Rx – All “C” 5

PANCREATIC ENZYME DEFICIENCY
Comment: Seen in chronic pancreatitis, postpancreatectomy, cystic fi brosis,
steatorrhea, post-GI tract bypass surgery, and ductal obstruction from neoplasia. May
sprinkle cap; however, do not crush or chew cap or tab. May mix with applesauce or
other acidic food; follow with water or juice. Do not let any drug remain in mouth.
Take dose just prior to each meal or snack. Base dose on lipase units; adjust per diet
and clinical response (i.e., steatorrhea). Pancrelipase products are interchangeable.
Contraindicated with pork protein hypersensitivity.
PANCRELIPASE PRODUCTS
pancreatic enzymes (C)
Creon 500 units/kg per meal; max 2,500 units/kg per meal or <10,000 units/kg
per day or <4,000 units/g fat ingested per day
Pediatric: <12 months: 2,000-4,000 units per 120 ml formula or per
breast-feeding (do not mix directly into formula or breast milk; 12 months to
4 years: 1,000 units/kg per meal; max 2,500 units/kg per meal <10,000 units/
kg per day; >4 years: same as adult
Cap: Creon 3000 lip 3,000 units/pro 9,500 units/amyl 15,000 units del-rel
Creon 6000 lip 6,000 units/pro 19,000 units/amyl 30,000 units del-rel
Creon 12000 lip 12,000 units/pro 38,000 units/amyl 60,000 units del-rel
Creon 24000 lip 24,000 units/prot 76,000 units/amyl 120,000 units del-rel
Creon 36000 lip 36,000 units/pro114,000 units/amyl 180,000 units del-rel
Cotazym 1-3 tabs just prior to each meal or snack
Pediatric: not recommended
Tab: Cotazym lip 1,000 units/pro 12,500 units/amyl 12,500 units del-rel
Cotazym-S lip 5,000 units/pro 20,000 units/amyl 20,000 units del-rel
Donnazyme 1-3 caps just prior to each meal or snack
Pediatric: not recommended
Cap: Donnazyme lip 5,000 units/pro 20,000 units/amyl 20,000 units del-rel
Ku-Zyme 1-2 caps just prior to each meal or snack
Pediatric: not recommended
Cap: Ku-Zyme: lip 12,000 units/pro 15,000 units/amyl 15,000 units del-rel
Kutrase 1-2 caps just prior to each meal or snack
Pediatric: not recommended
Cap: Kutrase: lip 12,000 units/pro 30,000 units/amyl 30,000 units del-rel
Pancreaze 2,500 lipase units/kg per meal or <10,000 lipase units/kg per day or
<4,000 lipase units/gram fat ingested per day
Pediatric: <12 months: 2,000-4,000 lipase units per 120 ml formula or per
breastfeeding; >12 months to <4 years 1,000 lipase units/kg per meal; >4
years: 500 lipase units/kg per meal; max: adult dose
Cap: Pancreaze 4200 lip 4,200 units/pro 10,000 units/amyl 17,500 units
ec-microtabs
Pancreaze 10500 lip 10,500 units/pro 25,000 units/amyl 43,750 units
ec microtabs
Pancrease 16800 lip 16,800 units/pro 40,000 units/amyl 70,000 units
ec-microtabs
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318 ¦ Pa n c r e a t i c E n z y m e D e f i c i e n cy
Pancreaze 21000 lip 21,000 units/pro 37,000 units/amyl 61,000 units
ec-microtabs
Pertyze 12 months to 4 years and =8 kg: initially 1,000 lipase units/kg per meal; =4
years and =16 kg: initially 500 lipase units/kg per meal; Both: 2,500 lipase units/kg
per meal or <10,000 units/kg per day or <4,000 lipase units/g fat ingested per day
Cap: Pertyze 8000 lip 8,000 units/pro 28,750 units amyl 30,250 units del-rel
Pertyze 16000 lip 16,000 units/pro 57,500 units/amyl 65,000 units del-rel
Ultrase 1-3 tabs just prior to each meal or snack
Pediatric: same as adult
Cap: Ultrase lip 4,500 units/pro 20,000 units/amyl 25,000 units del-rel
Ultrase MT lip 12,000 units/pro 39,000 units/amyl 39,000 units del-rel
Ultrase MT 18 lip 18,000 units/pro 58,500 units/amyl 58,500 units del-rel
Ultrase MT 20 lip 20,000 units/pro 65,000 units/amyl 65,000 units del-rel
Viokace initially 500 lip units/kg per meal; max 2,500 lipase units/kg per meal,
or <10,000 lipase units/kg per meal, or <4,000 units/g fat ingested per day
Pediatric: same as adult
Tab: Viokace 8 lip 8,000 units/pro 30,000 units/amyl 30,000 units
Viokace 16 lip 16,000 units/pro 60,000 units amyl 60,000 units
Pediatric: not established
Viokace 0440 lip 10,440 units/pro 39,150 units amyl 39,150 units
Viokace 20880 lip 20,880 units/pro 78,300 units amyl 78,300 units
Comment: Viokace 10440 and Viokase 20880 should be taken with a daily proton
pump inhibitor.
Viokace Powder 1/4 tsp (0.7 g) with meals
Viokace Powder lip 16,800 units/pro 70,000 units/amyl 70,000 units per 1/4 tsp (8 oz)
Zenpep 500 units/kg per meal; max 2,500 units/kg per meal or <10,000 units/kg
per day or <4,000 units/g fat ingested per day
Pediatric: <12 months: 2,000-4,000 units per 120 ml formula or per breast
feeding (do not mix directly into formula or breast milk); 12 months-4 years:
1,000 units/kg per meal; max 2,500 units/kg per meal <10,000 units/kg per
day; >4 years: same as adult
Cap: Zenpep 5000 lip 5,000 units/prot 17,000 units/amyl 27,000 units del-rel
Zenpep 10000 lip 10,000 units/prot 34,000 units/amyl 55,000 units del-rel
Zenpep 15000 lip 15,000 units/prot 51,000 units/amyl 82,000 units del-rel
Zenpep 20000 lip 20,000 units/prot 68,000 units/amyl 109,000 units del-rel
Zymase 1-3 caps just prior to each meal or snack
Pediatric: not recommended
Cap: Zymase lip 12,000 units/prot 24,000 units/amyl 24,000 units del-rel
PANIC DISORDER
Comment: If possible when considering a benzodiazepine to treat anxiety, a shortacting
benzodiazepines should be used only prn to avert intense anxiety and panic
for the least time necessary while a diff erent non-addictive anti-anxiety regimen (e.g.,
SSRI, SNRI, TCA, buspirone, beta-blocker) is established and eff ective treatment
goals achieved. Co-administration of SSRIs with TCAs requires extreme caution.
Concomitant use of MAOIs and SSRIs is absolutely contraindicated. Avoid other
serotonergic drugs. A potentially fatal adverse event is serotonin syndrome, caused by
serotonin excess. Milder symptoms require HCP intervention to avert severe symptoms
which can be rapidly fatal without urgent/emergent medical care. Symptoms include
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Pa n i c D i s o r d e r ¦ 319
restlessness, agitation, confusion, hallucinations, tachycardia, hypertension, dilated
pupils, muscle twitching, muscle rigidity, loss of muscle coordination, diaphoresis,
diarrhea, headache, shivering, piloerection, hyperpyrexia, cardiac arrhythmias, seizures,
loss of consciousness, coma, death. Abrupt withdrawal or interruption of treatment
with an antidepressant medication is sometimes associated with an antidepressant
discontinuation syndrome which may be mediated by gradually tapering the drug
over a period of two weeks or longer, depending on the dose strength and length of
treatment. Common symptoms of the serotonin discontinuation syndrome include fl ulike
symptoms (nausea, vomiting, diarrhea, headaches, sweating), sleep disturbances
(insomnia, nightmares, constant sleepiness), mood disturbances (dysphoria, anxiety,
agitation), cognitive disturbances (mental confusion, hyperarousal), sensory and
movement disturbances (imbalance, tremors, vertigo, dizziness, electric-shock-like
sensations in the brain, oft en described by suff erers as “brain zaps.”
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
escitalopram (C)(G) initially 10 mg daily; may increase to 20 mg daily aft er 1 week;
Elderly or hepatic impairment: 10 mg once daily
Pediatric: <12 years: not recommended; 12-17 years: initially 10 mg once daily; may
increase to 20 mg once daily aft er 3 weeks
Lexapro Tab: 5, 10*, 20*mg
Lexapro Oral Solution Oral soln: 1 mg/ml (240 ml) (peppermint) (parabens)
fl uoxetine (C)(G)
Prozac initially 20 mg daily; may increase aft er 1 week; doses >20 mg/day
should be divided into AM and noon doses; max 80 mg/day
Pediatric: <7 years: not recommended; 7-17 years: initially 10 mg/day; may
increase aft er 2 weeks to 20 mg/day; range 20-60 mg/day; range for lower
weight children 20-30 mg/day
Cap: 10, 20, 40 mg; Tab: 30*, 60*mg; Oral soln: 20 mg/5 ml (4 oz) (mint)
Prozac Weekly following daily fl uoxetine therapy at 20 mg/day for 13 weeks,
may initiate Prozac Weekly 7 days aft er the last 20 mg fl uoxetine dose
Pediatric: not recommended
Cap: 90 mg ent-coat del-rel pellets
paroxetine maleate (D)(G)
Pediatric: not recommended
Paxil initially 20 mg daily in AM; may increase by 10 mg/day at weekly intervals
as needed; max 60 mg/day
Tab: 10*, 20*, 30, 40 mg
Paxil CR initially 25 mg daily in AM; may increase by 12.5 mg at weekly intervals
as needed; max 62.5 mg/day
Tab: 12.5, 25, 37.5 mg cont-rel ent-coat
Paxil Suspension initially 20 mg daily in AM; may increase by 10 mg/day at
weekly intervals as needed; max 60 mg/day
Oral susp: 10 mg/5 ml (250 ml) (orange)
sertraline (C) initially 50 mg daily; increase at 1 week intervals if needed; max
200 mg daily
Pediatric: <6 years: not recommended; 6-12 years: initially 25 mg daily; max
200 mg/day; 13-17 years: initially 50 mg daily; max 200 mg/day
Zoloft Tab: 15*, 50*, 100*mg; Oral conc: 20 mg per ml (60 ml, dilute just before
administering in 4 oz water, ginger ale, lemon-lime soda, lemonade, or orange
juice) (alcohol 12%)
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320 ¦ Pa n i c D i s o r d e r
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)
desvenlafaxine (C)(G) swallow whole; initially 50 mg once daily; max 120 mg/day
Pediatric: not recommended
Pristiq Tab: 50, 100 mg ext-rel
venlafaxine (C)
Eff exor initially 75 mg/day in 2-3 doses; may increase at 4 day intervals in
75 mg increments to 150 mg/day; max 375 mg/day
Pediatric: <18 years: not recommended
Tab: 25, 37.5, 50, 75, 100 mg
Eff exor XR initially 75 mg q AM; may start at 37.5 mg daily x 4-7 days, then
increase by increments of up to 75 mg/day at intervals of at least 4 days; usual
max 375 mg/day
Pediatric: not recommended
Cap: 37.5, 75, 150 mg ext-rel
TRICYCLIC ANTIDEPRESSANTS (TCAs)
doxepin (C)(G)
Pediatric: not recommended
Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
imipramine (C)(G)
Pediatric: not recommended
Tofranil initially 75 mg daily (max 200 mg); Adolescents: initially 30-40 mg daily
(max 100 mg/day); if maintenance dose exceeds 75 mg daily, may switch to
Tofranil PM for divided or bedtime dose
Tab: 10, 25, 50 mg
Tofranil PM initially 75 mg daily 1 hour before HS; max 200 mg
Cap: 75, 100, 125, 150
Tofranil Injection 50 mg IM; lower dose for adolescents; switch to oral form as
soon as possible
Amp: 25 mg/2 ml (2 ml)
1ST GENERATION ANTIHISTAMINE
hydroxyzine (C)(G) 50-100 mg qid; max 600 mg/day
Pediatric: <6 years: 50 mg/day divided qid; =6 years: 50-100 mg/day divided qid
Atarax Tab: 10, 25, 50, 100 mg; Syr: 10 mg/5 ml (alcohol 0.5%)
Vistaril Cap: 25, 50, 100 mg; Oral susp: 25 mg/5 ml (4 oz) (lemon)
AZASPIRONES
buspirone (B) initially 7.5 mg bid; may increase by 5 mg/day q 2-3 days; max 60 mg/day
Pediatric: <6 years: not recommended; 6-17 years: same as adult
BuSpar Tab: 5, 10, 15*, 30* mg
BENZODIAZEPINES
Short Acting
alprazolam (D)(IV)(G)
Pediatric: <18 years: not recommended
Niravam initially 0.25-0.5 mg tid; may titrate every 3-4 days; max 4 mg/day
Tab: 0.25*, 0.5*, 1*, 2*mg orally-disint
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Pa n i c D i s o r d e r ¦ 321
Xanax initially 0.25-0.5 mg tid; may titrate every 3-4 days; max 4 mg/day
Tab: 0.25*, 0.5*, 1*, 2*mg
Xanax XR initially 0.5-1 mg once daily, preferably in the AM; increase at intervals
of at least 3-4 days by up to 1 mg/day. Taper no faster than 0.5 mg every
3 days; max 10 mg/day. When switching from immediate-release alprazolam,
give total daily dose of immediate-release once daily.
Tab: 0.5, 1, 2, 3 mg ext-rel
oxazepam (C)(IV)(G) 10-15 mg tid-qid for moderate symptoms; 15-30 mg tid-qid
for severe symptoms
Pediatric: not recommended
Tab: 15 mg; Cap: 10, 15, 30 mg
Intermediate Acting
lorazepam (D)(IV)(G) 1-10 mg/day in 2-3 divided doses
Pediatric: not recommended
Ativan Tab: 0.5, 1*, 2*mg
Lorazepam Intensol Oral conc: 2 mg/ml (30 ml w. graduated dropper)
Long Acting
chlordiazepoxide (D)(IV)(G)
Pediatric: <6 years: not recommended; =6 years: 5 mg bid-qid; increase to 10 mg
bid-tid
Librium 5-10 mg tid-qid for moderate symptoms; 20-25 mg tid-qid for severe
symptoms
Cap: 5, 10, 25 mg
Librium Injectable 50-100 mg IM or IV; then 25-50 mg IM tid-qid prn; max
300 mg/day
Inj: 100 mg
chlordiazepoxide/clidinium (D)(IV) 1-2 caps tid-qid: max 8 caps/day
Pediatric: not recommended
Librax Cap: chlor 5 mg/clid 2.5 mg
clonazepam (D)(IV)(G) initially 0.25 mg bid; increase to 1 mg/day aft er 3 days
Pediatric: <18 years: not recommended
Klonopin Tab: 0.5*, 1, 2 mg
Klonopin Wafers dissolve in mouth with or without water
Wafer: 0.125, 0.25, 0.5, 1, 2 mg orally-disint
clorazepate (D)(IV)(G) 30 mg/day in divided doses; max 60 mg/day
Pediatric: <9 years: not recommended; =9 years: same as adult
Tranxene Tab: 3.75, 7.5, 15 mg
Tranxene SD do not use for initial therapy
Tab: 22.5 mg ext-rel
Tranxene SD Half Strength do not use for initial therapy
Tab: 11.25 mg ext-rel
Tranxene T-Tab Tab: 3.75*, 7.5*, 15*mg
diazepam (D)(IV)(G) 2-10 mg bid to qid
Pediatric: not recommended
Diastat Rectal gel delivery system: 2.5 mg
Diastat AcuDial Rectal gel delivery system: 10, 20 mg
Valium Tab: 2*, 5*, 10*mg
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322 ¦ Pa n i c D i s o r d e r
Valium Injectable Vial: 5 mg/ml (10 ml); Amp: 5 mg/ml (2 ml); Prefi lled syringe:
5 mg/ml (5 ml)
Valium Intensol Oral Solution Conc oral soln: 5 mg/ml (30 ml w. dropper)
(alcohol 19%)
Valium Oral Solution Oral soln: 5 mg/5 ml (500 ml) (wintergreen spice)
PHENOTHIAZINES
prochlorperazine (C)(G)
Compazine 5 mg tid-qid
Pediatric: not recommended
Tab: 5 mg; Syr: 5 mg/5 ml (4 oz) (fruit); Rectal supp: 2.5, 5, 25 mg
Compazine Spansule 15 mg q AM or 10 mg q 12 hours
Pediatric: not recommended
Spansule: 10, 15 mg sust-rel
trifl uoperazine (C)(G) 1-2 mg bid; max 6 mg/day; max 12 weeks
Pediatric: not recommended
Stelazine Tab: 1, 2, 5, 10 mg
PARKINSON’S DISEASE
Parkinson’s Disease-associated Dementia, see Dementia page 103
Comment: When administering carbidopa and levodopa separately, administer each
at the same time. Titrate daily dose ratio of 1:10 carbidopa to levodopa. Max daily
carbidopa 200 mg. Most patients will require levodopa 400 to 1600 mg/day in divided
doses every 4 to 8 hours. Aft er titrating both drugs to the desired eff ects without
intolerable side eff ects, switch to a carbidopa/levodopa combination form.
