac and HS: max 8 caps/day
Pediatric: not recommended
Librax Cap: chlor 5 mg/clid 2.5 mg
TRICYCLIC ANTIDEPRESSANTS (TCAs)
amitriptyline (C)(G) 25-50 mg q HS
Pediatric: not recommended
Tab: 10, 25, 50, 75, 100, 150 mg
imipramine (C)(G) 25-50 mg tid
Pediatric: not recommended
Tofranil initially 75 mg daily (max 200 mg); adolescents initially 30-40 mg daily
(max 100 mg/day); if maintenance dose exceeds 75 mg daily, may switch to
Tofranil PM for divided or bedtime dose
Tab: 10, 25, 50 mg
Tofranil PM initially 75 mg daily 1 hour before HS; max 200 mg
Cap: 75, 100, 125, 150
Tofranil Injection 50 mg IM; lower dose for adolescents; switch to oral form as
soon as possible
Amp: 25 mg/2 ml (2 ml)
JUVENILE RHEUMATOID ARTHRITIS (JRA)
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.
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Kera t i t i s / K e r a t o c o n j u n c t i v i t i s : V e r n a l ¦ 251
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 total 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.
methotrexate (X) 7.5 mg x 1 dose per week or 2.5 mg x 3 at 12-hour intervals once a
week; max 20 mg/week; therapeutic response begins in 3-6 weeks; administer methotrexate
injection SC only into the abdomen or thigh
Pediatric: <2 years: not recommended; =2 years: 10 mg/m2 once weekly; max 20 mg/m2
Rasuvo Autoinjector: 7.5 mg/0.15 ml, 10 mg/0.20 ml, 12.5 mg/0.25 ml, 15 mg/0.30
ml, 17.5 mg/0.35 ml, 20 mg/0.40 ml, 22.5 mg/0.45 ml, 25 mg/0.50 ml, 27.5 mg/0.55
ml, 30 mg/0.60 ml (solution concentration for SC injection is 50 mg/ml)
Rheumatrex Tab: 2.5*mg (5, 7.5, 10, 12.5, 15 mg/week, 4/card unit-of-use dose
pack)
Trexall Tab: 5*, 7.5*, 10*, 15*mg (5, 7.5, 10, 12.5, 15 mg/week, 4/card unit-ofuse
dose pack)
Comment: methotrexate (MTX) is contraindicated with immunodefi ciency, blood
dyscrasias, alcoholism, and chronic liver disease.
KERATITIS/KERATOCONJUNCTIVITIS:
HERPES SIMPLEX
ganciclovir (C) instill 1 drop 5 times per day (every 3 hours) while awake until corneal
ulcer heals; then 1 drop tid x 7 days
Pediatric: <2 years: not recommended; =2 years: same as adult
Zirgan Ophth gel: 0.15% (5 gm)(benzalkonium chloride)
idoxuridine (C) instill 1 drop q 1 hour during day and every other hour at night or 1
drop every minute for 5 minutes and repeat q 4 hours during day and night
Herplex Ophth soln: 0.1% (15 ml)
trifl uridine (C) instill 1 drop q 2 hours while awake (max 9 drops/day until reepithelialization;
then 1 drop q 4 hours x 7 more days (at least 5 drops/day); max 21 days
Pediatric: <6 years: not recommended; =6 years: same as adult
Viroptic Ophth soln: 1% (7.5 ml) (thimerosal)
vidarabine (C) apply 1/2 inch in lower conjunctival sac 5 times/day q 3 hours until
reepithelialization occurs, then bid x 7 more days
Pediatric: <2 years: not recommended; =2 years: same as adult
Vira-A Ophth oint: 3% (3.5 g)
KERATITIS/KERATOCONJUNCTIVITIS: VERNAL
OPHTHALMIC MAST CELL STABILIZERS
Comment: Contact lens wear is contraindicated
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252 ¦ K e r a t i t i s / K e r a t o c o n j u n c t i v i t i s : Ve r n a l
cromolyn sodium (B) 1-2 drops 4-6 times/day
Pediatric: <4 years: not recommended; =4 years: same as adult
Crolom, Opticrom Ophth soln: 4% (10 ml) (benzalkonium chloride)
lodoxamide tromethamine (B) 1-2 drops qid; max 3 months
Pediatric: <2 years: not recommended; =2 years: same as adult
Alomide Ophth susp: 0.1% (10 ml)
LABYRINTHITIS
meclizine (B) 25 mg tid
Pediatric: not recommended
Antivert Tab: 12.5, 25, 50*mg
Bonine (OTC) Cap: 15, 25, 30 mg; Tab: 12.5, 25, 50 mg; Chew tab/Film-coated
tab: 25 mg
Dramamine II (OTC) Tab: 25*mg
Zentrip Strip: 25 mg orally disintegrating
promethazine (C)(G) 25 mg tid
Pediatric: <2 years: not recommended; =2 years: 0.5 mg/lb or 6.25-25 mg tid
Phenergan Tab: 12.5*, 25*, 50 mg; Plain syr: 6.25 mg/5 ml; Fortis syr:
25 mg/5 ml; Rectal supp: 12.5, 25, 50 mg
scopolamine (C)
Transderm Scop 1 patch behind ear at least 4 hours before travel; each patch is
eff ective for 3 days
Transdermal patch: 1.5 mg (4/carton)
LACTOSE INTOLERANCE
lactase enzyme (NE) 9,000 FCC units taken with dairy food; adjust based on abatement
of symptoms; usual max 18,000 units/dose
Pediatric: same as adult
Lactaid Drops (OTC) 5-7 drops to each quart of milk and shake gently; may
increase to 10-15 drops if needed; hydrolyzes 70%-99% of lactose at refrigerator
temperature in 24 hours
Oral drops: 1,250 units/5 gtts (7 ml w. dropper)
Lactaid Extra (OTC) Cplt: 4,500 FCC units
Lactaid Fast ACT (OTC) Cplt: 9,000 FCC units; Chew tab: 9,000 FCC units
(vanilla twist)
Lactaid Original (OTC) Cplt: 3,000 FCC units
Lactaid Ultra (OTC) Cplt: 9,000 FCC units; Chew tab: 9,000 FCC units (vanilla twist)
LARVA MIGRANS: CUTANEOUS/VISCERAL
thiabendazole (C) Adult and pediatric dosing schedules are the same; dosing is bid,
is based on weight in pounds, and must be taken with meals.
Cutaneous Larva Migrans: treat bid x 2 days
Visceral Larva Migrans: treat bid x 7 days
<30 lbs: consult mfr pkg insert; 30 lbs: 250 mg bid; 50 lbs: 500 mg bid; 75
lbs: 750 mg bid; 100 lbs: 1000 mg bid; 125 lbs: 1250 mg bid: =150 lbs: 1500
mg bid; max 3000 mg/day.
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L e i s h m a n i a s i s : C u t a n e o u s , M u c o s a l , V i s c e r a l ¦ 253
Mintezol Chew tab: 500*mg (orange); Oral susp: 500 mg/5 ml (120 ml) (orange)
Comment: thiabendazole is not for prophylaxis. May impair mental alertness.
LEAD POISONING
Comment: Chelation therapy for lead poisoning requires maintenance of adequate
hydration, close monitoring of renal and hepatic function, and monitoring for
neutropenia; discontinue therapy at fi rst sign of toxicity. Contraindicated with severe
renal disease or anuria.
CHELATING AGENTS
deferoxamine mesylate (C) initially 1 g IM, followed by 500 mg IM every 4 hours x 2
doses; then repeat every 4-12 hours if needed; max 6 g/day
Pediatric: <3 months: not recommended; =3 months: same as adult
Desferal Vial: 250 mg/ml aft er reconstitution (500 mg)
edetate calcium disodium (EDTA) (B) administer IM or IV; use IM route of administration
for children and overt lead encephalopathy
Pediatric: same as adult; Serum lead level: 20-70 mcg/dL: 1 g/m2 per day; IV: infuse
over 8-12 hours; IM: divided doses q 8-12 hours; Treat for 5 days; then stop for 2-4
days; may repeat if serum lead level is >70 mcg/dL
Calcium Disodium Versenate Amp: 200 mg/ml (5 ml)
succimer (C) may swallow caps whole or put contents onto a small amount of soft
food or a spoon and swallow, followed by a fruit drink
Pediatric: <12 months: not recommended; =12 months: same as adult; Serum lead
level: >45 mcg/dL: initially 10 mg/kg (or 350 mg/m2) every 8 hours for 5 days; then
reduce frequency to every 12 hours for 14 more days; allow at least 14 days between
courses unless serum lead levels indicate a need for more prompt treatment; for more
than 3 consecutive weeks not recommended
Chemet Cap: 100 mg
LEG CRAMPS: NOCTURNAL, RECUMBENCY
quinine sulfate (C)(G) 1 tab or cap q HS
Pediatric: <16 years: not recommended; =16 years: same as adult
Qualaquin Tab: 260 mg; Cap: 260, 300, 325 mg
Comment: If hypokalemia is the cause of leg cramps, treat with potassium supplementation
(see page 229).
LEISHMANIASIS: CUTANEOUS, MUCOSAL, VISCERAL
Comment: Th e leishmanial parasite species addressed in this section are: cutaneous
leishmaniasis (due to Leishmania braziliensis, Leishmania guyanensis, Leishmania
panamensis), mucosal leishmaniasis (due to Leishmania braziliensis), and visceral
leishmaniasis (due to Leishmania donovani). Th e weight-based treatment for
adults and adolescents is the same for each of the species, the anti-leishmanial drug
miltefosone (Impavido). Contraindications to this drug include pregnancy, lactation,
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254 ¦ L e i s h m a n i a s i s : C u t a n e o u s , M u c o s a l , V i s c e r a l
and Sjogren-Larsson-Syndrome. Th e contraindication in pregnancy is due to embryofetal
toxicity, teratogenicity, and fetal death. Obtain a serum or urine pregnancy test
for females of reproductive potential and advise females to use eff ective contraception
during therapy and for 5 months following treatment. Breastfeeding is contraindicated
while taking this drug and for 5 months following termination of breastfeeding. Potential
ASEs include loss of appetite, abdominal pain, nausea, vomiting, diarrhea, headache,
dizziness, pruritis, somnolence, elevated liver transaminases, bilirubin, and serum
creatinine and thrombocytopenia. Miltefosine is associated with impaired fertility in
females and males in animal studies. To report a suspected adverse reaction to this drug,
call 888-550-6060 or the FDA at 800-FDA-1088 or visit www.fda.gov/medwatch
miltefosine (D)(G) 30-44 kg: one cap bid x 28 consecutive days; =45 kg: one cap tid x
28 consecutive days; take with a full meal
Pediatric: <12 years, <30 kg (60 lbs): not established
Impavido Cap: 50 mg
LENTIGINES: BENIGN, SENILE
Comment: Wash aff ected area with a soap-free cleanser; pat dry and wait 20-30
minutes; then apply agent sparingly to aff ected area; use only once daily in PM. Avoid
eyes, ears, nostrils, mouth, and healthy skin. Avoid sun exposure. Cautious use of
concomitant astringents, alcohol-based products, sulfur-containing products, salicylic
acid-containing products, soap, and other topical agents.
TOPICAL RETINOIDS
tazarotene (X) apply daily at HS
Pediatric: not recommended
Avage Cream Crm: 0.1% (30 g)
Tazorac Cream Crm: 0.05, 0.1% (15, 30, 60 g)
Tazorac Gel Gel: 0.05, 0.1% (30, 100 g)
tretinoin (C)(G) apply daily at HS
Pediatric: <12 years: not recommended; =12 years: same as adult
Avita Crm: 0.025% (20, 45 g); Gel: 0.025% (20, 45 g)
Renova Crm: 0.02% (40 g); 0.05% (40, 60 g)
Retin-A Cream Crm: 0.025, 0.05, 0.1% (20, 45 g)
Retin-A Gel Gel: 0.01, 0.025% (15, 45 g) (alcohol 90%)
Retin-A Liquid Liq: 0.05% (28 ml; alcohol 55%)
Retin-A Micro Microspheres: 0.04, 0.1% (20, 45 g)
Retin-A Micro Gel Gel: 0.04, 0.1% (20, 45 g)
LISTERIOSIS
erythromycin base (B)(G) 500 mg qid x 10 days
Pediatric: <45 kg: 30-40 mg/kg/day in 4 divided doses x 10 days; =45 kg: same as adult
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
y
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Ly m e D i s e a s e ( E r y t h e m a C h r o n i c u m M i g r a n s ) ¦ 255
erythromycin ethylsuccinate (B)(G) 400 mg PO qid x 10 days
Pediatric: 30-50 mg/kg/day in 4 divided doses x 10 days; may double dose with severe
infection; max 100 mg/kg/day; see page 574 for dose by weight
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100,
200 ml; banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab: 200 mg
wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (7.5 ml) (thimerosal)
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.
LOW BACK STRAIN
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
LOW LIBIDO, HYPOACTIVE SEXUAL DESIRE
DISORDER (HSDD)
5-HT1A AGONIST/5-HT2A
fl ibanserin (NE) 1 tab once daily at bedtime; discontinue if no improvement in 8
weeks
Pediatric: <18 years: not recommended
Tab: 100 mg
Comment: Addyi is for use in premenopausal women. Addyi is not for use
in men, postmenopausal women, and is not recommended in pregnancy, or
lactation. Potential ASEs include dry mouth, nausea, hypotension, dizziness,
syncope, fatigue, somnolence, and insomnia.
LYME DISEASE (ERYTHEMA CHRONICUM MIGRANS)
Comment: Th e bite of the deer tick (Ioxodes scapularis) carries the Borrelia burgdorferi
organism causing Lyme disease. Proper removal of the tick, and early diagnosis and
treatment are essential to eff ective management of this disease.