DOPAMINE PRECURSOR
levodopa (C)(G)
Tab: 125, 150, 200 mg
DECARBOXYLASE INHIBITOR
carbidopa (C)(G)
Lodosyn Tab: 25 mg
DOPAMINE RECEPTOR AGONISTS
amantadine (C) initially 100 mg bid; may increase aft er 1-2 weeks by 100 mg/day;
max 400 mg/day in divided doses; for extrapyramidal eff ects, 100 mg bid; max 300
mg/day in divided doses
Symmetrel Cap: 100 mg; Syr: 50 mg/5 ml (16 oz) (raspberry)
bromocriptine (B)(G) initially 1.25 mg bid to 2.5 mg tid with meals; increase as needed
every 2-4 weeks by 2.5 mg/day; max 100 mg/day
Parlodel Tab: 2.5*mg; Cap: 5 mg
pramipexole (C)(G) initially 0.125 mg tid; increase at intervals q 5-7 days; max 1.5
mg tid
Mirapex Tab: 0.125, 0.25*, 0.5*, 1*, 1.5*mg
ropinirole (C) initially 0.25 mg tid for fi rst week; then 0.5 mg tid for second week;
then 0.75 mg tid for third week; then 1 mg tid for fourth week; may increase by
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Pa r k i n s o n ’ s D i s e a s e ¦ 323
1.5 mg/day at 1 week intervals to 9 mg/day; then increase up to 3 mg/day at 1 week
intervals; max 24 mg/day
Requip Tab: 0.25, 0.5, 1, 2, 4, 5 mg
rotigotine transdermal patch (C) apply to clean, dry, intact skin on abdomen, thigh,
hip, fl ank, shoulder, or upper arm; rotate sites and allow 14 days before reusing site;
if hairy, shave site at least 3 days before application to site; avoid abrupt cessation;
taper by 2 mg/24 hours every other day; Early stage: initially 2 mg/24 hour patch
once daily; may increase weekly by 2 mg/24 hour if needed; max 6 mg/24 hour once
daily; Advanced stage: initially 4 mg/24 hour patch once daily; may increase weekly
by 2 mg/24 hour if needed; max 8 mg/24 hour once daily
Neupro Trans patch: 1 mg/24 hr, 2 mg/24 hr, 3 mg/24 hr, 4 mg/24 hr, 6 mg/24
hr, 8 mg/24 hr (30/carton) (sulfi tes)
DOPA-DECARBOXYLASE INHIBITORS
Comment: Contraindicated in narrow-angle glaucoma. Use with caution with sympathomimetics
and antihypertensive agents.
carbidopa/levodopa (C)(G) usually 400-1600 mg levodopa/day
Pediatric: <18 years: not established
Duopa Ent susp: carb 4.63 mg/levo 20 mg single-use cassettes for use w. CADD
Legacy 1400 Pump
Sinemet 10/100 initially 1 tab tid-qid; increase if needed daily or every other
day up to qid
Tab: carb 10 mg/levo 100 mg* Sinemet 25/100 initially 1 tab bid-tid; increase
if needed daily or every other day up to qid
Tab: carb 25 mg/lev 100 mg*
Sinemet 25/250 1 tab tid-qid
Tab: carb 25 mg/lev 250 mg*
Sinemet CR 25/100 initially one 25/100 tab bid; allow 3 days between dosage
adjustments
Tab: carb 25 mg/levo 100 mg cont-rel
Sinemet CR 50/200 initially one 50/200 tab bid; allow 3 days between dosage
adjustments
Tab: carb 50 mg/levo 200 mg cont-rel*
DOPA-DECARBOXYLASE INHIBITOR/DOPAMINE PRECURSOR/COMT
INHIBITOR COMBINATION
carbidopa/levodopa/entacapone (C) titrate individually with separate components;
then switch to corresponding strength levodopa and carbidopa; max 8 tabs/day
Tab: Stalevo 50: carb 12.5 mg/levo 50 mg/enta 200 mg
Stalevo 75: carb 12.5 mg/levo 75 mg/enta 200 mg
Stalevo 100: carb 12.5 mg/levo 100 mg/enta 200 mg
Stalevo 125: carb 12.5 mg/levo 125 mg/enta 200 mg
Stalevo 150: carb 12.5 mg/levo 150 mg/enta 200 mg
Stalevo 200: carb 12.5 mg/levo 200 mg/enta 200 mg
MONOAMINE OXIDASE INHIBITORS (MAOIS)
rasagiline (C)(G) usual maintenance: 0.5-1 mg/day; max: 1 mg/day; initial dose
for patients on concomitant levodopa: 0.5 mg daily; initial dose for patients not on
concomitant levodopa: 1 mg daily
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324 ¦ Pa r k i n s o n ’ s D i s e a s e
Azilect Tab: 0.5, 1 mg
Comment: Azelect is indicated as monotherapy or as adjunct to levodopa. With
mild hepatic dysfunction (Child-Pugh 5-6), limit Azelect dose to 0.5 mg daily.
With moderate to severe hepatic dysfunction (Child-Pugh 7-15), Azelect is not
recommended. Contraindications include co-administration with meperidine,
methadone, mirtazapine, propoxyphene, tramadol, dextromethorphan, St.
John’s wort, cyclobenzaprine, methylphenidate, dexmethylphenidate, or other
MAOIs.
selegiline (C)(G) 5 mg at breakfast and at lunch; max 10 mg/day
Tab/Cap: 5 mg
selegiline (C)(G) 1.25 mg daily; max 2.5 mg/day
Zelapar ODT: 1.25 mg orally-disint (phenylalanine)
COMT INHIBITORS
entacapone (C) 1 tab with each dose of levodopa or carbidopa; max 8 tabs/day
Comtan Tab: 200 mg
Comment: Comtan is an adjunct to levodopa/carbidopa in patients with endof-
dose wearing off .
tolcapone (C) 100-200 mg tid; max 600 mg/day
Tasmar Tab: 100, 200 mg
Comment: Monitor LFTs every 2 weeks. Withdraw Tasmar if no substantial
improvement in the fi rst 3 weeks of treatment.
CENTRALLY ACTING ANTICHOLINERGICS
benztropine mesylate (C) initially 0.5-1 mg q HS, increase if needed; for extrapyramidal
disorders 1-4 mg once daily-bid; max 6 mg/day
Cogentin Tab: 0.5*, 1*, 2*mg
biperiden hydrochloride (C) initially 1 tab tid or qid, then increase as needed; max
8 tabs/day
Akineton Tab: 2 mg
procyclidine (C) initially 2.5 mg tid; may increase as needed to 5 mg tid-qid every
3-5 days; max 15 mg/day
Kemadrin Tab: 5 mg
trihexyphenidyl (C)(G) initially 1 mg; increase as needed by 2 mg every 3-5 days;
max 15 mg/day
Artane Tab: 2*, 5*mg
PARONYCHIA (PERIUNGUAL ABSCESS)
cephalexin (B)(G) 500 mg bid x 10 days
Pediatric: 25-50 mg/day in 2 divided doses x 10 days
Kefl ex Cap: 250, 333, 500, 750 mg; Oral susp: 125, 250 mg/5 ml (100, 200 ml)
(strawberry)
clindamycin (B)(G) 150-300 mg q 6 hours x 10 days
Pediatric: 8-16 mg/kg/day in 3-4 divided doses x 10 days
Cleocin Cap: 75 (tartrazine), 150 (tartrazine), 300 mg
Cleocin Pediatric Granules Oral susp: 75 mg/5 ml (100 ml) (cherry)
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Pe d i c u l o s i s : Pe d i c u l o s i s H u m a n u s C a p i t i s ¦ 325
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) 500 mg q 6 hours x 10 days
Pediatric: <45 kg: 30-50 mg in 2-4 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.
erythromycin ethylsuccinate (B)(G) 400 mg q 6 hours x 10 days
Pediatric: 30-50 mg/kg/day in 4 divided doses q 6 hours 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 (100, 200 ml) (cherry)
E.E.S. 400 Tablets Tab: 400 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
PEDICULOSIS: PEDICULOSIS HUMANUS CAPITIS
(HEAD LICE)/PHTHIRUS (PUBIC LICE)
ivermectin (C) thoroughly wet hair; leave on for 10 minutes; then rinse off with water;
do not re-treat
Pediatric: <6 months, <33 lbs: not recommended; =6 months, =33 lbs: same as adult
Sklice Lotn: 0.5% (4 oz, 117 g, laminate tube)
lindane (C)(G) apply, leave on for 4 minutes, then thoroughly wash off
Pediatric: <2 years: not recommended; =2 years: same as adult
Kwell Shampoo Shampoo: 1% (60 ml)
malathion (B)(G) thoroughly wet hair; allow to dry naturally; shampoo and rinse
aft er 8-12 hours; use a fi ne tooth comb to remove lice and nits; if lice persist aft er 7-9
days, may repeat treatment
Pediatric: same as adult
Ovide (OTC) Lotn: 59% (2 oz)
permethrin (B)(G) apply to washed and towel-dried hair; allow to remain on for 10
minutes, then rinse off ; repeat aft er 7 days if needed
Pediatric: <2 months: not recommended; =2 months: same as adult
Nix (OTC) Crm rinse: 1% (2 oz w. comb)
pyrethrins with piperonyl butoxide (C)(G) apply and leave on for 10 minutes, then
wash off
A-200 Shampoo: pyr 0.33%/pip but 3%
Rid Mousse Shampoo: pyr 0.33%/pip but 4%
Rid Shampoo S hampoo: pyr 0.33%/pip but 3%
Comment: To remove nits, soak hair in equal parts white vinegar and water for
15-20 minutes.
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326 ¦ Pe l v i c I n f l a m m a t o r y D i s e a s e ( P I D )
PELVIC INFLAMMATORY DISEASE (PID)
Comment: Th e following treatment regimens are published in the 2015 CDC Sexually
Transmitted Diseases Treatment Guidelines. Treatment regimens are presented by
generic drug name fi rst, followed by information about brands and dose forms. Treat
all sexual partners. Because of the high risk for maternal morbidity and preterm
delivery, pregnant women who have suspected PID should be hospitalized and treated
with parenteral antibiotics. HIV-infected women with PID respond equally well to
standard parenteral and antibiotic regimens as HIV-negative women.
OUTPATIENT REGIMENS
Regimen 1
ceft riaxone 250 mg IM in a single dose plus
doxycycline 100 mg bid x 14 days with or without
metronidazole 500 mg PO bid x 14 days
Regimen 2
cefoxitin 2 g IM in a single dose plus
probenecid 1 g PO in a single dose administered concurrently plus doxycycline 100
mg bid x 14 days with or without
metronidazole 500 mg PO bid x 14 days
Regimen 3
Other parenteral third-generation cephalosporin (e.g., ceft izoxime or cefotaxime) in
a single dose) plus
doxycycline 100 mg bid x 14 days with or without
metronidazole 500 mg PO bid x 14 days
DRUG BRANDS AND DOSE FORMS
cefoxitin (B)(G)
Mefoxin Vial: 1, 2 g
ceft riaxone (B)(G)
Rocephin Vials 250, 500 mg: 1, 2 g
doxycycline (D)(G)
Actilate Tab: 75, 150** mg
Adoxa Tab: 50, 75, 100, 150 mg ent-coat
Doryx Tab: 50, 75, 100, 150, 200 mg del-rel
Monodox Cap: 50, 75, 100 mg
Oracea Cap: 40 mg del-rel
Vibramycin Tab: 100 mg; Cap: 50, 100 mg; Syr: 50 mg/5 ml (raspberry-apple)
(sulfi tes); Oral susp: 25 mg/5 ml (raspberry)
Vibra-Tab Tab: 100 mg fi lm-coat
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.
t
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Pe p t i c U l c e r D i s e a s e ( P U D ) ¦ 327
metronidazole (not for use in 1st; B in 2nd, 3rd)
Flagyl Tab: 250*, 500*mg
Flagyl 375 Cap: 375 mg
Flagyl ER Tab: 750 mg ext-rel
Comment: Alcohol is contraindicated during treatment with oral metronidazole
and for 72 hours aft er therapy due to a possible disulfi ram-like reaction (nausea,
vomiting, fl ushing, headache).
probenecid (B)(G)
Benemid Tab: 500*mg; Cap: 500 mg
PEPTIC ULCER DISEASE (PUD)
Helicobacter pylori Eradication Regimens see page 180
H2 ANTAGONISTS
cimetidine (B)(G)
Pediatric: <16 years: not recommended; =16 years: same as adult
Tagamet 800 mg bid or 400 mg qid; max 2.4 g/day
Tab: 300, 400*, 800* mg
Tagamet HB (OTC) Prophylaxis: 1 tab ac; Treatment: 1 tab bid
Tab: 200 mg
Tagamet HB Oral Suspension (OTC) Prophylaxis: 1 tsp ac; Treatment: 1 tsp bid
Oral susp: 200 mg/20 ml (12 oz)
Tagamet Liquid Liq: 300 mg/5 ml (mint-peach) (alcohol 2.8%)
famotidine (B)(G) 20 mg bid or 40 mg q HS; max 6 weeks
Pediatric: 0.5 mg/kg/day q HS or in 2 divided doses; max 40 mg/day
Pepcid Tab: 20, 40 mg; Oral susp: 40 mg/5 ml (50 ml)
Pepcid AC (OTC) 1 tab ac; max 2 doses/day
Tab/Rapid dissolving tab: 10 mg
Pepcid Complete (OTC) 1 tab ac; max 2 doses/day
Tab: fam 10 mg/CaCO2 800 mg/Mg hydroxide 165 mg
Pepcid RPD
Tab: 20, 40 mg rapid-dissolving
nizatidine (B)(G) 150 mg bid; max 12 weeks
Pediatric: not recommended
Axid Cap: 150, 300 mg
Axid AR (OTC) 1 tab ac; max 150 mg/day
Tab: 75 mg
ranitidine (B)(G)
Pediatric: <1 month: not recommended; 1 month-16 years: 2-4 mg/kg/day in 2
divided doses; max 300 mg/day; Duodenal/Gastric Ulcer: 2-4 mg/kg/day divided
bid; max 300 mg/day; Erosive Esophagitis: 5-10 mg/kg/day divided bid; max 300
mg/day; >16 years: same as adult
Zantac 150 mg bid or 300 mg q HS
Tab: 150, 300 mg
Zantac 75 (OTC) 1 tab ac
Tab: 75 mg
Zantac EFFERdose dissolve 25 mg tab in 5 ml water; dissolve 150 mg tab in 6-8
oz water
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328 ¦ Pe p t i c U l c e r D i s e a s e ( P U D )
Eff erdose: 25, 150 mg eff ervescent (phenylalanine)
Zantac Syrup Syr: 15 mg/ml (peppermint) (alcohol 7.5%)
ranitidine bismuth citrate (C) 400 mg bid
Pediatric: not recommended
Tritec Tab: 400 mg
PROTON PUMP INHIBITORS (PPIS)
Comment: If hepatic impairment, or if patient is Asian, consider reducing the PPI
dosage. Research has demonstrated associations between PPI use and fractures of the
hip, wrist, and spine, hypomagnesemia, kidney injuries and chronic kidney disease,
possible cardiovascular drug interactions, and infections (e.g., Clostridium diffi cile and
pneumonia). Reducing the acidity of the stomach allows bacteria to thrive and spread
to other organs like the lungs and intestines. Th is risk is increased with high dose and
chronic use and greatest in the elderly. Th e most recent class-wide FDA warning cites
reports of cutaneous and systemic lupus erythematosis (CLS/SLE) associates with PPIs
in patients with both new onset and exacerbation of existing autoimmune disease. PPI
treatment should be discontinued and the patient should be referred to a specialist.
(http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm213259.htm)
dexlansoprazole (B)(G) 30-60 mg daily for up to 4 weeks
Pediatric: <18 years: not recommended
Dexilant Cap: 30, 60 mg ent-coat del-rel granules; may open and sprinkle on
applesauce; do not crush or chew granules
Dexilant SoluTab Tab: 30 mg del-rel orally-disint
esomeprazole (B)(OTC)(G) 20-40 mg daily; max 8 weeks; take 1 hour before food;
swallow whole or mix granules with food or juice and take immediately; do not crush
or chew granules
Pediatric: <1 year: not recommended; 1-11 years: <20 kg: 10 mg; =20 kg: 10-20 mg
once daily; 12-17 years: 20-40 mg once daily; max 8 weeks
Nexium Cap: 20, 40 mg ent-coat del-rel pellets
Nexium for Oral Suspension Oral susp: 10, 20, 40 mg ent-coat del-rel granules/
pkt; mix in 2 tblsp water and drink immediately; 30 pkt/carton
lansoprazole (B)(OTC)(G) 15-30 mg daily for up to 8 weeks; may repeat course; take
before eating
Pediatric: <1 year: not recommended; 1-11, <30 kg: 15 mg once daily; =12 years:
same as adult
Prevacid Cap: 15, 30 mg ent-coat del-rel granules; swallow whole or mix granules
with food or juice and take immediately; do not crush or chew granules;
follow with water
Prevacid for Oral Suspension Oral susp: 15, 30 mg ent-coat del-rel granules/pkt;
mix in 2 tblsp water and drink immediately; 30 pkt/carton (strawberry)
Prevacid SoluTab ODT: 15, 30 mg (strawberry) (phenylalanine)
Prevacid 24HR 15 mg ent-coat del-rel granules; swallow whole or mix granules
with food or juice and take immediately; do not crush or chew granules; follow
with water
omeprazole (C)(OTC)(G) 20-40 mg daily; take before eating; swallow whole or mix
granules with applesauce and take immediately; do not crush or chew; follow with water
Pediatric: <1 year: not recommended; 5-<10 kg: 5 mg daily; 10-<20 kg: 10 mg daily;
=20 kg: same as adult
Prilosec Cap: 10, 20, 40 mg ent-coat del-rel granules
Pediatric: <18 years: not recommended y
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Pe r i p h e r a l N e u r i t i s , D i a b e t i c N e u r o p a t h i c P a i n ¦ 329
Prilosec OTC Tab: 20 mg del-rel (regular, wild berry)
pantoprazole (B) initially 40 mg bid
Pediatric: not recommended
Protonix (G) Tab: 40 mg ent-coat del-rel
Protonix for Oral Suspension Oral susp: 40 mg ent-coat del-rel granules/pkt;
mix in 1 tsp apple juice for 5 seconds or sprinkle on 1 tsp apple sauce, and
swallow immediately; do not mix in water or any other liquid or food; take
approximately 30 minutes prior to a meal; 30 pkt/carton
rabeprazole (B)(OTC)(G) initially 20 mg daily; then titrate; may take 100 mg daily in
divided doses or 60 mg bid
Pediatric: <12 years: not recommended; =12 years: 20 mg once daily; max 8 weeks
AcipHex Tab: 20 mg ent-coat del-rel
Antacids see GERD page 151
OTHER
glycopyrrolate (B)(G) initially 1-2 mg bid-tid; Maintenance: 1 mg bid; max 8 mg/day
Pediatric: <12 years: not recommended; =12 years: same as adult
Robinul Tab: 1 mg (dye-free)
Robinul Forte Tab: 2 mg (dye-free)
Comment: glycopyrrolate is an anticholinergic adjunct to PUD treatment.
mepenzolate (B)(G) 25-50 mg divided qid, with meals and at HS
Cantil Tab: 25 mg
sucralfate (B)(G) Active ulcer: 1 g qid; Maintenance: 1 g bid
Carafate Tab: 1*g; Oral susp: 1 g/10 ml (14 oz)
PROPHYLAXIS
misoprostol (X) 200 mg qid with food for prevention of NSAID-induced gastric ulcers
Cytotec Tab: 100, 200 mg
PERIPHERAL NEURITIS, DIABETIC NEUROPATHIC
PAIN, PERIPHERAL NEUROPATHIC PAIN
Acetaminophen for IV Infusion see Pain page 306
acetaminophen (B)(G) see Fever page 143
aspirin (D)(G) see Fever page 144
Comment: aspirin-containing medications are contraindicated with history of
allergic-type reaction to aspirin, children and adolescents with Varicella or other
viral illness, and 3rd trimester pregnancy.
a2-DELTA LIGAND
pregabalin (GABA analog) (C)(V) initially 150 mg daily divided bid-tid; may titrate
within one week; max 600 mg divided bid-tid; discontinue over one week
Pediatric: <18 years: not recommended
Lyrica Cap: 25, 50, 75, 100, 150, 200, 225, 300 mg; Oral soln: 20 mg/ml y
y
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330 ¦ Pe r i p h e r a l N e u r i t i s , D i a b e t i c N e u r o p a t h i c Pa i n
SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)
duloxetine (C) swallow whole; 30-60 mg once daily; may increase by 30 mg at 1 week
intervals; usual target 60 mg daily; max 120 mg/day
Pediatric: not recommended
Cymbalta Cap: 20, 30, 60 mg ent-coat pellets
Comment: Cymbalta is indicated for chronic pain syndromes (e.g., arthritis,
fi bromyalgia, lowback pain).