STAGE 1
amoxicillin (B)(G) 500-875 mg bid or 250-500 mg tid x 10 days
Pediatric: <40 kg (88 lb): 20-40 mg/kg/day in 3 divided doses x 10 days or 25-45 mg/kg/
day in 2 divided doses x 10 days; =40 kg: same as adult; see page 554 for dose by weight
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256 ¦ Ly m e D i s e a s e ( E r y t h e m a C h r o n i c u m M i g r a n s )
Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg (cherry-
banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml (80, 100,
150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble gum); Oral
drops: 50 mg/ml (30 ml) (bubble gum)
Moxatag Tab: 775 mg ext-rel
Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80,
100, 150 ml) (raspberry-strawberry)
cefuroxime axetil (B)(G) 500 mg bid x 20 days
Pediatric: <3 months: not recommended; =3 months: 15 mg/kg bid x 20 days
Ceft in Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 100 ml) (tutti-frutti)
clarithromycin (C)(G) 500 mg bid or 500 mg ext-rel daily x 14-21 days
Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg bid x 7 days; see
page 569 for dose by weight
Biaxin Tab: 250, 500 mg
Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml)
Biaxin XL Tab: 500 mg ext-rel
doxycycline (D)(G) 100 mg bid x 14-21 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.
minocycline (D)(G) 200 mg on fi rst day; then 100 mg q 12 hours x 9 more days
Pediatric: =8 years: not recommended; =8 years, <100 lb: 2 mg/lb on fi rst day in 2
divided doses, followed by 1 mg/lb q 12 hours x 9 more days; =8 years, >100 lb: same
as adult
Dynacin Cap: 50, 100 mg
Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (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) 250-500 mg qid ac x 21 days
Pediatric: <8 years: not recommended; =8 years, =100 lb: 25-50 mg/kg/day in 2-4 divided
doses x 7 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)
y y y y y
Lymphogranuloma Venereum ¦ 257
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.
LYMPHADENITIS
Comment: Th erapy should continue for no less than 5 days aft er resolution of
symptoms.
amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200,
400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana), 250
mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml) (orange)
(phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided
bid x 10 days see pages 556-557 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml)
(strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day
in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
cephalexin (B)(G) 500 mg bid x 10 days
Pediatric: 25-50 mg/kg/day in 4 divided doses x 10 days; see page 568 for dose by
weight
Kefl ex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml)
(strawberry)
dicloxacillin (B) 500 mg qid x 10 days
Pediatric: 12.5-25 mg/kg/day in 4 divided doses x 10 days; see page 571 for dose by
weight
Dynapen Cap: 125, 250, 500 mg; Oral susp: 62.5 mg/5 ml (80, 100, 200 ml)
LYMPHOGRANULOMA VENEREUM
Comment: Th e following treatment regimens are published in the 2015 CDC Sexually
Transmitted Diseases Treatment Guidelines. Th is section contains treatment
regimens 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. Treat all sexual contacts. Persons with both
LGV and HIV infection should receive the same treatment regimens as those who are
HIV-negative; however, prolonged treatment may be required and delay in resolution
of symptoms may occur.
RECOMMENDED REGIMEN
Regimen 1
doxycycline 100 mg bid x 21 days
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258 ¦ Lymphogranuloma Venereum
ALTERNATIVE REGIMEN
Regimen 1
erythromycin base 500 mg qid x 21 days or erythromycin ethylsuccinate 400 mg qid
x 21 days
RECOMMENDED REGIMENS FOR THE MANAGEMENT OF SEXUAL CONTACTS
Comment: LGV is caused by C. trachomatis serovars L1, L2, or L3. Persons who have
had sexual contact with a patient who has LGV within 60 days before onset of the
patient’s symptoms should be examined, tested for urethral or cervical chlamydial
infection, and treated with a chlamydia regimen.
Regimen 1
azithromycin 1 g in a single dose
Regimen 2
doxycycline 100 mg bid x 7 days
DRUG BRANDS AND DOSE FORMS
azithromycin (B)
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml);
200 mg/5 ml (15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
doxycycline (D)(G)
Actilate Tab: 75, 150** mg
Adoxa Tab: 50, 75, 100, 150 mg ent-coat
Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
Monodox Cap: 50, 75, 100 mg
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)
y y y y y y y
M a l a r i a ¦ 259
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.
MALARIA (PLASMODIUM FALCIPARUM,
PLASMODIUM VIVAX)
doxycycline (D)(G) 100 mg daily; initiate 1-2 days prior to travel; take during travel;
continue for 4 weeks aft er leaving the endemic area
Pediatric: =8 years: not recommended; =8 years, =100 lb: 1 mg/lb/day prior to travel;
take during travel; continue for 4 weeks aft er leaving the endemic area; =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
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.
minocycline (D)(G) 100 mg daily; initiate 1-2 days prior to travel; take during travel;
continue for 4 weeks aft er leaving the endemic area
Pediatric: <8 years: not recommended; =8 years, =100 lb: 2 mg/lb on fi rst day in 2 divided
doses, followed by 1 mg/lb q 12 hours x 9 more days; =8 years, >100 lb: same as adult
Dynacin Cap: 50, 100 mg
Minocin Cap: 50, 75, 100 mg; Oral susp: 50 mg/5 ml (60 ml) (custard) (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 2 hours of taking another drug.
tetracycline (D) 250 mg daily; initiate 1-2 days prior to travel; take during travel;
continue for 4 weeks aft er leaving the endemic area
Pediatric: <8 years: not recommended; =8 years, =100 lb: 25-50 mg/kg/day in 4 divided
doses x 10 days; =8 years, >100 lb: same as adult; see page 585 for dose by weight
Achromycin V Cap: 250, 500 mg
Sumycin Tab: 250, 500 mg; Cap: 250, 500 mg; Oral susp: 125 mg/5 ml (100,
200 ml) (fruit) (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 2 hours of taking another drug.
ANTIMALARIALS
quinine sulfate (C)(G) 1 tab or cap every 8 hours x 7 days
Pediatric: <16 years: not recommended; =16 years: same as adult
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260 ¦ M a l a r i a
Tab: 260 mg; Cap: 260, 300, 325 mg
Qualaquin Cap: 324 mg
Comment: Qualaquin is indicated in the treatment of uncomplicated
P. falciparum malaria (including chloroquine-resistant strains).
atovaquone (C)(G) take as a single dose with food or a milky drink at the same time
each day; repeat dose if vomited within 1 hour; Prophylaxis: 1,500 mg once daily;
Treatment: 750 mg bid x 21 days
Mepron Susp: 750 mg/5 ml
atovaquone/proguanil (C)(G) take as a single dose with food or a milky drink at the
same time each day; repeat dose if vomited within 1 hour; Prophylaxis: 1 tab daily
starting 1-2 days before entering endemic area, during stay, and for 7 days aft er return;
Treatment (acute, uncomplicated): 4 tabs daily x 3 days
Pediatric: <5 kg: not recommended; 5-40 kg
Prophylaxis: daily dose starting 1-2 days before entering endemic area, during stay,
and for 7 days aft er return; 5-20 kg: 1 ped tab; 21-30 kg: 2 ped tabs; 31-40 kg: 3 ped
tabs; =40 kg: same as adult; Treatment (acute, uncomplicated): daily dose x 3 days;
5-8 kg: 2 ped tabs; 9-10 kg: 3 ped tabs; 11-20 kg: 1 adult tab; 21-30 kg: 2 adult tabs;
31-40 kg: 3 adult tabs; >40 kg: same as adult
Malarone Tab: atov 250 mg/prog 100 mg
Malarone Pediatric Tab: atov 62.5 mg/prog 25 mg
Comment: atovaquone is antagonized by tetracycline and metoclopramide.
Concomitant rifampin is not recommended (may elevate LFTs).
chloroquine (C)(G) Prophylaxis: 500 mg once weekly (on the same day of each
week); start 2 weeks prior to exposure, continue while in the endemic area, and
continue 4 weeks aft er departure; Treatment: initially 1 g; then 500 mg 6 hours, 24
hours, and 48 hours aft er initial dose or initially 200-250 mg IM; may repeat in 6
hours; max 1 g in fi rst 24 hours; continue to 1.875 g in 3 days
Pediatric: Suppression: 8.35 mg/kg (max 500 mg) weekly (on the same day of each
week); Treatment: initially 16.7 mg/kg (max 1 g); then 8.35 mg/kg (max 500 mg)
6 hours, 24 hours, and 48 hours aft er initial dose, or initially 6.25 mg/kg IM; may
repeat in 6 hours; max 12.5 mg/kg/day
Aralen Tab: 500 mg; Amp: 50 mg/ml (5 ml)
hydroxychloroquine (C)(G) Prophylaxis: 400 mg once weekly (on the same day of
each week); start 2 weeks prior to exposure, continue while in the endemic area, and
continue 8 weeks aft er departure; Treatment: initially 800 mg; then 400 mg 6 hours,
24 hours, and 48 hours aft er initial dose
Pediatric: Suppression: 6.45 mg/kg (max 400 mg) weekly (on the same day of each
week) beginning 2 weeks prior to arrival, continuing while in endemic area, and
continuing 4 weeks aft er departure; Treatment: initially 12.9 mg/kg (max 800 mg);
then 6.45 mg/kg (max 400 mg) 6 hours, 24 hours, and 48 hours aft er initial dose
hours aft er initial dose
Plaquenil Tab: 200 mg
mefl oquine (C) Prophylaxis: 250 mg once weekly (on the same day of each week);
start 1 week prior to exposure, continue while in the endemic area, and continue for
4 weeks aft er departure; Treatment: 1,250 mg as a single dose
Pediatric: <6 months: not recommended; Prophylaxis: =6 months: 3-5 mg/kg (max
250 mg) weekly (on the same day of each week); start 1 week prior to exposure,
continue while in the endemic area, and continue for 4 weeks aft er departure; Treatment:
=6 months: 25-50 mg/kg as a single dose; max 250 mg
Lariam Tab: 250*mg
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M a s t i t i s ( B r e a s t A b s c e s s ) ¦ 261
Comment: mefl oquine is contraindicated with active or recent history of depression,
generalized anxiety disorder, psychosis, schizophrenia or any other psychiatric
disorder or history of convulsions.
MASTITIS (BREAST ABSCESS)
ANTI-INFECTIVES
amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200,
400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana), 250
mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml) (orange)
(phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided
bid x 10 days see pages 556-557 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml)
(strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day
in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
cefaclor (B)(G) 250-500 mg q 8 hours x 10 days; max 2 g/day
Pediatric: <1 month: not recommended; 20-40 mg/kg bid or q 12 hours x 10 days;
max 1 g/day; see page 560 for dose by weight
Tab: 500 mg; Cap: 250, 500 mg; Susp: 125 mg/5 ml (75, 150 ml) (strawberry);
187 mg/5 ml (50, 100 ml) (strawberry); 250 mg/5 ml (75, 150 ml) (strawberry);
375 mg/5 ml (50, 100 ml) (strawberry)
Pediatric: <16 years: ext-rel not recommended; =12 years: same as adult
Cefaclor Extended Release Tab: 375, 500 mg ext-rel
ceft riaxone (B)(G) 1-2 grams IM daily continued 2 days aft er signs of infection have
disappeared; max 4 g/day
Pediatric: 50 mg/kg IM daily continued 2 days aft er signs of infection have disappeared
Rocephin Vial: 250, 500 mg; 1, 2 g
cephalexin (B)(G) 500 mg bid x 10 days
Pediatric: 25-50 mg/kg/day in 4 divided doses x 10 days; see page 568 for dose by weight
Kefl ex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml)
(strawberry)
clindamycin (B)(G) 300 mg tid x 10 days
Pediatric: not recommended
Cleocin Cap: 75 (tartrazine), 150 (tartrazine), 300 mg
Cleocin Pediatric Granules Oral susp: 75 mg/5 ml (100 ml) (cherry)
erythromycin base (B)(G) 250-500 mg qid x 10 days
Pediatric: <45 kg: 30-40 mg/kg/day in 4 divided doses x 10 days; =45 kg: same as
adult
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
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262 ¦ Melasma
MELASMA
SKIN DEPIGMENTING AGENTS
hydroquinone (C) apply a thin fi lm to clean dry aff ected areas bid; discontinue if
lightening does not occur aft er 2 months
Pediatric: not recommended
Lustra Crm: hydro 4% (1, 2 oz) (sulfi tes)
Lustra AF Crm: hydro 4% (1, 2 oz) (sunscreens, sulfi tes)
hydroquinone/fl uocinolone acetonide/tretinoin (C) apply a thin fi lm to clean dry affected
areas once daily at least 30 minutes before bedtime
Pediatric: not recommended
Tri-Luma Crm: hydro 4%/fl uo acet 0.01%/tret 0.05% (30 g) (sulfi tes, parabens)
MENIERE’S DISEASE
diazepam (D)(IV)(G) initially 1-2.5 mg tid-qid; may increase gradually
Pediatric: <6 months: not recommended; =6 months: same as adult
Diastat Rectal gel delivery system: 2.5 mg
Diastat AcuDial Rectal gel delivery system: 10, 20 mg
Valium Tab: 2*, 5*, 10*mg
Valium Intensol Oral Solution Conc oral soln: 5 mg/ml (30 ml w. dropper)
(alcohol 19%)
Valium Oral Solution Oral soln: 5 mg/5 ml (500 ml) (wintergreen-spice)
dimenhydrinate (B) 50 mg q 4-6 hours
Pediatric: <2 years: not recommended; 2-6 years: 12.5-25 mg q 6-8 hours; max 75
mg/day; >6-11 years: 25-50 mg q 6-8 hours; max 150 mg/day; >11 years: same as
adult
Dramamine (OTC) Tab: 50*mg; Chew tab: 50 mg (phenylalanine, tartrazine);
Liq: 12.5 mg/5 ml (4 oz)
diphenhydramine (B)(OTC)(G) 25-50 mg q 6-8 hours; max 100 mg/day
Pediatric: <2 years: not recommended; 2-6 years: 6.25 mg q 4-6 hours; max 37.5