TOPICAL/TRANSDERMAL NSAIDs
capsaicin (B)(G) apply tid-qid prn to intact skin
Pediatric: <2 years: not recommended; =2 years: apply sparingly tid-qid prn
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)
capsaicin 8% patch (B) apply up to 4 patches for one 60-minute application to
clean dry skin; may prep area with topical anesthetic; wear nonlatex gloves; patches
may be cut to size/shape; treatment may be repeated every 3 months; remove with
cleansing gel aft er treatment
Pediatric: <18 years: not recommended
Qutenza Patch: 8% 1640 mcg/cm (179 mg) (1 or 2 patches, each w. 1-50 g tube
cleansing gel/carton)
diclofenac epolamine transdermal patch (C) apply one patch to aff ected area bid;
remove during bathing; avoid nonintact skin
Pediatric: not recommended
Flector Patch Patch: 180 mg/patch (30/carton)
capsaicin (B)(G) apply tid to 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)
capsaicin 8% patch (B) apply up to 4 patches for one 60-minute application to clean
dry skin; may prep area with topical anesthetic; wear non-latex gloves; patches may
be cut to size/shape; treatment may be repeated every 3 months; remove with cleansing
gel aft er treatment
Pediatric: <18 years: not recommended
Qutenza Patch: 8% 1640 mcg/cm (179 mg) (1 or 2 patches w. 1-50 g tube
cleansing gel/carton)
lidocaine 5% patch (B)(G) apply up to 3 patches at one time for up to 12 hours/24-
hour period (12 hours on/12 hours off ); patches may be cut into smaller sizes before
removal of the release liner; do not re-use y
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Pe r i p h e r a l Va s c u l a r D i s e a s e ¦ 331
Pediatric: not recommended
Lidoderm Patch: 5% (10×14 cm, 30/carton)
ORAL ANALGESICS
tramadol (C)(IV)(G)
Rybix ODT initially 100 mg once daily; may increase by 100 mg every 5 days;
max 300 mg/day; CrCl <30 mL/min or severe hepatic impairment: not recommended;
Cirrhosis: max 50 mg q 12 hours
Pediatric: <17 years: not recommended
ODT: 50 mg (mint) (phenylalanine)
Ryzolt initially 100 mg once daily; may increase by 100 mg every; 5 days; max 300
mg/day; CrCl <30 mL/min or severe hepatic impairment: not recommended
Pediatric: <16 years: not recommended; =16 years: same as adult
Tab: 100, 200, 300 mg ext-rel
Ultram 50-100 mg q 4-6 hours prn; max 400 mg/day; CrCl <30 mL/min: max
100 mg q 12 hours; Cirrhosis: max 50 mg q 12 hours
Pediatric: <16 years: not recommended; =16 years: same as adult
Tab: 50 mg
Ultram ER initially 100 mg once daily; may increase by 100 mg every 5 days; max
300 mg/day; CrCl <30 mL/min or severe hepatic impairment: not recommended
Pediatric: <18 years: not recommended
Tab: 100, 200, 300 mg ext-rel
tramadol/acetaminophen (C)(IV)(G) 2 tabs q 4-6 hours; max 8 tabs/day; 5 days;
CrCl <30 mL/min: max 2 tabs q 12 hours; max 4 tabs/day x 5 days
Pediatric: <16 years: not recommended; =16 years: same as adult
Ultracet Tab: tram 37.5/acet 325 mg
MU-OPIOID AGONIST/NOREPINEPHRINE REUPTAKE INHIBITOR
tapentadol (C)
Pediatric: <18 years: not recommended
Nucynta 50-100 mg q 4-6 hours prn; max 700 mg/day on the fi rst day; 600 mg/
day on subsequent days
Tab: 50, 75, 100 mg
Nucynta ER Opioid-naïve: initially 50 mg q 12 hours, then titrate to optimal
dose within therapeutic range; usual therapeutic range 100-250 mg q 12 hours;
doses >500 mg not recommended; Converting from Nucynta: divide total
Nucynta daily dose into 2 Nucynta ER doses and administer q 12 hours; converting
from oxycodone CR and other opioids, see mfr recommendations
Tab: 50, 100, 150, 200, 250 mg ext-rel
Other Oral Analgesics see Pain page 308
PERIPHERAL VASCULAR DISEASE (PVD, ARTERIAL
INSUFFICIENCY, INTERMITTENT CLAUDICATION)
ANTIPLATELET THERAPY
aspirin (D)(OTC) usually 81 mg once daily; range 75-325 mg once daily
Ecotrin Tab/Cap: 81, 325, 500 mg ent-coat
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332 ¦ Pe r i p h e r a l Va s c u l a r D i s e a s e
cilostazol (C) 100 mg bid 1/2 hour before or 2 hours aft er breakfast or dinner; may
reduce to 50 mg bid if used with CYP 3A4 (e.g., azole antifungals, macrolides, diltiazem,
fl uvoxamine, fl uoxetine, nefazodone, sertraline) or CYP 2C19 (e.g., omeprazole)
inhibitors
Pletal Tab: 50, 100 mg
Comment: May be used with aspirin. Cautious use with other antiplatelet agents
and anticoagulants.
clopidogrel (B) 75 mg daily
Plavix Tab: 75 mg
dipyridamole (B)(G) 25-100 mg tid-qid
Persantine Tab: 25, 50, 75 mg
Comment: Does not potentiate warfarin and may be taken concomitantly. Do not
administer dipyridamole concomitantly with aspirin.
pentoxifylline (C) 400 mg tid with food
PentoPak Tab: 400 mg ext-rel
Trental Tab: 400 mg sust-rel
ticlopidine (B) 250 mg bid with food
Ticlid Tab: 250 mg
Comment: Monitor for neutropenia; resolves aft er discontinuation.
warfarin (X) adjust dose to maintain INR in recommended range; see Anticoagulation
Th erapy page 526
Coumadin Tab: 1*, 2*, 2.5*, 5*, 7.5*, 10*mg
Coumadin for Injection Vial: 2 mg/ml (5 mg) pwdr for reconstitution
Comment: Treatment for over-anticoagulation with warfarin is vitamin K.
PERTUSSIS (WHOOPING COUGH)
Prophylaxis see Childhood Immunizations page 478
POSTEXPOSURE PROPHYLAXIS AND TREATMENT
Comment: Antibiotics do not alter the course of illness, but they do prevent
transmission. Infected persons should be isolated until aft er the fi ft h day of antibiotic
treatment.
azithromycin (B)(G) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or
500 mg daily x 3 days
Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
Comment: azithromycin is the drug of choice for infants <1 month-of-age.
clarithromycin (C)(G) 250 mg bid or 500 mg ext-rel daily x 10 days
Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg divided bid x 10
days; see page 569 for dose by weight
Biaxin Tab: 250, 500 mg
Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit-punch)
Biaxin XL Tab: 500 mg ext-rel
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Phar y n g i t i s : G o n o c o c c a l ¦ 333
erythromycin base (B)(G) 1 g/day divided qid x 14 days
Pediatric: 40 mg/kg/day in divided doses x 14 days
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
erythromycin ethylsuccinate (B)(G) 1 g/day in 4 divided doses x 14 days
Pediatric: 40-50 mg/kg/day in 4 divided doses x 7 days; may double dose with
severe infection; max 100 mg/kg/day; see page 574 for dose by weight
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100, 200
ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab: 200 mg
wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
E.E.S. 400 Tablets Tab: 400 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
trimethoprim/sulfamethoxazole (C)(G)
Pediatric: <2 months: not recommended; =2 months: 40 mg/kg/day of sulfamethoxazole
in 2 doses bid x 10 days; see page 587 for dose by weight
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg
Bactrim Pediatric Suspension, Septra Pediatric Suspension
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy
or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended.
TREATMENT
Same as Postexposure Prophylaxis
PHARYNGITIS: GONOCOCCAL
Comment: Treat all sexual contacts. Empiric therapy requires concomitant treatment for
Chlamydia. Post-treatment culture recommended with PMHx history rheumatic fever.
PRIMARY THERAPY
azithromycin (B)(G) 1 g x 1 dose
Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
Comment: Per the CDC 2015 STD Treatment Guidelines, azithromycin should be
used with ceft riaxone 250mg.
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334 ¦ P h a r y n g i t i s : Gonococcal
ceft riaxone (B)(G) 250 mg IM x 1 dose
Pediatric: <45 kg: 125 mg IM x 1 dose; =45 kg: same as adult
Rocephin Vial: 250, 500 mg; 1, 2 g
PHARYNGITIS: STREPTOCOCCAL
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 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
azithromycin (B)(G) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500
mg daily x 3 days
Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
cefaclor (B)(G) 250 mg tid or 375 mg bid x 5 days
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)
Cefaclor Extended Release
Pediatric: <16 years: ext-rel not recommended; =16 years: same as adult
Tab: 375, 500 mg ext-rel
cefadroxil (B) 1 g in 1-2 doses x 10 days
Pediatric: 30 mg/kg/day in 2 divided doses x 10 days; see page 561 for dose by weight y
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Phar y n g i t i s : S t r e p t o c o c c a l ¦ 335
Duricef Cap: 500 mg; Tab: 1 g; Oral susp: 250 mg/5 ml (100 ml); 500 mg/5 ml
(75, 100 ml) (orange-pineapple)
cefdinir (B) 300 mg bid x 10 days
Pediatric: <6 months: not recommended; 6 months-12 years: 14 mg/kg/day in 1-2
doses x 10 days; >12 years: same as adult; see page 562 for dose by weight
Omnicef Cap: 300 mg; Oral susp: 125 mg/5 ml (60, 100 ml) (strawberry)
cefditoren pivoxil (B) 200 mg bid x 10 days
Pediatric: not recommended
Spectracef Tab: 200 mg
Comment: Spectracef is contraindicated with milk protein allergy or carnitine
defi ciency.
cefi xime (B) 400 mg daily x 5 days
Pediatric: <6 month s: not recommended; 6 months-12 years, <50 kg: 8 mg/kg/day
in 1-2 divided doses x 10 days; >12 years, =50 kg: same as adult; see page 563 for
dose by weight
Suprax Tab: 400 mg; Cap: 400 mg; Oral susp: 100, 200 mg/5 ml (50, 75, 100 ml)
(strawberry)
cefpodoxime proxetil (B) 100 mg bid x 5-7 days
Pediatric: <2 months: not recommended; 2 months-12 years: 10 mg/kg/day in
2 divided doses x 5-7 days; >12 years: same as adult; see page 564 for dose by
weight
Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 ml) (lemon
creme)
cefprozil (B) 500 mg daily x 10 days
Pediatric: <2 years: not recommended; 2-12 years: 7.5 mg/kg divided bid x 10 days;
>12 years: same as adult; see page 565 for dose by weight
Cefzil Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 75, 100 ml) (bubble
gum) (phenylalanine)
ceft ibuten (B) 400 mg daily x 5 days
Pediatric: 9 mg/kg daily x 5 days; see page 566 for dose by weight
Cedax Cap: 400 mg; Oral susp: 90 mg/5 ml (30, 60, 90, 120 ml); 180 mg/5 ml
(30, 60, 120 ml) (cherry)
cefuroxime axetil (B)(G) 250 mg bid x 10 days
Pediatric: <3 months: not recommended; =3 months: 20 mg/kg/day divided bid x
10 days; see page 567 for dose by weight
Ceft in Tab: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (50, 100 ml) (tutti-frutti)
cephalexin (B)(G) 500 mg bid x 10 days
Pediatric: 25-50 mg/kg/day in 2 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) 250 mg bid or 500 mg ext-rel daily x 10 days
Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg divided bid x 10
days; see page 569 for dose by weight
Biaxin Tab: 250, 500 mg
Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit-punch)
Biaxin XL Tab: 500 mg ext-rel
dirithromycin (C)(G) 500 mg daily x 10 days
Pediatric: <12 years: not recommended; =12 years: same as adult
Dynabac Tab: 250 mg
y y y y y y y y y y
336 ¦ P h a r y n g i t i s : S t r e p t o c o c c a l
erythromycin base (B)(G) 500 mg qid x 10 days
Pediatric: <45 kg: 30-50 mg divided bid-qid 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.
erythromycin estolate (B)(G) 250-500 mg qid x 10 days
Pediatric: 20-50 mg/kg divided q 6 hours x 10 days; see page 573 for dose by weight
Ilosone Pulvule: 250 mg; Tab: 500 mg; Liq: 125, 250 mg/5 ml (100 ml)
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
erythromycin ethylsuccinate (B)(G) 400 mg qid or 800 mg bid x 10 days
Pediatric: 30-50 mg/kg/day in 4 divided doses x 7 days; may double dose with
severe infection; max 100 mg/kg/day; see page 574 for dose by weight
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100,
200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab:
200 mg wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
E.E.S. 400 Tablets Tab: 400 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
loracarbef (B) 200 mg bid x 5 days
Pediatric: 15 mg/kg/day in 2 divided doses x 5 days; see page 581 for dose by
weight
Lorabid Pulvule: 200, 400 mg; Oral susp: 100 mg/5 ml (50, 100 ml);
200 mg/5 ml (50, 75, 100 ml) (strawberry bubble gum)
penicillin G (benzathine) (B)(G) 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 and 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; >60 mg: same as adult
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)(G) 500 mg bid or 250 mg qid x 10 days
Pediatric: 25-50 mg/kg day in 4 divided doses x 10 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)
Veetids Tab: 250, 500 mg; Oral soln: 125, 250 mg/5 ml (100, 200 ml)
PHEOCHROMOCYTOMA
ALPHA-BLOCKER
phenoxybenzamine (C) initially 10 mg bid; increase every other day as needed; usually
20-40 mg bid-tid
Dibenzyline Cap: 10 mg
y y y y y y y
t
y
P i t y r i a s i s A l b a ¦ 337
PINWORM (ENTEROBIUS VERMICULARIS)
Comment: Treatment of all family members is recommended.
ANTHELMINTICS
albendazole (C) 400 mg x 1 dose; may repeat in 2-3 weeks if needed; take with a meal
Pediatric: <20 kg: 200 mg as a single dose; >20kg: same as adult
Albenza Tab: 200 mg
mebendazole (C) chew, swallow, or mix with food; 100 mg x 1 dose; may repeat in 3
weeks if needed; take with a meal
Pediatric: <2 years: not recommended; =2 years: same as adult
Emverm Chew tab: 100 mg
Vermox (G) Chew tab: 100 mg
pyrantel pamoate (C) 11 mg/kg x 1 dose; max 1 g/dose; may repeat in 2-3 weeks if
needed; take with a meal
Pediatric: 25-37 lb: 1/2 tsp x 1 dose; 38-62 lb: 1 tsp x 1 dose; 63-87 lb: 1 tsp x 1 dose;
88-112 lb: 2 tsp x 1 dose; 113-137 lb: 2 tsp x 1 dose; 138-162 lb: 3 tsp x 1 dose; 163-
187 lb: 3 tsp x 1 dose; >187 lb: 4 tsp x 1 dose
Pin-X (OTC); Cap: 180 mg; Liq: 50 mg/ml (30 ml); 144 mg/ml (30 ml); Oral
susp: 50 mg/ml (30 ml)
thiabendazole (C) 50 mg/kg x 1 dose aft er a meal; max 3 g; may repeat in 2-3 weeks
if needed; take with a meal
Pediatric: same as adult
Mintezol Chew tab: 500*mg (orange); Oral susp: 500 mg/5 ml (120 ml) (orange)
Comment: thiabendazole should not be used as fi rst-line therapy for pinworms.
May impair mental alertness.
PITYRIASIS ALBA
Comment: Pityriasis alba is a chronic skin disorder seen in children with a genetic
predisposition to atopic disease. Treatment is directed toward controlling roughness
and pruritus. Th ere is no known treatment for the associated skin pigment changes.
Pityriasis alba resolves spontaneously and permanently in the 2nd or 3rd decade of life.
Topical Corticosteroids see page 506
COAL TAR PREPARATIONS
coal tar (C)
Pediatric: same as adult
Scytera (OTC) apply qd-qid; use lowest eff ective dose
Foam: 2%
T/Gel Shampoo Extra Strength (OTC) use every other day; max 4 x/week;
massage into aff ected area for 5 minutes; rinse; repeat
Shampoo: 1%
T/Gel Shampoo Original Formula (OTC) use every other day; max 7 x/week;
massage into aff ected area for 5 minutes; rinse; repeat
Shampoo: 0.5%
t
y y y y
t
y
338 ¦ P i t y r i a s i s A l b a
T/Gel Shampoo Stubborn Itch Control (OTC) use every other day; max 7 x/
week; massage into aff ected area for 5 minutes; rinse; repeat
Shampoo: 0.5%
EMOLLIENTS AND OTHER MOISTURIZING AGENTS
see Dermatitis: Atopic page 110
PITYRIASIS ROSEA
Topical Corticosteroids see page 506
Oral Drugs for Allergy, Cough, and Cold see page 535
PLAGUE (YERSINIA PESTIS)
Comment: Yersinia pestis is transmitted via the bite of a fl ea from an infected rodent or
the bite, lick, or scratch of an infected cat. Untreated bubonic plague may progress to
secondary pneumonic plague, which may be transmitted via contaminated respiratory
droplet spread.
streptomycin (C)(G) 15mg/kg IM bid x 10 days
Pediatric: same as adult
Amp: 1 g/2.5 ml or 400 mg/ml (2.5 ml)
Comment: For patients with renal impairment, reduce dose of streptomycin to 20
mg/kg/day if mild and 8 mg/kg/day q 3 days if advanced). For patients who are
pregnant or who have hearing impairment, shorten the course of treatment to 3
days aft er fever has resolved.
moxifl oxacin (C)(G) 400 mg daily x 10 days
Pediatric: <18 years: not recommended
Avelox Tab: 400 mg; IV soln: 400 mg/250 mg (latex-free, preservative-free)
Comment: moxifl oxacin is for prophylaxis as well as treatment for pneumonia
and septic plague. moxifl oxacin is contraindicated <18 years of age and during
pregnancy and lactation. Risk of tendonitis or tendon rupture, especially 60 yearsof-
age and older.
tetracycline (D)(G) 500 mg qid or 25-50 mg/kg/day divided q 6 hours x 10 days
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.
PNEUMOCYSTIS JIROVECI PNEUMONIA
atovaquone (C) take with food; Treatment: 750 mg once daily x 21 days; Prophylaxis:
1500 mg once daily
Pediatric: see mfr pkg insert
Mepron Susp: 750 mg/5 ml (citrus)
trimethoprim/sulfamethoxazole (C)(G) Prophylaxis: 1 tab 3 x/week; Treatment: 1 tab
daily x 3 weeks; Septra can be given if intolerable to Bactrim
t
t
y y y
t
y y
Pneumonia: C h l a m y d i a l ¦ 339
Pediatric: <2 months: not recommended; =2 months: 40 mg/kg/day of
sulfamethoxazole in 2 doses bid x 10 days
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg*
Bactrim Pediatric Suspension, Septra Pediatric Suspension
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy
or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended
PNEUMONIA: CHLAMYDIAL
RECOMMENDED REGIMEN
erythromycin base (B)(G) 500 mg qid hours x 10-14 days
Pediatric: <45 kg: 50 mg in 4 divided doses x 10-14 days; =45 kg: same as adult
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
erythromycin ethylsuccinate (B)(G) 400 mg qid x 10-14 days
Pediatric: <45 kg: 50 mg/kg/day in 4 divided doses x 10-14 days; =45 kg: same
as adult; see page 574 for dose by weight
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100, 200
ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab: 200 mg
wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
E.E.S. 400 Tablets Tab: 400 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
ALTERNATE REGIMENS
azithromycin (B)(G) 500 mg once daily x 10 days
Pediatric: 20 mg/kg per dose once daily x 3 days; max 500 mg/day; see page 559 for
dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
levofl oxacin (C) Uncomplicated: 500 mg daily x 7 days; Complicated: 750 mg daily
x 7 days
Pediatric: <18 years: not recommended
Levaquin Tab: 250, 500, 750 mg; Oral soln: 25 mg/ml (480 ml) (benzyl alcohol);
Inj conc: 25 mg/ml for IV infusion aft er dilution (20, 30 ml single-use vial)
(preservative-free); Premix soln: 5 mg/ml for IV infusion (50, 100, 150 ml)
(preservative-free)
t
y y y y
340 ¦ Pneumonia: C h l a m y d i a l
Comment: levofl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
PNEUMONIA: COMMUNITY ACQUIRED (CAP)/
COMMUNITY ACQUIRED BACTERIAL PNEUMONIA (CABP)
ANTI-INFFECTIVES
Age 3 Months-5 Years
amoxicillin (B)(G)
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
Amoxil Cap: 250, 500 mg; Tab: 875 mg; Chew tab: 125, 200, 250, 400 mg
(cherry-banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml (80,
100, 150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble gum);
Oral drops: 50 mg/ml (30 ml) (bubble gum)
Moxatag Tab: 775 mg ext-rel
Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80,
100, 150 ml) (raspberry-strawberry)
amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200,
400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana), 250
mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml) (orange)
(phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided
bid x 10 days see pages 556-557 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml)
(strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day
in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
azithromycin (B)(G)
Pediatric: <6 months: not recommended; =6 months: 10 mg/kg x 1 dose on day 1,
then 5 mg/kg/day on days 2-5; max 500 mg/day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
cefaclor (B)(G) 250 mg tid or 375 mg bid x 10 days
Pediatric: <1 month: not recommended; 20-40 mg/kg divided 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)
Cefaclor Extended Release
t
y y y y
Pneumonia: CAP/CABP ¦ 341
Pediatric: <16 years: ext-rel not recommended; =16 years: same as adult
Tab: 375, 500 mg ext-rel
ceft riaxone(B)(G)
Pediatric: 50-75 mg/kg IM in 2 divided doses; max 2 g/day
Rocephin Vial: 250, 500 mg; 1, 2 g
clarithromycin (C) 500 mg q 12 hours or 500 mg ext-rel daily x 10 days
Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg divided bid x 7-14
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
erythromycin base (B)(G)
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 estolate (B)(G)
Pediatric: 30-50 mg/kg/day in divided doses x 10 days; see page 573 for dose by
weight
Ilosone Pulvule: 250 mg; Tab: 500 mg; Liq: 125, 250 mg/5 ml (100 ml)
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
Age 5-18 Years
amoxicillin (B)(G) 875 mg bid or 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)
Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80,
100, 150 ml) (raspberry-strawberry)
amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200,
400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana),
250 mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml)
(orange) (phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided
bid x 10 days see pages 556-557 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml)
(strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day
in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
y y y y y y
342 ¦ Pneumonia: CAP/CABP
azithromycin (B)(G) weight-based or 500 mg x 1 dose on day 1, then 250 mg daily on
days 2-5 or 500 mg daily x 3 days or Zmax 2 g in a single dose
Pediatric: 10 mg/kg x 1 dose on day 1, then 5 mg/kg/day on days 2-5; max 500 mg/
day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
cefaclor (B)(G) 250 mg tid or 375 mg bid x 5 days
Pediatric: <1 month: not recommended; 20-40 mg/kg divided 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)
Cefaclor Extended Release
Pediatric: <16 years: ext-rel not recommended; =16 years: same as adult
Tab: 375, 500 mg ext-rel
cefdinir (B) 300 mg bid or 600 mg daily x 10 days
Pediatric: <6 months: not recommended; 6 months-12 years: 14 mg/kg/day in a
single or 2 divided doses x 10 days; >12 years: same as adult; see page 562 for dose
by weight
Omnicef
Cap: 300 mg; Oral susp: 125 mg/5 ml (60, 100 ml) (strawberry)
cefpodoxime proxetil (B) 200 mg bid x 14 days
Pediatric: 2 months-12 years: 10 mg/kg/day in 2 doses x 14 days; >12 years: same as
adult; see page 564 for dose by weight
Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 ml) (lemon creme)
ceft riaxone (B)
Pediatric: 50-75 mg/kg IM in 2 divided doses; max 2 g/day
Rocephin Vial: 250, 500 mg; 1, 2 g
clarithromycin (C) 7.5 mg/kg divided bid x 7-14 days
Pediatric: <6 months: not recommended; =6 months: 7.5 mg/kg bid x 7-14 days
Biaxin Tab: 250, 500 mg
Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruitpunch)
Biaxin XL Tab: 500 mg ext-rel
dirithromycin (C)(G) 500 mg daily x 14 days
Pediatric: <12 years: not recommended; =12 years: same as adult
Dynabac Tab: 250 mg
erythromycin base (B)(G) 500 mg q 6 hours x 10 days
Pediatric: <45 kg: 30-50 mg in 2-4 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.
erythromycin estolate (B) 250 mg q 6 hours or 500 mg bid x 10 days
Pediatric: 30-50 mg/kg/day in divided doses x 10 days; see page 573 for dose by weight
Ilosone Pulvule: 250 mg; Tab: 500 mg; Liq: 125, 250 mg/5 ml (100 ml)
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
y y y y y y y y y
Pneumonia: CAP/CABP ¦ 343
Age 18-60 Years Without Comorbidity
amoxicillin (B)(G) 500-875 mg bid or 250-500 mg tid x 10 days
Amoxil Cap: 250, 500 mg; Tab: 875*mg; Chew tab: 125, 200, 250, 400 mg
(cherry-banana-peppermint) (phenylalanine); Oral susp: 125, 250 mg/5 ml
(80, 100, 150 ml) (strawberry); 200, 400 mg/5 ml (50, 75, 100 ml) (bubble
gum); Oral drops: 50 mg/ml (30 ml) (bubble gum)
Moxatag Tab: 775 mg ext-rel
Trimox Tab: 125, 250 mg; Cap: 250, 500 mg; Oral susp: 125, 250 mg/5 ml (80,
100, 150 ml) (raspberry-strawberry)
amoxicillin/clavulanate (B)(G) 500 mg tid or 875 mg bid x 10 days
Augmentin Tab: 250, 500, 875 mg; Chew tab: 125, 250 mg (lemon-lime); 200,
400 mg (cherry-banana) (phenylalanine); Oral susp: 125 mg/5 ml (banana), 250
mg/5 ml (75, 100, 150 ml) (orange); 200, 400 mg/5 ml (50, 75, 100 ml) (orange)
(phenylalanine)
Pediatric: 40-45 mg/kg/day divided tid x 10 days or 90 mg/kg/day divided
bid x 10 days see pages 556-557 for dose by weight
Augmentin ES-600 Oral susp: 600 mg/5 ml (50, 75, 100, 125, 150, 200 ml)
(strawberry cream) (phenylalanine) every 12 hours
Pediatric: <3 months: not recommended; =3 months, <40 kg: 90 mg/kg/day
in 2 divided doses; =40 kg: not recommended
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
azithromycin (B)(G) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500
mg daily x 3 days or Zmax 2 g in a single dose
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 mg tid or 375 mg bid x 10 days
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)
Cefaclor Extended Release
Pediatric: <16 years: ext-rel not recommended; =16 years: same as adult
Tab: 375, 500 mg ext-rel
cefdinir (B) 300 mg bid or 600 mg daily x 10 days
Omnicef Cap: 300 mg; Oral susp: 125 mg/5 ml (60, 100 ml) (strawberry)
cefpodoxime proxetil (B) 200 mg bid x 14 days
Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 ml) (lemon creme)
ceft aroline fosamil (B) administer by IV infusion aft er reconstitution every 12 hours
x 5-7 days; CrCl =50 mL/min: 600 mg; CrCl >30-<50 mL/min: 400 mg; CrCl: >15-
<30 mL/min: 300 mg; ES RD: 200 mg
Tefl aro Vial: 400, 600 mg
ceft riaxone (B)(G) 1-2 g IM daily; max 4 g
Rocephin Vial: 250, 500 mg; 1, 2 g
clarithromycin (C)(G) 500 mg bid or 500 mg ext-rel daily x 7-14 days
Biaxin Tab: 250, 500 mg
Biaxin Oral Suspension Oral susp: 125, 250 mg/5 ml (50, 100 ml) (fruit-punch)
y y y y y y y y y
344 ¦ Pneumonia: CAP/CABP
Biaxin XL Tab: 500 mg ext-rel
dirithromycin (C)(G) 500 mg daily x 14 days
Dynabac Tab: 250 mg
doxycycline (D)(G) 100 mg bid x 7-14 days
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.
ertapenem (B) 1 g daily; CrCl <30 mL/min: 500 mg daily x 3-10 days; may switch to
an oral antibiotic aft er 3 days if warranted; IV infusion: administer over 30 minutes;
IM injection: reconstitute with lidocaine only
Ivanz Vial: 1 g pwdr for reconstitution
erythromycin base (B)(G) 500 mg q 6 hours x 14-21 days; <45 kg: 30-50 mg in 2-4
doses x 14-21 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 estolate (B) 500 mg q 6 hours x 14-21 days
Ilosone Pulvule: 250 mg; Tab: 500 mg; Liq: 125, 250 mg/5 ml (100 ml)
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
gemifl oxacin (C)(G) 320 mg daily x 5-7 days
Pediatric: <18 years: not recommended
Factive Tab: 320* mg
Comment: gemifl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
levofl oxacin (C) Uncomplicated: 500 mg once daily x 7-14 days; Complicated: 750 mg
once daily x 7-14 days
Pediatric: <18 years: not recommended
Levaquin Tab: 250, 500, 750 mg; Oral soln: 25 mg/ml (480 ml) (benzyl alcohol);
Inj conc: 25 mg/ml for IV infusion aft er dilution (20, 30 ml single-use vial)
(preservative-free); Premix soln: 5 mg/ml for IV infusion (50, 100, 150 ml)
(preservative-free)
Comment: levofl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
linezolid (C)(G) 600 mg q 12 hours x 10-14 days
Pediatric: <5 years: 10 mg/kg q 8 hours x 10-14 days; 5-11 years: 10 mg/kg q 12 hours
x 10-14 days; >11years: same as adult
Zyvox Tab: 400, 600 mg; Oral susp: 100 mg/5 ml (150 ml) (orange) (phenylalanine)
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Pneumonia: CAP/CABP ¦ 345
Comment: linezolid is indicated to treat susceptible vancomycin-resistant E. faecium
infections.
loracarbef (B) 400 mg bid x 14 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)
moxifl oxacin (C)(G) 400 mg daily x 10 days
Pediatric: <18 years: recommended
Avelox Tab: 400 mg; IV soln: 400 mg/250 mg (latex-free, preservative-free)
Comment: moxifl oxacin is contraindicated <18 years of age and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
ofl oxacin (C)(G) 400 mg bid x 10 days
Pediatric: <18 years: not recommended
Floxin Tab: 200, 300, 400 mg
Comment: ofloxacin is contraindicated <18 years of age and during pregnancy and
lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
tedizolid phosphate (B) administer 200 mg once daily x 6 days, via PO or IV infusion
over 1 hour
Pediatric: <18 years: not established
Sivextro Tab: 200 mg (6/blister pck)
Comment: Sivextro is indicated for the treatment of adults with community
acquired bacterial pneumonia (CABP)
telithromycin (C) 2 x 400 mg tabs in a singe dose daily x 7-10 days
Ketek Tab: 300, 400 mg
Comment: telithromycin is contraindicated with PMHx hepatitis or jaundice
associated with macrolide use.
tigecycline (D)(G) 100 mg once; then 50 mg q 12 hours x 7-14 days; Severe hepatic
impaitment (Child Pugh C): 100 mg once; then 25 mg q 12 hours
Pediatric: <18 years: not recommended
Tygacil Vial: 50 mg pwdr for reconstitution and IV infusion (preservative-free)
Comment: Tygacil is indicated only for the treatment of adults with community
acquired bacterial pneumonia (CABP). tigecycline is contraindicated <8 yearsof-
age, in pregnancy, and lactation (discolors developing tooth enamel). A side
eff ect may be photo-sensitivity (photophobia). Do not give with antacids, calcium
supplements, milk or other dairy, or within two hours of taking another drug.
Age Over 60 Years or Presence of Comorbidity
Comment: Consider respiratory quinolone for presence of comorbidity
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
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346 ¦ Pneumonia: CAP/CABP
Augmentin XR 2 tabs q 12 hours x 7-10 days
Pediatric: <16 years: use other forms; =16 years: same as adult
Tab: 1000*mg ext-rel
azithromycin (B)(G) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500
mg daily x 3 days or Zmax 2 g in a single dose
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 mg tid or 375 mg bid x 7 days
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)
Cefaclor Extended Release
Pediatric: <16 years: ext-rel not recommended
Tab: 375, 500 mg ext-rel
cefdinir (B) 300 mg bid or 600 mg daily x 10 days
Omnicef Cap: 300 mg; Oral susp: 125 mg/5 ml (60, 100 ml) (strawberry)
cefpodoxime proxetil (B) 200 mg bid x 14 days
Vantin Tab: 100, 200 mg; Oral susp: 50, 100 mg/5 ml (50, 75, 100 ml) (lemon
creme)
ceft riaxone (B)(G) 1-2 g IM once daily; max 4 g
Rocephin Vial: 250, 500 mg; 1, 2 g
clarithromycin (C)(G) 500 mg bid x 7-14 days
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
dirithromycin (C)(G) 500 mg daily x 14 days
Dynabac Tab: 250 mg
gemifl oxacin (C)(G) 320 mg daily x 5-7 days
Pediatric: <18 years: not recommended
Factive Tab: 320* mg
Comment: gemifl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
levofl oxacin (C)
Pediatric: <18 years: not recommended; Uncomplicated: 500 mg daily x 7-14 days;
Complicated: 750 mg daily x 7-14 days
Levaquin Tab: 250, 500, 750 mg; Oral soln: 25 mg/ml (480 ml) (benzyl alcohol);
Inj conc: 25 mg/ml for IV infusion aft er dilution (20, 30 ml single-use vial)
(preservative-free); Premix soln: 5 mg/ml for IV infusion (50, 100, 150 ml)
(preservative-free)
Comment: levofl oxacin is contraindicated <18 years-of-age and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
loracarbef (B) 400 mg bid x 14 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)
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Pneumonia: L e g i o n e l l a ¦ 347
trimethoprim/sulfamethoxazole (C)(G)
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg*
Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy
or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended.
telithromycin (C) 2 x 400 mg tabs in a singe dose daily x 7-10 days
Ketek Tab: 300, 400 mg
Comment: telithromycin is contraindicated with PMHx hepatitis or jaundice
associated with macrolide use.
PNEUMONIA: LEGIONELLA
ciprofl oxacin (C) 500 mg bid x 14-21 days
Pediatric: <18 years: not recommended
Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry)
Cipro XR Tab: 500, 1000 mg ext-rel
ProQuin XR Tab: 500 mg ext-rel
Comment: ciprofl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
clarithromycin (C)(G) 500 mg bid or 500 mg ext-rel daily x 14-21 days
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
dirithromycin (C)(G) 500 mg once daily x 14-21 days
Dynabac Tab: 250 mg
erythromycin base (B)(G) 500 mg qid x 14-21 days
Pediatric: <45 kg: 30-50 mg in 2-4 divided doses x 14-21 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 estolate (B)(G) 1-2 g daily in divided doses x 14-21 days
Pediatric: 30-50 mg/kg/day in divided doses x 14-21 days; see page 573 for dose by
weight
Ilosone Pulvule: 250 mg; Tab: 500 mg; Liq: 125, 250 mg/5 ml (100 ml)
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
trimethoprim/sulfamethoxazole (C)(G)
Pediatric: <2 months: not recommended; =2 months: 40 mg/kg/day of sulfamethoxazole
in 2 doses bid x 10 days
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg*
Bactrim Pediatric Suspension, Septra Pediatric Suspension
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348 ¦ Pneumonia: L e g i o n e l l a
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy
or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended.