mg/day; >6-12 years: 12.5-25 mg q 4-6 hours; max 150 mg/day; >12 years: same
as adult
Benadryl (OTC) Chew tab: 12.5 mg (grape; phenylalanine); Liq: 12.5 mg/5 ml
(4, 8 oz); Cap: 25 mg; Tab: 25 mg; dye-free soft gel: 25 mg; Dye-free liq: 12.5 mg/5
ml (4, 8 oz)
meclizine (B)(G) 25-100/day in divided doses
Pediatric: not recommended
Antivert Tab: 12.5, 25, 50*mg; Amp: 50 mg/ml (1 ml); Vial: 50 mg/ml (1 ml
single-use); 50 mg/ml (10 ml multi-dose)
Bonine (OTC) Cap: 15, 25, 30 mg; Tab: 12.5, 25, 50 mg; Chew tab/Film-coat tab:
25 mg
Dramamine II 25 mg bid; max 50 mg/day
Tab: 25*mg
Zentrip Strip: 25 mg orally disintegrating
promethazine (C) 12.5-25 q 4-6 hours PO or rectally
Pediatric: <2 years: not recommended; =2 years: 0.5 mg/lb or 6.25-25 mg q 4-6 hours
PO or rectally
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M e n i n g i t i s ¦ 263
Phenergan Tab: 12.5*, 25*, 50 mg; Plain syr: 6.25 mg/5 ml; Fortis syr:
25 mg/5 ml; Rectal supp: 12.5, 25, 50 mg
scopolamine transdermal patch (C) 1 patch behind ear; each patch is eff ective for 3
days; change patch every 4th day; alternate sites
Pediatric: not recommended
Transderm Scop Patch: 1.5 mg (4/carton)
MENINGITIS (NEISSERIA MENINGITIDIS)
PROPHYLAXIS
Comment: Meningitis vaccine is a 3-dose series (0, 2, 6 month schedule) indicated for
persons age =10-25 years. Have epinephrine 1:1,000 readily available and monitor for
15 minutes post-dose of meningitis vaccine.
Meningococcal group b vaccine [recombinant, absorbed] administer fi rst dose IM
in the deltoid; administer second dose 2 months later; administer the third dose 6
months from the fi rst dose;
Pediatric: <10 years: not established; =10 years: same as adult
Bexsero Susp for IM inj: 0.5 ml single-dose prefi lled syringes (1, 10/carton)
Trumenba Susp for IM inj: 0.5 ml single-dose prefilled syringes
(5, 10/ carton)
Neisseria meningitides oligosaccharide conjugate quadrivalent meningonococcal
vaccine (B) contains Corynebacterium diphtheria CRM197 protein; 10 mcg of Group
A + 5 mcg each of Group C, Y, and W-135 + 32.7-64.1 mcg of diphtheria CRM 197
protein per 0.5 m.
Pediatric: <11 years: not recommended; =11-55 years: 0.5 ml IM x 1 dose in the deltoid
Menveo Vial multi-dose: 5 doses/vial (MenA conjugate component pwdr for
reconstitution + 1 vial liquid MenCWY conjugate component for reconstitution)
(preservative-free)
Neisseria meningitidis polysaccharides vaccine (C) 0.5 ml SC x 1 dose; if at high risk,
may revaccinate aft er 3-5 years; age =55 years contact mfr
Menactra (A/C/Y/W-135)
Pediatric: <2 years: see mfr pkg insert; =2 years: same as adult; if at high risk,
may revaccinate children fi rst vaccinated =4 years-of-age aft er 2-3 years
Vial (single-dose): 4 mcg each of group A, C, Y, and W-135 per 0.5 ml (pwdr
for SC inj aft er reconstitution) (preservative-free diluent); Vial (multi-dose): 4
mcg each of group A, C, Y, and W-130 per 0.5 ml [pwdr for SC inj aft er reconstitution
(5 doses/vial) (preservative-free)] Comment: Latex allergy is a contraindication to Menactra.
Menomune-A/C/Y/W-135
Pediatric: <2 years: not recommended (except =3 months of age as short-term
protection against group A); =2 years: same as adult; if at high risk, may revaccinate
children fi rst vaccinated =4 years of age aft er 2-3 years (older children
aft er 3-5 years)
Vial (single-dose): 50 mcg each of group A, C, Y, and W-135 per 0.5 ml (pwdr
for SC inj aft er reconstitution; preservative-free diluent); Vial (multi-dose): 50
mcg each of group A, C, Y, and W-130 per 0.5 ml [pwdr for SC inj aft er reconstitution
(10 doses/vial) (thimerosal-preserved diluent)] Comment: Use precaution with latex allergy.
y
t
y y y
264 ¦ Menopause
MENOPAUSE
Comment: Estrogen replacement lowers LDL and raises HDL. Estrogen replacement
is indicated for osteoporosis prevention. Exogenous estrogen administration
increases risk for endometrial cancer, MI, stroke, invasive breast cancer, pulmonary
embolism, and DVT. Estrogen replacement is contraindicated in known or
suspected pregnancy, known or suspected cancer of the breast, known or suspected
estrogen-dependent neoplasia, undiagnosed genital bleeding, and active thrombophlebitis
or thromboembolic disorders. Use HRT with caution in patients with
cardiovascular or peripheral vascular disease.
VAGINAL RINGS
estradiol, acetate (X)
Femring Vaginal Ring insert high into vagina; replace every 90 days
estradiol, micronized (X)
Estring Vaginal Ring insert high into vagina; replace every 90 days
Vag ring: 7.5 mcg/24 hours (1/pck)
REGIMENS FOR PATIENTS WITH INTACT UTERUS
Vaginal Preparations (With Uterus)
Comment: Vaginal preparations provide relief from vaginal and urinary symptoms
only (i.e., atrophic vaginitis, dyspareunia, dysuria, and urinary frequency).
estradiol (X)(G)
Vagifem Tabs insert one 10 mcg or 25 mcg vaginal tablet once daily x 2 weeks;
then twice weekly for 2 weeks (e.g., tues/fri); consider the addition of a progestin
Vag tab: 10, 25 mcg (8, 18/blister pck with applicator)
Yuvafem Vaginal Tablet 1 tab intravaginally daily x 2 weeks; then 1 tab intravaginally
twice weekly
Vag tab: 10 mcg (15 tabs w. applicators)
estradiol, micronized (X) Estrace Vaginal Cream 2-4 g daily x 1-2 weeks, then gradually
reduced to 1/2 initial dose x 1-2 weeks, then maintenance dose of 1 g 1-3 times/
week
Vag crm: 0.01% (12, 42.5 g w. calib applicator)
estrogen, conjugated equine (X)
Premarin Vaginal Cream 0.5-2 g/day intravaginally; cyclically (3 weeks on,
1 week off )
Vag crm: 1.5 oz w. applicator marked in 1/2 g increments to max of 2 g
Transdermal Systems (With Uterus)
Comment: Alternate sites. Do not apply patches on or near breasts.