PNEUMONIA: MYCOPLASMA
ANTI-INFECTIVES
azithromycin (B)(G) 500 mg x 1 dose on day 1, then 250 mg daily on days 2-5 or 500
mg daily x 3 days or Zmax 2 g in a single dose
Pediatric: 12 mg/kg/day x 5 days; max 500 mg/day; see page 559 for dose by weight
Zithromax Tab: 250, 500, 600 mg; Oral susp: 100 mg/5 ml (15 ml); 200 mg/5 ml
(15, 22.5, 30 ml) (cherry); Pkt: 1 g for reconstitution (cherry-banana)
Zithromax Tri-pak Tab: 3 x 500 mg tabs/pck
Zithromax Z-pak Tab: 6 x 250 mg tabs/pck
Zmax Oral susp: 2 g ext-rel for reconstitution (cherry-banana) (148 mg Na+)
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) (fruit-punch)
Biaxin XL Tab: 500 mg ext-rel
erythromycin base (B)(G) 500 mg q 6 hours x 14-21 days
Pediatric: <45 kg: 30-50 mg in 2-4 doses x 14-21 days; =45 kg: same as adult
Ery-Tab Tab: 250, 333, 500 mg ent-coat
PCE Tab: 333, 500 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
erythromycin ethylsuccinate (B)(G) 400 mg qid x 14-21 days
Pediatric: 30-50 mg/kg/day in 4 divided doses x 14-21 days; may double dose with
severe infection; max 100 mg/kg/day; see page 574 for dose by weight
EryPed Oral susp: 200 mg/5 ml (100, 200 ml) (fruit); 400 mg/5 ml (60, 100,
200 ml) (banana); Oral drops: 200, 400 mg/5 ml (50 ml) (fruit); Chew tab:
200 mg wafer (fruit)
E.E.S. Oral susp: 200, 400 mg/5 ml (100 ml) (fruit)
E.E.S. Granules Oral susp: 200 mg/5 ml (100, 200 ml) (cherry)
E.E.S. 400 Tablets Tab: 400 mg
Comment: erythromycin may increase INR with concomitant warfarin, as well as
increase serum level of digoxin, benzodiazepines and statins.
tetracycline (D)(G) 500 mg qid
Pediatric: <8 years: not recommended; =8 years, <100 lb: 25-50 mg/kg/day in 2-4
divided doses; =8 years, =100 lb: same as adult; see page 585 for dose by weight
Achromycin V Cap: 250, 500 mg
Sumycin Tab: 250, 500 mg; Cap: 250, 500 mg; Oral susp: 125 mg/5 ml (100, 200
ml) (fruit) (sulfi tes)
Comment: tetracycline is contraindicated <8 years-of-age, in pregnancy, and
lactation (discolors developing tooth enamel). A side eff ect may be photosensitivity
(photophobia). Do not give with antacids, calcium supplements, milk or
other dairy, or within two hours of taking another drug.
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Po l y a r t i c u l a r J u v e n i l e I d i o p a t h i c A r t h r i t i s ( P J I A ) ¦ 349
PNEUMONIA: PNEUMOCOCCAL
PROPHYLAXIS
pneumococcal vaccine (C) 0.5 ml IM or SC in deltoid x 1 dose
Pneumovax
Pediatric: <2 years: not recommended; =2 years: same as adult
Vial: 25 mcg/0.5 ml (0.5 ml single-dose, 10/pck; 2.5 ml)
Pnu-Imune 23
Pediatric: <2 years: not recommended; =2 years: same as adult
Vial: 25 mcg/0.5 ml (0.5 ml single-dose, 5/pck; 2.5 ml)
Prevnar 13 for adults =50 years of age
Pediatric: total 4 doses: 2, 4, 6, and 12-15 months-of-age; may start at 6 weeks
of age; administer fi rst 3 doses 4-8 weeks apart and the 4th dose at least 2
months aft er the 3rd dose
Vial: 25 mcg/0.5 ml (2.5 ml multi-dose; Prefi lled syringe: (0.5 ml single-dose
10/pck)
Comment: Pneumococcal vaccine contains 23 polysaccharide isolates representing
approximately 85-90% of common U.S. isolates. Administer the pneumococcal
vaccine in the anterolateral aspect of the thigh for infants and the deltoid for
toddlers, children, and adults.
TREATMENT
see CAP/CABP page 340
POLIOMYELITIS
PROPHYLAXIS
trivalent poliovirus vaccine, inactivated (type 1, 2, and 3) (C)
Pediatric: <6 weeks: not recommended; =6 weeks: one dose at 2, 4, 6-18 months
and 4-6 years of age
Ipol 0.5 ml SC or IM in deltoid area
POLYARTICULAR JUVENILE IDIOPATHIC
ARTHRITIS (PJIA)
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 or qid prn to intact skin
Pediatric: <2 years: not recommended; =2 years: same as adult
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350 ¦ Po l y a r t i c u l a r J u v e n i l e I d i o p a t h i c A r t h r i t i s ( P J I A )
Axsain Crm: 0.075% (1, 2 oz)
Capsin Lotn: 0.025, 0.075% (59 ml)
Capzasin-P (OTC) Crm: 0.025% (1.5 oz); Lotn: 0.025% (2 oz)
Dolorac Crm: 0.025% (28 g)
Double Cap (OTC) Crm: 0.05% (2 oz)
R-Gel Gel: 0.025% (15, 30 g)
Zostrix (OTC) Crm: 0.025% (0.7, 1.5, 3 oz)
Zostrix HP (OTC) Emol crm: 0.075% (1, 2 oz)
Comment: Provides some relief by 1-2 weeks; optimal benefi t may take 4-6 weeks.
ORAL SALICYLATES
indomethacin (C) initially 25 mg bid or tid, increase as needed at weekly intervals by
25-50 mg/day; max 200 mg/day
Pediatric: <14 years: usually not recommended; >2 years, if risk warranted: 1-2 mg/
kg/day in divided doses; max 3-4 mg/kg/day (or 150-200 mg/day, whichever is less;
<14 years, ER cap not recommended
Cap: 25, 50 mg; Susp; 25 mg/5 ml (pineapple-coconut, mint) (alcohol 1%); Supp: 50
mg; ER Cap: 75 mg ext-rel
Comment: indomethacin is indicated only for acute painful fl ares. Administer with
food and/or antacids. Use lowest eff ective dose for shortest duration.
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 dose pack)
Trexall Tab: 5*, 7.5*, 10*, 15*mg (5, 7.5, 10, 12.5, 15 mg/week, 4/card unit dose
pack)
Comment: methotrexate (MTX) is contraindicated with immunodefi ciency, blood
dyscrasias, alcoholism, and chronic liver disease.
POLYCYSTIC OVARIAN SYNDROME
(PCOS, STEIN-LEVENTHAL DISEASE)
See Contraceptives page 486
See Type 2 Diabetes Mellitus page 431
POLYMYALGIA RHEUMATICA
Comment: Initial treatment is low-dose prednsone at 12-25 mg/day. May attempt a
very slow tapering regimen aft er 2-4 weeks. If relapse occurs, increase the daily dose of
corticosteroid to the previous eff ective dose. Most people with polymyalgia rheumatica
need to continue corticosteroid treatment for at least a year. Approximately 30-60%
of people will have at least one relapse during corticosteroid tapering. Joint guidelines
from the American Academy of Rheumatology (AAR) and the European League
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Po s t h e r p e t i c N e u r a l g i a ¦ 351
Against Rheumatism (ELAR) suggest using concomitant methotrexate (MTX) along
with corticosteroids in some patients. It may be useful early in the course of treatment
or later, if the patient relapses or does not respond to corticosteroids. 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.
Oral Corticosteroids see page 509
For calcium and vitamin D supplementation, see Hypocalcemia page 226
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 dose pack)
TrexallR Tab: 5*, 7.5*, 10*, 15*mg (5, 7.5, 10, 12.5, 15 mg/week, 4/card unit dose
pack)
Comment: methotrexate (MTX) is contraindicated with immunodefi ciency, blood
dyscrasias, alcoholism, and chronic liver disease.
POSTHERPETIC NEURALGIA
GAMMA AMINOBUTYRIC ACID ANALOG
gabapentin (C) CrCl 30-60 mL/min: 600-1800 mg; CrCl <30 mL/min or on hemodialysis:
not recommended
Comment: Avoid abrupt cessation of gabapentin and gabapentin enacarbil. To
discontinue, withdraw gradually over 1 week or longer.
Pediatric: <18 years: not recommended
Gralise initially 300 mg on Day 1; then 600 mg on Day 2; then 900 mg on Days
3-6; then 1200 mg on Days 7-10; then 1500 mg on Days 11-14; titrate up to
1800 mg on Day 15; take entire dose once daily with the evening meal; do not
crush, split, or chew
Tab: 300, 600 mg
Neurontin (G) 300mg daily x 1 day, then 300 mg bid x 1 day, then 300 mg tid
continuously; max 1,800 mg/day in 3 divided doses; taper over 7 days
Pediatric: <3 years: not recommended; 3-12 years: initially 10-15 mg/kg/
day in 3 divided doses; max 12 hours between doses; titrate over 3 days; 3-4
years: titrate to 40 mg/kg/day; 5-12 years: titrate to 25-35 mg/kg/day; max
50 mg/kg/day;
Tab: 600*, 800* mg; Cap: 100, 300, 400 mg; Oral soln: 250 mg/5 ml (480 ml)
(strawberry-anise) >12 years: same as adult
gabapentin enacarbil (C) 600 mg once daily at about 5:00 PM; if dose not taken at
recommended time, next dose should be taken the following day; swallow whole;
take with food; CrCl 30-59 mL/min: 600 mg on Day 1, Day 3, and every day thereafter;
CrCl <30 mL/min: or on hemodialysis: not recommended
Pediatric: not recommended
Horizant Tab: 600 ext-rel
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352 ¦ Po s t h e r p e t i c N e u r a l g i a
Tricyclic Antidepressants (TCAs)
Comment: Co-administration of SSRIs and TCAs requires extreme caution.
amitriptyline (C)(G) initially 75 mg/day in divided doses of 50-100 mg/day q HS;
max 300 mg/day
Pediatric: not recommended
Tab: 10, 25, 50, 75, 100, 150 mg
amoxapine (C) initially 50 mg bid-tid; aft er 1 week may increase to 100 mg bid-tid;
usual eff ective dose 200-300 mg/day; if total dose exceeds 300 mg/day, give in divided
doses (max 400 mg/day); may give as a single bedtime dose (max 300 mg q HS)
Pediatric: not recommended
Tab: 25, 50, 100, 150 mg
desipramine (C)(G) 100-200 mg/day in single or divided doses; max 300 mg/day
Pediatric: not recommended
Norpramin Tab: 10, 25, 50, 75, 100, 150 mg
doxepin (C)(G) 75 mg/day; max 150 mg/day
Pediatric: not recommended
Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
imipramine (C)(G)
Pediatric: not recommended
Tofranil initially 75 mg daily (max 200 mg); adolescents initially 30-40 mg daily
(max 100 mg/day); if maintenance dose exceeds 75 mg daily, may switch to
Tofranil PM for divided or bedtime dose
Tab: 10, 25, 50 mg
Tofranil PM initially 75 mg daily 1 hour before HS; max 200 mg
Cap: 75, 100, 125, 150 mg
Tofranil Injection 50 mg IM; lower dose for adolescents; switch to oral form as
soon as possible
Amp: 25 mg/2 ml (2 ml)
nortriptyline (D)(G) initially 25 mg tid-qid; max 150 mg/day
Pediatric: not recommended
Pamelor Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml (16 oz)
protriptyline (C) initially 5 mg tid; usual dose 15-40 mg/day in 3-4 divided doses;
max 60 mg/day
Pediatric: <12 years: not recommended
Vivactyl Tab: 5, 10 mg
trimipramine (C) initially 75 mg/day in divided doses; max 200 mg/day
Pediatric: not recommended
Surmontil Cap: 25, 50, 100 mg
a2-DELTA LIGAND
pregabalin (GABA analog) (C)(V) initially 150 mg daily divided bid-tid and may
titrate within one week; max 600 mg divided bid-tid; discontinue over one week
Pediatric: <18 years: not recommended
Lyrica Cap: 25, 50, 75, 100, 150, 200, 225, 300 mg; Oral soln: 20 mg/ml
TOPICAL/TRANSDERMAL ANALGESICS
capsaicin (B)(G) apply tid-qid prn to intact skin; avoid mucus membranes
Pediatric: <2 years: not recommended; =2 years: same as adult
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Po s t h e r p e t i c N e u r a l g i a ¦ 353
Double Cap (OTC) Crm: 0.05% (2 oz)
Qutenza Patch: 8% (1-2, both with 50 g tube of cleansing gel)
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.
diclofenac epolamine (C) apply one patch to aff ected area bid; remove during bathing;
avoid non-intact skin; do not re-use
Pediatric: not recommended
Flector Patch Patch: 180 mg/patch (30/carton)
Comment: diclofenac is contraindicated with aspirin allergy and late pregnancy.
doxepin (B) cream apply to aff ected area qid at intervals of at least 3-4 hours; max
8 days
Pediatric: not recommended
Prudoxin Crm: 5% (45 g)
Zonalon Crm: 5% (30, 45 g)
tacrolimus (C) apply to aff ected area bid; continue for 1 week aft er clearing
Pediatric: <2 years: not recommended; 2-15 years: use 0.03% strength
Protopic Oint: 0.03, 0.1% (30, 60 g)
TOPICAL/TRANSDERMAL ANESTHETICS
lidocaine cream (B)
Pediatric: not recommended
LidaMantle Crm: 3% (1, 2 oz)
Lidoderm Crm: 3% (85 g)
lidocaine lotion (B)
Pediatric: not recommended
LidaMantle Lotn: 3% (177 ml)
lidocaine 5% patch (B)(G) apply up to 3 patches at one time for up to 12 hours/24-
hour period (12 hours on/12 hours off ); patches may be cut into smaller sizes before
removal of the release liner; do not re-use
Pediatric: not recommended
Lidoderm Patch: 5% (10×14 cm; 30/carton)
lidocaine/dexamethasone (B)
Decadron Phosphate with Xylocaine dexa 4 mg/lido 10 mg per ml (5 ml)
lidocaine/hydrocortisone (B)(G)
Pediatric: not recommended
LidaMantle HC Crm: lido 3%/hydro 0.5% (1, 3 oz); Lotn: (177 ml)
Acetaminophen for IV Infusion see Pain page 306
ORAL ANALGESICS
acetaminophen (B)(G) see Fever page 143
aspirin (D)(G) see Fever page 144
Comment: aspirin-containing medications are contraindicated with history of
allergic-type reaction to aspirin, children and adolescents with Varicella or other
viral illness, and 3rd trimester pregnancy.
tramadol (C)(IV)(G)
Rybix ODT initially 100 mg once daily; may increase by 100 mg every 5 days;
max 300 mg/day; CrCl <30 mL/min or severe hepatic impairment: not recommended;
Cirrhosis: max 50 mg q 12 hours
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354 ¦ Po s t h e r p e t i c N e u r a l g i a
Pediatric: <17 years: not recommended
ODT: 50 mg (mint) (phenylalanine)
Ryzolt initially 100 mg once daily; may increase by 100 mg every 5 days; max 300
mg/day; CrCl <30 mL/min or severe hepatic impairment: not recommended
Pediatric: <16 years: not recommended; =16 years: same as adult
Tab: 100, 200, 300 mg ext-rel
Ultram 50-100 mg q 4-6 hours prn; max 400 mg/day; CrCl <30 mL/min: max
100 mg q 12 hours; Cirrhosis: max 50 mg q 12 hours
Pediatric: <16 years: not recommended; =16 years: same as adult
Tab: 50*mg
Ultram ER initially 100 mg once daily; may increase by 100 mg every 5 days; max
300 mg/day; CrCl <30 mL/min: or severe hepatic impairment: not recommended
Pediatric: <18 years: not recommended
Tab: 100, 200, 300 mg ext-rel
tramadol/acetaminophen (C)(IV)(G) 2 tabs q 4-6 hours; max 8 tabs/day; 5 days;
CrCl <30 mL/min: max 2 tabs q 12 hours; max 4 tabs/day x 5 days
Pediatric: <16 years: not recommended; =16 years: same as adult
Ultracet Tab: tram 37.5/acet 325 mg
Other Oral Analgesics see Pain page 308
TRICYCLIC ANTIDEPRESSANTS (TCAs)
Comment: Co-administration of TCAs with SSRIs requires extreme caution.
amitriptyline (C)(G) titrate to achieve pain relief; max 300 mg/day
Pediatric: not recommended
Tab: 10, 25, 50, 75, 100, 150 mg
amoxapine (C) titrate to achieve pain relief; if total dose exceeds 300 mg/day, give
in divided doses; max 400 mg/day
Pediatric: not recommended
Tab: 25, 50, 100, 150 mg
desipramine (C)(G) titrate to achieve pain relief; max 300 mg/day
Pediatric: not recommended
Norpramin Tab: 10, 25, 50, 75, 100, 150 mg
doxepin (C)(G) titrate to achieve pain relief; max 150 mg/day
Pediatric: not recommended
Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
imipramine (C)(G)
Pediatric: not recommended
Tofranil titrate to achieve pain relief; max 200 mg/day; adolescents max 100
mg/day; if maintenance dose exceeds 75 mg/day, may switch to Tofranil PM at
bedtime
Tab: 10, 25, 50 mg
Tofranil PM titrate to achieve pain relief; initially 75 mg at HS; max 200 mg at HS
Cap: 75, 100, 125, 150 mg
Tofranil Injection 50 mg IM; lower dose for adolescents; switch to oral form as
soon as possible
Amp: 25 mg/2 ml (2 ml)
nortriptyline (D)(G) titrate to achieve pain relief; initially 10-25 mg tid-qid; max
150 mg/day; lower doses for elderly and adolescents
Pediatric: not recommended
Pamelor titrate to achieve pain relief; max 150 mg/day y
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Po s t – Traumat i c S t r e s s D i s o r d e r ( P T S D ) ¦ 355
Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml (16 oz)
protriptyline (C) titrate to achieve pain relief; initially 5 mg tid; max 60 mg/day
Pediatric: <12 years: not recommended
Vivactyl Tab: 5, 10 mg
trimipramine (C) titrate to achieve pain relief; max 200 mg/day
Pediatric: not recommended
Surmontil Cap: 25, 50, 100 mg
POST-TRAUMATIC STRESS DISORDER (PTSD)
Comment: No one pharmacological agent has emerged as the best treatment
for PTSD. A combination of pharmacological agents (e.g., antidepressants,
nonadrenergic agents, antipsychosis drugs) may comprise an individualized
treatment plan to successfully manage core symptoms of PTSD as well as associated
anxiety, depression, sleep disturbances, and co-occurring psychiatric disorders.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Comment: Th e FDA has approved two SSRIs for the treatment of PTSD: paroxetine
and sertraline. However, the safety and effi cacy of other SSRIs (fl uoxetine, citalopram,
escitalopram, fl uvoxamine) have been tested in clinical practice. Co-administration
of SSRIs with TCAs requires extreme caution. Concomitant use of MAOIs and SSRIs
is absolutely contraindicated. Avoid St. John’s wort and other serotonergic agents.
A potentially fatal adverse event is serotonin syndrome, caused by serotonin excess.
Milder symptoms require HCP intervention to avert severe symptoms which can be
rapidly fatal without urgent/emergent medical care. Symptoms include restlessness,
agitation, confusion, hallucinations, tachycardia, hypertension, dilated pupils,
muscle twitching, muscle rigidity, loss of muscle coordination, diaphoresis, diarrhea,
headache, shivering, piloerection, hyperpyrexia, cardiac arrhythmias, seizures, loss
of consciousness, coma, death. Abrupt withdrawal or interruption of treatment
with an antidepressant medication is sometimes associated with an Antidepressant
Discontinuation Syndrome which may be mediated by gradually tapering the drug
over a period of two weeks or longer, depending on the dose strength and length of
treatment. Common symptoms of the serotonin discontinuation Syndrome include fl ulike
symptoms (nausea, vomiting, diarrhea, headaches, sweating), sleep disturbances
(insomnia, nightmares, constant sleepiness), mood disturbances (dysphoria, anxiety,
agitation), cognitive disturbances (mental confusion, hyperarousal), sensory and
movement disturbances (imbalance, tremors, vertigo, dizziness, electric-shock-like
sensations in the brain, oft en described by suff erers as “brain zaps.”
paroxetine maleate (D)(G)
Pediatric: not recommended
Paxil initially 20 mg daily in AM; may increase by 10 mg/day at weekly intervals
as needed; max 60 mg/day
Tab: 10*, 20*, 30, 40 mg
Paxil CR initially 25 mg daily in AM; may increase by 12.5 mg at weekly intervals
as needed; max 62.5 mg/day
Tab: 12.5, 25, 37.5 mg cont-rel ent-coat
Paxil Suspension initially 20 mg daily in AM; may increase by 10 mg/day at
weekly intervals as needed; max 60 mg/day
Oral susp:10 mg/5 ml (250 ml; orange)
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sertraline (C) initially 50 mg daily; increase at 1 week intervals if needed; max
200 mg daily
Pediatric: <6 years: not recommended; 6-12 years: initially 25 mg daily; max 200
mg/day; 13-17 years: initially 50 mg daily; max 200 mg/day
Zoloft Tab: 15*, 50*, 100*mg; Oral conc: 20 mg per ml (60 ml [dilute just before
administering in 4 oz water, ginger ale, lemon-lime soda, lemonade, or orange
juice]) (alcohol 12%)
ATYPICAL ANTIPSYCHOSIS DRUGS
olanzapine (C)(G) initially 2.5-5 mg once daily at HS; increase by 5 mg every week to
20 mg at HS; usual maintenance 10-20 mg/day
Zyprexa Tab: 2.5, 5, 7.5, 10, 15, 20 mg
Zyprexa Zydis ODT: 5, 10, 15, 20 mg (phenylalanine)
quetiapine (C)(G) initially 25 mg bid; increase total daily dose by 50 mg, as needed
and tolerated, to max 300-600 mg/day
Seroquel Tab: 25, 100, 200, 300 mg
Seroquel XR Tab: 50, 150, 200, 300, 400 mg ext-rel
risperidone (C)(G) initially 0.5-1 mg bid; titrate to 3 mg bid by the end of the fi rst
week; usual maintenance 4-6 mg/day
Risperdal Tab: 0.25, 0.5, 1, 2, 3, 4 mg; Soln: 1 mg/ml (30 ml w. pipette); Consta
(Inj): 25, 37.5, 50 mg
Risperdal M-Tabs M-tab: 0.5, 1, 2, 3, 4 mg orally-disint (phenylalanine)
NONADRENERGIC AGENTS
ALPHA-1 ANTAGONISTS
Comment: prazosin is useful in reducing combat-trauma nightmares, normalizing
dreams for combat veterans, and mediating other sleep disturbances.
prazosin (C)(G) fi rst dose at HS, 1 mg bid-tid; increase dose slowly; usual range 6-15
mg/day in divided doses; max 20-40 mg/day
Pediatric: not recommended
Minipress Cap: 1, 2, 5 mg
CENTRAL ALPHA-2 AGONISTS
Comment: clonidine is useful to reduce nightmares, hypervigilance, startle reactions,
and outbursts of rage.
clonidine (C)
Pediatric: <12 years: not recommended; =12 years: same as adult
Catapres initially 0.1 mg bid; usual range 0.2-0.6 mg/day in divided doses; max
2.4 mg/day Tab: 0.1*, 0.2*, 0.3*mg
Catapres-TTS initially 0.1 mg patch weekly; increase aft er 1-2 weeks if needed;
max 0.6 mg/day
Patch: 0.1, 0.2 mg/day (12/carton); 0.3 mg/day (4/carton)
Kapvay (G) initially 0.1 mg bid; usual range 0.2-0.6 mg/day in divided doses;
max 2.4 mg/day Tab: 0.1, 0.2 mg
Nexiclon XR initially 0.18 mg (2 ml) suspension or 0.17 mg tab once daily;
usual max 0.52 mg (6 ml suspension) once daily
Tab: 0.17, 0.26 mg ext-rel; Oral susp: 0.09 mg/ml ext-rel (4 oz)
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Po s t – Traumat i c S t r e s s D i s o r d e r ( P T S D ) ¦ 357
BETA-ADRENERGIC BLOCKER (NON-CARDIOSELECTIVE)
Comment: propranolol is useful to mediate hyperarousal. For other noncardioselective
beta-adrenergic blockers, see Hypertension, page 208
propranolol (C)(G) 40-240 mg daily
Pediatric: not recommended
Inderal Tab: 10*, 20*, 40*, 60*, 80*mg
Inderal LA initially 80 mg daily in a single dose; increase q 3-7 days; usual range
120-160 mg/day; max 320 mg/day in a single dose
SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)
desvenlafaxine (C)(G) swallow whole; initially 50 mg once daily; max 120 mg/day
Pediatric: not recommended
Pristiq Tab: 50, 100 mg ext-rel
duloxetine (C)(G) swallow whole; initially 30 mg once daily x 1 week; then increase
to 60 mg once daily; max 120 mg/day
Pediatric: not recommended
Cymbalta Cap: 20, 30, 40, 60 mg del-rel
venlafaxine (C)(G)
Eff exor initially 75 mg/day in 2-3 divided doses; may increase at 4-day intervals
in 75 mg increments to 150 mg/day; max 225 mg/day
Pediatric: <18 years: not recommended
Tab: 37.5, 75, 150, 225 mg
Eff exor XR initially 75 mg q AM; may start at 37.5 mg daily x 4-7 days, then
increase by increments of up to 75 mg/day at intervals of at least 4 days; usual
max 375 mg/day
Pediatric: not recommended
Tab/Cap: 37.5, 75, 150 mg ext-rel
5HT2/3 RECEPTOR BLOCKERS
mirtazapine (C) initially 15 mg q HS; increase at intervals of 1-2 weeks; 1-2 weeks;
usual range 15-60 mg/day; max 60 mg/day
Pediatric: not recommended
Remeron Tab: 15*, 30*, 45*mg
Remeron SolTab ODT: 15, 30, 45 mg (orange) (phenylalanine)
SEROTONIN/ACETYLCHOLINE/NOREPINEPHRINE/DOPAMINE BLOCKER
trazodone (C)(G) initially 150 mg/day in divided doses with food; increase by 50 mg/
day q 3-4 days; max 400 mg/day in divided doses or 50-400 mg at HS
Pediatric: <18 years: not recommended
Oleptro Tab: 50, 100*, 150*, 200, 250, 300 mg
TRICYCLIC ANTIDEPRESSANTS (TCAs)
amitriptyline (C)(G) 10-20 mg at HS
Pediatric: not recommended
Tab: 10, 25, 50, 75, 100, 150 mg
doxepin (C)(G) 10-200 mg at HS
Pediatric: not recommended
Cap: 10, 25, 50, 75, 100, 150 mg; Oral conc: 10 mg/ml (4 oz w. dropper)
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358 ¦ Po s t – Traumat i c S t r e s s D i s o r d e r ( P T S D )
imipramine (C)(G) 10-200 mg q HS
Tofranil 100-300 mg at HS or divided bid or tid
Pediatric: <6 years: not recommended; 6-12 years: initially 25 mg; >12 years:
50 mg max 2.5 mg/kg/day
Tab: 10, 25, 50 mg
Tofranil PM initially 75 mg daily 1 hour before HS; max 200 mg
Cap: 75, 100, 125, 150 mg
Tofranil Injection 50 mg IM; lower dose for adolescents; switch to oral form as
soon as possible
Amp: 25 mg/2 ml (2 ml)
nortriptyline (D)(G) 10-150 mg q HS
Pediatric: not recommended
Pamelor Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml
MONOAMINE OXIDASE INHIBITORS (MAOIS)
Comment: Many drug and food interactions with this class of drugs, use cautiously.
MAOIs should be reserved for refractory depression that has not responded to other
classes of antidepressants. Concomitant use of MAOIs and SSRIs is contraindicated.
See mfr pkg insert for drug and food interactions. MAOIs have been used to reduce
recurrent recollections of the trauma, nightmares, fl ashbacks, numbing, sleep
disturbances, and social withdrawal in PTSD.
phenelzine (C)(G) initially 15 mg tid; max 90 mg/day
Pediatric: <16 years: not recommended; =16 years: same as adult
Nardil
Tab: 15 mg
selegiline (C) initially 10 mg tid; max 60 mg/day
Pediatric: <12 years: not recommended; =12 years: same as adult
Emsam Transdermal patch: 6 mg/24 hrs, 9 mg/24 hrs, 12 mg/24 hrs
Comment: At the Emsam transdermal patch 6 mg/24 hrs dose, the dietary restrictions
commonly required when using nonselective MAOIs are not necessary.
PREGNANCY
see Appendix Z: Prescription Prenatal Vitamins page 532
Comment: Prenatal vitamins should have at least 400 mcg of folic acid content.
Take one dose once daily. It is recommended that prenatal vitamins be started at
least 3 months prior to conception to improve preconception nutritional status,
and continued throughout pregnancy and the postnatal period, in lactating and
nonlactating women, and throughout the childbearing years.
NAUSEA/VOMITING
doxyalamine succinate/pyridoxine (A)(G) do not crush or chew; take on an empty
stomach with water; initially 2 tabs at HS on day 1; may increase to 1 tab AM and 2
tabs at HS day 2; may increase to 1 tab AM, 1 tab mid-aft ernoon, 2 tabs at HS; max
4 tabs/day
Diclegis Tab: doxyl 10 mg/pyri 10 mg del-rel
Comment: Diclegis is the only FDA-approved drug for the treatment of morning
sickness. It has not been studied in women with hyperemesis gravidarum.
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P r e m e n s t r u a l D y s p h o r p h i c D i s o r d e r ( P M D D ) ¦ 359
promethazine (C)(G) 12.5-50 mg PO/IM/rectally q 4-6 hours prn
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; Amp: 25, 50 mg/ml (1 ml)
ondansetron (C)(G) 4-8 mg bid prn
Zofran Tab: 4, 8, 24 mg
Zofran Injection Vial: 2 mg/ml (2 ml single-dose); 2 mg/ml (20 ml multi-dose)
for IV or IM administration
Zofran ODT ODT: 4, 8 mg (strawberry) (phenylalanine)
Zofran Oral Solution Oral soln: 4 mg/5 ml (50 ml) (strawberry)
Zuplenz Oral Soluble Film: 4, 8 mg orally-disint (10/carton) (peppermint)
PREMENSTRUAL DYSPHORPHIC DISORDER (PMDD)
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 308
Other Oral Contraceptives see page 485
ORAL ESTROGEN/PROGESTERONE COMBINATIONS
Comment: Rajani (a generic form of Beyaz) and Yaz; also available in generic Forms
(Gianvi, Ocella, Syeda, Vestura, Yasmin, Zarah) have an FDA indication for treatment
of PMDD in females who choose to use an OCP. Contraindicated with renal and
adrenal insuffi ciency. Monitor k+ level during the fi rst cycle if the patient is at risk
for hyperkalemia for any reason. If the patient is taking a drug that increase serum
potassium (e.g., ACEIs, ARBS, NSAIDs, K+ sparing diuretics), the patient is at risk for
hyperkalemia.
ethinyl estradiol/drospirenone (X)(G) 1 tab once daily x 28 days; repeat cycle; start on
fi rst Sunday aft er menses begins or on fi rst day of next menses
Yaz Tab: ethin estra 20 mcg/drospir 3 mg
ethinyl/estradiol/drospirenone/levomefolate calcium (X)(G) 1 tab once daily x 28
days; repeat cycle; start on fi rst Sunday aft er menses begins or on fi rst day of next
menses preceded by a negative pregnancy test
Beyaz Tab: ethin estra 20 mcg/drospir 3 mg/levo 0.451 mg
Rajani Tab: ethin estra 20 mcg/drospir 3 mg/levo 0.451 mg
DIURETICS
spironolactone (D)(G) initially 50-100 mg once daily or in divided doses; titrate at
2-week intervals
Pediatric: not recommended
Aldactone Tab: 25, 50*, 100*mg
ANTIDEPRESSANTS
fl uoxetine (C)(G)
Prozac initially 20 mg daily; may increase aft er 1 week; doses >20 mg/day
should be divided into AM and noon doses; max 80 mg/day
Pediatric: <8 years: not recommended; 8-17 years: initially 10 or 20 mg/
day; start lower weight children at 10 mg/day; if starting at 10 mg/day, may
increase aft er 1 week to 20 mg/day
Tab: 10*mg; Cap: 10, 20, 40 mg; Oral soln: 20 mg/5 ml (4 oz) (mint)
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360 ¦ P r e m e n s t r u a l D y s p h o r p h i c D i s o r d e r ( P M D D )
Prozac Weekly following daily fl uoxetine therapy at 20 mg/day for 13 weeks,
may initiate Prozac Weekly 7 days aft er the last 20 mg fl uoxetine dose
Pediatric: not recommended
Cap: 90 mg ent-coat del-rel pellets
Sarafem administer daily or 14 days before expected menses and through fi rst
full day of menses; initially 20 mg/day; max 80 mg/day
Tab: 10, 15, 20 mg; Cap: 20 mg
paroxetine maleate (D)(G)
Pediatric: not recommended
Paxil initially 20 mg daily in AM; may increase by 10 mg/day at weekly intervals
as needed; max 60 mg/day
Tab: 10*, 20*, 30, 40 mg
Paxil CR initially 25 mg daily in AM; may increase by 12.5 mg at weekly
intervals as needed; max 62.5 mg/day; may start 14 days before and continue
through day one of menses
Tab: 12.5, 25, 37.5 mg cont-rel ent-coat
Paxil Suspension initially 20 mg daily in AM; may increase by 10 mg/day at
weekly intervals as needed; max 60 mg/day
Oral susp: 10 mg/5 ml (250 ml) (orange)
sertraline (C)
For 2 weeks prior to onset of menses: initially 50 mg daily x 3; then increase to
100 mg daily for remainder of the cycle; For full cycle: initially 50 mg daily; then
may increase by 50 mg/day each cycle to max 150 mg/day
Pediatric: not recommended
Zoloft Tab: 25*, 50*, 100*mg; Oral conc: 20 mg per ml (60 ml) (alcohol 12%);
dilute just before administering in 4 oz water, ginger ale, lemon-lime soda,
lemonade, or orange juice
nortriptyline (D)(G) initially 25 mg tid-qid; max 150 mg/day
Pediatric: not recommended
Pamelor Cap: 10, 25, 50, 75 mg; Oral soln: 10 mg/5 ml
Contraceptives see page 485
CALCIUM SUPPLEMENTS
calcium (C) 1200 mg/day
see Osteoporosis page 294
PRIMARY IMMUNODEFICIENCY IN ADULTS
recombinant human hyaluronidase (human normal immunoglobulin) (C)
HyQvia see mfr pkg insert for dose by weight table and dose schedule table
Vial: 10%; 2.5 g/200 u, 5 g/400 u, 10 g/800 u, 20 g/1600 u, 30 g/2400 u (2
single-use/dual-vial unit (preservative-free)
Comment: HyQvia is an immune globulin with a recombinant human
hyaluronidase indicated for the treatment of primary immunodefi ciency (PI) in
adults. Th is includes, but is not limited to, common variable immunodefi ciency
(CVID), X-linked agammaglobulinemia, congenital agammaglobulinemia,
Wiskott-Aldrich syndrome, and severe combined immunodefi ciencies.
HyQvia contains IgG antibodies, collected from human plasma donated by
healthy people. HyQvia is a dual vial unit with one vial of immune globulin y
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P r o s t a t i t i s : A c u t e ¦ 361
infusion 10% (Human) and one vial of recombinant human hyaluronidase. Th e
hyaluronidase part of HyQvia helps more of the immune globulin get absorbed
into the body. HyQvia is a ready-for-use sterile, liquid preparation of highly
purifi ed, concentrated, broad spectrum IgG antibodies. Th e distribution of the
IgG subclasses is similar to that of normal plasma. Contains 100 mg/ml protein.
HyQvia is collected only at FDA approved blood establishments and is tested by
FDA licensed serological tests for Hepatitis B Surface Antigen (HBsAg), and for
antibodies to Human Immunodefi ciency Virus (HIV-1/HIV-2) and Hepatitis C
Virus (HCV) in accordance with U.S. regulatory requirements. As an additional
safety measure, mini-pools of the plasma are tested for the presence of HIV-1
and HCV by FDA licensed Nucleic Acid Testing (NAT). Protect from light. Use
within 3 months aft er removal to room temperature but within the expiration
date on the carton and vial labels. Do not return vials to the refrigerator aft er
being stored at room temperature.
PROCTITIS: ACUTE (PROCTOCOLITIS/ENTERITIS)
Comment: Th e following regimen for the treatment of proctitis, proctocolitis, and
enteritis is published in the 2015 CDC Sexually Transmitted Diseases Treatment
Guidelines.
RECOMMENDED REGIMEN
ceft riaxone (B)(G) 250 mg IM in a single dose
Rocephin Vial: 250, 500 mg; 1, 2 g
plus
doxycycline 100 mg bid x 7 days
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.