estradiol (X)
Climara initially 0.025 mg/day patch once/week to trunk (3 weeks on and 1
week off )
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (4/pck)
Esclim apply twice weekly x 3 weeks, then 1 week off ; use with an oral progestin
to prevent endometrial hyperplasia
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (8, 48/pck)
t
y y y y y y
Menopause ¦ 265
Vivelle initially one 0.0375 mg/day patch twice weekly to trunk area; use with
an oral progestin to prevent endometrial hyperplasia
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (8, 48/pck)
Vivelle-Dot initially one 0.05 mg/day patch twice weekly to lower abdomen,
below the waist; use with an oral progestin to prevent endometrial hyperplasia
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (8, 24/pck)
estradiol/levonorgestrel (X) apply 1 patch weekly to lower abdomen; avoid waistline;
alternate sites
Climara Pro Transdermal patch: estra 0.045 mg/levo 0.015 mg per day (4/pck)
estradiol/norethindrone (X)
CombiPatch apply twice weekly or q 3-4 days
Transdermal patch: 9 cm2: estra 0.05 mg/noreth 0.14 mg; 16 cm2: estra 0.05
mg/noreth 0.25 mg
Comment: May cause irregular bleeding in fi rst 6 months of therapy, but usually
decreases over time (oft en to amenorrhea).
ORAL AGENTS (WITH UTERUS)
estradiol (X)(G)
Estrace 1-2 mg daily cyclically (3 weeks on and 1 week off )
Tab: 0.5, 1, 2*mg (tartrazine)
estradiol/drospirenone (X)
Angeliq 1 tab daily
Tab: Angeliq 0.5/0.25: estra 0.5 mg/dros 0.25 mg
Angeliq 1/0.5: estra 1 mg/dros 0.5 mg
estradiol/norethindrone (X) 1 tab daily
Activella (G) Tab: estra 1 mg/noreth 0.5 mg
FemHRT (G) 1/5 Tab: estra 5 mcg/noreth 1 mg
Fyavolv (G) Tab: estra 0.25 mg/noreth 1 mg; Tab: estra 0.5 mg/noreth 1 mg
Mimvey LO Tab: estra 0.5 mg/noreth 0.1 mg
estradiol/norgestimate (X) 1 x estradiol 1 mg tab once daily x 3 days, then 1 x estradiol
1 mg/norgestimate 0.09 mg tab daily x 3 days; repeat this pattern continuously
Ortho-Prefest Tab: estra 1 mg/norgest 0.09 mg (30/blister pck)
estrogen, conjugated/medroxyprogesterone (X)
Prempro 1 tab daily
Tab: Prempro 0.3/1.5: conj estra 0.3 mg/medroxy 1.5 mg
Prempro 0.45/1.5: conj estra 0.45 mg/medroxy 1.5 mg
Prempro 0.625/2.5: conj estra 0.625 mg/medroxy 2.5 mg
Prempro 0.625/5: conj estra 0.625 mg/medroxy 5 mg
Premphase 0.625 estrogen on days 1-14, then 0.625 mg estrogen/5 mg
medroxyprogesterone on days 15-28
Tab (in dial dispenser): conj estra 0.625 mg (14 maroon tabs) + medroxy 5 mg
(14 blue tabs)
estrogen, esterifi ed (plant derived) (X)
Menest 0.3-2.5 mg daily cyclically, 3 weeks on and 1 week off (with progestins
in the latter part of the cycle to prevent endometrial hyperplasia)
Tab: 0.3, 0.625, 1.25, 2.5 mg
estrogen, esterifi ed/methyltestosterone (X)
Estratest 1 tab daily cyclically, 3 weeks on and 1 week off
Tab: ester estra 1.25 mg/meth 2.5 mg
y y y y y y y y y
266 ¦ Menopause
Estratest HS 1-2 tabs daily cyclically, 3 weeks on and 1 week off
Tab: ester estra 0.625 mg/meth 1.25 mg
ethinyl estradiol (X) 0.02-0.05 mg q 1-2 days cyclically, 3 weeks on and 1 week off
(with progestins in the latter part of the cycle to prevent endometrial hyperplasia)
Estinyl Tab: 0.02 (tartrazine), 0.05 mg
estropipate, piperazine estrone sulfate (X)(G)
Ogen 0.625-1.25 mg daily cyclically (3 weeks on and 1 week off )
Tab: 0.625, 1.25, 2.5 mg
Ortho-Est 0.75-6 mg daily cyclically (3 weeks on and 1 week off )
Tab: 0.625, 1.25 mg
medroxyprogesterone (X) 5-10 mg daily for 12 sequential days of each 28-day cycle
to prevent endometrial hyperplasia in the postmenopausal women with an intact
uterus receiving conjugated estrogens
Provera Tab: 2.5, 5, 10 mg
norethindrone acetate (X) 2.5-10 mg daily x 5-10 days during second half of menstrual
cycle
Aygestin Tab: 5*mg
progesterone, micronized (X)(G)
Prometrium 200 mg daily in the PM for 12 sequential days of each 28-day cycle
to prevent endometrial hyperplasia in the postmenopausal woman with an
intact uterus receiving conjugated estrogens
Cap: 100, 200 mg (peanut oil)
ESTROGENS, CONJUGATED/ESTROGEN AGONIST-ANTAGONIST
estrogen, conjugated/bazedoxifene (X)
Duavee 1 tab daily
Tab: conj estra 0.45 mg/baze 20 mg
REGIMENS FOR PATIENTS WITHOUT UTERUS
Oral Agents (Without Uterus)
estradiol (X)(G)
Estrace 1-2 mg daily
Tab: 0.5*, 1*, 2*mg (tartrazine)
estrogen, conjugated (equine) (X)
Premarin 1 tab daily
Tab: 0.3, 0.45, 0.625, 0.9, 1.25, 2.5 mg
estrogen, conjugated (synthetic) (X) 1 tab daily; may titrate up to max 1.25 mg/day
Cenestin Tab: 0.3, 0.625, 0.9, 1.25 mg
Enjuvia Tab: 0.3, 0.45, 0.625 mg
estrogen, esterifi ed (plant derived) (X) 1 tab daily
Estratab Tab: 0.3, 0.625, 2.5 mg
Menest Tab: 0.3, 0.625, 1.25, 2.5 mg
ethinyl estradiol (X) 0.02-0.05 mg q 1-2 days
Estinyl Tab: 0.02 (tartrazine), 0.05 mg
Vaginal Preparations (Without Uterus)
Comment: Vaginal preparations provide relief from vaginal and urinary symptoms
only (i.e., atrophic vaginitis, dyspareunia, dysuria, and urinary frequency).
y y y y y y y y y y y
Menopause ¦ 267
estradiol (X)(G)
Vagifem Tabs insert one 10 mcg or 25 mcg vaginal tablet once daily x 2
weeks; then twice weekly for 2 weeks (e.g., tues/fri); consider the addition of
a progestin
Vag tab: 10, 25 mcg (8, 18/blister pck with applicator)
Yuvafem Vaginal Tablet 1 tab intravaginally daily x 2 weeks; then 1 tab intravaginally
twice weekly
Vag tab: 10 mcg (15 tabs w. applicators)
Topical Agents (Without Uterus)
estradiol (X)
Estrasorb apply 3.48 g (2 pouches) every morning; apply one pouch to each leg
from the upper thigh to the calf; rub in for 3 minutes; rub excess on hands onto
buttocks
Emul: 0.025 mg/day/pouch (2.5 mg/g; 1.74 g/pouch)
EstroGel apply 1.25 g (one compression) to one arm from wrist to shoulder
once daily at the same time each day
Gel: 0.06% per compression (93 g)
Transdermal Systems (Without Uterus)
Comment: Do not apply patches on or near breasts. Alternate sites.
estradiol (X)
Alora initially 0.05 mg/day apply patch twice weekly to lower abdomen, upper
quadrant of buttocks or outer aspect of hip
Transdermal patch: 0.025, 0.05, 0.075, 0.1 mg/day (8, 24/pck)
Climara initially 0.025 mg/day patch once/week to trunk
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (4, 8, 24/pck)
Esclim initially 0.025 mg/day apply patch twice weekly to buttocks, femoral
triangle, or upper arm
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (8/pck)
Estraderm initially apply one 0.05 mg/day patch twice weekly to trunk
Transdermal patch: 0.05, 0.1 mg/day (8, 24/pck)
Menostar apply one patch weekly to lower abdomen, below the waist; avoid the
breasts; alternate sites
Transdermal patch: 14 mcg/day (4/pck)
Minivelle initially one 0.0375 mg/day patch twice weekly to trunk area; adjust
aft er one month of therapy
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (8/pck)
Vivelle initially one 0.0375 mg/day patch twice weekly to trunk area; adjust aft er
one month of therapy
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (8, 48/pck)
Vivelle-Dot initially apply one 0.05 mg/day patch twice weekly to lower abdomen,
below the waist; adjust aft er one month of therapy
Transdermal patch: 0.025, 0.0375, 0.05, 0.075, 0.1 mg/day (8, 24/pck)
Comment: Th e estrogens in Alora, Climara, Estraderm, and Vivelle-Dot are
plant derived. y
y
y
268 ¦ Menometorrha g i a : I r r e g u l a r H e a v y M e n s t r u a l B l e e d i n g
MENOMETORRHAGIA: IRREGULAR HEAVY
MENSTRUAL BLEEDING/MENORRHAGIA: HEAVY
CYCLICAL MENSTRUAL BLEEDING
ANTIFIBROLYTIC AGENT
tranexamic acid (B)(G) 1,300 mg tid; treat for up to 5 days during menses; Normal
renal function (SCr =1.4 mg/dL): 1,300 mg tid; SCr =1.4-2.8 mg/dL: 1,300 mg bid; SCr
=2.8-5.7 mg/dL: 1,300 mg once daily; SCr =5.7 mg/dL: 650 mg once daily
Pediatric: <18 years: not recommended
Lysteda Tab: 650 mg
Injectible Progesterone Only Contraceptives
medroxyprogesterone (X)(G)
Depo-Provera 150 mg deep IM q 3 months
Vial: 150 mg/ml (1 ml)
Prefi lled syringe: 150 mg/ml
Depo-SubQ 104 mg SC q 3 months
Prefi lled syringe: 104 mg/ml (0.65 ml; parabens)
Comment: Administer fi rst dose within 5 days of onset of normal menses, within
5 days postpartum if not breastfeeding, or at 6 weeks postpartum if breastfeeding
exclusively. Do not use for >2 years unless other methods are inadequate.
Combined Oral Contraceptives see page 585
Intrauterine Devices see page 497
MITRAL VALVE PROLAPSE (MVP)
propranolol (C)(G)
Inderal 10-30 mg tid-qid
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
MONONUCLEOSIS (MONO)
ANALGESICS
acetaminophen (B) see Fever page 143
Acetaminophen for IV Infusion see page 501
Other Oral Analgesics see Pain page 308
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
prednisone (C) initially 40-80 mg/day, then taper off over 5-7 days
Comment: Corticosteroids recommended in patients with signifi cant pharyngeal edema.
t
y y
t
y
t
y y
M u l t i p l e S cl e r o s i s ( M S ) ¦ 269
MOTION SICKNESS
dimenhydrinate (B)(OTC) 50-100 mg q 4-6 hours; start 1 hour before travel; max
400 mg/day
Pediatric: <2 years: not recommended; 2-6 years: 12.5-25 mg; max 75 mg/day; start
1 hour before travel; may repeat q 6-8 hours; 6-11 years: 25-50 mg; max 150 mg/
day; start 1 hour before travel; may repeat q 6-8 hours; =12 years: same as adult
Dramamine
Tab: 50*mg; Chew tab: 50 mg (phenylalanine, tartrazine); Liq: 12.5 mg/5 ml (4 oz)
meclizine (B)(G) 25-50 mg 1 hour before travel; may repeat q 24 hours as needed;
max 50 mg/day
Pediatric: not recommended
Antivert Tab: 12.5, 25, 50*mg
Bonine (OTC) Cap: 15, 25, 50 mg; Tab: 12.5, 25, 50 mg;
Chew tab/Film-coat tab: 25 mg
Dramamine II (OTC) Tab: 25 mg
Zentrip Strip: 25 mg orally-disint
prochlorperazine (C)(G)
Compazine 5-10 mg q 4 hours as needed
Pediatric: not recommended
Tab: 5 mg; Syr: 5 mg/5 ml (4 oz; fruit); Rectal supp: 2.5, 5, 25 mg
Compazine Spansule15 mg q AM or 10 mg q 12 hours
Spansules: 10, 15 mg sust-rel
promethazine (C)(G) 25 mg 30-60 minutes before travel; may repeat in 8-12 hours
Pediatric: <2 years: not recommended; =2 years: 12.5-25 mg 30-60 minutes before
travel; may repeat in 8-12 hours
Phenergan Tab: 12.5*, 25*, 50 mg; Plain syr: 6.25 mg/5 ml; Fortis syr: 25 mg/5
ml; Rectal supp: 12.5, 25, 50 mg
scopolamine (C)
Scopace 0.4-0.8 mg 1 hour before travel; may repeat in 8 hours
Pediatric: not recommended
Tab: 0.4 mg
Transderm Scop 1 patch behind ear at least 4 hours before travel; each patch is
eff ective for 3 days
Pediatric: not recommended
Transdermal patch: 1.5 mg (4/carton)
MULTIPLE SCLEROSIS (MS)
NICOTINIC ACID RECEPTOR AGONIST
dimethyl fumarate (C) initially 120 mg bid x 7 days; then maintenance 240 mg bid
Pediatric: <18 years: not recommended
Tecfi dera Cap: 120, 240 mg del-rel; Starter Pack: 14 x 120 mg, 46 x 240 mg
Comment: Th e mechanism by which dimethyl fumarate (DMF) exerts its
therapeutic eff ect in multiple sclerosis is unknown. DMF and the metabolite, monomethyl
fumarate (MMF), have been shown to activate the nuclear factor (erythroidderived
2)-like 2 (Nrf2) pathway in vitro and in vivo in animals and humans. Th e
Nrf2 pathway is involved in the cellular response to oxidative stress. MMF has been
identifi ed as a nicotinic acid receptor agonist in vitro.