PROSTATITIS: ACUTE
ANTI-INFECTIVES
ciprofl oxacin (C) 500 mg bid x 4-6 weeks
Pediatric: <18 years: not recommended
Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml)
(strawberry)
Cipro XR Tab: 500, 1000 mg ext-rel
ProQuin XR Tab: 500 mg ext-rel
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362 ¦ P r o c t i t i s : A c u t e
Comment: ciprofl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
norfl oxacin (C) 400 mg bid x 28 days
Noroxin Tab: 400 mg
Comment: norfl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
ofl oxacin (C)(G) 300 mg x bid x 6 weeks
Floxin Tab: 200, 300, 400 mg
Comment: ofl oxacin is contraindicated <18 years-of-age, and during pregnancy and
lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
trimethoprim/sulfamethoxazole (C)(G)
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg*
Bactrim Pediatric Suspension, Septra Pediatric Suspension
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended
PROSTATITIS: CHRONIC
ANTI-INFECTIVES
carbenicillin (B) 2 tabs qid x 4-12 weeks
Geocillin Tab: 382 mg
ciprofl oxacin (C) 500 mg bid x 3 or more months
Pediatric: <18 years: not recommended
Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml) (strawberry)
Cipro XR Tab: 500, 1000 mg ext-rel
ProQuin XR Tab: 500 mg ext-rel
Comment: ciprofl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
ofl oxacin (C)(G) 300 mg bid x 4-12 weeks
Floxin Tab: 200, 300, 400 mg
Comment: ofl oxacin is contraindicated <18 years-of-age, and during pregnancy and
lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
norfl oxacin (C) 400 mg bid x 4-12 weeks
Noroxin Tab: 400 mg
Comment: norfl oxacin contraindicated <18 years-of-age, and during pregnancy and
lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and older.
trimethoprim/sulfamethoxazole (C)(G)
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg
Bactrim Pediatric Suspension, Septra Pediatric Suspension 20 ml bid x 10 days
y y y
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y y y y y
P r u r i t u s ¦ 363
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended
SUPPRESSION THERAPY
trimethoprim/sulfamethoxazole (C)(G)
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg*
Bactrim Pediatric Suspension, Septra Pediatric Suspension 20 ml bid x 10 days
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended
PRURITUS
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
Eucerin Products (OTC)
Lac-Hydrin Products (OTC)
Lubriderm Products (OTC)
Aveeno Products (OTC)
TOPICAL OIL
fl uocinolone acetamide 0.01% topical oil (C)
Pediatric: <6 years: not recommended; =6 years: apply sparingly bid for up to 4 weeks
Derma-Smoothe/FS Topical Oil apply sparingly tid
Topical oil: 0.01% (4 oz) (peanut oil)
TOPICAL ANALGESICS
capsaicin (B)(G) apply tid-qid prn to intact skin
Pediatric: <2 years: not recommended; =2 years: same as adult
Double Cap (OTC) Crm: 0.05% (2 oz)
Qutenza (B) Patch: 8% (1-2, both with 50 g tube of cleansing gel)
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.
doxepin (B) cream apply to aff ected area qid at intervals of at least 3-4 hours; max 8 days
Pediatric: not recommended
Prudoxin Crm: 5% (45 g)
Zonalon Crm: 5% (30, 45 g)
tacrolimus (C) apply to aff ected area bid; continue for 1 week aft er clearing
Pediatric: <2 years: not recommended; 2-15 years: use 0.03% strength; apply to
aff ected area bid; continue for 1 week aft er clearing
Protopic Oint: 0.03, 0.1% (30, 60 g)
y
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y y y y
364 ¦ P s e u d o b u l b a r A f f e c t ( P B A ) D i s o r d e r
PSEUDOBULBAR AFFECT (PBA) DISORDER
Comment: Pseudobulbar aff ect (PBA), emotional lability, labile aff ect, or emotional
incontinence refers by to a neurologic disorder characterized involuntary crying or
uncontrollable episodes of crying and/or laughing, or other emotional displays. PBA
occurs secondary to a neurologic disease or brain injury. Brain injury or neurologic
diseases such as traumatic brain injury, stroke, Parkinson’s disease, multiple sclerosis,
and amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease).
dextromethorphan/quinidine (C) 1 cap once daily x 7 days; then starting on day 8,
1 cap bid
Nuedexta apply bid to lesions and gently rub in completely
Pediatric: not recommended
Cap: dextro 20 mg/quini 10 mg
PSEUDOGOUT
Injectable Acetaminophen 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
PSEUDOMEMBRANOUS COLITIS
Comment: Staphylococcal enterocolitis and antibiotic-associated pseudomembranous
colitis caused by C. diffi cile.
ANTI-INFECTIVES
vancomycin (B, caps; C, susp)(G) 500 mg to 2 g in 3-4 doses x 7-10 days; max 2 g/day
Pediatric: 40 mg/kg/day in 3-4 doses x 7-10 days; max 2 g/day
metronidazole (not for use in 1st; B in 2nd, 3rd)(G) 500 mg tid x 14 days
Flagyl Tab: 250*, 500*mg
Flagyl 375 Cap: 375 mg
Flagyl ER Tab: 750 mg ext-rel
Comment: Alcohol is contraindicated during treatment with oral metronidazole
and for 72 hours aft er therapy due to a possible disulfi ram-like reaction (nausea,
vomiting, fl ushing, headache).
PSITTACOSIS
ANTI-INFECTIVES
tetracycline (D)(G) 250 mg qid or 500 mg tid x 7-14 days
Pediatric: <8 years: not recommended; =8 years, <100 lb: 25-50 mg/kg/day in 4
doses x 7-14 days; =8 years, =100 lb: same as adult
t
y
t
t
y y
t
y
P s o r i a s i s ¦ 365
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 or calcium supplements within
two hours of another drug.
PSORIASIS
Emollients see Dermatitis: Atopic page 110
Topical Corticosteroids see page 506
VITAMIN D-3 DERIVATIVES
calcipotriene (C)
Dovonex apply bid to lesions and gently rub in completely
Pediatric: not recommended
Crm: 0.005% (30, 120 g)
VITAMIN D-3 DERIVATIVE/CORTICOSTEROID COMBINATIONS
calcipotriene/betamethasone dipropionate (C)(G)
Pediatric: <18 years: not recommended
Enstilar apply to aff ected area and gently rub in once daily x up to 4 weeks; limit
treatment area to 30% of body surface area; do not occlude; do not use on face,
axillae, groin, or atrophic skin; max 100 g/week
Foam: calci 0.005%/beta 0.064% (60 g spray can)
Taclonex apply to aff ected area and gently rub in once daily as needed, up to 4
weeks
Taclonex Ointment apply bid to lesions and gently rub in completely; limit
treatment area to 30% of body surface area; do not occlude; do not use on face,
axillae, groin, or atrophic skin; max 100 g/week
Oint: calci 0.005%/beta 0.064% (60, 100 g)
Taclonex Scalp Topical Suspension apply to aff ected area and gently rub in once
daily x 2 weeks or until cleared; max 8 weeks; limit treatment area to 30% of
body surface area; do not occlude; do not use on face, axillae, groin, or atrophic
skin; max 100 g/week
Bottle: (30, 60 g; 120 g [2×60 g])
Calcitrol (C)
Vectical apply bid to lesions and gently rub in completely; max weekly dose
should not exceed 200 g
Pediatric: <18 years: not recommended
Oint: 3 mcg/g (100 g)
IMMUNOSUPPRESSANTS
alefacept (B) 7.5 mg IV bolus or 15 mg IM once weekly x 12 weeks; may re-treat x
12 weeks
Pediatric: not recommended
t
y y y y
366 ¦ P s o r i a s i s
Amevive IV dose pack: 7.5 mg single-use (w. 10 ml sterile water diluents [use
0.6 ml]; 1, 4/pck); IM dose pack: 15 mg single-use (w. 10 ml sterile water diluent
[use 0.6 ml]; 1, 4/pck)
Comment: CD4+ and T-lymphycyte count should be checked prior to initiating
treatment with alefacept and then monitored. Treatment should be withheld if
CD4+ T-lymphocyte counts are below 250 cells/mcl.
cyclosporine (C) 1.25 mg/kg bid; may increase aft er 4 weeks by 0.5mg/kg/day; then
adjust at 2-week intervals; max 4 mg/kg/day; administer with meals
Pediatric: <18 years: not recommended
Neoral Cap: 25, 100 mg (alcohol)
Neoral Oral Solution Oral soln: 100 mg/ml (50 ml) may dilute in room temperature
apple juice or orange juice (alcohol)
ANTIMITOTICS
anthralin (C) apply once daily
Pediatric: not recommended
Zithranol-RR Crm: 1.2% (15, 45 g)
RETINOIDS
acitretin (X)(G) 25-50 mg once daily with main meal
Pediatric: not recommended
Soriatane Cap: 10, 25 mg
tazarotene (X)(G) apply once daily at HS
Pediatric: not recommended
Avage Cream Crm: 0.1% (30 g)
Tazorac Cream Crm: 0.05, 0.1% (15, 30, 60 g)
Tazorac Gel Gel: 0.05, 0.1% (30, 100 g)
COAL TAR PREPARATIONS
coal tar (C)(G)
Pediatric: same as adult
Scytera (OTC) apply qd-qid; use lowest eff ective dose
Foam: 2%
T/Gel Shampoo Extra Strength (OTC) use every other day; max 4 x/week;
massage into aff ected areas for 5 minutes; rinse; repeat Shampoo: 1%
T/Gel Shampoo Original Formula (OTC) use every other day; max 7 x/week;
massage into aff ected areas for 5 minutes; rinse; repeat Shampoo: 0.5%
T/Gel Shampoo Stubborn Itch Control (OTC) use every other day; max 7 x/
week; massage into aff ected areas for 5 minutes; rinse; repeat Shampoo: 0.5%
INTERLEUKIN-17A ANTAGONIST
secukinumab (B) inject SC into the upper arm, abdomen, or thigh; rotate sites; administer
300 mg SC (as two separate 150 mg SC injections) at weeks 0, 1, 2, 3, and 4;
then 300 mg every 4 weeks; for some patients, 150 mg/dose may be suffi cient
Pediatric: <18 years: not recommended
Cosentyx Vial: 150 mg/ml pwdr for SC inj aft er reconstitution single-use
(preservative-free)
Comment: Cosentyx may be used as monotherapy or in combination with
methotrexate (MTX). y
y
y
y
y
y
P s o r i a s i s ¦ 367
INTERLEUKIN-12/INTERLEUKIN-23 ANTAGONIST
ustekinumab (B) inject SC; rotate sites; <100 kg: 45 mg once; then 4 weeks later; then
every 12 weeks; =100 kg: 90 mg once; then 4 weeks later; then every 12 weeks
Pediatric: <18 years: not recommended
Stelara Vial: 45 mg/0.5 ml single-use (preservative-free)
Comment: Stelara may be used as monotherapy or in combination with
methotrexate (MTX).
TUMOR NECROSIS FACTOR (TNF) BLOCKERS
adalimumab (B) initially 80 mg SC once followed by 40 mg once every other week
starting one week aft er initial dose; inject into thigh or abdomen; rotate sites
Pediatric: <18 years: not recommended
Humira Prefi lled syringe: 20 mg/0.4 ml; 40 mg/0.8 ml single-dose (2/pck; 2, 6/
starter pck) (preservative-free)
etanercept (B) inject SC into thigh, abdomen, or upper arm; rotate sites; initially
50 mg twice weekly (3-4 days apart) for 3 months; then 50 mg/week maintenance or
25 mg or 50 mg per week for 3 months; then 50 mg/week maintenance
Pediatric: <4 years: not recommended; 4-17 years: Chronic moderate-to-severe
plaque psoriasis
Enbrel Vial: 25 mg pwdr for SC injection aft er reconstitution (4/carton
w. supplies) (preservative-free, diluent contains benzyl alcohol); Prefi lled
syringe: 25, 50 mg/ml (preservative-free); SureClick autoinjector: 50 mg/ml
(preservative-free)
golimumab (B) administer SC or IV infusion (in combination with methotrexate [MTX])
Pediatric: <18 years: not established
Simponi 50 mg SC once monthly; rotate sites
Prefi lled syringe, SmartJect autoinjector: 50 mg/0.5 ml, single-use (preservativefree)
Simponi Aria 2 mg/kg IV infusion week 0 and week 4; then every 8 weeks
thereaft er
Vial: 50 mg/4 ml, single-use, soln for IV infusion aft er dilution (latex-free,
preservative-free)
infl iximab (B) administer by IV infusion over 2 hours; 5 mg/kg weeks 0, 2, 6; then
once every 8 weeks
Pediatric: <6 years: not recommended; =6 years: same as adult
Remicade Vial: 100 mg pwdr for reconstitution for IV infusion (20 ml,
single-use) (preservative-free)
Infl ectra Vial: 100 mg pwdr for reconstitution for IV infusion (20 ml,
single-use) (preservative-free)
MOISTURIZING AGENTS
Aquaphor Healing Ointment (OTC) Oint: (1.75, 3.5, 14 oz) (alcohol)
Eucerin Daily Sun Defense (OTC) Lotn: 6 oz (fragrance-free)
Comment: Eucerin Daily Sun Defense is a moisturizer with SPF 15.
Eucerin Facial Lotion (OTC) Lotn: 4 oz
Eucerin Light Lotion (OTC) Lotn: 8 oz
Eucerin Lotion (OTC) Lotn: 8, 16 oz
Eucerin Original Creme (OTC) Crm: 2, 4, 16 oz (alcohol)
Eucerin Plus Creme Crm: 4 oz
y y y y y
368 ¦ P s o r i a s i s
Eucerin Plus Lotion (OTC) Lotn: 6, 12 oz
Eucerin Protective Lotion (OTC) Lotn: 4 oz (alcohol)
Comment: Eucerin Protective Lotion is a moisturizer with SPF 25.
Lac-Hydrin Cream (OTC) Crm: 280, 385 g
Lac-Hydrin Lotion (OTC) Lotn: 225, 400 g
Lubriderm Dry Skin Scented (OTC) Lotn: 6, 10, 16, 32 oz
Lubriderm Dry Skin Unscented (OTC) Lotn: 3.3, 6, 10, 16 oz (fragrance-free)
Lubriderm Sensitive Skin Lotion (OTC) Lotn: 3.3, 6, 10, 16 oz (lanolin-free)
Lubriderm Dry Skin (OTC) Lotn (scented): 2.5, 6, 10, 16 oz;
Lotn (fragrance-free): 1, 2.5, 6, 10, 16 oz
Lubriderm Bath 1-2 capfuls in bath or rub onto wet skin as needed; then rinse
Oil: 8 oz
PSORIATIC ARTHRITIS
Injectable Acetaminophen see Pain page 306
Oral Prescription NSAIDs see page 501
Other Oral Analgesics see Pain page 306
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.
trolamine salicylate (NE)
Mobisyl apply tid-qid
Crm: 10%
Comment: Provides some relief by 1-2 weeks; optimal benefi t may take 4-6 weeks.
diclofenac sodium (C; D =30 wks) apply qid prn to intact skin
Pediatric: not established
Pennsaid 1.5% in 10 drop increments, dispense and rub into front, side, and
back of knee: usually; 40 drops (40 mg) qid
Topical soln: 1.5% (150 ml)
Pennsaid 2% apply 2 pump actuations (40 mg) and rub into front, side, and
back of knee bid
Topical soln: 2% (20 mg/pump actuation, 112 g)
Comment: Pennsaid is indicated for the treatment of pain associated with
osteoarthritis of the knee.
t
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P s o r i a t i c A r t h r i t i s ¦ 369
Pennsaid 2% apply 2 pump actuations (40 mg) and rub into front, side, and
back of knee bid
Topical soln: 2% (20 mg/pump actuation; 112 g)
Voltaren Gel (G) Gel: 1% (100 g)
Comment: Contraindicated with aspirin allergy. As with other NSAIDs,
Voltaren Gel should be avoided in late pregnancy (=30 weeks) because it may
cause premature closure of the ductus arteriosus.
ORAL SALICYLATE
indomethacin (C) initially 25 mg bid-tid, increase as needed at weekly intervals by
25-50 mg/day; max 200 mg/day
Pediatric: <14 years: usually not recommended; >2 years, if risk warranted: 1-2 mg/
kg/day in divided doses; max 3-4 mg/kg/day or 150-200 mg/day, whichever is less;
<14 years, ER cap not recommended
Cap: 25, 50 mg; Susp; 25 mg/5 ml (pineapple-coconut, mint; alcohol 1%); Supp:
50 mg; ER Cap: 75 mg ext-rel
Comment: indomethacin is indicated only for acute painful fl ares. Administer with
food and/or antacids. Use lowest eff ective dose for shortest duration.
ORAL NSAIDs
See more Oral NSAIDs page 511
diclofenac sodium (C)
Voltaren 50 mg bid-qid or 75 mg bid or 25 mg qid with an additional 25 mg at
HS if necessary
Tab: 25, 50, 75 mg ent-coat
Voltaren XR 100 mg once daily; rarely, 100 mg bid may be used
Tab: 100 mg ext-rel
NSAID PLUS PPI
esomeprazole/naproxen (C)(G) 1 tab bid; use lowest eff ective dose for the shortest
duration swallow whole; take at least 30 minutes before a meal
Pediatric: <18 years: not recommended
Vimovo Tab: nap 375 mg/eso 20 mg ext-rel; nap 500 mg/eso 20 mg ext-rel
Comment: Vimovo is indicated to improve signs/symptoms, and risk of gastric
ulcer in patients at risk of developing NSAID-associated gastric ulcer.
COX-2 INHIBITORS
Comment: Cox-2 inhibitors are contraindicated with history of asthma, urticaria, and
allergic-type reactions to aspirin, other NSAIDs, and sulfonamides, 3rd trimester of
pregnancy, and coronary artery bypass graft (CABG) surgery.
celecoxib (C)(G) 50-400 mg once daily-bid; max 800 mg/day
Pediatric: <18 years: not recommended
Celebrex Cap: 50, 100, 200, 400 mg
meloxicam (C)(G) initially 7.5 mg once daily; max 15 mg once daily
Pediatric: <2 years: not recommended; =2 years: 0.125 mg/kg; max 7.5 mg once daily
Mobic Tab: 7.5, 15 mg; Oral susp: 7.5 mg/5 ml (100 ml) (raspberry)
Vivlodex Cap: 5, 10 mg
y y y y y
370 ¦ P s o r i a t i c A r t h r i t i s
PHOSPHODIESTERASE 4 (PDE4) INHIBITOR
apremilast (C) swallow whole; initial titration over 5 days; maintenance 30 mg bid;
Day 1: 10 mg in AM; Day 2: 10 mg AM and 10 mg PM; Day 3: 10 mg AM and 20 mg
PM; Day 4: 20 mg AM and 20 mg PM; Day 5: 20 mg AM and 30 mg PM; Day 6 and
ongoing: 30 mg AM and 30 mg PM
Pediatric: <18 years: not established
Otezla Tab: 10, 20, 30 mg; 2-Week Starter Pack
Comment: Register pregnant patients exposed to by calling 877-311-8972.
INTERLEUKIN-12/INTERLEUKIN-23 ANTAGONIST
ustekinumab (B) inject SC; rotate sites; <100 kg: 45 mg once; then 4 weeks later; then
every 12 weeks; =100 kg: 90 mg once; then 4 weeks later; then every 12 weeks
Pediatric: <18 years: not recommended
Stelara Vial: 45 mg/0.5 ml single-use (preservative-free)
Comment: Stelara may be used as monotherapy or in combination with
methohtrexate (MTX).