t
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270 ¦ M u l t i p l e S cl e r o s i s ( M S )
POTASSIUM CHANNEL BLOCKER
dalfampridine (C) 10 mg q 12 hours
Pediatric: <18 years: not recommended
Ampyra Tab: 10 mg ext-rel
Comment: dalfampridine is indicated to improve walking speed.
PYRIMIDINE SYNTHESIS INHIBITOR (DMARD)
terifl unomide (X) 7 mg or 14 mg once daily
Pediatric: not recommended
Aubagio Tab: 7, 14 mg
Comment: Contraindicated with severe hepatic impairment and women
of childbearing potential not using reliable contraception. Co-administer
terifl unomide with the DMARD lefl unomide (Arava).
IMMUNOMODULATORS
Comment: Th e role of immunomodulators in the treatment of MS is to slow the
progression of physical disability and to decrease frequency of clinical exacerbations.
alemtuzumab (C) administer two treatment courses:
First treatment course: 12 mg/day x 5 days (total 60 mg); Second treatment course: 12
months later, administer 12 mg/day x 3 days (total 36 mg); complete all immunizations
6 weeks prior to the fi rst treatment; premedicate with 1000 mg methylprednisolone
or equivalent immediately prior to the fi rst 3 treatment days in each
treatment course
Pediatric: <18 years: not recommended
Lemtrada Vial: 12 mg/1.2 ml soln for IV infusion, single-use vial
Comment: Lemtrada is indicated for the treatment of patients with relapsing
forms of MS. Because of its safety profi le, the use of Lemtrada should generally
be reserved for patients who have had an inadequate response to two or more
drugs indicated for the treatment of MS. Lemtrada REMS is a restricted
distribution program, which allows early detection and management of some of
the serious risks associated with its use.
fi ngolimod (C) 0.5 mg once daily
Pediatric: <18 years: not recommended
Gilenya Cap: 0.5 mg
Comment: First-dose monitoring for bradycardia. In the fi rst 2 weeks, fi rst-dose
monitoring is recommended aft er an interruption of 1 day or more. During weeks
3 and 4, fi rst-dose monitoring is recommended aft er an interruption of more than
7 days.
glatiramer acetate (B)(G) 20-40 mg SC daily
Pediatric: <18 years: not recommended
Copaxone Prefi lled syringe: 20, 40 mg/ml (mannitol, preservative-free)
interferon beta-1a (C)
Pediatric: <18 years: not recommended
Avonex 30 mcg IM weekly; rotate sites; may titrate to reduce fl u-like symptoms;
may use concurrent analgesics/antipyretics on treatment days; Titration
Schedule: 7.5 mcg week 1; 15 mcg week 2; 22.5 mcg week 3; 30 mcg week 4 and
ongoing
y y y y y y
M u m p s ( I n f e c t i o u s Pa r o t i t i s ) ¦ 271
Vial: 30 mcg/vial pwdr for reconstitution (single-dose w. diluent, 4 vials/kit)
(albumin [human], preservative-free); Prefi lled syringe: 30 mcg single-dose
(0.5 ml) (4/dose pck)
Rebif, administer SC 3x/week (at least 48 hours apart and preferably in the late
aft ernoon or evening); increase over 4 weeks to usual dose 22-44 mcg 3x/week;
Titration Schedule (22 mcg prescribed dose): 4.4 mcg week 1 & 2; 11 mcg week
3 & 4; 22 mcg week 5 and ongoing; Titration Schedule (44 mcg prescribed dose):
8.8 mcg week 1 & 2; 22 mcg week 3 & 4; 44 mcg week 5 and ongoing
Prefi lled syringe: 22, 44 mcg/0.5 ml w. needle (12/carton) (albumin [human],
preservative-free); (titration pack, 6 doses of 8.8 mcg [0.2 ml] w. needle per
carton) (albumin [human], preservative-free)
Comment: Only prefi lled syringes (Rebif) can be used to titrate to the 22 mcg
prescribed dose. Prefi lled syringes or autoinjectors (Rebif Rebidose) can be
used to titrate to the 44 mcg prescribed dose.
Rebif Rebidose administer SC 3x/week (at least 48 hours apart and preferably in
the late aft ernoon or evening) aft er titration to 22 mcg or 44 mcg
Titration Schedule: see Rebif.
Prefi lled autoinjector: 22, 44 mcg/0.5 ml (0.5ml, 12/carton) (titration pack,
6 doses of 8.8 mcg [0.2 ml] per carton (albumin [human], preservative-free)
Comment: Only prefi lled syringes (Rebif) can be used to titrate to the 22 mcg
prescribed dose. Prefi lled syringes or autoinjectors (Rebif Rebidose) can be
used to titrate to the 44 mcg prescribed dose.
interferon beta-1b (C)
Pediatric: <18 years: not recommended
Actimmune BSA =0.5m2: 1.5 mgc/kg SC in a single dose 3 times weekly; BSA
=0.5m2: 50 mgc/m2 SC in a single dose 3 times weekly Vial: 100 mcg/0.5 ml
single-dose for SC injection
Betaseron, Extavia 0.0625 mg (0.25 ml) SC every other day; increase over
6 weeks to 0.25 mg (1 ml) SC every other day
Vial: 0.3 mg/vial pwdr for reconstitution (single-dose w. prefi lled diluents
syringes) (albumin [human], mannitol, preservative-free)
natalizumab (C) administer 300 mg by IV infusion over 1 hour every 4 weeks;
monitor during infusion and for 1 hour postinfusion
Pediatric: <18 years: not recommended
Tysabri Vial: 300 mg/15 ml (15 ml)
MUMPS (INFECTIOUS PAROTITIS)
PROPHYLAXIS
measles, mumps, rubella, live, attenuated, neomycin vaccine (C)
MMR II 25 mcg SC (preservative-free)
Comment: Contraindications: hypersensitivity to neomycin or eggs, primary
or acquired immune defi ciency, immunosuppressant therapy, bone marrow or
lymphatic malignancy, and pregnancy (within 3 months aft er vaccination).
see Childhood Immunizations page 574
Parenteral Corticosteroids see page 511
Oral Corticosteroids see page 509
Antipyretics see Fever page 143
y y
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272 ¦ Muscl e S t r a i n