TUMOR NECROSIS FACTOR (TNF) BLOCKERS
adalimumab (B) 40 mg SC once every other week; may increase to once weekly without
methotrexate (MTX); administer in abdomen or thigh; rotate sites; 2-17 years,
supervise fi rst dose
Pediatric: <2 years, <10 kg: not recommended; 10-<15 kg: 10 mg every other week;
15-<30 kg: 20 mg every other week; 30 kg: 40 mg every other week
Humira Prefi lled syringe: 20 mg/0.4 ml; 40 mg/0.8 ml single-dose (2/pck; 2, 6/
starter pck) (preservative-free)
Comment: Humira may use with methotrexate (MTX), DMARDS, corticoids,
salicylates, NSAIDs, or analgesics.
etanercept (B) 25 mg SC twice weekly (72-96 hours apart) or 50 mg SC weekly; rotate
sites
Pediatric: <4 years: not recommended; 4-17 years: 0.4 mg/kg SC twice weekly, 72-96
hours apart (max 25 mg/dose) or 0.8 mg/kg SC weekly (max 50 mg/dose)
Enbrel Vial: 25 mg pwdr for SC injection aft er reconstitution (4/carton
w. supplies) (preservative-free; diluent contains benzyl alcohol); Prefi lled
syringe: 25, 50 mg/ml (preservative-free); SureClick Autoinjector: 50 mg/ml
(preservative-free)
Comment: etanercept reduces pain, morning stiff ness, and swelling. May be
administered in combination with methotrexate. Live vaccines should not be
administered concurrently. Do not administer with active infection.
golimumab (B) administer SC or IV infusion (in combination with methotrexate
[MTX])
Pediatric: <18 years: not established
Simponi 50 mg SC once monthly; rotate sites
Prefi lled syringe, SmartJect autoinjector: 50 mg/0.5 ml, single-use (preservativefree)
Simponi Aria 2 mg/kg IV infusion week 0 and week 4; then every 8 weeks
thereaft er
Vial: 50 mg/4 ml, single-use, soln for IV infusion aft er dilution (latex-free,
preservative-free)
y y y y y
Pulmonar y A r t e r i a l H y p e r t e n s i o n ( PA H ) ¦ 371
Comment: Corticosteroids, nonbiologic DMARDs, and/or NSAIDs may be
continued during treatment with golimumab.
infi ximab (B) administer SC or IV infusion (in combination with methotrexate
[MTX]) administer by IV infusion over at least 2 hours; 5 mg/kg once weekly at
weeks 0, 2, 6, and then every 8 weeks
Pediatric: <18 years: not established
Remicade Vial: 100 mg pwdr for reconstitution and dilution; (preservative-free)
PULMONARY ARTERIAL HYPERTENSION (PAH)
(WHO GROUP I)
PROSTACYCLIN RECEPTOR AGONIST
selexipag (X) initially 200 mcg bid; increase by 200 mcg bid to highest tolerated dose
up to 1600 mcg bid; Moderate hepatic impairment (Child-Pugh B): initially 200 mcg
once daily; increase by 200 mcg once daily at weekly intervals as tolerated; swallow
whole; may take with food to improve tolerability
Pediatric: not established
Uptravi
Tab: 200, 400, 600, 800, 1000, 1200, 1400, 1600 mcg; Titration pck: 140 x 200
mcg + 60 x 800 mcg)
Comment: Discontinue Uptravi if pulmonary veno-occlusive disease is confi
rmed or severe hepatic impairment (Child-Pugh C). May be potentiated by
concomitant strong CYP2C8 inhibitors (e.g., gemfi brozil); Nursing mothers: not
recommended. Discontinue breastfeeding or discontinue the drug.
GUANYLATE CYCLASE STIMULATOR
riociguat (X) initially 0.5-1 mg tid; titrate every 2 weeks as tolerated (SBP =95 and
absence of hypotensive symptoms) to highest tolerated dose; max 2.5 mg tid
Pediatric: not recommended
Adempas
Tab: 0.5, 1, 1.5, 2, 2.5 mg
Comment: If Adempas is interrupted for =3 days, re-titrate. Consider titrating
to dosage higher than 2.5 mg tid, if tolerated, in patients who smoke. Consider
a starting dose of 0.5 mg tid when initiating Adempas in patients receiving
strong cytochrome P450 (CYP) and P-glycoprotein/breast cancer resistance
protein (P-gp/BCRP) inhibitors such as azole antimycotics (e.g., ketoconazole,
itraconazole) or HIV protease inhibitors (e.g., ritonavir). Monitor for signs and
symptoms of hypotension with strong CYP and P-gp/BCRP inhibitors. Obtain
pregnancy tests prior to initiation and monthly during treatment. Adempas has
consistently shown to have teratogenic eff ects when administered to animals.
Females can only receive Adempas through the Adempas Risk Evaluation and
Mitigation Strategy (REMS) Program, a restricted distribution program: www
.AdempasREMS.com or 855-4 ADEMPAS. It is not known if Adempas is
present in human milk; however, riociguat or its metabolites were present
in the milk of rats. Because of the potential for serious adverse reactions in
nursing infants from riociguat, discontinue nursing or Adempas. In placebocontrolled
clinical trials, serious bleeding has occurred (including hemoptysis,
hematemesis, vaginal hemorrhage, catheter site hemorrhage, subdural
y
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372 ¦ Pulmonar y A r t e r i a l H y p e r t e n s i o n ( PAH)
hematoma, and intra-abdominal hemorrhage. Safety and effi cacy have not been
demonstrated in patients with creatinine clearance <15 mL/min or on dialysis
or severe hepatic impairment (Child-Pugh C).
Endothelin Receptor Antagonist, Selective for the Endothelin Type-A (ETA)
Receptor
ambrisentan (X) 20 mg once daily; at 4-week intervals, either the dose of Letairis Letaris
initially 5 mg once daily, with or without or tadalafi l can be increased, as needed
and tolerated, to Letairis 10 mg or tadalafi l 40 mg; do not split, crush, or chew.
Pediatric: not recommended
Letairis
Tab: 5, 10 mg fi lm-coat
Comment: In patients with PAH, plasma ET-1 concentrations are increased
as much as 10-fold and correlate with increased mean right atrial pressure and
disease severity. ET-1 and ET-1 mRNA concentrations are increased as much as
9-fold in the lung tissue of patients with PAH, primarily in the endothelium of
pulmonary arteries. Th ese fi ndings suggest that ET-1 may play a critical role in
the pathogenesis and progression of PAH. When taken with tadalafi l, Letairis
is indicated to reduce the risk of disease progression and hospitalization, to
reduce the risk of hospitalization due to worsening PAH, and to improve exercise
tolerance. Letaris is contraindicated in idiopathic pulmonary fi brosis (IPF).
Exclude pregnancy before the initiation of treatment with Letairis. Females of
reproductive potential must use acceptable methods of contraception during
treatment with Letairis and for one month aft er treatment. Obtain monthly
pregnancy tests during treatment and 1 month aft er discontinuation of treatment.
Females can only receive Letairis through the Letairis Risk Evaluation and
Mitigation Strategy (REMS) Program, a restricted distribution program, because
of the risk of embryo-fetal toxicity: www.Letairisrems.com or 1-866-664-5327.
PHOSPHODIESTERASE TYPE 5 (PDE5) INHIBITORS, CGMP-SPECIFIC DRUGS
sildenafi l citrate (B)(G) Orally: initially 5 or 20 mg tid, 4-6 hours apart; max 20 mg
tid; IV bolus: 2.5 mg or 10 mg bolus injection tid, 4-6 hours apart; max 10 mg tid; the
dose does not need to be adjusted for body weight.
Pediatric: not recommended
Revatio
Tab: 20 mg fi lm-coat; Oral susp: 10 mg/ml pwdr for reconstitution (1.12 g,
112 ml) (grape) (sorbitol); Vial: 10 mg/12.5 ml (0.8 mg/ml)
Comment: A 10 mg IV dose is predicted to provide pharmacological eff ect
equivalent to the 20 mg oral dose. Revatio is contraindicated with concomitant
nitrate drugs including nitroglycerin, isosorbide dinitrate, isosorbide
mononitrate, and some recreational drugs such as “poppers.” Taking Revatio
with a nitrate can cause a sudden and serious decrease in blood pressure. Revatio
is contraindicated with concomitant guanylate cyclase stimulator drugs such as
riociguat (Adempas). Avoid the use of grapefruit products while taking Revatio.
Stop Revatio and get emergency medical help if sudden vision loss. Revatio
is contraindicated with other phosphodiesterase type 5 (PDE5) Inhibitors,
cGMP-specifi c drugs such as avanafi l (Stendra), tadalafi l (Cialis) or vardenafi l
(Levitra). Caution with history of recent MI, stroke, life-threatening arrhythmia,
hypotension, hypertension, cardiac failure, unstable angina, retinitis pigmentosa,
CYP3A4 inhibitors (e.g., cimetidine, the azoles, erythromycin, protease
inhibitors (e.g., ritonavir), CYP3A4 inducers (e.g., rifampin, carbamazepine, y
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P y e l o n e p h r i t i s : A c u t e ¦ 373
phenytoin, phenobarbital), alcohol, antihypertensive agents. Side eff ects include
headache, fl ushing, nasal congestion, rhinitis, dyspepsia, and diarrhea. Use
Revatio with caution in patients with anatomical deformation of the penis (e.g.,
angulation, cavernosal fi brosis, or Peyronie’s disease) or in patients who have
conditions, which may predispose them to priapism (e.g., sickle cell anemia,
multiple myeloma, or leukemia). In the event of an erection that persists longer
than 4 hours, the patient should seek immediate medical assistance. If priapism
(painful erection greater than 6 hours in duration) is not treated immediately,
penile tissue damage and permanent loss of potency could result.
tadalafi l (B) 40mg once daily; CrCl 31-80 mL/min: initially 20 mg once daily; increase
to 40mg once daily if tolerated; CrCl <30 mL/min: not recommended; Mild or
moderate hepatic cirrhosis (Child Pugh Class A or B): initially 20 mg once daily. Severe
hepatic cirrhosis (Child Pugh Class C): not recommended; use with ritonavir; Receiving
ritonavir for at least 1 week: initiate tadalafi l at 20 mg once daily; may increase
to 40mg once daily if tolerated; Already on tadalafi l: stop tadalafi l at least 24 hours
prior to initiating ritonavir; resume tadalafi l at 20 mg once daily aft er at least 1 week;
may increase to 40mg once daily if tolerated
Pediatric: not established
Adcirca
Comment: Contraindicated with concomitant organic nitrates and guanylate
cyclase stimulators (e.g., riociguat).
treprostinil (B) swallow whole; take with food
Orenitram
Tab: 0.125, 0.25, 1, 2.5 mg ext-rel
Comment: Orenitram is indicated to improve exercise capacity. It is
contraindicated with severe hepatic impairment (Child-Pugh C). Orenitram
inhibits platelet aggregation and increases the risk of bleeding. Concomitant
administration of Orenitram with diuretics, antihypertensive agents or other
vasodilators increases the risk of symptomatic hypotension.
PYELONEPHRITIS: ACUTE
URINARY TRACT ANALGESIA
phenazopyridine (B)(G) 95-200 mg q 6 hours prn; max 2 days
Pediatric: not recommended
AZO Standard, Prodium, Uristat (OTC) Tab: 95 mg
AZO Standard Maximum Strength (OTC) Tab: 97.5 mg
Pyridium, Urogesic Tab: 100, 200 mg
OUTPATIENT ANTI-INFECTIVE TREATMENT
Comment: Acute pyelonephritis can be treated with a single IM antibiotic administration
followed by a PO antibiotic regimen and close follow up. Example: Rocephin 1 g IM
followed by Bactrim DS, cephalexin, ciprofl oxacin, levofl oxacin, or loracarbef.
cephalexin (B)(G) 1-4 g/day in 4 divided doses x 10-14 days
Pediatric: 25-50 mg/kg/day in 4 divided doses x 10-14 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)
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374 ¦ P y e l o n e p h r i t i s : A c u t e
ciprofl oxacin (C) 500 mg bid or 1000 mg XR once daily x 3-14 days
Pediatric: <18 years: not recommended
Cipro (G) Tab: 250, 500, 750 mg; Oral susp: 250, 500 mg/5 ml (100 ml)
(strawberry)
Cipro XR Tab: 500, 1000 mg ext-rel
ProQuin XR Tab: 500 mg ext-rel
Comment: ciprofl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
levofl oxacin (C) Uncomplicated: 500 mg once daily x 10 days; Complicated: 750 mg
once daily x 10 days
Pediatric: <18 years: not recommended
Levaquin Tab: 250, 500, 750 mg; Oral soln: 25 mg/ml (480 ml) (benzyl alcohol);
Inj conc: 25 mg/ml for IV infusion aft er dilution for IV infusion (50, 100, 150
ml) (preservative-free)
Comment: levofl oxacin is contraindicated <18 years-of-age, and during pregnancy
and lactation. Risk of tendonitis or tendon rupture, especially 60 years-of-age and
older.
loracarbef (B) 400 mg bid x 14 days
Pediatric: 15 mg/kg/day in 2 divided doses x 14 days; see page 581 for dose by weight
Lorabid Pulvule: 200, 400 mg; Oral susp: 100 mg/5 ml (50, 100 ml); 200 mg/5
ml (50, 75, 100 ml) (strawberry bubble gum)
trimethoprim/sulfamethoxazole (D)(G) bid x 10 days
Pediatric: <2 months: not recommended; =2 months: 40 mg/kg/day of sulfamethoxazole
in 2 divided doses x 10 days; see page 587 for dose by weight
Bactrim, Septra 2 tabs bid x 10 days
Tab: trim 80 mg/sulfa 400 mg*
Bactrim DS, Septra DS 1 tab bid x 10 days
Tab: trim 160 mg/sulfa 800 mg*
Bactrim Pediatric Suspension, Septra Pediatric Suspension
Oral susp: trim 40 mg/sulfa 200 mg per 5 ml (100 ml) (cherry) (alcohol 0.3%)
Comment: trimethoprim/sulfamethoxazole is not recommended in pregnancy
or lactation. CrCl 15-30 mL/min: reduce dose by 1/2; CrCl <15 mL/min: not
recommended
RABIES
PRE-EXPOSURE PROPHYLAXIS
Comment: Postpone pre-exposure prophylaxis during acute febrile illness or infection.
Have epinephrine 1:1000 readily available.
rabies immune globulin, human (HRIG) (C) 3 injections of 1 ml IM each on day 0, 7,
and either day 21 or 28; booster doses 1 ml IM every 2 years
Pediatric: same as adult (except for infants administer in the vastus lateralis muscle)
Imovax Vial: 2.5 u/ml (1 ml, single dose)
POSTEXPOSURE PROPHYLAXIS
Comment: Have epinephrine 1:1000 readily available.
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R e s t l e s s L e g S S y n d r o m e ( R L S ) ¦ 375
rabies immune globulin, human (HRIG) (C) 20 IU/kg infi ltrated into wound area as
much as feasible, then remaining dose administered IM at site remote from vaccine
administration
Pediatric: same as adult
BayRab, Imogam Rabies Vial: 150 IU/ml (2, 10 ml)
rabies vaccine, human diploid cell (C) Not previously immunized: administer fi rst
dose 1 ml in the deltoid as soon as possible aft er exposure; then repeat on days 3, 7,
14, 28 or 30, and 90; administer 1st dose with rabies immune globulin; Previously
immunized: only 2 doses are administered, immediately aft er exposure and again 3
days later; no rabies immune globulin is needed.
Pediatric: same as adult (except for infants administer in vastus lateralis muscle)
Imovax, RabAvert Vial: 2.5 IU/ml (2.5 IU of freeze-dried vaccine w. diluent)
TETANUS PROPHYLAXIS
see Tetanus page 408 for patients not previously immunized
RESPIRATORY SYNCYTIAL VIRUS (RSV)
PROPHYLAXIS
palivizumab 15 mg/kg IM administered monthly throughout the RSV season
Synagis Vial: 100 mg/ml
Treatment see Bronchiolitis page 58
RESTLESS LEGS SYNDROME (RLS)
GAMMA AMINOBUTYRIC ACID ANALOGS
gabapentin (C)(G) 100 mg once daily x 1 day; then 100 mg bid x 1 day; then 100 mg
tid thereaft er; max 900 mg tid
Pediatric: not recommended
Gralise (C) initially 300 mg on Day 1; then 600 mg on Day 2; then 900 mg on
Days 3-6; then 1200 mg on Days 7-10; then 1500 mg on Days 11-14; titrate up
to 1800 mg on Day 15; take entire dose once daily with the evening meal; do not
crush, split, or chew
Tab: 300, 600 mg
Neurontin (G) 100 mg daily x 1 day, then 100 mg bid x 1 day, then 100 mg
tid continuously; max 900 mg tid
Pediatric: <3 years: not recommended; 3-12 years: initially 10-15 mg/kg/day in 3
divided doses; max 12 hours between doses; titrate over 3 days; 3-4 years: titrate
to 40 mg/kg/day; 5-12 years: titrate to 25-35 mg/kg/day; max 50 mg/kg/day;
gabapentin enacarbil (C) 600 mg once daily at about 5:00 PM; if dose not taken at
recommended time, next dose should be taken the following day; swallow whole;
take with food; CrCl 30-59 mL/min: 600 mg on Day 1, Day 3, and every day thereafter;
CrCl <30 mL/min or on hemodialysis: not recommended
Pediatric: not recommended
Horizant Tab: 600 ext-rel
Comment: Avoid abrupt cessation of gabapentin and gabapentin enacarbil. To discontinue,
withdraw gradually over 1 week or longer.
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376 ¦ R e s t l e s s L e g S S y n d r o m e ( R L S )
DOPAMINE RECEPTOR AGONISTS
pramipexole dihydrochloride (C)(G) initially 0.125 mg once daily 2-3 hours before
bedtime; may double dose every 4-7 days; max 0.75 mg/day
Pediatric: not recommended
Mirapex Tab: 0.125, 0.25*, 0.5*, 0.75*, 1*, 1.5* mg
ropinirole (C) take once daily 1-3 hours prior to bedtime; initially 0.25 mg on days 1
and 2; then 0.5 mg on days 3-7; increase by 0.5 mg/day at 1 week intervals to 3 mg;
max 4 mg/day
Pediatric: not recommended
Requip Tab: 0.25, 0.5, 1, 2, 3, 4, 5 mg
rotigotine transdermal patch (C) apply to clean, dry, intact skin on abdomen, thigh,
hip, fl ank, shoulder, or upper arm; initially 1mg/24 hour patch once daily; may increase
weekly by 1mg/24 hour if needed; max 3mg/24 hour once daily; rotate sites
and allow 14 days before reusing site; if hairy, shave site at least 3 days before application
to site; avoid abrupt cessation; reduce by 1 mg/24 hour every other day
Pediatric: not recommended
Neupro Trans patch: 1mg/24hrs, 2mg/24hrs, 3mg/24hrs, 4mg/24 hrs,
6mg/24hrs, 8mg/24hrs (30/carton) (sulfi tes)